NMS Q&A Family Medicine

2 NMS Q&A Family Medicinefollowing is most necessary to complete the physicalexamination?(A) Check for plantar reflex response(B) Complete neurological examination(C) Visual-field examination(D) Checking the perineum and inner thighs fortouch, sharp and dull pain perception andconducting a digital rectal examination(E) Test for proprioception in the lower extremities5 What is the average maximum time period from theonset of symptoms and signs for the diagnosis andtreatment of the patient in questions 2 through 4 inorder to achieve the best therapeutic result?(A) Hours(B) 48 hours(C) 72 hours(D) 5 days(E) Days6 A 60-year-old male—newly diagnosed Type II diabetic—complains of unremitting and increasingly severe lowback pain for the past 48 hours. He has been unableto find a comfortable position, that is, whether he issitting, standing, flexed at the hips supine or on hisside. There is radiation down the left lateral thigh. Hedenies urinary symptoms of any sort. His vital signsare normal except for a temperature of 100.8 F.Examination shows no abdominal mass or tenderness,and there is no costovertebral angle or otherback tenderness. There is no saddle numbness or sensoryloss. Deep tendon reflexes of the lower extremitiesare brisk and symmetrical. Straight-leg-raisingtest is unworkable due to the patient writhing in painwhen in the supine position. Complete blood count(CBC) shows a leukocytosis of 18,000 with 80 neutrophilsand a slight shift toward immature forms.The urinalysis is unremarkable. Which of the followingis the most important next step in evaluating thispatient?(A) 100 mg meperidine intravenously for empiricevaluation of his response(B) Urology consultation for a possible obstructingurolith accounting for normal urinalysis(C) Computed tomography (CT) of thelumbosacral spine(D) Stat blood cultures to be drawn(E) Start intravenous levofloxacin7 Of the following, which is the most urgent of thepossible diagnoses of the patient in Question 6?(A) Acute pyelonephritis(B) Metastatic malignancy in the spinal cord orcolumn(C) Vertebral body pathologic fracture due toosteoporosis(D) Epidural abscess(E) Acute cholecystitis8 A 63-year-old Caucasian male, with a history of frequentheadaches during his adult years, was leavinghis yacht club after docking his boat and, en route tohis car, noted the onset, over less than a minute, of asevere headache; he had no history whatsoever ofheadaches in the past. His friend drove him to thefamily doctor’s office within 15 minutes of the onset.The patient, who walked into the office accompaniedby his friend, was by that time having difficultyremembering what he was trying to say when hewould start a sentence. However, there was no aphasianoted, neither motor nor expressive. In orderingthe patient to be delivered forthwith to the nearestemergency department (ED), which of the followingis the most logical of urgent diagnostic studies to beobtained?(A) CT scan of the head without contrast(B) Lumbar puncture(C) CT scan of the head with contrast(D) Magnetic resonance imaging (MRI) of the brain(E) Stat CBC and differential9 A 25-year-old woman suffers a direct blow to thehead from the elbow of a teammate in a volleyballgame. She manifests a few minutes of confusion afterwhich she is oriented to person, place and time andnotes tenderness and swelling on the right frontaleminence of her head where the blow occurred. Sheis playing in her hometown and lives with her husband.Which of the following constitutes the mostreasonable approach if she consults her family physicianin a private office setting?(A) Reassurance and arrangements for the patientto call the office or the nearest ED if symptomsrecur(B) Ordering an emergency MRI of the head(C) Instructing her husband in checking thepatient’s pupil sizes and reactivity plus her stateof alertness frequently over the next 48 hours(D) Ordering routine skull x-rays and discharging ifnegative, after instructing in observational careover the next 48 hours(E) Ordering an emergency CT scan of the headwith contrast10 If the husband of the patient in Question 9 calls laterthat day, after hours, to express concern over thepatient’s alertness, which of the following dispositionsis the correct one?