A boy presents to clinic for a well-baby check. The mother notes that her child is able to move his head from side to side following a moving object, can lift his head from a prone position, smiles when played with, and makes cooing sounds. The physical examination reveals a calm, afebrile, baby boy with pink conjunctivae, clear breath sounds, adynamic precordium, distinct heart sounds, no heart murmurs, soft non-tender abdomen, full equal pulses and no edema. He is unable to maintain a seated position. Which of the following is the most likely age of the infant?

• 1 month

• 12 months

• 4 months

• 7 months

A 24-year-old woman comes to the clinic complaining of lower abdominal and pelvic pain. She says the pain has been ongoing for 3 to 4 weeks and is exacerbated when she has sexual intercourse with her boyfriend. She has had four sexual partners in the past year and only uses oral contraceptive pills for birth control. She also has dysuria and dysmenorrhea. Physical examination shows diffuse tenderness in the lower abdominal quadrants and cervical discharge. Which of the following is the most likely diagnosis?

• Ectopic pregnancy

• Endometriosis

• Human papillomavirus

• Pelvic inflammatory disease

A 28-year-old female presents on examination with enlarged ovaries bilaterally. The possible diagnosis of polycystic ovarian syndrome is enhanced by finding which of the following?

• Anorexia

• Dyspareunia

• Gynecomastia

• Hirsutism

A 71-year-old man presents to the Emergency Department complaining of left eye pain that has been increasing over the last few hours. The pain is associated with blurred vision and nausea. Physical examination of the left eye is shown. Which aspect of the comprehensive eye examination is contraindicated in this patient?

• Eversion of the eyelids

• Fundoscopic examination

• Pupillary dilation

• Snellen chart

A previously healthy 10-year-old boy presents to the clinic with his mother because she is worried he has an infection. He has had a fever and malaise for five days for which he was given antipyretics. On physical examination his vital signs are within normal limits for age except for a low-grade fever. Which of the following is most consistent with mumps virus infection?

• Gradual bilateral swelling of the parotid glands

• Sudden onset of firm, erythematous swelling of the parotid gland

• Unilateral painless parotid swelling

• Unilateral parotid swelling and tenderness that becomes bilateral

A 4-year-old girl presents with a three day history of malaise, fever of 40o C, cough and coryza. She then developed an erythematous maculopapular rash that started on the face before spreading to the trunk and lower body. Her immunization record shows that aside from an initial dose of hepatitis B vaccine given at delivery, no other vaccinations have been given. On physical examination, the patient is weak-looking and febrile with a generalized, pruritic, maculopapular rash, watery nasal discharge, white pinpoint lesions on bright red mucosa opposite the lower molars, and occasional crackles upon auscultation. Which of the following is the most likely diagnosis?

• Fifth disease

• Rubella

• Rubeola

• Sixth disease

A 26-year-old man presents to your clinic with complaints of fever, fatigue and right-sided knee stiffness and pain. He tells you that he was treated for a sexually transmitted infection three weeks ago and was feeling fine until now. Physical exam findings include right-sided tenderness, warmth and inflammation of the right knee as well as bilateral conjunctival injection. Which of the following is the most likely diagnosis?

• Gout

• Reactive arthritis

• Rheumatoid arthritis

• Septic arthritis

A previously healthy, non-smoking, 50-year-old man presents to your office for his annual physical exam. He wants to make sure he is up to date on all of his immunizations and asks if he needs to get the pneumococcal vaccine. Which of the following pneumococcal immunization guidelines is most appropriate to share with the patient?

• Immunocompromised patients should be vaccinated against pneumococcal infection starting at age 50 years

• Pneumococcal vaccination is based on patient preference

• Pneumococcal vaccination is not recommended for children

• Pneumococcal vaccination is recommended for all adults 65 years and older

Which of the following physical exam findings is most suggestive of emphysema?

• Diffuse hyperresonance to percussion

• Dullness to percussion at left lung base

• Localized area of egophony and increased tactile fremitus

• Unilateral diminished breath sounds and tactile fremitus

A 52-year-old man with no known medical history presents to the emergency room complaining of abdominal pain that has been persistent for 3 hours. He describes the pain as an 8/10 stabbing pain in his upper abdomen that radiates to his back. He admits to chronic alcohol abuse and reports drinking 1 liter of vodka daily. Physical exam reveals significant tenderness to palpation of the epigastric region without peritoneal signs or guarding. The lab work is remarkable for white blood cell count of 17,000/mcL, blood glucose of 175 mg/dl, lactate dehydrogenase of 310 U/L, lipase of 1,400 U/L, and aspartate aminotransferase of 290 U/L. Which of the following is associated with a worse prognosis in early acute pancreatitis?

• Age of 52

• Aspartate aminotransferase of 290 U/L

• Blood glucose of 175 mg/dl

• Lactate dehydrogenase of 310 U/L