COMSAE Phase 1 Form 113 Actual Exam Questions And Detailed Solutions - OBGYN & Pediatrics Core Review - 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 patient with nephrotic syndrome proteinuria >3.5 g/day hypoalbuminemia edema hyperlipidemia. Pathophysiology?
A. Only nephritic
B. Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable
C. Nephritic hematuria HTN
D. No proteinuria
Answer: B
Rationale: Nephrotic increased permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable.
2. A 25-year-old female with fever, sore throat, exudative pharyngitis, posterior cervical lymphadenopathy, fatigue, splenomegaly, atypical lymphocytes.
What is diagnosis?
A. Only strep
B. Infectious mononucleosis EBV - fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes heterophile
antibody positive Monospot - avoid contact sports splenic rupture
C. No mono
D. Strep throat
Answer: B
Rationale: Infectious mononucleosis EBV fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes
heterophile Monospot positive avoid contact sports splenic rupture risk 3 weeks.
3. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Reassure
B. Only repeat US
C. No biopsy
D. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
Answer: D
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
4. A 55-year-old male with chronic alcohol use, confusion, ataxia, ophthalmoplegia, nystagmus. What deficiency and treatment?
A. No deficiency
B. Wernicke encephalopathy thiamine B1 deficiency - triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use - treat thiamine 500 mg IV TID before
glucose to prevent Korsakoff
C. B12 deficiency
D. Only folate
Answer: B
Rationale: Wernicke encephalopathy thiamine B1 deficiency triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use treat thiamine 500 mg IV TID
before glucose prevent Korsakoff.
5. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
A. Pathologic <24 hours
B. No jaundice
C. Always pathologic
D. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
Answer: D
Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
6. 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. HHNKS
C. Only HHNKS
D. No acidosis
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.
7. 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. 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
B. GERD
C. Gastric ulcer worse after food
D. No ulcer
Answer: A
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID treat triple clarithromycin amoxicillin PPI or quadruple bismuth metronidazole tetracycline
PPI stop NSAID.
8. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
,A. No jaundice
B. Pathologic <24 hours
C. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
D. Always pathologic
Answer: C
Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
9. 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. Reassure
C. Only repeat US
D. No biopsy
Answer: A
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
10. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Only muscle strain
B. Osteoporosis compression fracture - decreased bone density T-score <=-2.5 decreased estrogen increased osteoclast activity decreased osteoblast, risk fragility
fracture after minimal trauma, sudden severe back pain height loss kyphosis - treat calcium vitamin D bisphosphonate alendronate
C. Osteoarthritis
D. No fracture
Answer: B
Rationale: Osteoporosis compression fracture decreased bone density T-score <=-2.5 decreased estrogen increased osteoclast decreased osteoblast fragility
fracture minimal trauma sudden severe back pain height loss kyphosis calcium vitamin D bisphosphonate alendronate.
11. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. No anticoagulation
B. No rate control
C. 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
D. Only rate control
Answer: C
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.
12. A 25-year-old female with fever, sore throat, exudative pharyngitis, posterior cervical lymphadenopathy, fatigue, splenomegaly, atypical lymphocytes.
What is diagnosis?
A. No mono
B. Strep throat
C. Infectious mononucleosis EBV - fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes heterophile
antibody positive Monospot - avoid contact sports splenic rupture
D. Only strep
Answer: C
Rationale: Infectious mononucleosis EBV fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes
heterophile Monospot positive avoid contact sports splenic rupture risk 3 weeks.
13. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, low TSH high free T4. Diagnosis?
A. No thyroid
B. Hypothyroidism
C. Only hypothyroid
D. Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune TSI stimulates TSH receptor treat
methimazole PTU beta blocker propranolol
Answer: D
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos TSI stimulates TSH receptor methimazole
PTU beta blocker propranolol.
14. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. 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%
B. No steroids
C. Only oxygen
D. No bronchodilators
Answer: A
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
15. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, low TSH high free T4. Diagnosis?
A. Only hypothyroid
B. Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune TSI stimulates TSH receptor treat
methimazole PTU beta blocker propranolol
C. Hypothyroidism
D. No thyroid
Answer: B
, Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos TSI stimulates TSH receptor methimazole
PTU beta blocker propranolol.
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. 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
B. GERD
C. Pericarditis
D. Stable angina
Answer: A
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 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. No autoimmune
C. RA
D. Only OA
Answer: A
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
18. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. Only prostatitis
B. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
C. Prostate cancer
D. No BPH
Answer: B
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
19. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Only type 1
B. No diabetes
C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. Type 1 autoimmune
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
20. 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. 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
B. Stable angina
C. Pericarditis
D. GERD
Answer: A
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.
21. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. No STI
B. Only UTI
C. Chlamydia only
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.
22. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Only muscle strain
B. Osteoarthritis
C. No fracture
D. Osteoporosis compression fracture - decreased bone density T-score <=-2.5 decreased estrogen increased osteoclast activity decreased osteoblast, risk fragility
fracture after minimal trauma, sudden severe back pain height loss kyphosis - treat calcium vitamin D bisphosphonate alendronate
Answer: D
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 patient with nephrotic syndrome proteinuria >3.5 g/day hypoalbuminemia edema hyperlipidemia. Pathophysiology?
A. Only nephritic
B. Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable
C. Nephritic hematuria HTN
D. No proteinuria
Answer: B
Rationale: Nephrotic increased permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable.
2. A 25-year-old female with fever, sore throat, exudative pharyngitis, posterior cervical lymphadenopathy, fatigue, splenomegaly, atypical lymphocytes.
What is diagnosis?
A. Only strep
B. Infectious mononucleosis EBV - fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes heterophile
antibody positive Monospot - avoid contact sports splenic rupture
C. No mono
D. Strep throat
Answer: B
Rationale: Infectious mononucleosis EBV fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes
heterophile Monospot positive avoid contact sports splenic rupture risk 3 weeks.
3. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Reassure
B. Only repeat US
C. No biopsy
D. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
Answer: D
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
4. A 55-year-old male with chronic alcohol use, confusion, ataxia, ophthalmoplegia, nystagmus. What deficiency and treatment?
A. No deficiency
B. Wernicke encephalopathy thiamine B1 deficiency - triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use - treat thiamine 500 mg IV TID before
glucose to prevent Korsakoff
C. B12 deficiency
D. Only folate
Answer: B
Rationale: Wernicke encephalopathy thiamine B1 deficiency triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use treat thiamine 500 mg IV TID
before glucose prevent Korsakoff.
5. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
A. Pathologic <24 hours
B. No jaundice
C. Always pathologic
D. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
Answer: D
Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
6. 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. HHNKS
C. Only HHNKS
D. No acidosis
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.
7. 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. 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
B. GERD
C. Gastric ulcer worse after food
D. No ulcer
Answer: A
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID treat triple clarithromycin amoxicillin PPI or quadruple bismuth metronidazole tetracycline
PPI stop NSAID.
8. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
,A. No jaundice
B. Pathologic <24 hours
C. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
D. Always pathologic
Answer: C
Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
9. 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. Reassure
C. Only repeat US
D. No biopsy
Answer: A
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
10. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Only muscle strain
B. Osteoporosis compression fracture - decreased bone density T-score <=-2.5 decreased estrogen increased osteoclast activity decreased osteoblast, risk fragility
fracture after minimal trauma, sudden severe back pain height loss kyphosis - treat calcium vitamin D bisphosphonate alendronate
C. Osteoarthritis
D. No fracture
Answer: B
Rationale: Osteoporosis compression fracture decreased bone density T-score <=-2.5 decreased estrogen increased osteoclast decreased osteoblast fragility
fracture minimal trauma sudden severe back pain height loss kyphosis calcium vitamin D bisphosphonate alendronate.
11. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. No anticoagulation
B. No rate control
C. 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
D. Only rate control
Answer: C
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.
12. A 25-year-old female with fever, sore throat, exudative pharyngitis, posterior cervical lymphadenopathy, fatigue, splenomegaly, atypical lymphocytes.
What is diagnosis?
A. No mono
B. Strep throat
C. Infectious mononucleosis EBV - fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes heterophile
antibody positive Monospot - avoid contact sports splenic rupture
D. Only strep
Answer: C
Rationale: Infectious mononucleosis EBV fever sore throat exudative pharyngitis posterior cervical lymphadenopathy fatigue splenomegaly atypical lymphocytes
heterophile Monospot positive avoid contact sports splenic rupture risk 3 weeks.
13. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, low TSH high free T4. Diagnosis?
A. No thyroid
B. Hypothyroidism
C. Only hypothyroid
D. Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune TSI stimulates TSH receptor treat
methimazole PTU beta blocker propranolol
Answer: D
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos TSI stimulates TSH receptor methimazole
PTU beta blocker propranolol.
14. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. 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%
B. No steroids
C. Only oxygen
D. No bronchodilators
Answer: A
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
15. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, low TSH high free T4. Diagnosis?
A. Only hypothyroid
B. Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune TSI stimulates TSH receptor treat
methimazole PTU beta blocker propranolol
C. Hypothyroidism
D. No thyroid
Answer: B
, Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos TSI stimulates TSH receptor methimazole
PTU beta blocker propranolol.
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. 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
B. GERD
C. Pericarditis
D. Stable angina
Answer: A
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 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. No autoimmune
C. RA
D. Only OA
Answer: A
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
18. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. Only prostatitis
B. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
C. Prostate cancer
D. No BPH
Answer: B
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
19. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Only type 1
B. No diabetes
C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. Type 1 autoimmune
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
20. 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. 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
B. Stable angina
C. Pericarditis
D. GERD
Answer: A
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.
21. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. No STI
B. Only UTI
C. Chlamydia only
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.
22. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Only muscle strain
B. Osteoarthritis
C. No fracture
D. Osteoporosis compression fracture - decreased bone density T-score <=-2.5 decreased estrogen increased osteoclast activity decreased osteoblast, risk fragility
fracture after minimal trauma, sudden severe back pain height loss kyphosis - treat calcium vitamin D bisphosphonate alendronate
Answer: D
