Family Medicine COMAT Exam Questions
With Correct Answers
A |56-year-old |female |complains |of |palpitations |and |an |unintentional |20 |lb |weight |loss |in |the |
past |six |months. |History |reveals |that |her |menstrual |periods |stopped |approximately |7 |years |
ago. |Vital |signs |include |a |blood |pressure |of |135/85 |and |a |heart |rate |of |110. |Physical |
examination |reveals |a |non-tender |enlarged |thyroid |gland |without |nodules. |Structural |
examination |reveals |tissue |texture |changes |at |T2 |associated |with |an |upper |thoracic |flexion |
hump. |Laboratory |studies |reveal |the |following
TSH: |0.05
free |T3: |380
free |T4: |22
A |thyroid |stimulating |immunoglobulin |test |is |positive. |The |most |appropriate |initial |
management |is |
A. |levothyroxine
B. |methimazole
C. |proylthiouracil
D. |radioactive |iodine |ablation
E. |thyroidectomy |- |CORRECT |ANSWER✔✔-B |(although |treatment |with |methimazole, |
proylthiouracil, |radioactive |iodine, |and |surgical |removal |of |the |thyroid |gland |are |plausible |
treatments |for |Grave's |disease, |methimazole |is |recommnded |as |a |first |line |agent |over |
propylthiouracil |due |to |potential |hepatotoxicity)
A |66-year |old |female |complains |that |the |nail |of |her |right |great |toe |is |discolored |and |brittle. |
She |states |that |she |first |noticed |it |4 |months |ago |during |a |pedicure. |Physical |examination |
,reveals |the |right |great |toenail |to |be |yellowed, |thickened, |and |has |white |subungual |debris. |The
|most |appropriate |modality |to |confirm |the |most |likely |diagnosis |is
A. |bacterial |culture |of |nail |clippings
B. |culture |of |toenail |scrapings |on |Sabouraud's |medium
C. |histopathologic |examination |of |nail |clippings |under |periodic |acid-Schiff |stain
D. |microscopic |evaluation |of |toenail |scrapings |using |KOH |prep
E. |one |month |terbinafine |to |confirm |resolution |- |CORRECT |ANSWER✔✔-D |(the |most |likely |
diagnosis |is |onychomycosis |- |microscopic |evaluation |is |the |best |first |step |to |make |the |
diagnosis) |(A; |bacterial |infection |is |less |likely |than |fungal) |(B; |Sabouraud's |agar |is |used |to |grow
|fungal |specimens |- |culture |results |usually |return |after |weeks, |a |microscopic |evaluation |would |
be |faster |- |culturing |would |be |indicated |if |the |initial |KOH |prep |shows |absent |fungi) |(C; |this |
procedure |stains |fungal |cell |walls |and |helps |in |visualization |- |however, |while |this |test |is |more |
sensitive, |it |is |more |expensive) |(E; |empiric |treatment |is |not |recommended |due |to |side |effects |-
|additionally, |treatment |usually |lasts |3 |months, |not |1, |due |to |the |slow |growing |nature |of |
toenails)
A |70-year-old |female |who |is |3 |days |status-post |urologic |surgery |develops |a |fever |overnight |in |
the |hospital. |She |has |an |indwelling |Foley |catheter |with |good |urine |output. |Her |past |medical |
history |includes |hypertension |and |urinary |incontinence. |She |has |no |significant |family |history. |
Vitals |reveal |her |temperature |to |be |102.2F, |pulse |82, |respirations |15, |and |blood |pressure |
134/85. |Physical |examination |is |remarkable |for |mild |suprapubic |tenderness. |You |note |a |tender
|nodule |on |the |lateral |border |of |the |umbilicus. |Urinalysis |reveals |60 |WBC/hpf, |trace |protein, |
positive |leukocyte |esterase, |positive |nitrites, |and |no |casts. |A |reflex |culture |grows |motile, |gram-
negative |rods |with |a |dark |green |appearance |and |fruity |odor. |The |most |appropriate |
pharmacologic |therapy |includes
A. |amoxicillin
B. |cefotaxime
C. |ceftriaxone
D. |ciprofloxacin
,E. |trimethoprim-sulfamethoxazole |- |CORRECT |ANSWER✔✔-D |(indwelling |catheter |can |cause |a |
UTI |with |Pseudomonas |aeruginosa |- |the |indicated |treatment |is |with |a |fluoroquinolone |like |
ciprofloxacin |or |levofloxacin) |(none |of |the |other |answer |choices |have |action |against |
Pseudomonas)
A |32-year-old |G1P0 |female |at |16 |weeks' |gestation |presents |with |vaginal |bleeding. |History |
reveals |she |had |pelvic |inflammatory |disease |of |unknown |etiology |prior |to |conception. |Pelvic |
examination |reveals |the |cervical |os |to |be |closed. |The |most |likely |diagnosis |is |
A. |complete |abortion
B. |incomplete |abortion
C. |inevitable |abortion
D. |partial |abortion
E. |threatened |abortion |- |CORRECT |ANSWER✔✔-E |(threatened |abortion |is |used |to |describe |any
|vaginal |bleeding |that |occurs |within |the |first |20 |weeks |of |pregnancy) |(A; |a |complete |abortion |
is |when |the |products |of |conception |have |completely |evacuated |the |uterus |and |the |cervical |os |
is |closed) |(B; |an |incomplete |abortion |is |when |the |products |of |conception |can |be |seen |or |
palpated |in |the |cervical |canal, |and |the |cervical |os |is |open) |(C; |an |inevitable |abortion |is |when |
the |products |of |conception |can |be |seen |or |palpated |within |the |uterus |through |the |dilated |
cervical |os) |(D; |partial |abortion |is |not |an |appropriate |or |defined |medical |term)
A |32-year-old |G1P0 |female |at |16 |weeks' |gestation |presents |with |vaginal |bleeding. |History |
reveals |she |had |pelvic |inflammatory |disease |of |unknown |etiology |prior |to |conception. |Pelvic |
examination |reveals |the |cervical |os |to |be |closed. |The |patient |ultimately |has |a |miscarriage |and |
undergoes |a |successful |dilation |and |curettage. |You |explain |that |she |is |likely |to |experience |
another |miscarriage |because |she |has |a |history |of |
A. |advanced |maternal |age
B. |nulliparity
C. |pelvic |inflammatory |disease
D. |spontaneous |abortion
, E. |uterine |instrumentation |- |CORRECT |ANSWER✔✔-D |(the |most |documented |causes |of |
miscarriages |are |maternal |age, |history |of |previous |miscarriage, |and |maternal |smoking) |(A; |risk |
of |miscarriage |according |to |maternal |age |is |20% |for |35 |years, |40% |for |40 |years, |and |80% |for |
45 |years) |(B; |miscarriages |can |be |related |to |increased |gravidity |but |not |nulliparity) |(C; |PID |
increases |a |patient's |risk |for |infertility, |but |not |miscarriage |unless |there |is |an |active |infection) |
(E; |there |are |no |studies |to |indicate |that |this |is |a |significant |contributor)
A |30-year-old |female |presents |to |the |office |for |a |health |maintenance |examination. |She |states |
she |feels |healthy |and |wants |a |routine |check |as |she |is |planning |to |become |pregnant |in |the |
near |future. |Physical |exam |is |normal |and |osteopathic |structural |exam |reveals |only |mild |
anterior |innominate |rotation |on |the |left |without |significant |TART |changes |throughout |the |
spine. |A |urinalysis |is |obtained |and |dipstick |reveals |the |following
Color: |yellow
Specific |gravity: |1.012
pH: |5.5
Blood: |none
Protein: |none
Glucose: |none
Leukocyte |esterase: |none
Nitrite: |none
Bacteria: |occult
RBC: |2/hpf
WBC: |5/hpf
A |follow-up |urine |culture |is |obtained |revealing |two |different |types |of |bacteria |with |10^3 |
CFU/mL. |The |most |likely |diagnosis |is
A. |contaminated |specimen
With Correct Answers
A |56-year-old |female |complains |of |palpitations |and |an |unintentional |20 |lb |weight |loss |in |the |
past |six |months. |History |reveals |that |her |menstrual |periods |stopped |approximately |7 |years |
ago. |Vital |signs |include |a |blood |pressure |of |135/85 |and |a |heart |rate |of |110. |Physical |
examination |reveals |a |non-tender |enlarged |thyroid |gland |without |nodules. |Structural |
examination |reveals |tissue |texture |changes |at |T2 |associated |with |an |upper |thoracic |flexion |
hump. |Laboratory |studies |reveal |the |following
TSH: |0.05
free |T3: |380
free |T4: |22
A |thyroid |stimulating |immunoglobulin |test |is |positive. |The |most |appropriate |initial |
management |is |
A. |levothyroxine
B. |methimazole
C. |proylthiouracil
D. |radioactive |iodine |ablation
E. |thyroidectomy |- |CORRECT |ANSWER✔✔-B |(although |treatment |with |methimazole, |
proylthiouracil, |radioactive |iodine, |and |surgical |removal |of |the |thyroid |gland |are |plausible |
treatments |for |Grave's |disease, |methimazole |is |recommnded |as |a |first |line |agent |over |
propylthiouracil |due |to |potential |hepatotoxicity)
A |66-year |old |female |complains |that |the |nail |of |her |right |great |toe |is |discolored |and |brittle. |
She |states |that |she |first |noticed |it |4 |months |ago |during |a |pedicure. |Physical |examination |
,reveals |the |right |great |toenail |to |be |yellowed, |thickened, |and |has |white |subungual |debris. |The
|most |appropriate |modality |to |confirm |the |most |likely |diagnosis |is
A. |bacterial |culture |of |nail |clippings
B. |culture |of |toenail |scrapings |on |Sabouraud's |medium
C. |histopathologic |examination |of |nail |clippings |under |periodic |acid-Schiff |stain
D. |microscopic |evaluation |of |toenail |scrapings |using |KOH |prep
E. |one |month |terbinafine |to |confirm |resolution |- |CORRECT |ANSWER✔✔-D |(the |most |likely |
diagnosis |is |onychomycosis |- |microscopic |evaluation |is |the |best |first |step |to |make |the |
diagnosis) |(A; |bacterial |infection |is |less |likely |than |fungal) |(B; |Sabouraud's |agar |is |used |to |grow
|fungal |specimens |- |culture |results |usually |return |after |weeks, |a |microscopic |evaluation |would |
be |faster |- |culturing |would |be |indicated |if |the |initial |KOH |prep |shows |absent |fungi) |(C; |this |
procedure |stains |fungal |cell |walls |and |helps |in |visualization |- |however, |while |this |test |is |more |
sensitive, |it |is |more |expensive) |(E; |empiric |treatment |is |not |recommended |due |to |side |effects |-
|additionally, |treatment |usually |lasts |3 |months, |not |1, |due |to |the |slow |growing |nature |of |
toenails)
A |70-year-old |female |who |is |3 |days |status-post |urologic |surgery |develops |a |fever |overnight |in |
the |hospital. |She |has |an |indwelling |Foley |catheter |with |good |urine |output. |Her |past |medical |
history |includes |hypertension |and |urinary |incontinence. |She |has |no |significant |family |history. |
Vitals |reveal |her |temperature |to |be |102.2F, |pulse |82, |respirations |15, |and |blood |pressure |
134/85. |Physical |examination |is |remarkable |for |mild |suprapubic |tenderness. |You |note |a |tender
|nodule |on |the |lateral |border |of |the |umbilicus. |Urinalysis |reveals |60 |WBC/hpf, |trace |protein, |
positive |leukocyte |esterase, |positive |nitrites, |and |no |casts. |A |reflex |culture |grows |motile, |gram-
negative |rods |with |a |dark |green |appearance |and |fruity |odor. |The |most |appropriate |
pharmacologic |therapy |includes
A. |amoxicillin
B. |cefotaxime
C. |ceftriaxone
D. |ciprofloxacin
,E. |trimethoprim-sulfamethoxazole |- |CORRECT |ANSWER✔✔-D |(indwelling |catheter |can |cause |a |
UTI |with |Pseudomonas |aeruginosa |- |the |indicated |treatment |is |with |a |fluoroquinolone |like |
ciprofloxacin |or |levofloxacin) |(none |of |the |other |answer |choices |have |action |against |
Pseudomonas)
A |32-year-old |G1P0 |female |at |16 |weeks' |gestation |presents |with |vaginal |bleeding. |History |
reveals |she |had |pelvic |inflammatory |disease |of |unknown |etiology |prior |to |conception. |Pelvic |
examination |reveals |the |cervical |os |to |be |closed. |The |most |likely |diagnosis |is |
A. |complete |abortion
B. |incomplete |abortion
C. |inevitable |abortion
D. |partial |abortion
E. |threatened |abortion |- |CORRECT |ANSWER✔✔-E |(threatened |abortion |is |used |to |describe |any
|vaginal |bleeding |that |occurs |within |the |first |20 |weeks |of |pregnancy) |(A; |a |complete |abortion |
is |when |the |products |of |conception |have |completely |evacuated |the |uterus |and |the |cervical |os |
is |closed) |(B; |an |incomplete |abortion |is |when |the |products |of |conception |can |be |seen |or |
palpated |in |the |cervical |canal, |and |the |cervical |os |is |open) |(C; |an |inevitable |abortion |is |when |
the |products |of |conception |can |be |seen |or |palpated |within |the |uterus |through |the |dilated |
cervical |os) |(D; |partial |abortion |is |not |an |appropriate |or |defined |medical |term)
A |32-year-old |G1P0 |female |at |16 |weeks' |gestation |presents |with |vaginal |bleeding. |History |
reveals |she |had |pelvic |inflammatory |disease |of |unknown |etiology |prior |to |conception. |Pelvic |
examination |reveals |the |cervical |os |to |be |closed. |The |patient |ultimately |has |a |miscarriage |and |
undergoes |a |successful |dilation |and |curettage. |You |explain |that |she |is |likely |to |experience |
another |miscarriage |because |she |has |a |history |of |
A. |advanced |maternal |age
B. |nulliparity
C. |pelvic |inflammatory |disease
D. |spontaneous |abortion
, E. |uterine |instrumentation |- |CORRECT |ANSWER✔✔-D |(the |most |documented |causes |of |
miscarriages |are |maternal |age, |history |of |previous |miscarriage, |and |maternal |smoking) |(A; |risk |
of |miscarriage |according |to |maternal |age |is |20% |for |35 |years, |40% |for |40 |years, |and |80% |for |
45 |years) |(B; |miscarriages |can |be |related |to |increased |gravidity |but |not |nulliparity) |(C; |PID |
increases |a |patient's |risk |for |infertility, |but |not |miscarriage |unless |there |is |an |active |infection) |
(E; |there |are |no |studies |to |indicate |that |this |is |a |significant |contributor)
A |30-year-old |female |presents |to |the |office |for |a |health |maintenance |examination. |She |states |
she |feels |healthy |and |wants |a |routine |check |as |she |is |planning |to |become |pregnant |in |the |
near |future. |Physical |exam |is |normal |and |osteopathic |structural |exam |reveals |only |mild |
anterior |innominate |rotation |on |the |left |without |significant |TART |changes |throughout |the |
spine. |A |urinalysis |is |obtained |and |dipstick |reveals |the |following
Color: |yellow
Specific |gravity: |1.012
pH: |5.5
Blood: |none
Protein: |none
Glucose: |none
Leukocyte |esterase: |none
Nitrite: |none
Bacteria: |occult
RBC: |2/hpf
WBC: |5/hpf
A |follow-up |urine |culture |is |obtained |revealing |two |different |types |of |bacteria |with |10^3 |
CFU/mL. |The |most |likely |diagnosis |is
A. |contaminated |specimen
