WISE MD –2025 MEDICAL LICENSING EXAM 150 PRACTICE
QUESTIONS WITH CORRECT ANSWERS | CLINICAL KNOWLEDGE
REVIEW COVERING THE MOST TESTED QUESTIONS GRADED A+
THE WISE MD TEST INCLUDES CLINICAL SCENARIOS AND QUESTIONS SIMILAR
TO THOSE USED IN MEDICAL LICENSING EXAMS, FOCUSING ON DIAGNOSTIC
REASONING, TREATMENT PLANNING, AND EVIDENCE-BASED DECISIONS. IT IS
DESIGNED TO ENHANCE PREPARATION FOR RESIDENCY APPLICATIONS, ECFMG
CERTIFICATION, AND PRACTICE-READY COMPETENCY.
A 49-year-old man is referred for evaluation of a left groin mass found during a routine screening
physical. He has well-controlled hypertension but no other chronic disease or history of prior
surgery. He is 70 in (178 cm) tall and weighs 160 lb (73 kg). On physical examination, blood pressure
is 132/80 mm Hg, pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly, and no masses are
palpated. No groin or scrotal masses are appreciated, and there is no tenderness to palpation.
Which of the following is the most appropriate next step in management?
a. Reassure the patient that no hernia is present
b. Order computed tomography of the pelvis
c. Have the patient stand up and perform the Valsalva maneuver
d. Advise the patient to return to clinic when the mass is protruding
e. Obtain an ultrasound of the groin - CORRECT ANSWER-c. Have the patient stand up and perform
the Valsalva maneuver
A 49-year-old man is referred for evaluation of a left groin mass found during a routine screening
physical. He has well-controlled hypertension but no other chronic disease or history of prior
surgery. He is 70 in (178 cm) tall and weighs 160 lb (73 kg). On physical examination, blood pressure
is 132/80 mm Hg, pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly, and no masses are
palpated. No groin or scrotal masses are appreciated, and there is no tenderness to palpation.
Which of the following differentials should be given greatest consideration when choosing the next
step in management?
a. Epididymitis
b. Testicular torsion
c. Indirect or direct inguinal hernia
d. Direct inguinal hernia but not indirect
,e. Indirect inguinal hernia but not direct - CORRECT ANSWER-c. Indirect or direct inguinal hernia
A 25-year-old man comes to the emergency department because of a 4-week history of increasingly
severe bloody diarrhea and abdominal pain without fever or chills. He has been obstipated over the
past 24 hours. He has had 2 previous episodes of less severe symptoms that were treated on an
outpatient basis. With the exception of an appendectomy at the age of 12 years, he has no other
significant medical history and he takes no medications.
On physical examination, his temperature is 97.7°F (36.5°C), pulse is 90/min, respirations are
22/min, and blood pressure is 130/90 mm Hg. The abdomen is distended and mildly tender in the
right lower quadrant without guarding or rebound. Laboratory studies show a leukocyte count of
11,300/μL and hemoglobin of 12 g/dL.
Which of the following is the most likely diagnosis?
a. Meckle's diverticulitis
b. Colon cancer
c. Yersinia enterocolitis
d. Crohn's disease
e. Adhesive small bowel - CORRECT ANSWER-Crohn's disease
A 72-year-old woman comes to the emergency department with a 2-day history of vomiting and
intermittent colicky abdominal pain. She has not had any recent weight loss. For the past 10 years,
she has had postprandial upper abdominal pain that resolves with self medication with an analgesic.
She has no other significant medical history, and she takes no other medications.
On physical examination, her temperature is 96.8°F (36.0°C), pulse is 90/min and regular,
respirations are 22/min, and blood pressure is 130/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. The abdomen is distended and mildly tender to deep palpation.
Bowel sounds are high pitched and tinkling. A plain radiograph of the abdomen shows branching air
collections projecting over the liver with distended small bowel and decompressed colon.
Which of the following is the most likely diagnosis?
a. Gallstone ileus
b. Ad - CORRECT ANSWER-Gallstone ileus
The presence of air in branching pattern over the liver is characteristic of biliary air seen in patient
presenting with small bowel obstruction due to a gallstone that is typically stuck at the ileo-cecal
valve.
,A previously healthy 22-month-old boy is brought to the emergency department because of
paroxysms of severe colicky abdominal discomfort that has persisted for 24 hours. His mother
reports that he passed maroon-colored stool earlier today. He has not had fever.
The patient's temperature is 98.6°F (37.0°C), pulse is 90/min, respirations are 24/min, and blood
pressure is 105/80 mm Hg. On cardiac examination, S1 and S2 are normal, and no murmurs are
heard. The lungs are clear to auscultation. Abdominal examination shows distention and right-sided
fullness. Laboratory studies show a leukocyte count of 7800/mm3. An abdominal radiograph shows
dilated loops of small bowel.
Which of the following is the best next step in diagnosis?
a. Upper gastrointestinal series with water-soluble contrast
b. Barium enema
c. Colonoscopy
d. Computed tomography of the abdomen
e. Surgical exploration - CORRECT ANSWER-Barium enema- intussusception
A 45-year-old woman comes to the emergency department because of a 2-day history of severe
periumbilical, colicky pain and abdominal distention. She is nauseated and has vomited light green
vomitus 6 times in the past 24 hours. She has not passed stools or flatus for 48 hours. Her medical
history is remarkable only for appendectomy at the age of 14 years.
On physical examination, her temperature is 100.4°F (38.0°C), pulse is 100/min and regular,
respirations are 24/min, and blood pressure is 120/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. The abdomen is distended and mildly tender with rebound on
deep palpation. Bowel sounds are rare and high pitched.
Laboratory studies show a leukocyte count of 15,000/mm3. Plain films of the abdomen show
dilated proximal small bowel with pneumatosis.
A nasogastric tube is placed and intravenous fluids are begun. Which of the following - CORRECT
ANSWER-Exploratory laparotomy
Presence of peritoneal signs and pneumoatosis on x-rays are concerning for compromised or dead
bowel. Especially in light of the leukocytosis and low grad temperature.
A 60-year-old man is evaluated for a 5-day history of lower abdominal pain and tenesmus. For the
past 2 days, the abdominal pain has increased, and he has had nausea without vomiting. He has 2
previous episodes of similar symptoms that were treated on an outpatient basis. The patient has a
history of chronic constipation that he manages with magnesium hydroxide.
On physical examination, his temperature is 100.8°F (38.2°C), pulse is 90/min and regular,
respirations are 16/min, and blood pressure is 140/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. There is significant tenderness in the left lower quadrant with
guarding but no rebound. Laboratory studies show a leukocyte count of 12,400/mm3 and
hemoglobin of 12 g/dL.
, Which of the following is the most likely diagnosis?
a. Diverticulitis
b. Sigmoid volvulus
c. Carcinoma of the colon
d. Ischemic colitis
e. Crohn disease - CORRECT ANSWER-Diverticulitis often presents with low grade temps, left lower
quadrant pain and tenderness, and leukocytosis.
A 60-year-old man is evaluated for a 5-day history of lower abdominal pain and tenesmus. For the
past 2 days, the abdominal pain has increased, and he has had nausea without vomiting. He has 2
previous episodes of similar symptoms that were treated on an outpatient basis. The patient has a
history of chronic constipation that he manages with magnesium hydroxide.
On physical examination, his temperature is 100.8°F (38.2°C), pulse is 90/min and regular,
respirations are 16/min, and blood pressure is 140/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. The abdomen is distended with high-pitched tinkling bowel
sounds. There is significant tenderness in the left lower quadrant with guarding but no rebound.
Laboratory studies show a leukocyte count of 12,400/mm3 and hemoglobin of 12 g/dL.
A nasogastric tube is placed and intravenous fluids are begun. Which of the following is the most -
CORRECT ANSWER-Computed tomography of the abdomen
A 44-year-old woman who underwent laparoscopic cholecystectomy 36 hours ago comes to the
emergency department because of a 8-hour history of severe periumbilical pain. She is nauseated
and has vomited 4 times in the past 12 hours.
On physical examination, the trochar site appears clean. Her temperature is 101.3°F (38.5°C), pulse
is 118/min and regular, respirations are 22/min, and blood pressure is 120/90 mm Hg. No murmurs
are heard. Diffuse crackles are heard at the bases of both lungs. The abdomen is distended and
diffusely tender to palpation and percussion.
Laboratory studies show a serum bilirubin of 0.8 mg/dL. Hepatobiliary iminodiacetic acid (HIDA)
scan shows no evidence of a bile leak.
Which of the following is the best next step in management?
a.Exploratory laparotomy
b. Computed tomography of the abdomen
c. Abdominal ultrasound
d. Observation and antibiotic therapy
e. Upper gastrointestinal series - CORRECT ANSWER-Exploratory laparotomy.
Patient is presenting with a picture of systemic sepsis and an acute abdomen
QUESTIONS WITH CORRECT ANSWERS | CLINICAL KNOWLEDGE
REVIEW COVERING THE MOST TESTED QUESTIONS GRADED A+
THE WISE MD TEST INCLUDES CLINICAL SCENARIOS AND QUESTIONS SIMILAR
TO THOSE USED IN MEDICAL LICENSING EXAMS, FOCUSING ON DIAGNOSTIC
REASONING, TREATMENT PLANNING, AND EVIDENCE-BASED DECISIONS. IT IS
DESIGNED TO ENHANCE PREPARATION FOR RESIDENCY APPLICATIONS, ECFMG
CERTIFICATION, AND PRACTICE-READY COMPETENCY.
A 49-year-old man is referred for evaluation of a left groin mass found during a routine screening
physical. He has well-controlled hypertension but no other chronic disease or history of prior
surgery. He is 70 in (178 cm) tall and weighs 160 lb (73 kg). On physical examination, blood pressure
is 132/80 mm Hg, pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly, and no masses are
palpated. No groin or scrotal masses are appreciated, and there is no tenderness to palpation.
Which of the following is the most appropriate next step in management?
a. Reassure the patient that no hernia is present
b. Order computed tomography of the pelvis
c. Have the patient stand up and perform the Valsalva maneuver
d. Advise the patient to return to clinic when the mass is protruding
e. Obtain an ultrasound of the groin - CORRECT ANSWER-c. Have the patient stand up and perform
the Valsalva maneuver
A 49-year-old man is referred for evaluation of a left groin mass found during a routine screening
physical. He has well-controlled hypertension but no other chronic disease or history of prior
surgery. He is 70 in (178 cm) tall and weighs 160 lb (73 kg). On physical examination, blood pressure
is 132/80 mm Hg, pulse is 75/min, and respirations are 16/min and unlabored. With the patient in
supine position, the abdomen is soft and nontender; there is no organomegaly, and no masses are
palpated. No groin or scrotal masses are appreciated, and there is no tenderness to palpation.
Which of the following differentials should be given greatest consideration when choosing the next
step in management?
a. Epididymitis
b. Testicular torsion
c. Indirect or direct inguinal hernia
d. Direct inguinal hernia but not indirect
,e. Indirect inguinal hernia but not direct - CORRECT ANSWER-c. Indirect or direct inguinal hernia
A 25-year-old man comes to the emergency department because of a 4-week history of increasingly
severe bloody diarrhea and abdominal pain without fever or chills. He has been obstipated over the
past 24 hours. He has had 2 previous episodes of less severe symptoms that were treated on an
outpatient basis. With the exception of an appendectomy at the age of 12 years, he has no other
significant medical history and he takes no medications.
On physical examination, his temperature is 97.7°F (36.5°C), pulse is 90/min, respirations are
22/min, and blood pressure is 130/90 mm Hg. The abdomen is distended and mildly tender in the
right lower quadrant without guarding or rebound. Laboratory studies show a leukocyte count of
11,300/μL and hemoglobin of 12 g/dL.
Which of the following is the most likely diagnosis?
a. Meckle's diverticulitis
b. Colon cancer
c. Yersinia enterocolitis
d. Crohn's disease
e. Adhesive small bowel - CORRECT ANSWER-Crohn's disease
A 72-year-old woman comes to the emergency department with a 2-day history of vomiting and
intermittent colicky abdominal pain. She has not had any recent weight loss. For the past 10 years,
she has had postprandial upper abdominal pain that resolves with self medication with an analgesic.
She has no other significant medical history, and she takes no other medications.
On physical examination, her temperature is 96.8°F (36.0°C), pulse is 90/min and regular,
respirations are 22/min, and blood pressure is 130/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. The abdomen is distended and mildly tender to deep palpation.
Bowel sounds are high pitched and tinkling. A plain radiograph of the abdomen shows branching air
collections projecting over the liver with distended small bowel and decompressed colon.
Which of the following is the most likely diagnosis?
a. Gallstone ileus
b. Ad - CORRECT ANSWER-Gallstone ileus
The presence of air in branching pattern over the liver is characteristic of biliary air seen in patient
presenting with small bowel obstruction due to a gallstone that is typically stuck at the ileo-cecal
valve.
,A previously healthy 22-month-old boy is brought to the emergency department because of
paroxysms of severe colicky abdominal discomfort that has persisted for 24 hours. His mother
reports that he passed maroon-colored stool earlier today. He has not had fever.
The patient's temperature is 98.6°F (37.0°C), pulse is 90/min, respirations are 24/min, and blood
pressure is 105/80 mm Hg. On cardiac examination, S1 and S2 are normal, and no murmurs are
heard. The lungs are clear to auscultation. Abdominal examination shows distention and right-sided
fullness. Laboratory studies show a leukocyte count of 7800/mm3. An abdominal radiograph shows
dilated loops of small bowel.
Which of the following is the best next step in diagnosis?
a. Upper gastrointestinal series with water-soluble contrast
b. Barium enema
c. Colonoscopy
d. Computed tomography of the abdomen
e. Surgical exploration - CORRECT ANSWER-Barium enema- intussusception
A 45-year-old woman comes to the emergency department because of a 2-day history of severe
periumbilical, colicky pain and abdominal distention. She is nauseated and has vomited light green
vomitus 6 times in the past 24 hours. She has not passed stools or flatus for 48 hours. Her medical
history is remarkable only for appendectomy at the age of 14 years.
On physical examination, her temperature is 100.4°F (38.0°C), pulse is 100/min and regular,
respirations are 24/min, and blood pressure is 120/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. The abdomen is distended and mildly tender with rebound on
deep palpation. Bowel sounds are rare and high pitched.
Laboratory studies show a leukocyte count of 15,000/mm3. Plain films of the abdomen show
dilated proximal small bowel with pneumatosis.
A nasogastric tube is placed and intravenous fluids are begun. Which of the following - CORRECT
ANSWER-Exploratory laparotomy
Presence of peritoneal signs and pneumoatosis on x-rays are concerning for compromised or dead
bowel. Especially in light of the leukocytosis and low grad temperature.
A 60-year-old man is evaluated for a 5-day history of lower abdominal pain and tenesmus. For the
past 2 days, the abdominal pain has increased, and he has had nausea without vomiting. He has 2
previous episodes of similar symptoms that were treated on an outpatient basis. The patient has a
history of chronic constipation that he manages with magnesium hydroxide.
On physical examination, his temperature is 100.8°F (38.2°C), pulse is 90/min and regular,
respirations are 16/min, and blood pressure is 140/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. There is significant tenderness in the left lower quadrant with
guarding but no rebound. Laboratory studies show a leukocyte count of 12,400/mm3 and
hemoglobin of 12 g/dL.
, Which of the following is the most likely diagnosis?
a. Diverticulitis
b. Sigmoid volvulus
c. Carcinoma of the colon
d. Ischemic colitis
e. Crohn disease - CORRECT ANSWER-Diverticulitis often presents with low grade temps, left lower
quadrant pain and tenderness, and leukocytosis.
A 60-year-old man is evaluated for a 5-day history of lower abdominal pain and tenesmus. For the
past 2 days, the abdominal pain has increased, and he has had nausea without vomiting. He has 2
previous episodes of similar symptoms that were treated on an outpatient basis. The patient has a
history of chronic constipation that he manages with magnesium hydroxide.
On physical examination, his temperature is 100.8°F (38.2°C), pulse is 90/min and regular,
respirations are 16/min, and blood pressure is 140/90 mm Hg. No murmurs are heard. The lungs are
clear to auscultation and percussion. The abdomen is distended with high-pitched tinkling bowel
sounds. There is significant tenderness in the left lower quadrant with guarding but no rebound.
Laboratory studies show a leukocyte count of 12,400/mm3 and hemoglobin of 12 g/dL.
A nasogastric tube is placed and intravenous fluids are begun. Which of the following is the most -
CORRECT ANSWER-Computed tomography of the abdomen
A 44-year-old woman who underwent laparoscopic cholecystectomy 36 hours ago comes to the
emergency department because of a 8-hour history of severe periumbilical pain. She is nauseated
and has vomited 4 times in the past 12 hours.
On physical examination, the trochar site appears clean. Her temperature is 101.3°F (38.5°C), pulse
is 118/min and regular, respirations are 22/min, and blood pressure is 120/90 mm Hg. No murmurs
are heard. Diffuse crackles are heard at the bases of both lungs. The abdomen is distended and
diffusely tender to palpation and percussion.
Laboratory studies show a serum bilirubin of 0.8 mg/dL. Hepatobiliary iminodiacetic acid (HIDA)
scan shows no evidence of a bile leak.
Which of the following is the best next step in management?
a.Exploratory laparotomy
b. Computed tomography of the abdomen
c. Abdominal ultrasound
d. Observation and antibiotic therapy
e. Upper gastrointestinal series - CORRECT ANSWER-Exploratory laparotomy.
Patient is presenting with a picture of systemic sepsis and an acute abdomen
