Medical Exam Questions Quiz

A previously healthy 39-year-old woman at 37 weeks' gestation comes to the emergency department 2 hours after the onset of acute pain in the left hemithorax. She says that the pain is exacerbated by breathing. Her temperature is $38.2°C$ ($100.8°F$), pulse is 120/min, respirations are 24/min, and blood pressure is 110/70 mm Hg. Fetal heart tones are 170/min. Examination shows no abnormalities. An x-ray of the chest shows no abnormalities. An ECG shows nonspecific changes. Arterial blood gas analysis on room air shows: $pH = 7.43$ $Pco_2 = 35 mm Hg$ $P0_2 = 70 mm Hg$ Which of the following is the most likely diagnosis?

A 52-year-old woman comes to the physician for a routine examination. She has mild hypothyroidism well controlled with levothyroxine. Five years ago, she was diagnosed with stage I breast cancer; she completed tamoxifen therapy 1 year ago and is currently in remission. Menopause occurred 4 years ago. Her mother sustained a femoral fracture in a bicycle collision at the age of 55 years. The patient has smoked two cigarettes weekly for 25 years. She is 150 cm (4 ft 11 in) tall and weighs 43 kg (95 lb); BMI is 19 kg/m². Examination shows no thyromegaly. There is a small, well-healed surgical scar over the upper outer quadrant of the left breast. The remainder of the breast and pelvic examinations show no abnormalities. Which of the following historical findings is the greatest risk factor for osteoporotic fracture in this patient?

A 20-year-old woman comes to the physician because of a 1-week history of vaginal discharge. She is sexually active with one partner, and they use condoms inconsistently. She reports that he was recently treated for syphilis. Physical examination of the patient shows no abnormalities. Pelvic examination shows white verrucous lesions over the upper vaginal wall and cervix. A Pap smear is reported as atypical squamous cells. Human papillomavirus testing is negative for high-risk types. Which of the following is the most likely diagnosis?

A 25-year-old woman comes to the physician because of a 4-week history of right-sided pelvic pain. She has been sexually active with one partner for 3 years; they use condoms for contraception. Her last menstrual period was 3 weeks ago. She is afebrile. Pelvic examination shows a 12-cm, cystic, mobile, right adnexal mass. Her serum CA 125 concentration is 35 U/mL (N<35). Serum β-hCG testing is negative. An x-ray of the abdomen shows calcium deposits in the mass. Which of the following is the most likely diagnosis?

Five weeks after the uncomplicated delivery of her newborn, a 25-year-old woman, gravida 1, para 1, comes to the physician with concerns about insomnia, restlessness, extreme fatigue, irritability, and depression. She has not been eating well. She finds the baby's crying increasingly annoying and has been letting him cry alone in the crib for long periods of time. She is having difficulty with her memory and ability to concentrate. While her husband has been supportive, she has had difficulty involving him in the care of the baby. She is afraid that she may hurt her child and says that maybe she would be better off dead. Which of the following is the most appropriate initial step in management?

A 36-year-old woman, gravida 1, para 1, has been unable to conceive for 1 year. Her vaginal delivery 2 years ago was complicated by postpartum hemorrhage and endometritis treated with dilatation and curettage. She has not resumed menses since delivery but does have cyclic abdominal pain. Examination shows normal findings. Her husband's semen analysis shows normal findings. Which of the following is the most likely cause?

A 32-year-old woman, gravida 2, para 1, at 27 weeks' gestation is brought to the emergency department because of a 3-hour history of painful contractions every 5 minutes. She has not had vaginal discharge or itching. During her first prenatal visit, routine urine culture grew 10,000 colonies/mL of Streptococcus agalactiae (group B). She was not treated at that time because she was asymptomatic. She has no history of serious illness. Pregnancy had been otherwise uncomplicated. She takes no medications and has an allergy to penicillin. Her first pregnancy ended in spontaneous vaginal delivery at 33 weeks' gestation. Her temperature is $37.8°C$ ($100°F$), pulse is 100/min, and blood pressure is 90/50 mm Hg. Abdominal examination shows tenderness to percussion over the right flank. The uterus is nontender and consistent in size with a 27-week gestation. The fetal heart rate is 160/min. Uterine contractions occur every 5 minutes and last 45 seconds. On pelvic examination, the cervix is 2 cm dilated and 75% effaced; the vertex is at 0 station. Which of the following is the most likely cause of this patient's symptoms?

A 22-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the physician for a routine prenatal visit. She feels well other than intermittent, mild, low back pain, and her pregnancy has been uncomplicated. Her pulse is 100/min, and blood pressure is 130/90 mm Hg. Physical examination shows no abnormalities. The estimated fetal weight is 3629 g (8 lb). The fetal heart rate is 120/min. The cervix is 4 cm dilated and 100% effaced; the vertex is at -1 station. Which of the following is the most likely cause of these findings?

A 15-year-old girl is brought to the physician because of a 3-day history of fever, abdominal pain, and nausea. She also has had a thick, white vaginal discharge. Menarche was at the age of 13 years, and her menses occur at irregular 28- to 40-day intervals. She became sexually active 1 month ago and uses condoms inconsistently. Her temperature is $39.6°C$ ($103.2°F$), pulse is 108/min, respirations are 20/min, and blood pressure is 102/80 mm Hg. Examination shows lower abdominal tenderness. Pelvic examination shows pain with cervical motion and adnexal tenderness with a 3-cm mass. A Gram stain of vaginal discharge shows gram-negative diplococci. Which of the following is the most likely explanation for this patient's susceptibility to this condition?

A previously healthy 5-year-old girl is brought to the physician because of a 2-day history of a foul-smelling, yellow discharge and vaginal spotting on her underpants. She has not had pain with urination. Physical examination shows no abnormalities. Pelvic examination shows mild vulvar erythema and a purulent discharge at the vaginal opening. Which of the following is the most likely cause?

A moderately obese 27-year-old woman, gravida 1, para 1, comes to the physician because of pain and tenderness in her left thigh for 2 days. She delivered a healthy newborn at term 6 days ago. Examination shows tenderness and swelling over the left thigh and calf. There is pain in the left calf with dorsiflexion of the left foot. Which of the following is the most appropriate next step to confirm the diagnosis?

A 21-year-old primigravid woman at 8 weeks' gestation comes to the physician for her first prenatal visit. She has sickle cell disease and is concerned about the risk for transmitting this disease to her fetus. Her pregnancy has been otherwise uncomplicated. Examination shows a uterus consistent in size with an 8-week gestation. Her husband's hemoglobin electrophoresis shows: Hemoglobin A 42% (N=95%-98%) Hemoglobin A2 3% (N=2%-3%) Hemoglobin F 2% (N=0.8%-2%) Hemoglobin S 53% (N=0%) This patient should be counseled that the probability her fetus will have sickle cell disease is closest to which of the following?

A 37-year-old primigravid woman at 35 weeks' gestation comes to the physician for a routine prenatal visit. She has been receiving routine prenatal care since 8 weeks' gestation. Pregnancy has been complicated by the onset of hypertension at 18 weeks' gestation that has been well controlled with labetalol. She has an 18-year history of type 1 diabetes mellitus. Her hemoglobin A1c at 8 weeks' gestation was 5.7%. Her blood pressure now is 140/90 mm Hg. Examination shows a soft uterus with a fundal height of 32 cm. The fetal heart rate is 140/min. Serum studies show a urea nitrogen concentration of 8 mg/dL and creatinine concentration of 1 mg/dL. A 24-hour urine collection shows a protein concentration of 800 mg. Ultrasonography shows a normal fetus at the 5th percentile for weight; the placenta is anterior and fundal. There is a mild decrease in the amount of amniotic fluid. Which of the following is the most likely cause of the ultrasound findings?

A 57-year-old woman, gravida 3, para 3, comes to the physician because of loss of urine for 2 weeks. She now wears an absorbent pad constantly and frequently soaks the pad. All of her children were delivered vaginally with no complications. Three years ago, she received radiation therapy for cervical cancer and has been cancer free since then. She has no other history of serious illness and takes no medications. Vital signs are within normal limits. Physical examination shows no abnormalities. Genitourinary examination shows thin, atrophic, moist vaginal mucosa; there is a pool of fluid in the vaginal canal. Her postvoid residual volume is less than 10 mL. Urinalysis shows no abnormalities. Which of the following is the most likely diagnosis?

A 57-year-old woman, gravida 6, para 6, comes to the physician because of a 6-month history of immediate loss of urine when she coughs or exercises. Her children were born by vaginal delivery. Her last menstrual period was 10 years ago, and she has never received estrogen therapy. Pelvic examination shows a normal-sized uterus and ovaries. There is downward mobility of the urethral vesical junction with Valsalva maneuver. Which of the following is the most likely diagnosis?

A 15-year-old girl is brought to the physician because of a 1-week history of constant severe abdominal pain. During the past year, she has had 10 episodes of cramps; each episode lasts 3 to 5 days. She has no history of serious illness and takes no medications. She has never had a menstrual period. She is sexually active with one male partner, and they do not use contraception. She is at the 80th percentile for height and weight. Her temperature is $37.8°C$ ($100°F$), pulse is 120/min, respirations are 16/min, and blood pressure is 90/50 mm Hg. Breast and genital development is Tanner stage 5. Abdominal examination shows moderate tenderness. A mass is palpated in the suprapubic region at the midline. Pelvic examination shows normal-appearing external genitalia and lower vagina. The cervix cannot be visualized because of bluish bulging vaginal tissue that obscures the upper vagina. Which of the following is the most appropriate next step in management?

A 27-year-old woman who is a long-distance runner comes to the physician because of a 1-month history of postcoital spotting lasting 1 to 2 days. Menses have occurred at regular intervals since menarche at the age of 14 years. She underwent a bilateral tubal ligation 9 months ago. She is sexually active with a new partner. Which of the following is the most likely diagnosis?

A 32-year-old woman comes to the physician because of a 3-year history of increasingly irregular menses. Menses had occurred at irregular 45- to 60-day intervals since menarche at the age of 14 years, but now her cycle interval is up to 90 days. Her menstrual periods typically last 2 to 7 days. She is otherwise asymptomatic and has no history of serious illness. She is 163 cm (5 ft 4 in) tall and weighs 103 kg (227 lb); BMI is 39 kg/m². Her pulse is 80/min, and blood pressure is 140/80 mm Hg. Physical examination shows velvety pigmented skin over the axillae and groin. Which of the following serum hormone concentrations is most likely to be increased in this patient?

A 27-year-old woman, gravida 2, para 1, aborta 1, comes to the physician because of a 3-day history of increasing abdominal pain and a 1-day history of fever. Five days ago, she underwent an uncomplicated abortion at 10 weeks' gestation and received prophylactic antibiotics. Her temperature is $39.2°C$ ($102.6°F$), pulse is 110/min, respirations are 24/min, and blood pressure is 90/50 mm Hg. Physical examination shows a tender uterus consistent in size with a 12-week gestation and no adnexal masses. Pelvic ultrasonography shows a heterogeneous endometrial mass. After intravenous antibiotic therapy is started, she undergoes suction dilatation and curettage followed by sharp curettage to remove the infected material. This patient is at increased risk for which of the following conditions?

A 19-year-old woman comes to the emergency department because of moderate lower abdominal pain and vaginal spotting that began after her last menstrual period 2 weeks ago. Menses occur at regular 28-day intervals. She underwent a first trimester elective abortion 8 months ago and has been using an oral contraceptive since then. She has been sexually active with one male partner for 1 year. Her temperature is $37.6°C$ ($99.6°F$); other vital signs are within normal limits. Abdominal examination shows no tenderness. Pelvic examination shows blood-tinged discharge at the cervical os. There is cervical motion and mild uterine tenderness. A urine pregnancy test is negative. Which of the following is the most likely cause of this patient's symptoms?

A 17-year-old primigravid patient comes to the physician because she has had decreased fetal movement over the past 2 days. She does not recall the date of her last menstrual period and has had only one previous prenatal visit. Examination shows a uterus consistent in size with a 32-week gestation. Ultrasonography shows a biparietal diameter consistent with a 31-week gestation. There is a duodenal bubble and flaccid tone of the fetus. Which of the following is the most likely cause of these findings?

A 34-year-old woman, gravida 4, para 3, at 40 weeks' gestation is admitted because of a blood pressure of 160/95 mm Hg. She has chronic hypertension and is being treated with methyldopa. Ultrasonography shows fetal growth restriction. Four hours after induction of labor with oxytocin, the cervix is 6 cm dilated. A fetal heart tracing is shown. Which of the following is the most likely explanation for the findings shown in the fetal heart tracing?

A 22-year-old woman comes to the physician because of a 2-week history of increasingly severe vaginal burning and discharge. She has been sexually active with one partner for 1 year, and they use condoms consistently for contraception. Examination shows normal external genitalia and a gray frothy vaginal discharge. The pH of the vaginal discharge is 5; microscopic examination shows squamous epithelial cells coated with bacteria. Which of the following is the most appropriate pharmacotherapy?

A 23-year-old primigravid woman at 33 weeks' gestation is admitted to the hospital because she has not felt fetal movement for 2 days. Pregnancy had been uncomplicated. She has no history of serious illness. Her sister has had three spontaneous abortions. The patient's temperature is $37°C$ ($98.6°F$), pulse is 80/min, and blood pressure is 110/60 mm Hg. Examination shows a soft uterus consistent in size with a 33-week gestation. Fundal height is 34 cm. Fetal heart tones cannot be auscultated. Ultrasonography confirms intrauterine fetal demise. Laboratory studies show the patient to be a homozygote for the factor $V$ Leiden mutation. Thrombosis of which of the following is the most likely cause of the fetal demise?

Acute Left Hemithorax Pain

Fetal Heart Tones

Diagnosis for Chest Pain

Risk Factors for Osteoporotic Fracture

Osteoporosis Risk Factors

Vaginal Discharge in Young Woman

White Verrucous Lesions

CA-125 Concentration

Fetal Heart Rate Pattern

Contraception Effectiveness

Cesarean Delivery Complications

Pelvic Pain Diagnosis

Hypothyroidism and Bone Health

Tamoxifen Therapy

Inconsistent Condom Use

Pap Smear Result

Anticipated Clinical Findings

Chlamydia Trachomatis History

Contraceptive Counseling

Right Occipitoposterior Position

Endometritis Symptoms

Pelvic Hemorrhage Signs

Viral Pneumonia

Tachycardia in Pregnant Patients

Family History of Fractures