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1.You are evaluating a 33-year-old man with rectal pain and He reports that he initially felt a mass near his rectum several days ago. It was associated with some bright red blood on the toilet paper when he wiped after a bowel movement. The area became acutely painful over the last 24 hours. On examination, you note an exquisitely tender, purple nodule distal to the dentate line. What is the office-based treatment of choice for his condition?
- Hydrocortisone suppositories
- Rubber band ligation
- Incision and drainage
2. You are evaluating a patient in the office with He has had chronic constipation, and reports bright red blood from his rectum associated with extremely painful bowel movements. After defecation, he complains of a dull ache and a feeling of “spasm” in the anal canal. The pain resolves within a few hours. On external examination, no abnormali- ties are noted. What is his most likely diagnosis?
- Anal fissure
- Thrombosed external hemorrhoid
- Internal hemorrhoid
- Thrombosed internal hemorrhoid
- Peri-anal abscess
3. A 23-year-old woman presents to your office complaining of Which of the following characteristics is more likely to be associated with migraine headaches than other types of headaches?
- Unilateral symptoms
- Severe in intensity
4. You are evaluating a patient with a Of the following, which is the most important in characterizing the type of headache the patient is experiencing?
- Physical examination
- Blood work
- Consultation with neurology
5. You are talking with a 24-year-old woman complaining of a She reports that before she has the headache, she experiences visual symp- toms associated with slight nausea. When the headache occurs later, it is throbbing, pulsating, and unilateral. During the headache, she experiences light sensitivity. Sleep improves the symptoms. Her symptoms are disrupt- ing her daily life, and you decide to try prophylactic therapy. Which of the following is the most studied prophylactic agent to use?
- Calcium channel blockers
- Selective serotonin reuptake inhibitors
6. One of your patients has been on beta-blocker therapy for migraine prophylaxis. Her symptoms are not optimally controlled, and she is inter- ested in other What agent, when added to the beta-blocker, has a synergistic effect in the prophylaxis of migraines?
- Calcium channel blockers
- Tricyclic antidepressants
- Selective serotonin reuptake inihibitors
7. You are caring for a 33-year-old migraine He is currently complaining of an acute migraine attack, and is interested in abortive ther- apy. Which of the following options is least likely to be effective?
- 5-HT agonists
8. You are discussing migraine management with a 30-year-old She wants to use prophylactic medications, but had debilitating fatigue and symptoms of depression on beta-blockers. Which of the following medica- tions is an acceptable alternative?
9. A 41-year-old man comes to the office to discuss his headache symp- toms. He first began having symptoms a couple of years He describes the headaches dramatically—“like an ice pick is going through my eye!”— and describes it as the worst pain in his life. The headaches begin suddenly, are unilateral, last up to 2 hours, and are associated with runny nose and watery eye. He gets several attacks over a couple of months, but is symp- tom free for months in-between flare ups. What is the best approach for long term management of the attacks?
- Fluoxetine, 20–60 mg daily
- Prednisone, 10 mg daily
- Indomethacin, 120 mg daily
- Nifedipine, 40–120 mg daily during the symptomatic period
- Ergotamine, 1–2 mg daily during the symptomatic period
10. A 40-year-old man transfers to your office from out of state after moving to your He suffers from cluster headaches, and would like a medication to manage the acutely painful episodes. Which of the fol- lowing would be best for treatment of the acute episodes?
- Indomethacin, 120 mg by mouth
- Oxycodone, 5–10 mg by mouth
- Sumatriptan, 50–100 mg by mouth
- Ergotamine, 1–2 mg by mouth
- 4% lidocaine, 1 mL administered into the nostril
11. You are talking with a 33-year-old woman who is complaining of She has had these headaches for 5 months, and they are increas- ing in frequency. She reports that the headaches may last anywhere from an hour to several days. They are now occurring about 5–10 times a month, without relationship to her menstrual cycle. She describes the headache as bilateral, and the pain is described as a pressure around her forehead. She denies nausea, is not sensitive to sound, but is sensitive to light during an attack. On examination, she has no obvious neurological deficit. What is the best approach to take at this point?
- Prescribe narcotic analgesics and follow up if no improvement
- Prescribe NSAIDs and follow up if no improvement
- Order blood work to rule out secondary cause
- Order a CT of the brain
- Order an MRI of the brain
12. You are evaluating a 48-year-old woman with She reports a long history of occasional sinus headaches, usually responding to over- the-counter treatment. Over the last several months, the headaches are occurring more frequently, and are actually more painful than they have been in the past. Over-the-counter medications, effective in the past, no longer work. What is the most appropriate next step?
- Use antibiotics to treat sinusitis and follow up if no improvement
- Use prescription antihistamines and follow up if no improvement
- Use prescription decongestants and follow up if no improvement
- Use NSAIDs and follow up if no improvement
- Obtain radiological imaging of the brain
13. You are taking care of a 36-year-old woman with mild hypertension, arthritis, and She also has been taking daily oral penicillin for a streptococcal throat infection. She notes the acute onset of hematuria, and comes to your office for evaluation. Which of the following medica- tions is most likely to cause this symptom?
- Oral contraceptives
14. A 16-year-old sexually active woman comes to your office complain- ing of blood in her She reports suprapubic pain, dysuria, and fre- quency. What is the likely diagnosis?
- Bladder cancer
- A sexually transmitted infection
15. You are evaluating a 56-year-old generally healthy man who is seeing you after finding blood in his He denies pain, dysuria, frequency, or urgency. He is a smoker, and has worked for years in the printing industry. What is the most likely cause of his hematuria?
- Acute prostatitis
- Chronic prostatitis
- A UTI
- Urinary stones
- Bladder carcinoma
16. A 16-year-old girl comes to your office complaining of blood in her She is asymptomatic, and not menstruating. Urinalysis reveals grossly pink urine, but urine dipstick is negative for blood. Which of the following foods is the likely cause?
17. A 65-year-old African American man is seeing you because he has had blood in his urine for 1 On further questioning, you find that the blood appears at the end of micturition, and is not associated with pain, frequency, urgency, or other symptoms. Of the following, which is the most likely cause of his hematuria?
- Urethral cancer
- Renal cancer
- Prostate cancer
- Urethral trauma
18. You are seeing a 14-year-old boy who reports seeing blood in his He is currently asymptomatic. On urinalysis, he has more than 10 red blood cells per high-powered field, he has red cell casts, and his creatitine is 2.3 (H). What is the next step in the evaluation?
- Intravenous pyelography
- Renal ultrasound
- Noncontrast helical CT
- Antistreptolysin O titer
19. You are evaluating a 35-year-old man with His urinalysis does not reveal casts or protein, but does show moderate blood. His urine culture is negative, as is his intravenous pyelogram, and he has a normal creatinine. Which of the following is most appropriate in this case?
- Reassurance and periodic monitoring
- Renal ultrasound
- ASO titer
- Renal biopsy
20. A daycare worker presents to your office after turning “yellow.” She reports feeling feverish and fatigued, and describes right upper quadrant abdominal pain and On examination, her skin tone, conjunctivae, and mucous membranes are yellow-tinged. Serologies indicate acute hepatitis A infection. Which of the following is true about this infection?
- She is most infectious while she is jaundiced
- Fecal shedding of the virus continues until liver enzymes have normalized
- Complete recovery is the norm
- Relapses are common
- This infection can lead to chronic infection