1. Your recently hospitalized patient was treated for pneumonia and has now developed pseudomembranous colitis. Which one of the following organisms is responsible for this condition? A) Clostridium difficile

2. A 23-year-old Hispanic male presents with his fiancée to discuss the best treatment for his Crohn disease. He has been using Rowasa enemas when he has flares of his mild disease, but she is wondering if there is a better way of treating his condition rather than using enemas, which she finds off-putting. You advise them of which one of the following?

3. A 33-year-old salesman is recovering from an acute viral infection and is worried that he will have liver problems going forward. You advise him that his acute hepatitis was due to a virus, which is not associated with a chronic infection. Which one of the following forms of hepatitis did he have?

4. A 19-year-old presents with complaints of acute diarrhea with foul-smelling flatulence. He had been camping this past weekend and drinking water from a mountain stream. You suspect a Giardia lamblia infection. Which one of the following statements about giardiasis is true?

5. A 52-year-old lumberjack recently attended a wild-game feed banquet, consumed summer sausage made from bear meat and presents now with complaints of abdominal cramping, diarrhea, and muscle tenderness. The most likely diagnosis is which one of the following?

6. You have been caring for a young man with chronic diarrhea and he has been diagnosed with Crohn disease. This condition is associated with which one of the following?

7. You are seeing a 37-year-old white male with complaints of diarrhea for the past 2 to 3 weeks. He denies blood in the stool, fever, and has no weight loss and no recent travel. Appropriate management at this time includes which one of the following?

8. A 26-year-old mailman presents to your office with complaints of diarrhea. He states that he has had loose stools for the past week. You obtain a stool sample for fecal leukocytes and that the laboratory report indicates the presence of polymorphonuclear fecal leukocytes in his sample. This finding most likely supports which one of the following diagnoses?

9. Which one of the following tests is recommended to be used to screen when celiac sprue is suspected?

10. Which one of the following has been shown in multiple cohort studies to reduce the risk of colon cancer?

11. A 63-year-old white female smoker presents for follow-up care after recovering from a bout of acute diverticulitis. She is wondering what she can do to avoid having a recurrence. You advise her that any of the following have been found to be helpful in preventing recurrent diverticulitis, except which one?

12. A 21-year-old college student has come in after a 3-week trip to Central America. She has developed significant diarrhea, with abdominal pain and cramping—she also thinks that she saw some blood in her stool this morning. You decide to prescribe an antibiotic. The most effective drug for the treatment of traveler’s diarrhea is which one of the following medications?

13. A 55-year-old black male patient present to the ED with severe abdominal pain, which has been radiating to his back, along with persistent vomiting over the previous few hours. Other than a history of hypertriglyceridemia (512 mg/dL), he has been healthy. Acute laboratory test results are obtained and include the following abnormalities: White blood cell (WBC) count: 20,000 Glucose: 295 mg/dL Aspartate aminotransferase (AST): 333 IU/L Lactate dehydrogenase: 375 IU/L The most likely diagnosis to explain his presentation is which one of the following conditions?

14. You are seeing a 27-year-old Hispanic male who has been diagnosed with ulcerative colitis. True statements regarding this condition include all, except which one of the following?

17. The use of PPIs has been associated with a deficiency in which one of the following vitamins?

3. A 54-year-old Hispanic woman presents with complaints of frequent sweating episodes, palpitations, nervousness, and sensitivity to heat. She notes that she has been losing weight, yet has been eating more. Which one of the following conditions is the most likely cause of her symptoms?

17. A patient presents with complaints of palpitations and a racing heart. She has recently been losing weight. On examination she is sweaty and you detect a goiter. You are concerned that she is experiencing a thyroid storm. Which one of the following medications should be avoided in this condition?

5. Which one of the following statements about hyperglycemic hyperosmolar nonketotic coma is true?

Which one of the following test results would be detected in a patient with Graves disease?

19. Acromegaly is associated with which one of the following factors?

20. A 58-year-old secretary presents with asthenia and hyperpigmented changes on her elbows and inner cheek. She also has noted her BP is low and she is dizzy when she stands. She has recently lost 10 pounds and has some nausea but no vomiting. A recent workup included a positive test for coccidioidomycosis. Appropriate testing at this time would include which one of the following?

9. You are evaluating a 16-year-old who is on insulin for T1DM, which he developed during puberty. He has been sick for the past 3 days and you are concerned that he has developed DKA. Which one of the following factors would not be associated with a DKA diagnosis?

22. Which of the following laboratory results best supports the diagnosis of subclinical hypothyroidism?

11. A 53-year-old school teacher is asking for a blood test because she is worried about diabetes. Her older brother was recently diagnosed with diabetes, and she states that it runs in her family. Which of the following is a diagnostic criterion for the presence of diabetes mellitus?

You are seeing a patient who is on thyroid replacement therapy and have recently increased her levothyroxine to 75 mcg/d. Which one of the following test is best for assessing the adequacy of this replacement dosage?

13. A 57-year-old black diabetic presents with a sore that she has noticed on the side of her right foot; although not painful, it has been slowly enlarging. Which one of the following is true about diabetic foot ulcers?

16. A 62-year-old woman presents complaining of joint pain, polyuria, polydipsia, and generalized fatigue. Her past medical history is remarkable for recurrent kidney stones, and she has also suffered from depression. You obtain a plain film of her hands as she is complaining that those joints are worse lately. The X-rays show osteopenia and subperiosteal resorption on the phalanges. Which of the following blood tests may best help determine the cause of her symptoms?

17. You are seeing a middle-aged white female with complaints of weakness and fatigue over the past couple of months. She has lost her appetite and having episodes of diarrhea. Her husband notes that she seems to have developed darkening skin around her gums, nipples, and vagina. You suspect Addison disease, which is associated with which one of the following?

You are seeing a 57-year-old diabetic who has been recently started on insulin therapy. He is arguing with his wife over the best location to give his injections—he has been using his thigh and she insists that he should do the injections in his belly as her aunt who had diabetes used to do. Which one of the following statements is true regarding insulin injections?

Based on the USPSTF recommendation for all women, without fracture risk factors, screening dual-energy X-ray absorptiometry (DEXA) scan should start at which age?

Type II renal tubular acidosis is associated with which one of the following?

You are treating a 23-year-old white male with Goodpasture syndrome who is complaining of mild hemoptysis. Which one of the following conditions would you also be expected to find associated with this condition?

A 20-year-old otherwise healthy woman presents with cloudy urine, burning on urination, and urinary frequency. The patient has no allergies. On examination she is afebrile, with mild suprapubic pain to palpation but no costovertebral angle tenderness. Urinalysis is positive for nitrites and leukocyte esterase. Which one of the following is the most appropriate treatment at this time?

4. A 52-year-old male presents for follow-up with his wife after passing another kidney stone last month. He has passed several calcium oxalate kidney stones over the past few years and his wife returns for recommendations on his diet. The most appropriate advice would be to recommend which one of the following?

You are seeing a patient in the ED who has been involved in a motor vehicle accident. His urine dipstick is positive for hemoglobin, but no erythrocytes are seen on a reflex microscopic examination of the urinary sediment. Which one of the following is the most likely diagnosis in this situation?

A 31-year-old woman has had frequent UTIs over the years and presents with recurrent dysuria. She has felt ill for the past couple of days and presents now with nausea and vomiting. On examination, she has a temperature of 103.2°F and flank pain. The most appropriate treatment at this time would be which one of the following?

Which one of the following clinical findings is consistent with the syndrome of inappropriate antidiuretic hormone (SIADH)?

A BUN to serum creatinine ratio greater than 20 is associated with which one of the following conditions?

A 33-year-old white male presents for a visit after passing a 4-mm calcium oxalate stone. This was his first episode of nephrolithiasis, but he is worried and wants to know how he can prevent developing more kidney stones in the future, as this was a painful experience for him. You would advise which of the following?

A 22-year-old sexually active woman calls the office with complaints of dysuria that began last night. She is otherwise healthy and has no other symptoms. The best management of this situation would include which one of the following?

A urine culture obtained from an asymptomatic patient grows more than 100,000 colony-forming units. For which one of the following patients is treatment indicated?

You are assessing a 33-year-old black male with right flank pain. He has been having intermittent pain for the past couple of days and his urinalysis is positive for erythrocytes, but his leukocyte esterase and urinary nitrates are negative. You suspect that he has a ureteral obstruction secondary to renal lithiasis. Which one of the following is the best test to detect such a condition?

You are following a 57-year-old diabetic, and a recent metabolic panel revealed a glomerulofiltration rate (GFR) of 31 mL/min. This result is consistent with renal insufficiency and would be considered what stage of chronic renal failure?

You are seeing a 65-year-old white male for follow-up. He had presented with hematuria and was diagnosed with RCC. You inform him that all of the following statements about RCC are true, except which one?

You are treating a 67-year-old white male for HTN, which has been resistant to your prescribed therapy. His examination is benign, but you are considering that he may have secondary HTN and consider RAS as the cause. All of the following statements about RAS are true, except which one?

Your recently hospitalized patient was treated for pneumonia and has now developed pseudomembranous colitis. Which one of the following organisms is responsible for this condition?

A 33-year-old salesman is recovering from an acute viral infection and is worried that he will have liver problems going forward. You advise him that his acute hepatitis was due to a virus, which is not associated with a chronic infection. Which one of the following forms of hepatitis did he have?

A 19-year-old presents with complaints of acute diarrhea with foul-smelling flatulence. He had been camping this past weekend and drinking water from a mountain stream. You suspect a Giardia lamblia infection. Which one of the following statements about giardiasis is true?

You have been caring for a young man with chronic diarrhea and he has been diagnosed with Crohn disease. This condition is associated with which one of the following?

You are seeing a 37-year-old white male with complaints of diarrhea for the past 2 to 3 weeks. He denies blood in the stool, fever, and has no weight loss and no recent travel. Appropriate management at this time includes which one of the following?

A 35-year-old woman has returned from a prolonged stay due to business in the Caribbean islands with a complaint of severe and unrelenting diarrhea. She had not been taking antibiotics and had no history of diarrhea in the past. She has lost weight and com- plains of fatigue. Her blood count shows hemoglobin level of 10 g/dL with a mean cell volume measured at 101 m 3 (normal 80 to 96). The stools are bulky, par- ticularly foul smelling and they float. Which of the following is most likely the best treatment, assuming confirmation of the diagnosis?

A 45-year-old female enters an urgent care center with a complaint of acute abdominal pain. She relates two attacks of less severe abdominal pain within the past 3 months that radiated around the right flank to the mid-thoracic dorsal area. On examination, she exhibits spider angiomata and dilated flank veins. The pain has rapidly built over a period of about 36 hours. The pain radiates through to the back oppo- site the epigastric area and seems to be relieved by leaning forward. Each of the following is true regard- ing this case except for which statement?

Which of the following colorectal cancer screening recommendations would be acceptable for a 35-year- old woman whose father had colon cancer at the age of 55 years and an older brother who had 6 adenom- atous polyps discovered on routine dual contrast barium enema (DCBE) at the age of 48 years?

Which of the following parasite is capable of causing intestinal malabsorption?

A 75-year-old white woman with presumptive recur- rent pneumonia was readmitted to the hospital where she had been kept for 2 weeks as a result of her pro- longed course. She had been discharged on levofloxa- cin. After a period of recovery, she began to have fever again plus weakness, dyspnea, and watery diarrhea with mucus. Upon readmission, she was placed on moxi- floxin and doxycycline, based on x-ray findings of pneumonia. A complete blood count showed a leuko- cytosis level greater than that which had been found on the previous admission, 30,000/mm 3 with a neutro- philia and a left shift toward young cells (band nuclei). Which of the following is the likely cause of her illness?

A man who weighs 220 pounds at a height of 5 ft 10 in. undergoes a routine physical examination. The physician finds the liver to be palpable at 6 cm ( 2 in.) below the right costal margin. A chemical profile shows AST elevated threefold above normal and the ALT twice normal. A needle biopsy shows fatty infiltration (steatohepatosis). Each of the fol- lowing conditions is in the top four most likely causes except for which one?

A 28-year-old woman who admits to a history of intra- venous drug abuse is planning a serious new relation- ship and is concerned about the possibility of passing hepatitis to her new sex partner. A screening test for anti-hepatitis C antibody was negative. You obtain a hepatitis B panel. Which of the following sets of labora- tory findings make the diagnosis of hepatitis B carrier?

Which of the following is the best indicator of a high degree of hepatitis B virus (HBV) replication, hence marker of infectivity?

The woman seeking testing for hepatitis B before start- ing a serious relationship exhibits the following results: HBeAg negative, HBc antibody positive, HBs antibody positive, ALT, and AST levels normal. What is your advice to the patient vis-a-vis her prospective fiancée’? 101 102 NMS Q&A Family Medicine

A 56-year-old male patient who had transfusions 20 years ago and contracted hepatitis C comes to you as a new patient. During your examination, you notice dilated flank veins, redness of the palms, and suspi- cion of ascites. From a computed tomography scan, you find ascites and conclude that the patient has cir- rhosis. Knowing that hepatitis C is a strong risk factor for hepatocellular carcinoma, stronger even than hepatitis B, you decide to begin with a screening baseline test for that disease. Which of the following tests serves that purpose?