Name: Score:
95 Multiple choice questions
Term 1 of 95
A 54-year-old male with a history of chronic gout and GERD presents to your office for his
health maintenance exam. Vital signs today are blood pressure 138/88 mmHg, pulse 65
beats/min, respiratory rate 12 breaths/minute, afebrile, BMI 29 kg/m2. He does not smoke
cigarettes or use illicit substances, and he does drink one or two glasses of wine most evenings.
He currently jogs three times a week for approximately 30 minutes at a time. He and his partner
order takeout food for supper twice per week and otherwise cook at home. He does not
particularly like vegetables, but he tries to eat a piece of fruit every day. He has no current
concerns, review of systems is negative, and his physical exam is unremarkable. You
recommend lifestyle changes. Which of the following changes is most likely to improve his
cardiovascular risk?
The best option is indicated below. Your selections are indicated by the shaded boxes.
·
Alcohol cessation
·
DASH eating plan
·
Increased exercise
·
Increasing dietary potassium
·
Supplementation with vitamin D
,Term 2 of 95
1. Mark is a 5-month-old male who is brought to the urgent care clinic with a three-day history
of rhinorrhea and non-productive cough. When he was born he was large for gestational age,
and his exam then was notable for macrocephaly, macroglossia, and hypospadias. On physical
exam now his vitals signs are stable. He has copious nasal discharge, but his lungs are clear to
auscultation. On abdominal exam, you palpate an abdominal mass on the right side just below
the subcostal margin. It is 7 cm in diameter and does not cross the midline. The abdomen is soft
and non-tender with active bowel sounds. What is the most likely cause of his mass?
· Wilms' tumor
· Teratoma
· Renal cell carcinoma
· Hepatoblastoma
Polycystic kidney disease
Renal cell carcinoma
Wilm's tumor
Neuroblastoma
Term 3 of 95
Mr. Giovanni is a 37-year-old male who drives a delivery truck. He presents to your clinic after
acute onset of severe lower back pain that began after lifting a large package while at work.
When you enter the room, you find him standing, unable to sit comfortably.
On physical exam, he has limited lumbar flexion, reduced to 45 degrees, positive straight leg
test at 45 degrees on the left, normal gait, but difficulty with heel walk. He has 4/5 strength on
the left with ankle plantar flexion. Strength is preserved on the right.
Which additional physical exam finding would be consistent with this man's level of disc
herniation?
The best option is indicated below. Your selections are indicated by the shaded boxes.
2/5 strength on hip flexion
Decreased range of motion on lumbar extension
Decreased rectal tone
Hypoactive ankle tendon reflex
Positive Stoop test
,Term 4 of 95
A 22-year-old female with no significant past medical history experienced an inversion-type
injury to her right ankle while playing volleyball. The ankle quickly became edematous, but she
used ice and was able to bear weight on the foot. When the patient presents at the family
medicine ambulatory practice two days following her injury, minimal swelling is noted and
motor functions and sensation are preserved. She has tenderness at the anterior lower lateral
malleolus but not inferiorly or posteriorly. You diagnose her with an ankle sprain. You
recommend continued relative rest and also tell the patient to keep it elevated and ice it
several times during the day to help with the pain and swelling. You inform the patient that
immobilization and compression is good for the conservative management of her condition.
What is the best compression device to use in this situation?
The best option is indicated below. Your selections are indicated by the shaded boxes.
·
Compression stockings
·
Elastic wrap
·
Semi-rigid ankle support
·
Solid cast for eight weeks
·
Tape
, Term 5 of 95
1. You are seeing a 72-year-old female with a recent diagnosis of diastolic heart failure (HFpEF)
with an ejection fraction of 60% on a recent echo. She was given a diuretic in the ER last week
and told to follow up with you. She complains of mild new dyspnea on exertion, orthopnea
and lower extremity edema. On exam, her vitals include a blood pressure of 142/86 mmHg,
pulse of 84 beats/minute, respirations of 16/minute and oxygen saturation of 98% on room air.
Pulmonary exam reveals mild bibasilar crackles, cardiac exam reveals a regular rate and
rhythm with no murmurs, and her extremities have 1+ edema to the lower shins. Of the following,
which would be the most appropriate choice of medication for this patient?
· Amlodipine
· Digoxin
· Metoprolol succinate
· Hydrochlorothiazide
· Spironolactone
Atenolol
Bisoprolol
Metoprolol tartrate
Metoprolol succinate
95 Multiple choice questions
Term 1 of 95
A 54-year-old male with a history of chronic gout and GERD presents to your office for his
health maintenance exam. Vital signs today are blood pressure 138/88 mmHg, pulse 65
beats/min, respiratory rate 12 breaths/minute, afebrile, BMI 29 kg/m2. He does not smoke
cigarettes or use illicit substances, and he does drink one or two glasses of wine most evenings.
He currently jogs three times a week for approximately 30 minutes at a time. He and his partner
order takeout food for supper twice per week and otherwise cook at home. He does not
particularly like vegetables, but he tries to eat a piece of fruit every day. He has no current
concerns, review of systems is negative, and his physical exam is unremarkable. You
recommend lifestyle changes. Which of the following changes is most likely to improve his
cardiovascular risk?
The best option is indicated below. Your selections are indicated by the shaded boxes.
·
Alcohol cessation
·
DASH eating plan
·
Increased exercise
·
Increasing dietary potassium
·
Supplementation with vitamin D
,Term 2 of 95
1. Mark is a 5-month-old male who is brought to the urgent care clinic with a three-day history
of rhinorrhea and non-productive cough. When he was born he was large for gestational age,
and his exam then was notable for macrocephaly, macroglossia, and hypospadias. On physical
exam now his vitals signs are stable. He has copious nasal discharge, but his lungs are clear to
auscultation. On abdominal exam, you palpate an abdominal mass on the right side just below
the subcostal margin. It is 7 cm in diameter and does not cross the midline. The abdomen is soft
and non-tender with active bowel sounds. What is the most likely cause of his mass?
· Wilms' tumor
· Teratoma
· Renal cell carcinoma
· Hepatoblastoma
Polycystic kidney disease
Renal cell carcinoma
Wilm's tumor
Neuroblastoma
Term 3 of 95
Mr. Giovanni is a 37-year-old male who drives a delivery truck. He presents to your clinic after
acute onset of severe lower back pain that began after lifting a large package while at work.
When you enter the room, you find him standing, unable to sit comfortably.
On physical exam, he has limited lumbar flexion, reduced to 45 degrees, positive straight leg
test at 45 degrees on the left, normal gait, but difficulty with heel walk. He has 4/5 strength on
the left with ankle plantar flexion. Strength is preserved on the right.
Which additional physical exam finding would be consistent with this man's level of disc
herniation?
The best option is indicated below. Your selections are indicated by the shaded boxes.
2/5 strength on hip flexion
Decreased range of motion on lumbar extension
Decreased rectal tone
Hypoactive ankle tendon reflex
Positive Stoop test
,Term 4 of 95
A 22-year-old female with no significant past medical history experienced an inversion-type
injury to her right ankle while playing volleyball. The ankle quickly became edematous, but she
used ice and was able to bear weight on the foot. When the patient presents at the family
medicine ambulatory practice two days following her injury, minimal swelling is noted and
motor functions and sensation are preserved. She has tenderness at the anterior lower lateral
malleolus but not inferiorly or posteriorly. You diagnose her with an ankle sprain. You
recommend continued relative rest and also tell the patient to keep it elevated and ice it
several times during the day to help with the pain and swelling. You inform the patient that
immobilization and compression is good for the conservative management of her condition.
What is the best compression device to use in this situation?
The best option is indicated below. Your selections are indicated by the shaded boxes.
·
Compression stockings
·
Elastic wrap
·
Semi-rigid ankle support
·
Solid cast for eight weeks
·
Tape
, Term 5 of 95
1. You are seeing a 72-year-old female with a recent diagnosis of diastolic heart failure (HFpEF)
with an ejection fraction of 60% on a recent echo. She was given a diuretic in the ER last week
and told to follow up with you. She complains of mild new dyspnea on exertion, orthopnea
and lower extremity edema. On exam, her vitals include a blood pressure of 142/86 mmHg,
pulse of 84 beats/minute, respirations of 16/minute and oxygen saturation of 98% on room air.
Pulmonary exam reveals mild bibasilar crackles, cardiac exam reveals a regular rate and
rhythm with no murmurs, and her extremities have 1+ edema to the lower shins. Of the following,
which would be the most appropriate choice of medication for this patient?
· Amlodipine
· Digoxin
· Metoprolol succinate
· Hydrochlorothiazide
· Spironolactone
Atenolol
Bisoprolol
Metoprolol tartrate
Metoprolol succinate
