HIGH YIELD IM EOR Exam| 400 Questions
Complete with Correct Answers
Which of the following is not a component of Charcot's triad of symptoms used in the
identification cholangitis?
A. Right upper quadrant pain
B. Hepatomegaly
C. Fever
D. Jaundice
E. Altered mental status CORRECT ANSWER: hepatomegaly
A woman presents to the clinic complaining of pedal edema. Which of the following would be
most suggestive of congestive heart failure as the likely etiology?
A. History of bulimia nervosa
B. History of chronic renal insufficiency
C. History of diabetes mellitus
D. History of inflammatory bowel disease CORRECT ANSWER: C. History of diabetes
mellitus
Which of the following conditions is most commonly associated with malar or "butterfly" rash?
A. Parvovirus B19 infection
B. Pregnancy
C. Rosacea
D. Systemic lupus erythematosus CORRECT ANSWER: D. Systemic lupus erythematosus
A patient presents with a grade II/VI late systolic murmur heard best in the fifth intercostal space
in the midclavicular line. Which of the following cardiac processes best correlates with this
finding?
A. Left-to-right blood flow across a small, muscular ventricular septal defect
,B. Regurgitant blood flow from the left ventricle to the left atrium
C. Regurgitant blood flow from the right ventricle to the right atrium
D. Turbulent blood flow across redundant mitral valve tissue CORRECT ANSWER: D.
Turbulent blood flow across redundant mitral valve tissue
-Turbulent blood flow across redundant mitral valve tissue describes MITRAL VALVE
PROLAPSE, which is the most common cause of a late systolic murmur and is typically
preceded by a click.
A 68-year-old man presents to the clinic with a medical history of hepatitis B infection and
hepatic cirrhosis. Which of the following is the best choice of surveillance for the development
of hepatocellular carcinoma in this patient?
A. Abdominal CT scan every 12 months
B. Abdominal CT scan every 2 years
C. Liver ultrasound every 12 months
D. Liver ultrasound every 6 months CORRECT ANSWER: D. Liver ultrasound every 6
months
-Patients with cirrhosis of any type should receive a liver ultrasound every 6 months to monitor
for the development of hepatocellular cancer.
A 24-year-old man presents to the emergency department with fever and chills, right upper
quadrant pain, and jaundice. Abdominal ultrasound shows dilation of the common bile duct.
What is the most likely diagnosis?
A. Acute cholangitis
B. Acute cholecystitis
C. Acute hepatitis
D. Cholelithiasis CORRECT ANSWER: A. Acute cholangitis
-Acute cholangitis is a bacterial infection caused by obstruction of the biliary tree, most
commonly by a gallstone
-Patients can present with classic symptoms of fever, right upper quadrant pain, and jaundice,
known as Charcot triad.
,A 59-year-old woman presents to the clinic reporting numbness in her hands and around her
mouth, as well as muscle cramps, fatigue, and intermittent hoarseness. Her medical history
includes hypertension, hyperlipidemia, diabetes, and a thyroid malignancy which was recently
treated by surgical excision. On physical examination, she is noted to have an ataxic gait,
hyperresponsive deep tendon reflexes, and appears to be anxious. Additionally, carpal spasms
are noted when her blood pressure is taken. Her vital signs are within normal limits for her age.
Results of a complete blood count and complete metabolic profile are notable for a low total
calcium. Which of the following is the most likely diagnosis?
A. Hyperparathyroidism
B. Hypoparathyroidism
C. Hypophosphatemia
D. Hypothyroidism CORRECT ANSWER: B. Hypoparathyroidism
-Hypoparathyroidism is a deficiency of parathyroid hormone (PTH) that results in low levels of
calcium, particularly low ionized calcium
When evaluating a patient with chest pain, you note ST-segment elevation in leads II, III and
aVF. Which of the following is the most likely diagnosis?
A. Anterior wall myocardial ischemia
B. Inferior wall myocardial ischemia
C. Lateral wall myocardial ischemia
D. Posterior wall myocardial ischemia CORRECT ANSWER: B. Inferior wall myocardial
ischemia
-Right ventricular ischemia or infarction will present with inferior ECG changes (ST-segment
shifts or Q waves in leads II, III, and aVF).
A 60-year-old man presents to the clinic with a high-pitched, blowing systolic murmur heard
best at the apex and radiating to his left axilla. Which of the following is the most likely
diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Pulmonic stenosis
D. Tricuspid regurgitation CORRECT ANSWER: B. Mitral regurgitation
, -Mitral regurgitation is associated with a high-pitched, blowing systolic murmur heard best at the
apex and radiating to the left axilla, as well as a wide splitting of S2 due to early closure of the
aortic valve.
A 44-year-old man presents for a follow-up visit for his known gastroesophageal reflux disease.
He has been taking a histamine-2-receptor antagonist twice a day. He continues to have
symptoms at least three times per week. Which of the following is the next best therapy?
A. Calcium carbonate
B. Famotidine
C. Omeprazole
D. Sucralfate CORRECT ANSWER: C. Omeprazole
-Proton pump inhibitors (PPIs), such as omeprazole, should be used in patients who fail twice-
daily histamine-2-receptor antagonist therapy, in patients with erosive esophagitis, or patients
with severe and frequent symptoms of GERD
A 77-year-old woman presents to the clinic complaining of recent onset of headaches. She denies
any visual changes and vitals are normal. On exam, she is tender over the right temporal area.
She follows with cardiology for a history of a heart valve replacement and with rheumatology for
a disease that "has a long name" which she can't remember. Which of the following is the most
likely diagnosis?
A. Cluster headache
B. Fibromyalgia
C. Giant cell arteritis
D. Trigeminal neuralgia CORRECT ANSWER: C. Giant cell arteritis
-Giant cell arteritis, or temporal arteritis, is the most common vasculitis of large and medium-
sized vessels. It is more commonly seen in women > 50 years of age
A 35-year-old man presents to the office with acute onset right flank pain radiating to the groin
with intermittent nausea and vomiting. A urinalysis and computed tomography of the abdomen
and pelvis without contrast were ordered. An urgent referral for outpatient urologist evaluation
would be most appropriate for which of the following findings?
A. A 10.5 mm mid-ureteral stone
B. A 3 mm stone in the distal ureter
Complete with Correct Answers
Which of the following is not a component of Charcot's triad of symptoms used in the
identification cholangitis?
A. Right upper quadrant pain
B. Hepatomegaly
C. Fever
D. Jaundice
E. Altered mental status CORRECT ANSWER: hepatomegaly
A woman presents to the clinic complaining of pedal edema. Which of the following would be
most suggestive of congestive heart failure as the likely etiology?
A. History of bulimia nervosa
B. History of chronic renal insufficiency
C. History of diabetes mellitus
D. History of inflammatory bowel disease CORRECT ANSWER: C. History of diabetes
mellitus
Which of the following conditions is most commonly associated with malar or "butterfly" rash?
A. Parvovirus B19 infection
B. Pregnancy
C. Rosacea
D. Systemic lupus erythematosus CORRECT ANSWER: D. Systemic lupus erythematosus
A patient presents with a grade II/VI late systolic murmur heard best in the fifth intercostal space
in the midclavicular line. Which of the following cardiac processes best correlates with this
finding?
A. Left-to-right blood flow across a small, muscular ventricular septal defect
,B. Regurgitant blood flow from the left ventricle to the left atrium
C. Regurgitant blood flow from the right ventricle to the right atrium
D. Turbulent blood flow across redundant mitral valve tissue CORRECT ANSWER: D.
Turbulent blood flow across redundant mitral valve tissue
-Turbulent blood flow across redundant mitral valve tissue describes MITRAL VALVE
PROLAPSE, which is the most common cause of a late systolic murmur and is typically
preceded by a click.
A 68-year-old man presents to the clinic with a medical history of hepatitis B infection and
hepatic cirrhosis. Which of the following is the best choice of surveillance for the development
of hepatocellular carcinoma in this patient?
A. Abdominal CT scan every 12 months
B. Abdominal CT scan every 2 years
C. Liver ultrasound every 12 months
D. Liver ultrasound every 6 months CORRECT ANSWER: D. Liver ultrasound every 6
months
-Patients with cirrhosis of any type should receive a liver ultrasound every 6 months to monitor
for the development of hepatocellular cancer.
A 24-year-old man presents to the emergency department with fever and chills, right upper
quadrant pain, and jaundice. Abdominal ultrasound shows dilation of the common bile duct.
What is the most likely diagnosis?
A. Acute cholangitis
B. Acute cholecystitis
C. Acute hepatitis
D. Cholelithiasis CORRECT ANSWER: A. Acute cholangitis
-Acute cholangitis is a bacterial infection caused by obstruction of the biliary tree, most
commonly by a gallstone
-Patients can present with classic symptoms of fever, right upper quadrant pain, and jaundice,
known as Charcot triad.
,A 59-year-old woman presents to the clinic reporting numbness in her hands and around her
mouth, as well as muscle cramps, fatigue, and intermittent hoarseness. Her medical history
includes hypertension, hyperlipidemia, diabetes, and a thyroid malignancy which was recently
treated by surgical excision. On physical examination, she is noted to have an ataxic gait,
hyperresponsive deep tendon reflexes, and appears to be anxious. Additionally, carpal spasms
are noted when her blood pressure is taken. Her vital signs are within normal limits for her age.
Results of a complete blood count and complete metabolic profile are notable for a low total
calcium. Which of the following is the most likely diagnosis?
A. Hyperparathyroidism
B. Hypoparathyroidism
C. Hypophosphatemia
D. Hypothyroidism CORRECT ANSWER: B. Hypoparathyroidism
-Hypoparathyroidism is a deficiency of parathyroid hormone (PTH) that results in low levels of
calcium, particularly low ionized calcium
When evaluating a patient with chest pain, you note ST-segment elevation in leads II, III and
aVF. Which of the following is the most likely diagnosis?
A. Anterior wall myocardial ischemia
B. Inferior wall myocardial ischemia
C. Lateral wall myocardial ischemia
D. Posterior wall myocardial ischemia CORRECT ANSWER: B. Inferior wall myocardial
ischemia
-Right ventricular ischemia or infarction will present with inferior ECG changes (ST-segment
shifts or Q waves in leads II, III, and aVF).
A 60-year-old man presents to the clinic with a high-pitched, blowing systolic murmur heard
best at the apex and radiating to his left axilla. Which of the following is the most likely
diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Pulmonic stenosis
D. Tricuspid regurgitation CORRECT ANSWER: B. Mitral regurgitation
, -Mitral regurgitation is associated with a high-pitched, blowing systolic murmur heard best at the
apex and radiating to the left axilla, as well as a wide splitting of S2 due to early closure of the
aortic valve.
A 44-year-old man presents for a follow-up visit for his known gastroesophageal reflux disease.
He has been taking a histamine-2-receptor antagonist twice a day. He continues to have
symptoms at least three times per week. Which of the following is the next best therapy?
A. Calcium carbonate
B. Famotidine
C. Omeprazole
D. Sucralfate CORRECT ANSWER: C. Omeprazole
-Proton pump inhibitors (PPIs), such as omeprazole, should be used in patients who fail twice-
daily histamine-2-receptor antagonist therapy, in patients with erosive esophagitis, or patients
with severe and frequent symptoms of GERD
A 77-year-old woman presents to the clinic complaining of recent onset of headaches. She denies
any visual changes and vitals are normal. On exam, she is tender over the right temporal area.
She follows with cardiology for a history of a heart valve replacement and with rheumatology for
a disease that "has a long name" which she can't remember. Which of the following is the most
likely diagnosis?
A. Cluster headache
B. Fibromyalgia
C. Giant cell arteritis
D. Trigeminal neuralgia CORRECT ANSWER: C. Giant cell arteritis
-Giant cell arteritis, or temporal arteritis, is the most common vasculitis of large and medium-
sized vessels. It is more commonly seen in women > 50 years of age
A 35-year-old man presents to the office with acute onset right flank pain radiating to the groin
with intermittent nausea and vomiting. A urinalysis and computed tomography of the abdomen
and pelvis without contrast were ordered. An urgent referral for outpatient urologist evaluation
would be most appropriate for which of the following findings?
A. A 10.5 mm mid-ureteral stone
B. A 3 mm stone in the distal ureter
