medicine pre test.
Medicine Pretest for Family
Medicine*496 VERIFIED QUESTIONS
AND ANSWERS.
1. A 30-year-old male patient complains of fever and sore throat for several days. The patient
presents to you today with additional complaints of hoarseness, difficulty breathing, and
drooling. On examination, the patient is febrile and has inspiratory stridor. Which of the
following is the best course of action?
a. Begin outpatient treatment with ampicillin.
b. Culture throat for β-hemolytic streptococci.
c. Admit to intensive care unit and obtain otolaryngology consultation.
d. Schedule for chest x-ray.
e. Obtain Epstein-Barr serology.
2. A 70-year-old patient with long-standing type 2 diabetes mellitus presents with complaints of
pain in the left ear with purulent drainage. On physical examination, the patient is afebrile. The
pinna of the left ear is tender, and the external auditory canal is swollen and edematous. The
white blood cell count is normal. Which of the following organisms is most likely to grow from
the purulent drainage?
a. Pseudomonas aeruginosa
b. Streptococcus pneumoniae
c. Candida albicans
d. Haemophilus influenzae
e. Moraxella catarrhalis
3. A 25-year-old male student presents with the chief complaint of rash. He denies headache, fever,
or myalgia. A slightly pruritic maculo-papular rash is noted over the abdomen, trunk, palms of
the hands, and soles of the feet. Inguinal, occipital, and cervical lymphadenopathy is also noted.
Hypertrophic, flat, wart-like lesions are noted around the anal area. Laboratory studies show the
following:
Hct: 40%
Hgb: 14 g/dL
WBC: 13,000/µL
Diff: 50% segmented neutrophils, 50% lymphocytes
Which of the following is the most useful laboratory test in this patient?
a. Weil-Felix titer
b. Venereal Disease Research Laboratory (VDRL) test
c. Chlamydia titer
d. Blood cultures
e. Biopsy of perianal lesions
4. A 35-year-old previously healthy male develops cough with purulent sputum over several days.
On presentation to the emergency room, he is lethargic. Temperature is 39 C, pulse 110, and
blood pressure 100/70. He has rales and dullness to percussion at the left base. There is no rash.
Flexion of the patient’s neck when supine results in spontaneous flexion of hip and knee.
Neurologic examination is otherwise normal. There is no papilledema. A lumbar puncture is
performed in the emergency room. The cerebrospinal fluid (CSF) shows 8000 leukocytes/µL,
,medicine pre test.
90% of which are polys. Glucose is 30 mg/dL with a peripheral glucose of 80 mg/dL. CSF
protein is elevated to 200 mg/dL. A CSF Gram stain shows gram-positive diplococci. Which of
the following is the correct treatment option?
,medicine pre test.
a. Begin acyclovir for herpes simplex encephalitis.
b. Obtain emergency MRI scan before beginning treatment.
c. Begin ceftriaxone and vancomycin for pneumococcal meningitis.
d. Begin ceftriaxone, vancomycin, and ampicillin to cover both pneumococci and Listeria.
e. Begin high-dose penicillin for meningococcal meningitis.
5. A 20-year-old female college student presents with a 5-day history of cough, low-grade fever
(temperature 37.8 C [100 F]), sore throat, and coryza. On examination, there is mild
conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is
seen. Chest examination shows a few basilar rales. Sputum Gram stain shows white blood cells
without organisms. Laboratory findings are as follows:
Hct: 31
WBC: 12,000/µL
Lymphocytes: 50%
Mean corpuscular volume (MCV): 94 nL
Reticulocytes: 9% of red cells
CXR: bilateral patchy lower lobe infiltrates
Which of the following is the best method for confirmation of the diagnosis?
a. High titers of antibody to adenovirus
b. High titers of IgM cold agglutinins or complement fixation test
c. Methenamine silver stain
d. Blood culture
e. Culture of sputum on chocolate media
8. A 30-year-old male presents with right upper quadrant pain. He has been well except for an
episode of diarrhea that occurred 4 months ago, just after he returned from a missionary trip to
Mexico. He has lost 7 pounds. He is not having diarrhea. His blood pressure is 140/70, pulse 80,
and temperature 37.5 C (99.5 F). On physical examination there is right upper-quadrant
tenderness without rebound. There is some radiation of the pain to the shoulder. The liver is
percussed at 14 cm. There is no lower-quadrant tenderness. Bowel sounds are normal and active.
Which of the following is the most appropriate next step in evaluation of the patient?
a. Serology and ultrasound
b. Stool for ova and parasite
c. Blood cultures
d. Diagnostic aspirate
e. Empiric broad-spectrum antibiotic therapy
9. An 80-year-old male complains of a 3-day history of a painful rash extending over the left half
of his forehead and down to his left eyelid. There are weeping vesicular lesions on physical
examination. Which of the following is the most likely diagnosis?
a. Impetigo
b. Adult chickenpox
c. Herpes zoster
d. Coxsackie A virus
e. Herpes simplex
, medicine pre test.
10. A 28-year-old female presents to her internist with a 2-day history of low-grade fever and
lower abdominal pain. She denies nausea, vomiting, or diarrhea. On physical examination,
there is temperature of 38.3 C (100.9 F) and bilateral lower quadrant tenderness, without point
or rebound tenderness. Bowel sounds are normal. On pelvic examination, an exudate is
present and there is tenderness on motion of the cervix. Her white blood cell count is 15,000/µL
and urinalysis shows no red or white blood cells. Serum β-hCG is undetectable. Which of the
following is the best next step in management?
a. Treatment with ceftriaxone and doxycycline
b. Endometrial biopsy
c. Surgical exploration
d. Dilation and curettage
e. Aztreonam
12. A 25-year-old woman complains of dysuria, frequency, and supra-pubic pain. She has not had
previous symptoms of dysuria and is not on antibiotics. She is sexually active and on birth
control pills. She has no fever, vaginal discharge or history of herpes infection. She denies back
pain, nausea, or vomiting. On physical examination she appears well and has no costo-vertebral
angle tenderness. A urinalysis shows 20 white blood cells per high power field. Which of the
following statements is correct?
a. A 3-day regimen of trimethoprim-sulfamethoxazole is adequate therapy.
b. Quantitative urine culture with antimicrobial sensitivity testing is mandatory.
c. Obstruction resulting from renal stone should be ruled out by ultrasound.
d. Low-dose antibiotic therapy should be prescribed while the patient remains sexually active.
e. The etiologic agent is more likely to be sensitive to trimethoprim-sulfamethoxazole than to
fluoroquinolones.
14. You are a physician in charge of patients who reside in a nursing home. Several of the patients
have developed influenza-like symptoms, and the community is in the midst of influenza A
outbreak. None of the nursing home residents have received the influenza vaccine. Which
course of action is most appropriate?
a. Give the influenza vaccine to all residents who do not have a contraindication to the vaccine (ie,
allergy to eggs).
b. Give the influenza vaccine to all residents who do not have a contraindication to the vaccine;
also give oseltamivir for 2 weeks to all residents.
c. Give amantadine alone to all residents.
d. Give azithromycin to all residents to prevent influenza-associated pneumonia.
e. Do not give any prophylactic regimen.
18. A 40-year-old female nurse was admitted to the hospital because of fever to 39.4 C (103 F).
Despite a thorough workup in the hospital for over 3 weeks, no etiology has been found, and
she continues to have temperature spikes greater than 38.9 C (102 F). Which of the following
statements about diagnosis is correct?
a. Chronic infection, malignancy, and collagen vascular disease are the most common
explanations for this presentation.
b. Influenza may also present in this manner.
c. Lymphoma can be ruled out in the absence of palpable lymphadenopathy.
d. SLE is an increasing cause for this syndrome.
e. Factitious fever should be considered only in the patient with known psychopathology.
Medicine Pretest for Family
Medicine*496 VERIFIED QUESTIONS
AND ANSWERS.
1. A 30-year-old male patient complains of fever and sore throat for several days. The patient
presents to you today with additional complaints of hoarseness, difficulty breathing, and
drooling. On examination, the patient is febrile and has inspiratory stridor. Which of the
following is the best course of action?
a. Begin outpatient treatment with ampicillin.
b. Culture throat for β-hemolytic streptococci.
c. Admit to intensive care unit and obtain otolaryngology consultation.
d. Schedule for chest x-ray.
e. Obtain Epstein-Barr serology.
2. A 70-year-old patient with long-standing type 2 diabetes mellitus presents with complaints of
pain in the left ear with purulent drainage. On physical examination, the patient is afebrile. The
pinna of the left ear is tender, and the external auditory canal is swollen and edematous. The
white blood cell count is normal. Which of the following organisms is most likely to grow from
the purulent drainage?
a. Pseudomonas aeruginosa
b. Streptococcus pneumoniae
c. Candida albicans
d. Haemophilus influenzae
e. Moraxella catarrhalis
3. A 25-year-old male student presents with the chief complaint of rash. He denies headache, fever,
or myalgia. A slightly pruritic maculo-papular rash is noted over the abdomen, trunk, palms of
the hands, and soles of the feet. Inguinal, occipital, and cervical lymphadenopathy is also noted.
Hypertrophic, flat, wart-like lesions are noted around the anal area. Laboratory studies show the
following:
Hct: 40%
Hgb: 14 g/dL
WBC: 13,000/µL
Diff: 50% segmented neutrophils, 50% lymphocytes
Which of the following is the most useful laboratory test in this patient?
a. Weil-Felix titer
b. Venereal Disease Research Laboratory (VDRL) test
c. Chlamydia titer
d. Blood cultures
e. Biopsy of perianal lesions
4. A 35-year-old previously healthy male develops cough with purulent sputum over several days.
On presentation to the emergency room, he is lethargic. Temperature is 39 C, pulse 110, and
blood pressure 100/70. He has rales and dullness to percussion at the left base. There is no rash.
Flexion of the patient’s neck when supine results in spontaneous flexion of hip and knee.
Neurologic examination is otherwise normal. There is no papilledema. A lumbar puncture is
performed in the emergency room. The cerebrospinal fluid (CSF) shows 8000 leukocytes/µL,
,medicine pre test.
90% of which are polys. Glucose is 30 mg/dL with a peripheral glucose of 80 mg/dL. CSF
protein is elevated to 200 mg/dL. A CSF Gram stain shows gram-positive diplococci. Which of
the following is the correct treatment option?
,medicine pre test.
a. Begin acyclovir for herpes simplex encephalitis.
b. Obtain emergency MRI scan before beginning treatment.
c. Begin ceftriaxone and vancomycin for pneumococcal meningitis.
d. Begin ceftriaxone, vancomycin, and ampicillin to cover both pneumococci and Listeria.
e. Begin high-dose penicillin for meningococcal meningitis.
5. A 20-year-old female college student presents with a 5-day history of cough, low-grade fever
(temperature 37.8 C [100 F]), sore throat, and coryza. On examination, there is mild
conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is
seen. Chest examination shows a few basilar rales. Sputum Gram stain shows white blood cells
without organisms. Laboratory findings are as follows:
Hct: 31
WBC: 12,000/µL
Lymphocytes: 50%
Mean corpuscular volume (MCV): 94 nL
Reticulocytes: 9% of red cells
CXR: bilateral patchy lower lobe infiltrates
Which of the following is the best method for confirmation of the diagnosis?
a. High titers of antibody to adenovirus
b. High titers of IgM cold agglutinins or complement fixation test
c. Methenamine silver stain
d. Blood culture
e. Culture of sputum on chocolate media
8. A 30-year-old male presents with right upper quadrant pain. He has been well except for an
episode of diarrhea that occurred 4 months ago, just after he returned from a missionary trip to
Mexico. He has lost 7 pounds. He is not having diarrhea. His blood pressure is 140/70, pulse 80,
and temperature 37.5 C (99.5 F). On physical examination there is right upper-quadrant
tenderness without rebound. There is some radiation of the pain to the shoulder. The liver is
percussed at 14 cm. There is no lower-quadrant tenderness. Bowel sounds are normal and active.
Which of the following is the most appropriate next step in evaluation of the patient?
a. Serology and ultrasound
b. Stool for ova and parasite
c. Blood cultures
d. Diagnostic aspirate
e. Empiric broad-spectrum antibiotic therapy
9. An 80-year-old male complains of a 3-day history of a painful rash extending over the left half
of his forehead and down to his left eyelid. There are weeping vesicular lesions on physical
examination. Which of the following is the most likely diagnosis?
a. Impetigo
b. Adult chickenpox
c. Herpes zoster
d. Coxsackie A virus
e. Herpes simplex
, medicine pre test.
10. A 28-year-old female presents to her internist with a 2-day history of low-grade fever and
lower abdominal pain. She denies nausea, vomiting, or diarrhea. On physical examination,
there is temperature of 38.3 C (100.9 F) and bilateral lower quadrant tenderness, without point
or rebound tenderness. Bowel sounds are normal. On pelvic examination, an exudate is
present and there is tenderness on motion of the cervix. Her white blood cell count is 15,000/µL
and urinalysis shows no red or white blood cells. Serum β-hCG is undetectable. Which of the
following is the best next step in management?
a. Treatment with ceftriaxone and doxycycline
b. Endometrial biopsy
c. Surgical exploration
d. Dilation and curettage
e. Aztreonam
12. A 25-year-old woman complains of dysuria, frequency, and supra-pubic pain. She has not had
previous symptoms of dysuria and is not on antibiotics. She is sexually active and on birth
control pills. She has no fever, vaginal discharge or history of herpes infection. She denies back
pain, nausea, or vomiting. On physical examination she appears well and has no costo-vertebral
angle tenderness. A urinalysis shows 20 white blood cells per high power field. Which of the
following statements is correct?
a. A 3-day regimen of trimethoprim-sulfamethoxazole is adequate therapy.
b. Quantitative urine culture with antimicrobial sensitivity testing is mandatory.
c. Obstruction resulting from renal stone should be ruled out by ultrasound.
d. Low-dose antibiotic therapy should be prescribed while the patient remains sexually active.
e. The etiologic agent is more likely to be sensitive to trimethoprim-sulfamethoxazole than to
fluoroquinolones.
14. You are a physician in charge of patients who reside in a nursing home. Several of the patients
have developed influenza-like symptoms, and the community is in the midst of influenza A
outbreak. None of the nursing home residents have received the influenza vaccine. Which
course of action is most appropriate?
a. Give the influenza vaccine to all residents who do not have a contraindication to the vaccine (ie,
allergy to eggs).
b. Give the influenza vaccine to all residents who do not have a contraindication to the vaccine;
also give oseltamivir for 2 weeks to all residents.
c. Give amantadine alone to all residents.
d. Give azithromycin to all residents to prevent influenza-associated pneumonia.
e. Do not give any prophylactic regimen.
18. A 40-year-old female nurse was admitted to the hospital because of fever to 39.4 C (103 F).
Despite a thorough workup in the hospital for over 3 weeks, no etiology has been found, and
she continues to have temperature spikes greater than 38.9 C (102 F). Which of the following
statements about diagnosis is correct?
a. Chronic infection, malignancy, and collagen vascular disease are the most common
explanations for this presentation.
b. Influenza may also present in this manner.
c. Lymphoma can be ruled out in the absence of palpable lymphadenopathy.
d. SLE is an increasing cause for this syndrome.
e. Factitious fever should be considered only in the patient with known psychopathology.
