Exam 1 - Advanced Health Assessment

Select all risk factors below that are modifiable: a. obesity b. cigarette smoking c. hypertension d. heredity e. race f. physical inactivity

A, B, C, F

A 62-year-old patient with rheumatoid arthritis complains of increased joint stiffness. What characteristic(s) are consistent with her diagnosis of RA? a. tophi are found in the subcutaneous tissue b. it most frequently involves the first metatarsophalangeal joint c. stiffness follows activity d. swelling of the synovial tissue is seen in joints and tendon sheaths e. joint distribution is asymmetrical

swelling of the synovial tissue is seen in joints and tendon sheaths

A 25-year-old construction worker is complaining of a swishing noise in both ears that never goes away and has occurred for about 6 months. He is otherwise healthy, is able to work on his job (operating large, vibrating machinery) without problems, and is not taking any medications. A complete examination reveals an abnormality. Which of the following abnormality is most often associated with tinnitus? a. mild tremor b. headache c. bilateral earache d. vertigo e. ear wax

vertigo

A 14-year-old high school student comes to the clinic for a 3-month history of periodic dyspnea when playing basketball. It resolves shortly after resting. He has not had fever, chills, cough, sputum production, or chest pain. He has no history of serious illness. Based on the boy's history, asthma is suspected. Which of the following sounds heard on expiration during lung auscultation would be most suggestive of asthma? a. pleural rub b. rhonchi c. stridor d. mediastinal crunch e. wheezes

wheezes

All of the statements about the right coronary artery below are true EXCEPT: a. Significant occlusion results in an inferior wall myocardial infarction b. Significant occlusion impacts the anterior wall of the heart and may cause cardiogenic shock c. Provides blood supply to both SA and AV node; infarction may results in arrythmias. d. Provides blood supply to right ventricle

Significant occlusion impacts the anterior wall of the heart and may cause cardiogenic shock

Is the following information subjective or objective? Mr. M has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest.

Subjective

You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10-year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent? a. hypertension b. peripheral arterial disease c. systematic lupus erythematosus d. COPD

peripheral arterial disease

A 25-year-old accountant presents to your clinic complaining of intermittent lower right-sided chest pain for several days. He describes it as knifelike and states it only lasts for 3 to 5 seconds, taking his breath away. He states he feels like he has to breathe shallowly to keep it from reoccurring. The only thing that makes it better is lying quietly on his right side. It is much worse when he takes a deep breath. He has taken some Tylenol and put a heating pad on his side but neither has helped. He remembers that 2 weeks ago he had an upper respiratory infection with a severe hacking cough. He denies any recent trauma. His past medical history is unremarkable. His parents and siblings are in good health. He has recently married with a baby due in 2 months. He denies any smoking or illegal drugs. He drinks two to three beers once a month. He state he eats a healthy diet and runs regularly, but not since his recent illness. He denies any cardiac, gastrointestinal, or musculoskeletal symptoms. On exam he is lying on his right side but appears quite comfortable. His temperature, blood pressure, pulse, and respirations are unremarkable. His chest has normal breath sounds on auscultation. Percussion of the chest is unremarkable. During palpation the ribs are nontender. What disorder of the chest best describes his symptoms? a. pericarditis b. chest wall pain c. pleural pain d. angina pectoralis

pleural pain

A 24-year-old graphic designer presents to the clinic with a concern for a breast mass. A rubbery, mobile, nontender mass is palpated in the right breast as described by the patient, which is consistent with a fibroadenoma. In describing the location of the mass, the examiner notes that it is 3cm proximal to and 3cm to the left edge of the nipple. Which of the following would be the most appropriate way to report this finding? a. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from the nipple." b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant." c. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple." d. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant." e. "Rubbery, mobile, nontender mass located in right breast, upper outer quadrant."

"Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple."

An 87-year-old woman who is generally healthy and cognitively sharp complains to the clinician of slow loss of vision, with similar problems in both eyes, particularly when she looks straight ahead. She is having difficulty reading of late. What is a reasonable response to her? a. "This may be the onset of macular degeneration, which an ophthalmologist should confirm." b. "This is a common occurrence with aging and unlikely to have a diagnosis." c. "Are you experiencing any depression or stress?" d. "This is a classic 'floater' and no cause for concern." e. "This is an unusual occurence, even among elderly, and may be due to a problem within the brain (since it is bilateral)."

"This may be the onset of macular degeneration, which an ophthalmologist should confirm."

A 55-year-old actress sustains a heart attack and the follow-up electrocardiogram demonstrates a left bundle branch block. What would be the likely duration of the QRS complex? a. 90 milliseconds b. 75 milliseconds c. 95 milliseconds d. 125 milliseconds e. 100 milliseconds

125 milliseconds

A 45-year-old physician is placed on a beta blocker for hypertension. Prior to medication administration, the patient's heart rate is 75 beats per minute with a cardiac output of 5 liters per minute. Following initiation of the medication, the heart rate decreases to 60 beats per minute without a change in stroke volume. What would be the expected new cardiac output? a. 6 liters per minute b. 4 liters per minute c. 5 liters per minute d. 10 liters per minute e. 3 liters per minute

4 liters per minute

A 42-year-old woman presents with fatigue associated with a 40-lb weight gain over the past 2 years. She has always struggled with her weight but has continued to gain despite various attempts at diet and exercise regimens; she inquires if she might be a candidate for gastric bypass surgery. In evaluating patients who are overweight, which of the following best defines obesity in medical terms? a. a patient with a waist-to-hip ratio (WHR) >1.75 b. A patient with a body mass index (BMI) >30 c. A patient with a body mass index (BMI) <26 d. A patient consuming >1.5x the recommended daily caloric intake e. A patient who weighs at least 1 standard deviation (SD) greater than the mean for his or her age and gender

A patient with a body mass index (BMI) >30

Match the following skin conditions with the correct description. Question: Acne _____ Contact dermatitis _____ Folliculitis _____ Herpes Zoster _____ Answer Choices: a. facial comedomes and pustules b. linear vesicles on arms c. tender, firm nodule with surrounding redness d. parethesias and vesicles in one dermatome area

Acne - A Contact dermatitis - B Folliculitis - C Herpes Zoster - D

If the following patient develops a sustained sinus tachycardia, treatment such as beta blockade to decrease the rate should be considered: a. Acute coronary syndrome with evolving myocardial infarction b. Congestive heart failure with ejection fraction of 30% c. GI bleed d. Multiple trauma

Acute coronary syndrome with evolving myocardial infarction

Physical assessment plays a key role in the patient with acute coronary syndrome. Match the physical finding with the correct pathophysiology: a. 1 cm JVD in the supine position-heart failure b. New S3heart sound - heart failure c. New systolic murmur - ruptured papillary muscle with mitral valve insufficiency d. All but answer 1 are correct

All but answer 1 are correct

A 53-year-old caterer comes to the clinic for a routine examination. She has type 2 diabetes mellitus, which is well controlled on medication. Her history from her last visit reveals that she smoked one pack of cigarettes a day at that time. The 5 As Model is a useful approach to take with trying to help patients to quit smoking. What is the 5 As Model? a. Admonish, action, available, assess, alleviating factors b. Ask, advise, assess, assist, arrange c. Agitate, assist, alleviating factors, able, action d. Arrange, alleviating factors, action, attitude, able e. Affable, associated manifestations, ask, admonish, available

Ask, advise, assess, assist, arrange

A 56 year old man complains of having a morning cough for 5 years that has increased in the last 2 days. He is a 30 Pack year smoker and has also noticed wheezing and dyspnea lately. His PFT is as follows: FVC: predicted 6.0 liters, Measured 4.0 liters (% predicted 67%) FEV1: predicted 5.0 liters, Measured 2.0 liters ( % predicted 40%) FEV1:FVC: predicted 84%, Measured: 50%, (% predicted 60%) What is the most likely diagnosis? a. pulmonary fibrosis b. asthma c. COPD d. sarcoidosis

COPD

A 62-year-old construction worker presents to your clinic complaining of almost a year of chronic cough and occasional shortness of breath. Although he has had worsening of symptoms occasionally with a cold, his symptoms have stayed about the same. The cough has occasional mucous drainage but never any blood. He denies any chest pain. He has had no weight gain, weight loss, fever, or night sweats. His past medical history is significant for high blood pressure and arthritis. He has smoked two packs a day for the past 45 years. He drinks occasionally but denies any illegal drug use. He is married with two children. He denies any foreign travel. His father died of a heart attack and his mother died of Alzheimer's disease. On exam you see a man looking slightly older than his stated age. His blood pressure is 130/80 and his pulse is 88. He is breathing comfortably with respirations of 12. His head, eyes, ears, nose, and throat exams are unremarkable. His cardiac exam is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus. What thorax or lung disorder is most likely causing his symptoms? a. COPD b. spontaneous pneumothorax c. asthma d. pneumonia

COPD

A 23-year-old physician assistant (PA) student found that she felt nervous when called upon to examine men in her age group. On one occasion, she encountered a young male patient who appeared embarrassed to see her walk into the room. What should the PA do to minimize their mutual discomfort? a. explain that she is a PA student b. explain how the examination will proceed c. adjust lighting so it is tangential to the patients' body d. provide ongoing interpretation of findings e. ask the patient where he comes from

Explain how the examination will proceed.

A 34-year-old male with a history of complex social and medical needs (including current substance abuse) presents to a primary care teaching clinic. The patient has experienced a number of adversarial relationships with prior clinicians, including voluntarily leaving two practices within the previous year and being asked to leave care at a third clinic due to misbehavior. The attending physician desires to utilize the approaches to this patient that are most likely to lead to comprehensive care and patient compliance. Which of the following is the most appropriate interview style for the attending physician to use? a. focusing on the need for immediate diagnostic certainty over personal connection b. following the patient's lead to understand their thoughts, ideas, concerns and requests c. taking charge of the interaction to meet the clinician's desire to acquire diagnostic information d. taking a symptom-focused approach to reduce the involvement of the patient's emotional difficulties e. deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete details about the patient's condition

Following the patient's lead to understand their thoughts, ideas, concerns and requests

An 82-year-old gentleman seems to be speaking loudly during an examination, suggesting that he may not be hearing well. What is a good question to ask him to help identify whether or not he has hearing loss? a. Does he have vertigo? b. Has he been having an earache? c. How well does he understand people in a noisy environment such as a restaurant? d. Has he been listening to loud music? e. Does he have discharge from his ear?

How well does he understand people in a noisy environment such as a restaurant?

A student is practicing the performance of a lung examination on a classmate. Which of the following is the correct order for performing the components of the lung examination? a) Auscultation, inspection, palpation, and percussion b) Palpation, inspection, auscultation, and percussion c) Auscultation, percussion, palpation, and inspection d) Inspection, auscultation, percussion, and palpation e) Auscultation, inspection, palpation, and percussion f) Inspection, palpation, percussion, and auscultation

Inspection, palpation, percussion, and auscultation

A 42-year-old fair-skinned woman of Irish origin presents with an abnormal skin growth that was first noted 7 years ago. On examination, a 2x3-cm lesion is noted over her left bicep. Which of the following historical elements most increases the suspicion that the lesion is malignant? a. Proximal location, that is, over the bicep rather than the distal arm b. No evolution in size since onset, but mild intermittent pruritis over the past 2 years c. Presence of similar pinkish tan lesions on the sun-exposed areas including the face and hands d. No evolution in size since onset, but uniformly darkly pigmented color e. Minimal but discernible increase in size over the past 6 months

Minimal but discernible increase in size over the past 6 months

Please match the following EKG findings in acute coronary syndrome (ACS). Question: Normal _____ Ischemia _____ Injury _____ Infarction _____ Answer Choices: A. T wave inversion B. ST segment elevation>2mm C. Abnormal Q waves D. Absence of ischemia, injury, or infarction at this time

Normal - D Ischemia - A Injury - B Infarction - C

Your responsibility for a patient with a new sinus tachycardia of 150 includes: a. Nursing assessment to identify the underlying cause and intervene if appropriate b. Anticipate administration of Adenocard(Adenosine) 6mg IV push with a physician's order. c. Anticipation administration of Atropine 0.5mg IV push with a physicians order d. Don't overreact to one pulse measurement, retake apical pulse in one hour

Nursing assessment to identify the underlying cause and intervene if appropriate

Mary, a 51-year old female, comes in complaining that she has a small 1 cm size nodule in her upper R breast for less than 1 month. You find a hard, slightly tender, moveable 1 cm nodule with irregular borders. You should: a. Obtain a mammogram and refer to a surgeon for surgical biopsy b. Considered this a normal finding as her mammogram was WNL 2 months ago c. Observe for 1-2 months, decrease caffeine intake, then refer for biopsy d. Treat with antibiotics and recheck in 1 month

Obtain a mammogram and refer to a surgeon for surgical biopsy

A 44-year-old female comes to your clinic complaining of severe dry skin in the area over her right nipple. She denies any trauma to the area. She noticed the skin change during a self-breast exam 2 months ago. She also admits that she had felt a lump under the nipple but kept putting off making an appointment. She does admit to 6 months of fatigue but no weight loss, weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism. She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug use. On exam you find a middle-aged woman appearing her stated age. Inspection of her right breast reveals a scaly eczema-like crust around her nipple. Underneath you palpate a nontender 2 cm mass. The axilla contains only soft moveable nodes. The left breast exam and axilla are unremarkable. What visible skin change of the breast does she have? a. nipple retraction b. Paget's disease c. peau d'orange sign

Paget's disease

One important examination technique involves using the third fingers of each hand to determine the health of internal organs. What is the name of this technique? a. percussion b. inspection c. auscultation d. listening e. palpation

Percussion

All of the statements about the left coronary artery listed below are correct EXCEPT: a. Major blood supply to anterior, lateral, and posterior wall of left ventricle b. Provides major blood supply to AV node c. Divides into left anterior descending and left circumflex d. Significant occlusion of this coronary artery is referred to as the "widow maker" due to the major impact on left ventricular wall function.

Provides major blood supply to AV node

A 68-year-old former paleontologist presents to the clinic with concerns about her breast cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A younger cousin developed the disease a few years ago before the age of 50 years, but this individual was not tested for the BRCA1 and BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s and had radiation to the chest. She did take hormone replacement therapy for a few years before data emerged that this may contribute to breast cancer risk. She has had several mammograms in her 50s for persistently dense breasts with subtle findings, but follow-up biopsies never showed any malignant pathology. Which of the following is true regarding MRI screening of this patient? a. no agency recommends breast MRI for a patient such as this one, who has moderately but not extraordinary risk factors for breast cancer b. the U.S. Preventative Services Task Force (USPSTF) recommends screening with MRI for patients with such risk factors c. Regardless of recommendations, the high sensitivity of breast MRI comes at the expense of markedly decreased specificity (ie, the ability to rule out disease in healthy breasts) d. mammograms are not affected by breast density and thus density is not a factor in choosing MRIs over mammograms in patients such as this individual e. history of chest radiation is not a risk factor for breast cancer and is thus not relevant to deciding whether MRI is appropriate for this patient.

Regardless of recommendations, the high sensitivity of breast MRI comes at the expense of markedly decreased specificity (ie, the ability to rule out disease in healthy breasts)

Normally sound is heard longer through air than bone, which test is used to determine this? a. Rhinne b. Weber

Rhinne

A viral upper respiratory infection is best described as: a. Purulent nasal discharge, pain over sinuses, facial pain, or tooth pain. Nasal turbinates red, swollen. Symptoms for greater than 1 week., May have red streaks on TM. b. Sneezing, itching eyes, post-nasal drip, clear nasal discharge, turbinates boggy, swollen, and congested. c. Clear to yellowish nasal discharge, no sinus pain, and nasal mucosa is reddened; TM s may be slightly reddened. Symptoms are lasting 2-3 days and are gradually improving. Exposure to others with similar symptoms

Sneezing, itching eyes, post-nasal drip, clear nasal discharge, turbinates boggy, swollen, and congested.

Please match the symptoms with the description of coronary artery disease. Question: Stable angina _____ Unstable angina _____ Variant angina _____ Acute myocardial infarction _____ Answer Choices: A. Stable chest pain pattern relieved by rest or NTG B. Increase in frequency or duration of chest pain C. Chest pain associated with coronary spasm D. Any chest pain exceeding 15 minutes and unrelieved by NTG or rest should be presumed infarction until proven otherwise.

Stable angina - A Unstable angina - B Variant angina - C Acute myocardial infarction - D

A diagnosis of Influenza most closely fits which of the following descriptions: a. Fever 101.5 or greater, severe sore throat, sudden onset, no cough or rhinorrhea, other family members ill with sore throat. b. Low grade fever to 104, onset 1-2 days after other cold symptoms, has 2 of the following: cough, rhinorrhea, conjunctivitis, hoarseness. c. Sudden onset of fever of 100-104, systemic complaints of myalgia, cough, rhinorrhea, and sore throat present.

Sudden onset of fever of 100-104, systemic complaints of myalgia, cough, rhinorrhea, and sore throat present.

A 17-year-old woman presents with her parents to her primary care provider. She desires to utilize a tanning facility ahead of an upcoming event. Her parents have heard that this is a dangerous practice, although the tanning facility insists it is safe without risk of skin cancer in the future after tanning. Which of the following is true regarding ultraviolet (UV) light exposure and subsequent risk of skin cancer? a. tanning beds and sunlamps do not increase risks of skin cancer as they utilize UV wavelengths that are not carcinogenic b. sunscreen with a sun protective factor (SPF) of 15 blocks -50% of UV-B light c. targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors d. water-resistant sunscreens confer no advantage over water-soluble products e. chronic sun exposure confers greater risk for skin cancer than intermittent intensive exposure

Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors

A clinician, evaluating a patient for valvular competency in the communicating veins of the saphenous system, starts with the patient supine, then elevates one leg to about 90 degrees to empty it of venous blood. Next, the great saphenous vein in the upper part of the thigh is occluded with manual compression, and the patient stands. The clinician keeps the vein occluded while watching for venous filling in the leg. Which test is being performed? a. Trendelenberg b. Ankle-brachial index c. Straight leg raise d. Allen e. Romberg

Trendelenberg

A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother, who convinced the patient to attend the clinic after he disclosed that he prefers homosexual partners but is afraid his last partner may have given him an infection. The patient expresses to the intake nurse that he is unashamed of his sexual orientation and will not stay through the visit if he feels that he is dismissed or discriminated against because of it. The nurse practitioner receives this communication prior to entering the examination room and decides to employ active listening to best connect with the patient at this critical conjuncture in his care with the clinic. Which of the following is an example of an active listening technique? a. setting aside the patient's emotional state to focus on his medical needs b. considering a differential diagnosis while the patient is speaking to maximize the patient's time with the provider c. paring down the patients concerns to concrete medical needs d. ignoring the visual clues to focus on the patient's exact words e. using nonverbal communication to encourage the patient to expand their narrative

Using nonverbal communication to encourage the patient to expand their narrative

What is responsible for the inspiratory splitting of S 2? a. closure of aortic then pulmonic valves b. closure of mitral then tricuspid valves c. closure of aortic then tricuspid valves d. closure of mitral then pulmonic valves

closure of aortic then pulmonic valves

Epiglottis requires: a. outpatient treatment with antibiotis b. immediate referral to ER c. a careful and thorough exam of the mouth and pharynx

immediate referral to the ER

A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is involved based on the location of the murmur? a. mitral b. tricuspid c. aortic d. pulmonic

mitral

A 58-year-old teacher presents to your clinic with a complaint of chest pain. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems? a. abdominal pain b. hematochezia c. orthopnea d. tenesmus

orthopnea

A newborn baby has an embryologic defect affecting the aortic valve. What other cardiac valve is most likely to be affected? a. tricuspid valve b. pyloric valve c. mitral valve d. pulmonic valve e. eustachian valve

pulmonic valve

The components of the health history include all of the following except: a. review of systems b. thorax and lungs c. present illness d. personal and social items

thorax and lungs

A 42-year-old female mathematician presents for follow up care regarding a new diagnosis of systemic lupus erythematosus 6 months ago after a lengthy diagnostic process during which she was debilitated with fatigue and joint pain. Since her diagnosis, she has been minimally compliant with medications and has switched her rheumatology provider twice. She continues to feel ill, and, in explanation for her lack of adherence to the prescribed treatment, she simply says, "I don't like it." At this initial visit with her third rheumatology provider, the clinician elects to explore the issues behind her noncompliance before engaging in diagnostics and treatment using the FIFE model. Which of the following best describes the elements of the FIFE model? a. Feelings, Impression, Fantasy, and Emotion b. Focus, Intensity, Function, and Evaluation c. Facts, Intensity, Focus, and evidence d. Facts, Intelligence, Fortuity, and Eventuality e, Feelings, Ideas, Function, and Expectations

Feelings, Ideas, Function, and Expectations

A 16-year-old boy is brought to the Emergency Department (ED) after a motor vehicle accident for shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a pneumothorax on the right side. The ED physician decides that a chest tube needs to be placed in the fourth intercostal space. How does he determine where the fourth intercostal space is? a. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to the second intercostal space, third rib, third intercostal space, fourth rib and then fourth intercostal space. b. He finds the angle of Louis and then moves his finger laterally to the third rib. The fourth intercostal space is just below the third rib. c. He finds the suprasternal notch and then moves his finger laterally to the third rib. The fourth intercostal space is just below the third rib. d. He finds the angle of Louis and then moves laterally to the first rib. He walks down from there to the fourth intercostal space. e. He finds the clavicle. The second intercostal space is just below the clavicle. He then walks down to the third rib, third intercostal space, fourth rib and then fourth intercostal space.

He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to the second intercostal space, third rib, third intercostal space, fourth rib and then fourth intercostal space.

A 59-year-old unemployed man complains of almost always feeling tired and hungry, despite getting sufficient rest and having a good appetite and access to sufficient food. The patient is obese and, despite the warm weather outside, wearing thermal socks with his sandals. He says this is because his feet are always cold and "feel funny." With which body system should the clinician begin the examination? a. nervous system b. abdomen c. Head and neck d. posterior thorax e. lower extremeties

Head and neck

A concerned mother brings her 9-year-old daughter to the clinic with several days of a diffuse rash on the trunk. The child was previously healthy and is current on her vaccinations. The mother relates a history of decreased appetite, easy fatigue, and low-grade subjective fevers. On examination, temperature is recorded at 100.5F, the rash is confirmed as described by the mother, and additional physical findings of a strawberry tongue and erythema of the palms and soles are noted. Non painful peeling of the skin of the child's fingertips is noted incidentally. Based on the history and physical findings, which is the most likely diagnosis and course of action? a. contact dermatitis, for which antihistamines are indicated b. measles, for which review of the vaccination history is critical c. Kawasaki disease, for which close monitoring and possible hospitalization may be required d. non-specific viral exanthem, for which observant management is advised e. strep throat, for which amoxicillin is indicated

Kawasaki disease, for which close monitoring and possible hospitalization may be required

Knowing that the rapid strep test has an average sensitivity of 75 to 85 % and specificity 95 to 98 %, what should you do if the test is negative? a. culture for Group A Beta hemolytic strep b. tell the patient they do not need antibiotics c. treat the patient with Pen VK or amoxicillin for 10 days

culture for Group A Beta hemolytic strep

A 55-year-old truck driver with obstructive sleep apnea has diastolic heart failure. An echocardiogram demonstrates significant biatrial enlargement. What portion of his electrocardiogram would likely be abnormal? a. S wave b. T wave c. R wave d. P wave e. QRS complex

P wave

A first-year medical student is examining a standardized patient with a structurally normal heart. The student is having difficulty auscultating the splitting of the second heart sound. At what area on the patient's chest would the student have the best opportunity of hearing this sound? a. mid-sternum b. lower left sternal border c. right second interspace d. apex e. left second and third interspace

left second and third interspace

A 54-year-old female dietician presents for a routine annual examination. On review of systems, she reports that she has had many breast findings over several years, including one biopsy with normal pathology. She feels that her breasts have become far less lumpy since she underwent menopause 3 years ago. Which of the following is true regarding changes in the breasts with menopause? a. mammography performs most poorly in the menopausal and post-menopausal age group and should be limited for that reason b. glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of lobules c. breast density has no genetic component and is entirely due to estrogen dose from endogenous and exogenous sources over the lifetime d. estrogen in hormone replacement therapy (HRT) has no effect on breast density after menopause e. transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity and specificity of mammograms.

glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of lobules

STEMI myocardial infarction is suspected in what location of the heart? a. anterior wall myocardial infarction b. inferior wall infarction c. pericarditis d. lateral wall myocardial infarction

inferior wall infarction

A 31-year-old day care worker presents with a worsening stiff, painful neck. On inspection, the patient's head is laterally deviated toward the shoulder and rotated. At this point of the examination, what is the most likely diagnosis? a. osteoarthritis b. thoracic kyphosis c. spondylolisthesis d. ankylosing spondylitis e. torticollis

torticollis

Oral malignancies are most likely to develop: a. on the tongue b. on the soft palate c. under the tongue d. in the buccal cavity

under the tongue

You are beginning the examination of the patient. All of the following areas are important to observe as part of the General Survey except: a. level of consciousness b. signs of distress c. dress, grooming, and personal hygiene d. blood pressure

blood pressure

On routine physical examination, a 40-year-old teacher is found to have a single second heart sound. The most likely explanation for this finding is what? a. the patient has pulmonic stenosis b. the patient has a left bundle branch block c. Auscultation occurred during expiration d. Auscultation occurred during inspiration e. the patient has a right bundle branch block

Auscultation occurred during expiration

A 20-year-old college student is experiencing dyspnea on exertion and palpitations. On cardiac auscultation, the second heart sound is split and fixed on both inspiration and expiration. What is the most likely cardiac condition associated with this finding? a. left bundle branch block b. tricuspid stenosis c. right bundle branch block d. pulmonic stenosis e. atrial septal defect

atrial septal defect

A 62-year-old manual laborer presents to an annual physical examination with concerns about skin cancer screening. He does not have any lesions of concern, but was recently told by a friend that he should have his skin checked by a doctor yearly. What is the best advice for this patient according to the U.S. Preventative Services Task Force (USPSTF) recommendations on skin cancer screening from 2015?

The USPSTF recommends against routine screening for skin cancer due to lack of evidence for this intervention across the general population

A 70-year-old man complains of double vision. Which of the following associated symptoms or signs would be worrying about an underlying neurological problem (as opposed to pathology in the eye)? a. an associated conjunctivitis b. diplopia persisting in the right eye when the left eye is closed c. abnormality in extra-ocular movements on examination d. worsening vision bilaterally on examination e. symptoms of flashing light

abnormality in extra-ocular movements on examination

A 65-year-old overweight male presents at the clinic with hoarseness which has lasted for around 2 months. He thinks it began along with a cold. He is not feeling badly other than frequent heartburn, and he has continued to work as a bartender (for the past 30 years), but he is having difficulty being heard and understood because of his hoarse voice. A diagnosis that is on the differential list includes which of the following? a. environmental allergies b. inhalation of fumes c. acid reflux d. viral infection e. voice strain from bartending and talking amidst loud ambient noise

acid reflux

A 16-year-old male high school student presents with a primary concern of acne. He relates a history of 2 years of moderate mild acne and closed comedones (whiteheads), which have recently worsened such that a classmate started calling him a pirate due to a large pustule that developed at the tip of his nose. He has increasing outbreaks of cyst-like acne as well as a generally poor complexion with pitting and scarring from outbreaks. Which of the following best describes this condition in the adolescent population? a. acne vulgaris is associated with an identified virus for which there is no definitive treatment b. acne vulgaris is always associated with underlying endocrine disorders and/or pituitary dysfunction c. acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as well as other contributory factors d. the primary hormonal stimulus for acne vulgaris is estrogen, causing preferentially worse cases in females and males with lower testosterone levels. e. acne vulagris affects <50% of the adolescent population

acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as well as other contributory factors

A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin,covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? a. actinic keratosis b. seborrheic keratosis c. basal cell carcinoma d. squamous cell carcinoma

actinic keratosis

The CAGE questionnaire is a short screening examination administered in the office to evaluate for which of the following? a. alcohol misuse b. risk for illicit substance abuse c. bipolar disorder d. major depressive disorder e. likelihood that the patient complaints are "psychosomatic"

alcohol misuse

A 28-year-old male business executive presents to the primary care provider with concerns about hair loss. He is otherwise healthy without chronic medical conditions or current medications. He has a chart history of allergy to sulfa medications, although this happened when he was a young child, and he does not recall the incident or the reaction. He is unsure at what age his father went bald, as he never remembers his father having hair. He remarks jokingly that he is losing more hair than his dogs at home, who shed frequently but are otherwise healthy. On examination, he has a single uniform oval patch of hair loss over the left temporal area without any scaling, inflammation, or other skin changes where the hair is missing. Which of the following is the most likely explanation for his hair loss? a. alopecia areata, as evidence by patchy hair loss without associated changes b. drug rash, as evidence by his allergy to sulfa drugs c. trichotillomania, as evidence by his anxiety and need to diffuse uncomfortable situations with inappropriate humor d. tinea capitis, as evidenced by his exposure to animals that may carry this pathogen e. male pattern baldness, as evidenced by his father's baldness at a young age

alopecia areata, as evidence by patchy hair loss without associated changes

A thin, 58-year-old patient complains of lower back pain for years, the clinician finds that the patient has tenderness over the sacroiliac area. Which of the following conditions is most consistent with this physical sign? a. osteoporosis b. ankylosing spondylitis c. torticollis d. malignancy e. infection

ankylosing spondylitis

A 13-year-old girl is brought in by her mother to the clinic one day before the start of eighth grade because of a 3-day history of episodes of shortness of breath. When she gets the shortness of breath, she also notices tingling around her lips. She has no fever, cough, sputum production, or chest pain. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Cardiac, lung, and extremity examinations show no abnormalities. Which of the following is the most likely diagnosis? a. anxiety b. left-sided heart failure c. pneumonia d. aspiration of a foreign body e. asthma

anxiety

A 77-year-old man is experiencing progressive shortness of breath and dizziness. The patient undergoes cardiac catheterization, and the systolic blood pressure measured in the left ventricle is 180mm Hg, while the systolic blood pressure measured in the aorta is 140mm Hg. The patient is most likely experiencing symptoms related to what valvular condition? a. pulmonic stenosis b. mitral regurgitation c. aortic insufficiency d. aortic stenosis e. mitral stenosis

aortic stenosis

You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse or increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse? a. hypothyroidism b. aortic stenosis, with pressure overload of the left ventricle c. mitral stenosis, with volume overload of the left atrium d. aortic regurgitation, with volume overload of the left ventricle

aortic stenosis, with pressure overload of the left ventricle

A 72-year-old retired woman presents to a primary care provider for evaluation of a suspicious mole. She noticed this lesion 3 weeks ago on her right flank in an area where she had previously seen no abnormality. She is very concerned about melanoma and asks if this could be a possible diagnosis and also wonders if this should have been noticed at her annual examination 7 months ago. Concerning the initial recognition of melanoma, which of the following is true? a. approximately 50% of melanomas are initially noticed by patients, then brought to the attention of a practitioner b. general screening programs conducted by medical facilities identify -75% of melanomas c. asymmetry of a mole is rarely associated with melanoma d. the majority of melanomas are recognized during an annual physical examination e. most melanomas are initially identified in individuals with positive family histories by DNA analysis for causative genes

approximately 50% of melanomas are initially noticed by patients, then brought to the attention of a practitioner

A 21-year-old college senior presents to your clinic complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is only significant for seasonal allergies, for which she takes a nasal steroid. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On exam she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat exam are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and a high-pitched hissing on expiration in all lobes. Percussion reveals resonant lungs. Which disorder of the thorax or lung does this best describe? a. spontaneous pneumothorax b. COPD c. asthma d. pneumonia

asthma

After examining a patient who is in the hospital for shortness of breath, the clinician records the following for lung examination: "There is dullness to percussion over the right lung base. Breath sounds are absent at the right lung base. There are no crackles, wheezes, or rhonchi. There are no transmitted voice sounds." Which of the following is the most likely diagnosis? a. atelectasis b. pneumonia c. left-sided heart failure d. COPD e. pneumothorax

atelectasis

When assessing for the femoral pulse, where should the clinician begin deeply palpating? a. above the inguinal ligament, just medial to the anterior superior iliac spine b. below the inguinal ligament, just lateral to the symphysis pubis c. above the inguinal ligament, just lateral to the symphysis pubis d. below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis e. blow the inguinal ligament, just medial to the anterior superior iliac spine

below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis

A 63-year-old nurse comes to your office upset because she has found an enlarged lymph node under her right arm. She states she found it last week while taking a shower. She isn't sure if she has any breast lumps because she doesn't know how to do self- breast exams. She states her last mammogram was 5 years ago and it was normal. Her past medical history is significant for high blood pressure and chronic obstructive pulmonary disease. She quit smoking 2 years ago after a 55-pack a year history. She denies any illegal drugs and drinks alcohol rarely. Her mother died of a heart attack and her father died of a stroke. She has no children. On exam you see an older female appearing her stated age. On visual inspection of her right axilla you see nothing unusual. Palpating this area you feel a 2 cm hard fixed lymph node. She denies any tenderness. Visualization of both breasts is normal. Palpation of her left axilla and breast is unremarkable. On palpation of her right breast you feel a non tender 1 cm lump in the tail of Spence. What disorder of the axilla is most likely responsible for her symptoms? a. lymphadenopathy of infectious origin b. hidradenitis suppurativa c. breast cancer

breast cancer

A 72-year-old woman presents with concerns about several ruby-red spots on her chest and abdomen. She reports that these are growing in both size and number over time. On examination, the provider notes a number of cherry angiomas at the locations indicated by the patient. No other abnormalities are noted. Which of the following best describes the clinical characteristics and significance of a cherry angioma? a. cherry angiomas are a marker for underlying pathology that requires additional evaluation b. cherry angiomas never show blanching under pressure c. cherry angiomas are associated with liver disease and B vitamin deficiencies d. cherry angiomas are benign and may increase in size and number with aging e. cherry angiomas rarely occur on the trunk and are most often noted on the legs near veins

cherry angiomas are benign and may increase in size and number with aging

A young adult patient presents to the clinic stating that something is wrong as he looks in the mirror and sees that his shoulders are uneven. He fractured his left arm 8 weeks ago and remains in a cast. He noticed the uneven shoulders over the last week. Upon inspection, his shoulder heights are unequal and there is winging of the scapula. As the examination continues, which of the following maneuvers would confirm a likely diagnosis? a. check for listing of his trunk b. compare the strength of his trapezius muscles c. assess his ability to touch his toes d. assess the lateral bending movement of his neck e. assess his ability to extend his back

compare the strength of his trapezius muscles

What symptom is usually not indicative of strep throat? a. fever b. pharyngeal exudates c. lymphadenopathy d. cough

cough

A 73-year-old retired salesman presents to the Emergency Department complaining of chest pain that started about 2 hours ago. Electrocardiogram, cardiac enzymes, and chest x-ray are normal. The nurse notes that his blood pressure in the right arm are significantly lower than of blood pressures in his left arm. Based on history and physical examination, which of the following will most likely explain his signs and symptoms? a. pulmonary embolism (PE) b. myocardial infarction (MI) c. pericarditis d. coarctation of the aorta e. dissecting aortic aneurysm

dissecting aortic aneurysm

The clinician is palpating pulses in the foot of a diabetic patient while in the clinic. A strong pulse is felt located on the dorsum of the foot, just lateral to the extensor tendon of the big toe. Which artery is being assessed? a. posterior tibial b. dorsalis pedis c. femoral d. popliteal e. arterial arch of the foot

dorsalis pedis

A 32-year-old cab driver complains of pain in his left leg. He has a history of type 2 diabetes, is a smoker, and was recently diagnosed with hypertension. He does not remember injuring his leg; however, he notes that there is a small wound on the lateral aspect of his mid-shin. Upon examination, some mild erythema surrounding the wound and flat, nonpalpable red streaks progressing up his leg are noted. What do these streaks likely represent? a. occluded arterial vessels b. dilated arterioles c. dilated veins secondary to incompetent valves d. draining lymphatic channels e. thrombus formation in a superficial vein

draining lymphatic channels

You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism? a. moist and smooth b. moist and rough c. dry and smooth d. dry and rough

dry and rough

A 33-year-old nurse presents with a history of weight gain, decreased energy, and menorrhagia over the past several months. Review of her family history reveals Hashimoto thyroiditis and hypothyroidism in four female first-degree relatives (her mother and three sisters). Which of the following skin findings best supports a diagnosis of clinical hypothyroidism? a. thickened, taut skin with sclerodactyly and telangiectasia b. warm moist skin, hyperpigmentation, and pretibial myxedema c. spider angiomas, telangiectasia, palmar erythema, and terry nails d. discoid rash, alopecia, oral ulcers, and Reynaud phenomenon e. dry skin, myxedema, alopecia of the eyebrows, and brittle nails

dry skin, myxedema, alopecia of the eyebrows, and brittle nails

A 39-year-old architect comes to the clinic for a 2-day history of fever, chills, cough productive of green sputum, and dyspnea. He has no history of serious illness. His temperature is 101.2F. His other vital signs are within normal limits. Late inspiratory crackles are heard on auscultation over the left lower lung posteriorly. When the clinician listens over that area and instructs the patient to say "ee", it sounds like "A". Which of the following would most likely be found on percussion of his lungs? a. hyperresonance b. tympany c. dullness d. flatness e. stridor

dullness

A 19-year-old carwash attendant sustained a laceration to the ulnar aspect of his mid-forearm while at work last week. He did not have it evaluated at that time and is now noticing purulent discharge and increasing pain from the wound along with fever and chills. Where would the clinician expect to find the first signs of lymphadenopathy? a. infraclavicular nodes b. central axillary nodes c. epitrochlear nodes d. lateral axillary nodes e. cervical chain nodes

epitrochlear nodes

A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? a. ptosis b. exopthalmos c. ectropion d. epicanthus

exopthalmos

During a musculoskeletal examination of the spine, what is the action(s) of the erector spinae muscle group? a. extension of the spine b. rotation of the spine c. flexion of the spine d. lateral bending of the spine e. rotation and lateral bending of the spine

extension of the spine

The clinician is seeing a middle-aged patient who has a diagnosis of lumbar spinal stenosis. The patient's history is consistent with this diagnosis as he has pain in the back with walking that improves with rest. Which physical sign(s) are most consistent with his diagnosis? a. positive straight-leg raise b. pelvic tilt or drop c. thoracic kyphosis d. hyperreflexia of the lower limb e. flexed forward posture with lower extremity weakness

flexed forward posture with lower extremity weakness

A 70-year-old patient has suspected chronic obstructive pulmonary disease. The clinician instructs the patient to take a deep breath in, and then with is mouth open, breathe out as fast and completely as he can. For what is the clinician checking? a. tactile fremitus b. forced expiratory time c. egophony d. whispered pectoriloquy e. bronchophony

forced expiratory time

A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis? a. dacryocystitis b. chalazion c. hordeolum d. xanthelasma

hordeolum

A patient that has a known history of cardiovascular disease including a myocardial infarction and positive ankle-brachial index indicating peripheral arterial disease in his left leg is now having some issues with erectile dysfunction (ED). The clinician suspects it may be due to medications or further vascular disease. He does not complain of any other symptoms. If his symptoms are related to vascular disease, where would the lesion likely be located? a. superficial femoral b. popliteal c. common femoral d. aortorenal e. iliac pudendal

iliac pudendal

A physician assistant (PA) has had a long day and has seen many patients. The last patient of the day is an 80-year-old woman brought to the office by her 35-year-old granddaughter. This is the patient's first visit to the office. As part of the patient's past history, the PA obtains information about childhood illnesses and adult illnesses and then moves on to inquire about the family history. Which important area of the past history has she omitted? a. social history b. allergies c. chief complaint d. immunizations e. medications

immunizations

You are evaluating a 57-year-old army veteran as part of the heart failure (HF) clinic. You palpate a heave on examination. Which of the following conditions could be responsible for creating this finding? a. left ventricular hypertrophy b. atrial septal defect c. tricuspid stenosis d. tricuspid regurgitation

left ventricular hypertrophy

A 43-year-old store clerk comes to your office upset because she has found an enlarged lymph node under her left arm. She states she found it yesterday when she was feeling pain under her arm during movement. She states the lymph node is about an inch long and is very painful. She checks her breasts monthly and gets a yearly mammogram (her last was 2 months ago) and until now everything has been normal. She states she is so upset because her mother died in her 50s of breast cancer. The patient does not smoke, drink, or use illegal drugs. Her father is in good health. On exam you see a tense female appearing her stated age. On visual inspection of her left axilla you see a tense red area. There is no scarring around the axilla. Palpating this area you feel a 2 cm tender movable lymph node underlying hot skin. Other shoddy nodes are also in the area. Visualization of both breasts is normal. Palpation of her right axilla and both breasts is unremarkable. Examining her left arm you see a scabbed-over superficial laceration over her left hand. Upon your questioning she remembers she cut her hand gardening last week. What disorder of the axilla is most likely responsible for her symptoms? a. breast cancer b. lymphadenopathy of infectious origin c. hidradenitis suppurativa

lymphadenopathy of infectious origin

A 66-year-old female museum curator presents for a routine annual examination. On examination, a notably enlarged supraclavicular lymph node is appreciated on the right side. The lymph node is nontender and feels firm and rubbery. She denies any localized or systemic symptoms such as breast lumps, fevers, or night sweats. She has been taking conjugated estrogen tablets for 9 years since menopause, though she has not taken progestin compounds since she had a hysterectomy for heavy bleeding at age 45 years. Which of the following is true about this presentation of lymphadenopathy? a. supraclavicular nodes are generally considered benign and require no further evaluation or follow up b. breast cancer always presents with axillary lymphadenopathy because the lymphatics of the breast uniformly drain into the axilla c. firm, rubbery lymph nodes are generally considered to be benign d. supraclavicular nodes are found along the anterior edge of the trapezius muscle in the neck e. metastatic breast cancer cells may spread directly into the infraclavicular and supraclavicular nodes without first causing notable changes in the axillary nodes

metastatic breast cancer cells may spread directly into the infraclavicular and supraclavicular nodes without first causing notable changes in the axillary nodes

You are performing a cardiac examination on a patient with shortness of breath and palpitations. You listen to the heart with the patient sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position? a. aortic b. pulmonic c. tricuspid d. mitral

mitral

A patient with cystic fibrosis (CF) has been complaining of fullness in his left nasal cavity. Examination of his nose using an otoscope and a speculum reveals a normal nasal septum, but a pale, scalike growth of inflamed tissue that is obstructing a large part of the nasal cavity. What is the most likely diagnosis? a. nasal polyp b. allergic rhinitis c. ulcer d. viral rhinitis e. deviated nasal septum

nasal polyp

A 65-year-old retired pilot visits the clinic because of recurrent headache. The patient reports dizziness of recent onset (previous 2 weeks) and occasional numbness on the left side. Which of the following systems or regions should be examined in the clinician's focused assessment? a. musculoskeletal b. nervous c. cardiovascular d. respiratory e. gastrointestinal

nervous

A 68-year-old retired administrative assistant complains of a 3-month history of recurring pain after ambulating that radiates from her back in the upper lumbar region into both buttocks, bilateral thighs, and mid-calf region. Her pain is typically improved by sitting or by leaning forward. The origin of her pain is likely secondary to which of the following? a. venous stasis b. abdominal aortic anuerysm c. neurogenic claudication d. peripheral arterial disease (PAD) e. acute arterial occlusion

neurogenic claudication

The clinician is seeing a 58-year-old patient with a diagnosis of arthritis. The patient complains of pain in his knees, hips, hands, wrists, neck, and low back. Based on which joints are involved, the patient most likely has which joint problem? a. osteoarthritis b. psoriatic arthritis c. polymyalgia rheumatica d. rheumatoid arthritis e. gout

osteoarthritis

You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between the jugular venous pulsation and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse? a. palpable b. soft, rapid, undulating quality c. pulsation eliminated by light pressure on the vessel d. level of pulsation changes with changes in position

palpable

A 29-year-old waiter comes to the clinic for a 2-month history of a cough. When he lowers his gown so the clinician can listen to his lungs, the clinician notices a depression on the lower part of his sternum. Which of the following best describes the appearance of his chest? a. thoracic kyphoscoliosis b. barrel chest c. flail chest d. pectus excavatum e. pigeon chest

pectus excavatum

A 35-year-old G0P0 woman presents to the clinic with a complaint of bilateral nipple discharge. The discharge started several weeks ago and has occurred at irregular intervals since that time. She does not complain of local tenderness, redness, fever, or any other systemic symptoms aside from slightly irregular periods over the last few months. On examination, she is able to express a small amount of discharge, which is sent to the laboratory and found to be consistent with breast milk but without any signs of blood or pus. Screening laboratories are also sent, which reveal a normal blood count, metabolic panel, thyroid-stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories are still pending. Which of the following is the most likely diagnosis? a. prolactinoma b. paget disease of the breast c. occult pregnancy d. mastitis e. ductal carcinoma in situ

prolactinoma

A 67-year-old lawyer comes to your clinic for an annual examination. He denies any history of eye trauma. He denies any visual changes. You inspect his eyes and find a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. He has a normal papillary reaction to light and accommodation. Based on this description, what is the most likely diagnosis? a. corneal arcus b. cataracts c. corneal scar d. pterygium

pterygium

A 61-year-old retired librarian was recently diagnosed with ovarian cancer. She was otherwise healthy until her recent cancer diagnosis. She has not been feeling well lately and has had a cough and some mild shortness of breath for the past couple of days. She now presents to the clinic complaining of pain and swelling in her right groin and leg, which she says has been there for about a week but is worsening. On physical examination, 2+ edema of the right leg up to the thigh; 1+ femoral, popliteal, dorsalis pedis, and posterior tibial pulses; and no significant erythema are noted. What is the chief concern with this patient? a. ovarian metastasis b. acute arterial occlusion c. acute lymphangitis d. pulmonary embolism (PE) e. superficial thrombophlebitis

pulmonary emobolism (PE)

An elderly patient with a history of smoking two packs of cigarettes a day for 50 years complains to her physician of progressive shortness of breath. On cardiac examination, the physician feels the most prominent palpable impulse to be in the xiphoid area. This is most likely a result of what condition? a. aortic stenosis b. pulmonary hypertension c. mitral regurgitation d. hypertrophic cardiomyopathy e. hypertension

pulmonary hypertension

A 62-year-old patient presents in your office. During a routine EKG, new onset atrial fibrillation with a controlled ventricular rate of 88 is found and the patient appears stable. You should: a. have the rhythm stopped by using valsalva or carotid sinus massage b. refer to a cardiologist for evaluation c. work up causes such as anxiety, pain, or fever d. order and echocardiogram and return visit in 2 weeks

refer to a cardiologist for evaluation

A 74-year-old man is being seen because of a 1-day history of a painful right eye. He also mentions that he has blurred vision in that eye. He thought something had blown into his eye, but after flushing it out, the pain and blurred vision remains. What is the best course of action? a. check his blood pressure b. refer to an ophthalmologist emergently with the possibility of corneal ulcer, uveitis, or acute glaucoma c. perform a complete neurological examination d. perform a vision examination e. reassure him that pain from a foreign body can remain for a day or two (even after the foreign body is removed)

refer to an ophthalmologist emergently with the possibility of corneal ulcer, uveitis, or acute glaucoma

A 70-year-old retired business executive presents to the Emergency Department with progressive shortness of breath and two-pillow orthopnea. On physical examination, the blood pressure is 145/90 mm Hg, there is jugular venous distention, lower extremity pitting edema to the knee, and a blowing holosystolic murmur heard best at the lower left sternal border. No other murmurs or thrills are auscultated on physical exam. Which of the following interventions is most likely to improve the patient's symptoms? a. removal of intravascular volume with diuresis b. repair of a ventricular septal defect c. replacement of the aortic valve d. replacement of the mitral valve e. decrease in blood pressure

removal of intravascular volume with diuresis

A 52-year-old male presents for an annual examination. He discloses on review of family history that his father has died of skin cancer since his last visit. He personally has to actinic keratoses frozen and has further lesions that require evaluation today. He is very concerned about his personal and family history and would like to know more about the potential for skin cancer to spread and become a dangerous condition. Which of the following skin lesions is the least likely to metastasize? a. basal cell carcinoma (BCC) b. seborrheic keratosis c. squamous cell carcinoma d. melanoma e. actinic keratosis

seborrheic keratosis

A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wart-like texture on palpation. Based on this description, what is your most likely diagnosis? a. actinic keratosis b. seborrheic keratosis c. basal cell carcinoma d. squamous cell carcinoma

seborrheic keratosis

A 42-year-old female website developer presents for an annual preventive examination with questions about breast cancer screening. She is concerned about the radiation exposure associated with mammography and is interested in magnetic resonance imaging (MRI) as a possible alternative for routine screening. She is otherwise healthy with no family history of breast, ovarian, or colon cancer. Which of the following is true about MRI as a screening modality for breast cancer in the general population? a. the patient is an ideal candidate for screening via breast MRI based on current evidence b. known BRCA1 or BRCA2 mutation is insufficient criteria to justify screening with a breast MRI c. breast cancer screening by MRI has been well studied in the general population d. sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity e. women at low lifetime risk of breast cancer (<20%) are recommended to undergo screening MRI

sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity

Apthous ulcers are: a. caused by coxsackievirus small grayish spots then ulcers less than 5 mm. b. gingiva that is inflamed and ulcerated and spreads to post pharynx. c. shallow ulcers on the buccal mucosa d. vesicles that can involve pharynx

shallow ulcers on the buccal mucosa

A 44-year-old retail salesperson has noticed an increasing dilation of the veins in her legs. Upon inspection, it is noted that she has significant variscosities on the posterior aspects of both legs which begin in the lateral side of the foot and pass upward along the posterior calf. The remainder of the veins in the legs appears normal at this time. Which veins are currently affected? a. femoral b. small saphenous c. perforating d. dorsal venous arch e. great saphenous

small saphenous

During a musculoskeletal examination, the clinician instructs the patient to look over one shoulder, and then the other shoulder. This action assesses the movement of which muscle(s)? a. sternocleidomastoid b. scalenes c. prevertebral muscles d. splenius capitis e. splenius cervicis

sternocleidomastoid

During an evaluation of an athletic 30-year-old patient, the clinician conducts an active range of motion evaluation at the neck. Which muscle is being assessed when the patient is asked to flex the neck? a. splenius capitis b. trapezius c. sternocleidomastoid d. sacrospinalis e. splenius cervicis

sternocleidomastoid

A clinician is percussing the lungs of a patient with chronic obstructive pulmonary disease to see if they sound hyperresonant. Which of the following is an example of good technique for percussion? a. strike using the finger pad of the fourth finger b. strike using the tip of the third finger c. the proximal interphalangeal joint is the joint that is struck d. the wrist is kept still during percussion e. put the third and fourth fingers next to each other on the chest

strike using the tip of the third finger

A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis? a. subconjunctival hemorrhage b. conjunctivitis c. corneal abrasion d. acute iritis

subconjunctival hemorrhage

A 48-year-old female psychologist presents to the clinic with concerns about her breast cancer risk after an age-matched cousin was recently diagnosed with this disease. This cousin is the third family member on her father's side in as many years to be diagnosed with breast cancer, including the patient's own father, who had surgery and subsequent treatment 3 years ago for breast cancer. The patient has little knowledge of her family history, only that her grandparents independently arrived from Eastern Europe near the end of World War II and were among very few family members of their family that survived the war. The patient has been reading about testing for the breast cancer genes (BRCA1 and BRCA2) and desires further information about whether this would be appropriate for her. Which of the following is true about this patient's indications for BRCA testing? a. breast cancer in a male relative does not add significant weight to the decision to test for the BRCA genes in this patient b. the BRCAPRO calculator does not add any further clinical information to this patient's risk for carrying the BRCA gene c. her familial lineage is irrelevant to her risk of BRCA genes and should be discounted in assessing her risk for these genes d. this patient carries several risk factors that together justify BRCA testing e. Even if this patient is BRCA positive, no changes in screening or treatment are recommended for patients with this genetic mutation, so the test is not recommended

this patient carries several risk factors that together justify BRCA testing

A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-examination (BSE) at home. The mass is nontender without skin changes, erythema, or overlying swelling. She has heard that most breast cancers are found by patients themselves, and she is very concerned that she may have breast cancer. Which of the following is true about BSE and self-detection of breast cancer? a. this patient is more likely to find a fibroadenoma than a cancer on self-examination b. BSE is universally recommended because of very high sensitivity and specifity for finding cancerous lesions c. because of this patient's age, breast masses should not be pursued with imaging and diagnosis because the risk of cancer is so low d. the most likely breast mass this patient is likely to find in herself is an abscess complicating underlying mastitis e. most masses that women find at home and bring to a provider's attention turn out to be malignant

this patient is more likely to find a fibroadenoma than a cancer on self-examination

A 44-year-old female mathematician presents to the clinic with a complaint of a mass in the right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty because she has only had one mammogram and does not engage in breast self-examination (BSE) on a regular basis. She has no family history of breast cancer, and her prior mammogram was ordered as a routine screening test at age 43 years after a brief discussion with her primary care provider. After a throrough investigation reveals a benign cyst, what advice should be given to this patient about screening for breast cancer in her age group? a. BSE is well evidenced, and all recommending agencies agree that it should be taught and reinforced b. clinical breast exam (CBE) is superior to BSE and should be a routine part of annual examinations starting at age 30 c. breast cancer screening is extremely well studied, and no controversy exists on the recommended norms for screening and follow up d. mammography is the most sensitive and specific for women in their 40s, when breast tissue is still dense enough to image accurately e. this patient was in compliance with the U.S. Preventative Services Task Force (USPSTF) recommendations for her age group and risk factors prior to her current complaint

this patient was in compliance with the U.S. Preventative Services Task Force (USPSTF) recommendations for her age group and risk factors prior to her current complaint

You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur? a. upright b. upright, but leaning forward c. supine d. left lateral decubitus

upright, but leaning forward

An obese 50-year-old patient presents with a long history of back trouble. What structure in the spine supports the body's weight? a. vertebral body b. intervertebral disk c. transverse process d. vertebral arch e. spinous process

vertebral body