Cerebrospinal fluid serves as a:
a. to regulate the chemical environment of the nervous tissue
b. to rinse metabolic wastes from the nervous tissue
c. to provide oxygen and nutrients to the nervous tissue
d. to protect the brain from striking the cranium when the head is jolted
At what age should the infant begin to transfer objects from hand to hand?
a. 2 months
b. 4 months
c. 7 months
d. 10 months
Deep pressure tests are used mostly for patients who are experiencing:
a. absent superficial pain sensation.
b. gait and stepping disturbances.
c. lordosis, osteoporosis, or arthritis.
d. brisk reflexes.
As Mr. B enters the room, you observe that his gait is wide-based and he staggers from side to side while swaying his trunk. You would document Mr. B’s pattern as:
a. dystonic ataxia.
b. cerebellar ataxia.
c. steppage gait.
d. tabetic stamping.
Cranial nerve XII may be assessed in an infant by:
a. watching the infant's facial expressions when crying.
b. observing the infant suck and swallow.
c. clapping hands and watching the infant blink.
d. observing the infant's rooting reflex.
If a patient cannot shrug his or her shoulders against resistance, which cranial nerve (CN) requires further evaluation?
a. CN I, olfactory
b. CN V, trigeminal
c. CN IX, glossopharyngeal
d. CN XI, spinal accessory
Ipsilateral Horner syndrome indicates a cerebrovascular accident (CVA) occurring in the:
a. anterior spinal artery.
b. internal or middle cerebral artery.
c. posterior inferior cerebellar artery.
d. vertebral or basilar arteries.
A neurologic past medical history should include data about:
a. family patterns of dexterity and dominance.
b. circulatory problems.
c. educational level.
An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14 days earlier and that primarily affects the motor and autonomic peripheral nerves in an ascending pattern is:
a. cerebral palsy.
b. HIV encephalopathy.
c. GuillainBarré syndrome.
d. Rett syndrome.
Diabetic peripheral neuropathy will likely produce:
a. hyperactive ankle reflexes.
b. diminished pain sensation.
c. exaggerated vibratory sense.
d. hypersensitive temperature perception.
A major risk factor for arterial embolic disease is:
a. venous thrombosis.
b. atrial fibrillation.
d. diuretic therapy.
An idiopathic spasm of arterioles in the digits is termed:
a. arteriosclerosis obliterans.
b. giant cell arteritis.
c. arteriovenous fistula.
d. Raynaud disease.
Conduction system impairment should be suspected if an irregular heartbeat is:
If pitting edema is unilateral, you would suspect occlusion of a:
a. lymphatic duct.
b. major vein.
c. surface capillary.
d. superficial artery.
A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud phenomenon includes which of the following?
b. Digital ischemia with pain.
c. Triphasic demarcated skin.
d. Cold and achy improving with warming.
A venous hum heard over the internal jugular vein of a child:
a. usually signifies untreatable illness.
b. usually has no pathologic significance.
c. usually requires surgical intervention.
d. must be monitored until the child is grown.
A bounding pulse in an infant may be associated with:
a. patent ductus arteriosus.
b. coarctation of the aorta.
c. decreased cardiac output.
d. peripheral vaso-occlusion.
A pulsation that is diminished to the point of being barely palpable would be graded as:
During a routine prenatal visit, Ms. T was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings:
a. are usual conditions during pregnancy.
b. indicate a need for hospitalization.
c. indicate the need for amniocentesis.
d. suggest that she is having twins.
A sound similar to a murmur that is heard over arteries is a:
c. friction rub.
A firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient’s breast. You should:
a. ask the patient if she has a history of breast cancer.
b. refer the patient to a surgeon.
c. ask the patient to have a mammogram as soon as possible.
d. record the finding in the patient's record.
A 23-year-old white woman has come to the clinic because she has missed two menstrual periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your response to this finding is to:
a. instruct her that this is a side effect of birth control injection therapy.
b. suggest pregnancy testing.
c. question her use of tanning beds.
d. schedule an appointment with a surgeon.
If your patient has nipple discharge, you will most likely need a:
a. Vacutainer tube.
b. glass slide and fixative.
c. specimen jar with formaldehyde.
d. tape strip to test pH.
A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a:
a. normal finding.
b. sign of carcinoma.
c. skin disease.
d. symptom of malnutrition.
Contraction of breast smooth muscle results in:
a. benign breast lumps.
b. the emptying of milk ducts.
c. nipple inversion.
d. nipple tenderness.
Documentation of a breast mass location is done:
a. according to illustration, without a narra-tive.
b. according to clock positions from the nip-ple.
c. by measuring with calipers from the nip-ple.
d. by measuring in centimeters from the sternal notch.
During pregnancy, which of the following changes normally occurs in the breasts because of the effects of luteal and placental hormones?
a. The amount of connective tissue increases.
b. The epithelial secretory activity decreases.
c. The alveoli increase in size and number.
d. Vascularization decreases.
A 50-year-old woman presents as a new patient. Which finding in her personal and social history would increase her risk profile for developing breast cancer?
a. Drinking three glasses of wine per week
b. Early menopause
d. Late menarche
A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythemic breasts bilaterally. You should advise the patient to:
a. massage gently and continue nursing.
b. apply warm compresses and stop nursing.
c. monitor her temperature and restrict flu-ids.
d. sleep wearing a bra and wash her breasts with antibacterial soap.
For purposes of examination and communication of physical findings, the breast is divided into:
a. halves (upper and lower).
b. thirds (left, middle, and right).
c. four quadrants plus a tail.
d. circles (six consecutive rings, each 1 inch farther away from nipple).
Equipment for examination of the anus, rectum, and prostate routinely includes gloves and:
a. a hand mirror and gauze.
b. a lubricant and penlight.
c. slides and normal saline.
d. swabs and culture medium.
A healthy prostate protrudes into the rectal wall a distance of _____ cm.
a. less than 1
b. 1 to 2
c. 2 to 3
d. 3 to 4
A common cause of dark green or black stools during pregnancy is:
a. consumption of iron preparations.
b. consumption of vitamins.
c. slow intestinal bleeding.
d. slow bleeding of hemorrhoids.
In males, which surface of the prostate gland is accessible by digital examination?
a. Median lobe
Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. Which sign would indicate to the health care provider that she has a closed anal passageway?
a. Development of a scaphoid abdomen
b. Vomiting after her first feeding
c. Bleeding from the rectum
d. Failure to pass meconium stool
A 70-year-old man has a prostate-specific antigen (PSA) value of 6 ng/mL and a negative digital rectal examination (DRE). These results indicate:
a. prostatic hypertrophy.
b. prostate cancer.
c. internal hemorrhoids.
d. a normal finding.
An infant with constipation and a consistently empty rectum may need evaluation for:
a. sexual abuse.
b. Hirschsprung disease.
c. rectal abscess.
d. intestinal parasites.
An expected anal or rectal finding late in pregnancy is the presence of:
A lower spinal cord lesion may be indicated by which finding?
a. Lack of an anal wink
b. Rectal prolapse
c. Anal fistula
d. Small flaps of anal skin
Factors associated with increased risk of prostate cancer include:
a. African descent.
b. cigarette smoking.
c. a low-fat diet.
Bimanual examination of the uterus includes:
a. grasping the cervix between the examining fingers.
b. grasping the vaginal wall and pulling it downward.
c. inserting one finger into the fundus.
d. placing the thumb on the clitoris and the forefinger on the cervix.
A young, sexually active woman comes to the urgent care clinic complaining of suprapubic abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria and no vaginal discharge or odor. A pelvic examination is done. She has pain with cervical motion, and you palpate a painful mass over the left adnexal area. Your prioritized action is to:
a. swab for gonococcal infection and then dip her urine.
b. obtain a surgical consult immediately.
c. remove the foreign body.
d. dip her urine and then swab for Chlamy-dia.
A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vaginal vault, you should first:
a. insert a pediatric vaginal speculum.
b. place the child prone and in the fetal posi-tion.
c. insert a cotton-tipped applicator and press down.
d. pull the labia forward and slightly to the side.
Asking the woman to close the introitus during a pelvic examination is a test for:
c. cervical polyps.
d. sphincter tone.
A cervical polyp usually appears as a:
a. grainy area at the ectocervical junction.
b. bright red, soft protrusion from the endo-cervical canal.
c. transverse or stellate scar.
d. hard granular surface at or near the os.
A bluish color to the cervix during pregnancy is called (the):
a. McDonald sign.
c. Goodell sign.
d. Chadwick sign.
Dacron swabs are necessary when testing for which condition?
A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. On inspection, you find posterior vulvar and gross perineum bruising.These findings are consistent with:
a. chronic masturbation.
b. congenital defects.
c. acute urinary tract infection.
d. sexual abuse.
A fixed uterus may indicate ______________.
An examiner has rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
a. Gonococcal cultureb
b. Cytology smear
c. Haemophilus smear
d. Trichomonas smear
A third heart sound is created by:
a. atrial contraction.
b. ventricular contraction.
c. diastolic filling.
d. regurgitation between the right and left ventricles.
A grade IV mitral regurgitation murmur would:
a. be described as a diastolic murmur.
b. not be expected to have a thrill.
c. radiate to the axilla.
d. be heard best at the base.
An example of a functional heart murmur is one that is caused by:
b. a ventricular septal defect.
c. an atrial septal defect.
d. mitral valve prolapse.
A lift along the left sternal border is most likely the result of:
a. aortic stenosis.
b. atrial septal defect.
c. pulmonary hypertension.
d. right ventricular hypertrophy.
A grade I or II murmur, without radiation and of medium pitch, is a common variation found in:
a. school-age children.
b. older women.
c. middle-age men.
d. older adults.
A condition that is likely to present with dizziness and syncope is:
a. bacterial endocarditis.
c. sick sinus syndrome.
An apical PMI palpated beyond the fifth intercostal space may indicate:
a. decreased cardiac output.
c. left ventricular hypertrophy.
A patient you are seeing in the emergency department for chest pain is believed to be having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of“heart trouble.” The most important follow-up question you should pose is which of the following?
a. "Did your father have coronary bypass surgery?"
b. "Did your father's father have heart trouble also?"
c. "What were your father's usual dietary habits?"
d. "What age was your father at the time of his death?"
A split second heart sound is:
b. greatest at the peak of inspiration.
c. heard best after forceful expiration.
d. supposed to disappear with deep inspira-tion.
A palpable rushing vibration over the base of the heart at the second intercostal space is called a:
Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe’s lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe’s symptoms?
b. Kidney stones
c. Meconium ileus
d. Pyloric stenosis
A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:
a. use a topical, over the counter hemorrhoid treatment for 1 week.
b. exercise and eat more fiber.
c. come to the laboratory for a stool guaiac test.
d. eat six small meals a day.
A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. A patient response to a history of present illness questions that further supports a tentative diagnosis of renal calculi is which of the following?
a. use a topical, over the counter hemorrhoid treatment for 1 week.
b. exercise and eat more fiber.
c. come to the laboratory for a stool guaiac test.
d. eat six small meals a day.
A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child’s diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a(n):
a. fixed mass palpated in the hypogastric area.
b. tender, midline abdominal mass.
c. olive-sized mass of the right upper qua-drant.
d. nontender, slightly movable, flank mass.
An umbilical assessment in the newborn that is of concern is:
a. a thick cord.
b. umbilical hernia.
c. one umbilical artery and two veins.
d. pulsations superior to the umbilicus.
Before performing an abdominal examination, the examiner should:
a. ascertain the patient's HIV status.
b. have the patient empty his or her bladder.
c. don double gloves.
d. completely disrobe the patient.
A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:
Contraction of the gallbladder propels bile into the:
d. large intestine.
A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. Which organ is most likely injured?
After thorough inspection of the abdomen, the next assessment step is:
d. rectal examination.
A 12-year-old boy relates that his left scrotum has a soft swollen mass. The scrotum is not painful on palpation. The left inguinal canal is without masses. The mass transilluminates with a penlight. This collection of symptoms is consistent with:
b. a hydrocele.
c. a rectocele.
d. a scrotal hernia.
Expected genitalia changes that occur as men age include that:
a. the ejaculatory volume decreases with age.
b. erections develop more quickly.
c. the viability of sperm increases.
d. the scrotum becomes more pendulous.
A premature infant’s scrotum will appear:
A painless indurated lesion on the glans penis is most consistent with a _________.
Difficulty replacing the retracted foreskin of the penis to its normal position is called:
b. Peyronie disease.
An enlarged painless testicle in an adolescent or adult male may indicate:
b. testicular torsion.
c. a tumor.
d. an undescended testicle.
An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria or fever. Your priority action should be to:
a. obtain urine and DNA probe urethral samples.
b. lift the left scrotum to confirm epididymi-tis.
c. establish absent cremasteric reflex.
d. transilluminate the left and right scrotum.
A characteristic related to syphilis or diabetic neuropathy is testicular:
a. dropping, with asymmetry.
c. insensitivity to painful stimulation.
d. recession into the abdomen.
A cremasteric reflex should result in:
a. testicular and scrotal rise on the stroked side.
b. penile deviation to the left side.
c. bilateral elevation of the scrotum.
d. immediate erection of the penis.
A finding associated with recurrent male genital herpes is:
a. disseminated lymphadenopathy.
b. pain subsiding with scrotal elevation.
c. soft, red papules on the prepuce.
d. superficial penile vesicles.
A 3-year-old is brought to the clinic complaining of a painful right elbow. He is holding his right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of:
a. radial head subluxation.
b. femoral anteversion.
c. carpal tunnel syndrome.
A common finding in markedly obese patients and pregnant women is:
A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign.
A finding that is indicative of osteoarthritis is (are):
a. swan neck deformities.
b. Bouchard nodes.
d. Heberden nodes.
A red, hot, swollen joint in a 40-year-old man should lead you to suspect:
A dowager hump is:
A positive straight leg raise test usually indicates:
a. leg length discrepancy.
b. improperly conditioned muscles.
c. lumbar nerve root irritation.
d. hip bursitis.
A wheelchair-dependent older woman would most likely develop skin breakdown at:
b. the iliac crests.
d. the gibbus.
A goniometer is used to assess:
a. bone maturity.
b. joint proportions.
c. range of motion.
d. muscle strength.
A 7-year-old child who begins to limp and complains of persistent hip pain may have:
a. congenital hip dislocation.
b. Dupuytren contracture.
c. Legg-Calvé-Perthes disease.
Functional assessment is most important during the examination of a(n):
c. older adult.
d. young adult.
An ophthalmoscopic eye examination involves:
a. lens inspection.
b. near vision evaluation.
c. sclera observation.
d. visual field assessment.
For a routine physical examination, all the following equipment is necessary except:
a. a penlight.
b. a measuring tape.
c. examination gloves.
d. a monofilament.
A common method for estimating gestational age of a newborn is to assess:
a. middle finger length.
b. creases on the sole of the foot.
c. umbilical placement.
d. visual acuity.
Examination of the patient in the lithotomy, or knee-chest, position includes:
a. inspection for inguinal hernias.
b. palpation of anal sphincter tone.
c. percussion of pelvic structures.
d. stereognosis testing.
According to the usual examination procedure, you would first assist your patient to assume which position?
An examiner might be able to help a patient who seems uncomfortable with close contact during an examination by:
a. acknowledging the discomfort.
b. backing away from the patient.
c. joking about the patient's discomfort.
d. moving briskly to completion.
At your first meeting with a patient, it is usually best to say:
a. "Let's get to the point.".
b. "I hope you will learn to trust me.".
c. "Let me tell you what I can do for you.".
d. "Tell me about yourself.".
As you greet the patient, which examination technique is first implemented?
In crying infants, it is often difficult to:
a. perform tactile fremitus assessments.
b. determine lung expansion.
c. auscultate heart sounds.
d. visualize the pharynx.
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