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1. You are examining an elderly man and notice the following: Decreased vibration sense
in the feet and ankles, diminished gag reflex, right patellar reflex less than the left, and
diminished abdominal reflexes. Which of these is abnormal?
• Decreased vibration sense
• Diminished gag reflex
Diminished right patellar reflex compared to the left
• Diminished abdominal reflexes
Question Points: 1..0
2. A 68-year-old retired farmer presents to your office for evaluation of a skin lesion. On
the right temporal area of the forehead, you see a flattened papule the same color as his
skin, covered by a dry scale that is round and feels hard. He has several more of these
scattered on the forehead, arms, and legs. Based on this description, what is your most
likely diagnosis?
Actinic keratosis
• Seborrheic keratosis
• Basal cell carcinoma
• Squamous cell carcinoma
, Question Points: 1..0
3. A 14-year-old junior high school student is brought in by his mother and father
because he seems to be developing breasts. The mother is upset because she read on the
Internet that smoking marijuana leads to breast enlargement in males. The young man
adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes
in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is
unremarkable. His parents are both in good health. He has two older brothers who never
had this problem. On examination, you see a mildly overweight teenager with enlarged
breast tissue that is slightly tender on both sides. Otherwise his examination is normal.
He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia?
• Breast cancer
Imbalance of hormones of puberty
• Drug use
• Alcohol use
Question Points: 1..0
5. A 26-year-old flight attendant presents in for a third trimester prenatal visit. She has
had prenatal care since her sixth week of pregnancy. She has no complaints today and her
prenatal course has been unremarkable. Today her blood pressure and weight gain are
appropriate, and her urine is unremarkable. You have a firstyear medical student
shadowing you, so you ask the student to get Doptones and measure the patient's uterus in
centimeters. The nurse practitioner student promptly reports fetal heart tones of 140, but
he is having difficulty obtaining the correct measurement. He knows one end of the tape
goes over the uterine fundus. From what inferior anatomic position should the tape be
placed?
• Vagina
• Clitoris
Pubic symphysis
• Umbilicus
, Question Points: 1..0
6. A 58-year-old gardener presents to your office for evaluation of a new lesion on her
upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated
with a flat surface. It has a rough, wart like texture on palpation. Based on this description,
what is your most likely diagnosis?
• Actinic keratosis
• Seborrheic keratosis
• Basal cell carcinoma
• Squamous cell carcinoma
MISSING ANSWER
Question Points: 0..0
7. Which of the following represents age-related changes in the lungs?
Decrease in chest wall compliance
• Speed of expiration increases
• Increase in respiratory muscle strength
• Increased elastic recoil of lung tissue
Question Points: 1..0
8. A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and fussiness.
The ear examination is as follows: external ear, normal appearance and no tenderness with
manipulation; canal, normal diameter without evidence of inflammation; tympanic
, membrane, bulging, erythematous, and opaque. Insufflation is deferred due to pain. What is
the most likely condition here?
• Otitis externa
• Cholesteatoma
• Ruptured tympanic membrane
Otitis media
Question Points: 1..0
9. A 28-year-old musician presents to your clinic, complaining of a “spot” on his penis.
He states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt.
He has had no burning with urination and no pain during intercourse. He has had several
partners in the last year and uses condoms occasionally. His past medical history consists of
nongonococcal urethritis from Chlamydia and prostatitis. He denies any surgeries. He
smokes two packs of cigarettes a day, drinks a case of beer a week, and smokes marijuana
and occasionally crack. He has injected IV drugs before but not in the last few years. He is
single and currently unemployed. His mother has rheumatoid arthritis, and he doesn't know
anything about his father. On examination, you see a young man appearing deconditioned
but pleasant. His vital signs are unremarkable. On visualization of his penis, there is a 6-
mm red, oval ulcer with an indurated base just proximal to the corona. There is no prepuce
because of neonatal circumcision. On palpation, the ulcer is nontender. In the inguinal
region, there is nontender lymphadenopathy.
What disorder of the penis is most likely the diagnosis?
• Condylomata acuminata
• Genital herpes
Syphilitic chancre
• Penile carcinoma