1|Page
MN 566 2025-2026 FINAL EXAM COMPLETE
QUESTIONS AND VERIFIED ANSWERS - PURDUE
1)
A 58-year-old with HTN and T2DM has new microalbuminuria (UACR 120
mg/g). BP 146/88 on amlodipine 10 mg daily. Best next step?
A. Add HCTZ
B. Switch to ARB
C. Add ACE inhibitor
D. Start beta-blocker
Answer: C.
Why: ACEi (or ARB) is first-line for diabetic kidney disease to reduce
proteinuria and protect kidneys. Add ACEi to control BP and reduce
albuminuria.
2)
Which maneuver increases the murmur of hypertrophic cardiomyopathy
(HCM)?
A. Squatting
B. Handgrip
C. Valsalva
D. Passive leg raise
Answer: C.
Why: Valsalva decreases preload, worsening LV outflow obstruction and
intensifying HCM murmurs. Squatting/leg raise increase preload and soften
it.
3)
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25-year-old with unilateral sore throat, trismus, “hot-potato” voice, and
uvular deviation. Diagnosis?
A. Epiglottitis
B. Peritonsillar abscess
C. Retropharyngeal abscess
D. Severe tonsillitis
Answer: B.
Why: Classic triad: muffled voice, trismus, uvular deviation away from the
affected side.
4)
Smoker, 40-pack-years, COPD on LAMA. Two exacerbations last year.
Daily symptoms; CAT=21. Best add-on?
A. SABA PRN only
B. Add LABA/ICS combo
C. Switch to ICS alone
D. Add oral prednisone chronically
Answer: B.
Why: High symptoms + ≥2 exacerbations → escalate to dual bronchodilator
± ICS; history of exacerbations favors LABA/ICS (or triple therapy
depending on eosinophils).
5)
70-year-old with OA knee pain most days; normal renal function; on
omeprazole. First-line?
A. Topical NSAID
B. Oral NSAID
C. Intra-articular steroid
D. Tramadol PRN
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Answer: A.
Why: Topical NSAIDs are first-line for knee OA, especially in older adults
to limit systemic adverse effects.
6)
Rinne test: AC > BC bilaterally; Weber lateralizes to the right.
Interpretation?
A. Right sensorineural loss
B. Left sensorineural loss
C. Right conductive loss
D. Normal hearing
Answer: A.
Why: Normal Rinne (AC>BC) with Weber to one ear indicates
sensorineural loss in the opposite ear? Careful: Weber lateralizes to the
better ear in sensorineural loss. If Weber to right, left has SNHL. Wait—
question asks interpretation of findings: AC>BC both sides (rules out
conductive). Weber to right → left SNHL or right conductive. But Rinne
normal excludes conductive → Left SNHL.
Corrected Answer: B.
Why: With normal Rinne and Weber to right, the left ear has sensorineural
loss.
7)
35-year-old with dysuria and frequency, afebrile, no flank pain, UA:
nitrites+, leuk est+, no vaginal symptoms. Best management?
A. Culture then wait
B. TMP-SMX x3 days (if local resistance <20%)
C. Ciprofloxacin x7 days
D. Nitrofurantoin x1 day
, 4|Page
Answer: B.
Why: Uncomplicated cystitis: TMP-SMX 3 days (or nitrofurantoin 5 days
or fosfomycin once). Avoid fluoroquinolones for simple cystitis.
8)
Newly diagnosed A-fib, stable, CHA₂DS₂-VASc = 3. Next step?
A. Aspirin 81 mg
B. No anticoagulation
C. Start DOAC
D. Start warfarin only if HAS-BLED ≥3
Answer: C.
Why: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) warrants oral
anticoagulation; DOAC preferred if no valvular AF.
9)
50-year-old with fatigue, pruritus, dark urine, RUQ discomfort. Labs:
AST/ALT mildly ↑, ALP markedly ↑, GGT ↑, positive antimitochondrial
antibody. Likely diagnosis?
A. PSC
B. PBC
C. Alcoholic hepatitis
D. Viral hepatitis
Answer: B.
Why: Middle-aged woman, cholestatic pattern, +AMA → primary biliary
cholangitis.
10)
T2DM patient A1c 9.2% on metformin maxed; BMI 35; ASCVD risk high.
Best add-on?
A. Sulfonylurea
B. DPP-4 inhibitor
MN 566 2025-2026 FINAL EXAM COMPLETE
QUESTIONS AND VERIFIED ANSWERS - PURDUE
1)
A 58-year-old with HTN and T2DM has new microalbuminuria (UACR 120
mg/g). BP 146/88 on amlodipine 10 mg daily. Best next step?
A. Add HCTZ
B. Switch to ARB
C. Add ACE inhibitor
D. Start beta-blocker
Answer: C.
Why: ACEi (or ARB) is first-line for diabetic kidney disease to reduce
proteinuria and protect kidneys. Add ACEi to control BP and reduce
albuminuria.
2)
Which maneuver increases the murmur of hypertrophic cardiomyopathy
(HCM)?
A. Squatting
B. Handgrip
C. Valsalva
D. Passive leg raise
Answer: C.
Why: Valsalva decreases preload, worsening LV outflow obstruction and
intensifying HCM murmurs. Squatting/leg raise increase preload and soften
it.
3)
,2|Page
25-year-old with unilateral sore throat, trismus, “hot-potato” voice, and
uvular deviation. Diagnosis?
A. Epiglottitis
B. Peritonsillar abscess
C. Retropharyngeal abscess
D. Severe tonsillitis
Answer: B.
Why: Classic triad: muffled voice, trismus, uvular deviation away from the
affected side.
4)
Smoker, 40-pack-years, COPD on LAMA. Two exacerbations last year.
Daily symptoms; CAT=21. Best add-on?
A. SABA PRN only
B. Add LABA/ICS combo
C. Switch to ICS alone
D. Add oral prednisone chronically
Answer: B.
Why: High symptoms + ≥2 exacerbations → escalate to dual bronchodilator
± ICS; history of exacerbations favors LABA/ICS (or triple therapy
depending on eosinophils).
5)
70-year-old with OA knee pain most days; normal renal function; on
omeprazole. First-line?
A. Topical NSAID
B. Oral NSAID
C. Intra-articular steroid
D. Tramadol PRN
,3|Page
Answer: A.
Why: Topical NSAIDs are first-line for knee OA, especially in older adults
to limit systemic adverse effects.
6)
Rinne test: AC > BC bilaterally; Weber lateralizes to the right.
Interpretation?
A. Right sensorineural loss
B. Left sensorineural loss
C. Right conductive loss
D. Normal hearing
Answer: A.
Why: Normal Rinne (AC>BC) with Weber to one ear indicates
sensorineural loss in the opposite ear? Careful: Weber lateralizes to the
better ear in sensorineural loss. If Weber to right, left has SNHL. Wait—
question asks interpretation of findings: AC>BC both sides (rules out
conductive). Weber to right → left SNHL or right conductive. But Rinne
normal excludes conductive → Left SNHL.
Corrected Answer: B.
Why: With normal Rinne and Weber to right, the left ear has sensorineural
loss.
7)
35-year-old with dysuria and frequency, afebrile, no flank pain, UA:
nitrites+, leuk est+, no vaginal symptoms. Best management?
A. Culture then wait
B. TMP-SMX x3 days (if local resistance <20%)
C. Ciprofloxacin x7 days
D. Nitrofurantoin x1 day
, 4|Page
Answer: B.
Why: Uncomplicated cystitis: TMP-SMX 3 days (or nitrofurantoin 5 days
or fosfomycin once). Avoid fluoroquinolones for simple cystitis.
8)
Newly diagnosed A-fib, stable, CHA₂DS₂-VASc = 3. Next step?
A. Aspirin 81 mg
B. No anticoagulation
C. Start DOAC
D. Start warfarin only if HAS-BLED ≥3
Answer: C.
Why: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) warrants oral
anticoagulation; DOAC preferred if no valvular AF.
9)
50-year-old with fatigue, pruritus, dark urine, RUQ discomfort. Labs:
AST/ALT mildly ↑, ALP markedly ↑, GGT ↑, positive antimitochondrial
antibody. Likely diagnosis?
A. PSC
B. PBC
C. Alcoholic hepatitis
D. Viral hepatitis
Answer: B.
Why: Middle-aged woman, cholestatic pattern, +AMA → primary biliary
cholangitis.
10)
T2DM patient A1c 9.2% on metformin maxed; BMI 35; ASCVD risk high.
Best add-on?
A. Sulfonylurea
B. DPP-4 inhibitor
