CMS quiz Q & As:

Question 1

A 50-year-old patient presents with acute onset sore throat. On physical examination, palatal petechiae are detected. Assume a pretest probability for infectious mononucleosis of 1% and that palatal petechiae has a likelihood ratio of 5 for detecting infectious mononucleosis. Assume also that you set a testing threshold of 10% for this condition. What action is now most appropriate?

a. Consider infectious mononucleosis an active alternative and order heterophile antibody testing

b. Consider infectious mononucleosis an active alternative and order EBV viral capsid antigen (VCA) testing

c. Rule out infectious mononucleosis

d. Treat infectious mononucleosis

Answer 1

c. Rule out infectious mononucleosis

Recall how you might easily apply a LR of 5 to a pretest probability of 1%. Then consider whether this is above or below your testing threshold and what this would mean.

Question 2

What is the main reason that a naturopathic doctor avoid examination with a tongue depressor in a patient in whom they suspect epiglottitis?

a. It may cause spasm and airway obstruction

b. It is not worth the time when urgent referral is needed

c. The posterior pharynx can only be visualized in about 20% of cases and the diagnostic yield is therefore low

d. The patient is likely to be in distress already and this examination is uncomfortable

Answer 2

a. It may cause spasm and airway obstruction

Question 3

What is the best approximation of the frequency of strep among children ages 5-15 with sore throat?

a. 80%
b. 5%
c. 30%
d. 50%

Answer 3

c. 30%

Question 4

In addition to acute onset of fever with severe sore throat and a toxic appearance, what should naturopathic doctor ask about in assessing whether their patient has epiglottitis?

a. Difficulty swallowing
b. Dizziness
c. Dyspepsia
d. Diarrhea

Answer 4

a. Difficulty swallowing

Question 5

An 11-year-old patient presents with acute onset sore throat. The have no cough.

On physical examination, you note that they have a fever and that the anterior cervical lymph nodes are enlarged and tender. The oropharyngeal exam reveals tonsillar exudates.

What condition is most likely?

a. A coronavirus
b. Mononucleosis
c. A rhinovirus
d. Streptococcal pharyngitis

Answer 5

d. Streptococcal pharyngitis