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1.A 46-year-old man is seeing you for help with smoking In addition to this, he reports having some sexual concerns. He complains of being unable to achieve erection, despite having strong interest in sexual activity. Which of the following is true regarding disorders of this sexual response phase?
- Overcoming this disorder may require more visual stimulation
- Overcoming this disorder may require more emphasis on the relationship
- Overcoming this disorder requires an intact parasympathetic nervous system
- Overcoming this disorder requires an intact sympathetic nervous system
- Overcoming this disorder requires the use of androgens
2. A 36-year-old sees you to discuss a lack of sexual He is not having sexual fantasies and is unmotivated to begin sexual activity. He does not report depressive symptoms and has no other physical complaints. His physical examination is normal. Which of the following laboratory tests is most appropriate?
- Total testosterone
- Free testosterone
- Thyroid stimulating hormone
- Prostate specific antigen
3. You are caring for a 45-year-old man with hypertension, gastroe- sophageal reflux, and His medication list includes hydrochloroth- iazide, verapamil, terazosin, omeprazole, bupropion, and trazodone. He is complaining of ejaculatory dysfunction. Which of the medications is most likely to cause this problem?
4. You have diagnosed a 30-year-old woman with She is concerned that medical treatment may cause sexual dysfunction. Which of the following antidepressants is least likely to cause sexual dysfunction?
5. A 26-year-old newlywed man comes to your office to discuss prema- ture He has had this condition since beginning sexual activity at 17 years old. He has tried behavioral methods, but these have not been successful. Which of the following medications is most likely to help this condition?
6. You are seeing a 61-year-old patient and are concerned about sub- stance He is single, employed as a lawyer in an extremely high stress job. Which of the characteristics listed below are known to increase his risk for a substance use disorder?
- His age
- His marital status
- His job as a lawyer
- His job stress
- His level of education
7. You are evaluating a 31-year-old man who is concerned about He reports depressed mood, increased irritability, anhedonia, and sleep and appetite disturbances for 3–4 weeks. He reports a long his- tory of alcohol use, and is currently drinking 6 drinks a day on the week- days, up to 12 on the weekends. His laboratory results are consistent with alcohol abuse. Which of the following is the most appropriate next step?
- Treat with a selective serotonin reuptake inhibitor
- Treat with bupropion
- Recommend detoxification and abstinence
- Recommend detoxification and abstinence and start a selective serotonin reup- take inhibitor
- Recommend detoxification and abstinence and start bupropion
8. You suspect that a 50-year-old female patient is abusing alcohol. Which of the following is the most sensitive laboratory test to confirm this?
- Mean corpuscular volume (MCV)
- Alanine aminotransferase (ALT)
- Aspartate aminotransferase (AST)
- Gamma-glutamyl transferase (GGT)
- Lactate dehydrogenase (LDH)
9. An alcoholic patient of yours is interested in pharmacologic therapy to help him in his His counselor recommended he try naltrexone, and he asks you how that medication works in alcoholism. Which of the following is the best answer for your patient?
- If the person taking naltrexone ingests alcohol, it causes an adverse reaction
- Naltrexone reduces the reinforcing effects of alcohol
- Naltrexone blocks the effects of alcohol by binding to alcohol receptor sites on cells
- Naltrexone saturates the alcohol receptor sites on cells by acting as an alcohol agonist
- Naltrexone changes the binding sites on alcohol, making it unable to bind to cells
10. An alcoholic patient of yours is interested in pharmacologic therapy to help him in his His counselor recommended he try disulfiram, and he asks you how that medication works in alcoholism. Which of the following is the best answer for your patient?
- If the person taking disulfiram ingests alcohol, it causes an adverse reaction
- Disulfiram reduces the reinforcing effects of alcohol
- Disulfiram blocks the effects of alcohol by binding to alcohol receptor sites on cells
- Disulfiram saturates the alcohol receptor sites on cells by acting as an alcohol agonist
- Disulfiram changes the binding sites on alcohol, making it unable to bind to cells
11. A 33-year-old male patient is seeing you for advice on how to quit He has tried many times in the past and has been unsuccessful. Which of the following symptoms characterize the nicotine withdrawal syndrome?
- Depressed mood
- Psychomotor retardation
- Amotivational syndrome
12. A 25-year-old woman is trying to stop She has difficulty with sudden cravings for nicotine and wonders which nicotine replace- ment system offers the fastest delivery of nicotine. Which of the following methods of nicotine replacement delivers nicotine fastest?
- Nicotine gum
- Nicotine lozenges
- Transdermal nicotine patch
- Nicotine nasal spray
- Nicotine inhaler
13. One of your patients has tested positive for cocaine Upon ques- tioning, he says he would like to quit, but has a difficult time with cocaine withdrawal. Which of the following symptoms is expected from cocaine withdrawal?
14. You are caring for a 35-year-old man in the hospital, admitted with On day 2 of his hospitalization, he becomes diaphoretic, rest- less, and irritable. Within hours, he is complaining of severe pain, abdom- inal cramps, and diarrhea. Which of the following would likely be present in his urine toxicology screen?
- 3,4-Methylenedioxymethampheatmine (MDMA or ecstasy)
15. A 64-year-old woman comes to see you as a new She is inter- ested in finding the cause of her hand deformities. Upon inspection, you see the joints in her hands are nodular and enlarged as in the picture below:
(Reproduced, with permission, from South-Paul J. Current Diagnosis & Treatment in Family Medicine, 1st ed. New York: McGraw-Hill, 2004:266.)
Which of the following laboratory findings is likely in her case?
- Her laboratory evaluation will likely be normal
- Her serum uric acid level will likely be elevated
- Her sedimentation rate will likely be elevated
- Her c-reactive protein level will likely be elevated
- Her rheumatoid factor will likely be elevated
16. You are evaluating a 62-year-old man who is complaining of joint His pain involves his left knee, right ankle, and both hands. He reports that his symptoms have been present for years, but are worsening. He has more pain with activity. On examination, you note some swelling in the joints with mild tenderness and crepitus. What is the likely cause of his symptoms?
- Rheumatoid arthritis
17. A 43-year-old obese patient comes to your office with a painful, inflamed, swollen He reports that the pain began suddenly last evening, without a known precipitant or trauma. The pain is exquisite, and does not allow him to move his elbow at all—in fact, even the pressure of his bed sheet on his elbow was painful. On examination, he has an elbow effusion with warmth, erythema, and intense pain with movement. Which of the following is most likely the cause?
- Rheumatoid arthritis
- A stress fracture
18. You are caring for a 31-year-old woman who complains of joint She notes that her hands seem to be stiff in the morning, and that she seems to improve with time, movement, and heat. She reports more fatigue than usual as well. On examination, her wrists are swollen bilaterally, as are sev- eral of her metacarpal-phalangeal joints on each hand. Which of the follow- ing is her most likely diagnosis?
- Rheumatoid arthritis
19. A 70-year-old man with diabetes and long-term osteoarthritis in his knees is presenting for follow He reports that his pain has become much more severe, and says he is having difficulty with ambulation and actually becoming fairly inactive. In the past, he tried ibuprofen and naproxen, but those offered limited improvement and he developed secondary ulcers. He says that taking acetaminophen is like “taking a sugar pill”—and says it offers no help. He had some relief from steroid injections 3 months ago, and again 1 month ago, but they were short-lived. A recent x-ray is shown below:
Which of the following is the next most appropriate step in the treatment of his condition?
- Use oral steroids
- Try another steroid injection
- Inject the knee joint with ketorolac (Toradol)
- Inject hyaluronic acid into his knee joints
- Refer for knee replacements
(Reproduced, with permission, from South-Paul J. Current Diagnosis & Treatment in Family Medicine, 1st ed. New York: McGraw-Hill, 2004:267)
20. You are seeing a 43-year-old man who complains of recurrent flares of He notes that he gets “attacks” after drinking alcohol and asks why. Which of the following is the best response?
- Alcohol causes the release of uric acid from the liver
- Alcohol itself increases crystal formation in the joint
- Alcohol alters renal excretion of uric acid
- Alcohol contains relatively large quantities of uric acid
- Alcohol contains sulfites that metabolize into uric acid after absorption in the gut