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   Name American Board of Family Practice IN-TRAINING EXAMINATIONBOOK I: MULTIPLE-CHOICE QUESTIONSTIME–3 HOURS  Read the instructions on the back first. Do not break the seal until you are told to do so.  1Write your name in the blank at the top of the page.2.Record your Program Number, Resident Number,and Residency Year on the answer sheet, as shownin the sample on the right. Be sure to fill in boththe boxes and the circles. Publication or reproduction in whole or in part is strictly prohibited. Copyright © 2002 The American Board of Family Practice. All rights reserved.    SAMPLE   1 1. A 3-year-old white female is brought to your office because she is complaining of pain in her rightarm. Her mother tells you the pain began after she pulled her daughter by the arm while the girlwas fighting with her brother. You examine the child and diagnose “nursemaid’s elbow.” You recommend which one of the following? A)Manipulation of the forearm to reduce radial head subluxation B)Long arm cast immobilization C)Use of a sling for arm rest D)A cock-up wrist splint 2. A 39-year-old African-American multigravida at 36 weeks gestation presents with a temperatureof 40.0° C (104.0° F), chills, backache, and vomiting. On physical examination, the uterus isnoted to be nontender. There is slight bilateral costovertebral angle tenderness. A urinalysisreveals many leukocytes, some in clumps, as well as numerous bacteria. Of the following, the most appropriate therapy at this time would be A)oral trimethoprim/sulfamethoxazole (Bactrim, Septra) B)oral nitrofurantoin (Macrodantin)C)oral levofloxacin (Levaquin) D)intravenous doxycycline (Vibramycin) E)intravenous ceftriaxone (Rocephin) 3. A painful thrombosed external hemorrhoid diagnosed within the first 24 hours after occurrenceis ideally treated by A)appropriate antibiotics B)office banding C)office cryotherapy D)thrombectomy under local anesthesia E)total hemorrhoidectomy 4. A 10-year-old female presents with a mildly itchy rash of 10 days’ duration. She hadstreptococcal pharyngitis 2 weeks ago. A red, papular rash with scaling is present on the trunk and proximal extremities. The lesions are 1–3 cm in diameter. This presentation is most consistent with A)scarlet fever B)guttate psoriasis C)atopic dermatitis D)scabies E)erythema marginatum  2 5. An anxious and agitated 18-year-old white male presents to your office with a 2-hour history of severe muscle spasms in the neck and back. He was seen 2 days ago in a local emergencydepartment with symptoms of gastroenteritis, treated with intravenous fluids, and sent home witha prescription for prochlorperazine (Compazine) suppositories. The best therapy for this problem is intravenous administration of A)atropine B)diphenhydramine (Benadryl) C)haloperidol (Haldol) D)succinylcholine (Anectine) E)carbamazepine (Tegretol) 6. A healthy 68-year-old white male comes to your office for a health maintenance visit. He tellsyou he last saw a physician 6 years ago, and he recalls receiving a “flu shot” and a “pneumoniashot” at that time. According to current Centers for Disease Control (CDC) recommendations for giving pneumococcal vaccine (Pneumovax) in the elderly, this patient should be revaccinated A)every 5 years B)every 3 years C)yearly D)once E)never 7. A 35-year-old white female comes to your office with a 3-month history of the gradual onset of  pain and tenderness in the wrists and hands. She also complains of 1 hour of morning stiffness.She denies rash, fever, or skin changes. On physical examination she has symmetric swelling of the proximal interphalangeal joints and metacarpophalangeal joints. Motion of these joints is painful. She has no rash or mouth ulcers. Radiographs of the hands and wrists are negative, anda chest film is unremarkable. Her CBC is normal, but the erythrocyte sedimentation rate iselevated at 40 mm/hr. Latex fixation for rheumatoid factor is negative, and an antinuclear antibody (ANA) test is negative. The most likely diagnosis in this patient is A)rheumatoid arthritis B)systemic lupus erythematosus C)sarcoidosis D)Lyme disease E)calcium pyrophosphate deposition disease  3 8. Contraindications to thrombolytic therapy in acute stroke include which one of the following? A)Age >80 B)Resolving transient ischemic attack C)Blood glucose >200 mg/dL D)Deficit present for >1 hour 9.  Now that the blood supply is routinely screened for antibody to hepatitis C virus (HCV), what has become the leading mode of transmission of HCV? A)Injection drug use B)Sexual transmission C)Perinatal maternal-child transmission D)Occupational exposure of health-care workers E)Household and day-care contact 10. A 33-year-old white female comes to your office accompanied by her spouse. In the last 9 monthsshe has withdrawn from a master’s degree program and has requested a leave of absence from her  job as a teacher. Her husband says that she no longer will accept social engagements, and that shewas formerly highly active in church and teaching Sunday school, but has also withdrawn fromthese activities. Her marriage remains strong, she sleeps well, and she continues independentrunning and cycling. Which one of the following would be appropriate as initial treatment? A)Lithium B)Paroxetine (Paxil) C)Haloperidol (Haldol) D)Alprazolam (Xanax) E)Trazodone (Desyrel) 11. A 70-year-old Asian male presents with hematochezia. He has stable vital signs. Lower endoscopy is performed, but is unsuccessful due to active bleeding. Which one of the following would be the next appropriate investigation? A)An abdominal CT scan B)A barium enema C)A technetium-99m blood pool scan D)Exploratory laparotomy E)A small-bowel radiograph


Jul 23, 2017
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