Abfm2020 Qs

Ame ican B a d f
Famil Medicine
IN-TRAINING EXAMINATION
P blica i n e d c i n in h le in a i ic l hibi ed.

C igh 2020 The Ame ican B a d f Famil Medicine. All igh e e ed.
1. A 42- ea - ld A ian male e en f f ll - f ele a ed bl d e e. He ha n
addi i nal ch nic medical blem and i he i e a m ma ic. An e amina i n i
ignifican f a bl d e e f 162/95 mm Hg b i he i e n ema kable.
Lab a Finding
S di m 138 mE /L (N 135 145)

P a i m 3.9 mE /L (N 3.5 5.5)
Fa ing gl c e 86 mg/dL
BUN 14 mg/dL (N 10 20)
C ea inine 0.6 mg/dL (N 0.6 1.3)
U ine mic alb min nega i e
Acc ding he Ame ican C llege f Ca di l g /Ame ican Hea A cia i n 2017 g ideline ,
hich ne f he f ll ing ld be he m a ia e medica i n ini ia e a hi ime?
A) Cl nidine (Ca a e ), 0.1 mg ice dail

B) H d ala ine, 25 mg h ee ime dail
C) Li in il/h d chl hia ide (Ze e ic), 10/12.5 mg dail
D) Me l l a a e (L e ), 25 mg ice dail
E) T iam e ene (D eni m), 50 mg dail
2. D ing nd a he n ing h me, a e inf med ha he e a e e iden n he ni

i h lab a -c nfi med infl en a. Acc ding CDC g ideline , h h ld ecei e
chem h la i f infl en a?
A) Onl m ma ic e iden n he ame ni

B) Onl m ma ic e iden in he en i e facili
C) All a m ma ic e iden n he ame ni
D) All e iden f he facili ega dle f m m
E) All aff ega dle f m m
3. A 24- ea - ld female e en i h a 2-da hi f mild m de a e el ic ain. She ha had

male e a ne in he la 6 m n h and e al c n ace i e and me ime c nd m.
A h ical e amina i n e eal a em e a e f 36.4 C (97.5 F) and m de a e ce ical m i n
and e ine ende ne . U ine hCG and a inal i a e nega i e. Vaginal mic c h nl
WBC .
The ini ia i n f an ibi ic f ea men f el ic inflamma di ea e in hi a ien
A) i a ia e a hi ime
B) e i e an ele a ed em e a e, WBC c n , C- eac i e ein le el
C) h ld be ba ed n he e l f g n hea and Chlam dia e ing
D) h ld be ba ed n he e l f el ic l a n g a h
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4. A 24- ea - ld a ien an a he ce f an i i ning f m female male. He ha
been king i h a chia i h ha c nfi med he diagn i f gende d h ia.
Which ne f he f ll ing ld be he be ini ial ea men f hi a ien ?
A) Cl mi hene
B) Le le (Fema a)
C) Le lide (Eliga d)
D) S i n lac ne (Aldac ne)
E) Te e ne
5. Ba ed n Ame ican Cance S cie g ideline f ce ical cance c eening, hen h ld HPV
DNA c - e ing fi be e f med al ng i h Pa anic la e ing?
A) A he n e f e al ac i i
B) A age 21
C) A age 25
D) A age 30
E) A age 35
6. L ng- e m n m inhibi ei a cia ed i h an inc ea ed i k f
A) Ba e e hag
B) g
C) h e en i n
D) ne m nia
E) e 2 diabe e
7. An 87- ea - ld female c me ffice f an ann al heal h main enance i i . She a ea

cachec ic and ell ha f he a 6 m n h he ha had a dec ea ed a e i e and
gene ali ed m cle eakne . The a ien i ale and ien ed e n and lace. She ha a
10% eigh l , d m c memb ane , and en ing f he kin n he e en face f he
hand . While infla ing he bl d e e c ff n he igh a m b e e ca edal a m .
Which ne f he f ll ing i he m likel elec l e di bance?
A) H e calcemia
B) H calcemia
C) H kalemia
D) H e na emia
E) H na emia
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8. A 24- ea ld female e en ffice i h a 3-m n h hi f diffic l lee ing. She
a ha he ggle fall a lee and ake m l i le ime a nigh a lea h ee ime a
eek. She ie g bed a 10:00 .m. and ake a 6:30 a.m. a he da . She lie
a ake f an h in bed bef e falling a lee and end 2h a ake in he middle f
he nigh ing fall back a lee . La el he ha been feeling fa ig ed and ha ing diffic l
c ncen a ing a k. Y c nd c a f ll hi and h ical e amina i n and ell he e n
in 2 eek i h a lee dia . A hi f ll - ii ee f m he dia ha he i lee ing
an a e age f 5 h e nigh .
Which ne f he f ll ing ld be he m a ia e ec mmenda i n?
A) Se he ala m f 5:30 a.m.

B) Add a mid-af e n n na
C) M e he bed ime 9:00 .m.
D) M e he bed ime 12:30 a.m.
E) Sa f an h if he ake a 3:00 a.m.
9. A 45- ea - ld female e en he eme genc de a men i h a 1- eek hi f facial

elling and g e i e d nea i h e e i n. She a diagn ed 1 eek ag ih
n n-H dgkin l m h ma b he medical hi i he i e n ema kable. A che adi g a h
i h n bel .
Af e h i al admi i n, hich ne f he f ll ing ld be he m a ia e ne e

in he managemen f hi c ndi i n?
A) In a en an ibi ic
B) U gen chem he a and adia i n
C) U gen chem he a and la ma he e i
D) U gen ech ca di g a h
E) U gen b nch c
10. A n n e bal 22- ea - ld male i h in ellec al di abili i b gh ffice b he aff

f he g h me he e he li e . The e ha he a ien ha been f nc i ning a hi
ba eline n il hi m ning hen he a f nd ha e l d b ea hing. N he hi i
a ailable a he ime f hi i i .
On e amina i n he ha a em e a e f 37.3 C (99.1 F), a bl d e e f 124/82 mm Hg,

a l e a e f 100 bea /min, and a e i a a e f 16/min. The a ien a ea be in mild
di e and a high- i ched hi ling, c ing nd n in i a i n i hea d a alk in he
m.
Which ne f he f ll ing ld be he m a ia e ne e f hi a ien ?
A) O al an ibi ic
B) O al c ic e id
C) Neb li ed alb e l
D) Neb li ed e ine h ine
E) U gen e al a i n in he eme genc de a men
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I em #9
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11. A 16- ea - ld female e en i h ch nic acne n he n e, f ehead, and chin c n i ing f
a fe c med ne and a fe mildl inflamed a le and le . She a i i minimall
im ed af e 12 eek f dail ada alene 0.1% gel. The e a e n ca c . The a ien
ld like achie e be e c n l.
Which ne f he f ll ing ld ec mmend a hi ime?
A) C n in e ada alene 0.1% gel f 12 m e eek

B) Add clindam cin (Cle cin T) 1% gel f 12 eek
C) Add clindam cin 1% gel f main enance
D) S ada alene 0.1% gel and a clindam cin 1% gel f main enance
E) S ada alene 0.1% gel and a e h m cin 2% gel f main enance
12. A 32- ea - ld female h i ne f l ng ime a ien call beca e f a 24-h hi

f ainf l ina i n i h ina f e enc and genc . She i he i e heal h and d e n
ha e an fe e , chill , back ain, aginal di cha ge. She e an al c n ace i e ill and
a e ha he la men al e i d a n mal and cc ed la eek.
Which ne f he f ll ing ld be m a ia e a hi ime?
A) Em i ic an ibi ic ea men
B) A inal i
C) A ine c l e
D) Plain abd minal adi g a h
E) Pel ic l a n g a h
13. A 70- ea - ld female de el h mb c enia d ing a l nged h i ali a i n f

end ca di i . He c en medica i n incl de ched led nf ac i na ed he a in injec i n f
en h mb emb li m h la i . Y ec he a in-ind ced h mb c enia (HIT).
A ming ha he h mb c enia i ca ed b HIT, hich ne f he f ll ing i he m

likel c m lica i n?
A) Ana h la i
B) Di emina ed in a a c la c ag la i n
C) Hem hage
D) Se i
E) Th mb i
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14. Y a e a ked f ad ice a a f a c mmi ee f med b l cal heal h em
f c n fall e en i n.
Ba ed n U.S. P e en i e Se ice Ta k F ce ec mmenda i n , hich ne f he f ll ing

in e en i n ha he nge e idence f e en ing fall in c mm ni -d elling lde ad l
a inc ea ed i k f fall ?
A) Calci m lemen a i n
B) Vi amin D lemen a i n
C) S i ef ea
D) E e ci e cla e
E) C gni i e-beha i al he a
15. A 42- ea - ld male e en i h a 10-da hi f h a ene . He al ha a 2-m n h hi

f efl m m and ha been aking an acid a needed. He d e n ake an he
medica i n . The e i n hi f fe e , eigh l , nigh ea , a e i e change . Y
n e ha he a ien i h a e, and a h ical e amina i n i n mal, incl ding HEENT,
ca di a c la , and lm na e amina i n . He i a membe f a c mm ni ch i ha
ehea e ice a eek.
In addi i n ice e , hich ne f he f ll ing ld be m a ia e a hi ime?
A) S i e ca e nl
B) A i h m cin (Zi h ma )
C) Ome a le (P il ec)
D) Ac e f edni ne
16. A 57- ea - ld male i h a hi f hea fail e ee f f ll - . He de c ibe

m m f mild d nea n e e i n i h dina ac i i ie ch a h ing ad k.
An ech ca di g am h an ejec i n f ac i n f 37%.
Acc ding he Ne Y k Hea A cia i n c i e ia, hi a ien hea fail e ld be

cla ified a hich ne f he f ll ing?
A) Cla I
B) Cla II
C) Cla III
D) Cla IV
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17. A 40- ea - ld nne e en i h ain in he lef leg. He i aining f a ma a h n and ha
been inc ea ing hi nning di ance in ecen eek . He e l cali ed ain and elling a
he mid in f he hin e he a 4 eek ha begin af e a n and la f a fe da ,
b n he elling and ende ne ha e la ed f e e al da and he e i e e e ain hen
he ie n. Y ec a ibial e f ac e.
Which ne f he f ll ing imaging m dali ie ld be indica ed ini iall ?
A) A lain film
B) Ul a n g a h
C) CT
D) MRI
E) B ne cin ig a h
18. A 24- ea - ld female e en ih g e i el ening l a ain f 3 da . On

e amina i n a 3 3-cm ende , fl c an ma i n ed n he igh labia min a. She had a
imila e i de f hi blem la ea .
Which ne f he f ll ing ld be he m a ia e managemen ?
A) E ec an managemen
B) Fine-needle a i a i n
C) Inci i n and d ainage
D) Ma iali a i n
E) E ci i n nde gene al ane he ia
19. Which ne f he f ll ing h ld NOT be c n med d ing egnanc d e a en iall high

me c c n en ?
A) Ca fi h
B) C a fi h, h im , and l b e
C) Fl nde and hadd ck
D) Salm n and
E) Sha k and dfi h
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20. An 18-m n h- ld female i b gh ffice b he m he f e al a i n f a c gh. The
a ien ha had l -g ade fe e and a nn n e f 2 da . She n ha a c gh ha i e
a nigh . On e amina i n he ha a em e a e f 37.5 C (99.5 F), a l e a e f 120
bea /min, a e i a a e f 30/min, and an gen a a i n f 92% n m ai . She i
n ed ha e h a ene , mild in i a id , and a ba king c gh. She d e n ha e
d ling a m ffled ice.
Which ne f he f ll ing h ld be de ed c nfi m he diagn i ?
A) N f he e ing
B) A CBC
C) A i al c l e
D) Ra id an igen e ing
E) A adi g a h f he neck
21. A 25- ea - ld male e en i h a 4-m n h hi f c am abd minal ain, dia hea, and
fa ig e. Hi m m began g ad all b ha e bec me m e e e e and he i n
e e iencing ec al bleeding. He a ha hi abd minal ain eem em a il im e af e
ea ing. He ha m ked fi e ciga e e e da f he a 8 ea . He i i ed lea n ha
he ha l 7 kg (15 lb) hen he i eighed da .
Hi i al ign incl de a bl d e e f 116/70 mm Hg, a hea a e f 76 bea /min, a

e ia a e f 12/min, and a em e a e f 37.7 C (99.9 F). A h ical e amina i n
e eal abd minal ende ne and mild di en i n. An an ec al e amina i n i ignifican f a
e ianal fi la. A lab a e al a i n i n able f mild anemia. Hi kidne and li e
f nc i n a e n mal.
Which ne f he f ll ing i he m likel diagn i ?
A) Celiac di ea e
B) Ch nic anc ea i i
C) C hn di ea e
D) I i able b el nd me
E) Ulce a i e c li i
22. A 34- ea - ld female a 32 eek ge a i n e en i h a igh - ided, nding headache ha

began 8 h ag and i imila headache he ha had in he a . She i en i i e ligh
and nd, and ha mi ed e e al ime ince he n e f ain. She ha aken ace amin hen
ih elief. She ake ena al i amin b n he ine medica i n . On e amina i n he
bl d e e i n mal.
Which ne f he f ll ing ld be he m a ia e ea men f hi a ien ?
A) Dih d e g amine
B) Me cl amide (Reglan)
C) Na en
D) O c d ne (O C n in)
E) S ma i an (Imi e )
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23. Which ne f he f ll ing U-100 in lin d c ha he l nge d a i n f ac i n?
A) Degl dec (T e iba)

B) Gla gine (Lan )
C) I hane NPH (H m lin N)
D) Li (H mal g)
E) Reg la (H m lin R)
24. When e f ming a ge ia ic a e men , hich ne f he f ll ing i an in men al ac i i

f dail li ing?
A) Ba hing
B) D e ing
C) T an fe ing be een he bed and a chai
D) U ing he ele h ne
E) U ing he ile
25. A 21- ea - ld female ee f a medical e al a i n i admi i n a ea men

g am f an e ia ne a. The effec f an e ia n he h halamic- i i a a i can
ca e hich ne f he f ll ing?
A) B ne l
B) Ele a ed e e ne
C) H e gl cemia
D) H h idi m
E) Men hagia
26. A 9- ea - ld male i h a hi f m de a e e i en a hma i b gh he eme genc

de a men i h an ac e e ace ba i n. Hi m m began i h a nn n e and na al
c nge i n 2 da ag . Hi a en a e ha he ha n had an fe e chill and he a
ea ing and d inking ell n il a fe h ag hen hi b ea hing a ed a ea m e
lab ed. Af e m l i le ea men i h inhaled alb e l (P en il, Ven lin) and al
edni l ne he emain ach neic and hee .
Which ne f he f ll ing in a en medica i n h ld be added he a ien c en

ea men ed ce he likelih d f h i al admi i n?
x
A) Ke lac
B) Magne i m lfa e IV ,
C) Me h l edni l ne
*
D) Omali mab (X lai )
E) The h lline
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27. A 10- ea - ld female i b gh
- ffice f a e a ici a i n e amina i n. Y
n e h acic ib a mme d ing he Adam f a d bend e . Radi g a h c nfi m
igh a d h ac l mba c li i i h a C bb angle f 32 . Tri .sk if 429 ?
-
angle
A) Gene ic e ing (Sc liSc e)

B) MRI f he h acic and l mba ine ih c n a
C) Sc li i adi g a h in 1 ea
D) Refe al h ical he a
E) Refe al a edia ic h edi
28. An 85- ea - ld n ing h me a ien i h demen ia h ha bila e al hea ing aid ha been
ligh l m e c nf ed e he a 2 eek acc ding he aff. He i al eaking a a
l de l me han n mal. He d e n ha e an ain, b an e amina i n h im ac ed
ce men in b h ea .
Which ne f he f ll ing ld be m a ia e in he managemen f hi a ien ?
A) N he a
B) I iga i n f he ea i h c ld a e
C) U e f li e il d
D) Rem al f he ce men ing e ide
E) Re aining he a ien and a em ing man al em al f he ce men
29. A e i l heal h 18- ea - ld female e en i h finge ain. Ab 5 da ag he a ed

ha e mild b ning f he lef di al inde finge . T da la e he de el ed ening ain
and edne f he finge i . She d e n emembe inj ing he finge ha ing a imila
blem e i l .
On e amina i n n e e hema f he medial alma i f he affec ed finge , i h e e al

e icle ha ha e a e fl id in hem. The di al digi al l i f b ende .
Which ne f he f ll ing i he m a ia e ea men f hi c ndi i n?
A) Wa m a e ak
B) Pain c n l and d e ing herpetic with low .
C) An ibi ic
D) An if ngal
E) Inci i n and d ainage
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30. A 52- ea - ld g a ida 4 a a 4 e en i h b he me inc n inence, ed minan l ih
c ghing and aining. In addi i n a h ical e amina i n, inal i , and mea emen f
id e id al l me, hich ne f he f ll ing e i ec mmended a a f he ini ial
e al a i n?
A) C gh e e ing
B) U d namic e ing
C) Pel ic l a n g a h i h a aginal be
D) C c
31. The m he f a 1- ea - ld child an kn h ef l infl en a accine i f e en ing

infl en a in ng child en. The infl en a ea n i icall ignifican in a ea and he
child a end da ca e. Y an e he e i n b e laining h man child en need be
accina ed in de e en ne ca e f infl en a.
Thi a i ic i efe ed a he
A) ab l e i k ed c i n
B) ela i e i k ed c i n
C) n mbe needed ea
D) n mbe needed ha m
E) e alence
32. A 45- ea - ld male c me ffice f a ine heal h main enance e amina i n. Hi

medical hi i ignifican f a c id i , hich a diagn ed 5 ea ag d ing a k
f hila aden a h een n a ine che adi g a h. He ha been en i el a m ma ic f
he a 2 ea and ha ne e e i ed an ea men .
Which ne f he f ll ing ann al c eening ld be m a ia e?
A) B ne den i c eening if patient on steroid .
B) Ech ca di g a h
C) High- e l i n CT f he che
D) An h halm l gic e amina i n
E)
X A inal i anime not affected with sarcoidosis .
33. A 34- ea - ld female ha a b m n he middle finge ( h n bel ). She hink i ha been

he e a ima el a m n h b a ha i nl ecen l began b he he . She ha n ied
ea i .
Thi le i n i m likel a
A) ba al cell ca cin ma
B) de ma fib ma
C) ke a acan h ma
D) m c c
E) a
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I em #33
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34. A 73- ea - ld female ee f he fi ime f a heal h main enance i i . He medical
hi incl de h e li idemia, GERD, in mnia, and e a h ii , b he i he i e
heal h . He e ima ed 10- ea i k f a he cle ic ca di a c la di ea e i 14%. She li e
inde enden l . She ha a a hi f alc h l ab e b ha n ed alc h l in 20 ea , and
i a life ime n n m ke . He c en medica i n egimen incl de a i in, 81 mg nce dail ;
mela nin, 3 mg a bed ime; ace amin hen, 500 mg h ee ime dail ; a a a in (Li i ),
20 mg nce dail ; and fam idine (Pe cid), 20 mg nce dail .
T da he bl d e e i 130/70 mm Hg, l e a e 72 bea /min, and gen a a i n 95%

n m ai .
Which ne f he f ll ing change he c en medica i n egimen ld im e he

likelih d f benefi and ed ce he likelih d f ha m?
A) S ing a i in
B) S ing mela nin
C) S ing ace amin hen and a ing dicl fenac, 50 mg ice dail
D) S ing a a a in and a ing a a in (C e ), 40 mg a bed ime
E) S ing fam idine and a ing me a le (P il ec), 20 mg nce dail
35. A 14- ea - ld female i b gh ffice a a ne a ien f a ine ell child

e amina i n. She ha had e li le medical ca e ince he e-kinde ga en e al a i n. She feel
ell and d e n ake an medica i n . He a medical, gical, famil , and cial hi ie
a e n ema kable. A e ie f em i n able f n hi f men a i n. An
e amina i n i n able f a heigh a he fi e cen ile and a lack f an b ea de el men .
Lab a die e eal an ele a ed FSH le el.
Which ne f he f ll ing ld be he m a ia e ne e ?
A) F ll - e e 3 6 m n h f a e men f be al de el men
B) Ac ic in im la i n e
C) Ka ing
D) Radi g a h f he hand f b ne age
E) MRI f he b ain and i i a
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36. A 42- ea - ld male ee f f ll - af e hi hi d e i de f ne m nia. He ha n he
ignifican medical hi . He ha ne e m ked, d ink alc h l cca i nall , and ha n he
d g e kn n e e . A h ical e amina i n i n mal. P lm na f nc i n e
dem n a e an FEV1 f 72% f edic ed and an FEV1/FVC a i f 0.68, hich d e n
n mali e i h b nch dila admini a i n. A che adi g a h h h e infla i n b n
he ignifican finding .
Lab a Finding
Pla ele 102,000/mm3 (N 150,000 450,000)

AST 56 U/L (N 8 48)
ALT 43 U/L (N 7 55)
Alb min 3.3 g/dL (N 3.5 5.0)
Which ne f he f ll ing c ndi i n be e lain hi a ien abn mal finding ?
A) 1-An i in deficienc
B) C ic fib i
C) G d a e nd me
D) He edi a hem ch ma i
E) Sa c id i
37. Which ne f he f ll ing i m likel ca e a fal e- ii e ine d g c een f

am he amine ?
A) Aml di ine (N a c)
B) B i n (Wellb in)
C) Le fl acin (Le a in)
D) Pan a le (P ni )
E) Se aline (Z l f )
38. The U.S. P e en i e Se ice Ta k F ce ec mmend c eening f de e i n f
A) all ad l
B) all men b n men
C) nl ad l i h a famil hi f de e i n
D) nl ad l i h a kn n e nal hi f de e i n
E) nl ad l i h a hi f di abili , medical illne , c m lica ed g ief, ch nic lee
di bance, and/ l neline
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39. A 62- ea - ld female ee f a ine heal h main enance e amina i n. She ha a hi
f b ea cance diagn ed 6 ea ag ha a ea ed i h l m ec m , adia i n, and
end c ine he a . She i feeling ell da and ha n m m f c nce n. The e i n famil
hi f b ea , a ian, c l n, a e cance .
In addi i n mamm g a h , hich ne f he f ll ing ann al e ld im e hi

a ien chance f i al?
A) N e
B) CT f he che
C) MRI f he b ea
D) B ea l a n g a h
E) A b ne can
40. A 62- ea - ld male i h h e en i n e en ffice i h b e nal che ain adia ing

in hi lef a m f he a 20 min e . He al ha dia h e i and na ea. He ha a bl d
e e f 156/96 mm Hg, a l e a e f 84 bea /min, and an gen a a i n f 93% n
m ai . An EKG h ST- egmen ele a i n in lead V1 and V2. Y medical a i an
call 911 f immedia e an he l cal h i al eme genc de a men . While a ai ing
he amb lance a i al gi e he a ien l -d e a i in and bling al ni gl ce in.
Which ne f he f ll ing ld be m a ia e ega ding gen he a a hi ime?
A) N gen he a
B) O gen ia na al cann la a 2 L/min
C) O gen ia na al cann la a 6 L/min
D) 100% gen i h a eg la ma k
E) 100% gen i h a n n eb ea hing ma k
41. Y ee an 89- ea - ld female i h ad anced demen ia h ha ed ea ing. The a ien

da gh e a k ab he le f be feeding in hi i a i n. Y di c he i k and
benefi .
In a ien i h ad anced demen ia h ha e a feeding be laced, he e i e idence f

inc ea ed
A) n i i nal a
B) healing f e e lce
C) ali f life
D) i al
E) eme genc de a men i i
15
42. A 55- ea - ld male i h a BMI f 32 kg/m2 e en ffice di c eigh
managemen . He ha m de a el ell c n lled e 2 diabe e and h e en i n. He efe
n m dif hi die and ld like kn if he can e ec ignifican eigh l f m
e e ci ing. He lan alk b i kl f 45 min e dail .
Which ne f he f ll ing ld be he be ad ice f hi a ien ?
A) M de a e e e ci e al ne i ineffec i e f eigh l
B) M de a e e e ci e al ne i ei die a change f eigh l
C) M de a e e e ci e al ne i m de a el beneficial f eigh l
D) Adding m de a e e e ci e die a change b an iall inc ea e eigh l
43. A 67- ea - ld female a ien began aking a bi h h na e f ea men f e i 2 ea

ag af e a DXA can e ealed a T- c e f 2.7. He FRAX c e h ed a 10- ea babili
f hi f ac e f 5%. Y de a e ea DXA can and he T- c e i n 2.3 and he FRAX
c e i 3.5%.
Which ne f he f ll ing h ld ec mmend hi a ien ega ding he d a i n f

ea men i h a bi h h na e?
A) S aking i n
B) C n in e aking i f 1 m e ea
C) C n in e aking i f 3 m e ea
D) C n in e aking i f 7 m e ea
E) C n in e aking i indefini el
44. A 43- ea - ld male e en he eme genc de a men i h he ac e n e f ha , abbing

che ain hen inhaling and e haling. The ain en i h c ghing and dee b ea hing. He
ha n ignifican e i medical hi b ecen l e ned f m a k i Ja an and
ha n ed igh leg elling f he a eek. He ha n he m m . He i a m ke and
ha a famil hi f c na a e di ea e in hi a e nal g andfa he . On e amina i n he
a ea nc mf able, and hi l ng a e clea . A ca diac e amina i n i n able f ach ca dia.
He ha a bl d e e f 110/70 mm Hg, a hea a e f 112 bea /min, a e i a ae f
18/min, a em e a e f 37.7 C (99.9 F), and an gen a a i n f 89% n m ai .
Which ne f he f ll ing e e l i m likel c nfi m he diagn i ?
A) Ele a ed nin le el
B) Acid-fa bacilli n a G am ain
C) A filling defec n CT angi g a h
D) Ai in he le al ace n a che adi g a h
E) Diff e ST ele a i n n an EKG
16
45. Y ha e a med he ca e f a ell e abli hed a ien in ac ice h e medica i n
incl de ch nic al a lam (Xana ) ea men f an ie and c deine f ch nic back ain
f ll ing a k acciden ea ea lie . Hi P e c i i n D g M ni ing P g am e
h a c n i en a e n f filling he medica i n a e c ibed. Y de a ine
imm n a a f i id and ben dia e ine . The e l ae ii ef i id b nega i e
f ben dia e ine .
A) Pe f m c nfi ma e ing f al a lam

B) Re ea he ine imm n a a f ben dia e ine
C) In e iga e f ible di e i n f al a lam
D) S e c ibing al a lam
E) S e c ibing c n lled b ance
46. F a ien i h a ial fib illa i n, hich ne f he f ll ing c m bid c ndi i n e e en

he nge indica i n f h mb h la i i h a fa in (C madin), a he han a di ec
al an ic ag lan ?
A) A CHA2DS2-VASc c e 3
B) End- age ch nic kidne di ea e
C) A mechanical hea al e
D) Mild mi al en i
E) Se e e mi al eg gi a i n
47. Acc ding he In i e f Medicine, hich ne f he f ll ing d main f heal h ca e ali

i m im ac ed b cial de e minan f heal h?
A) Effec i ene
B) Efficienc
C) E i
D) Safe
E) Timeline
48. The m c mm n m m f alc h l i hd a al in he elde l i
A) c nf i n
B) ei e
C) ach ca dia
D) em
E) mi ing
17
49. Acc ding he O a a ankle and f le , hich ne f he f ll ing a ien i h ankle
f ain af e a i ing inj e ie adi g a h le a f ac e?
A) An 18- ea - ld male ba ke ball la e h landed n an ing la e f hile

eb nding he ball and ha ende ne an e i he la e al malle l
B) A 23- ea - ld female h i ed he ankle hile la ing cce and ha ende ne a
he ba e f he fif h me a a al
C) A 30- ea - ld male h i ed hi ankle a eek ag af e e ing n hi child
and ha e i en elling i h ende ne an e i he medial malle l
D) A 48- ea - ld female h li ed hile g ing d n ai and ha ende ne and
b i ing infe i he la e al malle l
50. A 65- ea - ld female e en he eme genc de a men i h a 24-h hi f abd minal

ain, na ea, and mi ing. She e ha he la b el m emen a 2 da ag and he
ha n a ed an fla . The ain i diff e and he a e i a 4 n a cale f 10 b a ha
i eache a le el f 8 a ime . She ha h e en i n, hich ha been c n lled i h aml di ine
(N a c), 5 mg dail . She had an a endec m a age 25 and had n mal aginal
deli e ie . She ha been men a al ince age 52.
An e amina i n e eal a bl d e e f 120/80 mm Hg, a l e a e f 110 bea /min, a

e ia a e f 16/min and n nlab ed, and an gen a a i n f 95% n m ai .
E amina i n f he hea and l ng i n mal. On e amina i n f he abd men n e
high- i ched b el nd , and he abd men i di ended and m anic, and diff el ende
i h n a eciable ma e . A adi g a h f he abd men h a mall b el b c i n.
Which ne f he f ll ing i he m likel ca e f hi a ien mall b el b c i n?
A) C n i ai n
B) In e inal adhe i n
C) A ne la m
D) Ven al he nia i n
E) V l l
18
51. A 68- ea - ld female c me ffice di c e l f m ecen lab a e ing.
D ing ine m ni ing f elec l e hile aking li in il (P ini il, Ze il) f
h e en i n, he a f nd ha e a e m calci m le el f 10.6 mg/dL (N 8.6 10.0).
F ll - lab a die e ealed a a a h id h m ne le el f 106 g/mL (N 10 65) and
n mal le el f i amin D, h h , alb min, and c ea inine. The a ien feel ell da
and ha n m m f c nce n.
The a ien a medical hi incl de h e en i n, h h idi m, and e i . He

c en medica i n incl de li in il, le h ine (S n h id), alend na e (F ama ), and
i amin D. An e amina i n da i n mal, incl ding a bl d e e f 122/74 mm Hg.
Which ne f he f ll ing cha ac e i ic ld be an indica i n f gical managemen f

hi a ien c ndi i n?
A) Age >50
B) H e en i n
C) H h idi m
D) O e i
E) A e m calci m le el <11 mg/dL
52. Y a e e amining a 65- ea - ld male f m Cen al Ame ica i h a hi f he ma ic

al la di ea e. Which ne f he f ll ing i he inci al a c l a finding f a ic
eg gi a i n?
A) An S3 gall hea d be a he ca diac a e i h he a ien ine

B) A i ha ic e ica dial f ic i n b i h he a ien ea ed and leaning f ad
C) A l - i ched dec e cend dia lic m m ha i l de a he l e lef e nal
b de i h he a ien ea ed and leaning f ad
D) A high- i ched c e cend /dec e cend mid lic m m ha i l de a he igh
e e nal b de and adia e he ca id a e ie i h he a ien i ing igh
E) A ha h h l lic m m ha i l de a he l e lef e nal b de and adia e
he lef la e al che all i h he a ien in he lef la e al dec bi ii n
19
53. A 50- ea - ld male i h n ignifican a medical hi e en i h a 5-da hi f
fe e 101 F, chill , and mild diff e j in and m cle ain . He al e a mild headache
b ha n had an e h a , hin hea, c gh, h ne f b ea h, na ea, mi ing,
change in b el habi . He n iced a nd ed a h ( h n bel ) a fe da ag n hi leg
ha ha g n in i e ince hen. I i minimall i ic b n ainf l. He ha n he a he .
He ecen l a eled Ve m n f hi famil ann al fall hiking i b d e n ecall an
in ec bi e . He d e n ake an medica i n and ha n d g alle gie . He ha a bl d e e
f 120/74 mm Hg, a l e a e f 84 bea /min, and a em e a e f 37.8 C (100.0 F).
Ca diac, lm na , m c l kele al, and abd minal e amina i n a e n mal.
A) Aden i
B) Eh lichi i
C) Infl en a
D) L me di ea e
E) R ck M n ain ed fe e
54. A 16- ea - ld male h a ecen l diagn ed i h m de a e e i en a hma ee f

f ll - in ea l Se embe . He e fl ica ne i na e/ alme e l (Ad ai ), 250/50 g
ice dail . He ha an A hma C n l Te c e f 22, hich indica e ell c n lled a hma,
and hi eak fl i 90% f he edic ed al e. S i me e f med 6 m n h ag h ed
an FEV1 f 90% f he edic ed al e. He can dem n a e g d echni e f ing hi
inhale .
A) Alle g e ing
B) The A hma The a A e men Q e i nnai e
C) Inc ea ing fl ica ne i na e/ alme e l 500/50 g ice dail
D) Infl en a accine
E) S i me
55. Which ne f he f ll ing al i n e a a i n i m effec i e f he ea men fi n

deficienc anemia in a a ien i h n n dial i -de enden ch nic kidne di ea e?
A) Fe ic ci a e (A ia)
B) Fe f ma a e
C) Fe gl c na e
D) Fe lfa e
20
I em #53
21
56. A 76- ea - ld male ee f a ine heal h main enance e amina i n. He a ha he ha
de el ed a mild em e he a fe ea , and i ha n bec me b he me him
beca e i affec hi hand i ing and hi abili ea in blic. Hi m he had a imila
em . He ha n em a e . When a k him h ld hi hand , n e a em
in b h hand and i . Hi ice i al me ha em l . He a k if he e a e an
ea men ed ce he em .
A) Ob e a i n nl
B) A ial f a -bl cke
C) A ial f a d amine gic agen
D) Se m ce l la min and 24-h ina c e e c e i n le el
E) MRI f he b ain
57. One f a ien ill n 65 in 2 eek and ac ice manage inel enc age
ched ling a Welc me Medica e e en i e i i n af e a ien 65 h bi hda . Thi
a ien c n in e k f ll ime and i c en l in ed h gh hi em l e - n ed
heal h in ance.
In de bill f a Welc me Medica e i i af e hi a ien n 65, hich ne f he

f ll ing i e?
A) The a ien m be en lled in Medica e Pa A

B) The a ien m be en lled in Medica e Pa B
C) The a ien m be en lled in Medica e Pa D
D) The a ien m be e age 65 and he ecific e f Medica e en llmen i n
ele an
58. An be e 60- ea - ld male e en i h knee ain af e a fall. He e ha 2 da ag he

li ed n me ice and fell f cef ll n hi lef knee. He i able alk b d e ha e a
n iceable lim . On e amina i n he i able fle hi knee a 90 and ha n in ende ne .
A) An i-inflamma medica i n
B) A c ic e id injec i n
C) A knee b ace
D) A adi g a h
E) MRI
22
59. A 32- ea - ld female c me ffice beca e f al i a i n . She e a en a i n f
he hea acing ha la f e e al ec nd , cc a e , and ha been cc ing dail f
he a c le f eek . She ha n had an l f c n ci ne he a cia ed
m m , ha n hi f ecen e an ie , and d e n d ink caffeine ake an
illici d g . She i he i e heal h and ake n medica i n . An e amina i n i n ema kable
and an EKG and ba ic lab a die a e all n mal.
Which ne f he f ll ing ld be he m a ia e ne e in e al a i n?
A) Rea ance nl
B) A 24-h H l e m ni
C) A 30-da ca diac e en m ni
D) An e e ci e e e
E) T an h acic ech ca di g a h
60. A 55- ea - ld male i h a 40- ack- ea m king hi c me ffice i h he e l

f i me he had a a heal h fai . He i m king 1 ea ag . He d e n ha e an c gh,
d nea, hee ing, m d c i n, b he i c nce ned ha he i me e l h
an FEV1/FVC a i f 0.65 and an FEV1 f 70% f edic ed, hich indica e mild m de a e
ai fl b c i n.
Ba ed n he be a ailable e idence, hich ne f he f ll ing h ld ec mmend in de

e en he de el men f m ma ic ai fl b c i n?
A) N ea men
B) A l ng-ac ing an ich line gic
C) A l ng-ac ing -ag ni
D) An inhaled c ic e id
E) C mbina i n he a ihac ic e id and l ng-ac ing -ag ni
61. A 37- ea - ld male ee di c me men al heal h c nce n . He a e ha he ha

ecen l been nable mee deadline a k and ha been e imanded b hi b . He feel
he cann c m le e he a k d ing hi kh and i ied he i g ing l e hi j b.
Y e al a i n indica e ha he migh ha e ad l a en i n-defici /h e ac i i di de
(ADHD).
Which ne f he f ll ing i e ega ding ad l ADHD?
A) S m m f ADHD m be e en bef e age 6

B) Ina en i n d e n e i in ad l h d
C) H e ac i i m m en in ad l h d
D) S im lan h ld n be e c ibed in ad l e he age f 30
E) Ad l i h ADHD h ld be c eened f c e i ing chia ic di de
23
62. An lde a ien e en ffice i h finding c n i en i h l m algia he ma ica.
Thi a ien i a g ea e ikf hich ne f he f ll ing a cia ed c ndi i n ?
A) An ine hil c la mic an ib d a cia ed a c li i

B) P l a e ii n d a
C) Taka a a e i i
D) Tem al a e i i
E) Wegene g an l ma i
63. R ine f ll - bl d e f c l ec al cance i h ld incl de
A) ca cin emb nic an igen (CEA) le el nl

B) li e f nc i n e nl
C) CBC and CEA le el nl
D) CBC and li e f nc i n e nl
E) CBC , CEA le el , and li e f nc i n e
64. An be e 45- ea - ld female e n f f ll - di c ecen lab a e l . She ha

kn n h e en i n and ake aml di ine (N a c), 5 mg dail . She ha bila e al knee
e a h i i and e ib fen a needed f ain. Recen lab a die h a fa ing
gl c e le el f 120 mg/dL, n mal elec l e , and n mal kidne and li e f nc i n. She ha
a al ch le e l le el f 203 mg/dL, an LDL-ch le e l le el f 134 mg/dL, an
HDL-ch le e l le el f 46 mg/dL, and a igl ce ide le el f 260 mg/dL. She ha a ng
famil hi f diabe e melli and ca di a c la di ea e.
Which ne f he f ll ing ha been h n be m effec i e in e en ing diabe e in

a ien ch a hi ?
A) Pa ici a i n in he Na i nal Diabe e P e en i n P g am

B) Aca b e (P ec e)
C) Li agl ide (Vic a)
D) Me f min (Gl c hage)
65. Which ne f he f ll ing i c n ide ed ne f he m c mm n f d alle gen ?
A) Beef
B) Black bean
C) Fi h
D) Oni n
E) Wa e mel n
24
66. Y a e ad i ing a g f medical den h a e lanning a bacc ce a i n g am f
e ec an m he . The medical den an b ild an ad e i ing g am ha he
egnanc benefi f bacc ce a i n.
Y ell he medical den ha e idence gge ha bacc ce a i n in egnan men
A) dec ea e he i k f ce a ean deli e

B) dec ea e he i k f eeclam ia
C) dec ea e he need f e id al ane he ia
D) inc ea e infan bi h eigh
E) inc ea e he i k f e e m deli e
67. A 49- ea - ld female e en ffice in n he n Calif nia i h a 6- eek hi f

inc ea ing c gh, hee ing, fe e , and inc ea ed h ne f b ea h. She ha e 2 diabe e
and e i en a hma nc n lled n high-d e b de nide/f m e l (S mbic ) and
m n el ka (Sing lai ). T eek ag he a ea ed i h a i h m cin (Zi h ma ) and a
10-da a e f edni ne. He m m ini iall im ed b ha e ened in he a 3
da . She ha n a eled ecen l .
On e amina i n da he ha a em e a e f 37.7 C (99.9 F), a e i a a e f 22/min,

and an gen a a i n f 92% n m ai . A lm na e amina i n i ignifican f
diff e e i a hee ing. A che adi g a h h me in e i ial hickening and i ead
a c nce ning f b nchiec a i . A CBC i ignifican f e in hilia i h an e in hil c n
f 960/mm3 (N 30 350). HIV e ing i nega i e.
Te ing f hich ne f he f ll ing gani m i m likel e eal a c n ib ing fac

he illne ?
A) A e gill
B) C ccidi ide immi i
C) Hi la ma
D) M c bac e i m be c l i
E) Pne m c i ji eci
25
68. A 28- ea - ld female e en i h a e e al-m n h hi f g ad all ening ain n he
adial ide f he igh i ha inc ea e hile he i a k. She d e n ha e an n mbne
ingling. He m m began af e he a ed a ne j b a a machini e a ing a e ,
hich in l e e e i i e g abbing and lling.
An e amina i n e eal n g abn mali ie and nl minimal f - i e ende ne a nd

he ba e f he h mb. Range f m i n f he h mb i limi ed b ain ha i ked hen
he make a fi e he h mb and m e he hand in lna de ia i n. The e i n ain i h
a ial c m e i n a i n f he fi me aca halangeal j in .
A) A h i i f he fi ca me aca al j in
B) Ca al nnel nd me
C) de Q e ain en n i i
D) S e f ac e f he ca h id
E) Ulna ne e en a men
69. A 13- ea - ld female i b gh ffice b he ad i e m he . The d n kn he

a ien bi l gical famil hi . The a e c nce ned beca e, nlike all f he f iend , he
ha n e a ed men a e. B ea de el men began 2 ea ag . On e amina i n he
b ea h a ec nda m nd f m he a e la and ni le ab e he c n f he b ea . She
ha da k, c a e hai c e ing he m n bi c n i en i h a age 4 e al ma i a ing.
If he e al de el men c n in e be n mal, a ha age h ld ec mmend e al a i n

f ima amen hea?
A) 13
B) 14
C) 15
D) 16
E) 17
70. A 42- ea - ld male e en ffice i h c lick flank ain f e e al h d a i n.

A inal i h hema ia and CT c nfi m a 6-mm kidne ne in he igh mid- e e . In
addi i n ain c n l, he a k if he e i an hing ha can be d ne ha en ne a age.
Ba ed n c en e idence, ec mmend
A) f emide (La i )
B) h d chl hia ide
C) b nin
D) ildenafil (Viag a)
E) am l in (Fl ma )
26
71. A 57- ea - ld female i h a hi f diabe e melli , h e en i n, and de e i n ee
f a ine f ll - i i . He i al ign incl de a hea a e f 88 bea /min, a bl d
e e f 162/84 mm Hg, and a BMI f 32 kg/m2.
The ec mmended an ih e en i e egimen f ed cing ca di a c la e en in hi a ien

i an ACE inhibi l
A) an -bl cke
B) an angi en in ece bl cke
C) a calci m channel bl cke
D) al di e ic
72. A 56- ea - ld male i h a l ng- anding hi f e e e COPD e en i h a 1- eek hi

f g e i e d nea. He a ha e e da i ened he in he e he c ld n eak
in f ll en ence . On e amina i n he a ea ale and dia h e ic. He ha a bl d e e f
100/58 mm Hg, a l e a e f 122 bea /min, a e i a a e f 28/min, and an gen
a a i n f 82% n m ai . He ha dimini hed ai en bila e all . A che adi g a hi
h n bel .
Which ne f he f ll ing i LEAST likel elie e hi a ien d nea?
A) S lemen al 100% gen

B) Neb li ed alb e l and i a i m (A en )
C) Needle h acen e i
D) Che be lacemen
73. An elde l h mele male i b gh he eme genc de a men . He i clea l h he mic

d e c ld e e and ha e ficial f bi e f hi e emi ie . He i ill c n ci and
hi e ing.
In addi i n e a ming him, hich ne f he f ll ing h ld admini e ?
A) Ace a lamide (Diam Se el )

B) Ami i line
C) Cef ia ne
D) Ib fen
E) PA
74. A 56- ea - ld female i h a BMI f 37 kg/m2 eek ad ice ega ding eigh l . Which
ne f he f ll ing medica i n in he c en egimen i m likel c n ib e eigh
gain?
A) B i n (Wellb in)
B) Li in il (P ini il, Ze il)
C) Me f min (Gl c hage)
D) Mi a a ine (Reme n)
E) Na en
27
I em #72
28
75. A 70- ea - ld male ee f e al a i n i ca a ac ge . He ha ell c n lled
h e en i n, a ell a ediabe e and e ec ile d f nc i n.
Which ne f he f ll ing ld be m a ia e i he ced e?
A) N e ing
B) A h mbin ime and INR de e mina i n
C) A CBC
D) A e ing EKG
E) 2D ech ca di g a h
76. A 72- ea - ld female e en i h b he me al i a i n . She i he i e heal h and i n

aking an medica i n . A h ical e amina i n i n mal, incl ding h id and e e
e amina i n . Lab a die e eal a e m TSH le el f 0.2 U/mL (N 0.4 4.0) and
n mal T3 and f ee T4 le el . An EKG e eal f e en ema e a ial c n ac i n b i
he i e n mal. Ul a n g a h f he h id d e n e eal an n d le , h id
cin ig a h h diff e ake, and an an i h in- ece ( h id- im la ing
imm n gl b lin) an ib d le el i ignifican l ele a ed.
A) Cen al h h idi m
B) G a e di ea e
C) I dine deficienc
D) S li a ic h id n d le
E) T ic m l in d la g i e
77. A 52- ea - ld male ee f a ine f ll - i i f diabe e melli . Hi hem gl bin

A1c i 7.6%. He al n e ha he ha been ha ing inc ea ing ain in hi igh h lde e he
a fe m n h b he cann ecall an ecific inj . The ain i a d ll, l l cali ed
ache ha adia e in he bice and i agg a a ed hen he eache e head. On e amina i n
n e dec ea ed ange f m i n in f a d fle i n, in e nal and e e nal a i n, and
abd c i n. The e i n mal eng h i h e i ed ac i a i n f he a c ff m cle and he e
a e n im ingemen m m .
A) O e a h i i f he h lde
B) Adhe i e ca li i
C) SLAP le i n
D) Inf a ina endin a h
E) S a ina endin a h
29
78. A 25- ea - ld female a 28 eek ge a i n c me ffice f a ine ena al i i . She
ecei ed Tda accine 3 ea ag af e he a bi en b a h e.
Which ne f he f ll ing ld be m effec i e ed ce he ne b n i k f c n ac ing

e i?
A) Tda accina i n f he m he n
B) Tda accina i n f he m he a m
C) N Tda accina i n f he m he n a m, and Tda accina i n f he
famil membe
D) N Tda accina i n f he m he n a m, and Tda accina i n f he
ne b n i hin 72 h f bi h
E) N Tda accina i n f he m he n a m, and a ec mmenda i n f g d
hand h giene ec he ne b n
79. A 45- ea - ld female e n clinic af e lm na f nc i n e ing f d nea. He

eb nch dila FEV1/FVC a i a 0.65, hich im ed 0.9 b nch dila .
The e finding a e m c n i en ih hich ne f he f ll ing?
A) A hma
B) COPD
C) In e i ial l ng di ea e
D) P lm na h e en i n
80. A 42- ea - ld male ee beca e f abn mal lab a e l f m a ecen heal h fai .
Lab a Finding
Alb min 4.1 g/dL (N 3.5 5.5)

Alkaline h ha a e 88 U/L (N 36 92)
AST 152 U/L (N 10 59)
ALT 70 U/L (N 13 40)
T al bili bin 0.9 mg/dL (0.3 1.2)
Ba ed n he e e l , hich ne f he f ll ing i he m likel ca e f hi ele a ed li e

an amina e le el ?
A) Ac e i al he a i i
B) Alc h lic li e di ea e
C) Ch le a i
D) N nalc h lic fa li e di ea e
30
81. A 47- ea - ld male i h be i , h e en i n, and e 2 diabe e ee beca e f g h
f hi b ea . An e amina i n c nfi m g nec ma ia.
S ing hich ne f he f ll ing medica i n in hi a ien c en egimen ld m

likel e l in eg e i n f hi g nec ma ia?
B) H d chl hia ide
C) Li agl ide (Vic a)
D) Pi gli a ne (Ac )
E) S i n lac ne (Aldac ne)
82. A 68- ea - ld male i h a hi f diabe e melli , h e en i n, c na a e di ea e,

and hea fail e i h ed ced ejec i n f ac i n ee f a f ll - i i 2 eek af e
ca diac ca he e i a i n and lacemen f d g-el ing en . He ell ha h ne f
b ea h ligh l limi hi h ical ac i i . Bef e he ced e an ech ca di g am e ealed
a ical h kine i and an e ima ed lef en ic la ejec i n f ac i n f 25%. Hi c en
medica i n incl de ca edil l (C eg), a a a in (Li i ), a i in, cl id g el (Pla i ),
i n lac ne (Aldac ne), ac bi il/ al a an (En e ), me f min (Gl c hage), and
em aglifl in (Ja diance). On e amina i n he a ien i e lemic, hi l e a e i 58
bea /min, hi bl d e e i 112/60 mm Hg, and hi hem gl bin A 1c i 7.2%.
Which ne f he f ll ing ld be he m a ia e managemen f hi hea di ea e?
A) N medica i n change and e ea ech ca di g a h in 2 m n h

B) Re lacing em aglifl in i h i agli in (Jan ia)
C) Re lacing ac bi il/ al a an i h li in il (P ini il, Ze il)
D) Immedia e lacemen f an im lan able ca diac defib illa
E) Refe al f lef a ial a endage cl e
83. An 81- ea - ld female i h a hi fh h idi m, e 2 diabe e , and age 4 ch nic

kidne di ea e e en clinic i h m de a e e e e l back ain ha began 2 da
ag . A hi i nega i e f a ma, fe e , and he emic m m . He i al ign a e
i hin n mal limi . A h ical e amina i n e eal m de a e in ende ne al a i n
ac he l e h acic and e l mba ine, b i he i e n ema kable, incl ding a
nega i e aigh leg ai ing e .
A lain adi g a h f he h acic and l mba ine e eal degene a i e change and gge
an e ic c m e i n f ac e. A CBC, e h c e edimen a i n a e, and C- eac i e
ein le el a e n mal.
Which ne f he f ll ing ld be m a ia e a hi in ?
A) Den mab (P lia)

B) Sched led ke lac
C) Sched led ace amin hen and lid caine a che
D) A fen an l a ch (D age ic), 25 g/h
E) Refe al a ne ge n f e c ane e eb al a gmen a i n
31
84. A 70- ea - ld female i admi ed he h i al i h igh e ad an ain de e mined
be ec nda ac e ch lec i i . Af e ini ial abili ing ea men he ge n ec mmend
ch lec ec m b he a ien decline . He famil an he ha e he ge and he ell
he hink he ha demen ia and cann make hi deci i n.
De e mining he a ien ca aci make a ecific medical deci i n h ld incl de a e men

f hich ne f he f ll ing?
A) Belief , al e , ea ning, and c mm nica i n

B) In eg i , c m e ence, fea , and c mm nica i n
C) Unde anding, a ecia i n, ea ning, and c mm nica i n
D) Unde anding, e nal i he , in elligence, and c mm nica i n
E) Val e , in elligence, e e i n, and dial g e
85. A 45- ea - ld female ee f he fi ime f a heal h main enance e amina i n. She ha

a 20- ack- ea hi f m king. She ha been e all ac i e i h men nl , ha been in
a m n gam ela i n hi f 15 ea , and ha ne e been egnan . A Pa anic la mea
2 ea ag a n mal. She a e ed 15 ea ag f hili and he a i i B i h nega i e
e l . She ha n had an he c eening e f e all an mi ed infec i n .
Which ne f he f ll ing c eening ld be a ia e f hi a ien ?
A) Bac e ial agin i

B) Chlam dia ach ma i and g n hea
C) HIV
D) HPV
E) S hili
86. A 40- ea - ld female e en f f ll - f a ecen diagn i f e e e e i en a hma.

Skin e ing f c mm n inhalan alle gen i nega i e, and he e m IgE le el a e n mal. She
ha a hi f hin hea and hee ing i h e e a i in.
Which ne f he f ll ing addi i nal c ndi i n i m likel be e en ?
A) Alle gic hini i

B) A e gill i
C) Ec ema
D) Na al l
E) Obe i
32
87. A 34- ea - ld female i h e 2 diabe e ha had e i l been managed i h me f min
(Gl c hage) and li agl ide (Vic a) a i ched in lin f gl cemic managemen d ing
he egnanc . In he eek bef e deli e he a achie ing fa ing and andial gl c e
a ge i h an in lin egimen f in lin de emi (Le emi ), 16 U dail , and in lin li
(H mal g), 4 U i h meal . He lab a ind ced a 37 eek ge a i n d e ele a ed bl d
e e and he had an nc m lica ed aginal deli e . She i lanning b ea feed.
Which ne f he f ll ing gl c e managemen egimen ld ec mmend f he in he

immedia e a m e i d?
A) C n in e he c en d age f in lin
B) C n in e in lin de emi and in lin li
C) C n in e in lin li and in lin de emi
D) Di c n in e in lin and eini ia e me f min
E) Di c n in e in lin and eini ia e li agl ide
88. Which ne f he f ll ing cance c n i en l declined in b h incidence and m ali

be een 1975 and 2015?
A) B ea cance
B) Ce ical cance
C) H dgkin l m h ma
D) L ng cance
E) P a e cance
89. An EKG e f med n a a ien i h a hi f hea fail e and an ejec i n f ac i n f 30%

e eal in h hm i h a hea a e f 55 bea /min and ne lef b ndle b anch bl ck i h a
QRS in e al f 160 m ec. The a ien i aking a -bl cke b ha a hi f
ace lch line e a e inhibi ind ced angi edema.
A) Ami da ne
B) I ab adine (C lan )
C) Sac bi il/ al a an (En e )
D) Sin a ial n de abla i n
E) Ca diac e nch ni a i n he a
90. Which ne f he f ll ing an ih e en i e medica i n i a cia ed i h ed ced ge i n

f diabe ic kidne di ea e?
B) Chl halid ne
C) Labe al l (T anda e)
D) S i n lac ne (Aldac ne)
E) Val a an (Di an)
33
91. A 22- ea - ld R ian female ha ecen l been hi ed ka clinic. She i g ing
h gh he ien a i n and c eening ce and a e a ked c een he f be c l i .
She ell ha he ecei ed he bacille Calme e-G in (BCG) accine a a child.
Which ne f he f ll ing ld be he ec mmended c eening f hi a ien ?
A) N c eening
B) A be c lin kin e (TST)
C) A - e TST
D) An in e fe n-gamma elea e a a (IGRA, Q an iFERON-TB G ld)
E) A che adi g a h
92. A 66- ea - ld male i h a hi f diabe e melli , h e en i n, and en in fficienc

e en i h a 3-cm diame e lce a i n n hi la e al l e leg. Recen a c la die h
n ignifican a e ial ccl i n and a f m n filamen e amina i n i n mal. Y a e he
nd and d n find ignifican de i ali ed i e ign f infec i n.
Which ne f he f ll ing in e en i n i m likel m e nd healing?
A) A c m e i n bandage
B) De mal ma i d e ing
C) H d gel d e ing
D) We - -d d e ing
E) P e c i i n diabe ic f ea
93. Y ac ice i a ing a c eening g am f de e i n. Which ne f he f ll ing i a

ca dinal m m f de e i n incl ded in he Pa ien Heal h Q e i nnai e 2 (PHQ-2)
c eening in men ?
A) Fa ig e
B) Lack f a e i e
C) Li le in e e lea e in d ing hing
D) Re le ne
E) Slee di bance
94. A 17- ea - ld male e en ffice be c eened f celiac di ea e. Hi lde i e a

ecen l diagn ed i h bi -c nfi med celiac di ea e. He ha had in e mi en abd minal
bl a ing b n he m m.
Which ne f he f ll ing i he c en be ac ice c een f celiac di ea e in hi

i a i n?
A) N c eening and ea men ba ed n famil hi

B) An igliadin an ib die
C) End m ial an ib die
D) Se m al IgA le el and IgA TG an ib die
E) E hag ga d den c i h mall b el bi ie
34
95. A 3- ea - ld male i b gh ffice b hi m he beca e he ha been lim ing. The
m he e ha he a him fall hile la ing a he a k i h me he child en
e e da , b ha he eemed fine af e a d. Thi m ning, h e e , he did n an an
eigh n he leg hen he g . The child ha al had a fe e ff and n f 3 5 da . Hi
m he a e ha he had a em e a e f 102 F da . The child d e n an bea eigh
n he affec ed e emi . Plain film imaging f b h l e e emi ie i nega i e.
Which ne f he f ll ing ld be he m a ia e ne e in he k ?
A) A CBC, e h c e edimen a i n a e, and C- eac i e ein le el

B) J in a i a i n
C) Ul a n g a h
D) B ne cin ig a h
E) MRI
96. A 72- ea - ld male c me ffice f an ann al heal h main enance i i . He men i n

ha me f hi f iend ecen l nde en heal h c eening and he a k if he e a e an
ca di a c la c eening e ec mmended f him. Hi bl d e e i ell c n lled and
he d e n ha e an h ne f b ea h che ain. He e e ci e eg la l . He a ed
m king ciga e e hile he a ended c llege b i a age 25. He d e n ha e a ignifican
famil hi f ca di a c la di ea e.
Which ne f he f ll ing e i ec mmended b he U.S. P e en i e Se ice Ta k F ce

f a ien ch a hi ?
A) An ankle-b achial inde

B) A high- en i i i C- eac i e ein le el
C) A c na a e calci m c e
D) Abd minal a ic ane m c eening i h l a n g a h
E) Ech ca di g a h
97. Y ee a 22- ea - ld female a 12 eek e ima ed ge a i n. An ib d e ing indica e ha

he i bella e i cal.
Which ne f he f ll ing i ec mmended b he CDC Ad i C mmi ee n

Imm ni a i n P ac ice ?
A) Recheck he bella an ib d i e af e deli e

B) Admini e MMR accine immedia el
C) Admini e MMR accine af e he fi ime e
D) Admini e MMR accine af e deli e
E) Rec mmend accina i n nl if he a ien ha n i ec d f ecei ing MMR
35
98. A heal h 2-m n h- ld female b n a e m i b gh ffice f a ell child check. The
a en e ha he child i e cl i el b ea fed and a k he he he h ld be iding
an addi i nal n i i n.
Which ne f he f ll ing ld ad i e?
A) N lemen a i n n il he child i 6 m n h ld
B) Wa e
C) Fl ide
D) Vi amin D
E) Rice ce eal
99. A 66- ea - ld female i h m l i le medical blem ha ine lab a k e f med

d ing a eg la l ched led clinic i i . All f he lab a al e a e n mal e ce f a
e m calci m le el f 11.0 mg/dL (N 8.5 10.2).
Which ne f he f ll ing medica i n in he c en egimen i m likel ca e an

ele a ed calci m le el?
A) Alend na e (F ama )
B) Li hi m
C) Ome a le (P il ec)
D) Se aline (Z l f )
E) S i n lac ne (Aldac ne)
100. The inabili e and make en e f n mbe i a c mm n blem enc n e ed in

h ician- a ien c mm nica i n ha can make i diffic l achie e ha ed deci i n-making.
Which ne f he f ll ing me h d ha been h n be a hel f l a eg hen di c ing
n mbe ?
A) U ing ela i e i k in ead f ab l e i k

B) U ing ic n a a ( ic g a h ) h ai
C) U ing e cen age in ead f f e encie
D) F aming c me in ei he i i e nega i e e m , b n b h
36
101. A 65- ea - ld female i h h e en i n and h e li idemia ee f f ll - af e a i i
1 eek ag beca e f nc n lled h e en i n and ne - n e e 2 diabe e . She ha m ked
ne ack f ciga e e e da f he a 40 ea . He medica i n incl de aml di ine
(N a c), 10 mg dail ; h d chl hia ide, 12.5 mg dail ; and a a a in (Li i ), 20 mg
dail . A la eek i i added me f min (Gl c hage), 500 mg ice dail , and li in il
(P ini il, Ze il), 5 mg dail .
The a ien i h icall ac i e and a m ma ic. She i 165 cm (65 in) all and eigh 59 kg
(130 lb) i h a BMI f 22 kg/m2. A h ical e amina i n i n mal. A mma f he ecen
i al ign and lab a da a i li ed bel .
One eek ag T da
Bl d e e 165/92 mm Hg 162/88 mm Hg
P le 72 bea /min 76 bea /min
Hem gl bin A1c 7.2% n mea ed
Gl c e 183 mg/dL 156 mg/dL
S di m 140 mE /L (N 135 145) 141 mE /L
P a i m 4.2 mE /L (N 3.5 5.0) 5.1 mE /L
BUN 12 mg/dL (N 8 25) 20 mg/dL
C ea inine 0.8 mg/dL (N 0.6 1.2) 1.4 mg/dL
Y diagn e e i an h e en i n and c n ide e al a ing f an nde l ing ca e f

ec nda h e en i n. Which ne f he f ll ing e ld m likel ield a diagn i
in hi ca e?
A) Pla ma f ee me ane h ine

B) A l -d e de ame ha ne e i n e
C) MR angi g a h f he enal a e ie
D) P l mn g a h
102. A 60- ea - ld male i h a l ng- anding hi f e 2 diabe e i admi ed he h i al.

He ake f al medica i n f he ea men f diabe e a h me. Y decide i ch him
in lin in ead f c n in ing al medica i n hile he i h i ali ed. He i ea ing hi meal
ell.
Af e calc la ing he al dail in lin d e, hich ne f he f ll ing ld be m

a ia e?
A) Admini e he al dail d e a l ng-ac ing in lin in e al d e e e 12 h

B) Admini e half f he al dail d e f in lin a l ng-ac ing in lin and he he half
a h -ac ing in lin in h ee di ided d e , gi en i h each meal
C) Admini e he al dail d e a h -ac ing in lin in h ee di ided d e , gi en i h
each meal
D) Admini e he al dail d e a h -ac ing in lin in f di ided d e , gi en i h
each meal and a bed ime
E) Admini e he al dail d e a a h -ac ing liding cale egimen ba ed n bed ide
gl c e eading , in f di ided d e
37
103. A 60- ea - ld male e en i h d nea n e e i n, cca i nal hee ing, and a ch nic
c gh ha i d c i e. He ha ne e been h i ali ed. He ha m ked ne ack f ciga e e
e da ince he age f 20. An e amina i n e eal dimini hed b ea h nd b n c ackle ,
j g la en di en i n, gall , edema. S i me h a b nch dila FEV 1 ha
i 45% f he edic ed al e, and he e e i f hi di ea e i a ed a Gl bal Ini ia i e f
Ch nic Ob c i e L ng Di ea e (GOLD) g C.
In addi i n alb e l a needed f m ma ic elief and m king ce a i n, he ini ial

ea men h ld incl de
A) becl me ha ne
B) b de nide/f m e l (S mbic )
C) fl mila (Dali e )
D) he h lline
E) i i m (S i i a)
104. A 63- ea - ld female e en ffice i h a dden n e f ligh headedne and mild

na ea ha he fi n ed hen ge ing f bed hi m ning. She ha had e ea ed e i de
f a inning en a i n hen il ing he head d n. He m m ha e been e ee
ha he c ld n g k da . She ha a hi f e en ial h e en i n ha i ell
c n lled n h d chl hia ide. She ha n had an headache, hea ing l , inni ,
ecen illne a ma. She ha a em e a e f 36.8 C (98.2 F), a bl d e e f 136/80
mm Hg, a hea a e f 80 bea /min, a e i a a e f 12/min, and an gen a a i n f
96% n m ai . Y e f m he Di -Hall ike mane e i h he igh ea d n and in he
de enden i i n and n e a la en i nal, bea ing n agm .
The m a ia e in e en i n a hi ime ld be
A) l nged igh i i ning

B) canali h e i i ning ced e
C) e ib la f nc i n e ing
D) e ib la e an medica i n
E) MRI f he b ain
105. A 24- ea - ld male e en f e al a i n f cla ic la ain af e a fall hile m n ain biking.

On e amina i n he ha a ainf l al able l m and b i ing e he middle hi d f hi lef
cla icle. He ha n mal e i he al l e , and eng h and en a i n f hi lef a m a e in ac .
Radi g a h e eal a mid haf cla ic la f ac e ha i di laced a ima el 1.5 ime he
id h f he cla icle and i h ened b 2 cm. The imal i ni a dl di laced.
Which ne f he f ll ing ld be he m a ia e managemen f hi inj ?
A) A fig e- f-eigh lin

B) A ling
C) Cl ed ed c i n and a ling
D) Ca ing
E) E al a i n f gical fi a i n
38
106. A 30- ea - ld male ha m de a e e e e ec al ain ha cc i h b el m emen and
la f e e al h . He e minimal b igh ed bl d n he ile i e. On e amina i n
he i n ed ha e an anal fi e in he e i midline. Si ba h and fibe lemen a i n
ha e ided n elief, and ical nifedi ine he a did n e l e hi m m.
Which ne f he f ll ing ld be an effec i e ea men ?
A) -Bl cke injec i n

B) B lin m in injec i n
C) C ic e id injec i n
D) Lid caine injec i n
E) R bbe band liga i n
107. A 72- ea - ld female ha a kn n hi f a ic en i . Which ne f he f ll ing

m m h ical finding ld indica e a need f gen e ea ech ca di g a h and
ca di l g efe al?
A) Headache
B) Pal i a i n
C) P e nc e
D) Edema f b h l e e emi ie
E) A g ade 2/6 lic ejec i n m m adia ing he a a
108. A 25- ea - ld female i c nce ned ab kin le i n ha ha e e ea edl a ea ed and

e l ed, me ime la ing f m n h . She ha ied ea men i h ical e - he-c n e
an ibi ic in men ihn cce . She a e ha he m he ha imila le i n .
On e amina i n he i al ign a e n ema kable e ce f a BMI f 32 kg/m2. The e amina i n

al e eal m l i le dee - ea ed inflamma n d le in b h a illae ha a e 1.5 cm in
i e and ainf l ch. Y al n e me mal d d ainage and ca in he a illae ha
he a a e f m e i le i n . N he a ea a e affec ed. She i afeb ile and ha n he
m m.
A) Acne c ngl ba a
B) C ane C hn di ea e
C) Hid adeni i ai a
D) Pil nidal c
E) Rec en ima bac e ial ab ce
39
109. A 50- ea - ld female ee f he fi ime. She i ac i e and ha n een a h ician f
2 ea . The la accine he ecei ed a Tda f ll ing he bi h f he g andda gh e 2 ea
ag . She ha a a hi f e en ial h e en i n and h e li idemia b he medical hi
i he i e n ema kable.
Ba ed n CDC g ideline , hich ne f he f ll ing accine h ld ec mmend f hi

a ien da ?
A) HPV
B) Pne m c ccal c nj ga e (PCV13, P e na 13)
C) Pne m c ccal l accha ide (PPSV23, Pne m a 23)
D) Li e e (Z a a )
E) Rec mbinan e (Shing i )
110. A 48- ea - ld male e en i h a 1- ea hi f feeling ne . He feel ell he i e

e ce f mild di c mf f m a h i i in b h knee . A h ical e amina i n i n mal, and
lab a die , incl ding h id f nc i n, a e al n mal. Y make a diagn i f
gene ali ed an ie di de . The a ien decline ch he a and efe ha mac l gic
ea men .
Which ne f he f ll ing i he fi -line l ng- e m ea men f hi a ien ?
A) Al a lam (Xana )
B) B i ne
C) D l e ine (C mbal a)
D) Imi amine (T f anil)
E) Q e ia ine (Se el)
111. A 50- ea - ld female ee f a ine heal h main enance i i . On e amina i n n e

a h id n d le and l a n g a h c nfi m a lid 1.5-cm n d le. He TSH le el i n mal.
Which ne f he f ll ing ld be he m a ia e ne e in he managemen f hi

a ien ?
A) An i h id an ib d i e
B) A h id can
C) A fine-needle a i a i n bi
D) S gical e ci i n f he n d le
E) Re ea l a n g a h in 6 m n h
40
112. A 58- ea - ld a hle ic aine e en i h ac e l back ain. He hink he ain began af e
he a ed a ne eigh lif ing egimen 3 eek ag . The ain d e n adia e, and l nged
anding e ace ba e he ain. He d e n ha e an b el bladde inc n inence, fe e ,
addle ane he ia. He a k hich e f he a i m likel h en he c e f he ain.
Which ne f he f ll ing ld be he be ec mmenda i n?
A) Ice
B) Ta ge ed e e ci e
C) O al analge ic
D) S inal mani la i n
E) E idence d e n he ei i f an m dali
113. Which ne f he f ll ing a ien fac ld be m likel c n aindica e e f a

hia ide di e ic ch a chl halid ne?
A) Ch nic g
B) An ejec i n f ac i n f 45%
C) H h idi m
D) S age 3b ch nic kidne di ea e
E) A hi f a a h hen aking ime h im/ lfame h a le (Bac im) in childh d
114. A famil in ac ice incl de an 11- ea - ld female and a 17- ea - ld male h a e b h

heal h . The a e een e a a el i h and i h hei a en and ha e n e idence f geni al
a he le i n . The 11- ea - ld i n e all ac i e b he 17- ea - ld ha gi en and
ecei ed al e f m a e i gi lf iend. He a he i n e all ac i e a hi ime.
Nei he f he e a ien ha ecei ed HPV accine in he a .
Which ne f he f ll ing h ld ec mmend ega ding HPV accina i n?
A) N HPV accine f ei he ibling

B) A -d e HPV accine e ie f b h ibling
C) A h ee-d e HPV accine e ie f b h ibling
D) A -d e HPV accine e ie f he 11- ea - ld and a h ee-d e HPV accine e ie
f he 17- ea - ld
E) A h ee-d e HPV accine e ie f he 11- ea - ld and a -d e HPV accine e ie
f he 17- ea - ld
115. Which ne f he f ll ing medica i n h ld be c n ide ed f a ien aking m e han 50

m hine millig am e i alen (MME ) dail f ch nic ain?
A) Cl na e am (Kl n in)
B) Cl nidine (Ca a e )
C) Me had ne
D) Nal ne
E) Nal e ne (Vi i l)
41
116. L ng- e m gen he a i ec mmended f a ien i h COPD h ha e a e ing gen
a ai na bel a h e h ld f
A) 88%
B) 89%
C) 90%
D) 93%
E) 95%
117. A heal h 29- ea - ld female ee f a heal h main enance i i . Y ec mmend infl en a

accine b he decline beca e he ha angi edema i h inge i n f an egg egg d c .
She ha an e ine h ine a -injec (E iPen) and la ed i a ima el 9 m n h ag hen
he acciden all inge ed a mall am n f egg. She ha n een he alle gi in m e han 3
ea b i lanning call n f an a in men .
Ba ed n CDC g ideline , hich ne f he f ll ing ld ec mmend f hi a ien

ega ding infl en a accina i n?
A) N infl en a accina i n ega dle f accine f m

B) Vaccina i n nl i h inac i a ed infl en a accine
C) Vaccina i n i h an licen ed f m f infl en a accine
D) Refe al an alle gi f ecific alle gen e ing i accina i n
118. A 67- ea - ld female i h a hi f e 2 diabe e , h e en i n, e a h i i , and

h e li idemia ee f f ll - f lab a e l af e he a ic ea i and mild
len megal e e n ed n abd minal l a n g a h e f med d ing a ecen eme genc
de a men i i f igh e ad an ain. She i c en l a m ma ic. He i al ign
incl de a bl d e e f 128/72 mm Hg and a BMI f 34 kg/m2. An e amina i n i
ignifican nl f ace bila e al l e e emi edema. A ca di a c la e amina i n i
he i e n mal and ne l gic and abd minal e amina i n a e n mal.
Lab a Finding
Pla ele 112,000/mm3 (N 150,000 450,000)

Hem gl bin A1c 6.6%
AST 68 U/L (N 8 48)
ALT 55 U/L (N 7 55)
Alb min 3.2 g/dL (N 3.5 5.0)
Bili bin 0.5 mg/dL (N 0.1 1.2)
INR 1.0 (N <1.2)
Which ne f he f ll ing medica i n h ld be AVOIDED in hi a ien ed ce he

likelih d f c m lica i n f he medical c ndi i n?
A) Ace amin hen

B) A a a in (Li i )
C) Ib fen
D) Li in il (P ini il, Ze il)
E) Me f min (Gl c hage)
42
119. Which ne f he f ll ing e f hall cina i n i a cia ed i h Pa kin n di ea e?
A) A di nl
B) A di and i al
C) H nag gic
D) H n m ic
E) Vi al nl
120. A 23- ea - ld male e en f e al a i n f i ain af e he fell hile ka eb a ding. On

e amina i n he ha lef i ain i h n ffb ende ne . A adi g a h f hi i h a
f ac e h gh he mid i n f he ca h id i h 2 mm f di lacemen .
Which ne f he f ll ing ld be he m a ia e ea men f hi inj ?
A) A h mb ica ca
B) A h a m ca
C) A l ng a m ca
D) Cl ed ed c i n f ll ed b a h mb ica ca
E) S gical fi a i n
121. A 21- ea - ld female c me ffice beca e f c nce n ab e ce hai g h. She

ha da k hai n he e li and chin and a nd he ni le ha ha e been c n i en l
e en ince be , and he i di a i fied i h he c me ic e l f a i hai em al
me h d . She ha eg la men e and d e n ih bec me egnan a hi ime. An
e amina i n i c n i en i h me e minal hai in he di ib i n he de c ibe and i
he i e n ema kable.
A) An ea l m ning al e e ne le el
B) A f ll h m nal k incl ding h id f nc i n e ing, lac in,
17-h d ge e ne, and deh d e iand e ne lfa e (DHEAS) le el
C) T an aginal l a n g a h
D) A 6-m n h ial f al c n ace i e ill
122. The ini ial ea men f ch ice f head lice i
A) lindane 1% ham
B) e me h in 1% ham (Ni )
C) e h m 0.3%/ i e n l b ide 4% ham (Rid)
D) i e mec in 0.5% l i n (Sklice)
E) mala hi n 0.5% l i n (O ide)
43
123. Y a e king in an gen ca e clinic hen a 68- ea - ld male i h ch nic h e en i n
ee f efill f hi medica i n . He ha been f hi medica i n f he a m n h and
c ld n ge an a in men i h hi ima ca e h ician f efill . Hi bl d e ei
e i en l 190/115 mm Hg, e en af e he ha e ed in a ie m f 30 min e . Hi bl d
e e e i l had been ell c n lled. He ha a m de a e headache b he i e feel
ell. An e amina i n, incl ding a f nd c ic e amina i n, i n mal.
Which ne f he f ll ing managemen i n ld be m a ia e a hi ime?
A) Refill hi al medica i n and a ange f f ll - in 1 eek

B) Admini e al labe al l (T anda e) e e 30 min e n il hi bl d e e i
<180/110 mm Hg
C) Admini e al nifedi ine (P ca dia) e e 30 min e n il hi bl d e e i
<180/110 mm Hg
D) Admini e bling al nifedi ine e e 30 min e n il hi bl d e e i <180/110
mm Hg
E) Refe f immedia e h i ali a i n f in a en an ih e en i e ea men
124. The U.S. P e en i e Se ice Ta k F ce ec mmend hich ne f he f ll ing f b ea

cance c eening?
A) Ann al c eening mamm g a h f men age 40 75

B) Ann al c eening mamm g a h f men age 50 75
C) Biennial c eening mamm g a h f men age 35 75
D) Biennial c eening mamm g a h f men age 50 75
E) Biennial c eening mamm g a h f men age 45 50 and ann al c eening
mamm g a h f men age 51 75
125. Y ad i e a 58- ea - ld male i h ch nic kidne di ea e limi hi al in ake. He a k ab

he benefi f hi change, ince he h ghl enj hi high- al die .
F a ien i h ch nic kidne di ea e, c en e idence h ha a l - al die
A) dec ea e m ali
B) l e bl d e e
C) inc ea e ein ia
D) inc ea e he ime endage enal di ea e and he need f dial i
44
126. A 65- ea - ld male e en ffice i h bila e al eakne ha ha been e en f
e e al eek . He n e inc ea ing diffic l in climbing ai b i able alk n hi e
and heel n mall . He can en a ja and n a d kn b i h diffic l b ha ble
eaching an e head helf. The hi i c nfi med b a h ical e amina i n.
Which ne f he f ll ing i m f en a cia ed i h hi e f m cle eakne ?
A) Fl in l ne e
B) F ail nd me
C) G illain-Ba nd me
D) M l i le cle i
E) P l m ii
127. A a ine i i , a 65- ea - ld male f me m ke e h ne f b ea h and a c gh ha

ha been ening l l e he la 6 m n h . On e amina i n hea biba ila in i a
c ackle . An EKG, che adi g a h, and ech ca di g am a e n mal. CT f he che h
m l i le bila e al a ch a ea f c n lida i n.
The m a ia e ne e i
A) ake a de ailed hi f medica i n e and life ime en i nmen al e e

B) a an an ibi ic
C) a f emide (La i )
D) a an inhaled h -ac ing -ag ni a needed
E) efe f lm na ehabili a i n
45
128. A 24- ea - ld male i h ickle cell di ea e (Hb SS) e en he eme genc de a men (ED)
i h a 5-da hi f e e e ain in hi l e back, leg , and h lde . The e ie f
em i i i e f ja ndice and cle al ic e , b i nega i e f headache, che ain,
h ne f b ea h, and ia i m. He e ha hi m m ae ical f hi e i
a - ccl i e ain, and he belie e hi e i de a igge ed b he ecen c ld ea he . He
ied a id c ming he ED b ing al medica i n a h me, incl ding na en, 500 mg
ice dail , and immedia e- elea e c d ne (R ic d ne), 10 mg e e 4 h a needed.
He ake n he medica i n and e n kn n d g alle gie . He i ain f ee n
a ima el 75% f da , and he can icall manage hi ain a h me d ing he emaining
ime .
The a ien i al ign a e n ema kable e ce f a mildl ele a ed l e a e f 102

bea /min. Hi WBC c n i 17,000/mm3 (N 5000 10,000) and hi hem gl bin le el i a i
ba eline f 8.0 g/dL. The a ien i admi ed he h i al f in a en fl id and ain
medica i n ia a ien -c n lled analge ia. Thi i hi ec nd admi i n f he ea f a
a - ccl i e ain c i i . He e nd ell e he ne fe da and i di cha ged h me
in g d c ndi i n.
Which ne f he f ll ing h ld be di c ed i h he a ien a f ll - ?
A) Dail h d ea he a
B) O al enicillin h la i
C) S i ching f m immedia e- elea e c d ne l ng-ac ing c d ne (O C n in)
ice dail
D) Ann al an c anial D le l a n g a h
E) Sched led bl d an f i n main ain a hem gl bin le el >10 g/dL
129. A heal h 26- ea - ld female ld like a ing eg la c n ace i n and a k ab he

i n . He men e a e n mal and he la men al e i d a 10 da ag .
If ini ia ed da , hich ne f he f ll ing c n ace i e me h d d e NOT e i e he e

f back c n ace i n?
A) O al c n ace i e
B) An e n ge el bde mal im lan (Ne lan n)
C) Ac e -c n aining IUD (Pa aGa d)
D) A le n ge el IUD (Mi ena)
130. In a a ien i h d c men ed Helic bac e l i infec i n, hich ne f he f ll ing die

h ld be e f med d c men clea ance f he infec i n?
A) An H. l i IgG le el
B) An H. l i IgM le el
C) A l an igen e 1 eek af e he c m le i n f an ibi ic he a
D) A ea b ea h e 1 m n h af e he c m le i n f an ibi ic he a
E) A ga ic bi
46
131. A 26- ea - ld female i h a hi f bi la di de ee f f ll - f ch nic j in
ain. The e ie f em i i i e f in e mi en a he n he d al hand and face and
lef - ided le i ic che ain. An e amina i n e eal ende elling f he hand and i
j in bila e all . E amina i n f he l ng e eal dimini hed b ea h nd a he lef ba e i h
in - f-ca e l a n g a h finding c n i en i h a mall le al eff i n. Ini ial lab a
e a e ignifican f a la ele c n f 96,000/mm3 (N 130,000 450,000), a ii e
an in clea an ib d e i h a 1:80 i e (N <1:40), and nega i e L me di ea e and HIV e .
Which ne f he f ll ing ld hel c nfi m ec ed diagn i ?
A) Ele a ed an ic clic ci llina ed e ide an ib die

B) Ele a ed an i m h m cle an ib die
C) Ele a ed an i-cen me e an ib die
D) L c m lemen le el
E) P i i e HLA-B27
132. A 40- ea - ld female e en i h a 3-m n h hi f m m gge i e f ca al nnel

nd me. Which ne f he f ll ing icall e l f m im ai men f he median ne e
in hi c ndi i n?
A) Weakne f h mb abd c i n
B) Weakne f fle i n in he h mb, inde , and middle finge
C) N mbne n he d m f he hand
D) N mbne in he lna ide f he ing finge and in he li le finge
E) Pa e he ia ain in he h mb, inde finge , middle finge , and adial ide f he ing
finge
133. An 18- ea - ld male i b gh clinic b hi a en . He e dail e f alc h l and

i id ha he ha been ge ing illegall f m hi f iend . Thi habi a ed 3 ea ag hen
he a ed high ch l.
In addi i n c n eling, hich ne f he f ll ing ha mac l gic agen i indica ed ea

b h f hi b ance e di de ?
A) Acam ae
B) B i n (Wellb in)
C) Di lfi am (An ab e)
D) Me had ne
E) Nal e ne
47
134. While e ing a eam h ician a a f ball game n a h af e n n a e a ked e al a e
an be e 17- ea - ld la e h ha beg n lim ing. The la e e ha he i e h . An
e amina i n i n mal e ce f a ga cnemi a m. Y diagn e hea c am . A
e ae a ea men i h i nic fl id, e ching, and ma age, he c ach a k h
n he a hle e can e n la .
Y inf m he c ach ha he la e can e me a ici a i n
A) n
B) m
C) n e l i n f hi m m
D) hen hi em e a e i <38.3 C (100.9 F)
E) af e acclima ing he hea f 1 eek
135. Which ne f he f ll ing a ien h ld ecei e an ibi ic h la i e en infec i e

end ca di i i ha ing den al k ha ill incl de e i d n al mani la i n?
A) A 6- ea - ld male i h an n e ai ed a ial e al defec

B) A 32- ea - ld female i h mi al al e la e i h ignifican eg gi a i n
C) A 52- ea - ld male i h a a hi f a an ca he e a ic al e e lacemen
D) A 60- ea - ld male i h a ial fib illa i n d e he ma ic mi al al e di ea e
E) A 70- ea - ld female i h hem d namicall ignifican a ic en i /a ic
in fficienc
136. A 55- ea - ld female e en ffice beca e he ha in e mi en l cking f he igh

ing finge hen i i fle ed. I i ainf l and he f en ha e he he hand e end he
finge . He k in l e e e i i e m emen f he hand and he e e a ea men i n
ha ill in l e a li le mi ed ime f m ka ible.
Which ne f he f ll ing ld be he m c -effec i e i n?
A) NSAID
B) A c ic e id injec i n
C) S lin ing f he di al in e halangeal j in
D) Ph ical he a
E) S gical c ec i n
137. In a ien h i ali ed i h ac e e i a infec i n , calci nin le el a e ef l f
A) n i i nal a a e men
B) ed cing ina ia e e f an ibi ic
C) ling lm na emb li m
D) ea l iden ifica i n f he nd me f ina ia e ec e i n f an idi e ic h m ne
(SIADH)
E) iden if ing ac e e i a di e nd me
48
138. A 36- ea - ld male ee f f ll - f g e i e fa ig e and ligh headedne ha ha
ened e he a 3 m n h . He ha l 5 kg (11 lb) d ing hi ime. On e amina i n he
ha a BMI f 21 kg/m2, a bl d e e f 88/48 mm Hg, and a l e a e f 66 bea /min. A
kin e amina i n i n able f a che f n n igmen ed kin n he hand . Ini ial lab a
e ing i ignifican f a di m le el f 132 mE /L (N 135 145) and a a i m le el f 5.3
mE /L (N 3.5 5.0).
Which ne f he f ll ing e ld c nfi m he m likel diagn i ?
A) 17-h d ge e ne
B) ACTH im la i n
C) De ame ha ne e i n
D) La e nigh ali a c i l
E) Pla ma enin and ald e ne
139. A 45- ea - ld female ee f he fi ime f a heal h main enance i i . She ha a hi

f ch nic l and midback ain f e e al ea , hich he ea i h ib fen, m cle
ela e , and a hea ing ad. She ake a c mbined al c n ace i e ill c n l hea
men al c cle . She ecen l en an gen ca e clinic f ea men f an e e ia
ac infec i n. She al men i n he g ad al a ea ance f a a h n he back b a ha i
d e n b he he . A kin e amina i n i n able f e ic la b n h e igmen a i n f he
en i e back ( h n bel ).
Which ne f he f ll ing i he m likel ca e f he kin change ?
A) E hema ab igne
B) Hen ch-Sch nlein a
C) Idi a hic g a e h melan i
D) Tinea e ic l
140. A a ien b n in 1954 e e c eening f he a i i C. Hi an i-HCV an ib d c een i

i i e.
A) A c nfi ma ec nd an i-HCV e in 4 6 eek

B) A ali a i e HCV RNA e
C) Q an i a i e HCV gen ing
D) T ea men i h a d al an i i al egimen ending addi i nal e ing
E) Refe al f a e c ane li e bi
49
I em #139
50
141. Y a e ca ing f an 84- ea - ld female i h Al heime demen ia. She i di ien ed ime
b all ien ed e n and lace. She i h meb nd b i f e en l i i ed b famil .
The a ien da gh e feel c nflic ed b an he m he g a killed ca e facili . The
a ien i adaman ha he d e n an lea e he h me. D ing a ecen h me i i
n ed ha he melled f ine and had a e e e in e igin ah ici f Candida. He
bed ide Mini-Men al S a e E amina i n c e a 24/30.
Which ne f he f ll ing e hical inci le h ld be he ima c n ide a i n hen

de e mining he he hi a ien h ld c n in e li e a h me?
A) A n m
B) C m e ence
C) Ha m
D) J ice
E) Safe
142. A 38- ea - ld male e en i h a 2-m n h hi f inc ea ed andial na ea and

n nbl d , ainle , l e l . He feel ell he i e. Ten m n h ag he nde en
ba ia ic ge , hich in l ed c ea ing a mall mach ch. The e e e n c m lica i n
f m he ge and he d e n ake an medica i n . A e ie f hi die e eal ha he ha
h ee mall meal and nack dail . He ha ne e ing f ege able b ead i h each
meal. He ha 16 f c ffee i h b eakfa , 12 f da i h l nch, 12 f bee i h
dinne , and a c f ae milk i h nack . Hi nack i all chee e ean b e and
a c acke . An e amina i n i n ema kable.
Y a e c nce ned i h hi die habi and ec mmenda i n incl de
A) n fl id f 15 min e bef e af e meal and nack

B) limi ing ca b na ed be e age 8 e meal nack
C) inc ea ing dail e ing f fib ege able and h le g ain b ead
D) ea ing ne meal and h ee nack dail
E) ea ing a die l e in fa
51
143. A heal h 52- ea - ld male h n f 40 min e 4 5 ime e eek c me ffice
beca e he ha ecen l n ed ain in he inne a ec f hi igh knee al ng he j in line. He
al e mild elling and iffne in hi knee al ng i h a clicking en a i n hen he
fle e and e end i . In addi i n, he a ha a n edic able ime he feel like hi knee
migh gi e a . D ing he e amina i n he e ain al ng he medial j in line i h
al a i n, and he McM a e i i i e. A b e en MRI dem n a e a degene a i e
ea in he la e al i n f he medial meni c i h n ignifican degene a i e a h i i . Y
begin di c a managemen lan i h him, c n ide ing a i gical and n n gical
i n.
Gi en hi a ien age and clinical finding , hich ne f he f ll ing ha been h n

d ce be e l ng- e m c me han c n e a i e managemen ?
A) In a-a ic la c ic e id
B) H lan GF 20 (S n i c)
C) A h c ic meni cec m
D) A h c ic meni c e ai
E) N addi i nal ea men a egie
144. Which ne f he f ll ing clinical fea e i a c m nen f he STOP-Bang e i nnai e

ed a a c eening lf b c i e lee a nea?
A) Bl d e e
B) P l e ae
C) Re ing gen a a i n
D) Sm king a
E) Wai ci c mfe ence
145. A 12- ea - ld male i b gh ffice b hi g a dian. In he la 12 m n h he a

ended f m ch l m l i le ime f b ll ing and figh ing. He kick he famil d g and
g e a nigh i h e mi i n. He an a a f m h me 2 eek ag and he lie
c n an l . He ki ch l and d e n ca e ab hi g ade . A en i n-defici /h e ac i i
di de a e i l led . T da ag he a g nded and e alia ed b de ing
hi g a dian c m e . D ing he ffice i i he a ch l i b ing and id.
Which ne f he f ll ing ld be he m a ia e ne e in managing hi a ien ?
A) Ca bama e ine (Teg e l)

B) Hal e id l
C) Li hi m
D) Q e ia ine (Se el)
E) Refe al f ch cial in e en i n
52
146. A 35- ea - ld female e en i h fa ig e. She f ll a ic egan die and d e n ake an
medica i n . The e i n hi f an abn mal bleeding. Al h gh he ha had fa ig e f 2
ea , he n n ice ha he ha a c a ing f ice. Re l f a lab a e al a i n a e
h n bel .
WBC 5100/mm3 (N 3400 10,800)

Ba hil 0.0 103/ L (N 0.0 0.2)
Imma e g an l c e 0%
Imma e g an l c e c n 0.0 103/ L (N 0.0 0.1)
Pla ele 271,000/mm3 (N 150,000 379,000)
RBC 4.75 milli n/mm3 (N 3.77 5.28)
Re ic l c e 1.2% (N 0.6 2.6)
Hem gl bin 9.2 g/dL (N 11.1 15.9)
Hema c i 32.3% (N 34.0 46.6)
Mean c c la l me 68 m3 (N 79 97)
Mean c c la hem gl bin 19.4 g/cell (N 26.6 33.0)
Mean c c la hem gl bin
c ncen a i n 28.5 g/dL (N 31.5 35.7)
RDW 18.1% (N 12.3 15.4)
T al i n binding ca aci 519 g/dL (N 250 450)
Un a a ed i n binding ca aci 482 g/dL (N 131 425)
I n 37 g/dL (N 27 159)
I n a ai n 7% (N 15 55)
T an fe in 405 mg/dL (N 200 370)
Fe i in 4 ng/mL (N 15 150)
Vi amin B12 353 g/mL (N 160 950)
Gi en he e e l , hich ne f he f ll ing ld be he ne e in he managemen f hi

a ien ?
A) Recheck he hem gl bin le el in 3 m n h

B) S a fe lfa e, 325 mg all
C) O de an in a en i n inf i n
D) O de a bl d an f i n
E) Refe f c l n c
147. In a a ien n ch nic a fa in (C madin) he a h ha a able INR in he he a e ic

ange, hich ne f he f ll ing an ibi ic ld be m likel ele a e he INR?
A) Ce hale in (Kefle )
B) Clindam cin (Cle cin)
C) Penicillin G
D) Rifam in (Rifadin)
E) T ime h im/ lfame h a le (Bac im)
53
148. A 6-m n h- ld male i b gh ffice b hi a en f a ell child check. He i hei
fi child. On e amina i n n e ha he ha e ed ee h. The famil li e in a n
i h fl ida ed a e and he a en ld like kn h ca e f hei child ee h.
Which ne f he f ll ing i he m effec i e e en i e mea ef hi child ne l

e ed ee h?
A) N ca e i needed a hi in
B) A a en i ing b hing he ee h i h a e ice dail
C) A a en b hing he ee h i h a mea f l -fl ide h a e ice dail
D) A fl ide lemen dail
E) T ical ealan
149. A 36- ea - ld male e en i h a 6- eek hi f a mildl i ic a h in hi g in. An

e amina i n e eal mall ed-b n mac le and la ge a che i h a ha b de . A W d
lam e amina i n e eal c al- ed fl e cence.
Which ne f he f ll ing ld be he m a ia e ea men f hi c ndi i n?
A) 0.1% iamcin l ne c eam

B) 2.5% h d c i ne c eam
C) N a in c eam
D) E h m cin gel
E) Fl c na le (Difl can) all
150. A 46- ea - ld female i h m m f lid and li id d hagia nde g e e hageal

man me f ec ed achala ia. The e m m f achala ia a e ca ed b hich ne f
he f ll ing a h h i l gic mechani m ?
A) M e han 50% f all being eak failed

B) A e i al i in he di al - hi d f he e hag , i h inc m le e l e e hageal
hinc e ela a i n
C) High- e e e hageal c n ac i n , i h n mal ela a i n f he e hag ga ic
j nc i n
D) Inc ea ed ema e c n ac i n f he di al e hag , i h n mal ela a i n f he
e hag ga ic j nc i n
E) Mechanical b c i n d e an e e hageal eb
151. Which ne f he f ll ing m m i m c n i en i h lan a fa cii i ?
A) B ning e he infe medial a ec f he calcane

B) Pain i h e i ed fle i n f he g ea e
C) Pa e he ia in he lan a a ec f he f
D) S elling and ain in he e calcaneal egi n
E) S abbing ain e he an e medial lan a a ec f he heel
54
152. A 65- ea - ld female c me ffice f he Welc me Medica e i i . He c en
medica i n egimen incl de l a an (C aa ), 50 mg dail , f h e en i n; b nin, 5
mg dail , f e ac i e bladde ; d e in, 5 mg a nigh , f de e i n and in mnia; and
a a a in (Li i ), 10 mg dail , f h e li idemia. She i d ing ell n he c en
medica i n and i e e ing efill da .
Y ad i e he ha he benefi f he c en egimen f he e ac i e bladde and de e i n

need be eighed again he inc ea ed i k f
A) ci h i
B) demen ia
C) Pa kin n di ea e
D) e i he al a c la di ea e
E) lm na fib i
153. The U.S. P e en i e Se ice Ta k F ce ec mmend i i n c eening de ec ambl ia
A) a 2 ea f age
B) a 3 5 ea f age
C) he mme bef e he child en e fi g ade
D) nce a 4 5 ea f age and nce a 8 9 ea f age
154. A 65- ea - ld female ee e abli h ima ca e. He a medical hi i ignifican

nl f h e en i n, hich i ell managed n h d chl hia ide, and men a al
m m managed i h al e gen/ ge gen f he a 10 ea . She ha n c en
heal h c nce n and he i al ign a e n mal. She e e a efill f he h m ne medica i n.
A) Refill he h m ne medica i n, b i h a a e ing ched le end he he a

B) Rec mmend i ching f m al h m ne he a aginal e gen and al
ge gen
C) Di c he ible i k f c n in ed h m ne he a bef e deciding he he he
h ld c n in e
D) O de a b ne den i e and e he e l de e mine he he c n in e h m ne
he a
E) Rec mmend di c n in a i n f h m ne he a a na ible, a he ha al ead
been n he ea men f m e han 5 ea
55
155. A 42- ea - ld male c me ffice f a heal h main enance e al a i n. He ha n been
ffice in he a 5 ea and ha n medical i e . He ell ha hi fa he a
diagn ed i h h e li idemia and h e en i n in hi i ie . He ecen l ed an nline clinic
he e he c ld ge f ee medical ad ice and e e ne e ing. He a ad i ed ee f
a e e . He ha ecen l a ed an e e ci e g am and i alking 5 da a eek f 30
min e a da i h n ignifican che ain h ne f b ea h. He an a nning and
k a 5K ace.
Ba ed n U.S. P e en i e Se ice Ta k F ce and he e e g ideline n e e ing,

hich ne f he f ll ing ld ad i e f hi a ien ?
A) N e e ing
B) An e e ci e EKG
C) E e ci e ech ca di g a h
D) An e e ci e e amibi e e
E) D b amine e ech ca di g a h
156. A 28- ea - ld g a ida 2 a a 1 a 28 eek ge a i n ee beca e he 2- ea - ld n a

diagn ed i h infl en a A ea lie ha da . She ha a hi f a hma. He n had ecei ed
he infl en a accine hi infl en a ea n b he had declined d e c nce n ab ad e e
effec n he egnanc .
In addi i n infl en a accine n , hich ne f he f ll ing i ec mmended f

e e chem h la i f infl en a in hi a ien ?
A) Bal a i ma b il (X fl a)
B) O el ami i (Tamifl )
C) Pe ami i (Ra i ab)
D) Riman adine (Fl madine)
E) Zanami i (Relen a)
56
157. A 34- ea - ld female c me ffice f f ll - af e an eme genc de a men i i
beca e f an ie . She n e e i en an ie , f c , and al i a i n . She al e
ha he i n h ng and ha l e e al nd . She e dd hing ha ening ch a
dden eakne in he leg , falling, and ge ing l .
When aking he hi n e ha he a ien i h e e bal and di la angen ial eech.

She ha a em e a e f 37.4 C (99.3 F), a hea a e f 134 bea /min, a e i a ae f
20/min, and a bl d e e f 117/69 mm Hg. A h ical e amina i n e eal an
an i -a ea ing female h i em l a e . A HEENT e amina i n h e h halm
b n h megal . A ca diac e amina i n i n ema kable a ide f m ach ca dia. A
lm na e amina i n e eal fain biba ila c ackle . An EKG h in ach ca dia.
Lab a e l a e a f ll :
CBC i hin n mal limi

Ba ic me ab lic anel i hin n mal limi
TSH <0.08 U/mL (N 0.35 3.00)
F ee T4 4.51 ng/dL (N 0.89 1.80)
F ee T3 >19.0 g/dL (N 2.3 4.2)
A) S a me hima le (Ta a le)

B) Check f h id ece an ib d
C) Ob ain a adi ac i e i dine ake can
D) Refe he end c in l g
E) Admi he he h i al
158. A 19- ea - ld f ball la e e en ffice af e being em ed f m a game hen he

ained a head inj . He ha mi ed ice ince he inj and i di ien ed. Y de e mine
ha imaging i indica ed.
A) Plain adi g a h f he k ll
B) CT f he head
C) MRI f he b ain
D) F nc i nal MRI f he b ain
57
159. A 58- ea - ld male i h nc n lled e 2 diabe e ee f f ll - af e a ecen
h i ali a i n f e i ea men i h in a en an ibi ic he a . Hi h i al c e
a c m lica ed b Cl idi ide (Cl idi m) difficile c li i , and he c m le ed al
anc m cin (Vanc cin) he a 2 eek ag . He a nea l back hi ba eline b ha had
ec en a e dia hea f he a 3 da . Y c nfi m a ec en infec i n.
Which ne f he f ll ing ld be he m a ia e ea men ?
A) P bi ic
B) Fida micin (Dificid), 200 mg ice dail f 10 da
C) Me nida le (Flag l), 500 mg h ee ime dail f 10 da
D) Vanc m cin, 125 mg f ime dail f 10 da
E) Fecal mic bi a an lan a i n
160. A 26- ea - ld female e en ffice af e i ing a nad ha de ed he h me

3 m n h ag . She e c n in ed in en e fea and an ie hen he e i a m. Y
diagn e he i h a ma ic e di de .
Which ne f he f ll ing ha he be e idence f effec i ene f he c ndi i n?
A) Ami i line
B) A ical an i ch ic
C) Ben dia e ine
D) T i ama e (T ama )
E) C gni i e-beha i al he a
161. A 59- ea - ld male e en i h ain e he la e al di al a ec f hi igh f . He a e

ha he acciden all ck a filing cabine i h hi f ab 5 da ag . He immedia el had
ain and elling e he d m f hi f and hi ec nd fif h e , and he e ha been n
im emen . He ha ied b dd a ing hi e b hi ha n ided an elief.
A h ical e amina i n i n able f ace edema e he d m f he igh f and

ende ne al a i n e he di al fif h me a a al and fif h halan . The f i
ne a c la l in ac i h a ng d ali edi l e and n mal en a i n. A adi g a h f
he igh f i h n bel .
In addi i n ain c n l, hich ne f he f ll ing ld be m a ia e?
A) A igid- le h e and eigh bea ing a le a ed

B) A ne ma ic b ace and eigh bea ing a le a ed
C) A h leg alking ca and eigh bea ing a le a ed
D) A ei lin and n eigh bea ing
E) Immedia e efe al an h edic ge n and n eigh bea ing
58
I em #161
59
162. A 41- ea - ld Hi anic male e en ffice i h a c gh. He d e n eak Engli h
and hi 16- ea - ld da gh e ffe an la e f him.
Which ne f he f ll ing i m a ia e ega ding medical in e ee f a ien h

d n eak Engli h?
A) If a ained medical in e e e i n n aff, ing a famil membe i an acce able

al e na i e
B) A ained medical in e e e h ld be ffe ed dec ea e e , im e clinical
c me , and im e a i fac i n in ca e
C) When ing an in e e e , he h ician h ld add e he in e e e di ec l a id
c nf i n and m e be e c mm nica i n
D) U ing a famil membe f in e e a i n mee he legal e i emen f Ti le VI f he
Ci il Righ Ac f a ien i h limi ed Engli h
163. Y ee an he i e heal h 67- ea - ld male h i ec e ing in he h i al af e a knee

e lacemen . The a ien kin i c ld and clamm and he i ha ing ble emembe ing he e
he i . He i ecei ing gen ia na al cann la, hich ha e l ed me mild de a a i n he
a ha ing hi m ning. The a ien em e a e i 39.6 C (103.3 F) and hi hea a e i
142 bea /min. The n e ell ha he a ien WBC c n a ele a ed hi m ning.
Which ne f he f ll ing in e en i n h ld be e f med immedia el ?
A) An inf i n f in a en fl id
B) An inf i n f d amine
C) An inf i n f n e ine h ine
D) CT angi g a h
164. An be e 10- ea - ld female ha been diagn ed i h h e en i n and i a ing ea men .

Which ne f he f ll ing h ld be he a ge f l e ing he lic and dia lic bl d
e e?
A) <130/80 mm Hg
B) <140/90 mm Hg
C) <90 h e cen ile f age, e , and heigh
D) <95 h e cen ile f age, e , and heigh
60
165. A 48- ea - ld female e en i h c nce n ab hai l . She ha n iced g ad al hinning
f he hai n he f he head f he la ea . He cal i n i ible h gh he hai . She
i n aking an al medica i n . A le n ge el IUD (Mi ena) a laced 4 ea ag . She
ha n had an ecen illne e e and a e ie f em i nega i e. He m he had
imila hai l a ing in he fif ie . On e amina i n n e hin hai n he f he cal ,
an in ac f n al hai line, and g h f hin, i hai n he c n.
Which ne f he f ll ing ld be m a ia e f hi a ien ?
A) Rem al f he le n ge el IUD
B) S i n lac ne (Aldac ne), 50 mg dail f 6 m n h
C) Fina e ide (P ca ), 5 mg dail indefini el
D) Min idil (R gaine) 2% l i n f 6 m n h
E) Min idil 5% f am indefini el
166. A heal h 18- ea - ld Af ican-Ame ican female c me ffice i h a 5-da hi f

ha che ain ha en i h b h in i a i n and e i a i n. She ha al n iced ha he
ain en i h la ghing c ghing. She had m m f an e e ia infec i n
a eek ag i h n fe e h ne f b ea h. She ha n hi f a ma and n ignifican
a medical hi , and ake n eg la medica i n . He i al ign a e n mal, incl ding
gen a a i n, and a h ical e amina i n i n ema kable. A che adi g a h i al
n mal.
A) A D-dime le el
B) An EKG
C) S i al che CT
D) Dicl fenac, 75 mg ice dail
E) P edni ne, 50 mg dail f 5 da
167. A 53- ea - ld female h icall j g 8 10 mile e eek e en ffice i h ain

n he an e i a f he lef kneeca ha inc ea e i h nning and hen he g e
d n ai . She ha been aking ib fen, 600 mg h ee ime dail , i h a ial elief. Plain
film adi g a h a e nega i e.
A) Ili ibial band nd me

B) O g d-Schla e di ea e
C) O e ch nd i i di ecan
D) Pa ell fem al e a h i i
E) Pa ell fem al ain nd me
61
168. A 38- ea - ld male c me ffice f f ll - f hi diabe e melli . He ake
me f min (Gl c hage) and d lagl ide (T lici ) and hi hem gl bin A 1c i 6.5%. He ha an
LDL-ch le e l le el f 120 mg/dL, an HDL-ch le e l le el f 55 mg/dL, and a igl ce ide
le el f 190 mg/dL. He a k ad ice ab a in he a f ch le e l managemen .
Y ad i e him a
A) a l -in en i a in n
B) a m de a e-in en i a in n
C) a in he a a 40 ea f age
D) a in he a hen hi 10- ea a he cle ic ca di a c la di ea e (ASCVD) i k i
>5%
E) a in he a hen hi 10- ea ASCVD i k i >7.5%
169. A 16- ea - ld M lim male i h e 1 diabe e ld like a fa ing d ing Ramadan. He

c en l ake in lin gla gine (Lan ) e e m ning and eg la in lin i h meal .
Which ne f he f ll ing i he m a ia e ec mmenda i n f hi a ien d ing

Ramadan?
A) A id fa ing beca e i i n afe in a ien ih e 1 diabe e

B) Dec ea e in lin gla gine b 50%
C) Dec ea e in lin gla gine b 50% and ake i a nigh
D) Dec ea e in lin gla gine b 25% and e liding cale eg la in lin i h meal
E) S in lin gla gine and e liding cale eg la in lin f ime a da
170. A 20- ea - ld female i h n ignifican a medical hi i b gh ffice i h a

dden n e f hi e , h ne f b ea h, di ine , and mi ing. The a ien i in
ana h la i .
In am c la admini a i n f e ine h ine h ld be gi en immedia el a hich ne f he

f ll ing i e ?
A) Mid- e a ec f he h lde
B) Mid- e a ec f he b ck
C) Mid- e a ec f he high
D) Mid- e a ec f he calf
E) L e medial abd minal all
62
171. A 72- ea - ld female c me ffice di c ne l diagn ed e i he al a e di ea e.
She ha a hi f l ng- anding e 2 diabe e , h e en i n, and h e li idemia. He
c en medica i n incl de a a a in (Li i ), 80 mg dail ; me f min (Gl c hage XR),
2000 mg dail ; li in il (P ini il, Ze il), 40 mg dail ; and a i in, 81 mg dail . On
e amina i n he ha a bl d e e f 114/62 mm Hg. Lab a die e eal an
LDL-ch le e l le el f 68 mg/dL and a hem gl bin A1c f 7.7%.
If added he c en egimen, hich ne f he f ll ing medica i n ld m likel

im e he alking di ance?
A) Cil a l
B) Cl id g el (Pla i )
C) E e imibe (Ze ia)
D) Li agl ide (Vic a)
E) Wa fa in (C madin)
172. A 3- ea - ld female i b gh ffice b he m he i h a 3-da hi f a a h. The

a ien m he e ha he child i ea ing le han al b le a ing fl id . The m he
al e ha he child en in he a ien da ca e ha e a imila a h.
On e amina i n he a ien em e a e i 38.2 C (100.8 F). The a ien a ea ale and

ac i e. E amina i n f he ha n e eal lce a i n in he ei al ca i and f
ala e. The e i a mac l a la a h n he finge , le f he fee , and geni al . The
emainde f he e amina i n i n mal.
A) S m ma ic ea men nl , and inc ea ed al h d a i n

B) Am icillin ice dail f 7 da
C) Valac cl i (Val e ) ice dail f 7 da
D) An in clea an ib d e ing
E) Ra id la ma eagin e ing
173. A 43- ea - ld male i h nc m lica ed a endici i efe an ibi ic he a al ne e

gical ea men . Y ad i e him ha hi ill inc ea e hi i k f hich ne f he f ll ing?
A) A l nge ab ence f m k
B) The need f ain medica i n
C) Di abili
D) S b e en ge
63
174. A 46- ea - ld male h injec he in dail e en i h a 6-m n h hi f ge i e
d nea n e e i n, a d c i e c gh, and fa ig e. He d e n ha e an fe e , chill ,
malai e, hem i . He ha n had an ick c n ac and ha ne e m ked. On h ical
e amina i n he h n ign f di e , ha a n mal gen a a i n n m ai , and ha
n mal b ea h nd . A che adi g a h e eal bila e al e ihila had ing.
A be en l ng bi ill m likel h
A) aden ca cin ma
B) b anching h hae
C) f eign b d g an l ma
D) ca ea ing g an l ma
E) n nca ea ing g an l ma
175. A 12- ea - ld female i b gh ffice beca e f a le i n n he lef la e al e e elid

( h n bel ). The le i n a ed 3 da ag a a mall, ed im le, and ince hen i ha
inc ea ed in i e and i ende . She d e n ha e an fe e , ea ing, c nj nc i al i i a i n.
N ea men ha been a em ed.
Which ne f he f ll ing ld be he m a ia e ini ial managemen ?
A) Wa m, dam c m e e f 10 min e f ime dail

B) T ical e h m cin h halmic in men (Il cin)
C) T ical h d c i ne 0.5%
D) S emic an ibi ic i h c e age f a h l c cci
E) Inci i nal d ainage ing a e ile 18- 20-ga ge needle
176. Y ee a 60- ea - ld male f an ini ial ffice i i . He ha a a hi f a m ca dial

infa c i n. He ha m ked ack f ciga e e dail ince he age f 18. He a ha he
enj m king and ha n lan i.
Which ne f he f ll ing ld be he m a ia e e n e?
A) I m ad i e ha m king i e bad f heal h

B) Did kn ha m king inc ea e i k f an he hea a ack?
C) Wha d kn ab m king effec n heal h in gene al?
D) W ld i be ka if e di c m king?
E) Can I ched le a f ll - a in men n f c n i ing m king?
64
I em #175
65
177. A 68- ea - ld female i h a hi f diabe e melli , h e en i n, and hea fail e i h
e e ed ejec i n f ac i n e en i h a l ng- anding diabe ic f lce . The a ien e
n ign f an ga in e inal bleeding, n bl d in he ine, n bleeding g m , and n
aginal bleeding. He medica i n incl de me f min (Gl c hage), in lin gla gine (Lan ),
li in il (P ini il, Ze il), a a a in (Li i ), and f emide (La i ).
A CBC e eal a WBC c n f 7600/mm3 (N 4500 11,000), a hem gl bin le el f 9.7 g/dL
(N 14.0 17.5), a mean c c la l me f 89 m3 (N 80 100), and a la ele c n f
3
412,000/mm (N 150,000 400,000).
T f he a e he a ien anemia b ain he f ll ing lab a e l :
Fe i in 293 ng/mL (N 22 275)

Se m i n 43 g/dL (N 50 175)
T an fe in 190 mg/dL (N 177 264)
Re ic l c e c n 3.2% (N 0.5 1.5)
Vi amin B12 564 g/mL (N 230 1050)
Ha gl bin 198 mg/dL (N 63 273)
Which ne f he f ll ing i he m likel ca e f he anemia?
A) Anemia f ch nic di ea e
B) B ne ma e i n
C) Hem l i
D) I n deficienc
E) Vi amin B12 deficienc
178. A heal h 30-m n h- ld male i b gh ffice beca e f igh elb ain ha began
ac el da hen hi fa he g abbed hi i a he fell ff a l a h me. The e a e n he
m m . An e amina i n i n able f he a ien e i ance m e hi igh a m, hich
he h ld a iall fle ed and na ed a he elb . The affec ed a m i he i e n mal.
Which ne f he f ll ing ld ec mmend a hi ime?
A) S lin ing and cl e f ll -

B) A em ed ed c i n f he bl ed adial head n
C) A adi g a h f he igh elb
D) Refe al h ical he a
E) Refe al an h edic ge n
66
179. A 6-m n h- ld female i b gh he eme genc de a men b he a en i h a 4-da
hi f fe e , c nge i n, c gh, h ne f b ea h, and dec ea ed a e i e. On e amina i n
f he l ng n e hee e and c ackle h gh . Y al n e bc al e ac i n , an
gen a a i n f 91% n m ai , and a e i a a e f 42/min. A che adi g a h
e eal e ib nchial ma king i h n infil a e . The a en a ha he a ien eenage
c in i i ed ecen l and a ha ing c ld m m . Y ec b nchi li i .
Which ne f he f ll ing ld ec mmend ne ?
A) Main aining h d a i n and kee ing gen a a i n >90%

B) Dee na al c i ning
C) Alb e l ia neb li e
D) B ad- ec m an ibi ic
E) S emic c ic e id
180. A 32- ea - ld hi e female e en ffice f a heal h main enance i i e i ed b he

em l e . The a ien li e i h he h band and child en. He h bbie incl de a e kiing
and a eling. She d e n ha e an ignifican a medical hi . He la Pa anic la
(Pa ) mea a n mal 1 ea ag , and all f he e i Pa mea ha e been n mal. A
e ie f em and a h ical e amina i n a e n ema kable.
Ba ed n U.S. P e en i e Se ice Ta k F ce ec mmenda i n , he e i g d e idence

c een hi a ien f
A) illici d g e
B) in ima e a ne i lence
C) kin cance
D) i amin D deficienc
181. A 55- ea - ld male c me a ien clinic f an ann al heal h main enance i i . He

i a life ime n n m ke , c n me ne alc h lic be e age a fe da e eek, and e e ci e
a a l cal g m h ee ime eekl . He e a ng famil hi f ca di a c la di ea e.
Hi fa he had a m ca dial infa c i n (MI) a age 58, hi m he had an MI a age 62, and hi
58- ea - ld b he ha been diagn ed i h ca di a c la di ea e.
The a ien a k f clinical ini n ega ding he be die a a ache f he ima

e en i n f ca di a c la di ea e. Which ne f he f ll ing i e idence-ba ed
ec mmenda i n?
A) Ski b eakfa eg la l ed ce al cal ic in ake

B) Sa -ca ene lemen a i n
C) S a high-d e mega-3 fa acid lemen a i n
D) S a he Die a A ache S H e en i n (DASH) die
E) S a he ke genic die
67
182. A 60- ea - ld male e en i h lef l e ad an abd minal ain. Hi medical and gical
hi ie a e ema kable nl f a hi f h e en i n c n lled i h h d chl hia ide
and li in il (P ini il, Ze il), and n l een n c eening c l n c 5 ea ag . He
i afeb ile, and a h ical e amina i n i n able nl f mild abd minal ende ne in he lef
l e ad an i h e i neal ign . A inal i i n mal. Y diagn e mild di e ic li i .
Which ne f he f ll ing managemen i n ld be indica ed a hi ime?
A) Re and clea li id
B) A idance f eed , n , and c n
C) Abd minal CT
D) Refe al f c l n c
E) H i al admi i n f in a en fl id and in a en an ibi ic
183. A 36- ea - ld female i h n ignifican a medical hi e en ffice f ll ing

a nc al e i de. A h gh hi and h ical e amina i n a e n mal.
Ba ed n Ame ican C llege f Ca di l g /Ame ican Hea A cia i n/Hea Rh hm S cie

g ideline , hich ne f he f ll ing ld ec mmend a hi ime?
A) Rea ance, and f ll - nl if he ha an he nc al e i de

B) A nin le el
C) Elec l e le el
D) A che adi g a h
E) An EKG
184. A 60- ea - ld e i ed d ck ke e en ffice i h ch nic l back ain d e

m l i le he nia ed l mba di c , i h adic la ain d n b h leg . He a e hi ain a a 3
f 10. He c en l ake c d ne (O C n in), 10 mg e e 12 h ; egabalin (L ica),
150 mg e e 12 h ; ace amin hen, 1000 mg e e 8 h ; mel icam (M bic), 15 mg
dail ; and c cl ben a ine, 10 mg e e 8 h . The e medica i n ha e been e c ibed b
an he h ician f he a 5 ea . He ell ha hi ain i le able b hi e d i e and
ene g le el ha e eadil dec ea ed ince a ing he e medica i n .
Which ne f he f ll ing medica i n in hi a ien egimen ld be m likel

dec ea e hi libid ?
A) Ace amin hen

B) C cl ben a ine
C) Mel icam
D) O c d ne
E) P egabalin
68
185. A 45- ea - ld female ee f f ll - af e an eme genc de a men i i in hich CT
f he abd men and el i a e f med de ec kidne ne . Kidne ne e e n een
and he flank ain a de e mined be m c l kele al in igin. She i feeling be e n .
H e e , he CT h ed a im le-a ea ing 5.2-cm a ian c i h a e men limi ed b
a ifac . She d e n ha e an m m , el ic ain, bl a ing, fe e , nigh ea ,
nin en i nal eigh l . The e i n famil hi f a ian b ea cance . She e
eg la men al c cle .
A) Rea ance nl
B) A CA-125 le el
C) Ul a n g a h f he el i
D) MRI f he el i
E) Refe al a g nec l gic nc l gi
186. A 56- ea - ld male c me ffice beca e f igh h lde ain f he a eek. I

a ed hen he lif ed a hea iece f f ni e hile hel ing a f iend m e. He fel immedia e
ha ain in hi h lde , hich ha ince adia ed d n he bice a d he igh adial
f ea m. On e amina i n he e i n def mi f he h lde a m. He ha inc ea ed ain
i h al a i n in he an e i h lde nea he bici i al g e f he h me .
Y ec bice endini i . An e i h lde ain i h hich ne f he f ll ing

e amina i n mane e f he igh a m ld be m c n i en i h hi diagn i ?
A) Ac i e a i ec add c i n f he a m a he h lde
B) Sh ing ain he h mb i h a ial c m e i n f he head i h he neck fle ed
a d he igh h lde
C) Re i ed e en i n f he elb i h he h lde in a ne al ii n
D) Re i ed in e nal a i n f he h lde i h he elb fle ed 90
E) Re i ed ina i n f he hand i h he elb fle ed 90
187. A 35- ea - ld male fi e en ed ffice 4 m n h ag i h a e i en ch nic c gh.

He i a n n m ke i h n ignifican a medical hi . O e he a fe m n h he ha
been e al a ed f GERD, a hma, e in hilic b nchi i , and e ai a c gh nd me
ih m ma ic elief diagn i .
Which ne f he f ll ing i ec mmended f ch nic ef ac c gh in hi he ie

heal h male?
A) C cl ben a ine
B) D l e ine (C mbal a)
C) Gaba en in (Ne n in)
D) L a e am (A i an)
E) P an l l
69
188. A 35- ea - ld female c me ffice f f ll - f an eme genc de a men (ED) i i
f al i a i n . She ell ha he a d i ing n he high a i h he h ee mall child en
hen he ddenl fel he hea acing, al ng i h che igh ne , ligh headedne , and e e e
an ie . She lled e and called 911. While he ai ed f EMS he k dil ia em
(Ca di em), 30 mg all , hich had been e c ibed f ll ing a imila e i de e e al ea
ag . He m m la ed ab 10 min e and had im ed b he ime EMS a i ed. An
e amina i n, EKG, and che adi g a h in he ED e e all n mal.
Which ne f he f ll ing finding in he e i medical ec d ld c nfi m

diagn i ?
A) A Gene ali ed An ie Di de 7 (GAD-7) c e f 6

B) An ele a ed TSH le el
C) P a e hidden i hin a na QRS c m le n an e en ec de
D) Mi al al e la e n an ech ca di g am
E) A he cle ic la e een n ca id l a n g a h
189. A 36- ea - ld female e en ffice i h a 24-h hi f edne in he igh e e.

I i a cia ed i h mild ain b n d ainage. On e amina i n he i al ac i i 20/20
bila e all , he illa efle i n mal, e a c la m emen a e in ac , and he e i n
di cha ge n ed. The e i a f cal a ea f h e emia f he e i cle al bl d e el n ed al ng
he medial a ec f he e e. Fl e cein aining i n mal.
Thi a ien e en a i n i m c n i en ih hich ne f he f ll ing?
A) Bac e ial c nj nc i i i
B) Vi al c nj nc i i i
C) E i cle i i
D) I ii
E) Ke a i i
70
190. A f ll imm ni ed 7-m n h- ld male i b gh gen l ffice af e hi a en n ed
a ible ei e. The m he a ha he infan began hake all e f ab 3 4
min e and hen m l fell a lee f ab 20 min e . When he a ke he a ale b
f and c ing. He ha been ill f he la fe da i h a c gh, c nge i n, dec ea ed al
in ake, and fe e 101 F.
On e amina i n he ha an al em e a e f 38.3 C (100.9 F), a hea a e f 170 bea /min,

a e ia a e f 50/min, and an gen a a i n f 97% n m ai . The infan i f
b c n lable. Hi m c memb ane a e m i , hi m anic memb ane a e clea , and he
ha a n mal ha n . He ha clea hin hea. E amina i n f he hea i n mal, and
e amina i n f he l ng e eal h nchi and hee e . He i m ing all f hi e emi ie
n mall .
Which ne f he f ll ing ld be he m a ia e ini ial e in he e al a i n f hi

child?
A) A ba ic me ab lic anel
B) Radi g a h f he che
C) MRI f he b ain
D) Elec ence hal g a h
E) A l mba nc e
191. Which ne f he f ll ing de el men al mile ne ld be e ec ed in a ical

12-m n h- ld child?
A) S anding inde enden l

B) Iden if ing a lea b d a
C) U ing h ee d he han name
D) Sc ibbling n ane l
E) B ilding a h ee-c be e
192. An 18- ea - ld male i b gh he gen ca e clinic b hi f iend e e al h af e he c

hi hand hen he nched me ne in he m h d ing a figh in l ing e e al e le. On
e amina i n he i ligh l in ica ed b ale , and h n ign f a a en di e . He ha
m l i le e ficial c a che n hi a m and leg , elling e hi lef e e, and a 5-mm
lace a i n e he hi d me aca halangeal j in f hi igh hand i h in ac en a i n and
m f nc i n and n ac i e bleeding. The e i n a eciable e hema.
Which ne f he f ll ing ld be he m a ia e ea men f hi hand inj ?
A) I iga i n f he nd al ne
B) I iga i n f he nd f ll ed b ing f he lace a i n
C) I iga i n f he nd and al am icillin/cla lana e (A gmen in), i h f ll -
in 24 h
D) In am c la cef ia ne, i h f ll - in 24 h
E) Refe al he h i al f admi i n and in a en an ibi ic
71
193. A 39- ea - ld female e en ffice f e al a i n f a lef - ided headache. She n e
ain in he em al egi n and infe i he g ma. The ain i c n an and d ll b en
i h che ing. The e i n hi f ecen a ma. He a medical hi incl de
fib m algia and he nl medica i n i ami i line, 25 mg a bed ime. He i al ign a e
i hin n mal limi and he i afeb ile. On e amina i n n e ende ne al a i n e
he em ali egi n b n ma c d. The e i n elling edema f he head, face,
neck.
A) Gian cell a e i i
B) A ali a ne
C) Sin i i
D) Tem mandib la di de
E) T igeminal ne algia
194. A 3- ea - ld female i b gh ffice b he m he i h a 3-da hi f c gh, and

diagn e a c mm n c ld. The m he a k f a ec mmenda i n elie e he c gh.
Y ell he ha he afe and m effec i e managemen f c gh ld be
A) h ne
B) c deine
C) de me h han
D) di henh d amine
E) ib fen
195. Which ne f he f ll ing e f ca di m a h i a cia ed i h a lic m m n

e amina i n ha inc ea e in in en i d ing Val al a mane e ?
A) Dila ed
B) H e hic
C) Pe i a m
D) Re ic i e
E) Tak b
196. Which ne f he f ll ing a ien h ld nde g c eening f i amin D deficienc ?
A) A 27- ea - ld male i h ec en maj de e i e di de

B) A 58- ea - ld male i h a gl me la fil a i n a e f 28 mL/min/1.73 m 2
C) A 69- ea - ld female i h ch nic e a h i i ain
D) A 75- ea - ld female i h ec en fall
E) An 88- ea - ld male i h e e e fa ig e
72
197. A 46- ea - ld male e en ffice and a k c een him f anc ea ic cance . He
ell ha hi be f iend a ecen l diagn ed i h anc ea ic cance a age 45. Hi f iend
a e i l heal h and had n famil hi f cance . The a ien i d ing ell and ha
n m m . He d e n ha e a famil hi f cance .
Ba ed n U.S. P e en i e Se ice Ta k F ce ec mmenda i n , hich ne f he f ll ing

ld be m a ia e a hi ime?
A) N c eening
B) Ul a n g a h f he abd men
C) CT f he abd men i h c n a
D) CT f he abd men i h c n a
E) MRI f he abd men
198. A 27- ea - ld male ha n iced me mall b m a nd he i f hi eni and i c nce ned

ha he migh ha e a e all an mi ed infec i n. An e amina i n e eal a f
a ima el 2-mm, d me- ha ed, kin-c l ed a le in a ing-like di ib i n a nd he
c na f he glan eni .
A) Angi ke a ma
B) Geni al a
C) Lichen ni id
D) Pea l a le
E) S am cell ca cin ma
199. Y diagn e l m algia he ma ica in a 63- ea - ld female and begin ea men i h al

edni ne, 20 mg dail . Y an ici a e e e al m n h f ea men i h edni ne and lan
a e he d e a le a ed b a e c nce ned ab he b ne heal h.
Which ne f he f ll ing ld be m a ia e f hel ing e en e ic

f ac e in hi a ien ?
A) A FRAX c e ba ed n DXA e l n
B) A FRAX c e ba ed n DXA e l in 6 m n h
C) A calci m in ake f 1200 mg dail
D) Alend na e, 35 mg eekl
73
200. A e i l heal h 62- ea - ld female e en ffice i h a 3-da hi f fe e and
a c gh d ci e f len m. On e amina i n he ha a em e a e f 39.2 C
(102.6 F), a bl d e e f 110/70 mm Hg, a l e a e f 92 bea /min, a e i a ae
f 25/min, and an gen a a i n f 94% n m ai . She h n ign f c nf i n. An
e amina i n i ignifican f c ackle a he igh l e l ng ba e and a che adi g a h
c nfi m an infil a e in he ame l ca i n.
Which ne f he f ll ing ea men e ing ld be m a ia e a hi ime f hi

a ien c mm ni -ac i ed ne m nia?
A) O a ien
B) The eme genc de a men
C) A eg la h i al in a ien fl
D) The in en i e-ca e ni
74

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Ame ican B a d f

P blica i n e d c i n in h le in a i ic l hibi ed.

S di m 138 mE /L (N 135 145)

A) Cl nidine (Ca a e ), 0.1 mg ice dail

2. D ing nd a he n ing h me, a e inf med ha he e a e e iden n he ni

A) Onl m ma ic e iden n he ame ni

3. A 24- ea - ld female e en i h a 2-da hi f mild m de a e el ic ain. She ha had

The ini ia i n f an ibi ic f ea men f el ic inflamma di ea e in hi a ien

Which ne f he f ll ing ld be he be ini ial ea men f hi a ien ?

6. L ng- e m n m inhibi ei a cia ed i h an inc ea ed i k f

7. An 87- ea - ld female c me ffice f an ann al heal h main enance i i . She a ea

Which ne f he f ll ing i he m likel elec l e di bance?

Which ne f he f ll ing ld be he m a ia e ec mmenda i n?

A) Se he ala m f 5:30 a.m.

9. A 45- ea - ld female e en he eme genc de a men i h a 1- eek hi f facial

Af e h i al admi i n, hich ne f he f ll ing ld be he m a ia e ne e

10. A n n e bal 22- ea - ld male i h in ellec al di abili i b gh ffice b he aff

On e amina i n he ha a em e a e f 37.3 C (99.1 F), a bl d e e f 124/82 mm Hg,

Which ne f he f ll ing ld be he m a ia e ne e f hi a ien ?

Which ne f he f ll ing ld ec mmend a hi ime?

A) C n in e ada alene 0.1% gel f 12 m e eek

12. A 32- ea - ld female h i ne f l ng ime a ien call beca e f a 24-h hi

Which ne f he f ll ing ld be m a ia e a hi ime?

13. A 70- ea - ld female de el h mb c enia d ing a l nged h i ali a i n f

A ming ha he h mb c enia i ca ed b HIT, hich ne f he f ll ing i he m

Ba ed n U.S. P e en i e Se ice Ta k F ce ec mmenda i n , hich ne f he f ll ing

15. A 42- ea - ld male e en i h a 10-da hi f h a ene . He al ha a 2-m n h hi

In addi i n ice e , hich ne f he f ll ing ld be m a ia e a hi ime?

16. A 57- ea - ld male i h a hi f hea fail e ee f f ll - . He de c ibe

Acc ding he Ne Y k Hea A cia i n c i e ia, hi a ien hea fail e ld be

Which ne f he f ll ing imaging m dali ie ld be indica ed ini iall ?

18. A 24- ea - ld female e en ih g e i el ening l a ain f 3 da . On

Which ne f he f ll ing ld be he m a ia e managemen ?

19. Which ne f he f ll ing h ld NOT be c n med d ing egnanc d e a en iall high

Which ne f he f ll ing h ld be de ed c nfi m he diagn i ?

Hi i al ign incl de a bl d e e f 116/70 mm Hg, a hea a e f 76 bea /min, a

Which ne f he f ll ing i he m likel diagn i ?

22. A 34- ea - ld female a 32 eek ge a i n e en i h a igh - ided, nding headache ha

Which ne f he f ll ing ld be he m a ia e ea men f hi a ien ?

A) Degl dec (T e iba)

24. When e f ming a ge ia ic a e men , hich ne f he f ll ing i an in men al ac i i

25. A 21- ea - ld female ee f a medical e al a i n i admi i n a ea men

26. A 9- ea - ld male i h a hi f m de a e e i en a hma i b gh he eme genc

Which ne f he f ll ing in a en medica i n h ld be added he a ien c en

A) Gene ic e ing (Sc liSc e)

Which ne f he f ll ing ld be m a ia e in he managemen f hi a ien ?

29. A e i l heal h 18- ea - ld female e en i h finge ain. Ab 5 da ag he a ed

On e amina i n n e e hema f he medial alma i f he affec ed finge , i h e e al

Which ne f he f ll ing i he m a ia e ea men f hi c ndi i n?

31. The m he f a 1- ea - ld child an kn h ef l infl en a accine i f e en ing

32. A 45- ea - ld male c me ffice f a ine heal h main enance e amina i n. Hi

Which ne f he f ll ing ann al c eening ld be m a ia e?

A) B ne den i c eening if patient on steroid .

33. A 34- ea - ld female ha a b m n he middle finge ( h n bel ). She hink i ha been

T da he bl d e e i 130/70 mm Hg, l e a e 72 bea /min, and gen a a i n 95%

Which ne f he f ll ing change he c en medica i n egimen ld im e he

35. A 14- ea - ld female i b gh ffice a a ne a ien f a ine ell child

Pla ele 102,000/mm3 (N 150,000 450,000)

Which ne f he f ll ing c ndi i n be e lain hi a ien abn mal finding ?