2024 Written Exam Questions
Here at ExamPro we want to be your partner in passing your exams. Keeping that in mind, we have created a new FREE resource for you. Question of the Week. Each week one question will be posted to our website. These questions will be difficult. Getting the correct answer will require some logic and deduction, just like the real exam.
We are excited to bring you this tool to help you. Remember the questions will be posted on Thursdays and will only be up for one week. (Answers will be published the next week with the new question).
QUESTION: USE OF "DISTRACTORS" IN ANSWER CHOICES
Anti-D Immune Globulin should be administered to a Rh-negative
pregnant woman in which of the following situations?
A. Rh D Allo-Immunization documented in a prior pregnancy
B. Term Cesarean delivery with permanent sterilization procedure
C. Threatened first-trimester miscarriage
D. Pregnancy continuing after 40 0/7 weeks of gestation, with
anti-D immune globulin administered at 28 weeks
Last Week's Question:
QUESTION: MOST APPROPRIATE NEXT STEP
A 57 year old gravida 3 para 3 comes to see you for her annual GYN exam. Her LMP was 4 years ago. She has a primary care provider who recently did a “full lab evaluation” which was unremarkable. She does not take any medications or supplements. She eats a varied diet but doesn’t consume dairy due to lactose intolerance. She is physically active, and her BMI is 24. While reviewing her history she tells you that her mother recently suffered a lumbar compression fracture. The next most appropriate step in managing her risk for a fracture would be:
A. Initiation of Calcium Supplementation
B. Ordering a DXA Scan
C. Bisphosphonate Therapy
D. Performing a FRAX Score
Answer: D
Discussion:
This patient has several risk factors for osteoporosis including menopause and family history of a spinal fracture. The question is an excellent example of what you should expect to encounter in the board exam. There is a reasonable amount of detail provided in the question, intentionally placed there to create some distraction or uncertainty. After reading the question it is important to recognize that the topic is “risk of fracture” in a patient who does not have a specific diagnosis yet established, such as a vitamin deficiency or osteoporosis. In looking at the answer choices, all four could be reasonable steps to take for a given patient. However, one of them is the BEST choice for this patient.
Exam Strategy and Technique:
This question is an example of the “
Next Most Appropriate Step” question format.
This common question type is reviewed in detail in the ExamPro Written Skills Technique Course.
The strategy for approaching a question in this format is:
1. Recognize the “Next Most Appropriate Step” wording
2. Ask ourselves, “Do we have a diagnosis in this question yet?”
This question type exists in two forms. In the most common form, there is not yet a confirmed diagnosis for which we should choose management. This question is such an example.
3. Now evaluate the answer choices. As is commonly seen in this question type, two answer choices involve treatment or intervention (A and C) and two involve further evaluation for a diagnosis (B and D). In this question we are looking for further evaluation, rather than treating the patient. Therefore, we eliminate A and C.
4. Identify the “Key Words” in this question. In this question format, the Key Words, which define the correct and in correct answer choices, usually follow the “Next Most Appropriate Step” phrase. In this question the words are managing “
Risk of Fracture”.
5. Now, we evaluate Answers B and D for the best fit in identifying Risk of Fracture. Answer B, a DXA study, identifies a diagnosis of Osteopenia or Osteoporosis based on T-Scores or Z-Scores. Answer D, the FRAX Score, is a direct method of assessing a person’s Fracture Risk.
The recommended daily allowance for calcium and vitamin D in this patient would be 1200 mg and 600 IU respectively. This recommendation is for maintaining bone health, however, there is no evidence that it reduces fracture risk. Ordering a DXA scan is the preferred method of diagnosing osteoporosis if this patient’s level of fracture risk supported further evaluation. If an indicated DXA scan revealed osteoporosis, then bisphosphonate therapy would be a reasonable treatment option. In this case, while we are presented with risk factors for osteoporosis, we are NOT given an objective quantification of that risk. The most appropriate action would be to attempt to quantify the level of risk which could be done with a FRAX calculation.
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