, SECTION I 0
General Considerations in Clinical Medicine
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0000 QUESTIONS
DIRECTIONS:0Choose0the0one0best0response0to0each0question.
I-
1.0All0of0the0following0statements0regarding0practice0guidelines0set0forth0by0governing0agencies0and0professional
0organizations0are0true0EXCEPT:
A. Clinical0practice0guidelines0protect0caregivers0against0inappropriate0charges0of0malpractice,0yetdo0not0provi
de0protection0for0patients0from0receiving0substandard0care.
B. Practice0guidelines0have0largely0reached0a0stage0of0nuance0allowing0them0to0address0every0uniqueillness0an
d0patient0presented0to0the0modern0physician.
C. Practice0guidelines0provide0a0legal0constraint0to0physicians,0and0deviation0from0guideline-
basedcare0invariably0leaves0physicians0vulnerable0to0legal0action.
D. Where0different0organizations0disagree0regarding0practice0guidelines,0a0third-
party0agency0has0been0appointed0to0mitigate0these0disagreements0such0that0now0all0major0organizations’0g
uidelines0are0consistent.
E. All0of0the0above0statements0are0not0true.
I-
2.0Regarding0molecular0medicine,0which0of0the0following0statements0represents0an0INACCURATE0example0of0the
0listed0area0of0study:
A. Exposomics:0An0endocrinologist0studies0sunlight0exposure0and0population0risk0of0hip0fracture.
B. Metabolomics:0A0biochemist0studies0the0rate0of0flux0through0the0creatine0kinase0pathway0during0the0cardia
c0cycle.
C. Metagenomics:0A0biologist0studies0the0genomic0alterations0in0molds0commonly0found0in0humandwellings.
D. Microbiomics:0A0microbiologist0studies0the0genomic0variation0in0thermophiles,0bacteria0that0cansurvive0extr
eme0heat0near0deep0ocean0vents.
E. Proteomics:0A0cardiologist0studies0desmosomal0proteins0and0their0posttranslational0modifications0in0studyin
g0arrhythmogenic0right0ventricular0dysplasia.
I-3.0Which0of0the0following0is0the0best0definition0of0evidence-based0medicine?
A. A0summary0of0existing0data0from0existing0clinical0trials0with0a0critical0methodologic0review0andstatistical0an
alysis0of0summative0data
B. A0type0of0research0that0compares0the0results0of0one0approach0to0treating0disease0with0anotherapproach0to0
treating0the0same0disease
C. Clinical0decision-
making0support0tools0developed0by0professional0organizations0that0includeexpert0opinions0and0data0from0cl
inical0trials
D. Clinical0decision0making0supported0by0data,0preferably0randomized0controlled0clinical0trials
E. One0physician’s0clinical0experience0in0caring0for0multiple0patients0with0a0specific0disorder0over0many0years
I-
4.0Which0of0the0following0is0the0standard0measure0for0determining0the0impact0of0a0health0condition0on0a0popula
tion?
, A. Disability-adjusted0life-years
B. Infant0mortality
C. Life0expectancy
D. Standardized0mortality0ratio
E. Years0of0life0lost
I-5.0Which0of0the0following0statements0regarding0disease0patterns0worldwide0is0true?
A. Childhood0undernutrition0is0the0leading0risk0factor0for0global0disease0burden.
B. In0a020060publication,0the0World0Health0Organization0(WHO)0estimated0that010%0of0the0totalglobal0burden0
of0disease0was0due0to0modifiable0environmental0risk0factors.
C. In02010,0ischemic0heart0disease0was0the0leading0cause0of0death0among0adults.
D. In0the0last0two0decades,0mortality0attributed0to0communicable0diseases,0maternal0and0perinatalconditions,0
and0nutritional0deficiencies0has0remained0fairly0stable,0with0the0majority0(76%)0of0mortality0from0these0caus
es0occurring0in0sub-Saharan0Africa0and0southern0Asia.
E. While0poverty0status0has0been0shown0to0be0linked0to0health0status0on0the0individual0level,0thesame0relation
ship0does0not0hold0true0when0studying0the0link0between0national0health0indicators0and0gross0domestic0prod
uct0per0capita0among0nations.
I-
6.0You0are0appointed0to0a0governmental0healthcare0advisory0subcommittee0concerned0with0addressing0problem
s0facing0the0global0health0community.0Your0task0is0to0draw0general0conclusions0from0the0global0fight0against0tub
erculosis0(TB)0and0human0immunodeficiency0virus0(HIV)/acquired0immunodeficiency0syndrome0(AIDS)0that0may0
be0applied0in0combatting0other0diseases,0including0noncommunicable0diseases.0Which0of0the0following0conclusi
ons0is0reasonable0when0considering0HIV/AIDS0and0TB0as0chronic0diseases?
A. Barriers0to0adequate0healthcare0and0patient0adherence0imposed0by0extreme0poverty0must0beconcomitantly
0addressed0to0adequately0treat0and0prevent0chronic0disease0in0developing0nations.
B. Charging0small0fees0for0health0services0(e.g.,0AIDS0prevention0and0care)0supplies0the0patient0witha0sense0of0
the0treatment’s0value0and0increases0compliance0and0overall0public0health.
C. Despite0adequate0available0tools0to0practice0their0trade0locally0in0developing0nations,0manyphysicians0and0n
urses0emigrate0to0developed0nations0to0practice0their0respective0trades,0a0phenomenon0called0“brain0drain.
”
D. In0developed0nations0where0physicians0are0abundant,0community0health0worker0supervision0ofthe0care0of0c
hronically0ill0patients0is0not0effective.
E. In0the0case0of0chronic0infectious0diseases,0switching0from0one0drug0to0another0through0aprolonged0course0o
f0treatment0provides0the0highest0cure0rate0by0obviating0the0infectious0agent’s0ability0to0develop0resistance0t
o0any0single0drug.
I-7.0Mrs.0Jones,0a022-year-
old0African0American0woman,0presents0to0Dr.0Smith,0an0internal0medicine0specialist,0with0a0facial0rash.0Mrs.0Jon
es0states0that0the0rash0began0after0spending0a0day0at0the0beach0with0her0family.0She0also0notes0that0her0metaca
rpophalangeal0and0proximal0interphalangeal0joints0have0been0painful0and0swollen0for0the0preceding020weeks.0O
n0examination,0the0joints0are0swollen0and0tender.0Laboratory0analysis0discloses0reduced0creatinine0clearance,0pr
oteinuria,0and0hemolytic0anemia.0Antinuclear0antibodies0(a0test0with0a0high0negative0predictive0value0for0system
ic0lupus0erythematosus)0are0detected0at0significant0titer,0and0ultimately,0the0diagnosis0of0systemic0lupus0erythe
matosus0is0made.
Two0weeks0later,0Mrs.0Johnson,0a024-year-
old0African0American0woman,0presents0with0a0facial0rash0and0elbow0pain0to0Dr.0Smith.0After0a0cursory0interview0
and0brief0physical0exam,0Dr.0Smith0sends0blood0work0only0testing0for0antinuclear0antibodies.0When0the0test0retu
rns0negative0(no0antibodies0detected),0Dr.0Smith0presumes0this0to0be0a0false-
negative0result0and0starts0Mrs.0Johnson0on0hydroxychloroquine0and0prednisone0for0treatment0of0systemic0lupus0
erythematosus.0Which0heuristic(s)0did0Dr.0Smith0likely0employ0in0diagnosing0Mrs.0Johnson0with0systemic0lupus0e
rythematosus?
A. Availability0heuristic
B. Anchoring0heuristic
, C. Bayes’0rule
D. Confirmation0bias
E. A0and0B
I-
8.0You0have0invented0a0blood0test,0which0you0name0“veritangin,”0to0determine0if0patients0are0having0a0myocardi
al0infarction.0You0devise0an0experiment0to0determine0the0performance0of0your0veritangin0assay0by0testing0it0ver
sus0the0troponin0assay,0the0currently0accepted0gold0standard0for0determining0myocardial0infarction,0in01000rand
om0emergency0department0patients0with0chest0pain.0You0choose0a0veritangin0result0>10ng/dL0as0positive0for0my
ocardial0infarction.0Your0results0are0listed0in0the0table0below.
Which0of0the0following0statements0regarding0the0characteristics0of0the0veritangin0assay0in0this0trial0is0true?
A. The0posttest0probability0of0the0veritangin0test0does0not0depend0on0the0population0studied.
B. The0sensitivity0of0the0veritangin0assay0depends0on0the0population0studied0and0the0diseaseprevalence0in0tha
t0population.
C. The0sensitivity0of0the0veritangin0assay0will0decrease0by050%0if0you0reduce0the0threshold0for0apositive0result0
to0>0.50ng/dL.
D. The0sensitivity0of0the0veritangin0test0cannot0be0calculated0based0on0the0above0data.
E. The0specificity0of0the0veritangin0assay0is00.930(70/75).
I-
9.0You0are0designing0a0clinical0trial0to0test0the0use0of0a0novel0anticoagulant,0clotbegone,0in0the0treatment0of0dee
p0vein0thrombosis.0Which0of0the0following0statements0regarding0the0design0of0the0trial0is0true?
A. An0optimal0study0design0would0assign0many0patients0to0clotbegone0and0compare0their0outcomesto0the0out
comes0of0prior0(historical)0patients0not0taking0clotbegone.0This0would0allow0faster0trial0completion.
B. If0the0trial0returns0a0positive0result0(clotbegone0is0superior0to0placebo),0that0means0that0anypatient0with0a0cl
ot0would0benefit0from0clotbegone0therapy.
C. Observing0the0outcomes0of0patients0already0taking0clotbegone0versus0patients0who0are0not0ispreferable0to0
assigning0patients0to0clotbegone0or0placebo0in0a0blinded0fashion.0The0observational0strategy0is0more0“real0w
orld,”0applicable0to0the0general0population,0and0free0of0bias.
D. Population0selection0for0the0trial0enrollment0is0not0important0as0long0as0careful0attention0torandomization0a
nd0blinding0is0observed.
E. The0advantage0of0performing0a0randomized0clinical0trial0of0clotbegone0over0a0prospectiveobservational0stud
y0of0clotbegone0is0the0avoidance0of0treatment0selection0bias.
I-
10.0A0receiver0operating0characteristic0(ROC)0curve0is0constructed0for0a0new0test0developed0to0diagnose0disease0
X.0All0of0the0following0statements0regarding0the0ROC0curve0are0true0EXCEPT:
A. One0criticism0of0the0ROC0curve0is0that0it0is0developed0for0testing0only0one0test0or0clinicalparameter0with0exc
lusion0of0other0potentially0relevant0data.
B. ROC0curve0allows0the0selection0of0a0threshold0value0for0a0test0that0yields0the0best0sensitivity0withthe0fewest
0false-positive0tests.
C. The0axes0of0the0ROC0curve0are0sensitivity0versus010–0specificity.
D. The0ideal0ROC0curve0will0have0a0value0of00.5.
