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2011 WAPA Test Taking Workshop
1. A 11-month-old girl presents with a 3-day history of fever, vomiting, and watery, non-bloody diarrhea.
On physical examination, she appears dehydrated. Which of the following is the most likely infecting
organism?
a. Norwalk virus
b. Parvovirus
c. Rotavirus
d. Salmonella
e. Shigella
2. A 64-year-old man presents with preserved speech, but language content is incorrect. He has
nonexistent words and an outpouring of jargon. Grammar, syntax, rate, intonation and stress are normal.
Substitutions of one word for another (paraphasias, e.g. “telephone” for “television”) are present.
Neurologic testing reveals that his comprehension of auditory and visual language is severely disturbed.
He also exhibits an inability to repeat language. The patient has which of the following types of aphasia?
a. Broca (expressive)
b. Conduction
c. Global
d. Mixed transcortical
e. Wernicke (receptive)
3. A young mother comes to the emergency room with her 4-day-old son. She explains that he has been
feeding poorly over the last 2 days and has been very irritable, crying all the time, jittery during the day.
She had also noticed that his breathing had become irregular over the last few hours and his hands and
feet have turned blue. The pregnancy was uneventful, but labor was prolonged and the membranes had
ruptured 12 hours before the baby was delivered. On physical examination, the infant has a temperature
of 35.6C (96.1 F), pulse is 95/min, and respirations are 30/min. He is irritable and grunting during the
examination. The anterior fontanelle is bulging and there is peripheral cyanosis. Which of the following is
the most likely diagnosis?
a. Congenital rubella
b. Congenital syphilis
c. Congenital toxoplasmosis
d. Neonatal herpes simplex virus infection
e. Neonatal sepsis
4. Which of the following is most likely to cause a hypochromic microcytic anemia?
a. Folate deficiency
b. Hereditary spherocytosis
c. Iron deficiency anemia
d. Sickle cell anemia
e. Vitamin B12 deficiency
5. A 68-year-old man presents with complaints of chronic fatigue and exertional and nocturnal dyspnea,
orthopnea, and a chronic nonproductive cough. On examination, respiratory wheezing and rhonchi are
noted. Cardiac examination reveals a diminished first heart sound and an S3 gallop. The patient indicates
that he was recently treated for hypertension and vasospastic angina. On the basis of his initial
presentation, which of the following agents was most likely prescribed?
a. Amlodipine
b. Captopril
c. Furosemide
d. Hydralazine
e. Verapamil
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2011 WAPA Test Taking Workshop
6. A young man is stabbed in the right chest and comes into the emergency room fully awake and alert.
He states that he feels short of breath in a normal tone of voice. His vital signs are normal and on
physical examination, he has no breath sounds at the right bases and only faint breath sounds at the
apex. He is dull to percussion over the right base. A chest x-ray film confirms that he has a hemothorax in
that side. Which of the following is the most appropriate next step in management?
a. Exploratory thoracotomy
b. Insertion of a chest tube at the right base
c. No specific intervention
d. Intubation
e. Oxygen mask and analgesics
7. A 60-year-old man suddenly becomes completely blind in one eye, and angiography demonstrates
occlusion of the central retinal artery. Which of the following is the most likely cause of the occlusion?
a. Athersclerotic disease
b. Cranial (temporal) arteritis
c. Hypertension
d. Polycythemia vera
e. Tumor
8. A caucasian farmer has a non-healing, indolent, punched out, clean looking 2-cm ulcer over the left
temple. The ulcer has been slowly growing over the past three years. There are no enlarged lymph nodes
in the head and neck. He comes to the office now for evaluation. Which of the following would best dictate
proper management?
a. Full thickness biopsy of the center of the lesion
b. Full thickness biopsy of the edge of the lesion
c. Pathologic studies after the entire lesion is resected with a margin of 1 cm of normal skin all around
d. A trial of radiation therapy
e. Scraping and culture of ulcer base
9. A 27-year-old man who was recently diagnosed with acquired immune deficiency syndrome presents
complaining of odynophagia, dysphagia, and severe retrosternal pain. Endoscopic evaluation shows
linear yellow-white plaques. The most likely diagnosis is:
a. cytomegalovirus
b. candidal esophagitis
c. herpes simplex esophagitis
d. gastroesophageal reflux
e. pill-induced esophagitis
10. A 60-year-old woman comes to the office for an annual examination. She has no complaints. She had
her last menstrual period at age 55 and has had no vaginal bleeding since. She has no medical problems
and has never had surgery. She takes no medications and has no allergies to medications. The physical
examination is unremarkable. She is concerned about cancer and wants to know which type is the major
cause of cancer death in women. Which is the correct response?
a. Breast cancer
b. Cervical cancer
c. Endometrial cancer
d. Lung cancer
e. Ovarian cancer
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2011 WAPA Test Taking Workshop
11. A 59-year-old man calls the office complaining of a cold, pale, and painful right leg starting an hour
ago. He was recently admitted to the hospital for palpitations and found to have newly diagnosed atrial
fibrillation (AF). He was placed on digoxin and verapamil for rate control and loaded with warfarin for
anticoagulation. After several trips to the anticoagulation clinic, he decided to stop taking his warfarin.
Which of the following is the most likely explanation for his symptoms?
a. Drug reaction
b. Deep vein thrombosis (DVT)
c. Multiple sclerosis (MS)
d. Raynaud syndrome
e. Thromboembolism
12. A 19-year-old college freshman comes to the university health clinic because of recurrent episodes of
wheezing during basketball practices. He has been hampered by shortness of breath shortly after
beginning practice and during games. The symptoms are accompanied by a nonproductive cough and
chest tightness. He denies any symptoms at rest. On physical examination, he is comfortable and denies
any symptoms. His physical examination is unremarkable. Which of the following cells are most likely to
mediate his symptoms?
a. Eosinophils
b. Lymphocytes
c. Mast cells
d. monocytes
e. Neutrophils
13. Which of the following would most likely be observed in the lungs during an autopsy of a 2-week-old
infant who died of neonatal respiratory distress syndrome?
a. Alveoli filled with neutrophilis
b. Dense fibrosis of the alveolar walls
c. Enlarged air spaces
d. Hyaline membranes and collapsed alveoli
e. Normal lung histology for age
14. A 24-year-old woman has fever, malaise, and a dry, nonproductive cough. She also complains of
headache, muscle aches, and leg pain. Laboratory values are significant for elevated cold agglutinins.
Which of the following microorganism is responsible for her symptoms?
a. Haemophilus
b. Klebsiella pneumoniae
c. Legionella pneumophila
d. Mycoplasma pneumoniae
e. Streptococcus pneumoniae
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2011 WAPA Test Taking Workshop
15. A 45-year-old woman is taken to the emergency room due to feeling light-headed after an all day car
trip, during which she did not have adequate access to fluids. She had required many bathroom stops to
urinate. In the emergency room, she is found to have severe postural hypotension. Urine dipstick is
negative for glucose. She continues to produce large volumes of urine and urine osmolarity is low. Her
husband states that she "usually goes through four six-packs of diet soft drink" on a normal day. The
patient's condition improves with intravenous fluid replacement. Vasopressin injection increases her urine
osmolarity by more than 50%. Which of the following is the most likely diagnosis?
a. Central diabetes insipidus
b. Compulsive water drinking
c. Diabetes mellitus type 1
d. Diabetes mellitus type 2
e. Nephrogenic diabetes insipidus
16. A 19-year-old woman without any significant past medical history comes to the PA for a pre-college
physical examination required by her school. She has no complaints, and her review of systems is
negative. Her temperature is 37.0C (98.6F), blood pressure is 120/80 mm Hg, pulse is 80/min, and
respirations are 16/min. Physical examination reveals a single nodule on the left lobe of the thyroid gland.
Her thyroid-stimulating hormone is within normal limits. Which of the following is the most appropriate
next step in management?
a. CT scan of the thyroid gland
b. Fine needle biopsy
c. Repeat examination in 6 months
d. Thyroid uptake scanning
17. A 25-year-old woman presents with a 12 month history of palpitations, intermittent diarrhea, anxiety,
and a 1-month history of "bulging of both eyes." What is the most likely cause of her symptoms?
a. Graves disease
b. Hashimoto thyroiditis
c. Multinodular toxi goiter
d. Papillary carcinoma
e. Subacute thyroiditis
18. A 69-year-old woman with a history of diabetes type 2, chronic renal insufficiency (baseline creatinine
of 2.3 mg/dL), and hypertension, has shortness of breath and right-sided pleuric chest pain. She denies
fevers, chills, or cough. Her temperature is 38.1C (100.6F), blood pressure is 130/70 mm Hg, pulse is
110/min, and respirations are 24/min. Physical examination is normal. Chest x-ray reveals no active
disease. At this time, which of the following is the diagnostic test of choice for this patient?
a. Angiography
b. D-dimer studies
c. Lower extremity venogram
d. MR angiogram
e. Spiral CT scan
19. A 55-year-old man with a longstanding history of type 2 diabetes mellitus is most likely to exhibit
which of the renal lesion?
a. blunting of the calyx
b. diffuse glomerulosclerosis
c. focal glomerular sclerosis
d. membranous nephropathy
e. minimal change
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20. A 5-day-old girl is brought to the office by her mother, who states that the girl had an episode
following feeding during which she began to breathe deeply, become blue, and then lost consciousness.
The mother states that she picked her up and held her, and the infant became alert but retains a dusky
color. Physical examination reveals a harsh systolic murmur. Which of the following is the most likely
diagnosis?
a. Aortic stenosis
b. Coarctation of the aorta
c. patent ductus arteriosus
d. Tetralogy of Fallot
e. Ventricular septal defect
21. A 22-year-old male arrives in the emergency room with multiple gunshot wounds to the chest and
abdomen. He has labored breathing and cyanotic, diaphoretic, cold, and shivering. An initial survey
reveals a blood pressure of 60/40 mm Hg. His pulse is 150/min and barely perceptible. He is in obvious
respiratory distress and has large, distended veins in his neck and forehead. His trachea is deviated to
the left, and the right side of his chest is hyperresonant to percussion, with no breath sounds. Which of
the following is the most appropriate initial step in management?
a. Emergency blood gases
b. Immediate chest x-ray films
c. IV fluids
d. A 16 gauge needle inserted in the second right intercostal space
e. Pericardiocentesis
22. An 81-year-old woman with diabetes consults a PA because of severe and persistent earache.
Otoscopic examination demonstrates foul-sweet smelling purulent otorrhea. Biopsy of the mass
demonstrates granulation tissue rather than tumor. Which of the following is the most likely causative
organism?
a. Escherichia coli
b. Haemophilus influenzae
c. Proteus vulgaris
d. pseudomonas aeruginosa
e. Staphylococcus aureus
23. During the recent H1N1 influenza epidemic, most deaths have been due to:
a. dehydration
b. bacterial pneumonia
c. myocarditis
d. bronchiectasis
e. Reyes syndrome
24. A 56-year-old man develops slow, progressive paralysis of the facial nerve on the same side as his
hearing loss. It took many months for the full-blown paralysis to become obvious. It affects both the
forehead and the lower face. He has no pain anywhere and no palpable masses by physical examination.
Which of the following is the most likely diagnosis?
a. Acoutic neuroma
b. Bell’s palsy
c. Hemorrhagic stroke
d. Parotid gland cancer
e. Pleomorphic adenoma of the parotid gland
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25. A 55-year-old man is brought to the emergency room because of increasing incoherence over the
past 24 hours. He has a history of hypertension and diabetes. He is disoriented. On physical examination,
he is afebrile. His BP is 230/130 mm Hg, Pulse is 120/min. He has an S4 on cardiac examination. Blood
glucose level is 110 mg/dL. The patient is placed on a cardiac monitor, an IV and intra-arterial lines are
placed. A head CT scan shows no mass or bleed. Which of the following is the most appropriate next
step in management?
a. Observe in a quiet room
b. Check chemistry for an anion gap
c. Administer beta blocker
d. Administer sodium nitroprusside
e. Perform lumbar puncture
26. A 60-year-old alcoholic with a 50 pack per year history of smoking presents with hoarseness and
dysphagia. Physical examination reveals cervical lymphadenopathy. Laryngoscopy reveals an ulcerated
nodule on the laryngeal surface. Which of the following is the most likely diagnosis?
a. Adenocarcinoma
b. Anaplastic carcinoma
c. Malignant papilloma
d. Squamous cell carcinoma
e. Transitional cell carcinoma
27. A patient's left hypoglossal nerve (CNXII) is injured during a carotid endarterectomy. Which of the
following would most likely result from this injury?
a. Decreased gag reflex on the left
b. Decreased salivation from the left submandibular and sublingual salivary glands
c. Deviation of the tongue to the left on protrusion
d. Inability to elevate the pharynx on the left during swallowing
e. Inability to perceive sweet and salty taste sensations on the anterior part of the left side of the tongue
28. A 32-year-old woman with one child has tried unsuccessfully to conceive for the past 2 years. She
tells her PA that she has had problems putting on weight and is often anxious and irritable. On physical
examination, her thyroid is enlarged with no palpable nodules. Which of the following laboratory findings
would be most suggestive of a diagnosis of secondary hyperthyroidism?
a. Decreased thyroxine-binding globulin (TBG)
b. Elevated triiodothyronine (T3)
c. Elevated thyroxine (T4)
d. Elevated thyroid-stimulating hormone (TSH)
e. Presence of serum thyroid-stimulating autoantibodies
29. A 57-year-old woman with a 30-year history of alcoholism and liver disease visits her physician
complaining of abdominal swelling and shortness of breath. The physician determines that she has
severe ascites. Which of the following factors contributes to the accumulation of fluid in the abdominal
cavity?
a. Decreased plasma epinephrine and norepinephrine
b. Decreased plasma volume
c. Increased hepatic lymph flow
d. Increased hydrostatic pressure in splanchnic capillary beds
e. Increased natriuresis
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30. A 56-year-old man has been having bloody bowel movements on and off for the past several weeks.
He reports that the blood is bright red, it coats the outside of the stools, and he can see it in the toilet bowl
even before he wipes himself. There is also blood on the toilet paper. He has been constipated for the
past two months and that the caliber of the stools has changed. They are now very thin compared to the
usual diameter of an inch or more. He has no pain. Which of the following is the most likely diagnosis?
a. Anal fissure
b. Cancer of the rectum
c. Crohn’s disease
d. External hemorrhoids
e. Internal Hemorrhoids
31. A 29-year-old man consults a health care provider about a 2 cm neck mass. The patient has no
systemic symptoms at that time. The mass is resected and proves to be a lymph node showing
replacement of normal follicles by sheets lacunar histiocytes, noted on the pathologist’s report as ReedSteinberg cells. Which of the following is the most likely diagnosis?
a. Burkitt lymphoma
b. Hairy cell leukemia
c. Hodgkin’s lymphoma
d. Mycosis fungoides
e. Waldenstrom macroglobulinemia
32. A 37 year-old male presents with headaches for the past 2 months. They occur daily and are worse in
the morning. In the past week, he has noticed a tendency to drop things from his right hand. On
examination, vital signs are normal, and general examination is unremarkable. Neurologic examination
reveals mild weakness of the right upper extremity compared to the left. Which of the following is the most
likely diagnosis?
a. focal seizure disorder
b. intracerebral neoplasm
c. transient ischemic attack
d. amyotrophic lateral sclerosis
e. neuropathy
33. A patient undergoes a total gastrectomy because of a proximally located gastric cancer. After surgery,
which of the following digestive enzymes will be produced in inadequate amounts?
a. Amylase
b. Chymotrypsin
c. Lipase
d. Pepsin
e. Trypsin
34. A 53-year-old woman comes to the office for an annual examination. She has no complaints. She has
hypertension for which she takes a thiazide diuretic, but no other medical problems. Her past gynecologic
history is significant for normal annual pap tests for many years, her last being 2 months ago. A recent
mammogram was negative. Heart, lung, breast, abdomen, and pelvic examination are unremarkable.
Which of the following procedures or tests should most likely be performed on this patient?
a. Chest x-ray
b. EKG
c. Pap test
d. Pelvic ultrasound
e. Colonoscopy
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35. A 62-year-old man is prescribed a pharmaceutical agent that inhibits the activity of the enzyme HMGCoA reductase. This patient most likely has which of the following conditions?
a. Chronic inflammation
b. Hypercholestrolemia
c. Hypertension
d. Hyperuricemia
e. Type 2 diabetes
36. A 56-year-old man with diabetes notices a gradual increase of erectile dysfunction over several years.
Initially he was able to get erections, but they did not last long enough. Later, he noticed a decrease in the
quality of his erections, and more recently he has become, by his own criteria, completely impotent. He
has occasional, brief nocturnal erections, but "he can never get an erection when he needs one." He is
very frustrated. Which of the following is the most appropriate initial step in management?
a. Psychotherapy
b. Pharmacologic therapy
c. erectile nerve reconstruction
d. Implantable penile prothesis
e. Pudendal artery revascularization
37. A 35-year-old man is taken to an emergency room by a friend after the man starts having severe tonic
spasms that cause his arms and legs to flail. The patient's difficulties had begun a day and half earlier
when he noticed jaw stiffness. This has since progressed to difficulty swallowing, sore throat, stiff neck,
fever, chills, and tonic spasms of his arms and legs. The patient's speech is difficult to understand
because he has trouble "making his jaws work right". Mental status is intact. Which of the following is the
most likely diagnosis?
a. Botulism
b. Diphtheria
c. Lyme Disease
d. Pertussis
e. Tetanus
38. A 59-year-old African American man has a hard, discrete, 1.5 cm nodule that is felt in his prostate
during a routine physical examination. He is completely asymptomatic, and his prostatic specific antigen
(PSA) done 3 months ago was normal for his age. His last rectal examination was performed a year
earlier and was unremarkable. He denies any family history of prostate cancer. Which of the following will
best establish the diagnosis?
a. Clinical follow-up during the ensuing year
b. Repeat determination of PSA
c. Transrectal needle biopsy of the mass
d. Transrectal sonogram of the prostate
e. Transurethral resection of the prostate
39. A 14-year-old boy slides down a banister and crashes into a large ornamental knob at the base,
thereby injuring his scrotum. He presents in the emergency room with acute testicular pain and a scrotal
hematoma the size of a grapefruit. He is able to void normally, and his urine does not contain blood. A
rectal examination is unremarkable. Which is the next step?
a. Aspiration of scrotal contents
b. Retrograde cystogram
c. Retrograde urethrogram
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d. Scrotal sonogram
e. Scrotal surgical exploration
40. A 53-year-old man is admitted to the hospital for fever and abdominal pain. He has a history of
cirrhosis and is known to be hepatitis C positive. He was diagnosed with cirrhosis 4 years ago. He denies
any alcohol or tobacco use. His only medications are spironolactone and propranolol. He reports that 5
days ago, he had a temperature of 38.9C (102F) and the gradual onset of diffuse abdominal pain. On
examination, his temperature is 38.3C (101F), his blood pressure is 100/50 mm Hg, and his pulse is
110/min and regular. His lungs are clear, he has numerous spider angiomata on his thorax and back, and
his abdomen is massively dissented, with shifting dullness by percussion. Laboratory studies show:
Leukocytes-13,200/mm3, Hematocrit-33%, Prothrombin time-15.2 seconds, Albumin-0.1 g/dL, Sodium135 mEq/L, Potassium-4.7 mEq/L. Which of the following is the most appropriate next step in diagnosis?
a. Abdominal ultrasound
b. Abdominal CT scan
c. Electrocardiogram
d. Abdominal paracentesis
e. Lumbar puncture
41. A 29-year-old man comes to the clinic with a 2-day history of severe left-sided scrotal pain and
swelling. He is sexually active and has multiple partners. He has no history of sexually transmitted
diseases. His temperature is 38.2C (100.8F), blood pressure is 120/70 mm Hg, and his pulse is 80/min.
Examination shows unilateral intrascrotal tenderness and swelling. Testicular support makes the pain less
intense. Which of the following is the most likely diagnosis?
a. Epididymitis
b. Prostatitis
c. Testicular torsion
d. Urethritis
e. Varicocele
42. A 45-year-old woman, who wears high-heeled pointed shoes, complains of pain in the forefoot after
prolonged standing or walking. Occasionally, she also experiences numbness, a burning sensation, and
tingling in the area. Physical examination shows no obvious deformities and a very tender spot in the third
interspace, between the third and fourth toes. There is no redness, limitation of motion, or other signs of
inflammation. Which of the following is the most likely diagnosis?
a. Gout
b. Hallix rigidus
c. MetatarsophaLange-CMDTal articulation pain
d. Morton neuroma
e. Plantar fasciitis
43. While playing outside, an 8-year-old girl is bitten on the leg by a neighbor's cat. She presents the next
day with fever and bone pain localized to her right calf and shin. An x-ray film reveals a lytic lesion of the
right tibia. Results of the bone culture are pending. Which of the following is the most likely pathogen?
a. Brucella melitensis
b. Eikenella corrodens
c. Francisella tularensis
d. Pasteurella multocida
e. Yersinia pestis
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44. A 36-year-old gravid woman notes vaginal bleeding. Ultrasound reveals small grape-like cystic
structures without evidence of a developing embryo. A diagnosis of complete hydatidiform mole is made
at the hospital. Further analysis is most likely to reveal that:
a. the genotype of the mole is 46 XX and is completely paternal in origin
b. the genotype of the mole is triploid
c. human chorionic gonadotropin (hCG) levels are markedly decreased
d. serum levels of alpha fetoprotein are elevated
e. two or more sperm fertilized the ovum
45. A 17-year-old adolescent is brought to the hospital by police after being stopped for driving too slowly.
He denies any use if alcohol, but seems slow. He is laughing inappropriately, complaining of being
hungry, and has a dry mouth. His gait is somewhat slow and his coordination is impaired. There is
significant conjunctival injection, which he tries to explain as being due to pollen allergy. Which of the
following drugs will most likely appear in a urine drug screen?
a. Amphetamines
b. Benzodiazapines
c. Cocaine
d. Opiates
e. Tetrahydrocannibol
46. A term newborn is delivered vaginally following a breech presentation. On physical examination, the
Barlow test is positive for bilateral subluxation of the hips. There is decreased abduction of both hips.
Besides breech presentation, which of the following infants are most at risk for this condition?
a. African American infants
b. Female infants
c. Second-born infants
d. Infants of mothers with preeclampsia
e. Premature infants
47. A 35-year-old woman presents to her PA with paresthesias of the left shoulder and arm. She has also
noticed a hard bony structure in the left side of her neck above the clavicle. Which of the following
diagnosis best accounts for her symptoms?
a. Horner syndrome
b. Osteopetrosis
c. Pancoast tumor
d. Shoulder dislocation
e. Thoracic outlet obstruction
48. Over a span of years, an individual develops thickening of the fascia of one palm, which eventually
causes a flexion contracture of the hand, most markedly involving the fourth and fifth fingers. The patient
most probably has which of the following conditions?
a. Desmoid
b. Dupuytren contracture
c. Neurofibroma
d. Peyronie disease
e. Plantar fibromatosis
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49. A 47-year-old man presents with acute pain in his big toe. Laboratory tests reveal a uric acid level of
10 mg/dL. He is started on medication. Several days after the resolution of the acute attack, he is started
on a second medication that decreases uric acid in both serum and the urine. Which if the following is the
second medication?
a. Allopurinol
b. Colchicine
c. Indomethacin
d. Probenecid
e. Sulfinpyrazone
50. A 60-year-old woman complains of increasing weakness and fatigue over the past several months.
She reports that any physical activity leads to fatigue, and she is unable to find any comfortable position
at rest. She has lost 5 lbs. over the past 3 months. prior to this, she has always been healthy and is not
on any medications. Physical examination is unremarkable. Which of the following is the most likely
diagnosis?
a. Depression
b. Hypokalemia
c. Polymyalgia rheumatica
d. Polymyositis
e. Temporal arteritis
51. A 75-year-old woman comes to the office because of irregular vaginal bleeding. She has been
menopausal for the last 25 years, but has noted on and off spotting for the past 2 years, which she finds
intolerable. She has a complicated past medical history including hypertension, diabetes, and severe
chronic obstructive pulmonary disease. Examination is unremarkable. An endometrial biopsy is performed
that demonstrates an endometrial polyp with atypical cells that are difficult to grade. Which of the
following is the most appropriate next step in management?
a. Hormone replacement therapy
b. Oral contraceptive pill
c. Hysteroscopy
d. Laparoscopy
e. Hysterectomy
52. A newborn infant is noted to have microcephaly after birth. His mother is 38-years-old. She also has a
5-year-old son who is mentally retarded, and she had one previous second-trimester miscarriage. In
addition, she has a genetic disease that required a special diet, but she discontinued the diet many years
ago. On physical examination, the infants weight and length are both below the 10th percentile for his
gestational age. He is also noted to have a grade III systolic ejection murmur best heard at the lower left
sternal border. Which of the following conditions does the mother most likely have?
a. Fragile X syndrome
b. Galactosemia
c. Hypothyroidism
d. Maple syrup urine disease
e. Phenylketonuria
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53. A 34-year-old woman comes to the PA because of lower abdominal cramping. The cramping started
2 days ago and she noted spotting in small amounts at the onset of cramping. Urine hCG is positive, and
pelvic ultrasound reveals a 10 week intrauterine pregnancy with a fetal heart rate of 160. The patient
states that she is not sure whether to keep the pregnancy. Which of the following is the most appropriate
next step in management?
a. Counsel the patient or refer to an appropriate counselor
b. Notify the patient's parents
c. Notify the patient's partner
d. Schedule a termination of pregnancy
e. Tell the patient she is likely to have a miscarriage
54. Folate supplements during pregnancy have shown to reduce the risk of which of the following fetal
abnormalities?
a. Arnold-Chiari malformations
b. Germinal matrix hemorrhage
c. Holoprosencephaly
d. Neural tube defects
e. Syringomyelia
55. A 44-year-old homeless woman is brought to the emergency room because she is "bleeding from the
breast." Physical examination shows a fungating, ulcerated mass that occupies the entire right breast and
is firmly attached to the chest wall. The right axilla is full of hard masses that are not movable either. Core
biopsies of the breast are read as highly undifferentiated infiltrating ductal carcinoma, and assay for
estrogen and progesterone receptors are negative. Which of the following is the most appropriate next
step in management?
a. Local wound care, but no specific antineoplastic therapy
b. Tamoxifen therapy
c. Radiation and chemotherapy
d. Palliative mastectomy
e. Radical mastectomy with extended lymph node dissection
56. A 24-year-old student is arrested for threatening a neighbor with a knife. His roommate arrives and
states that the patient has been "very odd" over the past 7 months. He is socially withdrawn and had been
overheard saying that the FBI is giving him tips on patient care and the "people from the sky" are telling
him to do "bad things." He stopped going on his Ob-Gyn rotation because he believes that the babies are
"coming to earth" to give him messages. He appears apathetic and has emotional blunting. The physical
examination is otherwise normal. Toxicologic screening is negative. Which of the following is the most
likely diagnosis?
a. Bipolar disorder
b. Brief psychotic disorder
c. Delusional disorder
d. Schizophrenia
e. Schizophreniform disorder
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57. A 17-year-old girl is referred for evaluation because of persistent headaches for the past three months
and diminished peripheral vision first noticed 2 weeks ago. On physical examination, she is short for her
age. She has fully developed breasts but no axillary or pubic hair. She started menstruating 2 years ago
but has irregular periods. She has no libido. The absence of axillary and pubic hair in this girl is indicative
of which of the following conditions?
a. Excessive production of androgens
b. Excessive production of estrogens
c. High blood levels of prolactin
d. Insufficient production of androgens
e. Insufficient productions of estrogens
58. A 52-year-old man is brought to the emergency room by his wife because he has been complaining of
a severe headache. Physical examination reveals ptosis of the right eyelid with the right eye facing down
and out. There is a fixed and dilated right pupil with an inability to accommodate. Subarachnoid blood
appears on non-contrast CT scan. Magnetic resonance angiography (MRA) would be expected to reveal
an aneurysm of which of the following arteries?
a. Anterior cerebral
b. Anterior choroidal
c. Anterior Communicating
d. Middle cerebral
e. Posterior communicating
59. The office gets a phone call from a frantic mother. Her 7-year-old daughter was playing under the sink
and accidentally spilled a strong, corrosive alkaline drain cleaner all over her arms and legs. The nurse on
the phone can hear the girl screaming in the backround. The office and nearest hospital are a few miles
away. Which of the following are the most appropriate instructions to give the mother?
a. Cover the burned areas with triple antibiotic ointment until the girl can be seen by the office
b. Get the girl into the shower right away and keep water running over her for 30 minutes before bringing
her to the emergency room
c. Get the girl to the emergency room as soon as possible
d. Wash the burned areas with diluted vinegar and bring the girl to the office
e. Wrap the burned areas in sterile dressings before bringing the girl to the emergency room
60. A 36-year-old woman complains of chest pain and pressure. She has had similar episodes in the
past, and evaluations were normal. At the time of the initial workup, she told the PA that she has been a
"worrier" since childhood and is still quite anxious. The PA told her that she has a "nervous heart," but she
still believes she has a serious heart disease. Since puberty, she suffered from dysmenorrhea, nausea,
vomiting, and fatigue, and she "finally" had a hysterectomy with bilateral silpingo-oophorectomy 5 years
ago because of severe menorrhagia, which was "the last straw." She suffers from an "irritable colon" and
a "weak stomach." She suffers from migraine headaches and the standard migraine medications do not
help her. She has been hospitalized seven times in the last 5 years for many of these reasons. Which of
the following is the most likely diagnosis?
a. Conversion disorder
b. Generalized anxiety disorder
c. Masked depression
d. Pain disorder
e. Somatization disorder
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61. A 3-week-old female infant born at 38 weeks gestation through an uncomplicated vaginal delivery is
brought to the emergency room with a 2-day history of fever. The infant had been healthy since birth. Her
temperature in the emergency room is 40.0C (104.0F). She appears to be quite lethargic. A culture taken
from the infant grows group B Streptococcus in 24 hours. The mother did not receive any prenatal care.
Which of the following infections is the most consistent with this presentation?
a. Endocarditis
b. Gastroenteritis
c. Meningitis
d. Pneumonia
e. Pyelonephritis
62. An elderly man is involved in a rear end automobile collision in which he hyperextends his neck. He
develops paralysis and burning pain of both upper extremities, while maintaining good motor function in
his legs. Which of the following is the most likely diagnosis?
a. Anterior cord syndrome
b. Central cord syndrome
c. Posterior cord syndrome
d. Reflex sympathetic dystrophy
e. Spinal cord hemisection
63. A 77-year-old man becomes "senile" over a period of 3 or 4 weeks. He used to be active and
managed all of his financial affairs. His daily routine typically included gardening, long walks with the dog,
and household chores. Now, he stares at the wall, barely talks, and sleeps most of the day. His daughter
recalls that he slipped in the tub and hit his head about a week before the mental changes began.. Which
of the following would a CT scan of his head most likely show?
a. Chronic epidural hematoma
b. Chronic subdural hematoma
c. Diffuse intracranial bleeding
d. Frontal lobe infarction
e. Generalized, severe brain atrophy
64. An 80-year-old woman presents with a 3-week history of fatigue and shortness of breath, especially
on exertion. She mentions having to get up at night because of acute shortness of breath. She denies
edema, weight gain, or other symptoms. Physical examination reveals crackles in both lung bases. Based
on this history and these physical findings the most likely diagnosis is:
a. asthma
b. biventricular heart failure
c. cor pulmonale
d. left ventricle heart failure
e. right ventricular heart failure
65. A 12-year-old boy is brought to the clinic because of a several-month history of strange behavior.
According to his parents, the boy will occasionally start staring and not respond. These episodes last
several seconds and he then returns to his baseline. He has not sustained any head trauma and is on no
medications. Which of the following drugs is the most appropriate treatment?
a. Diazepam
b. Diphenhydramine
c. Ethosuximide
d. Phenobarbital
e. Phenytoin
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66. A 40-year-old woman is evaluated by a provider because she has many pigmented lesions on her
body. Examination of the skin and scalp demonstrates over 100 individual lesions, most of which vary in
size from 5 to 12 mm. They are found all over her body, but most commonly on the sun-exposed skin.
They are predominately round in shape, but some have subtly notched borders or are slightly
asymmetrical. The woman's entire skin surface is photographed, and when the photographs are repeated
six months later, no change in appearance of any lesions is noted. Which of the following is the most
likely diagnosis?
a. Compound nevi
b. Dyplastic nevi
c. Halo nevi
d. Lentigos
e. Malignant melanomas
67. A 12-year-old boy is brought to the office because of a pattern of behavior that has been worsening
over the past year. His mother states that he has been bullying other boys at school, staying out late
without permission, setting small fires in abandoned lots, and physically abusing neighborhood cats.
Which of the following is the most likely diagnosis?
a. Antisocial personality disorder
b. Attention deficit hyperactivity disorder (ADHD)
c. Conduct disorder
d. Oppositional disorder(ODD)
e. Tourette syndrome
68. A 24-year-old graduate student and teaching assistant comes into the student health center after
being instructed by his college dean to seek counseling. According to the collateral history obtained from
the patient's roommates and instructors, the man exhibits annoyingly grandiose behavior, is frequently
demanding of his peers' admiration, and has had to be reprimanded for treating his undergraduate
students without empathy or understanding. Given this history, which of the following is the most likely
diagnosis?
a. Borderline personality disorder
b. Narcissistic personality disorder
c. Paranoid personality disorder
d. Passive-aggressive personality disorder
e. Schizotypal personality disorder
69. A 40-year-old woman consults a PA about lesions on her neck that she finds cosmetically
unattractive. On examination of the neck, multiple lesions that seem to be hanging off the skin are seen.
Each lesion is small, soft and pedunculated. The largest lesion is about 4 mm in diameter. The color of
the different lesions varies from flesh colored to slightly hyperpigmented. Which of the following is the
most likely diagnosis?
a. Acrochordons
b. Lentigos
c. Lipomas
d. Seborrheic keratosis
e. Spider angioma
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70. A 5-day-old boy who was born at home is being evaluated in the urgent care clinic for bruising and
gastrointestinal bleeding. Which of the following is the most likely etiology of the infant’s bleeding?
a. Factor VIII deficiency
b. Factor IX deficiency
c. Idiopathic thrombocytopenic purpura
d. Liver disease
e. Vitamin K deficiency
71. A 35-year-old woman had been employed as a stockbroker. She was fired because she sold
securities in her clients' accounts and invested money in securities that had glossy portfolios but were
worthless. On multiple occassions she has worked 22 to 24 hours per day for 10 days at a time, gorged
herself on junk food, and drank alcohol excessively. Which of the following is the most likely diagnosis?
a. Bipolar disorder, type I
b. Bipolar disorder, type II
c. Cyclothymic disorder
d. Schizophrenic disorder, paranoid type
e. Substance induced delirium
72. A 7-year-old boy is brought to the emergency room in acute distress. His parents explain that over the
past 3 or 4 days he has become progressively ill with generalized fatigue and mild, mid-abdominal pain
that have become steadily worse. On physical examination he has a maculopapular rash on his thighs
and feet with some spread of the rash to his buttocks. The rash does not blanch and the same lesions
near the ankles look petechial or bruised. His temperature is 39.0C (102.2F0 and he is drawing his knees
to his chest for some relief of his stomach pains. He is nauseated and vomited once before coming to the
hospital. He has semi-soft dark stool, which is positive for occult blood. Which of the following is the most
likely diagnosis?
a. Pancreatitis
b. Rocky Mountain spotted fever
c. Nephrotic syndrome
d. Henoch-Schonlein purpura
e. Appendicitis
73. A 58-year-old surgical nurse consults a PA because of a rash above both her ankles. She says that
her ankles have been swollen for a few months, but she only recently noticed the rash. Physical
examination demonstrates marked ankle edema with erythemia, mild scaling, and brown discoloration of
the overlying skin of the distal lower legs. Variicose veins are also noted. Which of the following is the
most likely diagnosis?
a. Atopic dermatitis
b. Cellulitis
c. Lichen simplex chronicus
d. Nummular dermatitis
e. Stasis dermatitis
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74. Ocular examination is performed on a patient during a routine medical check up. Retinal examination
demonstrates a generalized retinal arteriolar constriction. The light reflex on the arterioles is broad and
dull. Two areas of the flame-shaped hemorrhages and multiple cotton wool spots are seen. These
findings are most suggestive of which of the following?
a. Central retinal artery occlusion
b. Central retinal vein occlusion
c. Hypertensive retinopathy
d. Non proliferative diabetic retinopathy
e. Proliferative diabetic retinopathy
75. A hunter develops an inflamed papule on one finger after skinning wild rabbits. The papule rapidly
enlarges and then bursts, releasing pus and forming a clean ulcer cavity. Several days later the patient
develops severe illness with atypical pneumonia and delirium on examination. The regional lymph nodes
of the axilla of the affected arm are enlarged. Reduced breath sounds and occasional crackles are heard.
Splenomegaly is noted. Blood studies show a mild leukocytosis. Which of the following is the most likely
diagnosis?
a. Actinomycosis
b. Brucellosis
c. Meliodosis
d. Plague
e. Tularemia
76. The most common complaint of a patient presenting with an acute thoracic aortic dissection is:
a. claudication
b. tearing back pain
c. angina
d. palpitations
e. shortness of breath
77. A 45-year-old man suddenly loses consciousness and falls to the ground, He has previously been
healthy and has been on no medications. There is no obvious evidence of trauma. An electrocardiogram
reveals wide complex tachycardia at a rate of 300 beats per minute. Which of the following is the most
appropriate intervention?
a. Obtain vital signs
b. Administer a bolus of intravenous lidocaine
c. Administer a thrombolytic agent
d. Perform asynchronous cardioversion
e. Perform synchronous cardioversion
78. A patient presents to the PA complaining of "something wrong with her foot" that causes her to trip
and fall. Physical examination reveals an inability to dorsiflex (extend) the foot and loss of sensation
between the first and second toes. There is no other motor or sensory loss. Which of the following nerves
was most likely injured?
a. Deep peroneal
b. Femoral
c. Superficial peroneal
d. Sural
e. Tibial
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2011 WAPA Test Taking Workshop
79. A 3-year-old boy is brought to a health care worker for a health supervision checkup. The parents
state that he has been well but has lately lost his appetite and seems a little moody. They attribute this to
the fact that they moved in with the mother's parents. In addition, her parents' house is old. They started
doing renovations by de-plastering the walls in the boys room and repainting it. On physical examination,
the child is in no acute distress but seems a little apathic. He is in the 20th percentile for weight and the
30th percentile for height. There is a pigmented line at his gum line. On the smear there is basophilic
stippling. Which of the following is the most important measure in the management of this child?
a. Blood transfusion
b. Administer calcium disodium edetate
c. Iron supplementation
d. Reassure the parents that improvement will ensue as the child adjusts to the new environment
e. Remove the child from his current environment
80. A 4000 g male neonate develops severe cyanosis that begins within minutes of birth. Blood drawn
one hour after birth shows metabolic acidosis with respiratory acidosis. A chest x-ray film shows the aorta
positioned directly anterior to the pulmonary artery, leading to an impression of a narrow mediastinum. An
electrocardiogram is normal. Which of the following is the most likely diagnosis?
a. Aortic valve stenosis
b. Complete atrioventricular canal defect
c. Tetralogy of Fallot
d. Transposition of the great arteries
e. Underdeveloped (hypoplastic) left ventricle syndrome
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