Board

A 58-year-old woman presents with left lower extremity swelling for 2 days and associated 2+ pitting edema. She also reports the recent onset of mild chest discomfort. Pulmonary perfusion scan, lower extremity ultrasound, D-dimer. ECG, chest X-ray, cardiac enzymes. Chest CT angiography, CBC, troponin. Echocardiogram, BNP, lower extremity X-ray Correct answer: A. Pulmonary perfusion scan, lower extremity ultrasound, D-dimer.

An 82-year-old woman presents to the clinic with a history of frequent falls over the past few months. Mini-Mental State Examination (MMSE). Romberg Test. Timed Get Up and Go Test. Dix-Hallpike maneuver.

A 70-year-old woman with Parkinson's disease returns for a follow-up visit. She is currently on carbidopa-levodopa and reports the return of her resting tremor,. Decrease the current dose of carbidopa-levodopa. Discontinue the medication. Increase the current dose of carbidopa-levodopa. this is expected in the progression of the disease.

A 6-year-old boy is brought to the clinic for evaluation of learning difficulties. His teacher reports problems with attention and hyperactivity. On physical exam, he has moderate microcephaly, short palpebral fissures, and a smooth philtrum. His mother reports alcohol consumption during pregnancy. Down Syndrome. Fetal Alcohol Syndrome. Fragile X Syndrome. Williams Syndrome.

A 35-year-old woman presents with sudden-onset dizziness, nausea, and imbalance that began two days ago. She denies hearing loss, tinnitus, or ear fullness. She had an upper respiratory infection one week ago. Vestibular neuritis. Meniere's disease. Acoustic neuroma (vestibular schwannoma). Motor neuron disease.

A 6-year-old boy was recently diagnosed with acute otitis media. The next morning, his mother notices bloody discharge on his pillow. Ruptured tympanic membrane. Otitis externa. Cholesteatoma. Mastoiditis. Foreign body in the ear canal.

A 42-year-old man presents with acute low back pain after lifting a heavy box at work. The pain is sharp and radiates down his left leg to the posterior thigh and calf. He also notes numbness and tingling in the same leg. Positive Straight Leg Raise test (lumbar radiculopathy/sciatica). FABER test (hip or sacroiliac joint pathology). Lachman test (anterior cruciate ligament injury). McMurray test (meniscal tear.

A 60-year-old man with a history of type 2 diabetes and hyperlipidemia is on maximum-dose statin therapy and reports good adherence. Despite this, his LDL remains elevated, and he also has low HDL and high triglycerides. He is asymptomatic, and physical exam is normal. Add ezetimibe. Switch to fibrate therapy. Order TSH. Increase statin dose further.

A 42-year-old woman presents with increased urinary frequency, vaginal itching, and a thick white discharge. She reports having had multiple urinary tract infections in the past year. Start empiric fluconazole therapy. Check fasting blood glucose or HbA1c. Test for HIV. Prescribe prophylactic antibiotics for recurrent UTIs.

7-year-old boy is brought to the clinic due to limping for the past 3 weeks. His parents report that the limp is painless at first but now he complains of hip pain and stiffness, flattening and fragmentation of the femoral head. Slipped capital femoral epiphysis (SCFE). Legg-Calvé-Perthes disease. Transient synovitis. Juvenile idiopathic arthritis.

A 7-year-old boy is brought to the clinic by his mother after learning that he was exposed to a family member diagnosed with hepatitis A. The exposure occurred approximately 24 hours ago while sharing food at a family gathering. The child has never received the hepatitis A vaccine and has no prior immunitIty. Administer hepatitis A immune globulin only. Begin hepatitis B vaccination series. Administer the hepatitis A vaccine. Order hepatitis A IgM serology to confirm exposure.

A 2-day-old full-term newborn is evaluated for yellowing of the skin and sclerae. The baby is breastfeeding well and has normal vital signs. What is the most likely cause of this newborn's jaundice?. Physiologic jaundice. Breast milk jaundice (formula-fed infant). ABO incompatibility. Cephalohematoma.

On physical exam, you note erythematous plaques with overlying silvery scale. When gently removing a scale, you observe pinpoint bleeding underneath. This is referred to as the Auspitz sign. Formation of new psoriatic lesions in areas of trauma. Pinpoint bleeding after removal of scale due to exposure of dermal capillaries. Fragility of the dermis leading to easy blistering. Urticaria or wheal formation when stroking the lesion.

A 29-year-old woman presents with recurrent unilateral throbbing headaches, accompanied by nausea, photophobia, and occasional visual aura. Headaches last several hours and improve with rest in a dark room. Physical exam, including neurologic exam, is unremarkable. Which of the following findings is most consistent with a migraine?. Bilateral pain over the temporal arteries. Neck stiffness on physical exam. Normal fundoscopic (ophthalmoscopic) exam. Conjunctival injection and tearing of one eye.

A 30-year-old pregnant woman at 30 weeks gestation presents with dysuria, urgency, and hematuria. She was recently started on cephalexin for a presumed urinary tract infection. Today she reports worsening symptoms and visible blood in her urine. She is afebrile, and her vitals are stable. Increase the dose of cephalexin. Add ciprofloxacin. Add a sulfonylurea. Order a urine culture and sensitivity.

A 2-year-old child presents with fever, ear tugging, and irritability. The otoscopic exam reveals a bulging, erythematous tympanic membrane with loss of normal landmarks. The clinical diagnosis of acute otitis media (AOM) is made. Hemophilus influenzae. Moraxella catarrhalis. Group A Streptococcus. Streptococcus pneumoniae.

A 27-year-old man presents for evaluation after routine lab work showed positive hepatitis B surface antigen (HBsAg). Which of the following is the most likely diagnosis?. Chronic hepatitis B infection. Immunity due to prior hepatitis B vaccination. Acute hepatitis B infection. Window period of hepatitis B infection.

A 65-year-old woman presents with gradually worsening joint pain in both hands over the past several years. She reports stiffness in the morning that improves within 20 minutes of activity. On physical exam, there are firm, bony enlargements at the proximal interphalangeal (PIP) joints bilaterally, as well as at the distal interphalangeal (DIP) joints. There is no significant warmth or erythema. Bouchard’s nodes are classically found in which joints?. Distal interphalangeal joints (DIP). Carpometacarpal joints (CMC). Proximal interphalangeal joints (PIP). Interphalangeal joint of the thumb.

A 72-year-old woman presents with a 2-month history of pain and stiffness in the shoulders, neck, and hips. She says the stiffness is worse in the morning. Rheumatoid arthritis. Osteoarthritis. Fibromyalgia. Polymyalgia rheumatica.

A 16-year-old male comes in for a physical exam before joining the high school basketball team. He is healthy and active with no complaints. As part of the pre-participation sports physical, which of the following is the most important aspect of history to assess?. Social history, including tobacco and alcohol use. Family history of sudden cardiac death. History of allergies or asthma. Beverage consumption and hydration practices.

A 38-year-old man presents with a gradual onset of right elbow pain for the past 3 weeks. He works as a painter and frequently uses repetitive wrist extension movements. On exam, there is tenderness over the lateral epicondyle of the humerus, and pain is reproduced with resisted wrist extension. What is the most likely diagnosis?. Medial epicondylitis. Olecranon bursitis. Lateral epicondylitis. Radial head fracture.

A 76-year-old woman comes in for routine lab work as part of her annual exam. She feels well and denies fever, weight loss, fatigue, or pain. She has no known chronic inflammatory or infectious conditions. On exams, vital signs are stable, and physical findings are unremarkable. Lab results show: mm/hr Erythrocyte Sedimentation Rate (ESR): 22 Reference range in lab: 0-20 mm/hr Which of the following is the best interpretation of this finding?. Strongly suggestive of temporal arteritis. Diagnostic of underlying occult malignancy. This is a slightly elevated ESR and may be normal in elderly individuals. Indicates active systemic lupus erythematosus.

A 45-year-old woman presents with burning pain and numbness between the third and fourth toes of her right foot. She describes the sensation as “walking on a pebble.” Symptoms worsen when wearing tight shoes and improve when she goes barefoot. On exam, there is localized tenderness between the third and fourth metatarsal heads. Plantar fasciitis. Metatarsal stress fracture. Morton’s neuroma. SesamoiditisI’m.

A 68-year-old man presents for evaluation of multiple dark, thick skin lesions on his upper back and chest. He says they have developed gradually over the past several years, are asymptomatic, and some have a waxy, stuck-on appearance. Which of the following is the most appropriate treatment for these lesions?. Cryotherapy with liquid nitrogen. Oral isotretinoin. Topical corticosteroids twice daily. Wide surgical excision with clear margins.

A 32-year-old man comes to the clinic with a rash on his left ankle that appeared 3 days ago. He recently returned from a weekend camping trip. He describes the lesion as painless and not itchy, but it has slowly enlarged. On physical exam, there is a 5 cm circular erythematous lesion with central clearing. Which of the following is the best next step in management?. Start oral doxycycline without further testing. Order Lyme IgG and IgM serologies. Prescribe topical antifungal cream. Reassure the patient and observe for 1 week.

Which of the following conditions is classified as a reportable disease to public health authorities in the United States?. Atopic dermatitis. Lyme disease. Tinea corporis. Psoriasis.

A 58-year-old man is evaluated for imbalance. He reports unsteadiness when walking in the dark. On neurologic examination, muscle strength is intact and cerebellar testing (finger-to-nose, heel-to-shin) is normal. When standing with feet together and eyes open, he maintains balance. However, when he closes his eyes, he begins to sway and loses balance What does a positive Romberg sign indicate?. Cerebellar dysfunction. Sensory (proprioceptive) ataxia due to impaired dorsal column function. Benign paroxysmal positional vertigo. . Acute labyrinthitis.

A 58-year-old man presents with hearing difficulty. A Rinne test is performed. Bone conduction lasts longer than air conduction. Bone conduction is equal to air conduction. Air conduction lasts approximately twice as long as bone conduction. The patient does not hear the sound in front of the ear.

A 36-year-old woman presents with sudden onset of right-sided facial weakness noticed this morning. She is unable to close her right eye completely and drooling occurs from the right corner of her mouth. She denies headache, limb weakness, or sensory loss. On exam, she has weakness of both the upper and lower right side of her face. Her forehead does not wrinkle when she tries to raise her eyebrows. Which of the following best describes the condition?. Ischemic stroke involving the motor cortex of the frontal lobe. Inflammation of the facial nerve (cranial nerve VII), most often idiopathic or viral in origin. Demyelinating disease causing multiple cranial neuropathies. Inflammation of the trigeminal nerve leading to unilateral facial pain.

A 72-year-old man comes for a routine checkup. high-pitched sounds like birds chirping or doorbells are harder to heard Which of the following best describes the type of hearing loss this patient has?. Conductive hearing loss due to cerumen impaction. Sensorineural hearing loss due to cochlear degeneration. Central hearing loss due to stroke.

Cardiac auscutation reveals a mid systole dick followed by a late systole murmur. Aortic stenosis. Mitral valve prolapse. Hypertrophic cardiomyopathy. Mitral regurgitation due to rheumatic heart disease.

A new 31-year-old woman with a history of intravenous drug use presents to the emergency department with fever, chills, fatigue, and pleuritic chest pain for the past 5 days. She appears ill and is febrile (38.7°C), with a heart rate of 108 bpm and a blood pressure of 110/60 mmHg. On examination, you note a new holosystolic murmur best heard at the lower left sternal border. She has petechiae on her conjunctivae, splinter hemorrhages under her fingernails, Janeway lesions on her palms, and tender nodules on the pads of her fingers. You also observe mild respiratory distress. Rheumatic fever. Pulmonary embolism. Infective endocarditis. Tuberculosis.

A 35-year-old man presents to the clinic with sharp chest pain that began two days ago. He describes the pain as worsening when lying flat and improving when sitting up and leaning forward What is the most likely diagnosis?. Acute coronary syndrome. Aortic dissection. Pulmonary embolism. Acute pericarditis.

A 66-year-old man with a 40-pack-year smoking history presents to the clinic complaining of persistent cough that has worsened over the past year. He states that the cough is now accompanied by daily sputum production, especially in the mornings. He denies fever, weight loss, or recent illness. He has no history of asthma or recurrent infections, and physical exam reveals scattered rhonchi but no crackles or clubbing. Which of the following is the most likely cause of this patient's symptoms?. Smoker's cough. Bronchiectasis. Emphysema. Chronic bronchitis.

A 74-year-old woman presents to the clinic with complaints of jaw claudication. Facial stiffness. She denies vision changes, headaches, or scalp tenderness. Serum calcium. Creatine Kinase (CK). Erythrocyte sedimentation rate (ESR). Comprehensive metabolic panel (CMP).

A 56-year-old male presents to the clinic with uncontrolled hypertension despite being on three antihypertensive medications at maximum doses. He also reports fatigue and dark discoloration on his left flank. On exam, his blood pressure is 210/120 mmHg and there is ecchymosis over the left flank. No trauma is reported. Labs reveal elevated creatinine and borderline potassium.Which of the following is the most likely diagnosis?. Primary hypertension. Hypertensive emergency with end-organ damage. Secondary hypertension due to pheochromocytoma. Renal artery stenosis (renovascular hypertension).

Which of the following is the strongest stimulus for increasing respiratory rate in a healthy individual?. Hypocapnia. Hypercapnia. Low oxygen (hypoxia). High oxygen levels.

56-year-old male presents to the clinic with uncontrolled hypertension despite being on three antihypertensive medications at maximum doses. He also reports fatigue and dark discoloration on his left flank. On exam, his blood pressure is 210/120 mmHg and there is ecchymosis over the left flank. No trauma is reported. Labs reveal elevated creatinine and borderline potassium. Which of the following is the most appropriate next Step in evaluating?. Exercise stress test. Holter monitor for 24 hours. Echocardiogram. Cardiac event monitor (30-day).

A Cardiac event monitor can be worn for weeks, and the patient can activate it during symptoms 63- Which of the following best describes lesions caused by herpes simplex virus (HSV)?. Clustered vesicles on a flesh-colored base. Grouped pustules on a purpuric base. Grouped vesicles on an erythematous base. Scattered papules on a hyperpigmented base.

A 45-year-old woman presents with chronic eye irritation, itching, and a gritty or burning sensation in both eyes. She reports that her symptoms are worse in the morning. On physical exam, there is redness at the lid margins. Topical Corticosteroids. Oral azithromycin. Warm compresses and diluted baby shampoo lid scrubs. Artificial tears onl.

A 49-year-old man presents with recurrent eye irritation and crusting of the eyelids for the past several months. He describes burning, redness, and a gritty sensation, worse in the mornings. On examination, there is erythema and thickening of the eyelid margins with flaky debris at the base of the eyelashes. Conjunctiva is mildly injected, but vision is preserved. What is the first-line management for this condition?. Topical fluoroquinolone drops for 7–10 days. Oral doxycycline therapy. Warm compresses and lid hygiene with diluted baby shampoo or commercial lid wipes. Immediate ophthalmology referral for surgical intervention.

A 38-year-old woman was recently diagnosed with hyperthyroidism and started on methimazole. At her first follow-up visit, she reports feeling less anxious and her palpitations have improved. Lab results today show: TSH: 0.1 mlU/L (normal: 0.4-4.0) Free T4: low-normal 66- What is the most appropriate next step in management?. Increase the dose of methimazole. Maintain the current dose of methimazole. Decrease the dose of methimazole. Stop methimazole and start levothyroxine.

A 16-year-old female has not yet had her menarche. Which of the following laboratory tests is most appropriate to order?. Lipid panel. AST and ALT. Complete blood count (CBC).

A 72-year-old man presents with a 3-month history of progressive constipation and a recent change in bowel habits. He reports that his stools have become thin and pencil-like. He also notes occasional streaks of blood on the stool and an unintentional 8-lb weight loss. He denies abdominal pain, fever, or recent travel. On exam, vital signs are stable, and the abdomen is soft without tenderness. Irritable bowel syndrome. Colorectal (colon) cancer. Chronic constipation due to low-fiber die. Hemorrhoids.

A 34-year-old woman comes to the clinic with a 7-day history of nasal congestion, purulent nasal discharge, and facial pain. She describes the pain as a pressure-like sensation over her cheeks that worsens when she bends forward. She also notes that the pain occasionally radiates to her upper teeth. On exam, she has tenderness to palpation over the maxillary sinuses. Forehead (frontal region). Behind the eyes (retro-orbital). Upper teeth. Mastoid regio.

A 70-year-old man comes to the clinic for a routine eye exam. He has a history of progressive blurry vision over the past 2 years, especially at night. He denies eye pain or redness. Ophthalmologic exam reveals lens opacification consistent with cataract. He asks what he can do to prevent his condition from worsening before surgery is considered. Which of the following is recommended to help slow the progression of cataracts?. Avoid caffeine and drink more water. Wear sunglasses with UV protection when outdoors. Low-dose aspirin therapy. High-protein diet supplementation.

A 32-year-old man presents to the emergency department after accidentally scratching his right eye while putting on his contact lens. He complains of severe eye pain, tearing, and photophobia. On fluorescein staining, a linear corneal abrasion is noted. During discharge teaching, the nurse reviews home care instructions. The patient then states: “I will need anesthetic drops for my eyes so I don’t feel the pain.” Which of the following is the correct nursing response regarding this statement?. Yes, you can continue anesthetic eye drops at home until the pain resolves.”. “You should use topical corticosteroid drops to prevent inflammation. No, topical anesthetic drops are not prescribed for home use because they delay healing and can cause corneal damage. “Oral corticosteroids are recommended to speed up corneal healing.

A 5-year-old boy is brought to the clinic by his mother due to persistent foul-smelling nasal discharge. He had an upper respiratory infection 2 weeks ago, treated with amoxicillin, but his cough and congestion have improved. However, his mother reports ongoing purulent, bad-smelling mucus from only the right nostril. No fever or systemic symptoms are noted. On exam, there is unilateral mucopurulent nasal discharge with foul odor. What is the most likely diagnosis?. Acute bacterial sinusitis. Allergic rhinitis. Nasal foreign body. Viral upper respiratory infectio.

A 19-year-old woman is being treated for moderate acne vulgaris with topical tretinoin (Retin-A). After 2 weeks of therapy, she returns complaining of redness, dryness, and skin irritation. She has been applying the cream every night as prescribed. On exam, there is mild erythema and peeling of the skin but no signs of infection. What is the most appropriate next step to help with this patient’s side effects while continuing treatment?. Discontinue tretinoin permanently and switch to oral isotretinoin. Apply tretinoin in the morning instead of the evening. Reduce the frequency of application to every other night or three times per week. Increase the concentration of tretinoin for faster results.

A 28-year-old man comes to the clinic with a 2-week history of an itchy rash on his left forearm. He reports that the lesion has been slowly enlarging. On examination, there is a circular, erythematous, scaly lesion with a raised border and central clearing. No systemic symptoms are present. What is the most likely diagnosis and initial treatment?. Psoriasis – treat with topical corticosteroids. Eczema – treat with emollients and topical steroids. Tinea corporis (ringworm) – treat with topical azole antifungal such as clotrimazole. Contact dermatitis – treat with avoidance and topical steroids.