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   Name American Board of Family Practice IN-TRAINING EXAMINATIONBOOK II: CLINICAL SET PROBLEMSTIME–1 HOUR   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 PATIENT A Options 1–11 A 65-year-old retired male university professor who is in vigorous health comes to you for a periodic healthexamination. While palpating the abdomen you note a pulsatile mass left of the midline, between the xiphoidand the umbilicus. You estimate that the mass measures about 3–4 cm, and suspect an abdominal aorticaneurysm. When you discuss these findings with the professor, he asks how common this problem is. Which of the following would be an accurate response to his question? 1. It is more common in smokers 2. It is more prevalent in men 3. It is more common in people who have a first degree relative with an abdominal aortic aneurysm Based on the estimated size of the mass, you determine that an imaging examination is required. Appropriatechoices include 4.  plain abdominal radiography 5.   -mode ultrasonography 6. a CT scan 7. arteriography The results of the imaging procedure indicate that the aneurysm measures 5.2 cm in diameter. You discussmanagement options with your patient. True statements about the natural history of the problem and surgical options include which of the following?  8. The annual risk of rupture for an aneurysm of this size is around 20% 9. Current guidelines from the Society for Vascular Surgery and the International Society for Cardiovascular Surgery recommend following asymptomatic aneurysms between 5.0 and 7.0 cmwith an imaging examination every 6 months 10. In this patient, surgery should be delayed until the aneurysm reaches 7.0 cm 11. Once the aneurysm is repaired, the patient can expect a 5-year survival rate better than that of hisage-matched peers  2 PATIENT B Options 12–22 A 32-year-old white male visits your office complaining of pain of 12 hours’ duration in themetatarsophalangeal joint of his left large toe. He says the joint is exquisitely tender to touch, and deniesany history of trauma. He takes no medications and was last seen by you 15 months ago for an unrelated problem. Physical examination is within normal limits except for a large area of erythema extending over his left large toe and up onto the dorsum of his foot. No lymphangitis is noted. Tests which would help establish a definitive diagnosis include which of the following? 12. A Gram’s stain of fluid aspirated from the joint 13. 24-hour urine collection for protein 14. A radiograph of the foot and ankle 15. Microscopic examination for crystals in synovial fluid aspirate 16. Intravenous pyelography Appropriate drug choices for initial management of this acute problem include which of the following? 17. Colchicine 18. Probenecid (Benemid) 19.  Nafcillin (Unipen) 20. Prednisone 21. Indomethacin (Indocin) 22. Allopurinol (Zyloprim) PATIENT C Options 23–35 A 33-year-old white male presents to your office with colicky flank pain radiating into a testicle. Hissymptoms are similar to those he had when he passed kidney stones on two occasions in the past 3 years.He was treated in emergency departments both times and never came in for follow-up evaluations. Hishistory and physical findings are otherwise unremarkable. A KUB done on the same day demonstrates a 3-mm radiopaque calculus in the distal third of the right ureter.Further management at this time should include 23. a renal MRI 24. urology referral for stone extraction Analysis of the stone shows it to be calcium oxalate. Appropriate studies to obtain at this point include 25. serum calcium 26. 24-hr urine for citrate, calcium, and oxalate 27. 24-hr urine cystine 28.  parathyroid hormone

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Jul 23, 2017
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