NU 650/ NU650 Midterm Exam | Health Assessment (Latest 2025/ 2026 Update) | Questions and Verified Answers | GRADED A | 100% Correct – Regis

NU 650/ NU650 Midterm Exam | Health Assessment (Latest 2025/ 2026 Update) | Questions and Verified Answers | GRADED A | 100% Correct – Regis Which valve lesion typically produces a murmur of equal intensity throughout systole? A) Aortic stenosis B) Mitral insufficiency C) Pulmonic stenosis D) Aortic insufficiency B You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely? A) Emphysema B) Asthma exacerbation C) Severe left heart failure D) Cardiac tamponade C Suzanne is a 20-year-old college student who complains of chest pain. This is intermittent and is located to the left of her sternum. There are no associated symptoms. On examination, you hear a short, high-pitched sound in systole, followed by a murmur which increases in intensity until S2. This is heard best over the apex. When she squats, this noise moves later in systole along with the murmur. Which of the following is the most likely diagnosis? A) Mitral stenosis B) Mitral insufficiency C) Mitral valve prolapse D) Mitral valve papillary muscle ischemia C A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system? A) Intermittent claudication B) Chest pressure with exertion C) Shortness of breath D) Knee pain A ./ A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and states that there is a place in town that does tests to let her know if she has this or not. Which of the following disease process is a risk factor for peripheral vascular disease? A) Gastroesophageal reflux disease B) Coronary artery disease C) Migraine headaches D) Osteoarthritis B A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition? A) Venogram B)CT scan of the lower legs C) Ankle-brachial index (ABI) D) PET sca C A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms? A) Femoral pulse, popliteal pulse B) Dorsalis pedis pulse, posterior tibial pulse C) Carotid pulse D) Radial pulse, brachial pulse D ./ You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination? A) Size, symmetry, and skin color B) Muscle bulk and tone C) Nodules in joints D) Lower extremity strength A ./ You are assessing a patient for peripheral vascular disease in the arms, secondary to a complaint of increased weakness and a history of coronary artery disease and diabetes. You assess the brachial and radial pulses and note that they are bounding. What does that translate to on a scale of 0 to 3? A) 0 B) 3+ C) 2+ D) 1+ B You are obtaining an ABG in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you: A) Checked for patency of the radial artery B) Checked for patency of the brachial artery C) Checked for patency of the ulnar artery D) Checked for patency of the femoral artery C ./ You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient's pain make you concerned for this disease process? A) Thigh B) Knee C) Calf D) Ankle C You are performing a routine check-up on an 81-year-old retired cotton farmer in the vascular surgery clinic. You note that he has a history of chronic arterial insufficiency. Which of the following physical examination findings in the lower extremities would be expected with this disease? A) Normal pulsation B) Normal temperature C) Marked edema D) Thin, shiny, atrophic Skin D A 77-year-old retired nurse has an ulcer on a lower extremity that you are asked to evaluate when you do your weekly rounds at a local long-term care facility. All of the following are responsible for causing ulcers in the lower extremities except for which condition? A) Arterial insufficiency B) Venous insufficiency C) Diminished sensation in pressure points D) Hypertension D ./ As the internal diameter of a blood vessel changes, the resistance also changes. Which of the following descriptions depicts this relationship? A) Resistance varies linearly with the diameter. B) Resistance varies proportionally to the second power of the diameter. C) Resistance varies proportionally to the third power of the diameter. D) Resistance varies proportionally to the fourth power of the diameter. D Which area of the arm drains to the epitrochlear nodes? A) Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger B) Radial surface of the forearm and hand, thumb and index fingers, and radial middle finger C) Ulnar surface of the forearm and hand; second, third, and fourth fingers D) Radial surface of the forearm and hand; second, third, and fourth fingers A ./ Mr. E complains of cramps and difficulties with walking. The cramps occur in his calves consistently after walking about 100 yards. After a period of rest, he can start to walk again, but after 100 yards these same symptoms recur. Which of the following would suggest spinal stenosis as a cause of this pain? A) Coldness and pallor of the legs B) Relief of the pain with bending at the waist C) Color changes of the skin D) Swelling with tenderness of the skin B Which of the following pairs of ischemic symptoms versus vascular supply is correct? A) Lower calf/superficial femoral B) Erectile dysfunction/iliac or pudendal C) Buttock/common femoral D) Upper calf/tibial or peroneal B ./ The ankle-brachial index (ABI) is calculated by dividing the systolic BP at the dorsalis pedis by the systolic BP at the brachial artery. Which of the following values would be consistent with mild peripheral arterial disease? A) 1.1 B) 0.85 C) 0.65 D) 0.35 B ./ Asymmetric BPs are seen in which of the following conditions? A) Coronary artery disease B) Congenital narrowing of the aorta C) Diffuse atherosclerosis D) Vasculitis, as seen in systemic lupus erythematous B Diminished radial pulses may be seen in patients with which of the following? A) Aortic insufficiency B) Hyperthyroidism C) Arterial emboli D) Early "warm" septic shock C ./ When assessing skin temperature, which portion of your hand should be used? A) Fingertips B) Palms C) Backs of fingers D) Ulnar aspect of the hand C ./ A patient presents with claudication symptoms and diminished pulses. Which of the following is consistent with chronic arterial insufficiency? A) Pallor of the foot when raised to 60 degrees for one minute B) Return of color to the skin within 5 seconds of allowing legs to dangle C) Filling of the veins of the ankles within 10 seconds of allowing the legs to dangle D) Hyperpigmentation of the skin A ./ You note a painful ulcerative lesion near the medial malleolus, with accompanying hyperpigmentation. Which of the following etiologies is most likely? A) Arterial insufficiency B) Neuropathic ulcer C) Venous insufficiency D) Trauma C ./ A patient demonstrates left facial droop but can wrinkle both sides of the forehead. The examiner should suspect a problem with: (A) Central innervation of cranial nerve VII (facial) (B) Cranial nerve V (trigeminal) (C) Peripheral innervation of cranial nerve VII (D) Frontalis muscle A Mr. T. is complaining of a headache. He has just awakened from a nap and states that the headache always begins behind one eye, "feels like an icepick," and is accompanied by tearing and a runny nose. You suspect Mr. T has: (A) Migraine headache (B) Tension headache (C) Cluster headache (D) A stroke C The muscles in the neck that are innervated by cranial nerve XI are: (A) Spinal accessory and omohyoid (B) Sternomastoid and trapezius (C) Trapezius and sternomandibular (D) Sternomandibular and spinal accessory B During your examination you note that your client's eyes are puffy. You further assess coarse and dry hair. You suspect: (A) Scleroderma (B) Cachexia (C) Myxedema (D) Cretinism C You have just completed your examination and you document that the patient is unable to differentiate between sharp and dull touch bilaterally. You interpret this as: (A) Bell's palsy (B) Scleroderma of the face and cheeks (C) Damage to cranial nerve V (trigeminal nerve) (D) Paralysis C You notice that your patient's submental lymph nodes are enlarged. You would then assess the: (A) Supraclavicular area (B) Infraclavicular area (C) Area proximal to the enlarged node (D) Area distal to the enlarged node C A 26-year-old woman presents for evaluation of hair loss. She also has noticed increased weight loss and diarrhea. You diagnose Graves' disease (hyperthyroidism). On physical examination of the hair, what would you expect to find? (A) Fine texture (B) Coarse texture (C) Oily hair (D) Dry hair A A 25-year-old swim instructor presents to your clinic complaining of an itchy scalp. You diagnose seborrheic dermatitis. What physical findings are most consistent with this diagnosis? (A) Erythema of the scalp (B) Pustules on the scalp (C) Dry, flaking areas on the scalp (D) Ecchymoses on the scalp C A 55-year-old construction worker presents to the clinic to evaluate fatigue and weakness. During the course of the interview, the patient reveals that he has noticed both an increase in his ring size and his shoe size; you ask to look at his driver's license and also at any pictures that he has in his wallet of himself from an earlier time period. Upon looking at these pictures, you are able to strongly theorize that he has acromegaly. Which physical finding is most consistent with this diagnosis? (A) High forehead (B) Small, recessed jaw (C) Coarsening of the facial features (D) Ptosis C An 18-year-old college student presents to the clinic with the complaint that her heart is "racing." You obtain blood for thyroid studies and diagnose her with Graves' disease (hyperthyroidism). On physical examination of her eyes, what would you expect to see? (A) Recession (B) Protrusion (C) Clouding of the cornea (D) Ciliary injection B A 75-year-old retired farmer presents to your office for a hospital follow-up visit. He was diagnosed with a stroke and placed on medication. On review of the hospital chart, he was noted to have a stroke in the optic chiasm. What findings do you expect on examination of his visual fields? (A) Right homonymous hemianopsia (B) Horizontal defect (C) Bilateral visual field obliteration (D) Bitemporal hemianopsia D A 57-year-old auto mechanic comes to your office for evaluation of decreased vision in his right eye. You perform a fundoscopic examination and diagnose a cataract. What did you see to make this diagnosis? (A) Absence of the red reflex (B) Neovascularization (C) Hemorrhage in the fundus (D) Uveitis A A 38-year-old warehouse stocker presents to your office complaining of a headache. He has had these headaches intermittently for several years, but they have been increasing in frequency. In your clinic today, his blood pressure is 170/110 mm Hg. His urine dipstick is positive for proteinuria only, and his fingerstick glucose is 100 mg/dL. You diagnose him with uncontrolled hypertension. What finding on fundoscopic examination would support this diagnosis? (A) Cotton-wool spots (B) Arteriovenous (AV) nicking (C) Blurred optic disc margins (D) Macular star B A 50-year-old truck driver presents to your office for a routine physical examination. He denies any medical problems; he has never had surgery; he takes no medications or over-the-counter supplements. He has smoked 1 pack of cigarettes daily for 30 years. He does not use alcohol or illicit drugs. His family history is remarkable for hypertension and stroke. On physical examination, you notice that one pupil is larger than the other by 0.4 mm; everything else is normal. What is the most likely diagnosis? (A) Horner's syndrome (B) Anisocoria (C) Brain tumor (D) Tonic pupil B A 78-year-old grandmother presents for evaluation of weakness in her face. She has a long-standing history of hypertension that has been under fair control. On physical examination, you note that she has ptosis and miosis of the left eye, and left facial anhidrosis. What is your most likely diagnosis? (A) Horner's syndrome (B) Anisocoria (C) Acute angle-closure glaucoma (D) Myasthenia gravis A When you look at the tympanic membrane with the otoscope, what normal landmark is present? (A) Umbo (B) Otoliths (C) Stapes (D) Tragus A A 3-year-old boy is brought to your office by his mother for evaluation of fever, loss of appetite, and emesis. The symptoms have been present for 2 days; the fever is only temporarily relieved with antipyretics. You perform a physical examination and diagnose otitis media. What is your most likely physical finding on otoscopic examination? (A) Erythematous, bulging tympanic membrane (B) Erythematous, retracted tympanic membrane (C) Erythematous, scaly external ear canal (D) Erythematous helix A A 15-year-old high school student presents to your clinic complaining of pain in his left ear. He noticed that it occurred shortly after starting swimming lessons at the local YMCA. Upon physical examination, you notice that the external canal is swollen and tender during insertion of the speculum. What is your most likely diagnosis? (A) Otitis media (B) Serous otitis (C) Eustachian tube dysfunction (D) Otitis externa D A 15-year-old member of the high school marching band comes to your office for evaluation of hearing loss. He had multiple ear infections as an infant and toddler, and had to have myringotomy tubes inserted in his ears. Additionally, he suffers from many allergies. His hearing is diminished in the right ear. When you place a vibrating tuning fork on the top of his head, the sound lateralizes to the right ear. The name of this test is: (A) Weber's test (B) Rinne's test (C) Whisper test (D) Romberg test A You place a vibrating tuning fork on a teenager's right mastoid process, asking him to let you know when the sound is gone, then immediately place that same tuning fork near his right ear. He hears the sound equally in air as against his bone. The name of this test is: (A) Weber's test (B) Rinne's test (C) Whisper test (D) Romberg test B A 22-year-old agricultural worker presents to your office for evaluation of coughing. She has had this cough for 6 weeks; it is nonproductive and worst first thing in the morning. She denies fever, chills, weight loss, or night sweats; she does have clear rhinorrhea and itchy, watery eyes. You diagnose her with allergic rhinoconjunctivitis. On physical examination of the nasal mucosa, what would you expect to find? (A) Erythematous, ulcerated mucosa (B) Pale to bluish, boggy mucosa (C) Pink mucosa (D) Ulcerated mucosa B A 2-week-old infant is brought into your clinic by his parents because they have noticed that their child is having some difficulty with feeding and that there is something strange in his mouth. You diagnose thrush. What is the most likely physical finding you will see upon examination of his mouth? (A) Koplik's spots (B) White plaques (C) Erythematous plaques (D) Epstein's pearls B A 7-year-old elementary school child is brought into the clinic by her mother for evaluation of fever and nausea. Upon further physical examination you diagnose tonsillitis. What are you typically expecting to see on physical examination of the oropharynx? (A) Exudates on the tonsils (B) Small tonsils (C) Hemorrhage of the tonsils (D) Pseudomembranes A A 28-year-old housewife presents to your office for a 6-week postpartum checkup. She complains of fatigue greater than expected and palpitations. Her hair is falling out as well. She denies sadness or depression symptoms. Before this, she had not had any medical problems. She is breastfeeding her child and is not on any birth control. She had her first period since giving birth last week. A pregnancy test done in the office is negative. What is your most likely diagnosis? (A) Thyroiditis (B) Iron-deficiency anemia (C) Addison's disease (D) Sheehan's syndrome A When performing posterior palpation of the thyroid gland, you should do all of the following EXCEPT: (A) Have the patient tip his or her head forward and slightly to the side. (B) Place your index fingers above the cricoid cartilage. (C) Palpate between the sternocleidomastoid muscle and the trachea for the thyroid isthmus. (D) Move your fingers laterally to palpate for the thyroid lobes. B EYES _____ 1. Pupillary reaction to light _____ 2. Anisocoria _____ 3. Extraocular movements _____ 4. Blind spot _____ 5. Normal visual acuity (A) CN III (oculomotor), CN IV (trochlear), and CN VI (abducens) (B) 15 degrees temporal to the line of gaze (C) CN II (optic) and CN III (oculomotor) (D) 20/20 (E) Pupillary inequality of less than 0.5 mm 1. C 2. E 3. A 4. B 5. D EARS _____ 6. Weber's test _____ 7. Rinne's test _____ 8. Enables optimal examination of adult's tympanic membrane _____ 9. Enables optimal examination of child's tympanic membrane (A) Normally air conduction is two times longer than bone conduction (B) Lateralization of sound with tuning fork (C) External ear pulled up and backward (D) External ear pulled down and forward 6. B 7. A 8. D 9. C NOSE _____ 10. Turbinates that are visible on inspection _____ 11. Sinuses that are palpable (A) Middle turbinate (B) Superior turbinate (C) Inferior turbinate (D) Maxillary sinus (E) Frontal sinus (F) Sphenoid sinus 10. A & C 11. D & E MOUTH AND PHARYNX _____ 12. Normal number of adult teeth _____ 13. Raises soft palate _____ 14. Enables tongue protrusion (A) 32 (B) 28 (C) 40 (D) CN XII (hypoglossal) (E) CN X (vagus) (F) CN VII (facial) (G) CN VI (abducens) 12. A 13. E 14. D NECK _____ 15. Anterior triangle boundaries _____ 16. Posterior triangle boundaries _____ 17. Normal position of the trachea _____ 18. Palpation of the thyroid gland _____ 19. Enlarged thyroid gland (A) Sternomastoid muscle, trapezius muscle, clavicle (B) Mandible, sternomastoid muscle, midline of neck (C) Presence of a bruit (D) Above the cricoid cartilage (E) Below the cricoid cartilage (F) Midline 15. B 16. A 17. F 18. E 19. C A young toddler is brought to the emergency room by his parents. The mother states that the child was playing on the floor with toys and suddenly began to wheeze. The mother reports no recent illnesses. The nurse suspects that the most likely cause of the wheezing is: A increased secretions B exercise induced asthma C a severe cold D foreign body obstruction D ./ The nurse documents vesicular lung sounds upon auscultation. The nurse heard what type of sound? A. short silence between inspiration and expiration B. sound heard throughout inspiration and two thirds of expiration C. expiratory sounds lasting longer than inspiratory D. inspiratory and expiratory sounds equal in length B A patient appears in the clinic with a cough that began 24 hours prior to coming to this visit. The nurse evaluates the patient based on the most common cause of an acute cough, which is A. chronic bronchitis B. asthma C. viral respiratory infection D. pneumonia C A 21-year-old college senior presents to your clinic, complaining of SOB and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, CP, GI symptoms, or urinary tract symptoms. PMH significant only for seasonal allergies. On exam she is in no acute distress; temp is 98.6, BP is 120/80, her pulse is 80, and her RR is 20. On auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs. Which disorder of the thorax or lung does this best describe? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia C A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath, and a productive cough with golden sputum. She says she had a cold last week and her symptoms have only gotten worse, despite using over-the-counter cold remedies. She looks ill, temp is elevated, at 101; BP and pulse unremarkable. Edema of the nasal turbinates. On auscultation she has decreased air movement, and coarse crackles are heard over LLL. There is dullness on percussion, increased fremitus during palpation, and egophony and whispered pectoriloquy on auscultation. What disorder of the thorax or lung best describes her symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia D A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe SOB. Denies any recent traumas or illnesses. PMH unremarkable. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and RR 35. On auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion he is hyperresonant over RUL. Palpation: absent fremitus over the RUL. What disorder of the thorax or lung best describes his symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia A A 62-year-old construction worker presents to your clinic, complaining of almost a year of chronic cough and occasional shortness of breath. Although he has had worsening of symptoms occasionally with a cold, his symptoms have stayed about the same. The cough has occasional mucous drainage but never any blood. He denies any chest pain. PMH significant for high BP and arthritis. 2 pack/day smoker x45 years packs a day for the past 45 years. On examination you see a man looking slightly older than his stated age. His BP is 130/80, pulse 88. He is breathing comfortably -RR 12. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus. What thorax or lung disorder is most likely causing his symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia B A 36-year-old teacher presents to your clinic, complaining of sharp, knifelike pain on the left side of her chest x2 days. Breathing and lying down make the pain worse, while sitting forward helps her pain. Tylenol and ibuprofen have not helped. Her pain does not radiate to any other area. She denies any upper respiratory or gastrointestinal symptoms. PMH systemic lupus. On examination you find her to be distressed, leaning over and holding her left arm and hand to her left chest. BP 130/70, RR 12, and pulse 90. On auscultation her lung fields have normal breath sounds. A scratching noise is heard at the lower left sternal border, coincident with systole; leaning forward relieves some of her pain. What disorder of the chest best describes this disorder? A) Angina pectoris B) Pericarditis C) Dissecting aortic aneurysm D) Pleural pain B ./ A 68-year-old retired postman presents to your clinic, complaining of dull, intermittent left-sided chest pain over the last few weeks. The pain occurs after he mows his lawn or chops wood. Pain radiates to the left side of his jaw but nowhere else. He has felt light-headed and nauseated with the pain but has had no other symptoms. He states when he sits down for several minutes the pain goes away. Ibuprofen, Tylenol, and antacids have not improved his symptoms. PMH of HTN and arthritis. Smoking hx. Exam: healthy- appearing and breathing comfortably. BP 140/90, pulse 80. His lungs have normal breath sounds and no abnormalities. Normal S1 and S2; no S3 or S4. Which disorder of the chest best describes these symptoms? A) Angina pectoris B) Pericarditis C) Dissecting aortic aneurysm D) Pleural pain A A 75-year-old retired teacher presents to your clinic, complaining of severe, unrelenting anterior chest pain radiating to her back. She describes it as if someone is "ripping out her heart." It began less than an hour ago. She states she is feeling very nauseated and may pass out. Denies any trauma or recent illnesses. PMH: difficult-to-control HTN & CAD requiring 2 stents. Exam: great deal of distress. She is lying on the table, curled up, holding her left and right arms against her chest and is restless, trying to find a comfortable position. BP 180/110 R arm and 130/60 L arm, and pulse 120. Right carotid pulse is bounding but the left carotid pulse is weak. Afebrile, RR 24. Lungs are clear and her cardiac exam unremarkable. What disorder of the chest best describes her symptoms? A) Angina pectoris B) Pericarditis C) Dissecting aortic aneurysm D) Pleural pain C A 25-year-old accountant presents to your clinic, complaining of intermittent lower right-sided chest pain for several days. He describes it as knifelike and states it only lasts for 3 to 5 seconds, taking his breath away. He states he feels like he has to breathe shallowly to keep it from recurring. The only thing that makes it better is lying quietly on his right side. It is much worse when he takes a deep breath. 2 weeks ago he had an upper respiratory infection with a severe hacking cough. Exam: lying on his right side but appears quite comfortable. Temp, BP, pulse, and RR unremarkable. Normal breath sounds, percussion unremarkable. Ribs are nontender. What disorder of the chest best describes his symptoms? A) Pericarditis B) Chest wall pain C) Pleural pain D) Angina pectoralis C A 60-year-old baker presents to your clinic, complaining of increasing SOB and nonproductive cough x1 month. She feels like she can't do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. PMH: HTN and CAD. Exam: no acute distress. BP 160/100, pulse 100, afebrile, RR 16. With auscultation she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination the S1 and S2 are distant and an S3 is heard over the apex. What disorder of the chest best describes her symptoms? A) Pneumonia B) Chronic obstructive pulmonary disease (COPD) C) Pleural pain D) Left-sided heart failure D A grandmother brings her 13-year-old grandson to you for evaluation. She noticed last week when he took off his shirt that his breastbone seemed collapsed. He seems embarrassed and tells you that it has been that way for quite awhile. Asymptomatic and just tries not to take off his shirt in front of anyone. Denies SOB, chest pain, or lightheadedness on exertion. PMH unremarkable. Exam of chest you see that the lower portion of the sternum is depressed. Auscultation unremarkable. What disorder of the thorax best describes your findings? A) Barrel chest B) Funnel chest (pectus excavatum) C) Pigeon chest (pectus carinatum) D) Thoracic kyphoscoliosis B Which of the following anatomic landmark associations is correct? A) 2nd intercostal space for needle insertion in tension pneumothorax B) T6 for lower margin of endotracheal tube C) Sternal angle marks the 4th rib D) 5th intercostal space for chest tube insertion A ./ A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture? A) Bronchitis B) Costochondritis C) Pericarditis D) Angina pectoris D ./ A 62-year-old smoker complains of "coughing up small amounts of blood," so you consider hemoptysis. Which of the following should you also consider? A) Intestinal bleeding B) Hematoma of the nasal septum C) Epistaxis D) Bruising of the tongue C ./ Which of the following occurs in respiratory distress? A) Speaking in sentences of 10-20 words B) Skin between the ribs moves inward with inspiration C) Neck muscles are relaxed D) Patient torso leans posteriorly B Which of the following is consistent with good percussion technique? A) Allow all of the fingers to touch the chest while performing percussion. B) Maintain a stiff wrist and hand. C) Leave the plexor finger on the pleximeter after each strike. D) Strike the pleximeter over the distal inter-phalangeal joint. D Which of the following percussion notes would you obtain over the gastric bubble? A) Resonance B) Tympany C) Hyperresonance D) Flatness B Which of the following conditions would produce a hyperresonant percussion note? A) Large pneumothorax B) Lobar pneumonia C) Pleural effusion D) Empyema A ./ Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration? A) Bronchovesicular B) Vesicular C) Bronchial D) Tracheal C A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these? A) Asthma B) COPD C) Bronchiectasis D) Heart failure D ./ When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology? A) Bronchitis B) Simple asthma C) Cystic fibrosis D) Heart failure A ./ A patient with longstanding COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next? A) Percuss the lower border of the liver B) Measure the span of the liver C) Order a hepatitis panel D) Obtain an ultrasound of the liver B You are at your family reunion playing football when your uncle takes a hit to his right lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very remote area. What would your next step be? A) Call a medevac helicopter B) Drive him to the city (4 hours away) C) Press on his sternum and spine simultaneously D) Examine him for tenderness over the injured area C ./ A 38-year-old accountant comes to your clinic for evaluation of a headache. The throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to 10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, < 1/wk, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over-the counter analgesic and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache? A) Tension B) Migraine C) Cluster D) Analgesic rebound B A 29-year-old computer programmer comes to your office for evaluation of a headache. The tightening sensation is located all over the head and is of moderate intensity. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours each day at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain but not taken it away. Based on this description, what is your most likely diagnosis? A) Tension B) Migraine C) Cluster D) Analgesic rebound A ./ Which of the following is a symptom involving the eye? A) Scotomas B) Tinnitus C) Dysphagia D) Rhinorrhea A - specks in the vision or areas where the patient cannot see ./ A 49-year-old administrative assistant comes to your office for eval of dizziness. You elicit the information that the dizziness is a spinning sensation of sudden onset, worse with head position changes. The episodes last a few seconds and then go away, and they are accompanied by intense nausea. Vomiting x1. She denies tinnitus. You perform a physical exam of the head and neck and note that the patient's hearing is intact to Weber and Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the most likely diagnosis? A) Benign positional vertigo B) Vestibular neuronitis C) Ménière's disease D) Acoustic neuroma A A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea with vomiting; the episode resolved spontaneously. He has had five episodes in the past 1½ weeks. He does note some tinnitus that comes and goes. Upon physical examination, you note that he has a normal gait. The Weber localizes to the right side and the air conduction is equal to the bone conduction in the right ear. Nystagmus is present. Based on this description, what is the most likely diagnosis? A) Benign positional vertigo B) Vestibular neuronitis C) Ménière's disease D) Acoustic neuroma C A 73-year-old nurse comes to your office to evaluate new onset of tremors. She is not on any medications and does not take herbs or supplements. She has no chronic medical conditions. She does not smoke or drink alcohol. She walks into the examination room with slow movements and shuffling steps. She has decreased facial mobility and a blunt expression, without any changes in hair distribution on her face. Based on this description, what is the most likely reason for the patient's symptoms? A) Cushing's syndrome B) Nephrotic syndrome C) Myxedema D) Parkinson's disease D A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? A) Ptosis B) Exophthalmos C) Ectropion D) Epicanthus B May suggest Grave"s ./ 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? A) Dacryocystitis B) Chalazion C) Hordeolum D) Xanthelasma C Hordeolum - aka Stye ./ A 15 yo presents to the emergency room with his mother for eval of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical exam, the PERRL, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis? A) Conjunctivitis B) Acute iritis C) Corneal abrasion D) Subconjunctival hemorrhage D A 67-year-old lawyer comes to your clinic for an annual examination. He denies any history of eye trauma. He denies any visual changes. You inspect his eyes and find a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. He has a normal pupillary reaction to light and accommodation. Based on this description, what is the most likely diagnosis? A) Corneal arcus B) Cataracts C) Corneal scar D) Pterygium D a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side ./ Which of the following is a "red flag" regarding patients presenting with headache? A) Unilateral headache B) Pain over the sinuses C) Age over 50 D) Phonophobia and photophobia C ./ A sudden, painless unilateral vision loss may be caused by which of the following? A) Retinal detachment B) Corneal ulcer C) Acute glaucoma D) Uveitis A Sudden, painful unilateral loss of vision may be caused by which of the following conditions? A) Vitreous hemorrhage B) Central retinal artery occlusion C) Macular degeneration D) Optic neuritis D Diplopia, which is present with one eye covered, can be caused by which of the following problems? A) Weakness of CN III B) Weakness of CN IV C) A lesion of the brainstem D) An irregularity in the cornea or lens D A patient complains of epistaxis. Which other cause should be considered? A) Intracranial hemorrhage B) Hematemesis C) Intestinal hemorrhage D) Hematoma of the nasal septum B ./ Glaucoma is the leading cause of blindness in African-Americans and the second leading cause of blindness overall. What features would be noted on funduscopic examination? A) Increased cup-to-disc ratio B) AV nicking C) Cotton wool spots D) Microaneurysms A Very sensitive methods for detecting hearing loss include which of the following? A) The whisper test B) The finger rub test C) The tuning fork test D) Audiometric testing D ./ Which area of the fundus is the central focal point for incoming images? A) The fovea B) The macula C) The optic disk D) The physiologic cup A A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon? A) Direct reaction B) Consensual reaction C) Near reaction D) Accommodation B A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true? A) She obtains a 20% correct score at 100 feet. B) She can accurately name 20% of the letters at 20 feet. C) She can see at 20 feet what a normal person could see at 100 feet. D) She can see at 100 feet what a normal person could see at 20 feet C ./ On visual confrontation testing, a stroke patient is unable to see your fingers on his entire right side with either eye covered. Which of the following terms would describe this finding? A) Bitemporal hemianopsia B) Right temporal hemianopsia C) Right homonymous hemianopsia D) Binasal hemianopsia C You note that a patient has anisocoria on examination. Pathologic causes of this include which of the following? A) Horner's syndrome B) Benign anisocoria C) Differing light intensities for each eye D) Eye prosthesis A Testing the near reaction, in this case, may help you to find an Argyll Robertson or tonic (Adie's) pupil A patient is examined with the ophthalmoscope and found to have red reflexes bilaterally. Which of the following have you essentially excluded from your differential? A) Retinoblastoma B) Cataract C) Artificial eye D) Hypertensive retinopathy A ./ A patient presents with ear pain. She is an avid swimmer. Hx: pain and drainage from the left ear. On exam, she has pain when the ear is manipulated, including the tragus. The canal is narrowed and erythematous, with some white debris in the canal. The rest of the exam is normal. What diagnosis would you assign this patient? A) Otitis media B) External otitis C) Perforation of the tympanum D) Cholesteatoma B A patient with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne maneuvers. The abnormal results are as follows: BC>AC on the left, and the patient hears the sound of the tuning fork better on the left. Which of the following is most likely? A) Otosclerosis of the left ear B) Exposure to chronic loud noise of the right ear C) Otitis media of the right ear D) Perforation of the right eardrum A consistent with a conductive loss on the left side. Causes: foreign body, otitis media, perforation, and otosclerosis of the involved side A young man is concerned about a hard mass he has just noticed in the midline of his palate. On exam, it is indeed hard and in the midline. There are no mucosal abnormalities associated with this lesion. He is experiencing no other symptoms. What will you tell him is the most likely diagnosis? A) Leukoplakia B) Torus palatinus C) Thrush (candidiasis) D) Kaposi's sarcoma B A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely? A) CN IX lesion on the left B) CN IX lesion on the right C) CN X lesion on the left D) CN X lesion on the right D ./ A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on her enlarged tonsils. You do a careful lymphatic exam and notice some scattered small, mobile lymph nodes just behind her sternocleidomastoid muscles bilaterally. What group of nodes is this? A) Submandibular B) Tonsillar C) Occipital D) Posterior cervical D You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-side directions. Which of the following is most likely? A) Cancer B) Lymph node C) Deep scar D) Muscle B ./ You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate slightly. Both are noted to constrict briskly when the light is placed on the right eye. What is the most likely problem? A) Optic nerve damage on the right B) Optic nerve damage on the left C) Efferent nerve damage on the right D) Efferent nerve damage on the left B ./ A 35-year-old archaeologist visits your office (Phoenix, AZ) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient? A) Age B) Hair color C) Actinic lentigines D) Heavy sun exposure A Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution B You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism? A) Moist and smooth B) Moist and rough C) Dry and smooth D) Dry and rough D A 28 yo patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema A A 19 yo construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema B Tinea = fungal and promoted by moisture ./ A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma A A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma B ./ A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the SubQ tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 C ./ An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis? A) Alopecia areata B) Trichotillomania C) Tinea capitis D) Traction alopecia A ./ A mother brings her 11 month old to you because her mother-in-law and others have told her that her baby is jaundiced. She is eating and growing well and performing the developmental milestones she should for her age. On exam you indeed notice a yellow tone to her skin from head to toe. Her sclerae are white. To which area should your next questions be related? A) Diet B) Family history of liver diseases C) Family history of blood diseases D) Ethnicity of the child A A new mother is concerned that her child occasionally "turns blue." On further questioning, she mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is otherwise eating and growing well. What would you do now? A) Reassure her that this is normal B) Obtain an echocardiogram to check for structural heart disease and consult cardiology C) Admit the child to the hospital for further observation D) Question the validity of her story A ./ You are examining an unconscious patient from another region and notice Beau's lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next? A) Conclude this is caused by a cultural practice. B) Conclude this finding is most likely secondary to trauma. C) Look for information from family and records regarding any problems which occurred 3 months ago. D) Ask about dietary intake. C Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of exposure to ill people or other agents in the environment. He has a slight fever in the office. The rash consists of small, bright red marks. When they are pressed, the red color remains. What should you do? A) Prescribe a steroid cream to decrease inflammation. B) Consider admitting the patient to the hospital. C) Reassure the parents and the patient that this should resolve within a week. D) Tell him not to scratch them, and follow up in 3 days. B ./ Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash? A) It is likely to be related to her lupus. B) It is likely to be related to an exposure to a chemical. C) It is likely to be related to an allergic reaction. D) It should not cause any problems A ./ Jacob, a 33-year-old construction worker, complains of a "lump on his back" over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely? A) An enlarged lymph node B) A sebaceous cyst C) An actinic keratosis D) A malignant lesion B ./ A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection C Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites B) Urticaria, or hives C) Psoriasis D) Purpura B Ms. Whiting is a 68 yo who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do? A) Conclude that these are lesions she has had for a long time. B) Wait for her to mention them before asking further questions. C) Ask how she acquired them. D) Conduct the visit as usual for the patient. C ./ A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do? A) Reassure him that there is nothing to worry about. B) Do laboratory work to check for platelet problems. C) Obtain an extensive history regarding blood problems and bleeding disorders. D) Do a skin biopsy in the office. A