Block 2 exam PDI Flashcards
- What is the preferred order for examination of the abdomen?
(A) Inspection, auscultation, percussion, palpation
(B) Percussion, auscultation, palpation, inspection
(C) Auscultation, inspection, palpation, percussion
(D) Inspection, palpation, auscultation, percussion
(A) Inspection, auscultation, percussion, palpation
- You are in the emergency room assessing a patient with abdominal pain and fever. You are performing
an abdominal examination to assess for peritoneal signs. Which one of the following is NOT a
peritoneal sign?
(A) Rebound tenderness
(B) Involuntary guarding
(C) Rigidity of the abdomen
(D) Voluntary guarding
C
- A 15-year-old high school student presents to the clinic with a 1-day history of
nausea and anorexia. He describes the pain as generalized yesterday, but today it
has localized to the right lower quadrant. You palpate the left lower quadrant and
the patient experiences pain in the right lower quadrant. What is the name of
this sign?
(A) Psoas sign
(B) Obturator sign
(C) Rovsing’s sign
(D) Cutaneous hyperesthesia
C
A 25-year-old veterinarian presents to the clinic for evaluation of flank pain,
dysuria, nausea, and fever. A urine pregnancy test is negative. A urine dipstick is
positive for leukocyte esterase. On physical examination, what would be the most
likely sign expected?
(A) Psoas sign
(B) CVA tenderness
(C) Rovsing’s sign
(D) Murphy’s sign
B
A 40-year-old flight attendant presents to your office for evaluation of abdominal
pain. It is worse after eating, especially if she has a meal that is spicy or high in fat.
She has tried over-the-counter antacids, but they have not helped the pain. After
examining her abdomen, you strongly suspect cholecystitis. Which sign on examination
increases your suspicion for this diagnosis?
(A) Psoas sign
(B) Rovsing’s sign
(C) Murphy’s sign
(D) Grey Turner’s sign
C
A 22-year-old celebrity with a known history of intravenous drug use presents to
the emergency room for evaluation of a 5-day history of nausea, emesis, and rightupper-
quadrant abdominal pain. On general survey, he appears ill and his skin is
distinctly yellow. He has a temperature of 102.5°F and a heart rate of 112 bpm.
You provisionally diagnose him with acute hepatitis. What would you expect to
find on abdominal examination?
(A) Liver edge is tender and 4 to 5 finger-breadths below the RCM
(B) Liver edge is nonpalpable
(C) Liver edge is tender and 1 finger-breadth below the RCM
(D) Liver edge is nontender and 4 to 5 finger-breadths below the RCM
A
Match each numbered item with the appropriate lettered phrase or phrases. 1) LIVER EDGE 2) SPLEEN EDGE 3) ROVSING SIGN 4) PSOSA'S SIGN 5) OBTURATOR SIGN CUTANEOUS HYPERESTHESIA
(A) Palpable deep to the left costal margin during inspiration
(B) Palpable 6 cm below the right costal margin in the midclavicular line during
inspiration
(C) Pain elicited when the patient’s right thigh is flexed at the hip with the knee bent, and the leg is internally rotated at the hip
(D) Examiner’s hand is placed on the patient’s right knee and the patient is asked
to raise his or her right thigh against the examiner’s hand
(E) Pain elicited by gently picking up a fold of abdominal skin anteriorly without
pinching it
(F) Pain in the right lower quadrant during palpation of the left lower quadrant
- Liver edge - palpable 6 cm below the right costal margin in the midclavicular line during inspiration
- Spleen edge- palpable deep to the left costal margin during inspiration
- Rovsing’s sign -Pain in the right lower quadrant during palpation of the left lower quadrant.
- Psoas sign - Examiner’s hand is placed on the patient’s right knee and the patient is asked to raise his or her right thigh against the examiner’s hand
- Obturator sign -Pain elicited when the patient’s right thigh is flexed at the hip with the knee bent, and the leg is internally rotated at the hip
- Cutaneous hyperesthesia - Pain elicited by gently picking up a fold of abdominal skin anteriorly
Ms. G. is a 42-year-old housewife who makes an appointment at your clinic because she has been experiencing pain in her upper abdomen for the past 3 months. She describes the pain as an “ache” that sometimes radiates into her right upper back and right shoulder. The pain gets worse after eating fatty or greasy foods, so she has eliminated these foods from her diet. She feels nauseated when the pain occurs and sometimes vomits. She denies fever or chills, weight loss, chest pain, diarrhea, constipation,
melena, rectal bleeding, and dysuria. She has not been exposed to anyone who has
been sick.Ms. G. is healthy. She does not smoke, drink, or use illicit drugs.Her family history is significant for hypertension in her mother and diabetes in her father. Her mother had gallbladder surgery in her mid-40s.
What parts of the exam would you like to perform? (Circle the appropriate areas.)
General Survey Breasts and Axillae
Vital Signs, Female Genitalia
Skin Male Genitalia
Head and Neck Anus, Rectum, and Prostate
Thorax and Lungs Peripheral Vascular/Extremities
Cardiovascular Musculoskeletal
Abdomen Nervous System
What physical findings are you looking for to help determine the diagnosis?
general survey vital signs skin thorax and lungs Cardiovascular Abdomen
History of Present Illness:
Mrs. M., a 30-year-old dental hygienist, presents to the clinic because of a grayish,
foul-smelling vaginal discharge that has been present for 1 week. There is no vaginal
itching or burning with urination. Mrs. M. is sexually active in a monogamous
relationship with her husband of 10 years. She states that she and her husband have
no other sexual partners. She reports no fever, chills, abdominal pain, or pelvic pain.
Her last menstrual period was 1% weeks ago.
Mrs. M.’s medical history is unremarkable; she had a bilateral tubal ligation after
the birth of her last child, 3 years ago.
What parts of the exam would you like to perform? (Circle the appropriate areas.)
General Survey Breasts and Axillae
Vital Signs Female Genitalia
Skin Male Genitalia
Head and Neck Anus, Rectum, and Prostate
Thorax and Lungs Peripheral Vascular/Extremities
Cardiovascular Musculoskeletal
Abdomen Nervous System
What physical findings are you looking for to help determine the diagnosis?
IDK
A 19-year-old sexually active college student presents for evaluation of a vaginal discharge. She has been in a monogamous relationship since becoming sexually
active and is married to her partner. She denies that he has been unfaithful. She denies fever or chills. She states that the discharge is thick, white, and curdlike, and although there is no bad odor, she does experience some itching. Upon physical examination of the vagina, you see an inflamed vulva, with a slightly red vaginal mucosa. The discharge is thick and white. There is no cervical motion tenderness.The uterus is normal in size without adnexal masses. Based on this information, what is your most likely diagnosis?
(A) Bacterial vaginosis
(B) Trichomonas vaginalis infection
(C) Candida vaginitis
(D) Pelvic inflammatory disease
C
A 35-year-old woman presents for evaluation of several new lesions on her vagina.
She denies any previous medical problems. She is sexually active. She has had four
pregnancies and has given birth to two children. She has had more than ten sexual
partners in her lifetime. She is currently divorced but involved in a new relationship
with a man whose past sexual history is unknown. On physical examination
of the external vagina, you see cauliflower-like lesions scattered on the labia. These
are nontender to palpation; the largest is 1 cm in diameter. The remainder of the
pelvic examination is unremarkable, and there is no vaginal discharge. Based on
this information, what is your most likely diagnosis?
(A) Epidermoid inclusion cysts
(B) Venereal warts
(C) Genital herpes
(D) Syphilitic chancre
B
A 28-year-old housewife presents for an annual checkup. When queried, she mentions
that she has noticed bleeding in between her periods for the past several months. She has been pregnant five times and has given birth to five infants. She is sexually active in a monogamous relationship with her husband. On physical examination of the uterus, you palpate an irregular nodule that is approximately 3 cm in diameter. Based on this information, what is your most likely diagnosis?
(A) Leiomyoma or fibroid
(B) Cervical cancer
(C) Uterine cancer
(D) Cystocele
A
A 23-year-old sex worker presents to the emergency room for evaluation of pelvic
pain and fever. You obtain a pregnancy test, which is negative. Her last menstrual
period was 1 week ago and was normal. You obtain a complete blood count, and
the white blood cell count is elevated. On pelvic examination, she has cervical
motion tenderness and a right adnexal mass that is larger than 5 cm in diameter
and is extremely tender to palpation. What is the most likely cause of this adnexal
mass?
(A) Ovarian tumor
(B) Ruptured ovarian cyst
(C) Ruptured tubal pregnancy
(D) Tubo-ovarian abscess
D
Mr. P., a 65-year-old retired farmer, comes to your office because he is worried about
a sudden loss of dark red blood from the rectum. He normally has a bowel movement
every other day; he does not need to strain. He drinks prune juice daily to keep his
bowel movements regular. He reports no fever, chills, night sweats, weight loss,
abdominal pain, tarry black stools, or rectal pain. He does feel weak and tired.
Mr. P. has had hypertension for 30 years, well controlled with medications.
He had a left inguinal hernia repair when he was 30 years old.
He has smoked three packs of cigarettes daily since the age of 15. He does not
drink alcohol, and he has never used illicit drugs.His mother died at age 60 of complications of colon cancer. His father had hypertension and died of a heart attack at age 85.
- As part of a routine checkup, you are examining the prostate of 65-year-old man.
He denies nocturia and urinary hesitancy. On physical examination, you palpate
the prostate gland and feel a mass. Which one of the following descriptors would
you use to characterize this mass?
(A) Color
(B) Size
(C) Presence of discharge
(D)Presence of rash
B
You are performing a routine physical examination on a 70-year-old retired banker.
On examination of the prostate, you palpate a mass that is 1 cm in diameter, hard,
and nontender. The patient has had a 6-month history of fatigue. He denies weight
loss and night sweats. What is your most likely diagnosis?
(A) Benign prostatic hyperplasia
(B) Internal hemorrhoid
(C) Prostatitis
(D)Prostate cancer
D
An 80-year-old retired secretary presents to the emergency room because of difficulty
having a bowel movement, stating that “it feels like something is coming
out.” She denies fever or chills and weight loss. She has had constipation and has
used an over-the-counter stool softener and increased her water intake. She denies
pain with defecation. On physical examination of the anus, you see a doughnut of
red tissue, with concentrically circular folds where the anus should be. What is
your most likely diagnosis?
(A)Thrombosed external hemorrhoid
(B) Anal fissure
(C) Rectal prolapse
(D)Rectal cancer
C
A 25-year-old pregnant woman (G1, P0) at 12 weeks’ gestation presents to your
office for routine prenatal care. When you ask her about how she is feeling, she
states that she has been unable to keep down food and that food tastes “funny” to
her. You look at her vital signs; she has lost 5 pounds since her previous visit. The
fetal heart tones are normal, and the rest of her examination is unremarkable.
What step should you take next with this patient?
(A) You reassure her that pregnancy-related nausea usually lasts only for the first trimester and that most likely her nausea and appetite will improve soon.
(B) You are concerned about a peptic ulcer and want to start her on medication.
(C) You are concerned about hyperthyroidism and obtain a thyroid-stimulating
hormone (TSH) level.
(D) You diagnose her with hyperemesis gravidarum and proceed with further diagnostic workup.
A
- A 35-year-old pregnant woman (G4, P3) at 24 weeks’ gestation presents to your
office for routine prenatal care. Her major concern is a backache that began 2
weeks ago and has not gone away. She denies dysuria, fever, and chills but does
admit to urinary frequency. She is taking a mild over-the-counter analgesic for the
pain and is using a heating pad. You obtain a urinalysis, for which the results are
normal. What step should you take next for this patient?
(A) You give her antibiotics for her pyelonephritis.
(B) You diagnose her with a kidney stone and ask her to strain her urine and increase her fluid intake.
(C) You diagnose her with meningitis and admit her to the hospital for treatment with intravenous antibiotics.
(D) You reassure her that this is a normal part of pregnancy because the hormones are causing relaxation of the joints and ligaments, which changes the normalcurvature of the lower spine.
D
You are performing a routine checkup on a pregnant woman who is at 37 weeks’
gestation. Her blood pressure is 110/65 mm Hg. The size of the uterus is appropriate
for her dates; the fetal heart rate is in the 140s. She has trace pedal edema. You
perform an examination for the size of the fetus and its position. What is this
maneuver called?
(A) Nagele’s maneuver
(B) Leopold’s maneuvers
(C) Bickley’s maneuver
(D) Bates’ maneuver
B
What is Leopard Maneuver is
(A) Calculation to determine expected date of confinement
(B) Date of delivery
(C) Technique to determine size and position of the fetus
(D) Most recent onset of menses
C
e emergency room with a history of a football injury to the left flank earlier that day while at practice. He reports that at the time of the injury he only had the “wind knocked out of him” and he recovered in a few minutes. About 1 h later he began to experience pain in the left upper quadrant and left shoulder. He also feels dizzy and light-headed on standing. Physical examination demonstrates orthostatic changes in blood pressure and heart rate. Heart and lung examinations are normal. Abdominal auscultation reveals normal bowel sounds, but the patient complains of tenderness when palpating the left upper quadrant. Rectal
exam is normal. Which of the following is the most likely diagnosis?
a. Dislocation of the left shoulder
b. Left rib fracture
c. Left pneumothorax
d. Ruptured spleen
e. Contusion of the left kidney
D
- Which of the following is the
proper sequence for examination of
the abdomen?
a. Auscultation, percussion, inspection, palpation
b. Auscultation, inspection, palpation, percussion
c. Inspection, percussion, auscultation, palpation
d. Inspection, auscultation, percussion, palpation
e. Inspection, percussion, palpation, auscultation
D
Which of the following statements
is true regarding the term
“scaphoid” abdomen?
a. An unremarkable abdomen should be called scaphoid b. It is a convex abdomen c. It is seen in patients who have ascites d. It is absent in obese patients e. It implies guarding f. It implies rigidity
D
- Which of the following best
describes the location of McBurney’s
point?
a. In the midclavicular line just under the right costal margin
b. At the midpoint of a line connecting the symphysis pubis and the anterior superior iliac spine
c. Midway along the right inguinal ligament
d. One-third of the way along a line drawn from the right anterior superior iliac spine to the umbilicus
e. One centimeter to the right of the umbilicus
D
201. A 38-year-old man arrives at the emergency room with the chief complaint of hematemesis for 3 h. He does not drink alcohol and has no previous medical history. He spent the previous night vomiting approximately 10–12 times aftereating some “bad chicken.” The patient is squirming on the stretcherand is retching. He is afebrile with a heart rate of 120/min and a bloodpressure of 90/60 mm Hg. Abdominal exam is positive for diffuse tenderness,but the patient has no rigidity, guarding, or rebound tenderness. There is no hepatosplenomegaly. Rectal exam is negative for occult blood. A nasogastric tube is inserted and reveals bright red blood. Which of the following is the most likely diagnosis? a. Esophageal varices b. Mallory-Weiss tear c. Gastritis d. Peptic ulcer disease e. Boerhaave syndrome f. Dieulafoy lesion
B
202. A 24-year-old HIV-positive patient who has had AIDS for 3 years presents with painful swallowing and dysphagia to solids and liquids. He has no previous history of heartburn or reflux disease. His CD4 count is 41/μL and he recently required 3 wk of antibiotics for Pneumocystis carinii pneumonia. Examination of the pharynx reveals no oral thrush. Barium swallow demonstrates multiple nodular filling defects of various sizes that resemble a “cluster of grapes.” Which of the following is the most likely diagnosis?
a. Candida esophagitis
b. Reflux disease
c. Barrett’s esophagus
d. Pneumocystis esophagitis
e. Achalasia
f. Plummer-Vinson syndrome
E
- Which of the following statements
is true regarding the liver?
a. Macronodular cirrhosis is defined as liver nodules of 3 mm c. Normal liver size is 12 cm in the midclavicular line (MCL) d. Macronodular cirrhosis is most likely due to alcohol use e. Micronodular cirrhosis is most likely due to viral infection
C
204. A 70-year-old woman with a 25-year history of diabetes mellitus presents with early satiety, bloating, and nausea after meals. She has had previous surgery for gallbladder stones and appendicitis. Her diabetes is complicated by retinopathy and peripheral neuropathy. On physical examination, bowel sounds are normal. A succussion splash is audible. The abdomen is tympanic and there is no hepatosplenomegaly. There is no tenderness. Rectal examination is normal. Serum glucose is 310 mg/dL. Which of the following is the most likely diagnosis?
a. Celiac sprue
b. Whipple’s disease
c. Gastroparesis
d. Gluten-sensitive enteropathy
e. Tropical sprue
C
206. A 42-year-old morbidly obese woman complains of a nonproductive cough for 8 mo. She denies abdominal discomfort after eating and has never “suffered” from heartburn. Rarely, she has regurgitation, and when she does it has a sour taste to it. Abdominal examination is normal. Rectal examination is FOBT negative. Which of the following is the most likely diagnosis? a. Carcinoma of the lung b. Gastroesophageal reflux disease c. Chronic obstructive lung disease d. Lactose deficiency e. Chronic cholestasis
B
207. A 16-year-old boy has had lifelong constipation. He requires suppositories and often enemas to initiate bowel movements. His abdomen is distended. Palpation reveals a tubular mass in the left lower quadrant. Rectal exam reveals no stool in the vault. Barium enema reveals a dilated colon above a normal-appearing rectum. Which of the following is the most likely diagnosis?
a. Colon carcinoma
b. Gardner syndrome
c. Peutz-Jeghers syndrome
d. Hirschsprung’s disease
e. Volvulus
D
A 45-year-old patient presents
with altered mental status. His wife
states that over the last week her husband has been taking acetaminophen for some abdominal discomfort. He uses no illicit drugs but drinks 4–5 beers daily. Over the last
24 h the patient has become progressively
Letha rgic. Vital signs reveal a temperature of 97°F, a blood pressure of 100/70 mm Hg, a heart rate of 120/min, and a respiratory
rate of 26/min. The patient is jaundiced with RUQ abdominal tenderness on palpation. He has no rebound tenderness or splenomegaly but has an enlarged liver.
There is no ascites or peripheral edema. Heart and lung examinations
are normal. The patient responds to painful stimuli and has
asterixis. He has no focal neurologic deficit. Which of the following is the
most likely diagnosis?
a. Alcohol intoxication
b. Alcohol withdrawal
c. Delirium tremens
d. Acetaminophen toxicity
e. Wilson’s disease
D
209. A 19-year-old girl attending school in Massachusetts presents with the chief complaint of bloody diarrhea for 2 mo. She has abdominal discomfort and feels she has lost some weight. She also complains of tenesmus. Abdominal examination is normal. The rectal exam reveals stool containing blood and pus. Which of the following is the most likely diagnosis? a. Irritable bowel syndrome b. Ulcerative colitis c. Giardiasis d. Hemorrhoids e. Diverticulosis
A
211. A 44-year-old man with a history of peptic ulcer surgery presents with palpitations, tachycardia, lightheadedness, and diaphoresis after eating a meal. The symptoms typically begin 30 min after eating. Which of the following is the most likely diagnosis?
a. Malabsorption
b. Peptic ulcer recurrence
c. Gastric carcinoma
d. Gastritis
e. Dumping syndrome
f. Esophagitis
E
For each organ, choose the appropriate sound with percussion. a. Tympany b. Hyperresonance c. Dullness d. Flatness
Liver (CHOOSE 1 SOUND) -
Stomach (CHOOSE 1
SOUND) -
Liver - C
Stomach - A
218. The border of dullness moves to the dependent side and tympany moves toward the top when the patient turns to the side from the supine position. (CHOOSE 1 SIGN)
a. Shifting dullness
b. Fluid wave
c. Puddle sign
d. Bulging flanks
A
219. A 54-year-old woman presents with generalized pruritus that keeps her awake at night. Liver size by percussion in the midclavicular line is 17 cm. There is no splenomegaly. Serum alkaline phosphatase level is 3 times the normal value
Pick 1
For each patient with liver disease, choose the most likely disorder. a. Hemochromatosis b. Primary biliary cirrhosis c. Sclerosing cholangitis d. Hepatocellular carcinoma e. Zollinger-Ellison syndrome f. Alcoholic hepatitis g. Wilson’s disease h. α1 antitrypsin deficiency i. Metastatic carcinoma of the liver j. Budd-Chiari syndrome
b. Primary biliary cirrhosis
220. A 44-year-old man with a 20- year history of ulcerative colitis presents with fever and right upper quadrant pain. Physical examination reveals jaundice and RUQ tenderness with palpation. Endoscopic retrograde cholangiopancreatography (ERCP) shows multifocal strictures of the extrahepatic biliary tree
c. Sclerosing cholangitis
222. A 53-year-old alcoholic presents with mild RUQ tenderness and jaundice. Liver function tests reveal an elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) level, but the AST is 2 times greater than the ALT. (CHOOSE 1 DISORDER)
f. Alcoholic hepatitis
A 39-year-old man presents with jaundice and ascites. He has a history of diabetes mellitus and was recently diagnosed as having heart disease. On physical examination, he has a bronze-like appearance to his skin, arthritic changes of the fingers, and testicular atrophy. (CHOOSE 1 DISORDER)
a. Hemochromatosis
224. A 43-year-old man presents with cirrhosis. Slit-lamp examination reveals a yellow-brown ring in the limbus of the cornea. The patient has recently developed an unsteady gait, tremors, and involuntary chorea-like movements. (CHOOSE 1 DISORDER)
g. Wilson’s disease
A 23-year-old man presents
with mild, persistent jaundice. The
serum bilirubin is always
E
226. A 17-year-old woman presents with moderate jaundice, which is primarily conjugated bilirubin. She develops jaundice during pregnancy and in times of illness. She has mild hepatomegaly. Liver biopsy reveals black pigment in the hepatocytes. (CHOOSE 1 DISORDER) -
a. Dubin-Johnson syndrome b. Rotor syndrome c. Crigler-Najjar type 1 syndrome d. Crigler-Najjar type 2 syndrome e. Gilbert syndrome
A
231. A 48-year-old man presents with peripheral edema. He has been healthy and physically active all of his life. His family history is unremarkable. His blood pressure is normal. On physical examination, the patient is noted to have anasarca. Kidneys are not palpable. Urinalysis reveals a moderate amount of proteinuria and “grape clusters” are seen under light microscopy. Which of the following is the most likely diagnosis?
a. Glomerulonephritis
b. Rhabdomyolysis
c. Nephrotic syndrome
d. Acute interstitial nephritis
e. Acute tubular necrosis
C
234. A 41-year-old man complains of soft, raised, flesh-colored growths or projections on his glans penis, prepuce, and penile shaft. Several excisional biopsies are done to look for malignancy. Which of the following is the most likely diagnosis?
a. Genital herpes
b. Condyloma acuminatum
c. Molluscum contagiosum
d. Condylomata lata
e. Peyronie’s disease
B
A 32-year-old woman is referred to the emergency room for renal failure that was discovered in a preemployment screening examination. The patient has a blood urea nitrogen (BUN) of 100 mg/dL and a serum creatinine of 8.4 mg/dL. Her only complaint is bilateral flank pain. Family history reveals that her mother and one sibling have renal failure and receive hemodialysis. Her mother has had a recent stroke. The patient’s blood pressure is 170/100 mm Hg. Heart examination reveals a midsystolic click and murmur that increases with Valsalva maneuver. Kidneys are palpated bilaterally and are each 20 cm large. Which of the following is the most likely diagnosis?
a. Horseshoe kidney
b. Polycystic kidney disease
c. Bilateral hydronephrosis
d. Kidney carcinoma
e. Medullary sponge kidney
B
- Which of the following best
characterizes the sensitivity of the
digital rectal examination (DRE)?
a. High for both rectal carcinoma and prostate cancer b. High for prostate cancer but low for appendicitis c. High for both appendicitis and prostate cancer d. Low for appendicitis, prostate cancer, and colon carcinoma e. Low for prostate cancer and high for rectal carcinoma
B
- A 49-year-old man with
multiple myeloma presents with
glucosuria, hypophosphatemia, hypokalemia,
hypouricemia, aminoaciduria,
and proteinuria. Further
analysis of the electrolytes reveals
the patient to have a metabolic acidosis.
The urine pH is The urine pH is The urine pH is
A
244. A 19-year-old woman presents with severe right-sided flank pain accompanied by fever, shaking chills, dysuria, and frequency. She is sexually active with one partner and always uses condoms. Her last menstrual period was 5 days ago. On physical examination, her temperature is 103.8°F and her heart rate is 120/min. Blood pressure and respirations are normal. Abdominal examination reveals suprapubic tenderness with palpation. The patient complains of pain when percussion is performed with the ulnar surface of the fist over the right costovertebral angle (CVA). Pelvic examination is normal.
Which of the following is the most likely diagnosis? a. Diverticulitis b. Acute cystitis c. Renal calculi d. Pyelonephritis e. Appendicitis
D
50. An 18-year-old woman presents to your office for a blood pressure check. The patient has a history of hypertension diagnosed by a previous physician who recently retired. The patient takes three antihypertensives and is compliant. Except for an occasional headache, she has no complaints. There is no family history of hypertension. Blood pressure is 145/90 mm Hg in both arms. Funduscopic examination reveals exudates and hemorrhages. Heart and lungs are normal. Abdominal examination reveals a systolic and diastolic bruit heard in the right midabdomen and through to the back. The remainder of the examination is normal. Which of the following is the most likely diagnosis?
a. Pheochromocytoma
b. Coarctation of the aorta
c. Renal artery stenosis
d. Hyperaldosteronism
e. Cushing’s disease
C
A 55-year-old man presents with hematuria, flank pain, and fever. Physical examination reveals the presence of an abdominal mass. (CHOOSE 1 DIAGNOSIS)
a. Prostate cancer
b. Renal cell carcinoma
c. Bladder cancer
d. Carcinoma of the ureter
B
A 57-year-old man with a history of smoking presents with hematuria. He has owned and operated a chain of dry cleaners for over 30 years. (CHOOSE 1 DIAGNOSIS )a. Prostate cancer b. Renal cell carcinoma c. Bladder cancer d. Carcinoma of the ureter
C
x 3. A 22-year-old college student presents to your office because she has not menstruated
in 3 months. She is sexually active in a monogamous relationship. You perform
a physical examination and determine that she is pregnant. What did you see
and feel on examination of the cervix and uterus?
(A) Pink cervical os; firm to palpation
(B) Cyanotic cervical os; soft to palpation
(C) Pink cervical os; soft to palpation
(D) Cyanotic cervical os; firm to palpation
D
247. A 71-year-old man presents with a history of nocturia, frequency, and urgency about half the time. He states that for the last month he has had difficulty starting and maintaining his urine stream (has to push or strain) more than half of the time. He always feels like his bladder is not empty after urinating. On physical examination, the prostate gland is enlarged, nodular, and nontender. The PSA level is 2.7 ng/ml. Which of the following is the most likely diagnosis?
a. Mild BPH
b. Moderate BPH
c. Severe BPH
d. Prostate cancer
e. Prostatitis
B
You are performing a routine examination on a pregnant woman who is at 24
weeks’ gestation. She had early prenatal care, no medical problems, and an uncomplicated
pregnancy to date. Her last menstrual period (LMP) correlates with the
gestational age of her pregnancy. You would expect the following to be true at her
24-week checkup:
(A) The patient will feel the baby move.
(B) The fundal height will be 20 cm.
(C) The fetal heart rate will be 60 bpm.
(D) The uterus will be anteverted and pear-shaped.
A
- A 60-year-old man with a previous history of appendectomy
30 years ago presents to the emergency room complaining of abdominal
pain. He describes the pain as colicky and crampy and
feels it builds up, then improves on its own. He has vomited at least 10
times since the pain started this morning. He states that he has not
had a bowel movement for 2 days and cannot recall the last time he
passed flatus. The abdomen is slightly distended. Abdominal auscultation
reveals high-pitched bowel sounds and peristaltic
rushes. Percussion reveals a tympanic abdomen. The patient is diffusely
tender with palpation but has no rebound tenderness. Rectal
examination reveals the absence of
stool. Which of the following is the
most likely diagnosis?
a. Cholecystitis
b. Diverticulitis
c. Pancreatitis
d. Gastroenteritis
e. Intestinal obstruction
E
- A 23-year-old woman presents with fever and bilateral lower
quadrant abdominal pain for two days. She complains of the onset of
a mucopurulent vaginal discharge with her menses, which she states
is yellowish in color. She has a new sexual partner and uses a nonbarrier
method of contraception. Her temperature is 103.2°F. She has
bilateral lower quadrant tenderness with palpation, and pelvic examination
reveals cervical and adnexal motion tenderness. A mass is palpable
in the left adnexa. Which of the following is the most likely
diagnosis?
a. Fitz-Hugh-Curtis syndrome
b. Pelvic inflammatory disease
c. Perihepatitis
d. Acute inflammation of Bartholin’s
gland
e. Chancroid
B
- A 37-year-old woman in her 32nd wk of gestation (G2P1) presents
with a seizure. She has been healthy and does not smoke cigarettes,
drink alcohol, or use illicit drugs. She has been poorly compliant
in receiving her prenatal care. Physical examination reveals a
blood pressure of 150/95 mm Hg. The patient’s face and hands appear
edematous. Other than the patient being postictal (confused and disoriented after the seizure), the neurologic examination is normal. The urinalysis reveals proteinuria. The rest of the patient’s laboratory data is normal. Which of the following
is the most likely diagnosis?
a. HELLP syndrome
b. Preeclampsia- may also occur up to six weeks post-partum.
c. Eclampsia
d. Essential hypertension
e. Primary seizure disorder
C
- A 20-year-old woman presents with the sudden onset of severe lower abdominal pain that radiates to her left shoulder. She has some vaginal bleeding now, but
her last menstrual period was 6 wk ago. She has no history of sexually
transmitted diseases and has never been pregnant. She uses condoms
inconsistently about 50% of the time with her partner of 18 mo. She
denies dysuria or frequency. On physical examination, blood pressure
is 100/70 mm Hg, heart rate is 100/min, and temperature is normal.
Abdominal exam reveals tenderness and rebound in the left
lower quadrant. Adler sign is positive. Pelvic examination reveals a
boggy and poorly delineated mass in the left adnexa. The patient’s
abdominal pain worsens upon slight movement of the cervix.
Which of the following is the most likely diagnosis?
a. Pelvic inflammatory disease
b. Pyelonephritis
c. Appendicitis
d. Ectopic pregnancy
e. Ruptured corpus luteum cyst
D
Which of the following best
describes irregular, prolonged, and
heavy menstrual bleeding?
a. Menorrhagia
b. Metrorrhagia
c. Menometrorrhagia
d. Polymenorrhea
e. Oligomenorrhea
C
456. A 24-year-old woman, gravida 3, para 2, presents with the chief complaint of some lower abdominal pain accompanied by a small amount of vaginal bleeding. She is 16 wk pregnant and has been healthy throughout the pregnancy. She does not smoke cigarettes, drink alcohol, or use illicit drugs. Abdominal examination is normal. Pelvic examination reveals that the internal cervical os is closed. Which of the following is the most likely diagnosis? a. Complete abortion b. Incomplete abortion c. Threatened abortion d. Inevitable abortion e. Missed abortion
C
458. A 32-year-old woman in her third trimester presents with painless and profuse bright red vaginal bleeding. Pelvic examination is deferred. Transvaginal ultrasonographyrevealsanabnormallypositioned placenta. Which of the following is the most likely diagnosis? a. Placenta accreta b. Placenta previa c. Abruptio placentae d. Bloody show e. Vasa previa
B
A 52-year-old woman complains of recurrent episodes in which she becomes extremely hot and diaphoretic. During these episodes, she becomes anxious and feels like her heart is racing. Each episode lasts approximately 5 min. The episodes are so intense that she must put on the air conditioner or open a window until the episode resolves. Hot weather and stress often precipitate the symptoms. The episodes seem to be worse at night. The patient further states that she has been amenorrheic for 12 mo and has recently begun experiencing vaginal dryness and dyspareunia. Physical examination is normal. Which of the following is the most likely diagnosis? a. Depression b. Menopause c. Hypothyroidism d. Somatization e. Personality disorder
B
462. A 64-year-old woman presents with vaginal bleeding similar to “spotting” that has occurred daily for 1 mo. Her last menses was at age 50 and she has been healthy her entire life. She denies fever, weight loss, or abdominal pain. Physical examination is normal. Which of the following is the most likely diagnosis? a. Atrophic vaginitis b. Endometriosis c. Uterine leiomyoma d. Endometrial carcinoma e. Polycystic ovarian syndrome
A
464. A 23-year-old woman presents to your office for a prenatal visit. She has not received any previous prenatal care and does not know the date of her last menstrual period. On physical examination, the fundal height is palpated to be at the level of the umbilicus. Which of the following is the estimated number of weeks of gestation? a. 10 wk b. 15 wk c. 20 wk d. 25 wk e. 30 wk
C
466. A 35-year-old woman presents with vaginal itching. Examination reveals strawberry patches or petechiae on the cervix and vaginal mucosa and a frothy green-colored discharge. A pear-shaped organism is visible on wet mount preparation. (SELECT 1 ORGANISM)
a. Trichomonas vaginalis
b. Neisseria gonorrhoeae
c. Gardnerella vaginalis
d. Candida albicans
e. Chlamydia trachomatis
f. Enterobius vermicularis
A
467. A 31-year-old woman presents with vaginal burning and a white, cheeselike vaginal discharge. Pseudohyphae are visible with a KOH preparation -
a. Trichomonas vaginalis
b. Neisseria gonorrhoeae
c. Gardnerella vaginalis
d. Candida albicans
e. Chlamydia trachomatis
f. Enterobius vermicularis
D
An 18 year-old white female comes into the clinic with her significant other. She is complaining of RLQ pain, diffuse coming on gradually. She has felt some nausea, but has not vomited. It hurts a lot when she is moves. Her shoulder hurts and she has felt dizzy at times over the last three days. She is running a low-grade tem. Of 99.6F her last menstrual period ended three day ago. What is the most likely diagnosis?
Adnexal mass Ectopic pregnancy Ovarian cysts Appendicitis Entrauterine pregnancy
Appendicitis
30 yo pt. Is Hospital. The pt is suffering form the acute abdominal pain. The cause of the pain is the statistically second major cause of the acute abdomen during pregnancy. This pathology is associated with pregnancy related increased estrogen and progesterone serum concentrations. This pt is complaing about:
Steady aching pain in the epigatstium, radiating in the subscapular region.
65yo male pt has an acute abdominal pain he is pale and dehydrated. He complained about passage of bloody stool. During the process of taking clinical history of this pt, the MDIV students noticed that he is taking regularly digitek (digoxin tablests) and lasix (furocemide) as a part of the treatment his CHF. The 1st diagnosis you’ll need to confirm is
Mesenteric ischemia
Acute renal failure
Myocardial infrction
Acute cholecystitis
idk
1A. A 30 yr old male with HIV presents with a C/O flank pain and hematuria that have occurred suddenly. He is writhing in pain. Urinalysis shows many RBCs without casts, few WBC. The most likely diagnosis one can think of in this patient is:
Urolithiasis b. Glomerulonephritis
Bladder tumor d. Pyelonphritis
……..
D
