DERM
A 57-year-old male presents with a complaint of 5 days of cough productive of yellow, blood-tinged sputum; difficulty breathing; chest pain with cough and deep inspiration; and shaking chills. Physical exam reveals crackles in the right base on auscultation of the lungs. There is also slight dullness to percussion over the right lower lung. What is the most likely diagnosis? A.Community-acquired pneumonia of the right lower lobe B.Nosocomial pneumonia of the right lower lobe C.Acute bronchitis D.Aspiration pneumonia
A. Community-acquired pneumonia of the right lower lobe
A 5-year-old child presents with an acute case of fever, chills, adenopathy, and pharyngitis. The caretaker has tried symptomatic treatment for more than a week. What would be the next appropriate step in this situation? A.Perform a cervical spine radiograph to look at the soft-tissue structures of the neck B.Perform a throat swab C.Start amoxicillin D.Observe the patient for 48 hours before starting treatment
B.Perform a throat swab
A 45-year-old female presents with a temperature of 38.8°C, heart rate of 105 beats per minute, blood pressure of 140/75 mm Hg, oxygen saturation of 92% on room air, pleuritic chest pain, and cough with purulent sputum. What is the best chest radiograph view to evaluate a possible pneumonia? Normal values Pulse: 60 to 100 beats per minute (bpm) Blood pressure: Systolic 90 to 120, diastolic 60 to 80 Temperature: 37.0°C Oxygen saturation: 94% to 100% A.Lateral decubitus views B.Posteroanterior (PA) and lateral views C.Anteroposterior (AP) view D.Inspiratory and expiratory views
B.Posteroanterior (PA) and lateral views
A 22-year-old African American male presents with mildly pruritic hypopigmented macules and patches on his upper back and neck that he has had for several weeks. Which of the following diagnostic procedures would you do to solidify your diagnosis? A.Punch biopsy B.Potassium hydroxide (KOH) test C.Patch test D.Tzanck smear
B.Potassium hydroxide (KOH) test
Which of the following examinations/tests would be most helpful in screening the differential diagnosis for an enlarged prostate? A.Digital rectal exam (DRE) B.Prostate-specific antigen (PSA) C.Bone scan of the lumbar spine D.Urethrocystoscopy
B.Prostate-specific antigen (PSA)
A 23-year-old otherwise-healthy college student presents with complaints of a newly developing rash located on his knees and elbows. On physical exam you note large raised plaques with a silvery appearance that bleed when scraped. What is the most likely diagnosis? A.Erythema nodosum B.Psoriasis C.Tinea corporis D.Nummular eczema
B.Psoriasis
Mrs. R., a 52-year-old golfer, comes in to see you about her "ruined complexion." She states that over the last 4 to 5 months her nose and cheeks just keep getting redder and redder. She states that she is embarrassed at the acne-looking pustules that are on her nose, forehead, and cheeks. When asked what she thinks makes the condition better or worse she states, "I know you will think this is really weird but whenever I go to Amigos, an outdoor Mexican restaurant after a full day of golfing in the sun, things just get worse. I am not sure why that combination is such a problem. I've even given up margaritas!" What is the most likely diagnosis? A.Herpes zoster B.Rosacea C.Erysipelas D.Tinea corporis
B.Rosacea
How are the borders of actinic keratosis lesions best described? A.Smooth and pearly B.Rough and often hyperkeratotic C.Greasy and "stuck on" D.Raised with a fine scale
B.Rough and often hyperkeratotic
A 42-year-old male presents with a firm, nontender, nonulcerated mass in his scalp. The mass slides easily on the scalp. What is the most likely diagnosis? A.Basal cell carcinoma B.Sebaceous cyst C.Cellulitis D.Hematoma E.Cephalhematoma
B.Sebaceous cyst
You are caring for a 69-year-old male who presents complaining of easy fatigability. As part of your workup you perform a 12-lead electrocardiogram (ECG). You note that the ECG demonstrates progressive lengthening of the PR segment. Every fifth P wave is not followed by a QRS complex. What rhythm does this finding describe? A.First-degree heart block B.Second-degree heart block—Mobitz I C.Second-degree heart block—Mobitz II D.Third-degree heart block
B.Second-degree heart block—Mobitz I
What type of bronchogenic carcinoma is associated with the worst prognosis? A.Squamous cell carcinoma B.Small cell carcinoma C.Adenocarcinoma D.Large cell carcinoma E.The prognosis is the same for all types
B.Small cell carcinoma
A patient presents for a routine checkup and you note his blood pressure to be 142/84 mm Hg. Which of the following is the appropriate diagnosis for this patient? A.Prehypertension B.Stage I hypertension C.Stage II hypertension D.Accelerated hypertension E.Malignant hypertension
B.Stage I hypertension
A 3-year-old presents with drooling, stridor, and difficulty swallowing. On exam, he is sitting with his knees pulled toward his chest, and he is leaning forward. What would you expect to see on a lateral radiograph of the neck? A.Steeple sign B.Thumbprint sign C.Teardrop sign D.Sail sign
B.Thumbprint sign
Gently scraping the scale of the lesion and evaluating it under a microscope with potassium hydroxide (KOH) reveals a "meatball and spaghetti" pattern. What is the most likely diagnosis? A.Guttate psoriasis B.Tinea versicolor C.Pityriasis rosea D.Nummular eczema
B.Tinea versicolor
A 19-year-old G0 female presents with a breast lump that she found yesterday. Her mother was recently diagnosed with breast cancer at age 53 and is undergoing chemotherapy. Her maternal aunt developed breast cancer at age 48. On exam there is a 2 × 2-cm nontender mobile mass in the upper outer quadrant of the left breast. What is the most appropriate next step? A.Mammogram B.Ultrasound C.Breast magnetic resonance imaging (MRI) D.Biopsy
B.Ultrasound
A 22-year-old male presents with a painless lump on his left testicle. Which of the following tests is the initial diagnostic study of choice in your patient? A.Computed tomography (CT) scan of the pelvis B.Ultrasound C.Complete blood count with differential D.Alpha fetoprotein levels
B.Ultrasound
What is the normal pH of the vagina in reproductive-age women? A.pH 2.5 to 3.5 B.pH 3.5 to 4.0 C.pH 6.5 to 7.0 D.pH 7.0 to 8.0
B.pH 3.5 to 4.0
What radiographic finding is associated with croup? A."Thumbprint sign" B."Throckmorton's sign" C."Empty cup sign" D."Steeple sign"
D."Steeple sign"
A barium esophagogram showing a "bird's beak" appearance is characteristic of what disorder? A.Esophageal spasm B.Scleroderma C.Esophageal web D.Achalasia
D.Achalasia
Which of the following is a common cause of intrinsic renal failure? A.Diuretic-induced azotemia B.Bladder neck obstruction C.Prostate cancer D.Acute tubular necrosis
D.Acute tubular necrosis
A 76-year-old male has complaints of frequency of urination, nocturia, hesitancy, urgency, and a weak urinary stream. He has been taking doxazosin for 5 months now with no relief. What is the next logical treatment of choice? A.Transurethral resection of the prostate (TURP) procedure B.Open prostatectomy C.Thermotherapy D.Addition of 5-alpha-reductase inhibitors
D.Addition of 5-alpha-reductase inhibitors
In regard to the "ABCD" rule for moles, what does "A" represent? A.Ascription B.Assessment C.Allowance of margins D.Asymmetry
D.Asymmetry
The term "blue bloater" refers to a patient with what disease? A.Asthma B.Cystic fibrosis C.Emphysema D.Chronic bronchitis
D.Chronic bronchitis
Rib notching on a chest x-ray is associated with which of the following conditions? A.Aortic aneurysm B.Aortic dissection C.Arteriovenous fistula D.Coarctation of the aorta E.Subclavian steal syndrome
D.Coarctation of the aorta
A 16-year-old female presents with primary amenorrhea. Physical exam is unremarkable. The patient is Tanner stage 3, with height 5′8″ and weight 140 lb. What is the most likely diagnosis? A.Polycystic ovary syndrome B.Turner's syndrome C.Kallmann's syndrome D.Constitutional delay E.Anorexia nervosa
D.Constitutional delay
Which of the following would more likely be benign prostate hyperplasia than prostate cancer? Prostate-specific antigen normal values: 0-49 years old: <2.5 ng/mL 50-59 years old: <3.5 ng/mL 60-69 years old: <5.5 ng/mL >69 years old: <6.5 ng/mL A.A 42-year-old African American male with an enlarged hard prostate B.Prostate-specific antigen levels of 15 and 20 taken over 3 months C.Prostate nodule found on a 55-year-old D.Enlarged prostate with a prostate-specific antigen level of 1.4
D.Enlarged prostate with a prostate-specific antigen level of 1.4
A 46-year-old male presents with complaints of dysphagia of solid foods for 3 months. He also states he believes he is getting a cold because of recent development of a hoarse voice. He has noted a 16-pound weight loss in about 6 months. His medical history includes gastroesophageal reflux disease. His social history includes a 10-year history of drinking a case of beer every other day, and he has smoked about one pack of cigarettes daily since age 16. Aside from this information, his review of systems is negative. Vital signs and exam are normal. What is the most likely diagnosis? A.Alcoholism B.Malnutrition C.Barrett's esophagus D.Esophageal tumor
D.Esophageal tumor
Mesothelioma is a type of lung cancer that is associated with which of the following? A.Chronic exposure to silica dust B.Exposure to benzene C.Chronic alcohol use D.Exposure to asbestos
D.Exposure to asbestos
A 55-year-old male has been treated for an ulcer with a proton pump inhibitor for the last 4 months, and he states the symptoms are not improving. He still complains of heartburn symptoms and now has had episodes of diarrhea and steatorrhea. He states that he has noticed weight loss of about 12 pounds in the last 4 months. He denies noting any blood in the stool, has not traveled anywhere recently, and has had no complaints of emesis. A recent upper endoscopy showed a solitary ulcer in the duodenal bulb. A recent fasting gastrin level was more than 150 pg/mL. What is the most likely diagnosis? Normal value gastrin: <100 pg/mL A.Gastric outlet obstruction B.Peptic ulcer disease C.Hiatal hernia D.Gastrinoma
D.Gastrinoma
Which of the following disorders is most commonly associated with Barrett's esophagus? A.Variceal disease B.Esophageal spasm C.Achalasia D.Gastroesophageal reflux disease (GERD)
D.Gastroesophageal reflux disease (GERD)
What is the most common pathogen involved in pulmonary bacterial superinfection after influenza infection? A.Staphylococcus aureus B.Nocardia asteroids C.Streptococcus pneumoniae D.Haemophilus influenzae
D.Haemophilus influenzae
An 18-year-old patient presents with enlarged, beefy-red tonsils. She is empirically treated with amoxicillin for a presumed bacterial infection. Two days later she returns to the clinic with a diffuse rash all over her body. Which diagnostic test would best confirm your diagnosis? A.Complete blood count B.Lyme titer C.Human immunodeficiency virus (HIV) titer D.Heterophile test
D.Heterophile test
A 24-year-old patient presents with a small tender bump on his upper eyelid. He states that 2 days ago his eye was irritated and this morning he woke up and noticed the bump. He denies any fever, chills, headache, changes in vision, photophobia, or recent upper respiratory infection. On exam you notice a discrete, small, painful nodule on his upper lid. What is the most likely diagnosis? A.Blepharitis B.Dacryocystitis C.Esotropia D.Hordeolum
D.Hordeolum
Which of the following findings is most commonly associated with chronic venous insufficiency of the legs? A.Atrophy of the calf muscles B.Diminished dorsalis pedis pulses C.Gangrene of the distal toes D.Hyperpigmentation of the ankles
D.Hyperpigmentation of the ankles
You are following a 15-year-old male for a syncopal episode he experienced during basketball practice. Your physical examination was unremarkable, but you sent him for an echocardiogram and cardiology follow-up. Today the echo report has arrived and noted marked hypertrophy of the ventricular septum. What is the most likely diagnosis? A.Aortic stenosis B.Dilated cardiomyopathy C.Ebstein anomaly D.Hypertrophic cardiomyopathy E.Ventricular septal defect
D.Hypertrophic cardiomyopathy
What characterizes a positive Murphy's sign on physical examination? A.Pain when percussing the right upper abdomen B.Tenderness in the right upper abdomen C.A palpable fullness to the gallbladder D.Inspiratory arrest with palpation of the right upper abdomen
D.Inspiratory arrest with palpation of the right upper abdomen
While examining a 45-year-old female who presented complaining of dyspnea on exertion, you note a regular S1 and S2 followed by an opening snap. The sound is heard best at the apex. What diagnosis do these findings suggest? A.Aortic regurgitation B.Aortic stenosis C.Mitral regurgitation D.Mitral stenosis
D.Mitral stenosis
A 5-year-old boy presents with a 3-day history of painful sores in his mouth. On examination, he has a fever and swollen lymph nodes. You diagnose the patient with herpetic stomatitis. What would you expect to find when examining his mouth? A.Thick, white patches B.Deep purple-colored lesions C.Small red spots D.Multiple small vesicles
D.Multiple small vesicles
Which of the following are risk factors for developing breast cancer? A.Multiparity, late menarche, early menopause B.Nulliparity, late menarche, late menopause C.Multiparity, early menarche, late menopause D.Nulliparity, early menarche, late menopause
D.Nulliparity, early menarche, late menopause
A 25-year-old male presents to the clinic complaining of pain in his scrotum since this morning. He woke up with a dull ache and now it "hurts bad." On examination, you find a very tender right testicle, especially posteriorly. The testicles hang equally, appear symmetrical, are not enlarged, and are equal in size. The patient has a positive Prehn's sign. What is the most appropriate next step in the management of this patient? A.Immediately refer for surgical exploration B.Provide scrotal support, an antibiotic directed at Escherichia coli, and pain medication C.Transilluminate the scrotum D.Order a color Doppler scrotal ultrasound
D.Order a color Doppler scrotal ultrasound
A 53-year-old male presents with painless jaundice that started last night. The patient admits to a 14-pound weight loss over 3 months and has a diminished appetite. On evaluation, the patient appears jaundiced. The only abdominal abnormality per exam is a hard palpable periumbilical (Sister Joseph's) nodule. The initial plain abdominal radiograph series reveals widening of the duodenal loop, and an initial urinalysis reveals glycosuria. Further tests are pending. What is the most likely diagnosis? A.Acute pancreatitis B.Gallbladder carcinoma C.Hepatic cirrhosis D.Pancreatic carcinoma
D.Pancreatic carcinoma
A 14-year-old girl presents with sore throat, dysphagia, neck pain, stridor, and a fever. On examination of the throat she has tonsillar enlargement and her uvula is deviated to the left. What is the most likely diagnosis? A.Epiglottitis B.Tonsillitis C.Mononucleosis D.Peritonsillar abscess
D.Peritonsillar abscess
A 3-year-old boy develops a solitary, round, pink lesion with a raised border and fine, adherent scales in the margin. Approximately 1 week later, oval, salmon-colored, slightly raised maculopapular lesions in a "Christmas tree" distribution appear on the boy's trunk. What is the most likely diagnosis? A.Varicella B.Measles C.Scarlet fever D.Pityriasis rosea E.Fifth disease
D.Pityriasis rosea
A 38-year-old construction worker states he has a chronic irritation of his left eye. He states it is constantly tearing, but he has no associated pain or discomfort. On examination a yellowish elevation extending from the medial canthus to the nasal cornea is noted. What is the most likely diagnosis? A.Rust ring subsequent to a foreign body in the eye B.Cataract C.Corneal ulcer D.Pterygium
D.Pterygium
A 71-year-old male with a history of prostate cancer presents to the emergency department with a complaint of a sudden onset of dyspnea and chest pain with inspiration. On physical exam he is found to have a blood pressure of 128/84, pulse of 118, respiratory rate of 28, and a temperature of 100.2°F (oral). The chest x-ray is unremarkable, and the electrocardiogram (ECG) reveals sinus tachycardia at 120 but is otherwise normal. There are slight crackles present in the right base. Which of the following is the most likely diagnosis? Normal values Pulse: 60 to 100 beats/minute Respiration: 12 to 20 per minute Blood pressure: Systolic 90 to 120, diastolic 60 to 80 Temperature: 98.6°F A.Pneumonia B.Chronic obstructive pulmonary disease (COPD) C.Myocardial infarction (MI) D.Pulmonary embolism
D.Pulmonary embolism
A 6-week-old infant is brought to you because of feeding problems noted over the last week. The mother says that the infant seems to have emesis after each meal and appears persistently hungry. She is now concerned because the child has lost about 1 pound over the week and seems more fatigued than normal. On exam, the child is alert and consolable but appears slightly dehydrated. Abdominal exam reveals a firm 1- to 2-cm palpable olivelike mass in the epigastrium. What is the most likely diagnosis? A.Pyelonephritis B.Gastroenteritis C.Ileus D.Pyloric stenosis
D.Pyloric stenosis
A patient with angle-closure glaucoma will present with which of the following complaints? A.Painless progressive central vision loss B.Decreased acuity, photophobia, and floaters C.Unilateral sudden loss of vision D.Red, painful eye with cloudy vision
D.Red, painful eye with cloudy vision
A 17-year-old girl is seen by her pediatrician for complaints of periodic lower abdominal pain that she attributes to stress. She notes it lasts 2 days and is associated with bloating and constipation. Her family history is positive for irritable bowel syndrome in her mother. Menarche has not occurred. The patient denies sexual activity. Her exam shows a well-nourished female, 5′7″ tall and weighing 135 lb. She is a Tanner stage 5. Pelvic exam shows normal external genitalia, but the cervix is not visible. Her urine human chorionic gonadotropin (hCG) is negative. Which would be the next best step? A.Refer to a gastrointestinal specialist B.Colonoscopy C.Barium enema D.Refer to a gynecologist E.Urinalysis and culture and sensitivity
D.Refer to a gynecologist
Diverticulosis occurs more frequently in which of the following locations? A.Ascending colon B.Descending colon C.Transverse colon D.Sigmoid colon
D.Sigmoid colon
In a 12-year-old male with symptoms of epididymitis, what is the most common differential diagnosis that first must be ruled out? A.Acute orchitis B.Hydrocele C.Spermatocele D.Testicular torsion E.Testicular tumor
D.Testicular torsion
A 75-year-old woman presents with postmenopausal bleeding. Her endometrial biopsy shows well-differentiated endometrial cancer. What is the best treatment for her? A.Radiation therapy B.Chemotherapy with cisplatinum C.Combination of radiation and chemotherapy with cisplatinum D.Total abdominal hysterectomy with bilateral salpingo-oophorectomy
D.Total abdominal hysterectomy with bilateral salpingo-oophorectomy
Which of the following cardiac enzymes is the most specific indicator of myocardial tissue death? A.Creatinine B.Creatine kinase C.Myoglobin D.Troponin
D.Troponin
A 32-year-old woman presents to your office with dysuria and frequency with no previous history of genitourinary tract problems. What is the most likely diagnosis? A.Cervical cancer B.Pregnancy C.Uterine fibroid D.Urinary tract infection
D.Urinary tract infection
A 13-year-old boy complains of heaviness in his scrotum and some vague pain that worsens with exertion. Palpation of the scrotum reveals a mass above the left testis that is nontender, is freely moveable, and feels like a collection of soft tubules. What is the most likely diagnosis? A.Orchitis B.Testicular torsion C.Epididymitis D.Varicocele
D.Varicocele
You are called to the bedside of a 56-year-old male who is scheduled to undergo elective cardiac catheterization. The nurse reports that she was just speaking with the patient when he suddenly lost consciousness and she is having difficulty locating a pulse. You attach a cardiac monitor, which demonstrates chaotic electrical activity with no discernible pattern. What diagnosis does this scenario suggest? A.Asystole B.First-degree heart block C.Torsades de pointes D.Ventricular fibrillation E.Ventricular tachycardia
D.Ventricular fibrillation
Which finding is most specific in distinguishing pyelonephritis from cystitis? A.Costovertebral angle (CVA) tenderness B.Fever and chills C.Leukocytosis D.White cell casts
D.White cell casts
After an episode of unprotected intercourse, when should emergency contraception be administered? A.Within 24 hours B.Within 36 hours C.Within 48 hours D.Within 72 hours
D.Within 72 hours
A 16-year-old male presents to your office complaining of occasional episodes of tachycardia. His blood pressure and heart rate are normal. A 12-lead electrocardiogram is performed, and you note that there is no distinct return to baseline between each P wave and the QRS complex. Instead, the waves appear to be slurred together. What diagnosis do these findings suggest? A.First-degree heart block B.Intraventricular conduction delay C.Second-degree heart block type 2 D.Wolff-Parkinson-White (WPW) syndrome
D.Wolff-Parkinson-White (WPW) syndrome
On a routine urinalysis, a 50-year-old man is noted to have microscopic hematuria. He is asymptomatic and cannot recall if he ever had hematuria previously. After taking a history, you decide to further evaluate this finding. Which factor increases the likelihood that there is a serious underlying abnormality? A.Acetaminophen use for chronic low back pain B.Cigarette smoking C.A high number of white blood cells in the urine D.Urge incontinence E.Recent vigorous exercise
A.Acetaminophen use for chronic low back pain
A 43-year-old mildly obese female presents with moderate epigastric pain radiating to her mid back. She has accompanying nausea and vomiting but no change in bowel habits. She states that the pain seems to wax and wane. A general assessment reveals her to be in mild-moderate pain, holding her epigastrium. Her skin is warm and dry, and she has no evidence of jaundice. Her pulses are intact throughout. Her abdomen exam demonstrates pain to palpation of the epigastrium with guarding and diminished bowel sounds. There is a negative Murphy's sign, and there is no evidence of abdominal mass or bruit. What is the most likely diagnosis? A.Acute pancreatitis B.Acute cholecystitis C.Acute mesenteric ischemia D.Acute hepatitis
A.Acute pancreatitis
A 7-year-old boy presents with persistent abdominal pain for 24 hours accompanied by anorexia and nausea. His physical examination is remarkable for right lower quadrant tenderness and guarding. What is the most likely diagnosis? A.Appendicitis B.Gastroenteritis C.Intussusception D.Pyloric stenosis
A.Appendicitis
A 33-year-old G3P2 female presents with a year-long history of amenorrhea. She is sexually active and uses her husband's vasectomy as birth control. Her past medical history is significant for two normal spontaneous vaginal deliveries. She also had a miscarriage, which was treated with a dilation and curettage (D&C) last year. Her pelvic exam shows a normal-sized uterus and both ovaries are nontender and normal size. What is the most likely diagnosis? A.Asherman's syndrome B.Sheehan's syndrome C.Kallmann's syndrome D.Hyperprolactinemia E.Hypothyroidism
A.Asherman's syndrome
A 76-year-old female presents for a routine physical examination. Her history is significant for longstanding hypertension. During the physical examination, you note her pulse to be irregularly irregular. Which of the following diagnoses does this finding suggest? A.Atrial fibrillation B.First-degree heart block C.Third-degree heart block D.Left-ventricular hypertrophy
A.Atrial fibrillation
Which of the following studies is most accurate in establishing a diagnosis of congestive heart failure? A.B-type natriuretic peptide B.Creatine kinase C.Myoglobin D.Troponin
A.B-type natriuretic peptide
A 45-year-old male who is a professional surfer develops a raised papule with a pearly border containing telangiectatic vessels on his face. What is the most likely diagnosis? A.Basal cell carcinoma B.Squamous cell carcinoma C.Mycosis fungoides D.Malignant melanoma E.Bowen's disease
A.Basal cell carcinoma
Your patient is 74 years old with red hair and blue eyes. She presents with a raised, smooth tumor on the left nasolabial area surrounded by telangiectasia. She reports that the lesion has been slowly growing for 6 years. What is your most likely diagnosis? A.Basal cell carcinoma B.Squamous cell carcinoma C.Seborrheic keratosis D.Malignant melanoma
A.Basal cell carcinoma
Which of the following is the most common cause of secondary hypertension? A.Chronic renal failure B.Coarctation of the aorta C.Hyperthyroidism D.Pheochromocytoma E.Renal artery stenosis
A.Chronic renal failure
A 58-year-old previously healthy male presents for routine screening. He states that he feels well except that occasionally he is unable to complete his exercise routine because he is a little tired. His vitals are unremarkable except you notice a 10-pound weight loss since his last visit 1 year ago. His exam is only remarkable for occult blood in the stool, and his hemoglobin is 9.8 g/dL. What is the next step in the evaluation of this patient? Normal value hemoglobin: 12-18 g/dL A.Colonoscopy B.Barium enema C.Computed tomography (CT) scan D.Positron emission tomography (PET) scan
A.Colonoscopy
A 24-year-old patient presents with recurring sinusitis that has not been responsive to traditional antibiotic treatment. Which of the following diagnostic tests would you order next in the evaluation of this patient? A.Computed tomography (CT) scan B.Radiograph C.Ultrasound D.Magnetic resonance imaging (MRI)
A.Computed tomography (CT) scan
Which of the following is the gold standard test for the evaluation of coronary artery disease? A.Coronary angiography B.Echocardiography C.Electrocardiography D.Nuclear medicine imaging
A.Coronary angiography
Mrs. Jones presents with her 2-year-old male child, whose chief complaints are chronic respiratory infections, foul-smelling pale stools, weight loss, and wheezing. The parent reports using moist mist treatments repeatedly with some relief. Clinical exam shows delayed growth, enlarged spleen upon palpation, and clubbing of fingers and toes. Auscultation of the lungs demonstrates pulmonary congestion. Lab results report a positive fecal fat test and a sweat chloride test. What is the most likely diagnosis? A.Cystic fibrosis B.Pulmonary aspergilloma C.Pulmonary histiocytosis D.Pulmonary nocardiosis E.Pulmonary tuberculosis
A.Cystic fibrosis
Which of the following represents an obstructive pattern of impairment during pulmonary function testing? Forced expiratory volume in 1 sec = FEV1 Forced vital capacity = FVC Maximal midexpiratory flow rate = MMFR Residual volume = RV A.Decreased FEV1/FVC ratio and MMFR, high RV B.Normal FEV1/FVC ratio, decreased RV and vital capacity C.Increased FVC, decreased FEV1 and RV D.Increased FVC, FEV1, and RV E.Normal FEV 1, FVC, and RV
A.Decreased FEV1/FVC ratio and MMFR, high RV
A 49-year-old male presents complaining of itchy blisters on both hands for 1 week. On exam, you note that the vesicles are 1 to 2 mm, that there is no surrounding erythema or burrows, and that they are distributed on the palms and sides of the fingers of both hands. A potassium hydroxide (KOH) preparation does not reveal any hyphae. What is the most likely diagnosis? A.Dyshidrosis B.Tinea manus C.Zoster D.Scabies E.Bullous pemphigoid
A.Dyshidrosis
Which of the following tumors is associated with elevations in both α-fetoprotein (AFP) and β-human chorionic gonadotropin (β-hCG)? A.Embryonal carcinoma B.Endodermal sinus tumor C.Seminoma D.Teratoma E.Choriocarcinoma
A.Embryonal carcinoma
A 57-year-old woman presents for a routine gynecological exam without any complaints. She has been menopausal since age 54. She does have a family history of breast cancer and her mammogram 2 months ago was normal. Review of systems reveals occasional spotting with intercourse. Her exam is unremarkable, and a transvaginal ultrasound shows an endometrial lining of 9 mm. What do you recommend? A.Endometrial biopsy B.Pelvic ultrasound C.Pelvic CT D.Colposcopy
A.Endometrial biopsy
What is a well-known potential side effect of tamoxifen? A.Endometrial cancer B.Breast cancer C.Osteoporosis D.Ovarian cancer
A.Endometrial cancer
Which of the following conditions would have a positive Prehn's sign? A.Epididymitis B.Testicular torsion C.Acute prostatitis D.Chronic prostatitis E.Paraphimosis
A.Epididymitis
A 28-year-old, 3-month gravid female presents with a rash that has persisted for 1 week. On exam, you note multiple target lesions on her arms and soles. She has no other complaints. What is your most likely diagnosis? A.Erythema multiforme B.Systemic lupus erythematosus C.Stevens-Johnson syndrome D.Toxic epidermal necrolysis
A.Erythema multiforme
A 70-year-old nursing home resident developed a painful swelling of the right testicle 3 days ago with a temperature of 102°F. Examination reveals no costovertebral angle tenderness, a diffusely enlarged tender prostate without nodules, and a tender small mass along the posterior aspect of the right superior testicle. What is the organism most likely responsible for this patient's condition? A.Escherichia coli B.Staphylococcus aureus C.Enterococcus species D.Chlamydia trachomatis
A.Escherichia coli
What is the most common pathogen associated with acute cystitis in females? A.Escherichia coli B.Pseudomonas species C.Staphylococcus epidermidis D.Chlamydia trachomatis
A.Escherichia coli
You diagnose benign prostatic hyperplasia (BPH) in an elderly gentleman. Which of the following medications prevents the conversion of testosterone to dihydrotestosterone to decrease the size of the prostate? A.Finasteride B.Terazosin C.Prazosin D.Oxybutynin
A.Finasteride
.What type of tumor causes Zollinger-Ellison syndrome? A.Gastrin secreting B.Epinephrine secreting C.Bile secreting D.Prostaglandin secreting
A.Gastrin secreting
A 32-year-old male presents with stabbing central chest pain. The pain increases with respiration and is relieved by leaning forward. The patient notes he felt febrile yesterday. What finding would you expect on this patient's 12-lead electrocardiogram? A.Generalized ST segment elevation B.Q waves in leads II, III, and aVF C.A large, notched P wave in lead V1 D.An upright QRS complex in lead aVR
A.Generalized ST segment elevation
An overweight 34-year-old woman presents with a swollen, painful lesion in her right axilla. On further questioning, she states that she has had these before and that she is a smoker. Physical exam reveals a fluctuant, tender nodule with no erythema or streaking. The patient is afebrile and nontoxic with normal vital signs. What is your treatment? A.Incision and drainage B.Topical antibiotics C.Oral antibiotics D.Parenteral antibiotics
A.Incision and drainage
A 32-year-old female presents with complaints of fever, chills, malaise, myalgias, headache, congestion, sore throat, and a dry cough. Physical exam reveals mild pharyngeal erythema and mild conjunctival injection bilaterally. The lungs are clear to auscultation bilaterally. She appears sick but not toxic and is in no distress. What diagnosis is suspected? A.Influenza B.Pneumonia C.Pertussis D.Severe acute respiratory syndrome (SARS)
A.Influenza
Which of the following tests is the preferred choice for acute pancreatitis? A.Lipase B.Amylase C.Alkaline phosphatase D.Bilirubin
A.Lipase
A 75-year-old male has cough, dyspnea, and headache associated with neck vein distention and puffiness of the face and arms. What is the most likely diagnosis? A.Lung cancer B.Thymoma C.Hodgkin's disease D.Metastatic cancer of the thyroid
A.Lung cancer
A 56-year-old G3P3 female presents with a palpable breast lump, which she found on breast self-exam 3 days ago. Her mammogram last year was normal. Her family history is negative for breast cancer. On exam there is a 3 × 3-cm firm mobile mass under the left nipple. No nipple discharge is noted. What is the most appropriate next step? A.Mammogram B.Ultrasound C.Breast magnetic resonance imaging (MRI) D.Biopsy
A.Mammogram
A 40-year-old male with a 10-year history of frequently using chewing tobacco presents with a "white patch" on the side of his cheek. He is not sure how long it has been there, but he is concerned because it did not come off when he tried to remove it with his toothbrush. On exam, you notice a thickened white patch on his inner buccal mucosa, which cannot be removed with a tongue depressor. You advise the patient that the lesion should be further evaluated because this type of lesion can lead to which of the following? A.Oral squamous cell carcinoma B.Kaposi's sarcoma C.Lichen planus D.Oral candidiasis
A.Oral squamous cell carcinoma
Hepatitis A is commonly spread by which of the following? A.Oral-fecal route B.Intravenous drug use C.Sexual intercourse D.Mother-fetus transmission
A.Oral-fecal route
A 21-year-old man who recently recovered from the mumps presents to the emergency room complaining of a swollen and painful left testicle. Physical examination reveals testicular tenderness. What is the most likely diagnosis? A.Orchitis B.Epididymitis C.Testicular torsion D.Varicocele E.Spermatocele
A.Orchitis
A patient was just in a fight and was taken by ambulance to the emergency department. As you examine the extraocular movements, the patient states he is seeing double when he looks down and to the side. Based on this information what would you do next? A.Order a computed tomography (CT) scan of the orbits B.Order a magnetic resonance imaging (MRI) study of the orbits C.Order a bone scan of the skull D.Order a positron emission tomography (PET) scan of the orbits
A.Order a computed tomography (CT) scan of the orbits
A 12-year-old boy presents with a fever, sore throat, and swollen lymph nodes. His quick strep is positive. He has no allergies to medications. What is the initial treatment? A.Penicillin VK B.Amoxicillin C.Azithromycin D.Erythromycin
A.Penicillin VK
A 32-year-old female presents with persistent dermatitis of her nipple for the last several months. She has been seen previously and was given a weak steroidal cream. What should you do next? A.Schedule a biopsy B.Prescribe a more potent steroidal cream C.Test for human immunodeficiency virus (HIV) D.Treat with cryotherapy E.Prescribe an antibacterial cream
A.Schedule a biopsy
What is the most common type of ovarian cancer in the United States? A.Serous carcinoma B.Endometrioid carcinoma C.Undifferentiated tumor D.Brenner tumor E.Clear cell carcinoma
A.Serous carcinoma
A 28-year-old G1P1 female presents for evaluation of amenorrhea of 14 months duration. She delivered a baby 10 months ago by normal spontaneous vaginal delivery. Her pregnancy was complicated by gestational diabetes and a postpartum hemorrhage requiring several transfusions. She was unable to breastfeed, and her human chorionic gonadotropin (hCG) is negative. What is the most likely etiology for her amenorrhea? A.Sheehan's syndrome B.Stein-Leventhal syndrome C.Polycystic ovary syndrome D.Asherman's syndrome
A.Sheehan's syndrome
A 68-year-old female complains of a chronic, itchy rash on her legs that is sometimes red and weeping and sometimes crusted over. She admits to poor circulation and says that her brother has a similar problem. What is your most likely diagnosis? A.Stasis dermatitis B.Venous ulcerations C.Cellulitis D.Seborrheic dermatitis
A.Stasis dermatitis
What is the most common pathogen associated with otitis media? A.Streptococcus pneumoniae B.Haemophilus influenzae C.Moraxella catarrhalis D.Staphylococcal aureus
A.Streptococcus pneumoniae
A 68-year-old farmer presents for a routine health examination. He states he has been doing well. On exam you note that the patient has some sun damage to his skin and that he has a dark complexion. There is a hyperpigmented, slightly raised lesion measuring 1 cm on his left forearm. There is no lymphadenopathy in his arm or axilla. The patient states that he does not really remember noticing this lesion before; he denies using any sunscreen. You are worried that the lesion on his forearm may be a melanoma. What characteristic would reduce the likelihood of it being melanoma? A.Symmetry B.Flatness C.Irregular pigmentation D.Indistinct borders
A.Symmetry
Which of the following is a hallmark of unstable angina? A.The pain occurs with decreasing exertion levels B.The pain is associated with dyspnea C.The pain is characterized as retrosternal burning D.The pain is associated with palpitations
A.The pain occurs with decreasing exertion levels
For menopausal patients with symptomatic atrophic vaginitis, what is the treatment of choice? A.Topical estrogen B.Oral estrogen C.Oral progesterone D.Topical progesterone
A.Topical estrogen
Which of the following findings is more likely to be noted on evaluation of a patient with sarcoidosis than on an evaluation of a patient with emphysema? A.Prolonged expiratory phase B.Elevated serum alpha1-antitrypsin level C.Increased total lung capacity D.Hyperlucency of the lungs E.Elevated serum angiotensin-converting enzyme level
E.Elevated serum angiotensin-converting enzyme level
Which two cell types must be present on a Pap test for it to be considered adequate? A.Endocervical and endometrial B.Endometrial and squamous C.Endometrial and epithelial D.Epithelial and squamous E.Endocervical and squamous
E.Endocervical and squamous
A 55-year-old female has a sudden episode of pleuritic chest pain on the left side. The patient was in the hospital for 20 days after a laparotomy for a perforated gallbladder complicated by peritonitis. She gives a history of congestive cardiac failure. What is the most likely diagnosis? A.Bronchiectasis B.Cytomegalovirus pneumonitis C.Left upper lobe abscess D.Lobar pneumococcal pneumonia E.Pulmonary embolism
E.Pulmonary embolism
What is the most common benign ovarian cyst of epithelial origin? A.Transitional cell B.Mucinous C.Endometrioma D.Clear cell E.Serous
E.Serous
A 22-year-old G0 female presents to the emergency department with abdominal pain that has been increasing for the past 3 days. She describes the pain as crampy with increased intensity with activity. She is sexually active and uses oral contraceptives for birth control. Her vital signs are temperature 101.3°F, blood pressure 134/78, pulse 84, and pain level 7/10. Her abdomen has normal bowel sounds with no masses or distention. She is tender in both lower quadrants with rebound tenderness and guarding. Pelvic exam shows normal external genitalia with a normal cervix. The uterus is normal sized with cervical motion tenderness and bilaterally tender adnexa. What is the best management of this patient? Normal values Pulse: 60-100 beats/minute Blood pressure: Systolic 90-120, diastolic 60-80 Temperature: 98.6°F A.Outpatient therapy with oral cefotaxime and doxycycline B.Outpatient therapy with oral ceftizoxime, doxycycline, and metronidazole C.Admit the patient and start intravenous (IV) cefoxitin, clindamycin, and gentamicin D.Admit the patient and start IV cefoxitin
C.Admit the patient and start intravenous (IV) cefoxitin, clindamycin, and gentamicin
A young boy is diagnosed with otitis media. What would you treat the child with if he was allergic to penicillin? A.Cefuroxime B.Amoxicillin C.Azithromycin D.Cephalexin
C.Azithromycin
What test would best determine the etiology of common esophageal motility disorders? A.Computed tomography (CT) scan B.Esophageal endoscopy C.Barium esophagogram D.Transesophageal ultrasound
C.Barium esophagogram
Which of the following would you expect to find on a funduscopic examination in a patient recently diagnosed with a central retinal artery occlusion? A.Cotton wool spot B.Drusen C.Cherry red spot D.Pale white spot
C.Cherry red spot
A 60-year-old male smoker presents to the clinic suddenly with complaints of blood-tinged productive sputum on coughing and weight loss. He was found to have a temperature of 100.0°F and significant weight loss. There is no family history of cancer. What would be the next step in evaluating the patient? Normal temperature: 98.6°F A.Purified protein derivative (PPD) skin test B.Sputum culture C.Chest x-ray D.Bronchoscopy E.Oral antibiotics
C.Chest x-ray
What is the method of choice for diagnosing colon cancer? A.Carcinoembryonic antigen (CEA) testing B.Digital rectal examination C.Colonoscopy D.Fecal occult blood
C.Colonoscopy
Which of the following is the most likely cause of a transudative pleural effusion? A.Bacterial infection B.Chest trauma C.Congestive heart failure D.Malignancy
C.Congestive heart failure
A 3-year-old boy presents to the Emergency Department febrile, drooling, and sitting in a tripod position to help breathing. Which of the following should be avoided? A.Auscultation of the lungs B.Auscultation of the heart C.Direct examination of the throat D.Direct examination of his eyes and ears
C.Direct examination of the throat
Which of the following findings helps to confirm the diagnosis of a peritonsillar abscess? A.Enlarged tonsils B.Pharyngeal erythema C.Displacement of the uvula D.Swollen lymph nodes
C.Displacement of the uvula
Which of the following is the procedure of choice for the assessment of pericardial effusion? A.Chest x-ray B.Contrast chest computed tomography (CT) C.Echocardiography D.Magnetic resonance imaging
C.Echocardiography
Which of the following radiographic findings is suggestive of chronic silicosis? A.Honeycombing B.Large nodules that appear in the lower lobes C.Eggshell calcifications D.Pleural thickening and plaques
C.Eggshell calcifications
A 27-year-old G0P0 female presents with a 6-month history of dysmenorrhea. She has been married for 3 years and has not been using birth control. Her pain is unresponsive to acetaminophen and ibuprofen, and she has been consistently missing work for the first 2 days of her period. Exam shows an anteverted, anteflexed uterus of normal size. There is no cervical motion tenderness. The rectovaginal exam shows some palpable firm nodules posterior to the cervix. What is the most likely diagnosis? A.Leiomyoma B.Functional cyst C.Endometriosis D.Inflammatory bowel disease
C.Endometriosis
A 20-year-old college student presents to the emergency room with fever, nonproductive cough, bullous myringitis, and patchy infiltrates on chest x-ray. Her serum cold-agglutinin titers were positive. What is the first-line treatment? A.Vancomycin B.Trimethoprim-sulfamethoxazole C.Erythromycin D.Ceftazidime E.Amoxicillin/clavulanate
C.Erythromycin
What grading system is used to evaluate the histology of a prostate biopsy specimen? A.Ranson score B.Osler score C.Gleason score D.Simpson score
C.Gleason score
A funduscopic examination that reveals tortuous vessels and silver wiring is most commonly associated with which of the following diagnoses? A.Acquired immunodeficiency syndrome B.Diabetes C.Hypertension D.Marfan syndrome E.Sarcoidosis
C.Hypertension
A 50-year-old male who has smoked two packs of cigarettes per day for the past 30 years presents with a lung mass on chest x-ray. He also says that he has recently gained weight. Laboratory examination shows hyponatremia with hyperosmolar urine. What is the most likely diagnosis? A.Addison's disease B.Conn's syndrome C.Inappropriate antidiuretic hormone D.Pituitary failure E.Renal failure
C.Inappropriate antidiuretic hormone
A 19-year-old female presents with complaints of intermittent lower abdominal crampy pain for about 3 months. She has noticed varying bouts of diarrhea and constipation. She states that the pain is relieved by defecation. What is the most likely diagnosis? A.Diverticulitis B.Appendicitis C.Irritable bowel syndrome D.Small bowel obstruction
C.Irritable bowel syndrome
Which of the following contraceptive methods offers the most protection against sexually transmitted diseases? A.Intrauterine devices (IUDs) B.Oral contraceptive pills C.Latex condoms D.Cervical caps E.Diaphragms
C.Latex condoms
A 47-year-old G3P3 female status post-tubal ligation presents for an annual exam with complaints of menorrhagia. On exam there is a palpable abdominal mass, which is firm and nontender. Pelvic exam shows an enlarged uterus measuring 16 cm above the pubic symphysis. Urine human chorionic gonadotropin (hCG) is negative. What is the most likely diagnosis? A.Pregnancy B.Adenomyosis C.Leiomyoma D.Ovarian cyst
C.Leiomyoma
Which of the following lipids plays the most significant role in the development of atherosclerotic disease? A.Chylomicrons B.High-density lipoproteins C.Low-density lipoproteins D.Triglycerides
C.Low-density lipoproteins
A 25-year-old G1P1 female presents to the emergency department with right lower quadrant pain of 4 hours duration. On pelvic computed tomography (CT) scan, a tooth-shaped object is noted in an enlarged right ovary. What is the most likely diagnosis? A.Endometrioma B.Serous adenoma C.Mature teratoma D.Ectopic pregnancy E.Corpus luteum cyst
C.Mature teratoma
Mr. B., an 18-year-old wrestler, states that he has had "funky bumps" on his head, abdomen, and armpits for several weeks now. These "bumps" you find appear to be pearly, papular, umbilicated, and normopigmented in some areas and hypopigmented in others. The bumps measure 2 to 5 mm in diameter. What is the presumptive diagnosis? A.Verruca vulgaris B.Herpes simplex C.Molluscum contagiosum D.Folliculitis capitis
C.Molluscum contagiosum
An 8-year-old female has been brought to your office for evaluation for complaints of decreased activity; low-grade fever; mildly runny nose; and an itchy, slightly tender rash that broke out on the torso 2 days ago and has begun to develop in the mucosal regions of the body. Your diagnosis is chicken-pox because of which of the following dermatological findings? A.Multiple pink, slightly raised lesions from 2 to 5 cm in diameter B.Multiple macular and blistering lesions with a positive Nikolsky's sign C.Multiple pink/red-based lesions found in various stages, including macular, vesicular, and crusted, throughout the torso and face with little involvement of the extremities D.Multiple small pink/red-based lesions with small vesicles located in a dermatome distribution on the right side of the face
C.Multiple pink/red-based lesions found in various stages, including macular, vesicular, and crusted, throughout the torso and face with little involvement of the extremities
A 40-year-old woman presents with a sudden onset of episodic vertigo, tinnitus, and hearing loss. She states that she had two episodes over the past week and each one lasted about 20 minutes. She cannot remember any factors that may have precipitated the episodes. What is the most likely diagnosis? A.Otosclerosis B.Positional vertigo C.Ménière's disease D.Acoustic neuroma
C.Ménière's disease
What is the earliest symptom of vitamin A deficiency? A.Corneal ulceration B.Endophthalmitis C.Night blindness D.Mouth sores
C.Night blindness
A 24-year-old man was just hit in the right eye with a baseball. He states he is having double vision, and on examination he has enophthalmos. What would you do next? A.Patch the eye and discharge B.Start intravenous antibiotics C.Ophthalmology consult D.Order a magnetic resonance imaging (MRI) study
C.Ophthalmology consult
What is the name for the acute, benign, self-limiting skin condition that presents initially with a large single lesion that is followed by sharply defined, thin, oval plaques with a collarette of scale? A.Acne vulgaris B.Guttate psoriasis C.Pityriasis rosea D.Tinea corporis
C.Pityriasis rosea
A 45-year-old African American male presents to your office with a chief complaint of back pain. Examination of the back is normal. A digital rectal exam is performed and shows some areas of prostatic indurations and an intact rectal sphincter. The patient denies any urological symptoms, smoking, or drug abuse. What is the most likely diagnosis? A.Bladder cancer B.Benign prostatic hyperplasia C.Prostate cancer D.Hemorrhoids E.Chronic prostatitis
C.Prostate cancer
A patient presents with a severe posterior nosebleed. What initial laboratory studies should you order on this patient? A.Complete metabolic panel B.Factor V Leiden C.Prothrombin time (PT) and partial thromboplastin time (PTT) D.Serum iron
C.Prothrombin time (PT) and partial thromboplastin time (PTT)
What is the next step in the evaluation of a solitary pulmonary nodule seen on chest x-ray? A.Obtain a computed tomography (CT) scan B.Obtain a magnetic resonance imaging (MRI) study C.Review old chest x-rays D.Confirm the diagnosis with repeat posteroanterior (PA) and lateral chest x-rays
C.Review old chest x-rays
A 4-year-old girl develops an erythematous rash that feels like sandpaper and that appears on the upper torso and spreads to the remainder of the trunk, sparing her palms and soles. She is feverish and complains of a headache. Examination of the oral cavity reveals a "strawberry" tongue. Her vaccines are up to date. What is the most likely diagnosis? A.Varicella B.Measles C.Scarlet fever D.Pityriasis rosea E.Fifth disease
C.Scarlet fever
In reviewing a patient's electrocardiogram strip, you note that there are two P waves for every QRS complex. What rhythm does this finding describe? A.First-degree heart block B.Second-degree heart block—Mobitz I C.Second-degree heart block—Mobitz II D.Third-degree heart block
C.Second-degree heart block—Mobitz II
Which of the following diagnostic aids has utility in distinguishing obstructive lung disease from restrictive lung disease and can be used to determine the severity of functional impairment? A.Pulse oximetry B.Arterial blood gas analysis C.Spirometry D.Chest radiography
C.Spirometry
A healthy-appearing 25-year-old male cigarette smoker presents to the emergency department with pleuritic chest pain and dyspnea. He is in mild distress. He is tall and thin and gives no medical history of significant problems. What is the most likely diagnosis? A.Pulmonary embolism B.Malignant effusion C.Spontaneous pneumothorax D.Pericarditis
C.Spontaneous pneumothorax
What organism is most commonly associated with infectious endocarditis in a patient who is an intravenous drug abuser? A.Cardiobacterium hominis B.Eikenella corrodens C.Staphylococcus aureus D.Streptococcus mutans
C.Staphylococcus aureus
Prostatic indurations are noted on a routine examination of an asymptomatic 57-year-old male. A prostate-specific antigen (PSA) test and urinalysis are done several days later. The PSA is 12 ng/mL and the urinalysis is normal. A repeat PSA done 2 weeks later is 10 ng/mL. You refer this patient to the urologist to rule out a genitourinary disorder. What will be the urologist's first step? Normal value prostate-specific antigen for 50-59 years old: <3.5 ng/mL A.Scrotal ultrasound B.Pelvic computed tomography (CT) scan C.Transrectal ultrasound-guided biopsy D.Bone scan of the lumbar spine E.Cystoscopy
C.Transrectal ultrasound-guided biopsy
Which of the following is the treatment of choice for Pneumocystis jiroveci (formerly carinii) pneumonia? A.Penicillin B.A macrolide antibiotic C.Trimethoprim-sulfamethoxazole D.Amoxicillin with clavulanate
C.Trimethoprim-sulfamethoxazole
A 65-year-old man attended a community health fair, where it was discovered that his prostate-specific antigen (PSA) level was elevated. He was referred to you for further evaluation. The patient states that he had always been healthy and that he has not seen a physician for years. On review of systems, he does note some frequency, hesitancy, and urgency on urination, which he has been experiencing for the past few years. Digital rectal exam reveals a smooth, nontender, symmetrically enlarged prostate gland and brown guaiac-negative stool. Which of the following is unlikely to cause elevation of PSA levels? A.Prostate cancer B.Benign prostatic hyperplasia C.Urethritis D.Prostatitis
C.Urethritis
Fifth disease (Erythema infectiosum) can present with what type of appearance? A."Dew drops on rose petals" rash B."Slapped cheek" appearance C."Christmas tree" distribution rash D."Strawberry" tongue
B."Slapped cheek" appearance
A 20-year-old female presents for routine gynecological care. Her mother has a history of endometriosis. What is the patient's chance of developing endometriosis? A.1 percent B.7 percent C.12 percent D.17 percent
B.7 percent
Chest radiography in the patient with acute respiratory distress syndrome (ARDS) reveals which of the following classic patterns? A.Lobar consolidation B.A diffuse white-out appearance C.A visible pleural line D.Bilateral "bat wing-shaped" infiltrates
B.A diffuse white-out appearance
Systemic and topical retinoids, systemic and topical antimicrobials, and systemic hormonal therapy are the main therapeutic classes of treatment for which of the following dermatological complaints? A.Hidradenitis suppurativa B.Acne vulgaris C.Psoriasis D.Cellulitis
B.Acne vulgaris
A 73-year-old African American female presents with vaginal bleeding. It is not severe and occurs only after intercourse. She is not taking hormone replacement therapy (HRT). What is the most likely diagnosis? A.Cervical polyps B.Atrophic vaginitis C.Cervical cancer D.Endometrial cancer E.Endometrial hyperplasia
B.Atrophic vaginitis
What is the preferred initial image study when there is a suspicion that a patient has pancreatic cancer? A.Endoscopic ultrasound B.Computed tomography (CT) scan C.Cholangiography D.Endoscopic retrograde cholangiopancreatography (ERCP)
B.Computed tomography (CT) scan
A 62-year-old female presents to your office complaining of increasing fatigue for the past 6 months. She states she often feels weak and short of breath. On physical examination the patient is afebrile. You note moderate jugular venous distention. Crackles are present in the lower third of the lungs bilaterally. Cardiac auscultation reveals a regular S1 and S2 with an S3. There is moderate pitting edema of both lower extremities. What diagnosis does this presentation suggest? A.Atypical pneumonia B.Congestive heart failure C.Idiopathic pulmonary fibrosis D.Influenza E.Pulmonary embolism
B.Congestive heart failure
Examination of fluid from a pleural effusion reveals that the fluid is a transudate. Which of the following is the most likely etiology? A.Pulmonary malignancy B.Congestive heart failure C.Pneumonia D.Tuberculosis
B.Congestive heart failure
A patient was told by his dermatologist that he has seborrheic blepharitis. What physical examination findings support this diagnosis? A.Erythema and swelling around the eyelids B.Crusting and oily material around the eyelids C.Redness and watery discharge from the eye D.Nontender, nonerythematous, and nonfluctuant nodules on the eyelid
B.Crusting and oily material around the eyelids
A 14-year-old boy complains of gradually worsening scrotal pain and swelling and dysuria. On examination, the scrotum is edematous and erythematous. There is exquisite tenderness when palpating posterolaterally to the testicle. When you elevate the testicle, the scrotal pain is relieved. What is the most likely diagnosis? A.Orchitis B.Epididymitis C.Testicular torsion D.Varicocele E.Hydrocele
B.Epididymitis
Which of the following presentations suggests Prinzmetal angina? A.Sharp, central chest pain associated with exertion B.Episodic, early morning chest pressure that radiates to the neck C.Severe, tearing sensation that radiates to the back D.A fluttering sensation in the chest associated with syncope
B.Episodic, early morning chest pressure that radiates to the neck
A 47-year-old female presents with a recent onset of difficulty swallowing foods and chest pain. She had a barium esophagogram that showed a "corkscrew" appearance to the esophagus. What is the most likely diagnosis? A.Achalasia B.Esophageal spasm C.Esophageal webs D.Esophageal tumor
B.Esophageal spasm
A 33-year-old male presents with frank hematemesis. His family states that shortly after an uneventful waking this morning, they noticed the patient spitting up "quite a bit" of red blood. The family states that the patient has a history of cirrhosis of the liver but never had problems with swallowing or bleeding previously. His exam demonstrates hypotension, tachycardia, and persistent frank hematemesis. What is the most likely cause of his bleeding? A.Mallory-Weiss tear B.Esophageal varices C.Esophageal neoplasm D.Gastritis
B.Esophageal varices
A 27-year-old male presents to your office complaining of sharp central chest pain. He notes that the pain is somewhat relieved by sitting upright and leaning forward. His medical history is significant only for a cough and fever a month ago for which he did not seek treatment. Which of the following physical exam findings will confirm your suspected diagnosis? A.Fever B.Friction rub C.Hypertension D.Tachycardia E.Tachypnea
B.Friction rub
Which of the following are most commonly associated with acute pancreatitis? A.Drugs/toxins B.Gallstones/alcoholism C.Trauma/iatrogenic D.Metabolic/genetic factors
B.Gallstones/alcoholism
A 43-year-old alcoholic presents with complaints of weight loss, weakness, fatigue, muscle cramps, and an anorexic appetite. Your exam reveals hepatomegaly, spider nevi, mild jaundice, and cheilosis. What is the most likely diagnosis? A.Acute pancreatitis B.Hepatic cirrhosis C.Vitamin K deficiency D.Wernicke-Korsakoff syndrome
B.Hepatic cirrhosis
Which scrotal mass will transilluminate? A.Varicocele B.Hydrocele C.Seminoma D.Torsion of the testicle
B.Hydrocele
During a physical exam of a 23-year-old male, you place a fingertip into the scrotal sac and advance up into the inguinal canal. You notice a slight bulge protruding from the superolateral ring to the inferomedial region and the bulge lightly strikes the distal tip of the finger. What type of hernia is thisterm-111 consistent with? A.Direct inguinal hernia B.Indirect inguinal hernia C.Incisional hernia D.Umbilical hernia
B.Indirect inguinal hernia
What does the term metrorrhagia refer to? A.Heavy, excessive bleeding B.Irregular bleeding C.Infrequent bleeding D.Spotting E.Pain with menstruation
B.Irregular bleeding
A 70-year-old alcoholic male with a history of chronic obstructive lung disease is admitted to the hospital suffering from fever, shortness of breath, chest pain, and cough productive of "currant jelly" sputum and blood. Physical examination reveals a temperature of 104°F, a respiratory rate of 28 per minute, and decreased breath sounds heard in the right upper lobe. Chest x-ray confirms the presence of a right upper lobe pneumonia. What is the most likely causative organism? Respiration: 12-20 per minute Temperature: 98.6°F, 37.0°C A.Streptococcus pneumoniae B.Klebsiella pneumoniae C.Mycoplasma pneumoniae D.Haemophilus influenzae E.Staphylococcus aureus
B.Klebsiella pneumoniae
What is the reproduction of skin lesions as a result of nonspecific trauma such as scratching, sunlight, or a burn called? A.Lichenification B.Köbner's phenomenon C.Wickham's striae D.Auspitz phenomenon
B.Köbner's phenomenon
A 7-year-old boy tested positive for group A beta-hemolytic streptococcus (GABS). What physical finding supports the diagnosis of GABS? A.Gray exudates on the tonsils B.Large red tonsils with or without exudates C.Trismus D.Tonsillar asymmetry
B.Large red tonsils with or without
A patient presents with a feeling of fullness in her right ear. She states it started 2 days ago and is getting worse. You examine her ear and it is full of wax. What would you most likely find on the Weber test? A.Lateralization away from the affected ear B.Lateralization to the affected ear C.Air conduction (AC) greater then bone conduction (BC) D.BC greater than AC
B.Lateralization to the affected ear
An anterior wall myocardial infarction typically results from atherosclerotic disease of which of the following coronary arteries? A.Circumflex B.Left anterior descending C.Posterior descending artery D.Right
B.Left anterior descending
Which of the following is considered a papulosquamous rash? A.Nodular acne B.Lichen planus C.Tinea versicolor D.Erysipelas
B.Lichen planus
A 25-year-old previously healthy woman presents to the Emergency Department with a sudden onset of painless hematemesis that followed an episode of vomiting after heavy alcohol use last night. What is the most likely diagnosis? A.Bleeding esophageal varices B.Mallory-Weiss tears C.Esophagitis D.Gastric cancer
B.Mallory-Weiss tears
Concurrent use of which class of drugs is an absolute contraindication to taking a phosphodiesterase type-5 inhibitor? A.Thiazide diuretics B.Nitrates C.Androgens D.Alpha-1 receptor blockers
B.Nitrates
A 78-year-old G5P5 woman presents for a routine annual pelvic exam. She has noted some weight gain recently but has no other complaints. On exam, her abdomen is soft, nontender, and slightly obese with no palpable masses. Her liver span is 12 cm in the midclavicular line. She has a negative Murphy's sign. Her pelvic exam shows atrophic genitalia with a lack of rugation of the vaginal walls and a small, nontender, mobile uterus. Her left ovary is palpable, mobile, and nontender. The right ovary is not palpable. What physical finding is abnormal in this patient? A.Nonpalpable right ovary B.Palpable left ovary C.Liver span of 12 cm D.Lack of vaginal wall rugation E.Parous cervix
B.Palpable left ovary
A 45-year-old patient presents with sudden onset of pain, tenderness, and swelling on the right side of his face. On examination the right side of the patient's face and neck are tender and swollen. Prior to the onset of these symptoms, the patient states he has been well. What is the most likely diagnosis? A.Mastoiditis B.Parotitis C.Otitis media D.Retropharyngeal abscess
B.Parotitis
A 7-year-old female is brought to your office by her mother. The child has been sent home from school because she has been scratching her head nonstop. On close inspection you find egg sacks cemented to the hair shafts, forming nits. Which of the following is the most likely cause of her symptoms? A.Sarcoptes scabiei B.Pediculosis humanus C.Human papillomavirus D.Trichophyton tonsurans E.Candida albicans
B.Pediculosis humanus
