CPM Final Exam- JSMBS

1- In a problem focused visit, for which chief complaint/concern would it be most important to elicit a pertinent family history as part of the HPI? -"I sprained my ankle while playing soccer" -"I have had sinus pressure and congestions for 6 days" -"For the past 3 months I have experienced chest pain while walking up stairs" -"I was working in my garden yesterday and have developed an itchy rash."

"For the past 3 months I have experienced chest pain while walking up stairs"

4- During a discussion with a patient, which level of personal disclosure on the part of the physician would be most appropriate? -"You think your diarrhea is bad? Let me tell you about what happened to me last time my wife and I travelled to Mexico." -"I know you think that your heart problems are bad, but my mother is about to have a heart valve replacement, so look at things in perspective." -"I realize that having your first baby can be very nerve-racking. I was nervous too when I had my first child" -"I wish I could help you with your itchy rash, but I have been on call and haven't slept for 3 days. I am really tired."

"I realize that having your first baby can be very nerve-racking. I was nervous too when I had my first child"

4- A patient is angry at you because they have seen you 3 times for their back pain, and still are not better. Which would be the most appropriate immediate response? -"It's not my fault your back pain isn't better. These things take time." -"If you don't like the care I am giving you, why don't you find another doctor?" -"If you would have listened to my advice to lose weight, you wouldn't be having this problem". -"I understand that having continued pain in your back has made you upset. Tell me how the pain is still affecting you".

"I understand that having continued pain in your back has made you upset. Tell me how the pain is still affecting you".

1- A patient presents to the doctor's office complaining of "back pain". You enter the room and introduce yourself to the patient. What would be the best opening statement on your part once the patient says "I'm here because my back hurts"? -"Does your pain radiate into your leg?" -"Do you have any chronic medical conditions?" -"Are you having any urinary problems with this back pain?" -"Please tell me more about your back pain?"

"Please tell me more about your back pain?"

1- Which question would be most likely to encourage a patient to provide complete information about their sexual history? -"Are you married?" -"Do you have a boyfriend ?" -"Would you please tell me about your sexual relationships?" -"Do you have a girlfriend?"

"Would you please tell me about your sexual relationships?"

3- From a medical-legal perspective, which statement is most correct? -If you didn't document in the medical record that you did or said something regarding a patient encounter, then it will later be assumed that you didn't do or say it ("If you didn't document it, you didn't do it") -Since there are so many details involved in patient care, you can't be expected to write down everything you did, so, at a later date, when your actions are brought into question, your recollection of the encounter is as acceptable as your documentation of the encounter. -Since you are a medical student, and will have access to the electronic medical record in various offices and institutions, it will be acceptable for you to look up test results for your family and friends. -Since most medical records are now electronic, it is acceptable to send personal medical information using commercial e-mail services like Gmail.

-If you didn't document in the medical record that you did or said something regarding a patient encounter, then it will later be assumed that you didn't do or say it ("If you didn't document it, you didn't do it")

5- A patient comes to your preceptor's office for a gynecological exam. The patient is currently not pregnant. Your preceptor's note indicates that this is a 28 year old female who is G3P2012. Using your White Book as your guide, match the element of this patient's obstetric history with the proper number. premature births

0

5- A patient comes to your preceptor's office for a gynecological exam. The patient is currently not pregnant. Your preceptor's note indicates that this is a 28 year old female who is G3P2012. Using your White Book as your guide, match the element of this patient's obstetric history with the proper number. miscarriages or abortions

1

6. You have your full set of teeth including wisdom teeth. You have a toothache in the upper left most posterior molar. What number tooth is this? -1 -16 -17 -32

16

5- A patient comes to your preceptor's office for a gynecological exam. The patient is currently not pregnant. Your preceptor's note indicates that this is a 28 year old female who is G3P2012. Using your White Book as your guide, match the element of this patient's obstetric history with the proper number. full-term births

2

5- A patient comes to your preceptor's office for a gynecological exam. The patient is currently not pregnant. Your preceptor's note indicates that this is a 28 year old female who is G3P2012. Using your White Book as your guide, match the element of this patient's obstetric history with the proper number. living children

2

3- A patient with a history of congestive heart failure presents to you for evaluation of leg swelling. According to Seidel, In which grade of pitting edema does the "pit" usually disappear in 10-15 seconds? -1+ -2+ -3+ -4+

2+

5- A patient comes to your preceptor's office for a gynecological exam. The patient is currently not pregnant. Your preceptor's note indicates that this is a 28 year old female who is G3P2012. Using your White Book as your guide, match the element of this patient's obstetric history with the proper number. total number of times pregnant

3

6- Tonsils which are nearly touching the uvula are graded as -1+ -2+ -3+ -4+

3+

6- In looking at the tongue and palate, and posterior pharynx, you assign a Mallampati score. A patient with which score is more likely to have sleep apnea, or be a challenge to intubate? -1 -2 -4 -The Mallampati score has no bearing on ease of intubating or sleep apnea

4

8- Your patient likes having wine with dinner. They want to know if that is a "problem". You decide to use the Audit-C tool to characterize their drinking pattern. What is you patient's AUDIT-C score if they: Have an alcoholic drink 3 times a week Drink one or two 5 oz glasses of wine each time they drink Consume 6 or more drinks in an occasion less than monthly (maybe at a Superbowl party or on New Years) -0 -1 -2 -3 -4 -5

4

2- Your patient wants to talk with you about quitting smoking. You want to ASSESS their smoking history. They tell you that they have smoked 2 packs per day for 20 years. How many "pack years" does this history represent? -2 -10 -20 -40

40

8- Which of the following most closely represents a standard alcoholic drink? -a 16 oz draft beer -A Martini with 2 shots (3 oz) of gin -A 5 oz. glass of wine -A 40 oz bottle of malt liquor

A 5 oz. glass of wine

3- Match the description of the murmur with the likely valve disease Aortic regurgitation (leaky valve)

A blowing diastolic murmur heard best at the second right intercostal space at the right sternal border

3- Match the description of the murmur with the likely valve disease Mitral regurgitation (leaky valve)

A blowing systolic murmur heard best at the apex and transmitted to the axilla

9- There are several tools for screening for cognitive defecits in the elderly. One is called the Folstein Mini-Mental State Examination (White Book). Another screening tool, which is brief and easy to administer, is called the "Mini-Cog". With this tool, the patient is asked to repeat three items, recall those three items a feww minutes later, and draw something. Which of the following are they asked to draw? -A dog or cat -A human face with nose, eyes, and ears -A house -A clock face with the hands set to a time (such as 11:10)

A clock face with the hands set to a time (such as 11:10)

3- Match the description of the murmur with the likely valve disease Aortic stenosis (narrowed valve)

A coarse systolic ejection murmur heard best at the second right intercostal space at the right sternal border (though it may radiate to the apex and into the carotids)

3- Match the description of the murmur with the likely valve disease Mitral stenosis (narrowed valve)

A diastolic rumble-like murmur heard best at the apex

4- "Retractions" are evidence of; -Low oxygen level -Pneumonia -Anxiety -Airway obstruction

Airway obstruction

2- Which is not one of the principles of the "5-A's" for engaging patients to quit smoking? -Ask about tobacco use -Advise all tobacco users to quit -Assess interest in quitting -Assist in developing a quit plan and Arrange for follow-up -Arrange for follow-up -Allow the patient to contact you when they feel like quitting

Allow the patient to contact you when they feel like quitting

4- Which represents a normal healthy adult? -Anteroposterior chest diameter is greater than transverse diameter -Anteroposterior chest diameter is equal to transverse diameter -Anteroposterior chest diameter is less than transverse diameter -There is no relationship between anteroposterior and transverse chest diameter

Anteroposterior chest diameter is less than transverse diameter

3- Match the heart valve with the proper area for auscultating that valve: Mitral Valve

Apex of the heart in the fifth left intercostal space at the midclavicular line

1- An important part of the medical interview involves screening for lifestyle choices which may impact a patient's health. One of the screening tools we discussed is the "CAGE questions". The "A" in the CAGE questions stands for: -Do you feel you consume Alcohol in excess? -Have you physically Abused someone when drinking alcohol? -Are you Annoyed when people criticize your drinking? -Are you Able to arrive at work despite your drinking?

Are you Annoyed when people criticize your drinking?

8- The "A" in the CAGE questions stands for -Do you feel you consume Alcohol in excess? -Have you physically Abused someone when drinking alcohol? -Are you Annoyed when people criticize your drinking? -Are you Able to arrive at work despite your drinking?

Are you Annoyed when people criticize your drinking?

5- Which initial approach would most likely lead to an open and informative discussion about an adult patient's sexuality? -Ask "are you married?" -Ask "do you have a boyfriend ?" -Ask "are you involved in a sexual relationship, and if so would you please tell me about the relationship?"

Ask "are you involved in a sexual relationship, and if so would you please tell me about the relationship?"

3- A 62 year old patient with a history of hypertension reports to you that they feel their heart "jumping around" in their chest and "skipping beats". Which condition would present with an irregular heart RHYTHM? -Sinus bradycardia -Ventricular tachycardia -Normal sinus rhythm -Atrial fibrillation

Atrial fibrillation

6- Which appearance of TM may indicate pus in the middle ear (otitis media)? -Bulging, red, cloudy with no mobility -Red, translucent, mobile -Retracted, translucent, amber/yellow -Pearly grey, mobile, translucent

Bulging, red, cloudy with no mobility

6- Which is least indicative of "strep throat"? -Exudates on the tonsils -Cough -cervical adenopathy -fever

Cough

4- Dyspnea refers to -Rapid breathing -Difficult, labored breathing -Slow breathing -Shallow breathing

Difficult, labored breathing

9- Which statement is true about older adults? -Increased pain is a normal part of aging -Disease symptoms may be more vague and less dramatic than in younger patients -Older patients with multiple medical problems are used to managing multiple medications, so are less likely to experience adverse drug interactions -Older adults should not be offered opportunities to express what matters to them regarding goals of care.

Disease symptoms may be more vague and less dramatic than in younger patients

4- Match the lung finding the best fits the condition; Pleural effusion

Dullness to percussion with absent breath sounds over the effected area

4- Match the lung finding the best fits the condition; Pneumonia

Dullness to percussion with crackles and rhonchi

3- Match the heart valve with the proper area for auscultating that valve: Tricuspid valve

Fourth left intercostal space along the lower left sternal border

9- In the Functional Assessment, which is NOT considered a "Basic Activity of Daily Living (ADL)"? -Gardening -Dressing -Bathing (Hygiene) -Toileting -Eating -Ambulating

Gardening

1- The complete medical encounter includes the Subjective, Objective, Assessment, and Plan (SOAP). Which of the following belongs in the objective section of a note? -Heart rate: 68 beats per minute -The patient is employed as a high school teacher -The patient has been experiencing heartburn after eating pizza. -The patient's father died of colon cancer at age 57

Heart rate: 68 beats per minute

4- Match the lung finding the best fits the condition; Pneumothorax

Hyperresonance to percussion, diminished to absent breath sounds

3- Which is the most significant potential problem with using templates in documenting the physical exam in the electronic medical record? -Elements of the template might not be spelled correctly -The template might use terminology which is not familiar to other physicians in the practice. -Using a template usually increases the amount of time it takes to complete a note. -If not properly edited, the template may contain elements of the physical exam which were not actually performed during the encounter

If not properly edited, the template may contain elements of the physical exam which were not actually performed during the encounter

4- What is generally the preferred sequence for examining the lungs? -Inspection, palpation, percussion, auscultation -Auscultation, percussion, palpation, inpection -Inspection, auscultation, palpation, percussion -Percussion, auscultation, inspection, palpation

Inspection, palpation, percussion, auscultation

2- You want to talk with your patient about smoking cessation. Which statement is most correct? -Counseling adds almost nothing to medication when it comes to success in quitting. -If you can't block out at least 20 minutes in the visit, don't attempt to cousel the patient, as shorter times are not effective. -Motivational interviewing by a healthcare professional for as little as 3-5 minutes has been shown to increase cessation success. -All patients wanting to discuss smoking scessaion should be referred to a certified counsellor.

Motivational interviewing by a healthcare professional for as little as 3-5 minutes has been shown to increase cessation success.

3- What is a bruit? -A cheap men's cologne -A pulse which feels weaker than expected -Murmur or unexpected sound heard over a blood vessel -Discoloration of the skin due to venous insufficiency

Murmur or unexpected sound heard over a blood vessel

1- Which statement is true regarding effective patient-doctor communication? -Although it is a nice thing to strive for, it does not have any measurable impact on patient-care -Physicians who are good communicators are usually better able to deal with emotional situations. and often find increased professional satisfaction. -Doctor-patient communication is not a significant factor in most malpractice cases -Patients usually don't care too much about their doctor's communications skills

Physicians who are good communicators are usually better able to deal with emotional situations. and often find increased professional satisfaction.

1- If a patient presents to you in the ER with crushing chest pain and is visibly short of breath, which type of history are you likely to obtain most immediately? -Complete history -Inventory history -Problem (or focused) history -Interim history

Problem (or focused) history

4- Match the lung finding the best fits the condition; Asthma

Prolonged expiratory wheeze with diminished lung sounds

7- As part of their annual health maintenance visit, a patient screens positive for depression when the nurse administered the PHQ-2. Your preceptor asks you to interview the patient regarding the possible diagnosis of major depressive disorder. You choose to use the SIG-E-CAPS mnemonic to guide your interview. Match the letter of "SIG E CAPS" to the proper symptom of depression. For the two S's, you must use the order as indicated in the white book.

S-Increased or decreased sleep I- Decreased interest or pleasure in almost all activities G- Increased (inappropriate ) guilt or increased feelings of worthlessness. hopelessness E- Decreased energy C- Decreased concentration A- Increased or decreased appetite P- psychomotor agitation or retardation S- Suicidal ideation, plan or attempt

8- Which practice may help address the opioid use disorder problem faced in our community? -Prescribe opioids only for chronic pain. -Limit opioid prescriptions to only 3 tablets per day -Screen patients for substance use disorder prior to considering them for opioid therapy -Recommend that patients travel to Canada to buy legal marijuana to treat their pain instead of taking opioids.

Screen patients for substance use disorder prior to considering them for opioid therapy

3- Match the heart valve with the proper area for auscultating that valve: Pulmonic Valve

Second and third intercostal space at the left sternal border

3- Match the heart valve with the proper area for auscultating that valve: Aortic Valve

Second right intercostal space at the right sternal border

1- All of the following are strategies for establishing effective communication with the patient except -Eye contact which is assuring and comfortable -Nodding in agreement -Echoing and summarizing to confirm understanding -Standing during the entire patient interview out of respect for the patient

Standing during the entire patient interview out of respect for the patient

4- Asking the patient to say "ninety-nine" is used to check for: -Wheezing -Tactile fremitus -Crepitus -Dyspnea

Tactile fremitus

3- The systolic blood pressure is recorded as: -The disappearance of the Korotkoff sounds upon deflation of the cuff -The disappearance of a palpable brachial pulse of the inflation of the BP cuff -The initial muffling of the Korotkoff sounds upon deflation of the cuff -The appearance of 2 consecutive beats upon deflation of the cuff

The appearance of 2 consecutive beats upon deflation of the cuff

3- Which corresponds to the first heart sound ("S1" or "lubb")? -The closing of the aortic and pulmonic valves during diastole -The opening of the mitral and tricuspid valves during systole -The opening of the aortic and pulmonic valves during diastole -The closing of the mitral and tricuspid valves during systole

The closing of the mitral and tricuspid valves during systole

9- When a patient has a bad outcome which we call "iatrogenic", what do we mean? -The harm was self-inflicted -The harm was due to the natural progression of a disease process. -The harm was brought on, at least in part, by medical examination or treatment -The harm was not of any medical consequence.

The harm was brought on, at least in part, by medical examination or treatment

6- Which element of the head, ears, nose and throat exam is usually saved for the end of the physical exam in small children and why? -The fontanel exam because the fontanel is usually bulging at first when children are first undressed -The otoscopic exam because this part of the exam often makes children cry, making subsequent parts of the exam difficult -The thyroid exam because, once the child cries, the thyroid is more easily palpated -The mouth because parents usually feed their children just before an exam, and you need to allow time for the saliva to clear the milk from the oral cavity

The otoscopic exam because this part of the exam often makes children cry, making subsequent parts of the exam difficult

6- When palpating lymph nodes, it is best to use; -The tips of all 5 fingers -The palms of your hands -The pads of the 3 middle fingers -The back of your hand

The pads of the 3 middle fingers

3- Which is the preferred way to communicate with a patient whose language you do not speak? -Use a professional interpreter, either in person or via a translator phone. -Use the patients child as an interpreter. -Use hand gestures and whatever limited English the patient understands in order to obtain the history. -Use a friend or neighbor to interpret.

Use a professional interpreter, either in person or via a translator phone.

2- As presented in the smoking cessation article, what is the "patch plus" method for smoking cessation? -Using a nicotine patch plus varenicline (Chantix) -Using a nicotine patch plus increasing coffee consumption -Using a nicotine patch plus a short-acting form of nicotine replacement like lozenges and gum for urges not relieved by the patch. -nicotine patches plus scheduling an appointment with a psychiatrist or social worker.

Using a nicotine patch plus a short-acting form of nictine replacement like lozenges and gum for urges not relieved by the patch.

4- Three of these lung sounds are considered abnormal ("adventitious"). Only one is considered a normal, expected finding. Which lung sound is considered a normal, expected finding? -Vesicular -Crackle -Wheeze -Rhonchi

Vesicular

9- As we grow older, which of the following is inevitable? -We will all suffer major depression -We will all experience dementia -We will all suffer debilitating pain -We will all need care in a nursing home. -We will all die.

We will all die

4- Egophony is best described as: -A dullness is heard to percussion -A vibration is palpated when the patient breath -A crackly sound is heard outside the respiratory tree -When the patient says "ee", it sounds like "aa" due to a lung consolidation

When the patient says "ee", it sounds like "aa" due to a lung consolidation

2- Your patient is overweight, with a BMI of 32, and you just informed them that they are "pre-diabetic". They want to talk with you about options for modifying their diet. You learn that your patient loves to cook. According to the "OARS" principle of motivational interviewing, which statement would be most appropriate? -You love cooking, and you want to pursue a healthy diet. Would you like to explore options for healthy menu choices? -You love to cook, but now you are "pre-diabetic". You need to stop cooking pasta dishes. -You are prediabetic, so you need to decide what is more important to you, your health, or baking cakes. -You should follow a diabetic diet.

You love cooking, and you want to pursue a healthy diet. Would you like to explore options for healthy menu choices?

6- Which is a normal Rhinne test? -air conduction heard longer than bone conduction by ratio of 2:1 -bone conduction heard longer than air conduction by ratio of 2:1 -equal bone and air conduction -The Rhinne test doesn't test bone and air conduction

air conduction heard longer than bone conduction by ratio of 2:1

6- Palpating which structure on the infant can give a clue as to infection or increased intracranial pressure? -anterior fontanel -posterior fontanel -frontal sinuses -tempromandibular joint

anterior fontanel

6- When examining the thyroid from behind, the thyroid isthmus can palpated -beneath the cricoid cartilage -in the posterior triangle -above the cricoid cartilage -in the sternal notch

beneath the cricoid cartilage

1- In which part of the patient encounter would it be most appropriate to include the following statement; " My head feels like it is going to explode"? -chief complaint/concern -history of present illness -past medical history -assessment -plan

chief complaint/concern

2- Your patient agrees that smoking is a problem, and would like to consider quitting, but they have no plan to quit within the next month . In which stage of readiness to change is your patient? -precontemplation -contemplation -preparation -action -maintenance

contemplation

8- Your patient agrees that smoking is a problem, and would like to consider quitting, but they have no plan to quit within the next month . In which stage of readiness to change is your patient? -precontemplation -contemplation -preparation -action -maintenance

contemplation

6- Which best describes a normal thyroid? -Firm, pliable, fixed, nodular -Firm, woody, free-moving, smooth -Firm, pliable, free-moving, nodular -firm, pliable, free moving, smooth

firm, pliable, free moving, smooth

1- In which part of the patient encounter would it be most appropriate to include the following phrase: Mr. Smith, a 55 year old male smoker with hypertension, was feeling well until last Sunday when he experienced chest pain while mowing the lawn. It radiated to his left arm. It was relieved when he sat down for 5 minutes. It occurred again this morning when he needed to climb the stairs since the elevator at work was broken. -chief complaint/concern -history of present illness -past medical history -assessment -plan

history of present illness

6- Pain when pulling the pinna as well as a swollen auditory canal with discharge is suggestive of -otitis externa ("swimmer's ear") -otitis media -Inner ear infection -Perforated tympanic membrane

otitis externa ("swimmer's ear")

4- During an interview with a patient, the patient begins to cry. What would be an appropriate response -provide a tissue, offer support, allow the moment to pass, and resume once the patient is ready -tell the patient that since he is so upset, you will leave the room and bring the preceptor -Tell the patient that things are really not so bad, so they don't need to cry -change the subject so the patient will stop thinking about whatever made them upset

provide a tissue, offer support, allow the moment to pass, and resume once the patient is ready

6- Which feature of sinusitis is most suggestive of acute bacterial rhinosinusitis, and hence appropriate for consideration for antibiotics, as opposed to a viral upper respiratory infection? -nasal congestion -symptoms lasting more than 10 days -Cough -watery eyes

symptoms lasting more than 10 days

2- Which best describes the goals of motivational interviewing? -to convince the patient to agree to adapt behaviors that will improve their health -to help the patient resolve their ambivalence, develop some momentum and believe that behavior change is possible -to provide the patient with a list of referrals to resources such as dieticians and counselors in case they should decide to pursue helath behavior change -to make sure that you document the health behvior's that are impeding your ability to treat the patient's chronic conditions.

to help the patient resolve their ambivalence, develop some momentum and believe that behavior change is possible

6- What is the description of a normal tympanic membrane? -Opaque, yellow, visible light reflex, mobile -Translucent, pearly gray, bulging, mobile -Opaque, red, visible light reflex, immobile -translucent, pearly gray, visible light reflex, mobile

translucent, pearly gray, visible light reflex, mobile