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1.You are evaluating a 55-year-old man with hypertension and hyper- lipidemia who complains of unilateral lower extremity It has been present on and off for almost a year. He denies dyspnea or recent trauma, and has no evidence of inflammation. Which of the following would the best treatment option for his condition?
- Elastic stockings
- Sodium restriction
- An angiotensin converting enzyme (ACE) inhibitor
2. You are evaluating a 5-year-old girl brought in by her parents to dis- cuss She was toilet trained in the daytime at the age of 3 years, and was dry at night at about 31/2 years of age. Four months ago, her par- ents had another child, and the 5-year-old began to wet the bed at night. She has no medical condition that would account for the change. What term correctly describes this condition?
- Primary nocturnal enuresis
- Primary diurnal enuresis
- Secondary nocturnal enuresis
- Secondary diurnal enuresis
- Primary intentional enuresis
3. You are seeing a 6-year-old girl whose parents brought her in to have her bedwetting She has been toilet trained during the day since the age of 4, but still wets the bed at night. Her father wet the bed until the age of 8 years. Her physical examination reveals no abnormalities, and her urinalysis is normal. Which of the following statements is true regarding this situation?
- Up to 20% of 6-year-olds are enuretic
- Her father’s history is inconsequential in this situation
- It is unusual for young girls to have a problem with enuresis
- The problem is likely due to her being a deeper sleeper than other children
- There is likely an organic cause to her problem
4. You are counseling a parent whose 7-year-old son wets the bed at Which intervention has proven to be the most effective for this condition?
- Frequent night-time wakening to encourage voiding
- Use of an alarm that wakes the child when he wets at night
- Use of desmopressin (synthetic DDAVP)
- Use of tricyclic antidepressant medications (e.g., imipramine)
- Use of an anticholinergic antispasmodic (e.g., oxybutynin)
5. You are evaluating a 6-year-old His mother has brought him in because he wets the bed. He has never been dry at night, and his parents are starting to get concerned. You obtain a thorough voiding history, and find the child to be completely normal on physical examination. He is otherwise developmentally normal. His urinalysis is also normal. What is the next step in the workup of this patient?
- X-rays of the lumbar and sacral spine
- Renal ultrasound
- Voiding cystourethrogram (VCUG)
- Both renal ultrasound and voiding cystourethrogram
6. One of the children in your practice is troubled by nocturnal enure- He is 7 years old, and has avoided overnight activities with friends. Which of the following is the best initial treatment measure?
- Treatment of constipation
- Motivational therapy with consequences for not maintaining a dry bed
- Desmopressin acetate (DDAVP)
- Imipramine (Tofranil)
- Tolterodine (Detrol)
7. You are discussing enuresis therapy with the mother of an 8-year-old girl that you care She is not interested in pharmacologic therapies, but would like to discuss using a moisture-sensitive alarm. Which of the fol- lowing is true regarding the use of these alarms for nocturnal enuresis?
- The goal of this alarm is to wake the child just after the initiation of urination
- The success rate is greater for boys than for girls
- The success rate is less than 50%
- If the process will be successful, it only takes 3–4 weeks on average
- The alarms are easier for families because the child takes responsibility for the treatment
8. You are seeing a 13-month-old Caucasian His growth chart is shown. His past medical history and physical examination are otherwise unremarkable, and he is meeting his developmental milestones. Which of the following is most likely to reveal the cause of his growth pattern?
- A thorough dietary history
- Serum albumin levels
- Serum prealbumin levels
- Assessment of the thyroid stimulating hormone
- Serum IgA levels
9. You are evaluating a 9-month-old Caucasian girl for poor weight She has gone from the 75th percentile to the 10th percentile in height and weight. She has had recurrent respiratory infections and diarrhea, but cultures obtained have been negative. Which of the following will be the most useful test in this setting?
- A Mantoux test for tuberculosis
- Assessment for human immunodeficiency virus
- Stool for ova and parasites
- A sweat chloride test
- Renal function tests
10. You are seeing a 15-month-old for a well-child His parents have no concerns and his developmental history is normal. His growth chart is shown.
Which of the following is the most likely?
- Familial short stature
- Failure to thrive
- A normal breast-fed infant
- Constitutional growth delay
11. You have been following a 12-month-old At 9 months, his height was at the 25th percentile while his weight was at the 5th percentile. At 12 months, his weight and height are unchanged. His physical exami- nation shows:
Blood pressure: 62/32 (low) Heart rate: 72 beats per minute Respiratory rate: 16 per minute Temperature: 98.8°F
Which is the best therapeutic option for this child?
- Nutritional instruction to take two times the normal caloric intake
- Iron supplementation with increased calorie intake
- Zinc with increased caloric intake
- Referral to social services for neglect
- Hospital admission
12. A 19-year-old presented to your office with a 3-day history of fatigue, sore throat, and low-grade fevers. On examination, his temperature was 3°F, and you noted an exudative pharyngitis with cervical adenopathy. You sent a throat culture and started him on amoxicillin prophylactically. Two days later, he presents for follow up with continued symptoms and a diffuse, symmetrical erythematous maculopapular rash. What is the most likely cause of his symptoms?
- Scarlet fever
- Allergic reaction to amoxicillin
- Viral exanthem
13. A 48-year-old man presents with a history of “feeling tired” for about 6 His previous doctor told him he probably had chronic fatigue syndrome, and he is presenting to you for a second opinion. He reports that his sleep is not refreshing. He has postexertional fatigue, weight loss, and also reports impaired concentration and headaches. Which of those symptoms is less likely to be associated with chronic fatigue syndrome?
- Unrefreshing sleep
- Postexertional fatigue
- Weight loss
- Impaired concentration
14. A 23-year-old woman presents to your office to discuss She describes a “lack of energy” and “tiredness,” denying weakness or hyper- somnolence. What is the next step in the workup?
- Screen for depression
- Screen for sleep apnea
- Screen for anemia
- Screen for hypothyroidism
- Screen for pregnancy
15. You are discussing fatigue with one of your 53-year-old She reports that her symptoms have occurred for the past 6 months, and have been getting progressively worse. She reports increased stress and working longer hours at work, and she is drinking a glass of red wine each evening after work to relax. Which component of her history points to a physical cause of her fatigue?
- Symptoms for 6 months
- Progressively worsening
- Associated with increased stress
- Occurring when working longer hours
- Alcohol overuse
16. You are evaluating a 55-year-old African American man for His history and physical are unremarkable, and your diagnosis is uncer- tain. What should be included in your initial workup?
- Chest x-ray
- HIV test
- Prostate cancer screen
- Drug screen
17. A mother brings her son in to see He is almost 2 years old, and had a significant amount of painless bleeding from his rectum last evening. He is currently hemodynamically stable, and in no distress when you see him. What is the most likely diagnosis?
- Juvenile polyposis
- Anal fissure
- Meckel’s diverticulum
18. A 36-year-old man reports a 1-day history of He is complaining of some mild abdominal pain, but otherwise feels well. He denies alcohol use. On examination, he is tender in the epigastric region without peritoneal signs. His fecal occult blood test is positive, but his stool is not grossly bloody. What is the next step in his workup?
- Gastric lavage
- Barium study
- Red cell scan
19. You are evaluating a 44-year-old man with painless, large volume intestinal You suspect a Meckel’s diverticulum as the possible cause. What is the best test to confirm this diagnosis?
- An esophagogastroduodenoscopy
- A sigmoidoscopy
- A colonoscopy
- A technetium-99m pertechnetate scintigraphic study
- A laparotomy
20. A 56-year-old man is found to have asymptomatic diverticulosis on screening He is concerned about his risk for GI bleeding from the diverticula. Which of the following statements is most accurate regard- ing his concern?
- Severe diverticular bleeding is relatively common, occurring in up to 50% of patients with diverticulosis
- Diverticular bleeding is usually triggered by the ingestion of nuts, berries, seeds, popcorn, or other relatively indigestible material
- Diverticular bleeding resolves spontaneously in the vast majority of cases
- In patients with diverticular bleeding undergoing colonoscopy, blood emanat- ing from a diverticulum is usually seen
- If colonoscopy fails to localize the source of active bleeding, a subtotal colec- tomy is needed to ensure no future bleeding