GFACT CERTIFICATION EXAM (ACTUAL 2026)
ALL QUESTIONS AND CORRECT GRADED A+
13. A 45-year-old female who works as a house cleaner
presents with left shoulder pain. On examination she has pain
and relative weakness when pushing toward the midline
against resistance while the shoulder is adducted and the
elbow is bent to 90°. With the elbow still at 90° she is unable
to keep her left hand away from her body when you position
her hand behind her back.
This presentation is most consistent with an injury of which
one of the following tendons?
A) Deltoid
B) Infraspinatus
C) Subscapularis
D) Supraspinatus
E) Teres minor - <<<Ansqwers>>>ANSWER: C
This patient's pain and weakness while pushing against
resistance reveals weakness on internal rotation of the
shoulder, which suggests a possible tear of the subscapularis
tendon. The inability to keep her hand away from her body
when it is placed behind her back describes a positive internal
lag test, also suggesting involvement of the subscapularis
tendon. The infraspinatus and teres minor are involved in
external rotation rather than internal rotation. The
supraspinatus and deltoid are involved in abduction of the
shoulder.
, GFACT CERTIFICATION EXAM (ACTUAL 2025)
ALL QUESTIONS AND CORRECT GRADED A+
70. You admit a previously healthy 62-year-old female to the
hospital for intractable nausea and
vomiting with intravascular volume depletion and
hypotension. She lives in rural northern
New Mexico. Prior to the onset of her symptoms she had been
gardening and cleaning out
a chicken coop, where she encountered several rodents. She is
febrile and you obtain blood
and urine cultures. Two out of four blood culture bottles are
positive for gram-negative rods.
Which one of the following is the most likely pathogen?
A) Brucella melitensis
B) Coxiella burnetii
C) Escherichia coli
D) Listeria monocytogenes
E) Yersinia pestis - <<<Ansqwers>>>ANSWER: E
Yersinia pestis is an aerobic fermentative gram-negative rod.
It causes a zoonotic infection with humans
as the accidental host. The disease is spread by a bite from a
flea vector, direct contact with infected tissue,
or inhalation of infectious aerosols from a person with
pulmonary plague. Plague occurs in two regions
, GFACT CERTIFICATION EXAM (ACTUAL 2025)
ALL QUESTIONS AND CORRECT GRADED A+
in the western United States. One region includes northern
New Mexico, northern Arizona, and southern
Colorado, and the other region includes California, southern
Oregon, and far western Nevada.
Escherichia coli is also an aerobic fermentative gram-negative
rod but it generally causes symptoms of
gastroenteritis, hemolytic-uremic syndrome, urinary tract
infection, intra-abdominal infection, and
meningitis. E. coli infection does not have a specific regional
distribution. Listeria monocytogenes is a
gram-positive rod and causes an influenza-like illness with or
without gastroenteritis in adults. Infection
occurs through ingestion of contaminated food products such
as milk, cheese, processed meats, and raw
vegetables. Outbreaks can occur in any geographic
distribution.
25
Coxiella burnetii is a gram-negative intracellular bacterium
that causes Q fever. Human infections are
associated with contact with infected cattle, sheep, goats,
dogs, and cats. Brucella melitensis is a
gram-negative coccobacilli that causes brucellosis. Humans
are accidental hosts who can develop the
disease from contact with tissues rich in erythritol, and from
shedding of organisms in milk, urine, and
birth products from goats and sheep.
, GFACT CERTIFICATION EXAM (ACTUAL 2025)
ALL QUESTIONS AND CORRECT GRADED A+
71. A 21-year-old female is being evaluated for secondary
causes of refractory hypertension.
Which one of the following would be most specific for
fibromuscular dysplasia?
A) A serum creatinine level
B) An aldosterone:renin ratio
C) 24-hour urine for metanephrines
D) Renal ultrasonography
E) Magnetic resonance angiography of the renal arteries -
<<<Ansqwers>>>ANSWER: E
In young adults diagnosed with secondary hypertension,
evaluation for fibromuscular dysplasia of the renal
arteries with MR angiography or CT angiography is indicated
(SOR C). The aldosterone/renin ratio is the
most sensitive test to diagnose primary hyperaldosteronism.
Renal ultrasonography is an indirect test that
is not as sensitive or specific for fibromuscular dysplasia.
Serum creatinine elevation shows renal
involvement but does not identify the cause. Testing for
metanephrines is indicated only if a
pheochromocytoma is suspected.
ALL QUESTIONS AND CORRECT GRADED A+
13. A 45-year-old female who works as a house cleaner
presents with left shoulder pain. On examination she has pain
and relative weakness when pushing toward the midline
against resistance while the shoulder is adducted and the
elbow is bent to 90°. With the elbow still at 90° she is unable
to keep her left hand away from her body when you position
her hand behind her back.
This presentation is most consistent with an injury of which
one of the following tendons?
A) Deltoid
B) Infraspinatus
C) Subscapularis
D) Supraspinatus
E) Teres minor - <<<Ansqwers>>>ANSWER: C
This patient's pain and weakness while pushing against
resistance reveals weakness on internal rotation of the
shoulder, which suggests a possible tear of the subscapularis
tendon. The inability to keep her hand away from her body
when it is placed behind her back describes a positive internal
lag test, also suggesting involvement of the subscapularis
tendon. The infraspinatus and teres minor are involved in
external rotation rather than internal rotation. The
supraspinatus and deltoid are involved in abduction of the
shoulder.
, GFACT CERTIFICATION EXAM (ACTUAL 2025)
ALL QUESTIONS AND CORRECT GRADED A+
70. You admit a previously healthy 62-year-old female to the
hospital for intractable nausea and
vomiting with intravascular volume depletion and
hypotension. She lives in rural northern
New Mexico. Prior to the onset of her symptoms she had been
gardening and cleaning out
a chicken coop, where she encountered several rodents. She is
febrile and you obtain blood
and urine cultures. Two out of four blood culture bottles are
positive for gram-negative rods.
Which one of the following is the most likely pathogen?
A) Brucella melitensis
B) Coxiella burnetii
C) Escherichia coli
D) Listeria monocytogenes
E) Yersinia pestis - <<<Ansqwers>>>ANSWER: E
Yersinia pestis is an aerobic fermentative gram-negative rod.
It causes a zoonotic infection with humans
as the accidental host. The disease is spread by a bite from a
flea vector, direct contact with infected tissue,
or inhalation of infectious aerosols from a person with
pulmonary plague. Plague occurs in two regions
, GFACT CERTIFICATION EXAM (ACTUAL 2025)
ALL QUESTIONS AND CORRECT GRADED A+
in the western United States. One region includes northern
New Mexico, northern Arizona, and southern
Colorado, and the other region includes California, southern
Oregon, and far western Nevada.
Escherichia coli is also an aerobic fermentative gram-negative
rod but it generally causes symptoms of
gastroenteritis, hemolytic-uremic syndrome, urinary tract
infection, intra-abdominal infection, and
meningitis. E. coli infection does not have a specific regional
distribution. Listeria monocytogenes is a
gram-positive rod and causes an influenza-like illness with or
without gastroenteritis in adults. Infection
occurs through ingestion of contaminated food products such
as milk, cheese, processed meats, and raw
vegetables. Outbreaks can occur in any geographic
distribution.
25
Coxiella burnetii is a gram-negative intracellular bacterium
that causes Q fever. Human infections are
associated with contact with infected cattle, sheep, goats,
dogs, and cats. Brucella melitensis is a
gram-negative coccobacilli that causes brucellosis. Humans
are accidental hosts who can develop the
disease from contact with tissues rich in erythritol, and from
shedding of organisms in milk, urine, and
birth products from goats and sheep.
, GFACT CERTIFICATION EXAM (ACTUAL 2025)
ALL QUESTIONS AND CORRECT GRADED A+
71. A 21-year-old female is being evaluated for secondary
causes of refractory hypertension.
Which one of the following would be most specific for
fibromuscular dysplasia?
A) A serum creatinine level
B) An aldosterone:renin ratio
C) 24-hour urine for metanephrines
D) Renal ultrasonography
E) Magnetic resonance angiography of the renal arteries -
<<<Ansqwers>>>ANSWER: E
In young adults diagnosed with secondary hypertension,
evaluation for fibromuscular dysplasia of the renal
arteries with MR angiography or CT angiography is indicated
(SOR C). The aldosterone/renin ratio is the
most sensitive test to diagnose primary hyperaldosteronism.
Renal ultrasonography is an indirect test that
is not as sensitive or specific for fibromuscular dysplasia.
Serum creatinine elevation shows renal
involvement but does not identify the cause. Testing for
metanephrines is indicated only if a
pheochromocytoma is suspected.
