A 62-year-old woman, who has been coming to you for 3 years, has a recent onset of hypertension.
Question 1

A 62-year-old woman, who has been coming to you for 3 years, has a recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next?

Add a fourth medicine

Refer to nephrology

Get a CT scan

Listen closely to her abdomen

Question 2

Mrs. Jaeger is a 67–year-old who went through menopause at age 55. She has now had some vaginal bleeding. Which of the following should be considered?

Endometrial cancer

Hormone replacement therapy

Uterine or cervical polyps

All of these

Question 3

A 73-year-old retired accountant presents to your office for her annual examination. She has incontinence of urine when she coughs or sneezes. She takes several medications for control of hypertension and diabetes. You use the DIAPERS mnemonic to assess the cause of her incontinence. All of the following are items represented by the mnemonic except for:

Atrophic vaginitis

Depression

Pharmaceuticals

Restricted mobility

Question 4

A 58-year-old gardener presents to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?

Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Question 5

A patient presents to you because she is experiencing a tremor only when she reaches for things. This becomes worse as she nears the “target.” When you ask her to hold out her hands, no tremor is apparent. What type of tremor does this most likely represent?

Intention tremor