FINAL PRIMARY CARE REVIEW TEST | COMPREHENSIVE ADULT PRIMARY CARE
STUDY GUIDE, PRACTICE QUESTIONS & ANSWERS 2026/2027
What type of pharmacological agent would be used as a first-line medication to treat obsessive
compulsive disorder?
A. risperidone
B. lorazepam
C. fluoxetine
D. trazadone
E. venlafaxine - ANS ✔✔fluoxetine
The risk of extrapyramidal side effects (pseudoparkinsonism) and tardive dyskinesia is associated with
which class of medications? - ANS ✔✔typical (first-generation) antipsychotics
A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory
hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted
to have a flat affect, perceptual distortions, and behaves like he is detached from his own actions.
*Which of the following medications used in treatment of this disease has the risk of prolonging the QTc
interval?*
Aripiprazole (Abilify)
Chlorpromazine (Thorazine)
Loxapine (Loxitane)
Quetiapine (Seroquel)
Ziprasidone (Geodon) - ANS ✔✔Chlorpromazine (Thorazine)
Which of the following psychiatric conditions has the highest mortality rate? - ANS ✔✔anorexia nervosa
(higher than any psych illness, including depression)
A 24-year-old woman comes to your office complaining of anxiety. The patient had *witnessed a
traumatic event 3 days earlier* that made her feel fearful. She has not been able to tell her family about
this experience. She now feels like she is numb and in a dazed, dreamlike state with poor concentration,
and difficulty sleeping. She experienced a flashback of the event yesterday. *What is the most likely
diagnosis?* - ANS ✔✔acute stress disorder
*Mr. Smith leaves home and does not return* nor does he go to work. *A friend of Mr. Smith sees him in
another state* while on vacation. When he approaches Mr. Smith, he does not recognize him and has a
total different demeanor. *What type of disorder does Mr. Smith have?* - ANS ✔✔dissociative fugue
Which of the following indicates a poor prognosis for someone diagnosed with schizophrenia?
A. acute onset
B. co-morbid mood disorder
C. obvious precipitating event
D. younger age at diagnosis - ANS ✔✔younger age at diagnosis
,A 16-year-old Caucasian female is brought to your family practice office by her mother because she has
been missing school and her mother is concerned. The patient has symptoms consistent with mild to
moderate depression. *She has a history of menstrual migraines* and now has vague constitutional
symptoms all the time and doesn't want to get out of bed in the morning. The patient confesses that
over the past month she has felt that she is not important to anyone and wonders if the world will be
better off without her. *Of the following, which is your greatest concern when considering prescribing
her a selective serotonin reuptake inhibitor (SSRI)?*
- compliance to the medication regime
- increased risk of suicide as detailed in black box warnings
- nausea-related side effects as you titrate upwards
- risk of pregnancy when taking psychiatric medications
- risk of serotonin syndrome, should you need to prescribe a tr - ANS ✔✔risk of serotonin syndrome,
should you need to prescribe a triptan for her migraines
A 37-year-old woman under your care is diagnosed with bipolar I disorder. As part of her drug regimen,
you prescribe lithium carbonate as long-term maintenance therapy. *What lab would be most
appropriate to order prior to the initiation of lithium carbonate?* - ANS ✔✔serum creatinine
A *68-year-old* man is recently *diagnosed with depression* associated with the loss of his close sister
to an automobile accident. He is currently taking oxybutynin for *overactive bladder disease* and
lisinopril for hypertension. He has no known drug allergies. *What medication would be most
appropriate to prescribe for this patient?* - ANS ✔✔amitriptyline
A patient describes a desire for close relationships and to be more successful at work. However, she
views herself as being undesirable and inferior. Because of these feelings she avoids social activities and
extra occupational projects out of fear of criticism, rejection, and embarrassment. *Which diagnosis
personality disorder best fits this description?* - ANS ✔✔avoidant personality disorder
A 30-year-old male patient, who has a history of schizotypal personality disorder, presents to the
emergency department due to a decompensation to psychosis. He has had transient episodes similar to
this in the past. *What is the best medication for this patient during this period of psychosis?* - ANS
✔✔Haloperidol (Haldol)
Infection with human papillomavirus may cause which of the following conditions?
Carcinoma of the cervix
Chancroid
Granuloma inguinale
Condyloma acuminata
Plantar warts - ANS ✔✔Carcinoma of the cervix, Condyloma acuminata, and Plantar warts
A 37-year old *moderately obese* female presents with c/o a "bothersome" pruritic rash underneath
both her breast for the past couple of weeks. She describes some initial relief with the use of A&D
ointment for a few days, but it has gotten worse since then. Her PMH/SHX is unremarkable, VSS are
normal and the exam reveals an *erythematous, largely diffuse macular rash underneath her breast.
What additional condition should she be tested for?* - ANS ✔✔Diabetes
,A 3-year old girl has a 5-day history of *low-grade fevers* (100.5-101), HA, and rhinorrhea after which a
rash appears. Examination shows a *bilateral erythematous malar rash* with circumoral pallor. *What
organism is the most likely cause of the illness?* - ANS ✔✔Parovirus
Scarlet fever is caused by what organisms? - ANS ✔✔Streptococcus pyogenes
In the United States, the most concerning diseases associated with fever and a rash are?
Meningococcemia
Staphylococcal TSS
RMSF
TTP/HUS
All of the above - ANS ✔✔All of the above
Which of the following conditions is the least likely cause of fever of unknown origin (FUO)?
Tuberculosis
Autoimmune diseases
Atypical pneumonia
Malignancies
Fungal infections - ANS ✔✔Atypical pneumonia
A 40-year old male presents with several day history of *painful rash affecting the area around the upper
right back-shoulder blade.* He denies any significant PMHX, allergy to medications and is not taking any
medication. His vitals are otherwise normal, but he has a temp. of 101.2 and there is an erythematous
cluster of vesicular lesions that extend from the mid-back, lower right scapula to the anterior chest.
*Which of the following medications would be appropriate?*
Valtrex (valacyclovir) 1gm P.O. TID
Zovirax (Acyclovir) 800mg P.O. every 4hours (5x/d)
Famvir (Famciclovir) 500mg P.O. TID
Any of the above
Augmentin 875mg P.O. BID - ANS ✔✔Any of the above
A 58 y/o male with silicosis develops latent tuberculosis infection with a 15mm reaction to the Mantoux
tuberculin skin test. *What treatment option is best indicated in this person?* - ANS ✔✔INH for 9
months
Which of the following medications may cause pulmonary fibrosis?
Amiodarone
Nitrofurantoin
Bleomycin
Methotrexate
All of the above - ANS ✔✔All of the above (Amiodarone, Nitrofurantoin, Bleomycin, Methotrexate)
, A 44 y/o male who *takes care of pigeons* presents with a chronic *cough & dyspnea* with exertion.
CXR shows a diffuse nodular lung pattern. Labs reveal an elevated erythrocyte sedimentation rate and C-
related peptide. *What is the most likely diagnosis?* - ANS ✔✔Hypersensitivity pneumonitis
Following a motor vehicle accident with blood loss leading to prolonged, severe hypotension, a 30 y/o
male is *intubated and placed on a mechanical ventilator.* He has progressively *decreasing oxygen
saturations despite increasing PEEP* and FI02 of 100%. He remains afebrile. He dies 3 days later. At
autopsy, the distal lungs show *pink hyaline membranes, thickened interstitium, and many
macrophages* but few neutrophils. *Which of the following pulmonary diseases most likely complicated
his course?* - ANS ✔✔Acute Respiratory Distress Syndrome
A 12-year-old boy is admitted to your ED complaining of difficulty in breathing. Arterial blood gas (ABG)
studies performed while the patient is breathing room air (21% oxygen) reveal *pH 7.21*; Po2 65 mm
Hg; *Pco2 62* mm Hg; and Hco3 25mEq/liter. *Which of the following reflect this child's ABG results?*
Metabolic Alkalosis
Metabolic Acidosis
Respiratory Alkalosis
Respiratory Acidosis - ANS ✔✔Respiratory Acidosis
A 23-year-old female with gestational diabetes has an uncomplicated pregnancy until the 29th week of
gestation, when she has the onset of premature labor and delivers. *The infant initially has Apgar scores
of 4 and 6 at 1 and 5 minutes, but within an hour is in severe respiratory distress* and requires
intubation with mechanical ventilation. *Which treatment should be administered to the infant at this
time?* - ANS ✔✔Surfactant
A 50-year-old African American male presents with increasing shortness of breath for the past 4 months.
He denies any tobacco use history. On physical examination his temperature is 98.6 F. There are fine rales
auscultated in all lung fields. CXR reveals *hilar lymphadenopathy* and a reticulonodular pattern of
small densities in all lung fields. A transbronchial biopsy is performed that microscopically shows
numerous *small pulmonary interstitial non-caseating granulomas. What is the most likely diagnosis?* -
ANS ✔✔Sarcoidosis
A 21 y/o male presents with a five day history of an upper respiratory tract infection and a two day
history of progressive shortness of breath. He has a five year history of allergic rhinitis. *His father has
asthma.* On physical exam, he appears anxious. His temperature is 37.8°C (100°F), pulse is 115/min,
respirations are 24/min and labored, and blood pressure is 140/90 mm Hg. *Diffuse wheezes* are heard
throughout all lung fields. Examination shows no other abnormalities. *CXR shows hyperinflation.* Pulse
oximetry on room air shows an oxygen saturation of 94%. *What is the most appropriate treatment?* -
ANS ✔✔Corticosteroid therapy and inhaled β2-adrenergic agonist therapy
A 60 y/o male who is s/p ORIF of the left hip presents with acute onset of shortness of breath with
exertion. On physical exam, he appears anxious and tachypneic. His temperature is 37.8°C (100°F), pulse
is 120 beats per minute, respirations are 24/min and labored, and blood pressure is 140/90 mm Hg.
Lungs are clear to auscultation bilaterally. Cardiac exam reveals an increased pulmonic component of S2.
*ECG reveals a S wave in lead I, a Q wave in lead III, and T wave changes in lead III. What is the best
diagnostic study indicated in this patient?* - ANS ✔✔Sprial CT of the chest
STUDY GUIDE, PRACTICE QUESTIONS & ANSWERS 2026/2027
What type of pharmacological agent would be used as a first-line medication to treat obsessive
compulsive disorder?
A. risperidone
B. lorazepam
C. fluoxetine
D. trazadone
E. venlafaxine - ANS ✔✔fluoxetine
The risk of extrapyramidal side effects (pseudoparkinsonism) and tardive dyskinesia is associated with
which class of medications? - ANS ✔✔typical (first-generation) antipsychotics
A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory
hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted
to have a flat affect, perceptual distortions, and behaves like he is detached from his own actions.
*Which of the following medications used in treatment of this disease has the risk of prolonging the QTc
interval?*
Aripiprazole (Abilify)
Chlorpromazine (Thorazine)
Loxapine (Loxitane)
Quetiapine (Seroquel)
Ziprasidone (Geodon) - ANS ✔✔Chlorpromazine (Thorazine)
Which of the following psychiatric conditions has the highest mortality rate? - ANS ✔✔anorexia nervosa
(higher than any psych illness, including depression)
A 24-year-old woman comes to your office complaining of anxiety. The patient had *witnessed a
traumatic event 3 days earlier* that made her feel fearful. She has not been able to tell her family about
this experience. She now feels like she is numb and in a dazed, dreamlike state with poor concentration,
and difficulty sleeping. She experienced a flashback of the event yesterday. *What is the most likely
diagnosis?* - ANS ✔✔acute stress disorder
*Mr. Smith leaves home and does not return* nor does he go to work. *A friend of Mr. Smith sees him in
another state* while on vacation. When he approaches Mr. Smith, he does not recognize him and has a
total different demeanor. *What type of disorder does Mr. Smith have?* - ANS ✔✔dissociative fugue
Which of the following indicates a poor prognosis for someone diagnosed with schizophrenia?
A. acute onset
B. co-morbid mood disorder
C. obvious precipitating event
D. younger age at diagnosis - ANS ✔✔younger age at diagnosis
,A 16-year-old Caucasian female is brought to your family practice office by her mother because she has
been missing school and her mother is concerned. The patient has symptoms consistent with mild to
moderate depression. *She has a history of menstrual migraines* and now has vague constitutional
symptoms all the time and doesn't want to get out of bed in the morning. The patient confesses that
over the past month she has felt that she is not important to anyone and wonders if the world will be
better off without her. *Of the following, which is your greatest concern when considering prescribing
her a selective serotonin reuptake inhibitor (SSRI)?*
- compliance to the medication regime
- increased risk of suicide as detailed in black box warnings
- nausea-related side effects as you titrate upwards
- risk of pregnancy when taking psychiatric medications
- risk of serotonin syndrome, should you need to prescribe a tr - ANS ✔✔risk of serotonin syndrome,
should you need to prescribe a triptan for her migraines
A 37-year-old woman under your care is diagnosed with bipolar I disorder. As part of her drug regimen,
you prescribe lithium carbonate as long-term maintenance therapy. *What lab would be most
appropriate to order prior to the initiation of lithium carbonate?* - ANS ✔✔serum creatinine
A *68-year-old* man is recently *diagnosed with depression* associated with the loss of his close sister
to an automobile accident. He is currently taking oxybutynin for *overactive bladder disease* and
lisinopril for hypertension. He has no known drug allergies. *What medication would be most
appropriate to prescribe for this patient?* - ANS ✔✔amitriptyline
A patient describes a desire for close relationships and to be more successful at work. However, she
views herself as being undesirable and inferior. Because of these feelings she avoids social activities and
extra occupational projects out of fear of criticism, rejection, and embarrassment. *Which diagnosis
personality disorder best fits this description?* - ANS ✔✔avoidant personality disorder
A 30-year-old male patient, who has a history of schizotypal personality disorder, presents to the
emergency department due to a decompensation to psychosis. He has had transient episodes similar to
this in the past. *What is the best medication for this patient during this period of psychosis?* - ANS
✔✔Haloperidol (Haldol)
Infection with human papillomavirus may cause which of the following conditions?
Carcinoma of the cervix
Chancroid
Granuloma inguinale
Condyloma acuminata
Plantar warts - ANS ✔✔Carcinoma of the cervix, Condyloma acuminata, and Plantar warts
A 37-year old *moderately obese* female presents with c/o a "bothersome" pruritic rash underneath
both her breast for the past couple of weeks. She describes some initial relief with the use of A&D
ointment for a few days, but it has gotten worse since then. Her PMH/SHX is unremarkable, VSS are
normal and the exam reveals an *erythematous, largely diffuse macular rash underneath her breast.
What additional condition should she be tested for?* - ANS ✔✔Diabetes
,A 3-year old girl has a 5-day history of *low-grade fevers* (100.5-101), HA, and rhinorrhea after which a
rash appears. Examination shows a *bilateral erythematous malar rash* with circumoral pallor. *What
organism is the most likely cause of the illness?* - ANS ✔✔Parovirus
Scarlet fever is caused by what organisms? - ANS ✔✔Streptococcus pyogenes
In the United States, the most concerning diseases associated with fever and a rash are?
Meningococcemia
Staphylococcal TSS
RMSF
TTP/HUS
All of the above - ANS ✔✔All of the above
Which of the following conditions is the least likely cause of fever of unknown origin (FUO)?
Tuberculosis
Autoimmune diseases
Atypical pneumonia
Malignancies
Fungal infections - ANS ✔✔Atypical pneumonia
A 40-year old male presents with several day history of *painful rash affecting the area around the upper
right back-shoulder blade.* He denies any significant PMHX, allergy to medications and is not taking any
medication. His vitals are otherwise normal, but he has a temp. of 101.2 and there is an erythematous
cluster of vesicular lesions that extend from the mid-back, lower right scapula to the anterior chest.
*Which of the following medications would be appropriate?*
Valtrex (valacyclovir) 1gm P.O. TID
Zovirax (Acyclovir) 800mg P.O. every 4hours (5x/d)
Famvir (Famciclovir) 500mg P.O. TID
Any of the above
Augmentin 875mg P.O. BID - ANS ✔✔Any of the above
A 58 y/o male with silicosis develops latent tuberculosis infection with a 15mm reaction to the Mantoux
tuberculin skin test. *What treatment option is best indicated in this person?* - ANS ✔✔INH for 9
months
Which of the following medications may cause pulmonary fibrosis?
Amiodarone
Nitrofurantoin
Bleomycin
Methotrexate
All of the above - ANS ✔✔All of the above (Amiodarone, Nitrofurantoin, Bleomycin, Methotrexate)
, A 44 y/o male who *takes care of pigeons* presents with a chronic *cough & dyspnea* with exertion.
CXR shows a diffuse nodular lung pattern. Labs reveal an elevated erythrocyte sedimentation rate and C-
related peptide. *What is the most likely diagnosis?* - ANS ✔✔Hypersensitivity pneumonitis
Following a motor vehicle accident with blood loss leading to prolonged, severe hypotension, a 30 y/o
male is *intubated and placed on a mechanical ventilator.* He has progressively *decreasing oxygen
saturations despite increasing PEEP* and FI02 of 100%. He remains afebrile. He dies 3 days later. At
autopsy, the distal lungs show *pink hyaline membranes, thickened interstitium, and many
macrophages* but few neutrophils. *Which of the following pulmonary diseases most likely complicated
his course?* - ANS ✔✔Acute Respiratory Distress Syndrome
A 12-year-old boy is admitted to your ED complaining of difficulty in breathing. Arterial blood gas (ABG)
studies performed while the patient is breathing room air (21% oxygen) reveal *pH 7.21*; Po2 65 mm
Hg; *Pco2 62* mm Hg; and Hco3 25mEq/liter. *Which of the following reflect this child's ABG results?*
Metabolic Alkalosis
Metabolic Acidosis
Respiratory Alkalosis
Respiratory Acidosis - ANS ✔✔Respiratory Acidosis
A 23-year-old female with gestational diabetes has an uncomplicated pregnancy until the 29th week of
gestation, when she has the onset of premature labor and delivers. *The infant initially has Apgar scores
of 4 and 6 at 1 and 5 minutes, but within an hour is in severe respiratory distress* and requires
intubation with mechanical ventilation. *Which treatment should be administered to the infant at this
time?* - ANS ✔✔Surfactant
A 50-year-old African American male presents with increasing shortness of breath for the past 4 months.
He denies any tobacco use history. On physical examination his temperature is 98.6 F. There are fine rales
auscultated in all lung fields. CXR reveals *hilar lymphadenopathy* and a reticulonodular pattern of
small densities in all lung fields. A transbronchial biopsy is performed that microscopically shows
numerous *small pulmonary interstitial non-caseating granulomas. What is the most likely diagnosis?* -
ANS ✔✔Sarcoidosis
A 21 y/o male presents with a five day history of an upper respiratory tract infection and a two day
history of progressive shortness of breath. He has a five year history of allergic rhinitis. *His father has
asthma.* On physical exam, he appears anxious. His temperature is 37.8°C (100°F), pulse is 115/min,
respirations are 24/min and labored, and blood pressure is 140/90 mm Hg. *Diffuse wheezes* are heard
throughout all lung fields. Examination shows no other abnormalities. *CXR shows hyperinflation.* Pulse
oximetry on room air shows an oxygen saturation of 94%. *What is the most appropriate treatment?* -
ANS ✔✔Corticosteroid therapy and inhaled β2-adrenergic agonist therapy
A 60 y/o male who is s/p ORIF of the left hip presents with acute onset of shortness of breath with
exertion. On physical exam, he appears anxious and tachypneic. His temperature is 37.8°C (100°F), pulse
is 120 beats per minute, respirations are 24/min and labored, and blood pressure is 140/90 mm Hg.
Lungs are clear to auscultation bilaterally. Cardiac exam reveals an increased pulmonic component of S2.
*ECG reveals a S wave in lead I, a Q wave in lead III, and T wave changes in lead III. What is the best
diagnostic study indicated in this patient?* - ANS ✔✔Sprial CT of the chest
