Dunphy Exam 3 Comprehensive Primary Care
EXAM 2026-2027 LATEST UPDATED VERSION
250 QUESTIONS AND ANS
1. A 58-year-old male presents with a circular lesion on his abdomen that has an
advancing, red, scaly border with central clearing. The nurse practitioner
recognizes this as:
• A. Tinea corporis
• B. Psoriasis
• C. Pityriasis rosea
• D. Contact dermatitis
Correct Answer: A. Tinea corporis
Rationale: Tinea corporis (ringworm) classically presents as an annular lesion
with an advancing, scaly, red border and central clearing. Psoriasis presents with
well-demarcated salmon plaques with silvery scale. Pityriasis rosea has a herald
patch followed by a Christmas-tree distribution. Contact dermatitis is usually more
diffuse and pruritic without central clearing.
2. Which of the following is a primary prevention measure for a 76-year-old man
newly diagnosed with testosterone deficiency?
• A. Testosterone replacement therapy
• B. Annual PSA screening
• C. Fall prevention education
• D. DEXA bone density scan
Correct Answer: C. Fall prevention education
, Rationale: Primary prevention aims to prevent disease or injury before it
occurs. In an older adult with testosterone deficiency, fall prevention education
addresses a primary risk (falls) before injury happens. Testosterone replacement is
treatment (secondary/tertiary prevention). PSA screening is secondary
prevention. DEXA is secondary prevention for osteoporosis.
3. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is elevated and free T4 is low. The most likely diagnosis is:
• A. Hyperthyroidism
• B. Hypothyroidism
• C. Subclinical hypothyroidism
• D. Thyroid storm
Correct Answer: B. Hypothyroidism
Rationale: Elevated TSH with low free T4 confirms overt primary
hypothyroidism. Symptoms of fatigue, weight gain, cold intolerance, and
constipation are classic. Subclinical hypothyroidism would have elevated TSH with
normal free T4. Hyperthyroidism would show low TSH and high free T4.
4. Which medication is first-line for a patient with newly diagnosed
hypertension without comorbidities?
• A. Lisinopril
• B. Metoprolol
• C. Hydrochlorothiazide
• D. Amlodipine
Correct Answer: C. Hydrochlorothiazide
, Rationale: For uncomplicated hypertension, thiazide diuretics (e.g.,
hydrochlorothiazide) are recommended as first-line therapy per JNC 8 and many
guidelines. ACE inhibitors, ARBs, calcium channel blockers, and thiazides are all
acceptable first-line, but thiazides are often preferred initially in Black patients and
in general uncomplicated cases.
5. A 62-year-old male with diabetes presents with a HbA1c of 8.5%. He is
currently on metformin 1000 mg BID. What is the most appropriate next step?
• A. Add a sulfonylurea
• B. Add basal insulin
• C. Add an SGLT2 inhibitor
• D. Switch to insulin monotherapy
Correct Answer: C. Add an SGLT2 inhibitor
Rationale: For patients with type 2 diabetes and inadequate control on
metformin, adding an SGLT2 inhibitor or GLP-1 receptor agonist is recommended,
especially if there is cardiovascular or renal comorbidity. Sulfonylureas are no
longer preferred due to hypoglycemia and weight gain. Basal insulin is typically
added later.
6. A 30-year-old female presents with dysuria, frequency, and urgency. Urinalysis
shows positive leukocyte esterase and nitrites. The most likely organism is:
• A. Staphylococcus saprophyticus
• B. Escherichia coli
• C. Klebsiella pneumoniae
• D. Proteus mirabilis
Correct Answer: B. Escherichia coli
, Rationale: E. coli is the most common cause of uncomplicated urinary tract
infections, accounting for 75–95% of cases. Staphylococcus saprophyticus is
second most common in young women. Klebsiella and Proteus are more common
in complicated UTIs or healthcare-associated infections.
7. A 55-year-old male presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 180/100 mmHg. The most important
initial diagnostic test is:
• A. ECG
• B. Chest X-ray
• C. CT angiography
• D. Troponin
Correct Answer: C. CT angiography
Rationale: The presentation is highly concerning for aortic dissection. CT
angiography is the definitive diagnostic test. ECG and troponin help rule out
myocardial infarction. Chest X-ray may show widened mediastinum but is not
definitive.
8. A 28-year-old female presents with a 3-day history of burning on urination
and cloudy urine. She is 12 weeks pregnant. Which antibiotic is contraindicated?
• A. Nitrofurantoin
• B. Amoxicillin
• C. Ciprofloxacin
• D. Cephalexin
Correct Answer: C. Ciprofloxacin
EXAM 2026-2027 LATEST UPDATED VERSION
250 QUESTIONS AND ANS
1. A 58-year-old male presents with a circular lesion on his abdomen that has an
advancing, red, scaly border with central clearing. The nurse practitioner
recognizes this as:
• A. Tinea corporis
• B. Psoriasis
• C. Pityriasis rosea
• D. Contact dermatitis
Correct Answer: A. Tinea corporis
Rationale: Tinea corporis (ringworm) classically presents as an annular lesion
with an advancing, scaly, red border and central clearing. Psoriasis presents with
well-demarcated salmon plaques with silvery scale. Pityriasis rosea has a herald
patch followed by a Christmas-tree distribution. Contact dermatitis is usually more
diffuse and pruritic without central clearing.
2. Which of the following is a primary prevention measure for a 76-year-old man
newly diagnosed with testosterone deficiency?
• A. Testosterone replacement therapy
• B. Annual PSA screening
• C. Fall prevention education
• D. DEXA bone density scan
Correct Answer: C. Fall prevention education
, Rationale: Primary prevention aims to prevent disease or injury before it
occurs. In an older adult with testosterone deficiency, fall prevention education
addresses a primary risk (falls) before injury happens. Testosterone replacement is
treatment (secondary/tertiary prevention). PSA screening is secondary
prevention. DEXA is secondary prevention for osteoporosis.
3. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is elevated and free T4 is low. The most likely diagnosis is:
• A. Hyperthyroidism
• B. Hypothyroidism
• C. Subclinical hypothyroidism
• D. Thyroid storm
Correct Answer: B. Hypothyroidism
Rationale: Elevated TSH with low free T4 confirms overt primary
hypothyroidism. Symptoms of fatigue, weight gain, cold intolerance, and
constipation are classic. Subclinical hypothyroidism would have elevated TSH with
normal free T4. Hyperthyroidism would show low TSH and high free T4.
4. Which medication is first-line for a patient with newly diagnosed
hypertension without comorbidities?
• A. Lisinopril
• B. Metoprolol
• C. Hydrochlorothiazide
• D. Amlodipine
Correct Answer: C. Hydrochlorothiazide
, Rationale: For uncomplicated hypertension, thiazide diuretics (e.g.,
hydrochlorothiazide) are recommended as first-line therapy per JNC 8 and many
guidelines. ACE inhibitors, ARBs, calcium channel blockers, and thiazides are all
acceptable first-line, but thiazides are often preferred initially in Black patients and
in general uncomplicated cases.
5. A 62-year-old male with diabetes presents with a HbA1c of 8.5%. He is
currently on metformin 1000 mg BID. What is the most appropriate next step?
• A. Add a sulfonylurea
• B. Add basal insulin
• C. Add an SGLT2 inhibitor
• D. Switch to insulin monotherapy
Correct Answer: C. Add an SGLT2 inhibitor
Rationale: For patients with type 2 diabetes and inadequate control on
metformin, adding an SGLT2 inhibitor or GLP-1 receptor agonist is recommended,
especially if there is cardiovascular or renal comorbidity. Sulfonylureas are no
longer preferred due to hypoglycemia and weight gain. Basal insulin is typically
added later.
6. A 30-year-old female presents with dysuria, frequency, and urgency. Urinalysis
shows positive leukocyte esterase and nitrites. The most likely organism is:
• A. Staphylococcus saprophyticus
• B. Escherichia coli
• C. Klebsiella pneumoniae
• D. Proteus mirabilis
Correct Answer: B. Escherichia coli
, Rationale: E. coli is the most common cause of uncomplicated urinary tract
infections, accounting for 75–95% of cases. Staphylococcus saprophyticus is
second most common in young women. Klebsiella and Proteus are more common
in complicated UTIs or healthcare-associated infections.
7. A 55-year-old male presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 180/100 mmHg. The most important
initial diagnostic test is:
• A. ECG
• B. Chest X-ray
• C. CT angiography
• D. Troponin
Correct Answer: C. CT angiography
Rationale: The presentation is highly concerning for aortic dissection. CT
angiography is the definitive diagnostic test. ECG and troponin help rule out
myocardial infarction. Chest X-ray may show widened mediastinum but is not
definitive.
8. A 28-year-old female presents with a 3-day history of burning on urination
and cloudy urine. She is 12 weeks pregnant. Which antibiotic is contraindicated?
• A. Nitrofurantoin
• B. Amoxicillin
• C. Ciprofloxacin
• D. Cephalexin
Correct Answer: C. Ciprofloxacin
