ADVANCED CLINICAL ASSESSMENT &
PATHOPHYSIOLOGY COMPREHENSIVE STUDY
QUESTIONS NOTES AND CORRECT ANSWERS 2026
During a post-hospital discharge visit, you no ce your 71 year old female pa ent has been
diagnosed with a "new murmur" found by the hospitalist during their recent hospitaliza on for
CHF exacerba on. In evalua ng the pa ent, during which phase of the cardiac cycle would you
an cipate ausculta on of a S3 or S4 heart sound? - correct answers Diastole
The point of maximum impulse (PMI) is most o en palpable in healthy adults when posi oned
in the supine or le lateral decubitus posi on. Which one of the following loca ons is most
commonly described as the PMI in a healthy adult? - correct answers le 5th ICS, MCL
The nurse prac oner assessing the pa ent with a rapid cardiac rhythm may assess for a pulse
deficit by ausculta ng the pa ent's heart while watching the EKG rhythm. Where would the S1
heart sound correlate with the electrocardiographic waves? - correct answers Peak of the R
wave
Michael, a 72 year old male pa ent 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?
*Prescribe metoprolol (Lopressor) 12.5mg PO BID
*Prescribe aspirin 81mg PO daily
*Refer to cardiology for angiography
• Check for thyroid dysfunc on - correct answers Check for thyroid dysfunc on
,Your newly established pa ent states in the past year, they have progressively developed a
no ceable bump on their neck and when asked about symptoms, they report feeling very
anxious, have developed a tremor, and are commonly feeling palpita ons in their chest.On
examina on, you iden fy an enlarged thyroid gland suspicious for a goiter. Of the following
diagnoses, which is most likely for the pa ent to develop based on these findings above? -
correct answers thyrotoxicosis
Your pa ent has a diagnosis of Addison's disease. Which of the following might you expect to
find during examina on? - correct answers low body temperature
Your pa ent with a diagnosis of autoimmune hepa s is beingseen in your clinic for rou ne
liver serology and follow-up examina on. Which of the following correctly iden fies the normal
liver span when percussing the liver of a HEALTHY adult? - correct answers 6-12 cm in the right
midclavicular line.
The 19 year old male pa ent presents with acute symptomsof abdominal pain and a history of
intermi ent heartburn and spicy foodintolerance, as well as anxiety due to his college athle c
performance. You have a concern the pa ent may have a perforated gastric ulcer and is
experiencing peritoni s. Which of the following exam findings is NOT suppor ve of this
diagnosis? - correct answers Absence of pain with withdrawal of palpa on.
Your new pa ent intake history of an elderly man includes a history of Ehlers-Danlos with
complica ons of re nal detachment treated with gas pneumopexy. In discussing this history,
you recall the transparent mass of gela nous material where the gas pneumopexy is performed
can be found in which chamber(s) of the eye? - correct answers Anterior only
While assessing the pa ent, you covered their right eye while you covered your le eye, then
brought a set number of fingers or wiggling fingers into each quadrant of the pa ent's visual
field while you had them iden fy when they saw your fingers/movement. A normal exam would
be documented as which of the following? - correct answers Normal Confronta on
, A pa ent of Mediterranean descent who presents with microcy c anemia with normal red cell
distribu on width should be evaluated using gel electrophoresis to confirm which of the
following types of anemia? - correct answers Thalassemia
The 43 year old male pa ent with macrocy c anemia should be evaluated for which of the
following lab levels to help narrow down the e ology? - correct answers Vitamin B12
While examining a 53 year old female pa ent, you auscultate abnormal breath sounds over all
fields, and now assess transmission of voice sounds by having the pa ent say "ee" while
ausculta ng the chest with the diaphragm of your stethoscope. Normally, you should auscultate
a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the following
will you document is present?*Posi ve stereognosis.*Posi ve for egophony.*Nega ve for
bronchophony.*Nega ve for egophony - correct answers Posi ve for egophony
While assessing the 19 year old pa ent for a new onset cough, the nurse prac oner may
inspect, auscultate, palpate, and/or percuss.How does performing percussion of the thorax
assist the provider during the physical examina on?*To assist with the confirma on of cardiac
origin of angina.*To assess for deep-seated lesion and tumors.*To assess for any pain or
discomfort prior to palpita on of the chest wall.*To iden fy if underlying ssue are air-filled,
fluid-filled or consolidated - correct answers To iden fy if underlying ssue are air-filled, fluid-
filled or consolidated
Your 42 year old male pa ent has been referred to your clinic for establishing care and on his
intake survey, you note he has documented diagnosis of inters al lung disease. You have
decided to perform a diaphragma c excursion test on the pa ent. Which one of the following
results would you expect to see in this pa ent? - correct answers Approximately equal level of
change in the descent of the diaphragm bilaterally during maximal inspira on and expira on.
with a decreased overall inspiratory capacity
Your 50 year old Caucasian male pa ent has not seen a primary care giver in 20+ years and is
here for a history and physical examina on. While examining the head and face, you see your
pa ent has nonpi ng periorbital edema, par cularly underneath their eyes and very dry,
thinned hair, including the lateral third of eyebrows (as pictured below: Sparse hairline, thin
PATHOPHYSIOLOGY COMPREHENSIVE STUDY
QUESTIONS NOTES AND CORRECT ANSWERS 2026
During a post-hospital discharge visit, you no ce your 71 year old female pa ent has been
diagnosed with a "new murmur" found by the hospitalist during their recent hospitaliza on for
CHF exacerba on. In evalua ng the pa ent, during which phase of the cardiac cycle would you
an cipate ausculta on of a S3 or S4 heart sound? - correct answers Diastole
The point of maximum impulse (PMI) is most o en palpable in healthy adults when posi oned
in the supine or le lateral decubitus posi on. Which one of the following loca ons is most
commonly described as the PMI in a healthy adult? - correct answers le 5th ICS, MCL
The nurse prac oner assessing the pa ent with a rapid cardiac rhythm may assess for a pulse
deficit by ausculta ng the pa ent's heart while watching the EKG rhythm. Where would the S1
heart sound correlate with the electrocardiographic waves? - correct answers Peak of the R
wave
Michael, a 72 year old male pa ent 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?
*Prescribe metoprolol (Lopressor) 12.5mg PO BID
*Prescribe aspirin 81mg PO daily
*Refer to cardiology for angiography
• Check for thyroid dysfunc on - correct answers Check for thyroid dysfunc on
,Your newly established pa ent states in the past year, they have progressively developed a
no ceable bump on their neck and when asked about symptoms, they report feeling very
anxious, have developed a tremor, and are commonly feeling palpita ons in their chest.On
examina on, you iden fy an enlarged thyroid gland suspicious for a goiter. Of the following
diagnoses, which is most likely for the pa ent to develop based on these findings above? -
correct answers thyrotoxicosis
Your pa ent has a diagnosis of Addison's disease. Which of the following might you expect to
find during examina on? - correct answers low body temperature
Your pa ent with a diagnosis of autoimmune hepa s is beingseen in your clinic for rou ne
liver serology and follow-up examina on. Which of the following correctly iden fies the normal
liver span when percussing the liver of a HEALTHY adult? - correct answers 6-12 cm in the right
midclavicular line.
The 19 year old male pa ent presents with acute symptomsof abdominal pain and a history of
intermi ent heartburn and spicy foodintolerance, as well as anxiety due to his college athle c
performance. You have a concern the pa ent may have a perforated gastric ulcer and is
experiencing peritoni s. Which of the following exam findings is NOT suppor ve of this
diagnosis? - correct answers Absence of pain with withdrawal of palpa on.
Your new pa ent intake history of an elderly man includes a history of Ehlers-Danlos with
complica ons of re nal detachment treated with gas pneumopexy. In discussing this history,
you recall the transparent mass of gela nous material where the gas pneumopexy is performed
can be found in which chamber(s) of the eye? - correct answers Anterior only
While assessing the pa ent, you covered their right eye while you covered your le eye, then
brought a set number of fingers or wiggling fingers into each quadrant of the pa ent's visual
field while you had them iden fy when they saw your fingers/movement. A normal exam would
be documented as which of the following? - correct answers Normal Confronta on
, A pa ent of Mediterranean descent who presents with microcy c anemia with normal red cell
distribu on width should be evaluated using gel electrophoresis to confirm which of the
following types of anemia? - correct answers Thalassemia
The 43 year old male pa ent with macrocy c anemia should be evaluated for which of the
following lab levels to help narrow down the e ology? - correct answers Vitamin B12
While examining a 53 year old female pa ent, you auscultate abnormal breath sounds over all
fields, and now assess transmission of voice sounds by having the pa ent say "ee" while
ausculta ng the chest with the diaphragm of your stethoscope. Normally, you should auscultate
a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the following
will you document is present?*Posi ve stereognosis.*Posi ve for egophony.*Nega ve for
bronchophony.*Nega ve for egophony - correct answers Posi ve for egophony
While assessing the 19 year old pa ent for a new onset cough, the nurse prac oner may
inspect, auscultate, palpate, and/or percuss.How does performing percussion of the thorax
assist the provider during the physical examina on?*To assist with the confirma on of cardiac
origin of angina.*To assess for deep-seated lesion and tumors.*To assess for any pain or
discomfort prior to palpita on of the chest wall.*To iden fy if underlying ssue are air-filled,
fluid-filled or consolidated - correct answers To iden fy if underlying ssue are air-filled, fluid-
filled or consolidated
Your 42 year old male pa ent has been referred to your clinic for establishing care and on his
intake survey, you note he has documented diagnosis of inters al lung disease. You have
decided to perform a diaphragma c excursion test on the pa ent. Which one of the following
results would you expect to see in this pa ent? - correct answers Approximately equal level of
change in the descent of the diaphragm bilaterally during maximal inspira on and expira on.
with a decreased overall inspiratory capacity
Your 50 year old Caucasian male pa ent has not seen a primary care giver in 20+ years and is
here for a history and physical examina on. While examining the head and face, you see your
pa ent has nonpi ng periorbital edema, par cularly underneath their eyes and very dry,
thinned hair, including the lateral third of eyebrows (as pictured below: Sparse hairline, thin
