NMS Q&A Family Medicine

chapter 48Care and Prevention of theOlder Adult, Age 65 and OlderExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Which of the following statements best supports theposition of the Guide to Preventive Services of theU.S. Preventive Services Task Force regarding screeningfor cutaneous melanoma?(A) Patients over 65 years of age should undergototal body skin examination by a physician onan annual basis.(B) Patients should carry out total body skinself-examination on a regular basis.(C) Patients over 65 years of age with more than50 moles should be examined on a regularbasis for melanoma.(D) Dark complexioned people over the age of65 should see a physician annually for totalbody skin examination.(E) Any mole that is asymmetrical, variegated incolor, or greater than 6 mm in diameter shouldbe referred for excision.2 A 78-year-old woman has seemed difficulty to followin conversation. In interviewing her, the doctorsometimes wonders if her mind had wanderedbecause she cannot discern a coherent message in herconversation. Otherwise, she manifests no neurologicalsymptoms or signs. A comprehensive metabolicprofile reveals both alanine aminotransferase andaspartate aminotransferase levels to be elevated byabout 50% of their normal values. Suspecting alcoholism,you (the doctor) contemplate which strategyyou should use to confirm this fact. Which of the followingwould be the most sensitive?(A) Ask the patient how much she drinks(B) Check the patient’s cerebellar function onphysical examination(C) Ask the patient standardized screeningquestions for alcoholism, such as those from theCAGE questionnaire(D) Palpate for ascites(E) Look for spider angiomas on the patient’s skin3 A 65-year-old female is being seen for a general physicalexamination. She is active and without complaints.She had a complete hysterectomy 20 yearsago for benign uterine fibroids. Two months ago, shehad a negative mammogram as ordered by her gynecologist.She has no family history of colorectal cancer(CRC). She had a flu vaccination two months agoand a pneumonia vaccination five years ago. She hada normal mammogram last year. She had a normalcholesterol level 2 years ago. Her physical examinationis unremarkable. Her lungs are clear. Her breastshave no masses. There are no abdominal masses. Herrectal examination is negative. She is concernedregarding the cost. Which of the following preventivemeasures is clearly indicated for her?(A) Repeat pneumonia vaccination(B) CRC screening(C) Mammogram(D) Pap smear(E) Lipid profile4 A 55-year-old female of mixed English and Scottishdescent is undergoing her annual pelvic examination,Pap smear, and breast examination. The subject ofher cigarette smoking comes up, as it does each year.Again, the doctor takes time to point out the dangersof smoking, hoping for the “teachable moment.” Foreach of the following items, smoking is a significantrisk, except for which one?(A) Bladder cancer(B) Bulimia nervosa(C) Hip fracture(D) Lung cancer(E) Peptic ulcer disease279