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1. You are working with a 48-year-old type 2 diabetic, diagnosed 1 month The patient wishes to lose weight to help manage his illness, but is not really interested in exercise. You work with him on a dietary plan that dimin- ishes his daily calorie intake by 500 calories per day. All things being equal, how much weight can this patient expect to lose in 6 weeks?
- 3 lb
- 6 lb
- 9 lb
- 12 lb
- 15 lb
2. After 2 months of working on diet and attempting an exercise pro- gram, a patient complains of making limited Indeed, her weight has stayed stable despite engaging in 20 minutes of walking 3 days per week, and limiting caloric intake. She asks if she can try medication to help with her weight loss goals. Which of the following is true regarding the use of medication in weight loss programs?
- Medications used for weight loss are unsafe and should be avoided
- There is no role for medications in weight loss programs
- Short courses of some medications have been shown to be helpful in initiating and maintaining weight loss
- Long courses of some medications have been shown to be helpful in initiating and maintaining weight loss
- Medications can be a helpful adjunct to a weight loss program
3. A 49-year-old African American perimenopausal woman is seeing you after having fractured her Her past medical history is significant for oral contraceptive use for 20 years, obesity and Grave’s disease leading to cur- rent hypothyroidism. She nursed two children for 6 months each. Which component of the patient’s history puts her at increased risk for osteoporosis?
- African American race
- Oral contraceptive use
- Grave’s disease
- Breast feeding
4. A 32-year-old woman is seeing you because her mother has been diag- nosed with She asks you what type of exercise will help her pre- vent the development of the disease. According to recommendations, which of the following exercises is recommended to help maintain bone mass?
5. You are caring for a 48-year-old Caucasian woman with a history of anorexia nervosa in her late She was an elite track and field athlete in her late teens and early 20s, and was considered for the US Olympic team in her prime. Which of the following options is best for primary osteo- porosis screening in this woman?
- Physical examination
- Serum calcium
- Serum human osteocalcin levels
- Bone density imaging
6. You are evaluating a 76-year-old woman on long-term glucocortico- steroid therapy for polymyalgia Which of the following is the diagnostic imaging test of choice to diagnose osteoporosis?
- Plain radiographs
- Single photon absorptiometry
- Dual photon absorptiometry
- Dual energy x-ray absorptiometry
- Quantitative computerized tomography of bone
7. You screened a 52-year-old, at-risk woman for osteoporosis using a DEXA You received a T-score and a Z-score in the report. Which of the following indicates osteoporosis?
- An equal T- and Z-score
- A T-score of +2.5
- A T-score of -2.5
- A Z-score of +2.5
- A Z-score of -2.5
8. You have diagnosed a 53-year-old woman with She is postmenopausal, and you are considering estrogen replacement therapy. Which of the following is not an absolute contraindication to estrogen replacement therapy?
- A history of breast cancer
- A history of uterine cancer
- A history of estrogen-dependent neoplasia
- Abnormal genital bleeding
- A history of a thromboembolic disorder
9. You are treating an elderly postmenopausal woman with osteoporo- She recently suffered an acute osteoporotic vertebral fracture, and is suffering from secondary pain. Which osteoporosis treatment also has anal- gesic effects with respect to bone pain?
- The combination of calcium and vitamin D
- Alendronate (Fosamax)
- Raloxifene (Evista)
10. You have just diagnosed osteoporosis in a postmenopausal She is considering treatment alternatives and wonders about the bisphos- phonates. Which of the following is the best description of how this class of medications works?
- They increase calcium absorption in the gastrointestinal (GI) tract
- They block the activity of the cytokines that stimulate bone reabsorption
- They bind to bone surfaces to inhibit osteoclast activity
- They stimulate osteoblasts and increase bone formation
- They mimic estrogen’s effect on bone
11. You are seeing a 32-year-old woman for Your differential diagnosis includes major depressive disorder, but she does not describe a depressed or irritable mood. Of the following choices, which symptom of depression must be present in order to diagnose a major depressive disor- der in someone without depressed mood?
- Sleep changes
- Loss of interest or pleasure in usually enjoyable activities
- Guilt or feelings of worthlessness
- Loss of energy
- Change in appetite
12. You have just diagnosed depression in an otherwise healthy adult He has agreed to start an antidepressant medication, but is concerned about sexual side effects. Which of the following medications is least likely to cause sexual side effects in this patient?
13. You are discussing treatment options for a 43-year-old woman with major depressive Which of the following is a true statement regarding the effectiveness of treatment for depressive disorders?
- Only about 25% of patients that receive medication alone will find the medica- tion to be effective
- Patients who find one medication ineffective are likely to find all medications ineffective
- In order to prevent a relapse of depressive symptoms, patients should continue treatment for 3–4 months
- In general, patients respond best to the combination of medication and counseling
- Electroconvulsive therapy is ineffective when compared with newer medical therapy
14. You are treating a 48-year-old man for major His medical history includes a head injury several years ago that has left him with a seizure disorder. Which of the following antidepressants would be contraindicated?
15. Which of the following conditions is considered an anxiety disorder?
- Social phobia
- Conversion disorder
- Somatization disorder
- Anorexia nervosa
- Histrionic personality disorder
16. You are following a 16-year-old girl with a suspected eating Which of the following, if present, would help differentiate anorexia ner- vosa from bulimia nervosa?
- Binge eating or purging
- The use of laxatives, diuretics, or enemas
- Self-evaluation is unduly influenced by body weight and shape
- Episodic lack of control over eating
- Inappropriate behaviors to prevent weight gain
17. Which of the following is a major risk factor for the development of attention-deficit/hyperactivity disorder (ADHD)?
- Environmental exposure to tobacco smoke
- Environmental allergies
- A family history of ADHD
- Low self-esteem
- Academic underachievement
18. A 26-year-old male college graduate is seeing you for an office He is concerned that he may have adult ADHD. Which of the following is true regarding this condition?
- The symptoms are likely to be more pronounced in adults as compared with children
- Children diagnosed with ADHD commonly continue to have symptoms into adulthood
- Sleep disturbance is a distinctive feature of adult ADHD
- Appetite disturbance is a distinctive feature of adult ADHD
- The symptom picture of adult ADHD mimics that in children
19. What is the principal mechanism by which stimulant medications work to improve symptoms of ADHD?
- Inhibition of serotonin reuptake
- Stimulation of serotonin production
- Inhibition of dopamine and norepinephrine reuptake
- Stimulation of dopamine and norepinepherine production
- Blocking the release of serotonin
20. A 45-year-old woman presents to your office for She reports that over the last few weeks, she’s noted an enlarging mass in the front of her neck. She feels well, has had no changes in her health, and denies symptoms of hyper- or hypothyroidism. She also denies recent viral illness. On examination, you note a diffusely enlarged thyroid that is ten- der to touch. What is her most likely diagnosis?
- Hashimoto’s thyroiditis
- Subacute lymphocytic thyroiditis
- Subacute granulomatous thyroiditis
- Suppurative thyroiditis
- Invasive fibrous thyroiditis
21. A 26-year-old woman presents with weight gain, lethargy, dry skin, sweatiness, cold intolerance, and thinning You suspect hypothy- roidism and order the appropriate laboratory tests. Her thyroid stimulating hormone is high, and her free T3 and free T4 are both low. Which of the following is the most likely diagnosis?
- Primary hypothyroidism
- Secondary hypothyroidism
- Iodine deficiency
- Thyroid hormone resistance
- Subclinical hypothyroidism
22. You are screening a 35-year-old woman who presents with tachycar- dia, nervousness, tremor, palpitations, heat intolerance, and weight You suspect Graves’ disease. What single test is best for differentiating Graves’ disease from other causes of hyperthyroidism?
- Thyroid stimulating hormone
- TSH with free T4 and free T3
- Thyroid receptor antibodies
- Radionucleotide imaging of the thyroid
- Thyroid ultrasound
23. When examining a 35-year-old, you notice a firm 3 cm thyroid nod- ule. His thyroid studies are normal, and he is clinically Radionu- cleotide imaging demonstrates uptake in the thyroid nodule. What is the most likely diagnosis?
- Colloid cyst
- Thyroid adenoma
- Thyroid carcinoma
- Metastatic disease