Time limit: 0
Quiz Summary
0 of 40 Questions completed
Questions:
Information
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
Results
Quiz complete. Results are being recorded.
Results
0 of 40 Questions answered correctly
Your time:
Time has elapsed
You have reached 0 of 0 point(s), (0)
Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)
Categories
- Not categorized 0%
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
- 39
- 40
- Current
- Review
- Answered
- Correct
- Incorrect
-
Question 1 of 40
1. Question
A 55-year-old man comes to the office due to chronic pain in his buttock, hip, and thigh muscles. The aching pain is present in both legs and is usually associated with walking. He has multiple medical conditions and takes several medications. He has a 30-pack-year smoking history. Temperature is 36.7 C (98.1 F), blood pressure is 150/88 mm Hg, pulse is 80/min, and respirations are 16/min. Examination shows decreased femoral, popliteal, and dorsalis pedis pulses in both legs. Which of the following additional findings is most likely in this patient?
CorrectIncorrect -
Question 2 of 40
2. Question
A 27-year-old woman comes to the office due to a 3-month history of irritability and decreased concentration. During that time, she has lost 2.3 kg (5 lb) despite no changes in diet or exercise. Examination shows enlargement of the right side of the thyroid gland. The remainder of the examination, including ocular examination, is normal. Serum TSH is 0.1 µU/mL. Ultrasonogram of the thyroid reveals a well-circumscribed, 1.5 cm × 1.5 cm hyperechoic nodule at the lower pole of the right lobe of the thyroid. Scintigraphy with a radioiodine tracer is performed. Which of the following is the most likely pattern of tracer uptake in this patient?
CorrectIncorrect -
Question 3 of 40
3. Question
A 69-year-old man is evaluated for abdominal pain. Upper gastrointestinal endoscopy shows a single shallow, 1-cm ulcer in the duodenal bulb and mild gastric erythema. Biopsy specimens from the gastric antrum do not show Helicobacter pylori, and stool testing for H pylori antigen is negative. Which of the following parts of this patient’s history is most likely to reveal the cause of his current condition?
CorrectIncorrect -
Question 4 of 40
4. Question
A newborn girl is being evaluated for cyanosis. She was born at 23 weeks gestation via spontaneous vaginal delivery to a 37-year-old primigravida. The patient’s weight at delivery was 1.05 kg (2 lb 5 oz). Shortly after birth, she developed cyanosis that is most pronounced in the lower extremities. Supplemental oxygen at an FiO2 of 70% was administered. Pulse oximetry shows 85% in the hands and 70% in the feet. Examination is significant for generalized and mucosal cyanosis, tachypnea, intercostal retractions, and nasal flaring. Which of the following is most likely present in this patient?
CorrectIncorrect -
Question 5 of 40
5. Question
A 32-year-old woman comes to the clinic due to 6 weeks of bloating and diarrhea. She has multiple watery bowel movements a day without visible blood. The patient underwent Roux-en-Y gastric bypass surgery for morbid obesity 3 years ago and has no other medical conditions. Vital signs are within normal limits. Physical examination is unremarkable. A jejunal aspirate shows a bacterial count of >105/mL, consistent with small intestinal bacterial overgrowth. Which of the following serum levels is most likely to be increased in this patient?
CorrectIncorrect -
Question 6 of 40
6. Question
A 45-year-old man comes to the emergency department after an episode of syncope. Medical history is unremarkable except for an upper respiratory infection 1 week ago. Temperature is 37.2 C (99 F), blood pressure is 100/60 mm Hg, pulse is 90/min, and respirations are 13/min. The neck veins are distended, and heart sounds are distant. The lungs are clear to auscultation bilaterally. Chest x-ray reveals small bilateral pleural effusions and an enlarged cardiac silhouette. Which of the following ECG findings, if present, would best support the most likely diagnosis?
CorrectIncorrect -
Question 7 of 40
7. Question
A 22-year-old man comes to the office due to hair loss on the posterior scalp over the past 6 weeks. The affected area is free from pain or pruritus. Medical history includes celiac disease, for which the patient eats a gluten-free diet. Examination findings of the posterior scalp are shown in the exhibit. There is no hair loss elsewhere, and the remainder of the examination is normal. Which of the following best describes the mechanism of hair loss in this patient?
CorrectIncorrect -
Question 8 of 40
8. Question
A study assessed the association between pregnancy and risk for cerebral infarction and intracerebral hemorrhage. The medical records from several hospitals were used to identify women age 15-44. Individual patient records were evaluated by 2 neurologists, and the determination was made on whether the women had been pregnant at the time of a stroke or up to 6 weeks before it occurred. For study purposes, the 6-week period after pregnancy could begin with an induced or spontaneous abortion or with the delivery of a live or stillborn child. An excerpt of the study results is shown in the table below.
Age- and race-adjusted RR of stroke according to a woman’s pregnancy status
Risk period*
Cerebral infarction
RR (95% CI)Intracerebral hemorrhage
RR (95% CI)Either type of stroke
RR (95% CI)During pregnancy 0.7 (0.3-1.6)
2.5 (0.9-6.4)
1.1 (0.6-2.0)
During 6 weeks after pregnancy
5.4 (2.9-10.0)
18.2 (8.7-38.1)
7.9 (5.0-12.7)
After delivery 8.7 (4.6-16.7)
28.3 (13.0-61.4)
12.7 (7.8-20.7)
After abortion 1.1 (0.2-7.9)
4.5 (0.6-33.1)
1.8 (0.4-7.2)
*The 6-week period after pregnancy was defined as the 6 weeks after a spontaneous or induced abortion, stillbirth, or live birth. CI = confidence interval; RR = relative risk.
Which of the following is the most appropriate conclusion regarding these data?
CorrectIncorrect -
Question 9 of 40
9. Question
A 63-year-old woman with a prolonged history of hypertension is brought to the emergency department after a syncopal episode. The patient was at church when she experienced sudden-onset, severe chest pain radiating to her back and collapsed to the floor. She regained consciousness spontaneously but has had persistent chest pain. On arrival at the emergency department, the patient is confused and agitated. Blood pressure is 85/60 mm Hg and pulse is 110/min. The jugular veins are distended. The lungs are clear on auscultation. An intraarterial catheter in the radial artery shows significant variation in systolic blood pressure related to the respiratory cycle. Chest x-ray reveals widening of the mediastinum. Which of the following is the most likely cause of this patient’s syncope?
CorrectIncorrect -
Question 10 of 40
10. Question
The following vignette applies to the next 2 items. The items in the set must be answered in sequential order. Once you click Proceed to Next Item, you will not be able to add or change an answer.
A 62-year-old man is being evaluated for frequent thirst and large daily urine volume. He has no other medical problems. The patient has smoked a pack of cigarettes daily for 30 years and drinks alcohol occasionally. A water deprivation test is performed. At the beginning of the test, his serum osmolality is 290 mosmol/kg and his urine osmolality is 170 mosmol/kg. After 4 hours of water deprivation, his serum osmolality is 310 mosmol/kg and urine osmolality is 180 mosmol/kg. At that time, his serum vasopressin level is 3 times higher than baseline.
Item 1 of 2
This patient’s test results are most suggestive of which of the following?
CorrectIncorrect -
Question 11 of 40
11. Question
Item 2 of 2
The patient is diagnosed with nephrogenic diabetes insipidus. Further evaluation in this patient shows a lung nodule in the right upper lobe. Which of the following is the most likely underlying cause of this patient’s water deprivation test results?
CorrectIncorrect -
Question 12 of 40
12. Question
A 64-year-old man comes to the emergency department due to numbness of the left side of his body for the past 3 hours. The patient also states that he has to actively focus to see objects in his left visual field. Medical history is significant for prolonged hypertension and heavy tobacco and alcohol use. Blood pressure is 150/90 mm Hg and pulse is 102/min and irregular. Physical examination shows normal pupils and extraocular movements. Visual field testing shows left homonymous hemianopia with macular sparing. There is impairment of light touch, pain, and temperature sensation on the left-side of the face and left upper and lower extremities. Muscle strength and deep tendon reflexes are normal bilaterally. Cognition, speech, and gait are normal. Occlusion of which of the following arteries is the most likely cause of this patient’s current symptoms?
CorrectIncorrect -
Question 13 of 40
13. Question
Researchers studying advanced breast cancer notice that patients who are treated with cytotoxic combination chemotherapy have higher cure rates but also experience prolonged severe neutropenia with increased risk of infections. These patients often require treatment with granulocyte-colony stimulating factor (G-CSF) to improve neutrophil counts. A clinical trial is conducted to determine if administering prophylactic G-CSF would prevent prolonged neutropenia in patients undergoing cytotoxic chemotherapy. The researchers find that the duration of neutropenia is longer in patients who receive G-CSF concurrently with the chemotherapy drugs compared with patients who receive G-CSF 3 days after chemotherapy treatment. Which of the following is the most likely explanation for the longer duration of neutropenia when G-CSF is administered concurrently with chemotherapy?
CorrectIncorrect -
Question 14 of 40
14. Question
A 42-year-old man comes to the emergency department due to right shoulder and back pain for a month. He does not remember injuring himself but works as a delivery man lifting heavy boxes. He also reports a constant, nonproductive cough, but no fever, night sweats, or weight loss. Right shoulder x-ray results are unremarkable except for a suggested mediastinal mass. Follow-up CT scan of the chest demonstrates a posterior mediastinal mass. Biopsy from this patient’s mass would most likely reveal which of the following?
CorrectIncorrect -
Question 15 of 40
15. Question
A newborn is being evaluated in the nursery for cyanosis. The patient was born at 38 weeks gestation to a mother who had limited prenatal care. Oxygen saturation is decreased and does not improve with supplemental oxygen. Echocardiogram reveals a single common arterial trunk arising from the ventricles. A defect in which of the following events during embryonic development most likely resulted in these findings?
CorrectIncorrect -
Question 16 of 40
16. Question
An 8-year-old boy returns to the emergency department due to a pruritic rash that began 30 minutes ago. Earlier in the day, he was diagnosed with acute tonsillopharyngitis and oral amoxicillin was prescribed. The patient has no known drug allergies and had received penicillin on one previous occasion. Vital signs are within normal limits. Physical examination shows urticaria on the extremities and torso. There is faint bilateral wheezing. Which of the following factors was most essential for the current adverse reaction to occur in this patient?
CorrectIncorrect -
Question 17 of 40
17. Question
A 32-year-old woman comes to the office due to lower back pain after lifting heavy furniture a week ago. She recently moved to the area with her boyfriend, who is starting a new job. Physical examination shows mild paraspinal muscle tenderness. There is no radiation of pain on either side during the straight-leg raise test, and no neurologic deficits are noted in the lower extremities. However, multiple bruises in various stages of healing are noted on her abdomen and back. When the patient is asked about the bruising, she says, “It’s nothing. I’m just really clumsy and bump into things.” The patient provides brief responses and avoids eye contact throughout the evaluation. Which of the following is the most appropriate statement?
CorrectIncorrect -
Question 18 of 40
18. Question
A 34-year-old man is evaluated in the clinic due to easy bruising. The patient says that even minor trauma causes a bruise and that he sometimes has spontaneous bruising over his legs. He has also experienced generalized fatigue, poor appetite, and dull pain and stiffness in his lower back at night. The patient has a history of Crohn disease that required a partial bowel resection a year ago; he had no excessive bleeding during the perioperative period. Three months ago, he was treated with oral antibiotics for a perianal fistula. Physical examination shows an abdominal wall hematoma and several large ecchymoses on his lower extremities. There are no palpable purpura. Which of the following is the most likely underlying cause of this patient’s excessive bleeding?
CorrectIncorrect -
Question 19 of 40
19. Question
A 16-year-old boy is brought to the emergency department due to right knee pain. His symptoms started after a skiing accident in which he caught the inside edge of his ski and fell. The patient has no medical conditions and takes no medications. On examination, swelling and tenderness are present over the medial aspect of the right knee. Opening of the medial joint line can be felt when a gentle force is applied to the lateral knee with the lower leg kept stationary. Which of the following labeled structures is most likely injured in this patient?
CorrectIncorrect -
Question 20 of 40
20. Question
A research publication claims that a new diagnostic test for testicular cancer is 85% sensitive and 95% specific. Based on this information, which of the following would be the expected number of false negatives (FN) and false positives (FP) in a sample of 200 adult men, of whom 20 truly have testicular cancer?
CorrectIncorrect -
Question 21 of 40
21. Question
A 55-year-old man is evaluated for progressive fatigue, weakness, and unintentional weight loss. He has no other medical issues and takes no medications. Physical examination shows mucosal pallor. Stool testing for occult blood is positive, and a subsequent colonoscopy reveals a solitary mass in the ascending colon. Biopsy is consistent with colon adenocarcinoma, and surgical resection is planned. Which of the following features would carry the worst prognosis in this patient?
CorrectIncorrect -
Question 22 of 40
22. Question
An 18-month-old boy is brought to the rural health clinic by his mother to establish care. The patient got some routine childhood vaccinations from previous providers but has not had a pneumococcal vaccination. Vital signs are normal for age. A pneumococcal conjugate vaccine is ordered, but the clinic manager advises the physician that the vaccine is not available due to delays in shipment from the supplier; however, the pneumococcal polysaccharide vaccine is available. Which of the following statements is true regarding the difference between these vaccine types?
CorrectIncorrect -
Question 23 of 40
23. Question
A 3-year-old boy is brought to the clinic due to cough. His parents report that he had a low-grade fever last night, and this morning he woke up with a temperature of 39 C (102.2 F), itchy rash all over his body, and cough. Two weeks ago, the patient was playing with his cousin who also developed an itchy rash that lasted about a week. He has a history of liver transplantation and is taking immunosuppressive medications. Temperature is 38.4 C (101.1 F), pulse is 120/min, blood pressure is 95/60 mm Hg, and respirations are 35/min. Oxygen saturation is 95% on room air. On examination, conjunctivae are clear, mucous membranes are moist, and tympanic membranes are gray. Heart sounds are normal. Lungs have coarse crackles bilaterally. Abdomen is soft and nontender. Diffuse papules and vesicles containing clear fluid are present. Chest x-ray shows bilateral infiltrates. Which of the following is the most likely etiology of this patient’s symptoms?
CorrectIncorrect -
Question 24 of 40
24. Question
A 33-year-old woman, gravida 2 para 1, comes to the office for a prenatal visit at 20 weeks gestation. She feels well and reports experiencing fetal movements. The patient and her husband have no medical conditions, but their first child, a 3-year-old boy, was born with spina bifida. Physical examination is unremarkable, and uterine size is in accordance with dates established using ultrasonography. The patient is worried that the fetus may develop the same birth defect as her first child. The inheritance pattern of her child’s birth defect is most similar to which of the following conditions?
CorrectIncorrect -
Question 25 of 40
25. Question
A 62-year-old man is evaluated for worsening cough, shortness of breath, and episodic hemoptysis over the past 6 months. The patient has also had a 15-kg (33-lb) weight loss over the same period without any change in his diet or activity level. He has a 50-pack-year smoking history and does not use alcohol or illicit drugs. BMI is 18 kg/m2. The patient appears cachectic with temporal wasting and generalized loss of muscle mass. Chest x-ray reveals a large lung mass with mediastinal lymphadenopathy and pleural effusion. Which of the following cellular processes is most likely responsible for this patient’s muscle loss?
CorrectIncorrect -
Question 26 of 40
26. Question
A 30-year-old woman comes to the office for a health maintenance evaluation. The patient is in good health and reports no symptoms. Her only medication is an oral contraceptive pill. She has been reading about long-term birth control options and would like to undergo a tubal ligation because she is tired of taking medication daily and sometimes forgets. The patient has had no adverse effects from oral contraceptives. She shares that she does not want to have children. The patient has been married for 10 years and describes the relationship as very stable. Which of the following is the most appropriate response to the patient’s request for tubal ligation?
CorrectIncorrect -
Question 27 of 40
27. Question
The following vignette applies to the next 2 items. The items in the set must be answered in sequential order. Once you click Proceed to Next Item, you will not be able to add or change an answer.
A blood sample is taken from a 10-year-old patient with right upper-quadrant pain and jaundice. The blood is tested for hemolysis in buffered salt solutions at varying salt concentrations, and the results are plotted on the graph below.
Item 1 of 2
Which of the following findings would most likely be seen on this patient’s peripherial blood smear?
CorrectIncorrect -
Question 28 of 40
28. Question
Item 2 of 2
This patient’s physical examination reveals splenomegaly. Which of the following complications can most likely be prevented by performing a splenectomy in this patient?
CorrectIncorrect -
Question 29 of 40
29. Question
A 44-year-old man comes to the clinic due to increasing fatigue, trouble sleeping, and palpitations. He has lost 9 kg (20 lb) over the last year despite eating well. The patient says he is under a lot of pressure at work but cannot think of any other precipitating factors for his insomnia. He has no other medical problems and takes no medications. The patient does not use tobacco, alcohol, or recreational drugs. His mother has a history of a thyroid problem. Blood pressure is 140/80 mm Hg and pulse is 108/min. On physical examination, the thyroid is diffusely enlarged. His serum free thyroxine level is elevated and TSH level is decreased. He is found to have a positive assay for thyrotropin receptor antibodies. Compared to other forms of thyroid disease, which of the following findings would be most specific for this patient’s underlying pathophysiologic process?
CorrectIncorrect -
Question 30 of 40
30. Question
A 29-year-old man comes to the office due to increased sweating, heat intolerance, insomnia, and unintentional weight loss over the past 4 weeks. The patient has also noticed that his right testis feels bigger than the left but has had no scrotal pain. He has no prior medical problems and takes no medications. The patient does not use tobacco, alcohol, or illicit drugs. Blood pressure is 121/71 mm Hg and pulse is 108/min. On examination, the thyroid is mildly enlarged. Testicular examination reveals an enlarged, nontender right testicle. Laboratory testing shows elevated serum thyroxine and triiodothyronine levels. Scrotal ultrasonography demonstrates a hypoechoic mass within the right testicle. Elevated levels of which of the following substances would most likely explain this patient’s symptoms?
CorrectIncorrect -
Question 31 of 40
31. Question
A 4-week-old, full-term boy is brought to the emergency department due to vomiting. His parents describe the emesis as undigested formula without blood or bile. The vomiting occurs after feeds and has increased in frequency and force over the past 3 days. He is afebrile. Blood pressure is normal, pulse is 182/min, and oxygen saturation of 98% on room air. Examination shows a sunken anterior fontanelle and dry mucous membranes. Cardiac examination reveals tachycardia but no murmurs or gallops. The abdomen is soft, nontender, and nondistended. Arterial blood gas analysis is most likely to reveal which of the following sets of values?
CorrectIncorrect -
Question 32 of 40
32. Question
A 6-year-old boy is brought to the office due to fatigue and abdominal distension. The parents state that the patient bruises easily and appears pale. Physical examination shows subconjunctival pallor and several ecchymoses on the boy’s extremities. His abdomen is distended with nontender massive splenomegaly and moderate hepatomegaly. Laboratory studies reveal that his hemoglobin level is 8 g/dL, leukocyte count is 3,800 cells/mm3 with no immature forms, and platelet count is 90,000 cells/mm3. Bone marrow aspirate results are shown in the exhibit. Which of the following is the most likely diagnosis?
CorrectIncorrect -
Question 33 of 40
33. Question
A 45-year-old previously healthy man comes to the office due to worsening muscle pain and weakness over the past 6 months. Carrying heavy items such as groceries has become increasingly difficult, and any prolonged activity causes diffuse muscle cramps. He has also had a 4.5-kg (10-lb) weight gain over this time. The patient takes no medications and does not use tobacco, alcohol, or illicit drugs. Blood pressure is 140/90 mm Hg and pulse is 56/min. BMI is 26 kg/m2. Physical examination shows muscle weakness, predominantly of the shoulder and hip girdles. When the knee reflex is elicited, the quadriceps muscle contracts briskly but relaxation takes longer than normal. There are splitting and peeling of the nails. Serum creatine kinase is elevated. Which of the following tests is most likely to identify the cause of this patient’s muscle weakness?
CorrectIncorrect -
Question 34 of 40
34. Question
A 67-year-old man comes to the office due to increased fatigue and weight gain over the past 6 months. He has hypertension controlled with a calcium channel blocker. Two years ago, the patient’s physical examination was unremarkable, and his blood tests, including a lipid panel, were normal. Blood pressure is 135/98 mm Hg, and pulse is 62/min. BMI is 28 kg/m2. On physical examination, the thyroid appears to be mildly enlarged and is irregular and firm in consistency. Laboratory studies reveal elevated TSH, low free thyroxine (T4), high total and LDL cholesterol, and mildly elevated triglyceride levels. Which of the following is the most likely underlying mechanism for the elevated cholesterol in this patient?
CorrectIncorrect -
Question 35 of 40
35. Question
A 62-year-old man comes to the office due to pain while swallowing for the past 4 weeks. He has had no fever, upper respiratory illness, or cough but has noticed a lump on the left upper anterior neck. Medical history is significant for prolonged tobacco use. Physical examination shows a firm mass at the base of the tongue. CT scan confirms a 3-cm mass at the tongue base with a small central area of necrosis. Several anterior cervical lymph nodes are enlarged on the left side. Biopsy of the tongue lesion shows invasive squamous cell carcinoma. External beam radiation therapy is planned. Malignant cells in which of the following portions of the tumor mass would be most resistant to this treatment?
CorrectIncorrect -
Question 36 of 40
36. Question
A 30-year-old woman comes to the office due to depressed mood. The patient has felt “disappointed and sad” since she was passed over for promotion 3 weeks ago. She has trouble falling asleep because she thinks about what she could have done differently at work. The patient’s appetite, energy, and concentration are not affected, and she still enjoys going out with friends and attending choir group. She has no significant medical or psychiatric history. Vital signs and physical examination are within normal limits. A course of psychotherapy is recommended, to which she responds, “Have you ever had depression or been in therapy, doctor?” Which of the following is the best response to this patient?
CorrectIncorrect -
Question 37 of 40
37. Question
A 34-year-old man comes to the hospital due to difficulty swallowing, dry mouth, and blurred vision that began several hours ago. Examination shows mydriasis and poorly reactive pupils. Electrodiagnostic studies reveal normal nerve conduction velocity but decreased compound muscle action potential (CMAP). Rapid, repetitive nerve stimulation leads to facilitation of CMAP. Further review of this patient’s medical history would most likely reveal which of the following?
CorrectIncorrect -
Question 38 of 40
38. Question
A 32-year-old woman experiences double vision, heaviness in her eyelids, and weakness in her hands that worsens throughout the day. Chest imaging reveals an anterior mediastinal mass. Histologic analysis confirms the mass originates from an organ that is embryonically derived from a pharyngeal pouch. Which of the following structures most directly originates from that same pharyngeal pouch?
CorrectIncorrect -
Question 39 of 40
39. Question
A 55-year-old man comes to the office due to a 1.5-cm, red, scaly plaque on the forehead. The lesion has been present for 3 months. Histologic examination shows atypical keratinocytes with hyperchromatic, pleomorphic nuclei extending upward from the basal epidermal layer but not involving the full thickness of the epidermis. Scattered mitotic figures are present, and the epidermis is mildly thickened. Which of the following is the most likely diagnosis?
CorrectIncorrect -
Question 40 of 40
40. Question
A 23-year-old hiker loses a foothold and falls several feet during a mountain climb. He sustains no major injury but loses his backpack. He walks in the heat without water for the next 8 hours; by the time he reaches a shelter, he is extremely thirsty. Fluid from which of the following nephron segments is likely to be the most hypoosmotic in this individual?
CorrectIncorrect