NMS Q&A Family Medicine

chapter 7Peripheral Vascular DiseaseExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case .1 A 45-year-old female diabetic patient with a bodymass index (BMI) of 35 has a non-healing foot ulcer,and her physician fears the development of osteomyelitisof the adjacent bony structures. Which of thefollowing is the most sensitive test to allow realisticconsideration of this diagnosis?(A) Computed tomography (CT) scan of the foot(B) Plain x-ray of the foot(C) White cell scan(D) Bone scan(E) MRI of the foot2 A 35-year-old Caucasian man comes to a family physician’soffice complaining of pain in the right lowerleg. He has no history of similar complaints, venousthrombotic disease or pulmonary embolus. In consideringnon-invasive studies, which of the followingis the most sensitive for phlebothrombosis?(A) Bone scan(B) Plain x-ray(C) Compression ultrasound study(D) Serum D-dimer level(E) Examination for Homan’s sign3 Which of the following best describes the applicabilityof the Well’s criteria in thromboembolic disease?(A) Differentiation of peripheral arterial occlusionversus atherosclerotic or embolic disease(B) Differentiation as to whether thromboticdisease is arterial versus venous disease(C) Assist in diagnosis of pulmonary embolism(PE)(D) Differentiation of hemorrhagic versusthrombotic cerebrovascular disease(E) Measure of right heart strain in PE4 A 35-year-old man complains of pain and swelling ofhis right leg (calf, lower leg) for 3 days. History revealsthat, 8 weeks ago, he was bedridden for 4 days for asevere bout of influenza. He has had no surgeryrequiring general anesthesia, he has never been diagnosedwith cancer, and he does not have any neurologicdisability. Vital signs are normal. Examinationfinds 1 pitting edema and redness and diffuseswelling of the right leg. The patient has also a slight,thin, grayish discharge from the edge of his rightgreat toenail. There are no visible superficial veins. AD-dimer test was within normal limits. Which of thefollowing is least appropriate for the clinical dispositionat this point in time?(A) Empirically prescribe an antibiotic effectiveagainst infection in the lower half of the body(B) Prescribe warm compresses and elevation of theaffected extremity(C) Draw a white blood cell count and differential(D) Order a venous Doppler study of the right leg(E) Order culture and sensitivity test of the toedischarge5 A 55-year-old woman who underwent cancer chemotherapy3 months ago following surgery for breastcancer complains of left calf pain, swelling, andtenderness. The entire left leg (below the knee) isswollen with 1 to 2 pitting edema, and there is tendernessalong the distribution of the deep vein path.The D-dimer serum level is elevated. Venous Dopplerstudy is negative for the evidence of deep vein thrombosis(DVT). Which of the following is the bestapproach at this time?(A) Venography(B) Serial ultrasonography(C) Surgical exploration(D) Bone scan for metastatic breast cancer disease(E) Prescribe cefadroxil6 A 60-year-old male smoker complains of the acuteonset of pain in the right leg. Examination showscoldness of one-third of the extremity below the kneedistally. Popliteal, posterior tibial, and dorsalis pedispulses are nonpalpable. With no additional information,which of the following is the most likely sourceof this arterial insufficiency?(A) Abdominal aortic aneurysm(B) Myocardial infarction47