Exam block 4 Flashcards
(26 cards)
A 62-year-old man is seen in an emergency department because of severe pain in his lower back, Ieft buttock and the posterolateral aspect of his left leg. The pain began acutely after he lifted his 8-year-old granddaughter into the back of a truck, and he describes it as “shooting” in nature. When examined by the physician, he has curled into a fetal position, which he says relieves the pain. Attempts to extend the man’s spine cause a marked exacerbation of the pain. PIain spinal x-ray films show disk space narrowing in the involved area of the spine, and herniation with protrusion of the nucleus pulposus of one disk is demonstrated by CT scan. The normal location of the disk is between which of the following?
A. The body of the superior vertebrae and the body of the inferior vertebrae
/ B. The inferior articular process of the superior vertebrae and the superior articular process of the inferior vertebrae
/ C. The pedicle of the superior vertebrae and the pedicle of the inferior vertebrae
/ D. The superior articular process of the superior vertebrae and the inferior articular process of the inferior vertebrae
/ E. The vertebral canal of the superior vertebrae and the vertebral canal of the inferior vertebrae
A
A 62-year-old man is seen in an emergency department because of severe pain in his lower back, Ieft buttock and the posterolateral aspect of his left leg. The pain began acutely after he lifted his 8-year-old granddaughter into the back of a truck, and he describes it as “shooting” in nature. When examined by the physician, he has curled into a fetal position, which he says relieves the pain. Attempts to extend the man’s spine cause a marked exacerbation of the pain. More detailed examination demonstrates foot drop with weakness of the anterior tibiaI, posterior tibiaI, and peroneal muscles. Sensory loss is demonstrated over the anterior shin and dorsal foot. These findings suggest a radiculopathy at which of the following cord levels?
A. C-7 B. L-5 C. S-3 D. T-9 E. T-12
B
A 27-year-old woman presents to her gynecologist for follow-up for IRREGULAR, PAINFUL menstrual cycles. She has undergone a complete work-up, which is NEGATIVE. She is very distressed about her condition and states that she thinks it’s probably related to whatever is causing her bouts of generalized “weakness,” which have been occurring about once a month for the last year and associated with headache. She has a past medical history of several food intolerances and irritable bowel syndrome, both of which cause her significant abdominal pain and are managed by a gastroenterologist. She states that she’s recently had episodes of chest pain, lasting 20-30 minutes, unrelated to exercise, and requests to be referred to both a cardiologist and a neurologist. On exam, she is a thin, athletic woman who appears healthy. What is the most appropriate next step in treatment?
A. Discharge her from care B. Establish a primary care provider C. Send her directly to the ER D. Refer her to a psychiatrist E. Refer her to both a cardiologist and a neurologist
B
A 32-year-old woman comes in to see her physician because she has had undiagnosed abdominal pain for the past 3 and a half years. Her pain is NOT related to meals and does not correspond to a particular time of day, although she does report nausea and bloating. In the past two years she has had two endoscopies, a colonoscopy, and an exploratory laproscopy - without any results. She is very concerned because her mother has a history of colon cancer. The patient has been unable to work or maintain a social life because she’s constantly worrying about her condition. What is this patient’s most likely diagnosis?
A. Somatic symptom disorder B. Functional neurologic symptom disorder C. Hypochondriasis D. Factitious disorder E. Body dysmorphic disorder
A
A 14-year old girl is brought to the emergency department by her grandmother because of the sudden onset of headache, dizziness, and blurry vision. Her grandmother says that the patient was placed in her care 2 months ago because of her mother’s cocaine addiction. She also says that she had a recent conflict with the patient regarding the patient’s mother, but she is otherwise doing well at home and at school. The patient willingly talks about her symptoms but denies having any concerns or feelings about potential stressors in her life at the present time. Physical examination and routine laboratory test show no abnormalities. Which of the following is the most likely diagnosis?
A. ADJUSTMENT DISORDER B. CONVERSION DISORDER (FUNCTIONAL NEUROLOGICAL C. SYMPTOM DISORDER) DISSOCIATIVE AMNESIA WITH DISSOCIATIVE FUGUE D. SEPARATION ANXIETY DISORDER E. SOMATIC SYMPTOM DISORDER
B
For evaluating, by a primary care physician, hypochondriasis in a 54-year-old male patient using true/false questions, what is the most appropriate test?
(A) TAT
(B) MMPI-2
(C) WISC-R
(D) Rorschach Test
B
A 41-year-old man says that he has been “sickly” for most of his life. He has seen many doctors but is angry with most of them because they ultimately referred him for psychological help. He now fears that he has stomach cancer because his stomach makes noises after he eats. Physical examination is unremarkable and body weight is normal. Which disorder best fits this clinical picture?
(A) Post-traumatic stress disorder (B) Hypochondriasis (C) Obsessive-compulsive disorder (D) Panic disorder (E) Somatization disorder
B
A 41-year-old man says that he has been “sickly” for the past 3 months. He fears that he has stomach cancer. The patient is unshaven and appears thin and slowed down. Physical examination, including a gastrointestinal workup, is unremarkable except that the patient has lost 15 pounds since his last visit 1 year ago. Which disorder best fits this clinical picture?
(A) Post-traumatic stress disorder
(b) Somatization disorder
(C) Obsessive-compulsive disorder
(D) Panic disorder
(e) Hypochondriasis
E
A 65-year-old woman comes to the emergency department because of mild left hem iparesis and mild left-sided sensory deficit that began suddenly 2 days earlier. She has a history of myocardial infarction and takes aspirin, 81 mg daily. Which of the following is the most appropriate next step in the management of this patient?
A. Increase the aspirin dose to 325 mg daily
.
B. Discontinue aspirin and begin clopidogrel, 75 mg daily.
C. Change aspirin to combined low-dose aspirin/extended-release dipyridamole.
D. Discontinue aspirin and begin warfarin (target international normalized ratio, 2.0 to 3.0).
E. Initiate inpatient diagnostic evaluation
E
A 38-year-old man comes to the office because of paresthesias in his feet that began approximately 8 months ago. He now also has bilateral foot drop and weakness of the right hand. On examination, he has severe weakness in the foot dorsiflexors bilaterally and moderate weakness of foot eversion, inversion, and plantar flexion. He has mild weakness of hip flexion and is unable to rise from a chair without using his arms. There is also weakness in the ulnar-innervated hand muscles, slightly more pronounced on the right than on the left. There are no obtainable reflexes, and he has moderate proprioceptive loss in the toes. Which of the following is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Chronic inflammatory demyelinating polyneuropathy
C. Polymyositis
D. Myasthenia gravis
B
An obese 66-year old man has had increasing pain and numbness of the right anterior thigh over the past 3 weeks. He has not seen a physcian in more than 20 years. On examination, he has moderate weakness o right nee extension, thigh adduction, and hip flexion. The right knee jerk reflex is absent; the left knee jerk is 1+… Achilles reflexes are absent bilaterally. He has sensory loss in the right anterior thigh region and a stocking-glove istribution of sensory loss in the distal legs. MRI of the lumbosacral spine and luumbosacral plexus is normal. Which of the following studies is most likely to be diagnostic?
A. Creatine kinase level B. hemoglobin a 10 level C. Thyroid function D. Lumbar puncure E. Erythrocyte sedimentation rate
B
A 45-year-old woman says that she frequently feels “nervous” and often has an “upset stomach,” which includes heartburn, indigestion, and diarrhea. She has had this problem since she was 25 years of age and notes that other family members also are “tense and nervous.” Which of the following disorders best fits this clinical picture?
(A) Hypochondriasis (B) Obsessive-compulsive disorder (C) Panic disorder (D) Generalized anxiety disorder (E) Acute stress disorder
D
The parents and teacher of a 7-year-old boy note that he frequently shrugs his shoulders. Often he blinks his eyes excessively and, at other times, shouts out words for no reason. In adulthood this child is at risk to develop which of the following conditions?
(A) A seizure disorder (B) Obsessive-compulsive disorder (C) Conduct disorder (D) Schizophrenia (E) ASD
B
Two days after a 23-year-old man is rescued from a burning building he has no memory of the fire or of the few hours before or after it. Physical examination is unremarkable. The most likely explanation for this clinical picture is
(A) posttraumatic stress disorder (B) dissociative amnesia (C) adjustment disorder (D) early-onset Alzheimer disease (E) subarachnoid hemorrhage
B
A 14-year-old adolescent female is here to see you for complaints of greenish vaginal discharge. She is sexually active with one partner and does not use condoms. You do a culture and find that she has Trichomonas vaginitis. She asks you not to tell her mother about this diagnosis or that she is sexually active. Which of the following statements is most accurate regarding disclosure or nondisclosure of this information to her parents?
A.You can keep this information confidential. However, it is advisable to talk with the teen about her sexual history and discuss communication issues between her and her parents.
B.Since she is a minor, you must disclose this information to her parents.
C. You can only keep this confidential for today for enhancing therapy, but then disclosure to the parents must be demonstrated and documented.
D. You may keep this confidential from the parents but you must call the partner to notify him of the infection.
A
In which of the following situations may a physician keep information confidential from parents or other authorities?
A. The physician finds injuries consistent with physical abuse while examining a 13-year-old but the patient fears further injury if the abuse is reported.
B. A depressed teenager reports a strong desire to kill herself and that she has secretly obtained a gun that she keeps in her bedroom.
C. An undocumented immigrant patient has active tuberculosis and fears deportation if the illness is reported.
D. A 19-year-old female college student, who is still on her parents’ insurance plan, reports a consensual sexual relationship with a 35-year-old man and requests contraception but does not want her parents to know.
D
Which of the following is most accurate regarding the term “emancipation” as it applies to a minor?
A. Able to vote
B. Able to purchase and consume alcohol
C. Able to make their own medical decisions without parental consent
D. Legally financially independent
C
Which of the following statements regarding a minor’s ability to consent for an abortion is most accurate?
A. Because of medical confidentiality, a minor is able to consent to any medical therapy she chooses without the consent of her parents or guardian.
B. Although consent requirements for abortion services vary depending on the state, most states either have some form of required consent for abortion services to minors or a mandatory wait period.
C. There are no states in which a minor can obtain an abortion without the consent of a parent or guardian.
D. A minor cannot consent to any medical therapy without her parents’ approval unless she has received a court order.
B
A 45-year-old woman says that she frequently feels “nervous” and often has an “upset stomach,” which includes heartburn, indigestion, and diarrhea. She has had this problem since she was 25 years of age and notes that other family members also are “tense and nervous.” Which of the following disorders best fits this clinical picture?
(A) Hypochondriasis (B) Obsessive-compulsive disorder (C) Panic disorder (D) Generalized anxiety disorder (E) Acute stress disorder
D
The parents and teacher of a 7-year-old boy note that he frequently shrugs his shoulders. Often he blinks his eyes excessively and, at other times, shouts out words for no reason. In adulthood this child is at risk to develop which of the following conditions?
(A) A seizure disorder (B) Obsessive-compulsive disorder (C) Conduct disorder (D) Schizophrenia (E) ASD
B
A 72 year old female with no significant past medical history passes out while exercising. He has intermittent exertional chest pains and dyspnea on exertion as well. Her physical examination reveals a III/VI late-peaking creshendo-decreshendo murmur at the right upper sternal border and a III/VI holosystolic murmur at the apex. Her S2 heart sound is very soft and her carotid upstroke is weak and delayed. Which of the following is most likely causing her symptoms?
A) Aortic valve regurgitation B) Aortic valve stenosis C) Mitral valve regurgitation D) Mitral valve stenosis E) Mitral valve prolapse
B
A 56 year old African American female with a history of asthma is diagnosed with hypertension. Laboratory studies reveal a creatinine of 3.0 mg/dL and a potassium level of 5.1 mg/dL. Which of the following medications is appropriate to treat her hypertension?
A) amlodipine B) hydrochlorothiazide C) enalapril D) propranolol E) spironolactone
A
A 60-year-old male presents with palpitations. He reports drinking many glasses of wine over several hours at a family wedding the previous evening. An EKG reveals absent P waves and irregularly irregular rhythm. He does not take any medications. Which is most likely responsible for the patient’s symptoms? A. Atrial fibrillation B. Transmural myocardial infarction C. Untreated hypertension D. Torsades de pointes E. Ventricular hypertrophy
A
A 55-year-old woman presents with complaints of chest pain. She states that the chest pain predictably occurs when she climbs four flights of stairs to reach her apartment or when she has been jogging for more than 10 minutes. She is particularly concerned because her mother died of a myocardial infarction at 50 years of age. Which of the following best describes this patient’s statement?
A. Arrhythmia B. Myocardial Infarction C. Prinzmetal Angina D. Stable Angina Pectoris E. Unstable Angina Pectoris
D
