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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. Lower extremities
b. Head and neck
c. Posterior thorax
d. Abdomen
e. Nervous system
A 65-year-old retired pilot visits the clinic because of recurrent headache. The patient reports
dizziness of recent onset (previous 2 weeks) and occasional numbness on the left side. Which of
the following systems or regions should be examined in the clinician's focused assessment?
a. Nervous
b. Cardiovascular
c. Musculoskeletal
d. Respiratory
e. Gastrointestinal
Chapter 7
(no chapter 5 or 6)
A 21-year-old college student experiences tachycardia following a night of heavy drinking. She
is advised to undergo a stress electrocardiogram (ECG). As she exercises, the recently calibrated
pulse oximeter records a heart rate ranging from 25 beats per minute (bpm) at rest to 50 bpm
while jogging. The test is stopped and re-started twice, and each time the pulse oximeter yields a
resting heart rate of 25 and a jogging heart rate of 50. Which aspect of this instrument does the
ECG technician question?
a. Prevalence
,b. Validity
c. Sensitivity
d. Specificity
e. Predictive value
A 23-year-old farm worker submits urine for testing. Three test strips from Container A show
abnormally low pH levels in the urine. However, three test strips from Container B, purchased
more recently, consistently indicate that the pH of this patient's urine is normal. Which of the
following is a true statement about the test strips?
a. The test strips demonstratehigh interobserver reliability.
b. The test strips demonstratelow intraobserver reliability.
c. The test strips demonstrate high intraobserver reliability.
d. The test strips demonstrate high sensitivity.
e. The test strips demonstrate high specificity.
A 51-year-old moderately overweight college professor visits the clinic with a complaint of chest
pain after tennis matches. He jokes that his tennis partner "is in a lot better shape than I am" but
says that he is trying to keep up. Later in the day, a 28-year-old female student at the same
college reports that "my chest often feels hot and tight." She also feels stressed on the evening
before mid-term exams. The clinician recommends an immediate evaluation for coronary artery
disease (CAD) for the professor, but not for the student. Why?
a. Positive predictive value of an observation is higher in a group with a higher prevalence
of disease.
b. Positive predictive value of an observation is lower in a group with a higher prevalence of
disease.
c. Negative predictive value of an observation is lower in a group with a higher prevalence of
disease.
d. Negative predictive value of an observation is higher in a group with a higher prevalence of
disease.
e. Positive predictive value of an observation is greater in older people than in younger people.
A 45-year-old forklift driver presents to the clinic at 4 o'clock in the afternoon complaining of
intense substernal chest pain and nausea. He appears pale and sweaty. At work that day, he filled
in for an absent co-worker and was asked to perform heavy lifting not normally a part of his job.
The physician assistant (PA) questions the patient in detail about his nausea, eating habits, and
digestive history. Which of the following steps of clinical reasoning has the PA failed to follow?
a. Elicit information about the patient’s gastrointestinal (GI) system
b. Localize findings anatomically
c. Match findings against conditions that could cause them
d. Give special consideration to potential life-threatening problems
e. Elicit information about the patient’s family history of digestive disorders
The positive predictive value of a test is calculated as the number of true positives identified by
the test divided by the total positives found by the test. If a novel test for strep throat yields 150
true-positive results and 150 false-positive results, what is the positive predictive value of this
test?
a. 10%
b. 25%
c. 50%
d. 75%
,e. 100%
The negative predictive value of a test is calculated as the number of true negatives identified by
the test divided by the total negatives found by the test. If a novel test for strep throat yields 85
true-negative results and 15 false-negative results, what is the negative predictive value of this
test?
a. 10%
b. 15%
c. 75%
d. 85%
e. 99%
A 58-year-old carpenter presents for his annual physical examination. The physician assistant
notes a systolic murmur on auscultation of the aorta. However, she does not immediately
conclude that this patient has aortic stenosis. Which of the following is the reason that she seeks
additional information?
a. Systolic murmurs have high sensitivity and high specificity for aortic stenosis.
b. Systolic murmurs have low sensitivity and low specificity for aortic stenosis.
c. Systolic murmurs have low sensitivity but high specificity for aortic stenosis.
d. Systolic murmurs have high sensitivity but low specificity for aortic stenosis.
e. Systolic murmurs are unrelated to aortic stenosis.
A mother brings her 8-year-old daughter to the clinic because she found a tick in the girl's hair
and would like her daughter to be tested for Lyme disease. The nurse practitioner (NP) explains
that the enzyme-linked immunosorbent assay (ELISA), an early test for Lyme disease, is
effective in finding early cases of Lyme disease but can also give positive results in some people
who do not have the disease, making additional testing necessary. This means that the ELISA
test has which of the following?
a. Low sensitivity, high specificity
b. High sensitivity, high specificity
c. High sensitivity, low specificity
d. Low sensitivity, low specificity
e. Undetermined sensitivity and specificity
A theoretical laboratory test for infection with HIV is known to have high sensitivity. This means
that the test has which of the following?
a. Good ability to rule in HIV in those who do have HIV
b. Good ability to rule out HIV in those who do not have HIV
c. High intraobserver reliability
d. High interobserver reliability
e. Good ability to diagnose AIDS
A theoretical new laboratory test for strep throat has high specificity. When a test has high
specificity, clinicians can be confident in which of the following aspects?
a. If the test result is positive, the patient probably has strep throat.
b. If the test result is positive, the patient probably does not have strep throat.
c. If the test result is negative, the patient probably has strep throat.
d. If the test result is negative, the patient probably does not have strep throat.
e. If the test result is positive, a confirmatory test should be performed.
Chapter 8
, Weight change may indicate the presence of important underlying pathology requiring further
investigation. Which of the following best describes a significant weight change that requires
further evaluation?
a. A 45-year-old male with baseline weight of 280 lb who decides to undertake a light
exercise regimen and loses 15% of his total body weight in 3 months
b. A 32-year-old female with a baseline weight of 175 lb who checks her weight irregularly but
reports a 5-lb unintended weight loss over 3 months
c. A 45-year-old recently menopausal female who gains 5% beyond her baseline weight of 140
lb in 6 months
d. A 26-year-old female with a baseline body mass index (BMI) of 25 who loses 5% of her body
weight with 6 months of diet and exercise modification
e. A 31-year-old male with a baseline body mass index (BMI) of 20 who loses 3 lb after a
prolonged bout of infectious gastroenteritis
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 appearance.
e. The prognosis is similar regardless of whether individuals are diagnosed and treated in the
early or late stage of these disorders.
A 55-year-old air traffic control agent reports his home blood pressure log to clinic after he was
diagnosed with hypertension at a prior visit. He notes that he consistently measures within the
normal range at home, but seems to fall outside the normal range every time he comes to the
clinic. Which of the following blood pressure measurements is considered to be most accurate
(i.e., reflecting the patient's "true" blood pressure)?
a. Blood pressure recorded in three positions in the health practitioner’s office
b. Three separate blood pressure measurements recorded by a medical technician within 90
minutes of awakening in the morning in an office setting using an automated device
c. Blood pressure recorded in three positions in the health practitioner’s office after resting for a
10-minute period in a supine position
d. Regular ambulatory monitoring recorded outside of the office setting
e. A total of six blood pressures averaged over three visits to a health practitioner’s office over a
3-month period
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.