Physical Examination Assessment Test

152 Questions | Total Attempts: 93

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Physical Examination Assessment Test

Questions and Answers
  • 1. 
    A 45 year old, previously healthy woman is presented with jaundice, confusion, and fever. Initial physical examination is unremarkable except for scattered petechiae on the lower extremities, sclera icterus, and disorientation on mental status examination. Laboratory examination discloses:
    • Hct 27%, WBC 12,000/uL, Platelets 10,000/uL,    PT/PTT=normal
    • Total Bilirubin 5 mg/dL, Direct Bilirubin 0.6 mg/dL, BUN 60 mg/dL, Creatinine 4.5 mg/dL
    • RBC smear looks like this:
    What is your diagnosis?
    • A. 

      Thrombocytopenia

    • B. 

      Hemolytic anemia

    • C. 

      Has recent mechanical valve placement

    • D. 

      Thrombotic thrombocytopenic purpura(TTP)

    • E. 

      Bleeding disorder

  • 2. 
    A patient comes to see you in your general medicine clinic complaining of long-standing generalized weakness. Initially, the weakness started several months ago with difficulty climbing up stairs and rising out of a chair. She had been seen for this several times in the E.D. and most recently had to have stiches placed for a forehead laceration incurred during a "weakness" fall. Having had enough, she comes to you specifically complaining of a 2 week history of difficulty combing her hair. On examination the patient has this.(See image below) What is your diagnosis?
    • A. 

      Infective endocarditis

    • B. 

      Fungal infections

    • C. 

      Hyperkeratosis

    • D. 

      Solar burns

    • E. 

      Dermatomyositis

  • 3. 
    This particular lady has wheezing with her flushing episodes, as well as diarrhea. On examination she also has pulsatile hepatomegaly and a 2/6 systolic ejection murmur along the left sternal border that increases with respiration. She also has associated paroxysmal hypotension during a typical flushing episode. The appropriate diagnosis can be made by which of the following:
    • A. 

      Serum Gastrin level

    • B. 

      Serum VIP level

    • C. 

      Urinary catecholamines, VMA, metanephrines

    • D. 

      Urinary 5-HIAA, 5-HT

    • E. 

      Serum TSH

    • F. 

      Urine collection for histamine, histamine metabolites, PGD2 metabolities with/without serum histamine level

  • 4. 
    A 72 year old white woman presents to the ED complaining of left-leg discoloration, pain, and swelling which developed over several hours, associated with a burning-itching sensation. She noticed that a large area of her left upper leg was reddish-blue with small blisters. The patient denies any fever, trauma, or bites. Doppler ultrasonography of her left leg two weeks prior had yielded normal results. PHYSICAL EXAMINATION: The patient is alert, appears pale and anxious, and is in moderate discomfort from pain in her left leg. Her vital signs are temperature 97.8 degrees F, pulse 73 beats/min, blood pressure 113/59 mm of Hg, and respirations 18 breaths/minute. The results of her HEENT, cardiovascular, respiratory, abdominal, and neurological exams are normal. Her left leg is tender to palpation without crepitus. Pitting edema extends the entire length of the leg with a reddish- blue discoloration. Numerous small vesicles are also noted with three, 3- 5 cm hemorrhagic bullae on the medial thigh. What is your diagnosis?
    • A. 

      Necrotizing fasciitis

    • B. 

      Waterhouse-Friderichsen syndrome

    • C. 

      Pemphigus vulgaris

    • D. 

      Pemphigoid

    • E. 

      Hemophilia

  • 5. 
    A 30 year old woman presents with sudden, progressive "blurring" of vision in the left eye only. You dilate her eyes and do an ophthalmologic examination. Her right eye is normal. The left eye shows the following: What is your diagnosis?
    • A. 

      Brain tumor

    • B. 

      Pseudotumor cerebri

    • C. 

      Intracerebral hemorrhage

    • D. 

      Optic nerve glioma

    • E. 

      Malignant hypertension

    • F. 

      Diabetes Mellitus

  • 6. 
    Which of the following case histories would most likely be associated with the urinary sediment depicted below?
    • A. 

      A 23-year-old man with newly diagnosed lymphoblastic lymphoma who is found to have a rising creatinine level 2 days after the administration of combination chemotherapy

    • B. 

      A 23-year-old woman 1 year after surgery performed because of morbid obesity

    • C. 

      A 45-year-old woman with a history of multiple urinary tract infections with urea-splitting organisms

    • D. 

      A 40-year-old man with edema, hypoalbuminemia and proteinuria.

    • E. 

      An 18-year-old man with flank pain, hematuria and a positive family history for renal stones in youth

  • 7. 
    A 60-year-old mildly obese woman complains of a very bothersome burning pain on the anterolateral aspect of her right thigh from the groin almost as far distally as the knee. Examination shows reduction of sensation to touch and pinprick in the affected area. There is no loss of muscle strength, and reflexes are normal. The most likely diagnosis is?
    • A. 

      Ruptured intervertebral disk

    • B. 

      Femoral hernia

    • C. 

      Nutritional neuropathy

    • D. 

      Compression of the lateral femoral cutaneous nerve

    • E. 

      Disruption of the lumbosacral plexus

  • 8. 
    A 65 year-old man with a history of hypertension and chronic obstructive pulmonary disease secondary to cigarette smoking presents to a physician in the clinic because his wife thought "he looked different". He also has had the development of right back and shoulder pain. This is a picture of his face. What is your diagnosis?
    • A. 

      Grave’s disease

    • B. 

      Glaucoma

    • C. 

      Intracranial hypertension

    • D. 

      Hyperthyroidism

    • E. 

      Pancoast's tumor

  • 9. 
    A 45-year-old man presents to you with the following leg ulcer of the lateral calf. He has had this lesion going on 3-4 months. It is minimally painful and has failed to heal soaking in water, wrapping it with bandages, cleaning with hydrogen peroxide or applying bacitracin. Being the astute clinician you do a complete history and on review of systems you also get a history of arthralgias and occasional bloody diarrhea over the past few years. On exam, he does have some evidence of synovitis in diffuse joints but otherwise the physical exam is unremarkable. The most likely diagnosis is?
    • A. 

      Venous insufficiency ulcer

    • B. 

      Pyoderma Gangrenosum

    • C. 

      Ulceration of squamous cell carcinoma

    • D. 

      Ulceration of squamous cell carcinoma

    • E. 

      Necrotizing vasculitis

    • F. 

      Ulceration associated with arterial insufficiency

  • 10. 
    A 79 year old man is diagnosed with terminal prostate cancer. He is admitted in the Hospice with severe respiratory distress, dehydration and anemia. On examination, B.P 90/60mmHg, R/R 30/min, Pulse is 65/min. He is unconscious. After the examination, the attending Physician writes out the treatment.  The Nurse on duty reminds the ER doctor that the patient has a signed “DNR”.   What is your understanding of the term “Do Not Resuscitate” (DNR)?
    • A. 

      No intubation and ventilation

    • B. 

      No artificial nutrition by tube

    • C. 

      No medication

    • D. 

      No CPR

    • E. 

      No IVF or blood transfusion

    • F. 

      No admission to intensive care

    • G. 

      No life support

    • H. 

      No surgical intervention

  • 11. 
    Paramedics bring a 41- year old man to the emergency room. He is complaining of headache, dizziness, nausea and abdominal pain. The paramedics state that the patient's apartment has a coal furnace. His blood pleasure is 110/70 mmHg, respirations are 20 breath per minute, and pulse is 100 beats per minute. The patient has a cherry red appearance most noticeable around the lips and nail beds. Neurologic examination reveals a disoriented and confused man without facials deficits. Oxygen saturation by pulse oximetry is normal. Which of the following is the most likely disgnosis ?
    • A. 

      Drug overdose

    • B. 

      Carbon monoxide poisoning

    • C. 

      Alcohol intoxication

    • D. 

      Methemoglobinemia

    • E. 

      Anti-freeze poison

  • 12. 
    A 75 year old woman complains of neck pains. She has a prior history of hypertension, diabetes and CHF. On examination, she has kyphosis, BP is 129/87 mmHg, Pulse 78/min., tender lower neck posteriorly, with mild pedal edema.  Her cervical X-ray is shown below. What is your diagnosis?
    • A. 

      Osteomyelitis

    • B. 

      Osteoporosis

    • C. 

      Rheumatoid arthritis

    • D. 

      Osteoarthritis

    • E. 

      Multiple myeloma

  • 13. 
    A 12 year old African migrant girl is diagnosed with iron deficiency anemia. She has koilonychias. Blood work-up showed microcytosis, Increased TIBC, decreased ferritin, and decreased serum Iron. There were no sickled cells.  What else might you find on physical examination?
    • A. 

      Frontal bossing of the skull

    • B. 

      Joint swellings

    • C. 

      Jaundice

    • D. 

      Autosplenectomy

    • E. 

      Glossitis

    • F. 

      Macrocytosis

    • G. 

      Increased TIBC

    • H. 

      Decreased ferritin

  • 14. 
    A 68 year old man with history of prostate cancer, diabetes, hypertension, and fungal infection, comes to the clinic for follow up and complained of problems with his finger nails. The image is shown below.  The doctor notes transverse depression in nail plate and concludes that the patient’s nail finding has something to do with?
    • A. 

      Side effects of antihypertensive medication

    • B. 

      He has onychomycosis

    • C. 

      Cancer metastasis

    • D. 

      Side effect of steroids

    • E. 

      Side effect of antineoplastic drugs

  • 15. 
    During physical examination, a doctor notes that his recently referred 56 year old man has nail plate that is white with narrow pink distal band. He describes it as “ground glass appearance”.  There is no tenderness, and clubbing. Which of the following will not be the likely diagnosis?
    • A. 

      Cirrhosis.

    • B. 

      Chronic CHF.

    • C. 

      Hemodialysis patients.

    • D. 

      Renal transplant recipients.

    • E. 

      HIV/AIDS patients.

    • F. 

      Paronychia

  • 16. 
    A 62 year old bell ringer for 25 years complains of pain resulting from thumb and wrist motion on his right hand. There is no history of trauma. He has no prior medical record, although he drinks alcohol socially. His blood pressure is 135/89 mmHg, chest is clear to auscultation; resp is 16/min., pulse 89/min. He has tenderness, thickening, and a prominence at the radial styloid. Crepitation is felt at the first dorsal compartment over the radial styloid. Flexion of the thumb across the palm and then ulnar deviation of the wrist causes sharp pain at the first dorsal compartment.   What is your most likely diagnosis?
    • A. 

      Carpal tunnel syndrome.

    • B. 

      Rheumatoid arthritis.

    • C. 

      Gout.

    • D. 

      Osteomyelitis.

    • E. 

      De Quervains tenosynovitis.

    • F. 

      Fracture of the radius in the lower one third.

  • 17. 
    A 48 year old white female secretary presents with progressive difficulty typing over the past month. She also notes that her hands begin to feel numb and weak after typing for long periods of time.  On testing which of the following deficits would be predicted?
    • A. 

      Difficulty abducting the fifth finger

    • B. 

      Difficulty in adducting the thumb

    • C. 

      Loss of sensation over the lateral three and half fingers of the palm

    • D. 

      Difficulty in opposition of the thumb

    • E. 

      Loss of sensation over the medial aspect of the palm

  • 18. 
    A 32-year-old secretary comes to the office for a periodic health evaluation and Pap smear. She says, "I've been doing fine except that for the past 2 months my right hand sometimes has been tingling and feels numb, especially at night. I'm always dropping things, too." She takes oral contraceptive pills and thyroid replacement medication for hypothyroidism. She is right-hand dominant. She has no history of acute trauma. On physical examination, she has numbness and tingling in the thumb and first two digits of her right hand after 15 seconds of a wrist flexion test. The remainder of the examination is normal.  Which of the following studies is most likely to establish a diagnosis?
    • A. 

      Cervical spine x-ray films

    • B. 

      MRI of the brain

    • C. 

      Nerve conduction studies

    • D. 

      Serum thyroid-stimulating hormone (TSH) concentration

    • E. 

      X-ray film of the right hand and wrist

    • F. 

      CT scan of the brain and wrist.

  • 19. 
    A 50 year old Japanese man complains of malaise, night sweets, and weight loss. Physical examination is remarkable for faint radial pulses and absent pulses over the lower extremities. What is the likely diagnosis?
    • A. 

      Buerger disease

    • B. 

      Kawasaki disease

    • C. 

      Takayasu disease

    • D. 

      Thrombophlebitis

    • E. 

      Wegener granulomatosis

  • 20. 
    A 70 year old man is admitted for chest pain and dyspnea.  Physical examination reveals a systolic murmur suggestive of mitral regurgitation due to rupture of chordate tendineae. Which of the following will increase in this man?
    • A. 

      Aortic diastolic pressure

    • B. 

      Aortic systolic pressure

    • C. 

      Left atrial pressure at end of diastole

    • D. 

      Left atrial pressure at end of systole

    • E. 

      Right atrial pressure at the end of systole

    • F. 

      Right atrial pressure at the end of diastole

  • 21. 
    A sky jumper injures his arm during training. Physical examination reveals a right wrist drop with absent triceps reflex on the right side.  Which of the following nerves was most probably injured?
    • A. 

      Axillary

    • B. 

      Median

    • C. 

      Musculocutaneous

    • D. 

      Radial

    • E. 

      Ulnar

  • 22. 
    A 22 year old ice-skater dies suddenly on the ice during a performance at the Olympic games with his partner. What would be the most likely finding in his heart at autopsy?
    • A. 

      Thrombosis of the left anterior descending coronary artery

    • B. 

      Aortic outflow obstruction

    • C. 

      Pulmonic outflow obstruction

    • D. 

      Aortic regurgitation

    • E. 

      Congestive heart disease

    • F. 

      Mitral valve prolapse

  • 23. 
    A 65 year old man presents with unilateral throbbing headache, malaise and fatigue. On examination, he is tender at both temples, with low grade fever. A biopsy of the temporal artery is normal. He is anemic with a very high ESR, and positive CRP. This patient should be treated aggressively to avoid?
    • A. 

      Blindness

    • B. 

      Deafness

    • C. 

      Loss of tactile sensation

    • D. 

      Loss of ability to speak

    • E. 

      Stroke

    • F. 

      Myocardial infarction

  • 24. 
    A 3 year old boy is being evaluated for mental retardation. Physical examination is remarkable for long face, large ears, and bilateral enlarged testes. What is your diagnosis?
    • A. 

      Down syndrome

    • B. 

      Edward syndrome

    • C. 

      Fragile X syndrome

    • D. 

      Klinefelter syndrome

    • E. 

      Turner syndrome

    • F. 

      Potter’s sequence

    • G. 

      Fetal alcohol syndrome

  • 25. 
    A neurologist examines a 50 year old banker. When the patient’s right eye is touched with a wisp of cotton wool, both eyes blinks. But when the patient’s left eye is touched with same cotton wisp, neither eye blinks. What might you expect on further examination of this patient?
    • A. 

      Loss of pain and temperature sensations from the left face.

    • B. 

      Loss of taste sensation from anterior two-thirds of the left tongue.

    • C. 

      Ptosis of the left eye.

    • D. 

      Hyperacusis of the left ear.

    • E. 

      Inability to abduct the left eye

    • F. 

      Absence of papillary reflex of the left eye.