COMAT Family Medicine Exam V3 | COMAT Family
Medicine Exam V3 | COMAT Family Medicine Exam
V3
1. A 62-year-old African American male presents for a follow-up of hypertension. His home
blood pressure readings average 148/94 mmHg despite adherence to lifestyle modifications.
His medical history is notable for type 2 diabetes and stage 2 chronic kidney disease. Which of
the following is the most appropriate initial pharmacological agent for this patient?
A. Metoprolol
B. Amlodipine
C. Chlorthalidone
D. Lisinopril
Correct Answer: D
Explanation: According to the ACC/AHA guidelines, patients with chronic kidney disease
(CKD) and hypertension should be treated with an ACE inhibitor or ARB to provide renal
protection and reduce albuminuria. While thiazide-type diuretics and calcium channel
blockers are typically preferred in the African American population, the presence of CKD
with albuminuria makes an ACE inhibitor like Lisinopril the priority choice regardless of
race. Clinicians must monitor serum potassium and creatinine levels within 1-2 weeks of
initiating therapy to avoid acute kidney injury.
,2. A 52-year-old female presents for her annual physical exam. She has a BMI of 31 kg/m2 but
no other known medical conditions. She asks about screening for type 2 diabetes. According
to the USPSTF guidelines, what is the most appropriate recommendation for this patient?
A. Screening is not recommended until age 55
B. Screening only if she develops symptoms like polyuria
C. Screening with Hemoglobin A1c now
D. Screening with fasting glucose every 5 years
Correct Answer: C
Explanation: The USPSTF recommends screening for prediabetes and type 2 diabetes in
adults aged 35 to 70 years who are overweight or obese (BMI ≥ 25 kg/m2). Screening can
be performed using fasting plasma glucose, Hemoglobin A1c, or an oral glucose tolerance
test. Identifying patients at the prediabetic stage allows for intensive behavioral
interventions to prevent or delay the onset of overt diabetes.
3. A 4-year-old boy is brought to the clinic for a well-child visit. He is up to date on his
vaccinations except for his 4-year boosters. Which set of vaccines should he receive today?
A. MMR, Varicella, and Meningococcal
B. Tdap, IPV, Hib, and PCV13
C. DTaP, Rotavirus, and Hepatitis B
D. DTaP, IPV, MMR, and Varicella
,Correct Answer: D
Explanation: Children aged 4 to 6 years require booster doses of DTaP, IPV, MMR, and
Varicella to maintain immunity before entering school. This schedule ensures long-term
protection against pertussis, polio, measles, and chickenpox. Failing to complete this series
increases the risk of local outbreaks in educational settings.
4. A 68-year-old male with a 40-pack-year smoking history presents for an annual wellness
visit. He quit smoking 5 years ago. Which of the following screening tests is specifically
indicated for this patient based on his smoking history?
A. Chest X-ray annually
B. Alpha-1 antitrypsin levels
C. Abdominal ultrasound
D. Sputum cytology
Correct Answer: C
Explanation: The USPSTF recommends a one-time screening for abdominal aortic
aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
This patient meets the criteria due to his age and significant smoking history. Early
detection of AAA is critical because surgical repair of large aneurysms significantly reduces
mortality compared to emergency repair after rupture.
, 5. A 24-year-old female presents with a 2-day history of dysuria, urgency, and suprapubic
pain. She denies fever, chills, or flank pain. A urine dipstick is positive for nitrites and
leukocyte esterase. What is the most appropriate next step in management?
A. Obtain a urine culture and wait for results
B. Prescribe Nitrofurantoin for 5 days
C. Order a renal ultrasound
D. Prescribe Ciprofloxacin for 7 days
Correct Answer: B
Explanation: This patient presents with classic symptoms of uncomplicated cystitis, and
the positive dipstick confirms the diagnosis. Nitrofurantoin (for 5 days) or TMP-SMX (for 3
days) are first-line treatments for uncomplicated UTI in non-pregnant women.
Fluoroquinolones like Ciprofloxacin should be reserved for complicated cases or when
first-line agents cannot be used due to the risk of significant side effects.
6. A 45-year-old male presents for a routine check-up. He has no significant medical history
and no family history of colorectal cancer. When should he begin screening for colorectal
cancer according to the most recent guidelines?
A. Age 40
B. Age 55
C. Age 50
D. Age 45
Medicine Exam V3 | COMAT Family Medicine Exam
V3
1. A 62-year-old African American male presents for a follow-up of hypertension. His home
blood pressure readings average 148/94 mmHg despite adherence to lifestyle modifications.
His medical history is notable for type 2 diabetes and stage 2 chronic kidney disease. Which of
the following is the most appropriate initial pharmacological agent for this patient?
A. Metoprolol
B. Amlodipine
C. Chlorthalidone
D. Lisinopril
Correct Answer: D
Explanation: According to the ACC/AHA guidelines, patients with chronic kidney disease
(CKD) and hypertension should be treated with an ACE inhibitor or ARB to provide renal
protection and reduce albuminuria. While thiazide-type diuretics and calcium channel
blockers are typically preferred in the African American population, the presence of CKD
with albuminuria makes an ACE inhibitor like Lisinopril the priority choice regardless of
race. Clinicians must monitor serum potassium and creatinine levels within 1-2 weeks of
initiating therapy to avoid acute kidney injury.
,2. A 52-year-old female presents for her annual physical exam. She has a BMI of 31 kg/m2 but
no other known medical conditions. She asks about screening for type 2 diabetes. According
to the USPSTF guidelines, what is the most appropriate recommendation for this patient?
A. Screening is not recommended until age 55
B. Screening only if she develops symptoms like polyuria
C. Screening with Hemoglobin A1c now
D. Screening with fasting glucose every 5 years
Correct Answer: C
Explanation: The USPSTF recommends screening for prediabetes and type 2 diabetes in
adults aged 35 to 70 years who are overweight or obese (BMI ≥ 25 kg/m2). Screening can
be performed using fasting plasma glucose, Hemoglobin A1c, or an oral glucose tolerance
test. Identifying patients at the prediabetic stage allows for intensive behavioral
interventions to prevent or delay the onset of overt diabetes.
3. A 4-year-old boy is brought to the clinic for a well-child visit. He is up to date on his
vaccinations except for his 4-year boosters. Which set of vaccines should he receive today?
A. MMR, Varicella, and Meningococcal
B. Tdap, IPV, Hib, and PCV13
C. DTaP, Rotavirus, and Hepatitis B
D. DTaP, IPV, MMR, and Varicella
,Correct Answer: D
Explanation: Children aged 4 to 6 years require booster doses of DTaP, IPV, MMR, and
Varicella to maintain immunity before entering school. This schedule ensures long-term
protection against pertussis, polio, measles, and chickenpox. Failing to complete this series
increases the risk of local outbreaks in educational settings.
4. A 68-year-old male with a 40-pack-year smoking history presents for an annual wellness
visit. He quit smoking 5 years ago. Which of the following screening tests is specifically
indicated for this patient based on his smoking history?
A. Chest X-ray annually
B. Alpha-1 antitrypsin levels
C. Abdominal ultrasound
D. Sputum cytology
Correct Answer: C
Explanation: The USPSTF recommends a one-time screening for abdominal aortic
aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
This patient meets the criteria due to his age and significant smoking history. Early
detection of AAA is critical because surgical repair of large aneurysms significantly reduces
mortality compared to emergency repair after rupture.
, 5. A 24-year-old female presents with a 2-day history of dysuria, urgency, and suprapubic
pain. She denies fever, chills, or flank pain. A urine dipstick is positive for nitrites and
leukocyte esterase. What is the most appropriate next step in management?
A. Obtain a urine culture and wait for results
B. Prescribe Nitrofurantoin for 5 days
C. Order a renal ultrasound
D. Prescribe Ciprofloxacin for 7 days
Correct Answer: B
Explanation: This patient presents with classic symptoms of uncomplicated cystitis, and
the positive dipstick confirms the diagnosis. Nitrofurantoin (for 5 days) or TMP-SMX (for 3
days) are first-line treatments for uncomplicated UTI in non-pregnant women.
Fluoroquinolones like Ciprofloxacin should be reserved for complicated cases or when
first-line agents cannot be used due to the risk of significant side effects.
6. A 45-year-old male presents for a routine check-up. He has no significant medical history
and no family history of colorectal cancer. When should he begin screening for colorectal
cancer according to the most recent guidelines?
A. Age 40
B. Age 55
C. Age 50
D. Age 45
