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NR 509 / NR509 Advanced Physical Assessment
Week 1 Midterm Exam
Questions with Verified Answers - Chamberlain
Consist of 100 multiple choices Questions with Answers
1. A young man feels something in his scrotum and comes to you for clarifi- cation. On your examination, you note what feels like a "bag of worms" in the left scrotum, superior to the testicles. Which of the following is most likely? A) Hydrocele of the spermatic cord B) Varicocele C) Testicular carcinoma D) A normal vas deferens ANS Varicocle Varicoceles are common in normal men. They are often found in the left
scrotum or bilaterally and should normally resolve in the supine position. This is because they represent varicosities within the scrotum. These require further investigation if they occur only on the right side or do not resolve in the supine position. They can contribute to infertility because the testicles are unable to achieve a cool enough temperature for sperm production, due to increased blood flow from the varicocele. A hydrocele would be a painless mass on the spermatic cord and the vas deferens is palpated as part of the spermatic cord. You should lightly pinch the scrotum medially and move laterally until you feel the spermatic cord pass between your fingers.
2. Which of the following changes are expected in vision as part of the normal aging process? A) Cataracts B) Glaucoma C) Macular degeneration D) Blurring of near vision ANS D The lens loses its elasticity over time as part of the normal aging process, and the eye is less able to accommodate and focus on near objects; therefore, the patient will be expected to have blurring of near vision.
5. 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 ANS D) Dry and rough 6. Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash? A) It is likely to be related to her lupus. B) It is likely to be related to an exposure to a chemical. C) It is likely to be related to an allergic reaction. D) It should not cause any problems. ANS A. It is likely to be related to her lupus
7. You are palpating the abdomen and feel a small mass. Which of the following would you do next? A) Ultrasound B) Examination with the abdominal muscles tensed C) Surgery referral D) Determine size by percussion ANS b) examination with the abdominal muscles tensed. 8. 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) Systemic lupus erythematosus D) Chronic obstructive pulmonary disease (COPD) ANS B) Peripheral Artery Dis- ease
- In obtaining a history, you note that a client uses the word "largely" repeat- edly, to the point of being a distraction to your task. Which word
10. A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast cancer. She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable.Which risk factor of her personal and family history most puts her in danger of getting breast cancer? A) First-degree relative with premenopausal breast cancer B) Age at menarche of less than 12 C) First live birth between the ages of 25 and 29 D) First-degree relative with postmenopausal breast cancer ANS 1st degree relative 11. A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for
about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper res- piratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells).What type of vaginitis best describes her findings? A) Trichomonas vaginitis B) Candida vaginitis C) Bacterial vaginosis D) Atrophic vaginitis ANS C) Bacterial Vaginosis
13. Lucille is in her 24th week. You notice a new onset of high blood pressure readings. Today's value is 168/96. Her urine is normal. What do you suspect? A) Preeclampsia B) Chronic hypertension C) Supine hypotensive syndrome D) Gestational hypertension ANS D) Gestational hypertension 14. A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition? A) Venogram B) CT scan of the lower legs C) Ankle-brachial index (ABI) D) PET scan ANS ABI
- A 20-year-old part-time college student comes to your clinic, complaining of growths on his penile shaft. They have been there for
about 6 weeks and haven't gone away. In fact, he thinks there may be more now. He denies any pain with intercourse or urination. He has had three former partners and has been with his current girlfriend for 6 months. He says that because she is on the pill they don't use condoms. He denies any fever, weight loss, or night sweats. He is engaged to be married and has no children. On visualization of his penis you see several moist papules along all sides of his penile shaft and even two on the corona. He has been circumcised. On palpation of his inguinal region there is no inguinal lymphadenopathy.Which abnormality of the penis does this patient most likely have? ANS Condyloma Acumulata
- Right lower quadrant pain is associated with ANS Appendicitis 17. which is true of the third heart sound (s3) A) it is not heard in atrial fibrillation B) it reflects normal compliance of the left ventricle C) it marks atrial contraction D) it is caused by rapid deceleration of blood against the ventricular wall ANS D rapid deceleration against the ventricle wall 18. A 29-year-old woman comes to your office. As you take the history, you notice that she is speaking very quickly, and jumping from topic
of the left rapidly that you have trouble following her. You are able to find some con- nections between ideas, but it is difficult. Which word describes this thought process? A) Derailment B) Flight of ideas C) Circumstantiality D) Incoherence ANS B) Flight of ideas
19. identify the macula on the image representing the structures fundus ANS
- a young hispanic mother brings her son in with a questionable bruse ANS mon- golian spot 21. HPV Vaccine does what? Administered? prevents ano-genital lesions? ANS Prevents ano-genital lesions? 22. Which of the following represents age-related changes in the lungs?
A) Decrease in chest wall compliance B) Speed of expiration increases C) Increase in respiratory muscle strength D) Increased elastic recoil of lung tissue ANS A) Decrease in chest wall compliance
23. What is a nonmodifiable risk factor for breast cancer? cigarette smoking alcoho l age paternal aunt had breast cancer ?? ANS checking for expansion 24. A 22-year-old law student comes to the office complaining of severe ab- dominal pain radiating to his back. He states it began last night after hours of heavy drinking. He has had abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep any food or water down, and these symptoms have been going on for almost 12 hours. He has had
week of pregnancy? A) Generalized hair loss B) A hyperpigmented rash over the maxillary region bilaterally C) Nosebleeds D) Facial edema ANS D) Facial edema
26. A 50-year-old realtor comes to your office for evaluation of neck pain .She was in a motor vehicle collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think that she needed to go to the emergency room at that time .Now, she has severe pain and stiffness in her neck .On physical examination, you note pain and spasm over the paraspinous muscles on the left side of the neck, and pain when you make the patient do active range of motion of the cervical spine .What is the most likely cause of this neck pain? ANS Cervical sprain 27. You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process? a. tenderness b. cool to touch c. erythema d. nodules
ANS tenderness
d) Impaired neural innervation ANS B Psychological issues
31. A 26-year-old stewardess comes in for a third trimester prenatal visit. She has had prenatal care since her sixth week of pregnancy. She has no complaints today and her prenatal course has been unremarkable. Today her blood pressure and weight gain are appropriate and her urine is unremarkable. You have a first-year medical student shadowing you, so you ask the student to get Doptones and measure the patient'suterus in centimeters. The student promptly reports fetal heart tones of 140, but he is having difficulty obtaining the correct measurement. He knows one end of the tape goes over the uterine fundus. From what inferior anatomic position should the tape be placed? A) Vagina B) Clitoris C) Pubic symphysis D) Umbilicus ANS Pubic Symphysis 32. Which of the following represents metrorrhagia? a) Fewer than 21 days between menses b) Excessive flow c) Infrequent bleeding
d) Bleeding between periods ANS bleeding between periods
