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Question 1 of 60
1. Question
Case 1
Mrs. Backed Up, 55, presents complaining of constipation over several weeks. She has experienced intermittent constipation throughout her adult life. Her bowel pattern until recently consisted of a soft, brown, well-formed bowel movement every 2 days. Now, her stool is firm, small, round, and difficult to pass. She has been taking acetaminophen nightly for a sprained ankle which she suffered a month ago. She also takes amlodipine and levothyroxine. Her last TSH, done a year ago, was normal.
- What other symptoms would you ask about on history? Name EIGHT. (8 points)
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Question 2 of 60
2. Question
- Name FOUR lifestyle measures that might help Mrs. Backed Up return to her usual pattern. (4 points)
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Question 3 of 60
3. Question
- Name FOUR classes of medications for constipation and name one medication from each class. (8 points)
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Question 4 of 60
4. Question
Mrs. Backed Up applies your suggestions for lifestyle change and her bowel function reverts to normal. Two years later, she presents for her periodic health exam. Her bowel movements are regular and soft. She denies weight loss, fatigue, or constitutional symptoms. She has maintained the dietary changes that she started two years ago. You offer her screening for colon cancer.
- What ONE laboratory investigation do you order? (1 point)
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Question 5 of 60
5. Question
- How often do you suggest that she has this test? (1 point)
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Question 6 of 60
6. Question
- If the result of the above test is positive, what is your next course of action? Name ONE. (1 point)
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Question 7 of 60
7. Question
Case 2
Mr Key is a 34 year old healthy patient of yours who is travelling to Thailand in 3 months and he states he will be an area where malaria is prevalent. He comes to you for travel counselling.
- What are THREE non-pharmacologic strategies to protect against malaria? (3 points)
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Question 8 of 60
8. Question
- Name FOUR pharmacologic agents that can be taken to protect against malaria? (4 points)
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Question 9 of 60
9. Question
- Mr. Key is fair-skinned and burns easily. What medication would you prefer to avoid in him? (1 point)
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Question 10 of 60
10. Question
- Mr. Key reports that he has had periods of time in his life when he required treatment for depression and suicidal ideation. Which medication would you avoid prescribing to him? (1 point)
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Question 11 of 60
11. Question
- Mr. Key returns to your office 2 weeks after his trip presenting with fever of unknown origin. When you ask him if he completed the prophylactic medication you had prescribed, he states he forgot to take it. What investigation will confirm your suspected diagnosis of malaria? (1 point)
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Question 12 of 60
12. Question
Case 3
Rachelle, age 16, presents at the after-hours clinic on Sunday afternoon. She had unprotected intercourse and a friend told her she could prevent pregnancy with a pill. She has no allergies and is taking no medications.
- As you consider whether the morning-after pill is appropriate, what is the most important question to ask Rachelle? State ONE. (1 point)
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Question 13 of 60
13. Question
- What is the most common side effect of oral post-coital contraception? State ONE. (1 point)
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Question 14 of 60
14. Question
- Excluding allergy, what is an absolute contraindication to treatment with oral post-coital contraception? State ONE. (1 point)
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Question 15 of 60
15. Question
- Rachelle is concerned about the possible side effects of oral post-coital contraception. What other option exists for morning-after contraception? State ONE. (1 point)
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Question 16 of 60
16. Question
- What other subjects do you discuss with Rachelle? List THREE. (3 points)
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Question 17 of 60
17. Question
Case 4
A 20-year old competitive female basketball player presents with a knee injury. She was playing basketball the evening before and injured her knee while attempting a rapid pivot. Her knee gave out and she heard a pop. She required help to leave the playing surface and did not return to the game. Her knee started to swell within an hour.
- What diagnosis do you suspect? (1 point)
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Question 18 of 60
18. Question
- List THREE points from the history which support this diagnosis. (3 points)
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Question 19 of 60
19. Question
- Name TWO maneuvers on physical exam which test for this condition. (2 points)
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Question 20 of 60
20. Question
Two weeks later, she tells you that the swelling is improving but that she “doesn’t trust” the knee, feeling as if it will give out on her. In fact, there has been one episode of painless buckling. Your physical exam confirms the diagnosis.
- What are the indications for surgical repair in this patient? (3 points)
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Question 21 of 60
21. Question
Case 5
A 66 year-old female comes into the office for an exam. She had recently slipped on ice and fell on her back. She complains of pain in her lower back but denies any neurological symptoms or lower extremity weakness. She is a smoker and weighs 58kg. She is menopausal and has celiac disease but is otherwise healthy. She takes a multivitamin but otherwise takes no other medications.
- Name FIVE risk factors for osteoporosis? (5 points)
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Question 22 of 60
22. Question
- Name THREE findings you could look for on physical exam in someone with risk factors for low bone mineral density? (3 points)
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Question 23 of 60
23. Question
- What is the definition of osteoporosis on bone mineral density testing? (1 point)
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Question 24 of 60
24. Question
- What laboratory investigations would you order to rule out secondary causes of osteoporosis? Name FIVE. (5 points)
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Question 25 of 60
25. Question
- Not including vitamin and mineral supplementation, what lifestyle changes would you discuss with this patient? Name THREE. (3 points)
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Question 26 of 60
26. Question
- What is her daily recommended intake of calcium? (1 point)
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Question 27 of 60
27. Question
- If her CAROC/FRAX score indicated that she was high risk for osteoporosis, what classes of medications could you use? Name THREE. (3 points)
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Question 28 of 60
28. Question
Case 6
Elizabeth Drolet visits you in your office for a discussion about breast cancer screening. She is a healthy, non-smoking 51 year-old woman with no family history of breast cancer. Her BMI is normal. She has not had a mammogram.
- Is Ms. Drolet at high, average, or low risk of contracting breast cancer? (1 point)
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Question 29 of 60
29. Question
- What is the approximate Number Needed to Screen (NNS) to prevent one death from breast cancer for women aged 50 – 69 years? (1 point)
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Question 30 of 60
30. Question
- If you recommend mammography for this woman, how often should she be screened? (1 point)
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Question 31 of 60
31. Question
- In counseling Ms. Drolet, what pros and cons of screening would you discuss? Name FOUR. (4 points)
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Question 32 of 60
32. Question
- Name FIVE qualities of a good screening test? (5 points)
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Question 33 of 60
33. Question
Case 7
Mrs. A. brings in her 12 month old, Madelyn to clinic. She states Madelyn has had a cold for the past 3 days and has been increasingly “fussy” over the past 24h. She’s not feeding as well and crying more often. Mrs. A. has also observed the baby pulling at her right ear. Despite this, Madelyn is feeding well and sleeping normally. This morning she had an axillary temperature of 38 degrees C.
- What are THREE signs you would look for on examination of the patient’s ears that would be consistent with a diagnosis of Acute Otitis Media? (3 points)
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Question 34 of 60
34. Question
- What are TWO risk factors for the development of AOM? (2 points)
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Question 35 of 60
35. Question
- Name TWO of the three major bacterial pathogens that cause AOM? (2 points)
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Question 36 of 60
36. Question
- If you decided to treat this patient with antibiotics, name the first-line agent you would use and the duration of therapy in an uncomplicated case. (2 points)
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Question 37 of 60
37. Question
- Name 2 second-line anti-microbial agents you could choose: (2 points)
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Question 38 of 60
38. Question
- What is the “Watchful Waiting” approach? (1 point)
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Question 39 of 60
39. Question
- What are the criteria for the “Watchful Waiting” approach? (3 points)
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Question 40 of 60
40. Question
Case 8
A healthy 45 year-old Caucasian man presents for his periodic health exam. His father suffers from hemochromatosis and your patient asks about his risk of acquiring this problem.
- What is the inheritance pattern of familial hemochromatosis? (1 point)
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Question 41 of 60
41. Question
- Patients originating from which part of the world are at highest risk? (1 point)
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Question 42 of 60
42. Question
- What is the mechanism by which familial hemochromatosis causes iron overload? (2 points)
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Question 43 of 60
43. Question
- What is the most common presentation of hemochromatosis? Name TWO. (2 points)
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Question 44 of 60
44. Question
- Name FIVE clinical conditions that can result from familial hemochromatosis. (5 points)
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Question 45 of 60
45. Question
- What is the most sensitive lab test to order for a patient suspected of having this condition? (1 point)
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Question 46 of 60
46. Question
- What ONE other investigation could you offer your patient to confirm the diagnosis? (1 point)
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Question 47 of 60
47. Question
- What is the treatment for hemochromatosis? (1 point)
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Question 48 of 60
48. Question
- Which test would you use to monitor your patient’s progress through therapy? (1 point)
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Question 49 of 60
49. Question
- What other specific conditions might lead to elevation in the value of this test? Name THREE. (3 points)
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Question 50 of 60
50. Question
Case 9
Mrs. H.T, an otherwise healthy 55 year-old woman, is seeing you in follow-up for essential hypertension. She has been managed with a thiazide diuretic, and lifestyle modification. She has achieved and maintained a target BP of 138/84, until her last visit, when her BP was 150/96. She continues to walk 1 hour per day, has lost 10lbs, and has increased the number of servings of fresh fruits and vegetables in her diet. Today, her BP is 154/96. Home BP readings have averaged in the 150s/90s.
- Name FOUR classes of first line agents that can be used in the medical management of hypertension for this patient. (4 points)
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Question 51 of 60
51. Question
You would like to change her current regimen to achieve better blood pressure control. You decide to start your favourite ACE-I.
- What two laboratory investigations will you perform in a few weeks to rule out adverse effects of this medication? (2 points)
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Question 52 of 60
52. Question
Mrs. H.T. tells you her husband has a home BP cuff. You calibrate the cuff and ensure appropriate fit.
- What is her target blood pressure when using this cuff? (1 point)
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Question 53 of 60
53. Question
- You instruct Mrs. H.T. about proper technique for taking blood pressure at home. What do you advise? Name SIX. (6 points)
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Question 54 of 60
54. Question
- If Mrs. H.T.’s hemoglobin A1C is 7.4%, what is her blood pressure goal? (1 point)
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Question 55 of 60
55. Question
- Mrs. H.T. is trying to manage her salt intake. What is the current Canadian recommendation for maximum sodium intake per day for a person with hypertension? (1 point)
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Question 56 of 60
56. Question
Case 10
A 58 year-old man presents to your local emergency department with a one-day history of confusion. He has no history of head trauma, no alcohol use and he has no fever. Serum calcium is found to be 5.0 (critically high).
- List FOUR symptoms of hypercalcemia. (4 points)
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Question 57 of 60
57. Question
- List TWO acute treatments of hypercalcemia. (2 points)
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Question 58 of 60
58. Question
- List the TWO most common causes of hypercalcemia. (2 points)
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Question 59 of 60
59. Question
- List THREE blood tests you would order next to help determine the severity and cause of the hypercalcemia. (3 points)
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Question 60 of 60
60. Question
- What are TWO potentially life threatening consequences of hypercalcemia? (2 points)
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