APMLE Part 2 Practice Questions With Complete Solutions
A 10-year-old girl is brought to a hospital emergency
department. She is seen by a podiatric physician for treatment of
a large abscess on the dorsum of the foot, where she was bitten
by an insect 3 days ago. Physical examination reveals a
temperature of 103°F with a grade IV/VI holosystolic murmur
radiating all over the chest wall. In this situation, it would be
most appropriate for the podiatric physician to do which of the
following?
(A) Request a cardiac consultation and take no further action
until the consultation
(B) Order an echocardiogram and take no further action until the
results are reviewed
(C) Take prophylactic measures for endocarditis and proceed
with surgery
(D) Admit the patient to the hospital, begin intravenous
antibiotics, and wait for a stat. cardiac consultation before taking
further action Correct Answers D
Although the intensity of the murmur does not
indicate the severity of a valve defect, a patient
with cardiac murmur should be medically cleared by
an M.D. or D.O. prior to undergoing any invasive
treatment such as surgical intervention. In this case,
there is the potential for incision and drainage.
A 12-year-old patient presents with arch pain. Gait evaluation
reveals hyperpronation throughout the stance phase of gait.
Resting calcaneal stance position is 2 degrees valgus.
,Radiographic evaluation reveals an anterior break in the cyma
line and an increased Kite's angle. This patient most likely has
(A) a flexible flatfoot
(B) a clubfoot deformity
(C) a cavovarus foot
(D) an equinovarus foot Correct Answers A
The clinical and radiographic features described in
this question are associated with an excessively
pronated foot, such as flexible flatfoot.
A 2-year-old child presents with symptoms of jaundice, chronic
anemia, and episodes of abdominal, back, and limb pain. The
child's symptoms seem to be precipitated by dehydration.
Physical examination reveals swelling of the hands and feet.
Treatment consists of fluid maintenance and the administration
of analgesics. This case description is characteristic of
(A) juvenile diabetes
(B) juvenile arthritis
(C) sickle cell anemia
(D) collagen disease Correct Answers C
Sickle cell anemia manifests itself in infancy.
Clinical manifestations include all the symptoms
described in the question. Management is largely
symptomatic and supportive.
A 23-year-old man is seen in the emergency department for a
diagnosed right ankle fracture/dislocation. Vascular evaluation
reveals an absence of all pulses below the knee. Closed
reduction is not successful. The patient has just eaten a large
meal. Assuming a thigh tourniquet will be used, what is the most
appropriate type of anesthesia for this patient?
, (A) Spinal
(B) Local infiltration
(C) General (inhalation anesthesia)
(D) Intravenous sedation Correct Answers A
Open reduction and internal fixation are now
indicated for the patient. Spinal anesthesia would
provide anesthesia at the appropriate level for lower
extremity surgery with a thigh tourniquet. Also, with
spinal anesthesia there is no risk that the food
recently eaten by the patient will be aspirated.
A 23-year-old runner presents with anterior leg pain that has
been present for 3 weeks and is greatest when running on hills.
Pain is elicited on palpation of the anterior aspect of the lower
leg, lateral to the anterior crest of the tibia. The most likely
diagnosis is
(A) peroneal tendinitis
(B) anterior shin splints
(C) iliotibial band syndrome
(D) anterior tibial compartment syndrome Correct Answers B
The anatomic location of the patient's pain narrows
the diagnosis to the anterior muscle compartment.
Shin splints are a common injury in runners and are
most symptomatic when a person is running on hills.
Overpronation is often the etiology.
A 25-year-old runner presents with achy soreness poorly
localized to the lateral border of the foot and complains of
something "going out of" and "popping into" place. This
condition has been present for several months with periods of
exacerbation and remission. The area is not warm or swollen
, and the patient has never noticed edema or redness. Palpation
localizes tenderness to the calcaneocuboid joint. The most likely
diagnosis is
(A) plantar fasciitis
(B) a midtarsal stress fracture
(C) cuboid subluxation syndrome
(D) peroneal tendinitis Correct Answers C
The calcaneocuboid joint is prone to abduction in
runners with pronation. This can then progress to
subluxation, unless it is controlled with an orthotic
device.
A 30-year-old patient is scheduled to have major rearfoot
reconstruction. The patient has a history of asthma and is
currently on an albuterol nebulizer and has taken prednisone, 7.5
milligrams, daily for the past 2 years. Prior to surgery, the
podiatric physician should do which of the following?
(A) Begin aspirin therapy 24 hours prior to surgery.
(B) Begin antibiotic prophylaxis to prevent endocarditis. (C)
Increase the prednisone dose to at least 20 milligrams per day.
(D) Stop the prednisone 2 days prior to surgery to aid in wound
healing. Correct Answers C
Long-term steroid usage suppresses the
hypothalamic-pituitary axis (HPA) and increases
the risk for hypotensive shock. Preoperative
supplementation with high-dose steroids will help
avert this complication.
A 33-year-old woman presents with heat intolerance headaches
and excessive sweating of 2 months' duration. She has a visible
hand tremor and her handwriting is uneven. She jogs 5 miles a
A 10-year-old girl is brought to a hospital emergency
department. She is seen by a podiatric physician for treatment of
a large abscess on the dorsum of the foot, where she was bitten
by an insect 3 days ago. Physical examination reveals a
temperature of 103°F with a grade IV/VI holosystolic murmur
radiating all over the chest wall. In this situation, it would be
most appropriate for the podiatric physician to do which of the
following?
(A) Request a cardiac consultation and take no further action
until the consultation
(B) Order an echocardiogram and take no further action until the
results are reviewed
(C) Take prophylactic measures for endocarditis and proceed
with surgery
(D) Admit the patient to the hospital, begin intravenous
antibiotics, and wait for a stat. cardiac consultation before taking
further action Correct Answers D
Although the intensity of the murmur does not
indicate the severity of a valve defect, a patient
with cardiac murmur should be medically cleared by
an M.D. or D.O. prior to undergoing any invasive
treatment such as surgical intervention. In this case,
there is the potential for incision and drainage.
A 12-year-old patient presents with arch pain. Gait evaluation
reveals hyperpronation throughout the stance phase of gait.
Resting calcaneal stance position is 2 degrees valgus.
,Radiographic evaluation reveals an anterior break in the cyma
line and an increased Kite's angle. This patient most likely has
(A) a flexible flatfoot
(B) a clubfoot deformity
(C) a cavovarus foot
(D) an equinovarus foot Correct Answers A
The clinical and radiographic features described in
this question are associated with an excessively
pronated foot, such as flexible flatfoot.
A 2-year-old child presents with symptoms of jaundice, chronic
anemia, and episodes of abdominal, back, and limb pain. The
child's symptoms seem to be precipitated by dehydration.
Physical examination reveals swelling of the hands and feet.
Treatment consists of fluid maintenance and the administration
of analgesics. This case description is characteristic of
(A) juvenile diabetes
(B) juvenile arthritis
(C) sickle cell anemia
(D) collagen disease Correct Answers C
Sickle cell anemia manifests itself in infancy.
Clinical manifestations include all the symptoms
described in the question. Management is largely
symptomatic and supportive.
A 23-year-old man is seen in the emergency department for a
diagnosed right ankle fracture/dislocation. Vascular evaluation
reveals an absence of all pulses below the knee. Closed
reduction is not successful. The patient has just eaten a large
meal. Assuming a thigh tourniquet will be used, what is the most
appropriate type of anesthesia for this patient?
, (A) Spinal
(B) Local infiltration
(C) General (inhalation anesthesia)
(D) Intravenous sedation Correct Answers A
Open reduction and internal fixation are now
indicated for the patient. Spinal anesthesia would
provide anesthesia at the appropriate level for lower
extremity surgery with a thigh tourniquet. Also, with
spinal anesthesia there is no risk that the food
recently eaten by the patient will be aspirated.
A 23-year-old runner presents with anterior leg pain that has
been present for 3 weeks and is greatest when running on hills.
Pain is elicited on palpation of the anterior aspect of the lower
leg, lateral to the anterior crest of the tibia. The most likely
diagnosis is
(A) peroneal tendinitis
(B) anterior shin splints
(C) iliotibial band syndrome
(D) anterior tibial compartment syndrome Correct Answers B
The anatomic location of the patient's pain narrows
the diagnosis to the anterior muscle compartment.
Shin splints are a common injury in runners and are
most symptomatic when a person is running on hills.
Overpronation is often the etiology.
A 25-year-old runner presents with achy soreness poorly
localized to the lateral border of the foot and complains of
something "going out of" and "popping into" place. This
condition has been present for several months with periods of
exacerbation and remission. The area is not warm or swollen
, and the patient has never noticed edema or redness. Palpation
localizes tenderness to the calcaneocuboid joint. The most likely
diagnosis is
(A) plantar fasciitis
(B) a midtarsal stress fracture
(C) cuboid subluxation syndrome
(D) peroneal tendinitis Correct Answers C
The calcaneocuboid joint is prone to abduction in
runners with pronation. This can then progress to
subluxation, unless it is controlled with an orthotic
device.
A 30-year-old patient is scheduled to have major rearfoot
reconstruction. The patient has a history of asthma and is
currently on an albuterol nebulizer and has taken prednisone, 7.5
milligrams, daily for the past 2 years. Prior to surgery, the
podiatric physician should do which of the following?
(A) Begin aspirin therapy 24 hours prior to surgery.
(B) Begin antibiotic prophylaxis to prevent endocarditis. (C)
Increase the prednisone dose to at least 20 milligrams per day.
(D) Stop the prednisone 2 days prior to surgery to aid in wound
healing. Correct Answers C
Long-term steroid usage suppresses the
hypothalamic-pituitary axis (HPA) and increases
the risk for hypotensive shock. Preoperative
supplementation with high-dose steroids will help
avert this complication.
A 33-year-old woman presents with heat intolerance headaches
and excessive sweating of 2 months' duration. She has a visible
hand tremor and her handwriting is uneven. She jogs 5 miles a
