11.

A 62-year-old morbidly obese male with type 2 diabetes mellitus is being started on
metformin. Which of the following is the most common drug adverse effect affecting
compliance?
Diarrhea
Weight gain
Fatigue
Headache
Edema
12.A 32-year-old woman presents to the emergency complaining of feeling anxious, short of
breath, nauseated and dizzy. She is sweaty and complains of feeling "pins and needles" in her
hands. Upon questioning, she describes the room as spinning. She is certain that something
terrible is happening to her "like a heart attack." Which one of the following symptoms should
alert you to a medical condition presenting as a panic attack? Fear of dying
Paresthesias
Diaphoresis
Dyspnea
Vertigo
13. A 65-year-old woman, who is otherwise well, has disabling rheumatoid arthritis. You elect
to treat her with the nonsteroidal anti-inflammatory agent (NSAID) ibuprofen in an attempt to
reduce the inflammatory response and pain she suffers. Which one of the following side effects
of NSAIDs is most likely to develop in this patient? Thrombocytopenia.
Duodenal ulcer.
Congestive heart failure.
Gastritis.
Acute renal failure.
14. A 7-year-old boy with a past history of chronic kidney disease due to posterior urethral
valves diagnosed at birth presents to the Emergency Department with a 48-hour history of
diarrhea and vomiting. He weighs 30 kg and his height is 130 cm. Examination reveals a pale
child with cool hands and feet and a prolonged capillary refill time. Laboratory results showed:
Sodium 134 mmol/L Potassium 5.2 mmol/L Bicarbonate 19 mmol/L Creatinine 170
mol/L Urea 17.5 mmol/L Which one of the following would be the most appropriate to
order as an intravenous bolus to treat this acute illness?
600 mL of 5% dextrose 0.45% saline.
400 mL of 0.9% saline.
150 mL of 0.2% saline with 10 mmol/L KCl.
500 mL of 0.45% saline.
300 mL of 0.2% saline with 20 mmol/L KCl.
15.Compared with control subjects, patients with major depression generally show
frequent REM periods and decreased density. decreased REM latency and decreased stage 4
sleep.
shortened REM time and decreased stage 2 sleep. shortened REM time and no change in
stage 4 sleep.
increased rapid eye movement (REM) latency and increased stage 2 sleep.

16. A 39-year-old woman presents to your office and requests the birth control pill. She has
used oral contraceptives in the past with no problems. She is healthy and does not take any
medications. Her mother had breast cancer. Before prescribing the pill, which one of the
following interventions would be most appropriate?
Review her past Papanicolaou smears for abnormalities.
Order a mammogram.
Draw blood for a lipid profile.
Assess her smoking status.
Do a urine pregnancy test.
17. Four weeks ago, a 42-year-old woman presented to your office having already started
taking St. John's Wort 300 mg 3 times a day as recommended by her naturopath. She had a twomonth history of feeling sad and distant from her family, crying spells when alone and difficulty
falling asleep. She continued to work part time. Although she continued to take St. John's Wort
300 mg TID, she now reports that she feels more distracted, has sleepless nights and more
frequent crying spells. She is not suicidal. In addition to regular follow up, which one of the
following is the most appropriate management plan?
Stop St. John's Wort and begin venlafaxine (Effexor XR) 75 mg QAM, after a wash out period.
Continue St. John's Wort at the current dose and add paroxetine (Paxil) 20 mg OD.
Increase the dose of St. John's Wort to 600 mg TID.
Add Omega-3 5 g/day to the current dose of St. John's Wort.
Add Lithium 600 mg daily to augment her current dose of St. John's Wort.
18.A woman, gravida 2, para 1, consults at 10 weeks of gestation. In obtaining her history, which
of the following is the most important risk factor for preterm delivery?
She has a history of anorexia nervosa.
Her first baby was born at 34 weeks.
She was treated for Chlamydia 6 months ago.
She works as a sales person in a department store. She is 36 years old.