2011 Exam Multichoice questions Flashcards Preview

168.123 Assessment and clinical decision making > 2011 Exam Multichoice questions > Flashcards

Flashcards in 2011 Exam Multichoice questions Deck (30):
1

1. Your patient tells you he is allergic to penicillin. What would be your next response?
a) "Are you allergic to any other drugs?"
b) "I'll write your allergy on your medication chart so you won't receive any."
c) "Would you describe what happens to you when you take penicillin?"
d) "How often have you received penicillin?"

c) "Would you describe what happens to you when you take penicillin?"

2

2. Which of the following statements is true regarding the assessment of mental status?
a) Mental status can be assessed directly, just like other systems of the body, e.g., cardiac and breath sounds.
b) Mental disorders occur in response to everyday life stressors.
c) Mental status functioning is inferred through assessment of an individual's behaviours.
d) Mental status assessment diagnoses specific psychiatric disorders.

b) Mental disorders occur in response to everyday life stressors.

Not sure

3

3. When percussing over the ribs of your patient you note a flat sound. You would:
a) consider this an abnormal finding and refer the patient for additional treatment.
b) reposition your hands and attempt to percuss in this area again.
c) consider this a normal finding.
d) palpate this area for an underlying mass.

c) consider this a normal finding.

4

4. The force or strength of the pulse:
a) is a reflection of the heart's stroke volume.
b) reflects the blood volume in the arteries during diastole.
c) demonstrates elasticity of the vessel wall.
d) is usually recorded on a 0-2 scale.

a) is a reflection of the heart's stroke volume.

From lecture notes

5

5. When auscultating the blood pressure of a 25-year old, you hear the Phase I Korotkoff sounds begin at 200 mm Hg; at 100 mm Hg the Korotkoff sounds muffle; at 92 mm Hg the Korotkoff sounds disappear. How should you record this patient's blood pressure?
a) 200/100/92
b) 200/100
c) 200/92
d) 100/200/92

a) 200/100/92

Weber and Kelly - Page 93 - Note that the American Heart Association recommends that values in phase IV and V be recorded when both a change in the sounds and a cessation in the sounds occur.

6

6. Erik comes to your clinic complaining of neck and shoulder pain, and is unable to turn his head. You suspect damage to the _____ cranial nerve, and proceed with your examination by:
a) 12th; percussing the sternocleidomastoid and submandibular neck muscles.
b) 11th: palpating the anterior and posterior triangles.
c) 12th; assessing for a positive Romberg.
d) 11th; asking the patient to shrug his shoulders against resistance.

d) 11th; asking the patient to shrug his shoulders against resistance.

From lecture notes

7

7. Movement of the extraocular muscles is:
a) stimulated by cranial nerves III, IV and VI.
b) impaired in a patient with cataracts.
c) stimulated by cranial nerves II, III and V.
d) decreased in the elderly.

a) stimulated by cranial nerves III, IV and VI.

8

8. Stimulation of the sympathetic branch of the autonomic nervous system:
a) causes pupillary constriction.
b) elevates the eyelid and dilates the pupil.
c) causes contraction of the ciliary body.
d) adjusts the eye for near vision.

b) elevates the eyelid and dilates the pupil.

Fight or flight - also decreased GI, bronchioles dilation, increased HR pupil dilation

9

9. A patient's vision is recorded as 6/9 (20/30) using the Snellen eye chart. What does this mean?
a) The patient can read from 9 metres (30 feet) what a person with normal vision can read from 6 metres (20 feet).
b) The patient can read the chart from 6 metres (20 feet) in the left eye and 9 metres (30 feet) in the right eye.
c) At 9 metres (30 feet) the patient can read the entire chart.
d) The patient can read at 6 metres (20 feet) what a person with normal vision can read at 9 metres (30 feet)
.

d) The patient can read at 6 metres (20 feet) what a person with normal vision can read at 9 metres (30 feet)

It's answer d).

Let's disassemble it. There is a certain font size a person with normal visual acuity can distinguish at a distance of 6 metres or 20 feet. That's know as 6/6 or 20/20 vision. They can also distinguish larger font sizes at larger distances. So for example, at 9m or 30ft. That would be expressed as 9/9 or 30/30 vision.

But if you have someone who can only distinguish patterns at 6m a person with normal visual acuity can distinguish 9m, then they have 6/9 or 20/30 vision. So first number is always 6 or 20 and the second is at what distance they can see that normed sizes clearly.

On the other hand, some people may have better than average visual acuity and may be able to distinguish patterns most people will only be able to see at 3m or 10ft. These guys have 6/3 or 20/10.

Hope that makes sense!
Jana

10

10. What should the examiner palpate for tenderness prior to examining the ear with the otoscope?
a) helix, external auditory meatus and lobule.
b) mastoid process, tympanic membrane and malleus.
c) pinna, pars flaccida and antitragus.
d) pinna, tragus and mastoid process.

d) pinna, tragus and mastoid process.

11

11. In the Rinne test, the 2 to 1 ratio refers to:
a) the loudness of the tone heard by the two ears.
b) the length of time until the patient stops hearing the tone by air conduction and by bone conduction.
c) the length of time until the patient no longer hears the tone and the examiner no longer hears the tone.
d) the examiner hearing the tone twice as long as the patient hears it.

b) the length of time until the patient stops hearing the tone by air conduction and by bone conduction.

12

12. A normal finding on inspection of the thorax would be documented as follows:
a) anteroposterior diameter less than transverse.
b) barrel chest appearance of the thorax.
c) transverse and anteroposterior diameter equal.
d) transverse diameter less than anteroposterior

d) transverse diameter less than anteroposterior

13

13. Adventitious lung sounds are:
a) bronchial breath sounds heard over the trachea.
b) added sounds not normally heard in the lungs.
c) sounds normally auscultated over the lung fields
d) sounds normally auscultated over the adventitious.

b) added sounds not normally heard in the lungs.

14

14. The trachea bifurcates anteriorly at the:
a) costal angle.
b) xiphoid process.
c) suprasternal notch.
d) manubriosternal angle.

d) manubriosternal angle.

Weber and Kelly p 340 says sternal angle.
The costal angle is below the xiphoid process and suprasternal notch is too high

15

15. Over which of the following locations would it be normal to feel tactile fremitus most intensely?
a) 2nd right intercostal space (RICS) @ sternal border (SB)
b) 3rd right intercostal space (RICS) @ mid axillary line (MAL)
c) 5th left intercostal space (LICS) @ midcl0avicular line (MCL)
d) 7th right intercostal space (RICS) @ anterior axillary line (AAL)

a) 2nd right intercostal space (RICS) @ sternal border (SB)

Normally, fremitus is most prominent between the scapulae and around the sternum. These are sites where the major bronchi are closest to the chest wall. Fremitus normally decreases as one progress down the chest because more tissue impedes sound transmission.
From google

16

16. When auscultating the lungs of an adult patient, you note that over the posterior lower lobes you hear low pitched, soft breath sounds with inspiration being longer than expiration. You know that these are:
a) bronchial breath sounds and are normal in that location.
b) bronchovesicular breath sounds and are normal in that location.
c) vesicular breath sounds and are normal in that location.
d) sounds normally auscultated over the trachea.



c) vesicular breath sounds and are normal in that location.

Weber and Kelly pg 355

17

17. The left lung:
a) is shorter than the right because of the underlying stomach.
b) consists of two lobes.
c) consists primarily of an upper lobe on the posterior chest.
d) is divided by the percardial fissure.

b) consists of two lobes.

18

18. Identify the blood vessel that runs diagonally across the sternomastoid muscle.
a) Temporal artery.
b) Carotid artery.
c) External jugular vein.
d) Internal Jugular vein.

c) External jugular vein.

19

19. The first heart sound (S1) is the result of:
a) aortic and pulmonic valve closure.
b) aortic and mitral valve closure.
c) mitral and tricuspid valve closure.
d) tricuspid and pulmonic valve closure.

c) mitral and tricuspid valve closure.

S1 is lub and first sound of heart beat, S1 Starts systole - where blood is ejected from the ventricles (ventricular contraction)

20

20. In your assessment of a healthy adult, where would you expect to palpate the apical impulse?
a) third left intercostal space at the midclavicular line.
b) fifth left intercostal space at the midclavicular line.
c) fourth left intercostal space at the sternal border.
d) fourth left intercostal space at the anterior axillary line.

b) fifth left intercostal space at the midclavicular line.

Use palmer of hand to palpate intercostal spaces and will find the apical pulse in the mitral area. Use one finger pad for more accurate palpation.

Not always possible to palpate, consider patient sitting upright and leaning forward or on their lateral left side

Page 405 Weber and Kelly

21

21. While counting the apical pulse on a 16-year-old patient, you note an irregular rhythm. His rate speeds up on inspiration and slows on expiration. What would be your response?
a) Refer the patient to a cardiologist for further testing.
b) No further response needed as this is a normal finding.
c) Talk with patient about his intake of caffeine.
d) Do an electrocardiogram following the exam.

d) Do an electrocardiogram following the exam.

22

22. The valve closures that can BEST be heard at the base of the heart are:
a) aortic, pulmonic
b) mitral, tricuspid
c) mitral, pulmonic
d) tricuspid, aortic

a) aortic, pulmonic

Aortic area - 2nd intercostal at right sternal border (base of the heart)
Pulmonic area - 2nd intercostal at the left sternal border (base of the heart)

Erbs point - 3rd to 5th intercostal space at the left sternal border
Mitral (apical) - 5th intercostal space near the midclavicular line (the apex of the heart)
Tricuspid area - 4th or 5th intercostal space at the lower left sternal border

Page 396 Weber & Kelly

23

23. To assess the dorsalis pedis artery, you would palpate:
a) in the groove behind the medial malleolus.
b) lateral to the extensor tendon of the great toe.
c) over the lateral malleolus.
d) behind the knee.

b) lateral to the extensor tendon of the great toe.

Dorsiflex the patients foot and apply light pressure lateral to and along the side of the extensor tendon of the big toe.

Assess amplitude bilaterally

Page 437 Weber and Kelly

24

24. When testing the triceps reflex, what is the expected response?
a) Flexion of the hand.
b) Extension of the forearm.
c) Flexion and supination of the forearm.
d) Pronation of the hand.

b) Extension of the forearm.

Pg 614 Weber and Kelly
Elbow extends, tricep contracts.

25

25. Joe is being assessed for range of joint movement. You ask him to move his arm in towards the center of his body. This movement is called:
a) flexion.
b) extension.
c) adduction.
d) abduction.

c) adduction.

26

26. In assessing the tonsils of a 30-year-old, you note they are involuted, granular in appearance, and appear to have deep crypts. What would be your response to these findings?
a) Nothing, this is the appearance of normal tonsils.
b) Obtain a throat culture on the patient for possible strep infection.
c) Refer patient to a throat specialist.
d) Continue with assessment looking for any other abnormal findings.

a) Nothing, this is the appearance of normal tonsils.

Check this answer? from quizlet

Tonsilitis (detecting and grading)
1+ Tonsils are visible
2+ Tonsils are midway between tonsillar pillars and uvula
3+ Tonsils touch the uvula
4+ Tonsils touch each other

27

27. The salivary gland that is located in the cheek in front of the ear is the:
a) Submandibular gland.
b) Sublingual gland.
c) Stenson’s gland.
d) Parotid gland.

d) Parotid gland.

28

28. Select the sequence of techniques used during an examination of the abdomen.
a) Percussion, inspection, palpation, auscultation.
b) Inspection, palpation, percussion, auscultation.
c) Inspection, auscultation, percussion, palpation.
d) Auscultation, inspection, palpation, percussion.

c) Inspection, auscultation, percussion, palpation.

29

29. Borborygmi could best be described as:
a) a loud continuous hum.
b) a peritoneal friction rub.
c) hyperactive bowel sounds.
d) hypoactive bowel sounds.

c) hyperactive bowel sounds.

30

30. A woman complains of a thick, white vaginal discharge with intense itching. These symptoms are suggestive of:
a) vaginitis
b) trichomoniasis
c) chlamydia
d) candidiasis

d) candidiasis