MIDTERM EXAM (LATEST ): ADVANCED
PHYSICAL ASSESSMENT - CHAMBERLAIN/GET IT
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SIMPLE | TRUSTED TEST SOLUTIONS!
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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, Answer: c. Following the patient's lead to understand their
thoughts, ideas, concerns, and requests
A 36-year-old female air traffic controller presents to her primary care provider for a routine
visit 3 months after losing her spouse to a lengthy battle with a neurodegenerative disease.
The patient denies any psychiatric symptoms on review of systems and, in fact, states that
she has slept better in the last month than she had in the previous years. She endorses a
healthy support system, including the extended family of her deceased spouse, with whom
she is still close. She becomes wistful and briefly tearful when speaking of the plans that
they had when they first married that were never fulfilled; she then changes the subject
rapidly to whether her Pap smear is due. Which of the following is an example of an
empathetic response to this patient?
a. Assuming that the event caused her to become depressed and expressing the same
feeling on behalf of the patient
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
,b. Recognizing the patient's emotions by asking or con Answer: b. Recognizing the patient's
emotions by asking or confirming how she feels about the event
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 Answer: c.
Both of these eating disorders are associated with a real or imagined fear of appearing fat.
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. Answer: b. Explain how the examination will
proceed.
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
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
,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 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
c. Feelings, ideas, function, and expectations
d. Feelings, impression, fantasy, and em Answer: c. Feelings, ideas, function, and
expectations
A 39-year-old nurse who is a well-established patient complains of irregular menstrual
periods and pelvic pain. She says that she is having trouble sleeping and asks whether she
could be given a "sleeping pill." The patient also says she is thinking of leaving her job. What
is the best "next step" in caring for this patient?
a. Perform a pelvic examination.
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
, b. Obtain a urine sample for testing.
c. Obtain a more complete description of problems.
d. Obtain blood for testing.
e. Ask about recent travel destinations. Answer: c. Obtain a more complete description of
problems.
A 29-year-old female professional athlete presents to a new primary care provider with
chronic menstrual complaints. She remarks to the nursing staff that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical fitness and
conditioning. She is seeking a care provider who will explore the issue in more detail and
work with her particular concerns. Which of the following is the description of the patient-
centered care this individual seeks?
a. Structured and clinician-centered with open-ended questions
b. Validating and empathetic with open-ended questions
c. Dismissive and concrete with open-ended questions
d. Affirming and reassuring with close-ended questions
e. Factual and structured with active listening Answer: b. Validating and empathetic with
open-ended questions
A 63-year-old male presents to establish care at a new primary care clinic to discuss issues
with pain and fatigue. The clinician conducting the visit begins with general historical
questions but quickly becomes suspicious that the patient is suffering from
decompensated heart failure. When the patient mentions that he has had vague chest pain
since last night, the clinician feels that the focus must be redirected to this potentially
emergent condition. Which of the following interview techniques is the most appropriate to
effectively manage this visit?
a. Providing serial reassurances such as, "Don't worry, you're going to be fine."
b. Asking a series of negative questions such as, "You don't have any swelling in your feet,
do you?"
c. Nonverbally cuing the patient to focus on his narrative regarding a motor vehicle
accident
4
APPHIA - Crafted with Care and Precision for Academic Excellence.
PHYSICAL ASSESSMENT - CHAMBERLAIN/GET IT
100% ACCURATE! /GRADED A+ | TOP SCORES MADE
SIMPLE | TRUSTED TEST SOLUTIONS!
QUALITY CONTENT YOU CAN RELY ON!
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, Answer: c. Following the patient's lead to understand their
thoughts, ideas, concerns, and requests
A 36-year-old female air traffic controller presents to her primary care provider for a routine
visit 3 months after losing her spouse to a lengthy battle with a neurodegenerative disease.
The patient denies any psychiatric symptoms on review of systems and, in fact, states that
she has slept better in the last month than she had in the previous years. She endorses a
healthy support system, including the extended family of her deceased spouse, with whom
she is still close. She becomes wistful and briefly tearful when speaking of the plans that
they had when they first married that were never fulfilled; she then changes the subject
rapidly to whether her Pap smear is due. Which of the following is an example of an
empathetic response to this patient?
a. Assuming that the event caused her to become depressed and expressing the same
feeling on behalf of the patient
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
,b. Recognizing the patient's emotions by asking or con Answer: b. Recognizing the patient's
emotions by asking or confirming how she feels about the event
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 Answer: c.
Both of these eating disorders are associated with a real or imagined fear of appearing fat.
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. Answer: b. Explain how the examination will
proceed.
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
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
,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 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
c. Feelings, ideas, function, and expectations
d. Feelings, impression, fantasy, and em Answer: c. Feelings, ideas, function, and
expectations
A 39-year-old nurse who is a well-established patient complains of irregular menstrual
periods and pelvic pain. She says that she is having trouble sleeping and asks whether she
could be given a "sleeping pill." The patient also says she is thinking of leaving her job. What
is the best "next step" in caring for this patient?
a. Perform a pelvic examination.
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
, b. Obtain a urine sample for testing.
c. Obtain a more complete description of problems.
d. Obtain blood for testing.
e. Ask about recent travel destinations. Answer: c. Obtain a more complete description of
problems.
A 29-year-old female professional athlete presents to a new primary care provider with
chronic menstrual complaints. She remarks to the nursing staff that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical fitness and
conditioning. She is seeking a care provider who will explore the issue in more detail and
work with her particular concerns. Which of the following is the description of the patient-
centered care this individual seeks?
a. Structured and clinician-centered with open-ended questions
b. Validating and empathetic with open-ended questions
c. Dismissive and concrete with open-ended questions
d. Affirming and reassuring with close-ended questions
e. Factual and structured with active listening Answer: b. Validating and empathetic with
open-ended questions
A 63-year-old male presents to establish care at a new primary care clinic to discuss issues
with pain and fatigue. The clinician conducting the visit begins with general historical
questions but quickly becomes suspicious that the patient is suffering from
decompensated heart failure. When the patient mentions that he has had vague chest pain
since last night, the clinician feels that the focus must be redirected to this potentially
emergent condition. Which of the following interview techniques is the most appropriate to
effectively manage this visit?
a. Providing serial reassurances such as, "Don't worry, you're going to be fine."
b. Asking a series of negative questions such as, "You don't have any swelling in your feet,
do you?"
c. Nonverbally cuing the patient to focus on his narrative regarding a motor vehicle
accident
4
APPHIA - Crafted with Care and Precision for Academic Excellence.
