ATI RN
Jarvis Physical Examination and Health Assessment Practice Questions Questions
Question 1 of 9
A 29-year-old computer programmer comes 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?
Correct Answer: A
Rationale: The description provided fits the criteria for tension-type headache. Tension-type headaches are typically described as a mild to moderate, dull, band-like pressure or tightness around the head. They can last from minutes to days and are often triggered by stress, anxiety, poor posture, or prolonged computer use. The absence of symptoms like photophobia and nausea, along with the response to over-the-counter medication, further support the diagnosis of tension-type headache in this case. Other headache types such as migraines or cluster headaches usually present with additional symptoms like nausea, photophobia, or tearing of the eye, which are not mentioned in this scenario. Analgesic rebound headaches typically occur in individuals who overuse pain medications, leading to worsening headaches when the medication wears off, but this patient's history does not suggest such misuse.
Question 2 of 9
You are growing fatigued of performing a maneuver on examination because you have never found a positive and are usually pressed for time. How should you next approach this maneuver?
Correct Answer: A
Rationale: It is important to adjust your approach based on the clinical context and your suspicion for a certain condition. If you have never found a positive result with a particular maneuver and you are usually pressed for time during examinations, it may be more beneficial to reserve that maneuver for situations where you have a higher suspicion for a correlating condition. This allows you to use your time and resources more effectively, targeting specific tests based on the clinical scenario to increase the chances of identifying any relevant issues. By using the test selectively, you can improve the diagnostic yield without compromising the overall assessment.
Question 3 of 9
A 24-year-old travel agent comes to your clinic, complaining of pain and swelling in her vulvar area. She states that 2 days earlier she could feel a small tender spot on the left side of her vagina but now it is larger and extremely tender. Her last period was 1 year ago, and she is sexually active. She uses the Depo-Provera shot for contraception. She denies any nausea, vomiting, constipation, diarrhea, pain with urination, or fever. Her past medical history is significant for ankle surgery. Her mother is healthy, and her father has type 2 diabetes. On examination she appears her stated age and is standing up. She states she cannot sit down without excruciating pain. Her blood pressure, temperature, and pulse are unremarkable. On visualization of her perineum, a large, red, tense swelling is seen to the left of her introitus. Palpation of the mass causes a great deal of pain. What disorder of the vulva is most likely causing her problems?
Correct Answer: A
Rationale: The clinical presentation described is consistent with a Bartholin's gland infection, also known as Bartholin's abscess. The Bartholin's glands are located on each side of the vaginal opening and can become blocked, leading to glandular secretions accumulating and forming an abscess. Symptoms of Bartholin's gland infection include pain, swelling, and tenderness in the vulvar area. The pain can be severe and exacerbated by sitting, similar to what the patient is experiencing. On examination, a red, tense swelling to the side of the introitus is a characteristic finding.
Question 4 of 9
Which of the following may be missed unless the patient is placed in the left lateral decubitus position and auscultated with the bell?
Correct Answer: D
Rationale: Placing the patient in the left lateral decubitus position and auscultating with the bell is important to detect subtle sounds like the mitral stenosis murmur, opening snap of the mitral valve, and S3 and S4 gallops. The left lateral decubitus position helps bring the heart closer to the chest wall, allowing for better transmission of these sounds that may be missed in the supine position.
Question 5 of 9
Mr. Edwards complains of cramps and difficulties with walking. The cramps occur in his calves consistently after walking about 100 yards. After a period of rest, he can start to walk again, but after 100 yards these same symptoms recur. Which of the following would suggest spinal stenosis as a cause of this pain?
Correct Answer: B
Rationale: Relief of the pain with bending at the waist is a key hallmark of spinal stenosis. This position helps relieve the pressure on the nerves in the spinal canal, which is often the root cause of the leg symptoms experienced by the patient. The symptoms described by Mr. Edwards, such as cramps in the calves after walking a certain distance, followed by relief with rest and recurrence upon walking again, are highly suggestive of spinal stenosis. This condition involves narrowing of the spinal canal, leading to compression of the nerves and resulting in symptoms like leg cramps, weakness, and difficulty walking, especially with prolonged activity. The relief of symptoms when bending forward (e.g., leaning on a shopping cart while walking) is a characteristic feature of neurogenic claudication associated with spinal stenosis.
Question 6 of 9
On auscultation her lung fields have normal breath sounds with no rhonchi, wheezes, or crackles. Percussion and palpation are unremarkable. Auscultation of the heart has an S and S 1 2 with no S or S . A scratching noise is heard at the lower left sternal border, coincident with 3 4 systole; leaning forward relieves some of her pain. She is nontender with palpation of the chest wall. What disorder of the chest best describes this disorder?
Correct Answer: B
Rationale: The clinical presentation described involves a patient with pericarditis. Pericarditis is inflammation of the pericardium, the sac surrounding the heart, which can lead to characteristic findings such as a scratching noise heard on auscultation, leaning forward relieving pain, and normal lung examination findings. The presence of pericarditis can also lead to a pericardial friction rub, which is often described as a scratching or grating sound heard best at the lower left sternal border.
Question 7 of 9
An elderly woman with dementia is brought in by her daughter for a "rectal mass." On examination you notice a moist pink mass protruding from the anus, which is nontender. It is soft and does not have any associated bleeding. Which of the following is most likely?
Correct Answer: A
Rationale: Rectal prolapse occurs when the rectum protrudes through the anus. It typically appears as a moist, pink mass that protrudes outside the body. The prolapse is usually painless and can be seen and felt by the patient or the examiner. It is commonly seen in elderly individuals, especially women, and those with conditions like chronic constipation, pelvic floor weakness, or dementia. On the other hand, external hemorrhoids are swollen veins located around the anus, usually painful and may cause bleeding. Perianal fistula is an abnormal tunnel-like connection between the skin near the anus and the rectum, which can cause pain and discharge. Prolapsed internal hemorrhoids are internal hemorrhoids that have descended outside the anal canal and may require manual reduction. Given the symptoms described in the scenario - a moist pink mass protruding from the anus that is nontender and soft without bleeding - the most likely diagnosis is rectal prol
Question 8 of 9
A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis?
Correct Answer: A
Rationale: In a 30-year-old man with a firm, 2-cm mass under his areola and no other symptoms, the most likely diagnosis is breast tissue. Gynecomastia is a common condition in males where there is proliferation of breast tissue. It typically presents as a firm subareolar mass and can occur due to hormonal imbalances, medication use, or underlying medical conditions. Given the lack of family history of breast cancer, absence of other symptoms, and the age of the patient, breast tissue is the most probable diagnosis in this case. Breast cancer is less likely in this scenario, especially without any additional concerning findings or family history. Fibrocystic disease and lymph node involvement are also less likely given the presentation of a firm mass under the areola.
Question 9 of 9
A man's wife is upset because when she hugs him with her hands on his left shoulder blade, "it feels creepy." This came on gradually after a recent severe left-sided rotator cuff tear. How long does it usually take to develop muscular atrophy with increased prominence of the scapular spine following a rotator cuff tear?
Correct Answer: D
Rationale: Following a severe rotator cuff tear, it typically takes around 2-3 months for muscular atrophy to develop with increased prominence of the scapular spine. This is due to disuse of the affected shoulder muscles leading to muscle wasting and changes in the bony structures around the shoulder blade. Over time, the lack of muscle activity causes the shoulder blade to become more prominent and noticeable, which can result in altered sensations during activities like hugging. The gradual onset of these changes aligns with the timeline provided in the question, where the wife started to feel discomfort in her husband's left shoulder blade after the recent severe rotator cuff tear.