Question Count: 289
Question #1
QID: 15405
Topic: Sensitivity and Specificity
Subject: PMCH
If the threshold of a screening test is increased. How it will affect sensitivity and specificity?
a) Sensitivity increase & specificity decrease
b) Sensitivity decrease and specificity increase
c) Both sensitivity and specificity increase
d) Both sensitivity and specificity decrease
The correct answer is b)
Explanation:
In the classic model above. The definitions are as follows:
Sensitivity = a/(a+c) which is the true positive rate. Meaning of all the people with the disease the portion that will
actually test positive.
Specificity = d/(b+d) which is the true negative rate. Meaning of all the people without the disease the portion that
will actually test negative.
A real world example will clearly explain that will happen if the threshold is increased. Say we are testing people for
diabetes. We are using our current random blood sugar value of 200 and a threshold for a positive test. We test 40
people. See the model, where the black circles represent normal people and the red are those with diabetes. Then we
test again using a threshold value of 250 for random blood sugar.
Tables are as follows:
Calculations of the sensitivity and specificity clearly shows that when you increase the threshold the sensitivity will
decrease and the specificity will increase.
Question #2
QID: 15417
Topic: STD
Subject: PMCH
A man suspects that he may have gonorrhea. Tests confirm it. He tells you that his wife works at the hospital and he
wishes to keep this a secret to avoid possible conflicts and embarrassment. What is the appropriate way to handle this
situation at this point?
a) Inform the patient about the nature and implications of the infection and importance of treating his wife as well
b) You must call his wife and let her know.
c) Don’t listen to him
d) Send his wife a letter
e) Suggest relationship counselling
,The correct answer is a)
Explanation:
Gonnorhea should be reported to local public health unit. Since gonorrhea is an STD that is communicable, his partner
should know about it also. Since patient confidentiality must be respected, it is best to ask him to tell his wife about
this.
Contact tracing includes an educational component, in order to ensure that the index case and contacts are informed
about the nature and implications of the infection, modes of transmission and prevention, and treatment options. The
health care provider should be culturally aware and have basic counselling skills and other personal qualities such as
tact, empathy and awareness of the physical, emotional, and social conditions of the client. The provider also needs
current and accurate knowledge of treatment and support services and must be familiar with the HPPA and other legal
aspects of STI management
Question #3
QID: 16579
Topic: STD
Subject: PMCH
Screening for Chlamydia trachomatis infection should be performed on which one of the following asymptomatic
patients who present for routine evaluation?
a) A 16-year-old female who states that she is not sexually active
b) A 20-year-old female who uses birth control pills for contraception and has a new sexual partner
c) A 26-year-old male with multiple sexual partners with no STD history who uses condoms consistently
d) A 28-year-old female who is married, has no history of sexually transmitted disease, and uses the rhythm method
to avoid pregnancy
The correct answer is b)
Explanation:
It is estimated that 70%-90% of women and a large percentage of men with Chlamydia trachomatis infection are
asymptomatic. The most predictive risk factor for the presence of the disease is sexual activity at a young age. Other
risks include being unmarried, black race, a past history of sexually transmitted disease, new or multiple sexual
partners, cervical ectopy, and inconsistent use of barrier contraceptives. Asymptomatic Chlamydia infection can cause
pelvic inflammatory disease and result in ectopic pregnancy, infertility, and chronic pelvic pain in women.
There are good screening tests available and effective treatments for women with the disease. Unfortunately, there are
currently no studies describing the effectiveness of routine screening or early treatment of men. The Preventive
Services Task Force strongly recommends (class A) routine screening for Chlamydia infection in all sexually active
women 25 years and younger, as well as in other asymptomatic women at increased risk. The Centers for Disease
Control and Prevention recommend routine screening of sexually active adolescent women and screening of older
women who are at increased risk for the disease.
,Question #4
QID: 16807
Topic: STD
Subject: PMCH
A 31-year-old female presents with her first outbreak of genital herpes. She has been married for 4 years and says she
has not had sexual relations with anyone other than her husband since they started dating.
When counseling this patient, which one of the following would be appropriate advice?
a) Because the average incubation period for herpes is 3 months, her husband has most likely had another sexual
partner in the past few months
b) Suppressive therapy can decrease transmission to sexual partners
c) If type-specific serologies are negative, genital herpes can be ruled out
d) Daily application of topical acyclovir (Zovirax) is effective for suppressant therapy
The correct answer is b)
Explanation:
The average incubation period after contracting genital herpes is 4 days. However, a significant number of patients do
not recognize the initial infection.
Type-specific serologic tests can assist in the classification of infection as primary or recurrent, but there is significant
potential for false-negative results. Oral once-daily suppressant therapy can reduce the risk of transmission of herpes
simplex to uninfected partners but topical therapy is not effective. Acyclovir, valacyclovir, and famciclovir are all
effective for suppressive therapy.
Question #5
QID: 16869
Topic: STD
Subject: PMCH
A 70-year-old white female presents with a pruritic rash on her sacrum that has occurred intermittently over the last 6
years. She reports that the area is always very tender just before the blister-like lesions erupt. She is otherwise in good
health, and takes no medications. Her past medical history is unremarkable. You provide appropriate treatment for the
condition.
You should advise the patient to avoid which one of the following during future outbreaks?
a) Excessive intake of green, leafy vegetables
b) Sexual contact
c) Perfumed soaps or body lotions
d) Sun exposure
e) Prolonged sitting
The correct answer is b)
Explanation:
Genital herpes is the most common sexually transmitted genital ulcer disease. It can occur at any age, and data
suggests that it may be the most common sexually transmitted disease in women over the age of 50 years. Extragenital
sites are involved in one-fourth of infected women, and the sacrum and buttocks are frequent locations. Sacral nerve
, innervations from the vaginal area provides a pathway for the virus. Prevention of transmission depends upon cogent
patient education advising abstinence from skin-to-skin contact when active lesions are present.
Question #6
QID: 15420
Topic: Coronary Artery Disease
Subject: PMCH
Coronary artery disease (CAD) is more common in men compared to women. Which of the following is also true?
a) After menopause, the incidence of CAD in women decreases
b) All diagnostic tests work equally well in both men and women
c) Women have worse outcomes following MI compared to men
d) Many more men than women display "atypical" patterns when they develop CAD
e) The male survivors of MI have a worse prognosis than the female survivors
The correct answer is c)
Explanation:
Men run a higher risk of developing the disease than premenopausal women. After menopause, the incidence of CAD
in women increases, and can be equal to men.
Coronary artery disease is a leading cause of death of women throughout the world.
Women have unique risk factors for heart disease. These risk factors include hormone replacement therapy, birth
control pills, and pregnancy-related problems.
Unfortunately, many more women than men display "atypical" patterns when they develop CAD, and these atypical
patterns all too often lead to missed diagnoses and inadequate therapy, and therefore, to worse outcomes.
Diagnostic tests that work quite well in men can be misleading in women. The most common problem is seen with
stress testing - in women, the electrocardiogram (ECG) during exercise can often show changes suggesting CAD,
whether CAD is present or not, making the study difficult to interpret.
Among survivors, 18% of men and 34% of women have a second MI within 6 years, 7% of men and 6% of women
die suddenly, 22% of men and 46% of women are disabled with CHF, and 8% of men and 11% of women have a
stroke
Question #7
QID: 15437
Topic: Cause of Death
Subject: PMCH
A 71-year-old male dies in the hospital. He was admitted into the hospital 4 days ago because of acute small bowel
obstruction. He underwent abdominal surgery for adhesion lysis. He had been recovering fairly well when he
developed a massive pulmonary embolus 12 hours ago that was confirmed by ventilation-perfusion scan. His past
medical history is significant for diverticulitis 15 years ago, COPD diagnosed 12 years ago ,and small cell lung
carcinoma diagnosed 6 months with metastases to the brain confirmed 3 months ago. What is the immediate cause of
death?
a) Pulmonary embolism
Question #1
QID: 15405
Topic: Sensitivity and Specificity
Subject: PMCH
If the threshold of a screening test is increased. How it will affect sensitivity and specificity?
a) Sensitivity increase & specificity decrease
b) Sensitivity decrease and specificity increase
c) Both sensitivity and specificity increase
d) Both sensitivity and specificity decrease
The correct answer is b)
Explanation:
In the classic model above. The definitions are as follows:
Sensitivity = a/(a+c) which is the true positive rate. Meaning of all the people with the disease the portion that will
actually test positive.
Specificity = d/(b+d) which is the true negative rate. Meaning of all the people without the disease the portion that
will actually test negative.
A real world example will clearly explain that will happen if the threshold is increased. Say we are testing people for
diabetes. We are using our current random blood sugar value of 200 and a threshold for a positive test. We test 40
people. See the model, where the black circles represent normal people and the red are those with diabetes. Then we
test again using a threshold value of 250 for random blood sugar.
Tables are as follows:
Calculations of the sensitivity and specificity clearly shows that when you increase the threshold the sensitivity will
decrease and the specificity will increase.
Question #2
QID: 15417
Topic: STD
Subject: PMCH
A man suspects that he may have gonorrhea. Tests confirm it. He tells you that his wife works at the hospital and he
wishes to keep this a secret to avoid possible conflicts and embarrassment. What is the appropriate way to handle this
situation at this point?
a) Inform the patient about the nature and implications of the infection and importance of treating his wife as well
b) You must call his wife and let her know.
c) Don’t listen to him
d) Send his wife a letter
e) Suggest relationship counselling
,The correct answer is a)
Explanation:
Gonnorhea should be reported to local public health unit. Since gonorrhea is an STD that is communicable, his partner
should know about it also. Since patient confidentiality must be respected, it is best to ask him to tell his wife about
this.
Contact tracing includes an educational component, in order to ensure that the index case and contacts are informed
about the nature and implications of the infection, modes of transmission and prevention, and treatment options. The
health care provider should be culturally aware and have basic counselling skills and other personal qualities such as
tact, empathy and awareness of the physical, emotional, and social conditions of the client. The provider also needs
current and accurate knowledge of treatment and support services and must be familiar with the HPPA and other legal
aspects of STI management
Question #3
QID: 16579
Topic: STD
Subject: PMCH
Screening for Chlamydia trachomatis infection should be performed on which one of the following asymptomatic
patients who present for routine evaluation?
a) A 16-year-old female who states that she is not sexually active
b) A 20-year-old female who uses birth control pills for contraception and has a new sexual partner
c) A 26-year-old male with multiple sexual partners with no STD history who uses condoms consistently
d) A 28-year-old female who is married, has no history of sexually transmitted disease, and uses the rhythm method
to avoid pregnancy
The correct answer is b)
Explanation:
It is estimated that 70%-90% of women and a large percentage of men with Chlamydia trachomatis infection are
asymptomatic. The most predictive risk factor for the presence of the disease is sexual activity at a young age. Other
risks include being unmarried, black race, a past history of sexually transmitted disease, new or multiple sexual
partners, cervical ectopy, and inconsistent use of barrier contraceptives. Asymptomatic Chlamydia infection can cause
pelvic inflammatory disease and result in ectopic pregnancy, infertility, and chronic pelvic pain in women.
There are good screening tests available and effective treatments for women with the disease. Unfortunately, there are
currently no studies describing the effectiveness of routine screening or early treatment of men. The Preventive
Services Task Force strongly recommends (class A) routine screening for Chlamydia infection in all sexually active
women 25 years and younger, as well as in other asymptomatic women at increased risk. The Centers for Disease
Control and Prevention recommend routine screening of sexually active adolescent women and screening of older
women who are at increased risk for the disease.
,Question #4
QID: 16807
Topic: STD
Subject: PMCH
A 31-year-old female presents with her first outbreak of genital herpes. She has been married for 4 years and says she
has not had sexual relations with anyone other than her husband since they started dating.
When counseling this patient, which one of the following would be appropriate advice?
a) Because the average incubation period for herpes is 3 months, her husband has most likely had another sexual
partner in the past few months
b) Suppressive therapy can decrease transmission to sexual partners
c) If type-specific serologies are negative, genital herpes can be ruled out
d) Daily application of topical acyclovir (Zovirax) is effective for suppressant therapy
The correct answer is b)
Explanation:
The average incubation period after contracting genital herpes is 4 days. However, a significant number of patients do
not recognize the initial infection.
Type-specific serologic tests can assist in the classification of infection as primary or recurrent, but there is significant
potential for false-negative results. Oral once-daily suppressant therapy can reduce the risk of transmission of herpes
simplex to uninfected partners but topical therapy is not effective. Acyclovir, valacyclovir, and famciclovir are all
effective for suppressive therapy.
Question #5
QID: 16869
Topic: STD
Subject: PMCH
A 70-year-old white female presents with a pruritic rash on her sacrum that has occurred intermittently over the last 6
years. She reports that the area is always very tender just before the blister-like lesions erupt. She is otherwise in good
health, and takes no medications. Her past medical history is unremarkable. You provide appropriate treatment for the
condition.
You should advise the patient to avoid which one of the following during future outbreaks?
a) Excessive intake of green, leafy vegetables
b) Sexual contact
c) Perfumed soaps or body lotions
d) Sun exposure
e) Prolonged sitting
The correct answer is b)
Explanation:
Genital herpes is the most common sexually transmitted genital ulcer disease. It can occur at any age, and data
suggests that it may be the most common sexually transmitted disease in women over the age of 50 years. Extragenital
sites are involved in one-fourth of infected women, and the sacrum and buttocks are frequent locations. Sacral nerve
, innervations from the vaginal area provides a pathway for the virus. Prevention of transmission depends upon cogent
patient education advising abstinence from skin-to-skin contact when active lesions are present.
Question #6
QID: 15420
Topic: Coronary Artery Disease
Subject: PMCH
Coronary artery disease (CAD) is more common in men compared to women. Which of the following is also true?
a) After menopause, the incidence of CAD in women decreases
b) All diagnostic tests work equally well in both men and women
c) Women have worse outcomes following MI compared to men
d) Many more men than women display "atypical" patterns when they develop CAD
e) The male survivors of MI have a worse prognosis than the female survivors
The correct answer is c)
Explanation:
Men run a higher risk of developing the disease than premenopausal women. After menopause, the incidence of CAD
in women increases, and can be equal to men.
Coronary artery disease is a leading cause of death of women throughout the world.
Women have unique risk factors for heart disease. These risk factors include hormone replacement therapy, birth
control pills, and pregnancy-related problems.
Unfortunately, many more women than men display "atypical" patterns when they develop CAD, and these atypical
patterns all too often lead to missed diagnoses and inadequate therapy, and therefore, to worse outcomes.
Diagnostic tests that work quite well in men can be misleading in women. The most common problem is seen with
stress testing - in women, the electrocardiogram (ECG) during exercise can often show changes suggesting CAD,
whether CAD is present or not, making the study difficult to interpret.
Among survivors, 18% of men and 34% of women have a second MI within 6 years, 7% of men and 6% of women
die suddenly, 22% of men and 46% of women are disabled with CHF, and 8% of men and 11% of women have a
stroke
Question #7
QID: 15437
Topic: Cause of Death
Subject: PMCH
A 71-year-old male dies in the hospital. He was admitted into the hospital 4 days ago because of acute small bowel
obstruction. He underwent abdominal surgery for adhesion lysis. He had been recovering fairly well when he
developed a massive pulmonary embolus 12 hours ago that was confirmed by ventilation-perfusion scan. His past
medical history is significant for diverticulitis 15 years ago, COPD diagnosed 12 years ago ,and small cell lung
carcinoma diagnosed 6 months with metastases to the brain confirmed 3 months ago. What is the immediate cause of
death?
a) Pulmonary embolism
