NMS Q&A Family Medicine

180 NMS Q&A Family Medicineperipheral edema. Which of the following is the likelydiagnosis?(A) Patent ductus arteriosus(B) Ventricular septal defect(C) Hypertrophic cardiomyopathy(D) Pulmonic stenosis (PS)(E) Congestive heart failure7 A routine preparticipation physical examinationuncovers a systolic cardiac murmur that was loudestat the upper left sternal border and is heard in theneck and posterior lung fields. Which of the followingwould be the most important disposition to helpdetermine whether this athlete should proceed toparticipate in high-exertion competitive sports?(A) Twelve-lead electrocardiogram(B) Echocardiogram(C) Right heart catheterization(D) Computed tomography scan of the chest(E) Magnetic resonance image of the chest8 Regarding athletics, what is the main objective ofbeing a physician to athletes and making a preparticipation(medical) evaluation?(A) To diagnose hypertrophic subaortic stenosis inhigh-energy-output athletics(B) To diagnose exercise-induced asthma and significantcardiac conditions that pose a threat toan exertional athlete or one in a sport of highcontact(C) To identify medical threats to an exertional athleteand to recommend techniques of trainingthat would tend to maximize success in athletics(D) To identify conditions that will place the athleteat risk of exacerbation of an existing illness orinjury or at risk of incurring a new problem(E) To cover the practitioner against liability lest heor she approve for athletic participation an athletewith a condition that might lead to suddendeath9 Which of the following tests is the one in current useto diagnose (illicit) anabolic steroid use in athletics?(A) Testosterone-to-epitestosterone ratio(B) Androstendione level(C) Testosterone level(D) Estrogen level(E) Follicle-stimulating hormone level10 A 20-year-old star receiver for a Big Ten football teamwith a reputation for heroic catches leaps into the airand outward nearly 90 degrees to his right to effect areception. His body is rotated so that the right shoulderis positioned straight downward. After catchingthe pass he falls onto his right shoulder and immediatelyis seen to writhe in pain in the shoulder area. Hemisses the next two games because of the pain. Thereis no sensory component. Hand strength, includingintrinsic muscles, as well as elbow flexion and extensionare within normal limits. There is an irregularityto the contour of the right shoulder near the humeralhead. An x-ray shows no bone fracture but doesreveal an abnormality. The patient is able, uponexamination, to abduct, albeit associated with pain,to 150 degrees. Which of the following is the mostlikely diagnosis?(A) Rotator cuff partial tear(B) Rotator cuff complete tear(C) Fracture of the clavicle(D) Separation of the acromioclavicular joint(E) Herniated disc at C4For Questions 11 through 13, match the numbered grade ofconcussion with the defined clinical picture, represented bycapital letters. LOC loss of consciousness. More than oneanswer may be correct.11 Grade 1 concussion12 Grade 2 concussion13 Grade 3 concussion(A) Dazed without LOC, vertigo or amnesia for theevent(B) Confusion with amnesia 15 minutes, no LOC(C) Confusion with amnesia and LOC 5 minutes,amnesia 24 hours(D) LOC 20 minutes, confusion 10 minutes,amnesia for 2 minutes prior to the event(E) LOC 5 minutes or amnesia lasting 24 hours