You are examining an elderly man and notice the following: Decreased vibration
sense in the feet and ankles, diminished gag reflex, right patellar reflex less than the
left, and diminished abdominal reflexes. Which of these is abnormal?

Decreased vibration sense Answers available at https://bit.ly/3bxCcN6

Diminished gag reflex

Diminished right patellar reflex compared to the left

Diminished abdominal reflexes


Question Points: 1.0 / 1.0 Answers available at https://bit.ly/3bxCcN6
A 68-year-old retired farmer presents to your office for evaluation of a skin lesion.
On the right temporal area of the forehead, you see a flattened papule the same
color as his skin, covered by a dry scale that is round and feels hard. He has several
more of these scattered on the forehead, arms, and legs. Based on this description,
what is your most likely diagnosis?

Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0
A 14-year-old junior high school student is brought in by his mother and father
because he seems to be developing breasts. The mother is upset because she read on the
Internet that smoking marijuana leads to breast enlargement in males. The young man
adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed
changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical
history is unremarkable. His parents are both in good health. He has two older
brothers who never had this problem. On examination, you see a mildly overweight
teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise his
examination is normal. He is agreeable to taking a drug test.

What is the most likely cause of his gynecomastia?
Breast cancer

Imbalance of hormones of puberty

Drug use
Answers available at https://bit.ly/3bxCcN6

Alcohol use


Question Points: 1.0 / 1.0
A 17-year-old female presents to your office, complaining of a clear discharge from
her right breast for 2 months. She states that she noticed it when she and her
boyfriend were “messing around” and he squeezed her nipple. She continues to
have this discharge anytime she squeezes that nipple. She denies any trauma to her
breasts. Her past medical history is unremarkable. She denies any pregnancies.
Both of her parents are healthy. She denies using tobacco or illegal drugs and
drinks three to four beers a week. On examination, her breasts are symmetric with
no skin changes. You are able to express clear discharge from her right nipple. You
feel no discrete masses and her axillae are normal. The remainder of her heart,
lung, abdominal, and pelvic examinations are unremarkable. A urine pregnancy
test is negative.
What cause of nipple discharge is the most likely in her circumstance?

Benign breast abnormality

Breast cancer

Nonpuerperal galactorrhea

Answers available at https://bit.ly/3bxCcN6
Pagets disease

Question Points: 1.0 / 1.0


A 26-year-old flight attendant presents in for a third trimester prenatal visit. She
has had prenatal care since her sixth week of pregnancy. She has no complaints
today and her prenatal course has been unremarkable. Today her blood pressure
and weight gain are appropriate, and her urine is unremarkable. You have a firstyear medical student shadowing you, so you ask the student to get Doptones and
measure the patient's uterus in centimeters. The nurse practitioner student
promptly reports fetal heart tones of 140, but he is having difficulty obtaining the
correct measurement. He knows one end of the tape goes over the uterine fundus.
From what inferior anatomic position should the tape be placed?
Vagina

Clitoris

Pubic symphysis

Umbilicus
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0

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, wart like texture on palpation. Based on
this description, what is your most likely diagnosis?

Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Question Points: 0.0 / 1.0


Which of the following represents age-related changes in the lungs?
Decrease in chest wall compliance

Speed of expiration increases

Increase in respiratory muscle strength

Increased elastic recoil of lung tissue

Answers available at https://bit.ly/3bxCcN6
Question Points: 1.0 / 1.0


A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and
fussiness. The ear examination is as follows: external ear, normal appearance
and no tenderness with manipulation; canal, normal diameter without evidence
of inflammation; tympanic membrane, bulging, erythematous, and opaque.
Insufflation is deferred due to pain. What is the most likely condition here?

Otitis externa

Cholesteatoma

Ruptured tympanic membrane

Otitis media

Question Points: 1.0 / 1.0
A 28-year-old musician presents to your clinic, complaining of a “spot” on his penis.
He states his partner noticed it 2 days ago and it hasn't gone away. He says it
doesn't hurt. He has had no burning with urination and no pain during intercourse.
He has had several partners in the last year and uses condoms occasionally. His past
medical history consists of nongonococcal urethritis from Chlamydia and
prostatitis. He denies any surgeries. He smokes two packs of cigarettes a day, drinks
a case of beer a week, and smokes marijuana and occasionally crack. He has
injected IV drugs before but not in the last few years. He is single and currently
unemployed. His mother has rheumatoid arthritis, and he doesn't know anything
about his father. On examination, you see a young man appearing deconditioned
but pleasant. His vital signs are unremarkable. On visualization of his penis, there is
a 6-mm red, oval ulcer with an indurated base just proximal to the corona. There is
no prepuce because of neonatal circumcision. On palpation, the ulcer is nontender.
In the inguinal region, there is nontender lymphadenopathy.
What disorder of the penis is most likely the diagnosis?

Condylomata acuminata

Answers available at https://bit.ly/3bxCcN6
Genital herpes

Syphilitic chancre

Penile carcinoma

Question Points: 1.0 / 1.0

A 22-year-old law student presents to your office complaining of severe abdominal
pain radiating to his back. He states it began last night after hours of heavy
drinking. He has had abdominal pain and vomiting in the past after drinking but
never as bad as this. He cannot keep any food or water down, and these symptoms
have been going on for almost 12 hours. He has had no recent illnesses or injuries.
His past medical history is unremarkable. He denies smoking or using illegal drugs
but admits to drinking 6 to 10 beers per weekend night. He admits that last night he
drank something like 14 drinks. On examination you find a young male appearing
his stated age in some distress. He is leaning over on the examination table and
holding his abdomen with his arms. His blood pressure is 90/60 and his pulse is 120.
He is afebrile. His abdominal examination reveals normal bowel sounds, but he is
very tender in the left upper quadrant and epigastric area. He has no Murphy's sign
or tenderness in the right lower quadrant. The remainder of his abdominal
examination is normal. His rectal, prostate, penile, and testicular examinations are
normal. He has no inguinal hernias or tenderness with that examination. Blood
work is pending.
What etiology of abdominal pain is most likely causing his symptoms?

Peptic ulcer disease

Biliary colic

Acute cholecystitis

Answers available at https://bit.ly/3bxCcN6
Acute pancreatitis

Question Points: 1.0 / 1.0

A 56-year-old female presents to your clinic complaining that her left breast looks
unusual. She says that for 2 months the angle of the nipple has changed direction.
She does not do self-examinations, so she doesn't know if she has a lump. She has no
history of weight loss, weight gain, fever, or night sweats. Her past medical history
is significant for high blood pressure. She smokes two packs of cigarettes a day and
has three to four drinks per weekend night. Her paternal aunt died of breast cancer
in her forties. Her mother is healthy, but her father died of prostate cancer. On
examination, you find a middle-aged woman appearing older than her stated age.
Inspection of her left breast reveals a flattened nipple deviating toward the lateral
side. On palpation, the nipple feels thickened. Lateral to the areola you palpate a
nontender 4-cm mass. The axilla contains several fixed nodes. The right breast and
axilla examinations are unremarkable.
What visible skin change of the breast does she have?

Nipple retraction

Paget's disease

Peau d'orange sign

Mastitis
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0

A 32-year-old white female presents to your clinic complaining of overwhelming
sadness. She says for the past 2 months she has had crying episodes, difficulty
sleeping, and problems with overeating. She says she used to go out with her friends
from work, but now she just wants to go home and be by herself. She also thinks
that her work productivity has been dropping because she just is too tired to care or
concentrate. She denies any feelings of guilt or any suicidal ideation. She states that
she has never felt this way in the past. She denies any recent illness or injuries. Her
past medical history consists of an appendectomy when she was a teenager;
otherwise, she has been healthy. She is single and works as a clerk in a medical
office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood
pressure and her father has had a history of mental illness. On examination, you see
a woman appearing her stated age who seems quite sad. Her facial expression does
not change while you talk to her and she makes little eye contact. She speaks so
softly you cannot always understand her. Her thought processes and content seem
unremarkable.
What type of mood disorder do you think is most likely?

Dysthymic disorder

Manic (bipolar) disorder

Major depressive episode

Anxiety disorder
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0

A young Hispanic mother brings in her 2-month-old son. She is upset because her
neighbors have threatened to call the Child Protective Agency because they think
his birthmark is a bruise. Her son was the product of an uneventful pregnancy and
spontaneous vaginal delivery. On examination, you see a large, smooth-bordered
bluish mark on his buttock and lower back. Otherwise his examination is
unremarkable.
What form of birthmark is this likely to be?

Café-au-lait spot

Salmon patch

Mongolian spot

Cherry hemangioma

Question Points: 1.0 / 1.0

A 15-year-old high school sophomore presents to the clinic for evaluation of a 3week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and
nonproductive cough.
Which is the most likely pathologic process?

Infection

Inflammation

Allergic

Vascular
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0

A 22-year-old clerk, primigravida, presents to your office for a prenatal visit. She is
in her second trimester and has had prenatal care since she was 8 weeks pregnant.
Her only complaint is that she has a new brownish line straight down her abdomen.
On examination her vital signs are unremarkable. Her urine has no protein,
glucose, or leukocytes. With a doppler the fetal heart rate is 140, and her uterus is
palpated to the umbilicus. Today you are sending her for congenital abnormality
screening and setting up an ultrasound.
What physical finding is responsible for her new “brown line”?

Corpus luteum

Linea nigra

Linea alba

Diastasis recti

Question Points: 1.0 / 1.0

Mr. Q. is a 45-year-old salesman who presents to your office for evaluation of
fatigue. He has come to the office many times in the past with a variety of injuries,
and you suspect that he has a problem with alcohol. Which one of the following
questions will be most helpful in diagnosing this problem?


You are an alcoholic, aren't you?

When was your last drink?

Do you drink 2 to 3 beers every weekend?

Do you drink alcohol when you are supposed to be working?
Question Points: 1.0 / 1.0
Answers available at https://bit.ly/3bxCcN6
A 35-year-old bus driver presents to your office for a prenatal visit. She is
approximately 28 weeks pregnant and has had no complications. She is complaining
only of heartburn and has had no fatigue, headaches, leg swelling, contractions,
leakage of fluid, or bleeding. On examination, her blood pressure is 142/92 and her
urine shows no glucose, protein, or leukocytes. Her weight gain is appropriate, with no
large recent increases. Fetal tones are 140 and her uterus measures 32 cm from the
pubic bone. Looking back through her chart, you see her prenatal blood pressure was
120/70 and her blood pressures during the first 20 weeks were usually 120 to 130/70 to
80.
What type of blood pressure is this?

Normotensive for pregnancy

Chronic hypertension

Gestational hypertension

Preeclampsia

Question Points: 1.0 / 1.0
A sudden, painless unilateral vision loss may be caused by which of the
following?
 Retinal detachment

Corneal ulcer

Acute glaucoma

Uveitis

Answers available at https://bit.ly/3bxCcN6
Question Points: 0.0 / 1.0

A 40-year-old mother of two presents to your office for consultation. She is
interested in knowing what her relative risks are for developing breast cancer. She
is concerned because her sister had unilateral breast cancer 6 years ago at age 38.
The patient reports on her history that she began having periods at age 11 and has
been fairly regular ever since, except during her two pregnancies. Her first child
arrived when she was 26 and her second at age 28. Otherwise, she has had no health
problems. Her father has high blood pressure. Her mother had unilateral breast
cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family
law attorney and is married. Her examination is essentially unremarkable.
Which risk factor of her personal and family history most puts her in danger of
getting breast cancer?

First-degree relative with premenopausal breast cancer

Age at menarche of less than 12

Answers available at https://bit.ly/3bxCcN6
First live birth between the ages of 25 and 29

First-degree relative with postmenopausal breast cancer

Question Points: 1.0 / 1.0


When should a woman conduct breast self-examination with respect to her menses?
Five to seven days following her menses

Midcycle

Immediately prior to menses

During her menses

Question Points: 1.0 / 1.0

Jacob, a 33-year-old construction worker, complains of a “lump on his back” over
his scapula. It has been there for about a year and is getting larger. He says his wife
has been able to squeeze out a cheesy-textured substance on occasion. He worries
this may be cancer. When gently pinched from the side, a prominent dimple forms
in the middle of the mass.
What is most likely?
An enlarged lymph node


A sebaceous cyst

An actinic keratosis

A malignant lesion

Question Points: 1.0 / 1.0


You have been unable to hear normal S2 splitting in children up to this point. What
technique will maximize your chances of hearing this phenomenon?
Answers available at https://bit.ly/3bxCcN6
Listen with the diaphragm over the left lower sternal border.

Listen with the bell over the 2nd left intercostal space.

Listen with the bell over the apex.

Listen with the diaphragm in the axilla.

Question Points: 1.0 / 1.0

A grandmother brings her 13-year-old grandson to you for evaluation. She noticed
last week when he took off his shirt that his breastbone seemed collapsed. He seems
embarrassed and tells you that it has been that way for quite some time. He states
he has no symptoms from it, and he just tries not to take off his shirt in front of
anyone. He denies any shortness of breath, chest pain, or lightheadedness on
exertion. His past medical history is unremarkable. He is in sixth grade and just
moved in with his grandmother after his father was deployed to the Middle East.
His mother died several years ago in a car accident. He states that he does not
smoke and has never touched alcohol. On examination, you see a teenage boy
appearing his stated age. On visual examination, of his chest you see that the lower
portion of the sternum is depressed. Auscultation of the lungs and heart are
unremarkable.
What disorder of the thorax best describes your findings?

Barrel chest

Funnel chest (pectus excavatum)

Pigeon chest (pectus carinatum)

Thoracic kyphoscoliosis

Question Points: 0.0 / 1.0

Ray works a physical job and notes pain when he attempts to lift his arm over his
head. When you move the shoulder passively, he has full range of motion without
pain and there is no gross swelling or tenderness. What type of joint disease does
this most likely represent?

Articular

Extra-articular

Neither

Answers available at https://bit.ly/3bxCcN6
Both

Question Points: 1.0 / 1.0

Blood pressure abnormalities found more commonly in Western elderly include
which of the following?

Isolated elevation of the diastolic BP

Narrow pulse pressure

Elevation of the systolic BP

Elevation of the BP with standing

Question Points: 1.0 / 1.0

A 22-year-old architecture major presents to your office complaining of severe
burning with urination, a fever of 101 degrees, and aching all over. She denies any
upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past
medical history consists of severe acne. She is currently on an oral contraceptive.
She has had no pregnancies or surgeries. She reports one new partner within the
last month. She does not smoke but does drink occasionally. Her parents are both in
good health. On examination, you see a young woman appearing slightly ill. Her
temperature is 100.3 and her pulse and blood pressure are unremarkable. Her
head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are
unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally.
On visualization of the perineum, there are more than 10 shallow ulcers along each
side of the vulva. Speculum and bimanual examination are unremarkable for
findings, although she is very tender at the introitus. Urine analysis has some white
blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative.
Which disorder of the vulva is most likely in this case?

Genital herpes

Condylomata acuminata

Syphilitic chancre

Epidermoid cyst

Answers available at https://bit.ly/3bxCcN6
Question Points: 0.0 / 1.0

A 36-year-old married bank teller presents to your office, complaining of pain with
defecation and occasional blood on the toilet paper. She states that last week she
had food poisoning with nausea, vomiting, and diarrhea. She had runny stools but
no black or bloody stools. Ever since her illness, she has continued to have severe
pain with bowel movements. She now tries to put off defecation as long as possible.
Although she is having constipation she denies any further diarrhea or leakage of
stool. She has a past medical history of hypothyroidism and two spontaneous
vaginal deliveries. She has had no other chronic illnesses or surgeries. She does not
smoke and rarely drinks. She has two children. There is no family history of breast
or colon cancer. She has had no weight gain, weight loss, fever, or night sweats. On
examination she is afebrile, with a blood pressure of 115/70 and a pulse of 80. On
abdominal examination, she has active bowel sounds, is nontender in all quadrants,
and has no hepatosplenomegaly. Inspection of the anus reveals inflammation on the
posterior side with erythema. Digital rectal examination is painful for the patient
but no abnormalities are palpated. Anoscopic examination reveals no inflammation
or bleeding. What is the anal disorder that best describes her symptoms?

Anorectal fistula

External hemorrhoids

Anal fissure

Answers available at https://bit.ly/3bxCcN6
Anorectal cancer

Question Points: 0.0 / 1.0

Adam is a very successful 15-year-old student and athlete. His mother brings him in
today because he no longer studies, works out, or sees his friends. This has gone on
for a month and a half. When you speak with him alone in the room, he states it
“would be better if I was not here.” What would you do next?

Tell him that he has a very promising career in anything he chooses and soon he will feel
better.

Tell him that he needs an antidepressant and it will take about 4 weeks to work.

Speak with his mother about getting him together more with his friends.

Assess his suicide risk.

Question Points: 1.0 / 1.0


Which of the following is a “red flag” regarding patients presenting with headache?
Unilateral headache

Pain over the sinuses

New onset over age 40

Answers available at https://bit.ly/3bxCcN6
Aggravated or relieved by change in position
Question Points: 1.0 / 1.0

A 73-year-old nurse presents to your office for evaluation of new onset of pill rolling
tremors. She is not on any medications and does not take herbs or supplements. She
has no chronic medical conditions. She does not smoke or drink alcohol. She walks
into the examination room with slow movements and shuffling steps. She has
decreased facial mobility and a blunt expression, without any changes in hair
distribution on her face. Based on this description, what is the most likely reason for
the patient's symptoms?

Cushing's syndrome

Nephrotic syndrome

Myxedema

Answers available at https://bit.ly/3bxCcN6
Parkinson's disease

Question Points: 1.0 / 1.0


Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She
presents with elbow pain worse on the right. On examination, it hurts her elbows to
dorsiflex her hands against resistance when her palms face the floor. What
condition does she have?
Medial epicondylitis (golfer's elbow)

Olecranon bursitis

Lateral epicondylitis (tennis elbow)

Supracondylar fracture

Question Points: 0.0 / 1.0

A 26-year-old violinist presents to your clinic complaining of anxiety. He is a firstchair violinist in the local symphony orchestra and has started having symptoms
during performances, such as sweating, shaking, and hyperventilating. It has gotten
so bad that he has thought about giving up his first-chair status so he does not have
to play the solo during one of the movements. He says that he never has these
symptoms during rehearsals or when he is practicing. He denies having any of these
symptoms at any other time. His past medical history is unremarkable. He denies
any tobacco use, drug use, or alcohol abuse. His parents are both healthy. On
examination you see a young man who appears worried. His vital signs and physical
examination are unremarkable.
What type of anxiety disorder best describes this situation?

Panic disorder

Specific phobia

Social phobia

Generalized anxiety disorder

Question Points: 0.0 / 1.0


A 52-year-old secretary presents to your office, complaining about accidentally
leaking urine when she coughs or sneezes. She says this has been going on for about
a year now. She relates that she has not had a period for 2 years. She denies any
recent illness or injuries. Her past medical history is significant for four
spontaneous vaginal deliveries. She is married and has four children. She denies
alcohol, tobacco, or drug use. During her pelvic examination, you note some
atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal
examinations are unremarkable.
Which type of urinary incontinence does she have?
Stress incontinence

Urge incontinence

Overflow incontinence

Mixed Incontinence

Question Points: 0.0 / 1.0
Answers available at https://bit.ly/3bxCcN6

A 37-year-old nurse presents for evaluation of colicky right upper quadrant
abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2
hours after eating greasy foods. Which one of the following physical examination
descriptions would be most consistent with the diagnosis of cholecystitis?

Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.

Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or
guarding.

Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the
point of stopping inspiration, and there is no rebound or guarding.

Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or
guarding.

Question Points: 0.0 / 1.0


A 29-year-old computer programmer presents to your office for evaluation of a
headache. The tightening sensation is located all over the head and is of moderate
intensity. It used to last minutes, but this time it has lasted for 5 days. He denies
photophobia and nausea. He spends several hours each day at a computer
monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain
but not taken it away. Based on this description, what is your most likely diagnosis?
Tension

Migraine

Cluster

Answers available at https://bit.ly/3bxCcN6
Analgesic rebound

Question Points: 1.0 / 1.0

An 81 year old patient complains of shortness of breath for the past few days. On
examination, you note late inspiratory crackles in the lower third of the chest and
bilateral pedal edema that were not present a week ago. What is the most likely
explanation for these?

Asthma

COPD

Bronchiectasis

Heart failure

Answers available at https://bit.ly/3bxCcN6
Question Points: 1.0 / 1.0

A high school soccer player “blew out his knee” when the opposing goalie's head
and shoulder struck his flexed knee while the goalie was diving for the ball. All of
the following structures were involved in some way in his injury, but which of the
following is actually an extra-articular structure?
Synovium

Joint capsule

Juxta-articular bone

Tendons

Question Points: 1.0 / 1.0

A woman in her 30th week has a cervical length estimated at 1 cm. Should you be
concerned?

Yes; she may be at risk for preterm labor.

Yes; she most likely has a bicornuate uterus.

No; this is a normal measurement for this gestational age.
Answers available at https://bit.ly/3bxCcN6

Yes; it likely indicates the fetus is in the breech position.


Question Points: 1.0 / 1.0


A young woman presents in for a routine wellness examination. You notice that her
vaginal walls have deep rugae and are slightly bluish in color. She also has a thicker
white discharge. What should you suspect?
Hypoxia

Varicosities

Pregnancy

Sexually transmitted infection

Answers available at https://bit.ly/3bxCcN6
Question Points: 1.0 / 1.0


Ms. Whiting is a 68-year-old who presents in for her usual follow-up visit. You
notice a few flat, red, and purple lesions, about 6 centimeters in diameter, on the
ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are
tender when you examine them. What should you do?
Conclude that these are lesions she has had for a long time.

Wait for her to mention them before asking further questions.

Ask how she acquired them.

Conduct the visit as usual for the patient.

Question Points: 1.0 / 1.0


A 58-year-old man presents to your office complaining of bilateral back pain that
now awakens him at night. This has been steadily increasing for the past 2 months.
Which one of the following is the most reassuring to you as a clinician in this patient
with back pain?
Age over 50

Pain at night

Pain lasting more than 1 month or not responding to therapy

Pain that is bilateral

Question Points: 1.0 / 1.0


A 19-year-old childcare worker presents to you for her first prenatal visit. She
cannot remember when her last period was but thinks it was between 2 and 5
months ago. When she began gaining weight and feeling “something” moving down
there, she did a home pregnancy test and it was positive. She states she felt the
movement about a week ago. She has had no nausea, vomiting, fatigue, or fevers.
Her past medical history is remarkable only for irregular periods. She has been
dating the same young man for a year. She says they were not using condoms. On
examination, you see an overweight young lady appearing her stated age. Her head,
eyes, ears, nose, throat, neck, thyroid, cardiac, and pulmonary examinations are
unremarkable. Her abdomen is nontender, with normal bowel sounds, and the
gravid uterus is palpated to the level of the umbilicus. Fetal tones are easily found
with doppler, and, with the fetoscope, a faint heart rate of 140 is heard. By
speculum examination, the cervix is bluish, and by bimanual examination, the
cervix is soft. Results of Pap smear, cultures, and blood work are pending. You give
the patient her due date and how far along she is based on your clinical findings. An
OB ultrasound to confirm her dates is ordered.
With only the clinical examination, how many weeks pregnant did you tell this
patient she is?
6 to 8 weeks

12 to 14 weeks

18 to 20 weeks

Answers available at https://bit.ly/3bxCcN6
24 to 26 weeks

Question Points: 1.0 / 1.0

When you enter your patient's examination room, his wife is waiting there with him.
Which of the following is most appropriate?

Ask if it's okay to carry out the visit with both people in the room.

Carry on as you would ordinarily. The permission is implied because his wife is in the room
with him.

Ask his wife to leave the room for reasons of confidentiality.

First ask his wife what she thinks is going on.

Question Points: 1.0 / 1.0


Mrs. Buckley is a 75-year-old widow who wants you to look at her teeth because over
the past 2 weeks she has had right-sided jaw pain when eating. It does not occur
otherwise. She also has had a headache. Which of the following should be considered?
Palpation of her temples

Dental referral

Ultrasound of the gallbladder

Inquiry about anosmia
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0


Glaucoma is the leading cause of blindness in African-Americans and the second leading
cause of blindness overall. What features would be noted on funduscopic examination?
Increased cup-to-disc ratio

AV nicking

Cotton wool spots

Microaneurysms

Question Points: 1.0 / 1.0


A 26-year-old telephone operator presents to your office for her first prenatal visit. This
is her first pregnancy. Her last period was about 2 months ago. She has no current
complaints. She is eating healthily, taking vitamins, and exercising. She has a past
medical history of an appendectomy as a teenager. Her mother had three children
vaginally with no complications. On examination, she appears healthy and her vital signs
are unremarkable. Her head, eyes, ears, nose, throat, thyroid, cardiac, pulmonary, and
abdominal examinations are also unremarkable. By speculum examination, her cervix
appears bluish in color and highly vascular. A bimanual examination reveals a soft cervix
and a 12-week-sized uterus. No masses are felt in either adnexal area. Results of her Pap,
cultures, and blood work are pending.
What clinical sign is responsible for her blue, highly vascular cervix?
Chadwick's sign

Hegar's sign

Leopold's sign

Leo's sign

Question Points: 1.0 / 1.0

A 20-year-old part-time college student presents to your clinic, complaining of growths
on his penile shaft. They have been there for about 6 weeks and haven't gone away. In
fact, he thinks there may be more now. He denies any pain with intercourse or urination.
He has had three former partners and has been with his current girlfriend for 6 months.
He says that because she is on the pill they don't use condoms. He denies any fever,
weight loss, or night sweats. His past medical history is unremarkable. In addition to
college, he works part-time for his father in construction. He is engaged to be married
and has no children. His father is healthy, and his mother has hypothyroidism. On
examination, the young man appears healthy. His vital signs are unremarkable. On
visualization of his penis, you see several moist papules along all sides of his penile shaft

and even two on the corona. He has been circumcised. On palpation of his inguinal
region, there is no inguinal lymphadenopathy.
Which abnormality of the penis does this patient most likely have?
Condylomata acuminata

Answers available at https://bit.ly/3bxCcN6
Genital herpes

Syphilitic chancre

Penile carcinoma

Question Points: 0.0 / 1.0


You are having trouble examining the abdomen of a school-aged child due to
ticklishness. What should you do?
Have the child press on your hand.

Have the parent insist that the child allow you to examine her.

Ask the parent to leave the room.

Make the child realize that this is part of the examination and must be done.

Question Points: 1.0 / 1.0

A 27-year-old woman is brought to your office by her mother. The mother tells you that
her daughter has been schizophrenic for the last 8 years and is starting to decompensate
despite medication. The patient states that she has been taking her antipsychotic and she
is doing just fine. Her mother retorts that her daughter has become quite paranoid. When
asked why, the mother gives an example about the mailman. She says that her daughter
goes and gets the mail every day and then microwaves the letters. The patient agrees that
she does this but only because she sees the mailman flipping through the envelopes and
she knows he's putting anthrax on the letters. Her mother turns to her and says, “He's
only sorting the mail!” Answers available at https://bit.ly/3bxCcN6

Which best describes the patient's abnormality of perception?
Illusion

Hallucination

Fugue state

Facticious

Question Points: 0.0 / 1.0


A 29-year-old married computer programmer presents to your clinic, complaining of
“something strange” going on in his scrotum. Last month while he was doing his
testicular self-examination, he felt a lump in his left testis. He waited a month and felt
the area again, but the lump was still there. He has had some aching in his left testis
but denies any pain with urination or sexual intercourse. He denies any fever, malaise,
or night sweats. His past medical history consists of groin surgery when he was a
baby and a tonsillectomy as a teenager. He eats a healthy diet and works out at the
gym five times a week. He denies any tobacco or illegal drugs and drinks alcohol
occasionally. His parents are both healthy. On examination, you see a muscular,
healthy, young-appearing man with unremarkable vital signs. On visualization, the
penis is circumcised with no lesions; there is a scar in his right inguinal region. There
is no lymphadenopathy. Palpation of his scrotum is unremarkable on the right but
indicates a large mass on the left. Placing a finger through the inguinal ring on the
right, you have the patient bear down. Nothing is felt. You attempt to place your
finger through the left inguinal ring but cannot get above the mass. On rectal
examination, his prostate is unremarkable.
What disorder of the testes is most likely the diagnosis?
Hydrocele

Inguinal hernia
Answers available at https://bit.ly/3bxCcN6

Scrotal edema

Varicocele

Question Points: 1.0 / 1.0


Mr. R. is a 92-year-old retired teacher who presents to your clinic accompanied by her
daughter. You ask Mrs. R. why she came to your clinic today. She looks at her
daughter and doesn't say anything in response to your question. This is an example of
which type of challenging patient?
Talkative patient

Angry patient

Silent patient

Happy Patient
Answers available at https://bit.ly/3bxCcN6


Question Points: 1.0 / 1.0

A high school football player injured his wrist in a game. He is tender between the two
tendons at the base of the thumb. Which of the following should be considered?
DeQuervain's tenosynovitis

Scaphoid fracture

Wrist sprain

Rheumatoid arthritis
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0

An adolescent male presents to your clinic with a note from his mother stating it is okay
for him to be seen today without her presence. He has come in for his annual sports

physical required to play football. For his age his physical examination is unremarkable,
and you sign his school's physical examination form. You decide to take this opportunity
to do some health education with him. He admits to wondering a lot lately if he is
normal. Although he is in football he really enjoys science and computers more. He is
worried that all his buddies will think he is a geek. He is convinced he also won't get a
date for the Sadie Hawkins dance next week because the girls all think he is boring, too.
He denies any experimentation with tobacco or alcohol, and he blushes when you
mention sex. After hitting all the pertinent age-appropriate education points, you give
him his sports physical form and he leaves.
The patient's concerns during the visit most resemble what developmental stage of
adolescence?
Early adolescence (10 to 14 years old)

Middle adolescence (15 to 16 years old)

Late adolescence (17 to 20 years old)

Adulthood
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0


You are observing an infant who is able to pull to a stand, uses “mama” and “dada”
specifically, and indicates his wants by vocalization and pointing. Where would you
place this child's developmental age?
12 months

10 months

8 months

6 months
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0


A 77-year-old retired school superintendent presents to your office, complaining of
unsteady hands. He says that, for the past 6 months, when his hands are resting in his lap
they shake uncontrollably. He says when he holds them out in front of his body the
shaking diminishes, and when he uses his hands the shaking is also better. He also
complains of some difficulty getting up out of his chair and walking around. He denies
any recent illnesses or injuries. His past medical history is significant for high blood
pressure and coronary artery disease, requiring a stent in the past. He has been married
for more than 50 years and has five children and 12 grandchildren. He denies any
tobacco, alcohol, or drug use. His mother died of a stroke in her 70s, and his father died
of a heart attack in his 60s. He has a younger sister who has arthritis problems. His
children are all essentially healthy. On examination, you see a fine, pill-rolling tremor of
his left hand. His right shows less movement. His cranial nerve examination is normal.
He has some difficulty rising from his chair, his gait is slow, and it takes him time to turn
around to walk back toward you. He has almost no “arm swing” with his gait.
What type of tremor is he most likely to have?
Resting tremor

Postural tremor

Intention tremor

Drug Induced Tremor

Question Points: 1.0 / 1.0
Which of the following percussion notes would you obtain over the gastric bubble?
 Resonance

Tympany

Hyperresonance

Flatness

Question Points: 1.0 / 1.0


A 35-year-old stockbroker presents to your office, complaining of feeling tired and
irritable. She also says she feels like nothing ever goes her way and that nothing good
ever happens. When you ask her how long she has felt this way she laughs and says,
“Since when have I not?” She relates that she has felt pessimistic about life in general
since she was in high school. She denies any problems with sleep, appetite, or
concentration, and states she hasn't thought about killing herself. She reports no recent
illnesses or injuries. She is single. She smokes one pack of cigarettes a day, drinks
occasionally, and hasn't taken any illegal drugs since college. Her mother suffers from
depression and her father has high blood pressure. On examination her vital signs and
physical examination are unremarkable.
What mental health disorder best describes her symptoms?
Major depressive episode

Dysthymic disorder

Cyclothymic disorder

Hypothryoidism

Question Points: 0.0 / 1.0


Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The
pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least
and an 8 at the worst. The pain, which started a few weeks ago, comes and goes, lasts for
2 to 3 hours at a time, and seems to be worse a couple of hours after eating. She has
noticed that it starts after eating greasy foods, so she has cut down on these as much as
she can. Initially, it occurred once a week, but now it is occurring every other day.
Nothing makes it better. From this description, which of the seven attributes of a
symptom has been omitted?
Setting in which the symptom occurs

Associated manifestations

Quality
Answers available at https://bit.ly/3bxCcN6

Timing

Question Points: 1.0 / 1.0


Susane is a 27-year-old who has had headaches, muscle aches, and fatigue for the last 2
months. You have completed a thorough history, examination, and laboratory workup
but have not found a cause. What would be an appropriate next course of action?
A referral to a neurologist

A referral to a rheumatologist

To tell the patient you can't find anything

To screen for depression

Question Points: 0.0 / 1.0


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 DIAPPERS 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
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0


A 8-year-old patient presents to the office for evaluation of a rash. At first, there was
only one large patch, but then more lesions erupted suddenly on the back and torso; the
lesions itch. On physical examination, you note that the pattern of eruption is like a
Christmas tree and that there are a variety of erythematous papules and macules on the
cleavage lines of the back. Based on this description, what is the most likely diagnosis?
Pityriasis rosea

Tinea versicolor

Psoriasis

Atopic eczema
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0


A 79-year-old retired banker presents to your office for evaluation of difficulty with
urination; he gets up five to six times per night to urinate and has to go at least that often
in the daytime. He does not feel as if his bladder empties completely; the strength of the
urinary stream is diminished. He denies dysuria or hematuria. This problem has been
present for several years but has worsened over the last 8 months. You palpate his
prostate. What is your expected physical examination finding, based on this description?
Normal size, smooth

Normal size, boggy

Enlarged size, smooth

Enlarged size, boggy

Question Points: 1.0 / 1.0

A 49-year-old administrative assistant presents to your office for evaluation of dizziness.
You elicit the information that the dizziness is a spinning sensation of sudden onset,

worse with head position changes. The episodes last a few seconds and then go away,
and they are accompanied by intense nausea. She has vomited one time. She denies
tinnitus. You perform a physical examination of the head and neck and note that the
patient's hearing is intact. Pt has normal results of Weber and Rinne and that there is
nystagmus. Her gait is normal. Based on this description, what is the most likely
diagnosis?
Benign paroxysmal positional vertigo

Vestibular neuronitis

Ménière's disease

Acoustic neuroma

Question Points: 0.0 / 1.0


An 88-year-old retired piano teacher presents for evaluation of fatigue. You notice that
her clothes are hanging loosely off her frame and that she has lost 15 pounds. She is
unaware of this. Her husband of 63 years died a few months ago. You ask the patient to
complete a Rapid Screen for Dietary Intake. Which of the following statements is
considered to be part of this rapid screen?
I eat more than two meals per day.

I drink one glass of alcohol every day.

Without wanting to, I have lost or gained 10 pounds in the last 6 months.

I eat with at least one other person most of the time.

Question Points: 1.0 / 1.0

A 23-year-old real estate agent is brought in by her husband because he is concerned
about her recent behavior. He states that for the last 2 weeks she has been completely out
of control. He says that she hasn't showered in days, stays awake most of the night

cleaning their apartment, and has run up more than $1,000 on their credit cards. While he
is talking, the patient interrupts him frequently and declares this is all untrue, and she has
never been so happy and fulfilled in her whole life. She speaks very quickly, changing
the subject often. After a longer than normal interview you find out she has had no recent
illnesses or injuries. Her past medical history is unremarkable. Both her parents are
healthy, but the husband has heard rumors about an aunt with similar symptoms. She and
her husband have no children. She smokes one pack of cigarettes a day (although she has
been chain-smoking in the last 2 weeks), drinks four to six drinks a week, and smokes
marijuana occasionally. On examination, she is very loud and outspoken. Her physical
examination is unremarkable.
Which mood disorder is most likely here?
Major depressive episode Answers available at https://bit.ly/3bxCcN6

Manic episode

Dysthymic disorder

Somatic Disorder

Question Points: 1.0 / 1.0


A 75-year-old homemaker brings her 76-year-old husband to your clinic. She states that
4 months ago he had a stroke and ever since she has been frustrated with his problems
with communication. They were at a restaurant after church one Sunday when he
suddenly became quiet. When she realized something was wrong he was taken to the
hospital by EMS. He spent 2 weeks in the hospital with right-sided weakness and
difficulty speaking. After hospitalization he was in a rehab center, where he regained the
ability to walk and most of the use of his right hand. He also began to speak more, but
she says that much of the time “he doesn't make any sense.” She gives an example that
when she reminded him the car needed to be serviced he told her “I will change the
Kool-Aid out of the sink myself with the ludrip.” She says that these sayings are
becoming frustrating. She wants you to tell her what is wrong and what you can do about
it. While you write up a consult to neurology, you describe the syndrome to her.
Wernicke's aphasia

Broca's aphasia

Dysarthria

Dementia
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0


A 12-year-old presents to the clinic with his father for evaluation of a painful lump at the
left eyelid. It started this morning. He denies any trauma or injury. There is no visual
disturbance. Upon physical examination, there is a red raised area at the margin of the
eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on
this description, what is the most likely diagnosis?
Dacryocystitis

Chalazion

Hordeolum

Xanthelasma
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0


A young man feels something in his scrotum and presents to you for clarification. On
your examination, you note what feels like a “bag of worms” in the left scrotum, superior
to the testicles. Which of the following is most likely?
Hydrocele of the spermatic cord

Varicocele

Testicular carcinoma

A normal vas deferens

Question Points: 0.0 / 1.0

A 28-year-old graduate student presents to your clinic for evaluation of pain “all over.”
With further questioning, she is able to relate that the pain is worse in the neck,
shoulders, hands, lower back, and knees. She denies swelling in her joints; she states that
the pain is worse in the morning; there is no limitation in her range of motion. On
physical examination, she has several points on the muscles of the neck, shoulders, and
back that are tender to palpation; muscle strength and range of motion are normal. Which
of the following is likely the cause of her pain?
Rheumatoid arthritis

Osteoarthritis

Fibromyalgia

Polymyalgia rheumatic

Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0

Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with
emesis, which has been occurring for 2 days. He does note a dark, granular substance
resembling coffee grounds. What do you suspect?

Bleeding from a diverticulum

Bleeding from a peptic ulcer

Bleeding from a colon cancer

Bleeding from cholecystitis

Question Points: 1.0 / 1.0

The following information is recorded in the health history: “I feel really tired.”
To which category does this information belong?
Chief complaint


Present illness

Personal and social history

Review of systems
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0


A 24-year-old secretary presents to your clinic complaining of difficulty sleeping, severe
nightmares, and irritability. She states it all began 6 months ago when she went to a fastfood restaurant at midnight. While she was waiting in her car, a man entered through the
passenger door and put a gun to her head. He had her drive to a remote area where he
took her money and threatened to kill her. When the gun jammed, he panicked and ran
off. Ever since this occurred, the patient has been having these symptoms. She states she
jumps at every noise and refuses to drive at night. She states her anxiety has had such a
marked influence on her job performance that she is afraid she will be fired. She denies
any recent illnesses or injuries. Her past medical history is unremarkable. On
examination you find a nervous woman appearing her stated age. Her physical
examination is unremarkable. You recommend medication and counseling.
What anxiety disorder do you think this young women most likely has?
Specific phobia

Acute stress disorder

Post-traumatic stress disorder

Generalized anxiety disorder

Question Points: 1.0 / 1.0

A mother brings her 15-month-old daughter to your office for evaluation of a rash and
fever. She says the rash started one day and the fever developed the next day. Her
daughter has had all of her vaccinations up to 10 months. The mother sheepishly admits
that she hasn't had time to bring her daughter in since her 10-month check-up. On

examination you see a mildly sick-appearing toddler with a 102-degree temperature.
Looking at her skin you see at least 100 of a variety of papules, vesicles, and ulcers in
different stages of development.
What illness prevented by proper vaccination does this toddler most likely have?
Varicella (chickenpox)

Measles

Smallpox

Rubella
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0


A 38-year-old accountant presents to your clinic for evaluation of a headache. The
throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to
10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has
had headaches like this in the past, usually fewer than one per week, but not as severe.
She does not know of any inciting factors. There has been no change in the frequency of
her headaches. She usually takes an over-the-counter analgesic and this results in
resolution of the headache. Based on this description, what is the most likely type of
headache?
Tension

Migraine

Cluster

Analgesic rebound
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0

A 7-year-old child is brought to your clinic by her mother. The mother states that her
daughter is doing poorly in school because she has some kind of “ADD” (attention
deficit disorder). You ask the mother what makes her think the child has ADD. The

mother tells you that both at home and at school her daughter will just zone out for
several seconds and lick her lips. She states it happens at least four to six times an hour.
She says this has been happening for about a year. After several seconds of lip-licking
her daughter seems normal again. She states her daughter has been generally healthy
with just normal childhood colds and ear infections. The patient's parents are both
healthy and no other family members have had these symptoms.
What type of seizure disorder is she most likely to have?
Generalized tonic–clonic seizure

Generalized absence seizure

Simple partial seizure (Jacksonian)

Complex partial seizure

Question Points: 1.0 / 1.0


A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of
your physical examination, you listen to her heart and hear a murmur only at the cardiac
apex. Based on the location of the murmur, which valve is most likely to be involved?
Mitral

Tricuspid

Aortic

Pulmonic

Question Points: 1.0 / 1.0

A 15-year-old high school football player is brought to your office by his mother. He is
complaining of severe testicular pain since exactly 8:00 a.m. He denies any sexual
activity and states that he hurts so bad he can't even urinate. He is nauseated and is
throwing up. He denies any recent illness or fever. His past medical history is

unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good
health. On examination, you see a young teenager lying on the bed with an emesis basin.
He is very uncomfortable and keeps shifting his position. His blood pressure is 150/100,
his pulse is 110, and his respirations are 24. On visualization of the penis, he is
circumcised, and there are no lesions and no discharge from the meatus. His scrotal skin
is tense and red. Palpation of the left testicle causes severe pain and the patient begins to
cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left
but is normal on the right. By catheter you get a urine sample and the analysis is
unremarkable. You send the boy with his mother to the emergency room for further
workup.
What is the most likely diagnosis for this young man's symptoms?
Acute orchitis

Answers available at https://bit.ly/3bxCcN6
Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Question Points: 1.0 / 1.0


Which of the following conditions would produce a hyperresonant percussion note?
Large pneumothorax

Lobar pneumonia

Pleural effusion

Empyema
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0

A 41-year-old real estate agent presents to your office, complaining that he feels like his
face is paralyzed on the left. He states that last week he felt his left eyelid was drowsy

and as the day progressed he was unable to close his eyelid all the way. Later he felt like
his smile became affected also. He denies any recent injuries but had an upper respiratory
viral infection last month. His past medical history is unremarkable. He is divorced and
has one child. He smokes one pack of cigarettes a day, occasionally drinks alcohol, and
denies any illegal drug use. His mother has high blood pressure, and his father has
sarcoidosis. On examination, you ask him to close his eyes. He is unable to close his left
eye. You ask him to open his eyes and raise his eyebrows. His right forehead furrows but
his left remains flat. You then ask him to give you a big smile. The right corner of his
mouth raises but the left side of his mouth remains the same.
What type of facial paralysis does he have?
Peripheral CN VII paralysis

Central CN VII paralysis

CN V Neuralgia

CN V paralysis
Answers available at https://bit.ly/3bxCcN6

Question Points: 0.0 / 1.0


Which of the following booster immunizations is recommended in the older adult
population?
Tetanus

Diphtheria

Measles

Mumps

Question Points: 1.0 / 1.0

Hill is a 28-year-old African-American with a history of SLE (systemic lupus
erythematosus). She has noticed a raised, dark red rash on her legs. When you press on
the rash, it doesn't blanch. What would you tell her regarding her rash?

It is likely to be related to her lupus.

It is likely to be related to an exposure to a chemical.

Answers available at https://bit.ly/3bxCcN6
It is likely to be related to an allergic reaction.

It should not cause any problems.

Question Points: 1.0 / 1.0


Which of the following brief screening measures is useful in assessing memory?
Three-item recall

Serial 7s

Spelling “world” backward

Copying intersecting pentagrams


Question Points: 1.0 / 1.0
A 60-year-old baker presents to your clinic, complaining of increasing shortness of
breath and nonproductive cough over the last month. She feels like she can't do as much
activity as she used to do without becoming tired. She even has to sleep upright in her
recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or
sweating. Her past medical history is significant for high blood pressure and coronary
artery disease. She had a hysterectomy in her 40s. She is married and is retiring from the
local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a
stroke and her father died from prostate cancer. She denies any recent upper respiratory
illness, and she has had no other symptoms. On examination, she is in no acute distress.
Her blood pressure is 160/100 and her pulse is 100. She is afebrile and her respiratory
rate is 16. With auscultation, she has distant air sounds and she has late inspiratory
crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an
S3 is heard over the apex.
What disorder of the chest best describes her symptoms?

Pneumonia

Chronic obstructive pulmonary disease (COPD)

Pleural pain

Left-sided heart failure

Question Points: 1.0 / 1.0


A 22-year-old man is brought to your office by his father to discuss his son's mentalhealth disorder. The patient was diagnosed with schizophrenia 6 months ago and has
been taking medication since. The father states that his son's dose isn't high enough and
you need to raise it. He states that his son has been hearing things that don't exist. You
ask the young man what is going on and he tells you that his father is just jealous because
his sister talks only to him. His father turns to him and says, “Son, you know your sister
died 2 years ago!” His son replies, “Well, she still talks to me in my head all the time!”
Which best describes this patient's abnormality of perception?
Illusion

Hallucination

Fugue state

Delusional
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0

A 68-year-old retired postman presents to your clinic, complaining of dull, intermittent
left-sided chest pain over the last few weeks. The pain occurs after he mows his lawn or
chops wood. He says that the pain radiates to the left side of his jaw but nowhere else. He
has felt light-headed and nauseated with the pain but has had no other symptoms. He
states when he sits down for several minutes the pain goes away. Ibuprofen, Tylenol, and
antacids have not improved his symptoms. He reports no recent weight gain, weight loss,

fever, or night sweats. He has a past medical history of high blood pressure and arthritis
which he takes medications for. He quit smoking 10 years ago after smoking one pack a
day for 40 years. He denies any recent alcohol use and reports no drug use. He is married
and has two healthy children. His mother died of breast cancer and his father died of a
stroke. His younger brother has had bypass surgery. On examination you find him
healthy-appearing and breathing comfortably. His blood pressure is 140/90 and he has a
pulse of 80. His head, eyes, ears, nose, and throat examinations are unremarkable. His
lungs have normal breath sounds and there are no abnormalities with percussion and
palpation of the chest. His heart has a regular S1 and S2 and no S3 or S4. Further workup
is pending.
Which disorder of the chest best describes these symptoms?
Angina pectoris

Pericarditis

Dissecting aortic aneurysm

Pleural pain
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0


How should you determine whether a murmur is systolic or diastolic?
Palpate the carotid pulse.

Palpate the radial pulse.

Judge the relative length of systole and diastole by auscultation.

Correlate the murmur with a bedside heart monitor.

Question Points: 0.0 / 1.0

A 26-year-old white female presents to your clinic at 38 weeks, complaining of
intermittent contractions. They last for 30 seconds and are coming every 10 minutes. Her

prenatal course has so far been uneventful. You send her to labor and delivery for a labor
assessment. On vaginal examination, she has effaced 4 cm, but you cannot feel a
presenting part. You admit her for active labor; however, you wish to assess if she is
vertex (baby's head is down), so you do the Leopold's maneuver. Palpating the upper
pole with your hands, you feel a firm round mass. Placing your hand along the right side
of her abdomen, you feel a smooth firmness. Palpating your other hand along the left side
of her abdomen, you feel irregular bumps. Above the pelvic brim you feel a firm
irregular mass. While awaiting ultrasound to confirm your diagnosis, you write the
pertinent orders.
How is this fetus presenting?
Vertex

Answers available at https://bit.ly/3bxCcN6
Breech

Transverse

Anteverted



Question Points: 1.0 / 1.0
A 29-year-old homemaker who is G4P3 presents to your clinic for her first prenatal
check. Her last period was 2 months ago. She has had three previous pregnancies and
deliveries with no complications. She has no medical problems and has had no surgeries.
Her only current complaint is of severe reflux that occurs in the mornings and evenings.
On examination she is in no acute distress. Her vitals are 110/70 with a pulse of 88. Her
respirations are 16. Her head, eyes, ears, nose, throat, thyroid, cardiac, pulmonary, and
abdominal examinations are unremarkable. On bimanual examination her cervix is soft
and her uterus is 10 weeks in size. Pap smear, cultures, and blood work are pending.
What is the most likely cause of her first-trimester reflux?
Increasing prolactin levels

Increasing ADH (antidiuretic hormone) levels

Increasing progesterone

Enlarged gravid uterus

Question Points: 0.0 / 1.0


A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is
true?
She obtains a 20% correct score at 100 feet.

She can accurately name 20% of the letters at 20 feet.

She can see at 20 feet what a normal person could see at 100 feet.

She can see at 100 feet what a normal person could see at 20 feet.
Answers available at https://bit.ly/3bxCcN6
 Question Points: 1.0 / 1.0


A 50-year-old realtor presents to your office for evaluation of neck pain. She was in a
motor vehicle collision 2 days ago and was assessed by the emergency medical
technicians on site, but she didn't think that she needed to go to the emergency room
at that time. Now, she has severe pain and stiffness in her neck. On physical
examination, you note pain and spasm over the paraspinous muscles on the left side of
the neck, and pain when you make the patient do active range of motion of the
cervical spine. What is the most likely cause of this neck pain?
Simple stiff neck

Aching neck

Cervical sprain

Cervical herniated disc

Question Points: 1.0 / 1.0


Which of the following will help to optimize yield from a pediatric examination?
Doing the examination out of order if necessary to take advantage of quiet periods for
auscultation, etc.

Being very orderly, so as not to miss a portion of the examination

Using firmness as needed to make it through your examination

Making sure to place the infant on the table during the examination while mom watches close
by
Answers available at https://bit.ly/3bxCcN6
Question Points: 1.0 / 1.0



A 6-month-old infant is brought in for a well check. It is noted his head circumference is
off the chart and at a much higher percentile than was previously measured. What should
you do next?
Recommend a neurology consult.

Order a CT of the head.

Remeasure the circumference.

Admit the child to the hospital for further workup.

Question Points: 1.0 / 1.0


Glynn is 90 years old and lives alone. She is able to bathe, dress, prepare her food, and
transfer from bed to chair independently. She has children in the area who help her with
her medications and transportation needs. Which of the following is considered an
instrumental activity of daily living?
Bathing

Dressing

Preparing food

Transferring from bed to chair
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0


A 72-year-old African-American male is brought to your clinic by his daughter for a
follow-up visit after his recent hospitalization. He had been admitted to the local hospital
for speech problems and weakness in his right arm and leg. On admission, his MRI
showed a small stroke. The patient was in rehab for 1 month following his initial
presentation. He is now walking with a walker and has good use of his arm. His daughter
complains, however, that everyone is still having trouble communicating with the
patient. You ask the patient how he thinks he is doing. Although it is hard for you to
make out his words, you believe his answer is “well . . . fine . . . doing . . . okay.” His
prior medical history involved high blood pressure and coronary artery disease. He is a
widower and retired handyman. He has three children who are healthy. He denies
tobacco, alcohol, or drug use. He has no other current symptoms. On examination, he is
in no acute distress but does seem embarrassed when it takes him so long to answer. His
blood pressure is 150/90 and his other vital signs are normal. Other than his weak right
arm and leg, his physical examination is unremarkable.
What disorder of speech does he have?
Wernicke's aphasia

Broca's aphasia

Dysarthria

Answers available at https://bit.ly/3bxCcN6
Dementia

Question Points: 0.0 /

A pregnant woman finally presents in for her prenatal checkup. She complains today of
headache and abdominal pain of several months' duration. She appears somewhat hurried
or nervous. What question would you ask next?
Have you been eating properly and taking a prenatal vitamin?


Do you feel safe at home?

How much activity have you been able to fit into your schedule?

Do you have a family history of thyroid disease?
Answers available at https://bit.ly/3bxCcN6

Question Points: 1.0 / 1.0