Health Assessment and Physical Examination Test Bank

Health Assessment and Physical Examination Test Bank Related

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A 42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons. What is the best choice for the cause of her constipation?

  • A. Large bowel obstruction
  • B. Irritable bowel syndrome
  • C. Rectal cancer
  • D. Hypothyroidism
Correct Answer: D

Rationale: The constellation of symptoms described in the scenario, including chronic constipation, fatigue, weight gain, irregular periods, cold intolerance, and delayed deep tendon reflexes, suggests hypothyroidism as the likely cause. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowdown in bodily functions. Constipation is a common symptom of hypothyroidism due to the decreased motility of the bowel. The presence of cold intolerance, weight gain, and irregular periods further supports this diagnosis, as these are classic symptoms of hypothyroidism. The delayed deep tendon reflexes, especially in the Achilles tendons, are indicative of the myopathic changes that can occur in hypothyroidism. It is important to further investigate thyroid function through laboratory testing to confirm the diagnosis and initiate appropriate treatment. Other conditions such as large bowel obstruction, irritable bowel syndrome, and rectal cancer are less likely based

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He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit?

  • A. Refer the patient to a nutritionist because he is anorexic.
  • B. Reassure the patient that he has a normal body weight.
  • C. Give the patient information about reduction of fat, cholesterol, and calories because he is overweight.
  • D. Give the patient information about reduction of fat and cholesterol because he is obese.
Correct Answer: C

Rationale: The appropriate counsel for the patient during the visit would be to give information about the reduction of fat, cholesterol, and calories because he is concerned about his weight. This option addresses the patient's concern and provides guidance on making healthier choices to manage weight. Referring the patient to a nutritionist because he is anorexic (Option A) is not appropriate based on the information provided. Reassuring the patient that he has a normal body weight (Option B) may not address his concerns about weight. Giving the patient information about reducing fat and cholesterol only because he is obese (Option D) does not cover all aspects of a healthy diet such as managing calorie intake.

A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?

  • A. Stage 1
  • B. Stage 2
  • C. Stage 3
  • D. Stage 4
Correct Answer: C

Rationale: A stage 3 pressure ulcer involves full-thickness skin loss with damage and necrosis of the subcutaneous tissue, but the underlying muscle is not affected. In this case, the description of the full-thickness skin loss with involvement of the subcutaneous tissue but not the muscle corresponds to a stage 3 pressure ulcer. Stage 1 involves intact skin with non-blanchable redness, stage 2 involves partial-thickness skin loss with a shallow open ulcer, and stage 4 involves full-thickness tissue loss with the involvement of muscle, bone, or supporting structures.

Which of the following is consistent with good percussion technique?

  • A. Allow all of the fingers to touch the chest while performing percussion.
  • B. Maintain a stiff wrist and hand.
  • C. Leave the plexor finger on the pleximeter after each strike.
  • D. Strike the pleximeter over the distal interphalangeal joint.
Correct Answer: C

Rationale: Leaving the plexor finger on the pleximeter after each strike is consistent with good percussion technique. This helps to maintain stability and precision during percussion by providing a consistent point of contact for accurate assessment of the underlying structures. This technique also helps to control the force and angle of the percussive strike, ensuring accurate interpretation of the resulting sounds produced. Maintaining this contact can enhance the effectiveness of percussion as a diagnostic tool in physical examinations.

Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of her pain?

  • A. Trigeminal neuralgia
  • B. Temporomandibular joint syndrome
  • C. Temporal arteritis
  • D. Tumor of the mandible
Correct Answer: B

Rationale: Mrs. Fletcher's symptoms of unilateral pain during chewing, which is chronic, without facial tenderness or tenderness of the scalp are more suggestive of temporomandibular joint (TMJ) syndrome rather than other conditions listed. TMJ syndrome is characterized by pain and dysfunction of the jaw muscles and the joints that connect the jaw to the skull. The pain is often worsened by chewing or opening the mouth widely. In this case, the absence of facial tenderness or signs of temporal arteritis makes these conditions less likely. Trigeminal neuralgia typically presents with sudden, severe facial pain in the distribution of the trigeminal nerve. Tumor of the mandible would likely present with other symptoms such as swelling, bone destruction, or difficulty with mouth opening and chewing. Temporal arteritis usually presents with symptoms such as headache, scalp tenderness, and visual disturbances. Given Mrs. Fletcher's presentation,

Which of the following events occurs at the start of diastole?

  • A. Closure of the tricuspid valve
  • B. Opening of the pulmonic valve
  • C. Closure of the aortic valve
  • D. Production of the first heart sound (S )
Correct Answer: B

Rationale: At the start of diastole, the ventricles relax and begin to fill with blood from the atria. As this relaxation phase begins, the pulmonic valve opens to allow blood to flow from the right ventricle to the pulmonary artery and then to the lungs for oxygenation. This marks the beginning of diastole, the period of the cardiac cycle when the heart is filling with blood. The closure of the tricuspid valve, closure of the aortic valve, and production of the first heart sound (S1) occur during systole, the phase of the cardiac cycle when the heart is contracting to pump blood out to the body.

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