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FM comat Exam 2- Questions & 100% Correct Answers
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FM comat Exam 2- Questions & 100% CorrectAnswers
A 52-year-old female presents to your office after a random blood glucose level of 250 mg/dL
was discovered at a screening health fair. She is sent for some additional lab work and you are
awaiting the results before initiating pharmacologic therapy. Which of the following would
establish a diagnosis of diabetes mellitus?
A. 2-hour blood glucose level of 190 mg/dL during a 75 gram oral glucose tolerance test
B. fasting blood glucose of 130 mg/dL
C. hemoglobin A1C of 6.0%
D. random blood glucose of 150 mg/dL with classic symptoms of hyperglycemia
E.random blood glucose of 240 mg/dL without symptoms - ✔✔The correct answer is: B
Type 2 diabetes mellitus occurs because of tissue resistance to insulin which leads to
hyperglycemia. Eventually the β-islet cells of the pancreas are unable to produce sufficient
insulin to meet the bodies demand. Usually type 2 diabetes mellitus is diagnosed later in life
with gradual onset of symptoms of polyuria, polydipsia, weight loss, and vision changes.
Untreated it can lead to retinopathy, nephropathy, neuropathy, and hyperosmolar
hyperglycemic non-ketotic coma. There are several ways to diagnose diabetes according to the
American Diabetes Association. These include hemoglobin A1C greater than or equal to 6.5%,
fasting plasma glucose greater than or equal to 126 mg/dL, oral glucose tolerance test with 2
hour blood glucose level greater than or equal to 200 mg/dL, or random plasma glucose greater
than 200 mg/dL in a patient with classic symptoms of diabetes. These tests should always be
repeated for confirmation.
A 10-year-old female presents to the office with chronic cough of three months' duration that
awakens her twice weekly. Review of systems is negative for recent illness, chest congestion,
nasal discharge, upset stomach, and ear pain. Pulse oximetry reveals an oxygen saturation of
99% on room air. Physical examination reveals pink and moist oral and nasal mucosa without
lesions or exudation, a neck that is absent for lymphadenopathy, and normal heart sounds.
Auscultation of the chest reveals diffuse mild expiratory wheezes. Spirometry performed during
the visit reveals an FEV1 that is 72% of predicted values. The most appropriate pharmacologic
therapy for long-term maintenance is
,A. albuterol as needed
B. daily fluticasone/salmeterol
C.daily montelukast
D. daily salmeterol
E. prednisone dose pack - ✔✔The correct answer is: B
Asthma is defined by a triad that includes airway inflammation, airway hyperresponsiveness,
and reversible airflow obstruction. It can occur at any age and can have many triggers, including
pollen, dust, mold, animals, cold air, viral infections, tobacco smoke, medications, and exercise.
The above triad manifests clinically as dyspnea, wheeze, chest tightness, and cough. Severity
varies, though symptoms typically begin within 30 minutes of irritant exposure. Symptoms are
usually worse at night and wheeze can be on both inspiration and expiration, and is the most
common finding on physical examination. Though the most common cause of wheeze is
asthma, many conditions mimic large-airway bronchospasm that can cause wheeze, including
congestive heart failure, chronic obstructive pulmonary disease, cardiomyopathy, and lung
cancer. Pulmonary function tests are required for diagnosis and spirometry before and after
bronchodilators can confirm diagnosis by demonstrating reversible airway obstruction.
Asthma severity is determined by considering the following factors: reported symptoms over
the previous two to four weeks, current level of lung function, and number of exacerbations
requiring oral glucocorticoids per year. Various charts are available that define categories of
asthma severity, typically using frequency of daytime asthma symptoms per week and number
of nocturnal awakenings per month. In this patient, who is awakened up to twice weekly,
moderate persistent asthma is likely. These categories become important in determining
appropriate chronic treatment options.
This patient has moderate persistent asthma, which is characterized by daily asthma symptoms,
nocturnal awakenings more than once weekly (though not nightly), daily need for SABA (short-
acting beta agonist), FEV1 between 60 and 80%
Vaccine for A 25-year-old healthcare professional presents to the primary care physician for a
pre-employment examination. - ✔✔Hepatitis B vaccine is an inactivated vaccine series with 3
injections (0 month, 1 month and 6 months). If there is a questionable history of vaccination,
hepatitis B titers can be checked prior to administering hepatitis B vaccination series. Mode of
,transmission of hepatitis B includes sexual intercourse and blood or blood contaminated
products. Therefore, it is highly recommended for adults with increased risk of sexual
transmission of infections including men who have sex with men, multiple sexual partners, sex
partner of a patient with hepatitis B and upon evaluation of any sexually transmitted infection.
Other indications include all health care workers, comorbidities (diabetes mellitus, HIV
infection, chronic liver disease, end-stage kidney disease), and travelers to countries with
endemic hepatitis B. As per CDC recommendation, hepatitis B vaccination series are
recommended for all age groups, since it is one of the leading causes of chronic liver disease
and cirrhosis worldwide. Therefore, all adults with high risk sexual behavior including men who
have sex with men should be recommended a hepatitis B vaccination
A vaccine for 26-year-old female who just had a positive pregnancy test at home presents to
her primary care physician and asks which vaccination carries the highest risk of birth defects. -
✔✔Varicella vaccine is a live, attenuated vaccination. Varicella vaccine has been part of the
children immunizations since 1996. It is recommended in all persons born after 1980 unless
there is a physician documented evidence of either varicella or varicella vaccination. Since it is a
live vaccine it is used with caution in immunocompromised patients. It is contraindicated in
pregnancy and women who become pregnant within one month of vaccination should be
counseled regarding the risk of birth defects from a live vaccine. Since all the other vaccinations
listed above are inactivated vaccines except varicella, varicella has the highest possible risk of
birth defects
Vaccine for A 66-year-old male presents to the primary care physician after placement of new
cochlear implants. - ✔✔Pneumococcal vaccine is an inactivated vaccination recommended in
all adults of age 65 years and older. In adults age 19 - 64 years of age, specific indications
include diabetes mellitus, chronic pulmonary disease (asthma and COPD), cigarette smoking,
cochlear implant, alcoholism, immunocompromised patients (HIV, multiple myeloma, chronic
corticosteroids) and asplenia to list a few. Patients who are vaccinated prior to age 65 years,
receive a booster dose at age 65 or 5 years after initial vaccination, whichever is later.
Therefore, given the history of cochlear implant, pneumococcal vaccine is the most likely
diagnosis.
Vaccine for An 18-year-old male who recently started college, living on campus. -
✔✔Meningococcal vaccination is also an inactivated vaccination typically administered as
one shot. Most common recommendation is in teenagers starting college due to living in closed
spaces like dormitories. For similar reasons, it is also recommended in military personnel as
well. Other indications include patients with asplenia and complement deficiencies as well as
, HIV infection patients. Therefore, patient's history of joining the military makes it the most
likely vaccination to be administered.
A 60-year-old female presents to her primary care physician with hip pain which she reports is
worse at the end of the day. Vital signs are obtained as follows:
Height 1.32 m (60 in)
Weight 104 kg (230 lbs)
Temperature 37.6ºC (99.8ºF)
Blood Pressure 135/85 mmHg
Pulse 88/min
Respiration 18/min
O2 saturation 98%
Physical examination reveals decreased range of motion in her affected joints and deformity of
her distal interphalangeal joints on her hands. Structural examination reveals a positive seated
flexion test on the left, a sacrum with a deep left sulcus, a left inferior lateral angle that is
inferior and posterior, and springing at the left sulcus.
Most likely diagnosis is: - ✔✔Osteoarthritis is a chronic joint disease caused by articular
cartilage degeneration which results in decreased joint space. It most commonly affects weight
bearing joints including hips and knees but can also affect hands, wrists, shoulders, and
vertebrae. Risk factors include increased age, obesity, family history, and previous joint trauma.
Patients will present with pain and joint stiffness that gets worse with activity and weight-
bearing activity and is usually relieved by rest. Patients will have decreased range of motion.
Osteoarthritis commonly affects the distal interphalangeal joints of the hands causing
deformities called Heberden's nodes. Radiographs of the affected joints will demonstrate joint
space narrowing, osteophytes, subchondral sclerosis and subchondral cysts. Osteoarthritis is
generally non-inflammatory and treatments includes weight loss, lifestyle modification,
analgesics, corticosteroid injections, and as the disease progresses possibly joint replacement.
Osteoporosis is not likely in this patient because of her age and her weight. Screening for
osteoporosis is recommended to start at age 65. Bone density decreases with a decrease in the
amount of estrogen that women experience with menopause. The typical osteoporosis patient
is a thin white female. This patient's weight increases load bearing on her bones which leads to
increase in bone mineralization to compensate for the extra stress.
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