Family Medicine COMAT With Complete
Questions And Answers Exam
1.A 56-year-old female complains of palpitations and an
unintentional 20 lb weight loss in the past six months. History
reveals that her menstrual periods stopped approximately 7 years
ago. Vital signs include a blood pressure of 135/85 and a heart rate
of 110. Physical examination reveals a non-tender enlarged thyroid
gland without nodules. Structural examination reveals tissue texture
changes at T2 associated with an upper thoracic flexion hump.
Labora- tory studies reveal the following
TSH: 0.05
Free T3: 380
Free T4: 22
A thyroid stimulating immunoglobulin test is positive. The most
appropriate initial management is
A. Levothyroxine
B. Methimazole
C. Proylthiouracil
D. Radioactive iodine ablation
E. Thyroidectomy: B (although treatment with methimazole, proylthiouracil, radioactive iodine,
and surgical removal of the thyroid gland are plausible treatments for Grave's disease, methimazole is
recommnded as a first line agent over propylthiouracil due to potential hepatotoxicity)
2. A 66-year old female complains that the nail of her right great toe is
discolored and brittle. She states that she first noticed it 4 months ago
during a pedicure. Physical examination reveals the right great toenail to
,be yellowed, thickened, and has white subungual debris. The most
appropriate modality to confirm the most likely diagnosis is
A. Bacterial culture of nail clippings
B. Culture of toenail scrapings on Sabouraud's medium
C. Histopathologic examination of nail clippings under periodic
acid-Schiff stain
,D. Microscopic evaluation of toenail scrapings using KOH prep
E. One month terbinafine to confirm resolution: D (the most likely diagnosis is
onychomycosis
- microscopic evaluation is the best first step to make the diagnosis) (A; bacterial infection is less likely than
fungal) (B; Sabouraud's agar is used to grow fungal specimens - culture results usually return after weeks, a
microscopic evaluation would be faster - culturing would be indicated if the initial KOH prep shows abse
fungi) (C; this procedure stains fungal cell walls and helps in visualization - however, while this test is mor
sensitive, it is more expensive) (E; empiric treatment is not recommended due to side ettects - additionally,
treatment usually lasts 3 months, not 1, due to the slow growing nature of toenails)
3. A 70-year-old female who is 3 days status-post urologic surgery
develops a fever overnight in the hospital. She has an indwelling
Foley catheter with good urine output. Her past medical history
includes hypertension and urinary in- continence. She has no
significant family history. Vitals reveal her temperature to be 102.2F,
pulse 82, respirations 15, and blood pressure 134/85. Physical
examination is remarkable for mild suprapubic tenderness. You note
a tender nodule on the lateral border of the umbilicus. Urinalysis
reveals 60 WBC/hpf, trace protein, positive leukocyte esterase,
positive nitrites, and no casts. A reflex culture grows motile, gram-
negative rods with a dark green appearance and fruity odor. The
most appropriate pharmacologic therapy includes
A. Amoxicillin
B. Cefotaxime
C. Ceftriaxone
D. Ciprofloxacin
, E. Trimethoprim-sulfamethoxazole: D (indwelling catheter can cause a UTI with
Pseudomonas aerug- inosa - the indicated treatment is with a fluoroquinolone like ciprofloxacin or
levofloxacin) (none of the other answer choices have action against Pseudomonas)
4. A 32-year-old G1P0 female at 16 weeks' gestation presents with
vaginal bleed- ing. History reveals she had pelvic inflammatory
disease of unknown etiology prior to conception. Pelvic examination
reveals the cervical os to be closed. The most likely diagnosis is
A. Complete abortion
Questions And Answers Exam
1.A 56-year-old female complains of palpitations and an
unintentional 20 lb weight loss in the past six months. History
reveals that her menstrual periods stopped approximately 7 years
ago. Vital signs include a blood pressure of 135/85 and a heart rate
of 110. Physical examination reveals a non-tender enlarged thyroid
gland without nodules. Structural examination reveals tissue texture
changes at T2 associated with an upper thoracic flexion hump.
Labora- tory studies reveal the following
TSH: 0.05
Free T3: 380
Free T4: 22
A thyroid stimulating immunoglobulin test is positive. The most
appropriate initial management is
A. Levothyroxine
B. Methimazole
C. Proylthiouracil
D. Radioactive iodine ablation
E. Thyroidectomy: B (although treatment with methimazole, proylthiouracil, radioactive iodine,
and surgical removal of the thyroid gland are plausible treatments for Grave's disease, methimazole is
recommnded as a first line agent over propylthiouracil due to potential hepatotoxicity)
2. A 66-year old female complains that the nail of her right great toe is
discolored and brittle. She states that she first noticed it 4 months ago
during a pedicure. Physical examination reveals the right great toenail to
,be yellowed, thickened, and has white subungual debris. The most
appropriate modality to confirm the most likely diagnosis is
A. Bacterial culture of nail clippings
B. Culture of toenail scrapings on Sabouraud's medium
C. Histopathologic examination of nail clippings under periodic
acid-Schiff stain
,D. Microscopic evaluation of toenail scrapings using KOH prep
E. One month terbinafine to confirm resolution: D (the most likely diagnosis is
onychomycosis
- microscopic evaluation is the best first step to make the diagnosis) (A; bacterial infection is less likely than
fungal) (B; Sabouraud's agar is used to grow fungal specimens - culture results usually return after weeks, a
microscopic evaluation would be faster - culturing would be indicated if the initial KOH prep shows abse
fungi) (C; this procedure stains fungal cell walls and helps in visualization - however, while this test is mor
sensitive, it is more expensive) (E; empiric treatment is not recommended due to side ettects - additionally,
treatment usually lasts 3 months, not 1, due to the slow growing nature of toenails)
3. A 70-year-old female who is 3 days status-post urologic surgery
develops a fever overnight in the hospital. She has an indwelling
Foley catheter with good urine output. Her past medical history
includes hypertension and urinary in- continence. She has no
significant family history. Vitals reveal her temperature to be 102.2F,
pulse 82, respirations 15, and blood pressure 134/85. Physical
examination is remarkable for mild suprapubic tenderness. You note
a tender nodule on the lateral border of the umbilicus. Urinalysis
reveals 60 WBC/hpf, trace protein, positive leukocyte esterase,
positive nitrites, and no casts. A reflex culture grows motile, gram-
negative rods with a dark green appearance and fruity odor. The
most appropriate pharmacologic therapy includes
A. Amoxicillin
B. Cefotaxime
C. Ceftriaxone
D. Ciprofloxacin
, E. Trimethoprim-sulfamethoxazole: D (indwelling catheter can cause a UTI with
Pseudomonas aerug- inosa - the indicated treatment is with a fluoroquinolone like ciprofloxacin or
levofloxacin) (none of the other answer choices have action against Pseudomonas)
4. A 32-year-old G1P0 female at 16 weeks' gestation presents with
vaginal bleed- ing. History reveals she had pelvic inflammatory
disease of unknown etiology prior to conception. Pelvic examination
reveals the cervical os to be closed. The most likely diagnosis is
A. Complete abortion
