2 Item: 1 of 20 11 PMark <:1 t:>- jf ~ 1.

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Q.ld: 2193 ( Previous Ne><t Lab Values Notes Calculator

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6 A 7-year-old boy is brought to your office with a sore throat, decreased appetite. and nausea. His past
7 medical history is insignificant. All of his vaccinations are up-to-date. He has no known allergies. His
8 temperature is 39 .o•c (102 .5.F). blood pressure is 11 0/70 mmHg. pulse is 104/min. and respirations are
9 16/min. On examination. the pharynx and tonsils are red. swollen. and have white exudates on their surface.
10 There is also bilateral tender cervical lymphadenopathy. The rapid diagnostic test for streptococcal antigen is
11 positive. What is the most appropriate next step in management?
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13
14 r A. Throat culture
15 r B. Monospot test
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17 r C. Antistreptolysin 0 antibodies
18 r D. Oral penicillin V
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20 r E. Oral azithromycin
r F. Symptomatic treatment
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Item: 2 of 20
Q.ld: 2844 (
11 PMark -<:1
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A 62-year-old male comes to your office for a routine follow-up appointment. He has smoked one pack of
7 cigarettes per day for the past 30 years and adamantly refuses to quit. He also drinks six to ten beers each
8 weekend. His past medical history is significant for type 2 diabetes mellitus and hypertension. His last
9 2
hemoglobin A1c was 8.3%. He is overweight with a current BMI of 27.5 kg/m . While examining him. you
10
11 notice a whitish patch over the anterior floor of his mouth. The lesion appears to have a granular texture and
12 is not removed by scraping with a tongue depressor. Which of the following is most likely cause of his oral
13 lesion?
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15 r A. Candidiasis
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17 r B. Leukoplakia
18 r C. Herpes simplex virus infection
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20 r D. Melanoma
r E. Squamous cell carcinoma
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Item: 3 of 20
Q.ld: 4902 (
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A 27-year-old woman at 30 weeks gestation complains of difficulty hearing. especially on the right side. She
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denies any ear pain or discharge. Her pregnancy was complicated by acute pyelonephritis at 22 weeks
8 gestation. which was treated with antibiotics. She denies tobacco or alcohol use. and she eats a balanced
9 diet. She takes no medications aside from a multivitamin. Her blood pressure is 160/1 DO mmHg and pulse is
10 75/min. Cardiac and pulmonary examinations are unremarkable. She appreciates a louder tone when a
11 tuning fork is placed on her right mastoid process for nearly 15 seconds but a softer tone for 5 seconds when
12 the tuning fork is placed near her right external auditory meatus. When the vibrating tuning fork is placed on
13 the middle of her forehead, she feels the vibration better in her right ear than the left ear. No other focal
14 abnormalities are found on neurologic examination. Audiometry shows right low-frequency hearing loss.
15 Which of the following is the most likely cause of this patient's complaints?
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r A. Antibiotic treatment
19 r B. Hypertension of pregnancy
20 r C. Meniere's disease
r D. Otosclerosis
r E. Chronic otitis media
r F. Acoustic neuroma
r G. Presbycusis
2 Item: 4 of 20 11 PMark <:1 t:>- jf ~ 1.":~

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Q.ld: 2195 ( Previous Ne><t Lab Values Notes Calculator

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6 A 30-year-old school teacher presents with a three-day history of fever. chills. and sore throat. He also
7 complains of difficulty swallowing that started yesterday. He denies any cough, chest pain, or difficulty
8 breathing. He is married and denies any new sexual encounters. His temperature is 39 .s•c (102 .2.F). blood
9 pressure is 118/76 mmHg. pulse is 102/min. and respirations are 19/min. On examination. his voice is
10 muffled. Enlarged. tender cervical lymph nodes are palpated on the left, and his uvula is deviated to the right.
11 What is the most appropriate treatment for this patient?
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r A. Throat swabs and oral antibiotics
15 r B. Monospot test and oral antibiotics
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17
r C. Emergency laryngoscopy
18 r D. Cricothyroidotomy
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r E. Needle peritonsillar aspiration
2 Item: 5 of 20 11 PMark <:1 t:>- jf ~ 1.":~ I

Q.ld: 4282 ( Previous Ne><t Lab Values Notes Calculator

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A 55-year-old female presents to the office with a one-week history of left-sided ear pain and itchiness. The
pain is especially bothersome at night, and is exacerbated by chewing. She denies any hearing loss. Her
past medical history is significant for hypertension. type 2 diabetes mellitus. hyperlipidemia. and gout. Current
medications include lisinopril, allopurinol, and metformin. She has missed her last two appointments with her
10 primary care physician. Her temperature is 38 .3•c ( 101 .O.F). blood pressure is 140/90 mmHg. and pulse is
11 98/min. On examination. there is granulation tissue in the left ear canal with a scant amount of discharge.
12 Which of the following is the best initial treatment for this patient?
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14
15
r A. Topical neomycin
16 r B. Topical low-strength corticosteroids
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18
r C. Ciprofloxacin
19 r D. Ampicillin/sulbactam
20
r E. Surgical debridement
2 Item: 6 of 20 11 PMark <:1 C>- jf r.p;- 1.":~ I

Q.ld: 2194 ( Previous Ne><t Lab Values Notes Calculator

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A 26-year-old man comes to your office with a one-week history of right-sided ear pain. The pain often wakes
him up at night, and increases in severity when he chews food. He cannot recall any recent episodes of
pharyngitis. He denies having any ear discharge. sinus tenderness. or skin rash. He exercises by swimming
frequently at a local club. He is sexually active and uses condoms "quite regularly." He lives with his brother,
who often comments on his habit of grinding his teeth at night. On examination. his ears are normal with a
11 mild amount of wax. Pain is not elicited by pulling on the pinna. There are no hearing deficits appreciated.
12 Mobility of the tympanic membrane is normal, and the Weber and Rinne test results are within normal limits.
13 What is the most likely diagnosis?
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r A. Ramsay Hunt syndrome
17 r B. Glossopharyngeal neuralgia
18
19
r C. Otitis media
20 r D. Temporomandibular joint dysfunction
r E. Otitis extern a
r F. Cerumen impaction
2 Item: 7 of 20 II PMark <:] t:>- il ~· r:-:~ I

Q.ld: 2847 ( Previous Ne><t Lab Values Notes Calculator

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A 28-year-old Caucasian male presents to the emergency department complaining of neck pain for the past
tvvo days. He states that a chicken bone scratched the back of his throat a week ago. Two weeks ago, he
was in Arizona visiting his friends. He is otherwise healthy and has never been hospitalized. His temperature
is 39•c (102 .2.F). blood pressure is 125/85 mmHg. and heart rate is 120/min. On examination. he refuses to
fully open his mouth. Neck movements. especially neck extension. are restricted secondary to pain. Which
of the following is the most likely diagnosis?
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13
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r A. Meningitis
15 r B. Herpangina
16
r C. Epiglottitis
17
18 r D. Diphtheria
19
r E. Infectious mononucleosis
20
r F. Retropharyngeal abscess
2 Item: 8 of 20
Q.ld: 490
:. f' Marl< -<J
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6 A 24-year-old Caucasian female complains of recurrent painful ulcers in her mouth and occasional abdominal
pain. She has also unintentionally lost 5 pounds over the last six months. She is not sexually active, and
denies use of tobacco, alcohol, or drugs. Past medical history is noncontributory and she takes no regular
medications. Her mother suffers from asthma and her father has prostate cancer. She is afebrile with a
10 blood pressure of 118/69 mmHg and pulse of 71/min. Physical examination reveals mild abdominal
11 tenderness primarily in the lower abdomen without guarding or rebound. Several shallow ulcers are seen on
12 the buccal mucosa. A biopsy of one of the ulcers demonstrates granulomatous inflammation. Her hematocrit
13 is 42%. Which of the following is the most likely cause of this patient's complaints?
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r A. Celiac disease
17 r B. Folic acid deficiency
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19
r· C. Crohn's disease
20 r D. Oral candidiasis
r E. Squamous cell carcinoma
r F. Hyperthyroidism
r· G. Anorexia nervosa
2 Item: 9 of 20 II PMark <:] t:>- il ~· r:-:~ I

Q.ld: 2839 ( Previous Ne><t Lab Values Notes Calculator

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6 A 32-year-old male complains of difficulty hearing in his left ear for the past month. He denies any headaches.
7 fever, chills, weight loss, or ear discharge. He is HIV positive, and is currently being treated with highly active

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antiretroviral therapy (HAART). He also takes trimethoprim/sulfamethoxazole daily. His most recent CD4
count was 425/ mm3. Examination of the affected ear shows a dull, hypomobile tympanic membrane. What
is the most likely cause of hearing loss in this patient?

r A. Neoplasia
14 r B. Non-infectious effusion
15
16
r C. Otosclerosis
17 r D. Opportunistic infection
18
r E. Demyelinization
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2 Item: 10 of 20 11 PMark <:1 t:>- jf ~ 1.":~ I

Q.ld: 2830 [ Previous Ne><t Lab Values Notes Calculator

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6 A 6-year-old boy is brought to the office by his mother due to a decreased appetite and irritability for the past
7 three days. He also had an episode of diarrhea yesterday. Lately, he has been sitting close to the television
8 with the volume turned up very loudly. His temperature is 88.1•c (1 00.5.F), blood pressure is 110/60 mmHg,

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and heart rate is 11 0/min. On examination, there is left-sided yellowish ear discharge. His nasal mucosa
appears boggy and postnasal drip is present. What is the most likely diagnosis?

r A. Bullous myringitis
r B. Acute otitis media
15
16
r C. Otitis externa
17 r D. Cholesteatoma
18
r E. Sinusitis
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2 Item: 11 of 20 II PMark <:] t:>- il ~· r:-:~ I

Q.ld: 2838 [ Previous Ne><t Lab Values Notes Calculator

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6 A 60-year-old man comes to your office complaining of difficulty hearing for the past few weeks. He has type
7 2 diabetes mellitus, which is well-controlled by diet alone. His past medical history is also significant for
8 essential hypertension, congestive heart failure secondary to diastolic dysfunction, and chronic renal
9 failure. Medications include aspirin, diuretics, an ACE inhibitor, and a beta-blocker. His pulse is 82/min, blood

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pressure is 140/90 mmHg, and respirations are 14/min. Examination reveals hearing loss in both
ears. Which of the following medication is a potential cause of this patient's hearing problems?

r A. Lisinopril
r B. Aspirin
16
r C. Metoprolol
17
18 r D. Furosemide
19
r E. Hydrochlorothiazide
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Q.ld: 2845
• P' Marl< <:J
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6 A 45-year-old Asian immigrant complains of a progressively worsening sore throat and difficulty swallowing for
7 the past 24 hours. You notice that his voice is muffled and he is drooling. He also has a harsh shrill
8 associated with respiration. His temperature is 39 .3•c ( 103.F). blood pressure is 120/80 mmHg. pulse is
9 106/min. and respiratory rate is 22/min. On examination. a few cervical lymph nodes are palpable and there is
10 tenderness to palpation over his larynx. Which of the following are the two most common organisms that
11 cause this condition?

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r · A. Haemophilus influenzae and Streptococcus pyogenes
15 r B. Mycobacterium tuberculosis and herpes simplex virus
16
17
r C. Haemophilus influenzae and Candida species
18 r D. Streptococcus pyogenes and Klebsiella pneumoniae
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r E. Staphylococcus aureus and Pseudomonas aeruginosa
2 Item: 13 of 20 !II PMark <:J t>- jf ~· 1.":~ I

Q.ld: 284S [ Previous Ne><t Lab Values Notes Calculator

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6 A 36-year-old woman presents to your office with complaints of worsening throat pain for the past six days.
7 She also has pain in her ears and neck as well as difficulty swallowing. On examination, she has excessive
8 salivation and difficulty opening her mouth. Her temperature is 39•c ( 102 .2.F), blood pressure is 130/80
9 mmHg, pulse is 1DO/min, and respiratory rate is 18/min. Which of the following neck space infections carries
10 the highest risk of mediastinal involvement?
11

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r A. Submandibular space
r B. Sublingual space
r C. Parapharyngeal space
r D. Retropharyngeal space
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2 Item: 14 of 20 [ii P Mark <:1 t:>- jf ~ 1.":~ I

Q.ld: 4376 [ Previous Ne><t Lab Values Notes Calculator

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6 A 37-year-old woman presents to your office with severe vertigo, postural instability, and vomiting. She also
7 complains of "a buzzing sound" in her right ear. She has had two similar episodes over the previous year that
8 lasted several hours and resolved spontaneously. She has no other medical problems. Her mother died of
9 breast cancer at 55 years of age and her father is currently suffering from colon cancer. Her heart rate is
10 90/min and blood pressure is 130/80 mmHg. Her BMI is 25.3 kg/m2. Examination reveals horizontal
11 nystagmus. Which of the following could have prevented this patient's symptoms?
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r A. Caloric restriction
r B. Low salt diet
r C. Gluten-free diet
r D. High complex carbohydrate diet
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r E. Calcium supplementation
r F. Cobalamin supplementation
2 Item: 15 of 20 11 PMark <:1 t:>- jf ~ 1.":~ I

Q.ld: <W90 [ Previous Ne><t Lab Values Notes Calculator

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6 A 6-year-old boy is brought to the physician by his mother because of "inattentiveness." His mother reports
7 that when asked to perform tasks at home, he ignores her and continues to do whatever he is engaged
8 in. She has had difficulty disciplining him at home because of this, but reports that he is otherwise a happy
9 and affectionate child. His school teacher frequently complains about him, stating that he "has trouble
10 following directions and just does not listen." He rarely completes his classroom assignments on time. He
11 has limited language skills compared to his peers and usually prefers to play alone. Which of the following is
12 the most likely diagnosis in this case?
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r A. Selective mutism
r B. Attention deficit hyperactivity disorder
r C. Undetected hearing impairment
r D.Autism
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r E. Oppositional defiant disorder
2 Item: 16 of 20 1111 PMark <:J t>- jf ~· 1.":~ I

Q.ld: 2828 [ Previous Ne><t Lab Values Notes Calculator

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6 A 65-year-old female complains of difficulty eating over the last two days. She states that food drops out of
7 her mouth. She has also been having some discharge in her left ear recently. She denies any sore throat,
8 nasal discharge, chest pain, cough, or difficulty breathing. Her past medical history is significant for type 2
9 diabetes mellitus, hypertension, and hyperlipidemia. She has been poorly compliant with follow-up
10 appointments. Her temperature is 38 .8•c ( 101 .rF), pulse is 96/min, blood pressure is 140/90 mmHg, and
11 respirations are 18/min. Examination of the left ear canal shows granulations. There is facial asymmetry, and
12 the angle of the mouth on the left is deviated downward. Which of the following is the most likely causative
13 organism for this patient's condition?
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r A. Rhizopus species
r B. Pseudomonas aeruginosa
r C. Staphylococcus aureus
r D. Aspergillus niger
r E. Herpes zoster
2 Item: 17 of 20 1111 PMark <:J t>- jf ~· 1.":~ I

Q.ld: 3449 [ Previous Ne><t Lab Values Notes Calculator

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6 A 33-year-old Caucasian female has suffered from recurrent episodes of dizziness over the last six
7 months. She describes the episodes as a sensation of severe spinning that last one to tvvo hours and are
8 accompanied by intense nausea. She also feels unsteady during the episode, and has to lie down with her
9 eyes closed for relief. There is no particular factor that precipitates the episodes. She denies any headaches,
10 but complains of fullness in her right ear. She has no ear pain or ear discharge. She has used some over-
11 the-counter ear drops with minimal relief of the fullness sensation. She prefers holding her cell phone on the
12 left side. Which of the following is the most likely cause of this patient's condition?
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r A. Middle ear disease

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r B. Inner ear disease
r C. Cranial nerve VIII lesion
r D. Cerebellar disease
r E. Lesion in the medulla
2 Item: 18 of 20
Q.ld: 2831
ill f> Marl< -<.J
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6 A 12-year-old girl comes to the office complaining of a small amount of left-sided ear discharge that has
7 persisted for the last three weeks. She has completed tvvo courses of antibiotics that were prescribed during
8 her previous visits. She also complains of hearing loss on the left side. On examination. she is afebrile.
9 Otoscopy reveals an intact left tympanic membrane with peripheral granulation and some skin debris. The
10 patient should be evaluated for which of the following?
11
12
13
r A. Meniere·s disease
14 r B. Craniopharyngioma
15
16
r C. Otosclerosis
17 r D. Cholesteatoma

19
r E. Middle ear osteoma
20
 2 Item: 19 of 20 II PMark -<:] t:>- il ~· r:-:~ I

Q.ld: 2842 [ Previous Ne><t Lab Values Notes Calculator

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6 A 28-year-old African American female complains of recurrent nasal discharge and increasing nasal
7 congestion. She has a constant sensation of dripping in the back of her throat. and states that food has
8 tasted bland to her recently. She is known to have sickle cell trait. She came to the emergency department
9 for severe wheezing after taking naproxen for menstrual cramping one year ago. She has no history of head
10 trauma. She does not smoke cigarettes. but she admits to smoking marijuana occasionally. Which of the
11 following is the most likely diagnosis?
12
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14
r A. Angiofibroma
15 r B. Inverted papilloma
16
r C. Nasal polyp
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r D. Perforated nasal septum
r E. Pyogenic granuloma
2 Item: 20 of 20 11 PMark <:1 t:>- jf ~ 1.":~ I

Q.ld: 2836 [ Previous Ne><t Lab Values Notes Calculator

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6 A 70-year-old man comes to your office with complaints of difficulty hearing. His wife says that he has been
7 raising the television volume much louder recently. The patient claims that he can hear well when he talks to
8 his family members at home, but he has significant difficulty hearing in restaurants or during other family
9 gatherings, which is why he prefers to stay at home most of the time. He worked in a shipbuilding yard for 30
10 years, and retired five years ago. He has no history of significant noise exposure. What is the most likely
11 diagnosis?
12
13
14
r A. Otosclerosis
15 r B. Presbycusis
16
r C. Middle ear effusion
17
18 r D. Meniere's disease

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r E. Acoustic neuroma
r F. Depression