Aquifer Family Medicine & Internal Medicine Cases 2026: Question Bank and Study Blueprint

Which of the following daily activities is Mrs. Rosenzweig struggling with that indicates cognitive impairment? A. Gardening B. Finances C. Socializing with friends D. Watching television Rationale: Difficulty managing finances, driving, medication, and meal preparation are key indicators of functional decline due to cognitive impairment. Other options are not as diagnostically specific. Based on Mrs. Rosenzweig’s history and exam, which of the following is the most likely combination of causes for her cognitive changes? A. Parkinson dementia, Frontotemporal dementia, NPH B. Mixed dementia, Vascular dementia, Alzheimer's C. Depression, Normal aging, Dementia with Lewy bodies D. Frontotemporal dementia, Normal aging, Parkinson dementia Rationale: Mixed dementia, vascular dementia, and Alzheimer's are most consistent with progressive cognitive decline and functional deficits seen in this patient. The other options do not match her symptom profile. Is Mrs. Rosenzweig’s MoCA score alone sufficient to diagnose Alzheimer’s dementia? A. Yes, refer immediately to a specialist B. Yes, you can diagnose and manage in the office C. No, I can manage in the office D. No, she must be admitted for further testing Rationale: MoCA is a screening tool; while it helps identify cognitive impairment, the diagnosis of Alzheimer’s can often be managed in-office with appropriate history, exam, and labs. Referral to a specialist is not mandatory unless atypical features exist. Which blood tests are highest yield to rule out reversible causes of dementia? A. Lipid panel, uric acid, C-reactive protein B. CBC with differential, Renal function, Electrolytes, Hepatic function, TSH, Glucose, Vitamin B12 C. Serum calcium, urinalysis, cortisol D. ESR, CRP, troponin Rationale: These labs screen for common reversible contributors to cognitive decline (thyroid, B12 deficiency, metabolic or renal dysfunction). Other options either miss key tests or are unrelated. Can imaging alone diagnose dementia? A. No B. Yes, MRI is definitive C. Yes, CT scan is definitive D. Yes, PET scan is always diagnostic Rationale: Imaging can support the diagnosis by showing patterns of atrophy or vascular changes but cannot diagnose dementia on its own. Diagnosis requires clinical correlation. What is the most likely type of dementia in Mrs. Rosenzweig after full evaluation? A. Vascular dementia B. Mixed dementia C. Alzheimer’s Dementia D. Frontotemporal dementia Rationale: Her history, functional deficits, labs, and imaging are most consistent with Alzheimer’s dementia. Vascular and mixed dementia are possibilities but less likely in this context. Which USPSTF grade is assigned to EBCT (electron beam computed tomography)? A. Grade II B. Grade III C. Grade I D. Grade IV Rationale: Grade I indicates strong evidence supporting the test’s benefit. Other grades reflect weaker or insufficient evidence. What are potential harms of minimally invasive tests like blood work or ECG? A. No harms exist B. Falsely abnormal tests, financial cost, incidental findings, patient anxiety, time spent reviewing tests C. Only physical harms D. Only emotional harms Rationale: Even minimally invasive tests can lead to false positives, patient anxiety, incidental findings, and costs. Ignoring these can affect clinical decision-making. Which of the following is a major step in patient intervention? A. Prescribe, monitor, discharge B. Assess, advise, agree, assist, arrange C. Diagnose, treat, follow-up D. Evaluate, ignore, refer Rationale: The 5 A’s model is widely used in clinical interventions, particularly for lifestyle modification and chronic disease management. Other options are incomplete or inaccurate. How effective are oral medications like bupropion or varenicline in helping smokers quit? A. Not effective B. Somewhat effective—3–5x the placebo quit rate at 12 months C. Highly effective, 90% quit rate D. Only effective short-term Rationale: These medications improve quit rates over placebo but do not guarantee success. Other options either exaggerate or underestimate efficacy. Which characteristic defines a good screening test? A. Test is expensive and invasive B. There should be a treatment, a latent stage, acceptability, and cost-effectiveness C. The disease is rare and untreatable D. Only available in tertiary centers Rationale: Screening tests are valuable when the disease can be treated, has a detectable latent phase, is acceptable to the population, and is economically feasible. Other choices contradict screening principles. Did a diagnostic error occur in Ms. Shakil’s case? A. No B. Yes C. Cannot tell D. Only if patient was harmed physically Rationale: The scenario outlines a missed or delayed diagnosis of cancer, which constitutes a diagnostic error. Physical harm is not required for the error to exist. Which of the following is a potential emotional harm of a diagnostic error to a patient? A. Infection B. Regret about missed opportunity to treat cancer C. Increased insurance premiums D. Bleeding Rationale: Emotional harm refers to psychological impact. Physical or financial harms are separate categories. Which cognitive bias likely caused Dr. Peterson to order an unnecessary colonoscopy for Ms. Hernandez? A. Confirmation bias B. Anchoring bias C. Availability heuristic D. Hindsight bias Rationale: The availability heuristic occurs when recent or vivid cases overly influence clinical decision-making. Other biases do not fit the scenario. True or False: Tight blood sugar control (80–110 mg/dL) in critically ill patients reduces mortality compared to less tight control. A. False B. True Rationale: Evidence shows tight glycemic control in critically ill patients increases risk of hypoglycemia without improving mortality. Which medication should be considered for discontinuation in a patient with reduced ejection fraction? A. Metformin B. Lisinopril C. Pioglitazone D. Atenolol Rationale: Pioglitazone can cause fluid retention and worsen heart failure. The other medications are either neutral or beneficial for reduced EF. Which lifestyle modification reduces blood pressure as much as a single antihypertensive drug? A. Aerobic exercise only B. Smoking cessation only C. DASH diet D. Low-protein diet Rationale: The DASH diet (Dietary Approaches to Stop Hypertension) is proven to lower blood pressure comparably to one medication. Other options help but are less effective alone. If Mr. Hicks’ blood pressure was 125/76 mmHg on his first visit, when should he follow up? A. 1 month B. 3 months C. 6 months D. 1 year Rationale: Blood pressure <130/80 mmHg with no comorbidities requires routine follow-up every six months. More frequent follow-up is unnecessary. Which of the following are recommendations for preventing or slowing diabetic retinopathy? (Select all that apply) A. Optimal blood pressure control B. Optimal glucose control C. Smoking cessation D. Only insulin therapy Rationale: Controlling blood pressure and glucose, along with smoking cessation, reduces the risk and progression of diabetic retinopathy. Insulin therapy alone does not fully prevent complications. Which of the following are types of neuropathies a patient with diabetes might develop? (Select all that apply) A. Distal symmetric polyneuropathy B. Erectile dysfunction C. Gastroparesis D. Postural hypotension E. Resting tachycardia F. Osteoarthritis Rationale: Diabetes can cause a variety of autonomic and peripheral neuropathies. Osteoarthritis is unrelated to diabetic neuropathy. Which exam findings could suggest long-standing hypertension or a secondary cause? (Select all that apply) A. Diffuse or displaced point of maximal impulse B. Retinopathy C. Pulsatile abdominal mass D. Discrepant blood pressures between arms and legs E. Renal artery bruit with systolic component F. Thyromegaly G. Hearing loss Rationale: These findings suggest either target organ damage from chronic hypertension or a secondary cause. Hearing loss is unrelated. What underlying process should be considered if a patient has hypertension and a potassium of 2.7 mmol/L? A. Hypothyroidism B. Chronic kidney disease C. Hyperaldosteronism D. Cushing syndrome Rationale: Hypokalemia with hypertension suggests primary hyperaldosteronism. Other options do not typically present with low potassium.