Multiple Choice Items

Need answer to 40 Multiple choice questions.

Need to answer 40 Multiple Choice Items. Just Highlight correct answer with yellow.

Test 40 QS

· Question Points: 0.0 / 1.0

· Which of the following represents age-related changes in the lungs?

· Decrease in chest wall compliance

· Speed of expiration increases

· Increase in respiratory muscle strength

· Increased elastic recoil of lung tissue

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· A 32-year-old white female presents to your clinic complaining of overwhelming sadness. She says for the past 2 months she has had crying episodes, difficulty sleeping, and problems with overeating. She says she used to go out with her friends from work, but now she just wants to go home and be by herself. She also thinks that her work productivity has been dropping because she just is too tired to care or concentrate. She denies any feelings of guilt or any suicidal ideation. She states that she has never felt this way in the past. She denies any recent illness or injuries. Her past medical history consists of an appendectomy when she was a teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her father has had a history of mental illness. On examination, you see a woman appearing her stated age who seems quite sad. Her facial expression does not change while you talk to her and she makes little eye contact. She speaks so softly you cannot always understand her. Her thought processes and content seem unremarkable.

What type of mood disorder do you think is most likely?

· Dysthymic disorder

· Manic (bipolar) disorder

· Major depressive episode

· Anxiety disorder

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· A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast cancer. She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise, she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable.

Which risk factor of her personal and family history most puts her in danger of getting breast cancer?

.

· Age at menarche of less than 12

· First live birth between the ages of 25 and 29

·

· First-degree relative with postmenopausal breast cancer

· First-degree relative with premenopausal breast cancer

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· Ray works a physical job and notes pain when he attempts to lift his arm over his head. When you move the shoulder passively, he has full range of motion without pain and there is no gross swelling or tenderness. What type of joint disease does this most likely represent?

· Articular

· Extra-articular

· Neither

· Both

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·  A 36-year-old married bank teller presents to your office, complaining of pain with defecation and occasional blood on the toilet paper. She states that last week she had food poisoning with nausea, vomiting, and diarrhea. She had runny stools but no black or bloody stools. Ever since her illness, she has continued to have severe pain with bowel movements. She now tries to put off defecation as long as possible. Although she is having constipation she denies any further diarrhea or leakage of stool. She has a past medical history of hypothyroidism and two spontaneous vaginal deliveries. She has had no other chronic illnesses or surgeries. She does not smoke and rarely drinks. She has two children. There is no family history of breast or colon cancer. She has had no weight gain, weight loss, fever, or night sweats. On examination she is afebrile, with a blood pressure of 115/70 and a pulse of 80. On abdominal examination, she has active bowel sounds, is nontender in all quadrants, and has no hepatosplenomegaly. Inspection of the anus reveals inflammation on the posterior side with erythema. Digital rectal examination is painful for the patient but no abnormalities are palpated. Anoscopic examination reveals no inflammation or bleeding. What is the anal disorder that best describes her symptoms?

· Anorectal fistula

· External hemorrhoids

· Anal fissure

· Anorectal cancer

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· Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When you speak with him alone in the room, he states it “would be better if I was not here.” What would you do next?

· Tell him that he has a very promising career in anything he chooses and soon he will feel better.

· Tell him that he needs an antidepressant and it will take about 4 weeks to work.

· Speak with his mother about getting him together more with his friends.

· Assess his suicide risk.

· Question Points: 1.0 / 1.0

· Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have?

· Medial epicondylitis (golfer’s elbow)

· Olecranon bursitis

· Lateral epicondylitis (tennis elbow)

· Supracondylar fracture

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· A 26-year-old violinist presents to your clinic complaining of anxiety. He is a first-chair violinist in the local symphony orchestra and has started having symptoms during performances, such as sweating, shaking, and hyperventilating. It has gotten so bad that he has thought about giving up his first-chair status so he does not have to play the solo during one of the movements. He says that he never has these symptoms during rehearsals or when he is practicing. He denies having any of these symptoms at any other time. His past medical history is unremarkable. He denies any tobacco use, drug use, or alcohol abuse. His parents are both healthy. On examination you see a young man who appears worried. His vital signs and physical examination are unremarkable.

What type of anxiety disorder best describes this situation?

· Panic disorder

· Specific phobia

· Social phobia

· Generalized anxiety disorder

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· A 52-year-old secretary presents to your office, complaining about accidentally leaking urine when she coughs or sneezes. She says this has been going on for about a year now. She relates that she has not had a period for 2 years. She denies any recent illness or injuries. Her past medical history is significant for four spontaneous vaginal deliveries. She is married and has four children. She denies alcohol, tobacco, or drug use. During her pelvic examination, you note some atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal examinations are unremarkable.

Which type of urinary incontinence does she have?

· Stress incontinence

· Urge incontinence

· Overflow incontinence

· Mixed Incontinence

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· A 37-year-old nurse presents for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?

· Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.

· Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.

· Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.

· Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.

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· A 29-year-old computer programmer presents to your office for evaluation of a headache. The tightening sensation is located all over the head and is of moderate intensity. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours each day at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain but not taken it away. Based on this description, what is your most likely diagnosis?

· Tension

· Migraine

· Cluster

· Analgesic rebound

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· You are having trouble examining the abdomen of a school-aged child due to ticklishness. What should you do?

· Have the child press on your hand.

· Have the parent insist that the child allow you to examine her.

· Ask the parent to leave the room.

· Make the child realize that this is part of the examination and must be done.

· Question Points: 1.0 / 1.0

· A 27-year-old woman is brought to your office by her mother. The mother tells you that her daughter has been schizophrenic for the last 8 years and is starting to decompensate despite medication. The patient states that she has been taking her antipsychotic and she is doing just fine. Her mother retorts that her daughter has become quite paranoid. When asked why, the mother gives an example about the mailman. She says that her daughter goes and gets the mail every day and then microwaves the letters. The patient agrees that she does this but only because she sees the mailman flipping through the envelopes and she knows he’s putting anthrax on the letters. Her mother turns to her and says, “He’s only sorting the mail!”

Which best describes the patient’s abnormality of perception?

· Illusion

· Hallucination

· Fugue state

· Facticious

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Top of Form

· A 29-year-old married computer programmer presents to your clinic, complaining of “something strange” going on in his scrotum. Last month while he was doing his testicular self-examination, he felt a lump in his left testis. He waited a month and felt the area again, but the lump was still there. He has had some aching in his left testis but denies any pain with urination or sexual intercourse. He denies any fever, malaise, or night sweats. His past medical history consists of groin surgery when he was a baby and a tonsillectomy as a teenager. He eats a healthy diet and works out at the gym five times a week. He denies any tobacco or illegal drugs and drinks alcohol occasionally. His parents are both healthy. On examination, you see a muscular, healthy, young-appearing man with unremarkable vital signs. On visualization, the penis is circumcised with no lesions; there is a scar in his right inguinal region. There is no lymphadenopathy. Palpation of his scrotum is unremarkable on the right but indicates a large mass on the left. Placing a finger through the inguinal ring on the right, you have the patient bear down. Nothing is felt. You attempt to place your finger through the left inguinal ring but cannot get above the mass. On rectal examination, his prostate is unremarkable.

What disorder of the testes is most likely the diagnosis?

· Hydrocele

· Inguinal hernia

· Scrotal edema

· Varicocele

· Question Points: 1.0 / 1.0

Bottom of Form

· A high school football player injured his wrist in a game. He is tender between the two tendons at the base of the thumb. Which of the following should be considered?

· DeQuervain’s tenosynovitis

· Scaphoid fracture

· Wrist sprain

· Rheumatoid arthritis

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· An adolescent male presents to your clinic with a note from his mother stating it is okay for him to be seen today without her presence. He has come in for his annual sports physical required to play football. For his age his physical examination is unremarkable, and you sign his school’s physical examination form. You decide to take this opportunity to do some health education with him. He admits to wondering a lot lately if he is normal. Although he is in football he really enjoys science and computers more. He is worried that all his buddies will think he is a geek. He is convinced he also won’t get a date for the Sadie Hawkins dance next week because the girls all think he is boring, too. He denies any experimentation with tobacco or alcohol, and he blushes when you mention sex. After hitting all the pertinent age-appropriate education points, you give him his sports physical form and he leaves.

The patient’s concerns during the visit most resemble what developmental stage of adolescence?

· Early adolescence (10 to 14 years old)

· Middle adolescence (15 to 16 years old)

· Late adolescence (17 to 20 years old)

· Adulthood

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· You are observing an infant who is able to pull to a stand, uses “mama” and “dada” specifically, and indicates his wants by vocalization and pointing. Where would you place this child’s developmental age?

· 12 months

· 10 months

· 8 months

· 6 months

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· A 77-year-old retired school superintendent presents to your office, complaining of unsteady hands. He says that, for the past 6 months, when his hands are resting in his lap they shake uncontrollably. He says when he holds them out in front of his body the shaking diminishes, and when he uses his hands the shaking is also better. He also complains of some difficulty getting up out of his chair and walking around. He denies any recent illnesses or injuries. His past medical history is significant for high blood pressure and coronary artery disease, requiring a stent in the past. He has been married for more than 50 years and has five children and 12 grandchildren. He denies any tobacco, alcohol, or drug use. His mother died of a stroke in her 70s, and his father died of a heart attack in his 60s. He has a younger sister who has arthritis problems. His children are all essentially healthy. On examination, you see a fine, pill-rolling tremor of his left hand. His right shows less movement. His cranial nerve examination is normal. He has some difficulty rising from his chair, his gait is slow, and it takes him time to turn around to walk back toward you. He has almost no “arm swing” with his gait.

What type of tremor is he most likely to have?

· Resting tremor

· Postural tremor

· Intention tremor

· Drug Induced Tremor

· Question Points: 1.0 / 1.0

· A 35-year-old stockbroker presents to your office, complaining of feeling tired and irritable. She also says she feels like nothing ever goes her way and that nothing good ever happens. When you ask her how long she has felt this way she laughs and says, “Since when have I not?” She relates that she has felt pessimistic about life in general since she was in high school. She denies any problems with sleep, appetite, or concentration, and states she hasn’t thought about killing herself. She reports no recent illnesses or injuries. She is single. She smokes one pack of cigarettes a day, drinks occasionally, and hasn’t taken any illegal drugs since college. Her mother suffers from depression and her father has high blood pressure. On examination her vital signs and physical examination are unremarkable.

What mental health disorder best describes her symptoms?

· Major depressive episode

· Dysthymic disorder

· Cyclothymic disorder

· Hypothryoidism

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· 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, which started a few weeks ago, comes and goes, lasts for 2 to 3 hours at a time, and 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?

· Setting in which the symptom occurs

· Associated manifestations

· Quality

· Timing

· Question Points: 1.0 / 1.0

· Susane is a 27-year-old who has had headaches, muscle aches, and fatigue for the last 2 months. You have completed a thorough history, examination, and laboratory workup but have not found a cause. What would be an appropriate next course of action?

· A referral to a neurologist

· A referral to a rheumatologist

· To tell the patient you can’t find anything

· To screen for depression

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· A 73-year-old retired accountant presents to your office for her annual examination. She has incontinence of urine when she coughs or sneezes. She takes several medications for control of hypertension and diabetes. You use the DIAPPERS mnemonic to assess the cause of her incontinence. All of the following are items represented by the mnemonic except for:

· Atrophic vaginitis

· Depression

· Pharmaceuticals

· Restricted mobility

· Question Points: 1.0 / 1.0

· A 8-year-old patient presents to the office for evaluation of a rash. At first, there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?

· Pityriasis rosea

· Tinea versicolor

· Psoriasis

· Atopic eczema

· Question Points: 0.0 / 1.0

· A 79-year-old retired banker presents to your office for evaluation of difficulty with urination; he gets up five to six times per night to urinate and has to go at least that often in the daytime. He does not feel as if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria. This problem has been present for several years but has worsened over the last 8 months. You palpate his prostate. What is your expected physical examination finding, based on this description?

· Normal size, smooth

· Normal size, boggy

· Enlarged size, smooth

· Enlarged size, boggy

· Question Points: 1.0 / 1.0

· A 49-year-old administrative assistant presents to your office for evaluation of dizziness. You elicit the information that the dizziness is a spinning sensation of sudden onset, worse with head position changes. The episodes last a few seconds and then go away, and they are accompanied by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical examination of the head and neck and note that the patient’s hearing is intact. Pt has normal results of Weber and Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the most likely diagnosis?

· Benign paroxysmal positional vertigo

· Vestibular neuronitis

· Ménière’s disease

· Acoustic neuroma

· Question Points: 0.0 / 1.0

· An 88-year-old retired piano teacher presents for evaluation of fatigue. You notice that her clothes are hanging loosely off her frame and that she has lost 15 pounds. She is unaware of this. Her husband of 63 years died a few months ago. You ask the patient to complete a Rapid Screen for Dietary Intake. Which of the following statements is considered to be part of this rapid screen?

· I eat more than two meals per day.

· I drink one glass of alcohol every day.

· Without wanting to, I have lost or gained 10 pounds in the last 6 months.

· I eat with at least one other person most of the time.

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· A 75-year-old homemaker brings her 76-year-old husband to your clinic. She states that 4 months ago he had a stroke and ever since she has been frustrated with his problems with communication. They were at a restaurant after church one Sunday when he suddenly became quiet. When she realized something was wrong he was taken to the hospital by EMS. He spent 2 weeks in the hospital with right-sided weakness and difficulty speaking. After hospitalization he was in a rehab center, where he regained the ability to walk and most of the use of his right hand. He also began to speak more, but she says that much of the time “he doesn’t make any sense.” She gives an example that when she reminded him the car needed to be serviced he told her “I will change the Kool-Aid out of the sink myself with the ludrip.” She says that these sayings are becoming frustrating. She wants you to tell her what is wrong and what you can do about it. While you write up a consult to neurology, you describe the syndrome to her.

· Wernicke’s aphasia

· Broca’s aphasia

· Dysarthria

· Dementia

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· A 12-year-old presents to the clinic with his father for evaluation of a painful lump at the left eyelid. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?

· Dacryocystitis

· Chalazion

· Hordeolum

· Xanthelasma

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· A young man feels something in his scrotum and presents to you for clarification. On your examination, you note what feels like a “bag of worms” in the left scrotum, superior to the testicles. Which of the following is most likely?

· Hydrocele of the spermatic cord

· Varicocele

· Testicular carcinoma

· A normal vas deferens

· Question Points: 0.0 / 1.0

· A 28-year-old graduate student presents to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, lower back, and knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal. Which of the following is likely the cause of her pain?

· Rheumatoid arthritis

· Osteoarthritis

· Fibromyalgia

· Polymyalgia rheumatic

· Question Points: 0.0 / 1.0

· 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 coffee grounds. What do you suspect?

· Bleeding from a diverticulum

· Bleeding from a peptic ulcer

· Bleeding from a colon cancer

· Bleeding from cholecystitis

· Question Points: 1.0 / 1.0

· The following information is recorded in the health history: “I feel really tired.”

To which category does this information belong?

· Chief complaint

· Present illness

· Personal and social history

· Review of systems

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· A 24-year-old secretary presents to your clinic complaining of difficulty sleeping, severe nightmares, and irritability. She states it all began 6 months ago when she went to a fast-food restaurant at midnight. While she was waiting in her car, a man entered through the passenger door and put a gun to her head. He had her drive to a remote area where he took her money and threatened to kill her. When the gun jammed, he panicked and ran off. Ever since this occurred, the patient has been having these symptoms. She states she jumps at every noise and refuses to drive at night. She states her anxiety has had such a marked influence on her job performance that she is afraid she will be fired. She denies any recent illnesses or injuries. Her past medical history is unremarkable. On examination you find a nervous woman appearing her stated age. Her physical examination is unremarkable. You recommend medication and counseling.

What anxiety disorder do you think this young women most likely has?

· Specific phobia

· Acute stress disorder

· Post-traumatic stress disorder

· Generalized anxiety disorder

· Question Points: 1.0 / 1.0

· A 41-year-old real estate agent presents to your office, complaining that he feels like his face is paralyzed on the left. He states that last week he felt his left eyelid was drowsy and as the day progressed he was unable to close his eyelid all the way. Later he felt like his smile became affected also. He denies any recent injuries but had an upper respiratory viral infection last month. His past medical history is unremarkable. He is divorced and has one child. He smokes one pack of cigarettes a day, occasionally drinks alcohol, and denies any illegal drug use. His mother has high blood pressure, and his father has sarcoidosis. On examination, you ask him to close his eyes. He is unable to close his left eye. You ask him to open his eyes and raise his eyebrows. His right forehead furrows but his left remains flat. You then ask him to give you a big smile. The right corner of his mouth raises but the left side of his mouth remains the same.

What type of facial paralysis does he have?

· Peripheral CN VII paralysis

· Central CN VII paralysis

· CN V Neuralgia

· CN V paralysis

· Question Points: 0.0 / 1.0

· Which of the following booster immunizations is recommended in the older adult population?

· Tetanus

· Diphtheria

· Measles

· Mumps

· Question Points: 0.0 / 1.0

· A 26-year-old white female presents to your clinic at 38 weeks, complaining of intermittent contractions. They last for 30 seconds and are coming every 10 minutes. Her prenatal course has so far been uneventful. You send her to labor and delivery for a labor assessment. On vaginal examination, she has effaced 4 cm, but you cannot feel a presenting part. You admit her for active labor; however, you wish to assess if she is vertex (baby’s head is down), so you do the Leopold’s maneuver. Palpating the upper pole with your hands, you feel a firm round mass. Placing your hand along the right side of her abdomen, you feel a smooth firmness. Palpating your other hand along the left side of her abdomen, you feel irregular bumps. Above the pelvic brim you feel a firm irregular mass. While awaiting ultrasound to confirm your diagnosis, you write the pertinent orders.

How is this fetus presenting?

· Vertex

· Breech

· Transverse

· Anteverted

· Question Points: 1.0 / 1.0

· A 29-year-old homemaker who is G4P3 presents to your clinic for her first prenatal check. Her last period was 2 months ago. She has had three previous pregnancies and deliveries with no complications. She has no medical problems and has had no surgeries. Her only current complaint is of severe reflux that occurs in the mornings and evenings. On examination she is in no acute distress. Her vitals are 110/70 with a pulse of 88. Her respirations are 16. Her head, eyes, ears, nose, throat, thyroid, cardiac, pulmonary, and abdominal examinations are unremarkable. On bimanual examination her cervix is soft and her uterus is 10 weeks in size. Pap smear, cultures, and blood work are pending.

What is the most likely cause of her first-trimester reflux?

· Increasing prolactin levels

· Increasing ADH (antidiuretic hormone) levels

· Increasing progesterone

· Enlarged gravid uterus

· Question Points: 0.0 / 1.0

· A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true?

· She obtains a 20% correct score at 100 feet.

· She can accurately name 20% of the letters at 20 feet.

· She can see at 20 feet what a normal person could see at 100 feet.

· She can see at 100 feet what a normal person could see at 20 feet.

· Question Points: 1.0 / 1.0

· A 72-year-old African-American male is brought to your clinic by his daughter for a follow-up visit after his recent hospitalization. He had been admitted to the local hospital for speech problems and weakness in his right arm and leg. On admission, his MRI showed a small stroke. The patient was in rehab for 1 month following his initial presentation. He is now walking with a walker and has good use of his arm. His daughter complains, however, that everyone is still having trouble communicating with the patient. You ask the patient how he thinks he is doing. Although it is hard for you to make out his words, you believe his answer is “well . . . fine . . . doing . . . okay.” His prior medical history involved high blood pressure and coronary artery disease. He is a widower and retired handyman. He has three children who are healthy. He denies tobacco, alcohol, or drug use. He has no other current symptoms. On examination, he is in no acute distress but does seem embarrassed when it takes him so long to answer. His blood pressure is 150/90 and his other vital signs are normal. Other than his weak right arm and leg, his physical examination is unremarkable.

What disorder of speech does he have?

· Wernicke’s aphasia

· Broca’s aphasia

· Dysarthria

· Dementia

· Question Points: 0.0 /

· A pregnant woman finally presents in for her prenatal checkup. She complains today of headache and abdominal pain of several months’ duration. She appears somewhat hurried or nervous. What question would you ask next?

· Have you been eating properly and taking a prenatal vitamin?

· Do you feel safe at home?

· How much activity have you been able to fit into your schedule?

· Do you have a family history of thyroid disease?

 

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