You are counseling a 45-year-old obese male regarding weight loss. The patient has elevated triglycerides, low HDL-cholesterol, and stage 1 hypertension. He does not currently take medications and would like to avoid taking medications in the future. The patient has heard good things about low-carbohydrate diets and asks your opinion.


A low-carbohydrate diet in a patient such as this is most likely to result in?

• Increased LDL-cholesterol

• Increased triglycerides

• Increased blood pressure

• Development of metabolic syndrome

• Better short-term weight loss than with a low-fat diet

A 24-year-od nulligravida comes to your office for contraception counseling. She has a seizure disorder that is well controlled on carbamazepine (Tegretol). She is a nonsmoker and has no other medical problems or complaints. She is currently in a relationship and does not want to get pregnant in the next several years.

Which one of the following contraceptive options would be the most appropriate?

• Progestin-only pills

• Combined oral contraceptives

• The etonogestrel/ethinyl estradiol vaginal ring (NuvaRing)

• The norelgestromin/ethinyl estradiol contraceptive patch (Ortho Evra)

• A levonorgestrel intrauterine device (Mirena)

A 78-year-old male is on dual antiplatelet therapy (aspirin and clopidogrel) as a result of a stroke 6 months ago. He recently underwent coronary angiography, and his cardiologist has scheduled coronary artery bypass surgery for a week from today.

Which one of the following is recommended with regard to his antiplatelet therapy?

• Stopping only aspirin 5 days before surgery

• Stopping only clopidogrel 5 days before surgery

• Stopping both aspirin and clopidogrel 5 days before surgery

• Continuing both aspirin and clopidogrel

Misleadingly low serum sodium can be caused by?

• Hyperglycemia

• Diuretic use

• Heart Failure

• Renal Disease

The parents of a 5-year-old male ask you about treating him for attention-deficit/hyperactivity disorder (ADHD) because of his hyperactivity at home and preschool. According to the newest guidelines, the most appropriate next step is to?

• prescribe a very low dose of stimulant medication

• explain to the parents that drug therapy for ADHD is not appropriate at this age

• perform a dietary history focusing on the child’s sugar intake

• explore the nature of his hyperactivity and whether there are coexisting behavioral problems

A 17-year-old female presents to your office with anterior knee pain. She tells you she recently started a running program. She says the pain is worse running down hills, and is vaguely localized just medial to the patella. Examination of the knee shows no effusion or instability, and there is no joint-line pain or patellar tenderness. McMurray’s maneuver is negative. Plain radiographs of the knee appear normal.

Which one of the following would be most appropriate at this point?

• MRI of the knee

• Modification of her running program and a quadriceps and hip strengthening program

• Static stretching of the quadriceps and hamstrings prior to running

• A corticosteroid injection in the area of the pes anserine bursa

A 50-year-old female reports a 1-month history of pain in her wrists. She does not recall any injury. On examination both wrists are warm but not red, feel boggy on palpation, and lack 30° of both flexion and extension. No other joints are affected. She feels fatigued and unwell, but attributes this to her busy schedule. Radiographs of the wrists are normal. Laboratory findings are unremarkable except for a mildly elevated erythrocyte sedimentation rate and a negative rheumatoid factor.

Which one of the following is the most likely diagnosis?

• Rheumatoid arthritis

• Osteoarthritis

• Inapparent injury

• Fibromyalgia

• Lyme disease

During a well child examination, you notice that a 2-month-old male has a flattened left occiput. His records show that his skull was normally shaped at birth. Further evaluation shows that the left frontal region is more prominent than the right, and the left ear is slightly forward of its expected position. The infant seems comfortable rotating his head to either side while being held in his mother’s arms.

Which one of the following would be appropriate at this time?

• Recommend that the infant sleep in a prone position, and follow up in 1 month

• Educate the parents about positioning and follow up in 2 months

• Order physical therapy

• Order CT of the head E

• Refer for surgical evaluation

Which one of the following is the most common cause of sudden cardiac death in young athletes?

• Coronary artery abnormalities

• Myocarditis

• Hypertrophic cardiomyopathy

• Brugada syndrome

• Idiopathic left ventricular hypertrophy

During a routine office visit, a 65-year-old female asks if she should be screened for carotid artery stenosis. The patient has a history of controlled hypertension and hypercholesterolemia, and a family history of stroke. Physical examination of the carotid artery is normal and the patient is asymptomatic.
Which one of the following is consistent with U.S. Preventive Services Task Force and American Heart Association recommendations regarding carotid artery ultrasonography for this patient?

• She does not need screening ultrasonography at this time

• She should have one-time screening ultrasonography now

• She should have routine screening ultrasonography now and every 5 years

• She should have routine screening ultrasonography now and every 10 years