Internal Med EOR Exam Questions and
Answers
A 42-year-old woman presents complaining of shortness of breath, three days of fever as high as 103F,
and a cough productive of green sputum. On physical examination, you hear crackles in her lungs. A
chest radiograph reveals a consolidation in the left lower lobe. What tactile fremitus findings do you
expect to observe in the left lower lobe region?
A
Absent
B
Decreased
C
Hyperresonant
,D
Increased
E
Normal - Answer-The Correct Answer is: D
Tactile fremitus is increased (D) by processes that cause consolidation within the lung parenchyma and
decreased (B) by processes that insulate the lung parenchyma from transmitting vibration (e.g.,
pneumothorax, hemothorax) or airway obstruction.
A 54-year-old female presents complaining of decreased visual acuity to her right eye over the past few
hours. She denies pain, and describes having wavy vision and seeing flashes of light. Her visual acuity in
the affected eye is 20/200. What condition best describes the following physical finding?
A
Retinal detachment
B
Central retinal artery occlusion
C
Open angle glaucoma
D
Angle closure glaucoma
E
Optic neuritis - Answer-The Correct Answer is: A
The image demonstrates a detached retina. The superior aspect of the retina appears wavy and flowing.
A central retinal artery occlusion is characterized by a pale retina, as well as a cherry red spot on the
macula. Open angle glaucoma does not cause acute vision loss. Angle closure glaucoma causes painful
acute vision loss. Optic neuritis is characterized by painful visual loss and a swollen optic disc.
,A 66-year-old male with a history of hypertension, diabetes mellitus, and hypercholesterolemia presents
by emergency medical services (EMS) to the emergency department complaining of severe chest pain
with radiation into his back. The patient states that he was feeling well in the morning, but while
performing some light activity he felt a "ripping" sensation in his back, which he initially thought was a
pulled muscle. The pain continued and the patient started to have chest pain, shortness of breath, and
lightheadedness. On initial examination the patient is still in pain, pale, diaphoretic, and has a blood
pressure of 85/40. His chest is clear to auscultation, and he has a 3/6 diastolic murmur best appreciated
at the base of the heart. Given this clinical scenario, what is the best test to definitively diagnose this
medical problem?
A
Chest x-ray
B
Transthoracic echocardiography
C
Transesophageal echocardiogra - Answer-The Correct Answer is: E
This patient is exhibiting a history and physical examination that is consistent with a thoracic aneurysm.
The patient's history of hypertension, along with the "ripping" sensation in his back and hypotension
give a clinical presentation that is suggestive of a thoracic aneurysm dissection. Given this clinical
situation, the best test to evaluate for a potential dissection is by computed tomography (E). This test is
sensitive enough to determine if there is a luminal irregularity. While echocardiography (B and C) may
be able to show evidence of an aneurysm, it is not specific enough to show all the areas of an aneurysm.
In this situation a chest x-ray (A) would not give enough specificity to appropriately diagnose an
aneurysm, as well as a cardiac catheterization (D).
A 72-year-old female presents with a several month history of symmetric pain to the hands, wrists, and
feet. She also is noticing a change to the appearance of the joints of the hands and feet, with a more
"nobby" appearance than before. When the patient wakes up in the morning, the joints are particularly
stiff and red at times. Out of all the areas that are painful, it is the hands that are the most painful. Based
on this history, what physical exam findings would you expect to find on the hands that are classic
findings of this disease?
A
Radial deviation and subluxation of the DIP joints
B
, Radial deviation and subluxation of the MCP joints
C
Radial deviation and subluxation at the PIP joints
D
Ulnar deviation and subluxation at the MCP joints
E
Ulnar deviation and subluxation at the PIP joints - Answer-The Correct Answer is: D
Rheumatoid arthritis is a systemic autoimmune disease that is incurable and affects woman more than
men by a 3 to one ratio. It can damage any joint, but it most often affects joints of the hands, wrists,
knees, feet and ankles. The classic appearance of hands that have been afflicted with progressive
rheumatoid arthritis is that they demonstrate ulnar deviation and subluxation at the MCP joints.
Involvement of the PIP joints is not uncommon, but DIP joints are generally not as significantly affected.
Radial deviation is not a typical characteristic of rheumatoid arthritis of the hands.
What is the most common pulmonary complaint of a patient with tuberculosis?
A
Hemoptysis
B
Chronic cough
C
Wheezing
D
Dyspnea
E
Chest pain - Answer-The Correct Answer is: B
Chronic cough is the most common complaint. Hemoptysis can occur but is rare, and a productive cough
becomes more prevalent after the chronic cough has been established for a while.
Answers
A 42-year-old woman presents complaining of shortness of breath, three days of fever as high as 103F,
and a cough productive of green sputum. On physical examination, you hear crackles in her lungs. A
chest radiograph reveals a consolidation in the left lower lobe. What tactile fremitus findings do you
expect to observe in the left lower lobe region?
A
Absent
B
Decreased
C
Hyperresonant
,D
Increased
E
Normal - Answer-The Correct Answer is: D
Tactile fremitus is increased (D) by processes that cause consolidation within the lung parenchyma and
decreased (B) by processes that insulate the lung parenchyma from transmitting vibration (e.g.,
pneumothorax, hemothorax) or airway obstruction.
A 54-year-old female presents complaining of decreased visual acuity to her right eye over the past few
hours. She denies pain, and describes having wavy vision and seeing flashes of light. Her visual acuity in
the affected eye is 20/200. What condition best describes the following physical finding?
A
Retinal detachment
B
Central retinal artery occlusion
C
Open angle glaucoma
D
Angle closure glaucoma
E
Optic neuritis - Answer-The Correct Answer is: A
The image demonstrates a detached retina. The superior aspect of the retina appears wavy and flowing.
A central retinal artery occlusion is characterized by a pale retina, as well as a cherry red spot on the
macula. Open angle glaucoma does not cause acute vision loss. Angle closure glaucoma causes painful
acute vision loss. Optic neuritis is characterized by painful visual loss and a swollen optic disc.
,A 66-year-old male with a history of hypertension, diabetes mellitus, and hypercholesterolemia presents
by emergency medical services (EMS) to the emergency department complaining of severe chest pain
with radiation into his back. The patient states that he was feeling well in the morning, but while
performing some light activity he felt a "ripping" sensation in his back, which he initially thought was a
pulled muscle. The pain continued and the patient started to have chest pain, shortness of breath, and
lightheadedness. On initial examination the patient is still in pain, pale, diaphoretic, and has a blood
pressure of 85/40. His chest is clear to auscultation, and he has a 3/6 diastolic murmur best appreciated
at the base of the heart. Given this clinical scenario, what is the best test to definitively diagnose this
medical problem?
A
Chest x-ray
B
Transthoracic echocardiography
C
Transesophageal echocardiogra - Answer-The Correct Answer is: E
This patient is exhibiting a history and physical examination that is consistent with a thoracic aneurysm.
The patient's history of hypertension, along with the "ripping" sensation in his back and hypotension
give a clinical presentation that is suggestive of a thoracic aneurysm dissection. Given this clinical
situation, the best test to evaluate for a potential dissection is by computed tomography (E). This test is
sensitive enough to determine if there is a luminal irregularity. While echocardiography (B and C) may
be able to show evidence of an aneurysm, it is not specific enough to show all the areas of an aneurysm.
In this situation a chest x-ray (A) would not give enough specificity to appropriately diagnose an
aneurysm, as well as a cardiac catheterization (D).
A 72-year-old female presents with a several month history of symmetric pain to the hands, wrists, and
feet. She also is noticing a change to the appearance of the joints of the hands and feet, with a more
"nobby" appearance than before. When the patient wakes up in the morning, the joints are particularly
stiff and red at times. Out of all the areas that are painful, it is the hands that are the most painful. Based
on this history, what physical exam findings would you expect to find on the hands that are classic
findings of this disease?
A
Radial deviation and subluxation of the DIP joints
B
, Radial deviation and subluxation of the MCP joints
C
Radial deviation and subluxation at the PIP joints
D
Ulnar deviation and subluxation at the MCP joints
E
Ulnar deviation and subluxation at the PIP joints - Answer-The Correct Answer is: D
Rheumatoid arthritis is a systemic autoimmune disease that is incurable and affects woman more than
men by a 3 to one ratio. It can damage any joint, but it most often affects joints of the hands, wrists,
knees, feet and ankles. The classic appearance of hands that have been afflicted with progressive
rheumatoid arthritis is that they demonstrate ulnar deviation and subluxation at the MCP joints.
Involvement of the PIP joints is not uncommon, but DIP joints are generally not as significantly affected.
Radial deviation is not a typical characteristic of rheumatoid arthritis of the hands.
What is the most common pulmonary complaint of a patient with tuberculosis?
A
Hemoptysis
B
Chronic cough
C
Wheezing
D
Dyspnea
E
Chest pain - Answer-The Correct Answer is: B
Chronic cough is the most common complaint. Hemoptysis can occur but is rare, and a productive cough
becomes more prevalent after the chronic cough has been established for a while.
