TESTBANK FOR CURRENT MEDICAL DIAGNOSIS & TREATMENT 2026
,TABLE OF CONTENTS
1. Disease Prevention & Health Promotion
2. Common Symptoms
3. Preoperative Evaluation & Perioperative Management
4. Geriatric Disorders
5. Palliative Care & Pain Management
6. Dermatologic Disorders
7. Disorders of the Eyes & Lids
8. Otolaryngology Disorders
9. Oral Disorders
10. Pulmonary Disorders
11. Heart Disease
12. Vascular & Lymphatic Disorders
13. Blood Disorders
14. Disorders of Hemostasis, Thrombosis, & Antithrombotic Therapy
15. Gastrointestinal Disorders
16. Liver, Biliary Tract, & Pancreas Disorders
17. Breast Disorders
18. Women's Health Issues
19. Gynecologic Disorders
20. Obstetrics & Obstetric Disorders
21. Rheumatologic, Immunologic, & Allergic Disorders
22. Electrolyte & Acid-Base Disorders
23. Kidney Disease
24. Urologic Disorders
25. Nervous System Disorders
26. Psychiatric Disorders
, 27. Disorders of the Pituitary, Thyroid, & Adrenal Glands
28. Disorders of Bone Metabolism & Parathyroid Glands
29. Male Hypogonadism & Gynecomastia, Hirsutism & Virilization
30. Diabetes Mellitus & Hypoglycemia
31. Lipid Disorders
32. Nutrition, Nutritional Disorders, & Obesity
33. Common Problems in Infectious Diseases & Antimicrobial Therapy
34. HIV Infection & AIDS
35. Viral & Rickettsial Infections
36. Bacterial & Chlamydial Infections
37. Spirochetal Infections
38. Protozoal & Helminthic Infections
39. Mycotic Infections
40. Disorders Related to Environmental Emergencies
41. Poisoning
42. Cancer
43. Genetic & Genomic Disorders
44. Orthopedic Disorders & Sports Medicine
45. Sexual & Gender Minority Health
46. Substance Use Disorders
47. Health Care in International Settings
48. Integrative Medicine
CURRENT Medical Diagnosis & Treatment 2026 (65th Edition)
Part 1: Disease Prevention & Health Promotion
Question 1
A 44-year-old woman with obesity presents after several elevated blood-pressure readings obtained at a
pharmacy. Her office blood pressure is 148/92 mm Hg in the right arm and 146/90 mm Hg in the left arm. She
,has no headaches, visual symptoms, cardiovascular disease, kidney disease, or diabetes. Physical examination
and basic laboratory findings are unremarkable. Which action is most appropriate before labeling her as having
hypertension and beginning lifelong medication?
A. Obtain ambulatory or validated home blood-pressure measurements
B. Begin two antihypertensive agents immediately
C. Order renal artery imaging
D. Recheck her blood pressure in five years
Correct Answer
A. Obtain ambulatory or validated home blood-pressure measurements
Rationale
Repeatedly elevated office measurements suggest hypertension, but out-of-office monitoring should generally
be used to confirm the diagnosis before treatment is initiated in an otherwise stable, asymptomatic adult.
Ambulatory or home monitoring can distinguish sustained hypertension from white-coat hypertension and
provides a more reliable estimate of the patient’s usual blood pressure.
Why the Other Options Are Less Appropriate
B. Immediate dual therapy is premature before sustained hypertension is confirmed and the overall
cardiovascular risk is assessed.
C. Renal artery imaging is not routinely indicated without resistant hypertension, abrupt worsening, renal
dysfunction after renin-angiotensin system blockade, or other evidence of renovascular disease.
D. Waiting five years would expose the patient to prolonged cardiovascular risk if hypertension is confirmed.
Clinical Pearl
An elevated office blood pressure is a screening result; confirmation outside the clinical setting helps establish
the diagnosis.
CMDT Review Note
Accurate blood-pressure technique, repeated measurements and confirmation with ambulatory or home
monitoring reduce both missed diagnoses and unnecessary treatment.
Question 2
A 57-year-old man stopped smoking 12 years ago after accumulating a 28-pack-year history. He has no cough,
weight loss, hemoptysis or occupational exposure to asbestos. His father died from lung cancer at age 74. The
patient asks whether a chest radiograph, sputum cytology or low-dose CT would be the most appropriate
screening strategy. Which recommendation is best?
A. Annual chest radiography because he has a family history of lung cancer
B. Sputum cytology every year until 15 years after smoking cessation
,C. No screening because he currently has no respiratory symptoms
D. Annual low-dose CT after a discussion of potential benefits and harms
Correct Answer
D. Annual low-dose CT after a discussion of potential benefits and harms
Rationale
This patient falls within the population for whom annual low-dose CT lung-cancer screening is recommended:
an adult aged 50–80 years with at least a 20-pack-year smoking history who currently smokes or quit within
the previous 15 years. Screening should follow shared decision-making because false-positive findings,
incidental abnormalities and radiation exposure can occur.
Why the Other Options Are Less Appropriate
A. Chest radiography has not demonstrated an adequate mortality benefit as a lung-cancer screening test.
B. Sputum cytology is not an accepted stand-alone screening strategy for asymptomatic adults.
C. Screening is specifically intended for eligible people before symptoms develop.
Clinical Pearl
Eligibility for lung-cancer screening depends on age, cumulative smoking exposure and time since quitting—
not on the presence of symptoms.
CMDT Review Note
Low-dose CT screening should be discontinued when a patient exceeds the recommended age range, has not
smoked for more than 15 years, or develops a condition that substantially limits curative treatment.
Question 3
A 62-year-old woman with hypertension and hyperlipidemia has no history of myocardial infarction, stroke,
peripheral arterial disease or gastrointestinal bleeding. Her estimated 10-year cardiovascular risk is 13%. After
reading that aspirin prevents heart attacks, she asks for a daily prescription. Which response best reflects an
appropriate preventive-care decision?
A. Aspirin is required because her estimated risk exceeds 10%
B. Aspirin should generally not be initiated routinely for primary prevention at her age
C. Aspirin should be started only after a normal screening endoscopy
D. Aspirin and clopidogrel should be prescribed together for maximum protection
Correct Answer
B. Aspirin should generally not be initiated routinely for primary prevention at her age
Rationale
,In adults aged 60 years or older without established cardiovascular disease, initiating low-dose aspirin for
primary prevention generally offers little or no net benefit because the modest reduction in ischemic events is
offset by increased gastrointestinal and intracranial bleeding. Management should instead prioritize blood-
pressure control, lipid management, exercise, nutrition and smoking avoidance.
Why the Other Options Are Less Appropriate
A. Cardiovascular risk alone does not eliminate the age-related bleeding risk associated with aspirin.
C. A normal endoscopy does not predict or eliminate future aspirin-related bleeding.
D. Dual antiplatelet therapy carries substantially greater bleeding risk and has no role in routine primary
prevention.
Clinical Pearl
A treatment that lowers cardiovascular events may still be inappropriate when its competing harms eliminate
the overall preventive benefit.
CMDT Review Note
Primary prevention requires assessment of absolute benefit, bleeding risk, age, comorbidities and patient
preferences rather than automatic treatment based on one risk threshold.
Question 4
A 51-year-old woman with a body mass index of 33 kg/m² presents for health maintenance. She has no
polyuria, polydipsia or unexplained weight loss. Her blood pressure is 138/86 mm Hg, and her mother has type
2 diabetes. Three years ago, her fasting glucose was normal. Which preventive intervention is most appropriate
now?
A. Begin metformin without additional testing
B. Obtain a fasting insulin concentration
C. Screen for prediabetes and type 2 diabetes
D. Defer screening until symptoms develop
Correct Answer
C. Screen for prediabetes and type 2 diabetes
Rationale
An asymptomatic adult aged 35–70 years who has overweight or obesity should be screened for prediabetes
and type 2 diabetes. Appropriate methods include fasting plasma glucose, HbA1c or an oral glucose-tolerance
test. Early identification allows timely lifestyle intervention and cardiovascular risk reduction.
Why the Other Options Are Less Appropriate
A. Medication should not be started without establishing the patient’s glycemic status and considering the
individual risk-benefit profile.
,B. Fasting insulin is not recommended as a routine screening test for diabetes.
D. Waiting for symptoms may delay diagnosis because type 2 diabetes can remain clinically silent for years.
Clinical Pearl
Preventive screening is most valuable when disease has a prolonged asymptomatic phase and early
intervention can alter its course.
CMDT Review Note
Patients found to have prediabetes should be offered effective preventive interventions, particularly structured
programs promoting sustainable dietary change, physical activity and weight reduction.
Question 5
A healthy 47-year-old man has no gastrointestinal symptoms, inflammatory bowel disease or known hereditary
cancer syndrome. His mother developed colorectal cancer at age 78. He assumes screening can be postponed
until age 50 because he feels well. Which recommendation is most appropriate?
A. Begin colorectal-cancer screening now using an accepted screening strategy
B. Wait until age 50 because symptoms are absent
C. Order serum carcinoembryonic antigen annually
D. Perform abdominal CT every five years
Correct Answer
A. Begin colorectal-cancer screening now using an accepted screening strategy
Rationale
Average-risk colorectal-cancer screening begins at age 45. Acceptable approaches include stool-based testing
and direct visualization strategies, with intervals determined by the selected test. The patient’s lack of
symptoms does not justify delay because screening targets preclinical disease and premalignant lesions.
Why the Other Options Are Less Appropriate
B. Delaying until age 50 is inconsistent with current recommendations for average-risk adults.
C. Carcinoembryonic antigen is not sufficiently sensitive or specific for population screening.
D. Routine abdominal CT is not an accepted colorectal-cancer screening method.
Clinical Pearl
Screening recommendations are designed for asymptomatic people; waiting for symptoms changes screening
into diagnostic evaluation.
CMDT Review Note
The best colorectal-cancer screening test is an evidence-based option the patient is willing and able to
complete, followed by appropriate evaluation of abnormal results.
, Question 6
A 66-year-old woman has completed menopause and has no history of fragility fracture. She exercises regularly
and takes no glucocorticoids. Her sister sustained a hip fracture at age 73. Physical examination is normal.
Which preventive measure is most appropriate?
A. Prescribe bisphosphonate therapy without measuring bone density
B. Measure serum calcium annually as the only screening method
C. Obtain spinal radiographs despite the absence of symptoms
D. Arrange bone-density screening with dual-energy x-ray absorptiometry
Correct Answer
D. Arrange bone-density screening with dual-energy x-ray absorptiometry
Rationale
Women aged 65 years or older should be screened for osteoporosis to identify those at increased risk of
osteoporotic fracture. Dual-energy x-ray absorptiometry is the standard screening method. Her family history
further increases concern but treatment decisions should follow assessment of bone density and overall
fracture risk.
Why the Other Options Are Less Appropriate
A. Empiric pharmacologic treatment without determining fracture risk may expose the patient to unnecessary
adverse effects.
B. Serum calcium can remain normal in osteoporosis and does not measure bone strength.
C. Plain radiographs are insensitive for early bone loss and are not the preferred screening test.
Clinical Pearl
Osteoporosis is often clinically silent until a fracture occurs; normal serum calcium does not exclude it.
CMDT Review Note
Bone-density results should be interpreted with age, prior fractures, medication exposure and validated
fracture-risk assessment rather than in isolation.
Question 7
A 39-year-old nurse reports smoking 15 cigarettes daily and wants to quit. Two previous unaided attempts
ended within one week because of severe cravings. She is not pregnant, has no seizure disorder and takes no
interacting medications. Which strategy offers the best chance of sustained abstinence?
A. Advise gradual reduction without setting a quit date or arranging follow-up
B. Combine structured behavioral support with an evidence-based cessation medication
C. Recommend switching completely to occasional cigar smoking
D. Delay treatment until she demonstrates stronger motivation
, Correct Answer
B. Combine structured behavioral support with an evidence-based cessation medication
Rationale
Behavioral counseling and pharmacotherapy are both effective, but their combination produces the best
likelihood of successful smoking cessation. Treatment should be matched to the patient’s preferences, clinical
history and prior experience, with continued support because tobacco dependence commonly involves
relapse.
Why the Other Options Are Less Appropriate
A. Unstructured reduction without follow-up is less effective than a coordinated cessation plan.
C. Cigar smoking continues exposure to toxic combustion products and is not a safe cessation strategy.
D. A stated desire to quit is sufficient reason to offer treatment; withholding assistance may miss an important
preventive opportunity.
Clinical Pearl
A previous unsuccessful quit attempt is not evidence of treatment failure; it identifies a need for stronger
support and a revised strategy.
CMDT Review Note
Tobacco use should be treated as a chronic relapsing condition, with repeated counseling, pharmacotherapy
when appropriate and follow-up after the quit date.
Question 8
A 58-year-old sedentary accountant with hypertension asks how much exercise is needed to obtain meaningful
health benefits. He has no chest discomfort, exertional dyspnea, syncope or functional limitation. Examination
is normal, and his hypertension is controlled. Which plan is most appropriate?
A. Accumulate 150–300 minutes of moderate aerobic activity weekly and perform muscle-strengthening
activity on at least two days
B. Perform vigorous exercise for at least two hours every day
C. Avoid resistance exercise because it provides no preventive benefit
D. Undergo coronary angiography before beginning brisk walking
Correct Answer
A. Accumulate 150–300 minutes of moderate aerobic activity weekly and perform muscle-strengthening
activity on at least two days
Rationale
, Adults obtain substantial health benefits from 150–300 minutes of moderate-intensity aerobic activity per
week, together with muscle-strengthening activities involving major muscle groups on at least two days.
Previously inactive adults should progress gradually according to ability and clinical status.
Why the Other Options Are Less Appropriate
B. This volume is unnecessary, difficult to sustain and could increase injury risk in a previously sedentary
individual.
C. Muscle-strengthening activity supports metabolic health, functional capacity and preservation of lean mass.
D. Invasive coronary evaluation is not indicated before moderate activity in an asymptomatic adult without
another clinical indication.
Clinical Pearl
Some physical activity is better than none; gradual, sustainable progression is more valuable than an extreme
prescription that the patient cannot maintain.
CMDT Review Note
Exercise counseling should include aerobic activity, strengthening, reduced sedentary time and individualized
progression based on symptoms, fitness and comorbidities.
Question 9
A 33-year-old woman plans to become pregnant within the next year. She has epilepsy that has remained
controlled with medication and previously delivered an infant with a neural-tube defect. She takes a standard
over-the-counter multivitamin. Which preventive intervention requires the most urgent individualized
attention before conception?
A. Discontinue all antiseizure medication immediately
B. Wait until pregnancy is confirmed before discussing supplementation
C. Replace folate with vitamin A because it is more effective for fetal neurologic development
D. Arrange preconception medication review and prescribe an appropriately higher folic-acid dose
Correct Answer
D. Arrange preconception medication review and prescribe an appropriately higher folic-acid dose
Rationale
A previous pregnancy affected by a neural-tube defect places this patient at high recurrence risk. She requires
preconception counseling, review of antiseizure therapy and higher-dose folic-acid supplementation initiated
before conception. Abruptly stopping antiseizure medication could cause seizures and endanger both the
patient and a future pregnancy.
Why the Other Options Are Less Appropriate
,TABLE OF CONTENTS
1. Disease Prevention & Health Promotion
2. Common Symptoms
3. Preoperative Evaluation & Perioperative Management
4. Geriatric Disorders
5. Palliative Care & Pain Management
6. Dermatologic Disorders
7. Disorders of the Eyes & Lids
8. Otolaryngology Disorders
9. Oral Disorders
10. Pulmonary Disorders
11. Heart Disease
12. Vascular & Lymphatic Disorders
13. Blood Disorders
14. Disorders of Hemostasis, Thrombosis, & Antithrombotic Therapy
15. Gastrointestinal Disorders
16. Liver, Biliary Tract, & Pancreas Disorders
17. Breast Disorders
18. Women's Health Issues
19. Gynecologic Disorders
20. Obstetrics & Obstetric Disorders
21. Rheumatologic, Immunologic, & Allergic Disorders
22. Electrolyte & Acid-Base Disorders
23. Kidney Disease
24. Urologic Disorders
25. Nervous System Disorders
26. Psychiatric Disorders
, 27. Disorders of the Pituitary, Thyroid, & Adrenal Glands
28. Disorders of Bone Metabolism & Parathyroid Glands
29. Male Hypogonadism & Gynecomastia, Hirsutism & Virilization
30. Diabetes Mellitus & Hypoglycemia
31. Lipid Disorders
32. Nutrition, Nutritional Disorders, & Obesity
33. Common Problems in Infectious Diseases & Antimicrobial Therapy
34. HIV Infection & AIDS
35. Viral & Rickettsial Infections
36. Bacterial & Chlamydial Infections
37. Spirochetal Infections
38. Protozoal & Helminthic Infections
39. Mycotic Infections
40. Disorders Related to Environmental Emergencies
41. Poisoning
42. Cancer
43. Genetic & Genomic Disorders
44. Orthopedic Disorders & Sports Medicine
45. Sexual & Gender Minority Health
46. Substance Use Disorders
47. Health Care in International Settings
48. Integrative Medicine
CURRENT Medical Diagnosis & Treatment 2026 (65th Edition)
Part 1: Disease Prevention & Health Promotion
Question 1
A 44-year-old woman with obesity presents after several elevated blood-pressure readings obtained at a
pharmacy. Her office blood pressure is 148/92 mm Hg in the right arm and 146/90 mm Hg in the left arm. She
,has no headaches, visual symptoms, cardiovascular disease, kidney disease, or diabetes. Physical examination
and basic laboratory findings are unremarkable. Which action is most appropriate before labeling her as having
hypertension and beginning lifelong medication?
A. Obtain ambulatory or validated home blood-pressure measurements
B. Begin two antihypertensive agents immediately
C. Order renal artery imaging
D. Recheck her blood pressure in five years
Correct Answer
A. Obtain ambulatory or validated home blood-pressure measurements
Rationale
Repeatedly elevated office measurements suggest hypertension, but out-of-office monitoring should generally
be used to confirm the diagnosis before treatment is initiated in an otherwise stable, asymptomatic adult.
Ambulatory or home monitoring can distinguish sustained hypertension from white-coat hypertension and
provides a more reliable estimate of the patient’s usual blood pressure.
Why the Other Options Are Less Appropriate
B. Immediate dual therapy is premature before sustained hypertension is confirmed and the overall
cardiovascular risk is assessed.
C. Renal artery imaging is not routinely indicated without resistant hypertension, abrupt worsening, renal
dysfunction after renin-angiotensin system blockade, or other evidence of renovascular disease.
D. Waiting five years would expose the patient to prolonged cardiovascular risk if hypertension is confirmed.
Clinical Pearl
An elevated office blood pressure is a screening result; confirmation outside the clinical setting helps establish
the diagnosis.
CMDT Review Note
Accurate blood-pressure technique, repeated measurements and confirmation with ambulatory or home
monitoring reduce both missed diagnoses and unnecessary treatment.
Question 2
A 57-year-old man stopped smoking 12 years ago after accumulating a 28-pack-year history. He has no cough,
weight loss, hemoptysis or occupational exposure to asbestos. His father died from lung cancer at age 74. The
patient asks whether a chest radiograph, sputum cytology or low-dose CT would be the most appropriate
screening strategy. Which recommendation is best?
A. Annual chest radiography because he has a family history of lung cancer
B. Sputum cytology every year until 15 years after smoking cessation
,C. No screening because he currently has no respiratory symptoms
D. Annual low-dose CT after a discussion of potential benefits and harms
Correct Answer
D. Annual low-dose CT after a discussion of potential benefits and harms
Rationale
This patient falls within the population for whom annual low-dose CT lung-cancer screening is recommended:
an adult aged 50–80 years with at least a 20-pack-year smoking history who currently smokes or quit within
the previous 15 years. Screening should follow shared decision-making because false-positive findings,
incidental abnormalities and radiation exposure can occur.
Why the Other Options Are Less Appropriate
A. Chest radiography has not demonstrated an adequate mortality benefit as a lung-cancer screening test.
B. Sputum cytology is not an accepted stand-alone screening strategy for asymptomatic adults.
C. Screening is specifically intended for eligible people before symptoms develop.
Clinical Pearl
Eligibility for lung-cancer screening depends on age, cumulative smoking exposure and time since quitting—
not on the presence of symptoms.
CMDT Review Note
Low-dose CT screening should be discontinued when a patient exceeds the recommended age range, has not
smoked for more than 15 years, or develops a condition that substantially limits curative treatment.
Question 3
A 62-year-old woman with hypertension and hyperlipidemia has no history of myocardial infarction, stroke,
peripheral arterial disease or gastrointestinal bleeding. Her estimated 10-year cardiovascular risk is 13%. After
reading that aspirin prevents heart attacks, she asks for a daily prescription. Which response best reflects an
appropriate preventive-care decision?
A. Aspirin is required because her estimated risk exceeds 10%
B. Aspirin should generally not be initiated routinely for primary prevention at her age
C. Aspirin should be started only after a normal screening endoscopy
D. Aspirin and clopidogrel should be prescribed together for maximum protection
Correct Answer
B. Aspirin should generally not be initiated routinely for primary prevention at her age
Rationale
,In adults aged 60 years or older without established cardiovascular disease, initiating low-dose aspirin for
primary prevention generally offers little or no net benefit because the modest reduction in ischemic events is
offset by increased gastrointestinal and intracranial bleeding. Management should instead prioritize blood-
pressure control, lipid management, exercise, nutrition and smoking avoidance.
Why the Other Options Are Less Appropriate
A. Cardiovascular risk alone does not eliminate the age-related bleeding risk associated with aspirin.
C. A normal endoscopy does not predict or eliminate future aspirin-related bleeding.
D. Dual antiplatelet therapy carries substantially greater bleeding risk and has no role in routine primary
prevention.
Clinical Pearl
A treatment that lowers cardiovascular events may still be inappropriate when its competing harms eliminate
the overall preventive benefit.
CMDT Review Note
Primary prevention requires assessment of absolute benefit, bleeding risk, age, comorbidities and patient
preferences rather than automatic treatment based on one risk threshold.
Question 4
A 51-year-old woman with a body mass index of 33 kg/m² presents for health maintenance. She has no
polyuria, polydipsia or unexplained weight loss. Her blood pressure is 138/86 mm Hg, and her mother has type
2 diabetes. Three years ago, her fasting glucose was normal. Which preventive intervention is most appropriate
now?
A. Begin metformin without additional testing
B. Obtain a fasting insulin concentration
C. Screen for prediabetes and type 2 diabetes
D. Defer screening until symptoms develop
Correct Answer
C. Screen for prediabetes and type 2 diabetes
Rationale
An asymptomatic adult aged 35–70 years who has overweight or obesity should be screened for prediabetes
and type 2 diabetes. Appropriate methods include fasting plasma glucose, HbA1c or an oral glucose-tolerance
test. Early identification allows timely lifestyle intervention and cardiovascular risk reduction.
Why the Other Options Are Less Appropriate
A. Medication should not be started without establishing the patient’s glycemic status and considering the
individual risk-benefit profile.
,B. Fasting insulin is not recommended as a routine screening test for diabetes.
D. Waiting for symptoms may delay diagnosis because type 2 diabetes can remain clinically silent for years.
Clinical Pearl
Preventive screening is most valuable when disease has a prolonged asymptomatic phase and early
intervention can alter its course.
CMDT Review Note
Patients found to have prediabetes should be offered effective preventive interventions, particularly structured
programs promoting sustainable dietary change, physical activity and weight reduction.
Question 5
A healthy 47-year-old man has no gastrointestinal symptoms, inflammatory bowel disease or known hereditary
cancer syndrome. His mother developed colorectal cancer at age 78. He assumes screening can be postponed
until age 50 because he feels well. Which recommendation is most appropriate?
A. Begin colorectal-cancer screening now using an accepted screening strategy
B. Wait until age 50 because symptoms are absent
C. Order serum carcinoembryonic antigen annually
D. Perform abdominal CT every five years
Correct Answer
A. Begin colorectal-cancer screening now using an accepted screening strategy
Rationale
Average-risk colorectal-cancer screening begins at age 45. Acceptable approaches include stool-based testing
and direct visualization strategies, with intervals determined by the selected test. The patient’s lack of
symptoms does not justify delay because screening targets preclinical disease and premalignant lesions.
Why the Other Options Are Less Appropriate
B. Delaying until age 50 is inconsistent with current recommendations for average-risk adults.
C. Carcinoembryonic antigen is not sufficiently sensitive or specific for population screening.
D. Routine abdominal CT is not an accepted colorectal-cancer screening method.
Clinical Pearl
Screening recommendations are designed for asymptomatic people; waiting for symptoms changes screening
into diagnostic evaluation.
CMDT Review Note
The best colorectal-cancer screening test is an evidence-based option the patient is willing and able to
complete, followed by appropriate evaluation of abnormal results.
, Question 6
A 66-year-old woman has completed menopause and has no history of fragility fracture. She exercises regularly
and takes no glucocorticoids. Her sister sustained a hip fracture at age 73. Physical examination is normal.
Which preventive measure is most appropriate?
A. Prescribe bisphosphonate therapy without measuring bone density
B. Measure serum calcium annually as the only screening method
C. Obtain spinal radiographs despite the absence of symptoms
D. Arrange bone-density screening with dual-energy x-ray absorptiometry
Correct Answer
D. Arrange bone-density screening with dual-energy x-ray absorptiometry
Rationale
Women aged 65 years or older should be screened for osteoporosis to identify those at increased risk of
osteoporotic fracture. Dual-energy x-ray absorptiometry is the standard screening method. Her family history
further increases concern but treatment decisions should follow assessment of bone density and overall
fracture risk.
Why the Other Options Are Less Appropriate
A. Empiric pharmacologic treatment without determining fracture risk may expose the patient to unnecessary
adverse effects.
B. Serum calcium can remain normal in osteoporosis and does not measure bone strength.
C. Plain radiographs are insensitive for early bone loss and are not the preferred screening test.
Clinical Pearl
Osteoporosis is often clinically silent until a fracture occurs; normal serum calcium does not exclude it.
CMDT Review Note
Bone-density results should be interpreted with age, prior fractures, medication exposure and validated
fracture-risk assessment rather than in isolation.
Question 7
A 39-year-old nurse reports smoking 15 cigarettes daily and wants to quit. Two previous unaided attempts
ended within one week because of severe cravings. She is not pregnant, has no seizure disorder and takes no
interacting medications. Which strategy offers the best chance of sustained abstinence?
A. Advise gradual reduction without setting a quit date or arranging follow-up
B. Combine structured behavioral support with an evidence-based cessation medication
C. Recommend switching completely to occasional cigar smoking
D. Delay treatment until she demonstrates stronger motivation
, Correct Answer
B. Combine structured behavioral support with an evidence-based cessation medication
Rationale
Behavioral counseling and pharmacotherapy are both effective, but their combination produces the best
likelihood of successful smoking cessation. Treatment should be matched to the patient’s preferences, clinical
history and prior experience, with continued support because tobacco dependence commonly involves
relapse.
Why the Other Options Are Less Appropriate
A. Unstructured reduction without follow-up is less effective than a coordinated cessation plan.
C. Cigar smoking continues exposure to toxic combustion products and is not a safe cessation strategy.
D. A stated desire to quit is sufficient reason to offer treatment; withholding assistance may miss an important
preventive opportunity.
Clinical Pearl
A previous unsuccessful quit attempt is not evidence of treatment failure; it identifies a need for stronger
support and a revised strategy.
CMDT Review Note
Tobacco use should be treated as a chronic relapsing condition, with repeated counseling, pharmacotherapy
when appropriate and follow-up after the quit date.
Question 8
A 58-year-old sedentary accountant with hypertension asks how much exercise is needed to obtain meaningful
health benefits. He has no chest discomfort, exertional dyspnea, syncope or functional limitation. Examination
is normal, and his hypertension is controlled. Which plan is most appropriate?
A. Accumulate 150–300 minutes of moderate aerobic activity weekly and perform muscle-strengthening
activity on at least two days
B. Perform vigorous exercise for at least two hours every day
C. Avoid resistance exercise because it provides no preventive benefit
D. Undergo coronary angiography before beginning brisk walking
Correct Answer
A. Accumulate 150–300 minutes of moderate aerobic activity weekly and perform muscle-strengthening
activity on at least two days
Rationale
, Adults obtain substantial health benefits from 150–300 minutes of moderate-intensity aerobic activity per
week, together with muscle-strengthening activities involving major muscle groups on at least two days.
Previously inactive adults should progress gradually according to ability and clinical status.
Why the Other Options Are Less Appropriate
B. This volume is unnecessary, difficult to sustain and could increase injury risk in a previously sedentary
individual.
C. Muscle-strengthening activity supports metabolic health, functional capacity and preservation of lean mass.
D. Invasive coronary evaluation is not indicated before moderate activity in an asymptomatic adult without
another clinical indication.
Clinical Pearl
Some physical activity is better than none; gradual, sustainable progression is more valuable than an extreme
prescription that the patient cannot maintain.
CMDT Review Note
Exercise counseling should include aerobic activity, strengthening, reduced sedentary time and individualized
progression based on symptoms, fitness and comorbidities.
Question 9
A 33-year-old woman plans to become pregnant within the next year. She has epilepsy that has remained
controlled with medication and previously delivered an infant with a neural-tube defect. She takes a standard
over-the-counter multivitamin. Which preventive intervention requires the most urgent individualized
attention before conception?
A. Discontinue all antiseizure medication immediately
B. Wait until pregnancy is confirmed before discussing supplementation
C. Replace folate with vitamin A because it is more effective for fetal neurologic development
D. Arrange preconception medication review and prescribe an appropriately higher folic-acid dose
Correct Answer
D. Arrange preconception medication review and prescribe an appropriately higher folic-acid dose
Rationale
A previous pregnancy affected by a neural-tube defect places this patient at high recurrence risk. She requires
preconception counseling, review of antiseizure therapy and higher-dose folic-acid supplementation initiated
before conception. Abruptly stopping antiseizure medication could cause seizures and endanger both the
patient and a future pregnancy.
Why the Other Options Are Less Appropriate
