Chapter·CCS CasesOrdering tests

Specialized diagnostic proceduresDownloads

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1

A 57-year-old man presents to his family physician for a routine exam. He feels well and reports no new complaints since his visit last year. Last year, he had a colonoscopy which showed no polyps, a low dose chest computerized tomography (CT) scan that showed no masses, and routine labs which showed a fasting glucose of 93 mg/dL. He is relatively sedentary and has a body mass index (BMI) of 24 kg/m^2. He has a history of using methamphetamines, alcohol (4-5 drinks per day since age 30), and tobacco (1 pack per day since age 18), but he joined Alcoholics Anonymous and has been in recovery, not using any of these for the past 7 years. Which of the following is indicated at this time?

AColonoscopy

BChest computerized tomography (CT) scan

CAbdominal ultrasound

DChest radiograph

EFasting glucose

2

A 43-year-old woman comes to the physician because of tingling and weakness in her left arm for the past 2 days. An image of the brachial plexus is shown. Nerve conduction study shows decreased transmission of electrical impulses in the labeled structure. Physical examination is most likely to show impairment of which of the following movements?

AOpposition of the thumb

BFlexion of the forearm

CAbduction of the shoulder above 100 degrees

DExtension of the wrist and fingers

EFlexion of the metacarpophalangeal joints

3

A 56-year-old woman presents to her primary care physician complaining of heartburn, belching, and epigastric pain that is aggravated by coffee and fatty foods. She states that she has recently been having difficulty swallowing in addition to her usual symptoms. What is the most appropriate next step in management of this patient?

ATrial of an H2 receptor antagonist

BTrial of a proton pump inhibitor

CUpper endoscopy

DNissen fundoplication

ELifestyle changes - don't lie down after eating; avoid spicy foods; eat small servings

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