NR509 | NR509 Advanced Physical Assessment
Final Exam v2 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 55-year-old male presents with a complaint of sudden visual loss in his right eye. During
the fundoscopic exam, the clinician notes a ‘pale retina with a cherry-red spot’ at the fovea.
What is the most likely diagnosis?
A. Central Retinal Artery Occlusion
B. Retinal Detachment
C. Acute Angle-Closure Glaucoma
D. Diabetic Retinopathy
Correct Answer: A
Expert Explanation: Central retinal artery occlusion typically presents as sudden, painless
unilateral vision loss. The classic physical finding is a pale, opaque retina due to edema,
with a contrasting cherry-red spot at the fovea. This condition is considered an ocular
emergency requiring immediate specialist intervention.
2. When assessing a patient for a suspected carotid bruit, which part of the stethoscope
should be used and what instructions should the patient receive?
A. Diaphragm; breathe deeply
B. Diaphragm; hold their breath
C. Bell; hold their breath
D. Bell; cough once
Correct Answer: C
Expert Explanation: A bruit is a low-pitched blowing sound caused by turbulent blood
flow. The bell of the stethoscope is best suited for detecting these low-frequency sounds.
Asking the patient to hold their breath prevents breath sounds from obscuring the vascular
sounds during auscultation.
3. A clinician is performing the Weber test on a patient with suspected hearing loss. The
sound lateralizes to the patient’s right ear. If the right ear has conductive hearing loss, what is
the expected result of the Rinne test in that same ear?
A. Air conduction is longer than bone conduction
B. Bone conduction is equal to air conduction
,C. Bone conduction is longer than air conduction
D. The patient hears nothing in the right ear
Correct Answer: C
Expert Explanation: In the Weber test, sound lateralizes to the impaired ear in conductive
hearing loss. In the same ear, the Rinne test will show that bone conduction (BC) is greater
than or equal to air conduction (AC). This indicates an obstruction or pathology in the
external or middle ear preventing normal air conduction.
4. During a respiratory assessment, the clinician notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with which of the following conditions?
A. Pneumothorax
B. Pleural Effusion
C. Pneumonia with consolidation
D. Chronic Obstructive Pulmonary Disease
Correct Answer: C
Expert Explanation: Tactile fremitus refers to the palpable vibrations transmitted through
the bronchopulmonary system to the chest wall. Solid or consolidated tissue, such as in
lobar pneumonia, conducts vibrations better than air. Therefore, increased fremitus is a
hallmark sign of pulmonary consolidation.
5. To evaluate for a possible meniscus tear in the knee, which of the following special tests
should the clinician perform?
A. Lachman test
B. Anterior Drawer test
C. McMurray test
D. Varus stress test
Correct Answer: C
Expert Explanation: The McMurray test is specifically designed to detect tears in the
meniscus of the knee. The clinician rotates the lower leg and extends the knee while
applying pressure to the joint line. A palpable click or pop accompanied by pain constitutes
a positive result for a meniscal injury.
6. Which heart sound is specifically associated with the ‘atrial kick’ and is frequently heard in
patients with stiffened left ventricles due to hypertension?
A. S4
B. S2
, C. S3
D. S1
Correct Answer: A
Expert Explanation: The S4 heart sound, or atrial gallop, occurs just before S1 at the end
of diastole. It is produced by the atria contracting against a non-compliant or stiff ventricle.
This is a common finding in conditions like long-standing systemic hypertension or
hypertrophic cardiomyopathy.
7. When assessing the thyroid gland using the posterior approach, where should the
clinician’s fingers be positioned to palpate the lobes?
A. Above the hyoid bone
B. On the posterior aspect of the neck muscles
C. Between the trachea and the sternocleidomastoid muscle
D. Directly over the thyroid cartilage
Correct Answer: C
Expert Explanation: The posterior approach involves standing behind the patient and
placing the fingers of both hands on the patient’s neck. The fingers are positioned between
the trachea and the sternocleidomastoid muscle to feel for the thyroid lobes. Asking the
patient to swallow helps the thyroid move upward, making it easier to palpate.
8. A positive Murphy sign is most indicative of which underlying condition?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Splenomegaly
D. Pyelonephritis
Correct Answer: A
Expert Explanation: A Murphy sign is elicited by palpating the right upper quadrant at the
gallbladder location while the patient takes a deep breath. If the patient abruptly stops
inhaling due to pain when the gallbladder contacts the examiner’s fingers, the test is
positive. This finding is highly sensitive for acute cholecystitis.
9. During an eye examination, the clinician observes ‘AV nicking.’ This finding is traditionally
associated with which chronic condition?
A. Diabetes Mellitus
B. Hyperthyroidism
C. Hypertensive Retinopathy
Final Exam v2 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 55-year-old male presents with a complaint of sudden visual loss in his right eye. During
the fundoscopic exam, the clinician notes a ‘pale retina with a cherry-red spot’ at the fovea.
What is the most likely diagnosis?
A. Central Retinal Artery Occlusion
B. Retinal Detachment
C. Acute Angle-Closure Glaucoma
D. Diabetic Retinopathy
Correct Answer: A
Expert Explanation: Central retinal artery occlusion typically presents as sudden, painless
unilateral vision loss. The classic physical finding is a pale, opaque retina due to edema,
with a contrasting cherry-red spot at the fovea. This condition is considered an ocular
emergency requiring immediate specialist intervention.
2. When assessing a patient for a suspected carotid bruit, which part of the stethoscope
should be used and what instructions should the patient receive?
A. Diaphragm; breathe deeply
B. Diaphragm; hold their breath
C. Bell; hold their breath
D. Bell; cough once
Correct Answer: C
Expert Explanation: A bruit is a low-pitched blowing sound caused by turbulent blood
flow. The bell of the stethoscope is best suited for detecting these low-frequency sounds.
Asking the patient to hold their breath prevents breath sounds from obscuring the vascular
sounds during auscultation.
3. A clinician is performing the Weber test on a patient with suspected hearing loss. The
sound lateralizes to the patient’s right ear. If the right ear has conductive hearing loss, what is
the expected result of the Rinne test in that same ear?
A. Air conduction is longer than bone conduction
B. Bone conduction is equal to air conduction
,C. Bone conduction is longer than air conduction
D. The patient hears nothing in the right ear
Correct Answer: C
Expert Explanation: In the Weber test, sound lateralizes to the impaired ear in conductive
hearing loss. In the same ear, the Rinne test will show that bone conduction (BC) is greater
than or equal to air conduction (AC). This indicates an obstruction or pathology in the
external or middle ear preventing normal air conduction.
4. During a respiratory assessment, the clinician notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with which of the following conditions?
A. Pneumothorax
B. Pleural Effusion
C. Pneumonia with consolidation
D. Chronic Obstructive Pulmonary Disease
Correct Answer: C
Expert Explanation: Tactile fremitus refers to the palpable vibrations transmitted through
the bronchopulmonary system to the chest wall. Solid or consolidated tissue, such as in
lobar pneumonia, conducts vibrations better than air. Therefore, increased fremitus is a
hallmark sign of pulmonary consolidation.
5. To evaluate for a possible meniscus tear in the knee, which of the following special tests
should the clinician perform?
A. Lachman test
B. Anterior Drawer test
C. McMurray test
D. Varus stress test
Correct Answer: C
Expert Explanation: The McMurray test is specifically designed to detect tears in the
meniscus of the knee. The clinician rotates the lower leg and extends the knee while
applying pressure to the joint line. A palpable click or pop accompanied by pain constitutes
a positive result for a meniscal injury.
6. Which heart sound is specifically associated with the ‘atrial kick’ and is frequently heard in
patients with stiffened left ventricles due to hypertension?
A. S4
B. S2
, C. S3
D. S1
Correct Answer: A
Expert Explanation: The S4 heart sound, or atrial gallop, occurs just before S1 at the end
of diastole. It is produced by the atria contracting against a non-compliant or stiff ventricle.
This is a common finding in conditions like long-standing systemic hypertension or
hypertrophic cardiomyopathy.
7. When assessing the thyroid gland using the posterior approach, where should the
clinician’s fingers be positioned to palpate the lobes?
A. Above the hyoid bone
B. On the posterior aspect of the neck muscles
C. Between the trachea and the sternocleidomastoid muscle
D. Directly over the thyroid cartilage
Correct Answer: C
Expert Explanation: The posterior approach involves standing behind the patient and
placing the fingers of both hands on the patient’s neck. The fingers are positioned between
the trachea and the sternocleidomastoid muscle to feel for the thyroid lobes. Asking the
patient to swallow helps the thyroid move upward, making it easier to palpate.
8. A positive Murphy sign is most indicative of which underlying condition?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Splenomegaly
D. Pyelonephritis
Correct Answer: A
Expert Explanation: A Murphy sign is elicited by palpating the right upper quadrant at the
gallbladder location while the patient takes a deep breath. If the patient abruptly stops
inhaling due to pain when the gallbladder contacts the examiner’s fingers, the test is
positive. This finding is highly sensitive for acute cholecystitis.
9. During an eye examination, the clinician observes ‘AV nicking.’ This finding is traditionally
associated with which chronic condition?
A. Diabetes Mellitus
B. Hyperthyroidism
C. Hypertensive Retinopathy
