Cardiology Practice Exam Quiz!

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Cardiology Practice Exam Quiz! - Quiz

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Questions and Answers
  • 1. 

    An 80 year old woman presents to your clinic for evaluation of palpations and shortness of breath.  You obtain an electrocardiogram, which reveals an irregularly irregular rhythm without discrete p waves.  You diagnosis her with atrial fibrillation.  The most likely physical finding upon auscultation of her heart is

    • A.

      An irregulary irregular rhythm

    • B.

      A rapid regular rhythm

    • C.

      A midsystolic click

    • D.

      Bigeminy

    Correct Answer
    A. An irregulary irregular rhythm
    Explanation
    The correct answer is an irregularly irregular rhythm. Atrial fibrillation is characterized by an irregularly irregular rhythm on auscultation of the heart. This means that the intervals between the beats are inconsistent and there is no predictable pattern. This is due to the chaotic electrical activity in the atria, resulting in an irregular ventricular response. The absence of discrete p waves on the electrocardiogram also supports the diagnosis of atrial fibrillation.

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  • 2. 

    A 61 year old hairdresser presents for evaluation of shortness of breath.  You examine her jugular venous pulse (JVP) and listen to her heart.  You diagnosis her with right-sided heart failure.  Your JVP measurement is most likely to be:

    • A.

      1 cm above the sternal angle

    • B.

      3 cm above the sternal angle

    • C.

      6 cm above the sternal angle

    • D.

      1 cm below the sternal angle

    Correct Answer
    C. 6 cm above the sternal angle
    Explanation
    In right-sided heart failure, there is an increase in venous pressure, leading to jugular venous distention. The jugular venous pulse (JVP) is measured as the vertical distance above the sternal angle. In a normal individual, the JVP is typically 1-2 cm above the sternal angle. However, in right-sided heart failure, the JVP can be significantly elevated. Therefore, in this case, the JVP measurement of 6 cm above the sternal angle is most likely due to the right-sided heart failure.

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  • 3. 

    A 22 year old waitress presents to your clinic for evaluation of pain in her chest.  She appears to be anxious.  The pain is worse with physical exertion, such as climbing stairs.  She does not smoke, use alcohol or illicit drugs, or consume excessive amounts of caffeine.  You auscultate her heart and diagnosis mitral valve prolapsed.  What did you hear to make this diagnosis ?

    • A.

      An opening snap

    • B.

      A midsystolic click

    • C.

      A diastolic rumble

    • D.

      A holo-systolic murmur

    Correct Answer
    B. A midsystolic click
    Explanation
    The presence of a midsystolic click suggests a diagnosis of mitral valve prolapse. Mitral valve prolapse is a condition where the valve between the left atrium and left ventricle does not close properly, causing blood to leak back into the left atrium. This can result in symptoms such as chest pain, especially with physical exertion. The midsystolic click is caused by the prolapsed valve snapping back into place during systole, and it is a characteristic sound associated with this condition.

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  • 4. 

    What could you ask a patient to do to accentuate the findings of a mitral valve prolapsed?

    • A.

      Perform a Valsalva maneuver

    • B.

      Squat

    • C.

      Hop on one foot

    • D.

      Kneel

    Correct Answer
    A. Perform a Valsalva maneuver
    Explanation
    Performing a Valsalva maneuver can accentuate the findings of a mitral valve prolapse. This maneuver involves the patient exhaling forcefully against a closed airway, which increases intrathoracic pressure. This increased pressure can cause the prolapsed mitral valve to move further into the left atrium, making the prolapse more pronounced and easier to detect during examination.

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  • 5. 

    A 73 year old retired publisher presents to your clinic for a routine checkup.  He has a history of class III congestive heart failure, hypertension, and hyperlipidemia.  He is doing well and is taking his medication as prescribed.  On examination of his cardiovascular system, what would you expect to find?

    • A.

      PMI in the fifth interspace, midclavicular line, 8 cm lateral to the midsternal line

    • B.

      PMI in the fifth interspace, anterior axillary line

    • C.

      PMI in the third interspace, midclavicular line

    • D.

      PMI in the eight interspace, anterior axillary line

    Correct Answer
    B. PMI in the fifth interspace, anterior axillary line
    Explanation
    In this case, the correct answer is "PMI in the fifth interspace, anterior axillary line." PMI stands for Point of Maximum Impulse, which refers to the location where the heartbeat can be felt or heard most prominently. In a healthy individual, the PMI is typically located in the fifth interspace, midclavicular line. However, in patients with congestive heart failure, the heart may enlarge and shift the PMI to a different location. In this patient with class III congestive heart failure, it is expected that the PMI would be found in the fifth interspace, but in the anterior axillary line rather than the midclavicular line.

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  • 6. 

    Which of the following describes the S2 heart sound?

    • A.

      Occurs during atrial contraction

    • B.

      Produced by the closure of the mitral & tricuspid valve

    • C.

      Occurs after the mitral valve opens; rapid ventricular filling

    • D.

      Produced by closure of the aortic & pulmonic valve

    Correct Answer
    D. Produced by closure of the aortic & pulmonic valve
    Explanation
    The S2 heart sound is produced by the closure of the aortic and pulmonic valves. This sound occurs during the diastolic phase of the cardiac cycle when the ventricles relax and the aortic and pulmonic valves close to prevent blood from flowing back into the ventricles. This closure produces the second heart sound, known as S2. It is a normal sound heard during a routine cardiac examination and indicates proper functioning of the heart valves.

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  • 7. 

    Which of the following describes the S3 heart sound?

    • A.

      Occurs during atrial contraction

    • B.

      Produced by the closure of the mitral & tricuspid valves

    • C.

      Occurs after the mitral valve opens; rapid ventricular filling

    • D.

      Produced by closure of the aortic & pulmonic valves

    Correct Answer
    C. Occurs after the mitral valve opens; rapid ventricular filling
    Explanation
    The S3 heart sound occurs after the mitral valve opens and is associated with rapid ventricular filling. This sound is caused by the sudden deceleration of blood flow when it enters the ventricles during early diastole. It is often heard in conditions of increased blood volume or decreased ventricular compliance, such as heart failure. The closure of the mitral and tricuspid valves does not produce the S3 sound.

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  • 8. 

    Which of the following describes the S4 heart sound?

    • A.

      Occurs during atrial contraction

    • B.

      Produced by the closure of the mitral & tricuspid valves

    • C.

      Occurs after the mitral valve opens; rapid ventricular filling

    • D.

      Produced by closure of the aortic & pulmonic valves

    Correct Answer
    A. Occurs during atrial contraction
    Explanation
    The S4 heart sound occurs during atrial contraction. This sound is caused by the blood forcefully entering the ventricles and vibrating the ventricular walls. It is typically heard as a low-pitched sound and is associated with conditions such as ventricular hypertrophy or stiffened ventricles. The closure of the mitral and tricuspid valves does not produce the S4 sound, and it does not occur after the mitral valve opens or the closure of the aortic and pulmonic valves.

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  • 9. 

    Which of the following descriptions best describes a GRADE 1 murmur?

    • A.

      Loud; may be associated with a thrill

    • B.

      Very faint

    • C.

      May be heard when the stethoscope is entirely off the chest

    Correct Answer
    B. Very faint
    Explanation
    A Grade 1 murmur is described as very faint. This means that it is barely audible and may be difficult to detect even with a stethoscope. It is the softest type of murmur and may require a trained ear to hear. This murmur is typically not associated with any other physical findings such as a thrill, which is a vibrating sensation felt on the chest wall. It is important for healthcare professionals to accurately identify the grade of a murmur as it can provide valuable information about the severity and potential underlying causes of the condition.

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  • 10. 

    Which of the following descriptions best describes a GRADE 6 murmur?

    • A.

      Loud; may be associated with a thrill

    • B.

      Very faint

    • C.

      May be heard when the stethoscope is entirely off the chest

    Correct Answer
    C. May be heard when the stethoscope is entirely off the chest
    Explanation
    A Grade 6 murmur is a very loud murmur that may be associated with a thrill. It is so intense that it can still be heard even when the stethoscope is not in contact with the chest.

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  • 11. 

    Which of the following descriptions best describes a GRADE 4 murmur?

    • A.

      Loud; may be associated with a thrill

    • B.

      Very faint

    • C.

      May be heard when the stethoscope is entirely off the chest

    Correct Answer
    A. Loud; may be associated with a thrill
    Explanation
    A grade 4 murmur is described as loud and may be associated with a thrill. A thrill refers to a vibrating sensation felt on the chest wall when the hand is placed over the area where the murmur is heard. This indicates a significant and easily audible murmur that can be heard even without the stethoscope being fully on the chest.

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  • 12. 

    When auscultating a patients heart sounds you hear an Early diastolic decreased murmur. This would be indicative of what?

    • A.

      Aortic stenosis

    • B.

      Mitral regurgitation

    • C.

      Mitral valve stenosis

    • D.

      Aortic Regurgitation

    Correct Answer
    C. Mitral valve stenosis
    Explanation
    A decreased murmur heard during early diastole suggests an abnormality in the mitral valve. Mitral valve stenosis occurs when the mitral valve becomes narrowed, restricting blood flow from the left atrium to the left ventricle during diastole. This results in a decreased flow of blood and a murmur can be heard during early diastole as the blood tries to pass through the narrowed valve. Therefore, the correct answer is Mitral valve stenosis.

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  • 13. 

    When auscultating a patients heart sounds you hear a Pan-systolic plateau murmur. This would be indicative of what?

    • A.

      Aortic stenosis

    • B.

      Mitral regurgitation

    • C.

      Mitral valve stenosis

    • D.

      Aortic Regurgitation

    Correct Answer
    B. Mitral regurgitation
    Explanation
    A pan-systolic plateau murmur heard during auscultation of a patient's heart sounds is indicative of mitral regurgitation. This type of murmur is characterized by a continuous sound throughout systole, without any crescendo or decrescendo. Mitral regurgitation occurs when the mitral valve fails to close properly, allowing blood to leak back into the left atrium during ventricular contraction. This results in a turbulent flow of blood and the pan-systolic plateau murmur. Aortic stenosis, mitral valve stenosis, and aortic regurgitation would present with different types of murmurs and are not consistent with the given description.

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  • 14. 

    When auscultating a patients heart sounds you hear a Midsystolic crescendo-decrescendo murmur. This would be indicative of what?

    • A.

      Aortic stenosis

    • B.

      Mitral regurgitation

    • C.

      Mitral valve stenosis

    • D.

      Aortic Regurgitation

    Correct Answer
    A. Aortic stenosis
    Explanation
    A midsystolic crescendo-decrescendo murmur is characteristic of aortic stenosis. This type of murmur occurs when there is obstruction to blood flow across the aortic valve during systole. The murmur starts soft, increases in intensity, and then decreases in intensity as systole progresses. Aortic stenosis is a narrowing of the aortic valve, which can lead to reduced blood flow from the left ventricle to the aorta.

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  • 15. 

    A 68-year-old retired kindergarten teacher presents to your office for evaluation of swelling in her right arm. On questioning her further, you discover that she has had a recent mastectomy for right-sided ductal carcinoma in situ. What is you most likely diagnosis?

    • A.

      Orthostatic edema

    • B.

      Lymphedema

    • C.

      Lipedema

    • D.

      Chronic venous insufficiency

    Correct Answer
    B. Lymphedema
    Explanation
    The most likely diagnosis for the 68-year-old retired kindergarten teacher with swelling in her right arm after a recent mastectomy for right-sided ductal carcinoma in situ is lymphedema. Lymphedema is a condition characterized by the accumulation of lymphatic fluid, leading to swelling in the affected limb. In this case, the surgery and removal of lymph nodes during the mastectomy may have disrupted the normal lymphatic drainage, resulting in lymphedema.

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  • 16. 

    A 55-year-old construction worker presents for evaluation of swelling in his feet. He has smoked 2 packs of cigarettes daily since the age of 15. He has noticed pain in both legs when walking, which is relieved with resting for 10 minutes. On physical examination, his dorsalis pedis pulses are decreased bilaterally in comparison with his femoral pulses. His feet are cool to the touch when compared with his upper legs. He has no pedal edema. What is your most likely diagnosis?

    • A.

      Deep vein thrombosis

    • B.

      Arterial insufficiency

    • C.

      Venous insufficiency

    • D.

      Peripheral neuropathy

    Correct Answer
    B. Arterial insufficiency
    Explanation
    Based on the information provided, the patient is a heavy smoker and presents with pain in both legs when walking, which is relieved with resting. Physical examination reveals decreased dorsalis pedis pulses and cool feet compared to the upper legs. These findings suggest arterial insufficiency, which is commonly seen in smokers due to the development of peripheral arterial disease (PAD). PAD is characterized by narrowing or blockage of the arteries that supply blood to the limbs, resulting in decreased blood flow and oxygenation to the tissues. This can lead to symptoms such as pain, decreased pulses, and coolness in the affected area.

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  • 17. 

    A 62-year-old accountant presents for evaluation of a rash on his lower legs. He has had this rash for several months. He denies fever or chills. The skin itches. He has tried OTC creams without success. He has smoked ½ pack of cigarettes daily for the past 20 years. On physical examination, the skin of his lower legs is hyperpigmented and bluish-red. He has a shallow ulcer on his right medial calf. His dorsalis pedis pulses are 2+ bilaterally, and he has normal hair distribution on his lower legs. These findings are most compatible with which one?

    • A.

      Deep vein thrombosis

    • B.

      Tinea pedis

    • C.

      Arterial insufficiency

    • D.

      Venous insufficiency

    Correct Answer
    D. Venous insufficiency
    Explanation
    The patient's presentation of hyperpigmented and bluish-red skin, along with a shallow ulcer on the lower leg, suggests venous insufficiency. Venous insufficiency is characterized by impaired blood flow in the veins, leading to pooling of blood and increased pressure in the lower extremities. This can cause skin changes such as hyperpigmentation and ulceration. The presence of 2+ dorsalis pedis pulses and normal hair distribution on the lower legs suggests that arterial insufficiency is less likely. Deep vein thrombosis and tinea pedis do not typically present with the same skin findings as described in the patient.

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  • 18. 

    A 55-year-old- nursing assistant presents to your office because of persistent swelling in her feet. She is a nonsmoker. Her medical history is noncontributory. She has never had any surgeries. She works two 8-hour shifts daily, 6 days weekly. On physical examination, her BP is 110/60 mm/Hg; her cardiovascular examination is normal; and her legs have 2+ pitting edema bilaterally without rashes, thickening, or ulceration of the skin. What is your most likely diagnosis?

    • A.

      Orthostatic edema

    • B.

      Lymphedema

    • C.

      Lipedema

    • D.

      Chronic venous insufficiency

    Correct Answer
    A. Orthostatic edema
    Explanation
    Orthostatic edema is the most likely diagnosis in this case. The patient's symptoms of persistent swelling in her feet, along with the absence of any skin abnormalities, suggest that the edema is not caused by a skin condition such as lymphedema or lipedema. Additionally, the patient's normal cardiovascular examination and blood pressure indicate that the edema is not likely due to chronic venous insufficiency. Orthostatic edema refers to swelling that occurs due to prolonged standing or sitting, which is consistent with the patient's work schedule of two 8-hour shifts daily.

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  • 19. 

    What kind of edema would you see with Right sided heart failure?

    • A.

      Dependent edema; sacral edema when patient is supine; may see increased JVD, enlarged liver, enlarged heart;

    • B.

      Edema in the loose subcutaneous tissues of the eyelids; may also appear in the feet and legs

    • C.

      Localized edema; involves one or both legs

    • D.

      Edema of the dependent areas; no cardiac or hepatic signs

    Correct Answer
    A. Dependent edema; sacral edema when patient is supine; may see increased JVD, enlarged liver, enlarged heart;
    Explanation
    Right sided heart failure leads to increased pressure in the right side of the heart, causing fluid to back up into the venous system. This results in dependent edema, which is edema that occurs in the lower parts of the body such as the legs, ankles, and feet. Additionally, when the patient is supine, fluid may accumulate in the sacral area due to gravity. Other signs of right sided heart failure include increased jugular venous distention (JVD), an enlarged liver, and an enlarged heart.

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  • 20. 

    A 50-year-old physician presents for evaluation of pain in his right shoulder. The pain has been intermittent for the past 20 years, but over the past 3 weeks, it has been present daily. He has tried OTC analgesics, but they do not relieve the symptoms. 5 years ago, he fell on the icy pavement and landed on his shoulder. You perform a physical examination maneuver, because you suspect a rotator cuff tear. What is the name of this test?

    • A.

      Drop arm test

    • B.

      McMurray’s test

    • C.

      Anterior drawer test

    • D.

      Tinel’s test

    Correct Answer
    A. Drop arm test
    Explanation
    The drop arm test is used to assess for a rotator cuff tear. In this test, the patient is asked to actively abduct their arm to 90 degrees and then slowly lower it back down to their side. If the patient is unable to smoothly and controlled lower their arm, it suggests a rotator cuff tear. This test is specific for assessing the integrity of the supraspinatus tendon.

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  • 21. 

    A 35-year-old factory worker presents to your office for evaluation of pain in his left arm. He denies any acute trauma or injury. His job involves inspecting jars, and he has to test the opening and closing of the jar lids. He denies fever or chills. On physical examination, there is no swelling over the elbow. You palpate the olecranon process, and he has tenderness on the left lateral epicondyle but not on the medial epicondyle. Based on this information, what is your most likely diagnosis?

    • A.

      Olecranon bursitis

    • B.

      Osteoarthritis

    • C.

      Lateral epicondylitis

    • D.

      Epicondylar fracture

    Correct Answer
    C. Lateral epicondylitis
    Explanation
    The patient's symptoms of pain in the left arm, tenderness on the left lateral epicondyle, and the nature of his job involving repetitive motions suggest a diagnosis of lateral epicondylitis, also known as tennis elbow. This condition is characterized by inflammation of the tendons on the outside of the elbow, typically caused by overuse or repetitive strain. Olecranon bursitis, osteoarthritis, and epicondylar fracture are less likely based on the absence of swelling, fever, acute trauma, and tenderness on the medial epicondyle.

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  • 22. 

    A 27-year-old software specialist presents to your office for evaluation of numbness and pain in his fingers. He has noticed that the numbness increases as the day goes on; at first he noticed it only at the end of the day, but now it is present upon awakening. It is present in both his hands. The pain started several months ago and is not relieved by OTC analgesics. The patient’s family history is significant for HTN and cerebrovascular disease. On physical examination, his BP is 110/70 mmHg and his thenar eminence is atrophic. Which tests would you perform to confirm your initial hypothesis of carpal tunnel syndrome

    • A.

      Tinel’s test

    • B.

      Anterior drawer test

    • C.

      McMurray’s test

    • D.

      Allen test

    Correct Answer
    A. Tinel’s test
    Explanation
    Tinel's test is used to assess for carpal tunnel syndrome. It involves tapping over the median nerve at the wrist to elicit tingling or numbness in the distribution of the median nerve, which is indicative of nerve compression. In this case, the patient's symptoms of numbness and pain in the fingers, worsening throughout the day and present in both hands, along with the atrophy of the thenar eminence, are consistent with carpal tunnel syndrome. Therefore, performing Tinel's test would help confirm the initial hypothesis.

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  • 23. 

    A 35-year-old postal worker presents to your office for evaluation of pain in her joints. She states that the pain is worse in her fingers and wrists; both hands are affected. She notices that it takes her longer than 1 hour to get moving in the morning because she is so stiff. For the past few weeks, she has been having fevers, some as high as 100.5℉. You notice that she has fusiform swelling in her fingers and wrists bilaterally and that the PIP and MCP joints are tender to palpation. Based on the history and physical examination findings, what is your most likely diagnosis?

    • A.

      Osteoarthritis

    • B.

      Rheumatoid arthritis

    • C.

      Gouty arthritis

    • D.

      Ankylosing spondylitis

    Correct Answer
    B. Rheumatoid arthritis
    Explanation
    Based on the patient's symptoms of joint pain, stiffness, fevers, and specific physical examination findings such as fusiform swelling in the fingers and wrists and tenderness in the PIP and MCP joints, the most likely diagnosis is rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease that primarily affects the joints, causing pain, swelling, and stiffness. The symmetrical involvement of multiple joints, along with systemic symptoms like fevers, is characteristic of rheumatoid arthritis.

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  • 24. 

    A 55-year-old executive assistant presents to your office for evaluation of pain in her wrist. She states that the pain has been present daily. She has taken OTC analgesics for the pain, which seem to help. She denies fever, chills, or rashes. On physical examination, she has pain and tenderness over the right wrist but not the left. She has a hard dorsolateral nodule on the DIP joint of her right middle finger. The MCP joints are normal. What is your most likely diagnosis?

    • A.

      Gouty arthritis

    • B.

      Rheumatoid arthritis

    • C.

      Systemic lupus erythematosus

    • D.

      Osteoarthritis

    Correct Answer
    D. Osteoarthritis
    Explanation
    The most likely diagnosis in this case is osteoarthritis. Osteoarthritis is a degenerative joint disease that commonly affects the hands, particularly the DIP joints. The presence of pain and tenderness over the right wrist, along with the hard dorsolateral nodule on the DIP joint of the right middle finger, are consistent with osteoarthritis. Gouty arthritis is less likely as it typically presents with sudden, severe pain and swelling in a single joint. Rheumatoid arthritis and systemic lupus erythematosus are also less likely as they usually involve multiple joints and may have other systemic symptoms.

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  • 25. 

    A 13-year-old junior high school student is brought into your office by her mother for evaluation of unequal shoulder height. Her mother first noticed this problem 2 weeks ago. There is no history of birth trauma or recent injury. On physical examination, there is a lateral curvature to the spine. The curvature is more pronounced with forward flexion. Based on this information, what is your most likely diagnosis?

    • A.

      Normal spinal curvature

    • B.

      Kyphosis

    • C.

      Scoliosis

    • D.

      Lumbar lordosis

    Correct Answer
    C. Scoliosis
    Explanation
    Based on the information provided, the most likely diagnosis for the 13-year-old junior high school student with unequal shoulder height and a lateral curvature to the spine is scoliosis. Scoliosis is a condition characterized by an abnormal sideways curvature of the spine. The fact that the curvature is more pronounced with forward flexion further supports this diagnosis. There is no mention of any other symptoms or history that would suggest a different diagnosis such as kyphosis or lumbar lordosis. Therefore, scoliosis is the most likely explanation for the patient's presentation.

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  • 26. 

    An 18-year-old college football player comes to your office after sustaining an injury on the field. He states that he planted his foot and had to pivot to catch the ball. He heard a “pop,” and his right knee gave way and started to swell. The trainer iced it down. On physical examination, you note increased swelling and tenderness over the right knee. He has significant forward excursion when you perform the Lachman test. He also has more movement of the right tibia when you draw it forward when compared with the left. Based on this information, what is your most likely diagnosis?

    • A.

      Posterior cruciate ligament tear

    • B.

      Anterior cruciate ligament tear

    • C.

      Meniscus tear

    • D.

      Patellar tear

    Correct Answer
    B. Anterior cruciate ligament tear
    Explanation
    Based on the given information, the 18-year-old football player experienced a "pop" sound and his right knee gave way after pivoting during a catch. He also has increased swelling and tenderness over the right knee. The Lachman test shows significant forward excursion and there is more movement of the right tibia compared to the left. These findings are consistent with an anterior cruciate ligament (ACL) tear. The ACL is responsible for stabilizing the knee joint, and its tear can lead to instability and increased movement of the tibia.

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  • 27. 

    A 23-year-old fast food worker presents to your office for evaluation of pain in his feet, especially the heels. He notes that the pain is most intense when he first awakens, then eases up somewhat after walking for a few minutes. By the end of the day, the pain has returned again to its full intensity. He has tried OTC analgesics without success. He denies fever, chills, trauma, or injury to his feet. On physical examination, he has tenderness upon palpation of the plantar fascia. There are no deformities or joint swelling. What is your most likely diagnosis?

    • A.

      Ankle sprain

    • B.

      Heel spur

    • C.

      Plantar fasciitis

    • D.

      Gout

    Correct Answer
    C. Plantar fasciitis
    Explanation
    The most likely diagnosis for the patient's symptoms is plantar fasciitis. The patient's pain is most intense in the morning and eases up after walking for a few minutes, which is a common characteristic of plantar fasciitis. The tenderness upon palpation of the plantar fascia also supports this diagnosis. Ankle sprain, heel spur, and gout are less likely as they do not typically present with the same pattern of pain and tenderness in the plantar fascia.

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  • 28. 

    An 18-year-old college freshman presents to the emergency room for evaluation of fever, headache, and neck stiffness.  On physical examination, the patient is resting quietly and has a flushed face.  His vital signs are as follows: temperature, 104 degrees F; pulse, 110 bpm; and BP, 105/70 mmHg.  He has no rashes. During the physical examination, you flex the patient’s neck and hips and knees flex in response, indicating meningeal irritation.  The name of this positive sign is:

    • A.

      Kernig’s sign

    • B.

      Brudzinski’s sign

    • C.

      Babinski’s sign

    • D.

      Lachman’s sign

    Correct Answer
    B. Brudzinski’s sign
    Explanation
    Brudzinski's sign is a positive sign indicating meningeal irritation. It is observed when the patient's hips and knees flex involuntarily in response to flexing the neck. This sign suggests inflammation of the meninges, which can be seen in conditions such as meningitis. Kernig's sign, on the other hand, is characterized by pain and resistance when attempting to extend the leg at the knee while the hip is flexed, indicating irritation of the meninges. Babinski's sign is a neurological sign characterized by the upward movement of the big toe and fanning of the other toes when the sole of the foot is stimulated, indicating damage to the upper motor neurons. Lachman's sign is a physical examination maneuver used to assess the integrity of the anterior cruciate ligament in the knee.

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  • 29. 

    A 22-year-old daycare worker comes to the clinic for evaluation of fever as high as 103.5 degrees F, headache, and neck pain.  She has photophobia and neck stiffness.  During the physical examination, you flex the patient’s leg at both the hip and the knee and then straighten her knee to elicit meningeal irritation.  The patient experiences severe pain.  The name of this sign is:

    • A.

      Kernig’s sign

    • B.

      Brudzinski’s sign

    • C.

      Babinski’s sign

    • D.

      Lachman’s sign

    Correct Answer
    A. Kernig’s sign
    Explanation
    During the physical examination, the healthcare provider flexes the patient's leg at both the hip and the knee and then straightens her knee. If the patient experiences severe pain during this maneuver, it indicates meningeal irritation. This sign is called Kernig's sign.

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  • 30. 

    This is your first day on the medical ICU rotation.  One of the patients you have been assigned to follow is comatose.  You want to decide whether this patient’s coma is due to a metabolic or structural cause; therefore, you examine the patient’s papillary response to light.  If the patient were in a coma due to an opiate overdose, you would expect to see which type of reaction?

    • A.

      Pupils equal and reactive to light, pinpoint

    • B.

      Pupils fixed and dilated

    • C.

      Pupils unequal to light

    • D.

      One pupil fixed and dilated

    Correct Answer
    A. Pupils equal and reactive to light, pinpoint
    Explanation
    In the given scenario, the question is asking about the expected pupillary response in a patient who is in a coma due to an opiate overdose. Opiates, such as opioids, can cause pinpoint pupils, which means that the pupils are constricted and appear very small. Therefore, the correct answer is "Pupils equal and reactive to light, pinpoint." This response suggests that the patient's coma is likely due to a metabolic cause, specifically an opiate overdose.

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  • 31. 

    A patient is brought to the emergency room for evaluation of mental status changes.  She has a history of a fever as high 105 degrees F.  She has had a headache and symptoms consistent with an upper respiratory infection 2 weeks before the worsening of these symptoms tonight.  You are updating this patient’s clinical progress.  You diagnose her with a coma.  You note that her respiratory pattern has become irregular, with Cheyne-Stokes breathing.  Her pupils, which were previously equal, are now unequally reactive to light.  What is the most likely cause of her coma?

    • A.

      Drug overdose

    • B.

      Alcohol intoxication

    • C.

      Uremia

    • D.

      Brain abscess

    Correct Answer
    D. Brain abscess
    Explanation
    The most likely cause of the patient's coma is a brain abscess. The patient's history of fever, headache, and upper respiratory infection suggests an underlying infection. The development of a coma, irregular respiratory pattern (Cheyne-Stokes breathing), and unequal pupil reactivity to light are all consistent with a brain abscess. Drug overdose and alcohol intoxication may cause altered mental status, but they do not typically present with the other symptoms mentioned. Uremia, which is a buildup of waste products in the blood due to kidney dysfunction, can cause altered mental status but does not explain the other findings.

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  • 32. 

    A 25-year-old housewife presents to the urgent care clinic for evaluation of paralysis in her face.  She has a history of an upper respiratory 2 weeks before the onset of these symptoms.  She states that her face is drooping and that she is unable to close her eye.  On physical examination, you note that her forehead is smooth on the right side, her palpebral fissure appears widened, and her nasolabial fold appears flattened and she is drooling.  Based on this information, what is the most likely diagnosis?

    • A.

      Cortical stroke

    • B.

      Bell’s palsy

    • C.

      Horner’s syndrome

    • D.

      Stress reaction

    Correct Answer
    B. Bell’s palsy
    Explanation
    The most likely diagnosis in this case is Bell's palsy. Bell's palsy is a condition characterized by sudden, unilateral facial paralysis that is often preceded by an upper respiratory infection. The symptoms include drooping of the face, inability to close the eye, smooth forehead on the affected side, widened palpebral fissure, flattened nasolabial fold, and drooling. These findings are consistent with the given patient's presentation, making Bell's palsy the most likely diagnosis. Cortical stroke would typically present with other neurological symptoms, and Horner's syndrome and stress reaction do not explain the facial paralysis.

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  • 33. 

    A 35-year-old reporter presents to you office for evaluation of back pain and weakness in his left leg.  He was play-wrestling with his nephew and hurt his back 2 weeks ago.  He states that he has noticed tingling in his left leg as well.  He has not noticed incontinence of bowel or bladder function.  You perform a physical examination and confirm that he is dragging his left foot when he walks and that his Achilles reflex is diminished. You diagnose him with a herniated disc.  Which nerve root are you testing with the Achilles reflex?

    • A.

      C5, C6

    • B.

      L2, L3, L4

    • C.

      S1

    • D.

      L4, L5

    Correct Answer
    C. S1
    Explanation
    The Achilles reflex is a reflex that tests the integrity of the S1 nerve root. In this scenario, the patient's diminished Achilles reflex indicates dysfunction or compression of the S1 nerve root, which is consistent with a herniated disc. The other nerve roots listed (C5, C6, L2, L3, L4, L4, L5) are not specifically associated with the Achilles reflex.

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  • 34. 

    A 75-year-old retired short-order cook presents to the office for evaluation of weakness.  He has a history of hypertension; he stopped taking his medication a few months ago because he couldn’t tell that it was making a difference and it was too expensive.  On physical examination, his blood pressure is 220/110 mmHg.  He has deviation of the tongue to the left side.  Which cranial nerve would have to be affected for this finding to be present?

    • A.

      CN I (olfactory)

    • B.

      CN V (trigeminal)

    • C.

      CN VII (facial)

    • D.

      CN XII (hypoglossal)

    Correct Answer
    D. CN XII (hypoglossal)
    Explanation
    The finding of tongue deviation to the left side suggests a dysfunction of the hypoglossal nerve (CN XII). The hypoglossal nerve innervates the muscles of the tongue, and any impairment in its function can result in weakness or deviation of the tongue. The patient's history of hypertension and non-compliance with medication may have contributed to the development of this cranial nerve dysfunction.

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  • 35. 

    Define attention:

    • A.

      Awareness of who or what the person is in relation to time, place, and people

    • B.

      Ability to retain information over an interval of minutes, hours, or days

    • C.

      Ability to retain information over an Interval of years

    • D.

      Ability to focus or concentrate over time on one task or activity

    • E.

      Alertness and state of awareness of the environment

    Correct Answer
    D. Ability to focus or concentrate over time on one task or activity
    Explanation
    Attention refers to the ability to focus or concentrate on a particular task or activity for a sustained period of time. It involves directing cognitive resources towards a specific stimulus or goal while ignoring distractions. This ability allows individuals to filter out irrelevant information and allocate their mental resources effectively. Attention is crucial for learning, problem-solving, and completing tasks efficiently.

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  • 36. 

    Define Recent Memory.

    • A.

      Awareness of who or what the person is in relation to time, place, and people

    • B.

      Ability to retain information over an interval of minutes, hours, or days

    • C.

      Ability to retain information over an Interval of years

    • D.

      Ability to focus or concentrate over time on one task or activity

    • E.

      Alertness and state of awareness of the environment

    Correct Answer
    B. Ability to retain information over an interval of minutes, hours, or days
    Explanation
    Recent memory refers to the ability to retain information over a short period of time, ranging from minutes to hours or even days. It involves the capacity to remember and recall events, facts, or experiences that have occurred recently. This type of memory allows individuals to retain and access information that is relevant to their immediate needs and activities. It is an essential cognitive function that enables us to navigate daily life, make decisions, and engage in conversations by remembering recent events and conversations.

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  • 37. 

    Define Remote Memory.

    • A.

      Awareness of who or what the person is in relation to time, place, and people

    • B.

      Ability to retain information over an interval of minutes, hours, or days

    • C.

      Ability to retain information over an Interval of years

    • D.

      Ability to focus or concentrate over time on one task or activity

    • E.

      Alertness and state of awareness of the environment

    Correct Answer
    C. Ability to retain information over an Interval of years
    Explanation
    Remote memory refers to the ability to retain information over a long period of time, typically spanning years. It involves the recollection of past events, experiences, and knowledge that have been stored in memory for an extended duration. This type of memory allows individuals to recall and retrieve information from the distant past, demonstrating their ability to retain information over a significant interval of time.

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  • 38. 

    Define Orientation

    • A.

      Awareness of who or what the person is in relation to time, place, and people

    • B.

      Ability to retain information over an interval of minutes, hours, or days

    • C.

      Ability to retain information over an Interval of years

    • D.

      Ability to focus or concentrate over time on one task or activity

    • E.

      Alertness and state of awareness of the environment

    Correct Answer
    A. Awareness of who or what the person is in relation to time, place, and people
    Explanation
    Orientation refers to the awareness an individual has of their surroundings, including their understanding of time, place, and the people around them. It involves being cognizant of one's own identity in relation to these factors. This awareness allows individuals to navigate and interact with their environment effectively.

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  • 39. 

    Which cranial nerve controls tongue symmetry, movement and position?

    • A.

      CN 2 (Optic)

    • B.

      CN 9 (glossopharyngeal)

    • C.

      CN 5 (trigeminal)

    • D.

      CN 12 (hypoglossal)

    Correct Answer
    D. CN 12 (hypoglossal)
    Explanation
    The cranial nerve that controls tongue symmetry, movement, and position is CN 12 (hypoglossal). This nerve innervates the muscles of the tongue, allowing for its voluntary movements and maintaining its proper position within the oral cavity.

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  • 40. 

    Which cranial nerve is responsible for pharyngeal movement, taste, sensing carotid BP,  sensation on posterior tongue and pharynx?

    • A.

      CN 7 (facial)

    • B.

      CN 12 (Hypoglossal)

    • C.

      CN 9 (glossopharyngeal)

    • D.

      CN 1 (Olfactory)

    Correct Answer
    C. CN 9 (glossopharyngeal)
    Explanation
    The glossopharyngeal nerve (CN 9) is responsible for pharyngeal movement, taste, sensing carotid blood pressure, and sensation on the posterior tongue and pharynx. This nerve innervates the muscles involved in swallowing and helps in the coordination of swallowing and speech. It also carries taste sensations from the posterior third of the tongue. Additionally, the glossopharyngeal nerve has baroreceptor fibers that sense changes in blood pressure in the carotid sinus. Therefore, CN 9 is the correct answer for this question.

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  • 41. 

    Which cranial nerve is responsible for vision?

    • A.

      CN 3 (Oculomotor)

    • B.

      CN 2 (Optic)

    • C.

      CN 8 (Vestibulocochlear)

    • D.

      CN 1 (Olfactory)

    Correct Answer
    B. CN 2 (Optic)
    Explanation
    The cranial nerve responsible for vision is CN 2 (Optic). The optic nerve carries visual information from the retina to the brain, allowing us to perceive and interpret visual stimuli. CN 3 (Oculomotor) controls the movement of the eye, CN 8 (Vestibulocochlear) is responsible for hearing and balance, and CN 1 (Olfactory) is involved in the sense of smell. However, only CN 2 is specifically related to vision.

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  • 42. 

    Which cranial nerve is responsible for downward & inward movement of eye, and innervates superior oblique muscle?

    • A.

      CN 4 (trochlear)

    • B.

      CN 5 (Trigeminal)

    • C.

      CN 6 (abducens)

    • D.

      CN 3 (Oculomotor)

    Correct Answer
    A. CN 4 (trochlear)
    Explanation
    Cranial nerve 4, also known as the trochlear nerve, is responsible for the downward and inward movement of the eye. It innervates the superior oblique muscle, which is involved in these movements. The trochlear nerve is the smallest cranial nerve and originates from the midbrain. It controls the movement of the eye and helps to coordinate eye movements with the other cranial nerves.

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  • 43. 

    Which cranial nerve is responsible for smell?

    • A.

      CN 1 (Olfactory)

    • B.

      CN 7 (facial)

    • C.

      CN 8 (Vestibulocochlear)

    • D.

      CN 2 (Optic)

    Correct Answer
    A. CN 1 (Olfactory)
    Explanation
    The cranial nerve responsible for smell is CN 1, also known as the Olfactory nerve. This nerve is responsible for transmitting information related to smell from the nose to the brain. It plays a crucial role in our sense of smell and is responsible for detecting and identifying different odors.

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  • 44. 

    Which cranial nerve is responsible for chewing, sensation on the face,  & corneal reflex.

    • A.

      CN 7 (Facial)

    • B.

      CN 9 (glossopharyngeal)

    • C.

      CN 5 (trigeminal)

    • D.

      CN 11 (Spinal Accessory)

    Correct Answer
    C. CN 5 (trigeminal)
    Explanation
    The trigeminal nerve (CN 5) is responsible for chewing, sensation on the face, and the corneal reflex. It is the largest cranial nerve and has three main branches: the ophthalmic branch, the maxillary branch, and the mandibular branch. The ophthalmic branch provides sensation to the forehead, scalp, and upper eyelid. The maxillary branch provides sensation to the lower eyelid, cheek, and upper lip. The mandibular branch controls the muscles of mastication (chewing) and provides sensation to the lower lip, chin, and lower teeth. Therefore, CN 5 is the correct answer for this question.

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  • 45. 

    Which cranial nerve is responsible for facial movement, facial expressions,& secretion of tears and saliva?

    • A.

      CN 5 (trigeminal)

    • B.

      CN 8 (vestibulocochlear)

    • C.

      CN 3 (Oculomotor)

    • D.

      CN 7 (Facial)

    Correct Answer
    D. CN 7 (Facial)
    Explanation
    Cranial nerve 7, also known as the Facial nerve, is responsible for facial movement, facial expressions, and secretion of tears and saliva. This nerve innervates the muscles of facial expression, allowing us to smile, frown, and make various facial expressions. It also controls the lacrimal and salivary glands, which produce tears and saliva respectively. Therefore, the correct answer is CN 7 (Facial).

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  • 46. 

    Which cranial nerve is responsible for turning eye laterally?

    • A.

      CN 6 (Abducens)

    • B.

      CN 3 (Oculomotor)

    • C.

      CN 1 (Optic)

    • D.

      CN 5 (Trigeminal)

    Correct Answer
    A. CN 6 (Abducens)
    Explanation
    The cranial nerve responsible for turning the eye laterally is CN 6 (Abducens). This nerve innervates the lateral rectus muscle, which is responsible for abduction of the eye, or turning it outward. CN 3 (Oculomotor) controls the movement of most of the other extraocular muscles, but not the lateral rectus. CN 1 (Optic) is responsible for vision and CN 5 (Trigeminal) is responsible for sensation in the face.

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  • 47. 

    Which cranial nerve is responsible for hearing & sense of balance (equilibrium)?

    • A.

      CN 11 (Spinal Accessory)

    • B.

      CN 8 (Vestibulocochlear)

    • C.

      CN 4 (Trochlear)

    • D.

      CN 10 (vagus)

    Correct Answer
    B. CN 8 (Vestibulocochlear)
    Explanation
    The cranial nerve responsible for hearing and sense of balance (equilibrium) is CN 8, also known as the Vestibulocochlear nerve. This nerve has two components: the vestibular branch, which is responsible for balance and spatial orientation, and the cochlear branch, which is responsible for hearing. CN 11 (Spinal Accessory) is responsible for controlling certain muscles in the neck and shoulders, CN 4 (Trochlear) is responsible for eye movement, and CN 10 (vagus) is responsible for various functions such as heart rate, digestion, and speech.

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  • 48. 

    Which cranial nerve is responsible for PERRLA (Pupillary reactions) & visual fields?

    • A.

      CN 2 (Optic)

    • B.

      CN 6 (Abducens)

    • C.

      CN 3 (Oculomotor)

    • D.

      CN 12 (hypoglossal)

    Correct Answer
    C. CN 3 (Oculomotor)
    Explanation
    The correct answer is CN 3 (Oculomotor). The oculomotor nerve is responsible for controlling the movement of the eye muscles and also plays a role in pupillary reactions. It innervates the muscles that control the constriction and dilation of the pupil, which are important for assessing the pupillary light reflex. Additionally, CN 3 is involved in controlling the extraocular muscles that move the eye and is responsible for coordinating eye movements and maintaining visual fields.

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  • 49. 

    You have arrived to class early and find Mrs. Hammack is not quite herself. She is sitting on the assessment table talking to Harvey the Dummy. Her eyes are open spontaneously as she is intently staring at Harvey. When you speak with Mrs. Hammock she is able to answer questions appropriately, but is confused in conversation.  She does not follow your commands but when you pinch her hand she purposefully pulls away her hand and threatens to flunk you. What is Mrs. Hammocks current Glasgow Coma Scale score? 

    • A.

      GCS 15

    • B.

      GCS 9

    • C.

      GCS 13

    • D.

      GCS 11

    Correct Answer
    C. GCS 13
    Explanation
    Eyes- 4 (open spontaneously)
    Verbal- 4 (answers questions, confused in conversation)
    Motor- 5 (will not follow commands, purposefully withdraws to pain)

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  • 50. 

    You are doing an assessment on Mr. Donald who is an inpatient at this time. When you call out Mr. Donald's name he does not respond to you nor open his eyes.  You are only able to get him to open his eyes upon deep painful stimulus. At this point he also mumbles some incomprensible speech and then shuts his eyes again. He will not follow commands and there is only a slight withdrawal from pain. What is Mr. Donalds Glasgow Coma Scale score

    • A.

      GCS 8

    • B.

      GCS 5

    • C.

      GCS 12

    • D.

      GCS 3

    Correct Answer
    A. GCS 8
    Explanation
    Mr. Donald's Glasgow Coma Scale (GCS) score is 8. This score is determined based on his response to stimuli, eye opening, and verbal response. In this case, Mr. Donald does not respond to his name being called and only opens his eyes upon deep painful stimulus. He mumbles incomprehensible speech and then shuts his eyes again. He does not follow commands and only shows a slight withdrawal from pain. Based on these responses, his GCS score is 8.

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  • Mar 20, 2023
    Quiz Edited by
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  • Oct 14, 2008
    Quiz Created by
    Scottishduffy
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