ATI RN
Test Bank Physical Examination and Health Assessment Questions
Question 1 of 9
Which of the following occurs in respiratory distress?
Correct Answer: B
Rationale: In respiratory distress, the skin between the ribs moves inward with inspiration, a phenomenon known as retractions. This is a sign of increased work of breathing as the body tries to pull in more air due to difficulty in breathing. The inward movement of the skin between the ribs indicates that the individual is not able to generate enough negative pressure in the chest cavity to inhale properly. This can be seen in conditions such as asthma, pneumonia, or other respiratory issues. Skin retractions are a concerning sign and may indicate a severe respiratory compromise that requires immediate medical attention. The other options listed do not specifically describe a characteristic of respiratory distress.
Question 2 of 9
Where is the point of maximal impulse (PMI) normally located?
Correct Answer: A
Rationale: The point of maximal impulse (PMI), also known as the apical impulse, is the point where the left ventricle is closest to the chest wall. Normally, the PMI is located in the left 5th intercostal space, around 7 to 9 cm lateral to the sternum. This area corresponds to the apex of the heart. By palpating the PMI, healthcare providers can assess the size, strength, and regularity of the heart's contractions, which can provide important diagnostic information about cardiac health. Locating the PMI accurately is essential for physical examination and diagnosis of cardiac conditions.
Question 3 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 4 of 9
Which of the following is consistent with obturator sign?
Correct Answer: C
Rationale: The obturator sign is a physical examination maneuver used to assess for irritation of the obturator muscle due to an inflamed appendix that is in close proximity. This pain is typically felt in the right lower quadrant or hypogastric region. The sign is elicited by passively flexing the hip and knee of the patient, then internally rotating the hip. An alternative method is to position the patient on her left side and ask her to raise her right thigh against resistance while the examiner provides counterpressure. Pain experienced by the patient with these maneuvers is consistent with obturator sign, indicating possible appendicitis. Hence, option C is the correct answer.
Question 5 of 9
Which of the following is a "red flag" regarding patients presenting with headache?
Correct Answer: C
Rationale: A "red flag" regarding patients presenting with a headache is their age being over 50. This is because new-onset or persistent headaches in individuals over 50 may raise concerns about underlying serious conditions such as temporal arteritis, brain tumor, or other vascular issues. It is important to thoroughly evaluate and consider these possibilities in older patients with headaches to ensure appropriate management and timely intervention.
Question 6 of 9
Susanne is a 27-year-old who has had headaches, muscle aches, and fatigue for the last 2 months. You have completed a thorough history, examination, and laboratory workup but have not found a cause. What would your next action be?
Correct Answer: D
Rationale: Since the patient, Susanne, has been experiencing headaches, muscle aches, and fatigue for the last 2 months, and a thorough history, examination, and laboratory workup have not revealed a definitive cause, the next step would be to screen for depression. Depression can present with physical symptoms such as headaches, muscle aches, and fatigue. It is important to consider mental health factors that could be contributing to Susanne's symptoms before proceeding with further referrals to specialists. Screening for depression would help in determining if psychological factors are playing a role in her physical symptoms.
Question 7 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 8 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.
Question 9 of 9
He is afebrile and his cardiac, lung, and abdominal examinations are normal. On visualization of the anus you see no inflammation, masses, or fissures. Digital rectal examination reveals a smooth, enlarged prostate. No discrete masses are felt. There is no blood on the glove or on guaiac testing. An analysis of the urine shows no red blood cells, white blood cells, or bacteria. What disorder of the anus, rectum, or prostate is this most likely to be?
Correct Answer: A
Rationale: The clinical presentation described in the scenario is consistent with benign prostatic hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate gland, typically seen in older males. The findings of a smooth, enlarged prostate on digital rectal examination without discrete masses, along with the absence of other alarming signs such as blood in the urine or on examination, make BPH the most likely diagnosis in this case.