ATI RN
Health Assessment and Physical Examination Test Bank Questions
Question 1 of 5
A 42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons. What is the best choice for the cause of her constipation?
Correct Answer: D
Rationale: The constellation of symptoms described in the scenario, including chronic constipation, fatigue, weight gain, irregular periods, cold intolerance, and delayed deep tendon reflexes, suggests hypothyroidism as the likely cause. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowdown in bodily functions. Constipation is a common symptom of hypothyroidism due to the decreased motility of the bowel. The presence of cold intolerance, weight gain, and irregular periods further supports this diagnosis, as these are classic symptoms of hypothyroidism. The delayed deep tendon reflexes, especially in the Achilles tendons, are indicative of the myopathic changes that can occur in hypothyroidism. It is important to further investigate thyroid function through laboratory testing to confirm the diagnosis and initiate appropriate treatment. Other conditions such as large bowel obstruction, irritable bowel syndrome, and rectal cancer are less likely based
Question 2 of 5
An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?
Correct Answer: B
Rationale: In an elderly woman with a history of coronary bypass surgery presenting with severe, diffuse abdominal pain that is not worsened by abdominal palpation, neuropathy should be suspected. Neuropathy refers to nerve damage, which can result in abnormal sensations of pain, often described as burning, shooting, or stabbing. Abdominal neuropathy can be caused by various conditions such as diabetes, alcohol abuse, vitamin deficiencies, or certain medications. The absence of worsening pain upon palpation makes organic abdominal pathology less likely, suggesting a neuropathic etiology. In this case, further evaluation and testing for neuropathy would be warranted.
Question 3 of 5
Which area of the arm drains to the epitrochlear nodes?
Correct Answer: A
Rationale: The area of the arm that drains to the epitrochlear nodes includes the ulnar surface of the forearm and hand, little and ring fingers, and the ulnar side of the middle finger. The epitrochlear nodes are located in the medial aspect of the arm above the elbow, close to the insertion of the biceps brachii muscle. These nodes receive lymphatic drainage from the above-mentioned areas and play a role in the immune response against infections in these regions.
Question 4 of 5
A 29-year-old married computer programmer comes 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?
Correct Answer: B
Rationale: The most likely diagnosis in this case is a scrotal hernia. The patient's history of a previous groin surgery as a baby is a key clue, as it increases the risk for developing a hernia. The lump in the left testis with aching, along with the inability to palpate above the mass through the left inguinal ring, suggests that the lump may be a hernia protruding through the inguinal canal into the scrotum. The presence of a scar in the right inguinal region also supports the likelihood of a hernia. The normal prostate on rectal examination rules out any involvement of the prostate in the presentation. Scrotal hernias may present as painless masses in the scrotum, often increasing in size with activities that increase intra-abdominal pressure, such as straining or coughing. Surgical repair is often necessary to prevent complications such as incarceration or strangulation
Question 5 of 5
A tender, painful swelling of the scrotum should suggest which of the following?
Correct Answer: A
Rationale: A tender, painful swelling of the scrotum is a common symptom of acute epididymitis, which is the inflammation of the epididymis. The epididymis is a tube located at the back of the testicle that stores and transports sperm. In acute epididymitis, the swelling is usually accompanied by pain, tenderness, redness, and warmth in the affected area. Other symptoms may include fever, chills, and discharge from the penis. Prompt medical evaluation and treatment are necessary to prevent complications such as abscess formation or chronic epididymitis. Strangulated inguinal hernia and torsion of the spermatic cord may present with severe pain and swelling in the scrotum, but they have distinct mechanisms and require different management approaches.