Medical Licensing Exam Practice Questions

TEST 7
Q:1-Campylobacter jejuni is usually treated with which antibiotic? Mark one answer:
o Isoniazid
o Cefuroxime
o Ciprofloxacin
o Azithromycin
Q:2-After undergoing a mastectomy, a 55-year-old female is found to have injury to the long thoracic
nerve. Which of the following is most likely? Mark one answer:
o Inability to shrug her shoulders
o Inability to comb her hair
o Winging of scapula
o Shortness of breath
Q:3-Active labor occurs during the: Mark one answer:
o 1st stage of labor

o 2nd stage of labor
o 3rd stage of labor
o 4th stage of labor
Q:4-Which is most deleterious to the maintenance of youthful skin? Mark one answer:
o Suntan
o Comedone producing makeup
o Excessive bathing
o Smoking
Q:5-Which of the following drugs has the highest total global production? Mark one answer:
o Opium
o Cocaine
o Cannabis
o Amphetamine-type stimulants
Q:6-Which spinal nerve innervates the biceps muscle? Mark one answer:
o C4
o C5
o C6
o C7
Q:7-What type of lung cancer is known to produce Cushing syndrome? Mark one answer:
o Large cell
o Small cell
o Adenocarcinoma
o Squamous cell
Q:8-What is the class of drugs which are frequently used to loosen and thin secretions from the
respiratory tract? Mark one answer:
o Antitussives
o Expectorants
o Decongestants
o Bronchodilators
Q:9-The major blood supply to the breast is from which of the following? Mark one answer:
o Internal mammary branches

o Axillary artery
o Lateral thoracic artery
o Aorta
Q:10-What type of electrolyte abnormality can occur in patients who had a transurethral resection of
the prostate? Mark one answer:
o Hypocalcemia
o Hypokalemia
o Hypernatremia
o Hyponatremia
TEST 8
Q:1-What is the best test for a patient with rapidly progressive glomerulonephritis? Mark one answer:
o Urine analysis
o MRI
o Renal biopsy
o Serology
Q:2-What is not present in an asymptomatic patient with chlamydia? Mark one answer:
o Mucopurulent discharge
o A friable cervix that bleeds easily
o Painful vulvar lesions
o Risk of pelvic inflammatory disease
Q:3-A 60 year old male complains of regurgitation of undigested food eaten days earlier. He also has
dysphagia with solids on occasion. Halitosis is the only physical finding. Which of the following is the
most likely diagnosis? Mark one answer:
o Zenker diverticulum
o Schatzke ring
o Achalasia
o Diffuse esophageal spasm
Q:4-A 67-year-old male undergoes surgery for a lung mass. The pathology sections reveal a malignant
midhilar tumor composed of keratinizing cells interlinked with one another with intercellular bridges
and desmosomes. The lesion is most likely which of the following? Mark one answer:
o Squamous cell carcinoma (SCC)

o Carcinoid
o Small cell cancer
o Adenocarcinoma
Q:5-A patient has suffered an injury from a rusty nail. The patient had a tetanus shot 5 years ago. Which
of the following is most appropriate for the treatment of this patient? Mark one answer:
o Antibiotics
o Clean and debride wound
o Administer tetanus immune globulin
o Give tetanus vaccine
Q:6-Which is true of congenital atresia of bile ducts? Mark one answer:
o Most babies do not present until 6-9 months of age

o Stools are pale and appear pasty
o Early phototherapy helps resolve the jaundice
o Diagnosis is made by ultrasound
Q:7-What happens to urinary sodium in patients with cirrhosis? Mark one answer:
o No change
o Increases
o Decreases
o No relationship
Q:8-Which of the following types of patients may refuse treatment and transport to a hospital by
Emergency Medical Services? Mark one answer:
o Head injury
o Intoxicated
o Chest pain
o Mentally incapacitated
Q:9-Which of the following measures is very important to prevent drug related adverse effects in the
elderly? Mark one answer:
o Adequate hydration
o Dose adjustment
o Plasmapheresis
o Weight reduction
Q:10-In patients with unstable angina (UA), which of the following is recommended in those with
contraindications to beta-blockade? Mark one answer:
o Penicillin
o Non-dihydropyridine calcium channel blocker
o Dihydropyridine calcium channel blocker
o NSAIDs
Test 9
Q:1-A 10 year-old who has been treated for Sever disease for a month with limitation of activities,
ibuprofen, and daily stretching reports worsening pain causing insomnia. Exam shows redness and
swelling. There is no fever or chills. Initial radiographs showed mild sclerosis and fragmentation only.
What would be the next step in management? Mark one answer:
o Reassurance that healing takes time and the condition will improve. Advise to continue the
same treatment
o Obtain further studies including CBC, sedimentation rate, and MRI
o Obtain further studies, including bone scan and biopsy of the calcaneus
o Place the patient in a short leg cast, due to concern of noncompliance with the limitation of
activities
Q:2-EMTs find a pregnant woman of 40 weeks with meconium stained amniotic fluid. What is the next
best step in management? Mark one answer:
o Transport her immediately

o Prepare for imminent birth
o Intubate the mother
o None of the above
Q:3-Which of the following is appropriate treatment for chlamydial cervicitis? Mark one answer:
Doxycycline 100 mg twice daily for 3 days Azithromycin 1 gram in a single dose Ceftriaxone 250 mg as a
single IM dose Keflex 500 mg daily for 10 days Q:4-Which nerve root is involved with disk herniation
between L4 and L5? Mark one answer:
o L3
o L4
o L5
o S1
Q:5-Which of the following would be most helpful in an amitriptyline overdose? Mark one answer:
o Calcium
o Magnesium
o Phosphorous
o Sodium
Q:6-Which is an absolute contraindication to femoral artery cannulation? Mark one answer:
o Infection in groin
o Atherosclerosis
o Burns
o Prior femoral -femoral graft
Q:7-An 18 year old male presents to the emergency room with penile pain. The foreskin is retracted but
cannot be reduced. What is the diagnosis? Mark one answer:
o Phimosis
o Paraphimosis
o Balanitis
o Balanoposthitis
Q:8-An adult female with no complaints has a routine mammogram that is reported as breast imaging
reporting and data system (BI-RADS) 0. What does this mean? Mark one answer:
o The assessment is incomplete

o Negative study
o Benign finding
o Known biopsy-proven cancer
Q:9-At 10 months, an infant can do all of the following except: Mark one answer:
o Feed herself
o Say 1 or 2 words
o Feel shame
o Roll over
Q:10-Which is not seen in pericardial tamponade? Mark one answer:
o Muffled heart sounds

o Hypertension
o Jugular venous distention (JVD)
o Equalization of cardiac chamber pressures
Test 10
Q:1-A 2-year-old girl has an umbilical hernia. The hernia measures 2 x 2 cm and the abdominal exam is
unremarkable. Which of the following is most appropriate for the treatment of this patient?
Mark one answer:
o Surgery as soon as possible

o Surgery within the next 6 months
o Surgery only if the hernia becomes incarcerated
o Surgery before school age
Q:2-Which of the following conditions does not require a pacemaker? Mark one answer:
o Sick sinus syndrome
o Mobitz type 2
o Third degree heart block
o First degree heart block
Q:3-A 6 month old male regurgitates most of each feeding. pH monitoring shows low readings over
extended periods. The infant is at the 50th percentile for height and weight. There is no other medical
history or findings. Select the most appropriate management. Mark one answer:
o Proton pump inhibitors

o Close follow up
o Fundoplication
o Barium swallow with upper GI
Q:4-In a patient with active lupus, what laboratory feature would be more reflective of the disease?
Mark one answer:
o White blood cells

o Hypocomplementia
o Hypogammaglobulinemia
o Elevated blood urea nitrogen (BUN) and creatinine
Q:5-Headache is a common side effect of which of the following drugs? Mark one answer:
o Digoxin
o Nitroglycerin
o Verapamil
o Propranolol
Q:6-Which instruction is appropriate for patients after concussion? Mark one answer:
o Return for persistent headache

o Return for decreasing level of consciousness, drowsiness
o Return for persistent vomiting
o All of the above
Q:7-Which is the in incorrect action for prolapsed cord during delivery? Mark one answer:
o Manual elevation of the presenting part with an attendant's hand

o Knee-chest or Trendelenburg position
o McRoberts maneuver, followed by suprapubic pressure
o Emergent delivery of the baby
Q:8-What is the first priority in the treatment of an unconscious patient? Mark one answer:
o Checking blood pressure

o Establishing IV access
o Establishing an airway
o Checking the pulse
Q:9-A 65 year old male presents to the ER with complaint of severe onset of pain which started in the
anterior chest. He says the pain is excruciating and now radiates between his scapula. His RR is 22, P is
120 and BP is 80/55. The most likely diagnosis is: Mark one answer:
o Myocardial infarction
o Aortic dissection
o Cardiac tamponade
o Arthritis
Q:10-Weakness in unilateral facial expression is indicative of which cranial nerve? Mark one answer:
o Olfactory nerve-CN II
o Facial nerve-CN VII
o Abducens nerve- CN VI
o Hypoglossal nerve-CN XII
Test 11
Q:1-The Stroop effect has often been used to assess what type of disorder? Mark one answer:
o Depression
o Constipation
o Blurred vision
o Intelligence
Q:2-Dermatitis herpetiformis is treated with which of the following medications? Mark one answer:
o Methotrexate
o Prednisone
o Dapsone
o Cyclosporine
Q:3-Which of the following about fetal blood sampling is FALSE? Mark one answer:
o Assesses fetal wellness

o Only obtained from vertex position
o Recommended during continuous monitoring
o Assesses oxygen saturation
Q:4-A blueberry muffin baby is classically seen in infants with which infection? Mark one answer:
o Measles
o Rubella
o HIV
o Gonorrhea
Q:5-A 56-year-old with hyperkalemia is unlikely to present with which symptom? Mark one answer:
o Constipation
o Cramps
o Nausea
o Weakness
Q:6-A young male who is a glass blower presents to you with a bulging mass on the upper chest. A
diagnosis of a soft non-tender crepitant swelling is made. Which radiograph would be most diagnostic?
Mark one answer:
o PA (posteroanterior) chest radiograph

o Lateral chest radiograph
o Oblique radiograph tangential to the defect
o Ribs views
Q:7-An acquired progressive lymphangioma, appearing on the thigh of a 17-year-old male, is generally
treated by which of the following methods? Mark one answer:
o Excision with a 1 cm border

o Laser removal
o Cryotherapy
o Observation
Q:8-A patient with a long history of cigarette smoking and alcohol abuse complains of difficulty
swallowing and acknowledges recent weight loss of 9 kilograms. What is the most likely diagnosis?
Mark one answer:
o Achalasia
o Adenocarcinoma of the esophagus
o Hiatal hernia
o Schatzki ring
Q:9-What is the most common cause of xanthopsia in North America? Mark one answer:
o Gallstones
o Conjunctivitis
o Digoxin
o Tay-Sachs disease
Q:10-Which medication can be used to treat the symptoms of diabetic gastropathy? Mark one answer:
o Cimetidine
o Metoclopramide
o Lansoprazole
o Loperamide
Test 12
Q:1-Which chemotherapeutic agent causes pancreatitis? Mark one answer:
o 6-Mercaptopurine
o Doxorubicin
o Methotrexate
o Asparaginase
Q:2-What is the cosyntropin stimulation test used to diagnose? Mark one answer:
o Type 2 diabetes mellitus

o Pheochromocytoma
o Acute adrenal insufficiency
o None of the above
Q:3-Cryoprecipitate does NOT contain which clotting factor? Mark one answer:
o Factor VII
o Fibrinogen
o Factor V
o Factor XIII
Q:4-In a 55-year-old with central pain syndrome, you would expect to find which of the following
Mark one answer:
o Malignancy
o Radiation myelopathy
o Spinal stenosis
o Traumatic compression
Q:5-Which is false about pheochromocytoma? Mark one answer:
o Majority are malignant

o Can cause paroxysms of hypertension
o Can be associated with MEN syndrome
o 10% are bilateral
Q:6-Which of the following is true regarding dermatomyositis? Mark one answer:
o Adults have calcinosis more often than children

o Proximal muscle weakness often precedes skin manifestations
o Elevated muscle enzymes and abnormal electromyography and muscle biopsy
o Associated malignancy is seen more often in children
Q:7-Broca aphasia is also known as: Mark one answer:
o Fluent aphasia
o Agnosia
o Expressive aphasia
o Alexia
Q:8-Which of the following drug classes do not cause erectile dysfunction? Mark one answer:
o Anticholinergics
o Antihypertensives
o Diuretics
o Antidepressants
Q:9-A normal infant smiles responsively, laughs, regards faces, and stares at her hands. She does not try
to reach an object that is out of reach. How old is the infant? Mark one answer:
o 4 weeks
o 2 months
o 4 months
o 6 months
Q:10-A patient is under treatment for lung cancer and complains of a backache for a 2 weeks that has
somewhat responded to ibuprofen. He now has right lower quadrant abdominal pain and inguinal pain.
He is tender over the lower thoracic spine and symmetrical weakness of the lower extremities with
hyperreflexia. There is symmetrical decreased sensation below T11. What is the next step?
Mark one answer:
o Glucocorticoids
o Thoracic and lumbar radiographs
o Start pregabalin (Lyrica) for pain control
o Check for paraneoplastic antibodies
Test 13
Q:1-A 56-year-old with multifocal tachycardia is best treated with which of the following? Mark
one answer:
o Amiodarone
o Verapamil
o Phenytoin
o Metoprolol
Q:2-A 24-month-old child is seen in the clinic and found to have Brushfield spots. He may have what
condition? Mark one answer:
o Down syndrome
o Herpes keratitis
o Pterygium
o Hordeolum
Q:3-Which of the following tests is best for acute retroviral syndrome? Mark one answer:
o Rapid detection of
o HIV antibody HIV RNA by polymerase chain reaction (PCR) or P24 antigen
o CD4+ lymphocyte count
o HIV antibody by Elisa
Q:4-Which of the following is NOT a sign and/or symptom of malignant hyperthermia?

Mark one answer:
o Increased end-tidal CO2

o Increased temperature
o Whole body rigidity
o Hypokalemia
Q:5-What ophthalmic finding is consistent with acute mountain sickness? Mark one answer:
o Hemorrhage
o Glaucoma
o Optic neuritis
o Macular degeneration
Q:6-Unintentional weight loss in an elderly nursing home patient is most likely due to which of the
following? Mark one answer:
o Major depression
o Malignancy
o Drug side effects
o Neurological disorders
Q:7-Hormonal replacement therapy is widely used to treat which of the following? Mark one answer:
o Libido
o Hot flashes
o Cardioprotective
o Cancer
Q:8-Which of the following is a brand name for a bile acid sequestrant? Mark one answer:
o Colyte
o Prevalite
o Generlac
o SyrSpend
Q:9-What is the mechanism of action of digoxin? Mark one answer:
o Inhibiting calcium pump

o Inhibiting sodium pump
o Inhibiting phosphodiesterase
o Stimulating potassium secretion into renal tubules
Q:10-What percentage of oxygen is given to a patient with cluster headaches? Mark one answer:
o 20
o 40
o 70
o 100
Test 14
Q:1-Which type of encephalitis is seen in the western U.S., western Canada, and South America?
Mark one answer:
o St. Louis encephalitis

o Western equine encephalitis
o California La Crosse encephalitis
o West Nile encephalitis
Q:2-Which of the following can be used for Cushing syndrome? Mark one answer:
o Digoxin
o Spironolactone
o Ketoconazole
o Misoprostol
Q:3-Which lung volume is mostly affected with the usage of continuous positive pressure airway
pressure (CPAP)? Mark one answer:
o Inspiratory reserve volume

o Functional residual capacity
o Total lung capacity I
o nspiratory capacity
Q:4-Which of the following may alleviate the chest pain of stable angina? Mark one answer:
o Oxygen
o Rest
o Nitroglycerin
o All of the above
Q:5-Which factor does not increase the risk of recurrence of hepatocellular carcinoma?
Mark one answer:
o Poor differentiation
o Invasion of the liver capsule
o Single nodule
o Vascular invasion
Q:6-A halo nevus is discovered on exam, what is the biggest concern for this patient? Mark one answer:
Alopecia Vitiligo Squamous cell carcinoma Junctional nevi
Q:7-Select the patient most at risk for Eisenmenger syndrome. Mark one answer:
o A 6 year old with patent foramen ovale

o A 2 week old with isolated L-transposition of the great vessels
o A 4 month old with small ventricular septal defect
o A 9 month old with tricuspid atresia and a systemic-to-pulmonary artery shunt
Q:8-You are teaching your diabetic patient about insulin lispro. Which of the following is true of this
insulin? Mark one answer:
o It has an onset of less than 30 minutes

o It peaks between 2 to 4 hours
o It lasts 5 to 7 hours
o It should be taken 20 to 30 minutes before meals
Q:9-What is the greatest source of histamine? Mark one answer:
o Lymphocytes
o Neutrophils
o Platelets
o Mast cells
Q:10-In a patient with stable angina, what is the emphasis of treatment? Mark one answer:
o Start vasodilatorsa
o Adjust blood pressure medications
o Treat all modifiable risk factors
o Obtain a stress test or an angiogram
Test 15
Q:1-Which medication would help stabilize blood pressure in a person already taking isosorbide for
angina? Mark one answer:
o Ramipril
o Hydrochlorothiazide
o Amlodipine
o Metoprolol
Q:2-Which is true of hyperkalemia? Mark one answer:
o The classic signs are mainly GI related

o Intravenous dextrose/insulin can cause a fall in potassium levels
o Lactulose given via the rectum is the first choice for treatment
o ECG signs are generally absent
Q:3-The day after delivery, a mother develops confusion, disorientation, and loss of touch with reality.
Which is the most likely diagnosis? Mark one answer:
o Postpartum depression
o Postpartum blues
o Postpartum psychosis
o Bipolar depression
Q:4-Lactation is promoted by which of the following hormones? Mark one answer:
o Testosterone
o Estrogen
o FSH
o Prolactin
Q:5-What condition is least likely in subacute blood loss? Mark one answer:
o Low hemoglobin
o Low reticulocyte
o Macrocytic anemia
o Hypovolemia
Q:6-A 66-year-old patient develops shortness of breath and dry cough after starting a chemotherapeutic
agent. What drug is most likely? Mark one answer:
o Bleomycin
o Dacarbazine
o Doxorubicin
o Cyclophosphamide
Q:7-Which drug is most likely to precipitate congestive heart failure? Mark one answer:
o Lisinopril
o Thiazide
o Aspirin
o Verapamil
Q:8-Which one of the following does not encourage sleepiness? Mark one answer:
o Herbal chamomile
o Relaxing in a hot tub of water
o Any physically exerting activity
o Visual stimulation
Q:9-What type of arterial blood gas can be seen in a patient with Guillain Barre syndrome?
Mark one answer:
o Respiratory acidosis
o Respiratory alkalosis
o Metabolic acidosis
o Metabolic alkalosis
Q:10-Corns are most common in which group of patients? Mark one answer:
o Female with multiple sclerosis
o Individuals with pes planus
o Diabetic with bunions
o Young child with orthotics
Test 16
Q:1-Drug induced lupus is common in patients taking which of the following medications? Mark one
answer: Pravastatin Carvedilol Nitroglycerin Hydralazine
Q:2-Complications of enteral tube feedings include all of the following, except: Mark one answer:
o Aspiration pneumonia
o Hypercholesterolemia
o Hyperglycemia
o Fluid and electrolyte disturbances
Q:3-Which of the following people is likely to have senile cataracts? Mark one answer:
o Elderly
o Diabetics
o Infectious
o Demented
Q:4-What is an absolute contraindication to inducing labor? Mark one answer:
o Mild PIH
o Polyhydramnios
o Breech
o Placenta previa
Q:5-A 16 year old male presents with hemoptysis. Hemoglobin was 10.5 mg/dL. Blood pressure was
greater than 130/90 mm Hg for the hospitalization. Urinalysis showed proteinuria and hematuria. What
is the most likely diagnosis? Mark one answer:
o Wegener granulomatosis
o Poststreptococcal glomerulonephritis
o Goodpasture syndrome
o Multiple emboli
Q:6-Severe cystic acne is best treated with: Mark one answer:
o Tretinoin gel (Retin-A)

o Benzoyl peroxide/erythromycin (Benzamycin)
o Oral contraceptive + tetracycline
o Isotretinoin (Accutane)
Q:7-A translucent swelling in the groin is usually caused by which of the following? Mark one answer:
o Testicular mass
o Hematoma
o Torsion
o Hydrocele
Q:8-Nephrolithiasis is associated with which of the following antiretroviral? Mark one answer:
o Indinavir
o Nelfinavir
o Ritonavir
o Darunavir
Q:9-Which of the following symptoms do not go along with the diagnosis of moderate persistent
asthma? Mark one answer:
o Daily symptoms of cough and wheezing

o Coughing at night
o Daily night time awakening
o Some limitation of daily activity
Q:10-Which is a very rare complication of epidural anesthesia? Mark one answer:
o Headache
o Infection
o Respiratory depression
o Urine retention
Test 17
Q:1-What is the normal post-void bladder residual volume in adults? Mark one answer:
o 25 mL
o 30 mL
o 45 mL
o 60 mL
Q:2-Which of the following complications is seen in almost always in type 1 and not type 2 diabetes
mellitus? Mark one answer:
o Ketoacidosis
o Neuropathy
o Retinopathy
o Hyperosmolar coma
Q:3-Which of the following is NOT included in the mnemonic PICO used in EBP? Mark one answer:
o Patient or problem
o Intervention
o Competition
o Outcomes
Q:4-An 18 year old male has acute onset of muscle cramps of both hands and perioral tingling. Exam
shows an anxious man with elevated respiratory and ABG showing increased pH and decreased
bicarbonate and PCO2. Which of the following is most likely decreased in the serum? Mark one answer:
o Sodium
o Calcium
o Oxygen
o Potassium
Q:5-A patient awakens and there is a bat in his room. No bite was found and the bat escaped. Select the
correct statement. Mark one answer:
o Rabies vaccine should be started immediately

o Rabies is not a concern as bats do not carry the disease
o The patient only needs treatment if symptoms occur
o Rabies immune globulin and rabies vaccine should be given
Q:6-Which is not a characteristic of multiple system atrophy? Mark one answer:
o Impotence
o Myalgias
o Dementia
o Hypotension
Q:7-What complication is reduced by starting a patient with diabetes mellitus on a postoperative insulin
drip? Mark one answer:
o Wound infection
o Cerebral infarction
o Death
Q:8-Which is least likely to be found in a patient with hepatic cirrhosis? Mark one answer:
o Ascites
o Palmar erythema
o Gynecomastia
o Hemoptysis
Q:9-An patient with C1 esterase inhibitor deficiency disease will have what type of genetic inheritance
pattern? Mark one answer:
o Autosomal dominant
o Autosomal recessive
o X linked dominant
o X linked recessive
Q:10-A 19-year-old male develops tremor, rigidity, and mild dementia. When given levodopa he has
jerking movements of the limbs and becomes agitated. His father died in his 30s of progressive
dementia with jerking limb movements. What is his most likely diagnosis? Mark one answer:
o Sydenham chorea
o Gestational chorea
o Huntington disease
o Complex partial seizures
Test 18
Q:1-What is the drug of choice for N. gonorrhoeae? Mark one answer:
o Ceftriaxone
o Erythromycin
o Trimethoprim
o Azithromycin
Q:2-What is the most common secondary cause of hypertension in a 25-year female? Mark one answer:
o Peripheral vascular disease

o Smoking
o Hypercholesterolemia
o Renal disease
Q:3-What is the organism responsible for encephalitis by the California subgroup? Mark one answer:
o Herpes
o Streptococcus
o LaCrosse
o Influenza
Q:4-What is a term for sudden loss of consciousness due to vasodilation? Mark one answer:
o Heat stroke
o Vascular collapse
o Heat syncope
o Sun sickness
Q:5-Which autonomic symptoms may accompany cluster headaches? Mark one answer:
o Horner's syndrome, ptosis, and miosis

o Lacrimation, conjunctival injection, eyelid edema
o Ipsilateral rhinorrhea and nasal congestion
o All of the above
Q:6-Which is often the first clue that an infant will have Hirschsprung disease? Mark one answer:
o Abdominal distension
o Constipation
o Delayed passage of meconium
o Poor nutrition
Q:7-What is not true about the early latent phase of labor? Mark one answer:
o The latent phase ends when the cervical dilation rate reaches about 1.2 cm/hr in nulliparous
patients and 1.5 cm/h in multiparous patients
o The latent phase ends when the cervix is about 3 to 4 cm dilated
o In nulliparous patients, the latent phase of labor usually lasts less than 20 hours
o In multiparous patients, the latent phase of labor usually lasts more than 14 hours
Q:8-A 52 year old male asks for sildenaphil. He complains that over the past 6 months he has been
unable to maintain an erection. He awakens with an erection twice a week but when he attempts sexual
relations he loses the erections quickly. He is married and monogamous but recently lost his job due to
the economy. He does not drink, smoke, or use illicit drugs. He has hypertension treated with
hydrochlorothiazide. His exam is normal including genital and prostate exams. PSA, free and total
testosterone are normal. Select the next step in management. Mark one answer:
o Prescribe sildenaphil
o Stop hydrochlorothiazide
o Discuss emotional issues and refer the patient for cognitive therapy
o Arrange for nocturnal phallometry
Q:9-What is the gold standard of the diagnosis of endometriosis? Mark one answer:
o Clinical
o Ultrasound
o CT scan
o Laparoscopy
Q:10-Which nerve supplies sensation to the fifth finger? Mark one answer:
o Ulnar
o Median
o Radial
o Musculocutaneous
Test 19
Q:1-An female presents with vaginal discharge and lower abdominal discomfort. Gram stain of the
discharge reveals a Gram negative diplococci. What is the best treatment for this patient?
Mark one answer:
o One dose of ceftriaxone

o Ceftriaxone plus azithromycin
o Azithromycin only
o Ciprofloxacin
Q:2-Which of the following organisms is not common in HIV patents? Mark one answer:
o Toxoplasmosis
o Mycobacterium avium intracellulare
o CMV
o Legionella
Q:3-Iron deficiency in elderly patients occurs most often due to: Mark one answer:
o Interference of cardiac medications

o Chronic diarrhea or constipation
o Inability to digest iron supplements
o Poor intake of iron rich foods
Q:4-The 2011 guidelines for brain death published by the American Academy of Pediatrics state that:
Mark one answer:
o All patients must have apnea testing, if possible
o Infants less than 37 weeks gestational age are included in the criteria
o 3 separate physicians must confirm the diagnosis
o Ancillary testing such as EEG or nuclear medicine brain flow studies is needed to make the
diagnosis
Q:5-Which muscle would not be affected by deep peroneal nerve damage? Mark one answer:
o Extensor digitorum brevis muscle

o Tibialis posterior muscle
o Tibialis anterior muscle
o Extensor digitorum longus muscle
Q:6-What will the electrolyte composition of sweat in patients with cystic fibrosis reveal?
Mark one answer:
o High chloride
o Low potassium
o High magnesium
o High bicarbonate
Q:7-Which of the following nerves supplies the skin on the medial aspect of the arm? Mark one answer:
o Median nerve
o Ulnar nerve
o Medial brachial cutaneous nerve
o Radial nerve
Q:8-Which is a classic ECG feature of Torsade de pointes? Mark one answer:
o Short QT
o Elevated ST
o Long QT
o Short PR
Q:9-Which of the following situation is most likely to cause diarrhea in the newborn? Mark one answer:
o Infectious colitis
o Lactose intolerance
o Hirschsprung disease
o Protein intolerance
Q:10-Respiratory alkalosis can develop from: Mark one answer:
o Systemic infection
o Morphine toxicity
o Administration of naloxone
o Poor nutrition
Test 20
Q:1-What is an indication for cardiopulmonary exercise testing? Mark one answer:
o Diagnosis of heart disease

o Diagnosis of chronic obstructive pulmonary disease
o Evaluation of dyspnea out of proportion to findings of static PFTs
o None of the above
Q:2-A patient complaining of tearing back pain has a pulsatile abdominal mass on physical exam. What is
the most likely diagnosis? Mark one answer:
o Gastroenteritis
o Abdominal aortic aneurysm
o Hepatitis
o None of the above
Q:3-A 33 year old male with poorly controlled diabetes mellitus type 2, obstructive sleep apnea, morbid
obesity, hypertension, and hyperlipidemia is treated with multiple medications. Given that this patient
has metabolic syndrome, select the underlying condition that should be the main focus of treatment.
Mark one answer:
o Obstructive sleep apnea

o Hypertension
o Hyperglycemia
o Obesity
Q:4-What is the risk of having an asthmatic child if both parents are asthmatic? Mark one answer: 30%
72% 13% 50%
Q:5-Which of the following is the most appropriate medical treatment of prolactinomas?

Mark one answer:
o Atropine
o Haloperidol
o Fluoxetine
o Bromocriptine
Q:6-A term infant with unremarkable delivery initially has acrocyanosis, a heart rate of 110, gasping
respirations, and poor tone. Initially, the infant is dried and stimulated, and then free flow oxygen by
mask is started. There is continued decline with progressive cyanosis, and heart rate declines to 95.
What is the appropriate intervention? Mark one answer:
o Intubation and positive pressure ventilation

o Bag valve mask with positive pressure ventilation
o Continue free flow oxygen by mask
o Begin chest compressions
Q:7-Which of the following is the most frequent indication for placement of an inferior vena cava filter?
Mark one answer:
o Chronic pulmonary hypertension

o DVT/PE in a patient with contraindication to anticoagulation therapy
o Heparin induced thrombocytopenia
o Recurrent DVT/PE while on anticoagulation therapy
Q:8-What is the best location to detect pediculosis corporis? Mark one answer:
o At the groin
o At clothing seams
o In skin folds
o At skin lesions
Q:9-What is the effect of hormone replacement therapy on a woman's lipids? Mark one answer:
o An increase in her LDL
o An increase in her HDL
o An increase in her total cholesterol
o A decrease in her HDL
Q:10-Children with Beckwith-Wiedemann syndrome are at increased risk for which of the following
pediatric malignancies? Mark one answer:
o Medulloblastoma
o Hepatoblastoma
o Acute lymphoblastic leukemia
o Retinoblastoma
Test 21
Q:1-What test is used to diagnose pheochromocytoma? Mark one answer:
o Specific gravity
o Increased protein
o Vanillylmandelic acid
o Uric acid
Q:2-What medication acts by enhancing the effect of GABA on receptors? Mark one answer:
o Naloxone
o Chloral hydrate
o Diazepam
o Ethanol
Q:3-Compare to monophasic shock for cardioversion, biphasic shock requires: Mark one answer:
o More energy
o Less energy
o Same energy
o It is variable
Q:4-Which medication is used to treat Crohn disease? Mark one answer:

o Cyclophosphamide
o Methotrexate
o Robotic surgery
o Infliximab
Q:5-A 70 year old female presents with a 60 pack year history of smoking, dry cough, dyspnea, and
chest discomfort. The lung exam shows decreased breath sounds and wheezing at the left base. Which
of the following orders should be the first priority? Mark one answer:
o Pulse oximetry
o Chest radiograph
o Pulmonary function tests
o Sputum culture
Q:6-Which is false about blood donation? Mark one answer:
o Consent is required for blood donation

o Autologous donors have to be screened for infectious organisms
o Donated blood is tested for hepatitis, syphilis, and HIV
o CMV is not a contraindication to blood donation
Q:7-Which of the following is the best initial method of removing foreign body from the ear of a child?
Mark one answer:
o Observation
o Irrigation
o ENT consultation
o Vacuum
Q:8-In a patient with yellow nail syndrome, one would expect to find which of the following?
Mark one answer:
o Infertility
o Dextrocardia
o Lymphedema
o High levels of arsenic
Q:9-Which urinary microscopic finding is indicative of glomerulonephritis? Mark one answer:
o Bacteria
o Proteinuria > 1g
o RBC casts
o WBC casts
Q:10-A patient has been complaining of left hand pain for 3 months. Examination reveals a possible
mass. Radiography reveals a "soap bubble" lesion on the metacarpal with a sharply defined border. The
patient has which of the following conditions? Mark one answer:
o Ewing sarcoma
o Osteogenic sarcoma
o Giant cell tumor
o Osteomyelitis
Test 22
Q:1-The most body water is contained in which body compartment? Mark one answer:
o Extracellular
o Intercellular
o Intracellular
o Interstitial
Q:2-Cervical dilatation pain during delivery can be relieved with what type of regional block?
Mark one answer:
o Femoral
o Inguinal
o Paracervical
o Pudendal
Q:3-Chlamydia is associated with which of the following? Mark one answer:
o Ectopic pregnancy
o Chronic pelvic pain
o Pelvic inflammatory disease
o All of them
Q:4-What is the current therapy for a 44-year-old male with newly diagnosed Hodgkin's lymphoma
localized to the mediastinum ? Mark one answer:
o Radiation with chemotherapy

o Surgery
o Radiation only
o Immune therapy
Q:5-A 32-year-old male with AIDS has headaches followed right hemiparesis. MRI shows a left frontal
white matter lesion that homogeneously enhances. What is the most likely tumor? Mark one answer:
o Kaposi sarcoma
o Primary CNS lymphoma
o Metastatic carcinoma
o Glioblastoma multiforme
Q:6-Which of the following is the most appropriate instrument to use when performing gynecologic
exam on a teenager? Mark one answer:
o Graves speculum
o Pederson speculum
o Pediatric speculum
o Vaginoscope
Q:7-To avoid travelers' diarrhea from bad food while vacationing in Mexico, one should take which of
the following drugs? Mark one answer:
o Metronidazole
o Omeprazole
o Bismuth subsalicylate
o Loperamide
Q:8-After stripping and varnishing the home, a 71-year-old man with no history of illness becomes
agitated and confused. What is the most likely diagnosis? Mark one answer:
o Depression with psychosis

o Dementia related to organic illness
o Delirium related to becoming extremely over-tired
o Delirium related to exposure to toxic substances
Q:9-Which of the following is the most likely diagnosis of a one month old infant with bilious emesis
who has a double-bubble sign on an upper GI series? Mark one answer:
o Intussusception
o Gastroenteritis
o Volvulus
o Pyloric stenosis
Q:10-In a patient with mild chest discomfort, there is an audible diastolic murmur heard over the
femoral artery when it is compressed. Which of the following may be present? Mark one answer:
o Atherosclerosis of the femoral artery

o Coarctation of aorta
o Aortic regurgitation
o Aortic aneurysm
Test 23
Q:1-A patient with a history of asthma was walking though fields. Four hours later, she developes
dyspnea, wheezing, and coughing. In the ER, she had a fever, dyspnea, tachycardia, and tachypnea. She
appears in respiratory distress and very fatigued. What is the initial drug of choice for the patient?
Mark one answer:
o Inhaled salmeterol
o Oral diphenhydramine
o Nebulized albuterol
o IV steroids
Q:2-Which is not a complication of a retropharyngeal abscess? Mark one answer:
o Atlantooccipital dislocation
o Airway obstruction
o Acute respiratory distress syndrome
o Erosion into the jugular vein
Q:3-Which of the following medications is contraindicated in a patient with asthma? Mark one answer:
o Propranolol
o Acetaminophen
o Morphine
o Albuterol
Q:4-Which signal that most suggests another is open to communication? Mark one answer:
o Crossed arms
o Leaning forward
o Focusing on an object
o Furrowed eyebrows
Q:5-What is the risk of developing uterine cancer in a woman who has complex hyperplasia with atypia
on endometrial biopsy? Mark one answer:
o 5%
o 30%
o 90%
o Not determinable without more information
Q:6-An 18-year-old female complains of a mass in her left breast. On examination, she has a very
fibrous, lumpy breast but no palpable mass is felt. Needle aspiration reveals stromal fibrosis and
sclerosing adenosis. This patient most likely has which of the following conditions? Mark one answer:
o Fat necrosis
o Lobular carcinoma in situ
o Cystosarcoma phyllodes
o Fibrocystic disease
Q:7-How long should antibiotics be given for chronic maxillary sinusitis treatment? Mark one answer:
o 7 days
o 10 days
o 2 weeks
o 3-6 weeks
Q:8-An 18-year-old asymptomatic pregnant patient is diagnosed with hyperthyroidism. What is the
treatment of choice? Mark one answer:
o Radioactive iodine thyroid ablation

o Propylthiouracil
o Methimazole
o Propranolol
Q:9-Which of the following is rarely a symptom of Sydenham chorea? Mark one answer:
o Mood disorder
o Dysarthria
o Hypertonia
o Headache
Q:10-What is the most common neurologic deficit seen with pseudomigraine with lymphocytic
pleocytosis? Mark one answer:
o Sensory changes
o Motor deficits
o Speech problems
o Visual changes
Test 24
Q:1-Which of the following is TRUE of a right side hemothorax? Mark one answer:
o May occur with spontaneous pneumothorax

o Diagnosis is always made clinically
o Most can be treated with aspiration rather than a thoracostomy tube
o Cannot be assessed until one has at least 100 cc in the chest cavity
Q:2-Which is true of acute abdomen? Mark one answer:
o Colicky pain indicates obstruction of a hollow viscus

o Should never be initially treated with narcotics before surgical evaluation
o Chest pain never mimics abdominal pain
o Most cases are treated medically
Q:3-What symptoms are associated with the medical emergency pituitary apoplexy? Mark one answer:
o Epistaxis
o Severe hypertension
o Sudden onset of headache
o Loss of visual acuity
Q:4-Which of the following is an irritant laxative? Mark one answer:
o Bethanechol
o Castor oil
o Bisacodyl
o Codeine
Q:5-Senile cataracts are related to which of the following? Mark one answer:
o Age
o Trauma
o Infection
o Autoimmune
Q:6-Which group is most likely to develop headaches lasting 15 to 180 minutes that cause the patient to
wake, do not have autonomic features, and occur more than half of days? Mark one answer:
o Teenage females
o Middle aged males
o Elderly males
o Elderly females
Q:7 -In giant cell arteritis, which vessel is usually involved? Mark one answer:
o Inferior thyroid
o Ophthalmic
o Internal carotid
o Anterior cerebral
Q:8-Which of the following is true of patients receiving oral hypoglycemic agents (OHAs) like glyburide
(Glynase Pres Tab)? Mark one answer:
o They do not need to maintain a regular schedule of meals and activity

o They are likely to maintain normal blood glucose levels
o They should discontinue use if pregnant or breastfeeding
o They may become allergic to insulin
Q:9-A 15 year old female has a 6 month history of weight loss, intermittent fevers, pain with defecation,
periumbilical abdominal pain, and diarrhea. She has seen blood per rectum on several occasions. Select
the most likely diagnosis. Mark one answer:
o Ulcerative colitis
o Laxative abuse
o Crohn disease
o Cystic fibrosis
Q:10-The oral contraceptive pill can be associated with which of the following symptoms?
Mark one answer:
o Bleeding disorders
o Diarrhea
o Glucose intolerance
o Constipation
Test 25
Q:1-Which is most important for treatment of essential hypertension? Mark one answer:
o Weight loss
o Stress reduction
o Medication compliance
o Exercise
Q:2-Which of the following is the etiology of cystic fibrosis? Mark one answer:
o Decreased factor VIII

o Epithelial chloride transport defect
o Absence of phenylalanine hydroxylase
o Hexosaminidase A defect
Q:3-What is the recommended starting dose of carbamazepine for adults? Mark one answer:
o 10 mg daily
o 10 mg twice daily
o 100 mg daily
o 100 mg twice daily
Q:4-An adult male presents with history of alcohol abuse, tobacco abuse, and hypertension and
complainins of difficulty swallowing that has been worsening for the past month, black stools, and
weight loss. What is the likely diagnosis? Mark one answer:
o Achalasia
o Gastric ulcer
o Esophageal carcinoma
o Plummer Vinson syndrome
Q:5-Esophageal webs are often seen in a patient with which of the following? Mark one answer:
o Zenker diverticulum
o Mallory Weiss
o Esophageal varices
o Plummer Vinson syndrome
Q:6-What is the recommendation for LDL cholesterol level for patient with known coronary heart
disease? Mark one answer:
o 100 mg per dL
o 120 mg per dL
o 150 mg per dL
o 200 mg per dL
Q:7-Which of the following can be a side effect of therapy with amiodarone? Mark one answer:
o Hypertension
o Pulmonary fibrosis
o Pulmonary embolus
o Congestive heart failure
Q:8-A 38-year-old bicyclist comes to the clinic with a complaint of pain while sitting on a bicycle and on a
chair for the last two years. He reports a maximum pain of 7/10, and it varies between 4/10 and 7/10.
He also complains of constipation, increased frequency of urination, and perineal numbness. Which of
the following is the best initial treatment for this patient? Mark one answer:
o Sacral neuromodulation
o Avoidance of stimulus
o Surgical decompression
o Pulsed radiofrequency ablation
Q:9-A 6-year-old male presents to the emergency department with a 5-day history of fever and cough
with subsequent development of vesicles and small bullae on the arms that spread to the face, lips and
oral gingiva. His parents deny any recent medications use, previous oral rashes. What is the next best
step in management? Mark one answer:
o Obtain a two-view chest x-ray to assess for atypical pneumonia

o Prescribe "magic mouthwash" prescription and patient education for "hand, foot and mouth"
disease
o Transfer to a burn center for an obvious case of toxic epidermal necrolysis (TEN)
o Prescribe oral acyclovir for a "bad case of herpes"
Q:10-A 3-year-old is brought in with a rash present for over a year but worse for the past few days. The
mother has tried many over-the-counter treatments with intermittent success. The child picks and
scratches constantly. The exam shows dry and excoriated skin that is thickened. There are fissures,
erosions, and crusty exudates. The worst areas are at the antecubital and popliteal fossa. A cluster of
vesicles and lymphadenopathy are noted. What may be the cause of the vesicles? Mark one answer:
*Varicella zoster * Contact dermatitis * Eczema herpeticum * Atopic dermatitis
Test 26
Q:1-A young male has a solitary indurated penile ulcer with fairly clean margins, no obvious raised
granulomatous areas, and no discoloration. It began as a hard, nonpainful nodule. Regional
lymphadenopathy is present. What is the most likely etiologic agent? Mark one answer:
o Haemophilus ducreyi
o Human papillomavirus, serotype 11
o Streptococcus pyogenes
o Treponema pallidum
Q:2-A 65-year-old woman is evaluated for a 3-day history of fever, nausea, vomiting and abdominal pain
localized to the right lower quadrant. Her past medical history is unremarkable, and she takes no
medications. On physical examination, the temperature is 39.1 C (102.4 F), blood pressure is 112/72 mm
Hg, pulse rate is 94/min, and respiration rate is 18/min. There is right lower quadrant abdominal pain
with tenderness, guarding, and rebound phenomena. The chest is clear to auscultation with no heart
murmurs. No lymphadenopathy is present. Contrast-enhanced CT scan of the abdomen and pelvis
shows acute appendicitis. No other abnormalities are seen. The patient undergoes a laparoscopic
appendectomy. Histologic examination shows acute appendicitis with a well-differentiated tumor, 1 cm
in diameter. On further evaluation, it is determined that this tumor has a neuroendocrine cell origin.
Which of the following is the most appropriate management? Mark one answer:
o No further intervention
o Indium-111 pentotreotide scan S
o treptozocin with 5-fluorouracil
o Octreotide
Q:3-A 66-year-old female presents with complaints of slowly developing pain in her limbs and difficulty
getting up from a chair over several months. Examination reveals proximal limb weakness and a red
purplish rash on her fingers and around her eyes. What is the most likely diagnosis? Mark one answer:
o Lupus
o Psoriasis
o Dermatomyositis
o Scleroderma
Q:4-A 17-year-old female is in a motor vehicle accident. She complains of a deep and aching pain and a
burning sensation in her left lower leg. A firmness of the anterior left lower leg is noted on deep
palpation. Also, there is decreased two-point discrimination. What is the definitive treatment for this
patient? Mark one answer:
* Analgesia *Leg elevation *Angioplasty * Fasciotomy
Q:5-A 17-year-old male comes to the emergency department complaining of fatigue, dyspnea, chest
pain, and syncope that occurs especially when he plays soccer. This has been going on for the past 2
weeks. He has no significant past medical history. He denies smoking, caffeine intake, tinnitus, vomiting,
or coughing. He has been taking NSAIDs regularly for the past year due to headaches that he attributes
to "being stressed out from my new job in Minnesota." On examination, BP: 120/81 mmHg, HR: 55 bpm,
RR: 18/min, and O2: 99% on room air. Skin examination: no rashes, abdominal examination: mild
epigastric tenderness but no organomegaly, chest examination: equal air entry bilaterally with no
abnormal sounds. ECG shows P waves and QRS complexes that are independent of each other. Blood
tests show antibodies to the organism in the picture. Which of the following is the most appropriate
treatment for this patients case? Mark one answer:
o Hospitalization for close monitoring with telemetry and IV amiodarone

o Hospitalization for close monitoring with telemetry and IV ceftriaxone
o Hospitalization for close monitoring with telemetry and triple therapy with clarithromycin,
amoxicillin, and lansoprazole
o Hospitalization for close monitoring with telemetry and IV lansoprazole only
Q:6-A 65-year-old man with a past medical history of hypertension and diabetes mellitus type 2 comes is
complaining of shortness of breath and occasional chest pain that comes and goes for 1 month. He
denies syncope, cough, fever, or swelling in his extremities. He has never smoked cigarettes and drinks 1
glass of wine a week. On examination, there is a systolic ejection murmur in the right second intercostal
space. His medications include hydrochlorothiazide, captopril, and metformin. ECG shows signs of left
ventricular hypertrophy, and an echocardiogram shows severe aortic stenosis. Which of the following
findings is indicative of severe valvular disease? Mark one answer:
o Wide pulse pressure

o Low-intensity second heart sound
o A single second heart sound during inspiration
o High-intensity second heart sound
Q:7-A 65-year-old male complains that an abdominal wound has not healed properly several months
after surgery. On clinical examination, the clinician observes a well-demarcated linear, erythematous,
and scaly plaque at the site of the excision. General physical examination reveals scaly plaques in his
scalp and irregular pitting of two fingernails. A biopsy of the skin plaques surrounding the wound was
taken and sent for histopathology, which demonstrated spongiform pustules, microabscesses with the
neutrophil collection in the upper epidermis. Histopathology also reveals orthokeratosis and tortuous
dilated papillary capillaries. Which of the following is the most likely diagnosis? Mark one answer:
 Lichen planus
 Wound infection
 Stitch granuloma
 Psoriasis
Q:8-A 25-year-old woman presented with slowly increasing, hypo- and hyperpigmented, atrophic, linear
marks on her upper arms. She admitted to having been applying a bleaching cream to the affected areas
for the last 2 years, which she had purchased in a pharmacy in Africa. This cream contained which of the
following ingredients? Mark one answer:
 Mercury
 Hydroquinone
 Sunscreen
 Clobetasol propionate
Q:9-A 2-year-old previously healthy child presents with a 2-day history of a rash with a temperature of
102.1F. His mother reports the rash started on the face and then spread to the rest of the body and
began blistering today. The lesions slough off with pressure and do not involve the oral mucosa. Which
of the following antibiotics is appropriate for this condition? Mark one answer:
 Ciprofloxacin
 Aztreonam
 Nafcillin
 Penicillin
Q:10-A 17-year-old male presents with a chief complaint of the worst pain of his life in his right leg. He
states that he was riding his dirt bike 2 days ago and at one point crashed into a tree sustaining a cut to
the area with a branch. He did not seek care at the time because he did not believe the injury was
serious. Vitals are temperature 102.3 F, heart rate 122 beats/min, respiratory rate 21, blood pressure
107/74 mmHg. There is a brownish discoloration of the right anterior leg along with blackish drainage
over the area. Palpable crepitus also is noted over the area and surrounding tissue. What is the most
appropriate immediate action that should be taken in this patient? Mark one answer:
 Hyperbaric oxygen therapy

 Initiate broad-spectrum antibiotics
 Begin broad-spectrum antibiotics and immediate surgical debridement
 Tourniquet
Test 27
Q:1-A 69-year-old heavy smoker presents to the emergency department with severe knife-like chest
pain and diaphoresis that woke him up from his sleep 2 hours ago. He denies being short of breath but
claims that the pain is severe, continuous, and radiates to his upper back and shoulders. His past medical
history reveals longstanding poorly controlled hypertension, diabetes, and peripheral vascular disease.
He is not compliant with his medications, smoked 1 pack of cigarettes daily for the past 30 years, and
drinks alcohol regularly. By the time the physical exam is done, the patient’s chest pain has subsided. His
blood pressure is 180/90 mm/Hg in his right arm and 120/63 mm/Hg in his left arm, pulse is 110 bpm,
respiratory rate is 18 breaths/min, and temperature is 98.8 F. He is alert. His ECG shows T-wave
inversions in leads V3 an V4. He undergoes a CT angiogram of the chest depicted in the image. What is
the next best step in the management of this patient? Mark one answer:
 Aspirin
 Esmolol
 Sodium nitroprusside
 Observation for 24 hours
Q:2-A 72-year-old female with osteoporosis presents with constant, sharp pain localized to her lower
back for the past week. She does not recall sustaining any trauma. A lumbar spine radiograph
demonstrates an ageindeterminate, wedge-shaped vertebral compression deformity. What imaging
modality is recommended to determine the chronicity of the vertebral compression fracture?
Mark one answer:
 Magnetic resonance imaging

 Computed tomography
 Dual-energy x-ray absorptiometry
 Ultrasonography
Q:3-A 7-month-old female was brought to the emergency department by her mother due to complaints
of vomiting, fussiness, and head tilt. Her birth history and perinatal course have been unremarkable. She
has been growing and developing well in the 50th percentile for height weight and head circumference.
Her symptoms are episodic with two similar incidents in the past 3 to 4 weeks. Mother denies any
diarrhea or other gastrointestinal problems. The patient appears pale and fussy. On physical
examination, her head tilts to the left, and the sternocleidomastoid muscles are symmetric with no
palpable mass. On straightening her head, she returns to the tilted posture. Her eye exam is normal,
including visual tracking, no nystagmus, and there is symmetry of facial muscles during crying. She has a
normal tone and muscular strength. Abdominal is soft, non-distended, non-tender, and no
organomegaly. What is the most likely diagnosis of this infant? Mark one answer:
 Neonatal seizure
 Paroxysmal torticollis of infancy
 Brain tumor
 Congenital muscular torticollis
Q:4-A 16-year-old male presented with fever, neck stiffness, and fatigue in early summer. Imaging of his
brain was unremarkable. He underwent lumbar puncture. Which of the following cerebrospinal fluid
profiles is most consistent with viral meningitis? Mark one answer:
 1 white blood cell (WBC), 0 red blood cells (RBC), protein 40 mg/dl, glucose 70 mg/dl
 250 WBCs, 12 RBCs, protein 85 mg/dl, glucose 65 mg/dl
Q:5-A 17-year-old girl presents to the emergency department accompanied by law enforcement. The
patient is emaciated and covered in flesh-colored, dome-shaped, pearly lesions on her trunk, thighs, and
genitalia. She was recovered in a home handcuffed to a bed during a human trafficking raid. What skin
infection is suspected? Mark one answer:
 Pityriasis rosea
 Rubella
 Molluscum contagiosum
 Chickenpox
Q:6-A 3-year-old previously healthy girl is brought to the emergency department with a 24-hour history
of vomiting. Her parents state that she has been unable to keep much down and has had 5 episodes of
nonbloody, non-bilious emesis. Her vital signs upon arrival reveal a temperature of 37.7 C, heart rate
133/min, blood pressure 93/52 mmHg, and respiratory rate of 25/min. Her current weight of 14.3 kg is
down 0.1 kg from her well-child visit two weeks ago. On exam, she is irritable but is consoled when
placed in her parent's lap and given a smartphone. She has slightly dry mucous membranes, mildly
reduced skin turgor, capillary refill of approximately 3 seconds, and slightly cool extremities. What is the
best initial step in the management of this patient? Mark one answer:
 Obtain a complete metabolic panel

 Place peripheral IV and administer 20 ml/kg isotonic fluid bolus
 Offer the child an oral rehydration drink or popsicle
 Place nasogastric tube and administer 20 ml/kg oral rehydration fluid bolus
Q:7-A 29-year-old female with a history of rhinitis presents with a one-year history of intermittent
epistaxis, nasal obstruction, and nasal crusting. Examination shows an 8 mm anterior nasal septal
perforation with moderately associated crusting. Which of the following is the least appropriate step in
the ensuing workup? Mark one answer:
 Biopsy of perforation margin

 Serum cholesterol level
 Serum erythrocyte sedimentation rate
 Serum antineutrophil cytoplasmic antibodies titers
Q:8-A 65-year-old female presents to the emergency department with the complaint of worsening
dyspnea for the past 4 months. She was perfectly fine until recently. She noticed the dyspnea when she
could not walk over the 4 blocks near her home. Initially, she was treated with a bronchodilator because
of wheezing, but it has stopped relieving her symptoms over time. She was treated in the past for an
abnormal heart rhythm, which developed when she started her thyroid medications for hypothyroidism.
She also had a remote appendectomy, cholecystectomy, radiofrequency ablation for her heart disease,
and an injury to her left ankle during a fall. She is currently on an inhaler, aspirin, thyroxine and has no
allergies. Which of the following may have contributed to her lung disease? Mark one answer:
 Methenamine
 Radiofrequency ablation
 Thyroxine
 Amiodarone
Q:9-An 8-year-old girl presents to her provider with a complaint of a painless limp. She first noticed that
she was walking differently 1 month ago, and her gait has progressively worsened since that time. The
patient is afebrile, blood pressure is 120/72 mmHg, heart rate is 70 bpm, and BMI is in the 60th
percentile. On exam, the patient has limited abduction and internal rotation of the left hip. When asked
to walk down the hallway, the patient displays an antalgic gait. X-rays are ordered and are pictured
below. What is the most likely underlying pathology? Mark one answer:
 Decreased blood flow through the medial femoral circumflex artery

 Developmental dysplasia of the hip
 Septic arthritis
 Slipped capital femoral epiphysis
Q:10-A 75-year-old male with a past medical history of hypertension, coronary artery disease, type 2
diabetes, extreme obesity, and hyperlipidemia presents to the emergency room with a complaint of
retrosternal, squeezing and pressure-like chest pain that began in his primary physician's office. No
aggravating or alleviating factors were mentioned, but similar episodes occurred last night associated
with nausea and vomiting that resolved on their own. He is found to be hypotensive, and ECG reveals
right ventricular outflow tract ventricular tachycardia (RVOT-VT) (Fig. 1) that required external
cardioversion. He is subsequently loaded with intravenous amiodarone. Bedside portable
ultrasonography reveals a proximal high pressure and distal low-pressure chamber in the right ventricle
separated by a septum. Which of the following test has a limited role in obtaining the definitive
diagnosis in this patient? Mark one answer:
 Cardiac MRI
 Cardiac catheterization
 Transthoracic echocardiography
 Transesophageal echocardiography
Test 28
Q:1-A 65-year-old female patient presented to the emergency department with progressive abdominal
distension, pain, and altered sensorium. In terms of her medical history, she has had primary biliary
cirrhosis. On physical examination, vitals are stable, but the patient is lethargic with GCS of 9/15. She
follows commands occasionally and has yellowish discoloration of the sclera, and the abdomen is
distended with 2+ pitting pedal edema. Labs are significant for macrocytic anemia with Hb of 9 g/dl and
ammonia level of 65. What medication will be helpful for her altered sensorium? Mark one answer:
 Gentamicin
 Lactulose
 Terbinafine
 Tobramycin
Q:2-A 43-year-old female presents with missing lashes from her eyelids and stubs of lashes of different
lengths. Examination of her scalp, body, eyelids, and eyes does not reveal any other abnormalities or
loss of any other hair. What is the likely diagnosis? Mark one answer:
 Alopecia areata
 Trichotillomania
 Demodex infestation
 Conjunctivitis
Q:3-A 66-year-old male presents to the emergency department with a one-day history of left lower
quadrant pain, nausea, vomiting, and fever. His temperature is measured to be 39 C, pulse 98/min and
blood pressure 102/74 mmHg. Blood tests showed an elevated WBC count. CT scan shows sigmoid wall
thickening and perisigmoid fat stranding. Which of the following is a risk factor for this patients
 Family history of similar disease

 Descendents of Ashkenazi jews
 Aflatoxin ingestion
 Low fiber and high-fat diet
Q:4-A 47-year-old female is being investigated in your clinic for left forearm symptoms that have
bothered her while she is washing dishes and do gardening over the past several months. Her vital signs
are normal and general neurologic exam is intact. Examination of the forearm reveals forearm pain,
hand weakness, and inability to make an "OK" sign. There is no sensory loss. What is the most likely
diagnosis? Mark one answer:
 Cubital tunnel syndrome

 Carpal tunnel syndrome
 Anterior interosseous syndrome
 Ulnar nerve entrapment
Q:5-A 22-year-old female presents with a history of skin lesions on her elbows. The lesions are very
pruritic and uncomfortable. She has tried numerous over-the-counter medications, but nothing has
helped. The examination reveals numerous vesicles on the extensor surfaces of both elbows. A biopsy
reveals a granular pattern of IgA deposits at the dermal-epidermal junction. What is the most likely
 Pemphigoid
 Acne
 Dermatitis herpetiformis
 Psoriasis
Q:6-A 65-year-old female presents to her healthcare provider with the complaint of a cough for six
weeks duration. She describes the cough as dry and pronounced, especially at night. This cough is
accompanied by hoarseness and sore throat. On further questioning, she reports a sensation of burning
in her chest and "indigestion" that is greater whenever she lies down. Her current medications include
lisinopril, metformin, and atorvastatin, all of which she has been using for several months. She claims to
have been a smoker for 15 years but quit recently. She denies any history of allergies, rhinorrhea,
wheezing, or difficulty breathing. Which of the following is the most likely cause of her symptoms?
Mark one answer:
 Cough variant asthma

 Upper airway cough syndrome
 Gastroesophageal reflux disease (GERD)
 Medication side effect
Q:7-A man in his 60s had a cardiac event some weeks ago and was prescribed five new medicines
including aspirin, hydrochlorothiazide, metoprolol, quinapril, and nitroglycerin. He presents with an
itchy, blistering rash confined to his upper chest, extensor arms and dorsal hands. He attributes the rash
to a fishing expedition the previous weekend. What is the most likely cause? Mark one answer:
 It is likely that contaminated sea water is the cause of the rash

 The rash may be drug-induced photosensitive eczema due to hydrochlorothiazide
 The rash is lichenoid drug eruption due to quinapril
 He has discoid eczema unrelated to the fishing expedition
Q:8-A 65-year-old female is seen in your office for chronic heel pain. Her pain is described as sharp and
burning with numbness along the plantar aspect of the foot running into the first, second, and third
toes. She has a remote history of an unspecified ankle injury over 1 year ago for which she did not seek
treatment. Physical exam reveals a positive Tinel’s sign over the medial aspect of the ankle. What is the
most likely diagnosis? Mark one answer:
 Chronic ankle instability

 Tarsal tunnel syndrome
 Peroneal tendonitis
 Achilles tendonitis
Q:9-A 16-year-old male presents to the emergency department for evaluation, 2 hours after an assault.
The patient states that he was "minding his own business" when he was punched in the head multiple
times by an unknown assailant. He complains of left ear pain. He denies loss of consciousness, hearing
difficulty, vision changes, or neck pain. Pulse is 99/min, blood pressure is 155/80 mmHg, the
temperature is 98.7 F, and oxygen saturation is 98% on room air. On examination, the patient has a
small scalp hematoma on the left side. There is no facial bone crepitus, malocclusion, hemotympanum,
tympanic membrane perforation, or septal hematoma. The patient is noted to have a lumpy appearance
of a portion of his external left ear with associated erythema and tenderness. What is the next best step
in the care of this patient's ear? Mark one answer:
 Application of a pressure dressing

 Administration of intravenous antibiotics
 Needle aspiration
 Refer to otolaryngology within 2-3 days for definitive management
Q:10-A 65-year-old male with a 40 pack-year smoking history comes in with worsening shortness of
breath on exertion. Pulmonary function tests confirm the diagnosis of chronic obstructive pulmonary
disease (COPD). Which of the following changes in his lung volumes and capacities should be expected?
Mark one answer:
 Increased total lung capacity (TLC), increased functional residual capacity (FRC), and increased
residual volume (RV)
 Increased TLC, increased FRC, and decreased RV
 Increased TLC, decreased FRC, and decreased RV
 Decreased TLC, decreased FRC, decreased RV
Test 29
Q:1-A 17-year-old female is brought in by her parents for hair loss. The patient herself is not worried.
The exam shows the part in her hair is widened with decreased hair density. The hair in the area is
coarse and of multiple different lengths. Gentle traction does not pull out any hairs. The skin of the scalp
has some light brown scales. The eyelashes show varying lengths. Which of the following would be the
most appropriate question? Mark one answer:
o Have you had a perm recently?

o Do you color your hair?
o Do you twirl or pull your hair?
o Do you have a desire to eat paper or dirt?
Q:2-A 3-year-old is brought in with a rash around the mouth, on the upper chest, and on the neck. It is
erythematous with scaling and moist red skin under the scales. There are a few fragile blisters. The
mucosa is not involved. The patient is febrile and dehydrated. The patient has no significant past
medical history and has not been on any medications. What is the most probable diagnosis?
Mark one answer:
o Staphylococcal scalded skin syndrome

o Child abuse
o Stevens-Johnson syndrome
o Toxic epidermal necrolysis
Q:3-A 17-year-old male is brought in to the emergency department after a motor vehicle accident in
which he was an unrestrained passenger. He has no significant past medical history. He reports that he
is having difficulty moving his right leg and has pain in his lower back. Examination reveals 3/5 strength
in the right lower extremity. His strength is otherwise 5/5. Which of the following exam findings would
suggest injury to the central nervous system as the cause of his right lower extremity weakness?
Mark one answer:
o A combination of weakness and numbness in the right lower extremity

o Absence of a patellar reflex in the right lower extremity
o The presence of the Babinski reflexes in the right lower extremity
o Pain with flexion and extension of the right hip
Q:4-A 28-year-old female developed itchy papules on the backs of her hands, her forearms, and anterior
chest in the evening after being outdoors for several hours. She reported that a similar rash had
occurred on several previous occasions during the spring and summer months despite applying
sunscreen products. Which of the following statements are true? Mark one answer:
o Polymorphous light eruption is a more likely diagnosis than solar urticaria

o She has an 80% chance of carrying a positive antinuclear antibody
o The most suitable long-term prophylaxis is oral prednisone 20 mg daily for three months
o This type of rash only affects patients with fair skin (Fitzpatrick skin phototype 1 and 2)
Q:5-A 17-year-old female is a frequent hiker and camper. She presents complaining of fever, chills,
headache, and rash for the past few days. On exam, she is febrile and has a maculopapular rash on her
extremities including her palms and soles. What is the most likely diagnosis? Mark one answer:
o Lyme disease
o Rocky Mountain spotted fever
o Ehrlichiosis
o Contact dermatitis
Q:6-A 65-year-old male patient presents with a 2-month history of abdominal discomfort, distention and
2 episodes of hematemesis. He denies any sick contact or travel, except for visiting the Philippines about
6 years ago where he swam in local rivers. He also reported that 1 month after the trip, he developed a
selflimiting illness where he had subjective fevers, chills, fatigue, bloody diarrhea with enlargement of
his liver. However, he did not seek medical attention and it resolved after a few weeks. His vital signs are
within normal limits. The physical exam is significant for hepatosplenomegaly. Lab work shows WBC
3700/microliter, platelets 94000/microliter, alanine aminotransferase 75 U/L, aspartate
aminotransferase 65 U/L, and alkaline phosphatase 120 U/L with normal bilirubin. CT of the abdomen
revealed hepatosplenomegaly. Kato Katz stool was positive for parasitic eggs after which he was started
on the appropriate treatment. Esophagogastroduodenoscopy was done which showed grade 2 non-
bleeding esophageal varices. Where is the likely source of this patient’s portal hypertension?
Mark one answer:
o Prehepatic
o Pre-sinusoidal intrahepatic
o Sinusoidal intrahepatic
o Posthepatic
Q:7-On your infectious disease rotation, you encounter a 3-year old patient brought to the hospital due
to anal pruritis that occurs especially at night. Upon further investigation, you learn that the patient has
a parasite infection. The patient is started on appropriate treatment. Which of the following is the
mechanism of action of the prescribed medication? Mark one answer:
o Binds to chloride ion channels in the parasite increasing Cl- permeability resulting in paralysis via
hyperpolarization.
o Inhibits tubulin polymerization resulting in the inability to form microtubules.
o Sensitizes the parasite to phagocytosis which immobilizes it.
o Causes an increased calcium permeability in the parasite leading to muscle contraction and
ultimate paralysis caused by sustained muscle contraction.
Q:8-A 37-year-old male presents to the clinic for a rash. He states the rash has been there for several
months and is itchy. He also states he has been having some joint pain in both his hands. Physical exam
reveals erythematous plaques with a silver scale on the extensor surfaces of bilateral arms and bilateral
anterior knees. He also presents with nail findings in both his finger and toenails as presented in the
image. The physician explains that this is due to the separation of the nail plate from the nail bed,
commonly seen in his condition. Which of the following best describes these findings? Mark one answer:
o Pitting
o Splinter hemorrhages
o Onychomycosis
o Onycholysis
Q:9-A 13-year-old male presents with the complaint of right knee pain for the past 2 months. He is an
avid basketball player and states his pain is worse when he is playing and relieved by rest. What
structure can be left permanently altered from this condition? Mark one answer:
o Pes anserinus
o Lateral meniscus
o Anterior collateral ligament
o Tibial tubercle
Q:10-An 8-year-old boy, in the United States, with no previous medical history, presents with his mother
for an evaluation of his scalp. The mother reports that over the last month his scalp has become scaley
and inflamed. The mother has tried over the counter shampoos and coconut oil without improvement.
The patient's pulse is 94/min, blood pressure 115/70 mmHg, respirations 12/min, and temperature
36.7°C (98°F). The physical examination reveals scaley erythematous plaques on the scalp with patchy
alopecia. Broken hair shafts that appear as black dots are also present. What is the most effective
medication for this condition? Mark one answer:
o Griseofulvin
o Terbinafine
o Permethrin
o Lindane lotion
Test 30
Q:1-A 59-year-old man presents with the complaint of diffuse rash. He states he initially developed dry
flaking scalp that "came up overnight" and spread to involve his entire head about 4 weeks ago. He has
been using over the counter pyrithione zinc shampoo with no improvement. About 2 weeks ago, he
developed a bumpy red rash on the top of her fingers followed by a diffuse red rash on the chest, back,
and abdomen. He denies recent illness or new medication use. On exam, temperature 98.6 degrees
Fahrenheit, blood pressure 118/78 mmHg, heart rate 80 beats per minute, respiratory rate 14 breaths
per minute. There is a diffuse, welldemarcated red-orange plaque with prominent follicular
hyperkeratosis on chest, abdomen, back, and extremities with intervening areas of normal skin and
orange hyperkeratotic scale on palms and soles. What is the most likely diagnosis? Mark one answer:
o Psoriasis
o Seborrheic dermatitis
o Pityriasis rubra pilaris
o Allergic contact dermatitis
Q:2-Examination of a 67-year-old female complaining of chest pain when climbing stairs reveals yellow
plaques over both sets of eyelids. She denies any symptoms associated with the plaques. A familial
history includes paternal coronary artery disease and a sibling with the same kind of lesion on her
eyelids. Which laboratory test would be most helpful in determining the origin of the lesions?
Mark one answer:
o Comprehensive metabolic profile

o Complete blood count
o Hepatic profile
o Lipid profile
Q:3-A 75-year-old male presents to the clinic with a complaint of palpitations for the past week. He
denies any associated symptoms. He has a past medical history of hypertension and diabetes mellitus
for which he takes lisinopril and metformin at home. He smokes 1 pack of cigarettes per day and drinks
1-2 beers daily. On physical exam his blood pressure is 158/90 mmHg, the pulse is irregularly irregular
with a rate of 110/min, respirations are 16/min, the temperature is 99.4-degree Fahrenheit, and pulse
oximetry is 97% on room air. A rhythm strip from his examination is provided. Which of the following
treatments is most appropriate at this time to prevent adverse effects from his arrhythmia?
Mark one answer:
o Synchronized cardioversion
o Aspirin
o Clopidogrel
o Apixaban
Q:4-A 17-year-old patient with lamellar ichthyosis presents to the office for routine evaluation. Besides
lamellar ichthyosis, she has a negative past medical history. On a daily basis, she uses emollients. She
also uses an alpha-hydroxy acid medication. Her condition can lead to what type of anhidrosis?
Mark one answer:
o Obstruction
o Idiopathic
o Central/neuropathic
o Iatrogenic
Q:5-A 17-year-old student who suddenly collapsed while playing soccer was brought to the emergency
department by emergency medical services. On arrival, he had no pulse and was in full cardiac arrest
with an ongoing cardiopulmonary resuscitation (CPR). He has no past medical history according to his
family member. He is intubated in the emergency department where good quality CPR is being
monitored by waveform capnography. The patient is connected to the cardiac monitor. What is the
most common rhythm that will be found in this condition? Mark one answer:
o Ventricular tachycardia
o Pulseless electrical activity
o Bradycardia
o Supraventricular tachycardia
Q:6-A 22-year-old male complains of worsening pain in his left wrist over the past week. The pain is
nonradiating and limited to the anterolateral portion of his wrist. He reports that his pain is mildly
improved with NSAID use, but it provides no permanent relief. Upon further questioning, he reveals that
he is a college football player and states he first experienced these symptoms after diving to catch a
pass. He has no significant past medical history and takes no other medications. His vital signs are
normal. The physical exam reveals radial-sided tenderness in his left hand with a weak pincer grasp. His
right hand appears normal. Radiographic imaging is shown below. What is the best next step in the
management of this patient's condition? Mark one answer:
o Activity modification and NSAID use

o Wrist immobilization with a cast and serial x-ray monitoring
o Local corticosteroid injection and short-term follow-up
o Surgical intervention
Q:7-A 15-year-old male presents with his mother, who is concerned about stripes on his back, which she
describes as whip marks. She says they have been present for several months. He denies having eaten
any shiitake mushrooms or pruritis in the area of concern. What treatment may be effective for this
o Topical tretinoin
o Oral antihistamines
o Topical corticosteroid
o Dermabrasion
Q:8-A 17-year-old male presents to the hospital with fever, malaise, and vision changes. Past medical
history is significant for intravenous drug use for the past three years. Ocular examination reveals
hemorrhages in the retina with white centers. What would the histological examination likely reveal?
Mark one answer:
o Lymphocytes diffusely scattered within the choroid

o Skip lesions of caseating granulomas
o Adipose tissue
o White centered lesions composed mostly of fibrin
Q:9-An 82-year-old female is brought to the emergency department from her nursing home with
complaints of frequency, urgency, dysuria, and confusion. On arrival, the patient is delirious, tachypneic
and febrile. Her blood leukocyte count is significantly elevated. All the necessary cultures are taken and
it is decided to treat the patient on a presumptive diagnosis of sepsis. Various attempts to place a
peripheral intravenous line are unsuccessful, so a central line is ordered. The intensivist performing the
central line placement is unable to place it in the internal jugular and subclavian veins. A final attempt is
made for the placement in the femoral vein. While visualizing the femoral vessel lumens with
ultrasound, which lumen should be targeted based off of anatomical location? Mark one answer:
o Medial lumen
o Lateral lumen
o Deep lumen
o Superficial lumen
Q:10-A 6-year-old male presents to the clinician for evaluation of unilateral chronic middle ear effusion.
Upon questioning the parent reveals to you that the symptoms began following an adenoidectomy
procedure in another state. Damage to which structure during the adenoidectomy procedure could
result in these findings? Mark one answer:
o Torus tubarius
o Uvula
o Posterior aspect of the vomer
o The soft palate
Test 31
Q:1-A 55-year-old male with a long history of alcohol abuse presents with generalized weakness and
fatigue. His last drink was 5 hours ago. Vitals signs are: BPL 86/54, pulse: 110, respiratory rate: 26,
temperature: 103F. Physical examination reveals dry oral mucosa and tachypnea, but no use of
accessory respiratory muscles. On auscultation of the chest, he has crackles in the right lower lobes.
Laboratory examination shows an elevated WBC count, and kidney function tests show an elevated
creatinine and BUN. ECG shows sinus tachycardia. Chest X-ray shows right lower lobe pneumonia. For
his low blood pressure, he receives a bolus of 2 liters of Ringer's lactate and is admitted to the telemetry
floor with a diagnosis of aspiration pneumonia. Appropriate cultures are drawn, and he is started on
proper antibiotics and Ringer's lactate at 150 mL/hour. After 8 hours rapid response is called as he is
very agitated and restless. He is diagnosed with delirium tremens (DTs) and receives 2 mg of lorazepam
with no improvement. He is moved to medical ICU, and 1 hour later he is sedated and intubated due to
extreme agitation and restlessness. By the second day, his blood pressure and white count improve but
he is still agitated and is kept on sedatives. He is reseated and started on tube feeds. Sedative
medications are stopped on the third day. Later that day, the patient's telemetry monitor shows an
abnormal pattern. BP is 100/55, phosphate: 2.2mEq/L (normal 2.5-4 mEq/L) and potassium is 3.2mEq/L
(normal 3.5-5mEq/L). His ECG is shown in the figure. What is the next step in the management of this
o Amiodarone
o Oral potassium
o IV Magnesium sulfate
o Reinitiate sedative medications
Q:2-A 17-year-old female presented with a 2-day history of periumbilical pain which had localized to the
right iliac fossa by the time she attended hospital. She describes the pain as sharp, constant, and
aggravated by movement. She has no bowel or urinary symptoms and no previous abdominal problems.
Her first-degree cousin died of colorectal carcinoma at a young age. Her vital signs were blood pressure
137/89 mmHg, pulse 96/min, respiratory rate 18/min, and temperature 100.6 F. Physical examination
was unremarkable except for a mild tenderness in the right iliac fossa. Complete blood count (CBC)
showed leukocytosis with left shift. Which of the following is the next best step in the management of
this patient? Mark one answer:
o Ultrasound abdomen (USG)

o Contrast-enhanced CT abdomen (CECT)
o Plain CT abdomen
o Proceed for laparoscopic appendectomy
Q:3-A 38-year-old male presents with the complaint of dark brown, velvety eruption underneath his
armpits. It is neither painful nor itchy. He noticed the eruption a few weeks ago but is not sure if it was
always present. He thinks that it is due to staying out in the sun for too much time. He has had a weight
loss of 2 kg in the past 2 months but believes that his diet and exercise regimen has helped him reduce
his weight. His family history is unremarkable. On examination, his vital signs are blood pressure 120/70
mmHg, pulse 60/min, and a temperature of 97.7F. BMI is 30. What is the next best step in the
management of this patient? Mark one answer:
o Topical corticosteroids
o CT scan of stomach
o Blood glucose levels
o Blood creatinine kinase (CK) levels
Q:4-A patient is admitted to the hospital because of watery diarrhea, abdominal pain, nausea, and
diffuse abdominal tenderness but no rigidity. He states he has been taking antibiotics for a skin
infection. Further investigations include colonoscopy seen in the image. It reveals histological evidence
of colitis. An abdominal x-ray shows dilatation of the transverse colon with a colonic diameter over 6 cm
at the point of maximum dilatation. The patient has tachycardia of 110 beats per minute and
leukocytosis of 11.5 x109/L. Which one of the following is most likely to be the cause of his
presentation? Mark one answer:
o Inflammatory bowel disease

o Campylobacter colitis
o Pseudomembranous colitis
o Microscopic colitis
Q:5-A 65-year-old African American female presents to the clinic for new changes in her vision. Her
previous ocular history was unremarkable. Her past medical history is significant for chronic back pain.
Ocular examination revealed the retinal vasculature was mildly dilated and tortuous in both eyes, with
minimal crossing changes. Additionally, there were multiple, deep, round retinal hemorrhages, with
distinctively white centers, mostly located in the midperiphery of both eyes. Few subhyaloid
hemorrhages were appreciated as well. A fluorescein angiogram was done which ruled out retinal
venous occlusions and showed no evidence of vasculitis. Blood pressure was measured in the clinic and
was 125/69 mmHg. The complete cardiac workup was negative. What further testing is needed?
Mark one answer:

o Urinary analysis
o Thyroid testing
o Observation with no further tests
Q:6-A 70-year-old obese male presents to his provider with a chief complaint of temporary loss of vision.
The painless transient vision loss lasted for 2 minutes and only presented in his left eye. He has never
experienced anything like this before. After further workup, he was found to have Hollenhorst plaques
in his retina. What is his most likely diagnosis? Mark one answer:
o Sickle cell anemia

o Amaurosis fugax
o Central retinal artery occlusion
o Temporal arteritis
Q:7-A 17-year-old male presents after a recent vacation to Brazil. During this trip, the patient spent a
night in a village where he was bitten by a kissing bug. He has subsequently developed fever, malaise
and a 4 cm area of induration with a surrounding rash near his left orbit. What is the next step in the
evaluation of this patient? Mark one answer:
o Urinalysis with microscopy

o Skin scraping with KOH prep
o Slit lamp exam with fluorescein
o Blood smear with Giemsa stain
Q:8-A 65-year-old man has a long history of stable chronic plaque psoriasis. He presents with an
exacerbation of psoriasis, which is extending to new sites and causing more itch than usual. She also has
a past medical history of hypertension for which was taking a combination drug, including valsartan and
hydrochlorothiazide. Recently, her clinician changed her medication for hypertension. Which of the
following medications started a few weeks earlier may have caused his psoriasis to flare?
Mark one answer:
o Losartan
o Metoprolol
o Furosemide
o Aspirin
Q:9-A 16-year-old has returned from a mission trip. He has been home for 30 days. He has developed a
fever, abdominal pain, constipation, and weakness. On physical exam, a rose-colored rash is seen on the
chest. Which of the following is the most likely cause of the patient's condition? Mark one answer:
o Typhoid fever
o Hepatitis
o Measles
o Chicken pox
Q:10-A pregnant patient has an extensive pustular eruption that forms along the margins of
erythematous patches. What is the most likely diagnosis? Mark one answer:
o Generalized pustular psoriasis

o Pruritic urticarial papules and plaques of pregnancy
o Prurigo gravidarum
o Intrahepatic cholestasis of pregnancy
Test 32
Q:1-A 6-year-old male has a 10-day history of a rash and sore throat. The patient has had no fevers or
upper respiratory symptoms. The patient has erythema of the posterior pharynx and 1- to 10-millimeter
erythematous plaques over the trunk in a random pattern. A rapid strep screen is positive, and the
patient is treated with antibiotics. What should the parents be told about the rash? Mark one answer:
o It will clear within 2 weeks and not recur

o It will improve but may persist for life
o It is contagious and the rest of the family will need to watch for signs of the rash
o There will be post inflammatory depigmentation
Q:2-A 51-year-old male presents with a complaint of unilateral sharp shooting pain in his jaw that
radiates to the ear, leading to difficulty in swallowing. He also reports ringing in his ear. The turning of
the neck exacerbate the symptoms. His blood pressure is 150/90 mmHg, random blood sugar is 170
mg/dl — no history of trauma or any other lesions in the ear or mouth. The examining provider explains
to the patient that this a rare type of lesion which is seen in the suprahyoid muscles. What is the most
likely cause of this patient's symptoms? Mark one answer:
o Damage to the nerve supplying the digastric muscle

o Development abnormality of the geniohyoid muscle
o Vascular damage to the mylohyoid muscle
o Ossification of the ligament of the stylohyoid muscle
Q:3-A patient presents with hair loss in a well-defined area that started 3 weeks ago. The patient has no
other complaints or significant medical history. On the exam, there is a 2 x 2-centimeter area without
hair in the parietal area. The skin is smooth and without erythema. The hairs at the borders of the lesion
come out with minimal traction. What is the most probable diagnosis? Mark one answer:
o Tinea capitis
o Alopecia areata
o Lichen planopilaris
o Telogen effluvium
Q:4-A 65-year-old white male presents to his primary care provider for a routine physical examination.
He has a history of hypertension, hypercholesterolemia, type 2 diabetes mellitus, and emphysema.
Medications include losartan, rosuvastatin, and metformin. Blood pressure is 142/76 mmHg, heart rate
72 bpm, and temperature 98.8 F. Physical examination is within normal limits other than the findings
shown in the attached figure. Swabbing of the lesion is most likely to reveal which of the following
microorganisms? Mark one answer:
o Candida albicans
o Bacteroides
o Peptostreptococcus
o Aspergillus fumigatus
Q:5-A patient presents with complaints of fatigue and shortness of breath. The patient says this has
been worsening for the past several months, and they have begun to notice swelling in their legs. The
past medical history includes a myocardial infarction with subsequent heart catheterization 6 years ago.
The patient also has longstanding hypertension and is not adherent with medications at this time. An
echocardiogram shows an ejection fraction of 35%. What is the most likely diagnosis? Mark one answer:
o Restrictive cardiomyopathy
o Diastolic heart failure
o Systolic heart failure
Q:6-A 67-year-old male presents with a vague history of not feeling well, anxiety, and restlessness. He
has had several admissions over the past few months for falls, hypoglycemia, and abdominal discomfort.
He simply is unable to provide any type of medical history, and his medical chart is not yet available. On
a physical exam, you note that he has tachypnea, marked gynecomastia, and spider angiomas. What is
the initial working diagnosis? Mark one answer:
o Opioid abuse
o Testicular cancer
o Alcohol use disorder
o Digoxin overdose
Q:7-Based on the National Comprehensive Cancer Network (NCCN) guidelines, which of the following
patients should not be offered genetic testing for hereditary breast and ovarian cancer syndrome?
Mark one answer:
o A 61-year-old woman who develops infiltrating ductal carcinoma which is triple negative
o A 44-year-old woman who develops infiltrating ductal carcinoma which is estrogen and
progesterone receptor positive
o A 61-year old woman who previously who was previously diagnosed with ovarian cancer and
who develops infiltrating ductal carcinoma
o A 44-year-old woman with whose father had breast cancer and who develops infiltrating ductal
carcinoma which is estrogen receptor positive
Q:8-A 66-year-old female presents to the emergency department complaining of intense pain on the
right lower extremity from the toes to the calf. She has a history of hypertension, coronary artery
disease, and diabetes. The patient states that the pain had a sudden onset, and she woke up with a
burning sensation of the leg. The pain is only alleviated when the patient lets the leg hanging on the
edge of the bed. Physical exam of the right lower extremity shows an absence of distal pulses, cold skin,
and abnormal sensory exam. What is the next best step in the management of this patient?
Mark one answer:
o Arterial duplex ultrasound of the right lower extremity

o D-dimer and venous ultrasound of the right lower extremity
o Pain control and referral to the vascular clinic for workup of peripheral arterial disease
o Vascular surgery consultation
Q:9-The patient is a 75-year-old male with a past medical history of hypertension, diabetes mellitus,
coronary artery disease status post coronary artery bypass grafts, and history of inferior vena cava (IVC)
filter placement who presents to the emergency department with a chief complaint of shortness of
breath. Physical examination reveals lungs that are clear to auscultation bilaterally, cardiac exam shows
regular rate and rhythm, normal S1, S2, no murmurs. EKG was obtained showing sinus tachycardia. CT of
the chest with contrast was obtained showing bilateral pulmonary emboli. The patient was started on
intravenous heparin. What is the next step in management? Mark one answer:
o Doppler ultrasound bilateral lower extremities

o CT abdomen and pelvis
o Abdominal ultrasound evaluating the IVC
o MRI of abdomen and pelvis
Q:10-A 17-year-old with daily cannabis use presents with refractory cyclical vomiting and abdominal
pain. She reports chronic cannabis use. Which of the following may relieve her symptoms?
Mark one answer:
o Cold bathing
o Capsaicin cream
o Increasing use of marijuana
o H2 blocker
Test 33
Q:1-A 39-year-old female comes to the office with complaints of right-hand pain for the last 3 days. She
is a gardener by profession and has no significant past medical history. On further questioning, she
indicates that she has pain at the base of her right thumb. The provider passively stretches her thumb
ulnarly while keeping her forearm at the edge of the table. She endorses exacerbation of her pain. What
structures are involved during this maneuver? Mark one answer:
o Extensor carpi radialis brevis

o Extensor pollicis brevis and abductor pollicis longus
o Flexor digitorum superficialis
o Extensor carpi ulnaris and flexor carpi ulnaris
Q:2-A 34-year-old female with a past medical history of Graves disease presents to your clinic for a 1
year follow up. Her current hyperthyroidism medications include methimazole. Lab results indicate that
the methimazole has failed to achieve euthyroid status. The patient inquires about radioactive iodine
therapy (RAI) as a means of treating her hyperthyroidism. What should be ordered before initiating RAI
therapy? Mark one answer:
o A repeat thyroid stimulating hormone for confirmation

o A renal panel
o A hepatitis panel
o Serum beta-hCG
Q:3-A 34-year-old Asian woman reported a history of losing weight and cough over a period of 5
months. On examination, she was anemic and on auscultation left apical crackles were noted. Her chest
x-ray revealed left apical shadowing with cavitation. What is the next stage in her management?
Mark one answer:
o A chest CT scan and infectious disease serological panel

o Tuberculin skin test and sputum culture
o Bronchoscopy and histology of bronchial secretions
o HIV ELISA test
Q:4-A one-year-old toddler presented with tonic-clonic generalized seizures. Magnetic resonance
imaging (MRI) of the brain revealed a high riding third ventricle and "Racing car sign." Which of the
following is the most common intracranial abnormality associated with the primary diagnosis in this
child? Mark one answer:
o Lipoma of the interhemispheric fissure

o Encephalocele
o Interhemispheric cyst with hydrocephalus
o Dandy-Walker malformation
Q:5-A 65-year-old female with a history of hyperlipidemia and type 2 diabetes mellitus comes for a
routine check-up. She complains of fatigue at times, but other than that has no other symptoms. She
takes 2-3 alcoholic drinks per day, drinks 3 cups of coffee, and smokes 3 cigarettes per day with coffee.
Her medications include atorvastatin and insulin. The physical exam is unremarkable except for her BMI,
which is 39 kg/m. Her labs show an alanine aminotransferase (ALT) of 62 U/L, aspartate
aminotransferase (AST) of 38 U/L, bilirubin of 0.2 mg/dL and albumin of 4.5 g/dL. Her hepatitis A, B, and
C panel is negative. She mentions that her lab values have always been in this range, and she is not
worried about them. What is the most appropriate next step in the management of this patient?
Mark one answer:
o Increase the dose of atorvastatin

o Stop atorvastatin
o Advise weight loss
o Stop alcohol intake
Q:6-A 55-year gentleman is pulled out from a house fire with heavy smoke. He presents to the
emergency department with a decreased level of consciousness, gasping for air with cherry-red skin
color. His blood pressure is 96/59 mmHg, oxygen saturation 95%, heart rate 99 bpm, respiratory rate 11
breaths per minute, with high anion-gap metabolic acidosis. An electrocardiography reveals atrial
fibrillation. Which is the best first-line management for this patient after providing supportive care?
Mark one answer:
o Deferoxamine
o Cyanocobalamin
o Hydroxocobalamin
o Beta-blocker
Q:7-A 40-year-old male presents with symptoms of weight gain, myalgia, and swollen extremities. His
labs showed a thyroid stimulating hormone (TSH) of 107.6 IU/ml, unmeasurable free thyroxine (T4).
Exam shows hypertrophy of extremities. His creatinine is at 0.89 mg/dL and electrolytes were within
normal limits. What is the best initial treatment of this patient? Mark one answer:
o High dose corticosteroids

o Low dose corticosteroids
o NSAIDs and warm compresses
o Levothyroxine
Q:8-A 65-year-old male presented with complaints of chest pain, fatigue, fever, sweats, and generalized
body aches for the past week. His past medical history is significant for uncontrolled diabetes mellitus
and rheumatic heart disease. On presentation, his vitals are heart rate 105/min, blood pressure 100/45
mmHg, temperature 101 F, and oxygen saturation of 91% at room air. On physical examination, he looks
pale, has fine crepitations at the base of the lungs, and bilateral pedal edema. He is admitted, and
diagnostic workup is started with the suspicion of acute infective endocarditis. Throughout his disease,
the patient's condition continues to deteriorate, showing an inadequate response to antimicrobial
therapy and develops an atrioventricular conduction block on EKG. What is the next best diagnostic
imaging study to evaluate the patient? Mark one answer:
o Transthoracic echocardiography
o Transesophageal echocardiography
o Cardiac CT
o Chest x-ray
Q:9-A 12-year-old female presents to the emergency department with 5 days of worsening right lower
quadrant abdominal pain. She has had a fever of 101.7 F at home, heart rate of 96 bpm, and otherwise,
her vitals are normal. She has focal discomfort in the right lower quadrant without rebound tenderness
and is asking for food. She is not sexually active and has not had menarche. An ultrasound of the right
lower quadrant shows a complex fluid collection near the cecum, with a fecalith present in the
collection. What is the best immediate intervention for this problem? Mark one answer:
o Laparoscopic appendectomy
o Interventional radiology guided drain placement
o Laparotomy
o Observation
Q:10-A 65-year-old male presents to the clinic, with the chief complaints of weakness and fatigue. He
has a history of smoking for the past 25 years. On examination, muscle weakness was present in the
limbs. The repetitive nerve stimulation test at high rates showed considerable increment in the
response. Which disease is associated with his muscle weakness? Mark one answer:
o Benign prostate hypertrop

o Polyneuropathy
o Lung cancer
o Myasthenia gravis
Test 34
Q:1-An 85-year-old man was hospitalized because of acute exacerbation of chronic obstructive lung
disease secondary to lung infection. He has a history of chronic bronchitis, heart failure with reduced
ejection fraction, hypertension and coronary artery disease. On the following night, his blood pressure
dropped to 80/65 mm/Hg. He was started on a one-liter normal saline fluid bolus. After 30 minutes, his
repeated blood pressure was 82/64 mm/Hg. On evaluation, the patient is feeling dizzy and not-fully
comprehensive but denies any ongoing chest pain. Pulse is 85 /min and oxygen saturation 84% on room
air. Chest examination shows bilateral fine crackles and jugular venous distention. The rest of the
examination is unremarkable. The patient is started on oxygen therapy and his oxygen saturation
improved to 90%. He is transferred to the intensive care unit, and bedside ultrasound shows dilated
inferior vena cava. Bloodwork reveals worsened kidney function and elevated troponin. Which of the
following is the next best step in the management of this patient? Mark one answer:
o Continue fluid resuscitation with another 1 L fluid bolus

o Start him on loading dose loop diuretic followed by a diuretic infusion
o Start him on aspirin and heparin drip
o Proceed with venous ultrafiltration
Q:2-An 80-year-old female presents to the emergency department with worsening shortness of breath
over the past 2 days. She denies associated fevers or cough. She has a past medical history of idiopathic
pulmonary fibrosis, chronic hypoxemic respiratory failure, chronic kidney disease, and ischemic
cardiomyopathy. Her home medications include atorvastatin, aspirin, metoprolol, nintedanib, and
nitroglycerin as needed or chest pain. She uses 3 L of oxygen at home. On examination, she is in mild
respiratory distress. Her jugular venous pressure is elevated. Crackles are heard bilaterally. She has 2+
pitting edema. Her vitals are the following: BP 134/82 mmHg, HR 100 bpm, T 99.1 F, and sat 88% on 3L
oxygen. She has a 6 lb weight increase from her baseline weight. A chest x-ray showed diffused
interstitial chronic fibrotic changes. A CT scan shows stable interstitial fibrotic changes with
superimposed edema, and an echocardiogram shows reduced ejection fraction. What is the best next
step in management? Mark one answer:
o High dose corticosteroids

o Referral for a lung transplant
o Bronchodilators
o Furosemide
Q:3-A 35-year-old male patient comes to the clinic for evaluation of diarrhea that has been occurring
intermittently for the last five days. Which of the following is most consistent with a diagnosis of osmotic
diarrhea in this patient? Mark one answer:
o Diarrhea does not occur after a 2-day fast

o Diarrhea is constant throughout the day and night
o Diarrhea contains large amounts of blood and mucus
o Diarrhea is accompanied by fever and nausea
Q:4-A 40-year-old patient presents with a constant dull pharyngeal pain, localized to the left tonsillar
fossa over the last several months. Occasionally her pain is referred to the ear, and she reports the pain
is aggravated by rotation of the head. Additionally, there is reported dysphagia, odynophagia, and
ipsilateral headaches. She is afebrile with otherwise normal vitals and a normal neurologic examination.
A welldemarcated bony mass is palpated on examination of the affected tonsillar fossa, and pressing on
this structure seems to reproduce her symptoms. What is the next best step in management?
Mark one answer:
o Refer the patient to otorhinolaryngology

o CT imaging and analgesics
o Preparing the operating suite for emergent airway management
o Discharge home with antibiotics
Q:5-A 17-year-old girl presents with complaints of feeling "depressed, and cold" in the last 2 weeks. She
has no significant medical history. She asks, "How can I be so fat, and still feel so cold?". She reports that
she goes for running 2 hours every day, which helps her to warm up. Her father has major depressive
disorder, and her mother is healthy. Physical examination shows a thin young girl, wearing an extra layer
of clothing, with dry skin, brittle hair, and nails. Temperature is 36.2 C, blood pressure is 95/60 mmHg,
and the pulse is 52/min. BMI is 17.3 Kg/m2. Which of the following is the most appropriate treatment
for this patient? Mark one answer:
*Olanzapine *Cognitive-behavioral therapy *Thyroxine *Fluoxetine
Q:6-A 33-year old post-partum female presents with tenderness in her right breast. She mentions that
her right breast suddenly developed discoloration and was painful to the touch. She denies any trauma
or use of any medications. She has no history of breast cancer. Examination reveals prominent and
engorged superficial veins over the lateral aspect of the breast area. Palpating the breast area over
these veins is associated with pain. How will you manage this patient? Mark one answer:
o Order a mammogram
o Fine needle biopsy
o Warm compress and ibuprofen
o Reduction mammoplasty
Q:7-A 61-year-old male with a past medical history significant for alcoholic cirrhosis of the liver is
brought to the emergency department by ambulance for altered mental status. He appears lethargic
and is unable to coherently answer questions. His speech is slurred. He is not oriented to place or time.
On exam, he exhibits a "hand-flapping" tremor. Serum ammonia is 300 micromoles/liter. What
medication will improve this patient's mental status? Mark one answer:
*Quetiapine *Flumazenil * Memantine *Donepezil
Q:8-A 15-year-old male with a past medical history of cystic fibrosis is hospitalized for an acute
respiratory tract infection. He has lost 10 lbs in 1 month despite maintaining a high caloric diet. He
denies any polyuria or polydipsia. He had three 2-hour postprandial plasma glucose levels of 210 mg/dL.
He had two-morning fasting plasma glucose of 130 mg/dL and 145 mg/dL during his hospitalization. The
hemoglobin A1c level is 6.8%. Urine analysis reveals trace ketones. What is the most likely diagnosis?
Mark one answer:
o Type 2 diabetes and cystic fibrosis

o Cystic fibrosis-related diabetes
o Type 1 diabetes and cystic fibrosis
o Monogenetic diabetes
Q:9-A patient with mild, persistent asthma has been well controlled with low-dose inhaled
corticosteroids. He presents for follow up complaining of some limitation with normal activities and
needing albuterol for symptom relief 3 to 4 days per week over the past month. Which of the following
is the preferred next step? Mark one answer:
o Begin an oral corticosteroid burst

o Medium-dose inhaled corticosteroid
o Add a leukotriene receptor antagonist
o Begin omalizumab
Q:10-An 11-year-old African American male is brought in by his mother, who is concerned about the fact
that the patient wets the bed 1 or 2 times per week. Mother states that this has been an issue for the
past four years, but she thought it was a behavioral problem and tried to discipline the child without any
response. The mother decided to bring the patient for medical evaluation after he had 1 episode of
daytime incontinence three days ago. Which of the following comorbidities is most likely to be present
in the patient? Mark one answer:
o Sickle cell disease

o Gastroesophageal reflux disease
o Aortic stenosis
o Wilson disease
Test 35
Q:1-A 10-year-old male presents to the clinic with his father complaining of itchiness, runny nose, and
watery eyes for the past two weeks. The father reports the symptoms are worse during the pollen
season. The child was given cetirizine, which provided some relief but made the child sleepy during the
daytime. Allergic rhinitis is suspected. Which of the following is the next best step in the management of
o Triamcinolone ointment
o Nasal decongestant
o Intranasal triamcinolone spray
o Nasal saline
Q:2-A 45-year-old business executive with a high-stress job presents with epigastric pain which is dull,
chronic, and lasting for hours during the day with no radiation. Bloating, diarrhea and occasional nausea
have been present off and on for months. The physical examination reveals epigastric tenderness. He
has read about Helicobacter pylori infection on the internet and wants to see if he should be tested for
it. What group of patients below should all be tested for H pylori? Mark one answer:
o Any person with epigastric pain of more than 1 month and undiagnosed nausea
o Active peptic ulcer disease or chronic peptic ulcer disease treated with proton pump inhibitor
o Low-grade gastric mucosa-associated lymphoid tissue (MALT) and late gastric cancer
o Any unexplained gastrointestinal symptoms such as nausea, bloating, pain, dyspepsia, bleeding
Q:3-An 18-year-old male in college with a history of anxiety, attention deficit hyperactivity disorder,
insomnia, and daily chronic cannabis use comes in to see his provider for a follow-up. Since starting a
parttime job, he is required to have a primary care physician and had arranged a physical. Over a series
of visits, psychotropics are discussed, psychotherapy is initiated, and he is counseled about the
detrimental effects of marijuana on his mental health. He is ready to quit and would like
recommendations as to how he should approach this as prior attempts have failed. What is the most
likely risk for failing the cessation of marijuana? Mark one answer:
o Impulsivity
o Fear of losing their job
o Fear of academic repercussions
o Discomfort tolerating the cessation
Q:4-A patient presents with a long history of recurrent painful lesions under her armpit. The lesions
started as a mild rash, which slowly evolved into large acne-like lesions. The lesions are painful to touch
and produce discharge. She has been on multiple antibiotic courses for her lesions which will mildly
help, but never resolve the condition. Her lesions have been present for at least 6 months. Examination
reveals a dozen erythematous tender papules about 1 cm in diameter. There is notable discharge from
some nodules and the patient is exquisitely tender to light palpation. Which of the following accurately
describes the pathogenesis of this condition? Mark one
answer:
o Genetic mutation
o Sexually transmitted disease
o Relapsing and remitting folliculitis
o Chronic inflammatory disorder of the apocrine glands
Q:5-A 66-year-old female presents with complaints of slowly developing pain in her limbs and difficulty
getting up from a chair over several months. Examination reveals proximal limb weakness and a red
purplish rash on her fingers and around her eyes. What is the most likely diagnosis? Mark one answer:
* Lupus *Psoriasis *Dermatomyositis *Scleroderma
Q:6-A 3-year-old is brought in with a rash around the mouth, on the upper chest, and on the neck. It is
erythematous with scaling and moist red skin under the scales. There are a few fragile blisters. The
mucosa is not involved. The patient is febrile and dehydrated. The patient has no significant past
medical history and has not been on any medications. What is the most probable diagnosis?
Mark one answer:
o Staphylococcal scalded skin syndrome

o Child abuse
o Stevens-Johnson syndrome
o Toxic epidermal necrolysis
Q:7-A 6-year-old male presents to the clinician for evaluation of unilateral chronic middle ear effusion.
Upon questioning the parent reveals to you that the symptoms began following an adenoidectomy
procedure in another state. Damage to which structure during the adenoidectomy procedure could
result in these findings? Mark one answer:
o Torus tubarius
o Uvula
o Posterior aspect of the vomer
o The soft palate
Q:8-A young male has a solitary indurated penile ulcer with fairly clean margins, no obvious raised
granulomatous areas, and no discoloration. It began as a hard, nonpainful nodule. Regional
lymphadenopathy is present. What is the most likely etiologic agent? Mark one answer:
o Haemophilus ducrey
o Human papillomavirus, serotype 11
o Streptococcus pyogenes
o Treponema pallidumd
Q:9-A 66-year-old male sustained a fall and landed on his right shoulder three days ago. He presents to
the clinic due to an inability to move his right shoulder due to pain. The physician administers a
subacromial injection and recommends follow up after. The patient returns and reports persistent pain
and loss of abduction past 80 degrees. Which of the following would indicate the most likely pathology?
Mark one answer:
o Inability to abduct the pronated arm against resistance in the scapular plane
o Inability to create an A-OK sign with the thumb and index finger
o Palpation of a bulge in the anterior arm at the biceps muscle belly
o Inability to abduct the fingers against resistance
Q:10-A 16-year-old male presented with fever, neck stiffness, and fatigue in early summer. Imaging of
his brain was unremarkable. He underwent lumbar puncture. Which of the following cerebrospinal fluid
profiles is most consistent with viral meningitis? Mark one answer:
o 1 white blood cell (WBC), 0 red blood cells (RBC), protein 40 mg/dl, glucose 70 mg/dl
o 250 WBCs, 12 RBCs, protein 85 mg/dl, glucose 65 mg/dl
Test 36
Q:1-A 70-year-old obese male presents to his provider with a chief complaint of temporary loss of vision.
The painless transient vision loss lasted for 2 minutes and only presented in his left eye. He has never
experienced anything like this before. After further workup, he was found to have Hollenhorst plaques
in his retina. What is his most likely diagnosis? Mark one answer:
o Sickle cell anemia

o Amaurosis fugax
o Central retinal artery occlusion
o Temporal arteritis
Q:2-A 17-year-old patient with lamellar ichthyosis presents to the office for routine evaluation. Besides
lamellar ichthyosis, she has a negative past medical history. On a daily basis, she uses emollients. She
also uses an alpha-hydroxy acid medication. Her condition can lead to what type of anhidrosis?
Mark one answer:
o Obstruction
o Idiopathic
o Central/neuropathic
o Iatrogenic
Q:3-A 17-year-old male is brought in to the emergency department after a motor vehicle accident in
which he was an unrestrained passenger. He has no significant past medical history. He reports that he
is having difficulty moving his right leg and has pain in his lower back. Examination reveals 3/5 strength
in the right lower extremity. His strength is otherwise 5/5. Which of the following exam findings would
suggest injury to the central nervous system as the cause of his right lower extremity weakness?
Mark one answer:
o A combination of weakness and numbness in the right lower extremity

o Absence of a patellar reflex in the right lower extremity
o The presence of the Babinski reflexes in the right lower extremity
o Pain with flexion and extension of the right hip
Q:4-A 13-year-old male presents with the complaint of right knee pain for the past 2 months. He is an
avid basketball player and states his pain is worse when he is playing and relieved by rest. What
structure can be left permanently altered from this condition? Mark one answer:
o Pes anserinus
o Lateral meniscus
o Anterior collateral ligament
o Tibial tubercle
Q:5-A 65-year-old male presents to the emergency department with acute shortness of breath. He is
unresponsive and hemodynamically unstable. A portable chest x-ray reveals bilateral pleural effusions.
Bedside echocardiogram reveals a flailed mitral leaflet with a left ventricular ejection fraction of 25%.
His last echocardiogram performed 6 months prior showed an ejection fraction of 52%. Despite optimal
medical therapy, the patient continues to deteriorate and requires immediate mitral valve surgery. On
postoperative day 2, the patient is recovering well until he becomes unresponsive again. Repeat imaging
demonstrated a normal mitral valve with a normal ejection fraction. A 12-lead electrocardiogram reveals
regular but dissociated atrial and ventricular rhythms and the likely source for his current unresponsive
state. Which of the following is most likely demonstrated on the electrocardiogram? Mark one answer:
o First degree AV block

o Atrial fibrillation
o Second degree AV block Mobitz type 1
o Third degree AV block
Q:6-A 3-year-old previously healthy girl is brought to the emergency department with a 24-hour history
of vomiting. Her parents state that she has been unable to keep much down and has had 5 episodes of
nonbloody, non-bilious emesis. Her vital signs upon arrival reveal a temperature of 37.7 C, heart rate
133/min, blood pressure 93/52 mmHg, and respiratory rate of 25/min. Her current weight of 14.3 kg is
down 0.1 kg from her well-child visit two weeks ago. On exam, she is irritable but is consoled when
placed in her parent's lap and given a smartphone. She has slightly dry mucous membranes, mildly
reduced skin turgor, capillary refill of approximately 3 seconds, and slightly cool extremities. What is the
best initial step in the management of this patient? Mark one answer:
o Obtain a complete metabolic panel

o Place peripheral IV and administer 20 ml/kg isotonic fluid bolus
o Offer the child an oral rehydration drink or popsicle
o Place nasogastric tube and administer 20 ml/kg oral rehydration fluid bolus
Q:7-An 8-year-old girl presents to her provider with a complaint of a painless limp. She first noticed that
she was walking differently 1 month ago, and her gait has progressively worsened since that time. The
patient is afebrile, blood pressure is 120/72 mmHg, heart rate is 70 bpm, and BMI is in the 60th
percentile. On exam, the patient has limited abduction and internal rotation of the left hip. When asked
to walk down the hallway, the patient displays an antalgic gait. X-rays are ordered and are pictured
below. What is the most likely underlying pathology? Mark one answer:
o Decreased blood flow through the medial femoral circumflex artery

o Developmental dysplasia of the hip
o Septic arthritis
o Slipped capital femoral epiphysis
Q:8-A 25-year-old man, landscaper, presents to the office complaining of pruritic lesions on his left foot.
The patient has no known medical conditions. He smokes a half a pack of cigarettes per day and does
not drink alcohol. On physical examination, multiple serpiginous, reddish-brown tracks are seen on his
left foot. He acknowledges working on a beach project lately. If the patient's clinical findings are due to a
parasitic infection, which drug can be given to treat him? Mark one answer:
o Ivermectin
o Cefuroxime
o Diethylcarbamazine
o Sodium stibogluconate
Q:9-A 35-year-old male was brought in to the emergency department after an assault with a
pocketknife. He suffered multiple stab wounds, including penetrating injury on the right side of his neck.
On physical examination, weakness is noted on one side of his body, along with an impaired sense of
position and pressure sensation. He has right-sided ptosis and anisocoria. He is unable to appreciate
pain and temperature sensation on the left side. MR imaging revealed a transaction at the level of C5
and C6 of the spinal cord. Which side of the body will show weakness and deficits in the dorsal column
system? Mark one answer:
o The weakness of the left side and altered pressure, vibration, and proprioception on the right
o The weakness of the right side and altered pressure, vibration and proprioception on the left
side
o The bilateral weakness of the arms
o The weakness of the right side and altered pressure, vibration and proprioception
Q:10-A 55-year-old patient with alcohol use disorder arrives unconscious with a very elevated blood
alcohol level. He has a blood pressure of 75/40 mmHg, a pulse of 120 bpm, and a hemoglobin of 9 g/dl.
On examination, he has ecchymosis around the flanks bilaterally. Bedside ultrasound shows no visible
intraabdominal bleeding, and a chest x-ray is negative. Repeat hemoglobin shows a further drop in
hemoglobin. Rectal examination shows no bleeding or melena, and there is no sign of external bleeding.
A nasogastric tube shows no gastric blood. Which of the following is the most likely source for the drop
in hemoglobin? Mark one answer:
o Massive upper gastrointestinal bleeding

o Massive lower gastrointestinal bleeding
o Retroperitoneal bleeding
o Microangiopathic hemolytic anemia
Test 37
Q:1-A 65-year-old male presents to the emergency department with the sudden onset of flashes and
floaters. There is no evidence of ocular trauma. On further questioning, he describes a loss of vision like
a curtain being pulled down across his visual field. A dilated fundus exam confirms the detachment of
light-sensitive tissue of the eye. Which of the following provides blood supply to the disrupted
structure? Mark one answer:
o Choriocapillaris and central retinal artery

o Anterior ciliary artery and choriocapillaris
o Anterior ciliary artery, choriocapillaris, and central retinal artery
o Anterior ciliary and central retinal arteries
Q:2-A 17-year-old male presents after a recent vacation to Brazil. During this trip, the patient spent a
night in a village where he was bitten by a kissing bug. He has subsequently developed fever, malaise
and a 4 cm area of induration with a surrounding rash near his left orbit. What is the next step in the
evaluation of this patient? Mark one answer:
o Urinalysis with microscopy

o Skin scraping with KOH prep
o Slit lamp exam with fluorescein
o Blood smear with Giemsa stain
Q:3-A 17-year-old female is brought in by her parents for hair loss. The patient herself is not worried.
The exam shows the part in her hair is widened with decreased hair density. The hair in the area is
coarse and of multiple different lengths. Gentle traction does not pull out any hairs. The skin of the scalp
has some light brown scales. The eyelashes show varying lengths. Which of the following would be the
most appropriate question? Mark one answer:
o Have you had a perm recently?

o Do you color your hair?
o Do you twirl or pull your hair?
o Do you have a desire to eat paper or dirt?
Q:4-Examination of a 67-year-old female complaining of chest pain when climbing stairs reveals yellow
plaques over both sets of eyelids. She denies any symptoms associated with the plaques. A familial
history includes paternal coronary artery disease and a sibling with the same kind of lesion on her
eyelids. Which laboratory test would be most helpful in determining the origin of the lesions?
Mark one answer:
o Comprehensive metabolic profile

o Hepatic profile
o Lipid profile
Q:5-A 69-year-old female presents to the emergency department with a complaint of dyspnea. Chest
radiography reveals a large right pleural effusion. The provider performs a thoracentesis but incorrectly
guides the needle under the eighth rib, rather than above the rib. Which of the following is the greatest
direct risk due to incorrect needle placement? Mark one answer:
o Artery of Adamkiewicz
o 9th intercostal artery
o 8th intercostal artery
o Posterior spinal artery
Q:6-A patient presents with hair loss in a well-defined area that started 3 weeks ago. The patient has no
other complaints or significant medical history. On the exam, there is a 2 x 2-centimeter area without
hair in the parietal area. The skin is smooth and without erythema. The hairs at the borders of the lesion
come out with minimal traction. What is the most probable diagnosis? Mark one answer:
o Tinea capitis
o Alopecia areata
o Lichen planopilaris
o Telogen effluvium
Q:7-On your infectious disease rotation, you encounter a 3-year old patient brought to the hospital due
to anal pruritis that occurs especially at night. Upon further investigation, you learn that the patient has
a parasite infection. The patient is started on appropriate treatment. Which of the following is the
mechanism of action of the prescribed medication? Mark one answer:
o Binds to chloride ion channels in the parasite increasing Cl- permeability resulting in paralysis via
hyperpolarization.
o Inhibits tubulin polymerization resulting in the inability to form microtubules.
o Sensitizes the parasite to phagocytosis which immobilizes it.
o Causes an increased calcium permeability in the parasite leading to muscle contraction and
ultimate paralysis caused by sustained muscle contraction.
Q:8-A 16-year-old has returned from a mission trip. He has been home for 30 days. He has developed a
fever, abdominal pain, constipation, and weakness. On physical exam, a rose-colored rash is seen on the
chest. Which of the following is the most likely cause of the patient's condition? Mark one answer:
*Typhoid fever * Hepatitis * Measles *Chicken pox
Q:9-A 78-year-old male presents to the clinic with constipation, left-sided abdominal pain, and weight
loss for about two weeks. A colonoscopy reveals a dilated tortuous blood vessel in the wall of the
descending colon without bleeding. Which of the following structures has the highest prevalence of this
finding on an endoscopic procedure? Mark one answer:
o Esophagus
o Right colon
o Small intestine
o Left colon
Q:10-A 65-year-old female presents to her healthcare provider with the complaint of a cough for six
weeks duration. She describes the cough as dry and pronounced, especially at night. This cough is
accompanied by hoarseness and sore throat. On further questioning, she reports a sensation of burning
in her chest and "indigestion" that is greater whenever she lies down. Her current medications include
lisinopril, metformin, and atorvastatin, all of which she has been using for several months. She claims to
have been a smoker for 15 years but quit recently. She denies any history of allergies, rhinorrhea,
wheezing, or difficulty breathing. Which of the following is the most likely cause of her symptoms?
Mark one answer:
o Cough variant asthma

o Upper airway cough syndrome
o Gastroesophageal reflux disease (GERD)
o Medication side effect
Test 38
Q:1-A 47-year-old female is being investigated in your clinic for left forearm symptoms that have
bothered her while she is washing dishes and do gardening over the past several months. Her vital signs
are normal and general neurologic exam is intact. Examination of the forearm reveals forearm pain,
hand weakness, and inability to make an "OK" sign. There is no sensory loss. What is the most likely
o Cubital tunnel syndrome

o Carpal tunnel syndrome
o Anterior interosseous syndrome
o Ulnar nerve entrapment
Q:2-A 33-year old patient with AIDS is seen in the eye clinic. He previously was examined because it was
suspected that he had developed HIV retinopathy. What is the most common eye finding in these
patients? Mark one answer:
o Conjunctivitis
o Punctate keratitis
o Cotton wool spots
o Papilledema
Q:3-A 3-year-old is brought in with a rash present for over a year but worse for the past few days. The
mother has tried many over-the-counter treatments with intermittent success. The child picks and
scratches constantly. The exam shows dry and excoriated skin that is thickened. There are fissures,
erosions, and crusty exudates. The worst areas are at the antecubital and popliteal fossa. A cluster of
vesicles and lymphadenopathy are noted. What may be the cause of the vesicles? Mark one answer:
o Varicella zoster
o Contact dermatitis
o Eczema herpeticum
o Atopic dermatitis
Q:4-A 20-year-old female with inherited bone marrow failure syndrome is undergoing evaluation for
stem cell transplant. Her older brother was recently confirmed to be a match. The patient has received
transfusions: one unit of packed red blood cells and two units of platelets in the last two years from
anonymous donors. Medications are acyclovir and trimethoprim/sulfamethoxazole. Vitals including
orthostatic blood pressure is stable. Physical examination reveals a well-developed female with
conjunctival pallor, dried blood in nares, and petechiae over bilateral anterior legs. Labs are notable for
hemoglobin 7.0 mg/dL, platelets 10000/microL, reticulocyte 0.5%, and white blood cell count
2100/microL with 30% polymorphonuclear leukocytes (PMNs). Cytomegalovirus (CMV) IgG and IgM
antibodies are negative. Which of the following is the most appropriate next step in management?
Mark one answer:
o One unit leukoreduced platelets from a cross-matched unrelated donor

o One unit leukoreduced CMV-negative platelets from a cross-matched unrelated donor
o One unit leukoreduced CMV-negative platelets from the patient’s older brother
o One unit each platelet and red blood cells, both leukoreduced and CMV-negative, from a cross-
matched unrelated donor
Q:5-A patient presents with chronic fatigue and trouble breathing. Upon inspection, you note
peripheral edema and significant jugular venous pressure. The patient has had longstanding
hypertension with exertional fatigue, which has been worsening over the past several years. The patient
has not been adherent to medications. What is the most common cause of this patient's heart failure?
Mark one answer:
o Left-sided heart failure

o Pulmonary hypertension
o Renal failure
Q:6-A 65-year-old man with a past medical history of inflammatory bowel disease and congestive heart
failure comes to the emergency department due to abdominal pain and diarrhea that been present for
four days. He appears to be dehydrated and is found to have hypotension, fever, and heart rate of
125/min. The complete blood count shows WBC of 15,000 cells/mcL. An abdominal x-ray done on
admission shows left colon dilation of 7cm. A few days ago, he was started on a new medication. What is
the most likely medication that could have precipitated his current medical problem? Mark
one answer:
* Oxycodone * Spironolactone * Ibuprofen *Cobalamin
Q:7-A 49-year-old male presents with a cyclical headache that occurs when he wakes up. He reports
attempting to go back to sleep under the covers. He has no significant past medical history, and his
physical exam is benign. He has had prior work-up for this headache, which includes routine lab work
such as a basic metabolic panel, complete blood count, erythrocyte sedimentation rate, and C-reactive
protein, which were all within normal limits. He recently underwent an MRI of the brain with, and
without contrast which did not reveal any evidence of a brain mass and was found to be normal as well.
In terms of the suspected diagnosis for this patient, what is the prognosis in patients that are treated?
Mark one answer:
o Life expectancy of 6 months

o Complete remission of headache
o Incomplete remission with many relapses
o Spontaneous remission without any treatment
Q:8-A 5-year-old boy is brought in for infected bug bites on the legs and facial puffiness. The patient has
periorbital edema and excoriated, crusted lesions on both legs. Select the next step in management.
Mark one answer:
o Oral cephalexin for the skin infection

o Complete blood count and electron spin resonance
o Urinalysis
o Oral corticosteroids
Q:9-A 48-year-old woman, in her oncological control for breast cancer, undergoes a screening
colonoscopy. She is found to have multiple hamartomatous polyps throughout the colon. She reports
that her father died of colon cancer. She has a personal history of fibrocystic mammary disease, thyroid
nodules, and lipomas in the back and abdomen. According to hereditary colorectal cancer, which of the
following would you suspect? Mark one answer:
o Lynch syndrome
o Turcot syndrome type I
o Cowden syndrome
o Hamartoma tumor syndrome
Q:10-Rubbing a brownish macule produces a wheal. This is diagnostic of what condition?

Mark one answer:
o Neurofibromatosis
o Tuberous sclerosis
o Addison's disease
o Urticaria pigmentosa
Test 39
Q:1-A 44-year-old female presents to your clinic with fatigue and weakness. She states that over the
past 2 years she has been feeling increasingly tired and having difficulty with her everyday tasks. She
also has gained 15 pounds despite trying to lose weight. Her past medical history is significant for
Sjogren syndrome, which was diagnosed 20 years ago and has been treated medically. On physical
exam, she has dry skin, notable hair loss, and nonpitting lower extremity edema. Her neck exam reveals
a rubbery, nontender goiter. Her thyroid-stimulating hormone levels are increased. What is the most
likely diagnosis? Mark one answer:
o Graves disease
o Hashimoto thyroiditis
o Subacute thyroiditis
o Depression
Q:2-A 24-year-old male presents with recurrent episodes of pain and swelling of the first metatarsal.
After a detailed physical examination and relevant laboratory tests, the patient is placed on a
medication that prevents the synthesis of uric acid from its precursor. Which of the following would be
elevated in the serum of this patient due to this medication? Mark one answer:
o Urate
o Xanthine
o Allantoin
o Uricase
Q:3-A 31-year-old female presents to the provider complaining of her inability to conceive over the past
14 months. She reports having regular unprotected sexual intercourse with her husband for the past 14
months without success. She states that the onset of her periods was at the age of 12. Since it started,
her menstrual cycles have come at regular intervals. Her husband has no documented infertility. On
today’s exam, her temperature is 98.5°F (36.9°C), the pulse is 72 bpm, blood pressure is 118/82 mmHg,
and respirations are 16. The patient has a BMI of 26.5 and does not use alcohol or tobacco. She does not
have a significant past medical or surgical history of note, and her only daily medication is a prenatal
vitamin. Which of the following options would be the least important in the workup of this patient’s
infertility? Mark one answer:
o Semen analysis to detect male factor infertility

o Perform an endometrial biopsy to look for chronic endometritis
o Evaluate the uterus and the tubes via a hysterosalpingogram
o Laboratory tests to evaluate for ovarian insufficiency or an ovulatory disorder
Q:4-An elderly female patient presents with localized lower back pain that was not relieved with back
surgery. She describes the pain as throbbing, non-radiating, and presents in a band-like pattern around
her lower back. She rates the pain an 8/10 when worse but denies any fecal or urinary incontinence.
Which of the following etiologies is most likely in this patient? Mark one answer:
o Foraminal stenosis with numbness at left S1 distribution

o Epidural fibrosis with a burning sensation at right L4 nerve distribution
o Disc herniation with occasional tingling at the left foot
o Facet arthropathy with positive facet loading
Q:5-A 65-year-old female with a history of hypertension, hyperlipidemia, end-stage renal disease, and
recently diagnosed symptomatic aortic stenosis presents to the clinic for evaluation of treatment
options. Which of the following is recommended at this time? Mark one answer:
o Surgical replacement
o Transcatheter replacement
o Medical therapy
o Serial echocardiography
Q:6-A 30-year-old woman presents with right eye vision loss and pain worsened with eye movement,
which started four days ago. She has a history of left eye blurry vision two years ago that resolved after
one month, as well as numbness and tingling of her left arm six months ago that resolved after three
weeks. MRI of brain and orbit with and without contrast reveals a single lesion. Which of the following
would be expected on examination? Mark one answer:
o Dilation of the left pupil when light is shone in the left eye during the swinging flashlight test
o Dilation of the right pupil when light is shone in the right eye during the swinging flashlight test
o Dilation of the left pupil when light is shone in both eyes during the swinging flashlight test
o Dilation of the right pupil when light is shone in the left eye during the swinging flashlight test
Q:7-A 15-year-old patient reports pain in the left leg while playing basketball two weeks ago. On exam,
his left thigh circumference is same as his right, but his left mid-calf is 2.6 cm greater than the right, and
there is some discoloration just above the medial aspect of the ankle. What is the most likely diagnosis?
Mark one answer:
o Deep vein thrombosis

o Baker cyst
o Ruptured medial head of gastrocnemius
o Popliteal artery aneurysm
Q:8-A patient presents with symptoms of gastric reflux disease. He has had both an upper endoscopy
and a barium swallow including work up to exclude heart disease. He continues to have intermittent
mid-epigastric pain. What is the most definitive test to diagnose the patient’s condition? Mark
one answer:
o Esophageal manometry
o 24-hour pH monitoring
o Bernstein’s test
o Holter monitoring
Q:9-A 35-year-old male presents with right elbow pain after falling during a golf tournament this past
weekend. Examination reveals a tender joint over the olecranon without any limitations in range of
motion. Minimal swelling and no erythema are noted on exam over the olecranon along the area of the
bursa. A radiograph of the joint is normal. A bursa aspirate reveals less than 1,000 white blood cells/HPF
and blood levels of C-reactive protein and erythrocyte sedimentation rate (ESR) are normal without any
elevation. What is the most appropriate next step in management for the patient's likely condition?
Mark one answer:
o Outpatient oral doxycycline

o Admission for further MRI evaluation
o Rest, ice, compression, elevation, and NSAIDs
o Splint and orthopedic follow up as an outpatient
Q:10-A 12-month-old female is brought to the clinician for the first time. She was born at term via
cesarian section due to breech delivery. She had an unremarkable prenatal and post-natal course except
for congenital muscular torticollis which was identified at the age of 4 weeks and since then has been
receiving physical therapy. The mother mentions she has been compliant with the exercises, but there is
minimal improvement. Which of the following is the next best step in the management of this patient?
Mark one answer:
o CT scan
o MRI
o Cervical spine radiography
o Ultrasonography of the neck
Test 40
Q:1-A 24-year-old female, who is an amateur marathon runner presents with running-induced bilateral
leg pain. She states she has never had this before and is frustrated that she is not able to maintain her
training due to the pain. The physical exam is notable for tenderness along 6.0 cm of the distal
posteromedial border of both lower extremities, increased navicular drop with normal findings on hip,
knee, and ankle exams, and the range of motion is also within normal limits. Which of the following is a
risk factor for this patient's condition? Mark one answer:
o Increased ankle plantarflexion

o Decreased hip extension
o Male gender
o Increased navicular drop
Q:2-A 65-year-old previously healthy woman comes to her healthcare provider for a follow-up
evaluation of retrosternal pain for two months. The pain worsens after heavy meals and upon lying
down on the bed at night. She has taken oral omeprazole for several months without any relief of her
symptoms. She is a chronic smoker for 15 years. Esophagogastroduodenoscopy shows distal esophageal
ulcerations. A biopsy of the distal esophagus shows the presence of columnar epithelium with goblet
cells. What is the most likely etiology of this change? Mark one answer:
o Chronic irritation
o Infection by a microorganism
o Increasing age
o Drug effect
Q:3-A 22-year-old female presents with difficulty sleeping for the past 4 months. She admits to taking
several school exams and increased stress. She also states that she has lost 5 pounds but has been
eating normally. On physical exam, she appears anxious and has a diffusely enlarged, nontender thyroid
gland. Her thyroidstimulating hormone levels are low, and her radioactive iodine uptake scan shows
increased uptake. What is the most likely diagnosis? Mark one answer:
o Graves Disease
o Hashimoto thyroiditis
o Primary insomnia
o Subacute thyroiditis
Q:4-A 27-year-old female presents with a 3-week history of cough, congestion, and fevers. She has been
using over-the-counter decongestant nasal spray since the onset of her symptoms. She states her cough
and fevers have resolved, but she continues to have a thin nasal discharge that seems to be worsening.
What would be the most appropriate recommendation for this patient's current symptoms?
Mark one answer:
o A course of antibiotics for probable bacterial sinusitis

o Continue nasal decongestants until symptoms resolve completely
o Skin allergy testing
o Cessation of nasal decongestants
Q:5-A 53-year-old female with a medical history of hypertension is being evaluated for an annual exam.
She is being treated with lisinopril and amlodipine for hypertension. She has no current complaints and
feels well. She does not smoke and denies any alcohol or illicit drug use. She is active and bikes for 20-30
minutes, 4-5 times per week. A physical examination is normal. Her blood pressure is 126/72 mmHg, and
the pulse is 72 beats per minute. Her laboratory test reveals total cholesterol of 160 milligrams per
deciliter (mg/dl), highdensity lipoprotein of 33mg/dl, low-density lipoprotein of 110 mg/dl, and
triglycerides 138 mg/dl. Which of the following is the next best step in the management of this patient?
Mark one answer:
o Begin moderate-intensity statin

o Calculate the 10-year arteriosclerotic cardiovascular disease (ASCVD) risk
o Begin high-intensity statin
o Repeat the lipid levels in 3 years
Q:6-A 72-year-old male patient presents to the clinic due to severe pain in his ear that is associated with
discharge. The patient has a history of poorly controlled diabetes for the last 20 years. On examination,
granulations are seen in the external auditory canal. Moreover, the patient has symptoms of facial nerve
palsy. Which of the following is the most appropriate therapy for the patient's condition?
Mark one answer:
* Amoxicillin and metronidazole * Vancomycin *Clarithromycin * Ciprofloxacin
Q:7-A 45-year-old patient with hyperlipidemia, obesity, and hypertension asks for dietary advice. She is
told to primarily eat plant-based food including vegetables, fruit, and whole grains. Instead of butter,
she is to use canola or olive oil. Fish and seafood should be consumed twice a month while red meat and
sweets should be limited. Which lipid parameter change is most likely? Mark one answer:
o Increased HDL
o Decreased LDL
o Decreased HDL
o Increased LDL
Q:8-A patient presents with concerns about persisting skin lesions and is seeking medical treatment. She
has been following a strict regimen of cleaning her face without clearance of the bumps. She denies
smoking and does not take any medications. Examination reveals mild comedones on the chin and
forehead. Which of the following would be the first-line treatment for her? Mark one answer:
o Topical tretinoin and benzoyl peroxide

o Topical retinoid
o Oral retinoid
o Oral retinoid and benzoyl peroxide
Q:9-A young mother brings her 3-year old son to the clinic because she discovered a mass in his
abdomen. The child has been irritable and complaining of pain in his abdomen. Two days ago she
noticed some blood in his urine. Physical exam reveals a palpable abdominal mass. CT scan suggests that
there is a 6 x 6 cm mass arising from the right kidney. What type of tumor is most common in children?
Mark one answer:
o Adenocarcinoma
o Wilms tumor
o Neuroblastoma
o Pheochromocytoma
Q:10-A 40-year-old female with two prior miscarriages and one vaginal birth presents with persistent
vaginal bleeding for 2 weeks, and 2 ultrasound scans with intrauterine gestational sac without cardiac
activity. Her HCG 6 days ago was 2557 UI/I and 850 UI/I 2 days ago. On pelvic exam, she has mild
bleeding and a closed os. Repeat ultrasound today showed a gestational sac without cardiac activity, and
her HCG was now 400 UI/I. She denies any fevers, vaginal discharge, or dysuria. The woman expresses
her wishes to watchful waiting. Based on the diagnosis, how long could one safely wait before advising
surgical intervention? Mark one answer:
*One week * Two weeks * Six weeks * Four weeks
Test 41
Q:1-Travis is bitten by his dog "Old Yeller". The dog had recently fended off an attack by a wild wolf.
Travis presents to the emergency department with grimaced facial expression, generalized muscle
spasms associated with severe pain, drooling, uncontrolled urination and defecation, and back arching
spasm. He has moderate respiratory distress. What is the best approach to making the diagnosis?
Mark one answer:
o Clinical history and physical

o Wound culture
o Immunofluorescent staining
o Tetanospasmin immunoassay
Q:2-What is the most common symptom of bladder cancer? Mark one answer:
o Urinary incontinence
o Hematuria
o Flank pain
o Urinary frequency
Q:3-A 25-year-old man presents to the emergency department with nausea, malaise, headache,
lethargy, and confusion. His vital signs are blood pressure of 131/82 mmHg, temperature of 98.6 F, and
pulse of 85 beats per minute. The patient’s laboratory values are sodium 120 mmol/L, potassium 4
mmol/L, magnesium 1 mmol/L, and glucose 5 mmol/L. The patient has a history of seizures, and he was
prescribed oxcarbazepine four months ago for treatment. Which of the following is the most likely cause
of this patient's presentation? Mark one answer:
o Hypoglycemia
o Hypokalemia
o Hyponatremia
o Hypomagnesemia
Q:4-A 52-year-old woman with a history of total abdominal hysterectomy for multiple uterine fibroids
presents to the office with worsening menopausal symptoms. She states that after having the total
hysterectomy 3 years ago, she has been on conjugated estrogen 0.3 mg daily which has not relieved her
menopausal symptoms. She reports worsening symptoms over the last few months, with disrupted
sleep due to "sweating through my sheets." What is the next best step in managing this patient’s
worsening symptoms? Mark one answer:
o Keep the current dose and allow for maximum efficacy to occur
o Adjust the current regimen to the 0.6 mg per day
o Increase the current estrogen dose gradually
o Abdominal CT scan
Q:5-A 44-year-old male presents complaining of difficulty rotating his neck to the left. Upon physical
exam, there are palpate several taut bands in his left cervical paraspinal musculature. Which of the
following qualities is most characteristic of the diagnosis? Mark one answer:
o Vesicles overlying the skin

o Muscle twitch in response to palpation
o Warmth and redness at the site of the taut bands
o Radiation of pain with palpation
Q:6-A 6-year-old boy presents to the emergency department with right arm pain. He holds his arm
straight and cries when his mother touches him. There is no laceration or bruises. According to his
mother, the pain started after his mother pulled his hand while going upstairs. What is the most likely
diagnosis in this patient? Mark one answer:
o Radial head fracture

o Child abuse
o Tendinitis
o Radial head subluxation
Q:7-A 3-year-old male is brought to a clinic by his mother for high-grade fever and sore throat for the
past five days. His 20-year-old cousin had visited the house about a week ago and had the same illness.
On physical examination, the patient has a fever of 104 F with a heart rate of 98 bpm, and blood
pressure of 108/70 mmHg. Throat examination revealed enlarged tonsils. There is also submandibular
lymphadenopathy and hepatosplenomegaly. The child was initially treated with amoxicillin which led to
the development of a maculopapular rash on the body, so the medication was immediately stopped.
Laboratory workup showed a hemoglobin of 11.0 mg/dl, white blood cell count of 15,000
cells/microliter with more than 50% lymphocytes. A peripheral blood film showed about 13% atypical
lymphocytes. What is the next most appropriate course of action? Mark one answer:
o Obtain a monospot test

o Obtain Epstein-Barr virus antibody titers
o Prescribe ampicillin
o Refer the patient to otorhinolaryngology surgeon for tonsillectomy
Q:8-A 35-year-old otherwise healthy male presents for a follow up of a cough of three weeks duration.
He was seen two weeks prior for a runny nose, low-grade fever, cough, and myalgias. He was treated
symptomatically with antipyretics and antitussives. Vital signs and physical exam are within normal
limits. The patient is requesting for antibiotics to be prescribed as the cough has been prolonged. What
is the most appropriate course of action? Mark one answer:
* Codeine * Antibiotics * Beta-agonists * Reassurance
Q:9-A 65-year-old female with a history of chronic obstructive pulmonary disease presents to the
emergency department with shortness of breath and increased sputum production. She is treated with
nebulized bronchodilator therapy and oxygen, with gradual improvement in her dyspnea. Further review
shows that she was admitted to the hospital earlier this year with the same complaint and diagnosis.
According to the American College of Chest Physicians, what is indicated at this time to prevent her
frequent readmissions? Mark one answer:
o Long-term macrolide therapy

o Lon-term systemic corticosteroid therapy
o Continuous oxygen therapy
o Nebulized bronchodilator therapy
Q:10-A 26-year-old female patient referred for evaluation of galactorrhea. She has no significant past
medical history and is not on any medications. Her menstrual cycles are regular. She first noticed the
milk discharge a year ago. Of late, she has been having spontaneous galactorrhea and has been affecting
her social life. Physical examination is unremarkable. Prolactin level was normal at 15 (0-25 ng/dl). Basic
metabolic panel, thyroid stimulating hormone (TSH), pregnancy test were all unremarkable. Magnetic
resonance imaging of the pituitary gland is normal. What is the next step in management?
Mark one answer:
o Repeat prolactin levels in 1 month

o Serial dilution of prolactin to assess "hook effect"
o Start treatment with dopamine agonists
o Refer to psychiatry for treatment of depression
Test 42
Q:1-A 17-year-old woman is evaluated for low potassium in the serum. She does not have specific
complaints except for occasional weakness. On the physical exam, her body mass index (BMI) is 22
kg/m2, her blood pressure (BP) is 98/55 mmHg, heart rate 86/min, chest exam is normal, and abdominal
exam is normal. Laboratory data show: sodium of 142 mEq/L, potassium of 3.0 mEq/L, bicarbonate of 32
mEq/L, creatinine of 0.8 mg/dl, and magnesium of 1.0 mg/dl (normal range 1.7-2.1 mg/dl). The
healthcare provider requests urine electrolytes. Which of the urine electrolytes are significant in this
o Urine sodium, and chloride

o Urine sodium, chloride and potassium
o Urine sodium, chloride, potassium, and calcium
o Urine sodium, chloride, potassium, and magnesium
Q:2-A 25-year-old female presents with vague lower abdominal pain and bleeding per vagina. She says
she has not been feeling well for the past 3 days. She had unprotected sexual intercourse 6 weeks ago.
The physical reveals a diffusely tender abdomen and a positive pregnancy test. An ultrasound scan
reveals an empty uterus. Which of the following is known to be a risk factor for her condition?
Mark one answer:
o Pelvic inflammatory disease

o Use of skin patch for contraception
o Dilatation and curettage
o Systemic lupus erythematosus
Q:3-A 65-year-old female presents to the emergency department complaining of progressively

worsening shortness of breath, bilateral lower extremity edema, and orthopnea. A new murmur is heard
on the exam. A transthoracic echocardiogram was completed, which revealed a "hockey stick
appearance" of the mitral valve. What is the title of the name of the criteria used to identify the
predisposing cause? Mark one answer:
o Jones criteria
o DSM criteria
o Brugada criteria
o Modified Duke
Q:4-A 12-hours-old female baby with ambiguous genitalia is under evaluation in the newborn nursery.
The pregnancy was uncomplicated, and the mother was not taking any medications other than prenatal
vitamins. The provider examines the baby and notes a phallus which is 2 cm in stretched length, a 1 mm
orifice at the base of the phallus, no visible vaginal opening, and no palpable gonads. The rest of the
physical examination is unremarkable. Which of the following enzymes is most likely to be deficient in
o 11-beta-hydroxylase
o 17-OH progesterone
o 17-a- hydroxylase
o 21-hydroxylase
Q:5-A 40-year-old female presents to the clinic for follow up. She has had two prior miscarriages and
one vaginal birth. She has no history of medical problems such as bleeding disorders or anemia. She
currently complains of persistent vaginal bleeding for two weeks, and ultrasound shows intrauterine
gestational sac without cardiac activity. Her hCG was 850 IUI/I 2 days ago. She denies any pain, fever,
vaginal discharge or dysuria. The patient has normal vital signs. Her hemoglobin is within normal limits
as well. Her blood type is O-negative. Which of the following is the next best step in the management of
o Discharge home after administration of anti-D antibodies

o Discharge home with close OB/GYN follow up
o Admit to OB/GYN for emergent dilatation and curettage
o Admit to OBGYN for serial HCG levels
Q:6-A 10-year-old girl presents to the clinic for multiple hypochromic lesions on her face, trunk, and
extremities. Family history is positive for vitiligo. Physical examination reveals disseminated and sharply
demarcated hypopigmented plaques, with some lesions showing evidence of sclerosis. Which of the
following is the next best step in the management of this patient? Mark one answer:
o Diagnose her with vitiligo

o Reassess in three months
o Skin biopsy
o Mucosal and genital examinations
Q:7-A 65-year-old male with a past medical history of hypertension, diabetes mellitus type 2, chronic
kidney disease stage III, presents to the clinic for a well visit. He has no complaints and reports exercising
regularly. His laboratory evaluation reveals hemoglobin of 9.9 g/dL, mean corpuscular volume of 85 fL,
with 35% transferrin saturation and a ferritin level of 600 ng/mL. His methylmalonic acid and
homocysteine levels are normal. His last colonoscopy was 8 years ago at which time 3 hyperplastic
polyps were removed. What is the likely cause of his anemia? Mark one answer:
o Vitamin B-12 deficiency

o Iron deficiency
o Folic acid deficiency
o Anemia of chronic disease
Q:8-A 43-year-old man developed type 1 diabetes after having a pancreatic injury from a motorcycle
accident when he was 25. He is on insulin, and his blood sugars are usually well controlled. He comes in
for nausea, occasional vomiting, and early satiety that started over one year ago. He has not lost weight
but is having problems maintaining his blood sugars due to the vomiting. He also complains of
occasional abdominal pain after a meal, mainly when he eats out at his favorite burger joint. Which of
the following factors will help improve the patient's symptoms? Mark one answer:
o Eating more cold foods as opposed to warm foods

o Increasing the liquid component of the food
o Eating simple carbohydrates and fats with high caloric content
o Eating three regular meals that meet the caloric intake fully, instead of snacking on smaller
meals throughout the day
Q:9-A 45-year-old female presented to the office with the complaint of tiredness throughout the day for
the past three months. She has no significant past medical history. Review of the systems is negative.
Lab results are unremarkable. No cause of her tiredness is found. What should be the next step in this
case? Mark one answer:
o Patient education
o Repeat complete blood count
o Psychiatry referral
o Confront the patient about malingering
Q:10-A 30-year old female patient with diabetes mellitus presents to the emergency department with
pain, itching, and a sensation of fullness in her ear of 2 days duration. Examination of the ear reveals
moderate edema, erythema, and narrowing of the external auditory canal. There is also a trace of a
serous discharge. Gram stain and culture disclose the presence of a gram-negative rod motile organism.
Which of the following is the most appropriate antibiotic agent to treat this condition?
Mark one answer:
o Trimethoprim-sulfamethoxazole
o Doxycycline
o Ciprofloxacin
o Vancomycin
Test 43
Q:1-A 17-year-old female presents in the emergency department with complaints of constipation, high-
grade fever, and abdominal pain for the past twelve days. On examination, the healthcare provider
observes macular red-purplish spots on the lower chest. There is also tenderness in the abdomen. What
can be the most common complication of the disease, if not properly treated? Mark one answer:
o Brain abscess
o Intestinal perforation
o Hepatomegaly
o Appendicitis
Q:2-A 24-year-old female presents with a complaint of pain her right elbow. She is an amateur tennis
player at has been working hard to make the team at the local university. On physical exam, she has
pain about the lateral epicondyle. When resisted wrist extension is performed, she is unable to resist a
volar force due to pain. What is the most likely diagnosis for this patient? Mark one answer:
o Medial epicondylitis
o Lateral epicondylitis
o Extensor digitorum communis tenosynovitis
o Radial tunnel syndrome
Q:3-Many theories have been postulated concerning the pathogenesis of chronic traumatic
encephalopathy (CTE) to date. Many types of research are being undertaken to solve this missing link in
the pathogenesis. The most logical theory advocating the pathogenesis of CTE has been linked to which
one of the following? Mark one answer:
o Glutamate toxicity
o Inflammatory cascades
o Immuno-excitotoxicity
o Disruption of the blood-brain barrier
Q:4-A 35-year-old female presents with 3 months of joint pain. Initially, the pain was in her feet but then
moved to her hands and wrists. She reports morning stiffness and 4/10, constant, dull pain in her hands
and wrists bilaterally for several hours a day. The pain is worse when she wakes up and better after
moving around for an hour or two. She otherwise is healthy and takes a vitamin supplement daily. On
physical exam, she has signs of synovitis in a total of seven metacarpophalangeal and proximal
interphalangeal joints bilaterally. There are no signs of synovitis in her feet. What diagnostic test should
be done next? Mark one answer:
o X-rays of her hands and wrists bilaterally

o X-rays of her cervical spine
o Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP)
o C-reactive protein, antinuclear antibody, RF, erythrocyte sedimentation rate, and anti-CCP
Q:5-A 70-year-old female came to the emergency department with sudden onset right-side weakness.
Initial CT scan on arrival showed a 4 cm right basal ganglia hemorrhage. On obtaining further history, the
patient admits to taking apixaban for atrial fibrillation. Immediately the systolic blood pressure is
lowered to less than 160 mm Hg with nitroprusside to prevent further hematoma expansion. Which of
the following is the best immediate step in the management for this patient? Mark one answer:
o Vitamin K
o Cryoprecipitate
o Andexanet alfa
o Idarucizumab
Q:6-A 68-year-old right-handed African American male presents to the emergency department with a
sudden onset of numbness affecting his whole right side that started 2 hours ago. He has a history of
hypertension, diabetes, and hyperlipidemia and is compliant with his hydrochlorothiazide, metformin,
and lovastatin. His vitals at the ED showed a blood pressure of 150/90 mm Hg, pulse 78/min, sinus
rhythm, and 98% oxygen saturation. His NIH stroke scale score is 3. IV tPA was not given due to his mild
stroke. His CT scan was negative. The patient was observed overnight in the hospital and discharged
home without any change in his neurological signs or symptoms. Which of the following is the most
important treatment for this patient to prevent future strokes? Mark one answer:
o Lower his blood pressure to below 130/80 mm Hg

o Control his diabetes better with a target HBA1C of < 7%
o Lower his LDL cholesterol to < 70 mg/dl
o Oral anticoagulant
Q:7-A 22-year-old male athlete presents today with new-onset severe head and neck pain. Physical
exam elicits abnormal gait with the patient leaning to the right side and requiring assistance. He is a
college basketball player and goes to his chiropractor twice a week but has not suffered any physical
trauma recently. Also, he is noted to have nystagmus and decreased pain and temperature sensation on
the right side of his face and left upper and lower extremity. Pupils are 4 mm, equal reactive to light with
no ptosis noted. Which of the following locations is most likely injured in this patient? Mark one answer:
o Aorta
o Frontal lobe
o Medulla
o Thalamus
Q:8-A 65-year-old female with a history of hypertension, diabetes mellitus, presented with non-specific
chest pain. During her hospital stay, she developed hypotension, change in mental status and
examination showed muffled heart sounds, elevated jugular venous distension. She was diagnosed with
cardiac tamponade. What is the next step in management? Mark one answer:
o Pericardiocentesis
o Observation
o Cardiac catheterization
o Inotropes
Q:9-A 67-year-old female with a past medical history of coronary artery disease and cardiomyopathy
presents to the primary care office for a regular follow-up appointment. It is noticed that she is in visible
emotional distress. The patient states that her husband passed away over 6 months ago, and "life just
hasn't been the same." She makes remarks during the visit that there is "nothing left to live for." She has
lost a significant amount of weight since her last appointment and is unable to sleep at night. Before her
husband passing away, the patient would regularly go to the senior center and play bingo with her
friends, but now she hasn't gone in over 2 months. Furthermore, she is unable to remain attentive
during a casual conversation during her examination. She is started on an unusually high dose of
psychiatric medication. Several months later she is hospitalized due to life-threatening arrhythmia.
Which of the following medications is most likely a contributing factor to her hospitalization?
Mark one answer:
o Citalopram
o Bupropion
o Sertraline
o Mirtazapine
Q:10-A 28-year-old female has had a 4-year history of headaches, joint pain, chest pain, flatulence,
abdominal pain, dyspareunia, and dysuria with no objective findings after evaluation by multiple
specialists. The patient reports that these symptoms have interfered with her work and social life, and
have caused her excessive worry. Which of the following is the most probable diagnosis?
Mark one answer:
o Generalized anxiety disorder

o Factitious disorder
o Somatic symptom disorder
o Malingering
Test 44
Q:1-A 72-year-old female is brought in by her husband with increasing forgetfulness, decreased activity,
and decreased appetite for 2 months. She has a history of hypertension of lisinopril. The exam is normal
and the mini-mental status exam provides a score of 24 but she declines to answer some questions and
needs to be urged to participate in the assessment. What is the most likely diagnosis? Mark one answer:
o Alzheimer disease
o Vascular dementia
o Pseudodementia
o Medication toxicity
Q:2-A middle-aged man present with leg pain. His right calf had an audible snap when serving during
tennis earlier. Now his right calf is painful and swollen. A right gastrocnemius muscle sprain is suspected.
What imaging study should be done? Mark one answer:
o Plain film
o Ultrasound
o Computerized tomography
o Magnetic resonance imaging
Q:3-A 45-year-old male presents with an asymptomatic pulsatile groin mass. Past medical history
reveals uncontrolled hypertension and a 25-year smoking history. When should the patient undergo
repair of the most likely condition responsible for his findings? Mark one answer:
o Size larger than 2.5 cm

o Size of 1 cm
o Mild compression of the muscle on imaging without symptoms
o Presence of atherosclerotic lesion in the aneurysm
Q:4-A 65-year-old woman presents to the clinic with bilateral papules coalescing into plaques localized
on areolas, present for the last five months. Dermatological examination shows numerous yellowish
papules of 3-8 mm in diameter, coalescing into plaques. A biopsy was taken, and histopathological
reports showed multiple hyperplastic mature sebaceous glands, on the upper dermis. Which of the
following is the most likely diagnosis? Mark one answer:
o Breast Paget’s disease

o Breast cancer
o Sebaceous hyperplasia
o Bowen's disease
Q:5-A 65-year-old male presents to the office with three months of neck pain, right upper extremity
pain, and numbness and tingling in his left arm. An MRI obtained demonstrates a disc herniation
between C5 and C6. In which of the following locations would the patient have decreased sensation?
Mark one answer:
o Lateral arm
o Lateral forearm and thumb
o Medial forearm
o Long finger
Q:6-A 55-year-old has benign prostatic hyperplasia. What type of urinary incontinence is he likely to
develop? Mark one answer:
o Overflow
o Neuropathy
o Stress
o Urge
Q:7-A female patient presents with difficulties sleeping for the past 6 years. She has tried all types of
remedies over the past few years but nothing has helped. At present, she is taking no medications and
has no allergies. According to the American College of Physicians, what is the first treatment of choice in
such patients? Mark one answer:
o Low dose benzodiazepines

o Melatonin
o Cognitive behavioral therapy
o Hypnosis
Q:8-A young male complains of back pain that is improved with exercise. He has no history of
gastrointestinal illness or symptoms of urethritis. On exam, he is found to have restricted lumbar
mobility, tenderness of sacroiliac joints, and an x-ray showing sacroiliac sclerosis. Which of the following
is true? Mark one answer:
o His symptoms are most likely due to lumbar strain

o His rheumatoid factor will be positive
o He likely experiences prolonged morning stiffness
o Radiographic changes in sacroiliac joints are asymmetric
Q:9-A patient presents with eye pain after vinegar splashed in her eye while cooking. After irrigation
with normal saline, a strip of litmus paper placed against the conjunctival fornix shows a pH of 7.2.
Vision is 20/20 in both eyes. Fluorescein stain shows no abnormalities, and there is no sign of corneal
scarring, perforation of the globe, or lid deformities. Which of the following is the next best step in the
management of this patient? Mark one answer:
o Observation with close follow-up

o Erythromycin and cyclopentolate drops
o Ofloxacin and tetracaine drops
o Prednisolone acetate ophthalmic suspension and oxycodone
Q:10-A divorced 37-year-old female comes to the clinic for a routine visit. Her surgical history is
significant for two prior cesarean sections, an appendectomy, and a complete hysterectomy. She reports
being sexually active without condom use because she "can't get pregnant anyway." She now has a new
sex partner, and she is concerned because he is not monogamous with her. How should this patient be
counseled regarding the recommendations for chlamydia screening? Mark one answer:
o Only women who are 25 years old or younger should be screened.

o All women should be screened yearly regardless of risk.
o Women older than 25 should be screened only if they have risk factors.
o Women older than 25 should only be screened if they have HIV.

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TEST 7

Q:3-Active labor occurs during the: Mark one answer:

o 1st stage of labor

o Internal mammary branches

o Squamous cell carcinoma (SCC)

Q:6-Which is true of congenital atresia of bile ducts? Mark one answer:

o Most babies do not present until 6-9 months of age

o Transport her immediately

Q:6-Which is an absolute contraindication to femoral artery cannulation? Mark one answer:

o The assessment is incomplete

Q:10-Which is not seen in pericardial tamponade? Mark one answer:

o Muffled heart sounds

o Surgery as soon as possible

o Proton pump inhibitors

o White blood cells

o Return for persistent headache

o Manual elevation of the presenting part with an attendant's hand

o Checking blood pressure

o Assesses fetal wellness

o PA (posteroanterior) chest radiograph

o Excision with a 1 cm border

o Type 2 diabetes mellitus

Q:5-Which is false about pheochromocytoma? Mark one answer:

o Majority are malignant

Q:6-Which of the following is true regarding dermatomyositis? Mark one answer:

o Adults have calcinosis more often than children

Q:7-Broca aphasia is also known as: Mark one answer:

Q:4-Which of the following is NOT a sign and/or symptom of malignant hyperthermia?

o Increased end-tidal CO2

Q:9-What is the mechanism of action of digoxin? Mark one answer:

o Inhibiting calcium pump

o St. Louis encephalitis

o Inspiratory reserve volume

o A 6 year old with patent foramen ovale

o It has an onset of less than 30 minutes

Q:9-What is the greatest source of histamine? Mark one answer:

Q:2-Which is true of hyperkalemia? Mark one answer:

o The classic signs are mainly GI related

Q:4-Lactation is promoted by which of the following hormones? Mark one answer:

Q:4-What is an absolute contraindication to inducing labor? Mark one answer:

Q:6-Severe cystic acne is best treated with: Mark one answer:

o Tretinoin gel (Retin-A)

o Daily symptoms of cough and wheezing

Q:10-Which is a very rare complication of epidural anesthesia? Mark one answer:

o Rabies vaccine should be started immediately

Q:6-Which is not a characteristic of multiple system atrophy? Mark one answer:

Q:1-What is the drug of choice for N. gonorrhoeae? Mark one answer:

o Peripheral vascular disease

o Horner's syndrome, ptosis, and miosis

o One dose of ceftriaxone

o Interference of cardiac medications

o Extensor digitorum brevis muscle

Q:8-Which is a classic ECG feature of Torsade de pointes? Mark one answer:

Q:10-Respiratory alkalosis can develop from: Mark one answer:

o Diagnosis of heart disease

o Obstructive sleep apnea

Q:5-Which of the following is the most appropriate medical treatment of prolactinomas?

o Intubation and positive pressure ventilation

o Chronic pulmonary hypertension

Q:4-Which medication is used to treat Crohn disease? Mark one answer:

Q:6-Which is false about blood donation? Mark one answer:

o Consent is required for blood donation

Q:3-Chlamydia is associated with which of the following? Mark one answer:

* Analgesia Leg elevation Angioplasty * Fasciotomy

Olanzapine Cognitive-behavioral therapy Thyroxine Fluoxetine

Quetiapine Flumazenil * Memantine *Donepezil

* Lupus Psoriasis Dermatomyositis *Scleroderma