ADVANCED HEALTH ASSESSMENT
AND CLINICAL DIAGNOSIS IN
PRIMARY CARE - 10TH EDITION
QUESTIONS AND ANSWERS
1. When conducting a comprehensive history for a patient presenting with chronic cough,
which aspect of the clinical reasoning process is most critical for narrowing the differential
diagnosis?
A. Identifying associated symptoms such as postnasal drip, heartburn, or wheezing.
B. Documenting the exact duration of the cough in days.
C. Performing a standard physical exam before taking the history.
D. Ordering a chest X-ray immediately to rule out malignancy.
Answer: A
Conceptual Explanation: Clinical reasoning involves identifying clusters of symptoms that
point toward specific etiologies. Identifying associated symptoms like postnasal drip
(GERD/UARS) or wheezing (Asthma) helps differentiate between common causes of
chronic cough.
,2. A 55-year-old male presents with acute onset of severe left great toe pain. On
examination, the joint is erythematous, swollen, and exquisitely tender. What is the
definitive diagnostic procedure for the suspected condition?
A. Synovial fluid analysis for crystals.
B. Radiographic imaging of the foot.
C. Serum uric acid level.
D. Trial of colchicine to see if symptoms resolve.
Answer: A
Conceptual Explanation: While serum uric acid may be elevated, the definitive diagnosis
of gout requires the identification of monosodium urate crystals in synovial fluid under
polarized light microscopy.
3. Which physical examination finding is the most specific for a diagnosis of acute
cholecystitis?
A. Presence of a palpable abdominal mass.
B. Rebound tenderness in the left lower quadrant.
C. Positive Murphy’s sign.
D. Hyperactive bowel sounds.
Answer: C
, Conceptual Explanation: Murphy’s sign (inspiratory arrest on deep palpation of the RUQ)
has high specificity for acute cholecystitis.
4. In a geriatric patient presenting with a new onset of confusion and agitation, which is the
most likely non-neurological cause that must be ruled out?
A. Urinary tract infection (UTI).
B. Early-onset Alzheimer’s disease.
C. Normal pressure hydrocephalus.
D. Vitamin D deficiency.
Answer: A
Conceptual Explanation: In older adults, systemic infections, particularly UTIs, often
manifest as delirium or acute mental status changes rather than classic symptoms like
dysuria.
5. When evaluating a heart murmur, which maneuver is used to differentiate the murmur of
Hypertrophic Cardiomyopathy (HCM) from Aortic Stenosis?
A. Valsalva maneuver, which decreases the HCM murmur.
B. Squatting, which decreases the HCM murmur.
C. Handgrip exercise, which increases the HCM murmur.
D. Standing, which decreases the HCM murmur.
Answer: B
AND CLINICAL DIAGNOSIS IN
PRIMARY CARE - 10TH EDITION
QUESTIONS AND ANSWERS
1. When conducting a comprehensive history for a patient presenting with chronic cough,
which aspect of the clinical reasoning process is most critical for narrowing the differential
diagnosis?
A. Identifying associated symptoms such as postnasal drip, heartburn, or wheezing.
B. Documenting the exact duration of the cough in days.
C. Performing a standard physical exam before taking the history.
D. Ordering a chest X-ray immediately to rule out malignancy.
Answer: A
Conceptual Explanation: Clinical reasoning involves identifying clusters of symptoms that
point toward specific etiologies. Identifying associated symptoms like postnasal drip
(GERD/UARS) or wheezing (Asthma) helps differentiate between common causes of
chronic cough.
,2. A 55-year-old male presents with acute onset of severe left great toe pain. On
examination, the joint is erythematous, swollen, and exquisitely tender. What is the
definitive diagnostic procedure for the suspected condition?
A. Synovial fluid analysis for crystals.
B. Radiographic imaging of the foot.
C. Serum uric acid level.
D. Trial of colchicine to see if symptoms resolve.
Answer: A
Conceptual Explanation: While serum uric acid may be elevated, the definitive diagnosis
of gout requires the identification of monosodium urate crystals in synovial fluid under
polarized light microscopy.
3. Which physical examination finding is the most specific for a diagnosis of acute
cholecystitis?
A. Presence of a palpable abdominal mass.
B. Rebound tenderness in the left lower quadrant.
C. Positive Murphy’s sign.
D. Hyperactive bowel sounds.
Answer: C
, Conceptual Explanation: Murphy’s sign (inspiratory arrest on deep palpation of the RUQ)
has high specificity for acute cholecystitis.
4. In a geriatric patient presenting with a new onset of confusion and agitation, which is the
most likely non-neurological cause that must be ruled out?
A. Urinary tract infection (UTI).
B. Early-onset Alzheimer’s disease.
C. Normal pressure hydrocephalus.
D. Vitamin D deficiency.
Answer: A
Conceptual Explanation: In older adults, systemic infections, particularly UTIs, often
manifest as delirium or acute mental status changes rather than classic symptoms like
dysuria.
5. When evaluating a heart murmur, which maneuver is used to differentiate the murmur of
Hypertrophic Cardiomyopathy (HCM) from Aortic Stenosis?
A. Valsalva maneuver, which decreases the HCM murmur.
B. Squatting, which decreases the HCM murmur.
C. Handgrip exercise, which increases the HCM murmur.
D. Standing, which decreases the HCM murmur.
Answer: B
