Tiffany is a 43-year-old female with a family history of breast cancer in her mother, 1 of 3 maternal aunts, and a paternal grandmother. All of the women were diagnosed postmenopausally.  She is 5’7” and weight is 179 pounds (BMI 28).  Menarche at age 14.  Her first live birth was at age 25, she has 3 children total.  She continues to have regular periods every 28-30 days.  She has never smoked. She does drink a glass of wine each night but will sometimes have 2-3 glasses on Friday and Saturday nights. She walks for 30 minutes 2 days per week.  Her mother did undergo genetic testing and was found to be negative.  You have used the IBIS risk model and determined her lifetime risk to be 26.3%.  What interventions would you recommend at this time? 0.5 points given for each intervention. 

Please describe the most common GI disease you have seen in clinical? What type of labs did you order? What type of medications? Would you have done anything differently than your preceptor?  1 point for each question answered. 

The following statements are true about Wilms’ tumor EXCEPT:

You are examining a healthy 58 year old male as part of a routine annual physical and note a systolic murmur on exam. How would you decide if an echocardiogram is indicated to further evaluate the murmur (0.5 points)? In your response, please include at least three things that would lead you to order an echo in this case (1.5 points).   

Typical drug screens detect: Select all that apply

Red flag on physical exam to consider child abuse:

Which of the following are barriers to completion of advance directives?  Select all that apply.

Which one of the following symptoms indicates physiologic gastroesophageal reflux instead of GERD in infants and children?

Mom of a 10-year-old patient in your practice, Jack, calls with concerns.  Teachers at school are asking for Jack to be assessed for ADHD. After a history review, behavioral ratings from both parents and teachers, an office visit for  physical exam, and consideration of differential or other comorbidities, you diagnose ADHD. You add a consult for behavioral therapy and your first medication recommendation is:

Jennifer is a 42 year old female well-known to your practice. In the last 10 months she has presented at least once/month with diffuse abdominal pain.  The pain is rated as severe, she has quit her job related to the symptoms.  All medical evaluation has been negative including: xray, CT scan, ultrasound, and colonoscopy.  Today she states she is checking her blood pressure and pulse multiple times daily and is highly anxious in the office. You consult psychiatry and consider a diagnosis of: