FM COMAT Exam Study Guide
Solutions
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.
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,Most likely diagnosis is: - ANSWER✔✔-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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,A 40-year-old male presents with fever and pain, swelling, and tenderness of the right
great toe for the past 12 hours. Joint aspiration reveals negatively birefringent crystals.
The most appropriate recommendation at this time is
A. allopurinol
B. colchicine
C. indomethacin
D. low purine diet
E. probenecid - ANSWER✔✔-C. indomethacin
Gout is a crystal-induced arthropathy caused by deposition of monosodium urate
crystals. The most common joint affected is the first metatarsophalangeal joint but it can
also affect other joints including ankle, foot, and knee. Joint aspiration shows needle
shaped, negatively birefringent crystals. These crystals form secondary to high levels of
uric acid. These high levels are typically due to underexcretion although it can be due to
overproduction as well. These crystals cause an inflammatory response and an intense,
sudden onset of pain. Gout flares are typically seen when there is an acute increase or
decrease in uric acid levels. Acute gout attacks are treated primarily with pain relief
with NSAIDs, indomethacin is a commonly used NSAID but any of them can be used.
A 68-year-old male with atrial fibrillation presents to the office for blood testing.
History reveals that he takes warfarin 2 mg by mouth daily. Laboratory studies reveal a
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, prothrombin time of 17.75 sec and INR of 2.32. The most appropriate recommendation
at this time is to
A. administer vitamin K
B. continue with the current dosing schedule
C. discontinue warfarin and start aspirin 81 mg PO
D. increase warfarin to 4 mg PO daily
E. skip the next dose and continue with 2 mg PO four times per week - ANSWER✔✔-B.
continue with the current dosing schedule
Atrial fibrillation (AF) is caused by multiple foci in the atria that fire continuously in a
chaotic pattern, causing an irregular, rapid ventricular rate. Instead of contracting
intermittently, the atria quiver continuously. Atrial rate is typically over 400/min but
most impulses are blocked, so ventricular rate ranges between 75/min and 175/min.
Patients with AF and underlying heart disease are at a markedly increased risk for
adverse events, such as thromboembolism. Some common causes of AF include heart
disease (coronary artery disease, myocardial infarction, hypertension, mitral valve
disease), pulmonary disease, thyroid disease, systemic illness, stress, excessive alcohol
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Solutions
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.
CELESTINE808 Page 1/143
,Most likely diagnosis is: - ANSWER✔✔-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.
CELESTINE808 Page 2/143
,A 40-year-old male presents with fever and pain, swelling, and tenderness of the right
great toe for the past 12 hours. Joint aspiration reveals negatively birefringent crystals.
The most appropriate recommendation at this time is
A. allopurinol
B. colchicine
C. indomethacin
D. low purine diet
E. probenecid - ANSWER✔✔-C. indomethacin
Gout is a crystal-induced arthropathy caused by deposition of monosodium urate
crystals. The most common joint affected is the first metatarsophalangeal joint but it can
also affect other joints including ankle, foot, and knee. Joint aspiration shows needle
shaped, negatively birefringent crystals. These crystals form secondary to high levels of
uric acid. These high levels are typically due to underexcretion although it can be due to
overproduction as well. These crystals cause an inflammatory response and an intense,
sudden onset of pain. Gout flares are typically seen when there is an acute increase or
decrease in uric acid levels. Acute gout attacks are treated primarily with pain relief
with NSAIDs, indomethacin is a commonly used NSAID but any of them can be used.
A 68-year-old male with atrial fibrillation presents to the office for blood testing.
History reveals that he takes warfarin 2 mg by mouth daily. Laboratory studies reveal a
CELESTINE808 Page 3/143
, prothrombin time of 17.75 sec and INR of 2.32. The most appropriate recommendation
at this time is to
A. administer vitamin K
B. continue with the current dosing schedule
C. discontinue warfarin and start aspirin 81 mg PO
D. increase warfarin to 4 mg PO daily
E. skip the next dose and continue with 2 mg PO four times per week - ANSWER✔✔-B.
continue with the current dosing schedule
Atrial fibrillation (AF) is caused by multiple foci in the atria that fire continuously in a
chaotic pattern, causing an irregular, rapid ventricular rate. Instead of contracting
intermittently, the atria quiver continuously. Atrial rate is typically over 400/min but
most impulses are blocked, so ventricular rate ranges between 75/min and 175/min.
Patients with AF and underlying heart disease are at a markedly increased risk for
adverse events, such as thromboembolism. Some common causes of AF include heart
disease (coronary artery disease, myocardial infarction, hypertension, mitral valve
disease), pulmonary disease, thyroid disease, systemic illness, stress, excessive alcohol
CELESTINE808 Page 4/143
