LMR - GEORGETTE'S EXAM
Comprehensive Medical Licensing Practice Examination
SECTION 1: CLINICAL PRESENTATION & DIFFERENTIAL DIAGNOSIS (Q1–Q25)
Q1: A 58-year-old man presents with acute onset of severe, tearing chest pain
radiating to the back. Blood pressure is 160/90 in the right arm and 110/70 in the
left arm. Which diagnostic study is most appropriate initially?
A. Chest X-ray
B. CT angiogram of the chest [CORRECT]
C. Transthoracic echocardiogram
D. ECG with troponin
Correct Answer: B
Rationale: Correct because aortic dissection presents with tearing pain and blood
pressure differential; CT angiogram is the definitive initial imaging study for
diagnosis.
Q2: A 45-year-old woman with no significant medical history presents with fatigue,
joint pain, and a malar rash. Laboratory studies show positive ANA and anti-dsDNA
antibodies. Which medication is first-line for long-term management?
A. Hydroxychloroquine [CORRECT]
B. Prednisone
C. Methotrexate
D. Cyclophosphamide
Correct Answer: A
Rationale: Correct because hydroxychloroquine is first-line for mild to moderate
systemic lupus erythematosus to reduce flares and prevent organ damage, with
prednisone reserved for acute flares.
Q3: A newborn is noted to have a flat, red, sharply demarcated capillary
malformation on the forehead and upper eyelid that blanches with pressure. The
lesion is present at birth and does not change with crying. This is most consistent
with:
,A. Port-wine stain (nevus flammeus) [CORRECT]
B. Salmon patch (stork bite)
C. Infantile hemangioma
D. Capillary aneurysm
Correct Answer: A
Rationale: Correct because a port-wine stain is a flat, pink to red capillary
malformation present at birth, does not involute, and involves the forehead/eyelid,
unlike a salmon patch which typically fades.
Q4: A 68-year-old man with hypertension and diabetes presents with sudden,
painless vision loss in the right eye described as "a curtain coming down."
Fundoscopic examination reveals a pale retina with a cherry-red spot at the fovea.
This is most consistent with:
A. Central retinal vein occlusion
B. Central retinal artery occlusion [CORRECT]
C. Acute angle-closure glaucoma
D. Optic neuritis
Correct Answer: B
Rationale: Correct because central retinal artery occlusion presents with acute,
painless monocular vision loss, pale retina, and cherry-red spot (fovea appearing red
against pale ischemic retina).
Q5: A 32-year-old woman at 38 weeks gestation presents with sudden onset of severe
abdominal pain, vaginal bleeding, and a firm, tender uterus. She has a history of two
previous cesarean sections. Fetal heart rate shows late decelerations. Priority
intervention is:
A. Ultrasound to confirm diagnosis
B. Immediate cesarean delivery [CORRECT]
C. Tocolysis to stop contractions
D. External cephalic version
Correct Answer: B
,Rationale: Correct because suspected uterine rupture in a term pregnancy with
abnormal fetal tracing requires immediate cesarean delivery for maternal and fetal
survival; delay increases mortality.
Q6: A 22-year-old college student presents with a 3-day history of sore throat, fever
of 102°F, and painful anterior cervical lymphadenopathy. On examination, the tonsils
are erythematous with white exudates, and there is palatal petechiae. The most likely
causative organism is:
A. Rhinovirus
B. Group A Streptococcus [CORRECT]
C. Epstein-Barr virus
D. Corynebacterium diphtheriae
Correct Answer: B
Rationale: Correct because the Centor criteria—fever, tonsillar exudates, tender
anterior cervical nodes, and absence of cough—strongly suggest group A
Streptococcus pharyngitis requiring testing and treatment.
Q7: A 55-year-old man with a 40 pack-year smoking history presents with a 3-month
history of cough, hemoptysis, and 10-pound weight loss. Chest X-ray reveals a 4 cm
spiculated mass in the right upper lobe. The most appropriate next step is:
A. PET-CT scan
B. CT-guided biopsy [CORRECT]
C. Bronchoscopy with biopsy
D. Surgical resection
Correct Answer: B
Rationale: Correct because a peripheral spiculated lung mass in a heavy smoker is
highly suspicious for lung cancer; CT-guided percutaneous biopsy provides tissue
diagnosis for staging prior to treatment planning.
Q8: A 28-year-old woman presents with episodic, severe, unilateral periorbital
headache associated with lacrimation, nasal congestion, and restlessness. Attacks
occur daily for 2 weeks, then remit for months. This pattern is most consistent with:
A. Tension-type headache
B. Migraine without aura
, C. Cluster headache [CORRECT]
D. Trigeminal neuralgia
Correct Answer: C
Rationale: Correct because cluster headache presents with severe unilateral
periorbital pain, autonomic features (lacrimation, rhinorrhea), restlessness, and a
characteristic episodic pattern with periods of remission.
Q9: A 6-month-old infant is brought to the emergency department with a 2-day
history of non-bilious, projectile vomiting after every feeding. Physical examination
reveals a small, firm, olive-shaped mass in the right upper quadrant. The most likely
diagnosis is:
A. Gastroesophageal reflux disease
B. Intussusception
C. Pyloric stenosis [CORRECT]
D. Malrotation with volvulus
Correct Answer: C
Rationale: Correct because pyloric stenosis presents in infants 2–8 weeks of age with
non-bilious projectile vomiting and a palpable olive-shaped mass due to hypertrophy
of the pyloric muscle.
Q10: A 42-year-old man presents with progressive dysphagia to solids and then
liquids over 6 months. He reports regurgitation of undigested food and halitosis.
Barium swallow shows a dilated esophagus with a "bird's beak" appearance at the
distal end. The diagnosis is:
A. Esophageal cancer
B. Achalasia [CORRECT]
C. Scleroderma
D. Diffuse esophageal spasm
Correct Answer: B
Rationale: Correct because achalasia presents with progressive dysphagia to solids
and liquids, regurgitation, and the classic "bird's beak" narrowing on barium
swallow due to failure of lower esophageal sphincter relaxation.
Comprehensive Medical Licensing Practice Examination
SECTION 1: CLINICAL PRESENTATION & DIFFERENTIAL DIAGNOSIS (Q1–Q25)
Q1: A 58-year-old man presents with acute onset of severe, tearing chest pain
radiating to the back. Blood pressure is 160/90 in the right arm and 110/70 in the
left arm. Which diagnostic study is most appropriate initially?
A. Chest X-ray
B. CT angiogram of the chest [CORRECT]
C. Transthoracic echocardiogram
D. ECG with troponin
Correct Answer: B
Rationale: Correct because aortic dissection presents with tearing pain and blood
pressure differential; CT angiogram is the definitive initial imaging study for
diagnosis.
Q2: A 45-year-old woman with no significant medical history presents with fatigue,
joint pain, and a malar rash. Laboratory studies show positive ANA and anti-dsDNA
antibodies. Which medication is first-line for long-term management?
A. Hydroxychloroquine [CORRECT]
B. Prednisone
C. Methotrexate
D. Cyclophosphamide
Correct Answer: A
Rationale: Correct because hydroxychloroquine is first-line for mild to moderate
systemic lupus erythematosus to reduce flares and prevent organ damage, with
prednisone reserved for acute flares.
Q3: A newborn is noted to have a flat, red, sharply demarcated capillary
malformation on the forehead and upper eyelid that blanches with pressure. The
lesion is present at birth and does not change with crying. This is most consistent
with:
,A. Port-wine stain (nevus flammeus) [CORRECT]
B. Salmon patch (stork bite)
C. Infantile hemangioma
D. Capillary aneurysm
Correct Answer: A
Rationale: Correct because a port-wine stain is a flat, pink to red capillary
malformation present at birth, does not involute, and involves the forehead/eyelid,
unlike a salmon patch which typically fades.
Q4: A 68-year-old man with hypertension and diabetes presents with sudden,
painless vision loss in the right eye described as "a curtain coming down."
Fundoscopic examination reveals a pale retina with a cherry-red spot at the fovea.
This is most consistent with:
A. Central retinal vein occlusion
B. Central retinal artery occlusion [CORRECT]
C. Acute angle-closure glaucoma
D. Optic neuritis
Correct Answer: B
Rationale: Correct because central retinal artery occlusion presents with acute,
painless monocular vision loss, pale retina, and cherry-red spot (fovea appearing red
against pale ischemic retina).
Q5: A 32-year-old woman at 38 weeks gestation presents with sudden onset of severe
abdominal pain, vaginal bleeding, and a firm, tender uterus. She has a history of two
previous cesarean sections. Fetal heart rate shows late decelerations. Priority
intervention is:
A. Ultrasound to confirm diagnosis
B. Immediate cesarean delivery [CORRECT]
C. Tocolysis to stop contractions
D. External cephalic version
Correct Answer: B
,Rationale: Correct because suspected uterine rupture in a term pregnancy with
abnormal fetal tracing requires immediate cesarean delivery for maternal and fetal
survival; delay increases mortality.
Q6: A 22-year-old college student presents with a 3-day history of sore throat, fever
of 102°F, and painful anterior cervical lymphadenopathy. On examination, the tonsils
are erythematous with white exudates, and there is palatal petechiae. The most likely
causative organism is:
A. Rhinovirus
B. Group A Streptococcus [CORRECT]
C. Epstein-Barr virus
D. Corynebacterium diphtheriae
Correct Answer: B
Rationale: Correct because the Centor criteria—fever, tonsillar exudates, tender
anterior cervical nodes, and absence of cough—strongly suggest group A
Streptococcus pharyngitis requiring testing and treatment.
Q7: A 55-year-old man with a 40 pack-year smoking history presents with a 3-month
history of cough, hemoptysis, and 10-pound weight loss. Chest X-ray reveals a 4 cm
spiculated mass in the right upper lobe. The most appropriate next step is:
A. PET-CT scan
B. CT-guided biopsy [CORRECT]
C. Bronchoscopy with biopsy
D. Surgical resection
Correct Answer: B
Rationale: Correct because a peripheral spiculated lung mass in a heavy smoker is
highly suspicious for lung cancer; CT-guided percutaneous biopsy provides tissue
diagnosis for staging prior to treatment planning.
Q8: A 28-year-old woman presents with episodic, severe, unilateral periorbital
headache associated with lacrimation, nasal congestion, and restlessness. Attacks
occur daily for 2 weeks, then remit for months. This pattern is most consistent with:
A. Tension-type headache
B. Migraine without aura
, C. Cluster headache [CORRECT]
D. Trigeminal neuralgia
Correct Answer: C
Rationale: Correct because cluster headache presents with severe unilateral
periorbital pain, autonomic features (lacrimation, rhinorrhea), restlessness, and a
characteristic episodic pattern with periods of remission.
Q9: A 6-month-old infant is brought to the emergency department with a 2-day
history of non-bilious, projectile vomiting after every feeding. Physical examination
reveals a small, firm, olive-shaped mass in the right upper quadrant. The most likely
diagnosis is:
A. Gastroesophageal reflux disease
B. Intussusception
C. Pyloric stenosis [CORRECT]
D. Malrotation with volvulus
Correct Answer: C
Rationale: Correct because pyloric stenosis presents in infants 2–8 weeks of age with
non-bilious projectile vomiting and a palpable olive-shaped mass due to hypertrophy
of the pyloric muscle.
Q10: A 42-year-old man presents with progressive dysphagia to solids and then
liquids over 6 months. He reports regurgitation of undigested food and halitosis.
Barium swallow shows a dilated esophagus with a "bird's beak" appearance at the
distal end. The diagnosis is:
A. Esophageal cancer
B. Achalasia [CORRECT]
C. Scleroderma
D. Diffuse esophageal spasm
Correct Answer: B
Rationale: Correct because achalasia presents with progressive dysphagia to solids
and liquids, regurgitation, and the classic "bird's beak" narrowing on barium
swallow due to failure of lower esophageal sphincter relaxation.
