CMN 571 COMPREHESIVE EXAM QUESTIONS AND
ANSWERS GRADED A+
✔✔In the ASYMPTOMATIC HIV-infected patient what modifications would you make to
their scheduled vaccinations? - ✔✔The clinician would not give the ACTIVATED form of
poliomyelitis vaccine. Only the inactivated version is indicated. All other vaccines are
okay.
✔✔In the SYMPTOMATIC HIV-infectied patient what modifications would you make to
their scheduled vaccinations? - ✔✔Avoid all live virus vaccines.
✔✔Your patient comes in after an allogenic bone marrow transplant. Which vaccines
are indicated? - ✔✔All vaccines are indicated, the pt has host pre-existing immunities.
Oral live polio vaccine should be avoided.
✔✔Who is the zoster vaccination contraindicated in?
a. people 60 and older
b. immunocompromised
c. women of child-bearing age
d. all of the above - ✔✔B. immunocompromised
✔✔Which of the following patients should be screened for lipid disorder?
a. 32 y.o. male with history of ETOH use
b. 20 y.o. male who smokes
c. 48 y.o. female with a normal HgbA1C
d. none of the above - ✔✔B. Beginning at age 20, men with risk factors should be
screened.
Women without risk factors don't have to be screened according to table 1-3.
✔✔Smoking increases your risk for which of the following diseases
a. osteporosis
b. breast Ca
c. Alzheimer's disease
d. all of the above - ✔✔D
✔✔A patient would like to Bupropion to aid with smoking cessation. Which of the
following is a contraindication?
a. history of seizure disorder
b. depression
c. COPD
d. patients already using a nicotine patch - ✔✔A
✔✔How much calcium supplementation is necessary to decrease fracture risk? -
✔✔1200mg per day or more with or without Vit D
,✔✔A 63 year old women comes into your clinic. You screen for osteoporisis and
discover that she has low bone mineral density. What treatment would you consider and
what are risks of therapy? - ✔✔Biphosphonates. These may increase the risk of certain
types of fractures and osteonecrosis of the jaw.
✔✔What is metabolic syndrome? - ✔✔Presence of any 3 of the following: waist
measurement of 40in+ for men or 35in+ for women, triglyceride level of 150+, HDL<40
for men and 50 for women, BP >130/85, fasting blood glucose>100
✔✔Which of the following patient populations is at an increased risk for hepatocellular
carcinoma?
a.Blacks
b. Whites
c. Hispanics
d. Asians - ✔✔D. Asians. Primary prevention can be acheived through ensuring this
population has received the Hep B vaccination.
✔✔When will most women begin biennial screening mammography according to the
USPSTF? - ✔✔Age 50
✔✔How can colorectal cancer screening be done? - ✔✔With fecal occult blood testing,
sigmoidoscopy, or colonoscopy. Perform routinely in ages 50-75.
✔✔T/F: A 2008 study revealed that PSA screening is associated with increased
psychological harm with uncertain potential benefits. - ✔✔True
✔✔When should a man be screened for prostate cancer? - ✔✔It depends on who you
ask. The USPSTF has "insufficient evidence to recommend for or against". The
American Cancer Society recommends that providers offer annual testing to men>50.
✔✔What is an example of a question you might use to screen for intimate partner
violence? - ✔✔1. Have you ever been hit, kicked, punched, or otherwise hurt by
someone within the past year?
2. Do you feel safe in your current relationship?
3. Is there a partner from a previous relationship who is making you feel unsafe now?
✔✔Our test recommends two tests for ETOH abuse screening. The CAGE and AUDIT
questionnaire. What scores on these test would be concerning? - ✔✔2 yes answers on
the CAGE test
5 or more on the AUDIT questionnaire
✔✔Which of the following is the PREFERRED medication for ETOH detoxification?
a. long-acting benzodiazepines
,b. disulfiram
c. naltrexone
d. acamprosate - ✔✔A. long-acting benzodiazepines
✔✔As a clinician you consider prescribing Topiramate to aid with smoking cessation.
Which of the following is true regarding this medication?
a. it has shown increased ETOH intake when compared with the drug Naltrexone
b. it has an unfavorable side effect profile
c. it is not approved by the FDA for this indication
d. it should be given to patients with history of seizure disorder - ✔✔C
✔✔What laboratory tests would you order during a workup for HTN?
[According to the JNC Reference Card ] - ✔✔urinalysis, blood glucose, hematocrit and
lipid
panel, serum potassium, creatinine, and calcium.
Optional: urinary albumin/creatinine ratio.
✔✔Which of the following patients does NOT have a major risk factor for cardiovascular
disease (CVD)?
a. A 60 year old man with no family hx of CVD
b. A 60 year old woman with family hx of premature CVD
c.A 65 year old man with a GFR of 65 mL/min
d. A 55 year old woman with a sedentary lifestyle - ✔✔C
Risk Factors include:
• Physical inactivity
• Microalbuminuria, estimated GFR <60 mL/min
• Age (>55 for men, >65 for women)
• Family history of premature CVD
(men age <55, women age <65)
✔✔Which of the following is an identifiable cause of hypertension?
a. sleep apnea
b. kidney disease
c. Cushing's syndrome
d. parathyroid disease
e. all of the above - ✔✔E. all of these are identifiable causes of HTN
✔✔What is a "goal" BP in a patient with diabetes or chronic kidney disease? -
✔✔130/80. BPs exceeding this should be treated in this population.
✔✔Your patient presents with a blood pressure of 164/90. How long should you wait to
reassess it according to the in-office BP management technique?
a. Reassess immediately.
b. Wait 5 minutes
c. Ask pt to return the next day
, d. Ask pt to visit a CVS for a BP reading 4 hours later - ✔✔B. Reassess after 5 minutes
✔✔When is ambulatory BP monitoring indicated? - ✔✔To evaluate patient for white
coat HTN
✔✔In which of the following compelling indications would a drug from the Thiazide
diuretic class NOT be a good selection?
a. Heart failure
b. Diabetes
c. Chronic kidney disease
d. Recurrent stroke prevention - ✔✔C. Chronic Kidney Disease
✔✔What lifestyle modifications should you suggest to the patient with prehypertension
to reduce their risk of developing HTN? - ✔✔Components of lifestyle modifications
include weight reduction, DASH eating plan, dietary sodium reduction, aerobic physical
activity, and moderation of alcohol consumption.
✔✔When should cervical cancer screenings using the Pap test be discontinued?
A) after age 50
B) after age 65
C) after a total hysterectomy due to benign disease with removal of the cervix
D) after a hysterectomy leaving the cervix intact
E) b & c - ✔✔E. b & c
✔✔Most cervical screening failures are a result of what?
A) the inadequacy of the Pap test to detect cervical cancer
B) poor awareness among women about the need to receive regular screenings
C) limited access to screenings resulting in delayed diagnosis
D) poor provider education on the topic of the need for cervical cancer screening among
women - ✔✔C) limited access to screenings resulting in delayed diagnosis
✔✔A woman >/30 may receive cervical cancer screenings with the Pap test every 3
years if they meet which criteria?
A) one prior negative screening
B) two prior negative screenings
C) three prior negative screenings
D) four prior negative screenings - ✔✔C) three prior negative screenings
✔✔Which of the following patients should be screened annually for cervical cancer with
the Pap test?
A) 23 year old college student
B) 31 year old mother of two with anxiety
C) 50 yr old teacher with back pain
ANSWERS GRADED A+
✔✔In the ASYMPTOMATIC HIV-infected patient what modifications would you make to
their scheduled vaccinations? - ✔✔The clinician would not give the ACTIVATED form of
poliomyelitis vaccine. Only the inactivated version is indicated. All other vaccines are
okay.
✔✔In the SYMPTOMATIC HIV-infectied patient what modifications would you make to
their scheduled vaccinations? - ✔✔Avoid all live virus vaccines.
✔✔Your patient comes in after an allogenic bone marrow transplant. Which vaccines
are indicated? - ✔✔All vaccines are indicated, the pt has host pre-existing immunities.
Oral live polio vaccine should be avoided.
✔✔Who is the zoster vaccination contraindicated in?
a. people 60 and older
b. immunocompromised
c. women of child-bearing age
d. all of the above - ✔✔B. immunocompromised
✔✔Which of the following patients should be screened for lipid disorder?
a. 32 y.o. male with history of ETOH use
b. 20 y.o. male who smokes
c. 48 y.o. female with a normal HgbA1C
d. none of the above - ✔✔B. Beginning at age 20, men with risk factors should be
screened.
Women without risk factors don't have to be screened according to table 1-3.
✔✔Smoking increases your risk for which of the following diseases
a. osteporosis
b. breast Ca
c. Alzheimer's disease
d. all of the above - ✔✔D
✔✔A patient would like to Bupropion to aid with smoking cessation. Which of the
following is a contraindication?
a. history of seizure disorder
b. depression
c. COPD
d. patients already using a nicotine patch - ✔✔A
✔✔How much calcium supplementation is necessary to decrease fracture risk? -
✔✔1200mg per day or more with or without Vit D
,✔✔A 63 year old women comes into your clinic. You screen for osteoporisis and
discover that she has low bone mineral density. What treatment would you consider and
what are risks of therapy? - ✔✔Biphosphonates. These may increase the risk of certain
types of fractures and osteonecrosis of the jaw.
✔✔What is metabolic syndrome? - ✔✔Presence of any 3 of the following: waist
measurement of 40in+ for men or 35in+ for women, triglyceride level of 150+, HDL<40
for men and 50 for women, BP >130/85, fasting blood glucose>100
✔✔Which of the following patient populations is at an increased risk for hepatocellular
carcinoma?
a.Blacks
b. Whites
c. Hispanics
d. Asians - ✔✔D. Asians. Primary prevention can be acheived through ensuring this
population has received the Hep B vaccination.
✔✔When will most women begin biennial screening mammography according to the
USPSTF? - ✔✔Age 50
✔✔How can colorectal cancer screening be done? - ✔✔With fecal occult blood testing,
sigmoidoscopy, or colonoscopy. Perform routinely in ages 50-75.
✔✔T/F: A 2008 study revealed that PSA screening is associated with increased
psychological harm with uncertain potential benefits. - ✔✔True
✔✔When should a man be screened for prostate cancer? - ✔✔It depends on who you
ask. The USPSTF has "insufficient evidence to recommend for or against". The
American Cancer Society recommends that providers offer annual testing to men>50.
✔✔What is an example of a question you might use to screen for intimate partner
violence? - ✔✔1. Have you ever been hit, kicked, punched, or otherwise hurt by
someone within the past year?
2. Do you feel safe in your current relationship?
3. Is there a partner from a previous relationship who is making you feel unsafe now?
✔✔Our test recommends two tests for ETOH abuse screening. The CAGE and AUDIT
questionnaire. What scores on these test would be concerning? - ✔✔2 yes answers on
the CAGE test
5 or more on the AUDIT questionnaire
✔✔Which of the following is the PREFERRED medication for ETOH detoxification?
a. long-acting benzodiazepines
,b. disulfiram
c. naltrexone
d. acamprosate - ✔✔A. long-acting benzodiazepines
✔✔As a clinician you consider prescribing Topiramate to aid with smoking cessation.
Which of the following is true regarding this medication?
a. it has shown increased ETOH intake when compared with the drug Naltrexone
b. it has an unfavorable side effect profile
c. it is not approved by the FDA for this indication
d. it should be given to patients with history of seizure disorder - ✔✔C
✔✔What laboratory tests would you order during a workup for HTN?
[According to the JNC Reference Card ] - ✔✔urinalysis, blood glucose, hematocrit and
lipid
panel, serum potassium, creatinine, and calcium.
Optional: urinary albumin/creatinine ratio.
✔✔Which of the following patients does NOT have a major risk factor for cardiovascular
disease (CVD)?
a. A 60 year old man with no family hx of CVD
b. A 60 year old woman with family hx of premature CVD
c.A 65 year old man with a GFR of 65 mL/min
d. A 55 year old woman with a sedentary lifestyle - ✔✔C
Risk Factors include:
• Physical inactivity
• Microalbuminuria, estimated GFR <60 mL/min
• Age (>55 for men, >65 for women)
• Family history of premature CVD
(men age <55, women age <65)
✔✔Which of the following is an identifiable cause of hypertension?
a. sleep apnea
b. kidney disease
c. Cushing's syndrome
d. parathyroid disease
e. all of the above - ✔✔E. all of these are identifiable causes of HTN
✔✔What is a "goal" BP in a patient with diabetes or chronic kidney disease? -
✔✔130/80. BPs exceeding this should be treated in this population.
✔✔Your patient presents with a blood pressure of 164/90. How long should you wait to
reassess it according to the in-office BP management technique?
a. Reassess immediately.
b. Wait 5 minutes
c. Ask pt to return the next day
, d. Ask pt to visit a CVS for a BP reading 4 hours later - ✔✔B. Reassess after 5 minutes
✔✔When is ambulatory BP monitoring indicated? - ✔✔To evaluate patient for white
coat HTN
✔✔In which of the following compelling indications would a drug from the Thiazide
diuretic class NOT be a good selection?
a. Heart failure
b. Diabetes
c. Chronic kidney disease
d. Recurrent stroke prevention - ✔✔C. Chronic Kidney Disease
✔✔What lifestyle modifications should you suggest to the patient with prehypertension
to reduce their risk of developing HTN? - ✔✔Components of lifestyle modifications
include weight reduction, DASH eating plan, dietary sodium reduction, aerobic physical
activity, and moderation of alcohol consumption.
✔✔When should cervical cancer screenings using the Pap test be discontinued?
A) after age 50
B) after age 65
C) after a total hysterectomy due to benign disease with removal of the cervix
D) after a hysterectomy leaving the cervix intact
E) b & c - ✔✔E. b & c
✔✔Most cervical screening failures are a result of what?
A) the inadequacy of the Pap test to detect cervical cancer
B) poor awareness among women about the need to receive regular screenings
C) limited access to screenings resulting in delayed diagnosis
D) poor provider education on the topic of the need for cervical cancer screening among
women - ✔✔C) limited access to screenings resulting in delayed diagnosis
✔✔A woman >/30 may receive cervical cancer screenings with the Pap test every 3
years if they meet which criteria?
A) one prior negative screening
B) two prior negative screenings
C) three prior negative screenings
D) four prior negative screenings - ✔✔C) three prior negative screenings
✔✔Which of the following patients should be screened annually for cervical cancer with
the Pap test?
A) 23 year old college student
B) 31 year old mother of two with anxiety
C) 50 yr old teacher with back pain
