Board Review 4/2022

Board Review 4/2022

(hopefully not bored review)​

By Heather Autry

Multiple Choice

A 69-year-old male sees you for a routine examination and asks about lung cancer screening. He smoked one pack of cigarettes per day for about 35 years but quit 11 years ago. According to the U.S. Preventive Services Task Force and the American College of Chest Physicians, which one of the following should you recommend?

• A) No screening

• B) An annual history and examination focusing on lung symptoms

• C) Annual chest radiography

• D) Annual low-dose chest CT

Multiple Choice

Which one of the following is the most likely diagnosis?

• A) Calcaneal apophysitis (Sever's disease)

• B) Calcaneal stress fracture

• C) Peroneal tendinopathy

• D) Plantar fasciitis

• E) Tarsal tunnel syndrome

Multiple Choice

A 30-year-old female with type 2 diabetes and obesity sees you for follow-up. She has

experienced several episodes of symptomatic hypoglycemia, and because of this she stopped all

of her medications except metformin (Glucophage). Her hemoglobin A1c has increased to 8.4%.

Which one of the following would be the best additional treatment for this patient?

• A) Basal insulin (Lantus)

• B) Rapid-acting insulin (Humalog)

• C) Exenatide (Byetta)

• D) Glipizide (Glucotrol)

• E) Repaglinide

• Safety

• Tolerability

• Effectiveness

• ​Price

• Simplicity​

Multiple Choice

Polypharmacy increases the risk of adverse health outcomes. According to the Choosing Wisely campaign, adding to a threshold of how many medications in a patient’s regimen should prompt a thorough review to determine if any of the medications can be discontinued?

• A) 3

• B) 5

• C) 7

• D) 10

Multiple Choice

An 18-month-old female is brought to your office for a well child check. During the examination

you note that she is unable to say any words. She can follow a one-step command and point to

three body parts. She does wave goodbye and babble, and she appears to have normal

comprehension, emotional relationships, and fine and gross motor movements.

Which one of the following is the most likely diagnosis based on this patient’s speech

development?

• A) Autism spectrum disorder

• B) Cerebral palsy

• C) Congenital hearing loss

• D) Developmental speech and language delay

• E) Receptive language disorder

Multiple Choice

Which one of the following is the best evidence-based approach to counseling her about oral probiotics?

• A) There is no evidence that they will improve her IBS

• B) There is no evidence that they will decrease the risk of Clostridioides (Clostridium)

  difficile diarrhea when she is treated for a UTI

• C) There is strong evidence that they will decrease the risk of antibiotic-associated diarrhea

  when she is treated for a UTI

• D) There is strong evidence that they will decrease the risk of UTI recurrence

• E) There is strong evidence that they will decrease the risk of bacterial vaginosis recurrence

  16

Multiple Choice

Which one of the following would be the most appropriate next step in management?

• A) No further interventions

• B) Discontinuing amlodipine

• C) Reinforcing safe driving practices with education on age-related changes that may affect

  safe driving

• D) Recommending that he stop driving and surrender his license

Multiple Choice

A 70-year-old female with a history of coronary artery disease, a femorofemoral bypass 3 years

ago, and hypertension sees you for a follow-up visit. She has intermittent right arm pain that is

worse with exercise. The pain increases with all arm exercises and improves with rest. The

patient’s blood pressure is 140/70 mm Hg in the left arm and 120/64 mm Hg in the right arm.

Which one of the following would be the most appropriate next step?

• A) Radiographs of the right shoulder

• B) Arterial duplex ultrasonography of the upper extremities

• C) MR angiography

• D) No imaging, and referral to physical therapy

Multiple Choice

Which one of the following would be the most appropriate next step?

• A) Reassurance only

• B) A nasal swab for respiratory syncytial virus

• C) A chest radiograph

• D) Nebulized albuterol

• E) Oral amoxicillin

Multiple Choice

A 19-year-old female presents with a 4-year history of intermittent facial acne. She tells you that

her acne has never completely resolved, and it worsens during her menstrual period. She has

tried various over-the-counter facial cleansers although she does not recall what they contained.

On examination she has scattered open and closed comedones, and pustules on her forehead and around her mouth.

Which one of the following treatments would you recommend?

• A) Topical adapalene (Differin)

• B) Topical clindamycin (Cleocin T)

• C) Oral doxycycline

• D) Oral isotretinoin (Absorica)

Multiple Choice

Which one of the following would be the most appropriate next step in the care of this patient?

• A) A cognitive assessment

• B) Immediate referral to adult protective services

• C) Immediate referral to a neurologist

• D) Immediate referral to a psychiatrist

Multiple Choice

An otherwise healthy 21-year-old male sees you for follow-up after a hospitalization for

pneumonia. This was his second pneumonia infection of the year. He reports a history of

multiple sinus infections and upper respiratory infections over the years that were treated with

antibiotics on an outpatient basis. Laboratory studies reveal a normal CBC and a decreased IgA

level. A trial of pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23) reveals no

measurable response.

This presentation is most consistent with

• A) selective IgA deficiency

• B) common variable immuno-deficiency

• C) severe combined immunodeficiency

• D) DiGeorge syndrome

• E) Wiskott-Aldrich syndrome

Multiple Choice

Which one of the following vitamins is a well established therapy for the treatment of nausea and vomiting in pregnancy?

• A) Vitamin A

• B) Vitamin B6

• C) Vitamin B12

• D) Vitamin C

• E) Vitamin E

Multiple Choice

A 62-year-old female sees you for a routine health maintenance visit and asks for your advice

regarding vitamin D supplementation. She is healthy and active, and jogs 1–2 hours three times

weekly.

Which one of the following would be the most appropriate advice regarding vitamin D

supplementation in this patient?

• A) It is not recommended because she is asymptomatic

• B) It will reduce the risk of certain cancers

• C) It will reduce the risk of depression

• D) It will reduce the risk of diabetes mellitus

• E) It will reduce the risk of fractures

Multiple Choice

A 35-year-old male with type 1 diabetes asks you what his hemoglobin A1c goal should be. His

blood pressure and lipids are well controlled and he has not had any episodes of hypoglycemia.

He recently saw an ophthalmologist and a podiatrist.

You advise him that based on current American Diabetes Association recommendations his goal

should be to keep his hemoglobin A1c below a threshold value of

• A) 6.0%

• B) 7.0%

• C) 8.0%

• D) 9.0%

Multiple Choice

You diagnose major depressive disorder in a 69-year-old male. He has benign prostatic hyperplasia and is treated with prazosin (Minipress) for nocturia but he is otherwise healthy. He agrees to cognitive-behavioral therapy and starting an antidepressant but is concerned about side effects, especially falls.

Which one of the following would be the safest medication for this patient?

• A) Amitriptyline

• B) Duloxetine (Cymbalta)

• C) Escitalopram (Lexapro)

• D) Paroxetine (Paxil)

• E) Phenelzine (Nardil)

Multiple Choice

A 27-year-old soccer player presents with anterior hip pain along with a clicking sensation in the

hip when he runs or attempts lateral movements. The flexion, adduction, and internal rotation

(FADIR) test and the flexion, abduction, and external rotation (FABER) test both elicit pain.

You suspect a labral tear.

The most accurate imaging test for the suspected diagnosis is

• A) a standing radiograph of the hip

• B) anteroposterior and frog-leg lateral radiographs of the hip

• C) CT of the hip

• D) a bone scan

• E) MR arthrography

Multiple Choice

A 74-year-old male with type 2 diabetes, severe peripheral artery disease, and a history of

tobacco use is admitted to the hospital with wet gangrene of his right foot that does not improve

with appropriate wound care and antibiotics. His vascular surgeon recommends a below-the-knee amputation of the right leg but the patient has not given his consent.

Which one of the following would suggest that this patient lacks capacity to make this decision?

• A) He has a fear of having surgery

• B) He wants to consult with his family first

• C) He consistently believes that his foot will improve

• D) He understands that he may die if he forgoes the amputation

• E) He states that his brother had the same surgery and died a week later

Multiple Choice

The most common symptom of obstructive sleep apnea is

• A) cough

• B) excessive sleepiness

• C) leg swelling

• D) palpitations

• E) weight gain