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NR 509 / NR509 Advanced Physical Assessment
Final Exam
Questions with Verified Answers - Chamberlain
Consist of 100 multiple choices Questions with Answers
- A 44-year-old female mathematician presents to clinic with a complaint of a mass in the right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty because she has only had one mammogram and does not engage in breast self-examination (BSE) on any regular basis. She has no family history of breast cancer, and her prior mammogram was ordered as a routine screening test at age 43 years after a brief discussion with her primary care provider. After a thorough investigation reveals a benign cyst, what advice should be given to this patient about screening for breast cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and reinforced. b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual examinations starting at age 30 years. c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF) recommendations for her age group and risk factors prior to her current complaint. d. Mammography is most sensitive and specific for women in their 40s, when breast tissue is still dense enough to image accurately. e. Breast cancer screening is extremely well st ANS c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF) recommendations for her age group and risk factors prior to her current complaint.
- A 42-year-old female website developer presents for an annual preventive examination with questions about breast cancer screening. She is concerned about the radiation exposure associated with mammography and is interested in magnetic resonance imaging (MRI) as a possible alternative for routine screening. She is otherwise healthy
months. On examination, she is able to express a small amount of discharge, which is sent to the laboratory and found to be consistent with breast milk but without any signs of blood or pus. Screening laboratories are also sent, which reveal a normal blood count, metabolic panel, thyroid-stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories are still pending. Which of the following is the most likely diagnosis? a. Mastitis b. Ductal carcinoma in situ c. Paget disease of the breast d. Occult pregnancy e. Prolactinoma ANS e. Prolactinoma
- A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-examination (BSE) at home. The mass is non- tender without skin changes, erythema, or overlying swelling. She has heard that most breast cancers are found by patients themselves, and she is very concerned that she may have breast cancer. Which of the following is true about BSE and self-detection of breast cancer?
a. Most masses that women find at home and bring to a provider's attention turn out to be malignant. b. This patient is more likely to find a fibroadenoma than a cancer on self-ex- amination. c. The most likely breast mass this patient is likely to find in herself is an abscess complicating underlying mastitis. d. Because of this patient's age, breast masses should not be pursued with imaging and diagnosis because the risk of cancer is so low. e. BSE is universally recommended because of very high sensitivity and specificity for finding cancerous lesions. ANS b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
ANS d. This patient carries several risk factors that together justify BRCA testing.
- A 68-year-old former paleontologist presents to clinic with concerns about her breast cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A younger cousin developed the disease a few years ago before the age of 50 years, but this individual was not tested for the BRCA1 and BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s and had radiation to the chest. She did take hormone replacement therapy for a few years before data emerged that this may contribute to breast cancer risk. She has had several abnormal mammograms in her 50s for persistently dense breasts with subtle findings, but follow-up biopsies never showed any malignant pathology. Which of the following is true regarding magnetic resonance imaging (MRI) screening of this patient? a. No agency recommends breast MRI for a patient such as this one, who has moderately but not extraordinary risk factors for breast cancer. b. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with MRI for patients with such risk factors. c. Regardless of recommendations, the high sensitivity of breast MRI
comes at the expense of markedly decreased specificity (i.e., the ANS c. Regardless of rec-
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then supraclavicular nodes without first causing notable changes in the axillary nodes. ANS e. Metastatic breast cancer cells may spread directly into the infraclavicular and then supraclavicular nodes without first causing notable changes in the axillary nodes.
- A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A rubbery, mobile, nontender mass is palpated in the right breast as described by the patient, which is consistent with a firbroadenoma. In describing the location of the mass, the examiner notes that it is 3 cm proximal to and 3 cm to the left of the nipple. Which of the following would be the most appropriate way to report this finding? a. "Rubbery, mobile, nontender mass located in right breast, in the 10 :30 position from the nipple" b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant" c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant" d. "Rubbery, mobile, nontender mass located in the left breast, upper
outer quadrant" e. "Rubbery, mobile, nontender mass located in right breast, in the 1 : 30
ANS c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of lobules.
- An overweight 26-year-old public servant presents to the Emergency De- partment with 12 hours of intense abdominal pain, light- headedness, and a fainting episode that finally prompted her to seek medical attention. She has a strong family history of gallstones and is concerned about this possibility. She has not had any vomiting or diarrhea. She had a normal bowel movement this morning. Her ²human chorionic gonadotropin ( ² - hCG) is positive at triage. She reports that her last period was 10 weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her pelvic exam and, on palpation of her abdomen, finds invol- untary rigidity and rebound tenderness. What is the most likely diagnosis? a. Ruptured tubal (or ectopic) pregnancy b. Acute cholecystitis c. Ruptured appendix d. Perforated bowel wall e. Ruptured ovarian cyst ANS a. Ruptured tubal (or ectopic) pregnancy
- A 63-year-old janitor with a history of adenomatous colonic polyps pre- sents for a well visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase, alanine aminotransferase, ³-glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. He presents for a follow-up appoint- ment and the clinician performs an abdominal exam to assess his liver. Which of the following findings would be most consistent with hepatomegaly? a. Liver span of 11 cm at the midclavicular line b. Liver span of 8 cm at the midsternal line c. Dullness to percussion over a span of 11 cm at the midclavicular line d. Dullness to percussion over a span of 8 cm at the midsternal line e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration ANS e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
- A 63-year-old underweight administrative clerk with a 50-pack-year smok- ing history presents with a several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise and
on colonoscopy. He has no first-degree rela- tives with a history of colorectal cancer or adenomatous polyps. What are the
U.S. Preventive Services Task Force (USPSTF) screening recommendations for this patient? a. Do not screen routinely b. Continue annual FOBT screening until age 80 years c. Continue annual FOBT screening until age 85 years d. Repeat colonoscopy this year e. Sigmoidoscopy every 5 years with FOBT every 3 years ANS a. Do not screen routinely
- An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks each episode and is associated with onset of constipation. She describes infrequent, small hard stool that she finds very difficult to pass. She has tried to increase dietary fiber and water intake, but usually this is not sufficient and she resorts to over-the-counter laxatives, which she finds upset her stomach but do resolve the constipation. Symptoms typically gradually resolve with bowel movements. Which of the following is the most likely physiological mechanism for her constipation? a. A large, firm fecal mass in the rectum b. Decreased fecal bulk
e. A change in percussion from tympany to dullness in the left lower anterior chest wall on inspiration ANS a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
- An otherwise healthy 28-year-old lawyer presents to the Emergency De- partment with a 1-day history of severe abdominal pain. The emergency physi- cian suspects appendicitis and general surgery is consulted. The resident believes the patient has signs of peritonitis on exam. Which of the following physical exam findings supports peritonitis? a. Voluntary contraction of the abdominal wall that persists over several exam- inations b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain c. Abdominal pain that increases with hip flexion d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous process on a line drawn from the umbilicus e. Pain with internal rotation of the right hip ANS b. Pressing down onto the abdomen firmly and slowly and
withdrawing the hand quickly produces pain
- A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the last 10 months. He presents with a 4-month history of increasing weakness, recurrent epigastric pain radiating to his back, chronic diarrhea with stools 6-8 times daily, and weight loss of 18 lb over 4 months. What is the mechanism of his most likely diagnosis? a. Helicobacter pylori infection b. Inflammation of the gallbladder c. Inflammation of colonic diverticulum d. Reduced blood supply to the bowel e. Fibrosis of the pancreas ANS e. Fibrosis of the pancreas
- A 46-year-old executive who is obese and otherwise healthy presents to a family medicine clinic with a 3-month course of recurrent severe abdominal pain that usually resolves on its own after a few hours. Her last episode was prolonged lasting 6 hours, and she is frustrated that she has had to leave or miss work on three separate occasions. She would like a diagnosis and the problem fixed. Which symptoms or signs would be most suggestive of a diagnosis of biliary colic?
