Family Medicine Faux-bank

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Family Medicine Faux-bank

This is an unofficial unlicensed and unapproved practice qbank for family medicine created by me. This is the last year we are on the faculty written shelf and I thought it would be nice to have an added resource to the student manual, since I like using practice questions (and you do too, right? ). Doing a good job on this does not guarantee you a good shelf grade and I cannot guarantee perfection in the questions. I did do my best to base them all on the learning objectives and required readings. "Buyer beware:" I am human and easily could have made mistakes while making this. If you notice a glaring error, let me know and I'll try to fix it.


Questions and Answers
  • 1. 
    An 18 year old female presents to the emergency room complaining of 2 day history of vomiting and diarrhea. She is having 4-5 watery bowel movements a day. On questioning, the patient describes that she recently returned from a birthday trip to San Carlos, Mexico with several of her friends, two of which are also sick from the same symptoms. Which of the following is the most likely cause of her diarrhea?
    • A. 

      Shigella

    • B. 

      Campylobacter

    • C. 

      Enterotoxigenic Escherichia coli (ETEC)

    • D. 

      Salmonella

  • 2. 
    • A. 

      Pelvic exam

    • B. 

      Immediate referral to surgery

    • C. 

      Abdominal CT

    • D. 

      Pregnancy test

  • 3. 
    You are a third year medical student on your family medicine rotation at The Awesome FM Clinic. A 35 year old male presents with abdominal pain for the last 3 days. He admits to abdominal pain, diarrhea and nausea but denies fever, shaking chills, vomiting and hematochezia. On physical exam, his vital signs are normal, the abdomen is soft and there is no rebound or involuntary guarding. He is unable to specifically indicate the location of abdominal pain and uses his whole hand to indicate that his entire abdomen hurts "all over." You present a comprehensive differential diagnosis to your attending, which includes infectious diarrhea, diverticulitis, irritable bowel disease, GI obstruction, perforation and appendicitis. You suggest several effective diagnostic tests to investigate the root cause of the problem, but your attending simply recommends oral rehydration therapy and discharges the patient. Your attending then explains that extensive diagnostic testing is not warranted in this case because up to ___% of abdominal pain complaints subside without definitive diagnosis?
    • A. 

      40-50%

    • B. 

      90-100%

    • C. 

      25-30%

    • D. 

      60-80%

  • 4. 
    A 40 year old female with a PMH of HTN and OA presents to the clinic for evaluation of abdominal pain. On questioning, the patient admits to abdominal pain with hematemesis and difficulty swallowing. Medications include HCTZ, metoprolol and ibuprofen. Physical exam includes normal vital signs and tenderness to palpation over the epigastric area. Which of the following would be the next step in management?
    • A. 

      Give PPI, amoxicillin, and clarithromycin

    • B. 

      Esophagogastroduodenoscopy

    • C. 

      Perform urease breath test

    • D. 

      Discontinue ibuprofen

    • E. 

      Re-evaluate in 2 weeks

  • 5. 
    A 45 year old female presents with a chief complaint of low back pain. Physical exam reveals decreased ankle reflexes bilaterally and decreased sensation to light touch on the lateral ankles bilaterally. Evaluation of gait reveals difficulty walking on her toes. Which of the following nerve roots is most likely involved?
    • A. 

      S1

    • B. 

      L4

    • C. 

      L5

    • D. 

      T7

    • E. 

      T12

  • 6. 
    A 45 year old female presents with a chief complaint of low back pain. Physical exam reveals decreased patellar reflexes bilaterally and decreased sensation to light touch over the medial ankle. You also observe that the patient has difficulty when inverting her feet. Which of the following nerve roots is most likely affected?
    • A. 

      S1

    • B. 

      L4

    • C. 

      L5

    • D. 

      T7

    • E. 

      T12

  • 7. 
    You are evaluating a 65 year old female for back pain at the Awesome Family Medicine Clinic. This is her first doctor's visit in 10 years. On questioning, she enthusiastically shares that she has recently lost 25 pounds without even trying but it is hard for her to enjoy her increased self esteem with her back hurting so bad. Physical exam elicits point tenderness over the lumbar spine. You ask the patient if she's ever had routine age-related cancer screening and she says she had 1 mammogram at age 50 but never had one again because "they were too uncomfortable." Her mother and sister was diagnosed with breast cancer in their 50s. What is the best next step in management?
    • A. 

      Imaging with CT

    • B. 

      Mammogram

    • C. 

      Imaging with MRI

    • D. 

      Hydrocodone/APAP

    • E. 

      Physical therapy

    • F. 

      NSAIDs

    • G. 

      Re-evaluate in 4 weeks

  • 8. 
    A 75 year old male with a PMH of metastatic prostate cancer and heart failure is evaluated for back pain. Physical examination demonstrates point tenderness of the lumbar spine, and pain with movement. Additionally, a 5cm in diameter lump with an overlying well-healed linear surgical scar is observed inferior to the left clavicle. Which of the following is the best next management step?
    • A. 

      Imaging with CT

    • B. 

      Imaging with MRI

    • C. 

      Hydrocodone/APAP

    • D. 

      Physical therapy

    • E. 

      NSAIDs

    • F. 

      Re-evaluate in 4 weeks

    • G. 

      Prostate exam and PSA

  • 9. 
    Its another busy day at the Awesome Family Medicine Clinic. You go in to see a 42 year old female with severe sudden low back pain after picking up her 5 year old son during a temper tantrum. She says her pain radiates down her legs and it is very painful for her to sit. She appears obviously uncomfortable sitting on the exam table and switches positions often. Physical exam demonstrates left paraspinal tenderness and spasm in the area of the lumbar spine. The patient's vital signs are normal. What is the next best step in management?
    • A. 

      Bed rest for 2 days or until pain subsides

    • B. 

      MRI

    • C. 

      Percocet

    • D. 

      Continued activity as tolerated

  • 10. 
    Its another busy day at the Awesome Family Medicine Clinic. You go in to see a 42 year old female with severe sudden low back pain after picking up her 5 year old son during a temper tantrum. She says her pain radiates down her legs and it is very painful for her to sit. She appears obviously uncomfortable sitting on the exam table and switches positions often. Physical exam demonstrates left paraspinal tenderness and spasm in the area of the lumbar spine. The patient's vital signs are normal. What is the most likely etiology of her pain?
    • A. 

      Disk herniation

    • B. 

      Compression fracture

    • C. 

      Spinal stenosis

    • D. 

      Ankylosing spondylitis

    • E. 

      Malignancy

    • F. 

      Osteomyelitis

  • 11. 
    A 78 year old female with dementia is brought to the clinic by her son for 8 weeks of progressive low back pain. Although she cannot remember her son's name, she always knows where to find her cigarettes and how to mix a vodka tonic. Physical exam demonstrates a 90 pound female with point tenderness over her lumbar spine. Vital signs are normal. She was evaluated 1 year ago for a Colles fracture after tripping over a living room rug. Which of the following is the most likely etiology of her back pain?
    • A. 

      Herniated disk

    • B. 

      Osteomyelitis/diskitis

    • C. 

      Lumbar strain

    • D. 

      Ruptured AAA

    • E. 

      Compression fracture

  • 12. 
    A 65 year old male smoker is evaluated at the Awesome Family Medicine Clinic for shooting back pain and abdominal pain. He said he had pain stepping into the shower and passed out. Which of the following is highest on your differential?
    • A. 

      Herniated disk

    • B. 

      Ruptured AAA

    • C. 

      Mesenteric ischemia with colonic perforation

    • D. 

      Acute pancreatitis

    • E. 

      Osteomyelitis

  • 13. 
    A 20 year old mother brings her 2 year old son in for an evaluation. She says her son has been having diarrhea and crying a lot and she doesn't know what to do. She asks if it is possible if the child is faking because when he cries no tears come out. Physical exam reveals an ill-appearing child with a capillary refill time of 4 seconds and tenting of skin lateral to the umbilicus. BMP reveals normal electrolyte levels and vital signs are normal. What is the best next step in management?
    • A. 

      IV fluids

    • B. 

      Oral amoxicillin

    • C. 

      Oral rehydration therapy

    • D. 

      The child is probably just seeking attention. Discharge with a lollipop.

    • E. 

      Plain films of abdomen.

  • 14. 
    A 20 year old mother brings her 2 year old son in for an evaluation. She says her son has been having diarrhea and crying a lot and she doesn't know what to do. She asks if it is possible if the child is faking because when he cries no tears come out. Physical exam reveals an irritable and ill-appearing child with a capillary refill time of 4 seconds and tenting of skin lateral to the umbilicus. BMP reveals hyponatremia and vital signs are significant for increased respiratory rate and decreased blood pressure. What is the best next step in management?
    • A. 

      IV isotonic crystaloids

    • B. 

      Oral amoxicillin

    • C. 

      Oral rehydration therapy

    • D. 

      The child is probably just seeking attention. Discharge with a lollipop.

    • E. 

      Plain films of abdomen

  • 15. 
    A mother brings in her infant for a routine 2 month well-baby exam. When explaining the immunization schedule, what rare side effect is important to explain  to the mother regarding the rotavirus vaccine?
    • A. 

      Autism

    • B. 

      Severe Combined Immunodeficiency Disease (SCID)

    • C. 

      Intussusception

    • D. 

      Meningitis

    • E. 

      Gastroschisis

  • 16. 
    A mother brings her 2 year old child for evaluation of diarrhea after antibiotics were started for acute otitis media. The mom says she spent some time on google and asks if she should give her child probiotics for the diarrhea. What should you recommend to mom?
    • A. 

      It doesn't really matter, probiotics can't hurt, right?

    • B. 

      There is no evidence that probiotics are effective for treatment of antibiotic associated diarrhea.

    • C. 

      Probiotics could lead to overgrowth of gut bacteria and should be avoided in all children.

    • D. 

      Just give the child a Gogurt pack.

  • 17. 
    The above EKG was taken in a 65 year old male with a PMH of stable angina presenting to the Awesome Family Medicine Clinic with chest pain. What should you do next?
    • A. 

      Transport to the nearest hospital equipped for immediate cardiac catheterization.

    • B. 

      Walk him to the lab down the hall to draw troponin levels.

    • C. 

      This is just another episode of angina; tell him to take his nitroglycerine and repeat EKG.

    • D. 

      Perform a dobutamine stress test.

  • 18. 
    You are a third year medical student on your first week of your family medicine rotation at the Awesome Family Medicine Clinic. Your first patient of the day is a 58 year old woman with a PMH of HTN and non-insulin dependent DMII with a BMI of 42. She has a 40 pack-year smoking habit and arrived in a motorized scooter. Her medications include metformin, lisinopril, HCTZ and amlodipine. Her family history is significant for Diabetes on her maternal side and early MI in her paternal side. Her diet consists of convenience foods because she "doesn't like to cook." Her multitude of cardiac risk factors is totally overwhelming you, but you astutely decide that counseling her in which of the following lifestyle modifications will have the greatest and most immediate impact on her heart disease risk?
    • A. 

      Sell her scooter and start walking.

    • B. 

      Cook meals at home consisting of fresh vegetables and lean meats.

    • C. 

      Smoking cessation.

    • D. 

      Regular glucose monitoring

    • E. 

      Switch to insulin therapy.

    • F. 

      Add metoprolol for cardioprotection.

    • G. 

      Perform genetic testing for hereditary causes of Diabetes.

  • 19. 
    A 55 year old female presents to the Awesome Family Medicine Clinic for chest pain. She says for the last 2 days she has had pain on her ride side and under her arm. The patent has a PMH significant for stable angina treated with nitroglycerine. A complete physical exam demonstrates a unilateral erythematous vesicular rash on the right side of her torso. Which of the following is highest on your differential?
    • A. 

      Acute MI

    • B. 

      Emergence of unstable angina

    • C. 

      Heat rash

    • D. 

      Herpes Zoster

  • 20. 
    A 26 year old female presents to the Awesome Family Medicine Clinic with a chief complaint of chest pain. On questioning, she says that she's had severe bronchitis with cough for 3 months but the chest pain is new. She says her grandfather was in the hospital last year for a heart attack and wonders if she could be having one too. She describes that she hurts no matter what she does and cannot find a comfortable position even to sleep. On physical exam, she winces when you press on her right side along the axillary line and says "thats it - thats the pain." Which of the following is the best combination of etiology and choice in management?
    • A. 

      She has costochondritis. Give her Percocet.

    • B. 

      She has costochondritis. Treat with NSAIDs.

    • C. 

      She has costochondritis. It will get better on its own.

    • D. 

      She is having an acute MI. Refer her to the cath lab.

    • E. 

      She is having an acute MI. Administer Oxygen, aspirin, morphine and nitroglycerine.

    • F. 

      She has endocarditis. Give antibiotics.

    • G. 

      She has pericarditis. Give NSAIDs.

    • H. 

      She has costochondritis. Give prednisone.

    • I. 

      She has pericarditis. Give prednisone.

  • 21. 
    You are a family medicine resident on one of your inpatient rotations. You are about to evaluate a patient for admission complaining of chest pain and shortness of breath. The patient is a 46 year old female with a family history of sudden death. The patient says she flew to Thailand 10 days ago to receive discounted rhinoplasty. On physical exam she is normotensive but tachycardic with a heart rate of 112. Examination of the lower extremities reveals asymmetric  swelling and erythema. What is the next best step in management?
    • A. 

      Perform a D-dimer

    • B. 

      Perform lower extremity doppler study

    • C. 

      Perform ventilation-perfusion scan

    • D. 

      Perform helical CT pf pulmonary arteries

    • E. 

      Give antibiotics for the infection she likely contracted while traveling

  • 22. 
    You are evaluating a 40 year old male with a chief complaint of chest pain. You ask the patient to describe his pain more specifically and he says he has burning discomfort when he goes to bed. He says he gets off of work late and eats fast food/soda quickly before going to bed. He also complains of a sour taste in the back of his throat. He specifically denies any trouble swallowing, weight loss or hematemesis. What is the next best step in management? 
    • A. 

      Give omeprazole, amoxicillin and clarithromycin for likely H. pylori

    • B. 

      Give a 14 day trial of omeprazole and re-evaluate for improvement

    • C. 

      Perform esophagogastroduodenoscopy

    • D. 

      Recommend OTC Tums.

  • 23. 
    You are performing a new patient physical on a well 60 year old male. He just moved from Denver, CO to Phoenix, AZ even though all of his family is still in Denver because he "just can't stand the snow anymore." During your interview you inquire as to whether the patient has arranged for an advance directive in case he unable to make medical decisions. He raises an eyebrow and asks "why would I need to do that, are you saying I'm going to die, Doc?" What would be an appropriate response?
    • A. 

      "You're starting to get old so you should probably sign up for Hospice now."

    • B. 

      "It is important to make these decisions while you are healthy; there may be treatments you don't want and the only way for us to know your wishes is the advance directive."

    • C. 

      "You are getting to an age when people start to get sick so it is best to prepare now"

    • D. 

      "Without the advance directive emergency response teams will not be able to resuscitate you if you are found unconscious."

  • 24. 
    A 72 year old male is being evaluated after catheterization and stent placement for STEMI. He knows he needs to stop smoking, improve his diet and increase exercise but he wants to know what medicines he should take to prevent this from happening again. His last EKG showed Q waves but no atrial fibrillation. What medications are recommended for secondary prevention?
    • A. 

      Warfarin with INR between 2.0-3.0 for 12 months

    • B. 

      Heparin injections for 12 months

    • C. 

      Baby aspirin and clopidogrel for 12 months

    • D. 

      Start high dose atrovastatin

    • E. 

      No medications will improve his risk for repeat MI.

  • 25. 
    A 13 year old male with a recent diagnosis of asthma presents for a 1 month follow-up exam. He was initiated with an inhaled short acting beta agonist, and says he has used it about 4 times a week during the day and has woken up 3 times at night to use it in the last month. He also describes feeling short of breath while playing basketball with his friends after school even when he uses his inhaler. Which of the following would be appropriate "Step Up" therapy for this patient?
    • A. 

      Long-acting beta agonist

    • B. 

      Theophylline

    • C. 

      Cromolyn

    • D. 

      Low dose daily inhaled corticosteroid

    • E. 

      High dose daily inhaled corticosteroid

    • F. 

      The patient's asthma is under control. No change in treatment is required.

  • 26. 
    A 6 year old boy is brought to your clinic by her father complaining of cough. The father says his son has been coughing for the last 3 months and that the boys teachers say he gets tired before the other kids at recess. You listen to the boy's lungs and hear expiratory wheezes. Your suspicion of asthma is confirmed by spirometry. What pharmacologic agent is recommended to initiate in this child with a new diagnosis of asthma?
    • A. 

      Low-dose inhaled corticosteroids

    • B. 

      High dose inhaled corticosteroids

    • C. 

      Short-acting beta agonist

    • D. 

      Long-acting beta agonist

    • E. 

      Immunomodulating agents.

  • 27. 
    A 25 year old female presents to the clinic complaining of cough for the last 3 months. She has been taking OTC antitussives without relief. She says she is afraid she has asthma. The patient does not smoke and symptoms are not related to any triggers such as her pet chihuahua or the Palo Verde growing in her front yard. On physical exam, you note that her lungs are clear. Examination of her throat demonstrates cobble-stoning of the oral mucosa and drainage in the posterior oropharynx. What would be the next best step in management?
    • A. 

      Methacholine challenge to test for asthma

    • B. 

      Perform chest X ray to rule out pneumonia

    • C. 

      Initiate short acting beta agonist albuterol

    • D. 

      Trial of OTC decongestant and first-generation antihistamine

    • E. 

      Give amoxicillin

    • F. 

      Initiate inhaled corticosteroids

  • 28. 
    You are seeing a 16 year old male patient for a routine asthma follow up. The patient is managed on a short acting beta agonist and a low dose inhaled corticosteroid. The patient says he needs his short acting inhaler once a day and feels short of breath whenever he's at home. He thinks the problem is that his mom smokes in the house. Which of the following would be the next step in management?
    • A. 

      Step up treatment to a long acting beta agonist since daytime symptoms are >twice/week

    • B. 

      Include the family in in the discussion review strategies to minimize triggers, like mom smoking outside.

    • C. 

      Increase inhaled corticosteroid dose.

    • D. 

      Suggest nebulizer treatments since they might be more effective than inhalers.

  • 29. 
    A 30 year old male with asthma is evaluated for an acute exacerbation. He is wheezing and has interrupted speech. You decide to perform peak expiratory flow (PEF) to determine the exacerbation severity. At what % predicted would the patient be indicated for hospital admission?
    • A. 

      PEF >70% predicted

    • B. 

      PEF 40-69% predicted

    • C. 

      His physical exam findings are enough indication for admission. No need to obtain PEF.

    • D. 

      PEF

  • 30. 
    A 38 year old female presents to your clinic complaining of a sinus infection and wants antibiotics. On questioning, she says she has been having purulent nasal discharge, headache and facial pain for the last 7 days that distracts her from her work. On physical exam, vital signs are normal and her lungs are clear. What are current recommendations of treatment for this patient?
    • A. 

      No antibiotic therapy is indicated until symptoms persist for >10 days.

    • B. 

      Give amoxicillin

    • C. 

      Give amoxicillin-clavulanic acid

    • D. 

      Give fluroquinolone

  • 31. 
    A 21 year old female presents to your clinic complaining of sinus infection. She has had facial pain and purulent nasal discharge for the last 2 weeks. On physical exam, vital signs are significant for a temperature for 39 degrees C but her lungs are clear. If you were to perform a sinus aspirate and culture, what would be the most likely pathogen recovered?
    • A. 

      Staphylococcus aureus

    • B. 

      Streptococcus pyogenes

    • C. 

      Haemophylus influenzae

    • D. 

      Streptococcus pneumoniae

  • 32. 
    A 56 year old female with a PMH significant for poorly controlled hypertension presents for evaluation of cough. She says she has had a cough for the last week and a half and describes it as dry. Current medications include HCTZ, amlodipine and lisinopril, which she started 4 months ago. On physical exam, vital signs are normal and lungs are clear. What is the best next step in management?
    • A. 

      Chest X ray to rule out pneumonia

    • B. 

      Spirometry to evaluate for COPD

    • C. 

      Give oral antibiotics for probably infection

    • D. 

      Discontinue lisinopril and see if cough resolves

    • E. 

      Give oral corticosteroids to decrease inflammation.

  • 33. 
    You're volunteering on derm night at the Wesley Center and see a 28 year old Caucasian patient with a "thing on her back." She says she has a hard time seeing it and that a friend pointed it out at the pool the other day. On inspection, you note a circular homogenous brown sharply marginated macule measuring 0.5 cm in diameter. You also notice similar, though smaller macules surrounding the one of concern. What would be the next best step in management for this patient?
    • A. 

      This lesion is likely non-malignant. Continue to watch for any changes and recommend sunscreen use.

    • B. 

      Perform shave biopsy and send specimen to pathology.

    • C. 

      Obtain scrapings of the lesion and send for microbiologic analysis to determine need for antibiotics.

    • D. 

      Perform wide excision for likely melanoma.

  • 34. 
    A 60 year old male farmer presents to the clinic for a routine examination. On physical examination, you notice a lesion on his leg. The lesion is shaped like a tear-drop and part of the border blends with the surrounding skin. Most of the lesion is black and the rest is skin-colored to brown. The diameter is 1.0 cm. You ask the patient if the lesion has changed at all recently and he says he doesn't pay much attention to his skin. You perform an excision and the path report returns a diagnosis of malignant melanoma with a maximum thickness of 0.5mm. When you tell the patient the results, which of the following should you highlight as the most important determinant of prognosis?
    • A. 

      The asymmetric shape

    • B. 

      The irregular borders

    • C. 

      The irregularities of color

    • D. 

      The large diameter

    • E. 

      The depth of invasion

  • 35. 
    A 14 year old male presents to the clinic for evaluation of acne. He is self conscious about his face and is worried that his classmates at school make fun of him. On exam, you note several open and closed comedones on the forehead and cheeks but no papules, pustules or nodules. Which of the following would you recommend for management of this patient's acne?
    • A. 

      Topical retinoid

    • B. 

      Oral antibiotic

    • C. 

      Oral isotretinoin

    • D. 

      Benzoyl peroxide

    • E. 

      This is a normal part of growing up and will go away on its own. No treatment is necessary.

  • 36. 
    A 17 year old sexually active female presents to your clinic for evaluation of acne. She says she is unable to cover her acne with makeup and it is embarrassing for her to go to school. On inspection, you note the presence of moderate inflammatory pustules and a few nodules on her cheeks and chin. You ask her what she does to try and help the lesions and she says that topical tretinoin, over the counter benzoyl peroxide and topical clindamycin all haven't worked for her. At this point, an oral antibiotic might help her acne. Which of the following would be the best antibiotic for this patient? 
    • A. 

      Erythromycin

    • B. 

      Doxycyline

    • C. 

      Amoxicillin

    • D. 

      Gentamycin

    • E. 

      Moxifloxacin

  • 37. 
    An 18 year old sexually active female presents to the Awesome Family Medicine Clinic complaining of severe acne. She is tearful during the history and tells you that she is bullied for her ugly face. You note the presence of severe inflammatory papules, pustules and multiple nodules with scarring over her face. She says she has tried all the over the counter creams salves and ointments as well as antibiotics and nothing will make her acne go away. What would be the best next step in management of this patient's acne?
    • A. 

      Pregnancy test

    • B. 

      CBC and CMP

    • C. 

      Oral isotretinoin

    • D. 

      Give a trial of oral doxycycline.

  • 38. 
    You are volunteering for Derm Night at the Wesley Center and are evaluating a patient. You note that on the patient's arms, legs and torso are many solid, red papules with scale. You attempt to scrape the scale gently with a tongue depressor and the epithelium is intact. According to the Lynch Algorithm, from which of the following broad classes of skin disorders does this patient likely suffer?
    • A. 

      Eczematous disease

    • B. 

      Papulosquamous disease

    • C. 

      Vascular reaction

    • D. 

      Red macules, papules, and nodules

    • E. 

      Pustular diseases

    • F. 

      Vesiculobullous lesions

  • 39. 
    You are volunteering for Derm Night at the Wesley Center and are evaluating a patient. You note that on the patient's lower extremities are many solid red macules with no scale. The lesions are polymorphic, flat and confluent over the ankles. According to the Lynch Algorithm, from which of the following broad classes of skin disorders does this patient likely suffer?
    • A. 

      Vascular reactions

    • B. 

      Eczematous disease

    • C. 

      Papulosquamous disease

    • D. 

      Red macules, papules and nodules

    • E. 

      Pustular diseases

    • F. 

      Vesicubullous disease

  • 40. 
    You are volunteering for Derm Night at the Wesley Center and are evaluating a patient. You note that on the patient's left torso are many blisters. The blisters appear to be filled with clear fluid. According to the Lynch Algorithm, from which of the following broad classes of skin disorders does this patient likely suffer?
    • A. 

      Vesiculobullous diseases

    • B. 

      Pustular diseases

    • C. 

      Red macules, papules and nodules

    • D. 

      Vascular reactions

    • E. 

      Papulosquamous disease

    • F. 

      Eczematous disease

  • 41. 
    A 26 year old male with a PMH of asthma presents to your clinic for evaluation of a "skin problem." He says he is always itching and wants to know what his problem is. On physical exam, vital signs are normal and you observe red eruptions with a fine scale over his flexural surfaces. When you try to scrape the lesions with a scalpel, you notice that the epithelium is intact. You conclude that the patient has atopic dermatitis. Which of the following is NOT an associated complication in a patient with atopic dermatitis?
    • A. 

      Herpes simplex infection of affected area

    • B. 

      Infection with normal skin flora like Staph aureus or Step species

    • C. 

      Scarring from picking and scratching

    • D. 

      Increased risk of dermatologic malignancy in the affected area

    • E. 

      Atrophy of skin and striae related to prolonged corticosteroid use

  • 42. 
    You are evaluating a 40 year old male for a diabetes follow up. The patient checks his blood glucose every day and has been well-controlled on metformin and glipizide. His hemoglobin A1C is 6.4%. His office foot and eye exams are unremarkable, but you still make referrals for his annual podiatry and ophthalmology visits. You know how important visual screening is in diabetics. What other group is recommended to have regular vision screening?
    • A. 

      Anyone over the age of 65

    • B. 

      Newborns

    • C. 

      Men over age 65 who have ever smoked

    • D. 

      Everyone

  • 43. 
    A 5 year old girl is brought to your clinic by her mom for "red eyes." The girl is otherwise well. The girl's mother says she spends 5 half-days a week at daycare. The child is able to correctly identify shapes on an age-appropriate vision chart and plays in the exam room, seemingly unbothered by her eyes. On exam, you notice the child's conjunctivae are erythematous and there is crusting and matting of her eyelashes. Corneal fluorescein staining yields no significant findings. Which of the following causes of red eye are highest on your differential?
    • A. 

      Conjunctivitis

    • B. 

      Iritis

    • C. 

      Corneal ulceration

    • D. 

      Glaucoma

  • 44. 
    A 40 year old male with a PMH significant for psoriasis presents complaining of a "red eye." He says he has been dealing with a pretty bad outbreak of psoriasis and now his eyes are causing him pain too. He describes associated blurry vision and pain in his eyes. On exam, the patient winces in pain when you shine your penlight to check pupillary reflexes. You notice that his pupils are constricted and there is paracorneal injection of the eyes bilaterally. You dim the lights and perform fluorescein staining, which yields no significant findings. When making your referral to ophthalmology, which of the following causes of red eye is highest on your differential?
    • A. 

      Iritis

    • B. 

      Conjunctivitis

    • C. 

      Corneal ulceration

    • D. 

      Glaucoma

  • 45. 
    A 28 year old male with a PMH of myopia presents to the clinic with a red eye. He says he just returned home from a two week long road trip with friends and now his left eye hurts, like something is stuck in it. He says he wears contacts and did not remove them once during his trip because this was his last pair and he didn't want to deal with solutions or containers while on the road. On inspection, you observe a normal appearing right eye and a left eye with circumcorneal injection. The cornea is cloudy but the pupil size is normal and reactive to light. Flurescein staining with Wood lamp demonstrates a green defect on the left cornea. Which of the following causes of red eye is highest on your differential?
    • A. 

      Corneal ulceration

    • B. 

      Conjunctivitis

    • C. 

      Iritis

    • D. 

      Glaucoma

  • 46. 
    A 67 year old female with a PHM significant for diabetes presents for severe eye pain and blurry vision. She says the pain began suddenly and is so severe she feels sick to her stomach. On exam, she winces in pain when you shine a penlight to check her pupils, which are dilated. Her sclera are diffusely injected and her corneas appear "steamy." You lightly palpate her upper eyelids and note that the underlying globes feel firmer than you would expect. When making your emergency ophthalmology referral, which of the following is at the tops of your differential?
    • A. 

      Glaucoma

    • B. 

      Conjunctivitis

    • C. 

      Iritis

    • D. 

      Corneal ulceration

  • 47. 
    A 28 year old male with a PMH of myopia presents to the clinic with a red eye. He says he just returned home from a two week long road trip with friends and now his left eye hurts, like something is stuck in it. He says he wears contacts and did not remove them once during his trip because this was his last pair and he didn't want to deal with solutions or containers while on the road. On inspection, you observe a normal appearing right eye and a left eye with circumcorneal injection. The cornea is cloudy but the pupil size is normal and reactive to light. Flurescein staining with Wood lamp demonstrates a green defect on the left cornea. This patient obviously requires emergency ophthalmology referral, but what important special consideration should be made in his management?
    • A. 

      Topical fluoroquinolone

    • B. 

      IV antipseudomonal antibiotics

    • C. 

      The eye should be patched to prevent further injury

    • D. 

      Erythromycin ophthalmic ointment

    • E. 

      Polymyxin B/Trimethoprim ophthalmic solution

    • F. 

      Sulfacetamide 10% ophthalmic ointment

  • 48. 
    A 60 year old male with a past medical history of well-controlled type II diabetes presents to the clinic complaining of blurry vision. The vision change has taken place over a period of weeks. Which of the following is the LEAST likely cause of vision change in this patient?
    • A. 

      Presbyopia

    • B. 

      Diabetic retinopathy

    • C. 

      Cataracts

    • D. 

      Macular degeneration

    • E. 

      Primary open angle glaucoma

    • F. 

      Spontaneous retinal detachment

  • 49. 
    You are worried that your patient with eye pain might have retinal detachment. Emergency referral to an ophthalmologist is a given, but what test should be performed on every patient that presents with an ocular complaint?
    • A. 

      Visual acuity testing

    • B. 

      Visual field testing

    • C. 

      Funduscopic exam

    • D. 

      Slit lamp exam

    • E. 

      Intra-ocular pressure

  • 50. 
    A 40 year old man presents to your clinic with a painful red eye. Which of the following is the only eye emergency in which treatment should not be delayed in order to perform a visual acuity exam?
    • A. 

      Chemical injury

    • B. 

      Suspected globe rupture

    • C. 

      Retinal detachment

    • D. 

      High speed injury

    • E. 

      Central retinal artery occlusion

  • 51. 
    A 12 year old overweight child is present for evaluation. The child complains of being constantly thirsty and urinating often throughout the day. You suspect the child might have diabetes, but he has no family history. Hi A1C comes back at 9%. Which of the following would be an appropriate test to differentiate whether this child has Type I or Type II Diabetes? 
    • A. 

      C-peptide levels

    • B. 

      C-reactive protein

    • C. 

      Creatinine phosphokinase

    • D. 

      Complete metabolic panel

  • 52. 
    You are evaluating a 38 year old male with a PMH of well controlled HTN at the Awesome Family Medicine Clinic. He is overweight (BMI 28). When you receive his most recent lab results, you notice his blood glucose was 318. You are mildly surprised because he hasn't been complaining of any symptoms that aroused your suspicion of Diabetes. What proportion of patients with Type II Diabetes have complications at presentation?
    • A. 

      20-30%

    • B. 

      40-50%

    • C. 

      80-90%

    • D. 

      60-70%

  • 53. 
    You are evaluating a 38 year old male with a PMH of well controlled HTN at the Awesome Family Medicine Clinic. He is overweight (BMI 28) but has no other medical complaints. You are trying to decide if this patient should be screened for Diabetes. Which of the following most closely matches the current DM screening recommendations?
    • A. 

      USPSTF: limits screening to adults with sustained BP>135/80. ADA: same as USPSTF but includes treated and untreated patients plus other risk factors

    • B. 

      USPSTF: screen all asymptomatic adults >65. ADA: screen all asymptomatic adults >45

    • C. 

      USPSTF: screen all asymptomatic adults who are overweight (BMI>25). ADA: screen everyone

    • D. 

      USPSTF: screen asymptomatic adults with hyperlipidemia. ADA: same as USPSTF but also includes adults with HTN.

  • 54. 
    You are evaluating a 35 year old obese female with a new diagnosis of type II Diabetes. Her initial A1C was 14% and you are trying to decide the most appropriate initial therapy with which to start. Which of the following is recommended as initiation therapy in this case by the American College of Endocrinology?
    • A. 

      Insulin therapy

    • B. 

      High dose metformin alone

    • C. 

      Metformin + glipizide

    • D. 

      Metformin + glipizide + pioglitizone

    • E. 

      Initiate diet and exercise program and follow up in 1 month.

  • 55. 
    You are a third year medical student on your family medicine rotation at the Awesome Family Medicine Clinic. You just performed an exam on a 55 year old patient with a new diagnosis of diabetes. The patient's A1C is 8%. Your attending decides to start the patient with metformin. What is the greatest benefit of metformin for this patient over other choices?
    • A. 

      Metformin has less risk of hypoglycemia.

    • B. 

      Metformin has less risk of weight gain.

    • C. 

      Metformin is better for the liver.

    • D. 

      Metformin improves pancreatic function

  • 56. 
    Your attending asks you to evaluate a 35 year old overweight male. On questioning, he admits to polydipsia and polyuria. You suspect the patient has diabetes. Which of the following lab results would confirm this diagnosis?
    • A. 

      A1C 6.7%

    • B. 

      Random glucose 180mg/dL

    • C. 

      Fasting plasma glucose 125 mg/dL

    • D. 

      Two-hour plasma glucose during oral glucose tolerance test 150 mg/dL

    • E. 

      Presence of glucose on urine dipstick

  • 57. 
    A second-year medical student presents to the Awesome Family Medicine Clinic. She is studying for Step 1 and she is sure something is wrong. She says she has to urinate every 20 minutes while she is studying and is afraid she has diabetes. A quick check on the BMI wheel in your white coat pocket shows she has a BMI of 24. Which of the following additional history details would increase your suspicion that diabetes is more likely than pre-test nerves and would thus indicate further testing?
    • A. 

      Patient's fasting glucose of 112 at her previous annual exam

    • B. 

      Patient has noticed an increase in floaters in her vision

    • C. 

      Patient's maternal grandmother had diabetes

    • D. 

      Patient has family history of hyperlipidemia on paternal side.

  • 58. 
    A 40 year old male presents for  routine diabetes follow up appointment. His A1C is moderately controlled and has varied between 7.0-7.5% over the past year. His last ophthalmology appointment was 2 months ago and unremarkable. He is scheduled for his annual podiatry appointment in two weeks. He says he knows he needs his "regular blood work" including A1C and fasting lipid profile. What additional lab test would be indicated at this time?
    • A. 

      Microalbuminuria measurement

    • B. 

      Urine dipstick, especially to check for proteinuria/glycosuria

    • C. 

      Electromyography of the feet to check for peripheral neuropathy

    • D. 

      EKG to rule out cardiac ischemia

    • E. 

      Echocardiography to screen for heart failure

    • F. 

      Culture urine for bacterial infection

    • G. 

      Basic metabolic panel to evaluate creatinine level

  • 59. 
    A mother brings her 18 month old daughter to the Awesome Family Medicine Clinic  because of fever. The mother measured a temperature of 38.5 degrees C one day ago at home and wants to know if the child needs antibiotics. On inspection, the child is ill-appearing and just wants to lay on the exam table. Your MA performs a urine dipstick which demonstrates large leukocyte esterase and positive nitrates. The urine is sent off to the lab for culture. You tell the mother that her daughter likely has a UTI and that she will need antibiotics if the urine culture is positive. How long should the course of antibiotics be for this child?
    • A. 

      7-14 days

    • B. 

      3-5 days

    • C. 

      10 days

    • D. 

      21 days

  • 60. 
    An overweight 18 year old female with no significant PMH presents to the clinic complaining of vaginal discharge. On questioning, she says she started noticing increased grey discharge about a week ago and that it has a strong fishy odor. She says she has a new boyfriend and is afraid she might have an STD. Pregnancy test is negative. What is the most common cause of malodorous vaginal discharge?
    • A. 

      Bacterial vaginosis

    • B. 

      Diabetes

    • C. 

      Chlamydia trachomatis

    • D. 

      Neisseria gonorrhea

    • E. 

      Trichomonas

    • F. 

      Vaginal candidiasis

  • 61. 
    An 18 year old uninsured female presents to the clinic complaining of vaginal discharge. On questioning, she says she started noticing increased thick, white vaginal discharge one week ago. She also complains of vulvar itching and burning on urination. She says she has a new boyfriend and that it hurts when they have sex, so she is afraid she has an STD. She has never had symptoms like this before. You perform a pelvic exam and notice thick cottage-cheese-like discharge in the vaginal vault. You observe pseudohyphae on microscopic examination of the discharge with an absence of clue cells. A pregnancy test is negative. Which of the following would be the best course of treatment for this patient?
    • A. 

      Miconazole cream intravaginally for 7 days

    • B. 

      Fluconazole orally in a single dose

    • C. 

      Ceftriaxone IM once

    • D. 

      Metronidazole orally for 7 days

    • E. 

      TMP-SMX orally for 3 days

  • 62. 
    An 18 year old female presents to the clinic complaining of vaginal discharge. On questioning, she says she started noticing yellow-green discharge. She also complains of vulvar itching and burning on urination. She says she has a new boyfriend and that it hurts when they have sex, so she is afraid she has an STD. She has never had symptoms like this before. Examination of the discharge with potassium hydroxide solution demonstrates a positive whiff test. A pregnancy test is negative. Which of the following would confirm a diagnosis of trichomonas?
    • A. 

      Mobile organisms observed on wet mount

    • B. 

      Clue cells observed on wet mount

    • C. 

      Gram-negative diplococci on gram stain of discharge

    • D. 

      Pseudohyphae on wet mount

  • 63. 
    A 58 year old female with no significant PMH presents complaining of pain with sexual intercourse. She says she has had trouble ever since her menstrual cycle stopped and also complains of a small amount of odorless yellow vaginal discharge. The patient has no complaints of irregular vaginal bleeding or hot flushes. Which of the following would be the best course of management?
    • A. 

      Topical vaginal estrogen therapy

    • B. 

      Oral estrogen replacement therapy

    • C. 

      No treatment recommended. Risks of estrogen use are too high and this is a normal part of aging.

    • D. 

      Oral metronidazole for 7 days

  • 64. 
    A 28 year old female presents for evaluation of burning on urination. Urine dipstick demonstrates 7 WBCs per HPF, large leukocyte estrease and positive nitrites. Pregnancy test is negative. The antibiogram for your clinic shows local resistance to Bactrim of 5%. Which of the following is the best course of treatment for this patient?
    • A. 

      TMP-SMX bid for 3 days

    • B. 

      Ciprofloxacin bid for 3 days

    • C. 

      Metronidazole qd for 7 days

    • D. 

      Nitrofurantoin for 7 days

    • E. 

      Wait for urine culture results to choose a susceptible antibiotic

  • 65. 
    A 28 year old female presents for evaluation of burning on urination. Urine dipstick demonstrates 7 WBCs per HPF, large leukocyte estrease and positive nitrites. Pregnancy test is negative. The antibiogram for your clinic shows local resistance to Bactrim of 25%. Which of the following is the best course of treatment for this patient?
    • A. 

      Nitrofurantoin for 7 days

    • B. 

      TMP-SMX bid for 3 days

    • C. 

      Ciprofloxacin bid for 3 days

    • D. 

      Metronidazole qd for 7 days.

    • E. 

      Wait for urine culture results to choose a susceptible antibiotic

  • 66. 
    A 38 year old woman with no significant PMH presents to your office for a routine exam. She has no medical complaints but wants to know if you could prescribe her a course of antibiotics because she is about to take a 1 month mediterranean cruise with her husband and has trouble with recurrent UTIs after sexual intercourse. What would be the best course of action for this patient?
    • A. 

      Prescribe TMP/SMX and instruct 1-time dosing after each sexual encounter for prophylaxis.

    • B. 

      Deny the patient's request for antibiotics because prophylaxis contributes to antibiotic resistance.

    • C. 

      Prescribe TMP/SMX bid for 3 days if she develops symptoms of UTI while on her trip.

    • D. 

      Prescribe TMP/SMX and instruct bid use for the entirety of her trip.

  • 67. 
    A 38 year old male with a PMH significant for Type II Diabetes presents to the Awesome Family Medicine Clinic complaining of burning on urination. On exam, he is hemodynamically stable. Urine dipstick demonstrates 7 WBCs per HPF, large leukocyte esterase and positive nitrites. He sighs and says this will he the third UTI he has had this year. His urine is sent off for culture and sensitivity testing. What is the best course of therapy for this patient?
    • A. 

      Empiric oral ciprofloxacin and check for susceptibilities in 48-72 hours

    • B. 

      Empiric oral ciprofloxacin for 10-14 days

    • C. 

      IV fluoroquinolone for 14 days

    • D. 

      Empiric oral TMP/SMX for 3-5 days

    • E. 

      Empiric oral nitrofurantoin for 7 days

  • 68. 
    A 65 year old male smoker with a PMH significant for DM comes to the clinic for a routine exam. The patient has no medical complaints today. An office urine dipstick demonstrates positive blood and leukocyte esterase. The patient specifically denies dysuria or gross hematuria. Which of the following is the most appropriate course of management?
    • A. 

      Urine cytology

    • B. 

      Cystoscopy

    • C. 

      Empiric oral ciprofloxacin for 7-14 days

    • D. 

      Transrectal prostate exam

  • 69. 
    A 38 year old male body builder presents to the clinic for a routine exam. He admits to smoking 2-3 cigarettes when he drinks with friends, even though he knows it is unhealthy. Office urine dipstick is positive for blood. The patient specifically denies any dysuria or gross hematuria. Urine cytology and cystoscopy is negative. Which is the following is the most likely cause of the false positive result of blood on UA?
    • A. 

      Intense exercise

    • B. 

      A metabolic enzyme deficiency

    • C. 

      Occult malignancy

    • D. 

      Urinary tract infection

  • 70. 
    A 28 year old sexually active female presents to the clinic complaining of burning on urination. She denies fever and gross hematuria. You send her to the restroom with a sterile cup for urine collection. Which of the following is the most sensitive test for UTI?
    • A. 

      Positive leukocyte esterase and nitrites on urine dipstick

    • B. 

      Positive blood and leukocyte esterase

    • C. 

      Presence of glucose and positive blood

    • D. 

      Positive leukocyte esterase and protein

    • E. 

      Positive nitrite and protein

  • 71. 
    A 26 year old female with no significant PMH comes to the office complaining of ankle pain. She says she hurt her right ankle stepping off a curb during a wine walk and that her foot "turned a funny angle." She is afraid she broke her ankle. On inspection, you observe significant swelling and ecchymosis of the lateral right ankle joint. The ankle is diffusely tender to palpation but there is no point tenderness over the lateral or medial malleolus. You notice some laxity on passive range of motion. You ask her to walk across the exam room and she is able to do so, although she complains of pain and favors her uninjured foot. What is the best next step in management of this patient's injury?
    • A. 

      Rest and elevate foot, apply ice to affected area, wrap ankle in compression bandage

    • B. 

      Radiography to evaluate for likely fracture

    • C. 

      Immediate referral to surgery to repair torn ligament

    • D. 

      Apply heating pad to ankle for pain relief

    • E. 

      Bed rest for 2 days or until pain subsides

    • F. 

      Rest and Percocet for pain as needed

  • 72. 
    A 22 year old male presents to your office complaining of knee pain. He says he was at rugby practice when one of his teammates tackled him from the side. He does not feel stable to walk on his own. Which of the following is the most common knee injury and the likely cause of this patient's pain?
    • A. 

      Medial collateral ligament sprain

    • B. 

      Lateral collateral ligament sprain

    • C. 

      Anterior cruciate ligament sprain

    • D. 

      Posterior cruciate ligament sprain

    • E. 

      Medical meniscal tear

    • F. 

      Lateral meniscal tear

  • 73. 
    A 10 year old boy is brought to the office by his mother with a chief complaint of left knee pain. The boy says he hurt his knee when he jumped out of a tree that he likes to climb by his house. He says he heard it pop after he landed and now it hurts really bad. On inspection, you notice swelling in the left knee. There is significant joint line tenderness and you are able to milk a small effusion before the patient swats at you with his hands and tells you you're hurting him too much. What additional physical exam tests would confirm the type of injury you suspect in this patient?
    • A. 

      Lachman test

    • B. 

      Varus and valgus laxity

    • C. 

      McMurray's test

    • D. 

      Faber's test

  • 74. 
    A 40 year old overweight female with no significant past medical history presents to your clinic with a chief complaint of knee pain. She says she has intermittent pain in both knees and points to her anterior knee when asked where the pain is worst. She says the pain bothers her most when stepping off a curb or going down stairs and that sometimes she feels like her knee is going to collapse under her. She doesn't remember any significant injury to either knee but is afraid "something inside there might be broken." On physical exam, the patient shows apprehension as you approach the knee and you are able to elicit mild crepitus under the kneecap. Which of the following is the most likely cause of her knee pain?
    • A. 

      Patellofemoral pain syndrome

    • B. 

      Pes anserine busitis

    • C. 

      Osteoarthritis of the knee

    • D. 

      Medial meniscal tear

    • E. 

      Medical collateral ligament tear

  • 75. 
    A 65 year old obese female presents to our clinic complaining of right knee pain. She says she has had pain for years but that it is worse whenever she goes for a hike with her husband or does yard work. You asked if she's injured her knee in the past; she laughs and tells you she got into a severe bike accident when she was 11 that required stitches. She lifts her skirt above her knee to reveal a 10 cm linear scar just inferior to the patella. You tell her that she likely has osteoarthritis and that which of the following is the strongest modifiable risk factor?
    • A. 

      Obesity

    • B. 

      Prolonged stress on the knee joint from activity

    • C. 

      Calcium intake

    • D. 

      Lack of estrogen replacement therapy during menopause

  • 76. 
    A 50 year old female presents to your clinic with a chief complaint of foot pain. She says she has 4/10 pain in both feet that makes it difficult to walk. The pain is the worst first thing in the morning when stands from the bed. She says she has had this pain for years and that she's always been managed with steroid injections. On physical exam there is no visible deformity of the feet and no erythema or swelling observed. There is diffuse tenderness on the heels bilaterally . What is the most appropriate course of management for this patient?
    • A. 

      NSAIDs for pain

    • B. 

      Corticosteroid injection into plantar fascia

    • C. 

      Instruct patient to wear loose-fitting sandals to avoid pressure on feet

    • D. 

      Discontinue activities that involve prolonged walking

  • 77. 
    A 55 year old female with no significant PMH presents to the clinic complaining of right wrist pain. She is distraught because she makes her living knitting baby accessories for an online store and she is on backorder for many of her orders. On inspection, you note no deformity of the right hand. You ask the patient to grasp her thumb with her fingers and bend her wrist in the ulnar direction and are able to reproduce her pain. Which of the following tendon pairs are most likely affected by this patient's condition?
    • A. 

      Abductor pollicis longus and extensor pollicis brevis

    • B. 

      Flexor pollicis brevis and adductor pollicis

    • C. 

      Opponens pollicis and extensor pollicis brevis

    • D. 

      Abductor pollicis longus and adductor pollicis

    • E. 

      Flexor retinaculum and opponens pollicis

  • 78. 
    A 35 year old female with no PMH presents to the clinic complaining of bilateral wrist pain. She works at a call center in customer service for a major corporation and is having a hard time doing her computer work. On inspection, you notice atrophy of the thenar muscles. On exam the patient has parasthesias on the palmar side of the base of the thumbs, the second, third digit and the radial side of the 4th digits. Motor testing elicits weakened opposition. Tapping over the pisiform elicits pain. Which of the following nerves is most likely affected in this patient's condition?
    • A. 

      Median

    • B. 

      Ulnar

    • C. 

      Radial

    • D. 

      Axillary

    • E. 

      Musculocutaneous

  • 79. 
    An 18 year old female with no PMH presents to your clinic with a chief complaint of wrist pain. You ask her about her pain and she says her right wrist has been in severe pain ever since she fell while skating at roller derby practice yesterday. She wants to know if she broke her wrist. Which of the following is the most commonly fractured carpal bone?
    • A. 

      Scaphoid

    • B. 

      Hammate

    • C. 

      Lunate

    • D. 

      Trapezoid

    • E. 

      Capitiate

    • F. 

      Pisiform

  • 80. 
    A 40 year old male with no PMH presents to the clinic complaining of bilateral wrist pain. He is an avid bicyclist, and says he has had to cut his rides short because of his wrist pain. Physical examination of the wrist reveals no soft tissue swelling, muscle atrophy, or skin changes. He has parasthesias in the ulnar side of his left palmar 4th and entire 5th digit. Tapping on the wrist over the pisiform elicits tingling in the 5th digit. Which of the following nerves is most likely affected in this patient's condition?
    • A. 

      Ulnar

    • B. 

      Radial

    • C. 

      Median

    • D. 

      Axillary

    • E. 

      Musculoskeletal

  • 81. 
    A 45 year old male with no PMH presents to your clinic with a chief complaint of right shoulder pain and weakness. He explains that he has a job as a tree trimmer and his pain is interfering with his work. He is also having dull achy pain at night interfering with his sleep. Internal rotation of a flexed arm bent at the elbow elicits pain. Based on the history and physical exam, which of the following is the most likely cause of this patient's pain?
    • A. 

      Rotator cuff injury

    • B. 

      Glenohumeral instablity

    • C. 

      Adhesive capsulitis

    • D. 

      Acromioclavicular osteoarthritis

  • 82. 
    A 35 year old G2P3 female presents to the clinic for a 6 week post partum exam after having twins. She is a single mom. On questioning, the patient reveals that she has trouble sleeping even when the twins are sleeping and that she doesn't seem to be able to enjoy life anymore. She has been feeling this way for 2 weeks. She says that no matter what she does she feels worthless and empty inside. She denies having any violent thoughts towards her babies but does admit that she feels tempted to ignore them when they cry. Which of the following is the strongest risk factor for post partum depression?
    • A. 

      History of post partum depression in a previous pregnancy

    • B. 

      History of depression during the most recent pregnancy

    • C. 

      Being a single parent

    • D. 

      Gestational diabetes

    • E. 

      Having twins

  • 83. 
    A 45 year old male with a PMH significant for poorly controlled diabetes presents for a diabetic follow up appointment. He is currently managed on max doses of metformin and glipizide but his most recent hemoglobin A1C comes back as 9.4%. The patient has no symptoms or complications. On exam, he is hemodynamically stable and his weight is 120 kg. You counsel the patient that he will now need to start insulin therapy to try and achieve better control of his blood sugar. Which of the following insulin regimens would be best for this patient?
    • A. 

      45 units long acting, 15 units short acting (60 units total)

    • B. 

      20 units long acting, 10 units short acting (30 units total)

    • C. 

      Sliding scale insulin based on pre-prandial blood sugar

    • D. 

      20 units short acting insulin post prandial

  • 84. 
    You have been involved with the care of a now 28 year old patient for years. She has no significant past medical history but comes to your clinic every year for her annual exams. You know her to be generally well and happy individual with a solid support system at home with her husband and children. However, at her last appointment your patient admitted she has been struggling with "feeling down" and "sleep problems" for the past month or so, although she is sure the this will pass and is not interested in drugs. Which of the following is the best course of action for screening for suicidal ideation?
    • A. 

      Direct inquiry early allows for more effective treatment and management.

    • B. 

      This patient has few risk factors; direct early inquiry may "tip the scale" and push the patient to suicidal behavior.

    • C. 

      The patient should be followed at shorter intervals and then screened for suicidal ideation if depressive symptoms persist.

    • D. 

      This patient has few risk factors; delay screening for suicidal ideation until additional risk factors present.

  • 85. 
    A 20 year old female presents to your clinic complaining of depression. On questioning, the patient seems to meet the criteria for a major depressive episode. All her most recent labs including TSH and CMP and CBC were normal. Which of the following is most important to rule out before you decide on a treatment regimen for this patient?
    • A. 

      Bipolar disorder

    • B. 

      Dysthymic disorder

    • C. 

      Substance abuse

    • D. 

      Schizoaffective disorder.

  • 86. 
    A 20 year old female presents to your clinic complaining of depression. On questioning, the patient seems to meet the criteria for a major depressive episode. All her most recent labs including TSH and CMP and CBC were normal. Assuming that all other potential causes of her depression have been ruled out, what is the most effective course of treatment for this individual?
    • A. 

      Combination of pharmacology and psychotherapy

    • B. 

      Pharmacology alone

    • C. 

      Psychotherapy alone

    • D. 

      Electroshock therapy (ECT)

  • 87. 
    A 35 year old male with a PMH significant for depression presents for a follow-up appointment after beginning therapy with an SSRI. You initiated him on a dose of citalopram 20mg qday about 1 month ago. He says his outlook has improved and he doesn't feel as down anymore, but he is disappointed because he has decreased libido. He is not interested in taking Viagra or other ED medications because "those are for old people." Which of the following is an option to help this patient with this common SSRI side effect?
    • A. 

      Bupropion

    • B. 

      Discontinue the citalopram

    • C. 

      Vitamin supplementation

    • D. 

      Prescribe a PDE5 inhibitor

  • 88. 
    A 25 year old female presents to your clinic for an evaluation for depression. She has been having a hard time because she hasn't been able to find a job since graduating college and her boyfriend recently broke up with her. She has lost all interest in her normal hobbies and just wants to sleep all the time. She is interested in taking an antidepressant until things in her life straighten out. You ask her about her past medical history and she says she had epilepsy as a child but hasn't had a seizure in more than 15 years. Which of the following medications would be important to avoid in this patient?
    • A. 

      Bupropion

    • B. 

      Citalopram

    • C. 

      Venlafaxine

    • D. 

      Sertraline

    • E. 

      Fluoxetine

  • 89. 
    A 55 year old male with well-controlled hypertension presents to your clinic to be evaluated for depression. You have been attempting to help manage this man's depression for many years with pharmacotherapy with little improvement. He has tried multiple drugs in the SSRI class without relief. You tell the patient that it might be time to try a drug from a different class of antidepressants. Considering this man's PMH, which of the following antidepressant classes would it be most important to avoid?
    • A. 

      Monoamine oxidase inhibitors

    • B. 

      Serotonin-norepinephrine reuptake inhibitors

    • C. 

      Dopamine-norepinephrine reuptake inhibitors

    • D. 

      Tricyclic antidepressants

  • 90. 
    A 40 year old female with HTN and depression and seasonal allergies presents to your clinic with a chief complaint of fatigue. She has been feeling a lack of energy for the last 2 months and has difficulty carrying out household chores. You sigh heavily (in your mind, of course) because your differential diagnosis is rapidly spinning out of control. Further evaluation of this woman's fatigue is obviously necessary. How often do laboratory studies affect the management of a patient with fatigue?
    • A. 

      5%

    • B. 

      50%

    • C. 

      90%

    • D. 

      30%

  • 91. 
    You are performing a routine annual exam on a 40 year old male patient whom you have known for years. He is generally well and has only required treatment for minor upper respiratory infections in the past. Today, though, you notice something "off" about his affect and wonder if he might be struggling with depression. Which of the following would be the best course of action during his evaluation?
    • A. 

      Administer the Patient Health Questionaire-2 screening for depression.

    • B. 

      Evaluate for the DSM IV criteria for major depressive episode.

    • C. 

      Administer the Beck Depression Inventory.

    • D. 

      Schedule the patient for a 2 week follow up and address your concerns then.

    • E. 

      Refer the patient to a psychiatrist to talk about his personal issues

  • 92. 
    A 22 year old female comes to the clinic with a chief complaint of headache. She says she has had her headaches for years. She describes the headaches as left-sided and pulsatile, lasting a whole day. These headaches typically occur about twice a month. Taking Tylenol has provides some, but not complete relief from her headaches. She just graduated college and says that in the past she would just miss school and get her notes from friends later. However, now that she's graduated and started a new job she can't afford to miss work for her headaches. On exam, the patient is hemodynamically stable and a neuro exam was normal. She does not currently have a headache. Which of the following would be appropriate first-line treatment for a new diagnosis of headache in this patient?
    • A. 

      Combination OTC analgesic such as aspirin/acetaminophen/caffeine

    • B. 

      Sumatriptan

    • C. 

      Short-acting opiate such as oxycodone

    • D. 

      Combination barbiturate-containing analgesic such as butalbital/aspirin/caffeine

  • 93. 
    A 15 year old male with no significant PMH presents to your clinic complaining of headaches. He describes the headaches as left-sided and pulsatile, lasting a whole day. Additionally, there is associated photophobia and nausea/vomiting. He does not currently have a headache but wants to know what he should do next time he gets one. Which of the following additional symptoms would indicate a possible severe secondary cause of his headache and warrant additional imaging and evaluation?
    • A. 

      Gait abnormality

    • B. 

      Having to miss school

    • C. 

      Long-standing history of this type of headache

    • D. 

      Patient sees lights about an hour before he gets his headache

  • 94. 
    A 35 year old female with no significant PMH comes to your clinic for her annual appointment. On questioning, she shares that she has been having frequent headaches since the last time she saw you. On questioning, she puts both of her hands on her head and says "its like this intense pressing all over." She says she's been getting the headaches about once a week and are not affected by activity. "They seem to happen no matter what I"m doing." She denies nausea and vomiting but says that bright light sometimes bothers her. On exam she is hemodynamically stable and her neuro exam demonstrates no focal findings. Which of the following is the most common cause of primary headache and the most likely culprit in this case?
    • A. 

      Tension headache

    • B. 

      Migraine headache without aura

    • C. 

      Cluster headache

    • D. 

      Migraine headache with aura

  • 95. 
    A 35 year old male with a PMH of asthma and depression comes for his annual appointment. On questioning, he shares that she has been having frequent headaches since the last time he saw you. On questioning he says he gets severe headaches that always start around his right eye. They usually only last about 15 minutes but sometimes happen several times a day. He says he could probably handle the pain but his eyes tear up uncontrollably and his forehead sweats profusely, which is embarrassing for him at his job. On exam he is hemodynamically stable and his neuro exam is normal. He does not have a headache currently while at your office. This patient's headache is most characteristic of which of the following types of primary headache?
    • A. 

      Cluster headache

    • B. 

      Tension headache

    • C. 

      Migraine with aura

    • D. 

      Migraine without aura

  • 96. 
    An 18 year old male presents to the emergency room complaining of headache after falling while snowboarding. On questioning, he says he is learning how to snowboard and lost his balance when getting off the lift. He is currently experiencing 5/10 pain on the left posterior side of his head, where he hit the ground. On further questioning, he admits to feeling "woozy" but denies throwing up. Which of the following is the most sensitive test for ruling out an intracranial bleed in this patient?
    • A. 

      Magnetic resonance imaging

    • B. 

      A comprehensive neurological exam

    • C. 

      Computed tomography of the head

    • D. 

      Plain head radiographs

    • E. 

      Lumbar puncture

  • 97. 
    A 55 year old man with a PMH significant for poorly controlled hypertension presents to the emergency room complaining of a headache. On questioning, he says he's never had a headache like this before and that "it hit me so hard I fell to the floor." On exam, his blood pressure is 180/100. The patient did take acetaminophen and the headache has improved since it started but is still present. Which of the following is the next best course of management for this patient?
    • A. 

      Computed tomography of head

    • B. 

      Lumbar puncture

    • C. 

      Discharge home with instructions to return to the ED if headache returns

    • D. 

      A comprehensive neurologic exam

  • 98. 
    You have been managing a 30 year old female patient with migraines for several years. For some time she was adequately managed with sumatriptan at the onset of aura, but over the last year she has noticed that the sumatriptan is not as effective as it used to be. She is interested in trying a medication for prevention of migraines. Which of the following medications is recommended for migraine prophylaxis?
    • A. 

      Propranolol

    • B. 

      Pindolol

    • C. 

      Clonidine

    • D. 

      Acetazolamide

    • E. 

      Gabapentin

    • F. 

      Clonazepam

    • G. 

      Indomethacin

  • 99. 
    The Awesome Family Medicine Clinic has started offering acupuncture as a treatment modality option for qualified patients interested in alternative medicine techniques. Which of the following conditions would be most likely to respond to acupuncture therapy?
    • A. 

      Low back pain

    • B. 

      Rheumatoid arthritis

    • C. 

      Chronic neuropathic pain

    • D. 

      Cluster headache

    • E. 

      Obesity

    • F. 

      Smoking

  • 100. 
    You are asked to evaluate a 5 year old in the emergency department for headache. Which of the following is the most common cause of pediatric headache evaluated in the ED?
    • A. 

      Viral illness with fever

    • B. 

      Traumatic intracranial bleed

    • C. 

      Bacterial meningitis

    • D. 

      New diagnosis of migraine headaches

  • 101. 
    Adapted from Pediatrics In Review quiz: A 5 year old boy is brought to your clinic for evaluation of headache. The family is concerned that the child might have a brain tumor and ask if the boy should get imaging of his head. Which of the following history or physical exam details would be the strongest indicator for  magnetic resonance imaging in this patient?
    • A. 

      Headache causing sleep disturbance.

    • B. 

      Age

    • C. 

      Male gender.

    • D. 

      The patient continually pulls at his left ear.

    • E. 

      The father is treated for cluster headaches.

    • F. 

      The patient is not talkative.

  • 102. 
    Adapted from Pediatrics in Review Quiz: A 14 year old boy is brought to the Awesome Family Medicine Clinic by his mother for evaluation of headache. The patient has had weekly headaches for the last several months that make it difficult for him to concentrate on his homework. They both tell you that they would prefer to try non-pharmacologic treatments for his headache. On exam, the patient is hemodynamically stable and his neuro exam is normal. Which of the following lifestyle changes would be most likely to help this patient's headaches?
    • A. 

      Recommend riding his bike to school or some other daily aerobic exercise.

    • B. 

      One cup of coffee/glass of tea with breakfast.

    • C. 

      Limit fluid intake to 4 small water bottles a day.

    • D. 

      Earlier bedtime to allow for more sleep.

    • E. 

      Encourage stimulating activities before bed, such as reading, watching TV or video games.

  • 103. 
    It is your first day on your family medicine rotation at the Awesome Family Medicine Clinic. Your attending says the first patient on his schedule is present with the most common chief complaint seen in primary care. Which of the following is the most common symptom bringing patients to a primary care physician's office and the most common diagnosis?
    • A. 

      Cough, acute bronchitis

    • B. 

      Low back pain, acute muscle strain

    • C. 

      Neck pain, poor posture

    • D. 

      Headache, tension headache

    • E. 

      Diarrhea, infectious

    • F. 

      Knee pain, osteoarthritis

  • 104. 
    An 8 year old male patient is brought to your clinic by his mother for cough. He has had the cough for 5 days and his mother wants to know if the boy should take antibiotics. On questioning, the boy's mother says the cough is productive of green sputum and the boy hasn't wanted to play as much. On physical exam, the patient is hemodynamically stable. You note erythema in the oropharynx. What proportion of acute bronchitis infections is viral?
    • A. 

      >90%

    • B. 

    • C. 

      30%

    • D. 

      50%

    • E. 

      75%

  • 105. 
     An 8 year old male patient is brought to your clinic by his mother for cough. He has had the cough for 5 days and his mother wants to know if the boy should take antibiotics. On questioning, the boy's mother says the cough is productive of green sputum and the boy hasn't wanted to play as much. On physical exam, the patient is hemodynamically stable. You note erythema in the oropharynx. You inform the mother that regardless of the cause, she might expect the boy's cough to last how much longer?
    • A. 

      Up to 3 weeks

    • B. 

      Another day or two

    • C. 

      One more week

    • D. 

      The cough should have resolved by now

    • E. 

      Two more months

  • 106. 
    A mother brings her 10 year old daughter to the clinic complaining of cough. The mother says her daughter has had a productive cough for the last 10 days and she demands antibiotics. "Last time my daughter had a cough like this she took antibiotics and it got better right away." On exam, the child is hemodynamically stable with a temperature of 37.5 degrees C. You know that the patient's infection is likely viral and that antibiotics are not indicated. Which of the following is the best course of action to ensure patient satisfaction?
    • A. 

      Increased effort at effective communication regarding the mechanism of upper respiratory infections

    • B. 

      Prescribe a short course of amoxicillin since this has helped the patient in the past.

    • C. 

      Instruct the mother to use over the counter cough suppressants and tell her they have "antibiotic properties."

    • D. 

      Refuse to prescribe antibiotics but refer her to a physician who might be willing to do what she asks.

  • 107. 
    An 8 year old male patient is brought to your clinic by his mother for cough. He has had the cough for 5 days and his mother wants to know if the boy should take antibiotics. On questioning, the boy's mother says the cough is productive of green sputum and the boy hasn't wanted to play as much. On physical exam, the patient is hemodynamically stable. You note erythema in the oropharynx. You contemplate ordering a sputum culture to determine the causative organism. How often is the causative organism found in acute bronchitis?
    • A. 

      Less than one third of the time

    • B. 

      Less than one half of the time

    • C. 

      Sputum culture is very sensitive. If cultures are taken, the lab will likely identify an organism.

    • D. 

      Viral cultures will identify the organism if the cause is viral, so detection rate is high.

  • 108. 
    A 16 year old girl is brought to your office by her mother for sore throat. On questioning, the girl says her throat "hurts really bad" for the last 2 days. The patient denies having a cough. On exam, the patient's temperature is 38.9 degrees C and you observe enlarged tonsils with overlying patchy white exudate. Which of the following is the most appropriate next step in management?
    • A. 

      Rapid Antigen Detection Testing (RADT)

    • B. 

      Empiric antibiotics

    • C. 

      Echocardiogram

    • D. 

      No further testing or antibiotics indicated

  • 109. 
    A 6 year old boy is brought to your office by his mother for sore throat. On questioning, the boy says his throat "hurts really bad" for the last 2 days. The mother denies that the patient has had a cough. On exam, the patient's temperature is 38.9 degrees C and you observe enlarged tonsils with overlying patchy white exudate. The patient has no known allergies to medications. Which of the following would be the most appropriate treatment for this patient?
    • A. 

      Amoxicillin orally for 10 days

    • B. 

      Erythromycin orally for 10 days

    • C. 

      Penicillin G IM once

    • D. 

      Ciprofloxacin orally for 5 days

    • E. 

      Doxycycline orally for 7 days

  • 110. 
    A mother brings her 22-month-old son to your office for evaluation of possible ear infection. The mother says the child has been especially fussy for the last few days and has been pulling at both of his ears, and this is what happened last time he has an ear infection. On exam, the child's temperature is 38.5 degrees C and you observe erythematous tympanic membranes bilaterally with air-fluid levels. Which of the following is the first line treatment for otitis media in this child?
    • A. 

      Amoxicillin

    • B. 

      Ceftriaxone

    • C. 

      Trimethoprim/Sulfamethoxazole

    • D. 

      Erythromycin/sulfisoxazole

    • E. 

      Amoxicillin/Clavulanic acid

  • 111. 
    A young couple presents with their two children for an routine check-up. The mother is 25 years old with a PMH of asthma and the father is 30 years old with no significant PMH. Their son is 5 years old and their daughter is 2 months old. According to national guidelines, who should receive a flu vaccine today, assuming the vaccine is available?
    • A. 

      The mother, father, and 5-year old son should receive a flu vaccine.

    • B. 

      The entire family should receive a flu vaccine.

    • C. 

      Only the mother needs the flu vaccine today.

    • D. 

      Only the 2-month old daughter needs the flu vaccine today.

  • 112. 
    A 28 year old female presents to the Awesome Family Medicine Clinic with the chief complaint of cough. She says she has had a non-productive cough for the last 2 days and wants to know what is wrong with her. Associated symptoms include sore throat, myalgias, headache, and rhinorrhea. On exam, her temperature is 39.5 degrees C. Her throat is erythematous and the patient is actively coughing in the exam room but the remainder of the exam is otherwise normal. Which of the following physical exam or history details will help most in implicating influenza as a cause of this patient's illness over the common cold?
    • A. 

      High fever

    • B. 

      Non-productive cough

    • C. 

      Headache

    • D. 

      Erythematous throat

    • E. 

      Myalgias

  • 113. 
    A 20 year old male with no significant PMH presented to the clinic complaining of cough. On questioning, he says he has had a cough for the last 3 days and a fever at home of 100 degrees F. Associated symptoms include sore throat, headache and "achiness." On exam, his temperature in the office is 99.8 degrees F and you note erythema in the oropharynx. You inform the patient that he likely has a viral upper respiratory infection and that the infection will likely get better on its own. The patient says he understands but he wants to know what is causing his illness. Which of the following is the most common causative agent of the common cold?
    • A. 

      Rhinoviruses

    • B. 

      Coronavirus

    • C. 

      Respiratory Syncytial Virus

    • D. 

      Adenovirus

    • E. 

      Coxsackievirus

  • 114. 
    A 20 year old male with no PMH presents for his annual appointment. He is well today but wants to know what he can do to prevent getting a cold, since all his friends seem to be getting sick. Which of the following would be the best recommendation for this patient to prevent getting a cold?
    • A. 

      Handwashing

    • B. 

      Flu vaccine

    • C. 

      Echinacea

    • D. 

      Vitamin C

    • E. 

      Avoid air travel

    • F. 

      Garlic supplement

    • G. 

      Zinc supplement

  • 115. 
    A study is in the process of validating a test for Valley Fever. Results from 1100 participants are compared to the gold standard of fungal culture. Out of 135 positive test results, 85 agreed with culture results. Out of 965 negative test results, 950 agreed with culture results. What is the sensitivity of this new test?
    • A. 

      85%

    • B. 

      63%

    • C. 

      95%

    • D. 

      98%

  • 116. 
    A study is in the process of validating a test for Valley Fever. Results from 1100 participants are compared to the gold standard of fungal culture. Out of 135 positive test results, 85 agreed with culture results. Out of 965 negative test results, 950 agreed with culture results. What is the specificity of this test?
    • A. 

      95%

    • B. 

      85%

    • C. 

      63%

    • D. 

      98%

  • 117. 
    A study is in the process of validating a test for Valley Fever. Results from 1100 participants are compared to the gold standard of fungal culture. Out of 135 positive test results, 85 agreed with culture results. Out of 965 negative test results, 950 agreed with culture results. What is the positive predictive value of the test?
    • A. 

      63%

    • B. 

      95%

    • C. 

      98%

    • D. 

      85%

  • 118. 
    Although millions of Americans suffer from moderate to severe vision impairment, studies show that relatively few people seek eye care, leading to increased morbidity and healthcare costs. Which of the following is cited as the most common reason why adults do not seek regular eye care by the CDC?
    • A. 

      Cost/lack of insurance

    • B. 

      No reason to go

    • C. 

      Patient does not have an eye doctor

    • D. 

      Eye specialist too far/lack of transportation

    • E. 

      Patient could not get an appointment

  • 119. 
    A new test for Valley Fever has a specificity of 99%. In Arizona, the prevalence of Valley Fever is about 2.5 cases in 1000. If an asymptomatic person were screened with this test in the outpatient setting, what are the chances that a positive test result is real?
    • A. 

      About 10%

    • B. 

      About 50%

    • C. 

      About 90%

    • D. 

      99%

  • 120. 
    The Awesome Family Medicine Clinic is in the process of trying to decide how to utilize a new rapid screening test for Valley Fever. The sensitivity of the new test is 98% and the specificity is 99%. The prevalence of Valley Fever is 2.5/1000 in the endemic area. What would be the best way for this clinic to utilize the new screening test?
    • A. 

      Screen only after full history and physical exam yields findings consistent with Valley Fever.

    • B. 

      Screen all patients once regardless of chief complaint.

    • C. 

      Don't utilize the test due to the low overall prevalence of Valley Fever

    • D. 

      Screen all new patients and repeat test if positive result is obtained.

  • 121. 
    A 23 year old sexually-active female presents to the clinic for a well-woman exam. The Awesome Family Medicine Clinic follows USPSTF guidelines and offers screening for gonorrhea and chlamydia while she is here for her appointment. What type of preventative intervention is the test for gonorrhea and chlamydia?
    • A. 

      Secondary

    • B. 

      Primary

    • C. 

      Tertiary

    • D. 

      If the test result is positive, secondary intervention. If negative result, then primary prevention.

  • 122. 
    A 32 year old male presents to the clinic for his annual exam. A flu vaccine is administered while he is at the clinic. Later on in the season, the patient ends up contracting the flu anyway. What type of preventative intervention is the flu vaccine in this case?
    • A. 

      Primary

    • B. 

      Secondary

    • C. 

      Tertiary

    • D. 

      Since the vaccine didn't work, it is not preventative.

  • 123. 
    ***A 14 year old boy is being evaluated for colon cancer. He has multiple family members with Familial Adenomatous Polyposis. A screening colonoscopy demonstrated too many polyps to count and an area of constriction in his sigmoid colon. You are about to have a discussion with the boy regarding the need for eventual referral to a surgeon for total colectomy. What type of preventative intervention would a colectomy be for this patient?
    • A. 

      Tertiary

    • B. 

      Primary

    • C. 

      Secondary

    • D. 

      A colectomy will not prevent this patient from getting cancer.

  • 124. 
    A 67 year old female with no significant PMH presents to your clinic for a routine evaluation. The patient says she is particularly concerned about heart disease because she has had 2 friends get heart attacks and she doesn't want to have one. On exam, her blood pressure in the office is 124/84. The patient is not diabetic and has never smoked. She undergoes a fasting lipid profile and her total cholesterol is 140, with an HDL of 62. Which of the following is this patient's greatest risk factor for coronary heart disease? 
    • A. 

      Age >65

    • B. 

      Total cholesterol >130

    • C. 

      Female gender

    • D. 

      Diastolic BP >80

  • 125. 
    You just finished doing a physical on a 35 year old male. Aside from a 15 pack year history of smoking, the man is healthy. You ask him if he would like to talk about strategies for quitting smoking and his reply is: "You just told me I was healthy. Why does everyone keep bugging me to quit smoking?" Which of the following is a major reason why primary care physicians should provide behavioral counseling to patients?
    • A. 

      Half of mortality is related to lifestyle choices.

    • B. 

      Patient education ultimately decreases healthcare costs.

    • C. 

      Counseling prevents mortality from lifestyle-related diseases.

    • D. 

      People will not make healthy life choices without the help of their physician.

  • 126. 
    You just finished doing a physical on a 35 year old male. Aside from a 15 pack year history of smoking, the man is healthy. You ask him if he would like to talk about strategies for quitting smoking and his reply is: "You just told me I was healthy. Why does everyone keep bugging me to quit smoking?" Which of the following reflects current recommendations on how to handle this topic in the future?
    • A. 

      Continue behavioral counseling for smoking cessation at every visit.

    • B. 

      Make a note in the chart that the patient is pre-contemplative and wait until he approaches you for help to discuss the topic again.

    • C. 

      Fire the patient for refusing to quit smoking.

    • D. 

      Advise the patient to ask for help when he is interested in quitting smoking.

    • E. 

      Send smoking cessation information to his address to read at his leisure.

  • 127. 
    A 50 year old female with a PMH significant for hypertension presents to your clinic for a routine evaluation. The patient says she is particularly concerned about heart disease because she has had 2 friends get heart attacks and she doesn't want to have one. On exam, her blood pressure in the office is 146/95. Her BMI is 24. The patient is not diabetic and has never smoked. She undergoes a fasting lipid profile and her total cholesterol is 140, with an HDL of 50. Which of the following would be the most effective modifiable risk factor in this patient?
    • A. 

      Blood pressure

    • B. 

      Body Mass Index

    • C. 

      Cholesterol

    • D. 

      Fasting blood sugar

  • 128. 
    A 55 year old male with a PMH of hypertension and hyperlipidemia presents for a routine physical exam. His hypertension and hyperlipidemia are already adequately controlled with pharmacotherapy. The patient asks you if there is anything else he could take to help prevent cardiovascular disease. Which of the following would be the best recommendation?
    • A. 

      Aspirin 81 mg

    • B. 

      Aspirin 325 mg

    • C. 

      Nitroglycerine sublingual in case of chest pain

    • D. 

      Add a diuretic to his medication regimen

  • 129. 
    A 45 year old male with a PMH of erectile dysfunction presents to the clinic complaining of  sore throat. On physical exam, the patient has a BMI of 32, his temperature is 37.9 degrees C and his blood pressure is 160/84. Examination of his oropharynx demonstrates erythematous enlarged tonsils without exudates. You discharge him with supportive care for likely viral pharyngitis and schedule follow up in 2 weeks. At his next visit, he says his sore throat has resolved and he has no medical complaints. At this clinic visit, his blood pressure is 158/90. Based on this, what is the best next step in management?
    • A. 

      Counsel the patient regarding lifestyle modification and pharmacotherapy.

    • B. 

      Congratulate the patient for feeling better since his last visit and schedule follow up in 1 month to re-evaluate blood pressure.

    • C. 

      Prescribe an antihypertensive medication and discharge the patient. The pharmacist will counsel him on his new medication regimen.

    • D. 

      Tell the patient you will be unable to renew is Cialis prescription until he brings his blood pressure down.

  • 130. 
    A 40 year old female smoker presents to the clinic for routine follow-up. You ask her if she has put anymore thought into quitting smoking and she says: "You know, I've been thinking about quitting a lot lately. I know smoking is bad for me and I want to quit, but I don't know if I am ready yet." Which of the following stages is this patient in according to Prochaska's Stages of Change Model?
    • A. 

      Contemplation

    • B. 

      Pre-contemplation

    • C. 

      Action

    • D. 

      Maintenance

    • E. 

      Relapse

  • 131. 
    A 35 year old female presents to the clinic for a routine evaluation. She has a BMI of 28 but no other medical problems. When you counsel her about her weight she says she doesn't understand what is wrong because when she looks in the mirror she doesn't think she looks fat. You tell her that being overweight is similar in mortality risk to what other health risk factor?
    • A. 

      Smoking

    • B. 

      Hypertension

    • C. 

      Hyperlipidemia

    • D. 

      Drinking

    • E. 

      Previous heart attack

  • 132. 
    A 75 year old female presents to your clinic for a routine evaluation. She asks you if she still needs to get a mammogram every year. Her last mammogram was one year ago. She has never had an abnormal mammogram in the past. What is the current USPSTF recommendation regarding mammography for this patient?
    • A. 

      This woman doesn't need another mammogram for another 2 years.

    • B. 

      This woman doesn't need another mammogram.

    • C. 

      Since this woman's last mammogram was 1 year ago, she is due for another mammogram now.

    • D. 

      Since this woman is over 75 with no history of abnormal results, she doesn't need another mammogram for another 5 years.

  • 133. 
    A 35 year old female presents to the Awesome Family Medicine Clinic for her well-woman exam. She asks what can be done for breast cancer prevention. The patient has no history of breast cancer in her family. Which of the following most accurately reflects current USPSTF recommendations regarding breast exams?
    • A. 

      Teach the patient to perform breast self exams the day after her period is over.

    • B. 

      Teach the patient to perform breast self exams the week before her period is due.

    • C. 

      Perform a clinical breast exam during this appointment

    • D. 

      No breast exam is necessary.

  • 134. 
    A healthy 70 year old male presents to your clinic for a routine appointment. He says he got his regular 10-year colonoscopy one month ago and there were no abnormal findings. The patient has never had pathology identified on colonoscopy and has no family history of colon cancer. According to the USPSTF what is the recommendation for this patient regarding colon cancer screening?
    • A. 

      If the patient does not want anymore colonoscopies, then he doesn't have to have one again.

    • B. 

      The patient will be due for a colonoscopy in 10 years.

    • C. 

      After age 75, the patient can switch to yearly fecal occult blood testing.

    • D. 

      Because of the patient's age, he should repeat the colonoscopy promptly to identify lesions potentially missed on the most recent procedure.

  • 135. 
    A 40 year old alcoholic male presents to the clinic for a routine follow-up. You ask him if he has put anymore thought into quitting drinking and he says: "You know, I've been thinking more and more about quitting. I know my drinking is killing my liver so I have cut down from a six pack a night to three beers a night. I don't know if I'm ready to give it up completely yet though." Which of the following stages is this patient in according to Prochaska's Stages of Change Model?
    • A. 

      Action

    • B. 

      Contemplation

    • C. 

      Pre-contemplation

    • D. 

      Maintenance

    • E. 

      Relapse

  • 136. 
    A 45 year old obese female presents to your clinic for a routine follow-up appointment. She has a BMI of 35. Ten years ago, she had gastric bypass surgery and lost 80 pounds. Unfortunately, in the last few years, she has gained most of the weight back. You tell her that losing the weight again will dramatically affect risk factors to her health, but she says: "You know, I'm fat, and there's nothing I can do about it. Nothing bad has happened to me just because I was a little overweight." Which of the following stages is this patient in according to Prochaska's Stages of Change Model?
    • A. 

      Relapse

    • B. 

      Pre-contemplation

    • C. 

      Contemplation

    • D. 

      Action

    • E. 

      Maintenance

  • 137. 
    A 45 year old female with a PMH of well-controlled HTN presents to the Awesome Family Medicine Clinic for her well-woman appointment. She complains of a fishy vaginal discharge for the last week. Her last Pap test was 3 years ago, and 2 years ago she had a hysterectomy for fibroids. She has never had an abnormal Pap exam in the past. She denies any constitutional symptoms or abnormal vaginal bleeding. On exam, her temperature is 37.8 degrees C, BP is 135/74 and HR is 80. Which of the following is the best next course of management?
    • A. 

      Perform pelvic exam today.

    • B. 

      Offer a clinical breast exam.

    • C. 

      Perform Pap exam and wet mount today.

    • D. 

      Offer Pap exam with HPV testing so she can increase her screening interval to 5 years.

  • 138. 
    An 18 year old female presents to the clinic for contraceptive counseling. The patient is sexually active and admits to having multiple sexual partners without protection. She has no medical complaints at this time. In addition to recommending appropriate STD screening, which of the following is the most appropriate management strategy regarding cervical cancer screening?
    • A. 

      Instruct follow-up in 3 years for Pap exam.

    • B. 

      Perform Pap exam and HPV testing today to avoid loss to follow-up.

    • C. 

      Perform HPV testing without Pap exam.

    • D. 

      Instruct follow-up in 3 years for HPV testing. If positive at that time, perform colposcopy.

  • 139. 
    A healthy 64 year old woman presents to the clinic for a well-woman exam. She has no medical complaints today and is monogamous with her husband of 40 years. Her last Pap exam was 1 year ago. She has never had an abnormal Pap in the past. Which of the following is the most appropriate management regarding cervical cancer screening according to the USPSTF?
    • A. 

      The patient does not need anymore Pap exams.

    • B. 

      Instruct the patient to follow up in 2 years for her regular Pap exam.

    • C. 

      Perform a Pap exam today.

    • D. 

      The screening interval can be increased to every 5 years if concurrent HPV testing occurs with her next Pap exam.

  • 140. 
    A healthy 40 year old male presents to the clinic for his annual evaluation. He has no medical complaints at this time. As you are washing your hands prior to performing your physical exam, the patient sighs and says "Well doc, I guess I'm at the age when you have to examine my prostate. What do you need me to do?" The patient has no family history of prostate cancer, What is your USPSTF-informed response?
    • A. 

      "You do not need prostate cancer screening."

    • B. 

      "I will need to perform a transrectal prostate exam. I will excuse myself so you can change into this robe."

    • C. 

      "We will order labs today for prostate specific antigen to screen for prostate cancer."

    • D. 

      "We will schedule you for a prostate needle-core biopsy to screen for prostate cancer."

  • 141. 
    A 45 year old male patient with well-controlled HTN presents to your clinic for routine follow-up. He expresses concerns at this appointment because his father died of MI three years ago and his brother was hospitalized for MI last year. The patient wants to know what kind of screening he should get for coronary heart disease. "I'm afraid its my turn, next." His BP today is 136/74. Which of the following is the most appropriate management of this patient, according to the USPSTF?
    • A. 

      The patient does not need screening for coronary heart disease. Follow up as necessary with primary care provider.

    • B. 

      Screen the patient for coronary heart disease with a baseline EKG.

    • C. 

      Perform an treadmill exercise stress test to evaluate for cardiac ischemia.

    • D. 

      Perform electron-beam computerized tomography (EBCT) scanning for coronary calcium to assess for the presence of severe coronary artery stenosis (CAS).

    • E. 

      Tell the patient he is optimally medically managed and there is nothing he can do to alter his coronary heart disease risk.

  • 142. 
    An 18 year old female with no PMH presents to the clinic for a routine annual exam. She has no medical complaints today. Her BMI is 24, and her physical exam demonstrates normal findings. Which of the following diseases is recommended for routine screening in this patient according to the USPSTF?
    • A. 

      Hypertension

    • B. 

      Diabetes

    • C. 

      Ovarian cancer

    • D. 

      Thyroid disease

    • E. 

      Suicidal ideation

    • F. 

      This healthy 18 year old female is not indicated to have any routine screening at this time.

  • 143. 
    A 36 year old woman presents to the clinic to establish care. She has no significant past medical history, but admits to a positive family history for breast cancer. On questioning, she says her mother and grandmother died of breast cancer in their 50s and two of her sisters have been diagnosed with breast cancer. Her maternal aunt died at the age of 47 from ovarian cancer. Which of the following would be the most appropriate management for this patient?
    • A. 

      Refer to genetic counseling and recommend testing for the BRCA1/2 gene.

    • B. 

      Refer to surgery for prophylactic bilateral mastectomies.

    • C. 

      Begin annual mammograms 10 years before the youngest family member with breast cancer.

    • D. 

      Perform clinical breast exam today.

    • E. 

      Teach the patient to perform breast self exams.

  • 144. 
    You arrive on your first day of your family medicine rotation at the Awesome Family Medicine Clinic. Your first patient is a 14 year old female with asthma and a chief complaint of "vaccine catch up." Your attending asks you for a list of vaccines that  are recommended for adolescents. Which of the following is NOT considered an adolescent vaccine?
    • A. 

      Rotavirus

    • B. 

      Influenza

    • C. 

      Measles/Mumps/Rubella

    • D. 

      Human Papillomavirus

    • E. 

      Pneumococcus - 23

    • F. 

      Meningococcus

  • 145. 
    A 22 year old female presents to the clinic to establish care. She has no past medical history and no medical complaints today, although she requests to receive her last HPV vaccination. She has records of her first two HPV vaccinations, both of which were administered 5 years ago. On questioning, she says she did not receive her last HPV vaccine yet because she couldn't afford it until now. She is sexually active and had her first Pap exam performed last year, which was normal. Which of the following is the most appropriate next step in management regarding this patient's HPV vaccine?
    • A. 

      Administer her last HPV vaccine today.

    • B. 

      Start the vaccine series over with today as the new "time zero."

    • C. 

      Since the patient is sexually active, it is likely she already contracted HPV so there is no point in finishing the series.

    • D. 

      Provide a booster today and schedule a follow-up in two months for one last catch up injection.

  • 146. 
    A 24 year old G2P1 female patient at 22 weeks gestation presents for a prenatal care appointment. She wants to know about all the things she can do to protect her baby. After talking about diet, exercise, blood pressure monitoring, and routine infectious disease screening, she asks about vaccine recommendations. The patient is up to date with all of her immunizations, receiving her flu shot shortly before she found out she was pregnant, and receiving her TDAP 2 years ago with her first pregnancy. Which of the following is recommended for this patient in regards to vaccications?
    • A. 

      Administer TDAP today

    • B. 

      No vaccinations are necessary today.

    • C. 

      Administer TDAP after 27 weeks gestation.

    • D. 

      Repeat flu shot.

  • 147. 
    A 45 year old male presents to the emergency room after cutting his hand. On questioning, the man says he cut himself while gutting fish after a trip to the lake. He said he tried to clean the wound but he doesn't think it will close on its own. You examine the injury and note a 3 inch long laceration. You take a sterile swab and estimate the depth of the laceration at 0.5 cm, and note some residual fish scales. You ask the man if he remembers his last tetanus shot and his reply is "Oh I know I got one of those at some point. It was a few years ago, I reckon." Which of the following is recommended in terms of tetanus prophylaxis in this wound's management?
    • A. 

      Tetanus immune globulin and Tdap or Td.

    • B. 

      Tetanus immune globulin only

    • C. 

      Tdap or Td

    • D. 

      This patient has already received his Tdap so he is already protected from tetanus.

  • 148. 
    A 38 year old woman presents to your office 2 days after cutting herself with a kitchen knife while preparing Thanksgiving dinner for her family. She says she was chopping vegetables when the knife slipped and "gave her a good one." She denies any fevers or swelling of the affected hand. On questioning, she says she has received a tetanus shot every 10 years since she was 12. Which of the following is recommended in terms of tetanus prophylaxis in this wound's management?
    • A. 

      This patient is adequately protected against tetanus.

    • B. 

      Tdap or Td

    • C. 

      Tetanus immunoglobulin only

    • D. 

      Tetanus immunoglobulin and Tdap or Td.

  • 149. 
    A 52 year old diabetic female is being followed for established chronic kidney disease. She has recently scheduled placement of an AV fistula with her vascular surgeon for anticipated hemodialysis. Which of the following is the recommended schedule for the PPV-23 (pneumococcus) vaccine for this patient?
    • A. 

      One dose now, one in 5 years and a third at age 65

    • B. 

      One dose now and one in 5 years

    • C. 

      One dose at age 65

    • D. 

      The PPV-23 will not adequately protect this patient against pneumococcus.

  • 150. 
    A 20 year old male patient presents to your office for a routine annual physical. You offer him a flu shot but he says he doesn't think he can have one. When you ask him why he says that he is still getting over a cold and has egg and latex allergies. Also the last time he got a vaccine the injection site got really red and he got a fever. As a child, he was hospitalized for several days after a vaccine because he developed "breathing problems." Plus, "I just really don't like needles." Which of the following is considered a contraindication to vaccination?
    • A. 

      Anaphylaxis reaction in a previous vaccine or vaccine component.

    • B. 

      Egg allergy

    • C. 

      Latex allergy

    • D. 

      Local reaction at injection site with previous vaccine

    • E. 

      Fever with previous vaccine

    • F. 

      True phobia to needles

    • G. 

      Active symptoms of URI

  • 151. 
    A 20 year old male presents to the clinic with a chief complaint of penile discharge. He says for the last week he has noticed yellow-green discharge coming from the tip of his penis. He is sexually active with multiple female partners and uses condoms inconsistently. Which of the following is the most appropriate next step in management?
    • A. 

      Ceftriaxone 250mg IM, Azithromycin 2g orally once

    • B. 

      Ceftriaxone 250mg IM

    • C. 

      Azithromycin 2 g orally once

    • D. 

      Culture the discharge and treat based on culture results.

    • E. 

      Levofloxacin 250mg orally for 5 days

  • 152. 
    A 25 year old female presents to the clinic for a well-woman exam. Her sexual history is significant for multiple male sexual partners with inconsistent use of condoms. On exam, palpation of the abdomen yielded lower abdominal tenderness and the speculum elicits cervical motion tenderness. Which of the following additional findings is necessary to complete the minimum criteria for pelvic inflammatory disease?
    • A. 

      Adnexal tenderness on bimanual exam

    • B. 

      Observation of purulent discharge from cervical os.

    • C. 

      Observation gram negative diplococci on gram stain of endocervical swab

    • D. 

      Cervical erythema

    • E. 

      Positive urine test for gonorrhea, chlamydia or both.

  • 153. 
    A 30 year old male with no significant PMH presents to your office complaining of a rash. He says he started noticing the rash on his palms and feet a few days ago. He has never had a rash like this before. You take a complete sexual history and the patient reveals that he has multiple male partners and rarely uses condoms. On exam, his vital signs are all within normal limits and you note a macular erythematous rash on his hands and feet. You ask the patient if he has noticed any genital lesions in the past and he is unable to recall. The patient is allergic to penicillin. Which of the following is the most appropriate treatment for this patient?
    • A. 

      Penicillin G 2.4 million units IM x3 doses

    • B. 

      Penicillin G 2.4 million units IM x1 dose

    • C. 

      Penicillin V potassium 250 mg orally for 7 days

    • D. 

      Ceftriaxone 250mg IM once

    • E. 

      Azithromycin 1 g orally once

    • F. 

      Doxycycline 100mg orally or 7 days

  • 154. 
    A mother brings her 17 year old daughter for a routine annual exam. The patient has no significant PMH and has no medical complaints today. When inquiring about the patient's sexual history, her only reply is "I have a boyfriend." On exam, her vital signs are normal. At the end of the exam, you offer a flu shot, the HPV vaccine and HIV screening. The mother asks you why her daughter would need screening for HIV. What are CDC recommendations regarding HIV screening?
    • A. 

      All individuals 13-64 once

    • B. 

      Annually for all individuals age 13-64

    • C. 

      All high risk individuals once

    • D. 

      Those who give written consent

    • E. 

      All individuals 6-65

  • 155. 
    A 22 year old female with no PMH presents to your office for a well woman appointment. She is sexually active and has had 2 new males partners in the last year. On exam, her vital signs are normal. Pelvic exam demonstrates a normal looking cervix with no erythema or tenderness and no discharge in the vaginal vault. After the exam, you offer to test her urine for gonorrhea and chlamydia. The patient asks how she would know if she had gonorrhea or chlamydia. Which of the following is the most prominent symptom of these sexually transmitted diseases?
    • A. 

      No symptoms

    • B. 

      Urethritis

    • C. 

      Arthritis

    • D. 

      Pharyngitis

    • E. 

      Cervicitis

  • 156. 
    You are performing an evaluation on a 78 year old female who is living independently. The patient is present with her daughter. The daughter wants to know when she needs to think about setting her mother up with an assisted living facility. The patient has no medical concerns today and is adamant that she is just fine living at home by herself. You will need to assess this patient's ability to perform activities of daily living independently. Which of the following is an example of a basic activity of daily living? 
    • A. 

      Being able to walk up the two steps between her living room and dining room

    • B. 

      Cooking her own meals

    • C. 

      Folding her laundry

    • D. 

      Using her telephone to call her daughter

    • E. 

      Reading the labels on her prescriptions

    • F. 

      Attending Bingo Night with her friends

  • 157. 
    A 65 year old female presents to the clinic for a routine health evaluation. She is overweight (BMI 28) and has moderately controlled hypertension treated with lisinopril and HCTZ. On exam, her BP is 140/78. She asks what she can do to stay healthy. You tell her that regular exercise and increase aerobic fitness will greatly decrease risk for getting sick. Which of the following is the minimum amount of physical activity recommended to decrease risk of morbidity and mortality?
    • A. 

      30 minutes of aerobic activity 5 days a week

    • B. 

      1 hour of physical activity every day

    • C. 

      1 hour of weight lifting 3 days a week

    • D. 

      Daily stretching

  • 158. 
    You are evaluating a 65 year old female with HTN. You have been working with the patient for the last year to help her with smoking cessation. The patient has successfully cut down from 1 pack of cigarettes per day to 1 pack of cigarettes per week. She has no medical complaints today. On exam, blood pressure is 144/78. No matter what you say, she refuses to participate in any recommended screening tests or receive any vaccinations. At the end of her appointment, she laughs and says "something's got to get me in the end; what do you think it will be?" What is the most common cause of death in the United States?
    • A. 

      Heart disease

    • B. 

      Cancer

    • C. 

      Stroke

    • D. 

      COPD

    • E. 

      Pneumonia/influenza

    • F. 

      Accidents

  • 159. 
    A 42 year old male patient with developmental delay presents with his mother for a routine annual physical. The history is obtained from the mother, who says her son has been doing well at home. Her main concern today is how she should start planning for care for her son since she is starting to get older. Which of the following would be the best course of action for an aging caregiver of an adult with developmental disabilities?
    • A. 

      Start investigating and planning for residential and financial arrangements for when parent is no longer able to provide care.

    • B. 

      Go ahead and place the patient in an assisted living facility so he can start forming new relationships.

    • C. 

      Arrange for Hospice care since people with developmental disabilities have a shorter life span than the general population.

    • D. 

      Rely on other family members to take over care in the event of the death or illness of the parent.

  • 160. 
    Your attending asks you to see an 80 year old male patient for a chief complaint of "fall." He is accompanied by his daughter. On questioning, the patient denies any dizziness, lightheadedness, or loss of consciousness. "The dog just keeps getting underfoot is all." The patient has lived independently since his wife died ten years ago and his daughter comes to visit once a week. Vital signs are all within normal limits and physical exam is only significant for a small ecchymosis on the left thigh. He otherwise appears well-nourished and with good hygiene, even though you notice his shirt is buttoned up one button askew. He is alert and oriented to self and place only. You ask the patient if he can walk across the room and he stands with difficulty and shuffles across the exam room. The daughter asks you if she should start thinking about moving her father out of his home and into a skilled nursing facility. Your attending says this patient may benefit from a home visit. Which of the following reflects why a home visit would be beneficial?
    • A. 

      The patient may be functioning better in his home than in the office.

    • B. 

      The patient is at high risk for suicide.

    • C. 

      The home visit would prove the patient is likely taking his drugs incorrectly.

    • D. 

      The home visit would reveal the presence of elder abuse.

  • 161. 
    A 60 year old male with a PMH significant for hyperlipidemia and well-controlled HTN presents to the clinic for a routine appointment. His medications include lisinopril, HCTZ and pravastatin. His BMI is 28. The patient has a family history of hyperlipidemia and heart disease and you have been trying to encourage the patient to adopt a regular exercise plan as a part of reducing his cardiovascular risk. His response is "I'm too old for exercising to help much anymore."  Life expectancy can be increased with initiation of a regular exercise plan until roughly what age?
    • A. 

      75

    • B. 

      60

    • C. 

      50

    • D. 

      85

  • 162. 
    A 55 year old male with a PMH of osteoarthritis controlled with extra strength acetaminophen presents to the physician for a routine annual exam. He has no medical complaints today but wants to talk to you about joining a gym. The last of his 4 children moved out of the house recently and he is wanting to focus on his own health more. "I haven't exercised in a long time, doc. I don't want to hurt myself. Do I need approval from you to start?" The patient has a BMI of 25. On physical exam, his vital signs are within normal limits. Who needs a pre-exercise consultation with a physician?
    • A. 

      Anyone with a chronic medical condition.

    • B. 

      Anyone over age 50.

    • C. 

      Anyone over age 65.

    • D. 

      Only people with significant cardiovascular risk factors (CAD, DM, etc).

    • E. 

      Only people who with a BMI >30.

    • F. 

      Older adults should not initiate new exercise programs.

  • 163. 
    An 87 year old male is brought to your office by his daughter with a chief complaint of "memory problems." She says her father has started to forget things since his wife passed away a year ago. The daughter says he seems to forget to eat and that he has forgotten to call for family birthdays and holidays. "He even seems to have forgotten how to play cards, which was his favorite thing to do with Mom. Is it possible he has Alzheimers?" The patient scores a 28/30 in the MMSE, and a 7/15 on the geriatric depression scale. What percent of adults over the age of 85 have dementia?
    • A. 

      30%

    • B. 

      10%

    • C. 

      50%

    • D. 

      70%

    • E. 

      90%

  • 164. 
    A 38 year old male with no significant PMH presents to your office for a routine health evaluation. He has no medical concerns at this time, but wants to go over a commercial genetic screen he recently used. He hands you a packet of results analyzing his genome for single nucleotide polymorphisms (SNPs) associated with increased disease risk. He is particularly concerned about the analysis of genes associated with cardiovascular risk. You notice that the patients results demonstrate the presence of SNPs that confer an increased risk of cardiovascular disease. Today his vital signs are normal as is his physical exam. The patient says "now that I have these results I am going to join the gym and stop drinking soda. I don't want to die of heart disease if I don't have to." This reaction is an example of the genetic test's ____.
    • A. 

      Clinical utility

    • B. 

      Analytic validity

    • C. 

      Clinical validity

    • D. 

      Cost effectiveness

  • 165. 
    A 38 year old male with no significant PMH presents to your office for a routine health evaluation. He has no medical concerns at this time, but wants to go over a commercial genetic screen he recently used. He hands you a packet of results analyzing his genome for single nucleotide polymorphisms (SNPs) associated with increased disease risk. He is particularly concerned about the analysis of genes associated with cardiovascular risk. You notice that the patients results demonstrate the presence of SNPs that confer an increased risk of cardiovascular disease. Today his vital signs are normal as is his physical exam. When you review the evidence for this test, you find that genetic variants for CVD risk can be identified with good reliability. This is an example of _____.
    • A. 

      Analytic validity

    • B. 

      Clinical utility

    • C. 

      Clinical validity

    • D. 

      Cost effectiveness

    • E. 

      Analytic reliability

  • 166. 
    A 38 year old male with no significant PMH presents to your office for a routine health evaluation. He has no medical concerns at this time, but wants to go over a commercial genetic screen he recently used. He hands you a packet of results analyzing his genome for single nucleotide polymorphisms (SNPs) associated with increased disease risk. He is particularly concerned about the analysis of genes associated with cardiovascular risk. You notice that the patients results demonstrate the presence of SNPs that confer an increased risk of cardiovascular disease. Today his vital signs are normal as is his physical exam. As you research the patient's genetic test, you find that the test's odds ratio is 64% for the gene variants analyzed. This is an example of the test's _____.
    • A. 

      Clinical validity

    • B. 

      Analytic validity

    • C. 

      Clinical utility

    • D. 

      Cost effectiveness

    • E. 

      Analytic reliability

  • 167. 
    A 45 year old female with no PMH presents to your office for a hospital follow up. She was recently discharged from the hospital after being treated for an unprovoked venous thromboembolism in her left leg. She is currently on a three month course of warfarin. She wants to know if she should get tested for the Factor V Leiden mutation because her mother has it and has had multiple clots. Which of the following reflects the EGAPP recommendation for Factor V Leiden (FVL) mutation?
    • A. 

      Secondary prophylaxis offers similar benefits to patients regardless of mutation status.

    • B. 

      The patient should receive Factor V Leiden mutation testing because of her family history of FVL and clotting.

    • C. 

      The patient should receive Factor V Leiden mutation testing because of her unprovoked clot.

    • D. 

      Factor V Leiden mutation testing is too expensive to for widespread utilization.

    • E. 

      The analytic validity for Factor V Leiden mutation is too low to accurately identify gene variants.

  • 168. 
    A 40 year old male with no significant PMH presents to your office for a routine annual appointment. The patient is very health conscious and always has questions about screening tests during his visits. This time, the patient asks if he should consider commercial genetic testing for adult disease risk. You tell him that according to current guidelines, genetic testing is only recommended for which of the following scenarios?
    • A. 

      Lynch syndrome in the setting of newly diagnosed colorectal cancer

    • B. 

      Cardiovascular disease in those with a positive family history

    • C. 

      Diabetes in those with a positive family history

    • D. 

      Hemochromatosis in the general population

    • E. 

      Venous thromboembolism in those with family members positive for the Factor V Leiden mutation

    • F. 

      Family members of those with early onset dementia

  • 169. 
    A 60 year old female has two parents who died with dementia. Her father started showing signs of dementia at age 65 and tested positive for the APO E4 gene. Her mother, who recently died at the age of 89, began showing early signs of dementia three years before she died. The patient is very concerned for her risk of Alzheimer's and asks you if she should get genetic testing. What is the most appropriate recommendation to this patient?
    • A. 

      Genetic screening for dementia has low clinical utility and may not accurately predict risk.

    • B. 

      Since early onset dementia is autosomal dominant, there is no point in performing genetic screening.

    • C. 

      There are no reliable genetic variants to test for Alzheimer's disease.

    • D. 

      Since both parents had dementia, there is no point in genetic testing because her personal risk is so high already.

  • 170. 
    A 40 year old female presents to your office for a routine physical. She has no medical concerns today. Her vital signs are within normal limits as is her physical exam. She tells you she wants to undergo genetic testing for breast cancer because she received a brochure in the mail and it seems "like a good idea." She has no family history of breast cancer. Which of the following would be the most appropriate recommendation to this patient regarding breast cancer genetic screening?
    • A. 

      The risks of breast cancer screening in a patient without family history outweigh the benefits of screening.

    • B. 

      BRCA testing does not have enough analytic validity to accurately identify gene variants.

    • C. 

      Genetic testing helps avoid more unnecessary biopsies than traditional screening methods like mammogram.

    • D. 

      Genetic testing for breast cancer is not without risk. The patient is likely to get a false positive result.

    • E. 

      Genetic screening can identify high risk in patients without family history of malignancy.

  • 171. 
    A 30 year old male with a past medical history significant for anxiety presents to your office for a chief complaint of "anxiety." He says his brother was recently diagnosed with hemochromatosis. The patient says he did a google search and found out its possible he has it too and is scared that he's going to develop liver disease. He asks you if he can get tested for the disease as well. Which of the following gene mutations causes hemochromatosis?
    • A. 

      HFE

    • B. 

      Apo E4

    • C. 

      Cyp2C9

    • D. 

      MSH1

    • E. 

      F5

    • F. 

      9P21