Download Medicine PreTest Self-Assessment and Review 14th Edition PDF Free Medicine: PreTest Self-Assessment & Review is the perfect way for you to. 2 Jenny Quintana This Test Booklet contains: an Entry test tests for each File, in A and B versions Traveller Pre-Intermediate - Key to Test Booklet Traveller. Medicine PreTest Self-Assessment and Review 13th Edition [PDF]. Medicine PreTest Self-Assessment and Review 13th Edition [PDF].

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Views KB Size Report. DOWNLOAD PDF Pretest Self- Assessment and Review: Preventive Medicine and Public Health · Read more. Medicine PreTest Self-Assessment and Review 14th Edition PDF - If you found this book helpful then please like, subscribe and share. Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug.

The USPSTF has found that CT scanning, chest x-ray, and sputum cytology can detect lung cancer at an earlier stage than no screening at all, but also found no evidence that any screening strategy actually improves mortality. Therefore, no screening is recommended for this patient.

Of the interventions listed above, only prescribing folic acid has been shown to be beneficial prior to pregnancy. It will decrease the chance of neural tube defects in the baby. The other interventions should be done early in the pregnancy to ensure good pregnancy outcome. The American Academy of Family Physicians recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults beginning at age 50 and continuing until age The risk and benefits of these screening methods vary.

When there is a family history of colon cancer, it is generally recommended to start screening 10 years before the cancer was found in the family member, or at age 50, whichever is sooner.

M ammographic screening has been shown to decrease mortality from breast cancer. However, screening interval and recommendations have changed based on evidence review. There is a stronger recommendation that women between the age of 50 and 74 should get screening mammograms every 2 years.

Therefore, in this question, the correct answer is to begin routine screening at age The issues surrounding breast self-examination BSE remain controversial. While it is true that most breast cancers are found by women not by mammography or by clinical breast examination , the American Academy of Family Physicians AAFP and the USPSTF have reviewed the evidence and found that a significant number of additional imaging procedures and biopsies were performed for women performing BSE than control participants.

Prior to , there was insufficient evidence to recommend for or against teaching or performing BSE. There is evidence supporting DRE and PSA testing as a prostate cancer screen, but concerns exist regarding false-positive tests and any actual reduction in mortality that is gained from doing the tests. Therefore, AAFP feels the evidence is insufficient to recommend for or against routine prostate cancer screening in men younger than 75 years. In patients who are interested in screening, physicians should discuss the potential benefits and harms with the patients before making a decision to test.

There is a strong recommendation from AAFP for cervical cancer screening at least every 3 years for women who have ever had sex and have a cervix.

However, the optimal age at which to begin screening is less clear. Indirect evidence, coupled with the natural history of HPV infection, indicates that screening can safely be delayed until 3 years after the onset of sexual activity or age 21, whichever comes first.

Guidelines for low-risk women indicate that Pap testing should be conducted at least every 3 years in women who have ever had sex and still have a cervix. The guidelines regarding when to discontinue testing are not as clear.

The American Cancer Society recommends discontinuing screening at age 70, but also notes that a woman who has had three or more documented normal, technically satisfactory Pap tests, and has had no abnormal Pap tests in the last 10 years can safely stop screening.

The AAFP and the USPSTF recommend against routine referral for genetic counseling or routine genetic testing for breast cancer mutations when women do not meet specific high-risk criteria. In non-Ashkenazi Jewish women, high-risk criteria are: Ashkenazi Jewish women should be offered testing if any first-degree relative or two second-degree relatives on the same side of the family are diagnosed with breast or ovarian cancer.

Since the patient in this question does not meet the criteria, she should not be offered testing. The purpose of the preoperative evaluation is to identify and manage risk. The primary care physician is frequently asked to perform this evaluation on surgical patients. All surgeries involve some level of risk, and the evaluation allows the patient to balance the risks involved in surgery against the potential benefits, and allows the physician to minimize risks before, during, and after the procedure.

Potential surgical complications involve infectious wound infections, pneumonia, urinary tract infections, bacterial endocarditis, and sepsis , cardiac myocardial infarction, cardiac arrest, pulmonary edema, and complications of congestive heart failure , pulmonary pneumonia, atelectasis, bronchitis, respiratory failure , thrombosis peripheral venous thromboembolism, arterial thrombosis adverse reactions to anesthesia, gastrointestinal ulcer disease, ileus, hyperemesis , and psychologic delirium, exacerbation of existing psychiatric disease complications.

Of the complications listed, cardiac events are the events that are most likely to be lethal. Pulmonary complications are most likely to be seen in children and are common in obese patients, but are less likely to be lethal.

The preoperative workup should include a risk assessment of the type of surgery being performed. As a general rule, preoperative workups should be more thorough for patients undergoing higher risk surgeries. There are three categories of risk: They generally do not require additional cardiac preoperative testing. High-risk procedures have high anticipated blood loss and include aortic or peripheral vascular surgery. The American College of Cardiology and the American Heart Association have printed guidelines for preoperative cardiac evaluation.

If a patient has no known heart disease, the evaluator should look at clinical predictors for heart disease. M ajor clinical predictors would require coronary artery evaluation prior to surgery, and include unstable coronary syndromes, decompensated congestive heart failure CHF , significant arrhythmias, or severe valvular disease.

Intermediate clinical predictors include mild angina, a prior M I, compensated CHF, diabetes, and renal insufficiency. In a patient with poor functional capacity, noninvasive testing is recommended. In the question above, the patient has diabetes an intermediate clinical predictor and poor functional capacity. Therefore stress testing is recommended.

Recent coronary revascularization is a risk for poor perioperative outcomes. People with clinically important coronary artery disease should defer noncardiac procedures until 6 months after revascularization, when possible.

If surgery is necessary within 6 months after revascularization, repeated evaluation of the coronary arteries is necessary prior to surgery. In this case, because the surgery is elective, the patient should defer the surgery until 6 months has elapsed from the time of coronary revascularization.

If the patient is asymptomatic at that time, the patient may be able to proceed to surgery without reassessment. Asymptomatic patients who have had a normal stress test in the past 2 years, bypass surgery in the past 5 years, or angioplasty in the past 5 years are unlikely to have developed significant new disease.

Current recommendations are that these people may proceed to surgery without further cardiac workup. However, some experts suggest screening ECG should be done in patients older than 55 or with known cardiac disease. Assessment of left ventricular function such as an echocardiogram is not recommended, as it will unlikely change the perioperative management of the patient. Pulmonary complications from surgery are most common in surgeries that are anatomically close to the diaphragm. Preexisting respiratory disease increases the change of bad outcomes, and smoking is a risk factor for pulmonary problems after surgery.

Despite this, chest x-ray is not indicated as a routine baseline test for patients undergoing surgery. It may be indicated for the evaluation of physical examination abnormalities or reported symptoms of dyspnea or cough, but it is unhelpful in the absence of these symptoms. Pulmonary function testing is useful for demonstrating the status of asthma or chronic obstructive pulmonary disease COPD prior to surgery, but would not be an effective routine test in the absence of these diagnoses or symptoms leading one to suspect these diagnoses.

Pulse oximetry or arterial blood gasses are rarely useful in the preoperative patient without symptoms. M ore than 50 million Americans travel abroad each year.

Medicine PreTest Self-Assessment and Review 13th Edition [PDF]

M ost morbidity and mortality related to international travel is caused by common preventable health concerns, not by unusual diseases. It is followed by upper respiratory infection URI , viral syndromes, skin conditions, parasitic infections, malaria, hepatitis, and other more rare infections.

Heart disease is the most common cause of death while traveling, likely because it is such a common cause of death in general.

While traveling people engage in risky behavior that they otherwise might not indulge in. Dangerous recreation activities, increased drinking, driving in foreign countries all contribute to causing accidents. Discussing accident prevention is therefore the key when counseling patients planning to travel abroad. M ost of the times, the condition is self-limited. The CDC does recommend using common sense regarding food and water, eating nothing unless it is boiled, peeled, or cooked.

Yellow fever is the only legally required immunization and then, only for some countries. A single inactivated polio vaccine IPV booster is recommended for adult travelers who have had primary polio immunization, but who will be traveling to an area where polio is endemic. Cholera and typhus are generally not required immunizations for travelers. Hepatitis A is the most common vaccine-preventable illness acquired by travelers, but vaccination is not required.

South-Paul, pp In some patients, COCs cause a small increase in blood pressure. This risk increases with age. Both estrogen and progestin are known to cause blood pressure elevations, so changing formulations of COC or using progestin-only pills may not lead to problem resolution.

Once COCs are discontinued, blood pressure usually returns to normal within 3 months. Side effects of COCs include androgenic effects hair growth, male pattern baldness, nausea. Weight gain is thought to be a common side effect, but multiple studies have failed to show it to be a statistically significant side effect.

The side effect most frequently cited as the reason for stopping the use of COCs is irregular bleeding. It is common in the first 3 months of use and generally diminishes over time. The use of COC pills is associated with a threefold risk of venous thromboembolism.

COCs have a protective effect against ovarian cancer and endometrial cancer. The risk of hemorrhagic stroke is not increased by the use of COCs, and they have not been shown in studies to impact carbohydrate metabolism in a statistically significant way.

It is important to counsel patients appropriately if they miss an oral contraceptive pill. If an active pill is missed at any time, and no intercourse has occurred in the past 5 days, two pills should be taken immediately and a backup method should be used for 7 days.

If intercourse occurred in the previous 5 days, emergency contraception should be used immediately and pills should be restarted the following day. A backup method should be used for 5 days. There is no need to change contraceptive method. Progestin-only pills prevent conception through suppression of ovulation, thickening of cervical mucus, alteration of the endometrium, and inhibition of tubal transport.

The effectiveness of this method is dependent on consistency of use. In fact, if a pill is taken even after 3 hours, an alternative form of contraception should be used for 48 hours. There is no hormone-free period with these pills, and they should be taken every day. The pills do not carry an increased risk for thromboembolism, and the World Health Organization has reported this form of contraception to be safe for women with a history of venous thrombosis, pulmonary embolism, diabetes, obesity, or hypertension.

Nursing women can use this pill, but there is FDA approval for use in others as well. In general, progestin-only pills protect against ectopic pregnancy by lowering the chance of conception. Therefore, users should be aware of the symptoms for ectopic pregnancy.

Oral contraceptive pills containing estrogen and progestin components are contraindicated in smokers older than 35 years, because of an increased risk of thromboembolic events. An intravaginal ring or transdermal patch that releases estrogen and progestin is also contraindicated in smokers older than 35 years for the same reason. Women who use IUDs for contraception are at higher risk for acquiring a sexually transmitted infection and developing pelvic inflammatory disease PID as compared to women who use barrier or other hormonal birth control methods, and patients should be screened carefully.

An injectable long-acting progestin would therefore be the best choice in this woman. Emergency contraception is appropriate when no contraception was used including cases of sexual assault , or when there is contraceptive failure.

They should be used within 72 hours of intercourse, well before implantation implantation occurs days after intercourse. ECPs involve limited hormonal exposure, and therefore have not been shown to increase the risk of venous thromboembolism, stroke, or M I.

In fact, there are no medical contraindications to the use of emergency contraception pills. They do not disrupt an already implanted pregnancy and do not cause birth defects. There is no need to perform a pregnancy test when prescribing. The pedigree shown is for an autosomal dominant condition.

As the pedigree shows, males and females in the family are equally affected, and parents are transmitting the gene to their offspring vertical inheritance.

X-linked recessive traits affect more males than females, and X-linked dominant traits affect more females than males. The pedigree shown is for an X-linked recessive condition. As the pedigree shows, the condition affects more males than females, and inheritance is through the maternal side of the family diagonal inheritance. All daughters of an affected male are carriers, and none of his sons are affected. If this were an autosomal dominant condition, males and females would be equally affected, and parents would transmit the gene to their offspring.

If this were an autosomal recessive trait, horizontal inheritance would be present, with multiple children being affected from unaffected parents. If it were X-linked dominant, more females would be affected than males.

Cytogenetic analysis is a microscopic study of the chromosomes and is used to identify abnormalities in chromosome number, size, or structure. It is commonly ordered when patients are suspected of having a recognizable chromosomal syndrome trisomy 21 and in newborns with multiple malformations of unknown etiology or with ambiguous genitalia. Direct DNA testing is indicated for patients affected or predisposed to a condition for which the gene change that causes the condition has been identified cystic fibrosis.

Biochemical tests identify or quantify metabolites or enzymes to measure activity, and are commonly used to diagnose and monitor disorders of metabolism. Linkage analyses identify genetic sequences that are physically in close proximity to a disease gene of interest.

Rosner, pp Sensitivity is thought of as the probability that a symptom is present given that the person has the disease. Specificity can be thought of as the probability that the symptom is not present given that a person does not have a disease.

A false-negative is defined as a person who tests negative, but who is actually positive. Sensitivity is defined as the probability that the test would be positive, given that the person has strep throat. The specificity is the probability that the test would be negative if the person does not have strep.

The false-positive rate is defined as the percent of people who test positive, but are actually negative. The positive predictive value is the probability that a person has an illness, given that the test is positive. The incidence of a disease is the probability that a person with no prior disease will develop a new case of the disease over a specific time period. In this case, people developed diabetes. In the study, only people began with no prior disease.

The prevalence is the probability of having a disease at a specific point in time, and is obtained by dividing the number of people with the disease by the number of people in the study.

The p value for any hypothesis test is the level at which we would be indifferent between accepting or rejecting the null hypothesis given the sample data at hand. It can also be thought of as the probability of obtaining a test statistic as extreme or more extreme than the actual test statistic obtained, given that the null hypothesis is true. It does not reflect the absolute difference in the data between groups and the correctness of the data in the sample.

The positive predictive value refers to the probability that a positive test correctly identifies an individual who actually has the disease.

The negative predictive value is the probability that a negative test correctly identifies an individual who does not have the disease. Doctor-Patient Issues Questions Communication You are performing a medical interview with a patient and having some difficulty obtaining accurate information regarding the events that brought him into the office. Which of the following physician communication tactics leads to the collection of the most accurate information?

Controlling the interview with more directive questions b. Using medical terms that the physician feels the patient can understand c. Using open-ended questions You were involved in a minor motor vehicle accident on the way to work. As a result, you saw your first patient of the morning more than 1 hour after the scheduled appointment time. When you walk in, he appears extremely angry. Which of the following alternatives is the most patient-centered way to approach this situation? Explain what happened so that he will understand why you are late.

Apologize for the delay and efficiently take care of his problem. Explore the reasons for his anger if he brings it up. Help the patient understand that his anger should be directed at his illness, not at you. You are having trouble caring for a year-old woman with uncontrolled diabetes. Which of the following is the most effective way to measure her adherence to the prescribed medical regimen?

Ask her if she is taking her medications. Look for a reduction in her blood glucose measurements in subsequent visits.

Have her bring in her medications so that you may perform pill counts. M easure serum blood levels of her medications.

Ask her specific questions about her medication names, dosages, and administration times. You are seeing a year-old woman who has smoked for 50 years. You want her to quit, and are considering different communication tactics to use in the discussion. Which of the following is likely to be the most powerful motivator? Point out the positive results that can be expected if she complies with your advice. Point out the consequences of not following your advice.

Provide data. Ask about her experience with the illness that she is at risk for. A year-old man is following up to discuss the results of laboratory tests you did at his complete physical examination 1 week ago. His human immunodeficiency virus HIV screen was positive, and you need to tell him this news.

Which of the following is the most appropriate approach? Begin the session by inquiring about his understanding of HIV. Ensure you schedule enough time to discuss treatment goals and options. M ake sure he brings a support person into the room before you disclose the test results. Regarding patient education and counseling, which of the following statements is true? Patients usually understand and remember most information from their physician. Patients commonly believe that physicians give them too much information.

Patients are more likely to make behavior changes if they are given several options for change from which to choose. Physician eye contact does not improve patient recall.

Patients feel patronized when physicians repeat information. You are treating a year-old Chinese immigrant. You diagnose type 2 diabetes, but the patient is reluctant to make the dietary changes necessary to help treat the condition, as much of her high glycemic index diet is culturally based. Which of the following is the most culturally appropriate approach?

Ask to involve her Americanized children in future communication to help encourage the changes. Since her culture believes that health is a balance between yin and yang, tell her that the dietary changes you suggest will restore this balance.

Organize an appointment with the patient and a diabetes educator who can better take the time and explain the etiology and dietary regimen necessary for diabetes. Use a Chinese interpreter to ensure your message is being heard appropriately.

You are caring for a patient originally from M exico and are communicating with the help of a Spanish-speaking interpreter. Which of the following statements is true regarding the effective use of an interpreter? Ask the interpreter to explain your statements, when necessary. Arrange seats in a triad, and speak slowly, facing the interpreter. Act as if the interpreter is not present, speaking to the patient normally.

Use as many nonverbal gestures as possible. If you get an unexpected response, repeat the same question over again. You are interacting with a patient who has emigrated from Russia. The patient is not complying with the treatment plan you outlined for his hyperlipidemia. Which of the following is the most effective way to improve this situation? Speak with Russian colleagues to better understand the Russian culture. Refer the patient to a physician from the same cultural background as the patient.

Study the Russian culture as it relates to illness and healing, and offer alternatives for treatment consistent with the cultural norms. Examine the beliefs of Russian culture and use these beliefs to convince the patient to comply with treatment.

You are working at a medical office whose population includes a large proportion of Native American patients. Which of the following health issues has a higher prevalence in this population than in other American population groups?

Hypertension b. Coronary artery disease c. Obesity d.

Asthma e. Tuberculosis You are working in an office that provides care to a large population of homeless patients. Which is true about medical illnesses in homeless children as compared with other groups of children? Homeless children are more likely to develop type 2 diabetes.

Homeless children experience a higher number of ear infections. Homeless children are more likely to have chronic illness. Homeless children are more likely to have depression. Homeless children are more likely to have attention-deficit disorders. You are working in an office that serves a large uninsured population. Which of the following is true regarding this population as compared to the privately insured population?

This population has fewer chronic health conditions. This population has a lower mortality rate. This population has a better general health status. This population has a better mental health status.

This population has a higher rate of chronic disease among children. You are evaluating health disparities in your community and using mortality rates as a measure of overall health. Which of the following population subgroups in the United States has the lowest mortality rate at each age of the lifespan?

African Americans b. Hispanic Americans c. Native Americans d. Asian Americans e. Non-Hispanic white You are evaluating a Hispanic patient with multiple somatic complaints and suspect a mental health disorder.

Which of the following is true regarding mental health disparities in the United States today? M ental health disorders are diagnosed less frequently in minority populations than in non-Hispanic white patients. It is uncommon for minority groups to express mental health disorders via somatization. M inority patients are more likely to be misdiagnosed than nonminority counterparts.

M inorities who maintain cultural practices and resist involvement in the dominant culture have better mental health. Culture is less of a factor in mental health than in other organic syndromes or illnesses. Ethics and Professionalism You are taking care of a year-old woman with a urinary tract infection.

You prescribe trimethoprim-sulfamethoxazole Bactrim for her infection, but forget to ask about her allergies. Which of the following fundamental principles of medical professionalism has been violated? The principle of primacy of patient welfare b. The principle of patient autonomy c. The principle of social justice d.

The principle of professional competence e. The principle of honesty with patients You are working with a physician who is treating a patient for hypertension. The patient has a documented allergy to angiotensin-converting enzyme inhibitors, and you note that the physician is prescribing them. You assume that the physician knows best, and do not let the physician know of the potential mistake.

What professional responsibility have you violated? Commitment to honesty with patients b. Commitment to professional competence c. Commitment to maintaining appropriate patient relationships d. Commitment to improving quality of care e. Commitment to maintaining trust You are working as a student in the emergency room. After a cardiac arrest and a prolonged attempt at resuscitation, a patient dies. The attending physician asks if you would like to gain experience by practicing intubations on the patient who has died.

You feel that this relates to one of your professional responsibilities, to maintain clinical competence, and consider the offer.

Which fundamental principle of professionalism and ethics would be violated if you do this? The principle of patient welfare b. The principle of honesty with patients e. The principle of maintaining trust There are other health care providers in the elevator. What professional responsibility has your senior resident violated? Commitment to maintaining trust b. Commitment to improving quality of care c. Commitment to professional competence d. Commitment to scientific knowledge e.

Commitment to patient confidentiality One of your patients is 6 months pregnant, and is found to have a medical condition that, if left untreated, will be life-threatening to both her and the fetus. She believes that God will take care of her and the baby, and she refuses medical intervention offered to her. Which of the following best describes the principle of patient autonomy in this case?

She has no right to refuse the intervention, based on the fact that her decision is lethal to both her and her unborn infant. She has no right to refuse the intervention, based on the fact that her decision is lethal to her infant. She has the right to refuse the intervention regardless of the condition. She has the right to refuse the intervention, only if the father of her baby agrees. She has the right to refuse the intervention if she is found competent to make the decision.

You are caring for a year-old man with metastatic cancer. He thoroughly understands his condition, and realizes that he has only a few months to live. Tell her the truth about the situation because she has a right to know. Tell her the truth because you have the legal obligation to do so. Consult the ethics committee to help you make the decision.

You are caring for a patient who has suffered with amyotrophic lateral sclerosis ALS for several years. During the past month, she has been hospitalized twice with aspiration pneumonia and has required mechanical ventilation. She was admitted to the hospital again 4 days ago with difficulty in breathing and was found to have another pneumonia.

She is not responding to volume or pressers. Her creatinine rose today to 5.

Which of the following statements is most accurate regarding her situation? The patient is terminally ill and the physician should recommend withdrawal of support. The patient is terminally ill, but the physician cannot withdraw intervention as it would hasten death. The patient is experiencing an acute decompensation of a chronic condition and aggressive treatment is indicated.

The principle of beneficence requires aggressive treatment in this case. You are working in a small town emergency department with an attending physician trained in family medicine when the paramedics bring in a year-old woman after a car accident.

She suffered massive head trauma from the accident, and brain tissue is actually extruding from her skull. When the attending physician meets her family, they demand that she be transferred to the operating room for neurosurgery. Which of the following is the most ethically sound response? The physician should continue physiologic support until a health care power of attorney is identified and can make treatment decisions.

The physician should recommend a DNR do not resuscitate status, but continue support and discussions with the family. The physician should continue support until a court-appointed surrogate is identified. The physician should refuse to pursue further treatment. A patient with severe Alzheimer disease is admitted to the hospital for pneumonia. The patient is usually cared for at home, and has no living will or health care power of attorney.

Code status is not obtained upon admission. During hospitalization, the patient suffers a cardiac arrest. Which of the following is most appropriate? The patient should be resuscitated. The patient should have cardiopulmonary resuscitation CPR , but no intubation. The patient should have CPR, but no pressors should be given. The patient should not be resuscitated because care is futile.

The patient should not be resuscitated because he has a poor quality of life. While working in the hospital, you get called to help during a code blue. The patient is a year-old Caucasian female with a history of hypertension. The arrest was witnessed by a floor nurse and the initial rhythm was ventricular fibrillation.

Which of the following characteristics of this situation make CPR less likely to be successful? The fact that it was a witnessed arrest b. The fact that the initial rhythm was ventricular fibrillation c. You are working with a patient with advanced multiple sclerosis M S.

He has just been diagnosed with pneumonia and is being treated for respiratory failure. In the past, he has discussed with his family and his physician that he does not wish to be on permanent mechanical ventilation.

Neurology consultation has determined that his respiratory insufficiency is due to a combination of his M S and pneumonia. The physician writes a DNR order, but the family disagrees.

Which of the following is most correct in this situation? The DNR order should stand and be enforced. The court should determine if the DNR order should stand or not. The hospital ethics committee should be consulted. The physician should remove himself from the case. You are caring for a patient who has just assumed the home care for his father. The father has inoperable lung cancer, and it is expected that he has less than 6 months to live. The father and your patient want to be sure that in the event of an emergency requiring activation of emergency medical service providers, the emergency medical service EM S team does not resuscitate the father.

Which of the following is true regarding DNR orders in the home? EM S providers must resuscitate patients if they are called to respond to an emergency. The hospital DNR orders automatically transfer to the home setting and nothing needs to be done to ensure they will be followed by EM S providers. In order for a DNR order to be followed in the home, the attending physician must re-write a DNR order, and the family must produce it when EM S providers enter the home.

You are caring for an obese patient who would like for you to prescribe amphetamines to help her lose weight. You feel this is an inappropriate treatment. According to the ethical principle of autonomy, which of the following is correct? The patient must respect your decision not to prescribe amphetamines because of physician autonomy. The patient must respect your decision because the principle of physician paternalism overrides patient autonomy in this case.

You should refuse to treat the patient.

Medicine PreTest Self-Assessment and Review 13th Edition [PDF]

You are caring for a woman who has lung cancer and is discussing treatment options with you. She is choosing radiation therapy over surgery, despite the fact that the 5-year survival rate for radiation is lower than the 5-year survival rate for surgery for her type of cancer. You think surgery is the better option. The patient should have surgery because of physician autonomy. You are evaluating a year-old man who has a new complaint of back pain.

He lost his wife to breast cancer 8 years ago and has recently decided to marry his girlfriend. His workup includes lumbar spine x-rays that reveal metastatic lesions. The principle of patient autonomy dictates that you wait to tell the patient until his return.

The principle of physician autonomy dictates that you tell the patient at this visit. The principle of beneficence dictates that you wait to tell the patient until his return. The principle of physician paternalism dictates that you tell the patient at this visit. The principle of honesty dictates that you tell the patient at this visit. You are working with a patient who has been on benzodiazepines for more than 2 years. She was initially prescribed the medication for help with sleep, but you are now concerned that she has become dependent.

You decide to withdraw her from the medication using a trial of placebo sleeping aids. Which of the following statements is most correct regarding the use of placebos in this situation? Placebo use is never ethical. Placebo use is not ethical in this case. Placebo use is ethical in this case because the alternative to placebo use is unacceptable. Placebo use is ethical in this case because the patient is demanding treatment.

Complementary and Alternative Medicine The practice where you are working cares for a wide variety of patients. Which of the following subgroups is most likely to explore and use complementary and alternative medicine CAM? Children b. College students c.

Women e. The elderly Traditional therapies have offered limited benefit to a year-old woman who suffers from migraine headaches, and she asks you about alternative therapies. She currently takes mg of enteric-coated aspirin a day, and paroxetine, 20 mg daily.

Which of the following has the lowest risk of toxicity or harm? M egavitamins c. M acrobiotic diet d. Ginkgo biloba e. Acupuncture You are caring for a year-old woman who is depressed. She would like to try an alternative therapy, but is worried about the risks of different modalities. Which of the following therapies is most risky? M editation b. Guided imagery c.

Homeopathy e. You are caring for a year-old man with hyperlipidemia. He is complaining of difficulty starting his urinary stream and increasing nocturia. Which of the following botanical medicines has been shown to improve this situation? Gingko biloba b. Saw palmetto c. Garlic d. Bee pollen e. You are working with a smoker who has failed several attempts to quit smoking. He decides to try hypnosis in an effort to finally quit.

Which major domain of alternative medicine does this best fit under? Alternative health care systems b. M ind-body interventions c. Biologically based therapies d. Energy therapies e. Bioelectromagnetics Palliative Care After a prolonged fight with colon cancer, your year-old patient decides to forego further attempts at curative treatment and focus on palliative care.

He has tried nonsteroidal anti-inflammatory agents and acetaminophen for management of his pain, but this has been ineffective. Which of the following would be the best initial pain-management regimen?

A steroid burst to get the pain under control, then scheduled nonsteroidal antiinflammatory medications to maintain pain control. A long-acting narcotic pain patch at the lowest dose that controls the pain. A short-acting narcotic on a scheduled basis, with the possibility of additional short-acting narcotics as needed for breakthrough pain control.

A long-acting narcotic, with a short-acting narcotic as needed for breakthrough pain. A patient-controlled analgesia device using opioids. Your patient has terminal cancer with a life expectancy of less than 3 months. You are managing her chronic cancer pain with morphine sulfate. She has been stable and on the same dosage of medication for weeks, but is now requiring increasing amounts of opiates to maintain pain control.

Which of the following statements is true regarding this situation? The patient is developing tolerance and you should increase her medication. The patient is developing tolerance and you should maintain the dosage of medication to avoid dependence.

The patient is developing tolerance and you should slowly withdraw medication.

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You are caring for a year-old man with severe end-stage chronic obstructive pulmonary disease but a life expectancy longer than 6 months. One month ago, he developed a rash. The rash consisted of grouped vesicles on erythematous bases in a dermatomal pattern.

You effectively treated the rash, but the patient complains of a persistent burning and itching pain in the same area as the rash.

The pain is significant and keeps him from sleeping. What is the best approach for long-term pain management in this patient? Nonsteroidal anti-inflammatory agents b. Opiate analgesics c. Steroids d. Anticonvulsants e. Selective serotonin reuptake inhibitors You are caring for a year-old man with lung cancer.

He was diagnosed 4 months ago, and is not expected to live for more than 2 months. He is experiencing dyspnea. Which of the following is most likely to relieve his symptoms? Opioids b.

Nebulized morphine c. Benzodiazepines e. Albuterol You are caring for a year-old man who has had colon cancer for 3 years. Therapies have been unsuccessful, and he has chosen palliative care only. He complains of excessive fatigue, feeling tired after minimal activity, and lacking energy to perform the activities of daily living.

Emergency medicine: pretest self‐assessment and review, second edition

He denies depression, and feels he is handling his diagnosis well with the support of his family and friends. His laboratory evaluation is normal, except for mild anemia. Which of the following therapies would be most likely to help his symptoms? Transfusion b. Selective serotonin reuptake inhibitors d. Sedative hypnotics e. A Psychostimulant, like methylphenidate You are treating a year-old patient with end-stage ovarian cancer. You are concerned that she may be developing depression.

Which of the following would be the most reliable symptom of depression in this patient? Loss of appetite b. Fatigue c. Insomnia d. Sadness e. Anhedonia You are caring for a year-old woman who is dying of breast cancer. Her family wonders how to recognize the symptoms of impending death.

Which of the following is a reliable sign that death is near in this patient? Delirium b. Episodic hyperalertness c. Decreased communication d. Desire for favorite food e. Increased attention to dates and time You are making a home visit to a year-old man with terminal cancer.

His family says that his breathing seems to be labored. Which of the following drugs would be most useful in controlling this symptom?

Atropine b. Ketorolac c. Lorazepam d. Haloperidol e. A year-old sexually active homosexual male asks you about his risk for hepatitis. He is currently asymptomatic and unsure of his immune status. Which of the following should you recommend? Vaccination against hepatitis A only b. Vaccination against hepatitis B only c. Vaccine against hepatitis C only d. Vaccinations against both hepatitis A and B e.

Vaccinations against both hepatitis B and C A year-old homosexual man presents with blood on the toilet paper when wiping. Examination of the anal mucosa reveals this condition.

Which of the following statements is true regarding this condition? The Color Atlas of Family M edicine. New York, NY: McGraw-Hill; This condition is rarely seen in men who are not immunocompromised. The patient should be treated with intramuscular penicillin once a week for 3 weeks. The patient should be treated with valciclovir. The patient should be treated with one dose of azithromycin. A year-old gay male asks you about how his sexuality impacts his cancer risks.

Which of the following statements most accurately reflect his risk for cancer? Homosexual men have an increased rate of oral cancer. Homosexual men have an increased rate of colon cancer. Homosexual men have an increased rate of liver cancer.

Homosexual men have an increased rate of testicular cancer. Homosexual men have an increased rate of anal cancer. You are caring for a year-old lesbian woman. She has recently left a year monogamous relationship and is concerned about her risk for vaginal and other infections, once she resumes sexual activity with a new partner. Which of the following is true regarding her concern? The rate of sexually transmitted infections STIs among lesbians is less than the rate in heterosexual women.

The rate of genital warts is higher in lesbians than in heterosexual women. The rate of bacterial vaginosis is higher in lesbians than in heterosexual women. The rate of genital herpes is higher in lesbians than in heterosexual women.

Sexually active lesbians have a lower prevalence of HIV than women who have sex exclusively with men. You are caring for a year-old lesbian with no family history of breast cancer.

She asks you about her risk of having breast cancer. Which of the following is true regarding breast cancer among lesbian women? Breast cancer rates do not differ between lesbians and heterosexual women. Breast cancer rates are higher among lesbians because of nonparity. Breast cancer rates are higher among lesbians because of obesity. For matching sets, a group of questions will be preceded by a list of lettered options. For each question in the matching set, select one lettered option that is most closely associated with the question.

Each question in this book has a corresponding answer and a short discussion of various issues raised by the question and its answer. A listing of references for the entire book follows the last chapter. To simulate the time constraints imposed by the qualifying examinations for which this book is intended as a practice guide, the student or physician should allot about one minute for each question.

After answering all questions in a chapter, as much time as necessary should be spent in reviewing the explanations for each question at the end of the chapter. Attention should be given to all explanations, even if the examinee answered the question correctly. Those seeking more information on a subject should refer to the reference materials listed or to other standard texts in medicine. If you found this book helpful then please like, subscribe and share.

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This site uses Akismet to reduce spam.The answer is D. Users of COC pills have an increased risk of diabetes mellitus. Acute inferior MI can cause ischemia of the papillary muscle and thus acute mitral insufficiency.

A The first signs of toxicity are dizziness, tinnitus, periorbital tingling, and nystagmus B Systemic convulsions are rare and usually self-limited C Most allergic reactions are to aminoamide compounds D For patients allergic to local anesthetics, diphenhydramine hydrochloride 1 percent can be injected into the wound E To prevent toxicity, avoid rapid injections of local anesthetic into the wound Which of the following tests would be MOST appropriate at this point?

You are working in an office that provides care to a large population of homeless patients. Which of the following is true regarding this population as compared to the privately insured population?

Surgery should be deferred, as her risk is too great.