FM Aquifer End Q's
60-year-old patient presents to the office with increased frequency of urination
and fatigue for the past several months. She reports no fever, dysuria, back pain,
diarrhea, or abdominal pain. She has noted some weight loss without working on
diet or exercise. Her past medical history is significant for hyperlipidemia and
hypertension, for which she takes simvastatin and lisinopril. She is a nonsmoker
and consumes one to two glasses of wine per week. Her vitals are:
Pulse is 70 beats/minute
Blood pressure is 130/70 mmHg
Body mass index is 30 kg/m2
Physical examination reveals increased pigmentation in her axilla bilaterally. Her
labs are as follows:
✅✅
What is the next most appropriate step in establishing a diagnosis of diabetes
mellitus in this patient? - -The random blood glucose is sufficient
Diabetes can be diagnosed with either an HbA1C > 6.5%, a fasting plasma
glucose ≥ 126 mg/dl (7.0 mmol/l), a plasma glucose ≥ 200 mg/dl (11.1 mmol/l)
two hours after a 75 g glucose load, or symptoms (such as polyuria, polydipsia,
unexplained weight loss) and a random plasma glucose ≥ 200 mg/dl (11.1
mmol/l).
A 13-year-old female comes to your clinic stating she has been having fever and
chills for three days, and aching muscles for the last two days. She states she
has also had a mild cough but is not having any difficulty with breathing. She is
up to date on vaccines and her only other medical history is having her tonsils
and adenoids removed last year. On physical exam, you find her temperature is
39.2 °C (102.6 °F), pulse is 96 beats/minute, and her blood pressure is 108/62
mmHg. She has clear rhinorrhea and her oropharynx is mildly erythematous. The
rest of her physical exam is normal, and a rapid strep test in the office is
negative.
,What is the next best step in management? - ✅✅-Ibuprofen
A 15-year-old with a history of allergic rhinitis presents to the clinic with a five-day
history of productive cough and wheezing that is worse at night. She reports no
shortness of breath, chest pain, or fever. The patient states that she has had
similar symptoms in the past, especially when seasons change. The only
reported past medical history is atopic dermatitis, which is well-controlled with an
over-the-counter steroid cream. Her vitals are: temperature is 36.8 °C (98.2 °F),
pulse is 96 beats/minute, respiratory rate is 20 breaths/minute, oxygen saturation
is 98%, blood pressure is 110/72 mmHg. She is in no acute distress and is
breathing comfortably. On auscultation, there are some mild wheezes on
expiration but air movement is good.
What is the best next step? - ✅✅-Prescribe a short-acting beta-agonist inhaler
with close follow-up
A 19-year-old patient with no significant past medical history is the driver in a
motor vehicle accident and is brought to the Emergency Department by EMS.
She is complaining of severe pain in her right lower extremity that has worsened
since the accident. In addition, she has started to notice what she describes as a
"burning and tingling" sensation in her right foot. Physical exam shows that 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 greatly reduced compared to the left leg. She is unable to
confirm light touch of the foot and cannot wiggle her toes on command.
✅✅
Which of the following indicates the next best step in the management of this
patient? - -Emergent surgical consultation
A 20-year-old patient with no significant past history presents to the clinic for
evaluation of a 1-day history of dysuria, lower abdominal discomfort, and urinary
frequency and urgency. She notes a strong odor to her urine but reports no
change in its appearance. She reports no vaginal discharge or fever. Review of
systems is otherwise negative. The patient denies sexual activity and reports
normal menses. There are no known allergies. Physical examination is normal
other than mild suprapubic tenderness upon palpation.
, Urinalysis shows no significant abnormality and urine HCG is negative.
✅✅
Which of the following would be the next best step in her clinical management? -
-Initiate antibiotic treatment while awaiting urine culture results
A 21-year-old G1P0 patient presents to the clinic as a new patient to establish
✅✅
prenatal care. Which statement represents something that would not be expected
to be a benefit of group prenatal care for this patient? - -Increases
adherence to techniques for pain management during labor
A 21-year-old patient comes to the clinic because of a 1-day history of right ankle
pain after an inversion-type injury while playing soccer. She remembers having
immediate pain and swelling but was able to bear weight afterward and limp off
the field. She has noticed some significant swelling which is still present. She
indicates her pain is on the lateral side of her right ankle. Physical examination of
the right ankle demonstrates ecchymosis and edema of the lateral aspect,
moderate tenderness to palpation of the posterior edge of the lateral malleolus,
and mild tenderness to palpation of the anterior talofibular and calcaneofibular
ligaments. Sensation of the bilateral lower extremities is intact and symmetric
motor function is preserved. Anterior drawer test and squeeze test are both
normal.
What is the next best step in the management of this patient? - ✅✅-X-ray
imaging of right ankle
A 22-year-old patient with no significant past medical history presents to the clinic
for a 2-day history of right ankle pain due to an inversion-type injury while playing
volleyball. Her ankle quickly became edematous, but she used ice and was able
to bear weight on the foot after the injury. She has tenderness at the anterior
lower lateral malleolus but no tenderness to palpation of the inferior or posterior
aspects. You diagnose her with an ankle sprain. You recommend continued
relative rest and also tell the patient to keep it elevated and ice it several times
during the day to help with the pain and swelling. You inform the patient that
immobilization and compression are good for the conservative management of
her condition.
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