NMS Q&A Family Medicine

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230 NMS Q&A Family Medicineascites, encephalopathy, and gastrointestinal bleeding?(A) Direct-acting bilirubin(B) Presence or absence of ascites(C) Level of serum albumin(D) Preoperative Child–Turcotte–Pughclassification of cirrhosis score16 A 34-year-old woman is being prepared for hysterectomy,indicated by menometrorrhagia in a womanwho is gravida 4, para 4, and desires no more pregnancies.In preparing for surgery, you are aware thather hemoglobin (Hgb) may be decreased as a resultof an iron deficiency, which at various periods overthe past 3 years has required iron therapy. She hasbeen inconsistent in her compliance with the prescriptions.Which of the following is felt to be thepoint below which the risk of perioperative complicationsin otherwise healthy individuals is significantlyincreased?(A) 12 g/dL(B) 10 g/dL(C) 8 g/dL(D) 6 g/dL(E) 4 g/dL17 A 65-year-old man has been diagnosed with a symptomaticventricular septal defect (VSD), but surgicalcorrection is indicated because of the emergence ofconcentric cardiomegaly (diastolic dysfunction). Theblood pressure is 140/65. The patient is also diagnosed,in the course of his overall evaluation and thediscovery of a bruit over the right carotid artery, ashaving a 75% right carotid artery stenosis caused byatherosclerosis. While awaiting repair of the septaldefect, the patient experiences a 2-minute bout of avisual scotoma involving the right lower quadrant ofboth fields homonymously. Which of the following isthe most logical sequence of actions?(A) Perform repair of the VSD followed by carotidendarterectomy.(B) Perform coronary bypass grafting procedurefollowed by repair of the VSD.(C) Perform carotid endarterectomy followed byrepair of the VSD.(D) Carotid artery angiography followed byreevaluation before making further decision.(E) Treat the cardiac hypertrophy aggressivelymedically followed by carotid endarterectomywhen the cardiac status is stable and satisfactory.18 Which of the following ranks as the most specific andearnest preoperative preparation for an electiveabdominal operation on a 55-year-old man who is inchronic renal failure on dialysis?(A) Preoperative ECG within 24 hours of theoperation(B) Blood urea nitrogen and creatinine levels within24 hours of the surgery(C) CBC within 1 week of surgery(D) Dialysis within 24 hours and electrolytes studiesjust before surgery19 A 35-year-old female patient with chronic diarrheahas been diagnosed as having Crohn disease and isbeing considered for exploratory laparotomy. Consideringthe recent severe diarrhea, the patient’s stateof nutrition is a factor in preparing for surgery andplanning postoperative care. Below what level ofserum albumin, may she be considered to be severelymalnourished?(A) 4 g/dL(B) 3.5 g/dL(C) 2 g/dL(D) 1.5 g/dL20 A 63-year-old woman is being scheduled for an operationto relieve partial bowel obstruction that is dueto a descending colon carcinoma. Her symptomsconsist of alternating constipation (cessation ofmovements, normally daily) for periods of 2 to3 days, followed by diarrhea for 1 to 2 days. She says herappetite has waned during the period of these symptoms,approximately 6 weeks. Her weight is 120 lb(54.4 kg) at a height of 5 ft, 6 in. (1.68 m). In evaluatingher for the possible need of supplemental feeding,at least orally, before surgery to take place in1 week, what dietary intake should she be able toingest (caloric and percentage of protein oral intake),which would be adequate to obviate the need for anoral supplement (e.g., Ensure)?(A) 35 kcal/kg, of which 20% should be protein(B) 30 kcal/kg, with 30% protein(C) 40 kcal/kg, with 80 g of protein(D) Adequate oral intake as confirmed subjectivelyby the patient will suffice to ensure that thepatient is taking in an adequate amount to carryher through major surgery.(E) This calculation is not needed as long as thepatient’s serum albumin and transferrin levelsare within normal limits.
Preoperative Clearance 23121 Prophylactic antibiotics after surgery have become amuch more accepted practice over the past 20 years.However, there are guidelines and a theme for thispractice. Which of the following does not merit prophylacticantibiotic therapy after surgery?(A) Lymph node biopsy in the neck area(B) Thoracotomy(C) Hysterectomy(D) Biliary surgery(E) Urinary cystotomy22 For which of the following preexisting conditions ispreoperative antibiotic prophylaxis against bacterialendocarditis recommended?(A) Patients who have undergone coronary bypasssurgery(B) Patients with cardiac pacemakers(C) Patients with hypertrophic cardiomyopathy(D) Patients with previous Kawasaki disease(E) Patients with implanted defibrillators
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NMS Q&AFamily Medicine3rd EDITION
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Acquisitions Editor: Susan RhynerPr
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Foreword to the First EditionFamily
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AcknowledgmentsFor the contribution
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xivContentsChapter 15 Surgical Issu
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SECTION IUrgent Carechapter 1Urgent
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Urgent Care in Family Practice 3(A)
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Urgent Care in Family Practice 5Exa
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Urgent Care in Family Practice 7rem
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10 NMS Q&A Family Medicine(A) To pl
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12 NMS Q&A Family MedicineExaminati
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chapter 3Otolaryngology inPrimary C
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Otolaryngology in Primary Care 17tr
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Otolaryngology in Primary Care 1924
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Otolaryngology in Primary Care 21of
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Otolaryngology in Primary Care 23co
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26 NMS Q&A Family Medicine(A) Migra
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30 NMS Q&A Family MedicineQuestions
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32 NMS Q&A Family Medicine(A) Distu
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36 NMS Q&A Family Medicine80 mm Hg.
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SECTION IIICardiovascular Diseasesi
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Cardiology 41(A) Systolic crescendo
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Cardiology 43Examination Answers1.
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Cardiology 4516. The answer is C. T
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chapter 7Peripheral Vascular Diseas
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Peripheral Vascular Disease 49would
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Peripheral Vascular Disease 51Exami
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Peripheral Vascular Disease 53right
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chap ter 8Cerebrovascular DiseaseEx
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Cerebrovascular Disease 57(A) A non
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Cerebrovascular Disease 59ventricul
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chap ter 9Pediatric CardiologyExami
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Pediatric Cardiology 6315 You hear
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Pediatric Cardiology 65by placing o
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chap ter 10HypertensionExamination
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Hypertension 6915 In hypertensive p
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Hypertension 71systolic hypertensio
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74 NMS Q&A Family Medicine(A) Right
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Neurology 778. The answer is A. The
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SECTION VRespiratory Diseasesin Pri
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Pneumonia and Bronchitides 81(C) Co
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Pneumonia and Bronchitides 836. The
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chapter 13Respiratory Diseasesin Ch
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Respiratory Diseases in Children 87
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SECTION VIThe Gastrointestinal Trac
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Medical Problems of the Gastrointes
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Medical Problems of the Gastrointes
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chap ter 15Surgical Issues of theGa
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Surgical Issues of the Gastrointest
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Surgical Issues of the Gastrointest
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chap ter 16Problems of the LiverExa
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Problems of the Liver 103level, whe
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Problems of the Liver 105been inves
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SECTION VIIUrology and Nephrologyin
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Problems of the Urinary Tract 10913
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Problems of the Urinary Tract 11110
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114 NMS Q&A Family Medicine7 Which
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116 NMS Q&A Family MedicineExaminat
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118 NMS Q&A Family Medicineof malig
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120 NMS Q&A Family Medicine(D) Sulf
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124 NMS Q&A Family MedicineReferenc
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126 NMS Q&A Family Medicinecycle. H
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chapter 21Gynecology in Mature Adul
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Gynecology in Mature Adults 133amen
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Gynecology in Mature Adults 1357. T
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chapter 22Diseases of the Female Br
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Diseases of the Female Breast 139Ex
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Diseases of the Female Breast 141Re
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144 NMS Q&A Family Medicine(B) Long
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146 NMS Q&A Family Medicine(D) PIP
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148 NMS Q&A Family Medicine6. The a
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chapter 24Musculoskeletal Problemso
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Musculoskeletal Problems of the Nec
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Musculoskeletal Problems of the Nec
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chapter 25Musculoskeletal Problemso
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Musculoskeletal Problems of the Low
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Musculoskeletal Problems of the Low
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chapter 26Rheumatology in Primary C
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Rheumatology in Primary Care 165(D)
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Rheumatology in Primary Care 16710.
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170 NMS Q&A Family Medicineof 5 ft,
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172 NMS Q&A Family Medicinepresent.
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174 NMS Q&A Family Medicinenodules.
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178 NMS Q&A Family MedicineReferenc
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Page 207 and 208: chap ter 31Other Infectious Disease
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Page 213 and 214: SECTION XIEndocrinology inPrimary C
Page 215 and 216: Diabetes Mellitus 197normal saline
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Page 239 and 240: SECTION XIIAllergieschapter 36Atopi
Page 241 and 242: Atopic, Food, and Contact Allergies
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Page 253 and 254: chap ter 38Obesity and Dyslipidemia
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Page 259 and 260: chapter 39Smoking CessationExaminat
Page 261 and 262: Smoking Cessation 243Examination An
Page 263 and 264: chapter 40Exercise and HealthExamin
Page 265 and 266: Exercise and Health 247Examination
Page 267 and 268: chapter 41Concepts in Epidemiologya
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280 NMS Q&A Family Medicine5 Of the
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282 NMS Q&A Family Medicineclinicia
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284 NMS Q&A Family Medicine9 Regard
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288 NMS Q&A Family Medicinedenied a
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290 NMS Q&A Family Medicinewithout
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chapter 51Anxiety and PhobiasExamin
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Anxiety and Phobias 297Examination
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chapter 52Somatic Symptoms withoutO
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Somatic Symptoms without Organic Ba
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Somatic Symptoms without Organic Ba
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306 NMS Q&A Family Medicine5 A 25-y
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308 NMS Q&A Family Medicineperiorbi
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310 NMS Q&A Family Medicineand loti
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chapter 54GeriatricsExamination que
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Geriatrics 315Examination Answers1.
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chapter 55HematologyExamination que
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Hematology 31915 A 45-year-old busy
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Hematology 321Mean cell hemoglobin
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Hematology 323whereas in multiple m
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326 NMS Q&A Family Medicine7 A 45-y
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