ADVANCED PHYSICAL ASSESSMENT -FINAL
EXAMINATION WITH ALL DETAILED
ACCURATE SOLUTIONS
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. -
answer ✔✔-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.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?
A) Bronchitis
B) Simple asthma
C) Cystic fibrosis
D) Heart failure - answer ✔✔-A. Bronchitis
A patient with longstanding COPD was told by another practitioner that his liver was enlarged and this
needed to be assessed. Which of the following would be reasonable to do next?
A) Percuss the lower border of the liver
,B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver - answer ✔✔-A) Percuss the lower border of the liver
Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although
he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease.
Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the
following would you do next?
A) Check an ultrasound of the liver
B) Obtain a hepatitis panel
C) Determine liver span by percussion
D) Adopt a "watchful waiting" approach - answer ✔✔-c. Determine liver span by percussion
You are palpating the abdomen and feel a small mass. Which of the following would you do next?
A) Ultrasound
B) Examination with the abdominal muscles tensed
C) Surgery referral
D) Determine size by percussion - answer ✔✔-B) Examination with the abdominal muscles tensed
Mr. Kruger is an 84-year-old man who presents with a smooth lower abdominal mass in the midline
which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis
pubis. What does this most likely represent?
A) Sigmoid mass
B) Tumor in the abdominal wall
C) Hernia
D) Enlarged bladder - answer ✔✔-D) Enlarged bladder
,Which of the following is consistent with obturator sign?
A) Pain distant from the site used to check rebound tenderness
B) Right hypogastric pain with the right hip and knee flexed and the hip internally rotated
C) Pain with extension of the right thigh while the patient is on her left side or while pressing her knee
against your hand with thigh flexion
D) Pain that stops inhalation in the right upper quadrant - answer ✔✔-B) Right hypogastric pain with the
right hip and knee flexed and the hip internally rotated
A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked
two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have
peripheral vascular disease. Which of the following is part of common or concerning symptoms for the
peripheral vascular system?
A) Intermittent claudication
B) Chest pressure with exertion
C) Shortness of breath
D) Knee pain - answer ✔✔-A) Intermittent claudication
You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a
patient with known peripheral vascular disease in the legs. Which of the following aspects is important
to note when you perform your examination?
A) Size, symmetry, and skin color
B) Muscle bulk and tone
C) Nodules in joints
D) Lower extremity strength - answer ✔✔-A) Size, symmetry, and skin color
As the internal diameter of a blood vessel changes, the resistance changes as well. Which of the
following descriptions depicts this relationship?
A) Resistance varies linearly with the diameter.
, B) Resistance varies proportionally to the second power of the diameter.
C) Resistance varies proportionally to the third power of the diameter.
D) Resistance varies proportionally to the fourth power of the diameter. - answer ✔✔-D) Resistance
varies proportionally to the fourth power of the diameter.
A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of
pain after lifting a set of boxes that were heavier than usual. He also states that he has numbness and
tingling in the left leg. He wants to know if he needs to be off of work. What test should you perform to
assess for a herniated disc?
A) Leg-length test
B) Straight-leg raise
C) Tinel's test
D) Phalen's test - answer ✔✔-B) Straight-leg raise
A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle
collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think
that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her
neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side
of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is
the most likely cause of this neck pain?
A) Simple stiff neck
B) Aching neck
C) Cervical sprain
D) Cervical herniated disc - answer ✔✔-c. cervical sprain
A 28-year-old graduate student comes to your clinic for evaluation of pain "all over." With further
questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and
knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no
limitation in her range of motion. On physical examination, she has several points on the muscles of the
neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal.
Which of the following is likely the cause of her pain?
EXAMINATION WITH ALL DETAILED
ACCURATE SOLUTIONS
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. -
answer ✔✔-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.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?
A) Bronchitis
B) Simple asthma
C) Cystic fibrosis
D) Heart failure - answer ✔✔-A. Bronchitis
A patient with longstanding COPD was told by another practitioner that his liver was enlarged and this
needed to be assessed. Which of the following would be reasonable to do next?
A) Percuss the lower border of the liver
,B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver - answer ✔✔-A) Percuss the lower border of the liver
Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although
he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease.
Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the
following would you do next?
A) Check an ultrasound of the liver
B) Obtain a hepatitis panel
C) Determine liver span by percussion
D) Adopt a "watchful waiting" approach - answer ✔✔-c. Determine liver span by percussion
You are palpating the abdomen and feel a small mass. Which of the following would you do next?
A) Ultrasound
B) Examination with the abdominal muscles tensed
C) Surgery referral
D) Determine size by percussion - answer ✔✔-B) Examination with the abdominal muscles tensed
Mr. Kruger is an 84-year-old man who presents with a smooth lower abdominal mass in the midline
which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis
pubis. What does this most likely represent?
A) Sigmoid mass
B) Tumor in the abdominal wall
C) Hernia
D) Enlarged bladder - answer ✔✔-D) Enlarged bladder
,Which of the following is consistent with obturator sign?
A) Pain distant from the site used to check rebound tenderness
B) Right hypogastric pain with the right hip and knee flexed and the hip internally rotated
C) Pain with extension of the right thigh while the patient is on her left side or while pressing her knee
against your hand with thigh flexion
D) Pain that stops inhalation in the right upper quadrant - answer ✔✔-B) Right hypogastric pain with the
right hip and knee flexed and the hip internally rotated
A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked
two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have
peripheral vascular disease. Which of the following is part of common or concerning symptoms for the
peripheral vascular system?
A) Intermittent claudication
B) Chest pressure with exertion
C) Shortness of breath
D) Knee pain - answer ✔✔-A) Intermittent claudication
You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a
patient with known peripheral vascular disease in the legs. Which of the following aspects is important
to note when you perform your examination?
A) Size, symmetry, and skin color
B) Muscle bulk and tone
C) Nodules in joints
D) Lower extremity strength - answer ✔✔-A) Size, symmetry, and skin color
As the internal diameter of a blood vessel changes, the resistance changes as well. Which of the
following descriptions depicts this relationship?
A) Resistance varies linearly with the diameter.
, B) Resistance varies proportionally to the second power of the diameter.
C) Resistance varies proportionally to the third power of the diameter.
D) Resistance varies proportionally to the fourth power of the diameter. - answer ✔✔-D) Resistance
varies proportionally to the fourth power of the diameter.
A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of
pain after lifting a set of boxes that were heavier than usual. He also states that he has numbness and
tingling in the left leg. He wants to know if he needs to be off of work. What test should you perform to
assess for a herniated disc?
A) Leg-length test
B) Straight-leg raise
C) Tinel's test
D) Phalen's test - answer ✔✔-B) Straight-leg raise
A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle
collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think
that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her
neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side
of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is
the most likely cause of this neck pain?
A) Simple stiff neck
B) Aching neck
C) Cervical sprain
D) Cervical herniated disc - answer ✔✔-c. cervical sprain
A 28-year-old graduate student comes to your clinic for evaluation of pain "all over." With further
questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and
knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no
limitation in her range of motion. On physical examination, she has several points on the muscles of the
neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal.
Which of the following is likely the cause of her pain?
