Family (1) part 1 Rahaf.M
Which of the following statements is true according to prevention:
A. Primary Prevention: early diagnostics of pre-clinical stage of a disease
B. Secondary Prevention: disease prevention- avoiding development of a disease;
C. Tertiary Prevention: prevention of complications, disability
D. All of above
Which of the following statements is not true according to prevention?
A. Immunisation is a secondary prevention
B. PAP lest is a secondary prevention
C. Tertiary prevention means prevention of the complications and disability
D. Secondary prevention means early diagnosis at preclinical stage of a disease
Which of the following about the prevention is true:
A. Primary prevention is an early diagnostic of a disease;
B. Primary prevention is the prevention of disease complications, disability
C. Secondary prevention is immunization
D. Tertiary prevention is a avoiding development of a disease: healthyl ifestyle, minimizing risk-factors
E. Non of Above
Which of the following statements is not true according to prevention?
A. Tertiary prevention means prevention of the complications and disability
B. Secondary prevention means arty diagnosis at preclinical stage of a disease
C. Healthy lifestyle is a secondary prevention
D. PAP test is a secondary prevention
Smoking cessation to prevent lung cancer is an example of which type of prevention?
A. Primary
B. Secondary
C. Tertiary
D. Quaternary
E. Common sense
Which of the following statements are true according to primary health care?
A. Primary health care is the urgent care only
B. Primary health care is the management of acute problems only
C. Primary health care is the key to attaining health for all
D. Primary health care is the prevention, not the management of the diseases
All of the following statements are true according to primary health care, except:
A. Primary care is performed and managed by a personal physician who is specialized in family medicine
B. Primary care promotes effective communication with patients and encourages the role of the patient as a partner in health care.
C. Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern.
D. Primary care includes diagnosis and treatment of acute and chronic illnesses in a variety of health care settings and does not cover the prevention
All of the following statements are true according to levels of health care, except
A. Primary care is urgent care only
B. Secondary Care is offered by various specialists (other than GP / FD) at the hospitals (In-patient care)
C. Tertiary Care is High technology, highly specialized care offered at specialized centers and university clinics
D. Extended Care ensures rehabilitation and long term care to elderly people, to people with chronic illness and disability within special network of institutions
Which of the following is true about the characteristic of the discipline of FM/GP:
A. Normally the point of first medical contact within the health care system, providing open and unlimited access to its users, dealing with all health problems regardless of the age, sex, or any other characteristic of the person concerned.
B. Deals with health problems in their only medical dirnensions:
C. Manages only chronic health problems of individual
D. Manages only acute health problems of individual:
All of the following is true about the competencies of the discipline of FM/GP.
A. Person Centred Care
B. Holistic approach
C. Primary Care Management
D. Comprehensive approach
E. All of above
Which of the following is true about the compherentive consultation:
A. Changing attitude toward one's health and healthcare;
B. Solving additional problem;
C. Opportunistic health promotion:
D. Solving the presenting problem;
E. All of the above;
12.The benefit of good communication skills for the doctor is
A. Reducing complaints and litigation
B. Reducing stress and burnout
C. High satisfaction
D. All of the above
Which of the following statements is false according to diseases screening:
A. Screening is directed to early diagnosis of diseases, which has short preclinical stage
B. Screening is directed to early diagnosis of diseases, which Are characterized with high morbidity and mortality
C. Screening is directed to early diagnosis of diseases, which have a long preclinical stage
D. Screening is directed to early diagnosis of diseases, which have treatment options
14. Which of the following statements is false according to diseases screening: Screening is directed to early diagnosis of diseases, which:
A. Have a long preclinical stage
B. Have a short preclinical stage
C. Have treatment options
D. Are characterized with high morbidity and mortality
15. Which of the following statements is false according to diseases screening: Screening is directed to early diagnosis of diseases, which:
A. Are characterized with low morbidity and mortality
B. Are widespread
C. Effective treatment options exist on preclinical stage
D. Have a long preclinical stage
16. Which of the following screening test's characteristics is necessary for effective screening?
A. Validity and reliability (sensitivity and specificity)
B. Simple, easily acceptable
C. Acceptable for patients
D. Inexpensive
E. All of the above:
Which of the following characteristics of disease is nessesary for effective screening:
A. The disease must have long lasting pre-clinical phase;
B. The disease must be common (prevalence of the disease);
C. Availability of effective treatment on pre clinical phase;
D. Morbidity and mortality, frequency of fatal outcome;
E. All of the above;
18. Which of the following statements is true?
A. Asymptomatic disease screening, is the same, as secondary prevention and means detection of illness before symptoms develop;
B. Secondary prevention means carrying out actions which help to avoid complications of the diseases.
C. Primary prevention means screening of asymptomatic diseases.
19. All of the statements about open questions are correct, except:
A. Open questions encourage a patient to formulate his own thoughts, feelings, desires, requests
B. Open questions are questions with the answer “yes” or “no”
C. Open questions are very important during initial stage
D. Open questions help in determining the main reason of the visit
Definition of family medicine/general practice (according to European definition 2002) includes all above, except
A. Family medicine is a scientific discipline, which is orientated only to prevention;
B. GP/FM is an academic and scientific discipline with its own educational content, research, evidence base and clinical activity
C. It is a clinical specialty orientated to primary care
21.Definition of family medicine/general practice (according to European definition 2002) includes all above, except
A. GP/FM is an academic and scientific discipline with its own educational content, research, evidence base and clinical activity
B. Family medicine is a scientific discipline, which is orientated to prevention;
C. It is a clinical specialty orientated to primary care.
D. It is a specialty orientated to the management of chronic diseases only.
E. All of the above
You are working with a patient who recently retired from his job after 41 years. He is currently 67 years old and has hypertension and high cholesterol. His wife thinks he drinks too much, and during your visit, he admits to 3 alcoholic beverages per day. You have screened him for alcoholism, and he does not meet the criteria. You would like to negotiate a safe drinking amount for this patient. Which of the following best represents a safe level of alcohol intake for this patient?
A. Seven drinks per week, no more than 3 per occasion.
B. Fourteen drinks per week, no more than 4 per occasion.
C. No more than 1 drink per day.
D. No more than 2 beers or glasses of wine per day or no more than 1 alcoholic beverage per day.
E. There is no safe drinking amount for this patient
23.Current newborn screening can diagnose a handful of inborn errors of metabolism like Galactosemia?
A. True
B. False
24. An 18 year old women comes for health evaluation. Which preventive actions are taken in this case? P.62
A. Colorectal cancer screening
B. Physical examination
C. Mammography
D. Lipid profile
25. 27 years old worn admits for health evaluation. Which preventive actions are shown in this case?
A. Colonoscopy
B. Mammography
C. PAP test
D. Echocardiography
26. A 30-year-old man who weighs 170 pounds at a height of 5 ft 10.5 in. Has a repeatable blood pressure in the 110–130/70–75 range. His family history reveals that his parents are living and well at 50 and 55 years of age. He wishes to know when he should be screened for “cholesterol.” You reply that according to the U.S. Preventive Services Task Force that should begin at what age?
A. 25 years
B. 30 years
C. 35 years
D. 45 years
E. 50 years
49 years old woman admits for health evaluation. Which preventive actions are shown in this case except:
A. Mammography (50<)
B. Calculate BMI (at first or if she obesity)
C. Colonoscopy (45-75 years)
D. Lipid profile (45
E. Pap test (21<)
You are discussing cancer screening with a patient. Her father was diagnosed with colorectal cancer at age 62. When should you recommend she begins colorectal cancer screening?
A. 40 years
B. 50 years
C. 52 years
D. 60 years
E. 62 years
29.You are discussing cancer screening with a female patient. She has no family history of breast cancer, and routine risk analysis indicates that she is not at increased risk for the disease. According to the US Preventive Services Task Force (USPSTF), at what age should she start getting routine mammograms
A. 30 years
B. 40 years
C. 45 years
D. 50 years
E. 60 years
30. You are consulting with a 50-year-old man at the time of his first comprehensive physical examination in 15 years. You have on hand a baseline electrocardiogram (EKG) taken when he had his last examination 15 years ago, read as normal (another was unchanged during an emergency department visit for atypical chest pain 1 year ago). He expresses a desire to begin preventive health care under your guidance. Along the way, you elicit information that he smokes one pack of cigarettes per day, weighs 208 lb (94.2 kg) at a height of 5 ft 10 in. (1.78 m), and has a history of “high cholesterol.” Which of the following is the most appropriate combination of screening tests for this person, in addition to routine physical examination?
A. EKG, complete blood cell (CBC) count, and lipid screen
B. EKG stress test, CBC count, and liver and kidney function studies
C. Chest x-ray, EKG, and comprehensive chemical profile
D. Prostate-specific antigen (PSA) test, lipid screen, fecal occult blood test (FOBT), and blood sugar test
E. Chest x-ray, pulmonary function studies, lipid screen and routine chemistries, and CBC count
31. The U.S. Preventive Services Task Force (USPSTF) recommends which of the following screening tests for the listed patients?Harrison’s
A. 38-year-old prior smoker: ultrasound for abdominal aortic aneurysm
B. 45-year-old sexually active woman: nucleic acid amplifcation on a cervical swab for chlamydia
C. 50-year-old woman with a smoking history: dual-energy x-ray absorptiometry (DEXA) scan for osteoporosis
D. 80-year-old man: anti-hepatitis C virus (HV) antibody for hepatitis C
E. Non of the above
32. You are consulting a 52-year-old obese man. He is a smoker. Which of the following is the most appropriate screening test for this person?
A. ECG, complete blood cell (CBC) count, and lipid screen, Creatinine
B. Chest x-ray, ECG, and comprehensive chemical profile
C. Lipid screen, fecal occult blood test (FOBT), and blood sugar test
D. Chest x-ray, pulmonary function studies, lipid screen and routine chemistries, and CBC count
53 years old woman admits for health evaluation. Which preventive actions are shown in this case?
A. PAP test
B. Mammography
C. Colonoscopy
D. All of the above
55 years old man admits for health evaluation. Which preventive actions are shown in this case except
A. Abdominal US for Abdominal aortic aneurysm
B. Ask about physical activities
C. Ask about alcohol use
D. Calculate BMI
E. Lipid profile
You are seeing a 58-year-old smoker for a routine health examination. You have counseled him on discontinuing tobacco use, and he is considering that alternative. He denies coughing, shortness of breath, or hemoptysis. Which of the following is a recommended screen for lung cancer in this patient?
A. He should not be screened for lung cancer.
B. Chest x-ray.
C. Chest computed tomography (CT).
D. Sputum cytology.
E. Bronchoscopy.
61 years old woman admits for health evaluation. Which preventive actions are shown in this case?
A. Mammography
B. DEXA scan
C. Colonoscopy
D. All of the above
37. A 52-year-old woman with a history of hypertension and diabetes comes to the office for review of preventive medicine recommendations. She had a mammogram at age 50 but has had no other preventive medicine tests or advice that she can recall. She does not smoke cigarettes, does not drink alcohol, and is overweight (BMI = 29). Her mother developed breast cancer at age 75 and her father had colon cancer detected at age 65. According to the U.S. Preventive Services Task Force, which combination of screening tests should you recommend
A. Screening mammography, a chest x-ray, colonoscopy, a screening aortic sono-gram, and a bone density scan
B. Screening mammography, Pap smear, and colonoscopy
C. Screening mammography, a chest CT scan, colonoscopy, and a bone density scan
D. Screening mammography, a CA-125 blood test, Pap smear, and a bone density scan
E. Screening mammography, colonoscopy, and a bone density scan
38.A 75-year-old G2P2 presents to your gynecology office for a routine examination. She tells you that she does not have an internist and does not remember the last time she had a physical examination. She says she is very healthy and denies taking any medication, including hormone replacement therapy. She has no history of abnormal Pap smears. She is a nonsmoker and has an occasional cocktail with her dinner. She does not have any complaints. In addition, she denies any family history of cancer. The patient tells you that she is a widow and lives alone in an apartment in town. Her grown children have families of their own and live far away. She states that she is self- sufficient and spends her time visiting friends and volunteering at a local museum. Her blood pressure is 140/70 mm Hg. Her height is 5 ft 4 in and she weighs 130 lb. Her physical examination is completely normal. Which of the following are the most appropriate screening tests to order for this patient?
A. Pap smear and mammogram
B. Pap smear, mammogram, and colonoscopy
C. Mammogram, colonoscopy, and bone densitometry
D. Mammogram, colonoscopy, bone densitometry, and TB skin test
E. Mammogram, colonoscopy, bone densitometry, TB skin test, and auditory testing
A 21-year-old woman comes to the clinic for a health check-up. She has been sexually active since she was 17 years old and has never seen a gynecologist before. The physician discusses the importance of health screening with the patient and performs a Papanicolaou (or Pap) smear during the visit. Which of the following is the most appropriate screening schedule recommendation?
A. Pap tests every 3 years beginning approximately 3 years after first intercourse or at 21 years of age
B. Yearly Pap test and human papillomavirus DNA testing beginning approximately 3 years after first intercourse or at 21 years of age
C. Yearly Pap tests beginning approximately 3 years after first intercourse or at 21 years of age
D. Yearly Pap tests beginning at menarche and ending at menopause
E. Yearly Pap tests once a patient is sexually active or at 21 years of age
40. You are seeing a healthy 26-year-old woman for a routine health visit. She mentions that she and her husband are thinking about starting a family soon. She has never been pregnant before. Which of the following interventions, if done prior to pregnancy, has been shown to have a clear beneficial outcome for this woman and her potential child?
A. Blood typing and antibody testing
B. Screening for HIV
C. Screening for Chlamydia
D. Prescribing 0.4 to 0.8 mg of folic acid daily
41.65 years old men admits for health evaluation. She denies any complains. All of the following preventive actions are shown in this case except?
A. Lipid test;
B. Lungx-ray
C. Colonoscopy
D. Fecal occult blood test;
E. PSA:
42.A 28-year-old woman with a history of epilepsy presents for a preconception consultation visit. Which of the following is the most important advice to give to this patient?
A. Diabetes screening prior to pregnancy.
B. EEG reading that is normal prior to conception.
C. Preconception folate supplementation.
D. Stop epilepsy medication prior to pregnancy and through the first trimester.
43. All of the following preventive actions are shown in firs trimester prenatal care except: P.42
A. Glucose tolerance test (blood glucose measured 1 hour after oral ingestion of 50 g glucose in 150 mL fluid)
B. Hepatitis B surface antigen (HbsAg);
C. Hemoglobin/hematocrit
D. Gonorrhea/Chlamydia
E. Rubella titer
44. In which of the following categories of patients is screening for asymptomatic bacteriuria the standard of care?
A. Sexually active woman
B. Sexually active woman with history of recurrent UTIs
C. Adult man with history of prostatitis
D. Anyone with a history of pyelonephritis
E. Pregnant woman
45.A 25-year-old primigravida presents to the obstetrician’s offi ce for her fi rst prenatal visit. Which of the following titers is routinely obtained at the fi rst prenatal visit?
A. Cytomegalovirus and hepatitis B
B. Cytomegalovirus and rubella
C. Rubella and syphilis
D. Rubella, syphilis, HIV, hepatitis B, cytomegalovirus, and toxoplasmosis
E. Toxoplasmosis and HIV
46. A 40-year-old woman pregnant at 6 weeks gestation presents to your office for prenatal care. She is interested in prenatal testing for genetic abnormalities. She read on the Internet that an ultrasound measurement of the neck of the fetus can be used in prenatal diagnosis. Which of the following is correct information to tell your patient regarding ultrasound measurement of the fetal nuchal translucency for prenatal diagnosis?
A. It is a simple way to screen for Turner syndrome.
B. It can be performed by anyone trained in basic fetal ultrasonography.
C. It should be offered only to pregnant women less than 35 years.
D. It can be performed at any gestational age.
E. It is a screening test for Down syndrome performed between 10 and 13 weeks of pregnancy.
47. A patient who works as a nurse in the surgery intensive care unit at a local community hospital comes to see you for her annual gynecologic examination. She tells you that she plans to go off her oral contraceptives because she plans to attempt pregnancy in the next few months. This patient has many questions regarding updating her immunizations and whether or not she can do this when pregnant. Which of the following is the most appropriate recommendation?
A. The patient should be checked for immunity against the rubella (German measles) virus prior to conception because the rubella vaccine contains a live virus and should not be given during pregnancy.
B. The patient should be given the tetanus toxoid vaccination prior to becoming pregnant because it is a live virus vaccine that has been associated with multiple fetal anomalies when administered during pregnancy.
C. The Centers for Disease Control and Prevention recommends that all pregnant women should be vaccinated against the influenza virus during the first trimester.
D. If she is exposed to chicken pox while she is pregnant she can be immunized at that time since the chicken pox vaccine is safe during pregnancy.
E. Because of her occupation, the patient is at high risk for hepatitis B; she should complete the hepatitis B vaccination series before she conceives, since that vaccine has been associated with neonatal jaundice.
48. A 69-year-old man approaches a physician to ask about his target cholesterol level. He has history of coronary arteries disease. He does not smoke, denies diabetes, and has a body mass index of 26 kg/m2 . The man says he has heard there are multiple types of cholesterol, but wants to know just one marker that will be the best for him to follow. The physician advises that following the LDL cholesterol would be a reasonable option. At what LDL cholesterol level should be considered for this patient?First
A. LDL cholesterol >100 mg/dL
B. LDL cholesterol >160 mg/dL
C. LDL cholesterol >190 mg/dL
D. LDL cholesterol >200 mg/dL
49. A 54-year-old man visits his physician for a regular check-up. The man has a history of diverticular disease and diabetes and has no current medical complaints. He denies tobacco use or any family history of cardiac disease. On examination, the patient is afebrile and normotensive. His lipid profi le shows a total cholesterol level of 230 mg/dL, LDL cholesterol of 135 mg/dL, and HDL cholesterol of 47 mg/dL. In terms of managing this man’s hyperlipidemia, what is the best next step?
A. Lower LDL cholesterol to <100 mg/dL
B. Lower LDL cholesterol to <130 mg/dL
C. Raise HDL cholesterol to >50 mg/dL
D. Recommend a high-fi ber and low-fat diet
E. Recommend regular exercise
50. You send the patient to the laboratory for some screening tests. All of the following are appropriate tests to order in this patient except
A. Lipid profile
B. CA-125
C. TSH
D. Urinalysis
E. Fasting blood sugar
A 45-year-old man presents for a routine physical examination. He has no known medical history and has not seen a doctor in several years. On a screening lipid panel he is found to have a total cholesterol of 330 mg/dL, HDL- 50 mg/ dL, triglycerides of 100 mg/ dL, and LDL cholesterol of 220 mg/ d Which of the following management options is most appropriate?
A. TLC and high-intensity statin
B. Therapeutic lifestyle changes (TLC) only
C. TLC and low-intensity statin
D. TLC and moderate-intensity statin
Which of the following is a contraindication to receiving the live rubella vaccine
A. Children between 1 year old and puberty
B. infants <1 year old
C. Pregnant women
D. All exposed patients
E. All adults
53. Which of the following is true about well Adult Care-Immunizations and chemoprophylaxis except: P.69
A. Pneumococcal polysaccharide vaccine (PPV) is indicate for 65 years old pacients and older
B. Pneumococcal polysaccharide vaccine (PPV) is indicate for pacient after 45 years of pacient and older
C. Tetanus, diphtheria acellular pertussis (TdaP/Td)- All adults 18 age 65 (TdaP) 65 and older (Td), Booster every 10 years
D. Influenza vaccine (including H1N1)- All patients greater than 6 months of age (CDC recommendation). In particular, high risk groups include: Nursing home/institutional residents • Chronic disease • Pregnancy, second and third trimester
E. All of the following
54. A 5-year-old child is brought into the pediatrician's office for immunization and physical examination. The mother is concerned that her child is a little under the weather': Which of the following is a contraindication to vaccinating the child?
A. Acute otitis media with a temperature of 1 00°F requiring antibiotic therapy
B. Previous vaccination reaction that consisted of fever and fussiness that lasted for 2 days
C. History of an allergic reaction to penicillin
D. Previous vaccination reaction that consisted of wheezing and hypotension
55. A 48-year-old male municipal bus driver is 40 lb (18 kg) overweight. In counseling him to lose weight, you allude to all of the following problems as aggravated by obesity except for which one?
A. Coronary heart disease
B. Diabetes
C. Osteoporosis
D. Osteoarthritis
E. Hypertension
56. A 44-year-old G6P3215 presents for her well-woman examination. She tells you that all of her deliveries were vaginal and that her largest child weighed 2900 g at birth. How many full-term pregnancies did this patient have?
A. 1
B. 2
C. 3
D. 5
E. 6
57.Which of the following are Red Flags Suggesting Life-threatening Disease in Patients with Chest Pain: P.104
A. Electrocardiogram changes, especially ST segment elevation or new left bundle-branch block;
B. Hypotension, poor tissue perfusion, pulmonary edema, or oliguria
C. Tachycardia, tachypnea, hypoxia
D. All of the above
58. The classical risk factors for CAD according to INC-7 and ESH/ESC recommendations include: P.116
A. Hypertension;
B. Smoking;
C. Family history of early CAD;
D. Hyperlipidernia;
E. All of the above
59. A 47-year-old woman with a body mass index (BMI) of 37 kg/m2 was recently diagnosed with type 2 diabetes mellitus. As part of her patient education, you inform her that which of the following is the most common cause of death in adults with type 2 diabetes mellitus
A. Coronary artery disease
B. Infection
C. Neuropathy
D. Renal failure
E. Stroke
60. You are seeing a 51-year-old man with a known history of hypercholesterolemia and hypertension. He reports having a chest pressure, described as "heaviness” in the substernal area. It is n intermittently throughout the day. Which of the following is the best way to describe what the patient is feeling?
A. Atypical nonanginal pain
B. Classic angina
C. Nonanginal pain
D. Atypical angina
61. You are seeing a 36-year-old man complaining of shortness of breath. He reports symptoms associated with activity and relieved by rest. He is otherwise healthy, takes no medications, and denies chest pain or pressure. Which of the following is the best way to describe what the patient is feeling?
A. Classic angina
B. Atypical angina
C. Anginal equivalent
D. Nonanginal pain
E. Atypical nonanginal pain
62. You are seeing a 44-year-old woman with a known history of asthma who has had recent complaints of chest pain. She reports a stabbing pain that seems to be worse with inspiration. It is not associated with activity, but will occur intermittently throughout the day. Which of the following is the best way to describe what the patient is feeling?
A. Classic angina
B. Atypical angina
C. Anginal equivalent
D. Nonanginal pain
E. Atypical nonanginal pain
63. Which of following doesn't belong to CVD risk factors according to INC-7 and ESH/ESC recommendations?
A. Smoking;
B. Diabetes mellitus
C. Alcohol consumption
D. Age male > 55 years; female > 65 years;
Which of following doesn't belong to CVD risk factors according to INC-7 and ESH/ESC recommendations?
A. Smoking;
B. Dyslipidemia
C. Diabetes mellitus
D. BMI > 25
64.A 67-year-old smoking woman with known chronic obstructive lung disease and right ventricular hypertrophy has been treated with intermittent use of a beta- adrenergic agonist drug. She now has a bout of increased coughing and shortness of breath. Which of the following blood tests might be the best indicator ruling out dyspnea caused by heart failure?
A. Serum aldosterone level
B. Serum cortisol level
C. Serum pro-BNP level
D. Serum digoxin level
E. Serum creatinine level
65.You have diagnosed a 59-year-old woman with heart failure. She has a history of hypertension, but has never had heart failure before. Which of the following tests is routinely indicated in the initial evaluation of a person with a diagnosis of heart failure?
A. Pharmacology stress test
B. Left heart catheterization
C. Treadmill stress test
D. BNP
66. You are seeing a patient who was discharged from the hospital. She initially presented to the emergency room with dyspnea and was found to be in CHF. They admitted her for diuresis and initiation of appropriate first-line therapy. Since being released, she reports that she is comfortable at rest, but that ordinary activity results in mild dyspnea. According to the New York Heart Association (NYHA) functional classification, which class of heart failure best describes this patient?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Class V
67. A 68-year-old man with a history of myocardial infarction and congestive heart failure is comfortable at rest. However, when walking to his car, he develops dyspnea, fatigue, and sometimes palpitations. He must rest for several minutes before these symptoms resolve. Which of the following is his New York Heart Association classifcation?
A. Class I
B. Class II
C. Class III
D. Class IV
68.You have diagnosed a 69-year-old woman with heart failure. She has a history of hypertension, but has never had heart failure before. Which of the following tests is routinely indicated in the initial evaluation of a person with a new diagnosis of heart failure?
A. Echocardiogram
B. Holter monitor
C. Left heart catheterization
D. Pharmacologic test
69. An 81-year-old man is hospitalized for acute onset of shortness of breath and lower extremity edema. Although he lives by himself, it is very diffi cult for him to move around his apartment without experiencing fatigue. He has not seen his physician in years but was told in the past that he had high blood pressure. On physical examination his jugular venous pulse is palpated 9 cm above his sternal notch, inspiratory crackles are heard at his lung bases, and there is 3+ lower extremity edema.
A. Cardiac angiography
B. Echocardiography
C. Endomyocardial biopsy
D. Pulmonary function tests
E. X-ray of the chest
70. Which of the following ECG abnormalities are shown in patient with Atrial Fibrillation: P.122
A. Absence of P waves, regular ORS complexes
B. Absence of P waves, irregular chaotic QRS complexes
C. Absence P waves, irregular chaotic T waves
D. Regular P waves, irregular chaotic T waves
E. Regular P waves, irregular chaotic QRS complexes
71. You are evaluating a -year69-old man in the office who is complaining of irregular heart beat. Given his history and risk factors, you are concerned about Atrial fibrilation. Which of the following ECG features, if present, would suggest your dignosis?
A. Any ST-segment elevation greater than or equal to 1 mm
B. Absence of the P waves
C. T wave inversion
D. Q waves
E. Regular P waves, irregular chaotic T waves;
72. A 41-year-old business executive presents to your office and complains of palpitations and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previous evening. On examination, he is found to have an irregular heartbeat of 130 bpm. The most likely diagnosis is
A. Ventricular tachycardia
B. Ventricular fibrillation
C. Premature ventricular contractions (PVCs)
D. Atrial fibrillation
E. Wolff-Parkinson-White syndrome
73. You are seeing 57-year-old woman who is complaining of a “fluttering in her chest.” She is otherwise well, and denies shortness of breath or other acute symptoms. On examination, her pulse rate is rapid and irregular. Which of the following is her most likely diagnosis?
A. Atrial fibrillation
B. Paroxysmal supraventricular tachycardia (PSVT)
C. Stable ventricular tachycardia
D. Stimulant abuse
E. Hyperthyroidism
74. A 51-year-old man presents to your office and complains of palpitations and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previous evening. On examination, he is found to have an irregular heartbeat of 115 bpm. The most likely diagnosis is
A. Ventricular tachycardia
B. Premature ventricular contractions (PVCs)
C. Atrial fibrillation
D. Wolff-Parkinson-White syndrome
75. Which of the following is NOT considered a risk factor for MI?
A. Alcoholism
B. Homocystinemia
C. Type A personality
D. Male sex
E. Obesity
76. A 49-year-old male smoker comes to his family doctor 7 days after a 4-hour bout of squeezing anterior chest pain that occurred while he was away with a group on a hunting trip, on which they traveled by canoe for 5 days away from their automobiles. He thought that he had a bout of heartburn; he has felt well since the attack and made the appointment “just in case.” His electrocardiogram (ECG) shows Q waves in leads II, III, and AVF but no ST deviation nor clearly abnormal T-wave patterns. There is no prior ECG with which to compare. Which of the following available laboratory tests would be the most sensitive and specific indicator of a myocardial infarction (MI) having occurred 7 days before?
A. Aspartate amino transferase (AST, SGOT)
B. Myoglobin
C. Treponin
D. Creatine phosphate (CK-MB fraction)
77. A 49-year-old male smoker comes to his family doctor 7 days after a 4-hour bout of squeezing anterior chest pain that occurred during exercise. His electrocardiogram (ECG) shows Q waves in leads II, IIl, and AVF but no ST deviation. Which of the following available laboratory tests would be the most sensitive and specific indicator of a myocardial infarction (MI) having occurred 7 days before?
A. Aspartate amino transferase (AST, SGOT)
B. Creatine phosphate (CK-MB fraction)
C. Myoglobin
D. Troponin
E. Non of the above
78. You are evaluating a patient with chest pain in the emergency department. The ECG shows no Q waves or ST-segment changes. You wish to know whether the patient is suffering a myocardial infarction. Which of the following biomarkers is the preferred biochemical marker of myocardial infarction
A. Creatine kinase
B. CK-MB band
C. Erythrocyte sedimentation rate
D. Lactate dehydrogenase
E. Troponin I
79. You are evaluating a 61-year-old man in the office who is complaining of chest pain. Given his history and risk factors, you are concerned about myocardial ischemia, and order an ECG. Which of the following ECG features, if present, would most markedly increase the likelihood of an acute myocardial infarction?
A. Any ST-segment elevation greater than or equal to 1 mm
B. Any ST-segment depression
C. Any Q wave
D. Any conduction defect
E. New conduction defect
80. You are evaluating a 69-year-old man in the office who is complaining of chest pain. Given his history and risk factors, you are concerned about myocardial ischemia. Which of the following ECG features, if present, would most markedly increase the likelihood of an acute myocardial infarction?
A. Any ST-segment elevation greater than or equal to 1 mm
B. Absence of the P vawes
C. Any conduction defect
D. long QT
81. A 57-year-old woman presents to the hospital with a 2-hour history of retrosternal chest pain and dyspnea. Her electrocardiogram (ECG) reveals an acute myocardial infarction pattern. Which of the following ECG patterns is consistent with that interpretation?
A. Tall P waves
B. Prominent U waves
C. Small QRS complex
D. Elevated ST segments
E. Widened QRS complex
82. A 68-year-woman with hypertension and dyslipidemia presents with 30 minutes of retrosternal chest pain radiating to her neck. She is diaphoretic and in moderate distress. The ECG shows ST-segment elevation in the inferior leads. Which of the following mechanisms is the most likely cause of her condition?
A. Coronary plaque rupture
B. Aortic inflammation
C. Pericardial inflammation
D. vasculitis
E. myocarditis
83. A 75-year-old man comes into the emergency department with a 10-minute history of crushing substernal chest pain radiating to his left arm. This man is well known to the staff due to his long history of chest pain. His creatine phosphokinase level is elevated and his troponin T level is 0.4 g/mL. Which of the following is the most likely diagnosis?
A. Stable angina
B. Hypochondriasis
C. Unstable angina
D. Prinzmetal's angina
E. Acute myocardial infarction
84. You are evaluating a 40-year-old male patient in the office who is complaining of chest pain. His father had a myocardial infarction at age 42, and the patient is quite concerned. Which characteristic, if included in the history, decreases the likelihood that his chest pain is cardiac in origin?
A. The pain is worse with inspiration.
B. The pain radiates to his right arm.
C. The pain radiates to his left arm.
D. The pain is associated with nausea.
E. The pain is associated with sweatiness.
85. A 87-year-old woman presents to the emergency department with a chief complaint of shortness of breath over the past 2 days. She has a history of hypertension and coronary artery bypass surgery 25 years earlier. Her blood pressure is 178/92 mm Hg and she has jugular venous distension, hepatomegaly, and 3+ lower extremity edema. ECG is remarkable for left ventricular hypertrophy, no ST-segment elevations or depressions, no Q waves, and no Twave abnormalities. Echocardiogram reveals an ejection fraction of 60% and left atrial dilatation. There is universal left ventricular thickening. No valvular regurgitation or stenosis was noted. Which of the following underlying conditions is the most likely cause of this patient's symptoms?
A. Hypertrophic obstructive cardiomyopathy
B. Ischemic heart disease
C. Hypertensive heart disease
D. Myocarditis
E. Non of the above
86. A 63-year-old man with a history of hypertension and hyperlipidemia comes to the emergency department complaining of 1 hour of chest pain that came on at rest. The pain is substernal and radiates to both shoulders. He describes the pain as “diffuse pressure, not sharp” and says he feels nauseated and sweaty. He also feels like the pain improves when he curls up on his left side. His physical examination is notable only for some mild diaphoresis and a heart rate of 105 bpm with blood pressure of 140/ 88 mmHg. All of the following aspects of his history increase the likelihood of acute coronary syndrome EXCEPT:
A. Associated with feeling sweaty
B. Associated with nausea
C. Improved when lying on left side
D. Pressure, not sharp pain
E. Radiation to both shoulders
87. Mr. Gilotra is a 57-year-old oil rig worker with a history of hypertension, tobacco abuse, and diabetes mellitus. He presents to the emergency department with 30 minutes of crushing substernal chest pain radiating to the jaw and associated with profuse sweating and shortness of breath. His blood pressure is 115/90 mmHg, and heart rate is 95 bpm. What diagnostic test will provide the most rapid method of altering therapeutic management for Mr. Gilotra?
A. 12-lead ECG
B. Coronary CT angiography
C. Echocardiogram
D. Serum creatine kinase-MB (CK-MB) band level
E. Serum troponin I level
88. A 55 year-old-man has pain in his left leg during walking which began 6 month ago. He does not have chest pain, shortness of breath, palpitations or syncope. Medical history is unremarkable. He takes no medications. He is an ex-smoker with a 20 pack-year history. Patient does not use alcohol or illicit drugs. His father died at age 65 from MI. BP is 147/95mm, pulse 83 regular. Cardiac, pulmonary and abdominal examination are within normal limits. Peripheral pulses are decreased in the left leg. Ankle-brachial index is 0.65 in the left leg and 1,1 in the right. ECG-normal. Fasting glucose-normal, Cholesterol 220 mg/dl, HDL 50 mg/dI, LDL 135mg/dl, Triglycerides 150mg/dl. Which is the most appropriate next step in this patient?
A. Surgical revascularization
B. Aspirin alone
C. Aspirin and statin
D. Warfarin
89. Which of the following medications would improve survival following an MI
A. Warfarin
B. Morphine
C. Beta blocker
D. Hydrochlorothiazide
90. Which of the following medications would improve survival following an MI
A. ARB
B. Nitroglycerin
C. β-Blockers
D. Cordaron
91. You have diagnosed a 49-year-old man with CHF because of left ventricular systolic dysfunction. In addition to acute diuresis, which of the following is the best list-line agent to use for treatment, in the absence of contraindications?
A. ACE inhibitors
B. β-Blockers
C. Calcium channel blockers
D. Nitrates
E. Hydralazine
92. Which of the following combinations would be best utilized in the treatment of diastolic heart failure?
A. CCB + α-blocker
B. β-Blocker + diuretic
C. ACE inhibitor + α-blocker
D. CCB + ARB
E. ARB + CCB
93. Which of the following is definition of hypertension?
A. Systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80;
B. Systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥90;
C. Systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥85;
D. Systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90;
E. Systolic blood pressure ≥150 mm Hg, diastolic blood pressure ≥90;
94.Which of these patients need treatment for hypertension? (UNC-7)
A. 41 year old woman Systolic blood pressure 140 mm Hg, diastolic blood pressure 90mm found during one measurement
B. 27 year old man, smoker, systolic blood pressure 130 mm Hg, diastolic blood pressure 85mm;
C. 35 year old obese woman systolic blood pressure130 mm Hg, diastolic blood pressure 85;
D. 55 year old man with Systolic bloodpressure150 mm Hg, diastolic blood pressure 80;
95. Which of the following disease may cause a secondary arterial hypertension?
A. Sleep apnea
B. Kidney vascular disease
C. Pheochromocytoma
D. All of the above
96. Which of the following disease may cause a secondary arterial hypertension? P.129
A. Cushing's syndrome
B. Primary aldosteronism
C. Chronic kidney disease
D. Thyroid or parathyroid disease;
E. All of the above
97. Which of the following disease may cause a secondary arterial hypertension
A. Primary aldosteronism
B. Chronic kidney disease
C. Cushing syndrome
D. Sleep apnea
E. All of the above
98. Which of the following tests is considered routine (recommended) in the initial evaluation of a patient with hypertension?
A. Chest x-ray
B. TSH
C. Uric acid level
D. 24-hour urine protein
E. ECG
99. Which of the following tests is considered routine (recommended) in the initial evaluation of a patient with hypertension?
A. Echocardiography
B. TSH
C. 24-hour urine protein
D. ECG
100. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?
A. Blood creatinine
B. Blood glucose
C. Urinalysis
D. BNP
101. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?
A. Pottasium;
B. Blood glucose test
C. Creatinine:
D. Chest x-ray;
E. Lipid test;
102. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?
A. Potassium
B. Urinalysis
C. Fasting lipid profile
D. INR
103. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?
A. Blood glucose
B. Blood creatinine
C. Cholesterol
D. 24 hour urine test
104. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure ?
A. Blood creatinine;
B. Urinalysis:
C. Blood glucose;
D. Fasting lipid profile;
E. Prothrombin index;
105. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?
A. Fasting glucose
B. Potassium
C. ECG;
D. Lipid profile
E. ALT, AST
106. Which of the following is not considered to be routine test during primary evaluation of patients with high blood pressure?
A. CBC and Urynalisis
B. Fasting glucose test
C. BNP
D. Potassium
E. Fasting lipid profile
107. All of the following interventions are important for reduction of high blood pressure except P.130
A. Salt restriction
B. Prescribing aspirin
C. Exercise
D. Losing weight
E. DASH diet
108. A 39-year-old white man with essential hypertension presents for a routine health maintenance visit. He has no complaints and reports compliance with his hydrochlorothiazide. His pulse is 70/min, blood pressure is 145/92 mm Hg, and respiratory rate is 16/min. His body mass index is 24 kg/m2 . His physical examination is within normal limits. For which condition is the patient at increased risk?
A. End-stage renal disease
B. Hypercholesterolemia
C. Hypertrophic cardiomyopathy
D. Second-degree Mobitz I atrioventricular block
E. Type 2 diabetes mellitus
109. A 53-year-old with type 2 diabetes mellitus is found to have a blood pressure of 152/98. She has never had any ophthalmologic, cardiovascular, or renal complications of diabetes or hypertension (HTN). Based on recent recommendations of the JNC 7 (The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) which of the following is the currently recommended goal for blood pressure control in this case?
A. Less than 160/90
B. Less than 145/95
C. Less than 140/90
D. Less than 130/80
E. Less than 120/70
110. A 28-year-old woman has hypertension that is difcult to control. She was diagnosed at age 26. Since that time, she has been on increasing amounts of medication. On physical examination, she appears to be without distress. Blood pressure is 168/100 mmHg, and heart rate is 84 bpm. Cardiac examination is unremarkable, without rubs, gallops, or murmurs. She has good peripheral pulses and no edema. Her physical appearance does not reveal any hirsutism, fat maldistribution, or abnormalities of genitalia. Laboratory studies reveal a potassium of 2.8 mE/dL and a serum bicarbonate of 32 mE/dL. Fasting blood glucose is 105 mg/dL
A. Primary hyperaldosteronism
B. Hypertrophic cardiomyopathy
C. Congenital adrenal hyperplasia
D. Cushing syndrome
E. Fibromuscular dysplasia
F. Pheochromocytoma
111. Which of following is false with regard to medical therapy of hypertension?
A. If blood pressure is above the goal with 20 mmHg systolic or 10 mm Hg diastolic, treatment should be started
B. In 2/3 of cases controlling blood pressure is impossible with monotherapy.
C. In combination therapy one drug is usually thiazide diuretic.
D. Thiazides usually are not used as monotherapy
112. Despite lifestyle changes, a 37-year-old patient of yours still has blood pressures above goal. She has no other medical concerns and no abnormalities on physical examination or initial laboratory evaluation. Which of the following medications is best as an initial first-line monotherapy, according to the Joint National Committee 7 (JNC 7)? Pre-Test
A. A thiazide diuretic
B. An ACE inhibitor
C. An angiotensin receptor blocker
D. A calcium channel blocker
E. A β-blocker
113. You are seeing a 47-year-old hypertensive patient in your office. He is well- controlled with hydrochlorothiazide and is seeing you for a routine evaluation. His blood pressure at the visit is 118/76 mm Hg. Laboratory evaluation reveals a normal creatinine but he does have A1c 7.2. Which of the following interventions is indicated in this patient? Pre-Test
A. Work to achieve better blood pressure control through diet and exercise.
B. Add an angiotensin-converting enzyme (ACE) inhibitor
C. Commend him on his excellent control and make no changes
D. Add calcium channel-blocker
114. You are seeing a 43-year-old hypertensive patient in your office. He is well-controlled with hydrochlorothiazide and is seeing you for a routine evaluation. His blood pressure at the visit is 118/76 mm Hg. Laboratory evaluation reveals a normal creatinine and a GFR greater than 90 mL/min, but he does have microalbuminuria. Which of the following interventions is indicated in this patient?
A. Commend him on his excellent control and make no changes.
B. Work to achieve better blood pressure control through diet and exercise.
C. Increase his hydrochlorothiazide dose.
D. Add an angiotensin-converting enzyme (ACE) inhibitor.
E. Check a glycosolated hemoglobin level.
115. You have diagnosed a 35-year-old African-American man with hypertension. Lifestyle modifications helped reduce his blood pressure, but he was still above goal. You chose to start hydrochlorothiazide, 25 mg daily. This helped his blood pressure, but it is still 142/94 mm Hg. Which of the following is the best approach to take in this situation?
A. Increase his hydrochlorothiazide to 50 mg/d.
B. Change to a loop diuretic.
C. Change to an ACE inhibitor.
D. Change to a β-blocker.
E. Add an ACE inhibitor.
116. A 63-year-old woman has Type II diabetes mellitus, which is well-controlled. Her physical examination is positive for peripheral neuropathy in the feet and nonproliferative retinopathy. A urinalysis is positive for proteinuria. Which of the following treatments is most likely to attenuate the course of renal disease?
A. Calcium channel blockers
B. ACE inhibitors
C. Hepatic hydroxymethyl glutaryl- coenzyme A (HMG-CoA) inhibitors
D. Dietary carbohydrate restriction
117. 63 years old woman with DM type 2, which is small controlled. Her physical examination is positive for peripheral neuropathy in the feet and non-proliferative retinopathy. Urinalysis is positive for proteinuria. One of the following treatments is positive for attenuate the course of renal disease:
A. Beta blockers
B. ACE inhibitors
C. HMG-CoA
D. Dietary carbohydrate restriction
E. Weight reduction
118. A 55-year-old man comes to your office after not being seen by a physician in more than 10 years. He is found to be hypertensive, and his creatinine is found to be 2.3 mg/dL (H). Which medication is most likely to control his blood pressure and decrease the likelihood of progression of his renal disease?
A. A thiazide diuretic
B. An ACE inhibitor
C. A calcium channel blocker
D. A β-blocker
E. An aldosterone antagonist
119. A 51-year-old white man recently relocated to the area and presents to your office as a new patient. He denies having any history of medical problems. He made very infrequent visits to a primary care provider where he previously lived. He is on no medicines and denies having any significant family medical history. He is a current smoker with a 40 pack-year smoking history. His blood pressure is 170/95 mm Hg, and a fourth heart sound is present. His physical examination is otherwise unremarkable. Which of the following statements regarding treatment of this patient's hypertension is true? ACP
A. The most appropriate initial medical therapy for this patient is an alpha blocker
B. The most appropriate initial medical therapy for this patient is a thiazide diuretic
C. The most appropriate initial medical therapy for this patient is a thiazide diuretic in combination with another antihypertensive agent that works via a different blood pressure regulatory pathway
D. To have this patient stop smoking cigarettes would have little or no effect on the control of his hypertension
120. A 38-year-old African-American man is evaluated for the new diagnosis of hypertension. His workup has shown multiple elevated blood pressure readings in the past few months but no evidence of any other medical conditions. You plan to initiate an antihypertensive medication. Which of the following would be the best initial choice?
A. Calcium channel blocker
B. Angiotensin receptor blocker
C. B-bloker
D. Angiotensin converting enzyme inhibitor
121. A 64-year-old black man presents to your office for routine follow-up care. You have treated him for many years for hypertension with a calcium channel blocker and a thiazide diuretic. His hypertension has been moderately well controlled with this regimen. He asks you whether having a home blood pressure monitor would be useful for his care. Which of the following statements regarding ambulatory blood pressure monitoring (ABPM) is true?
A. ABPM is not useful in patients whose office blood pressure is normal and who have hypertensive target organ injury
B. ABPM is not a useful tool in the evaluation of suspected autonomic dysfunction in patients with orthostatic hypotension
C. Cross-sectional studies show that blood pressure averages obtained during office visits correlate better with the presence of target-organ injury (especially LVH) than those obtained with ABPM
D. ABPM is useful in establishing a diagnosis of white-coat hypertension
122. You have seen a 36-year-old man with elevated blood pressure. On one occasion, his blood pressure was 163/90 mm Hg, and on a second occasion, his blood pressure was 158/102 mm Hg. You have encouraged lifestyle modifications including weight loss using exercise and dietary changes. Despite some modest weight loss, at his current visit, his blood pressure is 166/92 mm Hg. Which of the following is the best treatment strategy at this point?
A. Use a thiazide diuretic.
B. Use an ACE inhibitor.
C. Use an angiotensin receptor blocker.
D. Use a β-blocker.
E. Use a two-drug combination of medications.
123. A 36-year-old woman has a history of hypertension and is planning on starting a family. She is currently taking lisinopril 10 mg daily for control of her blood pressure. She wants to stop taking her oral contraceptive medications. Her current blood pressure is 128/83 mmHg. What do you advise her about ongoing treatment with antihypertensive medications?
A. Because the cardiovascular changes that occur during pregnancy lead to a fall in blood pressure, she can safely discontinue her lisinopril when she stops her oral contraceptives.
B. She should continue lisinopril and start hydrochlorothiazide.
C. She should discontinue lisinopril and start irbesartan.
D. She should discontinue lisinopril and start labetalol.
E. She should not get pregnant because she is high risk of complications.
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