Cards
Which one of the following NSAIDs is safest for patients with a previous history of myocardial infarction? (check one)
A. Ibuprofen
B.Celecoxib (Celebrex)
C. Diclofenac (Zorvolex)
D. Meloxicam (Mobic)
E.Naproxen (Naprosyn)
What is...
E. Naproxen
You see a 58-year-old female whom you suspect has COPD and you recommend formal testing in order to confirm this diagnosis. The cutoff most often used for COPD diagnosis on a spirometry test performed while the patient is stable (not experiencing an acute exacerbation of symptoms) is a postbronchodilator FEV1/FVC ratio (check one)
A. <50% of predicted
B. <70% of predicted
C. <85% of predicted
D. >70% of predicted
E. >85% of predicted
Stretching has NO demonstrable benefit for which one of the following?
A. Hamstring strain
B. Chronic neck pain
C. Joint contracture
D. Osteoarthritis
E. Rehabilitation post knee replacement
What is...
C. Joint Contracture
Which one of the following has been shown to be LEAST effective in the treatment of irritable bowel syndrome? (check one)
A. Fiber
B. Probiotics
C. Antispasmodics
D. Antidepressants
What is...
A. Fiber
Which one of the following is associated with the use of stimulant medications for attention-deficit disorder in adults? (check one)
A. Lower success rates compared to nonstimulant medications
B. Weight gain
C. A low risk of medication abuse
D. Serious adverse cardiovascular events
E. Increases in blood pressure
what is...
E. increase in BP
A 70-year-old male with a past medical history significant for long-standing diabetes mellitus and hypertension presents with a stroke. CT of the head shows mild atrophy, with no acute bleeding.
In the first 24 hours after his stroke, starting treatment to control his blood pressure is recommended if it reaches what threshold level? (check one)
A. 150/90 mm Hg
B. 160/100 mm Hg
C. 180/100 mm Hg
D. 200/110 mm Hg
E. 220/120 mm Hg
What is...
E. 220/120 mm Hg
A 46-year-old male comes to your office to discuss smoking cessation. You have advised him to quit smoking at past visits, and after several months of contemplation he is now ready to address this problem. He has smoked 1 pack of cigarettes per day for the past 25 years. He is highly motivated and wants to use the most effective regimen.
In addition to behavioral counseling, which one of the following interventions is associated with the most successful outcome? (check one)
A. “Cold turkey” nicotine withdrawal
B. Electronic nicotine delivery systems
C. Hypnotherapy
D. Clonidine (Catapres)
E. Varenicline (Chantix)
What is...
B. Varenicline (Chantix)
A 34-year-old male presents with a 2-week history of right plantar heel pain that began after he started training for a marathon. The pain is most severe immediately upon standing in the morning and then gradually improves somewhat after ambulation. It worsens again if he stands after sitting for a period of time or after excessive walking or running.
Which one of the following is supported by evidence as a first-line intervention to provide pain relief for this condition? (check one)
A. Night splints
B. Plantar fascia stretching exercises
C. Acupuncture
D. Extracorporeal shock wave therapy
E. Platelet-rich plasma injection
What is...
B. PF stretching exercises
A 34-year-old female consults you because of excessive body and facial hair. She has a normal body weight, no other signs of virilization, and regular menses. She had a bilateral tubal ligation 4 years ago.
Which one of the following would be the most appropriate treatment for her mild hirsutism? (check one)
A. Leuprolide
B. Metformin (Glucophage)
C. Prednisone
D. Spironolactone (Aldactone)
What is ...
D. Spironolactone
The preferred site for an emergency airway is (check one)
A. the thyrohyoid membrane
B. the cricothyroid membrane
C. immediately below the cricoid cartilage
D. through the first and second tracheal rings
E. at the level of the thyroid isthmus
what is...
B. Cricothyroid membrane
An otherwise healthy 55-year-old female is diagnosed with hypertension, based on multiple measurements of systolic blood pressures ranging from 142 to 148 mm Hg and diastolic blood pressures in the range of 90–96 mm Hg over the past 4 months. You are now discussing medication options. The patient exercises regularly and conscientiously adheres to a very healthy diet, and has a BMI of 20 kg/m2. She is concerned with the potential long-term adverse side effects of medication in general, and asks if any agents have potential advantages.
Which one of the following medications has been shown to reduce bone loss and may reduce her risk of future hip fractures?
A. Amlodipine (Norvasc)
B. Hydrochlorothiazide
C. Lisinopril (Prinivil, Zestril)
D. Losartan (Cozaar)
E. Metoprolol (Lopressor, Toprol-XL)
what is...
B. HCTZ
A 2-year-old female is brought in by her father for evaluation of a cough. Her cough started 10 days ago along with a runny nose and a low-grade fever. The runny nose and fever are no longer present but a dry-sounding cough persists.
On examination the patient appears well and has a normal heart rate and respiratory rate. You note no retractions and lung sounds are also normal.
Which one of the following would be an appropriate management option? (check one)
A. Buckwheat honey
B. Albuterol (Proventil, Ventolin)
C. Azithromycin (Zithromax)
D. Dextromethorphan
E. Diphenhydramine (Benadryl
what is...
A. buckwheat honey
A 73-year-old female with diabetic neuropathy and osteoarthritis of the knees sees you to request a prescription for an assistive mobility device. The neuropathy has caused poor balance and the knee pain has made walking more painful. As a result her physical endurance has declined over the last several months.
Which one of the following assistive devices would be most appropriate for this patient? (check one)
A. A cane
B. Crutches
C. A walker
D. A wheelchair
C. a walker
A 44-year-old female presents with a 2-week history of postprandial right upper abdominal pain. Since yesterday her pain has worsened in intensity and she has been vomiting. The patient does not use tobacco or drink alcohol, and takes no medications. Laboratory findings include a serum lipase level of 105 IU/L (N 14–51), a serum amylase level of 155 U/L (N 36–128), a serum total bilirubin level of 1.5 mg/dL (N 0.0–1.0) and an alkaline phosphatase level of 200 IU/L (N 33–96).
The recommended initial imaging in this situation is (check one)
A. no routine imaging unless the clinical course becomes complicated
B. transabdominal ultrasonography
C. contrast-enhanced CT
D. magnetic resonance cholangiopancreatography (MRCP)
E. MRI
What is...
B. Transabdominal US
A 45-year-old male presents to your office accompanied by his sister. He tells you that 6 months ago he was laid off from a job where he had been employed for more than 20 years. He says that he declined a promotion 2 years ago because he was worried about working with a new team. He has been unable to secure a new job, stating that the interview process has been embarrassing and that he feels unfairly judged when his resume is critiqued. He reports feeling inadequate and says that he is more comfortable staying at home alone. His sister adds that he has been shy since he was a teenager, and now seems unwilling to change despite his dire financial situation. Depression and anxiety screenings are negative. He does not use alcohol or other substances.
Which one of the following personality disorders is most consistent with this patient’s presentation? (check one)
A. Antisocial
B. Avoidant
C. Borderline
D. Dependent
E. Histrionic
What is...
B. Avoidant
A healthy 55-year-old white male with a family history of coronary artery disease sees you for a routine health maintenance visit. He asks you what he could do to decrease his risk of cardiovascular disease. He is a nonsmoker, does not drink alcohol, and has no history of substance abuse. His BMI is normal and the physical examination is otherwise unremarkable. His vital signs include a heart rate of 80 beats/min, a blood pressure of 119/70 mm Hg, a respiratory rate of 15/min, and a temperature of 37.0°C (98.6°F).
Laboratory Findings
Fasting glucose 92 mg/dL
Total cholesterol 190 mg/dL
LDL-cholesterol 98 mg/dL
HDL-cholesterol 50 mg/dL
Triglycerides 145 mg/dL
His calculated 10-year risk for cardiovascular disease is 5.4%. Which one of the following has the best evidence to prevent cardiovascular disease in a patient such as this? (check one)
A. Moderate-intensity exercise, 150 minutes weekly
B. A low-dose statin
C. Aspirin, 81 mg daily
D. Fish oil supplements
E. Niacin supplements
WHAT IS...
A. Moderate-intensity exercise, 150 minutes weekly
A mother brings her 6-year-old son to your office for evaluation because she found a lump in his neck below the jaw on the right side. She first noted it a week ago, about a week after he had recovered from an upper respiratory infection. She reports that her son feels well and is back to full, unrestricted activity.
When you examine the child you find an enlarged lymph node in the right anterior cervical chain of nodes. It measures 2 cm in diameter and is somewhat firm, mobile, and nontender. The remainder of the examination is normal.
Which one of the following would be most appropriate at this point? (check one)
A. Ultrasound evaluation of the lymph node
B. A fine-needle biopsy of the node
C. An excisional biopsy of the node
D. A 10-day course of antibiotics
E. Follow-up examination in 1 month
what is...
E. f/u in 1 month
A 30-year-old male presents to the emergency department after spraining his ankle while playing basketball. He has pain over the lateral malleolus.
Radiographs of the ankle would be indicated if he has which one of the following? (check one)
A. An inversion injury
B. Swelling over the lateral malleolus
C. Ecchymosis over the lateral malleolus
D. The inability to bear weight to walk since the injury
E. A previous history of ankle injury
D. The inability to bear weight to walk since the injury
A 17-year-old male with a history of type 2 diabetes sees you because of fatigue and a 15-lb weight loss in the past month. The patient reports excessive and frequent urination, thirst, and nausea. His only medication has been metformin, but he states that he stopped taking it 6 months ago. His current weight in your office is 93 kg (205 lb), which confirms the reported weight loss. His blood pressure is 130/78 mm Hg, his pulse rate is 90 beats/min, and his temperature is 37.0°C (98.6°F). A physical examination is otherwise unremarkable. A capillary blood glucose level is 348 mg/dL, a hemoglobin A1c is 11.5%, serum ketones are negative, and a urinalysis shows 3+ glucosuria with concentrated urine but is otherwise normal.
Which one of the following would be the most appropriate treatment? (check one)
A. Resuming oral metformin
B. Starting oral empagliflozin (Jardiance)
C. Starting subcutaneous insulin
D. Starting subcutaneous liraglutide (Victoza)
E. Hospitalization for continuous intravenous insulin
What is...
C. starting SC insulin
A 23-year-old female complains of lower abdominal and pelvic pain, increased vaginal discharge, and postcoital bleeding. Her pain worsens during intercourse, and is accompanied by occasional nausea and vomiting and a feverish feeling. She is sexually active with several male partners.
A physical examination is remarkable for an oral temperature of 38.6°C (101.5°F), cervical motion tenderness, adnexal tenderness without a mass, and a prominent cervical discharge. Office laboratory results include an elevated erythrocyte sedimentation rate and an elevated WBC count. Saline microscopy of vaginal secretions shows abundant numbers of WBCs but is negative for Trichomonas vaginalis and bacterial vaginosis. You order nucleic-acid amplification tests for Chlamydia trachomatis and Neisseria gonorrhoeae.
Which one of the following would be most appropriate at this point? (check one)
A. Treatment based on clinical findings
B. Treatment when results of testing for Chlamydia trachomatis and Neisseria gonorrhoeae are available
C. Transvaginal ultrasonography
D. Pelvic CT
E. Laparoscopy
A. treatment based on clinical findings
A 65-year-old male comes to your office to establish care after hospitalization for an acute myocardial infarction. While reviewing his hospital record you see that he has normal renal function and had an echocardiogram showing a left ventricular ejection fraction of 40%. His current medications include metoprolol succinate (Toprol-XL), lisinopril (Prinivil, Zestril), atorvastatin (Lipitor), and aspirin. In your office today his blood pressure is 132/84 mm Hg and he is still feeling somewhat weak. He has 1+ pitting edema in his legs and mild dyspnea with exertion.
Which one of the following, when added to his current regimen, has evidence to support its use in preventing all-cause mortality? (check one)
A. Chlorthalidone
B. Spironolactone (Aldactone)
C. Ezetimibe (Zetia)
D. Losartan (Cozaar)
E. Fish oil
B. spironolatone
A 28-year-old previously healthy male nonsmoker has a 3-day history of fever and a productive cough. He presents to the urgent care clinic for evaluation after developing pain in the right lower chest when breathing deeply. He has not sought medical care for over 5 years and has never been immunized for influenza.
On examination you note a temperature of 38.6°C (101.4°F), a blood pressure of 136/74 mm Hg, a pulse rate of 90 beats/min, an oxygen saturation of 93% on room air, and a respiratory rate of 20/min. The patient appears uncomfortable but is not in significant distress. The presence of crackles over the right lower anterior chest prompts an order for chest radiography, which reveals an air bronchogram and a patchy alveolar infiltrate involving the medial middle lobe.
Which one of the following treatment options would be most appropriate at this time? (check one)
A. Outpatient treatment with oral azithromycin (Zithromax)
B. Outpatient treatment with oral ciprofloxacin (Cipro)
C. Outpatient treatment with oseltamivir (Tamiflu)
D. Inpatient treatment with intravenous ceftriaxone (Rocephin) and oral azithromycin
E. Inpatient treatment with intravenous ceftriaxone and ciprofloxacin
what is...
A. Outpatient treatment with oral azithromycin (Zithromax)
A 44-year-old African-American female reports diffuse aching, especially in her upper legs and shoulders. The aching has increased, and she now has trouble going up and down stairs because of weakness. She has no visual symptoms, and a neurologic examination is normal except for proximal muscle weakness. Laboratory tests reveal elevated levels of serum creatine kinase and aldolase. Her symptoms improve significantly when she is treated with corticosteroids.
Which one of the following is the most likely diagnosis? (check one)
A. Duchenne’s muscular dystrophy
B. Myasthenia gravis
C. Amyotrophic lateral sclerosis
D. Aseptic necrosis of the femoral head
E. Polymyositis
What is...
E. polymyositis
A 30-year-old otherwise healthy female has concerns about her menses and fertility. Her last menstrual period was 8 months ago when she stopped taking oral contraceptive pills (OCPs). In her teens and early twenties she had irregular, sporadic periods. Four years ago she developed menometrorrhagia and resultant iron deficiency anemia; this was corrected with the use of OCPs. She is now interested in becoming pregnant. Her physical examination, including a gynecologic examination, is normal. A urine pregnancy test is negative and her TSH level is in the normal range.
Which one of the following is the most appropriate next step? (check one)
A. A CBC and metabolic panel
B. Serum LH and FSH levels
C. Karyotype analysis
D. Pelvic ultrasonography
B. serum LH and FSH
A 74-year-old female presents to the emergency department in respiratory distress with a slightly altered mental status. Her urine drug screen is positive for opioids. The patient and her family deny opioid use. You know this patient well and also doubt she is taking opioids. She has been taking dextromethorphan, guaifenesin, azithromycin (Zithromax), and pseudoephedrine.
Which one of these could be causing a false-positive test for opioids on her urine drug screen? (check one)
A. Dextromethorphan
B. Guaifenesin
C. Azithromycin
D. Pseudoephedrine
A. Dextromethorphan