Baseline Exam Questions and Answers 2025.
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/ - ANSWER4. 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% - ANSWER1. 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 - ANSWER1. 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 - ANSWER1. 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 - ANSWER2. 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 - ANSWER1. 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 - ANSWER3. 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?
1. t - ANSWER3. emphysematous pyelonephritis
A 25-year-old woman with no significant past medical history presents with a history of
painless hematuria for the past week. The hematuria is not associated with any other
urinary complaint like dysuria, urinary urgency, or frequency. She reports an upper
respiratory tract infection that was treated with antibiotics 2-3 weeks ago. Her vitals are:
blood pressure, 180/90 mm Hg; pulse, 89/min; and respiratory rate, 16/min. She is
afebrile. Her extremities show no pitting edema and there are no changes on renal
ultrasound.
Her urinalysis shows:
Specific gravity = 1.005
pH = 6
Blood = +1
Proteins = +1
Ketones, glucose = Nil
Red blood cells = 10/hpf
Epithelial cells = Nil
Blood urea nitrogen = 70 mg/dL
Creatinine = 2.6 mg/dL
C3 and C4 levels = Low
24-hour urinary proteins = 1.4 g
Kidney biopsy is also performed and light microscopy shows marked cellular
proliferation and infiltration of neutrophils in the glomerular tu - ANSWER5. no treatment
needed
A 45-year-old man witnessed an armed robbery of a convenience store 1 week prior to
presenting to you for treatment. He complains of being constantly fearful, constantly
watching for threats, and frequently feels as though he is watching the events of his life
from the outside as a spectator. He often is unaware of where he is or how he got there.
On further questioning, he also says that, even though his usual routine would normally
include walking or driving by the store several times a day where the robbery occurred,
he now avoids the street and takes large detours to avoid the area. He also refuses to
enter convenience stores because the environment and certain objects commonly
present in convenience stores like lottery tickets trigger extremely vivid and distressing
memories. Which of the following is the most likely diagnosis for this patient?
1. Post-traumatic stress disorder
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/ - ANSWER4. 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% - ANSWER1. 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 - ANSWER1. 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 - ANSWER1. 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 - ANSWER2. 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 - ANSWER1. 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 - ANSWER3. 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?
1. t - ANSWER3. emphysematous pyelonephritis
A 25-year-old woman with no significant past medical history presents with a history of
painless hematuria for the past week. The hematuria is not associated with any other
urinary complaint like dysuria, urinary urgency, or frequency. She reports an upper
respiratory tract infection that was treated with antibiotics 2-3 weeks ago. Her vitals are:
blood pressure, 180/90 mm Hg; pulse, 89/min; and respiratory rate, 16/min. She is
afebrile. Her extremities show no pitting edema and there are no changes on renal
ultrasound.
Her urinalysis shows:
Specific gravity = 1.005
pH = 6
Blood = +1
Proteins = +1
Ketones, glucose = Nil
Red blood cells = 10/hpf
Epithelial cells = Nil
Blood urea nitrogen = 70 mg/dL
Creatinine = 2.6 mg/dL
C3 and C4 levels = Low
24-hour urinary proteins = 1.4 g
Kidney biopsy is also performed and light microscopy shows marked cellular
proliferation and infiltration of neutrophils in the glomerular tu - ANSWER5. no treatment
needed
A 45-year-old man witnessed an armed robbery of a convenience store 1 week prior to
presenting to you for treatment. He complains of being constantly fearful, constantly
watching for threats, and frequently feels as though he is watching the events of his life
from the outside as a spectator. He often is unaware of where he is or how he got there.
On further questioning, he also says that, even though his usual routine would normally
include walking or driving by the store several times a day where the robbery occurred,
he now avoids the street and takes large detours to avoid the area. He also refuses to
enter convenience stores because the environment and certain objects commonly
present in convenience stores like lottery tickets trigger extremely vivid and distressing
memories. Which of the following is the most likely diagnosis for this patient?
1. Post-traumatic stress disorder
