Question 1 0 / 2 points
Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which of the following ranges represents normal intraocular pressure?
a) 0 to 7 mm Hg
b) 8 to 21 mm Hg
c) 22 to 40 mm Hg
d) 40 to 80 mm Hg
Question 2 0 / 2 points
Which obstructive lung disease is classified as reversible?
b) Chronic bronchitis
Question 3 0 / 2 points
A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night vision, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the diagnosis of chronic open-angle glaucoma?
a) The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma.
b) The clinician can definitively diagnosis open-angle glaucoma based on the subjective complaints of the patient.
c) Physical diagnosis relies on gonioscopic evaluation of the angle by an ophthalmologist.
d) Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve.
Question 4 2 / 2 points
Heart valve damage resulting from acute rheumatic fever is a long-term sequelae resulting from infection with which of the following pathogens?
c) Francisella tularensis
d) Group A streptococcus
Question 5 2 / 2 points
The presence of hairy leukoplakia in a person with no other symptoms of immune suppression is strongly suggestive of which type of infection?
a) HSV type 2
Question 6 0 / 2 points
Your patient is on Therabid for his asthma. You want to maintain his serum levels between:
a) 0 to 5 mcg/mL
b) 5 to 10 mcg/mL
c) 5 to 15 mcg/mL
d) 10 to 20 mcg/mL
Question 7 0 / 2 points
African American patients seem to have a negative reaction to which of the following asthma medications?
a) Inhaled corticosteroids
b) Long-term beta-agonist bronchodilators
c) Leukotriene receptor agonists
d) Oral corticosteroids
Question 8 2 / 2 points
Which of the following statements is true concerning the use of bilberry as a complementary therapy for cataracts?
a) The body converts bilberry to vitamin A, which helps to maintain a healthy lens.
b) Bilberry blocks an enzyme that leads to sorbitol accumulation that contributes to cataract formation in diabetes.
c) Bilberry boosts oxygen and blood delivery to the eye.
d) Bilberry is a good choice for patients with diabetes as it does not interact with antidiabetic drugs.
Question 9 2 / 2 points
Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking?
a) He should stop smoking today.
b) He should stop smoking tomorrow.
c) His quit date should be in 1 week.
d) He will be ready to quit after the first 30 days.
Question 10 2 / 2 points
The forced vital capacity is decreased in:
b) Chronic bronchitis
d) Restrictive disease
Question 11 2 / 2 points
A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from:
Question 12 0 / 2 points
You have taught Jennifer, age 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate is 65%. What would you tell her?
a) “Take your short-acting beta-2 agonist, remain quiet, and call back tomorrow.”
b) “Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow.”
c) “Drive to the emergency room now.”
d) “Call 911.”
Question 13 2 / 2 points
Which of the following statements regarding pulmonary function is true?
a) Cigarette smoking accelerates the decline in pulmonary function tenfold.
b) Smoking cessation can reverse most pathological changes.
c) Cigarette smoking decreases mucus production.
d) There is a normal age-related decline in pulmonary function.
Question 14 0 / 2 points
You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex?
a) Baker phenomenon
b) Arnold reflex
c) Cough reflex
d) Tragus reflex
Question 15 0 / 2 points
Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do?
a) Hand him literature about smoking cessation at every visit.
b) Wait until he is ready to talk to you about quitting.
c) Document in the record that he is not ready to quit.
d) Continue to ask him at every visit if he is ready to quit.
Question 16 2 / 2 points
Which immunoglobulin mediates the type 1 hypersensitivity reaction involved in allergic rhinitis?
Question 17 2 / 2 points
Which of the following conditions is associated with cigarette smoking?
b) Increased sperm quality
c) Bladder cancer
Question 18 0 / 2 points
Which ethnic group has the highest lung cancer incidence and mortality rates?
a) African American men
b) Scandinavian men and women
c) Caucasian women
d) Asian men
Question 19 2 / 2 points
Which information should be included when you are teaching your patient about the use of nicotine gum?
a) The gum must be correctly chewed to a softened state and then placed in the buccal mucosa.
b) Patients should not eat for 30 minutes prior to or during the use of the gum.
c) Initially, one piece is chewed every 30 minutes while awake.
d) Acidic foods and beverages should be encouraged during nicotine therapy.
Question 20 2 / 2 points
Julie has a postnasal drip along with her cough. You assess her for:
c) Allergic or vasomotor rhinitis
Question 21 2 / 2 points
Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity?
a) Mild intermittent
b) Mild persistent
c) Moderate persistent
d) Severe persistent
Question 22 2 / 2 points
A chronic cough lasts longer than:
a) 3 weeks
b) 1 month
c) 6 months
d) 8 weeks
Question 23 0 / 2 points
Severe pain associated with acute otitis media signifies perforation of the tympanic membrane.
Question 24 0 / 2 points
As diabetic retinopathy progresses, the presence of ‘cotton wool’ spots can be detected. Cotton wool spots refer to:
a) Nerve fiber layer infarctions
b) Blood vessel proliferation
c) Venous beading
d) Retinal hemorrhage
Question 25 2 / 2 points
Which of the following is a possible consequence of sleep apnea?
b) Increased white blood cells
c) Insulin resistance
Question 26 2 / 2 points
Marta is taking TB drugs prophylactically. How do you instruct her to take them?
a) Take them on an empty stomach to facilitate absorption.
b) Take them with aspirin (ASA) to prevent flushing.
c) Take them with ibuprofen to prevent a headache.
d) Take them with food to prevent nausea.
Question 27 0 / 2 points
Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis?
c) Chronic bronchitis
Question 28 0 / 2 points
Which subtype of cataracts is characterized by significant nearsightedness and a slow indolent course?
a) Nuclear cataracts
b) Cortical cataracts
c) Posterior cataracts
d) Immature cataracts
Question 29 0 / 2 points
Otitis media is considered chronic when:
a) Inflammation persists more than 3 months with intermittent or persistent otic discharge.
b) There are more than six occurrences of otitis media in a 1-year period.
c) Otitis media does not resolve after two courses of antibiotics.
d) All of the above
Question 30 0 / 2 points
Which of the following is an example of sensorineural hearing loss?
a) Perforation of the tympanic membrane
Question 31 0 / 2 points
A patient presents with the following signs and symptoms: gradual onset of low-grade fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy. Based on the signs and symptoms alone, which of the following conditions is most likely the cause?
d) Herpes zoster
Question 32 0 / 2 points
You are using the CURB-65 clinical prediction tool to decide whether Mabel, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Her score is 3. What should you do?
a) Consider home treatment.
b) Plan for a short inpatient hospitalization.
c) Closely supervise her outpatient treatment.
d) Hospitalize and consider admitting her to the intensive care unit.
Question 33 2 / 2 points
The most significant precipitating event leading to otitis media with effusion is:
c) Viral upper respiratory infection (URI)
d) Perforation of the eardrum
Question 34 2 / 2 points
Patients with acute otitis media should be referred to a specialist in which of the following situations?
a) Concurrent vertigo or ataxia
b) Failed closure of a ruptured tympanic membrane
c) If symptoms worsen after 3 or 4 days of treatment
d) All of the above
Question 35 2 / 2 points
Marci has been started on a tuberculosis (TB) regimen.Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically?
Question 36 2 / 2 points
The barrel chest characteristic of emphysema is a result of:
a) Chronic coughing
d) Pulmonary hypertension
Question 37 0 / 2 points
A patient presents to the clinician with a sore throat, fever of 100.7?F, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be?
a) The patient should be instructed to rest and increase fluid intake as the infection is most likely viral and will resolve without antibiotic treatment.
b) Because the patient does not have strep throat, the clinician should start broad spectrum antibiotics in order to cover the offending pathogen.
c) A throat culture should be performed to confirm the results of the rapid strep test.
d) The patient should be treated with antibiotics for strep throat as the rapid strep test is not very sensitive.
Question 38 0 / 2 points
Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead?
c) Exudative pharyngitis
Question 39 0 / 2 points
Which statement about adenocarcinoma of the lung is accurate?
a) It is the least common type of lung cancer, representing approximately 5% to 10% of cases.
b) It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors.
c) It is more common in men than in women and occurs almost entirely in cigarette smokers.
d) It is aggressive, with rapid growth and early local and distant metastases via the lymphatic and blood vessels.
Question 40 0 / 2 points
A patient presents to the clinician complaining of ear pain.On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus. These findings are classic signs of which condition?
a) Otitis media
b) Meniere’s disease
d) Otitis externa
Question 41 2 / 2 points
Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD?
a) 3 to 5 hours
b) 6 to 10 hours
c) 11 to 14 hours
d) 15 to 18 hours
Question 42 0 / 2 points
Which of the following medications used in the treatment of glaucoma works by constricting the pupils to open the angle and allow aqueous fluid to escape?
Question 43 2 / 2 points
You are in the park playing with your children when you see that your friend is screaming for help. Her toddler has fallen and there is a stick lodged in his eye. The child is kicking and screaming and grabbing for the stick. You:
a) instruct his mother to hold him securely and not allow him to touch the stick, then carefully remove the stick from the eye.
b) stabilize the foreign object and accompany the mother and child to the local ER.
c) find a water fountain, hold the child to the water, and flush the eye.
d) call 911.
Question 44 2 / 2 points
You have a patient who is a positive for Strep on rapid antigen testing (rapid strep test). You order amoxacillin after checking for drug allergies (patient is negative) but he returns 3 days later, reporting that his temperature has gone up, not down (101.5 F in office). You also note significant adenopathy, most notably in the posterior and anterior cervical chains, some hepatomegaly, and a diffuse rash. You decide:
a) to refer the patient.
b) that he is having an allergic response and needs to be changed to a macrolide antibiotic.
c) that his antibiotic dosage is not sufficient and should be changed.
d) that he possibly has mononucleosis concurrent with his strep infection.
Question 45 2 / 2 points
Fluctuations and reductions in estrogen may be a contributing factor in which type of rhinitis?
a) Vasomotor rhinitis
b) Rhinitis medicamentosum
c) Atrophic rhinitis
d) Viral rhinitis
Question 46 2 / 2 points
In which of the following situations would referral to a specialist be needed for sinusitis?
a) Recurrent sinusitis
b) Allergic sinusitis
c) Sinusitis that is refractory to antibiotic therapy
d) All of the above
Question 47 0 / 2 points
The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient’s mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test?
a) Weber test
b) Schwabach test
c) Rinne test
d) Auditory brainstem response (ABR) test
Question 48 0 / 2 points
Sinusitis is considered chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than:
a) 4 weeks
b) 8 weeks
c) 12 weeks
d) 16 weeks
Question 49 2 / 2 points
Most nosocomial pneumonias are caused by:
c) Gram-negative bacteria
d) Pneumococcal pneumonia
Question 50 2 / 2 points
Joyce is taking a long-acting beta agonist for her asthma.What additional medication should she be taking?
a) Inhaled corticosteroid
b) Leukotriene receptor antagonist
c) Systemic corticosteroid
d) Methyl xanthenes