You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except:

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Question 1 of 5

You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except:

Correct Answer: D

Rationale: Blood pressure is not typically included in the initial assessment during the General Survey. The General Survey primarily focuses on obtaining an overall impression of the patient's health status and any noticeable cues such as level of consciousness, signs of distress, and appearance including dress, grooming, and personal hygiene. While blood pressure is an important vital sign to assess during a comprehensive examination, it is usually measured later in the assessment process and not part of the initial general observation.

Question 2 of 5

In obtaining a history, you note that a patient uses the word "largely" repeatedly, to the point of being a distraction to your task. Which word best describes this speech pattern?

Correct Answer: D

Rationale: Perseveration is a speech pattern characterized by repeating a particular word, phrase, or topic excessively, even when it is no longer relevant to the conversation. In this scenario, the patient's repetitive use of the word "largely" to the point of distraction is indicative of perseveration. This can be a symptom of various neurological or psychiatric conditions, highlighting the importance of recognizing and addressing this speech pattern during the patient interview.

Question 3 of 5

Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of exposure to ill people or other agents in the environment. He has a slight fever in the office. The rash consists of small, bright red marks. When they are pressed, the red color remains. What should you do?

Correct Answer: B

Rationale: Dakota's presentation of a rash with small, bright red marks that do not fade when pressed (non-blanching) along with a slight fever raises concern for a serious condition such as meningococcal infection. Non-blanching rashes, especially when associated with fever, can be a sign of meningococcal sepsis, a life-threatening condition that requires urgent medical attention. Admission to the hospital is warranted for close monitoring, further evaluation, and initiation of appropriate treatment if needed. It is important to err on the side of caution in such cases to ensure the best possible outcome for the patient.

Question 4 of 5

A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea with vomiting; the episode resolved spontaneously. He has had five episodes in the past 1½ weeks. He does note some tinnitus that comes and goes. Upon physical examination, you note that he has a normal gait. The Weber localizes to the right side and the air conduction is equal to the bone conduction in the right ear. Nystagmus is present. Based on this description, what is the most likely diagnosis?

Correct Answer: C

Rationale: The clinical presentation described in the case, including recurrent episodes of dizziness, nausea with vomiting, tinnitus, nystagmus, and normal gait, is suggestive of Menière's disease. Menière's disease is a disorder of the inner ear characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and aural fullness. The presence of tinnitus, episodic vertigo lasting for several hours, and nystagmus are key features that point towards Menière's disease. The Weber test result (localization to the right ear) can also be seen in Menière's disease due to sensorineural hearing loss in the affected ear. This set of symptoms and findings is more consistent with Menière's disease than the other options provided. Benign paroxysmal positional vertigo (BPPV) typically presents with brief episodes of vertigo triggered by changes in

Question 5 of 5

Glaucoma is the leading cause of blindness in African Americans and the second leading cause of blindness overall. What features would be noted on funduscopic examination?

Correct Answer: A

Rationale: Glaucoma is a progressive optic neuropathy characterized by changes to the optic nerve head. One of the hallmark features seen on funduscopic examination in glaucoma is an increased cup-to-disc ratio. This refers to the ratio of the size of the optic cup (depression in the center of the optic nerve head) to the size of the optic disc (the pinkish-orange area around the cup). In glaucoma, there is typically an enlargement of the cup relative to the disc due to damage of the retinal ganglion cell axons. This change is often associated with thinning of the neuroretinal rim and loss of nerve fibers.

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