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NMT200 > Midterm > Flashcards

Midterm Flashcards

1
Q

What percentage of Canadians are considered obese?

a. 1 in 10
b. 1 in 5
c. 1 in 3
d. 1 in 2

A

c. 1 in 3

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2
Q

Which of the following is a limitation of using BMI for body fat assessment?

a. Simple and quick to measure
b. Does not reflect body composition
c. Widely applicable to all populations
d. Costly to administer

A

b. Does not reflect body composition

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3
Q

Which method is considered the gold standard for fat assessment but is limited by cost and radiation exposure?

a. BMI
b. Waist-to-hip ratio
c. DEXA
d. Skinfold thickness

A

c. DEXA

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4
Q

Which of the following health conditions is associated with the highest prevalence in obese populations?

a. Hypertension
b. Type 2 Diabetes
c. Non-alcoholic fatty liver disease (NAFLD)
d. Obstructive Sleep Apnea

A

c. Non-alcoholic fatty liver disease (NAFLD)

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5
Q

What is the recommended weight gain during pregnancy for women with a pre-pregnancy BMI of 25.0 – 29.9?

a. 5-9 kg (11-20 lbs)
b. 7 - 11.5kg (15 - 25lbs)
c. 12.5-18 kg (28-40 lbs)
d. 0-5% weight loss

A

b. 7 - 11.5kg (15 - 25lbs)

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6
Q

Which of the following is a primary cause of weight gain, most commonly seen in women between 23-34 years?

a. Hyperthyroidism
b. Increased caloric intake
c. Cushing’s syndrome
d. Hypogonadism

A

b. Increased caloric intake

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7
Q

What is a red flag for assessing weight gain?

a. Increased appetite over weeks
b. Rapid weight gain over days to weeks
c. Gradual weight gain over months
d. Difficulty sleeping

A

b. Rapid weight gain over days to weeks

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8
Q

In the Edmonton Obesity Staging System, what does Stage 3 indicate?

a. No clinical risk factors
b. Subclinical risk factors
c. Established disease
d. Severe disease

A

d. Severe disease

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9
Q

Which of the following is a strength of bioelectric impedance analysis (BIA)?

a. Measures abdominal obesity
b. Gold standard for fat assessment
c. Accurate for assessing lean body mass
d. Does not require hydration control

A

c. Accurate for assessing lean body mass

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10
Q

Which of the following is NOT considered a common medical cause of secondary weight gain?

a. Cushing’s syndrome
b. Hyperthyroidism
c. Hypogonadism
d. Polycystic ovarian syndrome (PCOS)

A

b. Hyperthyroidism

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11
Q

Which of the following pregnancy complications is associated with a BMI ≥ 30?

a. Pre-eclampsia
b. Hyperemesis gravidarum
c. Gestational hypertension
d. Placenta previa

A

a. Pre-eclampsia

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12
Q

What is the prevalence of type 2 diabetes in the obese population?

a. 10-19%
b. 34-41%
c. 7-20%
d. 45%

A

c. 7-20%

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13
Q

What is the recommended frequency for checking bone densitometry after bariatric surgery?
a. Every 3 months
b. Every 6-12 months
c. Yearly
d. Every 2 years

A

d. Every 2 years

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14
Q

What is the recommended frequency for checking vitamin B12 if supplemented after bariatric surgery?
a. Every 3-6 months
b. Every 6-12 months
c. Yearly
d. Every 2 years

A

b. Every 3-6 months

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15
Q

Which method for assessing body fat is convenient, portable, but underestimates fat mass in overweight individuals?

a. Skinfold thickness
b. Waist-to-hip ratio
c. Bioelectric impedance (BIA)
d. DEXA

A

c. Bioelectric impedance (BIA)

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16
Q

In the STOP-Bang questionnaire for sleep apnea, which of the following is NOT a criterion?

a. Snoring
b. Neck circumference
c. Abdominal fat percentage
d. Gender

A

c. Abdominal fat percentage

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17
Q

Which of the following is considered a medical cause of secondary weight gain?

a. Increased caloric intake
b. Polycystic ovarian syndrome (PCOS)
c. Smoking cessation
d. Environmental chemicals

A

b. Polycystic ovarian syndrome (PCOS)

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17
Q

What is the estimated prevalence of hypertension in the obese population?

a. 49-65%
b. 34-41%
c. 10-19%
d. 7-20%

A

a. 49-65%

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18
Q

What proportion of pregnant women with a BMI > 25 are at risk for gestational diabetes?

a. 15-20%
b. 5-7%
c. 10-12%
d. 8-10%

A

d. 8-10%

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19
Q

Which of the following is a strength of using DEXA for body fat assessment?

a. Inexpensive
b. Quick to perform
c. Precise measurement
d. No radiation exposure

A

c. Precise measurement

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20
Q

What is the minimum percentage of hepatic steatosis required for a diagnosis of NAFLD?
a. 2%
b. 5%
c. 10%
d. 15%

A

b. 5%

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21
Q

What percentage of patients with NAFLD are overweight?
a. 30%
b. 50%
c. 40%
d. 10%

A

a. 30%

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22
Q

What condition is characterized by 5% or greater hepatic steatosis plus hepatocellular injury and inflammation?
a. Simple Steatosis
b. Nonalcoholic Fatty Liver Disease (NAFLD)
c. Nonalcoholic Steatohepatitis (NASH)
d. Cirrhosis

A

c. Nonalcoholic Steatohepatitis (NASH)

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23
Q

Which demographic group has the highest prevalence of NAFLD?
a. African Americans
b. Caucasians
c. Hispanics
d. Asians

A

c. Hispanics

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24
Q

What is the most significant risk factor for developing NAFLD?
a. Maternal obesity
b. High fructose consumption
c. Obesity
d. Genetics

A

c. Obesity

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25
Q

What is a common complication associated with NAFLD?
a. Osteoporosis
b. Chronic Kidney Disease
c. Asthma
d. Hypertension

A

b. Chronic Kidney Disease

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26
Q

Which of the following is considered a protective factor against NAFLD?
a. Alcohol consumption
b. Breastfeeding for more than 6 months
c. Sedentary lifestyle
d. High sugar diet

A

b. Breastfeeding for more than 6 months

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27
Q

What is the Fatty Liver Index score that rules in fatty liver?
a. < 30
b. ≥ 60
c. < 50
d. 40-60

A

b. ≥ 60

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28
Q

Which symptom is commonly associated with advanced liver disease?
a. Nausea
b. Palmar erythema
c. Diarrhea
d. Weight gain

A

b. Palmar erythema

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29
Q

What imaging modality is considered first-line for diagnosing fatty liver disease?
a. MRI
b. CT
c. Ultrasonography
d. PET scan

A

c. Ultrasonography

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30
Q

Which of the following is NOT a component of Metabolic Syndrome?
a. High blood pressure
b. Low HDL cholesterol
c. High triglycerides
d. Low blood sugar

A

d. Low blood sugar

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31
Q

What percentage of NAFLD patients are estimated to progress to end-stage liver disease within 10 years?
a. 15%
b. 30%
c. 45%
d. 60%

A

c. 45%

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32
Q

When should a patient with NASH be referred to a specialist?
a. For any mild symptom
b. Only for liver biopsy
c. When there is evidence of advanced fibrosis
d. If they are overweight

A

c. When there is evidence of advanced fibrosis

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33
Q

Which liver enzyme is often evaluated in NAFLD testing? a. Creatinine
b. ALT
c. Amylase
d. Bilirubin

A

b. ALT

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34
Q

Which lifestyle change is most beneficial for managing NAFLD?
a. Decrease physical activity
b. Increase dietary sugar
c. Weight loss and exercise
d. Increase alcohol consumption

A

c. Weight loss and exercise

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35
Q

What percentage of children are estimated to have NAFLD?
a. 1-3%
b. 5-10%
c. 3-10%
d. 10-15%

A

c. 3-10%

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36
Q

What factor is NOT considered a secondary cause of hepatic steatosis? a. Significant alcohol consumption
b. Chronic use of medications
c. Genetic disorders
d. Weight loss

A

d. Weight loss

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37
Q

Which stage of liver biopsy is characterized by fatty accumulation and ballooning degeneration?
a. Type 1
b. Type 2
c. Type 3
d. Type 4

A

c. Type 3

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38
Q

What is the role of dietary fructose restriction in the management of NAFLD?
a. It has no effect on liver health
b. It can help reduce hepatic fat accumulation
c. It increases liver fat
d. It only benefits patients with diabetes

A

b. It can help reduce hepatic fat accumulation

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39
Q

Which sign associated with hepatocellular disease and jaundice has the highest likelihood ratio (LR)?
a. Palmar erythema
b. Spider angioma
c. Caput medusae
d. Ascites

A

c. Caput medusae

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40
Q

What is the most common cause of end-stage renal disease (ESRD) in the United States?
a. Renal artery stenosis
b. Hypertension
c. Polycystic kidney disease
d. Diabetes mellitus

A

d. Diabetes mellitus

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41
Q

What percentage of adults in Canada are diagnosed with diabetes?
a. 5.0%
b. 10.5%
c. 14%
d. 20%

A

c. 14%

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42
Q

Which type of diabetes accounts for 90% of all diabetes cases?
a. Type 1 Diabetes
b. Gestational Diabetes
c. Type 2 Diabetes
d. MODY

A

c. Type 2 Diabetes

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43
Q

Which of the following is a characteristic feature of Type 1 diabetes?
a. Insulin resistance
b. Autoimmune destruction of beta cells
c. More common in adults
d. Associated with obesity

A

b. Autoimmune destruction of beta cells

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44
Q

What is a common risk factor for developing Type 2 diabetes?
a. Family history of Type 1 diabetes
b. HLA genetic factors
c. Obesity
d. Prolonged breastfeeding

A

c. Obesity

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45
Q

Screening for diabetes is recommended for asymptomatic adults with a BMI of ____________.
a. <18.5
b. > 30.0
c. > 25.0
d. screening is not recommended for asymptomatic adults

A

d. > 25.0

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46
Q

What condition is characterized by excessive urination and blurred vision in a diabetic patient?
a. Diabetic retinopathy
b. Diabetic neuropathy
c. Diabetic ketoacidosis
d. Hyperglycemic hyperosmolar state

A

c. Diabetic ketoacidosis

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47
Q

Which diabetes type is more common in children and adolescents?
a. Type 2 Diabetes
b. Type 1 Diabetes
c. Gestational Diabetes
d. MODY

A

b. Type 1 Diabetes

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48
Q

What is the typical follow-up for a patient diagnosed with gestational diabetes?
a. Screen every 6 months
b. Screen every year
c. Screen every 3 years
d. Screen every 5 years

A

c. Screen every 3 years

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49
Q

Which test provides an estimate of glucose control over the preceding 2-3 months? a. Fasting plasma glucose
b. Oral glucose tolerance test
c. Glycated hemoglobin (HbA1c)
d. Random plasma glucose

A

c. Glycated hemoglobin (HbA1c)

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50
Q

What is the primary complication associated with diabetic nephropathy? a. Diabetic retinopathy
b. Foot ulcers
c. End-stage renal disease
d. Cardiovascular disease

A

c. End-stage renal disease

51
Q

What is the lifetime risk of developing diabetic foot ulcers in patients with diabetes?
a. 5-10%
b. 10-15%
c. 19-34%
d. 35-50%

A

c. 19-34%

52
Q

Which group of patients is more likely to develop Type 2 diabetes?
a. Children under 10
b. Women with gestational diabetes
c. Men with low income
d. Individuals with autoimmune diseases

A

b. Women with gestational diabetes

53
Q

What is the primary diagnostic criterion for diabetic ketoacidosis?
a. Hyperglycemia, ketosis, and acidosis
b. Hypoglycemia and weight loss
c. Elevated blood pressure
d. Low HDL cholesterol

A

a. Hyperglycemia, ketosis, and acidosis

54
Q

What is a common finding in peripheral neuropathy associated with diabetes?
a. Nausea
b. Abdominal pain
c. Stocking-glove pattern
d. Visual disturbances

A

c. Stocking-glove pattern

55
Q

Which of the following is NOT a common environmental risk factor for Type 2 diabetes?
a. Obesity
b. Low physical activity
c. High protein diet
d. Socioeconomic status

A

c. High protein diet

56
Q

What is the recommendation for eye examinations for patients with diabetes?
a. Every year
b. Every 2 years
c. Every 3 years
d. Every 5 years

A

a. Every year

57
Q

What is the first-line treatment for a patient experiencing hyperglycemic hyperosmolar state (HHS)? a. Insulin therapy
b. Fluid replacement
c. Oral hypoglycemics
d. Corticosteroids

A

b. Fluid replacement

58
Q

What screening method is preferred for gestational diabetes?
a. Fasting glucose
b. Oral glucose tolerance test (two-step)
c. Random plasma glucose
d. HbA1c

A

b. Oral glucose tolerance test (two-step)

59
Q

What test is the most accurate (highest LR+) identifying the loss of protective sensation in diabetic patients, crucial for preventing foot ulcers and complications?
a. Monofilament test
b. 128-Hz tuning fork
c. Ipswich touch test
d. They are all equally accurate

A

b. 128-Hz tuning fork

60
Q

Which three organ systems are primarily involved in autonomic neuropathy associated with long-standing diabetes?
a. Respiratory, gastrointestinal, and endocrine
b. Cardiovascular, gastrointestinal, and genitourinary
c. Musculoskeletal, neurological, and renal
d. Integumentary, lymphatic, and reproductive

A

b. Cardiovascular, gastrointestinal, and genitourinary

61
Q

n the context of rotator cuff disorders, which condition is characterized by degeneration of collagen in the tendon?
a. Tendonitis
b. Tendinopathy
c. Complete tear
d. Biceps tendon rupture

A

b. Tendinopathy

62
Q

What is the most common cause of shoulder pain?
a. Rotator cuff tear
b. Shoulder impingement syndrome
c. Frozen shoulder
d. Shoulder instability

A

b. Shoulder impingement syndrome

63
Q

Which phase of adhesive capsulitis is characterized by stiffness and pain?
a. Phase 1
b. Phase 2
c. Phase 3
d. None of the above

A

a. Phase 1

64
Q

Which special test is used to diagnose a complete rotator cuff tear?
a. Hawkins test
b. Drop arm test
c. Apprehension test
d. Speed test

A

b. Drop arm test

65
Q

What is the primary cause of acromioclavicular joint injury?
a. Overhead sports
b. Direct trauma
c. Repetitive strain
d. Osteoarthritis

A

b. Direct trauma

66
Q

What does a positive Neer sign indicate?
a. Biceps tendonitis
b. Rotator cuff tear
c. Shoulder impingement syndrome
d. Adhesive capsulitis

A

c. Shoulder impingement syndrome

67
Q

Which test is used to assess for shoulder instability?
a. Load and shift test
b. Drop arm test
c. Hawkins test
d. Yergason test

A

a. Load and shift test

68
Q

What is the common demographic for frozen shoulder?
a. Young athletes
b. Males aged 35-54
c. Individuals aged 40-65
d. Elderly patients

A

c. Individuals aged 40-65

69
Q

What imaging finding suggests rotator cuff pathology?
a. Decreased joint space
b. Increased acromiohumeral distance
c. Critical shoulder angle > 35 degrees
d. Normal tendon thickness

A

c. Critical shoulder angle > 35 degrees

70
Q

What does a positive O’Brien test indicate?
a. Biceps tendon rupture
b. SLAP lesion
c. Rotator cuff tear
d. Frozen shoulder

A

b. SLAP lesion

71
Q

What is the typical treatment for Type II acromioclavicular joint injury?
a. Surgical intervention
b. Rest and rehabilitation
c. Corticosteroid injections
d. Immediate mobilization

A

b. Rest and rehabilitation

72
Q

What symptom indicates a possible shoulder dislocation?
a. Decreased external rotation
b. Visible swelling or deformity
c. Night pain
d. Difficulty with overhead activities

A

b. Visible swelling or deformity

73
Q

What condition is characterized by the “Popeye deformity”?
a. Shoulder impingement
b. Biceps tendon rupture
c. Rotator cuff tear
d. Adhesive capsulitis

A

b. Biceps tendon rupture

74
Q

What are “alarm symptoms” that warrant referral for shoulder conditions?
a. Visible swelling or deformity
b. Constant pain
c. Night pain
d. All of the above

A

d. All of the above

75
Q

What is a potential progression of supraspinatus tendonitis?
a. Acromioclavicular arthritis
b. Rotator cuff tear
c. Adhesive capsulitis
d. Glenohumeral arthritis

A

b. Rotator cuff tear

76
Q

A patient presents with shoulder pain and difficulty pushing open a door. What is a particularly useful clinical sign for diagnosing shoulder instability?
a. Feeling unstable when arm is in an abducted and externally rotated position
b. Limitation of movement of external rotation with the elbow by the side of the trunk
c. Weakness in the absence of pain on light resistance testing of specific rotator cuff muscles
d. Positive Neer impingement sign

A

a. Feeling unstable when arm is in an abducted and externally rotated position

77
Q

A patient presents with shoulder pain that is worse with overhead activities and improves with rest, anti-inflammatory medications, and ice but recurs upon return to activity. What is the most likely diagnosis?
a. Shoulder impingement syndrome
b. Biceps tendonitis
c. Glenohumeral arthritis
d. Adhesive capsulitis

A

a. Shoulder impingement syndrome

78
Q

What special test can indicate a biceps tendon tear?
a. Neer test
b. Speed test
c. Hawkins test
d. Load and shift test

A

b. Speed test

79
Q

What is the primary treatment for an acute shoulder dislocation?
a. Rest and ice
b. Surgical intervention
c. Immediate reduction
d. Physical therapy

A

c. Immediate reduction

80
Q

In which phase of adhesive capsulitis does significant pain decrease while stiffness remains?
a. Phase 1
b. Phase 2
c. Phase 3
d. None of the above

A

b. Phase 2

81
Q

What is the prevalence of rotator cuff disorders in primary care?
a. 48-58%
b. 24-28%
c. 60-70%
d. 10-15%

A

a. 48-58%

82
Q

What are the clinical diagnostic criteria for a biceps tendon rupture?

a. History of chronic shoulder pain, positive Neer test, and pain with overhead activities
b. History of a single traumatic event, palpable retraction of the tendon, and weakness in flexion and supination
c. Night pain, restricted range of motion, and positive Hawkins test
d. Visible swelling, deformity, and positive drop arm test

A

b. History of a single traumatic event, palpable retraction of the tendon, and weakness in flexion and supination

83
Q

In the context of acromioclavicular joint injuries, what characterizes Type III injuries?

a. Sprain of AC ligaments
b. Complete tear of AC ligaments with clavicle elevation
c. Posterior displacement of the clavicle
d. Inferolateral displacement of the clavicle

A

b. Complete tear of AC ligaments with clavicle elevation

84
Q

What is the most common cause of hypothyroidism in North America?
a. Pituitary TSH deficiency
b. Thyroid gland failure
c. Iodine deficiency
d. Autoimmune thyroiditis

A

d. Autoimmune thyroiditis

85
Q
  1. What percentage of hypothyroidism cases are due to primary thyroid gland dysfunction?
    a. 50%
    b. 75%
    c. 95%
    d. 99%
A

c. 95%

86
Q

What is the main cause of secondary hypothyroidism?
a. Pituitary tumors
b. Thyroidectomy
c. Radiation
d. Autoimmune diseases

A

a. Pituitary tumors

87
Q

Which of the following is NOT a cause of iatrogenic hypothyroidism?
a. Radiation
b. Medications
c. Pituitary tumors
d. Surgery

A

c. Pituitary tumors

88
Q

What is a common clinical sign of hypothyroidism?
a. Tachycardia
b. Thin, brittle nails
c. Weight loss
d. Diarrhea

A

b. Thin, brittle nails

89
Q

Which of the following conditions should be investigated if TSH is normal but hypothyroid symptoms persist?
a. Addison’s disease
b. Celiac disease
c. Iodine deficiency
d. Pituitary tumor

A

b. Celiac disease

90
Q

What is a hallmark sign of subclinical hypothyroidism on lab results?
a. Low TSH, low fT4
b. High TSH, normal fT4
c. Normal TSH, high fT4
d. Low TSH, high fT4

A

b. High TSH, normal fT4

91
Q

What lab value is characteristic of overt hypothyroidism?
a. High TSH, low fT4
b. Low TSH, high fT4
c. High TSH, normal fT4
d. Normal TSH, low fT4

A

a. High TSH, low fT4

92
Q

What percentage increase in thyroid hormone is often needed during the first trimester of pregnancy in women with hypothyroidism?
a. 10-15%
b. 20-40%
c. 50-60%
d. 70-80%

A

b. 20-40%

93
Q

In women with autoimmune thyroiditis, what percentage have co-existing Addison’s disease?
a. 0.5%
b. 1.17%
c. 2.5%
d. 5%

A

b. 1.17%

94
Q

What lab test should be used to rule out adrenal insufficiency in hypothyroid patients suspected of having Addison’s disease?
a. fT4
b. AM cortisol (8am)
c. rT3
d. TSH

A

b. AM cortisol (8am)

95
Q

What is the primary risk for patients with unrecognized Addison’s disease who start thyroid replacement therapy?
a. Hypertension
b. Adrenal crisis
c. Hyperglycemia
d. Arrhythmia

A

b. Adrenal crisis

96
Q

Which of the following is an emergency complication of untreated hypothyroidism?
a. Addisonian crisis
b. Myxedema coma
c. Acute coronary syndrome
d. Pulmonary embolism

A

b. Myxedema coma

97
Q

What is the expected thyroid hormone change with aging?
a. TSH decreases, fT4 increases
b. TSH increases, fT4 stays stable
c. TSH stays stable, fT4 decreases
d. TSH and fT4 both increase

A

b. TSH increases, fT4 stays stable

98
Q

What is the recommended approach for hypothyroid patients with unstable ischemic heart disease (IHD)?
a. Start with high doses of thyroid replacement
b. Start with low doses of thyroid replacement
c. Delay thyroid replacement
d. No treatment is required

A

b. Start with low doses of thyroid replacement

99
Q

Which thyroid hormone therapy adjustment is recommended for a patient with both celiac disease and hypothyroidism?
a. Increase the dose of thyroxine by 50%
b. Decrease the dose of thyroxine by 50%
c. Stop thyroxine treatment
d. No change is necessary

A

a. Increase the dose of thyroxine by 50%

100
Q

A patient with hypothyroidism is not showing symptomatic improvement with treatment. What is the appropriate action?
a. Increase the thyroxine dose
b. Refer to an endocrinologist
c. Investigate for mental health disorders
d. Stop thyroid replacement therapy

A

b. Refer to an endocrinologist

101
Q

Which of the following is NOT a risk of hypothyroidism in pregnancy?
a. Miscarriage
b. Postpartum hemorrhage
c. Fetal neurocognitive deficits
d. Increased birth weight

A

d. Increased birth weight

102
Q

Which symptom is associated with myxedema coma?
a. Hyperthermia
b. Bradycardia
c. Hypotension
d. Hyperventilation

A

c. Hypotension

103
Q

What is the first-line therapy for overt hypothyroidism?
a. Radioactive iodine
b. Levothyroxine
c. Beta-blockers
d. Corticosteroids

A

b. Levothyroxine

104
Q

What condition may cause falsely high fT4 and fT3 levels?
a. Biotin supplementation
b. Vitamin D deficiency
c. Celiac disease
d. Addison’s disease

A

a. Biotin supplementation

105
Q

What is the definition of acute fatigue?
a. Lasts <1 month and is relieved by rest
b. Lasts 1-6 months and is relieved by rest
c. Lasts >6 months and is not relieved by rest
d. Lasts 1-3 months and is not relieved by rest

A

a. Lasts <1 month and is relieved by rest

106
Q

Which of the following is a characteristic of chronic fatigue?
a. Lasts 1-3 months and is relieved by rest
b. Lasts 1-6 months and is partially relieved by rest
c. Lasts >6 months and is partially relieved by rest
d. Lasts >6 months and is not relieved by rest

A

d. Lasts >6 months and is not relieved by rest

107
Q

What is the prevalence of chronic fatigue in the general population?
a. 5-40 per 100,000
b. 1-2 per 1,000
c. 10-50 per 10,000
d. 50-100 per 100,000

A

a. 5-40 per 100,000

108
Q

According to SEID diagnostic criteria, how long must fatigue persist before diagnosis?
a. 3 months
b. 6 months
c. 1 year
d. 9 months

A

b. 6 months

109
Q

Which population is most commonly affected by SEID?
a. Women aged 20-40
b. Women aged 40-70
c. Men aged 30-50
d. Men aged 50-70

A

b. Women aged 40-70

110
Q

Which type of fatigue is caused by lifestyle imbalances and relieved by rest?
a. Chronic fatigue
b. Subacute fatigue
c. Physiologic fatigue
d. Secondary fatigue

A

c. Physiologic fatigue

111
Q

What differentiates sleepiness from fatigue?
a. Sleepiness is improved by rest, while fatigue is persistent
b. Sleepiness occurs only at night, while fatigue is felt throughout the day
c. Fatigue always occurs after physical activity, while sleepiness occurs without any activity
d. Fatigue is mental, while sleepiness is physical

A

a. Sleepiness is improved by rest, while fatigue is persistent

112
Q

When should a patient with fatigue be referred to a specialist?
a. When the patient is non-compliant with treatment
b. When the patient exhibits severe psychological illness
c. When the patient reports feeling better with time
d. When fatigue lasts for less than one month

A

b. When the patient exhibits severe psychological illness

113
Q

Which of the following is considered a “must-not-miss” diagnosis in patients with fatigue?
a. Hypertension
b. Malignancy
c. Chronic sinusitis
d. Seasonal allergies

A

b. Malignancy

114
Q
  1. Which of the following alarm symptoms in a patient with fatigue would suggest malignancy?
    a. Joint pain and stiffness
    b. Fever, night sweats, and weight loss
    c. Headache and dizziness
    d. Nausea and vomiting
A

b. Fever, night sweats, and weight loss

115
Q

What laboratory test is most appropriate to assess for anemia in a patient with fatigue?
a. Urinalysis
b. Complete blood count (CBC)
c. Liver function test
d. Lipid panel

A

b. Complete blood count (CBC)

116
Q

Which condition should be considered in the differential diagnosis of fatigue due to a rheumatologic cause?
a. Fibromyalgia
b. Hypertension
c. Chronic sinusitis
d. Chronic pancreatitis

A

a. Fibromyalgia

117
Q

What is the most common psychological disorder associated with fatigue?
a. Schizophrenia
b. Depression
c. Obsessive-compulsive disorder
d. Bipolar disorder

A

b. Depression

118
Q

Which lifestyle factor is most likely to contribute to non-organic fatigue?
a. Excessive exercise
b. Lack of exercise
c. Regular, balanced diet
d. Healthy sleep patterns

A

b. Lack of exercise

119
Q

What is a key management strategy for patients with SEID?
a. Advise patients to avoid any physical activity
b. Recommend high-intensity exercise
c. Encourage patients to engage in pacing and normal activities
d. Advise patients to take frequent naps

A

c. Encourage patients to engage in pacing and normal activities

120
Q

When should a polysomnography (sleep study) be considered in a patient with fatigue?
a. If there is a suspicion of sleep apnea
b. If the patient complains of headaches
c. If the patient has joint pain
d. If the patient experiences dizziness

A

a. If there is a suspicion of sleep apnea

121
Q

What is the recommended follow-up strategy for patients with chronic fatigue?
a. Follow-up once every year
b. Schedule regular visits to monitor symptoms and treatment effectiveness
c. No follow-up is needed if the patient feels well
d. Discharge the patient after the first visit

A

b. Schedule regular visits to monitor symptoms and treatment effectiveness

122
Q

A 50-year-old woman presents with chronic fatigue lasting 9 months. She has a history of hypothyroidism, which is well-controlled on medication. Laboratory tests, including thyroid function tests, are within normal limits. She experiences post-exertional malaise, unrefreshing sleep, and orthostatic intolerance. What is the next best step in managing this patient?
a. Discontinue her thyroid medication
b. Recommend cognitive-behavioral therapy (CBT) and pacing techniques
c. Refer for psychological counseling to rule out depression
d. Prescribe a stimulant medication to manage fatigue

A

b. Recommend cognitive-behavioral therapy (CBT) and pacing techniques

123
Q

A 30-year-old male presents with 6 months of persistent fatigue that has not improved with rest. He reports post-exertional malaise and unrefreshing sleep but denies any history of depression, anxiety, or recent illness. His thyroid function tests are normal. A sleep study shows no signs of sleep apnea. He also experiences cognitive impairment, such as difficulty concentrating at work. What is the most likely diagnosis?
a. Hypothyroidism
b. Systemic exertion intolerance disease (SEID)
c. Iron-deficiency anemia
d. Chronic obstructive pulmonary disease (COPD)

A

b. Systemic exertion intolerance disease (SEID)

124
Q

A 55-year-old female presents with chronic fatigue and intermittent joint pain. She has no significant past medical history. She describes her fatigue as unrelieved by rest and worsened by physical activity. Lab results reveal elevated ESR and normal thyroid function. What is the next best step in diagnosing the cause of her fatigue?
a. Refer to a rheumatologist for evaluation of rheumatoid arthritis or lupus
b. Order a sleep study to rule out sleep apnea
c. Perform an electrocardiogram to assess for heart failure
d. Prescribe a trial of antidepressants

A

a. Refer to a rheumatologist for evaluation of rheumatoid arthritis or lupus

NMT200 (1 decks)

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