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Advanced Health Assessment Newest Exam
Preparation With Complete Questions And Correct
Answers With Rationales Already Graded A+Brand
New Version!!
Question 1
A 68-year-old male presents with a two-month history of progressive
dysphagia, initially to solids and now to liquids. He reports associated
unintentional weight loss of 15 pounds. Which of the following findings
on physical examination would most strongly suggest an oropharyngeal
rather than an esophageal etiology for his dysphagia?
A) Regurgitation of undigested food immediately after swallowing
B) Sensation of food "sticking" in the substernal region
C) Nasal regurgitation of liquids
D) Heartburn and acid reflux symptoms
Answer: C
Explanation: Oropharyngeal dysphagia involves the transfer of the bolus
from the mouth to the upper esophagus. It is characterized by difficulty
initiating a swallow, coughing or choking during meals, and nasal
regurgitation due to poor velopharyngeal closure. Esophageal
dysphagia, by contrast, is perceived as a substernal sensation of
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obstruction and may be associated with regurgitation of food from the
esophagus, but not nasal regurgitation. Weight loss and progression
from solids to liquids are concerning for a malignant process such as
esophageal adenocarcinoma, but the localizing sign of nasal
regurgitation points to the oropharynx.
Question 2
During a cardiovascular examination, you note a systolic ejection
murmur at the right upper sternal border that radiates to the carotids.
The murmur increases in intensity with squatting and decreases with
Valsalva maneuver. These findings are most consistent with which of
the following?
A) Mitral valve prolapse
B) Hypertrophic obstructive cardiomyopathy
C) Aortic stenosis
D) Pulmonic stenosis
Answer: C
Explanation: Aortic stenosis characteristically produces a crescendo-
decrescendo systolic ejection murmur heard best at the right upper
sternal border with radiation to the carotid arteries. The murmur of
aortic stenosis typically increases with interventions that augment
stroke volume, such as squatting, and decreases with maneuvers that
reduce venous return and left ventricular filling, such as the Valsalva
maneuver or standing. Mitral valve prolapse produces a mid-systolic
click and late systolic murmur that shifts earlier with standing.
Hypertrophic cardiomyopathy also has a systolic murmur that increases
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with Valsalve, but it is best heard at the left lower sternal border and
does not typically radiate to the carotids.
Question 3
A 45-year-old female with a history of hypertension presents for a
routine physical examination. Her blood pressure is 142/90 mmHg in
the right arm and 138/88 in the left arm. Her examination reveals a
continuous bruit over the right supraclavicular fossa. Which of the
following is the most likely diagnosis?
A) Atherosclerotic carotid artery disease
B) Subclavian steal syndrome
C) Fibromuscular dysplasia of the renal arteries
D) Arteriovenous malformation
Answer: B
Explanation: Subclavian steal syndrome is characterized by stenosis or
occlusion of the subclavian artery proximal to the origin of the vertebral
artery. This leads to retrograde flow in the vertebral artery to perfuse
the distal subclavian, which can cause a systolic blood pressure
differential between the arms (typically >20 mmHg) and a continuous
bruit over the supraclavicular fossa. The bruit is continuous because
flow occurs throughout the cardiac cycle due to the pressure gradient.
Carotid artery disease typically produces a bruit over the mid-cervical
region and is not associated with arm blood pressure differentials.
Question 4
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A 22-year-old college student presents with acute onset of severe
pleuritic chest pain and dyspnea. On examination, you note tachypnea
and diminished breath sounds on the left side. Percussion of the left
chest reveals hyperresonance. Which of the following physical
examination maneuvers would be most useful in confirming your
suspected diagnosis?
A) Auscultation for a pericardial friction rub
B) Palpation for tactile fremitus
C) Assessment for egophony
D) Measurement of jugular venous pressure
Answer: B
Explanation: The clinical scenario is consistent with a spontaneous
pneumothorax. In pneumothorax, tactile fremitus is decreased or
absent on the affected side because air in the pleural space does not
transmit sound vibrations as effectively as lung tissue. The
hyperresonance on percussion is also consistent with air trapping.
Egophony, whispered pectoriloquy, and bronchophony are findings of
consolidation where sound transmission is increased. Jugular venous
pressure measurement is more relevant for conditions causing elevated
right-sided pressures. While a pericardial friction rub may occur in
pericarditis, the hyperresonance and diminished breath sounds are
more specific for pneumothorax.
Question 5
Which of the following is the correct technique for assessing for a
pleural friction rub?
Advanced Health Assessment Newest Exam
Preparation With Complete Questions And Correct
Answers With Rationales Already Graded A+Brand
New Version!!
Question 1
A 68-year-old male presents with a two-month history of progressive
dysphagia, initially to solids and now to liquids. He reports associated
unintentional weight loss of 15 pounds. Which of the following findings
on physical examination would most strongly suggest an oropharyngeal
rather than an esophageal etiology for his dysphagia?
A) Regurgitation of undigested food immediately after swallowing
B) Sensation of food "sticking" in the substernal region
C) Nasal regurgitation of liquids
D) Heartburn and acid reflux symptoms
Answer: C
Explanation: Oropharyngeal dysphagia involves the transfer of the bolus
from the mouth to the upper esophagus. It is characterized by difficulty
initiating a swallow, coughing or choking during meals, and nasal
regurgitation due to poor velopharyngeal closure. Esophageal
dysphagia, by contrast, is perceived as a substernal sensation of
,2|Page
obstruction and may be associated with regurgitation of food from the
esophagus, but not nasal regurgitation. Weight loss and progression
from solids to liquids are concerning for a malignant process such as
esophageal adenocarcinoma, but the localizing sign of nasal
regurgitation points to the oropharynx.
Question 2
During a cardiovascular examination, you note a systolic ejection
murmur at the right upper sternal border that radiates to the carotids.
The murmur increases in intensity with squatting and decreases with
Valsalva maneuver. These findings are most consistent with which of
the following?
A) Mitral valve prolapse
B) Hypertrophic obstructive cardiomyopathy
C) Aortic stenosis
D) Pulmonic stenosis
Answer: C
Explanation: Aortic stenosis characteristically produces a crescendo-
decrescendo systolic ejection murmur heard best at the right upper
sternal border with radiation to the carotid arteries. The murmur of
aortic stenosis typically increases with interventions that augment
stroke volume, such as squatting, and decreases with maneuvers that
reduce venous return and left ventricular filling, such as the Valsalva
maneuver or standing. Mitral valve prolapse produces a mid-systolic
click and late systolic murmur that shifts earlier with standing.
Hypertrophic cardiomyopathy also has a systolic murmur that increases
,3|Page
with Valsalve, but it is best heard at the left lower sternal border and
does not typically radiate to the carotids.
Question 3
A 45-year-old female with a history of hypertension presents for a
routine physical examination. Her blood pressure is 142/90 mmHg in
the right arm and 138/88 in the left arm. Her examination reveals a
continuous bruit over the right supraclavicular fossa. Which of the
following is the most likely diagnosis?
A) Atherosclerotic carotid artery disease
B) Subclavian steal syndrome
C) Fibromuscular dysplasia of the renal arteries
D) Arteriovenous malformation
Answer: B
Explanation: Subclavian steal syndrome is characterized by stenosis or
occlusion of the subclavian artery proximal to the origin of the vertebral
artery. This leads to retrograde flow in the vertebral artery to perfuse
the distal subclavian, which can cause a systolic blood pressure
differential between the arms (typically >20 mmHg) and a continuous
bruit over the supraclavicular fossa. The bruit is continuous because
flow occurs throughout the cardiac cycle due to the pressure gradient.
Carotid artery disease typically produces a bruit over the mid-cervical
region and is not associated with arm blood pressure differentials.
Question 4
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A 22-year-old college student presents with acute onset of severe
pleuritic chest pain and dyspnea. On examination, you note tachypnea
and diminished breath sounds on the left side. Percussion of the left
chest reveals hyperresonance. Which of the following physical
examination maneuvers would be most useful in confirming your
suspected diagnosis?
A) Auscultation for a pericardial friction rub
B) Palpation for tactile fremitus
C) Assessment for egophony
D) Measurement of jugular venous pressure
Answer: B
Explanation: The clinical scenario is consistent with a spontaneous
pneumothorax. In pneumothorax, tactile fremitus is decreased or
absent on the affected side because air in the pleural space does not
transmit sound vibrations as effectively as lung tissue. The
hyperresonance on percussion is also consistent with air trapping.
Egophony, whispered pectoriloquy, and bronchophony are findings of
consolidation where sound transmission is increased. Jugular venous
pressure measurement is more relevant for conditions causing elevated
right-sided pressures. While a pericardial friction rub may occur in
pericarditis, the hyperresonance and diminished breath sounds are
more specific for pneumothorax.
Question 5
Which of the following is the correct technique for assessing for a
pleural friction rub?
