Baseline Exam UPDATED QUESTIONS
AND CORRECT ANSWERS
A 65-year-old man is seen for loose stools 3 times per day for 1 week. Two weeks prior he
began a 6-week course of ciprofloxacin for prostatitis. There is no blood in his stool. His past
medical history is notable for atrial fibrillation, hypertension, and gout. He takes atenolol,
warfarin, hydrochlorothiazide, and allopurinol. He smoked 2 packs per day for 30 years but
quit 10 years ago. He no longer drinks, but he drank heavily until 10 years ago. He does not
use drugs. He works as a plumber. His mother and father both died of heart attacks in their
80s. He has not noted any bruising, epistaxis, or bleeding gums.
His temperature is 36.7, heart rate 89, blood pressure 115/84, respiratory rate 16, and oxygen
saturation 98% on room air. He weighs 70kg. He is alert and oriented and in no acute distress.
His physical examination is normal, and he has no ecchymoses.
His WBC count is 7,800/microliter, hemoglobin 14.6 g/ - CORRECT ANSWER 4.
hold warfarin and recheck INR in 2-3 days
A 22-year-old man presents for a pre-marital evaluation. He is asymptomatic and feels well.
His past medical history is notable for sickle cell trait. He takes a multivitamin and has no
allergies. He does not smoke, drink, or use drugs. He is a card dealer at a casino. His ROS
and exam are negative. His fiancée is also asymptomatic and has been diagnosed with alpha-
thalassemia trait based on hemoglobin electrophoresis. She is an immigrant from Kenya and
works in public relations.
What is the chance they will have a child with sickle cell disease?
1. 0%
2. 25%
3. 50%
4. 67%
5. 100% - CORRECT ANSWER 1. 0%
,A 64-year-old African American man presents with fatigue. His thyroid-stimulating hormone
level is normal, but he was found to have a normocytic anemia with a hemoglobin level of 9
g/dL. He has a reticulocyte count of 4%, and his ferritin level is normal. His lactate
dehydrogenase level is modestly elevated, as is his indirect bilirubin level. Haptoglobin levels
are low. His history is significant for mechanical mitral valve replacement in his 40s when he
had severe mitral regurgitation due to endocarditis.
A Coombs test is done and is negative. The hemoglobin electrophoresis is negative. A
peripheral blood smear shows numerous irregularly shaped, jagged, asymmetric red blood
cells.
Which of the following is the most likely cause of this patient's anemia?
1. microangiopathic hemolytic anemia
2. immune hemolysis
3. thalassemia
4. sickle cell anemia
5. hereditary spherocytosis - CORRECT ANSWER 1. microangiopathic hemolytic
anemia
A 61-year-old man with a history of hypertension complains of nocturia for the past several
months. He also describes symptoms of urinary urgency, hesitancy, and dribbling during the
same time period. He denies polyuria, polydipsia, and hematuria. He has no other complaints.
DRE reveals a prostate of approximately 3 fingerbreadths wide. The prostate is soft,
nontender, and there are no nodules. The rest of the physical examination is unremarkable.
What is the next best step in the treatment of this patient?
1. order UA, urine culture, and PSA tests
2. order transurethral ultrasonography of the prostate
3. start alpha-1-receptor blockade
4. start 5-alpha-reductase inhibitor
, 5. expectant management with DRE and PSA annually - CORRECT ANSWER 1.
order UA, urine culture, and PSA tests
A 32-year-old man complains of painful penile lesions. Physical examination reveals tender,
soft, putty-like ulcers (see image).
The patient also has a tender inguinal bubo. You suspect chancroid. Which of the following
clinical characteristics or diagnostic tests for chancroid is
1. biopsy needed for a pathologic confirmation of the diagnosis
2. presents as tender lymphadenopathy and genital ulcers
3. Chlamydia trachomatis on lesion smear
4. diagnosis is clinical with no need for culture
5. Serologic testing for herpes simplex virus - CORRECT ANSWER 2. presents as
tender lymphadenopathy and genital ulcers
A 21-year-old female presents with urinary retention, tender inguinal adenopathy, and lesions
as shown.
Which of the following is the most likely diagnosis?
1. herpes simplex virus primary infection
2. herpes simplex virus recurrent infection
3. Erosive lichen planus
4. recurrent treponema pallidum infection
5. primary treponema pallidum infection - CORRECT ANSWER 1. herpes simplex
virus primary infection
A 35-year-old woman presents to your office with abnormal laboratory results. She admits to
only mild fatigue and denies any nausea, vomiting, and diarrhea. There is no history of any
abdominal pathology. On physical examination, her vital signs are stable and there is no
abdominal or flank tenderness noted. Laboratory results show a sodium level of 140 mEq/L, a
, potassium level of 2.9 mEq/L, and a carbon dioxide level of 17 mEq/L. The serum creatinine
level is 0.4 mEq/L and blood glucose is 68 mg/dL. The results are similar to blood work
obtained 3 months ago. Urinalysis is positive for 2+ blood on urine dipstick. The microscopic
examination shows 30-50 red blood cells/HPF. Urine pH is 6.0 on urine dip. Given the
history and laboratory findings, which of the following would you expect to find?
1. calcium oxalate stones
2. magnesium ammonium phosphate stones
3. calcium phosphate stones
4. uric acid stones
5. cys - CORRECT ANSWER 3. calcium phosphate stones
A 65-year-old woman with a known history of diabetes for 15 years and hypertension for 9
years presents to you with a history of right flank pain and high-grade fever. She also notes
hematuria, dysuria, rigors, sweating, and nausea for the past 5 days. She has no history of
prior renal disease or other issues. On physical examination, her temperature is 103.6°F and
blood pressure is 95/50 mm Hg. She appears flushed and has severe right costovertebral
angle tenderness. No other abnormality is detected on physical examination.
Laboratory investigations reveal hemoglobin of 12.4 g/dL and white blood cell (WBC) count
of 24,000/mm3
Urea nitrogen = 19 mg/dL
Creatinine = 1.3 mg/dL
Sodium = 131 mEq/L
Potassium = 3.0 mEq/L
Urine analysis indicates:
WBC = 135 cells/hpf
Red blood cells, bacteria, and WBC casts = Numerous
CT scan of her abdomen shows air in the left renal parenchyma. What is the most likely
diagnosis?
AND CORRECT ANSWERS
A 65-year-old man is seen for loose stools 3 times per day for 1 week. Two weeks prior he
began a 6-week course of ciprofloxacin for prostatitis. There is no blood in his stool. His past
medical history is notable for atrial fibrillation, hypertension, and gout. He takes atenolol,
warfarin, hydrochlorothiazide, and allopurinol. He smoked 2 packs per day for 30 years but
quit 10 years ago. He no longer drinks, but he drank heavily until 10 years ago. He does not
use drugs. He works as a plumber. His mother and father both died of heart attacks in their
80s. He has not noted any bruising, epistaxis, or bleeding gums.
His temperature is 36.7, heart rate 89, blood pressure 115/84, respiratory rate 16, and oxygen
saturation 98% on room air. He weighs 70kg. He is alert and oriented and in no acute distress.
His physical examination is normal, and he has no ecchymoses.
His WBC count is 7,800/microliter, hemoglobin 14.6 g/ - CORRECT ANSWER 4.
hold warfarin and recheck INR in 2-3 days
A 22-year-old man presents for a pre-marital evaluation. He is asymptomatic and feels well.
His past medical history is notable for sickle cell trait. He takes a multivitamin and has no
allergies. He does not smoke, drink, or use drugs. He is a card dealer at a casino. His ROS
and exam are negative. His fiancée is also asymptomatic and has been diagnosed with alpha-
thalassemia trait based on hemoglobin electrophoresis. She is an immigrant from Kenya and
works in public relations.
What is the chance they will have a child with sickle cell disease?
1. 0%
2. 25%
3. 50%
4. 67%
5. 100% - CORRECT ANSWER 1. 0%
,A 64-year-old African American man presents with fatigue. His thyroid-stimulating hormone
level is normal, but he was found to have a normocytic anemia with a hemoglobin level of 9
g/dL. He has a reticulocyte count of 4%, and his ferritin level is normal. His lactate
dehydrogenase level is modestly elevated, as is his indirect bilirubin level. Haptoglobin levels
are low. His history is significant for mechanical mitral valve replacement in his 40s when he
had severe mitral regurgitation due to endocarditis.
A Coombs test is done and is negative. The hemoglobin electrophoresis is negative. A
peripheral blood smear shows numerous irregularly shaped, jagged, asymmetric red blood
cells.
Which of the following is the most likely cause of this patient's anemia?
1. microangiopathic hemolytic anemia
2. immune hemolysis
3. thalassemia
4. sickle cell anemia
5. hereditary spherocytosis - CORRECT ANSWER 1. microangiopathic hemolytic
anemia
A 61-year-old man with a history of hypertension complains of nocturia for the past several
months. He also describes symptoms of urinary urgency, hesitancy, and dribbling during the
same time period. He denies polyuria, polydipsia, and hematuria. He has no other complaints.
DRE reveals a prostate of approximately 3 fingerbreadths wide. The prostate is soft,
nontender, and there are no nodules. The rest of the physical examination is unremarkable.
What is the next best step in the treatment of this patient?
1. order UA, urine culture, and PSA tests
2. order transurethral ultrasonography of the prostate
3. start alpha-1-receptor blockade
4. start 5-alpha-reductase inhibitor
, 5. expectant management with DRE and PSA annually - CORRECT ANSWER 1.
order UA, urine culture, and PSA tests
A 32-year-old man complains of painful penile lesions. Physical examination reveals tender,
soft, putty-like ulcers (see image).
The patient also has a tender inguinal bubo. You suspect chancroid. Which of the following
clinical characteristics or diagnostic tests for chancroid is
1. biopsy needed for a pathologic confirmation of the diagnosis
2. presents as tender lymphadenopathy and genital ulcers
3. Chlamydia trachomatis on lesion smear
4. diagnosis is clinical with no need for culture
5. Serologic testing for herpes simplex virus - CORRECT ANSWER 2. presents as
tender lymphadenopathy and genital ulcers
A 21-year-old female presents with urinary retention, tender inguinal adenopathy, and lesions
as shown.
Which of the following is the most likely diagnosis?
1. herpes simplex virus primary infection
2. herpes simplex virus recurrent infection
3. Erosive lichen planus
4. recurrent treponema pallidum infection
5. primary treponema pallidum infection - CORRECT ANSWER 1. herpes simplex
virus primary infection
A 35-year-old woman presents to your office with abnormal laboratory results. She admits to
only mild fatigue and denies any nausea, vomiting, and diarrhea. There is no history of any
abdominal pathology. On physical examination, her vital signs are stable and there is no
abdominal or flank tenderness noted. Laboratory results show a sodium level of 140 mEq/L, a
, potassium level of 2.9 mEq/L, and a carbon dioxide level of 17 mEq/L. The serum creatinine
level is 0.4 mEq/L and blood glucose is 68 mg/dL. The results are similar to blood work
obtained 3 months ago. Urinalysis is positive for 2+ blood on urine dipstick. The microscopic
examination shows 30-50 red blood cells/HPF. Urine pH is 6.0 on urine dip. Given the
history and laboratory findings, which of the following would you expect to find?
1. calcium oxalate stones
2. magnesium ammonium phosphate stones
3. calcium phosphate stones
4. uric acid stones
5. cys - CORRECT ANSWER 3. calcium phosphate stones
A 65-year-old woman with a known history of diabetes for 15 years and hypertension for 9
years presents to you with a history of right flank pain and high-grade fever. She also notes
hematuria, dysuria, rigors, sweating, and nausea for the past 5 days. She has no history of
prior renal disease or other issues. On physical examination, her temperature is 103.6°F and
blood pressure is 95/50 mm Hg. She appears flushed and has severe right costovertebral
angle tenderness. No other abnormality is detected on physical examination.
Laboratory investigations reveal hemoglobin of 12.4 g/dL and white blood cell (WBC) count
of 24,000/mm3
Urea nitrogen = 19 mg/dL
Creatinine = 1.3 mg/dL
Sodium = 131 mEq/L
Potassium = 3.0 mEq/L
Urine analysis indicates:
WBC = 135 cells/hpf
Red blood cells, bacteria, and WBC casts = Numerous
CT scan of her abdomen shows air in the left renal parenchyma. What is the most likely
diagnosis?
