UVA Family Medicine EXAM Questions AND Correct Answers
1. A 50 year old female with a ten year history of type II diabetes
presents for regularly-scheduled follow up. She has no complaints,
and just visited her ophthalmologist last week. Current medications
include glyburide, metformin, and simvastatin. On physical exam, vital
signs are virtually unchanged from previous visits, with temperature
37.1 C (99 F), HR 80, BP 140/83, RR 15, and O2 Sat 98% on room air.
Neurological examination reveals diminished sensation to light touch
and pinprick in a stocking distribution on the lower extremities
bilaterally. Remainder of physical exam is benign. Laboratory
evaluation reveals: Na+ 136, K+ 3.9 Cl- 104, HCO3- 25, BUN 15, Cr 1.0,
Glucose 150; hemoglobin A1c: 7.1%; Urinalysis: negative for ketones,
glucose, bilirubin, leukocyte esterase, or blood; moderate protein;
Lipid profile: Total cholesterol 146, HDL 46, LDL 100. At this time,
which of the following would be the most appro - ✔✔E. Add lisinopril
All diabetics should be on ACE inhibitor or ARB for CV and renal
protection
10. A 71 year old male comes to his physicians office complaining of
muscle weakness. The weakness began insidiously several weeks ago,
and has now progressed to the point where he has difficulty with
normal activities such as brushing his hair or sitting unsupported. Past
medical history is significant for hyperlipidemia, chronic renal
insufficiency, coronary artery disease, and coronary artery bypass and
grafting. Current medications include atorvastatin, fosinopril,
metoprolol, aspirin, and spironolactone. Physical examination reveals
diminished deep tendon reflexes and decreased motor strength.
Laboratory evaluation shows Na+ 143, K+ 7.4, Cl- 101, HCO3- 28, BUN
30, and creatinine 1.8. EKG is obtained on presentation and is seen
,here. What is the most appropriate initial step in the management of
this patient?
A. Administer IV insulin and glucose
B. Administer po sodium polystyrene sulfate
C. Administer IV sodium - ✔✔D. Administer IV calcium gluconate
100. A 24 year old female returns to her physician after a routine Pap
smear showed atypical squamous cells of undetermined significance.
She has no past history of abnormal Pap smears or sexually-
transmitted infections, and other testing from her last visit (including
beta-hCG and testing for gonorrhea and chlamydia) was negative. She
has a lifetime total of four sexual partners, and is currently sexually
active with one partner, using only an oral contraceptive pill for birth
control. Menarche was at age 11, and menses have been
unremarkable. PCR reveals the presence of human papillomavirus
DNA, type 18. Which of the following is the most appropriate next
step in the management of this patient?
A. Rapid plasma reagin (RPR) testing
B. Begin imiquimod
C. Endometrial biopsy
D. Colposcopy
E. Reassurance and routine follow-up - ✔✔D. Colposcopy
100. A 24 year old female returns to her physician after a routine Pap
smear showed atypical squamous cells of undetermined significance.
She has no past history of abnormal Pap smears or sexually-
,transmitted infections, and other testing from her last visit (including
beta-hCG and testing for gonorrhea and chlamydia) was negative. She
has a lifetime total of four sexual partners, and is currently sexually
active with one partner, using only an oral contraceptive pill for birth
control. Menarche was at age 11, and menses have been
unremarkable. PCR reveals the presence of human papillomavirus
DNA, type 18. Which of the following is the most appropriate next
step in the management of this patient? - ✔✔
101. An otherwise healthy 2 year old male returns for follow-up of
bilateral ear effusions. Several months ago, the patient completed a
course of amoxicillin for bilateral acute otitis media, but later follow
up revealed persistent effusions. At his last visit, audiometry revealed
only slight hearing loss bilaterally (<20 db). Today, his mother states
that she does feel that he doesn't seem to hear as well as his siblings,
though he has been afebrile and has no other symptoms. Physical
exam reveals nonerythematous, immobile tympanic membranes with
persistent effusions bilaterally. Repeat audiometry reveals a bilateral
hearing deficit of 42 decibels. What is the most appropriate next step
in the management of this patient?
A. Chlorpheniramine and pseudophedrine
B. Prednisolone
C. Referral for tympanostomy tube placement
D. Cefdinir
E. Follow up in three months - ✔✔C. Referral for tympanostomy tube
placement (OME)
, 102. A 24 year old woman with a history of recurrent headaches
returns for follow up. For the past year and a half, she has
experienced severe headaches accompanied by nausea and vomiting
several times per week. Her pain is pulsating and throbbing, and
typically affects the left temporal region of her head. The headaches
last at least several hours, but have lasted as long as three days and
have required her to miss several days of work. Past medical history is
significant for major depression and dysmenorrhea. Her mother has a
history of similar headaches. Several weeks ago, she was seen and
given a prescription for oral sumatriptan. Today, she states that she
continues to have several headaches each week, just as she did
previously, but taking sumatriptan and lying in a dark room helps
relieve them within a few hours. Her neurological examination is
normal. There is no papilledema. Which of the following is the mos -
✔✔D. Amitriptyline
103. A 16 year old female presents with abdominal pain and fever.
The pain began 12 hours ago, and was initially focused in the umbilical
area, but has since shifted to the right lower quadrant. She has also
experienced nausea and had one episode of vomiting. She is sexually
active with one partner, and her last menstrual period was three
weeks ago. She has not eaten anything since yesterday and does not
feel hungry. Vital signs include temperature 38.1 C (100.5 F), pulse
96/min, blood pressure 112/70. The patient is lying very still on the
examination table with her hips flexed. Her abdominal examination
shows voluntary guarding and tenderness to palpation greatest in the
right lower quadrant, approximately midway between the umbilicus
and the anterior iliac spine. Laboratory analysis shows a white blood
1. A 50 year old female with a ten year history of type II diabetes
presents for regularly-scheduled follow up. She has no complaints,
and just visited her ophthalmologist last week. Current medications
include glyburide, metformin, and simvastatin. On physical exam, vital
signs are virtually unchanged from previous visits, with temperature
37.1 C (99 F), HR 80, BP 140/83, RR 15, and O2 Sat 98% on room air.
Neurological examination reveals diminished sensation to light touch
and pinprick in a stocking distribution on the lower extremities
bilaterally. Remainder of physical exam is benign. Laboratory
evaluation reveals: Na+ 136, K+ 3.9 Cl- 104, HCO3- 25, BUN 15, Cr 1.0,
Glucose 150; hemoglobin A1c: 7.1%; Urinalysis: negative for ketones,
glucose, bilirubin, leukocyte esterase, or blood; moderate protein;
Lipid profile: Total cholesterol 146, HDL 46, LDL 100. At this time,
which of the following would be the most appro - ✔✔E. Add lisinopril
All diabetics should be on ACE inhibitor or ARB for CV and renal
protection
10. A 71 year old male comes to his physicians office complaining of
muscle weakness. The weakness began insidiously several weeks ago,
and has now progressed to the point where he has difficulty with
normal activities such as brushing his hair or sitting unsupported. Past
medical history is significant for hyperlipidemia, chronic renal
insufficiency, coronary artery disease, and coronary artery bypass and
grafting. Current medications include atorvastatin, fosinopril,
metoprolol, aspirin, and spironolactone. Physical examination reveals
diminished deep tendon reflexes and decreased motor strength.
Laboratory evaluation shows Na+ 143, K+ 7.4, Cl- 101, HCO3- 28, BUN
30, and creatinine 1.8. EKG is obtained on presentation and is seen
,here. What is the most appropriate initial step in the management of
this patient?
A. Administer IV insulin and glucose
B. Administer po sodium polystyrene sulfate
C. Administer IV sodium - ✔✔D. Administer IV calcium gluconate
100. A 24 year old female returns to her physician after a routine Pap
smear showed atypical squamous cells of undetermined significance.
She has no past history of abnormal Pap smears or sexually-
transmitted infections, and other testing from her last visit (including
beta-hCG and testing for gonorrhea and chlamydia) was negative. She
has a lifetime total of four sexual partners, and is currently sexually
active with one partner, using only an oral contraceptive pill for birth
control. Menarche was at age 11, and menses have been
unremarkable. PCR reveals the presence of human papillomavirus
DNA, type 18. Which of the following is the most appropriate next
step in the management of this patient?
A. Rapid plasma reagin (RPR) testing
B. Begin imiquimod
C. Endometrial biopsy
D. Colposcopy
E. Reassurance and routine follow-up - ✔✔D. Colposcopy
100. A 24 year old female returns to her physician after a routine Pap
smear showed atypical squamous cells of undetermined significance.
She has no past history of abnormal Pap smears or sexually-
,transmitted infections, and other testing from her last visit (including
beta-hCG and testing for gonorrhea and chlamydia) was negative. She
has a lifetime total of four sexual partners, and is currently sexually
active with one partner, using only an oral contraceptive pill for birth
control. Menarche was at age 11, and menses have been
unremarkable. PCR reveals the presence of human papillomavirus
DNA, type 18. Which of the following is the most appropriate next
step in the management of this patient? - ✔✔
101. An otherwise healthy 2 year old male returns for follow-up of
bilateral ear effusions. Several months ago, the patient completed a
course of amoxicillin for bilateral acute otitis media, but later follow
up revealed persistent effusions. At his last visit, audiometry revealed
only slight hearing loss bilaterally (<20 db). Today, his mother states
that she does feel that he doesn't seem to hear as well as his siblings,
though he has been afebrile and has no other symptoms. Physical
exam reveals nonerythematous, immobile tympanic membranes with
persistent effusions bilaterally. Repeat audiometry reveals a bilateral
hearing deficit of 42 decibels. What is the most appropriate next step
in the management of this patient?
A. Chlorpheniramine and pseudophedrine
B. Prednisolone
C. Referral for tympanostomy tube placement
D. Cefdinir
E. Follow up in three months - ✔✔C. Referral for tympanostomy tube
placement (OME)
, 102. A 24 year old woman with a history of recurrent headaches
returns for follow up. For the past year and a half, she has
experienced severe headaches accompanied by nausea and vomiting
several times per week. Her pain is pulsating and throbbing, and
typically affects the left temporal region of her head. The headaches
last at least several hours, but have lasted as long as three days and
have required her to miss several days of work. Past medical history is
significant for major depression and dysmenorrhea. Her mother has a
history of similar headaches. Several weeks ago, she was seen and
given a prescription for oral sumatriptan. Today, she states that she
continues to have several headaches each week, just as she did
previously, but taking sumatriptan and lying in a dark room helps
relieve them within a few hours. Her neurological examination is
normal. There is no papilledema. Which of the following is the mos -
✔✔D. Amitriptyline
103. A 16 year old female presents with abdominal pain and fever.
The pain began 12 hours ago, and was initially focused in the umbilical
area, but has since shifted to the right lower quadrant. She has also
experienced nausea and had one episode of vomiting. She is sexually
active with one partner, and her last menstrual period was three
weeks ago. She has not eaten anything since yesterday and does not
feel hungry. Vital signs include temperature 38.1 C (100.5 F), pulse
96/min, blood pressure 112/70. The patient is lying very still on the
examination table with her hips flexed. Her abdominal examination
shows voluntary guarding and tenderness to palpation greatest in the
right lower quadrant, approximately midway between the umbilicus
and the anterior iliac spine. Laboratory analysis shows a white blood
