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Question 1
What is pulsus paradoxus?
- A decrease in systolic blood pressure >10 mmHg during inspiration
- An increase in systolic blood pressure >10 mmHg during inspiration
- A decrease in systolic blood pressure >10 mmHg during expiration
- An increase in pulse pressure during inspiration
Question 2
A 22-year-old student has studied for 2 days without sleep. She is restless, diaphoretic, tachycardic, has BP 150/90 mmHg, and is behaving bizarrely. What is the most likely diagnosis?
- Stimulant intoxication
- Alcohol withdrawal
- Opioid intoxication
- Panic attack
Question 3
Ad hoc interpretation by untrained bilingual family members should be avoided in non-emergency medical encounters because it may cause error and bias.
- True
- False
Question 4
Which medication is first-line for trigeminal neuralgia?
- Carbamazepine or oxcarbazepine
- Phenytoin
- Gabapentin
- Amitriptyline
Question 5
Which finding best indicates pyelonephritis rather than cystitis?
- White blood cell casts
- Nitrites
- Hematuria
- Proteinuria
Question 6
Cri-du-chat syndrome, a chromosomal deletion syndrome, is associated with increased maternal age.
- False
- True
Question 7
A pregnant woman has a positive IGRA but no TB symptoms. What is the next best step?
- Chest x-ray with appropriate shielding
- Start treatment for latent TB immediately
- Obtain sputum cultures first
- Amniocentesis
Question 8
In DKA, the best indicator of treatment response is the serum ___ gap.
Fill in the blank
Question 9
Which infection is the most common cause of a heterophile antibody-negative mononucleosis-like syndrome?
- Cytomegalovirus
- Epstein-Barr virus
- HHV-6
- Toxoplasmosis
Question 10
A pregnant woman is a known carrier of an autosomal recessive disease. What is the first next step to assess the fetus's risk?
- Test the father for the same disorder
- Chorionic villus sampling
- Amniocentesis
- Fetal DNA sequencing
Question 11
Screening asymptomatic patients with a smoking or family history for bladder cancer has been shown to improve survival and is recommended.
- False
- True
Question 12
Which opioid is preferred in chronic kidney disease because its liver metabolite is inactive?
- Fentanyl
- Morphine
- Codeine
- Meperidine
Question 13
A patient reports epigastric burning that is provoked by exertion and disappears with rest. What is the most appropriate next test?
- Exercise ECG
- Upper endoscopy
- Cardiac catheterization
- Reassurance only
Question 14
A 27-year-old man had an episode of syncope without prodrome or positional change, lasting 2 minutes with a few seconds of jerking and no confusion afterward. Which cause is most likely?
- Cardiac arrhythmia
- Vasovagal syncope
- Seizure
- Orthostatic hypotension
Question 15
A head CT is necessary in this patient because he had a syncopal episode with brief jerking 2 days ago.
- False
- True
Question 16
The most common cause of death in end-stage renal disease is ___.
Fill in the blank
Question 17
In end-stage renal disease, the second most common cause of death is infection.
- True
- False
Question 18
Arterial thrombosis causing acute limb ischemia occurs most often in patients without preexisting peripheral artery disease.
- False
- True
Question 19
A patient with peripheral artery disease faces a greater risk of myocardial infarction than of limb amputation.
- True
- False
Question 20
A patient with diabetes plans 30 minutes of aerobic exercise. Which adjustment best reduces the risk of exercise-induced hypoglycemia?
- Reduce the dose of short-acting insulin given with the preceding meal
- Reduce both basal and premeal insulin and increase carbohydrate intake
- Hold the basal insulin dose completely
- Take extra insulin before exercise
Question 21
For exercise lasting longer than 1 hour in a patient with diabetes, hypoglycemia risk may be reduced by decreasing both basal and premeal insulin and increasing carbohydrate intake, without completely stopping basal insulin.
- True
- False
Question 22
A patient asks for a diagnostic test that the physician does not believe is indicated. What is the best initial response?
- Explore the patient's concerns and motivations
- Order the test to preserve patient satisfaction
- Refuse without further discussion
- Tell the patient the request is unreasonable
Question 23
A study reports a bivariate OR of 3.0 and a multivariate OR of 1.5 for the same exposure. Which OR should guide conclusions?
- Multivariate (adjusted) OR
- Bivariate (unadjusted) OR
- The larger OR
- The OR closest to 1.0
Question 24
Which medication is a first-line antihypertensive in pregnancy?
- Labetalol
- Lisinopril
- Spironolactone
- Hydrochlorothiazide
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