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1. Question: A 6-year-old female presents to the clinic with sore throat. The point of care test for Group A Streptococcal infection is positive. Which of the following indicates the expected lymphadenopathy presentation in this case?
2. Question: Which of the following changes are expected in vision as part of the normal aging process?
3. Question: Identify the anatomical structure in this image between both of the examiner’s hands and fingertips.
4. Question: A 19-year-old African-American female presents to the clinic with moderate to severe right lower quadrant abdominal pain for the last 2 days. She has been experiencing nausea and vomiting but unsure if she has had Which of the following is a possible differential diagnosis?
5. Question: A 15-day old infant girl is brought to the outpatient clinic by her mother on a Monday morning. The mother is concerned about a rash that seems to have appeared suddenly after she and her infant daughter spent the previous weekend in Florida visiting family. The time of year is August and the house did not have air conditioning. The infant is a febrile, eating and drinking well, and does not appear to be in distress. You note scattered vesicles on an erythematous base involving the infant’s face and trunk. Based on the history and physical examination findings, what is the likely diagnosis?
6. Question: A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type 2 diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy appearing woman. Her blood pressure is 130/80 and her pulse is 70. Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. What vaginitis does this patient most likely have?
7. Question: A 32-year-old female presents with a complaint of a singular breast mass. The nurse practitioner collects a thorough history and physical examination of the client’s breast and related systems. Based on the characteristics of a soft, round, mobile, and tender mass, as well at the client’s age, select the most likely cause of the breast mass.
8. Question: A 16-year-old female presents with the complaint of acne as represented in this image. When documenting the assessment findings, what is the morphology of the predominant skin lesions?
9. Question: You are observing an infant born at 42-weeks gestation who is able to pull to a stand, uses “mama” and “dada” specifically, and indicates his wants by vocalization and pointing. Where would you place this child’s developmental age?
10. Question: Which of the following vaccinations are safe during pregnancy?
11. Question: A 50- year-old Caucasian male presents to the clinic with left leg pain that increases with rest and a feeling of warmth in the calf area. During your physical examination, you note erythema and increased warm involving the left posterior lower leg as well as a palpable cord. What diagnosis do you suspect?
12. Question: Upon physical examination of an 11-month-old infant, you note the skin findings represented in this image. What is your initial assessment?
13. Question: Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?
14. Question: A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?
15. Question: You note a painful ulcerative lesion near the medial malleolus, with accompanying hyperpigmentation. Which of the following etiologies is most likely?
16. Question: Which is the proper sequence of examination for the abdomen?
17. Question: An elderly woman with dementia is brought in by her daughter for a “rectal mass.” On examination you notice a moist pink mass protruding from the anus, which is non- tender. It is soft and does not have any associated bleeding. Which of the following is most likely?
18. Question: Which of the following is true of the human papilloma virus (HPV) vaccine?
19. Question: Susanne is a 27-year-old who has had headaches, muscle aches, and fatigue for the last 2 months. You have completed a thorough history, examination, and laboratory workup but have not found a cause. What would be your appropriate next action?
20. Question: A 24-year-old graduate student presents to the clinic with a chief complaint of abdominal pain, nausea, and diarrhea that has been occurring intermittently over the last 2 months. The patient states that symptoms often occur before taking course examinations and writing term papers. After performing a health history interview, physical examination, and reviewing lab and diagnostic test results, you determine that this patient has a diagnosis of irritable bowel syndrome (IBS). A mental health assessment would classify IBS as which of the following?
21. Question: Otoscopic examination of the patient’s ear reveals the findings represented in this image. What are your assessment findings of the TM and external auditory canal?
22. Question: Which of the following is worrisome in Melissa, a woman in her 26th week of pregnancy?
23. Question: A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition?
24. Question: A pregnant woman is concerned by the recent onset of mid-line abdominal swelling. It is soft and non-tender. What does this represent?
25. Question: A 60-year-old African-American male presents to the office with nail changes. He denies pain or history of injury, trauma, or chronic, systemic, inflammatory disease. What is the most likely etiology for the nail changes in this image?
26. Question: Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is the most likely cause for his problem?
27. Question: Dawn is a 55-year-old woman who comes in today for her yearly wellness examination. You carefully perform the rectal examination in the lithotomy position and feel an irregular mass against the bowel wall which is firm and immobile. Which of the following is most likely?
28. Question: A 29-year-old woman comes to your office. As you take the history, you notice that she is speaking very quickly, and jumping from topic to topic so rapidly that you have trouble following You are able to find some connections between ideas, but it is difficult. How would you document this thought process in your notes?
29. Question: Which of the following booster immunizations is recommended in the older adult population?
30. Question: A 26-year-old sports store manager comes to your clinic, complaining of severe right sided abdominal pain for 12 hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was last night and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination he appears ill and is lying on his right side. His temperature is 100.4 and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant. His rectal, inguinal, prostate, penile, and testicular examinations are normal. What is the most likely cause of his pain?
31. Question: A 32-year-old white female comes to your clinic, complaining of overwhelming sadness. She says for the past 2 months she has had crying episodes, difficulty sleeping and problems with overeating. She says she used to go out with her friends from work but now she just wants to go home and be by herself. She also thinks that her work productivity has been dropping because she just is too tired to care or concentrate. She denies any feelings of guilt or any suicidal ideation. She states that she has never felt this way in the past. She denies any recent illness or injuries. Her past medical history consists of an appendectomy when she was a teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her father has had a history of mental illness. On examination you see a woman appearing her stated age who seems quite sad. Her facial expression does not change while you talk to her and she makes little eye contact. She speaks so softly you cannot always understand her. Her thought processes and content seem unremarkable
32. Question: Which of the following represents age-related changes in the lungs?
33. Question: Delayed puberty is suspected in boys who have no signs of pubertal development by what age?
34. Question: In obtaining a history, you note that a patient uses the word “largely” repeatedly, to the point of being a distraction to your task. Which word best describes this speech pattern?
35. Question: A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?
36. Question: You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?
37. Question: A 33-year-old construction worker comes for evaluation and treatment of acute onset of low back pain. He notes that the pain is an aching located in the lumbosacral area. It has been present intermittently for several years; there is no known trauma or He points to the left lower back. The pain does not radiate and there is no numbness or tingling in the legs or incontinence. He was moving furniture for a friend over the weekend. On physical examination, you note muscle spasm, with normal deep tendon reflexes and muscle strength. What is the most likely cause of this patient’s low back pain?
38. Question: A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable. Which risk factor of her personal and family history most puts her in danger of getting breast cancer?
39. Question: What assessment is being performed in this image?
40. Question: You note the findings in this image while performing your physical examination of an 84- year-old pleasant, active, and cooperative male resident in a nursing home. What is your assessment?
41. Question: Which of the following lymph node groups is most commonly involved in breast cancer?
42. Question: Wright comes to your office, complaining of palpitations. While checking her pulse you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different. It sounds like a triplet rather than the usual “lub dup.” How would you document your examination finding?
43. Question: You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or non-inflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?
44. Question: Jackson is a 50-year-old African-American who has had discomfort between his scrotum and anus. He also has had some fevers and dysuria. The rectal examination is halted by tenderness anteriorly, but no frank mass is palpable. What is your most likely diagnosis?
45. Question: A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle collision 1 day ago and was assessed by the emergency medical technicians on site, but she didn’t think that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is the most likely cause of this neck pain?
46. Question: When collecting the health history, what non-modifiable risk factor in developing breast cancer is considered to be the most important?
47. Question: A 50-year-old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system His past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than six beers a week, and denies using any illegal drugs. His mother has high blood pressure and arthritis and his father died of lung cancer in his 60s. On examination, his blood pressure is 130/80 and his pulse is 80. His cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but on his digital rectal examination you palpate a soft, smooth, non- tender pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?
48. Question: Which of the following represents metrorrhagia?
49. Question: Which is true of a third heart sound (S3)?
50. Question: Geller is somewhat quiet today. She has several bruises of different colors on the ulnar aspects of her forearms and on her abdomen. She otherwise has no complaints and her diabetes and hypertension are well managed. Her son from out of state accompanies her today and has recently moved in to help her. What should you suspect?
51. Question: A 26-year-old stewardess comes in for a third trimester prenatal visit. She has had prenatal care since her sixth week of She has no complaints today and her prenatal course has been unremarkable. Today her blood pressure and weight gain are appropriate and her urine is unremarkable. You measure the patient’s uterus in centimeters by placing one end of the tape over the uterine fundus. From what inferior anatomic position should the beginning of the tape be placed?
52. Question: A 22-year-old unemployed roofer presents to your clinic, complaining of pain in his testicle and penis. He states the pain began last night and has steadily become worse. He states it hurts when he urinates and he has not attempted intercourse since the pain began. He has tried Tylenol and ibuprofen without improvement. He denies any fever or night sweats. His past medical history is unremarkable. He has had four previous sexual partners and has had a new partner for the last month. She is on oral contraceptives so he has not used condoms. His parents are both in good health. On examination you see a young man lying on his side. He appears mildly ill. His temperature is 100.2 and his blood pressure, respirations, and pulse are normal. On visualization of the penis he is circumcised, with no lesions or discharge from the meatus. Visualization of the scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria. What diagnosis of the male genitalia is most likely in this case?
53. Question: Where is the point of maximal impulse (PMI) normally located?
54. Question: Identify the macula on this image representing the structures of the left fundus.
55. Question: Lucille is in her 24th week. You notice a new onset of high blood pressure readings. Today’s value is 168/96. Her urine is normal. What do you suspect?
56. Question: Which of the following is true regarding breast self-examination?
57. Question: A woman has a positive pregnancy test and comes to you with abdominal pain. On physical examination, you palpate a large, fixed, and ill-defined adnexal mass. Which of the following should you suspect?
58. Question: A 20-year-old part-time college student comes to your clinic, complaining of growths on his penile shaft. They have been there for about 6 weeks and haven’t gone In fact, he thinks there may be more now. He denies any pain with intercourse orurination. He has had three former partners and has been with his current girlfriend for 6 months. He says that because she is on the pill they don’t use condoms. He denies any fever, weight loss, or night sweats. His past medical history is unremarkable. In addition to college, he works part-time for his father in construction. He is engaged to be married and has no children. His father is healthy and his mother has hypothyroidism. On examination the young man appears healthy. His vital signs are unremarkable. On visualization of his penis you see several moist papules along all sides of his penile shaft and even two on the corona. He has been circumcised. On palpation of his inguinal region there is no inguinal lymphadenopathy. Which abnormality of the penis does this patient most likely have?
59. Question: Which of the following positive physical examination finding supports peritonitis
60. Question: You are assessing Tanner staging of the breast in a young woman. You notice projection of the areola and nipple to form a secondary mound above the level of the breast. Which Tanner stage would this be?
61. Question: Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely?
62. Question: A mother brings her 15-month-old daughter to your office for evaluation of a rash and She says the rash started one day and the fever developed the next day. Her daughter has had all of her vaccinations up to 10 months. The mother sheepishly admits that she hasn’t had time to bring her daughter in since her 10-month check-up. On examination you see a mildly sick-appearing toddler with a 102-degree temperature. Looking at her skin you see at least 100 of a variety of papules, vesicles on an erythematous base, and ulcers in different stages of development. What illness prevented by proper vaccination does this toddler have?
63. Question: A 56-year-old man presents with itching, anorectal pain, and tenesmus of 1 week’s duration. Rectal examination reveals generalized tenderness without frank prostate abnormalities. Which of the following is most likely?
64. Question: In a patient with chronic venous insufficiency, the findings of edema, swelling , and ulceration:
65. Question: “A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells). What type of vaginitis best describes her findings?”
66. Question: Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). As you are conducting your physical examination, you note a raised, dark erythematous rash on the mid cheeks of her face. When you press on the rash, it doesn’t blanch. What would you tell her regarding her rash?
67. Question: You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between the jugular venous pulsation and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse?
68. Question: A 30-year-old Hispanic male presents to the clinic with complaint of a painless, rubbery, bump on his right lower eyelid which appeared several days ago approximately the size of a small bead. He reports that the bump became much larger although he denies manipulating the lesion. He denies changes in his vision, fever, chills, or feeling otherwise ill. What is your assessment?
69. Question: A 68-year-old mechanic presents to the emergency room for shortness of breath. You are concerned about a cardiac cause and measure his jugular venous pressure (JVP). It is elevated. Which one of the following conditions is NOT a potential cause of elevated JVP?
70. Question: LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?
71. Question: A 60-year-old coach comes to your clinic, complaining of difficulty starting to urinate for the last several months. He believes the problem is steadily getting worse. When asked he says he has a very weak stream and it feels like it takes 10 minutes to empty his bladder. He also has the urge to go to the bathroom more often than he used to. He denies any blood or sediment in his urine and any pain with urination. He has had no fever, weight gain, weight loss, or night sweats. His medical history includes type diabetes and high blood pressure treated with medications. He does not smoke but drinks a six pack of beer He has been married for 35 years. His mother died of a myocardial infarction in her 70s and his father is currently in his 80s with high blood pressure and arthritis. On examination you see a mildly obese male who is alert and cooperative. His blood pressure is 130/70 with a heart rate of 80. He is afebrile and his cardiac, lung, and abdominal examinations are normal. On visualization of the anus you see no inflammation, masses, or fissures. Digital rectal examination reveals a smooth, enlarged prostate. No discrete masses are felt. There is no blood on the glove or on guaiac testing. An analysis of the urine shows no red blood cells, white blood cells, or bacteria. What disorder of the anus, rectum, or prostate is this most likely to be?
72. Question: You are examining a newborn and note that the right testicle is not in the scrotum. What should you do next?