1. All of the following are true concerning the Pap Smear EXCEPT [1]:

   A. Sensitivity for abnormal pathology ~50%
   B. Can distinguish between high and low risk human papilloma virus infections
   C. Specificity for abnormal pathology >80%
   D. Pap screening reduces the risk of invasive cervical cancer >75%
   E. Can be performed every 2-3 years in women with previously normal Pap results

2. Which of the following should be considered standard of care in the treatment of moderate and severe heart failure (New York Heart Association Classes III or IV) [2] ?

   A. Angiotensin converting enzyme (ACE) Inhibitors
   B. Angiotensin II receptor blockers in ACE-Inhibitor intolerant patients
   C. ß-Adrenergic Blockers such as carvidilol or metoprolol
   D. Spironolactone, an aldosterone antagonist
   E. Amiodarone

3. All of the following concerning colon cancer are true EXCEPT [3]:

   A. Adjuvant therapy including 5-fluorouracil improves survival in Dukes' C Disease
   B. Stool occult blood screening leads to early detection and improves lives
   C. COX-II selective nonsteroidal anti-inflammatory drugs (NSAIDS) reduce the incidence of colon cancer in patients at high risk
   D. Screening sigmoidoscopy is recommended for routine early detection of colon cancer
   E. Flat as well as polypoid adenomas can contain cancerous foci and should be biopsied

4. All of the following are true concerning Helicobacter pylori infection EXCEPT [4]:

   A. Antibacterial therapy should only be instituted in patients with ulcers after they have failed at least one month of high dose proton pump inhibitor therapy
   B. The benefit of treating patients with non-ulcer dyspepsia and H. pylori infection is unclear
   C. All H. pylori positive gastric MALT lymphomas should be treated with full eradication therapy
   D. Eradication therapy with a combination of proton pump inhibitor (PPI) and two antibiotics is highly effective and simple
   E. Metronidazole is increasingly ineffective due to development of resistance

5. All of the following are true concerning clinical trials for novel therapeutics EXCEPT [5]

   A. Phase I is often conducted in normal volunteers
   B. Phase II studies often include various doses administered to patients with specific disease
   C. Phase II studies most often utilize surrogate disease progression markers, but clinical efficacy data should be included where possible
   D. Phase III studies are designed to show clinical efficacy in a defined population and often employ surrogate markers which can be used to gain Food and Drug Administration (FDA) approval
   E. Phase IV studies are carried out after drug approval by a regulatory body in order to evaluate the drug's effects in other diseases, dose modifications, or safety issues

6. Which statement concerning dietary fiber is NOT currently supported by most accumulated clinical data [6] ?

   A. Appears to decrease risk of coronary heart disease by ~20%
   B. Improves glycemic control and lipid profile in type 2 diabetes mellitus
   C. Clearly reduces the risk of colon cancer
   D. Appears to reduce the incidence of hypertension and diabetes mellitus
   E. Higher fiber diets may protect against obesity by reducing insulin levels

7. Which ONE of the following statements is TRUE concerning Fibromyalgia Therapy [7] ?

A. Tachyphylaxis to the pain medication tramadol (Ultram®) develops rapidly in patients with fibromyalgia
B. Tricyclic Antidepressants (TCAs) are currently the mainstay of therapy
C. TCAs maintain their efficacy after more than 6 months of therapy
D. Cyclobenzeprine is more effective than amitriptylline after 1 month of therapy
E. Combination of amitryptyline 25mg qhs and fluoxetine 20mg qam was no more effectivethan either agent used alone

8. Which ONE of the following nuclear medicine tests is the gold standard for detection of inflammation [8] ?

   A. Ga67-Citrate
   B. Indium-111 labelled leukocytes
   D. 99mTc-HMPAO-leukocytes
   E. 99mTc-antigranulocyte Fab' antibody (Ab)
   F. 99mTc-labelled human immunoglobulin (HIG)

9. All of the following are TRUE concerning wound healing EXCEPT [9]:

   A. Platelet derived growth factor (PDGF) is FDA approved in USA for treatment of diabetic foot ulcers
   B. Fibroblast growth factor (FGF) has shown some efficacy in enhancing wound healing and is approved in Japan
   C. Skin substitutes provide immediate coverage of the wound and reduce infection
   D. Autologous and allogeneic cultured epidermal cells can be used as skin substitutes
   E. Dermal skin substitutes can be used, but require lengthy preparation time

10. All of the following are TRUE concerning pain management for palliation EXCEPT

    A. The vast majority of patients with severe pain are well controlled
    B. Most pain at the end of life can be managed with currently available agents
    C. For verbal patients, the patient's perception of pain should guide therapy
    D. Adequate pain medication has not been found to hasten death
    E. Addiction is very uncommon among terminal patients with pain

Answers

1. B
2. E
3. C (These agents reduce the indicence of new polyps; cancer incidence under evaluation.)
4. A
5. D
6. C
7. B
8. B
9. E (Dermal skin substitutes are readily available and can be used immediately.)
10. A