A previously healthy 30-year-old woman presents to your office with a request to be screened for kidney disease. She says that she has a family history of kidney disease, but is unsure of the name or type of disease. Ultrasound findings show three small cysts on the right kidney and two on the left. Which of the following is the most important next step in treatment?

Which of the following is the most important treatable risk factor for prevention of stroke?

A 56-year-old man with a history of morbid obesity, hypertension, and diabetes mellitus presents with acute onset pain, swelling, and erythema of the left great toe that awoke him last night at midnight. His medications include hydrochlorothiazide and metformin. The physical examination reveals erythema and swelling of the first metatarsophalangeal joint, which is exquisitely tender to touch, and intact skin. Joint aspiration and analysis of the synovial fluid reveals elevated white blood cells and negatively birefringent crystals, with no bacteria on Gram stain. Which of the following is the most likely diagnosis?

A previously healthy 21-year-old woman presents to your clinic with a complaint of pelvic cramping. The cramping generally begins just before her menses, lasts for approximately three days and ends one to two days after her menses begins. Which of the following is the most appropriate therapy?

What condition is defined as the occurrence of repeated panic attacks that are associated with intense, debilitating fear of future panic attacks?

Which of the following patients should be offered a varicella-zoster vaccination?

A 34-year-old man presents to the emergency department with left arm pain after a fall on an outstretched hand while walking his dog. An X-ray is obtained as seen above. What eponym is associated with this fracture?

A 72-year-old woman presents with left knee pain for the past several months that has been worse over the last seven days. It is worse with walking and better with rest. She takes acetaminophen to alleviate the pain. She denies any injury or previous surgery on the knee. An X-ray is ordered and shows chondrocalcinosis, narrowed joint spaces, and subarticular reactive sclerosis. Bone spur formation is also noted. What is the most likely diagnosis?

A 32-year-old woman presents to the office after finding a mass in her left breast. After examining her, you believe the most likely diagnosis is a fibroadenoma. Which of the following physical exam findings would be most consistent with this diagnosis?

What delta pressure reading is most commonly used as the threshold for diagnosing compartment syndrome?

What does the “H” represent in HELLP syndrome?

A 64-year-old woman with a history of hypertension and coronary artery disease presents to the ED with acute onset of painless loss of vision in her left eye. Physical exam reveals visual acuity of 20/200 in the left and 20/25 in the right eye. Her funduscopic examination is seen above. Which of the following is the most likely diagnosis?

A 13-year-old boy presents to the office with pain in his legs with activity that has gradually become worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Examination of the heart reveals an ejection click and accentuation of the second heart sound. Femoral pulses are weak and delayed compared to the brachial pulses. Blood pressure obtained in both arms is elevated. Chest X-ray reveals rib notching. Which of the following is the most likely diagnosis?

A 32-year-old man presents after falling off a porch onto the driveway an hour ago. His family reports that he did not lose consciousness, but has become progressively more drowsy since the accident. He has vomited twice. His non-contrast head computed tomography scan is shown above. What is the most likely etiology of this condition?

A 22-year-old woman presents to the clinic with worsening right ear pain over the past two days. She states that she began to have drainage from the right ear canal today and became more concerned. Physical exam reveals a perforated, erythematous tympanic membrane and purulent otorrhea. She has no known drug allergies. Which of the following is the best pharmacologic treatment?

An 82-year-old man with a history of depression, hypertension, and diabetes is brought in by his home health nurse for altered mental status. She is concerned he attempted suicide as he was found confused in his bathroom surrounded by pill bottles. As you begin your assessment, the triage nurse brings you the electrocardiogram obtained in triage which shows a rate of 42 bpm in a regular rhythm. The QRS duration is 182 ms without any ST-segment changes. An overdose of which medication is most likely causing this patient’s presentation?

A 6-year-old girl presents to her pediatrician with skin bumps that started 3 days ago. On exam, the child appears well and has multiple dome-shaped, waxy, umbilicated papules on her face and arms. Which of the following is the most likely etiology of her condition?

A 32-year-old man presents to the emergency department with a persistent cough for the past four weeks and night sweats. A chest X-ray demonstrates mediastinal and left hilar lymphadenopathy, as well as left upper lobe consolidation. What is the most likely diagnosis?

A 15-year-old previously healthy boy presents with a complaint of his right eye being stuck shut in the morning, with discharge from the eye continuing throughout the day. On physical exam, the conjunctiva is erythematous with a copious purulent, green discharge. Which of the following is the most likely diagnosis?

In the United States, which of the following is the most common risk factor for hepatocellular carcinoma?

What is the treatment of choice for a 24-year-old man with acute epididymitis?

A patient was recently started on a statin for hyperlipidemia. Currently, the patient is complaining of muscle aches which he has not experienced previously. He also notes that his urine has been dark in color. Which of the following serum tests would best provide a reason for this patient's complaints?

What is the most common symptom associated with endometrial cancer?

A 20-year-old, otherwise healthy woman presents for follow up of a tuberculin skin test that was placed 48 hours ago. She is a Physician Assistant student and needed the test as a requirement before beginning her clinical rotations. She denies any cough or night sweats. The medical assistant performs the measurement and notes more than 15 mm of induration at the inoculation site. A chest X-ray is negative for any acute cardiopulmonary process. Which of the following is the best pharmacologic treatment option?

What reflex appears during infancy and persists indefinitely?

Chronic antipsychotic use is associated with the development of which syndrome?

Which of the following pancreatic cell types is responsible for the release of insulin?

A 4-year-old boy presents to the clinic with his very anxious mother. She reports that her son's penis does not look normal and he complained of pain when she tried to examine it at home. She denies history of abdominal pain or vomiting. Past medical history is unremarkable. On physical examination, the foreskin appears retracted and edematous and cannot be pulled back over the glans. What is this patient's most likely condition?

A 57-year-old woman is being evaluated on hospital rounds two days after a total thyroidectomy. She reports tingling of her extremities, muscle cramps, and perioral numbness that have progressed over the previous 18 hours. An ECG shows a moderately prolonged QT interval. Which of the following additional physical examination findings would be expected in this patient?

Renal cell carcinoma most commonly presents with which of the following symptoms or signs?

A 22-year-old man presents to the emergency department with pain in his left shoulder after an apparent fall. He indicates he was at work when he apparently fell down, but he does not recall the events. He looked up to find his co-workers around him when he was getting up. He had shoulder pain at the time hindering his ability to completely arise on his own. He assumes he slipped on the wet floor that he was cleaning. He denies any past medical history. Examination is remarkable only for tenderness over the left shoulder with a slight deformity. Radiographs show a posterior left shoulder dislocation. What is the most likely cause of this patient’s injury?

A 14-year-old girl present with a pruritic rash since yesterday. She began amoxicillin for acute pharyngitis three days ago. She still complains of sore throat, pain with swallowing, fatigue, and cervical lymphadenopathy. Physical exam reveals a diffuse, morbilliform rash. Which of the following is the most appropriate test to order?

Which of the following can cause reversible sensorineural hearing loss?

A 24-year-old pregnant woman presents to the office for her first prenatal visit. You are discussing nutrition and pregnancy. Which of the following statements is true regarding diet during pregnancy?

A child with a radial head subluxation will most likely present with the affected arm in which of the following positions?

A 16-year-old man presents to the clinic for a sports physical. He never experiences any chest pain or shortness of breath and exercises frequently. An ECG is performed and is shown above. What is the most likely diagnosis?

A 55-year-old man involved in a motor vehicle collision reports shortness of breath during morning rounds. He incurred a left open tibial fracture as a result of the collision and underwent intramedullary rod placement 48 hours ago. Physical examination reveals a diaphoretic patient in mild distress, rales in the right lower lobe, tachycardia without murmurs, and a swollen left lower extremity. His vital signs are remarkable for a pulse of 110 beats per minute and respiratory rate of 26 breaths per minute. His medical history is remarkable for a recent diagnosis of lung cancer. Which of the following is most likely to confirm the diagnosis?

What is the most common cause of adrenal insufficiency?

In suspected subarachnoid hemorrhage with a negative head CT, which of the following studies should be used to help establish the diagnosis?

What is the first-line treatment for primary hypothyroidism?

A 31 year-old-woman is admitted to the hospital in active labor. The last documentation in the chart indicated that she was a 2+ station. Which of the following best describes what is meant by this?

Samter’s triad is characterized by which three features?

What is the treatment of choice for central diabetes insipidus?

In what order, from earliest to latest, are the following findings seen on transvaginal ultrasound in pregnancy?

Which of the following signs and symptoms is associated with digoxin toxicity?

A 26-year-old woman presents with pain and swelling in her left eye following a blow to her face. When asked to perform extraocular movements, she is unable to look up with her left eye. What is the most appropriate medication used in the management of this diagnosis?

Which of the following enzymes is most specific for injury or death of the heart muscle?

Which of the following treatments is most appropriate for a stage I pressure ulcer?

Which of the following conditions is caused by reduced activity of the ADAMTS13 protease?

Which of the following is a risk factor for the development of aortic regurgitation?

A 24-year-old man presents with a generalized erythematous maculopapular rash, including on the palms and soles of the feet. He also has generalized lymphadenopathy and flat, moist lesions in the genital area. The patient admits to having had a lesion on his penis a month or so before, but it did not bother him. Which of the following is the most appropriate test to confirm the likely diagnosis?

A 47-year-old patient with Type 1 diabetes presents with altered mental status due to diabetic ketoacidosis. He is noted to have rapid deep breathing. Which of the following best describes this patient's breathing pattern?

A 60-year-old man with end stage renal disease has missed his last three hemodialysis sessions. He presents to the Emergency Department with fatigue and muscle cramps. He appears dyspneic. His vital signs are T 97.6 °F, HR 75 beats/minutes, RR 24 breaths/minute, BP 102/60 mm Hg, and oxygen saturation 95% on room air. His electrocardiogram is shown above. Which of the following therapies is most appropriate at this time?

A 5-year-old boy presents to the office with sneezing, nasal congestion, and a clear nasal discharge for the past four weeks. There is no history of fever. Physical exam reveals dark circles under the eyes and pale boggy turbinates bilaterally. Which of the following medications would best treat his symptoms?

A 4-year-old boy with a past medical history significant for sickle cell anemia presents to the emergency room with his mother with a chief complaint of lethargy. The patient's mother reports her son developed a fever with diarrhea four days ago which has since resolved. However, her son is now very tired with little energy to play or eat. The only finding on physical exam is a lacy, reticular rash on the chest and erythema to the cheeks which spares the nasolabial folds. A review of the electronic medical record shows a baseline hemoglobin of 7 g/dL. Labs obtained upon arrival to the emergency room reveal hemoglobin 4.9 g/dL, platelets 120 x 109/L and white blood cell count 2.1 x 109/L. What is the most likely diagnosis?

Which of the following is an anatomic finding seen in Tetralogy of Fallot?

Which of the following is the most likely physical examination finding in a patient with Peyronie’s disease?

A 24-year-old woman presents with right thumb pain. She recently fell while skiing. On examination, she has swelling and tenderness over the base of the thumb on the ulnar side. She has weakness when pinching an object between her thumb and index finger. Which of the following structures is most likely to be injured?

Primary hyperparathyroidism is characterized by which of the following?

What is the most common type of vulvar carcinoma?

A 39-year-old previously healthy man presents with a rash that he has had for several weeks. His symptoms have worsened in the last week. Physical exam shows hyperpigmentation of the chest, neck, and upper back. Several erythematous macules and patches are visible, with fine scale. A KOH prep is positive for hyphae and budding spores. Which of the following is the best treatment option?

Which of the following patients most likely has developed a sigmoid volvulus?

A 38-year-old African-American woman with stage II pulmonary sarcoidosis has a chest radiograph completed. What radiologic findings would be most consistent with her diagnosis?

Which of the following best correlates with severe maternal hemorrhage in placental abruption?

A 46-year-old man presents to the emergency department reporting abdominal pain, bloating, nausea, anorexia, and vomiting. His symptoms have been worsening since onset three days ago. His last bowel movement was four days ago, but he continues to pass flatus. Which of the following is most likely to confirm the diagnosis?

A 20-year-old woman with a history of cystic fibrosis presents for evaluation of a two year history of multiple episodes of what she describes as “bronchitis”. She complains of chronic cough productive of foul-smelling sputum. Auscultation reveals crackles at the lung bases. Chest X-ray is notable for airway dilatation and thickening. Which of the following is the most likely diagnosis?

A 55-year-old man presents with fever and right upper quadrant pain. On examination, you note that the patient is jaundiced and slightly altered. Clinically you make the diagnosis of cholangitis. Which of the following is the final component of Reynold’s pentad?

A 55-year-old woman presents with a complaint of left lower quadrant abdominal pain, constipation, and fever. On palpation, she is tender in the left lower quadrant with guarding and rebound tenderness. Which of the following is the most likely diagnosis?

A 26-year-old woman presents to the emergency department with sharp chest pain and pressure for two days. The pain is worse with deep inspiration and coughing. She indicates she cannot sleep well because the pain is much worse when she is lying down. She denies other symptoms such as shortness of breath and abdominal pain. She reports a mild cough and congestion last week. Physical examination is unremarkable. What is the most helpful diagnostic test to help establish the most likely diagnosis in this patient?

During a routine annual exam of a 42-year-old woman, a five millimeter, pale, slightly raised lesion is noted on her neck. It has a shiny pearled surface with small telangiectasias. There is no ulceration or surrounding induration.There is no cervical lymphadenopathy. What is the most likely diagnosis?

Which of the following is a known complication of chronic lithium toxicity?

Which of the following stages of labor results in full dilation and effacement of the cervix?

A 22-year-old man presents to the urgent care clinic with shortness of breath, facial swelling and rash. His mother states he was stung by a wasp 20 minutes ago and almost immediately began to have difficulties speaking and breathing. He has a heart rate of 110 beats per minute, respiratory rate 36 breaths per minute, oxygen saturation 92% on room air and blood pressure 92/46 mm Hg. An intravenous line has been placed. What is the most appropriate first step in your management?

A 67-year-old man presents to the clinic for evaluation of cough, wheezing, malaise, and shortness of breath. His social history is positive for daily cigar smoking for 30 years. He reports his symptoms have been present for four months. He had a similar presentation one year ago and was diagnosed with bronchitis. Which of the following is most likely on physical examination?

Patients with heart failure may have a combination of systolic and diastolic failure. Which of the following studies should be used in diagnosing heart failure?

A patient was recently diagnosed with Giardia lamblia. What is the treatment of choice?

A 57-year-old type 2 diabetic man presents to his primary care provider for his annual physical. He was diagnosed with diabetes seven years ago and has a history of alcohol abuse. His most recent hemoglobin A1C was 7.9 percent and fasting glucose of 156. He is not on any diabetic medications. He states that two years ago he had an episode of intense mid-abdominal pain that radiated to his back. He has had two more similar episodes. Ever since then, he has constant epigastric pain and has noticed loose, foul smelling stools that float in the toilet. Considering his glycemic control and past medical history, what class of anti-hyperglycemic agents is contraindicated for this patient?

Which of the following preventable childhood illnesses is associated with the development of orchitis?

Which of the following organs regulates body concentration of iron?

Which of the following pathogens is the most likely cause of painless genital ulcers, tender unilateral inguinal lymphadenopathy, and proctocolitis?

Which of the following conditions is associated with a right upper quadrant olive-shaped mass located on the lateral border of the rectus abdominus muscle?

A previously healthy 25-year-old man presents to your clinic with a complaint of a lesion on his penis. He tells you that he had a new male partner one month ago and wonders if this is sexually transmitted. Physical exam reveals an erythematous papule on the penile shaft with non-tender inguinal lymphadenopathy. Serum rapid plasma reagin testing comes back positive. Which of the following is the most appropriate therapy?

What is the most common benign condition of the breast?

What is the most common cause of erysipelas?

A 25-year-old man presents with complaints of worsening low back pain over the past 9 months. He describes the pain as dull in nature and has difficulty localizing it. He denies any history of trauma. The pain appears to be worse in the morning and has trouble getting out of bed because of stiffness. As he moves around, the pain and stiffness improves. Initial workup includes an elevated ESR, positive HLA-B27, and negative rheumatoid factor. X-rays of the lumbar spine reveal bilateral blurring of the sacroiliac joints. What is the most likely diagnosis?

A nine-year-old girl is in the clinic for a follow-up. She was diagnosed with asthma a few days ago after an emergency room visit. She would have night awakenings about twice a week. She would also use her inhaled short-acting beta agonists about every day for relief of shortness of breath. On physical examination, you notice occasional wheezing on right and left lung fields. Which of the following is the best classification of her asthma severity?

A 4-year-old girl presents with daily high fever (maximum 103°F) for 6 days despite using antipyretics. Her parents report she is increasingly fussy, eating and drinking less, complaining of abdominal pain, reluctant to move, and now has a diffuse maculopapular rash over her trunk. On exam, you also note she has bilateral bulbar conjunctivitis and puffy palms and feet. Which of the following is the most likely diagnosis?

A 5-year-old boy with a history of sickle cell anemia presents with dyspnea and fatigue. Mom notes that one week prior he had a fever, headache and bright red rash on his cheeks which has since resolved. Laboratory studies show a decrease in his baseline hemoglobin by 30%. Infection with which virus likely precipitated his current symptoms?

Which of the following is the most common pulmonary complication of influenza?

Which of the following laboratory results supports the diagnosis of pernicious anemia?

A 21-year-old woman is in active labor. Her cervix is 10 cm dilated and 100% effaced. The head of the fetus is engaged in the pelvis and she is feeling the urge to push. Which stage of labor is the patient in?

Which of the following vaccination series should be started at birth?

A 72-year-old woman with a history of hypertension, hyperlipidemia, and myocardial infarction presents to the emergency room with complaints of shortness of breath at rest over the past three days. She finds it difficult to walk short distances due to shortness of breath. Additionally, she complains of orthopnea and nocturnal dyspnea. Upon physical examination, the patient is short of breath, requiring numerous pauses during conversation. She is afebrile but tachycardic, diaphoretic, and her extremities are cool. There is a diminished first heart sound, S3 gallop, laterally displaced PMI, bibasilar rales and dullness to percussion and expiratory wheezing noted. There is no JVD noted, however, 2+ pitting edema of the lower extremities to the level of the mid-calf is evident. Which of the following is the most likely diagnosis?

Which valve is most commonly affected by acute rheumatic fever?

A 23-year-old woman presents to the Emergency Department with pain in her left eye after not changing out her soft contact lenses for three days. Fluorescein staining reveals diffuse superficial punctate lesions over the central cornea. Which of the following treatments would be most appropriate?

Which of the following organisms is the most frequent cause of roseola?

A 16-year-old boy presents with a marked hemarthrosis of his knee after tripping and striking it against the edge of a step. This has happened in the past. His activated partial thromboplastin time is prolonged and his prothrombin time and thrombin time are normal. What is the most likely diagnosis?

Which of the following differentiates hypertensive emergency from hypertension?

Which of the following is a risk factor for the development of deep vein thrombosis?

Which of the following occurs with paraphimosis?

A 29-year-old woman presents to the outpatient primary care office for follow-up on a chief complaint of fatigue. Her past medical history is significant for menstrual migraines. She was last seen one month ago for this complaint and labs were ordered. The results of lab testing reveal hemoglobin 10.9 g/dL, mean corpuscular volume 76 fL, ferritin 6 ng/mL and total iron binding capacity 115 μmol/L. What is the most likely diagnosis?

A 10-year-old girl presents with fever, sore throat, cough, headache, and general malaise worsening over the past four days. Lung auscultation reveals rales in the lower lobes. A chest radiograph demonstrates interstitial infiltrates in the lower lobes. Which of the following is the most likely causative pathogen?

Which of the following physical exam findings is most consistent with a diagnosis of vitamin B12 deficiency?

What is the treatment of choice for uncomplicated acute bacterial rhinosinusitis?

A 30-year-old man who was recently arrested is brought to the jail healthcare clinic for intake evaluation. He admits to having been arrested multiple times, with his first arrest occurring at 15-years-old after vandalizing his school auditorium. He states he has always had problems with authority figures and has a hard time getting along with his peers. He has never been able to keep a job for longer than a few weeks, which is why he resorted to stealing. He does not regret any of his actions. He denies the use of any illicit drugs but admits to binge drinking occasionally. What is the best way to diagnose this condition?

Which of the following is the most common type of breast cancer?

A 51-year-old woman presents to the clinic complaining of irregular menstrual cycles as well as hot flashes, sleep disturbance, mood swings, and vaginal dryness. Which of the following would you expect to see on laboratory examination?

Laboratory results of a child with suspicion of rickets show a normal calcium level, elevated parathyroid hormone level and elevated alkaline phosphatase. What vitamin deficiency is associated with these findings?

A 70-year-old man presents to the clinic with complaints of urinary hesitancy, frequency, dribbling, slow stream, and straining to void. The symptoms have been present and progressively worsening over the past five years. Which of the following physical exam findings is most consistent with a diagnosis of benign prostatic hyperplasia?

Which of the following is the most common cause of primary valvular heart disease in industrialized countries?

Which of the following findings can distinguish primary adrenal insufficiency from secondary adrenal insufficiency?

In addition to nephrotic range proteinuria, what additional substance is typically found in the urine in a patient with nephrotic syndrome?

A 37-year-old man with no significant past medical history presents to the Emergency Department with sudden onset back pain radiating to his left groin. He reports dysuria and hematuria that began this morning. Vital signs are T 98.5 ºF, HR 103 beats/minute, RR 12 breaths/minute, BP 125/85 mm Hg, oxygen saturation 99% on room air. He appears very uncomfortable and cannot sit still. A bedside ultrasound is obtained and is shown above. Which of the following is the most likely diagnosis?

A previously healthy 21-year-old man presents to the ED with sudden onset of chest pain and shortness of breath. On physical exam, you note diminished breath sounds on the right. His chest radiograph is shown above. Which of the following is the greatest risk factor for this disease process?

A 2-year-old boy is brought into the clinic by his mother with concerns for abdominal distention and bloating. She notes associated symptoms for the past week of loss of appetite and general malaise. Vital signs are within the normal range. Physical exam reveals a large abdominal mass in the right upper quadrant of the abdomen that does not seem tender when palpated. There are no other abnormalities on exam. Which of the following would be the best initial imaging study to order?

Which of the following medications is administered to control vasospasm in a patient with a subarachnoid hemorrhage secondary to a cerebral aneurysm?

For pregnant women 24 to 32 weeks of gestation, who are candidates for tocolysis, which of the following is first line therapy for labor inhibition?

A 44-year-old woman presents to the office with worsening fatigue and dizziness over the past few months. She decided to make an appointment because she had a few near fainting episodes at her indoor office job. After reviewing her chart, you note that she has lost about 15 pounds over the past year. Upon physical exam, you note that she has a blood pressure of 86/62 mm Hg and that she has areas of hyperpigmentation to her face, arms, hands and mucous membranes. Which of the following is most appropriate to diagnose her condition?

A 40-year-old man with history of hypertension and systolic congestive heart failure managed with an AICD presents to the emergency department complaining of right wrist pain. He reports slipping on ice about one hour ago and states he broke the fall with his right hand outstretched. He complains of 8/10 throbbing right wrist pain which is worse with movement. Physical examination reveals swelling of the dorsal aspect of the wrist with limited range of motion and tenderness to palpation of the anatomical snuffbox. Capillary refill is less than 2 seconds in all digits of right hand. Radial, ulnar, and median nerve sensory and motor function is intact. Plain films of the right wrist were within normal limits. Which of the following is the most appropriate management?

A 55-year-old woman presents with sudden throbbing headache to the left side of her temple, blurred vision vision in the left eye, and occasional jaw pain to the left side with chewing. She also complains that for the past few months she has had a lot of body aches and stiffness, especially to the shoulders and hips. You suspect giant cell arteritis and empirically start her on high dose steroids. What is the most definitive test to diagnose this condition?

A 17-year-old woman presents to your clinic with a chief complaint of sadness, loss of appetite, and the inability to sleep. She is having a hard time focusing at work and she is tired all of the time. She tells you that for the past month she has been hearing voices telling her to harm herself. She is interested in treatment. What is the most appropriate first-line therapy for this condition?

A 46-year-old man with a history of intravenous drug use presents with exertional dyspnea and fatigue. Physical exam reveals a blowing diastolic murmur, a pulse that rises and falls rapidly, and nailbed capillary pulsations. Which of the following is the most likely diagnosis?

Allergic rhinitis is mediated by which of the following?

A 52-year-old man presents to the emergency department with a complaint of worsening fever, shortness of breath and new nonproductive cough over the past ten days. Chest X-ray reveals diffuse infiltrates without effusion. A review of his medical record shows that his last CD4 count two weeks ago was 102 cells/µL. What is the treatment of choice for this patient's condition?

What is the treatment of choice for a patient with a kerion?

Which of the following is the most common cause of acute myocardial infarction?

Which of the following is considered a minor diagnostic criterion for diagnosis of infective endocarditis, according to the Duke criteria?

What is the most common pathogen of osteomyelitis?

Which of the following conditions is considered a surgical emergency and must be surgically repaired within four to six hours to improve the chance of preserving the testicle?

A two-year-old boy presents to the ED with his mother after a choking episode. His mother states he was playing with Legos when she noticed he began to cough and gag. He has not been able to eat or drink anything since that time and has vomited up even small sips of water. Which of the following is the most likely level of esophageal obstruction?

Which of the following is the most common mode of rabies transmission?

A 7-year-old girl with a history of eczema presents with her father complaining of copious watery nasal discharge. Physical exam reveals a transverse skin crease on the bridge of her nose a few millimeters from the tip. Which of the following diagnostic studies would confirm the diagnosis?

A 40-year-old man presents with concerns about a lesion on his right cheek. What physical exam finding is most suggestive of melanoma?

A young patient with a history of hemophilia presents to the Emergency Department with severe pain in the left calf for the past several hours. Pain is worse with movement and better with rest. He denies any injury to the area, weakness, or numbness. Physical exam reveals easily palpable distal pulses, normal color, and normal distal sensation to light touch. There is pain with palpation of the musculature and with passive stretch of the left calf. The patient is given morphine and it does not relieve the pain adequately. What is the most likely diagnosis?

What characteristic is more representative of a phobia rather than a fear?

A 36-year-old G1P0 woman presents at 32 weeks gestation with lower extremity and facial swelling. She is followed by an obstetrician and her pregnancy has been uncomplicated. Her vital signs are T 37.3°C, HR 95, BP 135/95, RR 20. Her urinalysis is notable for 4+ proteinuria. Which of the following is the cause of the patient’s conditions?

Which of the following physical examination findings is consistent with a herniated disc at L5-S1?

Which of the following laboratory studies should be ordered in a patient being evaluated for hypertriglyceridemia?

A 24-year-old man is initially found to have a single nodule in the right lobe of his thyroid gland on routine physical exam. He is clinically and chemically euthyroid. Thyroid ultrasound reveals a 2.2 cm mass with low suspicion characteristics. Which of the following is the next appropriate step?

When assessing a newborn, which of the following is included in determining the Apgar score?

A 12-year-old boy presents to the emergency department accompanied by his mother complaining of abdominal pain for the last twelve hours. The mother reports the pain initially began in the periumbilical area but her son is now complaining of right lower quadrant pain. He is complaining of associated nausea without vomiting. He does not have a fever and has not eaten anything all day. The patient has right lower quadrant pain with passive extension of the right hip. Which of the following is the best initial test to confirm your suspicion in this patient?

Which of the following laboratory abnormalities is most consistent with idiopathic thrombocytopenia?

A 28-year-old woman presents to the ED following a finger injury while playing flag football. The patient states that she sustained a direct blow to the pointer finger when the ball struck her fingertip. On physical exam, the patient has swelling and tenderness at the distal interphalangeal joint. The fingertip rests in 45 degrees of flexion. The patient is unable to demonstrate active extension of the distal interphalangeal joint but she has full passive extension. The skin is intact. X-ray of the finger is obtained which shows soft tissue swelling but no fracture or dislocation. Which of the following is the most appropriate management for this patient?

A 22-year-old woman who is a long term user of an intrauterine device presents with acute pelvic pain, vaginal discharge, chills, and nausea. She is febrile and her physical exam reveals exquisite cervical motion tenderness and a tender right adnexal mass. A pelvic ultrasound reveals a complex, right adnexal mass and an intrauterine device in place. Which of the following is the most likely causative pathogen?

A 12-year-old girl presents to the primary care physician for her first physical following her international adoption. She is feeling well, but her mother was recently diagnosed with fulminant hepatitis B. Which of the following would indicate the child is immune to hepatitis B due to vaccination?

Which of the following terms correctly describes a fetus that has both hips and knees flexed?

At what age should the quadrivalent meningococcal vaccine be offered to immunocompetent children?

A 48-year-old woman presents to the gynecology office with complaints of urine leakage which occurs frequently when she coughs or sneezes. She denies any urine leakage at any other time. A pelvic examination does not reveal any abnormalities. Urinalysis is completed and is unremarkable. What is the most likely diagnosis?

A 27-year-old woman presents to your office requesting a referral for psychotherapy. She tells you that she is constantly fighting with her current partner, has not been able to maintain a romantic relationship for more than three months, has not been able to maintain employment because “they treat me unfairly”, has a history of self mutilation by cutting and has multiple suicide attempts in the past. Which of the following is the most likely diagnosis?

A 14-year-old girl presents to the emergency department with malaise, sore throat and subjective fever for over six days. She has been taking ibuprofen for the symptoms but she does not feel like she is improving. Vital signs show HR 96, BP 112/68, RR 12, and T 37.9ºC. Physical examination shows mild pharyngeal erythema without exudates as well as mild tenderness and fullness in the left upper quadrant on abdominal exam. What is the most likely etiology for this patient’s symptoms?

A 4-year-old boy has a rash on his hands and buttocks that appeared when he woke up this morning. His mother had to pick him up from daycare two days ago because of a low-grade fever, sore throat, and lethargy. He is up to date on his vaccinations. Physical examination shows aphthous-like erosions on his soft palate, and vesicular macules on the palms of his hands, the buttocks, and the soles of his feet. Which of the following is the most likely diagnosis?

Which of the following historical factors in most commonly associated with a Mallory-Weiss tear?

A 19-year-old man presents to the clinic for a sports physical. He reports a painless mass in his left testicle that he recently noticed while showering. On physical exam the mass is non-tender and cannot be separated from the left testicle. It does not transilluminate. Which of the following is the most likely diagnosis?

Which of the following spine segments is most likely to be injured as a result of blunt-force trauma?

A 23-year-old man presents after being hit in the face with a baseball. Which of the following findings on exam would suggest blowout fracture as the most likely diagnosis?

Which of the following is a risk factor for shoulder dystocia?

A 14-month-old boy is brought into the Emergency Department by his parents for forceful coughing. His parents state that he was recently ill with clear rhinorrhea and mild cough lasting about two weeks. Recently, he has been coughing so forcefully that it is difficult for him to catch his breath. He has had several episodes of post-tussive vomiting. His parents relate an unremarkable birth history. He attends daycare and is unimmunized. What is the most likely diagnosis?

Which of the following physical findings suggests pernicious anemia?

Which of the following physical examination findings is most consistent with a diagnosis of tension-type headache?

Which of the following medications alleviates increased intraocular pressure by increasing the outflow of aqueous fluid in patients with open-angle glaucoma?

A 42-year-old woman presents to your office with complaints of dry eyes and mouth that have been worsening over the past year. Physical exam reveals bilateral parotid gland enlargement, dental caries, and eyelid inflammation. Laboratory testing results include elevated erythrocyte sedimentation rate and the presence of antinuclear antibodies. Which of the following is the most likely diagnosis?

Which of the following medications is indicated as first-line therapy for a patient with mild to moderate benign prostatic hyperplasia?

A 5-year-old girl presents with a blistering rash surrounding her mouth and extending into her nares after a recent head cold. A close examination of the area reveals multiple pus-filled blisters that erupt with minimal pressure, and diffuse honey-colored crusting lesions. Which of the following tests would best reveal the cause of this eruption and guide treatment?

A 30-year-old man presents with dysuria and purulent urethral discharge. Which of the following findings on microscopy would confirm the diagnosis of gonococcal urethritis?

A midshaft fracture of the humerus would most likely result in which of the following neurologic deficits?

A 30-year-old woman presents to your office with questions about human papillomavirus and if she can start the vaccination series. Which of the following immunization guidelines is most appropriate to share with the patient?

A 40-year-old woman with no significant past medical history presents to the Emergency Department complaining of a painful and swollen lesion in her axilla. She is afebrile and otherwise feels well. On exam, a tender enlarged axillary lymph node is appreciated with mild overlying erythema and warmth. The patient also reports an erythematous lesion to her hand a few weeks prior after playing with her neighbors cat. What is the most likely pathogen responsible for the patient’s presentation?

Which muscle is most commonly involved with rotator cuff injuries?

A 5-year-old Caucasian boy presents with failure to thrive and recurrent respiratory infections. The child is at the 5th percentile for both height and weight. Physical exam reveals a thin child with nasal polyps and digital clubbing, as well as scattered wheezes. A sweat chloride test reveals a chloride level of 65 mEq/L. Which of the following is the most common cause of his condition?

A boy presents to clinic for a well-baby check. The mother notes that her child is able to move his head from side to side following a moving object, can lift his head from a prone position, smiles when played with, and makes cooing sounds. The physical examination reveals a calm, afebrile, baby boy with pink conjunctivae, clear breath sounds, adynamic precordium, distinct heart sounds, no heart murmurs, soft non-tender abdomen, full equal pulses and no edema. He is unable to maintain a seated position. Which of the following is the most likely age of the infant?

A 24-year-old woman comes to the clinic complaining of lower abdominal and pelvic pain. She says the pain has been ongoing for 3 to 4 weeks and is exacerbated when she has sexual intercourse with her boyfriend. She has had four sexual partners in the past year and only uses oral contraceptive pills for birth control. She also has dysuria and dysmenorrhea. Physical examination shows diffuse tenderness in the lower abdominal quadrants and cervical discharge. Which of the following is the most likely diagnosis?

A 28-year-old female presents on examination with enlarged ovaries bilaterally. The possible diagnosis of polycystic ovarian syndrome is enhanced by finding which of the following?

A 71-year-old man presents to the Emergency Department complaining of left eye pain that has been increasing over the last few hours. The pain is associated with blurred vision and nausea. Physical examination of the left eye is shown. Which aspect of the comprehensive eye examination is contraindicated in this patient?

A previously healthy 10-year-old boy presents to the clinic with his mother because she is worried he has an infection. He has had a fever and malaise for five days for which he was given antipyretics. On physical examination his vital signs are within normal limits for age except for a low-grade fever. Which of the following is most consistent with mumps virus infection?

A 4-year-old girl presents with a three day history of malaise, fever of 40o C, cough and coryza. She then developed an erythematous maculopapular rash that started on the face before spreading to the trunk and lower body. Her immunization record shows that aside from an initial dose of hepatitis B vaccine given at delivery, no other vaccinations have been given. On physical examination, the patient is weak-looking and febrile with a generalized, pruritic, maculopapular rash, watery nasal discharge, white pinpoint lesions on bright red mucosa opposite the lower molars, and occasional crackles upon auscultation. Which of the following is the most likely diagnosis?

A 26-year-old man presents to your clinic with complaints of fever, fatigue and right-sided knee stiffness and pain. He tells you that he was treated for a sexually transmitted infection three weeks ago and was feeling fine until now. Physical exam findings include right-sided tenderness, warmth and inflammation of the right knee as well as bilateral conjunctival injection. Which of the following is the most likely diagnosis?

A previously healthy, non-smoking, 50-year-old man presents to your office for his annual physical exam. He wants to make sure he is up to date on all of his immunizations and asks if he needs to get the pneumococcal vaccine. Which of the following pneumococcal immunization guidelines is most appropriate to share with the patient?

Which of the following physical exam findings is most suggestive of emphysema?

A 52-year-old man with no known medical history presents to the emergency room complaining of abdominal pain that has been persistent for 3 hours. He describes the pain as an 8/10 stabbing pain in his upper abdomen that radiates to his back. He admits to chronic alcohol abuse and reports drinking 1 liter of vodka daily. Physical exam reveals significant tenderness to palpation of the epigastric region without peritoneal signs or guarding. The lab work is remarkable for white blood cell count of 17,000/mcL, blood glucose of 175 mg/dl, lactate dehydrogenase of 310 U/L, lipase of 1,400 U/L, and aspartate aminotransferase of 290 U/L. Which of the following is associated with a worse prognosis in early acute pancreatitis?

A 23-year-old woman presents to your clinic with a complaint of heavy menses. She tells you that since childhood she’s also had a history of nosebleeds and easy bruising and notes her sister has similar symptoms. Which of the following is the most appropriate initial screening test?

A previously healthy 26-year-old African-American woman presents with a cough and dyspnea of 3 months duration. She is a lifelong non-smoker with no past medical history of any lung disorders. On exam, lung sounds are normal, but you do note that she has a papular rash present on her nose and cheeks. A chest X-ray reveals bilateral hilar adenopathy. The patient undergoes a lung biopsy which reveals noncaseating granulomas. Which of the following is the most likely diagnosis?

Which of the following contributes most to the development of pulmonary carcinoid tumors?

An 8-year-old girl presents to your office with a complaint of scalp pruritus. The patient’s mother says that other children at the girl’s school have complained of similar symptoms. Which of the following physical exam findings is required to confirm the diagnosis of Pediculosis capitis?

A 4-month-old girl presents with two weeks of cough that includes severe coughing episodes with associated cyanosis, respiratory distress, and post-tussive emesis. Her mother and father both have upper respiratory infections. Which of the following is the treatment of choice?

A 32-year-old woman presents for a complete physical examination. During the exam, she complains of having diminished interest in daily activities. Upon further questioning, she also admits to feelings of worthlessness, hypersomnia, fatigue, and the inability to concentrate at work. These symptoms have been ongoing for the last month. She has never had symptoms like this in the past. Which of the following would be the most appropriate pharmacologic treatment at this time?

Which of the following describes the classic triad associated with renal cell carcinoma?

What physical finding is most consistent with polyarteritis nodosa?

Which of the following foodborne bacteria causes illness through a preformed toxin?

In August, a mother brings her 3-year-old son to your office stating since he attended a birthday party at a water park 2 days ago, he has been irritable and is pulling at his right ear. On examination, he is afebrile and well-appearing. The right external ear canal is edematous with moderate erythema and scant drainage.Which of the following is the most appropriate treatments for this patient?

Which of the following lab tests reflects long term folate availability?

A 35-year-old man presents to the clinic for his annual physical. He was a project manager for a construction company until a few weeks ago. He was fired for failing to complete multiple projects on time, which he states is because every detail needs to be perfect prior to submission. He disliked delegating tasks to his co-workers as he feels they were unable to complete things his way. At home he has been having some marital difficulties due to his preoccupation with saving as much as he can. Which of the following is the most likely diagnosis?

In infectious mononucleosis, where is lymphadenopathy most commonly noted?

Which class of medications is considered first-line therapy in a hypertensive patient with diabetes and proteinuria?

A 60-year-old woman with a history of hypertension presents to your office with a complaint of facial pain. She describes the pain as right-sided, stabbing, and localized from the corner of her mouth up into her jaw. It occurs 2-3 times per day and lasts for approximately 30 seconds with some residual burning sensation afterwards. She notes that she also has increased tearing when these episodes occur. Which of the following is the most appropriate therapy?

A 14-year-old boy presents with one week of an itchy rash over his back. On examination, there are multiple oval-shaped papules in linear distributions over his upper back. There is also a prominent oval-shaped plaque on his upper back. This larger plaque has a small area of central clearing and fine scale. What is the most likely diagnosis?

You are examining a patient that has spina bifida. His mother just found out she is pregnant with her second child. What is the folic acid dose the mother should take at this point in her pregnancy?

A 55-year-old woman with a history of HIV presents to the clinic complaining of productive cough and dyspnea for two weeks. Her oxygen saturation is 95%, temperature is 101.5°F, pulse is 95/minute, respirations are 17/minute, and blood pressure is 130/85. She has a 10-year history of rheumatoid arthritis and currently being treated with infliximab. Chest X-ray shows diffuse, bilateral, interstitial infiltrates. The diagnosis is confirmed by examination of respiratory secretions. Which of the following is the most appropriate therapy?

A 61-year-old woman presents with a trimalleolar ankle fracture after a fall. As part of her preoperative workup, an electrocardiogram is obtained. A portion of the rhythm strip is shown above. Which of the following is the most appropriate?

An 84-year-old man presents to the ED after a syncopal episode. Vital signs are BP 86/48 mm Hg, RR 20 breaths per minute, and T 98.6°F. His rhythm strip is shown above. Which of the following is the most appropriate initial step in management?