1. Which of the following has been shown to reduce the progression of coronary artery disease and to reduce the incidence of angina ? [1]

   
   A. Vitamin A
   B. Aspirin
   C. Vitamin C
   D. Vitamin E
   E. Calcium Channel Blockers

   
   

2. The use of mammography for breast cancer screening is most effective in which of the following groups [2] ?

   
   A. Young women with a family history of breast cancer
   B. Women over age 50 with fatty breasts
   C. Women age 40-50
   D. Women with rapidly growing breast tumors
   E. Women with fibrocystic breast changes

   
   

3. A 55 year old man presents to your clinic for evaluation of a chronic dry cough which has been bothering him for over 6 months. The cough comes in paroxysms which last 5-10 minutes, and is accompanied by pleuritic chest pain but not by sputum production. There are no fevers, chills, weight loss, hemoptysis, heartburn, sour taste in his mouth. He has a history of hypertension (treated with enalapril (Vasotec®) for over one year) and mild to moderate allergies, worse during spring and fall months. He has a 45 pack-year smoking history, but he quit 5 years ago. He walks 5 miles per day and has noticed a small amount of wheezing during this walking, particularly in the spring and fall months. The most likely diagnosis is [3]
   

   
   A. Smoking
   B. Cough Varient Asthma
   C. Bronchitis, COPD
   D. Gastrointestinal Reflux (GERD)
   E. ACE-Inhibitor Associated Cough

   
   

4. Which action is MOST appropriate for a woman taking oral contraceptive pills (OCP) who has early cycle bleeding (spotting) [4] ?

   
   A. Increase Estrogen Dose
   B. Decrease Estrogen Dosease
   C. Switch to triphasic OCP
   D. Increase progesterone dose
   E. Decrease progesterone dose

   
   

5. Of the following, which is the STRONGEST contraindication to the use of oral contraceptive pills [5] ?

   
   A. Concomittant use of glucocorticoids
   B. Systemic Lupus Erythematosus
   C. Hypertension
   D. Smoking in women <35 years of age
   E. Smoking in women >35 years of age

   
   

6. A 56 year old man presents to your outpatient clinic for routine health evaluation. He has been tested for high blood pressure in a community screening center. He brings in results from three previous screenings which document hypertension in the 150-160/88-95mm Hg range. He denies headaches, hematuria, chest pain, dyspnea on exertion or shortness of breath. He has had increasing difficulty urinating and awakens two to three times each night to urinate. His physical exam is unremarkable except for a mildly enlarged, smooth prostate. Renal function and urinalysis (dipstick and microscopic) are normal. His total cholesterol is 225mg/dL (normal <200mg/dL). The most appropriate class of blood pressure medications for this patient is [6]:

   
   A. ACE Inhibitors
   B. Beta-adrenergic Blockers
   C. Alpha-adrenergic Blockers
   D. Calcium Channal Blockers
   E. Thiazide Type Diuretics

   
   

7. A 33 year old woman with a 21 year history of insulin dependent diabetes mellitus presents for routine followup. Her blood pressure has been in the 120-130/82-84mm range in the past. She recently had it taken by a friend of hers who is a nurse, and the blood pressure was 135/92mm sitting. She has mild proliferative retinopathy and mild sensory neuropathy. The physical examination is unremarkable. A urinalysis is normal. The most appropriate class of blood pressure medications for this patient is [7]:

   
   A. ACE Inhibitors
   B. Beta-adrenergic Blockers
   C. Alpha-adrenergic Blockers
   D. Calcium Channal Blockers
   E. Thiazide Type Diuretics

   
   

8. Which of the following does NOT contribute to increased drug side effects in the elderly [8] ?

   
   A. Reduced creatinine clearance (even with normal serum creatinine level)
   B. Reduced hepatic metabolism
   C. Increased proportion of fat to muscle
   D. Use of other medications
   E. Decreased level of body fat

   
   

9. All of the following are true concerning hemorrhoids EXCEPT [9]:

   
   A. Hemorrhoids are highly dilated arteriovenous complexes
   B. Hemorrhoids appear through surface mucousa as purple tubular structures
   C. Symptomatic in >50% of persons over 50 years old
   D. A finding of hemorrhoids is sufficient to explain rectal bleeding without further workup
   E. Most common cause of rectal pain and/or bleeding in general population

   
   

10. All of the following are true concerning preoperative cardiac evaluation EXCEPT [10]:

    
    A. History and Physical examinations should be targetted to cardiovascular system
    B. Electrocardiography (ECG) may be reserved for persons with abnormal history or physical
    C. A pre-operative chest radiograph should be performed on all patients
    D. Stress Testing (exercise, nuclear medicine, echocardiogram) is generally not indicated
    E. Echocardiography is not routinely indicated in preoperative assessment

    
    

Answers

1. D
2. B
3. B
4. A
5. E
6. C
7. A
8. E
9. D
10. C