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Question 1. Which of the following is the preferred initial screening test for colorectal cancer in average-risk adults aged 50-75? A) Annual FOBT B) Colonoscopy every 10 years C) CT colonography every 5 years D) Flexible sigmoidoscopy every 5 years Answer: B – Explanation: Colonoscopy every 10 years is the USPSTF-recommended gold-standard screening for average-risk adults. Question 2. The USPSTF recommends that adults 18-64 receive which vaccine to prevent human papillomavirus infection? A) MMR B) Varicella C) HPV D) Hepatitis B Answer: C – Explanation: The HPV vaccine is recommended for all adults through age 26 and shared-decision making through age 45. Question 3. In the Circle of Caring model, which component emphasizes the nurse’s self-awareness and personal values? A) Caring for others B) Caring for self C) Caring for community D) Caring for the environment Answer: B – Explanation: “Caring for self” focuses on self-reflection, self-care, and personal values. Question 4. Which level of evidence is considered the highest in the hierarchy of evidence? A) Randomized controlled trial B) Cohort study C) Case-control study D) Expert opinion Answer: A – Explanation: Systematic reviews/meta-analyses of RCTs sit at the top, but a well-conducted RCT is the highest primary evidence. Question 5. A 35-year-old woman presents with a 2-week history of unilateral throbbing headache, photophobia, and nausea. Which diagnosis is most likely?
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A) Tension-type headache B) Migraine C) Cluster headache D) Sinusitis Answer: B – Explanation: Unilateral pulsating pain with photophobia and nausea is classic for migraine. Question 6. Which medication is first-line for acute migraine relief in most primary-care settings? A) Sumatriptan B) Propranolol C) Amitriptyline D) Topiramate Answer: A – Explanation: Triptans like sumatriptan are acute abortive agents for migraine. **Question 7. A patient reports brief, recurrent episodes of “spinning” sensation lasting seconds, triggered by head position changes. Which diagnosis is most likely? ** A) Benign paroxysmal positional vertigo B) Meniere disease C) Labyrinthitis D) Vestibular neuritis Answer: A – Explanation: BPPV presents with brief positional vertigo triggered by head movement. Question 8. The first-line treatment for a new diagnosis of generalized tonic-clonic seizure disorder in adults is: A) Phenytoin B) Carbamazepine C) Valproic acid D) Levetiracetam Answer: D – Explanation: Levetiracetam is effective, well-tolerated, and has minimal drug interactions. Question 9. Which of the following is a red-flag symptom in a patient with new-onset headache? A) Occurs after caffeine withdrawal B) Improves with rest C) Sudden “thunderclap” onset D) Associated with menstrual cycle
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Question 14. A 4-year-old child presents with honey-colored crusted lesions on the face. Which organism is most likely responsible? A) Staphylococcus aureus B) Streptococcus pyogenes C) Pseudomonas aeruginosa D) Candida albicans Answer: B – Explanation: Impetigo caused by Streptococcus pyogenes creates honey-colored crusts. Question 15. Which of the following is the most reliable sign of malignant melanoma according to the ABCDE criteria? A) Asymmetry B) Border irregularity C) Color variation D) Evolution over time Answer: D – Explanation: “Evolution” (change) is the most concerning feature for melanoma. Question 16. The first-line topical therapy for mild to moderate atopic dermatitis is: A) Topical corticosteroid B) Topical calcineurin inhibitor C) Coal tar D) Salicylic acid Answer: A – Explanation: Low- to mid-potency corticosteroids are first-line for flare control. Question 17. Which of the following is the most common cause of bacterial conjunctivitis in adults? A) Haemophilus influenzae B) Neisseria gonorrhoeae C) Staphylococcus epidermidis D) Pseudomonas aeruginosa Answer: A – Explanation: Haemophilus influenzae is the leading bacterial cause of adult conjunctivitis.
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Question 18. A 45-year-old man presents with progressive peripheral vision loss, elevated intra-ocular pressure, and optic disc cupping. Which diagnosis is most likely? A) Open-angle glaucoma B) Angle-closure glaucoma C) Cataract D) Macular degeneration Answer: A – Explanation: Open-angle glaucoma causes painless peripheral vision loss and optic cupping. Question 19. The most appropriate initial management for acute otitis media in a 3 - year-old child is: A) Oral amoxicillin B) Topical ciprofloxacin C) Watchful waiting D) Intravenous ceftriaxone Answer: A – Explanation: Amoxicillin is first-line for acute otitis media in children. Question 20. Which of the following is the most common pathogen causing community-acquired pneumonia in otherwise healthy adults? A) Streptococcus pneumoniae B) Haemophilus influenzae C) Mycoplasma pneumoniae D) Staphylococcus aureus Answer: A – Explanation: Streptococcus pneumoniae is the predominant CAP pathogen. Question 21. According to GOLD guidelines, which inhaled medication combination is recommended for a patient with severe COPD (GOLD 3) and frequent exacerbations? A) Short-acting β-agonist (SABA) only B) Long-acting muscarinic antagonist (LAMA)
- inhaled corticosteroid (ICS) C) LABA + LAMA D) Oral corticosteroids Answer: C – Explanation: LABA/LAMA dual bronchodilation is preferred for severe COPD with exacerbations.
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Answer: B – Explanation: Mitral regurgitation produces a holosystolic murmur radiating to the axilla. Question 27. In atrial fibrillation, which oral anticoagulant is contraindicated in patients with mechanical heart valves? A) Warfarin B) Apixaban C) Rivaroxaban D) Dabigatran Answer: D – Explanation: Direct oral anticoagulants (including dabigatran) are not approved for mechanical valves. Question 28. The most appropriate initial test for a patient with suspected gastroesophageal reflux disease (GERD) and alarm symptoms? A) Empiric PPI trial B) Upper endoscopy C) Barium swallow D) Esophageal pH monitoring Answer: B – Explanation: Alarm features (dysphagia, weight loss) warrant prompt endoscopy. Question 29. First-line eradication therapy for Helicobacter pylori infection according to current guidelines includes: A) Clarithromycin monotherapy B) Triple therapy with PPI, clarithromycin, amoxicillin C) Quadruple therapy with PPI, bismuth, metronidazole, tetracycline D) Levofloxacin-based regimen Answer: C – Explanation: Bismuth-based quadruple therapy is recommended as first-line in many regions. Question 30. Which of the following is the most appropriate screening test for colorectal cancer in a 45-year-old asymptomatic patient with a first-degree relative diagnosed at age 55? A) Annual FIT B) Colonoscopy every 5 years C) Colonoscopy every 10 years D) No screening until 50
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Answer: B – Explanation: A first-degree relative <60 y warrants colonoscopy every 5 years starting at age 40- 10 years before relative’s diagnosis. Question 31. In the management of acute uncomplicated cystitis in non-pregnant women, the recommended first-line oral antibiotic is: A) Nitrofurantoin B) Ciprofloxacin C) Trimethoprim-sulfamethoxazole D) Amoxicillin-clavulanate Answer: A – Explanation: Nitrofurantoin has high efficacy and low resistance for uncomplicated UTI. Question 32. Which laboratory finding is most consistent with chronic kidney disease stage 4? A) eGFR 90 mL/min/1.73 m² B) eGFR 55 mL/min/1.73 m² C) eGFR 30 mL/min/1.73 m² D) eGFR 15 mL/min/1.73 m² Answer: C – Explanation: Stage 4 CKD corresponds to eGFR 15- 29 mL/min/1.73 m²; 30 mL/min is the upper limit of stage 4. Question 33. The most common cause of primary hyperparathyroidism is: A) Parathyroid carcinoma B) Parathyroid adenoma C) Secondary hyperparathyroidism D) Tertiary hyperparathyroidism Answer: B – Explanation: A single parathyroid adenoma accounts for >80 % of primary hyperparathyroidism. Question 34. According to ADA standards, the target A1C for most non-pregnant adults with diabetes is: A) <6.0 % B) <7.0 % C) <8.0 % D) <9.0 % Answer: B – Explanation: An A1C <7 % balances glycemic control with hypoglycemia risk.
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A) Allopurinol B) Colchicine C) Indomethacin D) Febuxostat Answer: A – Explanation: Allopurinol is started for chronic urate-lowering when attacks are frequent. Question 40. Which imaging modality is most sensitive for detecting early osteoarthritis changes in the knee? A) Plain radiograph B) MRI C) Ultrasound D) CT scan Answer: B – Explanation: MRI visualizes cartilage loss and bone marrow lesions earlier than X-ray. Question 41. In the evaluation of low back pain, red-flag findings that warrant immediate imaging include all EXCEPT: A) Age > 70 years B) Unexplained weight loss C) History of minor strain D) Progressive neurological deficit Answer: C – Explanation: Minor strain without other red flags does not require emergent imaging. Question 42. First-line disease-modifying therapy for rheumatoid arthritis is: A) NSAIDs B) Glucocorticoids C) Methotrexate D) Hydroxychloroquine Answer: C – Explanation: Methotrexate is the anchor DMARD for RA. Question 43. The most common cause of community-acquired bacterial meningitis in adults is: A) Neisseria meningitidis B) Streptococcus pneumoniae C) Listeria monocytogenes D) Haemophilus influenzae Answer: B – Explanation: S. pneumoniae is the leading adult pathogen.
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Question 44. Which vaccine is contraindicated in pregnant women? A) Inactivated influenza B) Tdap C) MMR D) Hepatitis B Answer: C – Explanation: Live-attenuated MMR is avoided during pregnancy. Question 45. A 62-year-old man with COPD presents with increased dyspnea, sputum purulence, and fever. Which antibiotic regimen aligns with GOLD guideline for a moderate exacerbation? A) Azithromycin alone B) Amoxicillin-clavulanate C) Levofloxacin D) Prednisone only Answer: B – Explanation: Amoxicillin-clavulanate covers typical and atypical pathogens for moderate COPD exacerbations. Question 46. The STOP-BANG score component “B” stands for: A) Body mass index ≥ 35 kg/m² B) Blood pressure >140/90 C) Age > 50 D) Bag-mask ventilation need Answer: A – Explanation: “B” = BMI ≥ 35 kg/m² (obesity). Question 47. Which of the following is the most appropriate initial test to evaluate iron-deficiency anemia? A) Serum ferritin B) Serum iron C) Total iron-binding capacity D) Peripheral smear Answer: A – Explanation: Ferritin is the most sensitive indicator of iron stores. Question 48. In a patient with suspected acute coronary syndrome, the troponin level is drawn at presentation and again 3 hours later. Which pattern confirms myocardial infarction? A) Normal at both times B) Elevated at presentation, decreasing C) Normal at presentation, rising above the 99th percentile D) Elevated at presentation, unchanged
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Question 53. Which of the following is the most appropriate first-step in the evaluation of a patient with new-onset urinary incontinence? A) Urodynamic study B) Bladder ultrasound C) Detailed history and physical exam D) Cystoscopy Answer: C – Explanation: History and exam identify type (stress vs. urge) and guide further testing. Question 54. The most common cause of primary amenorrhea is: A) Turner syndrome B) Androgen insensitivity C) Pregnancy D) Polycystic ovary syndrome Answer: C – Explanation: Pregnancy must be ruled out first in any amenorrhea work-up. Question 55. Which of the following is the most appropriate pharmacologic therapy for a patient with chronic heart failure with reduced ejection fraction who remains symptomatic despite ACE-I and β-blocker? A) Digoxin B) Ivabradine C) Spironolactone D) Nitrate-hydralazine Answer: C – Explanation: Adding an aldosterone antagonist (spironolactone) improves outcomes. Question 56. In the assessment of a patient with suspected pulmonary embolism, which test has the highest sensitivity? A) D-dimer B) V/Q scan C) CT pulmonary angiography D) Pulmonary angiogram Answer: C – Explanation: CTPA is the most sensitive and specific non-invasive test. **Question 57. Which of the following is a contraindication to the use of metformin? **
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A) BMI > 30 kg/m² B) Chronic heart failure C) eGFR < 30 mL/min/1.73 m² D) Age > 65 years Answer: C – Explanation: Metformin is avoided when eGFR falls below 30 due to lactic acidosis risk. Question 58. The most common cause of secondary hypertension in adults is: A) Renal artery stenosis B) Primary aldosteronism C) Pheochromocytoma D) Obstructive sleep apnea Answer: D – Explanation: OSA is the leading reversible secondary cause of hypertension. Question 59. Which immunization is recommended annually for all adults regardless of risk factors? A) Tdap B) Hepatitis B C) Inactivated influenza D) Varicella Answer: C – Explanation: Yearly inactivated influenza vaccine is recommended for all adults. Question 60. A 70-year-old man with a history of atrial fibrillation is started on warfarin. Which INR range is therapeutic for most indications? A) 1.0-2.0 B) 2.0-3.0 C) 3.0-4.0 D) 4.0-5. Answer: B – Explanation: INR 2.0-3.0 is the standard therapeutic range for AF. Question 61. Which of the following best describes the “rule of halves” in hypertension management? A) Only half of patients achieve control B) Half of hypertensive patients are aware of their condition C) Half of treated patients are adherent D) All of the above Answer: D – Explanation: The rule of halves refers to awareness, treatment, and control each affecting roughly half of the population.
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Question 66. The most appropriate screening test for osteoporosis in postmenopausal women age 65 and older is: A) Serum calcium B) DEXA scan of the hip and lumbar spine C) Quantitative ultrasound of the calcaneus D) MRI of the femur Answer: B – Explanation: Dual-energy X-ray absorptiometry (DEXA) is the gold standard. Question 67. Which of the following best describes the “fasting lipid panel” components? A) Total cholesterol, HDL, LDL, triglycerides B) Total cholesterol, VLDL, LDL, glucose C) HDL, LDL, apolipoprotein B, Lp(a) D) Triglycerides, glucose, insulin, CRP Answer: A – Explanation: A standard fasting lipid panel includes total cholesterol, HDL-C, LDL-C, and triglycerides. Question 68. In the management of chronic hepatitis B infection, which laboratory marker indicates active viral replication? A) HBsAg positivity B) HBeAg positivity C) Anti-HBc IgM D) Anti-HBs positivity Answer: B – Explanation: Presence of HBeAg correlates with high viral replication. Question 69. Which of the following is the most common cause of community-acquired skin and soft-tissue infection in the United States? A) Streptococcus pyogenes B) Staphylococcus aureus C) Pseudomonas aeruginosa D) Enterococcus faecalis Answer: B – Explanation: Staph aureus, especially MRSA, dominates CA-SSTIs. Question 70. The most appropriate initial therapy for a patient with newly diagnosed stage 1 hypertension without compelling indications? A) Lifestyle modification alone B) ACE inhibitor C) Beta-blocker D) Thiazide diuretic
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Answer: A – Explanation: Lifestyle changes are first-line for stage 1 without comorbidities. Question 71. Which of the following is the most sensitive screening tool for detecting cervical cancer precursors? A) Pap smear B) HPV DNA testing C) Colposcopy D) Visual inspection with acetic acid Answer: B – Explanation: Primary HPV testing has higher sensitivity than cytology alone. Question 72. In a patient with suspected acute gout attack, which medication provides rapid pain relief? A) Allopurinol B) Colchicine C) Febuxostat D) Probenecid Answer: B – Explanation: Colchicine, when given early, rapidly reduces inflammation. Question 73. The most appropriate initial step in the evaluation of a patient with suspected peripheral arterial disease? A) Ankle-brachial index (ABI) B) Duplex ultrasonography C) CTA D) Angiography Answer: A – Explanation: ABI is a simple, non-invasive screening test for PAD. Question 74. Which of the following is the most common cause of secondary infertility in women? A) Polycystic ovary syndrome B) Endometriosis C) Tubal factor from PID D) Premature ovarian failure Answer: C – Explanation: Tubal scarring from PID is the leading secondary infertility cause.
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Answer: B – Explanation: An aldosterone-producing adenoma (Conn’s syndrome) is most frequent. Question 80. Which of the following is the most appropriate initial diagnostic test for suspected pulmonary tuberculosis? A) Sputum acid-fast bacilli smear B) Chest X-ray C) Interferon-γ release assay D) Tuberculin skin test Answer: A – Explanation: Sputum AFB smear (with culture) is the primary diagnostic test. Question 81. In a patient with chronic heart failure, which medication class has been shown to reduce mortality by antagonizing the renin-angiotensin-aldosterone system? A) Loop diuretics B) ACE inhibitors C) Digoxin D) Nitrates Answer: B – Explanation: ACE inhibitors improve survival in HFrEF. Question 82. Which of the following is the most common cause of secondary anemia in chronic disease? A) Iron deficiency B) Folate deficiency C) Impaired iron utilization D) Vitamin B deficiency Answer: C – Explanation: Inflammation leads to hepcidin-mediated iron sequestration. Question 83. The most appropriate screening interval for low-risk individuals for abdominal aortic aneurysm (AAA) is: A) One-time at age 65 B) Every 5 years from 65- 75 C) Every 2 years from 55- 75 D) No screening needed Answer: B – Explanation: USPSTF recommends a one-time ultrasound at 65–75; repeat every 5 years if normal.
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Question 84. Which of the following is the first-line pharmacologic treatment for opioid use disorder? A) Methadone B) Buprenorphine-naloxone C) Naltrexone D) Acamprosate Answer: B – Explanation: Buprenorphine-naloxone is a partial agonist with a favorable safety profile. Question 85. In the management of chronic obstructive pulmonary disease, which vaccination is strongly recommended? A) Live-attenuated influenza B) Pneumococcal polysaccharide vaccine (PPSV23) C) Rotavirus D) Yellow fever Answer: B – Explanation: PPSV23 (and PCV13 when indicated) reduces COPD exacerbations due to pneumococcus. Question 86. Which of the following best describes the “white coat hypertension” phenomenon? A) Elevated BP only at home B) Elevated BP in clinical setting but normal at home C) Persistent hypertension despite therapy D) Hypertension caused by medication side effects Answer: B – Explanation: White coat hypertension is office-only elevation. Question 87. The most appropriate initial therapy for a patient with newly diagnosed hypertension and diabetes? A) ACE inhibitor B) Thiazide diuretic C) Beta-blocker D) Calcium-channel blocker Answer: A – Explanation: ACE-I (or ARB) is first-line in diabetics for renal protection. Question 88. Which of the following is the most common cause of secondary osteoporosis in men?
