On This Finding, You Would Most Likely Expect Him to Complain Of

1) A 60 year old man presents with hard painless plaques on the dorsum of the penis. Based

on this finding, you would most likely expect him to complain of,

A) dysuria

B) polyuria

C) prolonged erections

D) crooked erections

E) urethral discharge

2) A 24 year old man with a history of sickle cell anemia presents with prolonged,

persistent, penile erection. This condition is called;

A) Epispadias

B) Hypospadias

C) Paraphimosis

D) Priapism

E) Phimosis

3) On examining a 30 year old man, you notice a soft irregular mass in the left scrotum

which feels like "a bag of worms." The most likely diagnosis is,

A) Carcinoma of the scrotum

B) Epididymitis

C) Lymphogranuloma Venereum

D) Varicocoele

E) Orchitis

4) A congenital malformation where the urethral meatus is found inferior to the surface of

the penis is termed;

A) Epispadias

B) Hypospadias

C) Paraphimosis

D) Phimosis

E) Hyperspadias

5) A 52 year old woman presents with complaints of dysparunia, vaginal burning and

pruritus. On examination, the vaginal mucosa is atrophic, dry, and bleeds easily. The vulva is

atrophic. The most likely diagnosis is;

A) Candida vaginitis

B) Trichomonas vaginitis

C) Estrogen deficiency

D) Bacterial vaginosis

E) Carcinoma of the cervix

6) A 17 year old boy presents with a nontender fluid filled mass in the scrotum that

transilluminates. The most likely diagnosis is;

A) Testicular cancer

B) Hematocele

C) Hydrocele

D) Epididymitis

E) Orchitis

7) A 10 year old boy presents to the emergency room with severe pain in the right testes of

sudden onset. On examination, an exquisitely tender irregular edematous mass is palpated in the

scrotum. The testes on the affected side lies higher than the left side. The most likely diagnosis

is;

A) Cryptorchidism

B) Carcinoma of the testes

C) Torsion of the spermatic cord

D) Scrotal hernia

E) Acute cystitis

8) You are called to see a 65 year old man who developed pain and swelling around the

penile glans shortly after having a foley catheter inserted. On examination, the foreskin is

retracted, tight, cyanotic and edematous. The most likely diagnosis is;

A) Phimosis

B) Paraphimosis

C) Cystitis

D) Urethritis

E) Candidal balanitis

9) A 78 year old man complains of nocturia, hesitancy and urgency worsening gradually

over the last 6 months. In addition, he would most likely have which of the following symptoms;

A) costovertebral angle tenderness (CVA tenderness)

B) stress incontinence

C) painful erections

D) decreased force of stream

10) A 46 year old is found to have a nontender firm erosion on the glans of the penis. The

most likely diagnosis is;

A) Balanitis

B) Venereal wart

C) Chancre

D) Chancroid

E) Genital herpes

11) While performing a pelvic examination, a bulge is noted in the posterior vaginal wall.

This finding most likely represents;

A) a cystocele

B) a cystourethrocele

C) a prolapsed uterus

D) a rectocele

12) While performing a pelvic examination, the uterus is not palpated except through the

rectal wall. This most likely represents;

A) a retroflexed uterus

B) a retroverted uterus

C) an anteverted uterus

13) Which of the following occurs first in normal sexual maturation in boys;

A) Coarse, dark and curly pubic hair over pubic symphysis

B) Enlargement and lengthening of the penis

C) Enlargement of scrotum with changes in texture

14) A 20 year old woman is found to have lesions on her vulva that are painful, shallow

vesicles on an erythematous base. The most likely diagnosis is;

A) Cancer of the vulva

B) Chancre

C) Chancroid

D) Genital herpes

E) Venereal warts

15) Which of the following statements regarding Hepatitis B is true:

A) All medical students should be vaccinated without testing for antibodies.

B) All medical students should be tested for antibodies and only those students with

anti-core antibodies should be vaccinated.

C) All medical students should be tested for surface antigen and only those found positive

should be vaccinated.

D) All medical students should receive immuneglobulin to prevent hepatitis B and C before

starting their 3rd year.

E) Medical students should be vaccinated only after needle puncture exposure to hepatitis B

16) A 23 year old woman, recently married, complains of urinary frequency and a sensation

of burning on urination over the last 3 days. She denies fever, vaginal discharge, or back pain.

The most likely diagnosis is;

A) renal colic

B) nephrolithiasis

C) cystitis

D) pyelonephritis

E) chlamydia cervicitis

17) A 40 year old woman complains of continuous urinary loss after a surgical procedure.

The most likely cause of this is;

A) diabetic neuropathy

B) prolapsed uterus

C) multiple pregnancies

D) vesicovaginal fistula

E) psychiatric disease

18) A 32 year old man complains of dysuria and hematuria at the start of voiding that resolves

as he continues to void. The most likely diagnosis is;

A) Urethritis

B) Acute prostatitis

C) Cystitis

D) Renal cancer

E) Coagulopathy

19) The umbilicus is a useful landmark because it generally coincides with;

A) Aortic bifurcation

B) T 10 innervation

C) Both of the above

D) Neither of the above

20) A 25 year old woman presents with 1 day history of nausea, vomiting, fever with shaking

chills, and right CVA (costovertebral angle) tenderness. The most likely diagnosis is;

A) Pheochromocytoma

B) Renal carcinoma

C) Pyelonephritis

D) Cystitis

21) A 25 year old woman is interested in fertility. She states that her menstrual period began

on February l and she bled for 5 days. Her next period began on February 28 and lasted for 3

days. The duration of her cycle should best be recorded as;

A) between 3 - 5 days

B) 23 days

C) 25 days

D) 28 days

E) 31 days

22) A 42 year old pregnant woman is asked for her obstetrical history. She states that she has

4 living children. She delivered 2 by C-section and 2 by vaginal delivery, all at term. She did not

have any abortions. The best way of recording this information is;

A) G4 P2

B) G4 P5

C) G4 P4

D) G5 P4

23) Menarche most commonly occurs;

A) Before breast development

B) Before pubic hair development

C) Before the growth spurt

D) None of the above

24) A 44 year old woman presents with concern regarding breast cancer. Of the following

physical findings of the breast, which is least likely to be associated with breast cancer;.

A) Dimpling of the skin

B) Flattening of the normal convex contour of the breast

C) Milky discharge

D) Retraction of the nipple

E) "Peau d'orange" or orange peel skin

25) On examining a 32 year old woman, you notice left axillary lymph nodes. This finding is

consistent with;

A) Breast cancer

B) Infection of the hand or arm

C) Both of the above

D) Neither of the above

26) An 18 year old woman states that she noticed a breast nodule on self-examination just

prior to her menses. You examine her several weeks later and you are not able to palpate the

lesion. The most likely diagnosis is;

A) Paget's disease of the breast

B) Breast cancer

C) Gynecomastia

D) Cyst

E) Fibroadenoma

27) A 50 year old man presents with a scrotal mass. On examination of the genitalia, you can

hear bowel sounds. When the patient lies down, the mass resolves. The most likely diagnosis is;

A) Direct hernia

B) Indirect hernia

C) Femoral hernia

D) Incarcerated hernia

E) Strangulated hernia

28) A 44 year old woman complains of excessive menstrual bleeding for several years. She is

otherwise healthy and has no other complaints. On performing a bimanual pelvic exam on, you

notice several firm, irregular nodules in continuity with the uterine surface. The most likely

diagnosis is;

A) Prolapse of the uterus

B) Anteflexed uterus

C) Myomas of the uterus

D) Normal variant

29) On examining an infant, which part of the exam is best left for the end of the exam;

A) Palpation of the head

B) Examination of the ears

C) Determining the range of motion of joints

D) Auscultation of the heart

30) An ill defined blackish blue area located over the buttocks and lower lumbar regions,

frequently seen in African-American, Native-American, and Oriental babies is most likely;

A) Cutis marmorata

B) Acrocyanosis

C) Mongolian spots

D) Lanuga

E) Harlequin dyschromia

31) The fine downy growth of hair found primarily over the shoulders and backs of infants is

most likely;

A) Premature adrenarche

B) Vernix caseosa

C) lanuga

D) Miliaria rubra

32) On examining a 10 year old child, you notice a small opening on the lower back in the

midline superficial to the coccyx associated with a small tuft of hair. The most likely diagnosis

is;

A) Sentinal tag

B) Anal fissure

C) Anal fistula

D) Pilonidal sinus

33) Which of the following statements regarding the prostate exam is true;

A) Finding a normal sized gland by palpation rules out the diagnosis of benign prostatic

hypertrophy.

B) Prostatic hypertrophy that obstructs urinary flow and causes symptoms is always

palpable.

C) Both of the above.

D) Neither of the above.

34) A 66 year old man is found to have a smooth firm enlarged prostate without nodules. On

abdominal exam, the bladder is percussed and found to be enlarged. This patient would be most

likely to complain of,

A) Stress incontinence

B) Urge incontinence

C) Overflow incontinence

D) Functional incontinence

35) 79 year old male presents with new onset of painless gross hematuria. He has had no

dysuria or fever. The most likely diagnosis is;

A) Bladder outlet obstruction

B) Cystitis

C) Bladder cancer

D) Pyelonephritis

36) A 35 year old woman presents with severe lower abdominal pain for the past 6 hours. On

pelvic examination, you note a tender left adnexal mass. This history and physical is least

consistent with which of the following diagnoses;

A) Pelvic inflamatory disease

B) Ectopic pregnancy

C) Diverticulosis

D) Ovarian cyst

37) In performing a pelvic examination, which of the.following statements is CORRECT;

A) Make sure all the curtains are opened to allow in the maximum amount of sunlight so it is

easier to see.

B) If this is the patient's first pelvic examination, assure her it will not hurt and perform it as

quickly as possible without speaking.

C) If the patient would like her spouse with her, have him stand near you so you can

demonstrate to him what you are doing.

D) Ask the patient to empty her bladder before the examination, even if she says she doesn't

have to.

E) Arrange the table so that it is facing the door of the room so that you may quickly leave

and reenter in case you forgot something.

38) Indications for performing a pelvic examination on a 17 year old include all of the

following except;

A) amenorrhea

B) dysmenorrhea

C) unexplained abdominal pain

D) vaginal discharge

E) routine yearly pap smear

39) Which of the following is TRUE about cancer screening and prevention in women;

A) Only the endocervical sample screens for cancer, the ectocervical sample screens for

sexually transmitted disease.

B) Lubricate the speculum with warm water as other lubricants may interfere with

interpretation of the pap smear.

C) Both of the above

D) Neither of the above

40) A rectal examination is useful in diagnosing all of the following conditions EXCEPT;

A) Neurologic disease

B) Epididymitis

C) Prostatic infection

D) Prostate cancer

E) Rectal cancer

41) 20 year old man presents with a painless nodule in his left testes. It is firm and does not

transilluminate. The most likely diagnosis is;

A) Spermatocele

B) Testicular Torsion

C) Epididymitis

D) Peyronie's disease

E) Testicular Cancer

42) All of the following. individuals have access to a patient's medical chart except;

A) the patient's insurance company

B) the utilization review nurse

C) the medical student on the team of the patient

D) the patient's spouse

43) A 55 year old man is in the hospital for complaints of chest pain. On the third hospital

day, the physician makes the following note: "Patient complains of severe left sided chest pain

with nausea. Antacids ordered." The best interpretation of this documentation is;

A) The patient has hiatal hernia.

B) The patient needs a cardiac catherization.

C) The patient needs a GI evaluation.

D) The patient was not examined.

44) A 58 year old woman presents for routine gynecologic evaluation. On pelvic exam the

ovaries are not palpable. The remainder of the exam is normal. The most likely diagnosis is;

A) Ovarian dysgenesis

B) Ovarian Cancer

C) Premature ovarian failure

D) Normal exam

45) Which age range is typically the more difficult one in which to examine a child?

A) 0-2 months

B) 2-9 months

C) 9-24 months

D) 3-5 years

E) Over 6 years

Match the following disease states with the most appropriate method to prevent spread of

infection in addition to handwashing:

46) A 44 year old paraplegic man presents with a deep purulent decubitus wound. Wound

culture grows Methicillin resistant Staph Aureus.

47) A 73 year old woman presents with hemoptysis. Sputum is sent for acid fast stain.

48) A 33 year old man is found to have Pneumocystis Carinii pneumonia. He is known to be

HIV positive.

49) A resident Physician on your team has a upper respiratory infection and is about to see a

patient 3 days post renal transplant.

A) Negative pressure isolation room

B) Surgical mask

C) Gloves

D) Surgical mask, gloves and gown

E) Handwashing alone is sufficient

50) After drawing blood from a patient in the hospital, you accidentally stick your finger with

the needle. Which of the following is the most appropriate action to take:

A) Document it in the patient's chart, so that if you get ill, you can sue the patient.

B) Immediately go to a center where you can get an anonymous HIV test.

C) Make an appointment within the next week to be seen at the StudentHealthCenter.

D) Immediately start taking AZT (Zidovudine).

E) Immediately call the emergency pager number for needle exposures.

ANSWERS: