NO 509 MIDTERM EXAM QUESTIONS AND ANSWERS
ALREADY GRADED A+
You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain
from an old war injury, and headaches. Today he complains of these pains, as well as
dull chest pain under his sternum. What would the order of priority be for your problem
list?
A) Arthritis, war injury pain, headaches, chest pain
B) War injury pain, arthritis, headaches, chest pain
C) Headaches, arthritis, war injury pain, chest pain
D) Chest pain, headaches, arthritis, war injury pain - D) Chest pain, headaches, arthritis,
war injury pain
The problem list should have the most active and serious problem first. This new
complaint of chest pain is almost certainly a higher priority than his other, more chronic
problems.
You are excited about a positive test finding you have just noticed on physical
examination
of your patient. You go on to do more examination, laboratory work, and diagnostic
tests, only
to find that there is no sign of the disease you thought would correlate with the finding.
This
same experience happens several times. What should you conclude?
A) Consider not doing this test routinely.
B) Use this test when you have a higher suspicion for a certain correlating condition.
C) Continue using the test, perhaps doing less laboratory work and diagnostics.
D) Omit this test from future examinations. - C) Continue using the test, perhaps doing
less laboratory work and diagnostics.
This is an example of a specific test that lacks sensitivity. With this scenario,
when you finally find a positive, you might be very certain that a given condition is
present.
We generally develop our examinations to fit our clinical experiences. Sensitive tests
are
performed routinely on the screening examination, while specific tests are usually saved
for the
detailed or "branched" examinations. Branched examinations are further maneuvers we
can
perform to investigate positive findings on our screening examinations. Save this type of
,maneuver to confirm your hypothesis.
You have recently returned from a medical missions trip to sub-Saharan Africa, where
you
learned a great deal about malaria. You decide to use some of the same questions and
maneuvers in your "routine" when examining patients in the midwestern United States.
You
are disappointed to find that despite getting some positive answers and findings, on
further
workup, none of your patients has malaria except one, who recently emigrated from
Ghana. How should you next approach these questions and maneuvers?
A) Continue asking these questions in a more selective way.
B) Stop asking these questions, because they are low yield.
C) Question the validity of the questions.
D) Ask these questions of all your patients. - A) Continue asking these questions in a
more selective way.
The predictive value of a positive finding depends upon the prevalence of a given
disease in a population. The prevalence of malaria in the Midwest is almost zero, except
in people immigrating from areas of high prevalence. You will waste time and resources
applying
these questions and maneuvers to all patients. It would be wise to continue applying
what you
learned to those who are from areas of high prevalence of a given disease. You will
learn to tailor your examination to the population you
are serving.
For which of the following patients would a comprehensive health history be
appropriate?
A) A new patient with the chief complaint of "I sprained my ankle".
B) An established patient with the chief complaint of "I have an upper respiratory
infection".
C) A new patient with the chief complaint of "I am here to establish care".
D) A new patient with the chief complaint of "I cut my hand". - C) A new patient with the
chief complaint of "I am here to establish care".
This patient is here to establish care, and because she is new to you, a
comprehensive health history is appropriate.
The components of the health history include all of the following except which one?
A) Review of systems
B) Thorax and lungs
,C) Present illness
D) Personal and social items - B) Thorax and lungs
The thorax and lungs are part of the physical examination, not part of the health
history.
A patient presents for evaluation of a sharp, aching chest pain which increases with
breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine - A) Musculoskeletal
Chest pain may be due to a musculoskeletal condition, such as costochondritis or
intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic
chest pain is also a sharp chest pain which increases with a deep breath. This type of
pain can
occur with inflammation of the pleura from pneumonia or other conditions and
pulmonary
embolus.
A patient comes to the emergency room for evaluation of shortness of breath. To which
anatomic region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic - C) Cardiac
Cardiac disorders such as congestive heart failure are the most likely on this list to
result in shortness of breath. There are cases within the other categories which may
also result
in shortness of breath, such as anemia in the hematologic category, pregnancy in the
reproductive
category, or sepsis with UTI in the urinary category.
A patient presents for evaluation of a cough. Which of the following anatomic regions
can be responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine - C) Cardiac
, The cardiac system can cause a cough if the patient has congestive heart failure. This
results in fluid buildup in the lungs, which in turn can cause a cough that produces pink,
frothy sputum. A foreign body in the ear may also cause a cough by stimulating Arnold's
branch of the vagus nerve, but this is less likely to be seen clinically than heart failure.
A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is
new,
located in the wrists and fingers bilaterally, with some subjective fever. The patient
denies a
rash; she also denies recent travel or camping activities. She has a family history
significant for
rheumatoid arthritis. Based on this information, which of the following pathologic
processes
would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic - B) Inflammatory
The description is most consistent with an inflammatory process, although all the other
etiologies should be considered. Lyme disease is an infection which commonly causes
arthritis, hemophilia is a hematologic condition which can cause bleeding in the joints,
and trauma can obviously cause joint pain.
A 47-year-old contractor presents for evaluation of neck pain, which has been
intermittent for several years. He normally takes over-the-counter medications to ease
the pain, but this time they haven't worked as well and he still has discomfort. He
recently wallpapered the entire second floor in his house, which caused him great
discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory
symptoms, trauma, or injury to the neck. Based on this description, what is the most
likely pathologic process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic - C) Degenerative
The description is most consistent with degenerative arthritis in the neck. The
patient has had intermittent symptoms and the questions asked to elicit pertinent
negative and
positive findings are negative for infectious, traumatic, or neoplastic disease.
A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week
history
ALREADY GRADED A+
You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain
from an old war injury, and headaches. Today he complains of these pains, as well as
dull chest pain under his sternum. What would the order of priority be for your problem
list?
A) Arthritis, war injury pain, headaches, chest pain
B) War injury pain, arthritis, headaches, chest pain
C) Headaches, arthritis, war injury pain, chest pain
D) Chest pain, headaches, arthritis, war injury pain - D) Chest pain, headaches, arthritis,
war injury pain
The problem list should have the most active and serious problem first. This new
complaint of chest pain is almost certainly a higher priority than his other, more chronic
problems.
You are excited about a positive test finding you have just noticed on physical
examination
of your patient. You go on to do more examination, laboratory work, and diagnostic
tests, only
to find that there is no sign of the disease you thought would correlate with the finding.
This
same experience happens several times. What should you conclude?
A) Consider not doing this test routinely.
B) Use this test when you have a higher suspicion for a certain correlating condition.
C) Continue using the test, perhaps doing less laboratory work and diagnostics.
D) Omit this test from future examinations. - C) Continue using the test, perhaps doing
less laboratory work and diagnostics.
This is an example of a specific test that lacks sensitivity. With this scenario,
when you finally find a positive, you might be very certain that a given condition is
present.
We generally develop our examinations to fit our clinical experiences. Sensitive tests
are
performed routinely on the screening examination, while specific tests are usually saved
for the
detailed or "branched" examinations. Branched examinations are further maneuvers we
can
perform to investigate positive findings on our screening examinations. Save this type of
,maneuver to confirm your hypothesis.
You have recently returned from a medical missions trip to sub-Saharan Africa, where
you
learned a great deal about malaria. You decide to use some of the same questions and
maneuvers in your "routine" when examining patients in the midwestern United States.
You
are disappointed to find that despite getting some positive answers and findings, on
further
workup, none of your patients has malaria except one, who recently emigrated from
Ghana. How should you next approach these questions and maneuvers?
A) Continue asking these questions in a more selective way.
B) Stop asking these questions, because they are low yield.
C) Question the validity of the questions.
D) Ask these questions of all your patients. - A) Continue asking these questions in a
more selective way.
The predictive value of a positive finding depends upon the prevalence of a given
disease in a population. The prevalence of malaria in the Midwest is almost zero, except
in people immigrating from areas of high prevalence. You will waste time and resources
applying
these questions and maneuvers to all patients. It would be wise to continue applying
what you
learned to those who are from areas of high prevalence of a given disease. You will
learn to tailor your examination to the population you
are serving.
For which of the following patients would a comprehensive health history be
appropriate?
A) A new patient with the chief complaint of "I sprained my ankle".
B) An established patient with the chief complaint of "I have an upper respiratory
infection".
C) A new patient with the chief complaint of "I am here to establish care".
D) A new patient with the chief complaint of "I cut my hand". - C) A new patient with the
chief complaint of "I am here to establish care".
This patient is here to establish care, and because she is new to you, a
comprehensive health history is appropriate.
The components of the health history include all of the following except which one?
A) Review of systems
B) Thorax and lungs
,C) Present illness
D) Personal and social items - B) Thorax and lungs
The thorax and lungs are part of the physical examination, not part of the health
history.
A patient presents for evaluation of a sharp, aching chest pain which increases with
breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine - A) Musculoskeletal
Chest pain may be due to a musculoskeletal condition, such as costochondritis or
intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic
chest pain is also a sharp chest pain which increases with a deep breath. This type of
pain can
occur with inflammation of the pleura from pneumonia or other conditions and
pulmonary
embolus.
A patient comes to the emergency room for evaluation of shortness of breath. To which
anatomic region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic - C) Cardiac
Cardiac disorders such as congestive heart failure are the most likely on this list to
result in shortness of breath. There are cases within the other categories which may
also result
in shortness of breath, such as anemia in the hematologic category, pregnancy in the
reproductive
category, or sepsis with UTI in the urinary category.
A patient presents for evaluation of a cough. Which of the following anatomic regions
can be responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine - C) Cardiac
, The cardiac system can cause a cough if the patient has congestive heart failure. This
results in fluid buildup in the lungs, which in turn can cause a cough that produces pink,
frothy sputum. A foreign body in the ear may also cause a cough by stimulating Arnold's
branch of the vagus nerve, but this is less likely to be seen clinically than heart failure.
A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is
new,
located in the wrists and fingers bilaterally, with some subjective fever. The patient
denies a
rash; she also denies recent travel or camping activities. She has a family history
significant for
rheumatoid arthritis. Based on this information, which of the following pathologic
processes
would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic - B) Inflammatory
The description is most consistent with an inflammatory process, although all the other
etiologies should be considered. Lyme disease is an infection which commonly causes
arthritis, hemophilia is a hematologic condition which can cause bleeding in the joints,
and trauma can obviously cause joint pain.
A 47-year-old contractor presents for evaluation of neck pain, which has been
intermittent for several years. He normally takes over-the-counter medications to ease
the pain, but this time they haven't worked as well and he still has discomfort. He
recently wallpapered the entire second floor in his house, which caused him great
discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory
symptoms, trauma, or injury to the neck. Based on this description, what is the most
likely pathologic process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic - C) Degenerative
The description is most consistent with degenerative arthritis in the neck. The
patient has had intermittent symptoms and the questions asked to elicit pertinent
negative and
positive findings are negative for infectious, traumatic, or neoplastic disease.
A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week
history
