Rosh Review: Family Medicine EOR Review Test || with
Complete Solutions.
A 21-year-old man presents to the urgent care four hours after injuring his right lower leg at the
gym. He states he dropped a 20-pound weight on the midshaft portion of his lower leg but
continued exercising. The pain became more severe, swelling increased, and his muscle felt
tight, prompting him to come to urgent care. On exam, the right lower leg is visibly larger than
the left and is tight, firm, and very tender to palpation circumferentially. There is ecchymosis
along the anterior leg in the midshaft area of the tibia. Sensation between the right great toe and
second toe is decreased, and dorsiflexion is weakened on the right foot.
Which of the following is the most likely diagnosis? correct answers Anterior compartment
syndrome of the right lower leg
A 78-year-old woman presents to your clinic for a routine wellness exam. She reports difficulty
initiating urination for the last few months. She also reports dysuria and increased urinary
frequency. She denies suprapubic pelvic pain and notes increased sensation of vaginal fullness,
which she describes as "sitting on a ball." On digital exam, you palpate a bulge at the anterior
vaginal wall.
What is the most likely diagnosis? correct answers Cystocele
A 15-year-old boy presents to the clinic with a three-hour history of intense left scrotal pain and
swelling after playing soccer. He is afebrile and mildly tachycardic. Physical examination reveals
a diffusely swollen left scrotum with a very tender, enlarged left testicle.
Which of the following additional physical exam findings would be consistent with a diagnosis
of testicular torsion? correct answers Absent left cremasteric reflex
A 45-year-old man is known to have human immunodeficiency viral infection. His last CD4
count was 100 cells/mcL, and he was started on antiretroviral therapy at that time. His current
CD4 count is 150 cells/mcL. He presents to his primary care physician asking about preventive
immunizations.
Which of the following vaccinations is contraindicated in this patient? correct answers Measles,
mumps and rubella (MMR) vaccine
What is the most important risk factor for spontaneous abortion in healthy women? correct
answers Advanced maternal age
A 54-year-old man presents to the clinic complaining of increased daily dyspnea, causing him to
stop for breath after walking only a few minutes on level ground. He has not had any
exacerbations of his condition in the past year and has never been hospitalized. He currently
takes daily inhaled salmeterol and inhaled albuterol as needed for relief of acute symptoms,
which provided him with adequate control of symptoms in the past.
,Which of the following is the next step in disease management for this patient? correct answers
Add inhaled tiotropium
A 57-year-old woman presents to your office with pain in the ball of her right foot for the past
six months. It is worse with wearing dress shoes and with prolonged walking. She has occasional
tingling of her third and fourth toes. Massaging the foot helps. On physical examination, she has
tenderness to deep palpation between the third and fourth metatarsal heads and pain when they
are compressed together. She has no pain and has full range of motion with flexion and extension
at the metatarsophalangeal joints.
Which of the following is the most likely diagnosis? correct answers Interdigital neuroma
A 65-year-old man with a history of type 2 diabetes mellitus and smoking presents to your office
with a complaint of bilateral leg pain that occurs with walking and improves with rest.
Which of the following physical exam findings is most consistent with the diagnosis? correct
answers Decreased ankle-brachial index
Which of the following antituberculous therapeutic agents requires concomitant vitamin B6
supplementation if dietary intake is insufficient? correct answers Isoniazid
A 28-year-old woman presents to the office with complaints of fatigue and numbness in her left
cheek and left arm. Symptoms have been developing over the past two weeks. She has
diminished sensation in her left upper extremity and on the left side of her face. An MRI of the
brain is obtained that reveals multiple ovoid-shaped demyelinating periventricular lesions.
What other findings would you expect to see on her physical examination? correct answers
Adduction weakness upon lateral gaze with abduction nystagmus in the contralateral eye
A 68-year-old man presents to the emergency department with fever and productive cough. The
initial vital signs show the patient has a low-grade fever, respiratory rate of 30/min, and normal
heart rate and blood pressure. He is alert and oriented and otherwise healthy. Laboratory findings
are unremarkable. Chest X-ray shows an infiltrate in the right lower lobe.
What is the best treatment plan based on the above information? correct answers Admission to
the floor and start empiric antibiotics
Which of the following organisms is the most common cause of bacterial sinusitis? correct
answers Streptococcus pneumoniae
A 54-year-old woman presents to your office with a bump over her right wrist, which she first
noticed about six months ago. It is not painful and has not changed in size. On examination, she
has a round, mobile, nontender, and well-circumscribed mass about 2 cm in diameter over the
dorsum of her wrist. The mass transilluminates with a flashlight. She has full range of motion of
her wrist. X-rays of the wrist are normal.
, Which of the following is the most appropriate next step in management? correct answers
Observation and reassurance
A previously healthy 48-year-old woman presents to your office for her preventive health exam.
Vital signs include a blood pressure reading of 142/86 mm Hg, body mass index of 31 kg/m2,
and a random blood glucose level of 150 mg/dL taken with finger-stick testing. She says in the
last year she had three vaginal yeast infections, and her mother has a history of diabetes.
Which of the following is the most appropriate diagnostic test? correct answers Fasting plasma
glucose level
A thin 25-year-old woman presents to the clinic for a routine examination. She has no specific
complaints at this time. Vitals reveal HR 83, RR 17, T 97.9° F, BP 121/82, and SpO2 99% on
room air. Physical examination reveals a sternal depression with a narrowed chest wall diameter
in the sagittal plane. Auscultation over the fifth intercostal space reveals a sharp click that occurs
midway between the first and second heart sounds.
Which of the following is the most likely diagnosis? correct answers Mitral valve prolapse
A 4-week-old male infant presents with persistent conjunctivitis that started two weeks ago. His
mother reports excessive tearing "that won't stop." He is up to date on immunizations. On
physical examination, the patient is well-appearing, well-nourished, and well-hydrated. He is
noted to have excessive bilateral tearing. Dacryostenosis is suspected.
Which of the following is the first-line treatment for this patient? correct answers Crigler
massage
A 48-year-old man presents to the clinic reporting right groin pain with heavy lifting and
straining for the past several months. Physical exam of the abdomen and groin with the patient
supine and standing reveals no masses or defects, although the exam is limited by obesity. When
the examiner invaginates the right scrotum and inserts a finger into the inguinal canal, a silky tap
is felt on the side of the finger when the patient coughs.
Which of the following is the most likely diagnosis? correct answers Direct inguinal hernia
A 25-year-old woman presents to the clinic with yellow vaginal discharge and dyspareunia for a
week. On exam, yellow frothy discharge and a strawberry cervix is seen.
What is the most sensitive diagnostic test for the most likely diagnosis? correct answers Nucleic
acid amplification test
A 65-year-old man with a history of diabetes and uncontrolled hypertension presents to the
urgent care clinic with a complaint of vision loss in his left eye. He states that he had an episode
earlier in the day of blindness in that eye, but the vision returned quickly and it was not painful,
so he was not worried. This time, the vision loss has lasted about an hour. He denies any eye
pain. On exam, the patient can only see shadows of fingers from the left eye. A carotid bruit is
Complete Solutions.
A 21-year-old man presents to the urgent care four hours after injuring his right lower leg at the
gym. He states he dropped a 20-pound weight on the midshaft portion of his lower leg but
continued exercising. The pain became more severe, swelling increased, and his muscle felt
tight, prompting him to come to urgent care. On exam, the right lower leg is visibly larger than
the left and is tight, firm, and very tender to palpation circumferentially. There is ecchymosis
along the anterior leg in the midshaft area of the tibia. Sensation between the right great toe and
second toe is decreased, and dorsiflexion is weakened on the right foot.
Which of the following is the most likely diagnosis? correct answers Anterior compartment
syndrome of the right lower leg
A 78-year-old woman presents to your clinic for a routine wellness exam. She reports difficulty
initiating urination for the last few months. She also reports dysuria and increased urinary
frequency. She denies suprapubic pelvic pain and notes increased sensation of vaginal fullness,
which she describes as "sitting on a ball." On digital exam, you palpate a bulge at the anterior
vaginal wall.
What is the most likely diagnosis? correct answers Cystocele
A 15-year-old boy presents to the clinic with a three-hour history of intense left scrotal pain and
swelling after playing soccer. He is afebrile and mildly tachycardic. Physical examination reveals
a diffusely swollen left scrotum with a very tender, enlarged left testicle.
Which of the following additional physical exam findings would be consistent with a diagnosis
of testicular torsion? correct answers Absent left cremasteric reflex
A 45-year-old man is known to have human immunodeficiency viral infection. His last CD4
count was 100 cells/mcL, and he was started on antiretroviral therapy at that time. His current
CD4 count is 150 cells/mcL. He presents to his primary care physician asking about preventive
immunizations.
Which of the following vaccinations is contraindicated in this patient? correct answers Measles,
mumps and rubella (MMR) vaccine
What is the most important risk factor for spontaneous abortion in healthy women? correct
answers Advanced maternal age
A 54-year-old man presents to the clinic complaining of increased daily dyspnea, causing him to
stop for breath after walking only a few minutes on level ground. He has not had any
exacerbations of his condition in the past year and has never been hospitalized. He currently
takes daily inhaled salmeterol and inhaled albuterol as needed for relief of acute symptoms,
which provided him with adequate control of symptoms in the past.
,Which of the following is the next step in disease management for this patient? correct answers
Add inhaled tiotropium
A 57-year-old woman presents to your office with pain in the ball of her right foot for the past
six months. It is worse with wearing dress shoes and with prolonged walking. She has occasional
tingling of her third and fourth toes. Massaging the foot helps. On physical examination, she has
tenderness to deep palpation between the third and fourth metatarsal heads and pain when they
are compressed together. She has no pain and has full range of motion with flexion and extension
at the metatarsophalangeal joints.
Which of the following is the most likely diagnosis? correct answers Interdigital neuroma
A 65-year-old man with a history of type 2 diabetes mellitus and smoking presents to your office
with a complaint of bilateral leg pain that occurs with walking and improves with rest.
Which of the following physical exam findings is most consistent with the diagnosis? correct
answers Decreased ankle-brachial index
Which of the following antituberculous therapeutic agents requires concomitant vitamin B6
supplementation if dietary intake is insufficient? correct answers Isoniazid
A 28-year-old woman presents to the office with complaints of fatigue and numbness in her left
cheek and left arm. Symptoms have been developing over the past two weeks. She has
diminished sensation in her left upper extremity and on the left side of her face. An MRI of the
brain is obtained that reveals multiple ovoid-shaped demyelinating periventricular lesions.
What other findings would you expect to see on her physical examination? correct answers
Adduction weakness upon lateral gaze with abduction nystagmus in the contralateral eye
A 68-year-old man presents to the emergency department with fever and productive cough. The
initial vital signs show the patient has a low-grade fever, respiratory rate of 30/min, and normal
heart rate and blood pressure. He is alert and oriented and otherwise healthy. Laboratory findings
are unremarkable. Chest X-ray shows an infiltrate in the right lower lobe.
What is the best treatment plan based on the above information? correct answers Admission to
the floor and start empiric antibiotics
Which of the following organisms is the most common cause of bacterial sinusitis? correct
answers Streptococcus pneumoniae
A 54-year-old woman presents to your office with a bump over her right wrist, which she first
noticed about six months ago. It is not painful and has not changed in size. On examination, she
has a round, mobile, nontender, and well-circumscribed mass about 2 cm in diameter over the
dorsum of her wrist. The mass transilluminates with a flashlight. She has full range of motion of
her wrist. X-rays of the wrist are normal.
, Which of the following is the most appropriate next step in management? correct answers
Observation and reassurance
A previously healthy 48-year-old woman presents to your office for her preventive health exam.
Vital signs include a blood pressure reading of 142/86 mm Hg, body mass index of 31 kg/m2,
and a random blood glucose level of 150 mg/dL taken with finger-stick testing. She says in the
last year she had three vaginal yeast infections, and her mother has a history of diabetes.
Which of the following is the most appropriate diagnostic test? correct answers Fasting plasma
glucose level
A thin 25-year-old woman presents to the clinic for a routine examination. She has no specific
complaints at this time. Vitals reveal HR 83, RR 17, T 97.9° F, BP 121/82, and SpO2 99% on
room air. Physical examination reveals a sternal depression with a narrowed chest wall diameter
in the sagittal plane. Auscultation over the fifth intercostal space reveals a sharp click that occurs
midway between the first and second heart sounds.
Which of the following is the most likely diagnosis? correct answers Mitral valve prolapse
A 4-week-old male infant presents with persistent conjunctivitis that started two weeks ago. His
mother reports excessive tearing "that won't stop." He is up to date on immunizations. On
physical examination, the patient is well-appearing, well-nourished, and well-hydrated. He is
noted to have excessive bilateral tearing. Dacryostenosis is suspected.
Which of the following is the first-line treatment for this patient? correct answers Crigler
massage
A 48-year-old man presents to the clinic reporting right groin pain with heavy lifting and
straining for the past several months. Physical exam of the abdomen and groin with the patient
supine and standing reveals no masses or defects, although the exam is limited by obesity. When
the examiner invaginates the right scrotum and inserts a finger into the inguinal canal, a silky tap
is felt on the side of the finger when the patient coughs.
Which of the following is the most likely diagnosis? correct answers Direct inguinal hernia
A 25-year-old woman presents to the clinic with yellow vaginal discharge and dyspareunia for a
week. On exam, yellow frothy discharge and a strawberry cervix is seen.
What is the most sensitive diagnostic test for the most likely diagnosis? correct answers Nucleic
acid amplification test
A 65-year-old man with a history of diabetes and uncontrolled hypertension presents to the
urgent care clinic with a complaint of vision loss in his left eye. He states that he had an episode
earlier in the day of blindness in that eye, but the vision returned quickly and it was not painful,
so he was not worried. This time, the vision loss has lasted about an hour. He denies any eye
pain. On exam, the patient can only see shadows of fingers from the left eye. A carotid bruit is
