Question

1. Jacob, a 33-year-old construction worker, complains of a “lump on his back” over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely?

A)  Pityriasis rosea

B)  Tinea versicolor

C)  Psoriasis

D)  Atopic eczema

2. 8-year-old retired farmer comes 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?

A) Actinic keratosis

B Seborrheic keratosis

C Basal cell carcinoma

D Squamous cell carcinomaTerm

3. A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with:

A) Contact dermatitis

B) Impetigo

C) Larva migrans

D) Scabies

4. A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain?

A) Age over 50

B) Pain at night

C) Pain lasting more than 1 month or not responding to therapy

D) Pain that is bilateral Term

5. A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of pain after lifting a set of boxes that were heavier than usual. He also states that he has numbness and tingling in the left leg. He wants to know if he needs to be off of work. What test should you perform to assess for a herniated disc?

A) Leg-length test

B) Straight-leg raise

C) Tinel’s test

D) Phalen’s testTerm

6. Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?

A) Insect bites

B) Urticaria or hives

C) Psoriasis

D) Purpura

7. A 50-year-old woman presents with “left hip pain” of several weeks duration. There is marked tenderness when you press over her proximal lateral thigh. What do you think she has?

A) Osteoarthritis

B) Rheumatoid arthritis

C) Sciatica

D) Trochanteric bursitis

8. A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain?

A) Rheumatoid arthritis

B) Osteoarthritis

C) Fibromyalgia

D) Polymyalgia rheumatica

9. A mother brings her 11-month-old to you because her mother-in-law and others have told her that her baby is jaundiced. She is eating and growing well and performing the developmental milestones she should for her age. On examination, you indeed notice a yellow tone to her skin from head to toe. Her sclerae are white. To which area should your next questions be related?

A) Diet

B) Family history of liver diseases

C) Family history of blood diseases

D) Ethnicity of the child

10. You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?

A) Moist and smooth

B) Moist and rough

C) Dry and smooth

D) Dry and rough

11. You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?

A)Tenderness

B)Cool temperature

C)Ecchymosis

D)Nodules

12. You are assessing a patient with diffuse joint pains and want to make sure that only the joints are the problem, and that the pain is not related to other diseases.Which of the following is a systemic cause of joint pain?

A) Gout

B) Osteoarthritis

C) Lupus

D) Spondylosis

13. A 19-year-old college sophomore comes to the clinic for evaluation of joint pains. The student has been back from spring break for 2 weeks; during her holiday, she went camping. She notes that she had a red spot, shaped like a target, but then it started spreading, and then the joint pains started. She used insect repellant but was in an area known to have ticks. She has never been sick and takes no medications routinely; she has never been sexually active. What is the most likely cause of her joint pain?

A) Trauma

B) Gonococcal arthritis

C) Psoriatic arthritis

D) Lyme disease

14. An 85-year-old retired housewife comes with her daughter to establish care. Her daughter is concerned because her mother has started to fall more. As part of her physical examination, you ask her to walk across the examination room. Which of the following is not part of the stance phase of gait? 

A) Foot arched

B) Heel strike

C) Mid-stance

D) Push-off

15. A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of pain after lifting a set of boxes that were heavier than usual. He also states that he has numbness and tingling in the left leg. He wants to know if he needs to be off of work. What test should you perform to assess for a herniated disc?

A) Leg-length test

B) Straight-leg raise

C) Tinel’s test

D) Phalen’s test

16. A 33-year-old construction worker comes for evaluation and treatment of acute onset of low back pain. He notes that the pain is an aching located in the lumbosacral area. It has been present intermittently for several years; there is no known trauma or injury. He points to the left lower back. The pain does not radiate and there is no numbness or tingling in the legs or incontinence.He was moving furniture for a friend over the weekend. On physical examination, you note muscle spasm, with normal deep tendon reflexes and muscle strength.What is the most likely cause of this patient’s low back pain?

A) Herniated disc

B) Compression fracture

C) Mechanical low back pain

D) Ankylosing spondylitis

17. A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn’t think that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is the most likely cause of this neck pain?

A) Simple stiff neck

B) Aching neck

C) Cervical sprain

D)Cervical herniated disc

18. A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal. Which of the following is likely the cause of her pain?

A) Rheumatoid arthritis

B) Osteoarthritis

C) Fibromyalgia

D) Polymyalgia rheumatic

19. A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims for 30 minutes daily, early in the morning. He notes a sharp, catching pain and a sensation of something grating when he tries overhead movements of his arm. On physical examination, you note tenderness just below the tip of the acromion in the area of the tendon insertions. The drop arm test is negative, and there is no limitation with shoulder shrug. The patient is not holding his arm close to his side, and there is no tenderness to palpation in the bicipital groove when the arm is at the patient’s side, flexed to 90 degrees, and then supinated against resistance. Based on this description, what is the most likely cause of his shoulder pain?

A) Calcific tendinitis

B) Rotator cuff tear

C) Rotator cuff tendinitis

D)Bicipital tendinitis

20. A high school soccer player “blew out his knee” when the opposing goalie’s head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is actually an extra-articular structure?

A) Synovium

B) Joint capsule

C) Juxta-articular bone

D) Tendons

21. Ray works a physical job and notes pain when he attempts to lift his arm over his head. When you move the shoulder passively, he has full range of motion without pain and there is no gross swelling or tenderness. What type of joint disease does this most likely represent?

A) Articular

B) Extra-articular

C) Neither

D) Both

22. Mark is a contractor who recently injured his back. He was told he had a “bulging disc”to account for the burning pain down his right leg and slight foot drop. The vertebral bodies of the spine involve which type of joint?

A) Synovial

B) Cartilaginous

C) Fibrous

D) Synostosis

23. Which of the following synovial joints would be an example of a condylar joint?

A) Hip

B) Interphalangeal joints of the hand

C) Temporomandibular joint

D) Intervertebral joint

24. A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain?

A) Age over 50

B) Pain at night

C) Pain lasting more than 1 month or not responding to therapy

D) Pain that is bilateral

25. Marion presents to your office with back pain associated with constipation and urinary retention. Which of the following is most likely?

A) Sciatica

B) Epidural abscess

C) Cauda equine

D) Idiopathic low back pain

26. Louise, a 60-year-old, complains of left knee pain associated with tenderness throughout, redness, and warmth over the joint. Which of the following is least helpful in determining if a joint problem is inflammatory?

A) Tenderness

B) Pain

C) Warmth

D) Redness

27. Pain, swelling, loss of both active and passive motion, locking, and deformity would be consistent with which of the following?

A) Articular joint pain

B) Bursitis

C) Muscular injury

D) Nerve damage

28. You are working in a college health clinic and seeing a young woman with a red, painful, swollen DIP joint on the left index finger. There are also a few papules, pustules, and vesicles on reddened bases, located on the distal extremities. This would be consistent with which of the following?

A) Lyme disease

B) Systemic lupus erythematosus

C) Hives (urticaria)

D) Gonococcal arthritis

29. An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which of the following is a risk factor for osteoporosis?

A) Obesity

B) Late menopause

C) Having an aunt with osteoporosis

D) Delayed menarche

30. A 38-year-old woman comes to you and has multiple small joints involved with pain, swelling, and stiffness. Which of the following is the most likely explanation?

A) Rheumatoid arthritis

B) Septic arthritis

C) Gout D)Trauma

31. Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of her pain?

A) Trigeminal neuralgia

B) Temporomandibular joint syndrome

C) Temporal arteritis

D) Tumor of the mandible

32. A man’s wife is upset because when she hugs him with her hands on his left shoulder blade, “it feels creepy.” This came on gradually after a recent severe left-sided rotator cuff tear. How long does it usually take to develop muscular atrophy with increased prominence of the scapular spine following a rotator cuff tear?

A) 1 week

B) 2–3 weeks

C) 1 month

D) 2–3 months

33. Phil comes to your office with left “shoulder pain.” You find that the pain is markedly worse when his left arm is drawn across his chest (adduction). Which of the following would you suspect?

A) Rotator cuff tear

B) Subacromial bursitis

C) Acromioclavicular joint involvement

D) Adhesive capsulitis

34. Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have?

A) Medial epicondylitis (golfer’s elbow)

B) Olecranon bursitis

C) Lateral epicondylitis (tennis elbow)

D) Supracondylar fracture

35. A high school football player injured his wrist in a game. He is tender between the two tendons at the base of the thumb. Which of the following should be considered?

A) DeQuervain’s tenosynovitis

B) Scaphoid fracture

C) Wrist sprain

D) Rheumatoid arthritis

36. Mrs.Fletcher complains of numbness of her right hand. On examination, sensation of the volar aspect of the web of the thumb and index finger and the pulp of the middle finger are normal. The pulp of the index finger has decreased sensation.Which of the following is affected?

A) Median nerve

B) Ulnar nerve

C) Radial nerve

37. A 50-year-old woman presents with “left hip pain” of several weeks duration.There is marked tenderness when you press over her proximal lateral thigh. What do you think she has?

A) Osteoarthritis

B) Rheumatoid arthritis

C) Sciatica

D) Trochanteric bursitis

38. Sarah presents with left lateral knee pain and has some locking in full extension.There is tenderness over the medial joint line. When the knee is extended with the foot externally rotated and some valgus stress is applied, a click is noted. What is the most likely diagnosis?

A) Torn anterior cruciate ligament

B) Torn posterior cruciate ligament

C) Torn medial meniscus

D) Torn lateral meniscus