1. On physical exam an S2, is fixed and split with [1]:

   A. Atrial septal defect
   B. Atrial stenosis
   C. Left bundle branch block
   D. Poor left ventricular function
   E. Right bundle branch block

2. Regarding transmission of disease, which of the following is true [2]?

   A. Large bore needle sticks have higher risk for HIV transmission
   B. Clinicians should treat patients with high-risk for HIV with extra precautions beyond that of other patients.
   C. Hepatitis B virus is the most commonly transmitted disease by transfusion
   D. Hepatitis C virus is commonly transmitted by sexual intercourse
   E. Herpes Simplex Virus Type 2 is is most commonly transmitted by oral contact

3. A test that has a sensitivity of 90 percent and a specificity of 95 percent. A patient with a pretest probability of disease of 50 percent undergoes the test. The test is positive. Therefore, the patient's post-test probability of disease is [3]:

   A. 90 percent
   B. 75 percent
   C. 65 percent
   D. 50 percent
   E. 45 percent

4. A patient with a routine mammogram, normal physical exam, at age 38 and has a finding on her mammogram of calcifications. You should recommend [4]:

   A. Follow through two menstrual cycles
   B. Reassure patients and repeat the mammogram annually
   C. Localize and biopsy the lesion
   D. Fine needle aspiration of the area
   E. Ultrasound the lesion

5. The 31 year old patient has family members with a history of polyps in the colon requiring surgery by age 40. This patient has too numerous to count polyps of <1 cm in found on colonoscopy. Two of the lesions after biopsy on pathology show benign adenoma. You should,

   A. Biopsy and remove all the polyps
   B. Re-screen in one-year
   C. Refer for colectomy
   D. Refer for genetic testing
   E. Screen for liver lesions

6. A 64 your old male is admitted for treatment of a right lower extremity cellulitis. He has a history of diabetes and intravenous drug abuse. He has smoked one packed a day for 40 years and continues smoking, and he drinks sparingly. Venous access is an issue, therefore he undergoes right subclavian line placement. During the procedure, he suddenly becomes light headed, and diaphoretic. He is tachypnic, tachycardic and his blood pressure is 110 over 60. Auscultation of the chest reveals a gurgling sound during both inspiration and expiration. The next step should be:

   A. Terminate the procedure and insertion chest tube on the right
   B. Flush the central venous catheter with high dose heparin
   C. Place the patient in a head down position on his left side
   D. Terminate the procedure, make the patient NPO, and obtain a barium swallow
   E. Take the patient emergently to the cardiac catheterization lab

7. The most common neoplasm associated with human immunodeficiency virus infection is [7]:

   A. Basal cell carcinoma of the skin
   B. Squamous cell carcinoma of the skin
   C. Kaposi's sarcoma
   D. Non-Hodgkin's lymphoma
   E. Melanoma

8. Prolongation of the QT interval by astimizole, terfenadine, or propulsid is exacerbated by antifungal azoles and some macrolide antibiotics. The most likely mechanism by which the azoles and macrolides exacerbate QT prolongation is [8]:

   A. Idiosyncratic drug reaction of unclear mechanism
   B. Inhibition of potassium channels in cardiac pacemaker cells
   C. Direct prolongation of the QT interval
   D. Blockade of glucuronidation of parent drugs
   E. Inhibition of cytochrome P450 enzymes

9. In patients with adverse drug reactions to penicillin, the expected cross reactivity with first generation cephalosporins is approximately [9]:

   A. One percent
   B. Five percent
   C. Twenty-Five percent
   D. Fifty percent
   E. Eighty percent

10. The most frequent malignancy in males aged 16 to 39 is [10]:

    A. Squamous cell carcinoma of the skin
    B. Testicular carcinoma
    C. Melanoma
    D. Non-Hodgkin's lymphoma
    E. Hodgkin's disease

Answers

1. A (Delayed pulmonic valve closure.)
2. A
3. A
4. D
5. C (Likely Familial Polyposis Syndrome; colectomy recommended for all patients >30 years.)
6. A
7. C
8. E
9. B
10. B