, Question 1
Which finding most reliably distinguishes primary Raynaud phenomenon from
secondary Raynaud phenomenon in a patient presenting with cold-induced
digital color changes?
A. Bilateral symmetric involvement of the fingers only
B. Positive ANA with a nucleolar pattern
C. Symptoms beginning after age 30 with asymmetric, unilateral
involvement
D. Presence of triphasic color change (white-blue-red)
Correct Answer: C - Symptoms beginning after age 30 with
asymmetric, unilateral involvement
RATIONALE
Secondary Raynaud is suggested by later onset (>30 years),
asymmetric/unilateral involvement, and association with connective
tissue disease. Bilateral symmetric triphasic changes are typical of
primary Raynaud. A nucleolar ANA is nonspecific and not a
diagnostic discriminator by itself.
Question 2
A patient with newly diagnosed type 2 diabetes has an eGFR of 52
mL/min/1.73 m² and a urine albumin-to-creatinine ratio of 350 mg/g. Which
medication class provides the strongest dual cardiorenal protection and should
be initiated first?
A. SGLT2 inhibitor
B. DPP-4 inhibitor
C. Sulfonylurea
D. Basal insulin
Correct Answer: A - SGLT2 inhibitor
Page 2
, RATIONALE
SGLT2 inhibitors reduce CKD progression and cardiovascular events
in patients with albuminuria and reduced eGFR, per ADA/KDIGO
guidance. DPP-4 inhibitors, sulfonylureas, and basal insulin do not
confer equivalent cardiorenal protection.
Question 3
Which ECG finding is most consistent with hyperkalemia in a patient with
advanced chronic kidney disease?
A. Prominent U waves and ST depression
B. Peaked T waves with widened QRS and flattened P waves
C. Sawtooth flutter waves at 300 bpm
D. Delta wave with short PR interval
Correct Answer: B - Peaked T waves with widened QRS and
flattened P waves
RATIONALE
Hyperkalemia classically produces peaked/tented T waves, PR
prolongation, P-wave flattening, and QRS widening that can progress
to sine wave. U waves and ST depression suggest hypokalemia; flutter
and delta waves indicate other arrhythmias.
Question 4
A postpartum patient reports unilateral breast pain, fever, and a tender,
erythematous, wedge-shaped area. Which management is most appropriate
according to current guidelines?
A. Continue breastfeeding and start dicloxacillin or cephalexin
B. Discontinue breastfeeding, apply warm compresses, and use NSAIDs
only
C. Start azithromycin and pump and discard milk
D. Immediate surgical incision and drainage
Page 3
, Correct Answer: A - Continue breastfeeding and start
dicloxacillin or cephalexin
RATIONALE
Lactational mastitis is treated with continued breastfeeding plus a
penicillinase-resistant penicillin or first-generation cephalosporin (e.g.,
dicloxacillin, cephalexin). Discontinuing breastfeeding and
azithromycin are not first-line; surgery is reserved for abscess.
Question 5
Which statement best reflects the USPSTF recommendation for lung cancer
screening in 2024?
A. Annual low-dose CT for adults 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 55-74 with any smoking history
C. Low-dose CT every 3 years for adults 40-80 with a 10 pack-year
history
D. No screening is recommended for former smokers
Correct Answer: A - Annual low-dose CT for adults 50-80 with a
20 pack-year history who currently smoke or quit within the past
15 years
RATIONALE
The 2021/2024 USPSTF recommendation is annual low-dose CT for
adults 50-80 with 20 pack-year history who currently smoke or quit
within 15 years. Chest X-ray is not recommended; the other
intervals/criteria are incorrect.
Question 6
A patient on warfarin for atrial fibrillation has an INR of 6.8 without bleeding.
Which is the most appropriate next step?
A. Hold warfarin and administer oral vitamin K 2.5-5 mg
Page 4
Which finding most reliably distinguishes primary Raynaud phenomenon from
secondary Raynaud phenomenon in a patient presenting with cold-induced
digital color changes?
A. Bilateral symmetric involvement of the fingers only
B. Positive ANA with a nucleolar pattern
C. Symptoms beginning after age 30 with asymmetric, unilateral
involvement
D. Presence of triphasic color change (white-blue-red)
Correct Answer: C - Symptoms beginning after age 30 with
asymmetric, unilateral involvement
RATIONALE
Secondary Raynaud is suggested by later onset (>30 years),
asymmetric/unilateral involvement, and association with connective
tissue disease. Bilateral symmetric triphasic changes are typical of
primary Raynaud. A nucleolar ANA is nonspecific and not a
diagnostic discriminator by itself.
Question 2
A patient with newly diagnosed type 2 diabetes has an eGFR of 52
mL/min/1.73 m² and a urine albumin-to-creatinine ratio of 350 mg/g. Which
medication class provides the strongest dual cardiorenal protection and should
be initiated first?
A. SGLT2 inhibitor
B. DPP-4 inhibitor
C. Sulfonylurea
D. Basal insulin
Correct Answer: A - SGLT2 inhibitor
Page 2
, RATIONALE
SGLT2 inhibitors reduce CKD progression and cardiovascular events
in patients with albuminuria and reduced eGFR, per ADA/KDIGO
guidance. DPP-4 inhibitors, sulfonylureas, and basal insulin do not
confer equivalent cardiorenal protection.
Question 3
Which ECG finding is most consistent with hyperkalemia in a patient with
advanced chronic kidney disease?
A. Prominent U waves and ST depression
B. Peaked T waves with widened QRS and flattened P waves
C. Sawtooth flutter waves at 300 bpm
D. Delta wave with short PR interval
Correct Answer: B - Peaked T waves with widened QRS and
flattened P waves
RATIONALE
Hyperkalemia classically produces peaked/tented T waves, PR
prolongation, P-wave flattening, and QRS widening that can progress
to sine wave. U waves and ST depression suggest hypokalemia; flutter
and delta waves indicate other arrhythmias.
Question 4
A postpartum patient reports unilateral breast pain, fever, and a tender,
erythematous, wedge-shaped area. Which management is most appropriate
according to current guidelines?
A. Continue breastfeeding and start dicloxacillin or cephalexin
B. Discontinue breastfeeding, apply warm compresses, and use NSAIDs
only
C. Start azithromycin and pump and discard milk
D. Immediate surgical incision and drainage
Page 3
, Correct Answer: A - Continue breastfeeding and start
dicloxacillin or cephalexin
RATIONALE
Lactational mastitis is treated with continued breastfeeding plus a
penicillinase-resistant penicillin or first-generation cephalosporin (e.g.,
dicloxacillin, cephalexin). Discontinuing breastfeeding and
azithromycin are not first-line; surgery is reserved for abscess.
Question 5
Which statement best reflects the USPSTF recommendation for lung cancer
screening in 2024?
A. Annual low-dose CT for adults 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 55-74 with any smoking history
C. Low-dose CT every 3 years for adults 40-80 with a 10 pack-year
history
D. No screening is recommended for former smokers
Correct Answer: A - Annual low-dose CT for adults 50-80 with a
20 pack-year history who currently smoke or quit within the past
15 years
RATIONALE
The 2021/2024 USPSTF recommendation is annual low-dose CT for
adults 50-80 with 20 pack-year history who currently smoke or quit
within 15 years. Chest X-ray is not recommended; the other
intervals/criteria are incorrect.
Question 6
A patient on warfarin for atrial fibrillation has an INR of 6.8 without bleeding.
Which is the most appropriate next step?
A. Hold warfarin and administer oral vitamin K 2.5-5 mg
Page 4
