ADVANCED HEALTH ASSESSMENT
AND CLINICAL DIAGNOSIS IN
PRIMARY CARE - 11TH EDITION
QUESTIONS AND ANSWERS
1. A patient presents with a mid-systolic click followed by a late systolic murmur at the apex.
Which maneuver would most likely cause this click to occur earlier in systole?
A. Squatting
B. Passive leg raise
C. Standing
D. Isometric handgrip
Answer: C
Conceptual Explanation: The clinical findings suggest Mitral Valve Prolapse (MVP).
Standing decreases venous return (preload), which decreases left ventricular volume,
causing the redundant mitral valve to prolapse earlier in systole, moving the click closer to
S1.
,2. Which of the following findings is most specific for the diagnosis of acute cholecystitis?
A. Epigastric tenderness
B. Positive Rovsing’s sign
C. Presence of a Psoas sign
D. Positive Murphy’s sign
Answer: D
Conceptual Explanation: Murphy’s sign (inspiratory arrest during deep palpation of the
RUQ) has a high specificity for acute cholecystitis. Rovsing’s and Psoas signs are associated
with appendicitis.
3. In diagnostic reasoning, the term ‘sensitivity’ refers to:
A. The probability that a person with a negative test result is truly disease-free.
B. The proportion of people with the disease who have a positive test.
C. The proportion of people without the disease who have a negative test.
D. The probability that a person with a positive test result truly has the disease.
Answer: B
Conceptual Explanation: Sensitivity is the ‘True Positive Rate.’ It measures the ability of a
test to correctly identify those with the disease. A highly sensitive test is useful for ‘ruling
out’ a disease (SnNout).
, 4. A 65-year-old male presents with sudden, painless loss of vision in his right eye.
Funduscopic exam reveals a ‘cherry-red spot’ at the fovea. What is the most likely diagnosis?
A. Central Retinal Vein Occlusion
B. Retinal Detachment
C. Acute Angle-Closure Glaucoma
D. Central Retinal Artery Occlusion
Answer: D
Conceptual Explanation: A cherry-red spot at the fovea with sudden painless vision loss is
the hallmark of Central Retinal Artery Occlusion (CRAO), often caused by an embolus.
5. When assessing for a pleural effusion, which physical exam finding is most likely to be
present over the affected area?
A. Dullness to percussion
B. Hyperresonance on percussion
C. Increased tactile fremitus
D. Vesicular breath sounds
Answer: A
Conceptual Explanation: Fluid in the pleural space (effusion) acts as a barrier to sound
and vibration, resulting in dullness to percussion, decreased tactile fremitus, and
diminished or absent breath sounds.
AND CLINICAL DIAGNOSIS IN
PRIMARY CARE - 11TH EDITION
QUESTIONS AND ANSWERS
1. A patient presents with a mid-systolic click followed by a late systolic murmur at the apex.
Which maneuver would most likely cause this click to occur earlier in systole?
A. Squatting
B. Passive leg raise
C. Standing
D. Isometric handgrip
Answer: C
Conceptual Explanation: The clinical findings suggest Mitral Valve Prolapse (MVP).
Standing decreases venous return (preload), which decreases left ventricular volume,
causing the redundant mitral valve to prolapse earlier in systole, moving the click closer to
S1.
,2. Which of the following findings is most specific for the diagnosis of acute cholecystitis?
A. Epigastric tenderness
B. Positive Rovsing’s sign
C. Presence of a Psoas sign
D. Positive Murphy’s sign
Answer: D
Conceptual Explanation: Murphy’s sign (inspiratory arrest during deep palpation of the
RUQ) has a high specificity for acute cholecystitis. Rovsing’s and Psoas signs are associated
with appendicitis.
3. In diagnostic reasoning, the term ‘sensitivity’ refers to:
A. The probability that a person with a negative test result is truly disease-free.
B. The proportion of people with the disease who have a positive test.
C. The proportion of people without the disease who have a negative test.
D. The probability that a person with a positive test result truly has the disease.
Answer: B
Conceptual Explanation: Sensitivity is the ‘True Positive Rate.’ It measures the ability of a
test to correctly identify those with the disease. A highly sensitive test is useful for ‘ruling
out’ a disease (SnNout).
, 4. A 65-year-old male presents with sudden, painless loss of vision in his right eye.
Funduscopic exam reveals a ‘cherry-red spot’ at the fovea. What is the most likely diagnosis?
A. Central Retinal Vein Occlusion
B. Retinal Detachment
C. Acute Angle-Closure Glaucoma
D. Central Retinal Artery Occlusion
Answer: D
Conceptual Explanation: A cherry-red spot at the fovea with sudden painless vision loss is
the hallmark of Central Retinal Artery Occlusion (CRAO), often caused by an embolus.
5. When assessing for a pleural effusion, which physical exam finding is most likely to be
present over the affected area?
A. Dullness to percussion
B. Hyperresonance on percussion
C. Increased tactile fremitus
D. Vesicular breath sounds
Answer: A
Conceptual Explanation: Fluid in the pleural space (effusion) acts as a barrier to sound
and vibration, resulting in dullness to percussion, decreased tactile fremitus, and
diminished or absent breath sounds.
