Please select a team.

A. B.

51%

49%

A. Team KalapakiB. Team Poipu

Broken Heart

I Am Woman

Head CaseThe Eyes Have It

Shoot Me 

10 10 10 10 10

20 20 20 20 20

30 30 30 30 30

40 40 40 40 40

50 50 50 50 50

Question 1 – 10Which of the following is considered the optimal device for reducing mortality in patients with cardiomyopathy and low

ejection fraction?

A. B. C. D.

11%

74%

1%

14%

A. Dual Chamber Pacemaker

B. Biventricular Pacemaker

C. External Automated Defibrillator -- EAD

D. Automated Internal Cardiac Defibrillator--AICD

Question 1 – 20 This Heart Sound is Characteristic of an Atrial

Septal Defect:

A. B. C. D. E.

8% 5% 5%

20%

61%

A. Ejection ClickB. Ventricular GallopC. Fixed Splitting of S2D. Split S1E. Opening Snap

Question 1 – 30The Most Common “Secondary” Cause of

Tricuspid Regurgitation is:

A. B. C. D. E.

3%9% 8%11%

70%A. Right Bundle Branch Block

B. Mitral RegurgitationC. Pulmonary

HypertensionD. EndocarditisE. Rheumatic Fever

Question 1 – 40List the 2 drugs typically employed in the “pill-in-the-pocket” regimen to control atrial fibrillation:

A. B. C. D. E.

3%

22%

7%

42%

26%

A. Quinidine & Procainamide

B. Propafanone & Flecanide

C. Digitalis & VerapamilD. Amiodarone &

DiltiazemE. Warfarin & Verapamil

Question 1 - 50A 50 yo man presents to you with 3 months of mild DOE and vague nonprogressive chest discomfort. His Px is normal except for BP = 140/92. CT angiogram shows 70-80% stenosis of his RCA, trivial stenosis elsewhere. His labs remarkable for LDL of 101 mg/dl, otherwise normal. You should recommend which of the following at this time:

Question 1 – 50You should recommend which of the following

at this time:

A. B. C. D. E.

26%

41%

3%

26%

3%

A. Nuclear perfusion imaging to assess ischemia

B. Referral to cardiac interventionalist for PTCA/stent

C. Referral to cardiac surg b/c of patients’ young age

D. Medical therapy without revascularization with: ASA, beta-blocker, and statin

E. Medical therapy with: clopidogrel, ACEI, and Niacin

Question 2 - 10

32 yo woman 2nd trimester preg has BP 150-160/90-95 multiple times in past 3 weeks. No edema, no proteinuria. No HTN hx. What is most appropriate next step in management:

Question 2 – 10What is most appropriate next step in

management:

A. B. C. D. E.

20%

5%

19%

4%

52%

A. Salt restriction & bed rest

B. Administer diureticC. Administer

methyldopaD. Administer lisinoprilE. Avoid anti-HTN drug if

diastolics below 100 mm Hg

Question 2 - 2072 yo woman presents for PHE. Hx + for HTN, Dyslip, Depression. Well otherwise, monogamous. FH + for cervical CA in sister. Last Pap smear 2 years ago neg. Regular paps neg over last 15 years. What should you advise re: Pap testing?

Question 2 – 20

What should you advise re: Pap testing?

A. B. C. D. E.

3% 2% 5%9%

81%

A. Pap now with HPV test

B. Pap now with reflex HPV test

C. D/C Pap testingD. Pap next yearE. Pt should decide how

often to test

Question 2 - 30

45 yo woman presents with menstrual change, hot flash, vag dryness. Menses previously regular, last 9 mo fluctuate between 20-90 days. Light vag bleeding between last 2 cycles. Took OCs in remote past well tolerated. Requests them again to regulate bleeding and hot flashes. Exam normal. Most appropriate next step:

Question 2 – 30

Most appropriate next step:

A. B. C. D. E.

32%

19%

24%

15%

9%

A. Reassure pt that bleeding pattern typical of peri-menopause & prescribe low dose OC

B. Reassure pt that bleeding pattern is typical of peri-menopause and advise against OC

C. Recommend menopausal HRT because she is per-menopausal.

D. Recommend pelvic USE. Recommend endometrial

biopsy

Question 2 - 40A 42 yo G2P2 woman with very heavy, painful menses seeks advice. Symptoms did not improve with OCs or endometrial ablation. She met with gynecologist and wishes to proceed with hysterectomy. Advised by OB/GYN to consider oopherectomy as well. She asks your advice. Fam hx. is positive for maternal aunt with ovarian CA. Which of the following is notan adverse risk associated with oopherectomy?

Question 2 – 40

Which of the following is not an adverse risk associated with oopherectomy?

A. B. C. D. E.

7%

66%

23%

2%1%

A. Increased risk of cognitive dysfunction

B. Increased risk of breast cancer

C. Increased risk of osteoporosis

D. Increased risk of cardiovascular disease

E. Increased risk of parkinsonism

Question 2 - 50

28 yo woman presents for refill of OCs (EE + Norgestimate). Since beginning 1 year ago she has HA during 1st 2 days of “blanks” each month. HA associated with black spot in vision with surrounding flashing lines left sided HA lasting 6-8 hours with nausea. Takes OTC analgesics and sleeps it off. She wishes to continue OCs. She takes “Excedrin” for HA. Px is normal. What is the best management plan?

Question 2 – 50

What is best management plan?

A. B. C. D.

11%

50%

11%

28%

A. Add low dose estrogen patch during pill-free week

B. Switch to extended-cycle combined OC—3 months before withdrawal

C. Take sumatriptan at onset of HA

D. Stop OCs and find alternative BC

Question 3 – 10This disorder is associated with nightmares, flashbacks, unwanted intrusive memories is:

A. B. C. D. E.

1%

99%

0%0%0%

A. Generalized Anxiety Disorder

B. Post Traumatic Stress Disorder

C. Obsessive Compulsive Disorder

D. Dissociative Identity Disorder

E. Bipolar Disorder

Question 3 - 20A 28 yo man taking paroxetine and lithium for bipolar disorder is hospitalized for severe MRSA cellulitis. He is placed on Linezolid and discharged home. 1 day post d/c he presents to the ED with confusion, agitation, vomiting, fever, hypotension and shivering. The most likely diagnosis is:

Question 3 – 20The most likely dx is:

A. B. C. D. E.

14%

1%5%

31%

50%A. Sepsis SyndromeB. Tardive DyskinesiaC. Serotonin SyndromeD. Neuroleptic Malignant

SyndromeE. Drug Induced

Akathesia

Question 3 - 30A 45 yo man presents seeking treatment for alcoholism. He has had 2 DUIs in last 2 years and lost 1 job related to drinking. He takes no other recreational drugs but smokes 1 PPD. His Px is normal except for BP 150/88. He continues to drink but wishes to stop. The best medication to assist him at this time is:

Question 3 – 30

The best medication to assist him at this time is:

A. B. C. D. E.

29%

1%

38%

20%

12%

A. ClonidineB. MethadoneC. LabeteololD. LorazepamE. Naltrexone

Question 3 - 40

A 45 yo woman presents with c/o of persistent fatigue, recurrent abdominal pain, recurrent HA, myalgias, dysuria, arthralgias, confusion, and dyspaureunia. She has undergone extensive lab testing and imaging, all are neg. Her Px is remarkable for multiple areas of tenderness on her body but no other abnormalities.

Question 3 – 40The most likely disorder is:

A. B. C. D. E.

29%

0% 1%0%

70%

A. Somatization Disorder B. Munchausen

SyndromeC. Fibromyalgia

SyndromeD. MalingeringE. Systemic Lupus

Erythemetosis

Question 3 - 50A 55 yo woman presents with c/o fatigue, malaise, sadness, anhedonia, impaired concentration, insomnia, anorexia, and anxiety. She notes that she has lost 4 pounds in last 2 months. Exam is neg except BMI = 19 and BP = 148/92. Prelim lab w/u is norm. At this time the best medical therapy for this patient is likely:

Question 3 – 50

At this time the best medical therapy for this patient is likely:

A. B. C. D. E.

2%

15%13%

43%

27%

A. Buspirone B. Venlafaxine C. MirtazapineD. FluoxetineE. No medications, refer

for psychological counsel

Question 4 – 10What is the term for inflammation of

the iris & ciliary body?

Question 4 – 10

What is the term for inflammation of the iris & ciliary body?

A. B. C. D. E.

6%

20%

70%

2%2%

A. KeratitisB. Ciliary FlushC. ConjunctivitisD. HyphemaE. Anterior Uveitis

Question 4 – 20

What is the most likely cause for the depicted image?

Question 4 – 20

What is the most likely cause for the depicted image?

A. B. C. D. E.

47%

34%

0%

18%

1%

A. Nisseria ghonorrohoea

B. Chlamydia trachomatis

C. Herpes KeratitisD. Staph. AureuesE. Corneal abrasion

Question 4 – 30The name for this fibro-vascular

tissue proliferation medial to the iris is?

Question 4 – 30The name for this fibro-vascular tissue

proliferation medial to the iris is?

A. B. C. D. E.

2% 3% 0%0%

95%A. ChalazionB. EntropionC. PterygiumD. HordeolumE. Stye

Question 4 - 40

What disease process is suggested by the accompanying image from a 60 –year old man’s fundus exam at routine Px:

Question 4 – 40What disease process is suggested by the

accompanying image from a 60 –year old man’s fundus exam at routine Px:

A. B. C. D. E.

5%

12%

33%

8%

42%A. Diabetic RetinopathyB. Macular DegenerationC. GlaucomaD. Retinal Vein OcclusionE. Papilledema

Question 4 - 50A 65 year old woman presents to your office complaining of fatigue which has been present for months. For the last 3 months she states she has had visual impairment R eye > L. She is having particular trouble with blurred faces, traffic lights, cars straight ahead. Your funduscopic exam is shown here.

Question 4 – 50The most likely diagnosis is:

A. B. C. D.

16%

52%

25%

7%

A. Roth spotsB. Bechet’s SyndromeC. Diabetic RetinopathyD. Age related macular

degeneration

Question 5 – 10Which vaccine is not indicated for a 20 year old healthy college

student living at home? He has received normal childhood vaccines of varicella, MMR and last Tdap was at age 10.

A. B. C. D.

4%

66%

20%

10%

A. InfluenzaB. HPVC. TdD. Meningococcus

Question 5 – 20A 65 year-old man presents to establish care. He cannot recall his vaccine history and states he has not seen an MD for > 20

years. Which of the following vaccines is not indicated?

A. B. C. D. E.

2% 1% 1%

93%

2%

A. TdapB. ZosterC. PneumoccocalD. MMRE. Influenza

Question 5 - 30A healthy 35 yo married woman in 12th

week of gestation is referred by her OB to estab 10 care. She cannot recall her vaccination history and is not sure if she has had chicken pox. She does not know how to obtain her childhood vaccine records. At this visit she should receive which vaccines:

Question 5 – 30At this visit she should receive which vaccines:

A. B. C. D. E. F.

76%

2%

11%10%

0%1%

A. InfluenzaB. VaricellaC. MMRD. HPVE. A & BF. A & C

Question 5 - 40

A 45 yo man with recently diagnosed HIV transfers his 10 care to you. His CD4 count is 185. His HIV is currently treated with HAART. He is unaware of his vaccine status, but notes he’s been getting annual flu shots. Which of the following vaccines is not contraindicated:

Question 5 – 40Which of the following vaccines is not

contraindicated:

A. B. C. D. E.

1%

86%

5%6%1%

A. VaricellaB. Pneumoccocal C. MMRD. ZosterE. Influenza, Live

Attenuated (LAIV)

Question 5 – 50For healthy adults in whom a vaccine series is indicated, which vaccine is typically given in a

series of 2 doses:

A. B. C. D. E.

1% 4%0%

8%

87%A. HPV—femaleB. HPV—maleC. Hepatitis AD. Hepatitis BE. Meningococcus