1 Flashcards
Which of the following conditions would cause a positive Kussmaul's sign on physical examination? Answers A. Left ventricular failure B. Pulmonary edema C. Coarctation of the aorta D. Constrictive pericarditis
(u) A. Left ventricular failure results in the back-up of blood into the left atrium and then the
pulmonary system so it would not be associated with Kussmaul’s sign.
(u) B. Pulmonary edema primarily results in increased pulmonary pressures rather than having
effects on the venous inflow into the heart.
(u) C. Coarctation of the aorta primarily affects outflow from the heart due to the stenosis resulting
in delayed and decreased femoral pulses; it has no effect on causing Kussmaul’s sign.
(c) D. Kussmaul’s sign is an increase rather than the normal decrease in the CVP during
inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in
patients with constrictive pericarditis or right ventricular infarction.
Anginal chest pain is most commonly described as which of the following?
Answers
A. Pain changing with position or respiration
B. A sensation of discomfort
C. Tearing pain radiating to the back
D. Pain lasting for several hours
(u) A. Pain changing with position or respiration is suggestive of pericarditis.
(c) B. Myocardial ischemia is often experienced as a sensation of discomfort lasting 5-15 minutes,
described as dull, aching or pressure.
(u) C. Tearing pain with radiation to the back represents aortic dissection.
(u) D. Chest pain lasting for several hours is more suggestive for myocardial infarction.
Eliciting a history from a patient presenting with dyspnea due to early heart failure, the
severity of the dyspnea should be quantified by
Answers
A. amount of activity that precipitates it.
B. how many pillows they sleep on at night.
C. how long it takes the dyspnea to resolve.
D. any associated comorbidities.
(c) A. The amount of activity that precipitates dyspnea should be quantified in the history.
(u) B. Orthopnea or paroxysmal nocturnal dyspnea can be quantified by how many pillows a
patient needs to sleep on to be comfortable.
(u) C. How long dyspnea takes to resolve or associated comorbidities has no bearing on
quantifying the severity of dyspnea.
(u) D. See answer C above.
A 25 year-old female presents with a three-day history of chest pain aggravated by
coughing and relieved by sitting. She is febrile and a CBC with differential reveals
leukocytosis. Which of the following physical exam signs is characteristic of her problem?
Answers
A. Pulsus paradoxus
B. Localized crackles
C. Pericardial friction rub
D. Wheezing
(u) A. Pulsus paradoxus is a classic finding for cardiac tamponade.
(u) B. Localized crackles are associated with pneumonia and consolidation, not pericarditis.
(c) C. Pericardial friction rub is characteristic of an inflammatory pericarditis.
(u) D. Wheezing is characteristic for pulmonary disorders, such as asthma.
A 65 year-old white female presents with dilated, tortuous veins on the medial aspect of
her lower extremities. Which of the following would be the most common initial
complaint?
Answers
A. Pain in the calf with ambulation
B. Dull, aching heaviness brought on by periods of standing
C. Brownish pigmentation above the ankle
D. Edema in the lower extremities
(u) A. Patients with deep venous thrombosis (DVT) may present with complaints of pain in the
calf with ambulation. Secondary varicosities may result from DVT’s.
(c) B. Dull, aching heaviness or a feeling of fatigue brought on by periods of standing is the most
common complaint of patients presenting initially with varicosities.
(u) C. Stasis Dermatitis and edema are most suggestive of chronic venous insufficiency.
(u) D. See C for explanation.
A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of
pericardial tamponade is strongly supported by the presence of
Answers
A. pulmonary edema.
B. wide pulse pressure.
C. distended neck veins.
D. an early diastolic murmur.
(u) A. Pulmonary edema may result with low output states as seen with myocardial contusions,
but it is not strongly suggestive of tamponade.
(u) B. Wide pulse pressure is seen in conditions of high stroke volume such as aortic insufficiency
or hyperthyroidism. Narrow pulse pressure is seen with cardiac tamponade.
(c) C. Cardiac compression will manifest with distended neck veins and cold clammy skin.
(u) D. The onset of diastolic murmur is suggestive of valvular disease, not tamponade.
A patient presents with a rash, characterized by red macules and edematous papules with
a clearing center. This best describes which of the following?
Answers
A. erythema marginatum
B. erythema multiforme
C. varicella
D. impetigo
(u) A. Erythema marginatum is associated with rheumatic fever and is characterized by macular
to maculopapular lesions. A clearing center is not found in the rash.
(c) B. Target lesions, also termed iris lesions, are characteristic of erythema multiforme. The rash
may be recurrent but typically resolves over 3-6 weeks.
(u) C. The rash of varicella typically has maculopapules, vesicles, and scabs in various stages of
development. A clearing center is not found in the rash.
(u) D. The lesions of impetigo are pustules that form a honey-colored crust after rupturing.
In a patient suspected of having seborrheic dermatitis, the most common site of involvement would be the Answers A. upper extremities. B. thighs. C. scalp. D. feet.
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. The most common site of involvement of seborrheic dermatitis is the scalp. Other common
sites include the eyebrows, eyelids, nasolabial fold, and ears.
(u) D. See C for explanation.
A 26-year-old obese female complains of a 3-4 month history of discrete erythematous
plaques on the pretibial areas of her legs. The lesions have increased in size, become
darker, and are painful. She is concerned because the centers of the lesions have become
ulcerated. This patient should be screened for which of the following?
Answers
A. Hypothyroidism
B. Diabetes mellitus
C. Melanoma
D. Scleroderma
(u) A. In hypothyroidism the skin of the pretibial area may thicken leading to edema. This is a
diffuse finding, involving the face and eyelids, without discrete lesions.
(c) B. The description of the skin lesions is characteristic of necrobiosis lipoidica diabeticorum,
one of the dermatologic manifestations of diabetes mellitus.
(u) C. The lesions of melanoma are typically not painful and do not ulcerate.
(u) D. Scleroderma is marked by thickening of the skin, with swelling of the fingers and hands.
The swelling may involve the forearms and face; the lower extremities are relatively spared.
A 40 year-old male presents to your clinic complaining of nontender, yellow patches on
both eyelids. He states his brother and uncle have similar growths. He denies any visual
changes or other complaints. Your primary suspicion is
Answers
A. gout.
B. lipoma.
C. hyperlipidemia.
D. seborrheic dermatitis.
(u) A. Tophaceous gout may appear as yellow skin lesions but they usually occur around the
joints and helix of the ear.
(u) B. Lipomas tend to be flesh-colored and are not usually bilateral.
(c) C. Xanthelasmas, along with xanthomas, are common findings in familial
hypercholesterolemia.
(u) D. Eyelids are a common location for seborrheic dermatitis but the lesions are not yellow in
color
A 4 year-old child presents with a rapid onset of high fever and extremely sore throat.
Which of the following findings are suggestive of the diagnosis of epiglottitis?
Answers
A. Croupy cough and drooling
B. Thick gray, adherent exudate
C. Beefy red uvula, palatal petechiae, white exudate
D. Inflammation and medial protrusion of one tonsil
(c) A. A croupy cough with drooling in a patient who appears very ill is consistent with epiglottitis.
Examining the throat is contraindicated, unless the airway can be maintained.
(u) B. Thick gray adherent exudate is suggestive of diphtheria.
(u) C. Beefy red uvula, palatal petechiae, and white exudate are findings suggestive of
streptococcal pharyngitis.
(u) D. Inflammation with medial protrusion of the tonsil is suggestive of a peritonsillar abscess.
Which of the following are normal findings in a Weber test?
Answers
A. The tympanic membrane is movable with pneumatic otoscopy.
B. The tympanic membrane is pearly gray with a sharp cone of light with apex at the umbo.
C. Sound is heard equally in both ears when a vibrating tuning fork is placed on the mid forehead.
D. Air conduction is greater than bone conduction when a vibrating tuning fork is moved from the
mastoid bone to close to the ear canal.
(u) A. A movable tympanic membrane indicates there is no effusion, and is not the Weber test.
(u) B. The tympanic membrane is evaluated by direct observation with an otoscope, and is not
the Weber test.
(c) C. A normal Weber test means there is no lateralization of sound perception when a vibrating
tuning fork is placed on the mid forehead.
(u) D. A normal Rinne test means that tuning fork vibration is heard longer through the air than
the bone.
Which of the following is diagnosed by use of the cover/uncover test? Answers A. Adie’s pupil B. Strabismus C. Glaucoma D. Myopia
(u) A. Adie’s pupil is a sluggish pupil reaction to light and accommodation, evaluated by papillary
reaction to light.
(c) B. The cover/uncover test is used to diagnose strabismus.
(u) C. Tonometry is used to measure intraocular pressure to evaluate for glaucoma.
(u) D. Myopia is evaluated by using a Snellen chart.
A patient is known to have end stage liver disease due to cirrhosis. Which of the following
physical examination findings would commonly be seen in this patient?
Answers
A. Testicular hypertrophy
B. Muscular pseudohypertrophy
C. Gynecomastia
D. Hepatomegaly
(u) A. Testicular atrophy, wasting of the muscles of the lower extremity, spider angiomas, caput
medusa and gynecomastia are physical examination findings associated with end stage liver
disease associated due to cirrhosis.
(u) B. Muscular pseudohypertrophy is seen in muscular dystrophy.
(c) C. See A for explanation.
(u) D. Patients with end stage liver failure who have cirrhosis have a small shrunken liver from the
ongoing cellular destruction and fibrosis.
Which of the following is the most consistent physical examination finding in a patient with duodenal ulcer? Answers A. Flank tenderness B. Right upper quadrant tenderness C. Epigastric tenderness D. Rebound tenderness
(u) A. Flank tenderness is caused by urologic disorders such as pyelonephritis and renal lithiasis.
(u) B. Right upper quadrant tenderness on palpation is a typical feature for cholecystitis.
(c) C. Epigastric tenderness is a key feature of duodenal ulcer.
(u) D. Rebound tenderness is a feature of peritonitis from rupture of a hollow viscus and is not
seen with just the presence of duodenal ulcer.
The initial sign or symptom of iron poisoning in a 3 year-old child is usually Answers A. vomiting and bloody diarrhea. B. convulsions and tetany. C. somnolence and coma. D. ataxia and colicky abdominal pain.
(c) A. Iron causes localized necrosis and hemorrhage at the point of contact in the GI system
resulting in abdominal pain, vomiting, bloody diarrhea, and hematemesis.
(u) B. Convulsions and tetany are symptoms of hypocalcemia.
(u) C. Somnolence and coma are not initial findings in iron ingestion.
(u) D. Ataxia and colicky abdominal pain are consistent with lead poisoning.
A classic skin finding seen in patients with inflammatory bowel disease would be
Answers
A. erythematous plaques on the extremities.
B. poorly healing, indolent ulcers on the lower extremities.
C. pretibial myxedema.
D. purple striae.
(u) A. Granuloma annulare is seen with diabetes mellitus. It consists of erythematous plaques on
the extremities or trunk.
(c) B. Pyoderma gangrenosum is classically seen with inflammatory bowel disease and is rarely
seen in the absence of inflammatory bowel disease.
(u) C. Pretibial myxedema is the skin manifestation of hyperthyroidism.
(u) D. The dermatologic manifestations of Cushing’s disease are purple striae and a
supraclavicular fat pad.
A 55-year-old non-smoking male presents with a hemoglobin of 18.5 g/dl and a hematocrit of 56%. Which of the following physical examination findings is the most likely to be noted with this patient? Answers A. Splenomegaly B. Cheilosis C. Purpura D. Decreased vibratory sense
(c) A. Patients with polycythemia vera present with elevated hemoglobin and hematocrit. On
physical examination plethora, engorged retinal veins, and splenomegaly are common.
(u) B. Cheilosis is noted in iron deficiency anemia.
(u) C. Purpura is typically noted in bleeding disorders.
(u) D. Decreased vibratory sense is noted in vitamin B12 deficiency.
A 73 year-old male presents to the clinic with his wife. His wife has noticed that he has
developed a resting tremor in his right hand and a shuffling gait over the last year. What
finding on physical examination would support your suspected diagnosis?
Answers
A. Chorea
B. Dystonia
C. Masked facies
D. Hyperreflexia
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. The patient symptoms are consistent with Parkinsonism. Physical exam findings include
masked facies, micrographia, decreased arm swing, and monotonous speech.
(u) D. See C for explanation.
A patient with an upper motor neuron lesion would exhibit which of the following findings? Answers A. Fasciculations B. Areflexia C. Muscular atrophy D. Spasticity
(u) A. Fasciculations, areflexia and muscle atrophy are consistent with lower motor neuron
lesions.
(u) B. See A for explanations.
(u) C. See A for explanation.
(c) D. Spasticity is an upper motor neuron lesion finding.
On examination of a pregnant patient the physician assistant notes a bluish or purplish
discoloration of the vagina and cervix. This is called
A. Hegar’s sign.
B. McDonald’s sign.
C. Cullen’s sign
D. Chadwick’s sign
(u) A. Hegar’s sign is the softening of the cervix that often occurs with pregnancy.
(u) B. McDonald’s sign is when the uterus becomes flexible at the uterocervical junction at 7-8
weeks.
(u) C. Cullen’s sign is a purplish discoloration periumbilical and noted in pancreatitis.
(c) D. Chadwick’s sign is a bluish or purplish discoloration of the vagina and cervix.
On examination of a pregnant patient the physician assistant notes the fundal height is at
the level of the umbilicus. This corresponds to what gestational age?
Answers
A. 16 weeks
B. 20 weeks
C. 24 weeks
D. 28 weeks
(u) A. See B for explanation.
(c) B. At 20-22 weeks the fundal height is typically at the level of the umbilicus.
(u) C. See B for explanation.
(u) D. See B for explanation.
Which of the following is the most common manifestation of polycystic ovarian syndrome? Answers A. Desquamation B. Hirsutism C. Galactorrhea D. Rebound tenderness
(u) A. Desquamation is noted in toxic shock syndrome.
(c) B. The patient with polycystic ovarian syndrome typically presents with hirsutism or infertility.
(u) C. Galactorrhea is noted in hyperprolactinemia.
(u) D. Rebound tenderness is noted in conditions causing peritonitis.
Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle? Answers A. Supraspinatus B. Infraspinatus C. Teres minor D. Subscapularis
(c) A. Abduction against resistance tests the supraspinatus.
(u) B. Lateral rotation against resistance tests the infraspinatus and teres minor.
(u) C. See B for explanation.
(u) D. Medial rotation against resistance tests the subscapularis.
A 22 year-old male presents to the ED after sustaining a blow to the knee during football
practice. The knee exam demonstrates significant forward translation of the tibia when
the knee is in 15 degrees of flexion and external rotation at the hip. Which of the following
knee maneuvers does this represent?
Answers
A. Abduction stress test
B. Anterior drawer sign
C. Lachman test
D. McMurray test
(u) A. The abduction stress test is performed to evaluate medial collateral ligament tears while
applying valgus stress.
(u) B. The anterior drawer sign is performed to evaluate the anterior cruciate ligament; however
the patient is supine, hips and knees flexed, and feet are flat on the table.
(c) C. The Lachman test is performed to evaluate the anterior cruciate ligament. The knee is
placed in 15 degrees of flexion and external rotation of the hip.
(u) D. The McMurray test is performed to
A 12 year-old female presents for a routine sports physical. The physical exam reveals
asymmetry of the posterior chest wall on forward bending. This is the most striking and
consistent abnormality of which of the following?
Answers
A. Spondylolysis
B. Spondolisthesis
C. Scoliosis
D. Herniated disc
(u) A. Spondylolysis presents with limitation of lumbar flexibility and tight hamstring muscles.
(u) B. Spondylolisthesis presents with reduced lumbar lordosis and sacral kyphosis.
(c) C. Asymmetry of the posterior chest wall on forward bending is the most striking and
consistent abnormality in patients with idiopathic scoliosis.
(u) D. Herniated disc presents with lumbar muscle spasm and a positive straight leg test.
