COMSAE Phase 1 Form 113 Actual Exam Questions And Detailed Solutions - Gastroenterology & Hepatology Essentials - Just Released
COMSAE Phase 1 Form 113 | NBOME | Osteopathic Medical Knowledge | High Yield
TABLE OF CONTENTS
1. I. Cardiology - STEMI Anterior V1-V4 LAD Occlusion Crushing Substernal Chest Pain Radiating Left Arm Diaphoresis Nausea ST Elevations
Aspirin 325 mg Oxygen NTG Heparin Activate Cath Lab PCI 90 min Door to Balloon Troponin, Afib Irregularly Irregular No P Waves Rate Control
Metoprolol Diltiazem Anticoagulation CHA2DS2-VASc Warfarin DOAC Apixaban Rivaroxaban
2. II. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Croup Barky
Cough Inspiratory Stridor Night Parainfluenza Dexamethasone 0.6 mg/kg Racemic Epi, ARDS Diffuse Alveolar Damage Increased Permeability
Protein-Rich Edema Hyaline Membrane V/Q Mismatch Shunt Severe Hypoxemia Refractory
3. III. Endocrine - Type 2 Diabetes Insulin Resistance Decreased Glucose Uptake Liver Increased Gluconeogenesis Beta Cell Dysfunction Relative
Deficiency Glucotoxicity Lipotoxicity, DKA Absolute Deficiency Lipolysis Ketogenesis Beta-Hydroxybutyrate Acidosis pH <7.3 Bicarbonate <18
Kussmaul Polyuria, Hyperthyroidism Graves Low TSH High Free T4 TSI Tremor Palpitations Exophthalmos Methimazole PTU Beta Blocker,
Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine
4. IV. Gastroenterology - Duodenal Ulcer Pain Worse Night Relieved Food H. pylori NSAID Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline, Osteoporosis Compression Fracture T-score <=-2.5 Decreased Estrogen Osteoclast Increased Osteoblast
Decreased Fragility Fracture Sudden Severe Back Pain Height Loss Kyphosis Calcium Vitamin D Bisphosphonate Alendronate, Wernicke Thiamine
B1 Deficiency Triad Confusion Ataxia Ophthalmoplegia Nystagmus Chronic Alcohol Thiamine 500 mg IV TID Before Glucose
5. V. Renal & Genitourinary - Nephrotic Increased Permeability Podocyte Injury Proteinuria >3.5 g/day Hypoalbuminemia Edema Hyperlipidemia
Hypercoagulable, BPH Urinary Hesitancy Weak Stream Nocturia Frequency Urgency Elevated PSA DRE Enlarged Smooth Non-Tender Tamsulosin
Finasteride, Gonorrhea Gram-Negative Intracellular Diplococci Urethral Discharge Dysuria Ceftriaxone 500 mg IM Plus Doxycycline Partner
Treatment
6. VI. Neurology & Psychiatry - Ischemic Stroke Thrombotic Embolic Occlusion Decreased Cerebral Blood Flow <20 mL/100g/min Ischemia
Penumbra Excitotoxicity Glutamate Calcium Cytotoxic Edema Infarction, Major Depressive Disorder Anhedonia Weight Loss Insomnia Suicidal
Ideation SSRI Sertraline Fluoxetine Black Box Suicidal Ideation Young Adults Safety Plan CBT
7. VII. Infectious Disease & Immunology - Infectious Mononucleosis EBV Fever Sore Throat Exudative Pharyngitis Posterior Cervical
Lymphadenopathy Fatigue Splenomegaly Atypical Lymphocytes Heterophile Monospot Avoid Contact Sports Splenic Rupture 3 Weeks, Strep Throat
Centor Criteria, SLE Autoimmune Type III Hypersensitivity Immune Complex ANA dsDNA Low C3 C4 Butterfly Rash Photosensitivity Joint Pain
Nephritis
8. VIII. OBGYN & Pediatrics - Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer, Physiologic Jaundice After 24 Hours Bilirubin <12-15 vs Pathologic <24 Hours >15, Normal
Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP Shunt
9. IX. Musculoskeletal & Dermatology - RA Autoimmune Chronic Synovitis Pannus TNF IL-1 IL-6 RF Anti-CCP Symmetric Small Joints Morning >30
min, OA Degenerative Cartilage Loss Osteophyte Non-Inflammatory Morning <30 min Crepitus Pain Worse Activity
10. X. Practice Questions - Each Asked Like Real COMSAE Phase 1 Form 113 Exam - Actual Exam Questions
11. XI. Answer Key with Detailed Solutions - Just Released
,COMSAE PHASE 1 FORM 113 - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on NBOME COMSAE Phase 1 Form 113 Blueprint - Cardiology Pulmonology Endocrine GI Renal Neuro Psych Infectious OBGYN Pediatrics Musculoskeletal. High Yield Just Released.
1. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Ectopic
B. Threatened abortion os closed
C. No abortion
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
2. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. Reassure
C. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
D. No biopsy
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
3. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Only type 1
B. Type 1 autoimmune
C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. No diabetes
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
4. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. No steroids
B. Only oxygen
C. COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume amoxicillin
doxycycline azithromycin oxygen target 88-92%
D. No bronchodilators
Answer: C
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
5. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men >=3
women, cardioversion if unstable
B. No anticoagulation
C. Only rate control
D. No rate control
Answer: A
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
6. A 62-year-old male with hypertension, diabetes, hyperlipidemia presents with crushing substernal chest pain radiating left arm, diaphoresis, nausea, ST
elevations V1-V4. What is diagnosis and immediate management?
A. Pericarditis
B. STEMI anterior wall - ST elevations V1-V4 LAD occlusion - immediate aspirin 325 mg, oxygen if hypoxic, nitroglycerin if no contraindications, heparin, activate cath
lab PCI within 90 min door to balloon, troponin, EKG, do not delay
C. Stable angina
D. GERD
Answer: B
Rationale: STEMI anterior V1-V4 LAD occlusion crushing substernal chest pain radiating left arm diaphoresis nausea ST elevations. Immediate aspirin 325 mg O2 if
hypoxic NTG if no contraindications heparin activate cath lab PCI 90 min door to balloon troponin EKG.
7. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
A. Pathologic <24 hours
B. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
C. No jaundice
D. Always pathologic
Answer: B
Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
8. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Only type 1
B. Type 1 autoimmune
,C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. No diabetes
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
9. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
B. Cardiogenic edema
C. No ARDS
D. Only cardiogenic
Answer: A
Rationale: ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe
hypoxemia refractory O2 sepsis pneumonia aspiration.
10. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. No biopsy
C. Reassure
D. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
Answer: D
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
11. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
B. Only OA
C. No autoimmune
D. RA
Answer: A
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
12. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. Cardiogenic edema
B. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
C. Only cardiogenic
D. No ARDS
Answer: B
Rationale: ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe
hypoxemia refractory O2 sepsis pneumonia aspiration.
13. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Only rate control
B. No rate control
C. No anticoagulation
D. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men
>=3 women, cardioversion if unstable
Answer: D
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
14. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. No BPH
B. Prostate cancer
C. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
D. Only prostatitis
Answer: C
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
15. A 62-year-old male with hypertension, diabetes, hyperlipidemia presents with crushing substernal chest pain radiating left arm, diaphoresis, nausea,
ST elevations V1-V4. What is diagnosis and immediate management?
A. Pericarditis
B. GERD
C. Stable angina
D. STEMI anterior wall - ST elevations V1-V4 LAD occlusion - immediate aspirin 325 mg, oxygen if hypoxic, nitroglycerin if no contraindications, heparin, activate cath
lab PCI within 90 min door to balloon, troponin, EKG, do not delay
Answer: D
, Rationale: STEMI anterior V1-V4 LAD occlusion crushing substernal chest pain radiating left arm diaphoresis nausea ST elevations. Immediate aspirin 325 mg O2 if
hypoxic NTG if no contraindications heparin activate cath lab PCI 90 min door to balloon troponin EKG.
16. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Gonorrhea Neisseria gonorrhoeae gram-negative intracellular diplococci purulent urethral discharge dysuria - treat ceftriaxone 500 mg IM plus doxycycline if
chlamydia not excluded, partner treatment
B. Chlamydia only
C. No STI
D. Only UTI
Answer: A
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
17. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. No BPH
B. Only prostatitis
C. Prostate cancer
D. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
Answer: D
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
18. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Type 1 autoimmune
B. Only type 1
C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. No diabetes
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
19. A patient with DKA polyuria polydipsia nausea vomiting abdominal pain Kussmaul breathing glucose 450 pH 7.1 bicarbonate 8 ketones positive.
Pathophysiology?
A. DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis pH low bicarbonate low Kussmaul
compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration
B. No acidosis
C. HHNKS
D. Only HHNKS
Answer: A
Rationale: DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate acidosis low pH low bicarbonate Kussmaul
hyperglycemia osmotic diuresis polyuria polydipsia dehydration.
20. A 55-year-old male with chronic alcohol use, confusion, ataxia, ophthalmoplegia, nystagmus. What deficiency and treatment?
A. Wernicke encephalopathy thiamine B1 deficiency - triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use - treat thiamine 500 mg IV TID before
glucose to prevent Korsakoff
B. No deficiency
C. B12 deficiency
D. Only folate
Answer: A
Rationale: Wernicke encephalopathy thiamine B1 deficiency triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use treat thiamine 500 mg IV TID
before glucose prevent Korsakoff.
21. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. Prostate cancer
B. No BPH
C. Only prostatitis
D. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
Answer: D
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
22. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. Only cardiogenic
B. Cardiogenic edema
C. No ARDS
D. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
Answer: D
COMSAE Phase 1 Form 113 | NBOME | Osteopathic Medical Knowledge | High Yield
TABLE OF CONTENTS
1. I. Cardiology - STEMI Anterior V1-V4 LAD Occlusion Crushing Substernal Chest Pain Radiating Left Arm Diaphoresis Nausea ST Elevations
Aspirin 325 mg Oxygen NTG Heparin Activate Cath Lab PCI 90 min Door to Balloon Troponin, Afib Irregularly Irregular No P Waves Rate Control
Metoprolol Diltiazem Anticoagulation CHA2DS2-VASc Warfarin DOAC Apixaban Rivaroxaban
2. II. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Croup Barky
Cough Inspiratory Stridor Night Parainfluenza Dexamethasone 0.6 mg/kg Racemic Epi, ARDS Diffuse Alveolar Damage Increased Permeability
Protein-Rich Edema Hyaline Membrane V/Q Mismatch Shunt Severe Hypoxemia Refractory
3. III. Endocrine - Type 2 Diabetes Insulin Resistance Decreased Glucose Uptake Liver Increased Gluconeogenesis Beta Cell Dysfunction Relative
Deficiency Glucotoxicity Lipotoxicity, DKA Absolute Deficiency Lipolysis Ketogenesis Beta-Hydroxybutyrate Acidosis pH <7.3 Bicarbonate <18
Kussmaul Polyuria, Hyperthyroidism Graves Low TSH High Free T4 TSI Tremor Palpitations Exophthalmos Methimazole PTU Beta Blocker,
Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine
4. IV. Gastroenterology - Duodenal Ulcer Pain Worse Night Relieved Food H. pylori NSAID Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline, Osteoporosis Compression Fracture T-score <=-2.5 Decreased Estrogen Osteoclast Increased Osteoblast
Decreased Fragility Fracture Sudden Severe Back Pain Height Loss Kyphosis Calcium Vitamin D Bisphosphonate Alendronate, Wernicke Thiamine
B1 Deficiency Triad Confusion Ataxia Ophthalmoplegia Nystagmus Chronic Alcohol Thiamine 500 mg IV TID Before Glucose
5. V. Renal & Genitourinary - Nephrotic Increased Permeability Podocyte Injury Proteinuria >3.5 g/day Hypoalbuminemia Edema Hyperlipidemia
Hypercoagulable, BPH Urinary Hesitancy Weak Stream Nocturia Frequency Urgency Elevated PSA DRE Enlarged Smooth Non-Tender Tamsulosin
Finasteride, Gonorrhea Gram-Negative Intracellular Diplococci Urethral Discharge Dysuria Ceftriaxone 500 mg IM Plus Doxycycline Partner
Treatment
6. VI. Neurology & Psychiatry - Ischemic Stroke Thrombotic Embolic Occlusion Decreased Cerebral Blood Flow <20 mL/100g/min Ischemia
Penumbra Excitotoxicity Glutamate Calcium Cytotoxic Edema Infarction, Major Depressive Disorder Anhedonia Weight Loss Insomnia Suicidal
Ideation SSRI Sertraline Fluoxetine Black Box Suicidal Ideation Young Adults Safety Plan CBT
7. VII. Infectious Disease & Immunology - Infectious Mononucleosis EBV Fever Sore Throat Exudative Pharyngitis Posterior Cervical
Lymphadenopathy Fatigue Splenomegaly Atypical Lymphocytes Heterophile Monospot Avoid Contact Sports Splenic Rupture 3 Weeks, Strep Throat
Centor Criteria, SLE Autoimmune Type III Hypersensitivity Immune Complex ANA dsDNA Low C3 C4 Butterfly Rash Photosensitivity Joint Pain
Nephritis
8. VIII. OBGYN & Pediatrics - Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer, Physiologic Jaundice After 24 Hours Bilirubin <12-15 vs Pathologic <24 Hours >15, Normal
Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP Shunt
9. IX. Musculoskeletal & Dermatology - RA Autoimmune Chronic Synovitis Pannus TNF IL-1 IL-6 RF Anti-CCP Symmetric Small Joints Morning >30
min, OA Degenerative Cartilage Loss Osteophyte Non-Inflammatory Morning <30 min Crepitus Pain Worse Activity
10. X. Practice Questions - Each Asked Like Real COMSAE Phase 1 Form 113 Exam - Actual Exam Questions
11. XI. Answer Key with Detailed Solutions - Just Released
,COMSAE PHASE 1 FORM 113 - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on NBOME COMSAE Phase 1 Form 113 Blueprint - Cardiology Pulmonology Endocrine GI Renal Neuro Psych Infectious OBGYN Pediatrics Musculoskeletal. High Yield Just Released.
1. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
A. Ectopic
B. Threatened abortion os closed
C. No abortion
D. Inevitable abortion os open bleeding cramping tissue - vs incomplete some tissue passed os open, complete all tissue passed os closed, threatened os closed
Answer: D
Rationale: Abortion inevitable os open bleeding cramping tissue incomplete some tissue passed os open complete all tissue passed os closed threatened os closed
bleeding cramping.
2. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. Reassure
C. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
D. No biopsy
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
3. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Only type 1
B. Type 1 autoimmune
C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. No diabetes
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
4. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. Treatment?
A. No steroids
B. Only oxygen
C. COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume amoxicillin
doxycycline azithromycin oxygen target 88-92%
D. No bronchodilators
Answer: C
Rationale: COPD exacerbation albuterol ipratropium steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea volume oxygen target 88-92%.
5. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men >=3
women, cardioversion if unstable
B. No anticoagulation
C. Only rate control
D. No rate control
Answer: A
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
6. A 62-year-old male with hypertension, diabetes, hyperlipidemia presents with crushing substernal chest pain radiating left arm, diaphoresis, nausea, ST
elevations V1-V4. What is diagnosis and immediate management?
A. Pericarditis
B. STEMI anterior wall - ST elevations V1-V4 LAD occlusion - immediate aspirin 325 mg, oxygen if hypoxic, nitroglycerin if no contraindications, heparin, activate cath
lab PCI within 90 min door to balloon, troponin, EKG, do not delay
C. Stable angina
D. GERD
Answer: B
Rationale: STEMI anterior V1-V4 LAD occlusion crushing substernal chest pain radiating left arm diaphoresis nausea ST elevations. Immediate aspirin 325 mg O2 if
hypoxic NTG if no contraindications heparin activate cath lab PCI 90 min door to balloon troponin EKG.
7. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type jaundice?
A. Pathologic <24 hours
B. Physiologic jaundice after 24 hours bilirubin <12-15 no hemolysis normal exam vs pathologic <24 hours >15 rapid rise hemolysis
C. No jaundice
D. Always pathologic
Answer: B
Rationale: Physiologic after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
8. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Only type 1
B. Type 1 autoimmune
,C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. No diabetes
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
9. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
B. Cardiogenic edema
C. No ARDS
D. Only cardiogenic
Answer: A
Rationale: ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe
hypoxemia refractory O2 sepsis pneumonia aspiration.
10. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm. Next step?
A. Only repeat US
B. No biopsy
C. Reassure
D. Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy endometrial biopsy to rule out cancer
Answer: D
Rationale: Postmenopausal bleeding concerning endometrial cancer thickness >4-5 mm requires biopsy.
11. A 25-year-old female with butterfly rash joint pain fatigue positive ANA dsDNA low C3 C4 proteinuria. Disease?
A. SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis
B. Only OA
C. No autoimmune
D. RA
Answer: A
Rationale: SLE autoimmune type III hypersensitivity immune complex ANA dsDNA low C3 C4 butterfly rash photosensitivity joint pain nephritis.
12. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. Cardiogenic edema
B. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
C. Only cardiogenic
D. No ARDS
Answer: B
Rationale: ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe
hypoxemia refractory O2 sepsis pneumonia aspiration.
13. A 65-year-old with atrial fibrillation irregularly irregular pulse, no P waves, rate 110. What is management?
A. Only rate control
B. No rate control
C. No anticoagulation
D. Afib irregularly irregular no P waves - rate control metoprolol diltiazem, anticoagulation CHA2DS2-VASc score warfarin DOAC apixaban rivaroxaban if >=2 men
>=3 women, cardioversion if unstable
Answer: D
Rationale: Afib irregularly irregular no P waves rate control metoprolol diltiazem anticoagulation CHA2DS2-VASc >=2 men >=3 women warfarin DOAC apixaban
rivaroxaban cardioversion if unstable.
14. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. No BPH
B. Prostate cancer
C. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
D. Only prostatitis
Answer: C
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
15. A 62-year-old male with hypertension, diabetes, hyperlipidemia presents with crushing substernal chest pain radiating left arm, diaphoresis, nausea,
ST elevations V1-V4. What is diagnosis and immediate management?
A. Pericarditis
B. GERD
C. Stable angina
D. STEMI anterior wall - ST elevations V1-V4 LAD occlusion - immediate aspirin 325 mg, oxygen if hypoxic, nitroglycerin if no contraindications, heparin, activate cath
lab PCI within 90 min door to balloon, troponin, EKG, do not delay
Answer: D
, Rationale: STEMI anterior V1-V4 LAD occlusion crushing substernal chest pain radiating left arm diaphoresis nausea ST elevations. Immediate aspirin 325 mg O2 if
hypoxic NTG if no contraindications heparin activate cath lab PCI 90 min door to balloon troponin EKG.
16. A 30-year-old male with urethral discharge, dysuria, gram-negative intracellular diplococci. What is diagnosis and treatment?
A. Gonorrhea Neisseria gonorrhoeae gram-negative intracellular diplococci purulent urethral discharge dysuria - treat ceftriaxone 500 mg IM plus doxycycline if
chlamydia not excluded, partner treatment
B. Chlamydia only
C. No STI
D. Only UTI
Answer: A
Rationale: Gonorrhea gram-negative intracellular diplococci urethral discharge dysuria treat ceftriaxone 500 mg IM plus doxycycline if chlamydia not excluded partner
treatment.
17. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. No BPH
B. Only prostatitis
C. Prostate cancer
D. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
Answer: D
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
18. A 45-year-old with polyuria polydipsia polyphagia fasting glucose 210 HbA1c 9.2% obesity insulin resistance. Pathophysiology type 2 diabetes?
A. Type 1 autoimmune
B. Only type 1
C. Type 2 insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation
D. No diabetes
Answer: C
Rationale: Type 2 insulin resistance peripheral decreased uptake liver increased gluconeogenesis beta cell dysfunction relative deficiency glucotoxicity lipotoxicity
obesity inflammation.
19. A patient with DKA polyuria polydipsia nausea vomiting abdominal pain Kussmaul breathing glucose 450 pH 7.1 bicarbonate 8 ketones positive.
Pathophysiology?
A. DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis pH low bicarbonate low Kussmaul
compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration
B. No acidosis
C. HHNKS
D. Only HHNKS
Answer: A
Rationale: DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate acidosis low pH low bicarbonate Kussmaul
hyperglycemia osmotic diuresis polyuria polydipsia dehydration.
20. A 55-year-old male with chronic alcohol use, confusion, ataxia, ophthalmoplegia, nystagmus. What deficiency and treatment?
A. Wernicke encephalopathy thiamine B1 deficiency - triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use - treat thiamine 500 mg IV TID before
glucose to prevent Korsakoff
B. No deficiency
C. B12 deficiency
D. Only folate
Answer: A
Rationale: Wernicke encephalopathy thiamine B1 deficiency triad confusion ataxia ophthalmoplegia nystagmus chronic alcohol use treat thiamine 500 mg IV TID
before glucose prevent Korsakoff.
21. A 60-year-old male with prostate enlargement, urinary hesitancy, weak stream, nocturia, elevated PSA 8 ng/mL, DRE enlarged smooth prostate.
Diagnosis?
A. Prostate cancer
B. No BPH
C. Only prostatitis
D. BPH benign prostatic hyperplasia - urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender prostate - treat
alpha blocker tamsulosin 5-alpha reductase finasteride
Answer: D
Rationale: BPH urinary hesitancy weak stream nocturia frequency urgency elevated PSA DRE enlarged smooth non-tender treat alpha blocker tamsulosin 5-alpha
reductase finasteride.
22. A patient with ARDS severe hypoxemia PaO2/FiO2 <300 bilateral infiltrates no cardiac failure after sepsis. Pathophysiology?
A. Only cardiogenic
B. Cardiogenic edema
C. No ARDS
D. ARDS diffuse alveolar damage increased permeability protein-rich edema hyaline membrane decreased compliance V/Q mismatch shunt severe hypoxemia
refractory O2 sepsis pneumonia aspiration
Answer: D
