COMAT –FAMILY MEDICINE 2024-2025 EXAM |COMPLETE
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS )
ALREADY GRADED A+.
B (although treatment with methimazole, proylthiouracil, radioactive
iodine, and surgical removal of the thyroid gland are plausible
treatments for Grave's disease, methimazole is recommnded as a first
line agent over propylthiouracil due to potential hepatotoxicity) -
ANSWER-A 56-year-old female complains of palpitations and an
unintentional 20 lb weight loss in the past six months. History reveals
that her menstrual periods stopped approximately 7 years ago. Vital
signs include a blood pressure of 135/85 and a heart rate of 110.
Physical examination reveals a non-tender enlarged thyroid gland
without nodules. Structural examination reveals tissue texture
changes at T2 associated with an upper thoracic flexion hump.
Laboratory studies reveal the following
TSH: 0.05 free
T3: 380 free
T4: 22
A thyroid stimulating immunoglobulin test is positive. The most
appropriate initial management is
A. levothyroxine
B. methimazole
C. proylthiouracil
,D. radioactive iodine ablation
E. thyroidectomy
D (the most likely diagnosis is onychomycosis - microscopic
evaluation is the best first step to make the diagnosis) (A; bacterial
infection is less likely than fungal) (B; Sabouraud's agar is used to
grow fungal specimens - culture results usually return after weeks, a
microscopic evaluation would be faster - culturing would be indicated
if the initial KOH prep shows absent fungi) (C; this procedure stains
fungal cell walls and helps in visualization - however, while this test is
more sensitive, it is more expensive) (E; empiric treatment is not
recommended due to side effects - additionally, treatment usually
lasts 3 months, not 1, due to the slow growing nature of toenails) -
ANSWER-A 66-year old female complains that the nail of her right
great toe is discolored and brittle. She states that she first noticed it 4
months ago during a pedicure. Physical examination reveals the right
great toenail to be yellowed, thickened, and has white subungual
debris. The most appropriate modality to confirm the most likely
diagnosis is
A. bacterial culture of nail clippings
B. culture of toenail scrapings on Sabouraud's medium
C. histopathologic examination of nail clippings under periodic acid-
Schiff stain
D. microscopic evaluation of toenail scrapings using KOH prep
E. one month terbinafine to confirm resolution
,D (indwelling catheter can cause a UTI with Pseudomonas aeruginosa
- the indicated treatment is with a fluoroquinolone like ciprofloxacin
or levofloxacin) (none of the other answer choices have action against
Pseudomonas) - ANSWER-A 70-year-old female who is 3 days status-
post urologic surgery develops a fever overnight in the hospital. She
has an indwelling Foley catheter with good urine output. Her past
medical history includes hypertension and urinary incontinence. She
has no significant family history. Vitals reveal her temperature to be
102.2F, pulse 82, respirations 15, and blood pressure 134/85. Physical
examination is remarkable for mild suprapubic tenderness. You note
a tender nodule on the lateral border of the umbilicus. Urinalysis
reveals 60 WBC/hpf, trace protein, positive leukocyte esterase,
positive nitrites, and no casts. A reflex culture grows motile, gram-
negative rods with a dark green appearance and fruity odor. The most
appropriate pharmacologic therapy includes
A. amoxicillin
B. cefotaxime
C. ceftriaxone
D. ciprofloxacin
E. trimethoprim-sulfamethoxazole
E (threatened abortion is used to describe any vaginal bleeding that
occurs within the first 20 weeks of pregnancy) (A; a complete abortion
is when the products of conception have completely evacuated the
uterus and the cervical os is closed) (B; an incomplete abortion is
, when the products of conception can be seen or palpated in the
cervical canal, and the cervical os is open) (C; an inevitable abortion
is when the products of conception can be seen or palpated within the
uterus through the dilated cervical os) (D; partial abortion is not an
appropriate or defined medical term) - ANSWER-A 32-year-old G1P0
female at 16 weeks' gestation presents with vaginal bleeding. History
reveals she had pelvic inflammatory disease of unknown etiology
prior to conception. Pelvic examination reveals the cervical os to be
closed. The most likely diagnosis is
A. complete abortion
B. incomplete abortion
C. inevitable abortion
D. partial abortion
E. threatened abortion
D (the most documented causes of miscarriages are maternal age,
history of previous miscarriage, and maternal smoking) (A; risk of
miscarriage according to maternal age is 20% for 35 years, 40% for 40
years, and 80% for 45 years) (B; miscarriages can be related to
increased gravidity but not nulliparity) (C; PID increases a patient's
risk for infertility, but not miscarriage unless there is an active
infection) (E; there are no studies to indicate that this is a significant
contributor) - ANSWER-A 32-year-old G1P0 female at 16 weeks'
gestation presents with vaginal bleeding. History reveals she had
pelvic inflammatory disease of unknown etiology prior to conception.
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