Free CM Practice Questions

Question 1

Eight hours after his last drink, a 42-year-old man booked into jail develops tremor, diaphoresis, nausea, and a pulse of 118/min. He is oriented, has a respiratory rate of 18/min, and has a blood alcohol concentration of 140 mg/dL. His record documents a previous alcohol-withdrawal seizure. Hospital transfer has been arranged; medication and cardiorespiratory monitoring are available while transport is pending. Which treatment should begin during this interval?

Accepted Answer

Start benzodiazepine treatment with monitoring for oversedation and respiratory depression.

Answer

Withhold withdrawal medication until the blood alcohol concentration becomes undetectable.

Answer

Use gabapentin alone initially because the detectable alcohol level precludes benzodiazepines.

Answer

Use clonidine alone to control the autonomic symptoms while avoiding additional sedation.

Question 2

The intake laboratory reports a reactive fourth-generation HIV antigen/antibody assay but a negative supplemental HIV-1/HIV-2 antibody differentiation assay. The patient reports sharing injection equipment three weeks earlier and now has fever, pharyngitis, and a generalized rash. What test should resolve the discordant HIV results?

Accepted Answer

An HIV-1 RNA nucleic acid test now.

Answer

A repeat HIV antibody differentiation assay in six weeks.

Answer

A CD4 lymphocyte count to establish whether HIV infection is present.

Answer

An HIV Western blot to confirm the reactive screening assay.

Question 3

At a juvenile facility, a 13-year-old with HIV is offered HPV vaccination for the first time. Antiretroviral treatment has produced an undetectable viral load and a CD4 count of 720 cells/mm3. Consent has been obtained, and there is no vaccine contraindication. Which schedule applies?

Accepted Answer

Three doses at 0, 1-2, and 6 months, despite the suppressed viral load.

Answer

Two doses at 0 and 1-2 months, because HIV requires a shorter interval.

Answer

Two doses at 0 and 6-12 months, because the first dose will precede age 15.

Answer

Three doses at 0, 1, and 2 months, to finish the series before a possible transfer.

Question 4

A 36-year-old jail resident was a close household contact of a person with infectious pulmonary tuberculosis three months ago. A tuberculin skin test now measures 8 mm of induration at 60 hours. He received BCG in infancy, has no TB symptoms, and has a normal chest radiograph. The clinical evaluation finds no evidence of active disease. How should the result guide care?

Accepted Answer

Offer treatment for latent TB infection; airborne isolation is not indicated.

Answer

Begin airborne isolation and a multidrug active-TB regimen because the test is positive.

Answer

Classify 8 mm as negative for a correctional resident.

Answer

Discount the result as a BCG reaction and repeat screening at the next annual review.

Question 5

During an examination, a man with a complete T4 spinal cord injury abruptly develops a pounding headache, facial flushing, and sweating above the injury. Blood pressure is 174/100 mm Hg, compared with his usual 100/60, and his pulse is 52/min. His catheter bag has been empty for several hours; the drainage tubing is visibly kinked beneath his thigh. What is the immediate bedside priority?

Accepted Answer

Sit him upright, release the catheter kink, and promptly reassess blood pressure.

Answer

Obtain brain imaging before repositioning him or restoring catheter drainage.

Answer

Administer a long-acting oral antihypertensive and postpone catheter assessment until it takes effect.

Answer

Lay him supine with his legs elevated before attempting to restore catheter drainage.

Question 6

A woman in an adult jail reports sexual assault by another resident 18 hours earlier. She requests emergency contraception and STI prophylaxis but declines to identify the assailant or participate in an investigative interview. The clinician determines that both treatments are indicated. What do the federal PREA standards require in this situation?

Accepted Answer

Provide the indicated care without cost or a cooperation requirement.

Answer

Offer treatment after the standard copayment unless she identifies the assailant.

Answer

Complete an investigative interview before dispensing the indicated prophylaxis.

Answer

Require a signed complaint, but allow her to withhold the assailant's name.

Question 7

A 33-year-old detainee answers yes to having thoughts of killing himself during the past week on the NIMH Ask Suicide-Screening Questions (ASQ). He answers no to having those thoughts right now, denies a current plan or intent, and has no agitation, intoxication, or other immediate safety concern identified. A trained clinician is available. What does this screening result call for before a disposition is selected?

Accepted Answer

A brief suicide safety assessment before choosing the level of care.

Answer

Automatic psychiatric hospitalization because any positive ASQ response establishes imminent risk.

Answer

Rescreening at the next routine visit without an additional assessment today.

Answer

Classification as a negative screen because the current-thoughts question was answered no.

Question 8

A receiving physician reviews records showing successful hepatitis C treatment, including undetectable HCV RNA 12 weeks after therapy. Eighteen months later, the intake panel again shows reactive HCV antibody and undetectable HCV RNA. There has been no recent exposure, and liver enzymes are normal. Which assessment belongs in the referral decision?

Accepted Answer

Current viremia is not demonstrated; the reactive antibody alone does not justify retreatment.

Answer

Current infection remains unclassified until a second antibody assay becomes nonreactive.

Answer

The reactive antibody indicates virologic relapse and warrants another antiviral course.

Answer

The combination demonstrates protective immunity, so future exposures do not require testing.

Question 9

At 31 weeks of gestation, a previously normotensive patient has blood pressures of 152/96 and 154/94 mm Hg four hours apart. Her platelet count has fallen from 218,000/microliter two weeks ago to 72,000/microliter, confirmed on repeat testing without platelet clumping. Urine protein-to-creatinine ratio is 0.12. Creatinine and liver enzymes are normal, and no alternative cause of thrombocytopenia is identified. Which diagnosis accounts for the combination of findings?

Accepted Answer

Preeclampsia with severe features despite the absence of proteinuria.

Answer

Gestational hypertension with incidental gestational thrombocytopenia.

Answer

Preeclampsia without severe features because the blood pressure is below 160/110 mm Hg.

Answer

Immune thrombocytopenia with coincidental gestational hypertension.

Question 10

After introducing enhanced wound-care access, a jail compares new symptomatic MRSA skin infections. January had 6 new infections during 6,000 at-risk resident-days; February had 4 during 2,000 at-risk resident-days. February screening also identified 8 asymptomatic nasal carriers without skin infection. Clinical case definitions and case-finding methods were unchanged. Which statement should the medical director make about February's clinical infection rate?

Accepted Answer

It was 2.0 per 1,000 resident-days, twice January's rate despite the lower case count.

Answer

It was 1.25 per 1,000 resident-days, using both months together to demonstrate improved control.

Answer

It was 0.67 per 1,000 resident-days, so the lower case count supports a one-third improvement.

Answer

It was 6.0 per 1,000 resident-days, after counting the newly detected carriers as clinical infections.

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