NUR-634 Final Exam Test Prep
You are examining an elderly man and notice the following: Decreased
vibration sense in the feet and ankles, diminished
... [Show More] gag reflex, right patellar reflex
less than the left, and diminished abdominal reflexes. Which of these is
abnormal?
Decreased vibration sense
Diminished gag reflex
Diminished right patellar reflex compared to the left
Diminished abdominal reflexes
Question Points: 1.0 / 1.0
A 68-year-old retired farmer presents 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?
Actinic keratosis
Seborrheic keratosis
Basal cell carcinoma
Squamous cell carcinoma
Question Points: 1.0 / 1.0
A 14-year-old junior high school student is brought in by his mother and
father because he seems to be developing breasts. The mother is upset because
she read on the Internet that smoking marijuana leads to breast enlargement in
males. The young man adamantly denies using any tobacco, alcohol, or drugs.
He has recently noticed changes in his penis, testicles, and pubic hair pattern.
Otherwise, his past medical history is unremarkable. His parents are both in good
health. He has two older brothers who never had this problem. On examination,
you see a mildly overweight teenager with enlarged breast tissue that is slightly
tender on both sides. Otherwise his examination is normal. He is agreeable to
taking a drug test.
What is the most likely cause of his gynecomastia?
Breast cancer
Imbalance of hormones of puberty
Drug use Alcohol use
Question Points: 1.0 / 1.0
A 17-year-old female presents to your office, complaining of a clear discharge
from her right breast for 2 months. She states that she noticed it when she and
her boyfriend were “messing around” and he squeezed her nipple. She continues
to have this discharge anytime she squeezes that nipple. She denies any trauma
to her breasts. Her past medical history is unremarkable. She denies any
pregnancies. Both of her parents are healthy. She denies using tobacco or illegal
drugs and drinks three to four beers a week. On examination, her breasts are
symmetric with no skin changes. You are able to express clear discharge from
her right nipple. You feel no discrete masses and her axillae are normal. The
remainder of her heart, lung, abdominal, and pelvic examinations are
unremarkable. A urine pregnancy test is negative.
What cause of nipple discharge is the most likely in her circumstance?
Benign breast abnormality
Breast cancer
Nonpuerperal galactorrhea
Pagets disease
Question Points: 1.0 / 1.0
A 26-year-old flight attendant presents 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's uterus in centimeters. The nurse
practitioner 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?
Vagina
Clitoris
Pubic symphysis
Umbilicus
Question Points: 1.0 / 1.0 A 58-year-old gardener presents 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?
Actinic keratosis
Seborrheic keratosis
Basal cell carcinoma
Squamous cell carcinoma
Question Points: 0.0 / 1.0
Which of the following represents age-related changes in the lungs?
Decrease in chest wall compliance
Speed of expiration increases
Increase in respiratory muscle strength
Increased elastic recoil of lung tissue
Question Points: 1.0 / 1.0
A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and
fussiness. The ear examination is as follows: external ear, normal appearance
and no tenderness with manipulation; canal, normal diameter without
evidence of inflammation; tympanic membrane, bulging, erythematous, and
opaque. Insufflation is deferred due to pain. What is the most likely condition
here?
Otitis externa
Cholesteatoma
Ruptured tympanic membrane
Otitis media
Question Points: 1.0 / 1.0
A 28-year-old musician presents to your clinic, complaining of a “spot” on his
penis. He states his partner noticed it 2 days ago and it hasn't gone away. He
says it doesn't hurt. He has had no burning with urination and no pain duringintercourse. He has had several partners in the last year and uses condoms
occasionally. His past medical history consists of nongonococcal urethritis from
Chlamydia and prostatitis. He denies any surgeries. He smokes two packs of
cigarettes a day, drinks a case of beer a week, and smokes marijuana and
occasionally crack. He has injected IV drugs before but not in the last few years.
He is single and currently unemployed. His mother has rheumatoid arthritis, and
he doesn't know anything about his father. On examination, you see a young
man appearing deconditioned but pleasant. His vital signs are unremarkable. On
visualization of his penis, there is a 6-mm red, oval ulcer with an indurated base
just proximal to the corona. There is no prepuce because of neonatal
circumcision. On palpation, the ulcer is nontender. In the inguinal region, there is
nontender lymphadenopathy.
What disorder of the penis is most likely the diagnosis?
Condylomata acuminata
Genital herpes
Syphilitic chancre
Penile carcinoma
Question Points: 1.0 / 1.0
A 22-year-old law student presents to your office complaining of severe
abdominal 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 no recent
illnesses or injuries. His past medical history is unremarkable. He denies smoking
or using illegal drugs but admits to drinking 6 to 10 beers per weekend night. He
admits that last night he drank something like 14 drinks. On examination you
find a young male appearing his stated age in some distress. He is leaning over
on the examination table and holding his abdomen with his arms. His blood
pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal examination
reveals normal bowel sounds, but he is very tender in the left upper quadrant
and epigastric area. He has no Murphy's sign or tenderness in the right lower
quadrant. The remainder of his abdominal examination is normal. His rectal,
prostate, penile, and testicular examinations are normal. He has no inguinal
hernias or tenderness with that examination. Blood work is pending.
What etiology of abdominal pain is most likely causing his symptoms?
Peptic ulcer disease
Biliary colic
Acute cholecystitis
Acute pancreatitis Question Points: 1.0 / 1.0
A 56-year-old female presents to your clinic complaining that her left breast
looks unusual. She says that for 2 months the angle of the nipple has changed
direction. She does not do self-examinations, so she doesn't know if she has a
lump. She has no history of weight loss, weight gain, fever, or night sweats. Her
past medical history is significant for high blood pressure. She smokes two packs
of cigarettes a day and has three to four drinks per weekend night. Her paternal
aunt died of breast cancer in her forties. Her mother is healthy, but her father
died of prostate cancer. On examination, you find a middle-aged woman
appearing older than her stated age. Inspection of her left breast reveals a
flattened nipple deviating toward the lateral side. On palpation, the nipple feels
thickened. Lateral to the areola you palpate a nontender 4-cm mass. The axilla
contains several fixed nodes. The right breast and axilla examinations are
unremarkable.
What visible skin change of the breast does she have?
Nipple retraction
Paget's disease
Peau d'orange sign
Mastitis
Question Points: 0.0 / 1.0
A 32-year-old white female presents to your clinic complaining of
overwhelming sadness. She says for the past 2 months she has had crying
episodes, difficulty sleeping, and problems with overeating. She says she used to
go out with her friends from work, but now she just wants to go home and be by
herself. She also thinks that her work productivity has been dropping because
she just is too tired to care or concentrate. She denies any feelings of guilt or any
suicidal ideation. She states that she has never felt this way in the past. She
denies any recent illness or injuries. Her past medical history consists of an
appendectomy when she was a teenager; otherwise, she has been healthy. She
is single and works as a clerk in a medical office. She denies tobacco, alcohol, or
illegal drug use. Her mother has high blood pressure and her father has had a
history of mental illness. On examination, you see a woman appearing her stated
age who seems quite sad. Her facial expression does not change while you talk
to her and she makes little eye contact. She speaks so softly you cannot always
understand her. Her thought processes and content seem unremarkable.
What type of mood disorder do you think is most likely?
Dysthymic disorder
Manic (bipolar) disorder
Major depressive episode
Anxiety disorder Question Points: 1.0 / 1.0
A young Hispanic mother brings in her 2-month-old son. She is upset
because her neighbors have threatened to call the Child Protective Agency
because they think his birthmark is a bruise. Her son was the product of an
uneventful pregnancy and spontaneous vaginal delivery. On examination, you
see a large, smooth-bordered bluish mark on his buttock and lower back.
Otherwise his examination is unremarkable.
What form of birthmark is this likely to be?
Café-au-lait spot
Salmon patch
Mongolian spot
Cherry hemangioma
Question Points: 1.0 / 1.0
A 15-year-old high school sophomore presents to the clinic for evaluation of a
3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain;
and nonproductive cough.
Which is the most likely pathologic process?
Infection
Inflammation
Allergic
Vascular
Question Points: 1.0 / 1.0
A 22-year-old clerk, primigravida, presents to your office for a prenatal visit.
She is in her second trimester and has had prenatal care since she was 8 weeks
pregnant. Her only complaint is that she has a new brownish line straight down
her abdomen. On examination her vital signs are unremarkable. Her urine has no
protein, glucose, or leukocytes. With a doppler the fetal heart rate is 140, and
her uterus is palpated to the umbilicus. Today you are sending her for congenital
abnormality screening and setting up an ultrasound.
What physical finding is responsible for her new “brown line”?
Corpus luteum
Linea nigra Linea alba
Diastasis recti
Question Points: 1.0 / 1.0
Mr. Q. is a 45-year-old salesman who presents to your office for evaluation of
fatigue. He has come to the office many times in the past with a variety of
injuries, and you suspect that he has a problem with alcohol. Which one of the
following questions will be most helpful in diagnosing this problem?
You are an alcoholic, aren't you?
When was your last drink?
Do you drink 2 to 3 beers every weekend?
Do you drink alcohol when you are supposed to be working?
Question Points: 1.0 / 1.0
A 35-year-old bus driver presents to your office for a prenatal visit. She is
approximately 28 weeks pregnant and has had no complications. She is
complaining only of heartburn and has had no fatigue, headaches, leg swelling,
contractions, leakage of fluid, or bleeding. On examination, her blood pressure is
142/92 and her urine shows no glucose, protein, or leukocytes. Her weight gain is
appropriate, with no large recent increases. Fetal tones are 140 and her uterus
measures 32 cm from the pubic bone. Looking back through her chart, you see
her prenatal blood pressure was 120/70 and her blood pressures during the first
20 weeks were usually 120 to 130/70 to 80.
What type of blood pressure is this?
Normotensive for pregnancy
Chronic hypertension
Gestational hypertension
Preeclampsia
Question Points: 1.0 / 1.0
A sudden, painless unilateral vision loss may be caused by which of the
following?
Retinal detachment Corneal ulcer
Acute glaucoma
Uveitis
Question Points: 0.0 / 1.0
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?
First-degree relative with premenopausal breast cancer
Age at menarche of less than 12
First live birth between the ages of 25 and 29
First-degree relative with postmenopausal breast cancer
Question Points: 1.0 / 1.0
When should a woman conduct breast self-examination with respect to her
menses?
Five to seven days following her menses
Midcycle
Immediately prior to menses
During her menses
Question Points: 1.0 / 1.0
Jacob, a 33-year-old construction worker, complains of a “lump on his back”
over his scapula. It has been there for about a year and is getting larger. He says
his wife has been able to squeeze out a cheesy-textured substance on occasion.He worries this may be cancer. When gently pinched from the side, a prominent
dimple forms in the middle of the mass.
What is most likely?
An enlarged lymph node
A sebaceous cyst
An actinic keratosis
A malignant lesion
Question Points: 1.0 / 1.0
You have been unable to hear normal S2 splitting in children up to this point.
What technique will maximize your chances of hearing this phenomenon?
Listen with the diaphragm over the left lower sternal border.
Listen with the bell over the 2nd left intercostal space.
Listen with the bell over the apex.
Listen with the diaphragm in the axilla.
Question Points: 1.0 / 1.0
A grandmother brings her 13-year-old grandson to you for evaluation. She
noticed last week when he took off his shirt that his breastbone seemed
collapsed. He seems embarrassed and tells you that it has been that way for
quite some time. He states he has no symptoms from it, and he just tries not to
take off his shirt in front of anyone. He denies any shortness of breath, chest
pain, or lightheadedness on exertion. His past medical history is unremarkable.
He is in sixth grade and just moved in with his grandmother after his father was
deployed to the Middle East. His mother died several years ago in a car accident.
He states that he does not smoke and has never touched alcohol. On
examination, you see a teenage boy appearing his stated age. On visual
examination, of his chest you see that the lower portion of the sternum is
depressed. Auscultation of the lungs and heart are unremarkable.
What disorder of the thorax best describes your findings?
Barrel chest
Funnel chest (pectus excavatum)
Pigeon chest (pectus carinatum)
Thoracic kyphoscoliosis Question Points: 0.0 / 1.0
Ray works a physical job and notes pain when he attempts to lift his arm
over his head. When you move the shoulder passively, he has full range of
motion without pain and there is no gross swelling or tenderness. What type of
joint disease does this most likely represent?
Articular
Extra-articular
Neither
Both
Question Points: 1.0 / 1.0
Blood pressure abnormalities found more commonly in Western elderly
include which of the following?
Isolated elevation of the diastolic BP
Narrow pulse pressure
Elevation of the systolic BP
Elevation of the BP with standing
Question Points: 1.0 / 1.0
A 22-year-old architecture major presents to your office complaining of
severe burning with urination, a fever of 101 degrees, and aching all over. She
denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms.
Her past medical history consists of severe acne. She is currently on an oral
contraceptive. She has had no pregnancies or surgeries. She reports one new
partner within the last month. She does not smoke but does drink occasionally.
Her parents are both in good health. On examination, you see a young woman
appearing slightly ill. Her temperature is 100.3 and her pulse and blood pressure
are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and
abdominal examinations are unremarkable. Palpation of the inguinal nodes
shows lymphadenopathy bilaterally. On visualization of the perineum, there are
more than 10 shallow ulcers along each side of the vulva. Speculum and
bimanual examination are unremarkable for findings, although she is very tender
at the introitus. Urine analysis has some white blood cells but no red blood cells
or bacteria. Her urine pregnancy test is negative.
Which disorder of the vulva is most likely in this case?
Genital herpes Condylomata acuminata
Syphilitic chancre
Epidermoid cyst
Question Points: 0.0 / 1.0
A 36-year-old married bank teller presents to your office, complaining of
pain with defecation and occasional blood on the toilet paper. She states that last
week she had food poisoning with nausea, vomiting, and diarrhea. She had runny
stools but no black or bloody stools. Ever since her illness, she has continued to
have severe pain with bowel movements. She now tries to put off defecation as
long as possible. Although she is having constipation she denies any further
diarrhea or leakage of stool. She has a past medical history of hypothyroidism
and two spontaneous vaginal deliveries. She has had no other chronic illnesses
or surgeries. She does not smoke and rarely drinks. She has two children. There
is no family history of breast or colon cancer. She has had no weight gain, weight
loss, fever, or night sweats. On examination she is afebrile, with a blood pressure
of 115/70 and a pulse of 80. On abdominal examination, she has active bowel
sounds, is nontender in all quadrants, and has no hepatosplenomegaly.
Inspection of the anus reveals inflammation on the posterior side with erythema.
Digital rectal examination is painful for the patient but no abnormalities are
palpated. Anoscopic examination reveals no inflammation or bleeding. What is
the anal disorder that best describes her symptoms?
Anorectal fistula
External hemorrhoids
Anal fissure
Anorectal cancer
Question Points: 0.0 / 1.0
Adam is a very successful 15-year-old student and athlete. His mother brings
him in today because he no longer studies, works out, or sees his friends. This
has gone on for a month and a half. When you speak with him alone in the room,
he states it “would be better if I was not here.” What would you do next?
Tell him that he has a very promising career in anything he chooses and soon he will
feel better.
Tell him that he needs an antidepressant and it will take about 4 weeks to work.
Speak with his mother about getting him together more with his friends.
Assess his suicide risk. Question Points: 1.0 / 1.0
Which of the following is a “red flag” regarding patients presenting with
headache?
Unilateral headache
Pain over the sinuses
New onset over age 40
Aggravated or relieved by change in position
Question Points: 1.0 / 1.0
A 73-year-old nurse presents to your office for evaluation of new onset of pill
rolling tremors. She is not on any medications and does not take herbs or
supplements. She has no chronic medical conditions. She does not smoke or
drink alcohol. She walks into the examination room with slow movements and
shuffling steps. She has decreased facial mobility and a blunt expression, without
any changes in hair distribution on her face. Based on this description, what is
the most likely reason for the patient's symptoms?
Cushing's syndrome
Nephrotic syndrome
Myxedema
Parkinson's disease
Question Points: 1.0 / 1.0
Two weeks ago, Mary started a job which requires carrying 40-pound buckets.
She presents with elbow pain worse on the right. On examination, it hurts her
elbows to dorsiflex her hands against resistance when her palms face the floor.
What condition does she have?
Medial epicondylitis (golfer's elbow)
Olecranon bursitis
Lateral epicondylitis (tennis elbow)
Supracondylar fracture Question Points: 0.0 / 1.0
A 26-year-old violinist presents to your clinic complaining of anxiety. He is a
first-chair violinist in the local symphony orchestra and has started having
symptoms during performances, such as sweating, shaking, and
hyperventilating. It has gotten so bad that he has thought about giving up his
first-chair status so he does not have to play the solo during one of the
movements. He says that he never has these symptoms during rehearsals or
when he is practicing. He denies having any of these symptoms at any other
time. His past medical history is unremarkable. He denies any tobacco use, drug
use, or alcohol abuse. His parents are both healthy. On examination you see a
young man who appears worried. His vital signs and physical examination are
unremarkable.
What type of anxiety disorder best describes this situation?
Panic disorder
Specific phobia
Social phobia
Generalized anxiety disorder
Question Points: 0.0 / 1.0
A 52-year-old secretary presents to your office, complaining about
accidentally leaking urine when she coughs or sneezes. She says this has been
going on for about a year now. She relates that she has not had a period for 2
years. She denies any recent illness or injuries. Her past medical history is
significant for four spontaneous vaginal deliveries. She is married and has four
children. She denies alcohol, tobacco, or drug use. During her pelvic
examination, you note some atrophic vaginal tissue, but the remainder of her
pelvic, abdominal, and rectal examinations are unremarkable.
Which type of urinary incontinence does she have?
Stress incontinence
Urge incontinence
Overflow incontinence
Mixed Incontinence
Question Points: 0.0 / 1.0
A 37-year-old nurse presents for evaluation of colicky right upper quadrant
abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to
2 hours after eating greasy foods. Which one of the following physicalexamination descriptions would be most consistent with the diagnosis of
cholecystitis?
Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or
masses.
Abdomen is soft and tender to palpation in the right lower quadrant, without rebound
or guarding.
Abdomen is soft and tender to palpation in the right upper quadrant with inspiration,
to the point of stopping inspiration, and there is no rebound or guarding.
Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound
or guarding.
Question Points: 0.0 / 1.0
A 29-year-old computer programmer presents to your office for evaluation of
a headache. The tightening sensation is located all over the head and is of
moderate intensity. It used to last minutes, but this time it has lasted for 5 days.
He denies photophobia and nausea. He spends several hours each day at a
computer monitor/keyboard. He has tried over-the-counter medication; it has
dulled the pain but not taken it away. Based on this description, what is your
most likely diagnosis?
Tension
Migraine
Cluster
Analgesic rebound
Question Points: 1.0 / 1.0
An 81 year old patient complains of shortness of breath for the past few
days. On examination, you note late inspiratory crackles in the lower third of the
chest and bilateral pedal edema that were not present a week ago. What is the
most likely explanation for these?
Asthma
COPD
Bronchiectasis
Heart failure
Question Points: 1.0 / 1.0 A high school soccer player “blew out his knee” when the opposing goalie's
head and shoulder struck his flexed knee while the goalie was diving for the ball.
All of the following structures were involved in some way in his injury, but which
of the following is actually an extra-articular structure?
Synovium
Joint capsule
Juxta-articular bone
Tendons
Question Points: 1.0 / 1.0
A woman in her 30th week has a cervical length estimated at 1 cm. Should
you be concerned?
Yes; she may be at risk for preterm labor.
Yes; she most likely has a bicornuate uterus.
No; this is a normal measurement for this gestational age.
Yes; it likely indicates the fetus is in the breech position.
Question Points: 1.0 / 1.0
A young woman presents in for a routine wellness examination. You notice
that her vaginal walls have deep rugae and are slightly bluish in color. She also
has a thicker white discharge. What should you suspect?
Hypoxia
Varicosities
Pregnancy
Sexually transmitted infection
Question Points: 1.0 / 1.0
Ms. Whiting is a 68-year-old who presents in for her usual follow-up visit. You
notice a few flat, red, and purple lesions, about 6 centimeters in diameter, on the
ulnar aspect of her forearms but nowhere else. She doesn't mention them. They
are tender when you examine them. What should you do?
Conclude that these are lesions she has had for a long time. Wait for her to mention them before asking further questions.
Ask how she acquired them.
Conduct the visit as usual for the patient.
Question Points: 1.0 / 1.0
A 58-year-old man presents to your office complaining of bilateral back pain
that now awakens him at night. This has been steadily increasing for the past 2
months. Which one of the following is the most reassuring to you as a clinician in
this patient with back pain?
Age over 50
Pain at night
Pain lasting more than 1 month or not responding to therapy
Pain that is bilateral
Question Points: 1.0 / 1.0
A 19-year-old childcare worker presents to you for her first prenatal visit. She
cannot remember when her last period was but thinks it was between 2 and 5
months ago. When she began gaining weight and feeling “something” moving
down there, she did a home pregnancy test and it was positive. She states she
felt the movement about a week ago. She has had no nausea, vomiting, fatigue,
or fevers. Her past medical history is remarkable only for irregular periods. She
has been dating the same young man for a year. She says they were not using
condoms. On examination, you see an overweight young lady appearing her
stated age. Her head, eyes, ears, nose, throat, neck, thyroid, cardiac, and
pulmonary examinations are unremarkable. Her abdomen is nontender, with
normal bowel sounds, and the gravid uterus is palpated to the level of the
umbilicus. Fetal tones are easily found with doppler, and, with the fetoscope, a
faint heart rate of 140 is heard. By speculum examination, the cervix is bluish,
and by bimanual examination, the cervix is soft. Results of Pap smear, cultures,
and blood work are pending. You give the patient her due date and how far along
she is based on your clinical findings. An OB ultrasound to confirm her dates is
ordered.
With only the clinical examination, how many weeks pregnant did you tell this
patient she is?
6 to 8 weeks
12 to 14 weeks
18 to 20 weeks 24 to 26 weeks
Question Points: 1.0 / 1.0
When you enter your patient's examination room, his wife is waiting there
with him. Which of the following is most appropriate?
Ask if it's okay to carry out the visit with both people in the room.
Carry on as you would ordinarily. The permission is implied because his wife is in the
room with him.
Ask his wife to leave the room for reasons of confidentiality.
First ask his wife what she thinks is going on.
Question Points: 1.0 / 1.0
Mrs. Buckley is a 75-year-old widow who wants you to look at her teeth
because over the past 2 weeks she has had right-sided jaw pain when eating. It
does not occur otherwise. She also has had a headache. Which of the following
should be considered?
Palpation of her temples
Dental referral
Ultrasound of the gallbladder
Inquiry about anosmia
Question Points: 1.0 / 1.0
Glaucoma is the leading cause of blindness in African-Americans and the
second leading cause of blindness overall. What features would be noted on
funduscopic examination?
Increased cup-to-disc ratio
AV nicking
Cotton wool spots
Microaneurysms
Question Points: 1.0 / 1.0 A 26-year-old telephone operator presents to your office for her first prenatal
visit. This is her first pregnancy. Her last period was about 2 months ago. She has
no current complaints. She is eating healthily, taking vitamins, and exercising.
She has a past medical history of an appendectomy as a teenager. Her mother
had three children vaginally with no complications. On examination, she appears
healthy and her vital signs are unremarkable. Her head, eyes, ears, nose, throat,
thyroid, cardiac, pulmonary, and abdominal examinations are also unremarkable.
By speculum examination, her cervix appears bluish in color and highly vascular.
A bimanual examination reveals a soft cervix and a 12-week-sized uterus. No
masses are felt in either adnexal area. Results of her Pap, cultures, and blood
work are pending.
What clinical sign is responsible for her blue, highly vascular cervix?
Chadwick's sign
Hegar's sign
Leopold's sign
Leo's sign
Question Points: 1.0 / 1.0
A 20-year-old part-time college student presents 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. His
past medical history is unremarkable. In addition to college, he works part-time
for his father in construction. He is engaged to be married and has no children.
His father is healthy, and his mother has hypothyroidism. On examination, the
young man appears healthy. His vital signs are unremarkable. 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?
Condylomata acuminata
Genital herpes
Syphilitic chancre
Penile carcinoma
Question Points: 0.0 / 1.0 You are having trouble examining the abdomen of a school-aged child due to
ticklishness. What should you do?
Have the child press on your hand.
Have the parent insist that the child allow you to examine her.
Ask the parent to leave the room.
Make the child realize that this is part of the examination and must be done.
Question Points: 1.0 / 1.0
A 27-year-old woman is brought to your office by her mother. The mother
tells you that her daughter has been schizophrenic for the last 8 years and is
starting to decompensate despite medication. The patient states that she has
been taking her antipsychotic and she is doing just fine. Her mother retorts that
her daughter has become quite paranoid. When asked why, the mother gives an
example about the mailman. She says that her daughter goes and gets the mail
every day and then microwaves the letters. The patient agrees that she does this
but only because she sees the mailman flipping through the envelopes and she
knows he's putting anthrax on the letters. Her mother turns to her and says,
“He's only sorting the mail!”
Which best describes the patient's abnormality of perception?
Illusion
Hallucination
Fugue state
Facticious
Question Points: 0.0 / 1.0
A 29-year-old married computer programmer presents to your clinic,
complaining of “something strange” going on in his scrotum. Last month while
he was doing his testicular self-examination, he felt a lump in his left testis. He
waited a month and felt the area again, but the lump was still there. He has
had some aching in his left testis but denies any pain with urination or sexual
intercourse. He denies any fever, malaise, or night sweats. His past medical
history consists of groin surgery when he was a baby and a tonsillectomy as a
teenager. He eats a healthy diet and works out at the gym five times a week.
He denies any tobacco or illegal drugs and drinks alcohol occasionally. His
parents are both healthy. On examination, you see a muscular, healthy,
young-appearing man with unremarkable vital signs. On visualization, the
penis is circumcised with no lesions; there is a scar in his right inguinal region.
There is no lymphadenopathy. Palpation of his scrotum is unremarkable on the
right but indicates a large mass on the left. Placing a finger through the
inguinal ring on the right, you have the patient bear down. Nothing is felt. Youattempt to place your finger through the left inguinal ring but cannot get
above the mass. On rectal examination, his prostate is unremarkable.
What disorder of the testes is most likely the diagnosis?
Hydrocele
Inguinal hernia
Scrotal edema
Varicocele
Question Points: 1.0 / 1.0
Mr. R. is a 92-year-old retired teacher who presents to your clinic
accompanied by her daughter. You ask Mrs. R. why she came to your clinic
today. She looks at her daughter and doesn't say anything in response to your
question. This is an example of which type of challenging patient?
Talkative patient
Angry patient
Silent patient
Happy Patient
Question Points: 1.0 / 1.0
A high school football player injured his wrist in a game. He is tender
between the two tendons at the base of the thumb. Which of the following
should be considered?
DeQuervain's tenosynovitis
Scaphoid fracture
Wrist sprain
Rheumatoid arthritis
Question Points: 0.0 / 1.0
An adolescent male presents to your clinic with a note from his mother
stating it is okay for him to be seen today without her presence. He has come in
for his annual sports physical required to play football. For his age his physicalexamination is unremarkable, and you sign his school's physical examination
form. You decide to take this opportunity to do some health education with him.
He admits to wondering a lot lately if he is normal. Although he is in football he
really enjoys science and computers more. He is worried that all his buddies will
think he is a geek. He is convinced he also won't get a date for the Sadie
Hawkins dance next week because the girls all think he is boring, too. He denies
any experimentation with tobacco or alcohol, and he blushes when you mention
sex. After hitting all the pertinent age-appropriate education points, you give him
his sports physical form and he leaves.
The patient's concerns during the visit most resemble what developmental stage
of adolescence?
Early adolescence (10 to 14 years old)
Middle adolescence (15 to 16 years old)
Late adolescence (17 to 20 years old)
Adulthood
Question Points: 0.0 / 1.0
You are observing an infant who is able to pull to a stand, uses “mama” and
“dada” specifically, and indicates his wants by vocalization and pointing. Where
would you place this child's developmental age?
12 months
10 months
8 months [Show Less]