ADVANCED PRIMARY CARE & PHARMACOLOGY EXAM
EXAM COMPLETE QUESTIONS WITH CORRECT
ANSWERS AND DETAILED RATIONALES - LATEST UPDATE
2026.
SECTION 1: DERMATOLOGY, CARDIOLOGY, PHARMACOLOGY & PRIMARY CARE
1. A patient presents with symmetrical erythematous lesions on extensor surfaces of elbows,
knees, and back. Margins are sharply defined. This is most likely:
A. Plaque psoriasis
B. Tinea corporis
C. Atopic dermatitis
D. Eczema
CORRECT ANSWER: A. Plaque psoriasis
RATIONALE:
Plaque psoriasis is a chronic inflammatory skin disorder characterized by:
• Symmetrical erythematous plaques
• Sharply demarcated borders
• Silvery-white scales
• Lesions commonly found on:
o Extensor surfaces of elbows
o Knees
o Lower back
o Scalp
,Exam Tip:
Psoriasis = Extensor surfaces + Silvery scales + Auspitz sign
2. Which patient is NOT considered at high risk for colorectal cancer?
A. 20-year-old with history of abdominal radiation from childhood cancer
B. 30-year-old woman whose grandmother was diagnosed with colorectal cancer at age 65
C. 38-year-old woman with ulcerative colitis
D. 50-year-old man with first-degree relative diagnosed with colorectal cancer at age 45
CORRECT ANSWER: B. 30-year-old woman whose grandmother was diagnosed with
colorectal cancer at age 65
RATIONALE:
High-risk colorectal cancer patients include:
History of childhood abdominal radiation
Inflammatory bowel disease (especially ulcerative colitis)
First-degree relative diagnosed before age 50
A grandmother is a second-degree relative, and diagnosis at age 65 does not significantly
increase risk.
3. Serious adverse effect of azithromycin
CORRECT ANSWER: QT prolongation
RATIONALE:
Azithromycin is a macrolide antibiotic that can delay cardiac repolarization.
Risk:
• QT interval prolongation
• Torsades de pointes
• Ventricular arrhythmias
Use caution in patients with:
• Cardiac disease
• Electrolyte abnormalities
, • Other QT-prolonging medications
4. Serious side effect of sildenafil
CORRECT ANSWER: Priapism
RATIONALE:
Sildenafil is a PDE-5 inhibitor used for erectile dysfunction.
Serious adverse effects:
• Priapism (erection lasting >4 hours)
• Severe hypotension
• Vision changes
Contraindicated with nitrates because the combination can cause life-threatening
hypotension.
5. Patient taking PPI for 6 months has diarrhea for 3 weeks. Consider:
CORRECT ANSWER: C. difficile infection
RATIONALE:
Long-term proton pump inhibitor use decreases gastric acid protection and increases the risk of
Clostridioides difficile infection.
Symptoms:
• Persistent watery diarrhea
• Abdominal cramping
• Fever
• Elevated WBC count
6. Which is an abnormal finding?
A. Apical pulse in a 22-year-old man
B. Systolic murmur in a woman who is 18 weeks pregnant with BMI of 38
, C. S4 in a 58-year-old obese man with DM
D. BP of 118/65 in a frail 78-year-old man
CORRECT ANSWER: C. S4 in a 58-year-old obese man with DM
RATIONALE:
S4 is caused by atrial contraction against a stiff ventricle.
Associated with:
• Hypertension
• Diabetes
• Left ventricular hypertrophy
• Diastolic heart failure
Memory:
S4 = Stiff ventricle
7. Side effect of azelastine ophthalmic drops for allergic conjunctivitis
CORRECT ANSWER: Bitter taste
RATIONALE:
Azelastine is an antihistamine eye drop.
Medication drains through the nasolacrimal duct into the throat, causing:
• Bitter taste
• Unpleasant aftertaste
8. Presbycusis
CORRECT ANSWER: Symmetrical hearing loss
RATIONALE:
Presbycusis is age-related sensorineural hearing loss.
Characteristics:
• Bilateral hearing loss
EXAM COMPLETE QUESTIONS WITH CORRECT
ANSWERS AND DETAILED RATIONALES - LATEST UPDATE
2026.
SECTION 1: DERMATOLOGY, CARDIOLOGY, PHARMACOLOGY & PRIMARY CARE
1. A patient presents with symmetrical erythematous lesions on extensor surfaces of elbows,
knees, and back. Margins are sharply defined. This is most likely:
A. Plaque psoriasis
B. Tinea corporis
C. Atopic dermatitis
D. Eczema
CORRECT ANSWER: A. Plaque psoriasis
RATIONALE:
Plaque psoriasis is a chronic inflammatory skin disorder characterized by:
• Symmetrical erythematous plaques
• Sharply demarcated borders
• Silvery-white scales
• Lesions commonly found on:
o Extensor surfaces of elbows
o Knees
o Lower back
o Scalp
,Exam Tip:
Psoriasis = Extensor surfaces + Silvery scales + Auspitz sign
2. Which patient is NOT considered at high risk for colorectal cancer?
A. 20-year-old with history of abdominal radiation from childhood cancer
B. 30-year-old woman whose grandmother was diagnosed with colorectal cancer at age 65
C. 38-year-old woman with ulcerative colitis
D. 50-year-old man with first-degree relative diagnosed with colorectal cancer at age 45
CORRECT ANSWER: B. 30-year-old woman whose grandmother was diagnosed with
colorectal cancer at age 65
RATIONALE:
High-risk colorectal cancer patients include:
History of childhood abdominal radiation
Inflammatory bowel disease (especially ulcerative colitis)
First-degree relative diagnosed before age 50
A grandmother is a second-degree relative, and diagnosis at age 65 does not significantly
increase risk.
3. Serious adverse effect of azithromycin
CORRECT ANSWER: QT prolongation
RATIONALE:
Azithromycin is a macrolide antibiotic that can delay cardiac repolarization.
Risk:
• QT interval prolongation
• Torsades de pointes
• Ventricular arrhythmias
Use caution in patients with:
• Cardiac disease
• Electrolyte abnormalities
, • Other QT-prolonging medications
4. Serious side effect of sildenafil
CORRECT ANSWER: Priapism
RATIONALE:
Sildenafil is a PDE-5 inhibitor used for erectile dysfunction.
Serious adverse effects:
• Priapism (erection lasting >4 hours)
• Severe hypotension
• Vision changes
Contraindicated with nitrates because the combination can cause life-threatening
hypotension.
5. Patient taking PPI for 6 months has diarrhea for 3 weeks. Consider:
CORRECT ANSWER: C. difficile infection
RATIONALE:
Long-term proton pump inhibitor use decreases gastric acid protection and increases the risk of
Clostridioides difficile infection.
Symptoms:
• Persistent watery diarrhea
• Abdominal cramping
• Fever
• Elevated WBC count
6. Which is an abnormal finding?
A. Apical pulse in a 22-year-old man
B. Systolic murmur in a woman who is 18 weeks pregnant with BMI of 38
, C. S4 in a 58-year-old obese man with DM
D. BP of 118/65 in a frail 78-year-old man
CORRECT ANSWER: C. S4 in a 58-year-old obese man with DM
RATIONALE:
S4 is caused by atrial contraction against a stiff ventricle.
Associated with:
• Hypertension
• Diabetes
• Left ventricular hypertrophy
• Diastolic heart failure
Memory:
S4 = Stiff ventricle
7. Side effect of azelastine ophthalmic drops for allergic conjunctivitis
CORRECT ANSWER: Bitter taste
RATIONALE:
Azelastine is an antihistamine eye drop.
Medication drains through the nasolacrimal duct into the throat, causing:
• Bitter taste
• Unpleasant aftertaste
8. Presbycusis
CORRECT ANSWER: Symmetrical hearing loss
RATIONALE:
Presbycusis is age-related sensorineural hearing loss.
Characteristics:
• Bilateral hearing loss
