Name: Score:
230 Multiple choice questions
Term 1 of 230
A 40-year-old woman presents with an intense, intermittent right upper quadrant pain that
radiates to her back. Pain is exacerbated by eating and is worse at night. She denies any fever or
chills. Laboratory studies are unremarkable. Which of the following diagnostic studies is the initial
test of choice?
A Computed tomography scan
B Endoscopic ultrasonography
C Hepatoiminodiacetic acid scan
D Transabdominal ultrasonography
Term 2 of 230
A 64-year-old man presents for a bulge in the groin area that he noticed over the last week. It is
not painful or tender. In the morning upon waking, he feels it is smaller, and as the day progresses
and he is on his feet for long hours at work, it gets larger. On physical exam, you notice a bulge in
the left inguinal area that is soft and increases with Valsalva maneuver. There is no overlying
erythema or warmth. Which of the following risk factors is associated with the most likely
diagnosis?
AAlcohol use disorder
BMale sex
CSubstance use disorder
DYounger age
B levothyroxine
C pseudocyst
B crohn disease
B male sex
,Term 3 of 230
A 64-year-old man with chronic atrial fibrillation and hypertension presents with sudden-onset
severe left lower-extremity pain for 30 minutes. His medications are carvedilol 12.5 mg PO once
daily and lisinopril 20 mg PO once daily. His initial vitals are T 37.2°C, HR 105 bpm, BP 137/60 mm
Hg, RR 17 breaths/min, and SpO2 97%. On examination of the left lower extremity, the patient has
cool and pale toes, capillary refill greater than seven seconds, and decreased sensation over the
plantar and dorsal aspects of the foot. The remainder of his physical exam is normal. Which of the
following is the best next step?
ACT angiography with IV contrast
BFasciotomy
CRevascularization
DSystemic thrombolysis
C revascularization
C medullary
C lipase
C inferior vena cava
Term 4 of 230
A 75-year-old man was admitted to the hospital from a long-term care facility for fever and an
elevated WBC count. A stage 3 sacral decubitus injury with superficial necrosis is discovered. He
is on sequential compression devices for deep vein thrombosis prophylaxis and is not on any
anticoagulants. Which of the following is an appropriate clinical intervention?
A Autolytic debridement
B Reposition the patient every 6 hours
C Sharp debridement
D Wet-to-dry dressing changes
,Term 5 of 230
A 24-year-old woman presents to the emergency department with acute right upper quadrant
abdominal pain that radiates to her right scapula. She has had similar episodes previously, but
they were less severe. Vital signs are T 100.6°F, HR 102 bpm, BP 128/78 mm Hg, RR 16/min, and
oxygen saturation 99% on room air. On exam, she has tenderness to palpation of the right upper
quadrant. Laboratory studies show a leukocytosis with normal bilirubin, alkaline phosphatase, and
liver transaminases. Her abdominal ultrasound is shown above. Which of the following is the most
likely diagnosis?
AAcute cholecystitis
BCholangitis
CCholedocholithiasis
DUncomplicated gallstone disease
C tmp smx
B acute pancreatitis
B needle aspiration
A acute cholecystitis
Term 6 of 230
A 72-year-old man with a history of cirrhosis presents to the emergency department with acute
confusion. His wife reports he ran out of his lactulose 3 days ago. On exam, the patient is lethargic
but arousable and has asterixis. Laboratory findings reveal a normal basic chemistry panel, and CT
of the head shows no acute abnormalities. What is the most likely diagnosis?
AGrade II hepatic encephalopathy
BGrade IV hepatic encephalopathy
CHypoglycemia
DUremic encephalopathy
A grade 2 heaptic encephalopathy
A ercp
A dark urine
A adenocarcinoma
, Term 7 of 230
A 21-year-old man presents to the office complaining of swelling and achiness to the right testicle.
He does not have any other complaints. Upon physical exam, there is a palpable, painless, scrotal
mass to the right testis with well-defined margins. The mass does not transilluminate when a light
is held behind the scrotum. He does not have any palpable lymph nodes to the inguinal or
supraclavicular areas. A testicular ultrasound reveals a well-defined hypoechoic lesion within the
right testicle. Which of the following is the most likely diagnosis?
A Orchitis
B Spermatocele
C Testicular cancer
D Varicocele
Term 8 of 230
A 55-year-old man presents to his primary care provider with a history of intermittent claudication
and pain in his right leg over the past several months. He has a history of diabetes mellitus,
hypertension, and hyperlipidemia. He has a 35 pack-year smoking history. His right leg is shown in
the image above. Distal pulses are diminished in the right ankle, and the right foot is cool to the
touch. Which of the following is the most appropriate clinical intervention at this time?
AAngioplasty
BSmoking cessation
CSurgical debridement
DWet-to-dry dressings
A boerhaave syndrome
D ulcerative colitis
C surgical debridement
C posterior midline
230 Multiple choice questions
Term 1 of 230
A 40-year-old woman presents with an intense, intermittent right upper quadrant pain that
radiates to her back. Pain is exacerbated by eating and is worse at night. She denies any fever or
chills. Laboratory studies are unremarkable. Which of the following diagnostic studies is the initial
test of choice?
A Computed tomography scan
B Endoscopic ultrasonography
C Hepatoiminodiacetic acid scan
D Transabdominal ultrasonography
Term 2 of 230
A 64-year-old man presents for a bulge in the groin area that he noticed over the last week. It is
not painful or tender. In the morning upon waking, he feels it is smaller, and as the day progresses
and he is on his feet for long hours at work, it gets larger. On physical exam, you notice a bulge in
the left inguinal area that is soft and increases with Valsalva maneuver. There is no overlying
erythema or warmth. Which of the following risk factors is associated with the most likely
diagnosis?
AAlcohol use disorder
BMale sex
CSubstance use disorder
DYounger age
B levothyroxine
C pseudocyst
B crohn disease
B male sex
,Term 3 of 230
A 64-year-old man with chronic atrial fibrillation and hypertension presents with sudden-onset
severe left lower-extremity pain for 30 minutes. His medications are carvedilol 12.5 mg PO once
daily and lisinopril 20 mg PO once daily. His initial vitals are T 37.2°C, HR 105 bpm, BP 137/60 mm
Hg, RR 17 breaths/min, and SpO2 97%. On examination of the left lower extremity, the patient has
cool and pale toes, capillary refill greater than seven seconds, and decreased sensation over the
plantar and dorsal aspects of the foot. The remainder of his physical exam is normal. Which of the
following is the best next step?
ACT angiography with IV contrast
BFasciotomy
CRevascularization
DSystemic thrombolysis
C revascularization
C medullary
C lipase
C inferior vena cava
Term 4 of 230
A 75-year-old man was admitted to the hospital from a long-term care facility for fever and an
elevated WBC count. A stage 3 sacral decubitus injury with superficial necrosis is discovered. He
is on sequential compression devices for deep vein thrombosis prophylaxis and is not on any
anticoagulants. Which of the following is an appropriate clinical intervention?
A Autolytic debridement
B Reposition the patient every 6 hours
C Sharp debridement
D Wet-to-dry dressing changes
,Term 5 of 230
A 24-year-old woman presents to the emergency department with acute right upper quadrant
abdominal pain that radiates to her right scapula. She has had similar episodes previously, but
they were less severe. Vital signs are T 100.6°F, HR 102 bpm, BP 128/78 mm Hg, RR 16/min, and
oxygen saturation 99% on room air. On exam, she has tenderness to palpation of the right upper
quadrant. Laboratory studies show a leukocytosis with normal bilirubin, alkaline phosphatase, and
liver transaminases. Her abdominal ultrasound is shown above. Which of the following is the most
likely diagnosis?
AAcute cholecystitis
BCholangitis
CCholedocholithiasis
DUncomplicated gallstone disease
C tmp smx
B acute pancreatitis
B needle aspiration
A acute cholecystitis
Term 6 of 230
A 72-year-old man with a history of cirrhosis presents to the emergency department with acute
confusion. His wife reports he ran out of his lactulose 3 days ago. On exam, the patient is lethargic
but arousable and has asterixis. Laboratory findings reveal a normal basic chemistry panel, and CT
of the head shows no acute abnormalities. What is the most likely diagnosis?
AGrade II hepatic encephalopathy
BGrade IV hepatic encephalopathy
CHypoglycemia
DUremic encephalopathy
A grade 2 heaptic encephalopathy
A ercp
A dark urine
A adenocarcinoma
, Term 7 of 230
A 21-year-old man presents to the office complaining of swelling and achiness to the right testicle.
He does not have any other complaints. Upon physical exam, there is a palpable, painless, scrotal
mass to the right testis with well-defined margins. The mass does not transilluminate when a light
is held behind the scrotum. He does not have any palpable lymph nodes to the inguinal or
supraclavicular areas. A testicular ultrasound reveals a well-defined hypoechoic lesion within the
right testicle. Which of the following is the most likely diagnosis?
A Orchitis
B Spermatocele
C Testicular cancer
D Varicocele
Term 8 of 230
A 55-year-old man presents to his primary care provider with a history of intermittent claudication
and pain in his right leg over the past several months. He has a history of diabetes mellitus,
hypertension, and hyperlipidemia. He has a 35 pack-year smoking history. His right leg is shown in
the image above. Distal pulses are diminished in the right ankle, and the right foot is cool to the
touch. Which of the following is the most appropriate clinical intervention at this time?
AAngioplasty
BSmoking cessation
CSurgical debridement
DWet-to-dry dressings
A boerhaave syndrome
D ulcerative colitis
C surgical debridement
C posterior midline
