,Question 1
Janet is a 30-year-old woman recently diagnosed with a herniated disc at the level of L5–S1. She is
currently in the emergency department with suspicion of cauda equina compression. Which of the
following is a sign or symptom of cauda equina compression?
A. Gastrocnemius weakness
B. Reduced or absent ankle reflex
C. Numbness of the lateral foot
D. Paresthesia of the perineum and buttocks
Correct Answer: D. Paresthesia of the perineum and buttocks
Rationale:
Cauda equina compression classically presents with saddle anesthesia, bowel or bladder dysfunction,
and lower extremity weakness. Perineal and buttock paresthesia is a hallmark red-flag symptom
requiring urgent intervention.
Question 2
A patient has acute pancreatitis with seven positive criteria based on Ranson’s Criteria. In planning care,
the clinician understands that this score indicates:
A. A high mortality rate
B. An increased chance of recurrence
C. A 7% chance of the disease becoming chronic
D. All of the above
Correct Answer: A. A high mortality rate
Rationale:
Ranson’s Criteria assess the severity of acute pancreatitis. A score of seven is associated with severe
disease and a high mortality rate, guiding the need for intensive monitoring and aggressive
management.
Question 3
Reuben, age 24, has HIV and recently underwent a routine viral load test. The results show a falling viral
load. What does this indicate?
,A. A favorable diagnostic trend
B. Disease progression
C. The need to be more aggressive with medications
D. Eradication of HIV
Correct Answer: A. A favorable diagnostic trend
Rationale:
A declining viral load indicates effective antiretroviral therapy and improved disease control. HIV cannot
be eradicated, but viral suppression is a key treatment goal.
Question 4
Which finding differentiates labyrinthitis from vestibular neuritis?
A. Vestibular neuritis has acute onset, whereas labyrinthitis is gradual
B. Hearing loss occurs with vestibular neuritis but not labyrinthitis
C. Labyrinthitis has acute onset, whereas vestibular neuritis is gradual
D. Hearing loss may occur with labyrinthitis but not vestibular neuritis
Correct Answer: D. Hearing loss may occur with labyrinthitis but not vestibular neuritis
Rationale:
Labyrinthitis affects both the vestibular and auditory components of the inner ear, leading to vertigo and
hearing loss, whereas vestibular neuritis affects only balance.
Question 5
A 27-year-old female presents with burning and pain on urination and has no prior history of urinary
tract infection. Which additional symptoms are consistent with a diagnosis of a lower urinary tract
infection?
A. Back and abdominal pain
B. Fever, chills, and costovertebral angle tenderness
C. Blood in urine and urinary frequency
D. Foul-smelling discharge and perineal itching
Correct Answer: C. Blood in urine and urinary frequency
Rationale:
Lower UTIs (cystitis) commonly present with dysuria, frequency, urgency, and hematuria. Systemic
symptoms suggest upper urinary tract involvement.
Question 6
The differential diagnosis for vertigo can be classified into which of the following categories?
, A. Peripheral vestibular disease
B. Central nervous system disorders
C. Systemic disorders
D. All of the above
Correct Answer: D. All of the above
Rationale:
Vertigo may result from peripheral vestibular causes, central neurologic disorders, or systemic
conditions, making a broad differential diagnosis essential.
Question 1
Sam is a 25-year-old man diagnosed with low back strain based on localized low back pain, muscle
spasm, and a normal neurologic examination. Low back pain is a diagnosis of exclusion. Which symptom
would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
A. Morning stiffness and limited lumbar mobility
B. Unilateral radicular pain extending below the knee and equal to or greater than back pain
C. Fever, chills, and elevated erythrocyte sedimentation rate
D. Pathologic fractures, severe night pain, weight loss, and fatigue
Correct Answer: B. Unilateral radicular pain extending below the knee and equal to or greater than
back pain
Rationale:
Radicular pain extending below the knee suggests nerve root compression, a hallmark of disc herniation
rather than simple muscular strain.
Question 2
Preceptors must always see the patients that students see in the clinical setting.
A. True
B. False
Correct Answer: A. True
Rationale:
Preceptors are legally and professionally responsible for patient care provided by students and must
directly evaluate patients to ensure safe and appropriate management.
Question 3
An 82-year-old man presents with urinary dribbling and difficulty initiating urination. Which conditions
should be included in the differential diagnosis?
Janet is a 30-year-old woman recently diagnosed with a herniated disc at the level of L5–S1. She is
currently in the emergency department with suspicion of cauda equina compression. Which of the
following is a sign or symptom of cauda equina compression?
A. Gastrocnemius weakness
B. Reduced or absent ankle reflex
C. Numbness of the lateral foot
D. Paresthesia of the perineum and buttocks
Correct Answer: D. Paresthesia of the perineum and buttocks
Rationale:
Cauda equina compression classically presents with saddle anesthesia, bowel or bladder dysfunction,
and lower extremity weakness. Perineal and buttock paresthesia is a hallmark red-flag symptom
requiring urgent intervention.
Question 2
A patient has acute pancreatitis with seven positive criteria based on Ranson’s Criteria. In planning care,
the clinician understands that this score indicates:
A. A high mortality rate
B. An increased chance of recurrence
C. A 7% chance of the disease becoming chronic
D. All of the above
Correct Answer: A. A high mortality rate
Rationale:
Ranson’s Criteria assess the severity of acute pancreatitis. A score of seven is associated with severe
disease and a high mortality rate, guiding the need for intensive monitoring and aggressive
management.
Question 3
Reuben, age 24, has HIV and recently underwent a routine viral load test. The results show a falling viral
load. What does this indicate?
,A. A favorable diagnostic trend
B. Disease progression
C. The need to be more aggressive with medications
D. Eradication of HIV
Correct Answer: A. A favorable diagnostic trend
Rationale:
A declining viral load indicates effective antiretroviral therapy and improved disease control. HIV cannot
be eradicated, but viral suppression is a key treatment goal.
Question 4
Which finding differentiates labyrinthitis from vestibular neuritis?
A. Vestibular neuritis has acute onset, whereas labyrinthitis is gradual
B. Hearing loss occurs with vestibular neuritis but not labyrinthitis
C. Labyrinthitis has acute onset, whereas vestibular neuritis is gradual
D. Hearing loss may occur with labyrinthitis but not vestibular neuritis
Correct Answer: D. Hearing loss may occur with labyrinthitis but not vestibular neuritis
Rationale:
Labyrinthitis affects both the vestibular and auditory components of the inner ear, leading to vertigo and
hearing loss, whereas vestibular neuritis affects only balance.
Question 5
A 27-year-old female presents with burning and pain on urination and has no prior history of urinary
tract infection. Which additional symptoms are consistent with a diagnosis of a lower urinary tract
infection?
A. Back and abdominal pain
B. Fever, chills, and costovertebral angle tenderness
C. Blood in urine and urinary frequency
D. Foul-smelling discharge and perineal itching
Correct Answer: C. Blood in urine and urinary frequency
Rationale:
Lower UTIs (cystitis) commonly present with dysuria, frequency, urgency, and hematuria. Systemic
symptoms suggest upper urinary tract involvement.
Question 6
The differential diagnosis for vertigo can be classified into which of the following categories?
, A. Peripheral vestibular disease
B. Central nervous system disorders
C. Systemic disorders
D. All of the above
Correct Answer: D. All of the above
Rationale:
Vertigo may result from peripheral vestibular causes, central neurologic disorders, or systemic
conditions, making a broad differential diagnosis essential.
Question 1
Sam is a 25-year-old man diagnosed with low back strain based on localized low back pain, muscle
spasm, and a normal neurologic examination. Low back pain is a diagnosis of exclusion. Which symptom
would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
A. Morning stiffness and limited lumbar mobility
B. Unilateral radicular pain extending below the knee and equal to or greater than back pain
C. Fever, chills, and elevated erythrocyte sedimentation rate
D. Pathologic fractures, severe night pain, weight loss, and fatigue
Correct Answer: B. Unilateral radicular pain extending below the knee and equal to or greater than
back pain
Rationale:
Radicular pain extending below the knee suggests nerve root compression, a hallmark of disc herniation
rather than simple muscular strain.
Question 2
Preceptors must always see the patients that students see in the clinical setting.
A. True
B. False
Correct Answer: A. True
Rationale:
Preceptors are legally and professionally responsible for patient care provided by students and must
directly evaluate patients to ensure safe and appropriate management.
Question 3
An 82-year-old man presents with urinary dribbling and difficulty initiating urination. Which conditions
should be included in the differential diagnosis?
