Internal medicine

What is the major difference between a vesicle and a bulla?

Select one:
a. The size: a vesicle is less than 1 centimeter in diameter, where as, a bulla is greater than
1 centimeter in diameter

A 4-year-old boy is brought to the emergency department. The examiner notes Kussmaul
respirations of 50 per minute. The child has no fever and no cough; good air movement is noted
in the lungs with no abnormal breath sounds auscultated. Which of the following questions would
be most helpful for the examiner to ask the parents?

c. “Where do you keep your medications at home?

A 55-year-old legal secretary comes into your office to establish care. She starts the interview by
telling you her whole life story, tells you about her husband, children, and grandchildren, and
then pulls out a written list of 20 different items that relate to her health that she wants to address
with you in today’s interview. She is very friendly and relaxed. What specific type of patient is
this?

c. Talkative patient

What is the name of the small collections of blood in this person's skin?

d. Petechiae

A 55-year-old realtor presents to your office for evaluation of a skin lesion that has been present
for a long time. She came in because her daughter had been reading about skin cancer in her
favorite women’s magazine and was worried about her mother. The lesion is located on her right
cheek. There is a central depression and a firm elevated border. Initially, when it first appeared 5
years ago, it was translucent. What is the most likely diagnosis?

d. Basal cell carcinoma

A 23-year-old man presents as he is concerned over recent hair loss. Examination reveals a
discrete area of hair loss on the left temporal region with no obvious abnormality of the
underlying scalp. What is the most likely diagnosis?

e. Alopecia areata

What is the name of this lesion?

c. Fissure

A patient with psoriasis visits the dermatology clinic. When inspecting the affected areas, the
physician expects to see which type of secondary lesion?
 a. Scale

A 6-year-old girl has freckles over her nose and cheeks. Freckles are a type of

b. Macule

Look at the image shown. Based on clinical findings which condition should be suspected?

d. Psoriasis

A 42-year-old retail manager is sitting in your clinic exam room, waiting for a routine checkup for
hypertension. You enter the room and sit down, making eye contact, and move your body slightly
toward the patient. You nod your head as the patient begins to bring you up to date on his life
since his last appointment. This interviewing technique is an example of:

Select one:
a. Nonverbal communication

A cause of the scarring alopecia include all except

 c. Alopecia areata

A 68-year-old retired mechanic comes to the office for an annual checkup. He is concerned that
the small red areas on his skin may be cancer. On physical examination, you see round, bright,
ruby-red lesions that are 1–3 mm in diameter and scattered on the anterior chest; they partially
blanch with pressure. What is the most likely diagnosis?

d. Cherry angioma

What are these secondary skin lesions?

d. Ulcers and scales
A 55-year-old postal worker presents to the emergency room with chest pain. On a scale of 1 to
10, he rates the pain a 9. It started 30 minutes ago and hasn’t gone away. He has never had it
before. He denies any injury or trauma; he has no medical conditions that are being treated.
Nothing makes the pain better or worse. When questioned further, he has noticed nausea and
increased sweating with the pain. Based on this description, which of the seven attributes of this
symptom have not been addressed?

d. Quality

The ABCDEs of skin cancer detection include all of the following except _____.

d. Density of skin growths in a particular body region

A 69-year-old woman presents to your office with the complaint of pain. She was diagnosed with
breast cancer that has metastasized to the bone 6 months ago. At the time, she did not want
radiation therapy even for relief of the pain. You then discussed with her that her prognosis is
poor and that her time to live is limited. She was not interested in hearing about it. You observe
that she has lost more weight and that she is even more anorexic than at her previous visit 1
month ago. Today, she is frustrated because she hurts when she gets up and tries to walk
around. She has planned a trip to the Bahamas to take place in 4 more months. What stage of
grief is this patient currently in?

e. Denial

A 16-year-old sophomore presents to the clinic for a sports physical; she is accompanied by her
mother. She is involved in gymnastics and has been since age 5. In addition to training for the
gymnastics team, she runs 10 miles per day. She is proud of her athleticism and states that she
is still too fat and wants to lose more weight. You note that her BMI is 15. She denies eating
excessively or making herself vomit. The patient’s mother states she barely eats. This patient is
at risk for which medical problem?

c. Anorexia nervosa
Orthostatic hypertension is

Select one:
a. systolic BP drop greater than 20 mm Hg and a diastolic drop of 10 mm Hg
The patient tells the examiner, “I have been coughing up a lot of yellowish green phlegm.” The
examiner should suspect
 b. bacterial pneumonia

Which of the following findings suggests that a patient has a fungal infection of the nail beds?

b. The nail plate is yellow and crumbling

Look at the image shown. Based on clinical findings which condition should be suspected?

c. Iron-deficiency anemia

A 67-year-old woman presents with a mole on her left lower leg, which she is worried about. She
67first noticed it about six weeks ago and thinks it has increased in size. There is no pain or
itching. What is this lesion?
 c. Melanoma

The examiner should expect the ratio of respiratory rate to heart rate to be approximately:

b. 1 to 4

In terms of history taking which one of the following best describes the role of the social history?

d. To identify risk factors for specific disease processes which may need further investigation
/ management? It also provides an opportunity to offer health promotion advice

An older patient asks the examiner, “Is this spot on my chin a cancer?” Which of the following
would indicate a need for further medical investigation?

Select one:
a. Reddish brown color of the lesion

A 22-year-old social worker comes into the clinic for a routine checkup. His blood pressure is
155/102. In each of his previous visits, including one 2 weeks ago for treatment of an upper
respiratory infection, his blood pressure has been 130s/80s. He has no family history of high
blood pressure. He has no symptoms of headache, blurred vision, or chest pain. What is the
most likely reason for his blood pressure being elevated today?
 b. He drank a cup of coffee 10 minutes prior to his blood pressure measurement

A 20-year-old college junior presents to the clinic for a physical; he is going to be a camp
counselor for the summer. He is healthy and exercises regularly. His BMI is 22. You take his
blood pressure and obtain a value of 160/100. Which of the following is the most likely reason for
the unexpected blood pressure measurement?

c. The length of the inflatable bladder was 50% of the upper arm circumference

Anagen phase of the hair indicates

b. phase of activity and growth

A 68-year-old tax attorney is in the hospital with a stroke. He has residual left-sided paralysis and
is bed-ridden. On examination of the skin, you notice an area on his sacrum that is red with a
boggy consistency, and you diagnose a pressure ulcer. What stage is this pressure ulcer?

Select one:
a. Stage I

During percussion, the patient holds his or her arms in front in order to

b. expose maximum lung area

An 85-year-old man presents with a lesion on his upper back that he is concerned about. He
thinks it has been present for about a year and says it has got larger and has bled a bit. What is
this lesion?
 d. Basal cell carcinoma

A 29-year old Chinese male presented with scalp inflammatory dermatosis for 10 years that
had resulted in keloid and scarring alopecia. He had no past medical history and was
generally healthy. Physical examination revealed a circumscribed area of approximate 8 cm
in length and 4 cm in width on the parietal and occipital areas of the scalp (see Figure
below), and the lesion was characterized by flat-elevated erythematous keloid with claw-like
extensions, on the surface of which several hair tufts of 10-30 normal-looking hairs arising
from a single dilated follicular ostium, and red papules with adherent yellow-white crusts
scattered nearby. What is the diagnosis?

Folliculitis decalvans (FD)

The examiner notes a diaphragmatic excursion of 4 cm on the right side and 8 cm on the left
side. What do these findings mean?

Select one:
a. The patient may have pleural effusion

An Enclosed cavity containing liquid or semisolid substance refers to

d. Cyst

Mrs. Kaymos is a 32-year-old postoperative patient who has undergone an appendectomy.

When assessing your patient, you should remember
 d. the patient’s previous experiences with pain

A 25-year-old graduate student presents to your clinic; she is concerned about her exposure to a
communicable disease that occurred at a party she recently attended. You, the interviewer, enter
the room and greet the patient and then ask what brought her into your office today. She states
that she wants to establish care, so you start by asking her if she has any specific concerns that
she would like you to address. She states that she is concerned that she may have gotten an
STD. You continue to maintain eye contact and state, “Go on.” Which type of interviewing
technique have you demonstrated?

d. Facilitation

A 50-year-old woman presented to the clinic with a 3-year history of asymptomatic,

progressive hair loss of the eyebrows and scalp in a band-like distribution. What is the
diagnosis
Frontal fibrosing alopecia

In which of the following conditions should the examiner expect the costal angle to be greater
than 90 degrees?

c. Chronic obstructive pulmonary disease

A female patient presents with diffuse alopecia. She had suffered from typhoid fever 4 months
back. The most probable diagnosis is

d. telogen effluvium

A 38-year-old landscape designer presents to the clinic to be evaluated for a cough. His vital
signs show a temperature of 39ºCelsius, a pulse of 120, and a blood pressure of 88/55. His
respiratory rate is 28. He appears to have labored breathing. All of these indicators are signs of

c. Respiratory distress

An Enclosed cavity containing liquid or semisolid substance refers to

 d. Cyst

Which one of the following best describes the role that history taking plays in patient
assessment?

b. Clinical history provides a primary guiding foundation when making clinical decisions