Exam 1: Quizzes

Question 1

TG presents with L eye pain. States it is difficult to open or move the eye due to pain and it feels like there is something in the eye. On exam you note excessive tearing and photophobia. What is the most likely diagnosis for TG?
a. Dry eye syndrome
b. Viral conjunctivitis
c. Corneal abrasion
d. Giant papillary conjunctivitis

Answer 1

c. Corneal abrasion

Question 2

For which of the following patients will you provide an urgent/STAT referral to ophthalmology?
a. 33 y/o using lubricant eye drops 8-10 times daily when working on their computer
b. 74 y/o presents with sudden loss of sight in their L eye
c. 29 y/o not responding to antihistamine drops for allergic conjunctivitis
d. 26 y/o experiencing flashes of light with a headache

Answer 2

b. 74 y/o presents with sudden loss of sight in their L eye

Question 3

ST is a 32 y/o who presents with c/o a 2-day history of waking with their eye “stuck shut”. Which of the following additional symptoms will most strongly support a diagnosis of bacterial conjunctivitis?
a. swollen upper eyelid, blurred vision
b. sensation of something in the eye, photophobia
c. consistent thick, creamy/yellow discharge, injection
d. intermittent watery discharge, pruritus, injection

Answer 3

c. consistent thick, creamy/yellow discharge, injection

Question 4

Which of the following will you include when educating your patient who has a pinguecula?
a. wear sunglasses and a wide-brimmed hat outside, use lubricant eye drops generously
b. use antihistamine and lubricant drops generously, flush eye with saline as needed
c. apply cool compresses and use lubricant drops generously, avoid contact lens use
d. use mast cell stabilizer drops and lubricant drops generously, avoid sun exposure

Answer 4

a. wear sunglasses and a wide-brimmed hat outside, use lubricant eye drops generously

Question 5

Which of the follow will you include in your management plan for you 68 y/o patient with dry eye syndrome?
a. avoid sun exposure, apply warm compresses 4x/day, wash lashes vigorously
b. use antihistamine drops 2x/day, apply cold compresses 2x/day, take omega-3 fatty acids
c. limit computer use, blink frequently, use lubricant drops frequently (up to hourly)
d. wear sunglasses whenever outside, avoid use of mascara, take AREDS vitamins

Answer 5

c. limit computer use, blink frequently, use lubricant drops frequently (up to hourly)

Question 6

Your patient presents with a painful, red, swollen R eye/eyelid. You are concerned about periorbital cellulitis. Which of the following additional features aligns with a diagnosis of periorbital cellulitis?
a. pain with EOMs, afebrile, recent trip across the country
b. vision impairment, diplopia, intact and painless extraocular movements
c. recent sinusitis, pain with extraocular movements, fever
d. proptosis, no vision impairment, intact and painless extraocular movements

Answer 6

c. recent sinusitis, pain with extraocular movements, fever

Question 7

Which of the following symptom clusters do you expect in your patient with blepharitis?
a. mucoid discharge, pruritis, flaking near eyelashes
b. hazy cornea, pain with blinking, loss of ‘red reflex’
c. tender eyelid, subQ lid nodule, lid erythema on affected side
d. burning/foreign body sensation, lid erythema, lid crusting

Answer 7

d. burning/foreign body sensation, lid erythema, lid crusting

Question 8

Your 64 y/o M patient has diabetes and is asking how to prevent eye problems. You advise:
a. follow the medical nutrition diet you were prescribed
b. exercise daily
c. have a dilated eye exam with an ophthalmologist at least once/year
d. maintain you A1C below 7%

Answer 8

d. maintain you A1C below 7%

Question 9

You expect the following symptoms in a patient with acute close angle glaucoma:
a. diplopia, reduced peripheral vision, headache, tearing
b. central vision loss, eye pain, pupillary constriction, tearing
c. slow onset visual disturbance, headache, injection
d. sudden blurry vision with halos, eye pain, injection

Answer 9

d. sudden blurry vision with halos, eye pain, injection

Question 10

Mr. Tessler is a 68 y/o M who presents reporting difficulty with reading and using road maps. Based on this information alone, which of the following diagnoses is most likely?
a. retinal detachment
b. age-related macular degeneration
c. open angle glaucoma
d. closed angle glaucoma

Answer 10

b. age-related macular degeneration

Question 11

Which of the following patients meets guideline criteria for a diagnosis of bacterial sinusitis?
a. 58-year-old with 9 days of nasal congestion, headache, low grade temperature, cough.
b. 48-year-old with 7 days of nasal congestion, productive cough, sneezing, no fever.
c. 38-year-old with 5 days of nasal congestion, slight cough, no fever.
d. 68 y/o with 11 days of nasal congestion, facial pain, slight cough, low grade fever

Answer 11

d. 68 y/o with 11 days of nasal congestion, facial pain, slight cough, low grade fever

Question 12

Carol is a 34-year-old married mother of 2 school aged kids. She presents with a 3-day history of acute sore throat. She says it is hard to swallow. She has been feeling feverish at home; however, she has not measured her temperature. She has a slight cough, a poor appetite mostly due to pain with swallowing, and feels tired. She has a slight headache. On exam you note a beefy red posterior pharynx with 2+ tonsillar hypertrophy and scattered exudate. She has tender anterior cervical and tonsillar adenopathy. What is your most likely diagnosis?
a. Post nasal drip
b. Beta hemolytic streptococcus, group A
c. Herpetic tonsillitis
d. Acute HIV infection

Answer 12

b. Beta hemolytic streptococcus, group A

Question 13

Sophia is a 22-year-old Black female who presents with complaint of left ear discomfort. In gathering the history, you learn that she had an upper respiratory infection (common cold) last week and her ear discomfort began last night. She occasionally hears popping sounds, especially with swallowing. She has not noticed any drainage from the ear and has not taken any medications for it. She does not smoke. On exam you note clear canals with fluid level and bubbles behind the pearly grey left tympanic membrane (TM). What is the most appropriate conservative treatment for Sophia’s symptoms?
a. Antibiotics
b. Antihistamines
c. Decongestants
d. Steroid otic drops

Answer 13

c. Decongestants

Question 14

In treating your primary care patient who has tested positive for covid (coronavirus), you will select an appropriate antiviral medication based on specific criteria established by the Centers for Disease Control and Prevention (CDC). Considering those criteria, which of the following patients is highest priority for receiving a prescription for an antiviral medication?
a. 44-year-old with onset of symptoms 5 days ago and has a BMI of 38kg/m2.
b. 59-year-old onset of symptoms 3 days ago and has rheumatoid arthritis.
c. 22-year-old with onset of symptoms 1-2 days ago and is planning a pregnancy soon.
d. 72-year-old with onset of symptoms 4 days ago and has asthma.

Answer 14

d. 72-year-old with onset of symptoms 4 days ago and has asthma.

Question 15

Which antibiotic will you prescribe first line to a patient with bacterial sinusitis? The patient has no medication allergies, takes no other medications, is mildly ill, and has not had antibiotics in the prior 6 months.
a. Azithromycin (Azithromax) 500mg PO on day 1 then 250mg PO daily on days 2-5
b. Moxifloxicin (Avelox) 400mg PO daily x 7 days
c. Amoxicillin/clavulanate (Augmentin) 875/125mg PO BID x 7 days
d. Doxycycline (Doxycycline) 100mg PO BID x 7 days

Answer 15

c. Amoxicillin/clavulanate (Augmentin) 875/125mg PO BID x 7 days

Question 16

Sophia is a 22-year-old Black female who presents with complaint of left ear discomfort. In gathering the history, you learn that she had an upper respiratory infection (common cold) last week and her ear discomfort began last night. She occasionally hears popping sounds, especially with swallowing. She has not noticed any drainage from the ear and has not taken any medications for it. She does not smoke. On exam you note clear canals with a fluid level and bubbles behind the pearly grey left tympanic membrane (TM). What is the most likely diagnosis for Sophia?
a. Otitis externa
b. Perforated TM
c. Serous otitis
d. Acute otitis media

Answer 16

c. Serous otitis

Question 17

Stephen is a 24-year-old healthy appearing male. He presents with complaint of upper respiratory “cold” symptoms that have persisted for 3 weeks. He describes clear nasal discharge, intermittent sore throat, sneezing, and nasal congestion. He has tried several different over-the-counter cold preparations; however, they made him sleepy and caused him difficulty in focusing at work. On physical exam you note that his turbinates have bluish streaks on the mucosa. What is your most likely diagnosis?
a. Allergic rhinitis
b. Sinusitis
c. Pharyngitis
d. Common cold

Answer 17

a. Allergic rhinitis

Question 18

Jessie returns for a repeat visit 2 days after being seen for ear pain. She was initially treated with conservative therapy and reports that the treatment did not work; her ear is now more painful. Her temperature is 101o F. On exam her left TM has a cloudy fluid level approximately halfway up; the right TM is bulging, has a whitish discoloration at one side, and is erythematic and injected. What is the most likely diagnosis for Jessie?
a. Perforate TM
b. Otitis externa
c. Acute otitis media
d. Serous otitis

Answer 18

c. Acute otitis media

Question 19

You have diagnosed your patient with infectious mononucleosis. Which of the following will you include in your patient education?
a. OTC nasal steroid, fever management, STI testing
b. STI testing, fever management, mucolytic use
c. saline gargles for sore throat, mucolytic use, OTC nasal steroid
d. saline gargles for sore throat, fever management, avoid contact sports

Answer 19

d. saline gargles for sore throat, fever management, avoid contact sports

Question 20

Which one of the following has information true of cerumen impaction?
a. get audiometry twice yearly, treat with OTC mast cell stablizer
b. antihistamine drops help prevent, treat by washing canals with warm soapy water
c. avoid exposure to repeated loud noise, use carbamide (Debrox) as needed
d. avoid use of ear plugs, treat with regular auto-insufflation

Answer 20

c. avoid exposure to repeated loud noise, use carbamide (Debrox) as needed

Question 21

MC is a 24-year-old Black female (she/her) who presents to primary care with complaint of increasing wheezing, chest tightness, and cold symptoms. She has mild intermittent asthma, which is usually well managed with an albuterol inhaler 2 puffs 4 x daily as needed. She reports using the inhaler daily this week. On exam, she has nontender sinuses; patent nares with +erythema, +edema, and clear to milky colored mucus; mild post cervical lymphadenopathy; lungs with expiratory wheezes, L > R. She does not smoke. Which test is appropriate?
a. Office peak flow measure
b. Arterial blood gases
c. Chest x-ray
d. Pre- and post-bronchodilator spirometry

Answer 21

a. Office peak flow measure

Question 22

Your 54-year-old patient (they/them) tested positive for coronavirus (Covid). They are using over-the-counter medications you recommended to manage their symptoms, which began 3 days ago. They are generally healthy with well-managed hypertension and well-managed diabetes type 2. Which of the following medications would be appropriate to prescribe?
a. casirivimab/imdevimab (REGEN-COV)
b. remdesivir (Veklury)
c. nirmatrelvir/ritonavir (Paxlovid)
d. tixagevimide/cilgavimab (Evusheld)

Answer 22

c. nirmatrelvir/ritonavir (Paxlovid)

Question 23

You see the following four patients in your primary care practice. Which one is at the lowest risk for sleep apnea?
a. A 65-year-old postmenopausal female (she/her).
b. A 35-year-old female (she/her) with controlled hypertension.
c. A 25-year-old female (she/her) with goiter whose partner complains about her snoring.
d. A 45-year-old male (he/him) with waist circumference of 35 inches.

Answer 23

d. A 45-year-old male (he/him) with waist circumference of 35 inches.

Question 24

Mr. K is a 67-year-old Hispanic male (he/him) who presents with shortness of breath that has been increasing over the past 3 months. He describes feeling tired and having trouble catching his breath sometimes at rest but especially upon exertion. He coughs up whitish phlegm frequently. He has a +30-pack year history of smoking. His BP is 144/84, P 94, RR 24, T 98.7F, resting O2
sat 95% (RA). Lungs have diminished breath sounds at both bases with occasional expiratory wheezes. What diagnostic test will you order for Mr. K to confirm your diagnosis?
a. Spiral computed tomography
b. Pulmonary function test
c. Arterial blood gas
d. Chest X-ray

Answer 24

b. Pulmonary function test

Question 25

JL is a 16-year-old Hispanic male (he/him) who presents for his annual summer camp physical exam. He is well and denies clinical symptoms. When asking about his past summer at camp, he says he was “out of shape” and had shortness of breath, cough, and sometimes wheezing when he did some activities. He doesn’t exercise much during the school year due to his schoolwork load. During the summer when he has time to exercise or play sports, he says he stops before other kids because he gets “too winded.” His lungs are clear on exam. Which test will you order?
a. Methacholine challenge test
b. Pre- and post-bronchodilator spirometry
c. Arterial blood gas
d. Allergy skin testing

Answer 25

a. Methacholine challenge test

Question 26

MC is a 24-year-old Black female (she/her) who presents to primary care with complaint of increasing wheezing, chest tightness, and cold symptoms. She has mild intermittent asthma, which is usually well managed with an albuterol inhaler 2 puffs 4 x daily as needed. She reports using the inhaler daily this week. On exam, she has nontender sinuses; patent nares with +erythema, +edema, and clear to milky colored mucus; mild post cervical lymphadenopathy; lungs with expiratory wheezes, L > R. She does not smoke. In addition to monitoring her breathing with her home meter, what will you prescribe for MC?
a. azithromycin (Zithromax) 250 mg, two tabs on day 1 and 1 tab daily for days 2-5
b. salmeterol (Serevent Diskus) 2 puffs twice daily
c. prednisone (Prednisone) 40 mg by mouth daily x 4 days
d. budesonide/formoterol (Symbicort) 80mcg/4.5mcg 2 puffs twice daily

Answer 26

d. budesonide/formoterol (Symbicort) 80mcg/4.5mcg 2 puffs twice daily

Question 27

For which of the following patients will you order low-dose chest CT to screen for lung cancer?
a. 58-year-old with 18 year-pack history who currently smokes.
b. 84-year-old with 30 pack-year history who currently smokes.
c. 60-year-old with 24 pack-year history who quit 2 years ago.
d. 62-year-old with 22 pack-year history who quit 18 years ago.

Answer 27

c. 60-year-old with 24 pack-year history who quit 2 years ago.

Question 28

MT is a 61-year-old Black male (he/him) who presents with shortness of breath that has been increasing over the past 3 months. He describes feeling tired and having trouble catching his breath sometimes at rest but especially upon exertion. He coughs up whitish phlegm frequently. He reports that this has been happening every winter for the past 5-6 years. He has a +30-pack year history of smoking. His BP is 140/86, P 94, RR 22, T 98.7F, O2 sat 96% (RA). Lungs have diminished breath sounds at both bases with occasional expiratory wheezes. What is the single most important factor for MT’s management plan?
a. Smoking cessation
b. NSAIDs as needed
c. Oral steroids
d. Oral antibiotics

Answer 28

a. Smoking cessation

Question 29

Your 67 y/o patient, Mr. Knight, has Medicare insurance. He was recently diagnoses with mild sleep apnea. He is otherwise generally healthy with a BMI of 33kg/m2. He takes Aspirin 81mg PO daily and a MV PO daily. He is concerned about the cost associated with treating his sleep apnea. Which of the following treatment options will you recommend to him?
a. Dental device
b. CPAP
c. Weight loss
d. Surgery

Answer 29

c. Weight loss

Question 30

JA presents with c/o 3 days of fever, chills, myalgias, fatigue, headache, coryza, and productive cough. She has had some nausea and loose stools, no vomiting or frank diarrhea. On exam you hear diffuse crackles that mostly clear after she coughs. Her cardiac and abdominal exams are normal. Which of the following treatment plans would you initiate?
a. Ribavirin (Copegus), rest, isolate from other people, return visit 4 weeks
b. Baloxivir (Xofluza), activity as tolerated, use a mask, high protein diet, return visit 2 weeks
c. Nirmatrelvir/Ritonavir (Paxlovid), rest, mask use, hydration, nutritious diet, follow-up call in 2 days
d. Molnupiravir (Lagevrio), activity as tolerated, isolate from other people, nutritious diet, return visit 4 weeks

Answer 30

c. Nirmatrelvir/Ritonavir (Paxlovid), rest, mask use, hydration, nutritious diet, follow-up call in 2 days

Question 31

SJ, a 68 y/o F, presents to the outpatient clinic with c/o cough and feeling ill for 2 days. She has PMH of HTN and overweight. Medications include: lisinopril 10mg daily, omega-3 supplement daily. She lives alone. Her daughter who lives nearby and visits daily is with her. SJ took her medications this morning and ate her usual breakfast of oatmeal. On examination she appears ill, slightly SOB, and flushed with BP 118/68, P 92, RR 22, T 101F, O2 94% on RA. HEENT is normal. Lungs have decreased breath sounds with scattered crackles and rales bilaterally. COR: S1S2, RRR, no M/R/G/C. Labs done today include: BUN 18, Cr 0.7, HgA1C 6.2%, H/H 12/40, Na+ 140. What is your plan for SJ?
a. Send to ED for admission to hospital
b. Prescribe azithromycin and albuterol
c. Order CT
d. Contact the visiting nurse association for home supportive care

Answer 31

b. Prescribe azithromycin and albuterol

Question 32

PJ presents with a productive cough, malaise, low-grade fever, and myalgias that started about a week ago and have slowly gotten progressively worse. Which of the following clinical findings would support a diagnosis of atypical community acquired PNA?
a. Wheezing
b. Distant breath sounds
c. Erythema multiforme
d. Reduced vocal fremitus

Answer 32

c. Erythema multiforme

Question 33

DD presents to your outpatient clinic with a 3 week hx of not feeling well. It started with fatigue and has slowly progressed to having a productive cough and occasional SOB. VS are normal. On exam you hear rales in LLL. Which of the below diagnoses is most likely?
a. Atypical PNA
b. CAP
c. Bronchitis
d. Asthma exacerbation

Answer 33

a. Atypical PNA

Question 34

EJ is a 76 y/o M who has chronic bronchitis and DMT2. He uses a combined inhaler with corticosteroid and long-acting beta agonist and takes Metformin. EJ presents today with upper resp tract symptoms of sore throat, rhinitis, and increased cough. You hear scattered wheezes in his lungs. He is afebrile and his peak flows are a little below normal. In addition to rest and increased fluids, which of the following is the best treatment plan?
a. Azithromycin, Albuterol inhaler
b. Salmeterol inhaler, acetaminophen as needed
c. NSAIDs as needed, Amoxicillin
d. Acetaminophen as needed, cough suppressant at night

Answer 34

a. Azithromycin, Albuterol inhaler

Question 35

BD is diagnosed with atypical community acquired PNA. You know persons with Psittacosis (Parrot Fever) often present with _______ and the best antibiotic to use for treatment is ________.
a. Low serum sodium and potassium, Moxifloxacin
b. Elevated LFTs, Tetracylcine
c. Erythema multiforme, Erythromycin
d. Horder’s spots, Doxycycline

Answer 35

b. Elevated LFTs, Tetracylcine
or
d. Horder’s spots, Doxycycline

Question 36

The following patients received a TST (PPD). Which one will you send for chest x-ray?
a. 65 y/o F, diabetes, TST 12mm induration
b. 29 y/o F, pregnant, TST 12mm induration
c. 75 y/o F, CHF, TST 7 mm induration
d. 35 y/o M, IVDU, TST 7mm induration

Answer 36

a. 65 y/o F, diabetes, TST 12mm induration

Question 37

You select an antibiotic to treat your patient’s community acquired atypical PNA based on your knowledge that the most common pathogen for community acquired atypical PNA is:
a. Hemophilus influenza
b. Mycoplasma
c. M. catarrhalis
d. Strep pneumoniae

Answer 37

b. Mycoplasma

Question 38

Your patient who resides in a long-term care facility demonstrates confusion and diaphoresis without a documented fever. They have been a few days after having a choking episode on soup. You order a CBC that shows a L shift, UA that has slightly elevated leukocytes and a CXR reveals consolidation in the posterior RLL. Your top differential is:
a. Healthcare associated PNA
b. TB
c. Aspiration PNA
d. Tularemia

Answer 38

c. Aspiration PNA

Question 39

GK is a 22 y/o M who is in the hospital for 4 days caring for his elderly mother last week. He is otherwise healthy with no chronic health concerns. On post-discharge day 3 he presents with coughing and a temperature of 101.8F. You suspect PNA given his presentation and the scattered fine crackles on lung exam. After diagnostic testing confirms your suspicion and you determine that outpatient treatment is appropriate, which of the following agents will you prescribe?
a. Vancomycin
b. Piperacillin/tazobactam (Zosyn)
c. Gentamicin
d. Levofloxacin (Levaquin)

Answer 39

d. Levofloxacin (Levaquin)

Question 40

You are providing education to your patient diagnoses with Meniere’s disease. Which of the following lifestyle recommendations will be included in your treatment plan for Sharon?
a. Fluid restriction
b. Support stockings
c. Eliminate caffiene
d. Salt restriction

Answer 40

d. Salt restriction

Question 41

Which of the following maneuvers will you perform to assist with diagnosing a patient with CC of dizziness-described as a sense of spinning after moving their head?
a. Dix-Hallpike
b. Caloric sign
c. Hyperventilation test
d. Epley maneuvers

Answer 41

a. Dix-Hallpike

Question 42

Which of the following is a common etiology of disequilibrium/dizziness?
a. astigmatism
b. cardiac arrhythmia
c. acoustic neuorma
d. MS

Answer 42

a. Astigmatism

Question 43

You are gathering a history from a patient with CC of feeling ‘dizzy’. To clarify the symptom, you will ask further questions. Which of the following responses suggests the concern is true vertigo?
a. the room spin if turns head
b. shaking since using new medication
c. off balance when on land after riding in a boat
d. suddenly loses consciousness

Answer 43

a. the room spins if turns head

Question 44

Your patient presents with concerns about feeling “dizzy” whenever they stand up. It only lasts a few minutes each time. They have no other symptoms. In the office you document their BP at 130/85 sitting and 100/65 standing after 8-10 minutes their BP returns to the sitting number. What is the best treatment for you patient?
a. an antiemetic
b. increase her antidepressant dose
c. a beta-blocker
d. Epley manuevers

Answer 44

c. Beta-blocker

Question 45

You are evaluating a patient with CC of dizziness. Which of the following symptoms suggests a serious underlying etiology?
a. episodic aural symptoms
b. symptoms precipitated consistently with position change
b. nystagmus inhibited with fixation
d. diplopia

Answer 45

d. diplopia

Question 46

Sharon is a 38 y/o F who presents to your office with a 1 year history of episodic dizziness, ringing in both ears, a feeling of aural fullness, and hearing loss. The symptoms come on every 1-2 weeks usually last for 12 hours. Nausea and vomiting are usually present. When asked to describe the dizziness, Sharon says “the world is spinning around me”. On PE, Sharon has horizontal nystagmus. The slow phase of the nystagmus is to the L and the rapid phase is to the R. Audiograms reveal bilateral sensorineural hearing loss in the low frequencies. What diagnosis is as the top of you differential?
a. Vestibular neuritis
b. Meniere’s Disease
c. BPPV
d. Ortho hypotension

Answer 46

b. Meniere’s disease

Question 47

Tonya is a 23 y/o F who comes to your office with a 6 month history of dizziness. She “feels dizzy” when she stands up (as if she is going to faint). The sensation disappears within a few minutes. She has a history of MDD. She started taking amitrptyline 9 months ago, her depression has improved signficantly since that time. her BP is 140/90 sitting and decreases to 108/70 when she stands. There is no ataxia, nystagmus, or other symptoms by history or on exam. After standing for several minutes her BP is 130/80. What diagnosis is at the top of your differential list for Tonya?
a. Vestibular neuritis
b. Meniere’s Disease
c. BPPV
d. Ortho hypotension

Answer 47

d. ortho hypotension

Question 48

Which of the following is associated with a clinical presenting compliant of light headedness?
a. nicotine withdrawal
b. tranquilizers
c. aminogylcoside antibiotics
d. anticonvulsant

Answer 48

a. nicotine withdrawal

Question 49

Which of the following clinical findings (H/P) is suggestive of a cerebellar disorder?
a. impaired proprioception
b. intact heel-toe walk
c. gaze evoked nystagmus
d. head-movement-induced nausea

Answer 49

c. gaze-evoked nystagmus