ATI RN
Physical Examination and Health Assessment 9th Edition Test Bank Questions
Question 1 of 5
Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites?
Correct Answer: B
Rationale: Ascites is the abnormal accumulation of fluid in the abdominal cavity. When ascites is present, dullness is typically heard on percussion due to the fluid in the abdomen. This dullness does not shift with changes in the patient's position. Therefore, the finding of dullness which remains despite a change in position would argue for the presence of ascites. The other choices (A, C, D) describe findings that are more consistent with gaseous distention rather than ascites.
Question 2 of 5
A 28-year-old musician comes to your clinic, complaining of a "spot" on his penis. He states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt. He has had no burning with urination and no pain during intercourse. He has had several partners in the last year and uses condoms occasionally. His past medical history consists of nongonococcal urethritis from Chlamydia and prostatitis. He denies any surgeries. He smokes two packs of cigarettes a day, drinks a case of beer a week, and smokes marijuana and occasionally crack. He has injected IV drugs before but not in the last few years. He is single and currently unemployed. His mother has rheumatoid arthritis and he doesn't know anything about his father. On examination you see a young man appearing deconditioned but pleasant. His vital signs are unremarkable. On visualization of his penis there is a 6-mm red, oval ulcer with an indurated base just proximal to the corona. There is no prepuce because of neonatal circumcision. On palpation the ulcer is nontender. In the inguinal region there is nontender lymphadenopathy. What disorder of the penis is most likely the diagnosis?
Correct Answer: C
Rationale: The presentation described in the scenario is consistent with a syphilitic chancre, which is the primary lesion of syphilis. Syphilitic chancres are painless, indurated ulcers that occur at the site of initial infection with Treponema pallidum. These chancres are typically 0.5-2 cm in size, have a clean base, and are often accompanied by regional lymphadenopathy. The red oval ulcer with an indurated base in this patient, along with the absence of pain and presence of lymphadenopathy, is consistent with a syphilitic chancre.
Question 3 of 5
Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?
Correct Answer: B
Rationale: Paraphimosis is a condition where the foreskin is retracted behind the glans penis and cannot be returned to its original position. This can lead to swelling and constriction of the penis, causing pain and potential damage to the tissue due to decreased blood flow. Phimosis (Choice A) refers to a tight prepuce that cannot be retracted over the glans penis. Balanitis (Choice C) is inflammation of the glans penis, often associated with poor hygiene or infections. Balanoposthitis (Choice D) refers to inflammation of both the glans penis and the foreskin.
Question 4 of 5
Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. What vaginitis does this patient most likely have?
Correct Answer: B
Rationale: The clinical presentation described in the question is consistent with Candida vaginitis, also known as vaginal yeast infection. Candida vaginitis typically presents with a thick, white, curdy discharge that can be visualized on examination. The low pH of 1 is characteristic of Candida infection. The negative KOH whiff test and absence of an unusual smell help differentiate Candida vaginitis from other types of vaginitis.
Question 5 of 5
He is afebrile. His cardiac, lung, and abdominal examinations are normal. Visualization of the anus shows no erythema, masses, or inflammation. Digital rectal examination elicits an irregular, firm mass on the posterior side of the rectum. After you remove your finger you notice frank blood on your glove. What anal or rectal disorder is this patient most likely to have?
Correct Answer: D
Rationale: The patient in this scenario presents with symptoms suggestive of an anorectal disorder. The presence of an irregular, firm mass on the posterior side of the rectum, along with frank blood seen on the glove after a digital rectal examination, raises suspicion for an underlying anorectal cancer. Anorectal cancer can present with symptoms such as rectal bleeding, changes in bowel habits, palpable masses, and weight loss. In this case, the findings of an irregular mass and rectal bleeding are concerning for a malignant process such as anorectal cancer. Further evaluation with imaging studies and biopsy would be warranted for confirmation and to guide appropriate management.