Bilateral Visual Field Obliteration

Thyroid Factor

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Choose the single best answer.

1. A 26-year-old woman presents for evaluation of hair loss. She also has noticed increased weight loss and diarrhea. You diagnose Graves' disease (hyperthyroidism). On physical examination of the hair, what would you expect to find?

(A) Fine texture

(B) Coarse texture

2. A 25-year-old swim instructor presents to your clinic complaining of an itchy scalp. You diagnose seborrheic dermatitis. What physical findings are most consistent with this diagnosis?

(A) Erythema of the scalp

(B) Pustules on the scalp

(C) Dry, flaking areas on the scalp

(D) Ecchymoses on the scalp

3. A 55-year-old construction worker presents to the clinic for evaluation of fatigue and weakness. During the course of the interview, the patient reveals that he has noticed both an increase in his ring size and his shoe size; you ask to look at his driver's license and also at any pictures that he has in his wallet of himself from an earlier time period. Upon looking at these pictures, you are able to strongly theorize that he has acromegaly. Which physical finding is most consistent with this diagnosis?

(A) High forehead

(B) Small, recessed jaw

(C) Coarsening of the facial features

(D) Ptosis

4. An 18-year-old college student presents to the clinic with the complaint that her heart is "racing." You obtain blood for thyroid studies and diagnose her with Graves' disease (hyperthyroidism). On physical examination of her eyes, what would you expect to see?

(A) Recession

(B) Protrusion

(C) Clouding of the cornea

(D) Ciliary injection

5. A 75-year-old retired farmer presents to your office for a hospital follow-up visit. He was diagnosed with a stroke and placed on medication. On review of the hospital chart, he was noted to have a stroke in the optic chiasm. What findings do you expect on examination of his visual fields?

(A) Right homonymous hemianopsia

(B) Horizontal defect

(C) Bilateral visual field obliteration

(D) Bitemporal hemianopsia

6. A 57-year-old auto mechanic comes to your office for evaluation of decreased vision in his right eye. You perform a fundoscopic examination and diagnose a cataract. What did you see to make this diagnosis?

(A) Absence of the red reflex

(B) Neovascularization

(C) Hemorrhage in the fundus

(D) Uveitis

7. A 38-year-old warehouse stocker presents to your office complaining of a headache. He has had these headaches intermittently for several years, but they have been increasing in frequency. In your clinic today, his blood pressure is 170/110 mm Hg. His urine dipstick is positive for proteinuria only, and his fingerstick glucose is 100 mg/dL. You diagnose him with uncontrolled hypertension. What finding on fundoscopic examination would support this diagnosis?

(A) Cotton-wool spots

(B) Arteriovenous (AV) nicking

(C) Blurred optic disc margins

(D) Macular star

8. A 50-year-old truck driver presents to your office for a routine physical examination. He denies any medical problems; he has never had surgery; he takes no medications or over-the-counter supplements. He has smoked 1 pack of cigarettes daily for 30 years. He does not use alcohol or illicit drugs. His family history is remarkable for hypertension and stroke. On physical examination, you notice that one pupil is larger than the other by 0.4 mm; everything else is normal. What is the most likely diagnosis?

(A) Horner's syndrome

(B) Anisocoria

(C) Brain tumor

(D) Tonic pupil

9. A 78-year-old grandmother presents for evaluation of weakness in her face. She has a long-standing history of hypertension that has been under fair control. On physical examination, you note that she has ptosis and miosis of the left eye, and left facial anhidrosis. What is your most likely diagnosis?

(A) Horner's syndrome

(B) Anisocoria

(C) Acute angle-closure glaucoma

(D) Myasthenia gravis

10. When you look at the tympanic membrane with the otoscope, what normal landmark is present?

(B) Otoliths

(C) Stapes

(D) Tragus

11. A 3-year-old boy is brought to your office by his mother for evaluation of fever, loss of appetite, and emesis. The symptoms have been present for 2 days; the fever is only temporarily relieved with antipyretics. You perform a physical examination and diagnose otitis media. What is your most likely physical finding on otoscopic examination?

(A) Erythematous, bulging tympanic membrane

(B) Erythematous, retracted tympanic membrane

(C) Erythematous, scaly external ear canal

(D) Erythematous helix

12. A 15-year-old high school student presents to your clinic complaining of pain in his left ear. He noticed that it occurred shortly after starting swimming lessons at the local YMCA. Upon physical examination, you notice that the external canal is swollen and tender during insertion of the speculum. What is your most likely diagnosis?

(A) Otitis media

(B) Serous otitis

(C) Eustachian tube dysfunction

(D) Otitis externa

13. A 15-year-old member of the high school marching band comes to your office for evaluation of hearing loss. He had multiple ear infections as an infant and toddler, and had to have myringotomy tubes inserted in his ears. Additionally, he suffers from many allergies. His hearing is diminished in the right ear. When you place a vibrating tuning fork on the top of his head, the sound lateralizes to the right ear. The name of this test is:

(C) Whisper test

(D) Romberg test

14. Next, you place a vibrating tuning fork on the teenager's right mastoid process, asking him to let you know when the sound is gone, then immediately place that same tuning fork near his right ear. He hears the sound equally in air as against his bone. The name of this test is:

(C) Whisper test

(D) Romberg test

15. A 22-year-old agricultural worker presents to your office for evaluation of coughing. She has had this cough for 6 weeks; it is nonproductive and worst first thing in the morning. She denies fever, chills, weight loss, or night sweats; she does have clear rhinorrhea and itchy, watery eyes. You diagnose her with allergic rhinoconjunctivitis. On physical examination of the nasal mucosa, what would you expect to find?

(A) Erythematous, ulcerated mucosa

(B) Pale to bluish, boggy mucosa

(C) Pink mucosa

(D) Ulcerated mucosa

16. A 2-week-old infant is brought into your clinic by his parents because they have noticed that their child is having some difficulty with feeding and that there is something strange in his mouth. You diagnose thrush. What is the most likely physical finding you will see upon examination of his mouth?

(A) Koplik's spots

(B) White plaques

(C) Erythematous plaques

(D) Epstein's pearls

17. A 7-year-old elementary school child is brought into the clinic by her mother for evaluation of fever and nausea. Upon further physical examination you diagnose tonsillitis. What are you typically expecting to see on physical examination of the oropharynx?

(A) Exudates on the tonsils

(B) Small tonsils

(C) Hemorrhage of the tonsils

(D) Pseudomembranes

18. A 28-year-old housewife presents to your office for a 6-week-postpartum checkup. She complains of fatigue greater than expected and palpitations. Her hair is falling out as well. She denies sadness or depression symptoms. Before this, she had not had any medical problems. She is breast-feeding her child and is not on any birth control. She had her first period since giving birth last week. A pregnancy test done in the office is negative. What is your most likely diagnosis?

(A) Thyroiditis

(B) Iron-deficiency anemia

(C) Addison's disease

(D) Sheehan's syndrome

19. When performing posterior palpation of the thyroid gland, you should do all of the following EXCEPT:

(A) Have the patient tip his or her head forward and slightly to the side.

(B) Place your index fingers above the cricoid cartilage.

(C) Palpate between the sternocleidomastoid muscle and the trachea for the thyroid isthmus.

(D) Move your fingers laterally to palpate for the thyroid lobes.

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