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1. A 55 year old Caucasian male comes to your clinic for a routine follow up visit. His past medical history is significant for HTN, DM Type II, and back pain for which he occasionally uses NSAIDs for pain relief. His medications include hydrochlorothiazide, metformin, and ASA. The patient recently had routine blood work done which was significant only for a BUN 28, Cr 1.6, glucose 102.  The patient states that he has no new complaints; he tries his best to eat right and is compliant with his medications. He states that he occasionally exercises on the treadmill every now and then for 30 min/day. He also says that his glucose readings at home range from 90 – 120 mg/dL and his blood pressure readings at home average around 120/80. The patient is in a good mood and is asking what is your advice regarding his health.  Which of the following statements would be most appropriate to state to the patient?

A.“You can take several NSAIDs a day as needed; I understand that your back pain is bothering you.”
B. “You’re doing great, let’s stay the course, and I will see you in another 6 months for a follow up visit.”
C. “I think it is time I referred you for your biennially diabetic ophthalmological and podiatry visits.”
D. “I think I need to review your medications.”
E. “Beginning at 55 in men with no risks factors for colon cancer a colonoscopy is recommended.”

2. A 84 y/o female is in the ICU in the state of Maryland due to presenting to the hospital 3 weeks prior to complaints of altered mental status. Her condition is complicated due to metastatic small cell lung carcinoma, COPD, DM, and HTN. She is currently intubated but is now showing signs and symptoms of sepsis her prognosis seems poor. She was being followed by a pulmonologist and cardiologist both individuals has recently written in the patient’s chart  that the patient will likely expire due to her current condition and continued maximal medical treatment is not going to benefit.  Prior to being intubated the patient did express that she would like you to  ‘give her something’ if her symptoms became worse to make her last few days relatively comfortable rather than suffering to her end. According to 
the current generally accepted guidelines you should:

A. Prescribe a medication that will lead to the patient’s demise
B. Prescribe a medication, but wait 24 hrs and reassess the patient and then possibly administer drug
C. The patient’s own words override any previous legal document, so you must administer the drug
D. The patient does not seem to want to suffer, withhold medications and treatment, palliative care.
E. Continue to offer supportive treatment

3. 3. A 55 y/o male presents to clinic presents to his primary care physician complaining of recent onsent generalized muscle pain with chronic onset. His medications include Lisinopril, Atorvastatin, ASA, and occasional Viagra. The patient states that he heard from one of his friends that supplementation with a certain vitamin, mineral, or substance can alleviate the symptoms. Which of the following substances could he be talking about?

A. Calcium 
B. CoQ-10 
C. Omega 3 Fatty Acids 
D. Selenium 
E. Zinc

4. A 42 y/o female whose mother suffers from DM Type II and has a BMI of 28 undergoes a screening test to diagnose diabetes, which of the following tests was most likely performed: 

A. Overnight fasting glucose 
B. HbA1c Measurement 
C. Random Glucose 
D. Urine Dipstick for Glucose 
E. Oral Glucose Tolerance Test

5. A 27 y/o male who is sexually active with several partners asks to be tested for HIV, since he admits to a history of recent risky sexual behavior. The patient concedes that he will most likely test positive, he wants to know more about HIV/AIDS. You start having a conversation about what HIV and AIDS is, related health conditions, and possible outcomes. During this conversation which of the following statements is most accurate: 

A. “If the tests come back and it is positive, unfortunately, I am sorry to say you will have AIDS” 
B. “Research trials indicate that a vaccine will be available soon due to the stable nature of gp120” 
C. “To diagnose the condition, an ELISA test will be done and if that is positive a confirmatory Western Blot test will be done. The former is specific while the later is sensitive” 
D. “If the test is positive then I will have to report it to the CDC, HIV is a reportable disease and the government keeps track of who has it to prevent or monitor any possible epidemic.”
E. “You or an immediate family member are eligible under certain conditions for a leave from work to deal with the condition.”

6. Which of the following interventions is the most effective method to reduce blood pressure?

A. Stop Smoking
B. Weight Loss
C. Reduce Alcohol Consumption
D. Dietary Sodium Restriction
E. Physical Activity

7. For which of the following conditions is there not an established screening method? 

A . Lung Cancer 
B. Colorectal Cancer 
C. Congenital Hypothyroidism 
E. Breast Cancer

8.  A patient who has a recently diagnosed DVT in her left lower extremity is now on Warfarin therapy for anticoagulation purposes. In an outpatient setting she goes to a Warfarin clinic to monitor her anticoagulation.  Her INR is 3.2 and she is told that is a therapeutic value. Which of the following medical conditions can account for this?

A. Congestive Heart Failure
B. Chronic GI Bleed
C. Bioprosthetic Valve
D. Hyperlipidemia
E. Mechanical Prosthetic Valve

Image Source: N Engl J Med 356;9 937.

How would you describe the preceding image? What is the most appropriate description of the three EKG tracings from left to right?
A. Sinus Tachycardia, Atrial Fibrillation, Sick Sinus Syndrome
B. Atrial Tachycardia, Atrial Flutter, Prolonged QT
C. Sinus Arrythmia, Multi Focal Atrial Tachycardia, Sinus Bradycardia
D. Wolf-Parkinson-White, Atrial Tachycardia, Mobitz II
E. Sinus Rhythm, Atrial Fibrillation, Prolonged QT

10. A 34 year old female presents to your clinic today inquiring about birth control pills, OCP (Oral Contraceptive Pill). Her blood pressure today was 159/89, recent HbA1c of 7.5, focal migraine symptoms, she occasionally drinks beer, and a family history of breast cancer in her mother and grandmother. Which of her medical conditions is the strongest indicator that an OCP is contraindicated?

A. Hypertension
B. Migraines
C. Alcohol Use
D. Diabetes
E. Family History of Breast Cancer