, SECTION I ,
General Considerations in Clinical Medicine
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,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,, QUESTIONS
DIRECTIONS:,Choose,the,one,best,response,to,each,question.
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1.,All,of,the,following,statements,regarding,practice,guidelines,set,forth,by,governing,agencies,and,professional,orga
nizations,are,true,EXCEPT:
A. Clinical,practice,guidelines,protect,caregivers,against,inappropriate,charges,of,malpractice,,yetdo,not,provide,pr
otection,for,patients,from,receiving,substandard,care.
B. Practice,guidelines,have,largely,reached,a,stage,of,nuance,allowing,them,to,address,every,uniqueillness,and,pati
ent,presented,to,the,modern,physician.
C. Practice,guidelines,provide,a,legal,constraint,to,physicians,,and,deviation,from,guideline-
basedcare,invariably,leaves,physicians,vulnerable,to,legal,action.
D. Where,different,organizations,disagree,regarding,practice,guidelines,,a,third-
party,agency,has,been,appointed,to,mitigate,these,disagreements,such,that,now,all,major,organizations’,guideli
nes,are,consistent.
E. All,of,the,above,statements,are,not,true.
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2.,Regarding,molecular,medicine,,which,of,the,following,statements,represents,an,INACCURATE,example,of,the,liste
d,area,of,study:
A. Exposomics:,An,endocrinologist,studies,sunlight,exposure,and,population,risk,of,hip,fracture.
B. Metabolomics:,A,biochemist,studies,the,rate,of,flux,through,the,creatine,kinase,pathway,during,the,cardiac,cycl
e.
C. Metagenomics:,A,biologist,studies,the,genomic,alterations,in,molds,commonly,found,in,humandwellings.
D. Microbiomics:,A,microbiologist,studies,the,genomic,variation,in,thermophiles,,bacteria,that,cansurvive,extreme
,heat,near,deep,ocean,vents.
E. Proteomics:,A,cardiologist,studies,desmosomal,proteins,and,their,posttranslational,modifications,in,studying,ar
rhythmogenic,right,ventricular,dysplasia.
I-3.,Which,of,the,following,is,the,best,definition,of,evidence-based,medicine?
A. A,summary,of,existing,data,from,existing,clinical,trials,with,a,critical,methodologic,review,andstatistical,analysis,
of,summative,data
B. A,type,of,research,that,compares,the,results,of,one,approach,to,treating,disease,with,anotherapproach,to,treati
ng,the,same,disease
C. Clinical,decision-
making,support,tools,developed,by,professional,organizations,that,includeexpert,opinions,and,data,from,clinica
l,trials
D. Clinical,decision,making,supported,by,data,,preferably,randomized,controlled,clinical,trials
E. One,physician’s,clinical,experience,in,caring,for,multiple,patients,with,a,specific,disorder,over,many,years
I-4.,Which,of,the,following,is,the,standard,measure,for,determining,the,impact,of,a,health,condition,on,a,population?
A. Disability-adjusted,life-years
, B. Infant,mortality
C. Life,expectancy
D. Standardized,mortality,ratio
E. Years,of,life,lost
I-5.,Which,of,the,following,statements,regarding,disease,patterns,worldwide,is,true?
A. Childhood,undernutrition,is,the,leading,risk,factor,for,global,disease,burden.
B. In,a,2006,publication,,the,World,Health,Organization,(WHO),estimated,that,10%,of,the,totalglobal,burden,of,dis
ease,was,due,to,modifiable,environmental,risk,factors.
C. In,2010,,ischemic,heart,disease,was,the,leading,cause,of,death,among,adults.
D. In,the,last,two,decades,,mortality,attributed,to,communicable,diseases,,maternal,and,perinatalconditions,,and,
nutritional,deficiencies,has,remained,fairly,stable,,with,the,majority,(76%),of,mortality,from,these,causes,occurr
ing,in,sub-Saharan,Africa,and,southern,Asia.
E. While,poverty,status,has,been,shown,to,be,linked,to,health,status,on,the,individual,level,,thesame,relationship,d
oes,not,hold,true,when,studying,the,link,between,national,health,indicators,and,gross,domestic,product,per,capi
ta,among,nations.
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6.,You,are,appointed,to,a,governmental,healthcare,advisory,subcommittee,concerned,with,addressing,problems,faci
ng,the,global,health,community.,Your,task,is,to,draw,general,conclusions,from,the,global,fight,against,tuberculosis,(T
B),and,human,immunodeficiency,virus,(HIV)/acquired,immunodeficiency,syndrome,(AIDS),that,may,be,applied,in,co
mbatting,other,diseases,,including,noncommunicable,diseases.,Which,of,the,following,conclusions,is,reasonable,wh
en,considering,HIV/AIDS,and,TB,as,chronic,diseases?
A. Barriers,to,adequate,healthcare,and,patient,adherence,imposed,by,extreme,poverty,must,beconcomitantly,add
ressed,to,adequately,treat,and,prevent,chronic,disease,in,developing,nations.
B. Charging,small,fees,for,health,services,(e.g.,,AIDS,prevention,and,care),supplies,the,patient,witha,sense,of,the,tre
atment’s,value,and,increases,compliance,and,overall,public,health.
C. Despite,adequate,available,tools,to,practice,their,trade,locally,in,developing,nations,,manyphysicians,and,nurse
s,emigrate,to,developed,nations,to,practice,their,respective,trades,,a,phenomenon,called,“brain,drain.”
D. In,developed,nations,where,physicians,are,abundant,,community,health,worker,supervision,ofthe,care,of,chroni
cally,ill,patients,is,not,effective.
E. In,the,case,of,chronic,infectious,diseases,,switching,from,one,drug,to,another,through,aprolonged,course,of,trea
tment,provides,the,highest,cure,rate,by,obviating,the,infectious,agent’s,ability,to,develop,resistance,to,any,singl
e,drug.
I-7.,Mrs.,Jones,,a,22-year-
old,African,American,woman,,presents,to,Dr.,Smith,,an,internal,medicine,specialist,,with,a,facial,rash.,Mrs.,Jones,stat
es,that,the,rash,began,after,spending,a,day,at,the,beach,with,her,family.,She,also,notes,that,her,metacarpophalangea
l,and,proximal,interphalangeal,joints,have,been,painful,and,swollen,for,the,preceding,2,weeks.,On,examination,,the,j
oints,are,swollen,and,tender.,Laboratory,analysis,discloses,reduced,creatinine,clearance,,proteinuria,,and,hemolytic,
anemia.,Antinuclear,antibodies,(a,test,with,a,high,negative,predictive,value,for,systemic,lupus,erythematosus),are,d
etected,at,significant,titer,,and,ultimately,,the,diagnosis,of,systemic,lupus,erythematosus,is,made.
Two,weeks,later,,Mrs.,Johnson,,a,24-year-
old,African,American,woman,,presents,with,a,facial,rash,and,elbow,pain,to,Dr.,Smith.,After,a,cursory,interview,and,br
ief,physical,exam,,Dr.,Smith,sends,blood,work,only,testing,for,antinuclear,antibodies.,When,the,test,returns,negative,
(no,antibodies,detected),,Dr.,Smith,presumes,this,to,be,a,false-
negative,result,and,starts,Mrs.,Johnson,on,hydroxychloroquine,and,prednisone,for,treatment,of,systemic,lupus,eryt
hematosus.,Which,heuristic(s),did,Dr.,Smith,likely,employ,in,diagnosing,Mrs.,Johnson,with,systemic,lupus,erythemat
osus?
A. Availability,heuristic
B. Anchoring,heuristic
C. Bayes’,rule
D. Confirmation,bias
, E. A,and,B
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8.,You,have,invented,a,blood,test,,which,you,name,“veritangin,”,to,determine,if,patients,are,having,a,myocardial,infa
rction.,You,devise,an,experiment,to,determine,the,performance,of,your,veritangin,assay,by,testing,it,versus,the,trop
onin,assay,,the,currently,accepted,gold,standard,for,determining,myocardial,infarction,,in,100,random,emergency,d
epartment,patients,with,chest,pain.,You,choose,a,veritangin,result,>1,ng/dL,as,positive,for,myocardial,infarction.,You
r,results,are,listed,in,the,table,below.
Which,of,the,following,statements,regarding,the,characteristics,of,the,veritangin,assay,in,this,trial,is,true?
A. The,posttest,probability,of,the,veritangin,test,does,not,depend,on,the,population,studied.
B. The,sensitivity,of,the,veritangin,assay,depends,on,the,population,studied,and,the,diseaseprevalence,in,that,pop
ulation.
C. The,sensitivity,of,the,veritangin,assay,will,decrease,by,50%,if,you,reduce,the,threshold,for,apositive,result,to,>0.
5,ng/dL.
D. The,sensitivity,of,the,veritangin,test,cannot,be,calculated,based,on,the,above,data.
E. The,specificity,of,the,veritangin,assay,is,0.93,(70/75).
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9.,You,are,designing,a,clinical,trial,to,test,the,use,of,a,novel,anticoagulant,,clotbegone,,in,the,treatment,of,deep,vein,t
hrombosis.,Which,of,the,following,statements,regarding,the,design,of,the,trial,is,true?
A. An,optimal,study,design,would,assign,many,patients,to,clotbegone,and,compare,their,outcomesto,the,outcome
s,of,prior,(historical),patients,not,taking,clotbegone.,This,would,allow,faster,trial,completion.
B. If,the,trial,returns,a,positive,result,(clotbegone,is,superior,to,placebo),,that,means,that,anypatient,with,a,clot,wo
uld,benefit,from,clotbegone,therapy.
C. Observing,the,outcomes,of,patients,already,taking,clotbegone,versus,patients,who,are,not,ispreferable,to,assig
ning,patients,to,clotbegone,or,placebo,in,a,blinded,fashion.,The,observational,strategy,is,more,“real,world,”,appl
icable,to,the,general,population,,and,free,of,bias.
D. Population,selection,for,the,trial,enrollment,is,not,important,as,long,as,careful,attention,torandomization,and,bl
inding,is,observed.
E. The,advantage,of,performing,a,randomized,clinical,trial,of,clotbegone,over,a,prospectiveobservational,study,of,
clotbegone,is,the,avoidance,of,treatment,selection,bias.
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10.,A,receiver,operating,characteristic,(ROC),curve,is,constructed,for,a,new,test,developed,to,diagnose,disease,X.,All,
of,the,following,statements,regarding,the,ROC,curve,are,true,EXCEPT:
A. One,criticism,of,the,ROC,curve,is,that,it,is,developed,for,testing,only,one,test,or,clinicalparameter,with,exclusion,
of,other,potentially,relevant,data.
B. ROC,curve,allows,the,selection,of,a,threshold,value,for,a,test,that,yields,the,best,sensitivity,withthe,fewest,false-
positive,tests.
C. The,axes,of,the,ROC,curve,are,sensitivity,versus,1,–,specificity.
D. The,ideal,ROC,curve,will,have,a,value,of,0.5.
E. The,value,of,the,ROC,curve,is,calculated,as,the,area,under,the,curve,generated,from,the,true-
positive,rate,versus,the,false-positive,rate.
