COMSAE Phase 1 Form 113 Actual Exam Questions And Detailed Solutions - Comprehensive Final Assessment - Just Released
COMSAE Phase 1 Form 113 | NBOME | Osteopathic Medical Knowledge | High Yield
TABLE OF CONTENTS
1. I. Cardiology - STEMI Anterior V1-V4 LAD Occlusion Crushing Substernal Chest Pain Radiating Left Arm Diaphoresis Nausea ST Elevations
Aspirin 325 mg Oxygen NTG Heparin Activate Cath Lab PCI 90 min Door to Balloon Troponin, Afib Irregularly Irregular No P Waves Rate Control
Metoprolol Diltiazem Anticoagulation CHA2DS2-VASc Warfarin DOAC Apixaban Rivaroxaban
2. II. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Croup Barky
Cough Inspiratory Stridor Night Parainfluenza Dexamethasone 0.6 mg/kg Racemic Epi, ARDS Diffuse Alveolar Damage Increased Permeability
Protein-Rich Edema Hyaline Membrane V/Q Mismatch Shunt Severe Hypoxemia Refractory
3. III. Endocrine - Type 2 Diabetes Insulin Resistance Decreased Glucose Uptake Liver Increased Gluconeogenesis Beta Cell Dysfunction Relative
Deficiency Glucotoxicity Lipotoxicity, DKA Absolute Deficiency Lipolysis Ketogenesis Beta-Hydroxybutyrate Acidosis pH <7.3 Bicarbonate <18
Kussmaul Polyuria, Hyperthyroidism Graves Low TSH High Free T4 TSI Tremor Palpitations Exophthalmos Methimazole PTU Beta Blocker,
Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine
4. IV. Gastroenterology - Duodenal Ulcer Pain Worse Night Relieved Food H. pylori NSAID Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline, Osteoporosis Compression Fracture T-score <=-2.5 Decreased Estrogen Osteoclast Increased Osteoblast
Decreased Fragility Fracture Sudden Severe Back Pain Height Loss Kyphosis Calcium Vitamin D Bisphosphonate Alendronate, Wernicke Thiamine
B1 Deficiency Triad Confusion Ataxia Ophthalmoplegia Nystagmus Chronic Alcohol Thiamine 500 mg IV TID Before Glucose
5. V. Renal & Genitourinary - Nephrotic Increased Permeability Podocyte Injury Proteinuria >3.5 g/day Hypoalbuminemia Edema Hyperlipidemia
Hypercoagulable, BPH Urinary Hesitancy Weak Stream Nocturia Frequency Urgency Elevated PSA DRE Enlarged Smooth Non-Tender Tamsulosin
Finasteride, Gonorrhea Gram-Negative Intracellular Diplococci Urethral Discharge Dysuria Ceftriaxone 500 mg IM Plus Doxycycline Partner
Treatment
6. VI. Neurology & Psychiatry - Ischemic Stroke Thrombotic Embolic Occlusion Decreased Cerebral Blood Flow <20 mL/100g/min Ischemia
Penumbra Excitotoxicity Glutamate Calcium Cytotoxic Edema Infarction, Major Depressive Disorder Anhedonia Weight Loss Insomnia Suicidal
Ideation SSRI Sertraline Fluoxetine Black Box Suicidal Ideation Young Adults Safety Plan CBT
7. VII. Infectious Disease & Immunology - Infectious Mononucleosis EBV Fever Sore Throat Exudative Pharyngitis Posterior Cervical
Lymphadenopathy Fatigue Splenomegaly Atypical Lymphocytes Heterophile Monospot Avoid Contact Sports Splenic Rupture 3 Weeks, Strep Throat
Centor Criteria, SLE Autoimmune Type III Hypersensitivity Immune Complex ANA dsDNA Low C3 C4 Butterfly Rash Photosensitivity Joint Pain
Nephritis
8. VIII. OBGYN & Pediatrics - Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer, Physiologic Jaundice After 24 Hours Bilirubin <12-15 vs Pathologic <24 Hours >15, Normal
Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP Shunt
9. IX. Musculoskeletal & Dermatology - RA Autoimmune Chronic Synovitis Pannus TNF IL-1 IL-6 RF Anti-CCP Symmetric Small Joints Morning >30
min, OA Degenerative Cartilage Loss Osteophyte Non-Inflammatory Morning <30 min Crepitus Pain Worse Activity
10. X. Practice Questions - Each Asked Like Real COMSAE Phase 1 Form 113 Exam - Actual Exam Questions
11. XI. Answer Key with Detailed Solutions - Just Released
,COMSAE PHASE 1 FORM 113 - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on NBOME COMSAE Phase 1 Form 113 Blueprint - Cardiology Pulmonology Endocrine GI Renal Neuro Psych Infectious OBGYN Pediatrics Musculoskeletal. High Yield Just Released.
1. A 50-year-old with major depressive disorder, anhedonia, weight loss, insomnia, suicidal ideation. What is treatment?
A. No treatment
B. No SSRI
C. Major depressive disorder anhedonia weight loss insomnia suicidal ideation - SSRI sertraline fluoxetine first line, black box warning suicidal ideation young adults
initial weeks safety plan close monitoring psychotherapy CBT
D. Only benzodiazepine
Answer: C
Rationale: MDD anhedonia weight loss insomnia suicidal ideation SSRI sertraline fluoxetine first line black box suicidal ideation young adults initial weeks safety plan
monitoring psychotherapy CBT.
2. A 2-year-old with barky cough, inspiratory stridor, low grade fever, worse at night. Diagnosis?
A. Epiglottitis
B. No croup
C. Asthma
D. Croup laryngotracheobronchitis parainfluenza most common barky cough stridor night low grade fever cool mist dexamethasone 0.6 mg/kg racemic epinephrine if
moderate-severe
Answer: D
Rationale: Croup barky cough inspiratory stridor night low grade fever parainfluenza cool mist dexamethasone 0.6 mg/kg racemic epi moderate-severe.
3. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Threatened abortion os closed
B. Ectopic
C. No abortion
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
4. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Ectopic
B. Threatened abortion os closed
C. No abortion
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
5. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. Reassure
C. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
D. No biopsy
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
6. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
B. No biopsy
C. Reassure
D. Only repeat US
Answer: A
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
7. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. Cardiogenic edema
B. Only cardiogenic
C. No ARDS
D. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
Answer: D
Rationale: ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe
hypoxemia refractory O2 sepsis pneumonia aspiration.
8. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
A. Pathologic <24 hours
B. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
C. Always pathologic
D. No jaundice
Answer: B
,Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
9. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. No bronchodilators
B. Only oxygen
C. COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume amoxicillin
doxycycline azithromycin oxygen target 88-92%
D. No steroids
Answer: C
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
10. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. RA
B. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
C. Only OA
D. No autoimmune
Answer: B
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
11. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Ectopic
B. Threatened abortion os closed
C. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
D. No abortion
Answer: C
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
12. A patient with DKA polyuria polydipsia nausea vomiting abdominal pain Kussmaul breathing glucose 450 pH 7.1 bicarbonate 8 ketones positive.
Pathophysiology?
A. DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis pH low bicarbonate low Kussmaul
compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration
B. Only HHNKS
C. No acidosis
D. HHNKS
Answer: A
Rationale: DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate acidosis low pH low bicarbonate Kussmaul
hyperglycemia osmotic diuresis polyuria polydipsia dehydration.
13. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men >=3
women, cardioversion if unstable
B. Only rate control
C. No anticoagulation
D. No rate control
Answer: A
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
14. A patient with nephrotic syndrome proteinuria >3.5 g/day hypoalbuminemia edema hyperlipidemia. Pathophysiology?
A. Nephritic hematuria HTN
B. Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable
C. No proteinuria
D. Only nephritic
Answer: B
Rationale: Nephrotic increased permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable.
15. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Chlamydia only
B. No STI
C. Only UTI
D. Gonorrhea Neisseria gonorrhoeae gram-negative intracellular diplococci purulent urethral discharge dysuria - treat ceftriaxone 500 mg IM plus doxycycline if
chlamydia not excluded, partner treatment
Answer: D
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
16. A 62-year-old male with hypertension, diabetes, hyperlipidemia presents with crushing substernal chest pain radiating left arm, diaphoresis, nausea,
ST elevations V1-V4. What is diagnosis and immediate management?
A. Stable angina
B. STEMI anterior wall - ST elevations V1-V4 LAD occlusion - immediate aspirin 325 mg, oxygen if hypoxic, nitroglycerin if no contraindications, heparin, activate cath
lab PCI within 90 min door to balloon, troponin, EKG, do not delay
, C. Pericarditis
D. GERD
Answer: B
Rationale: STEMI anterior V1-V4 LAD occlusion crushing substernal chest pain radiating left arm diaphoresis nausea ST elevations. Immediate aspirin 325 mg O2 if
hypoxic NTG if no contraindications heparin activate cath lab PCI 90 min door to balloon troponin EKG.
17. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. No STI
B. Chlamydia only
C. Gonorrhea Neisseria gonorrhoeae gram-negative intracellular diplococci purulent urethral discharge dysuria - treat ceftriaxone 500 mg IM plus doxycycline if
chlamydia not excluded, partner treatment
D. Only UTI
Answer: C
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
18. A 45-year-old male with epigastric pain worse at night relieved by food, H. pylori positive, NSAID use. What is diagnosis and treatment?
A. GERD
B. Gastric ulcer worse after food
C. No ulcer
D. Duodenal ulcer - pain worse at night relieved by food H. pylori NSAID risk - treat triple therapy clarithromycin amoxicillin PPI or quadruple bismuth metronidazole
tetracycline PPI stop NSAID
Answer: D
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID treat triple clarithromycin amoxicillin PPI or quadruple bismuth metronidazole tetracycline
PPI stop NSAID.
19. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. No abortion
B. Threatened abortion os closed
C. Ectopic
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
20. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. Only oxygen
B. No steroids
C. No bronchodilators
D. COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume amoxicillin
doxycycline azithromycin oxygen target 88-92%
Answer: D
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
21. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men >=3
women, cardioversion if unstable
B. Only rate control
C. No anticoagulation
D. No rate control
Answer: A
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
22. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
B. Only OA
C. RA
D. No autoimmune
Answer: A
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
23. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. No biopsy
B. Reassure
C. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
D. Only repeat US
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
24. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. Only OA
B. RA
COMSAE Phase 1 Form 113 | NBOME | Osteopathic Medical Knowledge | High Yield
TABLE OF CONTENTS
1. I. Cardiology - STEMI Anterior V1-V4 LAD Occlusion Crushing Substernal Chest Pain Radiating Left Arm Diaphoresis Nausea ST Elevations
Aspirin 325 mg Oxygen NTG Heparin Activate Cath Lab PCI 90 min Door to Balloon Troponin, Afib Irregularly Irregular No P Waves Rate Control
Metoprolol Diltiazem Anticoagulation CHA2DS2-VASc Warfarin DOAC Apixaban Rivaroxaban
2. II. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Croup Barky
Cough Inspiratory Stridor Night Parainfluenza Dexamethasone 0.6 mg/kg Racemic Epi, ARDS Diffuse Alveolar Damage Increased Permeability
Protein-Rich Edema Hyaline Membrane V/Q Mismatch Shunt Severe Hypoxemia Refractory
3. III. Endocrine - Type 2 Diabetes Insulin Resistance Decreased Glucose Uptake Liver Increased Gluconeogenesis Beta Cell Dysfunction Relative
Deficiency Glucotoxicity Lipotoxicity, DKA Absolute Deficiency Lipolysis Ketogenesis Beta-Hydroxybutyrate Acidosis pH <7.3 Bicarbonate <18
Kussmaul Polyuria, Hyperthyroidism Graves Low TSH High Free T4 TSI Tremor Palpitations Exophthalmos Methimazole PTU Beta Blocker,
Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine
4. IV. Gastroenterology - Duodenal Ulcer Pain Worse Night Relieved Food H. pylori NSAID Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline, Osteoporosis Compression Fracture T-score <=-2.5 Decreased Estrogen Osteoclast Increased Osteoblast
Decreased Fragility Fracture Sudden Severe Back Pain Height Loss Kyphosis Calcium Vitamin D Bisphosphonate Alendronate, Wernicke Thiamine
B1 Deficiency Triad Confusion Ataxia Ophthalmoplegia Nystagmus Chronic Alcohol Thiamine 500 mg IV TID Before Glucose
5. V. Renal & Genitourinary - Nephrotic Increased Permeability Podocyte Injury Proteinuria >3.5 g/day Hypoalbuminemia Edema Hyperlipidemia
Hypercoagulable, BPH Urinary Hesitancy Weak Stream Nocturia Frequency Urgency Elevated PSA DRE Enlarged Smooth Non-Tender Tamsulosin
Finasteride, Gonorrhea Gram-Negative Intracellular Diplococci Urethral Discharge Dysuria Ceftriaxone 500 mg IM Plus Doxycycline Partner
Treatment
6. VI. Neurology & Psychiatry - Ischemic Stroke Thrombotic Embolic Occlusion Decreased Cerebral Blood Flow <20 mL/100g/min Ischemia
Penumbra Excitotoxicity Glutamate Calcium Cytotoxic Edema Infarction, Major Depressive Disorder Anhedonia Weight Loss Insomnia Suicidal
Ideation SSRI Sertraline Fluoxetine Black Box Suicidal Ideation Young Adults Safety Plan CBT
7. VII. Infectious Disease & Immunology - Infectious Mononucleosis EBV Fever Sore Throat Exudative Pharyngitis Posterior Cervical
Lymphadenopathy Fatigue Splenomegaly Atypical Lymphocytes Heterophile Monospot Avoid Contact Sports Splenic Rupture 3 Weeks, Strep Throat
Centor Criteria, SLE Autoimmune Type III Hypersensitivity Immune Complex ANA dsDNA Low C3 C4 Butterfly Rash Photosensitivity Joint Pain
Nephritis
8. VIII. OBGYN & Pediatrics - Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer, Physiologic Jaundice After 24 Hours Bilirubin <12-15 vs Pathologic <24 Hours >15, Normal
Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP Shunt
9. IX. Musculoskeletal & Dermatology - RA Autoimmune Chronic Synovitis Pannus TNF IL-1 IL-6 RF Anti-CCP Symmetric Small Joints Morning >30
min, OA Degenerative Cartilage Loss Osteophyte Non-Inflammatory Morning <30 min Crepitus Pain Worse Activity
10. X. Practice Questions - Each Asked Like Real COMSAE Phase 1 Form 113 Exam - Actual Exam Questions
11. XI. Answer Key with Detailed Solutions - Just Released
,COMSAE PHASE 1 FORM 113 - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on NBOME COMSAE Phase 1 Form 113 Blueprint - Cardiology Pulmonology Endocrine GI Renal Neuro Psych Infectious OBGYN Pediatrics Musculoskeletal. High Yield Just Released.
1. A 50-year-old with major depressive disorder, anhedonia, weight loss, insomnia, suicidal ideation. What is treatment?
A. No treatment
B. No SSRI
C. Major depressive disorder anhedonia weight loss insomnia suicidal ideation - SSRI sertraline fluoxetine first line, black box warning suicidal ideation young adults
initial weeks safety plan close monitoring psychotherapy CBT
D. Only benzodiazepine
Answer: C
Rationale: MDD anhedonia weight loss insomnia suicidal ideation SSRI sertraline fluoxetine first line black box suicidal ideation young adults initial weeks safety plan
monitoring psychotherapy CBT.
2. A 2-year-old with barky cough, inspiratory stridor, low grade fever, worse at night. Diagnosis?
A. Epiglottitis
B. No croup
C. Asthma
D. Croup laryngotracheobronchitis parainfluenza most common barky cough stridor night low grade fever cool mist dexamethasone 0.6 mg/kg racemic epinephrine if
moderate-severe
Answer: D
Rationale: Croup barky cough inspiratory stridor night low grade fever parainfluenza cool mist dexamethasone 0.6 mg/kg racemic epi moderate-severe.
3. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Threatened abortion os closed
B. Ectopic
C. No abortion
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
4. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Ectopic
B. Threatened abortion os closed
C. No abortion
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
5. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. Reassure
C. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
D. No biopsy
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
6. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
B. No biopsy
C. Reassure
D. Only repeat US
Answer: A
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
7. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. Cardiogenic edema
B. Only cardiogenic
C. No ARDS
D. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
Answer: D
Rationale: ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe
hypoxemia refractory O2 sepsis pneumonia aspiration.
8. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
A. Pathologic <24 hours
B. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
C. Always pathologic
D. No jaundice
Answer: B
,Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
9. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. No bronchodilators
B. Only oxygen
C. COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume amoxicillin
doxycycline azithromycin oxygen target 88-92%
D. No steroids
Answer: C
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
10. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. RA
B. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
C. Only OA
D. No autoimmune
Answer: B
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
11. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Ectopic
B. Threatened abortion os closed
C. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
D. No abortion
Answer: C
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
12. A patient with DKA polyuria polydipsia nausea vomiting abdominal pain Kussmaul breathing glucose 450 pH 7.1 bicarbonate 8 ketones positive.
Pathophysiology?
A. DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis pH low bicarbonate low Kussmaul
compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration
B. Only HHNKS
C. No acidosis
D. HHNKS
Answer: A
Rationale: DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate acidosis low pH low bicarbonate Kussmaul
hyperglycemia osmotic diuresis polyuria polydipsia dehydration.
13. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men >=3
women, cardioversion if unstable
B. Only rate control
C. No anticoagulation
D. No rate control
Answer: A
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
14. A patient with nephrotic syndrome proteinuria >3.5 g/day hypoalbuminemia edema hyperlipidemia. Pathophysiology?
A. Nephritic hematuria HTN
B. Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable
C. No proteinuria
D. Only nephritic
Answer: B
Rationale: Nephrotic increased permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable.
15. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Chlamydia only
B. No STI
C. Only UTI
D. Gonorrhea Neisseria gonorrhoeae gram-negative intracellular diplococci purulent urethral discharge dysuria - treat ceftriaxone 500 mg IM plus doxycycline if
chlamydia not excluded, partner treatment
Answer: D
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
16. A 62-year-old male with hypertension, diabetes, hyperlipidemia presents with crushing substernal chest pain radiating left arm, diaphoresis, nausea,
ST elevations V1-V4. What is diagnosis and immediate management?
A. Stable angina
B. STEMI anterior wall - ST elevations V1-V4 LAD occlusion - immediate aspirin 325 mg, oxygen if hypoxic, nitroglycerin if no contraindications, heparin, activate cath
lab PCI within 90 min door to balloon, troponin, EKG, do not delay
, C. Pericarditis
D. GERD
Answer: B
Rationale: STEMI anterior V1-V4 LAD occlusion crushing substernal chest pain radiating left arm diaphoresis nausea ST elevations. Immediate aspirin 325 mg O2 if
hypoxic NTG if no contraindications heparin activate cath lab PCI 90 min door to balloon troponin EKG.
17. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. No STI
B. Chlamydia only
C. Gonorrhea Neisseria gonorrhoeae gram-negative intracellular diplococci purulent urethral discharge dysuria - treat ceftriaxone 500 mg IM plus doxycycline if
chlamydia not excluded, partner treatment
D. Only UTI
Answer: C
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
18. A 45-year-old male with epigastric pain worse at night relieved by food, H. pylori positive, NSAID use. What is diagnosis and treatment?
A. GERD
B. Gastric ulcer worse after food
C. No ulcer
D. Duodenal ulcer - pain worse at night relieved by food H. pylori NSAID risk - treat triple therapy clarithromycin amoxicillin PPI or quadruple bismuth metronidazole
tetracycline PPI stop NSAID
Answer: D
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID treat triple clarithromycin amoxicillin PPI or quadruple bismuth metronidazole tetracycline
PPI stop NSAID.
19. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. No abortion
B. Threatened abortion os closed
C. Ectopic
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
20. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. Only oxygen
B. No steroids
C. No bronchodilators
D. COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume amoxicillin
doxycycline azithromycin oxygen target 88-92%
Answer: D
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
21. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men >=3
women, cardioversion if unstable
B. Only rate control
C. No anticoagulation
D. No rate control
Answer: A
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
22. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
B. Only OA
C. RA
D. No autoimmune
Answer: A
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
23. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. No biopsy
B. Reassure
C. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
D. Only repeat US
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
24. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. Only OA
B. RA
