EXAM 3
Advanced Health Assessment
Questions And Answers Plus Rationales
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➢ Qs & Answers Plus Rationales
,1. A 62-year-old male with hypertension and type 2 diabetes
presents for an annual physical. His blood pressure is 138/86
mmHg. According to the 2026 USPSTF guidelines, which of the
following is the most appropriate next step?
a) Recheck BP in 1 year
b) Start a thiazide diuretic
c) Confirm with ambulatory blood pressure monitoring (ABPM) or home
readings before diagnosis
d) Order an echocardiogram
Answer: c (USPSTF recommends out-of-office BP confirmation (ABPM or
home monitoring) before diagnosing hypertension or adjusting therapy,
unless BP is severely elevated.)
2. A 45-year-old female reports episodic dizziness described as “the
room spinning.” Each episode lasts 1-2 minutes and is triggered by
turning her head in bed. Between episodes she is asymptomatic. The
most appropriate physical exam maneuver to confirm the diagnosis
is:
a) Orthostatic BP measurement
b) Dix-Hallpike test
c) Head impulse test
d) Romberg test
Answer: b (Dix-Hallpike is the diagnostic maneuver for benign
paroxysmal positional vertigo (BPPV) – reproduces nystagmus and
vertigo with latency and fatigability.)
,3. On auscultation of the lungs, you hear a high-pitched,
monophonic, inspiratory sound over the trachea in a 2-year-old with
stridor. This is most consistent with:
a) Croup
b) Epiglottitis
c) Foreign body aspiration
d) Laryngomalacia
Answer: d (Laryngomalacia is the most common cause of inspiratory
stridor in infants/young children; sound is high-pitched, worsens with
agitation or supine position, improves with prone.)
4. A 55-year-old male reports a 2-day history of severe right eye
pain, redness, and halos around lights. On exam, the right pupil is
mid-dilated and fixed, cornea is hazy, and intraocular pressure by
tonometry is 45 mmHg. The most likely diagnosis is:
a) Anterior uveitis
b) Acute angle-closure glaucoma
c) Corneal abrasion
d) Conjunctivitis
Answer: b (Acute angle-closure glaucoma presents with severe pain,
fixed mid-dilated pupil, corneal edema, high IOP; an ophthalmologic
emergency.)
5. Which of the following deep tendon reflexes is most difficult to
elicit and requires reinforcement (e.g., Jendrassik maneuver) in a
, normal adult?
a) Patellar reflex (L4)
b) Achilles reflex (S1)
c) Biceps reflex (C5-C6)
d) Brachioradialis reflex (C6)
Answer: b (Achilles reflex is often hypoactive or requires reinforcement
in older adults or those with relaxed muscles; Jendrassik maneuver
helps.)
6. A 32-year-old G2P1 woman at 16 weeks gestation reports a new,
pruritic, urticarial rash on her abdomen, sparing the umbilicus. The
most likely diagnosis is:
a) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
b) Pemphigoid gestationis
c) Intrahepatic cholestasis of pregnancy
d) Atopic dermatitis
Answer: a (PUPPP is the most common dermatosis of pregnancy,
typically occurring in third trimester but can begin earlier; starts in striae,
spares umbilicus. Pemphigoid gestationis often involves umbilicus.)
7. A 70-year-old patient with a history of COPD presents with
worsening dyspnea. On exam, you note a barrel chest, distant
breath sounds, and a liver edge palpated 4 cm below the costal
margin. Which of the following explains the palpable liver?
a) Hepatomegaly