Clin Skills Exam #3 Practice Q's
58-year-old woman with a history of diabetes mellitus presents to your office
with a complaint of finger pain. She says that when she flexes her right third
finger, it gets "stuck," and then snaps open quickly with manual manipulation.
After physical exam, she is diagnosed with trigger finger. Which of the
following is the next best step?
ASplinting
BSurgery
✅✅
CTopical analgesic
DWatchful waiting - -A Splinting
A 12 year-old female presents for a routine sports physical. The physical
exam reveals asymmetry of the posterior chest wall on forward bending. This
is the most striking and consistent abnormality of which of the following?
A
Spondylolysis
B
Spondolisthesis
✅✅
C Scoliosis
D Herniated disc - -C scoliosis
A 12-month-old in the emergency department is diagnosed with possible viral
meningitis. Which of the following cerebral spinal fluid (CSF) laboratory results
is most consistent with this diagnosis?
A
Decreased CSF glucose level and increased protein
B
Decreased CSF total protein level and very few neutrophils
C
Increased CSF mononuclear cells and normal glucose
✅✅
D
Increased CSF C-reactive protein and normal glucose - -C Increased
CSF mononuclear cells and normal glucose
A 13 year-old female presents to the office with right knee and thigh pain and
the inability to bear weight since waking yesterday morning. The mother states
the child had a fever of 100.9 degrees F this morning and continues to be non-
weight bearing. Examination reveals a warm, erythematous, swollen knee.
,Which of the following tests would be most beneficial in the diagnosis and
treatment of this patient?
A
Plain x-ray of the femur
B
Antistreptolysin O titer
C
Magnetic resonance imaging (MRI) of the femur
✅✅
D
Culture of joint aspirate - -D culture of joint aspirate
A 14 year-old patient, who fell on his outstretched hand, complains of pain
along his entire arm. There is point tenderness and swelling over the midshaft
of the radius. There is significant pain with limited flexion of the elbow joint. An
x-ray will most likely show which of the following fractures?
A
Galeazzi's
B
Scaphoid
C
Colles'
✅✅
D
Smith's - -A Galeazzi's
A 15 year-old softball player presents after jamming the distal tip of her finger
into severe flexion. She is unable to extend the distal phalanx and she has
pain on palpation of the distal interphalangeal joint. X-ray of the hand fails to
reveal any associated avulsion fracture. Which of the following is the
treatment of choice?
A
Open reduction and internal fixation
B
Continuous extension of the DIP with splinting
C
Continuous flexion of the PIP with splinting
✅✅
D
Application of short arm cast - -B continuous extension of the DIP with
splinting
, A 2-month-old infant has had a single, generalized tonic-clonic convulsion
lasting 4 to 5 minutes. There is no history of trauma and the infant had been
well previously. Physical findings include a temperature of 39.6 degrees C
(103.2 degrees F), a bulging tympanic membrane on the right, and an
inflamed pharynx. The next most appropriate step is to
A
Perform a lumbar puncture
B
Order x-ray studies of the skull
C
Obtain an electroencephalogram
✅✅
D
Send home with antibiotics and an anticonvulsant - -A perform a lumbar
puncture
A 21-year-old male college student is admitted to the hospital with suspected
meningitis. A lumbar puncture is performed. The results of the cerebrospinal
fluid (CSF) analysis reveals an elevated white blood cell count of 5,000/mcL
with over 90% neutrophils, a decreased glucose level of 35 mg/dL, and
elevated protein level of 150 mg/dL. What is the most likely diagnosis based
on these results?
A
Bacterial meningitis
B
Viral meningitis
C
Fungal meningitis
✅✅
D
Tuberculous meningitis - -A Bacterial meningitis
A 21-year-old man presents reporting that on several occasions in the last two
months he has awoken in a different room of his apartment or outside the
apartment. His roommate confirmed these nocturnal wanderings, but the
patient does not recall any episodes of sleepwalking. Which of the following
diagnostic studies would be most appropriate?
AHolter monitor worn for 48 hours
BHypocretin levels in the cerebrospinal fluid
✅✅
CMagnetic resonance imaging
DPolysomnography - -D Polysomnography
58-year-old woman with a history of diabetes mellitus presents to your office
with a complaint of finger pain. She says that when she flexes her right third
finger, it gets "stuck," and then snaps open quickly with manual manipulation.
After physical exam, she is diagnosed with trigger finger. Which of the
following is the next best step?
ASplinting
BSurgery
✅✅
CTopical analgesic
DWatchful waiting - -A Splinting
A 12 year-old female presents for a routine sports physical. The physical
exam reveals asymmetry of the posterior chest wall on forward bending. This
is the most striking and consistent abnormality of which of the following?
A
Spondylolysis
B
Spondolisthesis
✅✅
C Scoliosis
D Herniated disc - -C scoliosis
A 12-month-old in the emergency department is diagnosed with possible viral
meningitis. Which of the following cerebral spinal fluid (CSF) laboratory results
is most consistent with this diagnosis?
A
Decreased CSF glucose level and increased protein
B
Decreased CSF total protein level and very few neutrophils
C
Increased CSF mononuclear cells and normal glucose
✅✅
D
Increased CSF C-reactive protein and normal glucose - -C Increased
CSF mononuclear cells and normal glucose
A 13 year-old female presents to the office with right knee and thigh pain and
the inability to bear weight since waking yesterday morning. The mother states
the child had a fever of 100.9 degrees F this morning and continues to be non-
weight bearing. Examination reveals a warm, erythematous, swollen knee.
,Which of the following tests would be most beneficial in the diagnosis and
treatment of this patient?
A
Plain x-ray of the femur
B
Antistreptolysin O titer
C
Magnetic resonance imaging (MRI) of the femur
✅✅
D
Culture of joint aspirate - -D culture of joint aspirate
A 14 year-old patient, who fell on his outstretched hand, complains of pain
along his entire arm. There is point tenderness and swelling over the midshaft
of the radius. There is significant pain with limited flexion of the elbow joint. An
x-ray will most likely show which of the following fractures?
A
Galeazzi's
B
Scaphoid
C
Colles'
✅✅
D
Smith's - -A Galeazzi's
A 15 year-old softball player presents after jamming the distal tip of her finger
into severe flexion. She is unable to extend the distal phalanx and she has
pain on palpation of the distal interphalangeal joint. X-ray of the hand fails to
reveal any associated avulsion fracture. Which of the following is the
treatment of choice?
A
Open reduction and internal fixation
B
Continuous extension of the DIP with splinting
C
Continuous flexion of the PIP with splinting
✅✅
D
Application of short arm cast - -B continuous extension of the DIP with
splinting
, A 2-month-old infant has had a single, generalized tonic-clonic convulsion
lasting 4 to 5 minutes. There is no history of trauma and the infant had been
well previously. Physical findings include a temperature of 39.6 degrees C
(103.2 degrees F), a bulging tympanic membrane on the right, and an
inflamed pharynx. The next most appropriate step is to
A
Perform a lumbar puncture
B
Order x-ray studies of the skull
C
Obtain an electroencephalogram
✅✅
D
Send home with antibiotics and an anticonvulsant - -A perform a lumbar
puncture
A 21-year-old male college student is admitted to the hospital with suspected
meningitis. A lumbar puncture is performed. The results of the cerebrospinal
fluid (CSF) analysis reveals an elevated white blood cell count of 5,000/mcL
with over 90% neutrophils, a decreased glucose level of 35 mg/dL, and
elevated protein level of 150 mg/dL. What is the most likely diagnosis based
on these results?
A
Bacterial meningitis
B
Viral meningitis
C
Fungal meningitis
✅✅
D
Tuberculous meningitis - -A Bacterial meningitis
A 21-year-old man presents reporting that on several occasions in the last two
months he has awoken in a different room of his apartment or outside the
apartment. His roommate confirmed these nocturnal wanderings, but the
patient does not recall any episodes of sleepwalking. Which of the following
diagnostic studies would be most appropriate?
AHolter monitor worn for 48 hours
BHypocretin levels in the cerebrospinal fluid
✅✅
CMagnetic resonance imaging
DPolysomnography - -D Polysomnography
