Final Exam: Quizzes

Question 1

A 14 y/o is seen with c/o severe testicular pain. The clinician suspects testicular torsion. Which of the following is appropriate action?
a. Order a CT scan
b. Prescribe ice and ibuprofen for pain
c. Emergent referral to a urologist
d. Instruct the patient to elevate his scrotum

Answer 1

c. Emergent referral to a urologist

Question 2

Which of the following medication regimens is most appropriate for your patient with HTN and BPH?
a. Metoprolol 25mg PO BID
b. Finasteride 0.4mg PO BID
c. Lisinopril 10mg PO daily
d. Terazosin 2mg PO HS

Answer 2

d. Terazosin 2mg PO HS

Question 3

Which of the following is true regarding syphilis?
a. CXR is recommend for all persons with syphilis to screen for aortic dilation
b. RPR turns positive approximately 4 weeks (1 months) after chancre formation appears
c. The preferred diagnostic test is microhemagglutination assay T Pallidum
d. Screening is recommended for all pregnant women at their first prenatal appointment

Answer 3

d. Screening is recommended for all pregnant women at their first prenatal appointment

Question 4

You are evaluating your patient with symptoms of vaginitis. Your evaluation is guided by you knowledge that the most common cause include:
a. bacteria, trichomonas, candida
b. Mpox, bacteria, candida
c. trichomonas, bacteria, Mpox
d. candida, trichomonas, Mpox

Answer 4

a. bacteria, trichomonas, candida

Question 5

Your 32 y/o M patient presents with acute onset of fever, chills, and right groin pain. He also experiences lower back pain with sitting. He is generally healthy and does not have chronic medical problems. He does not take any medications. On exam his T is 101.8F, abdominal exam is normal, MS exam is normal, prostate is enlarged, boggy, and tender. What is your top differential diagnosis?
a. Prostate CA
b. Chronic prostatitis
b. Acute bacterial prostatitis
d. BPH

Answer 5

b. Acute bacterial prostatitis

Question 6

You have diagnosed your patient with genital warts. Which of the following treatments will you recommend?
a. HPV vaccine
b. Cryotherapy with liquid nitrous oxide
c. Podofilox oral tablets
d. Imiquimod topical cream

Answer 6

d. Imiquimod topical cream

Question 7

Mr. T presents with symptoms suggestive of chronic non-bacterial prostatitis. Which of the following therapeutic regimens will you recommend for him?
a. Metoprolol 25 mg PO BID x21 days
b. Ciprofloxacin 500 mg PO BID x14 days
c. Erythromycin 250 mg PO QID x 14 days
d. Ampicillin and gentamycin IV

Answer 7

b. Ciprofloxacin 500 mg PO BID x14 days

Question 8

According to the CBC and USPSTF, which of the following patients will you screen for chlamydia in the primary setting?
a. Sexually active female, 22 y/o who has a male partner
b. Transgender female, 33 y/o who has a female partner
c. Sexually active heterosexual male aged 25
d. Pregnant female, 32 y/o who has sex with a monogamous male partner

Answer 8

a. Sexually active female, 22 y/o who has a male partner

Question 9

Your patient has symptoms suggestive of gonorrhea. They are houseless and follow up is uncertain. What will you include in your treatment plan?
a. Doxycycline 100mg PO BID x12 days
b. Benzathine PNC G 7.2 million units IM now
c. Ceftriaxone 500mg IM now
d. Azithromycin 1g PO now

Answer 9

c. Ceftriaxone 500mg IM now

Question 10

You are evaluating a 68 y/o M for ED and low libido. You have completed a comprehensive H and P exam. The inital lab evaluation you order would include:
a. cholesterol panel, glucose, PSA, TSH, bioavailable testosterone
b. free testosterone, cholesterol panel, TSH, PSA, CBC, LH
c. hemoglobin A1C, cholesterol panel, total and free testosterone, PSA, CBC, LH
d. exercise treadmill testing, cholesterol panel, random glucose, LH, TSH, CBC

Answer 10

c. hemoglobin A1C, cholesterol panel, total and free testosterone, PSA, CBC, LH

Question 11

Many women experience mild decreases in memory and cognition at midlife. Which of the following related statements is true?
a. Vitamin B6 deficiencies are common cause of midlife memory and cognitive changes.
b. Every midlife woman must be evaluated for dementia using the MMSE
c. Memory and cognitive changes are much higher among women at midlife compared with men
d. Sleep disturbances frequency causes midlife memory and cognition changes among women.

Answer 11

d. Sleep disturbances frequency causes midlife memory and cognition changes among women

Question 12

You are assessing Martinique’s concerns about her decrease in libido. She is a 53 y/o married women with LMP 14 months ago. She is healthy with well managed HTN. As you talk with her you remain aware that:
a. relationship issues are the single most important component of sexual health for midlife women
b. testosterone level decreases affect sexual and libido changes for most midlife women
c. genitourinary syndrome of menopause symptoms affect libido for most midlife women
d. most women experience an increase in libido at midlife related to multitude of factors.

Answer 12

a. relationship issues are the single most important component of sexual health for midlife women

Question 13

Myia is a 54 y/o F. Her LMP was 14 months ago. She presents today with c/o vaginal dryness and painful intercourse. She has some hot flashes that do not really bother her. She is a healthy woman, has had no surgeries, and has a FH of osteoporosis in her mother and father. Her most recent DXA results were hip T-score of -0.7. In addition to a local lubricant for sexual activity, which of the following therapy options is most appropriate for Myia?
a. Systemic estrogn-progestogen therapy
b. SSRI
c. Systemic estrogen therapy
d. Local vaginal estrogen therapy

Answer 13

d. Local vaginal estrogen therapy

Question 14

Bio-identical compounded hormones my be the best option for a woman with bothersome moderate to severe hot flashes who…
a. Has a history of breast CA
b. Wants to follow hormones levels in her saliva to evaluate efficacy
c. Needs a dose not available from pharmaceutical produced hormones
d. Prefers to take hormones that are identical to those made by her own body.

Answer 14

c. Needs a dose not available from pharmaceutical produced hormones

Question 15

Your postmenopausal patient is experiencing a wide array of related symptoms. When explaining how the symptoms are related to postmenopause, you will educate her about:
a. Increases in her endogenously produced estrogen and progesterone hormones
b. Shifts in her FSH that reduces likelihood of ovulation
c. Locations of estrogen and progesterone receptors throughout her body, which relate to symptoms
d. Effects of inhibins on the hypothalamic-pituitary-ovarian axis

Answer 15

c. Locations of estrogen and progesterone receptors throughout her body, which relate to symptoms

Question 16

Sharon is a postmenopausal woman who presents with hot flashes and night sweats. She is generally healthy with a history of HTN and hLD, well managed by taking lisinopril and atorvastatin, respectively. She has no other ongoing medical problems and takes no other regular medications. She has never had surgery. She takes Calcium, Vitamin D, and a multivitamin daily. In addition to lifestyle changes, which of the following medication regimens is the most appropriate EBP option for Sharon?
a. Venlafaxine 37.5 mg PO daily
b. Estradiol/norethindrone acetate transdermal (Combipatch) 0.05/0.14 mg/d patch 2x weekly
c. Gabapentin 100 mg, 2 tablets PO HS
d. Conjugated estrogen 0.3mg PO daily with medroxyprogesterone 10mg for 10 days every 3-4 months

Answer 16

b. Estradiol/norethindrone acetate transdermal (Combipatch) 0.05/0.14 mg/d patch 2x weekly

Question 17

You are evaluating Deirdre, a 52 y/o F, who has concerns about sleep problems, hot flashes, and memory “blips” occurring when she cannot recall the correct word or must refer to her calendar more often to keep track of meetings. Which of the following DDx is most important to consider in addition to menopause-related symptoms?
a. Diabetes
b. Depression
c. New onset breast CA
d. Eating disorder

Answer 17

b. Depression

Question 18

Theresa is a 54 y/o Black F whose LMP was 3 year ago when she had a hysterectomy due to uterine fibroids with excessive bleeding. She is c/o increased hot flashes recently and wants to discuss medication to control them. She has a history of poorly controlled diabetes and HTN. Her family includes MI in her father, breast CA in her mother and sister, and thyroid dysfunction in her brother. In addition to a local lubricant for sexual activity, which of the following management plans is most appropriate for Theresa?
a. SSRI
b. Systemic oral black cohosh
c. Systemic oral estrogen-progestogen therapy
c. Local vaginal estrogen therapy

Answer 18

a. SSRI

Question 19

Cassandra is a 53 y/o F who presents with complaint of severe hot flashes. She had her LMP 13 months ago and her hot flashes have been progressively. She estimates that she is having 8-10 per day and 6-7 per night. She often has drenching sweats with the hot flashes. Her PMH includes well controlled HTN, overweight (BMI 26.2), and low bone mass (T-socre -2.0). She has had no surgeries. She takes lisinopril 10 mg PO daily and a calcium with Vit D supplement. She does aerobic exercise for 30 minutes most days of the week and recently started yoga. She is trying to watch what she eats to lose some weight. She does not smoke. She drinks alcohol socially, usually 2-3 drinks per week. Her BP and PE are normal. Considering her symptoms and history, and that she is open to trying what you recommend, which of the following would be the most effective EBP management plan for Cassandra?
a. Advise her to avoid triggers, dress in layers, and begin taking red clover isoflavone extract 50 mg PO daily
b. Advise her to avoid triggers, use fans in the bedroom with light sheets, and prescribe a combined estrogen-progestin patch for continuous use
c. Advise her to increase aerobic exercise to 60 minutes daily, increase water consumption, and prescribe gabapentin 100 mg, 2 tablets PO HS
d. Advise her to dress in layers with breathable fabrics, avoid high sugar content foods, and prescribe venlafaxine 37.5 mg PO daily

Answer 19

b. Advise her to avoid triggers, use fans in the bedroom with light sheets, and prescribe a combined estrogen-progestin patch for continuous use

Question 20

When considering herbal dietary supplements for managing menopause-related symptoms, which of the following is true?
a. The US Pharmacopeia mark means they have been tested and contain the ingredients on the label
b. Manufacturing standards are very similar to pharmaceutical produced medications
c. Doses of herbal dietary supplements are the same from brand to brand
d. Rheum rhaponticum (ERr-731) has a strong estrogen-receptor alpha effect and thus reduces anxiety

Answer 20

a. The US Pharmacopeia mark means they have been tested and contain the ingredients on the label

Question 21

In a patient with Hepatitis B infection, the HBeAg:
a. suggests increased risk for HCC
b. indicates a favorable host immune response to hepatitis B virus
c. suggests co-infection with HCV
d. appears after HBsAg in early infection

Answer 21

d. appears after HBsAg in early infection

Question 22

Your 20 y/o patient was recently diagnoses with acute Hepatitis B. He is sexually active, monogamous, and reports using a condom about 60% of the times. Which of the following is recommended for his male sexual partner who has the following lab results: negative HBsAg, negative anti-HBs, negative anti-HCV, positive anti-HAV?
a. HBV vaccine
b. HBIG
c. No vaccine is required at present
d. Both HBV vaccine and HBIG

Answer 22

a. HBV vaccine

Question 23

Mr. P is a 52 y/o M who has chronic Hepatitis C. His RF for HCV included having male sex partners and IVDU. His only medication is methadone 130 mg per day. Mr. P has not used alcohol or drugs for 2 years now. He smokes 1/2 pack of cigarettes a day. Mr. P is worried about his hepatitis. He has a friend who just started treatment, and he wants to know if you think he should start treatment too. He has heard that HCV treatmtent is painful and causes depression. You order blood work at this visit. Here are some of the results:
-HCV DNA 3,000,000
-HCV Genotype 3
-ALT 100
-AST 80
-Platelets 100,000
-Hgb: 13.0
-WBC: 3
Given the above results, how would you counsel Mr. P on hepatitis C treatment?
a. I am glad that you are considering treatment. Your lab results indicated that you have chronic hepatitis C; however your genotype and viral load do not match with current treatments. I recommend that you wait and start therapy in 6-12 months.
b. I would not recommend Hepatitis C treatment now. It has a lot of side effects. New medications are being developed that have better side-effect profiles and will be available soon.
c. You will likely clear the HCV on your own. I recommend that you give it some time.
d. I am glad you are considering treatment. Your lab results indicate that you have chronic hepatitis C infection, and your liver function is affected. I recommend that you start hepatitis C treatment now.

Answer 23

d. I am glad you are considering treatment. Your lab results indicate that you have chronic hepatitis C infection, and your liver function is affected. I recommend that you start hepatitis C treatment now.

Question 24

Jane is a 38 y/o sex worker who was recently screened for Hepatitis B. Her HBsAg was positive. Follow up labs show positive total anti-HBc, negative IgM, and negative anti-HBs. What is her diagnosis?
a. False positive for Hepatitis B
b. Acute hepatitis B
c. Chronic hepatitis B
d. Recovered/immune to Hepatitis B

Answer 24

c. Chronic hepatitis B

Question 25

Henry has chronic hepatitis B. He is seeing a specialist who has recommended he start Hepatitis B therapy. He comes to discuss the options with you as his primary care clinician. You suggest:
a. Peginterferon alfa-2a as it is the current recommended first line therapy
b. Ribavirin because it is less likely to cause flu-like symptoms, throbocytopenia, and depression of psychosis
c. That he discuss it with his specialist as that is the clinician who will order the therapy
d. Tenofovir as the 3rd generation nucleoide analogues are well tolerated and have low resistance.

Answer 25

d. Tenofovir as the 3rd generation nucleoide analogues are well tolerated and have low resistance.

Question 26

Your 52 y/o M patient presents with elevated ALT and AST. His physical exam is noncontributory and family history is benign. You identify no specific risk factors or behaviors. You order an acute hepatitis panel, which is negative. What laboratory test(s) will you order next?
a. Iron levels, HBV DNA, Alpha-1 antitrypsin
b. Alpha-1 antitrypsin, ceruloplasmin, iron levels
c. Ceruloplasmin, iron levels, FibroTest-ActiTest Panel
d. Alpha-1 antitrypsin, ceruloplasmin, HCV RNA

Answer 26

b. Alpha-1 antitrypsin, ceruloplasmin, iron levels

Question 27

Your 19 y/o patient has elevated ALT of 158 and AST of 182. He has low alcohol intake, does not smoke, uses no recreational drugs, and has one lifetime male partner. He has not been vaccinated for any hepatitis viruses. You ascertain no other risk factors. What will you screen him for?
a. Hepatitis B and C
b. Hepatitis D and E
c. Hepatitis C and D
d. Hepatitis A and B

Answer 27

a. Hepatitis B and C

Question 28

Your patient with persistent elevated ALT and AST tested positive for Wilson Disease. You referred him and are co-managing his care with a hepatologist. Your focus as his primary care provider is to:
a. Prescribe chelating agents, prescribe a low iron diet
b. Evaluate him for autoimmune diesases
c. Prescribe a low copper diet, advise on avoiding liver toxic agents
d. Treat for unhealthy alcohol use, prescribe cholesterol lowering medications

Answer 28

c. Prescribe a low copper diet, advise on avoiding liver toxic agents

Question 29

Pam is a 48 y/o who presents with elevated ALT, high fever, acute nausea and vomiting, signs of dehydration, and history of recent travel to East Africa. What will you do next?
a. Don PPE and take Pam’s temperature again
b. Test Pam fro influenza virus
c. Refer Pam for evaluation in the ED
d. Notify the CDC of a positive Ebola exposure

Answer 29

c. Refer Pam for evaluation in the ED

Question 30

Your patient with Hepatitis C has persistently elevated ALF and HCV RNA 2,400,000 genotype 1a. They are considering starting treatment. Which of the following will you evaluate prior to recommending a medication?
a. Liver CT scan
b. FibroTest-ActiTest Panel or liver biopsy
c. Serum rheumatoid factor
d. Lab testing for Hepatitis D

Answer 30

b. FibroTest-ActiTest Panel or liver biopsy

Question 31

In CKD, which of the following include common causes of nephrotic glomerular disease?
a. Diabetes, HTN, HIV
b. prior streptococcal infection, HTN, atherosclerosis
c. CHF, diabetes, cirrhosis
d. ureter obstruction, lupus, autosomal dominant polycystic kidney disease

Answer 31

a. Diabetes, HTN, HIV

Question 32

When partnering with your patient to develop a management plan for his CKD, you consider modifiable risk factors related to CKD progression. Based on this you will recommend
a. Avoiding use of contrast dye studies, limited use of PPIs
b. monitoring renal function tests, adequate hydration
c. diet and exercise to maintain a normal weight, smoking cessation
d. genetic testing, diet low in K+ and protein

Answer 32

c. diet and exercise to maintain a normal weight, smoking cessation

Question 33

You are evaluating your 70 y/o M patient with CKD. You complete a work-up and note that he has bilaterally small sized kidneys and minimal proteinuria. Based on these lab results, what is your top differential of the cause of his CKD?
a. Prior calculi
b. Prior pyelonephritis
c. Diabetes
d. HTN

Answer 33

d. HTN

Question 34

Primary care management of CKD includes:
a. tight management of BP and educating patients on diet low in sodium
b. tight management of diabetes and educating patients on diet high in healthy protein
c. tight management of HLD and educating patients on diet low in K+
d. weight management and diet high in phosphorus

Answer 34

a. tight management of BP and educating patients on diet low in sodium

Question 35

You suspect your 67 y/o patient has CKD. Which of the follow signs or symptoms do you expect to find with early disease?
a. normal UA, elevated urine albumin:creatine ratio (ACR)
b. fatigue, BUN:Cr ratio >20:1
c. low urine albumin:creatine ratio (ACR), decreased BUN
d. No subjective symptoms, low eGFR

Answer 35

d. No subjective symptoms, low eGFR

Question 36

You receive an abnormal result for the eGFR rate on your 73 y/o patient. You suspect CKD and repeat the test. The result is confirmed and sustained over enough time to confirm your suspicion. Which of the following will you order next to assist you with narrowing your DDx for the cause of the CKD?
a. urine protein:creatinine ratio (PCR), rheumatoid panel
b. renal US, UA with microscopy
c. BUN, serum Cr
d. low-dose CT, hepatitis panel

Answer 36

b. renal US, UA with microscopy

Question 37

You suspect your 70 y/o patient has CKD. Which of the following will confirm your diagnosis?
a. Proteinuria (urine protein:creatinine ratio [PCR] 1.8) for >/= 3 months
b. eGFR of 60mL/min for >/= 3 months
c. Asymmetrical kidney size identified on renal US
d. Albuminuria (urine albumin:creatinine ratio [ACR] <30) for >/= 3 months

Answer 37

b. eGFR of 60mL/min for >/= 3 months

Question 38

You have lab results back on 4 patients to review this morning. Which of the following raises concern for AKI?
a. increase in creatinine of 0.5 mg/dL in 48 hours
b. ACR of 20
c. normal BUN:Cr ratio
d. increase in Cr of 0.8x over baseline over a 2 week timeframe

Answer 38

a. increase in creatinine of 0.5 mg/dL in 48 hours

Question 39

You suspect your patient has early AKI. Which of the following findings is most likely?
a. Fatigue
b. reduced urine output
c. increased urine output
d. asymmetrical kidney size on US

Answer 39

b. reduced urine output

Question 40

Which of the following includes likely causes of AKI?
a. IV contrast, acetaminophen, amphotericin B
b. NSAIDS, erythromycin, PPIs
c. urethral obstruction, NSAIDs, IV contrast dye
d. Beta-lactam antibiotics, levothyroxine, PNC

Answer 40

c. urethral obstruction, NSAIDs, IV contrast dye