Family (1) part 2

Family 14. You are evaluating a 56 year-old obese woman who complains of fatigue. She has polydipsia, polyuria, polyphagia. Which of the following laboratory reports confirms the diagnosis of diabetes? P

5. You are evaluating a 36-year-old obese woman who complains of fatigue. She denies polydipsia, polyuria, polyphagia, or weight loss. Which of the following laboratory reports confirms the diagnosis of diabetes?

. A 52-year-old obese man presents for follow-up of his hypertension. His blood pressure is well controlled on a daily dose of hydrochlorothiazide. A finger-stick blood sugar test done an hour after he ate lunch was 130 mg/ dL. Which of the following test results would be diagnostic for diabetes mellitus?

. You are performing a screening physical examination on a 47-year-old man. He is generally healthy, and his review of systems is negative. His mother has type 2 diabetes, and he is overweight. Which of the following is generally accepted as the test of choice to screen for type 2 diabetes?

8. Which of the following is correct about hyperosmolar hyperglycemic state HHS: P.150

A 57-year-old man complains of increased thirst and urination. His examination is normal. Which of the following is the most appropriate initial diagnostic test?

. A 46-year-old woman with a 10-year history of insulin-requiring diabetes mellitus presents to the emergency room with nausea, vomiting, and abdominal pain. Family members state that the patient has recently been taking over-the-counter medications for an upper respiratory tract infection. The blood pressure is 90/60 mm Hg and the pulse is 120/min. The patient is lethargic but follows commands. Pupils are 3 mm bilaterally and reactive to light and accommodation. Abdominal examination reveals diffuse tenderness but no rebound tenderness. Neurologic examination reveals no focal deficits. Finger stick glucose is >800 mg/dL and arterial blood gas reveals a pH of 7.36. Which of the following is the most likely diagnosis?

A 39-year-old G1P0 woman who is a new patient presents to the office at 10 weeks' gestation. She is known to have type 2 diabetes mellitus and currently takes metformin. Her BMI of 34.7. This patient is at an increased risk for developing which of the following?

A 53-year-old woman with type 2 diabetes mellitus is found to have a blood pressure of 152/98. She has never had any ophthalmologic, cardiovascular, or renal complications of diabetes or hypertension (HTN). Based on recent recommendations of the JNC7 (The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) which of the following is the currently recommended goal for blood pressure control in this case?

A 34-year-old man was diagnosed with type 2 diabetes mellitus as a child and has been presenting for annual examinations since he was in his early 20s. Which of the following screening tests is indicated more than once a year

In which of the following categories should women undergo routine screening for gestational diabetes?

A 50-year-old woman is diagnosed with type 2 diabetes mellitus. Her hemoglobin A1C is now 7.6%. She has attempted to lose weight and to exercise with no improvement in her hemoglobin A1C, and drug therapy is now recommended. She has mild systemic hypertension that is well controlled and no other medical conditions. Which of the following is the most appropriate first-line therapy?

A 53-year-old woman's A1C is 7.6%. She has attempted to lose weight and to exercise with no improvement in her hemoglobin A1C, and drug therapy is now recommended. She has mild systemic hypertension that is well controlled and her LDL is 120mg/dL. Which of the following is the most appropriate first-line therapy

Patient with newly established diagnosis of type 2 diabetes mellitus. Along with diet and exercise, which of the following is the most appropriate initial management?

. A 49-year-old woman presents to her physician's office with a long-standing history of polydipsia, polyuria, central obesity, and hyperlipidemia. She is currently taking metformin, a sulfonylurea, and an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are most beneficial in preventing or slowing the progression of which of the following diabetic complications?

139. A 26-year-old woman presents with weight gain, lethargy, dry skin, sweatiness, cold intolerance, and thinning hair. You suspect hypothyroidism and order the appropriate laboratory tests. Her TSH is high, and her free T 3 and free T 4 are both low. Which of the following is the most likely diagnosis?

0. You have been following a 45-year-old man for hypothyroidism for the past 2 years without significant complaints. He was prescribed 100 g of levothyroxine 1 year ago, when the diagnosis was made, and his TSH fell to normal levels at the 3- month and 6-month visits. He returns for a routine annual recheck and manifests a normal blood pressure and apical heart rate of 80, regular. As he has a family history of adenomatous colon polyps, you arrange for colorectal cancer screening annually this decade. Then you draw routine fasting lipids because he has gained 5 lb (2.26 kg) during the past year and also draw in the same specimen serum TSH. The test results return normal except for TSH, whose level is 6.2 IU/mL (normal is 0.4 to 4.8). Each of the following may constitute explanations for this finding, except which factor?

1. A 25-year-old woman complains of fatigue and cold intolerance increasing over the past 3 months. On examination, she manifests a somewhat dry skin, which she says is a change from her usual. She admits to being puzzled and saddened over the situation. Her apical heart rate is 68 in a regular rhythm. Blood pressure is 110/68. The TSH level is 0.3 IU/mL (0.4 to 4.8). She gives a further history of being on bromocriptine for a microprolactinoma. Which of the following is the likely cause of her condition?

You are caring for a 35-year-old man who is complaining of fatigue and an inability to gain weight. Laboratory evaluation reveals a TSH of 6.0 mIU/L (H) but a normal free T 4. Which of the following is the best next step?

Which of the following statements about hyperglycemic hyperosmolar nonketotic coma is true?

144. Which of the following test results supports the diagnosis of Graves' disease?

145. In screening for primary thyroid disease (hypothyroidism or hyperthyroidism), which of the following serum tests is the most sensitive?

A 45-year-old white woman is undergoing a routine annual preventive health examination. After reviewing the routine mammogram and before performing the routine breast and pelvic examination, you proceed to a head-to-toe brief physical examination. You discover a palpable thyroid nodule that seems to be about 2.5 cm in diameter. Which of the following blood tests would be the most logical, in addition to certain routine medical profiles?

147. Which of the following is consistent with a diagnosis of hyperthyroidism? Harrison’s

A 28 year-old woman is noted to have had 10-Ib unintended weight gain hair loss, dry skin and fatigue. She is diagnosed with probable hypothyroidism. Which of the following laboratory test results is most consistent with hypothyroidism?

A 30-year-old female complains of fatigue, constipation, and weight gain. There is no prior history of neck surgery or radiation. Her voice is hoarse and her skin is dry. Serum TSH is elevated and T4 is low. The most likely cause of these findings is:

. A 35-year-old woman presents to her primary care physician because of 2 weeks of neck pain. The pain is constant and sharp (rated at 10 of 10) and is felt in the anterior portion of her neck. She also notes several weeks of loose stools and fatigue. Past medical history is significant for a viral upper respiratory infection about 1 month ago. She has a temperature of 37.9°C (100.2°F), heart rate of 96/min, and blood pressure of 136/82 mm Hg. On neck examination there is diffuse enlargement of the thyroid and it is exquisitely tender to even mild palpation. Her oropharynx. Laboratory studies are sent and reveal a white blood cell count of 14,100 cells/ML with a normal differential, erythrocyte sedimentation rate (ESR) of 53 mm/h. Thyroid antibodies are negative. What is the most likely

A 40-year-old woman presents to the outpatient clinic for a routine visit. On physical examination a 1-cm nodule is palpated in her thyroid. Her physical examination is otherwise unremarkable. Her heart rate is 70/min and regular, blood pressure is 126/82 mm Hg, and temperature is 36.7oC (98.0o F). Which of the following is a poor prognostic indicator for the thyroid nodule?

A 72-year-old man with atrial fibrillation presents with complaints of fatigue and feeling cold. He also notes constipation and dry skin. His daughter states he has seemed more forgetful over the past several months. His temperature is 37.3°C (99.1°F), heart rate is 48/min, and blood pressure is 130/82 mm Hg. Cardiac examination shows bradycardia but normal rhythm, and normal S1 and S2 with no murmurs; the lungs are clear to auscultation bilaterally and the abdomen is soft and nontender. The patient’s extremities are cool and puffy with dry, coarse skin. Laboratory studies show a thyroid-stimulating hormone level of 32 μU/L, free thyroxine of 0.3 ng/dL, and total triiodothyronine of 30 ng/dL. What medication is the patient likely taking for his atrial fi brillation?

153. It is common for throat pain to be referred to the P.191

The mother of a 9-month-old infant brings him in for irritability. The child has been fussy and has not been sleeping well for 2 days. His highest temperature has been 100°F, and he has had a clear runny nose and cough. On examination, the child is crying and irritable. Which physical examination finding, by itself, is insufficient to diagnose acute otitis media?

A 60 year old female patient has been complaining of left earache of 3 months duration. One month ago a swelling appeared in the left side of the neck that progressively increased in size. 2 days ago cot complained of change of her voice together with dysphagia. On indirect laryngoscopy there was froth in the region behind the larynx. What is the most possible diagnosis

A 35-year-old male graduate student complains of intermittent difficulty swallowing for the last 3 months. He notes that this happened 6 years ago and lasted for about 7 months. Which of the following symptoms would most enable you to reassure the patient that he does not have an organic basis for the dysphagia?

A 25 year old male presented to the ENT emergency room with severe right side throat pain, inability to swallow, accompanied by right earache of 2 days duration. The patient was unable to open his mouth and was feverish 40 C. On examination there was a tender swelling at the angle of the mandible The patient gave a history of sore throat and fever 39 C during the last week. What is the most possible diagnosis in this case?

A 12-year-old female patient is diagnosed as having streptococcal pharyngitis. To prevent rheumatic fever in this child, how soon must the treatment begin to eradicate the Streptococcus

A 22-year-old female patient is diagnosed as having streptococcal pharyngitis. To prevent rheumatic fever in this child, how soon must the treatment begin to eradicate the Streptococcus

A 21-year-old woman presents with a complaint of sore throat. She was in her usual state of health until 3 days ago, when she developed a nonproductive cough, nasal drainage, ear pain, and a sore throat. She denies having shortness of breath, sputum production, fever, rash, joint pains, or gastrointestinal symptoms. She also denies having been in contact with sick persons. For the past 2 years, she has been in a sexual relationship with a single sexual partner. On physical examination, the patient is found to have erythema of the posterior pharynx and nasal turbinates. Small, bilateral, serous, middle-ear fluid collections are noted. Lung examination is normal. The patient is afebrile. She requests antibiotics, stating that she always improves much more quickly with this therapy. Which of the following statements regarding pharyngitis is true?

. A 35 year-old boy presents to the physician's office complaining of fatigue, headache, myalgias, and sore throat that have been continuous for 1.5 weeks. The patient has generalized lymphadenopathy of the cervicaland submandibular nodes, in addition to splenomegaly. His tonsils are significantly enlarged with exu- date. Peripheral blood smear shows 65% lymphocytes, with 15% atypical lymphocytes. Which is the most likely cause of his syndrome?

. Which of the following causes of Abdominal Pain Based on Location is correct:

Which of the following causes of Abdominal Pain Based on Location and Quality is correct

What is true about abdominal pain?

A 53-year-old obese woman presents to your office complaining of the recent onset of abdominal pain. She describes pain that starts in the mid epigastric region, radiating to the back. It is associated with nausea and vomiting. Past history of alcohol use is negative. What is the most likely diagnosis?

A 42-year-old woman presents to your office complaining of the recent onset of abdominal pain. She describes pain that starts in the midepigastric region, radiating to the back. It is associated with nausea and vomiting. What is the most likely diagnosis?

. A 28-year-old man comes to your clinic complaining of diarrhea of 10 months’ duration. He is a graduate student and is currently writing a thesis. He has been sexually active with men in the past but not during the past 2 years. He denies experiencing weight loss or other constitutional symptoms. He notes no blood in the stool. He has no medical history. He explains that he has not sought attention before now because the problem is intermittent, and he notes that he sometimes experiences constipation rather than diarrhea. You include irritable bowel syndrome in your differential diagnosis. Which of the following descriptions is characteristic of irritable bowel syndrome?

168. Which of the following best describes irritable bowel syndrome?

. A 58-year-old woman presents to her internist with a 2-day history of low-grade fever and RUQ abdominal pain. She reports nausea but denies vomiting or diarrhea. On physical examination, she is pale and jaundiced. Her temperature is 38.1°C. She has RUQ tenderness without rigidity or rebound tenderness. Bowel sounds are normal. Her white blood cell count is 16,000/μL and urinalysis shows no red or white blood cells. Which of the following is the most likely diagnosis?

A 40-year-old Asian woman presents to the emergency department complaining of intermittent epigastric pain. The pain is severe, lasts for a few hours, and is sometimes accompanied by nausea and vomiting. Her bowel movements have been normal. Her temperature is 38.3°C (100.9°F), pulse is 100/min, blood pressure is 150/80 mm Hg, and respiratory rate is 22/min. Physical examination reveals moderate obesity and mildly icteric sclerae. Bowel sounds are normal, with an abrupt halt of inspiration upon palpation of the RUQ, and guarding is noted. Laboratory values reveal a WBC count of 13,000/mm³, total bilirubin of 3.3 mg/dL, and normal liver enzymes and alkaline phosphatase levels. Which of the following is the first diagnostic imaging study that should be performed?

171. All of the following statements is correct, except: P.225

172. Which of these is correct?

An 80-year-old man presents with mild, crampy, bilateral lower quadrant pain, decreased appetite, and low-grade fever for about 48 hours. Which of the following is the most likely diagnosis?

50 year-old women presents with mild, crampy, right lower quadrant pain, decreased appetite, and low-grade fever for about 48 hours. Which of the following is the most likely diagnosis

175. Pain from distended intestines is appreciated in

176. The diagnosis of GERD is typically made by

You are seeing a 75-year-old patient with complaints of heartburn, regurgitation, and belching. You suspect GERD. Which symptom, if present, would necessitate a referral for an upper endoscopy?

A 55-year-old female enters an urgent care center with a complaint of acute abdominal pain. She relates two attacks of less severe abdominal pain within the past 3 months. The pain radiates through to the back opposite the epigastric area and seems to be relieved by leaning forward. Each of the following is true regarding this case excep

A 72-year-old woman is in the surgical intensive care unit after a carotid endarterectomy. She has been taking clindamyein and ciprofl oxacin for the past 13 days. On postoperative day 2 the patient is febrile and tachycardic with a high WBC count and a low RBC count. She is also noted to be dehydrated and hypotensive. On physical examination she is distended and has abdominal tenderness with rebound andguarding. Stool is sent for Gram stain and analysis for fecal leukocytes, fecal occult blood, and Clostridium diffi cile toxin. Which of the following is most likely present in the stool sample? CK-USMLE

A 45-year-old HIV-positive woman comes to her primary care physician complaining of a 2-day history of bloody diarrhea. She states that she has been feeling well until 2 days ago, when she developed abdominal pain. She denies fevers, chills, night sweats, nausea, or vomiting. She admits to feeling tired over the last couple of weeks and has had a 2.3-kg (5-lb) weight loss over the past 2 weeks. Her stool sample shows WBCs and RBCs. Her Gram stain is shown in the image. Her CD4+ cell count is 201/mm³. Which of the following is the most likely cause of this woman’s symptoms? Image courtesy of the Centers for Disease Control and Prevention’s Public Health Image Library.

1. A 63-year-old man with diabetes is called by his primary care physician because of abnormal liver function test results, as follows: Aspartate aminotransferase: 85 U/L, Alanine aminotransferase: 102 U/L, Alkaline phosphatase: 180 U/L, Total bilirubin: 1.9 mg/dL On physical examination his liver is enlarged. His skin has a slightly yellow hue, especially on his face. The review of symptoms is signifi cant for some weight loss, weakness, arthritis in his hands, and inability to achieve an erection. What test would generate the most likely diagnosis

A 41-year-old man presents for evaluation of upper Gl discomfort present over the last 2 months. He says that he has a "full" sensation in the epigastric region. He denies blood in his stool, denies vomiting, and has had no dysphagia. He has lost 10 lb in the last few weeks unintentionally, which he attributes to not eating. His mother has hemorrhoids, and no family member has ever had colon cancer. Which of the following is the most appropriate next step in workup of this patient?

183. Which of the following H pylori eradication therapy regimen is correct: P.249 (Dyspe)

60-year-old man comes with persistent epigastric pain and nausea. Pain began after taking NSAIDs for headache. He took PPI for 2 weeks with mild relief. After stopping PPI pain began again. He has loss of appetite and occasionally nausea. He is a smoker, without other medical problems. Physical examination shows tenderness in epigastric area. Upper endoscopy reveals gastric erythema and a mass in the body of the stomach. Biopsy is competent with low-grade lymphoma from the mucosa associated lymphoid tissue (MALT). Which of the following is most likely involved in the pathogenesis of this condition?

A 62-year-old man presents with dark tarry stools and light-headedness. Upper endoscopy finds an ulcerating lesion in his stomach and biopsies confirm gastric cancer. Which of the following is a risk factor for carcinoma of the stomach?

Which of the following is the most important, productive, and practical reason to offer or refer for upper endoscopy in any patient over 45 years with persistent dyspepsia?

What may be the possible diagnosis for 3-week-old boy with 2 days of projectile nonbilious vomiting and constant feeding

A new mother brings her infant to see you to discuss his vomiting. He is 4 weeks old and is exclusively breast-fed. He vomits with every meal. On examination, his abdomen is distended with normal bowel sounds, and he appears dehydrated. He has lost 4 oz since his visit with you 2 weeks ago. Which of the following is the most likely diagnosis?

. You are caring for a 12-year-old boy with psychiatric and neurologic abnormalities. Laboratory evaluation show high serum and urine copper levels. Eye examination reveals Kayser Fleischer rings. Which of the following is the most likely cause of his condition?

A 15-year-old girl presents with malaise, fatigue, depression, and clinical evidence of hepatitis in the absence of viral causation. An older sister is awaiting liver transplantation. Which of the following blood studies may be most specifically helpful in establishing the diagnosis? NMS

1. You are evaluating a 65-year-old man who complains about arthritis, heart disease, erectile dysfunction. Laboratory evaluation reveals high blood iron transferrin saturation. Which of the following is the most likely cause of her problem? P.

A 45-year-old woman presents with fatigue, anorexia, brown urine, and malaise. She denies alcohol intake entirely, illicit drug use, and history of treatment with blood products, and she is on no medications that may cause elevation of hepatocellular enzymes. Examination reveals scleral icterus and mildly tender hepatomegaly. Both AST and ALT levels are elevated to four times normal, and smooth muscle antibody (SMA) and antinuclear antibody (ANA) levels are positive. She has a history of Hashimoto thyroiditis, but no history suggestive of inflammatory bowel disease. Alkaline phosphatase and gamma-glutamyl transpeptidase are both elevated to twice normal limits. A hepatitis profile yields no evidence of hepatitides A, B, C, or E. Which of the following may be the best initial presumptive diagnosis?

193. Which of the following statements is true about chronic hepatitis B? P.233 (Liver)

A 7 month male infant is brought to his pediatrician's office for a well-child visit. He has a temperature of 37.2°C (99°F) and clear nasal drainage. Physical examination is otherwise unremarkable. The infant is able to lift his head when prone, track past the midline, and coo. His immunization record indicates that he received is first hepatitis B vaccination at birth. Assuming this child is developing normally, which vaccines should this infant receive today?

. A 19-years- old sexually active homosexual man asks you about his risks for viral hepatitis. He is currently asymptomatic and unsure of his immune status. Which of the following should you recommend?

. Which of the following is the best indicator of a high degree of hepatitis B virus (HBV) replication, hence marker of infectivity?

You check serologies on a patient exposed to hepatitis B. His serologies are: HBsAg-Negative, HBeAg-Negative, Anti-HBs- Positive, Anti-Hb core IgGpositive. Which of the following terms best describes his disease status

. You check serologies on a patient exposed to hepatitis B. His serologies are shown below: • HBsAg: Negative • HBeAg: Negative • Anti-HBs: Positive • Anti-HBe: Negative Which of the following terms best describes his disease status?

199. Which of the following forms of hepatitis does NOT have a chronic state?

200. Which of the following is the most easily passed by a blood donor?

The Center for Disease Control and Prevention recommends that the following high-risk individuals should be tested for HCV infection. Which of following are a high risk: P.235

Which of the following is the next most common cause of blood transfusion-related hepatitis after hepatitis B?

A 26-year-old woman presents to your clinic and is interested in getting pregnant. She seeks your advice regarding vaccines she should obtain, and in particular asks about the hepatitis B vaccine. She works as a receptionist for a local business, denies alcohol or illicit drug use, and is in a monogamous relationship. Which of the following is true regarding hepatitis B vaccination?

A patient that you follow has recently started volunteering at a drug treatment hospital and requires hepatitis B vaccination. You find that he is hepatitis B surface antibody positive. Which of the following would be the best guideline to follow in this case?

205. A patient requires hepatitis B vaccination. You find that he is hepatitis B surface antibody positive. Which of the following would be the best guideline to follow in this case

206. Which of the following immunizations should be given in the newborn period? NMS

A 67 year old man comes to the office with 3 month history of fatigue and dyspnea on exertion. She does not take medicines and did not have cardiovascular disorders. Body temperature is normal, BP 160/80mm, pulse 110, respirations-22. Auscultation -2/6 mid-systolic murmur in the second right intercostal space with normal S2 splitting. No peripheral edema is noted. Rectal examination shows guaiac negative stools. ECG-sinus tachycardia. According to laboratory blood tests-Iron deficiency anemia. Which of the following is the most appropriate next step?

.A 35 year-old woman presents to the clinic with 3 days of abdominal discomfort and diarrhea with mucus and blood. She was recently hospitalized and finished a course of antibiotics for pneumonia. Stool sample is positive for WBCs Which of the following is most likely etiologic factor:

9.22-year-old woman comes to the emergency department accompanied by her boyfriend. She is complaining of nausea, vomiting, abdominal pain, and cramping over the past hour. She denies fever, headaches, or watery or bloody stools. She states that she was feeling fi ne until an hour ago, when she began experiencing the onset of her symptoms. She has been on a no-carbohydrate diet for the past 3 weeks. Her last meal was an egg salad for lunch approximately 3 hours ago. She denies any travel in her history. Her physical examination is normal except for mild abdominal tenderness with palpation. Stool testing is guaiac negative and reveals no fecal leukocytes. Which of the following is the most likely pathogen?

An 11-month-old male infant with intermittent bouts of crying and nonbilious vomiting, with a history of Meckel diverticulum. A small, elongated mass is felt on right side of his abdomen. What is the most possible diagnosis for this baby?

A 30-year -old man comes to the office due to low back pain and stiffness for 2 months. His pain is worse in the morning and improves with activity. The patient has also had intermittent diarrhea and lower abdominal pain for the past 3 months. He tried ibuprofen, which helped his back pain, but made his diarrhea worse. He has not travelled abroad. He has no other medical problems. Physical examination shows limited spine flexion and tenderness in the lower back. lab, studies show anemia and thrombocytosis. Stool cultures are negative. Which of the following is the most likely cause of this patient's symptoms?

A 25-year-old woman comes to your office worried that she might have IBS, which she heard about on the news. She reports abdominal pain and diarrhea for 3 months. She also reports observing blood in her stool several times. Her physical examination is normal except for a hemoccult-positive test after a rectal examination. While looking over her records you notice that she has lost 20 lb since she last saw you 3 months ago. Which of the following is an appropriate next step?

A 40-year-old man contracts a bacterial gastroenteritis associated with fever, severe abdominal pain, and profuse diarrhea. The etiologic agent is never determined. Which of the following statements accurately characterizes the complications that may ensue in this patient?

4. A 22 year old man comes in the office with a 5 week history of diarrhea. There is no blood in the stool. He recently returned from Africa, used unboiled water and had had foul smelling stool, abdominal cramps and bloating. Antibiotic treatment did not relieved his symptoms. His medical and family history is nor remarkable. He does not take medicines, illicit drugs and is not a smoker. Body temperature and BP are normal, pulse-86. Physical examination shows soft, non tender abdomen, with increased bowel sounds. Which of the following is the best next step?

215. Which of the following parasite is capable of causing intestinal malabsorption? NMS

A 31 year old man has acute diarrhea after he arrived from south America. The most effective treatment of his diarrhea is

217. The most effective drug for the treatment of traveler's diarrhea is Bratton’s

218. Which of the following about acute bronchitis is correct: P.627

.A 34-year-old man seeks evaluation of a cough. His illness began with a sore throat and nasal congestion 5 days ago. He subsequently developed a cough productive of green sputum and a burning sensation in the retrosternal chest that occurs with coughing spells. He has felt cold at times but denies shaking chills, shortness of breath, and hemoptysis. There is a history of seasonal allergies, but he takes no medications and has no known drug allergies. He is a nonsmoker who typically jogs 3 miles, four times weekly. Pulse oximetry reveals a normal resting oxygen saturation; the patient's temperature is 100.2° F (37.9° C). The chest is clear to percussion, with audible expiratory wheezes. After taking a deep breath, the patient coughs, producing green sputum. A Gram stain of the specimen reveals polymorphonuclear and mononuclear cells without microorganisms. A chest x-ray is normal. Which of the following would be the most appropriate choice for antimicrobial treatment of this patient's condition?

0. A 56-year-old patient who has smoked two packs of cigarettes a day for 40 years presents to your office for a second opinion. His previous physician recently diagnosed him as having chronic bronchitis. The patient reports that no work-up was done, "not even a chest x-ray." The patient asks, "How can my doctor know I have chronic bronchitis without doing any sort of examination or workup?" Which of the following is the most appropriate response to this patient's question?

221. The most common cause of bronchiolitis is P.627

222. Treatment of bronchiolitis should include all of the following except

223. Which of the following statements about influenza is true? Board

224. Which of the following statements about influenza is true?

225. According to the recommendations of the Center for Disease Control and Prevention, all of the following should receive the influenza vaccine except:

226. You are caring for a family and find that the mother would like her children vaccinated against influenza. Her children are aged 5 months, 22 months. Which of the following represents current immunization recommendations for influenza?

You are caring for a family and find that the mother would like her children vaccinated against influenza. Her children are aged 4 months, 24 months, and 5 years. Which of the following represents current immunization recommendations for influenza?

. A 68-year-old patient is seen for a general examination. Current recommendations for immunizations include B

8. Which of the following scenarios is appropriate to allow outpatient treatment for community acquired pneumonia (CAP)?

9.The most common cause of a community-acquired pneumonia in a 45-year-old otherwise healthy man is

A 57-year-old woman with diagnosed chronic obstructive pulmonary disease (COPD) who has smoked 2 packs per day for 40 years has developed fever, headache, purulent cough, and anorexia. She was recently discharged from a hospital, with likely diagnosis of Legionnaires disease in the patient. Which of the following would support the diagnosis of Legionnaires disease in this patient?

. A 53-year-old man with diabetes presents to the emergency department for the evaluation of fever. He was in his usual state of health until 36 hours ago, when he developed fever and fatigue; these symptoms were followed by a productive cough. Over the past few hours, he has developed worsening shortness of breath, cough, and dizziness. He has had diabetes mellitus for many years, and he states that he has not seen a physician in the past 12 months. On physical examination, the patient is tachycardic and tachypnic. His blood pressure is 94/46 mm Hg, he is orthostatic, and his temperature is 102.7° F (39.3° C). Hemoglobin O2 saturation is 88% on room air. The patient has rales and dullness to percussion at the right pulmonary base. Chest x-ray reveals a right lower lobe infiltrate. Laboratory data reveal a leukocytosis with left shift, as well as mild renal insufficiency. Which of the following statements regarding community-acquired pneumonia is true?

To assist in the decision whether to hospitalize a patient with community acquired pneumonia (CAP), each of the following may be a factor in favor of hospitalization EXCEPT for which one?

An acutely ill child presents to the emergency department with the signs and symptoms of acute epiglottitis. The diagnosis should be confirmed with direct visualization of the epiglottis?

234. A 59-year-old man with a known history of COPD presents with worsening dyspnea. On examination, he is febrile. His breath sounds are decreased bilaterally. He is noted to have jugular venous distension (JVD) and 2+ pitting edema of the lower extremities. Which of the following is the most likely cause of his increasing dyspnea?

A 60-year-old man is diagnosed with moderately severe (stage II) COPD. He admits to a long history of cigarette smoking and is still currently smoking in counseling him about the benefits of smoking cessation, which of the following statements is most accurate?

236. A 26-year-old woman presents to your office for the evaluation of fever. She was in her usual state of health until 24 hours ago, when she developed fatigue, myalgias, and severe headache. Her temperature rose to 102° F (38.9° C), and she developed a nonproductive cough and chest tightness. She reports worsening nausea and diarrhea over the same period. She denies having any sick contacts, and she was previously healthy. On physical examination, her temperature is 101.5° F (38.6° C). Bilateral rales with tachycardia are noted. She has no meningismus. Chest x-ray reveals bilateral, patchy air-space and interstitial infiltrates. She is admitted to the hospital for further evaluation and monitoring. Which of the following statements regarding Legionnaires disease is true?

. A 38-year-old woman presents with progressively worsening dyspnea and cough. She has never smoked cigarettes, has no known passive smoke exposure, and does not have any occupational exposure to chemicals. Pulmonary function testing shows obstructive lung disease that does not respond to bronchodilators. Which of the following is the most likely etiology?

You are treating a patient with COPD for an acute exacerbation. Assuming he has no allergies to medications, which of the following is true regarding antibiotic treatment in this case?

Which of the following medications is considered the treatment of choice for Bordetella pertussis infection?

Which of the following is the medication of choice for the treatment of Legionnaire's disease?

A 12 year old male with 4 days of sore throat comes into the office. He has been afebrile, has rhinorrhea, cough and one day of diarrhea associated with his sore throat. The throat is mildly erythematous with otherwise normal appearing tonsils. The best course of action is

242. Which of the following is true P.644

A 41-year-old woman presents to your office for the evaluation of fever. She was in her usual state of health until 7 days ago, when she developed fever and severe right facial pain. Her pain and fever have continued, and she has developed purulent nasal drainage and foul breath odor. She admits that she has suffered from similar symptoms in the past but never this severe. She denies having had any contact with sick persons. Her general state of health has been good, although she has a 30 packyear smoking history. On physical examination, the patient’s temperature is 100.5° F (38° C). Her pain is exacerbated when she leans forward, and there is tenderness to palpation over the right maxillary and right frontal sinuses. Each of these sinuses is opaque on transillumination. The rest of the examination is normal. Which of the following statements regarding acute and chronic sinusitis is true? A

A 36-year-old day care worker presents with generalized malaise and “a cold that won’t go away.” It started a couple of weeks ago with a runny nose and a low-grade fever. She reports that she has now having “coughing fits,” which are sometimes so severe that she vomits. She does not smoke and cannot remember when she last had any immunizations. On examination, you note excessive lacrimation and conjunctival injection. Her lungs are clear. Which one of the following is the most likely diagnosis?

245. Which of the following statements is true regarding pneumococcal vaccination?

246. Which respiration rate indicates that a child might have a pneumonia? (P.645)

A 45-year-old woman presents with persistent nasal congestion, facial pain and cough for the last 10 days. She has been treated with an extended course of nasal decongestants but despit symptoms remain. She is febrile and otherwise looks well. Appropriate management at this time includes

A 62-year-old man with recently diagnosed emphysema presents to your office in November for a routine examination. He has not had any immunizations in more than 10 years. Which of the following immunizations would be the most appropriate for this individual?

. A recently retired 67-year-old woman presents to you to establish care. She was a smoker for a long time, but quit 5 years ago. She is generally healthy, but her prior physician told her that she has “emphysema.” She was prescribed an “inhaler” to use asneeded and only uses it rarely. She asks about necessary immunizations. Her social history indicates that she lives with her daughter and often cares for her infant granddaughter. Her chart indicates that she had a pneumococcal polysaccharide vaccine at age 63 and a Td shot at age 63. Which of the following vaccines should she receive?

250. All of the following is common cause of cough except: P.626

. A 19-year-old male presents with sore throat, fever and cervical lymphadenopathy. A throat culture is done which is positive for group A streptococcus. Treatment is initiated with penicillin. He returns two days later with worsened symptoms, despite taking the medicine. Which of the following is the most appropriate step to do next

Which of the following test may assist the clinician discriminating viral from bacterial pneumonia? P.645

1. Which term is not proper for the family physician:

2. The characteristics of family medicine are all, except:

3. The family physician's role in the health care community is:

According to Georgian legislation in which cases may a family physician withhold information from the patient about his/her health status:

5. In which cases it is not obligatory to obtain an informed consent from a patient?

6. Confidential information could be disclosed by health care professional, if:

Which of the following statements are true according to Georgian Legislation about patient consent?

Is it admissible to attend medical procedures for individuals who do not participate in medical care?

9. In which case will you share information about the patient with your colleague?

10. How do you think, does a patient have a right to get acquainted to medical records?

. An asymptomatic 55 years-old-man comes to you for general checkup. Which of the following preventive tests you should make for this person?

28 years old woman admits for health evaluation. Which preventive actions are shown in this case?

. 34 years old man admits for health evaluation. Which preventive actions are shown in this case?

. You are making the round which is also attended by elementary course students. How would you act when entering the room?

Which of following doesn't belong to CVD risk factors according to JNC-7 and ESH/ESC recommendation?

If blood pressure isn't elevated and patient doesn't have CVD risk factors, how often blood pressure should be re-checked?