Aquifer Comprehensive Clinical Review 2026: Practice Questions, Rationales, and Exam Techniques

Which of the following is a physical harm that could result from a diagnostic error? A. Anxiety B. Regret C. Pain from an invasive tumor and metastases D. Increased insurance premiums Rationale: Physical harm refers to tangible bodily injury or complications. Anxiety and regret are emotional, and financial harm relates to costs. Which of the following is an emotional harm from a diagnostic error? A. Pain from tumor B. Bleeding C. Regret about missed opportunity to treat cancer D. Cost of testing Rationale: Emotional harm involves psychological or emotional effects. Physical and financial harms are separate categories. Which of the following is a financial harm from a diagnostic error? A. Costs of testing and treatment not covered by insurance B. Anxiety about treatment C. Pain from tumor D. Fatigue Rationale: Financial harm includes direct and indirect costs incurred by the patient and their family. Emotional and physical harms are not financial. What costs to the healthcare system and society may result from a diagnostic error? (Select all that apply) A. More extensive and expensive therapy B. Lost productivity C. Emotional distress D. None Rationale: Diagnostic errors can lead to increased resource use and societal loss of productivity. Emotional distress affects patients but is not a system cost. Which emotions may providers involved in a diagnostic error experience? A. Joy B. Guilt and other negative feelings C. Indifference D. Excitement Rationale: Providers often experience guilt, shame, or anxiety when involved in errors. Positive emotions are not typical responses. How does Ms. Hernandez’s pre-test probability of colon cancer compare to Ms. Shakil’s? A. Higher B. Equal C. Much less D. Cannot determine Rationale: Ms. Hernandez had very low risk factors, so her likelihood of having colon cancer before testing (pre-test probability) is much lower than Ms. Shakil’s. Which cognitive bias likely caused Dr. Peterson to order an unnecessary colonoscopy in Ms. Hernandez? A. Confirmation bias B. Anchoring bias C. Availability heuristic D. Hindsight bias Rationale: The availability heuristic occurs when clinicians overestimate the likelihood of a disease based on memorable recent cases. Other biases do not fit this scenario. Given Ms. Hernandez’s low pre-test probability, what is the primary harm from over-testing? A. There is no harm B. Only physical harm C. Only financial harm ProfAmelia - 2026 D. She may suffer emotional, physical, and financial harms Rationale: Over-testing can lead to unnecessary procedures, anxiety, complications, and additional costs. All harm categories are relevant. True or False: In critically ill patients, tight blood sugar control (80–110 mg/dL) reduces mortality compared to less strict control (140–180 mg/dL). A. False B. True Rationale: Tight glycemic control increases hypoglycemia risk without improving mortality; moderate control is safer. Which statement is true regarding the accuracy of hypoglycemia detection by symptoms alone? A. Patients always detect hypoglycemia B. Only type 1 diabetics detect it C. Patients cannot reliably detect hypoglycemia by symptoms alone D. Detection improves with age Rationale: Many patients, especially with long-standing diabetes, have hypoglycemia unawareness. Symptoms alone are unreliable. Which of the following daily activities is most affected in Mrs. Rosenzweig and helps confirm functional decline in dementia? A. Reading books B. Meal preparation C. Walking in the park D. Watching TV Rationale: Difficulty with meal preparation, finances, driving, and medication management reflects loss of independence, which is a key diagnostic clue for dementia. Other activities are less indicative. Considering her dementia, which type of intervention is most appropriate for Mrs. Rosenzweig? A. Immediate hospitalization B. Office-based management with monitoring and support C. Surgical intervention D. No intervention required Rationale: Mild to moderate Alzheimer’s dementia can often be managed in-office with support, education, and follow-up. Hospitalization or surgery is unnecessary unless complications arise. Which of the following are high-yield labs to rule out reversible causes of cognitive decline in Mrs. Rosenzweig? (Select all that apply) A. Lipid panel B. TSH C. Vitamin B12 D. Renal function E. Electrolytes F. Liver function Rationale: Thyroid dysfunction, B12 deficiency, renal or hepatic dysfunction, and electrolyte imbalances can all contribute to cognitive changes. Lipids are less directly relevant. Which step is NOT part of the 5 A’s approach to intervention? A. Ignore B. Assess C. Advise D. Agree Rationale: The 5 A’s are assess, advise, agree, assist, and arrange. “Ignore” is obviously not part of a structured intervention. Which lifestyle modification has been shown to reduce blood pressure as much as a single antihypertensive drug? A. Aerobic exercise only B. Smoking cessation only C. DASH diet D. Low-protein diet Rationale: The DASH diet is clinically proven to reduce blood pressure comparably to one antihypertensive agent. Exercise and smoking cessation are helpful but less impactful alone. If Mr. Hicks’ first blood pressure reading was 125/76 mmHg, when should he have been seen for follow-up? A. 1 month B. 3 months C. 6 months D. 1 year Rationale: Blood pressure in the normal range (<130/80 mmHg) without comorbidities warrants follow-up every six months. More frequent follow-up is unnecessary. Mr. Hicks’ ECG shows LVH with strain. Which organ systems are most likely affected by longstanding hypertension? (Select all that apply) A. Heart B. Kidneys C. Eyes D. Lungs E. Liver Rationale: Long-standing hypertension causes target organ damage primarily in the heart (LVH), kidneys (renal insufficiency), and eyes (retinopathy). Lungs and liver are less directly affected. Which complications is Mr. Hicks acutely at risk for due to severely elevated blood pressure? (Select all that apply) A. Stroke B. Myocardial infarction C. Renal failure D. Heart failure E. Aortic dissection F. Retinal hemorrhage Rationale: Severe or uncontrolled hypertension can precipitate end-organ damage across multiple systems. These are classic acute complications. Which of the following are appropriate office-based interventions for Mr. Morales’ obesity? (Select all that apply) A. Brief dietary counseling in the office B. Providing patient educational materials about diet and exercise C. Referral to a registered nutritionist D. Referral to an accredited diabetes care center for self-management education E. Bariatric surgery without lifestyle counseling Rationale: Evidence-based management focuses on lifestyle modification and patient education. Surgery is not first-line without counseling and support. Which of the following is correct regarding Mr. Reynolds’ cardiovascular risk history? (Select all that apply) A. Tobacco use B. Family history of cardiovascular disease C. Exercise habits D. History of chest or leg pain with exercise E. Excess alcohol use F. Eye color Rationale: These lifestyle and family factors directly affect cardiovascular risk. Eye color is irrelevant. Which of the following best describes the pre-test probability of colon cancer for Ms. Hernandez compared to Ms. Shakil? A. Higher B. Equal C. Much less D. Cannot determine Rationale: Ms. Hernandez has very low risk factors for colon cancer, so her likelihood of having the disease prior to testing is much lower than Ms. Shakil’s. What cognitive bias likely led to ordering an unnecessary colonoscopy for Ms. Hernandez? A. Confirmation bias B. Anchoring bias C. Availability heuristic D. Hindsight bias Rationale: The availability heuristic occurs when clinicians overestimate the likelihood of a disease based on memorable or recent cases. Other biases do not fit this scenario. Given Ms. Hernandez’s low pre-test probability, what types of harms could result from the colonoscopy? A. Only physical harms B. Only emotional harms C. Only financial harms D. Emotional, physical, and financial harms Rationale: Over-testing can lead to complications from procedures, patient anxiety, and additional costs. All three categories are relevant. Which statement is true regarding tight glycemic control (80–110 mg/dL) in critically ill patients? A. Reduces mortality compared to moderate control B. False – tight control does not lower mortality and increases hypoglycemia risk C. Always preferred in ICU patients D. Only beneficial in type 2 diabetes Rationale: Studies show tight glycemic control increases hypoglycemia risk without improving mortality in critically ill patients. Moderate targets (140–180 mg/dL) are safer. Can patients reliably detect hypoglycemia by symptoms alone? A. Yes B. Only if symptomatic for >10 years C. Only type 1 diabetics D. No Rationale: Many patients, especially with long-standing diabetes, develop hypoglycemia unawareness. Reliance on symptoms alone is unsafe. Which of the following are high-yield labs to rule out reversible causes of dementia? (Select all that apply) A. Lipid panel B. TSH C. Vitamin B12 D. Renal function E. Electrolytes F. Liver function Rationale: Thyroid dysfunction, B12 deficiency, renal or hepatic dysfunction, and electrolyte imbalances can contribute to cognitive changes. Lipids are less relevant. Which of the following are components of the 5 A’s approach to intervention? (Select all that apply) A. Assess B. Advise C. Agree D. Assist E. Arrange F. Ignore Rationale: The 5 A’s—assess, advise, agree, assist, arrange—are widely used in lifestyle and chronic disease management. Ignoring the patient is not part of the model. Which lifestyle modification has been shown to reduce blood pressure as much as a single drug? A. Aerobic exercise B. Smoking cessation C. DASH diet D. Low-protein diet Rationale: The DASH diet has strong evidence for reducing blood pressure comparably to one antihypertensive agent. Other measures are helpful but less effective alone. What follow-up interval is appropriate for a patient with blood pressure 125/76 mmHg at their first visit? A. 1 month B. 3 months C. 6 months D. 1 year Rationale: For normal blood pressure (<130/80 mmHg) without comorbidities, routine followup every six months is recommended. Which of the following complications is Mr. Hicks acutely at risk for due to severe hypertension? (Select all that apply) A. Stroke B. Myocardial infarction C. Encephalopathy D. Renal failure E. Aortic dissection F. Retinal hemorrhage G. Heart failure Rationale: Severe hypertension can cause multi-system end-organ damage. Appendicitis or unrelated conditions are not included. Which of the following findings suggest secondary hypertension or target organ damage? (Select all that apply) A. Diffuse or displaced point of maximal impulse B. Retinopathy C. Pulsatile abdominal mass D. Discrepant blood pressures between arms and legs E. Renal artery bruit with systolic component F. Thyromegaly Rationale: These findings indicate chronic hypertension effects or a secondary cause. Which underlying condition should be suspected in hypertension with hypokalemia (K⁺ = 2.7 mmol/L)? A. Hypothyroidism B. Chronic kidney disease C. Hyperaldosteronism D. Cushing syndrome Rationale: Hypokalemia with hypertension is classic for primary hyperaldosteroni