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Q1: Which statement is TRUE according to prevention?

C. Tertiary Prevention: prevention of complications, disability

Q2: Which statement is NOT TRUE about prevention? "Immunisation is secondary prevention"

A is FALSE — Immunization is PRIMARY prevention (prevents disease). Secondary = early diagnosis

Q3: Which statement about prevention is TRUE?

E. None of Above — Primary=disease prevention; Secondary=early diagnosis; Tertiary=preventing complications

Q4: Which statement is NOT TRUE? "Healthy lifestyle is a secondary prevention"

C is FALSE — Healthy lifestyle is PRIMARY prevention

Q5: Smoking cessation to prevent lung cancer is an example of which type of prevention?

A. Primary Prevention

Q6: Which statement is TRUE according to primary health care?

C. Primary health care is the key to attaining health for all

Q7: All true about primary health care EXCEPT?

D — FALSE: Primary care DOES cover prevention

Q8: All true about levels of health care EXCEPT?

A — FALSE: Primary care is NOT urgent care only

Q9: Which is TRUE about the characteristic of FM/GP?

A. First medical contact, open access, deals with all health problems regardless of age/sex

Q10: All true about competencies of FM/GP?

E. All of above (Person-centred care, holistic, primary care management, comprehensive)

Q11: Which is TRUE about the comprehensive consultation?

E. All of the above (changing attitude, solving additional problems, opportunistic health promotion, solving presenting problem)

Q12: The benefit of good communication skills for the doctor is?

D. All of the above (reducing complaints/litigation, reducing stress/burnout, high satisfaction)

Q13: Which statement is FALSE about disease screening?

A is FALSE — Screening targets diseases with LONG preclinical stage, not short

Q14: Which statement is FALSE about disease screening? "Have a short preclinical stage"

B is FALSE — screening targets LONG preclinical stage

Q15: Which statement is FALSE about disease screening? "Characterized with low morbidity/mortality"

A is FALSE — screening targets diseases with HIGH morbidity/mortality

Q16: Screening test characteristics necessary for effective screening?

E. All of the above (validity/reliability, simple, acceptable, inexpensive)

Q17: Disease characteristics necessary for effective screening?

E. All of the above (long pre-clinical phase, common, effective treatment, high morbidity/mortality)

Q18: Which statement is TRUE?

A. Asymptomatic disease screening = secondary prevention = detection before symptoms develop

Q19: All statements about open questions are correct EXCEPT?

B is FALSE — Open questions are NOT yes/no questions; they encourage free expression

Q20: FM/GP European definition 2002 includes all EXCEPT?

A — "orientated ONLY to prevention" is wrong; FM is comprehensive

Q21: FM/GP definition includes all EXCEPT?

D — "management of chronic diseases only" is wrong; FM manages all health problems

Q22: Safe level of alcohol intake for a 67-year-old patient?

C. No more than 1 drink per day (for patients >65 years)

Q23: Current newborn screening can diagnose inborn errors of metabolism — True or False?

B. False — newborn screening is NOT diagnostic; it is a screen with poor specificity

Q24: Preventive actions for an 18-year-old woman at health evaluation?

B. Physical examination (not mammography/colonoscopy/lipid profile — these start later)

Q25: Preventive actions for a 27-year-old woman at health evaluation?

C. PAP test (starts at age 21; not mammography/colonoscopy yet)

Q26: At what age should cholesterol screening begin in a low-risk 30-year-old man?

C. 35 years (USPSTF recommendation for men without risk factors)

Q27: Preventive actions for a 49-year-old woman EXCEPT?

A. Mammography — starts at age 50, so NOT indicated at 49

Q28: Father had colorectal cancer at 62 — when should daughter begin screening?

A. 40 years (10 years before first-degree relative's diagnosis or at 40, whichever is first)

Q29: At what age should average-risk women start routine mammograms (USPSTF)?

D. 50 years

Q30: Most appropriate screening for a 50-year-old male smoker with high cholesterol?

D. PSA test, lipid screen, fecal occult blood test (FOBT), and blood sugar test

Q31: USPSTF recommends which screening for these patients?

B. 45-year-old sexually active woman: nucleic acid amplification for chlamydia

Q32: Most appropriate screening for a 52-year-old obese male smoker?

C. Lipid screen, fecal occult blood test (FOBT), and blood sugar test

Q33: Preventive actions for a 53-year-old woman at health evaluation?

D. All of the above (PAP test + Mammography + Colonoscopy)

Q34: Preventive actions for a 55-year-old man EXCEPT?

A. Abdominal US for AAA — this is only for men aged 65–75 who have EVER smoked

Q35: Recommended lung cancer screen for a 58-year-old smoker?

C. Chest CT (low-dose CT scan)

Q36: Preventive actions for a 61-year-old woman?

D. All of the above (Mammography + DEXA + Colonoscopy)

Q37: Screening tests for a 52-year-old woman with HTN, DM, mother had breast cancer age 75, father had colon cancer age 65?

E. Screening mammography, colonoscopy, and a bone density scan

Q38: Most appropriate screening for a 75-year-old woman (nonsmoker, no family history, normal Pap smears)?

C. Mammogram, colonoscopy, and bone densitometry

Q39: Most appropriate PAP smear schedule for a 21-year-old sexually active woman?

A. Pap tests every 3 years beginning at age 21

Q40: Intervention prior to pregnancy with clear proven benefit for neural tube defects?

D. Prescribing 0.4–0.8 mg of folic acid daily

Q41: Preventive actions for a 65-year-old man EXCEPT?

B. Lung X-ray (not a recommended preventive screen)

Q42: Most important advice for a 28-year-old woman with epilepsy planning pregnancy?

C. Preconception folate supplementation (1 mg/day; continue epilepsy meds but avoid valproic acid)

Q43: First trimester prenatal care actions EXCEPT?

A. Glucose tolerance test — this is done at 24–28 weeks (2nd trimester), NOT 1st trimester

Q44: Screening for asymptomatic bacteriuria is standard of care in which patients?

E. Pregnant women

Q45: Titers routinely obtained at first prenatal visit?

D. Rubella, syphilis, HIV, hepatitis B, cytomegalovirus, and toxoplasmosis

Q46: Correct information about nuchal translucency ultrasound?

E. Screening test for Down syndrome performed between 10–13 weeks of pregnancy

Q47: Most appropriate recommendation for a nurse planning pregnancy regarding immunizations?

A. Check rubella immunity before conception — rubella vaccine is live virus, contraindicated in pregnancy

Q48: Target LDL for a 69-year-old man with coronary artery disease?

A. LDL >100 mg/dL is the threshold — goal is LDL <100 mg/dL in CAD patients

Q49: Best next step for a diabetic man with LDL 135, HDL 47, total cholesterol 230?

A. Lower LDL cholesterol to <100 mg/dL (diabetes = CAD equivalent)

Q50: Appropriate screening tests for women over 65 EXCEPT?

B. CA-125 — NOT recommended for routine ovarian cancer screening in low-risk women

Q51: Best management for a 45-year-old man with LDL 220, total cholesterol 330, no symptoms?

A. TLC and high-intensity statin

Q52: Contraindication to receiving live rubella vaccine?

C. Pregnant women (or anticipated pregnancy within 4 weeks)

Q53: True about adult immunizations EXCEPT?

B — PPV is NOT for patients after 45 years; it's indicated for patients 65 years and older

Q54: Contraindication to vaccinating a child?

D. Previous reaction of wheezing and hypotension (anaphylactic reaction = absolute contraindication)

Q55: Which condition is NOT aggravated by obesity?

C. Osteoporosis (associated with thin elderly women, NOT obesity)

Q56: G6P3215 — how many full-term pregnancies?

C. 3 full-term pregnancies (T=3 in GTPALC notation)

Q57: Red flags for life-threatening disease in chest pain patients?

D. All of the above (ECG changes, hypotension/pulmonary edema, tachycardia/tachypnea/hypoxia)

Q58: Classical CAD risk factors per INC-7/ESH/ESC?

E. All of the above (HTN, smoking, family history early CAD, hyperlipidemia)

Q59: Most common cause of death in adults with type 2 diabetes?

A. Coronary artery disease (14–50% of cardiovascular disease)

Q60: Chest heaviness in substernal area — quality of angina but not always with exertion — describe this pain?

D. Atypical angina (has quality OR exertion feature, but not both)

Q61: Dyspnea with activity, relieved by rest, no chest pain — describe this?

C. Anginal equivalent (cardiac ischemia symptoms without chest pain)

Q62: Stabbing chest pain worse with inspiration, not activity-related — describe this?

D. Nonanginal pain (stabbing/pleuritic = neither quality nor precipitating features of angina)

Q63: Which does NOT belong to CVD risk factors per INC-7/ESH/ESC?

C. Alcohol consumption (not a recognized CVD risk factor); also D — BMI >25 is not the threshold (BMI >30 is)

Q64: Best test to rule out heart failure as cause of dyspnea in COPD patient?

C. Serum pro-BNP level

Q65: Routinely indicated in initial evaluation of NEW heart failure diagnosis?

D. BNP (plus ECG, CBC, urinalysis, creatinine, potassium, albumin, thyroid function, echocardiogram)

Q66: CHF patient comfortable at rest but ordinary activity causes mild dyspnea — NYHA class?

B. Class II

Q67: CHF patient comfortable at rest, but walking to car causes dyspnea/fatigue/palpitations — NYHA class?

B. Class II

Q68: Routinely indicated in initial evaluation of new heart failure?

A. Echocardiogram (essential — assesses chamber size, function, ejection fraction)

Q69: Acute CHF exacerbation — best test?

B. Echocardiography (essential, noninvasive, assesses chamber size and ejection fraction)

Q70: ECG abnormalities in Atrial Fibrillation?

B. Absence of P waves + irregular chaotic QRS complexes

Q71: ECG feature suggesting Atrial Fibrillation?

B. Absence of P waves

Q72: Heavy alcohol the night before + irregular heartbeat 130 bpm — most likely diagnosis?

D. Atrial fibrillation (holiday heart)

Q73: "Fluttering in chest" + rapid irregular pulse — most likely diagnosis?

A. Atrial fibrillation

Q74: Heavy alcohol + irregular heartbeat 115 bpm — most likely diagnosis?

C. Atrial fibrillation

Q75: Which is NOT a risk factor for MI?

A. Alcoholism (not a recognized MI risk factor)

Q76: Most sensitive/specific indicator of MI 7 days ago?

C. Troponin (peaks at 12 hours, remains elevated up to 15 days)

Q77: Most sensitive/specific indicator of MI 7 days ago?

D. Troponin

Q78: Preferred biochemical marker for acute myocardial infarction?

E. Troponin I

Q79: ECG feature most markedly increasing likelihood of acute MI?

A. ST-segment elevation ≥1 mm

Q80: ECG feature most markedly increasing likelihood of acute MI?

A. ST-segment elevation ≥1 mm

Q81: ECG pattern consistent with acute MI?

D. Elevated ST segments

Q82: Most common mechanism of STEMI — ST elevation MI?

A. Coronary plaque rupture (acute rupture of atherosclerotic plaque)

Q83: Crushing substernal chest pain + elevated troponin — most likely diagnosis?

E. Acute myocardial infarction

Q84: Chest pain characteristic that DECREASES likelihood of cardiac origin?

A. Pain worse with inspiration (pleuritic — not cardiac)

Q85: 87-year-old with HTN + JVD + hepatomegaly + edema + EF 60% + LVH — most likely underlying condition?

C. Hypertensive heart disease

Q86: History NOT increasing likelihood of ACS?

C. Improved when lying on left side (suggests pericarditis, not ACS)

Q87: Fastest diagnostic test to alter management in suspected acute MI?

A. 12-lead ECG

Q88: Best next step for peripheral arterial disease patient with claudication (ABI 0.65)?

C. Aspirin and statin (antiplatelet + lipid-lowering therapy)

Q89: Medication improving survival after MI?

C. Beta blocker (reduces mortality in acute and long-term MI)

Q90: Medication improving survival after MI?

C. β-Blockers

Q91: Best first-line agent for CHF with left ventricular systolic dysfunction?

A. ACE inhibitors (decrease symptoms, hospitalizations, mortality)

Q92: Best combination for diastolic heart failure?

B. β-Blocker + diuretic

Q93: Definition of hypertension (JNC-7)?

D. SBP ≥140 mmHg AND/OR DBP ≥90 mmHg

Q94: Which patient needs treatment for hypertension?

D. 55-year-old man with SBP 150 mmHg — this clearly exceeds the threshold of ≥140

Q95: Diseases causing secondary hypertension?

D. All of the above (sleep apnea, renal vascular disease, pheochromocytoma)

Q96: Diseases causing secondary hypertension?

E. All of the above (Cushing's, primary aldosteronism, CKD, thyroid/parathyroid disease)

Q97: Diseases causing secondary hypertension?

E. All of the above (primary aldosteronism, CKD, Cushing's, sleep apnea)

Q98: Routine test in initial hypertension evaluation?

E. ECG

Q99: Routine test in initial hypertension evaluation?

D. ECG

Q100: NOT a routine test in primary evaluation of hypertension?

D. BNP (not routinely ordered in initial HTN workup)