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A 12-month-old boy is brought to the office by his mother for his routine health check-up. She informs you that she has just
been diagnosed with hypercholesterolemia. Her fasting serum total cholesterol concentration was 260 mg/dL and her
LDL-cholesterol concentration was 130 mg/dL (rec less than 129 mg/dL). She is unaware of a family history of coronary artery
disease because she was raised by her godmother when her parents died in their early 30s in a motor vehicle accident. A
special diet has been recommended for her; however, she is very concerned about the risk of hypercholesterolemia for her
son. The most appropriate management at this time is to
(A) ask her to reduce the child's fat intake and give him skim milk instead of whole milk
(B) do nothing until the child is 2 years of age
© have the child return for a fasting lipoprotein analysis
(D) obtain a random serum total cholesterol concentration for the child today
(E) refer the child to a lipid specialist


During a routine physical examination of a 2-week-old Jewish neonate, a grade 3/6 early systolic murmur is heard. The
mother reports no signs or symptoms of illness in the baby. The neonate is otherwise asymptomatic. Physical examination at
birth was normal. The most appropriate next step is to
(A) do funduscopic examination
(B) measure arterial blood pressures in the arms and legs
© order abdominal ultrasonography
(D) order chest x-ray film
(E) order electrocardiography


A 29-year-old Italian-American woman comes to the office for her first prenatal visit. Her last menstrual period was
16 weeks ago. This is her first pregnancy; her family history is unremarkable. She has heard that people ofMediterranean
ancestry are at risk for carrying a gene for β-thalassemia. She asks to be tested for this. Which of the following is the most
appropriate initial diagnostic study?
(A) Complete blood count with red cell indices
(B) Hemoglobin electrophoresis
© Red cell osmotic fragility test
(D) Restriction-fragment length polymorphism (RFLP) analysis of her β-globin gene
(E) Reticulocyte count

B/D/A

B/E/A

B/B/A................Always do least invasive study in your pt ...in order to pass this exam

follow this rule...for examle second pt..before xry and ekg..measure bp upper and lower extr



The correct answer is B. Measuring arterial blood pressures in the upper and lower extremities is the appropriate next step when evaluating an infant for congenital heart disease. This is especially helpful when considering coarctation of the aorta, as such infants may demonstrate a difference in the pulsations and blood pressures of the upper and lower extremities.

Funduscopic examination (choice A) is not the most appropriate examination in this child, who is suspected of having congenital heart disease. The funduscopic examination was used as a distracter because the question mentions that the infant is Jewish. The examiners are attempting to distract the test-taker by suggesting that this Jewish infant has Tay-Sachs disease, which is a neurodegenerative disorder prevalent in the Ashkenazi Jewish population. Children with Tay-Sachs disease may have a œcherry-red spot in the macular region on funduscopic examination.

Abdominal ultrasonography (choice C) would be done to rule out renal disease.
Likewise, although both a chest x-ray film (choice D) and an electrocardiograph (choice E) should be included in the evaluation of this patient, they are not the most appropriate next step. Always do the least invasive study on your patient

thanks shuun

yu welcome......ht09.

Another office one..


A 47-year-old Italian-American man comes to the office for the first time for routine medical care. He has been referred to you by his psychiatrist who has informed you that the patient has paranoid personality disorder. The patient has no other medical problems at this time. He is unmarried, lives alone and has no close friends, but he occasionally attends family
gatherings. He functions well working alone in a technical position in an engineering firm. Which of the following is the best way to structure the physician-patient relationship with this patient?

(A) Avoid giving him excessive details about possible, but infrequent, side effects and complications in order to avoid triggering his paranoia

(B) Explain the rationale for any diagnostic procedures and treatment regimens in some detail, adopting a professional, but not overly friendly stance

© Go out of your way to be warm and friendly so that he can develop trust in you

(D) Have his psychiatrist, with whom he has been working for several years, take the lead in presenting medical treatment options

(E) Try to communicate with his family or medical personnel when he is not present in order to overcome his withholding information because of distrust

@shuun
b

shunn, is this still MKSAP or something else? do you have it on line, disk, or.... ?

Meshi.
something else.......this is not mkasp