NBCE Part II: General Diagnosis (Mock Board Exam) Flashcards by Danny Rufus

Most of the information needed to make a diagnosis will come from:
A. inspection
B. history
C. physical signs
D. diagnostic tests

B. history

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When are open-ended questions most helpful?
A. During the chief complaint history
B. After several close-ended questions have been asked
C. While taking the family health history
D. While doing a review of systems

A. During the chief complaint history

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Your 15 year old patient sustained a head injury while playing soccer this morning. Which of the following questions is most important to document?
A. Did you lose consciousness?
B. Were you able to continue playing after you were hurt?
C. Are you taking any pain medicine?
D. Have you ever had this type of injury before?

A. Did you lose consciousness?

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Which is the most valuable tool regarding the clinical assessment of headache?
A. history
B. physical examination
C. blood pressure
D. drug and work history

A. history

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An example of objective information obtained during the physical assessment includes:
A. last menstrual period one month ago
B. patient history of allergies
C. patient use of medications
D. 2x5 cm. scar present on the right lower forearm

D. 2x5 cm. scar present on the right lower forearm

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When performing a physical assessment, which of the following techniques is always used first?
A. palpation
B. percussion
C. auscultation
D. inspection

D. inspection

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Upon examination, your patient's trachea is left of midline. Which of the following is the most likely cause:
A. Pneumothorax on the left
B. Pleural adhesions on the right
C. A large atelectasis on the left
D. A lung tumor on the left

C. A large atelectasis on the left

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Which of the following is not a likely cause of increased body temperature?
A. infection
B. malignancy
C. hypothyroidism
D. hyperthyroidism

C. hypothyroidism

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Which of the following is not one of the variables we normally document when recording the pulse?
A. rate
B. amplitude
C. how many seconds you counted the pulse
D. rhythm

C. how many seconds you counted the pulse

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Vital signs are generally higher in infants and children than in adults. Which of the following is the reading normally higher in adults?
A. temperature
B. pulse
C. respiratory rate
D. blood pressure

D. blood pressure

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Your patient exhibits truncal obesity that manifests as a 'buffalo hump' in the cervicodorsal region. This leads you to suspect that your patient has:
A. Acromegaly
B. Cushing's disease
C. Myxedema
D. Grave's disease

B. Cushing’s disease

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Virchow's sentinel node is lymph node enlargement which region?
A. deep cervical
B. submandibular
C. tonsillar
D. supraclavicular

D. supraclavicular

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Which of the following refers to an abnormal lung sound?
A. adventitious
B. bronchial
C. vesicular
D. bronchovesicular

A. adventitious

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Unequal chest expansion occurs when:
A. Bulging of the intercostal spaces is present
B. Part of the lung is obstructed or collapsed
C. The patient is obese
D. Accessory muscles are used to augment respiratory effort

B. Part of the lung is obstructed or collapse

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Pancreatitis may cause hemoperitoneum. During abdominal inspection, you may observe a bluish discoloration around the umbilicus, which is referred to as:
A. Cullen's sign
B. Chandelier's sign
C. Chadwick's sign
D. Blumberg's sign

A. Cullen’s sign

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Which of the following is the cause of ascites?
A. feces
B. flatus
C. fibroid tumors
D. fluid

D. fluid

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Your patient complains of tenderness along the costovertebral angles, which leads you to suspect:
A. gastric ulcer
B. liver enlargement
C. spleen enlargement
D. kidney inflammation

D. kidney inflammation

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When, in the male, the urethral meatus is positioned ventrally it is:
A. called hypospadius
B. the result of phimosis
C. often associated with aging
D. probably due to stricture

A. called hypospadius

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A small, palpable tuft of hair over the coccyx is most commonly a:
A. polyp
B. pruritis ani
C. benign tumor
D. pilonidal cyst

D. pilonidal cyst

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Gloves are used for examination of the male genitalia to:
A. facilitate grasp of the external organs
B. make masses easier to detect
C. prevent the spread of unsuspected infection
D. protect the patient from embarrassment

C. prevent the spread of unsuspected infection

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Accommodation refers to:
A. pupillary dilation when looking at a near object
B. pupillary constriction when looking at a near object
C. involuntary blinking in the presence of bright light
D. changes in peripheral vision in response to light

B. pupillary constriction when looking at a near object

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A pale optic disc is seen with:
A. Optic atrophy
B. Cataract
C. Papilledema
D. Retinal detachment

A. Optic atrophy

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The tissue that connects the tongue to the floor of the mouth is the:
A. uvula
B. palate
C. papillae
D. frenulum

D. frenulum

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The lymph node that is palpable just inferior to the anterior chin is:
A. Parotid
B. Submandibular
C. Tonsillar
D. Submental

D. Submental

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``` The component of the conduction system referred to as the pacemaker of the heart is the: A. bundle branches B. SA node C. AV node D. bundle of HIS ```

B. SA node

``` When asked to point to the location of their pain, your patient takes their clenched fist and places it over their chest. This is referred to as: A. Blumberg's sign B. Levine's sign C. Rovsing's sign D. Cullen's sign ```

B. Levine's sign

``` Approximately what percent of breast cancer occurs in males? A. 0.5% B. 1-2% C. 4-5% D. 10% ```

B. 1-2%

``` Patient presents with chronic headaches that radiate from the cervical spine up over the top of the head, your most likely diagnosis would be? A. Classic Migraine B. Cervicogenic headache C. Cluster headache D. Chronic Postural Cervical Strain ```

B. Cervicogenic headache

``` Atrophy of the intrinsic muscles of the hand is most likely due to a nerve root lesion at what level? A. C5-C6 B. C4-C5 C. C8-T1 D. C3-C4 ```

C. C8-T1

``` Patient complains of right shoulder pain, which orthopedic test would not be diagnostic? A. Yergason's B. Apley's Scratch C. Dugas D. Apley's Compression ```

D. Apley's Compression

``` Past pointing either to the finger or the nose is indicative of dysfunction of which area? A. Flocculonodular node B. Tonsil C. Vermis and paravermal region D. Lateral hemisphere ```

C. Vermis and paravermal region

``` Which tremor is most closely associated with chronic alcoholism? A. resting B. intention C. red nuclear D. postural ```

B. intention

``` Which tremor is likely to improve when the arms are held out in front of the individual? A. resting B. intention C. red nuclear D. postural ```

B. intention

``` Hemiballismus describes unilateral sudden violent flinging movements of the proximal limb muscles. Sub-cortical degeneration of which nuclei is the most likely cause? A. Substantia nigra B. Putamen C. Globus pallidus D. Subthalamus ```

D. Subthalamus

``` Which type of headache is most likely reduced by seclusion to a dark, quiet room? A. Cranial arteritis B. Cervicogenic C. Tension D. Migraine ```

D. Migraine

``` Which type of headache, when described by the patient, is unrelenting and constant? A. Migraine B. Pressure C. Psychotic D. Cluster ```

C. Psychotic

``` The most important part of your examination of a patient is their? A. History B. Orthopedic Examination C. Radiographic Examination D. Neurological Examination ```

A. History

When performing an otoscopic examination on an adult, which of the following is true? A. You pull the pinna up and back before inserting speculum B. Use the smallest speculum in order to decrease the amount of discomfort C. Once the speculum is in the ear you may release the traction D. Tilt the person's head toward you for easier speculum insertion

A. You pull the pinna up and back before inserting speculum

``` The isthmus of the thyroid gland is palpated at which vertebral level: A. C3 B. C4 C. C5 D. C6 ```

D. C6

``` Upon examination your patient appears to have streptococcal pharyngitis. You know it is important for your patient to receive appropriate medical care for this condition, as untreated streptococcal infection may later cause: A. Gastric ulcer B. Myocardial infarction C. Heart valve defects D. Adynamic ileus ```

C. Heart valve defects

``` While performing routine cardiac auscultation, you hear an irregular heartbeat with occasional skipped beats. Which of the following diagnostic tests will supply the most clinically helpful information? A. standard 12 lead ECG B. echocardiography C. twenty four hour Holter monitoring D. cardiac enzymes ```

C. twenty four hour Holter monitoring

``` When auscultating the lungs, the most important technique when progressing from one site to the next is: A. listen at every rib interspace B. posterior to anterior comparison C. side to side comparison D. top to bottom comparison ```

C. side to side comparison

``` A Positive Rinne Test is indicative of: A. Conductive deafness B. Neurosensorial deafness C. Normal D. Bone conduction is greated than air conduction ```

C. Normal

``` A Negative Rinne Test is indicative of: A. Conductive deafness B. Neurosensorial deafness C. Normal D. Bone conduction is greated than air conduction ```

A. Conductive deafness

``` A small elevation on the rim of the ear that is also considered the equivalent of the tip of a mammalian ear is referred to as: A. Tophus ear B. Chondrodermatitis Helicis C. Darwin’s Tubercle D. Sebaceous Cyst ```

C. Darwin’s Tubercle

``` Inversion of the eyelids is also known as: A. Entropion B. Esotropia C. Extropion D. Exotropia ```

A. Entropion

``` The perception of sound in the absence of acoustic stimulation is referred to as? A. Noise B. Meniere’s disease C. Tinnitis D. Dysequilibrium ```

C. Tinnitis

``` Nonconcomitant strabismus is caused by? A. Paralysis of ocular muscles B. Muscle weakness to one of the ocular muscles C. Cranial Nerve 5 disorder D. Esotropia ```

A. Paralysis of ocular muscles

``` A smooth, red tongue with a slick appearance indicates? A. B3 or B12 vitamin deficiency B. Oral Cancer C. Recent use of antibiotics D. Fungal infection ```

A. B3 or B12 vitamin deficiency

``` Protein in the urine is most likely to be caused by pathology in which of the following organs? A. Liver B. Pancreas C. Kidney D. Spleen ```

C. Kidney

``` Which of the following lab findings is most specific for liver disease? A. AST B. ALT C. CPK D. LDH ```

B. ALT

``` Elevated alkaline phosphatase is most often an indication of pathology in which of the following? A. Liver and/or Bone B. Thyroid and/or Pituitary C. Stomach and/or Large Intestine D. Prostate and or Testes ```

A. Liver and/or Bone

``` Which of the following is most likely to elevate due to emotional stress? A. CPK B. Leukocyte esterase C. Delta 6-desaturase D. Cortisol ```

D. Cortisol

``` Urobilinogen is formed in which of the following organs? A. Liver B. Stomach C. Intestines D. Bladder ```

C. Intestines

``` Leukocyte esterase in the urine most likely indicates which of the following? A. Blood in the urine B. Urinary tract infection C. Protein in the urine D. Kidney dysfunction ```

B. Urinary tract infection

``` Iron storage is best measured by which of the following? A. Serum Iron B. Serum Ferritin C. Total Iron Binding Capacity D. Serum Transferrin ```

B. Serum Ferritin

``` Chronic iron deficiency anemia is most likely to cause red blood cells to become: A. Hyperchromic, Microcytic B. Hypochromic, Macrocytic C. Hyperchromic, Macrocytic D. Hypochromic, Microcytic ```

D. Hypochromic, Microcytic

``` Which of the following is the most likely cause of elevated lymphocytes in the blood? A. Allergy B. Bacterial infection C. Viral infection D. Parasite infestation ```

C. Viral infection

``` Which of the following is the most specific for an insulinoma? A. Serum glucose B. Glycosolated Hemoglobin C. C-peptide D. Serum Lipase ```

C. C-peptide

``` Elevated RDW means the red blood cells are which of the following? A. All macrocytic B. All microcytic C. Deficient in iron D. Varied in size ```

D. Varied in size

``` Eosinophils typically elevate in the blood when stimulated by which of the following? A. Bacterial infection B. Allergy C. Viral infection D. Hypothyroidism ```

B. Allergy

``` Which of the following would you see the fewest of in normal healthy blood? A. Basophils B. Monocytes C. Neutrophils D. Eosinophils ```

A. Basophils

``` Which of the following would you see the most of in normal healthy blood? A. Basophils B. Monocytes C. Neutrophils D. Eosinophils ```

C. Neutrophils

``` Which of the following is the “gold standard” test for measuring gastric ph? A. The Heidelberg capsule B. Endoscopy C. The Brandenburg capsule D. Fecal ph minus 2.7 ```

A. The Heidelberg capsule

``` A 42 year old male presents with fatigue. His CBC reveals low hemoglobin, low MCV and low MCH. Which of the following is his most likely diagnosis? A. Leukemia B. Polycythemia C. Leukopenia D. Anemia ```

D. Anemia

``` A 73 year old male presents with extreme malaise and reports that he feels something is terribly wrong. Among other findings, you discover rouleaux patterns of red blood cells on the peripheral blood smear and Bence-Jones protein in the urine. This patient is most likely suffering from which of the following conditions? A. Ankylosing spondylitis B. Multiple myeloma C. Rheumatoid Arthritis D. Multiple sclerosis ```

B. Multiple myeloma

``` A seven year old female presents with lethargy, increased thirst, and increased urination. The most likely diagnosis is which of the following? A. Hyperglycemia B. Hypoglycemia C. Pancreatitis D. Kidney dysfunction ```

A. Hyperglycemia

``` A young adult complains of anxiety, palpitation, sweating, and slight tremor. The symptoms are relieved by eating. Which of the following is the most likely cause of these symptoms? A. Hyperglycemia B. Hypoglycemia C. Pancreatitis D. Mononucleosis ```

B. Hypoglycemia

``` Which of the following procedures is best to differentiate between pancreatitis and biliary tract obstruction? A. Serum Amylase B. Peripheral blood smear C. Diagnostic ultrasound D. Protein electrophoresis ```

C. Diagnostic ultrasound

``` A 53 year old woman presents with clustered lesions along her anterior left thigh down to her knee. She reports that a few days before, she felt an intense burning sensation along the same area, but there were no visible abnormalities. Which of the following conditions is the most likely cause of these signs and symptoms? A. Herpes zoster B. Herpes simplex C. Psoriasis D. Scleroderma ```

A. Herpes zoster

``` An overweight 44 year old female reports she has been having episodes of epigastric pain that starts mild then increases to a severe level, stays for a while, then slowly diminishes. The episodes sometimes follow eating high-fat foods. Which of the following is the most likely cause of her distress? A. Gastric Ulcer B. Duodenal Ulcer C. Celiac Disease D. Cholecystitis ```

D. Cholecystitis

``` Patient presents with right lower quadrant pain, rebound tenderness, and an increased WBC count, and pyrexia, your diagnosis would most likely be? A. Appendicitis B. Diverticulitis C. Cholecystitis D. Peritonitis ```

A. Appendicitis

``` Patient presents with post-auricular pain, severe tenderness, otoscopic exam is normal, your diagnosis would most likely be? A. Strep throat B. Mastoiditis C. Otitis Externa D. Otitis Media ```

B. Mastoiditis

``` Pain, numbness and tingling down the anterolateral thigh is indicative of? A. Herniated Disc at L4/L5 B. Psoas Spasm C. Meralgia Paresthetica D. Inguinal Hernia ```

C. Meralgia Paresthetica

``` Pain, inflammation and moderate swelling in the popliteal fossa, with no history of trauma, is indicative of? A. Anterior Cruciate tear B. Baker’s Cyst C. Osgood Schlatter’s D. Pes Anserinitis ```

B. Baker’s Cyst

``` Deep, severe, unrelenting chronic headache particularly at night, greater than six months duration with no remittance, would be indicative of? A. Myofascial Trigger points B. Traumatic Subdural Hematoma C. Space Occupying Lesion D. Cluster Headache ```

C. Space Occupying Lesion

``` Low back pain with causalgia pain radiating down the leg to the big toe would be indicative of a lesion at? A. L5/S1 B. L3/L4 C. S1/S2 D. Piriformis Syndrome ```

A. L5/S1

``` Angina like pain, pain into the jaw and left arm, and a complete cardiac workup that is negative is indicative of? A. Hiatal Hernia B. Cervical Angina C. Cervical Sympatheticotonia D. Hiatal Angina ```

B. Cervical Angina

``` The following statement is part of which History Taking category? “Patient’s mother died at 66 of myocardial infarction, had hypertension. Father had myocardial infarction at 55, had diabetes, died at 73 of stroke.” A. Past medical history B. Review of system C. Family history D. Social and environmental history ```

C. Family history

``` Patient is blind in the upper right visual field in both eyes. The lesion is in the? A. Right parietal lobe B. Right temporal lobe C. Left parietal lobe D. Left temporal lobe ```

D. Left temporal lobe

``` Patient complaints of having difficult time in readings. Patient says his eyes can not focus anymore. Shining light to either eye partially constrict both pupils (direct and consensual). The lesion is in? A. Optic nerve B. Optic tract C. Edinger Westphal D. Ciliary ganglion ```

B. Optic tract

``` Patient complaints of being sloppy and in-coordinated with his hands. MRI films show a spinal cord lesion. Patient denies of any motor weakness. Romberg’s test is positive in the patient. Which of the following lesion will result in a sensory ataxia? A. Dorsal column lesion B. Ventral funiculus lesion C. Spinothalamic tract lesion D. Ventral horn lesion ```

A. Dorsal column lesion

``` A frontal lobe cortical lesion left the patient with a flexed upper extremity on the contralateral side. This is due to a disinhibition of the? A. Rubrospinal tract B. Corticospinal tract C. Vestibulospinal tract D. Spinothalamic tract ```

A. Rubrospinal tract

``` You perform Hallpike’s maneuver and eyes show nystagmus when the patient’s head is turned to the right and hanging down at the edge of the table. There might be a problem with? A. Right anterior semicircular canal B. Right posterior semicircular canal C. Left anterior semicircular canal D. Left posterior semicircular canal ```

B. Right posterior semicircular canal

A 62-year old patient complaints of not hearing people well. You perform Weber’s test and the sound lateralizes to the right ear. This is a? A. Left facial nerve lesion B. Left trigeminal nerve lesion C. Conduction deafness in the left ear D. Sensorineural deafness in the left ear

D. Sensorineural deafness in the left ear

``` Patient complaints of dryness of the mouth and the right eye. The affected eye shows no response to the corneal reflex. This is a? A. Trigeminal nerve lesion B. Facial nerve lesion C. Glossopharyngeal nerve lesion D. Vagus nerve lesion ```

B. Facial nerve lesion

History-taking is a special form of the art of communication. Which of the following may have an adverse effect on the patient during history-taking? A. Try holding the hand of a frightened old lady B. Watching the patient’s gestural language to see if it matches his word C. Talking louder to make a point D. Identifying with the things that matter to the patient

C. Talking louder to make a point

``` Which of the following would you observe in a 35 year old male patient with hyperlipoproteinemia? A. Kayser-Fleischer ring B. Bilateral ptosis C. Café au lait macules D. Corneal arcus ```

D. Corneal arcus

Which of the following would you observe in a patient with generalize peritonitis? A. Localized asymmetrical distension of the abdomen B. Gentle rise of the abdomen in inspiration and fall in expiration C. Absent abdominal movement D. Scaphoid abdomen

C. Absent abdominal movement

``` Which of lymph node, if detection, should always be a cause for concern? A. Superficial cervical nodes B. Supraclavicular nodes C. Deep cervical nodes D. Posterior cervical nodes ```

B. Supraclavicular nodes

``` Which of the following unusual features of the face is associated with Parkinson’s disease? A. Hirsutism B. Prominent eyes C. Lack of facial expression D. Pallor ```

C. Lack of facial expression

``` Which rib articulates with the sternum at the angle of Louis? A. 1st B. 2nd C. 3rd D. 4th ```

B. 2nd

``` During palpation for thoracic expansion, at what level of the ribs do you place your thumbs? A. 7th B. 8th C. 9th D. 10th ```

D. 10th

``` For the examination of the lever, in which region of the abdomen do you initially place your two hands side by side on the abdomen? A. Left inguinal B. Right lumbar C. Right Hypochondriac D. Hypogastric ```

C. Right Hypochondriac

``` How long do you need to continuously auscultate the abdomen to establish absent bowel sound? A. 50 seconds B. 5 minutes C. 10 minutes D. 15 minutes ```

B. 5 minutes

``` Which of the following describes percussion over air filled viscera? A. Tympanic B. Hyperresonance C. Resonance D. Dullness ```

A. Tympanic

``` A 55 year old female patient presents with one year history of hoarseness of voice. She also had malaise and vague periarticular pain/stiffness over the same period. Radiographic findings show juxta-articular osteoporosis, marginal erosions and uniform loss of joint space. What is the diagnosis? A. Carcinoma of the larynx B. Systemic Lupus Erythematosus C. Rheumatoid arthritis D. Parkinson’s disease ```

C. Rheumatoid arthritis

``` A 60 year old male patient presents with fever, shaking chills, cough with purulent sputum. Percussion was dull over the right middle lobe. The CBC showed leukocytosis. Give the diagnosis. A. Urinary tract infection B. Bronchopneumonia C. Asthma D. Lobar pneumonia ```

D. Lobar pneumonia

``` “Precordial chest discomfort described as a sensation of tightness which is usually precipitated by stress or exertion and relieved rapidly by rest” suggests? A. Asthma B. Anaphylaxis C. Angina Pectoris D. Tietze’s disease ```

C. Angina Pectoris

``` A 45 year old Egyptian female patient presents with low back pain and fatigue. CBC showed microcytosis and hypochromia. The patient did not respond to iron supplement. What is the most likely diagnosis? A. Sickle cell anemia B. Beta thalasemia C. Alpha thalasemia D. Megaloblastic anemia ```

B. Beta thalasemia

``` A 30 year old female patient complained of cramping pain in the right lower quadrant of the abdomen. She had low grade fever, malaise, weight loss, loss of energy, intermittent non-bloody diarrhea and joint pain. Examination revealed a palpable tender mass in the right lower quadrant. Laboratory tests showed raised ESR and C-Reactive protein, with marcrocytosis and normochromia. Give the diagnosis. A. Irritable bowel syndrome B. Crohn’s disease C. Ulcerative colitis D. Celiac disease ```

B. Crohn’s disease

An autoimmune disease whose pathogenesis is destruction of the acetylcholine receptors in the post synaptic membrane would usually presents with which of the following? A. Unilateral partial ptosis with miosis B. Unilateral partial ptosis with mydriasis C. Bilateral partial ptosis D. None of the above

C. Bilateral partial ptosis

``` A 40 year old male patient gives a history of sudden severe left flank pain that woke him from sleep. The pain initially radiated to the abdomen. He was restless, nauseous and vomited a couple of times. The pain later radiated to the left testis. What is the likely diagnosis? A. Urinary stone B. Prostatic cancer C. Cystitis D. Acute Epididymitis ```

A. Urinary stone

``` A 50 year old male patient presents in your office with complaints of altered bowel function, general fatique and weight loss. With this history it is most important to rule out which of the following? A. Irritable bowel syndrome B. Carcinoma of the colon or rectum C. Hemorrhoids D. Viral hepatitis ```

B. Carcinoma of the colon or rectum

``` Epigastric distress 45 to 60 minutes after a meal, relieved by antacids, food or vomiting and worsens as the day progreses indicates which of the following? A. Gastritis B. Irritable bowel syndrome C. Duodenal ulcer D. Appendicitis ```

C. Duodenal ulcer

``` Chronology and timing of symptoms, may provide a clue to the origin and severity of the condition. Which of the following conditions presents with the highest severity of pain for that condition, immediately at the initial onset of pain? A. Aortic dissection B. Pulmonary embolism C. Myocardial infarction D. Pneumothorax ```

A. Aortic dissection

``` Your patient presents with a painful pinna, enlarged lymph nodes, and tells you he swims three days a week for exercise. The most likely diagnosis is? A. Otitis externa B. Acute otitis media C. Serous otitis media D. Upper respiratory infection ```

A. Otitis externa

``` Your patient experiences chest tightness and mild shortness of breath while exercising. His chest discomfort relieves with about 5 minutes of rest. What is the most likely cause of his chest tightness and shortness of breath? A. Unstable angina B. Stable angina C. Myocardial infarction D. Dissecting aortic aneurysm ```

B. Stable angina

``` Your patient is manifesting Rovsing's sign. Which body system is most likely impaired? A. Gastrointestinal B. Neurological C. Endocrine D. Cardiovascular ```

A. Gastrointestinal

Upon examination, your patient's right ear is occluded by a wall of earwax. What is the expected findings from the Rinne and Weber tests? A. Rinne AC > BC, Weber lateralizes to the right B. Rinne AC < BC, Weber lateralizes to the right C. Rinne AC > BC, Weber lateralizes to the left D. Rinne AC < BC, Weber lateralizes to the left

B. Rinne AC < BC, Weber lateralizes to the right