Assessment Final

1. As part of a routine checkup, you are examining the prostate of a 55 y/o man. He denies nocturia and urinary hesitancy. On physical exam, you palpate the prostate gland and feel a mass. Which of the following descriptors would you use to characterize this mass?

Color

Size

Presence of Discharge

Presence of Rash

2. What is the preferred order for examination of the abdomen?

Inspection, auscultation, percussion, palpation

Percussion, auscultation, palpation, inspection

Auscultation, inspection, palpation, percussion

Inspection, palpation, auscultation, percussion

3. What is Ascites?

Accumulation of fluid in the peritoneal cavity.

An abnormally high level of bilirubin in the blood leading to golden brown coloration of urine.

Yellow discoloration of the sclera

An abnormally large palpable liver.

4. In a healthy adult, the respiratory rate is:

4 to 14 breaths per minute

14-16 breaths per minute

14 - 20 breaths per minute

26-40 breaths per minute

5. How would you properly auscultate lung sounds?

Directly compare one lobe to the other, auscultating while moving your stethoscope back and forth across the chest.

Assess entire left side before moving on to assess right side.

Start at top, then work your way down. You only need to listen posteriorly.

However the heck I want to do it.... it doesn't matter as long as i auscultate it.

6. You are up on the floor doing rounds and walk into the room of a 72 yr old female. She is sitting up in a chair, hands on her knees and leaning slightly forward, and pursing her lips when she exhales. You look at her Past Medical history and are not at all surprised to see she has....

Pneumonia

Emphysema

Croup

Bronchitis

7. Which one of the following positions is acceptable for examining the anus and rectum?

Patient lying down on his or her side on the examining table

Patient sitting down with arms forward, leaning over the examining table

Patient standing upright with feet together and arms extended

Patient sitting upright with arms braced backward

8. A 25 year old truck driver presents to the ER for evaluation of pain in his left groin. He has noticed that the pain increases after lifting several boxes, each weighing more than 100 lbs, to fill up his truck. He has had this pain intermittently over the past 5 years, but it has gone away on its own. He is here because the pain has not gone away, and he is becoming nauseated. He denies fever, chills, constipation, or diarrhea. He denis urethral discharge; he is married and states he is faithful to his wife. On physical examination of the left testicular area, you note there is a buldge when you palpate the inguinal canal as you ask the patient to strain. You listen to the left testicular area and hear bowel sounds. Your most likely diagnosis is:

Appendicitis

Testicular torsion

Hernia

Pelvic inflammatory disease

9. An 18 y/o college student presents to your office for evaluation of rectal bleeding. You obtain a more thorough history and find that the blood was seen when she wiped after having a bowel movement; she has been constipated and has needed to strain to move her bowels. She denies a family history of colon cancer of inflammatory bowel disease. On physical examination, you note a 1 cm round mass at the 10 o’clock position at the rectum externally. What is your most likely diagnosis?

External hemorrhoids

Rectal prolapse

Uterine prolapse

Crohn’s disease

10. You are performing abdominal palpation on a 78 yr old Female. She states she emptied her bladder immediately prior to your exam, yet you can easily palpate the urinary bladder. Is this normal?

No, she may have bladder cancer

Yeah, you should be able to palpate the bladder at all times

No, she may have urinary Retention

Oh my god!!! That is not a bladder that is her uterus!! It's a miracle... She's pregnant!!!!!

11. A 65 year old smoker presents for evaluation of dyspnea. He has a 100-pack/year history of tobacco use. The dyspnea is exacerbated by exertion. He denies fever or chills; he has not had recent contact with anyone who is sick. You diagnose chronic obstructive pulmonary disease (COPD). On physical examination of the thorax, you would expect to find:

Increased AP diameter

Decreased AP diameter

No change in AP diameter

12. You are doing an abdominal assessment on a 16 yr old Male who came into the ER with severe abdominal pain. He states the pain is worst when he coughs. When palpating his stomach you notice a positive Rovsings sign and rebound tenderness. What is your most likely diagnosis?

Appendicitis

Cholecystitis

Pancreatitis

Hepatitis

13. A 19 year old college athlete presents to the student health center for evaluation of penile pain. He is sexually active and his last sexual encounter was one week ago. He has had more than 5 partners in his lifetime to date. You inspect his penis and see a cluster of small vesicles and a few swallow ulcerated areas. Your diagnosis based on this history and the physical examination is:

Carcinoma of the penis

Venereal Wart

Syphilitic chancre

Genital herpes

14. You are performing an abdominal auscultation on a patient with gastroenteritis, what sort of bowel sounds would you expect to hear?

Hypoactive

Normal

Hyperactive

None

15. You are in the ICU and assessing a patient who is now a Comfort measures patients. When looking at the respiratory rate you see a breathing pattern characterized by a period of apnea, followed by gradually increasing depth and frequency of respirations. What is this?

Cheyne-Stokes Respirations

Kussmaul Breathing

Agonal Breathing

Normal variations in breathing

16. A 19 y/o sexually active college student presents for evaluation of a vaginal discharge. She has been in a monogamous relationship since becoming sexually active and is married to her partner. She denies that he has been unfaithful. She denies fever or shills. She states that the discharge is thick, white, and curd like and although there is no bad odor, she does experience some itching. Upon physical examination of the vagina, you see an inflamed vulva, with a slightly red vaginal mucosa. The discharge is thick and white. There is no cervical motion tenderness. The uterus is normal in size without adnexal masses. Based on this information, what is your most likely diagnosis?

Bacterial vaginosis

Trichomonas vaginalis infection

Candida vaginitis

Pelvic inflammatory disease

17. What are crackles?

Bubbling, liquidy noise

Low pitch wheeze

Popping noises (kind of sound like rice krispies)

Absence of breath sounds

18. What is Cryptorchidism?

Undescended testicle

Ventral displacement of the urethral meatus on the penis

Tight prepuce; once retracted, cannot be returned

Tight prepuce that cannot be retracted over the glans

Inflammation of the glans

19. Which of the following is NOT a sign of labored breathing.

Use of accessory muscles

Auscultation of bilateral rhonchi

Nasal Flaring

Intercostal retractions

20. What sort of breathe sound may you expect to hear on an asthmatic patient?

High pitch wheeze

Rhonchi

Low Pitch wheeze

Crackles

21. What are normal bowel sounds?

20-55 per minutes

You should only hear them within 2 hours of eating.

< 10 per minute.

5- 34 per min

22. What is the purpose of Bartholins gland?

Tranports sperm from epididymis to urethra during ejaculation.

Provides lubrication to the vagina.

Small gland located in Anus which alerts you to sensation of having to defecate.

Located in breasts and produce milk in females.

23. A 40 year old flight attendant presents to your office for evaluation of abdominal pain. It is worse after eating, especially if she has a meal that is spicy or high in fat. She has tried over the counter antacids, but they have not helped the pain. After examining her abdomen, you strongly suspect cholecystitis. Which sign on examination increases your suspicion for this diagnosis?

Psoas sign

Rovsing’s sign

Murphy’s sign

Grey Turner’s sign

24. A 15 year old high school student presents to the clinic with a 1 day history of nausea and anorexia. He describes the pain as generalized yesterday, but today it has localized to his right lower quadrant. You palpate the left lower quadrant and the patient experiences pain in the right lower quadrant. What is the name of this sign?

Psoas sign

Obturator sign

Rovsing’s sign

Cuteaneuos hyperesthesia

25. You are percussing the chest of a patient with emphysema, what sound would you expect to hear?

Resonant

Hyperresonant

Dull

Wheezing

26. What is Balanitis?

Undescended testicle

Ventral displacement of the urethral meatus on the penis

Tight prepuce; once retracted, cannot be returned

Tight prepuce that cannot be retracted over the glans

Inflammation of the glans

27. According to our notes, which of the following pts would qualify as abusing alcohol?

44 yr old Male who has 12 drinks per week, 2 per ocassion

17 yr old patient who drinks 3 drinks per week.

32 yr old female who drinks 10 drinks per week, 4-5 per ocassion

28. You are doing a visual inspection on the abdomen of a patient with an abdominal Aortic aneurysm, what might you expect to see.

Swollen stomach, dull to percussion

Increased pulsations in the stomach

Scaphoid stomach, hypoactive bowel sounds

Increased vascularity of stomach & bruits

29. After what age should all men start receiving yearly PSA's and colonoscopy's?

40

50

60

35

30. A patient who suffers from a chronic cough in the AM probably has a past history of....

Cardiac Issues

Pneumonia

Smoker

Allergies

31. What areas do we auscultate for bowel sounds and for how long?

Only the RLQ for 30 seconds.

All four quadrants for 2 minutes each.

On all 4 quadrants and for 15 – 20 seconds each.

Only the RUQ and LUQ for 15 seconds each.

32. A 25 year old veterinarian presents to the clinic for evaluation of flank pain, dysuria, nausea and fever. A urine pregnancy test is negative. A urine dipstick is positive for leukocyte esterase. On physical examination, what would be the most likely sign?

Psoas sign

CVA (costovertebral angle) tenderness

Rosving’s sign

Murphy’s sign

33. You ask the patient to say 'ninety-nine' will you ausculate their posterior chest and attempt to distinguish their words. What are you testing for?

Egophony

Whisper Petriloquoy

Bronchophony

Nothing, i'm just messing with him.

34. A 42 year old waitress presents to your office for evaluation of shortness of breath. She has had a fever as high as 103F for the last few days and has a cough productive of green sputum. On physical examination, you hear crackles in her lungs. A chest radiograph reveals a consolidation in the left lower lobe. You diagnose her with lobar pneumonia. When you perform tactile fremitus of the left lower thorax, you would expect the fremitus to be:

Increased

Decreased

Unchanged

Displaced

35. In a healthy adult, the expected measurement of descent of the diaphragm is:

1-2 cm

5-6 cm

7-8 cm

10-12 cm

36. Which breath sounds should be heard over the majority of the chest upon auscultation?

Vesicular

Bronchial

Bronchovesicular

Tracheal

37. Which pattern of breathing would you expect to see on a patient with diabetic ketoacidosis?

Cheyne-stokes Breathing

Ketotic Breathing

Ataxic Breathing

Kussmaul Breathing

38. A 22 year old celebrity with a known history of intravenous drug use presents to the emergency room for evaluation of a 5 day history of nausea, emesis, and right upper quadrant abdominal pain. On general survey, he appears ill and his skin is distinctly yellow. He has a temperature of 102.5 F and a heart rate of 112 bpm. You provisionally diagnose him with acute hepatitis. What would you expect to find on abdominal examination?

Liver edge is tender and 4 to 5 finger breadths below RCM

Liver edge is nonpalpable

Liver edge is tender and 1 finger breadth below the RCM

Liver edge is non tender and 4 to 5 finger breadths below the RCM

39. What is the first thing we ask the client before assessing the abdomen?

If they have any pain which would prevent us from palpating.

If they emptied their bladder.

If they have any contagious diseases

If they are ticklish.

40. What is Rovsings sign?

Pain in the right lower quadrant during palpation of the left lower quadrant

Pain is elicited by gently picking up a fold of abdominal skin anteriorly without pinching it

Rebound tenderness

41. You are doing an abdominal assessment on a 50 yr old male and notice parietal pain and guarding on expiration. This would be suggestive of what?

Hepatitis

Cholecystitis

Abdominal Obstruction

Peritonitis

42. What would you expect to hear when percussing the left lower throax of a pt with lobar pneumonia?

Dull

Resonant

Flat

Hyperresonant

43. A 15 year old high school student wishing to join the school’s football and basketball teams presents to your office for a sports physical. As a part of the physical, you perform a hernia check. You notice that his right scrotum is markedly larger than his left. He denies pain or tenderness, as well as fever, night sweats, and weight loss. On palpitation, you feel a fluid filled mass in the scrotum but can’t get above the mass with your fingers. What is your most likely diagnosis?

Hydrocele

Testicular tumor

Varicocele

Epidermoid inclusion cyst

44. What is hypospadius?

Undescended testicle

Ventral displacement of the urethral meatus on the penis

Tight prepuce; once retracted, cannot be returned

Tight prepuce that cannot be retracted over the glans

Inflammation of the glans

45. A 35 y/o woman presents for evaluation of several new lesions on her vagina. She denies any previous medical problems. She is sexually active. She has had four pregnancies and has given birth to two children. She has had more than ten sexual partners in her lifetime. She is currently divorced but involved in a new relationship with a man whose past sexual history is unknown. On physical examination of the external vagina, you see cauliflower-like lesions scattered on the labia. These are nontender to palpation; the largest is 1 cm in diameter. The remainder of the pelvic exam is unremarkable, and there is no vaginal discharge. Based on this information, what is your most likely diagnosis?

Epidermoid inclusion cysts

Venereal warts

Genital herpes

Syphilitic chancre

46. Icterus is a yellow discoloration of....

Skin

Eyes

Nails

Urine

47. You are in the emergency room assessing a patient with abdominal pain and fever. You are performing an abdominal examination to assess for peritoneal signs. Which one of the following is NOT a peritoneal sign?

Rebound tenderness

Involuntary guarding

Rigidity of the abdomen

Voluntary guarding

48. Stridor is caused by...

Lower airway obstruction

Severe COPD

Upper airway obstruction

Narrowing of upper and lower airway.

49. A 18 year old high school student presents to his family doctor’s office for evaluation of acute onset of pain in the left testicle. He has had no problems until this morning. The pain has been intermittent, sharp, and radiates into the left groin. On physical examination, the testicle feels swollen and is tender to palpation. What is your most likely diagnosis

Epididymytis

Testicular torsion

Acute orchitis

Testicular cancer

50. What is Phimosis?

Undescended testicle

Ventral displacement of the urethral meatus on the penis

Tight prepuce; once retracted, cannot be returned

Tight prepuce that cannot be retracted over the glans

Inflammation of the glans

51. You are assessing for tactile fremitus on a patient you suspect has a pneumothorax. Which finding would help to cofirm your suspicion?

Decreased Fremitus

Increased Fremitus

Presence of Fremitus

52. A 19 year old college student presents to the emergency room for sudden onset of dyspnea. The general survey reveals that she is 6 feet 2 inches tall and weighs 135 pounds. She denies fever, chills, cough, and sore throat. She is a nonsmoker. You suspect that she has a pneumothorax. What findings would you expect with percussion of the thorax?

Decreased resonance on the affected side

Increased resonance (hyperresonance) on the affected side

Increased resonance on the nonaffected side

Dullness

53. An 80 y/o retired secretary presents to the emergency room because of difficulty having a bowel movement, stating that “it feels like something is coming out.” She denies fever or chills and weight loss. She has had constipation and has used an over-the-counter stool softener and increased her water intake. She denies pain with defecation. On physical examination of the anus, you see a doughnut of red tissue, with concentrically circular folds where the anus should be. What is your most likely diagnosis?

Thrombosed external hemorrhoid

Anal fissure

Rectal prolapse

Rectal cancer

54. In a patient with pneumothorax, what findings would you expect with auscultation of the thorax on the affected side?

Wheezes

Rhonchi

Absence of Breath Sounds

Hyperresonance

55. What is Paraphimosis?

Undescended testicle

Ventral displacement of the urethral meatus on the penis

Tight prepuce; once retracted, cannot be returned

Tight prepuce that cannot be retracted over the glans

Inflammation of the glans

56. When performing a test for Egophony on a pt with lobar pneumonia, what would you expect to hear?

Eeeee

Aaay

Ooooo

Whisper Petriloquoy

57. You are reading an ABG for a patient who has overdosed cocaine. The ABG looks like this:

pH 7.30 CO2 60 HCO3 26

What is this indicative of?

Metabolic Acidosis

Metabolic Alkalosis

Respiratory Acidosis

Respiratory Alkalosis

58. A 28 y/o housewife presents for an annual checkup. When queried, she mentions that she has noticed bleeding in between her periods for the past several months. She has been pregnant five times and has given birth to five infants. She is sexually active in a monogamous relationship with her husband. On physical exam of the uterus, you palpate an irregular nodule that is approximately 3 cm in diameter. Based on this information, what is your most likely diagnosis?

Leiomyoma or fibroid

Cervical cancer

Uterine cancer

Cystocele

59. What would you expect to see on an ABG for a patient who has had severe nauseau and vomitting for several days & NG suctioning of their stomach?

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

60. You are reading an ABG that was drawn on a pt who is vented in the unit to determine if this pt may be ready for extubation. What does this ABG tell you?

pH 7.41 CO2 38 HCO3 24 O2Sat 96

Respiratory Alkalosis

Respiratory Acidosis

Metabolic Alkalosis

Looks normal!

61. Upon auscultation in a patient with COPD, you would expect to hear:

Stridor

Delayed Expiratory Phase

Pleural Rub

Late Inspiratory Crackles

62. A 23 y/o sex worker presents to the ER for evaluation of pelvic pain and fever. You obtain a pregnancy test, which is negative. Her last menstrual period was 1 week ago and was normal. You obtain a complete blood count, and the white blood cell count is elevated. On pelvic exam, she has cervical motion tenderness and a right adnexal mass that is larger than 5 cm in diameter and is extremely tender to palpation. What is the most likely cause of this adnexal mass?

Ovarian tumor

Ruptured ovarian cyst

Ruptured tubal pregnancy

Tubo-ovarian abscess

63. You are reading an ABG on a 58 yr old dialysis patient. What does this ABG tell you?

pH 7.32 CO2 36 HCO3 18

Metabolic Acidosis

Metabolic Alkalosis

Respiratory Alkalosis

Respiratory Acidosis

Normal ABG

64. You are performaing a routine physical exam on a 70 y/o retired banker. On exam of the prostate, you palpate a mass that is 1 cm in diameter, hard and non tender. The pt has had a 6 mo history of fatigue. He denies weight loss and night sweats. What is your most likely diagnosis?

Benign prostatic hyperplasia

Internal hemmorrhoid

Prostatitis

Prostate cancer

65. You are visually assessing a 48 yr old Male in the ER. He came in for abdominal pain and nausea/vomitting. He states he has a lot of pain after eating and his stomach is swollen. You notice a small red circle around his belly button. What is your most likely diagnosis?

Pancreatitis

Peritonitis

Hepatitis

Stomach Flu