ENVISION SCRIBE PHYSICAL EXAM QUESTIONS AND
ANSWERS A+ GRADED WITH EXPERT SOLUTIONS -
140 Questions with Answers
Page 1
,Q1. A patient presents with new-onset headache and visual disturbances. On
fundoscopic exam, you note blurred disc margins and venous pulsations absent.
Which additional finding best distinguishes papilledema from optic neuritis?
A. Afferent pupillary defect
B. Loss of central vision early
C. Retinal hemorrhages
D. Pain with eye movement
Correct Answer: C. Retinal hemorrhages
Rationale: Papilledema, due to increased intracranial pressure, often presents with retinal
hemorrhages and exudates, whereas optic neuritis typically causes an afferent pupillary
defect and pain with eye movement. Loss of central vision early is more characteristic of
optic neuritis, and retinal hemorrhages are not typical of optic neuritis.
Why Wrong:
A - Afferent pupillary defect is more common in optic neuritis, not papilledema.
B - Early central vision loss is typical of optic neuritis, not papilledema.
D - Pain with eye movement is a hallmark of optic neuritis, not papilledema.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 11.
Q2. A patient with suspected aortic stenosis has a soft systolic murmur. Which
physical maneuver would most likely increase the intensity of the murmur?
A. Squatting
B. Handgrip
C. Valsalva maneuver
D. Standing
Correct Answer: B. Handgrip
Rationale: Handgrip increases afterload, which increases the intensity of aortic stenosis
murmurs. Squatting increases preload but also afterload, but the effect on AS is less
pronounced. Valsalva and standing decrease preload, reducing murmur intensity.
Why Wrong:
A - Squatting increases preload but also afterload; the net effect on AS is less
consistent.
C - Valsalva decreases preload, reducing murmur intensity.
D - Standing decreases preload, reducing murmur intensity.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 13.
Q3. During a respiratory exam, a patient has dullness to percussion and absent
breath sounds at the right base. Which finding on tactile fremitus would most support
a pleural effusion over consolidation?
Page 2
, A. Increased tactile fremitus
B. Decreased tactile fremitus
C. Normal tactile fremitus
D. Egophony on auscultation
Correct Answer: B. Decreased tactile fremitus
Rationale: Pleural effusion causes decreased or absent tactile fremitus due to fluid
dampening sound transmission, whereas consolidation increases fremitus. Egophony is
heard over consolidated lung, not effusion.
Why Wrong:
A - Increased tactile fremitus is characteristic of consolidation, not effusion.
C - Normal fremitus is not typical of either condition.
D - Egophony indicates consolidation, not effusion.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 8.
Q4. Which finding during a musculoskeletal exam is most specific for a tear of the
anterior cruciate ligament (ACL)?
A. Positive McMurray test
B. Positive Lachman test
C. Positive anterior drawer test
D. Positive valgus stress test
Correct Answer: B. Positive Lachman test
Rationale: The Lachman test is the most sensitive and specific for ACL tears, especially in
acute settings. The anterior drawer test is less sensitive. McMurray test is for meniscal
tears, and valgus stress test assesses MCL integrity.
Why Wrong:
A - McMurray test is for meniscal tears, not ACL.
C - Anterior drawer is less sensitive than Lachman, especially with swelling.
D - Valgus stress test assesses MCL, not ACL.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 16.
Q5. A patient has a pericardial friction rub. Which condition would most likely cause
the rub to disappear when the patient leans forward?
A. Pericarditis
B. Pleural effusion
C. Pneumothorax
D. Myocardial infarction
Correct Answer: B. Pleural effusion
Page 3
, Rationale: A pericardial friction rub is typically louder with the patient leaning forward,
but if a large pleural effusion is present, it can muffle heart sounds and the rub may
disappear. However, the rub is due to pericardial inflammation, so leaning forward should
make it more audible. The question is flawed, but among the options, pleural effusion is
the most likely to obscure the rub.
Why Wrong:
A - Pericarditis is the cause of the rub, and leaning forward typically intensifies it.
C - Pneumothorax would not specifically affect a pericardial rub.
D - Myocardial infarction may cause a transient rub but not specifically with leaning
forward.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 13.
Q6. Which cranial nerve test would be most sensitive for detecting a subtle lesion at
the cerebellopontine angle?
A. Testing extraocular movements
B. Testing corneal reflex
C. Testing hearing via Weber and Rinne
D. Testing gag reflex
Correct Answer: B. Testing corneal reflex
Rationale: The corneal reflex involves both the trigeminal (afferent) and facial (efferent)
nerves, and is often affected early by tumors at the cerebellopontine angle, such as
acoustic neuromas. Hearing loss is common but may be subtle, and the corneal reflex is a
sensitive indicator of compression.
Why Wrong:
A - Extraocular movements are less commonly affected early.
C - Hearing loss is a symptom but the corneal reflex is more sensitive on exam.
D - Gag reflex is not typically affected by CP angle lesions.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 17.
Q7. In a patient with suspected hyperthyroidism, which physical finding is most
specific for Graves disease?
A. Tachycardia
B. Warm moist skin
C. Pretibial myxedema
D. Lid lag
Correct Answer: C. Pretibial myxedema
Rationale: Pretibial myxedema is a specific dermopathy of Graves disease, occurring in a
small percentage of patients. Tachycardia, warm skin, and lid lag are common in
hyperthyroidism but not specific to Graves disease.
Page 4
ANSWERS A+ GRADED WITH EXPERT SOLUTIONS -
140 Questions with Answers
Page 1
,Q1. A patient presents with new-onset headache and visual disturbances. On
fundoscopic exam, you note blurred disc margins and venous pulsations absent.
Which additional finding best distinguishes papilledema from optic neuritis?
A. Afferent pupillary defect
B. Loss of central vision early
C. Retinal hemorrhages
D. Pain with eye movement
Correct Answer: C. Retinal hemorrhages
Rationale: Papilledema, due to increased intracranial pressure, often presents with retinal
hemorrhages and exudates, whereas optic neuritis typically causes an afferent pupillary
defect and pain with eye movement. Loss of central vision early is more characteristic of
optic neuritis, and retinal hemorrhages are not typical of optic neuritis.
Why Wrong:
A - Afferent pupillary defect is more common in optic neuritis, not papilledema.
B - Early central vision loss is typical of optic neuritis, not papilledema.
D - Pain with eye movement is a hallmark of optic neuritis, not papilledema.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 11.
Q2. A patient with suspected aortic stenosis has a soft systolic murmur. Which
physical maneuver would most likely increase the intensity of the murmur?
A. Squatting
B. Handgrip
C. Valsalva maneuver
D. Standing
Correct Answer: B. Handgrip
Rationale: Handgrip increases afterload, which increases the intensity of aortic stenosis
murmurs. Squatting increases preload but also afterload, but the effect on AS is less
pronounced. Valsalva and standing decrease preload, reducing murmur intensity.
Why Wrong:
A - Squatting increases preload but also afterload; the net effect on AS is less
consistent.
C - Valsalva decreases preload, reducing murmur intensity.
D - Standing decreases preload, reducing murmur intensity.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 13.
Q3. During a respiratory exam, a patient has dullness to percussion and absent
breath sounds at the right base. Which finding on tactile fremitus would most support
a pleural effusion over consolidation?
Page 2
, A. Increased tactile fremitus
B. Decreased tactile fremitus
C. Normal tactile fremitus
D. Egophony on auscultation
Correct Answer: B. Decreased tactile fremitus
Rationale: Pleural effusion causes decreased or absent tactile fremitus due to fluid
dampening sound transmission, whereas consolidation increases fremitus. Egophony is
heard over consolidated lung, not effusion.
Why Wrong:
A - Increased tactile fremitus is characteristic of consolidation, not effusion.
C - Normal fremitus is not typical of either condition.
D - Egophony indicates consolidation, not effusion.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 8.
Q4. Which finding during a musculoskeletal exam is most specific for a tear of the
anterior cruciate ligament (ACL)?
A. Positive McMurray test
B. Positive Lachman test
C. Positive anterior drawer test
D. Positive valgus stress test
Correct Answer: B. Positive Lachman test
Rationale: The Lachman test is the most sensitive and specific for ACL tears, especially in
acute settings. The anterior drawer test is less sensitive. McMurray test is for meniscal
tears, and valgus stress test assesses MCL integrity.
Why Wrong:
A - McMurray test is for meniscal tears, not ACL.
C - Anterior drawer is less sensitive than Lachman, especially with swelling.
D - Valgus stress test assesses MCL, not ACL.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 16.
Q5. A patient has a pericardial friction rub. Which condition would most likely cause
the rub to disappear when the patient leans forward?
A. Pericarditis
B. Pleural effusion
C. Pneumothorax
D. Myocardial infarction
Correct Answer: B. Pleural effusion
Page 3
, Rationale: A pericardial friction rub is typically louder with the patient leaning forward,
but if a large pleural effusion is present, it can muffle heart sounds and the rub may
disappear. However, the rub is due to pericardial inflammation, so leaning forward should
make it more audible. The question is flawed, but among the options, pleural effusion is
the most likely to obscure the rub.
Why Wrong:
A - Pericarditis is the cause of the rub, and leaning forward typically intensifies it.
C - Pneumothorax would not specifically affect a pericardial rub.
D - Myocardial infarction may cause a transient rub but not specifically with leaning
forward.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 13.
Q6. Which cranial nerve test would be most sensitive for detecting a subtle lesion at
the cerebellopontine angle?
A. Testing extraocular movements
B. Testing corneal reflex
C. Testing hearing via Weber and Rinne
D. Testing gag reflex
Correct Answer: B. Testing corneal reflex
Rationale: The corneal reflex involves both the trigeminal (afferent) and facial (efferent)
nerves, and is often affected early by tumors at the cerebellopontine angle, such as
acoustic neuromas. Hearing loss is common but may be subtle, and the corneal reflex is a
sensitive indicator of compression.
Why Wrong:
A - Extraocular movements are less commonly affected early.
C - Hearing loss is a symptom but the corneal reflex is more sensitive on exam.
D - Gag reflex is not typically affected by CP angle lesions.
Reference: Bickley, L. (2020). Bates' Guide to Physical Examination, 13th ed., Ch. 17.
Q7. In a patient with suspected hyperthyroidism, which physical finding is most
specific for Graves disease?
A. Tachycardia
B. Warm moist skin
C. Pretibial myxedema
D. Lid lag
Correct Answer: C. Pretibial myxedema
Rationale: Pretibial myxedema is a specific dermopathy of Graves disease, occurring in a
small percentage of patients. Tachycardia, warm skin, and lid lag are common in
hyperthyroidism but not specific to Graves disease.
Page 4
