Name: Score:
60 Multiple choice questions
Term 1 of 60
You are seeing a 6-year-old female in the family medicine office for a well-child exam. She and
her parents have no concerns about her health today. She is developing normally and is
thriving in first grade. She has no significant medical history, and she is up to date on her
immunizations. On exam, she is well-appearing with normal vital signs except for a BMI of 19.2
kg/m2, placing her at the 96th percentile for her age. The remainder of her examination is
normal.
Which of the following would be the most appropriate next step?
Advise diet and exercise with a goal of a 5% weight loss
Encourage healthy behaviors with a goal of maintaining her current weight
Order a TSH
Reassure her parents that since the remainder of her exam is normal, her weight is not a
concern
Referral to a multidisciplinary weight-management program
Term 2 of 60
A 47-year-old cisgendered female comes into your office for a health care maintenance exam.
She has hypertension and type 2 diabetes. She is not sexually active and has not yet
experienced menopause. There is no family history of cancer. Her blood pressure is 118/78, her
BMI is 34, and the remainder of her physical exam is within normal limits. Her vaccinations are up
to date, and she has a Pap test today and will have labs drawn. According to USPSTF, which of
the following is the best recommendation to give her concerning mammography?
Should have started at age 40 and every year thereafter
Should have started at age 40 and every 2 years thereafter
Should have started at age 45 and every year thereafter
Start at age 50 and every year thereafter
Start at age 50 and every 2 years thereafter
,Term 3 of 60
A 62-year-old female presents for follow-up of her hypertension and diabetes. In general, her
chronic diseases are well controlled and she has suffered no target organ damage. She has
worked hard to begin exercising, and is walking vigorously five times a week. She has also
worked hard on dietary changes, and has been following the DASH eating plan very seriously.
She quit smoking three months ago. Her blood pressure today is 148/88 mmHg, pulse is 72
beats/minute, respiratory rate is 16 breaths/minute, temperature is 37.1 C (98.7 F), and BMI is 32
kg/m2. She is taking metformin 500 mg twice daily, simvastatin 20 mg daily and
hydrochlorothiazide (HCTZ) 25 mg daily, and she is adherent with her daily medications. Her
labs today include an A1C of 6.6, an LDL of 88 and a basic metabolic panel within normal limits.
Which of the following management steps today do you consider the most appropriate?
Add amlodipine 5 mg daily
Change her simvastatin from 20 mg to 40 mg
Impress upon her the importance of making more lifestyle modifications
Increase HCTZ to 50 mg daily
Make no changes as she is at her treatment goals
,Term 4 of 60
A 45-year-old woman presents to the ED with two weeks of abdominal pain, progressive
weakness and palpitations. She notes an unexplained 3-lb weight loss as well as black, sticky
diarrhea. Her vital signs are:
Temperature: 99.1 Fahrenheit
Heart rate: 117 beats/minute
Respiratory rate: 22 breaths/minute
Blood pressure: 92/67 mmHg
She appears pale and diaphoretic. Her neck is supple and non-tender. Lungs are clear to
auscultation bilaterally. Cardiac exam reveals elevated heart rate and a diastolic murmur. Her
abdominal exam is notable for diffuse epigastric pain and hyperactive bowel sounds.
Which of the following additional lab values might you expect?
PaO2 of 60
Elevated LDH
Free T4 of 15 mcg/dL (nml range 4.5-11.2 mcg/dL)
TSH of 0.3 uU/mL (nml range 0.5-5.0 uU/mL
Hgb of 8.4 g/dL (nml range 12.0-16.0 g/dL)
Platelet count of 530,000 /mm3 (nml range 150,000-400,000/mm3)
, Term 5 of 60
A 66-year-old male presents to his primary care provider with concern for intermittent chest
pain. He describes several episodes a week of pressure under his sternum that comes on with
exertion, lasts for about 5 to 10 minutes and is improved with rest, over the last two weeks. He
notes some shortness of breath with the pain, but denies any associated diaphoresis, nausea, or
jaw pain. He has a history of hypertension and hyperlipidemia treated with lisinopril, simvastatin,
and aspirin. He exercises at a gym for 30 minutes, two to three times per week. Physical
examination shows his pulse is 78 beats/minute, respiratory rate is 16 breaths/minute, and blood
pressure is 145/80 mmHg. His lungs are clear, heart sounds are normal, and there is no lower-
extremity edema. His electrocardiogram (ECG) is normal. Which of the following is the most-
appropriate next step in his workup?
Cardiac catheterization
CT scan
Echocardiogram
Pharmacologic stress test with imaging
Treadmill stress test without imaging
Term 6 of 60
A 42-year-old female presents for a visit after recently being diagnosed with type 2 diabetes.
She has made a plan to work on diet and exercise. Her A1C is found to be 8.0%. What is the best
medicine to start at this time?
A sulfonylurea
An SGLT2 inhibitor
GLP-1 receptor agonist
Insulin
Metformin basal
60 Multiple choice questions
Term 1 of 60
You are seeing a 6-year-old female in the family medicine office for a well-child exam. She and
her parents have no concerns about her health today. She is developing normally and is
thriving in first grade. She has no significant medical history, and she is up to date on her
immunizations. On exam, she is well-appearing with normal vital signs except for a BMI of 19.2
kg/m2, placing her at the 96th percentile for her age. The remainder of her examination is
normal.
Which of the following would be the most appropriate next step?
Advise diet and exercise with a goal of a 5% weight loss
Encourage healthy behaviors with a goal of maintaining her current weight
Order a TSH
Reassure her parents that since the remainder of her exam is normal, her weight is not a
concern
Referral to a multidisciplinary weight-management program
Term 2 of 60
A 47-year-old cisgendered female comes into your office for a health care maintenance exam.
She has hypertension and type 2 diabetes. She is not sexually active and has not yet
experienced menopause. There is no family history of cancer. Her blood pressure is 118/78, her
BMI is 34, and the remainder of her physical exam is within normal limits. Her vaccinations are up
to date, and she has a Pap test today and will have labs drawn. According to USPSTF, which of
the following is the best recommendation to give her concerning mammography?
Should have started at age 40 and every year thereafter
Should have started at age 40 and every 2 years thereafter
Should have started at age 45 and every year thereafter
Start at age 50 and every year thereafter
Start at age 50 and every 2 years thereafter
,Term 3 of 60
A 62-year-old female presents for follow-up of her hypertension and diabetes. In general, her
chronic diseases are well controlled and she has suffered no target organ damage. She has
worked hard to begin exercising, and is walking vigorously five times a week. She has also
worked hard on dietary changes, and has been following the DASH eating plan very seriously.
She quit smoking three months ago. Her blood pressure today is 148/88 mmHg, pulse is 72
beats/minute, respiratory rate is 16 breaths/minute, temperature is 37.1 C (98.7 F), and BMI is 32
kg/m2. She is taking metformin 500 mg twice daily, simvastatin 20 mg daily and
hydrochlorothiazide (HCTZ) 25 mg daily, and she is adherent with her daily medications. Her
labs today include an A1C of 6.6, an LDL of 88 and a basic metabolic panel within normal limits.
Which of the following management steps today do you consider the most appropriate?
Add amlodipine 5 mg daily
Change her simvastatin from 20 mg to 40 mg
Impress upon her the importance of making more lifestyle modifications
Increase HCTZ to 50 mg daily
Make no changes as she is at her treatment goals
,Term 4 of 60
A 45-year-old woman presents to the ED with two weeks of abdominal pain, progressive
weakness and palpitations. She notes an unexplained 3-lb weight loss as well as black, sticky
diarrhea. Her vital signs are:
Temperature: 99.1 Fahrenheit
Heart rate: 117 beats/minute
Respiratory rate: 22 breaths/minute
Blood pressure: 92/67 mmHg
She appears pale and diaphoretic. Her neck is supple and non-tender. Lungs are clear to
auscultation bilaterally. Cardiac exam reveals elevated heart rate and a diastolic murmur. Her
abdominal exam is notable for diffuse epigastric pain and hyperactive bowel sounds.
Which of the following additional lab values might you expect?
PaO2 of 60
Elevated LDH
Free T4 of 15 mcg/dL (nml range 4.5-11.2 mcg/dL)
TSH of 0.3 uU/mL (nml range 0.5-5.0 uU/mL
Hgb of 8.4 g/dL (nml range 12.0-16.0 g/dL)
Platelet count of 530,000 /mm3 (nml range 150,000-400,000/mm3)
, Term 5 of 60
A 66-year-old male presents to his primary care provider with concern for intermittent chest
pain. He describes several episodes a week of pressure under his sternum that comes on with
exertion, lasts for about 5 to 10 minutes and is improved with rest, over the last two weeks. He
notes some shortness of breath with the pain, but denies any associated diaphoresis, nausea, or
jaw pain. He has a history of hypertension and hyperlipidemia treated with lisinopril, simvastatin,
and aspirin. He exercises at a gym for 30 minutes, two to three times per week. Physical
examination shows his pulse is 78 beats/minute, respiratory rate is 16 breaths/minute, and blood
pressure is 145/80 mmHg. His lungs are clear, heart sounds are normal, and there is no lower-
extremity edema. His electrocardiogram (ECG) is normal. Which of the following is the most-
appropriate next step in his workup?
Cardiac catheterization
CT scan
Echocardiogram
Pharmacologic stress test with imaging
Treadmill stress test without imaging
Term 6 of 60
A 42-year-old female presents for a visit after recently being diagnosed with type 2 diabetes.
She has made a plan to work on diet and exercise. Her A1C is found to be 8.0%. What is the best
medicine to start at this time?
A sulfonylurea
An SGLT2 inhibitor
GLP-1 receptor agonist
Insulin
Metformin basal
