LATEST EXAM 1 ADVANCED HEALTH ASSESSMENT NUR-631 QUESTIONS WITH COMPLETE SOLUTIONS

LATEST EXAM 1 ADVANCED HEALTH ASSESSMENT NUR-631 QUESTIONS WITH COMPLETE SOLUTIONS “A 59 year old patients tells the nurse practitioner that he thinks he must have ulcerative colitis. He has been having "black stools" for the last 24 hours. How would the nurse practitioner best document THE FACTS for his reason for seeking care? A) JM is a 59 year old male here for having "black stools" for the past 24 hours. B) JM came into the clinic complaining of black stools for the past 24 hours. C) JM is a 59 year old male here for "ulcerative colitis." D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked. - CORRECT ANSWER A) JM is a 59 year old male here for having "black stools" for the past 24 hours. Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek care. Make every effort to quote the patient's own words." "During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse practitioner knows that this occurs because of a decrease in: A) pigmentation B) thyroid stimulating hormone C) phagocytes D) fungacytes - CORRECT ANSWER A) pigmentation Hair undergoes a series of changes. Scalp hair loses its pigment (functioning of melanocytes) so the hair looks gray or white and feels thin and fine. The other options are not correct." "You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution - CORRECT ANSWER B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution" "You are examining the skin on a 22 year old female when you notice a circumscribed superficial lesion that is elevated approximately 0.5cm in diameter, filled with serous fluid. What type of lesion is this? A) macule B) papule C) vesicle D) spider angioma - CORRECT ANSWER C) vesicle Vesicle - up to 1.0 cm filled with serous fluid" "Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? A) Allow the patient to speak uninterrupted for the duration of the appointment. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end. - CORRECT ANSWER B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. Give the patient free rein for the first 5-10 minutes, listening closely to the conversation. Focus on what seems most important to the patient. Learn to set limits when needed. A brief summary may help you change the subject yet validate any concerns. Do no show your impatience." "Which of the following will help to optimize success from a pediatric examination? A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc. B) Being very orderly, so as not to miss a portion of the examination. C) Using firmness throughout your examination, letting the child know you are in charge. D) Making sure to place the infant on the table during the examination while Mom watches close by. - CORRECT ANSWER A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc. With certain exceptions, physical examination does not require use of the examining table, or with the child in a parent's lap. Plan the examination to start with the least distressing procedures and end with the most distressing, usually involving the throat and ears. Patience, distraction, play flexibility in the order of the examination, and caring but firm approach are all key to successfully examining the young child." "An Annual Low Dose Computed Tomography (LDCT) screening would be recommended for which patient? A) Tammy, age 57, who smokes a half pack of cigarettes a day for the last 20 years. B) Bob, age 72, who quit smoking 10 years ago after a 30-pack year history. C) Angela, age 43, and started smoking when she was 15 years old. D) George, age 80, who lives with his wife and is a smoker. - CORRECT ANSWER B) Bob, age 72, who quit smoking 10 years ago after a 30-pack year history. LDCT screenings are recommended to patients 55-74 years, a 30-pack year smoking history or current smoking or have quit in the last 15 years (Bates, p315-316)." "NP is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination? A) Immobility of the drum is a normal finding. B) The light reflex is cone shaped in the first few days of life. C) The appearance of the membrane is identical to that of an adult. D) The normal membrane may appear thick and opaque because of the vernix caseosa obscuring the tympanic membrane for the first few days of life. - CORRECT ANSWER D) The normal membrane may appear thick and opaque because of the vernix caseosa obscuring the tympanic membrane for the first few days of life. During the first few days, the tympanic membrane often looks thickened and opaque because there is vernix caseosa obscuring the tympanic membrane (Bates, p825)." "The projections in the nasal cavity that increase the surface area are called the: A) Kiesselbach plexus B) turbinates C) meatus D) septum - CORRECT ANSWER B) turbinates The lateral walls of each nasal cavity contain 3 parallel bony projections: the superior, middle, and inferior turbinates. They increase the surface area so that more blood vessels and mucous membrane are available to warm, humidify, and filter the inhaled air (Bates, p250)." "All of the following are true of the nasal inspection EXCEPT: A) Tilt the patient's head back a bit and insert the speculum gently into the vestibule of each nostril. Avoid contact with the nasal septum. You should inspect the inferior and middle turbinates, the nasal septum, and the narrow passage between them. B) In viral rhinitis, the mucosa is usually reddened and swollen, and in allergic rhinitis the mucosa is often pale, bluish, or red. C) Examine the inside of the nose without a speculum on the otoscope keeping the otoscope 6-10 inches away from the tip of the patient's nose are you look at each nostril. D) Use the largest available ear speculum on the otoscope during inspection. - CORRECT ANSWER C) Examine the inside of the nose without a speculum on the otoscope keeping the otoscope 6-10 inches away from the tip of the patient's nose are you look at each nostril. Tilt the patient's head back a bit and insert the speculum gently into the vestibule of each nostril. Avoid contact with the nasal septum. Use the largest available speculum. In viral rhinitis, the mucosa is usually reddened and swollen, and in allergic rhinitis the mucosa is often pale, bluish, or red." "A teenage patient comes to the emergency room with complaints of an "inability to breathe and a sharp pain in my left chest." Your assessment findings include the following: Cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with: A) acute pneumonia B) an asthmatic attack C) a pneumothorax D) bronchitis - CORRECT ANSWER C) a pneumothorax With a pneumothorax, free air in the pleural space causes partial or complete lung collapse. If the pneumothorax is large then tachypnea and cyanosis are seen. Unequal chest expansion, decreased or absent tactile fremitus, tracheal deviation to the unaffected side, decreased chest expansion, hyperresonnant percussion tones, and decreased or absent breath sounds are found with the presence of a pneumothorax. (Bates, p 340)" "The diameter of the PMI is approximately: A) 1-2.5 cm in diameter and any larger is evidence of mitral valve prolapse B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy C) .5-1 cm in diameter and any larger is evidence supporting left ventricular hypertrophy D) .5-1 cm in diameter and any larger is evidence of mitral valve prolapse - CORRECT ANSWER B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy (Bates p 344)" "The direction of blood flow through the heart is best described by which of the following? A) Aorta - R atrium - R ventricle - lungs - pulmonary vein - L atrium - L ventricle - vena cava B) R atrium - R ventricle - pulmonary vein - lungs - pulmonary artery - L atrium - L ventricle C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle D) Vena cava - R atrium - R ventricle - lungs - pulmonary artery- L atrium - L ventricle - CORRECT ANSWER C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle Returning blood from the body empties into the R atrium and flows into the R ventricle, then goes to the lungs through the pulmonary artery. The lungs oxygenate the blood and it is then returned to the L atrium by the pulmonary vein. It goes from there to the L ventricle and then out to the body through the aorta (Bates, pg 345)" "When listening to heart sounds, the nurse knows that the valve closures that can be heard for S2 is: A) pulmonic B) aortic C) tricuspid D) mitral - CORRECT ANSWER B) aortic The second heart sound (S2) occurs with the closure of the aortic valve and signals the end of systole. Although it is heard over all the precordium, S2 is loudest at the base of the heart. (Bates, p347)" "The cone of light of the tympanic membrane is found: A) on the posterior lower TM B) on the lower anterior part of the TM C) on the posterior upper TM D) on the upper anterior TM - CORRECT ANSWER B) on the lower anterior part of the TM The cone of light is found on the anterior lower TM (Bates, p243)" "A serous (otitis) effusion looks like: A) bright red bulging B) dull and retracted C) amber fluid or bubbles behind the tympanic membrane D) like a hole in the tympanic membrane - CORRECT ANSWER C) amber fluid or bubbles behind the tympanic membrane A serous (otitis) effusion appears as an air/fluid level or bubbles with amber colored fluid (Bates, p288)." "Psoriasis lesions are best described as: A) clustered pustules B) silvery scaly plaques/papules C) vesicular lesions progressing to craters D) macular patches - CORRECT ANSWER B) silvery scaly plaques/papules Bates, p192" "When looking at the retina, a macular star is usually caused by: A) diabetes B) trauma C) hypertension D) none of the above - CORRECT ANSWER C) hypertension A macular star is also known as hypertensive retinopathy with macular star and is caused by high blood pressure. (Bates, p283)" "Mrs. Elkins presents today with a complaint of a productive cough and fever that is worsened over the past 2-3 days. Which of the following respiratory problems is LEAST likely to have this HPI? A) acute pulmonary embolism B) bacterial pneumonia C) mycoplasma pneumonia D) acute bronchitis - CORRECT ANSWER A) acute pulmonary embolism Acute pulmonary embolisms usually present suddenly and are not typically associated with a fever of several days (Bates, p334)" "When listening to heart tones, you hear a murmur that is quiet but heard immediately after placing your stethoscope on the chest. How would you classify this murmur? A) 4/6 B) 1/6 C) 3/6 D) 2/6 - CORRECT ANSWER D) 2/6 Bates, p396" "A patient notes that they have a history of goiter. What is a goiter? A) a type of skin lesion B) the primary lymph node used for cancer staging C) an enlargement of the thyroid D) an ear abnormality - CORRECT ANSWER C) an enlargement of the thyroid Bates, p221, 262" "You are assessing a patient with Wilson's disease and you see a golden/brown ring around the iris. This is called: A) chalazion B) pterygium C) pinguecula D) Kayser-Fleischer ring - CORRECT ANSWER D) Kayser-Fleischer ring A ring around the iris from Wilson's disease is called a Kayser-Fleischer ring and it is from excessive copper (Bates, p276)." "If a patient is reporting light, gray colored stool, it is likely that ________ is missing from the stool. A) bile B) fiber C) bacteria D) mucus - CORRECT ANSWER A) bile Bile is what gives stools a darker color, so lighter, gray colored stools may indicate a bile duct obstruction (Bates, p461)." "Kidney pain is commonly described as "flank pain." Which of the following would be considered in the flank area? A) periumbilical B) costovertebral angle C) suprapubic D) epigastric - CORRECT ANSWER B) costovertebral angle Costovertabal angle (CVA) pain or tenderness with percussion is a common test for kidney pain (Bates, p463-464)." "At what age is colorectal cancer screening started in those with "average risk?" A) 50 B) 45 C) 25 D) 35 - CORRECT ANSWER A) 50 The recommendation for colorectal cancer screening starts at 50 years old for those with "average risk." Bates, p 469" "While performing a fundoscopic examination on a 38 year old African American female, the color of the fundus is a grayish brown, almost purple. You determine: A) this is a sign of diabetic retinopathy B) this is a sign of hypertensive retinopathy C) this indicates retinal detachment and requires immediate intervention D) this is a normal variation, no action is needed - CORRECT ANSWER D) this is a normal variation, no action is needed There are normal variants for darker skinned patients (Bates, p283)." "Wheezes are a result of: A) abnormal lung tissue B) narrowed air passages C) fibrosis D) fluid in the lungs - CORRECT ANSWER B) narrowed air passages Wheezes are the result of narrowed airways, like in asthma, COPD, or bronchitis (Bates, p338)" "Rhonchi suggests: A) secretions is large airways B) secretions in the pleural sac C) secretions in alveoli D) secretions in bronchioles - CORRECT ANSWER A) secretions is large airways Rhonchi are suggestive of secretions in large airways (Bates, p325)." "7. The following information is recorded in the health history: "I feel really tired." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems - CORRECT ANSWER A) chief complaint pt's own words" "8. The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems - CORRECT ANSWER D) review of systems" "9. The following information is best placed in which category? "The patient has had three cesarean sections." A) Adult illnesses B) Surgeries C) Obstetrics/gynecology D) Psychiatric - CORRECT ANSWER B) surgeries" "10. The following information is best placed in which category? "The patient had a stent placed in the left anterior descending artery (LAD) in 1999." A) Adult illnesses B) Surgeries C) Obstetrics/gynecology D) Psychiatric - CORRECT ANSWER A) adult illnesses *a stent is a major procedure but does not involve a surgeon*" "11. The following information is best placed in which category? "The patient was treated for an asthma exacerbation in the hospital last year; the patient has never been intubated." A) Adult illnesses B) Surgeries C) Obstetrics/gynecology D) Psychiatric - CORRECT ANSWER A) adult illnesses" "A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to? A) Musculoskeletal B) Reproductive C) Urinary D) Endocrine - CORRECT ANSWER A)musculoskeletal" "A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom? A) Reproductive B) Urinary C) Cardiac D) Hematologic - CORRECT ANSWER C)cardiac" "A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough? A) Ophthalmologic B) Auditory C) Cardiac D) Endocrine - CORRECT ANSWER C) cardiac" "A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct? A) Infectious B) Inflammatory C) Hematologic D) Traumatic - CORRECT ANSWER B) inflammatory" "A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven't worked as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process? A) Infectious B) Neoplastic C) Degenerative D) Traumatic - CORRECT ANSWER C) degenerative" "A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process? A) Infection B) Inflammation C) Allergic D) Vascular - CORRECT ANSWER C) allergic *consistent with allergic rhinitis*" "A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis? A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion - CORRECT ANSWER C)" "A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis? A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses. B) Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding. C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding. D) Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding. - CORRECT ANSWER C) tender to palpation in RUQ" "A 55-year-old data entry operator comes to the clinic to establish care. She has the following symptoms: headache, neck pain, sinus congestion, sore throat, ringing in ears, sharp brief chest pains at rest, burning abdominal pain with spicy foods, constipation, urinary frequency that is worse with coughing and sneezing, and swelling in legs. This cluster of symptoms is explained by: A) One disease process B) More than one disease process - CORRECT ANSWER B) more than one disease process" "You are running late after your quarterly quality improvement meeting at the hospital and have just gotten paged from the nurses' station because a family member of one of your patients wants to talk with you about that patient's care. You have clinic this afternoon and are double-booked for the first appointment time; three other patients also have arrived and are sitting in the waiting room. Which of the following demeanors is a behavior consistent with skilled interviewing when you walk into the examination room to speak with your first clinic patient? A) Irritability B) Impatience C) Boredom D) Calm - CORRECT ANSWER D) calm" "Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient-provider interview? A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story. B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport. C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan. D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport. - CORRECT ANSWER C) greet the patient, establish rapport, invite the patients story, establish agenda, expand and clarify the story, negotiate the plan" "Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted? A) Setting in which the symptom occurs B) Associated manifestations C) Quality D) Timing - CORRECT ANSWER B) associated manifestations is pain accompanied by N/V?" "Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Which of the following symptom attributes was not addressed in this description? A) Severity B) Setting in which the symptom occurs C) Timing D) Associated manifestations - CORRECT ANSWER A) severity should've asked pain on 0-10 scale" "You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning? A) Directed questioning: starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer B) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer C) Offering the patient multiple choices in order to clarify the character of the urinary symptoms that she is experiencing D) Asking her to tell you exactly what she means when she states that she has a urinary tract infection - CORRECT ANSWER B) reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer" "Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be checked out for the symptom of chest pain. As you listen to him describe his symptom in more detail, you say "Go on," and later, "Mm-hmmm." This is an example of which of the following skilled interviewing techniques? A) Echoing B) Nonverbal communication C) Facilitation D) Empathic response - CORRECT ANSWER C) facilitation" "Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn't say anything in response to your question. This is an example of which type of challenging patient? A) Talkative patient B) Angry patient C) Silent patient D) Hearing-impaired patient - CORRECT ANSWER C) silent patient" "Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? A) Allow the patient to speak uninterrupted for the duration of the appointment. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end. - CORRECT ANSWER B) briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you" "Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is unimpressed by the reception staff, the nurse, and the clinic in general and wants to know why the office wouldn't call in an antibiotic for her. Which of the following techniques is not useful in helping to calm this patient? A) Avoiding admission that you had a part in provoking her anger because you were late B) Accepting angry feelings from the patient and trying not to get angry in return C) Staying calm D) Keeping your posture relaxed - CORRECT ANSWER A) avoiding admission that you had a part in provoking her anger because you were late" "A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge. As the provider, you need to get a sexual history. Which one of the following questions is inappropriate for eliciting the information? A) Are you sexually active? B) When was the last time you had intimate physical contact with someone, and did that contact include sexual intercourse? C) Do you have sex with men, women, or both? D) How many sexual partners have you had in the last 6 months? - CORRECT ANSWER A) are you sexually active? the question is too vague" "Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem? A) You are an alcoholic, aren't you? B) When was your last drink? C) Do you drink 2 to 3 beers every weekend? D) Do you drink alcohol when you are supposed to be working? - CORRECT ANSWER B) when was your last drink?" "On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual visit for her blood pressure. She is on a low-dose diuretic chronically and denies any side effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her script, she mentions that it is hard not having her husband Bill around anymore. What would you do next? A) Hand her the script and make sure she has a 3-month follow-up appointment. B) Make sure she understands the script. C) Ask why Bill is not there. D) Explain that you will have more time at the next visit to discuss this. - CORRECT ANSWER C) ask why bill is not there? patient is looking for support and empathy" "A patient is describing a very personal part of her history very quickly and in great detail. How should you react to this? A) Write down as much as you can, as quickly as possible. B) Ask her to repeat key phrases or to pause at regular intervals, so you can get almost every word. C) Tell her that she can go over the notes later to make sure they are accurate. D) Push away from the keyboard or put down your pen and listen. - CORRECT ANSWER D) push away from the keyboard and put down your pen and listen" "You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire right side. She cannot speak (aphasia). You are supposed to examine her. You notice that the last examiner left her socks at the bottom of the bed, and although sensitive areas are covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would you do next? A) Carry out your examination, focusing on the neurologic portion, and then cover her properly. B) Carry out your examination and let the nurse assigned to her "put her back together." C) Put her socks back on and cover her completely before beginning the evaluation. D) Apologize for the last examiner but let the next examiner dress and cover her. - CORRECT ANSWER C) put her socks back on and cover her completely before beginning the evaluation *make patient comfortable before examining*" "When you enter your patient's examination room, his wife is waiting there with him. Which of the following is most appropriate? A) Ask if it's okay to carry out the visit with both people in the room. B) Carry on as you would ordinarily. The permission is implied because his wife is in the room with him. C) Ask his wife to leave the room for reasons of confidentiality. D) First ask his wife what she thinks is going on. - CORRECT ANSWER A) ask if it's okay to carry out the visit with both people in the room" "A patient complains of knee pain on your arrival in the room. What should your first sentence be after greeting the patient? A) How much pain are you having? B) Have you injured this knee in the past? C) When did this first occur? D) Could you please describe what happened? - CORRECT ANSWER D) could you please describe what happened" "You have just asked a patient how he feels about his emphysema. He becomes silent, folds his arms across his chest and leans back in his chair, and then replies, "It is what it is." How should you respond? A) "You seem bothered by this question." B) "Next, I would like to talk with you about your smoking habit." C) "Okay, let's move on to your other problems." D) "You have adopted a practical attitude toward your problem." - CORRECT ANSWER A) you seem bothered by this question" "A patient tells you about her experience with prolonged therapy for her breast cancer. You comment, "That must have been a very trying time for you." What is this an example of? A) Reassurance B) Empathy C) Summarization D) Validation - CORRECT ANSWER D) validation" "You are performing a young woman's first pelvic examination. You make sure to tell her verbally what is coming next and what to expect. Then you carry out each maneuver of the examination. You let her know at the outset that if she needs a break or wants to stop, this is possible. You ask several times during the examination, "How are you doing, Brittney?" What are you accomplishing with these techniques? A) Increasing the patient's sense of control B) Increasing the patient's trust in you as a caregiver C) Decreasing her sense of vulnerability D) All of the above - CORRECT ANSWER D) all of the above" "When using an interpreter to facilitate an interview, where should the interpreter be positioned? A) Behind you, the examiner, so that the lips of the patient and the patient's nonverbal cues can be seen B) Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues of the patient C) Between you and the patient so all parties can make the necessary observations D) In a corner of the room so as to provide minimal distraction to the interview - CORRECT ANSWER B) next to the patient , so that the examiner can maintain eye contact and observe non verbal cues of the patient" "A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter's weight. You measure her daughter's height and weight and obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate? A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic. B) Reassure the mother that this is a normal body weight. C) Give the patient information about exercise because the patient is obese. D) Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese. - CORRECT ANSWER B) reassure the mother that this is a normal body weight normal BMI is 18.5-24.9" "A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 26.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit? A) Refer the patient to a nutritionist because he is anorexic. B) Reassure the patient that he has a normal body weight. C) Give the patient information about reduction of fat, cholesterol, and calories because he is overweight. D) Give the patient information about reduction of fat and cholesterol because he is obese. - CORRECT ANSWER C) give the patient information about reduction of fat, cholesterol, and calories because he is overweight overweight BMI is 25-29.9" "A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30.0 kg/m2. What is the most appropriate amount for a weekly weight reduction goal? A) .5 to 1 pound per week B) 1 to 2.5 pounds per week C) 2.5 to 3.5 pounds per week D) 3.5 to 4.5 pounds per week - CORRECT ANSWER A) .5-1 pound per week" "A 67-year-old retired janitor comes to the clinic with his wife. She brought him in because she is concerned about his weight loss. He has a history of smoking 3 packs of cigarettes a day for 30 years, for a total of 90 pack-years. He has noticed a daily cough for the past several years, which he states is productive of sputum. He came into the clinic approximately 1 year ago, and at that time his weight was 140 pounds. Today, his weight is 110 pounds. Which one of the following questions would be the most important to ask if you suspect that he has lung cancer? A) Have you tried to force yourself to vomit after eating a meal? B) Do you have heartburn/indigestion and diarrhea? C) Do you have enough food to eat? D) Have you tried to lose weight? - CORRECT ANSWER D) have you tried to lose weight?" "Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except: A) Changes in weight B) Fatigue and weakness C) Cough D) Fever and chills - CORRECT ANSWER C) cough *done in the respiratory ROS*" "You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except: A) Level of consciousness B) Signs of distress C) Dress, grooming, and personal hygiene D) Blood pressure - CORRECT ANSWER D) blood pressure BP is a vital sign" "A 55-year-old bookkeeper comes to your office for a routine visit. You note that on a previous visit for treatment of contact dermatitis, her blood pressure was elevated. She does not have prior elevated readings and her family history is negative for hypertension. You measure her blood pressure in your office today. Which of the following factors can result in a false high reading? A) Blood pressure cuff is tightly fitted. B) Patient is seated quietly for 10 minutes prior to measurement. C) Blood pressure is measured on a bare arm. D) Patient's arm is resting, supported by your arm at her mid-chest level as you stand to measure the blood pressure. - CORRECT ANSWER A) blood pressure cuff is tightly fitted" "A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient's complete history and physical examination. When you palpate the pulse, what do you expect to feel? A) Large amplitude, forceful B) Small amplitude, weak C) Normal D) Bigeminal - CORRECT ANSWER B) small amplitude, weak CHF has decreased stroke volume" "An 18-year-old college freshman presents to the clinic for evaluation of gastroenteritis. You measure the patient's temperature and it is 104 degrees Fahrenheit. What type of pulse would you expect to feel during his initial examination? A) Large amplitude, forceful B) Small amplitude, weak C) Normal D) Bigeminal - CORRECT ANSWER A) large amplitude, forceful fever results in increased stroke volume" "A 25-year-old type 1 diabetic clerk presents to the emergency room with shortness of breath and states that his blood sugar was 605 at home. You diagnose the patient with diabetic ketoacidosis. What is the expected pattern of breathing? A) Normal B) Rapid and shallow C) Rapid and deep D) Slow - CORRECT ANSWER C) rapid and deep characteristic of DKA" "Mrs. Lenzo weighs herself every day with a very accurate balance-type scale. She has noticed that over the past 2 days she has gained 4 pounds. How would you best explain this? A) Attribute this to some overeating at the holidays. B) Attribute this to wearing different clothing. C) Attribute this to body fluid. D) Attribute this to instrument inaccuracy. - CORRECT ANSWER C) attribute this to body fluid" "Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell him? A) "When you get down to your goal weight, you will feel so much better." B) "Some people seem to be able to lose weight and others just can't, no matter how hard they try." C) "We are coming up with new medicines and methods to treat your conditions every day." D) "Even a weight loss of 10% can make a noticeable improvement in the problems you mention." - CORRECT ANSWER D) even a weight loss of 10% can make a noticeable improvement in the problems you mention benefits often come with even a 10% weight loss" "Jenny is one of your favorite patients who usually shares a joke with you and is nattily dressed. Today she is dressed in old jeans, lacks makeup, and avoids eye contact. To what do you attribute these changes? A) She is lacking sleep. B) She is fatigued from work. C) She is running into financial difficulty. D) She is depressed. - CORRECT ANSWER D) she is depressed" "You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office staff are: T 37.2, HR 78, BP 118/92, and RR 14, and she denies pain. You notice that she has some hypertensive changes in her retinas and you find mild proteinuria on a urine test in your office. You expected the BP to be higher. She is not on any medications. What do you think is causing this BP reading, which doesn't correlate with the other findings? A) It is caused by an "auscultatory gap." B) It is caused by a cuff size error. C) It is caused by the patient's emotional state. D) It is caused by resolution of the process which caused her retinopathy and kidney problems. - CORRECT ANSWER A) it is caused by an "auscultatory gap" *an unrecognized auscultatory gap may lead to serious underestimation of systolic and overestimation of diastolic" "A 50-year-old body builder is upset by a letter of denial from his life insurance company. He is very lean but has gained 2 pounds over the past 6 months. You personally performed his health assessment and found no problems whatsoever. He says he is classified as "high risk" because of obesity. What should you do next? A) Explain that even small amounts of weight gain can classify you as obese. B) Place him on a high-protein, low-fat diet. C) Advise him to increase his aerobic exercise for calorie burning. D) Measure his waist. - CORRECT ANSWER D) measure his waist" "You are observing a patient with heart failure and notice that there are pauses in his breathing. On closer examination, you notice that after the pauses the patient takes progressively deeper breaths and then progressively shallower breaths, which are followed by another apneic spell. The patient is not in any distress. You make the diagnosis of: A) Ataxic (Biot's) breathing B) Cheyne-Stokes respiration C) Kussmaul's respiration D) COPD with prolonged expiration - CORRECT ANSWER B) cheyne-stokes respiration kussmauls -metabolic acidosis COPD respirations are regular with no apnea ataxia - irregular in rhythm and depth and see in brain injury" "Mr. Garcia comes to your office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, you note a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side. What type of pain is this? A) Idiopathic pain B) Neuropathic pain C) Nociceptive or somatic pain D) Psychogenic pain - CORRECT ANSWER B) neuropathic sounds like shingles" "Despite having high BP readings in the office, Mr. Kelly tells you that his readings at home are much lower. He checks them twice a day at the same time of day and has kept a log. How do you respond? A) You diagnose "white coat hypertension." B) You assume he is quite nervous when he comes to your office. C) You question the accuracy of his measurements. D) You question the accuracy of your measurements. - CORRECT ANSWER C) you question the accuracy of his measurement presuming that this is white coat HTN can be dangerous because it's not treated. assume staff is well trained to take readings." "Ms. Wright comes to your office, complaining of palpitations. While checking her pulse you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different. It sounds like a triplet rather than the usual "lub dup." How would you document your examination? A) Regular rate and rhythm B) Irregularly irregular rhythm C) Regularly irregular rhythm D) Bradycardia - CORRECT ANSWER C) regularly irregular rhythm" "A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient? A) Age B) Hair color C) Actinic lentigines D) Heavy sun exposure - CORRECT ANSWER A) age melanoma risk increases at age 50" "You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution - CORRECT ANSWER B) ABCDE" "You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism? A) Moist and smooth B) Moist and rough C) Dry and smooth D) Dry and rough - CORRECT ANSWER D) dry and rough" "A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema - CORRECT ANSWER a) pityriasis rosea one large patch that erupted into many lesions "Christmas tree pattern"" "A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema - CORRECT ANSWER B) tinea versicolor fungal infection so sweating and increased moisture led to this" "A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma - CORRECT ANSWER A) actinic keratosis" "A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma - CORRECT ANSWER B) seborrheic keratosis "stuck on"" "A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 - CORRECT ANSWER C) stage 3 full thickness skin loss with damage to subcutaneous tissue" "An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis? A) Alopecia areata B) Trichotillomania C) Tinea capitis D) Traction alopecia - CORRECT ANSWER A) alopecia areata" "A mother brings her 11 month old to you because her mother-in-law and others have told her that her baby is jaundiced. She is eating and growing well and performing the developmental milestones she should for her age. On examination you indeed notice a yellow tone to her skin from head to toe. Her sclerae are white. To which area should your next questions be related? A) Diet B) Family history of liver diseases C) Family history of blood diseases D) Ethnicity of the child - CORRECT ANSWER A) diet" "A new mother is concerned that her child occasionally "turns blue." On further questioning, she mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is otherwise eating and growing well. What would you do now? A) Reassure her that this is normal B) Obtain an echocardiogram to check for structural heart disease and consult cardiology C) Admit the child to the hospital for further observation D) Question the validity of her story - CORRECT ANSWER A) reassure her that this is normal peripheral cyanosis when cold" "Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of exposure to ill people or other agents in the environment. He has a slight fever in the office. The rash consists of small, bright red marks. When they are pressed, the red color remains. What should you do? A) Prescribe a steroid cream to decrease inflammation. B) Consider admitting the patient to the hospital. C) Reassure the parents and the patient that this should resolve within a week. D) Tell him not to scratch them, and follow up in 3 days. - CORRECT ANSWER B) consider admitting patient to hospital non-blanchable means there is pinpoint bleeding under the skin" "Jacob, a 33-year-old construction worker, complains of a "lump on his back" over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely? A) An enlarged lymph node B) A sebaceous cyst C) An actinic keratosis D) A malignant lesion - CORRECT ANSWER B) a sebaceous cyst" "A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection - CORRECT ANSWER C) psoriasis" "Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites B) Urticaria, or hives C) Psoriasis D) Purpura - CORRECT ANSWER B) urticaria/hives "comes and goes"" "A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do? A) Reassure him that there is nothing to worry about. B) Do laboratory work to check for platelet problems. C) Obtain an extensive history regarding blood problems and bleeding disorders. D) Do a skin biopsy in the office. - CORRECT ANSWER A) reassure him there is nothing to worry about - this is a cherry angioma and it's benign" "Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do? A) Conclude that these are lesions she has had for a long time. B) Wait for her to mention them before asking further questions. C) Ask how she acquired them. D) Conduct the visit as usual for the patient. - CORRECT ANSWER C) ask how she acquired them abuse??" "match the following descriptions to the correct lesion or distribution name: 1. multiple lesions blending together 2. flat discoloration less than 1 cm 3. circumscribed area of skin edema 4. narrow linear crack into epidermis, exposing dermis 5. vesicle like lesion with purulent content 6. flat discoloration greater than 1 cm 7. raised lesion, larger than 1 cm, may be same or different color from the surrounding skin 8. net-like cluster 9. loss of epidermis and dermis 10. loss of skin markings and full skin thickness 11. skin thickening usually found over pruritic or friction areas 12. in a ring formation a. ulcer b. atrophy re d. reticular e. wheal f. pustule g. patch h. plaque i. macule j. confluent k. annular l. lichenification - CORRECT ANSWER 1. confluent 2. macule 3. wheal 4. fissure 5. pustule 6. patch 7. plaque 8. reticular 9. ulcer 10. atrophy 11. lichenification 12. annular" "one of the most common trigger agents for contact dermatitis is: a. exposure to nickel b. use of fabric softener c. bathing with liquid body wash d. eating spicy foods - CORRECT ANSWER a. exposure to nickel" "a common site for atopic dermatitis in an adult is on the: a. dorsum of the hand b. face c. neck d. flexor surfaces - CORRECT ANSWER d. flexor surfaces" "a 78 year old resident of a long term care facility complains of generalized itchiness at night that disturbs her sleep. Her examination is consistent with scabies. Which of the following do you expect to find on examination? a. excoriated papule on the interdigital area b. annular lesions over the buttocks c. vesicular lesions in a linear pattern d. honey-colored crusted lesions that began as vesicles - CORRECT ANSWER a. excoriated (from itching) papule on the interdigital area" "You examine a patient with psoriasis vulgaris and expect to find the following lesions: A. lichenified areas in flexor areas B. well-demarcated plaques on the knees C. greasy lesions throughout the scalp D. vesicular lesions over the upper thorax - CORRECT ANSWER b. well-demarcated plaques on the knees" "which of the following best describes seborrheic dermatitis lesions? a. flaking lesions in the AC and popliteal spaces b. greasy, scaling lesions in the nasolabial folds c. intensely itchy lesions in the groin folds d. silvery lesions on the elbows and knees - CORRECT ANSWER b. greasy, scaling lesions in the nasolabia folds think sebaceous glands so *greasy, oily*" "a 49 year old man presents with a skin lesion suspicious for malignant melanoma. you describe the lesion as having: a. deep, black-brown coloring throughout b. sharp borders c. a diameter of 3 mm or less d. variable pigmentation - CORRECT ANSWER d. variable pigmentation remember ABCDE rule" "a 72 year old woman presents with a newly formed painless, pearly, ulcerated nodule with an overlying telangiectasis on the upper lip. this most likely represents: a. actinic keratosis b. basal cell carcinoma c. squamous cell carcinoma d. molluscum contagiosa - CORRECT ANSWER basal cell carcinoma remember PUT ON" "when examining a mole for malignant melanoma, all of the following characteristics can indicate a melanoma, except: a. asymmetry with non matching sides b. color that is not uniform c. a recently formed lesion d. a lesion that has been present for at least 2 years - CORRECT ANSWER d. a lesion that has been present for at least 2 years ABCDE E-evolving (new or changing lesion)" "the most common sites for squamous and basal cell carcinoma include: a. palms of hands and soles of feet b. pelvic and lumbar c. abdomen d. the face and scalp - CORRECT ANSWER d. the face and scalp (where we get the most sun exposure)" "a 56 year old truck drive presents with a new nodular, opaque lesion with non distinct borders on his left forearm. This most likely represents: a. actinic keratosis b. squamous cell carcinoma c. basal cell carcinoma d. malignant melanoma - CORRECT ANSWER b. squamous cell carcinoma remember NO SUN" "An urticarial lesion is usually described as a: A. wheal B. plaque C. patch D. papule - CORRECT ANSWER a. wheal" "Which of the following changes are expected in vision as part of the normal aging process? A) Cataracts B) Glaucoma C) Macular degeneration D) Blurring of near vision - CORRECT ANSWER D) Blurring of near vision" "A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He has noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits to lip-reading more. He has a history of noise exposure in his young adult years: He worked as a sound engineer at a local arena and had to attend a lot of concerts. Based on this information, what is the most likely finding regarding his hearing acuity? A) Loss of acuity for middle-range sounds B) Increase of acuity for low-range sounds C) Loss of acuity for high-range sounds D) Increase of acuity for high-range sounds - CORRECT ANSWER A) Loss of acuity for middle-range sounds human speech is middle-range sound" "A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned about his memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed to buy from the grocery store and where he has parked the car. He denies getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died 8 months ago; his three children live in three different states; and he has limited his activities because the people he interacted with were "his wife's friends, not his." He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state examination and obtain a total score of 24 out of 28. Based on this information, what is your most likely diagnosis? A) Benign forgetfulness B) Dementia C) Meningitis D) Depression - CORRECT ANSWER D) Depression" "A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an ECG (electrocardiogram) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this. Which of the following symptoms would be more common in this patient's age group for an acute myocardial infarction? A) Chest pain B) Syncope C) Pain radiating into the left arm D) Pain radiating into the jaw - CORRECT ANSWER B) syncope" "An 88-year-old retired piano teacher comes for evaluation of fatigue. You notice that her clothes are hanging loosely off her frame and that she has lost 15 pounds. She is unaware of this. Her husband of 63 years died a few months ago. You ask the patient to complete a Rapid Screen for Dietary Intake. Which of the following statements is considered to be part of this rapid screen? A) I eat more than two meals per day. B) I drink one glass of alcohol every day. C) Without wanting to, I have lost or gained 10 pounds in the last 6 months. D) I eat with at least one other person most of the time. - CORRECT ANSWER C) Without wanting to, I have lost or gained 10 pounds in the last 6 months." "An 89-year-old retired school principal comes for an annual check-up. She would like to know whether or not she should undergo a screening colonoscopy. She has never done this before. Which of the following factors should not be considered when discussing whether she should go for this screening test? A) Life expectancy B) Time interval until benefit from screening accrues C) Patient preference D) Current age of patient - CORRECT ANSWER D) current age of the patient" "Which of the following booster immunizations is recommended in the older adult population? A) Tetanus B) Diphtheria C) Measles D) Mumps - CORRECT ANSWER A) tetanus" "You are asked to perform a home safety assessment for an 87-year-old retired farmer who lives by himself. Which of the following is not considered to be an increased risk for falls? A) Loose electrical cords B) Slippery or irregular surfaces C) Chairs at awkward angles D) Bright lighting - CORRECT ANSWER D) Bright lighting" "Which of the following brief screening measures is useful in assessing memory? A) Three-item recall B) Serial 7s C) Spelling "world" backward D) Copying intersecting pentagrams - CORRECT ANSWER A) Three-item recall" "Which of the following questions is part of the screening for physical disability? A) Are you able to go shopping for groceries or clothes? B) Are you able to walk one block? C) Are you able to pass the driver's license test? D) Are you able to perform light dusting and pick up after yourself around the house? - CORRECT ANSWER A) Are you able to go shopping for groceries or clothes?" "Blood pressure abnormalities found more commonly in Western elderly include which of the following? A) Isolated elevation of the diastolic BP B) Narrow pulse pressure C) Elevation of the systolic BP D) Elevation of the BP with standing - CORRECT ANSWER C) elevation of the systolic BP" "Mr. Chin is an 82-year-old man who comes to your office for a routine check. On examination, you notice a somewhat high-pitched murmur in the second right intercostal space during systole. It does not radiate and