Sample practice questions

A few real questions from this free bank, with full explanations. Use the practice tool above for the whole set.

1. 1. Assess

   A 67-year-old man asks about lung cancer screening. He smoked 1 pack per day for 25 years and quit 9 years ago. He has no symptoms and would accept surgery if cancer were found. Which screening plan matches the current USPSTF recommendation?

   • a.No screening, because he has already quit smoking
   • b.A single low-dose CT now, then stop if it is negative
   • c.Annual posteroanterior chest radiograph
   • d.Annual low-dose CT of the chest

   Answer: d

   Explanation: The 2021 USPSTF recommendation (grade B) covers adults 50 to 80 years old with at least a 20 pack-year history who currently smoke or quit within the past 15 years; he has 25 pack-years and quit 9 years ago, so annual low-dose CT applies. Chest radiography is not the recommended screening test. Quitting does not end eligibility until 15 years have passed, and the recommendation is for yearly screening, not a single scan.

2. 2. Assess

   A 22-year-old at 8 weeks of gestation has no history of sexually transmitted infection and one lifetime partner. Which statement about syphilis screening is correct?

   • a.Screen only at admission for delivery
   • b.Screen only if she reports a new partner
   • c.Screen her at this first visit
   • d.Screen only if a genital ulcer is seen

   Answer: c

   Explanation: The USPSTF (May 2025, grade A) recommends early, universal syphilis screening in pregnancy, whether or not risk factors are present, as soon as the patient first presents for care. Screening at delivery is only for patients who were not screened earlier, and waiting for a lesion or a new partner is not universal screening.

3. 3. Assess

   A 10-month-old girl has a fever of 39.2 C (102.6 F) with no source on examination, and a urinary tract infection is suspected. How should urine be obtained for culture?

   • a.As a clean-catch midstream sample
   • b.By urethral catheterization
   • c.From the diaper, for a dipstick only
   • d.With an adhesive collection bag

   Answer: b

   Explanation: For children 2 to 24 months old, diagnosing UTI requires a urinalysis suggesting infection plus at least 50,000 CFU/mL of a single uropathogen in urine obtained by catheterization or suprapubic aspiration, not urine collected in a bag. An infant this age cannot give a midstream sample, and a dipstick alone cannot confirm or exclude infection.

4. 4. Assess

   A 74-year-old man with new orthopnea, leg swelling, and a 2 kg weight gain over 3 days is being evaluated for heart failure. After an ECG, which test is usually the best first test?

   • a.Pulmonary function testing
   • b.Coronary angiography
   • c.Echocardiogram
   • d.Exercise treadmill test

   Answer: c

   Explanation: MedlinePlus notes that after an ECG, an echocardiogram is most often the best first test when heart failure is being evaluated, because it shows ventricular size, ejection fraction, and valve function and guides treatment. Stress testing and angiography look for ischemia, and pulmonary function tests evaluate lung disease rather than cardiac function.

5. 5. Diagnose

   A 24-year-old woman has a thin, gray, homogeneous vaginal discharge with a fishy odor that worsens after intercourse. Vaginal pH is 5.0, the whiff test is positive, and clue cells are seen on microscopy. What is the diagnosis?

   • a.Trichomoniasis
   • b.Vulvovaginal candidiasis
   • c.Bacterial vaginosis
   • d.Chlamydial cervicitis

   Answer: c

   Explanation: She meets all four Amsel criteria for bacterial vaginosis: thin homogeneous discharge, pH above 4.5, a positive whiff test, and clue cells. Candidiasis typically has a normal pH and pseudohyphae, trichomoniasis is diagnosed by finding motile trichomonads or a positive NAAT, and chlamydia infects the cervix and does not produce clue cells.

6. 6. Diagnose

   A 16-year-old has pain that began around his navel yesterday and has moved to the right lower abdomen. He has lost his appetite, is nauseated, and has a low-grade fever. The right lower quadrant is tender to pressure. What is the most likely diagnosis?

   • a.Viral gastroenteritis
   • b.Constipation
   • c.Acute appendicitis
   • d.Mesenteric adenitis after a cold

   Answer: c

   Explanation: Appendicitis classically begins with periumbilical or upper abdominal pain that becomes sharper and moves to the right lower abdomen, with anorexia, nausea, low-grade fever, and right lower quadrant tenderness. Gastroenteritis causes diffuse cramping with diarrhea, and constipation does not produce fever with pain that migrates and localizes. Mesenteric adenitis can mimic appendicitis, but it is a diagnosis made after appendicitis is excluded, not the most likely one here.

7. 7. Plan

   A 25-year-old woman at 20 weeks of gestation has symptomatic bacterial vaginosis. What is the appropriate plan?

   • a.Defer treatment until after delivery
   • b.Treat only if culture is positive
   • c.Treat her male partner instead of her
   • d.Treat with a recommended BV regimen now

   Answer: d

   Explanation: CDC recommends treating all symptomatic pregnant women with bacterial vaginosis because it is associated with preterm birth, premature rupture of membranes, and postpartum infection; the recommended nonpregnant regimens can be used in pregnancy. Treating male partners does not prevent recurrence, and BV is diagnosed by Amsel criteria or Gram stain, not by culture.

8. 8. Plan

   A 68-year-old woman with type 2 diabetes has no known cardiovascular disease and no additional ASCVD risk factors. What does the ADA recommend for lipid management, in addition to lifestyle therapy?

   • a.Fish oil supplements in place of a statin
   • b.Moderate-intensity statin therapy
   • c.No statin until her LDL exceeds 190 mg/dL
   • d.Niacin as first-line therapy

   Answer: b

   Explanation: The ADA recommends moderate-intensity statin therapy, in addition to lifestyle therapy, for people with diabetes aged 40 to 75 without ASCVD; high-intensity statins are for those at higher risk. Waiting for a very high LDL misses the indication created by diabetes itself, and niacin and fish oil supplements do not provide the cardiovascular benefit of statins.

9. 9. Plan

   A 31-year-old man has opioid use disorder and asks to be 'detoxed' over a week so he can stop all medication. What does the 2022 CDC guideline recommend?

   • a.Discharge him from the practice
   • b.Offer medication for opioid use disorder
   • c.Supervised withdrawal alone over 7 days
   • d.Prescribe a benzodiazepine taper for withdrawal

   Answer: b

   Explanation: The CDC guideline recommends offering or arranging evidence-based medication treatment, such as buprenorphine or methadone, for opioid use disorder, and states that detoxification alone without medication is not recommended because it increases the risk of resumed use, overdose, and overdose death. Discharging him abandons care, and benzodiazepines with opioids increase overdose risk.

10. 10. Evaluate

    An 81-year-old woman with type 2 diabetes, mild cognitive impairment, and falls takes glipizide and metformin. Her A1C is 6.4%, and she has had two episodes of glucose in the 50s this month. What is the best change?

    • a.Increase glipizide to prevent afternoon highs
    • b.Continue the same regimen, since her A1C is at goal
    • c.Stop or reduce the glipizide
    • d.Add basal insulin to lower her A1C further

    Answer: c

    Explanation: The ADA recommends deintensifying hypoglycemia-causing medications, such as sulfonylureas, or switching to a class with low hypoglycemia risk for people at high risk, and using less stringent goals (for example, A1C below 8.0%) for older adults with complex health. Her low A1C combined with recurrent hypoglycemia signals overtreatment, so adding insulin, increasing glipizide, or continuing unchanged would raise her risk.