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- Jul 4, 2004
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A 24-year-old man comes to the office because of intermittent chest pain that began a few weeks ago. You have been his physician for the past 2 years and he has been in otherwise good health. He says he is not having pain currently. A review of his medical record shows that his serum cholesterol concentration was normal at a pre-employment physical examination 1 year ago. You have not seen him since that visit and he says he has had no other complaints or problems in the interim. He reminds you that he smokes 1 pack of cigarettes per day. When you question him further, he says that he does not use any alcohol or illicit drugs. Although the details are vague, he describes the chest pain as a substernal tightness that is definitely not related to exertion.
5. Which of the following findings on physical examination would be most consistent with costochondritis as the cause of his chest pain?
A. Crepitance over the second and third ribs anteriorly
B. Deep tenderness to hand pressure on the sternum
C. Localized point tenderness in the parasternal area
D. Pain on deep inspiration
E. Normal physical examination
(Answer C)
6. In light of the patient's original denial of drug use, which of the following is the most appropriate next step to confirm a diagnosis of cocaine use?
A. Ask the laboratory if serum is available for toxicologic screening on a previous blood sample
B. Call his family to obtain corroborative history
C. Obtain a plasma catecholamine concentration
D. Obtain a urine sample for routine analysis but also request toxicologic screening
E. Present your findings to the patient and confront him with the suspected diagnosis
(Answer E)
are you kidding me, WTF, can some explain to be how question 6, E is the right answer. this is BS. Confront the patient??? are you serious. I had 4 of my colleagues do the question and they all picked C.
please, entertain me.
5. Which of the following findings on physical examination would be most consistent with costochondritis as the cause of his chest pain?
A. Crepitance over the second and third ribs anteriorly
B. Deep tenderness to hand pressure on the sternum
C. Localized point tenderness in the parasternal area
D. Pain on deep inspiration
E. Normal physical examination
(Answer C)
6. In light of the patient's original denial of drug use, which of the following is the most appropriate next step to confirm a diagnosis of cocaine use?
A. Ask the laboratory if serum is available for toxicologic screening on a previous blood sample
B. Call his family to obtain corroborative history
C. Obtain a plasma catecholamine concentration
D. Obtain a urine sample for routine analysis but also request toxicologic screening
E. Present your findings to the patient and confront him with the suspected diagnosis
(Answer E)
are you kidding me, WTF, can some explain to be how question 6, E is the right answer. this is BS. Confront the patient??? are you serious. I had 4 of my colleagues do the question and they all picked C.
please, entertain me.
