COMSAE Phase 1 Form 113 Actual Exam Questions And Detailed Solutions - Pulmonology & ENT Excellence - 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 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Osteoarthritis
B. Only muscle strain
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
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.
2. 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.
3. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. Reassure
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 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. Only OA
B. RA
C. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
D. No autoimmune
Answer: C
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
5. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Only UTI
B. Chlamydia only
C. No STI
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.
6. 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. No rate control
C. Only rate control
D. No anticoagulation
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.
7. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, low TSH high free T4. Diagnosis?
A. 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
B. Hypothyroidism
C. Only hypothyroid
D. No thyroid
Answer: A
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos TSI stimulates TSH receptor methimazole
PTU beta blocker propranolol.
8. 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. Gastric ulcer worse after food
,B. 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
C. No ulcer
D. GERD
Answer: B
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID treat triple clarithromycin amoxicillin PPI or quadruple bismuth metronidazole tetracycline
PPI stop NSAID.
9. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Only UTI
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. No STI
Answer: C
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
10. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
B. Only cardiogenic
C. Cardiogenic edema
D. No ARDS
Answer: A
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.
11. A patient with nephrotic syndrome proteinuria >3.5 g/day hypoalbuminemia edema hyperlipidemia. Pathophysiology?
A. Nephritic hematuria HTN
B. Only nephritic
C. No proteinuria
D. Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable
Answer: D
Rationale: Nephrotic increased permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable.
12. 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. GERD
B. Pericarditis
C. 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
D. Stable angina
Answer: C
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.
13. 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. No bronchodilators
D. Only oxygen
Answer: A
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
14. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Osteoarthritis
B. Only muscle strain
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
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.
15. A 2-year-old with barky cough, inspiratory stridor, low grade fever, worse at night. Diagnosis?
A. Asthma
B. Epiglottitis
C. No croup
, 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.
16. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. No fracture
B. Osteoarthritis
C. 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
D. Only muscle strain
Answer: C
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.
17. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. Prostate cancer
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. Only prostatitis
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.
18. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Threatened abortion os closed
B. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
C. No abortion
D. Ectopic
Answer: B
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.
19. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. No fracture
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. Only muscle strain
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.
20. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. No bronchodilators
B. No steroids
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. Only oxygen
Answer: C
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. Only rate control
B. 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
C. No rate control
D. No anticoagulation
Answer: B
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 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. Only oxygen
C. No bronchodilators
D. No steroids
Answer: A
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 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Osteoarthritis
B. Only muscle strain
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
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.
2. 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.
3. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. Reassure
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 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. Only OA
B. RA
C. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
D. No autoimmune
Answer: C
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
5. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Only UTI
B. Chlamydia only
C. No STI
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.
6. 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. No rate control
C. Only rate control
D. No anticoagulation
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.
7. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, low TSH high free T4. Diagnosis?
A. 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
B. Hypothyroidism
C. Only hypothyroid
D. No thyroid
Answer: A
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos TSI stimulates TSH receptor methimazole
PTU beta blocker propranolol.
8. 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. Gastric ulcer worse after food
,B. 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
C. No ulcer
D. GERD
Answer: B
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID treat triple clarithromycin amoxicillin PPI or quadruple bismuth metronidazole tetracycline
PPI stop NSAID.
9. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Only UTI
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. No STI
Answer: C
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
10. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
B. Only cardiogenic
C. Cardiogenic edema
D. No ARDS
Answer: A
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.
11. A patient with nephrotic syndrome proteinuria >3.5 g/day hypoalbuminemia edema hyperlipidemia. Pathophysiology?
A. Nephritic hematuria HTN
B. Only nephritic
C. No proteinuria
D. Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable
Answer: D
Rationale: Nephrotic increased permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia loss antithrombin
hypercoagulable.
12. 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. GERD
B. Pericarditis
C. 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
D. Stable angina
Answer: C
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.
13. 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. No bronchodilators
D. Only oxygen
Answer: A
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
14. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. Osteoarthritis
B. Only muscle strain
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
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.
15. A 2-year-old with barky cough, inspiratory stridor, low grade fever, worse at night. Diagnosis?
A. Asthma
B. Epiglottitis
C. No croup
, 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.
16. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. No fracture
B. Osteoarthritis
C. 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
D. Only muscle strain
Answer: C
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.
17. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. Prostate cancer
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. Only prostatitis
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.
18. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Threatened abortion os closed
B. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
C. No abortion
D. Ectopic
Answer: B
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.
19. A 70-year-old female with osteoporosis, sudden severe back pain after lifting, height loss, kyphosis. X-ray shows compression fracture L1.
Pathophysiology?
A. No fracture
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. Only muscle strain
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.
20. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. No bronchodilators
B. No steroids
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. Only oxygen
Answer: C
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. Only rate control
B. 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
C. No rate control
D. No anticoagulation
Answer: B
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 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. Only oxygen
C. No bronchodilators
D. No steroids
Answer: A
