ADVANCED HEALTH ASSESSMENT FINAL

Select the correct sequence of techniques used during an examination of a child's abdomen: a. Percussion, inspection, palpation, auscultation b. Inspection, palpation, percussion, auscultation c. Inspection, auscultation, percussion, palpation d. Auscultation, inspection, palpation, percussion - correct answer c. Inspection, auscultation, percussion, palpation When percussing a child's abdomen, you note tympany. This is indicative of the presence of: a. Fluid b. Air c. Feces d. Hepatomegaly - correct answer b. Air When inspecting the child's abdomen, the examiner notes a midline muscular separation with bulging at the child cries. This finding is a(n): a. Umbilical hernia b. Inguinal hernia c. Omphalocele d. Diastasis recti - correct answer d. Diastasis recti A 10-month-old infant is brought to the clinic with complaints of cough and rhinorrhea. When auscultating the child's lungs, you note a large, bulging umbilical mass. The mass is easily reducible but increases when the child cries. This assessment finding is a(n): a. Inguinal hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele - correct answer b. Umbilical hernia The iliopsoas (psoas sign) test is used to identify: a. Splenic enlargement b. Costovertebral tenderness c. Intra-abdominal inflammation d. Decreased peristalsis or intestinal activity - correct answer c. Intra-abdominal inflammation When auscultating bowel sounds in an infant or a young child, it is essential to use a pediatric stethoscope because: a. A stethoscope diaphragm that is too large may also encompass lung sounds, confusing the clinical picture b. A stethoscope diaphragm that is too large may also encompass vascular sounds, confusing the clinical picture c. A stethoscope diaphragm that is too large may cause pain in a small infant if pressure is applied during auscultation d. A stethoscope diaphragm that is too large may decrease the child's cooperation - correct answer a. A stethoscope diaphragm that is too large may also encompass lung sounds, confusing the clinical picture Decreased hepatic enzyme function in children from birth until age 3 to 4 years causes: a. Short drug half-lives b. Long drug half-lives c. Physiologic jaundice d. Hypoglycemia - correct answer b. Long drug half-lives The stomach capacity in a neonate is approximately: a. 30 mL b. 60 mL c. 90 mL d. 120 mL - correct answer b. 60 mL A dull percussion note at or beyond the anterior axillary line on the left indicates: a. Hepatomegaly b. Splenomegaly c. A normal finding d. A fibrotic spleen - correct answer b. Splenomegaly Assessment for renal tenderness should be performed with the child: a. Lying supine b. Lying prone c. In a side-lying position d. Sitting upright - correct answer d. Sitting upright Indirect percussion can be used to detect: a. Costovertebral tenderness b. Abdominal masses c. Rebound tenderness d. Hepatomegaly - correct answer a. Costovertebral tenderness The lower left quadrant (LLQ) contains the: a. Left ureter b. Pancreas (body) c. Stomach d. Liver (left lobe) - correct answer a. Left ureter The percussion note that is normally heard over a child's stomach is: a. Dull b. Tympany c. Resonance d. Hyperactive - correct answer b. Tympany A firm, olive-like mass palpable in the RUQ of a 3-week-old infant is likely a(n): a. Fecal mass b. Pyloric stenosis c. Umbilical hernia d. Inguinal hernia - correct answer b. Pyloric Stenosis Infants and toddlers have a protuberant abdomen due to: a. Increased pancreatic enzyme activity b. Weak abdominal musculature c. More abdominal subcutaneous tissue d. Decreased hepatic enzyme function - correct answer b. Weak abdominal musculature A young child's kidney is more susceptible to trauma because: a. Until age 5 years, kidneys rupture more easily b. More of the kidney is exposed because of the thin abdominal wall c. There is a proportionately larger abdomen in young children d. The urinary bladder capacity varies - correct answer b. More of the kidney is exposed because of the thin abdominal wall Which of the following is an appropriate response by the provider to a 30-month-old child who is resistant to the abdominal exam? a. Inspect only; auscultate and palpate only if necessary b. Ask the child to describe the symptoms in more detail c. Ask the child if he or she would like to listen to the stomach through the stethoscope and press on the stomach with his or her own hands d. Defer the exam - correct answer c. Ask the child if he or she would like to listen to the stomach through the stethoscope and press on the stomach with his or her own hands Which of the following findings in the child's prenatal history is relevant when conducting the abdominal assessment? a. Maternal oligohydramnios b. Amount of maternal weight gain c. Perinatal asphyxia d. Timing of the first meconium stool - correct answer a. Maternal oligohydramnios The RLQ contains the: a. Liver (right lobe) b. Pancreas c. Ascending colon d. Cecum - correct answer d. Cecum The provider palpates the child's abdomen slowly and deeply away from an area of tenderness, then quickly removes the palpating hand. The child experiences pain when the palpating hand is removed quickly. This describes: a. Light palpation b. Rebound tenderness c. Deep palpation d. Costovertebral tenderness - correct answer b. Rebound tenderness Deep palpation is used to assess: a. Areas of abdominal tenderness b. Underlying abdominal structures c. Areas of abdominal rigidity d. Abdominal tympany - correct answer b. Underlying abdominal structures Deep tenderness at McBurney's point is a sign of: a. Acute appendicitis b. Peritonitis c. Peptic ulcer disease d. Pelvic inflammatory disease - correct answer a. Acute appendicitis A 10-year-old child presents to the clinic with acute RLQ abdominal pain and fever. The examiner positions the child supine, then flexes each leg at the hip and rotates the hip internally and externally. The child complains of pain when this maneuver is conducted on the right leg. This is an elicitation of: a. The iliopsoas sign b. The obturator sign c. Murphy's sign d. Rebound tenderness - correct answer b. The obturator sign Which of the following terms defines movement away from the midline? a. Abduction b. Adduction c. Flexion d. Extension - correct answer a. Abduction Physical findings associated with talipes equinovarus are: a. Medial deviation of the forefoot that is flexible and can be abducted beyond the midline b. Laxity of ligaments supporting the foot's longitudinal arch, causing the feet to be positioned in abduction c. Internal rotation of the foot with forefoot adduction involving muscles, tendons and bone d. Marked inward deviation of the hand and an extremely short forearm - correct answer c. Internal rotation of the foot with forefoot adduction involving muscles, tendons and bone Assessment findings in an infant with developmental dysplasia of the hip can include: a. Negative Ortolani sign b. Positive Galeazzi sign c. Positive Trendelenburg sign d. Negative Barlow sign - correct answer b. Positive Galeazzi sign Sustained clonus that extends beyond six to eight beats or clonus that continues past the neonatal period may indicate: a. Cerebral palsy b. Increased intracranial pressure c. Talipes equinovarus d. Dystonia - correct answer a. Cerebral palsy Which of the following assessment findings is within normal limits for the child's age? a. A toddler with lordosis b. A 3-year-old with genu varum c. A 12-year-old with genu valgum A 2-day-old with syndactyly - correct answer a. A toddler with lordosis An antalgic gait indicates: a. Pain b. Infection c. Clubfoot d. Developmental dysplasia of the hip - correct answer a. Pain A visible lateral curvature of the spine when the child is standing indicates: a. Lordosis b. Spina bifida c. Kyphosis d. Scoliosis - correct answer d. Scoliosis Assessment of the hips to detect developmental dysplasia of the hip is done at every well-child exam until age: a. 6 months b. 1 year c. 18 months d. 2 years - correct answer b. 1 year Tibial torsion can be caused by: a. Birth injury b. Trauma c. Viral illness d. Sickle cell disease - correct answer b. Trauma A 15-month-old boy is in the clinic for a well-child visit. You note increased muscle tone. This is a red flag for: a. Adam syndrome b. Cerebral palsy c. Down syndrome d. Muscular dystrophy - correct answer b. Cerebral palsy Until approximately what age is slight genu valgum (knock-knee) within normal limits? a. 7-8 years b. 8-9 years c. 9-10 years d. 10-11 years - correct answer a. 7-8 years A child who exhibits a positive Gower sign likely has a: a. Fracture b. Myopathy c. Hip infection d. Seizure disorder - correct answer b. Myopathy Uneven knee height with knees flexed in a supine infant indicates: a. Genu varum b. Tibial torsion c. Developmental dysplasia of the hip d. Metatarsus adductus - correct answer c. Developmental dysplasia of the hip A rapid and rhythmic, jerking movement of the foot caused by the sudden stretching of a tendon is termed: a. Tremor b. Clonus c. Nystagmus d. Myoclonus - correct answer b. Clonus Muscle strength in the lower extremities can be assessed in a 6-month-old infant by: a. Pulling the infant from the sitting to the standing position b. Placing the infant prone and observing whether the infant can crawl c. Performing the Ortolani maneuver d. Observing the infant try to pull to stand - correct answer a. Pulling the infant from the sitting to the standing position The most common presenting symptom of neuromuscular disease in children is: a. Fatigue b. Muscle weakness c. Myoclonus d. Tremors - correct answer b. Muscle weakness Genu varum (bow legs) is normal until age: a. 3-4 years b. 4-5 years c. 5-6 years d. 6-7 years - correct answer a. 3-4 years The varus deformity of both tibias caused by chronic obesity is: a. Osgood-Schlatter disease b. McMurray disease c. Blount's disease d. Werdnig-Hoffmann disease - correct answer c. Blount's disease A marked limp or refusal to walk accompanied by fever, point tenderness, or limited range of motion in the hip suggests: a. Juvenile rheumatoid arthritis b. Osteomyelitis c. Cerebral palsy d. Sacroiliac inflammation - correct answer b. Osteomyelitis The forward bending test is an essential screening tool for: a. Lordosis in preschool children b. Kyphosis in school-aged children c. Torticollis in all age groups d. Scoliosis in school-aged children and adolescents - correct answer d. Scoliosis in school-aged children and adolescents A normal healthy full-term infant should be able to walk independently by age: a. 9-12 months b. 12-15 months c. 15-18 months d. 18-21 months - correct answer b. 12-15 months A 7-year-old child is asked to stand straight and then raise the right leg off the ground. When bearing weight on the left hip, the pelvis will drop on the right side. This finding is the: a. Trendelenburg sign b. Barlow sign c. Ortolani sign d. Galeazzi sign - correct answer a. Trendelenburg sign Which of the following statements regarding pes planus (flat feet) is true? a. A normal variation, beginning at 2 to 3 years and resolving by approximately 7 to 8 years b. A normal variation in infants as they first begin to walk, then slowly resolving as the child grows c. A normal variation in infants until approximately age 3 to 4 months d. A normal variation, beginning at 2 to 3 years, resolving by adolescence - correct answer b. A normal variation in infants as they first begin to walk, then slowly resolving as the child grows The most sensitive indicator of a child's neurologic status is: a. Mood and affect b. Gait and balance c. Cranial nerve assessment d. Level of consciousness - correct answer d. Level of consciousness Which of the following assessments indicates potential cerebellar dysfunction? a. Ataxia b. Graphesthesia c. Hearing deficits d. Stereognosis - correct answer a. Ataxia To assess vestibular function of the acoustic nerve in a child, the examiner would: a. Perform the whisper test b. Perform the Romberg test c. Perform the Weber test d. Perform the Rinne test - correct answer b. Perform the Romberg test To examine for the function of the hypoglossal nerve in a child, the examiner would: a. Ask the child to identify tastes b. Ask the child to stick out his or her tongue c. Test the child's ability to swallow d. Ask the child to nod his or her head from side to side - correct answer b. Ask the child to stick out his or her tongue Which of the following is the most appropriate method of evaluating cerebellar function in a preschool-age child? a. Perform the Romberg test b. Conduct a cranial nerve examination c. Observe heel-to-toe walking d. Ask the child to perform the finger-to-nose test - correct answer a. Perform the Romberg test Injury to Wernicke's area of the cerebral cortex results in: a. Executive function deficits b. Expressive aphasia c. Receptive aphasia d. Memory loss - correct answer c. Receptive aphasia The presence of Brudzinski's sign indicates: a. Increased intracranial pressure b. Meningeal irritation c. Cerebellar dysfunction d. Spinal cord injury - correct answer B. Meningeal irritation A 3-year-old child suffered a severe traumatic brain injury. The examiner would expect this child's Babinski reflex to be: a. Negative b. Positive c. Fluctuating, depending on intracranial pressure d. Unable to be assessed - correct answer b. Positive A 5-year-old boy is new to the clinical practice and presents for a kindergarten physical. During the examination, his gait is assessed. No limp or ataxia is noted, but he is toe walking. The provider asks his parents if this is how he normally walks and they say yes. Which of the following parts of the child's past medical history are important to assess? a. Previous history of hyperactive deep tendon reflexes b. Previous history of lower extremity injury c. History of perinatal or neonatal hypoxia or asphyxia d. History of high fever in infancy - correct answer c. History of perinatal or neonatal hypoxia or asphyxia Which of the following developmental assessment findings requires an in-depth neurologic assessment? a. Delayed expressive language milestone achievement b. Poor school performance c. Loss of developmental skills d. Poor social skills with peers - correct answer c. Loss of developmental skills Which of the following assessment findings indicates increased intracranial pressure? a. Papilledema on fundoscopic examination b. Nuchal rigidity c. Numbness and tingling d. Hyperactive deep tendon reflexes - correct answer a. Papilledema on fundoscopic examination A normal response to the elicitation of the Achilles tendon reflex is: a. Flexion of the toes b. Plantar flexion c. Extension of the great toe with fanning of the remaining toes d. Extension of the toes - correct answer b. Plantar flexion To test the sensory function of the trigeminal nerve in an infant, the examiner would: a. Elicit the startle reflex b. Elicit the gag reflex c. Assess direct and consensual pupillary response to light d. Elicit the corneal (blink) reflex - correct answer d. Elicit the corneal (blink) reflex To elicit the plantar reflex: a. Ask the child to slide the heel of the foot along the opposite shin b. Place a vibrating tuning fork on the child's ankle and ask the child when the vibration stops c. Strike the lateral aspect of the sole of the foot with the end of the reflex hammer d. Ask the child to perform a heel-to-toe walk - correct answer c. Strike the lateral aspect of the sole of the foot with the end of the reflex hammer A child has been hit by a car while riding her bicycle. The Glasgow Coma Scale assessment reveals a total score of 10. This is considered indicative of a: a. Mild head injury b. Moderate head injury c. Severe head injury d. Normal finding - correct answer b. Moderate head injury Which of the following postural reflexes should disappear between age 12 and 24 months? a. Positive support b. Landau c. Parachute d. Protective extension sitting position - correct answer b. Landau The Glasgow Coma Scale includes all of the following assessment areas except: a. Eye opening b. Thought processes c. Motor response d. Verbal response - correct answer b. Thought processes Because of the need for the child's cooperation during assessment, the sensory examination is not typically conducted until age: a. 2 years b. 3 years c. 4 years d. 5 years - correct answer b. 3 years Neurologic soft signs, when found on neurologic examination, indicate: a. A likely history of severe asphyxia and a poor neurologic outcome b. A sign of a moderate cerebral ischemic injury and likely motor and cognitive delays c. A minor abnormality and often are resolved by late school age to adolescence d. A lingering effect of traumatic brain injury - correct answer c. A minor abnormality and often are resolved by late school age to adolescence Which of the following neurologic assessments test proprioception? a. Assessment of the child's ability to identify direction of movement b. Assessment of pain c. Assessment of the child's ability to identify hot and cold temperature d. Assessment of ability to hop in place - correct answer a. Assessment of the child's ability to identify direction of movement Which of the following assessments is a function of the parasympathetic nervous system? a. Pupillary constriction b. Pupillary dilation c. Bronchial muscle relaxation d. Urinary bladder relaxation - correct answer a. Pupillary constriction Which of the following assessments is a function of the sympathetic nervous system? a. Increased salivation b. Bronchial muscle constriction c. Stomach peristalsis d. Adrenaline secretion - correct answer d. Adrenaline secretion A mental health assessment is being conducted on 16-year-old Melissa. Which of the following statements should not be kept confidential? a. "I have been sexually active with three boys." b. "I sometimes smoke pot." c. "I sometimes drink wine from my parent's alcohol cabinet." d. "Sometimes I feel like ending my life." - correct answer d. "Sometimes I feel like ending my life." Which of the following somatic complaints often accompanies anxiety disorders in children? a. Headache b. Somnolence c. Bradycardia d. Seizures - correct answer a. Headache Which of the following assessment findings is indicative of anxiety that is outside normal limits? a. a 15-month-old who cries intensely when she sees her mother gather her car keys and purse b. A 4-year-old who is afraid to take a bath because he is afraid of being sucked down the drain c. An 8-year-old who wakes up every night, seeking parental reassurance regarding fears and concerns about what will happen the next day d. An adolescent who is worried and preoccupied about social acceptance and social competence at school - correct answer c. An 8-year-old who wakes up every night, seeking parental reassurance regarding fears and concerns about what will happen the next day During a health maintenance visit, the mother of an 8-year-old boy says that he has received several warnings at school regarding his behavior. His teacher and the school social worker have documented that he loses his temper easily, repeatedly defies the teacher and school rules, argues with adults at school, and deliberately annoys his classmates. The healthcare provider should do a full screening for: a. Social phobias b. Depression c. Attention deficit hyperactivity disorder d. Oppositional defiant disorder - correct answer d. Oppositional defiant disorder Signs of nonsuicidal self-injury may include all of the following except: a. Emaciated appearance b. Wearing long-sleeved clothing in warm weather c. Overt suicidal ideation d. Scarring on visible skin - correct answer c. Overt suicidal ideation Common fears among school-aged children include: a. Loud noises b. Separation c. Peer rejection d. Physical well-being - correct answer c. Peer rejection Somatic indicators of anxiety in children may include: a. Nightmares b. Abdominal complaints c. Irritability d. Shaking - correct answer b. Abdominal complaints The mother of an 11-year-old boy is concerned because he has recently begun refusing to go to school, his teachers state that he seems extremely nervous when asked to speak in class, and he refuses invitations to school events or parties. Based on this information, the healthcare provider suspects: a. Social phobia b. Panic disorder c. Selective mutism d. Conduct disorder - correct answer a. Social phobia Which of the following signs in a 13-year-old girl raises suspicion for bulimia nervosa? a. Lanugo b. Dull hair c. Hypertension d. Enlarged parotid glands - correct answer d. Enlarged parotid glands The hallmark of obsessive-compulsive disorder is: a. Fear b. Worry c. Impulsivity d. Repetition - correct answer d. Repetition When conducting an overall screening for cognitive, emotional, and behavioral disorders in children aged 11 years and older, a suggested screening tool is: a. SAD PERSONS Scale b. Modified Checklist for Autism in Toddlers (M-CHAT) c. DSM-5 based diagnostic criteria d. Pediatric Symptom Checklist - correct answer d. Pediatric Symptom Checklist Signs of anorexia nervosa may include: a. Amenorrhea b. Hypertension c. Tachycardia d. 90% of expected weight - correct answer a. Amenorrhea The parents of a 6-year-old child bring him to the clinic with concerns about his behavior The parents have received numerous notes from the teacher and school social worker regarding his inability to stay in his seat during class, his failure to pay attention to the teacher, frequent class interruptions, and forgetting to bring completed assignments to class. The child has no cognitive delays, nor has he demonstrated any oppositional behavior. The provider should screen this child for: a. Anxiety disorder b. Autistic spectrum disorders c. Attention deficit hyperactivity disorder d. Oppositional defiant disorder - correct answer c. Attention deficit hyperactivity disorder Which of the following events in a 6-year-old child's life would prompt screening for posttraumatic stress disorder (PTSD)? a. Change of schools twice in the past year b. Death of the family pet c. Family dislocation due to a hurricane d. Loss of a beloved security object - correct answer c. Family dislocation due to a hurricane The most important component in the diagnosis of depression in children and adolescents is: a. The physical examination b. The clinical interview c. Results of self-report questionnaires d. Assessment of comorbid psychiatric disorders - correct answer b. The clinical interview A school-aged child displays a pattern of behavior that includes bullying, excessive teasing of the family dog, deliberate destruction of siblings' toys, and excessive lying. This child is displaying signs of: a. Conduct disorder b. Oppositional defiant disorder c. Sociopathy d. Bipolar disorder - correct answer a. Conduct disorder The likelihood of suicidality increases with: a. Obesity b. Social phobia c. Attention deficit hyperactivity disorder d. Mood disorders - correct answer d. Mood disorders The assessment finding of high concern for acute suicide risk in a highly depressed teen is: a. Low self-esteem b. Active hallucinations c. Excessive sleep d. History of substance abuse - correct answer b. Active hallucinations Adolescents with bipolar disorder are at risk for all of the following except: a. Suicide b. Sexually transmitted infections c. Self-mutilation d. Sleep disturbances - correct answer c. Self-mutilation A 9-year-old child of political refugees has recently arrived from a country that has been war-torn for 10 years. This child requires a school physical. During the health encounter, this child should be screened for all the following except: a. PTSD b. Depression c. Anxiety and panic disorder d. Obesity - correct answer d. Obesity Russell's sign (scars on knuckles) can be indicative of: a. Anorexia nervosa b. Bulimia nervosa c. Methamphetamine use d. Anabolic steroid use - correct answer b. Bulimia nervosa Constricted pupils on exam in a child or teen with no significant past medical history except history of drug use by be a sign of: a. Inhalant use b. Opioid use c. Cocaine use d. Benzodiazepine use - correct answer b. Opioid use Which of the following statements is not correct regarding potentially abusive families?