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1 | |
Which of the following statements concerning "practice guidelines" is correct? |
| | A) | Physicians must follow clinical practice guidelines to the letter in order to avoid malpractice lawsuits |
| | B) | Only guidelines that come from governmental agencies are relevant for the practicing clinician |
| | C) | Guidelines can protect patients from receiving substandard care |
| | D) | Guidelines are based on the premise that cost must be reduced in the practice of medicine |
| | E) | Guidelines can be expected to apply only to those patients in a "managed care" setting |
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2 | |
A 51-year-old married father of three presents with epigastric abdominal pain and weight loss. Computed tomography (CT) of the abdomen reveals an extensive mid- pancreatic mass with obvious liver metastases. Needle biopsy of one of the hepatic lesions is consistent with pancreatic adenocarcinoma. At this point the patient's primary care physician should tell the patient |
| | A) | that a referral to an oncologist will be made |
| | B) | the nature of histology and refer the patient to an oncologist and defer discussion of the prognosis |
| | C) | to get his affairs in order as quickly as possible |
| | D) | that we now have effective therapy for pancreatic carcinoma |
| | E) | that he has an extremely serious life-threatening illness, but that all measures will be undertaken to extend the quantity and quality of the patient's life |
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3 | |
A 35-year-old woman with a severe anxiety neurosis develops acute appendicitis. The primary care physician, the surgical consultant, and the infectious disease consultant all recommend urgent appendectomy. The patient wants to be treated only with antibiotics because she is concerned about the risks of anesthesia. The patients states she understands the reasons for the physician's recommendations and that she might die if she does not have this operation, yet she feels strongly that this is what is best for her. At this point the most appropriate course of action would be to |
| | A) | call a psychiatrist |
| | B) | tell the patient that you cannot treat her and refer her to another hospital |
| | C) | declare the patient legally incompetent, restrain her, and perform surgery since it will be life saving |
| | D) | treat the patient with antibiotics |
| | E) | call a lawyer |
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4 | |
What is the most important principle in discussions with a surrogate decision maker for a patient who is unconscious and incapable of making an important decision regarding advanced care, especially if there is no documentation of the patient's desires? |
| | A) | Without knowing the patient's specific wishes, prolongation of life must be carried out at all costs |
| | B) | The physician should make a judgment based on the medical facts |
| | C) | The physician should decide as the patient would under the circumstances, assuming the patient knew all information |
| | D) | The surrogate makes the decision based on what he or she thinks is best for the patient |
| | E) | The hospital ethics board must decide |
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5 | |
Which of the following is the most likely cause of death for a woman between the ages of 45 and 54 in the United States? |
| | A) | Breast cancer |
| | B) | Ischemic heart disease |
| | C) | Lung cancer |
| | D) | Suicide |
| | E) | Accidents |
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6 | |
A 52-year-old postmenopausal woman comes for a routine visit to her primary care physician. She asks about the value of hormone replacement therapy. Which of the following statements is correct regarding this situation? |
| | A) | Use of tamoxifen slows the development of osteoporosis but has no effect on the incidence of breast cancer |
| | B) | The use of tamoxifen reduces the risk of breast cancer but has no effect on osteoporosis |
| | C) | (C) The use of tamoxifen reduces both the risk of osteoporosis and breast cancer |
| | D) | Calcium and estrogen slow the development of osteoporosis and reduce the frequency of breast cancer |
| | E) | Alendronate has no effect on the development of osteoporosis |
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7 | |
Which of the following is a correct statement concerning the differences in the etiology and incidence of ischemic heart disease in men and women? |
| | A) | The incidence of ischemic heart disease is higher in women than in men |
| | B) | Women are more likely to present with angina as the initial symptom of ischemic heart disease, and men with myocardial infarction |
| | C) | The risk of morbidity and mortality after a myocardial infarction is lower in women than men |
| | D) | Women have a lower perioperative mortality rate after coronary artery bypass surgery than men |
| | E) | Men have more frequent problems secondary to bleeding complications with antithrombotic therapy |
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8 | |
A 35-year-old woman pregnant with her first child develops edema. She presents to her obstetrician, who finds that her blood pressure is 170/115 and that she has bipedal edema and bilateral rales on pulmonary examination. Laboratory studies reveal 6 g protein in a 24-h urine collection, elevated hepatic transaminases, and a platelet count of 80,000/L. The patient is currently at 31 weeks of pregnancy and is admitted to the hospital and put on bed rest. Her blood pressure and the status of the fetus are closely monitored. Which of the following additional measures represents the most appropriate treatment? |
| | A) | Magnesium sulfate: 6-g bolus over 15 min followed by 1 to 3 g/h by continuous infusion pump |
| | B) | Intravenous labetalol |
| | C) | Intravenous diazepam |
| | D) | Oral losaarten |
| | E) | Oral captopril around the clock |
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9 | |
Which of the following statements concerning the management of deep venous thrombosis in pregnancy is correct? |
| | A) | Low-molecular-weight heparins are contraindicated in the third trimester of pregnancy |
| | B) | Warfarin therapy is contraindicated only in the first trimester of pregnancy |
| | C) | Warfarin therapy is contraindicated throughout pregnancy but safe during breast feeding |
| | D) | Warfarin therapy is contraindicated throughout the pre- and postpartum periods |
| | E) | All therapies and measures appropriate for the nonpregnant individual are appropriate in those women who suffer a deep venous thrombosis during pregnancy |
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10 | |
A 30-year-old Hispanic woman in the second trimester of pregnancy receives a 100-g oral glucose challenge. She has elevated values of serum glucose at each of the 1-,2-, and 3-h time points. Which of the following statements concerning this clinical situation is correct? |
| | A) | A trial of caloric restriction and minimal intake of concentrated sweets should be undertaken |
| | B) | The patient should be given subcutaneous insulin therapy |
| | C) | The patient should be treated with oral hypoglycemic agents |
| | D) | The patient should be treated with magnesium sulfate |
| | E) | The patient should receive insulin by continuous intravenous infusion |
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11 | |
Which of the following strategies will best minimize the risk of mother-to-child transmission of HIV? |
| | A) | Induction of delivery as early as possible in pregnancy consistent with maintaining good fetal maturity |
| | B) | Cesarean section |
| | C) | Use of zidovudine |
| | D) | Elective cesarean section at term plus zidovudine |
| | E) | Zidovudine plus protease inhibitor therapy |
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12 | |
Which of the following is the LEAST likely symptom of hyperthyroidism in a 77-year-old man? |
| | A) | Atrial fibrillation |
| | B) | Confusion |
| | C) | Tremor |
| | D) | Weakness |
| | E) | Syncope |
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13 | |
An older spouse brings her 75-year-old husband to the primary care physician because he no longer has been working in his basement wood shop. He recently underwent radiation therapy for localized prostate cancer. The patient complains of a prolonged history of inability to fall asleep and arising early in the morning. He has not been eating well lately, and his energy level has really fallen off. He has not been doing his daily crossword; in fact, he is not interested in much of anything anymore. His general physical examination, including tests for cognitive function, is normal. Laboratory studies are also unhelpful at establishing the diagnosis. Which of the following would be the most useful systemic therapy? |
| | A) | Haloperidol |
| | B) | Amitriptyline |
| | C) | Methylphenidate |
| | D) | L-Thyroxine |
| | E) | Electroconvulsive therapy |
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14 | |
The most common cause of urinary incontinence in an older individual is |
| | A) | diuretics |
| | B) | stress incontinence |
| | C) | detrusor underactivity |
| | D) | detrusor overactivity |
| | E) | cognitive impairment |
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15 | |
A 75-year-old widower who lives alone is brought to his primary care physician by his daughter because she feels that he has been confused over the past few days. Prior to this he was quite independent and cognitively intact. The patient has a history of hypertension and is on hydrochlorothiazide. He is due for bilateral cataract extraction in 2 months. Of note, he reports a fall in his living room about two weeks earlier, at which time he sustained a hip bruise and bumped his head.
At this time his general physical examination is unremarkable; his neurologic examination is normal except for the mental status component, which discloses defects in short-term memory. Which of the following diagnostic studies is most likely to explain this patient's condition? |
| | A) | Neuropsychiatric battery |
| | B) | CT scan of head |
| | C) | Electroencephalogram |
| | D) | Serum chemistry panel |
| | E) | Urinary screen for toxic substances |
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