MEDICAL & DENTAL SPECIALIST EXAM 2026 –
COMPLETE QUESTIONS & 100% VERIFIED
ANSWERS WITH DETAILED RATIONALES |
ACCURATE A+ STUDY GUIDE
Question 1
Which of the following is the most likely cause of sudden, painless monocular vision
loss with a pale retina and a cherry-red spot at the macula?
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Retinal detachment
D. Optic neuritis
CORRECT ANSWER: (A) Central retinal artery occlusion
RATIONALE: Central retinal artery occlusion (CRAO) presents with sudden, painless
monocular vision loss. Fundoscopy classically shows a pale (ischemic) retina with a
cherry-red spot at the macula because the macula's thin fovea shows underlying
choroidal circulation. CRVO produces a "blood and thunder" retina with hemorrhages;
retinal detachment causes flashes/floaters and a curtain; optic neuritis causes painful
vision loss and a swollen optic disc (in some cases).
Question 2
A 65-year-old man with long-standing hypertension develops sudden severe chest pain
radiating to his back and unequal blood pressures in the arms. The most likely
diagnosis is:
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
CORRECT ANSWER: (B) Aortic dissection
RATIONALE: Aortic dissection classically presents with sudden severe tearing chest
pain radiating to the back and can cause differential blood pressures between arms due
to involvement of branch vessels. MI pain is usually substernal and may radiate to
arm/jaw without inter-arm BP difference. PE causes pleuritic chest pain and dyspnea;
pericarditis causes sharp pleuritic pain improved by leaning forward and diffuse ST
elevations on ECG.
,Question 3
Which antibiotic is the treatment of choice for a confirmed uncomplicated urinary tract
infection due to Escherichia coli in a non-pregnant adult with local susceptibility showing
>20% resistance to trimethoprim-sulfamethoxazole?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin-clavulanate
D. Doxycycline
CORRECT ANSWER: (A) Nitrofurantoin
RATIONALE: Nitrofurantoin is recommended for uncomplicated cystitis in non-
pregnant adults when local resistance to TMP-SMX is high; it attains high urinary
concentrations and is effective against E. coli. Fluoroquinolones (ciprofloxacin) are
effective but stewardship recommends avoiding them for simple cystitis due to adverse
effects and resistance. Amoxicillin-clavulanate has variable activity; doxycycline is not
first-line for uncomplicated UTI.
Question 4
A 3-year-old child presents with a barking cough, inspiratory stridor and hoarseness
worse at night. The most likely diagnosis is:
A. Croup (laryngotracheobronchitis)
B. Epiglottitis
C. Foreign body aspiration
D. Bacterial tracheitis
CORRECT ANSWER: (A) Croup (laryngotracheobronchitis)
RATIONALE: Croup, usually viral (parainfluenza), causes subglottic inflammation
producing a barking cough, inspiratory stridor, and hoarseness, worse at night.
Epiglottitis presents with high fever, drooling, muffled voice and rapid progression—a
medical emergency. Foreign body aspiration has sudden onset and often focal wheeze;
bacterial tracheitis presents with high fever and toxic appearance and may follow croup.
Question 5
Which of the following oral conditions is characterized by non-keratinized mucosa,
interlacing rete ridges, and saw-tooth appearance of rete pegs on histology?
A. Oral lichen planus
,B. Erythroplakia
C. Leukoplakia
D. Squamous papilloma
CORRECT ANSWER: (A) Oral lichen planus
RATIONALE: Oral lichen planus demonstrates a band-like lymphocytic infiltrate and
saw-tooth appearance of rete ridges on histology, typically affecting non-keratinized
mucosa such as buccal mucosa. Erythroplakia and leukoplakia are clinical lesions with
differing histology (erythroplakia often severe dysplasia), and squamous papilloma
shows fibrovascular cores with koilocytosis in viral cases.
Question 6
In acute myocardial infarction, the earliest ECG change typically seen is:
A. Pathological Q waves
B. ST-segment elevation
C. T-wave inversion
D. Peaked T waves
CORRECT ANSWER: (D) Peaked T waves
RATIONALE: The earliest ECG change in evolving transmural myocardial ischemia
can be hyperacute (peaked) T waves, followed by ST-segment elevation, then Q waves
and T-wave inversion later. Thus peaked T waves often precede ST elevation.
Question 7
Which local anesthetic has the longest duration of action for peripheral nerve block
among the following?
A. Lidocaine
B. Bupivacaine
C. Procaine
D. Mepivacaine
CORRECT ANSWER: (B) Bupivacaine
RATIONALE: Bupivacaine is a long-acting amide local anesthetic commonly used for
prolonged nerve blocks and epidurals. Lidocaine and mepivacaine are intermediate-
acting; procaine is a short-acting ester anesthetic.
, Question 8
A 28-year-old female presents with amenorrhea, galactorrhea and headaches. Serum
prolactin is elevated and MRI shows a 8 mm pituitary lesion. Initial treatment should be:
A. Transsphenoidal surgical removal
B. Dopamine agonist therapy (e.g., cabergoline)
C. Radiotherapy
D. Estrogen-progestin therapy
CORRECT ANSWER: (B) Dopamine agonist therapy (e.g., cabergoline)
RATIONALE: Microprolactinomas (<10 mm) are usually treated medically with
dopamine agonists (cabergoline or bromocriptine), which decrease prolactin levels and
tumor size. Surgery is reserved for medication resistance or intolerance, large
macroadenomas with mass effect, or apoplexy. Radiotherapy is rarely used.
Question 9
Which of the following organisms is most commonly responsible for dental caries?
A. Streptococcus mutans
B. Porphyromonas gingivalis
C. Actinomyces israelii
D. Candida albicans
CORRECT ANSWER: (A) Streptococcus mutans
RATIONALE: Streptococcus mutans plays a key role in dental caries due to its ability
to metabolize sugars to acids and adhere to tooth surfaces, forming biofilms.
Porphyromonas is associated with periodontitis; Actinomyces with actinomycosis;
Candida with oral candidiasis.
Question 10
A child with hemophilia A presents with hemarthrosis after minor trauma. Which factor is
deficient?
A. Factor VIII
B. Factor IX
C. Factor XI
D. Factor VII
COMPLETE QUESTIONS & 100% VERIFIED
ANSWERS WITH DETAILED RATIONALES |
ACCURATE A+ STUDY GUIDE
Question 1
Which of the following is the most likely cause of sudden, painless monocular vision
loss with a pale retina and a cherry-red spot at the macula?
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. Retinal detachment
D. Optic neuritis
CORRECT ANSWER: (A) Central retinal artery occlusion
RATIONALE: Central retinal artery occlusion (CRAO) presents with sudden, painless
monocular vision loss. Fundoscopy classically shows a pale (ischemic) retina with a
cherry-red spot at the macula because the macula's thin fovea shows underlying
choroidal circulation. CRVO produces a "blood and thunder" retina with hemorrhages;
retinal detachment causes flashes/floaters and a curtain; optic neuritis causes painful
vision loss and a swollen optic disc (in some cases).
Question 2
A 65-year-old man with long-standing hypertension develops sudden severe chest pain
radiating to his back and unequal blood pressures in the arms. The most likely
diagnosis is:
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
CORRECT ANSWER: (B) Aortic dissection
RATIONALE: Aortic dissection classically presents with sudden severe tearing chest
pain radiating to the back and can cause differential blood pressures between arms due
to involvement of branch vessels. MI pain is usually substernal and may radiate to
arm/jaw without inter-arm BP difference. PE causes pleuritic chest pain and dyspnea;
pericarditis causes sharp pleuritic pain improved by leaning forward and diffuse ST
elevations on ECG.
,Question 3
Which antibiotic is the treatment of choice for a confirmed uncomplicated urinary tract
infection due to Escherichia coli in a non-pregnant adult with local susceptibility showing
>20% resistance to trimethoprim-sulfamethoxazole?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin-clavulanate
D. Doxycycline
CORRECT ANSWER: (A) Nitrofurantoin
RATIONALE: Nitrofurantoin is recommended for uncomplicated cystitis in non-
pregnant adults when local resistance to TMP-SMX is high; it attains high urinary
concentrations and is effective against E. coli. Fluoroquinolones (ciprofloxacin) are
effective but stewardship recommends avoiding them for simple cystitis due to adverse
effects and resistance. Amoxicillin-clavulanate has variable activity; doxycycline is not
first-line for uncomplicated UTI.
Question 4
A 3-year-old child presents with a barking cough, inspiratory stridor and hoarseness
worse at night. The most likely diagnosis is:
A. Croup (laryngotracheobronchitis)
B. Epiglottitis
C. Foreign body aspiration
D. Bacterial tracheitis
CORRECT ANSWER: (A) Croup (laryngotracheobronchitis)
RATIONALE: Croup, usually viral (parainfluenza), causes subglottic inflammation
producing a barking cough, inspiratory stridor, and hoarseness, worse at night.
Epiglottitis presents with high fever, drooling, muffled voice and rapid progression—a
medical emergency. Foreign body aspiration has sudden onset and often focal wheeze;
bacterial tracheitis presents with high fever and toxic appearance and may follow croup.
Question 5
Which of the following oral conditions is characterized by non-keratinized mucosa,
interlacing rete ridges, and saw-tooth appearance of rete pegs on histology?
A. Oral lichen planus
,B. Erythroplakia
C. Leukoplakia
D. Squamous papilloma
CORRECT ANSWER: (A) Oral lichen planus
RATIONALE: Oral lichen planus demonstrates a band-like lymphocytic infiltrate and
saw-tooth appearance of rete ridges on histology, typically affecting non-keratinized
mucosa such as buccal mucosa. Erythroplakia and leukoplakia are clinical lesions with
differing histology (erythroplakia often severe dysplasia), and squamous papilloma
shows fibrovascular cores with koilocytosis in viral cases.
Question 6
In acute myocardial infarction, the earliest ECG change typically seen is:
A. Pathological Q waves
B. ST-segment elevation
C. T-wave inversion
D. Peaked T waves
CORRECT ANSWER: (D) Peaked T waves
RATIONALE: The earliest ECG change in evolving transmural myocardial ischemia
can be hyperacute (peaked) T waves, followed by ST-segment elevation, then Q waves
and T-wave inversion later. Thus peaked T waves often precede ST elevation.
Question 7
Which local anesthetic has the longest duration of action for peripheral nerve block
among the following?
A. Lidocaine
B. Bupivacaine
C. Procaine
D. Mepivacaine
CORRECT ANSWER: (B) Bupivacaine
RATIONALE: Bupivacaine is a long-acting amide local anesthetic commonly used for
prolonged nerve blocks and epidurals. Lidocaine and mepivacaine are intermediate-
acting; procaine is a short-acting ester anesthetic.
, Question 8
A 28-year-old female presents with amenorrhea, galactorrhea and headaches. Serum
prolactin is elevated and MRI shows a 8 mm pituitary lesion. Initial treatment should be:
A. Transsphenoidal surgical removal
B. Dopamine agonist therapy (e.g., cabergoline)
C. Radiotherapy
D. Estrogen-progestin therapy
CORRECT ANSWER: (B) Dopamine agonist therapy (e.g., cabergoline)
RATIONALE: Microprolactinomas (<10 mm) are usually treated medically with
dopamine agonists (cabergoline or bromocriptine), which decrease prolactin levels and
tumor size. Surgery is reserved for medication resistance or intolerance, large
macroadenomas with mass effect, or apoplexy. Radiotherapy is rarely used.
Question 9
Which of the following organisms is most commonly responsible for dental caries?
A. Streptococcus mutans
B. Porphyromonas gingivalis
C. Actinomyces israelii
D. Candida albicans
CORRECT ANSWER: (A) Streptococcus mutans
RATIONALE: Streptococcus mutans plays a key role in dental caries due to its ability
to metabolize sugars to acids and adhere to tooth surfaces, forming biofilms.
Porphyromonas is associated with periodontitis; Actinomyces with actinomycosis;
Candida with oral candidiasis.
Question 10
A child with hemophilia A presents with hemarthrosis after minor trauma. Which factor is
deficient?
A. Factor VIII
B. Factor IX
C. Factor XI
D. Factor VII
