[MCQs] The Quizzes about Chronic Conditions – Part 2 (20 test)

I. Start the exam by click the “Start” button

Chronic Conditions-2

Start

Congratulations - you have completed Chronic Conditions-2. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

A 66-year-old diabetic man comes to your office with acute monoar- ticular You suspect gout. Which of the following tests is the most helpful in establishing the diagnosis?

A	Sedimentation rate
B	C-reactive protein
C	Serum uric acid levels
D	Evaluation of joint aspirate
E	Twenty-four hour urine collection to measure uric acid excretion

Question 1 Explanation: 

An evaluation of the joint aspirate is strongly recommended to establish the diagnosis of gout. It is critical to differentiate gout from infectious arthritis which is a medical emergency, and a joint aspirate will do this rapidly and accurately. The sedimentation rates and c-reactive protein are both nonspecific. Serum uric acid levels can be normal or high in the setting of acute gout. A 24-hour urine collection may help determine the most effective treatment for gout, but is not needed for diagnosis.

Question 2

You are evaluating a patient with knee swelling and You per- form an arthrocentesis to help determine the diagnosis. The fluid analysis reveals rhomboid-shaped positive birefringent crystals. Which of the fol- lowing is the likely diagnosis?

A	Gout
B	Pseudogout
C	Infectious arthritis
D	Osteoarthritis
E	Rheumatoid arthritis

Question 2 Explanation: 

The crystals typical of gout are needle-shaped and have negative birefringement. The crystals of pseudogout are rhomboid-shaped and demonstrate positive birefringement. Infectious arthritis, osteoarthritis and rheumatoid arthritis would not present with crystals in the joint aspirate.

Question 3

You are evaluating a patient with a painful, swollen You per- form arthrocentesis to find cloudy fluid. Analysis reveals a white blood cell count of 50,000 with more than 90% identified as polymorphonuclear leukocytes. The glucose level in the joint fluid is decreased. Which of the following is the most likely diagnosis?  

A	Gout
B	Pseudogout
C	Infectious arthritis
D	Osteoarthritis
E	Rheumatoid arthritis

Question 3 Explanation: 

Infectious arthritis, gout and pseudogout may all be associated with cloudy joint aspirate fluid. The aspirate fluid obtained from a gout or pseudogout flare may also have a white blood cell count of 50,000 with a high proportion of polymorphonuclear leukocytes. However, glucose levels fluid aspirated from a knee with gout or pseudogout would be normal.

Question 4

You are evaluating a patient with a painful, swollen Joint aspi- rate reveals clear fluid with a white blood cell count of 5000, 20% of which are polymorphonuclear leukocytes. Which of the following is the most likely diagnosis?

A	Gout
B	Pseudogout
C	Infectious arthritis
D	Osteoarthritis
E	Rheumatoid arthritis

Question 4 Explanation: 

Fluid aspirated from an osteoarthritic knee is characterized by generally clear joint fluid with a white blood cell count of 2–10,000. The distinguishing factor is the polymorphonuclear leukocytes. In rheumatoid arthritis, more than 50% of the WBCs are PMNs, while in osteoarthritis, less than 50% of the WBCs are PMNs.

Question 5

The joint aspirate from the inflamed first metatarsal phalangeal joint of a 35-year-old woman reveals needle-shaped nonbirefringent crystals. Which of the following is the most appropriate initial treatment?

A	Colchicine
B	Corticosteroids
C	Opiates
D	Allopurinol
E	Probenecid

Question 5 Explanation: 

While a short course of nonsteroidal anti-inflammatory medication is one standard therapy for gout, another is a course of colchicine. Colchicine is given orally, one tablet every 1–2 hours until pain is controlled or side effects limit its use (the usual side effect is diarrhea). Most attacks respond to the first two or three pills, and the maximum number used in a 24 hour period is 6. Corticosteroids can provide quick relief, but should be reserved if initial therapy fails. Opiates may control pain, but will not lead to resolution of the inflammation. Allopurinol and probenecid are effective treatments for prevention, but should be used cautiously, as they can precpitiate a flare

Question 6

You are following a 52-year-old woman with stiff, swollen Her left hand is shown below:

(Reproduced, with permission, from South-Paul J. Current Diagnosis & Treatment in Family Medicine, 1st ed. New York: McGraw-Hill, 2004:276.)

Her right hand is similar. She describes prolonged morning symptoms, and excessive fatigu. Based on this information, which of the following is the most likely diagnosis?

A	Osteoarthritis
B	Gout
C	Tophaceous gout
D	Rheumatoid arthritis
E	Systemic lupus erythematosis

Question 6 Explanation: 

Swelling of the proximal interphalangeal joints (shown here in the second and third fingers) is typical of rheumatoid arthritis. Symmetrical swelling is almost unique to rheumatoid arthritis, and even lupus, often confused with RA in the early stages, is rarely as consistently symmetrical. Fatigue is often out of proportion to the lack of sleep, and the prolonged morning stiffness in the history is essential to diag

Question 7

You are caring for a 45-year-old woman who was diagnosed with rheumatoid arthritis 6 years Which of the following signs or symptoms, if present, would signal extra-articular manifestations of her condition?

A	Cough
B	Palpitations
C	Gastrointestinal distress
D	Peripheral neuropathy
E	Elevated creatinine

Question 7 Explanation: 

Extra-articular manifestations of RA can be seen at any stage of the disease. Most common are rheumatoid nodules that can occur anywhere on the body, but usually subcutaneously along pressure points. Vasculitis, dry eyes, dyspnea, or cough can all be seen. Cough and dyspnea may signal respiratory interstitial disease. Cardiac, GI, and renal systems are rarely involved. When a neuropathy is present, it is generally because of a compression syndrome, not as an extra-articular manifestation of the disease.

Question 8

You have recently determined that a patient in your office has rheuma- toid Which of the following is the most appropriate next step?

A	Control symptoms with nonsteroidal anti-inflammatory medications
B	Control symptoms with opiates
C	Use steroid treatment for flares, and nonsteroidal anti-inflammatory medica- tions for daily use
D	Use steroid injections to keep flares under control
E	Refer to rheumatology

Question 8 Explanation: 

In the past, most people treated the symptoms of RA with nonsteroidals until that was ineffective, then referred to rheumatology. Unfortunately, these agents did nothing to slow the progression of disease. The most important advancement in the treatment of rheumatoid arthritis has been the introduction of diseasemodifying antirheumatic drugs (DMARDs). These agents not only control patient symptoms but suppress the underlying factors that result in synovitis, tissue reactivity, erosions, subluxations, and other complications. These should be managed by rheumatologists and started early to avoid or delay joint deformity

Question 9

You are caring for a 35-year-old man with a long history of allergies and His asthma has been in good control, but his blood pressure has been elevated on more than two occasions despite weight loss, exercise and appropriate dietary intervention. Which of the following blood pres- sure medications should be avoided in this case?

A	Hydrochlorothiazide
B	Lisinopril (Zestril, Prinivil)
C	Nifedipine (Procardia)
D	Propranolol (Inderal)
E	Losartin (Cozaar)

Question 9 Explanation: 

Propranolol is a nonselective beta-blocker. They are contraindicated in asthma because they can trigger severe bronchospasm. The other choices would be appropriate in the right circumstances.

Question 10

You have recently diagnosed a 24-year-old man with You are discussing environmental measures he should take to control his symp- toms and avoid triggers. Which of the following is the most appropriate advice?

A	Keep humidity in the home relatively high, above 50%
B	Enclose his mattress and pillows with allergen impermeable covers
C	Launder bed linens with cold water
D	Install carpeting if possible
E	Use air filters to decrease the levels of dust mite allergens

Question 10 Explanation: 

Environmental measures can be an important component of asthma control. They include keeping humidity in the home relatively low, under 50%, enclosing the mattress, box spring and pillows with allergen impermeable covers (they can be dust reservoirs), laundering bed linens with hot water, and removing carpeting whenever possible. Air filters have not been shown to affect reservoir levels of house dust mite allergens.

Question 11

You are seeing a 19-year-old college student complaining of recur- rent and persistent cough. She has been treated for “bronchitis” several times, and you are concerned that her true diagnosis is asthma. Which of the following is most important in the diagnosis of asthma?

A	History
B	Allergy testing
C	Chest x-ray
D	Pulmonary function tests with and without bronchodilator therapy
E	Provocative testing with methocholine

Question 11 Explanation: 

The most important component in the diagnosis of asthma is history. Patients with asthma typically have recurrent episodes of wheezing, but not all asthma includes wheezing, and not all wheezing is asthma. Cough is the only symptom in coughvariant asthma. Allergy testing may help to identify specific allergens, but is not useful in diagnosing asthma. A chest x-ray is useful to rule-out other causes of cough or wheezing, but is not needed to diagnose asthma. Pulmonary function testing is usually confirmatory, not diagnostic. Provocative testing is indicated for the rare patient in whom the diagnosis is in question, but should be used cautiously, as life-threatening bronchospasm may occur.

Question 12

You are caring for a 30-year-old woman who has had asthma since Currently, she reports symptoms three or four times a week, but never more than once a day. Sometimes her symptoms cause her to skip her usual exercise regimen. She wakes in the night approximately three or four times a month to use her inhaler and return to bed. Which of the following classifications best characterizes her asthma?

A	Mild intermittent
B	Moderate intermittent
C	Mild persistent
D	Moderate persistent
E	Severe persistent

Question 12 Explanation: 

Asthma is classified by its severity, assessing daytime and nighttime symptoms. Patients with symptoms less than twice a week, with brief exacerbations, and with nighttime symptoms less than twice a month are classified as having “mild intermittent” asthma. There is no “moderate intermittent” classification. The “mild persistent” classification refers to symptoms more than twice a week but less than once a day, with symptoms that sometimes affect usual activity. Nighttime symptoms occur more than twice a month. The “moderate persistent” classification is characterized by daily symptoms and use of short-acting inhaler, with exacerbations that affect activity and may last for days. Nighttime symptoms occur at least weekly. “Severe persistent” asthma is characterized by continual symptoms that limit physical activities, with frequent exacerbations and nighttime symptoms.

Question 13

You are caring for an 18-year-old man with He smokes, and reports needing to use his short-acting bronchodilator daily. He gets flares of asthma at least twice a week, and while some days are relatively symp- tom free, some exacerbations may last several days. He wakes up at least once a week with symptoms. Which of the following classifications best characterizes his asthma?

A	Mild intermittent
B	Moderate intermittent
C	Mild persistent
D	Moderate persistent
E	Severe persistent

Question 13 Explanation: 

The patient described in this question fits the “moderate persistent” classification, characterized by daily symptoms and use of short-acting inhaler, with exacerbations that affect activity and may last for days. Nighttime symptoms occur at least weekly

Question 14

You are discussing asthma control with a 22-year-old patient. She monitors her therapy closely, and reports that her current peak flows are at about 80% of her best Which of the following is the best approach to take at this point?

A	Commend the patient on her diligent monitoring and excellent control
B	Reassure the patient that this is well within the normal range
C	Review the patient’s medications and technique and review environmental control
D	Have the patient take additional medication, or add a medication to her regimen
E	Consider hospitalization

Question 14 Explanation: 

Peak flow measurements parallel the forced expiratory volume in 1 second (FEV1), and are an easy and inexpensive way to monitor asthma control. The peak flow “zone system” allows patients’ to monitor their control and participate in the clinical decision-making around their illness. Measurements between 80–100% of the patient’s personal best are in the “green zone,” and indicate that the patient is doing well. Measurements between 50–80% of the personal best are in the “yellow zone,” and are a warning to consider a step up in therapy (review of medication technique, adherence, and environmental control, or use additional medication). Measurements below 50% of the personal best are an indicator that the patient needs immediate medical attention.

Question 15

You are caring for a young woman who has had mild intermittent asthma for She uses a short-acting bronchodilator as needed, but in the past has only needed therapy once or twice a month. Over the past 2 months, she has noted that she is using her inhaler more. In fact, she uses it at least three times a week, and on occasion has had to wake up in the middle of the night to use her inhaler. Of the following, which is the most appropriate treatment option at this point?

A	Change her short-acting beta-agonist from albuterol (Proventil, Ventolin) to pir- buterol (Maxair)
B	Add a long-acting beta-agonist
C	Add an inhaled corticosteroid
D	Add a leukotriene receptor antagonist
E	Add cromolyn (Intal)

Question 15 Explanation: 

Inhaled corticosteroids are the mainstay of long-term asthma treatment, and act at numerous sites in the inflammatory cascade. They should be prescribed for all patients with all but very mild asthma. Changing short-acting agents would not likely be beneficial. Long-acting beta-agonists do not impact airway inflammation and should not be used without a corticosteroid. A leukotriene receptor antagonist is an option, but is generally thought of as a “second best” choice. Inhaled corticosteroids and leukotriene antagonists have replaced cromolyn in current asthma therapy.

Question 16

You are caring for a man with He is currently taking an inhaled corticosteroid twice daily and using his short acting beta agonist as needed. Over the past 3 months, he has required escalating doses of his inhaled corticosteroid, and now he is at the maximum dosage, still using his “rescue” inhaler more than he would like. Of the following, which is the best medication to add to his regimen?

A	A burst and rapid taper of oral steroids
B	A long-acting beta-agonist
C	Cromolyn (Intal)
D	Ipratropium (Atrovent)
E	Theophylline

Question 16 Explanation: 

The patient described in this question has worsening asthma symptoms and needs additional therapy. Long-acting beta-agonists are considered the most appropriate medication in this case, and are often packaged with an inhaled corticosteroid for ease of use. A leukotriene receptor antagonist would also be appropriate. A burst and taper of oral steroids may be appropriate for an acute flare, but not in this case. Cromolyn has associated compliance issues as it is dosed four times a day. Atrovent is usually not used unless there is a component of COPD, and theophylline, though an appropriate “third line” agent, is not more effective than a long-acting beta agonist.

Question 17

You are caring for a 25-year-old woman who has had mild intermit- tent asthma since she was a She uses a short acting bronchodilator as needed. Over the past 5 weeks, she has been using her inhaler up to four times a week, and has had to wake up in the middle of the night to use her inhaler twice. She tried inhaled corticosteroids, but was intolerant of the side effects. Of the following, which is the most appropriate treatment option for her?

A	A long-acting beta-agonist
B	A leukotriene receptor antagonist
C	Cromolyn (Intal)
D	Theophylline
E	Oral corticosteroids

Question 17 Explanation: 

Long-acting beta-agonists are less effective if not paired with inhaled corticosteroids. A leukotriene receptor antagonist is a better choice in this case. Cromolyn therapy has been replaced by newer agents, mainly because of compliance issues. Theophylline and oral steroids would not be indicated in this case.

Question 18

341. A 22-year-old man is seeing you to discuss his low back He is athletic and exercises regularly. He denies any inciting event, does not have pain with movement, and denies radiation of the pain. Given this informa- tion, what is the most likely diagnosis?

A	Spondylolisthesis
B	Low back strain
C	Degenerative osteoarthritis
D	Lumbar disk herniation
E	Neoplasm

Question 18 Explanation: 

Spondylolisthesis is the most common cause of low back pain in patients younger than age 26, especially athletes. Back strain is also a common diagnosis, but would generally follow an inciting event, and pain would be associated with movement. The patient is likely too young for osteoarthritis to be a consideration, and a lumbar disk herniation can occur at any age, but is less likely to be the diagnosis in this case. Neoplasm is a rare cause of low back pain.

Question 19

You are performing a preparticipation physical examination on a 14-year-old girl interested in playing You note asymptomatic sco- liosis. You obtain x-rays that reveal a 15% thoracic curve to the right. Which of the following is the most appropriate next step?

A	Referral to orthopedic specialist
B	Refer for a thoracic back brace
C	Reassure, and reexamine the patient yearly
D	Obtain repeat x-rays every 6 months
E	Obtain an MRI (magnetic resonance imaging)

Question 19 Explanation: 

Scoliosis is a common finding, especially in young females. The initial evaluation of an adolescent found to have scoliosis should focus on the severity of the curvature noted on x-ray. Adolescents with curvatures of less than 20° and no evidence of an underlying etiology can safely be followed with x-rays every 6 months to evaluate progression. Those with angles greater than 20° should be referred to an orthopedic specialist. Bracing has been shown to halt the progression of less severe curves, but would not be indicated unless progression is observed. Since 90% of thoracic curves are to the right, a left thoracic curve should be evaluated with an MRI.

Question 20

You are seeing a 44-year-old woman who is complaining of low back pain. She reports that her symptoms began several months ago, and started The pain is worse in the morning, and is associated with stiffness. It gets better throughout the day and with activity. She denies radiation or neurological symptoms. Which of the following is the most likely cause?

A	Back strain
B	An inflammatory condition
C	Disk herniation
D	Compression fracture
E	Neoplasm

Question 20 Explanation: 

Back pain caused by an inflammatory condition (rheumatoid arthritis, ankylosing spondylitis, Reiter’s syndrome) are rare, but have characteristics that are helpful in differentiating them from other causes of pain. Inflammatory conditions generally produce greater pain and stiffness in the morning, while mechanical disorders tend to worsen throughout the day with activity. A disk herniation might be associated with radiation and neurological symptoms. A compression fracture would begin suddenly, and a neoplasm is unlikely to get better throughout the day

Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results

There are 20 questions to complete.

←

List

→

Return

Shaded items are complete.

1	2	3	4	5
6	7	8	9	10
11	12	13	14	15
16	17	18	19	20
End

Return

You have completed

questions

question

Your score is

Correct

Wrong

Partial-Credit

You have not finished your quiz. If you leave this page, your progress will be lost.

Correct Answer

You Selected

Not Attempted

Final Score on Quiz

Attempted Questions Correct

Attempted Questions Wrong

Questions Not Attempted

Total Questions on Quiz

Question Details

Results

Date

Score

Hint

Time allowed

minutes

seconds

Time used

Answer Choice(s) Selected

Question Text

All done

Need more practice!

Keep trying!

Not bad!

Good work!

Perfect!

Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 |

II. Preview all questions below

1.A 66-year-old diabetic man comes to your office with acute monoar- ticular You suspect gout. Which of the following tests is the most helpful in establishing the diagnosis?

1. Sedimentation rate
2. C-reactive protein
3. Serum uric acid levels
4. Evaluation of joint aspirate
5. Twenty-four hour urine collection to measure uric acid excretion

2. You are evaluating a patient with knee swelling and You per- form an arthrocentesis to help determine the diagnosis. The fluid analysis reveals rhomboid-shaped positive birefringent crystals. Which of the fol- lowing is the likely diagnosis?

1. Gout
2. Pseudogout
3. Infectious arthritis
4. Osteoarthritis
5. Rheumatoid arthritis

3. You are evaluating a patient with a painful, swollen You per- form arthrocentesis to find cloudy fluid. Analysis reveals a white blood cell count of 50,000 with more than 90% identified as polymorphonuclear leukocytes. The glucose level in the joint fluid is decreased. Which of the following is the most likely diagnosis?

1. Gout
2. Pseudogout
3. Infectious arthritis
4. Osteoarthritis
5. Rheumatoid arthritis

4. You are evaluating a patient with a painful, swollen Joint aspi- rate reveals clear fluid with a white blood cell count of 5000, 20% of which are polymorphonuclear leukocytes. Which of the following is the most likely diagnosis?

1. Gout
2. Pseudogout
3. Infectious arthritis
4. Osteoarthritis
5. Rheumatoid arthritis

5. The joint aspirate from the inflamed first metatarsal phalangeal joint of a 35-year-old woman reveals needle-shaped nonbirefringent crystals. Which of the following is the most appropriate initial treatment?

1. Colchicine
2. Corticosteroids
3. Opiates
4. Allopurinol
5. Probenecid

6. You are following a 52-year-old woman with stiff, swollen Her left hand is shown below:

(Reproduced, with permission, from South-Paul J. Current Diagnosis & Treatment in Family Medicine, 1st ed. New York: McGraw-Hill, 2004:276.)

1. Her right hand is similar. She describes prolonged morning symptoms, and excessive fatigue. Based on this information, which of the following is the most likely diagnosis?
2. Osteoarthritis
3. Gout
4. Tophaceous gout
5. Rheumatoid arthritis
6. Systemic lupus erythematosis

7. You are caring for a 45-year-old woman who was diagnosed with rheumatoid arthritis 6 years Which of the following signs or symptoms, if present, would signal extra-articular manifestations of her condition?

1. Cough
2. Palpitations
3. Gastrointestinal distress
4. Peripheral neuropathy
5. Elevated creatinine

8. You have recently determined that a patient in your office has rheuma- toid Which of the following is the most appropriate next step?

1. Control symptoms with nonsteroidal anti-inflammatory medications
2. Control symptoms with opiates
3. Use steroid treatment for flares, and nonsteroidal anti-inflammatory medica- tions for daily use
4. Use steroid injections to keep flares under control
5. Refer to rheumatology

9. You are caring for a 35-year-old man with a long history of allergies and His asthma has been in good control, but his blood pressure has been elevated on more than two occasions despite weight loss, exercise and appropriate dietary intervention. Which of the following blood pres- sure medications should be avoided in this case?

1. Hydrochlorothiazide
2. Lisinopril (Zestril, Prinivil)
3. Nifedipine (Procardia)
4. Propranolol (Inderal)
5. Losartin (Cozaar)

10. You have recently diagnosed a 24-year-old man with You are discussing environmental measures he should take to control his symp- toms and avoid triggers. Which of the following is the most appropriate advice?

1. Keep humidity in the home relatively high, above 50%
2. Enclose his mattress and pillows with allergen impermeable covers
3. Launder bed linens with cold water
4. Install carpeting if possible
5. Use air filters to decrease the levels of dust mite allergens

11. You are seeing a 19-year-old college student complaining of recur- rent and persistent cough. She has been treated for “bronchitis” several  times, and you are concerned that her true diagnosis is asthma. Which of the following is most important in the diagnosis of asthma?

1. History
2. Allergy testing
3. Chest x-ray
4. Pulmonary function tests with and without bronchodilator therapy
5. Provocative testing with methocholine

12. You are caring for a 30-year-old woman who has had asthma since Currently, she reports symptoms three or four times a week, but never more than once a day. Sometimes her symptoms cause her to skip her usual exercise regimen. She wakes in the night approximately three or four times a month to use her inhaler and return to bed. Which of the following classifications best characterizes her asthma?

1. Mild intermittent
2. Moderate intermittent
3. Mild persistent
4. Moderate persistent
5. Severe persistent

13. You are caring for an 18-year-old man with He smokes, and reports needing to use his short-acting bronchodilator daily. He gets flares of asthma at least twice a week, and while some days are relatively symp- tom free, some exacerbations may last several days. He wakes up at least once a week with symptoms. Which of the following classifications best characterizes his asthma?

1. Mild intermittent
2. Moderate intermittent
3. Mild persistent
4. Moderate persistent
5. Severe persistent

14. You are discussing asthma control with a 22-year-old patient. She monitors her therapy closely, and reports that her current peak flows are at about 80% of her best Which of the following is the best approach to take at this point?

1. Commend the patient on her diligent monitoring and excellent control
2. Reassure the patient that this is well within the normal range
3. Review the patient’s medications and technique and review environmental control
4. Have the patient take additional medication, or add a medication to her regimen
5. Consider hospitalization

15. You are caring for a young woman who has had mild intermittent asthma for She uses a short-acting bronchodilator as needed, but in the past has only needed therapy once or twice a month. Over the past 2 months, she has noted that she is using her inhaler more. In fact, she uses it at least three times a week, and on occasion has had to wake up in the middle of the night to use her inhaler. Of the following, which is the most appropriate treatment option at this point?

1. Change her short-acting beta-agonist from albuterol (Proventil, Ventolin) to pir- buterol (Maxair)
2. Add a long-acting beta-agonist
3. Add an inhaled corticosteroid
4. Add a leukotriene receptor antagonist
5. Add cromolyn (Intal)

16. You are caring for a man with He is currently taking an inhaled corticosteroid twice daily and using his short acting beta agonist as needed. Over the past 3 months, he has required escalating doses of his inhaled corticosteroid, and now he is at the maximum dosage, still using his “rescue” inhaler more than he would like. Of the following, which is the best medication to add to his regimen?

1. A burst and rapid taper of oral steroids
2. A long-acting beta-agonist
3. Cromolyn (Intal)
4. Ipratropium (Atrovent)
5. Theophylline

17. You are caring for a 25-year-old woman who has had mild intermit- tent asthma since she was a She uses a short acting bronchodilator as needed. Over the past 5 weeks, she has been using her inhaler up to four times a week, and has had to wake up in the middle of the night to use her inhaler twice. She tried inhaled corticosteroids, but was intolerant of the side effects. Of the following, which is the most appropriate treatment option for her?

1. A long-acting beta-agonist
2. A leukotriene receptor antagonist
3. Cromolyn (Intal)
4. Theophylline
5. Oral corticosteroids

18. A 22-year-old man is seeing you to discuss his low back He is athletic and exercises regularly. He denies any inciting event, does not have pain with movement, and denies radiation of the pain. Given this informa- tion, what is the most likely diagnosis?

Spondylolisthesis

1. Low back strain
2. Degenerative osteoarthritis
3. Lumbar disk herniation
4. Neoplasm

19. You are performing a preparticipation physical examination on a 14-year-old girl interested in playing You note asymptomatic sco- liosis. You obtain x-rays that reveal a 15% thoracic curve to the right. Which of the following is the most appropriate next step?

1. Referral to orthopedic specialist
2. Refer for a thoracic back brace
3. Reassure, and reexamine the patient yearly
4. Obtain repeat x-rays every 6 months
5. Obtain an MRI (magnetic resonance imaging)

20. You are seeing a 44-year-old woman who is complaining of low back pain. She reports that her symptoms began several months ago, and started The pain is worse in the morning, and is associated with stiffness. It gets better throughout the day and with activity. She denies radiation or neurological symptoms. Which of the following is the most likely cause?

1. Back strain
2. An inflammatory condition
3. Disk herniation
4. Compression fracture
5. Neoplasm