1.
The tuberculin Mantoux screening test reaction is considered to be positive in which minimum circumstance: 2.
Annual mammography screening should be performed for which of the following? 3.
The incidence of which of the following diseases have been dramatically lowered with adequate immunization programs: 4.
What is the primary nutritional disorder in the United States? 5.
Normal growth patterns and nutritional needs of children are assessed through: 6.
AN is a 36-year-old prenatal patient at 16 weeks gestational age. You are referring her for genetic risk assessment and she wants to know what are the traditional risks. Your most complete explanation includes all of the following EXCEPT: 7.
Each state requires different newborn screening tests, but all 50 states require screening for which of the following? 8.
Medical conditions that result in vomiting include: 9.
The most likely infectious agents in otitis media are: E. Coli, Haemophilus influenzae and Moraxella catarrhalis E. Coli and Moraxella catarrhalis Streptococcus pneumoniae and E. Coli Streptococcus pneumoniae, Heamophilus influenzae , and Lactobacillus Streptococcus pneumoniae, Haemophilus infuenzae , and Moraxella catarrhalis
10.
Childhood allergies may be expressed in which of the following forms? 11.
The common innocent murmurs of childhood are recognizable on auscultation. Such murmurs are normally heard by: 12.
Factors that are known to increase the risk of acne vulgaris include all of the following EXCEPT: 13.
Which of the following individuals would be most susceptible to Salter Harris injuries? 14.
All of the following should be included in an initial screening examination of a geriatric patient EXCEPT: 15.
Fire prevention in the home of an older person should include all the following EXCEPT: 16.
Cholinesterase inhibitors are currently the standard of practice for the treatment of: 17.
The most common cause of persistent incontinence in those over 75 years old is: 18.
Characteristics that place an older person at increased risk for being a victim of elder abuse include all of the following EXCEPT: 19.
In order to appropriately assess the patient’s condition during an emergency situation, the provider should utilize basic life support techniques. These techniques are referred to collectively as the "Abc's," which stands for: 20.
A patient who is suspected of having an MI will have all of the following changes on ECG EXCEPT: 21.
In the evaluation and treatment of the patient with hypercapnia, the clinician should do all of the following EXCEPT: 22.
Seventy percent of bacterial pneumonia cases are caused by: E. coli P. aeruginosa S. aureus Pneumococcus Group B streptococci
23.
All the following are clinical components of an "asthma attack" EXCEPT: 24.
An acute abdominal series is useful in assessing a patient for: 25.
A 25 year-old female presents to the emergency room via ambulance. The attendant states that they were contacted by the patient’s roommate, who found the patient at home in a very deep sleep. She attempted to awaken the patient but was unable to get more that a groan from her. The roommate was concerned because the apartment had a funny smell when she walked in and she could not find the source. The roommate doesn’t know if the patient was on any medications other than oral contraceptives, however she thought the patient might be on a diet because she has lost a lot of weight. 26.
A 68 year-old female was transported to the emergency department by the paramedics who state that she was walking in her kitchen and hit the side of her face on a cabinet door. The patient states that she is seeing double, but denies loss of consciousness after she hit her head. She denies any other symptoms. 27.
An 8 year-old boy presents to the ED for a nosebleed that started after he blew his nose. He denies any trauma, or placing anything in his nose. The parents state that he has had nosebleeds in the past but they were able to stop the bleeding by pinching the bridge of the patient’s nose. He has no prior medical problems. 28.
All of the following diagnostic test results are specific for Staphylococcal Scalded Skin Syndrome EXCEPT: Staphylococcus aureus
29.
All of the following are considered assessment priorities in the patient with an orthopedic injury EXCEPT: 30.
A 3 month-old presents to the emergency department with his mother who states he cries and cries for hours, and the crying increases when she picks him up. A Review of Systems shows (+) fever (103.4 degrees F Earscan). The mother reports that the baby eats poorly and appears very tired. Your tentative diagnosis is: 31.
Which of the following is NOT considered a respiratory emergency in the pediatric population? 32.
A child is admitted to the ED with traumatic injuries resulting from a bicycle accident. All of the following should be included in the primary survey EXCEPT? 33.
Delayed primary closure would be most appropriate for which of the following wounds? 34.
Which of the following is the most crucial factor in preventing nosocomial infections in the surgical patient? 35.
BL, an 8 year old girl, was examined by you for an ear infection. During the exam you noticed some bruising on her legs and forearms. Upon asking the parents what happened, you were informed that the child is clumsy and going through an awkward stage. You should: 36.
TH, a 40 year-old professional women, has not been taking her medication for hypertension. She states, "I have been following a mega vitamin program that someone at work told me about. He said it was a natural remedy and that it would control my blood pressure without any of the dangers of medicine." You should: 37.
A durable power of attorney is valid when: 38.
Which one of the following drugs would you choose in your initial pharmacologic management of a patient with uncomplicated hypertension? 39.
Management of a patient with an acute myocardial infarction includes each of the following EXCEPT: 40.
The underlying pathophysiology of diastolic heart failure includes each of the following EXCEPT: 41.
Which of the following agents has been shown to decrease hospitalizations at all stages of heart failure when the ejection fraction is less than 40%? 42.
A patient complains of a sudden onset of mid-center chest pain that radiates to the epigastrium. The pain is aggravated by coughing and inspiration, and relieved by sitting up and leaning forward. The most likely diagnosis is 43.
In a patient with atrial fibrillation and a history of mitral stenosis, which of the following medications would have the greatest impact in decreasing the occurrence of another stroke? 44.
A 21 year-old man was seen 6 months ago for a general physical. At that time he was told that his heart was enlarged and he was scheduled for a follow-up visit which he failed to keep. He is now requesting further evaluation. His past medical history reveals that between the ages of 3 and 5 years he "squatted" frequently to catch his breath. He is a non-smoker, no history of substance abuse or IV drug use, is heterosexual, with no identified risk behaviors. He describes his nails as having a "spoon-like" appearance, and his lips are always "blue." He has had no other obvious cardiac symptoms. Which of the following is the most likely diagnosis? 45.
A 72 year-old man presents with a history of syncope and dyspnea. On physical exam you identify a harsh systolic ejection murmur in the right second intercostal space. What is the most likely diagnosis? 46.
A 20 year old basketball player is concerned about his increasing shortness of breath experienced during his daily practice over the past month. His general health is excellent, although he did have one syncopal episode a few days ago after a very competitive game. He is a non-smoker, does not drink or abuse drugs. Physical exam reveals a crescendo-decrescendo harsh systolic murmur heard best between the apex and the left sternal border. Which of the following diagnostic studies would be most definitive in your evaluation of this patient? 47.
Which of the following times is most appropriate to obtain a blood specimen for a lipid profile? 48.
The primary goals in the management of contact dermatitis are: 49.
JR is a 78 year-old man who recently suffered a cerebrovascular accident, which resulted in new onset seizure disorder. His seizure disorder was treated with phenytoin. Within one week of initiation of therapy, his wife, who is his primary caregiver, noticed that JR had a "rash." She became alarmed when the rash spread to JR's face, trunk, and limbs and he became febrile. He had mouth ulcers, nasal crusting, and complained of blurred vision. On physical examination, he was found to have bilateral conjunctivitis. He was also noted to have disseminated cutaneous eruptions of discrete dark-red macules. What is the most likely diagnosis? 50.
A 12 year-old boy is brought in with a maculapapular erythematous rash over his chest. They are predominantly 2-6 cms in size and are scattered in distribution. His back is also affected to a lesser degree with one larger patch approximately 9 cms across that looks like all of the other lesions. There is no itching reported and there are no other members in the household with this rash. No lymphadenopathy is noted. Your assessment of this rash is: 51.
Which of the following best describes alopecia areata? 52.
Solar lentigo is commonly known as "liver spots" and is a brown macular proliferation of lesions on the epidermis. It typically appears after age 40 years due to: 53.
Impetigo is an acute bacterial infection of the skin that is at first: 54.
The incidence of Tinea pedis or "Athlete’s Foot" is increased in: 55.
Herpes simplex is an acute vesicular infection of the skin or mucous membranes caused by herpes simplex virus (HSV) Type 1 or Type 2. Asymptomatic carriers of the virus: 56.
The hallmark treatment for Scabies: 57.
Basal cell carcinoma is: 58.
A 65-year old woman complains of gradual onset of double vision. It goes away when she closes the right eye, but remains when she closes the left eye. She may have: 59.
Which of the following is NOT associated with acute uveitis: 60.
Speech discrimination testing does which of the following? 61.
In order to appropriately evaluate external ear pathology, the clinician should pay close attention to which of the following? 62.
Complication(s) of Group A beta-hemolytic streptococcal pharyngitis include: 63.
A key test in the diagnostic workup of the patient with postprandial hypoglycemia is: 64.
Which of the following fasting plasma glucose levels is the diagnostic cut-off for diabetes? 65.
Which of the following total cholesterol measurements would classify a patient as borderline risk according to the National Cholesterol Education Program (NCEP)? 66.
All of the following suggest malignancy in the patient with multinodular goiter EXCEPT: 67.
A 37-year-old woman, comes into the clinic with signs and symptoms of hypothyroidism. In your preliminary workup you found that her TSH was elevated. What other findings would you expect on your laboratory workup? 68.
All of the following clinical results are key to the diagnosis of hyperthyroidism EXCEPT 69.
Overnight dexamethasone suppression test and a 24-hour urine free cortisol determination are key tests for which of the following disorders? 70.
Spasticity and hyperreflexia are diagnostic signs of: 71.
Which of the following represents lower pH and bicarbonate levels and often occurs with the following:Starvation Uncontrolled diabetes Electrolyte, bicarbonate and water loss from diarrhea or enteric fistulas Any renal insufficiency or tubular defect that produces inadequate hydrogen ion excretion 72.
Which of the following is NOT a typical abnormality seen with nephrotic syndrome? 73.
Which of the following is NOT a common finding in acute renal failure? 74.
A 42 year-old patient with Type 1 diabetes presents for evaluation of renal failure secondary to chronic nephropathy. All of the following would be expected lab results EXCEPT: 75.
A 24 year-old male presents to the ER with complaints of excruciating right-sided testicular pain which began suddenly. He denies any recent injury. The pain is described as "coming in waves" and becomes progressively more severe. Examination reveals no genital lesions or palpable groin masses. Urinalysis reveals microscopic hematuria, but no white blood cells, casts or bacteria. The urine is highly alkaline. Which of the following is the MOST LIKELY diagnosis? 76.
A 72-year-old male patient presents with complaints of vague abdominal pain and the feeling of inability to completely empty his bladder completely. He reports that his urine stream is weak and the urine often just drips or leaks out. He also reports an increase in the number of micturitions per day and that his social outings are limited. 77.
Pharmacotherapy for BPH usually includes which of the following agents? 78.
All of the physical examination findings are supportive of a diagnosis of acute abdominal pain EXCEPT? 79.
BJ, a 65-year-old man, presents with swallowing difficulties that began 3 months ago. Except for a 15-pound weight loss since his last check-up, BJ’s physical exam findings are unremarkable. Based on this information, the most likely diagnosis is: 80.
Which of the following statements are true regarding gastric ulcers (GU) and duodenal ulcers (DU)? 81.
In patients with irritable bowel syndrome, abdominal pain is typically found in the: 82.
Risk factors associated with constipation include all of the following EXCEPT: 83.
During a regular annual exam on a multiparous woman you notice a flesh colored, asymptomatic anal protrusion. It is soft to the touch and easily retractable. The most probable diagnosis is: 84.
Which of the following is considered the current medical standard for the treatment of cholecystitis (gallstones)? 85.
All of the following are common signs and symptoms of acute viral hepatitis EXCEPT: 86.
AD, a 27-year-old male, presents to the clinic with a 3-day history of nausea, vomiting and umbilical pain. He complains that the pain has begun to worsen and move down and to the right. The patient has been anorexic for 24 hours and has also felt "hot and cold." A history reveals no prior medical conditions, allergies, or medications. His physical exam reveals a temperature of 38.2 C and significant abdominal tenderness in the right lower quadrant. Rebound tenderness is also present, and a rectal examination confirms a tenderness on the right side. There is no CVA tenderness. What is the likely diagnosis? 87.
The most essential diagnostic feature of acute pancreatitis is: 88.
A 33-year-old Caucasian woman presents with fatigue for many years. Her past medical history proves to be unremarkable. The only significant finding in the rest of her history is that her menstrual flow is very heavy for the first 5 days and then gradually tapers over the next 3 to 4 days. Her CBC shows hemoglobin of 9.9 gm/dL with a hematocrit of 30%. Based upon this information what is the most likely anemia? 89.
A patient recently had a gastrectomy for a peptic ulcer disease perforation. The patient presents with weight loss, abdominal pain and some non-bloody diarrhea. The physical exam shows slight pallor and glossitis. What type of anemia should be suspected? 12 deficiency anemia 90.
Which of the following is the most appropriate treatment of hemophilia B? 91.
Human immunodeficiency virus compromises the immune system primarily through the destruction of: 92.
Which tests listed below will provide a means of estimating the progression of the disease and determine the viral load? 93.
All are classes of antiretroviral drugs currently used EXCEPT: 94.
The percentage of bone that ends upon another following a fracture is referred to as: 95.
Complications involving nerve and artery injuries are common in which of the following? 96.
In children, displaced Galeazzi or Monteggia fracture-dislocations are best treated by: 97.
Which of the following fractures is most often associated with hemorrhage and death? 98.
A Jones fracture is defined as: 99.
Which of the following fractures is the most stable? 100.
Which of the following is the most common cause for shoulder pain? 101.
Which of the following is considered an orthopedic emergency? 102.
Inability to extend the finger at the distal interphalangeal joint after a traumatic injury is characteristic of: 103.
Which of the following tests should always be included in a routine examination of the patient complaining of low back pain? 104.
Kanavel's signs are indicative of which of the following conditions? 105.
A 36 year-old woman presents with malaise, fever, weight loss and morning stiffness. She complains of symmetrical wrist, shoulder and knee pain. Examination reveals swan neck deformities in the fingers, bilateral knee effusions. CBC reveals a hypochromic-microcytic anemia, with an elevated C-reactive protein. Skin exam reveals rheumatoid nodules. The most likely diagnosis is: 106.
All of the following are radiographic findings of osteoarthritis EXCEPT: 107.
BK, a 22 year-old man, presents with low back pain, especially in the sacroiliac joints. He also reports ongoing fatigue. His vital signs are BP 130/80, pulse 72, resp 12/min, and temp 100.0 F. Radiograph reveals sacroiliitis. Your most likely diagnosis, based on this information, is: 108.
Which of the following disorders is associated with the classic symptoms of "intoeing": 109.
JK presents to the clinic for evaluation of a headache. He states that his headache gets worse every day and is afraid that he may have a brain tumor. He reports the headache begins every day by "squeezing my head at the sides of my eyes." He obtains some relief with over-the-counter analgesics, which last 4-6 hours before the headache resumes. He denies nausea, vomiting or unilateral weakness. On examination the fundi are normal, the conjunctiva are clear and, the visual fields are full. There is moderate spasm of the posterior cervical musculature but the neck is supple. There is no palpable thickening of the temporal arteries, rhinorrhea, or sinus tenderness to percussion. 110.
Which of the following is not indicated in the evaluation of an acute stroke? 111.
A 58 year-old woman presents to the clinic for evaluation of an episode of slurred speech, confusion, and difficulty chewing her meal. This lasted for approximately 45 minutes and she was back "to normal." The spouse reports a similar episode 2 weeks previously. Neurologic examination is normal. This is most consistent with which of the following: 112.
A 23 year-old man is brought in by family members following a seizure. Over the past 2 weeks, the patient had complained of increasing headache, stating that it was just his "sinuses acting up with all this wind." Then, his headache lateralized to the left. On exam you find a lethargic man, with weakness in the right side of his face, upper extremity and papilledema. Kernig’s and Brudzinski’s signs are positive. Vital signs are Temp 100.8° F, B/P 138/90, respirations 20 and shallow, pulse 104. 113.
A 76 year-old, known alcoholic presents for evaluation of increasing lethargy and confusion over the past month. His family reports complaints of headaches and increasing weakness of his left leg. He has a new facial weakness on the right side and weight loss of 20 pounds without dieting over the past month. On exam you find mild fever, cough productive of thick white sputum, and an impaired swallow. There are no skin lesions or rashes. This is most suspicious for: 114.
Management of benign tremors is best achieved with: 115.
A 67 year-old man is evaluated for Alzheimer's disease. Mental status tests reveal some dementia with preserved verbal skills, and irritability. The man's son states that the irritability and moodiness have increased over the past 5 years, with occasional hallucinations. He states that his father often complains of a "jerking of his legs" which interferes with walking. This patient is most likely suffering from: 116.
All of the following statements regarding tonic-clonic seizures are true EXCEPT: 117.
The most life-threatening complication of acute Guillain-Barre syndrome is: 118.
A 52 year-old woman presents for evaluation of weakness. She reports the weakness is "worse in the evening, when I am so tired I can hardly eat or keep my eyes open." She also reports "blurred, double vision" in the evenings. By morning the weakness has decreased and her vision is normal. On exam you notice proximal muscle weakness, a nasal speech quality, poor swallow, and ptosis of both eyes. The most likely diagnosis is: 119.
Which of the following is an X-linked recessive disorder that results in the absence of dystrophin and corresponding muscle fiber degeneration? 120.
A 62 year-old man presents with complaints of numbness and burning pain in his feet. On exam you find distal weakness and sensory loss with painful anesthesia in a stocking-glove pattern. Decreased to absent reflexes distally and + Romberg’s are seen. You also happen to note pupil abnormalities, loss of sweating, and orthostatic hypotension. This is most consistent with: 12 / folate deficiency polyneuropathy 121.
A 57 year-old man presents to the ER with sudden onset of seizure and coma. On initial examination you find a blood pressure of 190/140 mmHg, pulse of 58, temperature of 99.0 degrees F. His skin is flushed. The left pupil responds well to light but the right pupil is sluggish. Retinal examination reveals bilateral papilledema. His left arm and leg abduct during painful stimulus. This is most likely caused by: 122.
The mental status examination is an objective description of the all of the following EXCEPT: 123.
Treatment for depression must first address the decision to treat a patient as an inpatient or an outpatient. Indications for hospitalization include all of the following EXCEPT: 124.
The clinical picture of bipolar disorder includes all of the following EXCEPT: 125.
Signs and symptoms of substance and alcohol abuse include all of the following EXCEPT: 126.
IV Naloxone would be appropriate pharmacological treatment for a patient who had taken an overdose of: 127.
Symptoms of benzodiazepine withdrawal include all of the following EXCEPT: 128.
DS, a 42 year-old man, comes to your office after having recently experienced recurring episodes of palpitations, sweating, shortness of breath, dizziness, shaking, and an intense fear of dying. These episodes have occurred more frequently over the past 2 weeks. The only other significant information on DS' history is that he has been promoted to a new job and is moving soon. But, he is happy about this and is not upset in any way. His physical examination and laboratory workup are all within normal limits. What is his most likely diagnosis? 129.
MV, a 57 year-old woman, is in your office complaining of an inability to have an orgasm. This is a new problem of recent months and she is with her same partner of 25 years. All of the following conditions should be considered as potential underlying causes of MV's condition EXCEPT: 130.
All of the following statements about sleep disorders are true EXCEPT: 131.
Treatment options for borderline personality disorder include all of the following EXCEPT: 132.
The goal of pharmacological treatment of psychoses is primarily: 133.
FB, a 56 year-old man, has recently complained that his asthma medications are no longer effective. Since his last visit three months ago, his asthma attacks have increased from 2-3 weekly to one almost every day. At night, the episodes have gone from about 3 each month to twice each week. Tests showed his FEV1 changed from 82% to 71% of predicted amounts and PEF variation went from 22 to 35%. After further evaluation and review of his current medications, general recommendations for control of this patient’s asthma were developed. Which of the following choices would provide the greatest benefit for long-term control under the current circumstances? 134.
Which of the following clinical findings would be helpful in the differential diagnosis of COPD? 135.
The definition of adult bacterial pneumonia is: 136.
Which of the following pharmacological agents is actually contraindicated in the treatment of the common cold? 137.
When the tuberculosis bacterium localizes in the recipient’s lung and causes a local inflammatory reaction, the person will have a positive skin test. At what point is the person considered to have active TB? 138.
Which of the fungal lung infections listed below is characterized by the following:Also known as Gilchrist's Disease Occurs most commonly in the Southeastern US and the Mississippi River valley Incidence is greatest in males 20-40 years old Inhaled spores cause lung infection that occasionally spreads through the blood stream 139.
What percentage of lung cancers is attributed to cigarette smoking? 140.
Diagnosis of interstitial lung disease relies primarily on which of the following? 141.
The most common emboli are thrombi that are dislodged from the deep veins of the calf. Risk factors for deep vein thrombosis include all of the following EXCEPT: 142.
Psychogenic causes that precipitate what is known as hyperventilation syndrome (HVS) include all of the following EXCEPT: 143.
Because of its antitussive properties, which drug has traditionally been the gold standard for treatment of chronic cough? 144.
An 18-year-old nulligravida patient has been sexually active for six months. She plans to attend college in the fall and the fear of pregnancy has become a real problem for her and her boyfriend. She states that an unwanted pregnancy would be disastrous right now. She tells you that she would never consider termination of any pregnancy. Her history reveals that her periods are regular with occasional cramping, for which she takes NSAIDS. She denies a history of thrombotic disease and takes no medication. Vital signs are normal. In listing all possible options, all of the following might be appropriate EXCEPT: 145.
What fetal complication is associated with preeclampsia? 146.
All of the following are risk factors for placenta previa EXCEPT: 147.
A 42-year-old female presents with a 2 1/2 week history of pelvic pain and abnormal vaginal bleeding which at present is only a scant amount. She denies any other abnormal vaginal discomfort including discharge, odor, itch or burning. She is married with 2 children and has not been using any form of birth control for 16 years except for fertility awareness. Her menstrual periods have always been regular, but she is now 3 weeks past the normal date. During the pelvic exam you notice that her uterus feels slightly enlarged and boggy, and there is a small amount of blood mixed within her vaginal pool. Her left adnexal area is somewhat tender but not necessarily enlarged. Her right adnexa is normal. 148.
Long-term management of abnormal uterine bleeding consists of: 149.
An 18 year old female college student presents complaining of recurrent, severe crampy abdominal pain that begins a few hours after the onset of menstrual flow and lasts for the first 48 hours of menstruation. The pain is described as crampy, recurrent and located in the lower abdomen. She occasionally takes OTC ibuprofen, which relieves some of the pain. She reports regular periods since menarche at age 13. Pelvic examination is unremarkable. The most likely diagnosis is: 150.
Cervical dysplasia is best diagnosed by: 151.
YK is a 42 year-old female who presents for routine pap and pelvic examination. You notice mucopurulent cervical discharge. Cultures for gonorrhea, trichomonas, candidiasis and other causes of vaginal discharge are negative. Gram stains of the cervical discharge show many leukocytes. The most likely diagnosis is: 152.
The most common cause of increased vaginal discharge due to infection is: 153.
A 50 year-old woman presents with a single, palpable mass in the upper outer quadrant of her left breast. Your examination reveals a discrete nodule without erythema or tenderness. The immediate course of action would be: 154.
Absolute contraindications to postmenopausal hormone replacement therapy include all the following EXCEPT: