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A range of medical exam questions and scenarios, including the identification of oral lesions, interpretation of family medical history, recognition of common auscultatory findings in congestive heart failure, and the appropriate imaging studies for evaluating abdominal pain. The questions test the reader's clinical knowledge and decision-making skills across various medical specialties, such as gastroenterology, cardiology, and ophthalmology. By studying this document, students can develop a deeper understanding of the diagnostic process, the importance of a thorough patient history, and the integration of physical exam findings with laboratory and imaging results to arrive at the correct diagnosis and management plan. The diverse range of topics and clinical scenarios presented in this document make it a valuable resource for medical students, nursing students, and healthcare professionals seeking to enhance their clinical reasoning and problem-solving abilities.
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Question 1.
observe a white ulceration surrounded by
erythematous base on the side of his tongue. The clinician should recognize that very often
this is: (Points : 2)
Malignant melanoma
Squamous cell carcinoma
Aphthous ulceration
Behcet’s syndrome
Question 2.
in a patient assessment? (Points : 2)
Colon cancer in family member at age 70
Breast cancer in family member at age 75
Myocardial infarction in family member at age 35
All of the above
Question 3.
Depleted iron stores
Impaired ability to use iron stores
Chronic uncorrectable bleeding
Reduced intestinal absorption of iron
Question 4.
: 2) Cataract
Macular degeneration
Acute closed-angle glaucoma
Chronic open-angle glaucoma
Question 5.
patient reports a smoking history of 2 packs of
cigarettes per day since age 16. This would be recorded in the chart as: (Points : 2)
50 x 2-pack years
100-pack years
50-year, 2-pack history
100-pack history
Question 6.
of older adults regarding
prevention of
gastroesophageal reflux
disease symptoms, the nurse practitioner will include
which of the following instructions? (Points : 2)
Raise the head of the bed with pillows at night and chew peppermints when symptoms
of heartburn begins.
Raise the head of the bed on blocks and take the proton pump inhibitor medication at
bedtime.
Sit up for an hour after taking any medication and restrict fluid intake.
Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor
before a meal.
Question 7.
and unintentional weight loss. At times he is constipated
and other times he has episodes of diarrhea. His physical examination is unremarkable.
It is important for the clinician to recognize the
importance of: (Points : 2)
CBC with differential
Stool culture and sensitivity
Abdominal X-ray
Colonoscopy
Question 8.
chest pain and left-sided shoulder pain. Pain begins
after strenuous activity, including walking. Pain is characterized as dull, aching; 8/
during activity, otherwise 0/10. Began a few months ago,
intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain
is retrosternal, radiating to left shoulder, definitely
affects quality of life by limiting activity. Pain is worse today; did not go away after he
stopped walking. BP 120/80. Pulse 72 and regular. Normal
heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses
would be most likely? (Points : 2)
Musculoskeletal chest wall syndrome with radiation
Esophageal motor disorder with radiation
Acute cholecystitis with cholelithiasis
Coronary artery disease with angina pectoris
Question 9.
Systolic ejection murmur
S3 gallop rhythm
Friction rub
Bradycardia
Question 10.
the following
symptoms is
common with
acute otitis
media? (Points :
Question 15.
gastric ulcers. What teaching should the nurse
practitioner plan for a patient who has a positive Helicobacter pylori test? (Points : 2)
It is highly contagious and a mask should be worn at home.
Treatment regimen is multiple lifetime medications.
Treatment regimen is multiple medications taken daily for a few weeks.
Treatment regimen is complicated and is not indicated unless the patient is
symptomatic.
Question 16.
patient include: (Points : 2)
ASA, ACE/ARB, beta-blocker, aldosterone blockade
ACE, ARB, Calcium channel blocker, ASA
Long-acting nitrates, warfarin, ACE, and ARB
ASA, clopidogrel, nitrates
Question 17.
(PointsConjunctivitis : 2)
Acute glaucoma
Head trauma
Corneal abrasion
Question 18.
Psoas sign
Obturator sign
Cullens sign
Murphy’s sign
Question 19.
weakness. She admits to having dark, tarry
stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-
medicates daily with ibuprofen, naprosyn, and
aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor.
Fecal occult blood test is positive. A likely etiology
of the patient’s problem is: (Points : 2)
Mallory-Weiss tear
Esophageal varices
Gastric ulcer
Colon cancer
Question 20.
older adults? (Points : 2)
Increased gastric emptying time
Regular ingestion of NSAIDs
Decreased salivation
Fungal infections such as
Candida
Question 21.
care practice for evaluation of a persistent,
daily cough with increased sputum production, worse in the morning, occurring over the
past three months. She tells you, “I have the
same thing, year after year.” Which of the following choices would you consider strongly
in your critical thinking process? (Points : 2)
Seasonal
allergies Acute
bronchitis
Bronchial asthma
Chronic bronchitis
Question 22.
‘throwing up blood”. On physical examination, you note
ascites and caput medusa. A likely cause for the hematemesis is: (Points : 2)
Peptic ulcer disease
Barrett’s esophagus
Esophageal varices
Pancreatitis
Question 23.
pain or chest pain that can last 4- 6 hours or less,
often radiates to the back (classically under the right shoulder blade) and is often
accompanied by nausea or vomiting and often follows a
heavy, fatty meal. (Points : 2)
Acute pancreatitis
Duodenal ulcer
Biliary colic
Cholecystitis
Question 24.
back. He was mowing his lawn. He reports the pain
When all lab work is returned within normal limits, what is the most practical imaging study
to order, considering cost, availability, and sensitivity?
(Points : 2)
Abdominal upright and flat plate x-ray
Abdominal MRI
Abdominal CT scan with contrast
Abdominal ultrasound
Question 29.
patients? (Points : 2)
Asymmetric chest expansion
Increased lateral diameter
Increased anterior-posterior diameter
Pectus excavatum
Question 30.
read the whole way through to the question.)
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an
appendectomy, presenting with an acute onset
of significant right upper-quadrant abdominal pain and vomiting. His pain began after
a large meal, was unrelieved by a proton-pump inhibitor,
was unlike his previous episodes of heartburn, but upon questioning, reports
milder, prodromal episodes of similar post-prandial pain. His pain
seems to radiate to his back. Despite a family history of cardiac disease, he reports
no classic anginal signs or chest pain. He furthermore
denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight
loss. Finally, there are no dermatologic signs, nor
genitourinary symptoms.
The chosen imaging study reveals: “GB normal in size without wall-thickening, but with
5- 6 stones with shadowing. Common bile duct not
dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What
is the most effective therapeutic/management
option at this point? (Points : 2)
Trial of ursodiol
‘Watchful waiting’
Surgical consult
HIDA scan
Question 31.
could be due to: (Points : 2)
Exercise-induced cough
Bronchiectasis
Alpha- 1 deficiency
Pericarditis
Question 32.
whole way through to the question.)
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an
appendectomy, presenting with an acute onset
of significant right upper-quadrant abdominal pain and vomiting. His pain began after
a large meal, was unrelieved by a proton-pump inhibitor,
was unlike his previous episodes of heartburn, but upon questioning, reports
milder, prodromal episodes of similar post-prandial pain. His
pain seems to radiate to his back. Despite a family history of cardiac disease, he reports
no classic anginal signs or chest pain. He furthermore
denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight
loss. Finally, there are no dermatologic signs, nor
genitourinary symptoms.
Of the following lab studies, which would provide little help in determining
your differential diagnosis? (Points : 2)
Abdominal plain
films Liver function
tests Amylase/lipase
Urinalysis
Question 33.
abdominal pain, which has been worsening over the
last 24 hours. On examination of the abdomen, there is a palpable mass and rebound
tenderness over the right lower quadrant. The clinician
should recognize the importance of: (Points : 2)
Digital rectal examination
Endoscopy
Pelvic examination
Urinalysis
Question 34.
air-fluid levels in the bowel. This is a diagnostic
finding found in: (Points : 2)
Appendicitis
Cholecystitis
Bowel Obstruction
Diverticulitis
Hemoglobin <12 g/dl, MCV decreased, MCH decreased
Hemoglobin >12 g/dl, MCV increased, MCH increased
Hemoglobin <12 g/dl, MCV normal, MCH normal
Hemoglobin >12 g/dl, MCV decreased, MCH increased