./ ./ ./ ./ ./
1. You. / are. / managing. / the. / warfarin. / dose. / for. / an. / older. / adult. / with. / a. / prostheti
c./heart. / valve.. / Which. / situation. / listed. / requires. / that. / warfarin. / be. / disconti
nued./now?:./INR./of./8,./no./significant./bleeding.
INR./is./a./good./measure./of./the./clotting./status./in./an./outpatient./who./takes./an./oral./anticoagulant./like./warfarin../Whe
n./warfarin./is./overdosed./and./INR./climbs,./or./when./warfarin./is./overdosed./because./of./food./or./medication./that./pro
duces./deleterious./side./ettects,./warfarin./doses./may./be./omitted./or./discontinued./until./the./INR./is./in./a./more./accept
able./range../Generally,./one./or./two./doses./may./be./omitted./before./rechecking./INR./and./resuming./warfarin./or./decrea
sing./the./dose.
2. The./frequency./for./cervical./screening./depends./on./the./patient./and./her./age../W
hat./is./the./longest./recommended./time./interval./between./cervical./screens./for./pat
ients./who./are./21-65./years./of./age?:./5./years
Women./ages./21-
65./who./have./a./cervix./should./be./screened./for./cervical./cancer../Screening./intervals./every./3./years./should./take./place./fo
r./women./of./who./are./aged./21-29./years../Women./aged./30-
65./should./take./place./every./3./years./if./only./cytology./is./performed./(this./is./not./preferred);./or./every./5./years./if./cytology.
/plus./HPV./screening./takes./place.
3. A. / 40-year-
old. / patient. / with. / newly. / diagnosed. / Type. / 2. / diabetes. / asks. / what. / his./target. / bloo
d. / pressure. / should. / be.. / The. / most. / correct. / response. / in. / mm. / Hg. / is:. / less./than./140/
90.
The./2017./American./Diabetes./Association's./target./blood./pressure./for./"most./patients./with./diabetes./and./hypertensio
n"./is./less./than./140/90./mmHg../Less./than./140/90./means./that./the./systolic./blood./pressure./should./be./in./the./130s./a
t./the./highest./and./the./diastolic./blood./pressure./should./be./in./the./80s./at./the./highest../Lower./blood./pressure./target
s./such./as./130/80./mmHg./may./be./appropriate./for./patients./at./high./risk./for./cardiovascular./disease./if./they./can./be./eas
ily./achieved./(Level./C).
4. Warfarin./treatment./is./greatly./influenced./by./a./patient's./food./and./medication./i
ntake../Which./group./listed./can./potentially./decrease./INR./(International./Nor-
malized./Ratio)./in./an./outpatient./who./takes./warfarin?:./Sucralfate./and./cholestyramine
The./drugs./listed./in./choice./D./will./decrease./international./normalized./ratio./(INR)./in./patients./who./take./warfarin./conc
urrently../Sucralfate./and./calcium./carbonate./decrease./absorption./of./warfarin../The./drugs./listed./in./the./other./choices./
will./increase./INR../Major./interactions./can./occur./with./celecoxib,./ketoprofen,./and./naproxen../These./three./NSAIDs./ar
e./commonly./taken./by./older./adults,./so./this./should./be./part./of./education./with./a./patient./who./takes./warfarin.
, ./ ./ ./ ./ ./
5. Which./class./of./medication./is./frequently./used./to./improve./long-term./out-
comes./in./patients./with./systolic./dysfunction?:./ACE./inhibitors
ACE./inhibitors./are./commonly./used./in./patients./with./systolic./dysfunction./because./they./reduce./morbidity./and./mortality,
i.e../these./medications./alter./prognosis../They./also./improve./symptoms./of./fatigue,./shortness./of./breath,./and./exercise
, ./ ./ ./ ./ ./
intolerance../Loop./and./thiazide./diuretics./improve./symptoms,./but./do./not./alter./long-
term./prognosis./with./heart./failure../Beta./blockers./should./be./used./in./conjunction./with./ACE./inhibitors./and./diuretics,
./but./not./as./solo./agents../Beta./blockers./can./potentially./worsen./heart./failure,./so./their./use./in./patients./with./heart./fai
lure./should./be./monitored./carefully../Despite./this./fact,./beta./blockers./decrease./morbidity./and./mortality./associated./
with./heart./failure.
6. Which. / of. / the. / following. / results. / in. / a. / clinically. / INSIGNIFICANT. / increase. / in. / t
he./prostatespecific./antigen./(PSA)?:./Digital./rectal./exam
Digital./rectal./exam./(DRE)./leads./to./a./clinically./insignificant./increase./of./0.26-0.4./ng/mL./for./about./48-
72./hours./afterwards../Prostate./biopsy./increases./the./PSA./about./8./ng/mL./for./up./to./4./weeks./following./biopsy../Prost
ate./infection./and./ejaculation./both./can./significantly./increase./the./PSA./levels./in./varying./amounts.
7. The./two./tests./that./can./indicate./current./infection./with./hepatitis./B./are::./presence./of.
/hepatitis./B./surface./antigen./and./IgM
The./earliest./serologic./marker./that./indicates./acute./hepatitis./B./infection./is./the./presence./of./hepatitis./B./surface./antigen../I
t./becomes./positive./about./1-
10./weeks./after./infection,./but./usually./before./symptom./onset../A./positive./IgM./indicates./current./infection../The./presenc
e./of./hepatitis./B./core./antibody./identifies./hepatitis./B./infection./(present./or./past)./with./certainty../It./does./not./indicate./
timing./of./infection.
8. Which./study./listed./below./is./considered./an./experimental./study?:./Meta-
analysis./Observational./studies./are./studies./in./which./subjects./are./observed../No./intervention./takes./place./with./t
hem../Examples./of./these./are./found./in./the./first./three./choices../A./meta-
analysis./takes./published./information./from./other./studies./and./combines./the./information./to./arrive./at./a./conclusion
../Although./a./meta./analysis./can./use./observational./studies,./these./should./be./reported./separately.
9. Which. / mitral. / disorder. / results. / from. / redundancy. / of. / the. / mitral. / valve's. / leaflets?-
:. / Mitral./valve./prolapse
Mitral./valve./prolapse./(MVP)./is./the./most./common./adult./murmur../It./is./best./heard./with./the./diaphragm./of./the./stethoscop
e./over./the./cardiac./apex../It./is./a./result./of./redundancy./of./the./mitral./valve./leaflets./and./subsequent./degeneration./of./
the./mitral./tissue../The./posterior./leaflet./is./more./commonly./attected./than./the./anterior./leaflet../The./valve's./annulus./b
ecomes./enlarged./in./conjunction./with./elongation./of./the./chordae./tendineae.
10. A./patient./who./takes./HCTZ./25./mg./daily./has./complaints./of./muscle./cramps../He./pr
obably./has::./hypokalemia.
HCTZ./is./a./thiazide./diuretic./that./is./potassium-
wasting../Patients./can./become./hypokalemic./and./experience./side./ettects./of./this../A./common./one./is./muscle./cramps.
, ./ ./ ./ ./ ./
11. A./mammogram./in./a./healthy./50-year-
old./female./patient./is./an./example./of::./secondary./prevention.
1. You. / are. / managing. / the. / warfarin. / dose. / for. / an. / older. / adult. / with. / a. / prostheti
c./heart. / valve.. / Which. / situation. / listed. / requires. / that. / warfarin. / be. / disconti
nued./now?:./INR./of./8,./no./significant./bleeding.
INR./is./a./good./measure./of./the./clotting./status./in./an./outpatient./who./takes./an./oral./anticoagulant./like./warfarin../Whe
n./warfarin./is./overdosed./and./INR./climbs,./or./when./warfarin./is./overdosed./because./of./food./or./medication./that./pro
duces./deleterious./side./ettects,./warfarin./doses./may./be./omitted./or./discontinued./until./the./INR./is./in./a./more./accept
able./range../Generally,./one./or./two./doses./may./be./omitted./before./rechecking./INR./and./resuming./warfarin./or./decrea
sing./the./dose.
2. The./frequency./for./cervical./screening./depends./on./the./patient./and./her./age../W
hat./is./the./longest./recommended./time./interval./between./cervical./screens./for./pat
ients./who./are./21-65./years./of./age?:./5./years
Women./ages./21-
65./who./have./a./cervix./should./be./screened./for./cervical./cancer../Screening./intervals./every./3./years./should./take./place./fo
r./women./of./who./are./aged./21-29./years../Women./aged./30-
65./should./take./place./every./3./years./if./only./cytology./is./performed./(this./is./not./preferred);./or./every./5./years./if./cytology.
/plus./HPV./screening./takes./place.
3. A. / 40-year-
old. / patient. / with. / newly. / diagnosed. / Type. / 2. / diabetes. / asks. / what. / his./target. / bloo
d. / pressure. / should. / be.. / The. / most. / correct. / response. / in. / mm. / Hg. / is:. / less./than./140/
90.
The./2017./American./Diabetes./Association's./target./blood./pressure./for./"most./patients./with./diabetes./and./hypertensio
n"./is./less./than./140/90./mmHg../Less./than./140/90./means./that./the./systolic./blood./pressure./should./be./in./the./130s./a
t./the./highest./and./the./diastolic./blood./pressure./should./be./in./the./80s./at./the./highest../Lower./blood./pressure./target
s./such./as./130/80./mmHg./may./be./appropriate./for./patients./at./high./risk./for./cardiovascular./disease./if./they./can./be./eas
ily./achieved./(Level./C).
4. Warfarin./treatment./is./greatly./influenced./by./a./patient's./food./and./medication./i
ntake../Which./group./listed./can./potentially./decrease./INR./(International./Nor-
malized./Ratio)./in./an./outpatient./who./takes./warfarin?:./Sucralfate./and./cholestyramine
The./drugs./listed./in./choice./D./will./decrease./international./normalized./ratio./(INR)./in./patients./who./take./warfarin./conc
urrently../Sucralfate./and./calcium./carbonate./decrease./absorption./of./warfarin../The./drugs./listed./in./the./other./choices./
will./increase./INR../Major./interactions./can./occur./with./celecoxib,./ketoprofen,./and./naproxen../These./three./NSAIDs./ar
e./commonly./taken./by./older./adults,./so./this./should./be./part./of./education./with./a./patient./who./takes./warfarin.
, ./ ./ ./ ./ ./
5. Which./class./of./medication./is./frequently./used./to./improve./long-term./out-
comes./in./patients./with./systolic./dysfunction?:./ACE./inhibitors
ACE./inhibitors./are./commonly./used./in./patients./with./systolic./dysfunction./because./they./reduce./morbidity./and./mortality,
i.e../these./medications./alter./prognosis../They./also./improve./symptoms./of./fatigue,./shortness./of./breath,./and./exercise
, ./ ./ ./ ./ ./
intolerance../Loop./and./thiazide./diuretics./improve./symptoms,./but./do./not./alter./long-
term./prognosis./with./heart./failure../Beta./blockers./should./be./used./in./conjunction./with./ACE./inhibitors./and./diuretics,
./but./not./as./solo./agents../Beta./blockers./can./potentially./worsen./heart./failure,./so./their./use./in./patients./with./heart./fai
lure./should./be./monitored./carefully../Despite./this./fact,./beta./blockers./decrease./morbidity./and./mortality./associated./
with./heart./failure.
6. Which. / of. / the. / following. / results. / in. / a. / clinically. / INSIGNIFICANT. / increase. / in. / t
he./prostatespecific./antigen./(PSA)?:./Digital./rectal./exam
Digital./rectal./exam./(DRE)./leads./to./a./clinically./insignificant./increase./of./0.26-0.4./ng/mL./for./about./48-
72./hours./afterwards../Prostate./biopsy./increases./the./PSA./about./8./ng/mL./for./up./to./4./weeks./following./biopsy../Prost
ate./infection./and./ejaculation./both./can./significantly./increase./the./PSA./levels./in./varying./amounts.
7. The./two./tests./that./can./indicate./current./infection./with./hepatitis./B./are::./presence./of.
/hepatitis./B./surface./antigen./and./IgM
The./earliest./serologic./marker./that./indicates./acute./hepatitis./B./infection./is./the./presence./of./hepatitis./B./surface./antigen../I
t./becomes./positive./about./1-
10./weeks./after./infection,./but./usually./before./symptom./onset../A./positive./IgM./indicates./current./infection../The./presenc
e./of./hepatitis./B./core./antibody./identifies./hepatitis./B./infection./(present./or./past)./with./certainty../It./does./not./indicate./
timing./of./infection.
8. Which./study./listed./below./is./considered./an./experimental./study?:./Meta-
analysis./Observational./studies./are./studies./in./which./subjects./are./observed../No./intervention./takes./place./with./t
hem../Examples./of./these./are./found./in./the./first./three./choices../A./meta-
analysis./takes./published./information./from./other./studies./and./combines./the./information./to./arrive./at./a./conclusion
../Although./a./meta./analysis./can./use./observational./studies,./these./should./be./reported./separately.
9. Which. / mitral. / disorder. / results. / from. / redundancy. / of. / the. / mitral. / valve's. / leaflets?-
:. / Mitral./valve./prolapse
Mitral./valve./prolapse./(MVP)./is./the./most./common./adult./murmur../It./is./best./heard./with./the./diaphragm./of./the./stethoscop
e./over./the./cardiac./apex../It./is./a./result./of./redundancy./of./the./mitral./valve./leaflets./and./subsequent./degeneration./of./
the./mitral./tissue../The./posterior./leaflet./is./more./commonly./attected./than./the./anterior./leaflet../The./valve's./annulus./b
ecomes./enlarged./in./conjunction./with./elongation./of./the./chordae./tendineae.
10. A./patient./who./takes./HCTZ./25./mg./daily./has./complaints./of./muscle./cramps../He./pr
obably./has::./hypokalemia.
HCTZ./is./a./thiazide./diuretic./that./is./potassium-
wasting../Patients./can./become./hypokalemic./and./experience./side./ettects./of./this../A./common./one./is./muscle./cramps.
, ./ ./ ./ ./ ./
11. A./mammogram./in./a./healthy./50-year-
old./female./patient./is./an./example./of::./secondary./prevention.
