SOLVED BY- 6 ENGLISH 2B
Экзаменационные вопросы 12-семестр 2020-г Семейная медицина
1. You are re-evaluating a 32-year-old woman in your office. You started
her on combination oral contraceptives (COCs) 3 months ago, and at each
of three visits since then, her blood pressure has been elevated. Which of
the following is an appropriate next step?
a. Discontinue the oral contraceptive and recommend a barrier method
b. Change to a pill with a higher estrogen component
c. Change to a pill with a lower estrogen component
d. Change to a pill with a lower progestin component
2. Which side effect of COCs is most frequently cited as the reason for
discontinuing their use?
a. Nausea
b. Breast tenderness
c. Fluid retention
d. Irregular bleeding
3. You are counseling a 23-year-old woman who is interested in starting
COC pills. Which of the following is true regarding risks associated with
COC use?
a. Users of COC pills have an increased risk of ovarian cancer
b. Users of COC pills have an increased risk of endometrial cancer
c. Users of COC pills have an increased risk of thromboembolism
d. Users of COC pills have an increased risk of hemorrhagic stroke
4. A 29-year-old obese woman with type 2 diabetes mellitus is asking
you about progestin-only pills as a method of contraception. Which of the
following is true?
a. Progestin-only pills are contraindicated in women with diabetes
b. Progestin-only pills would increase her risk of thromboembolic events
c. Progestin-only pills are only Food and Drug Administration (FDA) approved
for nursing women
d. Progestin-only pills should be taken every day of the month, without a hormonefree
period
5. You are counseling a patient regarding contraception options. She is
36-years-old, she smokes, weighs 145 lb, and has no other medical concerns.
She is sexually active, but not in a monogamous relationship. Of the
following, which is her best contraception option?
a. Combination oral contraceptive pills
b. An intravaginal ring system delivering estrogen and progestin
c. A transdermal contraceptive patch delivering estrogen and progestin
d. An injectable form of long-acting progestin
6. You are evaluating a 5-year-old girl brought in by her parents to discuss
eneuresis. She was toilet trained in the daytime at the age of 3 years,
and was dry at night at about 31/2 years of age. Four months ago, her parents
had another child, and the 5-year-old began to wet the bed at night.
She has no medical condition that would account for the change. What
term correctly describes this condition?
a. Primary nocturnal enuresis
b. Primary diurnal enuresis
c. Secondary nocturnal enuresis
d. Secondary diurnal enuresis
7. You are seeing a 6-year-old girl whose parents brought her in to have
her bedwetting evaluated. She has been toilet trained during the day since
the age of 4, but still wets the bed at night. Her father wet the bed until the
age of 8 years. Her physical examination reveals no abnormalities, and her
urinalysis is normal. Which of the following statements is true regarding
this situation?
a. Up to 20% of 6-year-olds are enuretic
b. Her father’s history is inconsequential in this situation
c. It is unusual for young girls to have a problem with enuresis
d. The problem is likely due to her being a deeper sleeper than other children
8. You are evaluating a 9-month-old Caucasian girl for poor weight
gain. She has gone from the 75th percentile to the 10th percentile in height
and weight. She has had recurrent respiratory infections and diarrhea, but
cultures obtained have been negative. Which of the following will be the
most useful test in this setting?
a. A Mantoux test for tuberculosis
b. Assessment for human immunodeficiency virus
c. Stool for ova and parasites
d. A sweat chloride test
e. RENAL FUNCTION TEST
9. You are seeing a 15-month-old for a well-child check. His parents
have no concerns and his developmental history is normal. His growth
chart is shown.
Which of the following is the most likely?
a. Familial short stature
b. Failure to thrive
c. Hypothyroidism
d. A normal breast-fed infant
10. You have been following a 12-month-old infant. At 9 months, his
height was at the 25th percentile while his weight was at the 5th percentile.
At 12 months, his weight and height are unchanged. His physical examination
shows:
Blood pressure: 62/32 (low)
Heart rate: 72 beats per minute
Respiratory rate: 16 per minute
Temperature: 98.8 F
Which is the best therapeutic option for this child?
a. Nutritional instruction to take two times the normal caloric intake
b. Iron supplementation with increased calorie intake
c. Zinc with increased caloric intake
d. Hospital admission
11. A 19-year-old presented to your office with a 3-day history of fatigue,
sore throat, and low-grade fevers. On examination, his temperature was
100.3 F, and you noted an exudative pharyngitis with cervical adenopathy.
You sent a throat culture and started him on amoxicillin prophylactically.
Two days later, he presents for follow up with continued symptoms and a
diffuse, symmetrical erythematous maculopapular rash. What is the most
likely cause of his symptoms?
a. Scarlet fever
b. Allergic reaction to amoxicillin
c. Viral exanthema
d. Mononucleosis
12. A 48-ear-old man presents with a history of “feeling tired” for about
6 months. His previous doctor told him he probably had chronic fatigue
syndrome, and he is presenting to you for a second opinion. He reports
that his sleep is not refreshing. He has postexertional fatigue, weight loss,
and also reports impaired concentration and headaches. Which of those
symptoms is less likely to be associated with chronic fatigue syndrome?
a. Unrefreshing sleep
b. Postexertional fatigue
c. Weight loss
d. Impaired concentration
13. A 23-year-old woman presents to your office to discuss fatigue. She
describes a “lack of energy” and “tiredness,” denying weakness or hypersomnolence.
What is the next step in the workup?
a. Screen for depression
b. Screen for sleep apnea
c. Screen for anemia
d. Screen for hypothyroidism
e. Screen for pregnancy
14. You are discussing fatigue with one of your 53-year-old patients. She
reports that her symptoms have occurred for the past 6 months, and have
been getting progressively worse. She reports increased stress and working
longer hours at work, and she is drinking a glass of red wine each evening
after work to relax. Which component of her history points to a physical
cause of her fatigue?
a. Symptoms for 6 months
b. Progressively worsening
c. Associated with increased stress
d. Occurring when working longer hours
e. Alcohol overuse
15. A 23-year-old woman presents to your office complaining of headaches.
Which of the following characteristics is more likely to be associated with
migraine headaches than other types of headaches?
a. Unilateral symptoms
b. Severe in intensity
c. Nausea
d. Rhinorrhea
16. You are evaluating a patient with a headache. Of the following, which
is the most important in characterizing the type of headache the patient is
experiencing?
a. History
b. Physical examination
c. Blood work
d. Imaging
17. You are talking with a 24-year-old woman complaining of a headache.
She reports that before she has the headache, she experiences visual symptoms
associated with slight nausea. When the headache occurs later, it is
throbbing, pulsating, and unilateral. During the headache, she experiences
light sensitivity. Sleep improves the symptoms. Her symptoms are disrupting
her daily life, and you decide to try prophylactic therapy. Which of the
following is the most studied prophylactic agent to use?
a. Beta-blockers
b. Calcium channel blockers
c. Selective serotonin reuptake inhibitors
d. Anticonvulsants
18. One of your patients has been on beta-blocker therapy for migraine
prophylaxis. Her symptoms are not optimally controlled, and she is interested
in other therapies. What agent, when added to the beta-blocker, has
a synergistic effect in the prophylaxis of migraines?
a. Calcium channel blockers
b. Tricyclic antidepressants
c. Selective serotonin reuptake inihibitors
d. Anticonvulsants
19. You are caring for a 33-year-old migraine sufferer. He is currently
complaining of an acute migraine attack, and is interested in abortive therapy.
Which of the following options is least likely to be effective?
a. Acetaminophen
b. NSAIDs
c Ergotamines
d. Narcotics
20. You are discussing migraine management with a 30-year-old woman.
She wants to use prophylactic medications, but had debilitating fatigue and
symptoms of depression on beta-blockers. Which of the following medications
is an acceptable alternative?
a. Nifedipine
b. Verapamil
c. Diltiazem
d. Amlodipine
e. Nicardipine
21.A 41-year-old man comes to the office to discuss his headache symptoms.
He first began having symptoms a couple of years ago. He describes
the headaches dramatically—“like an ice pick is going through my eye!”—
and describes it as the worst pain in his life. The headaches begin suddenly,
are unilateral, last up to 2 hours, and are associated with runny nose and
watery eye. He gets several attacks over a couple of months, but is symptom
free for months in-between flare ups. What is the best approach for
long term management of the attacks?
a. Fluoxetine, 20–60 mg daily
b. Prednisone, 10 mg daily
c. Indomethacin, 120 mg daily
d. Nifedipine, 40–120 mg daily during the symptomatic period
e. Ergotamine, 1–2 mg daily during the symptomatic period
22. A 40-year-old man transfers to your office from out of state after
moving to your community. He suffers from cluster headaches, and would
like a medication to manage the acutely painful episodes. Which of the following
would be best for treatment of the acute episodes?
a. Indomethacin, 120 mg by mouth
b. Oxycodone, 5–10 mg by mouth
c. Sumatriptan, 50–100 mg by mouth
d. Ergotamine, 1–2 mg by mouth
e. 4% lidocaine, 1 mL administered into the nostril
23. You are talking with a 33-year-old woman who is complaining of
headaches. She has had these headaches for 5 months, and they are increasing
in frequency. She reports that the headaches may last anywhere from an
hour to several days. They are now occurring about 5–10 times a month,
without relationship to her menstrual cycle. She describes the headache as
bilateral, and the pain is described as a pressure around her forehead. She
denies nausea, is not sensitive to sound, but is sensitive to light during an
attack. On examination, she has no obvious neurological deficit. What is the
best approach to take at this point?
a. Prescribe narcotic analgesics and follow up if no improvement
b. Prescribe NSAIDs and follow up if no improvement
c. Order blood work to rule out secondary cause
d. Order a CT of the brain
e. Order an MRI of the brain
24. You are evaluating a 48-year-old woman with headaches. She reports
a long history of occasional sinus headaches, usually responding to overthecounter treatment. Over the last several months, the headaches are
occurring more frequently, and are actually more painful than they have
been in the past. Over-the-counter medications, effective in the past, no
longer work. What is the most appropriate next step?
a. Use antibiotics to treat sinusitis and follow up if no improvement
b. Use prescription antihistamines and follow up if no improvement
c. Use prescription decongestants and follow up if no improvement
d. Use NSAIDs and follow up if no improvement
e. Obtain radiological imaging of the brain
25. You are taking care of a 36-year-old woman with mild hypertension,
arthritis, and depression. She also has been taking daily oral penicillin for
a streptococcal throat infection. She notes the acute onset of hematuria,
and comes to your office for evaluation. Which of the following medications
is most likely to cause this symptom?
a. Ibuprofen
b. Penicillin
c. Fluoxetine
d. Oral contraceptives
e. Hydrochlorothiazide
26. A 16-year-old sexually active woman comes to your office complaining
of blood in her urine. She reports suprapubic pain, dysuria, and frequency.
What is the likely diagnosis?
a. Cystitis
b. Pyelonephritis
c. Nephrolithiasis
d. Bladder cancer
e. A sexually transmitted infection
27. A 16-year-old girl comes to your office complaining of blood in her
urine. She is asymptomatic, and not menstruating. Urinalysis reveals grossly
pink urine, but urine dipstick is negative for blood. Which of the following
foods is the likely cause?
a. Spinach
b. Strawberries
c. Raspberries
d. Beets
e. Carrots
28. A 65-year-old African American man is seeing you because he has
had blood in his urine for 1 day. On further questioning, you find that the
blood appears at the end of micturition, and is not associated with pain,
frequency, urgency, or other symptoms. Of the following, which is the most
likely cause of his hematuria?
a. Urethral cancer
b. Renal cancer
c. Prostate cancer
d. Urolithiasis
e. Urethral trauma
29. You are seeing a 14-year-old boy who reports seeing blood in his
urine. He is currently asymptomatic. On urinalysis, he has more than 10 red
blood cells per high-powered field, he has red cell casts, and his creatitine is
2.3 (H). What is the next step in the evaluation?
a. Intravenous pyelography
b. Renal ultrasound
c. Cystoscopy
d. Noncontrast helical CT
e. Antistreptolysin O titer
30. You are evaluating a 35-year-old man with hematuria. His urinalysis
does not reveal casts or protein, but does show moderate blood. His urine
culture is negative, as is his intravenous pyelogram, and he has a normal
creatinine. Which of the following is most appropriate in this case?
a. Reassurance and periodic monitoring
b. Renal ultrasound
c. Cystoscopy
d. ASO titer
31. A daycare worker presents to your office after turning “yellow.” She
reports feeling feverish and fatigued, and describes right upper quadrant
abdominal pain and nausea. On examination, her skin tone, conjunctivae,
and mucous membranes are yellow-tinged. Serologies indicate acute
hepatitis A infection. Which of the following is true about this infection?
a. She is most infectious while she is jaundiced
b. Fecal shedding of the virus continues until liver enzymes have normalized
c. Complete recovery is the norm
d. Relapses are common
32. A patient is seeing you in follow up after being hospitalized for acute
hepatitis. He is concerned about his risk for hepatocellular carcinoma.
Which form of viral hepatitis is associated with a clearly increased risk of
hepatocellular carcinoma?
a. Hepatitis A virus
b. Hepatitis B virus
c. Hepatitis C virus
d. Hepatitis D virus
33. You are examining a newborn whose mother has a positive screen
for hepatitis B surface antigen. Which of the following is true regarding
this situation?
a. When acquired early in life, the large majority of those infected with hepatitis B
will have chronic disease
b. If the child has a normal immune system, his likelihood of developing chronic
disease is small
c. A higher percentage of adults infected with hepatitis B will develop chronic disease
as compared with children
d. A high percentage of children acutely infected will develop fulminant liver disease
e. When Hepatitis B is transmitted perinatally, the child generally develops the
typical symptoms of acute hepatitis
34. One of your patients had unprotected intercourse with a partner later
found to have chronic hepatitis B. In testing your patient, which of the following
serologic markers would be the first to appear?
a. Hepatitis B surface antigen
b. Hepatitis B core antigen
c. The IgM to the core protein (IgM anti-HBc)
d. Hepatitis B e antigen
e. The IgM to Hepatitis B e antigen
35. You are talking with a patient who recently found out that a coworker
has Hepatitis C. Which of the following is true about hepatitis C?
a. The hepatitis C virus is found in blood
b. The hepatitis C virus is found in semen
c. The hepatitis C virus is found in vaginal secretions
d. The hepatitis C virus is found in breast milk
e. The hepatitis C virus is found in saliva
36. You are following a patient after an acute hepatitis B infection. His
serologies are shown below:
• HBsAg: Positive
• HBeAg: Positive
• IgM anti-HBc: Negative
• IgG anti-HBc: Positive
• Anti-HBs: Negative
• Anti-HBe: Negative
• HBV-DNA: Positive
Which term best describes his disease status?
a. Acute infection, early phase
b. Acute infection, recovery phase
c. Chronic infection, replicating virus
d. Chronic infection, nonreplicating virus
e. Previous exposure with immunity
37. You check serologies on a patient exposed to hepatitis B. His serologies
are shown below:
• HBsAg: Negative
• HBeAg: Negative
• IgM anti-HBc: Negative
• IgG anti-HBc: Negative
• Anti-HBs: Positive
• Anti-HBe: Negative
• HBV-DNA: Negative
Which term best describes his disease status?
a. Acute infection, early phase
b. Acute infection, window phase
с. Previous exposure with immunity
d. Vaccination
38. You are seeing a 17-year-old patient who began menstruating at age 14,
and has been relatively regular since age 15. She made an appointment to be
seen today because she stopped having periods 2 months ago. She denies
sexual activity. What is the most common cause of secondary amenorrhea?
a. Polycystic ovarian syndrome
b. Functional hypothalamic amenorrhea
c. Pregnancy
d. Hypothyroidism
39. A 16-year-old woman comes to your office complaining of unpredictable
menstrual periods. She began her periods at age 14, and they have
never been predictable. She denies sexual activity in her lifetime, has no
systemic illness, uses no medications regularly, and her physical examination
is normal. What is her most likely diagnosis?
a. Pregnancy
b. Ovulatory bleeding
c. Anovulatory bleeding
d. Uterine leiomyoma
40. A healthy 60-year-old woman is seeing you to evaluate vaginal bleeding.
She has not had a menstrual period for approximately 7 years, but
3 months ago noted occasional pink spotting. Since then, it has increased
in amount and has become almost continuous. She is currently sexually
active with her husband. On examination, she appears well, her pelvic
examination is normal, and screens for sexually transmitted infections are
negative. What would be your next step?
a. Pelvic ultrasound to evaluate for fibroids
b. Pelvic CT scan to evaluate for pelvic tumor
c. Laparoscopy to evaluate for endometriosis
d. Endometrial biopsy
41. You are considering treatment for a 19-year-old female patient with
primary dysmenorrhea. What should be your first-line therapy?
a. Use of NSAIDs during menses
b. Use of NSAIDs daily
c. Use of opiates during menses
d. Use of a selective serotonin reuptake inhibitor (SSRI) daily
42. You are evaluating a 16-year-old who has not menstruated yet. She appears
short in stature. Which of the following is the most likely genetic diagnosis?
a. Turner’s syndrome
b. Fragile X syndrome
c. Down syndrome
d. Testicular feminization syndrome
43. You are evaluating a 32-year-old woman complaining of amenorrhea.
She has mild hypertension, hypothyroidism, gastroesophageal reflux disease,
and depression. On evaluation, her prolactin level was found to be 89 ng/mL
(H). Which of the following medications would be most likely to cause the
elevated prolactin level?
a. Proton pump inhibitors
b. Selective serotonin reuptake inhibitors
c. Thiazide diuretics
d. ACE inhibitors
44. You are evaluating 32-year-old woman who has not menstruated in
4 months. She has a long history of irregular menstrual periods, but has
never gone this long without a period in the past. She is not pregnant, her
laboratory evaluation is normal, and you decide to perform a progestin
challenge test. The week after she takes 10 mg of medroxyprogesterone
acetate (Provera) for 7 days, she reports having a period. Which of the
following is the most likely cause of her amenorrhea?
a. Premature ovarian failure
b. Turner’s syndrome
c. Asherman’s syndrome
d. Polycystic ovarian syndrome
45. You are evaluating a 16-year-old girl who has never menstruated. She
has normal secondary sexual characteristics, and her laboratory evaluation
is negative. She has no withdrawal bleeding after a progestin challenge, and
you choose to perform an estrogen-progestin challenge. She has no withdrawal
bleeding after that challenge as well. Which of the following is the
most likely reason for her amenorrhea?
a. An outflow tract obstruction
b. Hypergonadotropic amenorrhea
c. Hypogonadotropic amenorrhea
d. Polycystic ovarian syndrome
46. You are seeing a 24-year-old woman complaining of dysmenorrhea.
She has always had painful periods, but lately they seem to be worsening.
Her physical examination, including pelvic examination, is normal. She is
not currently sexually active. Which of the following is the most appropriate
next step in the workup?
a. No further workup is needed
b. Gonorrhea and Chlamydia cultures
c. Pelvic ultrasound
d. Laparoscopy
47. You are evaluating an 18-year-old college student complaining of
painful menstrual periods. She reports that she began menstruating at age 14.
Since that time, her periods have always been associated with pain. The
pain begins just prior to her period starting, and lasts for up to 3 days.
She has associated nausea, fatigue, and headache. Which of the following
is the most likely diagnosis?
a. Primary dysmenorrhea
b. Endometriosis
c. Leiomyoma
d. Adenomyosis
48. You are evaluating a 20-year-old with dysmenorrhea. Her history and
physical examination are normal, and you choose to treat her with a trial of
oral contraceptives. How do oral contraceptives work to treat dysmenorrhea?
a. Suppressing of prostaglandin synthesis
b. Suppressing of prostaglandin release
c. Causing endometrial hyperplasia
d. Increasing vasoconstriction in the uterus
49. You are caring for a 70-year-old hospitalized male who is currently 1 day
out from a carotid endarterectomy. You are called to the floor at 3:00 a.m.
because the patient removed his peripheral IV and is demanding to go home.
Reviewing his chart, you see he has a history of hypertension and hyperlipidemia,
both of which are well controlled with medication. He is working parttime
as an auto mechanic, and lives at home with his wife. On evaluation, he is
agitated but responds to questions, oriented to person only, and denies chest
pain, palpitations, shortness of breath, dizziness, or other problems. Of the following,
which characteristic points to delirium instead of dementia in this case?
a. The acute onset of his symptoms
b. The fact that he is disoriented to time and place
c. His history of hypertension
d. The fact that he is responsive to questions
50. You are in the emergency room caring for a 47-year-old man who
was brought in by his wife who states that he had an acute onset of confusion.
His past medical history is unremarkable, without evidence of drug or
alcohol use. On examination, you find his blood pressure to be 210/130,
his pulse to be 97, and his respirations to be 20 per minute. His temperature
is 98.4 F. Strength, sensation, and gait are normal. He has no tremor.
What would you expect to find on ophthalmologic examination?
a. Pinpoint pupils
b. Dilated pupils
c. Papilledema
d. 6th cranial nerve palsy
51. You are caring for a 21-year-old woman complaining of pelvic pain.
She reports a gradual onset of bilateral pain associated with fever, vaginal
discharge, and mild dysuria. Her pelvic examination demonstrates uterine,
adnexal, and cervical motion tenderness. What is the most likely cause of
the pain?
a. Pelvic inflammatory disease
b. Ectopic pregnancy
c. Ovarian cyst
d. . Appendicitis
52. You are caring for a 27-year-old woman complaining of pelvic pain.
She reports localized pain on the left side that has increased in severity over
the last 2 days. She also reports amenorrhea and nausea. On examination,
you note a tender adnexal mass on the left. What is the likely cause?
a. Pelvic inflammatory disease
b. Ectopic pregnancy
c. Ovarian cyst
d. Uterine leiomyoma
53. You are evaluating a 18-year-old male with a sore throat. It has been
present for 3 days, and is associated with fever, aches, and fatigue. On
examination, he has an exudative pharyngitis, soft palate petechiae, and
posterior cervical adenopathy. Which of the following is the most likely
diagnosis?
a. Group A streptococcal infection
b. Group A streptococcal colonization
c. Corynebacterium diphtheriaeinfection
d. Epstein-Barr virus infection
54. A 7-year-old boy comes to see you for a sore throat. He reports
fevers, chills, myalgias, and pain on swallowing. On examination, you note
anterior adenopathy, erythematous tonsils, and uveal edema. He has no
drug allergies. Which of the following would be the best treatment for his
condition?
a. Symptomatic care
b. Antiviral therapy
c. Doxycycline (Vibramycin)
d. Amoxicillin (Amoxil)
55. You are treating a 16-year-old girl with a sore throat. She denies
runny nose or cough, but does report fevers and myalgia. On examination,
she has an exudative pharyngitis, and posterior cervical adenopathy. Her
rapid streptococcal antigen is positive. You treat her with penicillin, and she
develops a diffuse maculopapular rash. What is the most likely diagnosis?
a. Scarlet fever
b. Infectious mononucleosis
c. Viral exanthem
d. Pityriasisrosea
56. An 8-year-old patient has a positive group A streptococcal throat culture
whether symptomatic or not. You have determined that he is a streptococcal
carrier. Assuming that the patient has no allergies, what is the best
therapeutic option in this patient?
a. Penicillin (PenVK)
b. Amoxicillin (Amoxil), using the usual dose
c. Amoxicillin (Amoxil), using high dosages
d. . Clindamycin (Cleocin)
57. You are treating a 16-year-old patient with a sore throat. She has had
3 days of symptoms, and does not have nasal congestion or cough. She also
reports laryngitis. On examination, she has an erythematous pharynx without
exudate. Which of the following is the most appropriate therapy based
on the symptoms described?
a. Supportive care
b. Penicillin (PenVK)
c. Amoxicillin (Amoxil)
d. Erythromycin (Emycin)
58. You are caring for a teen with fairly severe acne. Which of the following
has been shown to play a role in the development of acne?
a. Stress
b. Dirty skin
c. Chocolate
d. Increased greasy foods in the diet
59. You are discussing therapy with a patient who has recently been diagnosed
with psoriasis. He is interested in trying calcipotriene (Dovonex).
Which of the following best describes its mechanism of action?
a. It is a fatty-acid based moisturizer
b. It induces epidermal differentiation and inhibits keratinocyte proliferation
c. It binds to retinoic acid receptors in the skin, normalizing the epidermal
proliferation
d. It is a topical immunomodulator
60. A 32-year-old mother of two young children presents to your office
for evaluation of her left eye. She reports redness of the white part of her
eye, with a watery discharge. She reports mild itching and a sensation as if
something is in her eye. She denies a history of allergies, and reports no
concurrent allergic symptoms. Examination reveals a palpable preauricular
lymph node. Fluorescein staining does not reveal corneal dendrites. What
should be the treatment of choice in this case?
a. Antiviral eye drops
b. Corticosteroid eye drops
c. Combination antibiotic/corticosteroid eye drops
d. Supportive care
61. Which of the following causes of a red eye is a medical emergency
and requires immediate ophthalmologic referral?
a. Gonococcal conjunctivitis
b. Chlamydial conjunctivitis
c. Corneal abrasion
d. Sub-conjunctival hemorrhage
e. Blepharitis
62. You are seeing a 26-year-old male patient complaining of a red eye
who says, “I think I have pink eye.” He reports increased redness, tearing,
discharge, photophobia, and pain. Which of his reported symptoms would
be more suggestive of something other than conjunctivitis?
a. Redness
b. Discharge
c. Photophobia
d. Pain
64. You are seeing a 20-year-old college student who reports that her eye
became pink over the last 24 hours. She is otherwise healthy and takes no
medications except oral contraceptives. She reports redness, irritation, tearing,
discharge, and itching. Which of her symptoms are more specific for an
allergic etiology for her condition?
a. Use of oral contraceptives
b. Irritation
c. Discharge
d. Itching
65. You are caring for a 3-year-old boy who goes to daycare while his
parents are at work. His mother brought him to see you because the daycare
will not take him back until he’s had a doctor evaluate his eye symptoms.
He developed an acute redness of the left eye, associated with runny
nose, cough, and increased irritability. On examination, his eye is red and
watery. The discharge is clear, and he has mild eyelid edema. Which of the
following is the most common cause for his condition?
a. Coxsackie virus
b. Parainfluenza virus
c. Adenovirus
d. Rhinovirus
66. You are seeing a 32-year-old contact lens wearer who has recently
suffered from recurrent conjunctivitis. Which of the following treatments
would be best in this situation?
a. Supportive care
b. Ciprofloxacin (Ciloxan) ointment
c. Ploymyxin-trimentoprim (Polytrim) ointment
d. Gentamicin (Garamycin) ointment
67. You are evaluating a 20-year-old college student who complains of an
acute red eye. He complains that his eye is irritated, with significant yellowish
discharge. When he wipes his eye, it almost immediately reforms.
You confirm this by wiping his eye with a cotton swab. When asked, he
also reports dysuria and penile discharge. What is the most appropriate
treatment?
a. Ciprofloxacin ointment
b. Tobramycin ointment
c. Ceftriaxone (Rocephin) intramuscularly
d. Immediate ophthalmologic referral
68. You are caring for a 32-year-old female smoker with upper respiratory
symptoms. She reports congestion, facial pressure, nasal discharge,
tooth pain, and headache. Her symptoms have been present for 14 days.
Which portion of her history is most commonly used to define clinical rhinosinusitis?
a. Facial pressure
b. Nasal discharge
c. Headache
d. 14-days of illness
69. A 35-year-old man has been struggling with recurrent sinusitis. He
develops at least four sinus infections per year, and wonders what he can
do to prevent these. You are discussing predisposing factors with him, in an
effort to control any present. Which of the following is the most common
predisposing condition leading to chronic or recurrent sinusitis?
a. Allergic rhinitis
b. Gastroesophageal reflux disease
c. Cigarette smoking
d. Environmental pollutants
70. You are seeing a 21-year-old college student who complains of congestion,
headache, sinus pressure and tooth pain for more than 2 weeks.
She is otherwise healthy, but feels like she’s “having trouble shaking this
cold.” She has used over the counter decongestants with limited relief.
A CT scan of her sinuses demonstrates acute sinusitis. Of those listed,
which is the most common organism causing her symptoms?
a. Moraxella Catarrhalis
b. S. aureus
c. Group A beta hemolytic streptococcal species
d. Streptococcus pneumoniae
71. You are caring for a 42-year-old woman with a persistent sinusitis.
She first came to see you 3 months ago, was treated with amoxicillin, and
improved. She returned 2 months ago, received another course of amoxicillin,
and improved again. Last month, her symptoms reoccurred, and you
prescribed trimethoprim/sulfamethoxazole. She returns today with continued
symptoms. What would be your treatment of choice?
a. A macrolide for 10 days
b. A macrolide for 14–21 days
c. A fluoroquinolone for 10 days
d. A fluoroquinolone for 14–21 days
72. You are treating a woman with chronic and recurrent sinusitis. Along
with antibiotic therapy directed at the underlying bacterial cause, which of
the following has been shown to help break the cycle of recurrent disease?
a. Phenylpropanolamine
b. Pseudoephedrine
c. Topical alpha agonists (Afrin)
d. Topical nasal steroids
73. You are evaluating a 9-month-old child with recurrent wheezing. His
mother also reports that he vomits after formula as well. What is the best
test to determine the cause of his wheezing?
a. Pulmonary function testing
b. A chest x-ray
c. Upper endoscopy
d. A 24-hour pH probe
74. You are evaluating a 35-year-old patient with known asthma. He
comes to your office complaining of increased shortness of breath despite
compliance with his usual asthma regimen. He reports cough, but denies
fever or sputum production. His pulmonary examination reveals wheezing
bilaterally without crackles or rhonchi. Which of the following is most useful
in this setting?
a. Chest x-ray
b. Peak flow testing
c. Pulmonary function testing
d. A complete blood count
75. You are evaluating a patient with knee swelling and pain. You perform
an arthrocentesis to help determine the diagnosis. The fluid analysis
reveals rhomboid-shaped positive birefringent crystals. Which of the following
is the likely diagnosis?
a. Gout
b. Pseudogout
c. Infectious arthritis
d. Rheumatoid arthritis
76. The joint aspirate from the inflamed first metatarsal phalangeal joint
of a 35-year-old woman reveals needle-shaped nonbirefringent crystals.
Which of the following is the most appropriate initial treatment?
a. Colchicine
b. Corticosteroids
c. Opiates
d. Allopurinol
77. You are caring for a 45-year-old woman who was diagnosed with
rheumatoid arthritis 6 years ago. Which of the following signs or symptoms,
if present, would signal extra-articular manifestations of her condition?
a. Cough
b. Palpitations
c. Gastrointestinal distress
d. Peripheral neuropathy
78. You are caring for a 35-year-old man with a long history of allergies
and asthma. His asthma has been in good control, but his blood pressure
has been elevated on more than two occasions despite weight loss, exercise
and appropriate dietary intervention. Which of the following blood pressure
medications should be avoided in this case?
a. Hydrochlorothiazide
b. Lisinopril (Zestril, Prinivil)
c. Nifedipine (Procardia)
d. Propranolol (Inderal)
79. You are caring for a man with asthma. He is currently taking an
inhaled corticosteroid twice daily and using his short acting beta agonist as
needed. Over the past 3 months, he has required escalating doses of his
inhaled corticosteroid, and now he is at the maximum dosage, still using
his “rescue” inhaler more than he would like. Of the following, which is the
best medication to add to his regimen?
a. A burst and rapid taper of oral steroids
b. A long-acting beta-agonist
c. Cromolyn (Intal)
d. Ipratropium (Atrovent)
80. You are following a 45-year-old man with difficult to control diabetes.
As such, you are monitoring his kidney function and are alert to
changes suggesting the beginning of chronic renal insufficiency. Of the following,
which would occur first in the setting of chronic renal failure?
a. Hyperkalemia
b. Hyponatremia
c. Hyperphosphatemia
d. Anemia
81. You are following a 56-year-old patient who has been diagnosed with
hypertension and diabetes for 4 years. He does fairly well with diet and
exercise, and has remained compliant with his medications. Laboratory
evaluation demonstrates a normal serum creatinine, no microalbuminuria,
but a glomerular filtration rate (GFR) of 70 mL/minute. According to the
National Kidney Foundation staging guidelines, what stage of renal failure
does this represent?
a. Stage 0 renal failure
b. Stage 1 renal failure
c. Stage 2 renal failure
d. Stage 3 renal failure
82. You are seeing a hypertensive patient in you office. He is well-controlled
with hydrochlorozide, and is seeing you for a routine evaluation. His blood
pressure at the visit is 118/76. Laboratory evaluation reveals a normal creatinine
and a GFR greater than 90 mL/minute, but he does have microalbuminuria.
Which of the following interventions is indicated in this patient?
a. Commend him on his excellent control and make no changes
b. Work to achieve better blood pressure control through diet and exercise
c. Increase his hydrochlorothiazide dose
d. Add an ACE inhibitor
83. You are following a patient with hypertension and diabetes in your
office. Despite good blood pressure and glycemic control, his GFR has
started to decrease. GFR measurement was 74 mL/minute 3 months ago. At
this visit, GFR is 55 mL/minute. Creatinine is within normal limits, and his
serum potassium is 5.2 mmol/L (normal is up to 5.1 mmol/L). The patient
denies any changes in urination or other problems. Which of the following
is most appropriate at this stage?
a. See the patient more frequently, at least monthly
b. Increase his ACE inhibitor
c. Add diuretic therapy
d. Refer to a nephrologist
84. You are seeing a 48-year-old man with known cirrhosis. He has several
physical signs of his illness, including spider angiomata, palmar erythema,
Dupuytren’s contractures, gynecomastia, testicular atrophy, splenomegaly,
and parotid gland enlargement. Which of his physical examination findings
are more commonly seen in patients with nonalcoholic causes of cirrhosis?
a. Spider angiomata
b. Dupuytren’s contractures
c. Testicular atrophy
d. Splenomegaly
85. You are evaluating a 48-year-old man with liver disease. His laboratory
evaluation is as follows:
AST: 298 u/L (H)
ALT: 144 u/L (H)
AlkPhos: 140 u/L (H)
Bilirubin: 2.3 mg/dL (H)
GGT: 220 u/L (H)
What is the most likely cause?
a. Autoimmune hepatitis
b. Hepatitis B
c. Hepatitis C
d. Alcoholic hepatitis
86. You have just diagnosed a 46-year-old woman with cirrhosis. The
patient also has asthma, arthritis, hypertension, depression, and hypothyroidism.
Of the following, which medication should be avoided in this
patient?
a. Albuterol
b. Nonsteroidal anti-inflammatory agents
c. Selective serotonin reuptake inhibitors
d. Angiotension converting enzyme inhibitors
87.The obstetrics department at 3 AM calls the ED doctor
to the floor because of respiratory suppression in
a 35-year-old G2/P2 white female during her care for
tocolysis (the on-call obstetrician is in the middle of
an emergency Cesarean section). On which of the
following tocolytic medications is she most likely to
be?
(A) Indomethacin
(B) Nifedipine
(C) Magnesium sulfate
(D) Terbutaline
88. A 57-year-old ex-smoker has been followed for
chronic obstructive pulmonary disease (COPD). His
dyspnea has become worse over the past week. Queries
to discern whether the patient exhibits orthopnea
lead nowhere, because the patient has always slept sitting
up since his early adulthood. The neck veins are
unremarkable. Which of the following findings would
best support specifically the possibility that the patient
is suffering from congestive heart failure (CHF)?
(A) Sinus tachycardia
(B) “P pulmonale” in Lead II on electrocardiogram
(C) Afternoon fatigue
(D) Elevated beta-natriuretic protein (BNP)
89.A 33-year-old man complains of “canker sores,” present
for about a week. Physical examination shows a
4-mm ulcerated area on the left side of the oral buccal
mucosa. You prescribe fluocinonide in the adhesive
ointment Orabase, which he may apply as
needed with no limit on the frequency of applications.
You advise him that the painful stage should
last 7 to 10 days, and he should be healed within
3 weeks. Six weeks later, he returns and says the ulcer
is still present and just as irritating. Each of the following
may be associated with persistent aphthous
ulcers except
(A) Erythema multiforme
(B) Scleroderma
(C) Drug allergies
(D) Pemphigus
90.A new mother brings in her 2-month-old daughter for
routine well-baby care. She was born vaginally at
40 weeks of gestation and has had an uneventful course
to date. The mother asks about dental care. Which of
the following statements is true regarding routine
pediatric dental care and prevention of caries?
(A) Dental care need not be initiated until the
secondary teeth have all erupted.
(B) Because the family lives in a community that
has fluoridation of the water system, caries will
not be a problem.
(C) As long as the child is trained to avoid sugars,
caries can be evaded.
(D) Starting between 6 and 12 months of age, the
child is at risk of developing caries.
91.The mother of a 3-month-old child asks which of the
following food substances is the least likely to cause
cavities in her child’s teeth. You answer would be
(A) Cow’s milk
(B) Enfamil
(C) Soy formula with sucrose
(D) Similac
92. At what age of the child should one expect the eruption
of the last of the deciduous dentition?
(A) 18 months
(B) 2.5 years
(C) 3.5 years
(D) 4 years
93.A 75-year-old man complains for 3 weeks of irritation
of the tongue. An examination shows fiery
redness of the entire dorsum of the tongue. The
causes of this condition include all but which of the
following?
(A) Pernicious anemia
(B) Riboflavin deficiency
(C) Iron deficiency
(D) Rubeola
94.At what age should the first permanent teeth erupt?
(A) 4 to 6 years
(B) 6 to 7 years
(C) 9 to 10 years
(D) 12 to 13 years
95.A 22-year-old woman complains of an increasingly
severe sore throat over the last 4 days, worse in the
evening, without evolution to coryza or cough. The
appearance of the throat is that of diffuse redness;
anterior cervical lymph nodes are tender. Which of
the following organisms is virtually the sole possible
bacterial cause of this condition?
(A) Streptococcus pneumoniae
(B) Streptococcus pyogenes
(C) Staphylococcus aureus
(D) Moraxella catarrhalis
96.A 55-year-old man with 35 pack years smoking history
has had hoarseness for 3 months, and recently,
there has been inspiratory stridor. Which of the following
diagnostic measures is the most sensitive first
step in diagnostic evaluation to determine the cause
of the dysphonia?
(A) Laryngoscopy
(B) Magnetic resonance imaging (MRI)
(C) Computed tomography (CT) scan of the larynx
(D) Diagnostic therapeutic trial of proton pump
inhibitors.
97.A 24-year-old male is in the examining room to complain
of stuffy nose in the aftermath of a viral cold of
5-day duration. He relates that he has taken a proprietary
nasal spray for self-treatment of this symptom
for the past 3 days and has noted that the stuffiness
has become bilateral and has now interfered seriously
with his sleep. Which of the following is an accepted
rational approach to the treatment of this condition?
(A) Moist warm air nasal inhalation and inhaled
glucocorticoids while the topical medication is
withdrawn
(B) Prescribing more potent vasoconstrictors in a
topical preparation
(C) Prescription of longer acting nasal
decongestants
(D) Discontinue the nose drops and skin test for
desensitization to treat atopic allergies
98.A mother brings to you her 4-year-old child complaining
of right-sided earache for 12 hours following
three days of coryza, giving way to cough over the
past 2 days. The external ear is not tender nor is the
tempero-mandibular joint. The eardrum is retracted,
fiery red, slightly bulging, and reveals a pus/fluid
level. What are the three top-ranking bacterial organisms
in the causation of this condition, in descending
order of frequency?
(A) Streptococcus pyogenes, Staphylococcus aureus,
Klebsiella pneumoniae
(B) Moraxella catarrhalis , Streptococcus pyogenes,
Staphylococcus aureus
(C) Moraxella catarrhalis, Pseudomonas species,
Haemophilus influenzae
(D) Streptococcus pneumoniae, Haemophilus
influenzae, Moraxella catarrhalis
99.A 26-year-old woman complains of gradually developing
hearing loss on the left side. Her left tympanic
membrane appears to be discolored red as compared
to the right. Which of the following must be present
to make the diagnosis of otitis media?
(A) Air conduction better than bone conduction in
the involved ear
(B) Fever _101_F
(C) Conductive hearing loss in the involved ear
(D) Local tenderness of the tragus
100.A 45-year-old male, a right-handed, devout game
hunter, complains that his wife notes he often turns
his right ear to her to understand her in conversation.
Which of the following is the most likely pattern to
be found on a multiple-frequency audiogram?
(A) Flat audiogram across multiple frequencies in
both ears
(B) Low-frequency hearing loss in the left ear
(C) Early complaint of difficulty hearing at a
conversational level
(D) Deep involvement of the 4,000 cps in the left ear
101.A 55-year-old woman comes to you for vertigo of
recent and violent onset. She denies hearing loss and
tinnitus. Which of the following characteristics
reveals this as of peripheral origin (labyrinth) as
opposed to central origin?
(A) Immediate onset of nystagmus and vertigo with
the Hallpike maneuver
(B) Violent symptoms after a latent period upon
motion of the head affecting the semicircular
canals
(C) Causes include basilar artery insufficiency
(D) Associated nystagmus exhibits pendular motion
102.A 3-year-old girl presents with foul smelling postnasal
drip, temperature of 102 _ F, and perceptible
swelling of the face. Which of the following is the
most important reason to diagnose and treat this
condition in timely fashion?
(A) It presents with a malodorous discharge
(B) To avert febrile seizure
(C) It may be caused by lactamase-producing
organisms
(D) Orbital cellulitis is a feared complication
103.A 12-year-old female patient is diagnosed as having
streptococcal pharyngitis. To prevent rheumatic fever
in this child, how soon must the treatment begin to
eradicate the Streptococcus ?
(A) 48 hours
(B) Five days
(C) Nine days
(D) Fifteen days
104.A 35-year-old woman complains of cough that has
become debilitating, although not very productive.
The onset of her illness was 2 days before and was
gradual, with low-grade fever, malaise, headache, and
cough that was at first mild. On inspection, she does
not appear seriously ill; she manifests tender red nodules
on her anterior lower legs. Otologic examination
reveals an abnormality of the left eardrum. The
patient denies hearing loss, and the eardrum moves
when the patient performs a modified Valsalva
maneuver, but the Weber subtly lateralizes to the left
side. Which of the following is the most logical
empiric therapeutic approach to this patient?
(A) Prescribe penicillin V-K 250 mg 4 times daily
for 10 days
(B) Prescribe a codeine-containing antitussive
medication
(C) Prescribe clarithromycin, 500 mg extended
release, two tablets daily for 3 weeks
(D) Prescribe amoxicillin 875 mg 3 times a day for
10 days
105.Each of the following is a solid indication for neuroimaging
in a patient with headache except:
(A) Onset of headaches over the age of 50 years
(B) Seizures associated
(C) Prolonged aura
(D) Nausea and vomiting
106.Triptans, selective serotonin receptor agonists (SSRAs),
have made a huge impact on treatment of migraine
and to some extent cluster headaches. Of the many
contraindications to their usage, which of the following
is not a contraindication to taking a triptan?
(A) Presence of ischemic heart disease
(B) Taking within 24 hours of another triptan
(C) Concomitant use with nonsteroidal
antiinflammatory drugs (NSAIDs)
(D) Taking in concert with ergotamine
107.All of the following are commonly found in cluster
headache except for which one?
(A) Alcohol ingestion
(B) Tearing and rhinorrhea
(C) Visual aura
(D) Abrupt onset
108.A 26-year-old woman in her second trimester of
pregnancy complains of a recurrence of right hemicranial
headache that has been present for 24 hours
and is associated with photophobia and nausea as
occurred on numerous previous occasions. Which of
the following is acceptable and safe for relief of her
headache?
(A) Gabapentin (Neurontin)
(B) Valproic acid
(C) Vitamin B2
(D) Lisinopril (Prinivil)
109.A patient enters your practice with complaint of
recent onset of acute headache. Which of the following
would be the least indicative of serious pathology
underlying the cause of the headache?
(A) Occipitonuchal distribution
(B) Age 50 years
(C) Headache waking the patient from sleep
(D) History of taking ibuprofen daily for arthritis
110.A 35-year-old woman complains of headaches that
are throbbing and frontal or occipital in distribution.
These have been occurring for most of her adult life
but have become more severe over the last several
days, lasting the whole day, several times per week.
They require her to take over-the-counter ibuprofen
once or twice weekly and usually respond thereto.
Although the headaches remit during sleep, they
recur during the day. Neurological history (including
inquiry regarding visual and other neurological
symptoms accompanying the headaches) and examination
are negative. Funduscopy is negative for hemorrhages,
exudates, and papilledema. Blood pressure
is 116/75. Which of the following is most likely as the
diagnosis of the headaches?
(A) Tension headache
(B) Cluster headache
(C) Migraine headache
(D) Intracranial hemorrhage
111.A 45-year-old man complains of daily unilateral
headaches associated with rhinorrhea and tearing for
the past several weeks. Vascular examination is normal.
There are no visual or musculoskeletal symptoms.
Which of the following is the most likely
diagnosis?
(A) Migraine headache
(B) Temporal arteritis
(C) Cluster headache
(D) Hemicrania continua
112.Your female patient, an elementary school teacher,
complains of paroxysms of right occipital pain.
Examination is negative except for local tenderness
over the right side of the occipital scalp at the ridge,
and tapping the area produces a shocklike pain in the
area of the headache. What is this pain called?
(A) Tension headache
(B) Occipital neuralgia
(C) Migraine variant
(D) Cluster headache
113.A 71-year-old man complains of right-sided headache,
coming on only within the last several months.
Last week, he noted that, when he was chewing
enthusiastically, his jaw on the right side began to be
stiff and painful. Examination reveals tenderness of
the right temporal artery. Dental examination is negative.
A complete blood count is within normal limits,
except that the sedimentation rate is 65 mm/hour.
Which of the following is the most likely diagnosis?
(A) Migraine headache
(B) Subarachnoid hemorrhage (SAH)
(C) Cluster headache
(D) Giant cell arteritis
114.A 30-year-old woman complains of headaches that
have often occurred during her menstrual periods.
Recently, she has begun hearing her own pulsation in
her right ear. She weighs 120 lb (54.4 kg) and is 5 ft, 4
in. (1.63 m) tall; she has no blood pressure or lipid
abnormalities. You place your stethoscope over her
optic orbits and hear no abnormal sounds. When you
move the scope to the mastoid areas, you hear on the
right a bruit timed with her peripheral pulse. What is
the most likely explanation of these findings?
(A) Atherosclerotic stenosis of the right external
carotid artery
(B) Arteriovenous malformation
(C) Migraine headache
(D) Cluster headache
115.A 28-year-old woman complains of a 10-year history
of headaches. These headaches are fronto-occipital in
location and are noted often at the end of workdays;
they are more likely when sleep has been poor or
short and they are generally relieved by sleep. They
have always been quickly relieved by the use of
NSAIDs. She does note an increase in her headaches
when she is under stress or anticipates stress. Which
of the following characteristics is most commonly
associated with this type of headache?
(A) There is an aura about 30 minutes before onset
of the headache.
(B) There is nausea and emesis.
(C) There is a gradual, often not precisely noticed,
start and end to the headaches.
(D) They are more common in men.
116.A 45-year-old man began 2 weeks ago to have headaches
on a daily basis. They last 1 to 2 hours and are
associated with erythema of the face and rhinorrhea.
The man says that he had a string of similar headaches
about a year ago. He suffered a concussion
2 years ago and had headaches for several months
afterward, but he has had none since until the recurrent
headaches a year ago. Which of the following
does this patient have?
(A) Allergic rhinitis
(B) Classic migraine
(C) Cluster headache
(D) Tension, vascular headache
117.A 60-year-old Caucasian male complains of decreased
visual acuity, noted when he reads. The complaint
applies more or less equally to both eyes. His peripheral
vision is intact to the usual office testing. He sees
movement at 100 degrees laterally and 90 degrees
inferiorly in both eyes. Nasal and superior fields are
intact as well, limited only by the nose and brow
respectively. He counts fingers from center in all
directions. Fundoscopy reveals clusters of yellowish
round, small lesions rather close to the center of the
retinal fields in both eyes. What are the lesions?
(A) Drusen
(B) Cotton wool exudates
(C) Microaneurysms
(D) Flame hemorrhages
118.A 25-year-old mother of two children complains of
pain in the right eye immediately after the fifth fingernail
of her 6-month-old baby swiped across her
eye during bottle feeding 4 hours ago. On physical
examination, she exhibits striking photophobia.
Which of the following is the key aspect of diagnosis
of this condition?
(A) Disturbance in visual acuity
(B) Presence of diplopia
(C) Presence of limbal flush
(D Presence of green color upon examination of
the cornea when a cobalt blue light is shone
after application of fluorescein
119.You have diagnosed an 18-year-old man who plays
on the high school varsity basketball team and
incurred an injury to the left eye when another player
poked his finger into the eye an hour ago. Fluorescein
staining of the cornea is positive. Which of the
following is the mainstay of treatment of this
condition?
(A) Topical and oral analgesics with a follow-up in
24 hours
(B) Antibiotic ointment followed by double
patching and taping to prevent relative
movement of the eye during the healing process
(C) Mydriatic drops followed by patching with
follow-up in 24 hours
(D) Meiotic drops followed by patching with
follow-up in 24 hours
120.A 2-year-old boy is brought to your office by his parents
for the first time, after a day care attendant
expressed concern because the boy’s eyes do not
appear to be in parallel position. He and the mother
are concerned that the child has “cockeyes”: One eye
falls consistently to the outside of the direction of his
gaze. As a permanent condition, this is most often
caused by which of the following visual defects?
(A) Myopia
(B) Amblyopia
(C) Hyperopia
(D) Astigmatism
121.A 3-week-old female infant is brought to you by her
mother, who is concerned by the child’s left eye; it
shows crusting and matting of a conjunctival discharge.
The pupils are equal and reactive to light and
there appears to be no photophobia. What is the most
likely cause of this finding and what must be done, if
anything, to remediate the condition?
(A) Bacterial conjunctivitis—use ophthalmic
antibiotic drops
(B) Viral conjunctivitis—use ophthalmic antibiotic
drops
(C) Iritis—use patching and instill an ophthalmic
glucocorticoid preparation
(D) Obstructed lacrimal duct—use observation and
consider probing the lacrimal duct
122.A 58-year-old woman complains of dryness of her
eyes for the past several months and that, when she
has had occasion to cry, her tear production is sparse.
Over the last 2 years, she has had a spate of recurrent
dental caries. Within the last 2 weeks, she has noted
soreness of an enlargement behind her left ear and
that her mouth is dry most of the time. Which of the
following is most likely to be associated with her
condition?
(A) Atherosclerosis
(B) Multiple endocrine neoplasia type I
(C) Hashimoto thyroiditis
(D) Colorectal cancer
123.A 20-year-old student is being brought to you directly
from the scene of a bar fight in which he received a
fist blow to his left eye orbit. He manifests an impressive
periorbital hematoma (“black eye”), but no
hyphema is seen. The pupils are equal and round and
reactive equally to light. He complains of diplopia
when he directs his gaze to the right, and you find
that his left eye cannot follow your penlight more
than 15 degrees past the midline toward the right.
Which of the following is the likely cause of this complaint
and finding?
(A) Direct blow to the eyeball
(B) Rupture of the eyeball
(C) Fracture of the orbital rim
(D) Traumatic iritis
124.A 4-year-old male patient is brought to the family doctor
by his mother after 5 days of fever (101 _ F), because
of cracking and fissuring lips and bilateral painless
conjunctivitis. On examination he manifests a “strawberry
tongue,” unilateral cervical adenopathy, and redness
and swelling of the palms of the hands. A rapid
strep flocculation test and, 2 days later, a throat culture
were “negative” (latter meaning no beta-hemolytic
streptococcus growth). The fever remains over the
next 2 days. Each of the following complications may
occur during the next few days except for which one?
(A) Coronary aneurysm
(B) Myocarditis
(C) Pericarditis
(D) Valvular heart disease
125.You hear a carotid bruit in a 3-year-old girl who has
otherwise been healthy and has been growing and
developing appropriately for her age. She is on no
medications. Which of the following would you recommend?
(A) Aspirin 325 mg by mouth daily
(B) Persantine by mouth three times daily
(C) A carotid Doppler study
(D) Observation only
126.You see a newborn boy after a few hours of birth. His
weight is 8.5 lb (3.85 kg). You hear a loud murmur
along the lower left sternal border. You delay his discharge
home with the mother, pending evaluation of
the cardiac status. On day 3 the nursery reports that
the baby manifests cyanosis. Which of the following
most likely accounts for this picture?
(A) PDA
(B) Transposition of the great vessels
(C) Coarctation of the aorta
(D) ASD
127.A 4-year-old boy is brought to the family doctor for
inspiratory stridor that began last evening, 3 days
after the onset of coryza and evolving tracheobronchial
cough. His temperature was 99.8
F orally
(37.7
C). He demonstrates inspiratory stridor at rest
after a temporary response to nebulized racemic
epinephrine (2.25%). Lateral neck x-rays were read
as normal. Which of the following would be the best
next step, assuming hospitalization would not be
necessary?
(A) Send the child back to the urgent care center
(B) Arrange for home-delivered oxygen
(C) Inject 50 mg of ceftriaxone IM
(D) Dexamethasone 0.6 mg/kg IM
128.A 2-week-old full-term baby boy has developed
cough and exhibits fever, cyanosis, and tachypnea.
Which of the following organisms should be considered
in the choice of antibiotic therapy of this
community-acquired pneumonia (CAP)?
(A) Streptococcus pneumoniae and beta-hemolytic
streptococci
(B) Staphylococcus aureus and Hemophilus
organisms
(C) Chlamydia organisms and Staphylococcus albus
(D) Group B streptococci and coliform bacteria
129.A 2-month-old baby girl who lived at home since her
normal birth and delivery has respiratory distress,
although she manifests no fever. You suspect pneumonitis.
Which of the following is the likely best
choice of antibiotics, assuming the girl has a CAP and
is to be treated as an outpatient?
(A) Penicillin
(B) Azithromycin
(C) Amoxicillin
(D) Ceftriaxone
130.A previously healthy 1-year-old child has a rapid
onset of a rattling cough without preceding coryza.
Temperature is 101
F. He has a dull facial expression.
Which of the following is the best first choice of antibiotic
for this CAP in an outpatient setting?
(A) Penicillin V potassium
(B) Amoxicillin
(C) Erythromycin or other macrolide antibiotic
(D) Gentamycin
131.Which of the following agents is the cause of the vast
majority of cases of bronchiolitis?
(A) Influenza A
(B) Influenza B
(C) Adenoviruses
(D) Respiratory syncytial virus (RSV)
132.Which of the following is the peak season of RSV
infection?
(A) May through June
(B) July through August
(C) November through March
(D) March through May
133.Which of the following is an accepted method of
prophylaxis against RSV in the present state of technology?
(A) Vaccination with live attenuated RSV
(B) Vaccination with killed RSV preparation after
exposure
(C) Pooled gamma globulin
(D) Monoclonal antibody given monthly
134Which of the following is established as effective in
hospitalized RSV infection?
(A) Nebulized furosemide
(B) RSV immune globulin (RSV-IG)
(C) Aerosolized ribovirin
(D) Supportive care and supplemental oxygen
135.Which of the following organisms accounts for the
vast majority of cases of croup (laryngotracheobronchitis
[LTB], laryngotracheitis, or laryngotracheobronchopneumonitis)?
(A) RSV
(B) Parainfluenza viruses
(C) Mycoplasma organisms
(D) Chlamydia organisms
136. Which of the following best differentiates, by history,
LTB (croup) from epiglottitis?
(A) Temperature
(B) Presence of inspiratory stridor
(C) Length of time from onset to defining symptom
(D) Lung field auscultation
137.What is the most likely age range of an infant or child
with croup?
(A) Birth to 3 months
(B) 3 months to 6 months
(C 6 months to 12 years
(D) 12 months to 6 years
138. The parents of a 6-year-old boy report that he has
developed rapidly a temperature of 103
F at the same
time as he complains of dyspnea, drooling, inability
to swallow well, and soft inspiratory stridor. On
examination he manifests intercostal retractions. The
child is taken to the emergency department and met
by an otolaryngologist to examine the patient in the
operating room, where a tracheotomy could be performed
as the epiglottis and larynx were to be examined.
After the emergency has been dealt with, which
of the following antibiotics is appropriate?
(A) Penicillin
(B) Amoxicillin
(C) Clarithromycin
(D) Ceftriaxone
139.A 33-year-old woman has a diagnosis of post-inflammatory
cirrhosis after suffering a bout of hepatitis B.
Recently, on upper endoscopy, she demonstrated
presence of esophageal varices, and a decision was
made to utilize nonselective beta-adrenergic blockade
to prevent bleeding of the varices. Which of the
following is the parameter that in follow-up indicates
the therapeutic endpoint has been reached?
(A) Hemoglobin increases by 2 g/dL
(B) Pulse rate drops by about 25%
(C) Rise in blood pressure by 10%
(D) Normalization of AST and ALT
140.A man who weighs 220 pounds at a height of 5 ft
10 in. undergoes a routine physical examination.
The physician finds the liver to be palpable at 6 cm
(_2 in.) below the right costal margin. A chemical
profile shows AST elevated threefold above normal
and the ALT twice normal. A needle biopsy shows
fatty infiltration (steatohepatosis). Each of the following
conditions is in the top four most likely causes
except for which one?
(A) Iatrogenic of pathophysiologic glucocorticoid
effects
(B) Alcoholic liver disease
(C) Obesity
(D) Diabetes
141.A 28-year-old woman who admits to a history of intravenous
drug abuse is planning a serious new relationship
and is concerned about the possibility of passing
hepatitis to her new sex partner. A screening test for
anti-hepatitis C antibody was negative. Youobtain a
hepatitis B panel. Which of the following sets of laboratory
findings make the diagnosis of hepatitis B carrier?
(A) HBsAg negative, anti-HBc negative, anti-HBs
negative unexposed
(B) HBsAg negative, anti-HBc positive, anti-HBs
negative
(C) HBsAg negative, anti-HBc negative/positive,
anti-HBs positive
(D) HBsAg positive, anti-HBc positive, IgM antiHBc negative, anti-HBs negative
142.Which of the following is the best indicator of a high
degree of hepatitis B virus (HBV) replication, hence
marker of infectivity?
(A) HBsAg
(B) HBcAg
(C) HBeAg
(D) Anti-HBs
143.Which of the following is the most easily passed by a
blood donor?
(A) Hepatitis A
(B) Hepatitis B
(C) Hepatitis C
(D) Hepatitis D
144.A 45-year-old white man has undergone a routine periodic
physical examination. You note that, for the past 3
years, each hepatic profile testing ordered by your office
has shown ALT and AST elevations of up to two to
three times normal levels. You decide to investigate in
stepwise fashion. Each of the following steps would be
appropriate at this time, except for which one?
(A) Inquire as to drinking habits
(B) Inquire as to intravenous street drug usage
(C) Complete review of the patient’s medications
(D) Order an ultrasound study of the liver
145.A 35-year-old woman who has had two pregnancies
and is 20% overweight presents with jaundice. Serum
conjugated bilirubin level is elevated to twice the
upper limit of normal. Unconjugated bilirubin is
normal. Which of the following, as a single procedure,
is most likely to elucidate a cause of this clinical
situation?
(A) Blood draw for hepatitides A, B, and C
(B) Computed tomography scan of the liver
(C) Ultrasound study of the extrahepatic biliary
system
(D) Plain x-ray of the abdomen
146.A 45-year-old woman presents with fatigue, anorexia,
brown urine, and malaise. She denies alcohol intake
entirely, illicit drug use, and history of treatment with
blood products, and she is on no medications that may
cause elevation of hepatocellular enzymes. Examination
reveals scleral icterus and mildly tender hepatomegaly.
Both AST and ALT levels are elevated to four
times normal, and smooth muscle antibody (SMA)
and antinuclear antibody (ANA) levels are positive.
She has a history of Hashimoto thyroiditis, but no history
suggestive of inflammatory bowel disease. Alkaline
phosphatase and gamma-glutamyltranspeptidase
are both elevated to twice normal limits. A hepatitis
profile yields no evidence of hepatitides A, B, C, or E.
Which of the following may be the best initial presumptive
diagnosis?
(A) PSC
(B) PBC
(C) Viral hepatitis
(D) Autoimmune hepatitis
147.A 15-year-old girl presents with malaise, fatigue,
depression, and clinical evidence of hepatitis in the
absence of viral causation. An older sister is awaiting
liver transplantation. Which of the following blood
studies may be most specifically helpful in establishing
the diagnosis?
(A) ANA levels
(B) Anti-SMA levels
(C) Complete blood count
(D) Ceruloplasmin level
148.A 20-year-old woman calls at 2 am after a Saturday
night the family doctor on call for his group saying
she unexpectedly found herself having consensual
intercourse and is panicked over the fear of an
unwanted pregnancy. She agrees to call in a prescription
for the “morning after” pill. Which of the following
regimens should accomplish the objective?
(A) Norgestimate 0.180 mg/ethinyl estradiol
0.035 mg two tablets within 24 hours
(B) Levonorgestrel 0.75 mg course of two tablets
within 72 hours
(C) Drospirenone/ethinyl estradiol 3.0 mg/0.030 mg
three tablets over the next 24 hours
(D) D. Desogestrel/ethinyl estradiol 0.15 mg/0.02
mg two ASAP and one in every 4 hours time
four more doses.
149.A 37-year-old woman in a monogamous marriage
complains of a vaginal discharge with a fishy odor.
The vaginal pH is 4.8 and clue cells are present on the
smear. A culture reveals presence of Gardnerella vaginalis
. The family doctor diagnoses bacterial vaginosis.
Each of the following statements is true except for
which one.
(A) This condition may be a cause of premature
rupture of membranes in labor.
(B) Bacterial vaginosis may be the cause of
premature labor.
(C) The transmission of this condition is sexual.
(D) The condition is associated with postpartum
endometritis.
150.A 45-year-old woman complains of increasingly
irregular menstrual periods, which are becoming
lighter and less frequent, seldom appearing sooner
than 35 days after the previous one. She complains
also of gaining weight over the past 5 years. During
the same period, hair has grown on her upper lip and
she has developed acne for the first time in her life.
She weighs 165 lb (74.8 kg) at a height of 5 ft 4 in.
(1.63 m). On examination she manifests central obesity
and fading purple striae over the flanks of her
abdomen. Which of the following is the best causal
explanation for these findings?
(A) Type II diabetes mellitus
(B) Hypothyroidism
(C) Metabolic syndrome
(D) Polycystic ovary syndrome (PCOS)
151.Each of the following is a relative contraindication
for intrauterine device (IUD) insertion except for
which one?
(A) Nulliparity
(B) Active STD
(C) History of PID
(D) Multiparity
152.A 14-year-old nulliparous girl complains of primary
dysmenorrhea. She is overweight and attempting to
lose weight. Her parents have recently separated, and
she has been sporadically involved in drinking fairly
heavily and smoking at parties of young people but
has not become sexually active. Each of the following
aspects of her life situation is a risk factor for dysmenorrhea
except for which one?
(A) Drinking alcohol
(B) Smoking
(C) Losing weight
(D) Experiencing family stress
153.Which of the following is the only medication approved
specifically by the Food and Drug Administration for
the treatment of nausea and vomiting of pregnancy?
(A) Prochlorperizine (Compazine)
(B) Promethazine (Phenergan)
(C) Trimethobenzamide (Tigan)
(D) Pyridoxine/doxylamine (Bendectin)
(E) Ondansetron (Zofran)
154.A 21-year-old sexually active woman complains of
intense pain in the left vulvar area building over a
period of 2 to 3 days. She has not had similar symptoms
in the past, and she has not been with her sex
partner for several weeks. The pain is of such severity
that she has been afraid to attempt intercourse or
even to sit down normally. Which of the following is
the most likely diagnosis?
(A) Herpes simplex type 2
(B) Bartholin gland abscess
(C) Candida vaginitis
(D) Trichomonas vaginitis
155.A 65-year-old woman visits you for the first time to
complain of vaginal bleeding for the first time since
her natural menopause 15 years ago. The bleeding
began 2 weeks ago and is mild in flow. Which of the
following is the most critical question to be asked in
completing the history?
(A) Are there cramps associated with the bleeding?
(B) How many pads per days are needed to keep
abreast of the bleeding?
(C) Are you taking hormone therapy of any type?
(D) Have you developed light-headedness upon
standing after sitting for prolonged periods of
time?
156.You have diagnosed chlamydia on “routine” Pap
smear with an enzyme-linked test for STDs. The
woman confessed that she was concerned about the
possible infidelity of her husband. Which of the following
may be among the aspects of this infection
you must explain to this woman?
(A) The course for the infected female is virtually
always benign.
(B) Unless successfully treated she will have
significantly increased risk of spontaneous
abortion and infertility.
(C) The infection responds to amoxicillin.
(D) Macrosomia may occur in newborn babies of
mothers infected during pregnancy.
157.You are evaluating a 38-year-old woman who stopped
having periods 8 months ago. She has normal secondary
sexual development and shows no evidence
of virilization. Her pelvic exam shows a normal cervix
and fundus and no adnexal masses. Her urine
beta-human chorionic gonadotropin (hCG) test is
negative. Her thyroid-stimulating hormone and
serum prolactin levels are normal. She does not have
uterine bleeding during the withdrawal phase of a
progestin challenge, but does bleed after being on
conjugated estrogen (1.25 mg) for 21 days with a
progestin agent added on the last 5 days. Folliclestimulating
hormone (FSH) and LH are both elevated.
Which of the following is the most likely
diagnosis?
(A) Hypothalamic amenorrhea
(B) Asherman syndrome
(C) Premature ovarian failure
(D) Anovulatory cycle
158.A 38-year-old woman who has had an intrauterine
device (IUD) for 15 years without changing it (had
changed locations of residency several times) has
noted a virtually painless 6 cm red area over the lower
abdominal area for many weeks. This week the red
area has broken down to exhibit purulent discharge.
On pelvic examination, the adnexa are palpably fixed.
The pap smear is negative for caner or precancerous
findings. Which among the following is the most
likely offending entity?
(A) Stage 3 carcinoma of the cervix
(B) Streptococcus pyogenes
(C) Actinomycesisraelii
(D) Staphylococcus aureus
159.A 24-year-old male injection drug user complains of
dry mouth, dysphagia, dysphonia, diplopia, nausea,
and vomiting. In the past few hours, he has noted
shortness of breath. He is alert and oriented. His temperature
is normal. Breathing appears to be mildly
labored and shallow, but the lung fields are “clear” to
auscultation and percussion. Of the following that
are present in the differential diagnosis of these
symptoms, which one is the most likely?
(A) Tetanus
(B) Botulism
(C) Bowel obstruction
(D) Guillain–Barré syndrome
160.Each of the following is a special risk factor for infectious
bacterial endocarditis, except which one?
(A) Presence of prosthetic heart valves
(B) Previous bacterial endocarditis
(C) Complex cyanotic congenital heart disease
(D) Status 1 year post repair of ventricular septal
defect
161.Each of the following is true regarding genital herpes
simplex virus (HSV), except for which statement?
(A) Polymerase chain reaction testing is more
sensitive than viral culture.
(B) Viral culture is useful in differentiating HSV-1
from HSV-2 infection.
(C) Early therapy with recently developed antiviral
agents can cure the disease.
(D) Suppressant therapy can reduce the recurrence
rate by 70% to 80%.
162.Each of the following defines Type I (Immunoglobulin
E (IgE)-mediated) allergic response except for
which one?
(A) Immune hemolytic anemia
(B) Allergic asthma
(C) Atopic dermatitis
(D) Allergic gastroenteropathy
163.Which of the following might be a cause for accidentally
increasing the dosage of epinephrine in an emergency
situation?
(A) Increased body mass index of the patient
(B) Blood pressure rising to 170/110
(C) Current medications being taken by the patient
include propranolol.
(D) Patient has a history of frequent attacks of
allergic symptoms.
164.Twelve hours after successful epinephrine treatment of
anaphylaxis, a 35-year-old woman manifests angioneurotic
edema and urticaria. Which of the following is
the most reasonable approach for treatment of this
development?
(A) Diphenhydramine 25 to 50 mg given orally
every 6 hours
(B) Repeated injections of epinephrine
(C) Increase the volume of fluid therapy per unit
time by 50%
(D) Theophylline, 0.5 mg/kg/hour, after a loading
dose
165.A 35-year-old female patient has begun experiencing
hives at various times, usually within 30 minutes after
a meal. If you were to actuate a trial of food eliminations,
adding back one eliminated food every 5 days
until the occurrence of allergic symptoms, which of
the following groups of four foods would you choose
first, to obtain the earliest conclusion as to cause?
(A) Beef, rice, apples, bananas
(B) Tomatoes, peaches, wheat, potatoes
(C) Peanuts, tree nuts, vertebrate fish, shellfish
(D) Chicken, green beans, peas, corn
(E) Kidney beans, lima beans, lettuce, radishes
166.From the physiological point of view, which of the following
is the goal of immunotherapy in the treatment
of atopic allergies, for example, rhinitis and conjunctivitis,
in regard to allergen-specific antibodies?
(A) Increase IgE antibodies specific to the allergen
(B) Decrease IgG antibodies specific to the allergen
(C) Increase in IgE, decrease in IgG
(D) Increase in IgG, decrease in IgE
167.A healthy newborn boy, weighing 7 lb 6 oz (3.34 kg),
has been accepted for well baby care. In regard to
hydration and renal function, which of the following
is an accepted indication of adequate urine output in
the first 24 hours of life?
(A) Moist mucosae
(B) Good skin turgor
(C) Nonsunken eyeballs
(D) One wet diaper
168.What is the average caloric requirement for a newborn
infant?
(A) 50 kcal/kg/day
(B) 120 kcal/kg/day
(C) 150 kcal/kg/day
(D) 500 kcal/day
169.Which of the following immunizations should be
given in the newborn period?
(A) Diphtheria, tetanus, pertussis (DTaP), first dose
(B) Hemophilus influenzae type B (Hib), first dose
(C) Inactivated polio vaccine (IPV), first dose
(D) Pneumococcal vaccine (PCV), first dose
E) HEPATITIS B VACCINE 1ST DOSE
170.At birth, a full-term female infant has received silver
nitrate ointment 1%. Five days later she exhibits conjunctivitis.
Which of the following is the most significant
likely possible etiologic origin?
(A) S. aureus
(B) Group A beta-hemolytic streptococci
(C) Gonococcus
(D) H. Influenzae
E) Clamydia TRACHOMATIS
171.You are counseling an expectant couple regarding the
many benefits of breast feeding. Which of the following
is a recognized beneficial effect?
(A) It decreases neonatal jaundice.
(B) It increases weight gain in the infant relative to
those who are fed formula.
(C) Breast milk supplies IgG antibodies.
(D) The uterus returns to normal size faster in
mothers who breast feed.
172.In counseling a first-time mother regarding normal
growth and development of her baby, which of the
following do you outline as the normal course of
developmental milestones?
(A) Head up and controlled at 2 weeks, sit
unsupported at 7 months, crawl at 8 months,
and walk at 10 months
(B) Head up and controlled at 2 months, sit
unsupported at 4 months, crawl at 6 months,
and walk at 12 months
(C) Head up and controlled at 3 months, sit
unsupported at 6 months, crawl at 9 months,
and walk at 12 months
173.You are evaluating a 1-year-old child who is short
(less than fifth percentile on growth curves), even
when you correct for midparental height. There are
multiple potential causes for short stature. Which of
the following is not among them?
(A) Parental deprivation
(B) Intrauterine growth retardation
(C) Human immunodeficiency virus (HIV)
infection
(D) Klinefelter syndrome
174. A 4-year –old boy presents with a vesicular rush that appears in crops. What is a diagnosis?
a)
b)
c)
d)
Scabies
Chickenpox
Varicella zoster
Scarlet fever
175. Which of the following would be the approach most
fundamental toward addressing the causation of
infantile eczema?
(A) Triamcinolone ointment applied twice daily for
1 month and a follow-up visit at that time
(B) Systemic glucocorticoid course over a 2-week
period
(C) Admission to the hospital for intravenous
antibiotics
(D) Trial of change in formula from patient’s cow
milk-based preparation to a soybean-based
formula
177. 21 A 12-year-old female patient is diagnosed as having
streptococcal pharyngitis. To prevent rheumatic fever
in this child, how soon must the treatment begin to
eradicate the Streptococcus ?
(A) 48 hours
(B) Five days
(C) Nine days
(D) Fifteen days
178. A 24-year-old man with type I diabetes mellitus
comes to you with complaint of severe pain in the
right ear with onset over the previous 24 hours. On
examination, you find the ear to be extremely tender
upon light touch of the tragus and slight manipulation
of the auricle. You diagnose external otitis and
consider the possibility of malignant otitis externa.
Which of the following defines that condition?
(A) Conductive hearing loss
(B) Pseudomonas species
(C) Associated diabetes mellitus
(D) Osteomyelitis of the bony canal or mastoid
179.A 3-year-old girl presents with foul smelling postnasal
drip, temperature of 102 _ F, and perceptible
swelling of the face. Which of the following is the
most important reason to diagnose and treat this
condition in timely fashion?
(A) It presents with a malodorous discharge
(B) To avert febrile seizure
(C) It may be caused by lactamase-producing
organisms
(D) Orbital cellulitis is a feared complication
180.A 12-year-old female patient is diagnosed as having
streptococcal pharyngitis. To prevent rheumatic fever
in this child, how soon must the treatment begin to
eradicate the Streptococcus ?
(A) 48 hours
(B) Five days
(C) Nine days
(D) Fifteen days
181.A 14-year-old boy presents to your office with a mildly pruritic rash that
involves his chest and back. He reports it began with a single lesion on his
back, but now has spread to involve his entire back and chest. You note on
your examination the presence of multiple secondary lesions that appear to
follow cleavage lines. The most likely diagnosis is
A) Herpes zoster
B) Pityriasisrosea
C) Tinea versicolor
D) Varicella
182.At what age do children normally articulate most words and know basic
colors?
A) 3 years
B) 4 years
C) 5 years
D) 6 years
183.Which of the following statements is true regarding iron deficiency in
childhood?
A) Iron deficiency commonly occurs in term infants during the first 3
months.
B) Ingestion of cow’s milk can result in iron overload.
C) Iron deficiency rarely leads to complications.
D) Pica is associated with iron deficiency.
184.A 12-year-old boy is brought in to your office by his mother and father.
The child has been experiencing swelling of his joints, fevers, and a rash.
An examination reveals hepatosplenomegaly and lymphadenopathy.
Laboratory evaluation shows anemia, leukocytosis, and thrombocytosis.
You suspect juvenile rheumatoid arthritis (JRA). Which of the following
medications would be first-line treatment?
A) Acetaminophen
B) Ibuprofen
C) Codeine
D) Methotrexate
185.Which of the following findings is not associated with rotavirus
infections?
A)Metabolic acidosis
B) Hypernatremia
C) White blood cells (WBCs) noted in the stool
D) Normal WBC count
186. Which of the following blood tests may be helpful in determining a
recent strep infection in a patient that has a possible poststreptococcal
complication?
A) Erythrocyte sedimentation rate
B) C-reactive protein
C) Complete blood count (CBC)
D) Antistreptolysin O titer
187.The drug of choice for otitis media is
A) Azithromycin
B) Amoxicillin
C) Cefuroxime
D) Amoxicillin–clavulanate
188. Which of the following is a contraindication to influenza vaccine?
A) Allergy to eggs
B) Recent strep infection
C) Allergy to aluminum
D) Age <6 years
189. Which of the following statements regarding immunizations is true?
A) MMR vaccine can cause autism.
B) Hepatitis B vaccine can lead to multiple sclerosis.
C) Children with egg allergies may be given MMR vaccine.
D) Children with a prior local reaction to neomycin should avoid the
varicella vaccine.
190. You are called to see an infant in the newborn nursery. The child was
delivered 60 hours prior to your visit. The child appears jaundiced but
otherwise healthy. A total serum bilirubin level is measured at 18 mg/dL.
Appropriate treatment includes
A) Observation
B) Stop breast-feeding and switch to formula feedings
C) Begin phototherapy
D) Perform a septic workup
191. Bottle-feeding at bedtime can result in
A) Increased risk for aspiration
B) Dental caries
C) Oral candidiasis
D) Nasal polyps
192. Which of the following is true concerning DTaP vaccination?
A) The vaccine is routinely administered at 4, 6, and 12 months and again
at 5 years of age.
B) The whole-cell form is indicated for those who are
immunocompromised.
C) The oral form is an inactivated vaccine.
D) The acellular form is recommended for routine vaccination of all infants.
193. Which of the following vaccines is no longer recommended for routine
vaccination in children?
A) Live oral polio vaccine
B) Inactivated injectable polio vaccine
C) DTaP
D) Haemophilus influenzae type b
194. Which of the following is a risk factor for the development of otitis media in children?
A) Low birth weight
B) Premature birth
C) Family history of allergies/asthma
D) Pacifier use
195. The definition of amblyopia is
A) Congenital cataracts noted at birth
B) Subnormal visual acuity in one or both eyes despite correction of refractive error
C) Irregular pupillary size
D) Increased distance between the medial and lateral canthus
196. Leukocoria is most likely associated with
A) Pregnancy
B) Infection
C) Retinoblastoma
D) Leukemia
197. Preterm breast milk
A) Has the same components as breast milk produced at term
B) Persists for 1 week before the composition approaches that of term
infant breast milk
C) Contains lower concentrations of important electrolytes and
immunoglobulins
D) Typically requires fortification with human milk fortifiers
E) Contains excessive amounts of calcium
198. Which of the following is routinely given at birth to prevent hemorrhagic
disease of the newborn?
A) Erythromycin
B) Vitamin C
C) Vitamin K
D) Factor X
199. Which of the following is true regarding medications used in the
treatment of acne?
A) A low estrogen-containing oral contraceptive can be helpful in the
treatment of acne.
B) Doxycycline, tetracycline, and minocycline are contraindicated before
the age of 18.
C) Lipid values must be monitored when using isotretinoin.
D) Oral contraceptives are adequate to prevent pregnancy when
administeringisotretinoin.
200. Which of the following medications is recommended in the treatment of
mild to moderate croup?
A) Acyclovir
B) Dexamethasone
C) Theophylline
D) Atropine
201. Which of the following medications would not be a suitable alternative
for second-line treatment of otitis media in a 6-year-old?
A) Azithromycin
B) Cefaclor
C) Cefixime
D) Ciprofloxacin
202.Immunizations (excluding hepatitis B) for premature infants should be :
A) Delayed because of the infant’s immaturity
B) Administered at same designated times as normal infants on the basis of their age
C) Withheld for 1 year
D) Given earlier to help prevent diseases to which they are more
Susceptible
203. Bites from which of the following animals require rabies postexposure
prophylaxis?
A) Fox
B) Squirrel
C) Hamster
D) Gerbil
204. A 3-year-old boy presents to your office with a history of seven ear
infections over the last year. Appropriate management of this child consists
of
A) Tonsillectomy and adenoidectomy
B) Single-dose prophylactic antibiotics given at night
C) Tympanostomy tube placement
D) Long-term use of antihistamine-decongestant preparations
205. Which of the following statements about breast-feeding is true?
A) The infant should feed on each side for 8 to 15 minutes every 2 to 3 hours after birth.
B) Colostrum is excreted 7 to 10 days after delivery and contains important antibodies, high
calories, and other nutrients.
C) The mother should weigh infants before and after feeding to quantify the amount consumed.
D) Breast-feeding usually provides adequate nutrition for 2 to 4 months;supplementation should
begin at that point.
206. Conductive hearing loss noted in children may be caused by
A) Meningitis
B) Medications
C) Chronic eustachian tube dysfunction
D) Intracranialhemorrhage
207. Which of the following conditions is associated with giving whole milk
to infants younger than 1 year?
A) Iron-deficiency anemia
B) Mental retardati on
C) Hirschsprung’s disease
D None of the above
208. Which of the following drugs is concentrated in breast milk and should be avoided by
women who are breast-feeding?
A) Heparin
B) Alcohol
C) Digoxin
D) Penicillin
209. Which of the following immunizations may result in a false-negative purified protein
derivative (PPD) tuberculosis test?
A) Tetanus
B) Hepatitis B
C) Influenza
D) MMR
210.Early breast-feeding is associated with
A) Improved growth in the first 2 months
B) Lower risk of aspiration
C) Less temperature instability
D) Fewer apneic spells
211. A 6-month-old is brought to your office in mid-January. The child’s
mother reports that the infant has had a low-grade fever, wheezing with
coughing, and diminished appetite. The most likely diagnosis is
A) Bronchiolitis secondary to RSV
B) Pneumonia secondary to S. pneumoniae
C) Aspiration pneumonia
D) Asthma
212. Most children affected with rotavirus are
A) Younger than 6 months
B) Between 6 months and 2 years of age
C) Older than 2 years
D) Between 2 and 4 years of age
213. Which of the following is true regarding hepatitis B vaccination in
healthy infants?
A) The first immunization should be given by 2 months of age, second immunization 1 to 2
months later, and third immunization between 6 and 18 months.
B) Injections should be given in the buttock to increase immunogenicity.
C) Only infants at risk should receive hepatitis B vaccination.
D) Two doses will provide optimal results.
214. Which of the following conditions is associated with congenital
cataracts?
A) Maternal rubella infection
B) Maternal varicella infection
C) Congenital hypothyroidism
D) Acromegaly
215.Which of the following conditions is associated with atopic dermatitis?
A) Asthma
B) Vasomotor rhinitis
C) Elevated IgA levels
D) Melanoma
216.Which of the following would concern a physician about a child’s
development?
A) Rolls over at 4 months
B) First words at 15 months
C) Walks at 12 months
D) Tiesshoesat 5 years
217. Which of the following medications would be most effective to treat
postmenopausal flushing?
A) Venlafaxine
B) Amitryptyline
C) Green tea
D) Trazadone
218. Which of the following should be used in the management of those taking chronic opioids
for non–cancer-related pain?
A) Urine drug screens
B) Random pill counts
C Opioid contracts
D) All of the above
219. Which of the following is considered first-line therapy for primary dysmenorrhea?
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Selective serotonin reuptake inhibitors (SSRIs)
C) Antiestrogens
D) Acupuncture
220. A 21-year-old woman who is 12 weeks pregnant with her first child presents to your office.
A urinalysis shows evidence of bacteriuria. She is completely asymptomatic. Appropriate
management at this time includes which one of the following?
A) No treatment at this time; repeat urinalysis at her next visit.
B) Treat the patient with a 7-day course of amoxicillin.
C) No antibiotic treatment; ask the patient to drink more fluids and cranberry juice daily.
D) Discontinue urinalysis at OB visits because of the high rate of false positives.
221. Which of the following sports is contraindicated in pregnancy?
A) Walking
B) Stationary bicycle
C) Low-impact aerobics
D) Snowskiing
222. During pregnancy, it is important to counsel pregnant patients to add an additional
_________ calories to their dietary intake for normal activity.
A) 150
B) 300
C) 500
D) 1,000
223. Maternal temperature elevations above _________ can be detrimental to the fetus in the
first trimester of pregnancy.
A) Maternal temperature has no detrimental effects on the fetus.
B) 37.8°C (100.0°F)
C) 38.3°C (101.0°F)
D) 38.9°C (102.0°F)
224. Which of the following over-the-counter medications is generally avoided during
pregnancy?
A) Acetaminophen
B) Chlorpheniramine
C) Pseudoephedrine
D) Aspirin
225. The drug of choice for controlling eclamptic seizures is
A) Hydralazine
B) Phenobarbital
C) Phenytoin
D) Magnesium sulfate
226. The current diagnosis of preeclampsia consists of which of the following?
A) Elevated blood pressure and proteinuria
B) Elevated blood pressure, proteinuria, and edema
C) Elevated blood pressure, proteinuria, edema, and seizures
D) Elevated blood pressure, proteinuria, edema, seizure, and headaches
227. The most common cause of postpartum bleeding is
A) Retained placenta
B) Vaginal laceration
C) Uterine atony
D) HELLP syndrome
228. An 18-year-old woman pregnant with her first child is in the second stage of labor. She
complains of abdominal pain between uterine contractions. You suspect
A) Posterior presentation
B) Breech presentation
C) Abruption placenta
D) Vasa previa
229. 25-year-old presents to your office complaining of abnormal vaginal bleeding. Your first
consideration in the differential diagnosis is
A) Infection
B) Trauma
C) Foreign body
D) Pregnancy
230.Pregnant patients with established human immunodeficiency virus (HIV)infection
A) Should avoid all antiviral medications because of their teratogenic potential
B) Should receive only zidovudine at the time of delivery
C) Do not need to switch off efavirenz if taking it when pregnancy is diagnosed
D) Should avoid zidovudine because of its limited effectiveness
231. A 39-year-old mother presents to your office for preconception counseling. She has one
child affected with neural tube defect. Appropriate counseling concerning folic acid
supplementation should include
_________ daily.
A) 100 mcg
B) 400 mcg
C) 1 mg
D) 4 mg
232. A 36-year-old woman has a history of a prior deep venous thrombosis (DVT). She is
pregnant for the first time. In view of her prior history of DVT, you should recommend
A) Warfarin (Coumadin)
B) Heparin
C) Aspirin
D) Clopidogrel (Plavix)
233. When advising mothers concerning antiseizure medications during
pregnancy, which of the following statements is true?
A) Multiple medications are preferred to maintain lower levels of medication.
B) Antiseizure medications should be discontinued at the time pregnancy is determined.
C) Seizure activity in mothers has no impact on fetal outcomes.
D) Single agents are preferred to multiple medications.
234. The use of benzodiazepines during pregnancy has been associated with
A) Polydactily
B) Cleft lip
C) Spina bifida
D) Growthretardation
235. Which of the following is not associated with maternal obesity during
pregnancy?
A) Hydrocephalus
B) Maternal hypertension
C) Preeclampsia
D) Maternal diabetes
236. Pregnant women should avoid contact with cat litter because of the risk for developing
A) Cryptococcus
B) Cytomegalovirus
C) Toxoplasmosis
D) Coccidioidomycosis
237. What percentage of babies born to HIV-positive mothers is HIV positive?
A) 100%
B) 20% to 30%
C) 50% to 75%
D) 90% to 100%
238. A standard dose of Rh immune globulin (300 μg) prevents sensitization from fetomaternal
hemorrhage of up to
A) 30 mL of whole blood
B) 60 mL of whole blood
C) 100 mL of whole blood
D) 500 mL of whole blood
239. Which of the following statements regarding varicella during pregnancy is true?
A) If a pregnant woman has no history of varicella and tests negative for antibodies, she should
be immunized as soon as possible.
B) Varicella vaccination should be avoided in breast-feeding women.
C) Susceptible pregnant women who are exposed to varicella are candidates for varicella zoster
immune globulin.
D) Pregnancy should be delayed 6 months after varicella vaccination.
240. Rho(D) immune globulin (RhoGAM) is indicated when
A) The mother has type AB blood
B) The father is Rh negative
C) The mother is Rh positive
D) None of the above
241. When there is first-trimester bleeding, fetal viability can be definitely determined by which
of the following tests?
A) Qualitative β-human chorionic gonadotropin (hCG) determination
B) Serial quantitative β-hCG measurements
C) Transvaginal ultrasonography
D) Serum progesterone levels
242. A 26-year-old woman presents to your office with questions regarding an intrauterine
device (IUD) for birth control. Which of the following
statements is true?
A) IUD use is decreasing.
B) Failure rates can be as high as 10%.
C) IUDs currently available in the pose little risk for pelvic inflammatory disease (PID) in
appropriate candidates.
D) Placement of an IUD may affect future fertility.
243. An 18-year-old woman has noted diffuse darkened areas of skin on her face following the
initiation of oral contraceptives. The most likely diagnosis is
A) Melasma
B) Lupus pernio
C) Malignant melanoma
D) Sebaceous hyperplasia
244. Which of the following is the drug of choice for use in Group B streptococcal colonized
pregnant women in labor for the prevention of group B streptococcal infection in the neonate?
A) Intramuscular ceftriaxone
B) Oral ciprofloxacin
C) Intravenous penicillin G
D) Oral amoxicillin
245. The diagnostic test of choice for the detection of ectopic pregnancy is
A) A single quantitative β-hCG level
B) CT of pelvis
C) Laparoscopy
D) Transvaginal pelvic ultrasonography
246. A 44-year-old woman presents with irregular vaginal bleeding. Appropriate initial
management includes
A) Endometrial biopsy
B) Trial of oral contraceptives
C) Medroxyprogesterone injection
D) Surgical referral
247. Which of the following medications has been shown to be comparable to laparoscopic
salpingostomy in the treatment of small ectopic pregnancy that
A) Bromocriptine
B) Methotrexate
C) Thalidomide
D) Misoprostol
248. A 35-year-old woman presents to your office complaining of a copious
white vaginal discharge. Microscopic examination shows evidence of pseudohyphae. The most
appropriate treatment is
A) Penicillin G
B) Doxycycline
C) Terconazole (Terazol) vaginal cream
D) Metronidazole (Flagyl)
249. Which of the following is not true of oxytocin administration?
A) The drug must be given through a controlled infusion device.
B) Oxytocin must be administered as a continuous infusion or in “pulsed”
doses.
C) The medication can have a diuretic effect with high doses.
D) Hyperstimulation can result from oxytocin administration.
250. Which of the following medications has been used with success in gestational diabetes?
A) Glipizide (Glucotrol)
B) Glyburide (Micronase, Diabeta)
C) Glimepiride (Amaryl)
D) Rosiglitazone (Avandia)
251. The diagnosis of endometriosis is generally made by
A) Detection of increased estrogen levels
B) Endometrial biopsy
C) Pelvic ultrasound
D) Laparoscopy
252. Symptoms that present the greatest concern in pregnant women include
A) Chronic vomiting
B) Nausea
C) Heartburn
D) Abnormal cravings
253. Which of the following statements about primary dysmenorrhea is true?
A) The condition usually worsens with the use of oral contraceptives.
B) It is thought to be associated with excessive prostaglandin activity.
C) The onset of symptoms typically begins after 30 years of age.
D) Endometriosis is a common cause.
254. Which of the following medications is contraindicated for the
management of hypertension in pregnancy?
A) Methyldopa
B) Hydralazine
C) Labetalol
D) Losartan
255. Dysfunctional uterine bleeding is most common
A) During pregnancy
B) After sexual intercourse
C) At the time of menopause
D) With the development of PID
256. Which of the following statements about exercise-induced amenorrhea is true?
A) The condition is rarely reversible with weight gain.
B) It usually affects women who weigh >115 lb or those who have gained>10% to 15% in
muscle mass.
C) Osteoporosis can be associated.
D) It is usually associated with prolactinomas.
257. Painless and profuse vaginal bleeding in the third trimester is most likely
A) Placenta acreda
B) Placenta previa
C) Vasoprevia
D) Bloody show
258. Which of the following statements about dysfunctional uterine bleeding is true?
A) The condition is most common during the middle of a woman’s
reproductive years.
B) It typically occurs during pregnancy.
C) Most cases are seen with anovulatory cycles.
D) Gynecologic malignancies are related to dysfunctional uterine bleeding.
259. The maximum acceptable cumulative dose of ionizing radiation during
pregnancy is
A) 100 rads
B) 50 rads
C) 10 rads
D) 5 rads
260. Live virus vaccines, such as measles, mumps, and rubella, should be administered to
pregnant women
A) At the first prenatal visit following conception
B) At least 3 months before conception
C) During the second trimester
D) During the third trimester
E) At 18 to 20 weeks’ gestation
261. Women immunized for rubella should be counseled to avoid pregnancy for
A) 1 month
B) 3 months
C) 6 months
D) 1 year
262. Which of the following is recommended for postpartum breast engorgement?
A) Firm binding of breast with a comfortable wrap
B) Cabbage leaves
C) Bromocriptine
D) Initiation of oral contraceptives
263. A 17-year-old woman presents to your office complaining of dysfunctional uterine
bleeding. Appropriate management consists of
A) Endometrial sampling
B) Ultrasound examination of the uterus
C) Endometrial sampling and ultrasound evaluation
D) Use of oral contraceptives and observation
264. The most appropriate medication for the treatment of pyelonephritis in pregnancy is
A) Ampicillin + gentamicin
B) Ciprofloxacin
C) Tetracycline
D) Nitrofurantoin
265. Which of the following tests is indicated at the time of the first prenatal
visit in a healthy mother?
A) α-Fetoprotein testing
B) Quantitative β-hCG
C) Antibody test (indirect Coombs’ test)
D) Glucose tolerance test
266. Which of the following is an absolute contraindication for the use of oral contraceptives in
women above the age of 35?
A) Family history of stroke
B) Hypertension without vascular disease
C) Mild hyperlipidemia
D) Diabetes with neuropathy
267. Which of the following is associated with preeclampsia?
A) Blood pressure elevations >140 systolic and >90 diastolic
B) Trace proteinuria
C) Mild edema
D) Seizures
268. Gestational diabetic screening during pregnancy for women without risk factors for diabetes
should take place
A) At the first prenatal visit
B) At 12 to 16 weeks’ gestation
C) At 24 to 28 weeks’ gestation
D) At 30 to 34 weeks’ gestation
269. Which of the following test results is associated with pregnancy?
A) Increased white blood cell count
B) Decreased alkaline phosphatase
C) Increased hemoglobin
D) Decreasedlacticdehydrogenase
270. Studies have shown that the use of depot medroxyprogesterone acetate(DMPA)
contraception is associated with
A) Reversible bone loss
B) Increased migraines
C) Increased endometrial cancer
D) Increased pregnancy risk
271. Which of the following medications is used in PCOS to restore
menstrual cyclicity and induce ovulation?
A) Bromocriptine
B) Misoprostol
C) Rosiglitazone
D) Metformin (Glucophage)
272. Which of the following statements concerning oral contraceptive use is true?
A) Oral contraceptives may decrease the risk of cervical cancer.
B) Oral contraceptives increase the risk of cholelithiasis.
C) Women who use oral contraceptives have a higher incidence of ectopic pregnancy.
D) The use of oral contraceptives is associated with a higher incidence of PID.
273. Which of the following statements is NOT true regarding IUDs?
A) The risk of unintended pregnancy in the 1st year of IU use is <1% and 1 year continuation
rates for IUD use are near 80%.
B) IUDs can be placed at any time during the menstrual cycle, as long as
C)The copper IUD is an effective method of emergency contraception when inserted within 5
days of unprotected intercourse.
D) The detection of actinomyces on a cervical Pap of a woman with an IUD in place necessitates
IUD removal.
274. The vaginal ring contraceptive can be left in place for
A) 3 days
B) 1 week
C) 3 weeks
D) 3 months
275. How long can the vaginal ring be out of the vagina before an additional
form of contraception is necessary?
A) 30 minutes
B) 1 hour
C) 3 hours
D) 24 hours
276. A hypertensive woman uses enalapril for her blood pressure management. She has excellent
control. Which of the following oral contraceptives when used with enalapril can lead to
hyperkalemia?
A) Ethinyl estradiol–norelgestromin
B) Ethinyl estradiol–levonorgestrel
C) Norethindrone
D) Ethinyl estradiol–drospirenone
277. The oral contraceptive levonorgestrel–ethinyl estradiol (Seasonale) is different from 28-day
oral contraceptives due to having
A) Once-a-month dosing
B) Increased effectiveness
C) Higher adherence to correct usage
D) More days of active pills and fewer days of nonhormonal pills.
278. Which of the following statements about postpartum depression is
true?
A) Postpartum depression usually occurs 9 to 12 months after delivery.
B) Social support has little impact on the development of postpartumdepression.
C) Those with obstetric complications are at increased risk.
D) Those affected are at increased risk for postpartum depression with subsequent pregnancies.
279. Prenatal vitamins are important during pregnancy because they help to reduce the incidence
of neural tube defects. Which of the following is responsible for this protective effect?
A) Calcium
B) Iron
C) Folic acid
D) Vitamin C
280. Which of the following statements is true regarding postcoital emergency contraception?
A) Birth defects often occur if the method is unsuccessful.
B) Emergency contraception is 95% effective.
C) Emergency contraception is most effective if administered within 72 hours.
D) Ulipristal acetate (Ella®) is less effective than levonorgestrel taken as a single 1.5-mg pill
(Plan B One-Step™).
281. Rubella infection during pregnancy
A) Rarely affects the fetus
B) Has its most devastating effects during the third trimester
C) Is associated with cataracts, cardiac defects, and cleft palate
D) Is associated with neural tube defects
282. Which of the following is associated with oral contraceptive use?
A) Increased risk of endometrial cancer
B) Fewer ectopic pregnancies
C) Decreased risk of cervical cancer
D) Decreased risk of liver cancer
283. Which of the following statements about diaphragm contraception is true?
A) The diaphragm should be left in place for no more than 4 hours after intercourse.
B) The diaphragm should not be used with contraceptive jelly because of the risk of slippage.
C) The diaphragm is associated with an increase in vaginal and urinary infections.
D) The diaphragm can be prescribed on the basis of patient’s height and weight.
284. True statements regarding HIV testing before pregnancy
include which of the following?
A) HIV testing should only be offered to patients
in high-risk groups.
B) Women who test negative for HIV require no
further counseling.
C) Women testing positive for HIV must be counseled
regarding the risk of perinatal transmission
to the infant.
D) Offering contraception to women who test
positive for HIV compromises the woman's
autonomy and is considered unethical.
285.The most common identifiable cause of acute
childhood diarrhea is
(A) viral gastroenteritis
(B) giardiasis
(C) milk-borne toxins
(D) Escherichiacoli
286. A 42-year-old businesswoman presents to your office with the chief complaint o 2 days of
headache, sore throat, and nasal congestion productive o green mucus. She denies any
fever,contact with ill persons, and gastrointestinal symptoms, but she doeshave a history of
seasonal allergies. On examination, she has completely normal vital signs. Her
posteriororopharynx has mild erythema and postnasal drainage but no exudates. T ere is nasal
mucosal erythema and swelling with clear rhinorrhea. Her neck is supple with no adenopathy.
Respirations are clear. The most likely agent causing her symptoms and the most common cause
of acute rhinosinusitis is:
A) Rhinovirus
B) S. pneumoniae
C) H. influenzae
D) M. catarrhalis
E) Norwalk virus
287. A 42-year-old businesswoman presents to your office with the chief complaint o 2 days of
headache, sore throat, and nasal congestion productive o green mucus. She denies any fever,
contact with ill persons, and gastrointestinal symptoms, but she does have a history of seasonal
allergies. On examination, she has completely normal vital signs. Her posterior oropharynx has
mild erythema and postnasal drainage but no exudates. T ere is nasal mucosal erythema and
swelling with clear rhinorrhea. Her neck is supple with no adenopathy. Respirations are clear.
Initial treatment or this patient includes:
A) Oral decongestants
B) NSAIDs
C) Oral antibiotics
D) A and B
288. What is the most appropriate treatment for AOM?
A) Amoxicillin 40 mg/kg/day divided ID
B) Amoxicillin 80 to 90 mg/kg/day divided BID
C) Ceftriaxone 50 mg/kg IM once
D) Azithromycin 10 mg/kg or 1 day then 5 mg/kg or days 2 to 5
289. A 20-year old women presents with urinary frequency, haematuria and lower abdominal pain. What
is diagnosis?
A.
B.
C.
D.
Urinary tract infection
Hemorrhagic cystitis
Glomerulonephritis
Pyelonephritis
290. A 37-year-old woman presents with a 6-month history of secondary amenorrhea,
hirsutism and weight gain of 4 kg. She has suffered from irregular periods since menarche at
age of 13. Her BMI 31. What is diagnosis?
A.
B.
C.
D.
(e)
Thyrotoxicosis
Hypothyroidism
Turners syndrome
Primary ovarian failure
Polycystic ovarian syndrome
291. A 17-year –old virgin with normal secondary sexual characteristics presents to her GP with primary
amenorrhea. O/E: a bluish bulge is seen just inside the human and uterus shows 12 weeks gestation.
What is diagnosis?
A.
B.
C.
D.
Hypothyroidism
Turners syndrome
Primary ovarian failure
Cryptomenorrhoea
292. A 37-year old woman presents with a 3-month history of secondary amenorrhea. She admits to binge
eating and is concerned about being overweight. She goes to the gym daily and her BMI is 17.
A.
B.
C.
D.
Hypothyroidism
Turners syndrome
Primary ovarian failure
Anorexia nervosa
293. A 68-year-old type 2 diabetic man arrives for his annual follow-up at the diabetes clinic. Amydriatic
is needed for fundoscopy. Choose the most appropriate eye drops?
A.
B.
C.
D.
Atropine
Pilocarpine
Carbachol
Tropicamide
294. A 21 year old man is referred to the ophthalmology clinic with a 4-year history of congested eyes
and lacrimation occurring every spring, lasting about 2 month. Choose the most appropriate eye drops?
A.
B.
C.
D.
Atropine
Pilocarpine
Azelastine
Carbachol
295. A 71-year-old man under treatment for non-Hodgkin’s lymphoma presents with a 2 day history of
severe left ocular pain and photophobia. O/E: the left eye is very congested and multiple small vesicles
are noted at the nose. Choose the most appropriate eye drops?
A.
B.
C.
D.
Atropine
Carbachol
Pilocarpine
Tropicamide
296. A fit and healthy 69-year-old woman visits her optician to change her reading glasses. Fundoscopy
shows cupping of the optic disc. Choose the most appropriate eye drops?
A.
B.
C.
E.
Pilocarpine
Carbachol
Timolol
Atropine
297. A 49-year-old woman is referred to the rheumatology clinic with a 4-month history of itchy eyes, dry
mouse and bilateral parotid enlargement. Schemer’s test is positive. Choose the most appropriate eye
drops?
A.
B.
C.
D.
Atropine
Carbachol
Fluoroscein
Dipivefrin
298. Which method of contraception is contraindicated in migraine or a history of deep venous
thrombosis?
A.
B.
C.
D.
COCP
Depot progesterone
IUD
Progesterone-only contraceptive pill
299. Which method of contraception is contraindicated if either partner is not sure whether they would
like to have children in the future?
A.
B.
C.
D.
Depot progesterone
COCP
IUD
Sterilisation
300. Which method of contraception is contraindicated is only suitable in a stable relationship?
A.
B.
C.
D.
Depot progesterone
COCP
Periodic abstinence
Vaginal diaphragm
301. Which method of contraception is absolutely contraindicated if there is a history of ectopic
pregnancy or uterine abnormality?
A.
B.
C.
D.
Depot progesterone
COCP
Vaginal diaphragm
IUD
302. A 33-year-old woman has a diagnosis of post-inflammatory cirrhosis after suffering a bout
of hepatitis B.Recently, on upper endoscopy, she demonstrated presence of esophageal varices,
and a decision was made to utilize nonselective beta-adrenergic blockade to prevent bleeding of
the varices. Which of the following is the parameter that in follow-up indicates the therapeutic
endpoint has been reached?
A.
B.
C.
D.
Hemoglobin increases by 2 g/dL
Pulse rate drops by about 25%
Rise in blood pressure by 10%
Normalization of AST and ALT
303. A 28-year-old woman who admits to a history of intravenousdrug abuse is planning a
serious new relationship and is concerned about the possibility of passing hepatitis to her new
sex partner. A screening test for anti-hepatitis C antibody was negative. You obtain a hepatitis B
panel. Which of the following sets of laboratory findings make the diagnosis of hepatitis B
carrier?
A. HBsAg negative, anti-HBc negative, anti-HBs negative unexposed
B. HBsAg negative, anti-HBc positive, anti-HBs Negative
C. HBsAg negative, anti-HBc negative/positive, anti-HBs positive
D. anti-HBs negative HBsAg positive, anti-HBc positive, IgM anti-HBc negative, antiHBs negative
304. Which of the following is the best indicator of a high degree of hepatitis B virus (HBV)
replication, hence marker of infectivity?
A. HBsAg
B. HBcAg
C. HBeAg
D. Anti-HBs
305. A 35-year-old woman who has had two pregnancies and is 20% overweight presents with
jaundice. Serum conjugated bilirubin level is elevated to twice the upper limit of normal.
Unconjugated bilirubin is normal. Which of the following, as a single procedure, is most likely
to elucidate a cause of this clinical situation?
(A) Blood draw for hepatitides A, B, and C
(B) Computed tomography scan of the liver
(C) Ultrasound study of the extrahepatic biliary system
(D) Plain x-ray of the abdomen
306.Which of the following is the most easily passed by a blood donor?
(A) Hepatitis A
(B) Hepatitis B
(C) Hepatitis C
(D) Hepatitis D
307. Which of the following practices carries the highest
risk of contracting AIDS?
(A) Insertive vaginal intercourse with a female who
is HIV-positive
(B) Receptive vaginal intercourse with a male who is
HIV-positive
(C) Accidental needle stick with HIV-infected
blood
(D) Sharing of needles for illicit drug use with an
HIV-infected person
(E) Receptive anal intercourse with an HIV-positive
person participating in receptive anal intercourse
308. A 25-year-old male patient presents with fatigue and
weight loss and is found to be positive for HIV, confirmed
by the Western blot test. His CD4 count is
500 cells/mm 3 . Which of the following is the least
likely cause of his weight loss?
(A) Mycobacterium avium complex (MAC)
(B) Tuberculosis
(C) Malabsorption
(D) Kaposi sarcoma
(E) Hairy leukoplakia
309. In evaluating an AIDS patient for visual disturbance,
you notice perivascular hemorrhages and white fluffy
exudates. Which of the following is the most likely
cause?
(A) CMV
(B) Cotton wool exudates
(C) Cataracts
(D) Herpes virus
(E) Toxoplasmosis
310. Which of the following is typical of the acute, initial
infection with the HIV virus?
(A) Folliculitis
(B) Hairy leukoplakia
(C) Kaposi sarcoma
(D) Lymphadenopathy
(E) Vaginal candidiasis
311. A 24-year-old male injection drug user complains of
dry mouth, dysphagia, dysphonia, diplopia, nausea,
and vomiting. In the past few hours, he has noted
shortness of breath. He is alert and oriented. His temperature
is normal. Breathing appears to be mildly
labored and shallow, but the lung fields are “clear” to
auscultation and percussion. Of the following that
are present in the differential diagnosis of these
symptoms, which one is the most likely?
(A) Tetanus
(B) Botulism
(C) Bowel obstruction
(D) Guillain–Barré syndrome
(E) Myasthenia gravis
312. A 9-year-old boy is brought to you with complaints
of 2 days of fever, headache, nausea, vomiting, and a
macular rash of pink lesions that appears on the
palms, soles, wrists, forearms, and ankles. The lesions
blanch with pressure. He had been camping with his
family in North Carolina from 2 weeks ago until
about 5 days ago. Today, he has also begun to complain
of headache, cough, and pleuritic chest pain.
The boy has had no gastrointestinal complaints.
Examination is unremarkable except for the rash.
The neck is supple. Complete blood count shows
thrombocytopenia, hyponatremia, and hyperbilirubinemia,
with mostly indirect acting type. Which of
the following is the most likely possibility to pursue?
(A) Rubeola
(B) Meningococcemia
(C) Rocky mountain spotted fever (RMSF)
(D) Varicella
(E) Typhoid fever
313. A 4-year-old Chinese American boy has had a fever
for 5 days, with temperatures running between 100 _ F
and 101 _ F. Upon examination, he manifests conjunctival
injection, sore and fissured lips, palmar and
solar erythema with desquamation of the tips of one
index and one ring finger, transverse grooves in several
fingernails, and enlarged cervical lymph nodes.
Aside from the lips, the oral examination is unremarkable.
Which of the following must be considered?
(A) Roseola
(B) Rubeola
(C) Scarlatina
(D) Erythema infectiosum
(E) Kawasaki disease
314. A 36-year-old man complains of diffuse macular
rash, headache, and reddened eyes developing over
3 days. Today, his palms and soles show faintly and
finely vesicular changes. He complains also of the
recurrence over 4 days of soreness and focal redness
on the left side of his nose, manifesting a flameshaped
region of erythema involving the left naris. He
denies sore throat, and a rapid flocculation test for
beta-hemolytic streptococcus is negative. In the past
24 hours, he has developed vomiting and diarrhea.
Which of the following is the most likely diagnosis?
(A) Scarlatina
(B) Kawasaki syndrome
(C) Secondary syphilis
(D) Toxic shock syndrome
(E) Cirrhosis of the liver
315. Each of the following is a special risk factor for infectious
bacterial endocarditis, except which one?
(A) Presence of prosthetic heart valves
(B) Previous bacterial endocarditis
(C) Complex cyanotic congenital heart disease
(D) Status 1 year post repair of ventricular septal
defect
(E) Hypertrophic cardiomyopathy
316. A 35-year-old woman complains of a rash of variable
lesions, fever, and headache. She had been camping
in the New England states and had been in the wilderness
for a week without an opportunity to bathe.
She does not recall any prior skin lesions since the
exposure in the field. Examination reveals a generalized
rash of red lesions, some annular, some target
like, some more intense centrally. Which of the following
is the most likely cause of these symptoms?
(A) RMSF
(B) Tinea circinata
(C) Rubeola
(D) Secondary syphilis
E). LYME DISEASE
317. Each of the following is true regarding genital herpes
simplex virus (HSV), except for which statement?
(A) Polymerase chain reaction testing is more
sensitive than viral culture.
(B) Viral culture is useful in differentiating HSV-1
from HSV-2 infection.
(C) Early therapy with recently developed antiviral
agents can cure the disease.
(D) Suppressant therapy can reduce the recurrence
rate by 70% to 80%.
318. A young mother comes to you with her 8-month-old
formula-fed baby. She is concerned about a rash
involving the facial cheeks and the tops of folds of
skin over various parts of the body. On occasion, the
patches weep and form crusts. The baby does not
seem to be bothered greatly by the rash. Both the parents
are healthy and without especially apparent
inherited diseases, except that the mother has allergic
rhinitis in the autumn months and the father had
asthma as a child. Which of the following is the most
likely diagnosis of the rash?
(A) Psoriasis
(B) Eczema
(C) Chafing caused by lip licking
(D) Candidiasis
(E) Cellulitis
319. A 25-year-old male complains of severe sore throat for
3 days with no coryza or cough. Upon examination, he
speaks with a “hot potato voice” and manifests an
impressive membrane about the fauces and his intact
tonsils plus cervical adenopathy that is not particularly
tender. A quick streptococcus flocculation test and a
Monospot test are negative. The doctor treats the patient
empirically with ampicillin–clavulanate, and 3 days
later, the patient complains that he is not improved and
now has a morbilliform rash that includes pruritus in
certain areas. Which of the following is the diagnosis?
(A) Streptococcal pharyngitis
(B) Viral pharyngitis
(C) Infectious mononucleosis
(D) Measles
(E) Urticaria
320. Which of the following would be the approach most
fundamental toward addressing the causation of
infantile eczema?
(A) Triamcinolone ointment applied twice daily for
1 month and a follow-up visit at that time
(B) Systemic glucocorticoid course over a 2-week
period
(C) Admission to the hospital for intravenous
antibiotics
(D) Trial of change in formula from patient’s cow
milk-based preparation to a soybean-based
formula
(E) Application of topical antibiotic ointment
321. 12-year-old complains of pruritic patches of dry,
scaly skin at the antecubital fossae, the medial aspects
of the ankles above the malleoli and the popliteal
spaces. Which of the following therapeutic modalities
would be most appropriate and effective?
(A) Applications of lotion containing 1%
hydrocortisone 2 to 3 times daily
(B) Ten-day course of tapering prednisone, beginning
with 40 mg daily
(C) Prescription of hydroxyzine, 25 mg per os, every
4 hours as needed for pruritus
(D) Prescription of 2% hydrocortisone ointment to
be applied 4 times daily to the pruritic patches
as needed for itching
(E) Prescription of a food-elimination diet
322. Which of the following statements is true regarding influenza?
A) Treatment with antivirals should be initiated within 48 hours of the
onset of symptoms.
B) Anitiviral agents reduce the duration of fever by 1 week.
C) Amantadine is effective for both influenza types A and B.
D) Prophylactic therapy is the single most important measure to prevent
influenza outbreaks.
323. Which of the following medications is considered the treatment of choice
for Bordetella pertussis infection?
A) Penicillin
B) Ciprofloxacin
C) Azithromycin
D) Tetracycline
E) Cefuroxime
324. Which of the following is considered a first-line medication in the
treatment of hypertension?
A) Chlorthalidone
B) Lisinopril
C) Clonidine
D) Losartan
E) Amlodipine
325. Which of the following classes of drugs can be used safely with
NSAIDs without needing to closely monitor the patient’s renal function,
potassium levels, and/or blood pressure?
A) ACE inhibitors
B) CCBs
C) Diuretics
D) β-Blockers
326. Desensitization immunotherapy may be used in the treatment of
A) Chronic urticaria
B) Hymenoptera allergies
C) Atopic dermatitis
D) Milk allergy
327. Goodpasture’s syndrome is associated with
A) Osteoporosis and renal lithiasis
B) Pathologic fractures and thyroiditis
C) Hepatitis and recurrent cystitis
D) Pulmonary hemorrhage and glomerulonephritis
328. Which of the following is considered first-line therapy for primary
dysmenorrhea?
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Selective serotonin reuptake inhibitors (SSRIs)
C) Antiestrogens
D) Acupuncture
E) Tricyclic antidepressants
329. The current diagnosis of preeclampsia consists of which of the
following?
A) Elevated blood pressure and proteinuria
B) Elevated blood pressure, proteinuria, and edema
C) Elevated blood pressure, proteinuria, edema, and seizures
D) Elevated blood pressure, proteinuria, edema, seizure, and headaches
330. Which of the following symptoms is more likely to represent myocardial
ischemia in older patients?
A) Chest pain
B) Dyspnea
C) Diaphoresis
D) Back pain
331. Increasing age is associated with many effects on the kidney. These
effects include which of the following?
A) Increase in renal size
B) Increase in serum creatinine
C) Decreased glomerular filtration rate
D) Increase in renal blood flow
332.Which of the following statements is true regarding insomnia in the
elderly?
A) Women are more commonly affected.
B) The condition is associated with inadequate tryptophan ingestion.
C) Exercise before bedtime can help relieve symptoms of insomnia.
D) Low-dose trazodone (Desyrel) is recommended for treating insomnia.
E) Small doses of alcohol given at bedtime can be used to treat insomnia.
333. Which one of the following statements associated with Parkinson’s
disease is true?
A) The condition is associated with neurofibrillary tangles found in the
substantia nigra.
B) The carbidopa component of Sinemet blocks peripheral dopa
decarboxylase.
C) Amantadine is an antagonist of levodopa.
D) Benztropine (Cogentin) is helpful for the bradykinesia late in the course
of Parkinson’s disease.
E) Surgery for Parkinson’s disease has not been shown to be beneficial
334. A 40-year-old woman is found to have chronic cholestasis. The most
serious complication is the development of
A) Intractable hiccups
B) Primary biliary cirrhosis
C) Cholelithiasis
D) Hypercholesterolemia
335. Which of the following blood types is considered the universal donor?
A) AB positive
B) O positive
C) AB negative
D) O negative
336. Which of the following is typical of the acute, initial
infection with the HIV virus?
(A) Folliculitis
(B) Hairy leukoplakia
(C) Kaposi sarcoma
(D) Lymphadenopathy
(E) Vaginal candidiasis
337. Which of the following poses the least likely medium
of contagion for HIV?
(A) Saliva
(B) Shared toothbrush
(C) Blood and blood products
(D) Semen
(E) Cerebrospinal fluid
338. A 65-year-old man has persistent blood pressure levels
averaging 150/78, although his diastolic pressure
has never been above 90 mm Hg. Which of the following
drugs would have the best chance of controlling
the blood pressure as a single medication in
reasonable dosages?
(A) Lisinopril (an angiotensin-converting enzyme
inhibitor)
(B) Propranolol (a nonselective beta-adrenergic
blocker)
(C) Irbesartan (an angiotensin II receptor inhibitor)
(D) Hydrochlorothiazide/triamterene
(a combination thiazide diuretic and
potassium-saving diuretic)
339.A 65-year-old man has persistent blood pressure levels
averaging 150/78, although his diastolic pressure
has never been above 90 mm Hg. Which of the following
drugs would have the best chance of controlling
the blood pressure as a single medication in
reasonable dosages?
(A) Lisinopril (an angiotensin-converting enzyme
inhibitor)
(B) Propranolol (a nonselective beta-adrenergic
blocker)
(C) Irbesartan (an angiotensin II receptor inhibitor)
(D) Hydrochlorothiazide/triamterene
(a combination thiazide diuretic and
potassium-saving diuretic)
340. Treatment of common cold include all but:
A.
B.
C.
D.
Steam inhalation.
Warm fluid.
Antibiotics.
Bed rest.
341. Best treatment line in allergic rhinitis is:
A. Local antihistamine.
B. Local corticosteroid.
C. Systemic corticosteroid.
D. Allergen avoidance.
342. 21. Absolute indication of tonsillectomy is:
A. Chronic tonsillitis.
B. Diptheria carrier.
C. Obstructive sleep apnoea .
D. Rheumatic fever
343. Patching of the eye is contraindicated in:
a. Corneal abrasion
b. Bacterial corneal ulcer
c. Mucopurulent conjunctivitis
d. After glaucoma surgery
344. In viral epidemic kerato-conjunctlvitis characteristically there is
usually:
a. Copious purulent discharge
b. Copious muco-purulent discharge
c. Excessive watery lacrimation
d. Mucoid ropy white discharge
345. A painful, tender, non itchy localized redness of the conjunctiva can
be due to:
a. Bulbar spring catarrh.
b. Episcleritis.
c. Vascular pterygium.
d. Phlyctenular conjunctivitis
346. . Topical atropine is contraindicated in:
a. Retinoscopy in children
b. Iridocyclitis
c. Corneal ulcer
d. Primary angle closure glaucoma
347. Mydriasis is present in all the following except:
a. Third nerve lesion
b. Pontine haemorrhage
c. Datura poisoning
d. Fourth stage of anesthesia
348. The most common primary intraocular malignancy in adults is:
a. Retinoblastoma
b. Choroidal melanoma
c. Squamous cell carcinoma of conjunctiva
d. Iris nevus
349. All the following associated open angle glaucoma include all the
following except:
a. Roenne’s nasal step
b. Enlarged blind spot
c. Generalized depression of isopters
d. Loss of central fields
350. Phakolytic glaucoma is best treated by:
a. Fistulizing operation
b. Cataract extraction
c. Cyclo-destructive procedure
d. Miotics and Beta blockers