Questions

Question 1

1. For which of the following patients would a comprehensive health history be appropriate?

a) A new patient with the chief complaint of “I sprained my ankle”
b) An established patient with the chief complaint of “I have an upper respiratory infection”
c) A new patient with the chief complaint of “I am here to establish care”
d) A new patient with the chief complaint of “I cut my hand”

Answer 1

C

Question 2

The components of the health history include all of the following except which one?

a) Review of systems
b) Thorax and lungs
c) Present illness
d) Personal and social items

Answer 2

B

Question 3

Is the following information subjective or objective? Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest.

a) Subjective
b) Objective

Answer 3

A

Question 4

Is the following information subjective or objective? Mr. M. has a respiratory rate of 32 and a pulse rate of 120.

a) Subjective
b) Objective

Answer 4

B

Question 5

The following information is recorded in the health history: “The patient has had abdominal pain for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the mid-epigastric area.” Which of these categories does it belong to?

a) Chief complaint
b) Present illness
c) Personal and social history
d) Review of systems

Answer 5

B

Question 6

The following information is recorded in the health history: “The patient completed 8th grade. He currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass factory during the week.” Which category does it belong to?

a) Chief complaint
b) Present illness
c) Personal and social history
d) Review of systems

Answer 6

C

Question 7

The following information is recorded in the health history: “I feel really tired.” Which category does it belong to?

a) Chief complaint
b) Present illness
c) Personal and social history
d) Review of systems

Answer 7

A

Question 8

The following information is recorded in the health history: “Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea.” Which category does it belong to?

a) Chief complaint
b) Present illness
c) Personal and social history
d) Review of systems

Answer 8

D

Question 9

The following information is best placed in which category? “The patient has had three cesarean sections.”

a) Adult illnesses
b) Surgeries
c) Obstetrics/gynecology
d) Psychiatric

Answer 9

B

Question 10

The following information is best placed in which category? “The patient had a stent placed in the left anterior descending artery (LAD) in 1999.”

a) Adult illnesses
b) Surgeries
c) Obstetrics/gynecology
d) Psychiatric

Answer 10

A

Question 11

The following information is best placed in which category? “The patient was treated for an asthma exacerbation in the hospital last year; the patient has never been intubated.”

a) Adult illnesses
b) Surgeries
c) Obstetrics/gynecology
d) Psychiatric

Answer 11

A

Question 12

Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient–provider interview?

a) Establish the agenda, negotiate a plan, establish rapport, and invite the patient’s story.
b) Invite the patient’s story, negotiate a plan, establish the agenda, and establish rapport.
c) Greet the patient, establish rapport, invite the patient’s story, establish the agenda, expand and clarify the patient’s story, and negotiate a plan.
d) Negotiate a plan, establish an agenda, invite the patient’s story, and establish rapport.

Answer 12

C

Question 13

Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted?

a) Setting in which the symptom occurs
b) Associated manifestations
c) Quality
d) Timing

Answer 13

B

Question 14

Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Which of the following symptom attributes was not addressed in this description?

a) Severity
b) Setting in which the symptom occurs
c) Timing
d) Associated manifestations

Answer 14

A

Question 15

You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning?

a) Directed questioning: starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer
b) Reassuring the patient that the urinary symptoms are benign and that she doesn’t need to worry about it being a sign of cancer
c) Offering the patient multiple choices in order to clarify the character of the urinary symptoms that she is experiencing
d) Asking her to tell you exactly what she means when she states that she has a urinary tract infection

Answer 15

B

Question 16

Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be checked out for the symptom of chest pain. As you listen to him describe his symptom in more detail, you say “Go on,” and later, “Mm-hmmm.” This is an example of which of the following skilled interviewing techniques?

a) Echoing
b) Nonverbal communication
c) Facilitation
d) Empathic response

Answer 16

C

Question 17

Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient?

a) Allow the patient to speak uninterrupted for the duration of the appointment.
b) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you.
c) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview.
d) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end.

Answer 17

B

Question 18

Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is unimpressed by the reception staff, the nurse, and the clinic in general and wants to know why the office wouldn’t call in an antibiotic for her. Which of the following techniques is not useful in helping to calm this patient?

a) Avoiding admission that you had a part in provoking her anger because you were late
b) Accepting angry feelings from the patient and trying not to get angry in return
c) Staying calm
d) Keeping your posture relaxed

Answer 18

A

Question 19

Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem?

a) You are an alcoholic, aren’t you?
b) When was your last drink?
c) Do you drink 2 to 3 beers every weekend?
d) Do you drink alcohol when you are supposed to be working?

Answer 19

B

Question 20

On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual visit for her blood pressure. She is on a low-dose diuretic chronically and denies any side effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her script, she mentions that it is hard not having her husband Bill around anymore. What would you do next?

a) Hand her the script and make sure she has a 3-month follow-up appointment.
b) Make sure she understands the script.
c) Ask why Bill is not there.
d) Explain that you will have more time at the next visit to discuss this.

Answer 20

C

Question 21

A patient is describing a very personal part of her history very quickly and in great detail. How should you react to this?

a) Write down as much as you can, as quickly as possible.
b) Ask her to repeat key phrases or to pause at regular intervals, so you can get almost every word.
c) Tell her that she can go over the notes later to make sure they are accurate.
d) Push away from the keyboard or put down your pen and listen.

Answer 21

D

Question 22

You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire right side. She cannot speak (aphasia). You are supposed to examine her. You notice that the last examiner left her socks at the bottom of the bed, and although sensitive areas are covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would you do next?

a) Carry out your examination, focusing on the neurologic portion, and then cover her properly.
b) Carry out your examination and let the nurse assigned to her “put her back together.”
c) Put her socks back on and cover her completely before beginning the evaluation.
d) Apologize for the last examiner but let the next examiner dress and cover her.

Answer 22

C

Question 23

When you enter your patient’s examination room, his wife is waiting there with him. Which of the following is most appropriate?

a) Ask if it’s okay to carry out the visit with both people in the room.
b) Carry on as you would ordinarily. The permission is implied because his wife is in the room with him.
c) Ask his wife to leave the room for reasons of confidentiality.
d) First ask his wife what she thinks is going on.

Answer 23

A

Question 24

A patient complains of knee pain on your arrival in the room. What should your first sentence be after greeting the patient?

a) How much pain are you having?
b) When did this first occur?
c) Have you injured this knee in the past?
d) Could you please describe what happened?

Answer 24

D

Question 25

You have just asked a patient how he feels about his emphysema. He becomes silent, folds his arms across his chest and leans back in his chair, and then replies, “It is what it is.” How should you respond?

a) “You seem bothered by this question.”
b) “Next, I would like to talk with you about your smoking habit.”
c) “Okay, let’s move on to your other problems.”
d) “You have adopted a practical attitude toward your problem.”

Answer 25

A

Question 26

When using an interpreter to facilitate an interview, where should the interpreter be positioned?

a) Behind you, the examiner, so that the lips of the patient and the patient’s nonverbal cues can be seen
b) Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues of the patient
c) Between you and the patient so all parties can make the necessary observations
d) In a corner of the room so as to provide minimal distraction to the interview

Answer 26

B