Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses 4th Edition Goolsby Test Bank Complete

Chapter 1. Assessment and Clinical Decision-Making: Overview Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which type of clinical decision-making is most reliable? 1. Intuitive 2. Analytical 3. Experiential 4. Augenblick 2. Which of the following is false? To obtain adequate history, health-care providers must be: 1. Methodical and systematic 2. Attentive to the patient’s verbal and nonverbal language 1. Able to accurately interpret the patient’s responses 1. Adept at reading into the patient’s statements 3. Essential parts of a health history include all of the following except: 1. Chief complaint 2. History of the present illness 3. Current vital signs 4. All of the above are essential history components 4. Which of the following is false? While performing the physical examination, the examiner must be able to: 1. Differentiate between normal and abnormal findings 1. Recall knowledge of a range of conditions and their associated signs and symptoms 1. Recognize how certain conditions affect the response to other conditions 1. Foresee unpredictable findings 5. The following is the least reliable source of information for diagnostic statistics: 1. Evidence-based investigations 2. Primary reports of research 3. Estimation based on a provider’s experience 1. Published meta-analyses 6. The following can be used to assist in sound clinical decision-making: 1. Algorithm published in a peer-reviewed journal article 1. Clinical practice guidelines 2. Evidence-based research 3. All of the above 7. If a diagnostic study has high sensitivity, this indicates a: 1. High percentage of persons with the given condition will have an abnormal result 1. Low percentage of persons with the given condition will have an abnormal result 1. Low likelihood of normal result in persons without a given condition 1. None of the above 8. If a diagnostic study has high specificity, this indicates a: 1. Low percentage of healthy individuals will show a normal result 1. High percentage of healthy individuals will show a normal result 1. High percentage of individuals with a disorder will show a normal result 1. Low percentage of individuals with a disorder will show an abnormal result 9. A likelihood ratio above 1 indicates that a diagnostic test showing a: 1. Positive result is strongly associated with the disease 1. Negative result is strongly associated with absence of the disease 1. Positive result is weakly associated with the disease 1. Negative result is weakly associated with absence of the disease 10. Which of the following clinical reasoning tools is defined as evidencebased resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? 1. Clinical practice guideline 2. Clinical decision rule 3. Clinical algorithm 4. Clinical recommendation Chapter 2. An Overview of Genetic Assessment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The first step in the genomic assessment of a patient is obtaining information regarding: 1. Family history 2. Environmental exposures 3. Lifestyle and behaviors 4. Current medications 2. An affected individual who manifests symptoms of a particular condition through whom a family with a genetic disorder is ascertained is called a(n): 1. Consultand 2. Consulband 3. Index patient 4. Proband 3. An autosomal dominant disorder involves the: 1. X chromosome 2. Y chromosome 3. Mitochondrial DNA 4. Non-sex chromosomes 4. To illustrate a union between two second cousin family members in a pedigree, draw: 1. Arrows pointing to the male and female 2. Brackets around the male and female 3. Double horizontal lines between the male and female 1. Circles around the male and female 5. To illustrate two family members in an adoptive relationship in a pedigree: 1. Arrows are drawn pointing to the male and female 1. Brackets are drawn around the male and female 1. Double horizontal lines are drawn between the male and female 1. Circles are drawn around the male and female 6. When analyzing the pedigree for autosomal dominant disorders, it is common to see: 1. Several generations of affected members 2. Many consanguineous relationships 3. More members of the maternal lineage affected than paternal 1. More members of the paternal lineage affected than maternal 7. In autosomal recessive (AR) disorders, individuals need: 1. Only one mutated gene on the sex chromosomes to acquire the disease 1. Only one mutated gene to acquire the disease 1. Two mutated genes to acquire the disease 2. Two mutated genes to become carriers 8. In autosomal recessive disorders, carriers have: 1. Two mutated genes; one from each parent that cause disease 1. A mutation on a sex chromosome that causes a disease 1. A single gene mutation that causes the disease 1. One copy of a gene mutation but not the disease 9. With an autosomal recessive disorder, it is important that parents understand that if they both carry a mutation, the following are the risks to each of their offspring (each pregnancy): 1. 50% chance that offspring will carry the disease 1. 10% chance of offspring affected by disease 1. 25% chance children will carry the disease 1. 10% chance children will be disease free 10. A woman with an X-linked dominant disorder will: 1. Not be affected by the disorder herself 2. Transmit the disorder to 50 % of her offspring (male or female) 1. Not transmit the disorder to her daughters 2. Transmit the disorder to only her daughters 11. In creating your female patient’s pedigree, you note that she and both of her sisters were affected by the same genetic disorder. Although neither of her parents had indications of the disorder, her paternal grandmother and her paternal grandmother’s two sisters were affected by the same condition. This pattern suggests: 1. Autosomal dominant disorder 2. Chromosomal disorder 3. Mitochondrial DNA disorder 4. X-linked dominant disorder 12. A woman affected with an X-linked recessive disorder: 1. Has one X chromosome affected by the mutation 1. Will transmit the disorder to all of her children 1. Will transmit the disorder to all of her sons 1. Will not transmit the mutation to any of her daughters 13. Which of the following are found in an individual with aneuploidy? 1. An abnormal number of chromosomes 2. An X-linked disorder 3. Select cells containing abnormalappearing chromosomes 1. An autosomal recessive disorder 14. The pedigree of a family with a mitochondrial DNA disorder is unique in that: 1. None of the female offspring will have the disease 1. All offspring from an affected female will have disease 1. None of the offspring of an affected female will have the disease 1. All the offspring from an affected male will have disease 15. Which population is at highest risk for the occurrence of aneuploidy in offspring? 1. Mothers younger than 18 2. Fathers younger than 18 3. Mothers over age 35 4. Fathers over age 35 16. Approximately what percentage of cancers is due to a single-gene mutation? 1. 50% to 70% 2. 30% to 40% 3. 20% to 25% 4. 5% to 10% 1. 50% to 70% 2. 30% to 40% 3. 20% to 25% 4. 5% to 10% 17. According to the Genetic Information Nondiscrimination Act (GINA): 1. NPs should keep all genetic information of patients confidential 1. NPs must obtain informed consent prior to genetic testing of all patients 1. Employers cannot inquire about an employee’s genetic information 1. All of the above 18. The leading causes of death in the United States are due to: 1. Multifactorial inheritance 2. Single gene mutations 3. X-linked disorders 4. Aneuploidy 19. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? 1. Colon cancer in family member at age 70 2. Breast cancer in family member at age 75 3. Myocardial infarction in family member at age 35 1. All of the above 20. When patients express variable forms of the same hereditary disorder, this is due to: 1. Penetrance 2. Aneuploidy 3. De novo mutation 4. Sporadic inheritance 21. Your 2-year-old patient shows facial features, such as epicanthal folds, upslanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: 1. Variable expressivity related to inherited disease 1. Dysmorphic features related to genetic disease 1. De novo mutations of genetic disease 2. Different penetrant signs of genetic disease 22. In order to provide a comprehensive genetic history of a patient, the NP should: 1. Ask patients to complete a family history worksheet 1. Seek out pathology reports related to the patient’s disorder 1. Interview family members regarding genetic disorders 1. All of the above Chapter 3. Skin Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When a patient presents with a skin-related complaint, it is important to first: 1. Fully inspect all skin lesions before asking the patient how the lesion in question developed 1. Obtain a full history about the development of the skin lesion prior to the physical examination 1. Complete a full physical examination of the body prior to inspecting the skin lesion 1. Examine the skin lesion without hearing a health history in order to not prejudice the diagnosis 2. Jaundice is a state of high bilirubin in the bloodstream. It is most commonly seen first in the: 1. Sclera 2. Nailbeds 3. Palms of the hands 4. Unexposed skin areas 3. Skin turgor is best assessed by pinching skin over the: 1. Forehead 2. Forearm 3. Knees 4. Dorsum of the hand 4. What kind of lesions are caused by the herpes simplex virus? 1. Scales 2. Vesicles 3. Plaques 4. Urticaria 5. A patient presents with vesicles on a reddened base in a symmetrical pattern on the lower neck and upper back, stating that he had noticed discomfort prior to the onset of the “rash.” Which of the following should be considered in your differential diagnosis? 1. Dermatitis herpetiformis 2. Herpes zoster 3. Dishydrosis 4. Contact dermatitis 1. Dermatitis herpetiformis 2. Herpes zoster 3. Dishydrosis 4. Contact dermatitis 6. Herpetic whitlow is commonly located on: 1. The eyelid 2. The scalp 3. A finger 4. Lip 7. Which type of lesion is referred to as resembling “a dew drop on a rose petal?” 1. Varicella zoster 2. Measles 3. Rubella 4. Tinea 8. Which lesions are typically located along the distribution of dermatome? 1. Scabies 2. Herpes zoster 3. Tinea 4. Dishydrosis 9. Folliculitis is most commonly due to: 1. Contact dermatitis 2. Varicella zoster 3. Dermatophytes 4. Staphylococcal infection 10. A patient presents with polymorphous lesions consisting of small, red papules and vesicles, with a few eroded and crusted lesions. Your differential diagnosis should include all except which of the following? 1. Herpes simplex 2. Varicella 3. Bacterial folliculitis 4. Contactdermatitis 11. The following has been associated with cervical and anal cancer: 1. Secondary syphilis 2. Human papilloma virus 3. Herpes simplex 4. Epstein-Barr virus 12. During a routine exam, you notice a 5 mm lesion on the right medial cheek. The border is raised and pearlescent in color and the area is crusted. The patient admits that it has been present for several months and has only recently become tender with the development of the crusting. This is most likely: 1. Squamous cell carcinoma 2. Epidermoid cyst 3. Basal cell carcinoma 4. Actinic keratosis 1. Squamous cell carcinoma 2. Epidermoid cyst 3. Basal cell carcinoma 4. Actinic keratosis 13. A patient has a tender, firm, nodular cystic lesion on his scalp that produces cheesy discharge with foul odor. This is most likely a: 1. Bacterial folliculitis 2. Basal cell carcinoma 3. Bullous impetigo 4. Epidermoid cyst 14. Which of the following is not associated with development of erythema multiforme? 1. Herpes virus 2. Mycoplasms 3. Medications 4. Trauma 15. Your patient complains of a progressive loss of pigment in various patches on the body. Affected skin surfaces are otherwise normal (e.g. no scaling, vesicles, elevation, or other changes). The most likely cause is: 1. Vitiligo 2. Acanthosis nigricans 3. Psoriasis 4. Pityriasis alba 16. A patient has an irregularly shaped, brown to black lesion on the upper arm that has changed color recently. The widest diameter is 6 mm. You should: 1. Measure and record the dimensions and schedule follow-up to repeat measurement in 2 weeks 1. Biopsy the lesion 2. Obtain skin scraping for dermatophytes 3. All of the above 17. Which of the following skin disorders is associated with diabetes? 1. Acanthosis nigricans 2. Vitiligo 3. Impetigo 4. Folliculitis 18. Which of the following disorders often presents in patients with café-aulait spots ? 1. Diabetes 2. Malignancy 3. Neurofibromatosis 4. Autoimmune disease 1. Diabetes 2. Malignancy 3. Neurofibromatosis 4. Autoimmune disease 19. Patient presents with complaint of a “swollen node” under his arm. The area is tender and the node has progressed in size over the past few days. Which of the following should be included in your differential diagnosis? 1. Hidradenitis suppurativa 2. Epidermoid cyst 3. Furuncle 4. Both A and C 20. Which of the following skin conditions frequently heralds an anaphylactic reaction? 1. Contact dermatitis 2. Eczema 3. Urticaria 4. Erythema multiforme 21. A patient with sarcoidosis has firm, tender, reddened nodules, along the anterior aspect of the leg. These lesions are called: 1. Erythema multiforme 2. Erythema nodosum 3. A discoid rash 4. Lichen planus 22. A patient suffered a laceration of the shin three days ago, and today presents with a painful, warm, red swollen region around the area. The laceration has a purulent exudate. The clinician should recognize that the infected region is called: 1. Contact dermatitis 2. Folliculitis 3. Hidradenitis suppurative 4. Cellulitis 23. A woman complains of malaise and arthralgias. You note a butterflyshaped, macular, erythematous rash across her cheeks and nose. These conditions are common in: 1. Psoriasis 2. Lichen planus 3. Systemic lupus erythematosus 4. Erythema nodosum 24. Which of the following characteristics is not helpful in differentiating between psoriasis and atopic dermatitis? 1. Distribution 2. Family history 3. Lesion morphology 4. Chronicity 1. Distribution 2. Family history 3. Lesion morphology 4. Chronicity 25. A patient presents complaining of recent onset of aching and malaise followed by the development of a generalized rash. He denies previous rash although he does admit that about a month ago he had an open sore on his right hand that was nonpainful. The exam reveals a maculopapular rash and lymphadenopathy. This presentation is most consistent with: 1. Pityriasis rosea 2. Secondary syphilis 3. Herpetic whitlow 4. Pyogenic granuloma Chapter 4. Head, Face, and Neck Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When obtaining a health history focusing on the patient’s head, face, and neck, which of the following is particularly important in regard to risk of disease? 1. Past dental work 2. Use of alcohol and tobacco 3. History of tension headaches 4. Use of aspirin 2. Which of the cranial nerves should be tested if the patient complains of numbness of the cheek? 1. Cranial nerve III 2. Cranial nerve V 3. Cranial nerve VII 4. Cranial nerve X 3. Which of the cranial nerves should be tested when a patient presents with right-sided facial droop and inability to close the right eye? 1. Cranial nerve III 2. Cranial nerve V 3. Cranial nerve VII 4. Cranial nerve X 4. A patient complains of pain with chewing, earache, and grinding her teeth when asleep. These are symptoms of: 1. Temporomandibular joint syndrome 2. Trigeminal neuralgia 3. Facial nerve palsy 4. Angina 5. Inflammation of the parotid gland can cause which of the following conditions? 1. Trigeminal neuralgia 2. Bruxism 3. Mumps 4. Temporomandibular joint syndrome 6. Calcium phosphate stones can develop within the salivary gland ducts. This can occur in the disorder called: 1. Temporomandibular joint syndrome 2. Mumps 3. Trigeminal neuralgia 4. Sialoadenitis 1. Temporomandibular joint syndrome 2. Mumps 3. Trigeminal neuralgia 4. Sialoadenitis 7. Your patient presents to the ER due to a bee sting on the cheek. As you are examining the patient, you note increasing facial swelling and redness as well as swelling of the lips and eyes. This condition is due to: 1. Angioedema 2. Parotitis 3. Sinusitis 4. Sialoadenitis 8. Your patient accidentally cut his cheek while shaving 3 days ago. Today, the region is warm, erythematous, swollen, and has the appearance of an orange peel. There is a serous exudate coming from the wound. This is most likely due to: 1. Folliculitis 2. Cellulitis 3. Supurative Parotitis 4. Sialoadenitis 9. A patient with systemic lupus erythematosus has been taking a prolonged course of steroids. She complains that her face appears swollen and has experienced a 10- pound weight gain. This is often referred to as: 1. Angioedema 2. Parotitis 3. Cushingoid effect 4. Myxedema 10. A patient with a positive Lyme titer presents with left-sided unilateral facial droop and inability to close the left eye. This is most likely due to: 1. Trigeminal neuralgia 2. Temporomandibular joint syndrome 3. Multiple sclerosis 4. Bell’s palsy 11. A solitary cold nodule on Radioactive Iodine (RAI) uptake on a thyroid scan is suspicious for: 1. Hyperthyroidism 2. Myxedema 3. Trigeminal neuralgia 4. Thyroid Cancer 12. A 6-year-old patient complains of a constantly itchy scalp that developed after returning home from school today. The most common cause for this condition in a child is: 1. Seborrheic dermatitis 2. Pediculosis 3. Psoriasis 4. Basal cell carcinoma 1. Seborrheic dermatitis 2. Pediculosis 3. Psoriasis 4. Basal cell carcinoma 13. One of the most common signs of Epstein-Barr viral infection (infectious mononucleosis) is: 1. Swelling of the face 2. Parotitis 3. Cervical lymphadenopathy 4. Thyroid enlargement 14. A goiter is most commonly associated with: 1. Hypothyroidism 2. Hyperthyroidism 3. Euthyroid function 4. All of the above 15. On physical examination, your 55-year-old female patient has an enlarged thyroid gland. She complains of feeling hot all the time, nervousness, palpitations, tremor, and recent weight loss of 10 pounds over the past 3 weeks. These signs and symptoms are commonly due to: 1. Hypothyroidism 2. Hyperthyroidism 3. Thyroid cancer 4. All of the above 16. A patient complains of burning, epigastric pain, and regurgitation of food when lying flat. It is important to recognize that these symptoms are common in: 1. Gastroesophageal reflux disease 2. Neuromuscular disorders 3. Esophageal cancer 4. Achalasia 17. A patient presents with extremely tight, shiny skin over the hands and face. There is also a lack of nasolabial folds and blank facial expression. This is a common sign of: 1. Bell’s palsy 2. Trigeminal neuralgia 3. Scleroderma 4. Hypothyroid myxedema 18. Chronic abuse of alcohol and tobacco are associated with , which can present with lymphadenopathy of the head and neck. 1. Lymphoma 2. Squamous cell carcinoma 3. Leukemia 4. Thyroid cancer 19. Weight loss, fever, fatigue, cervical and mediastinal lymphadenopathy are often the presenting signs of: 1. Hypothyroidism 2. Scleroderma 3. Esophageal cancer 4. Lymphoma 20. The following is a sexually transmitted infection that can cause pharyngitis and cervical lymphadenopathy with oral sex: 1. Hemolytic streptococcus 2. Chlamydia trachomatis 3. Epstein-Barr virus 4. Cytomegalovirus Chapter 5. The Eye Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The most common type of eye disorder is: 1. Refractive errors 2. Macular conditions 3. Neurological conditions 4. Astigmatisms 2. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? 1. History of bright flash of light followed by significantly blurred vision 1. History of transient and painless monocular loss of vision 1. History of monocular severe eye pain, blurred vision, and ciliary flush 1. All of the above 3. The first assessment to complete related to the eyes is: 1. Eye lids 2. Visual acuity 3. Extraocular movements 4. Peripheral vision 4. It is important to not dilate the eye if is suspected. 1. Cataract 2. Macular degeneration 3. Acute closed-angle glaucoma 4. Chronic open-angle glaucoma 5. Which of the following is true concerning adjustment of diopters during funduscopic exam? 1. Moving towards more positive diopters shifts examiner’s focus posteriorly 1. Moving towards more negative diopters shifts examiner’s focus anteriorly 1. Moving towards more positive diopters broadens the examiner’s field of view 1. Moving towards more negative diopters broadens the examiner’s field of view 6. A clinician can assess the alignment of the eyes by all except: 1. Checking for a symmetric light reflex 2. Observing eye movements 3. Performing cover/uncover exam 4. Measuring the palpebral gap 7. The fundoscopic examination allows the clinician to directly observe: 1. Cranial nerve I 2. Cranial nerve II 3. Cranial nerve III 4. Cranial nerve IV 8. Shining a light directly on one pupil should make the other pupil constrict. This is called the: 1. Accommodation response 2. Red reflex 3. Corneal light reflex 4. Consensual pupil response 9. Your patient describes blurry vision as well as halos and glares in response to bright lights or when driving in the dark. There is no pain. These are symptoms of: 1. Glaucoma 2. Macular degeneration 3. Cataracts 4. Diabetic retinopathy 10. While assessing visual acuity, you notice that the patient is turning his head “side-to-side” for an oblique, or peripheral, view of the Snellen chart, raising your suspicion that the patient may suffer from: 1. Glaucoma 2. Cataract 3. Macular degeneration 4. Amaurosis fugax 11. When examining the six cardinal fields of gaze, the clinician is assessing function of: 1. CN III 2. CN IV 3. CN VI 4. All of the above 12. Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient? 1. Checking the macula 2. Estimating cup-to-disk ratio 3. Verifying a red reflex 4. Extraocular movements 1. Checking the macula 2. Estimating cup-to-disk ratio 3. Verifying a red reflex 4. Extraocular movements 13. A patient describes a brief episode of visual impairment where it was as if a dark shade was gradually coming down over one eye. The vision returned a moment later. This is most commonly described in which condition? 1. Glaucoma 2. Cataracts 3. Amaurosis fugax 4. Macular degeneration 14. A Marcus-Gunn effect involves: 1. Abnormal pupillary responses 2. Abnormal visual acuity 3. Abnormal funduscopic findings 4. All of the above 15. In the following condition, patients often describe a sudden, large flash of light with gradual loss of vision in one eye. 1. Amaurosis fugax 2. Acute glaucoma 3. Temporal arteritis 4. Retinal detachment 16. Macular degeneration is a visual disturbance due to: 1. Sudden head trauma 2. Ischemia of the central retinal artery 3. Elevated intraocular pressure 4. Physiological aging 17. An Amsler grid is used to evaluate which of the following conditions? 1. Optic neuritis 2. Macular degeneration 3. Amaurosis fugax 4. Retinal detachment 18. The most common cause of eye redness is: 1. Conjunctivitis 2. Acute glaucoma 3. Head trauma 4. Corneal abrasion 19. A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: 1. Bacterial conjunctivitis 2. Allergic conjunctivitis 3. Chemical conjunctivitis 4. Viral conjunctivitis 1. Bacterial conjunctivitis 2. Allergic conjunctivitis 3. Chemical conjunctivitis 4. Viral conjunctivitis 20. Your patient with Crohn’s Disease complains of eye pain and photophobia. This is likely related to: 1. Symptoms of temporal arteritis 2. Altered pupil response due to uveitis 3. Blurry vision due to bilateral cataracts 4. Subconjunctival hemorrhage 21. Your patient is suffering from herpes zoster along the trigeminal nerve distribution of the face. You should carefully assess for the presence of: 1. Keratitis 2. Uveitis 3. Scleritis 4. Conjunctivitis 22. A 4-day-old newborn presents with redness and tearing of one eye. Slight pressure over the lacrimal sac produces white discharge. The clinician should be aware that the following condition is common in newborns: 1. Conjunctivitis 2. Sinus infection 3. Dacryocystitis 4. Herpes infection 23. Ptosis is commonly the first sign of: 1. Stevens-Johnson syndrome 2. Hyperthyroidism 3. Temporal arteritis 4. Myasthenia gravis 24. A 9-month-old patient presents with fever and large areas of redness and bullae over the trunk, palms, legs, and sole of the feet. There is redness and swelling of the conjunctiva and lips. The clinician should recognize this condition as: 1. Giant cell arteritis 2. Stevens-Johnson syndrome 3. Botulism 4. Myasthenia gravis 25. In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? 1. History of prior red-eye episodes 2. Grossly visible corneal defect 3. Exophthalmos 4. Photophobia Chapter 6. Ear, Nose, Mouth, and Throat Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Upon physical examination of a 1-year-old patient, you note abnormal placement of the ears, hypertelorism, and strabismus. These are often signs of: 1. Genetic conditions 2. Deafness 3. Birth injury 4. Physical abuse 2. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: 1. Acoustic neuroma 2. Cerumen impaction 3. Otitis media 4. Ménière’s disease 3. A patient presents to the emergency department due to head trauma related to a motorcycle accident. On physical examination, you note clear, serous discharge from the ear. This is commonly a sign of: 1. Basilar skull fracture 2. Injury of the auricle 3. Otitis discharge 4. Tympanic membrane perforation 4. A pneumatic otoscopic examination is used to assess: 1. Inner ear conditions 2. Otitis externa 3. Cerumen impaction 4. Tympanic membrane mobility 5. In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of: 1. Bacterial sinusitis 2. Allergic rhinitis 3. Drug abuse 4. Skull fracture 6. With inspection of the mouth and buccal mucosa, Stensen’s duct can be seen on the: 1. Underside of the tongue 2. Buccal mucosa opposite the lower molars 3. Buccal mucosa opposite the upper molars 4. Soft palate 1. Underside of the tongue 2. Buccal mucosa opposite the lower molars 3. Buccal mucosa opposite the upper molars 4. Soft palate 7. To examine if there is an intact gag reflex, ask the patient to say “ah” as you observe the: 1. Movement of the uvula to the left 2. Movement of uvula to the right 3. Tongue extension in the midline 4. Upward movement of the uvula in the midline 8. Malignant oral cancerous lesions are most frequently located on the: 1. Tongue 2. Tonsils 3. Gums 4. Hard palate 9. Ear pain related to tenderness over the auricle and ear canal is most commonly related to: 1. Excessive exposure to noise 2. Cerumen impaction 3. Otitis externa 4. Ménière’s disease 10. A 6-year-old child presents with complaints of unilateral ear pain, fever, and sore throat. The clinician should recognize that this is most commonly due to: 1. Otitis externa 2. Inner ear infection 3. Sinusitis 4. Otitis media 11. Which of the following symptoms is common with acute otitis media? 1. Bulging tympanic membrane 2. Bright light reflex of tympanic membrane 3. Increased tympanic membrane mobility 4. All of the above 12. Which of the following microorganisms commonly causes otitis externa? 1. Streptococcus pneumoniae 2. Pseudomonas 3. Moraxella catarrhalis 4. Haemophilus influenza 13. A 5-year-old patient with a history of chronic otitis media complains of severe unilateral ear pain that worsens at night. The pain has progressively worsened over the past 3 days. Your examination reveals tenderness, erythema, and swelling below the right ear, and diminished hearing on the right. Which of the following is a likely diagnosis? 1. Sinus infection 2. Skull fracture 3. Mastoiditis 4. Foreign body 14. Presbycusis is the hearing impairment that is associated with: 1. Physiologic aging 2. Ménière’s disease 3. Cerumen impaction 4. Herpes zoster 15. A nonmalignant cancerous tumor affecting cranial nerve VIII that causes unilateral hearing loss, tinnitus, and vertigo is: 1. Otosclerosis 2. Acoustic neuroma 3. Cholesteatoma 4. Squamous cell carcinoma 16. Epistaxis can be a symptom of: 1. Over-anticoagulation 2. Hematologic malignancy 3. Cocaine abuse 4. All of the above 17. Nasal discharge of green-yellow mucus, pharyngitis, and otitis media commonly indicate: 1. Allergic rhinitis 2. Viral infection 3. Bacterial infection 4. Nasal polyps 18. The following disorder commonly presents with vesicular or ulcerated lesions with a yellow base on the oral mucosa and lips. 1. Aphthous ulcer 2. Herpes simplex I 3. Coxsackie viral infection 4. All of the above 19. Hand-foot-and mouth disease often causes vesicular lesions on the palms, soles of the feet, and oral mucosa. The microorganism that causes this disease is: 1. Herpes zoster 2. Herpes simplex I 3. Coxsackie virus 4. Candida 1. Herpes zoster 2. Herpes simplex I 3. Coxsackie virus 4. Candida 20. Thrush occurs as white patches surrounded by erythematous tissue in oral mucosa. The microorganism that causes this is: 1. Candida 2. Herpes simplex I 3. Coxsackie virus 4. Herpes zoster 21. A condition that presents as painless, raised white patches on the oral mucosa that predisposes to squamous cell carcinoma is: 1. Candida 2. Lichen planus 3. Coxsackie virus 4. Leukoplakia 22. Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: 1. Malignant melanoma 2. Squamous cell carcinoma 3. Aphthous ulceration 4. Behcet’s syndrome 23. A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? 1. Mono spot 2. Strep test 3. Throat culture 4. All of the above 24. Rheumatic heart disease is a complication that can arise from which type of infection? 1. Epstein-Barr virus 2. Diptheria 3. Group A beta hemolytic streptococcus 4. Streptococcus pneumoniae 25. Which microorganism is the most common cause of tonsillitis in adolescents? 1. Epstein-Barr virus 2. Streptococcus pneumoniae 3. Mycoplasma 4. Grp A beta hemolytic streptococcus 26. Which microorganism is the most common cause of peritonsillar abscess? 1. Epstein-Barr virus 2. Streptococcus pneumoniae 3. Mycoplasma 4. Grp A beta hemolytic streptococcus 27. Which of the following conditions can cause upper airway obstruction? 1. Behcet’s syndrome 2. Influenza 3. Epiglottitis 4. Thrush 28. Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of: 1. Thrush 2. Laryngeal cancer 3. Carotidynia 4. Thyroiditis 29. A 26-year-old female who gave birth 1 month ago presents with sudden development of fever, neck pain, sore throat with dysphagia, and radiation of pain to the ear. Which of the following conditions is most important to consider? 1. Diptheria 2. Epiglottitis 3. Thyroiditis 4. Otitis media Chapter 7. Cardiac and Peripheral Vascular Systems Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The first heart sound (S1) occurs because of the closure of the: 1. Aortic and mitral valves 2. Mitral and tricuspid valves 3. Pulmonic valve 4. Aortic valve 2. The second heart sound (S2) occurs because of the closure of the: 1. Aortic valve 2. Tricuspid valve 3. Aortic and pulmonic valve 4. A and B 3. To distinguish a physiologic split S2 heart sound, it is best to listen with the stethoscope at: 1. Left fifth intercostal space midclavicular line 1. Fourth intercostal space left sternal border with patient holding his or her breath 1. Second intercostal space left sternal border with inspiration 1. Fourth intercostal space right sternal border with expiration 4. An S3 gallop is commonly heard in: 1. Children with fever 2. Adults with heart failure 3. Children with aortic stenosis 4. Adults with hypertension 5. An S4 sound is commonly heard in: 1. Children with fever 2. Adults with atrial fibrillation 3. Adults with hypertension 4. Children with pulmonic stenosis 6. Which of the following heart sounds is commonly heard after myocardial infarction? 1. Friction rub 2. S4 3. S3 4. Opening snap 1. Friction rub 2. S4 3. S3 4. Opening snap 7. Which of the following is the most important question to ask during cardiovascular health history? 1. Number of offspring 2. Last physical examination 3. Sudden death of a family member 4. Use of caffeine 8. Cardiovascular disease risk increase in women after age: 1. 30 2. 40 3. 45 4. 55 9. Which of the following blood pressure measurements is categorized as prehypertension? 1. 110/78 2. 129/85 3. 142/80 4. 145/92 10. Xanthelasma is a skin condition that should alert the clinician to in a patient. 1. Familial hyperlipidemia 2. Type 2 diabetes 3. Congenital heart disease 4. Peripheral arterial disease 11. When palpating the chest, you find the point of maximal impulse (PMI) in the left mid-axillary region. This can be indicative of: 1. Normal PMI 2. Congenital heart disease 3. Ventricular hypertrophy 4. Hypertension 12. Upon inspecting the patient, you find jugular venous distension. This is a sign of: 1. Left ventricular hypertrophy 2. Right ventricular failure 3. Hypertension 4. Valve disease 13. On an electrocardiogram, you see a deepened Q wave that is greater than one-third the height of the QRS complex. This is indicative of: 1. Acute myocardial infarction 2. Acute myocardial ischemia 3. Left ventricular hypertrophy 4. Past myocardial infarction 14. Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of: 1. Anemia 2. Anxiety 3. Hyperthyroidism 4. All of the above 15. A pulse rate of 56 beats per minute can be normal in: 1. Elderly patients 2. Newborns 3. Athletic individuals 4. Hypertensive patients 16. Your patient has a dysrhythmia and has been on a diuretic for 2 months. Which of the following should be suspected? 1. Potassium imbalance 2. Sodium deficit 3. Calcium imbalance 4. Insufficient diuretic 17. Your patient has suffered an inferior wall myocardial infarction. This is most commonly due to an obstruction in the: 1. Posterior branch of the right coronary artery 1. Circumflex branch of the left coronary artery 1. Right main coronary artery 2. Left main coronary artery 18. Cardiac chest pain is most often described as: 1. Stabbing, piercing pain 2. Pain with inhalation 3. Crushing, squeezing pain 4. Burning, gnawing pain 19. On an electrocardiogram (ECG), an anterior wall myocardial infarction is demonstrated on leads: 1. II, III, AVR 2. II, III, AVF 3. V1, V2, V3, V4 4. I, AVL, V5, V6 1. II, III, AVR 2. II, III, AVF 3. V1, V2, V3, V4 4. I, AVL, V5, V6 20. Which is the most specific and sensitive test for validating a myocardial infarction? 1. 12-lead EKG 2. Troponin 3. CK-MB 4. CT scan 21. It is important for clinicians to recognize that individuals with often sustain silent myocardial infarction. 1. Diabetes mellitus 2. Hypertension 3. Valvular disorders 4. Congenital heart defects 22. The pain associated with pericarditis is . 1. Crushing and squeezing 2. Constant 3. Worse with inspiration 4. Only present with fever 23. Pain associated with a dissecting thoracic aortic aneurysm is commonly described as: 1. Retrosternal crushing and squeezing 2. Chest stabbing and sharp 3. Ripping and tearing in the chest or thoracic back 1. Worse with inspiration 24. The pain of can frequently be mistaken for cardiac chest pain. 1. Gastroesophageal reflux disease (GERD) 2. Peptic ulcer disease (PUD) 3. Cholecystitis 4. All of the above 25. The pain of pancreatitis is described as: 1. Abdominal sharp and piercing pain in the left upper quadrant 1. Dull and cramping pain in the right upper quadrant 1. Severe, epigastric pain radiating straight into the back 1. Sharp pain radiating to the shoulder 26. The pain of costochondritis typically . 1. Mimics cardiac crushing and squeezing pain 1. Worsens with movement and full inspiration 1. Radiates from epigastrium into the back 2. Is a tearing and ripping pain 27. The medical record of your patient lists a grade III systolic murmur. This indicates the patient has a heart murmur that is: 1. Soft and after S2 2. Loud and crescendo in quality 3. Moderately loud and after S1 4. Loud and after S2 28. The radiation of a mitral valve murmur is commonly heard in the: 1. Carotid arteries 2. Left mid-axillary line 3. Base of the heart 4. Left mid-clavicular line 29. The murmur of aortic stenosis is best heard in the: 1. Left second intercostal space left sternal border 1. Left fifth intercostal space mid-clavicular line 1. Right fourth intercostal space right sternal border 1. Right second intercostal space right sternal border 30. The pulmonary valve is best heard over the: 1. left second intercostal space left sternal border 1. left fifth intercostal space mid-clavicular line 1. right fourth intercostal space right sternal border 1. right second intercostal space right sternal border 31. The key sign(s) of aortic stenosis are: 1. Syncope 2. Dyspnea 3. Angina 4. All of the above 32. Classically in mitral valve prolapse, the clinician can hear a(n) . 1. Mid-systolic click followed by a grade I murmur that crescendos up to S2 1. Opening snap followed by a grade III holosystolic murmur 1. Crescendo-decrescendo grade I diastolic murmur after S2 1. Rough grade III holosystolic murmur that obscures S1 and S2 33. The best diagnostic test that allows analysis of a heart murmur is: 1. CT scan 2. Echocardiogram 3. MRI 4. ECG 34. The most common cause of tricuspid regurgitation is: 1. Left ventricular hypertrophy 2. Left atrial enlargement 3. Aortic stenosis 4. Pulmonary hypertension 35. The tricuspid valve is best heard over the: 1. Third intercostal space left sternal border 2. Fifth intercostal space right sternal border 3. Fourth intercostal space left sternal border 4. Third intercostal space right sternal border 36. From Erb’s point, all the heart valves can be heard equally. Erb’s point is located over the: 1. Third intercostal space left sternal border 2. Fifth intercostal space right sternal border 3. Fourth intercostal space left sternal border 4. Third intercostal space right sternal border 37. Upon examination of a child, an innocent systolic murmur is heard at the second intercostal space left sternal border. This is usually due to: 1. Atrial septal defect 2. Patent foramen ovale 3. Low flow velocity 4. High flow turbulence 38. In mitral stenosis, the murmur occurs: 1. From S1 through S2 as a holosystolic murmur 1. After an opening snap that is heard after S2 during diastole 1. As a soft mid-systolic click 2. A loud crescendo-decrescendo systolic murmur 1. From S1 through S2 as a holosystolic murmur 1. After an opening snap that is heard after S2 during diastole 1. As a soft mid-systolic click 2. A loud crescendo-decrescendo systolic murmur 39. In mitral stenosis, the murmur can be best heard with the patient in the: 1. Squatting position 2. Seated position 3. Left lateral recumbent 4. Supine position 40. Due to increased left atrial pressure, a patient with mitral stenosis often suffers from: 1. Pulmonary congestion 2. Hepatomegaly 3. Jugular venous distension 4. Ventricular tachycardia 41. In aortic stenosis, the patient’s point of maximal impulse is commonly located at the: 1. Fifth intercostal space mid-clavicular line 2. Fifth intercostal space mid-axillary line 3. Second intercostal space left sternal border 1. Second intercostal space right sternal border 42. Aortic regurgitation occurs after S2 during because there is turbulent flow that refluxes into the left ventricle after the aortic valve closes. 1. Early diastole 2. Late diastole 3. Early systole 4. Mid-systole 43. The murmur of a ventricular septal defect (VSD) occurs when the ventricle contracts and blood flows from the left ventricle into the right ventricle. This creates a heart murmur. 1. Holodiastolic 2. Early diastolic 3. Holosystolic 4. Late systolic 44. An atrial septal defect (ASD) causes a left to right shunt, which enlarges the right atrium. Because of this effect, which of the following conditions often occur with ASD? 1. Asthma 2. Jugular venous distension 3. Atrial fibrillation 4. B & C 45. A patient with hypertension who has hyperlipidemia should aim for LDL measurement to be: 1. 130 mg/dL or less 2. 40 mg/dL or less 3. 100 mg/dL or less 4. 60mg/dL or less 46. Your 47-year-old female patient has a waist to hip ratio of 1. In terms of cardiovascular disease risk, this is considered: 1. Ideal 2. Greater than acceptable limits 3. Less than acceptable limits 4. Within acceptable limits 47. Which of the following conditions is/are part of metabolic syndrome? 1. Hypertension 2. Hyperlipidemia 3. Insulin resistance 4. All of the above 48. The target body mass index for women is: 1. 27 kg/m2 2. 25 kg/m2 3. 22 kg/m2 4. 16 kg/m2 49. Dyspnea, cough, and pulmonary crackles are symptoms that can occur in left ventricular failure and respiratory disorders, such as pneumonia. Which of the blood tests below can be used to differentiate cardiovascular from pulmonary disease? 1. B type natriuretic peptide (BNP) 2. Pulse oximetry 3. Arterial blood gases 4. High sensitivity C reactive protein (hs- CRP) 50. When an examiner presses on the liver and elicits hepato-jugular reflux, which of the following conditions is likely? 1. Left ventricular failure 2. Right ventricular failure 3. Hepatomegaly 4. Pulmonary edema 1. Left ventricular failure 2. Right ventricular failure 3. Hepatomegaly 4. Pulmonary edema 51. Your patient has had hypertension for 10 years, a myocardial infarction 5 years ago, and now complains of dyspnea on exertion, cough, and 3-pillow orthopnea. Which of the following conditions is likely? 1. Right ventricular failure 2. Pulmonary embolism 3. Cor pulmonale 4. Left ventricular failure 52. Your patient complains of worsening ankle edema and weight gain over the last week. On physical examination, you note jugular venous distension, ascites, hepatomegaly, and splenomegaly. These conditions are indicative of: 1. Left ventricular failure 2. Pulmonary embolism 3. Right ventricular failure 4. Myocardial infarction 53. A 23-year-old patient presents the emergency department with high fever, chills, extreme fatigue, and arthralgias. Your physical examination reveals grade II heart murmur heard loudest over the fourth intercostal space left sternal border. The arms of the patient reveal past intravenous drug abuse. The clinician should recognize these are signs and symptoms of: 1. Pulmonary embolism 2. Right ventricular failure 3. Functional heart murmur 4. Bacterial endocarditis 54. A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms? 1. Arterial insufficiency 2. Femoral vein thrombus 3. Venous insufficiency 4. Peripheral neuropathy 55. Which of the following ankle-brachial index measurements require a referral to a vascular consultant? 1. ABI 1.2 2. ABI 1 3. ABI 0.9 4. ABI 0.5 56. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? 1. Femoral vein thrombosis 2. Femoral artery thrombus 3. Venous insufficiency 4. Musculoskeletal injury 57. After multiple pregnancies, the following vascular disorder is common: 1. Deep venous thrombosis 2. Varicose veins 3. Peripheral arterial disease 4. Aortic aneurysm Chapter 8. Respiratory System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: 17. 50 x 2-pack years 18. 100-pack years 19. 50-year, 2-pack history 20. 100 pack history 2. Which of the following is characteristic of COPD? 1. Asymmetric chest expansion 2. Increased lateral diameter 3. Increased anterior-posterior diameter 4. Pectus excavatum 3. When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of: 1. Pneumonia 2. Emphysema 3. Pneumothorax 4. Asthma 4. During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: 1. COPD 2. Pneumothorax 3. A normal finding 4. Pleural effusion 5. Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? 1. Computed tomography (CT) scan 2. Chest xray with PA, lateral, and lordotic views 1. Ultrasound 2. Positron emission tomography (PET) scan 6. Alpha-1 antitrypsin deficiency should be considered in patients diagnosed with: 1. Exercise-induced cough 2. Bronciectasis 3. COPD 4. Pericarditis 1. Exercise-induced cough 2. Bronciectasis 3. COPD 4. Pericarditis 7. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: 1. Pneumothorax 2. Pleural effusion 3. Pneumonia 4. Pulmonary embolism 8. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: 1. Pneumonia 2. Pleuritis 3. Pneumothorax 4. A and B 9. While assessing auscultated spoken sounds, the ausculated sound is heard as “a-a-a” when he is asked to repeat “e-e-e.” This is indicative of: 1. Asthma 2. Tumor 3. Pneumonia 4. Pleural effusion 10. A cough is described as chronic if it has been present for: 1. 2 weeks or more 2. 8 weeks or more 3. 3 months or more 4. 6 months or more 11. Which of the following medications are commonly associated with the side effect of cough? 1. Beta blocker 2. Diuretic 3. ACE inhibitor 4. Calcium antagonist 12. Which of the following details are NOT considered while staging asthma? 1. Nighttime awakenings 2. Long-acting beta agonist usage 3. Frequency of symptoms 4. Spirometry findings 13. When asthma is suspected, which of the following is NOT useful in making a diagnosis? 1. Decreased FEV1/FVC ratio 2. Decreased FEV1 3. Some reversibility with administration of bronchodilator 1. Peak flow meter reading 14. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: 1. Age over 40 2. Fever greater than 101 3. Tachypnea greater than 30 breaths/minute 4. Productive cough 15. The most common etiologic organism for community-acquired pneumonia is: 1. Streptococcus pneumoniae 2. Beta hemolytic streptococcus 3. Mycoplasma 4. Methicillin resistant staphylococcus 16. A 75-year-old patient with community-acquired pneumonia presents with temperature of 102.1, chills, productive cough, BP 90/5062, WBC 12,000, and blood urea nitrogen (BUN) 20 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: 1. Can be treated as an outpatient 2. Requires hospitalization for treatment 3. Requires a high dose of parenteral antibiotic 1. Can be treated with oral antibiotics 17. Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for: 1. Immediate endotracheal intubation 2. Broad spectrum intravenous antibiotics 3. Thoracentesis to rule out empyema 4. Gram stain and culture of sputum 18. If on physical examination the clinician auscultates rhonchi, the clinician should ask the patient to take a deep breath and cough in order to: 1. Mobilize secretions 2. Diagnose pleural effusion 3. Accurately distinguish lung sounds 4. A & C 19. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? 1. Fever of 102 2. Infiltrates on chest x-ray 3. Pleural effusion on chest x-ray 4. Elevated white blood cell count 20. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: 1. Barrel-shaped chest 2. Clubbing 3. Pectus excavatum 4. Prolonged capillary refill 21. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect: 1. Legionaire’s disease 2. Malaria 3. Tuberculosis 4. Pneumonia 22. A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest x-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: 1. Lung cancer 2. Tuberculosis 3. Pneumonia 4. COPD 23. Causes of pleural effusions include: 1. Malignancy 2. Pneumonia 3. Cardiomegaly 4. All of the above 24. Patients with pulmonary fibrosis show decreased lung tissue compliance and diminished forced vital capacity (FVC). Pulmonary fibrosis is a type of: 1. Obstructive disease 2. Restrictive disease 3. Hyperreactive airway disease 4. None of the above 25. A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: 1. Pulmonary embolism 2. Pleural effusion 3. Pneumothorax 4. Fracture of ribs Chapter 9. Breasts Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When examining the breasts of a 45-year-old female patient, you note nodularity throughout both breasts. There is no dominant mass, tenderness, nipple change, or skin change. Which of the following condition is most likely? 1. Multiple fibroadenomas 2. Fibrocystic breasts 3. Mastalgia 4. Mastitis 2. Your patient has a rubbery, firm, mobile breast mass. In order to completely exclude the possibility of cancer, the triple test is necessary, which includes: 1. CT scan 2. MRI 3. Biopsy 4. All of the above 3. A 23-year-old woman is concerned about a mass she found on palpation. Upon examination of the patient, the mass feels cystic, round, and mobile with discrete borders. The diagnostic study that is recommended is: 1. CT scan 2. Mammogram 3. Biopsy 4. Ultrasound 4. Which of the following variables is not a component of the Gail Model? 1. Age at menarche 2. Number of breast biopsies 3. Age at first live birth 4. Number of live births 5. A 62-year-old female presents with a singular, hard, 1 cm, non-tender, non-mobile mass in the right breast. There are no nipple or skin changes, however, you palpate an enlarged right-sided supraclavicular lymph node. The clinician should recognize these are signs of: 1. Fibroadenoma 2. Breast cyst 3. Malignancy 4. Paget’s disease 6. A 45-year-old female patient presents in the emergency department due to multiple chest injuries as a result of a motor vehicle accident. There is a palpable, tender, irregular 3 cm soft mass located in the left breast, with erythema and swelling of the breast. Which of the following is indicated? 1. Compression wrap for chest and breast trauma 1. Mammogram 2. Re-evaluation following complete resolution of obvious injuries 1. Ultrasound 7. A 23-year-old female presents with episodic bilateral breast tenderness. Upon palpation, there are multiple areas of nodularity with no dominant breast mass and no tenderness, nipple, or skin changes. It is best to recommend: 1. Ultrasound of the breasts 2. Mammogram of the breasts 3. Fine needle aspiration of one nodule within a breast 1. Diary of menstrual cycle and breast symptoms 8. A 34-year-old female who gave birth 2 weeks ago developed fever and pain in the right breast while nursing her baby. The patient has tenderness, eythema, and swelling of the nipple on the right breast. Which of the following diagnostic studies is indicated? 1. White blood cell (WBC) count 2. Breast milk culture 3. Ultrasound 4. Fine needle biopsy 9. Your patient is a 46-year-old woman suffering from psychosis complains of milky discharge from both her breasts. Upon examination, there are no significant findings and the patient is not pregnant, breastfeeding, or in the postpartum period. You should: 1. Order CT scan of head to rule out pituitary tumor 1. Obtain a complete list of the patient’s medications 1. Have the patient keep a menstrual cycle diary 1. Refer the patient for mammogram 10. Your patient is a 36-year-old woman who complains of milky discharge from both her breasts, episodes of headache, and menstrual irregularity. The patient is on no medications. Upon examination, there are no significant findings, and the patient is not pregnant, breastfeeding, or in the postpartum period. It is important to: 1. Order prolactin level 2. Obtain an MRI of head 3. Have the patient keep a menstrual cycle diary 1. Refer the patient for mammogram 1. Order prolactin level 2. Obtain an MRI of head 3. Have the patient keep a menstrual cycle diary 1. Refer the patient for mammogram 11. Bloody breast discharge is associated with which of the following? 1. Bleeding disorder such as von Willebrand disease 1. Malignancy 2. Excessive non-steroidal antiinflammatories 3. A and C 12. Your patient is a 64-year-old female who presents with complaints of a red, scaly rash on her nipple and areola of one breast. It has been present for a few months. There is no mass or nipple discharge. You should be suspicious of: 1. Contact dermatitis 2. Mastitis 3. Paget’s disease 4. Eczema 13. A 12-year-old boy is brought into the clinic by his mother. The teen boy is embarrassed because he has developed breast tissue and would like to know if there is any treatment. The physical examination reveals early stages of puberty, otherwise it is normal. This presentation is: 1. Associated with a high rate of malignancy 2. Most often due to altered hormonal levels in puberty 1. Commonly indicative of pituitary tumor triggered by puberty 1. Too dense for a mammogram and requires biopsy 14. A condition that increases risk of breast cancer in a male is: 1. Pseudogynecomastia 2. BRCA1 and 2 3. Klinefelter’s syndrome 4. B and C 15. A 52-year-old female complains of discharge from one of her breasts. There is no pain, no mass, and no skin changes. The physical examination is normal. When putting pressure on the affected breast, the nipple expresses a small amount of thick, white discharge. These findings are consistent with: 1. Duct ectasia 2. Mastitis 3. Fibroadenoma 4. Fibrocystic breasts 1. Duct ectasia 2. Mastitis 3. Fibroadenoma 4. Fibrocystic breasts Chapter 10. Abdomen Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When performing abdominal assessment, the clinician should perform examination techniques in the following order: 1. Inspection, palpation, percussion, and auscultation 1. Inspection, percussion, palpation, and auscultation 1. Inspection, auscultation, percussion, and palpation 1. Auscultation, palpation, percussion, and inspection 2. The clinician should auscultate the abdomen to listen for possible bruits of the: 1. Aorta 2. Renal artery 3. Iliac artery 4. All of the above 3. On abdominal examination, which of the following is assessed using percussion? 1. Liver 2. Kidneys 3. Pancreas 4. Esophagus 4. In abdominal assessment, a digital rectal examination is performed to assess for: 1. Hemorrhoids 2. Prostate size 3. Blood in stool 4. Ureteral stenosis 5. Rebound tenderness of the abdomen is a sign of: 1. Constipation 2. Peritoneal inflammation 3. Elevated venous pressure 4. Peritoneal edema 6. While assessing the abdomen, the clinician deeply palpates the left lower quadrant of the abdomen, and this causes pain in the patient’s right lower abdomen. This is most commonly indicative of: 1. Constipation 2. Diverticulitis 3. Appendicitis 4. Hepatitis 7. Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for peritoneal inflammation, the examiner should: 1. Percuss the right lower quadrant of the abdomen 1. Deeply palpate the right lower quadrant of the abdomen 1. Auscultate the right lower quadrant for hyperactive bowel sounds 1. Strike the plantar surface of the patient’s heel while the patient is supine 8. Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh. The examiner is testing the patient for: 1. Psoas sign 2. Obturator sign 3. Rovsing’s sign 4. Murphys’ sign 9. A patient is lying supine and the clinician deeply palpates the right upper quadrant of the abdomen while the patient inhales. The examiner is testing the patient for: 1. Psoas sign 2. Obturator sign 3. Rovsing’s sign 4. Murphys’ sign 10. Your patient has abdominal pain, and it is worsened when the examiner rotates the patient’s right hip inward with the knee bent and the obturator internus muscle is stretched. This is a sign of: 1. Diverticulitis 2. Cholecystitis 3. Appendicitis 4. Mesenteric adenitis 11. On abdominal examination as the clinician presses on the right upper quadrant to assess liver size, jugular vein distension becomes obvious. Hepatojugular reflux is indicative of: 1. Acute hepatitis 2. Right ventricular failure 3. Cholecystitis 4. Left ventricular failure 1. Acute hepatitis 2. Right ventricular failure 3. Cholecystitis 4. Left ventricular failure 12. Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative of: 1. Cholecystitis 2. Appendicitis 3. Ascites 4. Hepatitis 13. Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect: 1. Acute pancreatitis 2. Biliary duct obstruction 3. Acute hepatitis 4. Atypical appendicitis 14. The most common cause of acute pancreatitis is: 1. Trauma 2. Hepatitis virus A 3. Hyperlipidemia 4. Alcohol abuse 15. Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of: 1. Pleural involvement 2. Alcoholism 3. High mortality 4. Bile duct obstruction 16. Your patient complains of left upper quadrant pain, fever, extreme fatigue, and spontaneous bruising. The clinician should recognize that these symptoms are often related to: 1. Hematopoetic disorders 2. Hepatomegaly 3. Esophageal varices 4. Pleural effusion 17. A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, and left upper quadrant pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of: 1. Bacterial endocarditis 2. Infectious mononucleosis 3. Pneumonia with pleural effusion 4. Pancreatic cancer 18. Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: 1. Diverticulitis 2. Appendicitis 3. Colon cancer 4. Peptic ulcer disease 19. Which of the following is the most common cause of heartburn-type epigastric pain? 1. Decreased lower esophageal sphincter tone 1. Helicobacteria pylori infection of stomach 2. Esophageal spasm 3. Excess use of NSAIDs 20. A 22-year-old female enters the emergency room with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: 1. Digital rectal examination 2. Endoscopy 3. Ultrasound 4. Pelvic examination 21. The major sign of ectopic pregnancy is: 1. Sudden onset of severe epigastric pain 2. Amenorrhea with unilateral lower quadrant pain 1. Lower back and rectal pain 2. Palpable abdominal mass 22. When ruptured ectopic pregnancy is suspected, the following procedure is most important: 1. Culdocentesis 2. CT scan 3. Abdominal x-ray 4. Digital rectal examination 23. The majority of colon cancers are located in the: 1. Transverse colon 2. Cecum 3. Rectosigmoid region 4. Ascending colon 24. The following symptom(s) in the patient’s history should raise the clinician’s suspicion of colon cancer: 1. Alternating constipation and diarrhea 2. Narrowed caliber of stool 3. Hematochezia 4. All of the above 25. A patient presents to the emergency department with nausea and severe, colicky back pain that radiates into the groin. When asked to locate the pain, he points to the right costovertebral angle region. His physical examination is unremarkable. Which of the following lab tests is most important for the diagnosis? 1. Urinalysis 2. Serum electrolyte levels 3. Digital rectal exam 4. Lumbar x-ray 26. Your 34-year-old female patient complains of a feeling of “heaviness” in the right lower quadrant, achiness, and bloating. On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative. The diagnostic tool that would be most helpful is: 1. Digital rectal exam 2. Transvaginal ultrasound 3. Pap smear 4. Urinalysis 27. Your 54-year-old male patient complains of a painless “lump” in his lower left abdomen that comes and goes for the past couple of weeks. When examining the abdomen, you should have the patient: 1. Lie flat and take a deep breath 2. Stand and bear down against your hand 3. Prepare for a digital rectal examination 4. Lie in a left lateral recumbent position 28. A nurse practitioner reports that your patient’s abdominal x-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: 1. Appendicitis 2. Cholecystitis 3. Bowel obstruction 4. Diverticulitis 29. A 76-year-old patient presents to the emergency department with severe left lower quadrant