Download NR 509 MIDTERM EXAM LATEST EXAM QUESTIONS AND CORRECT ANSWERS | ALREADY GRADED A+ and more Exams Nursing in PDF only on Docsity! NR 509 MIDTERM EXAM LATEST EXAM QUESTIONS AND CORRECT ANSWERS | ALREADY GRADED A+ | VERIFIED ANSWERS | LATEST VERSION A 72-year-old retiree presents to the cardiology clinic with palpitations after several months of symptoms. An electrocardiogram (ECG) shows a tachyarrhythmia, which the cardiologist diagnoses as atrial fibrillation. In measuring the blood pressure of a patient with chronic atrial fibrillation, which of the following statements is true? a. The precise blood pressure is measured by taking the average of three pressures in both arms over a span of 20 minutes. b. Single automated measurement in the office setting provides a reliable value for the true blood pressure. c. Ambulatory monitoring over 2-24 hours is recommended because this rhythm produces variable and inconsistent blood pressures. d. Measuring blood pressure in patients with atrial fibrillation is no different than measuring blood pressure in patients with normal cardiac rhythms. e. Because atrial fibrillation is an uncommon arrhythmia, blood pressure manag ------CORRECT ANSWER---------------c. Ambulatory monitoring over 2-24 hours is recommended because this rhythm produces variable and inconsistent blood pressures. A 42-year-old architect presents with widespread pain complaints, including headaches almost daily, pain at the site of an old motor vehicle accident injury, and generalized achiness and hypersensitivity throughout the body. He recounts that his first episodes of ongoing pain occurred in his early 20s, and he has been to many practitioners over several years seeking a firm diagnosis and adequate treatment of his complaints. Which of the following statements is true regarding chronic pain? a. Following assessment and evaluation, ~80% of patients with non- cancer-related pain report control of their symptoms. b. Chronic pain is defined as pain not due to cancer or a recognized medical condition that persists for >3-6 months. c. Chronic pain is defined as focused pain lasting >8 months following acute injury or illness.d. In primary care practices, non-cancer-related chronic pain is seen in <10% of patients. e. Pain th ------CORRECT ANSWER---------------b. Chronic pain is defined as pain not due to cancer or a recognized medical condition that persists for >3-6 months. Disparities in pain treatment have been well described in numerous studies comparing Caucasian patients to those of African American and Hispanic origin. Which of the following statements is true concerning this issue? a. Racial and ethnic biases are only relevant in geographic areas that have a history of racial and ethnic discrimination. b. Racial and ethnic biases never involve two persons of the same race or ethnic group. c. Language barriers do not contribute to the problem of racial and ethnic biases. d. Biases of the treating clinician are associated with overtreatment of pain in minority patients and non-English speakers. e. Biases of the treating clinician are associated with under-treatment of pain in minority patients and non-English speakers. ------CORRECT ANSWER---------------e. Biases of the treating clinician are associated with under-treatment of pain in minority patients and non-English speakers. Which of the following statements is true concerning mental health disorders in primary care? a. The prevalence for mental disorders is estimated to be ~10%, of which only 25% are not diagnosed. c. Illusions involve an irrational fear or perceptions, whereas hallucinations are a misinterpretation of real external stimuli. d. Hallucinations may be ------CORRECT ANSWER---------------b. Illusions are a misinterpretation of real stimuli, whereas hallucinations are subjective perceptions in the absence of real stimuli. Abstract thinking is an important component of the human thought process. A person's ability to understand questions that test his or her ability to answer appropriately is dependent upon a number of factors. Which one of the following answers is true in identifying a patient with concrete thinking and a reduced ability to think abstractly? a. An inability to correctly perform serial 7s b. An inability to spell "world" backward c. An inability to name the occupations of common well-known public figures such as the President and Vice President d. An inability to draw a clock correctly including all numbers and make it tell time as requested (i.e., 10:15) e. An inability to discern the similarity between two words (e.g., a cat and a mouse by answering "The cat chases the mouse.") ------CORRECT ANSWER---------------e. An inability to discern the similarity between two words (e.g., a cat and a mouse by answering "The cat chases the mouse.") Concerning a patient that may demonstrate a diagnosis of aphasia, which of the following statements is true? a. It involves a loss of the voice or a slurring or hoarseness of speech secondary to pathology of the larynx or its nerve supply. b. It is best characterized by slurred speech with an associated defect in language control. c. It is best characterized by involuntary, rhythmic, repetitive movements involving the tongue and jaws making speech difficult to comprehend. d. The ability to write a full correct sentence does not rule out the presence of aphasia in a patient. e. It is defined as an inability to produce or understand language. ------ CORRECT ANSWER---------------e. It is defined as an inability to produce or understand language. A 23-year-old physician assistant (PA) student found that she felt nervous when called upon to examine men in her age group. On one occasion, she encountered a young male patient who appeared embarrassed to see her walk into the room. What should the PA do to minimize their mutual discomfort? a. Adjust lighting so it is tangential to the patient's body. b. Explain how the examination will proceed. c. Ask the patient where he comes from. d. Explain that she is a PA student. e. Provide ongoing interpretation of findings. ------CORRECT ANSWER----- ----------b. Explain how the examination will proceed. A 34-year-old male with a history of complex social and medical needs (including current substance abuse) presents to a primary care teaching clinic. The patient has experienced a number of adversarial relationships with prior clinicians, including voluntarily leaving two practices within the previous year and being asked to leave care at a third clinic due to misbehavior. The attending physician desires to utilize the approaches to this patient that are most likely lead to comprehensive care and patient compliance. Which of the following is the most appropriate interview style for the attending physician to use? a. Focusing on the need for immediate diagnostic certainty over personal connection b. Taking charge of the interaction to meet the clinician's desire to acquire diagnostic information c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests d. Deferring respect, empathy, ------CORRECT ANSWER---------------c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother, who convinced the patient to attend the clinic after he disclosed that he prefers homosexual partners but is afraid that his last partner may have given him an infection. The patient expresses to the intake nurse that he is unashamed of his sexual orientation and will not stay through the visit if he feels that he is dismissed or discriminated against because of it. The nurse practitioner receives this communication prior to entering the examination room and decides to employ active listening to best connect with the patient at this critical juncture in his care with the clinic. Which of the following is an example of an active listening technique? a. Ignoring visual cues to focus on the patient's exact words b. Setting aside the patient's emotional state to focus on his medical needs c. Paring down the patient's conce ------CORRECT ANSWER---------------d. Using nonverbal communication to encourage the patient to expand their narrative A 42-year-old female mathematician presents for follow-up care regarding a new diagnosis of systemic lupus erythematosus 6 months ago after a lengthy diagnostic process during which she was debilitated with fatigue and joint pain. Since her diagnosis, she has been minimally compliant with medications and has switched her rheumatology provider twice. She continues to feel ill, and, in explanation for her lack of adherence to the prescribed treatment, she simply says, "I don't like it." At this initial visit with her third rheumatology provider, the clinician elects to explore the issues behind her noncompliance before engaging in diagnostics and treatment using the FIFE model. Which of the following best defines the elements of the FIFE model? a. Focus, intensity, function, and evaluation b. Facts, intensity, focus, and evidence A 59-year-old patient presents to his primary care provider with a history of several episodes of sharp epigastric pain. His father died of pancreatic cancer at age 52 years, and the patient recalls to the clinician that, "His pain was just like mine is now ..." The patient then pauses several seconds. The clinician replies, "Just like?" after which the patient restarts his narrative. Which of the following is an example of the interviewing techniques employed by the clinician? a. Clarifying b. Echoing c. Encouraging with continuers d. Eliciting a graded response e. Asking a leading question ------CORRECT ANSWER---------------b. Echoing A 14-year-old male presents to a new primary care provider after his family relocates to a state. The patient underwent treatment for sarcoma when he was age 11 years, including an above-the-knee amputation. He has learned to successfully navigate with a prosthetic leg and even engage in competitive athletics at school. He does not like to speak of his experience with cancer and often makes up humorous stories to tell new acquaintances about his amputation (such as, "I got bit by a squirrel and they had to amputate."). Although he is very well engaged in most of the visit with the new clinician, when the topic of cancer arises, he demurs to his father, who accompanies him to this appointment. Which of the following statements is most likely to be helpful in cementing the patient's trust in the new provider a. "That sounds like a frightening experience that you are recovering well from." b. "You are becoming an adult ------CORRECT ANSWER---------------a. "That sounds like a frightening experience that you are recovering well from." A 29-year-old electrician complains of persistent cough and wheezing, particularly when he exercises. He says he smokes "occasionally" but rarely so much that he needs to purchase cigarettes: "Mostly, I bum them," he says, chuckling. Upon hearing this information, what is the best next step on the part of the clinician? a. Determine the patient's exercise regimen. b. Determine the number of pack-years the patient smokes. c. Conduct a mental status examination. d. Explain the relationship between smoking and cancer. e. Determine the patient's immunization history. ------CORRECT ANSWER- --------------b. Determine the number of pack-years the patient smokes. A 47-year-old fitness trainer visits the physician assistant (PA) because of skin dryness, night sweats, and irregular menstrual periods. It is the PA's first contact with this patient. The patient notes that "My sex life has really gone downhill lately" and says that she is considering divorcing her husband of 20 years, stating that "He's not a bad guy. I just think that I can do better." In which of the following ways should the clinician proceed? a. Obtain a menstrual history for the previous 6 months. b. Help the patient review the pros and cons of divorce. c. Inform the patient that menopause is a normal part of aging. d. Conduct a breast examination. e. Determine the patient's out-of-country travel history. ------CORRECT ANSWER---------------a. Obtain a menstrual history for the previous 6 months. One important examination technique involves using the third fingers of each hand to determine the health of internal organs. What is the name of this technique? a. Auscultation b. Percussion c. Inspection d. Palpation e. Listening ------CORRECT ANSWER---------------b. Percussion The CAGE questionnaire is a short screening examination administered in the office to evaluate for which of the following? a. Alcohol misuse b. Risk for illicit substance abuse c. Likelihood that the patient complaints are "psychosomatic" d. Major depressive disorder e. Bipolar disorder ------CORRECT ANSWER---------------a. Alcohol misuse A 53-year-old caterer comes to the clinic for a routine examination. She has type 2 diabetes mellitus, which is well controlled on medication. Her history from her last visit reveals that she smoked one pack of cigarettes a day at that time. The 5 As Model is a useful approach to take with trying to help patients to quit smoking. What is the 5 As Model? a. Admonish, action, available, assess, alleviating factors b. Agitate, assist, alleviating factors, able, action c. Affable, associated manifestations, ask, admonish, available d. Ask, advise, assess, assist, arrange e. Arrange, aggravating factors, action, attitude, able ------CORRECT ANSWER---------------d. Ask, advise, assess, assist, arrange A 21-year-old college student experiences tachycardia following a night of heavy drinking. She is advised to undergo a stress electrocardiogram (ECG). As she exercises, the recently calibrated pulse oximeter records a heart rate ranging from 25 beats per minute (bpm) at rest to 50 bpm while jogging. The test is stopped and re-started twice, and each time the pulse oximeter yields a resting heart rate of 25 and a jogging heart rate of 50. Which aspect of this instrument does the ECG technician question? a. Prevalence b. Validity c. Sensitivity d. Specificity e. Predictive value ------CORRECT ANSWER---------------b. Validity The negative predictive value of a test is calculated as the number of true negatives identified by the test divided by the total negatives found by the test. If a novel test for strep throat yields 85 true-negative results and 15 false-negative results, what is the negative predictive value of this test? a. 10% b. 15% c. 75% d. 85% e. 99% ------CORRECT ANSWER---------------d. 85% A 58-year-old carpenter presents for his annual physical examination. The physician assistant notes a systolic murmur on auscultation of the aorta. However, she does not immediately conclude that this patient has aortic stenosis. Which of the following is the reason that she seeks additional information? a. Systolic murmurs have high sensitivity and high specificity for aortic stenosis. b. Systolic murmurs have low sensitivity and low specificity for aortic stenosis. c. Systolic murmurs have low sensitivity but high specificity for aortic stenosis. d. Systolic murmurs have high sensitivity but low specificity for aortic stenosis. e. Systolic murmurs are unrelated to aortic stenosis. ------CORRECT ANSWER---------------d. Systolic murmurs have high sensitivity but low specificity for aortic stenosis. A mother brings her 8-year-old daughter to the clinic because she found a tick in the girl's hair and would like her daughter to be tested for Lyme disease. The nurse practitioner (NP) explains that the enzyme-linked immunosorbent assay (ELISA), an early test for Lyme disease, is effective in finding early cases of Lyme disease but can also give positive results in some people who do not have the disease, making additional testing necessary. This means that the ELISA test has which of the following? a. Low sensitivity, high specificity b. High sensitivity, high specificity c. High sensitivity, low specificity d. Low sensitivity, low specificity e. Undetermined sensitivity and specificity ------CORRECT ANSWER-------- -------c. High sensitivity, low specificity A theoretical laboratory test for infection with HIV is known to have high sensitivity. This means that the test has which of the following? a. Good ability to rule in HIV in those who do have HIV b. Good ability to rule out HIV in those who do not have HIV c. High intraobserver reliability d. High interobserver reliability e. Good ability to diagnose AIDS ------CORRECT ANSWER---------------b. Good ability to rule out HIV in those who do not have HIV A theoretical new laboratory test for strep throat has high specificity. When a test has high specificity, clinicians can be confident in which of the following aspects? a. If the test result is positive, the patient probably has strep throat. b. If the test result is positive, the patient probably does not have strep throat. c. If the test result is negative, the patient probably has strep throat. d. If the test result is negative, the patient probably does not have strep throat. e. If the test result is positive, a confirmatory test should be performed. ------ CORRECT ANSWER---------------a. If the test result is positive, the patient probably has strep throat. Weight change may indicate the presence of important underlying pathology requiring further investigation. Which of the following best describes a significant weight change that requires further evaluation? a. A 45-year-old male with baseline weight of 280 lb who decides to undertake a light exercise regimen and loses 15% of his total body weight in 3 months b. A 32-year-old female with a baseline weight of 175 lb who checks her weight irregularly but reports a 5-lb unintended weight loss over 3 months c. A 45-year-old recently menopausal female who gains 5% beyond her baseline weight of 140 lb in 6 months d. A 26-year-old female with a baseline body mass index (BMI) of 25 who loses 5% of her body weight with 6 months of diet and exercise modification e. A 31-year-old male with a baseline body mass index (BMI) of 20 who loses 3 lb after a prolonged bout of infectious gastroenteritis ------ CORRECT ANSWER---------------a. A 45-year-old male with baseline weight of 280 lb who decides to undertake a light exercise regimen and loses 15% of A 19-year-old student of art history presents to clinic after a syncopal (fainting) episode at school. He is notably thin; on a thorough review of his medical history, he admits that he eats only minimally to maintain a very low body weight that he feels is ideal. He is embarrassed that his issues were discussed by peers after this episode, especially because he believes that this is a problem that is only faced by girls and women. Concerning the two most common eating disorders (anorexia nervosa and bulimia nervosa), which of the following statements is true? a. Men and women are both afflicted, but with a female:male prevalence ratio estimated at ~2:1. b. Both of these eating disorders are associated with a body mass index (BMI) of <17.5. c. Both of these eating disorders are associated with a real or imagined fear of appearing fat. d. Persons with eating disorders are generally easily identified by their appeara ------CORRECT ANSWER---------------c. Both of these eating disorders are associated with a real or imagined fear of appearing fat. Abducens nerve: ------CORRECT ANSWER---------------6. Ability to move your eyes. Facial nerve: ------CORRECT ANSWER---------------7 Facial expressions and sense of taste. Auditory/vestibular nerve: ------CORRECT ANSWER---------------8 Sense of hearing and balance. ?? ------CORRECT ANSWER---------------9 Vagus nerve: ------CORRECT ANSWER---------------10 Digestion and heart rate. Accessory nerve (or spinal accessory nerve) ------CORRECT ANSWER----- ----------11 Shoulder and neck muscle movement. Hypoglossal nerve: ------CORRECT ANSWER---------------12 Ability to move your tongue. Optic nerve Optic neuritis ------CORRECT ANSWER---------------Central and peripheral vision (2) Optic neuritis: Sudden visual loss that is unilateral and can be painful, associated with multiple sclerosis FIFE ------CORRECT ANSWER---------------Helps to explore patient's perspective about health/illness Feelings, ideas, function, and expectations Silent patient ------CORRECT ANSWER---------------Silence can be therapeutic, reflection Differential diagnosis ------CORRECT ANSWER---------------List of possible diagnoses supported by problem list Pertinent negative ------CORRECT ANSWER---------------Absence of a sign or symptom that helps identify a patient's condition Pertinent positives ------CORRECT ANSWER---------------Specific symptoms that raise the physician's suspicion for a particular disease Chronic pain ------CORRECT ANSWER---------------Pain not associated with cancer or other medical conditions that persists for more than 3 to 6 months, pain lasting more than 1 month beyond the course of an acute illness or injury, or pain recurring at intervals of months or years. Chronic pain is the leading cause of disability and impaired performance at work. Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual activity. Depressive, somatoform, and anxiety disorders affect the patient's coping strategies and have to be identified in order to effectively treat acute pain, in particular, chronic pain. Visual acuity 20/100 ------CORRECT ANSWER---------------Means that at 20 feet the patient can read a print that a person with normal vision could read at 100 ft, the larger the second number the worse the vision. First # indicates the distance from the chart. Funduscopic exam ------CORRECT ANSWER---------------The use of an ophthalmoscope to look through the pupil and examine the interior surface of the posterior eye Signs of increased intracranial pressure ------CORRECT ANSWER----------- ----•Papilledema of the optic disc leads to elevated ICP causes intraaxonal edema along the optic nerve leading to engorgement and swelling on the optic disc -Pink, hyperemic, loss of venous pulsations, disc more visible, disc swollen with blurred margins, physiologic cup not visible •Headache, blurred vision, feeling less alert than usual, vomiting, changes in behavior, weakness or problems with moving or talking, lack of energy or sleepiness Edema scale ------CORRECT ANSWER---------------• 1+ Mild pitting, slight indentation, no perceptible swelling of the leg • 2+ Moderate pitting, indentation, subsides rapidly • 3+ Deep pitting, indentation remains for a short time, leg looks swollen • 4+ Very deep pitting, indentation lasts a long time, leg is very swollen A 17-year-old woman presents with her parents to her primary care provider. She desires to utilize a tanning facility ahead of an upcoming event. Her parents have heard that this is a dangerous practice, although the tanning facility insists it is safe without risk of skin cancer in the future after tanning. Which of the following is true regarding ultraviolet (UV) light exposure and subsequent risk of skin cancer? a. Chronic sun exposure confers greater risk for skin cancer than intermittent intensive exposure. b. Tanning beds and sunlamps do not increase risks of skin cancer as they utilize UV wavelengths that are not carcinogenic. c. Water-resistant sunscreens confer no advantage over water-soluble products. d. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors. e. Sunscreen with a sun protective factor (SPF) of 15 blocks ~50% of UV-B light. ------CORRECT ANSWER---------------d. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors. A 52-year-old male presents for an annual examination. He discloses on review of family history that his father has died of skin cancer since his last visit. He personally has had two actinic keratoses frozen and has further lesions that require evaluation today. He is very concerned about his personal and family history and would like to know more about the potential for skin cancer to spread and become a dangerous condition. Which of the following skin lesions is the least likely to metastasize? a. Squamous cell carcinoma (SCC) b. Actinic keratosis c. Melanoma d. Seborrheic keratosis e. Basal cell carcinoma (BCC) ------CORRECT ANSWER---------------d. Seborrheic keratosis A 62-year-old manual laborer presents to an annual physical examination with concerns about skin cancer screening. He does not have any lesions of concern but was recently told by a friend that he should have his skin checked by a doctor yearly. What is the best advice for this patient according to the U.S. Preventive Services Task Force (USPSTF) recommendations on skin cancer screening from 2015? a. The USPSTF recommends that all individual age >50 years be screened yearly for skin cancer regardless of risk factors. b. The USPSTF recommendations mirror those of the American Cancer Society (ACS) and American Academy of Dermatologists (AAD) in recommending and annual skin cancer screening for patients age >50 years. c. The USPSTF recommends skin cancer screening only in sun-exposed areas of fair-skinned individuals every 6 months. d. The USPSTF recommends focused screening of individuals with a history of dysplasti ------CORRECT ANSWER---------------e. The USPSTF recommends against routine screening for skin cancer due to lack of evidence for this intervention across the general population. A 72-year-old retired woman presents to a primary care provider for evaluation of a suspicious mole. She noticed this lesion 3 weeks ago on her right flank in an area where she had previously seen no abnormality. She is very concerned about melanoma and asks if this could be a possible diagnosis and also wonders if this should have been noticed at her annual examination 7 months ago. Concerning the initial recognition of melanoma, which of the following is true? a. The majority of melanomas are recognized during an annual physical examination. b. Approximately 50% of melanomas are initially noticed by patients then brought to the attention of a practitioner. c. General screening programs conducted by medical facilities identify ~75% of melanomas. d. Most melanomas are initially identified in individuals with positive family histories by DNA analysis for causative genes. e. Asymmetry of a mole is rarely associated wi ------CORRECT ANSWER-- -------------b. Approximately 50% of melanomas are initially noticed by patients then brought to the attention of a practitioner. A concerned mother brings her 9-year-old daughter to the clinic with several days of a diffuse rash on the trunk. The child was previously healthy and is current on her vaccinations. The mother relates a history of decreased appetite, easy fatigue, and low-grade subjective fevers. On examination, temperature is recorded at 100.5oF, the rash is confirmed as described by the mother, and additional physical findings of a strawberry tongue and erythema of the palms and soles are noted. Nonpainful peeling of the skin of the child's fingertips is noted incidentally. Based on the history and physical findings, which is the most likely diagnosis and course of action? a. Nonspecific viral exanthem, for which observant management is advised b. Contact dermatitis, for which antihistamines are indicated c. Measles, for which review of the vaccination history is critical d. Kawasaki disease, for which close monitoring and possib ------ CORRECT ANSWER---------------d. Kawasaki disease, for which close monitoring and possibly hospitalization might be required A 16-year-old male high school student presents with a primary concern of acne. He relates a history of 2 years of moderate mild acne and closed comedones (whiteheads), which have recently worsened such that a classmate started calling him a pirate due to a large pustule that developed at the tip of his nose. He has increasing outbreaks of cyst-like acne as well as a generally poor complexion with pitting and scarring from prior outbreaks. Which of the following best describes this condition in the adolescent population? a. Acne vulgaris affects <50% of the adolescent population. b. Acne vulgaris is associated with an identified virus for which there is no definitive treatment. c. Acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as well as other An 87-year-old woman who is generally healthy and cognitively sharp complains to the clinician of slow loss of vision, with similar problems in both eyes, particularly when she looks straight ahead. She is having difficulty reading of late. What is a reasonable response to her? a. "This is a common occurrence with aging and unlikely to have a diagnosis." b. "This is an unusual occurrence, even among elderly, and may be due to a problem within the brain (since it is bilateral)." c. "Are you experiencing depression or stress?" d. "This may be the onset of macular degeneration, which an ophthalmologist should confirm." e. "This is a classic 'floater' and no cause for concern." ------CORRECT ANSWER---------------d. "This may be the onset of macular degeneration, which an ophthalmologist should confirm." A 70-year-old man complains of double vision. Which of the following associated symptoms or signs would be worrying about an underlying neurological problem (as opposed to pathology in the eye)? a. Abnormality in extraocular movements on examination b. Diplopia persisting in the right eye when the left eye is closed c. An associated conjunctivitis d. Worsening vision bilaterally on examination e. Symptoms of flashing lights ------CORRECT ANSWER---------------a. Abnormality in extraocular movements on examination An 82-year-old gentleman seems to be speaking loudly during an examination, suggesting that he may not be hearing well. What is a good question to ask him to help identify whether or not he has hearing loss? a. Has he been listening to loud music? b. How well does he understand people in a noisy environment such as a restaurant? c. Does he have vertigo? d. Has he been having an earache? e. Does he have discharge from his ear? ------CORRECT ANSWER---------- -----b. How well does he understand people in a noisy environment such as a restaurant? A 25-year-old construction worker is complaining of a swishing noise in both ears that never goes away and has occurred for about 6 months. He is otherwise healthy, is able to work on his job (operating large, vibrating machinery) without problems, and is not taking any medications. A complete examination reveals an abnormality. Which of the following abnormality is most often associated with tinnitus? a. Bilateral earache b. Wax in both ears c. Headache d. Vertigo e. Mild tremor ------CORRECT ANSWER---------------d. Vertigo A patient with cystic fibrosis (CF) has been complaining of fullness in his left nasal cavity. Examination of his nose using an otoscope and a speculum reveals a normal nasal septum, but a pale, saclike growth of inflamed tissue that is obstructing a large part of the nasal cavity. What is the most likely diagnosis? a. Ulcer b. Viral rhinitis c. Allergic rhinitis d. Deviated nasal septum e. Nasal polyp ------CORRECT ANSWER---------------e. Nasal polyp 1. A 65-year-old overweight male presents at the clinic with hoarseness which has lasted for around 2 months. He thinks it began along with a cold. He is not feeling badly other than frequent heartburn, and he has continued to work as a bartender (for the past 30 years), but he is having difficulty being heard and understood because of his hoarse voice. A diagnosis that is on the differential list includes which of the following? a. Voice strain from bartending and talking amidst loud ambient noise b. Viral infection c. Acid reflux d. Inhalation of fumes e. Environmental allergies ------CORRECT ANSWER---------------c. Acid reflux A 39-year-old architect comes to the clinic for a 2-day history of fever, chills, cough productive of green sputum, and dyspnea. He has no history of serious illness. His temperature is 101.2oF. His other vital signs are within normal limits. Late inspiratory crackles are heard on auscultation over the left lower lung posteriorly. When the clinician listens over that area and instructs the patient to say "ee," it sounds like "A." Which of the following would most likely be found on percussion of his lungs? a. Flatness b. Hyperresonance c. Stridor d. Tympany e. Dullness ------CORRECT ANSWER---------------e. Dullness A student is practicing the performance of a lung examination on a classmate. Which of the following is the correct order for performing the components of the lung examination? a. Auscultation, inspection, palpation, and percussion b. Auscultation, percussion, palpation, and inspection c. Inspection, palpation, percussion, and auscultation d. Auscultation, inspection, palpation, and percussion e. Inspection, auscultation, percussion, and palpation f. Palpation, inspection, auscultation, and percussion ------CORRECT ANSWER---------------c. Inspection, palpation, percussion, and auscultation transmitted voice sounds." Which of the following is the most likely diagnosis? a. Atelectasis b. Left-sided heart failure c. Pneumonia d. Pneumothorax e. Chronic obstructive pulmonary disease (COPD) ------CORRECT ANSWER---------------a. Atelectasis A 16-year-old boy is brought to the Emergency Department (ED) after a motor vehicle accident for shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a pneumothorax on the right side. The ED physician decides that a chest tube needs to be placed in the fourth intercostal space. How does he determine where the fourth intercostal space is? a. He finds the suprasternal notch and then moves his finger laterally to the third rib. The fourth intercostal space is just below the third rib. b. He finds the angle of Louis and then moves laterally to the first rib. He walks down from there to the fourth intercostal space. c. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to the second intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space. d. He finds the clavicle. The second intercostal space is just below ------ CORRECT ANSWER---------------c. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to the second intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space An elderly patient with a history of smoking two packs of cigarettes a day for 50 years complains to her physician of progressive shortness of breath. On cardiac examination, the physician feels the most prominent palpable impulse to be in the xiphoid area. This is most likely a result of what condition? a. Aortic stenosis b. Hypertrophic cardiomyopathy c. Hypertension d. Pulmonary hypertension e. Mitral regurgitation ------CORRECT ANSWER---------------d. Pulmonary hypertension A newborn baby has an embryologic defect affecting the aortic valve. What other cardiac valve is most likely to be affected? a. Tricuspid valve b. Pulmonic valve c. Mitral valve d. Pyloric valve e. Eustachian valve ------CORRECT ANSWER---------------b. Pulmonic valve A 77-year-old man is experiencing progressive shortness of breath and dizziness. The patient undergoes cardiac catheterization, and the systolic blood pressure measured in the left ventricle is 180 mm Hg, while the systolic blood pressure measured in the aorta is 140 mm Hg. The patient is most likely experiencing symptoms related to what valvular condition? a. Aortic insufficiency b. Mitral stenosis c. Aortic stenosis d. Mitral regurgitation e. Pulmonic stenosis ------CORRECT ANSWER---------------c. Aortic stenosis On routine physical examination, a 40-year-old teacher is found to have a single second heart sound. The most likely explanation for this finding is what? a. Auscultation occurred during inspiration. b. The patient has pulmonic stenosis. c. Auscultation occurred during expiration. d. The patient has a right bundle branch block. e. The patient has a left bundle branch block. ------CORRECT ANSWER---- -----------c. Auscultation occurred during expiration. A first-year medical student is examining a standardized patient with a structurally normal heart. The student is having difficulty auscultating the splitting of the second heart sound. At what area on the patient's chest would the student have the best opportunity of hearing this sound? a. Apex b. Right second interspace c. Left second and third interspace d. Lower left sternal border e. Midsternum ------CORRECT ANSWER---------------c. Left second and third interspace A 20-year-old college student is experiencing dyspnea on exertion and palpitations. On cardiac auscultation, the second heart sound is split and fixed on both inspiration and expiration. What is the most likely cardiac condition associated with this finding? a. Left bundle branch block b. Pulmonic stenosis c. Right bundle branch block d. Atrial septal defect e. Tricuspid stenosis ------CORRECT ANSWER---------------d. Atrial septal defect c. Common femoral d. Superficial femoral e. Popliteal ------CORRECT ANSWER---------------b. Iliac pudendal A 73-year-old retired salesman presents to the Emergency Department complaining of chest pain that started about 2 hours ago. Electrocardiogram, cardiac enzymes, and chest x-ray are normal. The nurse notes that his blood pressures in the right arm are significantly lower than of blood pressures in his left arm. Based on history and physical examination, which of the following will most likely explain his signs and symptoms? a. Dissecting aortic aneurysm b. Coarctation of the aorta c. Myocardial infarction (MI) d. Pulmonary embolism (PE) e. Pericarditis ------CORRECT ANSWER---------------a. Dissecting aortic aneurysm A 19-year-old carwash attendant sustained a laceration to the ulnar aspect of his mid-forearm while at work last week. He did not have it evaluated at that time and is now noticing purulent discharge and increasing pain from the wound along with fever and chills. Where would the clinician expect to find the first signs of lymphadenopathy? a. Epitrochlear nodes b. Lateral axillary nodes c. Central axillary nodes d. Infraclavicular nodes e. Cervical chain nodes ------CORRECT ANSWER---------------a. Epitrochlear nodes When assessing for the femoral pulse, where should the clinician begin deeply palpating? a. Above the inguinal ligament, just lateral to the symphysis pubis b. Above the inguinal ligament, just medial to the anterior superior iliac spine c. Below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis d. Below the inguinal ligament, just lateral to the symphysis pubis e. Below the inguinal ligament, just medial to the anterior superior iliac spine ------CORRECT ANSWER---------------c. Below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis The clinician is palpating pulses in the foot of a diabetic patient while in the clinic. A strong pulse is felt located on the dorsum of the foot, just lateral to the extensor tendon of the big toe. Which artery is being assessed? a. Arterial arch of the foot b. Posterior tibial c. Dorsalis pedis d. Popliteal e. Femoral ------CORRECT ANSWER---------------c. Dorsalis pedis A 61-year-old retired librarian was recently diagnosed with ovarian cancer. She was otherwise healthy until her recent cancer diagnosis. She has not been feeling well lately and has had a cough and some mild shortness of breath for the past couple of days. She now presents to the clinic complaining of pain and swelling in her right groin and leg, which she says is been there for about a week but is worsening. On physical examination, 2+ edema of the right leg up to the thigh; 1+ femoral, popliteal, dorsalis pedis, and posterior tibial pulses; and no significant erythema are noted. What is the chief concern with this patient? a. Acute arterial occlusion b. Superficial thrombophlebitis c. Acute lymphangitis d. Pulmonary embolism (PE) e. Ovarian metastasis ------CORRECT ANSWER---------------d. Pulmonary embolism (PE) A 32-year-old cabdriver complains of pain in his left leg. He has a history of type 2 diabetes, is a smoker, and recently was diagnosed with hypertension. He does not remember injuring his leg; however, he notes that there is a small wound on the lateral aspect of his mid-shin. Upon examination, some mild erythema surrounding the wound and flat, nonpalpable red streaks progressing up his leg are noted. What do these streaks likely represent? a. Thrombus formation in a superficial vein b. Dilated veins secondary to incompetent valves c. Occluded arterial vessels d. Draining lymphatic channels e. Dilated arterioles ------CORRECT ANSWER---------------d. Draining lymphatic channels A clinician, evaluating a patient for valvular competency in the communicating veins of the saphenous system, starts with the patient supine, then elevates one leg to about 90° to empty it of venous blood. Next, the great saphenous vein in the upper part of the thigh is occluded with manual compression, and the patient stands. The clinician keeps the vein occluded while watching for venous filling in the leg. Which test is being performed? a. Allen b. Ankle-brachial index c. Straight-leg raise d. Romberg e. Trendelenburg ------CORRECT ANSWER---------------e. Trendelenburg A 44-year-old retail salesperson has noticed an increasing dilatation of the veins in her legs. Upon inspection, it is noted that she has significant