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