Advanced Health Assessment Test 1
1. 29.ID: 18659195769
When palpating enlarged lymph nodes in a patient with tuberculosis, which finding would you
expect?
A. Warm, tender nodes
B. Pulsating irregular nodes
C. Body temperature, nontender nodes
D. Hard, matted nodes - ANS -C. Body temperature, nontender nodes
In tuberculosis, the lymph nodes, often felt in the cervical chains, are usually body temperature,
soft, matted, and not tender or painful.
\1. 63.ID: 18659201348
Diaphragmatic excursion may be slightly elevated on the right side because of the presence of:
A. the spleen.
B. the right middle lobe.
C. the liver.
D. the stomach. - ANS -C. the liver.
The diaphragmatic excursion is the movement of the thoracic diaphragm that occurs with
inhalation and exhalation. The diaphragm is usually higher on the right than on the left because
it sits over the bulk of the liver.
\1. Mrs. Black is bringing her adolescent daughter in for her follow-up visit. Which of the
following statements is true about sexual maturation?
A. Breast and pubic hair development are not related to a growth spurt.
B. Sexual maturation occurs later in girls than boys.
C. Mexican American girls enter puberty later than blacks and earlier than whites.
D. Sexual maturation occurs later in taller girls. - ANS -C. Mexican American girls enter puberty
later than blacks and earlier than whites.
Sexual maturation begins earlier in girls with a higher body mass index. On average, black girls
enter puberty first, followed by Mexican American girls, and then white girls.
\1. Mrs. Jones has brought her 4-month-old female infant in for her routine physical. Which
statement is true about the baby's expected weight?
A. Weight doubles during the first 3 months, then triples by 1 year.
B. Weight doubles during the first 4 to 5 months, then triples by 1 year.
C. Weight doubles during the first 6 months, and doubles again by 1 year.
D. Weight doubles during the first 6 months, and then triples by 18 months. - ANS -B. Weight
doubles during the first 4 to 5 months, then triples by 1 year.
In general, infants double their birth weight by 4 to 5 months of age and triple their birth weight
by 12 months of age. The remaining answers are not true.
,\1. The appearance of secondary sexual characteristics in an 8-year-old boy followed by
progressive sexual maturation can be indicative of which problem?
A. Cushing syndrome
B. Klinefelter syndrome
C. Testicular tumor
D. Brain tumor - ANS -D. Brain tumor
A brain tumor or lesion (e.g., hypothalamic hamartoma) may activate the
hypothalamic-pituitary-gonadal axis, with gonadotropins triggering the growth of the gonads,
secretion of the sex hormones, and progressive sexual maturation. Answers a, b, and c result in
different characteristics.
\A "rubbing" that can be felt and heard is most closely associated with:
A. pleurisy.
B. pneumonia.
C. emphysema.
D. asthma. - ANS -A. pleurisy.
Pleurisy is an inflammatory process involving the visceral and parietal pleura characterized by
patients reporting subjective rubbing of the pleural surfaces.
\A 19-year-old man has a severe infection involving the fifth digit of the right hand. Where
should the examiner expect to palpate enlarged and tender lymph nodes?
A. Radial aspect of the wrist
B. Palmar aspect of the hand
C. Medial epicondyle of the humerus
D. Left lower neck - ANS -C. Medial epicondyle of the humerus
The epitrochlear lymph nodes drain the hand and lower arm. These nodes are located at the
elbow in the groove between the biceps and triceps muscles proximal and slightly anterior to the
medial epicondyle of the humerus.
\A 2-month-old infant is brought to the clinic for immunizations. The examiner palpates enlarged
inguinal nodes. What additional finding might explain the enlarged nodes?
A. The mother reports that the infant suffers from colic.
B. The infant's length and weight are above the 85th percentile.
C. The infant has a severe diaper rash.
D. A port wine stain is present on the infant's left thigh. - ANS -C. The infant has a severe diaper
rash.
Enlargement of the inguinal nodes suggests infection or metastatic carcinoma in the associated
anatomic area.
\A 22-year-old college student presents for a routine physical examination. Which finding would
you expect on examination of the student's thyroid gland?
A. The gland decreases when the student swallows.
B. The right lobe is about a quarter larger than the left.
C. A soft rushing sound is heard on auscultation of the gland.
,D. The glandular tissue feels gritty but free of nodules. - ANS -B. The right lobe is about a
quarter larger than the left.
The thyroid at its broadest dimension is approximately 4 cm, and the right lobe is often 25%
larger than the left.
\A 26-year-old woman presenting for a preemployment physical is found to have bruising on her
back and buttocks. What would be your best immediate response?
A. Ask, "Would you care to tell me about these bruises on your back and buttocks?"
B. Say, "I see bruises. How did you get them?"
C. Ask, "Do you feel safe in your current relationships?"
D. Say, "I am required by the law to document these bruises, so I am asking your permission to
take a picture of them." - ANS -B. Say, "I see bruises. How did you get them?"
Should the examiner see something suggestive like bruises, follow-up questions are required.
"How did you get them" is an appropriate nonjudgmental follow-up question. Answers a, c, and
d are representative of judgmental questions.
\A 4-month-old infant is brought to the clinic. At birth, the baby weighed 6 pounds 8 ounces. If
the baby is gaining weight at a desired rate, the examiner should expect the baby to now weigh
about:
A. 8 pounds.
B. 9½ pounds.
C. 12 pounds.
D. 15 pounds. - ANS -C. 12 pounds.
Most term newborns vary in weight between 2500 and 4000 g (5 lb and 8 oz to 8 lb and 13 oz).
After losing up to 10% of their birth weight, newborns regain that weight within 2 weeks, and
then gain weight at a rate of approximately 30 g (1 oz) per day. In general, infants double their
birth weight by 4 to 5 months of age and triple their birth weight by 12 months of age.
\A 45-year-old man tells you that he often has headaches in the evening that feel like a band is
being tightened around his head. These characteristics are indicative of which type of
headache?
A. Classic migraine
B. Cluster
C. Tension
D. Hypertensive - ANS -C. Tension
Muscular tension headaches can occur at anytime but usually present in the afternoon or
evening. Patients often report bandlike constriction with stress, anger, or bruxism.
\A 45-year-old patient presents with a complaint of anxiety related to his wife's criticism of his
drinking. During the history you ask several of the CAGE model questions and the patient tells
you that he wants to cut down on his drinking. Which conclusion would you draw about this
patient?
A. He is an alcoholic.
B. His drinking is caused by anxiety.
, C. He may be an alcohol abuser.
D. He should be examined for symptoms of withdrawal. - ANS -C. He may be an alcohol abuser.
The CAGE questionnaire is one model for discussing the use of alcohol. CAGE is an acronym
for Cutting down, Annoyed by criticism, Guilty feeling, Eye-openers. Its use does not ensure
absolute sensitivity in the detection of a problem. There is a difference between a screening and
an assessment interview. The goal of screening is to find out if a problem exists. This is
particularly true of CAGE, CRAFFT, and TACE screening tools. They are effective, but they are
only the start, and assessment goes on from there.
\A 6-month-old infant is brought to the clinic for immunizations. While examining the baby, the
examiner notes that the anterior fontanel has not closed. What is the significance of this finding?
A. This indicates a slight developmental delay.
B. This suggests a nutritional deficiency.
C. This is consistent with hydrocephaly.
D. This is a normal finding. - ANS -D. This is a normal finding.
The posterior fontanel usually closes by 2 months of age and the anterior fontanel by 12 to 15
months of age.
\A 6-year-old girl has freckles over her nose and cheeks. The examiner will recall that freckles
are a type of:
A. macule.
B. papule.
C. nodule.
D. patch. - ANS -A. macule.
A macule is a flat, circumscribed area that is a change in the color of the skin usually less than 1
cm in diameter. Freckles, flat moles, petechiae, and measles are examples of macules.
\A 76-year-old woman patient has a blood pressure that consistently runs between 106 to 114
systolic and 82 to 86 diastolic. How would you categorize her blood pressure?
A. Normal
B. Hypotension
C. Prehypertension
D. Stage 1 hypertension - ANS -C. Prehypertension
Prehypertension exists if the systolic blood pressure is between 120 to 139 or the diastolic is
between 80 to 89. Normal systolic is less than 120 and normal diastolic is less than 80, whereas
hypertension exists when the systolic is greater than 140 and the diastolic is greater than 90.
\A baby's height, until 2 years of age, is measured by:
A. the recumbent length.
B. stadiometer.
C. height weight parameters.
D. skinfold thickness. - ANS -A. the recumbent length.
1. 29.ID: 18659195769
When palpating enlarged lymph nodes in a patient with tuberculosis, which finding would you
expect?
A. Warm, tender nodes
B. Pulsating irregular nodes
C. Body temperature, nontender nodes
D. Hard, matted nodes - ANS -C. Body temperature, nontender nodes
In tuberculosis, the lymph nodes, often felt in the cervical chains, are usually body temperature,
soft, matted, and not tender or painful.
\1. 63.ID: 18659201348
Diaphragmatic excursion may be slightly elevated on the right side because of the presence of:
A. the spleen.
B. the right middle lobe.
C. the liver.
D. the stomach. - ANS -C. the liver.
The diaphragmatic excursion is the movement of the thoracic diaphragm that occurs with
inhalation and exhalation. The diaphragm is usually higher on the right than on the left because
it sits over the bulk of the liver.
\1. Mrs. Black is bringing her adolescent daughter in for her follow-up visit. Which of the
following statements is true about sexual maturation?
A. Breast and pubic hair development are not related to a growth spurt.
B. Sexual maturation occurs later in girls than boys.
C. Mexican American girls enter puberty later than blacks and earlier than whites.
D. Sexual maturation occurs later in taller girls. - ANS -C. Mexican American girls enter puberty
later than blacks and earlier than whites.
Sexual maturation begins earlier in girls with a higher body mass index. On average, black girls
enter puberty first, followed by Mexican American girls, and then white girls.
\1. Mrs. Jones has brought her 4-month-old female infant in for her routine physical. Which
statement is true about the baby's expected weight?
A. Weight doubles during the first 3 months, then triples by 1 year.
B. Weight doubles during the first 4 to 5 months, then triples by 1 year.
C. Weight doubles during the first 6 months, and doubles again by 1 year.
D. Weight doubles during the first 6 months, and then triples by 18 months. - ANS -B. Weight
doubles during the first 4 to 5 months, then triples by 1 year.
In general, infants double their birth weight by 4 to 5 months of age and triple their birth weight
by 12 months of age. The remaining answers are not true.
,\1. The appearance of secondary sexual characteristics in an 8-year-old boy followed by
progressive sexual maturation can be indicative of which problem?
A. Cushing syndrome
B. Klinefelter syndrome
C. Testicular tumor
D. Brain tumor - ANS -D. Brain tumor
A brain tumor or lesion (e.g., hypothalamic hamartoma) may activate the
hypothalamic-pituitary-gonadal axis, with gonadotropins triggering the growth of the gonads,
secretion of the sex hormones, and progressive sexual maturation. Answers a, b, and c result in
different characteristics.
\A "rubbing" that can be felt and heard is most closely associated with:
A. pleurisy.
B. pneumonia.
C. emphysema.
D. asthma. - ANS -A. pleurisy.
Pleurisy is an inflammatory process involving the visceral and parietal pleura characterized by
patients reporting subjective rubbing of the pleural surfaces.
\A 19-year-old man has a severe infection involving the fifth digit of the right hand. Where
should the examiner expect to palpate enlarged and tender lymph nodes?
A. Radial aspect of the wrist
B. Palmar aspect of the hand
C. Medial epicondyle of the humerus
D. Left lower neck - ANS -C. Medial epicondyle of the humerus
The epitrochlear lymph nodes drain the hand and lower arm. These nodes are located at the
elbow in the groove between the biceps and triceps muscles proximal and slightly anterior to the
medial epicondyle of the humerus.
\A 2-month-old infant is brought to the clinic for immunizations. The examiner palpates enlarged
inguinal nodes. What additional finding might explain the enlarged nodes?
A. The mother reports that the infant suffers from colic.
B. The infant's length and weight are above the 85th percentile.
C. The infant has a severe diaper rash.
D. A port wine stain is present on the infant's left thigh. - ANS -C. The infant has a severe diaper
rash.
Enlargement of the inguinal nodes suggests infection or metastatic carcinoma in the associated
anatomic area.
\A 22-year-old college student presents for a routine physical examination. Which finding would
you expect on examination of the student's thyroid gland?
A. The gland decreases when the student swallows.
B. The right lobe is about a quarter larger than the left.
C. A soft rushing sound is heard on auscultation of the gland.
,D. The glandular tissue feels gritty but free of nodules. - ANS -B. The right lobe is about a
quarter larger than the left.
The thyroid at its broadest dimension is approximately 4 cm, and the right lobe is often 25%
larger than the left.
\A 26-year-old woman presenting for a preemployment physical is found to have bruising on her
back and buttocks. What would be your best immediate response?
A. Ask, "Would you care to tell me about these bruises on your back and buttocks?"
B. Say, "I see bruises. How did you get them?"
C. Ask, "Do you feel safe in your current relationships?"
D. Say, "I am required by the law to document these bruises, so I am asking your permission to
take a picture of them." - ANS -B. Say, "I see bruises. How did you get them?"
Should the examiner see something suggestive like bruises, follow-up questions are required.
"How did you get them" is an appropriate nonjudgmental follow-up question. Answers a, c, and
d are representative of judgmental questions.
\A 4-month-old infant is brought to the clinic. At birth, the baby weighed 6 pounds 8 ounces. If
the baby is gaining weight at a desired rate, the examiner should expect the baby to now weigh
about:
A. 8 pounds.
B. 9½ pounds.
C. 12 pounds.
D. 15 pounds. - ANS -C. 12 pounds.
Most term newborns vary in weight between 2500 and 4000 g (5 lb and 8 oz to 8 lb and 13 oz).
After losing up to 10% of their birth weight, newborns regain that weight within 2 weeks, and
then gain weight at a rate of approximately 30 g (1 oz) per day. In general, infants double their
birth weight by 4 to 5 months of age and triple their birth weight by 12 months of age.
\A 45-year-old man tells you that he often has headaches in the evening that feel like a band is
being tightened around his head. These characteristics are indicative of which type of
headache?
A. Classic migraine
B. Cluster
C. Tension
D. Hypertensive - ANS -C. Tension
Muscular tension headaches can occur at anytime but usually present in the afternoon or
evening. Patients often report bandlike constriction with stress, anger, or bruxism.
\A 45-year-old patient presents with a complaint of anxiety related to his wife's criticism of his
drinking. During the history you ask several of the CAGE model questions and the patient tells
you that he wants to cut down on his drinking. Which conclusion would you draw about this
patient?
A. He is an alcoholic.
B. His drinking is caused by anxiety.
, C. He may be an alcohol abuser.
D. He should be examined for symptoms of withdrawal. - ANS -C. He may be an alcohol abuser.
The CAGE questionnaire is one model for discussing the use of alcohol. CAGE is an acronym
for Cutting down, Annoyed by criticism, Guilty feeling, Eye-openers. Its use does not ensure
absolute sensitivity in the detection of a problem. There is a difference between a screening and
an assessment interview. The goal of screening is to find out if a problem exists. This is
particularly true of CAGE, CRAFFT, and TACE screening tools. They are effective, but they are
only the start, and assessment goes on from there.
\A 6-month-old infant is brought to the clinic for immunizations. While examining the baby, the
examiner notes that the anterior fontanel has not closed. What is the significance of this finding?
A. This indicates a slight developmental delay.
B. This suggests a nutritional deficiency.
C. This is consistent with hydrocephaly.
D. This is a normal finding. - ANS -D. This is a normal finding.
The posterior fontanel usually closes by 2 months of age and the anterior fontanel by 12 to 15
months of age.
\A 6-year-old girl has freckles over her nose and cheeks. The examiner will recall that freckles
are a type of:
A. macule.
B. papule.
C. nodule.
D. patch. - ANS -A. macule.
A macule is a flat, circumscribed area that is a change in the color of the skin usually less than 1
cm in diameter. Freckles, flat moles, petechiae, and measles are examples of macules.
\A 76-year-old woman patient has a blood pressure that consistently runs between 106 to 114
systolic and 82 to 86 diastolic. How would you categorize her blood pressure?
A. Normal
B. Hypotension
C. Prehypertension
D. Stage 1 hypertension - ANS -C. Prehypertension
Prehypertension exists if the systolic blood pressure is between 120 to 139 or the diastolic is
between 80 to 89. Normal systolic is less than 120 and normal diastolic is less than 80, whereas
hypertension exists when the systolic is greater than 140 and the diastolic is greater than 90.
\A baby's height, until 2 years of age, is measured by:
A. the recumbent length.
B. stadiometer.
C. height weight parameters.
D. skinfold thickness. - ANS -A. the recumbent length.
