ATI RN
Test Bank Physical Examination and Health Assessment Questions
Question 1 of 9
A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims for 30 minutes daily, early in the morning. He notes a sharp, catching pain and a sensation of something grating when he tries overhead movements of his arm. On physical examination, you note tenderness just below the tip of the acromion in the area of the tendon insertions. The drop arm test is negative, and there is no limitation with shoulder shrug. The patient is not holding his arm close to his side, and there is no tenderness to palpation in the bicipital groove when the arm is at the patient's side, flexed to 90 degrees, and then supinated against resistance. Based on this description, what is the most likely cause of his shoulder pain?
Correct Answer: C
Rationale: The description of the patient's left shoulder pain, with a sharp catching pain and a sensation of something grating during overhead movements, in addition to tenderness just below the tip of the acromion in the area of tendon insertions, is suggestive of calcific tendinitis. Calcific tendinitis occurs when calcium deposits form within a tendon, most commonly affecting the rotator cuff tendons. This condition can cause pain, tenderness, and limited range of motion, particularly with certain movements like overhead reaching. The negative drop arm test, lack of limitation with shoulder shrug, absence of tenderness to palpation in the bicipital groove, and the patient not holding his arm close to his side help differentiate calcific tendinitis from other shoulder pathologies like rotator cuff tendinitis, rotator cuff tear, and bicipital tendinitis.
Question 2 of 9
A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur?
Correct Answer: A
Rationale: A murmur heard only at the cardiac apex is most likely due to mitral valve pathology. The mitral valve is located near the apex of the heart, and murmurs related to mitral valve issues are typically best heard at the apex during auscultation. Mitral valve diseases such as mitral valve prolapse, mitral stenosis, or mitral regurgitation can lead to the development of a murmur in this location.
Question 3 of 9
A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical history is unremarkable. He doesn't smoke but drinks several beers on the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an honors student and is on the basketball team. His parents are both in good health. He denies any recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the right upper lobe. What disorder of the thorax or lung best describes his symptoms?
Correct Answer: A
Rationale: The clinical presentation of this 17-year-old high school senior is concerning for a spontaneous pneumothorax. A spontaneous pneumothorax occurs when air enters the pleural space, resulting in lung collapse. Risk factors for spontaneous pneumothorax include tall, thin body habitus and smoking. In this case, the patient's sudden onset of right-sided chest pain and severe shortness of breath, along with absent breath sounds on the right side of the chest and hyperresonance on percussion, are consistent with a pneumothorax. The absence of lung sounds and fremitus on palpation over the right upper lobe further support this diagnosis. Chronic obstructive pulmonary disease (COPD) and asthma typically present with more chronic symptoms, while pneumonia is usually associated with fever, productive cough, and other signs of infection. Given the history and physical examination findings, spontaneous pneumothorax is the most
Question 4 of 9
You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain from an old war injury, and headaches. Today he complains of these pains, as well as dull chest pain under his sternum. What would the order of priority be for your problem list?
Correct Answer: D
Rationale: The correct order of priority for the problem list in this case would be chest pain, headaches, arthritis, and war injury pain. Chest pain should always be a priority as it could indicate a serious or life-threatening condition such as a heart attack. Headaches, while important, are less urgent than chest pain. Arthritis can generally be managed without immediate intervention, making it a lower priority. Finally, the pain from the old war injury, while significant, is not as urgent as the other complaints.
Question 5 of 9
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?
Correct Answer: A
Rationale: The most significant risk factor for breast cancer in the patient's personal and family history is having a first-degree relative with premenopausal breast cancer. This is because the age at which a family member was diagnosed with breast cancer can be indicative of potential genetic predispositions that may increase the patient's own risk of developing the disease. Women with a first-degree relative who was diagnosed with breast cancer before menopause (premenopausal) are at a higher risk themselves compared to those with a family history of postmenopausal breast cancer. In this case, the patient's mother had unilateral breast cancer in her 70s, which suggests a higher risk compared to postmenopausal breast cancer. Other factors such as early age at menarche or age at first live birth are also important in assessing breast cancer risk, but having a first-degree relative with premenopausal breast cancer is the most significant
Question 6 of 9
A 38-year-old woman comes to you and has multiple small joints involved with pain, swelling, and stiffness. Which of the following is the most likely explanation?
Correct Answer: A
Rationale: Rheumatoid arthritis is a systemic autoimmune disease that primarily affects the joints. It commonly presents with pain, swelling, and stiffness in multiple small joints such as those in the hands, wrists, and feet. It is more prevalent in females in their 30s to 50s. Rheumatoid arthritis is characterized by chronic inflammation of the synovial membrane, leading to joint damage and deformities over time. Laboratory tests showing elevated inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), along with positive rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies, can help in confirming the diagnosis of rheumatoid arthritis.
Question 7 of 9
A 77-year-old retired nurse has an ulcer on a lower extremity that you are asked to evaluate when you do your weekly rounds at a local long-term care facility. All of the following are responsible for causing ulcers in the lower extremities except for which condition?
Correct Answer: D
Rationale: Hypertension, or high blood pressure, is not typically associated with causing ulcers in the lower extremities. The most common causes of lower extremity ulcers are arterial insufficiency, venous insufficiency, and diminished sensation in pressure points. Arterial insufficiency leads to decreased blood flow to the lower extremities, causing tissue damage and ulcers. Venous insufficiency results in poor circulation and increased pressure in the veins, leading to ulcers. Diminished sensation in pressure points, often seen in conditions like diabetes, can cause ulcers due to lack of feeling and increased risk of trauma. So, hypertension is not directly related to the development of lower extremity ulcers.
Question 8 of 9
A 20-year-old part-time college student comes to your clinic, complaining of growths on his penile shaft. They have been there for about 6 weeks and haven't gone away. In fact, he thinks there may be more now. He denies any pain with intercourse or urination. He has had three former partners and has been with his current girlfriend for 6 months. He says that because she is on the pill they don't use condoms. He denies any fever, weight loss, or night sweats. His past medical history is unremarkable. In addition to college, he works part-time for his father in construction. He is engaged to be married and has no children. His father is healthy, and his mother has hypothyroidism. On examination the young man appears healthy. His vital signs are unremarkable. On visualization of his penis you see several moist papules along all sides of his penile shaft and even two on the corona. He has been circumcised. On palpation of his inguinal region there is no inguinal lymphadenopathy. Which abnormality of the penis does this patient most likely have?
Correct Answer: A
Rationale: The patient in the case presented has multiple moist papules on the penile shaft and corona, which are classic features of condylomata acuminata, also known as genital warts. Condylomata acuminata are caused by the human papillomavirus (HPV) and are typically painless, unlike other conditions such as genital herpes or syphilitic chancre which may be associated with pain or tender sores. Given the patient's history of multiple sexual partners and lack of condom use with his current girlfriend, there is a higher likelihood of exposure to HPV. Condylomata acuminata can be treated with various options including topical agents, cryotherapy, or surgical removal, and it is important to address the potential risk of HPV transmission to sexual partners.
Question 9 of 9
The following information is best placed in which category? "The patient was treated for an asthma exacerbation in the hospital last year; the patient has never been intubated."
Correct Answer: A
Rationale: The information provided about the patient being treated for an asthma exacerbation and not being intubated falls under the category of adult illnesses. Asthma is a common respiratory condition that affects people of various ages but is more prevalent in adults. The fact that the patient was treated for an asthma exacerbation and has not required intubation indicates a relevant medical history related to adult illnesses and respiratory conditions. This information would be considered when evaluating and managing the patient's current health status and potential risks related to respiratory issues.