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Emilio Sanchez is a 12 year old who presents for evaluation after getting hit on the side of the head with a fastball during a game. Which standardized tool would be appropriate to use to evaluate for concussion? A. Glasgow Coma Scale B. Garrick 2-Minute Screening C. SCAT3 form D. Mini Mental Status Exam ---------CORRECT ANSWER-----------------C:CorrectA diagnosis of a concussion involves a comprehensive assessment of the following domains: clinical symptoms, physical signs, behavior, balance, sleep, and cognition. These domains are covered in the Sports Concussion Assessment Tool 3 (SCAT3) form, which is a standardized tool for evaluating athletes 10 years and older for concussion. What is the minimal amount of time that a child with mononucleosis must refrain from playing his or her sport? A. 2 weeks B. 3 weeks C. 4 weeks
D. 6 weeks ---------CORRECT ANSWER-----------------B: CorrectPatients with a current viral illness such as mononucleosis may return to play after 3 weeks if no longer symptomatic and if no splenomegaly is present; fever at the time of the examination is an absolute contraindication because of the association with viral myocarditis. Mrs. Jones brings in her 16-year-old daughter for a routine preparticipation examination. Your concerns include the female athlete triad. This triad includes: A. eating disorder, amenorrhea, and osteoporosis. B. thyroid dysfunction, eating disorder, and amenorrhea. C. stress fractures, thyroid dysfunction, and oligomenorrhea. D. eating disorder, thyroid dysfunction, and osteoporosis. ---------CORRECT ANSWER-----------------A: CorrectA trio of problems, disordered eating, amenorrhea, and osteoporosis, define the female athlete triad. The greatest risk is for athletes whose sport stresses the need to be lean (gymnastics, figure skating, diving, ballet) or to be able to endure (distance running, swimming, cross- country skiing). Early recognition of a possible problem is essential, and the sports preparticipation physical evaluation (PPE) is the right time to begin. Which is an example of a Special Olympics sport that is particularly risky for persons with atlantoaxial instability? A. Swimming B. Badminton C. Floor hockey
fever. Carditis (inflammation of the heart) can result in sudden death with exertion, and fever is associated with an increased risk of heat-related illness (Rice, 2008). Mr. Simmons brings in his 17-year-old son for a preparticipation examination for wrestling. What is the importance of looking for asymmetries in range of motion, strength, and muscle bulk as part of the orthopedic component of the examination? A. Degree of physical development can be assessed. B. Acute or old poorly rehabilitated injuries are identified. C. Need for safety or supportive equipment can be determined. D. Appropriate training exercises can be prescribed. ---------CORRECT ANSWER----- ------------B: CorrectThe examination consists of observing the athlete in a variety of positions and postures that highlight asymmetries in range of motion, strength, and muscle bulk. These asymmetries serve to identify acute or old, poorly rehabilitated injuries. The American Academy of Pediatrics recommends limiting participation in which sport until the adolescent achieves sexual rating 5? A. Wrestling B. Tackle football C. Bodybuilding
D. Curling ---------CORRECT ANSWER-----------------C: CorrectThe American Academy of Pediatrics recommends limiting bodybuilding and power lifting until the adolescent achieves sexual rating 5 (Tanner stage V). The American Academy of Pediatrics opposes the participation of children, adolescents, and young adults in which sport? A. Rugby B. Boxing C. Rodeo D. Wrestling ---------CORRECT ANSWER-----------------B: CorrectThe American Academy of Pediatrics opposes participation in boxing for children, adolescents, and young adults (AAP, 1997). Secondary amenorrhea occurs in as many as ______% of female athletes. A. 10 B. 33 C. 48 D. 69 ---------CORRECT ANSWER-----------------D: CorrectAmong athletes, depending on the sport, secondary amenorrhea occurs in as many as 69% (Nazem and Ackerman, 2012).
Mrs. Casey brings her 14-month-old baby in for a checkup. Which examination approach is suggested for this patient? The baby should be completely undressed and lying down on an examination table. A. The fully clothed baby should be placed on the floor with toys B. the examiner should conduct the examination while the child plays. C. The baby should be completely undressed and held by the examiner. D. The baby should be wearing only a diaper and be sitting on his or her parent's lap. ---------CORRECT ANSWER-----------------D: CorrectThe parent's lap is a fine and helpful examining table. Begin with the child sitting and undressed except for the diaper or underpants. Which of the following assists the examiner in determining the gestational age of a newborn? A. Measurement of the head circumference B. Percussion to determine liver size C. Inspection of hair distribution of the scalp D. Inspection of the sole of the foot ---------CORRECT ANSWER-----------------D: CorrectThe full-term newborn (40 weeks' gestation) commonly has the following physical characteristics: many creases on the sole of the foot; the breast nodule of 4 mm diameter; cartilage present in the helix of the ear; and testes descended into the scrotum covered with rugae.
Mrs. Hilliard brings her 9-year-old daughter to your office. She has been diagnosed with autistic disorder. Which of the following statements best describes this disorder? A. Pervasive neurodevelopmental disorder B. Global intellectual deficit C. Social impairment syndrome D. Right brain dysfunction ---------CORRECT ANSWER-----------------A: CorrectAutism is a pervasive neurodevelopmental disorder of unknown etiology that includes a wide spectrum of disorders typically identified before 3 years of age and is more common in boys than girls. Mr. Edwards presents to the emergency department after an auto accident. Which of the following scales would be used to evaluate the mental status of a patient after head trauma? A. Mini-Mental State Examination B. Perceptual distortion assessment C. Glasgow Coma Scale D. Functional assessment ---------CORRECT ANSWER-----------------C: CorrectThe Glasgow Coma Scale is used to quantify level of consciousness after an acute brain injury or medical condition. The Mini-Mental State Examination (MMSE) is a standardized tool to assess cognitive function changes over time. Perceptual distortion assessment evaluates the variation between a reported perception of a stimulus and the normal response. Functional assessment is an objective measure of a person's ability to perform the activities of daily living.
Mrs. Tucker presents to your office today for a follow-up appointment. She appears to fidget in her seat and with her hands. Which of the following would assess her attention span? A. Are you usually this anxious? B. I am going to ask you to name four items; do the best you can. C. What does this phrase mean: "A stitch in time saves nine?" D. Could you take this paper, fold it in half, and put it on the counter? --------- CORRECT ANSWER-----------------D: CorrectAnswer d is an example of asking the patient a set of short commands that measures attention span. Answer a is a form of validation. Asking answer c measures cognitive abilities, whereas answer b does not provide enough information to determine what the examiner is trying to measure. A mother brings her child, an 18-month-old boy, to the clinic. She states that the child rarely talks or smiles. She has also noticed that he does not like to be held. She states that his motor development seems to be normal. With what condition are these symptoms consistent? A. Dementia B. Autistic disorder C. Attention deficit D. Delirium ---------CORRECT ANSWER-----------------B: CorrectSymptoms such as delayed or underdeveloped language skills and resisting being held or touched are signs of autism, a pervasive neurodevelopmental disorder of unknown etiology that includes a wide spectrum of disorders typically identified before 3 years of age and is more common in boys than girls.
Mr. Johnson presents to your office with a complaint of anxiety. Which area of the mental assessment corresponds to his complaint? A. Cognitive abilities B. Speech/language C. Emotional stability D. Appearance and behavior ---------CORRECT ANSWER-----------------C; CorrectEmotional stability is evaluated when the patient does not seem to be coping well or does not have resources to meet his or her personal needs. Anxiety may be present in other components of the mental assessment, but it is a measure of the patient's emotional stability. Mrs. Karon is a 46-year-old female patient who presents to your office for a physical. When you enter the room, her arms are folded tight and she will not look up to address you. Into which category of examination findings do these observations belong? A. Cognitive abilities B. Speech/language C. Emotional stability D. Appearance and behavior ---------CORRECT ANSWER-----------------D: CorrectBody language, grooming, and emotional status comprise the patient's appearance and behavior. A lack of concern with appearance, or inappropriate dress for season or occasion in a previously well-groomed individual may indicate depression, a psychiatric disorder, or dementia, which are indicative of the patient's emotional status. Answer b is inappropriate becauase the patient did not verbalize anything.
Vascular dementia is a type of dementia related to acute or embolic strokes or cerebral hemorrhages caused by hypertension. Up to 70% of Alzheimer dementia is caused by the presence of senile plaques and neurofibrillary tangles with abnormal amyloid processing or deposits. Which of the following actions would best evaluate the patient's judgment? A. Ask the patient the meaning of the statement "A stitch in time saves nine." B. Provide the patient with four unrelated words and ask the patient to remember them. C. Ask the patient, "What do you plan to do after you are discharged from the hospital?" D. Give the patient pencil and paper and ask him to write a paragraph about judgment. ---------CORRECT ANSWER-----------------C; correctQuestions that focus on the patient's plan for the future are used to assess the patient's judgment, as well as questions to illicit how the patient meets his or her social and familial obligations and those based on hypothetical situations. Answers a, b, and d measure other categories of mental functioning. Mr. Gates is a 68-year-old man who is brought to your office by his daughter. Which of the following would demonstrate an evaluation of thought process and content?
A. Observing the person's patterns of thinking, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed B. Observing congruence of affect and speech C. Inquiring about visual, auditory, or tactile hallucinations D. Asking the patient a question such as "What would you do if you were in a theater and saw a fire starting?" ---------CORRECT ANSWER-----------------A: CorrectThought process and content are evaluated by observing the patient's thought patterns, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed. The patient's thought process should be easy to follow, with logical and goal-directed ideas expressed. Illogical, disorganized, or unrealistic thought processes, flight of ideas (rapid disconnected thoughts), blocking (i.e., an inappropriate pause in the middle of a thought, phrase, or sentence), or impaired stream of thinking (e.g., repetition of a word, phrase, or behavior) indicates an emotional disturbance or a psychiatric disorder. Answers b, c, and d evaluate other components of mental function. Mr. Tucker is a 56-year-old patient who presents to your office with a complaint of rectal pain. On examination you are palpating the lateral and posterior rectal walls. What should you expect to feel? A. A smooth, even, and uninterrupted surface B. Small nodules from internal hemorrhoids C. Tissue folds from the valves of Houston D. Bulging from the bladder wall ---------CORRECT ANSWER-----------------A: CorrectThe walls should feel smooth, even, and uninterrupted.
A pregnant woman presents to the emergency department with the complaint of dark stools. She tells the examiner, "I read in a magazine that this is a sign of bleeding." Which question by the examiner is most applicable for this situation? A. "Where did you read that information?" B. "Have you been giving yourself enemas?" C. "How much fruit and vegetable intake have you had in the last few days?" D. "Are you taking prenatal vitamins?" ---------CORRECT ANSWER-----------------D: CorrectDuring pregnancy, the stool color may be dark green or black if the woman is taking iron supplements. Mr. Allen is a 56-year-old patient who presents for a routine physical examination. Before palpating his prostate, you should tell him, "You may feel an urge to _______." A. urinate B. defecate C. vomit D. faint ---------CORRECT ANSWER-----------------A: CorrectIn men, you can palpate the posterior surface of the prostate gland on the anterior wall. Tell the patient that he may feel the urge to urinate but that he will not. How is the anal ring assessed? A. Inspection of the anus
B. External palpation of the anus C. Use of a sigmoidoscope D. Rotation of a finger within the anal sphincter ---------CORRECT ANSWER----------- ------D: CorrectRotate your finger to examine the muscular anal ring. Which example best describes how firm you expect a healthy prostate gland to feel? A. It feels like a soft olive or grape. B. It feels like the topside of a plastic LEGO piece. C. It feels like a small baseball. D. It feels like a pencil eraser ---------CORRECT ANSWER-----------------D:. CorrectThe gland should feel like a pencil eraser—firm, smooth, and slightly movable—and it should be nontender. What is the best method of verifying anal patency in a newborn? A. Inserting a lubricated thermometer through the anus and into the rectum B. Inserting the fifth digit through the anus and into the rectum C. Checking for the passage of meconium in the first 24 to 48 hours after birth
"Boggy, enlarged, and tender" on rectal examination is descriptive of which condition? A. Prostatitis B. Anorectal abscess C. Prostatic carcinoma D. Rectal polyp ---------CORRECT ANSWER-----------------A: CorrectSeminal vesicles are often involved in prostatitis and may be dilated and tender on palpation; however, the prostate may feel boggy, enlarged, and tender or have palpable areas of fibrosis that simulate neoplasm. A newborn does not pass meconium in the first 24 hours after birth. Which problem must be suspected? A. Biliary atresia B. Cystic fibrosis C. Meckel diverticulum D. Spinal bifida ---------CORRECT ANSWER-----------------B: CorrectIf there is no passage of stool in 24 hours in a newborn, suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis. Enlargement of the prostate may cause:
A. urinary retention. B. a forceful urinary stream. C. infertility. D. prostate cancer. ---------CORRECT ANSWER-----------------A: CorrectSymptoms of an enlarged prostate relate to urinary obstruction: hesitancy, decreased force and caliber of stream, dribbling, incomplete emptying of the bladder, frequency, urgency, nocturia, and dysuria. The primary function of the rectum is: A. formation of feces. B. absorption of water. C. the absorption of nutrients. D. storage of feces. ---------CORRECT ANSWER-----------------D: CorrectAbove the anorectal junction, the rectum dilates and turns posteriorly into the hollow of the coccyx and sacrum, forming the rectal ampulla, which stores flatus and feces. Hemorrhoids are: A. ulcerations of the anal ring. B. varicose veins in the anal region. C. inflammatory lesions of the anal region. D. precursors to rectal polyps. ---------CORRECT ANSWER-----------------B: CorrectExternal hemorrhoids are varicose veins that originate below the anorectal
