1. All of the following cause infectious mononucleosis EXCEPT [1]:

   A. Toxoplasmosis
   B. Cytomegalovirus (CMV)
   C. Human herpesvirus 6
   D. Epstein Barr Virus (EBV)
   E. Human herpesvirus 8 (Kaposi-Sarcoma Associated Virus)

2. All of the following are indicated for treatment of congestive heart failure with left ventricular dysfunction EXCEPT [2]:

   A. ß-Adrenergic Receptor Blockers (ß-blockers)
   B. Angiotensin II Receptor Blockers (ARB)
   C. Dihydropyrimidine Calcium Channel Blockers (CCB)
   D. Spironolactone
   E. Angiotensin Converting Enzyme Inhibitors (ACE-I)

3. All of the following have been shown to reduce the risk of cardiac complications in patients undergoing noncardiac surgery EXCEPT [3]:

   A. Coronary Artery Bypass Grafting (CABG)
   B. Nitroglycerin
   C. ß-Adrenergic Blockers
   D. Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting at least 2 weeks prior to noncardiac surgery
   E. PTCA without stenting performed at least 90 days prior to noncardiac surgery

4. All of the following concerning homocysteine (HC) are true EXCEPT [4]:

   A. Increasing folate and pyridoxine (Vit B6) intake can reduce HC levels and vascular events
   B. Supplemental folate + Vit B6 improves exercise electrocardiography
   C. Vit B6 + B12 + folate reduce HC levels and atherosclerosis progression
   D. Vit B6 + B12 + folate reduces mortality in patients with elevated serum HC levels
   E. Vit B6 + B12 + folate reduce restenosis

5. All of the following are true concerning the treatment of depression in the primary care setting EXCEPT [5]:

   A. Overall 60-75% response to initial medication with a 10-25% relapse rates
   B. First line therapy for most patients is a serotonin selective reuptake inhibitor (SSRI)
   C. Paroxetine, sertraline and fluoxetine have similar effectiveness for depression
   D. Tricyclic antidepressants are reasonable alternative first line treatments
   E. Second line agents include mixed reuptake inhibitors and atypical agents

6. Which ONE of the following concerning reducing risk of HIV transmission from an HIV+ mother to a fetus is TRUE [6] ?

   A. Triple therapy including zidovudine and a protease inhibitor is recommended
   B. Zidovudine alone is recommended
   C. Nevirapine alone is recommended
   D. Zidovudine + Lamivudine is recommended
   E. Zidovudine + Nevirapine is recommended

7. Which ONE of the following concerning radiocontrast nephropathy is TRUE [7] ?

   A. Renal range (1-3.5µg/kg/min) dopamine reduces the risk of radiocontrast nephropathy
   B. N-Acetylcysteine, an antioxidant, reduces radiocontrast induced nephrotoxicity in patients with pre-existing renal dysfunction
   C. Forced diuresis with manitol and furosemide prevents renal dysfunction following radiocontrast material in diabetics
   D. Prophylactic hemodialysis in patients with serum creatinine >2.0mg/dL has been shown to prevent renal dysfunction after radiocontrast agents
   E. Radiocontrast nephropathy is best prevented by maintaining the patient in a slightly hypovolemic status

8. All of the following are true concerning the treatment of vancomycin resistant enterococcus (VRE) infections EXCEPT [8]:

   A. High dose vancomycin or ampicillin can be effective with Van B or Van C type resistance
   B. Linezolid (Zyvox®) is very active against Enterococcus faecium, E. faecalis and anaerobes
   C. Fosfomycin (Monural®) is often active for urinary tract infections due to enterococci
   D. Doxycycline is active in many VREF infections and synergistic with other agents
   E. Quinupristin-dalfopristin (Synercid®) is very active against E. faecium and E. faecalis

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

   A. Usually presents as sensory neuropathy
   B. Most commonly associated with small cell lung cancer
   C. May also occur with testicular cancer
   D. Commonly associated with pancreatic carcinoma along with migratory thrombophlebitis
   E. May include elements of autonomic neuropathy and/or ganglionopathy

10. All of the following are true concerning Anthrax EXCEPT []:
A. In cutaneous anthrax, the primary skin lesion is usually a painless, pruritic papule 3-5 days after inoculation
B. Lethal toxin initiates a cytokine cascade that resembles that in sepsis syndrome
C. Ciprofloxacin, oflaxacin, levofloxacin, doxycycline, penicillin, and trimethoprim-sulfamethoxazole are all effective antibiotics for treatment of anthrax
D. Successful treatment of anthrax requires very early initiation of therapy
E. In persons exposed to anthrax, prophylactic antibiotics and anthrax vaccine are recommended

Answers

1. E
2. C
3. B
4. D (Mortality benefit has not yet been demonstrated.)
5. D (Tricyclic antidepressants are only reasonable for second or third line treatment.)
6. A
7. E (Quinupristin-dalfopristin has no activity against E. faecalis.)
8. D
9. C (Trimethoprim-sulfamethoxazole and other sulfa drugs are not effective.)