REVIEW EXAM

FAMILY MEDICINE IN SERVICE REVIEW

Name:       Training Level:  

 Postgraduate Teaching Program:  Date:  

 

1. A 25-year-old male is evaluated for recurrent low back pain. At each of his previous visits, he was noted to have a sacral torsion. His symptoms improve following osteopathic manipulative treatment, with return of the pain within one to two weeks. The most appropriate next step in evaluating and treating this patient is:

a. bone scan
b. CT scan of the lumbar spine and pelvis
c. HLA-B27
d. MRI of the lumbar spine and pelvis
e. Postural study
 

2. You evaluate the thoracic cage of a patient complaining of left-sided chest pain.
You observe that the fifth rib on the left has a more prominent superior border, with a less prominent inferior border. The intercostals space above the rib is increased, and it is decreased below the rib. There is associated muscle hypertonicity and tenderness surrounding the rib. The most likely diagnosis is:

a. exhalation dysfunction, 4th rib on the left
 b. external rib torsion, 5th rib on the left
 c. inhalation  dysfunction, 5th rib on the left
 d. inhalation restriction, 5th rib on the left
 e. laterally flexed rib, 5th rib on the left

A 30 years-old male is evaluated with a complaint of left hip pain. Hip range of motion is normal. The left ASIS is superior and left PSIS is inferior. A standing flexion test reveals the left PSIS to be more superior when the patient is fully flexed forward.

3. The most likely diagnosis is:

a. left innominate anterior
 b. left innomative posterior
 c. right innomative anterior
 d. right innomative posterior
 e. sacral torsion


4. A 28 -year-old female complains of persistent right hip pain for the past 18 months.
Ibuprofen minimizes, but does not resolve her pain. Her medical history is benign.
Radiographs of her hips, pelvis, and lumbar spine are normal. On examination you note that the ASIS's are level, the sacral sulcus is deeper on the right, and the inferior lateral angle (ILA) is superior on the left. The standing flexion test is negative. The most likely diagnosis is:

a. bilateral sacral flexion
b. innominate rotation
c. innominate shear
d. innominate subluxation
e. sacral torsion

5. Dysfunction of which of the following muscles is most likely to contributes to this patient's problem?

a. left hamstrings
b. left piriformis
c. left quadriceps
d. right hip flexors
e. right piriformis

6. Which of the following muscle energy techniques is most likely to correct the innominate?

a. abduction of the left thigh against resistant
 b. abduction of the right thigh against resistance
 c. extension of the right thigh against resistance
 d. flexion of the left thigh against resistance
 e. flexion of the right thigh against resistance

7. Which of the following is an appropriate response to a biophysical profile report on a patient at 38 weeks of gestation?

a. 8/10 suggests delivery should be immediately facilitated
b. 6/10 should be repeated in 10 days
c. 4/10 should be repeated in one week
d. 2/10 should be immediately followed with a non stress test
e. 2/10 suggest delivery should be immediately facilitated

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8.Which of the following represents a positive screening test for gestational diabetes in a patient at 24-28 weeks of gestation?

a. 2+ glucosuria anytime after 24 weeks of gestation
b. a two-hour postprandrial plasma glucose of 153 mg/dL
c. plasma glucose of 158 mg/dL two hours after a 100 gram glucosa load
d. plasma glucose of 147 mg/dL one hour after a 50 gram glucose load
e. two abnormal plasma glucose values on a 3-hours glucose tolerance test

 
9. A 24 -year-old female of 36 weeks gestation reports that she has noticed decreased fetal activity for the past several days. Her prenatal history is normal. A non stress test (NST) is performed and is found to be "non-reactive". Which of the following is the most appropriate action?

a. repeat NDT twice each week until delivery
b. order a biophysical profile
c. schedule for immediate induction
d. order platelet count
e. order renal function studies

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10. Which of the following statements is TRUE  regarding shoulder dystocia?

a. Tall stature is a risk factor
b. A rapid first stage of labor is a risk factor
c. Most cases can be predicted and prevented
d. Flexing the mother's hips onto her abdomen is frequently effective
e. The immediate application of fundal pressure is frequently effective

11. A 28 -year-old female is hoping to conceive as soon as possible. Her only current medication is lisinopril (Prinivil) for hypertension. Her current blood pressure is 140/90. Which of the following is the most appropriate action regarding her current medication?

a. continue the lisinopril (Prinivil)
b. discontinue lisinopril; begin losartan (Cozaar)
c. discontinue lisinopril; begin furosemide (Lasix)
d. discontinue lisinopril; begin methyldopa (Aldomet)
e. discontinue all antihypertensives

12. Which of the following is recommended for the patient in question 30 while she is attempting to conceive?

a. folic acid supplementation
 b. vitamin A supplementation
 c. varicella vaccination
 d. rubella vaccination
 e. vitamin E supplementation

13. Which of the following statements regarding vaginitis is TRUE?

a. The partner of a patient with bacterial vaginosis should be treated
 b. The treatment of bacterial vaginosis in pregnancy has been proven to decrease the incidence of premature labor
 c. The vaginal pH is usually >4.5 in patients with monilial vaginitis
 d. Patients with asymptomatic trichomonas infections should be treated
 e. Patients with asymptomatic bacterial vaginosis should treated

14. Which of the folowing statements is TRUE:

a. The vaginal pH will be less than 4.5
 b. Treatment of male partners will prevent epididymitis
 c. Failure to treat can lead to pelvic inflammatory disease
 d. Resistant strains are usually sensitive to levofloxacin (Levaquin)
 e. Can be treated effectively with either oral or topical metronidazole

15. For a patient in the third trimester, which of the following findings is supportive of a diagnosis of preeclampsia?

a. uric acid of 6.5 mg/dL
 b. serum potassium of 4.5 mEq/L
 c. +1 ankle edema
 d. alkaline phosphatase of 130 mg/dL
 e. WBC of 11,000

 

This case is to be utilized for the next 2 questions

16. A 25 -year-old female, G1PO, at 39 weeks of gestation presents to he hospital in active labor. Review of her history reveals that her hepatitis B surface antigen is positive, and that she was treated for a group B streptococcal urinary tract infection at 18 weeks of pregnancy. The remainder of her prenatal history is normal. Which of the following intrapartum management strategies is most appropriate for this patient?

a. oral clindamycin
 b. intravenous penicillin
 c. antibiotics only if febrile
 d. intravenous gentamicin
 e. antibiotics only if urinalysis indicates current infection

17. Which of the following is appropriate for the infant after delivery?

a. hepatitis B vaccine only
 b. hepatitis B immune globulin only
 c. group B Streptococcus immune globulin only
d. withhold all immunizations until 2 months of age
 e. hepatitis B vaccine and hepatitis B immune globulin

18. In the acutely injured knee with rapid evolution of tense effusion, which of the following test would most effectively evaluate the anterior cruciate ligament?

a. anterior drawer test
 b. Lachman test
 c. McMurray test
 d. valgus stress test
 e. varus stress test

19. A 50-year-old Caucasian female with a history of untreated hyperthyroidism suffers a compression fracture of the L4 vertebra. Which of the following is an absolute indication for laminectomy?

a. a lower extremity neurological deficit such as weakness of the foot
 b. acute urinary incontinence
 c. chronic low back pain
 d. depression from chronic pain
 e. herniated disk observed on MRI

20. A 22 -year-old female presents to the office with a complaint of bilateral knee pain of three months' duration. The pain is described as an ache behind the patella. There is no history of injury. The pain is worsened with climbing stairs. On examination, the patient has a positive patellar grind and negative McMurray and drawer tests. The patient is noted to have weak vastus medialis muscles bilaterally. The most likely diagnosis is:

a. anterior cruciate ligament tear
 b. medial meniscal tear
 c. patellar dislocation
 d. patello-femoral tracking syndrome
 e. posterior cruciate ligament tear

21. An 11-year-old male complains of a swollen, red tender thigh. Seven weeks ago he was involved in a motor vehicle collision and suffered an open fracture of the distal right femur. This was surgically debrided an reduced, an external fixators were applied and parental antibiotics administered. He was doing well in rehabilitation when the current symptoms appeared quite suddenly. The best study to establish the underlying condition is:

a. blood cultures
 b. bone cultures
 c. magnetic resonance imaging
 d. technetium bone scan
 e. wound cultures by biopsy

22. A patient presents with pain and swelling of the left ankle secondary to a fall. He has pain with weight-bearing and decreased range of motion. There is mild to moderate ecchymosis and tenderness over the anterior talofibular ligament. There is mild instability. This injury is classified as a:

a. grade l ankle sprain
 b. grade ll ankle sprain
 c. grade lll ankle sprain
 d. grade lV ankle sprain
 e. grade V ankle sprain

23. A 65-year-old African-American male presents with a complaint of pain in his right foot. Two days ago he suffered a mechanical fall and bruised his right shin. He reports no other injury. Prior medical history is positive for myocardial infarction, congestive heart failure, hypertension and atrial fibrillation. His medications include nadolol (Corgard®),  digitoxin (Lanoxin®),  lovastatin (Mevacor®), furosemide (Lasix®), and warfarin (Coumadin®). On examination he has extensive ecchymosys of his right lower leg. His right foot is cool to tooch and no pulses can be palpated. The most appropriate approach is:

a. angiography
 b. neurosurgical consult for cauda equina syndrome
 c. orthopedic consult for fasciotomy
 d. pulsed topical oxygen at psi
 e. vascular surgery consult for angioplasty

                                

                                        

                                  

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