MARYVILLE 612 correct and completed questions and answers 2022/2023

MARYVILLE 612 correct and completed questions and answers 2022/2023 Which statement suggests that a patient may be at risk for contracting viral hepatitis A? a. I am a healthcare worker b. I had a blood transfusion recently c. I have renal failure and have hemodialysis 3x a week d. I have recently traveled overseas d. I have recently traveled overseas The examiner observes venous return to abdomen of the patient that moves upward from the pubis to the chest. This finding should make the examiner consider a. portal hypertension b. renal artery stenosis c. inferior vena cava obstruction d. mesentary arterial hypertension c. inferior vena cava obstruction Mrs. Cody is 36 weeks pregnant. She tells the examiner her stomach muscles feel like they are splitting. A protrusion at the midline of the abdomen is observed. This is recognized as: a. abdominal dehiscence b. swelling of the abdominal aorta c. diastasis recti umbilical herniation c. diastasis recti In which of the following patients would a slight pulsation in the epigastric area be considered a normal inspection finding? a. a very thin patient b. an obese patient c. a patient with ascites d. an older patient a. a very thin patient The examiner palpates an organ in the left costal margin. Which technique should the examiner use to differentiate between an enlarged kidney and an enlarged spleen? a. auscultation, listen for renal bruit b. auscultation, listen for abdominal friction rub c. palpation, using indirect fist palpation to assess for tenderness d. percussion, listening for dullness d. percussion, listening for dullness A hiatal hernia is described as a. a protrusion of abdominal contents through a weakening in the abdominal wall b. a protrusion of the stomach through the esophageal opening in the diaphragm c. an ulcer in the mucosa of the stomach that herniates into peritoneal cavity d. a herniation of the gallbladder into the cystic duct b. a protrusion of the stomach through the esophageal opening in the diaphragm An examiner may wish to use a bimanual technique for abdominal palpation when a. palpating superficial organs b. validating abdominal tenderness in the infant c. meeting muscle resistance while performing deep palpation d. determining the presence of excessive peritoneal fluid c. meeting muscle resistance while performing deep palpation You note that the midclavicular liver span of an adult male patient is 18 cm. With palpation you note that the liver is enlarged, and nontender. What does this suggest? a. diverticulitis b. ulcerative colitis c. hepatitis d. cirrhosis d. cirrhosis The examiner is unable to palpate the liver or kidney on the patient. Which of the following techniques will help assess tenderness to these organs? a. application of continuous firm pressure for 3 to 5 minutes b. percussion for tympany c. percussion for size d. indirect fist percussion d. indirect fist percussion A 2.5 yr old child presents with abdominal pain and stools that are red currant jelly in appearance. What does the examiner suspect? a. Meckel diverticulum b. Pyloric stenosis c. intussusception d. necrotizing enterocolitis c. intussusception Where is pain felt when an obturator muscle test is positive? a. right hip and thigh b. right hypogastric area c. right lower quadrant and groin d. beneath the right shoulder blade b. right hypogastric area Which of the following techniques is used to confirm presence of abdominal ascites? a. auscultation of fluid movement in abdomen b. palpation of rebound tenderness c. palpation of pitting edema on the abdomen d. percussion of dullness over the dependent areas of the abdomen d. percussion of dullness over the dependent areas of the abdomen Which of the following examination findings is indicative of peritoneal irritation or appendicitis? a. rebound tenderness on palpation b. percussion of shifting dullness over the abdomen c. auscultation of a bruit over the abdominal aorta d. percussion of dullness over the suprapubic area a. rebound tenderness on palpation A 61-year-old man has a presenting complaint of frequent constipation. He tells you there has been a change in his bowel movement habits - he gets constipated easily, the stool is very "skinny looking", and it is a different color than normal. What do these symptoms suggest? A. Diverticulitis B. Hepatitis B C. Colon or rectal cancer D. Pancreatitis C. Colon or rectal cancer The functional ability of the gastrointestinal tract most severely affected by aging is A. motility B. metabolism c. digestion d. catabolism A. motility Which finding on a newborn infant suggests a congenital anomaly? a. the umbilical cord has one artery and one vein b. the umbilical cord is thick c. the umbilical cord is thin d. there is a small mass around the umbilicus a. the umbilical cord has one artery and one vein Which rule states that the farther away from the navel abdominal pain occurs, the more likely it is to be of physical importance? A. Reglan law B. Apley rule C. Applegate rule D. Romberg rule B. Apley rule An absence of bowel sounds in the right lower quadrant is referred to as the ________________ sign. a. Cullen b. Striae c. Ballance d. Dance d. Dance Ecchymosis of the flanks associated with pancreatitis is identified as which of the following signs? a. Grey Turner b. Aaron c. Dance d. Markle a. Grey Turner Which of the following is the correct sequence for examining the abdomen? a. inspection, auscultation, percussion, palpation b. auscultation, inspection, percussion, palpation c. inspection, auscultation, palpation, percussion d. percussion, inspection, auscultation, palpation a. inspection, auscultation, percussion, palpation Which of the following identifies Murphys sign? a. pain down the medial aspect of the thigh to the knees b. abrupt cessation of inspiration on palpation of the gallbladder c. rebound tenderness and sharp pain when right lower quadrant is palpated d. right lower quadrant pain intensified by left lower clutching abdominal palpation b. abrupt cessation of inspiration on palpation of the gallbladder Peritoneal irritation is associated with which of the following? A. Aaron B. Balance C. Blumberg D. Dance c. blumberg Abdominal pain radiating to the left shoulder is indicative of which of the following? A. Appendicitis B. Intussusception C. Pancreatitis D. Splenic rupture D. Splenic rupture The spine of a newborn infant should be palpated with the examiner noting the shape of each spinal process. If a split is noted, what problem is suspected? a. Bifid defect b. Paget disease c. Down Syndrome d. Legg-Calve-Perthes disease a. Bifid defect Which questions would be most helpful in understanding a patient complaining of acute back pain? A. What medication do you currently take? B. Was there any activity or injury that occurred before the onset of pain? C. Were you born with any congenital deformities of the spine? D. Have you recently lost weight? B. Was there any activity or injury that occurred before the onset of pain? What spinal finding would be considered normal for a 72-year-old patient? A. Meningocele B. Myelomeningocele C. Kyphosis D. Scoliosis c. Kyphosis Which of the following data from a patient's history indicates an increased risk of osteomyelitis? A. Severe gout B. RA C. Severe osteoporosis D. Open fracture of the radius D. Open fracture of the radius What degree of knee flexion is considered normal? a. 15 b. 90 c. 130 d. 160 c. 130 What is considered a normal finding for a woman in her 8th month of pregnancy? a. stronger ligaments and spinal joints b. hypercalcemia c. a 25% loss of muscle strength d. lordosis d. lordosis When assessing for carpal tunnel syndrome, the Tinel sign can be performed by tapping the a. dorsal aspect of the wrist b. volar carpel ligament c. radial artery d. median nerve d. median nerve Which group is susceptible to subluxation of the head of the radius? a. infants and toddlers b. adolescents c. pregnant women d. older adults a. infants and toddlers To assess muscle strength of the temporalis and masseter muscles, the examine will as the patient to a. push jaw forward while the examiner applies counterforce b. attempt to open mouth while the examiner applies counterforce c. clench the teeth while the examiner palpates the contracted muscles d. clench the teeth while the examiner attempts to open the mouth with a tongue blade c. clench the teeth while the examiner palpates the contracted muscles Normal muscle strength is documented as grade a. 0 b. 1 c. 5 d. 10 c. 5 A patient complains of pain and a clicking noise with jaw movement. The pain extends into the face. These symptoms are suggestive of what? a. gout in the jaw b. TMJ dysfunction c. rheumatoid arthritis of the jaw d. bursitis of the temporomandibular joint b. TMJ dysfunction For which type of problem does a family history have significance? a. ankylosing spondylitis b. dislocation of the radius c. lumbosacral radiculopathy d. bursitis a. ankylosing spondylitis Mrs. Woods is a 28-year-old patient pregnant in her last trimester. Complains of numbness in her left hand. You diagnose carpel tunnel syndrome most likely related to a. repetitive movement b. fluid retention c. postural changes in neck caused by pregnancy d. eclampsia b. fluid retention Which statement made by a patient helps the examiner differentiate osteoarthritis from RA? a. I have swelling and pain in my joints b. I notice a crackling sound when I move my joints c. I get extremely tired by mid-morning, even when I sleep well d. I use to play the piano when I was younger c. I get extremely tired by mid-morning, even when I sleep well Mr. Manns is a 48-year-old who presents for the examination of his knee. On examination, you note excessive hyperextension of his knee. This may indicate a. genu valgum b. weakness of the quadriceps muscle c. weakness of cruciate ligament d. weakness of the collateral ligament b. weakness of the quadriceps muscle What would be assessed as part of ROM during assessment of thoracic and lumbar spine? a. extension, flexion, rotation b. eversion, inversion, rotation c. adduction and abduction d. extension, flexion, supination a. extension, flexion, rotation A lateral curvature of the thoracic spine indicates a. gibbus b. convex curves c. lordosis d. scoliosis d. scoliosis What test would detect a torn meniscus? a. Ballottement b. Varus test c. McMurray d. Bulge sign c. McMurray On examination of a patient, you note a difference in the size of the upper extremities. You decide that measurement of the circumference is indicated. How do you ensure the measurement of two extremities is comparable? a. measure both extremities in cm b. measure at the same distance from the same major landmark c. measure each extremity twice and average the results for each d. measure three locations on each extremity and obtain an average b. measure at the same distance from the same major landmark A patient comes to the clinic because of pain and swelling of the proximal interphalangeal joint on the third finger of the left hand. How would you examine her joints? a. affected joint first followed by the same joint on the right hand for comparison. b. left metacarpophalangeal joints, then the left proximal interphalangeal joints and, finally, the left distal interphalangeal joints. c. affected joint last to avoid causing discomfort, which would influence the remaining examination. d. left proximal interphalangeal joints starting with the index finger, then the ring finger and ending with the fifth finger c. affected joint last to avoid causing discomfort, which would influence the remaining examination. Which disorder is known to be hereditary? A. Peripheral Neuropathy B. Meningitis C. Huntington chorea D. Seizure Disorder C. Huntington chorea Which cranial nerve is not routinely tested unless a problem is suspected? a. I b. II c. V d. XI a. I The patient is able to touch each finger to his thumb in rapid sequence. What does this finding mean? a. intact trochlear and abducens cranial nerves b. appropriate cerebellar function c. an intact spinal accessory nerve d. kinesthetic sensation b. appropriate cerebellar function Which question may help determine prevention strategies for seizures that a patient has been experiencing? A. Where do your seizures typically begin?" B. "How do you feel after the seizure?" C. "What goes through your mind during a seizure?" D. "Are there any factors or activities that seem to start the seizures?" D. "Are there any factors or activities that seem to start the seizures?" The examiner asks the patient to close her eyes and then places a vibrating tuning fork on her ankle and ask her to indicate what is felt. What is being assessed? a. peripheral nerve sensory function b. cranial nerve sensory function c. primary sensory function d. level of consciousness c. primary sensory function Jack is a 52-year-old man with a history of poorly controlled diabetes. He also smokes. Based on these data, the examiner should recognize that Jack has several risk factors for a. seizures b. stroke c. multiple sclerosis d. Guillian-Barre syndrome b. stroke Which of the following assessment findings should not be surprising given that Jacks history of poorly controlled diabetes and smoking. a. inability to discern superficial touch or two-point discrimination on his legs b. reduced muscle tone on left side of his face c. asymmetry of the face when asked to smile and puff out cheeks d. slow and uncoordinated movement with finger-nose test a. inability to discern superficial touch or two-point discrimination on his legs The examiner is assessing deep tendon reflex response on a 12-year-old boy. The boy's response is an expected reflex. What score should be documented? a. 1+ b. 2+ c. 3+ d. 4+ b. 2+ An older patient tells the examiner "I have a hard time finding the right words when I am talking." The symptom may be a. a precursor to a seizure disorder b. an early symptom of Parkinson disease c. an indication of a dysfunction of the temporal lobe d. associated with a problem of the vestibular apparatus c. an indication of a dysfunction of the temporal lobe How can the examiner best gain the cooperation of a child to perform a neurologic exam? a. ask parent to perform exam while examiner observes b. ask mother or father to step out of the room c. promise the child a toy or treat if he or she does what you ask d. create a game from various aspects of the neurologic examination d. create a game from various aspects of the neurologic examination Which of the following infant reflex responses is considered normal? a. a 13-month-old baby's toes fan in response to stroking the lateral surface of the infant's sole. b. An 8-month-old infant demonstrates a positive Moro reflex when startled. c. A 3-month-old infant's fingers fan when the examiner's finger is placed in the infants hand. d. 2-month-old's legs flex up when infant is held upright and the dorsal side of the foot touches the table d. 2-month-old's legs flex up when infant is held upright and the dorsal side of the foot touches the table The examiner is conducting an interview with the mother of a 3-month-old infant as part of the neurologic system examination. Which response of the mother may indicate a need for further evaluation? a. "My baby sometimes falls asleep when I am feeding her." b. "My baby seems to jump when there is a loud noise in the room." c. "I drank a glass of wine about once a week while I was pregnant." d. "I had problems with hypertension the entire time I was pregnant." d. "I had problems with hypertension the entire time I was pregnant." A patient demonstrates impaired pain sensation. Which additional test is appropriate for further evaluation of this finding? a. heat and cold sensation b. ultrasonic perception c. deep tendon reflex d. transillumination of the involved areas a. heat and cold sensation The examiner squeezes the patient's biceps muscle as part of an examination. Which of the following responses verbalized by the patient is considered normal? a. "That makes my arm tingle." b. "That makes a burning sensation go up my arm." c. "That is uncomfortable." d. "My arm is twitching." c. "That is uncomfortable." Which of the following findings is associated with increased risk for skin breakdown and injury? a. inability to feel pressure applied by a monofilament b. inability to identify a familiar object by touch c. inability to identify a letter drawn in palm of hand d. 3+ deep tendon reflexes a. inability to feel pressure applied by a monofilamen Mrs. Sanders had a CVA 2 days ago. She moves when her name is called, and she moans when she experiences painful stimuli. Which of the following best describes Mrs. Sanders' level of consciousness? a. Confusion b. Delirium c. Lethargy d. Stupor d. stupor Mr. Stanton is a 52-year-old patient with diabetes who presents to the office for a routine examination. You have checked protective sensation with 5.07 monofilament, and you noted a loss of sensation. This indicates a. peripheral neuropathy. b. positive Kernig sign. c. positive Brudzinski sign. d. posturing. a. peripheral neuropathy. A patient is brought into the ER unresponsive following a motor accident. The patient's arms are fully extended with the forearms pronated. The wrists and fingers are flexed and the jaw is clenched. The neck is extended and the feet are plantar flexed. What does the examiner infer based on these findings? a. the patient has a brainstem injury b. the patient had a seizure c. the patient has damage to the corticospinal tracts d. the patient has a transection of the spinal cord a. the patient has a brainstem injury Which patient response indicates a positive Brudzinski sign? a. involuntary flexion of the hips and knees when the neck is flexed b. headache worsened by hyperextending and then flexing the head c. resistance to dorsiflexing the foot d. pain on adduction of the hip a. involuntary flexion of the hips and knees when the neck is flexed On examination of which patient would an examiner expect to find a positive Kerig sign? a. a patient with Parkinson disease b. a patient who had a stroke c. a patient with a whiplash injury d. a patient with meningitis d. a patient with meningitis As a patient walks from the waiting room to the examining room, the examiner notices that the patients feet are wide apart and his trunk sways as he staggers and lurches side to side. How should the examiner document this finding? a. dystrophic gait b. cerebellar ataxia c. dystonia d. spastic diplegia b. cerebellar ataxia Which characteristic suggests that a lesion on a patients breast is Paget disease and not eczema? a. itchy primarily at night b. erythematous and crusty c. confined to the nipple and areola of one breast d. does not respond to steroids d. does not respond to steroids How should a breast exam on a patient who had a lumectomy for breast cancer differ from a breast exam on a patient who has not had breast cancer? a. supraclavicular and infraclavicular lymph nodes are palpated b. the lateral position with hands over the head is used for palpation c. the area of the scar is palpated with 2 fingers using a circular motion d. the fingertips are used to palpate for intercostal breast tissue c. the area of the scar is palpated with 2 fingers using a circular motion While palpating the axilla, it is best to place the patient in a a. sitting position with the arm flexed at the elbow b. sitting position with the arm at the side c. supine position with the arms on the hips d. leteral position with the arms at the sides a. sitting position with the arm flexed at the elbow Nipple compression should be included as part of the breast exam for which of the following patients? a. a 23-year-old woman concerned about lumps and tenderness premenstrally b. a 35-year-old lactating woman with very sore nipples c. a 48-year-old woman reporting 2 episodes of bloody discharge from right nipple d. a 60-year-old man with gynecomastia c. a 48-year-old woman reporting 2 episodes of bloody discharge from right nipple A supernumerary nipple is found on a white newborn infant girl. Which of the following may accompany this finding? a. increased risk for breast cancer as an adult b. increased lactation volume as an adult c. congenital renal or cardiac anomalies d. mental retardation c. congenital renal or cardiac anomalies Which are typical descriptors of fibroadenoma? a. bilateral, stellate, rubbery, nontender b. multiple, unilateral, tender, well-defined c. single, discoid, firm, nontender d. unilateral, hard, stellate, fixed c. single, discoid, firm, nontender Which is the correct position in which to place a patient for breast palpation? a. supine with arms at the sides and a pillow under the neck b. supine with arm over the head and a small pillow under the shoulder of the side being assessed c. left lateral position with arm bent backward d. sitting slightly forward with the breasts hanging away from chest; hands on hips b. supine with arm over the head and a small pillow under the shoulder of the side being assessed Which statement by a 37-year-old woman would make you suspect fibrocystic disease? a. I have a lump in my breast that is non-tender b. my right breast is larger than my left breast c. my nipples are darker than before my baby was born d. I feel a lump before my period d. I feel a lump before my period A 3-week postpartum patient tells you that she is breastfeeding but might stop because her nipples are sore. You observe dry and cracked nipples. What question would be helpful in gaining information relevant to treating the problem? a. do you pump your breasts? b. how do you clean your breasts? c. have you been able to bond with your baby? d. what medications are you taking? b. how do you clean your breasts? A 68-year-old man presents with gynecomastia. Which factor is a potential cause of the problem? a. a decrease in physical activity b. increased lactiferous duct glands c. lymphatic engorgement d. a decrease in testosterone d. a decrease in testosterone Symptoms consistent with underlying ductal malignancy include a. erythema, heat and pain over and around one nipple b. red, scaling, crusty patch on one nipple c. bilateral inflammation, tenderness, sticky, multi-colored discharge d. gynecomastia and a deepening color of the nipple b. red, scaling, crusty patch on one nipple While examining the breast of a 52-year-old woman you note nipple discharge. Which diagnostic test would be appropriate? a. cytologic examination of the discharge b. culture and sensitivity examination of the discharge c. WBC count d. estrogen level a. cytologic examination of the discharge While examining the breast of a 68-year-old woman, you would expect which of the following findings? a. breast tissue has multiple large, firm lumps in it b. breast tissue has a granular feel to it c. the tail of Spence is no longer observed d. the axillary lymph nodes are enlarged b. breast tissue has a granular feel to it Which represents the first sign of puberty in girls? a. Thelarche b. Menarche c. proliferation of the lactiferous duct d. areolar elevation a. Thelarche A benign tumor of the subareolar duct that produces nipple discharge is a. Paget disease b. intraductal papilloma c. duct ectasia d. galactorrhea b. intraductal papilloma Mrs. Harris, a 38-year-old woman, is diagnosed with mastitis. What is likely the causative agent? a. Staphylococcus aureus b. Streptococcus aureus c. Neisseria gonorrhoeae d. Escherichia coli a. Staphylococcus aureus Which finding on examination of a female patient's breasts requires further investigation? a. wrinkled areolas b. prominent Montgomery tubercles c. one breast larger than the other d. unilateral visible venous network d. unilateral visible venous network Which finding on male breast exam can result from marijuana use? a. galactorrhea b. subareolar mass c. gynecomastia d. dimpling c. gynecomastia Which finding is suggestive of pelvic inflammatory disease? a. enlargement of the ovaries b. small and pale cervix c. pain resulting from movement of the cervix d. unilateral labial swelling, redness, and tenderness c. pain resulting from movement of the cervix While palpating the introitus of the vagina, the patient jumps and complains of severe tenderness. A mass is palapted that is warm to touch. With which of the following problems are these physical findings consistent? a. cancer of the cervix b. inflammation of the Bartholin glands c. a cystole d. acute genital wart infection b. inflammation of the Bartholin glands Which may be indicative of a pelvic mass? The cervix is a. pale in color b. deviating to the right c. protruding 2.5 cm into the vagina d. pointing anteriorly b. deviating to the right A patient complains of pain, dysmenorrhea and heavy prolonged menstrual flow. Tender nodules are palpable along the uterosacral ligament. These symptoms and findings suggest a. pelvic inflammatory disease b. endometriosis c. ectopic pregnancy d. ovarian cancer b. endometriosis An examinerplans to collect samples for cytologic studies during vaginal examination. Use of which type of lubricant on the speculum is least likely to interfere with specimen analysis and interpretation? a. water-soluble lubricant b. topical anesthetizing ointment c. warm water vaginal secretions c. warm water When examining a middle-aged woman with a history of endometrial cancer and a hysterectomy the examiner should a. avoid bimanual and palpation maneuvers b. obtain a Pap smear from the suture line c. omit cultures and specimens from the vagina d. palpate internal areas before inserting the speculum b. obtain a Pap smear from the suture line A patient complains of urinary incontinence when she is active. Which is associated with this problem? a. hernial protrusion in the posterior wall of the vagina b. hernial protrusion through the anterior wall of the vagina c. symptoms associated with PMS d. enlargement and protrusion of the cervix into the vaginal vault b. hernial protrusion through the anterior wall of the vagina Which finding suggests an infection with an STI? a. ulcers and vesicles on the vulva b. atrophy of the labia minora c. dilation of the urethral orifice d. bluish color to the cervix a. ulcers and vesicles on the vulva The examiner observes a slit-shaped cervical os in a nulliparous woman. What data explains this finding? a. an early onset of menarche b. has had multiple sex partners c. has had HPV d. had an abortion as a teenager d. had an abortion as a teenager A prominent labia minora in a newborn a. indicates maternal infection b. suggests ambiguous genitalia c. is consistent with prematurity d. is a normal finding d. is a normal finding Softness of the cervix is an expected finding for: A. An adolescent B. A pregnant woman C. A nonpregnant woman D. An older adult B. A pregnant woman By which week of pregnancy would you expect to be able to palpate the uterus at the symphysis pubis? a. 8th b. 10th c. 12th d. 14th c. 12th A cauliflower type mass found on the labia is most likely caused by a. primary syphilis b. condyloma lactum c. condyloma acuminatum d. venereal herpes c. condyloma acuminatum A patient reports that over the past year the interval between her menstrual periods has lengthened and her last 3 periods have been about 6 weeks apart. What is the proper term for this? a. amenorrhea b. hypomenorrhea c. hypermenorrhea d. oligomenorrhea d. oligomenorrhea On a newborn male infant, the examiner palpates a testicle in the inguinal canal that cannot be pushed into the scrotum. This is consistent with a. a retractile penis b. ambiguous genitalia c. a direct inguinal hernia d. an undescended testicle d. an undescended testicle Genital Self-Examination should be taught to patients who are at risk for a. testicular cancer b. Peyronie disease c. STI d. prostate enlargement c. STI On examination of patients scrotum, you note that it is unusually thickened and it pits. What is one type of problem suggested by these findings? a. STI b. Squamous cell carcinoma c. Liver disease d. Autoimmune disease c. Liver disease while examining a 2-year-old boy, the examiner should be aware that the a. scrotum is normally edematous until 4 y.o. b. foreskin of uncircumcised penis is not retractable until 3 or 4 y.o. c. testicles typically don't descend into scrotum until 5 y.o. d. cremasteric reflex does not become evident until 6 or 7 y.o. b. foreskin of uncircumcised penis is not retractable until 3 or 4 y.o. Which item in the patient history is considered a risk factor for cancer of the penis? a. circumcised at birth b. history of condyloma acuminatum infections c. had a congenital hydrocele d. history of untreated epispadias b. history of condyloma acuminatum infections In which situation is transillumination of the scrotum indicated? a. presence of syphilis chancre b. indirect hernia is palpated c. the examiner suspects a mass d. the examiner palpates testes c. the examiner suspects a mass The patient is asked to bare down while examining the inguinal ring. Examiner feels a soft swelling sensation on the fingertip. The patient complains of pain while straining. These findings are consistent with which of the following? a. indirect hernia b. direct hernia c. femoral hernia d. rectal hernia a. indirect hernia The examiner inspects the scrotum of a 43-yr-old man. Which finding requires further evaluation? a. left testicle hangs lower than right testicle b. scrotum is darker than the general skin color c. skin of scrotum is shiny and smooth d. the scrotum is midline raphe c. skin of scrotum is shiny and smooth Which finding may indicate diabetes? a. the vas deferens feels beaded or lumpy b. the testicle feels hard with a lump c. sebaceous cysts are present on the scrotal skin d. the urethra has a slitlike orifice a. the vas deferens feels beaded or lumpy During an examination for a hernia, an adult male patient should a. be asked to stand b. be in supine position c. sit on a table with heels together d. assume knee-to-chest position on the examination table a. be asked to stand Which of the following testiclular characteristics is (are) associated with syphilis or diabetic neuropathy? a. asymmetry and drooping b. bilateral enlargement c. insensitivity to pain d. migration into the abdomen c. insensitivity to pain What type of hernia would you most likely see in a 15 y.o. boy? a. femoral b. umbilical c. direct inguinal d. indirect inguinal d. indirect inguinal Which patient characteristic is associated with smegma as an expected finding? a. uncircumcised b. prepubertal c. sexually active d. transgender a. uncircumcised A 24-year-old man has scrotal pain and marked erythema. The examiner considers epididymitis. Which other finding is most consistent with this problem? a. absent cremasteric reflex b. anorexia and nausea c. acute onset of severe pain d. urethral discharge d. urethral discharge Hypospadias is a congenital defect in which the urethra meatus is located on the ventral surface of the glans penile shaft. This is thought to occur embryologically during urethral development during which stage of gestation? a. 4 to 6 wks b. 8 to 20 wks c. 15 to 25 wks d. 20 to 30 wks b. 8 to 20 wks Which of the following hernias occur more often in females and is the least common of all hernias? a. indirect b. direct c. femoral d. ventral c. femoral Which finding in an examination of a scrotal mass. which is neither a testicle or spermatic cord suggests the problem is an incarcerated hernia? a. mass does not transilluminate nor change in size when reduction is attempted b. mass does not transilluminate but decreases in size when reduction is attempted c. mass transilluminates but does not change in size when reduction is attempted d. mass both transilluminates and changes in size when reduction is attempted a. mass does not transilluminate nor change in size when reduction is attempted You examine Mr. LaCosta, a 22-year-old patient. His chief complaint is penile pain and swelling. On examination, you note a constricting band of tissue directly behind the head of the penis. Your diagnosis is a. paraphimosis b. hypospadias c. orchitis d. torsion a. paraphimosis You are examining a patient and note pearly-gray, smooth, umbilicated lesions. The most common cause of these lesions is a. syphilis b. condyloma acuminata c. molluscum contagiosum d. lymphogranuloma venereum c. molluscum contagiosum Which finding indicates a normal cremasteric reflex? a. penile erection in response to light touch b. descent of a testicle into scrotum in response to pressure on the abdominal wall c. drop of urine appearing at the urethral meatus in response to pressing the glans d. elevation of left testicle and scrotum in response to stroking the left inner thigh d. elevation of left testicle and scrotum in response to stroking the left inner thigh While palpating the lateral and posterior rectal walls, the examiner should expect to palpate a. a smooth, even, and uninterrupted surface b. small nodules from internal hemorrhoids c. tissue folds from the valves of Houston d. bulging from the bladder wall a. a smooth, even, and uninterrupted surface A patient presents with a chief complaint of rectal pain. The examiner will focus the history and examination on which known fact? a. rectal pain is almost always accompanied by an infection b. rectal pain is almost always an indication of local disease c. a complaint of rectal pain is usually associated with a serious systemic process d. one of the most common causes of rectal pain is prostatic enlargement b. rectal pain is almost always an indication of local disease Which is the appropriate response when a transwoman patient who had a gonadectomy says, " I am very glad I don't have to worry about prostate cancer anymore." a. that is definitely a benefit of the surgery b. your risk of prostate cancer is still the same; an gonadectomy doesn't change it. c. your risk is lowered but not elliminated d. unfortunately, the surgery actually increases your risk a slight degree b. your risk of prostate cancer is still the same; an gonadectomy doesn't change it. While examining the perineum of a 6-year-old girl, the examiner observes hemorrhoids. This finding suggests a. repeated events of sexual abuse b. the presence of chronic constipation c. a diet high in fibrous foods d. an underlying problem such as portal hypertension d. an underlying problem such as portal hypertension A patient tells the examiner that she has had clay colored stools. Stools this color results from a. a lack of bile pigment b. excessive fiber intake c. excessive dietary beef d. insufficient fluid intake a. a lack of bile pigment An older male patient is unable to assume a standing position for a routine rectal exam. What is the best alternative position? a. lithotomy b. left lateral position with the knees flexed c. knee-chest d. prone b. left lateral position with the knees flexed Before palpating the prostate, the examiner should tell the patient that he might feel the urge to do which of the following? A. Urinate B. Defecate C. Vomit D. Faint A. Urinate Which behavior observed while you are obtaining a history on a new patient is most suggestive of very acute rectal problems? a. rapidly tapping the feet up and down b. repeatedly crossing and uncrossing legs c. constant shifting from side to side in the chair d. slowly rubbing a hip and thigh c. constant shifting from side to side in the chair What examination finding in the child is a clue to diagnosis of Hirschsprung disease? a. passing of frequent, loose stools in the absence of other symptoms b. consistently empty rectum with a history of constipation c. itching and irritation around the anus d. rectal prolapse b. consistently empty rectum with a history of constipation In which situation would the examiner perform a rectal exam on an infant or child? a. a newborn passes greenish-black viscous stool 12 hours after birth b. the mother of a 3 month old describes the stool as loose and golden c. a stool of a 6 y.o. child is guaiac positive d. a mother tells the provider that her 3 y.o. was sent home from daycare after 2 episodes of diarrhea c. a stool of a 6 y.o. child is guaiac positive How is the anal ring assessed? a. inspection of the anus b. external palpation of the anus c. examination of the stool d. rotation of the finger within the anal sphincter d. rotation of the finger within the anal sphincter Which of the following best describes the feel of a normal prostate gland? a. soft olive or grape b. small sea sponge c. ping-pong ball d. pencil eraser d. pencil eraser Anal patency is verified in a newborn infant by a. inserting a lubricated thermometer through the anus and into the rectum b. inserting the fifth digit through the anus and into the rectum c. assessing for passage of a meconium stool in the first 24 to 48 hours after birth d. inspecting the anus for an anal opening c. assessing for passage of a meconium stool in the first 24 to 48 hours after birth Prostate enlargement is determined by the a. diameter of the rectum near the bladder b. circumference of the prostate c. estimation of the depth of the sulcus d. protrusion of the prostate into the rectum d. protrusion of the prostate into the rectum Which is the normal response to lightly touching the anal opening? a. dilation of the anus b. contraction of the anal sphincter c. relaxation of the internal sphincter d. shrinking of external hemorrhoids b. contraction of the anal sphincter Which direction would you give a patient in order to facilitate visualization of an anal fissure? a. take a deep breath and hold it b. squeeze your buttocks muscles c. bear down like you are going to have a bowel movement d. tighten your muscles as if to stop the flow of urine c. bear down like you are going to have a bowel movement The examiner palpates the prostate noting that it is hard and irregular. The median sulcus is not palpable. These findings are consistent with a. prostate cancer b. benign prostatic hypertrophy c. prostatitis d. a rectal mass a. prostate cancer A rectal prolapse in a young child is frequently associated with a. rickets b. cystic fibrosis c. Crohn disease d. chronic constipation or diarrhea d. chronic constipation or diarrhea