Assessment Final

You are observing a child stands independently , makes tower with 2 cubes , says one word with meaning and points to get objects . Where would you place this child's developmental age ? A. 12 months B. 10 months C. 8 months D. 7 months

A. 12 months

Claire's daughter brings her in today after Claire fell at her home . Which assessments are indicated at this time ? A. Orthostatic vital signs B. Review of her medications C. Assessment of gait and balance D. All of the above

All of the above

Menopause

Ansence of meses for 12 consecutive months.

Which of the following questions is part of the screening for physical disability ? A. Are you able to do strenuous activities like fast walking or bicycling ? B. Are you able to walk one block ? C. Are you able to pass the driver's license test ? D. Are you able to perform light dusting and pick up after yourself around the house ?

Are you able to do strenuous activities like fast walking or bicycling ?

Which of the following represents menorrhagia ? A. Fewer than 21 days between menses B. Excessive flow C. Infrequent bleeding D. Bleeding between periods

B. Excessive flow

These nodes are found at PIP joints in osteoarthritis . A. Bouchard's B. Heberden's C. Palma's nodes D. Hain's nodes

B. Heberdens

Which of the following conditions refers to an abnormal location of the urethral orifice to some point along the ventral surface of the glans or shaft of the penis . The foreskin is incompletely formed ventrally . A. Phimosis B. Hypospadias C. Balanitis D. Balanoposthitis

B. Hypospadias

A patient who presents to the clinic c / o hand pain states she was told by a friend that it is most likely carpal tunnel syndrome Upon assessing the patient , you note the following findings . Which would be most suggestive of carpal tunnel syndrome ? A. Hand pain when holding both hands in acute extension B. Numbness and tingling when tapping over the course of the median nerve C. Symptoms related to compression are evidet in all of the fingers D. None of the above

B. Numbness and tingling when tapping over the course median nerve

A 15 year old high school football player is in your clinic , c / o severe testicular pain since 8 am this morning Denies sexual activity . Unable to urinate due to pain . He is nauseated and is vomiting . He is lying on the table uncomfortably shifting his position . His BP is 150/100 , pulse is 110 , respirations are 24 There no lesions on the penis and no discharge from the meatus The scrotal skin is tense and red . Palpation of the left testicle causes severe pain and the patient begins cry . Prostate exam is normal . His cremasteric reflex is absent on the left but is normal on Urine sample ( by catheter ) is normal . You send him to the emergency room . What is the most likely diagnosis ? A. Acute orchitis B. Acute epididymitis C. Torsion of the spermatic cord D. Prostatitis

C. Torsion of the spermatic cord

A 7 year old boy is performing poorly in school . His teacher is frustrated because he is frequently seen " staring off into space " and not paying attention . If this is a seizure , it most likely represents which type ? A. Pseudoscizure B. Tonic - clonic seizure C. Absence D. Myodorus

C. Absence

Phil is c / o left shoulder pain . The pain is markedly worse when his left arm is drawn across his chest ( adduction ) . Which of the following would you suspect? A. Rotator cuff tear B. Subacromiat bursitis C. Acromioclavicular joint involvement D. Adhesive capsulitis

C. Acrmioclavicular joint involvement

Your 30 year old female patient bad - smelling vaginal discharge with mild itching for about 3 weeks . Douching did not help . Denies painful urination or intercourse . She noticed the smell increased after intercourse and during her period last week . There are no lesions on the perineum . No lymphadenopathy . On speculum examination , there is a thin gray - white discharge . The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide ( KOH ) is applied to the vaginal secretions on the slide . Wet prep shows epithelial cells with stippled border ( clue cells ) . What type of vaginitis best describes the findings ? A. Trichomonas vaginitis B. Candida vaginitis C. Bacterial vaginosis D. Atrophic vaginitis

C. Bacterial vaginosis

A positive Phalen's s sign might indicate : A. Shoulder impingement B. Cauda equina C. Carpal tunnel D. Torn ACL

C. Carpal tunnel

Marion presents to your office with back pain associated with constipation and urinary retention Which of the following is most likely ?A. Sciatica B. Epidural abscess C. Cauda equina D. Idiopathix low back pain

C. Cauda equina

It is summer and an 86 year old woman is brought to you from her home after seeing her primary care doctor 2 days ago . She was started on an antibiotic at that time . Today , she comes to the emergency room not knowing where she is or what year it is . What could be a likely cause of this ? A. Alzheimer's dementia B. Stroke C. Delirium D. Meningitis

C. Delirium

Mrs. Geller is somewhat quiet today . She has several bruises of different colors on the ulnar aspects of her forearms and She otherwise has no complaints and her diabetes and HTN are well managed . Her son from out of state accompanies her today and has recently moved in to help What should you suspect? A. Overuse of ASA B. Frequent falls C. Elder abuse D. Depression

C. Elder abuse

You are assessing Tanner staging of the breasts in a young woman . You notice further enlargement of elevation of breast and areola , with no separation of their contours Which Tanner stage would this be ? A. I B. II C. III D. IV

C. III

Lupita is a 27 year old pregnant woman who asks you today if her constipation is normal . Which of the following hormones is most likely responsible for this ? A. TSH B. Relaxin C. Progesterone D. Estrogen

C. Progesterone

A 26 year old comes in for a third trimester prenatal visit . She has had prenatal care since her 6th week of pregnancy . Her FHR is 132 . From what anatomic position should the measuring tape be placed to measure fundal height ? A. Vagina B. Clitoris C. Pubic symphysis D. Umbilicus

C. Pubic symphysis

Coordination of muscle movement requires that four areas of the nervous system function in an integrated way . Coordinating eye , head , and body movements applies to which area of the nervous system ? A. Motor system B. Cerebellar system C. Vestibular division D. Sensory system

C. Vestibular division

An adolescent male comes to your clinic ; his mother is in the waiting room . He has come in for his annual sports physical required to play football . For his age his physical examination is unremarkable and you complete the school form . You take this opportunity to do some health education with him . He admits to wondering a lot lately if he is normal . Although he is in football he really enjoys science and computers more . He is worried that all his buddies will think he is a geek . He is convinced he also won't get a date for the dance next week because the girls all think he is boring too . He denies any experimentation with tobacco or alcohol , and he blushes when you mention sex . After hitting all the pertinent age - appropriate education points you give him his sports physical form and he leaves . The patient's concern during the visit most resembles what developmental stage of adolescence ? A. Early adolescence ( 10 to 14 years old ) B. Middle adolescence ( 15 to 16 years old) C. Late adolescence (17 to 20 years old) D. Early adulthood

Early adolescence ( 10 to 14 years old )

It is necessary to use a 1024 Hz tuning fork to test for vibratory sense of the bony prominences of the extremities . A. True B. False

False

Rubella vaccine should administered at 27 to 36 weeks gestation if the patient is found to be nonimmune . True False

False

Tetanus and diptheria toxoids vaccine

One booster every 10 years

Influenza vaccine

One high dose vaccine annualy

Menarche

Onses of menses

Dysmenorrhea

Pain with menses

A young woman comes in for a routine wellness examination . You notice that her vaginal walls have deep rugae and are slightly bluish in color . She has a lower vaginal pH . There is a palpable softening of the cervical isthmus . She also has a thicker white discharge What should you suspect ? A. Hypoxia B. Varicosities C. Pregnancy D. STI

Pregnancy

A patient recognizes the number you have " written " on her hand , even though her eyes are closed . This is called :

graphesthesia

Mr. Smith , with his eyes closed identifies the object you placed in his hand . This is called

stereognosis

Zoster vaccination

2 doses 2-6 months apart for adults greater than or equal to 50.

Varicella vaccination

2 doses to older adults without evidence of immunity to varicella 4-8 weeks apart.

Mrs. Greenberg comes to you for her usual prenatal checkup . You measure the fundal height at 32cm . What would you estimate the length of her gestation to be ? A. 20 weeks B. 24 weeks C. 32 weeks D. 28 weeks

32 weeks

During the delivery of a female infant , you are there to assess the Apgar score . He was born through an intact pelvis and had no complications during labor or delivery At 1 minute he is pink all over and grimaces . He is flexing his arms and legs occasionally . He is breathing well and heart rate is 110. At 5 minutes he is still pink all over but now is crying vigorously , with active movement . His respiratory effort is good and his heart rate is 120 . What is his Apgar score ? A. 8 at 1 minute , 10 at 5 minutes B. 7 at 1 minute . 9 at 5 minutes C. 4 at 1 minute : 10 at 5 minutes D. 8 at 1 minute . 9 at 5 minutes

A. 8 at 1 minute. 10 at 5 minutes

A 22 year old male presents in your clinic , c / o pain in his testicle and penis . The pain began last night and has steadily become worse . He hurts when he urinates . He has not attempted intercourse since the pain began . He has tried Tylenol and Ibuprofen without improvement . Denies fever or night sweats . He has had 4 previous sexual partners and has had a new partner for the last month . She is using oral contraceptives and they do not use a condom . On exam , you see a young man lying on his side , mildly ill . His temp is 100.2 . There are no visible lesions on the penis , or discharge from the meatus . The scrotum appears normal . Palpation of the testes reveals severe tenderness at the superior pole of the normal - sized left testicle . He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall . The right testicle is unremarkable . An examining finger is placed through each inguinal ring without bulges noted with bearing down Urine analysis shows WBCs and bacteria . What diagnosis of the male genitalia is most like like ? A. Acute epididymitis B. Acite orchitis C. Torsion of smermatic cord D. Prostatitis

A. Acute epididymitis

You are conducting a mental status examination and note impairment of speech and judgement , but the rest of your examination is intact . Where is the most likely location of the problem ? A. Cerebrum B. Cerebellum C. Brainstem D. Basal ganglia

A. Cerebrum

A 26 year old woman comes to your office for her first prenatal visit . This is her first pregnancy . Her last period was about two months ago . She has no current complaints . She is eating healthily , taking vitamins , and exercising . She has a past medical history of an appendectomy as a teenager . Her mother had three children vaginally with no complications . She appears healthy and her vital signs are unremarkable . Her cervix appears bluish in color and highly vascular . A bimanual examination reveals a soft cervix and a 12 week sized uterus . What clinical sign is responsible for her blue , highly vascular cervix ? A. Chadwick's sign B. Hegar's sign C. Leopold's sign D. Loo's sign

A. Chadwick's sign

Which of the following will help to optimize yield from a pediatric examination ? A. Doing the examination out of order if necessary to take advantage of quiet periods for auscultation , etc. b. Being very orderly , so as not to miss a portion of the examination . C. Using firmness as needed to make it through your examination . D. Making sure to place the infant on the table during the examination while Mom watches close by .

A. Doing the examination out of order if necessary to take advantage of quiet periods for auscultation , etc.

Your 21 year old female patient is c / o severe burning with urination , fever of 101.1 , and aching all over . She takes oral contraceptives . She reports one new partner within the last month . Palpation of the inguinal nodes reveals bilateral lymphadenopathy . There are more than 10 shallow ulcers along each side of the vulva . She is very tender at the introitus . Urine has some WBCs but no RBCs or bacteria . Which disorder of the vulva is most likely ? A. Genital herpes B. Condylomata acuminata C. Syphilito chancre D. Epidermoid cyst

A. Genital herpes

Normal cardiovascular system changes in the older adult include (select all) A. Kinking and buckling of the carotid artery low in the neck B. Systolic aortic murmurs C. Significant increase in the maximum heart rate during exercise D. Auscultation of 4th heart sound S4

A. Kinking and buckling of the carotid artery low in the neck B. Systolic aortic murmurs D. Auscultation of a 4th heart sound S4

Two weeks ago , Mary began a job which requires carrying 40 pound buckets . She presents with elbow pain worse on the right . On examination , it hurts her elbows to flex her hands against resistance when her palms face the floor . What condition does have ? A. Medial epicondylitis ( golfer's elbow ) B. Olecranon bursitis C. Lateral epicondylitis ( tennis elbow ) D. Supracondylar fracture

A. Medial epicondylitis (golfers elbow)

A 38 year old woman is complaining of pain in multiple small joints ; she is also experiencing swelling and stiffness . Which of the following is the most likely explanation ? A. Rheumatoid arthritis B. Septic arthritis C. Gout D. Trauma

A. Rheumatoid arthritis

Neer's and Hawkin's signs are a test to diagnose a possible rotator cuff tear. A. True B. False

A. True

Positive Brudzinski's and Kernig's signs may be indicative of meningeal inflammation . A. True B. False

A. True

A mother brings her 15 month old daughter to your office for evaluation of a rash and fever . She says the rash started one day and the fever developed the next day . Her daughter has had all of her vaccinations up to ten months . The mother sheepishly admits that she has not had time to bring her daughter in since her 10 month check up . On examination you see a mildly sick - appearing toddler with a temp of 102 . Looking at her skin you see at least 100 of a variety of papules , vesicles , and ulcers in different stages of development . What illness prevented by proper vaccination does this toddler have ? A. Varicella B. Measles C. Smallpox

A. Varicella

Amenorrhea

Absence of menses

A patient comes to you for the appearance of purple patches on his forearms that have been present for several months . They remain for several weeks , then fade . He denies a history of trauma . Which of the following is likely ? A. Actinic keratosis B. Pseudoscars C. Actinic purpura D. Pseudoscars Cherry angiomas

Actinic purpura

A 29 year old married computer programmer is c / o " something strange " going on in his scrotum . Last month he felt a lump in his left testis , and it is still there . He has had some aching in the left testis but denies pain with urination or intercourse . Denies fever , malaise , night sweats . His PMH consisted of groin surgery as a baby and a tonsillectomy as an adolescent . He eats a healthy diet , exercises , denies tobacco or drugs . On exam the penis is circumcised with no lesions . No lymphadenopathy . Palpation of his scrotum is unremarkable on the right but indicates a large mass on the left . Placing a finger through the inguinal ring on the right you have the patient bear down . Nothing is felt . You attempt to place your finger through the left inguinal ring but cannot get above the mass . On rectal exam , his prostate is unremarkable . What disorder of the tests is most likely the diagnosis? A. Hydrocele B. Scrotal hernia C. Scrotal edema D. Varicocele

B. Scrotal hernia

A. Leg - length test B. Straight - leg raise C. Tinels test D. Phalens test

B. Straight leg raise

Which is true of prostate cancer ? Select all A. It is one of the less common forms of cancer . B. The prostate - specific antigen ( PSA ) blood test is the primary prostate cancer screening test . C. Age and ethnicity are strong risk factors . D. BPH , a common finding in older men , is not a risk factor for prostate cancer .

B. The prostate - specific antigen ( PSA ) blood test is the primary prostate cancer screening test . C. Age and ethnicity are strong risk factors . D. BPH , a common finding in older men , is not a risk factor for prostate cancer .

An 88 year old retired piano teacher comes for evaluation of fatigue . You notice that her clothes are hanging loosely off her frame and that she has lost 15 pounds . She is unaware of this . Her husband of 63 years died a few months ago . You ask the patient to complete a Rapid Screen for Dietary Intake . Which of the following statements is considered to be part of this rapid screen ? A. " I eat more than two meals per day B. . " I drink one glass of alcohol every day . " C. Without wanting to . I have lost or gained 10 pounds in the last 6 months . " D. " I eat with at least one other person most of the time

C. " Without wanting to . I have lost or gained 10 pounds in the last 6 months . "

While examining your patient , you note that his muscle strength is active against gravity and some resistance . You assign the following grade : A. +5 B. +3 C. +4 D. +1

C. +4

A 24 year old childcare worker comes to you for her first prenatal visit . She cannot remember when her last period was but thinks it was between 2 and 5 months ago . She began gaining weight , and feeling " something " moving down there . A home pregnancy test was positive . She felt movement about a week ago . Fetal tones with the Doppler reveal a fetal heart rate of 152. The cervix is bluish and soft . With only the clinical examination , how many weeks pregnant is this patient? A. 6 to 8 weeks B. 12 to 14 weeks C. 18 to 20 weeks D. 24 to 26 weeks

C. 18 to 20 weeks

Your 20 year old male patient is c / o growths on his penile shaft . He noticed them first about 6 weeks ago , and he thinks there are more now . Denies pain with intercourse or urination . He has had 3 former partners and has been with his current girlfriend for 6 months . She is on the pill so they do not use condoms . Denies fever , weight loss , night sweats His PMH is unremarkable . He is in college part time and works in construction and is engaged to be married and has no children . On exam , you see several moist papules along all sides of the penile shaft and two on the corona . He has been circumcised . On palpation of his inguinal region there is no inguinal lymphadenopathy . Which abnormality of the penis does this patient most likely have ? A. Condylomata acuminata B. Genital herpes C. Syphilitic chancre D. Penile carcinoma

Condylomata acuminata

An African American mother brings in her four month old son . She is upset because her neighbors have threatened to call the Child Protective Agency because they think his birthmark is a bruise . Her son was the product of an uneventful pregnancy and spontaneous vaginal delivery On examination you see a large , smooth dark colored mark on his buttock and lower back . Otherwise his examination is unremarkable . What form of birthmark is this likely to be ? A. Cafe - au - lait spot B. Salmon patch C. Congenital Dermal melanocytosis D. Herald patch

Congenital Dermal Melancytosis

Which of the following is worrisome in Samantha , a woman in her 25th week of pregnancy ? A. Mild hirsutism on the face B. A hyperpigmented rash over the maxillary region bilaterally C. Gingival enlargement D. Conjunctival pallor

Conjunctival pallor

While assessing the patient's mental status , you note the following : A. Thought process B. Long and short term memory C. Judgment D. All of the above

D. All of the above

Which of the following changes are expected in vision as part of the normal aging process ? A. Cataracts B. Glaucoma C. Macular dertoneration D. Blurring of near vision

D. Blurring of near vision

A mother brings her 18 month old son in for an evaluation . She is afraid he is not meeting his developmental milestones and wants to know if he should be sent to therapy . He was the product of an uneventful pregnancy and a spontaneous vaginal delivery . His Apgar scores were 8 and 9. Until reaching a year old the mother believes he has hitting his milestones appropriately You decide to administer the Denver Developmental Screening Test . You find that he is using a spoon to eat with and can take off his own shoes and shirt . . " He can build a tower of two cubes . His vocabulary consists of at least 15 words . He can stand alone and stoop and recover , but he is unable to walk without holding onto someone's hand What type of developmental delay does he have ? A. Personal / social B. Fine motor C. Language D. Gross motor

D. Gross motor

While assessing Mrs. Brown's reflexes , you assign a grade of 3+ . This means : A. Her reflexes are somewhat diminished or low normal . B. Her reflexes are very brisk , hyperactive with clonus C. Her reflexes are average or normal D. Her reflexes are brisker than average : possibly but not necessarily indicative of disease .

D. Her reflexes are brisker than average : possibly but not necessarily indicative of disease .

An obese 58 year old woman went through menarche at age 13 and menopause 3 years ago . She is concerned because an aunt had severe osteoporosis . She also has taken a proton - pump inhibitor for the last 15 years . Which of the following is a risk factor for osteoporosis ? A. Obesity B. Late menopause C. Regular physical activity D. Long - term use of proton - pump inhibitors

D. Long term use PPI

Which is a sign of benign prostatic hyperplasia ? A. Weight loss B. Bone pain C. Fever D. Nocturia

D. Nocturia

A 15 month old is brought to you for a fever of 38.6 degrees Celsius and fussiness . The ear examination is as follows : external ear , normal appearance and with manipulation ; canal , normal diameter without evidence of inflammation ; tympanic membrane , bulging , erythematous and opaque . 4 Insufflation is deferred due to pain . What is your diagnosis ? A. Otitis externa B. Cholestcatoma C. Ruptured typanic membrane D. Otitis media

D. Otitis media

During cardiac examination you notice a new parasternal systolic murmur of 2/6 intensity . palpation , the PMI is slightly higher than usual . What do you suspect ? A. Mammary souffle B. Mitral stenosis C. Mitral regurgitation D. Aortic insufficiency

Mammary souffle

You are asked to perform a home safety assessment for an 87 year old retired farmer who lives by himself . Which of the following is not considered to be an increased risk for falls ? A. Loose electrical cords B. Slippery or irregular surfaces C. Chairs at awkward angles D. Remove items that cause tripping like papers , books , and shoes from walkways

Remove items that cause tripping like papers , books , and shoes from walkways

A 20 year old female is c / o fatigue , nausea , and an increase in urination . Her last period was 3 months ago ( November 26 , 2020 ) . She is sexually active and always uses condoms . Her PMH is unremarkable . On pelvic examination a soft cervix is palpated and a 14 week sized uterus is palpated . A urine pregnancy test is positive . You then inform the patient that she is pregnant and , using Naegele's rule , give her the estimated date delivery ( EDD ) . What is the date you gave her ? A. December 2 , 2020 B. September 14 , 2021 C. September 2 , 2021 D. September 22 , 2021

September 2 , 2021

For patients with a conductive hearing loss , a noisy environment might actually help . True False

True

Pregnancy may be a time when women are more likely to be abused by an intimate partner or when patterns of abuse may intensify . True False

True