, Question 1
A patient with newly diagnosed heart failure with reduced ejection fraction
(HFrEF) and NYHA class II symptoms is initiated on guideline-directed
medical therapy. Which combination of drug classes has the strongest evidence
for reducing both mortality and hospitalizations?
A. ACE inhibitor + beta-blocker + mineralocorticoid receptor antagonist
B. Loop diuretic + digoxin + hydralazine/isosorbide dinitrate
C. Angiotensin receptor blocker + calcium channel blocker + statin
D. Beta-blocker + ivabradine + ranolazine
Correct Answer: A - ACE inhibitor + beta-blocker +
mineralocorticoid receptor antagonist
RATIONALE
ACE inhibitors (or ARBs/ARNIs), evidence-based beta-blockers, and
MRAs are the cornerstone of HFrEF therapy, each with mortality
benefit. Diuretics improve symptoms but not mortality; digoxin
reduces hospitalizations but not mortality. CCBs and ranolazine are
not first-line for HFrEF.
Question 2
Which statement best reflects the 2023 ADA Standards of Care regarding
screening for type 2 diabetes in asymptomatic adults?
A. Screen all adults beginning at age 45 regardless of risk factors.
B. Screen adults with overweight/obesity and one or more risk factors,
and all adults beginning at age 35.
C. Screen only adults with a family history of diabetes or hypertension.
D. Screen using fasting plasma glucose every 5 years for all adults.
Correct Answer: B - Screen adults with overweight/obesity and
one or more risk factors, and all adults beginning at age 35.
Page 2
, RATIONALE
The ADA now recommends screening all adults starting at age 35 and
those with overweight/obesity plus additional risk factors, regardless
of age. Universal screening at 45 is outdated; targeted screening based
solely on family history misses many cases. Fasting glucose every 5
years is not the recommended interval.
Question 3
A patient presents with acute onset of unilateral facial paralysis, inability to
close the eye, and loss of taste on the anterior tongue. Which finding would
most strongly suggest an alternative diagnosis to Bell's palsy?
A. Presence of hyperacusis
B. Involvement of only the lower face
C. Gradual onset over 2 weeks
D. Bilateral facial weakness
Correct Answer: D - Bilateral facial weakness
RATIONALE
Bell's palsy is typically unilateral; bilateral involvement raises concern
for Guillain-Barré syndrome, Lyme disease, or sarcoidosis.
Hyperacusis and anterior tongue taste loss are common in Bell's palsy
due to chorda tympani involvement. Lower face only suggests a
central (upper motor neuron) lesion. Gradual onset over weeks is
atypical for Bell's palsy and suggests tumor or other process.
Question 4
According to the 2021 USPSTF recommendations, which strategy is
recommended for lung cancer screening in high-risk adults?
A. Annual low-dose computed tomography (LDCT) for adults aged 50-80
with a 20 pack-year history who currently smoke or quit within the past
15 years.
B. Annual chest X-ray for adults aged 55-74 with a 30 pack-year history.
Page 3
, C. Once-only LDCT for adults aged 50-80 with any smoking history.
D. Sputum cytology every 2 years for adults aged 50-80 with a 20
pack-year history.
Correct Answer: A - Annual low-dose computed tomography
(LDCT) for adults aged 50-80 with a 20 pack-year history who
currently smoke or quit within the past 15 years.
RATIONALE
The 2021 USPSTF expanded LDCT screening to adults 50-80 with a
20 pack-year history who currently smoke or quit within 15 years.
Chest X-ray and sputum cytology are not recommended for screening.
Screening is annual, not once-only.
Question 5
A patient with COPD (GOLD stage 2) reports increased dyspnea and
productive cough. Which intervention has been shown to reduce exacerbations
and improve quality of life?
A. Regular use of short-acting beta-agonists alone
B. Inhaled corticosteroids (ICS) as monotherapy
C. Long-acting beta-agonist (LABA) + long-acting muscarinic antagonist
(LAMA) combination therapy
D. Oral theophylline as first-line maintenance
Correct Answer: C - Long-acting beta-agonist (LABA) +
long-acting muscarinic antagonist (LAMA) combination therapy
RATIONALE
LABA+LAMA combination therapy reduces exacerbations and
improves lung function and quality of life in COPD. SABA alone is
for rescue. ICS monotherapy is not recommended; ICS is added for
frequent exacerbations or eosinophilic phenotype. Theophylline has a
narrow therapeutic index and is not first-line.
Page 4
A patient with newly diagnosed heart failure with reduced ejection fraction
(HFrEF) and NYHA class II symptoms is initiated on guideline-directed
medical therapy. Which combination of drug classes has the strongest evidence
for reducing both mortality and hospitalizations?
A. ACE inhibitor + beta-blocker + mineralocorticoid receptor antagonist
B. Loop diuretic + digoxin + hydralazine/isosorbide dinitrate
C. Angiotensin receptor blocker + calcium channel blocker + statin
D. Beta-blocker + ivabradine + ranolazine
Correct Answer: A - ACE inhibitor + beta-blocker +
mineralocorticoid receptor antagonist
RATIONALE
ACE inhibitors (or ARBs/ARNIs), evidence-based beta-blockers, and
MRAs are the cornerstone of HFrEF therapy, each with mortality
benefit. Diuretics improve symptoms but not mortality; digoxin
reduces hospitalizations but not mortality. CCBs and ranolazine are
not first-line for HFrEF.
Question 2
Which statement best reflects the 2023 ADA Standards of Care regarding
screening for type 2 diabetes in asymptomatic adults?
A. Screen all adults beginning at age 45 regardless of risk factors.
B. Screen adults with overweight/obesity and one or more risk factors,
and all adults beginning at age 35.
C. Screen only adults with a family history of diabetes or hypertension.
D. Screen using fasting plasma glucose every 5 years for all adults.
Correct Answer: B - Screen adults with overweight/obesity and
one or more risk factors, and all adults beginning at age 35.
Page 2
, RATIONALE
The ADA now recommends screening all adults starting at age 35 and
those with overweight/obesity plus additional risk factors, regardless
of age. Universal screening at 45 is outdated; targeted screening based
solely on family history misses many cases. Fasting glucose every 5
years is not the recommended interval.
Question 3
A patient presents with acute onset of unilateral facial paralysis, inability to
close the eye, and loss of taste on the anterior tongue. Which finding would
most strongly suggest an alternative diagnosis to Bell's palsy?
A. Presence of hyperacusis
B. Involvement of only the lower face
C. Gradual onset over 2 weeks
D. Bilateral facial weakness
Correct Answer: D - Bilateral facial weakness
RATIONALE
Bell's palsy is typically unilateral; bilateral involvement raises concern
for Guillain-Barré syndrome, Lyme disease, or sarcoidosis.
Hyperacusis and anterior tongue taste loss are common in Bell's palsy
due to chorda tympani involvement. Lower face only suggests a
central (upper motor neuron) lesion. Gradual onset over weeks is
atypical for Bell's palsy and suggests tumor or other process.
Question 4
According to the 2021 USPSTF recommendations, which strategy is
recommended for lung cancer screening in high-risk adults?
A. Annual low-dose computed tomography (LDCT) for adults aged 50-80
with a 20 pack-year history who currently smoke or quit within the past
15 years.
B. Annual chest X-ray for adults aged 55-74 with a 30 pack-year history.
Page 3
, C. Once-only LDCT for adults aged 50-80 with any smoking history.
D. Sputum cytology every 2 years for adults aged 50-80 with a 20
pack-year history.
Correct Answer: A - Annual low-dose computed tomography
(LDCT) for adults aged 50-80 with a 20 pack-year history who
currently smoke or quit within the past 15 years.
RATIONALE
The 2021 USPSTF expanded LDCT screening to adults 50-80 with a
20 pack-year history who currently smoke or quit within 15 years.
Chest X-ray and sputum cytology are not recommended for screening.
Screening is annual, not once-only.
Question 5
A patient with COPD (GOLD stage 2) reports increased dyspnea and
productive cough. Which intervention has been shown to reduce exacerbations
and improve quality of life?
A. Regular use of short-acting beta-agonists alone
B. Inhaled corticosteroids (ICS) as monotherapy
C. Long-acting beta-agonist (LABA) + long-acting muscarinic antagonist
(LAMA) combination therapy
D. Oral theophylline as first-line maintenance
Correct Answer: C - Long-acting beta-agonist (LABA) +
long-acting muscarinic antagonist (LAMA) combination therapy
RATIONALE
LABA+LAMA combination therapy reduces exacerbations and
improves lung function and quality of life in COPD. SABA alone is
for rescue. ICS monotherapy is not recommended; ICS is added for
frequent exacerbations or eosinophilic phenotype. Theophylline has a
narrow therapeutic index and is not first-line.
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