1. A 2-month-old infant presents with poor feeding, tachycardia, and cold bluish skin. An
echocardiogram reveals an underdeveloped left ventricle, mitral valve, and aortic valve.
Which condition is most likely?
o A) Tetralogy of Fallot
o B) Hypoplastic Left Heart Syndrome
o C) Transposition of the Great Arteries
o D) Coarctation of the Aorta
o Correct Answer: B) Hypoplastic Left Heart Syndrome Rationale: HLHS involves the left
side of the heart (left ventricle, mitral valve, aortic valve) not developing fully, with
the right side initially compensating via PDA and PFO.
2. A patient with a history of Rheumatoid Arthritis reports persistent dry eyes and dry mouth.
Which diagnostic test result would confirm the suspected diagnosis?
o A) Positive IgA-tTG
o B) Positive SSA and SSB antibodies
o C) Elevated TSH
o D) Positive HLA-b*5801 allele
o Correct Answer: B) Positive SSA and SSB antibodies Rationale: Sjögren's syndrome is
an autoimmune disorder often accompanying RA or Lupus, and testing typically
reveals SSA+ and SSB+ antibodies.
3. A patient with diabetic neuropathy reports inadequate pain relief from gabapentin. Which
alternative medication combination is most appropriate to consider?
o A) Hydrochlorothiazide and Spironolactone
o B) Cymbalta (Duloxetine) and Lyrica (Pregabalin)
, o C) Flomax (Tamsulosin) and HCTZ
o D) Albuterol and Ipratropium
o Correct Answer: B) Cymbalta (Duloxetine) and Lyrica (Pregabalin) Rationale:
Cymbalta and Lyrica are first-line alternatives to gabapentin for treating neuropathic
pain, including diabetic neuropathy.
4. A patient is starting warfarin for atrial fibrillation. To minimize bleeding risk while achieving
therapeutic effect, what is the safest prescribing instruction?
o A) Start with a high loading dose for rapid effect
o B) Start with half the standard dose and monitor INR
o C) Combine with aspirin for synergistic effect
o D) Administer intramuscularly for faster absorption
o Correct Answer: B) Start with half the standard dose and monitor INR Rationale:
Starting warfarin at half the standard dose allows for monitoring of the INR to
prevent excessive anticoagulation and bleeding.
5. A child with sickle cell disease is brought to the clinic. To prevent illness that could trigger a
vaso-occlusive crisis, which intervention is most important?
o A) Daily low-dose aspirin
o B) Regular physical therapy sessions
o C) Administration of all scheduled vaccines
o D) Strict limitation of fluid intake
o Correct Answer: C) Administration of all scheduled vaccines Rationale: Illness can
exacerbate sickle cell crisis, so children with sickle cell disease should receive all
vaccines to prevent infections.
6. A pregnant woman at 30 weeks gestation develops a urinary tract infection. Which antibiotic
should be avoided due to risk of fetal musculoskeletal defects?
o A) Cefalexin (Keflex)
o B) Amoxicillin
, o C) Fluoroquinolones (Cipro, Levaquin)
o D) Nitrofurantoin
o Correct Answer: C) Fluoroquinolones (Cipro, Levaquin) Rationale: Fluoroquinolones
are contraindicated in pregnancy because they can cause fetal defects in
musculoskeletal formation.
7. A 25-year-old male with schizophrenia is started on a second-generation antipsychotic.
Which medication from this class is most commonly prescribed?
o A) Haloperidol
o B) Chlorpromazine
o C) Abilify (Aripiprazole)
o D) Fluphenazine
o Correct Answer: C) Abilify (Aripiprazole) Rationale: Abilify, Risperdal, Zyprexa,
Seroquel, and Geodon are all second-generation schizophrenia medications.
8. A patient who received a BCG vaccine in South America now has a PPD skin test read at 12
mm induration. How should this result be interpreted?
o A) Negative due to BCG cross-reactivity
o B) Positive, indicating latent TB infection
o C) Invalid due to prior vaccination
o D) Equivocal, requiring immediate chest x-ray
o Correct Answer: B) Positive, indicating latent TB infection Rationale: While BCG can
cause false positives, any induration >10 mm is considered positive regardless of BCG
status.
9. An elderly male presents with difficulty urinating and a feeling of bladder fullness. Which
medication works by relaxing the smooth muscle of the prostate to relieve these symptoms?
o A) Flomax (Tamsulosin)
o B) HCTZ (Hydrochlorothiazide)
o C) Lasix (Furosemide)
, o D) Norvasc (Amlodipine)
o Correct Answer: A) Flomax (Tamsulosin) Rationale: Flomax is an alpha-blocker that
relaxes smooth muscle in the prostate and bladder neck to treat BPH.
10. A patient’s echocardiogram reports a left ventricular ejection fraction of 45%. How is this
value classified?
o A) Normal
o B) Preserved
o C) Reduced
o D) Hyperdynamic
o Correct Answer: C) Reduced *Rationale: Normal EF is 55-60%; 50-54% is preserved;
less than 50% is considered reduced ejection fraction.*
11. A patient with congestive heart failure develops a large pleural effusion. If the effusion is
cardiac in nature, what treatment directly addresses the underlying cause?
o A) Thoracentesis
o B) Antibiotics
o C) Diuretics
o D) Anticoagulants
o Correct Answer: C) Diuretics Rationale: If the cause is cardiac (CHF), diuretics reduce
volume overload. Thoracentesis removes fluid but does not treat the cause.
12. A diabetic patient with hypertension should be started on which class of medication for
renal protective effects?
o A) Beta-blocker
o B) Calcium channel blocker
o C) ACE Inhibitor or ARB
o D) Thiazide diuretic
o Correct Answer: C) ACE Inhibitor or ARB Rationale: ACE inhibitors and ARBs have
protective effects on the kidneys in diabetic patients with hypertension.
echocardiogram reveals an underdeveloped left ventricle, mitral valve, and aortic valve.
Which condition is most likely?
o A) Tetralogy of Fallot
o B) Hypoplastic Left Heart Syndrome
o C) Transposition of the Great Arteries
o D) Coarctation of the Aorta
o Correct Answer: B) Hypoplastic Left Heart Syndrome Rationale: HLHS involves the left
side of the heart (left ventricle, mitral valve, aortic valve) not developing fully, with
the right side initially compensating via PDA and PFO.
2. A patient with a history of Rheumatoid Arthritis reports persistent dry eyes and dry mouth.
Which diagnostic test result would confirm the suspected diagnosis?
o A) Positive IgA-tTG
o B) Positive SSA and SSB antibodies
o C) Elevated TSH
o D) Positive HLA-b*5801 allele
o Correct Answer: B) Positive SSA and SSB antibodies Rationale: Sjögren's syndrome is
an autoimmune disorder often accompanying RA or Lupus, and testing typically
reveals SSA+ and SSB+ antibodies.
3. A patient with diabetic neuropathy reports inadequate pain relief from gabapentin. Which
alternative medication combination is most appropriate to consider?
o A) Hydrochlorothiazide and Spironolactone
o B) Cymbalta (Duloxetine) and Lyrica (Pregabalin)
, o C) Flomax (Tamsulosin) and HCTZ
o D) Albuterol and Ipratropium
o Correct Answer: B) Cymbalta (Duloxetine) and Lyrica (Pregabalin) Rationale:
Cymbalta and Lyrica are first-line alternatives to gabapentin for treating neuropathic
pain, including diabetic neuropathy.
4. A patient is starting warfarin for atrial fibrillation. To minimize bleeding risk while achieving
therapeutic effect, what is the safest prescribing instruction?
o A) Start with a high loading dose for rapid effect
o B) Start with half the standard dose and monitor INR
o C) Combine with aspirin for synergistic effect
o D) Administer intramuscularly for faster absorption
o Correct Answer: B) Start with half the standard dose and monitor INR Rationale:
Starting warfarin at half the standard dose allows for monitoring of the INR to
prevent excessive anticoagulation and bleeding.
5. A child with sickle cell disease is brought to the clinic. To prevent illness that could trigger a
vaso-occlusive crisis, which intervention is most important?
o A) Daily low-dose aspirin
o B) Regular physical therapy sessions
o C) Administration of all scheduled vaccines
o D) Strict limitation of fluid intake
o Correct Answer: C) Administration of all scheduled vaccines Rationale: Illness can
exacerbate sickle cell crisis, so children with sickle cell disease should receive all
vaccines to prevent infections.
6. A pregnant woman at 30 weeks gestation develops a urinary tract infection. Which antibiotic
should be avoided due to risk of fetal musculoskeletal defects?
o A) Cefalexin (Keflex)
o B) Amoxicillin
, o C) Fluoroquinolones (Cipro, Levaquin)
o D) Nitrofurantoin
o Correct Answer: C) Fluoroquinolones (Cipro, Levaquin) Rationale: Fluoroquinolones
are contraindicated in pregnancy because they can cause fetal defects in
musculoskeletal formation.
7. A 25-year-old male with schizophrenia is started on a second-generation antipsychotic.
Which medication from this class is most commonly prescribed?
o A) Haloperidol
o B) Chlorpromazine
o C) Abilify (Aripiprazole)
o D) Fluphenazine
o Correct Answer: C) Abilify (Aripiprazole) Rationale: Abilify, Risperdal, Zyprexa,
Seroquel, and Geodon are all second-generation schizophrenia medications.
8. A patient who received a BCG vaccine in South America now has a PPD skin test read at 12
mm induration. How should this result be interpreted?
o A) Negative due to BCG cross-reactivity
o B) Positive, indicating latent TB infection
o C) Invalid due to prior vaccination
o D) Equivocal, requiring immediate chest x-ray
o Correct Answer: B) Positive, indicating latent TB infection Rationale: While BCG can
cause false positives, any induration >10 mm is considered positive regardless of BCG
status.
9. An elderly male presents with difficulty urinating and a feeling of bladder fullness. Which
medication works by relaxing the smooth muscle of the prostate to relieve these symptoms?
o A) Flomax (Tamsulosin)
o B) HCTZ (Hydrochlorothiazide)
o C) Lasix (Furosemide)
, o D) Norvasc (Amlodipine)
o Correct Answer: A) Flomax (Tamsulosin) Rationale: Flomax is an alpha-blocker that
relaxes smooth muscle in the prostate and bladder neck to treat BPH.
10. A patient’s echocardiogram reports a left ventricular ejection fraction of 45%. How is this
value classified?
o A) Normal
o B) Preserved
o C) Reduced
o D) Hyperdynamic
o Correct Answer: C) Reduced *Rationale: Normal EF is 55-60%; 50-54% is preserved;
less than 50% is considered reduced ejection fraction.*
11. A patient with congestive heart failure develops a large pleural effusion. If the effusion is
cardiac in nature, what treatment directly addresses the underlying cause?
o A) Thoracentesis
o B) Antibiotics
o C) Diuretics
o D) Anticoagulants
o Correct Answer: C) Diuretics Rationale: If the cause is cardiac (CHF), diuretics reduce
volume overload. Thoracentesis removes fluid but does not treat the cause.
12. A diabetic patient with hypertension should be started on which class of medication for
renal protective effects?
o A) Beta-blocker
o B) Calcium channel blocker
o C) ACE Inhibitor or ARB
o D) Thiazide diuretic
o Correct Answer: C) ACE Inhibitor or ARB Rationale: ACE inhibitors and ARBs have
protective effects on the kidneys in diabetic patients with hypertension.
