28. A 78-year-old female with advanced dementia is brought to your office by her family for a wellness examination. Other than appearing chronically ill and showing significant cognitive impairment, she has an unremarkable examination.

Which one of the following should be offered to this patient?

38. A 46-year-old male comes to your office to discuss smoking cessation. You have advised him to quit smoking at past visits, and after several months of contemplation he is now ready to

address this problem. He has smoked 1 pack of cigarettes per day for the past 25 years. He is

highly motivated and wants to use the most effective regimen. In addition to behavioral counseling, which one of the following interventions is associated with the most successful outcome?

51. Which one of the following community health programs best fits the definition of secondary

prevention?

68. An 11-year-old female is brought to your office for a routine well child examination. The American Academy of Pediatrics recommends screening this patient for which one of the following?

96. A 58-year-old male comes to your office for a routine health maintenance examination. He has smoked 1 pack of cigarettes per day for the last 35 years. The U.S. Preventive Services Task Force recommends which one of the following lung cancer screening strategies for this patient?

135. You see a 12-year-old female for a well child check. She is healthy without any medical problems and neither she nor her father have any concerns today. She is up to date on her

immunizations except for her third dose of HPV vaccine. She received the first dose of the vaccine at her 11-year-old well child check and her second dose 1 month later. However, she was told by a few friends that they only needed to get two doses of HPV vaccine, so she is very excited that she does not need any shots today. According to the CDC, which one of the following is true regarding HPV vaccine for this

patient?

149. A 65-year-old female comes to your office in June for her Welcome to Medicare visit. She has no health concerns but believes she is due for some immunizations. She received Tdap 10 years ago. She has never had MMR and she did not receive influenza vaccine this past winter. According to the CDC adult immunization schedule, which one of the following is indicated for this patient?

233. A 22-year-old white female comes to your office for a routine health maintenance examination. She has a BMI of 27.0 kg/m2 and a blood pressure of 113/78 mm Hg. She has no significant past medical history or family history and the examination is normal.

According to U.S. Preventive Services Task Force guidelines, this patient should be screened for diabetes mellitus beginning at what age?

2. The strategy that will identify the highest percentage of previously unrecognized cases of chronic hepatitis C is to screen which one of the following?

40. The American Academy of Pediatrics recommends administration of an autism-specific

screening tool at which well child visits?

41. A 25-year-old female is concerned about contracting human papillomavirus (HPV) and cervical cancer because she has a new sexual partner who was recently treated for genital warts. She has not received any medical care in over 5 years. She reports a lifetime total of four sexual partners and denies any chronic medical problems, but is a smoker. Her maternal grandmother died of cervical cancer. Her chart indicates that she completed the HPV vaccination series. A physical examination is normal.

Which one of the following is the most appropriate screening test for this patient?

70. A 26-year-old male who is in a monogamous sexual relationship with another male sees you for a routine health maintenance visit. He is employed in a grocery store, is in good health, and reports having the usual immunizations as a child. Based on expert consensus, which one of the following would be most appropriate at this visit?

71. A 65-year-old white female requests bone density screening because her mother had premenopausal osteoporosis. The patient has no previous history of fracture, and her past medical and family histories are otherwise unremarkable. She has not had a hysterectomy and is not taking any medications or supplements. Her dietary calcium intake is low. DXA shows T-scores of –1.8 at the hip and –2.1 at the spine. Her estimated 10-year risk of hip fracture is 1.3%. Serum TSH, calcium, and 25-hydroxyvitamin D levels are normal.

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

93. A 30-year-old male asks about colon cancer screening. He is healthy, but his father was diagnosed with colon cancer at the age of 45. At what age would you recommend that this patient have his first screening colonoscopy?

232. A 70-year-old male comes to your office for a wellness evaluation. He smoked for many years, but quit 10 years ago. While searching through several health-related websites he read that because of his smoking history he should undergo screening for an abdominal aortic aneurysm.

Which one of the following screening tests for abdominal aortic aneurysm is recommended by the U.S. Preventive Services Task Force for this patient?

226. During a routine health maintenance visit a 38-year-old female expresses concern about her risk of breast cancer because her mother and another relative have had breast cancer. She is asymptomatic and your clinical breast examination reveals no masses. For this patient, the U.S. Preventive Services Task Force recommends which one of the following?

108. A 69-year-old female presents with postmenopausal bleeding. You consider whether to begin your evaluation with transvaginal ultrasonography to assess the thickness of her endometrium. In evaluating the usefulness of this test to either support or exclude a diagnosis of endometrial cancer, the most useful statistic is the:

128. In a study to evaluate a test as a screen for the presence of a disease, 235 of the 250 people with the disease had a positive test and 600 of the 680 people without the disease had a negative test.

Based on this data, the specificity of the test for the disease is

128. In a study to evaluate a test as a screen for the presence of a disease, 235 of the 250 people with the disease had a positive test and 600 of the 680 people without the disease had a negative test.

Based on this data, the negative predictive value of the test for the disease is

224. A patient is evaluated and admitted through the emergency department with nausea and vomiting after receiving chemotherapy 1 day earlier. The admission diagnosis is dehydration and acute kidney injury. Over the next 2 days the patient’s condition progressively declines. The diagnosis is changed to sepsis with multiple organ failure about 48 hours after admission. Antibiotics are not started in a timely manner. Upon review, it is felt that the diagnosis of sepsis and initiation of antibiotics could have been considered earlier in the hospital course.

Which one of the following cognitive processes most likely contributed to the diagnostic error?

174. A drug available for over 20 years has been noted to have beneficial effects for a common disease. Because it is a cheap, generically available drug, no pharmaceutical firm is willing to fund a clinical trial. What type of study would be best suited to evaluate this treatment?

A study finds that the positive predictive value of a new test for breast cancer is 75%, which means that

A randomized controlled trial compared a new drug to standard therapy in patients who had recent STEMI. The study found that patients on new drug had a 30 day mortality of 10%. Patients on standard therapy had a 30 day mortality of 20%. What is the relative risk reduction?

A randomized controlled trial compared a new drug to standard therapy in patients who had recent STEMI. The study found that patients on new drug had a 30 day mortality of 10%. Patients on standard therapy had a 30 day mortality of 20%. What is the absolute risk reduction?

A randomized controlled trial compared a new drug to standard therapy in patients who had recent STEMI. The study found that patients on new drug had a 30 day mortality of 10%. Patients on standard therapy had a 30 day mortality of 20%. What is the number needed to treat?