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1. A 45 year old man with a strong family history of cardiovascular disease presents for routine examination. He has no significant past medical history, takes no medications, and does not smoke. Physical examination is normal. A routine lipid screen shows a total cholesterol (TC) of 295mg/dL and an HDL of 36mg/dL. A fasting complete lipid profile is obtained: TC is 285mg/dL, HDL 34mg/dL, LDL 220mg/dL, Triglycerides are 155mg/dL. The most appropriate course of action is [1]:

   A. No therapy
   B. HMG CoA reductase inhibitor Therapy
   C. Niacin Therapy
   D. Gemfibrozil Therapy
   E. Referral to a Lipid Specialist

2. A diagnostic serum antibody test is developed for Lyme Disease. The test will take 1 hour to perform, and will cost less than 30% of a polymerase-chain-reaction (PCR) detection test, which takes 1 day to perform. The PCR based test is considered the gold standard, with 100% specificity and sensitivity when performed correctly. The new test is evaluated on 200 persons with a known positive PCR test and on 200 persons with a negative PCR test.Of the 200 PCR positive persons, the new test is positive in 194 of them. Of the 200 persons with a negative PCR test, the new test is positive in 4 of them. What are the sensitivity and specificity of the new test [2] ?

   A. 97% sensitive, 97% specific
   B. 94% sensitive, 98% specific
   C. 97% sensitive, 98% specific
   D. 98% sensitive, 96% specific
   E. 94% sensitive, 96% specific

3. The above test is used to screen a population where the expected prevelance of Lyme disease is 1% (1 in 100 persons). What are the positive (PPV) and negative predictive (NPV) values of the test [3] ?

   A. PPV ~ 33% NPV > 99%
   B. PPV ~ 15% NPV > 99%
   C. PPV ~ 67% NPV ~ 90%
   D. PPV ~ 90% NPV ~ 80%
   E. PPV > 99% NPV ~ 90%

4. Which of the following is NOT associated with fibromyalgia [4] ?

   A. Irritable Bowel Syndrome
   B. Sleep Disorder
   C. Chronic Fatigue
   D. Elevated Thyroid Stimulating Hormone (TSH)
   E. Myalgias

5. Which of the following groups of people should NOT receive the yearly influenza vaccination [5] ?

   A. Persons over 60 years old
   B. Persons with chronic diseases
   C. Persons with sickle cell anemia
   D. Persons at high risk for exposure to influenza
   E. None of the above

6. In persons vaccinated with hepatitis B vaccine, the serology will show [6] ?

   A. Anti-hepatitis B core antibody
   B. Anti-hepatitis B surface antibody
   C. Hepatitis B surface antigen
   D. Anti-hepatitis B surface and core antibodies
   E. Anti-hepatitis E antibody

7. Which of the following is NOT characteristic of patients with chronic alcoholic intake [7] ?

   A. Elevated Cholesterol
   B. Elevated red blood cell mean corpuscular volume (MCV)
   C. Depressed Folic Acid Levels
   D. Palmar Erythema
   E. Fatty Liver

8. Which of the following is NOT true regarding Lower Back Pain (LBP) [8] ?

   A. It is usually related to overexertion or strain
   B. It is best evaluated with history and physical examination
   C. Benign causes of LBP are often most symptomatic during the night
   D. It should be aggressively evaluated in persons with systemic symptoms
   E. Low levels of activity, as tolerated by the patient, is the best therapy in most cases

9. Which of the following is NOT true concerning health screening [9] ?

   A. Urinalysis should be done in all pregnant women
   B. Chest Radiography should be done every 2-3 years in all patients who smoke
   C. Cholesterol levels should be checked at least every 5 years in patients with normal levels
   D. Thyroid function should be checked in elderly persons with palpitations
   E. Blood pressure should be checked every 6-12 months in persons over 40 years of age

10. Which of the following agents is NOT appropriate for migraine prophylaxis [10] ?

    A. Propranolol
    B. Amitriptyline (Elavil®)
    C. Verapamil
    D. Non-steroidal Anti-inflammatory Drugs (NSAIDs)
    E. Butalbital (such as Fiorinal®)

Answers

1. C (First line treatment for high cholesterol, low HDL, and normal triglycerides.)
2. C
3. A
4. D (Thyroid dysfunction is not part of fibromyalgia.)
5. E
6. B
7. A (Alcohol lowers cholesterol levels.)
8. C (Tumors, infections, fractures are often more symptomatic during the night.)
9. B
10. E