1) A

66 y/o female with chronic cough is found to have a two-centimeter mediastinal

mass adjacent to the right main bronchus on chest radiograph. Which of the
following is the best imaging technique for further evaluation of this lesion?
a) CT
b) MRI
c) Nuclear medicine
d) Pulmonary angiography

2) A 66 y/o f presents for review of her bone density scan, which reveals a T-score of -
3.0. Which of the following agents can assist in reversal of this disease process?
a) Alendronate (Fosamax)
b) Calcitonin (Miacalcin)
c) Estrogen (premarin)
d) Vitamin D (Cholecalciferol)

3) A 23 y/o Male presents with partial thickness burns involving the entire anterior
surface of his trunk. Which of the following best represents the percentage of this
patient’s burned body surface?
a) 4.5%
b) 9%
c) 18%
d) 36%
4) A previously healthy 45 y/o female presents with sudden onset of painless, left
sided facial weakness and facial drooping following two days of left otalgia. Which
of the following physical examination finding would be consistent with this
condition?
a) Acute decreased visual acuity
b) Asymmetric elevation of the eyebrows
c) Ipsilateral tongue deviation
d) Unilateral anhydrosis
5) A 76-year old female presents with a six month history of burning left foot pain that
awakens her from sleep and is relieved is she dangles her feet over the edge of the
bed. On physical exam the left foot is cool, atrophic, and hairless with small dorsal
ulceration. Dependent rubor with pallor on elevation of the left foot is also noted.
Which of the following is the most likely diagnosis?
a) Diabetic neuropathy
b) Osteomyelitis
c) Tibial artery occlusion
d) Venous insufficiency
6) A 36 y/o female with a history of chronic adrenal insufficiency presents with fever,
weakness, abdominal pain, vomiting and diarrhea that began four days after she ran
out of her medications. Physical exam is significant for hypotension, tachycardia
and diffuse abdominal tenderness without guarding or rebounding. Laboratory
assessment reveals hyponatremia and hyperkalemia. Which of the following
interventions is indicated?
a) Intravenous dopamine
 b) Intravenous hydrocortisone
c) Oral bromocriptine (Parlodel)
d) Resume oral medications
7) Which of the following classes of medications can be prescribed to a patient with a
history of transient ischemic attacks to decrease thrombolytic stroke risk?
a) ACE-inhibitors
b) Antiplatelets
c) Beta adrenergic blockers
d) anticoagulants
8) Which of the following is a contraindication of estrogen therapy in a
postmenopausal female?
a) History of stroke
b) History of thyroid cancer
c) Superficial thrombophlebitis
d) Uterine fibroids
9) A 52 y/o female with stage III chronic kidney disease and poorly controlled type 2
DM presents for evaluation. Which of the following medications is contraindicated?
a) Glipizide (Glucotrol)
b) Metformin (Glucophage)
c) Repaglinide (Prandin)
d) Sitagliptin (Januvia)
10) A 53 y/o M presents with frequent HA and weight gain. He reports that his shoes
feel too tight. Physical examination is significant for frontal bossing and mandibular
enlargement. His feet are disproportionately large, but there is no lower extremity
edema. Which of the following additional signs is expected on PE?
a)Cardiomegaly
b) dry, course skin
c) glossitis
d) testicular enlargement.
11)During pelvic examination of a patient with pelvic inflammatory disease, which of
the following physical exam findings is most likely?
a) Cervical motion tenderness
b) cervical petechiae
c) uterine enlargement
d) white adherent discharge
12) A 68 y/o F recently treated with ciprofloxacin (Cipro) for cystitis had a syncopal
episode. EKG reveals normal sinus rhythm with a PR interval of 0.2 seconds, QTc of
0.53 seconds with a past medical history of dyslipidemia presents with diffuse
muscle aches. Current medications include a HMG-COA reductase inhibitor Physical
exam is positive for diffuse muscle tenderness on palpation. A UA is positive for
blood bt no red blood cells are identified on urine microscopic. Which of the
following syndromes is the most likely diagnosis?
a) Acquired Long QT
b) Brugada – hereditary Na channel dysfunction à sudden cardiac death in a young
person
 c) Takotsubo – cardiomyopathy, octopus jar shaped heart
d) Wolf-parkinson-white – delta wave = shortened PR, longer QRS
13) A 29 y/o F presents with fever, fatigue, and rash approximately five-days after
initiating treatment with acyclovir for primary infection with herpes simplex virus.
Examination reveals areas of erythema over torso and target lesions involving the
oral mucosa, face, palms, and soles of her feet. Which of the following interventions
is recommended?
a) Admit to ICU
b) Aspirate bullae fluid
c) Begin IV ganciclovir (vitrasert)
d) Begin IV penicillin G
14) Patients with lung carcinoma may present with hoarseness due to which of the
following nerves?
a) External laryngeal
b) Phrenic
c) Recurrent laryngeal
d) Vagus
15) In a patient presenting with clinical symptoms of nephrotic syndrome, the
histologic findings show no evidence of abnormalities on microscopy or with
immunofluorescence. Using electron microscopy, there is a notable loss of epithelia
foot processes. These finding are consistent with which of the following conditions?
a) Goodpasture syndrome
b) Henoch-schonlein purpura
c) Membranous nephropathy
d) Minimal change disease
16)In young adult men with cystic fibrosis, which of the following is the most
appropriate screening modality indicated secondary to an associated complication
of the disease?
a)colonoscopy
b) lipid profile
c) semen analysis
d) serum chloride
17) A 40 y/o F presents with increasing fatigue and bilateral hand pain. She reports
recent depressive symptoms and weight gain. Physical examination reveals
bradycardia, 1+ lower extremity edema, delayed relation of DTR and positive Phalen
sign. Which of the following in the most likely diagnosis?
a) Hyperaldosteronism
b) Hypercortisolism
c) Hypoparathyroidism
d) Hypothyroidism
18) A 44 y/o patient with no family history of colon cancer is found to have a 9mm
colon polyp in the transverse colon on dual-contrast enema. Which of the following
procedures is indicated?
a) Colonoscopy with polypectomy
b) Partial transverse colectomy
c) Repeat barium enema in six months
 d) Sigmoidoscopy with biopsy
19) An otherwise healthy 23 y/o F cyclist presents with a two-month history of
progressive chest tightness at onset of exercise. Auscultation reveals clear lungs,
and regular heart rate and rhythm without murmurs. Which of the following
treatments is indicated?
a) Albuterol (ProAir) HFA
b) Fluticasone (flovent) HFA
c) Salmeterol (Serevent) DPI
d) Theophyline (theo-Dur)
20)Which of the following organisms is a common cause of chronic otitis media?
a) Candida albicans
b) Haemophilus influenza
c) Staphylococcus aureus
d) Streptococcus pneumonia
21) A seven year old boy is evaluated for behavior problems. His father indicates he
does not listen to the teacher at school, has difficulty accomplishing his homework,
and gets distracted easily at karate lessons. Which of the following is the most likely
diagnosis?
a) Asperger syndrome
b) Attention-deficit disorder
c) Oppositional defiant disorder
d) Rett disorder
22) Topriamate (Topamax) is associated with which of the following side effects?
a) Hyperesthesia
b) Leukocytosis
c) Truncal obesity
d) Weight loss
23) A 45 y/o male presents in moderate respiratory distress following a motor vehicle
collision. While reviewing the patient’s chest radiograph shown, the patient
collapses. Which of the following represents the required immediate treatment?

a) Chest tube insertion
 b) Cricothyrotomy
c) Endotracheal intubation
d) Needle decompression
24) A 48 y/o F presents with significant decrease in vision in her right eye over the past
72 hours. She notes loss of color vision and pain with eye movement. Fundoscopic
exam reveal normal optic disc margins and healthy-appearing retina. Which of the
following is the most likely diagnosis?
a) Cataract
b) Chronic glaucoma
c) Optic neuritis
d) Retinal detachment
25)A 23 y/o female, non-smoker, presents complaining of 15 month history of cough,
SOB, and fatigue. PE reveals breath sounds in all lung fields and prolonged
expiratory phase. Spirometry results indicated FEV1/FVC ratio of 0.66 and FEV1
68% predicted value does not improve after beta agonist. Which of the following is
the most likely diagnosis?
a) Alpha-1 antitrypsin deficiency
b) Cystic fibrosis
c) Idiopathic pulmonary fibrosis
d) Sarcoidosis
26)A 70 y/o female is found to have an elevated serum calcium during a routine
evaluation. Additionally she reports some recent depressive symptoms, weakness
and constipation. Physical exam is notable for diffuse motor weakness and
hyporeflexia. This clinical presentation is most consistent with which of the
following disorders?
a) Hyperaldosteronism
b) Hyperparathyroidism
c) Hypoparathyroidism
d) Hypothyroidism
27)A 60 y/o male with a history of heavy alcohol use is seen in the ED with dyspnea,
tachycardia, warm extremities, and peripheral edema. During examination he is
noted to have nystagmus, and confusion before he collapses. Which of the following
interventions is the next step in management?
a) Defibrillation
b) IV mannitol
c) IV vitamin B
d) Pericardiocentesis
28) Which of the following medications indicated for the treatment of generalized
anxiety disorder carries the risk of developing dependence?
a) Alprazolam (Xanax)
b) Buspirone (Buspar)
c) Duloxetine (Cymbalta)
d) Sertraline (Zoloft)
29)A 66 y/o female presents with recurrent episodes of palpitations, SOB, and near-
syncope. Past medical history is significant for HTN and rheumatic heart disease.
Which of the following is an expected physical examination finding?
 a) Bilateral lower extremity edema
b) Coarse rhonchi of the bilateral lung bases
c) Diastolic murmur at the cardiac apex
d) Exaggerated carotid pulsations
30) A 68 y/o M two weeks status post hip replacement presents to the ED with chest
discomfort and dyspnea. Physical exam reveals a blood pressure of 180/110mmHg.
A 12 lead EKG reveals ST-segment elevation in leads II, III, and avF. Which of the
following is the most appropriate initial management?
a) Coronary artery bypass grafting
b) Intravenous thrombolytic therapy
c) Primary percutaneous coronary intervention
d) Subcutaneous enoxaparin (Lovenox)
31)Which of the following antidepressants should be avoided in a patient with a history
of seizure disorder?
a) Amitriptyline (Elavil)
b) Bupropion (Wellbutrin)
c) Sertraline (Zoloft)
d) Venlafaxine (Effexor)
32)A 67 y/o M was found to have a serum sodium of 121mEq/L during a pre-operative
work up for a perihilar lung mass. Lab studies indicate concentrated urine with
increased urinary sodium excretion. This presentation is most consistent with
which of the following disorders?
a) Acute kidney injury
b) Central diabetes insipidus
c) Primary aldosteronism
d) Syndrome of inappropriate antidiuretic hormone.
33)Which of the following is the correct interpretation of the rhythm strip below?

a) First degree AV block
b) Junctional escape rhythm
c) Mobitz type II AV block
d) Sinus bradycardia
34) A 46 y/o F presents with a rash and mild confusion. PE reveals a temperature of
103F (34.99C) and petechiae over the upper and lower extremities. Lab values are
as follows. HGB 7.2g/dL, HCT 22%, WBC 10.2 x 10^3/ul, platelet count 22,000/ul.
Peripheral blood smear reveals schistocytes. Which of the following is the most
appropriate treatment?
 a) Hemodialysis
b) Plasmapheresis
c) Platelet transfusion
d) Transfusion of packed red blood cells.
35)A 56 y/o F with a 40 pack year smoking history experiences a persistent dry cough,
gradually progressive fatigue and dyspnea over the past year. PE reveals diffuse,
dry, bibasilar crackles and fait late inspiratory wheezes on auscultation. Chest
radiograph is shown. Which of the following studies will confirm the diagnosis?

a) Bronchoalveolar lavage
b) Computed tomography
c) Positron emission tomography scan
d) Surgical lung biopsy
36) A one-year old boy is evaluated for inconsolable crying spells during which he
reportedly draws up his knees. After each episode, his mother notes bloody
diarrhea in his diaper. He is afebrile and physical exam reveals a sausage-shaped
mass in his mid abdomen that is tender to palpation with normal bowel sounds.
Which of the following is the appropriate management?
a) Air enema
b) Fine needle aspiration
c) Oral amoxicillin (Amoxil)
d) Watchful waiting
37)A 78 y/o male presents with urinary hesitancy, weak stream, and post-void
dribbling. Digital rectal exam reveals a smooth, firm, non-tender prostate with
diffuse enlargement. Which of the following treatments would be the best first-line
approach for this patient?
a) Ciprofloxacin (cipro)
b) Finasteride (Proscar)
c) Oxybutynin (Ditropan)
d) Saw palmetto
38) Which of the following pathophysiologic mechanisms results in the rhythm strip
below?

a) Block transmission of atrial impulses
b) Conduction through an accessory pathway
c) Delayed transmission through His bundle
d) Increased automaticity of junctional tissues
39) A 60 y/o female presents with vulvar erythema and edema. She experiences
intense pruritus leading to cyclic scratching. She has developed some ulcerations
and scar formation on the vulva as a result. Biopsy of the tissue reveals
hyperkeratosis, flattened epidermis, and hyalinization of the dermis. Which of the
following is first-line treatment?
a) Interlesional steroids
b) Systemic antifungals
c) Topical progesterone
d) Topical steroids
40) A two year old boy is brought to the clinic by his mother who reports that he is
holding his right ear and crying much more than usual. His temperature at home
last evening was 102F (38.9C). PMHx is significant for a severe allergic reaction to
penicillin. PE of the right ear reveals erythematous tympanic membrane with
decreased mobility on insufflation. Which of the following medications would be
the appropriate treatment?
a)amoxicillin/clavulanic acid (Augmentin)
b) Cefixime (Suprax)
c) ciprofloxacin (cipro)
d) erythromycin (EES liquid)
41) Which of the following is the most common complication of an anterior shoulder
dislocations?
a) Adhesive capsulitis
b) Avascular necrosis
c) Axillary artery tear
d) Brachial plexus injury
42)Cardiac auscultation of a newborn reveals a continuous rough machinery murmur,
accentuated in late systole that is best heard in the left second interspace at the left
sternal border. The pulse pressure is wide with a low diastolic pressure. The heart
is normal size and contour on west radiograph. Which of the following is the most
likely diagnosis?
a) Atrial septal defect
b) Patent ductus arteriosus
c) Tetralogy of fallot
d) Ventricular septal defect
43)Which of the following laboratory abnormalities may be seen in a patient with
bulimia nervosa who frequently binges and purges?
a) Hyperkalemia and hypernatremia
b) Hypernatremia and metabolic acidosis
c) Hypokalemia and metabolic alkalosis
d) Hyponatremia and hyperkalemia.
44) A 50 y/o M presents for a routine PE. Which of the following is the current US
Preventive Services Task Force recommendation for prostate CA screening?
a) Annual DRE
b) PSA and DRE
c) PSA test
d) Routine screening is not recommended
45) Which of the following pathogenic causes of inflammatory diarrhea is associated
with unpasteurized milk?
a) Campylobacter jejuni – maybe this one too?
b) Escherichia coli 0157:H7
c) Norwalk virus
d) Staphylococcus aureus
46)A 66 y/o M is two days status post MI secondary to occlusion of the circumflex
artery. Which of the following echocardiography findings is most consistent with
his recent event?
a) Aortic valvular stenosis
b) Lateral wall hypokinesis
c) Septal wall hypokinesia
d) Tricuspid regurgitation
47) A 36 y/o male presents with a non-tender scrotal mass that transilluminates. This
is consistent with which of the following conditions?
a) Hydrocele
b) Inguinal hernia
c) Spermatocele
d) Varicocele
48) Which of the following diagnostic studies is indicated prior to cardioversion in a
patient which atrial fibrillation with rapid ventricular response?
a) Electrophysiologic mapping
b) Lower extremity venous ultrasound
c) Spiral computed tomography
d) Transesophageal echocardiography
49) A 36 y/o M presents to his primary care provider for evaluation of an acute onset of
exquisite rectal pain for 24-hrs. He has experienced a fever of 102F and mild
suprapubic abdominal pain. Physical exam reveals perianal erythema, warmth, and
induration that is extremely sensitive to palpation. There is swelling in the
ischiorectal fossa on digital rectal exam. Which of the following is the best next
step?
a) Direct admission for IV antibiotics
b) Emergent surgical evaluation
c) Immediate incision and drainage in clinic
 d) Urgent colonoscopy
50) A 67 y/o M with history of pulmonary embolism is one-week status post hip
replacement when he presents to the ED with pleuritic chest pain and dyspnea. He
has previously been treated adequately with low molecular heparin and warfarin. A
helical-CT is positive for additional pulmonary emboli. Which of the following is the
most appropriate management at this time?
a) Fondaparinux (Arixtra) – contraindicated bc recent surgery
b) Inferior vena cava filter – only if CI to anticoag.
c) Pulmonary thromboendarterectomy – if unstable or fails TPA
d) tPA (Alteplase)
51)which of the following lab findings is most sensitive for detecting celiac disease in a
symptomatic patient?
a) Antigliadin antibody – not as sensitive
b) Fecal lactoferrin
c) IgA endomysial antibody
d) Serum Vitamin B-12
52)Which of the following drugs, when taken long-term, has been shown to increase the
risk of fracture in patients with osteoporosis?
a) Alendronate (Fosamax)
b) Esomeprazole (Nexium)
c) Naproxen sodium (Naprosyn)
d) Ranitidine (Zantac)
53)Transient monocular blindness is associated with which of the following
pathophysiologic mechanisms?
a) Carotid stenosis
b) Macular degeneration
c) Open-angle glaucoma
d) Pituitary adenoma
54) Which of the following instructions should be provided to patients with asthma
using inhaled corticosteroids?
a) Reduce the frequency of inhalations to once daily
b) Rinse the inhaler with salt water prior to each use
c) Use an inhalation chamber
d) Utilize tongue rake daily
55) Which of the following pediatric conditions most frequently presents with an
asymptomatic abdominal mass?
a) Intussusception
b) Non-Hodgkin lymphoma
c) Pyloric stenosis
d) Wilms tumor
56)Which of the following medications can suppress cravings and withdrawal
symptoms in an opioid dependent patient?
a) Bupropion (Wellbutrin)
b) Clonazepam (Klonopin)
c) Dronabinol (Marinol)
d) Methadone (Dolophine)
57)A 62 y/o F with heart failure presents with dyspnea, fatigue, and several syncopal
episodes over the past two months. Physical examination reveals oxygen saturation
of 93% on room air, jugular venous distention, bibasilar crackles, and a loud P2
component of S2. Which of the following is the most appropriate study to confirm
this diagnosis?
a) Doppler US
b) Pulmonary function testing
c) Right heart cath
d) Transthoracic echocardiogram
58) A 43 y/o male presents with chronic fatigue and problems with falling asleep at
work. His wife states he is a loud snorer. He has a 20 pack yr history of smoking
and consumes a case of beer on the weekends. Physical exam reveals a BMI of
38kg/m2. Which of the following recommendations would have the most dramatic
improvement in this condition?
a) Alcohol cessation
b) Elevate head of bed
c) Tobacco cessation
d) Weight loss
59) A 13 y/o M is brought in with a two week history of progressive dyspnea and
weakness that was preceded by fevers and myalgia. Physical exam reveals a third
heart sound, bibasilar crackles, and jugular venous distention. Echocardiography
reveals left ventricular dilation and dysfunction. Which of the following is the most
likely diagnosis?
a) Acute pericarditis
b) Bacterial endocarditis
c) Pericardial effusion
d) Viral myocarditis
60) An otherwise healthy 26 y/o F presents with recurrent exercise induce dyspnea,
palpitations, and dizziness. On PE she appear anxious with a regular heart rate of
180/min without murmur, rubs or gallops. Lungs are clear to auscultation. EKG
reveals a narrow complex tachycardia. Which of the following is the most
appropriate initial treatment?
a) Adenosine (Adenocard)
b) Diazepam (valium)
c) Levalbuterol (xopenex)
d) Procainamide (Pronestyl)
61) During examination of a newborn, which of the following tests detects displacement
of the femoral head out of the acetabulum by means of provocation?
a) Barlow
b) Faber
c) Ortolani
d) Perthes
62) Which of the following tuberculosis medications requires testing for red-green
color discrimination and visual acuity at baseline and then periodically as a
precaution against optic neuritis?
a) Ethambutol (Myambutol)
 b) Isoniazid (Rifamate)
c) Pyrazinamide (Rifater)
d) Rifampin (Rifadin)
63) A 23 y/o M presents with a three-month history of cramping abdominal pain,
hematochezia, and passage of mucous streaked stools. He also reports increased
frequency of loose bowel movements, intermittent fevers, plus a seven-pound
weight loss. Family history is significant for rheumatoid arthritis in his mother.
Which of the following is the most likely diagnosis?
a) Colon Cancer
b) Gluten sensitivity enteropathy
c) Inflammatory bowel disease - UC
d) Irritable bowel disease
64) An eight year old girl is evaluated for knee pain and isolated facial palsy. Past
medical history is significant for a flu-like illness followed by joint aches in various
locations over the past month. She spends a significant amount of time outdoors.
Which of the following medications is the best treatment for this patient?
a) Acyclovir (Zovirax)
b) Doxycycline (Doryx)
c) Ibuprofen (Motrin)
d) Prednisone
65)Which of the following cranial nerves is evaluated by asking the patient if a light
tough from a wisp of cotton along the cheek is felt while the eyes are closed?
a) II – optic n.
b) V – trigeminal nerve
c) VII – facial n. movements (smile frown puff cheeks)
d) XII – hypoglossal: stick tongue out
66) Which of the following elements of the history and PE is most suspicious for a
neoplasm of the pancreas?
a) Epigastric pain
b) Painless jaundice
c) Recurrent vomiting
d) Referred shoulder pain
67) A 58 y/o M presents with a six month history of exercise induce painful cramping of
his calf muscle that extends into his thigh and buttocks and improves with rest.
Physical exam reveals weak femoral pulses bilaterally. Which of the following is the
most likely diagnosis?
a) DVT
b) Occlusive arterial disease – the pt has claudication
c) Polymyositis
d) Spinal stenosis
68) A 24 y./o F presents with three-day history of fever, chills, dyspnea, and cough
productive for thick green sputum. Which of the following physical examination
findings best indicates the presence of consolidation?
a) Increased diaphragmatic excursion
b) Increased resonance to percussion – percussion would be more dull
c) Presence of “e” to “A” changes on auscultation - (+) sign for consolidation
 d) Verbalizing “99” sounds muffled on auscultation – muffled sounds are normal.
Usually sounds are clearly when lung is consolidated
69) A 70 y/o retired farmer presents with painless lump on his nose. Skin examination
reveals a round, pearly-pink lesion with central ulceration and fine telangiectasia
over the left nasal ala. Given this physical exam finding, which of the following is the
most likely diagnosis?
a) Actinic keratosis
b) Basal cell carcinoma
c) Seborrheic keratosis
d) Squamous cell carcinoma
70) Which of the following lab test results is most consistent with chronic iron
deficiency anemia?
a) TIBC-normal ( total iron binding capacity, TIBC is an indirect measure of
transferritin)
b) Ferritin-normal
c) MCHC-elevated
d) Red Cell Distribution width-elevated
71) Which of the following classes of antihypertensive medications is safe to use in a
patient with hyperkalemia?
a) ACE inhibitors – nope, causes hyperkalemia
b) Angiotensin receptor blockers – causes hyperK
c) Potassium sparing diuretics –nope.
d) Thiazide diuretics
72) Beta adrenergic blockers affect serum glucose concentrations by which of the
following mechanisms?
a) Acceleration of glycolysis
b) Increased sensitivity to insulin – alpha blockers do this
c) Inhibition of gluconeogenesis
d) Promotion of insulin resistance
73) A 33 y/o female presents with lower abdominal pain relieved with defecation. She
has also experienced alternating constipation and diarrhea with excessive gas and
bloating for more than a year. She denies weight loss or hematochezia. Symptoms
are worsened with stress. Which of the following is the most likely diagnosis?
a) Giardiasis
b) Crohn’s disease
c) Irritable bowel disease
d) Celiac disease
74) During an exam a patient describes right hypogastric pain with flexion and internal
rotation of the hip. This sign may indicate which of the following condition?
a) Appendicitis – Obturator sign
b) Choledocholithiasis
c) Ovarian torsion
d) Ureteral calculi
75) Which of the following physical exam findings is most consistent with peritonitits?
a) High pitched, tinkling bowel sounds à early stages of instestinal obstruction
b) Positive fluid-wave test à test for ascities
 c) Rigid, board-like abdomen
d) Ventral bulging in the midline. à hernia
76) In evaluating a child with recurrent UTIs, which of the following imaging studies is
the most useful in determining the presence of vesicoureteral reflux?
a) CT abdomen and pelvis
b) KUB radiograph
c) Renal US
d) Voiding cysto-urethrogram
77) The presence of dementia in a patient with long-standing hypertension is most
likely associated with which of the following conditions?
a) Accumulation of tau proteins
b) Basilar artery hemorrhage
c) Multiple lacunar infarcts
d) Periventricular plaques à MS
78) A 16 y/o M is evaluated for cough, excessive sputum production, foul-smelling loose
stools. The patient’s chloride sweat test comes back abnormal. Which of the
following pathogens would be found on sputum culture?
a) Bacillus cereus
b) Clostridium perfringens
c) Pseudomonas aeruginosa – Cystic Fibrosis
d) Stenotrophomonas maltophilia
79) A 32 y/o F presents with the inability to leave her house because she fears that she
may get trapped in a building. Which of the following conditions is the patient most
likely exhibiting?
a) Major depression
b) Panic disorder
c) Phobic disorder
d) Schizophrenia
80) A 77 y/o M presents with worsening constipation. PMHx is significant for DM and
CKD Recent colonoscopy was normal. Which of the following treatments in
contraindicated for frequent use in this patient?
a) Bisacodyl (Dolcolax)
b) Glycerine suppositories
c) Magnesium citrate à causes Hypermagnesemia
d) Polyethylene glycol (MiraLAX)
81) Which of the following is recommended for the prevention of varicella zoster virus
infection?
a) Acyclovir (Zovirax) post-exposure in immune competent patients
b) Varicella vaccine (Oka vaccine) two injection series beginning at six months of
age
c) Varicella zoster immune globulin (VZIG) for primary prevention
d) Zoster vaccine live (Zostavax for prevention of shingles in adults over 50 years of
age.
82) A 27 y/o F presents with vaginal discharge and vague abdominal pain for one week.
She has one current sexual partner and uses oral contraception for birth control On
examination, there is copious thin, yellow discharge in the vaginal vault with
 punctate hemorrhaging in the cervix. Mobile organisms are visible on saline wet
preparation. Which of the following is the most likely diagnosis?
a) Bacterial vaginosis – clue cells
b) Chlamydia
c) Recent vaginal intercourse
d) Trichomoniasis – mobile protozoa on wet mount
83) Repeated exposure to which of the following is a risk factor for the development of
the ear condition pictured below?

a) Altitude changes
b) Cold water
c) Cotton swabs
d) Loud noises
84) In a patient previously treated for Hepatitis B, which of the following laboratory
results indicated continued disease activity?
a) Negative HBV surface Antigen (HBsAg)
b) Positive HBV core Antibody (Anti-HBc)
c) Positive HBV DNA
d) Positive HBV surface antibody (Anti-HBs)
85) A 35 y/o female presents with frequent nocturnal leg paresthesias, burning, and
discomfort associated with recurrent leg movements that interrupt her sleep.
Which of the following laboratory studies would identify a treatable cause for her
condition?
a) Aminotransferases
b) Cortisol
c) Ferritin – RLS assoc with decr. Fe stores, but not anemia
d) Parathyroid hormone
86) A 70 y/o M has a tremor in his upper limbs, which occurs with movement and
improves when he drinks alcohol. His father had a similar type tremor. Which of
the following is the most likely diagnosis?
a) Delirium tremens
b) Essential tremor
c) Lew body dementia
d) Parkinsonian tremor
87)Which of the following suggest a diagnosis of secondary hypertension?
a) Black race
b) Family history of hypertension
c) Isolated diastolic hypertension
d) Onset before 20 years of age
88)Which of the following EKG findings is expected in a patient with restrictive
cardiomyopathy?
a) Delayed diastolic dysfunction
b) Left ventricular chamber dilation
c) Left ventricular hypertrophy
d) Normal ejection fraction
89) In an uncomplicated vaginal delivery, the fetal head is measured in relation to the
maternal ischial spines during which of the following stages of labor?
a) First
b) Second
c) Third
d) Puerperium
90) Laboratory values show a blood urea nitrogen to creatinine ration that exceeds
20:1 (à dehydration) , a low fractional excretion of (FENa<1%), and a urine
osmolality of greater than 500mOsm/kg (more concentrated). The results are
consistent with which of the following types of acute kidney injury?
a) Acute interstitial nephritis
b) Acute tubular necrosis
c) Postrenal azotemia
d) Prerenal azotemia
91) Which of the following types of renal calculi is associated with abnormal excretion
of amino acids?
a) Calcium
b) Cysteine
c) Struvite
d) Uric acid
92) A 52 y/o M presents with a one month history of recurrent unilateral headaches
occurring twice daily, approximately three times a week. The headaches last about
an hour in duration and are associated with periorbital pain, nasal congestion, and
conjunctival injection. Which of the following treatments would be the preferred
first line abortive treatment for this patient?
a) 100% oxygen à tx for cluster headaches
b) Ergotamine tartrate (Ergotamine) à migraine tx
c) Prednisone à tx for Giant Cell Arteritis
d) Topiramate (Topamax) à epilepsy & migraine prophylaxis tx
93)A 42 y/o female presents for evaluation of new-onset low-back pain. PMHx is
significant for gastric ulcers, diabetes, and gout. Which of the following medications
should be avoided in her treatment plan?
a) Acetaminophen (Tylenol)
b) Capsaicin topical (Qutenza)
c) Diclofenac (Voltaren) – this is an NSAID!
 d) Hydrocodone (Vicodin)
94) A 52 y/o M presents with six months of intermittent fatigue, muscle weakness,
difficulty chewing and swallowing, and diplopia. The symptoms worsen towards
the end of the day. Which of the following condition is the most likely diagnosis?
a) Guillain-Barre syndrome
b) Huntington disease
c) Multiple sclerosis
d) Myasthenia gravis
95) Systemic lymphadenopathy and a diffuse rash are seen in which of the following
stages of infection due to treponema pallidum?
a) Early latent
b) Late latent
c) Primary – painless ulcer
d) Secondary tx: Pen G
96) A 40 y/o F presents with urinary urgency, nocturia, and suprapubic pain relieved
with voiding. Which of the following is the most likely diagnosis?
a) Interstitial cystitis
b) Overactive bladder
c) Urinary tract infection
d) Yeast vaginitis
97) Acute kidney injury following initiation of an ACE inhibitor for hypertension is
consistent with which of the following conditions?
a) Amyloidosis
b) Glomerulonephritis : RBC casts, coke colored urine, hypertension, edema
c) Minimal change disease : proteinuria, hypoalbuminemia, edema (MC in kids) à
tx: prednisone
d) Renal artery stenosis
98) A two y/o girl is brought in for evaluation for fever, fussiness, and rash. PE reveals
coalescent, bright red maculopapular lesions concentrated on the cheeks with
sparse isolated lesions notes about the forehead. There are no lesions on the trunk
or extremities. Which of the following pathogens is responsible for this clinical
presentation?
a) Coxsackievirus A2 : hand foot mouth disease
b) Human herpesvirus 6
c) Paramyxovirus
d) Parvovirus b19 : slapped cheek appearance of rash
99) Which of the following is an effective non-pharmacologic intervention in the
management of allergic rhinitis?
a) Avoid encasing household pillows
b) Cover windows with drapes
c) Substitute natural fibers for synthetic ones
d) Use normal saline intranasally
100) Which of the following leukemias is characterized by the presence of the
Philadelphia chromosome?
a) Acute lymphoblastic
b) Acute myeloid
 c) Chronic lymphocytic
d) Chronic myeloid
101) Which of the following findings differentiates unstable angina from chronic
stable angina?
a) Crescendo pain pattern
b) Provoked by exertion
c) Radiation of pain to jaw
d) Substernal chest pain
102) A 35 y/o F presents with recent history of fatigue, myalgia, nausea, and
vomiting. Physical exam shows diffuse hyperpigmentation of the skin. Lab testing
reveals reduced morning cortisol levels. Which of the following additional lab
abnormalities is expected?
a) Abnormal cosyntropin stimulation test : pt given high dose ACTH, no cortisol
production
b) Adnormal dexamethasone supressiontest
c) Elevated serum epinephrine levels.
d) Elevated serum sodium levels.
103) A 43 y/o M presents to the ED with severe headache and vomiting. PE
reveals papilledema :optic disc swelling d/t incr ICP. Which of the following
interventions is indicated?
a) Furosemide (Lasix)
b) Lumbar puncture
c) Neurosurgical consult
d) Temporal artery biopsy.
104) A patient with carpal tunnel syndrome would classically experience
numbness and tingling in which of the following distributions?
a) Entire ring and middle finger
b) Ring and small fingers
c) Thumb to entire ring finger
d) Thumb to radial aspect of ring finger
105) A 30 y/o M presents to the ED with palpitations and dyspnea. He admits to
drinking an excessive amount of alcohol over the past two days. His 12-lead ECG is
pictured below. Which of the following is the most appropriate initial intervention?

a) Electrical cardioversion à newly recognized AF = good candidate for
cardioversion
b) Metoprolol (Lopressor)
c) Percutaneous coronary intervention
d) Propafenone (Rythmol)
106) A 49 y/o M presents with sudden onset of toe pain. PE of the left first
metatarsophalangeal joint reveals edema, warmth and tenderness to palpation.
Radiograph of the toe reveals punched-out erosions. To decrease frequency of
attacks, which of the following preventive measures is indicated?
a) Avoid red meats à GOUT! Tx: indomethacin, colchicine. Allopurinol prophylaxis
b) Increased dairy consumption
c) Restrict fluids
d) Supplement with glucosamine
107) A 58- y/o M who is HIV positive presents with acute onset of right sided
facial paralysis that he noticed on awaking this morning. It is accompanied by
diminished hearing on the right and difficulty with balance. He denies any recent
illness. External ear exam is pictured. In addition to prednisone, which of the
following treatments would be appropriate for this patient?

a) Acyclovir (zovirax)
b) Cefpime (Maxipime) – 4th gen cephalosporin
c) Ceftriaxone (Dextrose injection) – 3rd gen, poor coverage of pseudomonas
d) Fluconazole (Diflucan) – for candida infx
108) According to the current American diabetic Association guidelines, which of
the following preventive measures is indicated as an annual prevention in an
asymptomatic patient with type-2 diabetes mellitus?
a) Assessment of body mass
b) Blood pressure measurement
c) Hemoglobin A1C
d) Ophthalmologic evaluation
109) A 62 y/o F is diagnosed with diverticulosis after undergoing routine
colonoscopy. Which of the following dietary modifications is recommended for this
condition?
a) Decreased intake of red-meat
b) Decrease sodium intake
c) Increase intake of dietary fiber
d) Increased omega-3 fatty acid supplementation
110) A 17 y/o male presents with a three-month history of cough and wheezing
that is worse at night. PMHx is significant for sporadic episodes of runny nose,
sneezing, and itchy eyes. PE reveals bilateral erythematous conjunctiva, boggy
turbinates, and end-expiratory bibasilar wheezing with prolonged expiratory phase.
Lungs are clear to auscultation on examination. FEV-1 is 65% of predicted value.
Which of the following is the most likely diagnosis?
a) Acute bronchitis – inflammation of trachea & bronchi
b) Asthma
c) Bronchiolitis obliterans – chronic inflammation & fibrosis of bronchioles à
obstructive lung dz. Mosaic pattern on CT. MC in lung transplant rejection. Tx:
steroids & immunosuppression
d) Cystic fibrosis
111) Which of the following is the recommended screening examination for
human immunodeficiency virus (HIV)?
a) Absolute CD4 lymphocyte count – used to monitor opportunistic infections
b) HIV antibody test
c) HIV viral load – used to monitor treatment effectiveness
d) Western blot
112) A 41 y/o male presents with malaise, fever, pain and swelling of his right
lower legs two weeks after sustaining a crush injury. PE shows a temperature of
100.2F and an erythematous, warm, tender right lower leg with resolving
ecchymosis. Labs show an ESR 48mm/hr and WBC 16.2 cell/ml. Bone scintigraphy
reveals uptake in the distal tibia. Which of the following is the most appropriate
treatment for this patient?
a) Fasciotomy
b) Hyperbaric oxygen therapy
c) IV antibiotics
d) Surgical debridement.
113) A tall, then otherwise healthy 21 y/o M, smoker presents complaining of
right pleuritic chest pain and shortness of breath after a coughing spell earlier in the
day. Auscultation reveals mildly diminished breath sounds in the right apex. Which
of the following is the most likely diagnosis?
a) Community acquired pneumonia
b) Costochondritis
c) Pleuritis
d) Spontaneous pneumothorax
114) A 47 y/o female who is obese presents with new-onset menorrhagia.
Bimanual examination is ineffective because of her body habitus. Which of the
following diagnostic studies is the next step in her evaluation?
a) Pelvic CT
b) Pelvic MRI
c) Transabdominal US
d) Transvaginal US
115) A 32 y/o M presents with three-week history of watery diarrhea, abdominal
cramping and anorexia. He denies fever, chills or vomiting. Stool evaluation is
without blood or leukocytes. Wet mount reveal trophozoites. Which of the
following is this patient’s most likely diagnosis?
a) Axcariasis – large roundworms, infected from pigs
b) Enterobiasis - pinworms
c) Giardiasis
d) Strongyloidiasis – inhaled larvae migrate to duodenum & jejunum à become
worms
116) The renin-angiotensin-aldosterone system contributes to the regulation of
arterial pressure primarily through which of the following physiologic mechanisms?
a) Aldosterone mediated sodium retention
b) Angiotensin II mediated vasodilation vasoconstriction
c) Conversion of aldosterone by ACE aldosterone made by adrenal gland
d) Renin release from juxtaglomerular cells
117) A patient at 27 weeks gestation presents after experiencing a small gush of
blood-tinged fluid from her vagina. Pelvic exam reveals a closed cervical os with no
effacement. Evaluation of fluid pooled in the cul-de-sac is alkaline and a ferning
pattern on the slide examination is noted. Which of the following is the most likely
diagnosis?
a) Chorioamnionitis – infection of chorion or amnion. Fever, tachy, elevated WBC
b) Placenta previa – painless vaginal bleeding. PAINFUL? Accreta.
c) Premature rupture of membranes
d) Stress urinary incontinence
118) Cardiac auscultation of a 65 y/o M with chest pain and shortness of breath
reveals a systolic ejection murmur vest heard in the second intercostal space, right
sternal border, radiating to the next and apex. Which of the following condidiotn is
a risk factor for the development of this murmur? Aortic stenosis
a) Aortic dissection – ripping, tearing chest pain radiating to back
b) Collagen vascular disease
c) Dyslipidemia
d) Infective endocarditis – MC mitral valve. IVDU. DUKE criteria. Janeway, Roth.
119) A 27 y/o otherwise healthy female presents with a three day history of fever,
dyspnea and cough productive for green sputum. Vital signs reveal a temperature of
103.6F, pulse 110/min, respiratory rate 20/min, and oxygen saturation 94% on
room air. Inspiratory crackles are audible in the left lower lobe. She has no history
of previous antibiotic use during the previous three months. Which of the following
medications is the recommended treatment? CA-PNA
a) Amoxicillin
b) Azithromycin
c) Moxifloxacin
d) Trimethoprim-sulfamethoxazole (Bactrim)
120) Which of the following medications used in the treatment of bipolar disorder
requires frequent blood level monitoring due to its narrow therapeutic range?
a) Fluoxetine (Prozac)
b) Haloperidol (Haldol)
c) Lithium (lithobid)
d) Ziprasidone (Geodon)
121) Which of the following studies is diagnostic for ischemic colitis?
a) Abdominal US
b) CT abdomen
c) MRA of abdomen
d) Sigmoidoscopy
122) Which of the following therapies is considered an effective treatment for
major depressive disorder?
a) Hypnosis
b) Massage
c) Phototherapy
d) Psychotherapy
123) Which of the following physical examination findings is characteristic of
fibrocystic breast changes?
 a) Axillary involvement
b) Bilateral distribution
c) Predominant erythema
d) Non-tender to palpation
124) A 44 y/o M farmer with a history of tobacco and alcohol use presents with a
large lump on his neck, which he says has increased in size over the last 8-12 weeks.
PE reveals a 1 cm round hard fixed mass in the right anterior cervical region. Which
of the following is the most likely diagnosis?
a) Basal cell carcinoma
b) Lymphoma
c) Melanoma
d) Squamous cell carcinoma
125) Which of the following methods of birth control has the highest failure rate
even with perfect use?
a) Calendar method
b) Female condom
c) Male condom
d) Vaginal diaphragm
126) A 35 y/o F presents with a one-week history of fatigue, diplopia,
disequilibrium, and sensory disturbances in the extremities. Additionally, she
report urinary incontinence that began yesterday. She also describes a similar
episode that resolved approximately six months earlier. Which of the following
therapies is indicated for the treatment of this presentation? Myasthenia Gravis
a) Alemtuzumab (Campath)
b) Azathioprine (Imuran) à also used if sx are more severe. Initial tx:
pyridostigmine, an anticholinesterase (keeps Ach around in the synapse longer
by inhibiting the enzyme that breaks it down).
c) Interleukin-2 (aldesleukin)
d) Methylprednisone (Medrol)
127) A 27 y/o M presents with right hand pain after injury. Physical examination
reveals edema over the dorsum of the hand with a loss of knuckle prominence. The
radiograph obtained is shown. Which of the following fractures is most likely?

a) Bennett
b) Boxer
c) Colle’s
d) Scaphoid
128) A four y/o boy is evaluated for a non-tender facial rash. PE is significant for
discrete vesicles and confluent erosions with golden-colored crusting located about
the nose and perioral areas. Which of the following treatments is indicated?
a) Econazole cream (Econazole nitrate cream)
b) Hydrocortisone cream
c) Mupirocin ointment (Bactroban)
d) Penciclovir cream (Denavir)
129) A 20 y/o M presents with acute onset of fever, dyspnea, and vague chest
discomfort. He denies rhinorrhea, cough or ill contacts. PMHx is unremarkable. He
has a history of intravenous drug use. On PE he is febrile with a holosystolic
murmur along the left sternal border that increases with inspiration, bilateral
pulmonary rales, and Osler nodes. Which of the following is the most likely
diagnosis? Osler = Ouch. Painful nodes on pads of fingers
a) Bacterial pericarditis
b) Infective endocarditis
c) Rheumatic fever
d) Viral myocarditis
130) A 52 y/o M presents with increasing tightness of the ring finger and inability
to fully extend the digit. The symptoms have become more uncomfortable and
 unsightly. PE reveals a cord-like, palpable thickening of the palmar aspect of the
affected hand and the digit in 10 degrees of flexion. Which of the following is the
most likely diagnosis?
a) De Quervain tenosynovitis – pain along volar aspect of wrist, + Finklestein’s test,
affects APL & EPB tendons
b) Dupuytren contracture – fixed and chronic contracture
c) Ganglion cyst
d) Trigger finger – clicking, catching sensation with flexion over MCP joint, dynamic
and episodic
131) Evaluation of which of the following substances leads to the development of
edema and hyponatremia in congestive heart failure?
a) Aldosterone
b) Angiotensin II
c) Arginine vasopressin
d) Atrial natriuretic peptide.
132) Which of the following lab studies is consistent with high ventricular filling
pressures?
a) Antidiuretic hormone
b) Brain natriuretic peptide
c) Creatinine phosphokinase - CKMB
d) Troponin I – s/p MI
133) Which of the following is the most appropriate treatment for a patient with
meningitis due to streptococcus pneumoniae?
a) Gentamicin
b) Ampicillin
c) Penicillin G
d) Vancomycin + ceftriaxone
134) Which of the following laboratory findings is diagnostic for diabetes mellitus?
a) Fasting plasma glucose= 125mg/dl
b) Hemoglobin A1C=7.0% (>6.5%)
c) Plasma glucose= 139mg/dl two hours after oral glucose challenge (>200)
d) Random plasma glucose=163 mg/dl
135) Which of the following conditions is most closely associated with increased
mortality in a patient with CHF?
a) Chronic kidney disease
b) Hypertriglyceridemia
c) Ischemic stroke
d) Tricuspid regurgitation
136) For the surveillance of a solitary pulmonary nodule with low probability of
malignance, which of the following diagnostic modalities is most sensitive for
assessing nodule growth over time?
a) 3D reconstruction of high resolution CT
b) Fluoroscopic guided high resolution MRI
c) Serial chest radiographs
d) Transthoracic needle aspiration
137) A 20 y/o female presents for her annual exam. When asked about her mood
the patient admits to feeling mildly depressed off and on over the past two years.
She reports having a general loss of interest, fatigue, and low self esteem, and feeling
sad most days of the week. She denies any manic or hypomanic episodes or suicidal
ideation. Based on the history which of the following is the most likely diagnosis?
a) Seasonal affective disorder
b) Cyclothymic disorder – cycles of mania and depression
c) Dysthymic disorder
d) Premenstrual dysphoric disorder
138) Which of the following class of drugs affecting lipoprotein metabolism is
contraindicated in a patient with serum triglycerides over 500mg/dL?
a) Bile acid sequestrants bc they incr TG
b) Fibric acid derivatives
c) HMG coA reductase inhibitors
d) Nicotinic acid
139) Screening for which of the following conditions is recommended at the six
week postpartum visit?
a) Cardiomyopathy
b) Depression
c) Diabetes
d) Thyroiditis
140) When evaluating a male patient for infertility, which of the following test
would be most definitive?
a) Semen analysis
b) Sperm antibody assay
c) Sperm penetration assay
d) Testicular ultrasound
141) A 65 y/o M presents with HA, tinnitus, blurred vision, and fatigue for several
weeks. He also reported experiencing pruritus after taking hot showers. PE reveal
engorged retinal veins and splenomegaly. Which of the following is the most likely
diagnosis?
a) Intracranial mass
b) Meniere syndrome vertigo, hearing loss, tinnitis
c) Mononucleosis
d) Polycythemia vera
142) A 15 y/o girl is evaluated for fatigue, low grade fever, and body aches over
the last few weeks. She denies any upper respiratory symptoms. How long after the
exposure to the causative agent will the heterophile antibody test be positive?
a) 48 hrs
b) One week
c) Two weeks
d) One month
143) A 34 y/o M complains of a four day history of fever, dyspnea, and cough. PE
reveal dullness to percussion focally over the right lung base. A diagnostic
thoracentesis reveals exudate with a pH of 7.0. In addition to antibiotics, which of
the following therapies is indicated? pH <7.3 is abnormal for pleural fluid
 a) Albuterol nebulizer treatments
b) Chest tube insertion
c) Oxygen therapy
d) Pleurodesis
144) A 57 y/o M presents with insidious back pain with radiation into bilateral
buttocks and thighs. He also notices bilateral pain and weakness of the lower
extremities with prolonged standing, which improves by bending forward for lying
down. PE reproduces the thigh pain with 30 seconds of sustained lumbar extension.
Which of the following vascular findings is expected on PE?
a) 2+ distal pulses
b) ABI index of 0.5 1.0 is normal
c) Bounding femoral pulses
d) Presence of renal bruit
145) A 72 y/o female is transferred to the ED after she develops worsening
dyspnea over the previous eight hrs. She has been bedridden for the past 4 days
without improving. Vital signs show a temperature of 103.4F, pulse 114/min,
respiratory rate 30/min and 84% oxygen saturation on room air. Lung exam
reveals crackles bilaterally and accessory muscles use. CXR reveal bilateral
infiltrates and air bronchograms. Which of the following is the most appropriate
intervention?
a) Extracorporeal membrane oxygenation (ECMO)
b) Hyperbaric oxygen therapy
c) Intravenous methylprednisole (Solu-Medrol)
d) Mechanical ventilation
146) A pregnant female presents for delivery. Her past medical history is
significant for genital herpes but she has no active lesions. Yesterday, she began
experiencing prodromal symptoms similar to previous herpes outbreaks in the past.
Which of the following is recommended to reduce the risk of transmission to the
fetus?
a) Cesarean delivery
b) IV acyclovir at onset of labor – started at 36 weeks gestation
c) Oral valacyclovir at onset of labor
d) Vaginal delivery
147) Which of the following autosomal dominant conditions typically presents
with jerky, irregular, involuntary movements and progresses to behavioral, gait and
cognitive deterioration?
a) Huntington disease behavioral changes à chorea à dementia
b) Myasthenia gravis
c) Parkinson disease
d) Tic douloureux aka Trigeminal Neuralgia: brief episodic stabbing pain near
mouth, ear, eye (CN V) TX: carbamazepine
148) The 12 y/o old pictured below presents with fever, night sweats, and weight
loss. What would be the appropriate intervention at this time?
 Mastoiditis
a) Excisional biopsy
b) Incision and drainage (?)
c) Intravenous antibiotics
d) Laryngoscopy
149) A 72 y/o white female with a 60 pack yr history of tobacco use presents with
a six-month history of gradually progressing vision loss. She describes blurred
central vision and says objects appear to be distorted in size (micropsia). Which of
the following findings would be expected on funduscopic examination? MACULAR
DEGENERATION
a) Cotton wool spots = DM retinopathy, HTN retinopathy
b) Drusen = small, round, yellow-white spots on the outer retina
c) Flame hemorrhages = hypertensive retinopathy
d) Lipemia
150) A 25 y/o F with a history of sexual dysfunction and irregular menses
presents with frequent recurrent abdominal pains, difficulty swallowing, and
headaches over the past two years. Previous lab and diagnostic evaluations have
revealed no abnormalities. Which of the following is the most likely diagnosis?
a) Body dysmorphic disorder
b) Histrionic personality disorder
c) Muchanusen syndrome
d) Somatization disorder
151) A 29 y/o male presents with several year history of back pain and morning
stiffness. PE reveals a stooped posture and decreased range of motion of the axial
spine. Lab results are significant for presence of HLA-B27. Which of the following
would be the most likely finding on spine radiographs? Ankylosing spondylitis
a) Defect of the pars interarticularis – spondylolysis (the dog on plain film)
b) Demineralization of the spine
c) Forward slippage of vertebral bodies – spondylolisthesis
d) Squaring of the vertebral bodies – bamboo spine
152) Phototherapy can be used as monotherapy to treat which of the following
conditions?
a) Bipolar I disorder
b) Major depressive disorder
c) Seasonal affective disorder
 d) Dysthymic disorder
153) A 16 y/o M is evaluated for acute onset of fever, HA, and lethargy. PE reveals
a diffuse petechial rash and positive Brudzinksi sign. Which of the following studies
will confirm the diagnosis?
a) CT scan of brain
b) Elecrtoencephalogram
c) Lumbar puncture
d) MRI of the brain
154) If direct compression is inadequate to stop the bleeding, which of the
following agents can be applied intranasally in the treatment of anterior epistaxis?
a) Antibiotic
b) Antihistamine
c) Decongestant – Afrin/oxymetazoline intranasal spray à vasoconstriction
d) Steroid
155) A 28 y/o female complains of intermittent dizziness described as feeling like
“the room is spinning” over the last week. It occurs most often when rolling over in
bed, and occasionally has been accompanied by nausea. She denies tinnitus as well
as any recent trauma or upper respiratory infection. Physical examination
demonstrates nystagmus when quickly lowering her to a supine position with her
head extended below the table and turned to the right. Which of the following is the
most likely diagnosis?
a) Benign paroxysmal positional vertigo
b) Labyrinthitis = vestibular neuronitis + hearing loss/tinnitus
c) Meniere disease = vertigo, hearing loss, tinnitus
d) Vestibular neuronitis continuous, peripheral vertigo, n/v, gait disturbance, viral
infection. Inflammation of vestibular portion of CN 8. TX: meclizine
156) A 45 y/o man presents with symptoms of positive dysphagia for both solids
and liquids. A barium study of the esophagus and upper GI tract shows esophageal
dilation and loss of peristalsis, and a smooth symmetric tapering of the distal
esophagus with delaying emptying. Which of the following is the mostly likely
diagnosis?
a) Achalasia: dilated esophagus, dysphagia to liquid & solids
b) Adenocarcinoma – distal esophagus, Barretts esophagus
c) Schatzki’s ring = esophageal ring
d) Squamous cell carcinoma – middle esophagus, smoking and EtOH risk factors
157) A 38 y/o female presents with painful swelling of her left elbow after
bumping it two days ago. PE reveals a temp of 101F and an oval erythematous,
warm, tender swelling at the tip of the elbow with full range of motion (not an
effusion). Which of the following is the most appropriate diagnostic study?
a) Arthrocentesis to exclude septic arthritis
b) Aspiration of soft tissue
c) CT scan
d) Radiographs
158) Which of the following is consistent with an acute exacerbation of glucose-6-
phosphate dehydrogenase (G6PD) deficiency?
a) Contrast imaging two days ago
 b) Kayser-fleischer rings
c) Recent ingestion of amoxicillin sulfa drugs (Bactrim)
d) Splenomegaly
159) In addition to pleuritic chest pain, which of the following signs and symptoms
are most consistent with pulmonary embolism?
a) Anxiety and tachycardia
b) Cough and fever
c) Dyspnea and tachypnea
d) Wheezing and crackles
160) Which of the following medications blocks N-methyl-D aspartate (NMDA)
glutamate receptors in a patient with Alzheimer dementia?
a) donepezil (Aricept) – cholinesterase inhibitor
b) lamotrigine (Lamictal)
c) memantine (Namenda)
d) rivastigmine (Exelon) – cholinesterase inhibitor
161) A 52 y/o M presents for evaluation of this lesion on his upper back as
pictured. Given this physical exam finding which of the following is the most likely
diagnosis?

a) Malignant melanoma
b) Melanocytic nevus - mole
c) Seborrheic keratosis – stuck on appearance
d) Solar lentigo – age/liver spots
162) A 14 y/o boy is evaluated for a one-month history of left medial knee pain.
The pain radiates to the medial thigh and he has recently begun limping. BMI is
calculated to be at 86%. Left is non-tender with negative lachman test. Left hip
examination reveals limited internal rotation. Which of the following is the most
appropriate study to confirm the diagnosis? SLIPPED CAPITAL FEMORAL
EPIPHYSIS
a) Bone schintigraphy
b) Frog-lateral radiograph of the pelvis
c) Leg length measurement
d) MR arthrogram
163) A 68 y/o M presents with a two-day history of an itching, burning sensation
in both eyes. He denies vision changes. On physical exam his eyelids appear red-
 rimmed and scales are clinging to his eyelashes. Which of the following PE findings
would also be expected? Blepharitis
a) Entropion - eyelid folds inward
b) Erythematous meibomian gland
c) Greasy tears
d) Non-tender swelling of the upper eyelid
164) A 54 y/o M with a history of poorly controlled DM2 presents with left sided
thick foul smelling ear discharge accompanied by decreasing hearing on that side for
three weeks. PE reveals tender auricle with erythema and edema of the external
auditory canal. Pneumatic otoscopy demonstrates normal movement of the
tympanic membrane. Which of the following diagnostic studies will determine the
length of antibiotic therapy? Otitis externa. Tx: Cipro, IV if malignant
a) Auditory evoked potentials
b) CT of the sinuses
c) Culture of the drainage
d) MRI of the head to exclude malignant spread to bone in the skull
165) Which of the following best describes that pathophysiology of
bronchiectasis?
a) Fibrotic changes at the avoli-capillary interface with destruction of perialveolar
tissue.
b) Focal lymphocyte-mediated inflammatory changes of terminal bronchioles
c) Hyperresponsiveness of bronchiolar airways with excess mucus production.
d) Neutrophil-mediated bronchial inflammation with dilatation and destruction of
airway walls
166) Which of the following questions addresses the “E” in the CAGE screening
questionnaire?
a) Do you ever feel you should decrease the amount of alcohol you consume? Cut
back
b) Do you ever have feelings of guilt about drinking?
c) Do you ever feel criticized by people about your drinking? Annoyed
d) Do you ever have a drink first thing in the morning? Eye openers
167) As part of routine post-partum care, which of the following studies should be
administered to the mother if not previously received?
a) Live influenza vaccine
b) Pneumovax
c) Td
d) Tdap
168) Sublingual nitroglycerine decreases myocardial oxygen demand in an acute
coronary syndrome by which of the following mechanisms?
a) Decreasing inotropic effect
b) Inhibiting adrenergic activation
c) Reducing cardiac preload NTG relaxes vascular smooth muscle, allowing more
blood volume to pool in the venous system à reducing preload
d) Slowing the heart rate
169) Which of the following conditions is consistent with abnormal placenta
implantation?
 a) Abruption placentae placenta detaches from uterus
b) Placenta previa – placenta blocks the cervical opening
c) Premature rupture of membranes
d) Placenta increta
170) A 40 y/o M is hospitalized for acute pancreatitis. What counseling is most
important to include in his discharge instruction to help prevent recurrent
episodes?
a) Begin dietary fiber supplements
b) Discontinue alcohol use
c) Increase exercise frequency
d) Take pain medications with food
171) Which of the following physical examination findings distinguishes biceps
tendonitis from rotator cuff tendonitis?
a) Decreased range of motion of the shoulder
b) Decreased sensation over the bicep muscle
c) Tenderness over the anterior superior humerus
d) Tenderness with arm abduction against resistance.
172) Which of the following physical exam findings is characteristic of pulmonary
hypertension?
a) Decreased jugular venous pressure
b) Increased carotid pulse
c) Louder pulmonic component of S2
d) Murmur of mitral regurgitation
173) A 40 y/o F presents with recent onset of insomnia, anxiety, and dyspnea. Her
husband indicated that she frequently developed a “staring” appearance not
previous encountered. Medical history is significant only for a dysrhythmia treated
with amiodarone (cordarone) six months ago. Which of the following is the most
likely diagnosis?
a) absence seizures
b) hyperthyroidism
c) Pulmonary adenoma
d) pulmonary hypertension
174) Which of the following skin examination findings is most consistent with
cutaneous lichen planus?
a) Clusters of vesicles and erosions notes about the vermillion border of the mouth
b) Fine scaling macules and papules notes with a “herald plaque” of the dorsal
trunk
c) Violaceous, flat topped papules grouped about the flexor surfaces of the wrist
d) Yellowish-red waxy papules and plaques involving the nasolabial folds and scalp.
175) A 63 y/o M admitted to the hospital for a ST segment elevation MI, develops
chest pain, SOB, and palpitations. Sustained wide complex ventricular tachycardia is
noted on the monitor. He is hypotensive with cool extremities and delayed capillary
refill. Which of the following is the most appropriate initial intervention?
a) Intravenous amiodarone
b) IV lidocaine
c) Synchronized cardioversion
 d) Ventricular defibrillation
176) A 20 y/o college athlete presents with severe anterolateral right lower leg
pain and swelling two days after conditioning practice. PE reveals a tense,
edematous right lower extremity with decreased sensation and pain on passive
range of motion of the digits. Dorsalis pedis pulse is diminished in comparison to
the left. Which of the following is the most likely diagnosis?
a) Acute arterial occlusion
b) Compartment syndrome
c) Medial tibial syndrome
d) Tibial stress fracture.
177) A 44 y/o F presents with a six month history of bilateral pain and stiffness of
her hand and feet. The stiffness is predominatly in the morning and improves after
an hour. PE reveals edema of the proximal interphalangeal joints of the hands and
feet. Lab studies reveal the presence of anti-CCP antibodies and rheumatoid factor.
Which of the following pathologic findings is most consistent with this diagnosis?
Rheumatoid Arthritis
a) Chronic synovitis with pannus formation.
b) Erosions of cortical bone and soft tissue tophus
c) Inflammation of articular surfaces with trigger points
d) Joint space narrowing with osteophyte formation. – this is OA
178) A 30 y/o F presents after three days of low back pain, dysuria, hematuria,
and fever. Urine dipstick reveal positive leukocyte esterase and nitrites. Which of
the following criteria is an indication for hospital admission?
a) Fever that persists> 48hrs
b) Need for percutaneous nephrostomy
c) Treatment of a UTI within the prior month
d) White cell cats on microscopy.
179) A 50 y/o F presents with soft yellow orange plaques notes on the medial
canthi of the upper and lower eyelids. Which of the following is indicated in the
initial evaluation of this patient? Xanthelasma?
a) Liver function testing
b) Renal function testing
c) Serum lipid testing
d) Shave biopsy
180) A 46 y/o M presents with sudden onset of fever, chills, cough, and SOB. He
states he was feeling fine earlier in the day while moving hay bales on his farm but
now he feels exhausted. He admits to previous episodes although not this severe.
Vital signs indicated temp 102.6F pulse 110/min, resp 22/min, and o2 94% room
air. Pulmonary auscultation reveals bibasilar crackles are noted on auscultation.
Labs WBC 13,000/mm3 with 15% bands. Spirometry reveals decreased FEV1 and
FVC with a normal FEV1/FVC. Which of the following is the best treatment? PNA
a) Azithromycin
b) Indomethacin
c) Prednisone
d) Trimethoprim-Sulfamethaxazole (Bactim)
181) A 42 y/o M presents for evaluation of a rash on his chest. PE reveals diffuse,
copper colored macules and papules distributed over the trunk. A large
erythematous patch is present on the buccal mucosa. Which of the following is
indicated in the evaluation of this patient?
a) ASO titer – tests for Group A strep (rheumatic fever)
b) RPR titer
c) Scraping and microscopy
d) Wood’s lamp examination
182) Which of the following is the only treatment shown to reduce mortality in
patients with chronic obstructive pulmonary disease?
a) Levovloxacin (levaquin)
b) Oxygen therapy
c) Prednisone
d) Salmeterol (Serevent)
183) Which of the following is the most appropriate intervention for a patient with
heart failure who is at increased risk of sudden cardiac death?
a) Cardiac resynchronization therapy
b) Cardioverter defibrillator implantation
c) Coronary artery bypass grafting
d) Permanent pacemaker implantation
184) A 30 y/o M presents with three days of scrotal pain that radiates to his right
flank. PE reveals a temp of 1004.F and an enlarged, tender right testis. Which of the
following is the most likely diagnosis?
a) Cystitis
b) Epididymitis à needs azithromycin & ceftriaxone tx. GC/Chlamydia MCC in <35
c) Orchitis – similar presentation, but usually viral causes (mumps)
d) Prostatitis – dysuria, urinary sx
185) Which of the following is appropriate therapy for symptomatic von
Willebrand disease? Ineffective platelet aggregation à bleeding disorder. vWF
prevents Factor 8 from degradation
a) Clopidogrel (Plavix)
b) Desmopressin (DDAVP) incr vWF and Factor 8
c) Factor IX (BeneFix)
d) Prednisole (Prelone)
186) An eight y/o boy is evaluated for severe right eye pain after being poked in
the eye with a twig. On PE his left eye is teary and the conjunctiva is injected.
Examination with fluorescein dye and a cobalt blue lamp reveals a bright yellow
area over the cornea. Which of the following is the most appropriate management?
a) Erythromycin ointment
b) Eye patch
c) Ophthalmology referral
d) Saline lavage – this may be correct too, but then ophtho referral.
187) A 39 y/o F presents for evaluation of a recently identified painless thyroid
nodule. The presence of which of the following diagnostic findings is an indication
for fine needle aspiration?
a) Elevated antithyroperoxidase antibodies
 b) Elevated serum thyroid stimulating hormone levels
c) Hypoechoic features on US
d) Increased uptake of I-123
188) A 50 y/o male two weeks status post MI presents with a two day history of
substernal chest pain radiating to his neck and shoulders, worsened when he is
supine and relieved when he leans forward. On PE he is febrile with a pericardial
friction rub. Which of the following is the most appropriate treatment? Acute
pericarditis
a) Azithromycin
b) Ceftriazone
c) Indomethacin
d) Warfarin
189) A 67 y/o F with small cell lung cancer diagnosed six month earlier presents
with two-day history of swelling of the face and neck, headache and dizziness.
Which of the following is the most likely explanation for her symptoms
a) Apical lung tumor involving the C8 and T1-2 nerve roots
b) Mediastinal tumor pressing against her superior vena cava
c) Paraneoplastic syndrome
d) Pulmonary embolism with subcutaneous emphysema.
190) Which of the following represents the mechanism of action for bromocriptine
(Parlodel) in the treatment of an anterior pituitary adenoma?
a) Dopamine agonist – for prolactinoma, cabergoline can also be used
b) Gonadotropin antagonist
c) Oxytocin antagonist
d) Somatostatin agonist.
191) A 40 y/o M presents with a two-day history of non-radiating low-back pain.
He denies numbness, tingling, and bowel or bladder symptoms. PE is significant for
flexion of 70 degrees of lumbar spine and tenderness to palpation of the right
paraspinous muscles. There is a negative straight leg raise, 2+ knee jerk, and
symmetric distal sensation intact bilaterally. Which of the following agents is most
appropriate for initial management?
a) Hydrocodone/acetaminophen (Vicodin)
b) Meloxicam (Mobic) - NSAID
c) Methylprednisole (Medrol) - steroid
d) Tramadol (Ultram) – opiate
192) A 35 y/o F presents with left radial wrist pain after a fall on an out stretched
hand. PE reveals tenderness in the anatomic snuff box. No fracture is appreciated
on wrist radiograph. Which of the following is the most appropriate initial
intervention for this patient?
a) Closed reduction
b) Immediate orthopedic referral
c) Long-arm thumb spica cast for six weeks
d) Thumb spica splint for two weeks then repeat radiograph
193) Which of the following physical examination findings in an infant with
coarctation of the aorta is most likely?
a) Fixed splitting of the second heart sound
 b) Systolic murmur in the second intercostal space left sternal border
c) Upper extremity hypertension with delayed femoral pulses
d) Warm pink hands with cyanotic clubbed toes.
194) Which of the following is the recommended daily dietary intake of calcium
for a post-menopausal female?
a) 600mg
b) 1200mg
c) 1800mg
d) 2400mg
195) A 55 y/o M presents with a two-day history of perineal/sacral discomfort
and increased urinary frequency and urgency. Which of the following medication
would be considered first-line treatment? Prostatitis
a) Amoxicillin/ clavulanate (augmentin)
b) Ceftriaxone (Rocephin)
c) Ciprofloxacin (cipro) Fluroquinolones x 1 month
d) Doxycycline
196) An otherwise healthy 32 y/o M patient presents with his third episode of
oropharyngeal candidiasis in the past six months. He is not taking any medications,
Which of the following laboratory tests is indicated?
a) Complete blood count
b) HIV antibody
c) Liver function testing
d) RPR titer
197) A 24 y/o female presents with dysuria and vulva pruritis for the past three
days. She denies urinary frequency or urgency. Dipstick urinalysis reveals negative
leukocyte esterase, RBCs, and nitrites. No bacteria are seen in microscopic analysis.
Which of the following diagnostic test should be performed next?
a) BUN
b) Cystoscopy
c) KOH prep of vaginal sampling
d) Urine culture and sensitivity
198) Infections with which of the following forms of viral hepatitis carries the
highest risk of mortality in a pregnant patient?
a) Hepatitis A
b) Hepatitis B Hep D occurs with B.
c) Hepatitis C
d) Hepatitis E – esp in 3rd trimester à fulminant hepatitis
199) A 30 y/o F presents with palpitations and progressive dyspnea on exertion.
The onset of palpitations is related to changes in position. PMHx is unremarkable.
PE reveals a loud S1, mild JVD, and faint pulmonary crackles in the bilateral bases.
EKG reveals an ovoid hypodensity of the right atrium. Which of the following is the
most likely diagnosis?
a) Atrial myxoma – atrial tumor, presents like CHF
b) Atrial septal defect
c) Mitral viral prolapse (bicuspid)
d) Papillary muscle rupture.
200) A 71 y/o male presents with right hip pain and decreased ROM after a motor
vehicle accident. PE reveals the hip to be fixed in flexion, internal rotation, and
abduction. Which of the following is the best clinical intervention? Posterior hip
dislocation MC
a) Closed reduction
b) Non-weight bearing
c) Physical therapy
d) Surgical pinning
201) In an HIV infected patient, at which of the following CD4 lymphocyte counts
would pneumocystis jiroveci prophylaxis be indicated?
a) <75 cells/mcl initiate prophylaxis if CD4 count <200ul
b) >200 cells/mcl
c) <350 cells/mcl
d) <500 cells/mcl
202) A 26 u/o F, avid runner, presents with increasing pain over the dorsum of
her right foot, especially when running. PE of the right foot shows tenderness over
the second metatarsal and increased pain with flexion of the associated MTP joint.
Foot radiograph is negative for fracture. Which of the following is the most
appropriate intervention for this patient?
a) Intraarticular triamcinolong (Kenalog)
b) Oral acetaminophen (Tylenol)
c) Oral celecoxib (Celebrex)
d) Tropic diclofenac (Voltaren)
203) A 31 y/o F presents with a 3 mo history of worsening left jaw pain. The pain
is described as an aching sensation in front of her ear exacerbated by chewing. PE
reveals tenderness over the left temporomandibular joint with minimal crepitus and
normal ROM. Which of the following recommendations would provide the most
benefit?
a) Apply capsaicin cream
b) Apply moist heat
c) Avoid chewing gum
d) Inject intraarticular lidocaine.
204) Which of the following is the treatment of choice in a pregnant patient with a
confirmed Neisseria gonorrhoeae infection?
a) IM benzathine penicillin
b) IM ceftriaxone
c) Oral azithromycin (1g) + this one also for dual therapy against chlamydia
d) Oral ciprofloxacin
205) A 47 y/o F presents with hyperglycemia, central obesity with striae and
increased ACTH levels. Which of the following additional pathophysiologic features
would be expected? Cushing’s syndrome – excess glucocorticoid
a) Hypercalcemia
b) Hypokalemia
c) Lumphopenia
d) Neutropenia
206) Which of the following clinical findings would necessitate and urgent surgical
consultation in a patient with suspected cellulitis?
a) Crepitus and anesthesia of the involved skin
b) Fever and chills
c) Lymphangitic streaking
d) The area of warmth and erythema extends over hours
207) A 59 y/o F presents with intermittent spotting. Her last normal menstrual
period was two year ago. PE reveals bloody discharge from the servical os and an
enlarged uterus. Heterogeneous endometrial thickening is noted on transvaginal
ultrasound. Which of the following is the most likely diagnosis?
a) Adenomyosis – endometrial tissue within myometrium wall
b) Endometrial cancer – needs endometrial bx to confirm
c) Endometrial hyperplasia precursor to endometrial cancer
d) Leiomyoma
208) Which of the following physical examination findings is most likely in a
patient with hearing loss secondary to cerumen impaction of the right external ear
canal? Cerumen impaction = conductive hearing loss
a) Weber heard better on left, Rinne= air greater than bone
b) Weber heard better on right, Rinne=bone greater than air Weber lateralizes to
the abnormal ear, bc it’s receiving input only from bone and no air conduction
c) Weber heard better on right, Rinne=bone greater than air
d) Weber heard better on right, Rinne=air greater than bone.
209) Which of the following is an indication for the use of CCB in the treatment of
angina pectoris?
a) Adjunctive therapy to ACE-inhibitors
b) Inoperable coronary artery occlusion
c) Intolerance of beta-adrenergic blockers
d) Severe left ventricular dysfunction.
210) The development of which of the following symptoms in a patient with a
history of chronic aortic stenosis is associated with a poor prognosis if appropriate
intervention is not accomplished?
a) Dyspnea
b) Fatigue
c) Palpitations
d) Syncope
211) Which of the following clinical findings suggests a diagnosis of malignant
hypertension?
a) Confusion and visual disturbances
b) Dyspnea and decreased exercise tolerance
c) Episodic anxiety and palpitations
d) Lower extremity edema and dark urine.
212) Which of the following clinical findings supports a cardiovascular etiology of
chest pain?
a) Costochondral tenderness on palpation Costalchondritis
b) Cutaneous hyperesthesia along the T10 dermatome Zoster
c) Substernal burning worsened by postprandial recumbency GERD
 d) Tearing anterior chest pain radiating to the back aortic dissection
213) A 26 y/o F complains of “wicked pain” in her right eye noted on removing her
contacts after wearing them continuously for 48 hrs. PE reveals a hazy cornea with
a central ulceration. Hypopyon (pus in anterior chamber of eye) is present. Which
of the following ophthalmic agents should be started immediately? Concern for
bacterial keratitis à perforation of eye
a) Bacitracin
b) Ciprofloxacin
c) Natamycin
d) Sulfacetamide
214) A 21 y/o male presents with two day history of dyspnea. The chest
radiograph is shown. Which of the following is expected on physical examination of
the right hemithorax?

a) Hyperresonance to percussion
b) Increased chest wall excursion movement of diaphragm during breathing
c) Increased tactile fremitus – more dense or inflamed lung tissue
d) Increased vesicular breath sounds.
215) A 56 y/o F with a 35 pack year smoking history presents with one year
history of SOB, productive cough and wheezing which have worsened over the past
four months. Her sputum color has turned from white to green. PE reveals
diminished breath sounds globally with expiratory wheezes and a prolonged
expiratory phase. The patient’s DLco is normal. Which of the following is the most
likely diagnosis?
a) Chronic bronchitis
b) Emphysema
c) Hypersensitivity pneumonitis
d) Sarcoidosis
 216) Which of the following is a pathophysiologic mechanism of gestational
diabetes?
a) Decreased insulin production
b) Decreased insulin sensitivity
c) Decreased insulin-like growth factor
d) Increased gluconeogenesis
217) Examination of a 17 y/o F for a sports physical reveals multiple dental
erosions and increased lanugo. Which of the following is the most likely diagnosis?
a) Celiac disease – can’t eat gluten, diarrhea. Serologic IgA and TTG tests confirm
b) Crohn disease – transmural inflammation, mouth to anus
c) Eating disorder
d) Sjogren syndrome – autoimmune, dry eyes & mouth
218) Disulfiram (Antabuse) inhibits which of the following substances?
a) Monoamine oxidase
b) Dopamine
c) Acetaldehyde dehydrogenase makes EtOH feel like shit
d) GABA
219) Which of the following treatments results in the greatest reduction of
adverse cardiovascular events at 12 months post procedure in patient with left main
coronary artery disease?
a) Coronary artery bypass grafting
b) Fibrinolytic reperfusion therapy
c) Long-term antiplatelet therapy
d) Percutaneous coronary intervention