Prenatal Care
Respiratory
Screening
Labs
Immunizations
100
A 25-year-old gravida 1 para 0 sees you for a routine prenatal visit. This is a planned pregnancy and you calculate her to be at approximately 14 weeks gestation based on the dates of her last menstrual period. She is healthy without any medical problems, takes no medication, and does not use tobacco products. She is adopted and does not know her family history. She feels well today and has no specific concerns. Her vital signs are stable, her weight is normal, and fetal heart tones are auscultated with a Doppler stethoscope at approximately 140 beats/min. Which one of the following should be completed today? A) A 1-hour glucose tolerance test B) A group B Streptococcus screen C) A TSH level D) A urinalysis and urine culture E) Evaluation for bacterial vaginosis
What is D - UA and Ucx - all patients between 11-16 weeks to screen for asymptomatic bacteriuria a) 50 g glucose test between 24-28 weeks b) GBS at 35-37 weeks c)TSH level - only if family hx or risk factors for thyroid dx
100
A 20-year-old male with a history of exercise-induced bronchoconstriction presents to your office with a complaint of cough and decreasing performance when he runs. He is training for a marathon and is currently running 30 miles/week, but has noted that his times have been worsening and that he is using his albuterol inhaler (Proventil, Ventolin) as needed for symptom relief 5 days a week. Which one of the following is the best regimen for treatment of this condition? A) Inhaled albuterol before he runs B) A daily low-dose inhaled corticosteroid C) A daily inhaled long-acting 62-agonist D) A daily low-dose oral corticosteroid E) Immunotherapy
What is B - Daily low dose inhaled corticosteroid
100
A 48-year-old male sees you for a routine health maintenance examination. His blood pressure is 142/90 mm Hg and you recommend that he return for a repeat blood pressure measurement. Eight weeks later his blood pressure is 138/88 mm Hg. He denies any symptoms on a review of systems. He tells you that on his 40th birthday he abruptly stopped smoking after smoking a pack of cigarettes a day since his early twenties. He is adopted and cannot provide a family history. According to U.S. Preventive Services Task Force guidelines, which one of the following conditions should this patient be screened for now? A) Abdominal aortic aneurysm B) Peripheral arterial disease C) Colon cancer D) Type 2 diabetes mellitus E) Hemochromatosis
What is D - DM screening
100
Patients being treated with amiodarone (Cordarone) should be monitored periodically with serum levels of A) cortisol B) creatine phosphokinase C) creatinine D) LDH E) TSH
What is E - TSH
100
Which one of the following immunizations is indicated for all pregnant women at any stage of pregnancy? A) MMR B) Varicella C) Influenza D) HPV
What is C - influenza No pregnancy for 28 days after receiving MMR or Varicella
200
A 24-year-old gravida 2 para 1 at 9 weeks gestation sees you for a routine prenatal check. She complains of significant nausea, and recommended dietary modifications have not helped. She drives a school bus so she would like to avoid sedating medications. She appears well-hydrated and her examination is otherwise normal. Which one of the following would be best for relieving this patient’s nausea? A) Auricular acupressure B) A scopolamine patch (Transderm Scop) C) Vitamin B6 (pyridoxine) D) Methylprednisolone (Medrol)
What is C - B6, can add doxylamine B) - 1st trimester risk of trunk and limb deformities D) - Before 10 weeks gestation, risk of cleft palate
200
Which one of the following is associated with treatment of COPD with inhaled corticosteroids? A) An increased risk of monilial vaginitis B) An increased risk of bruising C) Consistent improvement in FEV1 D) A decreased risk of pneumonia E) Decreased mortality
What is B - increased risk of bruising as well as candidiasis, pneumonia
200
According to the U.S. Preventive Services Task Force, which one of the following is the most appropriate initial recommendation for weight-loss management in this patient? A) A high-protein diet B) A low-carbohydrate diet C) Behavioral counseling D) Bariatric surgery
What is C - behavioral counseling
200
American Urological Association guidelines define asymptomatic microscopic hematuria as which one of the following in the absence of an obvious benign cause? A) >1 RBCs/hpf B) >3 RBCs/hpf C) >10 RBCs/hpf D) A positive dipstick reading for blood
What is B >3 RBCs
200
Which one of the following is true regarding the live attenuated intranasal influenza vaccine? A) It is preferred in all children >6 months of age B) It is more effective in children age 2–6 years than the inactivated vaccine C) It is more effective in children >6 years of age than in younger children D) It is the vaccine of choice for pregnant women E) It is less effective in adults age 18–49 than the inactivated vaccine
What is: B, Recommended for ages 2-49 Contraindicated for Asthma/COPD, pregnancy and >49
300
A 28-year-old gravida 1 para 0 at 39 weeks gestation presents for routine outpatient obstetric care and is found to have a blood pressure of 145/95 mm Hg. A complete review of systems is notable only for chronic low back pain causing poor sleep. The physical examination is normal, including a nontender, gravid uterus and a fetal heart rate of 150 beats/min. The cervical examination reveals firm consistency, 1 cm dilation, 50% effacement, and –3 station. The patient’s blood pressure is checked 5 hours later and is 142/94 mm Hg. Which one following should be the next step in management? A)Admit the patient for induction of labor B)Measure 24-hour urine protein, with induction of labor if the level exceeds 300 mg C)Begin oral nifedipine (Procardia) and recheck her blood pressure in 24–48 hours D)Place the patient on strict bed rest and check her blood pressure twice weekly E)Begin twice-weekly office visits with assessment for preeclampsia
What is A - Induction of labor is indicated after 37 weeks in gestational hypertension
300
A 63-year-old female with corticosteroid-dependent COPD has developed pneumonia. Which one of the following pathogens should the antibiotic regimen cover in this patient that would be unlikely in someone with pneumonia and otherwise healthy lungs? A) Streptococcus pneumoniae B) Mycoplasma pneumoniae C) Haemophilus influenzae D) Staphylococcus aureus E) Pseudomonas aeruginosa
What is E - Pseudomonas Aeruginosa
300
A 50-year-old male sees you for a health maintenance visit. He has not been to a physician for 5 years because he feels very healthy and believed he was up-to-date on all preventive screenings. You review his medical record and notice he has never had an HIV screening test. On further questioning you confirm that he is at very low risk for contracting HIV. Based on recommendations from the U.S. Preventive Services Task Force, you tell him that you routinely conduct opt-out HIV screening for A) all patients age 5 to 75 B) all patients age 15 to 65 C) all patients younger than 50, and patients 50 or older who are at high risk D) only patients at high risk for HIV, regardless of age
What is B - All patient age 15-65
300
A 42-year-old male has symptoms of hypogonadism. Which one of the following should be ordered first? A) Early morning total serum testosterone B) Early morning total and free serum testosterone C) Early morning total and late afternoon total serum testosterone D) Early morning and late afternoon free serum testosterone E) Early morning and late afternoon total and free serum testosterone
What is A - Early morning total testosterone
300
You are the medical director of a long-term-care facility that has 60 residents. Several patients experience fever, cough, and upper respiratory symptoms. Two of these patients test positive for influenza A (H1N1) virus. Which one of the following is recommended by the Centers for Disease Control and Prevention (CDC) for this situation? A) Chemoprophylaxis with appropriate medications for all residents B) Treatment initiated on an individual basis once testing confirms that a resident has influenza C) Prophylaxis only for staff who have had direct patient contact with a resident with laboratory-confirmed infection D) No chemoprophylaxis for staff or residents who have been appropriately vaccinated
What is A - chemoprophylaxis for all
400
A 31-year-old gravida 1 para 0 presents for a routine visit at 32 weeks gestation. She has gestational diabetes mellitus (GDM) and has been following the dietary guidelines from her dietitian. However, her blood glucose is still elevated and you discuss starting medications for management of her GDM. She is adamant about not starting insulin but is willing to consider taking metformin (Glucophage). Before making a decision she would like to know the specific benefits to her and her baby. You would tell her that one benefit of treatment of GDM is a decreased risk for A) maternal type 2 diabetes mellitus after delivery B) maternal preeclampsia C) perinatal death D) a small-for-gestational-age infant
What is B - preeclampsia as well as operative delivery, large-for-gestational-age infants, shoulder dystocia
400
A 45-year-old male presents with shortness of breath and a cough. On pulmonary function testing his FVC is <80% of predicted, his FEV1/FVC is 90% of predicted, and there is no improvement with bronchodilator use. The diffusing capacity of the lung for carbon monoxide (DLCO) is also low. Based on these results, which one of the following is most likely to be the cause of this patient’s problem? A) Asthma B) Bronchiectasis C) COPD D) Cystic fibrosis E) Idiopathic pulmonary fibrosis
What is E - Idiopathic pulmonary fibrosis - Restrictive pattern Restrictive - FEV1/FVC Increased Obstructive - FEV1/FVC Decreased DLCO - increased in asthma, polycythemia
400
An asymptomatic 60-year-old male sees you for a health maintenance visit. His past medical history is significant for hypertension and hyperlipidemia. His medications include chlorthalidone, 25 mg daily, and atorvastatin (Lipitor), 20 mg daily. He smoked 2 packs of cigarettes a day for 20 years but quit 5 years ago. The physical examination is normal. Laboratory findings include a normal basic metabolic panel, a cholesterol level of 210 mg/dL, an HDL-cholesterol level of 34 mg/dL, an LDL-cholesterol level of 150 mg/dL, and a triglyceride level of 200 mg/dL. Which one of the following screening tests is recommended by the U.S. Preventive Services Task Force for this patient? A) Prostate-specific antigen (PSA) B) A bone density test C) Abdominal ultrasonography D) Low-dose chest CT E) Carotid ultrasonography
What is : D Between 55- 80 - with 30 pack hx, current smokers or quit within 15 years
400
In a patient with sepsis, which one of the following would confirm a diagnosis of septic shock? A) A 1.0 mg/dL increase in the creatinine level B) A platelet count of 20,000/mm3 (N 150,000–350,000) C) A WBC count of 25,000/mm3 (N 4300–10,800) D) A serum bilirubin level of 7.0 mg/dL (N <1.0) E) A serum lactate level of 2.0 mmol/L (N 0.5–1.0)
What is E - Lactate > 2
400
A healthy 68-year-old male is seen in December for a routine examination. A review of his immunizations indicates that he received a standard dose of inactivated influenza vaccine at the health clinic in September. He received 23-valent pneumococcal vaccine (Pneumovax 23) at age 65. He should now receive which one of the following? A) High-dose influenza vaccine B) 13-valent pneumococcal conjugate vaccine (Prevnar 13) C) 23-valent pneumococcal vaccine D) No vaccines at this time
What is B - Prevnar 13
500
A 34-year-old G2P0101 at 11 weeks gestation comes to your office to establish care for her pregnancy. In reviewing her history you find that her first pregnancy was complicated by preeclampsia and she required induction of labor at 33 weeks. She also has chronic hypertension treated with chlorthalidone. Her blood pressure today is 128/78 mm Hg. Which one of the following medications, if started today, will lower her risk of preeclampsia in this pregnancy? A) Aspirin B) Calcium C) Labetalol D) Nifedipine (Procardia) E) Vitamin E
What is A - Aspirin For high risk patients - hx of pre-eclampsia >= 2 pregnancies, or pre-eclampsia resulting in delivery <34 weeks NNT = 50
500
A 67-year-old male presents with a persistent, intermittent cough. He says that his exercise tolerance has decreased, noting that he becomes short of breath more easily while playing tennis. He smoked briefly while in college but has not smoked for over 45 years, and reports no history of known pulmonary disease. You obtain pulmonary function testing in the office to help you diagnose and manage his respiratory symptoms. His FVC and FEV1/FVC are both less than the lower limit of normal as defined by the Third National Health and Nutrition Examination Survey. Repeat testing following administration of a bronchodilator does not correct these values. Which one of the following would be most appropriate at this time? A) A methacholine challenge test B) A mannitol inhalation challenge test C) Exercise pulmonary function testing D) Testing for diffusing capacity of the lung for carbon monoxide (DLCO)
What is D - DLCO testing
500
A 69-year-old male sees you for a routine evaluation. He has been in good health and takes no medication other than tamsulosin (Flomax) for symptoms of benign prostatic hyperplasia. He has never smoked. His blood pressure is 121/78 mm Hg, pulse rate 72 beats/min, and respiratory rate 18/min. His general physical examination is unremarkable, including cardiac and abdominal examinations. A digital rectal examination reveals mild enlargement of the prostate, without nodules. According to the U.S. Preventive Services Task Force, this patient should be screened for A) elder abuse B) aortic aneurysm C) multifactorial fall risk D) dementia E) hepatitis C
What is E - For patients born between 1945 and 1965 - one time Hep C screening
500
A 23-year-old healthy male is sexually active with other men and does not use condoms. He is interested in reducing his risk of contracting HIV by using a daily oral antiretroviral medication. Which one of the following laboratory tests should be done no more than 7 days before initially prescribing pre-exposure prophylaxis with emtricitabine/tenofovir disoproxil (Truvada)? A) A CD4 cell count B) Antibody testing for HIV C) Hemoglobin concentration D) A platelet count E) An ALT level
What is B - antibody testing for HIV
500
Which one of the following is an indication for a second dose of pneumococcal polysaccharide vaccine in children? A) A cerebrospinal fluid leak B) Cyanotic congenital heart disease C) Type 1 diabetes mellitus D) Sickle cell disease E) Chronic bronchopulmonary dysplasia
What is D - Sickle cell disease
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