Advanced Health Assessment Midterm
Review
______is an allergic inflammation of the nasal airways. It occurs when an allergen, such as
pollen, dust or animal dander is inhaled by an individual with a sensitized immune system. In
such individuals; the allergen triggers the production of the antibody immunoglobulin E (IgE),
which binds to mast cells and basophils containing histamine.
allergic rhinitis
decompensation
deficiency
degeneration - ANS -allergic rhinitis
\A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye.
It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon
physical examination, there is a red raised area at the margin of the eyelid that is tender to
palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the
most likely diagnosis?
Xanthelasma
Hordeolum
Dacryocystitis
Chalazion - ANS -Hordeolum
\A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and fussiness. The ear
examination is as follows: external ear, normal appearance and no tenderness with
manipulation; canal, normal diameter without evidence of inflammation; tympanic membrane,
bulging, erythematous, and opaque. Insufflation is deferred due to pain. What is your diagnosis?
Otitis externa
Cholesteatoma
Ruptured tympanic membrane
Otitis media - ANS -Otitis media
,There is no inflammation of the outer ear, including the canal, thus excluding otitis externa.
Cholesteatoma is a painless white lesion behind the TM. There is no drainage from the TM;
thus, rupture is unlikely. This is a classic description of otitis media. Many examiners will forego
insufflation if the diagnosis is clear, because this can cause discomfort in an already
uncomfortable ear.
\A 15-year-old high school sophomore and her mother come to your clinic because the mother
is concerned about her daughter's weight. You measure her daughter's height and weight and
obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate?
Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
Reassure the mother that this is a normal body weight.
Give the patient information about exercise because the patient is obese.
Give the patient information concerning reduction of fat and cholesterol in her diet because she
is obese. - ANS -Reassure the mother that this is a normal body weight.
The patient has a normal BMI; the range for a normal BMI is 18.5 to 24.9 kg/m2. You may be
able to give the patient and her mother the lower limit of normal in pounds for her daughter's
height, or instruct her in how to use a BMI table.
\A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of
sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which
is the most likely pathologic process?
Infection
Inflammation
Allergic
Vascular - ANS -Allergic
This description is most consistent with allergic rhinitis.
\A 17-year-old high school student is brought in to your emergency room in a comatose state.
His friends have accompanied him and tell you that they have been shooting up heroin tonight
and they think their friend may have had too much. The patient is unconscious and cannot
protect his airway, so he is intubated. His heart rate is 60 and he is breathing through the
ventilator. He is not posturing and he does not respond to a sternal rub. Preparing to finish the
neurologic examination, you get a penlight.
What size pupils do you expect to see in this comatose patient?
Asymmetric pupils
,Irregularly shaped pupils
Pinpoint pupils
Large pupils - ANS -Pinpoint pupils
\A 19-year old-college student presents to the emergency room with fever, headache, and neck
pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of
her dorm mates have been vaccinated, but she hasn't been. Which of the following physical
examination descriptions is most consistent with meningitis?
Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of
motion
Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle
spasm and limited range of motion to the right
Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to
palpation, unable to perform range of motion
Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full
range of motion - ANS -Head is normocephalic and atraumatic, fundi with blurred disc margins,
neck tender to palpation, unable to perform range of motion
Blurred disc margins are consistent with papilledema, and neck tenderness and lack of range of
motion are consistent with neck stiffness, which in this scenario is likely to be caused by
meningeal inflammation. Later, you will learn about Kernig's and Brudzinski's signs, which are
helpful in testing for meningeal irritation on examination.
\A 21-year-old engineering student comes to your office, complaining of leg and back pain and
of tripping when he walks. He states this started 3 months ago with back and buttock pain but
has since progressed to feeling weak in his left leg. He denies any bowel or bladder symptoms.
He can think of no specific traumatic incidences but he was a defensive lineman in high school
and junior college. His past medical history is unremarkable. He denies tobacco use or alcohol
or drug abuse. His parents are both healthy. On examination he is tender over the lumbar spine
and he has a positive straight-leg raise on the left. His Achilles tendon deep reflex is decreased
on the left. While watching his gait you notice he has to pick his left foot up high in order not to
trip.
What abnormality of gait does he most likely have?
Parkinsonian gait
Steppage gait
Spastic hemiparesis
, Sensory ataxia - ANS -Steppage gait
\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?
Infectious
Inflammatory
Hematologic
Traumatic - ANS -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. Your clinical reasoning skills are important for sorting through all of
the data to arrive at the most likely conclusion.
\A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge. As
the provider, you need to get a sexual history. Which one of the following questions is
inappropriate for eliciting the information?
Are you sexually active?
When was the last time you had intimate physical contact with someone, and did that contact
include sexual intercourse?
Do you have sex with men, women, or both?
How many sexual partners have you had in the last 6 months? - ANS -Are you sexually active?
This is inappropriate because it is too vague. Given the complaint, you should probably assume
that he is sexually active. Sometimes patients may respond to this question with the phrase No,
I just lie there. A specific sexual history will help you to assess this patient's risk for other
sexually transmitted infections
\A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 26.0
kg/m2. He is concerned about his weight. Based on this information, what is appropriate
counsel for the patient during the visit?
Refer the patient to a nutritionist because he is anorexic.
Reassure the patient that he has a normal body weight.
Review
______is an allergic inflammation of the nasal airways. It occurs when an allergen, such as
pollen, dust or animal dander is inhaled by an individual with a sensitized immune system. In
such individuals; the allergen triggers the production of the antibody immunoglobulin E (IgE),
which binds to mast cells and basophils containing histamine.
allergic rhinitis
decompensation
deficiency
degeneration - ANS -allergic rhinitis
\A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye.
It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon
physical examination, there is a red raised area at the margin of the eyelid that is tender to
palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the
most likely diagnosis?
Xanthelasma
Hordeolum
Dacryocystitis
Chalazion - ANS -Hordeolum
\A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and fussiness. The ear
examination is as follows: external ear, normal appearance and no tenderness with
manipulation; canal, normal diameter without evidence of inflammation; tympanic membrane,
bulging, erythematous, and opaque. Insufflation is deferred due to pain. What is your diagnosis?
Otitis externa
Cholesteatoma
Ruptured tympanic membrane
Otitis media - ANS -Otitis media
,There is no inflammation of the outer ear, including the canal, thus excluding otitis externa.
Cholesteatoma is a painless white lesion behind the TM. There is no drainage from the TM;
thus, rupture is unlikely. This is a classic description of otitis media. Many examiners will forego
insufflation if the diagnosis is clear, because this can cause discomfort in an already
uncomfortable ear.
\A 15-year-old high school sophomore and her mother come to your clinic because the mother
is concerned about her daughter's weight. You measure her daughter's height and weight and
obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate?
Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
Reassure the mother that this is a normal body weight.
Give the patient information about exercise because the patient is obese.
Give the patient information concerning reduction of fat and cholesterol in her diet because she
is obese. - ANS -Reassure the mother that this is a normal body weight.
The patient has a normal BMI; the range for a normal BMI is 18.5 to 24.9 kg/m2. You may be
able to give the patient and her mother the lower limit of normal in pounds for her daughter's
height, or instruct her in how to use a BMI table.
\A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of
sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which
is the most likely pathologic process?
Infection
Inflammation
Allergic
Vascular - ANS -Allergic
This description is most consistent with allergic rhinitis.
\A 17-year-old high school student is brought in to your emergency room in a comatose state.
His friends have accompanied him and tell you that they have been shooting up heroin tonight
and they think their friend may have had too much. The patient is unconscious and cannot
protect his airway, so he is intubated. His heart rate is 60 and he is breathing through the
ventilator. He is not posturing and he does not respond to a sternal rub. Preparing to finish the
neurologic examination, you get a penlight.
What size pupils do you expect to see in this comatose patient?
Asymmetric pupils
,Irregularly shaped pupils
Pinpoint pupils
Large pupils - ANS -Pinpoint pupils
\A 19-year old-college student presents to the emergency room with fever, headache, and neck
pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of
her dorm mates have been vaccinated, but she hasn't been. Which of the following physical
examination descriptions is most consistent with meningitis?
Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of
motion
Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle
spasm and limited range of motion to the right
Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to
palpation, unable to perform range of motion
Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full
range of motion - ANS -Head is normocephalic and atraumatic, fundi with blurred disc margins,
neck tender to palpation, unable to perform range of motion
Blurred disc margins are consistent with papilledema, and neck tenderness and lack of range of
motion are consistent with neck stiffness, which in this scenario is likely to be caused by
meningeal inflammation. Later, you will learn about Kernig's and Brudzinski's signs, which are
helpful in testing for meningeal irritation on examination.
\A 21-year-old engineering student comes to your office, complaining of leg and back pain and
of tripping when he walks. He states this started 3 months ago with back and buttock pain but
has since progressed to feeling weak in his left leg. He denies any bowel or bladder symptoms.
He can think of no specific traumatic incidences but he was a defensive lineman in high school
and junior college. His past medical history is unremarkable. He denies tobacco use or alcohol
or drug abuse. His parents are both healthy. On examination he is tender over the lumbar spine
and he has a positive straight-leg raise on the left. His Achilles tendon deep reflex is decreased
on the left. While watching his gait you notice he has to pick his left foot up high in order not to
trip.
What abnormality of gait does he most likely have?
Parkinsonian gait
Steppage gait
Spastic hemiparesis
, Sensory ataxia - ANS -Steppage gait
\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?
Infectious
Inflammatory
Hematologic
Traumatic - ANS -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. Your clinical reasoning skills are important for sorting through all of
the data to arrive at the most likely conclusion.
\A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge. As
the provider, you need to get a sexual history. Which one of the following questions is
inappropriate for eliciting the information?
Are you sexually active?
When was the last time you had intimate physical contact with someone, and did that contact
include sexual intercourse?
Do you have sex with men, women, or both?
How many sexual partners have you had in the last 6 months? - ANS -Are you sexually active?
This is inappropriate because it is too vague. Given the complaint, you should probably assume
that he is sexually active. Sometimes patients may respond to this question with the phrase No,
I just lie there. A specific sexual history will help you to assess this patient's risk for other
sexually transmitted infections
\A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 26.0
kg/m2. He is concerned about his weight. Based on this information, what is appropriate
counsel for the patient during the visit?
Refer the patient to a nutritionist because he is anorexic.
Reassure the patient that he has a normal body weight.
