1. A 32 year old woman has seasonal allergies and mild to moderate asthma with nocturnalsymptoms. Her medical regimen should include all of the following EXCEPT [1]:

   A. Long acting ß-agonist inhaler
   B. Oral glucocorticoid therapy
   C. Short acting ß-agonist inhaler
   D. Inhaled glucocorticoid therapy
   E. Leukotriene receptor antagonist

2. Her symptoms are significantly improved on standard medications as described above. However, her nocturnal shortness of breath persists 3-4 times per week, necessitating acute short-acting ß-agonist therapy. You recommend which ONE of the following [2]:

   A. Theophylline long acting
   B. Oral antihistamine
   C. Oral decongestant
   D. Inhaled anticholinergic agent
   E. Oral ß2-agonist therapy

3. A 57 year old man with a history of angina and a previous two-vessel angioplasty presents with recurrent anginal pain 6 months after the original angioplasty. An electrocardiogram shows acute anterior ST-depressions. The man is admitted, placed on intravenous heparin, and myocardial infarction is ruled out with serial CK-MB and troponin I assays. An angiogram shows restenosis of one of the original angioplasty sites in the left anterior descending artery. The man is scheduled to undergo repeat angioplasty with stent placement. Which of the following medications is specifically indicated during angioplasty in this patient [3] ?

   A. Tissue plasminogen activator (TPA)
   B. Streptokinase
   C. Dipyridamole
   D. Abciximab (ReoPro®)
   E. Warfarin

4. All of the following should be considered in the treatment of 68 year old woman with stable congestive heart failure and an ejection fraction of 25% EXCEPT [4]:

   A. Carvidolol
   B. Sotalol
   C. Enalapril
   D. Furosemide
   E. Digitalis

5. A 57 year old man with 15 years of Type II diabetes mellitus is referred to you for worsening glucose control. His glycosylated hemoglobin (HbA1c) level is 10.1% and he is taking glyburide (a sulfonylurea) along with 60 units of NPH insulin daily. An ophthalmological examination 3 months prior to visit was unremarkable. He has continued to gain weight despite following a 2000 calorie ADA diet. His cholesterol level is 260mg/dL and his LDL level is 140mg/dL. His fasting triglyceride level is 450mg/dL and his HDL level is 30mg/dL. He is currently taking gemfibrozil for high cholesterol and hydrocholorothiazide for a history of hypertension. Examination is notable for an obese man with a slight S4 gallop and a II/VI systolic ejection murmer over the apex. Urinalysis shows microscopic proteinuria, but renal function is normal. After evaluation, you recommend which ONE of the following regimens [5]:

   A. Discontinue sulfonylurea, insulin, gemfibrozil, and hydrochlorothiazide, and begin:metformin, atorvastatin, aspirin, and enalapril
   B. Discontinue sulfonylurea and gemfibrozil and begin: aspirin, metformin and simvastatin
   C. Discontinue insulin, gemfibrozil, and hydrochlorothiazide, and begin:aspirin, niacin and enalapril
   D. Increase sulfonylurea, discontinue insulin, and add atorvastatin
   E. Add enalapril and aspirin to the current regimen

6. All of the following are poor prognostic indicators for breast cancer EXCEPT [6]

   A. Amplification of her2/neu
   B. Elevated S-phase fraction
   C. Aneuploidy
   D. Presence of progestin receptors
   E. BRCA-1 mutations

7. A 36 year old woman with a 5 year history of rheumatoid arthritis is referred to you for a second opinion. Four four years, her disease was well controlled on hydroxychloroquine (Plaquenil®). However, over the past year, she developed worsening symptoms, and radiographic erosions were noted. She was started on methotrexate, and her dose increased to 15mg weekly. Despite the methotrexate, her symptoms persisted and 30mg predisone daily was added, and gradually tapered. When the dose of prednisone reached 15-20mg per day, her symptoms reappeared. At times she became confined to a wheelchair. The most appropriate therapy is [7]:

   A. Add cyclosporine to the regimen
   B. Restart the hydroxychloroquine
   C. Administer a tumor necrosis factor alpha blocking agent
   D. Treat with methylprednisolone, 1gm intravenous for three days, followed by oral taper
   E. Switch the methotrexate to intramuscular administration

8. Sildenafil should not be taken by patients on which ONE of the following medications [8] ?

   A. Isosorbide dinitrate
   B. Lisinopril
   C. Hydrochlorothiazide
   D. Metoprolol
   E. Troglitazone

9. A 63 year old man with a history of three vessel coronary artery disease, a myocardial infarction, and an ejection fraction of 20% is admitted to the hospital for evaluation of syncope. While being monitored, he has multiple runs of 10 to 20 beat multifocal ventricular tachycardia. He feels nauseated and woozy during the runs. The most appropriate treatment for the arrythmias in this patient is [9]:

   A. Amiodarone
   B. Implantable cardioverter defibrillator
   C. Sotalol
   D. Propafanone
   E. Ibutilide

10. A 23 year old intravenous drug abuser presents to you for evaluation of fatigue, pruritus, and slight jaundice. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are three-times normal (~100 U/mL) and serum bilirubin is 3.5mg/dL. HIV testing is negative, hepatitis B virus surface antibody (HBsAb) is present, and antibody to hepatitis C virus (HCV) is positive. Serum levels of HCV are highly elevated. A liver biopsy reveals fibrosis and chronic damage. The most appropriate initial treatment for this patient is [10]:
A. Pegylated interferon alpha
B. Interferon alpha + ribavirin
C. Pegylated interferon alpha plus ribavirin
D. Ribavirin alone
E. Pegylated interferon alpha plus lamuvidine

Answers

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