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Ball: Seidel’s Guide to Physical Examination, 9th Edition

      Authors: Jane Ball Joyce Dains John Flynn Barry Solomon Rosalyn Stewart
      Hardcover ISBN: 9780323481953
      Paperback ISBN: 9780323639675
      eBook ISBN: 9780323545068
      Published Date: 26th January 2018
       Imprint: Mosby
      Page Count: 720

Chapter 01: The History and Interviewing Process

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Which question would be considered a “leading question?”
   a. “Please describe any associated symptoms with your headaches?”
   b. “You don’t get headaches often, do you?”
   c. “What activities affect the severity of your headaches?”
   d. “What times of the day are your headaches the most severe?”
   e. “What worries you most about your headache?”


ANS: B
This question would limit the information in the patient’s
ANSwer. The other choices allow the patient more discretion about the extent of an
ANSwer.
TOP: Discipline: Behavioral Science MSC: Organ System: General

... 2. Which action would best promote accurate tr
ANSlations as well as confidentiality when the caregiver does not speak the patient’s language?
a. Ask a person unfamiliar with the patient to tr
ANSlate.
b. Have a friend of the patient tr
ANSlate.
c. Ask simple leading questions that the patient may understand.
d. Use a neighbor as tr
ANSlator.
e. Involve the family with the tr
ANSlation.


ANS: A
When you do not speak the patient’s language, family members or friends may pose a
communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased.

TOP: Discipline: Behavioral Science MSC: Organ System: General

3. Periods of silence during the interview can serve important purposes, such as:
a. allowing the clinician to catch up on documentation.
b. giving you a clue that you should speed up the interview.
c. providing time for reflection.
d. increasing the length of the visit.
e. promoting a calm environment.


ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning of courage, and displaying compassion. It is usually a clue for you to go slower and not to push too hard.
TOP: Discipline: Behavioral Science MSC: Organ System: General

4. Which technique is most likely to result in the patient’s understanding of questions? a. Use phrases that are commonly used by other patients in the area.
b. Use the patient’s own terms if possible.
c. Use language that keeps the patient from being exp
ANSive in his or her
ANSwer.
d. Use proper medical and technical terminology.
e. Use the simplest language possible.

ANS: B To ensure that your questions have been correctly understood, be clear, and explicit while using the patient’s idiom and level of understanding.

TOP: Discipline: Behavioral Science MSC: Organ System: General

5. A patient becomes restless during the history and says, “I don’t have time for all of this conversation. I’ve got to get back to work.” Your most appropriate response would be to:
a. stop using open-ended questions and become more direct.
b. ask another open-ended question and insist on an
ANSwer.
c. ask questions about his anger and move closer to him.
d. acknowledge his anger and proceed with the history and examination.
e. ignore his displeasure and become more assertive about getting
ANSwers.


ANS: D
This is the only
ANSwer that resists the tendency for patient manipulation, pursues the information, and confronts the patient’s anger.
TOP: Discipline: Behavioral Science MSC: Organ System: General

6. When questioning a patient regarding alcohol intake, she tells you that she is “only a social drinker.” Which initial response is appropriate?
a. “I’m glad that you are a responsible drinker.”
b. “Many people who are really alcoholic say they are social drinkers.”
c. “What amount and what kind of alcohol do you drink in a week?”
d. “If you only drink socially, you won’t need to worry about always having a designated driver.”
e. “Do the other people in your household consume alcohol?”


ANS: C
This
ANSwer clarifies the patient’s own term without asking a leading question or being judgmental.
TOP: Discipline: Behavioral Science MSC: Organ System: General

7. A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate?
a. “Can you describe the pain?”
b. “The pain doesn’t radiate to your arm, does it?”
c. “Have you been treated for anxiety before?”
d. “Does your father have heart disease?”
e. “Are the pains worse after you eat?”


ANS: A
Initially, an open-ended question is a more appropriate response. “Can you describe the pain?” is an open-ended question that offers clues to the chief concern.
TOP: Discipline: Behavioral Science MSC: Organ System: General

8. Ms. A. states, “My life is just too painful. It isn’t worth it.” She appears depressed.
Which one of the following statements is the most appropriate caregiver response?
a. “Try to think about the good things in life.”
b. “You shouldn’t feel that way; look at all the good things in your life.”
c. “You can’t mean what you’re saying.”
d. “If you think about it, nothing is worth getting this upset about.”
e. “What in life is causing you such pain?”


ANS: E
Specific yet open-ended questions are best used when the patient has feelings of loss of self-worth and depression. The other responses hurry the patient and offer superficial assurance.
TOP: Discipline: Behavioral Science MSC: Organ System: General

9. During an interview, you have the impression that a patient may be considering suicide. Which action is essential?
a. Immediately begin proceedings for an involuntary commitment.
b. Ask whether the patient has considered self-harm.
c. Ask whether the patient would like to visit a psychiatrist.
d. Record the impression in the patient’s chart and refer the patient for hospitalization.
e. Avoid directly confronting the patient regarding your impression.

ANS: B
If you think the patient may be considering suicide or she probably is. Mentioning it gives permission to talk about it.
TOP: Discipline: Behavioral Science MSC: Organ System: General

10. You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should:
a. never be interviewed alone because this may alienate the parent.
b. be mailed a questionnaire in advance to avoid the need for her to talk.
c. be given the opportunity to be interviewed without the parent at some point.
d. be allowed to direct the flow of the interview.
e. be ignored while you address all questions to the parent.


ANS: C
An older child should be given the opportunity to give information directly. This enhances the probability that the child will follow your advice.
TOP: Discipline: Behavioral Science MSC: Organ System: General

11. When communicating with older children and teenagers, you should be sensitive to their:
a. parent’s needs.
b. natural urge to communicate.
c. need for verbal instructions.
d. typical reluctance to talk.
e. desire for adult companionship.

ANS: D
Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality.
TOP: Discipline: Behavioral Science MSC: Organ System: General

12. When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should:
a. order a neurology consult.
b. stop all of his medications.
c. continue to press the patient for appropriate
ANSwers.
d. validate the concern with his family or caregivers.
e. dismiss the finding as a normal age-related change.

ANS: D
When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps.
TOP: Discipline: Behavioral Science MSC: Organ System: General

13. To what extent should the patient with a physical disability or emotional disorder be involved in providing health history information to the health professional?
a. All information should be obtained from family members.
b. All information should be collected from past records while the patient is in another room.
c. The patient should be involved only when you sense that he or she may feel ignored.
d. The patient should be fully involved to the limit of his or her ability.
e. The patient should be present during information collection but should not be addressed directly.


ANS: D
Patients with disabilities may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Family members may help provide a more complete history but not at the exclusion of the patient.
TOP: Discipline: Behavioral Science MSC: Organ System: General

14. When taking a history, you should:
a. ask patients to give you any information they can recall about their health.
b. start the interview with the patient’s family history.
c. use a chronologic and sequential framework.
d. use a holistic and eclectic structure.
e. start the interview with the social history.


ANS: C To give structure to the present problem or chief concern, the provider should proceed in a chronologic and sequential framework. Asking patients to give you any information they can recall about their health and using a holistic and eclectic structure do not provide for structure. Starting the interview with the patient’s family history and with the social history are incorrect because gathering data about the chief concern is the initial step.
TOP: Discipline: Behavioral Science MSC: Organ System: General

15. When questioning the patient regarding his or her sexual history, which question should be asked initially?
a. “Do you have any particular sexual likes or dislikes?”
b. “Do you have any worries or concerns regarding your sex life?”
c. “How often do you have intercourse and with whom?”
d. “Do you have any reason to think you may have been exposed to a sexually tr
ANSmitted infection?”
e. “What sexually tr
ANSmitted diseases have you had in the past?”

ANS: B
When approaching questioning about a sensitive area, it is recommended that the provider first ask open-ended questions that explore the patient’s feelings about the issue.
TOP: Discipline: Behavioral Science MSC: Organ System: General

16. Direct questioning about intimate partner violence in the home should be:
a. a routine component of history taking with female patients.
b. avoided for fear of offending the woman’s partner.
c. conducted only in cases in which there is a history of abuse.
d. used only when the Patients obviously being victimized.
e. used only when bruises are found on physical examination.

ANS: A
The presence of intimate partner violence should be routinely queried, and the questioning should be direct for all female patients.
TOP: Discipline: Behavioral Science MSC: Organ System: General

17. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:
a. Miller Analogies Test.
b. PACE Assessment Instrument.
c. CAGE questionnaire.
d. Glasgow Coma Scale.
e. HITS questionnaire.

ANS: C
The CAGE questionnaire is a model for approaching a discussion of the use of alcohol.
TOP: Discipline: Behavioral Science MSC: Organ System: General

18. When you enter the examination room of a 3-year-old girl, you find her sitting on her father’s
lap. She turns away from you when you greet her. Initially, your best response is to: a. screen the child for sexual abuse.
b. ask the child to be seated on the examination table so you can talk to her father.
c. explain to the child that you will not hurt her and that she will have to trust you.
d. ask the father to persuade the child to cooperate with you.
e. leave the child sitting in the father’s lap while you talk to the father.

ANS: E
Interaction with children must be modified according to age and in a manner that promotes trust.
TOP: Discipline: Behavioral Science MSC: Organ System: General

19. Tom is a 16-year-old young man with diabetes who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health?
a. Attachment to parents
b. Tendency to give too much information
c. Low peer support needs
d. Propensity for risk taking
e. High self-esteem

ANS: D
Adolescents tend to experiment with risky behaviors that lead to a high incidence of morbidity and mortality. Adolescents may be reluctant to provide information.
TOP: Discipline: Behavioral Science MSC: Organ System: General

20. Pain is difficult to assess in older adults because:
a. their histories are usually unreliable
b. sharp pain may be felt as a dull ache.
c. they tend to exaggerate symptoms.
d. their language skills decline.
e. drugs act more rapidly with age.

ANS: B
Pain is often an unreliable symptom in older adults because they lose pain perception and experience pain in a different manner from those in other age groups.
TOP: Discipline: Behavioral Science MSC: Organ System: General

21. A survey of mobility and activities of daily living (ADL) is part of a(n):
a. ethnic assessment.
b. functional assessment.
c. genetic examination.
d. social history.
e. sexual history.

ANS: B
A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, activities of daily living, and instrumental activities of daily living.
TOP: Discipline: Behavioral Science MSC: Organ System: General

22. Constitutional symptoms in the ROS refer to:
a. height, visual acuity, and body mass index.
b. fever, chills, fatigue, and malaise.
c. hearing loss, tinnitus, and diplopia.
d. rashes, skin turgor, and temperature.
e. joint stiffness, redness, and swelling.

ANS: B
General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change).
TOP: Discipline: Behavioral Science MSC: Organ System: General

23. J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) history.
a. complete
b. inventory
c. problem or focused
d. interim
e. family

ANS: C
If the patient is well known or if you have been seeing the patient for the same problem over time, a focused history is appropriate.
TOP: Discipline: Behavioral Science MSC: Organ System: General

24. A pedigree diagram is drafted for the purpose of obtaining:
a. sexual orientation and history.
b. growth and developmental status.
c. genetic and familial health problems.
d. ethnic and cultural backgrounds.
e. the past medical history.

ANS: C
Drafting a pedigree diagram, or genogram, is a method to determine consanguinity of health problems.
TOP: Discipline: Behavioral Science MSC: Organ System: General

Chapter 02: Cultural Competency

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Which statement is true regarding the relationship of physical characteristics and culture?
a. Physical characteristics should be used to identify members of cultural groups.
b. There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics.
c. To be a member of a specific culture, an individual must have certain identifiable physical characteristics.
d. Gender and race are the two essential physical characteristics used to identify cultural groups.
e. Whereas all cultural traits can be viewed as static, physical traits are dynamic.
ANS: B
Physical characteristics do not symbolize cultural groups; there is a difference between the two, and they are considered separately. Cultures are dynamic in their evolution.
TOP: Discipline: Behavioral Science MSC: Organ System: General

... 2. A fixed image of any group that rejects its potential for originality or individuality is known as a(n):
a. acculturation.
b. norm.
c. stereotype.
d. ethnos.
e. custom.

ANS: C
This definition describes a stereotype. A norm, on the other hand, is a standard of allowable behavior within a group,
ethnos implies the same race or nationality, and acculturation is a process of adopting another culture’s behaviors.
A custom refers to a habitual activity of a group in a given situation.

TOP: Discipline: Behavioral Science MSC: Organ System: General

3. Your new patient is a 40-year-old Middle Eastern man with a complaint of new abdominal pain. You are concerned about violating
a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:
a. do the examination because it is a necessary part of the physical examination.
b. ask a colleague from the same geographic area if this examination is acceptable
c. inform the patient of the reason for the examination and ask if it is acceptable to him.
d. refer the patient to a provider more knowledgeable about cultural differences.
e. forego the examination for fear of violating cultural norms.

ANS: C
Asking, if you are not sure, is far better than making a damaging mistake. You would not be doing your job as a professional
if you deferred the examination without a reason. It is not necessary to refer a skill you are capable of performing.
TOP: Discipline: Behavioral Science MSC: Organ System: General

4. Which statement is true regarding impoverished people?
a. In the United States, socioeconomic status does not influence the delivery of health care.
b. The morbidity and mortality rates of impoverished people are greater than those of the middle class.
c. The morbidity and mortality rates of impoverished people are less than those of the middle class.
d. No reliable statistics exist regarding the relationship of poverty to morbidity and mortality.
e. The morbidity and mortality rates of impoverished people are similar to those of the middle class.

ANS: B
Poorly educated people and people in poverty die at higher rates than those who are advantaged; the same is true for morbidity.
TOP: Discipline: Behavioral Science MSC: Organ System: General

5. In terms of cultural communication differences, Americ
ANS are more likely to than other groups of patients.
a. emphasize attitudes and feelings
b. maintain eye contact
c. come quickly to the point
d. use silence comfortably
e. speak more softly than other cultures

ANS: C
In the United States, individuals are very direct in conversation and come to the point quickly. They also tend to talk more loudly and to worry less about being overheard.
TOP: Discipline: Behavioral Science MSC: Organ System: General

6. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?
a. “How often do you have a medical examination?”
b. “What are your age, race, and educational level?”
c. “What types of symptoms have you been having?”
d. “Why do you think you are having these symptoms?”
e. “Do you take herbal remedies?”

ANS: D
This open-ended question avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged.
TOP: Discipline: Behavioral Science MSC: Organ System: General

7. A person’s definition of illness is likely to be most influenced by:
a. race.
b. ritual.
c. enculturation.
d. age group.
e. socioeconomic class.

ANS: C
The definition of “ill” is determined in large part by the individualand the process whereby an individual assumes the traits and behaviors of a given culture.
TOP: Discipline: Behavioral Science MSC: Organ System: General

8. An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Arabs is Western medicine’s attempt to:
a. use a holistic approach that views a particular medical problem as part of a bigger picture.
b. determine a specific cause for every problem in a precise way.
c. establish harmony between a person and the entire cosmos.
d. use herbal remedies and rituals.
e. promote balance in an individual’s life.

ANS: B A more scientific approach to healthcare problem solving, in which a cause can be determined for every problem in a precise way,
is a Western approach. Hispanics, Native Americ
ANS, Asi
ANS, and Arabs embrace a more “holistic” approach.
TOP: Discipline: Behavioral Science MSC: Organ System: General

9. A naturalistic or holistic approach to health care often assumes:
a. that hot conditions require treatment with a hot remedy.
b. a reductionist view that looks to a very narrow cause and effect.
c. there are external factors that must be kept in balance.
d. that there are hot and cold conditions but not hot and cold remedies. e. that hot and cold conditions are the same among different cultures.

ANS: C
A naturalistic or holistic approach often assumes that there are external factors—some good, some bad—that must be kept in balance if we are to remain well.
TOP: Discipline: Behavioral Science MSC: Organ System: General

10. Which maternal factor is most predictive of whether an infant will receive inoculations? a. The mother has family support.
b. The mother is divorced.
c. The mother breast-feeds.
d. The mother uses drugs.
e. The mother received prenatal care.

ANS: E
Mothers who take advantage of appropriate prenatal care generally take advantage of other infant care practices as well.
TOP: Discipline: Behavioral Science MSC: Organ System: General

11. Knowledge of the culture(s) of the patient should be used to:
a. form a standard practice procedure for that culture.
b. draw conclusions regarding individual patient needs.
c. form stereotypical categories.
d. help make the interview questions more pertinent.
e. form a sense of the patient based on prior knowledge.

ANS: D
The purpose of understanding the patient’s culture(s) is to help the provider construct pertinent questioning and avoid stereotyping.
TOP: Discipline: Behavioral Science MSC: Organ System: General

12. The attitudes of the healthcare professional are largely:
a. acculturated and cannot be changed.
b. uninfluenced by patient behavior.
c. difficult for the patient to sense.
d. culturally derived.
e. irrelevant to the success of relationships with the patient.

ANS: D
The attitude of a healthcare provider is foundationally derived from his or her own culture but cannot cause stereotypical judgments to be made;
understanding this is relevant to the success of patient relationships. Attitudes of the healthcare
professional are easily detected by others, and they influence patient behavior.
TOP: Discipline: Behavioral Science MSC: Organ System: General

13. All of the following are important aspects of reducing disparities in health care except: a. identify and monitor conscious and unconscious biases.
b. help the patient to learn about his or her disease or condition.
c. consider the health literacy of one’s patients.
d. try to discuss aspects of care without the influence of friends, partner, or family members.
e. encourage patients to complete patient satisfaction and demographics forms.
ANS: D
All of the above are ways a healthcare provider can reduce disparities in health care except the exclusion of a patient’s friends,
partner, or family members. It is important in reducing disparities in health care for the provider
to partner with patients and families to provide high-quality care.
TOP: Discipline: Behavioral Science MSC: Organ System: General

14. Which of the following is not an aspect of cultural humility?
a. Ability to recognize one’s limitations in knowledge and cultural perspective
b. Self-reflection and self-critique
c. Assuming all patients of a particular culture fit a certain stereotype d. Meeting patients “where they are” without judgment
e. Genuine interest in understanding our patients’ belief systems and lives

ANS: C
Rather than assuming all patients of a particular culture fit a certain stereotype,
healthcare providers should view patients as individuals. In doing so, cultural humility
helps equalize the imbalance in the patient-provider relationship.
TOP: Discipline: Behavioral Science MSC: Organ System: General

Chapter 03: Examination Techniques and Equipment

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing:
a. suture removal.
b. trachea care and suctioning.
c. wet-to-dry dressing changes.
d. patient bathing.
e. tube feedings.
ANS: B
Masks and eye protection or a face mask are indicated during procedures that are likely to generate splashes or sprays of body fluids, which include endotracheal secretions.

TOP: Discipline: Pathophysiology MSC: Organ System: General

...

2. Standard Precautions apply to all patients:
a. with bloodborne infections.
b. with infected, draining wounds.
c. in intensive care units.
d. receiving care in hospitals or office settings.
e. believed to have an infectious disease.

ANS: D
Although all of these statements are true, the best answer is patients receiving care in hospitals. Standard Precautions were developed with the intent of application to the care of all hospitalized or outpatients; however, the standard has merit and should be applied to all cases of patient care regardless of the environment where care is delivered.

TOP: Discipline: Pathophysiology MSC: Organ System: General

3. Which patient is at the highest risk for the development of latex allergy?
a. A new patient who has no chronic illness and has never been hospitalized
b. A patient who has had multiple procedures or surgeries
c. A patient who is allergic to eggs
d. A patient who is allergic to contrast dye
e. A patient who is a vegetarian
ANS: B
A patient who has had multiple procedures or surgeries has a higher exposure rate to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response.

TOP: Discipline: Pathophysiology MSC: Organ System: General

4. Which patient position is useful for auscultating heart tones?
a. Lithotomy
b. Dorsal recumbent
c. Left lateral recumbent
d. Right Sims
e. Prone
ANS: C
The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for hearing low-pitched sounds such as the third and fourth heart sounds.

TOP: Discipline: Pathophysiology MSC: Organ System: General

5. The use of secondary, tangential lighting is most helpful in the detection of:
a. variations in skin color.
b. enlarged tonsils.
c. foreign objects in the nose or ear.
d. variations in contour of the body surface.
e. variations in texture and mobility.
ANS: D
Tangential lighting is used to cast shadows so as to best observe contours and variations in body surfaces. All the other choices are best observed with direct lighting that does not cast shadows.
TOP: Discipline: Pathophysiology MSC: Organ System: General

6. You are conducting a head to toe examination as part of a patient’s preventive health assessment. The room has adequate lighting, and you have access to both sides of the examining table.
7. What Position Should you assume while conducting this examination?
a. Behind the patient
b. To the left side of the patient
c. Seated in a chair in front of the patient
d. To the right side of the patient
e. Standing in front of the patient
ANS: D
Although conventionally taught to approach an examination from the patient’s right side, it is not always practical. Therefore, it is important that the examiner develop the skills necessary to approach either side of the patient.
TOP: Discipline: Pathophysiology MSC: Organ System: General

8. Which part of the examiner’s hand is best for palpating vibration?
a. Dorsal surface
b. The thumb
c. Fingertips
d. Ulnar surface and base of the fingers
e. Finger pads
ANS: D
The ulnar surface of the hand and the base of the fingers can best feel vibratory sensations such as thrills and fremitus.
TOP: Discipline: Pathophysiology MSC: Organ System: General

9. The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone?
a. The more dense the medium, the louder the percussion tone.
b. The less dense the medium, the louder the percussion tone.
c. The more hollow the area percussed, the quieter the percussion tone.
d. Percussion over bony areas produces the loudest percussion tones.
e. Percussion tones are produced by the structure immediately beneath the skin.
ANS: B
Percussion sounds vary according to the tissue being percussed. Whereas less dense tissue (e.g., over a normal lung) produces a loud tone, more dense tissue (e.g., a muscle) produces a softer tone. Percussion tones arise from vibrations 4 to 6 cm deep in the body tissue.

TOP: Discipline: Pathophysiology MSC: Organ System: General

10. Expected normal percussion tones include:
a. dullness over the lungs.
b. hyperresonance over the lungs.
c. tympany over an empty stomach.
d. flatness over an empty stomach.
e. resonance over the liver.
ANS: C
Whereas a normal lung produces resonance percussion tones, an empty stomach is expected to produce tympany. Dull Percussion tones are heard over the liver.
TOP: Discipline: Pathophysiology MSC: Organ System: General

11. When percussing, a dull tone is expected to be heard over:
a. most of the abdomen.
b. emphysemic lungs.
c. the liver.
d. healthy lung tissue.
e. an empty stomach.
ANS: C
Dull tones are expected over more dense areas such as the liver.

TOP: Discipline: Pathophysiology MSC: Organ System: General

12. During percussion, the downward snap of the striking fingers should originate from the:
a. wrist.
b. forearm.
c. shoulder.
d. interphalangeal joint.
e. elbow.
ANS: A


The dominant hand’s middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface.

TOP: Discipline: Pathophysiology MSC: Organ System: General

13. During auscultation, you can limit your perceptual field best by:
a. asking patients to describe their symptoms.
b. listening through the patient’s clothing.
c. closing your eyes.
d. performing palpation before percussion.
e. turning out the lights in the examination room.
ANS: C
By closing your eyes, your sense of hearing becomes more acute, increasing your ability to isolate sounds.

TOP: Discipline: Pathophysiology MSC: Organ System: General

14. When examining the abdomen, which technique should be used first?
a. Inspection
b. Light palpation
c. Percussion
d. Auscultation
e. Direct palpation
ANS: A
Inspection is always used as the first technique in all physical examinations, including the abdomen.
TOP: Discipline: Pathophysiology MSC: Organ System: General

15. Auscultation should be carried out last except when examining:
a. the neck area.
b. the abdomen.
c. the lungs.
d. the heart.
e. none of the above; auscultation is always carried out last in a proper physical examination.
ANS: B
Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection.

TOP: Discipline: Pathophysiology MSC: Organ System: General

16. Which of the following statements is true regarding tympanic membrane temperature?
a. It is taken by placing an infrared probe anterior to the ear.
b. The probe is placed in the external auditory canal to occlude it.
c. Temperatures taken with a tympanic thermometer never vary from those taken by the oral or rectal route.
d. It is an accurate measurement of body temperature because the tympanic membrane shares its blood supply with the hypothalamus.
e. It is taken by placing an infrared probe posterior to the ear.
ANS: D
The tympanic membrane shares its blood supply with the hypothalamus and is therefore an accurate measurement of body temperature. Tympanic thermometer probes are gently placed at the external opening of the ear canal, but not in the canal, and they should not occlude the canal.

TOP: Discipline: Pathophysiology MSC: Organ System: General

17. A scale used to assess a patient’s weight should be calibrated:
a. when the patient tells you the weight is not correct.
b. by a qualified technician at regularly scheduled intervals.
c. each time it is used.
d. when necessary, with the patient standing on the scale.
e. only by the manufacturer.
ANS: C
Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading.

TOP: Discipline: Pathophysiology MSC: Organ System: General

18. An infant should be placed in which position to have his or her height or length measured?
a. Vertical, with the examiner’s hands under the infant’s axilla
b. Supine on a measuring board
c. While being held by a parent
d. In the lateral position with the toes against a measuring board
e. Prone on a measuring board
ANS: B
An infant should be placed supine on a measuring board to measure height or length.

TOP: Discipline: Pathophysiology MSC: Organ System: General

19. The stethoscope’s diaphragm is most useful in the assessment of sounds.
a. high-pitched
b. dull
c. low-pitched
d. rhythmic
e. tympanic
ANS: A
The diaphragm is best for hearing high-pitched sounds, such as breath sounds, bowel sounds, and normal heart tones.

TOP: Discipline: Pathophysiology MSC: Organ System: General

20. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell
endpiece to the skin?
a. It transmits low-pitched sounds.
b. It functionally converts to a diaphragm endpiece.


c. Assessment findings are more accurate.
d. Most sounds are occluded.
e. Abnormally low sounds are better transmitted.
ANS: B
Applying firm pressure to the bell endpiece causes the skin to act as a diaphragm, obliterating the low-pitched sounds.

TOP: Discipline: Pathophysiology MSC: Organ System: General

21. Weak pulses, fetal heart activity, and vessel patency are all best assessed with which type of stethoscope?
a. Diaphragm end of an acoustic stethoscope
b. Electronic
c. Ultrasonic
d. Magnetic
e. Bell end of an acoustic stethoscope
ANS: C
Only the ultrasonic stethoscope, the Doppler, can detect blood flow rather than amplify sounds, which is needed in assessing weak pulses, fetal heart activity, and vessel patency.

TOP: Discipline: Pathophysiology MSC: Organ System: General

22. A patient in the emergency department has a concussion to the head. You suspect that the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient?
a. StrabismoScope
b. Red-free filter
c. Slit lamp
d. Small aperture
e. Grid
ANS: B
The red-free filter permits recognition of hemorrhages. The grid estimates the size of lesions, the slit lamp examines the anterior eye and assesses the elevation of lesions, and the small aperture is used with small pupils. The strabismoScope is used for detecting strabismus.

TOP: Discipline: Pathophysiology MSC: Organ System: General

23. Which type of speculum should be used to examine a patient’s tympanic membrane?
a. The smallest speculum that will illuminate the ear
b. The largest speculum that will fit comfortably in the ear
c. The shortest speculum available
d. Any speculum that will fit the otoscope head
e. The longest speculum available
ANS: B
To visualize the tympanic membrane adequately, the largest speculum that can comfortably fit in the car canal should be used. The other choices do not ensure greater visibility of the membrane and landmarks.
TOP: Discipline: Pathophysiology MSC: Organ System: General

24. The pneumatic attachment for the otoscope is used to evaluate:
a. ear canal patency.
b. eardrum landmarks.
c. hearing acuity.
d. tympanic membrane movement.
e. tympanic membrane temperature.
ANS: D
The pneumatic attachment on the otoscope produces a puff or air to the tympanic membrane, resulting in its movement.

TOP: Discipline: Pathophysiology MSC: Organ System: General

25. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:
a. vibratory sensations.
b. hearing from bone conduction.
c. hearing range of normal speech.
d. noise above the threshold level.
e. peripheral motor nerve damage.
ANS: C
Normal speech has a range of 300 to 3000 Hz; therefore, a 500- to 1000-Hz fork is used most often because it can estimate hearing loss in the range of normal speech.

TOP: Discipline: Pathophysiology MSC: Organ System: General
26. A variant of the percussion hammer is a neurologic hammer, which is equipped with which of the following?
a. Brush and needle
b. Tuning fork and cotton swab
c. Penlight and goniometer
d. Ruler and bell
e. Transilluminator
ANS: A
A neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews, to which a sharp needle is attached.

TOP: Discipline: Pathophysiology MSC: Organ System: General

27. Transillumination functions on the principle that:
a. infrared radiation is easily detected.
b. black light causes certain substances to fluoresce.
c. converging and diverging light brings structures into focus.
d. tangential light casts shadows that illuminate contours.
e. air, fluid, and tissue transmit light differentially.
ANS: E


Transillumination functions to differentiate between various media in a cavity. It can distinguish among air, fluid, and tissue. It consists of a strong light in the visible spectrum with a narrow beam.

TOP: Discipline: Pathophysiology MSC: Organ System: General

28. For a woman with a small vaginal opening, the examiner should use a _ speculum.
a. plastic Graves
b. Pederson
c. pediatric
d. nasal
e. metal Graves
ANS: B
The Pederson speculum has blades that are as long as those of the Graves speculum, but are narrower and flatter and are therefore more comfortable for women with small vaginal openings. Pediatric or nasal speculums would be too small for adult use. Plastic speculums are similar in use to their metal counterparts.

TOP: Discipline: Pathophysiology MSC: Organ System: General

29. You are performing a vaginal examination on a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation?
a. Replace the metal speculum with a plastic one.
b. Put a blanket over the patient’s legs.
c. Remove the speculum.
d. Take her blood pressure.
e. Raise her legs above her heart.
ANS: C
This patient is experiencing symptoms of autonomic hyperreflexia. The first reaction should be for the examiner to remove the source of the stimulation. Cold tables, stirrups, insertion of a speculum, and pressure during pelvic examinations are examples of stimulations.

TOP: Discipline: Pathophysiology MSC: Organ System: General

Chapter 04: Clinical Reasoning


Ball: Seidel’s Guide to Physical Examination, 9th Edition


MULTIPLE CHOICE

1. After the subjective and objective data have been prioritized, the next step is to:
a. order laboratory tests.
b. formulate a problem list.
c. establish the diagnosis.
d. initiate therapy.
e. initiate appropriate consultations.
ANS: B
Formulate a problem list problems as specifically as possible. Identify and list the signs and symptoms associated with each of patient’s concerns as well as abnormalities discovered during the physical examination.
TOP: Discipline: Behavioral Science MSC: Organ System: General
...


2. New symptoms or findings of unknown etiology are:
a. problems to be noted on the problem list.
b. deferred for subsequent visits.
c. diagnosed before physical examination.
d. reserved for specialists.
e. usually “red herrings.”

ANS: A
New findings of unknown causes are added to the problem list, but do not let them become a
“red herring” that distracts your attention from the central issues.
TOP: Discipline: Behavioral Science MSC: Organ System: General

3. Which of the following is an accepted method of making a diagnosis?
a. Always unifying your findings into one diagnosis
b. Making maximal use of laboratory tests
c. Using first assumptions
d. Using algorithms
e. Relying on intuition
ANS: D
Methods to make a diagnosis include recognizing patterns, sampling the universe, and using algorithms. Unifying all of your findings into one diagnosis is not always possible. More than one disease process can exist at one time in the same patient. Do not rely on intuition, extensive use of laboratory findings, or always going with your first assumptions.
TOP: Discipline: Behavioral Science MSC: Organ System: General

4. Medical decision making requires a balance between:
a. speculation and feelings.
b. opinions and beliefs.
c. knowledge and superstition.
d. Mechanism and probability.
e. trust and suspicion.
ANS: D
Medical decision making must have a balance between mechanism and probability (certainty in knowledge is impossible).
TOP: Discipline: Behavioral Science MSC: Organ System: General

5. When evaluating results of laboratory tests, a test that is highly sensitive implies that the test:
a. suggests that a disease is present when it actually is not.
b. will not have any false-positive results.
c. suggests that a disease is absent when it is absent.
d. is able to correctly identify for the disease being tested.
e. is able to confirm a diagnosis even when the disease is not present.
ANS: D
Testing that is sensitive is a test that will be able to correctly identify persons with the disease that the test has been designed to test for. Positive results are more likely to be positive for the disease. High specificity suggests the ability of an observation to identify correctly those who do not have the disease.
TOP: Discipline: Biostatistics MSC: Organ System: General

6. A specific test is one that has the ability to:
a. correctly identify those who have the disease.
b. correctly identify those who do not have the disease
c. be exclusively used to make a diagnosis.
d. suggest the presence of a disease that is not present.
e. exclude competing explanations for another test finding.
ANS: B
The specificity of a test is determined by its ability to identify those who do not have the disease that the test is designed to test for. Negative results are more likely to be valid.
TOP: Discipline: Biostatistics MSC: Organ System: General

7. The proportion of persons with an observation characteristic of a disease that have the disease is known as value.
a. sensitivity positive specific
b. negative specific
c. positive predictive
d. negative predictive
e. true negative
ANS: C
A positive predictive value is defined as the proportion of persons thought to have a disease who actually have the disease.
TOP: Discipline: Biostatistics MSC: Organ System: General

8. Which of the following is not a component of a management plan?
a. Presumptive diagnosis
b. Subspecialty consultation
c. Diet modification
d. Follow-up visit
e. Patient education
ANS: A
The management plan details what you are going to do about a patient problem such as subspecialty consultations, diet modifications, follow-up visits, and any necessary patient education.
TOP: Discipline: Behavioral Science MSC: Organ System: General

9. When determining priorities for planned actions, the practitioner should:
a. address problems in the order of their chronologic development.
b. consider whether the patient is concerned about a particular problem before addressing it.
c. ignore the patient’s social and economic circumstances.
d. address the most urgent problem first.
e. never consider if the cost of care will impact other areas of the patient’s life.
ANS: D
In developing patient care plans, priority should be given to the most life threatening and urgent physical needs of the patient. Then focus on addressing the patient’s social and economic circumstances and whether the cost of care will impact other areas of the patient’s life.
TOP: Discipline: Behavioral Science MSC: Organ System: General

10. Bits of information that are distracting and draw your thinking away from central issues are referred to as:
a. Bayes theorem.
b. true negatives.
c. mechanism and probability
d. red herrings.
e. false negatives.
ANS: D
Beware of red herrings, the bits of information that are distracting and draw your thinking away from central issues. Critically evaluate unexpected or unusual findings but do not let them distort full consideration of all you have learned.
TOP: Discipline: Behavioral Science MSC: Organ System: General

11. In issues surrounding ethical decision making, beneficence refers to the:
a. appropriate use of medical resources.
b. care provider acting as a father or mother figure.
c. care provider knowing what is best for the patient.
d. need to avoid harming the patient.
e. need to do good for the patient.
ANS: E
The definition of beneficence is to do good, not being paternalistic, and the need to avoid harm refers to nonmaleficence. Utilitarianism is the appropriate use of resources for the greater good of the larger community.
TOP: Discipline: Behavioral Science MSC: Organ System: General

12. The term denoting the caregiver’s need to do no harm to the patient is:
a. autonomy.
b. deontologic imperative.
c. nonmaleficence.
d. utilitarianism.
e. beneficence.
ANS: C
The definition of nonmaleficence is to do no harm.
TOP: Discipline: Behavioral Science MSC: Organ System: General

13. Which of the following is initially appropriate in the management of a patient’s diagnosed
problem?
a. Inform the patient of the treatment plan.
b. Give the patient detailed written instructions regarding the treatment plan.
c. Inform the patient that the plan has been tailored to his needs.
d. Inform the patient of treatment options and possible results.
e. Lead the patient to an understanding that you know the best treatment option.
ANS: D
An initial approach to a patient’s problem should allow for the greatest patient autonomy and should promote patient participation. The well-informed patient is better able to exercise autonomy. Only informing the patient of treatment options and possible results does this.
TOP: Discipline: Behavioral Science MSC: Organ System: General


Chapter 05: Documentation

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. During the course of the interview, you should:
a. take no notes of any kind.
b. take brief written notes.
c. take detailed written notes.
d. repeat pertinent comments into a Dictaphone.
e. interrupt the interview to formulate your thoughts.
ANS: B
During the interviewing process, it is important to maintain eye contact with the patient and to spend as little time as possible looking at your notes, so brief written notes are more practical. Later you can go back and formulate a well-versed history by linking all the pieces together.

TOP: Discipline: Behavioral Science MSC: Organ System: General
...


2. Subjective and symptomatic data are:
a. documented in your assessment.
b. not mentioned in the legal chart.
c. placed in the history sections.
d. recorded with the examination technique.
e. documented with the findings.
ANS: C
Subjective data, as well as symptomatic data, should not be part of the physical examination findings; rather, their documentation is appropriate for the history portion.
TOP: Discipline: Behavioral Science MSC: Organ System: General

3. The quality of a symptom, such as pain, is subjective information that should be:
a. deferred until the cause is determined.
b. described in the history using a 0 to 10 scale.
c. placed in the past medical history section.
d. placed in the history with objective data.
e. interpreted in light of your physical findings.
ANS: B
Pain is subjective, and only the patient can rate the perceived severity. Pain, therefore, should be recorded in the history using a 0 to 10 scale.
TOP: Discipline: Behavioral Science MSC: Organ System: General

4. Drawing of stick figures is most useful to:
a. compare findings in the extremities.
b. demonstrate radiation of pain.
c. indicate organ enlargement.
d. indicate mobility of masses.
e. indicate consistency of lymph nodes.
ANS: A
Simple drawings, such as stick figures, are more practical illustrations for findings in the extremities. Radiation of pain, organ enlargement, consistency of lymph nodes, and mobility of masses would not be adequately described by such simple drawings.

TOP: Discipline: Behavioral Science MSC: Organ System: General


5. Which of the following is an example of a problem requiring recording on the patient’s problem list?
a. Common age variations
b. Expected findings
c. Findings of unknown origin
d. Minor variations
e. Only findings that have a clear etiology
ANS: C
Any problem is worth noting on the patient problem list even if the etiology or significance is unknown. Common age variations, expected findings, and minor variations within normal limits should not be classified as problems.

TOP: Discipline: Behavioral Science MSC: Organ System: General

6. Differential diagnoses belong in the:
a. history.
b. physical examination.
c. assessment.
d. plan.
e. laboratory data.
ANS: C

Differential diagnoses for problems that have not been diagnosed are placed in the assessment category for each problem. The differentials are prioritized, and contributing factors are identified.

TOP: Discipline: Behavioral Science MSC: Organ System: General

7. When recording assessments during the construction of the problem-oriented medical record, the examiner should:
a. combine all data into one assessment.
b. create an assessment for each problem on the problem list.
c. create an assessment for every abnormal physical finding.
d. create an assessment for every symptom presented in the history.
e. create an assessment for each abnormal laboratory finding.
ANS: B
After the examiner has a list of problems constructed, an assessment is made for each unique problem.

TOP: Discipline: Behavioral Science MSC: Organ System: General

8. Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical examination. This visit would be documented by creating a(n):
a. progress note.
b. incident report.
c. problem-oriented medical record.
d. triage note.
e. new problem list.
ANS: A
A second visit with the clinician is always recorded on a progress note, noting any updates to the condition.
TOP: Discipline: Behavioral Science MSC: Organ System: General

9. The effect of the chief concern on the patient’s lifestyle is recorded in which section of the
medical record?
a. Chief complaint
b. History of present illness
c. Past medical history
d. General patient information
e. Social history
ANS: B
The effect of the patient’s complaint on his or her current everyday lifestyle or work
performance is recorded in the history of present illness.
TOP: Discipline: Behavioral Science MSC: Organ System: General

10. The patient’s perceived disabilities and functional limitations are recorded in the:
a. problem list.
b. general patient information.
c. social history.
d. review of systems.
e. past medical history.
ANS: E
Past medical history contains information about the patient’s lifetime as well as disabilities or
functional limitations that alter activities of daily living.
TOP: Discipline: Behavioral Science MSC: Organ System: General

11. The review of systems is a component of the:
a. physical examination.
b. health history.
c. assessment.
d. past medical and surgical history.
e. personal and social history.
ANS: E
Review of systems relates health history according to physical systems and is related just before the actual physical examination.
TOP: Discipline: Behavioral Science MSC: Organ System: General

12. Allergies to drugs and foods are generally listed in which section of the medical record?
a. General patient information
b. Past medical history
c. Social history
d. Problem list
e. History of present illness
ANS: B
The past medical history section contains information such as drugs, foods, and environmental allergies.
TOP: Discipline: Behavioral Science MSC: Organ System: General

13. Objective data are usually recorded:
a. by body systems.
b. in the history.
c. subsequent to the assessment and plan.
d. before the health history.
e. in the problem list.
ANS: A
All objective data are recorded by body systems and anatomic locations.

14.
TOP: Discipline: Behavioral Science MSC: Organ System: General
Information recorded about an infant differs from that of an adult, mainly because of the
infant’s:
a. attention span.
b. developmental status.
c. nutritional differences.
d. source of information.
e. limited past medical history.
ANS: B
The organizational structure of an infant’s record is different because the infant’s current and
future health is referenced in terms of developmental status.
TOP: Discipline: Behavioral Science MSC: Organ System: General

15. In which section of the newborn history would you find details of gestational assessment and extrauterine adjustment data?
a. Family
b. General patient information
c. Personal and social
d. Present problem
e. Past medical
ANS: D
For a newborn, the focus of recorded information is the details of the mother’s pregnancy, the gestational development, and events occurring since birth. These data are recorded in the present problem section of the history.
TOP: Discipline: Behavioral Science MSC: Organ System: General

16. Data relevant to the social history of older adults include information on:
a. family support systems.
b. extra time to assume positions.
c. over-the-counter medication intake.
d. date of last cancer screening.
e. previous healthcare visits.
ANS: A
The social history of older adults includes community and family support systems. Healthcare visits, medications, cancer screenings, and extra time to assume positions for the physical examination are not part of the social history.
TOP: Discipline: Behavioral Science MSC: Organ System: General

17. A SOAP note is used in which type of recording system?
a. Preventive care
b. Pedigree
c. Systems review
d. Traditional treatment
e. Problem oriented
ANS: E
A SOAP note, which includes subjective problem data, objective problem data, assessment, and plan, is a type of recording system that has a problem-oriented style.
TOP: Discipline: Behavioral Science MSC: Organ System: General

18. The examiner’s evaluation of a patient’s mental status belongs in the:
a. history of present illness.
b. review of systems.
c. physical examination.
d. patient education.
e. problem list.
ANS: C
Mental status assessment, including cognitive and emotional stability and speech and language, is part of the physical examination. Anything subjective is part of the review of systems and those findings that are objective are part of the provider’s assessment.
TOP: Discipline: Behavioral Science MSC: Organ System: General

19. When recording physical findings, which data are recorded first for all systems?
a. Review of systems
b. Percussion
c. Palpation
d. Auscultation
e. Inspection
ANS: E
Physical assessment for all systems begins with inspection.
TOP: Discipline: Behavioral Science MSC: Organ System: General

20. Regarding another provider’s documented work, it:
a. is not relevant in a legal proceeding.
b. will not affect clinical decisions.
c. may be copied verbatim into your documentation.
d. must be attributed to the source if entered.
e. does not affect patient care.
ANS: D
It is unacceptable to copy other providers’ documented work (e.g., history taken, examination performed, or thought processes outlined) and enter it into your own documentation as if you did the work. Text copied from another person’s note must always be attributed to the source. This is not only an important concept in a legal proceeding, but it is also critical for safe patient care.
TOP: Discipline: Behavioral Science MSC: Organ System: General

21. Which of the following abbreviations is approved by The Joint Commission on Accreditation of Hospitals?
a. U (unit)
b. qd (daily)
c. MS (morphine sulfate)
d. All of the above
e. None of the above
ANS: B
The Joint Commission has identified “improving communications among caregivers” as a patient safety goal. Certain abbreviations have been placed on a “do not use” list when an error in misreading the abbreviation could cause harm. All of the above abbreviations are on the “do not use” list.
TOP: Discipline: Behavioral Science MSC: Organ System: General



Chapter 06: Vital Signs and Pain Assessment

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Body temperature is regulated by the:
a. thalamus.
b. hypothalamus.
c. medulla.
d. pons.
e. cerebellum.
ANS: B
Body temperature is regulated by the hypothalamus.

TOP: Discipline: Pathophysiology MSC: Organ System: General
...

2. Which of the following is not involved in increasing body temperature?
a. Exogenous pyrogens
b. Vasoconstriction
c. Shivering
d. Vasodilation
e. Prostaglandins
ANS: D
Body cooling occurs by vasodilation, which increases heat loss through the skin and evaporation of perspiration.
TOP: Discipline: Pathophysiology MSC: Organ System: General

3. Which of the following is most closely related to damage or dysfunction of the central or peripheral nervous system?
a. Chronic pain
b. Neuropathic pain
c. Acute pain
d. Acute inflammation
e. Surgery
ANS: B
Neuropathic pain is a long-term pain associated with damage or dysfunction of the central or peripheral nervous system (e.g., amputation, complex pain syndrome).

TOP: Discipline: Pathophysiology MSC: Organ System: General

4. Nociceptors transmit pain impulses from the periphery along A-delta and C-polymodal fibers to the:
a. posterior horn of the spinal cord.
b. hypothalamus.
c. cerebellum.
d. dorsal horn of the spinal cord.
e. pons.
ANS: D
Pain impulses travel from the site of injury to the dorsal horn of the spinal cord and then through the ascending spinal tracts to the thalamus and cerebral cortex.

TOP: Discipline: Pathophysiology MSC: Organ System: General

5. Which of the following make infants more susceptible to hypothermia?
a. Low body surface area for weight
b. Thicker skin
c. Limited ability to cope with cold stress
d. Higher pulse rate
e. Lower blood pressure
ANS: C
Infants are more susceptible to hypothermia because of their large ratio of body surface area to weight, thinner skin, and limited ability to cope with cold stress. Infants have a higher pulse rate and lower blood pressure than adults, but this is unrelated to hypothermia.

TOP: Discipline: Pathophysiology MSC: Organ System: General

6. A 5-year-old is complaining of nondescriptive “belly pain.” Your next action should be to ask
him to: point a finger to the spot that hurts.
a. draw a circle around the area that hurts.
b. use a metaphor to describe the pain.
c. identify what makes the pain worse.
d. allow him to use a “pain-o-meter.”
ANS: A
Asking the child to point to the area of pain can help communicate a more precise location. The other choices are not appropriate for the age of the child.

TOP: Discipline: Behavioral Science MSC: Organ System: General

7. During pregnancy, all of the following may be related to back pain except:
a. lax pelvic ligaments.
b. weight gain.
c. hyperlordosis.
d. anterior tilt of the pelvis.
e. lower blood pressure.
ANS: E
Blood pressure commonly decreases beginning at about 8 weeks of gestation, gradually falling until a low point is reached at midpregnancy, but this is unrelated to the back pain some women experience during pregnancy.

TOP: Discipline: Pathophysiology MSC: Organ System: General

8. The value of the use of scales for patients to rate their pain intensity is that:
a. the emotional responses are factored in.


b. correlation with others’ expectations is achieved.
c. the patient’s response to therapy can be documented.
d. subjective responses are eliminated.
e. the patient’s perception is minimized.
ANS: C
The use of scales permits the very important day-to-day documentation of the response to
therapy. Although the patient’s perception is the controlling variable, the patient is still giving a subjective measurable response.

TOP: Discipline: Behavioral Science MSC: Organ System: General

9. A pain scale that is reliable and valid for children is the:
a. pain-o-meter scale.
b. pain-rating instrument scale.
c. numeric pain intensity scale.
d. Wong/Baker Faces Rating Scale.
e. descriptive pain intensity scale.
ANS: D
The Wong/Baker Faces Rating Scale and the Oucher Scale are examples of pain scales that are reliable and valid for use with children.

TOP: Discipline: Behavioral Science MSC: Organ System: General

10. Which is the most reliable indicator of a patient’s pain?
a. Facial grimacing

b. Grunting or groaning
c. Body movements
d. Reluctance to be moved



e. Patient’s report of the pain
ANS: E
The patient’s report of pain is the most reliable indicator of pain and should be believed even when observed behaviors do not seem to correspond.

TOP: Discipline: Pathophysiology MSC: Organ System: General

11. Which of the following groups has the greatest variation in pulse rate?
a. Toddlers
b. Premature infants
c. Neonates
d. Adolescents
e. Older adults
ANS: B
The newborn’s pulse rate is more variable than that of toddlers, adolescents, and older adults. The variation is greatest around the time of birth and is even more marked in premature infants.

TOP: Discipline: Pathophysiology MSC: Organ System: General


12. The heart rate of a pregnant woman may increase to a level at term that is _ higher than normal.
a. 5% to 10%
b. 10% to 30%
c. 40% to 60%
d. 60% to 80%
e. 80% to 100%
ANS: B
The heart rate of a pregnant woman gradually increases throughout pregnancy until it is 10% to 30% higher at term.

TOP: Discipline: Pathophysiology MSC: Organ System: General

13. Hypertension in a pregnant woman (blood pressure reading greater than or equal to 160 mm Hg systolic or 110 mm Hg diastolic) is one sign of:
a. a normal pregnancy.
b. a nulliparous woman.
c. preeclampsia.
d. a multiparous woman.
e. Braxton Hicks contractions.
ANS: C
A gradual increase in blood pressure is common from the second to the third trimester. However, hypertension in this range may be a sign of preeclampsia. Braxton Hicks contractions are sporadic uterine contractions that start at around 6 weeks of pregnancy and are not associated with gestational hypertension or preeclampsia.

TOP: Discipline: Pathophysiology MSC: Organ System: General

14. Blood pressure may increase during the process of aging caused by:
a. increasing vagal tone.
b. decreasing cardiac output.
c. diminished tolerance to pain.
d. increasing stiffness of the blood vessels.
e. decreasing vascular resistance.
ANS: D
During the process of aging the systolic blood pressure often increases because of increasing stiffness of the blood vessels and increased vascular resistance. Increasing vagal tone may decrease the pulse rate.

TOP: Discipline: Pathophysiology MSC: Organ System: General

15. The difference in blood pressure readings between the right and left arms is considered normal up to mm Hg.
a. 5
b. 10
c. 20
d. 25
e. 30



ANS: B
Blood pressure readings between the left and right arms may vary by as much as 10 mm Hg and tends to be higher in the right arm.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

16. Postural hypotension is defined as which of the following when the patient stands compared with a sitting or supine reading?
a. Blood pressure drop of more than 20 mm Hg in systolic and 10 mm Hg drop in diastolic
b. Pulse rate decrease with a systolic pressure increase of at least 15 mm Hg
c. Diastolic pressure increase of more than 5 mm Hg and no pulse rate changes
d. Pulse rate decrease and diastolic pressure decrease of more than 5 mm Hg
e. Decrease in pulse pressure
ANS: A
Postural hypotension (orthostatic hypotension) represents a significant decrease in systolic pressure (greater than 20 mm Hg) and a 10 mm Hg drop in diastolic pressure as a patient changes from a sitting to a standing position. An increase in heart rate often occurs as well.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

17. The most frequent cause of serious hypertension in children is:
a. malnutrition.
b. liver failure.
c. renal disease.
d. rheumatic fever.

e. heart disease.
ANS: C



Do not make the diagnosis of hypertension based on one reading. If the systolic blood pressure is elevated and the diastolic is not, anxiety may be responsible. Most children with a diagnosis of hypertension have an identifiable cause, usually renal disease.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

18. Systolic hypertension in the adult less than 60 years of age is generally defined as pressure in excess of:
a. 120 + the patient’s age.
b. 140.
c. 160.
d. 180.
e. 200.
ANS: B
Hypertension continues to be defined as a blood pressure consistently at 140/90 mm Hg or higher. The equation that systolic blood pressure should be less than 120 + the patient’s age is no longer the acceptable definition.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular


19. The risk of hypertension in children is about four times higher for those with BMI (body mass index) more than:
a. 50%
b. 65%
c. 75%
d. 85%
e. 95%
ANS: D
Because of the increase in numbers of children and adolescents who are obese, primary or essential hypertension is becoming more common. The risk of hypertension is about four times higher in children at more than 85th percentile of body mass index (BMI).

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

Chapter 07: Mental Status

Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE

1. When is the mental status portion of the neurologic system examination performed?
a. During the history-taking process
b. Immediately after the vital signs are taken
c. During the time when questions related to memory are asked
d. Constantly, throughout the entire interaction with a patient
e. During assessment of cranial nerves and deep tendon reflexes
ANS: D
A mental status evaluation should be continually evaluated throughout the patient encounter. Assessing and validating clues to determine the individual’s ability to interact with the environment is a priority of the mental status evaluation.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
...

2. Which statement is true regarding mental status changes in older adults?
a. There is usually a decline in general intelligence in older adults.
b. Vocabulary and inventories of information show a marked decrease in older adults.
c. Remote memory decline frequently causes problems in processing information.
d. Recent memory is usually more efficient than remote memory.
e. There is an increased risk of delirium with acute illness or metabolic derangement.

ANS: E

Acute illness or metabolic derangement of older adults places such a stress on the declining metabolism and synthesis of neurotransmitters that adaptation is inadequate, and delirium results. None of the other statements are true.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

3. A 69-year-old truck driver presents with a sudden loss of the ability to understand spoken language. This indicates a lesion in the:
a. temporal lobe.
b. Broca area.
c. frontal cortex.
d. precentral gyrus.
e. occipital lobe.
ANS: A
The temporal lobe, specifically in the Wernicke speech area, is responsible for the comprehension of spoken and written language.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

4. Slumped posture and a lack of facial expression may indicate depression or:
a. anxiety.
b. Parkinson disease.
c. loss of abstract reasoning.
d. attention-deficit/hyperactivity disorder.
e. hyperthyroidism.
ANS: B
A slumped posture and lack of facial expression may be clues to more than depression; they also are a defining characteristic of the neurologic disorder known as Parkinson disease.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

5. The ability for abstract thinking normally develops:
a. in utero.
b. during infancy.
c. during early childhood.
d. during adolescence.
e. during adulthood.
ANS: D
Abstract thinking is an intellectual maturation that develops during adolescence.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

6. The Mini-Mental State Examination (MMSE):
a. may be used to estimate cognitive changes quantitatively.
b. may be used to estimate personality disorders qualitatively.
c. scores do not vary with regard to age or education.
d. will determine the cause of memory loss.
e. is a good tool to diagnose neurologic disorders
ANS: A
The MMSE is a standard tool that functions to estimate cognitive function quantitatively or to document cognitive changes serially. None of the other statements are correct.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

7. Assessing orientation to person, place, and time helps determine:
a. the ability to understand analogies.
b. abstract reasoning.
c. attention span.
d. state of consciousness.
e. emotional status.
ANS: D
Orientation to person, place, and time are measures of states of consciousness and awareness, not degrees of attention span. Analogies and abstract reasoning are higher functions than orientation. Emotional status can be better evaluated by observing behaviors.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

8. A state of impaired cognition, consciousness, mood, and behavioral dysfunction of acute onset refers to:
a. lethargy.
b. delirium.
c. stupor.
d. coma.
e. confusion.
ANS: B
Delirium is a state of impaired cognition, consciousness, mood, and behavioral dysfunction of acute onset. Stupor describes arousals for short periods of time after a stimulus for arousal (e.g., visual, verbal, or painful). Lethargy relates to sleepiness with ease of arousal; coma is nonarousal and nonawareness. Confusion relates to inappropriate responses to questions with decreased attention span and memory.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

9. When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing which of the following?
a. Level of consciousness
b. Abstract reasoning
c. Emotional stability
d. Memory
e. Impaired judgment
ANS: B
Asking the patient to tell you the meaning of a proverb, metaphor, or fable assesses the patient’s ability to reason abstractly. This intelligence test does not assess level of consciousness, emotional health, judgment, or memory.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

10. Impairment of arithmetic skills is often caused by:
a. impaired execution of motor skills.
b. impaired judgment.
c. peripheral neuropathies.
d. depression.
e. perceptual distortions.
ANS: D
The patient with depression or diffuse brain disease can display difficulty with simple arithmetic calculations. This is not commonly seen with motor skill impairments, judgment impairments, or perceptual distortions and hallucinations. Peripheral neuropathies are best assessed by evaluating motor skills.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

11. Peripheral neuropathy is most likely to be manifested by:
a. impaired memory.
b. impaired abstract reasoning.
c. impaired writing ability.
d. hallucinations.
e. difficulties with analogies.
ANS: C


Uncoordinated writing or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or peripheral neuropathy due to nerve damage and loss of feeling in fingers making it difficult to hold a pencil.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

12. Loss of immediate and recent memory with retention of remote memory suggests:
a. attention-deficit/hyperactivity disorder (ADHD).
b. impaired judgment.
c. stupor.
d. dementia.
e. delirium.
ANS: D
Dementia is the loss of immediate and recent memory while retaining remote memories. ADHD is associated with recent and remote memory impairment, impaired judgments are thought process dysfunctions, and stupor is impaired consciousness. Delirium manifests with confusion with disordered perceptions as well as motor and sensory excitement, with inappropriate reactions to stimuli.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

13. Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for the assessment of:
a. mood and feelings.
b. attention span.
c. thought process and content.
d. abstract reasoning.
e. speech and language skills.
ANS: C
Thought process and content are examined while observing the patient’s patterns of thinking, especially appropriateness of sequence, logic, coherence, and relevance to the topics discussed.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

14. Facial muscle or tongue weakness may result in:
a. aphasia.
b. word salad.
c. neologisms.
d. echolalia.
e. impaired comprehension.
ANS: A
Aphasia can result from facial muscle or tongue weakness or from neurologic damage to the speech and language region of the brain. Neologisms (word choice based on sound so that words rhyme in a nonsensical way), word salad (meaningless, disconnected word choices), and echolalia (parrot speech) are coherence disturbances.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous


15. The examiner should be concerned about neurologic competence if a social smile cannot be elicited by the time a child is old.
a. 3 days
b. 2 weeks
c. 1 month
d. 3 months
e. 6 months
ANS: D
A social smile is expected in the 2- to 3-month-old infant. If it is difficult or impossible to elicit a social smile by 3 months, the infant may not be neurologically intact.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

16. Which of the following is usually related to structural diseases of the brain?
a. Delirium
b. Dementia
c. Depression
d. Anxiety
e. Psychosis
ANS: B
One of the distinguishing characteristics that distinguishes dementia from the others is that it is usually related to structural diseases of the brain such as abnormal deposits, or recurrent strokes. The other options are not structural diseases, but instead they are neurochemical imbalances.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous
17. Which statement is true in regard to attention-deficit/hyperactivity disorder (ADHD)?
a. It occurs before 7 years of age.
b. It is usually related to mental retardation.
c. It is usually related to dementia.
d. It is manifested by prolonged periods of catatonic behavior.
e. It usually first manifests with decorticate posturing.
ANS: A
ADHD occurs before 7 years of age, is not related to mental retardation or psychiatric disorders, and is not a form of dementia. Decorticate posturing in unresponsive patients indicates a significant lesion above the brainstem.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

18. An aversion to touch or being held, along with delayed or absent language development, is characteristic of:
a. attention-deficit/hyperactivity disorder.
b. autism.
c. dementia.
d. mental retardation.
e. schizophrenia.
ANS: B
Autistic disorder involves a combination of behavioral traits (e.g., lack of awareness of others, aversion to touch or being held, odd or repetitive behaviors, preoccupation with parts of objects) and communication deficits (usually echolalia [parrot speech]).

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

19. All of the following are usually associated with a neurochemical imbalance except:
a. schizophrenia.
b. mania.
c. anxiety disorder.
d. autism.
e. depression.
ANS: D
Autism is a pervasive neurodevelopmental disorder of unknown etiology that has a strong genetic influence. All of the other disorders can be related to neurochemical imbalances in the brain.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

20. While interviewing a patient, you ask him to explain “a stitch in time saves nine” to assess:
a. reading comprehension.
b. attention span.
c. mood and feeling.
d. reasoning skills.
e. perceptual distortions.

ANS: D
Having the patient explain fables, proverbs, or metaphors determines abstract reasoning skills.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

21. Expected memory skills vary with the age of the child. When testing immediate recall, a 5-year-old can be expected to repeat how many digits or words?
a. 1
b. 2
c. 3
d. 4
e. 5
ANS: D
When testing immediate recall, a 4-year-old can repeat three digits or words, a 5-year-old can repeat four digits or words, and a 6-year-old can repeat five digits or words.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

Chapter 08: Growth, Measurement, and Nutrition

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Two hypothalamic hormones control growth hormone synthesis and secretion in the anterior pituitary gland. Growth hormone–releasing hormone (GHRH) and:
a. IGF-I.
b. thyroid hormone.
c. leptin.
d. somatostatin.
e. thyroid-stimulating hormone.
ANS: D
Somatostatin, or growth hormone–inhibiting hormone (GHIBH), inhibits the secretion of both GHRH and thyroid-stimulating hormone (TSH).

TOP: Discipline: Physiology MSC: Organ System: Endocrine
...

2. Which hormone is known as the “hunger hormone”?
a. Leptin
b. IGF-I
c. Ghrelin
d. Somatostatin
e. TSH

ANS: C
Ghrelin, a peptide, known as the “hunger hormone,” helps control growth hormone release and influences food intake and obesity development.

TOP: Discipline: Physiology MSC: Organ System: Endocrine

3. After 50 years of age, stature:
a. becomes fixed.
b. begins a barely perceptible secondary increase.
c. increases at a rate of 0.5 cm/year.
d. declines.
e. declines and then begins a barely perceptible increase.
ANS: D
As an individual reaches 50 years of age, the intervertebral disk begins to thin and becomes more compressed, which leads to a decline in stature.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

4. By 10 to 12 years of age, lymphatic tissues are about adult size.
a. 25% of
b. 50% of
c. the same as
d. twice the
e. five times the
ANS: D
Lymphatic tissues are small compared to the total body size, but they are almost fully developed at birth. They grow fast and are about twice the adult size by 10 to 12 years of age.

TOP: Discipline: Physiology MSC: Organ System: Hematopoietic/Lymphoid

5. Which organ(s) complete(s) physical development more quickly than any other body part?
a. Brain
b. Kidneys
c. Heart
d. Lungs
e. Lymphoid tissue
ANS: A
Along with the skull, eyes, and ears, the brain completes development more quickly than any other part of the body; its most rapid growth occurs from conception to age 2 years.

TOP: Discipline: Physiology MSC: Organ System: Nervous

6. During adolescence, the head size normally increases as a result of:
a. sinus development.
b. brain mass increase.
c. evolution of lymphatic tissue.
d. hypertrophy of glial cells.
e. hypertrophy of myelin.

ANS: A
As the facial sinuses grow, the head size enlarges its surface area to accommodate this growth.

TOP: Discipline: Physiology MSC: Organ System: General

7. Fifty percent of an individual’s ideal weight is gained during:
a. pregnancy.
b. preschool years.
c. adolescence.
d. early adulthood.
e. older adulthood.
ANS: C
During adolescence, the trunk and legs grow the most, causing organs and the skeletal mass to double in size. During pregnancy, weight gain is accounted for by the growing fetus and pregnancy organs (placenta and uterus). In the preschool years, weight is gained at a steady rate, with fat tissue increasing slowly until about 7 years of age. In early adulthood, there is a reduction in size and weight. A decrease in weight for height and body mass index has been found with increasing age between 70 and 89 years of age.

TOP: Discipline: Physiology MSC: Organ System: General

8. Sexual maturation begins earlier in girls with a higher:
a. upper-to-lower segment ratio.
b. arm span.
c. head circumference.
d. gestational age.
e. body mass index (BMI).
ANS: E
Sexual maturation begins earlier in girls with a higher body mass index. On average, black girls enter puberty first, followed by Mexican American girls and then white girls. Sexual maturation, as measured by the onset of pubic hair development, begins earlier in black boys than white boys.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

9. The legs are the fastest growing body part during:
a. early infancy.
b. late infancy.
c. childhood.
d. adolescence.
e. early adulthood.
ANS: C
The legs grow the fastest during childhood, the trunk grows fastest in infancy, and the skeletal muscles and organs grow fastest in early adulthood.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

10. Skeletal mass and organ systems double in size during:

a. infancy.
b. early childhood.
c. adolescence.
d. early adulthood.
e. mid-life.
ANS: C
During puberty, sex steroids stimulate secretion of growth hormone, causing the organs and skeletal mass to double in size.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

11. Achieving an optimal infant birth weight is difficult for pregnant adolescents because:
a. they have not completed their own growth spurt.
b. there are insufficient uterine supporting structures.
c. the amnionic fluid is variable in adolescents.
d. blood volume has not reached adult proportions.
e. most of the maternal tissue growth occurs in the third trimester.
ANS: A
Pregnant adolescents younger than 16 years of age, or less than 2 years from menarche, may still be in their growth spurt. They may require higher weight gains during pregnancy to achieve an optimal infant birth weight. Maternal tissue growth accounts for most of the weight gain in the first and second trimesters.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

12. How much of the weight gained during a normal pregnancy is accounted for by an increase in blood volume?
a. Less than 1 pound
b. 1 to 2 pounds
c. 3 to 4 pounds
d. 4 to 6 pounds
e. 6 to 8 pounds
ANS: C
An increase in blood volume usually accounts for 3 to 4 pounds of the weight gained during pregnancy. The remainder is due to the fetus and increases in maternal tissues (fluid volume, breasts, uterus, amniotic fluid, and increases in maternal fat and protein stores).

TOP: Discipline: Physiology MSC: Organ System: Reproductive

13. Milestone achievements are data most likely to appear in the history of:
a. adolescents.
b. infants.
c. school-age children.
d. young adults.
e. older adults.
ANS: B
As part of the developmental assessment in infants, milestone achievements at certain ages, such as crawling, laughing, picking up the head, and turning over, are recorded.

TOP: Discipline: Behavioral Science MSC: Organ System: Nervous

14. Infants normally increase their birth length by % during the first year of life.
a. 10
b. 25
c. 50
d. 100
e. 200
ANS: C
Infant length generally increases by 50% in the first year of life.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

15. Healthy term babies generally double their birth weight by what age?
a. 1 month
b. 3 months
c. 5 months
d. 9 months
e. 12 months
ANS: C
In general, healthy infants double their birth weight by 4 to 5 months of age and triple their birth weight by 12 months of age. Formula-fed infants are heavier after the first 6 months of life than breast-fed infants; they grow faster in the first 6 months of life and experience slower growth in the second 6 months of the first year.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

16. You should measure the child’s head circumference at every health visit until at least age
months.
a. 3
b. 8
c. 12
d. 18
e. 24
ANS: E
Head circumference should be measured at every visit until 2 to 3 years of age.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

17. To measure head circumference, the tape is wrapped snugly around the child’s head at the
occipital protuberance and the:
a. supraorbital prominence.
b. brow line.
c. nasal bridge.
d. chin.

e. hairline.
ANS: A
The measuring tape should be snugly wrapped around the child’s head at the occipital protuberance and the supraorbital prominence, thereby documenting the largest circumference. Care should be taken to ensure that the tape does not cut the skin. Make the reading to the nearest 0.5 cm or inch; remember to remeasure the head circumference at least once to check the accuracy of your measurement.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

18. Between 5 and 24 months of life, the infant’s chest circumference is normally:
a. about equal to the head circumference.
b. greater than the head circumference by 2 inches.
c. smaller than the head circumference by about 4 inches.
d. at least 2 inches smaller than head circumference.
e. none of the above; there is no relation between head and chest circumference during this period.
ANS: A
Between the ages of 5 months and 2 years, the infant’s chest circumference should closely approximate the head circumference; the ratio should be monitored so that microcephaly can be identified, if present.

TOP: Discipline: Physiology MSC: Organ System: Reproductive


19. In clinical practice, the Ballard Assessment Tool is used to assess a newborn’s:
a. length.
b. weight.
c. lung maturity.
d. gestational age.
e. future IQ.
ANS: D
The Ballard Assessment Tool assesses six physical and six neuromuscular characteristics,
administered within 36 hours of birth, to confirm the newborn’s gestational age.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

20. The term large for gestational age (LGA) indicates that an infant is larger than % of
infants born at the same number of weeks’ gestation.
a. 10
b. 25
c. 50
d. 75
e. 90
ANS: E
LGA corresponds to an infant who is in the greater than 90th weight percentile.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

21. The upper-to-lower segment ratio should be calculated:
a. bimonthly for the first year of life.
b. annually for the first 5 years.
c. when a child is suspected of having a growth problem or unusual body proportions.
d. in children of first-generation immigrants.
e. every 6 months for the first 24 months.
ANS: C
The upper-to-lower ratio is assessed when a child is suspected of having a growth problem or unusual body proportions.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

22. An 11-year-old boy is brought in for an annual physical examination by his mother. You suspect when you measure his arm span at 65 inches and his height at 60 inches.
a. premature pubarche
b. hypothyroidism
c. scoliosis
d. Marfan syndrome
e. dwarfism
ANS: D
Arm span that is greater than a child’s height is associated with Marfan syndrome. These children can have cardiovascular problems and should be thoroughly evaluated with a cardiologist consult.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

23. Which of the following statements regarding female pubertal changes is true?
a. Most adolescent girls develop breasts before pubic hair.
b. Peak height velocity should occur after menarche.
c. Breast asymmetry is an abnormal finding.
d. Menarche should occur by Tanner breast stage B.
e. Sexual maturation begins later in taller and heavier girls.
ANS: A
In two-thirds of girls, breasts begin to develop before pubic hair. Peak height velocity actually occurs about 1 year before menarche, breast asymmetry is common, and menarche occurs after Tanner breast stage B. Sexual maturation begins earlier in taller and heavier girls.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

24. At what age does peak height growth velocity occur in boys?
a. 6 years
b. 10 years
c. 12 years
d. years
e. years
ANS: D
Peak height velocity occurs at an average age of years.


TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal


25. What is the youngest age at which pubic hair growth in a boy may be considered normal?
a. 7 years
b. 8 years
c. 9 years
d. 10 years
e. 11 years
ANS: C
In boys, sexual development before 9 years of age is precocious puberty and is considered an abnormal finding.

TOP: Discipline: Physiology MSC: Organ System: Endocrine

26. Which Tanner stage is marked by the most significant growth in penis length?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
e. Stage 5
ANS: C
Tanner stage 3 is marked by enlargement of the penis, especially in length.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

27. Which breast Tanner stage corresponds to a secondary areola mound development above the breast?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
e. Stage 5
ANS: D
Tanner stage 4 depicts the stage in which the areola forms a second mound above the breast.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

28. A woman with a normal prepregnancy body mass index (BMI) should gain around pounds during pregnancy.
a. 10
b. 15
c. 20
d. 30
e. 40
ANS: D
Women of normal BMI should expect to gain between 25 and 35 pounds during pregnancy.

TOP: Discipline: Physiology MSC : Organ System: Reproductive
29. Frontal skull bossing, cranial ridges, mandibular overgrowth, and maxillary widening are characteristics of:
a. infantile hydrocephalus.
b. acromegaly.
c. Cushing syndrome.
d. achondroplasia.
e. Turner syndrome.
ANS: B
These presenting features are all prominent characteristics of acromegaly; teeth separation and malocclusion can result from the maxillary widening.

TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine

30. A round face, preauricular fat, hyperpigmentation, and a buffalo hump in the posterior cervical area are associated with:
a. infantile hydrocephalus.
b. hypopituitary dwarfism.
c. Cushing syndrome.
d. achondroplasia.
e. acromegaly.
ANS: C


These are all commonly associated characteristics of Cushing syndrome, with the buffalo hump as a distinguishing feature.

TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine

31. Which of the following is the most accurate reflection of an individual’s food intake?
a. 24-hour diet recall
b. Food diary
c. Computerized nutrient analysis
d. Serum protein assays
e. Comparing the individual’s intake with the MyPlate.gov website.
ANS: B
A food diary is recorded as it happens, making this method the most accurate reflection of an
individual’s food intake.

TOP: Discipline: Physiology MSC: Organ System: General

32. Deficiency of which of the following is a concern in the vegetarian diet?
a. Ascorbic acid
b. Vitamin B12
c. Folate
d. Carbohydrates
e. Vitamin K
ANS: B
The nutrients that may be deficient in a vegetarian diet if not carefully planned include proteins, calcium, iron, vitamin B12 and vitamin D
TOP: Discipline: Physiology MSC: Organ System: General

33. Monitoring a patient’s waist-to-hip ratio provides data concerning:
a. daily caloric requirements.
b. lung capacity.
c. stomach cancer risk.
d. cardiovascular disease risk.
e. developing an eating disorder.
ANS: D
Waist-to-hip ratios may aid in predicting relative disease risk in terms of cardiovascular disease.

TOP: Discipline: Physiology MSC: Organ System: General

34. Which of the following is a macronutrient?
a. Iron
b. Thiamin
c. Calcium
d. Fat
e. Alcohol
ANS: D
Carbohydrates, protein, and fat are referred to as macronutrients because they are required in large amounts. Even though alcohol also provides calories, it is not required for any physiologic process by the body.

TOP: Discipline: Physiology MSC: Organ System: General

35. Which of the following hormones has a key role in regulating body fat mass and is believed to be a trigger for puberty?
a. Insulin-like growth factor I (IGF-I)
b. Leptin
c. Growth hormone
d. Somatostatin
e. Ghrelin
ANS: B
Leptin has a key role in regulating body fat mass, and its concentration is thought to be a trigger for puberty by informing the central nervous system that adequate nutritional status and body fat mass are present to support pubertal changes and growth.

TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine

36. Which of the following characteristics can distinguish patients with anorexia from those with bulimia?
a. Adolescent and young adult women are affected.
b. Patients may exercise excessively to lose weight.
c. Refusal to maintain body weight at 85% of ideal body weight.
d. Patients may abuse laxatives and diuretics.
e. Patients have amenorrhea
ANS: C
Bulimic individuals usually do not become malnourished (as occurs with anorexic patients) unless they drop to less than 85% of their weight.

TOP: Discipline: Behavioral Science MSC: Organ System: General

37. A major risk factor for developing an eating disorder is having:
a. parents who stress academia and social acceptance.
b. a first-degree relative with an eating disorder.
c. siblings who are low academic achievers.
d. parents who stress the importance of the food pyramid.
e. parents in a lower socioeconomic group.
ANS: B
A major risk factor for an eating disorder is having a family history of eating disorders, especially in a first-degree relative.

TOP: Discipline: Behavioral Science MSC: Organ System: General

38. What percentage of adults over age 20 are estimated to be obese in the United States?
a. 10%
b. 25%
c. 33%
d. 50%
e. 66%
ANS: C
In the United States it is estimated that more than one-third of adults older than 20 years are obese and more than two-thirds are overweight. Poor diet and physical inactivity (regardless of weight status) are associated with serious chronic diseases including type 2 diabetes, hypertension, cardiovascular disease, osteoporosis, and some types of cancer.

TOP: Discipline: Behavioral Science MSC: Organ System: General

Chapter 09: Skin, Hair, and Nails

Ball: Seidel’s Guide to Physical Examination, 9th Edition


MULTIPLE CHOICE
1. The skin repairs epidermal wounds by:
a. exaggerating cell replacement.
b. excreting lactic acid.
c. producing vitamins.
d. providing a mechanical barrier.
e. increasing the vascularity of the epidermis.
ANS: A
The skin’s tissue cells have a rapid rate of turnover and constant renewal, thereby enabling the skin to repair damaged surfaces. The epidermis is avascular and depends on the underlying dermis for its nutrition.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective ...
2. The adipose tissue in the hypodermis serves to:
a. provide sensory input.
b. generate heat and insulate.
c. create tensile strength.
d. restrict water loss.
e. secrete collagen.

ANS: B
The hypodermis layer consists of adipose tissue that serves to generate heat and to provide insulation, shock absorption, and a reserve of calories.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

3. The secretory activity of the sebaceous glands is stimulated by:
a. body heat.
b. ambient temperature.
c. sex hormones.
d. dietary protein.
e. emotional stimuli.
ANS: C
The sebaceous glands, when stimulated by the sex hormones, become stimulated to produce a lipid-rich substance that keeps the skin moist.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

4. Which structure is the site of new nail growth?
a. Cuticle
b. Paronychium
c. Eponychium
d. Nail bed
e. Matrix
ANS: E
The white, crescent-shaped area beyond the proximal nail fold (lunula) is the distal end of the nail matrix, which is the site of new nail growth.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

5. Newborns are more vulnerable to hypothermia because of:
a. the presence of coarse terminal hair.
b. desquamation of the stratum corneum.
c. their covering of vernix caseosa.
d. a poorly developed subcutaneous fat layer.
e. excessive secretion of eccrine sweat glands.
ANS: D
Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced ability to generate heat and become insulated from the environment. The eccrine sweat glands do not begin to function until after the first month of life.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

6. Normal hormone-related changes of adolescence include:
a. increased oil production.
b. the development of fine silky lanugo hair.
c. depletion of apocrine glands.
d. decreased sebaceous gland activity.
e. slowed hair growth.
ANS: A



During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

7. Expected hair distribution changes in the older adults include:
a. increased terminal hair follicles to the scalp.
b. more prominent axillary and pubic hair production.
c. increased terminal hair follicles to the tragus of men’s ears.
d. more prominent peripheral extremity hair production.
e. women possibly developing less coarse facial hair.
ANS: C
The transition from vellus to terminal hair pattern occurs in older men at the nares and the tragus.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

8. Brittle nails are typical findings in:
a. adolescents.
b. infants.
c. pregnant patients.
d. older adults.
e. children.
ANS: D
Older adults typically have decreased peripheral circulation to the nails, causing the nails characteristically to develop longitudinal ridges that are more brittle and susceptible to splitting into layers.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

9. The nails of older adults grow slowly because of:
a. decreased circulation.
b. dietary deficiencies.
c. fungal infections.
d. low hormone levels.
e. high estrogen levels.
ANS: A
Decreased circulation to the nails of older adults causes nail growth retardation.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

10. Risk factors for skin cancer include:
a. an olive complexion.
b. repeated trauma or irritation to the skin.
c. a history of allergic reactions to sunscreen.
d. dark eyes and hair.
e. pigmented bands in the nails,
ANS: B
Fair-skinned persons with light-colored eyes and repeated trauma or skin irritation have higher risk factor for skin cancer development. Pigmented bands in the nails are an expected finding in dark-skinned individuals.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

11. Inspection to determine color variations of the skin is best conducted:
a. using an episcope.
b. under fluorescent lighting.
c. with illumination provided by daylight.
d. using a Wood’s lamp.
e. using a pen light.
ANS: C
Daylight provides the best illumination source for determining color variations of the skin.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

12. Unusual white areas on the skin may be caused by:
a. adrenal disease.
b. polycythemia.
c. vitiligo.
d. Down syndrome.
e. lentigo.
ANS: C
The absence of melanin produces unpigmented white areas known as vitiligo.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

13. Which cultural group has the lowest incidence of nevi?
a. Native Americans
b. African Americans
c. Mexican Americans
d. Asians
e. Eastern Europeans
ANS: B
Nevi are more common in persons who burn rather than tan; therefore, African Americans have the lowest rates of nevi.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

14. A 29-year-old white woman appears jaundiced. A cause of liver disease has been excluded. What history questions should the nurse ask?
a. Whether she had unprotected sex
b. If she has a history of diabetes mellitus
c. Whether she has unusual bleeding problems
d. If she eats a lot of yellow and orange vegetables
e. If she has a family history of peripheral vascular disease
ANS: D
In the absence of liver disease, another cause of jaundice is increased carotene pigmentation. Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin appear to be jaundiced; however, carotene pigmentation will not cause the sclera to turn yellow.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

15. A flat, nonpalpable lesion is described as a macule if the diameter is:
a. greater than 1 cm.
b. less than 1 cm.
c. greater than 2 cm.
d. too irregular to measure.
e. exactly 5 mm.
ANS: B
A macule by definition is a flat, circumscribed area that is less than 1 cm in diameter. An example of a macular rash is measles.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

16. Skin turgor checks are performed to determine:
a. the temperature of the skin.
b. hydration status.
c. skin texture.
d. the extent of an ecchymosis.
e. skin moisture.
ANS: B
Skin will remain tented if the patient is dehydrated or will not tent if edema is present.

TOP: Discipline: Physiology MSC: Organ System: Skin/Connective

17. Skin lesions are transilluminated to determine:
a. vascular from nonvascular lesions.
b. furuncles from folliculitis lesions.
c. fluid-filled lesions in solid cysts or masses.
d. herpes zoster from varicella.
e. macules from papules.
ANS: C
Transillumination is used to determine the presence of fluid in cysts and masses. Fluid-filled lesions transilluminate with a red glow, but solid masses do not transilluminate. This technique does not differentiate the other choices.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

18. Fluorescing lesions are best distinguished using a(n):
a. incandescent lamp.
b. magnifying glass.
c. transilluminator.
d. Wood’s lamp.
e. halogen lamp.
ANS: D
Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow-green color under a
Wood’s lamp.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

19. Women with terminal hair growth in a male distribution pattern should receive further evaluation for a(n):
a. circulation condition.
b. gastrointestinal disorder.
c. inflammatory state.
d. nutritional deficit.
e. endocrine disorder.
ANS: E
Hirsutism in women (growth of terminal hair in a male distribution) can be a clinical sign of an endocrine disorder. Hair loss can be associated with poor circulation, inflammation, or nutritional deficits.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective


20. Transient mottling of the patient’s skin in a cool room is a common finding in:
a. menopausal women.
b. newborn infants.
c. pregnant patients.
d. sedentary adults.
e. older adults.
ANS: B
Cutis marmorata, a mottled appearance, is part of a newborn’s response to changes in
temperature.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

21. A single transverse crease seen on the palm of a small child may imply:
a. Down syndrome.
b. Turner syndrome.
c. systemic sclerosis.
d. profound dehydration.
e. neurofibromatosis.
ANS: A
A single transverse crease is seen on the palm of children with Down syndrome.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

22. Cafe au lait patches are numbered with each assessment of infants and young children because:
a. their numbers are expected to increase each year
b. coalescent lesions are a more serious finding.
c. the presence of more than six patches suggests neurofibromatosis.
d. decreasing numbers are expected with growth.
e. a higher number correlates with the development of erythema toxicum.
ANS: C
The presence of more than six patches with diameters of more than 5 mm in children younger than 5 years of age suggests neurofibromatosis. Fewer than five patches are usually considered harmless.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

23. Cherry angiomas are a common finding in:
a. adults older than 30 years.
b. newborns.
c. pregnant patients.
d. sunbathers.
e. adolescents.
ANS: A
Cherry angiomas occur in virtually everyone older than 30 years and increase numerically with age.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

24. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish:
a. cutaneous tags from lentigines.
b. furuncles from folliculitis.
c. sebaceous hyperplasia from eczema.
d. seborrheic keratoses from actinic keratoses.
e. herpes zoster from varicella.
ANS: D
Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

25. The most common inflammatory skin condition is:
a. cutis marmorata.
b. eczematous dermatitis.
c. intradermal nevus.
d. pityriasis rosea.
e. psoriasis.
ANS: B
The most common inflammatory skin disorder is eczematous dermatitis. Cutis marmorata and nevi are not inflammatory conditions, pityriasis rosea is not as common as eczema, and psoriasis is a disease of keratin synthesis.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
26. The characteristic that best differentiates psoriasis from other skin abnormalities is the:
a. color of the scales.
b. formation of tiny papules.
c. general distribution over the body.
d. recurrence.
e. loss of hair.
ANS: A
Unlike other skin conditions, silvery papules and plaques characterize psoriasis.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

27. Painful vesicles are associated with:
a. psoriasis.
b. pityriasis rosea.
c. paronychia.
d. herpes zoster.
e. rosacea.
ANS: D
Herpes zoster (shingles) produces painful itching or burning of the dermatome area. Psoriasis and pityriasis may itch. Paronychia infection and rosacea may be tender to touch and do not produce vesicles.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

28. Which of the following is an ABCD characteristic of malignant melanoma?
a. Asymmetric borders
b. Borders well demarcated
c. Color of lesion is uniform
d. Diameter less than 6 mm
e. Severe blistering or sunburns as a child
ANS: A
The ABCD melanoma mnemonic includes asymmetry, borders that are irregular, color that is not the same all over, and diameter greater than 6 mm and growing. Severe blistering or sunburns as a child is a risk factor and not part of the ABCD characteristics.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

29. The most common cutaneous neoplasm is:
a. basal cell carcinoma.
b. compound nevus.
c. seborrheic keratosis.
d. senile actinic keratosis.
e. malignant melanoma.
ANS: A
Basal cell carcinoma is the most common form of skin cancer. It occurs more frequently on sun-exposed parts of the body.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

30. You are conducting a preschool examination on a 5-year-old child. Which injury would most likely raise your suspicion that the child was being abused?
a. Recent bruising over both knees
b. A healed laceration under the chin
c. A bruise on the right shin with associated abrasion of tissue
d. Bruises in various stages of resolution over body soft tissues
e. A scab on the elbow
ANS: D
Toddlers and older children who bruise themselves accidentally are bruised over bony prominences, such as the knees, elbows, chin, and shin. Bruises over soft tissues are more consistent with abuse.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

31. Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older adults indicates:
a. sexual abuse.
b. physical neglect.
c. psychologic abuse.
d. violated rights.
e. financial abuse.
ANS: B
The question describes is the most common form of elder abuse—physical neglect.

TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective

Chapter 10: Lymphatic System

Ball: Seidel’s Guide to Physical Examination, 9th Edition


MULTIPLE CHOICE
1. Which of the following organs does not have lymphatic vessels?
a. Brain
b. Kidneys
c. Liver
d. Lungs
e. Appendix
ANS: A
Lymphatic tissues are found abundantly throughout the body except in two places, the placenta and the brain (central nervous system).

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid ...

2. The predominant formed elements of normal lymph fluid are:
a. red blood cells.
b. white blood cells.
c. platelets.
d. antigens.
e. antibodies.
ANS: B
Lymph fluid is mostly Composed of a variety of lymphocytes, minimal red blood cells, no platelets, and some antigens and antibodies according to its immune function.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

3. Cells that line the lymph node sinuses perform the specific function of:
a. fat absorption.
b. fetal immunization.
c. hematopoiesis.
d. platelet production.
e. phagocytosis.
ANS: E
Lymph nodes defend against the invasion of microorganisms by phagocytosis.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

4. Lymph ducts merge into the venous system at the:
a. portal vein.
b. pulmonic vein.
c. subclavian veins.
d. vena cava.
e. jugular veins.
ANS: C


The large ducts of the lymphatics merge into the venous system at the left and right subclavian veins.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

5. Lymph flows faster in response to:
a. massage.
b. decreased blood volume.
c. decreased metabolic rate.
d. decreased permeability of the capillary walls.
e. decreased capillary pressure.
ANS: A
Lymph flow increases with mounting capillary pressure, greater permeability of the capillary walls, increased metabolic rate, and massage.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

6. An organ that is essential to the development of protective immune function in infants but has little or no demonstrated function in adults is the:
a. spleen.
b. appendix.
c. thymus.
d. pancreas.
e. liver.
ANS: C
In adults, the thymus atrophies, and in older adults, it is replaced by fat and connective tissue.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

7. When enlarged, which lymph nodes are most likely to be a sign of malignancy?
a. Occipital
b. Anterior cervical
c. Posterior cervical
d. Femoral
e. Supraclavicular
ANS: E
Supraclavicular nodal enlargement is of special concern because it suggests a malignancy even in children; it may be the sentinel node of Hodgkin lymphoma.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

8. Lymphoid tissue normally regresses to adult size by:
a. 2 years of age.
b. 5 years of age.
c. 10 years of age.
d. puberty.
e. the early 20s.
ANS: D
The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

9. A congenital defect in the immune system of a 2-week-old infant may be suspected if:
a. there are small, palpable inguinal nodes.
b. the umbilical cord has not yet dropped off.
c. the tonsils are visible.
d. the thymus is visible on a chest radiograph.
e. the small postauricular nodes are palpable.
ANS: B
In some infants, delayed separation of the umbilical cord has been associated with abnormal granulocyte function.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

10. As adults age, their ability to resist infection decreases because of lymphatic nodes becoming more:
a. hematopoietic.
b. mucoid.
c. porous.
d. profuse.
e. fibrotic.
ANS: E
Older adults’ lymph nodes diminish in both number and size and are replaced with more
fibrotic and fatty tissues.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

11. Which risk factor is least likely to result in contracting HIV?
a. Prostitution
b. Hemophilia
c. Intravenous drug use
d. Working with AIDS patients
e. Sexual contact with intravenous drug users
ANS: D
As a work-related risk for HIV infection, providing health care is considered rare. Multiple and indiscriminate sexual contacts, hemophilia, and intravenous drug use carry higher rates of transmission of HIV.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

12. Which nodes are most often associated with inflammation?
a. Shotty
b. Movable
c. Fixed
d. Tender
e. Matted

ANS: D
Tenderness is almost always indicative of inflammation.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

13. Which landmark is the dividing line between the anterior and posterior cervical triangles?
a. Clavicle
b. Cervical spine
c. Sternocleidomastoid muscle
d. Sternum
e. Hyoid bone
ANS: C
The landmark dividing the anterior and posterior cervical triangles is the sternocleidomastoid muscle.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

14. Which nodes are also called Virchow nodes?
a. Internal mammary
b. Anterior axillary
c. Deep cervical
d. Supraclavicular
e. Preauricular
ANS: D
The supraclavicular nodes are also referred to as Virchow nodes.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

15. The harder and more discrete a node, the more likely a(n):
a. innocent cause.
b. infection.
c. malignancy.
d. metabolic disease.
e. drug reaction.
ANS: C
Tender nodes almost always indicate the presence of an infection, but a hard, discrete, and nontender node is more likely to represent a malignancy.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

16. Normal supraclavicular lymph nodes are:
a. clustered in a capsule.
b. firm and discrete.
c. less than 3 cm in diameter.
d. not palpable.
e. matted.
ANS: D
Supraclavicular nodes, when palpated, are a concern; normally, they are not palpable.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

17. Transillumination is done during an examination of the lymphatic system to:
a. detect lymphatic pulsation.
b. distinguish nodes from cysts.
c. evaluate nodal contours.
d. observe erythematous lesions.
e. distinguish blood vessels from nodes.
ANS: B
Larger nodal masses should be transilluminated to determine whether the mass is a cyst, rather than a node. A cyst will transilluminate; a node will not.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

18. When examining lymph nodes near a joint in the arm or leg, which of the following maneuvers is likely to facilitate the examination?
a. Extension of the extremity
b. Circumduction of the extremity
c. Abduction of the extremity
d. Rotation of the extremity
e. Flexion of the extremity
ANS: E
Bending joint areas will ease taut tissues and allow for better accessibility to palpation.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

19. To palpate the inguinal nodes, you should have the patient:
a. bend over a table and cough.
b. lie supine, with the knees slightly flexed.
c. lie supine, with the legs extended.
d. stand with the back extended.
e. lie prone, with the knees slightly flexed.
ANS: B
To palpate the inguinal nodes, you should have the patient lying supine, with the knees slightly flexed.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

20. It is not unusual to find postauricular and occipital nodes in:
a. children younger than 2 years of age.
b. school-age children.
c. adolescents.
d. adults.
e. older adults.
ANS: A
Children younger than 2 years of age often have enlarged postauricular and occipital nodes.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

21. Obstruction of the nasopharynx, pulmonary hypertension, and risk of sleep apnea may be associated with excessively enlarged:
a. branchial cleft cysts.
b. cystic hygromas.
c. palatine tonsils.
d. thyroglossal duct cysts.
e. lymphangiomas.
ANS: C
Palatine tonsil enlargement, grade 3+ to 4+, may obstruct the nasopharynx, which increases the risk of sleep apnea and, rarely, pulmonary hypertension. The other choices are congenital embryonic structures in the neck.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

22. The most important clue to the diagnosis of a child with an immunodeficiency disease is:
a. family history.
b. illness in siblings.
c. previous hospitalizations.
d. serious recurring infections.
e. cervical adenitis.
ANS: D
Although family history, illness in siblings, and previous hospitalizations are helpful clues to discover an immunodeficiency in a child, it is most important to review the occurrence of serious, uncommon Infections such as Pneumocystis jirovecii
and other fungal infections that do not respond as expected to therapy.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

23. A red streak that follows the course of the lymphatic collecting duct is a finding associated with:
a. Hodgkin lymphoma.
b. lymphangitis.
c. lymphedema.
d. non-Hodgkin lymphoma.
e. roseola infantum.
ANS: B
Lymphangitis, inflammation of the lymphatic vessels, is evident by a red streak that follows the course of the inflamed lymphatic duct. Hodgkin lymphoma and non-Hodgkin lymphoma refer to malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling that distinguishes itself from interstitial edema because it does not pit. Roseola is a common early childhood viral illness that may present with occipital and postauricular adenopathy.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid


24. To find the infection site associated with acute lymphangitis, the examiner should look to the inflammation.
a. proximal
b. distal
c. contralateral
d. anterior
e. posterior
ANS: B
The red streak of inflammation will follow the direction (proximal) of lymphatic flow, away from the periphery, and with the infection site distal to the streak.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

25. The most common causes of acute suppurative lymphadenitis are:
a. HIV and herpes zoster.
b. Haemophilus influenzae and adenovirus.
c. herpes simplex type 1 and type 2.
d. streptococcal and staphylococcal organisms.
e. mumps.
ANS: D
Group A beta-hemolytic streptococci and coagulase-positive staphylococci are the most common organisms responsible for suppurative (pus-forming) lymphadenitis. The other choices do not result in suppurative lymphadenitis.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

26. Which disorder is characterized by a single node that is chronically enlarged and nontender in
a patient with no other symptoms?
a. Retropharyngeal abscess
b. Streptococcal pharyngitis
c. Mononucleosis
d. Toxoplasmosis
e. Herpes simplex
ANS: D
Toxoplasmosis is displayed as a chronically enlarged, nontender, single node usually in the posterior cervical chain.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

27. Initial signs and symptoms of Epstein-Barr virus mononucleosis most often include:
a. pharyngitis, fever, and malaise.
b. bleeding gums and spontaneous nosebleeds.
c. headache, visual disturbance, and rash.
d. inguinal adenopathy and painful urination.
e. discrete labial and gingival ulcers and high-grade fever.
ANS: A
Presenting symptoms of Epstein-Barr virus mononucleosis include pharyngitis, fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly or rash.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid

28. Serum sickness is usually characterized first by the appearance of:
a. diffuse lymph node enlargement.
b. joint pain.
c. urticaria.
d. fever.
e. a single enlarged posterior cervical node.
ANS: C
Urticaria is the first reaction of serum sickness followed by lymphadenopathy, joint pain, fever, and facial edema.

TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid





Chapter 11: Head and Neck


Ball: Seidel’s Guide to Physical Examination, 9th Edition


MULTIPLE CHOICE
1. Which cranial nerves innervate the face?
a. II and V
b. III and VI
c. V and VII
d. VIII and IX
e. I and VII
ANS: C
Facial nerves are controlled by cranial nerves V and VII, cranial nerve I involves smell, cranial nerves II, III, and VI control the eyes, cranial nerve VIII deals with hearing, and cranial nerve IX deals with swallowing.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

2. The trapezius and sternocleidomastoid muscles and the clavicle form a landmark called the
triangle.
a. anterior
b. posterior
c. lateral
d. medial
e. ventral
ANS: B
Anatomically, these landmarks comprise what is referred to as the posterior triangle, which includes the posterior cervical lymph nodes. The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
...

3. The medial border of the sternocleidomastoid muscles and the mandible form the triangle.
a. dorsal
b. posterior
c. lateral
d. medial
e. anterior
ANS: E
The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The trapezius, sternocleidomastoid muscles, and clavicle form the posterior triangle. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

4. The largest endocrine gland in the body lies in the triangle.
a. anterior
b. posterior
c. lateral
d. medial
e. ventral
ANS: A
The thyroid gland is the largest endocrine gland and lies in the anterior triangle. The posterior triangle does contain cervical lymph nodes, and the lateral and medial triangles are not anatomic landmarks.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

5. Which structures disproportionately enlarge in males during adolescence?
a. Coronal sutures
b. Hyoid and cricoid cartilages
c. Mandible and maxilla bones
d. Nose and thyroid cartilages
e. Mastoid processes and ears
ANS: D
In adolescent males, the nose enlarges, and the thyroid cartilage becomes the largest component of the anterior larynx, known as the Adam’s apple.

TOP: Discipline: Physiology MSC: Organ System: General

6. When examining the skull of a 4-month-old baby, you should normally find:
a. closure of the anterior fontanel.
b. closure of the posterior fontanel.
c. ossification of the all sutures.
d. overlap of the cranial bones.
e. closure of the sagittal and coronal sutures.
ANS: B
At 2 months of age, the posterior fontanels should be closed or ossified with the anterior fontanels, a larger fontanel, closing at 12 to 15 months. The only time the cranial bones should overlap is during a vaginal birth as a result of pressure within the birth canal. Ossification of the sutures begins after completion of brain growth, at about 6 years of age, and is finished by adulthood.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

7. The thyroid gland is partially obscured by the:
a. cricoid cartilage.
b. carotid artery.
c. external jugular.
d. sternocleidomastoid.
e. hyoid bone.

ANS: D
The thyroid sits just below the cricoid, an anatomic landmark for location of the thyroid; the lobes curve are somewhat hidden by the sternocleidomastoid muscle.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

8. The brown or tan pigmentation on the forehead, nose, and malar prominence of some pregnant women is called:
a. hormonal acne.
b. erythema.
c. alopecia.
d. chloasma.
e. craniotabes.
ANS: D
Chloasma, brown or tan facial pigmentation during pregnancy, fades after delivery. Hormonal acne and erythema do not result in brown or tan pigmentation, and alopecia is loss of hair.
Craniotabes is a softening of the outer table of the skull of an infant, often associated with rickets and hydrocephalus.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

9. A bruit heard over the thyroid is suggestive of:
a. hypothyroidism.
b. hyperthyroidism.
c. thyroid cancer.
d. thyroid cyst.
e. thyroid nodule.
ANS: B
Because of hypermetabolic states such as hyperthyroidism, a bruit may be heard as a result of the increased blood flow to the area. Auscultating a bruit is not symptomatic of hypothyroidism, cancer, or a cyst. A nodule is more indicative of cancer.

TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine

10. What is the significance of a patient with asymmetry of the entire side of the face?
a. A degenerative process may be developing.
b. A peripheral trigeminal nerve problem exists.
c. Asymmetry of body sides is a normal finding.
d. Visual and hearing problems will be present.
e. Facial nerve paralysis may be present.
ANS: E
When the entire side of the face is asymmetrical, facial nerve paralysis may be the cause. When asymmetry is concentrated only to the lower portion of the face, weakness of the nerves in this area may be present; if the mouth is asymmetric, there may be an existing trigeminal nerve dysfunction. Degenerative processes are more correlated with facial spasms. Visual and hearing problems may result in a patient turning his or her head to one side to favor the good eye or ear.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous




11. Coarse, dry, and brittle hair is associated with which metabolic disorder?
a. Hypothyroidism
b. Diabetes mellitus
c. Addison disease
d. Cushing syndrome
e. Fetal alcohol syndrome
ANS: A
Hypothyroidism affects hair texture, resulting in coarse, dry, and brittle changes.

TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine

12. Which is the best way to position a patient’s neck for palpation of the thyroid?
a. Flexed away from the side being examined
b. Flexed directly forward
c. Flexed toward the side being examined
d. Hyperextended directly backward
e. Rotated away from the side being examined
ANS: C
The patient should be positioned so that the sternocleidomastoid muscle is relaxed and the thyroid is easier to palpate. This is done by having the patient flex the neck slightly forward and laterally toward the side being examined.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

13. A stethoscope is used in a Head and Neck Examination to assess:
a. intracranial fluid.
b. pulsating fontanels.
c. skull bone development.
d. thyroid vascular sounds.
e. parotid glands.
ANS: D
Although the skull is not routinely auscultated, the neck is auscultated using the bell of the stethoscope at the thyroid gland to screen for states of hypermetabolism that have increased with blood supply and produce bruits.

TOP: Discipline: Gross Anatomy MSC: Organ System: General

14. Tracheal tug suggests the presence of a(n):
a. enlarged thyroid.
b. swallowing disorder.
c. aortic aneurysm.
d. thoracic carcinoma.
e. hyperparathyroidism.
ANS: C
When palpating the trachea, an ominous sign of an aortic aneurysm is a tugging sensation in sync with the pulse of the patient. An enlarged thyroid, swallowing disorder, hyperparathyroidism, or thoracic carcinoma would not produce a tracheal tug.

TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory

15. The thyroid gland should:
a. be slightly left of midline.
b. have a clear vascular sound.
c. feel nodular.
d. tug with each heartbeat.
e. move when the patient swallows.
ANS: E
It is a normal finding for the thyroid gland to move with swallowing; however, being off center may indicate a nodular growth or enlargement. Vascular sounds indicate hypermetabolic states such as hyperthyroidism, and a tug with each heartbeat is a sign of an aortic aneurysm. The consistency of the thyroid should be firm but pliable, not nodular.

TOP: Discipline: Gross Anatomy MSC: Organ System: Endocrine

16. You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The
right lobe is 25% larger than the left. These data indicate:
a. a congenital anomaly.
b. a normal thyroid gland.
c. a multinodular goiter.
d. thyroiditis.
e. a hypothyroid goiter.
ANS: B
The situation described is moNst lRikelIy a nGormBa.l CfindMing; the right lobe of the thyroid gland is typically 25% larger than the left and measures 4 cm. The other choices produce enlargements
beyond these normal findings.

TOP: Discipline: Gross Anatomy MSC: Organ System: Endocrine

17. The most common form of birth trauma of the scalp is:
a. caput succedaneum.
b. cephalhematoma.
c. cranial bossing.
d. torticollis.
e. dilated scalp veins.
ANS: A
Caput succedaneum as a result of birth trauma causes swelling of the scalp. The swelling can cross the suture lines. Cephalohematoma is a hematoma under the skull, and cranial bossing is compensatory growth of the skull related to craniosynostosis. Torticollis involves the neck.
Dilated scalp veins and a head circumference increasing faster than expected may indicate increased intracranial pressure.

TOP: Discipline: Gross Anatomy MSC: Organ System: Skin/Connective

18. Which of the following is true regarding caput succedaneum?
a. It is a subperiosteal collection of blood.
b. It is firm and its edges are well defined.
c. It develops several days after delivery.
d. It is seen over the presenting part of the head.
e. It is a head circumference increasing faster than expected.
ANS: D
Caput succedaneum is subcutaneous edema seen over the presenting part of the head during delivery as the skull passes through the pelvis; the scalp usually feels edematous to touch, which fades after a few days.

TOP: Discipline: Gross Anatomy MSC: Organ System: Skin/Connective

19. Which of the following is true regarding cephalhematoma?
a. It is bound by suture lines.
b. The affected part feels soft.
c. It is obvious at birth.
d. The margins are poorly defined.
e. It never feels fluctuant on palpation.
ANS: A
The condition is subperiosteal, under the bone, and is contained by the margins of the suture lines; it does not cross the suture line. It is often unnoticed at birth and typically feels firm with its edges well defined. As it ages, it may liquefy and become fluctuant on palpation.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

20. When noting a bulging fontanel with marked pulsations in a 6-month-old infant, you suspect:
a. normal development.
b. Down syndrome.
c. increased intracranial pressure.
d. fever response to a viral infection.
e. cephalhematoma.
ANS: C
A bulging fontanel with pulsations suggests increased intracranial pressure. A normal fontanel feels slightly depressed with mild pulsations.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

21. Which type of headache occurs at night, is precipitated by alcohol consumption, and occurs more often in men than in women?
a. Classic migraine
b. Temporal arteritis
c. Muscular tension
d. Hypertensive
e. Cluster
ANS: E
Cluster headaches are usually unilateral and occur at night; they are associated with alcohol consumption and have a higher prevalence in men. Classic migraine, temporal arteritis, muscular tension, and hypertensive headaches do not meet these criteria.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

22. RJ presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a:
a. torticollis.
b. branchial cleft cyst.
c. Stensen duct stone.
d. thyroglossal duct cyst.
e. parotid gland tumor.
ANS: D
A thyroglossal duct cyst presents as a freely movable mass at the base of the tongue. Torticollis is associated with the sternocleidomastoid muscle. A parotid gland tumor occurs around the ear and cheek bone area, a branchial cleft cyst occurs around the lateral neck area, and a Stensen duct stone occurs in the parotid duct.

TOP: Discipline: Gross Anatomy MSC: Organ System: General

23. Moist skin with fine hair, prominent eyes, eyelid retraction, and a staring expression are characteristics associated with:
a. Cushing syndrome.
b. Graves disease.
c. myxedema.
d. systemic lupus erythematosus.
e. Hippocratic facies.
ANS: B
Skin problems along with changes in hair, protruding eyes, and a glazed look are symptoms associated with Graves disease or hyperthyroidism Myxedema is a condition of hypothyroidism. Cushing syndrome is characterized by plump skin around the face, and lupus
usually presents with a rash around the face. Hippocratic facies is usually seen in the terminal stages of illness; the skin is dry and rough.

TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine

24. Which of the following findings would be consistent with fetal alcohol syndrome?
a. Corneal clouding
b. Eye slanting
c. Mild ptosis
d. Symmetric bulging fontanels
e. Maxillary hypoplasia
ANS: C
With fetal alcohol syndrome (FAS), classic findings include a poorly formed or flat philtrum, widespread eyes with inner epicanthal folds and mild ptosis, a hirsute forehead, a short nose, a relatively thin upper lip, and small eye openings. Corneal clouding is seen with Hurler syndrome, eye slanting is seen in Down syndrome, and bulging fontanels are seen in hydrocephalus. Maxillary hypoplasia is seen with several congenital syndromes, but not FAS.

TOP: Discipline: Pathophysiology MSC: Organ System: General

25. The premature union of cranial sutures that involves the shape of the head without mental retardation is:
a. craniosynostosis.
b. encephalocele.
c. microcephaly.
d. myxedema.
e. fetal alcohol syndrome.
ANS: A
With craniosynostosis, the cranial sutures fuse prematurely, causing a misshapen head, but this does not involve mental retardation. Encephalocele, microcephaly, and fetal alcohol syndrome all involve mental retardation, and myxedema is a condition of hyperthyroidism.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

26. All of the following are recommendations of the American Academy of Pediatrics to reduce the risk of sleep-related infant deaths including SIDS except:
a. firm sleep surface.
b. breast-feeding.
c. routine immunizations.
d. prone sleeping position.
e. avoidance of tobacco smoke.
ANS: D
The recommendations include supine positioning (“Back to Sleep”), use of a firm sleep surface, breast-feeding, room-sharing without bed-sharing, routine immunizations, consideration of pacifier use, as well as avoidance of soft bedding, overheating, and exposure
to tobacco smoke, alcohol, and illicit drugs.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal



Chapter 12: Eyes

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE

1. Contraction or relaxation of the ciliary body:
a. allows voluntary blinking.
b. changes lens thickness.
c. regulates peripheral vision.
d. sends light impulses to the brain.
e. regulates tear production.
ANS: B
The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body.

TOP: Discipline: Physiology MSC: Organ System: Nervous

2. Term infants have a visual acuity of about:
a. 20/20.
b. 20/100.
c. 20/200.
d. 20/300.
e. 20/400.
ANS: E
Term infants are hyperopic, with a visual acuity of less than 20/400.
TOP: Discipline: Physiology MSC: Organ System: Nervous

3. At what age does an infant usually develop the ability to distinguish color?
a. At birth
b. 2 months
c. 6 months
d. 12 months
e. 16 months
ANS: C
By 6 months of age, vision has developed so that colors can be differentiated.

TOP: Discipline: Physiology MSC: Organ System: Nervous
...

4. An increased level of lysozyme in the tears will occur normally during which life stage?
a. Adolescence
b. Childhood
c. Infancy
d. Pregnancy
e. Older adults

ANS: D
Because of rising hormonal levels, lysozyme is present in an increased amount in the tears during pregnancy. Tears are not affected by increased lysozyme at any other stage in life.

TOP: Discipline: Physiology MSC: Organ System: Nervous

5. Which of the following is a relatively benign condition that may occur during pregnancy or labor?
a. Macular degeneration
b. Papilledema
c. Subconjunctival hemorrhage
d. Cupping of the optic disc
e. Presbyopia
ANS: C
Because of falling intraocular pressure during the late stages of pregnancy, hemorrhages may occur in the conjunctiva and resolve spontaneously. Papilledema is never a benign condition, and presbyopia, macular degeneration, and cupping of the optic disc occur in older adults.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

6. A condition that typically develops by the age of 45 years is:
a. presbyopia.
b. hyperopia.
c. myopia.
d. astigmatism.
e. cataracts.


ANS: A
By 45 years of age, a condition known as presbyopia develops that involves a weakening of accommodation. Hyperopia occurs in early infancy; myopia and astigmatism can occur at any time. Cataracts generally develop in older adults.

TOP: Discipline: Physiology MSC: Organ System: Nervous

7. Which of the following findings, when seen in an infant, is most ominous?
a. Difficulty tracking objects with the eyes
b. Appearing to have better peripheral than central vision
c. Blinking when bright light is directed at face
d. White pupils on photographs
e. The appearance of convergence
ANS: D
The absence of a red reflex, either by physical examination or by white pupils with flash photography, is indicative of retinoblastoma, a serious retina tumor. The other choices are expected at this age.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

8. Which of the following is a genetic eye disorder that should be included in the history and physical examination, under family history, for all members of the affected family?
a. Constrictive iritis
b. Retinoblastoma
c. Oval pupils
d. Retinal hemorrhages
e. Maculates
ANS: B
Retinal cancer, or retinoblastoma, is a tumor originating from the retina and often occurs during the first 24 months of life. It has been found to be caused by an autosomal trait or a mutation of the chromosomes. Constrictive iritis, maculates, oval pupils, and retinal hemorrhages are not autosomal dominant disorders.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

9. Mr. C’s visual acuity is 20/50. This means that he:
a. can see 50% of what the average person sees at 20 feet.
b. has perfect vision when tested at 50 feet.
c. can see 20% of the letters on the chart’s 20/50 line.
d. can read letters while standing 20 feet from the chart that the average person could read at 50 feet.
e. is legally blind.
ANS: D
Visual acuity is measured as a fraction in which the top number is the distance that the patient is standing from the chart and the bottom number is the distance that an average person can stand and still read the line. Vision not correctable to better than 20/200 is considered legal blindness.


TOP: Discipline: Physiology MSC: Organ System: Nervous

10. Peripheral vision can be estimated by means of which test?
a. Confrontation
b. Pupillary reaction
c. Accommodation
d. Snellen E chart
e. Swinging flashlight
ANS: A
The confrontation test measures peripheral vision. The examiner sits or stands across from the patient and asks the patient to close one eye while the examiner closes the opposite eye. The examiner then proceeds to wave the fingers while moving the extended arms from a lateral to a central position along both the temporal and the nasal fields. The pupillary reaction test is done by observing the pupil’s response to light. The accommodation test deals with pupil reaction to light, and the Snellen E chart measures visual acuity. The swinging flashlight test evaluates the health of the optic nerve by looking for an afferent pupillary defect.

TOP: Discipline: Physiology MSC: Organ System: Nervous

11. The criterion for adequacy of a patient’s visual field is:
a. the ability to discriminate primary colors.
b. the ability to discriminate details.
c. correspondence with the visual field of the examiner.
d. distance vision equal to that of an average person.
e. pupillary constriction when an object is moved close to the nose.
ANS: C
The examiner continuously compares his or her own peripheral vision with that of the patient while performing the confrontation test, so unless the examiner is aware of a problem with his or her own vision, the examiner could assume that the fields are full if they match. The confrontation test does not assess colors, details, or distance vision. Having a patient look at a distant object and then one held 10 cm from the nose tests the pupillary response to accommodation.

TOP: Discipline: Physiology MSC: Organ System: Nervous

12. Periorbital edema is:
a. an abnormal sign.
b. expected with aging.
c. more common in males.
d. present in children.
e. an abnormality of lipid metabolism.
ANS: A
A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise.

TOP: Discipline: Pathophysiology MSC: Organ System: General

13. Xanthelasma may suggest that the patient has an abnormality of:

a. lipid metabolism.
b. cognitive function.
c. renal metabolism.
d. bone marrow function.
e. thyroid disease.
ANS: A

Small, odd-shaped, yellow-colored plaques around the eyes are actually lipid deposits and are characteristics of a lipid metabolism problem. The other conditions are not associated with eye plaques.

TOP: Discipline: Pathophysiology MSC: Organ System: General

14. Ptosis may be secondary to:
a. blepharitis.
b. hyperthyroidism.
c. psoriasis.
d. paresis of a branch of cranial nerve III.
e. entropion.
ANS: D
Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthalmos, psoriasis is a skin condition, and blepharitis is a crusting of the eyelashes. Entropion is an inversion of the lower eyelid.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

15. Entropion implies that the eyelid is:
a. drooping.
b. everted.
c. edematous.
d. turned inward.
e. inflamed.
ANS: D
Entropion of the lower eyelid does not imply drooping, eversion, inflammation, or edema but is a slight inward turn of the lower eyelid.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

16. A condition in which the eyelids do not completely meet to cover the globe is called:
a. glaucoma.
b. lagophthalmos.
c. exophthalmos.
d. hordeolum.
e. blepharitis.
ANS: B
Lagophthalmos is a term used to describe the condition in which the eyelids do not completely meet when closing. Glaucoma involves the optic nerve, exophthalmos involves bulging eyes, and hordeolum is better known as a sty. Blepharitis is crusting along the eyelashes, which can have several causes.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

17. An allergy can cause the conjunctiva to have a:
a. cobblestone pattern.
b. dry surface.
c. subconjunctival hemorrhage.
d. rust-colored pigment.
e. pale appearance.
ANS: A
A red or cobblestone pattern, especially to the upper conjunctiva, indicates an allergic conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment.

TOP: Discipline: Pathophysiology MSC: Organ System: General

18. A pterygium is more common in people heavily exposed to:
a. high altitudes.
b. tuberculosis.
c. ultraviolet light.
d. cigarette smoke.
e. lead.
ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to pterygium developments. High altitudes, tuberculosis, lead, and cigarette smoke do not cause an overgrowth of the conjunctiva.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

19. Mr. B was admitted from the emergency department, and you are completing his physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been:
a. in a coma.
b. taking sympathomimetic drugs (e.g., cocaine).
c. taking opioid drugs (e.g., morphine).
d. treated for head trauma.
e. atropine overdosed.
ANS: C
Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or drops for glaucoma. Pupils are usually dilated greater than 6 mm in a coma and with sympathomimetic drugs, atropine, and head trauma.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

20. You observe a pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for:
a. confrontation reaction.
b. accommodation.
c. pupillary light reflex.
d. nystagmus.
e. corneal arcus senilis.
ANS: B

Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then look at another object much closer (pupils constrict). The other choices do not test for accommodation.

TOP: Discipline: Physiology MSC: Organ System: Nervous

21. Mydriasis accompanies:
a. coma.
b. diabetes.
c. hyperopia.
d. astigmatism.
e. morphine administration.
ANS: A
Coma patients always have mydriasis, which occurs when the pupils are dilated more than 6 mm. Diabetes may cause a coma but not mydriasis. Hyperopia is a condition of infants, describing their visual acuity as at or worse than 20/400. Astigmatism affects the shape of the lens, not the pupils. Opiates cause miosis.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

22. When inspecting the region of the lacrimal gland, palpate:
a. the lower orbital rim near the inner canthus.
b. in the area between the arch of the eyebrow and the upper eyelid.
c. beneath the lower eyelid adjacent to the inner canthus.
d. adjacent to the lateral aspect of the eye, just beneath the upper eyelid.
e. medially above the eyebrow.
ANS: A
The lacrimal gland is located in the area between the arch of the eyebrow and the upper lid. The lacrimal sac is located in the corner of the eye closest to the nose near the inner canthus.

TOP: Discipline: Physiology MSC: Organ System: General

23. To see retinal details in a patient with myopia, the examiner will need to:
a. adjust the ophthalmoscope into the plus lenses.
b. move the ophthalmoscope backward.
c. move the hand farther forward.
d. examine the patient in a well-lighted room.
e. turn the ophthalmoscope to a minus lens.
ANS: E
A patient with myopia (nearsighted) has longer eyeballs, so light rays focus in front of the retina. To see the retina, the examiner should use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a patient with hyperopia, a plus lens should be used.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
24. The unit of measurement in describing lesion size and location on the fundus is the:
a. disc diameter.
b. macular diameter.
c. pupillary diameter.
d. centimeter.
e. diopter.
ANS: A
When examining the eye and the fundus comes into focus, the branching of blood vessels becomes apparent. These always branch away from the optic disc and can be used as landmarks to locate the optic disc. The disc itself measures about 1.5 mm in diameter and the disc diameter is therefore the unit of measurement used to describe lesion size and location on the fundus.

TOP: Discipline: Physiology MSC: Organ System: Nervous
25. Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the:
a. retina.
b. lens.
c. retinal vessels.
d. macula.
e. optic disc.
ANS: D
The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light.

TOP: Discipline: Physiology MSC: Organ System: Nervous

26. After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate the optic disc. You should:
a. follow the vessel as it branches out.
b. have the patient move his or her eye laterally.
c. have the patient move his or her eye up.
d. have the patient move his or her eye down.
e. follow the vessel as it converges into larger vessels.
ANS: E
When you locate a vessel, follow it in the direction of the optic disc. Vessels nearer the disc are directionally toward the nose, are larger, and have less branching.

TOP: Discipline: Physiology MSC: Organ System: Nervous

27. If a patient has early papilledema, the examiner will be able to detect:
a. dilated retinal veins.
b. retinal vein pulsations.
c. sharply defined optic discs.
d. visual defects.
e. narrowed retinal veins.
ANS: A
Papilledema is caused by increased intracranial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. On examination, papilledema is characterized by loss of definition of the optic disc. Vein pulsations and visual defects are not visible with an ophthalmoscope.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

28. Cupping of the optic disc may be a result of:
a. migraine headaches.
b. diabetes.
c. glaucoma.
d. dehydration.
e. cataracts.
ANS: C
Cupping is seen with causes of increased intraocular pressure such as glaucoma. Migraine headaches and dehydration do not cause cupping of the optic disc. Diabetes results in cotton wool patches and hemorrhages. Cataracts are clouding of the lens.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

29. Drusen bodies are most commonly a consequence of:
a. glaucoma.
b. aging.
c. presbyopia.
d. papilledema.
e. hypertension.
ANS: B
Drusen bodies, or lesions or spots on the retina, are part of the aging process. Glaucoma, presbyopia, and papilledema do not present with spots on the retina. Retinal hemorrhages and cotton wool spots are associated with hypertensive retinopathy.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

30. Cotton wool spots are most closely associated with:
a. glaucoma.
b. normal aging processes.
c. hypertension.
d. eye trauma.
e. hyperthyroidism.
ANS: C
Cotton wool spots actually represent infarcts of the retina and are associated with hypertension or diabetes. Hyperthyroidism, glaucoma, and eye trauma do not present with cotton wool spots.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

31. White specks scattered in a linear pattern around the entire circumference of the iris are called:
a. drusen bodies.
b. cotton wool spots.
c. rust spots.
d. Brushfield spots.
e. band keratopathy.
ANS: D
Brushfield spots strongly suggest Down syndrome or mental retardation and are characterized by white specks that align perfectly around the circumference of the iris. Drusen bodies, cotton wool spots, band keratopathy, and rust spots are not associated with mental retardation.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

32. Opacities of the red reflex may indicate the presence of:
a. hypertension.
b. hydrocephalus.
c. cataracts.
d. myopia.
e. diabetes.
ANS: C
Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in newborns. Opacities or dark spots of the red reflex are not associated with hypertension, diabetes, hydrocephalus, or myopia.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

33. What maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic agents when examining a pregnant patient if the examination is mandatory?
a. Have the woman keep her eyes closed for several minutes.
b. Instill half the usual dosage.
c. Keep the patient supine.
d. Use nasolacrimal occlusion after instillation.
e. Have the patient keep her head turned and flexed.
ANS: D
To reduce absorption systemically, the examiner may use the nasolacrimal occlusion after application, which involves pinching the upper bridge of the nose. Keeping the eyes closed, instilling half of the usual dosage, and having the patient position her head a certain way will not prevent absorption through the nasal membranes.

TOP: Discipline: Physiology MSC: Organ System: Nervous

34. Episcleritis may indicate:
a. lipid abnormalities.
b. an autoimmune disorder.
c. an anaphylactoid reaction.
d. severe anemia.
e. thyroid disease.
ANS: B
Episcleritis is an inflammation of the sclera, involves purplish bumps, and is commonly associated with autoimmune disorder. Lipid abnormalities, anaphylactoid reactions, anemia, and thyroid disease are not associated with these symptoms.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

35. Horner syndrome is manifested by:
a. proptosis and contralateral mydriasis.
b. excessive watering of the eyes.
c. blurring of vision when glucose levels fall.
d. ipsilateral miosis and mild ptosis.
e. band keratopathy and miosis.
ANS: D
Horner syndrome is characterized by mild pupil constriction and drooping of the upper eyelid of the same eye. Horner syndrome is a result of a break in the sympathetic nerve supply to that eye. Mydriasis involves enlarged pupils. Watering of the eyes and blurred vision are not affected by a disruption in the sympathetic nervous system. Band keratopathy is a result of chronic corneal disease and is not associated with Horner syndrome.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

36. Dot hemorrhages, or microaneurysms, and the presence of hard and soft exudates are most commonly seen in:
a. Down syndrome.
b. diabetic retinopathy.
c. systemic lupus.
d. glaucoma.
e. retinitis pigmentosa.
ANS: B
Dot hemorrhages or tiny aneurysms are characteristics of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages. Aneurysms in the retina are not symptoms of Down syndrome, lupus, glaucoma, or retinitis pigmentosa.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

37. Changes seen in proliferative diabetic retinopathy are the result of:
a. anoxic stimulation.
b. macular damage.
c. papilledema.
d. minute hemorrhages.
e. chorioretinal scarring.
ANS: A
New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply because of failing capillaries causes new vessel growth. Macular damage, papilledema, chorioretinal inflammation, and resultant scarring do not involve new inadequate vessel growth.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

38. Bone spicule pigmentation is a hallmark of:
a. chorioretinal pigmentosa.
b. cytomegalovirus infection.
c. lipemia retinalis.
d. retinitis pigmentosa.
e. choroidal nevus.
ANS: D
Retinitis pigmentosa is inherited night blindness, characterized by the hallmark pigmentation of the peripheral fields or bone spicules.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

39. Retinal hemorrhages in an infant require investigation for:
a. retinoblastoma.
b. retrolental fibroplasia.
c. pituitary tumor.
d. child abuse.
e. strabismus.
ANS: D
Beyond newborn age, any hemorrhages to the retina indicate infection, allergy, or trauma and should be further investigated. Retinoblastoma, retrolental fibroplasia, pituitary tumors, and strabismus are not associated with retinal hemorrhages.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous




Chapter 13: Ears, Nose, and Throat

Ball: Seidel’s Guide to Physical Examination, 9th Edition


MULTIPLE CHOICE

1. The middle ear contains the:
a. cerumen and sebaceous glands.
b. umbo and malleus.
c. vestibule and cochlea.
d. pars tensa and semicircular canals.
e. helix and antihelix.
ANS: B
The middle ear contains the ossicles, which are three small bones: the malleus (the umbo is part of the malleus), the incus, and the stapes. The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa. Cerumen and sebaceous glands lie outside the middle ear; the semicircular canals, vestibule, and cochlea lie in the inner ear. The helix and antihelix are parts of the auricle.

TOP: Discipline: Gross Anatomy MSC: Organ System: General

2. The hair cells of Corti and membrane of Corti:
a. maintain equilibrium.
b. protect the ear from foreign particles.
c. stimulate the eighth cranial nerve.
d. transmit vibrations to the ossicles.
e. produce a waxy lubricant.
ANS: C
Vibrations from the tympanic membrane cause the delicate hair cells of the organ of Corti to strike against the membrane of Corti, stimulating impulses in the sensory endings of the auditory division of the eighth cranial nerve.

TOP: Discipline: Physiology MSC: Organ System: Nervous

3. Which ear structure is responsible for equalizing atmospheric pressure when swallowing, sneezing, and yawning?
a. Eustachian tube
b. Inner ear
c. Semicircular canals
d. Triangular fossa
e. Oval window
ANS: A
The eustachian tube is a cartilaginous and bony passageway between the nasopharynx and the middle ear that opens briefly to equalize the middle ear pressure with that of the atmospheric pressure when swallowing, yawning, or sneezing.

TOP: Discipline: Physiology MSC: Organ System: General
...
4. A 30-year-old woman presents with rapid swelling beneath her jaw that suddenly appears while she is eating. The swelling is mildly painful but is not hot or red. You suspect Wharton salivary duct stones and proceed to palpate:
a. bilaterally along the buccal mucosa.
b. under the tongue, along each side of the frenulum.
c. dorsum of the tongue.
d. beside the gingivae near each molar.
e. along the roof of the mouth.
ANS: B
The vast majority of these stones occur in the Wharton duct from the submaxillary gland, which can be palpated along each side of the frenulum under the tongue.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

5. An infant’s auditory canal, when compared with an adult’s, is:
a. short, narrow, and straight.
b. short and curved upward.
c. long, narrow, and curved forward.
d. short and curved downward.
e. long, wide, and straight.
ANS: B
Compared with an adult’s, the infant’s auditory canal is shorter and has an upward curve,
which is why pulling the pinna down straightens the canal.

TOP: Discipline: Gross Anatomy MSC: Organ System: General

6. When examining an infant’s middle ear, the practitioner should use one hand to stabilize the
otoscope against the head while using the other hand to:
a. pull the auricle down and back.
b. hold the speculum in the canal.
c. distract the infant.
d. stabilize the chest.
e. pull the auricle up.
ANS: A
You should use your other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal.

TOP: Discipline: Physiology MSC: Organ System: General

7. The pregnant patient can expect to experience:
a. more nasal stuffiness.
b. a sensitive sense of smell.
c. drooling.
d. enhanced hearing.
e. decreased vascularity of the gums.
ANS: A


Physiologic changes of pregnancy include nasal stuffiness, a decreased sense of smell, impaired hearing, epistaxis, and a sense of fullness in the ears. Increased vascularity and proliferation of connective tissue of the gums also may occur.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

8. During what developmental stage are hoarseness, voice cracking, and a persistent cough a common finding?
a. Adolescence
b. Infancy
c. Menopause
d. Pregnancy
e. Childhood
ANS: D
Laryngeal changes in pregnancy include hoarseness, deepening or cracking of the voice, vocal changes, and persistent cough.

TOP: Discipline: Physiology MSC: Organ System: General

9. Which of the following is associated with age-related hearing loss?
a. Degeneration of the hair cells of the organ of Corti
b. Excess resorption of bone cells of the ossicle chain
c. Increased pliability of the tympanic membrane
d. More serous cerumen
e. Proliferation of the stria vascularis

ANS: A

About two-thirds of adults ages 70 years and older have a hearing loss that affects their daily living. Age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea.

TOP: Discipline: Physiology MSC: Organ System: Nervous

10. Mr. S presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss?
a. Chlorothiazide
b. Acetaminophen
c. Salicylates
d. Cephalosporins
e. Penicillins
ANS: C
Ototoxic medications include aminoglycoside, salicylates, furosemide, streptomycin, quinine, ethacrynic acid, and cisplatin. Chlorothiazide diuretics, acetaminophen, penicillins, and cephalosporins are considered non-ototoxic.

TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Nervous

11. To approximate vocal frequencies, which tuning fork should be used to assess hearing?
a. 100 to 300 Hz
b. 200 to 400 Hz
c. 500 to 1000 Hz
d. 1500 to 2000 Hz
e. Greater than 2000 Hz
ANS: C
Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies.

TOP: Discipline: Physiology MSC: Organ System: Nervous

12. You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to:
a. remove all cerumen from the canal.
b. make sure the speculum is sealed form outside air.
c. squeeze the bulb with more force.
d. insert the speculum to depth of 2 cm.
e. use a smaller plastic speculum.
ANS: B
When using the pneumatic attachment, to see tympanic movement, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of pressure changes from the insufflator bulb.

TOP: Discipline: Physiology MSC: Organ System: General

13. An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or:

a. digestive disorder.
b. skeletal anomaly.
c. renal disorder.
d. Ménière disease.
e. heart defect.
ANS: C



A low-set position or unusual angle may indicate a genetic syndrome or be a clue to look for renal anomalies as the ears and kidneys grow at the same time during pregnancy.

TOP: Discipline: Pathophysiology MSC: Organ System: General

14. When conducting an adult otoscopic examination, you should:
a. position the patient’s head leaning toward you.
b. grasp the handle of the otoscope as you would a baseball bat.
c. select the largest speculum that will fit in the canal.
d. ask the patient to keep his or her eyes closed.
e. pull the auricle down and forward.
ANS: C
Select the largest speculum that will comfortably fit in the patient’s ear. The handle should be held between the thumb and the index finger, supported on the middle finger. The patient’s head should be positioned toward the opposite shoulder. To straighten the external auditory in an adult, pull the auricle up and back. There is no reason for the patient to keep her or his eyes shut.

TOP: Discipline: Physiology MSC: Organ System: General

15. Speech with a monotonous tone and erratic volume may indicate:
a. otitis externa.
b. hearing loss.
c. serous otitis media.
d. sinusitis.
e. dry cerumen.
ANS: B
Speech with a monotonous tone and erratic volume may indicate hearing loss. Although hearing may be affected in the other choices, they do not result in hearing loss.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

16. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test
for:
a. air conduction of sound.
b. bone versus air conduction.
c. otitis externa.
d. otitis media.
e. lateralization of sound.
ANS: E
Placing the fork on the midline vertex of the patient’s head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear.

TOP: Discipline: Physiology MSC: Organ System: Nervous


17. To perform the Rinne test, place the tuning fork on the:
a. top of the head.
b. mastoid bone.
c. forehead.
d. preauricular area.
e. occiput.
ANS: B
The tuning fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. The tuning fork is placed on the midline top of the patient’s head for the Weber test, a test that helps assess unilateral hearing loss.

TOP: Discipline: Physiology MSC: Organ System: Nervous

18. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, the air conduction to bone conduction-to-ratio was less than 2:1. You interpret these findings as suggestive of:
a. a defect in the inner ear.
b. a defect in the middle ear.
c. otitis externa.
d. impacted cerumen.
e. serous otitis.

ANS: A
These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa, impacted cerumen, and serous otitis are conditions that can cause conductive hearing problems.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

19. Nasal symptoms that imply an allergic response include:
a. purulent nasal drainage.
b. bluish gray turbinates.
c. small, atrophied nasal membranes.
d. a firm consistency of the turbinates.
e. a deviated septum.
ANS: B
An allergic finding includes bluish gray or pale pink nasal turbinates that are swollen and boggy and a transverse crease at the junction between the cartilage and the bone of the nose.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

20. A smooth red tongue with a slick appearance may indicate:
a. a niacin or vitamin B12 deficiency.
b. oral cancer.
c. recent use of antibiotics.
d. a fungal infection.
e. a geographic tongue.

ANS: A
A smooth red tongue with a slick appearance may indicate a vitamin B12 deficiency. Oral cancer involves lesions; recent use of antibiotics can turn the tongue yellow-brown to black and hairy; and fungal infections result in slightly raised white, cream-colored, or yellow spots in the mouth. A geographic tongue has irregular areas of whitish and red areas.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

21. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:
a. Fordyce spots.
b. aphthous ulcers.
c. Stensen ducts.
d. leukoedema.
e. angular cheilitis.
ANS: B
Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

22. A hairy tongue with yellowish brown to black elongated papillae on the dorsum:
a. is indicative of oral cancer.
b. is sometimes seen after antibiotic therapy.
c. usually indicates a vitamin deficiency.
d. usually indicates anemia.
e. is characteristic of a geographic tongue.
ANS: B
Recent antibiotic use can turn the tongue yellow-brown to black and hairy.

TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Gastrointestinal

23. To inspect the lateral borders of the tongue, you should:
a. ask the patient to extend the tongue outward.
b. insert the tongue blade obliquely against the tongue.
c. lift the tongue upward with gloved fingers.
d. pull the gauze-wrapped tongue to each side.
e. ask the patient to lift the tongue upward.
ANS: D
To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then pull the tongue to each side for inspection. The other maneuvers do not result in adequate lateral border inspection.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

24. Which variation may be an expected finding in the ear examination of a newborn?
a. Diffuse light reflex
b. Purulent material in the ear canal
c. Redness and swelling of the mastoid process
d. Small perforations of the tympanic membrane
e. Increased mobility and clarity of the tympanic membrane
ANS: A
The newborn’s tympanic membrane does not become conical for several months; therefore,
the light reflex appears diffuse.

TOP: Discipline: Physiology MSC: Organ System: General

25. For best results, an otoscopic and oral examination in a child should be:
a. conducted at the beginning of the assessment.
b. done after inspection.
c. performed at the end of the examination.
d. performed before palpation.
e. deferred until they can fully cooperate.
ANS: C
Because young children often resist otoscopic and oral examination, it may be wise to postpone these procedures until the end of the examination after you have gained some trust.

TOP: Discipline: Physiology MSC: Organ System: General

26. Expected physical changes associated with older adults include:
a. shiny buccal mucosa.
b. teeth appear shorter.
c. wetter nasal mucosa.
d. bristly hairs in the vestibule.
e. smoothing of the tongue.
ANS: D
With age, the buccal mucosa becomes less shiny, the teeth appear longer because of receding gums, the nasal mucosa are drier, the tongue may appear more fissured, and more bristly hairs appear in the nose, especially in men.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

27. Intense pain with movement of the pinna is most closely associated with:
a. sinusitis.
b. otitis externa.
c. purulent otitis media.
d. bacterial otitis media.
e. otitis media with effusion.
ANS: B
Suspect otitis externa (swimmer’s ear) when pulling the pinna reproduces ear pain. The other
conditions do not commonly cause the same finding.

TOP: Discipline: Pathophysiology MSC: Organ System: General

28. Severe vertigo, tinnitus, and episodes of hearing loss are the characteristics of:

a. cholesteatoma.
b. Ménière disease.
c. otosclerosis.
d. cocaine abuse.
e. labyrinthitis.
ANS: B
Ménière disease is an inner ear disorder characterized by episodes of hearing loss, vertigo, tinnitus, and ear fullness

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

29. Evidence-based practice suggests that the strongest predictor of sinusitis is:
a. a maxillary toothache.
b. dull or opaque sinus transilluminations.
c. ineffective decongestants and colored nasal drainage.
d. purulent nasal secretions.
e. any combination of the above.
ANS: E
Evidence-based practice suggests that the strongest predictor of sinusitis is any combination of these symptoms including maxillary toothache, purulent nasal secretions, dull or opaque sinus transillumination, poor response to decongestants, and colored nasal discharge.

TOP: Discipline: Pathophysiology MSC: Organ System: General

Chapter 14: Chest and Lungs

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Which bronchial structure(s) is (are) most susceptible to aspiration of foreign bodies?
a. Left mainstem bronchus
b. Terminal bronchioles
c. Right mainstem bronchus
d. Right respiratory bronchioles
e. Left respiratory bronchioles
ANS: C
The right mainstem bronchus has a more downward slope and is less angled than the left bronchus. Therefore, it is more likely to be a site of aspiration and is a more likely site for endotracheal tubes that are advanced too far.

TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory

2. When auscultating the apex of the lung, you should listen:
a. even with the second rib.
b. 4 cm above the first rib.
c. higher on the right side.
d. on the convex diaphragm surface.
e. directly over the clavicles.

ANS: B

The apices of the lungs are 4 cm above the first rib.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

3. You are documenting a rash between the eighth and ninth ribs on the lateral border. This intercostal space will be documented in terms of the:
a. rib immediately above it.
b. rib immediately below it.
c. number of centimeters it is positioned below the clavicle.
d. number of inches it is positioned below the clavicle.
e. relationship to the sternum.
ANS: A
The number of each intercostal space corresponds to that of the rib immediately above it.

TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory
...

4. To begin counting the ribs and the intercostal spaces, you begin by palpating the reference point of the:
a. distal point of the xiphoid.
b. manubriosternal junction.
c. suprasternal notch.
d. acromion process.
e. clavicle.
ANS: B
The angle of Louis, the junction of the manubrium and the sternum, corresponds to the second rib, the reference point for counting ribs and intercostal spaces.

TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory

5. The foramen ovale should close by:
a. 24 weeks of gestation.
b. the initiation of labor.
c. within minutes of birth.
d. 4 weeks of age.
e. 12 months of age.
ANS: C
The decrease in pulmonary pressures within the first minutes of life leads to closure of the foramen ovale.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

6. Increased oxygen tension in the arterial blood of a newborn infant causes:
a. closure of the ductus arteriosus.
b. hyperinflation of the lungs.
c. passive respiratory movements.
d. reopening of the foramen ovale.
e. the pulmonary arteries to contract.

ANS: A
Increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

7. To accommodate the enlarging uterus of pregnancy, the chest changes result in:
a. intercostal muscle atrophy.
b. lowering of the resting diaphragm.
c. decreased alveoli expansion.
d. decreased diaphragmatic movement.
e. increased costal angle.
ANS: E
The costal angle progressively increases from around 68.5 to 103.5 degrees in later pregnancy. The resting diaphragm rises, yet diaphragmatic movement increases, the alveolar ventilation and tidal volume increase, and the muscles do not atrophy.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

8. The characteristic barrel chest of an older adult is caused by a combination of factors, including:
a. skeletal changes of aging.
b. increased muscular expansion of the chest wall.
c. less fibrous alveoli.
d. increased vital capacity.
e. increased lung resiliency.
ANS: A
Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

9. A patient describes shortness of breath that gets worse when he sits up. Which term documents this?
a. Platypnea
b. Orthopnea
c. Tachypnea
d. Bradypnea
e. Hypopnea
ANS: A
Dyspnea that increases in the upright posture is called platypnea. Orthopnea is dyspnea that worsens with lying down, tachypnea is increased respiratory rate, and bradypnea is decreased respiratory rate. Hypopnea refers to abnormally shallow respirations.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

10. Bradypnea may accompany:
a. pneumothorax.
b. an excellent level of cardiovascular fitness
c. ascites.
d. a pulmonary embolus.
e. anxiety.
ANS: B
Bradypnea, a rate slower than 12 breaths/min, may result from cardiorespiratory fitness. The other choices accompany tachypnea.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

11. A 34-year-old man is being seen for complaints of dull pain between the shoulder blades that is more intense with deep breathing and coughing. Upon auscultation of the chest, you suspect that you will hear:
a. rhonchi.
b. expiratory wheeze.
c. crackles.
d. pleural friction rub.
e. crepitus.
ANS: A
This patient is describing the bronchi as the source of the pain; the trachea divides at T4-5, between the shoulder blades. The adventitious bronchial sound expected is rhonchi. Wheezing might be expected if the patient had productive coughing or dyspnea; a pleural friction rub usually causes sudden stabbing pain over the pleuritic site. Crepitus can be both palpated and heard; it indicates air in the subcutaneous tissue and is usually found anteriorly and toward the axilla.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

12. Both pleural effusion and lobar pneumonia are characterized by percussion.
a. tympany heard with
b. dullness heard on
c. resonance heard on
d. hyperresonance heard on
e. occasional hyperresonance heard on
ANS: B
Pleural effusion and lobar pneumonia are more dense than air, with an expected finding of dullness to percussion. Tympany is expected over hollow organs such as the stomach; resonance and hyperresonance are heard over air-filled areas.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

13. In which patient situation would you expect to assess tachypnea?
a. Patient with depression
b. Patient who abuses narcotics
c. Patient with metabolic acidosis
d. Patient with myasthenia ggravis
e. Patient with metabolic alkalosis
ANS: C
In metabolic acidosis, the body compensates by increasing the respiratory rate to blow off the excess carbon dioxide. The other choices cause respiratory depression.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

14. Respiratory effort usually exhibited by the patient with cerebral brain damage is called:
a. Cheyne-Stokes respiration.
b. paroxysmal nocturnal dyspnea.
c. Kussmaul breathing.
d. Biot respiration.
e. ataxic respiration.
ANS: A
Cheyne-Stokes respirations occur in children and older adults during sleep but otherwise occur in seriously ill patients, particularly those with brain damage at the cerebral level. The other choices are not apnea associated with cerebral damage.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

15. Which site of chest wall retractions indicates a more severe obstruction in a patient with asthma?
a. Lower chest
b. Along the anterior axillary line
c. Above the clavicles
d. At the nipple line
e. Along the posterior axillary line
ANS: C
Asthma more commonly produces retractions of the lower chest. The more severe the obstruction, the greater is the negative pressure produced in the chest during inspiration and retractions are seen in the upper thorax.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

16. Which type of apnea requires immediate action?
a. Primary apnea
b. Secondary apnea
c. Sleep apnea
d. Periodic apnea of the newborn
e. Apnea of prematurity
ANS: B
Primary apnea is self-limiting, sleep apnea should be evaluated but does not require immediate action, and periodic apnea of the newborn is a normal condition. Apnea of prematurity is a more intense version of periodic apnea of the newborn. Secondary apnea is grave, and unless resuscitative measures are immediately instituted, breathing will not resume spontaneously.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
17. Laryngeal obstructions would elicit which breath sound?
a. Fremitus
b. Stridor
c. Rhonchi
d. Crepitus
e. Wheezing
ANS: B
Obstructions high in the respiratory tree are characterized by stridor.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

18. Breath odors may alert the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:
a. uremia.
b. tuberculosis.
c. hepatic dysfunction.
d. diabetic ketoacidosis.
e. intestinal obstruction.
ANS: A
The breath smell described as ammonia-like suggests uremia, a renal condition; cinnamon suggests tuberculosis, a musty fish or clover odor suggests hepatic failure, a sweet and fruity odor suggests diabetic ketoacidosis; and a foul or feculent odor suggests intestinal obstruction.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

19. You would expect to document the presence of a pleural friction rub for a patient being treated for:
a. bronchitis.
b. atelectasis.
c. pleurisy.
d. emphysema.
e. pneumonia.
ANS: C
A pleural friction rub is caused by inflammation of the pleural surfaces and is expected to be auscultated with pleurisy.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

20. Tactile fremitus is best felt:
a. along the costal margin and xiphoid process.
b. in the suprasternal notch along the clavicle.
c. at the level of bifurcation of the bronchi.
d. posterolaterally over the scapulas.
e. in the midaxillary lines.

ANS: C
Fremitus is best felt posteriorly and laterally at the level of the bifurcation of the bronchi. There is great variability depending on the intensity and pitch of the voice and the structure and thickness of the chest wall. In addition, the scapulae obscure fremitus.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

21. In the most effective percussion technique of the posterior lung fields, the patient cooperates by:
a. folding the arms in front.
b. bending the head back.
c. standing and bending forward.
d. lying on the side and extending the top arm.
e. lying prone.
ANS: A
Asking the patient to sit with the head forward and arms folded in front moves the scapula laterally, exposing more lung to percussion.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

22. The examiner percusses for diaphragmatic excursion along the:
a. vertebral column.
b. midvertebral line.
c. midaxillary line.
d. scapular line.
e. sternum.
ANS: D
The technique for diaphragmatic excursion is to percuss along the scapular line, after the patient inhales deeply, and to mark the site when resonance changes to dullness, representing the diaphragm. The sequence is repeated with exhalation.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

23. The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it:
a. amplifies all types of sounds.
b. filters extraneous sounds.
c. pinpoints focal sound areas.
d. transmits high-pitched sounds.
e. transmits low-pitched sounds.
ANS: D
Unless specially modified, the stethoscope does not amplify sound, nor does it filter sound or pinpoint focal sounds. The stethoscope does transmit sound waves from the source to the ear. The diaphragm is the better source because it transmits the normally high-pitched sounds of the lung and has a broader area from which to listen.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

24. Breath sounds normally auscultated over most of the lung fields are called:
a. vesicular.
b. hyperresonance.
c. bronchial.
d. tubular.
e. bronchovesicular.
ANS: A
The low-intensity sounds heard over most healthy lung tissue are called vesicular breath sounds.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

25. Breath sounds normally heard over the trachea are called:
a. bronchovesicular.
b. amphoric.
c. crepitus.
d. vesicular.
e. bronchial.
ANS: E
The highest sounds in intensity and pitch are called the bronchial sounds, which are normally heard over the trachea.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

26. When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because:
a. consolidation will echo in the chest.
b. consolidation is a poor conductor of sound.
c. air-filled lung sounds are from smaller spaces.
d. air-filled lung tissue is an insulator of sound.
e. consolidation causes hyperinflation of the lungs.
ANS: D
Whereas air is a poor conductor of sound, more dense consolidation promotes louder sounds and is a better conductor of sound.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

27. The middle lobe of the right lung is best auscultated over the:
a. anterior chest.
b. posterior chest.
c. axilla.
d. midclavicular line.
e. scapula.
ANS: C
The sounds of the middle lobe of the right lung are best heard in the right axilla.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

28. To distinguish crackles from rhonchi, you should auscultate the lungs:
a. before and after the Patient coughs.
b. first at the lung base and then at the apex.
c. with the patient inhaling and then exhaling.
d. with the patient prone and then supine.
e. with the patient recumbent and then sitting.
ANS: A
To distinguish between crackles and rhonchi, ask the patient to cough and auscultate again over the same area. Rhonchi, because they represent secretions in larger airways, can clear with coughing.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

29. In what position can the mediastinal crunch (Hamman sign) be heard best?
a. In a supine position
b. Lying on the left side
c. Sitting completely upright
d. With the head elevated 30 degrees
e. In a prone position
ANS: B
The Hamman sign is heard with mediastinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are heard best when the patient leans to the left or lies down on the left side—these maneuvers bring the heart muscle closer to the chest wall.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

30. Changes in clarity and volume of spoken sounds during auscultation of the lungs can help you distinguish:
a. crepitus from stridor.
b. a foreign body from a purulent exudate.
c. pulmonary edema from pleurisy.
d. a right from left tracheal deviation.
e. consolidation from airway constriction.
ANS: E
When chest auscultation results in decreased breath sounds or wheezes, the examiner can use techniques that involve the spoken word to distinguish these adventitious breath sounds as a result of consolidation rather than narrowing of a patent lumen.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

31. How is the sputum of a viral infection different from the sputum of a bacterial infection?
a. There is more sputum production with viral conditions than bacterial infections.
b. The sputum is odorous with viral conditions and nonodorous with bacterial infections.
c. The sputum is yellow, green, or rust colored with bacterial infections and mucoid with viral.
d. The sputum is much thinner with bacterial infections and viscid with viral.
e. Viral pneumonia sputum is never blood streaked.
ANS: C
The more likely differentiating characteristic between viral and bacterial sputum is the color. Whereas viral infections typically produce mucoid sputum, bacterial infections produce
yellow, green, or rust-colored sputum.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

32. A signal for alarm during newborn chest assessment is:
a. crackles.
b. rhonchi.
c. gurgles from the gastrointestinal tract.
d. stridor.
e. a mobile xiphoid.
ANS: D
Crackles and rhonchi at birth are caused by the presence of remaining fetal fluid; intermittent gurgles are transmitted bowel sound through the thin-walled chest and are not alarming; stridor is alarming at any age. The newborn’s xiphoid process is more mobile and prominent than in older children.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

33. Bronchovesicular breath sounds in young children that are loud and harsh are an indication of:
a. an accumulation of fluid.
b. malignant tumors or solid masses.
c. normal, thin chest wall structures.
d. pus-filled abscesses and tumors.
e. tension pneumothorax.
ANS: C
Young children’s chest walls are usually thin and therefore able to normally transmit loud,
harsh, and more bronchial breath sounds than can adults.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

34. The pregnant woman is expected to develop:
a. tachypnea and decreased tidal volume.
b. deep breathing but not more frequent breathing.
c. dyspnea and increased functional residual capacity.
d. bradypnea and increased tidal volume.
e. tachypnea and increased functional residual capacity.
ANS: B
In pregnant women, tidal volume and vital capacity increase, and functional residual capacity decreases. Also, pregnant women breathe more deeply but not more frequently.

TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory

35. Which condition requires immediate emergency intervention?
a. Patient with pleuritic pain without dyspnea
b. Patient with fever and a productive cough
c. Patient with tachypnea but no chest retractions
d. Patient with pleuritic pain and rib tenderness
e. Patient with absent breath sounds and dull percussion tones
ANS: A
A patient who experiences unexpected pleuritic pain without prior respiratory distress or dyspnea has most likely developed a pulmonary embolism, a condition with a high mortality rate.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

36. Epiglottitis has frequently associated with infection by which organism?
a. Respiratory syncytial virus
b. Haemophilus influenzae type B
c. Adenovirus
d. Parainfluenza virus
e. Human metapneumovirus
ANS: B
Epiglottitis is an acute inflammation of the epiglottis caused by bacterial invasion. Immunization against the bacterium Haemophilus influenzae type B has greatly reduced the incidence in the United States. All of the other choices are viruses associated with bronchiolitis.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory




Chapter 15: Heart

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located:
a. more to the right and hanging more vertically.
b. more to the left and lying more horizontally.
c. riding higher in the chest and pushed anteriorly.
d. hanging lower in the chest and riding more vertically.
e. more to the right and lying more horizontally.
ANS: B
The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall, slender person’s heart tends to hang vertically and is positioned centrally. A stocky, short person’s heart tends to lie more to the left and more horizontally.

TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular

2. Which two heart structures are most anterior in the chest?
a. Both atria
b. Both ventricles
c. The right atrium and ventricle
d. The left atrium and ventricle
e. Superior and inferior venae cavae

ANS: C

The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart. The superior and inferior venae cavae lie posteriorly.

TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular

3. Contraction of the ventricles causes:
a. closure of the atrioventricular valves.
b. closure of the pulmonic and aortic valves.
c. opening of the mitral valve and closure of the tricuspid valve.
d. opening of the mitral and tricuspid valves.
e. opening of the auricular septa.
ANS: A
When the ventricles contract, the semilunar, pulmonic, and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular ...
4. The major heart sounds are normally created by:
a. valves opening.
b. valves closing.
c. the rapid movement of blood.
d. rubbing together of the cardiac walls.
e. pulmonic veins.
ANS: B
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 “lubb.” When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2 “dubb.” Valve opening is usually a silent event.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

5. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the:
a. P wave.
b. PR interval.
c. QRS complex.
d. ST segment.
e. T wave.
ANS: A
The P wave represents the Spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the
ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization).

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
6. A third heart sound is created by:
a. atrial contraction.
b. ventricular contraction.
c. diastolic filling.
d. regurgitation between the right and left ventricles.
e. blood in the pericardium.
ANS: C
Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria, and the filling sometimes produces a third heart sound S3.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

7. The “pacing” structure of the heart’s electrical activity is the:
a. atrioventricular (AV) node.
b. bundle of His.
c. Purkinje fibers.
d. coronary sinus.
e. sinoatrial (SA) node.
ANS: E
An electrical impulse stimulates each myocardial contraction, and this impulse originates in and is paced by the SA node.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

8. Purkinje fibers are located in the:
a. sinoatrial node.
b. atrioventricular node.
c. myocardium.
d. aortic arch.
e. pericardium.
ANS: C
The Purkinje fibers are located in the ventricular myocardium.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

9. The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the:
a. P wave.
b. QRS complex.
c. PR interval.
d. T wave.
e. U wave.
ANS: B
The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of the stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

10. In a fetus, the right ventricle pumps blood through the:
a. left atrium.
b. ductus arteriosus.
c. lungs.
d. foramen ovale.
e. septum primum.
ANS: B
The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

11. Closure of the ductus arteriosus usually occurs:
a. just before the initiation of labor.
b. 24 to 48 hours after birth.
c. after 7 days of life.
d. between the second and third months of life.
e. during the toddler stage.
ANS: B
Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

12. Which ECG change would not be expected as an age-related pattern?
a. First-degree block
b. Bundle branch block
c. Left ventricular hypertrophy
d. Ventricular fibrillation
e. Atrial fibrillation
ANS: D
Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

13. In an adult, the apical impulse should be most visible when the patient is in which position?
a. Supine
b. Leaning backward
c. Lithotomy
d. Right lateral recumbent
e. Upright
ANS: E
In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

14. If the apical impulse is more vigorous than expected to the chest wall, it is called:
a. a lift.
b. a thrill.
c. a bruit.
d. a murmur.
e. crepitus.
ANS: A
The apical impulse is more vigorous than expected; it is referred to as a heave or lift. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound that is caused by turbulent blood flow into, through, or out of the heart. Crepitus is air in the subcutaneous tissue from respirations.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

15. A palpable rushing vibration over the base of the heart at the second intercostal space is called a:
a. heave.
b. lift.
c. thrill.
d. thrust.
e. murmur.
ANS: C
A thrill is a fine, palpable, rushing vibration, or a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is a movement forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

16. An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate:

a. decreased cardiac output.
b. left ventricular hypertrophy.
c. hyperventilation.
d. obesity.
ANS: C
An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. In dextrocardia, the PMI would be displaced to the right.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

17. 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.
e. left ventricular hypertrophy.
ANS: D


A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

18. To estimate heart size by percussion, you should begin tapping at the:
a. apex.
b. left sternal border.
c. midclavicular line.
d. midsternal line.
e. anterior axillary line.
ANS: E
Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

19. Normal heart sounds are best heard:
a. directly over the semilunar and bicuspid heart valves.
b. over areas where blood flows after it passes through a valve.
c. near the carotid vessels.
d. over the central sternum.
e. over the ribs.
ANS: B
Normal heart sounds are best heard in areas where blood flows after it passes through a valve in the direction of blood flow.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

20. To hear diastolic heart sounds, you should ask patients to:
a. lie on their backs.
b. lie on their left sides.
c. lie on their right sides.
d. sit up and lean forward.
e. lie prone.
ANS: B
The left lateral recumbent position is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating a right rotated heart of dextrocardia.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

21. The carotid pulse should coincide with which heart sound?
a. S1
b. S2
c. S3
d. S4
e. S3-4
ANS: A
S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

22. You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following?
a. S1
b. S2
c. S3
d. S4
e. S3-4
ANS: B
S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
23. During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split.
You should ask the patient to inhale deeply while listening at the area.
a. aortic
b. pulmonic
c. tricuspid
d. mitral
e. apex
ANS: B
Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

24. The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing:
a. the splitting of S2.
b. high-pitched murmurs.
c. presystolic gallops.
d. systolic ejection sounds.
e. pericardial friction rub.
ANS: C


Using the bell of the stethoscope at the apex is more useful for low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

25. 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-aged men.
d. sedentary individuals.
e. older adults.
ANS: A
Many murmurs, particularly in children, adolescents, and especially young athletes, have no apparent cause. These are generally grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by splitting of S2.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

26. A split second heart sound is:
a. abnormal.
b. greatest at the peak of inspiration.
c. heard best after forceful expiration.
d. supposed to disappear with deep inspiration.
e. always accompanied by a thrill.

ANS: B
Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

27. The earliest sign of heart failure in an infant is frequently:
a. an apical impulse in the fourth intercostal space.
b. moisture in the lungs.
c. enlarged thyroid.
d. clubbing of the fingers.
e. liver enlargement.
ANS: E
If heart failure is suspected, note that the infant’s liver may enlarge before there is any suggestion of moisture in the lungs, and the left lobe of the liver may be more distinctly enlarged than the right. An apical impulse in the fourth intercostal space is a normal finding.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

28. Which dysrhythmia is a physiologic event during childhood?
a. First-degree AV block
b. Mobitz type II
c. Multifocal PVCs
d. Sinus dysrhythmia
e. Third-degree AV block
ANS: D
Sinus dysrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

29. Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of:
a. rheumatic fever.
b. cor pulmonale.
c. pericarditis.
d. endocarditis.
e. cardiac tamponade.
ANS: D
Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and a sudden onset of congestive heart symptoms. The lesions described are Janeway lesions.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
30. The most helpful finding in determining left-sided heart failure is:
a. dyspnea.
b. orthopnea.
c. jugular vein distention.
d. an S4 heart sound.
e. tachycardia.
ANS: C
Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. The other choices are not as reliable.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

31. Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associated with focal tenderness is most likely:
a. cardiac.
b. pleural.
c. esophageal.
d. musculoskeletal.
e. psychoneurotic.
ANS: D
The description given is a classic example of musculoskeletal chest pain.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

32. All of the following are characteristics of the Frailty syndrome in older adults except:
a. weight gain.
b. inability to climb one flight of stairs.
c. inability to walk one block.
d. most common in adults over age 70.
e. linked to comorbid conditions.
ANS: A
Frailty syndrome is characterized by signs and symptoms of being frail: weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. It is linked to comorbid conditions and carries an elevated risk of catastrophic declines in health and function, including disability, hospitalization falls, fracture, and death It is most common in adults older than 70 years old and is increasingly common after age 80 years of age.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

Chapter 16: Blood Vessels

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. The characteristics of arterial pulses are directly affected by all of the following except:
a. the volume of blood ejected.
b. peripheral arterial resistance.
c. venous valvular competence.
d. blood viscosity.
e. distensibility of aorta.
ANS: C
Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

2. The level at which the jugular venous pulse is visible gives an indication of:
a. mitral valve efficiency.
b. aortic valve efficiency.
c. stroke volume.
d. left ventricular pressure.
e. right atrial pressure.

ANS: E

The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

3. Vascular changes expected in older adults include:
a. loss of vessel elasticity.
b. decreased peripheral resistance.
c. decreased pulse pressure.
d. constriction of the aorta and major bronchi.
e. increased vasomotor tone.
ANS: A
With age, the walls of the arteries become calcified, and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
...

4. Which of the following statements is true regarding the examination of peripheral arteries?
a. The thumb should never be used to assess pulses.
b. Palpate at least one pulse in each extremity, usually the most proximal one.
c. The pulses are most readily felt over arteries that lie over bones.
d. Extremity pulses do not normally generate waveforms.
e. The pads of the fourth and fifth digits of the examiner’s hands are the most
sensitive.
ANS: C
The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers.
Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform).

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

5. Which arterial pulse is most useful in evaluating heart activity?
a. Femoral
b. Radial
c. Temporal
d. Brachial
e. Carotid
ANS: E
Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
6. The term claudication refers to:
a. pain from muscle ischemia.
b. lack of palpable pulsations.
c. visible extremity changes of arterial occlusion.
d. numbness and tingling in toes and fingers.
e. constriction or narrowing of a vessel.
ANS: A
Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

7. Conduction system impairment should be suspected if an irregular heartbeat is:
a. galloping.
b. paradoxical.
c. patternless.
d. weak.
e. bounding.

ANS: C
A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

8. You are examining Mr. S, a 79-year-old man with diabetes who is complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency?
a. Thick, calloused skin
b. Ruddy, thin skin
c. Warmer temperature of extremity in contrast to other body parts
d. Thin atrophied skin
e. Full superficial veins with rapid filling
ANS: D
An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed filling.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

9. A sound similar to a murmur that is heard over arteries is a:
a. thrill.
b. hum.
c. friction rub.
d. bruit.
e. heave.
ANS: D
A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

10. In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is:
a. color change.
b. edema.
c. pain with walking.
d. pain with palpation.
e. paralysis.
ANS: B
Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. Paralysis is a rare complication of arterial occlusion.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

11. To assess a patient’s jugular veins, he or she should first be placed in which position?
a. Supine
b. Semi-Fowler
c. Upright
d. Left lateral recumbent
e. Leaning forward
ANS: A
To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

12. Observation of hand veins can facilitate the assessment of:
a. mitral valve competency.
b. stoke volume.
c. right heart pressure.
d. pulse pressure.
e. left heart pressure.
ANS: C
Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient’s side. Then raise the hand until the veins collapse, and then use a ruler to measure the vertical distance between the midaxillary line (level of the
heart) and the level of the Collapsed hand veins.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

13. If pitting edema is unilateral, you would suspect occlusion of a:
a. lymphatic duct.
b. major vein.
c. surface capillary.
d. superficial artery.
e. deep artery.
ANS: B
If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

14. Which of the following statements is most accurate in describing hepatic jugular reflux?
a. It is an accurate indicator of heart failure.
b. It is exaggerated in patients with right heart failure.
c. It is normal when patients are sitting up straight.
d. It should be absent in older patients with heart failure.
e. It never elevates the jugular venous pressure (JVP) in patients without heart failure.
ANS: B
Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased JVP followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and the release of the abdominal hand pressure.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

15. 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.
e. painful, swollen extremities.
ANS: A
A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion.

TOP: Discipline: Pathophysiology MSC: Organ System : Cardiovascular
16. 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.
e. usually indicates dehydration.
ANS: B
A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

17. In pregnancy, blood pressure is lowest:
a. at conception.
b. during the first trimester.
c. during the second trimester.
d. during the third trimester.
e. at the time of delivery.
ANS: C

The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

18. A major risk factor for arterial embolic disease is:
a. venous thrombosis.
b. atrial fibrillation.
c. hypotension.
d. diuretic therapy.
e. constrictive pericarditis.
ANS: B
Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

19. In children, coarctation of the aorta should be suspected if you detect:
a. a delay between the radial and femoral pulses.
b. a simultaneous radial and femoral pulse.
c. an absent femoral pulse on the left.
d. bilateral absence of femoral pulses.
e. equal blood pressures in the arms and legs.
ANS: A
Coarctation of the aorta is a Congenital stenosis or narrowing seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum.
Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

Chapter 17: Breasts and Axillae

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE

1. The largest amount of glandular breast tissue lies in the:
a. upper inner quadrant.
b. lower inner.
c. tail of Spence.
d. upper outer quadrant.
e. lower outer.
ANS: D
The greatest amount of glandular tissue in the breast lies in the upper outer quadrant.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

2. Montgomery tubercles are most prominent in the breasts of:
a. men.
b. patients with lung disease.
c. adolescent girls.
d. prepubertal girls.
e. pregnant women.
ANS: E
Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women
TOP: Discipline: Physiology MSC: Organ System: Reproductive

3. Around 75% of women are menstruating by which Tanner stage of breast development?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
e. Stage 5
ANS: D
About one-fourth of women begin menstruation at stage 4. Around 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

4. Which breast change is typical after menopause?
a. Thickening of the inframammary ridge
b. Hypertrophy of glandular tissue
c. Increase in number of lactiferous ducts
d. Reduction of fat deposits
e. Shortening of Cooper’s ligaments
ANS: A
After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper’s ligaments relax.

TOP: Discipline: Physiology MSC: Organ System: Reproductive
...

5. In a woman complaining of a breast lump, it is most important to ask about:
a. its relationship to menses.
b. weight gain.
c. sleep patterns.
d. immunization status.
e. alcohol consumption.
ANS: A
Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

6. 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
c. Nulliparity
d. Late menarche
e. Young age at birth of first child
ANS: C
Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily.

TOP: Discipline: Biostatistics MSC: Organ System: Reproductive

7. Inspection of the breasts usually begins with the patient in which position?
a. Lateral
b. Sitting
c. Standing
d. Supine
e. Prone
ANS: B
Inspection begins with the patient in a sitting position with arms hanging loosely at the sides.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

8. In patients with breast cancer, peau d’orange skin is often first evident:
a. in the axilla.
b. in the upper inner quadrant.
c. on or around the nipple.
d. at the inframammary ridge.
e. in the tail of Spence.
ANS: C
The areola is the most common initial site to visualize peau d’orange skin.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

9. 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.
e. sign of late menarche.
ANS: A
Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

10. Recent unilateral inversion of a previously everted nipple suggests:
a. obesity.
b. cancer.
c. benign breast disease.
d. pregnancy.
e. mastitis.

ANS: B
Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

11. Which condition is more common in African American women than in white women?
a. Light areolae
b. Nipple inversion
c. Retracted areolae
d. Supernumerary nipples
e. Nipple and areolar colors do not match
ANS: D
The incidence of supernumerary nipples is higher in African American women than in white women.

TOP: Discipline: Biostatistics MSC: Organ System: Reproductive

12. When palpating breast tissue, the examiner should use the at each site.
a. fingertips
b. finger pads
c. palms of the hands
d. ulnar surface of the hands
e. thumbs
ANS: B
The finger pads are used for breast palpation because they are more sensitive than the fingertips.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

13. Documentation of a breast mass location is:
a. according to illustration, without a narrative.
b. according to clock positions from the nipple.
c. measured with calipers from the nipple.
d. measured in centimeters from the sternal notch.
e. measured in centimeters from the axilla.
ANS: B
Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

14. If 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 for biopsy.
c. ask the patient to have a mammogram as soon as possible.
d. record the finding in the patient’s record.
e. tell the patient to stop drinking alcohol
ANS: D
The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

15. A 12-year-old boy is being seen because of right-sided breast tenderness. Your examination technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pealike mass under the areola. Recommendations to the child and parent are to:
a. apply an Ace wrap compression bandage for 6 hours a day.
b. return for evaluation in 6 months if the problem persists.
c. obtain a surgical referral for needle biopsy.
d. discontinue all contact sports.
e. administer urine screen for illicit drugs.
ANS: B
Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

16. To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with:
a. her arms straight alongside her body.
b. both arms overhead with her palms upward.
c. her hands clasped just above her umbilicus.
d. one arm overhead and a pillow under her shoulder.
e. both hands pressed against her hips.
ANS: D
Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

17. When examining axillary lymph nodes, the patient’s arm is:
a. raised full above the head.
b. extended at the side.
c. pressed against the hip.
d. crossed over the chest.
e. flexed at the elbow.
ANS: E
To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your
hands and use your other hand to palpate the axilla.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

18. Lymphatic flow of the breast Primarily drains
a. inferiorly toward the abdomen.
b. laterally toward the corresponding arm.
c. radially.
d. medially toward the sternum.
e. inferomedially toward the xiphoid.
ANS: C
Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

19. You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area, you suspect that you felt a node. To improve your hooked technique, you should:
a. apply lotion to your hands.
b. use both hands simultaneously.
c. ask the patient to press both palms together.
d. ask the patient to lower her shoulder on that side.
e. ask the patient to turn her head toward that side.
ANS: E
Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

20. Male gynecomastia associated with recreational or prescription drug use can be expected to:
a. lessen when the body becomes accustomed to the drug.
b. resolve after the drug is discontinued.
c. leave permanent breast enlargement when the drug is discontinued.
d. cause purulent drainage if left untreated.
e. lead to an increased risk of breast cancer.
ANS: B
Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

21. A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic 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 fluids.
d. sleep with a bra and wash her breasts with antibacterial soap.
e. stop nursing and restrict fluids.
ANS: A
This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will Increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh
soaps can dry and crack the nipple and compound infection.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

22. You are conducting a clinical breast examination for a 30-year-old patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely movable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with:
a. fibroadenoma.
b. Paget disease.
c. cancer.
d. mammary duct ectasia.
e. fibrocystic changes.
ANS: E
Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile,
well-delineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive


23. Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed:
a. retention cyst.
b. case of Paget disease.
c. supernumerary nipple.
d. fat necrosis.
e. Montgomery tubercle.
ANS: C
Supernumerary nipples appear as one or more extra nipples located along the embryonic
mammary ridge (the “milk line”). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

24. All of the following are true statements about the risks of Breast Cancer Screening except:
a. risk of false-positive results.
b. possible pain from testing.
c. possibility of adverse psychologic responses.
d. there is little evidence that breast cancer screening reduces mortality.
e. overdiagnosis of lesions that would not become clinically significant.
ANS: D
While breast cancer screening is beneficial in reducing mortality, it also carries potential harms. Potential harms Include false positive and false -negative results, additional testing and biopsies, overdiagnosis (diagnosis of lesions that would not become clinically significant) and
subsequent treatment, pain from testing, and adverse psychologic responses.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

25. Most of the benefit of mammography screening occurs in which age group?
a. 24 to 50
b. 35 to 49
c. 50 to 74
d. 65 to 84
e. Over age 75
ANS: C
Breast cancer mortality is reduced with mammography screening, although estimates are of borderline statistical significance, the magnitudes of effect are small for younger ages, and results vary depending on how cases were accrued in trials. Most of the benefits of mammography results from screening during ages 50 to 74 years. There are insufficient data to assess the benefits and harms of screening women age 75 years or older.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

Chapter 18: Abdomen

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE

1. Peristalsis of intestinal contents is under the control of:
a. cognitive processes.
b. gravity.
c. the autonomic nervous system.
d. the fluid content of the stomach.
e. cerebellum.
ANS: C
The movement of food and digestive products is regulated by the autonomic nervous system.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

2. The superior most part of the stomach is the:
a. body.
b. fundus.
c. pylorus.
d. cardiac orifice.
e. pyloric orifice.
ANS: B
The most superior aspect of the stomach is the fundus, followed by the body, and then the most distal part, the pylorus.
TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

3. The appendix is an extension of the:
a. ileum.
b. cecum.
c. ascending colon.
d. transverse colon.
e. descending colon.
ANS: B
The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum.

TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal
...

4. One major function of the liver is to:
a. secrete pepsin.
b. emulsify fats.
c. store glycogen.
d. absorb bile.
e. produce insulin.

ANS: C
The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

5. The majority of nutrient absorption takes place in the:
a. stomach.
b. small intestine.
c. cecum.
d. transverse colon.
e. descending colon.
ANS: B
Very little absorption takes place in the stomach; most absorption takes place in the small intestine. The cecum and transverse colon are part of the large intestine, and its major function is water reabsorption.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

6. The major function of the large intestine is:
a. water absorption.
b. food digestion.
c. carbohydrate absorption.
d. mucous absorption.
e. glycogen breakdown.

ANS: A
The major function of the large intestine is the absorption of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

7. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the:
a. spleen.
b. kidney.
c. liver.
d. pancreas.
e. gallbladder.
ANS: C
The liver is responsible for converting fat-soluble waste to water-soluble materials so the kidneys can excrete them as well as convert ammonia to urea.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

8. Which abdominal organs also produce hormones and function as endocrine glands?
a. Kidney and liver
b. Liver and gallbladder
c. Stomach and spleen
d. Gallbladder and pancreas
e. Pancreas and kidney
ANS: E
The pancreas produces pancreatic juices as well as insulin and glucagon; the kidneys produce urine as well as the hormones rennin and erythropoietin.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

9. Mrs. G is 7 months’ pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as:
a. decreased movement through the colon and increased water absorption from stool.
b. increased movement through the colon and increased salt taken from foods.
c. looser anal sphincter and less nutrients taken from foods.
d. tighter anal sphincter and less iron eliminated in the stool.
e. increased absorption of nutrients and water in the colon.
ANS: A
Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. The colon does not absorb nutrients, and a tighter sphincter tone is not related to pregnancy.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

10. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is:
a. decreased hydrochloric acid production.
b. increased motility.
c. decreased bile absorption
d. decreased motility.
e. increased saliva secretion.
ANS: D
A decrease in motility of the gastrointestinal (GI) tract is the most pronounced GI change in older adults.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

11. The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it:
a. only affects the GI tract.
b. is one cause of malabsorption syndrome.
c. is a curable condition with medical intervention.
d. is the most frequent cause of diarrhea in general practice.
e. is a common genetic disorder.
ANS: B
Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent concerns.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

12. Infants born weighing less than 1500 g are at higher risk for:
a. hepatitis A.
b. necrotizing enterocolitis.
c. urinary urgency.
d. cystic fibrosis.
e. pancreatitis.
ANS: B
Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants; it involves infection and inflammation that causes destruction of the bowel, and it becomes more apparent after feedings. Low birth weight does not relate to the development of hepatitis A, urinary urgency, cystic fibrosis, or pancreatitis.

TOP: Discipline: Biostatistics MSC: Organ System: Gastrointestinal

13. Which structure is located in the hypogastric region of the abdomen?
a. Bladder
b. Cecum
c. Gallbladder
d. Stomach
e. Liver
ANS: A
The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus.


TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

14. When examining a patient with tense abdominal musculature, a helpful technique is to have
the patient:
a. hold his or her breath.
b. sit upright.
c. flex his or her knees.
d. raise his or her head off the pillow.
e. fully extend the legs.
ANS: C
To help relax the abdominal musculature, it is helpful to place a small pillow under the
patient’s head and under slightly flexed knees. The other choices increase muscle flexion.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

15. You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n):
a. small inguinal hernia.
b. large epigastric hernia.
c. abdominal lipoma.
d. diastasis recti.
e. incisional hernia.
ANS: D
A diastasis recti occurs when abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and most often occurs in repeated pregnancies and obesity.
TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

16. What condition is associated with striae that remain purplish?
a. Cushing disease
b. Diastasis recti
c. Liver cirrhosis
d. Recent pregnancy
e. Intraabdominal bleeding
ANS: A
Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white; striae associated with Cushing disease stay purplish.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

17. Visible intestinal peristalsis may indicate:
a. normal digestion.
b. intestinal obstruction.
c. increased pulse pressure of aorta.
d. aortic aneurysm.
e. paralytic ileus.
ANS: B
Peristalsis is not usually Visible and when detected May indicate an intestinal obstruction.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

18. After thorough inspection of the abdomen, the next assessment step is to:
a. percuss.
b. palpate nonpainful areas.
c. auscultate.
d. perform a rectal examination.
e. palpate painful areas.
ANS: C
Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation is done first.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

19. Peritonitis often produces bowel sounds that are:
a. decreased.
b. increased.
c. high pitched.
d. absent.
e. accentuated.

ANS: A
Decreased bowel sounds occur with peritonitis and paralytic ileus.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

20. An examiner can recognize a friction rub in the liver by a sound that is:
a. clicking, gurgling, and irregular.
b. high pitched and associated with respirations.
c. loud, prolonged, and gurgling.
d. soft, low-pitched, and continuous.
e. low pitched, tinkling, and unrelated to respirations.
ANS: B
An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

21. To correctly document absent bowel sounds, one must listen continuously for:
a. 30 seconds.
b. 1 minute.
c. 3 minutes.
d. 5 minutes.
e. 10 minutes.
ANS: D
Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

22. When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems?
a. Arterial bruit
b. Gastric rumbling
c. Renal hyperresonance
d. Borborygmi
e. Venous hum
ANS: E
Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, and a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

23. Percussion of the abdomen begins with establishing:
a. liver dullness.
b. spleen dullness.
c. gastric bubble tympany.
d. overall dullness and tympany in all quadrants.
e. bladder fullness.
ANS: D
Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

24. An umbilical assessment in the newborn that is of concern is:
a. a thick cord.
b. an umbilical hernia.
c. one umbilical artery and two veins.
d. pulsations superior to the umbilicus.
e. visible nondistended superficial veins.
ANS: C
What is expected is two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally spontaneously close by 2 years, and pulsations to the abdomen in the epigastric area are common. Nondistended superficial veins are usually visible in thin infants.

TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal

25. Failure to pass a meconium stool in the first 24 hours after birth along with abdominal distention is often the first sign of:
a. Meckel diverticulum.
b. cystic fibrosis.
c. biliary atresia.
d. hydramnios.
e. Wilms tumor.
ANS: B

Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

26. A patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?
a. Positive psoas sign
b. Positive McBurney sign
c. History of periumbilical pain
d. Rebound tenderness
e. Obturator muscle test
ANS: E
Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

27. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most associated with:

a. peptic ulcer disease.
b. pancreatitis.
c. ruptured ovarian cyst.
d. splenic rupture.
e. diverticulitis.
ANS: E
No choice other than diverticulitis has all of these presenting symptoms.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

28. A 45-year-old man relates a several-week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination, you review his laboratory work, anticipating a(n):
a. elevated white blood cell count.
b. decreased potassium level.
c. positive Helicobacter pylori result.
d. increased urine specific gravity.
e. folate deficiency.
ANS: C
The patient’s presenting symptoms suggest peptic ulcer disease. The supporting laboratory
finding is the presence of H. pylori.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

29. Costovertebral angle tenderness should be assessed whenever you suspect the patient may have:
a. cholecystitis.
b. pancreatitis.
c. pyelonephritis.
d. ulcerative colitis.
e. intussusception.
ANS: C
Pyelonephritis is characterized by flank pain and costovertebral angle tenderness.

TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary

30. The most common congenital anomaly of the gastrointestinal tract is:
a. biliary atresia.
b. meconium ileus.
c. intussusception.
d. Meckel diverticulum.
e. pyloric stenosis.
ANS: D
Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract.

TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal

31. 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?
a. Intussusception
b. Kidney stones
c. Meconium ileus
d. Pyloric stenosis
e. Necrotizing enterocolitis
ANS: A
Intussusception refers to the prolapse of one segment of the intestine into another causing intestinal obstruction. Whereas a sausage-shaped mass may be palpated in the right or left upper quadrant, the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

32. In older adults, overflow fecal incontinence is commonly caused by:
a. malabsorption.
b. parasitic diarrhea.
c. Meckel diverticulum.
d. fistula formation.
e. fecal impaction.
ANS: E
Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

33. Given the high certainty that screening results in reduced mortality, current recommendations include screening for colorectal cancer beginning at age 50 and continuing until age:
a. 65.
b. 70.
c. 75.
d. 80.
e. 85.
ANS: C
In 2016 the U.S. Preventive Services Task Force (USPSTF) updated its previous recommendations based on a review of the evidence assessing both benefits and harms of screening. Given the high certainty that screening results in reduced mortality, the USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. Screening for colorectal cancer in adults ages 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal


Chapter 19: Female Genitalia

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE

1. Posteriorly, the labia minora meet as two ridges that fuse to form the:
a. fourchette.
b. vulva.
c. clitoris.
d. perineum.
e. perineal body.
ANS: A
The labia minora join posteriorly at a junction called the fourchette.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

2. What structures are located at the 5 o’clock and the 7 o’clock positions of the vaginal orifice and open onto the sides of the vestibule in the groove between the labia minora and the hymen?
a. Skene glands
b. Perineal bodies
c. Labia majora
d. Bartholin glands
e. Labia minora

ANS: D
Bartholin glands are found posteriorly on each side of the vaginal orifice and open onto the sides of the vestibule.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

3. During sexual excitement, how is the vaginal introitus lubricated?
a. Bartholin glands secrete mucus.
b. Clitoris produces moisture.
c. Skene glands secrete fluid.
d. Urethral surfaces secrete water.
e. Hymen secretes mucus.
ANS: A
The Bartholin glands secrete mucus into the introitus for lubrication during sexual stimulation.

TOP: Discipline: Physiology MSC: Organ System: Reproductive
...

4. The adnexa of the uterus are composed of the:
a. corpus and cervix.
b. fallopian tubes and ovaries.
c. uterosacral and broad ligaments.
d. round ligaments and ovaries.
e. vagina and fundus.

ANS: B
The fallopian tubes and the ovaries are collectively referred to as the adnexa of the uterus.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

5. The pelvic joint that separates most appreciably during late pregnancy is the:
a. sacroiliac.
b. symphysis pubis
c. sacrococcygeal.
d. iliofemoral.
e. sacrosciatic notch.
ANS: B
Of the four pelvic joints, the one that appreciably moves later in pregnancy is the symphysis pubis. The sacrosciatic notch is not a joint, and no changes occur.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

6. Pregnancy-related cervical changes include:
a. flattening and lengthening.
b. thinning and reddening.
c. hardening and pallor.
d. shortening and reddening.
e. softening and bluish coloring.
ANS: E
During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign).

TOP: Discipline: Physiology MSC: Organ System: Reproductive

7. The conventional definition of menopause is:
a. 3 months with no menses.
b. 1 year with no menses.
c. 6 months of progressively shorter menses.
d. 3 consecutive anovulatory cycles.
e. the cessation of ovulation.
ANS: B
Menopause is defined as 1 year without menses.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

8. Which systemic feature is related to the effects of menopause?
a. Increased intraabdominal fat deposition
b. Decreased LDL levels
c. Cold intolerant
d. Decreased cholesterol levels
e. Decreased risk of cardiovascular disease
ANS: A
Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

9. The risk of ovarian cancer is increased by a history of:
a. low-fat diet.
b. cigarette smoking.
c. age between 35 and 50 years.
d. thin body habitus.
e. nulliparity.
ANS: E
There is a relationship between nulliparity and an increased risk of ovarian cancer. Although the risk increases with age, most ovarian cancers develop after menopause; half are found in women older than 63 years. The other choices have no relationship with ovarian cancer.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

10. The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her daughter’s underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child’s:
a. drug ingestion.
b. fluid intake.
c. risk for sexual abuse.
d. hormone responsiveness.
e. fat intake.
ANS: C
Vaginal discharge in a child could be related to a chemical irritation from soaps, lotions, or powders or to urinary tract infections. Concerned parents or children should be assessed for
the risk of sexual abuse.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

11. The female patient should ideally be in which position for the pelvic examination?
a. Fowler
b. Prone
c. Lateral-supine
d. Lithotomy
e. Trendelenburg
ANS: D
Ideally, position the woman in a lithotomy position for a pelvic examination.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

12. During a pelvic examination, you ask the patient to perform the Valsalva maneuver while you observe for bulging and urinary incontinence, to test for the presence of:
a. a cystocele.
b. a rectocele.
c. vaginal prolapse.
d. rectal prolapse.
e. hymenal remnants.

ANS: A
Asking the woman to bear down as you watch for anterior wall bulging and urinary incontinence is done to assess for the presence of a cystocele.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

13. When you plan to obtain cytologic studies, speculum introduction may be facilitated by:
a. Valsalva maneuver.
b. lubrication with warm water.
c. use of plastic speculum.
d. opening the blades completely.
e. lubrication with gel.
ANS: B
Until further studies conclusively determine that gel lubricant does not adversely interfere with specimen analysis, we continue to recommend lubrication with water. However, if gel lubricant is used, a thin layer on the external surface of the blades only will help avoid contamination of the specimen.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

14. When performing a gynecologic examination, the examiner should change gloves after
touching the patient’s:
a. anal area.
b. Bartholin glands.
c. Skene glands.
d. cervix.
e. urethra.
ANS: A
Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

15. During digital examination of the vagina, the cervix is noted to be positioned posteriorly. Upon bimanual examination of this woman, you would expect to palpate a(n) uterus.
a. retroverted
b. anteverted
c. midline
d. laterally deviated
e. retroflexed
ANS: B
The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

16. Which one of the following is a proper technique for use of a speculum during a vaginal examination?
a. Allow the labia to spread; insert the speculum slightly open.
b. Press the introitus upward; insert the closed speculum horizontally.
c. Press the introitus downward; insert the closed speculum obliquely.
d. Spread the labia; insert the closed speculum horizontally.
e. Insert one finger; insert the opened speculum.
ANS: C
Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

17. Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should:
a. chart this as nabothian cysts.
b. chart this as a friable cervix.
c. obtain a viral culture.
d. test the pH of the cervical os.
e. chart this as an eroded cervix.
ANS: A
This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

18. An examiner 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 culture
b. Cytology smear
c. Haemophilus smear
d. Trichomonas smear
e. Fungal cultures
ANS: B
This describes the technique for obtaining a cytology Pap smear.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

19. The visualization of a large proportion of “clue cells” on your wet mount slide examination suggests:
a. trichomonal infection.
b. bacterial vaginosis.
c. candidiasis.
d. gonorrhea.
e. cervical cancer.
ANS: B
Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount.

TOP: Discipline: Microbiology MSC: Organ System: Reproductive

20. The assessment of which structure is not part of the bimanual examination?
a. Cervix
b. Bladder
c. Uterus
d. Ovaries
e. Adnexa
ANS: B
The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

21. The rectovaginal examination is an important component of the total pelvic examination because it:
a. is the most direct cervical examination route.
b. is a more comfortable examination for the posthysterectomy patient.
c. is an alternate source for cytology specimens.
d. allows the examiner to reach almost 2.5 cm higher into the pelvis.
e. provides better evaluation of the bladder.
ANS: D
The rectovaginal Examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for
the patient and is not the source for cytology specimens or more complete evaluation of the bladder.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

22. Prominent labia minora are a normal finding in:
a. adolescents.
b. menopausal women.
c. newborns.
d. pregnant women.
e. postmenopausal women.
ANS: C
Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

23. The most common cause of a foul vaginal discharge in children is a(n):
a. rectocele.
b. foreign body.
c. infection.
d. ruptured hymen.
e. accident.
ANS: B
Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

24. 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. Upon 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.
e. malignancy.
ANS: D
A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

25. Fundal height to the level of the umbilicus normally occurs around week of pregnancy.
a. 10
b. 16
c. 20
d. 24
e. 30
ANS: C
At 20 weeks of gestation, the fundal height reaches the level of the umbilicus.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

26. During a pelvic examination for a postmenopausal woman, you would expect to assess:
a. a wider and longer vaginal vault.
b. absence of vaginal wall rugation.
c. a nonpalpable cervical os.
d. a more mobile cervix.
e. palpable ovaries.
ANS: B
Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, a less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

27. Asking the woman to close the introitus during a pelvic examination is a test for:
a. endometriosis.
b. rectocele.
c. cervical polyps.
d. muscle tone.
e. cystocele.
ANS: D
Test for muscle tone is to have the woman squeeze the vaginal opening around your finger. A rectocele can be seen as a bulge on the posterior wall. A cystocele will be seen as bulge on the anterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without squeezing.
TOP: Discipline: Physiology MSC: Organ System: Reproductive

28. The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is:
a. homogeneous and gray with a low pH.
b. scant and curdy with a low pH.
c. profuse and frothy with a high pH.
d. profuse and curdy with a low pH.
e. bloody and thin with a high pH.
ANS: C
Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5).

TOP: Discipline: Microbiology MSC: Organ System: Reproductive
29. Mittelschmerz may occur in which phase of the menstrual cycle?

a. Menstrual
b. Postmenstrual
c. Ovulation
d. Secretory
e. Luteal
ANS: C

Mittelschmerz, lower abdominal pain associated with ovulation, may also be accompanied by tenderness on the side where ovulation took place that month.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

30. Which of the following cancers is not associated with human papillomavirus (HPV) infection?
a. Cervical
b. Vaginal
c. Vulvar
d. Ovarian
e. Penile
ANS: C
HPV infection can cause cervical, vaginal, and vulvar cancers in women; penile cancer in men; anal and oropharyngeal cancer and genital warts in both men and women. Vaccination against HPV before exposure to the virus through sexual contact is recommended for preadolescent and adolescent girls and boys
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive


Chapter 20: Male Genitalia

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. What structure of the male genitalia travels through the inguinal canal and unites with the seminal vesicle to form the ejaculatory duct?
a. Epididymis
b. Corpus cavernosum
c. Urethra
d. Vas deferens
e. Ureter
ANS: D
The vas deferens begins at the end of the epididymis, travels the spermatic cord, goes through the inguinal canal, and then unites with the seminal vesicle to form the ejaculatory duct.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

2. While examining an 18-year-old man, you note that the penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be:
a. caused by a lack of testosterone.
b. suggestive of a skin fungus.
c. suggestive of psoriasis.
d. caused by excessive progesterone.

e. within normal limits.
ANS: E
Darker pigmentation from other body skin is a normal finding on the penis and testicles.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

3. In an uncircumcised male, retraction of the foreskin may reveal cheesy white material. This is usually:
a. evidence of a fungal infection.
b. a collection of sebaceous material.
c. indicative of penile carcinoma.
d. suggestive of diabetes.
e. evidence of a gonococcal infection.
ANS: B
The glans secretes a sebaceous material, smegma, in uncircumcised males. It looks like a cheesy white material. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. Smegma is not candidiasis nor is it suggestive of diabetes, cancer, or gonorrhea.

TOP: Discipline: Physiology MSC: Organ System: Reproductive
...

4. The greatest contribution to the volume of ejaculate comes from the:
a. prostate.
b. epididymis.
c. seminal vesicles.
d. corpus cavernosa.
e. testes.
ANS: A
The major volume of ejaculatory fluid comes from the prostate gland.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

5. Sexual differentiation in the fetus has occurred by weeks’ gestation.
a. 8
b. 12
c. 16
d. 20
e. 30
ANS: B
By 12 weeks’ gestation, sexual differentiation has occurred in the fetus.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

6. Expected genitalia changes that occur as men age include:
a. that ejaculatory volume decreases with age.
b. that erections develop more quickly.
c. that the viability of sperm increases.
d. that the scrotum becomes more pendulous.
e. an increase in time for mature sperm to develop.
ANS: D
Ejaculatory volume may increase with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. There is no change in the length of time necessary for mature sperm production.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

7. Which of the following is a risk factor for testicular cancer?
a. Circumcision
b. Condyloma acuminatum
c. Cryptorchidism
d. Poor hygiene
e. Multiple sexual partners
ANS: C
Cryptorchidism (testes that fail to descend by 12 months of age) is a risk factor for testicular cancer.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

8. You are inspecting the genitalia of an uncircumcised man. The foreskin is tight and cannot be easily retracted. You should:
a. chart the finding as paraphimosis.
b. inquire about previous penile infections.
c. retract the foreskin firmly.
d. transilluminate the glans.
e. chart the finding as balanitis.
ANS: B
This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum. Balanitis is inflammation of the glans that may occur with phimosis.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

9. Which type of hernia lies within the inguinal canal?
a. Umbilical
b. Direct
c. Indirect
d. Femoral
e. Incisional
ANS: C
Hernias found within the inguinal canal are called indirect hernias.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

10. Which one of the following conditions is of minor consequence on the adult male genitalia?
a. A viscus felt medial to the external canal
b. Continuous penile erection
c. Lumps in scrotal skin
d. Venous dilation in spermatic cord
e. Adhesions of the foreskin
ANS: C
Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits. The other choices require medical or surgical intervention.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

11. A characteristic related to syphilis or diabetic neuropathy is testicular:
a. dropping with asymmetry.
b. enlargement.
c. insensitivity to painful stimulation.
d. recession into the abdomen.
e. nodularity.
ANS: C
Diabetic neuropathy or syphilis can cause a marked reduction of tactile perceptions. Asymmetry is a normal finding; enlargement and recession are not related to diabetes or syphilis. Any nodules found on the testes must be evaluated for malignancy and are not characteristic of syphilis or diabetes.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

12. A normal vas deferens should feel:
a. tender.
b. smooth.
c. rugated.
d. spongy.
e. beaded.
ANS: B
The vas deferens should normally feel smooth, discrete, and nontender.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

13. A premature infant’s scrotum will be:
a. bifid.
b. loose.
c. rugated.
d. smooth.
e. enlarged.
ANS: D
A scrotum in a premature infant will appear underdeveloped and smooth without rugae or testes; a full-term infant should have a loose, pendulous scrotum with rugae and a midline raphe.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

14. An enlarged, painless testicle in an adolescent or adult may indicate:
a. epididymitis.
b. testicular torsion.
c. a tumor.
d. an undescended testicle.
e. hypospadias.
ANS: C
A hard, enlarged, painless testicle can indicate a tumor in an adolescent or adult male. Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months. Hypospadias is a congenital defect of the urethral opening causing the meatus to be located ventral to its normal position.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

15. The most emergent cause of testicular pain in a young male is:
a. varicocele.
b. epididymitis.
c. tumor.
d. hydrocele.
e. testicular torsion.
ANS: E
Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in a much lower salvage rate.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

16. When examining a small child, in which position should he be placed to help push the testicles into the scrotum?
a. Trendelenburg
b. Tailor
c. Standing
d. Prone
e. Supine
ANS: B
When the child is old enough to sit cooperatively, ask him to sit in a tailor position with legs crossed for the testicular examination.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

17. The most common type of hernia occurring in young males is:
a. direct inguinal
b. incisional.
c. indirect inguinal.
d. umbilical.
e. femoral.

ANS: C
The most common type of hernia in children and young males is an indirect inguinal hernia.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

18. Difficulty replacing the retracted foreskin of the penis to its normal position is called:
a. paraphimosis.
b. Peyronie disease.
c. prepuce.
d. priapism.
e. phimosis.
ANS: A
Paraphimosis refers to the inability to replace the foreskin to its original position after it has been retracted behind the glans.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

19. The finding of a painless indurated lesion on the glans penis is most consistent with:
a. herpes simplex.
b. herpes zoster.
c. warts.
d. chancre.
e. molluscum contagiosum.

ANS: D
Syphilitic chancre is a painless lesion with an indurated border and a clear base.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

20. A finding associated with male genital herpes is:
a. disseminated lymphadenopathy.
b. pain subsiding with scrotal elevation.
c. soft, red papules on the prepuce.
d. painful superficial penile vesicles.
e. pearly gray, dome-shaped lesions.
ANS: D
Genital herpes presents as painful superficial vesicles on an erythemic base.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

21. A male whose urethral meatus opens on the ventral surface of his penis has which condition?
a. Peyronie disease
b. Hydrocele
c. Hypospadias
d. Normal variation
e. Epispadias
ANS: C
The congenital defect in which the urethral meatus is located on the ventral surface of the glans is called hypospadias.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

22. Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably:
a. lymphogranuloma venereum.
b. condylomata.
c. molluscum contagiosum.
d. chancres.
e. herpetic lesions.
ANS: C
Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative of molluscum contagiosum.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

23. A 12-year-old boy says that his left scrotum has a soft swollen mass. The scrotum is not painful upon palpation. The left inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with:
a. orchitis.
b. hydrocele.
c. rectocele.
d. scrotal hernia.
e. epididymitis.

ANS: B
A hydrocele is a soft scrotal mass that occurs from fluid accumulation and therefore does transilluminate. Orchitis results in a swollen, tender testis. A rectocele does not result in scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal.
Epididymitis is an extremely painful condition.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

24. Which condition is a complication of mumps in an adolescent or adult?
a. Varicocele
b. Epididymitis
c. Orchitis
d. Paraphimosis
e. Cystitis
ANS: C
Orchitis is uncommon unless seen as a complication of mumps in an adolescent or adult.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

25. All males may receive the human papillomavirus vaccine through which age?
a. 16
b. 26
c. 36
d. 46
e. 56

ANS: B
Vaccination against HPV before exposure to the virus through sexual activity is recommended for preadolescent and adolescent girls and boys. All males may receive the vaccine through age 26 and should speak with their healthcare provider to determine whether getting vaccinated is right for them. The vaccine is also recommended for any man who has sex with men and men with compromised immune systems (including human immunodeficiency virus [HIV]) through age 26 if they did not get fully vaccinated when they were younger.

TOP: Discipline: Physiology MSC: Organ System: Reproductive


Chapter 21: Anus, Rectum, and Prostate

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. The adult internal rectal sphincter is controlled by the:
a. autonomic nervous system.
b. central nervous system.
c. peripheral nervous system.
d. lumbar spinal reflexes.
e. sacral spinal reflexes.
ANS: A
The internal ring of smooth muscle of the anal canal is under involuntary autonomic control.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

2. In males, which surface of the prostate gland is accessible by digital examination?
a. Median lobe
b. Posterior
c. Superior
d. Anterior
e. Lateral
ANS: B
The posterior surface of the prostate gland lies close to the anterior wall of the rectum and is palpable through digital rectal examination
TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary

3. Which of the following is a risk factor for anal cancer?
a. White race
b. Diet low in animal fats and proteins
c. Physical inactivity
d. Infection with high-risk type HPV
e. Low body fat
ANS: D
Infection with high-risk type human papillomavirus is considered a risk factor for anal cancer. The other answers are not.

TOP: Discipline: Biostatistics MSC: Organ System: Gastrointestinal
...

4. Factors associated with increased risk of prostate cancer include:
a. African American descent.
b. cigarette smoking.
c. low-fat diet.
d. alcoholism.
e. obesity.
ANS: A

The incidence rate of prostate cancer is more common in African Americans and in Caribbean patients of African ancestry; less common in Asian American and Hispanic/Latinos than in non-Hispanic whites.

TOP: Discipline: Biostatistics MSC: Organ System: Renal/Urinary

5. When performing a rectal examination in a man, in which position is the patient generally placed?
a. Lithotomy
b. Prone
c. Trendelenburg
d. Left lateral
e. Supine
ANS: D
Male patients are usually positioned left lateral or standing with upper body flexed at the waist over the examination table, with the toes pointed together for increased exposure of the area.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

6. Which of the following conditions is most commonly seen in adults with diabetes?
a. Pinworms
b. Pilonidal cysts
c. Perianal fistula
d. Pruritus ani
e. Anorectal fissure

ANS: D
Pruritus ani refers to chronic itching of the skin around the anus, which can be caused by fungal infections and is more common in diabetic patients. Pinworms are more common in children; the other conditions do not cause pruritus.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

7. To make visualization of polyps in the anorectal area easier, you should:
a. apply clear jelly around the anal orifice.
b. ask the patient to bear down.
c. ask the patient to relax the sphincter.
d. rotate your finger inside the anal canal.
e. have the patient contract the external sphincter.
ANS: B
Asking the patient to perform a Valsalva maneuver will make fistulas, fissures, polyps, and hemorrhoids more visible.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

8. Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience:
a. bulging and wrinkling.
b. constipation and pallor.
c. urinary symptoms.
d. tenderness and inflammation.
e. diarrhea and redness.
ANS: D
Pain, tenderness, and inflammation to the perianal area may be related to abscess, fistula or fissure, pilonidal cyst, or pruritus ani.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

9. The initial digital approach to the rectal examination should be:
a. at a right angle to the anus.
b. with direct horizontal pressure of fingertip.
c. with the finger pad pressed against anal verge.
d. during sphincter tightening.
e. bidigital palpation with thumbs.
ANS: A
The initial approach should be with the finger pad pressed against the perianal area at the anal junction. The sphincter will tighten and relax, and then the examination index finger should be flexed and inserted.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

10. 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
e. more than 4
ANS: A
A healthy prostate should not protrude more than 1 cm into the rectum.

TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary

11. The posterior surface of the prostate can be located by palpation of the:
a. posterior wall of the rectum.
b. anterior wall of the rectum.
c. lateral wall of the anus.
d. lower abdomen and perineum.
e. anal canal and perineum.
ANS: B
Palpation of the rectal anterior wall facilitates posterior prostate location.

TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary

12. Very light tan or gray stool may indicate:
a. Hirschsprung disease.
b. obstructive jaundice.
c. lower gastrointestinal bleeding.
d. polyposis.
e. upper gastrointestinal bleeding.
ANS: B
Very light tan or gray stools suggest obstructive jaundice.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

13. Tarry black stool should make you suspect:
a. internal hemorrhoids.
b. rectal fistula.
c. upper intestinal bleeding.
d. prostatic cancer.
e. lower intestinal bleeding.
ANS: C
Upper intestinal tract bleeding results in tarry black stools.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

14. Prostate-specific antigen (PSA) screening is controversial because:
a. there are few false-negative results.
b. PSA is produced by many other tissues.
c. it is less sensitive than digital rectal examination.
d. there are associated harms of false-positive test results.
e. it detects prostate cancer only in its late stage.
ANS: D
The persistent issue is whether the benefits of prostate cancer screening are large enough to outweigh the associated harms, which include false-positive screening test results,
unnecessary biopsies, and overdiagnosis
TOP: Discipline: Biostatistics MSC: Organ System: Renal/Urinary

15. A lower spinal cord lesion may be indicated by which finding?
a. Lack of an “anal wink”
b. Anorectal fissure
c. Anal fistula
d. Passage of meconium
e. Small flaps of anal skin
ANS: A
Lightly touching the anal opening of an infant should produce a contraction referred to as the
“anal wink.” A negative wink may indicate a lower spinal cord lesion.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

16. Pinworms and Candida may both cause:
a. shrunken buttocks.
b. hemorrhoids.
c. perirectal irritation.
d. perirectal protrusion.
e. constipation.
ANS: C
Pinworms and Candida both cause perirectal irritation and itch.

TOP: Discipline: Microbiology MSC: Organ System: Gastrointestinal

17. Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. When is it likely that her closed anal passageway will be suspected by her healthcare providers?
a. After she develops a scaphoid abdomen
b. During her first feeding when she vomits
c. When she bleeds from the rectum
d. When she fails to pass meconium stool
e. When the rectum prolapses
ANS: D
Anal patency of the newborn is confirmed by passage of meconium stool.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

18. A common cause of dark green or black stool color during pregnancy is indicative of:
a. consumption of iron preparations.
b. consumption of vitamins.
c. intestinal parasites.
d. slow bleeding of hemorrhoids.
e. slow intestinal bleeding.
ANS: A
The daily use of iron replacement therapy, as expected during pregnancy, causes dark green or black stools.

TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Gastrointestinal

19. An expected anal or rectal finding late in pregnancy is the presence of:
a. cysts.
b. rectal prolapse.
c. skin tags.
d. polyps.
e. hemorrhoids.
ANS: E
Hemorrhoids are an expected variation late in pregnancy.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

20. Palpation of a normal prostate in an older adult is likely to feel:
a. cool.
b. grainy.
c. polypoid.
d. rubbery.
e. hard.
ANS: D
Older men are more likely to experience prostate hypertrophy, which, when palpated, feels smooth, rubbery, and symmetric.

TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary

21. Prostate examination findings of a hard, irregular, painless nodule with obliteration of the median sulcus are signs of:
a. benign prostatic hypertrophy.
b. cancer of the prostate.
c. longstanding prostatitis.
d. swelling caused by aging.
e. acute prostatitis.
ANS: B
Obliteration of the median sulcus is consistent with organ enlargement; associated findings of a hard, irregular, and painless nodule are more likely a cancerous growth.

TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary


Chapter 22: Musculoskeletal System

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. Bones are attached to muscles by:
a. synovial membranes.
b. ligaments.
c. muscles.
d. cartilage.
e. tendons.
ANS: E
Tendons attach muscle to bone. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Ligaments attach bone to bone. Muscles are not bound together by other muscles, and cartilage helps in the production of new bone and acts as an insulator for bones in joints.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

2. The cruciate ligaments within the knee provide for:
a. anterior and posterior stability.
b. medial and lateral stability.
c. movement on one plane.
d. pivoting and rotation.
e. shock absorption.
ANS: A
The cruciate ligaments within the knee are positioned so as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane. Cartilage is the structure that provides shock absorption.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

3. Medial and lateral surfaces of the tibiotalar joint are protected by:
a. bursae.
b. tendons.
c. muscles.
d. ligaments.
e. synovial fluid.
ANS: D
The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides. Bursae, tendons, muscles, and synovial fluid do not offer stabilization protection to the ankle.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
...

4. Ligaments are stronger than bone until:
a. birth.
b. infancy.
c. adolescence.
d. middle adulthood.
e. old age.
ANS: C
Ligaments are stronger than bone during birth and infancy. It is not until adolescence that bone becomes stronger.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

5. The elasticity of pelvic ligaments and softening of cartilage in a pregnant patients are caused by:
a. decreased mineral deposition.
b. increased hormone secretion.
c. uterine enlargement.
d. gait changes.
e. increased mineral resorption.
ANS: B
Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

6. Skeletal changes in older adults are the result of:
a. increased bone deposition.
b. increased bone resorption
c. tendons becoming more elastic.
d. decreased bone deposition.
e. decreased bone resorption.
ANS: B
As a person ages, the skeletal system undergoes several changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition. Tendons become less elastic in older adults.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

7. The usual number of vertebrae is:
a. 23.
b. 24.
c. 25.
d. 26.
e. 27.
ANS: B
The number of vertebrae that is most common is 24; as few as 11% of persons have 23, and almost 5% have 26.

TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal

8. Risk factors for sports-related injuries include:
a. competing in colder climates.
b. previous fractures.
c. history of recent weight loss.
d. failure to warm up before activity.
e. light body frame.
ANS: D
Failure to warm up before exercise is one risk factor for sports-related injuries. Climate, previous fractures, and weight loss are not as strong risk factors for sports-related injuries. A light body frame is a risk factor for osteoporosis, not sports-related injuries.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

9. The musculoskeletal examination should begin when:
a. the patient enters the examination room.
b. during the collection of subjective data.
c. when height is measured.
d. when joint mobility is assessed.
e. the remainder of the physical examination is completed.
ANS: A
When the patient first walks in the room, the examiner should observe the gait and posture as part of the musculoskeletal examination.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

10. Pain, disease of the muscle, and damage to the motor neuron may all cause:
a. bony hypertrophy.
b. muscle crepitus.
c. muscle hypertrophy.
d. muscle wasting.
e. claudication.
ANS: D
Muscle wasting is a consequence of pain from injury, pathology of the muscle, and injury to the motor neuron.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

11. An increase in muscle tone is known as:
a. crepitus.
b. effusion.
c. tenosynovitis.
d. atrophy.
e. spasticity.
ANS: E
An increase in muscle tone is referred to as spasticity. Crepitus, effusion, and tenosynovitis do not relate to muscle, and atrophy is wasting or a decrease in muscle mass.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

12. A goniometer is used to assess:
a. bone maturity.
b. joint proportions.
c. range of motion.
d. muscle strength.
e. body fat.
ANS: C
The angle of a joint can be accurately measured using a goniometer. This is used when the joint range of motion is beyond the normal limits. Muscle strength, bone maturity, body fat, and joint proportions are not measured by a goniometer.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

13. When palpating joints, crepitus may be caused when:
a. irregular bony surfaces rub together.
b. supporting muscles are excessively spastic.
c. joints are excessively lax.
d. there is excess fluid within the synovial membrane.
e. there is muscle wasting.
ANS: A
Crepitus is felt or heard when irregular bony surfaces rub together. Spastic muscles, muscle wasting, lax joints, and excess synovial fluid do not produce this grating sound upon palpation.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
14. Expected normal findings during inspection of spinal alignment include:
a. asymmetrical skinfolds at the neck.
b. slight right-sided scapular elevation.
c. convex lumbar curve.
d. head positioned superiorly to the gluteal cleft.
e. convex cervical curve.
ANS: D
Spinal alignment is considered within normal limits when the patient’s head is positioned directly over the gluteal cleft. The skin folds should be symmetrical, the scapulae are at even heights, and both the cervical and lumbar curves are concave.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

15. When the patient flexes forward at the waist, what spinal observation would lead you to suspect scoliosis?
a. A prominent lumbar hump
b. A prominent cervical concave curve
c. Lateral curvature of the spine
d. Restricted ability to flex at the hips
e. A gibbus
ANS: C

Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

16. Ulnar deviation and boutonniere deformities are characteristics of:
a. winged scapula.
b. osteoarthritis.
c. osteoporosis.
d. congenital defects.
e. rheumatoid arthritis.
ANS: E
Deviation of the fingers toward the ulnar side and boutonniere deformities are classic symptoms of rheumatoid arthritis. Winged scapula, osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

17. A finding that is indicative of osteoarthritis is:
a. swan neck deformities.
b. Bouchard nodes.
c. ganglion cysts
d. Heberden nodes.
e. spindle-shaped fingers.
ANS: D
Heberden nodes are bony Overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint,
they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities and spindle-shaped fingers; ganglion cysts are not associated with osteoarthritis.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

18. A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive sign.
a. Phalen
b. Gower
c. Homan
d. Tinel
e. Allis
ANS: D
The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

19. Classic carpal tunnel syndrome would result in:
a. pain in the fourth and fifth digits.
b. a negative Phalen test.
c. reduced abduction of the thumb.
d. palm tingling.
e. a negative Tinel sign.
ANS: C
Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, a positive Phalen sign, reduced abduction of the thumb, and sparing of palm tingling. The median half of the fourth digit and entire fifth digit are asymptomatic.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

20. Excessive hyperextension of the knee with weight bearing may indicate:
a. advanced joint degeneration.
b. early signs of gout.
c. rotation of the Achilles tendon.
d. a meniscal tear.
e. weakness of the quadriceps muscle.
ANS: E
Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness. Gout, joint degeneration, Achilles tendon rotation, and meniscal tears do not cause hyperextension of the knee.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

21. Arm length is measured from the acromion process through the:
a. olecranon joint to carpal thumb hinge.
b. olecranon process to distal ulnar prominence
c. proximal radial prominence to distal joint.
d. proximal ulnar joint to middle fingertip.
e. olecranon process to the second fingertip.
ANS: B
Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow (olecranon process) joint to the wrist (distal ulnar prominence).

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

22. The Thomas test is used to detect:
a. hip dislocation.
b. unstable sacroiliac joints.
c. knee instability.
d. flexion contractures of the hip.
e. asymmetry in the level of the iliac crests.
ANS: D
The Thomas test requires the patient to lie supine with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture. The Thomas test does not assess hip dislocation, sacroiliac joints, knee instability, or asymmetry of the iliac crests.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

23. Which one of the following techniques is used to detect a torn meniscus?
a. Phalen test
b. McMurray test
c. Thomas test
d. Trendelenburg test
e. Drawer test
ANS: B
The McMurray test points to a meniscus tear. The Phalen test detects carpal tunnel syndrome. The drawer test detects an anterior cruciate ligament tear, the Thomas test detects hip contraction, and the Trendelenburg test detects weak hip abductor muscles.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

24. When performing the drawer test, the examiner would place the patient in a supine position and flex the knee 45 to 90 degrees, placing the foot flat on the table, and then:
a. grasp and evert the foot and extend the knee.
b. grasp and invert the foot and rotate the knee.
c. grasp the lower leg with both hands and draw the tibia forward and then backward.
d. apply varus stress with the foot planted.
e. apply valgus stress after the leg is extended.
ANS: C
The next step is to place both hands on the lower leg with the thumbs on the ridge of the anterior tibia just distal to the tibial tuberosity. Draw the tibia forward, forcing the tibia to
slide forward of the femur. Then push the tibia backward. Anterior or posterior movement of the knee greater than 5 mm in either direction is an unexpected finding.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

25. Anterior cruciate ligament integrity is assessed via the test.
a. Lachman
b. straight leg raise
c. valgus stress
d. Homan
e. Thomas
ANS: A
The Lachman test evaluates anterior cruciate ligament integrity. The straight leg raise test assesses nerve root damage, the valgus stress test assesses instability of the lateral and medial collateral ligaments, the Homan test assesses for blood clots in the legs, and the Thomas test is used to detect flexion contractures of the hips.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

26. During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the test.
a. varus stress


b. valgus stress
c. Apley
d. Lachman
e. drawer
ANS: B
The injury described will most likely result in a medial meniscus or medial collateral ligament damage. Your initial assessment would be to apply the valgus stress test to assess the medial meniscus.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

27. Term infants normally resist:
a. ankle dorsiflexion.
b. McMurray test.
c. forefoot adduction.
d. knee extension.
e. elbow flexion.
ANS: D
Along with elbows and hips, newborns tend to resist extension of the knee; however, movements should be symmetrical.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

28. What technique is performed at every infant examination during the first year of life to detect hip dislocation?
a. Ballottement maneuvers
b. Barlow-Ortolani maneuvers
c. Range of motion
d. Thomas McMurray assessment
e. Trendelenburg test
ANS: B
At every examination during an infant’s first year of life, the Barlow-Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation and is signified by a clicking noise with the maneuver.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

29. You note that a child has a positive Gower sign. You know that this indicates generalized:
a. arthropathy.
b. muscle weakness.
c. bursitis.
d. muscle hypertrophy.
e. scoliosis.
ANS: B
Gower sign is generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee, pushing down on the thighs while trying to pull up the trunk. It is often associated with muscular dystrophy.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

30. What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention?
a. Carpal tunnel syndrome
b. Osteitis deformans
c. Radial head subluxation
d. Talipes equinovarus
e. Legg-Calvé-Perthes disease
ANS: A
Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms of the syndrome.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

31. An adult with bowed tibias and a shortened thorax may have:
a. ankylosing spondylitis.
b. Paget disease.
c. rheumatoid arthritis.
d. Dupuytren contracture.
e. Sprengel deformity.
ANS: B
Paget disease is characterized by bowed tibias, asymmetric skull, shortened chest, and susceptibility to fractures.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

32. In differentiating osteoarthritis from rheumatoid arthritis (RA), the patient with osteoarthritis typically exhibits:
a. metatarsus adductus.
b. depression.
c. sudden onset.
d. less weakness and fatigue.
e. pain most pronounced after periods of rest.
ANS: D
One of the key differences between the symptoms of osteoarthritis and those of RA is that fatigue is uncommon in osteoarthritis patients. The joints of patients with RA are stiff after rest.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

33. Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would perform a:
a. startle reflex.
b. Barlow-Ortolani maneuver.
c. Trendelenburg test.
d. tibial torsion test.
e. Lachman test.
ANS: B
The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm results for hip dislocation.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

34. A 7-year-old child who begins to limp and complains of persistent hip pain may have:
a. myelomeningocele.
b. Dupuytren contracture.
c. Legg-Calvé-Perthes disease.
d. osteoarthritis.
e. congenital hip dislocation.
ANS: C
Constant hip pain with a limp in a young child is indicative of Legg-Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by inadequate blood supply. Myelomeningocele, Dupuytren contracture, osteoarthritis, and congenital hip dislocation are not characterized by age group and these symptoms.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

35. Dupuytren contracture affects the:
a. hip flexor muscle.
b. plantar fascia.
c. carpal tunnel.
d. palmar fascia.
e. rotator cuff.
ANS: D
A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

36. A dowager hump is:
a. the hallmark of osteoporosis.
b. pathognomic of scoliosis.
c. indicative of tendonitis.
d. characteristic of rickets.
e. indicative of muscular dystrophy.
ANS: A
Osteoporosis leads to vertebral compression and kyphotic bowing of the spine known as
dowager’s hump.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal


Chapter 23: Neurologic System

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE

1. The autonomic nervous system coordinates which of the following?
a. High-level cognitive function
b. Balance and affect
c. Internal organs of the body
d. Balance and equilibrium
e. Emotions and behavior
ANS: C
The autonomic nervous system coordinates the internal organs of the body by the sympathetic and parasympathetic nervous systems. The other options are associated with the cerebral cortex, whose function consists of determining intelligence, personality, and motor function.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

2. The major function of the sympathetic nervous system is to:
a. orchestrate the stress response.
b. coordinate fine motor movement.
c. determine proprioception.
d. contribute input from visual, labyrinthine, and proprioceptive sources.
e. perceive stereognosis.

ANS: A
Stimulation of the sympathetic branch of the autonomic nervous system prepares the body for emergencies for fight or flight (stress response). The cerebellum plays a key role in the coordination of fine motor movements. Recognition of body parts and awareness of body position (proprioception) are dependent on the parietal lobe. The basal ganglia contribute input from visual, labyrinthine, and proprioceptive sources. Stereognosis is the ability to perceive weight and form of solid objects by touch and is not under sympathetic control.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

3. The parasympathetic nervous system maintains the day-to-day function of:
a. digestion.
b. response to stress.
c. lymphatic supply to the brain.
d. lymphatic drainage of the brain.
e. coordinating fine motor movements.
ANS: A
The parasympathetic division functions in a complementary and counterbalancing manner to conserve body resources and maintain day-to-day body functions such as digestion and elimination.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous
...

4. The motor cortex of the brain is in the:
a. corpus callosum.
b. frontal lobe.
c. limbic system.
d. occipital lobe.
e. parietal lobe.
ANS: B
The frontal lobe contains the motor cortex associated with voluntary skeletal movement and fine repetitive motor movements, as well as the control of eye movements. The corpus callosum interconnects the counterpart areas in each hemisphere, unifying the cerebrum’s higher sensory and motor functions. The limbic system mediates the sense of smell and certain patterns of behavior that determine survival, such as mating, aggression, fear, and affection. The occipital lobe contains the primary vision center and provides interpretation of visual data. The parietal lobe is primarily responsible for processing sensory data as they are received.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

5. The thalamus is the major integration center for perception of:
a. speech.
b. olfaction.
c. pain.
d. thoughts.
e. visceral responses to emotions.
ANS: C
The thalamus is the major Integrating center for perception of various sensations such as pain and temperature, serving as the relay center between the basal ganglia and cerebellum. The
reception of speech and interpretation of speech is located in the Wernicke area. The olfactory sense is processed in the parietal lobe. The cerebrum holds memories, allows you to plan, and enables you to imagine and think. The limbic system mediates the sense of smell and certain patterns of behavior (primitive behaviors, visceral response to emotional and biologic rhythms) that determine survival, such as mating, aggression, fear, and affection.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

6. The awareness of body position is known as:
a. extrapyramidal.
b. graphesthesia.
c. stereognosis.
d. two-point discrimination.
e. proprioception.
ANS: E
Recognition of body parts and awareness of body position is known as proprioception. This is dependent on the parietal lobe.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

7. If a patient cannot shrug the 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
e. CN XII, hypoglossal
ANS: D
CN XI is responsible for the motor ability to shrug the shoulders. CN I is associated with smell reception and interpretation. CN V is associated with opening of the jaw; chewing; and sensation of the cornea, iris, conjunctiva, eyelids, forehead, nose, teeth, tongue, ear, and facial skin. CN IX is associated with swallowing function, sensation of the nasopharynx, gag reflex, taste, secretion of salivary glands, carotid reflex, and swallowing. CN XII is associated with movement of the tongue.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

8. The major portion of brain growth and myelinization occurs between year(s) of age.
a. birth and 1
b. 2 and 3
c. 4 and 7
d. 11 and 14
e. 16 and 21
ANS: A
The major portion of brain growth occurs in the first year of life along with myelinization of the brain and nervous system
TOP: Discipline: Neuroscience MSC: Organ System: Nervous

9. Motor maturation proceeds in an orderly progression from:
a. peripheral to central.
b. head to toe.
c. lateral to medial.
d. pedal to cephalic.
e. toe to head.
ANS: B
Motor maturation proceeds in a cephalocaudal direction. Motor control of the head and neck develops first followed by the trunk and extremities. The other choices are incorrect because they relate maturation sequence inappropriately.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

10. A neurologic past medical history should include data about:
a. family patterns of dexterity and dominance.
b. circulatory problems.
c. educational level.
d. immunizations.
e. allergies.

ANS: B
The neurologic past medical history should include data concerning neurovascular problems such as stroke, aneurysm, and brain surgery. The other answers are not pertinent medical information for the neurologic past medical history.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

11. You are initially evaluating the equilibrium of Ms. Q You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q has a positive:
a. Kernig sign.
b. Homan sign.
c. McMurray test.
d. Romberg sign.
e. Murphy sign.
ANS: D
The Romberg test has the patient stand with his or her eyes closed, feet together, and arms at the sides. Slight swaying movement of the body is expected but not to the extent of falling. Loss of balance results in a positive Romberg test. Kernig sign tests for meningeal irritation, Homan sign tests for venous thrombosis, and McMurray test is a rotation test for demonstrating a torn meniscus. A positive Murphy sign is usually a sign of gallbladder disease.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

12. The finger-to-nose test allows assessment of:
a. coordination and fine motor function.

b. point location.
c. sensory function.
d. two-point discrimination.
e. stereognosis.
ANS: A
To perform the finger-to-nose test, the patient closes both eyes, and touches his or her nose with the index finger, alternating hands while gradually increasing the speed. This tests coordination and fine motor skills. All of the other choices test sensory function without motor function.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

13. You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the:
a. back.
b. palms.
c. fingertips.
d. upper arms.
e. chest.
ANS: C
On the fingertips and toes, two points are commonly felt when 2 to 8 mm apart. A greater distance is expected for discrimination of two points on other body parts, such as the back (40 to 70 mm) or chest and forearms (40 mm).

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

14. 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.
e. Parkinsonian gait.
ANS: B
A cerebellar gait (cerebellar ataxia) occurs when the patient’s feet are wide based with a staggering gait, lurching from side to side, often accompanied by swaying of the trunk. Dystonic ataxia is jerky dancing movements that appear nondirectional. Steppage gait is noted when the hip and knee are elevated excessively high to lift the plantar flexed foot off the ground. The foot is brought down with a slap, and the patient is unable to walk on the heels.
Tabetic stamping occurs when the legs are positioned far apart, lifted high, and forcibly brought down with each step; in this case, the heel stamps on the ground. In Parkinsonian gait, the patient’s posture is stooped, and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous
15. 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.
e. tonic neck or torso spasms.
ANS: A
Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps muscle, thus causing discomfort. When superficial pain sensation is not intact, then further assessments of temperature and deep pressure sensation are performed.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

16. You have asked a patient to close his eyes and identify an object placed in his hand. You are evaluating:
a. stereognosis.
b. graphesthesia.
c. vibratory sense.
d. two-point discrimination.
e. extinction phenomenon.
ANS: A
Stereognosis is the ability to recognize an object through touch and manipulation. Tactile agnosia, an inability to recognize objects by touch, suggests a parietal lobe lesion.
Graphesthesia tests the patient’s ability to identify the figure being drawn on his or her palm. The vibratory sense uses a tuning fork placed on a bony prominence. Two-point discrimination uses two sharp objects to determine the distance at which the patient can no longer distinguish the two points. The extinction phenomenon tests sensation by simultaneously touching bilateral sides of the body with a sterile needle.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

17. Which one of the following conditions is consistent with Brown-Séquard syndrome?
a. Central sensory loss that is generalized
b. Motor paralysis on lesion side of the body
c. Multiple peripheral neuropathy of the joints
d. Spinal root paralysis below the umbilicus
e. Pain and temperature loss on lesion side of body
ANS: B
Partial spinal sensory syndrome (Brown-Séquard syndrome) is noted when pain and temperature sensation loss occur one to two dermatomes below the lesion on the opposite side of the body from the lesion. Proprioceptive loss and motor paralysis occur on the lesion side of the body.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

18. When using a monofilament to assess sensory function, the examiner:
a. uses two simultaneous monofilaments on similar bilateral points and then compares results.
b. applies both a monofilament and a pin on similar bilateral points and then compares results.
c. applies pressure to the monofilament until the filament bends.
d. strokes the monofilament along the skin from proximal to distal areas.
e. assesses only the dorsal surface of the foot with the patient’s eyes open.
ANS: C
The monofilament is placed on several smooth spots of the patient’s plantar foot for seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

19. It is especially important to test for ankle clonus if:
a. deep tendon reflexes are hyperactive.
b. the patient has a positive Kernig sign.
c. the Romberg sign is positive.
d. the patient has peripheral neuropathy.
e. deep tendon reflexes are hypoactive.
ANS: A
Test the ankle clonus when reflexes are hyperactive. Support the patient’s knee in a flexed position and briskly dorsiflex the foot with your other hand. If clonus is present, there is recurrent ankle plantar flexion movement as long as the examiner retains the foot in dorsiflexion. Sustained clonus signifies the hypertonia of an upper motor neuron lesion.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

20. When assessing a 17-year-old patient for nuchal rigidity, you gently raise his head off the examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test result, you would also perform a test for the sign.
a. Kernig
b. Babinski
c. obturator
d. Brudzinski
e. Murphy
ANS: A
The first action elicited the Brudzinski sign. This sign is an indicator of meningeal irritation. To confirm meningeal irritation, you would test for the Kerning sign, also a meningeal sign.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

21. 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.
e. checking the infant’s gag reflex.
ANS: B
Cranial nerve (CN) XII may be assessed in an infant by observing the infant suck and swallow and by pinching the nose and then observing for the mouth to open and the tip of the tongue to rise in a midline position. Watching the infant’s facial expressions when crying assesses CN VII, clapping hands and watching the infant blink tests CN VIII, and observing the rooting reflex assesses CN V. A gag reflex assesses CN IX and X.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

22. Which of the following is a concern, rather than an expected finding, in older adults?
a. Reduced ability to differentiate colors
b. Bilateral pillrolling of the fingers
c. Absent plantar reflex
d. Diminished senses of smell and taste
e. Reduced gag reflex
ANS: B
Bilateral pillrolling is indicative of Parkinson disease; the other choices are expected findings with aging.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous


23. Emotional lability, personality changes, and contralateral hemiplegia greater in the lower than upper extremities 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.
e. anterior cerebral artery.
ANS: E
The anterior cerebral artery supplies superior surfaces of frontal and parietal lobes and medial surface of cerebral hemispheres (includes motor and somesthetic cortex serving the legs), basal ganglia, corpus callosum.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

24. A postinfectious disorder following a nonspecific gastrointestinal or respiratory infection that causes an acute neuromuscular paralysis is:
a. cerebral palsy.
b. HIV encephalopathy.
c. Guillain-Barré syndrome.
d. Rett syndrome.
e. myasthenia gravis.
ANS: C
Guillain-Barré syndrome is an autoimmune disorder triggered by a bacterial or viral infection that damages the peripheral nerves, leading to denervation and atrophy.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous
25. The immune system attacks the synaptic junction between the nerve and muscle fibers blocking acetylcholine receptor sites in:
a. myasthenia gravis.
b. encephalitis.
c. multiple sclerosis.
d. cerebral palsy.
e. trigeminal neuralgia.
ANS: A
Myasthenia gravis is an autoimmune disorder of neuromuscular junction involved with muscle activation; autoantibodies directed against the acetylcholine receptors in the neuromuscular junction cause destruction and inflammatory changes in the postsynaptic membranes that lead to muscle dysfunction.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

26. A clinical syndrome of intracranial hypertension that mimics brain tumors is:
a. meningitis.
b. myasthenia gravis.
c. Guillain-Barré syndrome.
d. pseudotumor cerebri.
e. Bell palsy.

ANS: D
Pseudotumor cerebri is a clinical syndrome of intracranial hypertension that mimics brain tumors. Etiology is unknown, but proposed causes are excess cerebrospinal fluid (CSF) production or malabsorption. Obstructed venous drainage of CSF is also a potential cause. Obesity is considered a contributing factor.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous


Chapter 24: Sports Participation Evaluation

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing soccer. She has increased deep tendon reflexes, ankle clonus, and a positive Babinski sign. What would be your next course of action?
a. Cervical spine radiograph
b. Immediate referral to a neurosurgeon
c. Mini-Mental State Examination
d. Nerve conduction studies
e. Visual acuity
ANS: B
This girl is experiencing symptoms of atlantoaxial joint instability. These examination findings require immediate referral to a neurosurgeon with expertise in atlantoaxial instability.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

2. Part of the screening orthopedic component of the examination includes evaluating the person while:
a. performing push-ups.
b. duck walking
c. twisting at the waist.

d. crossing the arms over the chest.
e. performing jumping-jacks.
ANS: B

Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

3. Your 15-year-old female patient appears to have a too-thin body build. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her:
a. sleep patterns.
b. salt intake.
c. aerobic workouts.
d. menstrual cycles.
e. family history.
ANS: D
A too-thin body encourages a low estrogen state and the possibility of menstrual dysfunction and a resultant osteopenia or osteoporosis. The risk of stress fracture increases. The problem needs early recognition as it may be irreversible if discovered too late. The thorough menstrual history is a critical component of the PPE in female athletes.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
...

4. One of the most important aspects to consider in all portions of the orthopedic screening examination is:
a. muscle contraction.
b. flexibility.
c. muscle development.
d. balance.
e. symmetry.
ANS: E
One of the most important aspects to consider when conducting an orthopedic examination is to look for symmetry of muscle, stature, and joint movement.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

5. Which medical condition would exclude one from sports participation?
a. Asthma
b. Fever
c. Controlled seizures
d. Stage 1 hypertension
e. Sickle cell trait
ANS: B
Two conditions considered absolute contraindications to sports participation are carditis and fever. Carditis (inflammation of the heart) can result in sudden death with exertion, and fever is associated with an increased risk of heat-related illness. Fever can increase cardiopulmonary effort and impair exercise capacity. Asthma, seizures, stage 1 hypertension, and sickle cell trait, when controlled, do not exclude exercise.

TOP: Discipline: Pathophysiology MSC: Organ System: General

6. Which of the following radiographic studies is no longer recommended by the American Academy of Pediatrics (AAP) as a screening examination for individuals with Down syndrome?
a. Skull x-rays
b. Pelvic x-rays
c. Cervical spine x-rays
d. Thoracic spine x-rays
e. Lumbar spine x-rays
ANS: C
Individuals with Down syndrome are at increased risk of atlantoaxial subluxation. The AAP previously recommended routine radiologic screening of the cervical spine in asymptomatic children and adolescents. However, because radiographs do not accurately predict which children are at increased risk, the AAP no longer supports this practice. The other studies were never recommended as screening examinations.

TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal

7. Which of the following statements is true regarding sports-related concussions?
a. They are only caused by a direct blow to the head.
b. They may or may not involve a loss of consciousness.


c. They are usually associated with abnormal neuroimaging studies.
d. Symptoms largely reflect structural rather than functional disturbances.
e. They typically result in delayed onset of symptoms that rarely resolve spontaneously.
ANS: B
Sports-related concussions typically result in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course with 80% to 90% resolving in 7 to 10 days. The other statements are not true.

TOP: Discipline: Pathophysiology MSC: Organ System: General


Chapter 25: Putting it All Together

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. 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.
e. deferring parts of the examination.
ANS: A
Acknowledging the patient’s discomfort during the examination will help the patient feel more relaxed. It may help to consistently provide an explanation of which part of the examination comes next and to be honest about the potential of uncertainty, discomfort, or pain and how long it will last.

TOP: Discipline: Behavioral Science MSC: Organ System: General

2. The reliability of health-related findings and observations is the responsibility of the:
a. patient.
b. healthcare professionals.
c. attending clinician.
d. patient and patient’s family
e. professional and the patient
ANS: E


It is the responsibility of the health professional and the patient to present reliable findings and observations. They work as a team.

TOP: Discipline: Behavioral Science MSC: Organ System: General

3. Which of the following statements accurately reflects the sensitivity and specificity of laboratory tests?
a. Sensitivity and specificity are not related.
b. Sensitivity and specificity are inversely correlated.
c. Sensitivity and specificity are directly correlated.
d. No test has 100% sensitivity and specificity.
e. The “gold standard” test has 100% sensitivity and specificity.
ANS: D
No test has 100% sensitivity and specificity.

TOP: Discipline: Biostatistics MSC: Organ System: General
...

4. The sequence of the physical examination should be individualized to:
a. minimize the number of times that the patient must change positions.
b. maximize the convenience of the examiner.
c. improve patient flow.
d. minimize the time the patient is in the room.
e. maximize patient movements to assess their mobility.
ANS: A
There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient’s energy.

TOP: Discipline: Behavioral Science MSC: Organ System: General

5. According to the usual examination procedure, you would first assist your patient to assume which position?
a. Lithotomy
b. Prone
c. Standing
d. Supine
e. Sitting
ANS: E
Upon entering the examination room, you should assist the patient in the sitting position on the examining table. In the sitting position, you can examine the patient’s anterior and posterior upper trunk and head, which comprise the majority of focused assessments.

TOP: Discipline: Behavioral Science MSC: Organ System: General

6. An ophthalmoscopic eye examination involves:

a. lens inspection.
b. near vision evaluation.
c. sclera observation.
d. visual field assessment.
e. assessing extraocular eye muscles.
ANS: A
Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc, cup margins, vessels, and retinal surface. The other assessments do not involve the use of the ophthalmoscope.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

7. Which of the following are examined with the patient in a reclining 45-degree position?
a. Bilateral hips and popliteal angles
b. Facial bones and cranial nerves V and VII
c. Cardinal fields of gaze
d. Oropharynx and thyroid gland placement
e. Jugular venous pulsation and pressure
ANS: E
With the patient in a reclining 45-degree position, you can examine the jugular venous pulsations and measure jugular venous pressure. All of the other choices can be examined with the patient in a sitting position.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

8. To inspect the abdominal muscles, ask the:
a. supine patient to raise the head.
b. standing patient to bend forward.
c. prone patient to raise the lower legs.
d. standing patient to stand on tiptoes.
e. standing patient to lean backward.
ANS: A
Asking the patient to raise the head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. All of the other choices would not show the abdominal muscles contracting.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

9. Proprioception should be assessed while the patient is:
a. prone.
b. supine.
c. seated.
d. standing.
e. left lateral.
ANS: D
Proprioception examination involves the Romberg test, heel-to-toe walking, standing on one foot and then on the other with eyes closed, hopping in place, and deep knee bends. The standing position is required to conduct these examinations.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

10. 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.
e. percussion of abdominal structures.
ANS: B
With the patient in the lithotomy position, the examiner can inspect the external and internal female genitalia and perform rectal examination to assess and palpate anal sphincter tone. The other answers require the patient to be in the supine or standing position.

TOP: Discipline: Behavioral Science MSC: Organ System: General

11. Which portion of the physical examination is best done with the patient standing?
a. Spinal
b. Rectal
c. Neck
d. Musculoskeletal
e. Chest
ANS: A
With the patient in the standing position, the examiner can inspect and palpate the spine as the
patient bends over at the waist and test the patient’s range of motion.

TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal

12. The greatest risk for potential health problems occurs in which age group?
a. Newborn
b. Toddler
c. School-age
d. Adolescence
e. Young adult
ANS: A
The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups.

TOP: Discipline: Biostatistics MSC: Organ System: General

13. To promote your examination time with a cooperative child, your approach to the examination should be to:
a. ask the parent to give the child a bottle during the examination.
b. sing songs with the child during the examination.
c. conduct the physical examination on the child while the parent is holding the child.
d. let the child play with examination room equipment to feel more comfortable.
e. have the parent place the child in the prone position on the examination table.
ANS: C
For children, the examination sequence depends on their cooperation for as long as possible. To promote this, examine the child while the parent is holding the child, while maximizing
both inspection and opportunities for physical examination.

TOP: Discipline: Behavioral Science MSC: Organ System: General

14. The best way to ease the apprehension of a 3-year-old child before a physical examination is to:
a. explain that you will be gentle.
b. have the parents leave the examination room.
c. encourage child’s participation.
d. tell the child he or she will get a lollipop for good behavior.
e. hand the child a picture book.
ANS: C
The best way to ease the apprehension of a 3-year-old child before a physical examination is to encourage the child to participate by helping you. Ask the child to hold the endpiece of the stethoscope or to “blow out” your flashlight.

TOP: Discipline: Behavioral Science MSC: Organ System: General

15. 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.
e. assess facial symmetry.
ANS: C
For a crying infant, the lungs can be auscultated between consolable moments. While the infant is crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial symmetry, and appearance of the mouth and pharynx. Between breaths, the heart tone can be auscultated.

TOP: Discipline: Physiology MSC: Organ System: General
16. When you attempt to move a 10-month-old child from his mother’s lap to the examination
table, he screams loudly. Your best action is to:
a. move the child to the examination table and proceed matter-of-factly with the examination.
b. perform the examination while the child is in the mother’s lap.
c. ask the mother to get the child to stop crying.
d. defer the examination until another day.
e. have the mother place the child on the examination table.
ANS: B
The parent’s lap is a great “examination table” because it helps the child feel more at ease and is a good way to observe the nature of the parent-child relationship. None of the other actions would comfort the patient or make the situation better.

TOP: Discipline: Behavioral Science MSC: Organ System: General
17. Observation of the child playing in the playroom provides information about which two systems?
a. Dermatologic and cardiovascular
b. Neurologic and musculoskeletal
c. Respiratory and ear, nose, and throat
d. Gastrointestinal and genitourinary
e. Endocrine and hematopoietic
ANS: B
A child playing on the floor offers an opportunity to evaluate both the musculoskeletal and neurologic systems by noting the child’s coordination of activities, such as when throwing a ball, drawing, coloring, walking, and jumping.

TOP: Discipline: Physiology MSC: Organ System: General

18. When conducting a geriatric assessment, basic activities of daily living (ADL) include:
a. bathing.
b. housekeeping.
c. medication compliance.
d. communication skills.
e. money management.
ANS: A
Basic ADL include bathing, dressing, toileting, ambulating, and feeding. All of the other choices represent instrumental ADL.
TOP: Discipline: Behavioral Science MSC: Organ System: General

19. Functional assessment is most important during the examination of a(n):
a. adolescent.
b. infant.
c. older adult.
d. young adult.
e. toddler.
ANS: C
Functional assessment is most important when examining older adults. Initial observation and interaction can provide a great deal of information about the individual’s independent functional capacity. Attention should be given to self-care activities and instrumental activities.

TOP: Discipline: Behavioral Science MSC: Organ System: General

20. Which of the following is not assessed in a newborn’s Apgar score?
a. Color
b. Heart rate
c. Pupil reactivity
d. Muscle tone
e. Respirations
ANS: C
The Apgar score, taken at 1 and 5 minutes of age, provides insight to the baby’s in utero, intrapartum, and immediate postnatal experience. A low score for several of the variables—color, heart rate, respirations, muscle tone, and reflex irritability—is evidence of
difficulty.

TOP: Discipline: Behavioral Science MSC: Organ System: General


Chapter 26: Emergency or Life-Threatening Situations

Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE
1. The deepest level of coma determined by the Glasgow Coma Scale is a value of:
a. 0.
b. 1.
c. 2.
d. 3.
e. 4.
ANS: D
This tool allows numeric scoring of the patient’s verbal, motor, and eye opening responses to specific stimuli to assess the cerebral cortex and brainstem function. The patient’s best response in each category is matched to the criteria for scoring. The lowest score in each category is 1.

TOP: Discipline: Pathophysiology MSC: Organ System: General

2. Status epilepticus is defined as:
a. seizures with intermittent recovery of consciousness.
b. nonconvulsive brain wave disturbance with psychomotor dysfunction.
c. protracted convulsions with unresponsiveness lasting up to an hour.
d. seizures that result in hypotension, pallor, and prolonged diaphoresis.
e. convulsive activity uncontrolled by medication.


ANS: C
Status epilepticus is characterized by seizures that are protracted and recurrent without recovery of consciousness.

TOP: Discipline: Pathophysiology MSC: Organ System: Nervous

3. Cushing triad includes:
a. hypotension.
b. irregular respirations.
c. tachypnea.
d. constricted pupils.
e. tachycardia.
ANS: B
Cushing triad is associated with increased intracranial pressure. Cushing triad includes bradycardia, hypertension, and irregular respirations.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous
...

4. Paradoxical chest movement suggest a:
a. spontaneous pneumothorax.
b. status asthmaticus.
c. clavicle fracture.
d. pulmonary contusion.
e. flail chest.
ANS: E
Paradoxical chest movement is associated with fractured ribs or a flail chest. This fracture should be stabilized immediately.

TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory

5. You would complete a Glasgow Coma Scale rating during the:
a. health history.
b. physical examination.
c. primary survey.
d. secondary survey.
e. patient transport.
ANS: C
During the primary assessment, a brief neurologic evaluation is performed to identify significant disability. Assess the patient’s level of consciousness with the Glasgow Coma Scale.

TOP: Discipline: Pathophysiology MSC: Organ System: General

6. A life-threatening condition is recognized with the assessment of:
a. pain with downward pressure on both anterior superior iliac spines.
b. guarding and intense pain with deep palpation of the abdomen.
c. distant and muffled heart sounds with distended neck veins.
d. severe throbbing pain in One eye with photophobia.
e. painful blunt sternal pressure.
ANS: C
Distant, muffled heart sounds and distended neck veins may indicate cardiac tamponade, a life-threatening condition. Iliac spine pain indicates a pelvic fracture that may become life threatening depending on the extent of occult bleeding, intense pain with deep palpation is not certain to be deadly, and eye pain with photophobia signals acute glaucoma that can lead to blindness if treatment is delayed. Painful blunt sternal pressure would indicate a sternal or rib fractures, which are not necessarily life threatening.

TOP: Discipline: Pathophysiology MSC: Organ System: General

7. Until stabilized, trauma patients require reevaluation every:
a. 2 minutes.
b. 5 minutes.
c. 10 minutes.
d. 15 minutes.
e. hour.
ANS: B
An unstable patient must be reevaluated frequently so that any new signs and symptoms are not overlooked. A primary survey should be performed every 5 minutes and the results compared with those obtained in previous surveys.

TOP: Discipline: Pathophysiology MSC: Organ System: General

8. Adults and children display different physiologic responses to injury and acute illness. An important concept to remember when assessing infants and children is that they:
a. experience lethal dysrhythmias first, progressing to respiratory failure.
b. are smaller, so they are less prone to hypothermia than adults.
c. usually experience respiratory arrest before circulatory failure.
d. tolerate greater volume changes with less severe consequences.
e. usually experience cardiac arrest before respiratory failure.
ANS: C
Cardiac arrest is rarely a primary event in children as it is in adults. A child usually experiences respiratory and ventilatory failure that progresses to respiratory arrest first. Without rapid intervention, a cardiac arrest occurs as a secondary event.

TOP: Discipline: Pathophysiology MSC: Organ System: General

9. The mnemonic AMPLE is used to assess:
a. level of responsiveness.
b. respiratory status.
c. secondary assessment of a trauma patient.
d. level of coma.
e. an abbreviated history in an emergency condition.
ANS: E
AMPLE is a mnemonic that focuses on an abbreviated history relevant to an emergency condition.

TOP: Discipline: Pathophysiology MSC: Organ System: General



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