Internal Medicine Preventive Medicine and Health Maintenance: Review Questions Katherine Walsh, MD Dr. Walsh is a chief medical resident, Department of Medicine, University of Florida, Gainesville, FL. Choose the single best answer for each question.
	1. A 30-year-old man presents to the clinic for a routine physical examination prior to starting employment at a local hospital. The patient has no complaints and has not seen a doctor since childhood. His immunizations are current, and he has never been hospitalized. The patient takes no medications and has no drug allergies. He has smoked 1 pack of cigarettes per day since age 18 years and drinks 3 to 4 beers per week. His father was diagnosed with lung cancer and had a 30 pack-year smoking history. Which of the following is the next step in this patient’s management? Screening for hypertension Screening for hypertension and smoking cessation counseling Smoking cessation counseling Testicular examination Testicular examination and smoking cessation counseling Click here to compare your answer. 2. A 72-year-old African American man with a history of hypertension presents to the clinic for a 3-month follow-up appointment. He has no new complaints and states that his blood pressure has been adequately controlled with metoprolol 25 mg daily and lisinopril 10 mg daily. The patient continues to abstain from smoking since quitting 30 years ago and is able to perform activities of daily living without difficulty. He also has increased his exercise tolerance to walking 1 to 2 miles 3 times a week. Blood pressure is 125/70 mm Hg and heart rate is 61 bpm. What is the next best step in the management of this patient? Schedule an abdominal ultrasound Schedule an abdominal ultrasound and repeat in 5 years Schedule computed tomography of the abdomen and pelvis Schedule computed tomography of the abdomen and pelvis and repeat in 5 years No additional studies are needed at this time Click here to compare your answer. 3. A 61-year-old woman with rheumatoid arthritis presents to her primary care physician for a routine follow-up. The patient reports regular follow-up with her rheumatologist. She has been taking oral methotrexate 7.5 mg once a week for 2 years and has not experienced a flare during that time. She has no other medical problems except for an uncomplicated vaginal hysterectomy due to fibroids 6 years ago. With the help of regular smoking cessation counseling during clinic visits, the patient has reduced her smoking from 1 pack of cigarettes per day to a half pack per day. Physical examination reveals no abnormalities except for a small bruise on her left shin, which she states has improved since accidentally hitting her leg on the coffee table last week. The patient’s vital signs include blood pressure of 128/72 mm Hg, heart rate of 65 bpm, respiratory rate of 18 breaths/min, and an oxygen saturation of 96% on room air. She weighs 112 lb and is 5 ft 4 in with a body mass index of 19.2 kg/m2. Which of the following should be performed as part of routine screening? Abdominal ultrasound Ankle brachial index Dual energy x-ray absorptiometry (DEXA) scan Pelvic examination and Papanicolaou (Pap) smear Transvaginal ultrasound Click here to compare your answer.		4. A 67-year-old man with gastroesophageal reflux disease presents to the clinic for routine follow-up. One week ago, he cut his hand on a rusty nail while working in his garage, but the cut was minor and is healing well. The patient denies fevers or chills and pain or drainage from the wound. He feels well since being discharged from the hospital 1 month ago after evaluation of atypical chest pain. The symptoms were attributed to gastroesophageal reflux disease and completely resolved with twice-daily proton pump inhibitor therapy. A copy of his immunization records shows that he received a pneumococcal vaccine for the first time during his admission for atypical chest pain, an influenza vaccine 3 years ago, and a tetanus booster 7 years ago. He performs all daily activities without difficulty. Physical examination reveals no abnormalities. Vital signs include blood pressure of 128/65 mm Hg, heart rate of 62 bpm, respiratory rate of 18 breaths/min, and oxygen saturation of 96% on room air. Body mass index is 20 kg/m2. Laboratory testing, including low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, complete blood count, and basic metabolic panel, are normal. Which of the following is indicated at this time? Influenza vaccine only Influenza vaccine and pneumococcal vaccine Influenza vaccine and tetanus booster Tetanus booster only No immunizations are indicated at this time Click here to compare your answer. 5. A 42-year-old man presents to the clinic to establish a primary care provider. He recently moved to the area with his wife and son after retiring from the military. His immunizations are current, and he takes no medications. The patient has no medical problems and has never had surgery. He does not smoke or drink alcohol and is interested in training for marathons. There is no family history of cardiovascular disease or colorectal cancer. He asks for recommendations for maintaining his health. Which of the following should be recommended at this time? Colonoscopy Digital rectal examination and prostate-specific antigen testing Fecal occult blood testing and flexible sigmoidoscopy Lipid panel No additional testing is needed at this time Click here to compare your answer.
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