ATI RN
Jarvis Physical Examination and Health Assessment Practice Questions Questions
Question 1 of 9
A patient presents with ear pain. She is an avid swimmer. The history includes pain and drainage from the left ear. On examination, she has pain when the ear is manipulated, including manipulation of the tragus. The canal is narrowed and erythematous, with some white debris in the canal. The rest of the examination is normal. What diagnosis would you assign this patient?
Correct Answer: B
Rationale: The patient's history of swimming and presenting symptoms of ear pain, drainage, and manipulation tenderness are suggestive of external otitis, commonly known as swimmer's ear. External otitis is an infection of the outer ear canal, which can be caused by prolonged moisture exposure, trauma, or bacterial/fungal infections. The narrowed and erythematous canal with white debris is characteristic of this condition. Otitis media (Choice A) typically presents with deep ear pain, hearing loss, and sometimes fever, but does not involve the ear canal. Perforation of the tympanum (Choice C) would present with sudden relief of pain and possible drainage from the ear. Cholesteatoma (Choice D) is characterized by a painless cyst or mass in the middle ear, not presenting with these acute ear canal symptoms.
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 32-year-old white male comes to your clinic, complaining of aching on the right side of his testicle. He has felt this aching for several months. He states that as the day progresses the aching increases, but when he wakes up in the morning he is pain-free. He denies any pain with urination and states that the pain doesn't change with sexual activity. He denies any fatigue, weight gain, weight loss, fever, or night sweats. His past medical history is unremarkable. He is a married hospital administrator with two children. He notes that he and his wife have been trying to have another baby this year but have so far been unsuccessful despite frequent intercourse. He denies using tobacco, alcohol, or illegal drugs. His father has high blood pressure but his mother is healthy. On examination you see a young man appearing his stated age with unremarkable vital signs. On visualization of his penis, he is circumcised with no lesions. He has no scars along his inguinal area, and palpation of the area shows no lymphadenopathy. On palpation of his scrotum you feel testes with no discrete masses. Upon placing your finger through the right inguinal ring you feel what seems like a bunch of spaghetti. Asking him to bear down, you feel no bulges. The left inguinal ring is unremarkable, with no bulges on bearing down. His prostate examination is unremarkable. What abnormality of the scrotum does he most likely have?
Correct Answer: D
Rationale: The most likely abnormality of the scrotum that the patient has is a varicocele. This is indicated by the presence of a "bag of worms" feeling upon palpation of the right scrotum through the inguinal ring. Varicoceles are enlarged, twisted veins in the scrotum, similar to varicose veins that occur in the legs. They are more common on the left side, but can occur on the right side as well.
Question 4 of 9
His head, ears, nose, throat, and neck examinations are normal. His cardiac, lung, and abdominal examinations are also normal. On visualization of the anus there is no inflammation, masses, or fissures. Digital rectal examination elicits an irregular, asymmetric, hard nodule on the otherwise normal posterior surface of the prostate. Examination of the scrotum and penis are normal. Laboratory results are pending. What disorder of the anus, rectum, or prostate is mostly likely in this case?
Correct Answer: C
Rationale: The presence of an irregular, asymmetric, hard nodule on the posterior surface of the prostate detected during digital rectal examination raises suspicion for prostate cancer. Prostate cancer commonly presents with nodules or indurations on the prostate gland during physical examination. Other findings, such as no inflammation, masses, or fissures in the anus and normal examinations of the scrotum and penis, further support the likelihood of prostate cancer as the most probable diagnosis in this case. Additional laboratory results, including prostate-specific antigen (PSA) levels, can help confirm the diagnosis. Both benign prostatic hyperplasia (BPH) and prostatitis typically present with different symptoms than those described in the scenario, making prostate cancer the most likely disorder based on the provided information. Anorectal cancer is less likely given the absence of findings indicating involvement of the anus or rectum in this case.
Question 5 of 9
A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?
Correct Answer: A
Rationale: Intermittent claudication is a common symptom of peripheral vascular disease. It is characterized by muscle pain or cramping in the legs, usually in the calves, thighs, or buttocks, that occurs during physical activity such as walking and is relieved by rest. This symptom is due to inadequate blood flow to the muscles during exercise. It is important to assess for intermittent claudication in patients with risk factors such as smoking, diabetes, and hypertension, as it may indicate underlying peripheral arterial disease. The other symptoms listed (chest pressure with exertion, shortness of breath, knee pain) are not typically associated with peripheral vascular disease.
Question 6 of 9
You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office staff are: T 2, HR 78, BP 118/92, and RR 14, and she denies pain. You notice that she has some hypertensive changes in her retinas and you find mild proteinuria on a urine test in your office. You expected the BP to be higher. She is not on any medications. What do you think is causing this BP reading, which doesn't correlate with the other findings?
Correct Answer: D
Rationale: The most likely explanation for the discrepancy between the patient's relatively normal blood pressure reading (118/92) and the presence of hypertensive changes in her retinas and mild proteinuria is that the process causing her retinopathy and kidney problems has resolved. Hypertensive changes in the retinas and proteinuria are typically signs of chronic uncontrolled hypertension, but they can also be residual manifestations of previously uncontrolled hypertension that has now been effectively treated.
Question 7 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.
Question 8 of 9
A young woman comes to you with a cut on her finger caused by the lid of a can she was opening. She is pacing about the room, crying loudly, and through her sobs she says, "My career as a pianist is finished!" Which personality type exhibits these features?
Correct Answer: C
Rationale: The young woman in this scenario is exhibiting characteristics of histrionic personality disorder. Individuals with histrionic personality disorder tend to be overly dramatic, attention-seeking, and have a tendency to be excessively emotional in their reactions. The young woman's exaggerated response to a minor cut on her finger, along with her dramatic declaration that her career as a pianist is over, reflects the emotional and attention-seeking behaviors commonly associated with histrionic personality traits.
Question 9 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.