ITE 31-40

An 8-year-old male is brought to your office because of acute lower abdominal pain. He does not have constipation and has never had abdominal surgery. You suspect acute appendicitis. Which one of the following imaging modalities would be most appropriate to consider first?

• Plain radiography
• Ultrasonography
• CT without contrast
• CT with contrast
• MRI

A 33-year-old male presents to your office with a 4-week history of a runny and itchy nose, nasal congestion, watery eyes, sneezing, and cough. He reports that he always has similar symptoms this time of year. He has tried taking over-the-counter diphenhydramine (Benadryl Allergy) for the past week but finds it too sedating. He reports that his symptoms are interfering with his quality of life. On examination he has pale, boggy nasal mucosa with clear rhinorrhea. Lung auscultation is normal. Which one of the following is the most appropriate treatment?

• Butterbur herbal supplement
• Oral amoxicillin
• Oral montelukast
• Intranasal fluticasone
• Intramuscular methylprednisolone

A 45-year-old male sees you for a routine visit. His medical history includes hypertension treated with hydrochlorothiazide, amlodipine (Norvasc), and losartan (Cozaar). He also has type 2 diabetes treated with metformin and empagliflozin (Jardiance). Laboratory findings are significant for an LDL-cholesterol level of 167 mg/dL and you prescribe simvastatin (Zocor), 80 mg daily. At a follow-up visit 3 months later he tells you that he stopped taking the simvastatin after a week due to muscle pain and weakness. Which one of the following medications in this patient’s current regimen most likely contributed to his risk for developing statin-induced myopathy?

• Amlodipine
• Empagliflozin
• HCTZ
• Losartan
• Metformin

A 77-year-old female presents to your office as a new patient. She recently moved from New York to Florida to live with her daughter, after her partner died 2 years ago. Her past medical history is significant for hypertension, hypothyroidism, osteoarthritis, and cachexia. Her current medications, which were prescribed by her previous primary care physician, include the following: Acetaminophen Hydrochlorothiazide Levothyroxine (Synthroid) Losartan (Cozaar) Megestrol (Megace) A multivitamin Her vital signs are unremarkable except for a 7% weight loss in the past year. A recent TSH level was within the normal range. Which one of the following medications should be discontinued?

• Acetaminophen
• HCTZ
• Levothyroxine
• Losartan
• Megestrol

A 12-year-old female is brought to your office for a routine well child examination. The U.S. Preventive Services Task Force recommends screening this patient for which one of the following?

• Anemia
• Depression
• Diabetes Mellitus
• Dyslipidemia
• HIV

A 35-year-old female presents with very pruritic, recurrent, grouped papules, vesicles, and erosions on her knees and elbows. She does not have any known connective tissue diseases, gastrointestinal disturbances, sexually transmitted infections, or recurrent exposures. A skin biopsy is consistent with dermatitis herpetiformis. A positive test for which one of the following is most consistent with this diagnosis?

• Anti thydoid antibodies
• HSV antibody titers
• Intrinsic factor antibodies
• IgA tissue transglutaminase
• VZV antibody titers

Which one of the following regimens is recommended for the treatment of hypertension in a patient with stage 3 chronic kidney disease and proteinuria?

• A loop diuretic and a β-blocker
• An ACE inhibitor and an angiotensin receptor blocker
• An ACE inhibitor and a thiazide diuretic
• A calcium channel blocker and a thiazide diuretic
• A potassium-sparing diuretic and a thiazide diuretic

The most effective therapy to improve quality of life in patients with tinnitus is

• a benzodiazepine
• an SSRI
• transcutaneous electrical nerve stimulation (TENS)
• acupuncture
• CBT

A 65-year-old male is discharged following placement of a drug-eluting stent in the left anterior descending artery. Which one of the following is NOT appropriate first-line therapy in this patient?

• ASA and plavix
• Diltiazem
• Metoprolol
• Rosuvastatin

A recently divorced 47-year-old male comes to your office appearing disheveled, with the smell of alcohol on his breath. His Patient Health Questionnaire–9 (PHQ-9) score today is 20, and his last PHQ-9 score was 7. He has a history of depression and is currently taking citalopram (Celexa). The patient is tearful during the encounter and admits to thinking the world would be better without him in it. He does not have a weapon with him but keeps a gun in an unlocked drawer in his nightstand. Which one of the following would be most appropriate at this point?

• Avoiding direct inquiry about suicide
• Calling 911
• Crisis Planning
• Creating a suicide prevention contract
• Witholding psychogenic medications