, Question 1
A patient with prior spontaneous preterm delivery is being counseled on
cervical cancer screening. Which statement reflects the most accurate
application of current USPSTF and ASCCP guidance?
A. Prior preterm birth is an independent indication for annual cytology
regardless of HPV status.
B. Screening intervals should be based on age, screening history, and
HPV test results, not obstetric history.
C. History of preterm delivery mandates immediate colposcopy at the
next visit.
D. Cervical cancer screening should be deferred until after age 30 in all
patients with obstetric risk factors.
Correct Answer: B - Screening intervals should be based on age,
screening history, and HPV test results, not obstetric history.
RATIONALE
Current USPSTF and ASCCP risk-based management stratifies
screening by age, prior screening results, and HPV status; obstetric
history such as preterm delivery does not alter screening intervals.
Annual cytology or automatic colposcopy is not indicated based on
obstetric history alone, and deferring screening to age 30 is not
supported for average-risk patients.
Question 2
A patient with type 2 diabetes, ASCVD, and eGFR 42 mL/min/1.73 m² is on
metformin and a statin. Which addition best aligns with current ADA/KDIGO
cardiorenal protection standards?
A. Add a DPP-4 inhibitor for glycemic control.
B. Add an SGLT2 inhibitor with proven cardiovascular and renal benefit.
C. Add a sulfonylurea to intensify glycemic control.
D. Add low-dose aspirin for primary prevention of cardiovascular events.
Page 2
,Correct Answer: B - Add an SGLT2 inhibitor with proven
cardiovascular and renal benefit.
RATIONALE
In patients with T2DM, ASCVD, and reduced eGFR, SGLT2
inhibitors with proven CV/renal outcomes are recommended by ADA
and KDIGO to reduce cardiovascular events and slow CKD
progression. DPP-4 inhibitors and sulfonylureas lack comparable
cardiorenal benefit, and aspirin for primary prevention is not routinely
recommended in this context without high bleeding-risk assessment.
Question 3
A patient presents with acute monoarticular knee pain, swelling, and fever.
Which combination of findings most strongly supports a diagnosis of septic
arthritis over crystal-induced arthritis?
A. Serum uric acid > 8 mg/dL and negatively birefringent crystals.
B. Synovial fluid WBC > 50,000/mm³ with > 90% neutrophils and
positive Gram stain.
C. Synovial fluid WBC 2,000/mm³ with mononuclear predominance.
D. Presence of rheumatoid factor and anti-CCP antibodies.
Correct Answer: B - Synovial fluid WBC > 50,000/mm³ with >
90% neutrophils and positive Gram stain.
RATIONALE
Septic arthritis is characterized by synovial fluid WBC typically
>50,000/mm³ with neutrophil predominance and often positive Gram
stain/culture. Crystal-induced arthritis shows birefringent crystals with
lower WBC counts, while mononuclear predominance and serologies
suggest inflammatory or autoimmune etiologies rather than infection.
Page 3
, Question 4
A patient with COPD (GOLD 2) reports two exacerbations in the past year and
persistent dyspnea. According to GOLD 2026, which pharmacologic strategy is
most appropriate?
A. Continue short-acting bronchodilator monotherapy.
B. Initiate LABA + LAMA combination therapy.
C. Start high-dose inhaled corticosteroid monotherapy.
D. Add chronic oral corticosteroid therapy.
Correct Answer: B - Initiate LABA + LAMA combination
therapy.
RATIONALE
GOLD 2026 recommends LABA + LAMA as initial maintenance
therapy for symptomatic patients with exacerbation history (Group E).
ICS monotherapy is not recommended, SABA monotherapy is
insufficient for symptomatic disease, and chronic oral corticosteroids
are avoided due to adverse effects.
Question 5
A patient on warfarin for atrial fibrillation is started on fluconazole for a fungal
infection. Which monitoring plan best reflects the pharmacokinetic interaction?
A. No change; fluconazole does not affect warfarin metabolism.
B. Increase warfarin dose empirically and recheck INR in 4 weeks.
C. Monitor INR closely within 3-5 days and anticipate warfarin dose
reduction.
D. Switch to aspirin without INR monitoring.
Correct Answer: C - Monitor INR closely within 3-5 days and
anticipate warfarin dose reduction.
Page 4
A patient with prior spontaneous preterm delivery is being counseled on
cervical cancer screening. Which statement reflects the most accurate
application of current USPSTF and ASCCP guidance?
A. Prior preterm birth is an independent indication for annual cytology
regardless of HPV status.
B. Screening intervals should be based on age, screening history, and
HPV test results, not obstetric history.
C. History of preterm delivery mandates immediate colposcopy at the
next visit.
D. Cervical cancer screening should be deferred until after age 30 in all
patients with obstetric risk factors.
Correct Answer: B - Screening intervals should be based on age,
screening history, and HPV test results, not obstetric history.
RATIONALE
Current USPSTF and ASCCP risk-based management stratifies
screening by age, prior screening results, and HPV status; obstetric
history such as preterm delivery does not alter screening intervals.
Annual cytology or automatic colposcopy is not indicated based on
obstetric history alone, and deferring screening to age 30 is not
supported for average-risk patients.
Question 2
A patient with type 2 diabetes, ASCVD, and eGFR 42 mL/min/1.73 m² is on
metformin and a statin. Which addition best aligns with current ADA/KDIGO
cardiorenal protection standards?
A. Add a DPP-4 inhibitor for glycemic control.
B. Add an SGLT2 inhibitor with proven cardiovascular and renal benefit.
C. Add a sulfonylurea to intensify glycemic control.
D. Add low-dose aspirin for primary prevention of cardiovascular events.
Page 2
,Correct Answer: B - Add an SGLT2 inhibitor with proven
cardiovascular and renal benefit.
RATIONALE
In patients with T2DM, ASCVD, and reduced eGFR, SGLT2
inhibitors with proven CV/renal outcomes are recommended by ADA
and KDIGO to reduce cardiovascular events and slow CKD
progression. DPP-4 inhibitors and sulfonylureas lack comparable
cardiorenal benefit, and aspirin for primary prevention is not routinely
recommended in this context without high bleeding-risk assessment.
Question 3
A patient presents with acute monoarticular knee pain, swelling, and fever.
Which combination of findings most strongly supports a diagnosis of septic
arthritis over crystal-induced arthritis?
A. Serum uric acid > 8 mg/dL and negatively birefringent crystals.
B. Synovial fluid WBC > 50,000/mm³ with > 90% neutrophils and
positive Gram stain.
C. Synovial fluid WBC 2,000/mm³ with mononuclear predominance.
D. Presence of rheumatoid factor and anti-CCP antibodies.
Correct Answer: B - Synovial fluid WBC > 50,000/mm³ with >
90% neutrophils and positive Gram stain.
RATIONALE
Septic arthritis is characterized by synovial fluid WBC typically
>50,000/mm³ with neutrophil predominance and often positive Gram
stain/culture. Crystal-induced arthritis shows birefringent crystals with
lower WBC counts, while mononuclear predominance and serologies
suggest inflammatory or autoimmune etiologies rather than infection.
Page 3
, Question 4
A patient with COPD (GOLD 2) reports two exacerbations in the past year and
persistent dyspnea. According to GOLD 2026, which pharmacologic strategy is
most appropriate?
A. Continue short-acting bronchodilator monotherapy.
B. Initiate LABA + LAMA combination therapy.
C. Start high-dose inhaled corticosteroid monotherapy.
D. Add chronic oral corticosteroid therapy.
Correct Answer: B - Initiate LABA + LAMA combination
therapy.
RATIONALE
GOLD 2026 recommends LABA + LAMA as initial maintenance
therapy for symptomatic patients with exacerbation history (Group E).
ICS monotherapy is not recommended, SABA monotherapy is
insufficient for symptomatic disease, and chronic oral corticosteroids
are avoided due to adverse effects.
Question 5
A patient on warfarin for atrial fibrillation is started on fluconazole for a fungal
infection. Which monitoring plan best reflects the pharmacokinetic interaction?
A. No change; fluconazole does not affect warfarin metabolism.
B. Increase warfarin dose empirically and recheck INR in 4 weeks.
C. Monitor INR closely within 3-5 days and anticipate warfarin dose
reduction.
D. Switch to aspirin without INR monitoring.
Correct Answer: C - Monitor INR closely within 3-5 days and
anticipate warfarin dose reduction.
Page 4
