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1. A 38-year-old accountant comes to your clinic for eval- B
uation of a headache. The throbbing sensation is lo-
cated in the right temporal region and is an 8 on a
scale of 1 to 10. It started a few hours ago, and she
has noted nausea with sensitivity to light; she has had
headaches like this in the past, usually less than one
per week, but not as severe. She does not know of
any inciting factors. There has been no change in the
frequency of her headaches. She usually takes an over
the-counter analgesic, and this results in resolution of
the headache. Based on this description, what is the
most likely diagnosis of the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound
2. A 29-year-old computer programmer comes to your A
office for evaluation of a headache. The tightening
sensation is located all over the head and is of mod-
erate intensity. It used to last minutes, but this time it
has lasted for 5 days. He denies photophobia and nau-
sea. He spends several hours each day at a comput-
er monitor/keyboard. He has tried over-the-counter
medication; it has dulled the pain but not taken it
away. Based on this description, what is your
most likely diagnosis?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound
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3. Which of the following is a symptom involving the A
eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea
4. A 49-year-old administrative assistant comes to your A
office for evaluation of dizziness. You elicit the infor-
mation that the dizziness is a spinning sensation of
sudden onset, worse with head position changes. The
episodes last a few seconds and then go away, and
they are accompanied by intense nausea. She has
vomited one time. She denies tinnitus. You perform a
physical examination of the head and neck and note
that the patient's hearing is intact to Weber and Rinne
and that there is nystagmus. Her gait is normal. Based
on this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma
5. A 55-year-old bank teller comes to your office for per- C
sistent episodes of dizziness. The first episode started
suddenly and lasted 3 to 4 hours. He experienced
a lot of nausea with vomiting; the episode resolved
spontaneously. He has had five episodes in the past
1½ weeks. He does note
some tinnitus that comes and goes. Upon physical
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examination, you note that he has a normal gait. The
Weber localizes to the right side and the air conduc-
tion is equal to the bone conduction in the right ear.
Nystagmus is present. Based on this description, what
is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma
6. A 73-year-old nurse comes to your office for eval- D
uation of new onset of tremors. She is not on any
medications and does not take herbs or supplements.
She has no chronic medical conditions. She does not
smoke or drink alcohol. She walks into the examina-
tion room with slow movements and shuffling steps.
She has decreased facial mobility and a blunt expres-
sion,
without any changes in hair distribution on her face.
Based on this description, what is the most likely rea-
son for the patient's symptoms?
A) Cushing's syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson's disease
7. A 29-year-old physical therapist presents for evalua- B
tion of an eyelid problem. On observation, the right
eyeball appears to be protruding forward. Based on
this description, what is the most likely diagnosis?
A) Ptosis
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B) Exophthalmos
C) Ectropion
D) Epicanthus
8. A 12-year-old presents to the clinic with his father for C
evaluation of a painful lump in the left eye. It started
this morning. He denies any trauma or injury. There
is no visual disturbance. Upon physical examination,
there is a red raised area at the margin of the eyelid
that is tender to palpation; no tearing occurs with pal-
pation of the lesion. Based on this description, what is
the
most likely diagnosis?
A) Dacryocystitis
B) Chalazion
C) Hordeolum
D) Xanthelasma
9. A 15-year-old high school sophomore presents to the D
emergency room with his mother for evaluation of
an area of blood in the left eye. He denies trauma
or injury but has been coughing forcefully with a re-
cent cold. He denies visual disturbances, eye pain, or
discharge from the eye. On physical examination, the
pupils are equal, round, and reactive to light, with a
visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a
homogeneous, sharply demarcated area at the lateral
aspect of the base of the left eye. The cornea is clear.
Based on this description, what is the most likely di-
agnosis?