FM EOR NEWEST ACTUAL EXAM
QUESTIONS AND DETAILED CORRECT
ANSWERS WITH RATIONALE | END OF
ROTATION STUDYGUIDE 2025
A 25-year-old man presents to the clinic with generalized fatigue,
muscle aches and a rash. He states this has been going on for
about three to four days and seems to be getting worse. He was
on a canoeing trip in the boundary waters in northern Minnesota
three weeks ago, but did not notice any symptoms during that
time. He did tick checks every two to three days and never found
a tick on his body. Vital signs are within normal limits. Physical
exam reveals the rash shown above. What is the most likely
diagnosis? Correct Answer Lyme disease
Lyme disease is a tick-borne illness caused by the spirochete
Borrelia burgdorferi
Symptoms generally start seven to fourteen days after the tick
bite occurred.
A majority of patients will not report identifying a tick bite
Lyme Disease:
History of being in the woods, hiking, or camping
Presentation
Stage 1: erythema migrans (pathognomonic), viral-like syndrome
(fever, fatigue, malaise, myalgia, headache)
Stage 2: myocarditis, bilateral Bell palsy
Stage 3: chronic arthritis, chronic encephalopathy
PE will show slightly raised red lesion with central clearing,
erythema migrans (bull's-eye) rash
Most commonly caused by Borrelia burgdorferi carried by Ixodes
tick
Treatment is doxycycline
,Children: amoxicillin or doxycycline (if used for < 21 days)
Pregnant: amoxicillin
Bilateral facial nerve palsy is virtually pathognomonic for Lyme
disease
A 55-year-old man presents to the office for his annual check-up.
He has not had a physical exam in more than 10 years and is
asking to get screened for colon cancer since his brother was
recently found to have precancerous polyps. Which test is the
method of choice in screening for colonic polyps and colorectal
cancer? Correct Answer Colonoscopy
Colorectal Cancer Screening
Average risk adults
-USPTF (updated 2021): screen all age 45-75, select patients up
to age 85
- ACG: start screening at age 45
- AAFP: start screening at age 50
- Test options: colonoscopy every 10 years, fecal
immunochemical test yearly, multitarget fecal DNA every 3 years,
CT colonography every 5 years
One first-degree relative with colon cancer or advanced polyp:
colonoscopy at age 40 or 10 years earlier than the age at which
relative diagnosed
Familial adenomatous polyposis: sigmoidoscopy at age 12, then
every 1-2 years
A 40-year-old man presents for an annual health maintenance
check. His physical exam is unremarkable. The following lab
values were obtained: white blood cells 8,300/mcL, hemoglobin
16.1 g/dL, hematocrit 45%, platelets 220,000/mcL, high-density
lipoprotein 45 mg/dL, low-density lipoprotein 140 mg/dL,
triglycerides 148 mg/dL. Which of the following is the most likely
diagnosis? Correct Answer Hyperlipidemia
,Hyperlipidemia is an abnormally high concentration of fats, known
as lipids, in the blood. It is a major risk factor for heart disease.
Although this particular patient has normal levels of HDL and
triglycerides, his LDL is above the normal limits (85-125 mg/dL),
meeting criteria for hyperlipidemia. Total cholesterol levels over
200 mg/dL or triglycerides over 150 mg/dL also meet criteria for
the diagnosis.
A 40-year-old woman presents to the office with complaints of
worsening headaches and double vision over the past three
months. After reviewing her chart, you notice that she has gained
over 40 pounds since her last visit to the office one year ago.
Upon physical exam, you note her weight distribution is mainly in
the waist, she has increased adipose tissue in the face, proximal
muscle weakness and purple striae over the abdomen. She is not
currently taking any prescription or over-the-counter medications.
What is the most likely cause of her condition? Correct Answer
Benign pituitary adenoma
Cushing Syndrome:
Patient presents with amenorrhea, central obesity, depressive
symptoms, and easy bruising
PE will show purple striae, moon face (facial adiposity), buffalo
hump (increased adipose tissue in the neck and upper back), and
hypertension
Diagnosis is made by 24-hour urine cortisol and testing ACTH
levels
Most noniatrogenic cause is hypercortisolism from ACTH-
secreting pituitary tumor
If cause is pituitary tumor then it's called Cushing disease
Question: What life-threatening condition results from
discontinuing therapy in a patient who has been on long-term
corticosteroid treatment?
, Answer: Adrenal crisis.
Which of the following are typical symptoms of depression?
Correct Answer Multiple somatic complaints
Depression Symptoms
SIG E CAPS:
Sleep: insomnia or hypersomnia
Interest: anhedonia
Guilt: worthlessness
Energy: fatigue, lack of concentration
Cognition or concentration: reduced cognition, difficulty
concentrating
Appetite (weight loss): usually declined, occasionally increased
Psychomotor retardation or agitation: restlessness or slowness
Suicidality: thoughts of death
A 32-year-old man presents with persistent ringing in his ears that
occurs daily and lasts throughout the day. This has been going on
for several months, but recently has been getting gradually worse.
He is a construction worker by trade. Health history is
unremarkable except for lower back pain for which he pops some
ibuprofen throughout the day. He denies any other medications.
He does not smoke but usually has five to six beers on the
weekend. His examination is unremarkable. What is the most
likely cause of his tinnitus? Correct Answer Excessive Ibuprofen
use
Tinnitus
Acoustic neuroma: CN VIII, hearing loss + tinnitus +
disequilibrium
Ménière disease: recurrent vertigo + tinnitus + hearing loss
Ramsay Hunt syndrome: facial paralysis, zoster lesions, tinnitus
