NMS Q&A Family Medicine

270 NMS Q&A Family Medicineis exacerbation of acne, depression, and fatigue. The othereffects mentioned among the distracters are due to estrogeniceffects, in addition to which are thromboembolicphenomena (rare), cervical ectasia (cervical ectopy), andrise in biliary cholesterol.11. The answer is D, weight 85% of IBW. This correspondsapproximately to the definition of malnutrition,which is less than fifth percentile for body mass index. Useof percentile and percent of ideal may cause confusion:85% of ideal weight refers to the spectrum of people whoare living at less than ideal weight, only 5% of whomwould be expected to weigh less than 85% of ideal. Thus,the choice of 60% of ideal weight may hardly exist in aliving person, except in a prison camp situation. A weightof 100 lb (45 kg) in a female individual may well bewithin normal limits for a small person. There is no directrelationship between caloric intake and anorexia. However,anorectics may take in as little as 100 to 200 kcal/day.The formula of 100 lb plus 5 lb for every inch of heightover 60 in. is simply a rough formula for ideal weight estimation.There are two forms of anorexia: The “classic” isthe type wherein the individual, ostensibly in unreasonablefear of weight gain, simply overrides her appetite andrefuses to take in more than a minimal amount of food.The other form applies to those who vomit or purge followingfood intake, often prodigious amounts (i.e., bulimia).These people often experience deterioration ofteeth, particularly the upper incisors, from frequent vomiting.In both cases, amenorrhea occurs after a criticallevel of weight loss, which is the result of homeostaticmechanisms that result in hypothalamic hypofunction inresponse to malnutrition, especially when it occurs inassociation with stress. This can be thought of as a redirectingof energy resources in favor of survival.12. The answer is C. Vaccines of Td, a tetanus boosterwith an attenuated dose of diphtheria, should be administeredevery 10 years, starting when the child reaches theage of 11 or 12. Each of the other choices mentioned is upto date and completed at this point.ReferencesCenters for Disease Control : Adult Immunization Schedules,endorsed by ACIP, AAP, and AAFP.Family Medicine Board Review, 2009 . Kansas City, MO ; May3–10, 2009 .Hay WW , Levin MJ , Sondheimer JM , Deterding RR , eds. CurrentDiagnosis & Treatment Pediatrics , 19th ed . New York, Chicago :McGraw-Hill/Lange ; 2009 .Kurowski K . Preventive care of the preschool child (1–5 years) .In: Rudy DR , Kurowski K , eds. Baltimore, MD : Williams &Wilkins , 1997 : 689 – 702 .Rudy DR . Endocrinology . In: Rakel RE , ed. Textbook of FamilyPractice , 6th ed . Saunders ; 2002 .Sternback M , Lipsky MS . Preventive care of the dolescent(12–20 years) . In: Rudy DR , Kurowski K , eds. Family Medicine:House Officer Series . Baltimore, MD : Williams & Wilkins ;1997 : 713 – 720 .