AQUIFER FAMILY MEDICINE EXAMS SCRIPT
ANSWERS AND QUESTIONS SET A+
✔✔Mr. Jones is an 82-year-old man who presents to the office for his six-month chronic
disease visit. His diabetes and hypertension are controlled on his usual home
medications. He reports that his wife died four weeks ago, and he is now experiencing
insomnia most days of the week and fatigue and loss of energy nearly every day;
reports decreased enjoyment of his activities, such as playing chess with his neighbor;
and is also experiencing loss of appetite but no weight loss. He denies any suicidal
ideation and has no previous suicide attempts. Mr. Jones says he often hears his wife's
voice while going to bed. He says he goes to church to pray. You are trying to
determine if your patient's symptoms are normal grief or if you should diagnose and
treat him for Major Depressive Disorder (MDD). Which feature of Mr. Jones' case would
suggest MDD rather than a normal grief reaction?
A. Change in appetite
B. Fatigue
C. Heari - ✔✔D. Inability to experience any joy
✔✔Ms. Rogers is a 75-year-old woman who was found unresponsive in her house by
her neighbor who had come over to help clean her house. An empty unlabeled pill
container was found next to her on the bathroom floor. She was rushed to the ER,
stabilized and is now in ICU on a mechanical ventilator. Which of the following are true
regarding suicide in the elderly?
A. Approximately 75% of the elderly who commit suicide had visited a primary care
physician within the preceding month, but their symptoms went unrecognized.
B. Elderly persons attempting suicide are more likely to be married and living with their
spouse.
C. Elderly persons attempting suicide usually report good sleeping habits.
D. Firearms are the most common means of suicide in the elderly.
E. Suicidal behaviors increase with age, but rates of completed suicides don't. - ✔✔A.
Approximately 75% of the elderly who commit suicide had visited a primary care
physician within the preceding month, but their symptoms went unrecognized.
, ✔✔Ms. Burton is a 45-year-old woman who has never been to a primary care provider.
She presents today to establish care and get her health in order. Her concerns today
are: fatigue, weakness, numbness, insomnia, feeling sad at times, anhedonia,
increased appetite, weight gain, dry skin, and increasing hair loss within the past month.
Her vital signs are:
Heart rate: 78 beats/minute
Respiratory rate: 18 breaths/minute
Oxygen saturation: 95%
Blood pressure: 152/84 mmHg
Weight: 325 lbs
Body Mass Index: 41 kg/m2
Today, her physical exam is significant for thinning hair, poor dentition, a systolic
murmur heard at the left upper sternal border, an obese abdomen, and bilateral knee
stiffness and pain on range of motion exam. Remainder of the physical exam is within
normal limits. Which laboratory tests or studies can be done to rule out medical causes
of insomnia, fatigue, and depression?
A. CBC, CMP, and TSH
B. Chest-X Ray - ✔✔A. CBC, CMP, and TSH
✔✔A 41-year-old male with no significant past medical history is brought to the
Emergency Department after falling to the ground in the middle of a pick-up basketball
game with friends. He did not lose consciousness nor hit his head when he fell. As he
landed on the ball of his foot after having taken a shot, he recalls hearing a popping
sound followed by immediate pain in the posterior right ankle. On physical exam, the
posterior right ankle is edematous and tender to palpation. He is unable to plantarflex
his right foot. What is the most likely diagnosis of his current condition?
A. Achilles tendon rupture
B. Ankle arthritis
C. Ankle ligament sprain
D. Ankle tendonitis
E. Calcaneal fracture - ✔✔A. Achilles tendon rupture
✔✔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?
A. Emergent surgical consultation
B. Diagnostic imaging of right foot and ankle
ANSWERS AND QUESTIONS SET A+
✔✔Mr. Jones is an 82-year-old man who presents to the office for his six-month chronic
disease visit. His diabetes and hypertension are controlled on his usual home
medications. He reports that his wife died four weeks ago, and he is now experiencing
insomnia most days of the week and fatigue and loss of energy nearly every day;
reports decreased enjoyment of his activities, such as playing chess with his neighbor;
and is also experiencing loss of appetite but no weight loss. He denies any suicidal
ideation and has no previous suicide attempts. Mr. Jones says he often hears his wife's
voice while going to bed. He says he goes to church to pray. You are trying to
determine if your patient's symptoms are normal grief or if you should diagnose and
treat him for Major Depressive Disorder (MDD). Which feature of Mr. Jones' case would
suggest MDD rather than a normal grief reaction?
A. Change in appetite
B. Fatigue
C. Heari - ✔✔D. Inability to experience any joy
✔✔Ms. Rogers is a 75-year-old woman who was found unresponsive in her house by
her neighbor who had come over to help clean her house. An empty unlabeled pill
container was found next to her on the bathroom floor. She was rushed to the ER,
stabilized and is now in ICU on a mechanical ventilator. Which of the following are true
regarding suicide in the elderly?
A. Approximately 75% of the elderly who commit suicide had visited a primary care
physician within the preceding month, but their symptoms went unrecognized.
B. Elderly persons attempting suicide are more likely to be married and living with their
spouse.
C. Elderly persons attempting suicide usually report good sleeping habits.
D. Firearms are the most common means of suicide in the elderly.
E. Suicidal behaviors increase with age, but rates of completed suicides don't. - ✔✔A.
Approximately 75% of the elderly who commit suicide had visited a primary care
physician within the preceding month, but their symptoms went unrecognized.
, ✔✔Ms. Burton is a 45-year-old woman who has never been to a primary care provider.
She presents today to establish care and get her health in order. Her concerns today
are: fatigue, weakness, numbness, insomnia, feeling sad at times, anhedonia,
increased appetite, weight gain, dry skin, and increasing hair loss within the past month.
Her vital signs are:
Heart rate: 78 beats/minute
Respiratory rate: 18 breaths/minute
Oxygen saturation: 95%
Blood pressure: 152/84 mmHg
Weight: 325 lbs
Body Mass Index: 41 kg/m2
Today, her physical exam is significant for thinning hair, poor dentition, a systolic
murmur heard at the left upper sternal border, an obese abdomen, and bilateral knee
stiffness and pain on range of motion exam. Remainder of the physical exam is within
normal limits. Which laboratory tests or studies can be done to rule out medical causes
of insomnia, fatigue, and depression?
A. CBC, CMP, and TSH
B. Chest-X Ray - ✔✔A. CBC, CMP, and TSH
✔✔A 41-year-old male with no significant past medical history is brought to the
Emergency Department after falling to the ground in the middle of a pick-up basketball
game with friends. He did not lose consciousness nor hit his head when he fell. As he
landed on the ball of his foot after having taken a shot, he recalls hearing a popping
sound followed by immediate pain in the posterior right ankle. On physical exam, the
posterior right ankle is edematous and tender to palpation. He is unable to plantarflex
his right foot. What is the most likely diagnosis of his current condition?
A. Achilles tendon rupture
B. Ankle arthritis
C. Ankle ligament sprain
D. Ankle tendonitis
E. Calcaneal fracture - ✔✔A. Achilles tendon rupture
✔✔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?
A. Emergent surgical consultation
B. Diagnostic imaging of right foot and ankle
