History and Physical Exam I - Test 4 Practice Questions (Emma)

A 68-year-old male presents to the clinic because his "hats don't fit anymore." He reports a dull, aching bone pain in his head. On physical exam, you note prominent frontal bossing and protrusion of the jaw (prognathism). Which of the following conditions is the most likely cause?

A) Acromegaly

B) Paget's disease

C) Hydrocephalus

D) Cushing's syndrome

B) Paget's disease

A 25-year-old medical student presents during finals week complaining of a "tight band" squeezing his head. He denies nausea, vomiting, or sensitivity to light. The pain is bilateral and located at the base of the skull. Palpation reveals tenderness in the posterior cervical muscles. What is the most likely diagnosis?

A) Migraine headache

B) Cluster headache

C) Tension headache

D) Sinusitis

C) Tension headache

A 60-year-old female presents with sudden onset of facial asymmetry. On examination, she has a flattened nasolabial fold and drooping of the mouth on the left side. However, she is able to wrinkle her forehead on the left side. This finding suggests:

A) A peripheral facial nerve palsy (e.g., Bell's palsy)

B) A central facial nerve palsy (e.g., Stroke)

C) Trigeminal neuralgia

D) Temporal arteritis

B) A central facial nerve palsy (e.g., Stroke)

A 35-year-old female presents with fatigue and weight gain. On physical exam, she has a "puffy" face, dry skin, and coarse hair. You note that the lateral third of her eyebrows is thinning. This clinical picture is most consistent with:

A) Hyperthyroidism

B) Myxedema (Hypothyroidism)

C) Cushing's disease

D) Nephrotic syndrome

B) Myxedema (Hypothyroidism)

A 55-year-old male presents with a headache that has been waking him up in the middle of the night for the past two weeks. He mentions that the pain is worse in the morning when he wakes up. He has also noticed some unintentional weight loss. What is the primary concern in your differential diagnosis?

A) Chronic tension headache

B) Brain tumor causing increased intracranial pressure

C) Cluster headache

D) Sleep apnea

B) Brain tumor causing increased intracranial pressure

A 70-year-old male is brought in by his daughter, who notes he has "very little expression" on his face lately. On exam, he has a staring, "masked" facies, decreased blinking, and a resting tremor in his hands. These facial features are characteristic of:

A) Depression

B) Hypothyroidism

C) Parkinson's disease

D) Stroke

C) Parkinson's disease

A 40-year-old male presents with a painful, swollen lump on the left side of his neck. He reports a recent tooth infection that he hasn't treated. On exam, you palpate a tender, mobile, soft lymph node in the submandibular region. This finding is most consistent with:

A) Metastatic malignancy

B) Reactive lymphadenitis (Infection)

C) Lymphoma

D) Thyroid nodule

B) Reactive lymphadenitis (Infection)

A 30-year-old female presents to the ED with a severe headache, high fever, and photophobia. She has no focal neurologic deficits. You attempt to flex her neck, but she resists due to severe stiffness (nuchal rigidity). What is the next most appropriate diagnostic step?

A) MRI of the brain

B) Lumbar puncture (after ruling out raised ICP)

C) EEG

D) Temporal artery biopsy

B) Lumbar puncture (after ruling out raised ICP)

A 45-year-old male presents with recurrent episodes of severe, stabbing pain in his right eye. He also reports his right eye tears up and his nose runs during these episodes. The attacks occur daily, often at the same time of day. He is pacing the room in agony. What is the most likely diagnosis?

A) Migraine with aura

B) Cluster headache

C) Acute glaucoma

D) Trigeminal neuralgia

B) Cluster headache

A 50-year-old female presents with a palpable "lump" in her neck. On exam, you find a solitary, hard nodule on the right lobe of the thyroid. She has no symptoms of hyper- or hypothyroidism. According to your lecture, a solitary thyroid nodule is:

A) Less likely to be malignant than a multinodular goiter

B) More likely to be malignant than a multinodular goiter

C) Almost always a simple cyst

D) Diagnosed by auscultation

B) More likely to be malignant than a multinodular goiter

A 16-year-old male presents with a headache and facial pain. He reports having a "cold" for the past 10 days that seemed to get better, then got worse. He has thick, yellow nasal discharge. On exam, percussion over the maxillary sinuses elicits tenderness. Which of the following supports a diagnosis of bacterial sinusitis?

A) Symptoms lasting less than 3 days

B) Clear rhinorrhea

C) Symptoms persisting for more than 1 week

D) Associated ear pain

C) Symptoms persisting for more than 1 week

A 32-year-old female with a history of migraines presents with a new type of headache. She describes it as a steady ache that is not throbbing. However, she mentions she has been taking over-the-counter Excedrin and ibuprofen daily for the past 4 months to "prevent" her migraines. This presentation is most consistent with:

A) Cluster headaches

B) Medication overuse (rebound) headache / Chronic daily headache

C) Temporal arteritis

D) Trigeminal neuralgia

B) Medication overuse (rebound) headache / Chronic daily headache

A 62-year-old male presents for a physical. On neck inspection, you notice the trachea is deviated to the left. This finding is a critical indicator of:

A) Normal anatomical variation

B) Right-sided tension pneumothorax or large mass

C) Left-sided lung collapse

D) Thyroiditis

B) Right-sided tension pneumothorax or large mass

A 29-year-old female presents with a headache that she describes as "throbbing" on the right side of her head. She saw "flashing lights" in a zigzag pattern about 20 minutes before the pain started. This visual phenomenon is known as:

A) Glaucoma

B) Scintillating scotoma (Aura)

C) Diplopia

D) Papilledema

B) Scintillating scotoma (Aura)

During a lymph node exam, you ask the patient to shrug their shoulders against resistance. This maneuver helps you best identify lymph nodes in which chain?

A) Deep cervical chain

B) Supraclavicular chain

C) Submental chain

D) Posterior auricular chain

B) Supraclavicular chain

A 12-year-old boy presents with significant facial swelling that his mother notes is much worse in the morning when he wakes up. He has been misdiagnosed with allergies, but antihistamines haven't helped. On exam, you note pitting periorbital edema. What is the most likely diagnosis?

A) Angioedema

B) Nephrotic syndrome

C) Cushing's syndrome

D) Myxedema

B) Nephrotic syndrome

A 75-year-old female presents with a severe, unilateral headache and "scalp tenderness" when brushing her hair. She also mentions episodes of transient vision loss in her right eye. You suspect Temporal Arteritis. Which of the following is considered a pathognomonic symptom for this condition?

A) Scintillating scotoma

B) Jaw claudication (pain with chewing)

C) Unilateral rhinorrhea

D) Retro-orbital pain

B) Jaw claudication (pain with chewing)

A 45-year-old male presents with a headache that is precipitated by the Valsalva maneuver (straining, coughing, or sneezing). He also reports that the headache wakes him up at night. These "red flag" features are most concerning for:

A) Increased intracranial pressure (ICP)

B) Tension headache

C) Migraine with aura

D) Sinusitis

A) Increased intracranial pressure (ICP)

A 22-year-old female presents with fatigue and pallor. On HEENT examination, you gently pull down the lower eyelid to inspect the palpebral conjunctiva. You note a pale coloration compared to normal. This finding is a reliable indicator of:

A) Jaundice

B) Anemia

C) Polycythemia

D) Hypoxia

B) Anemia

A 60-year-old male is found to have an enlarged thyroid gland on routine examination. On auscultation of the neck, you hear a continuous sound over the lateral lobes of the thyroid. This "bruit" is caused by:

A) Turbulent airflow in the trachea

B) Transmission of heart sounds

C) Increased vascularity associated with hyperthyroidism (e.g., Graves' disease)

D) Carotid artery stenosis

C) Increased vascularity associated with hyperthyroidism (e.g., Graves' disease)

A 50-year-old female presents with excruciating, shock-like pain on the right side of her face. She says the wind hitting her face or eating dinner can trigger an attack. The pain lasts for a few seconds. Neurologic exam is otherwise normal. This presentation is classic for:

A) Post-herpetic neuralgia

B) Trigeminal neuralgia (Tic douloureux)

C) Temporomandibular joint (TMJ) dysfunction

D) Complex migraine

B) Trigeminal neuralgia (Tic douloureux)

A 30-year-old male presents with a headache that he describes as "the worst of his life." He states it started instantly like a "clap of thunder." He has some neck stiffness but no fever. A non-contrast CT head is negative. What is the mandatory next step to rule out a Subarachnoid Hemorrhage?

A) MRI of the brain with contrast

B) Lumbar puncture to look for xanthochromia/RBCs

C) Send home with analgesics and follow up in 24 hours

D) Electroencephalogram (EEG)

B) Lumbar puncture to look for xanthochromia/RBCs

A 68-year-old male presents with a sudden onset of severe right eye pain, blurred vision, and nausea. He sees "halos" around streetlights. On exam, the pupil is fixed in a mid-dilated position (4-6mm) and the cornea appears cloudy. What is the immediate diagnosis?

A) Acute angle-closure glaucoma

B) Retinal detachment

C) Corneal abrasion

D) Optic neuritis

A) Acute angle-closure glaucoma

A newborn is noted to have a rapidly increasing head circumference. On exam, the fontanelles are bulging and the scalp veins are dilated. This condition, caused by excess accumulation of CSF, is known as:

A) Microcephaly

B) Craniosynostosis

C) Hydrocephalus

D) Acromegaly

C) Hydrocephalus

A patient presents with blue discoloration of the lips and oral mucosa. This finding, known as central cyanosis, is most indicative of:

A) Cold exposure

B) Anemia

C) Hypoxia

D) Polycythemia

C) Hypoxia

A 34-year-old female presents with a "bump" on her right upper eyelid that has been present for 3 months. She reports it is painless and has been slowly growing. On exam, there is a non-tender, firm nodule located away from the lid margin. Eversion of the lid reveals a granulomatous lesion. What is the most likely diagnosis?

A) Hordeolum

B) Dacryocystitis

C) Chalazion

D) Xanthelasma

C) Chalazion

A 22-year-old male surfer presents with a complaint of a growth on his left eye. He denies pain but feels a "foreign body" sensation. Physical exam reveals a fleshy, pink, triangular tissue growing from the nasal conjunctiva onto the cornea. Visual acuity is slightly diminished in that eye. What is the most likely diagnosis?

A) Pinguecula

B) Pterygium

C) Cataract

D) Hyphema

B) Pterygium

A 65-year-old male with a history of smoking and hypertension presents with a "droopy" left eyelid. On examination, you note ptosis of the left lid, a constricted left pupil (miosis), and the patient reports he hasn't been sweating on the left side of his face. Which of the following is the most likely diagnosis?

A) CN III Palsy

B) Bell's Palsy

C) Horner's Syndrome

D) Adie's Pupil

C) Horner's Syndrome

A 7-year-old female is brought to the clinic with swelling and redness around her left eye. She had a sinus infection last week. On exam, the eyelid is erythematous and edematous. Importantly, she has no proptosis, her extraocular movements are full and painless, and her visual acuity is normal. What is the most likely diagnosis?

A) Orbital Cellulitis

B) Periorbital (Preseptal) Cellulitis

C) Dacryocystitis

D) Acute Angle-Closure Glaucoma

B) Periorbital (Preseptal) Cellulitis

A 45-year-old male presents to the ER with severe pain in his right eye and double vision. On exam, his right eyelid is drooping (ptosis). When you lift the lid, the eye is deviated downward and laterally ("down and out"). The right pupil is fixed and dilated. Which of the following is the primary concern that must be ruled out?

A) Cerebral Aneurysm

B) Brainstem Stroke

C) Optic Neuritis

D) Myasthenia Gravis

A) Cerebral Aneurysm

A 50-year-old female complains of severe right eye pain and photophobia. She usually wears contact lenses but slept in them last night. Fluorescein staining under a slit lamp reveals a branching, "dendritic" ulcer on the cornea. What organism is the most likely cause?

A) Pseudomonas aeruginosa

B) Staphylococcus aureus

C) Herpes Simplex Virus (HSV)

D) Adenovirus

C) Herpes Simplex Virus (HSV)

A 68-year-old male presents with a complaint of "tunnel vision." Visual field testing reveals bitemporal hemianopsia (loss of the temporal fields in both eyes). Where is the anatomical lesion most likely located?

A) Right Optic Tract

B) Left Optic Nerve

C) Optic Chiasm

D) Visual Cortex

C) Optic Chiasm

During a fundoscopic exam of a 55-year-old male with a history of poorly controlled hypertension, you note that the retinal veins appear indented or "nicked" where the arterioles cross over them. This finding is best documented as:

A) Neovascularization

B) AV Nicking

C) Papilledema

D) Copper Wiring

B) AV Nicking

A 30-year-old female presents with a sudden onset of "blurry vision" in her left eye and pain with eye movement. On the swinging flashlight test, when the light is moved from the right eye to the left eye, both pupils appear to dilate paradoxically. This finding is known as:

A) Argyll Robertson Pupil

B) Adie's Tonic Pupil

C) Afferent Pupillary Defect (Marcus-Gunn Pupil)

D) Anisocoria

C) Afferent Pupillary Defect (Marcus-Gunn Pupil)

A 25-year-old male presents with a history of intravenous drug use, fever, and fatigue. On cardiac exam, a new murmur is auscultated. Fundoscopic examination reveals retinal hemorrhages with white centers. These retinal findings are known as:

A) Cotton Wool Spots

B) Drusen

C) Roth Spots

D) Hard Exudates

C) Roth Spots

A 60-year-old patient with a long history of diabetes mellitus presents for a routine eye exam. Fundoscopy reveals neovascularization (new blood vessel formation), microaneurysms, and several fluffy white lesions ("cotton wool spots"). Which of the following is the most appropriate classification?

A) Non-proliferative Diabetic Retinopathy

B) Proliferative Diabetic Retinopathy

C) Hypertensive Retinopathy

D) Macular Degeneration

B) Proliferative Diabetic Retinopathy

A mother brings in her 2-month-old infant due to persistent tearing and discharge from the right eye. The conjunctiva is not injected. Palpation of the medial canthus results in the reflux of tears and mucoid discharge from the punctum. What is the most likely diagnosis?

A) Dacryostenosis

B) Dacryocystitis

C) Dacryoadenitis

D) Conjunctivitis

A) Dacryostenosis

A 72-year-old female presents with severe headaches that are worse upon awakening in the morning. Fundoscopic examination reveals bilateral blurring of the optic disc margins and an absence of spontaneous venous pulsations. What is the most likely underlying pathophysiology?

A) Retinal Detachment

B) Increased Intracranial Pressure (Papilledema)

C) Central Retinal Artery Occlusion

D) Acute Glaucoma

B) Increased Intracranial Pressure (Papilledema)

A patient presents with a red, painful lump on the edge of the lower eyelid. Examination reveals a tender, localized, erythematous swelling at the lid margin. This condition is caused by an acute obstruction and infection of which gland?

A) Lacrimal Gland

B) Meibomian Gland

C) Parotid Gland

D) Pituitary Gland

B) Meibomian Gland

A 58-year-old male presents with acute vision loss in the right visual field of both eyes (Right Homonymous Hemianopsia). Which of the following anatomical structures is most likely damaged?

A) Right Optic Nerve

B) Optic Chiasm

C) Left Optic Tract or Radiation

D) Right Optic Tract or Radiation

C) Left Optic Tract or Radiation

You are performing a fundoscopic exam on a patient with a history of Wilson's disease. You note a brownish-gold ring around the outer margin of the cornea. This finding is known as:

A) Arcus Senilis

B) Kayser-Fleischer Ring

C) Pterygium

D) Hypopyon

B) Kayser-Fleischer Ring

A 40-year-old female presents with a unilateral pupil that is dilated and reacts poorly to light. However, the pupil constricts slowly during near-vision accommodation. Deep tendon reflexes are noted to be absent in the lower extremities. What is the diagnosis?

A) Third Nerve Palsy

B) Horner's Syndrome

C) Adie's Tonic Pupil

D) Argyll Robertson Pupil

C) Adie's Tonic Pupil

A patient is brought to the ER after a bar fight. He has bruising around the right eye and complains of double vision when looking up. On exam, the right eye does not move upward during superior gaze testing, and there is numbness over the right cheek. What is the most likely diagnosis?

A) Retrobulbar Hematoma

B) Orbital Floor "Blow-out" Fracture

C) Ocular Globe Rupture

D) Detached Retina

B) Orbital Floor "Blow-out" Fracture

A 35-year-old male presents with a "red eye" after vigorous coughing. He denies pain, vision changes, or discharge. Exam reveals a sharp, demarcated area of blood on the lateral aspect of the sclera. The cornea and anterior chamber are clear. What is the most appropriate management?

A) Urgent Ophthalmology Referral

B) Topical Antibiotics

C) Reassurance and Observation

D) Topical Corticosteroids

C) Reassurance and Observation

A patient presents with small, bilateral, irregular pupils that constrict to accommodation (near focus) but do not react to bright light. This finding is historically associated with which condition?

A) Multiple Sclerosis

B) Tertiary Syphilis

C) Diabetes Mellitus

D) Lyme Disease

B) Tertiary Syphilis

A 75-year-old female with a history of type II diabetes and hypertension presents with sudden onset of profound, painless vision loss in her left eye that occurred one hour ago. She denies any eye pain or redness. On fundoscopic examination, you visualize a pale retina with a "cherry red" spot at the fovea. Which of the following is the most likely diagnosis?

A) Central retinal vein occlusion

B) Acute angle-closure glaucoma

C) Central retinal artery occlusion

D) Retinal detachment

C) Central retinal artery occlusion

A 69-year-old male presents to the clinic complaining of a severe left-sided retro-orbital headache associated with nausea and vomiting. He reports sudden onset of blurry vision and "halos" around lights. On physical exam, his left eye shows significant scleral erythema, a cloudy cornea, and a fixed, mid-position pupil. What is the most appropriate next step in management?

A) Administer topical antibiotics for corneal ulcer

B) Emergent referral for measurement of intraocular pressure

C) Reassurance and discharge with analgesics

D) Start oral corticosteroids for temporal arteritis

B) Emergent referral for measurement of intraocular pressure

A 22-year-old college swimmer presents with right ear pain that has worsened over the past 2 days. She reports purulent discharge from the ear. On physical exam, there is marked tenderness with palpation of the tragus and manipulation of the helix. The ear canal is erythematous and swollen. Which of the following is the most likely diagnosis?

A) Acute otitis media

B) Otitis media with effusion

C) Otitis externa

D) Cholesteatoma

C) Otitis externa

A 55-year-old male presents with sudden onset of painless visual loss in his right eye. He describes the sensation of a "black curtain" dropping over his visual field, preceded by flashing lights and floaters. Fundoscopic exam reveals a grey, elevated retina that appears to undulate. This presentation is most consistent with:

A) Vitreous hemorrhage

B) Retinal detachment

C) Age-related macular degeneration

D) Central retinal vein occlusion

B) Retinal detachment

A mother brings her 4-year-old son to the clinic due to fever and tugging at his left ear. He has had a runny nose for the past few days. On otoscopic examination of the left ear, you observe a red, bulging tympanic membrane with loss of landmarks. Pneumatic otoscopy reveals an immobile TM. What is the most likely diagnosis?

A) Otitis media with effusion

B) Acute otitis media

C) Bullous myringitis

D) Tympanosclerosis

B) Acute otitis media

A 65-year-old female presents with a 3-day history of a severe, deep aching pain in her right eye. She has a history of rheumatoid arthritis. Physical exam reveals a small, irregular pupil and a ring of redness around the cornea (ciliary flush). Which of the following is the most likely diagnosis?

A) Conjunctivitis

B) Iritis

C) Acute glaucoma

D) Corneal ulcer

B) Iritis

A 30-year-old male presents with a painless mass in his left testicle. However, he also mentions he has been having trouble hearing out of his left ear for several months. You perform a Weber test, and the sound lateralizes to the right ear. The Rinne test shows Air Conduction > Bone Conduction bilaterally. Which of the following is the most likely etiology for his hearing loss?

A) Cerumen impaction

B) Acoustic neuroma

C) Otosclerosis

D) Presbycusis

B) Acoustic neuroma

A 50-year-old patient complains of painless, gradual loss of central vision over the past year. They report difficulty reading and recognizing faces but can navigate the room using peripheral vision without issue. Fundoscopic exam reveals drusen deposits in the macula. What is the most likely diagnosis?

A) Open-angle glaucoma

B) Cataracts

C) Age-related macular degeneration (Dry)

D) Diabetic retinopathy

C) Age-related macular degeneration (Dry)

A 45-year-old female presents with complaints of dizziness where the room feels like it is spinning. She notes that the symptoms are provoked by head movement. On examination, you note horizontal nystagmus that suppresses with visual fixation. She has no focal neurologic deficits. This clinical picture is most consistent with:

A) Central vertigo

B) Peripheral vertigo

C) Cerebellar stroke

D) Brainstem tumor

B) Peripheral vertigo

A patient presents with "blood and thunder" fundus findings, including optic disc edema and diffuse retinal hemorrhages in all four quadrants. The patient describes a sudden, painless loss of vision. This finding is pathognomonic for:

A) Central retinal artery occlusion

B) Hypertensive retinopathy

C) Central retinal vein occlusion

D) Proliferative diabetic retinopathy

C) Central retinal vein occlusion

A 28-year-old contact lens wearer presents with a painful red eye and a sensation of something in her eye. She admits to sleeping in her contacts frequently. Slit-lamp exam reveals a white, depressed corneal lesion with surrounding redness. What is the most likely diagnosis?

A) Hyphema

B) Corneal ulcer

C) Pterygium

D) Viral conjunctivitis

B) Corneal ulcer

A 72-year-old male presents with a new onset of unilateral temporal headache and jaw pain while chewing his steak dinner. He also reports scalp tenderness when brushing his hair. You suspect giant cell arteritis. Which of the following is a potential serious complication if this condition is left untreated?

A) Conductive hearing loss

B) Meningitis

C) Permanent visual loss

D) Tympanic membrane perforation

C) Permanent visual loss

During a routine physical exam of a 6-year-old, you note an amber-colored fluid behind the tympanic membrane with visible air bubbles. The TM appears retracted, and the child reports a sensation of "ear fullness" but denies pain or fever. What is the most likely diagnosis?

A) Acute otitis media

B) Chronic otitis externa

C) Otitis media with effusion

D) Tympanic membrane perforation

C) Otitis media with effusion

A patient presents with a history of chronic ear infections and painless drainage (otorrhea) from the right ear. Otoscopic exam reveals a collection of squamous epithelium and granulation tissue in the middle ear. You suspect a cholesteatoma. Why is this condition considered dangerous?

A) It is highly contagious

B) It can erode bone and lead to intracranial complications

C) It causes systemic sepsis immediately

D) It is a sign of underlying malignancy

B) It can erode bone and lead to intracranial complications

You are evaluating a patient with diplopia. When the patient looks to the left, the diplopia worsens. You suspect a cranial nerve palsy. Which of the following cranial nerves are responsible for horizontal eye movements and could cause horizontal diplopia?

A) CN III and CN IV

B) CN III and CN VI

C) CN IV and CN VI

D) CN II and CN III

B) CN III and CN VI

A patient presents with acute vertigo, nausea, and vomiting. On examination, you observe vertical nystagmus that does not fatigue. The patient also demonstrates slight ataxia. Based on these findings, the etiology of the vertigo is most likely:

A) Benign Paroxysmal Positional Vertigo (BPPV)

B) Meniere's disease

C) Vestibular neuritis

D) Central pathology (brainstem or cerebellar)

D) Central pathology (brainstem or cerebellar)

A 12-year-old male was hit in the right eye with a baseball. He complains of pain and blurry vision. On exam, you note a pool of blood in the anterior chamber of the eye. What is this finding called?

A) Hypopyon

B) Hyphema

C) Subconjunctival hemorrhage

D) Vitreous hemorrhage

B) Hyphema

Which of the following medications is known to potentially cause sensorineural hearing loss and tinnitus?

A) Amoxicillin

B) Furosemide (Lasix)

C) Acetaminophen

D) Lisinopril

B) Furosemide (Lasix)

A patient presents with hearing loss in the right ear. The Weber test lateralizes to the right ear. The Rinne test in the right ear reveals Bone Conduction > Air Conduction. What type of hearing loss does this indicate?

A) Sensorineural hearing loss in the right ear

B) Conductive hearing loss in the right ear

C) Sensorineural hearing loss in the left ear

D) Normal hearing

B) Conductive hearing loss in the right ear

A 35-year-old female presents with episodic vertigo, tinnitus ("roaring" sound), and fluctuating unilateral hearing loss. She reports a sensation of fullness in the affected ear during episodes. These symptoms are the classic triad for:

A) Vestibular neuritis

B) Benign Paroxysmal Positional Vertigo (BPPV)

C) Meniere's disease

D) Labyrinthitis

C) Meniere's disease

A 65-year-old male presents with a 2-month history of a painless ulcer on the lateral border of his tongue. He has a 40-pack-year smoking history and consumes alcohol daily. On exam, the lesion is indurated and has rolled borders. Which of the following is the most likely diagnosis?

A) Aphthous ulcer

B) Oral candidiasis

C) Squamous cell carcinoma

D) Herpetic stomatitis

C) Squamous cell carcinoma

A 4-year-old female is brought to the clinic with a fever of 102°F, drooling, and difficulty eating. Physical exam reveals swollen, erythematous, and friable gums with multiple vesicular lesions on the oral mucosa and lips. Her mother reports she has not been drinking well. What is the most important initial step in management?

A) Administering oral acyclovir

B) Ensuring adequate hydration

C) Prescribing oral antibiotics

D) Refer for airway evaluation

B) Ensuring adequate hydration

A 22-year-old college student presents with a severe sore throat, fever, and "swollen glands" for 3 days. He denies a cough. On exam, his temperature is 101.5°F, there are tonsillar exudates, and tender anterior cervical lymphadenopathy. Based on the Centor criteria, what is the most appropriate next step?

A) Symptomatic treatment only

B) Rapid strep antigen test or throat culture

C) Empiric treatment with Amoxicillin

D) CT scan of the neck

C) Empiric treatment with Amoxicillin

A 30-year-old female complains of congestion, clear rhinorrhea, and sneezing that is worse in the spring. She denies facial pain or fever. Physical exam reveals pale, boggy turbinates. Which of the following is the most likely diagnosis?

A) Viral rhinitis

B) Bacterial sinusitis

C) Allergic rhinitis

D) Rhinitis medicamentosa

C) Allergic rhinitis

A 16-year-old male presents with a severe sore throat on the left side, difficulty opening his mouth (trismus), and a "hot potato" voice. On exam, the uvula is deviated to the right, and there is a fluctuant bulge in the left soft palate. What is the most likely diagnosis?

A) Epiglottitis

B) Peritonsillar abscess

C) Mononucleosis

D) Strep pharyngitis

B) Peritonsillar abscess

A 55-year-old male presents with "tooth pain" in his upper right molars that worsens when he bends forward to tie his shoes. He has had yellow-green nasal discharge for 10 days following a "cold." Physical exam reveals tenderness over the right cheek. Which sinus is most likely affected?

A) Frontal sinus

B) Ethmoid sinus

C) Sphenoid sinus

D) Maxillary sinus

D) Maxillary sinus

A 7-year-old boy is hit in the face with a baseball. He arrives holding a permanent incisor that was knocked out (avulsed) completely intact. The accident happened 20 minutes ago. What is the appropriate management?

A) Scrub the tooth vigorously and place it in milk

B) Do not reimplant the tooth; refer to a dentist next week

C) Reimplant the tooth immediately into the socket

D) Discard the tooth as it cannot be saved

C) Reimplant the tooth immediately into the socket

A 45-year-old female complains of a white patch on the inside of her cheek that she noticed 2 weeks ago. She smokes 1 pack of cigarettes per day. On exam, there is a thick, white plaque on the buccal mucosa that cannot be scraped off with a tongue blade. What is the most likely diagnosis?

A) Oral candidiasis (Thrush)

B) Leukoplakia

C) Lichen planus

D) Aphthous stomatitis

B) Leukoplakia

A 28-year-old male presents with a painful, round ulcer on the inside of his lower lip. It has a yellow-gray center surrounded by a red halo. He denies fever or systemic symptoms but notes he has been under a lot of stress at work. This lesion is most consistent with:

A) Herpes labialis

B) Chancre of syphilis

C) Aphthous ulcer

D) Squamous cell carcinoma

C) Aphthous ulcer

During a cranial nerve examination, you ask the patient to stick out their tongue. You observe the tongue deviating to the left side. This finding suggests a lesion of which cranial nerve?

A) Right CN XII (Hypoglossal)

B) Left CN XII (Hypoglossal)

C) Right CN X (Vagus)

D) Left CN IX (Glossopharyngeal)

B) Left CN XII (Hypoglossal)

A 50-year-old male presents for a routine physical. He mentions he has had some trouble reading the menu at restaurants recently and has to hold it further away. He denies eye pain or redness. Distance vision is 20/20. This condition is most likely due to:

A) Myopia

B) Hyperopia

C) Cataracts

D) Presbyopia

D) Presbyopia

A 35-year-old female presents with a painless, ulcerated nodule on her lip that appeared 4 weeks ago. She is sexually active with a new partner. The lesion has a clean base and indurated borders. She also has non-tender submandibular lymphadenopathy. What is the most likely diagnosis?

A) Primary Syphilis

B) Herpes Labialis

C) Impetigo

D) Traumatic ulcer

A) Primary Syphilis

A 68-year-old male presents with sudden, painless loss of vision in his right eye. He describes it as a "curtain coming down." This description is classically associated with:

A) Acute Angle-Closure Glaucoma

B) Retinal Detachment

C) Central Retinal Artery Occlusion

D) Macular Degeneration

B) Retinal Detachment

A 19-year-old female presents with a sore throat and profound fatigue. On exam, she has posterior cervical lymphadenopathy and splenomegaly. You suspect Infectious Mononucleosis. Which organism is the primary cause?

A) Streptococcus pyogenes

B) Cytomegalovirus (CMV)

C) Epstein-Barr Virus (EBV)

D) Coxsackie virus

C) Epstein-Barr Virus (EBV)

A 40-year-old male presents with unilateral hearing loss in his left ear that has been gradually worsening. He denies any history of noise exposure. An audiogram reveals sensorineural hearing loss in the left ear only. What is the most concerning differential diagnosis that must be ruled out?

A) Presbycusis

B) Otosclerosis

C) Acoustic Neuroma

D) Cerumen impaction

C) Acoustic Neuroma

A 5-year-old girl presents with a nosebleed. The bleeding is coming from the anterior septum. Which vascular structure is the most likely source of the bleeding?

A) Sphenopalatine artery

B) Kiesselbach's plexus

C) Posterior ethmoidal artery

D) Internal maxillary artery

B) Kiesselbach's plexus

A 60-year-old male with a history of poor dental hygiene presents with fever, chills, and swelling of the floor of his mouth. On exam, the tongue is elevated and protruding, and the submandibular area is firm and tender. He has stridor. What is the most likely diagnosis?

A) Peritonsillar abscess

B) Parotitis

C) Ludwig's angina

D) Sialolithiasis

C) Ludwig's angina

During an oral exam, you ask the patient to say "Ah." You notice the uvula deviates to the left. This indicates a potential lesion of:

A) Left CN X

B) Right CN X

C) Left CN XII

D) Right CN XII

B) Right CN X

A mother brings in her 6-month-old infant due to white patches on the tongue and inner cheeks. She tries to wipe them away with a washcloth, but they do not come off and the area bleeds slightly. The infant is otherwise healthy but recently finished a course of antibiotics for an ear infection. What is the diagnosis?

A) Leukoplakia

B) Oral Candidiasis

C) Milk residue

D) Geographic tongue

B) Oral Candidiasis

A patient presents with a high fever, sore throat, and difficulty breathing. On exam, there is a grayish-green membrane covering the tonsils and posterior pharynx. Attempting to remove it causes bleeding. The patient's immunization history is unknown. This presentation is classic for:

A) Streptococcal pharyngitis

B) Mononucleosis

C) Diphtheria

D) Epiglottitis

C) Diphtheria