The x-ray report of a seven-year-old male identifies a fracture line that involves the distal metaphysis and epiphyseal plate of the distal radius. The distal epiphysis is not involved. What type of Salter-Harris fracture is described by this report?

A 67-year-old male is evaluated for headaches, fatigue and difficulty sleeping. His BP is 210/106 mmHg. He reports that he was prescribed antihypertensive medications over 10 years ago but has not been “very good about taking his medicine.” Which one of the following sets of findings is most indicative of long-standing, uncontrolled hypertension?

A 59-year-old female presents inquiring about lung cancer screening. She was diagnosed with COPD 8 years ago and currently using ipratropium/albuterol and formoterol. On further questioning she discloses that she has noticed a slight increase in her cough over the past few months. Her social history reveals a 46 pack-year history of smoking; residence in Arizona her entire life. A chest CT reveals a 1.8 cm lesion within the medial, left lower lobe. What is the next best step in the management of this patient’s case?

A 23-year-old male presents describing a change in his bowel habits. He has been experiencing multiple loose, bloody stools that wake him in the middle of the night. This has been occurring for the past 6 weeks. He denies any recent travel, illness or known exposures to ill coworkers, colleagues or friends. He has not been on any recent antibiotics. He has been taking ibuprofen 800mg three times a day for the past two months for knee pain from a tennis injury. What is the most likely diagnosis?

Which one of the following medications used to treat HIV is the most likely to cause nephrolithiasis?

Which one of the following is more typically associated with rheumatoid arthritis than osteoarthritis?

A 7-year-old male presents to the office with a history of easy bruising. His mother reports a history of multiple small bruises on his lower extremities, arms and trunk. She adds that his gums bleed occasionally, and that if he injures himself, the wound seems to ooze for hours. Physical exam identifies multiple, small ecchymotic areas, but no purpuric lesions. There are no active bleeding sites. There is no hepatosplenomegaly or lymphadenopathy.
Labs reveal: CBC and WBC Normal
Platelet count 240,000
Bleeding Time prolonged at 11 minutes
INR normal at 1.0
aPTT prolonged at 37 seconds

Which of the following do you suspect as the underlying condition?

A 35-year-old female presents with episodes of right upper quadrant abdominal (RUQ) pain that occur after eating. Each episode lasts 5-10 minutes. Positional changes do not affect the discomfort. There have been no nocturnal episodes. Labs, including WBC, AST, and ALT are normal. Ultrasound and CT scan of the RUQ are normal. Which one of the following is the best imaging study to identify this patient’s underlying condition?

A 52-year-old diabetic, hypertensive male presents with puffy eyelids, leg swelling and abdominal bloating. His serum creatinine and BUN are both significantly elevated. Urinalysis identifies no cells on the microscopic examination but does report 4+ protein on the dipstick. Which of the following tests will assist most in determining a likely diagnosis?

A 15-year-old male presents complaining of left knee pain. He plays soccer and reports that he sustained a twisting injury two days ago during practice. Since then, he has noted intermittent “catching and locking” while walking and squatting. During the examination, you note a click as you passively extend the knee from a maximally flexed position while maintaining the leg externally rotated. Which of the following diagnoses is most likely?

A 37-year-old female presents with progressive shortness of breath and a productive cough over the past 6 weeks. She has experienced frequent fevers and mild fatigue; the remainder of the review of systems reveals a 15-pound weight loss. Physical examination reveals dullness to percussion in the left apex. Chest x-ray identifies cavitary lesions in the left lung. What is the most likely diagnosis?

Which of the following is the most common cause of blindness in the United States in patients under the age of 60 years old?

An infant who sits with only minimal support, who attempts to attain a toy beyond reach, and who can roll from supine to prone, but does not display a pincer grasp, is at which of the following developmental levels?

In a patient with Guilian-Barré Syndrome that has progressed to include weakness involving the proximal muscles of both lower extremities what is the most important step in determining this patient’s prognosis?

A 33-week gestation neonate is examined in the nursery and found to have a continuous holosystolic – holodiastolic murmur heard best over the left sternal border. He is not cyanotic. The murmur does not change with position of his neck. He has persistent tachycardia. What anomaly is most likely the cause of his murmur?

An asymptomatic 52-year-old woman with an obstetrical history significant for macrosomic infants has a fasting blood sugar of 136 mg/dL. Which one of the following is the most appropriate at this time?

A 71-year-old female presents with pain in the ball of her right foot that feels like there is a pebble in her shoe when she walks. The pain is reduced when she is barefoot; worse in shoes. She denies injury. On exam, you note tenderness with palpation in the region of the 2nd and 3rd metatarsals. X-rays are negative. What is the most likely diagnosis?

A patient tells you that during a recent visit to an urgent care center she was told that she has mitral valve prolapse. At which of the following anatomical locations should you place your stethoscope to best evaluate this condition?

A 12-year-old previously healthy female presents with a 7-day history of a dry, nonproductive cough, low-grade fever, headache and myalgias. Examination of the lungs reveals a few widely scattered rhonchi. Chest x-ray reveals bilateral, patchy interstitial infiltrates. A serum test for cold agglutinins is negative. Which of the following is the most likely diagnosis?

A 36-year-old male patient is following up after evaluation in an emergency department for nephrolithiasis; third occurrence in five months. The patient has no prior history of kidney stones or renal disease. Laboratory tests performed during the ED visit included a markedly elevated serum calcium level (11.9). You repeat the calcium and confirm that it remains elevated; his electrolytes, CBC, BUN and creatinine are normal. The urinalysis reports the presence of calcium oxalate crystals. Which one of the following should be done as the next step in his evaluation?

A 42-year-old patient with a history of chronic red, raised patches and plaques that are covered with silvery scales located mostly on the elbows and knees has tried numerous remedies. Which of the following is the best treatment for severe cases of this classic condition?

Which of the following is safest during pregnancy?

A 38-year-old male presents complaining that when he lies flat for a while he frequently gets a bad taste in his mouth. He has had several weeks of epigastric burning that radiates upward into his chest. He denies other symptoms. Which of the following in the most appropriate next step in the management of this presentation?

A 58-year-old male presents in an acute, confused state. He has bilateral papilledema. His blood pressure is 266/144mm Hg. Which one of the following is the intervention that is the most important first step in his management?

A 27-year-old high school teacher presents complaining of pain and numbness in her right upper extremity. She is right hand dominant and does a lot of writing and grading of essay papers. She was involved in an automobile accident 5 years ago and was diagnosed in the emergency department with “whiplash”. She intermittently experiences neck pain but attributes it to the stress of her job. Examination notes decreased sensation involving the index and long (third) fingers, weakness with triceps extension, and a diminished triceps reflex. At which of the following levels is her cervical radiculopathy located?

A 74-year-old male presents to the emergency department with a four-day history of fever, productive cough, and dyspnea. He has long-standing heart failure and poorly controlled diabetes. The patient denies smoking. He currently lives alone since the death of his wife two years ago. On examination, the patient appears acutely ill but is able to speak in full sentences. Vital signs are temperature is 103ºF, pulse 130, respiratory rate 28, pulse oximetry 93% (room air), and BP 90/60mm Hg. Localized rhonchi are noted in the left lower lung. His chest x-ray identifies a left lower lobe consolidation with associated parapneumonic pleural effusion. What would be the most appropriate next step in his management?

A 53-year-old female presents with generalized fatigue, pruritus, jaundice, and the following laboratory values:

AST 53 (nl 32); ALT 62 (nl 34); Alkaline Phosphatase 234 (nl 140).

ANA is elevated; anti-mitochondrial antibody is positive

What is the most likely diagnosis?

A 33-year-old tennis player has noted intermittent but worsening pain in the plantar aspect of her foot for the past three months. The pain was infrequent at first but now prevents her from playing tennis. The pain is worse when she gets up in the morning and seems better after an hour; exacerbated when she walks up stairs. X-ray studies of the foot show no abnormalities. Which of the following is the most likely diagnosis?

A 66-year-old male with a sore throat reports that as a child he had rheumatic fever. Which one of the following murmurs would most likely be a complication of his childhood case of rheumatic fever?

Of the following labs, which one should be done to evaluate elderly patients who present with a recent onset of depressive symptoms and signs?

During the preoperative evaluation of a 65-year-old female with a long history of cigarette smoking, a lung mass is identified on her chest x-ray. She is advised that a work-up for lung cancer must be done. Which one of the following defense mechanisms will this patent most likely manifest?

A 55-year-old female who works in a veterinarian’s office presents with a 10 day history of a dry cough, a severe headache, extreme fatigue, generalized arthralgias/myalgias, and a fever. Her laboratory reveals leukocytosis and thrombocytopenia. Which of the following is the most likely causative agent?

A jaundice patient presents with right upper quadrant pain. AST and ALT are two times normal, alkaline phosphatase is four times normal, and serum bilirubin is three times normal. Which of the following would be the most helpful initial study to obtain in the further evaluation of this patient?

A college student wants to be listed on the Dean’s Honor Roll. After failing an exam, she explains the failure by saying “Because I have to work to pay my tuition, I am behind in my coursework and that is the reason this happened. This course isn’t really that important to me any way.” Subconsciously she really hates the course. Which of the following is this patient displaying?

Which of the following hormones is the one that is primarily responsible for the development of proliferative endometrium?

Upon awakening most mornings, a 48-year-old female notes that her thumb, index finger, long (middle) finger, and radial aspect of her fourth (ring) finger tingle. Which of the following is the most likely underlying etiology of her condition?

A known intravenous drug user (IVDU) presents with a fever and a new diastolic murmur. He has several petechiae noted subungually. His lungs are clear. Which of the following is the most likely diagnosis?

A 47-year-old male construction worker was lifting a 75-pound bag of cement when he twisted and injured his back. He presents complaining of lumbar back pain with radiating pain into his right lower extremity. He denies any other trauma. He has never injured his back before. He denies loss of bladder or bowel function. He is noted to have decreased sensation over the heel and lateral border of his right foot. Right lower extremity strength is measured as follows: Quadriceps 5/5; Peroneals 3/5; EHL 5/5; EDL 5/5; Gastrocnemius 4/5.

Based upon this assessment, which nerve root is most likely involved?

A 17-year-old male is punched in the left eye. There is moderate swelling and ecchymosis around the left eye. The left upper eyelid does not open fully and during testing of the extraocular muscles the patient experiences diplopia. Which of the following diagnostic tests will provide the most accurate information regarding this injury?

During the physical examination of a 40-year-old female a single thyroid mass measuring approximately 0.75cm in diameter is identified. What is the best next step in the evaluation of this mass?

A 42-year-old female presents with complaints of burning with urination, urgency and frequency. She has no medical comorbidities. A urinalysis identifies > 50 WBCs/HPF. What of the following is the most appropriate next step in the management of her case?

A 36-year-old patient with asthma presents during an acute exacerbation. His dyspnea has been increasing for three days. The patient reports a productive cough. Exam reveals a respiratory rate of 40. He has a prolonged expiratory phase and diffuse wheezing. Which of the following is the best indicator of the severity of this patient’s condition?

Which of the following is the most reliable method of differentiating systolic from diastolic heart failure?

Which of the following findings in the CSF of a child with severe cephalgia and fever is the most diagnostic of bacterial meningitis?

Approximately two months after having sex with a new partner, a patient presents with several discrete, umbilicated, dome-shaped papular lesions on the lower abdomen. The lesions vary between skin-colored and pearly white in appearance. What is the most likely diagnosis?

Which one of the following is an indication to order a dobutamine (pharmacological) cardiac stress test rather than a Treadmill Stress Test with Echocardiogram or simply a Treadmill EKG?

What is the most common cause of death in people under the age of 35?

Which of the following is the most common cause of male infertility?

A 22-year-old male presents with a four day history of a sore throat. His voice sounds muffled and his uvula is noted to be deviated away from the midline. Further questioning reveals that he is having increasing difficulty swallowing and difficulty opening his moth widely. Which of the following is the most likely diagnosis?