Free Family Practice Test Questions

1. A 16-year-old boy presents with right shoulder pain after being hit during a neighborhood football game while he was attempting to throw the ball. He resists any arm motion and cradles it. During examination, dimpling is noted inferior to the acromion. What is the most likely diagnosis?

a. Rotator cuff tear
b. Shoulder dislocation
c. Rotator cuff impingement
d. Rupture of the long head of the biceps

2. During a routine well examination, a 62-year-old man is found to have Hgb of 11.5 g/dL. He admits to a poor diet. Further laboratory work reveals hypersegmented neutrophils, MCV of 120 fL, total serum iron of 155, vitamin B12 of 176 pg/mL, RBC folate of 130 pg/L, and a reticulocyte count of 1.1%. This patient has

a. anemia of chronic disease.
b. vitamin B12 deficiency.
c. iron deficiency anemia.
d. folic acid deficiency.

3. A 74-year-old woman reports that she has experienced "crampy" left lower quadrant abdominal pain with diarrhea for 4 days. On examination, she has a temperature of 101.5 °F, pulse of 110 beats per minute, decreased capillary refill, and moderate left lower quadrant abdominal pain. The complete blood count shows leukocytosis with a left shift. An abdominal CT helps diagnose diverticulitis and rules out an abscess. What is the best course of treatment?

a. Instruct the patient to follow a clear liquid diet and return to the office in 2 days for a follow-up appointment.
b. Instruct the patient to follow a clear liquid diet with ciprofloxacin and metronidazole for 10 days.
c. Instruct the patient to follow a clear liquid diet with ciprofloxacin and metronidazole for 10 days, plus add ibuprofen for the pain.
d. Hospitalize the patient with complete bowel rest and broad-spectrum intravenous antibiotics.

4. A previously healthy 66-year-old patient presents with a 5-day history of a productive cough, temperature of 101.8 °F, BP of 110/75, pulse of 95 beats/min, and a respiratory rate of 21/min. On examination, the physician finds the patient to be alert and oriented with rales in the right lower lobe. Laboratory tests indicate an elevated white count and BUN of 18. A chest x-ray confirms right lower lobe pneumonia. Which of the following is true?

a. According to CURB-65, this patient has a score of 3 and will respond best to IV antibiotics and must be hospitalized.
b. The gold standard to diagnose pneumonia is the detection of rales or crackles on examination.
c. According to CURB-65, this patient has a score of 1 and may be treated as an outpatient for community acquired pneumonia.
d. Community-acquired pneumonia should only be treated with combination antibiotic therapy.

29. A previously healthy 66-year-old patient presents with a 5-day history of a productive cough, temperature of 101.8°F, BP of 110/75, pulse of 95 beats/min, and a respiratory rate of 21/min. On examination, the physician finds the patient to be alert and oriented with rales in the right lower lobe. Laboratory tests indicate an elevated white count and BUN of 18. A chest x-ray confirms right lower lobe pneumonia. Which of the following is true?

a. According to CURB-65, this patient has a score of 3 and will respond best to IV antibiotics and must be hospitalized.
b. The gold standard to diagnose pneumonia is the detection of rales or crackles on examination.
c. According to CURB-65, this patient has a score of 1 and may be treated as an outpatient for community acquired pneumonia.
d. Community-acquired pneumonia should only be treated with combination antibiotic therapy.

Answers

1. B: Patients with rotator cuff tears can present with pain stiffness and occasional weakness around the shoulder, but are often asymptomatic. The symptoms typically have an insidious onset. With a complete tear, patients often exhibit a “drop arm sign” where the arm drops with abduction. Shoulder dislocations are typically sports-related in younger patients and the result of a fall in the elderly. Patients resist or refuse to move their arm. They usually occur when the injury involves the arm in abduction and maximal external rotation. The humeral head can typically be visualized as a bulge and dimpling occurs just inferior to the acromion where the humeral head should be. Rotator cuff impingement is a mainly a clinical diagnosis. The patient presents with dull shoulder pain increasing over weeks to months. The pain is exacerbated during the night with various sleeping positions, especially when the arm is overhead. Range of motion (ROM) is usually normal. However, a painful arc of motion may be noted especially on internal rotation and forward flexion. The “empty can test” (thumb pointing downward with arm abducted 90o and with 30o forward flexion) can test for supraspinatus strength. Finally, patients with a rupture of the long head of the biceps usually present with a rotator cuff tear. With the rupture, the patient notes a pop followed by an immediate decrease in symptoms. Physical examination reveals anterior bruising and a “Popeye muscle” upon flexion of the biceps.

2. A: Atopic dermatitis typically appears in the first year of life with pruritus being the hallmark of the disease. Lesions usually involve the face in infants become excoriated with weeping and crusting. Eventually lesions become scaly and lichenified. Unlike seborrheic dermatitis, it does not typically follow the distribution of oil glands. Psoriasis typically appears after infancy and tinea corporis spreads slower.

3. D: This patient presents with a macrocytic anemia (nl MCV=80-100 fL and nl male Hgb=13.5-17.5 g/dL). Iron deficiency anemia and anemia of chronic disease are both microcytic anemias. Since the levels of vitamin B12, iron, and reticulocyte count are normal (nl B12=150-900 pg/mL and nl iron=50-170 µg/dL, and nl retic=0.5-1.5%) and folate levels are low (less than 150 pg/L), he must have a folic acid deficiency.

4. D: Answer B is the best choice for those with mild diverticulitis who can tolerate oral rehydration. Ibuprofen should not be used in patients with diverticulitis due to the increased risk of GI bleeding. However, this patient exhibits signs of inflammation including fever and leukocytosis and signs of dehydration which require hospitalization. Diverticulitis tends to be more severe in elderly patients.

5. C: Pneumonia is the 6th leading cause of death in the United States. Diagnosis is based on a positive chest x-ray, tachypnea, crackles or rales, fever, and cough. Crackles and rales are only heard in 75-80% of patients with pneumonia and should not be the sole criterion for diagnosis. CURB-65 is a pneumonia severity score based on a 5-point system and can aid the physician in determining inpatient verses outpatient treatment as well as mortality. Scores of 0-1 indicate a low risk and may be treated on an outpatient basis and scores of 2-5 indicate increasing severity and should be admitted to the hospital for treatment. Each of the following is worth 1 point: confusion, BUN greater than 19 mg/dL, RR greater than 30/min, systolic BP less than 90 or diastolic less than 60 mmHg, and age greater than 65 years. With these criteria, the above patient had a score of 1 and C is true. Pneumonia may be treated with either monotherapy or combination therapy and is aimed at treating the pathogen.

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Last Updated: 04/21/2017


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