Clinical Questions

What constitutes a duplex carotid ultrasound?

A 17-year-old female presents to the emergency department after falling and hitting her head on the floor while playing volleyball. She reports hearing something "crack" at the time and is complaining of a severe headache. She has a scalp hematoma over the left parietal region. You are concerned about a skull fracture. What is the best exam to confirm your suspicion?

Which of the following is important to screen a patient for prior to performing an MRI?

A 59-year-old male with a past medical history of hypertension presents to your office with a palpable scalp mass. It is painful and tender to the touch and sometimes he feels it throbbing. On physical exam, you note an erythematous, tender 4 x 2 cm mass on the posterior occiput. You suspect folliculitis but are concerned that it could be a more serious abscess, so you decide to order a CT scan of the head with intravenous contrast to rule out abscess and assess the extent of infection. What blood-work should you perform to ensure the patient has no contraindications for receiving intravenous contrast?

You are an intern in the emergency department and are taking consent for a patient who is having an MRI of the brain with intravenous contrast. Which of the following is a risk you would advise the patient of?

A 40-year-old female is following up with an interventional radiologist after her recent diagnosis of a right anterior cerebral artery aneurysm. Due to its size and risk of rupture, the interventional radiologist recommends treatment. What other intra-abdominal pathology may this patient have, given her diagnosis of an anterior cerebral artery aneurysm?

A 34-year-old 20-week pregnant female presents to her obstetrician for a routine prenatal visit. She has been experiencing severe headaches over the past month which do not resolve with acetaminophen. The patient has no significant past medical history. What is the best imaging modality for evaluation of this new symptom in this patient?

A 38-year-old female presents to your office with a complaint of coughing. The patient explains that the cough began 3 weeks ago and has only gotten worse. Additionally, the patient informs you that last week she went to an urgent care center where she had a chest X-ray that was normal. In which of the following sections of the SOAP note would you document the chest X-ray?

A 59-year-old male presents to your office for his annual physical examination. While you take his history, he informs you that his last well visit was one year ago. This finding would be documented in which of the following sections of your note?

A 44-year-old female presents to your office for her annual physical examination. While taking this patient's history, you ask about her caffeine use and she informs you that she drinks 3-4 cups of coffee per day. This finding would be documented in which of the following sections of your note?

You are precepting a medical student in your office. The first visit of your day is a patient who presents with a 5-month history of low back pain. After a thorough history and physical examination, you are writing your SOAP note and explaining the contents of each section. You correctly inform the student that in the assessment section:

A 78-year-old female presents to your office with her daughter who is concerned about her mother’s safety. Her daughter reports her mother left the stove on and “almost burned down the kitchen”. She also states she got lost coming home from weekly errands. You decide to use the Mini Mental Exam to assess this patient’s cognition. Which of the following may give inaccurate results?

An 87-year-old male with a medical history of hypertension was brought in by his wife for an evaluation. She is concerned that her husband has been very forgetful. You decide to assess his cognition. Which of the following is the best assessment tool given the presentation of this patient?

A 72-year-old female with a medical history of dementia presents to your office. She has been receiving home health care for the past three years. She lives with her daughter who is her primary care giver. In her assessment of daily functioning, which of the following is considered an “Instrumental Activity of Daily Living”?

A hospitalized patient develops shortness of breath. A chest x-ray shows fluid accumulation in the pleural cavity of the chest. A sample of the fluid reveals it is lymphatic fluid. The medical term for this condition would be:

The parents of a 1-month-old baby report that his tongue is always sticking out of his mouth. The tongue is noted to be enlarged on exam. The term for this would be:

The most common cause of death globally is:

A 4-year-old child in Sierra Leone develops a fever, muscle and bone pain, nausea and vomiting, and bleeding from his mouth, rectum and urinary tract. He is taken to the local clinic for a blood test and a diagnosis of Ebola is made. This is an example of a/an:

A researcher collected data from a patients group for her study. She recorded the values of the outcome variables for each patient using a statistical program as in the figure attached. Which of these is a categorical variable?

The systolic blood pressures (in mmHg) of 20 women between the ages of 20 and 35 were measured before and after the administration of a newly developed oral contraceptive. The mean change of systolic blood pressure was 2 and its 95% confidence interval was (0.5, 4.5). Which of the following is a correct inference made based on the computed mean change of systolic blood pressure with its 95% confidence interval?

A disease that exists at a baseline level at all times is an isolated community would be known as?

Consider a class with 100 enrolled students. None of the students were ill at the beginning of the school year (September 1). On September 30th, 5 students reported having gastroenteritis. All continued to be ill on October 1, but all 5 recovered within 3 days (by October 4). On October 14th, 3 more students developed gastroenteritis. days later (by October 20).

A new screening test for ovarian cancer has been developed, with a sensitivity of 75% and a specificity of 99.5%. Based on these test characteristics, what can you say about the negative predictive value?

A new screening test for ovarian cancer has been developed, with a sensitivity of 75% and a specificity of 99.5%. Based on these test characteristics, which of the following can you state about the ability of the screening test to correctly identify those who do not have ovarian cancer?

A new screening test for ovarian cancer has been developed, with a sensitivity of 75% and a specificity of 99.5%. Based on these test characteristics, which of the following can you state about the ability of the screening test to correctly identify those who do have ovarian cancer?

A major source of emerging infectious diseases is:

A country that has increasing incidence of HIV which has now led to political instability causing civil unrest and international intervention is an example of a global health:

Which of the following findings is consistent with tachycardia?

A patient tells you how his illness has affected his life. You say, "I can see that you are going through a hard time right now." Which of the following interviewing techniques did you use?

A 55-year-old woman presents to your office for a physical exam and to discuss a nutritional plan for her to lose weight. The measurement of her BMI and waist circumference puts her in the category of “overweight”. Her BMI range is:

What is the maximum time period for symptoms of an acute stroke to resolve for it to be classified as a transient ischemic attack (TIA)?

What percent of individuals with a transient ischemic attack (TIA) will go on to have an acute ischemic stroke over the next 90 days?

Which of the following is correct regarding the Eighth Joint National Committee (JNC 8) guidelines for treatment of hypertension?

A 49-year-old man with a BMI of 32 has had in-clinic blood pressure (BP) measurements of 148/90 mg Hg and 150/94 mmHg. BP measurements at his local pharmacy have been consistently lower. A 24-hour ambulatory BP monitor revealed an average blood pressure of 142/88 mmHg. He is asymptomatic. At his current clinic visit, his BP is 140/90 mmHg, and his heart rate is 75 beats per minute. What is the most appropriate manner in which to interpret and act on this patient’s findings?

A 62-year-old female with a known history of hypertension presents to your office complaining of the abrupt onset of a severe headache, marked vertigo, nausea, vomiting, and unsteady gait. On physical exam, you note sensory loss, and weakness of the right face. BP is 185/112 mmHg. This patient’s presentation can be best explained by which of the following:

A 76-year-old female presents with difficult and labored breathing. The medical term for this would be:

A 10-year-old boy with Crohn’s disease has inflammation in his small intestines. The medical term for inflammation in the small intestines is:

A 2-year-old child is suspected to have meningitis and has a spinal tap performed. The cerebral spinal fluid is reported to be xanthochromic. The color of the cerebral spinal fluid is:

Which of the following diagnostic methods is necessary for determining if a patient with suggestive symptoms has chronic obstructive pulmonary disease (COPD)?

Which of the following is a feature of chronic obstructive pulmonary disease (COPD)?

A 45-year-old male with COPD is receiving maintenance care in your office. As part of your evaluation, you include a palpatory exam of his thoracic spine and ribcage. Which of the following most precisely describes your reason for palpating these regions?

A 44-year-old female presents to your office because she has decided to take action and quit smoking completely without any nicotine replacement therapy. You warn her that some of the common withdrawal symptoms include which of the following?

A 53-year-old male presents to your office for a sick visit. He explains how he began smoking cigarettes at the age of 18 and has progressed from 5 cigarettes per day to 2 packs per day over the years in order to “not be anxious”. This would be an example of which of the following?

A 42-year-old female with no significant medical history presents to your office as a new patient, requesting a routine physical examination. She admits she is worried about her strong family history of diabetes and heart disease and would like a “full workup”. On physical examination, her blood pressure is 138/88 mmHg,height is 5’4”, weight is 182 lbs., BMI is 31, and waist circumference is 41”. According to the NCEP Clinical Criteria, what is your next step to screen for metabolic syndrome?

requesting a routine physical examination. She admits she is worried about her strong family history of diabetes and heart disease and would like a “full workup”. On physical examination, her blood pressure is 138/88 mmHg, height is 5’4”, weight is 182 lbs., BMI is 31, and waist circumference is 41”. The patient’s BMI is considered:

A 45-year-old woman presents to your office for her employment physical. She works as a school bus driver. In your assessment of her social history, you find that she has about 4 full glasses of wine about 2-3 times a week. When further asked about her alcohol intake, she states that she doesn’t feel the need to cut down or that she even needs a drink first thing in the morning. Her husband makes her feel guilty from time to time, which annoys her. What is her score on the CAGE questionnaire?

Dr. Harrison was recently hired in a rural area. Over the past few months, the community he serves has gained an influx of migrant farm workers from Latin America. He does not speak Spanish fluently and is concerned that this can be a significant barrier in providing care for his patients. Which of the following describes Dr. Harrison’s cultural proficiency?

A 42-year-old Hispanic female presents to your office for the initial evaluation of diabetes because she has a strong family history of diabetes. The patient states she has been using her parent’s glucometer to check her blood sugar levels and reports the estimated average glucose measurement is 154 mg/dL. She reports her last menstrual period was one week ago and it was normal. The patient is asymptomatic at this time and denies symptoms of hypoglycemia or having blood glucose levels below 90 mg/dL. Physical examination reveals a BMI of 35.2 and a waist circumference of 40 inches. Her laboratory results reveal elevated insulin levels and were negative for autoimmune disease or genetic inheritance factors. Which of following would most likely reduce the risk of developing diabetic complications in this patient?

A 42-year-old Hispanic female presents to your office for the initial evaluation of diabetes because she has a strong family history of diabetes. The patient states she has been using her parent’s glucometer to check her blood sugar levels and reports the estimated average glucose measurement is 154 mg/dL. She reports her last menstrual period was one week ago and it was normal. The patient is asymptomatic at this time and denies symptoms of hypoglycemia or having blood glucose levels below 90 mg/dL. Physical examination reveals a BMI of 35.2 and a waist circumference of 40 inches. Her laboratory results reveal elevated insulin levels and were negative for autoimmune disease or genetic inheritance factors. Which of the following would be the most likely A1C level for this patient given her estimated average glucose levels?

A 42-year-old Hispanic female presents to your office for the initial evaluation of diabetes because she has a strong family history of diabetes. The patient states she has been using her parent’s glucometer to check her blood sugar levels and reports the estimated average glucose measurements is 154 mg/dl. She reports her last menstrual period was a week ago and it was normal. The patient is asymptomatic at this time and denies symptoms of hypoglycemia or having blood glucose levels below 90 mg/dl. Physical examination reveals a BMI of 35.2 and a waist circumference of 40 inches. Her laboratory results reveal elevated insulin levels and were negative for autoimmune disease or genetic inheritance factors. Which of the following is the most likely diagnosis for this patient?

A fairly healthy 50-year-old female with mild hypertension comes to your office for an annual visit with the only complaint of frustration that she cannot lose weight. She states she walks leisurely with her dog at least 30 minutes, 3 days a week. On physical examination, her blood pressure is 130/75 mmHg, heart rate is 72 bpm, weight is 200 lbs., and height is 5’5”. Her BMI falls in the obese category. What is the best way to advise this patient on how to lose 1 pound a week safely and effectively?

What is the most commonly used parameter to assess obesity in clinical practice today?

What is the most concentrated source of energy available to the human body?

A 3-month-old, full term boy, presents to your office for a well-child visit. His mother has no complaints. You notice on physical exam the finding seen in the attached figure. What is the cause of this finding?

A new born is in your office for a well visit. On exam, you find that there is an absence of a red reflex, which is descriptive of:


A 10-year-old female presents to your office for an annual visit. She has a BMI above the 90th percentile. You review her vitals and note for the past 2 visits her blood pressure has been between the 90th and 95th percentile. Which category does this patient’s blood pressure fall into?

A 65-year-old man presents to the emergency department with crushing substernal chest pain. Which of the following should be used to help rule in the diagnosis of acute myocardial infarction?

A 59-year-old woman is seen for a follow up visit in your primary care office. Medical history includes hypertension and type 2 diabetes mellitus. She works as an administrative assistant and is sedentary at home. She is able to do light housework without chest discomfort or dyspnea. On physical examination, her blood pressure is 134/70 mmHg and her BMI is 28. The remainder of her physical examination is normal. Hemoglobin A1c is 7.2%.Which of the following recommendations would you give this patient?

A 57-year-old man with a history of hypertension, hyperlipidemia, and chronic tobacco use presents to the office complaining of chest tightness that occurs every time he begins raking leaves. If he stops and rests, it is relieved within 5 minutes. He has no associated nausea or diaphoresis, but does admit to associated shortness of breath. Which of the following is the most likely diagnosis?

A 42-year-old female presents to your office with a chief complaint of abdominal pain for two days duration. The patient describes the pain as dull, achy, and worse in the morning and with food. The patient’s blood pressure is 126/80 mmHg, pulse is 76 bpm, respiratory rate is 14 bpm, temperature is 98.8°F, SPO2 is 99% on room air. When performing an abdominal exam which of the following is the correct sequence of steps?

A 69-year-old female presents to your office for her annual physical examination near the beginning of the influenza season. The patient is currently feeling well. She has a medical history including hypertension, hypercholesterolemia, hypothyroid, and anxiety/depression. Her immunization history includes receiving a Td (tetanus and diphtheria vaccine) 10 years ago and a pneumovax (Streptococcus pneumoniae vaccine) three years ago. She has never used tobacco, alcohol or drugs and is in a monogamous relationship with her husband of 48 years. Her only allergy is to penicillin. Which of the following is the correct recommendation for this patient?

A 66-year-old male presents to your office complaining of a worsening productive cough with yellow sputum over the past 8 days. He has taken Tylenol, but has not experienced any relief. He is concerned that he has pneumonia. On examination you discover a decreased somatic dysfunction of rib 3 on the right side. Which of the following is correct regarding the normal motion in this rib?

A 54-year-old male presents to the clinic to follow-up lab results. He is found to have a triglyceride level of 2340 mg/dL. Based on this result, you decide to order amylase and lipase levels. Which of the following diagnoses are you most concerned about?

A 34-year-old female presents to the clinic for an annual physical. She has a BMI of 34.4. Which of the following is another risk factor for atherosclerotic heart disease?

A 67-year-old male presents to the emergency department with a chief complaint of slurred speech and right-sided facial droop. Your work up determines that the patient’s problem is most likely secondary to atherosclerotic heart disease. Which of the following is considered a risk factor for the patient’s condition?

A 79-year-old male retired banker presents to your office with his wife. She is concerned about his hearing; however, he denies any issues with his hearing. His wife states that he has been playing the radio very loudly recently. You perform a hearing test. Given his age, which of the following would you expect the hearing test to reveal?

A 69-year-old male presents to the office for skin cancer screening. He is concerned about a lesion on his upper arm. He denies it being itchy. The number of these “spots” have been increasing with age. Which of the following best identifies this lesion seen? (Please see attachment)

A 77-year-old male presents to your office complaining about change in vision. He states he can’t see in the periphery of his view (Please see attachment). He denies eye pain, itching, or irritation. Which of the following is most likely the cause of his visual changes?