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During a post-hospital discharge visit, you notice your 71 year old female patient
has been diagnosed with a "new murmur" found by the hospitalist during their
recent hospitalization for CHF exacerbation. In evaluating the patient, during
which phase of the cardiac cycle would you anticipate auscultation of a S3 or S4
heart sound?
A. Diastole
B. 53 in systole while S4 in diastole
C. Systole
D. S4 in diastole while S3 in systole
A. Diastole
The point of maximum impulse (PMI) is MOST often palpable in healthy adults
when positioned in the supine or left lateral decubitus position. Which one of the
following locations is most commonly described as the PMI in a healthy adult?
A. Left 2nd intercostal space, midaxillary line.
B. Left 5th intercostal space, midclavicular line.
C. Right 4th intercostal space, midaxillary line.
D. Right 2nd intercostal space, midclavicular line.
B. Left 5th intercostal space, midclavicular line
,The nurse practitioner assessing the patient with a rapid cardiac rhythm may
assess for a pulse deficit by auscultating the patient's heart while watching the
EKG rhythm. Where would the S1 heart sounds correlate with the
electrocardiographic waves?
A. At the end of the T wave.
B. At the start of the T wave.
C. Peak of the R wave.
D. At the start of the P wave.
C. Peak of the R wave.
Michael, a 72 year old male patient who previously presented with stable cardiac-
type chest pain has underwent a stress test. He presents today to review the
stress test results, which show EKG findings of ST segment depression during the
exam in leads V3 and V4 as well as some concurrent chest discomfort. Based on
these findings, which of the following are NOT priority medical decisions?
A. Prescribe metoprolol (Lopressor) 12.5mg PO BID
B. Prescribe aspirin 81mg PO daily
C. Refer to cardiology for angiography
D. Check for thyroid dysfunction
D. Check for thyroid dysfunction
,While examining a 53 year old female patient, you auscultate abnormal breath
sounds over all fields, and now assess transmission of voice sounds by having the
patient say "ee" while auscultating the chest with the diaphragm of your
stethoscope. Normally, you should auscultate a muffled "e" sound, however, you
hear a nasally "a" sound. Which one of the following will you document is present?
A. Positive stereognosis.
B. Positive for egophony.
C. Negative for bronchophony.
D. Negative for egophony
B. Positive for egophony
While assessing the 19 year old patient for a new onset cough, the nurse
practitioner may inspect, auscultate, palpate, and/or percuss.
How does performing percussion of the thorax assist the provider during the
physical examination?
A. To assist with the confirmation of cardiac origin of angina.
B. To assess for deep-seated lesion and tumors.
C. To assess for any pain or discomfort prior to palpitation of the chest wall.
D. To identify if underlying tissue are air-filled, fluid-filled or consolidated
D. To identify if underlying tissue are air-filled, fluid-filled or consolidated
Your 42 year old male patient has been referred to your clinic for establishing care
and on his intake survey, you note he has documented diagnosis of interstitial lung
, disease. You have decided to perform a diaphragmatic excursion test on the
patient. Which one of the following results would you expect to see in this patient?
A. Approximately equal level of change in the descent of the diaphragm bilaterally
during maximal inspiration and expiration. with a decreased overall inspiratory
capacity.
B. Ascension of 8-12 inches of the diaphragm noted bilaterally on expiration,
though often much less on the right side due to the location of the heart and
great vessels.
C. Much greater descent of the diaphragm on the right side due to the liver
present (two-three times larger).
D. Absent or no change in movement of the diaphragm noted between full
inspiration and full expiration measurement.
A. Approximately equal level of change in the descent of the diaphragm bilaterally
during maximal inspiration and expiration. with a decreased overall inspiratory
capacity
Your 50 year old Caucasian male patient has not seen a primary care giver in 20+
years and is here for a history and physical examination. While examining the
head and face, you see your patient has nonpitting periorbital edema, particularly
underneath their eyes and very dry, thinned hair, including the lateral third of
eyebrows (as pictured below: Sparse hairline, thin lateral eyebrows, Periorbital
edema). Which one of the following would you expect to cause this finding?
A. Severe hypothyroidism
B. Addison's disease
C. Grave's disease
D. Alzhemiers.