, Question 1
A patient presents with polyuria, polydipsia, and a random plasma glucose of
210 mg/dL. Which additional finding would most strongly support a diagnosis
of diabetes mellitus rather than stress hyperglycemia?
A. Fasting plasma glucose of 118 mg/dL on two occasions
B. HbA1c of 6.4% with normal fasting glucose
C. 2-hour plasma glucose of 180 mg/dL during an OGTT
D. Presence of glycosuria on urinalysis
Correct Answer: C - 2-hour plasma glucose of 180 mg/dL during
an OGTT
RATIONALE
A 2-hour plasma glucose 200 mg/dL during an OGTT meets the
diagnostic threshold for diabetes. Fasting glucose of 118 mg/dL is
impaired fasting glucose, HbA1c 6.4% is prediabetes, and glycosuria
alone is nonspecific and can occur with lower glucose thresholds.
Question 2
Which pharmacologic strategy best aligns with current guidelines for managing
a patient with heart failure with reduced ejection fraction (HFrEF) and mild
symptoms?
A. Initiate a beta-blocker and loop diuretic, defer ACE inhibitor until
symptoms worsen
B. Start an ACE inhibitor/ARB, evidence-based beta-blocker, MRA, and
SGLT2 inhibitor
C. Prescribe digoxin as first-line therapy to improve survival
D. Use a calcium channel blocker and nitrate for symptom control
Correct Answer: B - Start an ACE inhibitor/ARB, evidence-based
beta-blocker, MRA, and SGLT2 inhibitor
Page 2
, RATIONALE
Guideline-directed medical therapy for HFrEF includes an ACE
inhibitor/ARB/ARNI, evidence-based beta-blocker, MRA, and SGLT2
inhibitor to reduce mortality and hospitalizations. Deferring ACE
inhibitors, using digoxin first-line, or using non-dihydropyridine
calcium channel blockers are not evidence-based for survival benefit.
Question 3
A patient with asthma reports using a short-acting beta-agonist (SABA) more
than twice weekly but less than daily. According to current GINA and NAEPP
guidelines, what is the most appropriate next step?
A. Continue SABA as needed and reassess in 6 months
B. Add a long-acting beta-agonist (LABA) monotherapy
C. Start a low-dose inhaled corticosteroid (ICS) or ICS-formoterol as
needed
D. Initiate oral prednisone burst therapy
Correct Answer: C - Start a low-dose inhaled corticosteroid (ICS)
or ICS-formoterol as needed
RATIONALE
Increasing SABA use indicates inadequate control; guidelines
recommend initiating or stepping up to low-dose ICS or
ICS-formoterol as needed. LABA monotherapy is contraindicated in
asthma, and oral steroids are reserved for exacerbations.
Question 4
Which laboratory finding is most consistent with primary hyperparathyroidism
in an asymptomatic patient with elevated calcium?
A. Low parathyroid hormone (PTH) and low phosphate
B. High PTH and high phosphate
C. High PTH and low phosphate
D. Low PTH and high phosphate
Page 3
, Correct Answer: C - High PTH and low phosphate
RATIONALE
Primary hyperparathyroidism typically presents with elevated calcium,
inappropriately normal or high PTH, and low phosphate due to
PTH-induced phosphaturia. Low PTH suggests malignancy or other
causes, and high phosphate with high PTH suggests secondary
hyperparathyroidism.
Question 5
A patient with major depressive disorder has not responded to an adequate trial
of an SSRI. Which action is most consistent with evidence-based practice?
A. Switch to a different SSRI immediately
B. Augment with an atypical antipsychotic or switch to a different class
C. Add a benzodiazepine for mood stabilization
D. Discontinue all pharmacotherapy and start psychotherapy alone
Correct Answer: B - Augment with an atypical antipsychotic or
switch to a different class
RATIONALE
After inadequate response to an SSRI, options include augmentation
with an atypical antipsychotic (e.g., aripiprazole) or switching to a
different antidepressant class. Benzodiazepines are not mood
stabilizers, and monotherapy psychotherapy may be insufficient for
moderate-severe depression.
Question 6
Which statement best reflects current recommendations for cervical cancer
screening in average-risk individuals?
A. Annual cytology starting at age 21
B. Primary HPV testing every 5 years starting at age 30
C. Cytology every 3 years starting at age 25
Page 4
A patient presents with polyuria, polydipsia, and a random plasma glucose of
210 mg/dL. Which additional finding would most strongly support a diagnosis
of diabetes mellitus rather than stress hyperglycemia?
A. Fasting plasma glucose of 118 mg/dL on two occasions
B. HbA1c of 6.4% with normal fasting glucose
C. 2-hour plasma glucose of 180 mg/dL during an OGTT
D. Presence of glycosuria on urinalysis
Correct Answer: C - 2-hour plasma glucose of 180 mg/dL during
an OGTT
RATIONALE
A 2-hour plasma glucose 200 mg/dL during an OGTT meets the
diagnostic threshold for diabetes. Fasting glucose of 118 mg/dL is
impaired fasting glucose, HbA1c 6.4% is prediabetes, and glycosuria
alone is nonspecific and can occur with lower glucose thresholds.
Question 2
Which pharmacologic strategy best aligns with current guidelines for managing
a patient with heart failure with reduced ejection fraction (HFrEF) and mild
symptoms?
A. Initiate a beta-blocker and loop diuretic, defer ACE inhibitor until
symptoms worsen
B. Start an ACE inhibitor/ARB, evidence-based beta-blocker, MRA, and
SGLT2 inhibitor
C. Prescribe digoxin as first-line therapy to improve survival
D. Use a calcium channel blocker and nitrate for symptom control
Correct Answer: B - Start an ACE inhibitor/ARB, evidence-based
beta-blocker, MRA, and SGLT2 inhibitor
Page 2
, RATIONALE
Guideline-directed medical therapy for HFrEF includes an ACE
inhibitor/ARB/ARNI, evidence-based beta-blocker, MRA, and SGLT2
inhibitor to reduce mortality and hospitalizations. Deferring ACE
inhibitors, using digoxin first-line, or using non-dihydropyridine
calcium channel blockers are not evidence-based for survival benefit.
Question 3
A patient with asthma reports using a short-acting beta-agonist (SABA) more
than twice weekly but less than daily. According to current GINA and NAEPP
guidelines, what is the most appropriate next step?
A. Continue SABA as needed and reassess in 6 months
B. Add a long-acting beta-agonist (LABA) monotherapy
C. Start a low-dose inhaled corticosteroid (ICS) or ICS-formoterol as
needed
D. Initiate oral prednisone burst therapy
Correct Answer: C - Start a low-dose inhaled corticosteroid (ICS)
or ICS-formoterol as needed
RATIONALE
Increasing SABA use indicates inadequate control; guidelines
recommend initiating or stepping up to low-dose ICS or
ICS-formoterol as needed. LABA monotherapy is contraindicated in
asthma, and oral steroids are reserved for exacerbations.
Question 4
Which laboratory finding is most consistent with primary hyperparathyroidism
in an asymptomatic patient with elevated calcium?
A. Low parathyroid hormone (PTH) and low phosphate
B. High PTH and high phosphate
C. High PTH and low phosphate
D. Low PTH and high phosphate
Page 3
, Correct Answer: C - High PTH and low phosphate
RATIONALE
Primary hyperparathyroidism typically presents with elevated calcium,
inappropriately normal or high PTH, and low phosphate due to
PTH-induced phosphaturia. Low PTH suggests malignancy or other
causes, and high phosphate with high PTH suggests secondary
hyperparathyroidism.
Question 5
A patient with major depressive disorder has not responded to an adequate trial
of an SSRI. Which action is most consistent with evidence-based practice?
A. Switch to a different SSRI immediately
B. Augment with an atypical antipsychotic or switch to a different class
C. Add a benzodiazepine for mood stabilization
D. Discontinue all pharmacotherapy and start psychotherapy alone
Correct Answer: B - Augment with an atypical antipsychotic or
switch to a different class
RATIONALE
After inadequate response to an SSRI, options include augmentation
with an atypical antipsychotic (e.g., aripiprazole) or switching to a
different antidepressant class. Benzodiazepines are not mood
stabilizers, and monotherapy psychotherapy may be insufficient for
moderate-severe depression.
Question 6
Which statement best reflects current recommendations for cervical cancer
screening in average-risk individuals?
A. Annual cytology starting at age 21
B. Primary HPV testing every 5 years starting at age 30
C. Cytology every 3 years starting at age 25
Page 4
