NMS Q&A Family Medicine

300 NMS Q&A Family Medicine7 In evaluating seizures as to true versus pseudoseizures,which of the following laboratory studiesdrawn during the seizure or shortly thereafter wouldbe most helpful in making that determination?(A) White blood cell count(B) Blood sugar(C) Lactic acid dehydrogenase(D) Prolactin(E) Alkaline phosphatase8 A 28-year-old female complains of vague left chestpain, occasional feelings of shortness of breath, andfatigue. At other times, she has complained of rightflank and lower quadrant abdominal pain. Two monthsago, she complained of left upper quadrant abdominalpains that were intermittent and “nondescript.” Overthe past year, she has complained of urinary frequency;chest pains unassociated with exertion, light-headedness,or diaphoresis. At other times, this patient hascramping abdominal pain, constipation, and diarrheaas well as vague difficulty in swallowing. Today, theabdominal examination is negative for deep orrebound tenderness except for a probable exaggeratedguarding response to deep palpation in the right lowerquadrant. From which of the following somatoformdisorders does this patient most likely suffer?(A) Conversion disorder(B) Somatization disorder(C) Pain disorder(D) Hypochondriasis(E) Depression9 A 45-year-old Caucasian man has sustained a cervicalstrain that prevents him from being able to managethe steering wheel to drive a truck as required onhis job. Over a period of 6 months, he has remainedoff work because his employer won’t entertain theconcept of “light duty.” He has returned regularlylooking haggard, complaining of ongoing pain inboth the neck and the lumbar spine regions. Thereare no radicular signs in either the cervical or the sciaticsectors of the physical examination. Electricalstudies have returned negative results. Physical therapymodalities have failed to yield results satisfactoryto the patient. From which of the following somatoformdisorders does he suffer?(A) Conversion disorder(B) Somatization disorder(C) Pain disorder(D) Hypochondriasis(E) Anxiety10 A 35-year-old woman complains of vague abdominalsensations attributed to a hepatic cyst that has beendiagnosed on a previous abdominal computed tomographyscan. She has been followed for several years for“gastrointestinal dysautonomia.” When she comes tothe doctor’s office, she invariably invokes a sensationwith an anatomic attachment, not usually involvingpain. In addition to the hepatic cyst, she has also citeda posterior lung field “cyst” attached to an otherwisevague right thoracic sensation. Which of the followingsomatoform syndromes does she display?(A) Conversion disorder(B) Somatization disorder(C) Pain disorder(D) Hypochondriasis(E) Malingering11 A 26-year-old man comes to the doctor with a complaintof low back pain radiating down the posteriorleft thigh to the midcalf. Deep tendon reflexes are difficultto evaluate and on occasion seem to anticipatethe tap of the hammer. The straight-leg raising test ispositive in that it results in a complaint of radiatingpain in the same pattern as described in the chiefcomplaint at 45 degrees. The doctor then has thepatient sit up on the examining table and extends theknee to horizontal without resulting in a complaintor facial register of pain. Which of the following isthe underlying condition?(A) Herniated nucleus pulposus at L5 to S1(B) Lumbosacral strain(C) Pain disorder(D) Hypochondriasis(E) Malingering12 Regarding the patient in Question 11, if instead ofworrying that she has cancer of the stomach, supposeshe insists she has cancer despite the definitive negativestudies. Which of the following fits the clinicalpicture best among the choices?(A) Somatization disorder(B) Factitious disorder(C) Depression(D) Hypochondriasis(E) Body dysmorphic disorder13 A 42-year-old lawyer makes an appointment for chestpains approximately 1 week after a 52-year-old associatesuffered a myocardial infarction. His pain is intermittent,not severe, not associated with exertion, andmore likely to occur while he is sitting and watchingtelevision in the evening. A resting electrocardiogram