Dr. Starbird, the Assistant CCC Director of the Thumb Region, has graciously provided you with practice NBME questions from the Family Medicine Resident In-service Exam.  These questions are likely more difficult than what you’ll see on your boards and shelf exam.  Nevertheless, they are good practice, and the answers will be good study materials.  Questions will periodically be posted on a Monday with answers and explanations posted the following Friday.

1. Which one of the following drugs inhibits platelet function for the life of the platelet?

A) AspirinB) IbuprofenC) Dipyridamole (Persantine)D) Ticlopidine (Ticlid)E) Warfarin (Coumadin)

2. A 55-year-old male who had a recent episode of atrial fibrillation that converted in the emergency department is asymptomatic and currently in sinus rhythm. He is in good health otherwise and has no history of hypertension, diabetes mellitus, heart failure, transient ischemic attack, or stroke.

Which one of the following would be best for preventing a stroke in this patient?

A) AspirinB) Clopidogrel (Plavix), 75 mg dailyC) Warfarin (Coumadin), with a goal INR of 1.5–2.5D) Warfarin, with a goal INR of 2.0–3.0E) Warfarin, with a goal INR of 2.5–3.5

3. A 42-year-old female presents to the emergency department with pleuritic chest pain. Her probability of pulmonary embolism is determined to be low.

Which one of the following should be ordered to further evaluate this patient?

A) Brain natriuretic peptide (BNP)B) CT pulmonary angiographyC) ELISA-based D-dimerD) A cardiac troponin levelE) A ventilation-perfusion lung scan

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4. A 17-year-old soccer player presents for a preparticipation examination. His family history is significant for the sudden death of his 12-year-old sister while playing basketball, and for his mother and maternal grandmother having recurrent syncopal episodes. His medical history and examination are completely normal.

Prior to approving his participation in sports, which one of the following is recommended?

A) A resting EKGB) A stress EKGC) An echocardiogramD) Pulmonary function testingE) No further evaluation

5. She has a history of hypertension treated with a thiazide diuretic. An echocardiogram reveals no evidence of valvular disease and no segmental wall motion abnormalities. Left ventricular hypertrophy is described, and the ejection fraction is 55%. Her pulse rate is 72 beats/min.

The most likely cause of her heart failure is

A) systolic dysfunctionB) diastolic dysfunctionC) hypertrophic cardiomyopathyD) high-output failure

6. A 68-year-old white male with diabetes mellitus is hospitalized after suffering a right middle cerebral artery stroke. A nurse in the intensive-care unit calls to advise you that his blood pressure is 200/110 mm Hg.

You should

A) continue monitoring the patientB) administer labetalol (Trandate)C) administer nicardipine (Cardene)D) administer nitroprusside (Nitropress)E) administer nitroglycerin

7. A 59-year-old white female has a blood pressure consistently at or above 140/90 mm Hg. Her only other significant medical problem is diabetes mellitus, which is controlled by diet.

Which one of the following is the most clearly established advantage of angiotensin receptor blockers (ARBs) when compared with ACE inhibitors in patients such as this?

A) Reduced risk of persistent coughB) Reduced risk of headacheC) Reduced risk of heart failureD) Improved control of blood pressureE) Improved lipid profile

8. Which one of the following antihypertensive drugs is most likely to cause ankle edema?

A) HydrochlorothiazideB) Amlodopine (Norvasc)C) Lisinopril (Prinivil, Zestril)D) Losartan (Cozar)E) Atenolol (Tenormin)

9. A 72-year-old male presents to your clinic in atrial fibrillation with a rate of 132 beats/min. He has hypertension, but no history of heart failure or structural heart disease. He is otherwise healthy and active.

The best INITIAL approach to his atrial fibrillation would be

A) rhythm control with antiarrythmics and warfarin (Coumadin) only if he cannot be consistently maintained in sinus rhythm

B) rhythm control with antiarrythmics and warfarin regardless of maintenance of sinus rhythm

C) ventricular rate control with digoxin, and warfarin for anticoagulationD) ventricular rate control with digoxin, and aspirin for anticoagulation E) ventricular rate control with a calcium channel blocker or n-blocker, and warfarin for

anticoagulation

10. A 50-year-old male presents with a 1-day history of fever and chest pain. The chest pain is worse when he is in a supine position and with deep inspiration, and improves when he leans forward. He has no shortness of breath and has never had this problem before. His vital signs are normal except for a temperature of 37.8°C (100.0°F). He has no other medical problems or allergies, and takes no medications. An EKG reveals widespread ST-segment elevation, upright T waves, and PR-segment depression. His troponin level is normal. An echocardiogram is pending.

Which one of the following would be the most appropriate treatment for this patient?

A) AspirinB) PrednisoneC) HeparinD) Enoxaparin (Lovenox)