AQUIFER FAMILY MEDICINE END OF CASE EXAM
QUESTIONS 2024-2025 ACTUAL EXAM 70
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES
Terms in this set (58)
,A 19-year-old female with The correct answer is E.
no significant past medical
history is involved as the This clinical scenario describes acute compartment
driver in a motor vehicle syndrome which is a vascular emergency. Emergent
accident and brought to the fasciotomy is the treatment of choice to relieve pressure
Emergency Department by in the calf and, if not performed, the limb could be lost
EMS. She is complaining of due to acute ischemia. While emergent radiographs of
severe pain in her right the tibia and fibula are appropriate to evaluate for co-
lower extremity that has existent fracture, x-rays of the foot and ankle are not
been worsening since the indicated. Reassurance, ice packs, urgent EMG and
accident. In addition, she immobilization are all incorrect treatments and place the
has started to notice what patient at risk of serious permanent adverse outcome.
she describes as "burning
and tingling" in her right
foot. On physical exam, her
right calf is edematous and
tender with tense overlying
skin. There is no swelling or
tenderness of the right foot
or ankle but the right
dorsalis pedis and posterior
tibial artery pulses are
barely palpable. She cannot
confirm light touch of the
foot and cannot wiggle her
toes on command. What is
the next best step in the
management of this
patient?
A. Reassurance and
icepacks q 2 hours
B. Immobilize leg and ankle
with a cast
C. Urgent EMG of the right
lower extremity
D. Diagnostic imaging of
,right foot and ankle
E. Emergent f
, A 20-year-old female who The correct answer is D.
is a long-standing patient at
this clinic with no significant There is very good evidence that common typical
past medical history symptoms of urinary tract infection (UTI) (e.g. dysuria
presents with first-time and frequency) with the absence of vaginal symptoms
onset of dysuria are highly predictive of UTI in young women who have
accompanied by frequency no systemic symptoms. The constellation of typical
and urgency for the past symptoms outweighs a normal urinalysis. Therefore,
day. She thinks that there is based on the symptoms presented, the most reasonable
a strange odor to her urine treatment option is to treat empirically with a standard
but denies any hematuria. In antibiotic for a short course. It is not unreasonable to
addition, she feels mild send urine for culture but management does not need to
lower abdominal discomfort wait till that result is available. While it is always prudent
but denies fevers, chills, to consider the possibility of sexually transmitted
nausea, vomiting, infection in this age group, based on the information
constipation, diarrhea, or presented about an established patient, it would be
costo-vertebral angle (CVA) inappropriate to insist on a pelvic exam or await results
pain. She reports no known of a urine DNA probe in the face of such strong UTI
allergies She has never symptoms.
been sexually active and
has no vaginal discharge
nor irritation. LMP was one
week ago and was typical.
She wonders if using a
perfumed bubble bath for
the first time a few days ago
might have triggered her
symptoms. On exam, her
vital signs are stable; she
has no CVA tenderness and
mild suprapubic discomfort.
Urinalysis of a mid-stream
catch is within normal limits,
and a pregnancy test on the
same sample, performed
despite her history
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