Sunken cheeks, wasting of temporalis muscles, flushing of face indicate ______ ______

systemic illness

Pale, puffy face = ______

hyperthyroidism

Goiter

nephritis

parkinsonism

nephritis

Startled expression = ______

hyperthyroidism

Goiter

nephritis

parkinsonism

hyperthyroidism

Immobile stare = ______

hyperthyroidism

Goiter

nephritis

parkinsonism

parkinsonism

______ = enlarged thyroid glands

hyperthyroidism

Goiter

nephritis

parkinsonism

Goiter

most common endocrine cancer

thyroid cancer

thyroid cancer seen more in men or women?

women

5-year survival rate all thyroid cancers = ___%

97

Thryoid Cancer- Decreasing or Increasing # of cases each year?

Increasing

Thryoid cancer: has been ___ death rate in men and ___ in women

increasing

stable

___ and ___ cancer includes cancers of mouth, nose, sinuses, salivary glands, throat, and lymph nodes

head and neck

___ % of all head and neck cancers linked to tobacco use

85

Mastoid process - part of ___ (impt in ear disease)

temporal

Mouth principle muscle- ___ ___

it surrounds lips and closes lips

orbicularis oris

Eye principle muscle - ___ ___ (___ eyelid)

orbicularis oculi

closes

___ - thin, superficial muscle of neck, crossing outer
border of mandible and extending over lower anterior portion of face

Platysma

Platysma Action- pull mandible ___ and ___

downward

backwards

Which muscle of mastication is described as the strongest and thickest facial muscle responsible for powerful jaw closure?

Masseter

The primary action of the masseter muscle is to:
A. Depress mandible forward
B. Elevate and retract mandible
C. Protrude mandible laterally
D. Stabilize hyoid bone

B. Elevate and retract mandible

A clinician palpates strong tension over the cheek while a patient clenches their teeth. Which muscle is being assessed?
A. Temporalis
B. Buccinator
C. Masseter
D. Medial pterygoid

C. Masseter

Muscles of mastication insert primarily onto which bone to produce chewing movements?

Mandible

Which cranial nerve provides motor innervation to the muscles of mastication?
A. Facial nerve (CN VII)
B. Glossopharyngeal nerve (CN IX)
C. Trigeminal nerve (CN V)
D. Hypoglossal nerve (CN XII)

C. Trigeminal nerve (CN V)

The trigeminal nerve carries sensory information from which of the following regions?
A. Neck muscles
B. Face, oral cavity, and teeth
C. Larynx and pharynx
D. Scalp and posterior neck

B. Face, oral cavity, and teeth

The sternocleidomastoid divides the neck into which two major anatomical regions?
A. Superior and inferior triangles
B. Medial and lateral compartments
C. Anterior and posterior triangles
D. Superficial and deep triangles

C. Anterior and posterior triangles

Which muscle elevates the sternum during forced respiration and helps form the boundary between neck triangles?

SCM

The sternocleidomastoid originates from which two structures?
A. Manubrium and clavicle
B. Clavicle and scapula
C. Sternum and hyoid
D. Mastoid and clavicle

A. Manubrium and clavicle

The insertion of the sternocleidomastoid muscle is located on the:
A. Zygomatic arch
B. Mandibular angle
C. Mastoid process
D. Occipital protuberance

C. Mastoid process

Motor innervation of the sternocleidomastoid muscle is primarily supplied by which cranial nerve?
A. CN X
B. CN XI
C. CN XII
D. CN VII

B. CN XI

The sternocleidomastoid muscle lies superficial to which important vascular and neural structure bundle?
A. Brachial plexus
B. Carotid sheath
C. Thoracic duct
D. Vertebral canal

B. Carotid sheath

Which structure is NOT contained within the carotid sheath?
A. Internal jugular vein
B. Vagus nerve
C. Common carotid artery
D. Phrenic nerve

D. Phrenic nerve

Which boundary helps form the inferior border of the anterior triangle of the neck?
A. Clavicle
B. Mandible
C. Mastoid process
D. Hyoid bone

A. Clavicle

Which of the following structures is located within the anterior triangle of the neck?
A. Brachial plexus
B. Thyroid gland
C. Vertebral artery
D. Spinal cord

B. Thyroid gland

Which gland found in the anterior triangle contributes to saliva production?
A. Parotid gland
B. Sublingual gland
C. Submandibular gland
D. Lacrimal gland

C. Submandibular gland

Which organ within the anterior triangle is directly involved in voice production?

Larynx

Enlargement of which structures in the anterior triangle most commonly reflects immune response to infection?
A. Salivary ducts
B. Lymph nodes
C. Carotid arteries
D. Thyroid follicles

B. Lymph nodes

The thyroid gland consists of two lobes connected by which structure?
A. Ligamentum flavum
B. Thyroid isthmus
C. Median raphe
D. Cricoid ligament

B. Thyroid isthmus

The thyroid gland primarily wraps around which two structures in the neck?
A. Esophagus and vertebrae
B. Larynx and trachea
C. Pharynx and esophagus
D. Mandible and hyoid

B. Larynx and trachea

The thyroid isthmus typically lies across the trachea just inferior to which cartilage?
A. Thyroid cartilage
B. Arytenoid cartilage
C. Cricoid cartilage
D. Epiglottic cartilage

C. Cricoid cartilage

The primary function of the thyroid gland is to: secrete _____ hormones

thyroid

Which muscles form the posterior boundary of the posterior triangle of the neck?

Which structure forms the inferior boundary of the posterior triangle of the neck?

Trapezius

Clavicle

A key structure commonly located within the posterior triangle of the neck is the:
A. Thyroid gland
B. Larynx
C. Lymph nodes
D. Esophagus

C. Lymph nodes

Approximately how many lymph nodes are typically present on each side of the neck?
A. 25
B. 50
C. 75
D. 150

C. 75

During physical examination, range of motion of the neck is commonly assessed to evaluate for:
A. Cranial nerve damage
B. Neck masses or stiffness
C. Cardiac abnormalities
D. Pulmonary restriction

B. Neck masses or stiffness

A painful neck mass most commonly suggests:
A. Acute infection
B. Congenital lesion
C. Malignancy
D. Metastasis

A. Acute infection

mass present for months may be _____

neoplastic

A neck mass present for only a few days most likely indicates:
A. Inflammation
B. Congenital abnormality
C. Metastatic disease
D. Thyroid carcinoma

A. Inflammation

A neck mass present for months to years without change in size is most consistent with:
A. Rapid malignancy
B. Acute abscess
C. Lesion
D. Severe inflammation

C. Lesion

A neck mass that fluctuates in size while eating most likely results from:
A. Thyroid enlargement
B. Salivary gland blockage
C. Lymphatic metastasis
D. Thyroglossal cyst

B. Salivary gland blockage

In patients younger than 20 years old, a neck mass is most commonly due to:
A. Metastatic carcinoma or congenital mass
B. Enlarged tonsillar node or congenital mass
C. Thyroid cancer or congenital mass
D. Gastric metastasis or congenital mass

B. Enlarged tonsillar node or congenital mass

A midline neck mass in a young patient most strongly suggests which condition?
A. Dermoid cyst
B. Thyroglossal cyst
C. Salivary obstruction
D. Metastatic lesion

B. Thyroglossal cyst

In patients aged 20–40 years, neck masses are most commonly related to:
A. Thyroid disease
B. Metastatic cancer
C. Congenital anomalies
D. Salivary tumors

A. Thyroid disease

In patients older than 40 years, a new neck mass should be considered:
A. Benign until proven malignant
B. Malignant until proven otherwise
C. Congenital until proven malignant
D. Infectious until proven benign

B. Malignant until proven otherwise

A midline neck mass is most commonly associated with:
A. Metastatic disease
B. Congenital or benign lesions
C. Salivary tumors
D. Lymphatic obstruction

B. Congenital or benign lesions

A lateral neck mass is most commonly suggestive of:
A. Congenital cyst
B. Benign thyroid disease
C. Neoplastic process
D. Salivary obstruction

C. Neoplastic process

Metastatic tumors in the upper neck most commonly originate from cancers of the:
A. Breast and stomach
B. Head and neck
C. Kidney and bladder
D. Liver and pancreas

B. Head and neck

Metastatic tumors in the lower neck most commonly originate from cancers of the:
A. Lung and pancreas
B. Breast and stomach
C. Thyroid and larynx
D. Brain and spinal cord

B. Breast and stomach

The most common cause of neck stiffness is:
A. Cervical fracture
B. Muscle sprain or strain
C. Spinal infection
D. Disc herniation

B. Muscle sprain or strain

Neck stiffness caused by muscular injury most commonly involves which muscle?
A. Sternocleidomastoid
B. Trapezius
C. Levator scapulae
D. Scalenes

C. Levator scapulae

The levator scapulae muscle connects the cervical spine to which structure?
A. Mandible
B. Shoulders
C. Sternum
D. Hyoid bone

B. Shoulders

The levator scapulae is primarily located along which region of the neck?
A. Anterior neck only
B. Back and side of neck
C. Deep anterior triangle
D. Midline posterior neck

B. Back and side of neck

The levator scapulae muscle receives motor innervation primarily from which cervical spinal nerves?

C3–C4

Sudden neck stiffness accompanied by high fever, nausea, vomiting, and headache should raise concern for:
A. Cervical radiculopathy
B. Meningeal irritation
C. Thyroid enlargement
D. Cervical disc degeneration

B. Meningeal irritation

Neck stiffness accompanied by fever should prompt:
A. Immediate surgical referral
B. Routine observation only
C. Medical evaluation
D. Physical therapy only

C. Medical evaluation

Neck pain may occur as referred pain from which organ system?
A. Respiratory system
B. Cardiovascular system
C. Gastrointestinal system
D. Renal system

B. Cardiovascular system

A patient with angina or myocardial infarction may complain of pain radiating to which area?
A. Lower back
B. Neck
C. Abdomen
D. Hip

B. Neck

Neck pain associated with myocardial ischemia is best explained by:
A. Direct cervical injury
B. Referred pain
C. Local muscle spasm
D. Thyroid inflammation

B. Referred pain

The most common psychological reaction to head and neck disease is:

Depression

During inspection of the head and neck, which structure should be examined for lesions and hair characteristics?

Scalp

During embryologic development, the thyroid gland migrates downward along which structure of the neck?
A. Lateral cervical region
B. Midline of the neck
C. Posterior cervical region
D. Submandibular space

B. Midline of the neck

Failure of the embryologic thyroid migration tract to close may result in formation of a:
A. Branchial cleft cyst
B. Dermoid cyst
C. Thyroglossal duct cyst
D. Salivary abscess

C. Thyroglossal duct cyst

A thyroglossal duct cyst forms when the persistent tract fills with:
A. Blood or lymph
B. Fluid or thick mucous-like material
C. Air or gas
D. Fat or connective tissue

B. Fluid or thick mucous-like material

A thyroglossal duct cyst most commonly appears as which type of neck mass?
A. Hard irregular lateral mass
B. Midline soft round mass
C. Deep posterior triangular mass
D. Painful supraclavicular mass

B. Midline soft round mass

Thyroglossal duct cysts are most commonly detected during which period of life?
A. Late adulthood
B. Adolescence
C. Early childhood
D. Prenatal period

C. Early childhood

The typical size of a thyroglossal duct cyst is approximately comparable to a:
A. Marble
B. Ping pong ball
C. Golf ball
D. Tennis ball

B. Ping pong ball

Before surgical removal of a thyroglossal duct cyst, clinicians must confirm the presence of a:
A. Normal parathyroid gland
B. Functional pituitary gland
C. Normal thyroid gland
D. Normal salivary gland

C. Normal thyroid gland

Thyroid tissue within a thyroglossal duct cyst may rarely develop which condition?
A. Hyperplasia
B. Thyroid cancer
C. Calcification
D. Fibrosis

B. Thyroid cancer

Forward displacement or bulging of the eyeball observed during examination is termed:
A. Exophoria
B. Proptosis
C. Enophthalmos
D. Ptosis

B. Proptosis

Bilateral proptosis is classically associated with which disorder?
A. Hashimoto thyroiditis
B. Graves disease
C. Pituitary adenoma
D. Cushing syndrome

B. Graves disease

Enlargement of the thyroid gland commonly results in:
A. Jaw asymmetry
B. Enlarged neck
C. Facial paralysis
D. Orbital edema

B. Enlarged neck

Prominent superficial veins in the neck may be observed in patients with:
A. Goiter
B. Lymphadenitis
C. Dermoid cyst
D. Tonsillar hypertrophy

A. Goiter

Multiple nodular neck masses are most commonly associated with:
A. Thyroid lymphoma
B. Multinodular goiter
C. Thyroglossal cyst
D. Parathyroid adenoma

B. Multinodular goiter

Auscultation of the neck during physical examination is commonly performed to detect:
A. Thyroid nodules
B. Jugular venous waves
C. Carotid bruits
D. Cervical muscle spasms

C. Carotid bruits

What approach? Anterior or Posterior?

Pt neck flexed and turning chin slightly to right- relax SCM on that side and easier to perform

Left hand of doc displace larynx to left and during swallowing, displaced left thyroid lobe palpated between examiner's right thumb and left SCM muscle

Anterior

What approach? Anterior or Posterior?

- patient neck slightly extended
- Again push thyroid to one side while patient swallow and doc rolls hand
over thyroid cartilage
- Hard for examiner to feel thyroid gland in normal state

Posterior

For thyroid exam:

Unusual ____ - cancer or scarring
____ - toxic goiter

hardness

Softness

When palpating lymph nodes of the head and neck, the examiner should assess for:
A. Warmth, pulse, color
B. Mobility, consistency, tenderness
C. Diameter, bruit, fluctuation
D. Shape, contour, transillumination

B. Mobility, consistency, tenderness

Tender cervical lymph nodes are most commonly associated with:
A. Malignancy
B. Inflammation
C. Congenital cysts
D. Fibrosis

B. Inflammation

Fixed, firm lymph nodes on neck palpation are most concerning for:
A. Viral infection
B. Acute inflammation
C. Malignancy
D. Salivary obstruction

C. Malignancy

Tenderness of the thyroid gland is most commonly associated with:
A. Chronic fibrosis
B. Acute infection or hemorrhage
C. Benign adenoma only
D. Metastatic spread only

B. Acute infection or hemorrhage

If the thyroid gland is enlarged, additional examination should include:
A. Auscultation
B. Transillumination
C. Percussion
D. Ophthalmoscopy

A. Auscultation

Which part of the stethoscope is best used to auscultate an enlarged thyroid gland?

Bell

During thyroid auscultation, the bell of the stethoscope is placed over the:
A. Cricoid cartilage
B. Thyroid lobes
C. Carotid bifurcation
D. Suprasternal notch

B. Thyroid lobes

A bruit heard over the thyroid gland represents:
A. Air moving in trachea
B. Turbulent blood flow
C. Vocal cord vibration
D. Lymphatic obstruction

B. Turbulent blood flow

A systolic bruit heard over the superior pole of the thyroid is highly suggestive of:
A. Thyroglossal cyst
B. Toxic goiter
C. Acute thyroid abscess
D. Multinodular carcinoma

B. Toxic goiter

To palpate the supraclavicular nodes, the examiner is best positioned:
A. In front of patient
B. Behind patient
C. Beside patient
D. Above patient

B. Behind patient

Supraclavicular nodes are palpated by placing the fingers:
A. Over the mastoid process
B. Beneath the mandible
C. In the medial supraclavicular fossae
D. Over the thyroid isthmus

C. In the medial supraclavicular fossae

While palpating the supraclavicular nodes, the examiner presses deeply:
A. Above and lateral to mandible
B. Over tracheal rings
C. Into and behind clavicles
D. Into posterior triangle only

C. Into and behind clavicles

Which adjacent muscle serves as a landmark during palpation of supraclavicular nodes?

Sternocleidomastoid

Supraclavicular lymph nodes are most likely to become palpable when the patient:
A. Swallows
B. Exhales fully
C. Inspires deeply
D. Turns head laterally

C. Inspires deeply

Iodine deficiency = thyroid ______

enlarged

Causes of ______ - infection, AI disease, cancer, isolated nodules

goiter

______ thyroid = hyperthyroidism, hypothyroid, or simple or multinodular goiter of normal function

Enlarged

Pemberton’s sign is primarily used to detect obstruction in which anatomical region?
A. Thoracic inlet
B. Cervical spinal canal
C. Carotid bifurcation
D. Posterior triangle

A. Thoracic inlet

Pemberton’s sign is tested by asking the patient to:
A. Rotate the head side to side
B. Elevate both arms overhead
C. Take repeated deep breaths
D. Flex the neck forward

B. Elevate both arms overhead

During the Pemberton maneuver, the patient’s arms are raised until they:
A. Cross over chest
B. Touch the side of head
C. Reach shoulder level
D. Extend straight forward

B. Touch the side of head

A positive Pemberton’s sign initially presents with:
A. Sudden hypotension and neck vein dilation
B. Facial suffusion and neck vein dilation
C. Severe neck pain and neck vein dilation
D. Rapid heart rate and neck vein dilation

B. Facial suffusion and neck vein dilation

If the Pemberton maneuver continues for 1–2 minutes in a positive test, the patient’s face may become:
A. Pale
B. Edematous
C. Erythematous
D. Cyanotic

D. Cyanotic

The most common cause of hyperthyroidism is:
A. Thyroid adenoma
B. Hashimoto thyroiditis
C. Diffuse toxic goiter
D. Multinodular goiter

C. Diffuse toxic goiter

Diffuse toxic goiter is also known as:
A. Graves disease
B. Addison disease
C. Cushing syndrome
D. Paget disease

A. Graves disease

Graves disease is classified as which type of disorder?
A. Infectious disorder
B. Autoimmune disorder
C. Genetic structural disorder
D. Degenerative disorder

B. Autoimmune disorder

Graves disease is caused by production of which antibody?
A. Thyroid peroxidase antibody
B. Thyroid-stimulating immunoglobulin
C. Antithyroglobulin antibody
D. Anti-TSH receptor blocker

B. Thyroid-stimulating immunoglobulin

A patient with hyperthyroidism most commonly presents with which skin finding?
A. Cool, dry skin
B. Warm skin
C. Thickened plaques
D. Hyperpigmented patches

B. Warm skin

Which neurologic symptom is commonly associated with hyperthyroidism?
A. Hand tremor
B. Facial paralysis
C. Loss of reflexes
D. Muscle rigidity

A. Hand tremor

Which psychiatric symptom is frequently seen in hyperthyroidism?
A. Depression and insomnia
B. Anxiety and insomnia
C. Hallucinations and insomnia
D. Memory loss and insomnia

B. Anxiety and insomnia

Heat intolerance in hyperthyroidism is primarily due to:
A. Reduced metabolism
B. Increased metabolic rate
C. Decreased circulation
D. Impaired sweating

B. Increased metabolic rate

Which reproductive symptom may occur in women with hyperthyroidism?

Amenorrhea

Excessive sweating associated with hyperthyroidism is termed:
A. Hyperthermia
B. Hyperhidrosis
C. Hyperemia
D. Hyperplasia

B. Hyperhidrosis

Which ocular sign is classically associated with Graves disease?
A. Ptosis
B. Proptosis
C. Enophthalmos
D. Strabismus

B. Proptosis

Hyperthyroidism may also cause cardiovascular symptoms such as:
A. Bradycardia
B. Palpitations
C. Heart block
D. Hypotension

B. Palpitations

Changes in which structure may occur in hyperthyroidism leading to abnormal growth patterns?
A. Teeth
B. Nails
C. Cartilage
D. Tendons

B. Nails

Hyperthyroidism may occasionally be caused by which thyroid abnormality?
A. Cold nodule
B. Fibrotic nodule
C. Hot nodule
D. Calcified nodule

C. Hot nodule

Patient with exophthalmos, weight loss, palpitations:

Thyroglossal duct cyst

Thyroid carcinoma

Graves’ Disease

Graves’ Disease

Older patient with firm, non-tender thyroid nodule:

Thyroglossal duct cyst

Thyroid carcinoma

Graves’ Disease

Thyroid carcinoma

Young patient with midline neck mass moving with swallowing:

Thyroglossal duct cyst

Thyroid carcinoma

Graves’ Disease

Thyroglossal duct cyst

Patient with progressively enlarging lateral neck mass:

Laryngeal SCC

Lymphoma or metastatic carcinoma

Meningitis

Lymphoma or metastatic carcinoma

Neck stiffness, fever, photophobia:

Laryngeal SCC

Lymphoma or metastatic carcinoma

Meningitis

Meningitis

Elderly male smoker with hoarseness >2 weeks:

Laryngeal SCC

Lymphoma or metastatic carcinoma

Meningitis

Laryngeal SCC

During axillary examination, proper technique requires the pectoral muscles to be:
A. Contracted firmly
B. Fully relaxed
C. Slightly flexed
D. Rotated laterally

B. Fully relaxed

When examining the patient’s right axilla, the examiner supports the patient’s right forearm with the examiner’s:
A. Left thumb
B. Opposite shoulder
C. Right hand
D. Left elbow

C. Right hand

In right axillary palpation, the examining fingers are usually those of the examiner’s:
A. Left hand
B. Right hand
C. Dominant hand
D. Both thumbs

A. Left hand

At the start of palpating the axilla, the examiner’s fingers should be placed:
A. Beneath the clavicle
B. Low in the axilla
C. Over the scapula
D. Near the sternum

B. Low in the axilla

As the patient’s right arm is drawn medially, the examiner should move the palpating hand:
A. Upward into the axilla
B. Outward from the chest
C. Down across the ribs
D. Back toward the scapula

A. Upward into the axilla

In addition to the axilla, which regions are specifically included in this lymph node exam?
A. Inguinal and femoral
B. Occipital and tonsillar
C. Supraclavicular and subclavian
D. Epitrochlear and popliteal

C. Supraclavicular and subclavian

Which finger movement is recommended for detecting adenopathy in the axilla?
A. Sharp repetitive tapping
B. Broad linear strokes
C. Small circular motions
D. Static deep pressure

C. Small circular motions

During this palpation technique, the examiner’s fingers are described as:
A. Sliding under muscles
B. Riding over the ribs
C. Pressing behind the sternum
D. Hooking above the clavicle

B. Riding over the ribs

Freely mobile axillary nodes measuring 3 to 5 mm are generally considered:
A. Common benign findings
B. Definite metastatic disease
C. Evidence of thyroid spread
D. Signs of vascular obstruction

A. Common benign findings

Small mobile axillary lymph nodes most often suggest lymphadenitis secondary to:
A. Upper GI infection
B. Minor hand trauma
C. Thyroid inflammation
D. Deep neck abscess

B. Minor hand trauma

Which body region is specifically mentioned as a source of trauma leading to these reactive nodes?
A. Foot and ankle
B. Abdomen and chest
C. Hand and arm
D. Face and scalp

C. Hand and arm

After one axilla has been examined, the other should be assessed with the examiner’s:
A. Same left hand
B. Dominant shoulder
C. Opposite hand
D. Right forearm

C. Opposite hand

Orthostatic hypotension: Dizziness may accompany the _____ in blood pressure. In most affected patients, there is also an _____ in heart rate.

drop

increase

Risk factors: old age, meds, cardiac, heat exposure, bed rest, pregnancy, alcohol

What is this?

Orthostatic hypotension

Korotkoff sounds are best described as:
A. High-pitched venous clicks
B. Turbulent arterial sounds
C. Pleural friction rubs
D. Valve closure noises

B. Turbulent arterial sounds

Korotkoff sounds are produced when a blood pressure cuff:
A. Partially occludes an artery
B. Completely blocks venous return
C. Compresses the radial nerve
D. Expands the vessel wall

A. Partially occludes an artery

Which Korotkoff phase is most accurate for determining diastolic blood pressure in adults?
A. Phase 1
B. Phase 3
C. Phase 4
D. Phase 5

D. Phase 5

Compared with phase 4 muffling, phase 5 is preferred because it reflects:
A. Earlier systolic ejection
B. Sound disappearance
C. Venous reopening
D. Peak arterial recoil

B. Sound disappearance

Masked hypertension refers to patients who:
A. Have only elevated office readings
B. Show normal readings only at night
C. Appear normal in clinic
D. Develop hypotension during stress

C. Appear normal in clinic

Masked hypertension is especially concerning because it indicates increased risk of:
A. Renal stones
B. Thyroid disease
C. Cardiovascular disease
D. Pulmonary fibrosis

C. Cardiovascular disease

If the patient’s arm is not supported at heart level during BP measurement, the reading may be falsely high because the patient is performing:
A. Passive stretching
B. Isometric exercise
C. Dynamic contraction
D. Respiratory straining

B. Isometric exercise

Failure to support the arm properly most directly causes an artificially elevated:
A. Pulse deficit
B. Blood pressure reading
C. Respiratory rate
D. Oxygen saturation

B. Blood pressure reading

Pressing too hard with the diaphragm significantly lowers which measurement?
A. Diastolic pressure
B. Mean arterial pressure
C. Systolic pressure
D. Pulse amplitude

A. Diastolic pressure

When positioning the cuff, the bladder should be centered over the:
A. Radial artery
B. Ulnar artery
C. Brachial artery
D. Axillary artery

C. Brachial artery

During blood pressure measurement by palpation, the systolic pressure is identified by the:
A. Disappearance of radial pulse
B. Return of brachial pulse
C. Muffling of Korotkoff sounds
D. Peak carotid upstroke

B. Return of brachial pulse

Coarctation of the aorta may occur as an isolated defect or in association with which cardiac lesion?
A. Atrial septal defect
B. Mitral valve prolapse
C. Bicuspid aortic valve
D. Tricuspid atresia

C. Bicuspid aortic valve

Which additional congenital lesion is commonly associated with coarctation of the aorta?
A. Ventricular septal defect
B. Patent foramen ovale
C. Ebstein anomaly
D. Aortic regurgitation

A. Ventricular septal defect

In a new patient with hypertension, evaluation for coarctation should always include blood pressure measurement in the:
A. Upper extremity
B. Lower extremity
C. Left arm
D. Right wrist

B. Lower extremity

During blood pressure assessment for suspected coarctation, the patient is positioned:
A. Supine
B. Sitting upright
C. Prone
D. Standing

C. Prone

For lower-extremity blood pressure measurement in suspected coarctation, the cuff is placed around the:
A. Distal calf
B. Anterior knee
C. Posterior midthigh
D. Lateral ankle

C. Posterior midthigh

When measuring leg blood pressure for coarctation, the stethoscope is commonly placed over the:
A. Femoral triangle
B. Popliteal fossa
C. Inguinal ligament
D. Greater saphenous vein

B. Popliteal fossa

In addition to the popliteal artery, which distal artery may be used for auscultation during this exam?
A. Ulnar artery
B. Temporal artery
C. Dorsalis pedis artery
D. Axillary artery

C. Dorsalis pedis artery

Which other distal artery may be used when checking lower-extremity pressure in suspected coarctation?
A. Posterior tibial artery
B. Deep brachial artery
C. Common carotid artery
D. Radial artery

A. Posterior tibial artery

A leg systolic blood pressure lower than the arm systolic pressure should raise suspicion for:
A. Aortic stenosis
B. Coarctation of the aorta
C. Mitral regurgitation
D. Pulmonary hypertension

B. Coarctation of the aorta

Suspicion for coarctation increases further when the femoral pulse is:
A. Bounding compared with carotid
B. Irregular compared with brachial
C. Absent only during expiration
D. Delayed compared with radial

D. Delayed compared with radial

In a normal patient, the femoral and radial pulses should:
A. Alternate in timing
B. Peak at the same time
C. Differ by one beat
D. Vary with inspiration only

B. Peak at the same time

Which pulse comparison is specifically useful when evaluating possible coarctation of the aorta?
A. Carotid and brachial
B. Radial and femoral
C. Popliteal and ulnar
D. Dorsalis pedis and carotid

B. Radial and femoral

A delayed femoral pulse relative to the radial pulse is classically termed:
A. Pulsus paradoxus
B. Radiofemoral delay
C. Pulsus alternans
D. Water-hammer pulse

B. Radiofemoral delay

The reason lower-extremity blood pressure is important in new hypertension evaluation is that coarctation can:
A. Cause isolated low arm pressure
B. Be missed without leg comparison
C. Present only with bradycardia
D. Eliminate all distal pulses

B. Be missed without leg comparison

During general inspection, the examiner should first assess the patient’s:
A. State of consciousness and grooming
B. Liver span and spleen size
C. Deep tendon reflexes
D. Urinary output and intake

A. State of consciousness and grooming

In overall inspection, nutritional status is evaluated because chronically ill patients are more often:
A. Obese from inactivity
B. Cachectic rather than overweight
C. Muscular from compensation
D. Edematous from overhydration

B. Cachectic rather than overweight

A thin body habitus with poor muscle development, small bone structure, and malnourishment is termed:
A. Sthenic
B. Hypersthenic
C. Asthenic
D. Mesomorphic

C. Asthenic

An athletic build with well-developed muscles and bones is most consistent with which body type?
A. Ectomorphic
B. Cachectic
C. Hypersthenic
D. Sthenic

D. Sthenic

A short, rounded body habitus with good musculature but frequent weight problems is described as:
A. Hypersthenic
B. Asthenic
C. Marfanoid
D. Wasted

A. Hypersthenic

During inspection, asymmetry is important because it may suggest:
A. Normal anatomic variation only
B. Underlying focal pathology
C. Exclusive psychiatric disease
D. Laboratory artifact

B. Underlying focal pathology

Left supraclavicular swelling on inspection should raise concern for:
A. Lung abscess
B. Hyperthyroidism
C. Gastric carcinoma
D. Appendicitis

C. Gastric carcinoma

A miotic pupil in the setting of asymmetry may suggest a:
A. Tumor of the lung apex
B. Frontal lobe infarct
C. Parotid gland cyst
D. Pituitary adenoma

A. Tumor of the lung apex

A left-sided varicocele may be a clue to:
A. Aortic stenosis
B. Hypernephroma
C. Pancreatitis
D. Diverticulitis

B. Hypernephroma

Inspection of speech patterns can provide important information about:
A. Cranial nerve function
B. Renal perfusion
C. Thyroid hormone levels
D. Peripheral pulses

A. Cranial nerve function

A basic mental status screen during inspection should include orientation to:
A. Age, sex, and occupation
B. Person, place, and date
C. Time, pulse, and gait
D. Memory, reflexes, and mood

B. Person, place, and date

Which of the following is one of the cardinal signs of inflammation?
A. Bradycardia
B. Pallor
C. Redness
D. Cyanosis

C. Redness

Which set correctly lists the classic cardinal signs of inflammation?
A. Swelling, heat, redness, pain, disturbed function
B. Fever, hypotension, edema, rash, syncope
C. Pallor, tremor, weakness, cough, confusion
D. Cyanosis, bruit, jaundice, fever, rigidity

A. Swelling, heat, redness, pain, disturbed function

The pain associated with swelling is primarily caused by:
A. Loss of arterial flow
B. Increased pressure on nerve fibers
C. Excess neurotransmitter release
D. Reduced venous turbulence

B. Increased pressure on nerve fibers

Which inspection finding best reflects a disturbance of function as part of inflammation?
A. Inability to use the affected part
B. Blue discoloration of nails
C. Loud bowel sounds
D. Hyperreflexia in both legs

A. Inability to use the affected part

Which body type is most likely to be described as thin with poor musculature?
A. Endomorphic
B. Hypersthenic
C. Sthenic
D. Ectomorphic

D. Ectomorphic

During palpation of the chest, an abnormal impulse on the right side is most concerning for:
A. Ascending aortic aneurysm
B. Right pleural effusion
C. Mitral valve prolapse
D. Splenic enlargement

A. Ascending aortic aneurysm

A pulsatile mass palpated in the abdomen should raise concern for:
A. Distended bladder
B. Inflamed gallbladder
C. Abdominal aortic aneurysm
D. Fecal impaction

C. Abdominal aortic aneurysm

An acutely tender right upper quadrant mass that descends with inspiration is most likely:
A. Enlarged pancreas
B. Hepatic abscess
C. Right renal tumor
D. Inflamed gallbladder

D. Inflamed gallbladder

Which condition is most likely to change the percussion note?
A. Solid abdominal tumor
B. Collapsed lung
C. Small inguinal hernia
D. Thyroid nodule

B. Collapsed lung

A dull percussion note in the lower midline abdomen of a man most likely represents:
A. Distended urinary bladder
B. Fecalith in sigmoid colon
C. Enlarged prostate
D. Pelvic kidney

A. Distended urinary bladder

When examining the heart, chest, and abdomen, auscultation should be:
A. Used only after palpation
B. Performed by itself first
C. Combined with other techniques
D. Limited to abnormal patients

C. Combined with other techniques

Absence of normal bowel sounds should raise concern for:
A. Functional dyspepsia
B. Surgical emergency
C. Thyroid crisis
D. Mild dehydration

B. Surgical emergency

Daylight is preferred for physical examination because artificial light may:
A. Dampen transmitted voice sounds
B. Blur vascular pulsations
C. Reduce tactile fremitus
D. Mask skin color changes

D. Mask skin color changes

Before beginning the examination, the examiner should:
A. Reassure the patient repeatedly
B. Start with auscultation
C. Wash hands
D. Dim the room lights

C. Wash hands

During the exam, it is best to:
A. Minimize unnecessary movement
B. Reposition after every step
C. Alternate standing and sitting
D. Examine one system at a time

A. Minimize unnecessary movement

Physical examination is generally organized by:
A. Chief complaint sequence
B. Organ system categories
C. Laboratory priorities
D. Body regions

D. Body regions

By convention, the examiner stands:
A. At the patient’s left
B. At the patient’s right
C. Behind the patient
D. At the foot of bed

B. At the patient’s right

By convention, the examiner primarily uses the:
A. Right hand
B. Left hand
C. Stronger hand only
D. Nondominant hand

A. Right hand

Which statement should the examiner avoid during the examination?
A. “Please take a breath”
B. “Tell me if tender”
C. “Roll toward me”
D. “That’s normal”

D. “That’s normal”

Universal precautions assume that all blood and body fluids may contain:
A. Only hepatitis B
B. Only HIV
C. Blood-borne pathogens
D. Normal skin flora

C. Blood-borne pathogens

In occupational exposure, the most important source of HIV, HBV, and HCV infection is:
A. Saliva
B. Blood
C. Sweat
D. Tears

B. Blood

Which preventive measure is specifically recommended for healthcare workers regarding HBV?
A. Routine chest imaging
B. Monthly blood cultures
C. Daily mask fit testing
D. HBV vaccination

D. HBV vaccination

Which item is considered a protective barrier?
A. Gloves
B. Reflex hammer
C. Otoscope
D. Tongue depressor

A. Gloves

Which is also listed as a protective barrier?
A. Tourniquet
B. Gown
C. Lubricant gel
D. Alcohol swab

B. Gown

Which item belongs to standard protective barriers?
A. Stethoscope cover
B. Bed sheet
C. Mask
D. ID badge

C. Mask

Which piece of equipment is included among protective barriers?
A. Eye protection
B. Bedside drape
C. Specimen cup
D. Wrist brace

A. Eye protection

Compared with lung collapse, which finding generally does not alter the percussion note?
A. Pleural effusion
B. Pneumothorax
C. Lobar collapse
D. Solid abdominal mass

D. Solid abdominal mass

Which finding most strongly supports acute gallbladder inflammation?
A. Right-sided chest impulse
B. RUQ mass descends inspiration
C. Midline dull pelvic note
D. Pulsatile abdominal mass

B. RUQ mass descends inspiration

Which statement best reflects proper overall exam technique?
A. Examine by systems only
B. Skip gloves if blood absent
C. Integrate methods and precautions
D. Use artificial light for skin

C. Integrate methods and precautions

Transmission-based precautions are primarily intended to:
A. Decrease pathogen transmission in hospitals
B. Replace standard vital sign assessment
C. Eliminate all diagnostic uncertainty
D. Reduce need for hand hygiene

A. Decrease pathogen transmission in hospitals

Which infection requires airborne precautions?
A. Influenza
B. Tuberculosis
C. Clostridioides difficile
D. Cellulitis

B. Tuberculosis

A patient with suspected varicella should be placed in a:
A. Positive-pressure room
B. Standard semiprivate room
C. Negative-pressure room
D. Droplet isolation bay

C. Negative-pressure room

Which personal protective equipment is specifically required for airborne precautions?
A. Surgical mask
B. Face shield only
C. Sterile gloves
D. N95 respirator

D. N95 respirator

Droplet precautions are used for pathogens spread primarily by:
A. Large respiratory droplets
B. Contaminated needles only
C. Blood transfusion exposure
D. Fecal-oral spores alone

A. Large respiratory droplets

Which precaution category is most appropriate for many respiratory viruses?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions
D. Reverse isolation

B. Droplet precautions

Under droplet precautions, appropriate protective equipment includes:
A. Surgical mask and gloves
B. Gown and N95 only
C. Cap and shoe covers
D. Eye shield only

A. Surgical mask and gloves

Contact precautions are mainly used for pathogens spread by:
A. Aerosolized nuclei
B. Waterborne exposure
C. Skin contact or surfaces
D. Vector transmission

C. Skin contact or surfaces

Which infection is a classic indication for contact precautions?
A. Tuberculosis
B. Varicella
C. Influenza
D. Clostridioides difficile

D. Clostridioides difficile

Which combination is standard for contact precautions?
A. N95 and eye shield
B. Surgical mask and gown
C. Gloves and face shield
D. Gown and gloves

D. Gown and gloves

After a needlestick injury, the affected area should first be:
A. Flushed vigorously with water
B. Covered and ignored
C. Scrubbed with alcohol only
D. Compressed until bleeding stops

A. Flushed vigorously with water

After initial cleansing of a needlestick injury, the next step is to:
A. Return to work immediately
B. Seek guidance from the needlestick coordinator
C. Start antibiotics automatically
D. Order a chest radiograph

B. Seek guidance from the needlestick coordinator

When indicated after needlestick exposure, HIV postexposure prophylaxis should be started:
A. After serology confirms infection
B. At the next annual checkup
C. As soon as possible
D. Only if symptoms develop

C. As soon as possible

Following a needlestick injury, the exposed provider should also be tested for:
A. Hepatitis B or hepatitis C
B. Measles and mumps
C. Varicella and rubella
D. Syphilis and gonorrhea

A. Hepatitis B or hepatitis C

Which vaccine is specifically recommended for all healthcare workers with direct patient contact?
A. Rabies vaccine
B. Hepatitis B vaccine
C. Polio booster only
D. Yellow fever vaccine

B. Hepatitis B vaccine

In addition to hepatitis B vaccination, healthcare workers should receive the:
A. Pneumococcal series every month
B. Tetanus booster every season
C. Meningococcal vaccine yearly
D. Annual influenza vaccine

D. Annual influenza vaccine

The most important contributors to validity of the physical examination are:
A. Expensive equipment and speed
B. Imaging confirmation and repetition
C. Clinical experience and technique reliability
D. Patient age and body habitus

C. Clinical experience and technique reliability

False-positive and false-negative findings primarily reduce the:
A. Precision of examination techniques
B. Cost of the examination
C. Need for documentation
D. Safety of isolation rooms

A. Precision of examination techniques

Which factor can distort the examiner’s interpretation of a physical finding?
A. Room temperature
B. Unconscious bias
C. Dominant hand preference
D. Presence of family members

B. Unconscious bias

Which statement best reflects a core goal of the physical exam?
A. Every exam finding is equally reliable
B. Technique matters more than experience
C. Bias has no effect on interpretation
D. Reliable methods improve diagnostic validity

D. Reliable methods improve diagnostic validity

Measures the proportion of actual positives correctly identified:

specificty

sensitivity

negative predictive value

positive predictive value

sensitivity

Measures the proportion of actual negatives correctly identified:

specificty

sensitivity

negative predictive value

positive predictive value

specificty

The probability that a person with a positive test actually has the disease:

specificty

sensitivity

negative predictive value

positive predictive value

positive predictive value

The probability that a person with a negative test actually does not have the disease:

specificty

sensitivity

negative predictive value

positive predictive value

negative predictive value

breathlessness, chronic coughing (with or without
mucus), wheezing, tightness in chest, and frequent clearing of the throat

COPD

COPD can be diagnosed with ________

spirometry

Which muscles provide the primary power for normal inspiration?
A. Intercostals and diaphragm
B. Rectus abdominis and pectoralis minor
C. SCM and trapezius
D. Latissimus dorsi and serratus posterior

A. Intercostals and diaphragm

Under normal resting conditions, expiration is usually:
A. Forced by abdominal contraction
B. Passive
C. Driven by diaphragm descent
D. Controlled by limb muscles

B. Passive

The primary breathing center is located in the:
A. Pons
B. Midbrain
C. Medulla
D. Cerebellum

C. Medulla

The trachea normally bifurcates into the main bronchi at approximately:
A. T2–T3
B. T3–T4
C. T5–T6
D. T4–T5

D. T4–T5

Compared with the left main bronchus, the right main bronchus is:
A. Shorter, wider, and straighter
B. Narrower, longer, and more curved
C. Longer, wider, and more horizontal
D. Shorter, narrower, and more oblique

A. Shorter, wider, and straighter

Which airway sequence is correct from larger to smaller structures?
A. Bronchi → alveolar sac → bronchioles → alveolar duct
B. Bronchi → bronchioles → alveolar duct → alveolar sac
C. Bronchioles → bronchi → alveolar sac → alveolar duct
D. Bronchi → alveolar duct → bronchioles → alveolar sac

B. Bronchi → bronchioles → alveolar duct → alveolar sac

Which type of fissure is present in both lungs?
A. Horizontal fissure
B. Accessory fissure
C. Oblique fissure
D. Costomediastinal fissure

C. Oblique fissure

On the anterior chest, the oblique fissure begins near the:
A. Fourth rib at MCL
B. Fifth rib at MAL
C. Seventh rib at AAL
D. Sixth rib at MCL

D. Sixth rib at MCL

As it courses laterally, the oblique fissure reaches approximately the:
A. Fifth rib at MAL
B. Sixth rib at MAL
C. Fifth rib at MCL
D. Fourth rib at PSL

A. Fifth rib at MAL

Posteriorly, the oblique fissure ends near the:
A. T1 spinous process
B. T3 spinous process
C. T5 spinous process
D. T7 spinous process

B. T3 spinous process

Which lobe lies inferior to the right oblique fissure?
A. Right upper lobe
B. Right middle lobe
C. Right lower lobe
D. Left lower lobe

C. Right lower lobe

Which lobes lie superior to the right oblique fissure?
A. Right middle only
B. Right upper only
C. Right lower and middle
D. Right upper and middle

D. Right upper and middle

Which lobe lies inferior to the left oblique fissure?
A. Left lower lobe
B. Left upper lobe
C. Lingula
D. Right lower lobe

A. Left lower lobe

Which lobe lies superior to the left oblique fissure?
A. Left lower lobe
B. Left upper lobe
C. Right upper lobe
D. Lingula only

B. Left upper lobe

A foreign body is more likely to enter the right main bronchus because it is:
A. Longer and narrower
B. More posterior and curved
C. Shorter, wider, and straighter
D. More superior and vertical only

C. Shorter, wider, and straighter

Which statement about the horizontal fissure is correct?
A. It is found in both lungs
B. It is present only in the right lung
C. It separates the lower lobe
D. It runs to the T3 spine

B. It is present only in the right lung

The horizontal fissure separates which two lobes?
A. Right upper from right middle
B. Right middle from right lower
C. Left upper from left lower
D. Right upper from right lower

A. Right upper from right middle

The horizontal fissure extends from the sternal border of the:
A. Third rib
B. Fifth rib
C. Fourth rib
D. Sixth rib

C. Fourth rib

Laterally, the horizontal fissure reaches the:
A. Fourth rib at MCL
B. Fifth rib at MAL
C. Sixth rib at MAL
D. Fifth rib at AAL

B. Fifth rib at MAL

The bifurcation of the trachea is called the:
A. Hilum
B. Glottis
C. Carina
D. Pleura

C. Carina

The carina lies approximately at the level of the:
A. T2 vertebra
B. T6 vertebra
C. T5 vertebra
D. T4 vertebra

D. T4 vertebra

The angle of Louis is an important landmark because it approximates the level of the:
A. Carina
B. Apex of lung
C. Xiphoid process
D. Diaphragmatic dome

A. Carina

At the end of expiration, the right hemidiaphragm is located anteriorly near the:
A. Third rib
B. Seventh rib
C. Sixth rib
D. Fifth rib

D. Fifth rib

Posteriorly, the right hemidiaphragm at end-expiration is near:
A. T7
B. T9
C. T11
D. T5

B. T9

The right hemidiaphragm normally sits slightly higher than the left primarily because of the:
A. Heart
B. Spleen
C. Liver
D. Stomach

C. Liver

Which pulmonary symptom is most common?
A. Cough
B. Hemoptysis
C. Wheezing
D. Pleurisy

A. Cough

A cough is best described as a:
A. Quiet inspiratory effort
B. Coordinated forced expiration
C. Passive recoil maneuver
D. Repeated inspiratory spasm

B. Coordinated forced expiration

Repeated closure of which structure interrupts the cough reflex?
A. Epiglottis
B. Vocal fold
C. Carina
D. Glottis

D. Glottis

During coughing, expiratory muscles contract against a partially closed glottis, causing:
A. Lower pleural pressure
B. Complete airway collapse
C. High intrapulmonary pressure
D. Loss of chest wall recoil

C. High intrapulmonary pressure

When the glottis suddenly opens during a cough, the result is:
A. Bronchospasm
B. Explosive rush of air
C. Silent expiration
D. Inspiratory wheeze

B. Explosive rush of air

The most common cause of chronic cough is probably:
A. Tobacco smoking
B. Pulmonary fibrosis
C. Heart failure
D. Tuberculosis

A. Tobacco smoking

Smoker’s cough is caused primarily by:
A. Cold air exposure
B. Recurrent aspiration
C. Viral inflammation
D. Inhaled tobacco irritants

D. Inhaled tobacco irritants

Smoker’s cough is usually most prominent:
A. After meals
B. At night
C. In the morning
D. During exercise

C. In the morning

A psychogenic cough is typically:
A. Productive and purulent
B. Nonproductive and stress-related
C. Bloody and painful
D. Positional and nocturnal

B. Nonproductive and stress-related

Psychogenic cough should be diagnosed only:
A. After chest CT
B. In children only
C. If sputum is absent
D. After excluding other causes

D. After excluding other causes

Uninfected sputum is usually described as:
A. Odorless mucoid material
B. Foul-smelling green pus
C. Thick bloody secretion
D. Frothy pink fluid

A. Odorless mucoid material

Uninfected sputum most commonly appears:
A. Black and granular
B. Transparent whitish-gray
C. Yellow and opaque
D. Rust-colored and sticky

B. Transparent whitish-gray

Sputum containing pus is termed:
A. Serous
B. Mucoid
C. Purulent
D. Hemorrhagic

C. Purulent

Purulent sputum is often what color?
A. Clear or silver
B. White or black
C. Blue or brown
D. Yellow or greenish

D. Yellow or greenish

Hemoptysis can occur when pulmonary emboli cause:
A. Pleural fibrosis
B. Bronchial spasm
C. Pulmonary infarction
D. Tracheal collapse

C. Pulmonary infarction

Hemoptysis from pulmonary embolism is associated with necrosis of the:
A. Pericardium
B. Pulmonary parenchyma
C. Bronchial cartilage
D. Diaphragmatic pleura

B. Pulmonary parenchyma

The most common cause of hemoptysis is probably:
A. Bronchitis
B. Lung abscess
C. Tuberculosis
D. Pulmonary edema

A. Bronchitis

Patients with hemoptysis may report which associated sensation?
A. Cold pressure in throat
B. Tingling in the neck
C. Sharp abdominal pain
D. Warmth in the chest

D. Warmth in the chest

Sudden shortness of breath that awakens a patient from sleep is called:
A. Orthopnea
B. Platypnea
C. Paroxysmal nocturnal dyspnea
D. Trepopnea

C. Paroxysmal nocturnal dyspnea

Which feature best characterizes paroxysmal nocturnal dyspnea?
A. Occurs only with exertion
B. Improves when sitting up
C. Worsens in recumbency only during daytime
D. Relieved by lying on one side

B. Improves when sitting up

Difficulty breathing while lying flat is termed:
A. Orthopnea
B. Trepopnea
C. Hyperpnea
D. Platypnea

A. Orthopnea

A patient who needs multiple pillows to sleep most likely has:
A. Pleuritic pain
B. Orthopnea
C. Trepopnea
D. Hemoptysis

B. Orthopnea

Dyspnea that occurs while sitting upright and improves when lying down is called:
A. Paroxysmal nocturnal dyspnea
B. Orthopnea
C. Trepopnea
D. Platypnea

D. Platypnea

A patient reports breathing is easier only when lying on the left side. This is called:
A. Platypnea
B. Trepopnea
C. Orthopnea
D. Bradypnea

B. Trepopnea

Unexplained dyspnea should prompt further questioning about:
A. Industrial exposure
B. Childhood height
C. Hand dominance
D. Visual acuity

A. Industrial exposure

Wheezes are best described as:
A. Low-pitched pleural sounds
B. Inspiratory crackling noises
C. High-pitched sounds from narrowed airways
D. Harsh sounds from the pharynx

C. High-pitched sounds from narrowed airways

Wheezes are usually heard most prominently during:
A. Inspiration
B. Breath holding
C. Swallowing
D. Expiration

D. Expiration

The usual mechanism producing wheezing is:
A. Complete airway collapse
B. Partially obstructed airflow
C. Fluid in the pleural space
D. Vibration of the diaphragm

B. Partially obstructed airflow

Which condition is a classic cause of wheezing due to bronchospasm?
A. Asthma
B. Pneumothorax
C. Pulmonary fibrosis
D. Pleural effusion

A. Asthma

Which of the following can also cause wheezing?
A. Mucosal edema
B. Liver enlargement
C. Bradycardia
D. Esophageal rupture

A. Mucosal edema

Loss of elastic support in the airways may contribute to:
A. Stridor only
B. Pleural friction rub
C. Wheezing
D. Bronchial breathing only

C. Wheezing

Which structural abnormality can cause wheezes?
A. Tortuous airways
B. Enlarged thymus
C. Flattened diaphragm only
D. Kyphosis alone

A. Tortuous airways

Which obstructive problem may produce wheezing?
A. Pericardial tamponade
B. Foreign body obstruction
C. Splenic infarct
D. Renal colic

B. Foreign body obstruction

A decrease in wheezing may indicate:
A. Airway opening or severe worsening
B. Resolution of all lung disease
C. Better diaphragmatic strength only
D. Improved cardiac output only

A. Airway opening or severe worsening

In acute asthma, disappearance of wheezing may be dangerous because it can reflect:
A. Pleural inflammation
B. Rising oxygen delivery
C. Progressive airway closure
D. Clearing of secretions only

C. Progressive airway closure

A “silent chest” during an acute asthmatic attack is:
A. A reassuring sign
B. Typical after recovery
C. Expected in mild disease
D. An ominous sign

D. An ominous sign

A silent chest in asthma most strongly suggests:
A. Worsening obstruction
B. Simple vocal cord dysfunction
C. Isolated pulmonary embolism
D. Resolved bronchospasm

A. Worsening obstruction

Central cyanosis most commonly results from:
A. Excess oxygen extraction in fingers
B. Inadequate gas exchange in the lungs
C. Local venous obstruction only
D. Peripheral vasospasm from cold

B. Inadequate gas exchange in the lungs

Which location is most useful for detecting central cyanosis?
A. Oral mucous membranes and lips
B. Popliteal fossae and heels
C. Fingertips after warming
D. Abdomen and lower back

A. Oral mucous membranes and lips

Cyanosis of the nails accompanied by warm hands is most suggestive of:
A. Peripheral vasoconstriction
B. Raynaud phenomenon
C. Venous stasis
D. Central cyanosis

D. Central cyanosis

A cyanotic area that does not disappear after warming is most consistent with:
A. Acrocyanosis
B. Peripheral cyanosis
C. Central cyanosis
D. Local cold exposure

C. Central cyanosis

Which nail finding may accompany longstanding central cyanosis?
A. Clubbing
B. Koilonychia
C. Beau lines
D. Splinter hemorrhages

A. Clubbing

Central cyanosis typically becomes more pronounced with:
A. Sleep
B. Eating
C. Warming the hands
D. Exercise

D. Exercise

Peripheral cyanosis occurs primarily because of:
A. Impaired hemoglobin synthesis
B. Pleural inflammation
C. Excessive oxygen extraction in the periphery
D. Increased pulmonary blood flow

C. Excessive oxygen extraction in the periphery

Peripheral cyanosis is usually limited to the:
A. Tongue and lips
B. Fingers, toes, and nose
C. Chest wall and abdomen
D. Soft palate and frenulum

B. Fingers, toes, and nose

Which feature best distinguishes peripheral cyanosis from central cyanosis?
A. It disappears when the area is warmed
B. It causes clubbing early
C. It worsens with exercise only
D. It is most visible on the lips

A. It disappears when the area is warmed

Hereditary methemoglobinemia is a cause of:
A. Intermittent pleuritic pain
B. Secondary clubbing
C. Obstructive sleep apnea
D. Congenital cyanosis

D. Congenital cyanosis

Pleuritic chest pain is usually caused by inflammation of the:
A. Visceral pleura
B. Pericardium
C. Parietal pleura
D. Diaphragmatic muscle

C. Parietal pleura

Pleuritic pain is classically described as:
A. Dull and pressure-like after meals
B. Sharp and worse with inspiration
C. Burning and relieved by exercise
D. Crushing and radiating to jaw

B. Sharp and worse with inspiration

Snoring is strongly associated with:
A. Obstructive sleep apnea
B. Pleural effusion
C. Pulmonary embolism
D. Bronchiectasis

A. Obstructive sleep apnea

Which patient profile is most suggestive of obstructive sleep apnea?
A. Thin patient with hemoptysis
B. Athlete with pleuritic pain
C. Young patient with cyanosis
D. Overweight patient with daytime sleepiness

D. Overweight patient with daytime sleepiness

Nasal flaring on general assessment most directly suggests:
A. Facial nerve palsy
B. Increased work of breathing
C. Chronic sinus drainage
D. Central cyanosis only

B. Increased work of breathing

Prominent use of the sternocleidomastoid and trapezius during inspiration suggests:
A. Normal quiet breathing
B. Pain from rib fracture only
C. Airway obstruction
D. Isolated cardiac disease

C. Airway obstruction

Increased anteroposterior chest diameter is commonly seen in:
A. Advanced COPD
B. Lobar pneumonia
C. Acute pericarditis
D. Pleural friction syndrome

A. Advanced COPD

When the AP diameter equals the lateral chest diameter, the finding is called:
A. Flail chest
B. Funnel chest
C. Kyphoscoliosis
D. Barrel chest

D. Barrel chest

Flail chest is characterized by:
A. Unilateral absent breath sounds
B. Fixed chest expansion
C. Paradoxical inward chest movement during inspiration
D. Bilateral wheezing with cough

C. Paradoxical inward chest movement during inspiration

Flail chest is most commonly associated with:
A. Severe asthma
B. Tension pneumothorax
C. COPD exacerbation
D. Multiple rib fractures

D. Multiple rib fractures

Kyphoscoliosis is best described as:
A. Straight spine with increased chest depth
B. Flattened diaphragm from emphysema
C. Inward sternum with valve disease
D. Abnormal AP diameter with lateral spinal curvature

D. Abnormal AP diameter with lateral spinal curvature

The major respiratory consequence of severe kyphoscoliosis is:
A. Excess mucus production
B. Restricted chest and lung expansion
C. Isolated tracheal deviation
D. Increased diffusion capacity

B. Restricted chest and lung expansion

Pectus excavatum is associated with:
A. Tricuspid stenosis
B. Aortic dissection
C. Mitral valve prolapse
D. Pulmonary fibrosis

C. Mitral valve prolapse

Which finding favors central rather than peripheral cyanosis?
A. Blue toes that improve with warming
B. Cyanosis limited to the nose
C. Cool fingers with acrocyanosis
D. Blue lips with oral mucosal discoloration

D. Blue lips with oral mucosal discoloration

Tactile fremitus is most useful for assessing the:
A. Density of underlying lung tissue
B. Cardiac output at rest
C. Strength of intercostal muscles
D. Diameter of the bronchi

A. Density of underlying lung tissue

Which process typically increases tactile fremitus?
A. Pleural air
B. Lung consolidation
C. Chest wall obesity
D. Hyperinflation

B. Lung consolidation

Pneumonia increases tactile fremitus primarily because the lung becomes:
A. More solid
B. More elastic
C. More compliant
D. More vascular

A. More solid

Which factor would most likely decrease tactile fremitus?
A. Lobar consolidation
B. Bronchial narrowing
C. Excess chest wall fat
D. Thickened pleura only

C. Excess chest wall fat

Air in the chest cavity generally causes tactile fremitus to:
A. Increase sharply
B. Become asymmetric only
C. Remain unchanged
D. Decrease

D. Decrease

Fluid in the chest cavity usually causes tactile fremitus to:
A. Increase bilaterally
B. Decrease
C. Localize to the trachea
D. Become tympanitic

B. Decrease

Overexpansion of the lungs, as in emphysema, generally causes tactile fremitus to:
A. Increase
B. Alternate with inspiration
C. Decrease
D. Become absent only posteriorly

C. Decrease

Which percussion note is expected over normal lung?
A. Resonant
B. Tympanic
C. Dull
D. Flat

A. Resonant

Which percussion note is expected over the stomach?
A. Flat
B. Dull
C. Tympanic
D. Resonant

C. Tympanic

Percussion over the liver normally produces a:
A. Hyperresonant note
B. Dull note
C. Flat tympany
D. Resonant note

B. Dull note

Which percussion note is expected over the thigh?
A. Resonant
B. Tympanic
C. Dull
D. Flat

D. Flat

Which combination best fits pneumonia?
A. Decreased fremitus, increased resonance
B. Increased fremitus, diminished resonance
C. Decreased fremitus, normal resonance
D. Increased fremitus, increased resonance

D. Increased fremitus, increased resonance

Which combination best fits pneumothorax?
A. Increased fremitus, dull percussion
B. Decreased fremitus, dull percussion
C. Decreased fremitus, increased resonance
D. Increased fremitus, flat percussion

C. Decreased fremitus, increased resonance

Which combination best fits pleural effusion?
A. Decreased fremitus, decreased resonance
B. Increased fremitus, increased resonance
C. Increased fremitus, normal resonance
D. Decreased fremitus, increased resonance

A. Decreased fremitus, decreased resonance

Smoker with chronic cough, dyspnea, barrel chest, pursed-lip breathing

Emphysema (COPD)

Young patient with wheezing, intermittent dyspnea, and nocturnal cough

Asthma

Patient with fever, productive cough, bronchial breath sounds, dullness on percussion

Pneumonia

Post-op patient with sudden dyspnea, pleuritic chest pain, tachycardia

Pulmonary Embolism

Thin young male with sudden chest pain and absent breath sounds on one side

Spontaneous Pneumothorax

Patient with dull percussion, absent breath sounds, and tracheal shift away

Large Pleural Effusion

Which cerebral structure subserves higher mental, sensory, motor, and associative processing?
A. Cerebellum
B. Cerebrum
C. Thalamus
D. Medulla

B. Cerebrum

A patient has a small infarct causing impaired voluntary movement of the right arm and leg. The lesion most likely involves the:
A. Postcentral gyrus
B. Calcarine cortex
C. Precentral gyrus
D. Transverse temporal gyrus

C. Precentral gyrus

Fibers arising from the primary motor cortex normally govern:
A. Ipsilateral visceral smooth muscle
B. Contralateral skeletal movement
C. Bilateral auditory reflexes
D. Ipsilateral sensory integration

B. Contralateral skeletal movement

A cortical lesion produces flaccid paralysis of the left face, arm, and leg. The lesion is most likely in the:
A. Right precentral gyrus
B. Left precentral gyrus
C. Right postcentral gyrus
D. Left internal capsule

A. Right precentral gyrus

A patient reports numb “pins-and-needles” over the right body after a cortical stroke. The damaged cortex is most likely the:
A. Left postcentral gyrus
B. Right precentral gyrus
C. Left temporal pole
D. Right occipital cortex

A. Left postcentral gyrus

The primary sensory cortex is located in the:
A. Precentral gyrus
B. Superior temporal gyrus
C. Postcentral gyrus
D. Cingulate gyrus

C. Postcentral gyrus

The primary visual cortex is centered in the:
A. Frontal lobe
B. Parietal operculum
C. Temporal pole
D. Occipital lobe

D. Occipital lobe

The fissure closely associated with primary visual cortex is the:
A. Central sulcus
B. Lateral sulcus
C. Calcarine fissure
D. Parieto-occipital sulcus

C. Calcarine fissure

The calcarine fissure anatomically separates the:
A. Cuneus and lingual gyri
B. Uncus and amygdala
C. Precentral and postcentral gyri
D. Caudate and putamen

A. Cuneus and lingual gyri

A patient with a right visual cortex lesion develops a left visual field deficit. The most likely deficit is:
A. Bitemporal hemianopsia
B. Left monocular blindness
C. Left homonymous hemianopsia
D. Right homonymous hemianopsia

C. Left homonymous hemianopsia

Occipital cortical irritation may cause all of the following except:
A. Flashes of light
B. Rainbow-like phenomena
C. Contralateral field loss
D. Complete central blindness

D. Complete central blindness

In a classic primary visual cortex lesion, which visual function is often preserved?
A. Peripheral temporal field
B. Red-green discrimination
C. Central macular vision
D. Binocular depth perception

C. Central macular vision

The primary auditory cortex lies in the:
A. Occipital lobe
B. Temporal lobe
C. Insular cortex
D. Parietal lobe

B. Temporal lobe

The gyrus most closely associated with primary auditory cortex is the:
A. Angular gyrus
B. Cingulate gyrus
C. Fusiform gyrus
D. Transverse temporal gyrus

D. Transverse temporal gyrus

A destructive lesion of primary auditory cortex most characteristically causes:
A. Complete cortical deafness
B. Contralateral hyperacusis
C. Tinnitus without true deafness
D. Loss of vestibulo-ocular reflexes

C. Tinnitus without true deafness

Which structure is classically linked to emotion as part of the limbic system?
A. Caudate nucleus
B. Amygdala
C. Globus pallidus
D. Subthalamic nucleus

B. Amygdala

The basal ganglia are most directly involved in modulation of:
A. Olfaction and memory storage
B. Vision, pupillary reflexes, autonomic integration
C. Fine voluntary movement, posture, autonomic integration
D. Language and reading comprehension

C. Fine voluntary movement, posture, autonomic integration

Basal ganglia lesions are most likely to produce:
A. Aphasia and apraxia
B. Tremor and rigidity
C. Blindness and anosmia
D. Hemianesthesia and neglect

B. Tremor and rigidity

The thalamus lies on each side of the:
A. Lateral ventricle
B. Fourth ventricle
C. Cerebral aqueduct
D. Third ventricle

D. Third ventricle

All sensory pathways except which modality relay through the thalamus?
A. Vision
B. Pain
C. Olfaction
D. Temperature

C. Olfaction

In addition to sensory relay, the thalamus is a major site for:
A. Motor modulation
B. CSF production
C. Language generation
D. Memory consolidation

A. Motor modulation

A patient retains crude pain and temperature perception despite destruction of primary sensory cortex. Which structure most likely preserves this function?
A. Hypothalamus
B. Thalamus
C. Amygdala
D. Cerebellum

B. Thalamus

The structure most responsible for maintaining alertness and attention by electrically exciting the cerebral cortex is the:
A. Hippocampus
B. Hypothalamus
C. Thalamus
D. Putamen

C. Thalamus

Emotional coloring of sensory experiences is strongly associated with the:
A. Thalamus
B. Medulla
C. Pons
D. Cerebellum

A. Thalamus

Which pair is included with the hypothalamic region?
A. Optic chiasm, neurohypophysis
B. Pineal gland, pulvinar
C. Mamillary body, colliculi
D. Fornix, caudate tail

A. Optic chiasm, neurohypophysis

Which function is most characteristically hypothalamic?
A. Fine touch localization
B. Voluntary motor initiation
C. Water balance regulation
D. Auditory discrimination

C. Water balance regulation

The brainstem consists of the:
A. Midbrain, pons, medulla
B. Diencephalon, pons, cerebellum
C. Midbrain, thalamus, medulla
D. Pons, medulla, cerebrum

A. Midbrain, pons, medulla

Cranial nerve nuclei associated with the brainstem are primarily:
A. CN I–VI
B. CN II–VIII
C. CN III–XII
D. CN V–XII only

C. CN III–XII

The brainstem reticular formation is most important for:
A. Smell discrimination
B. Constant muscle stimulation
C. Color vision processing
D. Language comprehension

B. Constant muscle stimulation

Injury to the ascending reticular activating system would most directly impair:
A. Consciousness and arousal
B. Voluntary eye movements
C. Contralateral pain sensation
D. Fine distal coordination

A. Consciousness and arousal

Which structure contains the superior and inferior colliculi?
A. Pons
B. Medulla
C. Midbrain

C. Midbrain

The motor nuclei of which cranial nerves are located in the midbrain?
A. II and III
B. III and IV
C. IV and V
D. V and VI

B. III and IV

A lesion causing vertical gaze difficulty with impaired upward gaze most likely involves the:
A. Inferior colliculus
B. Cerebral peduncle
C. Superior colliculus
D. Vestibular nuclei

C. Superior colliculus

The superior colliculi are functionally part of the:
A. Auditory system
B. Visual system
C. Limbic system
D. Somatic sensory system

B. Visual system

The inferior colliculi are functionally part of the:
A. Auditory system
B. Visual system
C. Vestibular system
D. Extrapyramidal system

A. Auditory system

A focal lesion of the cerebral peduncle would most likely cause:
A. Ipsilateral flaccid weakness
B. Contralateral spastic paralysis
C. Bilateral hearing loss
D. Upward gaze deviation

B. Contralateral spastic paralysis

Relative to the cerebellum, the pons lies:
A. Dorsal
B. Lateral
C. Ventral
D. Caudal

C. Ventral

Relative to the medulla, the pons is:
A. Rostral
B. Caudal
C. Posterior
D. Inferior only

A. Rostral

Which cranial nerve range is classically associated with the pons?
A. CN I–IV
B. CN V–VIII
C. CN IX–XII
D. CN III–VI

B. CN V–VIII

The acoustic/vestibular nuclei are associated with:
A. CN VI
B. CN VII
C. CN VIII
D. CN IX

C. CN VIII

The medulla is located between the:
A. Midbrain and pons
B. Pons and spinal cord
C. Thalamus and pons
D. Cerebellum and cord

B. Pons and spinal cord

A medullary lesion classically causes loss of pain and temperature:
A. Ipsilaterally
B. Bilaterally
C. Contralaterally
D. Segmentally only

C. Contralaterally

Hemiplegia from a medullary lesion is typically:
A. Ipsilateral
B. Contralateral
C. Bilateral
D. Axial only

B. Contralateral

Cranial nerve deficits from a medullary lesion most often occur:
A. Contralaterally
B. Bilaterally
C. Ipsilaterally
D. Cortically only

C. Ipsilaterally

Which cranial nerve group is most associated with the medulla?
A. CN V–VIII
B. CN IX–XII
C. CN II–V
D. CN III–VI

B. CN IX–XII

The cerebellum is located in the:
A. Middle cranial fossa
B. Posterior cranial fossa
C. Anterior cranial fossa
D. Suprasellar cistern

B. Posterior cranial fossa

The midline cerebellar structure is the:
A. Flocculus
B. Nodulus
C. Vermis
D. Tonsil

C. Vermis

The cerebellum consists of a vermis and:
A. Four lobules
B. Two lateral hemispheres
C. Two anterior horns
D. Paired peduncles only

B. Two lateral hemispheres

Which function is most characteristic of the cerebellum?
A. Hormonal secretion
B. Motor coordination
C. Language production
D. Pain localization

B. Motor coordination

The cerebellum is especially important for fine movements of the:
A. Eyes
B. Feet
C. Hands
D. Jaw

C. Hands

Which finding is most consistent with a cerebellar lesion?
A. Resting pill tremor
B. Intention tremor
C. Spastic diplegia
D. Fasciculations only

B. Intention tremor

Rapid alternating movement difficulty is called:
A. Dysmetria
B. Dysarthria
C. Dysdiadochokinesia
D. Dysesthesia

C. Dysdiadochokinesia

A patient with a cerebellar lesion is most likely to have:
A. Staggering gait
B. Aphasia
C. Hemianopia
D. Anosmia

A. Staggering gait

Proximally, the spinal cord is continuous with the:
A. Pons
B. Medulla
C. Midbrain
D. Cerebellum

B. Medulla

Distally, the spinal cord attaches to the first part of the:
A. Sacrum
B. Ilium
C. Coccyx
D. Femur

C. Coccyx

The anterior horn of spinal gray matter is primarily:
A. Sensory
B. Motor
C. Autonomic sensory
D. Associative only

B. Motor

Sympathetic preganglionic neurons are located in the lateral horn from:
A. C1–C8
B. T1–L2
C. L1–S2
D. S2–S4

B. T1–L2

The posterior horn of spinal gray matter is primarily:
A. Motor
B. Sensory
C. Parasympathetic
D. Extrapyramidal

B. Sensory

In the spinal cord, gray matter is:
A. Peripheral
B. Lateral only
C. Central
D. Dorsal only

C. Central

In the spinal cord, white matter is:
A. Central
B. Peripheral
C. Segmental only
D. Horn-restricted

B. Peripheral

The anterior white column contains the ventral:
A. Rubrospinal tract
B. Corticospinal tract
C. Reticulospinal tract
D. Spinocerebellar tract

B. Corticospinal tract

The ascending tract in the anterior white column is the ventral:
A. Spinothalamic tract
B. Spinocerebellar tract
C. Corticobulbar tract
D. Cuneocerebellar tract

C. Corticobulbar tract

The ventral corticospinal tract is mainly involved in:
A. Pain transmission
B. Voluntary motion
C. Reflex proprioception
D. Hearing reflexes

B. Voluntary motion

The ventral spinothalamic tract carries:
A. Vibration
B. Joint position
C. Light touch
D. Fine motor output

C. Light touch

The lateral white column contains the lateral:
A. Spinothalamic tract only
B. Corticospinal tract
C. Fasciculus gracilis
D. Medial lemniscus

B. Corticospinal tract

Which tract in the lateral white column conveys reflex proprioception?
A. Ventral corticospinal
B. Fasciculus cuneatus
C. Spinocerebellar tract
D. Ventral spinothalamic

C. Spinocerebellar tract

The lateral spinothalamic tract is found in the:
A. Posterior column
B. Lateral column
C. Anterior horn
D. Dorsal root

B. Lateral column

The posterior white column contains the fasciculi:
A. Gracilis and cuneatus
B. Spinothalamic and gracilis
C. Cuneatus and corticospinal
D. Rubrospinal and gracilis

A. Gracilis and cuneatus

Which sensation is carried by the posterior columns?
A. Crude touch only
B. Pain and temperature
C. Vibration sense
D. Auditory input

C. Vibration sense

Which modality is also carried in the posterior columns?
A. Passive motion
B. Light reflexes
C. Voluntary motor output
D. Sympathetic outflow

A. Passive motion

Two-point discrimination is carried mainly by the:
A. Lateral spinothalamic tract
B. Posterior white column
C. Ventral corticospinal tract
D. Spinoreticular tract

B. Posterior white column

How many pairs of spinal nerves are present?
A. 30 pairs
B. 31 pairs
C. 32 pairs
D. 33 pairs

B. 31 pairs

The cell bodies of dorsal root fibers are in the:
A. Ventral horn
B. Lateral horn
C. Dorsal root ganglion
D. Sympathetic chain

C. Dorsal root ganglion

A spinal reflex is best defined as coordination between afferent and efferent neurons at the:
A. Same spinal level
B. Same cerebral hemisphere
C. Opposite dorsal horn
D. Brainstem level only

A. Same spinal level

A patient loses pinprick on the right body after a left cord lesion. Pain and temperature fibers normally:
A. Cross within 1–2 segments
B. Cross in medulla only
C. Stay uncrossed to cortex
D. Decussate in pons

A. Cross within 1–2 segments

After crossing, pain and temperature fibers ascend in the:
A. Ipsilateral dorsal column
B. Contralateral lateral spinothalamic tract
C. Ventral corticospinal tract
D. Ipsilateral spinocerebellar tract

B. Contralateral lateral spinothalamic tract

Pain and temperature information ultimately projects from the thalamus to the:
A. Precentral gyrus
B. Cerebellar vermis
C. Postcentral gyrus
D. Superior colliculus

C. Postcentral gyrus

Conscious proprioceptive fibers first ascend in the:
A. Lateral spinothalamic tract
B. Spinocerebellar tract
C. Medial longitudinal fasciculus
D. Dorsal columns

D. Dorsal columns

Proprioceptive fibers from the cord initially synapse in:
A. Contralateral pontine nuclei
B. Ipsilateral gracile or cuneate nuclei
C. Ventral horn neurons
D. Inferior olivary nucleus

B. Ipsilateral gracile or cuneate nuclei

Proprioceptive fibers decussate in the:
A. Medial lemniscus
B. Internal capsule
C. Superior cerebellar peduncle
D. Lateral spinothalamic tract

A. Medial lemniscus

Headache is the most common:
A. Cerebellar complaint
B. Cranial neuropathy
C. Neurologic symptom
D. Vestibular disorder

C. Neurologic symptom

A sudden severe headache should raise concern for:
A. Migraine only
B. Muscle spasm
C. Cluster headache
D. Stroke

D. Stroke

Continuous headaches are most often associated with:
A. Muscle spasm
B. Vascular rupture
C. Seizure aura
D. Labyrinthitis

A. Muscle spasm

Recurrent headaches are classically associated with:
A. Stroke or tumor
B. Migraine or cluster headache
C. Meningitis only
D. Cerebellar infarction

B. Migraine or cluster headache

Throbbing headaches most strongly suggest:
A. Muscular causes
B. Psychogenic causes
C. Vascular problems
D. Demyelinating disease

C. Vascular problems

Pain from the sinuses, eyes, or teeth causing headache is:
A. Radicular pain
B. Central pain
C. Neuropathic pain
D. Referred pain

D. Referred pain

Headaches may be accompanied by:
A. Visual phenomena, nausea, vomiting
B. Aphasia, tremor, ptosis
C. Deafness, ataxia, syncope
D. Rigidity, hiccups, amnesia

A. Visual phenomena, nausea, vomiting

Migraine is best described as:
A. Monophasic pressure headache
B. Biphasic aura then headache
C. Brief stabbing facial pain
D. Constant occipital pain

B. Biphasic aura then headache

The prodromal phase of migraine is called the:
A. Tonic phase
B. Postictal phase
C. Aura
D. Clonus

C. Aura

During migraine aura, a patient may experience:
A. Photophobia, blurred vision, scotoma
B. Hemiplegia, aphasia, fever
C. Deafness, tinnitus, ptosis
D. Myoclonus, cyanosis, apnea

A. Photophobia, blurred vision, scotoma

As a migraine aura fades, the next phase usually is:
A. Deep sleep
B. Headache onset
C. Generalized seizure
D. Nasal drainage

B. Headache onset

Classic migraine pain is typically:
A. Bilateral and electric
B. Occipital and brief
C. Unilateral and pulsating
D. Diffuse and nonthrobbing

C. Unilateral and pulsating

Migraine duration commonly lasts:
A. Seconds to minutes
B. Minutes only
C. Weeks continuously
D. Hours to days

D. Hours to days

Which is a recognized migraine trigger?
A. Birth control pills
B. Hearing loss
C. Gentamicin exposure
D. Tongue biting

A. Birth control pills

Which dietary item can precipitate migraine?
A. Yogurt only
B. Chocolate
C. White rice
D. Plain bread

B. Chocolate

Migraine commonly has which background feature?
A. Family history
B. Male predominance only
C. Brainstem lesion
D. Focal deafness

A. Family history

Cluster headaches are attributed to:
A. Corticospinal irritation
B. Oculosympathetic disturbances
C. Temporal lobe seizure
D. Dorsal column failure

B. Oculosympathetic disturbances

The classic cluster headache patient is a middle-aged:
A. Woman with vertigo
B. Child with fever
C. Man with eye pain
D. Teen with aura

C. Man with eye pain

Cluster headache pain usually centers around the:
A. Jaw
B. Ear
C. Temple only
D. Eye

D. Eye

A single cluster headache attack usually lasts:
A. Up to 1 hour
B. 6 to 12 hours
C. 2 to 4 days
D. Less than 5 seconds

A. Up to 1 hour

Cluster headaches often awaken patients:
A. After meals for 2-4 weeks
B. During exercise for 2-4 weeks
C. From sleep repeatedly for 2-4 weeks
D. Only at noon for 2-4 weeks

C. From sleep repeatedly for 2-4 weeks

Which finding occurs during a cluster headache?
A. Contralateral mydriasis
B. Ipsilateral miosis
C. Bilateral papilledema
D. Facial fasciculations

B. Ipsilateral miosis

Which additional sign supports cluster headache?
A. Ptosis and tearing
B. Tongue biting
C. Cyanosis and apnea
D. Bilateral deafness

A. Ptosis and tearing

Cluster headaches may be precipitated by:
A. Caffeine withdrawal
B. High altitude
C. Alcohol
D. Hyperglycemia

C. Alcohol

A child briefly stares, loses awareness for 10 seconds, then rapidly returns to normal. This is most consistent with:
A. Myoclonic seizure
B. Absence seizure
C. Tonic-clonic seizure
D. Febrile convulsion

B. Absence seizure

Generalized tonic-clonic seizure may begin with:
A. Aura of giddiness
B. Visual neglect only
C. Isolated tearing
D. Sudden deafness

A. Aura of giddiness

During the tonic phase of a grand mal seizure, the patient typically has:
A. Rhythmic jerking only
B. Intact awareness
C. Rigidity with possible apnea
D. Isolated eyelid twitching

C. Rigidity with possible apnea

During the clonic phase, a patient may have:
A. Conjunctival edema only
B. Salivation and eye rolling
C. Fixed rigidity only
D. Normal continence

B. Salivation and eye rolling

Which feature is common after a generalized tonic-clonic seizure?
A. Immediate normal memory
B. Brief vertigo only
C. Instant return to baseline
D. Postictal confusion or deep sleep

D. Postictal confusion or deep sleep

Sudden brief contractions of the eyelids and forearms without loss of consciousness suggest:
A. Absence seizure
B. Febrile seizure
C. Myoclonic seizure
D. Atonic seizure

C. Myoclonic seizure

Febrile convulsions are most common in children:
A. 6 months to 6 years
B. Birth to 3 months
C. 7 to 12 years
D. 13 to 18 years

A. 6 months to 6 years

Vertigo is best described as:
A. Weakness without imbalance
B. Aphasia with confusion
C. Spinning with unsteady walking
D. Numbness with diplopia

C. Spinning with unsteady walking

Acute vertigo may be accompanied by:
A. Nausea, vomiting, sweating
B. Hemianopsia, neglect, aphasia
C. Ptosis, miosis, tearing
D. Tongue biting, cyanosis, apnea

A. Nausea, vomiting, sweating

A patient has severe vertigo, vomiting, hearing loss, tinnitus, and nystagmus away from the affected ear. The most likely diagnosis is:
A. Cluster headache
B. Meniere disease
C. Absence seizure
D. Supratentorial lesion

B. Meniere disease

A medication known to damage the labyrinth and cause deafness is:
A. Penicillin
B. Diazepam
C. Gentamicin
D. Acetaminophen

C. Gentamicin

Dizziness with stumbling should raise concern for:
A. Migraine
B. Stroke
C. Meniere disease
D. Cluster headache

B. Stroke

Persistent unsteadiness upright due to vestibular-ocular-cerebellar disruption is:
A. Vertigo
B. Ataxia
C. Hemiparesis
D. Paresthesia

B. Ataxia

Ataxia is typically worsened when the patient:
A. Watches the feet
B. Lies flat
C. Closes the eyes
D. Eats sugar

C. Closes the eyes

Ataxia is often improved when the patient:
A. Closes both eyes
B. Watches the feet
C. Turns rapidly
D. Hyperventilates

B. Watches the feet

Motor ataxia usually reflects abnormality of the:
A. Cerebellum and central vestibular pathways
B. Dorsal root ganglion only
C. Frontal eye fields only
D. Peripheral sympathetic chain

A. Cerebellum and central vestibular pathways

Motor ataxia classically produces a:
A. Narrow-based gait
B. Magnetic gait
C. Wide-based lurching gait
D. Shuffling festinating gait

C. Wide-based lurching gait

Hemiparesis, paresthesia, hemianopsia, garbled speech, and limb weakness suggest a:
A. Brainstem lesion
B. Peripheral neuropathy
C. Cerebellar lesion
D. Supratentorial lesion

D. Supratentorial lesion

Nystagmus, vomiting, diplopia, altered consciousness, and yawning suggest a:
A. Supratentorial lesion
B. Brainstem lesion
C. Basal ganglia lesion
D. Dorsal column lesion

B. Brainstem lesion

Which symptom pair best matches brainstem lesion localization?
A. Diplopia and nystagmus
B. Hemianopsia and aphasia
C. Eye pain and ptosis
D. Tinnitus and scotoma

A. Diplopia and nystagmus

After head trauma, a patient develops progressive confusion from a venous bleed beneath the dura. This is most consistent with:
A. Subdural hematoma
B. Epidural hematoma
C. Subarachnoid hemorrhage
D. Intraparenchymal bleed

A. Subdural hematoma

Head trauma with a subdural hematoma may commonly produce:
A. Isolated tinnitus
B. Changes in consciousness
C. Pure expressive aphasia
D. Intention tremor

B. Changes in consciousness

Sudden painless visual loss should make you think first of:
A. Acute glaucoma or detachment
B. Optic neuritis or detachment
C. Vascular accident or detachment
D. Cataract formation or detachment

C. Vascular accident or detachment

Chronic painless visual loss is more suggestive of:
A. Optic pathway compression
B. Acute retinal ischemia
C. Closed-angle glaucoma
D. Ocular migraine only

A. Optic pathway compression

Which condition is classically painful?
A. Chronic open-angle glaucoma
B. Acute closed-angle glaucoma
C. Amaurosis fugax
D. Retinal radiation injury

B. Acute closed-angle glaucoma

Which glaucoma pattern is usually not painful?
A. Acute angle closure
B. Secondary neovascular glaucoma
C. Chronic open-angle glaucoma
D. Traumatic glaucoma only

C. Chronic open-angle glaucoma

Visual loss occurring before a headache is most characteristic of:
A. Retinal detachment
B. Amaurosis fugax
C. Migraine
D. Optic tract compression

C. Migraine

Transient monocular visual loss lasting only minutes from carotid disease is:
A. Diplopia
B. Amaurosis fugax
C. Scotoma
D. Papilledema

B. Amaurosis fugax

Amaurosis fugax is most commonly due to disease of the:
A. External carotid artery
B. Middle cerebral artery
C. Basilar artery
D. Internal carotid artery

D. Internal carotid artery

Amaurosis fugax usually lasts:
A. Up to 3 minutes
B. 30 to 60 minutes
C. Several hours
D. 1 to 2 days

A. Up to 3 minutes

Diplopia most directly involves dysfunction of:
A. CN II, III, IV
B. CN III, IV, VI
C. CN V, VII, VIII
D. CN IX, X, XII

B. CN III, IV, VI

Which condition is a recognized cause of diplopia?
A. Thyroid disease
B. Parkinson disease
C. Trigeminal neuralgia
D. Dementia only

A. Thyroid disease

Another classic cause of diplopia is:
A. Chorea
B. Footdrop
C. Myasthenia gravis
D. Shingles

C. Myasthenia gravis

Brainstem lesions may produce:
A. Diplopia
B. Isolated anosmia
C. Monocular blindness only
D. Intact eye movements

A. Diplopia

A complete oculomotor palsy most classically causes:
A. Ptosis and mydriasis
B. Ptosis and miosis
C. Tearing and ptosis
D. Ptosis and proptosis

A. Ptosis and mydriasis

In a complete CN III palsy, all extraocular movements are lost except:
A. Adduction
B. Elevation
C. Abduction
D. Depression

C. Abduction

A painful complete CN III palsy should raise concern for:
A. Posterior communicating aneurysm
B. Basilar migraine
C. Meniere disease
D. Temporal arteritis only

A. Posterior communicating aneurysm

Another cause of complete CN III palsy is:
A. Carotid dissection
B. Cavernous sinus thrombosis
C. Vestibular neuritis
D. Frontal lobe tumor

B. Cavernous sinus thrombosis

Language problems and slurred speech are common in:
A. Migraine aura
B. Stroke
C. Meniere disease
D. Shingles

B. Stroke

Dementia is best defined as:
A. A single disease
B. Fixed memory loss
C. Progressive cognitive impairment
D. Only Alzheimer pathology

C. Progressive cognitive impairment

Dementia most often impairs:
A. Orientation, memory, judgment
B. Vision, hearing, smell
C. Reflexes, tone, strength
D. Pupils, gaze, balance

A. Orientation, memory, judgment

Which is the most common cause of dementia listed here?
A. Parkinson disease
B. Vitamin B12 deficiency
C. Tertiary syphilis
D. Alzheimer disease

D. Alzheimer disease

Which is also a listed cause of dementia?
A. Normal pressure hydrocephalus
B. Acute otitis media
C. Cluster headache
D. Retinal detachment

A. Normal pressure hydrocephalus

Transient ischemic attacks are best described as:
A. Long seizures with recovery
B. Short focal deficits
C. Progressive memory loss
D. Painful eye attacks

B. Short focal deficits

TIAs usually last:
A. Only a few minutes
B. Several weeks
C. At least one day
D. Until sleep occurs

A. Only a few minutes

TIAs are followed by complete:
A. Weakness progression
B. Visual decline
C. Recovery
D. Aphasia worsening

C. Recovery

Roughly what fraction of patients with TIAs develop stroke within 4–5 years?
A. 10%
B. 20%
C. 30%
D. 50%

C. 30%

Which gait best matches Parkinson disease?
A. Wide-based lurching gait
B. Short quick shuffling gait
C. Steppage gait with footdrop
D. Spastic circumduction gait

B. Short quick shuffling gait

Physiologic tremor usually occurs at:
A. 2 to 4 per second
B. 10 to 12 per second
C. 20 to 24 per second
D. 1 per second

B. 10 to 12 per second

Physiologic tremor becomes more obvious:
A. After exercise
B. During sleep
C. After eye closure
D. With cooling only

A. After exercise

Intention tremor is typically:
A. Fast and resting
B. Slow and movement-worsened
C. Brief and facial
D. Constant and painless

B. Slow and movement-worsened

Intention tremor frequency is usually:
A. 8 to 10 per second
B. 10 to 12 per second
C. 2 to 4 per second
D. 15 to 20 per second

C. 2 to 4 per second

Which is a listed cause of intention tremor?
A. Multiple sclerosis
B. Huntington disease
C. Trigeminal neuralgia
D. Acute glaucoma

A. Multiple sclerosis

Which other setting can cause intention tremor?
A. Thyroid eye disease
B. Alcohol withdrawal
C. Internal carotid stenosis
D. Retinal detachment

B. Alcohol withdrawal

Chorea is characterized by:
A. Involuntary jerky movements
B. Rhythmic resting tremor
C. Sustained muscle rigidity
D. Painful tonic spasms

A. Involuntary jerky movements

Chorea is classically associated with:
A. Parkinson disease
B. Alzheimer disease
C. Huntington disease
D. Meniere disease

C. Huntington disease

Huntington disease commonly includes:
A. Personality change, dementia
B. Ptosis, mydriasis
C. Hearing loss, vertigo
D. Eye pain, halos

A. Personality change, dementia

Lower extremity numbness is especially common in:
A. Multiple sclerosis
B. Diabetes mellitus
C. Trigeminal neuralgia
D. Cluster headache

B. Diabetes mellitus

Numbness occurring essentially anywhere is more typical of:
A. Diabetes mellitus
B. Peripheral arterial disease
C. Multiple sclerosis
D. Lumbar stenosis only

C. Multiple sclerosis

Proximal arm weakness makes it hardest to:
A. Button clothing
B. Use keys
C. Write
D. Brush hair

D. Brush hair

Distal arm weakness most impairs:
A. Reaching upward
B. Shaving overhead
C. Buttoning clothes
D. Rising from bed

C. Buttoning clothes

Distal leg motor weakness classically causes:
A. Wide-based gait
B. Footdrop
C. Stooped posture
D. Intention tremor

B. Footdrop

Proximal leg weakness makes it difficult to:
A. Climb stairs
B. Grip keys
C. Read fine print
D. Speak fluently

A. Climb stairs

Trigeminal neuralgia is best described as:
A. Extreme jabbing facial pain
B. Burning dermatomal rash
C. Persistent dull occipital pain
D. Bilateral jaw weakness

A. Extreme jabbing facial pain

Trigeminal neuralgia most often involves which divisions?
A. Ophthalmic and cervical
B. Maxillary and mandibular
C. Facial and vestibular
D. Frontal and occipital

B. Maxillary and mandibular

Trigeminal neuralgia may be provoked by:
A. Touch, chewing, cold
B. Standing, coughing, heat
C. Sleep, darkness, rest
D. Reading, blinking, noise

A. Touch, chewing, cold

Herpes zoster infection of a sensory root is called:
A. Impetigo
B. Cellulitis
C. Shingles
D. Erysipelas

C. Shingles

Shingles typically produces:
A. Painless macules
B. Linear vesicular eruption
C. Diffuse urticaria
D. Bullous palm rash

B. Linear vesicular eruption

In shingles, the rash usually appears:
A. Before all pain
B. 3–4 days after pain
C. Months after weakness
D. Only after fever resolves

B. 3–4 days after pain

Pain in shingles follows the:
A. Vascular territory
B. Muscle compartment
C. Sensory root distribution
D. Cranial suture line

C. Sensory root distribution

____ ____ of the ulnar aspect of the forearm and hand may be responsible for epitrochlear adenopathy. Epitrochlear nodes are also observed in non-Hodgkin ____.

Acute infections

lymphoma

true or false for carotids: It is often helpful to ask the patient to hold their breath during the auscultation. Usually, either nothing or transmitted heart sounds are heard.

true

carotids: The presence of a _____ should be noted. This may be a _____ resulting from local atherosclerotic disease of the carotid artery. Loud murmurs originating from the heart can occasionally be transmitted to the _____. With experience, the examiner can determine whether the disorder is local in the neck or distal in the heart.

murmur

bruit

neck

_____ is responsible for motor, sensory, associative, and higher mental functions

Cerebrum

Chief sensory and motor integrating mechanism

thalamus

Maintains and regulates consciousness, alertness, and attention by electrically exciting the cerebral cortex

thalamus

Acts to maintain orientation in space and modulate movements

Responsible for fine movements of the hands

cerebellum

Coordinates and refines muscle group actins for smoothness and accuracy

cerebellum

80% of the brain blood supply is from the ________

ICAs

_____ horn contains sympathetic preganglionic neurons from T1-L2

lateral

Lateral CS tract does _____ movement
Spinocerebellar tracts do _____ proprioception

voluntary

reflex

_____ _____ column is btwn the posterolateral and posterior median sulci: Contains ascending fibers of the fasciculus gracilis and cuneatus

Posterior white

_____ fibers pass into dorsal columns, fasciculus gracilis or cuneatus to their ipsilateral nuclei, cross in the _____ _____, thalamus, postcentral gyrus

Proprioception

medial lemniscus

wide-based gait with irregular placement of the feet and poor center of gravity, with lurching to each side: _____ ataxia due to ______

motor

lurching

Understand written and verbal commands but cannot repeat them: _____ lobe lesion

frontal

Patient has difficulty understanding written and verbal commands and cannot repeat them: _____ lobe lesion

Temporoparietal

_____ is failure to recognize a sensory stimulus despite normal primary sensation

Agnosnia

_____ _____ is when a patient has normal vision and can’t recognize an object.

Visual agnosia

_____ _____ is failure to recognize based on palpation.

Tactile agnosia

_____ is inability to perform a voluntary movement in absence of deficits in motor strength, sensation, or
coordination

_____ is decreased ability to perform the activity

_____ apraxia: the patient is unable to construct or draw simple design

Apraxia

Dyspraxia

Constructional

still able to wrinkle forehead in _____ lesion

UMN

Pt lies on back and tongue blade is quickly stroked horizontally laterally to medially towards the umbilicus. This will cause a contraction of the abdominal muscles with umbilicus deviating towards stimulus
a. Abdominal superficial reflex

b. Oppenhiem’s sign

c. Chaddock’s sign

d. Hoffmann’s sign

a. Abdominal superficial reflex

stroke the lateral aspect of foot and if the big toe
dorsiflexes then its indicative of pyramidal tract disease

a. Abdominal superficial reflex

b. Oppenhiem’s sign

c. Chaddock’s sign

d. Hoffmann’s sign

c. Chaddock’s sign

downward pressure along the shin causes the big toe to
dorsiflex. If this happens then it is also indicative of pyramidal track

a. Abdominal superficial reflex

b. Oppenhiem’s sign

c. Chaddock’s sign

d. Hoffmann’s sign

b. Oppenhiem’s sign

the patient’s hand is pronated, and the Doc grabs the terminal
phalanx of the middle finger between the index finger and thumb. With a sharp jerk, the phalanx is passively flexed and suddenly released.

Hoffmann’s sign

ability to identify a number “written” in the palm of one’s hand:

a. Graphesthesia

b. Stereognosis

c. diadochokinetic

d. Romberg

a. Graphesthesia

Graphesthesia indicates an issue in what lobe?

parietal

Have the pt attempt to identify and object
placed in the hand. Have the pt close his or her eyes. And place like a paperclip or coin or key in the pt hand and ask
them what is it?

a. Graphesthesia

b. Stereognosis

c. Diadochokinetic

d. Romberg

b. Stereognosis

which one is parietal and occipital lobe issue?

a. Graphesthesia

b. Stereognosis

c. Diadochokinetic

d. Romberg

b. Stereognosis

adiadochokinetic vs diadochokinetic

too little vs too much in rapid alternating movements

A patient with severe cerebral hemispheric injury develops abnormal flexion of the upper extremities with extension of the lower extremities. This posture is called:
A. Decerebrate posturing
B. Decorticate posturing
C. Choreiform posturing
D. Dystonic posturing

B. Decorticate posturing

Pt with midbrain or pons lesions have:
A. Decorticate posture
B. Decerebrate posture
C. Hemiballismus
D. Athetosis

B. Decerebrate posture

A 68-year-old man with severe COPD reports fatigue, worsening dyspnea, and a 20-lb unintentional weight loss over the past 10 months. His BMI remains within the normal range. The physician is concerned about nutritional status and pulmonary prognosis. Which of the following statements best explains the nutritional risk in this patient?

A. COPD patients losing ≥15% weight risk malnutrition
B. COPD patients losing ≥35% weight risk malnutrition
C. COPD patients losing ≥5% weight risk malnutrition
D. COPD patients losing ≥25% weight risk malnutrition

A. COPD patients losing ≥15% weight risk malnutrition

Which measure best reflects lean body mass and correlates with pulmonary prognostic markers such as six-minute walk distance, dyspnea, predicted FEV₁, airway obstruction, lung hyperinflation, and total lung capacity?

A. Body mass index
B. Fat-free mass index
C. Waist-to-hip ratio
D. Basal metabolic rate

B. Fat-free mass index

A COPD patient has a normal body weight but reduced skeletal muscle strength and poor exercise tolerance. Imaging shows reduced lean tissue mass despite stable total body weight. Which explanation best accounts for this finding?

A. Increased adipose storage masks muscle loss
B. Fat-free mass depletion reduces peripheral muscle strength
C. Elevated BMI increases respiratory workload
D. Lean mass increases oxygen consumption

B. Fat-free mass depletion reduces peripheral muscle strength

Which physiologic function most directly depends on adequate nutritional intake in COPD patients?

A. Surfactant synthesis and exercise capacity
B. Bronchial mucus production and exercise capacity
C. Respiratory muscle strength and exercise capacity
D. Alveolar macrophage activation and exercise capacity

C. Respiratory muscle strength and exercise capacity

Which mechanism best explains the increased susceptibility to respiratory infections in nutritionally depleted COPD patients?

A. Increased airway smooth muscle tone and mucosal resistance
B. Enhanced neutrophil apoptosis and mucosal resistance
C. Decreased cell-mediated immunity and mucosal resistance
D. Increased pulmonary capillary permeability and mucosal resistance

C. Decreased cell-mediated immunity and mucosal resistance

Which combination best represents antioxidant nutrients linked to improved lung function?

A. Vitamin A, zinc, copper, folate
B. Vitamin C, vitamin E, β-carotene, selenium
C. Vitamin D, calcium, magnesium, iron
D. Vitamin B6, niacin, riboflavin, biotin

B. Vitamin C, vitamin E, β-carotene, selenium

Investigators note that individuals with diets rich in tea, fruits, vegetables, and whole grains show improved lung function and slower disease progression. These foods likely benefit COPD patients primarily because they are:

A. High in antioxidants with protective pulmonary effects
B. High in saturated fats increasing caloric intake
C. Rich in simple carbohydrates increasing ventilation efficiency
D. Sources of dietary nitrates improving airway tone

A. High in antioxidants with protective pulmonary effects

Laboratory testing reveals increased oxidative stress within airway tissues. Which mechanism best explains these findings?

A. Excess nitric oxide suppressing macrophages
B. Imbalance between reactive oxygen species and antioxidants
C. Decreased mitochondrial respiration in pneumocytes
D. Increased surfactant degradation by proteases

B. Imbalance between reactive oxygen species and antioxidants

A patient with advanced COPD reports decreased food intake despite access to adequate food. He states he simply does not feel hungry most of the time. Which factor most directly explains this contributor to weight loss?

A. Reduced appetite
B. Increased caloric expenditure
C. Excess gastric acid secretion
D. Increased insulin release

A. Reduced appetite

A COPD patient complains that constant coughing and sputum production make eating unpleasant and difficult. Which mechanism best explains this effect on nutrition?

A. Increased gastric motility and swallowing difficulty
B. Altered taste and swallowing difficulty
C. Increased insulin sensitivity and swallowing difficulty
D. Reduced intestinal absorption and swallowing difficulty

B. Altered taste and swallowing difficulty

A patient with severe COPD lives alone and reports difficulty maintaining adequate nutrition. He states that preparing meals makes him short of breath and extremely tired. Which COPD-related factor most directly contributes to his weight loss?

A. Dyspnea and fatigue limiting food preparation
B. Increased intestinal absorption
C. Reduced respiratory rate
D. Increased appetite from hypoxia

A. Dyspnea and fatigue limiting food preparation

A COPD patient with persistent sadness and loss of interest in normal activities reports a reduced desire to eat and progressive weight loss. Which factor best explains this mechanism?

A. Hyperthyroidism
B. Depression causing anorexia
C. Increased gastric acid
D. Accelerated metabolism

B. Depression causing anorexia

A patient with advanced COPD reports feeling full after only a few bites of food and sometimes has difficulty swallowing. Examination reveals severe lung hyperinflation. Which mechanism best explains this symptom?

A. Lung hyperinflation compressing abdominal organs
B. Reduced intestinal compressing abdominal organs
C. Increased pancreas compressing abdominal organs
D. Enhanced gastric emptying compressing abdominal organs

A. Lung hyperinflation compressing abdominal organs

Which cytokine most directly contributes to weight loss, muscle loss, and increased resting energy requirements in COPD?

A. Tumor necrosis factor-α
B. Interleukin-2
C. Transforming growth factor-β
D. Interferon-γ

A. Tumor necrosis factor-α

A COPD patient with severe muscle wasting undergoes endocrine evaluation. Laboratory studies reveal low circulating leptin and testosterone levels. Which metabolic effect best explains the muscle loss observed in this patient?

A. Increased protein synthesis
B. Increased protein catabolism
C. Increased glycogen storage
D. Decreased lipid metabolism

B. Increased protein catabolism

A cachectic patient with severe COPD has elevated circulating growth hormone levels but persistent muscle wasting and metabolic dysfunction. Which mechanism best explains this paradox?

A. Increased insulin resistance
B. Growth hormone resistance
C. Excess cortisol secretion
D. Reduced thyroid hormone activity

B. Growth hormone resistance

A patient with advanced COPD reports severe fatigue and early muscle exhaustion during minimal exertion. Laboratory studies show reduced phosphocreatine stores in skeletal muscle. Which metabolic consequence most directly explains the exercise intolerance?

A. Reduced mitochondrial respiration
B. Early lactic acidosis
C. Increased glucose oxidation
D. Reduced fatty acid metabolism

B. Early lactic acidosis

A researcher studying severe COPD finds abnormalities in the metabolism of a branched-chain amino acid critical for muscle protein synthesis. Which amino acid is most likely involved?

A. Valine
B. Isoleucine
C. Leucine
D. Lysine

C. Leucine

Certain electrolytes (calcium, magnesium, potassium and phosphorus) are especially important because depletion may contribute to the impairment of ______ muscle function.

respiratory

When severely undernourished COPD patients are rapidly re-fed with glucose infusions, careful attention must be paid to these electrolytes to avoid ______ ______

refeeding syndrome

ghrelin improves body composition by decreasing muscle ______.

wasting

A nutrition plan is being designed for a patient with COPD and chronic systemic inflammation. Which dietary lipid pattern is least desirable because it may promote a proinflammatory state and worsen inflammatory burden?

A. High omega-6 PUFA intake
B. High omega-3 fish oil intake
C. Low-bioactive fatty acid intake
D. Balanced unsaturated fat intake

A. High omega-6 PUFA intake

A clinician modifies a COPD patient’s diet to reduce inflammation by replacing one class of polyunsaturated fatty acids with less bioactive fats derived from fish oils. Which change best reflects this strategy?

A. Replace omega-3 with omega-6
B. Replace omega-6 with omega-3
C. Replace saturated fat with trans fat
D. Replace omega-9 with cholesterol

B. Replace omega-6 with omega-3

assess ______ as a predictor of mortality

albumin

Which statement best explains why immunosuppressive drugs can significantly affect nutrition management?

A. They alter metabolism and intake
B. They improve gut absorption only
C. They reduce wound healing needs
D. They prevent steroid complications

A. They alter metabolism and intake

A patient taking cyclosporine develops hyperkalemia with elevated serum cholesterol and triglyceride levels. Which dietary modification is most appropriate?

A. Reduce potassium, saturated fat, cholesterol
B. Increase potassium, carbohydrate, protein
C. Reduce calcium, fiber, fluids
D. Increase sodium, cholesterol, fat

A. Reduce potassium, saturated fat, cholesterol

A transplant patient is switched from cyclosporine to tacrolimus. Which metabolic complication should the care team monitor most closely?

A. Hyperkalemia
B. Hyperglycemia
C. Hypocalcemia
D. Hyperuricemia

B. Hyperglycemia

A patient taking azathioprine complains of poor intake because of persistent gastrointestinal upset. Which adverse-effect combination is most characteristic of this drug?

A. Constipation, dry mouth, bloating
B. Nausea, vomiting, diarrhea
C. Hyperphagia, edema, dyspepsia
D. Reflux, constipation, ileus

B. Nausea, vomiting, diarrhea

A patient receiving mycophenolate mofetil reports chronic loose stools and upper abdominal discomfort. Which adverse-effect pair best matches this medication?

A. Diarrhea and dyspepsia
B. Hyperglycemia and edema
C. Hyperkalemia and nausea
D. Osteoporosis and vomiting

A. Diarrhea and dyspepsia

Which nutritional consequence is most strongly associated with corticosteroid therapy?

A. Hyperglycemia with obesity risk
B. Hypoglycemia with cachexia
C. Hyperkalemia with dehydration
D. Malabsorption with anemia

A. Hyperglycemia with obesity risk

While palpating the carotid artery of a healthy patient, the examiner notes a smooth contour with an upward stroke that is steeper and more rapid than the downward stroke. Which pulse description is most accurate?

A. Normal pulse
B. Diminished pulse
C. Increased pulse
D. Double-peaked pulse

A. Normal pulse

A frail patient with low cardiac output has a carotid pulse that feels small and weak. The examiner notes only a gentle pressure rise before reaching a distinct peak. Which pulse type is present?

A. Normal pulse
B. Diminished pulse
C. Increased pulse
D. Double-peaked pulse

B. Diminished pulse

During carotid palpation, the examiner feels a large, strong, hyperkinetic pulse with a rapid rise of the ascending limb and a quick sharp tap at the peak. Which pulse type best matches this finding?

A. Normal pulse
B. Diminished pulse
C. Increased pulse
D. Double-peaked pulse

C. Increased pulse

A patient’s carotid waveform is described as having a prominent percussion wave and tidal wave, with or without an additional dicrotic wave. Which pulse description is most accurate?

A. Normal pulse
B. Diminished pulse
C. Increased pulse
D. Double-peaked pulse

D. Double-peaked pulse

A clinician evaluating a patient’s pulse explains that cardiac rhythm on physical exam can be broadly described using which 3 categories?

A. Regular, regularly irregular, irregularly irregular
B. Normal, diminished, increased, double-peaked
C. Sinus, junctional, ventricular
D. Tachycardic, bradycardic, normocardic

A. Regular, regularly irregular, irregularly irregular

A patient’s pulse is irregular, but the irregularity repeats in a definite, predictable pattern on palpation. Which rhythm description is most accurate?

A. Regular
B. Regularly irregular
C. Irregularly irregular
D. Sinus tachycardia

B. Regularly irregular

A patient’s pulse has no repeating pattern whatsoever, with grossly variable intervals between beats. Which rhythm description best fits this finding?

A. Regular
B. Regularly irregular
C. Irregularly irregular
D. Bigeminal

C. Irregularly irregular

A medical student tries to classify an abnormal pulse only by palpation. The attending says the best method to definitively diagnose the rhythm is:

A. Carotid auscultation
B. Apical palpation
C. Electrocardiography
D. Blood pressure cuff

C. Electrocardiography

Which finding is most consistent with premature beats?

A. Completely random pauses only
B. Isolated extra beats in regular rhythm
C. Beat groups of three only
D. Continuous rapid regular rhythm

B. Isolated extra beats in regular rhythm

A patient has a coupled rhythm in which beats occur in pairs. The first beat is a sinus beat, followed by a premature beat that is usually ventricular. This pattern is called:

A. Trigeminy
B. Bigeminy
C. Fibrillation
D. Flutter

B. Bigeminy

A premature beat occurs very early in diastole. When assessing the rhythm only by palpation, what pitfall may occur?

A. The sinus beat feels exaggerated
B. The premature beat may be missed
C. The rhythm appears fully regular
D. The pulse pressure widens greatly

B. The premature beat may be missed

A patient has a grossly irregular pulse with no detectable pattern on physical exam. Which arrhythmia is classically associated with this finding?

A. Atrial fibrillation
B. Sinus bradycardia
C. Ventricular bigeminy
D. First-degree AV block

A. Atrial fibrillation

A dermatology student is reviewing the structure of the skin. Which layer contains keratin-producing cells that undergo maturation, keratinization, and shedding in a cycle that takes approximately 4 weeks?

A. Epidermis
B. Dermis
C. Subcutaneous tissue
D. Reticular layer

A. Epidermis

A patient presents with a deep skin laceration that disrupts the dense connective tissue stroma containing sensory and autonomic nerve fibers and forming the bulk of the skin. Which layer has most likely been damaged?

A. Epidermis
B. Dermis
C. Subcutaneous tissue
D. Hypodermis

B. Dermis

A surgeon makes an incision deep enough to reach the third layer of skin composed largely of fatty connective tissue that cushions underlying structures. Which layer is this?

A. Epidermis
B. Dermis
C. Subcutaneous tissue
D. Stratum corneum

C. Subcutaneous tissue

A patient presents with excessive sweating of the palms and soles during stress. Which sweat glands are primarily responsible for this pattern of secretion?

A. Apocrine glands
B. Eccrine glands
C. Sebaceous glands
D. Ceruminous glands

B. Eccrine glands

A clinician explains that certain sweat glands are larger and mainly located in the axillae, areolae, pubic region, and perineum. Which glands are being described?

A. Eccrine glands
B. Sebaceous glands
C. Apocrine glands
D. Meibomian glands

C. Apocrine glands

A teenager with acne has overactivity of glands associated with hair follicles that produce an oily secretion called sebum and are distributed across most of the body. Which glands are involved?

A. Eccrine glands
B. Apocrine glands
C. Sebaceous glands
D. Ceruminous glands

C. Sebaceous glands

During a nail exam, a clinician points to the whitish semilunar area at the base of the nail plate that represents proliferating epithelial cells from the nail matrix. What is this structure called?

A. Cuticle
B. Lunula
C. Nail bed
D. Nail fold

B. Lunula

A patient develops goosebumps in response to cold exposure. Which muscle attached to the hair follicle below the sebaceous gland is responsible for this reaction?

A. Arrector pili
B. Orbicularis pili
C. Dermal flexor
D. Sebaceous constrictor

A. Arrector pili

A patient complains of generalized itching without a visible rash. The clinician explains that pruritus may indicate either a skin condition or:

A. Vitamin deficiency only
B. Internal systemic illness
C. Bacterial colonization only
D. Local nerve injury

B. Internal systemic illness

A patient’s nails show splitting, discoloration, ridging, thickening, and separation from the nail bed. These findings are best described as:

A. Nail hypertrophy only
B. Normal aging changes
C. Nail abnormalities or dystrophy
D. Nail bed infections only

C. Nail abnormalities or dystrophy

A dermatology resident explains that many skin diseases cannot be cured directly and treatment often focuses on symptom relief rather than elimination of the underlying cause. This approach is called:

A. Preventive treatment
B. Curative therapy
C. Palliative therapy
D. Prophylactic therapy

C. Palliative therapy

A patient develops recurrent rashes during periods of intense psychological stress. Which factor most likely contributes to this skin reaction?

A. Viral activation only
B. Anxiety as a stressor
C. Increased melanin production
D. Reduced immune activity

B. Anxiety as a stressor

What is true?

A. Moisture occurs only in infections
B. Moisture may occur with fever or emotions
C. Moisture occurs only in endocrine disease
D. Moisture occurs only in dehydration

B. Moisture may occur with fever or emotions

dystrophic state in which the nail plate thins & a cuplike
depression develops; also called “spoon nail”

a. terry's nails

b. lindsay's nails

c. splinter hemorrhages

d. koilonychia

d. koilonychia

Most commonly associated with iron deficiency anemia:

a. terry's nails

b. lindsay's nails

c. splinter hemorrhages

d. koilonychia

d. koilonychia

Entirely white except for a band of pink at the distal tip:

a. terry's nails

b. lindsay's nails

c. splinter hemorrhages

d. koilonychia

a. terry's nails

also called “half-and-half nails”

a. terry's nails

b. lindsay's nails

c. splinter hemorrhages

d. koilonychia

b. lindsay's nails

blood spots that appear underneath the nail

a. terry's nails

b. lindsay's nails

c. splinter hemorrhages

d. koilonychia

c. splinter hemorrhages

Presence is most often related to local, light trauma:

a. terry's nails

b. lindsay's nails

c. splinter hemorrhages

d. koilonychia

c. splinter hemorrhages

white transverse line or band that result from poisoning or
an acute systemic illness

a. terry's nails

b. lindsay's nails

c. beau's lines

d. mees' bands

d. mees' bands

transverse grooves or depressions parallel to the lunula

a. terry's nails

b. lindsay's nails

c. beau's lines

d. mees' bands

c. beau's lines

what is this?

common wart

A patient presents with a small rough growth on the finger. The clinician explains it is a common wart. Which definition best describes a common wart?

A. Malignant dermal tumor from UV damage
B. Benign epidermal growth caused by HPV
C. Autoimmune destruction of keratinocytes
D. Bacterial infection of hair follicles

B. Benign epidermal growth caused by HPV

A child develops several warts after sharing towels with a classmate who also had warts. What is the most likely mode of transmission?

A. Airborne droplets only
B. Bloodborne spread
C. Person-to-person contact
D. Vector transmission

C. Person-to-person contact

On physical examination, a wart on the hand is palpated and appears as a firm raised lesion with a rough keratinized surface. Which description best matches the classic morphology of a wart?

A. Soft papule with smooth surface
B. Firm nodule with rough keratinous surface
C. Flat macule with scaling border
D. Fluctuant cystic lesion

B. Firm nodule with rough keratinous surface

A patient undergoes surgical treatment for a common wart. Because the lesion is confined to the epidermis, which surgical approach is typically sufficient for complete removal?

A. Excision to level of dermis
B. Removal to subcutaneous tissue
C. Removal to muscle fascia
D. Full-thickness skin excision

A. Excision to level of dermis

is this squamous or basal?

squamous

is this squamous or basal?

basal

what is this?

melanoma

A biopsy from a sun-exposed skin lesion shows a malignant neoplasm of keratinocytes arising in the epidermis with local invasion into the dermis. Which diagnosis is most likely?

A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Seborrheic keratosis
D. Common wart

B. Squamous cell carcinoma

A skin lesion presents as a scaling, crusting nodule that intermittently ulcerates and bleeds. Which diagnosis is most consistent with this morphology?

A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Dermatofibroma
D. Lipoma

B. Squamous cell carcinoma

A clinician evaluates a cutaneous malignancy that developed mainly on chronically sun-exposed skin. Which diagnosis is most strongly associated with predominant development on skin exposed to sunlight?

A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma in situ
D. Psoriasis

A. Squamous cell carcinoma

A malignant skin lesion is diagnosed as a neoplasm of basal cells of the epidermis and is noted to be the most common skin malignancy. Which diagnosis is this?

A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Merkel cell carcinoma
D. Keratoacanthoma

B. Basal cell carcinoma

A pearly skin lesion with a rolled, well-defined border and a central ulcerated depression is found on the face. Which diagnosis is most likely?

A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Actinic keratosis
D. Common wart

A. Basal cell carcinoma

Which feature best distinguishes basal cell carcinoma from squamous cell carcinoma?

A. Rapid growth with frequent metastasis
B. Preference for mucosal surfaces
C. Deep muscle invasion at onset
D. Slow growth with rare metastasis

D. Slow growth with rare metastasis

A biopsy from a deeply pigmented skin lesion shows a malignant neoplasm of melanocytes in the epidermis. Which diagnosis is most likely?

A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Melanoma
D. Common wart

C. Melanoma

Which statement best characterizes the epidemiology and prognosis of melanoma?

A. It is uncommon and rarely fatal
B. It is common but never metastasizes
C. It is uncommon but highly fatal
D. It is common and always curable

C. It is uncommon but highly fatal

A dermatologist notes that melanoma incidence has been:
A. Falling steadily for decades
B. Increasing faster than other malignancies
C. Stable across all age groups
D. Lower than all skin cancers

B. Increasing faster than other malignancies

Which skin finding is most consistent with the usual pigmentation pattern of melanoma?

A. Flesh-colored translucent papule
B. Uniform pink macule only
C. Varied black, blue, brown lesion
D. Yellow waxy plaque

C. Varied black, blue, brown lesion

Which melanoma subtype is frequently seen in geriatric patients and appears in areas of sun-exposed, sun-damaged skin?

A. Nodular melanoma
B. Lentigo maligna melanoma
C. Acral-lentiginous melanoma
D. Superficial spreading melanoma

B. Lentigo maligna melanoma

A lesion is diagnosed as the most common type of melanoma, accounting for about 70% of all cases, and appears as an irregularly colored plaque with sharp notches and variegated pigmentation. Which subtype is this?

A. Lentigo maligna melanoma
B. Nodular melanoma
C. Acral-lentiginous melanoma
D. Superficial spreading melanoma

D. Superficial spreading melanoma

Which melanoma subtype carries an excellent prognosis if diagnosed early?

A. Superficial spreading melanoma
B. Nodular melanoma
C. Lentigo maligna melanoma
D. Acral-lentiginous melanoma

A. Superficial spreading melanoma

A dark blue-black skin lesion has grown rapidly over several months. It represents the second most common melanoma subtype, comprising about 15% of cases. Which diagnosis is most likely?

A. Lentigo maligna melanoma
B. Nodular melanoma
C. Superficial spreading melanoma
D. Acral-lentiginous melanoma

B. Nodular melanoma

Which melanoma subtype is the most common form seen in African Americans and Asians and occurs on non-hair-bearing parts of the body?

A. Nodular melanoma
B. Lentigo maligna melanoma
C. Acral-lentiginous melanoma
D. Superficial spreading melanoma

C. Acral-lentiginous melanoma

In white individuals, melanomas tend to occur predominantly:
A. On the palms and soles
B. In the oral mucosa
C. In the lower extremities and back
D. On the eyelids only

C. In the lower extremities and back

Which melanoma locations are associated with a worse prognosis than lesions on the extremities?

A. Face, ears, eyelids
B. Back, axillae, neck, scalp
C. Hands, feet, nails
D. Abdomen, chest, groin

B. Back, axillae, neck, scalp

Melanoma occurs more often after which sun-exposure pattern in fair-skinned individuals?

A. Chronic occupational sun exposure
B. Brief intense sun exposure
C. No sun exposure
D. Night-shift light exposure

B. Brief intense sun exposure

Less than 5% of all melanomas occur in:
A. White patients
B. Asian patients
C. African-American patients
D. Geriatric patients

C. African-American patients

Cafe-au-lait spots, contact dermatitis, lipoma, neurofibroma?

contact dermatitis

Cafe-au-lait spots, contact dermatitis, lipoma, neurofibroma?

lipoma

Cafe-au-lait spots, contact dermatitis, lipoma, neurofibroma?

Cafe-au-lait spots

Cafe-au-lait spots, contact dermatitis, lipoma, neurofibroma?

neurofibroma

A patient presents with a soft-tissue mass under the skin that feels rubbery and is composed of benign subcutaneous fat. Which diagnosis is most likely?

A. Neurofibroma
B. Lipoma
C. Dermatofibroma
D. Sebaceous cyst

B. Lipoma

Which statement best describes a lipoma?

A. Malignant tumor of adipose tissue
B. Most common soft tissue cancer
C. Common benign subcutaneous fat growth
D. Epidermal proliferation of neural tissue

C. Common benign subcutaneous fat growth

A child is noted to have several flat, well-circumscribed brown patches on the trunk. Which lesion best matches this description?

A. Cafe-au-lait spots
B. Neurofibromas
C. Lipomas
D. Telangiectasias

A. Cafe-au-lait spots

Cafe-au-lait spots result from:
A. Dermal hemorrhage
B. Increased hyperactive melanocytes
C. Epidermal neural proliferation
D. Subcutaneous fat hypertrophy

B. Increased hyperactive melanocytes

An adult is found to have 7 cafe-au-lait spots, each measuring 2 cm in diameter. This finding should raise concern for:
A. Psoriasis
B. Basal cell carcinoma
C. Neurofibromatosis
D. Melanoma

C. Neurofibromatosis

A dermal tumor produced by focal proliferation of neural tissue with a normal overlying epidermis is called:
A. Lipoma
B. Neurofibroma
C. Dermatofibroma
D. Nevus

B. Neurofibroma

Which feature best distinguishes a neurofibroma from many other skin tumors?
A. It arises from subcutaneous fat
B. The epidermis remains normal
C. It is highly keratinized
D. It usually ulcerates early

B. The epidermis remains normal

On palpation, cutaneous neurofibromas are typically:
A. Hard and fixed
B. Fluctuant and tender
C. Soft in consistency
D. Rubbery like fat

C. Soft in consistency

What is this?

contact dermatitis, tinea corporis, psoriasis, onychomycosis

psoriasis

What is this?

contact dermatitis, tinea corporis, psoriasis, onychomycosis

tinea corporis

What is this?

contact dermatitis, tinea corporis, psoriasis, onychomycosis

onychomycosis

The underlying dermis displays mild inflammation:

contact dermatitis, fungal infections, psoriasis, onychomycosis

fungal infections

A patient presents with a chronic noninfectious skin disorder that often runs in families and may also affect the joints and nails. Which condition best fits this description?

A. Psoriasis
B. Tinea corporis
C. Impetigo
D. Contact dermatitis

A. Psoriasis

A patient with psoriasis presents with sharply demarcated plaques that are slightly raised and covered with thick scale due to excess keratin production. Which description best characterizes these lesions?

A. Vesicular plaques with crusting
B. Well-defined hyperkeratotic plaques
C. Diffuse macular erythema
D. Ulcerated nodular lesions

B. Well-defined hyperkeratotic plaques

A patient with psoriasis complains of severe itching and symmetric lesions. Which body locations are most characteristically involved?

A. Palms, soles, eyelids
B. Abdomen, chest, groin
C. Elbows, knees, scalp, intergluteal cleft
D. Face, ears, neck

C. Elbows, knees, scalp, intergluteal cleft

Dermatophyte infections affecting the skin, hair, and nails most commonly belong to which genera?

A. Candida, Aspergillus, Cryptococcus
B. Trichophyton, Microsporum, Epidermophyton
C. Histoplasma, Blastomyces, Coccidioides
D. Malassezia, Rhodotorula, Sporothrix

B. Trichophyton, Microsporum, Epidermophyton

What does the term “tinea” specifically indicate?

A. Bacterial infection
B. Viral infection
C. Fungal cause
D. Parasitic infestation

C. Fungal cause

A patient presents with a fungal infection in which organisms invade the nail bed. This condition is also noted to be the most common nail disorder. Which diagnosis is most likely?

A. Psoriatic nail disease
B. Onychomycosis
C. Paronychia
D. Clubbing

B. Onychomycosis

A patient with onychomycosis notices gradual worsening of the nail over time. Which set of nail changes is most characteristic?

A. Color, structure, texture changes
B. Pulse, temperature, sensation changes
C. Curvature, bleeding, ulceration changes
D. Matrix, lunula, cuticle changes

A. Color, structure, texture changes

Inflammation of the nail bed in onychomycosis promotes:
A. Nail bed atrophy and thinning
B. Hyperkeratosis and thickening
C. Matrix necrosis and shedding
D. Clubbing and sponginess

B. Hyperkeratosis and thickening

What is this?

Herpesvirus, Pityriasis rosea, Herpes zoster, Acne

Pityriasis rosea

What is this?

Herpesvirus, Pityriasis rosea, Herpes zoster, Acne

Herpes zoster

What is this?

Herpesvirus, Pityriasis rosea, Herpes zoster, Acne, tinea versicolor

Acne

what is this?

Herpesvirus, ganglion cyst, Pityriasis rosea, Herpes zoster, Acne, tinea versicolor

ganglion cyst

what is this?

Herpesvirus, ganglion cyst, Pityriasis rosea, Herpes zoster, Acne, tinea versicolor,

tinea versicolor

A 22-year-old patient presents with a common, acute, self-limiting inflammatory skin disease of unknown cause that typically appears during the spring. Which diagnosis best matches this description?

A. Pityriasis rosea
B. Herpes zoster
C. Psoriasis
D. Tinea corporis

A. Pityriasis rosea

A patient develops a widespread rash that was preceded several days earlier by a single lesion resembling tinea corporis. What is this initial lesion called?

A. Sentinel lesion
B. Herald patch
C. Primary plaque
D. Index lesion

B. Herald patch

A patient diagnosed with pityriasis rosea asks how long the rash will last. The clinician explains that the condition usually persists for approximately:

A. 1–2 days
B. 1 week
C. 3–6 weeks
D. 3–6 months

C. 3–6 weeks

A patient presents with shingles, characterized by a painful vesicular eruption following a dermatomal distribution. Which diagnosis best fits this condition?

A. Psoriasis
B. Herpes zoster
C. Pityriasis rosea
D. Tinea corporis

B. Herpes zoster

The underlying cause of herpes zoster is the reactivation of which virus?

A. Herpes simplex virus
B. Epstein–Barr virus
C. Varicella-zoster virus
D. Cytomegalovirus

C. Varicella-zoster virus

Herpesvirus infections are commonly encountered in which group of patients?

A. Patients with HIV infection
B. Patients with asthma
C. Patients with hypertension
D. Patients with diabetes

A. Patients with HIV infection

In patients with HIV, the presence of herpesvirus infections is thought to be:

A. Protective against opportunistic infections
B. Predictive of future progression to AIDS
C. A marker of viral cure
D. Unrelated to disease progression

B. Predictive of future progression to AIDS

The likelihood of herpesvirus infection becomes extremely high when CD4+ T-cell counts drop below which threshold?

A. 500 cells/mm³
B. 300 cells/mm³
C. 200 cells/mm³
D. 100 cells/mm³

D. 100 cells/mm³

Acne is best described as which type of disease?

A. Viral disease of sweat glands and sebaceous glands
B. Pustular disease of hair follicles and sebaceous glands
C. Fungal disease of epidermis and sebaceous glands
D. Autoimmune disease of dermis and sebaceous glands

B. Pustular disease of hair follicles and sebaceous glands

Which lesions are considered the primary lesions in acne?

A. Vesicles, bullae, plaques
B. Pustules, papules, comedones
C. Nodules, ulcers, scales
D. Macules, petechiae, purpura

B. Pustules, papules, comedones

Within the dermis in acne, the hair follicle becomes occluded by a collection of:

A. Melanin, collagen, lymphocytes
B. Keratin, sebum, inflammatory cells
C. Fibrin, platelets, erythrocytes
D. Calcium, lipids, macrophages

B. Keratin, sebum, inflammatory cells

A patient presents with a chronic, painless lesion on the dorsum of the wrist that is fluctuant and cystic. Which diagnosis best fits this description?

A. Lipoma
B. Ganglion cyst
C. Neurofibroma
D. Sebaceous cyst

B. Ganglion cyst

A ganglion cyst develops because of leakage of which substance through the tendon sheath of a joint capsule?

A. Lymphatic fluid
B. Synovial fluid
C. Blood plasma
D. Interstitial fluid

B. Synovial fluid

The name “Bible cyst” originated from a historical treatment method in which clinicians attempted to rupture the cyst by:

A. Freezing the lesion with ice
B. Striking it with a Bible or large book
C. Injecting alcohol into the cyst
D. Compressing it with bandages

B. Striking it with a Bible or large book

When multiple small ganglion cysts appear near one another, they may look like separate lesions but are usually connected by:

A. Shared epidermal tract
B. Fibrous dermal bridge
C. Common deep tissue stalk
D. Lymphatic channel

C. Common deep tissue stalk

A small pale red skin lesion with a pulsating central arteriole and radiating “legs” is identified on the upper chest. What is the most likely diagnosis?

A. Telangiectasia
B. Spider angioma
C. Hemangioma
D. Purpura

B. Spider angioma

Spider angiomas are most commonly found on which body areas?

A. Face, neck, arms, upper trunk
B. Lower legs and ankles
C. Palms and soles
D. Abdomen and groin

A. Face, neck, arms, upper trunk

Spider angiomas are more commonly associated with which patient populations?

A. Children and athletes
B. Elderly men only
C. Pregnant women and liver disease
D. Patients with kidney disease

C. Pregnant women and liver disease

Vitiligo, Scabies, Urticaria, Insect bites, Pyoderma gangrenosum, Erythema multiforme

Vitiligo

Vitiligo, Scabies, Urticaria, Insect bites, Pyoderma gangrenosum, Erythema multiforme, Karposi’s sarcoma

Urticaria

Vitiligo, Scabies, Urticaria, Insect bites, Pyoderma gangrenosum, Erythema multiforme, Karposi’s sarcoma

Erythema multiforme

Karposi’s sarcoma, Vitiligo, Scabies, Urticaria, Insect bites, Pyoderma gangrenosum, Erythema multiforme, Norwegian scabies

Scabies

Vitiligo, Scabies, Urticaria, Norwegian scabies, Insect bites, Pyoderma gangrenosum, Erythema multiforme, Karposi’s sarcoma

Norwegian scabies

Vitiligo, Scabies, Urticaria, Norwegian scabies, Insect bites, Pyoderma gangrenosum, Karposi’s sarcoma, Erythema multiforme

Pyoderma gangrenosum

Vitiligo, Scabies, Urticaria, Karposi’s sarcoma, Norwegian scabies, Insect bites, Pyoderma gangrenosum, Erythema multiforme

Insect bites

Vitiligo, Scabies, Urticaria, Karposi’s sarcoma, Norwegian scabies, Insect bites, Pyoderma gangrenosum, Erythema multiforme

Karposi’s sarcoma

Vitiligo lesions are best described morphologically as:

A. Large macules that are totally depigmented
B. Raised vesicles with scaling
C. Nodular plaques with erythema
D. Small papules with crusting