COMAT Family Medicine Exam V1 | COMAT Family
Medicine Exam V1 | COMAT Family Medicine Exam
V1
1. A 52-year-old male with a history of type 2 diabetes mellitus and hypertension presents for
a routine visit. His blood pressure today is 148/92 mmHg, similar to readings taken two
weeks ago. Laboratory results show a serum creatinine of 1.1 mg/dL and a urine albumin-to-
creatinine ratio of 150 mg/g. Which of the following is the most appropriate initial
antihypertensive agent for this patient?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol succinate
Correct Answer: B
Explanation: In patients with diabetes and albuminuria, ACE inhibitors such as lisinopril
are the preferred first-line agents to reduce the progression of nephropathy. This choice is
supported by evidence showing that ACE inhibitors provide renal protection beyond their
blood pressure lowering effects. While CCBs and diuretics are effective for blood pressure,
they do not offer the same level of renoprotection in the setting of albuminuria.
,2. A 68-year-old female presents with a 2-day history of burning during urination and
increased frequency. She has no fever, chills, or flank pain. She has a history of recurrent
urinary tract infections. Which of the following is the best initial management for this
patient?
A. Empiric treatment with nitrofurantoin
B. Imaging of the renal tract
C. Urine culture and sensitivity
D. Observation and increased fluid intake
Correct Answer: C
Explanation: For patients with recurrent urinary tract infections or complicated features,
a urine culture and sensitivity should be obtained to guide therapy and identify resistant
organisms. While empiric therapy is common for simple cystitis, recurrence necessitates
identification of the specific pathogen. Imaging is typically reserved for cases where
structural abnormalities or stones are suspected after repeated treatment failures.
3. A 35-year-old woman at 36 weeks gestation presents for a routine prenatal visit. She has
had an uncomplicated pregnancy. Which of the following screening tests should be
performed at this visit?
A. Glucose challenge test
B. HIV screening
C. Hepatitis B surface antigen
,D. Group B Streptococcus culture
Correct Answer: D
Explanation: Screening for Group B Streptococcus (GBS) via vaginal-rectal culture is
recommended for all pregnant women between 36 0/7 and 37 6/7 weeks of gestation.
Identifying GBS colonization allows for intrapartum antibiotic prophylaxis to prevent early-
onset neonatal sepsis. Other screenings like glucose challenge are typically done earlier,
between 24 and 28 weeks.
4. A 45-year-old male presents with acute onset of severe pain, redness, and swelling in his
left first metatarsophalangeal joint. He reports no trauma. A joint aspiration reveals
negatively birefringent needle-shaped crystals. Which of the following is the most
appropriate first-line treatment for his acute symptoms?
A. Allopurinol
B. Probenecid
C. Naproxen
D. Febuxostat
Correct Answer: C
Explanation: NSAIDs, like naproxen, or colchicine are first-line treatments for acute gouty
arthritis to reduce inflammation and pain. Urate-lowering therapies like allopurinol should
not be initiated during an acute flare as they can exacerbate the symptoms by shifting
, crystal deposits. Treatment should focus on symptomatic relief before addressing long-
term uric acid management.
5. A 62-year-old female presents for a health maintenance exam. She smokes one pack of
cigarettes per day and has for the past 40 years. Which of the following screening tests is
most appropriate for her based on USPSTF guidelines?
A. Sputum cytology
B. Annual chest X-ray
C. Annual low-dose CT of the chest
D. Carotid duplex ultrasound
Correct Answer: C
Explanation: The USPSTF recommends annual screening for lung cancer with low-dose
computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. Chest X-rays
have not been shown to reduce lung cancer mortality in screening programs. This
intervention is critical for early detection in a high-risk population.
6. A 12-month-old child is brought in for a well-child visit. Which of the following vaccines
should the child receive today?
A. Rotavirus
B. Measles, mumps, rubella (MMR)
C. Human papillomavirus (HPV)
Medicine Exam V1 | COMAT Family Medicine Exam
V1
1. A 52-year-old male with a history of type 2 diabetes mellitus and hypertension presents for
a routine visit. His blood pressure today is 148/92 mmHg, similar to readings taken two
weeks ago. Laboratory results show a serum creatinine of 1.1 mg/dL and a urine albumin-to-
creatinine ratio of 150 mg/g. Which of the following is the most appropriate initial
antihypertensive agent for this patient?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol succinate
Correct Answer: B
Explanation: In patients with diabetes and albuminuria, ACE inhibitors such as lisinopril
are the preferred first-line agents to reduce the progression of nephropathy. This choice is
supported by evidence showing that ACE inhibitors provide renal protection beyond their
blood pressure lowering effects. While CCBs and diuretics are effective for blood pressure,
they do not offer the same level of renoprotection in the setting of albuminuria.
,2. A 68-year-old female presents with a 2-day history of burning during urination and
increased frequency. She has no fever, chills, or flank pain. She has a history of recurrent
urinary tract infections. Which of the following is the best initial management for this
patient?
A. Empiric treatment with nitrofurantoin
B. Imaging of the renal tract
C. Urine culture and sensitivity
D. Observation and increased fluid intake
Correct Answer: C
Explanation: For patients with recurrent urinary tract infections or complicated features,
a urine culture and sensitivity should be obtained to guide therapy and identify resistant
organisms. While empiric therapy is common for simple cystitis, recurrence necessitates
identification of the specific pathogen. Imaging is typically reserved for cases where
structural abnormalities or stones are suspected after repeated treatment failures.
3. A 35-year-old woman at 36 weeks gestation presents for a routine prenatal visit. She has
had an uncomplicated pregnancy. Which of the following screening tests should be
performed at this visit?
A. Glucose challenge test
B. HIV screening
C. Hepatitis B surface antigen
,D. Group B Streptococcus culture
Correct Answer: D
Explanation: Screening for Group B Streptococcus (GBS) via vaginal-rectal culture is
recommended for all pregnant women between 36 0/7 and 37 6/7 weeks of gestation.
Identifying GBS colonization allows for intrapartum antibiotic prophylaxis to prevent early-
onset neonatal sepsis. Other screenings like glucose challenge are typically done earlier,
between 24 and 28 weeks.
4. A 45-year-old male presents with acute onset of severe pain, redness, and swelling in his
left first metatarsophalangeal joint. He reports no trauma. A joint aspiration reveals
negatively birefringent needle-shaped crystals. Which of the following is the most
appropriate first-line treatment for his acute symptoms?
A. Allopurinol
B. Probenecid
C. Naproxen
D. Febuxostat
Correct Answer: C
Explanation: NSAIDs, like naproxen, or colchicine are first-line treatments for acute gouty
arthritis to reduce inflammation and pain. Urate-lowering therapies like allopurinol should
not be initiated during an acute flare as they can exacerbate the symptoms by shifting
, crystal deposits. Treatment should focus on symptomatic relief before addressing long-
term uric acid management.
5. A 62-year-old female presents for a health maintenance exam. She smokes one pack of
cigarettes per day and has for the past 40 years. Which of the following screening tests is
most appropriate for her based on USPSTF guidelines?
A. Sputum cytology
B. Annual chest X-ray
C. Annual low-dose CT of the chest
D. Carotid duplex ultrasound
Correct Answer: C
Explanation: The USPSTF recommends annual screening for lung cancer with low-dose
computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. Chest X-rays
have not been shown to reduce lung cancer mortality in screening programs. This
intervention is critical for early detection in a high-risk population.
6. A 12-month-old child is brought in for a well-child visit. Which of the following vaccines
should the child receive today?
A. Rotavirus
B. Measles, mumps, rubella (MMR)
C. Human papillomavirus (HPV)
