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Exam 1 - Advanced Health Assessment
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. explain that she is a PA student b. explain how the examination will proceed c. adjust lighting so it is tangential to the patients' body d. provide ongoing interpretation of findings e. ask the patient where he comes from - correct answer 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 to 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. following the patient's lead to understand their thoughts, ideas, concerns and requests c. taking charge of the interaction to meet the clinician's desire to acquire diagnostic information d. taking a symptom-focused a - correct answer 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 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 conjuncture in his care with the clinic. Which of the following is an example of an active listening technique? a. setting aside the patient's emotional state to focus on his medical needs
b. considering a differential diagnosis while the patient is speaking to maximize the patient's tim - correct answer 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 describes the elements of the FIFE model? a. Feelings, Impression, Fantasy, and Emotion b. Focus, Intensity, Function, and Evaluation c. Facts, Intensity, Focus, and evidence d. Facts, Intelligence, Fortuity, and Even - correct answer Feelings, Ideas, Function, and Expectations 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. percussion b. inspection c. auscultation d. listening e. palpation - correct answer Percussion A 59-year-old unemployed man complains of almost always feeling tired and hungry, despite getting sufficient rest and having a good appetite and access to sufficient food. The patient is obese and, despite the warm weather outside, wearing thermal socks with his sandals. He says this is because his feet are always cold and "feel funny." With which body system should the clinician begin the examination? a. nervous system b. abdomen c. Head and neck d. posterior thorax e. lower extremeties - correct answer Head and neck
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. bipolar disorder d. major depressive disorder e. likelihood that the patient complaints are "psychosomatic" - correct answer 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. Ask, advise, assess, assist, arrange c. Agitate, assist, alleviating factors, able, action d. Arrange, alleviating factors, action, attitude, able e. Affable, associated manifestations, ask, admonish, available - correct answer Ask, advise, assess, assist, arrange A 42-year-old fair-skinned woman of Irish origin presents with an abnormal skin growth that was first noted 7 years ago. On examination, a 2x3-cm lesion is noted over her left bicep. Which of the following historical elements most increases the suspicion that the lesion is malignant? a. Proximal location, that is, over the bicep rather than the distal arm b. No evolution in size since onset, but mild intermittent pruritis over the past 2 years c. Presence of similar pinkish tan lesions on the sun-exposed areas including the face and hands d. No evolution in size since onset, but uniformly darkly pigmented color e. Minimal but discernible increase in size over the past 6 months - correct answer Minimal but discernible increase in size over the past 6 months 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. tanning beds and sunlamps do not increase risks of skin cancer as they utilize UV wavelengths that are not carcinogenic b. sunscreen with a sun protective factor (SPF) of 15 blocks -50% of UV-B light c. targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors d. water-resistant sunscreens confer no advantage over water-soluble products e. chronic sun exposure confers greater risk for skin cancer than intermittent intensive exposure - correct answer Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors Physical assessment plays a key role in the patient with acute coronary syndrome. Match the physical finding with the correct pathophysiology: a. 1 cm JVD in the supine position-heart failure b. New S3heart sound - heart failure c. New systolic murmur - ruptured papillary muscle with mitral valve insufficiency d. All but answer 1 are correct - correct answer All but answer 1 are correct Select all risk factors below that are modifiable: a. obesity b. cigarette smoking c. hypertension d. heredity e. race f. physical inactivity - correct answer A, B, C, F If the following patient develops a sustained sinus tachycardia, treatment such as beta blockade to decrease the rate should be considered: a. Acute coronary syndrome with evolving myocardial infarction b. Congestive heart failure with ejection fraction of 30% c. GI bleed d. Multiple trauma - correct answer Acute coronary syndrome with evolving myocardial infarction
B. Increase in frequency or duration of chest pain C. Chest pain associated with coronary spasm D. Any chest pain exceeding 15 minutes and unrelieved by NTG or rest should be presumed infarction until proven otherwise. - correct answer Stable angina - A Unstable angina - B Variant angina - C Acute myocardial infarction - D STEMI myocardial infarction is suspected in what location of the heart? a. anterior wall myocardial infarction b. inferior wall infarction c. pericarditis d. lateral wall myocardial infarction - correct answer inferior wall infarction Please match the following EKG findings in acute coronary syndrome (ACS). Question: Normal _____ Ischemia _____ Injury _____ Infarction _____ Answer Choices: A. T wave inversion B. ST segment elevation>2mm C. Abnormal Q waves D. Absence of ischemia, injury, or infarction at this time - correct answer Normal - D Ischemia - A Injury - B Infarction - C
You are beginning the examination of the patient. All of the following areas are important to observe as part of the General Survey except: a. level of consciousness b. signs of distress c. dress, grooming, and personal hygiene d. blood pressure - correct answer blood pressure The components of the health history include all of the following except: a. review of systems b. thorax and lungs c. present illness d. personal and social items - correct answer thorax and lungs A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? a. ptosis b. exopthalmos c. ectropion d. epicanthus - correct answer exopthalmos Epiglottis requires: a. outpatient treatment with antibiotis b. immediate referral to ER c. a careful and thorough exam of the mouth and pharynx - correct answer immediate referral to the ER A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wart- like texture on palpation. Based on this description, what is your most likely diagnosis? a. actinic keratosis b. seborrheic keratosis
Folliculitis _____ Herpes Zoster _____ Answer Choices: a. facial comedomes and pustules b. linear vesicles on arms c. tender, firm nodule with surrounding redness d. parethesias and vesicles in one dermatome area - correct answer Acne - A Contact dermatitis - B Folliculitis - C Herpes Zoster - D What symptom is usually not indicative of strep throat? a. fever b. pharyngeal exudates c. lymphadenopathy d. cough - correct answer cough A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis? a. dacryocystitis b. chalazion c. hordeolum d. xanthelasma - correct answer hordeolum Is the following information subjective or objective? Mr. M has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest. - correct answer Subjective
You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism? a. moist and smooth b. moist and rough c. dry and smooth d. dry and rough - correct answer dry and rough A 67-year-old lawyer comes to your clinic for an annual examination. He denies any history of eye trauma. He denies any visual changes. You inspect his eyes and find a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. He has a normal papillary reaction to light and accommodation. Based on this description, what is the most likely diagnosis? a. corneal arcus b. cataracts c. corneal scar d. pterygium - correct answer pterygium A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin,covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? a. actinic keratosis b. seborrheic keratosis c. basal cell carcinoma d. squamous cell carcinoma - correct answer actinic keratosis Normally sound is heard longer through air than bone, which test is used to determine this? a. Rhinne b. Weber - correct answer Rhinne
You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10-year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent? a. hypertension b. peripheral arterial disease c. systematic lupus erythematosus d. COPD - correct answer peripheral arterial disease A 58-year-old teacher presents to your clinic with a complaint of chest pain. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems? a. abdominal pain b. hematochezia c. orthopnea d. tenesmus - correct answer orthopnea You are performing a cardiac examination on a patient with shortness of breath and palpitations. You listen to the heart with the patient sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position? a. aortic b. pulmonic c. tricuspid d. mitral - correct answer mitral A 44-year-old female comes to your clinic complaining of severe dry skin in the area over her right nipple. She denies any trauma to the area. She noticed the skin change during a self-breast exam 2 months ago. She also admits that she had felt a lump under the nipple but kept putting off making an appointment. She does admit to 6 months of fatigue but no weight loss, weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism. She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug use. On exam you find a middle-aged woman appearing her stated age. Inspection of her right breast reveals a scaly eczema-like crust around her
nipple. Underneath you palpate a nontender 2 cm mass. The axilla contains only soft moveable nodes. The left breast exam and axilla are unremarkable. What visible skin change of the breast does she have? a. nipple retraction - correct answer Paget's disease A 56 year old man complains of having a morning cough for 5 years that has increased in the last 2 days. He is a 30 Pack year smoker and has also noticed wheezing and dyspnea lately. His PFT is as follows: FVC: predicted 6.0 liters, Measured 4.0 liters (% predicted 67%) FEV1: predicted 5.0 liters, Measured 2.0 liters ( % predicted 40%) FEV1:FVC: predicted 84%, Measured: 50%, (% predicted 60%) What is the most likely diagnosis? a. pulmonary fibrosis b. asthma c. COPD d. sarcoidosis - correct answer COPD A viral upper respiratory infection is best described as: a. Purulent nasal discharge, pain over sinuses, facial pain, or tooth pain. Nasal turbinates red, swollen. Symptoms for greater than 1 week., May have red streaks on TM. b. Sneezing, itching eyes, post-nasal drip, clear nasal discharge, turbinates boggy, swollen, and congested. c. Clear to yellowish nasal discharge, no sinus pain, and nasal mucosa is reddened; TM s may be slightly reddened. Symptoms are lasting 2-3 days and are gradually improving. Exposure to others with similar symptoms - correct answer Sneezing, itching eyes, post-nasal drip, clear nasal discharge, turbinates boggy, swollen, and congested. A diagnosis of Influenza most closely fits which of the following descriptions: a. Fever 101.5 or greater, severe sore throat, sudden onset, no cough or rhinorrhea, other family members ill with sore throat. b. Low grade fever to 104, onset 1-2 days after other cold symptoms, has 2 of the following: cough, rhinorrhea, conjunctivitis, hoarseness.
b. Considered this a normal finding as her mammogram was WNL 2 months ago c. Observe for 1-2 months, decrease caffeine intake, then refer for biopsy d. Treat with antibiotics and recheck in 1 month - correct answer Obtain a mammogram and refer to a surgeon for surgical biopsy What is responsible for the inspiratory splitting of S 2? a. closure of aortic then pulmonic valves b. closure of mitral then tricuspid valves c. closure of aortic then tricuspid valves d. closure of mitral then pulmonic valves - correct answer closure of aortic then pulmonic valves You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse or increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse? a. hypothyroidism b. aortic stenosis, with pressure overload of the left ventricle c. mitral stenosis, with volume overload of the left atrium d. aortic regurgitation, with volume overload of the left ventricle - correct answer aortic stenosis, with pressure overload of the left ventricle A 63-year-old nurse comes to your office upset because she has found an enlarged lymph node under her right arm. She states she found it last week while taking a shower. She isn't sure if she has any breast lumps because she doesn't know how to do self- breast exams. She states her last mammogram was 5 years ago and it was normal. Her past medical history is significant for high blood pressure and chronic obstructive pulmonary disease. She quit smoking 2 years ago after a 55-pack a year history. She denies any illegal drugs and drinks alcohol rarely. Her mother died of a heart attack and her father died of a stroke. She has no children. On exam you see an older female appearing her stated age. On visual inspection of her right axilla you see nothing unusual. Palpating this area you feel a 2 cm hard fixed lymph node. She denies any tenderness. Visualization of both breasts is normal. Palpation of her left axilla and b - correct answer breast cancer You are evaluating a 57-year-old army veteran as part of the heart failure (HF) clinic. You palpate a heave on examination. Which of the following conditions could be responsible for creating this finding? a. left ventricular hypertrophy
b. atrial septal defect c. tricuspid stenosis d. tricuspid regurgitation - correct answer left ventricular hypertrophy A 21-year-old college senior presents to your clinic complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is only significant for seasonal allergies, for which she takes a nasal steroid. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On exam she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her respirations are 20. H
- correct answer asthma A 43-year-old store clerk comes to your office upset because she has found an enlarged lymph node under her left arm. She states she found it yesterday when she was feeling pain under her arm during movement. She states the lymph node is about an inch long and is very painful. She checks her breasts monthly and gets a yearly mammogram (her last was 2 months ago) and until now everything has been normal. She states she is so upset because her mother died in her 50s of breast cancer. The patient does not smoke, drink, or use illegal drugs. Her father is in good health. On exam you see a tense female appearing her stated age. On visual inspection of her left axilla you see a tense red area. There is no scarring around the axilla. Palpating this area you feel a 2 cm tender movable lymph node underlying hot skin. Other shoddy nodes are also in the area. Visualization of both breasts is normal. Palpation of her right axill - correct answer lymphadenopathy of infectious origin 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 to 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. basal cell carcinoma (BCC) b. seborrheic keratosis c. squamous cell carcinoma d. melanoma e. actinic keratosis - correct answer seborrheic keratosis
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 outbreaks. Which of the following best describes this condition in the adolescent population? a. acne vulgaris is associated with an identified virus for which there is no definitive treatment b. acne vulgaris is always associated with underlying endocrine disorders and/or pituitary dysfunction c. acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as well as other contributory factors d. the primary hormonal stimulus for acne vulgaris is estrogen, ca - correct answer acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as well as other contributory factors A 72-year-old woman presents with concerns about several ruby-red spots on her chest and abdomen. She reports that these are growing in both size and number over time. On examination, the provider notes a number of cherry angiomas at the locations indicated by the patient. No other abnormalities are noted. Which of the following best describes the clinical characteristics and significance of a cherry angioma? a. cherry angiomas are a marker for underlying pathology that requires additional evaluation b. cherry angiomas never show blanching under pressure c. cherry angiomas are associated with liver disease and B vitamin deficiencies d. cherry angiomas are benign and may increase in size and number with aging e. cherry angiomas rarely occur on the trunk and are most often noted on the legs near veins - correct answer cherry angiomas are benign and may increase in size and number with aging A 28-year-old male business executive presents to the primary care provider with concerns about hair loss. He is otherwise healthy without chronic medical conditions or current medications. He has a chart history of allergy to sulfa medications, although this happened when he was a young child, and he does not recall the incident or the reaction. He is unsure at what age his father went bald, as he never remembers his father having hair. He remarks jokingly that he is losing more hair than his dogs at home, who shed frequently but are otherwise healthy. On examination, he has a single uniform oval patch of hair loss over the left temporal area without any scaling, inflammation, or other skin changes where the hair is missing. Which of the following is the most likely explanation for his hair loss? a. alopecia areata, as evidence by patchy hair loss without associated changes b. drug rash, as evidence by his allergy t - correct answer alopecia areata, as evidence by patchy hair loss without associated changes
A 33-year-old nurse presents with a history of weight gain, decreased energy, and menorrhagia over the past several months. Review of her family history reveals Hashimoto thyroiditis and hypothyroidism in four female first-degree relatives (her mother and three sisters). Which of the following skin findings best supports a diagnosis of clinical hypothyroidism? a. thickened, taut skin with sclerodactyly and telangiectasia b. warm moist skin, hyperpigmentation, and pretibial myxedema c. spider angiomas, telangiectasia, palmar erythema, and terry nails d. discoid rash, alopecia, oral ulcers, and Reynaud phenomenon e. dry skin, myxedema, alopecia of the eyebrows, and brittle nails - correct answer dry skin, myxedema, alopecia of the eyebrows, and brittle nails A 74-year-old man is being seen because of a 1-day history of a painful right eye. He also mentions that he has blurred vision in that eye. He thought something had blown into his eye, but after flushing it out, the pain and blurred vision remains. What is the best course of action? a. check his blood pressure b. refer to an ophthalmologist emergently with the possibility of corneal ulcer, uveitis, or acute glaucoma c. perform a complete neurological examination d. perform a vision examination e. reassure him that pain from a foreign body can remain for a day or two (even after the foreign body is removed) - correct answer refer to an ophthalmologist emergently with the possibility of corneal ulcer, uveitis, or acute glaucoma 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 may be the onset of macular degeneration, which an ophthalmologist should confirm." b. "This is a common occurrence with aging and unlikely to have a diagnosis." c. "Are you experiencing any depression or stress?" d. "This is a classic 'floater' and no cause for concern." e. "This is an unusual occurence, even among elderly, and may be due to a problem within the brain (since it is bilateral)." - correct answer "This may be the onset of macular degeneration, which an ophthalmologist should confirm."
