Where is the point of maximal impulse (PMI) normally located? - ANS In the left 5th intercostal
space 7 to 9 cm lateral to the sternum
A patient presents with claudication symptoms and diminished pulses. Which of the following is
consistent with peripheral arterial disease? - ANS Red shiny skin and hair loss on the lower
extremities
Displacement of the PMI lateral to the midclavicular line or greater than 10 cm lateral to the
midsternal line suggests what? - ANS Left ventricular enlargement, possibly from uncontrolled
hypertension.
Important questions to ask the patient concerning the gastrointestinal area include what? - ANS
ALL OF THE ABOVE
If a patient's anterior-posterior to lateral diameter is 1:1 (they are equal), what shape might his
chest have? - ANS Barrel chest
What is the best place to auscultate for a community-acquired pneumonia? - ANS Right lower
lobe
T/F
When you have your patient squat, the venous return to the right side of the heart increases and
the peripheral vascular resistance increases. The blood pressure, stroke volume, and the
volume of blood in the left ventricle all rise. This may help you to find a heart murmur or extra
sound. - ANS True
Mr. Johnson an African American attorney, in a highly stressful job, presents in your office with a
blood pressure of 130/80. He denies recent headaches, vision changes, shortness of breath,
nausea, chest pain, palpitation, etc. What is your recommendation? - ANS Re-check the blood
pressure to make sure a mistake was not made the first time and discuss therapeutic lifestyle
changes
When crackles, wheezes, or rhonchi clear with a cough which of the following is a likely
etiology? - ANS Bronchitis
You are teaching self breast exam to a patient. What "red flags" would you instruct her to
observe? - ANS ALL OF THE ABOVE
, A patient's anterior-posterior to lateral diameter of the chest should be what? - ANS 2:1
Which lung sound possesses the characteristics of being louder and higher in pitch, with a short
silence between inspiration and expiration and with expiration being longer than inspiration? -
ANS Bronchial
Jim is a 60 year old man who presents with vomiting. He denies seeing any blood with emesis,
which has been occurring for 2 days. He does note a dark, granular substance resembling the
coffee left in the filter after brewing. What do you suspect? - ANS Bleeding from a peptic ulcer
A 57 year old maintenance worker comes to your office for evaluation of pain in his legs. He has
smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned
that he may have peripheral vascular disease. Which of the following is part of common or
concerning symptoms for the peripheral vascular system? - ANS Intermittent claudication
A 58 year old teacher presents to your clinic with a complaint of breathlessness with activity.
The patient has no chronic conditions and does not take any medications, herbs, or
supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular
review of symptoms? - ANS Dyspnea
T/F
A positive obturator sign could indicate gallbladder disease. - ANS False
T/F
When listening to your patient's lung sounds, you only need to listen to the inspiration sounds. -
ANS Flase
Which is the proper sequence of examination for the abdomen? - ANS Inspection, Auscultation,
Percussion, Palpation
A 13 year old boy presents in your office. He denies any symptoms, shortness of breath, chest
pain, or lightheadedness on exertion. Yet his grandmother thinks his chest "looks funny." Upon
visual examination of the chest, you note that the lower portion of the sternum is depressed.
What disorder of the thorax would best describe this? - ANS Funnel chest (pectus excavatum)
A 21 year old receptionist comes to your clinic, complaining of frequent diarrhea. She states this
has occurred on and off since she was in high school. She denies any nausea, vomiting, or
blood in her stool. Occasionally she has periods of constipation but that is rare. She thinks the
diarrhea is much worse when she is nervous. Her past medial history is not significant. She is
single and a junior in college majoring in accounting. She smokes when she drinks alcohol but
denies using any illegal drugs. Both of her parents are healthy. Her entire physical examination
is unremarkable. What is most likely the etiology of her diarrhea? - ANS Irritable bowel
syndrome
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