Random qs

Question 1

Thrombus formation in the venous side of the circulatory system is most
commonly attributable to
A. vessel endothelium injury.
B. increased blood flow.
C. decreased blood flow.
D. disseminated intravascular coagulation.

Answer 1

Virchow’s triad
C. Thrombus formation is due to three factors known as Virchow’s triad: injury
or abnormality of the endothelial wall of the vessel, decreased blood flow, and
changes in the normal process of coagulation. On the venous side, blood
pressure is lower (as compared to arterial blood) and most thrombi are formed
because of decreased blood flow.

Question 2

Which of the following occurs in a patient experiencing hypovolemic shock?
A. Cardiac output is decreased, and systemic vascular resistance is increased.
B. Cardiac output is normal, and systemic vascular resistance is decreased.
C. Cardiac output is increased, and systemic vascular resistance is increased.
D. Cardiac output is decreased, and systemic vascular resistance is
decreased.

Answer 2

A. Hypovolemic shock is due to an inadequate volume of circulating blood,
thereby causing a decrease in venous return, which decreases cardiac output.
As compensation for the reduced cardiac output, vasoconstriction occurs, thus
increasing systemic vascular resistance.

COD~~~SVRi
Hypovolemic shock~CO decreased and SVR increased

Question 3

What is a developmental defect resulting from an abnormality in the cellular
organization or arrangement called?
A. Disruption
B. Malformation
C. Dysplasia
D. Deformation

Answer 3

C. Dysplasias are defects resulting from an abnormality in the cellular
organization or arrangement.
CODA
Cellular Organization~Dysplasia A

Question 4

Neoplasms are the result of alterations or mutations in the DNA sequence by
carcinogens, which disrupt normal cell regulation. Tumor suppressor genes
are an example of a regulatory gene found in the body. Which of the following
alterations in the tumor suppressor gene may cause the development of a
neoplasm?
A. Mutation of both alleles of the tumor suppressor gene, causing
overexpression of the protein product
B. Mutation of one allele of the tumor suppressor gene, causing
overexpression of the protein product
C. Mutation of one allele of the tumor suppressor gene, causing inactivation of
the protein product
D. Mutation of both alleles of the tumor suppressor gene, causing inactivation
of the protein product

Answer 4

D. Tumor suppressor genes are recessive, so both alleles must be mutated for
neoplastic growth to occur.

mutation of both tumor suppressor gene alleles=inactivation of protein product

Question 5

Which of the following substances released by endothelial cells is a potent
vasodilator?
A. Endothelin
B. Vasopressin
C. Dopamine
D. Nitric oxide

Answer 5

D. Nitric oxide is a potent vasodilator released by the endothelial cells in
response to changes in blood pressure.

Question 6

Which of the following substances released by endothelial cells is a potent
vasoconstrictor?
A. Nitric oxide
B. Endothelin
C. Renin
D. Aldosterone

Answer 6

B. Overstimulation of the production of endothelin may cause hypertension.

Question 7

Which patient will benefit most from atorvastatin 80 mg daily?
A. An 88-year-old man without diabetes with an ASCVD 10-year risk of 15%
and history of myopathies
B. A 55-year-old woman with diabetes and LDL-C 125 mg/dL and a 10-year
risk of 9.5%
C. A 65-year-old man without diabetes with a 10-year risk of 7.5% and LDL-C
69 mg/dL
D. A 32-year-old woman with no pertinent medical history and ASCVD score of
6% and LDL-C 90 mg/dL

Answer 7

B. A 55-year-old woman with diabetes and LDL-C 125 mg/dL and a 10-year
risk score of 9.5% meets criteria for benefiting from high-intensity statin
therapy.

Question 8

How often should colorectal cancer screening by colonoscopy occur in men
and women older than 50 years if deemed to have an average risk?
A. Every 2 years
B. Every 5 years
C. Every 10 years
D. Every 20 years

Answer 8

C. A colonoscopy should occur every 10 years for colorectal cancer screening
in patients who have been determined to have an average risk.
Average Risk Colonoscopy 10 yrs

Question 9

Goal fasting blood glucose levels for a diabetic patient should be between
A. 80 and 130 mg/dL.
B. 100 and 150 mg/dL.
C. 90 and 200 mg/dL.
D. 60 and 90 mg/dL.

Answer 9

A. The recommended goal fasting blood glucose levels for a patient with
diabetes should be between 80 and 130 mg/dL without symptoms of
hypoglycemia.
BO13O

Question 10

A patient’s medical history does not include which of the following?
A. Chief complaint and history of patient illness
B. Treatment plan
C. Past medical history of patient and family
D. Social history of patient

Answer 10

B. Medical history should include chief complaint, history of patient illness, past
medical history of the patient and his or her family, and his or her social history.
It will not include the treatment plan; this plan should be in the SOAP notes.

Question 11

In the patient’s physical assessment, inspection includes
A. observing the patient’s general physical and behavior appearance.
B. checking the patient’s blood pressure.
C. writing the SOAP notes.
D. obtaining the patient’s family history.

Answer 11

A. In the patient’s physical assessment, inspection includes observing the
patient’s general physical and behavior appearance before the next step of
examination of vital signs.

Question 12

Which medication class does not potentially cause a false high glucose level?
A. Loop diuretics
B. Corticosteroids
C. ACE inhibitors
D. Isoniazid

Answer 12

C. A false high glucose level is associated with loop diuretics, corticosteroids,
and isoniazid but not with ACE inhibitors.
false DIC glucose

Question 13

What is a normal blood pressure?
A. Less than 140/90 mmHg
B. Less than 130/80 mmHg
C. Less than 120/70 mmHg
D. Less than 120/80 mmHg

Answer 13

D. The recommended normal blood pressure should be less than 120/80
mmHg.

Question 14

Which of the following is the most appropriate initial therapy for a patient with
chronic obstructive pulmonary disease in addition to a prn short-acting inhaled
β2-agonist?
A. Inhaled corticosteroid
B. Theophylline
C. Long-acting inhaled anticholinergic
D. Short-acting inhaled anticholinergic

Answer 14

C. A long-acting anticholinergic (or a LABA) should be started with a prn
SABA. Short-acting anticholinergics have been replaced by long-acting agents.
Theophylline and ICS are reserved for more refractory patients.

Question 15

An adult patient presents to your clinic with community-acquired pneumonia.
She does not require hospital admission and has no drug allergies or
significant comorbidities. Which of the following is the most appropriate
treatment?
A. Amoxicillin
B. Clindamycin
C. Doxycycline
D. Levofloxacin

Answer 15

C. Doxycycline is a first-line agent for treating outpatient CAP in adults without
comorbidities. Azithromycin or clarithromycin would also be acceptable.
Neither amoxicillin nor clindamycin has a broad enough spectrum for empiric
CAP treatment. Levofloxacin is reserved for patients with comorbidities or
other special situations (e.g., relapses, resistant pneumococcus).

Outpatient CAP doxy

Question 16

Which of the following is the most appropriate treatment for a severe case of
Clostridium difficile–associated diarrhea in a hospitalized patient?
A. Oral metronidazole
B. IV metronidazole
C. Oral vancomycin
D. IV vancomycin

Answer 16

C. The therapy of choice for severe CDAD is po vancomycin. IV vancomycin is
not used in CDAD because it does not generate significant vancomycin levels
in the lumen of the GI tract. IV or po metronidazole is used for nonsevere
cases of CDAD.

Question 17

Which of the following toxin antidotes and toxins are correctly matched? (Mark
all that apply.)
A. Atropine and anticholinesterase insecticides
B. Hydroxocobalamin and cyanide
C. Succimer and digoxin
D. Activated charcoal and lead

Answer 17

A, B. Atropine and hydroxocobalamin are correctly matched. Succimer is used
for lead poisoning, and activated charcoal does not significantly adsorb heavy
metals like lead.

Question 18

Which of the following medications are not required to be packaged or
dispensed in a child-resistant container (safety cap)? (Mark all that apply.)
A. Acetaminophen with hydrocodone tablets
B. Nitroglycerin tablets
C. Aspirin tablets
D. Corticosteroid ointment

Answer 18

B, D. Child-resistant containers, also known as safety caps, are required for all
oral prescription drugs with the exception of drugs such as nitroglycerin.
Ointments do not require caps.

Question 19

Which of the following antidotes would be categorized as one that reacts with
a toxic metabolite of a drug?
A. Acetylcysteine
B. Activated charcoal
C. Naloxone
D. Pralidoxime

Answer 19

A. One of the major actions of acetylcysteine is to provide sulfhydryl groups in
the liver to detoxify an intermediary toxic metabolite of acetaminophen, Nacetyl-p-benzoquinoneimine.

Question 20

Which of the following drugs for substance use disorder is an extendedrelease
IM injection or an intradermal implant? (Mark all that apply.)
A. Naltrexone
B. Buprenorphine
C. Methadone
D. Acamprosate

Answer 20

A, B. Naltrexone can be given as an IM injection monthly, and buprenorphine
is available as an implantable pellet that lasts for 6 months. The other drugs
are available in oral forms.

Question 21

Which of the following is a treatment option for exposures to infectious
biological terrorist substances? (Mark all that apply.)
A. Administration of the appropriate antibiotic
B. Hyperbaric oxygen therapy
C. Decontamination of exposed skin with soap and water
D. Hemodialysis

Answer 21

A, C. The appropriate antibiotic, if one is available for the infectious agent, is
the best choice. If the person’s skin has been exposed to the infectious agent,
decontaminating the skin is also important to prevent further absorption and to
protect health care personnel. Methods of decontamination in addition to soap
and water may be needed. The other answer choices are not relevant for this
type of exposure unless other toxins or conditions exist.

Question 22

Which of the following statements correctly defines epidemiology?
A. Epidemiology is the study of how disease is distributed in populations and what factors influence the disease
distribution.
B. Epidemiology is the study of how disease is distributed in sentinel sites and what factors influence the disease
development.
C. Epidemiology is the study of what factors cause a specific disease in populations.
D. Epidemiology is the study of causal relationships between diseases and their risk factors in populations.

Answer 22

A. Epidemiology is the study of how disease is distributed in populations and what factors influence the disease

distribution. Sentinel sites are an important component of active surveillance, but they are only a component of
pharmacoepidemiology. Though risk factors for disease are important, there are three components of disease: the host, the agent, and the environment. Epidemiological studies are not designed to identify causal relationships.

Epidemiology Distribution and factors for distribution

Question 23

Which of the following is not part of the epidemiologic triad?
A. Host
B. Environment
C. Agent
D. Vector

Answer 23

D. The epidemiologic triad consists of the host, the agent, and the environment.

Question 24

Which of the following measures the risk that a certain disease newly develops in a given population within a
specified period?
A. Incidence
B. Prevalence
C. Mortality
D. Morbidity

Answer 24

A. Incidence measures the risk of developing a new disease. Prevalence is a measure of both new and old cases of
disease in a population at risk. Mortality is defined as death; whereas, mortality rate is a special type of incidence.
Morbidity is the negative effects of a disease, but it is not a rate.

Question 25

When do epidemiologists prefer incidence rates to incidence proportions?
A. When the population at risk varies with time
B. When the amount of observation time between people is the same
C. When new cases outnumber existing cases
D. When existing cases outnumber new cases

Answer 25

A. Incidence rate controls for the different periods during which each population member is at risk. The need to
control for the different period at risk exists because the population may lose old members or add new members
during the observation period. Although evaluation of the differences in prevalence and incidence by evaluating new
cases and existing cases is important, that evaluation is not pertinent to the question.

Incidence>proportions when people die/lose old members/varies w/time

Question 26

Which of the following statements is not a reason that mortality rates are often standardized by age?
A. Mortality rates vary by age.
B. Different populations have different age distributions.
C. Epidemiologists are interested in comparing mortality between different populations.
D. Populations are aging.

Answer 26

D. The standardization is needed because different populations have different age distributions, not because they are
aging. Because age is a significant factor in the mortality rate and different populations have different age
distributions, standardization of mortality rates is necessary to allow for the comparison of different populations.

Question 27

Which of the following is a characteristic of an active surveillance system?
A. It includes only sentinel site reporting.
B. It is a meticulously planned process.
C. It includes only disease or exposure registries.
D. Ii is required by the federal government for all medications.

Answer 27

B. Active surveillance systems involve meticulously planned processes. Disease registries, exposure registries, and sentinel sites are all part of active surveillance systems. Active surveillance through the REMS program is only
required by the FDA when the risks of medication use may outweigh the benefits or new safety information is discovered on an existing medication

Question 28

A prevalence study conducted from January 1 to December 31, 2017, on a population of 125,000 identified 500
cases of a disease. The incidence rate of this disease is 2 per 1,000. What percentage of the cases was newly
diagnosed in 2017?
A. 5%
B. 50%
C. 2%
D. Answer cannot be calculated from this data set.

Answer 28

B. Of 125,000 people, there were a total of 500 cases. An incidence rate of 2 per 1,000 means 250 new cases per
125,000 people. Thus, 50% are new cases.

Question 29

A cohort study can be used for which of the following factors? (Mark all that apply.)
A. Smoking
B. Physical activity
C. Obesity
D. Congenital anomalies

Answer 29

A, B, C. Smoking, physical activity, and obesity are all key risk factors for disease. Congenital anomalies are
disease outcomes, not risk factors.

Question 30

Of 100 people who had a disease, 10 had been exposed to a risk factor. Of 100 matched controls, 2 had been
exposed to a risk factor. Which of the following is true?
A. The relative risk is 5.
B. The odds ratio is 5.
C. The relative risk is 0.2.
D. The odds ratio is 0.2.

Answer 30

B. The case control study results in an odds ratio of (10/100)/(2/100) = 5.

Question 31

Which of the following statements are true regarding economic theory? (Mark all that
apply.)
A. The most well-known economic theory is the theory of supply and demand.
B. The supply and demand model provides a visualization of how prices will change
given a change in supply and demand for a given commodity.
C. As demand increases, supply increases to meet this increased demand, resulting
in a larger quantity being sold and at a higher price.
D. A well-known economic theory is Maslow’s Hierarchy of Needs

Answer 31

A, B, C. Maslow’s Hierarchy of Needs theory is a psychological theory, not an
economic theory.

Question 32

Which of the following statements is part of Mankiw’s 10 Principles of Economics?
(Mark all that apply.)
A. People face trade-offs.
B. People respond to incentives.
C. Prices tend to fall when the government prints too much money.
D. Society faces a short-run trade-off between inflation and unemployment.

Answer 32

A, B, D. The opposite tends to be true: prices generally rise when too much money is
in circulation.

Question 33

Which of the following statements are true regarding cost-effectiveness analysis?
(Mark all that apply.)
A. Cost-effectiveness studies are important for decision makers because both the
cost and the benefits are stated in monetary terms.
B. A less expensive medication may not be the best choice if its side effects are
costlier to treat than those of a more expensive medication.
C. A medication with a less expensive purchase price may not be the best choice if it
requires using more of the medication to reach the same level of effectiveness as a
lesser quantity of a more expensive medication.
D. The typical type of pharmacoeconomic analysis used for decision making is the
cost-effectiveness study.

Answer 33

B, C, D. The cost –benefit analysis provides both cost and benefits in monetary
terms, whereas cost-effectiveness is more likely to use a concrete outcome as a
benefit.

Question 34

Which of the following is best described as preference weights that help decision
makers understand value of or desirability for particular health states?
A. Patient-reported outcome
B. Quality-adjusted life-year
C. Utility
D. Time trade-off

Answer 34

C. Utility describes the relative value that an individual perceives to gain from
achieving certain levels of health. Patient-reported outcomes is an overarching term
for results of interventions that are not interpreted by a provider yet still measure the
effect of a therapy. A QALY is how one measures the quality of a year lived based on
a particular treatment’s likely outcomes. Time trade-off is a popular way to determine
health utility.

PWU
Preference weights Utility

QALY-treatment outcome quality of a year living from likely outcome

Health utility=
time trade-off

Question 35

Which of the following best describes why values are commonly discounted as part
of a multiyear cost-effectiveness model?
A. Patients receive lower costs of care by receiving services now rather than in the
future.
B. Improved health is worth more in the future than the present.
C. The discount reflects the expected lower costs of care in the future.
D. Health benefits are preferred in the present versus the future.

Answer 35

D. Generally, people prefer to be healthier today rather than in the future, so
discounting shows the health benefits in today’s dollars. Lower costs for care are not
guaranteed just because treatment was received in the short term rather than the
long term, and expected costs are not likely to be lower in the future.

Discounted=pwede today and discount??? vs future

Question 36

Which of the following best describes why sensitivity analyses are conducted as part
of a pharmacoeconomic model?
A. Sensitivity analyses help double check the work for errors.
B. This type of analysis allows the assessment to be changed from a cost–benefit
study to a cost-effectiveness study.
C. Sensitivity analyses account for assumptions made by varying the values applied
to inputs used throughout the model.
D. This analysis changes the primary perspective from that of the patient to that of
the payer

Answer 36

C. Sensitivity analysis allows for varying the inputs used, which helps account for the
assumptions made across the variables that were used. Sensitivity analysis is not
constructed to uncover errors made in the primary analysis; if errors are made in the
primary analysis, then they will affect every analysis conducted in the model.
Generally, only one type of model is run even though this could be changed if
needed. Similarly, the perspective is set from the onset of the study, and conducting a
sensitivity analysis would not change it.

Question 37

Which of the following best describes the value of collecting patient-reported
outcomes as a measure of health status?
A. Patient-reported outcomes are an exact measure of health status.
B. Patient-reported outcomes provide an interpretation of health status without
provider input.
C. These measures directly calculate QALYs.
D. Quantitative patient-reported outcome values more consistently describe health
status than clinical measures of disease

Answer 37

B. Understanding health status independent of provider interpretation is an important
way to determine how a patient is doing. PROs reflect health status but not in a
precise, quantitative way like other clinical measures. The values derived from PROs
are used to calculate QALYs, but this cannot be done directly without other
considerations. Although these values are useful and provide important measures of
health status, they are not necessarily a more consistent measure of health status
than established, validated clinical measures.

Question 38

Which of the following describes the comparison of costs per QALY gained?
A. Incremental cost-effectiveness ratio
B. Cost–benefit analysis
C. Health utility
D. Sensitivity analysis

Answer 38

A. Constructing an incremental cost-effectiveness ratio allows one to determine the
cost of each QALY when comparing treatment options. A cost –benefit analysis is an
overarching type of model within which one might create an incremental costeffectiveness
ratio. Health utility is a measure used to determine QALYs, and
sensitivity analysis may be used when conducting a cost-effectiveness analysis as a
way to see how varying the inputs leads to different interpretations of results.

COST EFFECTIVENESS QALY

Question 39

Which of the following best describes the concept of crowding out in terms of health
care markets?
A. The physical removal of a firm from operating in a certain market
B. A situation where too much government involvement limits private market
investment in health care
C. Increased interest in certain health care markets resulting in too many firms
competing for a limited number of patients
D. The reduction of disease incidence as a result of high rates of medication use or
vaccination

Answer 39

B. Although government intervention can often be efficient, in some cases too much
involvement can reduce how many private firms get involved with health care.
Crowding out is a concept that describes what happens to the overall market and not
necessarily the physical removal of a firm from that market. Answer C is incorrect
because one would likely see the opposite happen, and Answer D describes an
externality.