1. A 58 year old man complains of pain in his calf and
posterior aspect of the thigh, which is brought on after walking
one block vigorously and resolves with rest. This symptom
constellation may be associated with:
A. impotence
B. high risk for significant coronary disease,
C. a bruit in the femoral area on physical examination.
D. All of the above
E. None of the above
2. A 20 year old man is noted to have delayed carotid
upstrokes and a harsh systolic crescendo-decrescendo
murmur. This patient might be expected to have all of the
following EXCEPT:
A. PMI at the 6th intercostal space and midaxillary line
B. an audible S4
C. an ejection sound
D. pulsus paradoxicus
E. radiation of the murmur to the carotids
3. Which of the following is LEAST likely to be associated
with an "innocent" flow murmur;
A) A patient with Hyperthyroidism
B) A patient who uses IV drugs
C) A Pregnant patient
D) A patient with a severe Anemia
E) A patient with a high fever
4. All of the following can be associated with an "innocent"
flow murmur EXCEPT;
A) Ejection sound is usually audible on left lateral
decubitus position
B) Usually decreases or disappears on sitting
C) Located 2nd to 4th left interspaces between left sternal
border and apex
D) Murmur remains localized with an intensity of 1-2/6
E) Second heart sound splits on inspiration
5. An opening snap in the mitral area may be better heard;
A. Using the diaphragm of the stethoscope
B. Sitting the patient forward and listening while thepatient is inhaling
C. Both of the above
D. Neither of the Above
QUESTIONS 6-11 CONCERN THE SAME PATIENT
6) While covering another physician at a clinic, a nurse stops
you to tell you about a patient that has come without an
appointment complaining of a severe headache. She tells you that
this patient comes to the clinic at least once a week always
complaining of something different. You review her chart which is
quite thick and includes numerous laboratory studies and x-ray
reports. The patient is a 45 year old elementary school teacher.
On entering the room, you notice the patient has been crying. The
MOST appropriate INITIAL response from you would be;
A) "Tell me about the headache"
B) "How long have you been depressed?"
C) Give her a box of tissues and ask "How can I help you?"
D) Give her a box of tissues but avoid any direct eye
contact so as not to embarrass her
E) "I will get the nurse to give you something for your
headache and then I will come back when you are a little calmer"
7) The patient tells you that the headache began that morning,
it is quite severe, and it is associated with nausea and
vomiting. The MOST appropriate next response from you would be;
A) Have you ever had this before?
B) Do you have a family history of headaches?
C) Have you been in contact with someone with meningitis?
D) Can you describe the headache for me?
E) Have you ever seen a neurologist for this?
8) As you continue to interview the patient you get the, following information: The headaches started shortly after amajor financial stress in her life, she drinks about a 6 pk of beer a week, she smokes 1 pack of cigarettes a day for 20 years. Her husband has coronary heart disease and may need bypass surgery, her sister was diagnosed as having migraine headaches,she has dysuria once every 3-4 months. As you are writing up herstory, which of the following would be MOST appropriate forCHIEF COMPLAINT:
A) Headache
B) Migraine Headache
C) Rule out Meningitis
D) Depression
E) Alcohol abuse
9) Of the following, which information is LEAST related to the
STORY OF PRESENT ILLNESS;
A) Husband needs bypass surgery
B) Alcohol history
C) History of Dysuria
D) Financial problems
E) Family history of headaches
10) After completing a detailed history of her chief complaint,
you believe she is depressed. Which of the following is helpful
in distinguishing between a serious medical illness and
depression;
A) Fatigue
B) Loss of Appetite
C) Loss of Weight
D) All of the Above
E) None of the above
11) You perform a focused neurologic examination on the patient.
which of the following neurologic signs is/are indicative of a
disease process;
A) Rinne test; Air conduction is better than bone
conduction.
B) Occasional beats of nystagmus are visible on extreme
lateral gaze in both directions.
C) Sustained clonus is demonstrated on testing both
Achilles reflexes
D) Depressed deep tendon reflexes in all extremities
E) All of the above
MATCH THE FOLLOWING NEUROLOGIC SIGNS WITH THE APPROPRIATE
ABNORMALITY;
12) On asked to say "ahh", the uvula is rises to the left.
13) When asked to stick out the tongue, there is deviation to the
right with atrophy of that half of the tongue.
14) When asked to smile, there is flattening of the nasolabial
fold on the right.
15) When asked to turn head tothe right against resistance, there
is decreased definition of the sternocleidomastoid muscles on
that side.
16) When asked to follow a finger with the eyes until it touches
T me nose of the patient, there is constriction of the pupils
A) Glossopharyngeal and Vagus nerve deficit
B) Bells palsy (VII)
C) XII nerve palsy
D) XI nerve palsy
E) Normal finding
QUESTIONS 17 AND 18 ARE REGARDING CEREBELLAR TESTS
17) Which of the following are tests of cerebellar function?
A) Finger to nose
B) Babinski sign
C) Both of the Above
D) Neither of the Above
18) Which of the following are tests of cerebellar function?
A) Rapid alternating movements
B) Gait
C) Both of the Above
D) Neither of the Above
19) All of the following are true with regards to examination of
the oral cavity EXCEPT:
A) Unilateral fasciculation of the tongue is indicative of
Hypoglossal nerve deficit
B) Cancers frequently affect the lateral surfaces of the
tongue
C)Leukoplakia in a smoker is a normal finding and does not
require follow-up
D) Poor dental hygiene may be a risk for pulmonary
infections
E) Erosion of the enamel on the buccal side of the teeth
may indicate reflux esophagitis
20) On examination of the head/neck, all of the following
findings are considered normal variants EXCEPT;
A)Torus (or Tori)
B) Tophus (or Tophi)
C) Light Reflex of tympanic membrane
D) Red Reflex of fundus
E) "Cheesy debris" in tonsillar crypts
21) A 28 year old woman who moved to Houston 3 years ago presents
for complaints of "sinus problems". She brings with her a set of
recent sinus X-rays demonstrating opacification of both maxillary
sinuses. On examination, she is uncomfortable and has an oral
temperature of 101° F. From this information, you would expect to
find all of the following EXCEPT;
A) purulent nasal discharge
B) throbbing occipital headache
C) tenderness to digital pressure over sinuses
D) inability to transilluminate sinuses
E) Translucent tympanic membrane
22) All of the following are true with regards to examination of
the ears EXCEPT;
A) In a child, the auricle should be pulled gently downward
for best visualization.
B) Foreign bodies are a common cause of ear complaints in a
child.
C) External otitis (swimmer's ear) is characterized by
intense pain on manipulation of the auricle.
D) Otitis media is characterizedby intense pain on
manipulation of the auricle.
E) All of the above
23) A 23 year old woman presents to you with concern about a lump
in her neck. Her mother has thyroid disease. Which of the
following is TRUE with reference-to the thyroid exam;
A) It is best palpated standing behind the patient and
having her swallow.
B) It is difficult to distinguish between thyroid and lymph
nodes on exam as both move together on swallowing.
C) Both of the above
D) Neither of the above
24) A 70 year old man presents with acute onset of hemiparesis.
On a detailed neurologic examination you notice an abnormality of
visual fields. Using a red match head and testing each of the
patient's eyes separately, you notice that the left visual field
of each eye is restricted when compared to your own. This defect
is BEST described as;
A) a scotoma
B) Bitemporal hemianopsia
C) Homonymous hemianopsia
D) Amaurosis
E) None of the above
25) A 16 year old girl presents with a painful eruption on her
right arm. Your colleague describes it to you on the telephone as
being grouped vesicles on an erythematous base. Of the following,
the BEST descriptive term for this lesion is;
A) purpuric
B) herpetiform
C) serpiginous
D) verrucous
E) papulosquamous
26) A 30 year old woman presents with a "mole" on her back. Which
of the following features is LEAST suggestive of a malignant
melanoma;
A) The lesion is located on non-sunexposed skin
B) The lesion is 8 mm in diameter
C) The lesion is primarily black, with some variation of Color
D) The border of the lesion is slightly notched andirregular
E) The lesion was present at birth.
QUESTIONS 27-29 REFER TO THE SAME PATIENT
27) On further examination of the above individual you notice
that the PMI (point of maximal impulse) is in the 6th Left
intercostal space at the mid-axillary line, there is an audible
53 at the base, and a blowing decrescendo diastolic murmur heard
best along the sternal border. The MOST likely cardiac
abnormality in this patient is;
A) Aortic Stenosis
B) Aortic Insufficiency
C) Mitral Stenosis
D) Mitral Insufficiency
E) Ventricular Septal defect
28) Regarding the above patient, which of the following signs
would you expect him to exhibit;
A) Waterhammer pulse (also known as Corrigan's or
Collapsing pulse)
B) Pulsus Tardus and Parvus (or plateau pulse)
C) Pulsus paradoxus
D) Pulsus alternans
E) Bigeminal pulse
29) A 68 year old man is admitted with chest pain and a
presumptive diagnosis of dissecting aortic aneurysm is made from
the history, examination, and review of the Chest X-ray (widened
mediastinum). Of the following, which finding is NOT CONSISTENT
with this diagnosis;
A) History of hypertension
B) Chest pain that worsens with exertion
C) Chest pain that is "tearing" in quality
D) Unilateral carotid bruit
E) Blood pressure 180/100 in the right arm and 110/70 in
the left arm
30) A 16 year old boy is found to be hypertensive at the time of
a routine physical examination for school. Neither of his parents
are hypertensive. He complains of cramps in his calves on running
one mile in physical education class. On examination his BP is
160/110 in both arms. There is a marked diminution in pulse
volume in both femoral arteries. The MOST likely cause of this
patient's hypertension is;
A) Essential hypertension
B) Pheochromocytoma
C) Patent Ductus Arteriosus
D) Coarctation of the Aorta
E) Dissecting aortic aneurysm
31) A 74 year old man is thought to have parkinsonism based on a
"pill rolling" tremor. Which of the following gaits would you
most LIKELY observe in this gentleman;
A) The gait is broad based and the patient may stagger or
lurch irregularly.
B) The patient may have difficulty getting started, then he
may take short shuffling steps because of rigidity.
C) Bilateral foot drop causes the patient to lift his feet
high, bending at the knees.
D) There is circumduction of the leg with the knee stiff,
often with scraping of the outside of the foot.
E) The patient may take short uneven high steps in a
jerking fashion. Romberg test is positive.
32) To test for accommodation:
A) Use a swinging flashlight
B) Have the patient look across the room and then suddenly
fix on an object held 6 inches from his/her nose
C) Both of the Above
D) Neither of the Above
33) All of the following statements about testing the integrity
of the Trigeminal nerve (V) are true EXCEPT;
A) In testing sensation, always compare the top half of
each side of the face with the bottom half.
B) In testing the corneal reflex, brush a wisp of cotton
across the cornea while the patient looks away. Look for blinking
on both sides.
C) In testing the masseter and temporalis muscles, have the
patient clench his teeth.
D) The jaw jerk is elicited by having the patient partially
open the mouth with the jaw relaxed, and tap on your finger which
is resting on the patient's chin.
E) A unilateral lesion to the trigeminal nerve will cause
the jaw to deviate to the side of the weak muscles when the
patient opens and closes his mouth.
34) To obtain an adequate examination of the heart, all of the
following are appropriate EXCEPT;
A) Having the patient sit forward to listen for aortic
murmurs
B) Having the patient lie on their left side to listen for
mitral murmurs
C) Using the bell of the stethoscope to listen for low
frequency sounds
D) Having the patient sit up or stand up to listen for
changes in murmurs
E) Listening to the heart through a hospital gown or
brassiere to comply with the modesty of the patient
35) A 58 year old man presents with low back pain after helping
someone move a refrigerator at work. All of the following
techniques would be helpful in determining the source of the pain
EXCEPT;
A) One should palpate the paraspinous muscles looking for
spasm and local tenderness.
B) One should look for protective splinting by observing
the mobility of the spine to flexion, extension, and rotation.
C) One should have the patient in a supine position and
passively flex the straightened leg at the hip up to 90 degrees
watching for pain or involuntary spasm.
D) Have the patient bend over and touch his toes looking
for any early flexion at the hips.
E)One should passively flex the neck with the patient lying
supine and look for nuchal rigidity or flexion of the knees
(Brudzinski's sign).
QUESTIONS 36-41 RELATE TO THE SAME PATIENT
36) A 68 year old man who has been a heavy smoker for many years
presents to the clinic with dyspnea on exertion and a productive
cough with green sputum. He first noticed the dyspnea about 1
year ago when he had difficulty climbing 2 flights of stairs.
This has progressed such that yesterday he had difficulty walking
across the room and today he is short of breath with minimal
exertion. All of the following are consistent with the diagnosis
of chronic bronchitis EXCEPT;
A) He has had a chronic cough for many years with about 1/2
cup of white sputum production daily.
B) He has a history of deep venous thrombosis.
C) Occasionally his chest feels tight and he feels like he
is wheezing.
D) A physician noted clubbing of his nails.
E) He had hemoptysis last year during an upper respiratory
infection.
37) On examining the chest of the above patient you notice faint
breath sounds, bilateral wheezing, but no crackles. A chest X-
ray reveals hyperexpanded and hyperlucent lung fields, flat
diaphragms, increased anterior-posterior diameter, and no areas
of increased density. Which of the following statements is/are
consistent with these findings;
A) The wheezing is indicative of bronchospasm.
B) The chest will be dull to percussion.
C) Whispered pectoriloquy will be present.
D) Egophony will be present.
E) All of the above.
38) The cardiac exam of the above patient reveals the following;
mild sternal lift, distant heart sounds, loud P2 and an S4. These
findings are MOST consistent with;
A) Atrial fibrillation.
B) Left ventricular failure.
C) Myocardial infarction.
D) Pulmonary stenosis.
E) Pulmonary hypertension.
39) Completing the examination of the above patient you note a
distended abdomen and severe peripheral edema (4+) from the feet
up to the sacrum as well as scrotal edema. All of the following
statements are true about detecting the presence of ascites
EXCEPT;
A) A protuberant abdomen with bulging flanks suggests the
possibility of ascitic fluid.
B) After mapping the borders of tympany and dullness by
percussion with the patient lying on his back, ask the patient to
turn onto one side and percuss and mark the borders again. In a
person with ascites, the borders between tympany and dullness
will change or "shift".
C) With the patient supine, tap your fingers sharply
against one flank and feel for a fluid wave on the opposite
flank. This maneuver may require an assistant.
D) The physical diagnosis tests for the presence of ascites
are quite sensitive and correlate well with the amount of ascitic
fluid present, even in obese patient.
E) The ability to ballotte the liver by making a brief
jabbing movement directly toward the anticipated structure and
feeling for it to "bounce" off your fingers, is confirmatory for
the presence of ascitic fluid.
40) Based on the information given for the above patient, theMOST likely cause(s) of ascites in THIS patient is/are;
A) Cirrhosis
B) Cor pulmonale
C) Both of the above
D) Neither of the above
41) A 42 year old man was diagnosed by endoscopy last year with a
duodenal ulcer. He now returns to clinic saying that he is having
the same symptoms again. All of the following is consistent with
active duodenal ulcer disease EXCEPT;
A) He had several episodes of hematochezia
B) He had several episodes of hematemesis
C) He said that his stool became black and tarry
D) Location of pain is primarily epigastric
E) Pain is relieved by antacids
42) A 48 year old woman with severe abdominal pain, was found to
have gallstones on ultrasound examination. This pain was MOST
likely;
A) Burning in quality
B) Steady aching, lasting hours
C) Localized to the periumbilical area
D) Relieved by meals
E) Associated with bloody stools
43) A 20 year old college student presents with 2 hours of severe
abdominal pain and fever. He is concerned he has acute
appendicitis. The following findings are consistent with this
diagnosis;
A) The initial pain starts in the periumbilical area and
then shifts to the right lower quadrant.
B) The pain is worsened by coughing.
C) Both of the Above
D) Neither of the Above
44) A 50 year old woman presents because she says that her skin
Es turning yellow. On examination, her sclera are icteric. All of
the following are consistent with your exam-.EXCEPT;
A) She eats a lot of carrots
B) Her urine is like coca-cola or dark tea
C) Her stools are light colored-or gray
D) Her skin itches
E) She feels very fatigued
45) A 38 year old man is found to have. the following findings on
physical examination; muscle wasting, spider angiomata, palmar