NR 509 ADVANCED PHYSICAL ASSESSMENT FIN
h h h h h
AL EXAM 2025 SPRING- h h h
SUMMER QUESTIONS AND ANSWERS
h h h
Ah35-year-
oldhfemalehwithhahhistoryhofhmigraineshpresentshtohthehclinichwithhworseninghsymptomshforhthehpasthfewh
weeks.hShehreportshwakinghuphathnighthwithhheadacheshandhnausea.hHerhonlyhmedicationhhistoryhishoralhc
ontraceptivehpillsh(OCPs).hOtherwise,hshehstateshshehishhealthy.hWhichhofhthehfollowinghactionshifhtakenhby
hthehNPhishthehbesthnexthstep?
Takehahfurtherhhistoryhandhperformhahveryhcarefulhneurologicalhexam
Ahgrandmotherhishaccompanyinghherh9-year-
oldhgranddaughterhduringhahroutinehphysicalhexamination.hShehaskshyouhprivatelyhifhherhgranddaughterhh
ashstartedhpubertyhyet.hDuringhthehexamination,hthehNPhnoteshasymmetrichprojectionhofhthehareolahandhn
ipplehofhthehrighthchesthtohformhahsecondaryhmoundhabovehthehlevelhofhthehbreast.hThehlefthbreasthishund
erdeveloped.hThesehassessmenthfindingsharehconsistenthwithhwhichhTannerhStagehofhdevelopment?
IV
Primaryhpreventionhishdefinedhashwhichhofhthehfollowing?hIntervent
ionshdesignedhtohpreventhdisease
BasedhonhthehU.S.hPreventivehServiceshTaskhForceh(USPSTF)hrecommendations,hwhichhofhthehfollowinghsta
tementshishtruehabouthscreeninghforhbreasthcancerhinhaverage-riskhwomen?
,Mammographyhishrecommendedheveryh2hyearshforhwomenhagedh50-
74hwithhinsufficienthevidencehforhscreeninghwomenhoverhthehagehofh75.
WhichhofhthehfollowinghstatementshishtruehregardinghrecommendationshbyhtheheighthhJointhNationalhCom
mitteeh(JNC8)hforhadultshagedh60handholder?hSelecthallhthathapply.
Targethbloodhpressurehshouldhbeh</=h150/90hmmHghbuthnoteshthathifhtreatmenthresultshinhSBPh<140handhis
h"wellhtoleratedhandhwithouthadverseheffectshtohhealthhorhqualityhofhlive,htreatmenthdoeshnothneedhtohbeh
adjusted."
Inhthosehagedh80horholder,hbloodhpressurehtargetshofh140htoh<150/70htoh80happearhoptimalhforhnotablehre
ductionshinhstroke,hcardiovascularhevents,handhall-causehmortality.
Whichhofhthehfollowinghishahusefulhstrategyhwhenhexamininghyounghchildrenhbetweenhthehageshofh1handh4?
Havehthehparenthfacilitatehthehexamh(e.g.,hremovinghclothes,hholdinghthehchildhonhlap).
h
ThehNPhishcompletinghthehreviewhofhsystemshonhah4-month-
oldhfemalehduringhahroutinehencounter.hWhichhstatementhfromhthehparenthmayhindicatehahcardiachproble
mhinhthehinfanthandhrequirehahmorehthoroughhsubjectivehhistory?
"Ithoftenhtakeshthehbabyhmorehthanh30hminuteshtohfinishhahbottle."
Ah16-year-
oldhmalehpresentshtohthehclinichwithhahhistoryhofhahcongenitalhrighthupperheyelidhdroopinghashrepresentedh
inhthishimage.hHehhashnohcomplaintshandhdenieshinjuryhorhtrauma.hWhichhcranialhnerveh(CN)hishinvolvedhinh
thishcondition?
Patienthwithheyelidhdrooping
,CNIII
Whichhcranialhnerveh(CN)hinnervateshthehmuscleshofhthehpharynxhandhprovideshsensoryhfibershtohportionsh
ofhthehtympanichmembrane,hauditoryhcanal,hpharynx,handhthehposteriorhthirdhofhthehtongue?
CNhIX
ThehNPhshouldhsuspecthinjuryhtohwhichhcranialhnerveh(CN)hifhahpatienthpresentshwithhcomplaintshofhphotos
ensitivityhandhunevenhpupilshafterhbeinghstruckhinhtheheyehwithhahbaseball?
CNIII
Whichhofhthehfollowinghstatementshishtruehregardinghriskshandhrapidhrecognitionhofhsuspectedhstroke?hSele
cthallhthathapply
Obesityhdoubleshthehriskhofhstrokehevenhwithouthassociatedhglucosehintolerance
Hypertensionhishthehleadinghriskhfactorhforhbothhischemichandhhemorrhagichstroke
Thehcombinationhofhbothhreceptivehandhexpressivehaphasiahishahcharacteristichofhwhichhtypehofhspeechhdis
order?
globalhaphasia
ThehNPhishassessinghah42-year-
oldhfemalehwhohpresentshtohthehclinichwithhrecurringhheadaches.hWhathishanheffectivehquestionhtohaskhtheh
patient?
, Dohyouhhavehanyhaurahpriorhtohthehheadaches?
Ah55-year-
oldhfemalehpresentshtohthehclinichwithhahheadache.hDuringhthehinterview,hwhichhofhthehfollowinghsymptom
shshouldhprompththehNPhtohbehconcernedhandhinvestigatehfurther?
Thehpatienthreportshfever,hnighthsweats,handhthinkshshehlosthweight.
Whenhgradinghmusclehstrengthhonhahscalehofh1htoh5,hahgradehofh3hindicateshwhichhofhthehfollowing?hAct
ivehmovementhagainsthgravity
Whichhmusculoskeletalhdisorderhishpairedhcorrectlyhwithhthehassociatedhsystemichmanifestations?hLym
ehdiseasehandhexpandingherythematoushtargetoidhpatchhinhearlyhillness
Ah62-year-
oldhfemalehhashahdiagnosishofhrheumatoidharthritish(RA).hWhichhofhthehfollowingharehexpectedhassessment
hfindingshconsistenthwithhthehdiagnosis?
Swellinghofhthehsynovialhtissuehinhjointshandhtendonhsheaths.
Ah58-year-
oldhmalehcomplainshofhpainhinhhishknees,hhips,hhands,hwrists,hneck,handhlowerhback.hBasedhonhthehjointshin
volved,hthehNPhsuspectshthaththehpatienthmosthlikelyhhashwhichhcondition?
Osteoarthritis
h h h h h
AL EXAM 2025 SPRING- h h h
SUMMER QUESTIONS AND ANSWERS
h h h
Ah35-year-
oldhfemalehwithhahhistoryhofhmigraineshpresentshtohthehclinichwithhworseninghsymptomshforhthehpasthfewh
weeks.hShehreportshwakinghuphathnighthwithhheadacheshandhnausea.hHerhonlyhmedicationhhistoryhishoralhc
ontraceptivehpillsh(OCPs).hOtherwise,hshehstateshshehishhealthy.hWhichhofhthehfollowinghactionshifhtakenhby
hthehNPhishthehbesthnexthstep?
Takehahfurtherhhistoryhandhperformhahveryhcarefulhneurologicalhexam
Ahgrandmotherhishaccompanyinghherh9-year-
oldhgranddaughterhduringhahroutinehphysicalhexamination.hShehaskshyouhprivatelyhifhherhgranddaughterhh
ashstartedhpubertyhyet.hDuringhthehexamination,hthehNPhnoteshasymmetrichprojectionhofhthehareolahandhn
ipplehofhthehrighthchesthtohformhahsecondaryhmoundhabovehthehlevelhofhthehbreast.hThehlefthbreasthishund
erdeveloped.hThesehassessmenthfindingsharehconsistenthwithhwhichhTannerhStagehofhdevelopment?
IV
Primaryhpreventionhishdefinedhashwhichhofhthehfollowing?hIntervent
ionshdesignedhtohpreventhdisease
BasedhonhthehU.S.hPreventivehServiceshTaskhForceh(USPSTF)hrecommendations,hwhichhofhthehfollowinghsta
tementshishtruehabouthscreeninghforhbreasthcancerhinhaverage-riskhwomen?
,Mammographyhishrecommendedheveryh2hyearshforhwomenhagedh50-
74hwithhinsufficienthevidencehforhscreeninghwomenhoverhthehagehofh75.
WhichhofhthehfollowinghstatementshishtruehregardinghrecommendationshbyhtheheighthhJointhNationalhCom
mitteeh(JNC8)hforhadultshagedh60handholder?hSelecthallhthathapply.
Targethbloodhpressurehshouldhbeh</=h150/90hmmHghbuthnoteshthathifhtreatmenthresultshinhSBPh<140handhis
h"wellhtoleratedhandhwithouthadverseheffectshtohhealthhorhqualityhofhlive,htreatmenthdoeshnothneedhtohbeh
adjusted."
Inhthosehagedh80horholder,hbloodhpressurehtargetshofh140htoh<150/70htoh80happearhoptimalhforhnotablehre
ductionshinhstroke,hcardiovascularhevents,handhall-causehmortality.
Whichhofhthehfollowinghishahusefulhstrategyhwhenhexamininghyounghchildrenhbetweenhthehageshofh1handh4?
Havehthehparenthfacilitatehthehexamh(e.g.,hremovinghclothes,hholdinghthehchildhonhlap).
h
ThehNPhishcompletinghthehreviewhofhsystemshonhah4-month-
oldhfemalehduringhahroutinehencounter.hWhichhstatementhfromhthehparenthmayhindicatehahcardiachproble
mhinhthehinfanthandhrequirehahmorehthoroughhsubjectivehhistory?
"Ithoftenhtakeshthehbabyhmorehthanh30hminuteshtohfinishhahbottle."
Ah16-year-
oldhmalehpresentshtohthehclinichwithhahhistoryhofhahcongenitalhrighthupperheyelidhdroopinghashrepresentedh
inhthishimage.hHehhashnohcomplaintshandhdenieshinjuryhorhtrauma.hWhichhcranialhnerveh(CN)hishinvolvedhinh
thishcondition?
Patienthwithheyelidhdrooping
,CNIII
Whichhcranialhnerveh(CN)hinnervateshthehmuscleshofhthehpharynxhandhprovideshsensoryhfibershtohportionsh
ofhthehtympanichmembrane,hauditoryhcanal,hpharynx,handhthehposteriorhthirdhofhthehtongue?
CNhIX
ThehNPhshouldhsuspecthinjuryhtohwhichhcranialhnerveh(CN)hifhahpatienthpresentshwithhcomplaintshofhphotos
ensitivityhandhunevenhpupilshafterhbeinghstruckhinhtheheyehwithhahbaseball?
CNIII
Whichhofhthehfollowinghstatementshishtruehregardinghriskshandhrapidhrecognitionhofhsuspectedhstroke?hSele
cthallhthathapply
Obesityhdoubleshthehriskhofhstrokehevenhwithouthassociatedhglucosehintolerance
Hypertensionhishthehleadinghriskhfactorhforhbothhischemichandhhemorrhagichstroke
Thehcombinationhofhbothhreceptivehandhexpressivehaphasiahishahcharacteristichofhwhichhtypehofhspeechhdis
order?
globalhaphasia
ThehNPhishassessinghah42-year-
oldhfemalehwhohpresentshtohthehclinichwithhrecurringhheadaches.hWhathishanheffectivehquestionhtohaskhtheh
patient?
, Dohyouhhavehanyhaurahpriorhtohthehheadaches?
Ah55-year-
oldhfemalehpresentshtohthehclinichwithhahheadache.hDuringhthehinterview,hwhichhofhthehfollowinghsymptom
shshouldhprompththehNPhtohbehconcernedhandhinvestigatehfurther?
Thehpatienthreportshfever,hnighthsweats,handhthinkshshehlosthweight.
Whenhgradinghmusclehstrengthhonhahscalehofh1htoh5,hahgradehofh3hindicateshwhichhofhthehfollowing?hAct
ivehmovementhagainsthgravity
Whichhmusculoskeletalhdisorderhishpairedhcorrectlyhwithhthehassociatedhsystemichmanifestations?hLym
ehdiseasehandhexpandingherythematoushtargetoidhpatchhinhearlyhillness
Ah62-year-
oldhfemalehhashahdiagnosishofhrheumatoidharthritish(RA).hWhichhofhthehfollowingharehexpectedhassessment
hfindingshconsistenthwithhthehdiagnosis?
Swellinghofhthehsynovialhtissuehinhjointshandhtendonhsheaths.
Ah58-year-
oldhmalehcomplainshofhpainhinhhishknees,hhips,hhands,hwrists,hneck,handhlowerhback.hBasedhonhthehjointshin
volved,hthehNPhsuspectshthaththehpatienthmosthlikelyhhashwhichhcondition?
Osteoarthritis
