NMS Q&A Family Medicine

Peripheral Vascular Disease 49would be the best pharmaceutical choice for medicalmanagement of the patient’s claudication of thelegs.(A) Cilostazol (Pletal)(B) Nitroglycerin sublingually(C) Pentoxifylline (Trental)(D) Lisinopril(E) Propranolol15 A 65-year-old woman complains of new onset ofswelling of her right lower leg and ankle. Her vitalsigns are normal, and she does not complain ofdyspnea. There is deep calf tenderness. Which of thefollowing would be of the most assistance in quicklydetermining whether there may be DVT withoutresorting to venogram or venous Doppler study?(A) D-dimer serum level(B) Complete blood count(C) A/B measurements(D) Serial creatine kinase levels(E) Sedimentation rate16 Regarding the 65-year-old woman with leg swelling,the test you ordered is reported positive for suggestionof DVT. Along with a confirmatory venous Dopplerstudy, you wish to rule out PE. Which of thefollowing is the most sensitive and specific method,assuming no medical contraindications?(A) Electrocardiogram(B) Plain chest x-ray in the interest of time(C) Spiral CT scan of the chest(D) Ventilation/perfusion (V/Q) scan of the chest(E) Arterial blood gas test17 A patient has proven DVT, and pulmonary embolushas been satisfactorily ruled out. The patient demursregarding the option of hospitalization. You decide tocommit the patient to 6 months of anticoagulationtherapy. Which of the following is the most approvedmethod?(A) Administration of subcutaneous (SQ) heparinevery 6 hours based on partial thromboplastintimes (PTTs) for 5 days and immediateinitiation of warfarin(B) Initiation of warfarin and regulation of itsdosage based on daily prothrombin times (PTs)over the first 5 days, followed by daily warfarinand frequency of PT determined by the resultsand stability of follow-up(C) Home administration of SQ low-molecularweightheparin (LMWH), with dosage to beregulated according to PTT follow-up(D) Home administration of SQ LMWH for 5 days,initiating warfarin orally on day 2 of theLMWH, regulated according to serial PT(E) Administration of SQ LMWH daily or twicedaily for 6 months18 Relevant to the preceding vignettes, once a patientwith DVT has been diagnosed, stabilized, andanticoagulated, one should consider investigating thepatient for all except which of the following issues?(A) Occult malignancy(B) Deficiency of protein C(C) Deficiency of protein S(D) Raynaud’s phenomenon(E) Deficiency of antithrombin III19 A 58-year-old female patient was referred back toyou, her family physician, by an ophthalmologist. Sheconsulted for an episode of blindness of her left eye(only) lasting about 2 minutes that occurred 2 daysago. She denies visual disturbance since the episodeand has no areas of focal weakness or numbness, nordoes she have problems of mental concentration ormemory. Which of the following segments of thephysical examination is most likely to furnish themost helpful immediate findings?(A) Fundoscopy(B) Cardiac segment(C) Lung fields(D) Neck(E) Abdominal segment20 A 60-year-old man without specific complaints isundergoing a routine complete physical examinationby you. He has not been in since his last annual examination1 year ago. As is your custom on any patientolder than 40 years, after auscultation of the heartyou place the diaphragm of the stethoscope over thecarotid arteries and hear a bruit over the left carotid.The pulses are palpable. No goiter is present. Furtherhistory review confirms that he has had no neurologicsymptoms, including visual disturbance ormotor and somatic sensory symptoms. The remainderof the history and examination are normal, andthe patient is taking no ongoing medications. Whichof the following is the most logical next step in dispositionof the case?(A) Refer for carotid angiogram(B) Start aspirin 85 mg daily(C) Order carotid Doppler studies(D) Order cardiac stress testing(E) Refer for coronary angiography