FINAL EXAM
Advanced Health Assessment
Questions And Answers Plus Rationales
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➢ Qs & Answers Plus Rationales
,1. A 65-year-old male with a 50-pack-year smoking history presents
with a 3-month history of a non-productive cough and
unintentional weight loss of 15 lbs. On exam, you note a firm, fixed,
non-tender left supraclavicular lymph node. What is the most
appropriate next diagnostic step?
a) Chest X-ray
b) CT chest with contrast
c) Fine-needle aspiration of the supraclavicular node
d) Bronchoscopy
Answer: c (Virchow’s node in a smoker with constitutional symptoms
suggests metastatic lung cancer. FNA is minimally invasive and often
diagnostic.)
2. A 28-year-old female presents with episodic palpitations, chest
discomfort, and anxiety. During an episode, you auscultate a mid-
systolic click followed by a late systolic murmur at the apex. The
murmur becomes longer and louder when the patient stands. What
is the most likely diagnosis?
a) Aortic stenosis
b) Mitral valve prolapse
c) Hypertrophic cardiomyopathy
d) Tricuspid regurgitation
Answer: b (Mitral valve prolapse: mid-systolic click, late systolic murmur;
standing decreases preload, causing earlier prolapse and longer
murmur.)
,3. A 72-year-old male with a history of Parkinson’s disease reports
his feet feel “stuck to the floor” when he tries to walk through a
doorway. This phenomenon is best described as:
a) Festination
b) Freezing of gait
c) Retropulsion
d) Dystonia
Answer: b (Freezing of gait is a sudden, transient inability to move the
feet forward, often triggered by narrow spaces or turning; common in
advanced Parkinson’s.)
4. A 55-year-old female presents with acute-onset, severe, tearing
chest pain radiating to her back. Her right arm BP is 180/90 mmHg,
left arm BP is 100/60 mmHg. A decrescendo diastolic murmur is
heard at the left sternal border. What is the most likely diagnosis?
a) Acute myocardial infarction
b) Aortic dissection with aortic regurgitation
c) Pulmonary embolism
d) Pericarditis
Answer: b (Aortic dissection extending into the aortic root causes acute
aortic regurgitation (diastolic murmur) and pulse differential.)
5. A 34-year-old G2P1 woman at 32 weeks gestation presents with a
blood pressure of 142/92 mmHg and 1+ proteinuria. She denies
headaches or visual changes. Her platelet count is 220,000/µL, AST
, is 30 U/L. This is classified as:
a) Gestational hypertension
b) Preeclampsia without severe features
c) Severe preeclampsia
d) Chronic hypertension
Answer: b (BP ≥140/90 after 20 weeks with proteinuria, no severe
features (BP <160/110, normal platelets, LFTs, no cerebral symptoms).)
6. A 45-year-old male with a history of alcohol use disorder presents
with a 2-day history of severe epigastric pain radiating to the back,
nausea, and vomiting. On exam, he has epigastric tenderness and
hypoactive bowel sounds. Serum lipase is 1,200 U/L. What is the
most common early complication?
a) Pancreatic pseudocyst
b) Acute respiratory distress syndrome (ARDS)
c) Chronic pancreatitis
d) Pancreatic necrosis
Answer: b (ARDS, acute kidney injury, and SIRS are early complications
of severe acute pancreatitis. Pseudocyst develops after 4 weeks.)
7. A 68-year-old female presents with a 6-month history of
progressive forgetfulness, apathy, and urinary incontinence. Her
gait is magnetic (feet seem stuck to the floor). Which diagnostic
study is most likely to confirm the suspected diagnosis?
a) MRI brain showing ventriculomegaly with normal cortical sulci