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APMLE Part II study materials
APMLE Part II study resources

APMLE Part II practice questions

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Question 1History and Physical Examination

A 58-year-old man presents with sudden, painless loss of vision in one eye described as a 'curtain coming down.' He has a history of carotid atherosclerosis. Which finding on fundoscopic examination would most support the diagnosis?

  1. Retinal pallor with a cherry-red spot at the macula
  2. Cholesterol emboli (Hollenhorst plaques) at arteriolar bifurcations Correct answer.
  3. Flame-shaped hemorrhages along the vascular arcades
  4. Cupping of the optic disc with increased cup-to-disc ratio

Explanation

Amaurosis fugax from carotid disease is embolic; Hollenhorst plaques are refractile cholesterol emboli lodged at arteriolar bifurcations and directly implicate a carotid source. Retinal pallor with a cherry-red spot describes central retinal artery occlusion, which is a related but distinct entity. Flame hemorrhages suggest hypertensive retinopathy, and disc cupping indicates glaucoma.

Question 2History and Physical Examination

Which heart sound is best described as a low-pitched diastolic rumble heard best at the apex with the bell of the stethoscope while the patient lies in the left lateral decubitus position?

  1. Mitral stenosis murmur Correct answer.
  2. Aortic regurgitation murmur
  3. Aortic stenosis murmur
  4. Tricuspid regurgitation murmur

Explanation

Mitral stenosis produces a low-pitched diastolic rumble at the apex, best auscultated with the bell in the left lateral decubitus position. Aortic stenosis is a harsh systolic crescendo-decrescendo murmur, aortic regurgitation is an early diastolic decrescendo murmur at the left sternal border, and tricuspid regurgitation is a holosystolic murmur at the lower left sternal border.

Question 3History and Physical Examination

A patient is suspected of having a tension pneumothorax. Which physical examination finding is most characteristic?

  1. Hyperresonance to percussion with absent breath sounds on the affected side Correct answer.
  2. Dullness to percussion with egophony over the affected side
  3. Fine crackles at the lung bases bilaterally
  4. Tracheal deviation toward the affected side

Explanation

Tension pneumothorax produces air in the pleural space, yielding hyperresonance and absent breath sounds on the affected side, with tracheal deviation away from the affected side. Dullness with egophony suggests consolidation, and basilar crackles suggest fluid or interstitial disease.

Question 4History and Physical Examination

A 45-year-old woman reports episodic palpitations, diaphoresis, headache, and anxiety. Which finding on physical examination would most suggest pheochromocytoma?

  1. Continuous abdominal bruit with hypertension
  2. Orthostatic hypotension with hyperpigmentation
  3. Bradycardia with warm, flushed skin
  4. Paroxysmal hypertension during episodes with pallor Correct answer.

Explanation

Pheochromocytoma causes paroxysmal catecholamine surges with episodic hypertension, pallor, diaphoresis, and headache. Orthostatic hypotension with hyperpigmentation suggests adrenal insufficiency, and a continuous abdominal bruit suggests renal artery stenosis.

Question 5History and Physical Examination

When performing the Rinne test, a patient reports that air conduction is greater than bone conduction in the right ear. How should this result be interpreted?

  1. Central vestibular lesion
  2. Normal finding or sensorineural hearing loss in that ear Correct answer.
  3. Conductive hearing loss in that ear
  4. Complete deafness in that ear

Explanation

A normal Rinne test shows air conduction greater than bone conduction (AC > BC). This pattern occurs with normal hearing and with sensorineural loss, in which both are reduced but AC still exceeds BC. Conductive loss produces the opposite pattern (BC > AC).

Question 6History and Physical Examination

A patient is asked to flex the hip against resistance while the examiner palpates the anterior thigh. Which muscle is being tested?

  1. Adductor longus
  2. Iliopsoas Correct answer.
  3. Sartorius
  4. Gluteus maximus

Explanation

Resisted hip flexion with palpation of the anterior thigh tests the iliopsoas, the primary hip flexor. Gluteus maximus extends the hip, sartorius flexes and externally rotates the hip but is not the primary flexor tested this way, and adductor longus adducts the thigh.

Question 7History and Physical Examination

A 30-year-old presents with a resting tremor, and the examiner notes that the tremor diminishes when the patient reaches for an object. This phenomenon is best described as which of the following?

  1. Postural tremor
  2. Intention tremor
  3. Resting tremor with distractibility Correct answer.
  4. Essential tremor

Explanation

A resting tremor that attenuates with voluntary movement is characteristic of parkinsonism. Intention tremor worsens with goal-directed movement, and postural/essential tremor occurs with maintained posture.

Question 8History and Physical Examination

Which physical examination maneuver is used to assess for meningeal irritation by passively flexing the patient's neck?

  1. Lhermitte sign
  2. Babinski sign
  3. Brudzinski sign Correct answer.
  4. Kernig sign

Explanation

Brudzinski sign is positive when passive neck flexion produces involuntary flexion of the hips and knees, indicating meningeal irritation. Kernig sign involves resisted knee extension with the hip flexed, Babinski assesses the corticospinal tract, and Lhermitte sign relates to spinal cord posterior column disease.

Question 9History and Physical Examination

A 62-year-old man has a pulsatile abdominal mass. Which feature on physical examination most suggests an abdominal aortic aneurysm rather than a normal aorta?

  1. A bruit heard over the epigastrium
  2. Tenderness with rebound on deep palpation
  3. A pulsatile mass palpable above the umbilicus with lateral expansion Correct answer.
  4. A palpable liver edge below the costal margin

Explanation

An abdominal aortic aneurysm is suggested by a pulsatile mass with expansile (lateral) pulsation, typically at or above the umbilicus. A bruit may occur but is nonspecific, and tenderness with rebound suggests peritonitis rather than aneurysm.

Question 10History and Physical Examination

A patient with suspected carpal tunnel syndrome reports numbness. Which area of the hand is most typically affected?

  1. Volar aspect of the fifth digit
  2. Palmar and dorsal aspects of the thumb, index, and middle fingers Correct answer.
  3. Ulnar aspect of the forearm
  4. Dorsal web space between the thumb and index finger

Explanation

The median nerve supplies the palmar and dorsal aspects of the thumb, index, middle, and radial half of the ring finger; carpal tunnel syndrome affects these distributions. The fifth digit is ulnar nerve territory, and the dorsal first web space is radial nerve territory.

Question 11History and Physical Examination

A patient is asked to stand with feet together and eyes closed. The patient sways markedly and would fall. This finding most directly tests which of the following?

  1. Proprioception (posterior columns) Correct answer.
  2. Vestibular function
  3. Corticospinal tract integrity
  4. Cerebellar function

Explanation

The Romberg test compares sway with eyes open versus closed; marked worsening with eye closure indicates loss of proprioceptive input from the posterior columns. Cerebellar lesions cause ataxia that is not significantly worsened by eye closure, and the corticospinal tract is assessed by strength and reflexes.

Question 12History and Physical Examination

A patient with cirrhosis is examined for ascites. Which technique best detects a small amount of free peritoneal fluid?

  1. Inspection for abdominal distension
  2. Percussion for shifting dullness Correct answer.
  3. Auscultation for a venous hum
  4. Palpation for a fluid wave

Explanation

Shifting dullness is the most sensitive bedside maneuver for detecting small amounts of ascites, though the fluid wave is useful for larger volumes. A venous hum and simple distension are nonspecific.

Question 13History and Physical Examination

A 24-year-old presents with a sore throat. Which finding on examination most strongly suggests group A streptococcal pharyngitis rather than a viral etiology?

  1. Tonsillar exudates with tender anterior cervical lymphadenopathy and fever Correct answer.
  2. Conjunctival injection
  3. Hoarseness and diarrhea
  4. Cough and rhinorrhea

Explanation

Tonsillar exudates, tender anterior cervical adenopathy, fever, and absence of cough suggest streptococcal pharyngitis (Centor criteria). Cough, rhinorrhea, conjunctivitis, hoarseness, and diarrhea favor a viral cause.

Question 14History and Physical Examination

A patient is examined for thyroid enlargement. Which maneuver best helps detect a small thyroid nodule during palpation?

  1. Asking the patient to perform a Valsalva maneuver
  2. Auscultating the neck for a bruit
  3. Having the patient extend the neck and hold the breath
  4. Having the patient swallow while the examiner palpates the anterior neck Correct answer.

Explanation

The thyroid moves with swallowing, so palpating while the patient swallows helps distinguish thyroid tissue from other neck structures and detects small nodules. Valsalva and breath-holding do not facilitate thyroid palpation, and bruits assess vascularity rather than nodularity.

Question 15History and Physical Examination

Which finding on examination of the jugular venous pulse is most consistent with an elevated central venous pressure?

  1. Jugular venous distension greater than 3 cm above the sternal angle at 45 degrees Correct answer.
  2. Absent venous pulsations with inspiration
  3. A single prominent a wave
  4. A collapsing pulse with each systole

Explanation

Central venous pressure is estimated by the height of the jugular venous column above the sternal angle; a value greater than 3 cm at 45 degrees suggests elevation. The a wave reflects atrial contraction, and a collapsing pulse is an arterial finding.

Question 16History and Physical Examination

A patient reports a burning sensation in the epigastrium that worsens with fasting and improves with food. This symptom pattern is most consistent with which condition?

  1. Acute cholecystitis
  2. Duodenal ulcer Correct answer.
  3. Gastroesophageal reflux disease
  4. Acute pancreatitis

Explanation

Duodenal ulcer pain classically occurs with fasting and is relieved by food, whereas gastric ulcer pain tends to worsen with eating. Cholecystitis and pancreatitis produce more constant pain, often with other features such as fever or radiation.

Question 17History and Physical Examination

Which physical finding is most characteristic of a patient with a lesion of the facial nerve (CN VII) of the lower motor neuron type?

  1. Contralateral lower facial weakness with spared forehead
  2. Ipsilateral inability to close the eye and flattening of the nasolabial fold Correct answer.
  3. Loss of corneal sensation with preserved facial movement
  4. Bitemporal hemianopia

Explanation

A lower motor neuron facial nerve lesion affects the entire ipsilateral face, including the forehead, causing inability to close the eye and flattening of the nasolabial fold. Upper motor neuron lesions spare the forehead because of bilateral cortical innervation of the upper face.

Question 18History and Physical Examination

A patient is examined for signs of dehydration. Which finding is most reliable in an adult?

  1. Dry mucous membranes alone
  2. Bilateral pedal edema
  3. Prolonged capillary refill and orthostatic hypotension Correct answer.
  4. Yellowish skin color

Explanation

Prolonged capillary refill and orthostatic hypotension reflect reduced intravascular volume and are more reliable indicators of dehydration in adults. Dry mucous membranes are subjective and may occur without volume depletion, and pedal edema suggests fluid overload rather than deficit.

Question 19History and Physical Examination

A 70-year-old man has a positive straight leg raise test. Which nerve root is most commonly implicated?

  1. S4
  2. L2
  3. S1
  4. L5 Correct answer.

Explanation

A positive straight leg raise suggests lumbosacral nerve root irritation, most often at L5 or S1 from a herniated disc. L5 is the most commonly affected root in this context. L2 and S4 are less typical for this sign.

Question 20History and Physical Examination

Which finding on inspection of the skin is most suggestive of chronic liver disease?

  1. Petechiae on the lower extremities
  2. Spider angiomata on the upper trunk Correct answer.
  3. Erythema nodosum on the shins
  4. Koilonychia of the fingernails

Explanation

Spider angiomata result from hyperestrogenism in chronic liver disease and are found on the upper trunk and face. Petechiae suggest thrombocytopenia, erythema nodosum suggests inflammatory disease, and koilonychia suggests iron deficiency.

Question 21History and Physical Examination

A patient is tested for cerebellar dysfunction. Which finding would most suggest an ipsilateral cerebellar hemisphere lesion?

  1. Spasticity with hyperreflexia
  2. Dysdiadochokinesia on the affected side Correct answer.
  3. Resting tremor of the hands
  4. Loss of position sense in the toes

Explanation

Cerebellar hemisphere lesions cause ipsilateral limb ataxia with dysdiadochokinesia, dysmetria, and intention tremor. Resting tremor suggests parkinsonism, position sense loss suggests posterior column disease, and spasticity with hyperreflexia indicates corticospinal tract involvement.

Question 22History and Physical Examination

During examination of the eye, the examiner notes that the patient's pupil constricts when light is shone in the opposite eye but not when light is shone in the affected eye. This finding most suggests which of the following?

  1. Horner syndrome
  2. Oculomotor nerve lesion on the affected side
  3. Argyll Robertson pupil
  4. Optic nerve lesion on the affected side Correct answer.

Explanation

This describes a relative afferent pupillary defect: the affected eye's optic nerve cannot conduct the light signal, so the consensual response from the healthy eye is preserved while the direct response is impaired. Efferent (oculomotor) lesions cause a dilated, unreactive pupil, and Horner syndrome causes miosis with ptosis.

Question 23History and Physical Examination

A patient is asked to shrug the shoulders against resistance. Which cranial nerve is being tested?

  1. CN XII
  2. CN XI Correct answer.
  3. CN IX
  4. CN VII

Explanation

Shoulder shrug against resistance tests the spinal accessory nerve (CN XI), which supplies the trapezius. CN VII controls facial muscles, CN IX controls pharyngeal function, and CN XII controls the tongue.

Question 24History and Physical Examination

A patient reports pain in the right lower quadrant with rebound tenderness. Which maneuver, when positive, suggests appendicitis by producing pain in the right lower quadrant when the left lower quadrant is palpated?

  1. Obturator sign
  2. Psoas sign
  3. Rovsing sign Correct answer.
  4. Murphy sign

Explanation

Rovsing sign is pain in the right lower quadrant elicited by palpating the left lower quadrant, suggesting appendiceal irritation. The psoas and obturator signs test for retrocecal or pelvic appendicitis via hip maneuvers, and Murphy sign assesses cholecystitis.

Question 25History and Physical Examination

Which finding on breast examination is most concerning for malignancy?

  1. A soft, compressible mass that disappears with pressure
  2. Bilateral diffuse tenderness with no discrete mass
  3. A freely mobile, tender mass that varies with the menstrual cycle
  4. A firm, fixed, nontender mass with skin dimpling Correct answer.

Explanation

Malignant breast masses are typically firm, fixed, and nontender, and may cause skin dimpling or nipple retraction. Cyclical tender masses suggest fibrocystic change, and soft compressible masses suggest cysts or benign lesions.

Question 26History and Physical Examination

A 55-year-old man is examined for hearing loss. The examiner places a vibrating tuning fork on the mastoid process until the sound is no longer heard, then moves it adjacent to the ear canal. The patient reports hearing the sound again. What does this finding indicate?

  1. Sensorineural hearing loss in that ear
  2. Normal hearing in that ear
  3. A false-positive result due to improper technique
  4. Conductive hearing loss in that ear Correct answer.

Explanation

The Rinne test compares air conduction to bone conduction. In a normal ear, air conduction is greater than bone conduction (AC > BC), so the sound is not heard again after bone conduction fades. If the sound is heard again when the fork is placed near the ear canal (BC > AC), it indicates conductive hearing loss.

Question 27History and Physical Examination

A 45-year-old woman presents with episodic vertigo, hearing loss, and tinnitus. During the physical examination, the examiner performs the Dix-Hallpike maneuver. Which finding would most suggest benign paroxysmal positional vertigo (BPPV)?

  1. Vertigo and nystagmus that occur after a brief latency and fatigue with repetition Correct answer.
  2. Downbeat nystagmus that persists for several minutes
  3. Vertigo without nystagmus
  4. Horizontal nystagmus that changes direction with gaze

Explanation

In BPPV, the Dix-Hallpike maneuver typically provokes vertigo and a characteristic nystagmus (usually torsional-vertical) after a brief latency of a few seconds, and the response fatigues when the maneuver is repeated. This pattern reflects displaced otoconia in the posterior semicircular canal.

Question 28History and Physical Examination

A 60-year-old man with a history of alcohol use presents with confusion. On physical examination, the examiner notes a coarse tremor of the outstretched hands, jaundice, and spider angiomata. Which additional finding would most support a diagnosis of hepatic encephalopathy?

  1. Asterixis Correct answer.
  2. Caput medusae
  3. Fetor hepaticus
  4. Palmar erythema

Explanation

Asterixis, or flapping tremor, is a classic sign of hepatic encephalopathy and is elicited by having the patient extend the arms with wrists dorsiflexed. It reflects impaired cerebral function due to accumulated toxins such as ammonia.

Question 29History and Physical Examination

A 28-year-old woman complains of palpitations and heat intolerance. On examination, her pulse is irregular and her thyroid is diffusely enlarged. Which additional finding would best support the diagnosis of Graves' disease?

  1. A single firm thyroid nodule
  2. Bilateral exophthalmos Correct answer.
  3. Weight gain and cold intolerance
  4. Bradycardia with hypertension

Explanation

Graves' disease is an autoimmune hyperthyroidism often accompanied by ophthalmopathy, including exophthalmos (proptosis) and lid lag. The combination of a diffusely enlarged thyroid, palpitations, heat intolerance, and exophthalmos strongly suggests Graves' disease.

Question 30History and Physical Examination

A 70-year-old man is being evaluated for peripheral arterial disease. During the physical examination, the examiner palpates the dorsalis pedis and posterior tibial pulses. Which additional finding would most strongly suggest chronic limb ischemia?

  1. Varicose veins
  2. Warm, erythematous skin
  3. Pitting edema of the ankles
  4. Dependent rubor and pallor on elevation Correct answer.

Explanation

Chronic limb ischemia due to peripheral arterial disease classically produces dependent rubor (redness when the limb is below heart level) and pallor on elevation, reflecting impaired arterial perfusion. These findings are signs of inadequate blood flow to the distal extremity.

Question 31Diagnostic Testing and Imaging

A 62-year-old man with unilateral throbbing headache and jaw claudication has an elevated ESR. Which imaging study is most appropriate to confirm the diagnosis?

  1. Carotid angiography
  2. MRI of the brain
  3. Noncontrast head CT
  4. Temporal artery duplex ultrasonography Correct answer.

Explanation

Giant cell arteritis is confirmed by demonstrating the characteristic halo sign or stenosis of the temporal artery on duplex ultrasound, which is noninvasive and highly specific. Biopsy remains the reference standard, but ultrasound is the preferred initial confirmatory imaging.

Question 32Diagnostic Testing and Imaging

Which radiographic finding is most characteristic of a slipped capital femoral epiphysis on an AP pelvis film?

  1. Steel sign (double density at the superior femoral neck) Correct answer.
  2. Shenton line disruption with lateral femoral head displacement
  3. Crescent sign of the femoral head
  4. Joint space widening with subchondral cysts

Explanation

In SCFE the displaced epiphysis produces a double contour or 'steel sign' over the femoral neck on the AP view because the epiphysis overlaps the metaphysis. A frog-leg lateral view increases sensitivity.

Question 33Diagnostic Testing and Imaging

A 28-year-old woman presents with right lower quadrant pain and concern for appendicitis. Which imaging test is generally the first-line study in a nonpregnant adult?

  1. CT abdomen and pelvis with IV contrast Correct answer.
  2. MRI abdomen without contrast
  3. Plain abdominal radiograph
  4. Graded compression ultrasonography

Explanation

Contrast-enhanced CT has the highest accuracy for appendicitis and is first-line in nonpregnant adults, reducing negative appendectomy rates. Ultrasound is preferred in children and pregnant patients to avoid radiation.

Question 34Diagnostic Testing and Imaging

Which laboratory test is the most appropriate initial screening test for suspected primary hyperaldosteronism?

  1. 24-hour urinary metanephrines
  2. Plasma renin activity alone
  3. Serum cortisol after dexamethasone suppression
  4. Aldosterone-to-renin ratio Correct answer.

Explanation

The aldosterone-to-renin ratio screens for primary hyperaldosteronism by demonstrating elevated aldosterone with suppressed renin. Confirmatory testing follows a positive screen.

Question 35Diagnostic Testing and Imaging

A patient with suspected acute osteomyelitis of the foot has a normal plain radiograph. Which imaging modality best detects early bone infection?

  1. CT of the foot
  2. MRI with and without contrast Correct answer.
  3. Bone scan with technetium-99m
  4. Repeat plain radiography in 48 hours

Explanation

MRI is the most sensitive modality for early osteomyelitis, detecting marrow edema before osseous destruction is visible on radiographs. Plain films may remain normal for up to two weeks.

Question 36Diagnostic Testing and Imaging

Which finding on a ventilation-perfusion scan is considered high probability for pulmonary embolism?

  1. Diffuse bilateral perfusion reduction
  2. Mismatched segmental perfusion defect with normal ventilation Correct answer.
  3. Matched ventilation and perfusion defects
  4. Subsegmental defects in a single zone

Explanation

A high-probability V/Q scan shows one or more mismatched segmental or larger perfusion defects with normal ventilation. Matched defects suggest parenchymal disease rather than embolism.

Question 37Diagnostic Testing and Imaging

A 45-year-old woman has a thyroid nodule. Which sonographic feature most strongly suggests malignancy?

  1. Isoechoic solid nodule
  2. Microcalcifications Correct answer.
  3. Spongiform appearance
  4. Comet-tail artifact

Explanation

Microcalcifications (psammoma bodies) are a highly specific sonographic sign of papillary thyroid carcinoma. Spongiform and comet-tail features suggest benignity.

Question 38Diagnostic Testing and Imaging

Which ECG finding is most specific for acute pericarditis?

  1. ST elevation in a single vascular territory
  2. Pathologic Q waves
  3. Reciprocal ST depression
  4. PR depression with diffuse ST elevation Correct answer.

Explanation

Diffuse concave ST elevation with PR depression reflects pericardial inflammation. ST changes limited to one territory suggest myocardial infarction.

Question 39Diagnostic Testing and Imaging

A 70-year-old man has painless gross hematuria. Which imaging study is the most appropriate initial evaluation of the upper urinary tract?

  1. Retrograde urethrogram
  2. Renal ultrasound
  3. Intravenous pyelogram
  4. CT urography Correct answer.

Explanation

CT urography is the preferred study for hematuria because it detects urothelial tumors, stones, and renal masses with high sensitivity.

Question 40Diagnostic Testing and Imaging

Which ultrasound finding is the hallmark of a complete hydatidiform mole?

  1. Single gestational sac with yolk stalk
  2. Snowstorm appearance with multiple cystic spaces Correct answer.
  3. Empty sac with decidual reaction
  4. Thickened placenta with normal fetal heartbeat

Explanation

A complete mole produces a 'snowstorm' or 'bunch of grapes' appearance due to hydropic villi. No fetal parts are present in a complete mole.

Question 41Diagnostic Testing and Imaging

Which cerebrospinal fluid finding is most consistent with bacterial meningitis?

  1. Elevated neutrophils with low glucose Correct answer.
  2. Eosinophilic pleocytosis
  3. Lymphocytic pleocytosis with normal glucose
  4. Normal cell count with elevated protein

Explanation

Bacterial meningitis produces neutrophilic pleocytosis, low glucose, and high protein. Viral meningitis typically shows lymphocytic pleocytosis with normal glucose.

Question 42Diagnostic Testing and Imaging

Which test is most appropriate to confirm suspected heparin-induced thrombocytopenia?

  1. Bleeding time
  2. Serotonin release assay Correct answer.
  3. Platelet factor 4 antibody ELISA alone
  4. Prothrombin time

Explanation

The serotonin release assay is the functional confirmatory test for HIT because it detects pathogenic platelet-activating antibodies. The PF4 ELISA is used for screening but is less specific.

Question 43Diagnostic Testing and Imaging

A 55-year-old man has a solitary pulmonary nodule on chest radiograph. Which feature most strongly suggests malignancy?

  1. Nodule size less than 4 mm
  2. Smooth well-defined borders
  3. Spiculated margin Correct answer.
  4. Calcification in a diffuse pattern

Explanation

Spiculated or lobulated margins suggest malignant invasion. Benign nodules more often have smooth borders or characteristic calcification patterns.

Question 44Diagnostic Testing and Imaging

Which imaging modality is preferred for evaluating suspected acute cholecystitis in a pregnant patient?

  1. ERCP
  2. Right upper quadrant ultrasonography Correct answer.
  3. HIDA scan
  4. CT abdomen with contrast

Explanation

Ultrasound is the first-line study for cholecystitis and is safe in pregnancy, showing stones, wall thickening, and pericholecystic fluid.

Question 45Diagnostic Testing and Imaging

Which finding on a noncontrast head CT indicates an acute subarachnoid hemorrhage?

  1. Ring-enhancing lesion
  2. Hyperdense material in the basal cisterns Correct answer.
  3. Ventricular enlargement alone
  4. Hypodense lesion in the basal ganglia

Explanation

Acute subarachnoid hemorrhage appears as hyperdense blood in the basal cisterns and sulci on noncontrast CT. If CT is negative and suspicion remains high, lumbar puncture is performed.

Question 46Diagnostic Testing and Imaging

Which serum marker is most useful for monitoring disease activity in a patient with known colorectal cancer?

  1. Carcinoembryonic antigen Correct answer.
  2. Alpha-fetoprotein
  3. CA 19-9
  4. CA 125

Explanation

CEA is used to monitor treatment response and recurrence in colorectal cancer after diagnosis. It is not a screening test because of low sensitivity and specificity.

Question 47Diagnostic Testing and Imaging

A patient with suspected deep vein thrombosis has a low pretest probability and a negative D-dimer. What is the next step?

  1. No further imaging is required Correct answer.
  2. Proceed to compression ultrasound
  3. Repeat D-dimer in one week
  4. Start therapeutic anticoagulation

Explanation

In low-probability patients, a negative D-dimer has a high negative predictive value and excludes DVT without imaging. Ultrasound is reserved for positive D-dimer or high pretest probability.

Question 48Diagnostic Testing and Imaging

Which echocardiographic finding is characteristic of cardiac tamponade?

  1. Right ventricular diastolic collapse Correct answer.
  2. Ejection fraction below 30%
  3. Mitral valve prolapse
  4. Left ventricular hypertrophy

Explanation

Tamponade produces right-sided chamber collapse during diastole because pericardial pressure exceeds filling pressure. Pulsus paradoxus and inferior vena cava plethora support the diagnosis.

Question 49Diagnostic Testing and Imaging

Which test is the reference standard for diagnosing obstructive sleep apnea?

  1. Overnight pulse oximetry alone
  2. Epworth Sleepiness Scale
  3. Lateral cephalometric radiograph
  4. Polysomnography Correct answer.

Explanation

Attended polysomnography measures apnea-hypopnea index and oxygenation and is the diagnostic reference standard. Home sleep testing may be used in selected patients without comorbidity.

Question 50Diagnostic Testing and Imaging

A 30-year-old woman has a first febrile urinary tract infection. Which imaging is indicated?

  1. Renal ultrasound within 24 hours
  2. CT urography
  3. Voiding cystourethrogram
  4. No imaging is routinely indicated Correct answer.

Explanation

Uncomplicated febrile UTI in a healthy adult does not require routine imaging. Imaging is reserved for recurrent infection, suspected obstruction, or failure to improve.