1
FITZ Exit Exam Actual Exam 2025/2026 –
Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
[SECTION 1: Diagnostic Reasoning & Clinical Decision-Making — Questions 1-18]
Q1: A 52-year-old male presents with acute onset of severe chest pain that radiates to his left arm
and jaw. He is diaphoretic and reports nausea. The 12-lead ECG demonstrates ST-segment
elevation in leads V1 through V4. Which of the following is the most appropriate initial
diagnostic step to confirm the diagnosis and determine immediate treatment?
A. Obtain a CT angiography of the chest to rule out aortic dissection.
B. Measure cardiac biomarkers (troponin I and T) to assess for myocardial necrosis.
C. Perform urgent bedside echocardiography to visualize wall motion abnormalities.
D. Review the ECG findings which are diagnostic for ST-elevation Myocardial Infarction
(STEMI).
Correct Answer: D
Rationale: The patient presents with classic symptoms of myocardial ischemia and the ECG
shows ST-elevation in the anterior leads (V1-V4), which is diagnostic for an anterior STEMI.
While biomarkers will eventually be elevated, they are not required to diagnose STEMI or
initiate reperfusion therapy; time is muscle, and reperfusion (PCI or fibrinolysis) should occur
based on the ECG. CT angiography is for suspected dissection or PE, not primary STEMI
diagnosis. Echocardiography may show wall motion abnormalities but does not change the
immediate need for reperfusion. Immediate activation of the cath lab is the standard of care.
Q2: A 65-year-old female presents with a sudden onset of severe headache described as "the
worst of my life." She has a history of hypertension. Her neurological exam is non-focal. A non-
contrast CT head is ordered. What is the primary rationale for ordering this specific test first?
A. To differentiate between ischemic and hemorrhagic stroke prior to administering
thrombolytics.
B. To visualize cerebral vasospasm associated with a subarachnoid hemorrhage.
,2
C. To assess for the presence of a brain tumor causing increased intracranial pressure.
D. To detect acute blood (hyperdensity) indicative of a subarachnoid hemorrhage (SAH).
Correct Answer: D
Rationale: In a patient with a "thunderclap" headache, suspicion for subarachnoid hemorrhage
(SAH) is high. A non-contrast CT head is the initial diagnostic test of choice because it is highly
sensitive for acute blood within the first 6-12 hours. If the CT is negative and suspicion remains
high, a lumbar puncture is performed to look for xanthochromia. While distinguishing stroke
types is a function of CT, the description here points toward SAH. Vasospasm is a delayed
complication, not an acute finding. Tumors usually present with a more gradual history.
Q3: A 28-year-old female presents with a 2-day history of dysuria, urinary frequency, and
suprapubic pain. She has no fever or flank pain. A urinalysis is positive for leukocyte esterase
and nitrites. She has no known drug allergies. Which of the following is the most appropriate
diagnostic or management approach?
A. Obtain a urine culture and sensitivity prior to starting antibiotics.
B. Treat with empiric antibiotics for uncomplicated cystitis without a culture.
C. Perform a pelvic exam to rule out pelvic inflammatory disease.
D. Order a renal ultrasound to assess for hydronephrosis.
Correct Answer: B
Rationale: The patient presents with classic symptoms of uncomplicated acute cystitis in a non-
pregnant female. The presence of nitrites confirms gram-negative bacteria (likely E. coli).
Current guidelines recommend empiric antibiotic treatment (e.g., Nitrofurantoin or TMP-SMX)
without obtaining a urine culture, as it does not change outcomes and increases costs. A pelvic
exam is not indicated without vaginal symptoms or cervical motion tenderness. Imaging is
reserved for complicated UTIs (fever, flank pain, or immunosuppression).
Q4: A 45-year-old male presents for a routine commercial driver’s license exam. His blood
pressure is 158/92 mmHg in both arms. He denies headaches, vision changes, or chest pain.
According to ACC/AHA guidelines, what is the next best step in the management of this patient?
A. Initiate antihypertensive pharmacotherapy immediately.
,3
B. Repeat blood pressure measurement at a later visit or confirm with out-of-office monitoring.
C. Order a comprehensive metabolic panel (CMP) and lipid panel to assess for end-organ
damage.
D. Refer to the emergency department for immediate blood pressure management.
Correct Answer: B
Rationale: The diagnosis of hypertension requires confirmation out of the clinical setting
(Ambulatory Blood Pressure Monitoring - ABPM or Home Blood Pressure Monitoring - HBPM)
unless the patient has Stage 2 HTN (≥140/90) with high cardiovascular risk or end-organ
damage. This patient is asymptomatic. While labs will eventually be needed to assess renal
function and electrolytes, confirmation of the diagnosis is the priority. Immediate medication or
ED referral is not indicated for asymptomatic hypertension without evidence of hypertensive
emergency.
Q5: A 70-year-old male presents with progressive fatigue and shortness of breath on exertion.
His complete blood count (CBC) reveals Hemoglobin 9.0 g/dL, Mean Corpuscular Volume
(MCV) 78 fL, and Ferritin 8 ng/mL. Which of the following is the most likely diagnosis?
A. Vitamin B12 deficiency anemia.
B. Anemia of chronic disease.
C. Iron deficiency anemia.
D. Thalassemia minor.
Correct Answer: C
Rationale: The patient presents with microcytic anemia (low MCV). The ferritin level of 8 ng/mL
is diagnostic for iron deficiency anemia (IDA). In adults, IDA is almost always due to blood loss,
often from the GI tract, requiring colonoscopy or endoscopy. B12 deficiency causes macrocytic
anemia. Anemia of chronic disease typically has normal or high ferritin. Thalassemia minor
usually presents with very low MCV but mild anemia and normal iron studies.
Q6: A 22-year-old college student presents with fever, pharyngitis, and posterior cervical
lymphadenopathy. A rapid strep antigen test is negative. A CBC is performed which shows mild
, 4
leukocytosis with a lymphocyte predominance and atypical lymphocytes. Which of the following
is the most appropriate next step?
A. Treat with amoxicillin for presumed streptococcal pharyngitis.
B. Order a Monospot test (heterophile antibody test).
C. Perform a throat culture to rule out strep throat.
D. Prescribe oral corticosteroids to reduce airway swelling.
Correct Answer: B
Rationale: The clinical presentation (fever, pharyngitis, posterior cervical nodes) and CBC
findings (atypical lymphocytosis) are classic for Infectious Mononucleosis (EBV). Since the
rapid strep is negative, a Monospot test is indicated to confirm EBV. Amoxicillin is
contraindicated if mono is suspected due to the risk of a characteristic rash. Throat culture is
usually not needed if rapid strep is negative and clinical picture suggests mono, though can be
considered if high suspicion remains. Steroids are only indicated for complications like airway
obstruction.
Q7: A 55-year-old female presents with a breast lump. She notes it is smooth, mobile, and firm.
She has no family history of breast cancer. An ultrasound is performed which shows a simple,
fluid-filled cyst. Which of the following is the most appropriate management?
A. Aspiration of the cyst for cytology.
B. Core needle biopsy.
C. Observation and reassurance.
D. Referral for surgical excision.
Correct Answer: C
Rationale: A simple, fluid-filled cyst on ultrasound in a woman with no other risk factors is
benign. Aspiration is only indicated if the cyst is symptomatic (pain) or if it has complex features
(solid components). Biopsy and excision are not indicated for simple cysts. Routine observation
with patient education on breast self-awareness is the standard of care.
FITZ Exit Exam Actual Exam 2025/2026 –
Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
[SECTION 1: Diagnostic Reasoning & Clinical Decision-Making — Questions 1-18]
Q1: A 52-year-old male presents with acute onset of severe chest pain that radiates to his left arm
and jaw. He is diaphoretic and reports nausea. The 12-lead ECG demonstrates ST-segment
elevation in leads V1 through V4. Which of the following is the most appropriate initial
diagnostic step to confirm the diagnosis and determine immediate treatment?
A. Obtain a CT angiography of the chest to rule out aortic dissection.
B. Measure cardiac biomarkers (troponin I and T) to assess for myocardial necrosis.
C. Perform urgent bedside echocardiography to visualize wall motion abnormalities.
D. Review the ECG findings which are diagnostic for ST-elevation Myocardial Infarction
(STEMI).
Correct Answer: D
Rationale: The patient presents with classic symptoms of myocardial ischemia and the ECG
shows ST-elevation in the anterior leads (V1-V4), which is diagnostic for an anterior STEMI.
While biomarkers will eventually be elevated, they are not required to diagnose STEMI or
initiate reperfusion therapy; time is muscle, and reperfusion (PCI or fibrinolysis) should occur
based on the ECG. CT angiography is for suspected dissection or PE, not primary STEMI
diagnosis. Echocardiography may show wall motion abnormalities but does not change the
immediate need for reperfusion. Immediate activation of the cath lab is the standard of care.
Q2: A 65-year-old female presents with a sudden onset of severe headache described as "the
worst of my life." She has a history of hypertension. Her neurological exam is non-focal. A non-
contrast CT head is ordered. What is the primary rationale for ordering this specific test first?
A. To differentiate between ischemic and hemorrhagic stroke prior to administering
thrombolytics.
B. To visualize cerebral vasospasm associated with a subarachnoid hemorrhage.
,2
C. To assess for the presence of a brain tumor causing increased intracranial pressure.
D. To detect acute blood (hyperdensity) indicative of a subarachnoid hemorrhage (SAH).
Correct Answer: D
Rationale: In a patient with a "thunderclap" headache, suspicion for subarachnoid hemorrhage
(SAH) is high. A non-contrast CT head is the initial diagnostic test of choice because it is highly
sensitive for acute blood within the first 6-12 hours. If the CT is negative and suspicion remains
high, a lumbar puncture is performed to look for xanthochromia. While distinguishing stroke
types is a function of CT, the description here points toward SAH. Vasospasm is a delayed
complication, not an acute finding. Tumors usually present with a more gradual history.
Q3: A 28-year-old female presents with a 2-day history of dysuria, urinary frequency, and
suprapubic pain. She has no fever or flank pain. A urinalysis is positive for leukocyte esterase
and nitrites. She has no known drug allergies. Which of the following is the most appropriate
diagnostic or management approach?
A. Obtain a urine culture and sensitivity prior to starting antibiotics.
B. Treat with empiric antibiotics for uncomplicated cystitis without a culture.
C. Perform a pelvic exam to rule out pelvic inflammatory disease.
D. Order a renal ultrasound to assess for hydronephrosis.
Correct Answer: B
Rationale: The patient presents with classic symptoms of uncomplicated acute cystitis in a non-
pregnant female. The presence of nitrites confirms gram-negative bacteria (likely E. coli).
Current guidelines recommend empiric antibiotic treatment (e.g., Nitrofurantoin or TMP-SMX)
without obtaining a urine culture, as it does not change outcomes and increases costs. A pelvic
exam is not indicated without vaginal symptoms or cervical motion tenderness. Imaging is
reserved for complicated UTIs (fever, flank pain, or immunosuppression).
Q4: A 45-year-old male presents for a routine commercial driver’s license exam. His blood
pressure is 158/92 mmHg in both arms. He denies headaches, vision changes, or chest pain.
According to ACC/AHA guidelines, what is the next best step in the management of this patient?
A. Initiate antihypertensive pharmacotherapy immediately.
,3
B. Repeat blood pressure measurement at a later visit or confirm with out-of-office monitoring.
C. Order a comprehensive metabolic panel (CMP) and lipid panel to assess for end-organ
damage.
D. Refer to the emergency department for immediate blood pressure management.
Correct Answer: B
Rationale: The diagnosis of hypertension requires confirmation out of the clinical setting
(Ambulatory Blood Pressure Monitoring - ABPM or Home Blood Pressure Monitoring - HBPM)
unless the patient has Stage 2 HTN (≥140/90) with high cardiovascular risk or end-organ
damage. This patient is asymptomatic. While labs will eventually be needed to assess renal
function and electrolytes, confirmation of the diagnosis is the priority. Immediate medication or
ED referral is not indicated for asymptomatic hypertension without evidence of hypertensive
emergency.
Q5: A 70-year-old male presents with progressive fatigue and shortness of breath on exertion.
His complete blood count (CBC) reveals Hemoglobin 9.0 g/dL, Mean Corpuscular Volume
(MCV) 78 fL, and Ferritin 8 ng/mL. Which of the following is the most likely diagnosis?
A. Vitamin B12 deficiency anemia.
B. Anemia of chronic disease.
C. Iron deficiency anemia.
D. Thalassemia minor.
Correct Answer: C
Rationale: The patient presents with microcytic anemia (low MCV). The ferritin level of 8 ng/mL
is diagnostic for iron deficiency anemia (IDA). In adults, IDA is almost always due to blood loss,
often from the GI tract, requiring colonoscopy or endoscopy. B12 deficiency causes macrocytic
anemia. Anemia of chronic disease typically has normal or high ferritin. Thalassemia minor
usually presents with very low MCV but mild anemia and normal iron studies.
Q6: A 22-year-old college student presents with fever, pharyngitis, and posterior cervical
lymphadenopathy. A rapid strep antigen test is negative. A CBC is performed which shows mild
, 4
leukocytosis with a lymphocyte predominance and atypical lymphocytes. Which of the following
is the most appropriate next step?
A. Treat with amoxicillin for presumed streptococcal pharyngitis.
B. Order a Monospot test (heterophile antibody test).
C. Perform a throat culture to rule out strep throat.
D. Prescribe oral corticosteroids to reduce airway swelling.
Correct Answer: B
Rationale: The clinical presentation (fever, pharyngitis, posterior cervical nodes) and CBC
findings (atypical lymphocytosis) are classic for Infectious Mononucleosis (EBV). Since the
rapid strep is negative, a Monospot test is indicated to confirm EBV. Amoxicillin is
contraindicated if mono is suspected due to the risk of a characteristic rash. Throat culture is
usually not needed if rapid strep is negative and clinical picture suggests mono, though can be
considered if high suspicion remains. Steroids are only indicated for complications like airway
obstruction.
Q7: A 55-year-old female presents with a breast lump. She notes it is smooth, mobile, and firm.
She has no family history of breast cancer. An ultrasound is performed which shows a simple,
fluid-filled cyst. Which of the following is the most appropriate management?
A. Aspiration of the cyst for cytology.
B. Core needle biopsy.
C. Observation and reassurance.
D. Referral for surgical excision.
Correct Answer: C
Rationale: A simple, fluid-filled cyst on ultrasound in a woman with no other risk factors is
benign. Aspiration is only indicated if the cyst is symptomatic (pain) or if it has complex features
(solid components). Biopsy and excision are not indicated for simple cysts. Routine observation
with patient education on breast self-awareness is the standard of care.
