PACKRAT Family Med Review Questions and Answers Graded A+

What test is the single most useful test in establishing the diagnosis of multiple sclerosis? - ANSWER MRI On physical examination you note diminished breath sounds over the right lower lobe with decreased tactile fremitus and dullness to percussion. Which of the following is the most likely cause? - ANSWER Pleural Effusion A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive range of motion of the toes the patient "yells" in agony. The patient also states that the top of his foot has decreased sensation. On physical examination the physician assistant notes that the leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing should be done? - ANSWER Compartment Pressure The initial sign or symptom of iron poisoning in a 3 year-old child is usually... - ANSWER Vomiting and Bloody diarrhea A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The next step in the evaluation is... - ANSWER Fine-Needle Biopsy On examination of a pregnant patient the physician assistant notes the fundal height is at the level of the umbilicus. This corresponds to what gestational age? - ANSWER 20 weeks Cardiac nuclear scanning is done to detect... - ANSWER Ventricular Wall Dysfunction A classic skin finding seen in patients with inflammatory bowel disease would be... - ANSWER Poorly healing, indolent ulcers on lower extremities A patient with a 15-year history of type 2 diabetic mellitus presents for follow-up. Labs reveal a BUN 100 mg/dl, serum creatinine 9.2 mg/dl, and serum glucose 164 mg/dl. Which of the following would you expect to find on physical examination? - ANSWER Pruritus A 32 year-old carpenter complains of right eye irritation all day after driving a metal stake into the ground with his hammer. He states that "something flew into my eye." Visual acuity is 20/20. Pupils are equal, round, reactive to light and accommodation. Extraocular movements are intact. There is minimal right corneal injection. No foreign body is noted with lid eversion. Fluorescein stain reveals a tiny pinpoint uptake in the area of the corneal injection. Which of the following is the most appropriate diagnostic test at this stage? - ANSWER X-ray orbits A 45 year-old male complains of loss of hearing in his left ear. He also complains of ringing in the ear, and has had occasional dizziness. On exam, there is unilateral leftsided sensorineural hearing loss and a diminished corneal reflex. Neuro exam is otherwise normal. TMs are normal, and canals are clear. Neck is supple, without adenopathy. Oropharynx is normal. Of the following, the best diagnostic study to identify the cause of this patient's complaints is... - ANSWER Gadolinium-Enhanced MRI looking for acoustic neuromas A 64 year-old patient with known history of type 1 diabetes mellitus for 50 years has developed pain radiating from the right buttock to the calf. Patient states that the pain is made worse with walking and climbing stairs. Based upon this history which of the following would be the most appropriate test to order? - ANSWER Arterial Duplex Scanning looking at arterial perfusion A 73 year-old male presents to the clinic with his wife. His wife has noticed that he has developed a resting tremor in his right hand and a shuffling gait over the last year. What finding on physical examination would support your suspected diagnosis? - ANSWER Masked Facies (thinking Parkinson's) Primary biliary cirrhosis will have which of the following laboratory results? - ANSWER Antimitochondiral antibodies Which of the following historical factors differentiates post-traumatic stress disorder from acute stress disorder? - ANSWER A belief that their future has been foreshortened because of the event A 22 year-old male presents to the clinic complaining of excessive daytime somnolence and strong desires to sleep at inappropriate times. He came in today because he had an episode of "feeling paralyzed" as he was falling asleep yesterday. What is the most appropriate diagnostic test to confirm this patient's diagnosis? - ANSWER Multiple sleep latency test (trying to Dx narcolepsy) A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial tamponade is strongly supported by the presence of... - ANSWER Distended neck veins Young athlete presents w/ high pitched mid-systolic murmur heard best @ LLSB increasing w/ valsalva or standing and decreasing w/ squatting. Dx and Tx? - ANSWER Hypertrophic cardiomyopathy (HOCM). Refrain from vigorous physical activity. Beta blockers or CCBs. Surgical or alcohol ablation of hypertrophied septum and defibrillator insertion. Other than the classic murmur, other Sx of HOCM: - ANSWER Sustained PMI, bifid pulse, S4 gallop CHADS2 Score: - ANSWER Determining need for anticoagulation to prevent stroke. CHF, HTN, Age 75, DM all 1 point. Stroke Hx is 2 points. Results: 2 or more points -- hepatin to coumadin bridge (INR of 2-3) 1 point -- ASA or coumadin 0 points -- no therapy or ASA Sawtooth pattern on EKG: - ANSWER Atrial Flutter PR interval 0.2 seconds: - ANSWER 1st degree AV block PR interval gets longer, longer, then dropped beat. - ANSWER 2nd degree Type 1 AV block (Wenckebach) PR interval stays the same, then dropped beat - ANSWER 2nd Degree Type 2 AV block (Mobitz) Complete disagreement of P waves and QRS complexes - ANSWER 3rd degree AV block