NURS 5220: Exam #1 Module 2: Ch 9, 10, 11, 12, 14, 15, 16

Which of the following are functions of the skin (select all that apply)? A. Secrete sweat, urea, and lactic acid B. Produce vitamin C from precursors in the skin C. Contribute to blood pressure regulation by dilation of skin blood vessels D. Protect against microbial/foreign substance invasion and minor physical trauma

A, C, D The skin is the first layer of protection against microbial/foreign substance invasion and minor physical trauma. It excretes sweat, urea, and lactic acid, and it contributes to blood pressure regulation through constriction of skin blood vessels.

Mrs. Cousins is a 35-year-old patient who presents to your clinic. Your diagnosis is acute cervical lymphadenitis. Which of the following is the most likely etiology? A. Group A β-hemolytic strep B. Pneumocystis carinii infection C. Milroy disease D. Infectious mononucleosis

A: CorrectAcute lymphadenitis is infection and inflammation of a lymph node. Group A β-hemolytic streptococci and coagulase-positive staphylococci are the most common causes of the infection.

You are completing a fundoscopic examination on a 28-year-old patient. When examining the right eye with the ophthalmoscope, the examiner should use which hand to hold the ophthalmoscope? A. Right B. Left C. Dominant D. Nondominant

A: CorrectWhen using the ophthalmoscope, examine the patient's right eye with your right eye and the patient's left eye with your left. Hold the ophthalmoscope in the hand that corresponds to the examining eye.

You are examining a patient who presented with a complaint of shortness of breath. What direction do you give the patient to enable you to distinguish between a respiratory friction rub and a cardiac friction rub? A. Hold your breath. B. Lean forward. C. Say "ninety-nine" while you palpate the anterior chest. D. Turn on your right side.

A: CorrectA friction rub occurs outside the respiratory tree. It has a dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration. It may have a machine-like quality. Over the pericardium, this sound suggests pericarditis; over the lungs, pleurisy. The respiratory rub disappears when the breath is held; the cardiac rub does not.

With which condition should the examiner expect the costal angle to be greater than 90 degrees? A. Enlarged heart B. Pneumothorax C. Infant respiratory distress syndrome D. Atelectasis

A: CorrectA prolonged expiration and bulging on expiration are probably caused by airway outflow obstruction or the valvelike action of compression by a tumor, aneurysm, or enlarged heart. When this happens, the costal angle widens beyond 90 degrees.

Mrs. Jones presents to your office for a complaint of visual disturbances. On examination, you note an abnormal growth of conjunctiva from the limbus over the cornea. Which term best describes this condition? A. Pterygium B. Arcus limbus C. Xanthelasma D. Episcleritis

A: CorrectA pterygium is an abnormal growth of conjunctiva that extends over the cornea from the limbus. It occurs more commonly on the nasal side but may arise temporally as well. A pterygium is more common in people heavily exposed to ultraviolet light. It can interfere with vision if it advances over the pupil.

Mr. Jones brings his child into your clinic for her kindergarten physical. On assessment, you note a jugular venous hum. You are aware that this can be confused with which abnormality? A. Patent ductus arteriosis B. Ventrical septal defect C. Coarctation of the aorta D. Pediatric hypertension

A: CorrectA venous hum, common in children, usually has no pathologic significance. The venous hum can be confused with patent ductus arteriosus, aortic regurgitation, and the murmur of valvular aortic stenosis transmitted into the carotid arteries.

Mr. Lynch is a 46-year-old man who presents to your office for a routine examination. On examination of the corneal light reflex, you notice that there is asymmetry of the reflected light. What should your next step be? A. Perform the cover-uncover test. B. Test for accommodation. C. Evaluate the depth of the anterior chamber. D. Test EOMs.

A: CorrectAn asymmetric light reflex may indicate a true strabismus or hypertelorism. If you find an imbalance with the corneal light reflex test, perform the cover-uncover test or use a strabismoscope or photoscreening to evaluate.

Atelectasis is a condition that occurs: A. at any age. B. mostly during childbirth. C. rarely in older adults. D. strictly from tuberculosis.

A: CorrectAtelectasis is the incomplete expansion of the lung at birth or the collapse of the lung at any age.

Mr. Venturi is a 55-year-old marathon runner who presents to your office with a complaint of many days of fever, shortness of breath, and some chest discomfort. On examination, you note clinical signs of congestive heart failure. Which disease process should you consider? A. Bacterial endocarditis B. Infarction C. Myocarditis D. Cardiac tamponade

A: CorrectBacterial endocarditis is an infection of the endothelial layer of the heart and valves. It presents suddenly like congestive heart failure, with fever and chest discomfort.

Mrs. Jones is a 34-year-old pregnant patient. For what benign effect of pregnancy are you assessing when you inspect her face hyperpigmentation? A. Chloasma B. Vitiligo C. Cloaca D. Hyperpigmentosa

A: CorrectBeginning after 16 weeks of gestation, many pregnant women develop blotchy, brownish hyperpigmentation of the face, particularly over the malar prominences and the forehead. This chloasma, also called "mask of pregnancy," may further darken with sun exposure, but generally it fades after delivery.

Mrs. Troba is a 68-year-old patient who presents to your office with a complaint of elevated blood pressure. In older individuals, blood pressure tends to become elevated as a result of: A. increased peripheral vascular resistance. B. increased heart rate. C. increased cardiac output. D. significant electrocardiographic (ECG) changes.

A: CorrectCalcification and plaque buildup in the walls of the arteries can cause stiffness as well as dilation of the aorta, aortic branches, and the carotid arteries. The arterial walls lose elasticity and vasomotor tone and are less distensible. The resulting increased peripheral vascular resistance may lead to elevated blood pressure, especially systolic.

Mr. Black is a 66-year-old patient with a history of herpes simplex. He presents to your office with a concern of visual disturbances. Which of the following would explain why this individual may be unaware of an infection or injury to an eye? A. Decreased corneal sensitivity B. Diminished tearing C. Reduced visual acuity D. Increased density of the lens

A: CorrectDecreased corneal sensation is often associated with diabetes and herpes simplex and herpes zoster viral infections and after trigeminal neuralgia surgery.

Which examination finding is consistent with emphysema? A. Decreased fremitus B. Dullness with chest percussion C. Trachea in midline position D. An ammonia-like odor on the patient's breath

A: CorrectDecreased fremitus is a condition in which the lungs lose elasticity and alveoli enlarge in a way that disrupts function. Decreased or absent fremitus may be caused by excess air in the lungs or may indicate emphysema, pleural thickening or effusion, massive pulmonary edema, or bronchial obstruction.

Which is a serious risk factor for respiratory disability in older adults? A. Difficulty swallowing B. An environmental temperature below 75°F C. Frequent stair climbing D. A history of skin rashes

A: CorrectDifficulty swallowing for any reason poses a risk factor for any population. Older patients may have more difficulty breathing deeply and holding their breath than younger patients, and they may tire more quickly even when well.

When assessing the lymph nodes of the head, which nodes do you palpate first? A. Occipital B. Preauricular C. Postauricular D. Retropharyngeal

A: CorrectFeel for nodes on the head in the following six-step sequence: (1) occipital nodes at the base of the skull; (2) postauricular nodes located superficially over the mastoid process; (3) preauricular nodes just in front of the ear; (4) parotid and retropharyngeal (tonsillar) nodes at the angle of the mandible; (5) submandibular nodes halfway between the angle and the tip of the mandible; (6) submental nodes in the midline behind the tip of the mandible.

Changes in clarity and volume of spoken sounds during auscultation of the lungs can help you distinguish: A. consolidation from obstruction. B. foreign body from mucous. C. pulmonary edema from pleurisy. D. right from left tracheal deviation.

A: CorrectGreater clarity and increased loudness of spoken sounds are defined as bronchophony. If bronchophony is extreme (e.g., in the presence of consolidation of the lungs), even a whisper can be heard clearly and intelligibly through the stethoscope (whispered pectoriloquy).

During assessment of vocal resonance, you note that sound is intensified, that there is a nasal quality to the voice, and that es sound like as. This is indicative of: A. lung consolidation. B. emphysema. C. bronchial obstruction. D. asthma.

A: CorrectGreater clarity and increased loudness of spoken sounds are defined as bronchophony. If bronchophony is extreme (e.g., in the presence of consolidation of the lungs), even a whisper can be heard clearly and intelligibly through the stethoscope (whispered pectoriloquy).

A gradual symmetric hair loss in males during adulthood occurs as response to: A. elevated androgen levels. B. overactive sebaceous glands in the scalp. C. endocrine disorders. D. decreased circulation/nutritional deficiencies.

A: CorrectHair production is one response to changing androgen levels. Genetically predisposed men often display a gradual symmetric hair loss on the scalp during adulthood as a response to androgens. Asymmetric hair loss may indicate a pathologic condition.

Which finding in a 3-year-old child suggests an obstructive lung disease such as cystic fibrosis? A. Round chest B. Distant breath sounds C. Barking cough D. Abdominal breathing

A: CorrectIf the roundness of the young child's chest persists past the second year of life, be concerned about the possibility of a chronic obstructive pulmonary problem such as cystic fibrosis.

The persistence of a round "barrel" chest in a child past the second year of life may be indicative of: A. a chronic obstructive problem, such as cystic fibrosis. B. delayed growth and development. C. an immature pulmonary system. D. the possibility of developing pectus carinatum.

A: CorrectIf the roundness of the young child's chest persists past the second year of life, be concerned about the possibility of a chronic obstructive pulmonary problem such as cystic fibrosis. The persistence of a barrel chest at the age of 5 or 6 years can be ominous.

Mrs. Tucker is a 34-year-old patient who presents to your office with a complaint of a sore throat. On examination, you find an enlarged thyrolinguofacial lymph node. Which of the following would you assess? A. Area proximal to the enlarged node B. Posterior superficial cervical chain C. Occipital nodes D. Preauricular nodes

A: CorrectIf you discover an enlarged node, consider the associated region drained by the node to suggest possible sources for a presenting problem, as well as explore the accessible adjacent areas and regions drained by those nodes for signs of possible infection or malignancy.

On palpation of an older individual's skin, you observe "tenting." Which of the following would be most appropriate for you to do in regard to this condition? A. Have the individual further evaluated for dehydration. B. Refer the client for punch biopsy of the skin. C. Inform the individual to be especially vigilant in self-screening for skin cancer. D. Observe the skin carefully for other manifestations of loss of skin integrity.

A: CorrectIn the older individual, the skin often appears to hang loosely on the bony frame as a result of a general loss of elasticity, loss of underlying adipose tissue, and years of gravitational pull. You may observe tenting of the skin when testing for turgor. Tenting can be indicative of dehydration. How quickly the tent disappears provides a clue to the degree of dehydration

Physical differences between black and white Americans include which of the following? A. Blacks have a greater incidence of pigmentary demarcation lines. B. Whites have greater stratum lucidum. C. Blacks synthesize reticulum fibers more readily. D. Whites eliminate sweat, urea, and lactic acid more quickly.

A: CorrectIndividuals with dark skin may show pigmentary demarcation lines. These lines, a normal variation, mark the border between deeply pigmented skin and lighter pigmented skin. They are most commonly seen on the arms, legs, chest, and back and have been reported most often in black and Japanese populations.

Antibodies produced by B cells create which of the following type of immunity? A. Humoral immunity B. Immunocompetent immunity C. Effector immunity D. Cellular immunity

A: CorrectLymphocytes that are derived primarily from bone marrow (i.e., B lymphocytes) produce antibodies and are characterized by the various arrangements of immunoglobulins on their surface. They are involved in the humoral immune response.

Mrs. Jones presents with a complaint of a spot on her skin. Which type of lesion can develop in an already present nevi? A. Malignant melanoma B. Squamous cell carcinoma C. Basal cell carcinoma D. Kaposi sarcoma

A: CorrectMalignant melonoma is the most lethal form of skin cancer that develops from melanocytes. Squamous cell carcinoma, basal cell carcinoma, and Kaposi sarcoma rarely develop in an already existing nevi.

Mr. Bowers is a 55-year-old patient who presents to your office. On examination, you note a mass filling the area of the suprasternal notch at the anterior base of the neck; the mass glides upward when the patient swallows. Which condition is consistent with this finding? A. Enlarged thyroid B. Enlarged trachea C. Localized infection D. Tracheal tugging

A: CorrectMarked edema of the neck may be associated with local infections (e.g., cervical lymphadenitis). A mass filling the base of the neck or visible thyroid tissue that glides upward when the patient swallows may indicate an enlarged thyroid.

Which of the following should be used to test for near vision in a 50-year-old patient? A. Rosenbaum Pocket Vision Screener B. Snellen "E" chart C. Confrontation test D. Landolt C

A: CorrectMeasurement of near vision should be tested in each eye separately with a handheld card such as the Rosenbaum Pocket Vision Screener.

Milia in the newborn are caused by which of the following? A. Plugged sebaceous glands B. Inflammation of the sebaceous glands C. Plugged apocrine glands D. Overactive eccrine glands

A: CorrectMilia are small whitish, discrete papules on the face; they are commonly found during the first 2 to 3 months of life. The sebaceous glands function in an immature fashion at this age and are easily plugged by sebum.

In which age group are milia an expected finding? A. Newborns B. Young children C. Adolescents D. Older adults

A: CorrectMilia are small, whitish, discrete papules on the face; they are commonly found during the first 2 to 3 months of life. The sebaceous glands function in an immature fashion at this age and are easily plugged by sebum. Answers b, c, and d are incorrect.

Mrs. Doh presents to your office with her 7-year-old son. Because of his religion, he has not had routine immunizations. You are concerned that he has mumps. Which of the following would help differentiate mumps from cervical adenitis? A. Palpating the angle of the jaw B. Palpating enlarged lymph nodes C. Noting painful lymph nodes D. Noting swelling of the face

A: CorrectMumps, epidemic parotitis, is characterized by a somewhat painful swelling of the parotid glands unilaterally or bilaterally and, occasionally, by swelling and tenderness of the other salivary glands along the mandible. The swelling can obscure the angle of the jaw and may appear on inspection as a cervical adenitis. On palpation, however, the two are easily distinguished. A cervical adenitis does not ordinarily obscure the angle of the jaw. Your fingers can separate the node from the angle so that you can feel the hard sharpness of the bone, a finding generally not associated with parotid swelling.

Mr. Jones is a 72-year-old patient who presents with a complaint of fever and fatigue. On examination, you note tachycardia and pulsus alternans. Of which condition are these signs and symptoms most suggestive? A. Myocarditis B. Left ventricular hypertrophy C. Cardiac tamponade D. Cor pulmonale

A: CorrectMyocarditis is focal or diffuse inflammation of the myocardium. Patients with this disorder may report symptoms of fatigue, fever, palpitations, and dyspnea. The examiner may assess pulsus alternans, tachycardia, gallop rhythms, and cardiac enlargement.

A "rubbing" that can be felt and heard is most closely associated with: A. pleurisy. B. pneumonia. C. emphysema. D. asthma.

A: CorrectPleurisy is an inflammatory process involving the visceral and parietal pleura characterized by patients reporting subjective rubbing of the pleural surfaces.

Retractions are generally associated with: A. obstruction to inspiration. B. increased respiratory rate. C. abdominal breathing. D. thoracic breathing.

A: CorrectRetractions are seen when the chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles, and at the lowest costal margins. This suggests an obstruction to inspiration at any point in the respiratory tract. As intrapleural pressure becomes increasingly negative, the musculature "pulls back" in an effort to overcome blockage. Any significant obstruction makes the retraction observable with each inspiratory effort.

S3 and S4 become a major concern when accompanied by: A. an increase in intensity. B. an increase in heart rate. C. a decrease in blood pressure. D. a decreased intensity of S1 and S2.

A: CorrectS3 and S4 may or may not be present. Their absence is not an unusual finding, and their presence does not necessarily indicate a pathologic condition. Thus, evaluate S3 and S4 in relation to other sounds and events in the cardiac cycle. A loud S4 always suggests a pathologic condition and deserves additional evaluation. Increased intensity of either sound is suspect.

Which finding could indicate an intrathoracic infection? A. Malodorous breath B. Protrusion of the clavicle C. Clubbing of the nail beds D. Kussmaul respirations

A: CorrectSmell the breath; pulmonary infection may make it malodorous.

Mr. Webber is a 53-year-old patient who has a fixed split heart sound. Splitting is said to be fixed when it is unaffected by: A. respiration. B. stroke volume. C. blood pressure. D. heart rate.

A: CorrectSplitting is said to be fixed when it is unaffected by respiration. This occurs with delayed closure of the pulmonic valve when output of the right ventricle is greater than that of the left.

Which of the following is a warning sign of squamous cell carcinoma? A. A persistent scaly red patch B. Shiny nodules that are pearly C. Scarlike area that is white, yellow, or waxy D. An open sore that takes 6 weeks to heal

A: CorrectSquamous cell cancer is the second most common skin cancer. Objective signs include a persistent scaly red patch with irregular borders with or without crusting or bleeding, elevated growth with a central depression, wartlike growth that may or may not have crusting or bleeding, and an open sore that may have crusting.

Which condition is characterized by paroxysmal coughing and inspiratory and expiratory wheezing? A. Asthma B. Emphysema C. Pneumonia D. Pneumothorax

A: CorrectSubjective symptoms of asthma include episodes of paroxysmal dyspnea, as well as objective symptoms of tachypnea, paroxysmal coughing with wheezing on expiration and inspiration.

The anterior triangle is located: A. under the mandible, medial to the sternocleidomastoid muscle. B. between the trapezius and sternocleidomastoid muscle. C. at the base of the clavicle. D. between the cricoid and thyroid cartilages.

A: CorrectThe anterior triangle is formed by the medial border of the sternocleidomastoid muscles, the mandible, and the midline. The posterior triangle is formed by the trapezius and sternocleidomastoid muscles and the clavicle and contains the posterior cervical lymph nodes.

Which statement best describes the chest of a newborn? A. The anteroposterior (AP) diameter is about equal to the lateral diameter. B. The transverse diameter is greater than the AP diameter. C. The AP diameter approximates the circumference. D. The AP diameter is greater than the circumference of the head.

A: CorrectThe chest of the newborn is generally round, the AP diameter approximating the lateral diameter, and the circumference is roughly equal to that of the head until the child is about 2 years old.

Mrs. Tanker is a 62-year-old patient who presents to your office with a complaint of chest pain. On cardiac auscultation, you note a split heart sound. What is the physiologic basis of a split sound? A. The right side of the heart contracts later than the left side. B. The atria contract later than the ventricles. C. The ventricles contract later than the atria. D. The atria contract before the ventricles.

A: CorrectThe events of the cardiac cycle are not exactly identical on both sides of the heart. In fact, pressures in the right ventricle, right atrium, and pulmonary artery are lower than the left side of the heart; and the same events occur slightly later on the right side than on the left. The effect is that heart sounds sometimes have two distinct components, the first produced by the left side and the second by the right side. For example, the aortic valve closes slightly before the pulmonic, so that S2 is often heard as two distinct components, referred to as "split S2" (A2, then P2). Splitting occurs when the mitral and tricuspid valves or the pulmonic and aortic valves do not close simultaneously.

Where are the semilunar valves located? A. At the exit of each ventricle where the great vessels originate B. Between the left ventricle and left atria C. At the bifurcation of the pulmonary ascending aorta D. At the entrance of the superior vena cava into the right atria

A: CorrectThe four chambers of the heart are connected by two sets of valves: the atrioventricular and semilunar valves. The two semilunar valves each have three cusps. The pulmonic valve separates the right ventricle from the pulmonary artery. The aortic valve lies between the left ventricle and the aorta. Contraction of the ventricles (systole) opens the semilunar valves, causing blood to rush into the pulmonary artery and aorta. When the ventricles relax (diastole), the valves close, shutting off any backward flow into the ventricles.

Mrs. Gorski is a 38-year-old patient who is 8 months pregnant and presents to your office for a routine visit. Which of the following cardiovascular findings would be considered normal for Mrs. Gorski? A. The position of the heart shifts up and to the left; the apex moves laterally. B. Percussion reveals a decrease in left ventricular size. C. Assessment of the lower legs reveals 3+ pitting edema. D. Blood pressure is 150/118.

A: CorrectThe heart position is shifted during pregnancy, but the position varies with the size and position of the uterus. The apical impulse is upward and more lateral by 1 to 1.5 cm. Expect some changes in auscultated heart sounds because of the increased blood volume and extra effort of the heart. As the uterus enlarges and the diaphragm moves upward in pregnancy, the position of the heart is shifted toward a horizontal position, with slight axis rotation.

How does the carotid pulse different from the jugular pulse? A. The arterial pulse can be palpated, whereas the venous pulse is visualized. B. The arterial pulse contains both systolic and diastolic components, whereas the venous pulse only has a systolic component. C. The venous pulse has an a, c, and v wave, and the arterial pulse has an x, y, and z wave. D. The venous pulse is a reflection of pulmonary circulation, and the arterial pulse is a reflection of systemic circulation.

A: CorrectThe jugular pulse is a venous pulse and can only be visualized; it cannot be palpated. The carotid is an arterial pulse and can be palpated.

Mr. Black is a 62-year-old patient who presents to your office for routine examination. You note a prominent jugular vein with significant pulsations. Which problem is consistent with this finding? A. Right-sided heart failure B. Hypertension C. Cardiac ischemia D. Left ventricular hypertrophy

A: CorrectThe jugular veins, which empty directly into the superior vena cava, reflect the activity of the right side of the heart and offer clues to its competency. The level at which the jugular venous pulse is visible gives an indication of right atrial pressure. With right-sided heart failure, jugular veins may be more visible

Mrs. Delman brings her 1-month-old infant in for a routine examination. Which of the following is considered a routine part of a newborn examination? A. Assessing red reflex B. Assessing extraocular movements with six fields of gaze C. A fundoscopic examination D. Assessing visual acuity

A: CorrectThe red reflex is checked bilaterally in the newborn. Interruption of the red reflex may indicate congenital cataracts or retinoblastoma or other serious intraocular pathologic condition. A funduscopic examination is difficult to conduct on a newborn or young infant and is generally deferred until the infant is 2 to 6 months of age unless there is concern about a congenital eye abnormality, suspicion of physical abuse (shaken baby syndrome), trauma, or need for an assessment for retinopathy of prematurity.

Mrs. Carter has vision that at best is 20/210. Mrs. Carter is considered: A. legally blind. B. mildly myopic. C. moderately hyperopic. D. unilaterally anisocoric.

A: CorrectThe smaller the fraction, the worse is the vision. Vision not correctable to better than 20/200 is considered legal blindness.

What is the red pulp of the spleen? A. Venous sinusoids B. Recycled hemoglobin C. Clustered lymphoid nodules D. Activated antigen tissue

A: CorrectThe spleen is a highly vascular organ. It is composed of two systems: (1) the white pulp, made up of lymphatic nodules and diffuse lymphatic tissue, and (2) the red pulp, made up of venous sinusoids.

Decrease in pulmonary pressure as a result of the relaxation and expansion of the pulmonary arteries at birth causes: A. closure of the foramen ovale. B. hyperinflation of the lungs. C. passive respiratory movements. D. reopening of the ductus arteriosus.

A: CorrectThis relative decrease in pulmonary pressure most often leads to closure of the foramen ovale within minutes after birth, and the increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus (see Clinical Pearl, "Patent Ductus Arteriosus [PDA]").

Percussion of the back should be done with the patient's arms folded in front in order to: A. expose maximum lung area. B. make the scapulae protrude. C. prevent attacks of coughing. D. recognize thudlike sounds.

A: CorrectTo auscultate the back, ask the patient to sit as for percussion, with head bent forward and arms folded in front. Sitting moves the scapula laterally exposing more of the lung.

Where on the body would you palpate the epitrochlear lymph nodes? A. Groove between the triceps and the biceps at the elbow B. Deep in the medial aspect of the groin C. Just in front of the tragus D. At the angle of the mandible

A: CorrectTo palpate the epitrochlear nodes, support the arm in one hand as you explore the elbow with the other. Grasp the patient's right wrist, palm facing up, with your left hand. The elbow should be in a relaxed position at approximately 90 degrees. Place your right hand under the patient's right elbow and cup your fingers around the elbow to find the area that is proximal and slightly anterior to the medical epicondyle of the humerus. There is a groove between the triceps and biceps muscles. Here is where you find the epitrochlear lymph nodes.

When auscultating the lungs, which of the following sequences should be used? A. Side to side comparison, from apex to base B. Front to back comparison, from apex to base C. Listen to the right lung first, apex to base, then the left lung apex to base D. Listen to the right lung during inspiration, the left lung during expiration, from apex to base

A: CorrectWhen auscultating the lungs, listen systematically at each position throughout inspiration and expiration, taking advantage of a side-to-side comparison as you move downward from apex to base at intervals of several centimeters. The sounds of the middle lobe of the right lung and the lingula on the left are best heard in the respective axillae.

Mr. Charles is a 38-year-old patient who presents to your office with a complaint of fatigue and a family history of hypothyroidism. As the examiner palpates an enlarged lymph node, the patient complains of pain. This is an indication of: A. an inflammatory process. B. Hodgkin disease. C. immature lymph node development. D. malignancy.

A: CorrectWhen examining nodes, the examiner is reminded that, the more tender a node, the more likely it is an inflammatory process.

Mrs. Jones is a 45-year-old patient with asthma who presents to your office. On examination, chest movement can best be seen with: A. bright tangential lighting. B. daylight from a window. C. a flashlight in a dark room. D. fluorescent ceiling lights.

A: CorrectWhen examining the chest, having a bright tangential light is needed to highlight chest movement.

Mr. Davids is a 48-year-old patient with high cholesterol and diabetes. Individuals with abnormal lipid metabolism are at risk for deposition of flat, slightly raised, irregularly shaped, yellow tinted lesions on the periorbital tissues that are called: A. xanthelasma. B. xanthophose. C. xanthophylls. D. xanthosis.

A: CorrectWhen examining the surrounding structures, you may see flat to slightly raised, oval, irregularly shaped, yellow-tinted lesions on the periorbital tissues that represent depositions of lipids and may suggest that the patient has an abnormality of lipid metabolism. These lesions are called xanthelasma, an elevated plaque of cholesterol deposited in macrophages, most commonly in the nasal portion of the upper or lower lid.

While observing a patient's respirations, you note that, on inspiration, the lower thorax is drawn in and the abdomen protrudes. On expiration, the opposite occurs. This may be documented as: A. paradoxic breathing. B. Biot respiration. C. Kussmaul breathing. D. abdominal respiration.

A: CorrectWith paradoxic breathing, on inspiration the lower thorax is drawn in, and on expiration, the opposite occurs. This develops when negative intrathoracic pressure is transmitted to the abdomen by a weakened, poorly functioning diaphragm; obstructive airway disease; or during sleep, in the event of upper airway obstruction.

A patient with which lifestyle characteristic is at risk for respiratory disability? A. Severe obesity B. Exposure to ultraviolet lights in the office setting C. Rigorous daily exercise routine D. Increased dietary fiber intake

A: correctExtreme obesity is a characteristic that serves as a barrier to competent functioning.

A skin lesion that may be associated with neurofibromatosis or pulmonary stenosis is: A. café au lait spots. B. nevus vasculosus. C. port wine limb stain. D. spider angioma.

A:CorrectCafé au lait spots are flat, evenly pigmented spots varying in color from light brown to dark brown or black on dark skin, are larger than 5 mm in diameter, and are present at birth or shortly thereafter. They may be associated with neurofibromatosis or miscellaneous other conditions, including pulmonary stenosis, temporal lobe dysrhythmia, and tuberous sclerosis.

Moles is a common term used to identify which of the following? A. Nevi B. Striae C. Pimples D. Scars

A:CorrectNevi, or moles, occur in forms that vary in size and degree of pigmentation. Nevi are present on most persons regardless of skin color and may occur anywhere on the body.

Wrinkling of the skin is less marked in individuals who: A. are obese. B. demonstrate premature graying. C. are white. D. have overactive sebaceous and sweat gland activity.

A:CorrectObese individuals have more subcuatenous fat. A wrinkled appearance is the result of the dermis becoming less elastic, a loss of collagen and elastic fibers, and shrinkage. A lifetime of exposure to the sun also predisposes the skin to wrinkling.

The number of each intercostal space corresponds to that of: A. the rib immediately above it. B. the rib immediately below it. C. the number of centimeters it is positioned below the clavicle. D. the number of inches it is positioned below the clavicle.

A:CorrectOne can count the ribs and intercostal spaces from this point. The number of each intercostal space corresponds to that of the rib immediately above it.

Mrs. Xavier is a 45-year-old patient who presents to your office with a complaint of a rash. On examination, you find a herald patch (round plaque with fine superficial scaling). Which of the following conditions identifies this finding? A. Pityriasis rosea B. Dermatophytosis C. Rosacea D. Herpes zoster

A:CorrectPityriasis rosea is a self-limiting inflammation of unknown cause. The herald lesion is commonly missed, although the most common sign of this condition.

The sebaceous gland secretes sebum primarily in response to which of the following hormones? A. Testosterone B. Estrogen C. Progesterone D. Growth hormone

A:CorrectThe sebaceous glands secrete sebum, a lipid-rich substance that keeps the skin and hair from drying out. Secretory activity, which is stimulated by sex hormones (primarily testosterone), varies according to hormonal levels throughout the life span.

The examiner notes a large blue-black spot on the buttock of a 4-week-old black neonate. The mother states that the infant was born with it. The examiner should recognize that this: A. is an expected finding. B. may indicate child abuse. C. is related to birth trauma. D. suggests a congenital defect.

A:CorrectThis finding is indicative of Mongolian spots. Mongolian spots are irregular areas of deep blue pigmentation, usually in the sacral and gluteal regions, and are seen predominantly in newborns of African, Native American/American Indian, Asian, or Latin descent. They commonly appear on the back, buttocks, shoulders, and legs of well babies and usually disappear in the preschool years.

A 6-year-old girl has freckles over her nose and cheeks. The examiner will recall that freckles are a type of: A. macule. B. papule. C. nodule. D. patch.

A:correctA macule is a flat, circumscribed area that is a change in the color of the skin usually less than 1 cm in diameter. Freckles, flat moles, petechiae, and measles are examples of macules.

Mr. Herrara is a 42-year-old patient who presents for routine well visit. On examination during cardiac auscultation, you note a midsystolic murmur with a medium pitch; a coarse thrill is palpated as well. These findings are consistent with which condition? A. Aortic stenosis B. Aortic regurgitation C. Pulmonic stenosis D. Mitral stenosis

A; CorrectAortic stenosis is heard over the aortic area as an ejection sound at the second right intercostal boader. Characteristic subjective and objective data include midsystolic murmer with a medium pitch, with a coarse palpable thrill.

Periodic breathing is characterized by intervals of respiration separated by periods of: A. apnea. B. hyperpnea. C. hypopnea. D. eupnea.

A; CorrectApnea, the absence of spontaneous respiration, may have its origin in the respiratory system and, as well, in a variety of central nervous system and cardiac abnormalities.

Which of the following best describes the beginning of ventricular contraction? A. Pressure in the ventricle forces atrioventricular valves to close. B. Ventricular contraction is initiated at the Purkinje point and proceeds in concentric circles around the ventricles. C. Pressure in the ventricles forces semilunar valves to close. D. Ventricular contraction is initiated within the myocardial septum and is transmitted vertically from the endocardium to the epicardium.

A; CorrectAs systole begins, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, preventing backflow. This valve closure produces the first heart sound (S1), the characteristic "lubb." The intraventricular pressure rises until it exceeds that in the aorta and pulmonary artery. Then the aortic and pulmonic valves are forced open, and ejection of blood into the arteries begins. Valve opening is usually a silent event

Which is a normal physical variation commonly seen in preterm infants? A. Long, narrow head B. Broad nose bridge C. Low-set ears D. Webbed neck

A; CorrectHead shape with an unusual contour may be related to premature or irregular closing of suture lines. Preterm infants often have long, narrow heads (brachiocephaly) because their soft cranial bones become flattened with positioning and the weight of the head.

Mr. Torres is a 62-year-old patient who presents to your office with complaints of shortness of breath and dyspnea on exertion. On examination, you are unable to palpate the apical pulse. In addition, the heart sounds are very faint on auscultation. What condition should be considered? A. Pleural or pericardial fluid B. Congestive heart failure C. Mitral valve regurgitation D. Atrial septal defect

A; CorrectThe absence of a visible, palpable apical impulse in addition to faint heart sounds, particularly when the patient is in the left lateral recumbent position, suggests some intervening extracardiac problem, such as pleural or pericardial fluid.

The third intercostal space is located: A. between the third and fourth rib. B. between the second and third rib. C. 3 inches down from the clavicle. D. just below the third rib below the clavicle.

A; CorrectThe number of each intercostal space corresponds to that of the rib immediately above it.

Which is the correct technique for performing a fundoscopic examination with a traditional ophthalmoscope? Examine the patient's: A. right eye with your right eye, and the left eye with your left eye. B. right eye with your left eye, and the left eye with your right eye. C. right and left eyes with your dominant eye. D. right and left eyes with your nondominant eye.

A; CorrectThe ophthalmoscopic (fundoscopic) examination of the eyes can be a tiring process for the patient. Examine the patient's right eye with your right eye and the patient's left eye with your left. Hold the ophthalmoscope in the hand that corresponds to the examining eye.

Which type of breath sounds are normally auscultated over most of the lung fields? A. Vesicular B. Bronchovesicular C. Bronchial D. Tubular

A; CorrectVesicular breath sounds are low-pitched, low-intensity sounds heard over healthy lung tissue. They are heard over most of lung fieldsm, they are low-pitched, soft and short expirations.

Which fact reported in a patient's history indicates increased risk for a pterygium? A. Recent episode of carotinemia B. Frequent sunbathing C. Ingestion of megadoses of vitamin C D. History of skin tags

B: CorrectA pterygium is an abnormal growth of conjunctiva that extends over the cornea from the limbus. It occurs more commonly on the nasal side but may arise temporally as well. A pterygium is more common in people heavily exposed to ultraviolet light.

The tonsils that are located near the nasopharyngeal border are the: A. laryngeal tonsils. B. pharyngeal tonsils. C. palatine tonsils. D. lingual tonsils.

B; CorrectComposed principally of lymphoid tissue, the tonsils are organized as follicles and crypts; both are covered by mucous membrane. The pharyngeal tonsils, or adenoids, are located at the nasopharyngeal border.

Which question is most appropriate to ask a female patient with a suspected thyroid problem? A. "How much alcohol do you drink?" B. "Has your sleep pattern or energy level changed?" . C. "Do you have morning headaches?" D. "Do you use birth control?"

B: CorrectA change in mood and energy, irritability, nervousness, lethargy, and disinterest are a few problems a patient with thyroid problems may have

Wheezes are produced by which of the following? A. Fluid-filled airways opening up during inspiration B. High-velocity air flow through a narrowed airway C. Collapse of the airways during expiration D. Shunting of air away from an area of consolidation

B: CorrectA wheeze (sibilant wheeze) is sometimes thought of as a form of rhonchus. It is a continuous, high-pitched, musical sound (almost a whistle) heard during inspiration or expiration. It is caused by a relatively high-velocity air flow through a narrowed or obstructed airway.

Acceleration of sweat and sebaceous gland activity during pregnancy is for the purpose of: A. increasing elimination of waste products from the fetus. B. dissipating excessive heat from increased metabolism. C. promoting peripheral vasodilation of the increased numbers of capillaries. D. facilitating fat deposition to create better insulation for heat conservation.

B: CorrectAcceleration of sweat and sebaceous gland activity occurs. Both processes assist in dissipating the excess heat caused by increased metabolism during pregnancy.

Fibers that originate on the nasal retina decussate (cross over) at what point in the optic pathway? A. Optic tract B. Optic chiasm C. Optic radiation D. Optic cortex

B: CorrectAccurate binocular vision is achieved when an image is fused on the retina by the cornea and the lens. An object may be perceived in each visual cortex, even when one eye is covered, if the light impulse is cast on both the temporal and the nasal retina. Fibers located on the nasal retina decussate in the optic chiasm.

Ms. Williams is a 21-year-old patient who presents to your office. On examination, you find a cobblestone appearance of the conjunctiva. This is most likely related to: A. subconjunctival hemorrhage. B. allergic or infectious conjunctivitis. C. lagophthalmos. D. cytomegalovirus infection

B: CorrectAn erythematous or cobblestone appearance, especially on the tarsal conjunctiva, may indicate an allergic or infectious conjunctivitis.

Mrs. Jones is a 55-year-old patient who returns to your office today for a follow-up examination. You suspect that she has an arterial aneurysm. Which examination technique would you use to best detect an arterial aneurysm? A. Palpating for dilation of an artery B. Auscultating for a bruit over an artery C. Percussing for a thrill over an artery D. Observing for redness and swelling over an artery

B: CorrectArterial anerysm is a localized dilation, generally defined as 1.5 times the diameter of the normal artery, caused by a weakness in the arterial wall. To best detect this anomaly, the examiner auscultates over an artery for a bruit.

Arterial occlusion is characterized by: A. pale, moist skin, and absent pulses. B. pain, pallor, and pulselessness. C. pale, warm skin, and weak pulses. D. paresthesia, weak pulses, and polyarthritis.

B: CorrectArteries in any location can become narrowed, leading to decreased blood flow. The reduced circulation to the tissues will lead to signs and symptoms that are related to site, degree of narrowing, ability of collateral channels to compensate, and rapidity with which the problem develops. The first sign is usually pain, followed by pallor, and then pulselessness with advanced disease.

Which is a determinant of the degree of retraction on inspiration? A. Respiratory rate B. Extent of obstruction C. Body temperature D. Angle of the head of the bed

B: CorrectAs intrapleural pressure becomes increasingly negative, the musculature "pulls back" in an effort to overcome blockage. Any significant obstruction makes the retraction observable with each inspiratory effort. The degree and level of retraction depend on the extent and level of obstruction (see Box 14.6).

Before instilling a mydriatic eyedrop into a patient's eye for examination, the examiner should: A. assess the corneal reflex. B. check for a shallow anterior chamber. C. assess intraocular pressure. D. observe the eye for vascular changes.

B: CorrectBefore instillation of a mydriatic, inspect the patient's anterior chamber by shining a focused light tangentially at the limbus (the union of the conjunctiva and the sclera). Note the illumination of the iris nasally. This portion of the iris is not lighted when the patient has a shallow anterior chamber, indicating a risk of acute-angle glaucoma. Mydriatics should be avoided in these patients.

Mr. French is a 67-year-old patient who presents to your office with the following complaint: "I have a loss of vision in the outer half of each eye." Which of the following underlying problems should the examiner consider? A. Diabetes B. Pituitary tumor C. Glaucoma D. Cytomegalovirus (CMV) infection

B: CorrectBitemporal hemianopia is caused by a lesion—most commonly a pituitary tumor—interrupting the optic chiasm.

Mrs. Dublin is a 45-year-old patient who is referred to you with a lesion of the optic nerve at the optic chiasm. Which visual field defects would result from this lesion? A. Homonymous hemianopia B. Bitemporal hemianopia C. Binasal hemianopia D. Unilateral blindness

B: CorrectBitemporal hemianopia is caused by a lesion—most commonly a pituitary tumor—interrupting the optic chiasm.

Caput succedaneum, a form of birth trauma, is characterized by which of the following? A. A collection of blood in the subperiosteum B. Subcutaneous edema over the presenting part of the head C. Enlargement of the fontanels caused by fluid leaking into the periosteal spaces D. Bulging of the skull in the frontal area as a result of premature birth

B: CorrectCaput succedaneum is subcutaneous edema over the presenting part of the head at delivery. It is the most common form of birth trauma of the scalp and usually occurs over the occiput and crosses suture lines. The affected part of the scalp feels soft, and the margins are poorly defined. Generally, the edema goes away in a few days.

Mr. Tucker is a 68-year-old man who comes to your office complaining of spots on his skin. On examination, which lesion is an expected finding on the skin of healthy older adults? A. Acne vulgaris B. Cherry angioma C. Miliaria D. Trichotillomania

B: CorrectCherry angiomas are tiny, bright ruby-red, round papules that may become brown with time. They occur in virtually everyone older than 30 years and increase numerically with age.

Mrs. Black is a 35-year-old pregnant patient who presents to your office for follow-up. She complains of a brown patch of hyperpigmentation on her face. What is this condition found in pregnancy? A. Linea gravida B. Chloasma C. Carotenemia D. Café au lait spots

B: CorrectChloasma, or "mask of pregnancy," commonly occurs in pregnant women and is found on the forehead, cheeks, bridge of the nose, and chin. It is blotchy in appearance and is usually symmetric.

Mr. Garges is a 64-year-old patient who is experiencing calf pain when he exercises. Pain that results from muscle ischemia is identified as: A. ischemia muscularis. B. claudication. C. obstructive. D. Raynaud syndrome.

B: CorrectClaudication is pain caused by compromised blood flow to muscles resulting in muscular ischemia. It usually occurs during exercise and is a symptom of peripheral artery disease in which the vessels that supply blood flow to your legs or arms are narrowed.

Clubbing of the fingernail is commonly associated with: A. anemia. B. respiratory disorders. C. cancer. D. trauma.

B: CorrectClubbing of the fingernail is associated with a variety of respiratory and cardiovascular diseases, cirrhosis, colitis, and thyroid disease.

Crepitus is caused by: A. inflammation of the pleural lining. B. air in the subcutaneous spaces. C. a foreign body located in the right mainstem bronchus. D. a convergence of alveoli causing multiple bleb formations.

B: CorrectCrepitus, a crackly or crinkly sensation, can be both palpated and heard—a gentle, bubbly feeling. It indicates air in the subcutaneous tissue from a rupture somewhere in the respiratory system or by infection with a gas-producing organism.

A mother tells the examiner that her 2-year-old child has a cough that "sounds just like a bark." Given this history, which other findings should the examiner anticipate with respiratory examination? A. Wheezing and coarse crackles bilaterally B. Labored breathing and inspiratory stridor C. Hyperresonance with percussion D. Productive, blood-tinged, or "rusty" sputum

B: CorrectCroup or laryngotracheal bronchitis is a syndrome that generally results from infection with a variety of viral agents, particularly the parainfluenza viruses occurring most often in children from about 1½ to 3 years of age. Objective data include labored breathing, retraction, hoarseness, barking cough, and inspiratory stridor.

The examiner should expect the ratio of respiratory rate to heart rate to be approximately: A. 1:2. B. 1:4. C. 1:6. D. 1:8.

B: CorrectDetermine the respiratory rate. The rate should be 12 to 20 respirations per minute; the ratio of respirations to heartbeats is approximately 1:4.

Both pleural effusion and pneumonia are characterized by: A. tympany heard with percussion. B. dullness heard on percussion. C. resonance heard on percussion. D. hyperresonance heard on percussion.

B: CorrectDullness or flatness suggests pneumonia, atelectasis, pleural effusion, pneumothorax, or asthma.

Mr. Telford tells you that he feels short of breath and has difficulty breathing after climbing the stairs in his home. Based on his description, what term might be used to identify his breathing condition? A. Orthopnea B. Dyspnea C. Kussmaul D. Hyperpnea

B: CorrectDyspnea is difficult and labored breathing with shortness of breath, commonly observed with pulmonary or cardiac compromise.

The apex of the lung is: A. even with the second rib. B. 4 cm above the first rib. C. higher on the right side. D. on the convex diaphragm surface.

B: CorrectEach lung apex is rounded and extends anteriorly about 4 cm above the first rib into the base of the neck in adults. Posteriorly, the apices of the lungs rise to about the level of T1.

Mr. Wilson is a 65-year-old patient who presents to your office for routine examination. Lymph nodes in healthy adults are usually: A. large and soft. B. nonpalpable or minimally palpable. C. hard and irregular. D. large and hard.

B: CorrectEasily palpable lymph nodes generally are not found in healthy adults. Superficial nodes that are accessible to palpation but not large or firm enough to be felt are common.

Which condition is characterized by hyperresonance and a prolonged expiratory effort? A. Asthma B. Emphysema C. Pneumonia D. Pneumothorax

B: CorrectEmphysema is a condition in which the lungs lose elasticity and alveoli enlarge in a way that disrupts function. When percussed, the examiner will find hyperresonance and auscultate diminished breath sounds, as well as prolonged expiration.

A generalized red coloration of the skin that occurs in inflammation or infection is described best by which of the following terms? A. Erythroid B. Erythema C. Cythemic D. Ecchymotic

B: CorrectErythema is used to describe red or dark pink coloration of the skin.

Mr. Sherman is a 65-year-old patient who has long-standing hypertension. Which clinical finding would you expect? A. Decreased blood volume B. Thickened myocardium C. Increased stroke volume D. Decreased cardiac irritability

B: CorrectHeart size may decrease with age unless hypertension or heart disease causes enlargement. The myocardium becomes less elastic and more rigid so that recovery of myocardial contractility is delayed.

Nancy is a 14-year-old girl who presents at the clinic with complaints of severe, acute chest pain. Her mother reports that Nancy, apart from occasional colds, is not prone to respiratory problems. What factor is most important to assess relative to Nancy's present problem? A. Anorexia symptoms B. Cocaine use C. Last menses D. Signs of rheumatic fever

B: CorrectIf an adult—especially a young adult—or an adolescent complains of severe, acute chest pain, ask about drug use, particularly cocaine. Cocaine can cause tachycardia, hypertension, coronary arterial spasm (with infarction), and pneumothorax (lung collapse) with severe, acute chest pain being the common result.

Heart size estimated by percussion should be confirmed by: A. auscultation of the heart sounds. B. location of the apical pulse or PMI. C. palpating the left sternal border. D. palpating the heart base.

B: CorrectIf radiographic facilities are unavailable, percussion can be used to estimate the size of the heart. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border. Note these points with a marking pen and the outline of the heart is visually defined. On the left, the loss of resonance will generally be close to the point of maximal impulse at the apex of the heart.

A condition that results in progressive ischemia caused by insufficient perfusion is referred to as: A. Raynaud phenomenon. B. peripheral atherosclerotic disease. C. venous thrombosis. D. arterial aneurysm.

B: CorrectIn peripheral atherosclerotic disease, atherosclerotic plaques narrow arterial channels resulting in decreased blood flow to tissues and resultant tissue ischemia.

Skin color in a newborn is partly determined by: A. gestational age. B. amount of fat. C. composition of the vernix caseosa. D. amount of lanugo present.

B: CorrectIn the first few hours of life, the infant's skin may look very red. The gentle pink coloring that predominates in infancy usually surfaces in the first day after birth. Skin color is partly determined by the amount of subcutaneous fat: The less subcutaneous fat, the redder and more transparent the skin.

Mr. Sanchez is a 62-year-old patient who presents with chronic obstructive lung disease. Which finding on examination leads you to document that Mr. Sanchez has a barrel chest? A. There is a decrease in the anteroposterior diameter of the chest. B. There is an increase in the anteroposterior diameter of the chest. C. There is a decrease in the transverse diameter of the chest. D. There is an increase in the transverse diameter of the chest.

B: CorrectIncreased anteroposterior diameter of the chest or barrel chest is a classic symptom of chronic conditions like chronic obstructive pulmonary disease (COPD).

To inspect the chest, you should observe: A. after the patient begins to cough. B. while the patient breathes normally. C. while the patient holds his or her breath. D. with your palm on the patient's chest.

B: CorrectInspect the chest wall movement during respiration. Again, different angles of illumination will aid inspection and help delineate chest wall movement and possible deformities.

Visual acuity is essentially a measurement of: A. lens accommodation. B. central vision. C. depth perception. D. cranial nerve II, III, and VI integrity.

B: CorrectMeasurement of visual acuity—the discrimination of small visual details—tests CN II (optic nerve) and is essentially a measurement of central vision.

The mediastinal crunch (Hamman sign) can best be heard with the patient: A. in a supine position. B. lying on the left side. C. sitting completely upright. D. positioned with the head elevated 30 degrees.

B: CorrectMediastinal crunch (Hamman sign) is found with mediastinal emphysema. A great variety of sounds—loud crackles, clicking, and gurgling sounds—are heard over the precordium. They are synchronous with the heartbeat and not particularly so with respiration. These sounds can be more pronounced toward the end of expiration and are easiest to hear when the patient leans to the left or lies down on the left side.

Skin color is dependent on which of the following cells? A. Carotenocytes B. Melanocytes C. Dermatocytes D. Keratinocytes

B: CorrectMelanocytes are the cells that synthesize melanin. Melanin gives the skin its color.

Ms. Jones is a 25-year-old patient who presents to your office with a complaint of severe pulsating headaches accompanied by nausea, vomiting, and scotoma. Which type of headache would you conclude that Ms. Jones has? A. Temporal B. Migraine C. Cluster D. Traumatic

B: CorrectMigrane is a type of headache (pain in the head) that presents as pulsating or throbbing, accompanied by nausea, vomiting, and scotoma.

Mrs. Tamber presents to your office with her 3-month-old infant son. On examination, your findings include nuchal rigidity or resistance to flexion of the neck. Because of this finding you suspect: A. brain tumor. B. meningeal irritation. C. intracerebral aneurysm. D. hydrocephalus.

B: CorrectMovement should be smooth and painless and should not cause dizziness. Nuchal rigidity, resistance to flexion of the neck, may be associated with meningeal irritation.

Stroke volume is defined as the: A. amount of blood ejected per minute. B. amount of blood ejected per heartbeat. C. amount of blood ejected per second. D. combined amount of blood contained within each atria.

B: CorrectOxygenated blood of the systemic circulation returns to the heart and enters the systemic circulation through the pulmonary veins into the left atrium, then through the mitral valve into the left ventricle. The left ventricle contracts, forcing a volume of blood with each beat (stroke volume) through the aortic valve into the aorta, where it is distributed systemically through the arteries and capillaries.

Mrs. Nieland brings her toddler in for a routine office visit. She tells you that she has a new babysitter. Which finding is consistent with a physical abuse injury in a toddler? A. A burn to the skin with a splash pattern B. Bruising of the skin over soft tissue C. Bruising of the skin over a bony prominence D. Café au lait patches

B: CorrectPhysical findings in children who are physically abused include bruises, burns, lacerations, scars, bony deformities, alopecia, retinal hemorrhages, dental trauma, and head and abdominal injuries. Bruising associated with abuse occurs over soft tissue; toddlers and older children who bruise themselves accidentally do so over bony prominences.

An examiner is most likely to observe pseudostrabismus in which of the following groups? A. Older or frail adults B. Native American/American Indian infants C. Pregnant women D. Hispanic schoolchildren

B: CorrectPseudostrabismus, the false appearance of strabismus caused by a flattened nasal bridge or epicanthal folds, is an expected variant in Asian and Native American/American Indian infants, as well as in some whites.

Ptosis is a condition in which the eyelid: A. does not cover any portion of the iris. B. covers a portion of the iris and sometimes a portion of the pupil. C. is unable to cover any portion of the eyeball. D. is turned inward toward the globe.

B: CorrectPtosis indicates a congenital or acquired weakness of the levator muscle or a paresis of a branch of the third cranial nerve. Record the difference between the two lids in millimeters. It is a condition of the eyelid.

During a health history, your patient describes having experienced aimless, jerky movements, episodes of shortness of breath, and chest pain. With which disease are these symptoms associated? A. Heart failure B. Acute rheumatic fever C. Hypertension D. Atrial stenosis

B: CorrectRhuematic fever is a systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection characterized by unexplained fever, swollen joints, aimeless jerky movements (Sydenham chorea/St. Vitus dance), abdominal pain, skin rash (erythema marginatum), or nodules. Additional subjective symptoms may include shortness of breath, chest pain, palpitations, and a flat or slightly raised rash that is painless in nature.

What would you do to differentiate clubbed nails from curved nails? A. Palpate the nail beds. B. Inspect the shape of the nail. C. Inspect the nail plate. D. Inspect the nail/base angle.

D: CorrectThe average nail base angle should measure 160 degrees. In clubbing, the nail base is boggy and the angle increases and approaches or exceeds 180 degrees. One method of assessment is the Schamroth technique.

Mr. Marlin is a 58-year-old man who presents to your office for a follow-up examination. You are treating him for rosacea. Rosacea is: A. a recurrent disease of keratin synthesis. B. an inflammatory skin disorder with papules and pustules. C. an area filled with fluid near the skin of the nose. D. macules connected to the dermis by keratinocytes.

B: CorrectRosacea is a chronic inflammatory disorder characterized by telangiectasia, erythema, papules, and pustules that occur particularly in the central area of the face. Although it resembles acne, comedones are never present.

To best hear a splitting of the S2 sound unaffected by the respiratory cycle, which direction would you give the patient? A. Take a series of rapid, shallow breaths, then exhale deeply. B. Take a deep breath and hold it. C. Lie on your left side with your neck down and knees bent. D. Breathe quietly through your mouth.

B: CorrectS2, the result of closure of the aortic and pulmonic (semilunar) valves, indicates the end of systole and is best heard in the aortic and pulmonic areas. It is of higher pitch and shorter duration than S1. Splitting of S2 is an expected event, because pressures are higher and depolarization occurs earlier on the left side of the heart. During inspiration, the lungs fill with air as the chest wall expands. Ejection times tend to equalize when the breath is held in expiration, so this maneuver also tends to eliminate the split. The respiratory cycle is not always the dominant factor in splitting; the interval between the components may remain easily discernible throughout the respiratory cycle.

S3 and S4 are commonly heard in which of the following groups of individuals? A. Older adults B. Young children C. Middle-aged adults D. Pregnant women

B: CorrectS3 and S4 are commonly heard in pediatric patients. Increased intensity of either sound is suspect.

Mr. Green is a 63-year-old patient who is having a driver's physical examination completed. On examination, you note a senile hyaline plaque. Which of the following best describes this finding? A. This is a normal finding depending on the amount of melanin in the pigment epithelium. B. This is a dark, slate gray pigment just anterior to the insertion of the medial rectus muscle. C. This is a small, discrete spot slightly more yellow than the retina. D. This is a slightly raised, irregularly shaped yellow tinted lesion.

B: CorrectSenile hyaline plaque appears as a dark, slate gray pigment just anterior to the insertion of the medial rectus muscle. Its presence does not imply disease but should be noted.

You note asymmetry affecting the lower right side of a patient's face. You would suspect a problem with which nerve? A. Trigeminal B. Facial C. Hypoglossal D. Trochlear

B: CorrectSuspect facial nerve paralysis when the entire side of the face is affected, and suspect facial nerve weakness when the lower face is affected.

Which of the following is a type of blood cell that has a life span of 100 to 200 days? A. B cells B. T cells C. Stem cells D. Marrow-derived cells

B: CorrectT cells, which are four or five times as numerous as B cells, have a life span of 100 to 200 days. B cells live 3 to 4 days.

Mrs. Amons is a 52-year-old patient who presents to your office with a complaint of fever, malaise, muscle aches, mild loss of vision, and a severe throbbing headache. On examination, you note a red, swollen temporal artery. Which of the following best describes these clinical signs and symptoms? A. Arterial aneurysm B. Temporal arteritis C. Arterial thrombosis D. Venous thrombosis

B: CorrectTemporal arteritis, or giant cell arteritis, is an inflammatory disease of the branches of the aortic arch, including the temporal arteries. Mrs. Amons is displaying classic symptoms of this conditions.

What is the cause of barrel chest, which is characteristic of many older adults? A. Increased expansion of alveoli B. Decreased muscle strength and loss of lung resiliency C. Decreased expansion of alveoli and increased lung resiliency D. Increased blood pressure and decreased amount of body fat

B: CorrectThe barrel chest that is seen in many older adults results from loss of muscle strength in the thorax and diaphragm, coupled with the loss of lung resiliency. In addition, skeletal changes of aging tend to emphasize the dorsal curve of the thoracic spine, resulting in an increased anteroposterior (AP) chest diameter.

What is the major function of the heart valves? A. Separate the right side of the heart from the left B. Permit the flow of blood in one direction C. Separate the upper chambers from the lower chambers D. Augment the flow of blood through the heart

B: CorrectThe four chambers of the heart are connected by two sets of valves: the atrioventricular and semilunar valves. In the fully formed heart that is free of defect, these are the only intracardiac pathways and permit the flow of blood in only one direction.

In addition to the head, neck, axilla, and inguinal areas, the examiner may also assess lymph nodes: A. on the palmar aspect of the hands. B. in the popliteal region. C. in the patellar region. D. on the dorsum of the foot.

B: CorrectThe head, neck, axilla, inguinal areas, and the popliteal region are examples of lymph nodes most accessible to inspection and palpation.

Which of the following structures dilates or contracts to allow light into the eye? A. Pupil B. Iris C. Lens D. Rectus muscle

B: CorrectThe iris is a circular, contractile muscular disk containing pigment cells that produce the color of the eye. The central aperture of the iris is the pupil, through which light travels to the retina. By dilating and contracting, the iris controls the amount of light reaching the retina

Infection in which anatomic area can cause inguinal lymph node enlargement? A. Testes B. Surface of the penis C. Prostatic capsule D. Lower uterine segment

B: CorrectThe lymphatic drainage of the testes is into the abdomen. Enlarged nodes there are not accessible to inspection and palpation. Nodes in the inguinal area enlarge if there are lesions of the penile and scrotal surfaces.

The thick muscular middle layer of the heart that is responsible for contraction is the: A. atrial musculorum. B. myocardium. C. chordae tendineae. D. ventricular muscularis.

B: CorrectThe myocardium, the thick muscular middle layer, is responsible for the pumping action of the heart.

A 2-month-old infant is brought to the clinic for immunizations. The examiner palpates enlarged inguinal nodes. What additional finding might explain the enlarged nodes? A. The mother reports that the infant suffers from colic. B. The infant's length and weight are above the 85th percentile. C. The infant has a severe diaper rash. D. A port wine stain is present on the infant's left thigh.

C; CorrectEnlargement of the inguinal nodes suggests infection or metastatic carcinoma in the associated anatomic area.

Where would you place your stethescope to auscultate the pulmonic valve area? A. Fourth left intercostal space along the lower left sternal border B. Second left intercostal space at the left sternal border C. Second right intercostal space at the right sternal border D. Third left intercostal space at the left sternal border

B: CorrectThe pulmonic valve separates the right ventricle from the pulmonary artery. To auscultate the pulmonic valve, the examiner places the stethoscope at the second left intercostal space at the left sternal border.

You are assessing a patient and find that that the dorsalis pedis pulse is not palpable. Which pulse would you palpate next for maximum information about the blood flow to the distal extremity? A. Femoral B. Posterior tibial C. Popliteal D. Carotid

B: CorrectThe pulses are best palpated over arteries that are close to the surface of the body and lie over bones. These include the carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial arteries. An arterial pulsation is essentially a bounding wave of blood that diminishes with increasing distance from the heart. The carotid pulses are most easily accessible and closest to the cardiac source, making them most useful in evaluating heart function. Examine the arterial pulses in the extremities to determine the sufficiency of the entire arterial circulation. Palpate at least one pulse point in each extremity, usually at the most distal point.

You are completing a fundoscopic examination on a 45-year-old patient. During the examination, you note a red light reflex. What does this indicate? A. Normal hemoglobin content of the retina B. Light illuminating the retina C. Adequate dilation of the pupil D. Retinal hemorrhage

B: CorrectThe red reflex is caused by the light illuminating the retina. Any opacities in the path of the light will stand out as black densities. Absence of the red reflex is often the result of an improperly positioned ophthalmoscope, but it may also indicate total opacity of the pupil by a cataract or by hemorrhage into the vitreous humor.

Mrs. Taylor has brought her infant in for his 2-month checkup. On examination, you are concerned about hypothermia because you know: A. infants have an increased amount of stratum corneum. B. infants have decreased amounts of subcutaneous tissue. C. infants have a decreased amount of stratum germinativum. D. infants have a lanugo covering of the skin

B: CorrectThe subcutaneous fat layer is poorly developed in newborns, predisposing them to hypothermia.

Breath sounds are best heard if the patient: A. hyperventilates for 30 seconds before auscultation. B. breathes slowly and deeply through the mouth. C. breathes normally. D. inhales through the nose and exhales through the mouth.

B: CorrectTo assess the patient's breath sounds, have the patient sit upright, if possible, and breathe slowly and deeply through the mouth, exaggerating normal respiration. This allows for full lung expansion.

Thoracic expansion is assessed by: A. measuring the distance the diaphragm moves downward during maximal inspiration. B. observing the distance your thumbs diverge from the midspinal line during quiet and deep breathing. C. observing the symmetry of the shoulders rising during maximal inspiration and expiration. D. measuring the distance from the middle that fingers diverge toward the midaxillary line during quiet and deep breathing.

B: CorrectTo evaluate thoracic expansion during respiration, stand behind the patient and place your thumbs along the spinal processes at the level of the tenth rib, with your palms lightly in contact with the posterolateral surfaces. Watch your thumbs diverge during quiet and deep breathing. A loss of symmetry in the movement of the thumbs suggests a problem on one or both sides.

When testing the pupil for accommodation, which of the following results would be expected? A. As the individual focuses on a distant object, the pupils constrict. B. As the individual focuses on a close object, the pupils constrict. C. As the patient focuses on a distant object, the pupils diverge. D. As the patient focuses on a close object, the pupils converge.

B: CorrectTo test the pupillary respnse to accommodation ask the patient to look at a distant object and then at a test object (either a pencil or your finger) held 10 cm from the bridge of the nose. Expect the pupils to constrict when the eyes focus on the near object. With some patients, especially those with dark irides, it may be easier to observe pupillary dilation when the patient looks from near to far.

Mrs. Harold is a 36-year-old patient who presents to your office with a complaint of visual disturbances. As part of her eye examination, you assess for pupillary response to accommodation. Which method would you use? A. Shine a light into the pupil; note constriction. B. Ask the patient to shift her gaze from across the room to an object 6 inches away; note pupillary constriction. C. Ask the patient to follow an object through the six cardinal fields of gaze; note ocular movement. D. Cover one of the patient's eyes with a card; remove the card and note any deviation from a fixed gaze.

B: CorrectTo test the pupillary response to accommodation ask the patient to look at a distant object and then at a test object (either a pencil or your finger) held 10 cm from the bridge of the nose. Testing for pupillary response to accommodation is of diagnostic importance only if there is a defect in the pupillary response to light. A failure to respond to direct light but retaining constriction during accommodation is sometimes seen in patients with diabetes or syphilis.

A father brings his 3-year-old daughter to your office because she has been wheezing for the past 12 hours. The child has no history of health problems and has had regular well child visits. On examination, you find that the wheeze is asymmetric. What problem do you suspect? A. Allergic reaction B. Foreign body in the respiratory tract C. Onset of environmentally induced asthma D. Atypical croup

B: CorrectUnilateral or more sharply localized wheezing or stridor may occur with a foreign body.

Mrs. Allen is a 45-year-old patient who presents to your office with complaints of visual disturbances. On examination her visual acuity is recorded as 20/60. This can be interpreted to mean that: A. the person can read at 60 feet what an average person can read at 20 feet. B. the person can read at 20 feet what an average person can read at 60 feet. C. 20% of individuals tested can read 60% of the letters in this particular line. D. out of 100 individuals, 20% can read all the letters and 60% can read half of the letters in this particular line.

B: CorrectVisual acuity is recorded as a fraction in which the numerator indicates the distance of the patient from the chart (e.g., 20 feet or 6 m), and the denominator indicates the distance at which the average eye can read the line. Thus, 20/200 (6/60) means that the patient can read at 20 feet (6 m) what the average person can read at 200 feet (6 m). The smaller the fraction, the worse is the vision.

Mrs. Starman is a 68-year-old patient who presents to your office for a routine follow-up. On examination, you notice a ring of white in the periphery of the cornea. Your assessment of the condition is that: A. the individual needs to be screened for glaucoma. B. this is a normal age-related change in the eye. C. the individual has a potentially serious complication of diabetes. D. with early intervention the progression of the deposition can be stopped.

B: CorrectWhen examining the cornea, you may note a corneal arcus (arcus senilis), which is composed of lipids deposited in the periphery of the cornea. It may in time form a complete circle (circus senilis). Note the subtle clear area between the limbus and the arcus. An arcus is seen in many individuals older than 60 years. If present before 40, arcus senilis may indicate a lipid disorder.

Mrs. Yates is a 55-year-old patient who presents to your office with complaints of chest pain. To relate precordial palpation findings to the timing of the cardiac cycle, you place one hand over the precordium and the other hand over the: A. jugular pulse. B. carotid pulse. C. brachial pulse. D. femoral pulse.

B: CorrectWhile palpating the precordium, use your other hand to palpate the carotid artery so that you can describe the finding in relation to the cardiac cycle. The carotid pulse and S1 are practically synchronous. The carotid pulse is located just medial to and below the angle of the jaw.

The Hamman sign can best be heard when the patient is: A. in a supine position. B. lying on the left side. C. sitting completely upright. D. positioned with the head elevated 30 degrees.

B: correctMediastinal crunch (Hamman sign) is found with mediastinal emphysema. A great variety of sounds—loud crackles, clicking, and gurgling—are heard over the precordium. They are synchronous with the heartbeat and not particularly so with respiration. These sounds can be more pronounced toward the end of expiration and are easiest to hear when the patient leans to the left or lies down on the left side.

Your trauma patient has no auscultated breath sounds in the right lung field. You can hear adequate sounds in the left side. A likely cause of this abnormality could be that the patient: A. has a closed head injury. B. has fluid in the pleural space. C. is moaning in severe pain. D. is receiving high oxygen flow.

B: correctPleural effusion, which is an excess of nonpurulent fluid in the pleural space, is characterized by muted breath sounds in the affected area.

Which of the following conditions, if present, will alter the skin turgor of an individual? A. Jaundice B. Dehydration C. Vitiligo D. Cyanosis

B: correctThe skin should move easily when pinched and return to place immediately when released. Poor skin turgor can indicate severe dehydration. The skin is very slow to return to normal and "tents" up. This may occur with excessive vomiting, diarrhea, or dehydration for another cause.

Mr. Allen is a 66-year-old man who presents to your clinic for follow-up for his chronic obstructive pulmonary disease (COPD). When assessing for the presence of clubbing, the examiner specifically examines: A. the width of the nail base. B. the angle of the nail base. C. the thickness of the nail. D. the color of the nail.

B:CorrectThe average nail base angle should measure 160 degrees. In clubbing, the nail base is boggy and the angle increases and approaches or exceeds 180 degrees. Another method of assessment is the Schamroth technique. Clubbing is associated with a variety of respiratory and cardiovascular diseases, cirrhosis, colitis, and thyroid disease.

Which chest structure contains all the thoracic viscera except the lungs? A. Manubrium B. Mediastinum C. Sternum D. Xiphoid

B:CorrectThe interior of the chest is divided into three major spaces: the right and left pleural cavities and the mediastinum. The mediastinum, situated between the lungs, contains the heart and major blood vessels. The pleural cavities are lined with serous membranes (parietal and visceral pleurae), which enclose the lungs.

Which is often the cause of a pericardial friction rub? A. Inflammation of the AV and semilunar valves B. Inflammation of the pericardium C. Holosystolic murmur D. Protodiastolic gallop

B; CorrectA pericardial friction rub can be easily mistaken for cardiac-generated sounds. Inflammation of the pericardial sac causes a roughening of the parietal and visceral surfaces, which produces a rubbing machine-like sound audible on auscultation. It occupies both systole and diastole and overlies the intracardiac sounds.

Which factor increases the susceptibility of older adults to respiratory infection? A. Less elastic alveoli B. Drier mucous membranes C. Decreased tensile strength of the respiratory muscles D. Increased exposure to air pollution

B; CorrectAging mucous membranes tend to become drier, and older adults are less able to clear mucus. Retained mucus encourages bacterial growth and predisposes the older adult to respiratory infection.

Mr. Lynch has cyanotic lips and nailbeds. His lips are pursed, and he has nasal flaring. You suspect that he is suffering from cardiac or pulmonary difficulty. What other peripheral sign would support your impression? A. Callus formation on the heels B. Clubbing of the fingers C. Graying of the hair D. Swollen toes and ankles

B; CorrectObserve the lips and nails for cyanosis, the lips for pursing, the fingers for clubbing, and the alae nasi for flaring. Any of these peripheral clues suggests pulmonary or cardiac difficulty. Clubbing, enlargement of the terminal phalanges of the fingers and/or toes, is associated with emphysema, lung cancer, the cyanosis of congenital heart disease, or cystic fibrosis.

Molding of the infant's head is caused by: A. premature closure of the fontanels. B. shifting and overlapping of the skull bones during birth. C. subperiosteal edema. D. increased cerebrospinal fluid.

B; CorrectThe process of birth through the vaginal canal often causes molding of the newborn skull, during which the cranial bones may shift and overlap. Within days, the newborn skull usually resumes its appropriate shape and size.

A 22-year-old college student presents for a routine physical examination. Which finding would you expect on examination of the student's thyroid gland? A. The gland decreases when the student swallows. B. The right lobe is about a quarter larger than the left. C. A soft rushing sound is heard on auscultation of the gland. D. The glandular tissue feels gritty but free of nodules.

B; CorrectThe thyroid at its broadest dimension is approximately 4 cm, and the right lobe is often 25% larger than the left.

Where would you palpate a carotid pulse? A. Superior to the clavicle at the midclavicular line B. Superior and lateral to the cricoid cartilage C. Fingerbreadth above the suprasternal notch D. Inferior and medial to the angle of the jaw

D: CorrectThe carotid pulse is located just medial to and below the angle of the jaw.

The AP-to-lateral diameter ratio of the chest in infants is approximately: A. 1:2. B. 1:3. C. 2:1. D. 1:1.

D: CorrectThe chest of the newborn is generally round, the AP diameter approximating the lateral diameter, and the circumference is roughly equal to that of the head until the child is about 2 years old.

Mr. Babson is a 74-year-old man who presents to your office with a complaint of a "spot" on his chin and wants to know whether it is cancerous. Which of the following signs or symptoms indicates a need for further medical investigation? A. The "spot" is a reddish brown color. B. The "spot" has been on his chin for 20 years. C. The "spot" bleeds easily when it is touched. D. The "spot" is slightly raised and circumscribed.

C: CorrectA "spot" that bleeds easily when it is touched may be indicative of a more serious condition like basal cell carcinoma, the most common form of skin cancer.

Which type of examination are you performing when you identify a bruit? A. Observing chest movement B. Palpating an abdomen C. Auscultating an artery D. Inspecting the skin

C: CorrectA bruit is an unexpected audible swishing sound or murmur over an artery or vascular organ. Because a bruit is a sound, it is identified by auscultation.

Which is a defining characteristic of a cephalohematoma? A. Located over the occiput B. Margins are poorly defined C. Does not cross suture lines D. Gradually hardens with time

C: CorrectA cephalohematoma is a subperiosteal collection of blood and is therefore bound by the suture lines. It is commonly found in the parietal region and, unlike caput, may not be immediately obvious at birth. A cephalohematoma is firm, and its edges are well defined; it does not cross suture lines.

A palpable left supraclavicular lymph node is suggestive of which condition? A. Middle ear infection B. Mandibular abscess C. Abdominal malignancy D. Epstein-Barr mononucleosis

C: CorrectA palpable supraclavicular node on the left (Virchow node) is a significant clue to thoracic or abdominal malignancy.

The feel of "leather rubbing on leather" describes the sensation that may be palpable with: A. crepitus. B. vocal fremitus. C. pleural friction rub. D. tactile fremitus.

C: CorrectA palpable, coarse, grating vibration, usually on inspiration, suggests a pleural friction rub caused by inflammation of the pleural surfaces. Think of it as the feel of leather rubbing on leather.

A newborn should be inspected for jaundice using which of the following? A. Wood's light B. Fluorescent light C. Natural light D. Black light

C: CorrectAdequate lighting is essential when assessing the newborn. Daylight provides the best illumination for determining color variations, particularly jaundice. If daylight is unavailable or insufficient, supplement it with overhead fluorescent lighting. Inadequate lighting can result in inadequate assessment.

hordeolum (stye) is best described as a(n): A. infection of the eyelid. B. irritation and eversion of the eyelid. C. suppurative inflammation of the follicle of an eyelash. D. overgrowth of a Meibomian gland.

C: CorrectAn acute suppurative inflammation of the follicle of an eyelash can cause an erythematous or yellow lump. This hordeolum or stye is generally caused by a staphylococcal infection.

Which of the following characteristics differentiates an erosion from an ulcer? A. Color B. Diameter C. Depth D. Classification

C: CorrectAn erosion results from a loss of part of the epidermis and is depressed, moist, and glistening. It follows the rupture of a vesicle or bulla. An ulcer results from the loss of epidermis and dermis. It is concave and varies in size.

What happens to the electrical impulses as they pass through the atrioventricular (AV) node? A. They are converted to mechanical impulses. B. Their amplitude is augmented. C. They are slightly slowed down. D. They are selectively transmitted to the Purkinje node.

C: CorrectAn intrinsic electrical conduction system enables the heart to contract and coordinates the sequence of muscular contractions taking place during the cardiac cycle. The impulse originates in and is paced by the sinoatrial (SA) node, located in the wall of the right atrium. The impulse then travels through both atria to the AV node, located in the atrial septum. In the AV node, the impulse is delayed but then passes down the bundle of His to the Purkinje fibers, (heart muscle cells specialized for electrical conduction), located in the ventricular myocardium.

Mr. Jeffries is a 37-year-old carpenter who presents to your office with a complaint of visual disturbances. On examination, you notice inequality in pupil size which you identify as: A. mydriasis. B. esotropia. C. anisocoria. D. meiosis.

C: CorrectAnisocoria, inequality of pupillary size, is a common variation but may also occur in a large range of disease states.

Ms. Rodgers is a 21-year-old woman who presents to your office with a concern about skin cancer. She tells you that she sunbathes every summer at the shore and that her mother had skin cancer. Which of the following is not a risk factor for the development of skin cancer? A. Tendency to burn easily B. Light-colored hair or eyes C. Female gender D. Age older than 50

C: CorrectAnswers a, b, and d are risk factors for developing skin cancer, whereas answer c, being female, is not.

Breath sounds in young children that are loud, harsh, and bronchovesicular are associated with: A. an accumulation of fluid. B. malignant tumors or solid masses. C. normal, thin chest wall structures. D. pus-filled abscesses and tumors.

C: CorrectBecause of the thin chest wall, the breath sounds of the young child may sound louder, harsher, and more bronchial than those of the adult. Bronchovesicular breath sounds may be heard throughout the chest.

Which of the following helps differentiate caput succedaneum from cephalohematoma? A. Caput occurs over the parietal bones; cephalohematoma may occur anywhere. B. Caput is rarely seen in premature infants; cephalohematoma mostly occurs in premature infants. C. Caput crosses suture lines; cephalohematoma is bound by suture lines. D. Cephalohematoma is associated with brain injury; caput generally is not.

C: CorrectCephalohematoma is a subperiosteal collection of blood and is therefore bound by the suture lines. It is commonly found in the parietal region and, unlike caput, may not be immediately obvious at birth.

Mrs. Jones brings her 5-year-old son in for a well visit. As part of the child's examination you check for nystagmus. How do you do this? A. Assess visual acuity. B. Inspect the macula of the eye with an ophthalmoscope. C. Inspect movement of the eyes to the six cardinal fields of gaze. D. Palpate the globe while the child holds eyelids closed.

C: CorrectNystagmus refers to horizonatal, vertical or circular eye movements which are rapid, rhythmic, repetitious, and involuntary. Full movement of the eyes is controlled by the integrated function of the cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducens) and the six extraocular muscles. Do not be surprised to observe a few horizontal rhythmic movements (nystagmic beats) when checking eye movement.

Mr. Russel is a 17-year-old adolescent patient who presents with a complaint of acne. He asks the examiner why teens have more problems with acne than children. Which of the following would be an appropriate response? A. "Children have better hygiene habits than adolescents because of parental guidance." B. "Adolescents have reduced blood flow to the epidermal layer of the skin, making them more prone to infections." C. "At puberty, adolescents begin to secrete more oil from sebaceous glands." D. "Children have very little skin mass, which prevents development of acne."

C: CorrectDuring adolescence, the apocrine glands enlarge and become active, causing increased axillary sweating and sometimes body odor. Sebaceous glands increase sebum production in response to increased hormone levels, primarily androgen, giving the skin an oily appearance and predisposing the individual to acne.

Which examination finding may be indicative of a retro-orbital tumor? A. Episcleritis B. Argyll Robertson pupil C. Unilateral exophthalmos D. Retinitis pigmentosa

C: CorrectExophthalmos is bulging of eye anteriorly out of orbit. An eye that feels very firm and resists palpation may indicate severe glaucoma or retrobulbar tumor. When exopththalmos is unilateral, a retro-orbital tumor must be considered.

Ductus arteriosus is a defining characteristic of the fetal circulation. What is its function? A. Facilitates blood flow through the kidneys B. Increases blood supply to the liver C. Allows blood to bypass the lungs D. Diverts large amounts of oxygenated blood to the brain

C: CorrectFetal circulation, including the umbilical vessels, compensates for the nonfunctional fetal lungs. Blood flows from the right atrium into the left atrium via the foramen ovale. The right ventricle pumps blood through the patent ductus arteriosus rather than into the lungs.

Tactile fremitus is increased in conditions where there is: A. excess air in the lung tissue. B. an increased respiratory rate. C. an increase in lung tissue consolidation. D. concomitant crepitus.

C: CorrectGentle, more tremulous fremitus than expected occurs with some lung consolidations and some inflammatory and infectious processes.

Mr. Edwards is a 63-year-old patient with pleuritic pain and shallow respirations. What term describes abnormally shallow respirations as seen with limited excursion resulting from pleuritic pain? A. Bradypnea B. Hyperpnea C. Hypopnea D. Kussmaul breathing

C: CorrectHypopnea refers to abnormally shallow respirations (e.g., when pleuritic pain limits excursion).

Mrs. Bower is a 55-year-old patient who presents to your office with a complaint of fatigue. On palpating the precordium during her examination, a heave is identified with lateral displacement of the apical pulse. Which problem might this finding indicate? A. Mitral regurgitation B. Aortic stenosis C. Left ventricular enlargement D. Pericarditis

C: CorrectIf the apical impulse is more vigorous than expected, characterize it as a heave or lift. An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may indicate increased cardiac output or left ventricular hypertrophy.

Which is the correct technique for performing a fundoscopic examination with a PanOptic ophthalmoscope? Examin the patient's: A. right eye with your right eye, and the left eye with your left eye. B. right eye with your left eye, and the left eye with your right eye. C. right and left eyes with your dominant eye. D. right and left eyes with your nondominant eye.

C: CorrectIf using a PanOptic ophthalmoscope, you can use your dominant eye to examine both of the patient's eyes because of the increased distance between the patient and examiner. The focus wheel is adjusted with your thumb.

When palpating enlarged lymph nodes in a patient with tuberculosis, which finding would you expect? A. Warm, tender nodes B. Pulsating irregular nodes C. Body temperature, nontender nodes D. Hard, matted nodes

C: CorrectIn tuberculosis, the lymph nodes, often felt in the cervical chains, are usually body temperature, soft, matted, and not tender or painful.

Which finding indicates respiratory distress in the infant or young child? A. A respiratory rate of 30 breaths per minute B. An irregular respiratory pattern C. Observation of sternal and supraclavicular retractions with breathing D. Auscultation of bronchovesicular sounds throughout the lung field

C: CorrectInfants who have a narrow tracheal lumen from compression by a congenital malformation, tumor, abscess, or double aortic arch can develop stridor. Retraction at the supraclavicular notch and contraction of the sternocleidomastoid muscles indicates significant respiratory distress.

Which abnormality found when examing the eyes of a 12 year old can be indicative of nephrotic syndrome? A. Drusen spots B. Lid fasciculation C. Periorbital edema D. Xanthelasma

C: CorrectInspect the orbital and periorbital area for edema, puffiness, or redundant tissue below the orbit. Although puffiness may represent the loss of elastic tissue that occurs with aging, periorbital edema is always abnormal; the significance varies directly with the amount. It may represent the presence of thyroid eye disease, allergies, or (especially in youth) the presence of renal disease (nephrotic syndrome).

At which location would you auscultate to best assess the middle lobe of the right lung? A. Anterior chest B. Posterior chest C. Axilla D. Midclavicular line

C: CorrectListen systematically at each position throughout inspiration and expiration, taking advantage of a side-to-side comparison as you move downward from apex to base at intervals of several centimeters. The sounds of the middle lobe of the right lung and the lingula on the left are best heard in the respective axillae.

The major landmarks of the face are the: A. eyebrows, nose, and mouth. B. frontal, zygomatic, and ethmoid arches. C. palpebral fissures and nasolabial folds. D. orbital arches and mandibular angles.

C: CorrectMajor facial landmarks are the palpebral fissures and the nasolabial folds. Facial muscles are innervated by cranial nerve (CN) V and CN VII. The temporal artery is the major accessible artery of the face, passing just anterior to the ear, over the temporal muscle, and onto the forehead.

Which change in the cardiac cycle occurs when the heart rate increases? A. The intensity of S1 also increases. B. The frequency of S4 increases. C. The duration of diastole decreases. D. The intensity of S2 decreases.

C; CorrectDuring diastole, the ventricles dilate, drawing blood into the ventricles as the atria contract, thereby moving blood from the atria to the ventricles. When the heart is beating at a rate of 68 to 72 beats per minute, ventricular systole is shorter than diastole. As the rate increases to about 120 because of stress or pathologic factors, the two phases of the cardiac cycle tend to approximate each other in length.

Dullness to percussion in intercostal spaces suggests the presence of: A. cor pulmonale. B. empyema. C. pneumonia. D. sickle cell disease.

C: CorrectPneumonia is an inflammatory response of the bronchioles and alveoli to an infective agent (bacterial, fungal, or viral). When examining the patient, ask the patient to raise the arms overhead while you percuss the lateral and anterior chest. For all positions, percuss at 4- to 5-cm intervals over the intercostal spaces, moving systematically from superior to inferior and medial to lateral. Resonance, the expected sound, can usually be heard over all areas of the lungs. Hyperresonance associated with hyperinflation may indicate emphysema, pneumothorax, or asthma. Dullness or flatness suggests pneumonia, atelectasis, pleural effusion, pneumothorax, or asthma.

After examining a patient's eyes, you are documenting your findings. Which information would you include about a finding of ptosis? A. Severity of redness and injection of the lacrimal duct based on a range of 0 to 10 B. Number of millimeters separating the upper and lower lid when the eyes are closed C. Difference in millimeters between the position of the two upper lids relative to the limbus D. Degrees of eversion of the lower lid

C: CorrectPtosis indicates a congenital or acquired weakness of the levator muscle or a paresis of a branch of the third cranial nerve. Record the difference between the two lids in millimeters. The average upper lid position is 2 mm below the limbus (the border of the cornea and the sclera), and the average lower lid position is at the lower limbus.

Atrophy of the skin is associated with the development of which of the following lesions? A. Keloids B. Lichenification C. Striae D. Excoriations

C: CorrectSeveral variations in skin color occur in almost all healthy adults and children, including nonpigmented striae (i.e., silver or pink "stretch marks" that occur during pregnancy or weight gain), freckles in sun-exposed areas, some birthmarks, and some nevi. Atrophy of the skin involves thinning of the skin surface and loss of skin markings, resulting in a translucent and paper-like appearance. Examples of atrophy are striae and aging skin.

Stridor is usually the result of: A. a rapid collapse of lung tissue. B. air escaping from a traumatic wound to the chest. C. an obstruction high in the respiratory tree. D. uncontrolled coughing.

C: CorrectStridor is a high-pitched, piercing sound most often heard during inspiration. It is the result of an obstruction high in the respiratory tree.

What does a pulse amplitude of 2 indicate? A. Slightly diminished force B. Low to moderate force C. Expected force D. Full force

C: CorrectThe amplitude of the pulse is described on a scale of 0 to 4. Two is an expected force, with 0 indicating absent, 1 is diminished, 3 is full, and 4 is bounding.

The costal angle is generally no greater than: A. 45 degrees. B. 60 degrees. C. 90 degrees. D. 110 degrees.

C: CorrectThe angle formed by the costal margins at the sternum is usually no more than 90 degrees, with the ribs inserted at approximately 45-degree angles.

The costal angle is: A. located directly under the axillary lines. B. located at the most inferior edge of the rib cage. C. formed by the blending together of the costal margins at the sternum. D. formed by the blending together of the ribs at the vertebrae.

C: CorrectThe angle formed by the costal margins at the sternum. It is usually no more than 90 degrees, with the ribs inserted at approximately 45-degree angles.

Where would you place your stethescope to auscultate the aortic valve area? A. Fourth left intercostal space along the lower left sternal border B. Second left intercostal space at the left sternal border C. Second right intercostal space at the right sternal border D. Third left intercostal space at the left sternal border

C: CorrectThe aortic valve lies between the left ventricle and the aorta. There are five traditional auscultatory areas: aortic valve area, second right intercostal space at the right sternal border; pulmonic valve area, second left intercostal space at the left sternal border; second pulmonic area, third left intercostal space at the left sternal border; tricuspid area, fourth left intercostal space along the lower left sternal border; and mitral (or apical) area, at the apex of the heart in the fifth left intercostal space at the midclavicular line.

The apocrine gland responds primarily to which type of stimuli? A. Thermal B. Painful C. Emotional D. Environmental

C: CorrectThe apocrine glands are specialized structures found only in the axillae, nipples, areolae, anogenital area, eyelids, and external ears. These glands are larger and located more deeply than the eccrine glands. In response to emotional stimuli, the glands secrete a white fluid containing protein, carbohydrate, and other substances.

Diaphragmatic excursion may be slightly elevated on the right side because of the presence of: A. the spleen. B. the right middle lobe. C. the liver. D. the stomach.

C: CorrectThe diaphragmatic excursion is the movement of the thoracic diaphragm that occurs with inhalation and exhalation. The diaphragm is usually higher on the right than on the left because it sits over the bulk of the liver.

The eccrine glands are mainly responsible for: A. synthesis of eccrinolic acid. B. transport of body waste to the surface. C. regulation of body temperature. D. regulation of tissue growth and repair.

C: CorrectThe eccrine sweat glands open directly onto the surface of the skin and regulate body temperature through water secretion.

A 19-year-old man has a severe infection involving the fifth digit of the right hand. Where should the examiner expect to palpate enlarged and tender lymph nodes? A. Radial aspect of the wrist B. Palmar aspect of the hand C. Medial epicondyle of the humerus D. Left lower neck

C: CorrectThe epitrochlear lymph nodes drain the hand and lower arm. These nodes are located at the elbow in the groove between the biceps and triceps muscles proximal and slightly anterior to the medial epicondyle of the humerus.

Assuming that a newborn is not crying, you would expect a respiratory rate per minute of about: A. 10 to 20. B. 21 to 30. C. 40 to 60. D. 81 to 95.

C: CorrectThe expected rate varies from 40 to 60 respirations per minute, although a rate of 80 is not uncommon.

In which group would a slight enlargement of the thyroid gland on ultrasound be considered a normal finding? A. Infants B. Adolescents C. Pregnant women D. Frail elderly

C: CorrectThe fetal thyroid gland becomes functional in the second trimester. Before this time, the mother is the source of thyroid hormone, and pregnant women require increased iodine intake. As long as adequate iodine intake is maintained, the size of the thyroid will not change on physical examination. A slight enlargement may be detectible on ultrasound.

Which guideline will typically guide assessment of the lymph system? A. Assess the entire lymph system at once, exploring all accessible nodes. B. Assess both superficial and deep nodes, using palpation and a Doppler. C. Assess the lymph system region by region as each body system is assessed. D. Assess the lymph nodes when the patient's history suggests a need to do so.

C: CorrectThe lymphatic system is examined region by region during the examination of the other body systems (i.e., head and neck, breast and axillary, genitalia, and extremities) and by palpating the spleen. Sometimes you may perform a comprehensive lymphatic examination, exploring all the areas in which the nodes are accessible.

Which valve area are you listening to when you place your stethescope at the fifth left intercostal space at the midclavicular line? A. Tricuspid B. Pulmonic C. Mitral D. Aortic

C: CorrectThe mitral (or apical) value can be auscultated at the apex of the heart in the fifth left intercostal space at the midclavicular line.

Mr. Anthony is a 46-year-old patient who presents to your office with a history of thyroid dysfunction. Which maneuver will you ask him to perform while palpating his thyroid gland? A. Stick out the tongue. B. Cough deeply. C. Swallow. D. Say "ah."

C: CorrectThe patient is asked to swallow when the thyroid gland is being palpated because the thyroid gland moves with swallowing, whereas the subcutaneous fat that mimics a goiter does not.

Which patient demonstrates the highest risk factor for respiratory disability? A. A patient with a history of hypertension B. A child who has had a previous respiratory infection C. A patient with paraplegia D. An extremely thin female patient

C: CorrectThe patient may be less able to use the respiratory muscles because of muscle weakness, general physical disability, or a sedentary lifestyle. Being male or older; having a family history of respiratory compromise; having a history of smoking; and extreme obesity are additional barriers to normal respiratory functioning.

The primary muscle mass of the heart is formed by which of the following? A. Right ventricle and right atria B. Left ventricle and left atria C. Right and left ventricles D. Right and left atria

C: CorrectThe right and left ventricles together form the primary muscle mass of the heart.

Which of the following differentiates the venous system from the arterial system? A. Veins carry ventricular blood and arteries carry atrial blood. B. Veins transport nutrients and arteries transport waste material. C. Veins contain valves to keep blood flowing in one direction. D. Arteries can distend rapidly to serve as a reservoir for excess blood.

C: CorrectThe structure of the arteries and veins reflects their function. The arteries are thicker, with a greater smooth muscle layer and less ability to stretch and expand (distension) from internal pressure. They are subjected to much more pressure than are the veins. The veins are less sturdy and more distensible than the arteries. Venous return is less forceful than blood flow through the arteries, and veins contain valves to keep blood flowing in one direction. If blood volume increases significantly, the veins can expand and act as a repository for extra blood. This compensatory mechanism helps diminish stress on the heart.

Which person is most at risk for developing venous thrombosis? A person: A. who smokes one pack of cigarettes per day. B. with aortic valve insufficiency. C. on bed rest for 4 days after trauma. D. with rheumatoid arthritis.

C: CorrectThrombosis can occur suddenly or gradually and with varying severity of symptoms; it can be the result of trauma or prolonged immobilization such as related to bed rest, recent surgery, or a long airplane flight.

Mrs. Broad is a 34-year-old patient who presents for a routine examination. Which is an expected finding when observing the jugular venous pulse? A. A quick, sharp pulsation observed lateral to the trachea B. A ripple-like effect that follows the course of the vein up to the angle of the jaw when a person is placed in a 45-degree angle position C. Pulsations in a distended vein that may extend into the angle of the jaw when a person is lying supine D. A crisp, quick wave that increases and decreases with the respiration cycle

C: CorrectTo examine the jugular venous pulse, have the patient lie in a supine position. When the supine patient is initially placed flat, note the engorgement of the jugular veins. Gradually raise the head of the bed until the jugular venous pulsations become evident between the angle of the jaw and the clavicle. Palpating the carotid pulse helps identify the venous pulsations and distinguish them from the carotid pulsations.

Which is the best description of pectus carinatum? A. Horizontal ribs B. Indentation of the lower sternum C. Prominent sternal protrusion D. Displaced trachea

C: CorrectTwo common structural findings are pigeon chest (pectus carinatum), which is a prominent sternal protrusion, and funnel chest (pectus excavatum), which is an indentation of the lower sternum above the xiphoid process.

Mr. Kingman is a healthy 17 year old who presents with acute, severe chest pain. He has no history of illness or injury. Which cause of chest pain is the most logical problem to consider? A. Myocardial infarction B. Pulmonary embolus C. Cocaine use D. Unstable angina

C: CorrectUnlike in adults, chest pain in children and adolescents is seldom because of a cardiac problem. It is often difficult to find a cause, but trauma, exercise-induced asthma, and, even in a somewhat younger child, the use of cocaine should be among the considerations.

Vascular areas are predisposed to appear what color during periods of excitement or anxiety? A. Pale B. Yellow C. Red D. Blue

C: CorrectVascular areas appear red in color or erythematous because of increased cutaneous blood flow during periods of excitement or anxiety. Answers a, b, and d are present during other conditions.

Mrs. Torres presents to your office and states, "The calf of my left leg has been hurting a lot lately, especially when I move my foot up and down. It also seems more swollen than the other leg." Based on these symptoms, the examiner should suspect: A. hypertension. B. venous stenosis. C. venous thrombosis. D. arterial insufficiency.

C: CorrectVenous thrombosis can occur suddenly or gradually and with varying severity of symptoms. Mrs. Torres is displaying classic symptoms of venous thrombosis. It can be the result of trauma or prolonged immobilization.

In a newborn infant, a small chest-to-head size ratio is usually associated with: A. maternal diabetes. B. cocaine use during pregnancy. C. intrauterine growth retardation. D. a normal finding.

C: CorrectWhen examining the newborn, inspect the thoracic cage, noting size and shape; measure the chest circumference, which in the healthy full-term infant is usually about 30 to 36 cm, usually 2 to 3 cm smaller than the head circumference. This difference between the two increases with prematurity. An infant with intrauterine growth retardation will have a relatively smaller chest circumference compared with the head, whereas the infant of a mother with poorly controlled diabetes will have a relatively larger chest circumference.

Mr. Valen is a 28-year-old patient who presents to your office with a complaint of asymmetry of the mouth. The examiner should suspect a problem with: A. the facial nerve. B. the thyroid gland. C. the peripheral trigeminal nerve. D. the salivary duct.

C: CorrectWhen facial asymmetry is present, note whether all features on one side of the face are affected or only a portion of the face, such as the forehead, lower face, or mouth. Suspect facial nerve paralysis when the entire side of the face is affected, and suspect facial nerve weakness when the lower face is affected. If only the mouth is involved, suspect a problem with the peripheral trigeminal nerve.

Breath sounds normally heard over the trachea are called: A. bronchovesicular. B. amphoric. C. bronchial. D. vesicular.

C: correctBronchial or trachial (tubular) breath sounds are heard only over trachea. They are high pitched, loud, have long expirations, and are sometimes a bit longer than inspiration.

Mrs. Mills is a 61-year-old patient with chronic respiratory problems. Her laboratory results demonstrate a metabolic acidosis. The respiratory pattern typically exhibited by the patient with metabolic acidosis is called: A. platypnea. B. paroxysmal nocturnal dyspnea. C. Kussmaul breathing. D. Biot respiration.

C: correctKussmaul breathing, always deep and most often rapid, is the eponym applied to the respiratory effort associated with metabolic acidosis.

You have been assessing Ms. Tanner for suspected valvular problems. Which finding is consistent with severe tricuspid regurgitation? A. Early prominent C wave B. Late depressed v wave C. Holosystolic murmur in the tricuspid region D. Systolic murmur in the tricuspid region

C: correctTricuspid regurgitation is the backflow of blood into the right atrium during systole. A mild degree of tricuspid regurgitation can be seen in up to 75% of the normal adult population. Those with severe cases display a holosystolic murmer in the tricuspid region.

Ms. Randolph, who is 74 years of age, has no known health problems or diseases. You are doing a preventive health care history and examination. Which finding is a structural variation with limited clinical significance? A. Barrel chest B. Clubbed fingers C. Pectus carinatum D. Retractions

C: correctTwo common structural findings are pigeon chest (pectus carinatum), which is a prominent sternal protrusion, and funnel chest (pectus excavatum), which is an indentation of the lower sternum above the xiphoid process.

For which problem are you checking when you ask a patient to stand on the toes 10 times in succession and then palpate the leg for venous distention, noting how rapidly the distention disappears? A. Deep venous thrombosis B. Atherosclerosis C. Varicose veins D. Arterial obstruction

C: correctWith varicosities, the veins appear dilated and often tortuous. If varicose veins are suspected, have the patient stand on the toes 10 times in succession. Palpate the legs to feel the venous distention. When the venous system is competent, the distention of the veins disappears in a few seconds. If the distention of the veins is sustained for a longer time, suspect venous insufficiency.

Which approach provides the most objective basis for determining if a patient is developing a facies associated with a particular condition or syndrome? A. Ask the patient to describe recent changes in appearance. B. Ask a family member of the patient if any changes in appearance have been noted. C. Ask the patient to show you an old photograph of himself or herself. D. Ask the patient about any changes in body image or self-esteem.

C:CorrectFacies is defined as an expression or appearance of the face and features of the head and neck that, when considered together, is characteristic of a clinical condition or syndrome. One way to better appreciate these changes is to ask the patient to provide an old photograph of himself or herself.

Which events occur during the systolic phase of the cardiac cycle? A. The atria contract and the ventricles relax. B. The atria and the ventricles contract. C. The ventricles contract and the atria relax. D. The right side of the heart contracts and the left side relaxes.

C:CorrectThe heart contracts and relaxes rhythmically, creating a two-phase cardiac cycle. During systole, the ventricles contract, ejecting blood from the left ventricle into the aorta and simultaneously from the right ventricle into the pulmonary artery.

Which structure transports and filters air? A. Acinus B. Acromion C. Bronchus D. Stroma

C:CorrectThe tracheobronchial tree is a tubular system that provides a pathway along which air is filtered, humidified, and warmed as it moves from the upper airway to the alveoli.

Which of the following techniques helps the examiner determine whether a palpable skin mass is filled with fluid? A. Using a Wood's lamp B. Biopsy C. Transillumination D. Noting the odor of the lesion

C:CorrectTransillumination may be used to determine the presence of fluid in cysts and masses. Fluid-filled lesions will transilluminate with a red glow, whereas solid lesions will not.

A patient has an undiagnosed tumor in the middle lobe of the right lung, which has caused atelectasis. Which finding would alert the examiner to the possibility of this problem? A. A low-pitched grating sound heard during inspiration and expiration B. Hyperresonance in the right middle lobe C. Diminished or absent breath sounds over the area of the right middle lobe D. Coarse crackles auscultated throughout the lung field

C; CorrectAtelectasis is the incomplete expansion of the lung at birth or the collapse of the lung at any age. The area of the lung affected by atelectasis is airless and therefore breath sounds heard over the area are diminished or absent.

A 45-year-old man tells you that he often has headaches in the evening that feel like a band is being tightened around his head. These characteristics are indicative of which type of headache? A. Classic migraine B. Cluster C. Tension D. Hypertensive

C; CorrectMuscular tension headaches can occur at anytime but usually present in the afternoon or evening. Patients often report bandlike constriction with stress, anger, or bruxism.

Which is a pregnancy-associated change that occurs within the cardiovascular system? A. Significant electrocardiographic (ECG) changes related to stress testing B. Decrease in cardiac output C. Increase in blood volume D. Axis rotation resulting in dextrocardia

C; CorrectThe maternal blood volume increases 40% to 50% over the prepregnancy level. The rise mainly is due to an increase in plasma volume, which begins in the first trimester and reaches a maximum after the 30th week.

Mrs. Wolf is a 48-year-old patient who presents to your office with a complaint of chest pain. On examination, you note a murmur of medium pitch that fills systole. It is heard best at the apex and along the left sternal border. Which is a cause of these clinical findings? A. Aortic regurgitation B. Tricuspid stenosis C. Subaortic stenosis D. Mitral stenosis

C; CorrectThe murmur associated with subaortic stenosis is heard at the apex and along the left sternal border. The murmer fills systole, is a diamond-shaped, medium-pitched coarse thrill that is often palpable during systole at the apex and the right sternal boarder.

On meeting a new patient, you observe a nodding movement of the patient's head. Based on this observation, what assessment should you include as part of your examination of the patient? A. Auscultation of the parietal region of the skull for a bruit B. Percussion of the frontal bone for dullness C. Check for synchronization of the nod and the pulse D. Determination of arc of the nod

C; CorrectThe patient's head should be upright and still. A horizontal jerking or bobbing motion may be associated with a tremor; a nodding movement may be associated with aortic insufficiency, especially if the nodding is synchronized with the pulse.

How should the supraclavicular lymph nodes be assessed? A. Place the patient in a supine position, and ask the patient to hold his or her breath. B. Place the patient in the Trendelenburg position and illuminate the lymph nodes with a bright light. C. Palpate deeply behind the clavicles as the patient flexes his head forward. D. Palpate lightly below the clavicles with the patient in a sitting position.

C; CorrectTo palpate for supraclavicular lymph nodes, the examiner encourages the patient to relax the musculature of the upper extremities so that the clavicles drop. The examiner's free hand is used to flex the patient's head forward to relax the soft tissues of the anterior neck. The fingers are hooked over the clavicle lateral to the sternocleidomastoid muscle.

When examing a neonate, a thrill is felt over the lower left sternal border. This finding is consistent with which anomaly? A. Atrial septic defect B. Ventricular septal defect C. Patent ductus arteriosus D. Tetralogy of Fallot

D: CorrectTetralogy of Fallot is a congenital heart condition composed of four cardiac defects: ventricular septal defect, pulmonic stenosis, dextroposition of the aorta, and right ventricular hypertrophy. A common finding is a thrill during systole appreciated at the left lower sternal boarder.

Which statement best differentiates crackles from wheezes? A. Crackles are heard on inspiration, wheezes on expiration. B. Crackles are head with a bell, wheezes with a diaphragm. C. Crackles are heard in the upper lobes, wheezes in the lower lobes. D. Crackles are discontinuous sounds, wheezes continuous sounds.

D: CorrectA crackle is an abnormal respiratory sound heard more often during inspiration and characterized by discrete discontinuous sounds, each lasting just a few milliseconds. The individual noise tends to be brief and the interval to the next one similarly brief. Crackles are discontinuous; rhonchi and wheezes are continuous.

A keloid is characterized by which of the following? A. Rough, thickened epidermis B. Linear crack in the skin C. A large nodule greater than 5 cm in diameter D. An irregularly shaped, elevated, and enlarging scar

D: CorrectA keloid is an irregularly shaped, elevated, progressively enlarging scar that grows beyond the boundaries of the wound. Keloids are caused by excessive collagen formation during healing.

Mrs. Tubbs is a 42-year-old patient who presents to your office for a routine follow-up. Which is the best technique for hearing low-pitched filling sounds of the heart? A. Place the patient in supine position and listen with the bell of the stethoscope. B. Place the patient in a sitting position and listen with the diaphragm of the stethoscope. C. Place the patient in a sitting position and listen with the bell of the stethoscope. D. Place the patient in a left lateral recumbent position and listen with the bell of the stethoscope.

D: CorrectA thorough examination of the heart requires the patient to assume a variety of positions: sitting erect and leaning forward, lying supine, and being in the left lateral recumbent position. To best hear the low-pitched filling sounds in diastole, place the patient in left, lateral recumbant position and listen with the stethoscope

In which group is a jugular venous hum an ordinarily expected examination finding? A. Older adults B. Pregnant women C. Native Americans/American Indians D. Children

D: CorrectA venous hum, common in children, usually has no pathologic significance. It is caused by the turbulence of blood flow in the internal jugular veins.

Adults have two types of hair, which are identified as: A. primary and secondary. B. terminal and original. C. vellus and telogus. D. terminal and vellus.

D: CorrectAdults have both vellus and terminal hair. Vellus hair is short, fine, soft, and nonpigmented. Terminal hair is coarser, longer, thicker, and usually pigmented.

Which is a key indication of lower airway obstruction in a 2 year old? A. Barking cough B. Stridor C. Asymmetric chest movement D. Audible expiratory grunt

D: CorrectAn audible expiratory grunt can indicate lower airway obstruction or focal atelectasis.

Which information should be included in the history of a patient with asthma? A. Family members with asthma B. Onset and duration of the current problem C. Allergy skin test results D. All of the above

D: CorrectAsthma is a small airway obstruction caused by inflammation and hyperreactive airways. Answers a-c should be asked of patients with asthma as the responses to questions about these topics provide clues for focusing the physical examination and the development of an appropriate diagnostic evaluation.

You note when examining a 62-year-old patient that when she closes her eyes, the lids tremor. This finding would cause you to carefully assess for other symptoms of which disorder? A. Bell's palsy B. Pituitary tumor C. Acoustic neuroma D. Hyperthyroidism

D: CorrectExamine the patient's lightly closed eyes for fasciculations or tremors of the lids, a sign of hyperthyroidism.

Which would be an expected finding when palpating the adult chest? A. A costal angle of 100 degrees B. Crackling over the sternal notch C. Greater right chest expansion D. Inflexibility of the xiphoid

D: CorrectExpect bilateral symmetry and some elasticity of the rib cage, but the sternum and xiphoid should be relatively inflexible and the thoracic spine rigid.

Fetal gas exchange is mediated by the: A. lungs. B. heart. C. amniotic fluid. D. placenta.

D: CorrectFetal gas exchange is mediated by the placenta. Relatively passive respiratory movements occur throughout gestation; they do not open the alveoli or move the lung fields.

The lymphatic system plays an integral role in which of the following body processes? A. Maintenance of fluid balance B. Infection control C. Absorption of fat D. All of the above

D: CorrectFunctions of the lymphatic system include conserving fluid and plasma that leak from capillaries, defending the body against disease as part of the immune system, absorbing lipids from the intestinal tract, protecting the body from the antigenic substances of invading organisms, removing damaged cells from the circulation, and providing a partial, but often inefficient, barrier to the maturation of malignant cells within the body.

A disruption to the flow of blood into, through, or out of the heart produces which cardiac sound? A. Protodiastolic gallop B. Friction rub C. Extra heart sound (S3/S4) D. Murmur

D: CorrectHeart murmurs are relatively prolonged extra sounds heard during systole or diastole. They often indicate a problem. Murmurs are caused by some disruption in the flow of blood into, through, or out of the heart.

What structure can be displaced by atelectasis, pleural effusion, or thyroid enlargement? A. Aorta B. Esophagus C. Sternum D. Trachea

D: CorrectIn atelectasis the trachea deviates ipsilaterally. Thyroid enlargement or pleural effusion may cause the trachea to deviate away from the affected side. Pneumothorax can make the trachea go either way depending on whether there is a tension pneumothorax. In this case, pressure builds up on the side of the collapsed lung, and the deviation is away from the affected side. In contrast, with a simple collapsed lung, the trachea deviates to the affected side.

Mrs. Vallens brings her young child in for a routine checkup. On examination, you notice a pulse that is stronger in the upper extremities than it is in the lower extremities. Which of the following is suggested by this clinical finding? A. Patent ductus arteriosus B. Tetralogy of Fallot C. Corrigan pulse D. Coarctation of the aorta

D: CorrectIn coarctation of the aorta, a difference is noted in pulse amplitude between the upper extremities or between the femoral and radial pulses, or the femoral pulses are absent.

The right and left scapular lines are located: A. superior to each scapula. B. inferior to each scapula. C. lateral to the midaxillary lines. D. parallel to the vertebral line.

D: CorrectIn conjunction with the anatomic landmarks of the chest, the following imaginary lines on the surface will help localize the findings on physical examination to include the right and left scapular lines, which are parallel to the vertebral line, through the inferior angle of the scapula when the patient is erect.

Mrs. Young has brought her 2-year-old son in for a routine examination. On examination, you elicit a white reflex rather than a red reflex in her son. This indicates: A. congenital glaucoma. B. myosis. C. retinopathy. D. retinoblastoma.

D: CorrectInitial sign of retinoblastoma is leukocoria, a white reflex (also called a cat's eye reflex) rather than the usual red reflex.

Mr. Harold is a 47-year-old patient who presents to your office with a complaint of fatigue. The examiner is palpating the superior superficial inguinal lymph nodes on Mr. Harold. Where is the examiner palpating? A. At the lateral aspect of the groin B. Just above the groin along the base of the pelvic bone C. Between the femoral artery and femoral vein D. In the groin over the inguinal canals

D: CorrectLymph nodes usually occur in groups. Superficial nodes are located in subcutaneous connective tissues, and deeper nodes lie beneath the fascia of muscles and within the various body cavities. The superior superficial inguinal (femoral) nodes are close to the surface over the inguinal canals. The inferior superficial inguinal nodes lie deeper in the groin.

Which of the following lesion characteristics differentiates a macule from a papule? A. Diameter B. Contents C. Color D. Elevation

D: CorrectMaculaes are flat, circumscribed areas that change the color of the skin. Papules are elevated, firm, circumscribed areas of the skin. Both are less than 1 cm in diameter.

The usual landmark at which the examiner percusses for the lower border of diaphragmatic excursion is the: A. sternum. B. midvertebral line. C. midaxillary line. D. scapular line.

D: CorrectMeasure the diaphragmatic excursion, the movement of the thoracic diaphragm that occurs with inhalation and exhalation. The following steps suggest one approach to measuring the diaphragmatic excursion: Ask the patient to take a deep breath and hold it; percuss along the scapular line until you locate the lower border, the point marked by a change in note from resonance to dullness; and mark the point with a marking pen at the scapular line.

Mrs. Janker is a 58-year-old patient who presents to your office with recurrent respiratory problems. You best assess the quality of tactile fremitus by palpating at which location? A. Along the costal margin and xiphoid process B. In the suprasternal notch along the clavicle C. Parasternally at the second intercostal space D. Posterolaterally beneath the scapula

D: CorrectNote the quality of the tactile fremitus, the palpable vibration of the chest wall that results from speech or other verbalizations. Fremitus is best felt posteriorly and laterally at the level of the bifurcation of the bronchi. Two methods for evaluating tactile fremitus are with the palmar surface of both hands and with the ulnar aspect.

Which examination technique would you use when checking for Chvostek sign? A. Inspection B. Auscultation C. Palpation D. Percussion

D: CorrectPercussion of the head and neck is not routinely performed. One exception is when evaluating for hypercalcemia; percussion on the masseter muscle may produce a hyperactive masseteric reflex, Chvostek sign.

Which type of apnea is least worrisome? A. Primary apnea B. Secondary apnea C. Apneustic breathing D. Periodic apnea of the newborn

D: CorrectPeriodic apnea of the newborn is a normal condition characterized by an irregular pattern of rapid breathing interspersed with brief periods of apnea.

S1 is a ______________ sound that is heard the loudest at the _____________of the heart. A. diastolic; base B. systolic; base C. diastolic; apex D. systolic; apex

D: CorrectS1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. S1, which results from closure of the mitral and tricuspid (atrioventricular [AV]) valves, indicates the beginning of systole. It is best heard toward the apex, where it is usually louder than S2.

Mr. Lukas is a 48-year-old patient with diabetes and hypertension. Which heart sound heard on auscultation suggests a pathologic condition and requires additional evaluation? A. Split S1 B. Split S2 C. Soft S3 D. Loud S4

D: CorrectS3 and S4 may or may not be present. Their absence is not an unusual finding, and their presence does not necessarily indicate a pathologic condition. Thus, evaluate S3 and S4 in relation to other sounds and events in the cardiac cycle. A loud S4 always suggests a pathologic condition and deserves additional evaluation.

Mr. Tucker is a 65-year-old patient who presents to your office with a complaint of right-sided, throbbing headache, usually occurring in the morning. On examination, you note the presence of thickening and tenderness of the temporal artery. Which of the following best describes these findings? A. Cluster headache B. Occipital arteritis C. Migraine headache D. Temporal arteritis

D: CorrectTemporal arteritis is characterized by daily, throbbing headache, which can be unilateral or bilateral and last hours or days. It occurs in older adults. A bruit is highly suggestive of a vascular anomaly and can be associated with temporal arteritis.

Which is a reason why the diaphragm of the stethoscope is better than the bell for auscultation of the lungs? A. Amplifies all types of sounds B. Filters extraneous sounds C. Pinpoints focal sound areas D. Transmits high-pitched sounds

D: CorrectThe diaphragm of the stethoscope is usually preferable to the bell for listening to the lungs because it transmits the ordinarily high-pitched sounds better and because it provides a broader area of sound.

Which measure of jugular venous pressure is outside the expected normal limits? A. 3 cm H2O B. 6 cm H2O C. 9 cm H2O D. 12 cm H2O

D: CorrectThe examiner would expect to see a value less than 9 when examining jugular venous pressure. This is the normal expected value.

The jugular venous pulse is: A. a reflection of left-sided heart activity. B. an indirect measurement of systemic blood pressure. C. a direct measurement of ventricular contractility. D. a reflection of right-sided heart activity

D: CorrectThe jugular pulse is reflected back from the right side of the heart rather than pushed forward by the left side of the heart. The level at which the jugular venous pulse is visible gives an indication of right atrial pressure.

The tonsils located near the base of the tongue are the: A. laryngeal tonsils. B. pharyngeal tonsils. C. palatine tonsils. D. lingual tonsils.

D: CorrectThe lingual tonsils are located near the base of the tongue. Defensive responses to inhaled and intranasal antigens are activated in these tissues.

Mrs. Harris brings her 12-year-old daughter with Down syndrome to your office for a follow-up examination. Which of the following skin characteristics is associated with Down syndrome? A. Acrocyanosis B. Supernumerary nipples C. Mongolian spots D. Simian line (crease)

D: CorrectThe most commonly recognized pattern seen in children with Down syndrome is a single transverse crease in the palm.

Which two muscles allow movement and provide support to the head and neck? A. Pectoralis and coracobrachial B. Trapezius and pectoralis C. Sternocleidomastoid and coracobrachial D. Trapezius and sternocleidomastoid

D: CorrectThe neck is formed by the cervical vertebrae, ligaments, and sternocleidomastoid and trapezius muscles, which give it support and movement.

What is the fibrous sac that encases and protects the heart called? A. Mediastinum B. Precordium C. Endocardium D. Pericardium

D: CorrectThe pericardium is a tough, double-walled, fibrous sac encasing and protecting the heart.

A 6-month-old infant is brought to the clinic for immunizations. While examining the baby, the examiner notes that the anterior fontanel has not closed. What is the significance of this finding? A. This indicates a slight developmental delay. B. This suggests a nutritional deficiency. C. This is consistent with hydrocephaly. D. This is a normal finding.

D: CorrectThe posterior fontanel usually closes by 2 months of age and the anterior fontanel by 12 to 15 months of age.

Mr. Wilson is a 68-year-old gentleman who presents to your office for a routine examination. Which finding would be considered an expected effect of aging? A. Narrowed palpebral fissures B. Pulsating fontanels C. Uneven movement of the tongue D. Fibrosis of the thyroid gland

D: CorrectThe rate of T4 production and degradation gradually decreases with aging, and the thyroid gland becomes more fibrotic.

Mrs. Becker is a 68-year-old patient who presents to your office. On examination, you palpate a fibrotic, irregular thyroid. What is your primary conclusion about this finding? A. The thyroid needs further examination. B. A malignancy is likely. C. An autoimmune disease is likely. D. This is a normal finding in an older adult.

D: CorrectThe rate of T4 production and degradation gradually decreases with aging, and the thyroid gland becomes more fibrotic.

How would you differentiate between a respiratory and a cardiac friction rub? A. Compare the sounds heard through the anterior and posterior chest. B. Determine if the sound is louder on inspiration or expiration. C. Compare sounds at rest and after running in place to increase the pulse. D. Listen to the chest while the patient holds his or her breath.

D: CorrectThe respiratory rub disappears when the breath is held; the cardiac rub does not.

As the chest of a newborn is examined, bowel sounds are auscultated in the chest. What is the significance of this finding? A. This is a normal finding in newborns. B. This is an abnormal, but benign, finding in children until 2 years of age. C. This is abnormal and possibly indicates an enlarged liver. D. This is abnormal and possibly indicates a diaphragmatic hernia.

D: CorrectThe result of an imperfectly structured diaphragm occurs once in slightly more than 2000 live births. It is suspected if gastrointestinal gurgling sounds are persistently heard in the chest, but wide transmission of these sounds can sometimes be deceptive.

The best time to evaluate vocal resonance on a young child is while the child is: A. lying down, asleep. B. lying down, awake. C. sitting quietly in a parent's lap. D. crying.

D: CorrectThe spoken voice transmits sounds through the lung fields that may be heard with the stethoscope. Seize the opportunity that a crying child presents. A sob is often followed by a deep breath. The sob itself allows the evaluation of vocal resonance.

The isthmus of the thyroid gland lies just below which of the following structures? A. Hyoid bone B. Thyroid cartilage C. Pyramidal cartilage D. Cricoid cartilage

D: CorrectThis isthmus lies across the trachea below the cricoid cartilage. A pyramidal lobe, extending upward from the isthmus and slightly to the left of midline, is present in about one third of the population.

During pregnancy, which of the following occurs to create increased susceptibility to infection? Shift from: A. immunocompetent to effector-mediated immunity B. effector immunity to cell-mediated immunity C. antibody production to cell-mediated immunity D. cell-mediated to antibody production

D: CorrectUterine contractility decreases and macrophages produce cytokines beneficial to growth of the trophoblast. A balance results. The shift from cell-mediated immunity to antibody production/humoral immunity results in increased maternal susceptibility to certain infectious diseases. However, pregnancy can lead to remission of maternal autoimmune/inflammatory diseases (e.g., rheumatoid arthritis).

When sound is intensified, there is a nasal quality to the voice, and es sound like as. This is called: A. resonance. B. bronchophony. C. pectoriloquy. D. egophony.

D: CorrectWhen the intensity of the spoken voice is increased and there is a nasal quality (e.g., es become stuffy, broad as), the auditory quality is called egophony.

Mr. Booker is a 44-year-old patient who presents for routine examination. On examination, you suspect an enlarged lymph node but are unsure. Which examination method is used to differentiate an enlarged lymph node from a cyst? A. Palpation B. Auscultation for a bruit C. Biopsy D. Transillumination

D: CorrectWhen you are uncertain of the nature of the findings, check whether any large mass transilluminates; as a rule, nodes do not and fluid-filled cysts do.

Mrs. Yates presents to your office with a 3-month-old infant for examination. During your examination, you note white specks scattered in a linear pattern around the circumference of the iris. Which of the following would best identify this condition? A. Lipemia, suggesting hyperlipidemia remaining from the mother after birth B. Enlarged corneas, suggesting congenital glaucoma C. Coloboma, suggesting congenital abnormalities D. Brushfield spots, suggesting Down syndrome or mental retardation

D: CorrectWhite specks scattered in a linear pattern around the entire circumference of the iris, called Brushfield spots, strongly suggest Down syndrome.

The patient tells the examiner, "I have been coughing up a lot of yellowish-green phlegm." The examiner should suspect: A. viral infection. B. tuberculosis. C. pulmonary edema. D. bacterial pneumonia.

D: CorrectYellow-green sputum is an example of a characteristic that can aide the examiner in making a differential diagnosis of bacterial infection like pneumonia.

Mrs. Alexander is a 36-year-old patient who has asthma. On auscultation of the lungs, you hear a musical squeaking noise. What term do you use when documenting this finding? A. Friction rub B. Rales C. Rhonchi D. Wheezing

D: correctWheezing is a musical noise sounding like a squeak most often heard continuously during inspiration or expiration, usually louder during expiration.

Mrs. Housman is a 55-year-old woman with dark skin. She is concerned about her liver because she has had hepatitis in the past. In which of the following areas would jaundice be easiest to detect? A. Deep inner folds of the skin B. Earlobes C. Nasal turbinates D. Sclera

D:CorrectColor hues in dark-skinned persons are best seen in the sclera, conjunctiva, buccal mucosa, tongue, lips, nail beds, and palms. Be aware, however, that heavily callused palms in dark-skinned persons have an opaque yellow cast.

Mrs. Tomberg brings her 4-day-old infant to your office with a concern of a yellowish skin tone. Which of the following statements best describes the rationale for the skin tone? A. Increased formation of subcutaneous tissue causes a yellow hue. B. Capillaries broken during the birth process turn the skin slightly yellow as bruises heal. C. The yellowish color results from increased fat metabolism and heat production. D. The infant has hyperbilirubinemia.

D:CorrectHyperbilirubinemia, or physiologic jaundice, is present to a mild degree in many newborn infants. It usually starts after the first day of life and disappears by the eighth to tenth day but may persist for as long as 3 to 4 weeks. Intense and persistent jaundice suggests liver disease, a hemolytic process, or severe, overwhelming infection.

The examiner notes hyperkeratosis on a patient's palms and soles. The examiner recognizes that this: A. may be a sign of a systemic disorder. B. may be an indication of a congenital heart defect. C. is commonly found among individuals with Down syndrome. D. is considered a normal finding.

D:CorrectHyperkeratosis or callus is a superficial area that occurs on the weight-bearing areas of the feet and on the palmar surface of the hands. Calluses are less well demarcated than corns and are usually not tender.

Which of the following findings suggests that a patient has a fungal infection of the nail beds? A. The nail bed is wide and thick. B. The nail plate has a central depression, causing a spoon appearance. C. Superficial white spots are present in the nail plate. D. The nail plate is yellow and crumbling.

D:CorrectOnychonyocosis is a fungal infection of the nail that commonly presents as a crumbling as the fungus grows.

While examining the skin of an 87-year-old woman, the nurse observes significant tenting. Which of the following best explains that finding? A. Small tags of skin form on the neck. B. The skin becomes thin and takes on a parchment-like appearance. C. The skin becomes dry with significant flaking. D. There is a loss of adipose tissue and elasticity.

D:CorrectTenting occurs in the older adult as a result of loss of adipose tissue and elasticity. The skin often appears to hang loosely on the bony frame as a result of a general loss of elasticity, loss of underlying adipose tissue, and years of gravitational pull.

A patient with diabetes presents to the clinic complaining of an infected foot. On removing the patient's sock, the examiner notes an odor that resembles rotting apples. What type of infection is this consistent with? A. Pseudomonas infection B. Peritonitis C. Anaerobic infection D. Clostridium gas gangrene

D:CorrectThe skin, like other body parts, may have odors suggesting a variety of problems: infectious, metabolic, or neurologic. The smell of rotting apples usually indicates Clostridium gas gangrene.

Mrs. Baker brings in her 5-year-old daughter for a routine examination. On examination, you note a systolic ejection murmur that is loud, harsh, and high in pitch heard over the second intercostal space along the left sternal border. Which problem should you suspect? A. Mitral valve prolapse B. Mitral valve stenosis C. Coarctation of the aorta D. Atrial septal defect

D; CorrectCongenital defect in the septum dividing the left and right atria charaterized by diamond-shaped systolic ejection murmur, often loud, high pitched, and harsh, heard over the pulmonic area and may be accompanied by a brief, rumbling, early diastolic murmur.

Which instruction would you give a patient during inspection of his or her neck? A. Hold your breath. B. Clench your teeth. C. Look up toward the ceiling. D. Swallow.

D; CorrectInspect the neck in the usual anatomic position, in slight hyperextension, and as the patient swallows.

Mr. Becker is a 59-year-old patient who presents to your office with chronic respiratory problems. What term would you use to document a respiratory rate greater than 20 per minute in this patient? A. Dyspnea B. Orthopnea C. Platypnea D. Tachypnea

D; CorrectTachypnea is a persistent respiratory rate greater than 20 breaths per minute in an adult. Confirm that the respiratory rate is persistent.

Which of the following is the function of the lens? A. Converts light impulses into electrical impulses for image formation B. Controls the amount of light entering the eye C. Coordinates eye movement D. Permits images from varied distances to be focused on the retina

D; CorrectThe lens is a biconvex, transparent structure located immediately behind the iris. It is supported circumferentially by fibers arising from the ciliary body. The lens is highly elastic, and contraction or relaxation of the ciliary body changes its thickness, thereby permitting images from varied distances to be focused on the retina.

During what age period is the xiphoid process more prominent, more moveable, and more cartilaginous? A. Adolescence B. Adulthood C. Older adulthood D. Infancy

D; CorrectThe newborn's xiphoid process is more mobile and prominent than that of the older child or adult. It has a sharp inferior tip that moves slightly back and forth under your finger. The relatively thin chest wall of the infant and young child makes the bony structure more prominent than in the adult. It is more cartilaginous and yielding, and the xiphoid process is often more prominent and more movable.

The outer layer of the eye is composed of the sclera posteriorly and the _______________anteriorly. A. choroid B. lens C. conjunctiva D. cornea

D; CorrectThe outer wall of the eye is composed of the sclera posteriorly and the cornea anteriorly.

The examiner notes enlarged tonsils in a young child. The examiner should recognize that this: A. is an indication of a retropharyngeal abscess. B. may be an early indication of Epstein-Barr virus. C. is an indication that the child has lymphoma. D. may be a normal finding.

D; CorrectThe palatine tonsils are commonly referred to as "the tonsils." Small and diamond shaped, they are set between the palatine arches on either side of the pharynx just beyond the base of the tongue. The palatine tonsils may be enlarged in children; this in itself is not a problem.

What are you checking when you perform an Allen test on a patient? A. Response of arterial blood flow to exercise B. Tolerance of the venous system to compression C. Risk for thrombophlebitis D. Patency of the ulnar artery

D; CorrectThis test assesses the patency of the ulnar artery.

When would you perform the Allen test on a patient? A. Before drawing blood from the ulnar artery B. After C. In preparation for D. Before insertion of a radial artery catheter

D; CorrectThis test assesses the patency of the ulnar artery. Perform this test before radial artery puncture for arterial blood gas sampling or the insertion of a radial arterial catheter.