[MCQs] The Quizzes about Chronic Conditions – Part 8 (23 test)

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Chronic Conditions-8

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Question 1

You are working with a 48-year-old type 2 diabetic, diagnosed 1 month The patient wishes to lose weight to help manage his illness, but is not really interested in exercise. You work with him on a dietary plan that dimin- ishes his daily calorie intake by 500 calories per day. All things being equal, how much weight can this patient expect to lose in 6 weeks?

A	3 lb
B	6 lb
C	9 lb
D	12 lb
E	15 lb

Question 1 Explanation:

When discussing diet plans, it is important to ensure patients have realistic expectations regarding outcomes to avoid frustration and burnout. There are 3500 calories in a pound. All things being equal, diminishing food intake by 500 calories per day will result in weight loss of 1 lb p

Question 2

After 2 months of working on diet and attempting an exercise pro- gram, a patient complains of making limited Indeed, her weight has stayed stable despite engaging in 20 minutes of walking 3 days per week, and limiting caloric intake. She asks if she can try medication to help with her weight loss goals. Which of the following is true regarding the use of medication in weight loss programs?

A	Medications used for weight loss are unsafe and should be avoided
B	There is no role for medications in weight loss programs
C	Short courses of some medications have been shown to be helpful in initiating and maintaining weight loss
D	Long courses of some medications have been shown to be helpful in initiating and maintaining weight loss
E	Medications can be a helpful adjunct to a weight loss program

Question 2 Explanation:

Overweight patients often inquire about the use of medications to enhance weight loss. Some agents may be a helpful adjunct to diet and exercise, but should not be considered the primary solution. Some medications have been approved by the FDA and are not deemed unsafe when used as directed. Short courses of medication may help initiate weight reduction, but do not help in maintaining weight loss. In fact, in all cases, cessation of the drug has been shown to result in rapid accumulation of weight, if lifestyle changes are not maintained. Long courses of medications have not shown to be helpful in maintaining weight loss, and in most studies, weight is regained despite continued use of medication.

Question 3

A 49-year-old African American perimenopausal woman is seeing you after having fractured her Her past medical history is significant for oral contraceptive use for 20 years, obesity and Grave’s disease leading to cur- rent hypothyroidism. She nursed two children for 6 months each. Which component of the patient’s history puts her at increased risk for osteoporosis?

A	African American race
B	Oral contraceptive use
C	Obesity
D	Grave’s disease
E	Breast feeding

Question 3 Explanation:

Osteoporosis is due to poor acquisition of bone mass or accelerated bone loss. African Americans are less at risk than Caucasians or Asians. There is no evidence that oral contraceptive use increases risk. Obesity is considered to be protective due to increased estrogen production, as long as the person is not sedentary. Hyperthyroidism is a common cause of accelerated bone loss. Breast-feeding is a significant drain on calcium stores, but studies have shown that the associated bone mineral loss is completely reversed within 12 months of weaning

Question 4

A 32-year-old woman is seeing you because her mother has been diag- nosed with She asks you what type of exercise will help her pre- vent the development of the disease. According to recommendations, which of the following exercises is recommended to help maintain bone mass?

A	Tennis
B	Swimming
C	Cycling
D	Skating
E	Skiing

Question 4 Explanation:

Weight bearing activity is known to retard bone loss. While there have been no randomized clinical trials comparing the effect of various activities on bone mass, recommended activities include walking, jogging, weight lifting, aerobics, stair climbing, field sports, racquet sports, court sports, and dancing. Swimming is questionable, as it is not weight bearing. There is no data on cycling, skating, or skiing.

Question 5

You are caring for a 48-year-old Caucasian woman with a history of anorexia nervosa in her late She was an elite track and field athlete in her late teens and early 20s, and was considered for the US Olympic team in her prime. Which of the following options is best for primary osteo- porosis screening in this woman?

A	History
B	Physical examination
C	Serum calcium
D	Serum human osteocalcin levels
E	Bone density imaging

Question 5 Explanation:

Primary osteoporosis refers to deterioration of bone mass not associated with other chronicChronic Conditions Answers 275 illnesses or problems. History and physical are neither sensitive enough nor sufficient for the diagnosis of primary osteoporosis. While decreased serum calcium may indicate malabsorption or a vitamin D deficiency, it is not useful as a diagnostic tool for osteoporosis. Measures of bone turnover, like serum human osteocalcin levels, are of research interest, but are not useful for screening. Imaging studies are best.

Question 6

You are evaluating a 76-year-old woman on long-term glucocortico- steroid therapy for polymyalgia Which of the following is the diagnostic imaging test of choice to diagnose osteoporosis?

A	Plain radiographs
B	Single photon absorptiometry
C	Dual photon absorptiometry
D	Dual energy x-ray absorptiometry
E	Quantitative computerized tomography of bone

Question 6 Explanation:

Plain radiographs are not sensitive enough to diagnose osteoporosis until total density has decreased by 50%. Single and dual photon absorptiometry provide poor resolution and are less accurate than other methods. Dual energy x-ray absorptiometry (DEXA) scanning is most precise and is the test of choice. Quantitative CT scanning is the most sensitive, but exposes patients to significant levels of radiation exposure.

Question 7

You screened a 52-year-old, at-risk woman for osteoporosis using a DEXA You received a T-score and a Z-score in the report. Which of the following indicates osteoporosis?

A	An equal T- and Z-score
B	A T-score of 2.5
C	A T-score of 2.5
D	A Z-score of 2.5
E	A Z-score of 2.5

Question 7 Explanation:

Bone densitometry provides a T-score (the number of standard deviations above or below the mean matched to YOUNG controls) and a Z-score (the number of standard deviations above or below the mean-matched to age-matched controls). Z-scores are of little value to clinicians. A T-score more than 2.5 standard deviations below the mean (a score of –2.5 or lower) indicates osteoporosis.

Question 8

You have diagnosed a 53-year-old woman with She is postmenopausal, and you are considering estrogen replacement therapy. Which of the following is not an absolute contraindication to estrogen replacement therapy?

A	A history of breast cancer
B	A history of uterine cancer
C	A history of estrogen-dependent neoplasia
D	Abnormal genital bleeding
E	A history of a thromboembolic disorder

Question 8 Explanation:

Absolute contraindications to estrogen replacement therapy include a history of breast cancer or other estrogen-dependent cancer, undiagnosed or abnormal genital bleeding, and a history or an active thromboembolic disorder. Relative contraindications include migraine, a history of thromboembolism, familial hypertriglyceridemia, uterine leiomyoma, uterine cancer, gallbladder disease, a strong family history of breast cancer, chronic hepatic dysfunction, and endometriosis.

Question 9

You are treating an elderly postmenopausal woman with osteoporo- She recently suffered an acute osteoporotic vertebral fracture, and is suffering from secondary pain. Which osteoporosis treatment also has anal- gesic effects with respect to bone pain?

A	Estrogen
B	The combination of calcium and vitamin D
C	Calcitonin
D	Alendronate (Fosamax)
E	Raloxifene (Evista)

Question 9 Explanation:

Calcitonin directly inhibits osteoclastic bone resorption and is considered a reasonable treatment alternative for patients with established osteoporosis in whom estrogen replacement therapy is not recommended. It has the unique characteristic of producing an analgesic effect with respect to bone pain and is often prescribed for patients who have suffered an acute osteoporotic fracture.

Question 10

You have just diagnosed osteoporosis in a postmenopausal She is considering treatment alternatives and wonders about the bisphos- phonates. Which of the following is the best description of how this class of medications works?

A	They increase calcium absorption in the gastrointestinal (GI) tract
B	They block the activity of the cytokines that stimulate bone reabsorption
C	They bind to bone surfaces to inhibit osteoclast activity
D	They stimulate osteoblasts and increase bone formation
E	They mimic estrogen’s effect on bone

Question 10 Explanation:

Bisphosphonates work by binding to the bone surface and inhibiting osteoclastic activity. Vitamin D276 Family Medicine increases absorption of calcium in the GI tract. Estrogen and selective estrogen receptor modulators (raloxifene or Evista) work by blocking the activity of cytokines. Fluoride stimulates osteoblasts, but does not result in the formation of normal bone.

Question 11

You are seeing a 32-year-old woman for Your differential diagnosis includes major depressive disorder, but she does not describe a depressed or irritable mood. Of the following choices, which symptom of depression must be present in order to diagnose a major depressive disor- der in someone without depressed mood?

A	Sleep changes
B	Loss of interest or pleasure in usually enjoyable activities
C	Guilt or feelings of worthlessness
D	Loss of energy
E	Change in appetite

Question 11 Explanation:

Depression is commonly seen in primary care settings. In fact, it is estimated that only about 20% of depression-related health care occurs in mental health care settings. Nonpsychiatrists write approximately 80% of the prescriptions for antidepressants. Patients with major depressive disorder often present with vague physical symptoms rather than emotional complaints. To make the diagnosis of depression using DSM criteria, the patient must describe either depressed mood for most of the day nearly every day for at least 2 weeks, or loss of interest in usually enjoyable activities. Irritable mood may take the place of depressed mood to make the diagnosis as well. In addition to one of those two symptoms, the patient must experience other symptoms of depression, including sleep changes, feelings of guilt or worthlessness, loss of energy, loss of concentration, change in appetite, psychomotor speeding or slowing, or suicidal thoughts, plans or intent.

Question 12

You have just diagnosed depression in an otherwise healthy adult He has agreed to start an antidepressant medication, but is concerned about sexual side effects. Which of the following medications is least likely to cause sexual side effects in this patient?

A	Bupropion
B	Citalopram
C	Fluoxetine
D	Sertraline
E	Venlafaxine

Question 12 Explanation:

All of the answers to this question would be considered optimal first-line agents for depression, in terms of patient acceptance of side effects, safety, and quantity/quality of clinical trials data available for review. However, those medications that impact the serotonin system have a rather high incidence of sexual side effects (up to 20% in some estimates). Citalopram, fluoxetine, and sertraline are all selective serotonin reuptake inhibitors, and venlafaxine is both a serotonin and norepinephrine reuptake inhibitor. Bupropion is a dopamine and norepinephrine reuptake inhibitor, and therefore is less likely to cause sexual side effects.

Question 13

You are discussing treatment options for a 43-year-old woman with major depressive Which of the following is a true statement regarding the effectiveness of treatment for depressive disorders?

A	Only about 25% of patients that receive medication alone will find the medica- tion to be effective
B	Patients who find one medication ineffective are likely to find all medications ineffective
C	In order to prevent a relapse of depressive symptoms, patients should continue treatment for 3–4 months
D	In general, patients respond best to the combination of medication and counseling
E	Electroconvulsive therapy is ineffective when compared with newer medical therapy

Question 13 Explanation:

Physicians have various treatment options for depression. Studies have shown that the combination of medication and therapy offer the best treatment outcomes. However, antidepressants alone are effective in about 50–60% of patients with major depression. If a patient fails to respond to one medication, he/she may respond to another. At least 80% of patients with major depression will respond to at least one antidepressant medication. In order to prevent relapse, treatment should continue for 6–9 months. ElectroconvulsiveChronic Conditions Answers 277 therapy (ECT) has a high rate of therapeutic success, but is reserved for those who do not respond to other modalities of treatment.

Question 14

You are treating a 48-year-old man for major His medical history includes a head injury several years ago that has left him with a seizure disorder. Which of the following antidepressants would be contraindicated?

A	Venlafaxine
B	Nefazodone
C	Mirtazapine
D	Fluoxetine
E	Bupropion

Question 14 Explanation:

While many of the newer antidepressants are well-tolerated, physicians should be familiar with the adverse effects and contraindications for their use. Nefazodone should not be used in patients with liver disease. Hypertension is a relative contraindication to venlafaxine. Patients experiencing hypersomnia and motor retardation should avoid nefazodone and mirtazapine. Patients who report agitation and insomnia should avoid bupropion and venlafaxine. Mirtazapine and tricyclic antidepressants are less preferred for patients with obesity. Bupropion is contraindicated for patients with seizure disorder.

Question 15

Which of the following conditions is considered an anxiety disorder?

A	Social phobia
B	Conversion disorder
C	Somatization disorder
D	Anorexia nervosa
E	Histrionic personality disorder

Question 15 Explanation:

Anxiety disorders encompass several clinical conditions including generalized anxiety disorder, panic disorder, the phobias, obsessive-compulsive disorder, and posttraumatic stress disorder. Conversion disorder is not classified as an anxiety disorder, and involves an unintentionally produced motor or sensory function deficit, preceded by conflict or stress. Somatization disorder involves a history of many medical complaints for which treatment is sought that cannot be explained fully by a known medical condition, and is also not classified as an anxiety disorder. Anorexia is classified as an eating disorder, and histrionic personality disorder is a classified among the personality disorders, and involves a dramatic, attentionseeking, and emotional patient.

Question 16

You are following a 16-year-old girl with a suspected eating Which of the following, if present, would help differentiate anorexia ner- vosa from bulimia nervosa?

A	Binge eating or purging
B	The use of laxatives, diuretics, or enemas
C	Self-evaluation is unduly influenced by body weight and shape
D	Episodic lack of control over eating
E	Inappropriate behaviors to prevent weight gain

Question 16 Explanation:

Eating disorders are psychological disorders in which the person afflicted has an altered perception of body weight or shape and disturbances of eating behavior. Distinguishing between anorexia and bulimia may be important from a treatment standpoint. Some characteristics are common to both eating disorders, while other characteristics may help to differentiate them. Both disorders involve self-evaluation that is unduly influenced by body weight and/or shape. While binge eating or purging are considered characteristics of bulimia, there is a binge eating/purging subtype of anorexia that involves that behavior as well. Both bulimics and binge eating/purging subtypes of anorexics may use diuretics, enemas, and laxatives. Both engage in inappropriate behaviors to prevent weight gain. However, bulimics sense a lack of control over eating during episodes of binging, while anorexics often feel a strong sense of control. This is a characteristic that may help distinguish the two.

Question 17

Which of the following is a major risk factor for the development of attention-deficit/hyperactivity disorder (ADHD)?

A	Environmental exposure to tobacco smoke
B	Environmental allergies
C	A family history of ADHD
D	Low self-esteem
E	Academic underachievement

Question 17 Explanation:

The etiology of ADHD is not entirely clear, but genetic factors seem to play a role. Environmental factors including environmental exposure to allergens and toxins have been studied, but do not play a role. The major risk factor for the development of ADHD is family history. Rates of ADHD can be as high as 30% in siblings of an affected individual, and 50% in at least one parent. Low self-esteem and academic underachievement are considered comorbid conditions, but are not considered risk factors.

Question 18

A 26-year-old male college graduate is seeing you for an office He is concerned that he may have adult ADHD. Which of the following is true regarding this condition?

A	The symptoms are likely to be more pronounced in adults as compared with children
B	Children diagnosed with ADHD commonly continue to have symptoms into adulthood
C	Sleep disturbance is a distinctive feature of adult ADHD
D	Appetite disturbance is a distinctive feature of adult ADHD
E	The symptom picture of adult ADHD mimics that in children

Question 18 Explanation:

Of children diagnosed with ADHD, up to 60% will continue to exhibit symptoms into adulthood. In adults, symptoms of ADHD may be more subtle, and symptoms may actually change. Hyperactivity may be replaced with restlessness, and impulsivity may be replaced with inability to control emotions or social inappropriateness. Sleep and appetite disturbances in adults should alert the physician to the possibility of another disorder, especially depression.

Question 19

What is the principal mechanism by which stimulant medications work to improve symptoms of ADHD?

A	Inhibition of serotonin reuptake
B	Stimulation of serotonin production
C	Inhibition of dopamine and norepinephrine reuptake
D	Stimulation of dopamine and norepinepherine production
E	Blocking the release of serotonin

Question 19 Explanation:

Stimulants reduce symptoms of hyperactivity, impulsivity, and inattention. The mechanism of action is thought to be by inhibition of dopamine and norepinephrine reuptake. Approximately 70% of children respond to a specific stimulant, and 90% will respond to at least one stimulant. A positive response to stimulant medication is not diagnostic for ADHD. As children and adults without ADHD who take stimulants demonstrate improvement in attention, concentration, and memory tasks.

Question 20

A 45-year-old woman presents to your office for She reports that over the last few weeks, she’s noted an enlarging mass in the front of her neck. She feels well, has had no changes in her health, and denies symptoms of hyper- or hypothyroidism. She also denies recent viral illness. On examination, you note a diffusely enlarged thyroid that is ten- der to touch. What is her most likely diagnosis?

A	Hashimoto’s thyroiditis
B	Subacute lymphocytic thyroiditis
C	Subacute granulomatous thyroiditis
D	Suppurative thyroiditis
E	Invasive fibrous thyroiditis

Question 20 Explanation:

The most common cause of thyroiditis is chronic lymphocytic thyroiditis (also called Hashimoto’s thyroiditis). It is the most common cause of goiter in the United States. Generally seen in middle-aged women, this generally presents with enlargement of the thyroid, and most often there is associated tenderness. Subacute lymphocytic thyroiditis is less common, and although an acute increase in thyroid size is seen, it is generally nontender. Subacute granulomatous thyroiditis usually follows a viral illness and is also associated with a mildly painful gland. Suppurative thyroiditis is rare, and is associated with fever, a swollen thyroid and clinical manifestations of a bacterial illness. Invasive fibrous thyroiditis presents as a gradually increasing gland that is firm, but is nontender.

Question 21

A 26-year-old woman presents with weight gain, lethargy, dry skin, sweatiness, cold intolerance, and thinning You suspect hypothy- roidism and order the appropriate laboratory tests. Her thyroid stimulating hormone is high, and her free T3 and free T4 are both low. Which of the following is the most likely diagnosis?

A	Primary hypothyroidism
B	Secondary hypothyroidism
C	Iodine deficiency
D	Thyroid hormone resistance
E	Subclinical hypothyroidism

Question 21 Explanation:

Primary hypothyroidism is common, usually a result of Hashimoto’s thyroiditis or after Graves’ disease. In this case, the TSH would be elevated, and the free T3 and T4 would be low. Secondary hypothyroidism is related to hypothalamic or pituitary dysfunction. Iodine deficiency is a cause of primary hypothyroidism. Subclinical hypothyroidism is when the TSH is elevated, but the T3 and T4 are normal. Thyroid resistance would present with the TSH, T3, and T4 all being elevated.

Question 22

You are screening a 35-year-old woman who presents with tachycar- dia, nervousness, tremor, palpitations, heat intolerance, and weight You suspect Graves’ disease. What single test is best for differentiating Graves’ disease from other causes of hyperthyroidism?

A	Thyroid stimulating hormone
B	TSH with free T4 and free T3
C	Thyroid receptor antibodies
D	Radionucleotide imaging of the thyroid
E	Thyroid ultrasound

Question 22 Explanation:

Thyroid receptor antibodies are very specific, and differentiate Graves’ disease from other causes of hyperthyroidism. The TSH and free thyroid hormones are nonspecific, and only identify hyperthyroidism. Radionucleotide imaging is helpful in Graves’, showing diffuse uptake, but is not necessarily specific. Thyroid ultrasonography can identify nodules, but is also a nonspecific test for differentiating causes of hyperthyroidism.

Question 23

When examining a 35-year-old, you notice a firm 3 cm thyroid nod- ule. His thyroid studies are normal, and he is clinically Radionu- cleotide imaging demonstrates uptake in the thyroid nodule. What is the most likely diagnosis?

A	Colloid cyst
B	Thyroid adenoma
C	Thyroid carcinoma
D	Metastatic disease
E	Neurofibroma

Question 23 Explanation:

Once a thyroid nodule is found, the next step in the workup is radionucleotide imaging. If a nodule takes up radiotracer, it is termed a “hot” nodule. Colloidal cysts and tumors do not take up tracer and are “cold” nodules. Therefore, “hot” nodules are more likely benign. Neurofibromas would also be “cold.” Definitive diagnosis can be made through needle aspiration.

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1. You are working with a 48-year-old type 2 diabetic, diagnosed 1 month The patient wishes to lose weight to help manage his illness, but is not really interested in exercise. You work with him on a dietary plan that dimin- ishes his daily calorie intake by 500 calories per day. All things being equal, how much weight can this patient expect to lose in 6 weeks?

3 lb
6 lb
9 lb
12 lb
15 lb

2. After 2 months of working on diet and attempting an exercise pro- gram, a patient complains of making limited Indeed, her weight has stayed stable despite engaging in 20 minutes of walking 3 days per week, and limiting caloric intake. She asks if she can try medication to help with her weight loss goals. Which of the following is true regarding the use of medication in weight loss programs?

Medications used for weight loss are unsafe and should be avoided
There is no role for medications in weight loss programs
Short courses of some medications have been shown to be helpful in initiating and maintaining weight loss
Long courses of some medications have been shown to be helpful in initiating and maintaining weight loss
Medications can be a helpful adjunct to a weight loss program

3. A 49-year-old African American perimenopausal woman is seeing you after having fractured her Her past medical history is significant for oral contraceptive use for 20 years, obesity and Grave’s disease leading to cur- rent hypothyroidism. She nursed two children for 6 months each. Which component of the patient’s history puts her at increased risk for osteoporosis?

African American race
Oral contraceptive use
Obesity
Grave’s disease
Breast feeding

4. A 32-year-old woman is seeing you because her mother has been diag- nosed with She asks you what type of exercise will help her pre- vent the development of the disease. According to recommendations, which of the following exercises is recommended to help maintain bone mass?

Tennis
Swimming
Cycling
Skating
Skiing

5. You are caring for a 48-year-old Caucasian woman with a history of anorexia nervosa in her late She was an elite track and field athlete in her late teens and early 20s, and was considered for the US Olympic team in her prime. Which of the following options is best for primary osteo- porosis screening in this woman?

History
Physical examination
Serum calcium
Serum human osteocalcin levels
Bone density imaging

6. You are evaluating a 76-year-old woman on long-term glucocortico- steroid therapy for polymyalgia Which of the following is the diagnostic imaging test of choice to diagnose osteoporosis?

Plain radiographs
Single photon absorptiometry
Dual photon absorptiometry
Dual energy x-ray absorptiometry
Quantitative computerized tomography of bone

7. You screened a 52-year-old, at-risk woman for osteoporosis using a DEXA You received a T-score and a Z-score in the report. Which of the following indicates osteoporosis?

An equal T- and Z-score
A T-score of +2.5
A T-score of -2.5
A Z-score of +2.5
A Z-score of -2.5

8. You have diagnosed a 53-year-old woman with She is postmenopausal, and you are considering estrogen replacement therapy. Which of the following is not an absolute contraindication to estrogen replacement therapy?

A history of breast cancer
A history of uterine cancer
A history of estrogen-dependent neoplasia
Abnormal genital bleeding
A history of a thromboembolic disorder

9. You are treating an elderly postmenopausal woman with osteoporo- She recently suffered an acute osteoporotic vertebral fracture, and is suffering from secondary pain. Which osteoporosis treatment also has anal- gesic effects with respect to bone pain?

Estrogen
The combination of calcium and vitamin D
Calcitonin
Alendronate (Fosamax)
Raloxifene (Evista)

10. You have just diagnosed osteoporosis in a postmenopausal She is considering treatment alternatives and wonders about the bisphos- phonates. Which of the following is the best description of how this class of medications works?

They increase calcium absorption in the gastrointestinal (GI) tract
They block the activity of the cytokines that stimulate bone reabsorption
They bind to bone surfaces to inhibit osteoclast activity
They stimulate osteoblasts and increase bone formation
They mimic estrogen’s effect on bone

11. You are seeing a 32-year-old woman for Your differential diagnosis includes major depressive disorder, but she does not describe a depressed or irritable mood. Of the following choices, which symptom of depression must be present in order to diagnose a major depressive disor- der in someone without depressed mood?

Sleep changes
Loss of interest or pleasure in usually enjoyable activities
Guilt or feelings of worthlessness
Loss of energy
Change in appetite

12. You have just diagnosed depression in an otherwise healthy adult He has agreed to start an antidepressant medication, but is concerned about sexual side effects. Which of the following medications is least likely to cause sexual side effects in this patient?

Bupropion
Citalopram
Fluoxetine
Sertraline
Venlafaxine

13. You are discussing treatment options for a 43-year-old woman with major depressive Which of the following is a true statement regarding the effectiveness of treatment for depressive disorders?

Only about 25% of patients that receive medication alone will find the medica- tion to be effective
Patients who find one medication ineffective are likely to find all medications ineffective
In order to prevent a relapse of depressive symptoms, patients should continue treatment for 3–4 months
In general, patients respond best to the combination of medication and counseling
Electroconvulsive therapy is ineffective when compared with newer medical therapy

14. You are treating a 48-year-old man for major His medical history includes a head injury several years ago that has left him with a seizure disorder. Which of the following antidepressants would be contraindicated?

Venlafaxine
Nefazodone
Mirtazapine
Fluoxetine
Bupropion

15. Which of the following conditions is considered an anxiety disorder?

Social phobia
Conversion disorder
Somatization disorder
Anorexia nervosa
Histrionic personality disorder

16. You are following a 16-year-old girl with a suspected eating Which of the following, if present, would help differentiate anorexia ner- vosa from bulimia nervosa?

Binge eating or purging
The use of laxatives, diuretics, or enemas
Self-evaluation is unduly influenced by body weight and shape
Episodic lack of control over eating
Inappropriate behaviors to prevent weight gain

17. Which of the following is a major risk factor for the development of attention-deficit/hyperactivity disorder (ADHD)?

Environmental exposure to tobacco smoke
Environmental allergies
A family history of ADHD
Low self-esteem
Academic underachievement

18. A 26-year-old male college graduate is seeing you for an office He is concerned that he may have adult ADHD. Which of the following is true regarding this condition?

The symptoms are likely to be more pronounced in adults as compared with children
Children diagnosed with ADHD commonly continue to have symptoms into adulthood
Sleep disturbance is a distinctive feature of adult ADHD
Appetite disturbance is a distinctive feature of adult ADHD
The symptom picture of adult ADHD mimics that in children

19. What is the principal mechanism by which stimulant medications work to improve symptoms of ADHD?

Inhibition of serotonin reuptake
Stimulation of serotonin production
Inhibition of dopamine and norepinephrine reuptake
Stimulation of dopamine and norepinepherine production
Blocking the release of serotonin

20. A 45-year-old woman presents to your office for She reports that over the last few weeks, she’s noted an enlarging mass in the front of her neck. She feels well, has had no changes in her health, and denies symptoms of hyper- or hypothyroidism. She also denies recent viral illness. On examination, you note a diffusely enlarged thyroid that is ten- der to touch. What is her most likely diagnosis?

Hashimoto’s thyroiditis
Subacute lymphocytic thyroiditis
Subacute granulomatous thyroiditis
Suppurative thyroiditis
Invasive fibrous thyroiditis

21. A 26-year-old woman presents with weight gain, lethargy, dry skin, sweatiness, cold intolerance, and thinning You suspect hypothy- roidism and order the appropriate laboratory tests. Her thyroid stimulating hormone is high, and her free T3 and free T4 are both low. Which of the following is the most likely diagnosis?

Primary hypothyroidism
Secondary hypothyroidism
Iodine deficiency
Thyroid hormone resistance
Subclinical hypothyroidism

22. You are screening a 35-year-old woman who presents with tachycar- dia, nervousness, tremor, palpitations, heat intolerance, and weight You suspect Graves’ disease. What single test is best for differentiating Graves’ disease from other causes of hyperthyroidism?

Thyroid stimulating hormone
TSH with free T4 and free T3
Thyroid receptor antibodies
Radionucleotide imaging of the thyroid
Thyroid ultrasound

23. When examining a 35-year-old, you notice a firm 3 cm thyroid nod- ule. His thyroid studies are normal, and he is clinically Radionu- cleotide imaging demonstrates uptake in the thyroid nodule. What is the most likely diagnosis?

Colloid cyst
Thyroid adenoma
Thyroid carcinoma
Metastatic disease
Neurofibroma

[MCQs] The Quizzes about Chronic Conditions – Part 8 (23 test)

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