, Question 1
During cardiac auscultation, a mid-systolic click followed by a late systolic
murmur is best heard at the apex. Which maneuver would most reliably
intensify these findings?
A. Valsalva strain phase
B. Handgrip
C. Standing
D. Inspiration
Correct Answer: B - Handgrip
RATIONALE
Handgrip increases afterload, which reduces left ventricular volume
and intensifies the click and murmur of mitral valve prolapse. Valsalva
and standing decrease preload and move the click earlier, while
inspiration increases right-sided murmurs.
Question 2
A patient presents with dyspnea, dry cough, and diffuse end-inspiratory
crackles. Pulmonary function tests show a restrictive pattern with reduced
DLCO. Which exposure history is most consistent with this presentation?
A. Chronic tobacco smoking
B. Asbestos inhalation
C. Bird handling
D. Coal mining
Correct Answer: B - Asbestos inhalation
Page 2
, RATIONALE
Asbestosis causes interstitial fibrosis leading to restrictive lung disease
with reduced DLCO, often accompanied by dry cough and crackles.
Tobacco smoking causes obstructive disease, bird handling suggests
hypersensitivity pneumonitis (mixed pattern), and coal mining causes
obstructive disease.
Question 3
A patient reports right lower quadrant pain that migrates from the periumbilical
region, associated with anorexia and low-grade fever. Which physical sign,
when positive, most increases the likelihood of acute appendicitis?
A. Murphy sign
B. Rovsing sign
C. Psoas sign
D. Obturator sign
Correct Answer: B - Rovsing sign
RATIONALE
Rovsing sign (pain in the right lower quadrant when palpating the left
lower quadrant) is highly specific for appendicitis due to peritoneal
irritation. Murphy sign indicates cholecystitis, while psoas and
obturator signs are less sensitive and suggest retrocecal or pelvic
appendix, respectively.
Question 4
A patient exhibits resting tremor, bradykinesia, and cogwheel rigidity. Which
assessment finding would best differentiate Parkinson disease from essential
tremor?
A. Tremor alleviated by alcohol
B. Tremor present during voluntary movement
C. Unilateral onset of tremor
D. Tremor frequency of 8-12 Hz
Page 3
, Correct Answer: C - Unilateral onset of tremor
RATIONALE
Parkinson disease typically presents with asymmetric (unilateral)
onset of resting tremor, whereas essential tremor is bilateral,
action-induced, and often temporarily relieved by alcohol. Frequency
alone is not a reliable differentiator.
Question 5
A patient presents with sudden painless vision loss in one eye. Fundoscopic
exam reveals a pale retina with a cherry-red spot at the macula. Which
condition is most likely?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Vitreous hemorrhage
D. Retinal detachment
Correct Answer: B - Central retinal artery occlusion
RATIONALE
Central retinal artery occlusion causes sudden painless monocular
vision loss with a pale, ischemic retina and a cherry-red spot at the
fovea due to intact choroidal circulation. CRVO presents with
blood-filled veins and hemorrhages; vitreous hemorrhage causes
floaters and obscured fundus; retinal detachment presents with flashes
and a curtain-like defect.
Question 6
A patient reports chronic wrist pain and numbness in the thumb, index, and
middle fingers that worsens at night. Which provocative test is most specific
for carpal tunnel syndrome?
A. Phalen test
B. Tinel sign
Page 4
During cardiac auscultation, a mid-systolic click followed by a late systolic
murmur is best heard at the apex. Which maneuver would most reliably
intensify these findings?
A. Valsalva strain phase
B. Handgrip
C. Standing
D. Inspiration
Correct Answer: B - Handgrip
RATIONALE
Handgrip increases afterload, which reduces left ventricular volume
and intensifies the click and murmur of mitral valve prolapse. Valsalva
and standing decrease preload and move the click earlier, while
inspiration increases right-sided murmurs.
Question 2
A patient presents with dyspnea, dry cough, and diffuse end-inspiratory
crackles. Pulmonary function tests show a restrictive pattern with reduced
DLCO. Which exposure history is most consistent with this presentation?
A. Chronic tobacco smoking
B. Asbestos inhalation
C. Bird handling
D. Coal mining
Correct Answer: B - Asbestos inhalation
Page 2
, RATIONALE
Asbestosis causes interstitial fibrosis leading to restrictive lung disease
with reduced DLCO, often accompanied by dry cough and crackles.
Tobacco smoking causes obstructive disease, bird handling suggests
hypersensitivity pneumonitis (mixed pattern), and coal mining causes
obstructive disease.
Question 3
A patient reports right lower quadrant pain that migrates from the periumbilical
region, associated with anorexia and low-grade fever. Which physical sign,
when positive, most increases the likelihood of acute appendicitis?
A. Murphy sign
B. Rovsing sign
C. Psoas sign
D. Obturator sign
Correct Answer: B - Rovsing sign
RATIONALE
Rovsing sign (pain in the right lower quadrant when palpating the left
lower quadrant) is highly specific for appendicitis due to peritoneal
irritation. Murphy sign indicates cholecystitis, while psoas and
obturator signs are less sensitive and suggest retrocecal or pelvic
appendix, respectively.
Question 4
A patient exhibits resting tremor, bradykinesia, and cogwheel rigidity. Which
assessment finding would best differentiate Parkinson disease from essential
tremor?
A. Tremor alleviated by alcohol
B. Tremor present during voluntary movement
C. Unilateral onset of tremor
D. Tremor frequency of 8-12 Hz
Page 3
, Correct Answer: C - Unilateral onset of tremor
RATIONALE
Parkinson disease typically presents with asymmetric (unilateral)
onset of resting tremor, whereas essential tremor is bilateral,
action-induced, and often temporarily relieved by alcohol. Frequency
alone is not a reliable differentiator.
Question 5
A patient presents with sudden painless vision loss in one eye. Fundoscopic
exam reveals a pale retina with a cherry-red spot at the macula. Which
condition is most likely?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Vitreous hemorrhage
D. Retinal detachment
Correct Answer: B - Central retinal artery occlusion
RATIONALE
Central retinal artery occlusion causes sudden painless monocular
vision loss with a pale, ischemic retina and a cherry-red spot at the
fovea due to intact choroidal circulation. CRVO presents with
blood-filled veins and hemorrhages; vitreous hemorrhage causes
floaters and obscured fundus; retinal detachment presents with flashes
and a curtain-like defect.
Question 6
A patient reports chronic wrist pain and numbness in the thumb, index, and
middle fingers that worsens at night. Which provocative test is most specific
for carpal tunnel syndrome?
A. Phalen test
B. Tinel sign
Page 4
