PRAC 6645 CLINICAL SKILLS SELF
ASSESSMENT FORM EXAM QUESTIONS
WITH ANSWERS UPDATED
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Demonstrate advanced diagnostic reasoning by integrating history, physical exam, and diagnostic findings
2 Select and interpret appropriate diagnostic tests based on pretest probability and clinical guidelines
3 Formulate safe, evidence-based pharmacologic and non-pharmacologic management plans
4 Apply current clinical guidelines and standards of care to complex patient scenarios
5 PRAC 6645 CLINICAL SKILLS SELF ASSESSMENT FORM EXAM QUESTIONS WITH ANSWERS
UPDATED
6 Foundations of Advanced Clinical Skills and Diagnostic Reasoning
7 Applied Advanced Clinical Skills and Diagnostic Reasoning
8 Advanced Advanced Clinical Skills and Diagnostic Reasoning
9 Advanced Clinical Skills and Diagnostic Reasoning Review
ABSTRACT
This study document brings together 150 carefully worded exam questions drawn from PRAC 6645
CLINICAL SKILLS SELF ASSESSMENT FORM EXAM QUESTIONS WITH ANSWERS
UPDATED, with the strongest emphasis placed on Demonstrate advanced diagnostic reasoning by
integrating history, physical exam, and diagnostic findings, Select and interpret appropriate
diagnostic tests based on pretest probability and clinical guidelines, Formulate safe and
evidence-based pharmacologic and non-pharmacologic management plans. Every item follows the
wording style and level of reasoning you meet in the real paper, and each one is paired with a clear
rationale so the correct choice is never a guess. Work through the set at your own pace, mark the
questions that slow you down, then come back to them until the reasoning feels automatic.
Learners who revise this way walk into the exam room recognising the pattern behind the
questions instead of meeting them for the first time. Keep going - steady, honest practice is what
turns a difficult paper into a comfortable pass.
Page 1
,Q1 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
A patient presents with acute onset of severe, tearing chest pain radiating to the
back, with a blood pressure differential of 20 mm Hg between arms. Which
diagnostic study is most appropriate to confirm the suspected diagnosis?
A. Transthoracic echocardiography
B. Contrast-enhanced CT angiography CORRECT
C. Troponin and CK-MB
D. Exercise stress testing
RATIONALE: Contrast-enhanced CT angiography is the gold standard for diagnosing aortic
dissection, with high sensitivity and specificity. Echocardiography can be useful but is less
sensitive for the entire aorta. Troponin may be elevated if there is coronary involvement but is not
diagnostic. Stress testing is contraindicated in suspected dissection.
Q2 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
Which of the following is the most appropriate initial pharmacologic therapy for a
patient with newly diagnosed heart failure with reduced ejection fraction (HFrEF)
and no contraindications?
A. Furosemide alone
B. Metoprolol succinate, sacubitril/valsartan, and spironolactone CORRECT
C. Amlodipine and lisinopril
D. Digoxin and hydralazine
RATIONALE: Guideline-directed medical therapy for HFrEF includes a beta-blocker (e.g.,
metoprolol succinate), an ARNI (sacubitril/valsartan), and an aldosterone antagonist
(spironolactone) to reduce mortality and hospitalizations. Diuretics are for symptom relief, not
mortality benefit. Calcium channel blockers like amlodipine are not first-line. Digoxin and
hydralazine are older therapies with limited roles.
Page 2
,Q3 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
A patient with type 2 diabetes has an HbA1c of 8.5% on metformin and lifestyle
modifications. Which class of medication is most appropriate to add if the patient
has established atherosclerotic cardiovascular disease?
A. Sulfonylurea
B. DPP-4 inhibitor
C. SGLT2 inhibitor CORRECT
D. Insulin
RATIONALE: SGLT2 inhibitors have demonstrated cardiovascular benefit in patients with
ASCVD, reducing major adverse cardiac events. Sulfonylureas and DPP-4 inhibitors have neutral
cardiovascular effects. Insulin is effective for glycemic control but does not provide
cardiovascular benefit.
Q4 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
Which physical examination finding is most specific for detecting
community-acquired pneumonia in an adult with acute cough and fever?
A. Tachypnea
B. Egophony CORRECT
C. Dullness to percussion
D. Crackles on auscultation
RATIONALE: Egophony (increased resonance of 'E' to 'A') is highly specific for consolidation, as
seen in pneumonia. Tachypnea and crackles are sensitive but less specific. Dullness to
percussion can occur with pleural effusion or consolidation but is not as specific as egophony.
Page 3
, Q5 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
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. What is the most likely
diagnosis?
A. Central retinal vein occlusion
B. Central retinal artery occlusion CORRECT
C. Vitreous hemorrhage
D. Retinal detachment
RATIONALE: Central retinal artery occlusion (CRAO) typically presents with sudden, painless
monocular vision loss and a cherry-red spot due to ischemia of the retina except at the fovea,
which remains perfused by the choroid. CRVO presents with a blood-and-thunder fundus.
Vitreous hemorrhage and retinal detachment have different presentations.
Q6 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
Which of the following is the most appropriate next step in managing a patient
with suspected acute bacterial rhinosinusitis who has not improved after 10 days
of symptoms?
A. Prescribe amoxicillin-clavulanate CORRECT
B. Recommend saline nasal irrigation
C. Order a CT scan of the sinuses
D. Prescribe a topical decongestant
RATIONALE: For acute bacterial rhinosinusitis, first-line antibiotic therapy is
amoxicillin-clavulanate. Saline irrigation and decongestants are supportive but not definitive. CT
scan is reserved for complications or recurrent cases.
Page 4
ASSESSMENT FORM EXAM QUESTIONS
WITH ANSWERS UPDATED
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Demonstrate advanced diagnostic reasoning by integrating history, physical exam, and diagnostic findings
2 Select and interpret appropriate diagnostic tests based on pretest probability and clinical guidelines
3 Formulate safe, evidence-based pharmacologic and non-pharmacologic management plans
4 Apply current clinical guidelines and standards of care to complex patient scenarios
5 PRAC 6645 CLINICAL SKILLS SELF ASSESSMENT FORM EXAM QUESTIONS WITH ANSWERS
UPDATED
6 Foundations of Advanced Clinical Skills and Diagnostic Reasoning
7 Applied Advanced Clinical Skills and Diagnostic Reasoning
8 Advanced Advanced Clinical Skills and Diagnostic Reasoning
9 Advanced Clinical Skills and Diagnostic Reasoning Review
ABSTRACT
This study document brings together 150 carefully worded exam questions drawn from PRAC 6645
CLINICAL SKILLS SELF ASSESSMENT FORM EXAM QUESTIONS WITH ANSWERS
UPDATED, with the strongest emphasis placed on Demonstrate advanced diagnostic reasoning by
integrating history, physical exam, and diagnostic findings, Select and interpret appropriate
diagnostic tests based on pretest probability and clinical guidelines, Formulate safe and
evidence-based pharmacologic and non-pharmacologic management plans. Every item follows the
wording style and level of reasoning you meet in the real paper, and each one is paired with a clear
rationale so the correct choice is never a guess. Work through the set at your own pace, mark the
questions that slow you down, then come back to them until the reasoning feels automatic.
Learners who revise this way walk into the exam room recognising the pattern behind the
questions instead of meeting them for the first time. Keep going - steady, honest practice is what
turns a difficult paper into a comfortable pass.
Page 1
,Q1 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
A patient presents with acute onset of severe, tearing chest pain radiating to the
back, with a blood pressure differential of 20 mm Hg between arms. Which
diagnostic study is most appropriate to confirm the suspected diagnosis?
A. Transthoracic echocardiography
B. Contrast-enhanced CT angiography CORRECT
C. Troponin and CK-MB
D. Exercise stress testing
RATIONALE: Contrast-enhanced CT angiography is the gold standard for diagnosing aortic
dissection, with high sensitivity and specificity. Echocardiography can be useful but is less
sensitive for the entire aorta. Troponin may be elevated if there is coronary involvement but is not
diagnostic. Stress testing is contraindicated in suspected dissection.
Q2 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
Which of the following is the most appropriate initial pharmacologic therapy for a
patient with newly diagnosed heart failure with reduced ejection fraction (HFrEF)
and no contraindications?
A. Furosemide alone
B. Metoprolol succinate, sacubitril/valsartan, and spironolactone CORRECT
C. Amlodipine and lisinopril
D. Digoxin and hydralazine
RATIONALE: Guideline-directed medical therapy for HFrEF includes a beta-blocker (e.g.,
metoprolol succinate), an ARNI (sacubitril/valsartan), and an aldosterone antagonist
(spironolactone) to reduce mortality and hospitalizations. Diuretics are for symptom relief, not
mortality benefit. Calcium channel blockers like amlodipine are not first-line. Digoxin and
hydralazine are older therapies with limited roles.
Page 2
,Q3 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
A patient with type 2 diabetes has an HbA1c of 8.5% on metformin and lifestyle
modifications. Which class of medication is most appropriate to add if the patient
has established atherosclerotic cardiovascular disease?
A. Sulfonylurea
B. DPP-4 inhibitor
C. SGLT2 inhibitor CORRECT
D. Insulin
RATIONALE: SGLT2 inhibitors have demonstrated cardiovascular benefit in patients with
ASCVD, reducing major adverse cardiac events. Sulfonylureas and DPP-4 inhibitors have neutral
cardiovascular effects. Insulin is effective for glycemic control but does not provide
cardiovascular benefit.
Q4 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
Which physical examination finding is most specific for detecting
community-acquired pneumonia in an adult with acute cough and fever?
A. Tachypnea
B. Egophony CORRECT
C. Dullness to percussion
D. Crackles on auscultation
RATIONALE: Egophony (increased resonance of 'E' to 'A') is highly specific for consolidation, as
seen in pneumonia. Tachypnea and crackles are sensitive but less specific. Dullness to
percussion can occur with pleural effusion or consolidation but is not as specific as egophony.
Page 3
, Q5 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
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. What is the most likely
diagnosis?
A. Central retinal vein occlusion
B. Central retinal artery occlusion CORRECT
C. Vitreous hemorrhage
D. Retinal detachment
RATIONALE: Central retinal artery occlusion (CRAO) typically presents with sudden, painless
monocular vision loss and a cherry-red spot due to ischemia of the retina except at the fovea,
which remains perfused by the choroid. CRVO presents with a blood-and-thunder fundus.
Vitreous hemorrhage and retinal detachment have different presentations.
Q6 DEMONSTRATE ADVANCED DIAGNOSTIC REASONING BY INTEGRATING HISTORY,
PHYSICAL EXAM, AND DIAGNOSTIC FINDINGS
Which of the following is the most appropriate next step in managing a patient
with suspected acute bacterial rhinosinusitis who has not improved after 10 days
of symptoms?
A. Prescribe amoxicillin-clavulanate CORRECT
B. Recommend saline nasal irrigation
C. Order a CT scan of the sinuses
D. Prescribe a topical decongestant
RATIONALE: For acute bacterial rhinosinusitis, first-line antibiotic therapy is
amoxicillin-clavulanate. Saline irrigation and decongestants are supportive but not definitive. CT
scan is reserved for complications or recurrent cases.
Page 4
