ADVANCED HEALTH ASSESSMENT
AND CLINICAL DIAGNOSIS IN
PRIMARY CARE 9TH EDITION (DAINS)
EXAM QUESTIONS AND ANSWERS
1. A 45-year-old patient presents with acute abdominal pain in the right upper quadrant that
radiates to the right scapula. On examination, the patient halts inspiration during deep
palpation of the RUQ. What is the most likely diagnosis?
A. Acute Appendicitis
B. Acute Cholecystitis
C. Acute Pancreatitis
D. Peptic Ulcer Disease
Answer: B
Conceptual Explanation: The clinical presentation describes a positive Murphy’s sign and
radiation to the scapula (Boas’ sign), which are hallmark indicators of acute cholecystitis.
,2. When performing a neurological assessment, you observe a patient with a ‘pill-rolling’
tremor at rest that disappears with purposeful movement. This finding is highly suggestive of:
A. Multiple Sclerosis
B. Essential Tremor
C. Parkinson Disease
D. Hyperthyroidism
Answer: C
Conceptual Explanation: A resting tremor, often described as pill-rolling, is a classic
motor symptom of Parkinson’s disease, unlike essential tremors which occur during
activity.
3. Which of the following clinical findings is most specific for identifying a bacterial etiology in
a patient presenting with acute pharyngitis?
A. Cough and Rhinorrhea
B. Posterior cervical lymphadenopathy
C. Diffuse maculopapular rash
D. Anterior cervical lymphadenopathy and lack of cough
Answer: D
, Conceptual Explanation: According to the Centor Criteria, the presence of tonsillar
exudates, tender anterior cervical lymphadenopathy, fever, and the absence of a cough
increase the probability of Group A Beta-hemolytic Streptococcus.
4. A 68-year-old male presents with sudden onset of ‘the worst headache of my life.’ He has
no history of migraines. What is the priority diagnostic consideration?
A. Tension-type headache
B. Cluster headache
C. Subarachnoid hemorrhage
D. Temporal arteritis
Answer: C
Conceptual Explanation: A ‘thunderclap’ headache or the ‘worst headache of one’s life’ is
a red-flag symptom for a subarachnoid hemorrhage and requires emergent evaluation.
5. In differentiating between a common cold and allergic rhinitis, which physical finding is
most indicative of allergy?
A. Erythematous nasal mucosa
B. Purulent nasal discharge
C. Pale, boggy turbinates
D. High-grade fever
Answer: C
AND CLINICAL DIAGNOSIS IN
PRIMARY CARE 9TH EDITION (DAINS)
EXAM QUESTIONS AND ANSWERS
1. A 45-year-old patient presents with acute abdominal pain in the right upper quadrant that
radiates to the right scapula. On examination, the patient halts inspiration during deep
palpation of the RUQ. What is the most likely diagnosis?
A. Acute Appendicitis
B. Acute Cholecystitis
C. Acute Pancreatitis
D. Peptic Ulcer Disease
Answer: B
Conceptual Explanation: The clinical presentation describes a positive Murphy’s sign and
radiation to the scapula (Boas’ sign), which are hallmark indicators of acute cholecystitis.
,2. When performing a neurological assessment, you observe a patient with a ‘pill-rolling’
tremor at rest that disappears with purposeful movement. This finding is highly suggestive of:
A. Multiple Sclerosis
B. Essential Tremor
C. Parkinson Disease
D. Hyperthyroidism
Answer: C
Conceptual Explanation: A resting tremor, often described as pill-rolling, is a classic
motor symptom of Parkinson’s disease, unlike essential tremors which occur during
activity.
3. Which of the following clinical findings is most specific for identifying a bacterial etiology in
a patient presenting with acute pharyngitis?
A. Cough and Rhinorrhea
B. Posterior cervical lymphadenopathy
C. Diffuse maculopapular rash
D. Anterior cervical lymphadenopathy and lack of cough
Answer: D
, Conceptual Explanation: According to the Centor Criteria, the presence of tonsillar
exudates, tender anterior cervical lymphadenopathy, fever, and the absence of a cough
increase the probability of Group A Beta-hemolytic Streptococcus.
4. A 68-year-old male presents with sudden onset of ‘the worst headache of my life.’ He has
no history of migraines. What is the priority diagnostic consideration?
A. Tension-type headache
B. Cluster headache
C. Subarachnoid hemorrhage
D. Temporal arteritis
Answer: C
Conceptual Explanation: A ‘thunderclap’ headache or the ‘worst headache of one’s life’ is
a red-flag symptom for a subarachnoid hemorrhage and requires emergent evaluation.
5. In differentiating between a common cold and allergic rhinitis, which physical finding is
most indicative of allergy?
A. Erythematous nasal mucosa
B. Purulent nasal discharge
C. Pale, boggy turbinates
D. High-grade fever
Answer: C
