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A 58-year-old man with hypertension has a blood pressure of 154/96
mm Hg on two separate office visits. According to current hypertension
guidelines, which classification best describes his blood pressure?
A. Elevated blood pressure
B. Stage 1 hypertension
C. Stage 2 hypertension
D. Hypertensive crisis
Answer: C. Stage 2 hypertension
Rationale: Stage 2 hypertension is defined as a systolic blood pressure of
at least 140 mm Hg or a diastolic blood pressure of at least 90 mm Hg.
This patient meets both criteria. Elevated blood pressure is 120–129 mm
Hg with a diastolic pressure below 80 mm Hg, while Stage 1 hypertension
is 130–139 mm Hg systolic or 80–89 mm Hg diastolic.
Question 2
Which laboratory test is most appropriate for diagnosing diabetes
mellitus in an asymptomatic adult?
A. Random plasma glucose of 150 mg/dL
B. Hemoglobin A1c of 6.8% confirmed on repeat testing
,C. Finger-stick glucose of 125 mg/dL
D. Urine glucose
Answer: B. Hemoglobin A1c of 6.8% confirmed on repeat testing
Rationale: An HbA1c of 6.5% or greater on two separate tests confirms
diabetes in asymptomatic patients. Random glucose testing requires a
value of at least 200 mg/dL with symptoms. Urine glucose and finger-stick
values are not diagnostic.
Question 3
Which medication is considered first-line therapy for most adults with
newly diagnosed type 2 diabetes mellitus?
A. Glyburide
B. Metformin
C. Pioglitazone
D. Regular insulin
Answer: B. Metformin
Rationale: Metformin is recommended as the preferred initial medication
because it effectively lowers HbA1c, has a favorable safety profile,
promotes modest weight loss or weight neutrality, and has a low risk of
hypoglycemia.
Question 4
Which heart sound is commonly associated with heart failure due to left
ventricular volume overload?
,A. S1
B. S2
C. S3
D. Opening snap
Answer: C. S3
Rationale: An S3 gallop occurs during rapid ventricular filling and is
commonly associated with systolic heart failure and volume overload in
adults. Although it may be normal in children and young adults, it is
generally considered pathologic after age 40.
Question 5
A patient presents with crushing substernal chest pain radiating to the
left arm. Which diagnostic test should be performed immediately?
A. Chest radiograph
B. Electrocardiogram (ECG)
C. Echocardiogram
D. Cardiac stress test
Answer: B. Electrocardiogram (ECG)
Rationale: An ECG should be obtained within 10 minutes of presentation
for suspected acute coronary syndrome. Early identification of ST-
segment elevation or other ischemic changes guides urgent treatment
decisions.
Question 6
, Which organism is the most common cause of uncomplicated urinary
tract infections in women?
A. Klebsiella pneumoniae
B. Enterococcus faecalis
C. Escherichia coli
D. Proteus mirabilis
Answer: C. Escherichia coli
Rationale: Escherichia coli accounts for approximately 75–95% of
uncomplicated urinary tract infections because of its abundance in the
gastrointestinal tract and its ability to adhere to the urinary epithelium.
Question 7
Which immunization should be administered annually to adults?
A. Pneumococcal vaccine
B. Influenza vaccine
C. Tetanus vaccine
D. Shingles vaccine
Answer: B. Influenza vaccine
Rationale: Annual influenza vaccination is recommended for nearly
everyone aged 6 months and older to reduce morbidity, hospitalization,
and mortality associated with seasonal influenza.
Question 8
The most common cause of hypothyroidism in the United States is: