ADVANCED HEALTH ASSESSMENT
AND CLINICAL DIAGNOSIS QUESTIONS
AND ANSWERS
1. When evaluating a patient with acute vertigo, which finding on the HINTS (Head-Impulse—
Nystagmus—Test-of-Skew) exam is most suggestive of a central nervous system etiology
rather than peripheral vestibulopathy?
A. A positive head impulse test (presence of corrective saccade)
B. Unidirectional horizontal nystagmus
C. Presence of vertical or direction-changing nystagmus
D. Normal vertical ocular alignment (no skew deviation)
Answer: C
Conceptual Explanation: In the HINTS exam, a central cause (like stroke) is suggested by
bidirectional or vertical nystagmus, a normal head impulse test (no saccade), or the
presence of vertical skew deviation. A positive head impulse test usually points to a
peripheral cause like vestibular neuritis.
,2. A 65-year-old male presents with exertional dyspnea and syncope. On auscultation, you
note a harsh systolic crescendo-decrescendo murmur at the second right intercostal space
that radiates to the carotids. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Pulmonary Hypertension
Answer: B
Conceptual Explanation: Aortic stenosis typically presents with a harsh systolic
crescendo-decrescendo murmur at the right upper sternal border with radiation to the
neck, often accompanied by the clinical triad of chest pain, heart failure, and syncope.
3. Which clinical decision rule is most appropriate to help exclude pulmonary embolism in a
patient with a low pre-test probability?
A. Wells Criteria
B. CURB-65 Score
C. Centor Criteria
D. Ottawa Rules
Answer: A
, Conceptual Explanation: The Wells Criteria (or the PERC rule) are used to assess the
clinical probability of pulmonary embolism. Centor is for strep throat, CURB-65 for
pneumonia severity, and Ottawa for ankle/knee fractures.
4. A patient exhibits ‘shifting dullness’ during an abdominal examination. This finding has
high specificity for which condition?
A. Ascites
B. Intestinal Obstruction
C. Splenomegaly
D. Ovarian Cyst
Answer: A
Conceptual Explanation: Shifting dullness is a physical exam maneuver used to detect
peritoneal fluid (ascites). When the patient turns, the fluid moves to the dependent side,
changing the area of tympany to dullness.
5. In the context of evidence-based practice, what does a ‘high sensitivity’ for a diagnostic
test primarily indicate?
A. The test is excellent at confirming a diagnosis.
B. The test is useful for ruling out a disease when the result is negative.
C. The test has a low rate of false positives.
D. The test measures the precision of the diagnostic tool.
AND CLINICAL DIAGNOSIS QUESTIONS
AND ANSWERS
1. When evaluating a patient with acute vertigo, which finding on the HINTS (Head-Impulse—
Nystagmus—Test-of-Skew) exam is most suggestive of a central nervous system etiology
rather than peripheral vestibulopathy?
A. A positive head impulse test (presence of corrective saccade)
B. Unidirectional horizontal nystagmus
C. Presence of vertical or direction-changing nystagmus
D. Normal vertical ocular alignment (no skew deviation)
Answer: C
Conceptual Explanation: In the HINTS exam, a central cause (like stroke) is suggested by
bidirectional or vertical nystagmus, a normal head impulse test (no saccade), or the
presence of vertical skew deviation. A positive head impulse test usually points to a
peripheral cause like vestibular neuritis.
,2. A 65-year-old male presents with exertional dyspnea and syncope. On auscultation, you
note a harsh systolic crescendo-decrescendo murmur at the second right intercostal space
that radiates to the carotids. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Pulmonary Hypertension
Answer: B
Conceptual Explanation: Aortic stenosis typically presents with a harsh systolic
crescendo-decrescendo murmur at the right upper sternal border with radiation to the
neck, often accompanied by the clinical triad of chest pain, heart failure, and syncope.
3. Which clinical decision rule is most appropriate to help exclude pulmonary embolism in a
patient with a low pre-test probability?
A. Wells Criteria
B. CURB-65 Score
C. Centor Criteria
D. Ottawa Rules
Answer: A
, Conceptual Explanation: The Wells Criteria (or the PERC rule) are used to assess the
clinical probability of pulmonary embolism. Centor is for strep throat, CURB-65 for
pneumonia severity, and Ottawa for ankle/knee fractures.
4. A patient exhibits ‘shifting dullness’ during an abdominal examination. This finding has
high specificity for which condition?
A. Ascites
B. Intestinal Obstruction
C. Splenomegaly
D. Ovarian Cyst
Answer: A
Conceptual Explanation: Shifting dullness is a physical exam maneuver used to detect
peritoneal fluid (ascites). When the patient turns, the fluid moves to the dependent side,
changing the area of tympany to dullness.
5. In the context of evidence-based practice, what does a ‘high sensitivity’ for a diagnostic
test primarily indicate?
A. The test is excellent at confirming a diagnosis.
B. The test is useful for ruling out a disease when the result is negative.
C. The test has a low rate of false positives.
D. The test measures the precision of the diagnostic tool.
