Aquifer FM End of Case Questions and 100% Verified Correct Answers Guaranteed A+ 13-year-old female patient comes to your office for a physical. Her mother is concerned because she complains of menstrual cramps during her period each month. You determine that menarche was earlier that year and her periods have been mostly regular since that time. The pain is in her lower abdomen and is relieved with Ibuprofen and a heat pack. She has no other medical problems and her physical exam is normal.What is the most appropriate treatment for this patient?
- Continue ibuprofen and heat packs; return if worsening
- Copper IUD
- Start an SSRI
- Start danazol
- Start oral contraceptive pills (OCPs) - Ans The Correct Answer is A. From FM 32.
14-year-old Jennifer is brought to clinic by her mother who is concerned about ADHD.She states Jennifer lacks motivation, regularly does not clean her room, and has to be reminded to do chores around the house. She also is concerned Jennifer does not listen to her and avoids doing homework.Which of the following would most strongly support additional evaluation to assess for ADHD?
- A diagnosis of major depression
- A report card with good grades
- A teacher's report of inattentive behavior
- Fidgety behavior in the car when driving long distances
- Symptom onset with entry to high school - Ans The Correct Answer is C. From FM
23.
56-year old male with a past medical history of hypertension and type 2 diabetes mellitus presents with progressive dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and dependent edema over the prior 4 days. His social history is notable for a 30 pack-year tobacco history and occasional marijuana use. His family history is positive for bypass surgery in his mother at the age of 62. On exam, his vitals include a blood pressure of 166/86 mmHg, pulse of 98 beats/minute, respirations of 21/minute and a BMI of 32 kg/m^2. He appears mildly dyspneic. His neck reveals an elevated jugular venous pulse, his chest exam reveals bilateral crackles in the lower lung fields, and his cardiovascular exam reveals mild tachycardia, a regular rhythm, and no murmurs. His abdominal exam is unremarkable, and he has 2+ edema in his legs midway to his knees. An EKG reveals sinus tachycardia with a left axis deviation and Q waves in leads II, III, and AVF. A BNP is measured and is found to be 510 pg/ml.Which of the following is the most likely cause of this patient's heart failure?
- Atrial fibrillation 1 / 4
- Non-ischemic cardiomyopathy
- Valvular disease
- Pulmonary embolism
- Ischemic cardiomyopathy - Ans The Correct Answer is E. From FM 31.
A 7-year-old male is brought to your clinic with a fever of 38.9 to 39.4 C (102 to 103 F) for the past three days. He is up to date on all vaccinations and has no significant medical history. His mother notes that he has not had a cough but is eating and drinking less because "it hurts to swallow." On examination of his neck you notice tender cervical lymphadenopathy bilaterally, and auscultation of his back shows clear lung sounds on both sides. His oropharyngeal exam shows erythematous throat, but no tonsillar exudates.What would be the most appropriate next step?
- Chest x-ray
- Empiric levofloxacin (Levaquin) therapy
- Empiric oseltamivir (Tamiflu) therapy
- Empiric penicillin V therapy
- Rapid strep test - Ans The Correct Answer is E. From FM 21.
A 12-year-old male is brought to the clinic with a pruritic, red, scaly rash in the creases of his elbows. He denies new topical exposures and generally feels well. He has a history of seasonal allergies. Which of the following is the most appropriate course of action?
- Biopsy the skin lesion
- Ask the patient to return to the clinic after three days
- Prescribe topical corticosteroids
- Prescribe oral antibiotics
- Prescribe oral corticosteroids - Ans The Correct Answer is C. From FM 16.
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?
- Albuterol
- Amantadine
- Aspirin
- Ibuprofen
- Zanamivir - Ans The Correct Answer is D. From FM 21.
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A 13-year-old female patient comes to your office for a physical. Her mother is concerned because she complains of menstrual cramps during her period each month.You determine that menarche was earlier that year and her periods have been mostly regular since that time. The pain is in her lower abdomen and is relieved with Ibuprofen and a heat pack. She has no other medical problems and her physical exam is normal.What best describes this patient's condition?
- Menorrhagia
- Premenstrual dysphoric disorder
- Premenstrual syndrome
- Primary dysmenorrhea
- Secondary dysmenorrhea - Ans The Correct Answer is D. From FM 32.
A 15-year-old female 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 denies any 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. What is the best next step?
- Prescribe a short acting beta agonist inhaler with a short course of oral steroids
- Prescribe a long acting beta agonist inhaler
- Prescribe a daily corticosteroid inhaler
- Prescribe a daily corticosteroid and long acting beta agonist inhaler
- Prescribe antibiotic therapy - Ans The Correct Answer is A. From FM 13.
A 16-year-old male patient presents with dull, aching pain in his left scrotum. He says that the dull aching pain is more prominent upon standing.Which of the following the most likely diagnosis?
- Epididymitis
- Henoch-Schönlein purpura (HSP)
- Hydrocele
- Testicular torsion
- Varicocele - Ans The Correct Answer is E. From FM 27.
A 17-year-old male football player presents to the emergency department with acute onset of right-shoulder pain. The pain started approximately two hours ago when he was tackled during a game while carrying the football. Shoulder swelling and pain were present after injury. He is holding ice to a swollen shoulder, and on exam you notice severe bruising, pain on palpation over the lateral edge of the shoulder, and a raised bump over that same area. There is also severe tenderness over the coracoclavicular ligaments.What is the most likely diagnosis?
- AC joint sprain
- Rotator cuff tear
- Rotator cuff tendonitis
- Subacromial bursitis
- Subacromial impingement - Ans The Correct Answer is A. From FM 25. 3 / 4
A 19-year-old female 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 "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?
- Emergent surgical consultation
- Diagnostic imaging of right foot and ankle
- Immobilize leg and ankle with a cast
- Reassurance and icepacks q 2 hours
- Urgent EMG of the right lower extremity - Ans The Correct Answer is A. From FM 04.
A 20-year-old healthy female with no significant past history presents to your clinic with dysuria, lower abdominal discomfort, frequency, and urgency for one day. She notes an odor to her urine but denies any 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. Her examination is remarkable for mild suprapubic tenderness. Urinalysis: negative; urine HCG: negative.Which of the following would be the next best step in her clinical management?
- Await urine culture results before any treatment
- Initiate antibiotic treatment while awaiting urine culture results
- Insist that a pelvic exam and cervical DNA probe be performed today
- Reassure that this is not a urinary tract infection
- Urine DNA probe - Ans The Correct Answer is B. From FM 04.
A 21-year-old female comes into your family medicine office complaining of an abnormal discharge with a foul odor. She has been sexually active with four to five partners over the past year, and uses condoms inconsistently.Which of the following can be seen on a wet prep?
- Chlamydia
- Gonorrhea
- Herpes
- Syphilis
- Trichomonas - Ans The Correct Answer is E. From FM 27.
A 21-year-old female with no significant past medical history experienced an inversion- type injury to her right ankle while playing soccer a day prior to presentation to the family medicine ambulatory practice. She remembers immediate pain and swelling but was able to weight bear and limp off the field. She has noticed some significant swelling which is mostly still present. She has been icing the ankle since the injury as her coach recommended. Pain is still present near the lateral malleolus. Physical examination reveals an edematous lateral right ankle with purplish hue and intact bilateral pulses.
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