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NURS 6512 exam 3CA.. 100% Correct

• Positive anterior "drawer sign" Ruptured ACL • The condition in which a patient’s heart is either rotated or displaced to the right or is situated as a mirror image of the expected position is called a. amyloidosis. b. cardiomyopathy. c. dextrocardia. d. situs inversus. e. coarctation. Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by amyloid deposits in organs and tissues. Cardiomyopathy is the deterioration of heart muscle function. Coarctation is the compression of the walls of a vessel such as an aortic coarctation. Situs inversus occurs when the heart and stomach are displaced to the right and the liver is located to the left. REF: p. 294 • Which bronchial structure(s) is (are) most susceptible to aspiration of foreign bodies? a. Left mainstem bronchus b. Terminal bronchioles c. Right mainstem bronchus d. Right respiratory bronchioles e. Left respiratory bronchioles The right mainstem bronchus has a more downward slope and is less angled than the left bronchus. Therefore, it is more likely to be a site of aspiration and is a more likely site for endotracheal tubes that are advanced too far. REF: p. 263 • Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located a. more to the right and hanging more vertically. b. more to the left and lying more horizontally. c. riding higher in the chest and pushed anteriorly. d. hanging lower in the chest and riding more vertically. e. more to the right and lying more horizontally. The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall, slender person’s heart tends to hang vertically and is positioned centrally. A stocky, short person’s heart tends to lie more to the left and more horizontally. REF: p. 294 • Thin-walled reservoirs of the heart are the a. atria. b. pericardia. c. sinuses. d. ventricles. e. septa. The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the venous system. The pericardium is a double-walled membranous fibroserous sac enclosing the heart and the bases of the great vessels. A sinus is a dilated channel for venous blood. The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The ventricles are the primary muscle mass of the heart. The left heart and right heart are divided by a blood-tight partition called the cardiac septum. REF: p. 295 • Which cardiac structure is responsible for the heart’s pumping action? a. Pericardium b. Epicardium c. Myocardium d. Endocardium e. Atria The myocardium is the thick muscular middle layer that is responsible for the pumping action of the heart. The pericardium is the tough, double-walled, fibrous sac that protects the heart. The epicardium is the thin outermost muscle layer that covers the heart and extends onto the great vessels. The endocardium is the innermost layer that lines the chambers of the heart and covers heart valves. The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the veins throughout the body. REF: p. 295 • Which two heart structures are most anterior in the chest? a. Both atria b. Both ventricles c. The right atrium and ventricle d. The left atrium and ventricle e. Superior and inferior venae cavae The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart. The superior and inferior venae cavae lie posteriorly. REF: p. 295 • Contraction of the ventricles causes a. closure of the atrioventricular valves. b. closure of the pulmonic and aortic valves. c. opening of the mitral valve and closure of the tricuspid valve. d. opening of the mitral and tricuspid valves. e. opening of the auricular septa. When the ventricles contract, the semilunar, pulmonic, and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles. REF: p. 297 • Which two structures together form the primary muscle mass of the heart? a. Right atria and left ventricle b. Left ventricle and the aorta c. Right and left atria d. Left atrium and the pulmonary vein e. Right and left ventricles The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The right and left ventricles together form the primary muscle mass of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which provides blood to the rest of the body. The right and left atrium pumps blood through the tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood from the lungs to the left atria. REF: p. 295 • The major heart sounds are normally created by a. valves opening. b. valves closing. c. the rapid movement of blood. d. rubbing together of the cardiac walls. e. pulmonic veins. At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 “lubb.” When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2 “dubb.” Valve opening is usually a silent event. REF: p. 297 • Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the a. P wave. b. PR interval. c. QRS complex. d. ST segment. e. T wave. The P wave represents the spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization). REF: p. 299 • A third heart sound is created by a. atrial contraction. b. ventricular contraction. c. diastolic filling. d. regurgitation between the right and left ventricles. e. blood in the pericardium. Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria, and the filling sometimes produces a third heart sound S3. REF: p. 298 • The “pacing” structure of the heart’s electrical activity is the a. atrioventricular (AV) node. b. bundle of His. c. Purkinje fibers. d. coronary sinus. e. sinoatrial (SA) node. An electrical impulse stimulates each myocardial contraction, and this impulse originates in and is paced by the SA node. REF: p. 299 • Purkinje fibers are located in the a. sinoatrial node. b. atrioventricular node. c. myocardium. d. aortic arch. e. pericardium. The Purkinje fibers are located in the ventricular myocardium. REF: p. 299 • The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the a. P wave. b. QRS complex. c. PR interval. d. T wave. e. U wave. The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of the stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave. REF: p. 299 • In a fetus, the right ventricle pumps blood through the a. left atrium. b. ductus arteriosus. c. lungs. d. foramen ovale. e. septum primum. The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs. REF: p. 300 • In what group are the right and left ventricles equal in weight and muscle mass? a. Newborns b. School-age children c. Adolescents d. Older adults e. Pregnant women At the time of birth, the right and left ventricles are equal in weight and muscle mass because they both pump blood into the systemic circulation. Within 24 to 48 hours, closure of the ductus arteriosus and the interatrial foramen ovale cause pressure in the left atrium to increase. At this time, the right ventricles demand changes as the pulmonary circulation develops, and the left ventricle assumes total responsibility for providing systemic circulation. This results in an increase in the mass of the left ventricle. In older adults, the left ventricle wall thickens, and the valves become fibrotic and calcified. In pregnant women, the left ventricle increases in both wall thickness and mass. REF: p. 300 • Closure of the ductus arteriosus usually occurs a. just before the initiation of labor. b. 24 to 48 hours after birth. c. after 7 days of life. d. between the second and third months of life. e. during the toddler stage. Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth. REF: p. 300 • The apex of a 2-month-old baby’s heart typically lies closest to the a. left midsternal area. b. fourth left intercostal space. c. midthoracic spinal area. d. sixth left intercostal space. e. right midsternal area. In infants and young children, the heart lies more horizontally in the chest. The apex of the heart is located higher, sometimes well out into the fourth left intercostal space. REF: p. 300 • Normal cardiac changes that occur during pregnancy include a. decreased cardiac output. b. increased thickness and mass of the left ventricle. c. decreased heart rate. d. dilation of the ventricles. e. heart is shifted more vertical. The maternal blood volume increases by 40% to 50% because of an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally, and there is a slight axis rotation. REF: p. 300 • Which ECG change would not be expected as an age-related pattern? a. First-degree block b. Bundle branch block c. Left ventricular hypertrophy d. Ventricular fibrillation e. Atrial fibrillation Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation. REF: p. 327 • Mr. O, age 50 years, comes for his yearly health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should a. ask if he makes his own bed daily. b. have the patient describe his exercise. c. make a note that he walks each day. d. record “light exercise” in the history. e. record “questionable exercise” in the history. When Mr. O says he engages in light exercise, have him describe his exercise. To qualify his use of the term “light,” ask him the type, length of time, frequency, and intensity of his activities. REF: p. 304 • Pleural pain differs from chest discomfort caused by other conditions in that it is a. precipitated by breathing. b. eased with deep breathing. c. usually described as dull in nature. d. related to the time of day. e. eased with coughing. Pleural pain is precipitated by breathing and coughing and is usually described as a sharp pain that is present during respirations and absent during breath-holding. Angina is substernal and is provoked by effort, emotion, or eating; it is relieved by rest or nitroglycerin. Angina is usually accompanied by diaphoresis and occasionally by nausea. REF: p. 302 • Which of the following information belongs in the past medical history section related to heart and blood vessel assessment? a. Adolescent inguinal hernia b. Childhood mumps c. Past incidence of bee stings d. Previous unexplained fever e. Parents with a history of cardiac problems Previous unexplained fever should be included in the past medical history of a heart and blood vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart valve damage. REF: p. 303 • A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father died of heart trouble. The most important follow-up question you should pose is which of the following? a. “Did your father have coronary bypass surgery?” b. “Did your father’s father have heart trouble also?” c. “What were your father’s usual dietary habits?” d. “What age was your father at the time of his death?” e. “Did your mother also have heart trouble?” A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one’s chance of a similar occurrence. REF: p. 303 • Which one of the following is a common symptom of cardiovascular disorders in an older adult? a. Fatigue b. Joint pain c. Poor night vision d. Urticaria e. Fevers Common symptoms of cardiovascular disorders in older adults include confusion, dizziness, blackouts, syncope, palpitations, coughs and wheezes, hemoptysis, shortness of breath, chest pains or tightness, impotence, fatigue, and leg edema. REF: p. 304 • In an adult, the apical impulse should be most visible when the patient is in which position? a. Supine b. Leaning backward c. Lithotomy d. Right lateral recumbent e. Upright In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem. REF: p. 305 • If the apical impulse is more vigorous than expected to the chest wall, it is called a. a lift. b. a thrill. c. a bruit. d. a murmur. e. crepitus. The apical impulse is more vigorous than expected; it is referred to as a heave or lift. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound that is caused by turbulent blood flow into, through, or out of the heart. Crepitus is air in the subcutaneous tissue from respirations. REF: p. 306 • A palpable rushing vibration over the base of the heart at the second intercostal space is called a a. heave. b. lift. c. thrill. d. thrust. e. murmur. A thrill is a fine, palpable, rushing vibration, or a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is a movement forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow. REF: p. 306 • An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate a. decreased cardiac output. b. dextrocardia. c. left ventricular hypertrophy. d. hyperventilation. e. obesity. An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. In dextrocardia, the PMI would be displaced to the right. REF: p. 306 • A lift along the left sternal border is most likely the result of a. aortic stenosis. b. atrial septal defect. c. pulmonary hypertension. d. right ventricular hypertrophy. e. left ventricular hypertrophy. A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect. REF: p. 306 • To estimate heart size by percussion, you should begin tapping at the a. apex. b. left sternal border. c. midclavicular line. d. midsternal line. e. anterior axillary line. Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border. REF: p. 306 • Normal heart sounds are best heard a. directly over the semilunar and bicuspid heart valves. b. over areas where blood flows after it passes through a valve. c. near the carotid vessels. d. over the central sternum. e. over the ribs. Normal heart sounds are best heard in areas where blood flows after it passes through a valve in the direction of blood flow. REF: p. 307 • To hear diastolic heart sounds, you should ask patients to a. lie on their backs. b. lie on their left sides. c. lie on their right sides. d. sit up and lean forward. e. lie prone. The left lateral recumbent position is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating a right rotated heart of dextrocardia. REF: p. 308 • The carotid pulse should coincide with which heart sound? a. S1 b. S2 c. S3 d. S4 e. S3-4 S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound. REF: p. 306 • You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following? a. S1 b. S2 c. S3 d. S4 e. S3-4 S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration. REF: p. 308 • During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split. You should ask the patient to inhale deeply while listening at the _____ area. a. aortic b. pulmonic c. tricuspid d. mitral e. apex Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site. REF: p. 309 • The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing a. the splitting of S2. b. high-pitched murmurs. c. presystolic gallops. d. systolic ejection sounds. e. pericardial friction rub. Using the bell of the stethoscope at the apex is more useful for low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position. REF: p. 308 • You are conducting an examination of Mr. C’s heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is a. barely discernible. b. quiet but audible. c. moderately loud. d. loud with palpable thrill. e. very loud without a stethoscope. The intensity of a grade III murmur is described as moderately loud. Barely loud is a grade I murmur, quiet but clearly audible is a grade II, loud with a palpable thrill is a grade IV, and very loud without a stethoscope is a grade VI. REF: p. 313 • A grade I or II murmur, without radiation and of medium pitch, is a common variation found in a. school-age children. b. older women. c. middle-aged men. d. sedentary individuals. e. older adults. Many murmurs, particularly in children, adolescents, and especially young athletes, have no apparent cause. These are generally grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by splitting of S2. REF: p. 317 • An example of a functional heart murmur is one that is caused by a. anemia. b. a ventricular septal defect. c. an atrial septal defect. d. mitral valve prolapse. e. a leaking aortic valve. Not all murmurs are the result of valvular defects made by a healthy heart beating strongly, high-output demands that increase the speed of blood flow can cause murmurs. Anemia, pregnancy, and thyrotoxicosis can cause these functional heart murmurs. REF: p. 314 • A split second heart sound is a. abnormal. b. greatest at the peak of inspiration. c. heard best after forceful expiration. d. supposed to disappear with deep inspiration. e. always accompanied by a thrill. Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill. REF: p. 319 • The earliest sign of heart failure in an infant is frequently a. an apical impulse in the fourth intercostal space. b. moisture in the lungs. c. enlarged thyroid. d. clubbing of the fingers. e. liver enlargement. If heart failure is suspected, note that the infant’s liver may enlarge before there is any suggestion of moisture in the lungs, and the left lobe of the liver may be more distinctly enlarged than the right. An apical impulse in the fourth intercostal space is a normal finding. REF: p. 318 • Chest pain in a child with an organic cause is more likely the result of a. cardiac disease. b. asthma. c. esophageal reflux. d. arthritis. e. peptic ulcer disease. Unlike chest pain in adults, chest pain in children and adolescents seldom is caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use. REF: p. 302 • Which dysrhythmia is a physiologic event during childhood? a. First-degree AV block b. Mobitz type II c. Multifocal PVCs d. Sinus arrhythmia e. Third-degree AV block Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension. REF: p. 319 • An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in a. adults under stress. b. 4-year-old children. c. pregnant women. d. older adults. e. premature infants. Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child varies in a cyclic pattern, usually faster on inspiration and slow on expiration. REF: p. 319 • A condition that is likely to present with dizziness and fainting is a. bacterial endocarditis. b. hypertension. c. sick sinus syndrome. d. pericarditis. e. hyperlipidemia. Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent fainting, transient dizzy spells, lightheadedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunctions, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis along with a triphasic friction rub. Hyperlipidemia is a risk factor for myocardial infarction that commonly presents with chest pain. REF: p. 324 • The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to suspect a. congestive heart failure. b. mitral stenosis. c. endocarditis. d. cardiac tamponade. e. pericarditis. Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium. The key physical finding is the triphasic friction rub, which is comprised of ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy. REF: p. 322 • Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of a. rheumatic fever. b. cor pulmonale. c. pericarditis. d. endocarditis. e. cardiac tamponade. Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and a sudden onset of congestive heart symptoms. The lesions described are Janeway lesions. REF: p. 320 • Fat deposits in the circulatory system of an older adult can lead to a. diffuse conduction disturbances. b. exaggerated contractility. c. heart failure. d. thinning of the ventricles. e. amyloidosis. Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke. REF: p. 330 • A holosystolic murmur in an infant that is best heard along the left sternal border in the third to fifth intercostal spaces and does not radiate to the neck is indicative of a. a ventricular septal defect. b. patent ductus arteriosus. c. pulmonary stenosis. d. aortic sclerosis. e. dextrocardia. Regurgitation through the ventricular septal defect results in a holosystolic murmur as described. REF: p. 328 • Ms. S. is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect a. angina. b. acute rheumatic fever. c. cardiac amyloidosis. d. aortic sclerosis. e. sick sinus syndrome. Acute rheumatic fever is a systemic connective tissue disease that occurs after a streptococcal pharyngitis or a skin infection. It may result in serious cardiac valvular involvement of the mitral or aortic valve. Often the valve becomes stenotic and regurgitant. Prevention is adequate treatment of streptococcal pharyngitis or skin infections. The other possible answers do not have the presenting manifestations and occur mostly in older adults. REF: p. 330 • A grade IV mitral regurgitation murmur would a. be described as a diastolic murmur. b. not be expected to have a thrill. c. radiate to the axilla. d. be heard best at the base. e. radiate to the neck. A grade IV murmur would have a thrill, and a mitral regurgitation murmur is best heard at the apex, is holosystolic, and would radiate to the axilla. REF: p. 331 • The most helpful finding in determining left-sided heart failure is a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S4 heart sound. e. tachycardia. Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. The other choices are not as reliable. REF: p. 321 • Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associated with focal tenderness is most likely a. cardiac. b. pleural. c. esophageal. d. musculoskeletal. e. psychoneurotic. The description given is a classic example of musculoskeletal chest pain. REF: p. 302 • Which chest structure contains all the thoracic viscera except the lungs? a. Manubrium b. Mediastinum c. Sternum d. Xiphoid e. Pleural cavities The mediastinum, situated between the lungs, contains all the thoracic viscera except the lungs. The manubrium and xiphoid are parts of the sternum. The pleural cavities enclose the lungs. REF: p. 260 • The adult internal rectal sphincter is controlled by the a. autonomic nervous system. b. central nervous system. c. peripheral nervous system. d. lumbar spinal reflexes. e. sacral spinal reflexes. The internal ring of smooth muscle of the anal canal is under involuntary autonomic control. REF: p. 485 • The urge to defecate is caused by a. constriction of the internal sphincter. b. the rectum filling with feces. c. cognitive processes. d. fluid volume in the stomach. e. relaxation of the external sphincter. The sensation to defecate results from the rectum filling with feces, which, in turn, stimulates relaxation of the internal sphincter. REF: p. 486 • The proximal end of the rectum is continuous with the a. transverse colon. b. duodenum. c. ileum. d. internal rectal sphincter. e. sigmoid colon. Ascending from the anus is the rectum, then the sigmoid colon, which is at the proximal end of the rectum. REF: p. 486 • The mother of a 1-week-old breastfed baby tells you that she is concerned because her baby has a small bowel movement each time he feeds. You should let the mother know that a. this is normal. b. she should feed the baby less. c. this usually indicates a congenital abnormality. d. she needs to change the baby to formula. e. the baby’s internal sphincter is underdeveloped. The newborn’s myelination of the spinal cord is incomplete, and both internal and external sphincters are under involuntary reflexive control, that is, the gastrocolic reflex. Therefore, newborns stool after each feeding. REF: p. 486 • In males, which surface of the prostate gland is accessible by digital examination? a. Median lobe b. Posterior c. Superior d. Anterior e. Lateral The posterior surface of the prostate gland lies close to the anterior wall of the rectum and is palpable through digital rectal examination. REF: p. 486 • The prostatic sulcus a. divides the prostate into anterior and posterior lobes. b. is the site of the seminal vesicle emergence. c. refers to the anterior aspect of the prostate. d. secretes clear viscous mucus. e. divides the prostate into right and left lateral lobes. The median sulcus divides the two lateral lobes and is palpated as a shallow groove. REF: p. 486 • When the practitioner is inquiring about the patient’s lower GI tract history, the inquiry should include a. bowel habits. b. dietary habits. c. hemorrhoid surgery. d. laxative use. e. recent travel. Past medical history should inquire about hemorrhoids; spinal cord injury; benign prostatic hypertrophy; prostate, colorectal, breast, ovarian, and endometrial cancers; and episiotomies of fourth-degree lacerations during delivery. Habits and travel history are part of personal and social history; the use of laxatives is part of history of present illness. REF: p. 488 • The effects of aging on the gastrointestinal system lead to more frequent experiences of a. constipation. b. prolonged satiety. c. diarrhea. d. prostate glandular atrophy. e. urges to defecate. Older adults experience an elevated pressure threshold for the sensation of rectal distention and therefore are susceptible to constipation. They also experience early satiety, fecal incontinence, and prostate glandular hypertrophy. REF: p. 487 • Which of the following is a risk factor for anal cancer? a. White race b. Diet low in animal fats and proteins c. Physical inactivity d. Infection with high risk HPV e. Low body fat Infection with high-risk type human papillomavirus is considered a risk factor for anal cancer. The other answers are not. REF: p. 488 • Factors associated with increased risk of prostate cancer include a. African American descent. b. cigarette smoking. c. low-fat diet. d. alcoholism. e. obesity. The incidence rate of prostate cancer is higher for African American men compared with white American men. African American men also have a higher mortality rate from prostate cancer. REF: p. 488 • Caliber of urinary stream is routine information in the history of a. adolescents. b. infants. c. older men. d. sexually active men. e. pregnant women. Routine questions about the caliber of urinary stream and dribbling are directed toward older men because hypertrophy of the prostate gradually impedes urine flow. REF: p. 489 • Equipment for examination of the anus, rectum, and prostate routinely includes gloves and a. an anoscope. b. lubricant and penlight. c. slides and normal saline. d. swabs and culture medium. e. a hand mirror and gauze. Equipment for the examination includes penlight, lubricating jelly, gloves, and fecal occult blood testing materials. REF: p. 489 • When performing a rectal examination in a man, in which position is the patient generally placed? a. Lithotomy b. Prone c. Trendelenburg d. Left lateral e. Supine Male patients are usually positioned left lateral or standing with upper body flexed at the waist over the examination table, with the toes pointed together for increased exposure of the area. REF: p. 489 • Which of the following conditions is most commonly seen in adults with diabetes? a. Pinworms b. Pilonidal cysts c. Perianal fistula d. Pruritus ani e. Anorectal fissure Pruritus ani refers to chronic itching of the skin around the anus, which can be caused by fungal infections and is more common in diabetic patients. Pinworms are more common in children; the other conditions do not cause pruritus. REF: p. 489 • To make visualization of polyps in the anorectal area easier, you should a. apply clear jelly around the anal orifice. b. ask the patient to bear down. c. ask the patient to relax the sphincter. d. rotate your finger inside the anal canal. e. have the patient contract the external sphincter. Asking the patient to perform a Valsalva maneuver will make fistulas, fissures, polyps, and hemorrhoids more visible. REF: p. 489 • Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience a. bulging and wrinkling. b. constipation and pallor. c. urinary symptoms. d. tenderness and inflammation. e. diarrhea and redness. Pain, tenderness, and inflammation to the perianal area may be related to abscess, fistula or fissure, pilonidal cyst, or pruritus ani. REF: p. 489 • Palpation of the anal ring is done by a. bidigital palpation with thumbs. b. inserting the smallest finger into the anus. c. pressing a gauze pad over the anus. d. rotation of the forefinger inside the anus. e. rotation of the forefinger outside the anus. The anal muscular ring is palpated by rotating the examination finger. A bidigital palpation with your thumb against the perianal tissue helps assess the bulbourethral glands. REF: p. 489 • The initial digital approach to the rectal examination should be a. at a right angle to the anus. b. with direct horizontal pressure of fingertip. c. with the finger pad pressed against anal verge. d. during sphincter tightening. e. bidigital palpation with thumbs. The initial approach should be with the finger pad pressed against the perianal area at the anal junction. The sphincter will tighten and relax, and then the examination index finger should be flexed and inserted. REF: p. 490 • A healthy prostate protrudes into the rectal wall a distance of _____ cm. a. less than 1 b. 1 to 2 c. 2 to 3 d. 3 to 4 e. more than 4 A healthy prostate should not protrude more than 1 cm into the rectum. REF: p. 491 • The posterior surface of the prostate can be located by palpation of the a. posterior wall of the rectum. b. anterior wall of the rectum. c. lateral wall of the anus. d. lower abdomen and perineum. e. anal canal and perineum. Palpation of the rectal anterior wall facilitates posterior prostate location. REF: p. 491 • The cervix may normally be palpated through the a. anterior rectal wall. b. left lateral rectal wall. c. right lateral rectal wall. d. posterior uterine surface. e. posterior rectal wall. In women, the cervix can be palpated through the anterior rectal wall. It feels like a small, round mass. REF: p. 491 • Your patient’s chief complaint is repeated pencil-like stools. Further examination should include a. stool culture. b. parasite testing. c. digital rectal examination (DRE). d. prostate examination. e. cellulose tape test. Persistent pencil-shaped stools are indicative of stenosis from scarring or pressures from a mass. DRE should be performed to assess for a mass. REF: p. 492 • Very light tan or gray stool may indicate a. Hirschsprung disease. b. obstructive jaundice. c. lower gastrointestinal bleeding. d. polyposis. e. upper gastrointestinal bleeding. Very light tan or gray stools suggest obstructive jaundice. REF: p. 491 • Tarry black stool should make you suspect a. internal hemorrhoids. b. rectal fistula. c. upper intestinal bleeding. d. prostatic cancer. e. lower intestinal bleeding. Upper intestinal tract bleeding results in tarry black stools. REF: p. 491 • Prostate-specific antigen (PSA) screening is controversial because a. there are few false-negative results. b. PSA is produced by many other tissues. c. it is less sensitive than digital rectal examination. d. there are associated harms of false-positive test results. e. it detects prostate cancer only in its late stage. The persistent issue is whether the benefits of prostate cancer screening are large enough to outweigh the associated harms, which include false-positive screening test results, unnecessary biopsies, and overdiagnosis. REF: p. 491 • An infant with constipation and a consistently empty rectum may need evaluation for a. sexual abuse. b. Hirschsprung disease. c. pilonidal cyst. d. intestinal parasites. e. rectal abscess. A consistently empty rectum in the presence of constipation is a clue to the diagnosis of Hirschsprung disease. Other presentations include the failure to pass meconium in the first 24 hours coupled with a gradual onset of abdominal distention and vomiting. REF: p. 493 • A lower spinal cord lesion may be indicated by which finding? a. Lack of an “anal wink” b. Anorectal fissure c. Anal fistula d. Passage of meconium e. Small flaps of anal skin Lightly touching the anal opening of an infant should produce a contraction referred to as the “anal wink.” A negative wink may indicate a lower spinal cord lesion. REF: p. 492 • Pinworms and Candida may both cause a. shrunken buttocks. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion. e. constipation. Pinworms and Candida both cause perirectal irritation and itch. REF: p. 492 • Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. When is it likely that her closed anal passageway will be suspected by her health care providers? a. After she develops a scaphoid abdomen b. During her first feeding when she vomits c. When she bleeds from the rectum d. When she fails to pass meconium stool e. When the rectum prolapses Anal patency of the newborn is confirmed by passage of meconium stool. REF: p. 499 • A common cause of dark green or black stool color during pregnancy is indicative of a. consumption of iron preparations. b. consumption of vitamins. c. intestinal parasites. d. slow bleeding of hemorrhoids. e. slow intestinal bleeding. The daily use of iron replacement therapy, as expected during pregnancy, causes dark green or black stools. REF: p. 493 • An expected anal or rectal finding late in pregnancy is the presence of a. cysts. b. rectal prolapse. c. skin tags. d. polyps. e. hemorrhoids. Hemorrhoids are an expected variation late in pregnancy. REF: p. 493 • Thrombosed hemorrhoids are a. flabby skin sacs. b. red, inflamed, and painful. c. fluctuant soft papules. d. blue, shiny painful masses. e. pink to whitish. Thrombosed hemorrhoids appear as blue, shiny masses at the anus; they contain clotted blood and are edematous and painful. Flabby skin sacs describe a resolved hemorrhoid; red, inflamed, painful, and fluctuant describe a rectal abscess. Pink to whitish growths that occur on the anus describe the findings consistent with anal warts. REF: p. 496 • Palpation of a normal prostate in an older adult is likely to feel a. cool. b. grainy. c. polypoid. d. rubbery. e. hard. Older men are more likely to experience prostate hypertrophy, which, when palpated, feels smooth, rubbery, and symmetric. REF: p. 498 • Prostate examination findings of a hard, irregular, painless nodule with obliteration of the median sulcus are signs of a. benign prostatic hypertrophy. b. cancer of the prostate. c. longstanding prostatitis. d. swelling caused by aging. e. acute prostatitis. Obliteration of the median sulcus is consistent with organ enlargement; associated findings of a hard, irregular, and painless nodule are more likely a cancerous growth. REF: p. 499 • Cellulose tape test is used for the detection of a. imperforate anus. b. condyloma. c. anal fissure. d. steatorrhea. e. enterobiasis. Pinworms are collected by applying tape to the perianal folds and then pressing the tape on a glass slide. REF: p. 500 • The movement of the testes by cremasteric muscular action regulates a. ejaculatory flow. b. sebaceous material production. c. testicular temperature. d. urinary flow. e. prostate gland secretion. The cremasteric muscle contracts and relaxes the scrotum. This action alters the distance of the testes from the body to cool or warm the testes. REF: p. 466 • What structure of the male genitalia travels through the inguinal canal and unites with the seminal vesicle to form the ejaculatory duct? a. Epididymis b. Corpus cavernosum c. Urethra d. Vas deferens e. Ureter The vas deferens begins at the end of the epididymis, travels the spermatic cord, goes through the inguinal canal, and then unites with the seminal vesicle to form the ejaculatory duct. REF: p. 468 • Normally, the male urethral orifice is located a. 2 mm ventral to the tip of the glans. b. on the dorsal surface of the glans. c. cephalad to the dorsal vein. d. adjacent to the prostate. e. on the ventral surface of the corpus spongiosum. The urethral orifice is located approximately 2 mm ventral to the tip of the glans. REF: p. 466 • While examining an 18-year-old man, you note that the penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be a. caused by a lack of testosterone. b. suggestive of a skin fungus. c. suggestive of psoriasis. d. caused by excessive progesterone. e. within normal limits. Darker pigmentation from other body skin is a normal finding on the penis and testicles. REF: p. 466 • Testicular temperature must be maintained lower than 37° C for which of the following to occur? a. Penile erection b. Spermatogenesis c. Testosterone production d. Ejaculatory duct to function e. Sperm to ascend in the vas deferens The production of sperm is dependent on the maintenance of temperatures below normal body temperature of 37° C or 98.6° F. REF: p. 466 • In an uncircumcised male, retraction of the foreskin may reveal cheesy white material. This is usually a. evidence of a fungal infection. b. a collection of sebaceous material. c. indicative of penile carcinoma. d. suggestive of diabetes. e. evidence of a gonococcal infection. The glans secretes a sebaceous material, smegma, in uncircumcised males. It looks like a cheesy white material. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. Smegma is not candidiasis nor is it suggestive of diabetes, cancer, or gonorrhea. REF: p. 466 • The greatest contribution to the volume of ejaculate comes from the a. prostate. b. epididymis. c. seminal vesicles. d. corpus cavernosa. e. testes. The major volume of ejaculatory fluid comes from the prostate gland. REF: p. 468 • Inspection of the scrotum should reveal a. no epidermoid cysts. b. two testes per sac. c. smooth scrotal sacs. d. left scrotal sac lower than the right. e. lightly pigmented skin. The left cord is longer than the right; consequently, the left testis hangs somewhat lower. The scrotum is more darkly pigmented, has one testis per sac, and has small epidermoid cysts that give it a lumpy appearance. REF: p. 472 • Sexual differentiation in the fetus has occurred by _____ weeks’ gestation. a. 8 b. 12 c. 16 d. 20 e. 30 By 12 weeks’ gestation, sexual differentiation has occurred in the fetus. REF: p. 468 • How much blood usually engorges the two corpora cavernosa of the penis when it is erect? a. 5 to 15 mL b. 20 to 50 mL c. 60 to 80 mL d. 70 to 90 mL e. Over 100 mL Penile erection occurs when 20 to 50 mL of blood is contained in the corpora cavernosa. REF: p. 468 • Expected genitalia changes that occur as men age include a. that ejaculatory volume decreases with age. b. that erections develop more quickly. c. that the viability of sperm increases. d. that the scrotum becomes more pendulous. e. an increase in time for mature sperm to develop. Ejaculatory volume may increase with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. There is no change in the length of time necessary for mature sperm production. REF: p. 468 • Parents of a 6-year-old boy should be asked if he has a. erections. b. nocturnal emissions. c. rapid detumescence. d. scrotal swelling. e. a more pendulous scrotum. Scrotal swelling, especially with crying or with bowel movements, signals the presence of a hernia. The question of nocturnal emissions is asked of adolescents; erections and rapid detumescence questions are questions for older men. With the onset of puberty, the scrotum becomes more pendulous. REF: p. 469 • Which of the following is a risk factor for testicular cancer? a. Circumcision b. Condyloma acuminatum c. Cryptorchidism d. Poor hygiene e. Multiple sexual partners Cryptorchidism (testes that fail to descend by 12 months of age) is a risk factor for testicular cancer. REF: p. 470 • Gloves are used for examination of male genitalia to a. facilitate grasp of external organs. b. make masses easier to detect. c. prevent spread of unsuspected infection. d. protect the patient from embarrassment. e. decrease the incidence of erections. Inspection of male genitalia involves manipulation of the glans and scrotum. This potentially involves contact with body secretions and infections; therefore, gloves are required. REF: p. 471 • Inspection of the male urethral orifice requires the examiner to a. ask the patient to bear down. b. insert a small urethral speculum. c. press the glans between thumb and forefinger. d. transilluminate the penile shaft. e. apply a lubricant to the meatus. Inspection of the urethral orifice is accomplished by pressing the glans between the examiner’s thumb and forefinger. This maneuver opens the slitlike orifice for further inspection. REF: p. 472 • Which penile structure should be visible to inspection during the physical examination? a. Cowper glands b. Proximal urethral c. Epididymis d. Corpus cavernosa e. Dorsal vein The dorsal vein of the penis should be evident. The others are internal structures. REF: p. 471 • You are inspecting the genitalia of an uncircumcised man. The foreskin is tight and cannot be easily retracted. You should a. chart the finding as paraphimosis. b. inquire about previous penile infections. c. retract the foreskin firmly. d. transilluminate the glans. e. chart the finding as balanitis. This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum. Balanitis is inflammation of the glans that may occur with phimosis. REF: p. 471 • Which technique is appropriate to detect an inguinal hernia? a. Conduct percussion while the patient coughs. b. Have the patient strain as you pinch the testes. c. Inspect rectal areas as the patient bears down. d. Conduct the examination only in the supine position. e. Move your finger upward along the vas deferens. Examination for inguinal hernias is performed with the patient standing. Inspect the groin while the patient performs a Valsalva maneuver. Insert your examination finger into the lower part of the scrotum and follow upward along the vas deferens to screen for a hernia. REF: p. 473 • Which type of hernia lies within the inguinal canal? a. Umbilical b. Direct c. Indirect d. Femoral e. Incisional Hernias found within the inguinal canal are called indirect hernias. REF: p. 473 • Which one of the following conditions is of minor consequence on the adult male genitalia? a. A viscus felt medial to the external canal b. Continuous penile erection c. Lumps in scrotal skin d. Venous dilation in spermatic cord e. Adhesions of the foreskin Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits. The other choices require medical or surgical intervention. REF: p. 472 • Mr. L. has an unusually thick scrotum with edema and pitting. He has a history of cardiac problems. The appearance of his scrotum is more likely a(n) a. congenital defect that has worsened. b. indication of general fluid retention. c. normal consequence of aging. d. complication to the development of mumps. e. consequence of prior STDs. General fluid retention can cause scrotal thickening and pitting edema and is more often seen as a result of cardiac, renal, or hepatic disease. This swelling does not imply a condition of the genitalia but rather a condition of these related systems. REF: p. 472 • A characteristic related to syphilis or diabetic neuropathy is testicular a. dropping with asymmetry. b. enlargement. c. insensitivity to painful stimulation. d. recession into the abdomen. e. nodularity. Diabetic neuropathy or syphilis can cause a marked reduction of tactile perceptions. Asymmetry is a normal finding; enlargement and recession are not related to diabetes or syphilis. Any nodules found on the testes must be evaluated for malignancy and are not characteristic of syphilis or diabetes. REF: p. 473 • A normal vas deferens should feel a. tender. b. smooth. c. rugated. d. spongy. e. beaded. The vas deferens should normally feel smooth, discrete, and nontender. REF: p. 473 • A premature infant’s scrotum will be a. bifid. b. loose. c. rugated. d. smooth. e. enlarged. A scrotum in a premature infant will appear underdeveloped and smooth without rugae or testes; a full-term infant should have a loose, pendulous scrotum with rugae and a midline raphe. REF: p. 474 • An enlarged, painless testicle in an adolescent or adult may indicate a. epididymitis. b. testicular torsion. c. a tumor. d. an undescended testicle. e. hypospadias. A hard, enlarged, painless testicle can indicate a tumor in an adolescent or adult male. Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months. Hypospadias is a congenital defect of the urethral opening causing the meatus to be located ventral to its normal position. REF: p. 475 • You palpate a soft, slightly tender mass in the right scrotum of a man. You attempt to reduce the size of the mass, and there is no change in the mass size. Your next assessment maneuver is to a. use two fingers to attempt to reduce the mass. b. palpate the left scrotum simultaneously. c. lift the right testicle, then compare pain level. d. transilluminate the mass. e. culture the meatus for gonococcal infection. A soft mass is either a hernia or hydrocele. If the mass can be reduced, it is probably a hernia; a nonreducible mass should be transilluminated to determine whether it contains fluid and is possibly caused by a hydrocele. Lifting the scrotum should be done when epididymitis is suspected. Urethral cultures are not indicated at this point. REF: p. 475 • The most common cancer in young men age 15 to 30 years is a. testicular. b. penile. c. pancreatic. d. anal. e. prostate. Because testicular tumors are the most common cancer occurring in young adults, self-examination is encouraged. REF: p. 483 • The most emergent cause of testicular pain in a young male is a. varicocele. b. epididymitis. c. tumor. d. hydrocele. e. testicular torsion. Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in a much lower salvage rate. REF: p. 483 • An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria and fever. Your prioritized assessment should be to a. obtain urine and DNA probe urethral samples. b. lift the left scrotum to confirm epididymitis. c. establish absent cremasteric reflex. d. transilluminate the left and right scrotum. e. have the patient stand and observe the scrotum for a “bag of worms.” The patient is displaying symptoms of testicular torsion. An absent cremasteric reflex is a supporting finding to differentiate torsion from epididymitis. REF: p. 483 • When examining a small child, in which position should he be placed to help push the testicles into the scrotum? a. Trendelenburg b. Tailor c. Standing d. Prone e. Supine When the child is old enough to sit cooperatively, ask him to sit in a tailor position with legs crossed for the testicular examination. REF: p. 475 • The most common type of hernia occurring in young males is a. hiatal. b. incarcerated femoral. c. indirect inguinal. d. umbilical. e. femoral. The most common type of hernia in children and young males is an indirect inguinal hernia. REF: p. 476 • Difficulty replacing the retracted foreskin of the penis to its normal position is called a. paraphimosis. b. Peyronie disease. c. prepuce. d. priapism. e. phimosis. Paraphimosis refers to the inability to replace the foreskin to its original position after it has been retracted behind the glans. REF: p. 478 • The finding of a painless indurated lesion on the glans penis is most consistent with a. herpes simplex. b. herpes zoster. c. warts. d. chancre. e. molluscum contagiosum. Syphilitic chancre is a painless lesion with an indurated border and a clear base. REF: p. 478 • A finding associated with male genital herpes is a. disseminated lymphadenopathy. b. pain subsiding with scrotal elevation. c. soft, red papules on the prepuce. d. painful superficial penile vesicles. e. pearly gray, dome-shaped lesions. Genital herpes presents as painful superficial vesicles on an erythemic base. REF: p. 478 • A male whose urethral meatus opens on the ventral surface of his penis has which condition? a. Peyronie disease b. Hydrocele c. Hypospadias d. Normal variation e. Epispadias The congenital defect in which the urethral meatus is located on the ventral surface of the glans is called hypospadias. REF: p. 484 • Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably a. lymphogranuloma venereum. b. condylomata. c. molluscum contagiosum. d. chancres. e. herpetic lesions. Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative of molluscum contagiosum. REF: p. 480 • Self-examination of the male genitalia a. should be restricted to adults with prior cryptorchidism. b. should be performed while bathing. c. starts with palpation and then inspection. d. should be performed yearly. e. cannot be adequately performed due to poor visualization of the scrotum. Monthly self-examination is recommended as a screening test for testicular cancer as well as sexually transmitted infections for all young men starting at 15 years of age. It is encouraged during bathing because the scrotal skin is less thick at this time and because the scrotum hangs looser because of the warmth. Inspection is done first followed by palpation. REF: p. 470 • A 12-year-old boy says that his left scrotum has a soft swollen mass. The scrotum is not painful upon palpation. The left inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with a. orchitis. b. hydrocele. c. rectocele. d. scrotal hernia. e. epididymitis. A hydrocele is a soft scrotal mass that occurs from fluid accumulation and therefore does transilluminate. Orchitis results in a swollen, tender testis. A rectocele does not result in scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal. Epididymitis is an extremely painful condition. REF: p. 481 • Which condition is a complication of mumps in an adolescent or adult? a. Varicocele b. Epididymitis c. Orchitis d. Paraphimosis e. Cystitis Orchitis is uncommon unless seen as a complication of mumps in an adolescent or adult. REF: p. 482 • A man with Peyronie disease will usually complain of a. painful, inflamed testicles. b. deviation of the penis during erection. c. lack of sexual interest. d. painful lesions of the penis. e. a painless ulceration on the penile shaft. Peyronie disease is characterized by a fibrous band in the corpus cavernous. It results in unilateral deviation of the penis during erection. REF: p. 480 • A cremasteric reflex should result in a. the scrotum appear to contain a “bag of worms.” b. penile deviation to the left side. c. scrotum to elevate bilaterally. d. immediate erection of the penis. e. testicle and scrotal rise on the stroked side. Upon stroking the inner thigh with a blunt instrument or finger, the testicle and scrotum should rise on the stroked side. REF: p. 474 • Posteriorly, the labia minora meet as two ridges that fuse to form the a. fourchette. b. vulva. c. clitoris. d. perineum. e. perineal body. The labia minora join posteriorly at a junction called the fourchette. REF: p. 417 • What structures are located at the 5 o’clock and the 7 o’clock positions of the vaginal orifice and open onto the sides of the vestibule in the groove between the labia minora and the hymen? a. Skene glands b. Perineal bodies c. Labia majora d. Bartholin glands e. Labia minora Bartholin glands are found posteriorly on each side of the vaginal orifice and open onto the sides of the vestibule. REF: p. 417 • During sexual excitement, how is the vaginal introitus lubricated? a. Bartholin glands secrete mucus. b. Clitoris produces moisture. c. Skene glands secrete fluid. d. Urethral surfaces secrete water. e. Hymen secretes mucus. The Bartholin glands secrete mucus into the introitus for lubrication during sexual stimulation. REF: p. 417

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