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NR509 FINAL EXAM TEST BANK WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED DETAILED
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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 position from the nipple" a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple"
A 54-year-old female dietician presents for a routine annual examination. On review of systems, she reports that she has had many breast findings over several years, including one biopsy with normal pathology. She feels that her breasts have become far less lumpy since she underwent menopause 3 years ago. Which of the following is true regarding changes in the breasts with menopause?
a. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity and specificity of mammograms. b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after menopause. c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of lobules. d. Breast density has no genetic component and is entirely due to estrogen dose from endogenous and exogenous sources over the lifetime. e. Mammography performs most poorly in the menopausal and postmenopa 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 Department 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
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βhuman chorionic gonadotropin (β-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 involuntary rigidity and rebound tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy b. Acute cholecystitis c. Ruptured appendix d. P a. Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents 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, γ-glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. He presents for a follow-up appointment 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 expir
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 smoking history presents with a several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation. She reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of the following is her most significant risk factor for an AAA?
a. Female gender b. History of smoking c. Underweight d. Family history of ruptured aneurysm e. Hypertension
b. History of smoking A 76-year-old retired man with a history of prostate cancer and hypertension has been screened annually for colon cancer using high sensitivity fecal occult blood testing (FOBT). He presents for followup of his hypertension, during which the clinician scans his chart to ensure he is up to date with
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a. Voluntary contraction of the abdominal wall that persists over several examinations 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
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 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?
a. Exacerbating factor includes alcohol intake b. Positive McBurney point tenderness c. Poorly localized periumbilical pain d. Vomiting of bile e. Associated right shoulder pain e. Associated right shoulder pain
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While counseling him, the clinician mentions that multiple processes must take place to achieve an erection. Which of the following structures would be most affected by vascular deficiencies related to his preexisting medical conditions and is likely contributing to his symptoms?
a. Corpora cavernosa b. Ejaculatory duct c. Epididymis
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d. Seminal vesicle e. Vas deferens a. Corpora cavernosa
A 29-year-old graduate student states that he is able to achieve an erection and ejaculate during sexual intercourse; however, he does not experience any pleasurable sensation of orgasm. He is otherwise healthy and is not on any medications. What is the most likely cause of his problem?
a. Androgen insufficiency b. Endocrine dysfunction c. Peyronie disease d. Psychogenic e. Sexually transmitted infection (STI) d. Psychogenic
Multiple processes must take place in order for a male to sustain an erection. Various cues stimulate sympathetic outflow from higher brain centers to the T11-L2 levels of the spinal cord and parasympathetic outflow from S2 to S4 reflex arcs. Local vasodilatation within the penis erectile tissue results from increased levels of which of the following?
a. Follicle-stimulating hormone (FSH) b. Gonadotropin-releasing hormone (GRH) c. Luteinizing hormone (LH) d. Nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) e. Testosterone
d. Nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) The human papillomavirus (HPV) can cause genital warts in males and females as well as cervical cancer in females. Vaccination against HPV is available and should be offered to males between what ages?
a. 6-9 months b. 1-3 years c. 5-7 years d. 9-21 years e. 30-50 years d. 9-21 years
A 32-year-old male complains of a painless, cystic mass just above his left testicle. During the physical examination, a strong flashlight is placed behind the scrotum through the area in question and transillumination is noted. What is the most likely diagnosis?
a. Direct hernia b. Indirect hernia c. Spermatocele
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a. Early withdrawal b. Male condoms c. Spermicides d. Diaphragms e. Cervical caps b. Male condoms
A 21-year-old college student presents to the student health clinic for a full physical examination. He is generally healthy; however, he reports that he has had sexual intercourse with multiple partners in the past couple of months. He noticed a small lesion on the shaft of his penis a few days ago. While performing the examination, he unwillingly achieves an erection. How should the clinician proceed at this point?
a. Stop the examination immediately. b. Have him return to see another provider. c. Explain this is a normal response and finish the examination. d. Tell him the examination cannot proceed until the erection subsides. e. Assume that he is malingering. c. Explain this is a normal response and finish the examination.
A 45-year-old driver's education instructor presents to the clinic for heavy periods and pelvic pain during her menses. She reached menarche at age 13 years and has had regular periods except during her pregnancies. She is a G4P3013 and does not use birth control as her husband has had a vasectomy. She states this has been going on for about a year but seems to be getting worse. Her last period was 1 week ago. On bimanual exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. What is the best explanation for her physical finding?
a. Large colonic stool b. Ovarian mass c. Fibroids d. 4-Month pregnancy e. Bartholin gland enlargement c. Fibroids
A 32-year-old G0 woman comes for evaluation on why she and her husband have been unable to get pregnant. Her husband has been married before and has two other children, ages 7 and 4 years. The patient relates she began her periods at age 12 and has been fairly regular ever since. She began oral contraceptive pills from when she got married until last year, when she began to try for a pregnancy. Before this she had regular cycles for 10 years. She has had a history of five prior partners. She relates she was once treated for a severe genital infection when she was in college. Based on this patient's history, what is the best explanation for her infertility?
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a. Prior pelvic inflammatory disease (PID) b. Prior Bartholin gland infection c. Prior herpes infection d. Metabolic disorder with subsequent hormonal irregularities leading to anovulation e. Secondary amenorrhea
a. Prior pelvic inflammatory disease (PID) A 24-year-old retail clerk presents to the clinic for an annual exam. Her last Pap was 3 years ago and was normal. She is a G0 and is currently not sexually active although she has had two lifetime partners. She is on oral contraceptive pills for cycle control and has no medical problems. Based on guidelines, the clinician proceeds to perform a Pap smear and places the speculum. There are two layers of cells, squamous and columnar. Where is the most important area to obtain cells for a Pap smear?
a. Zona reticularis b. Transformation zone c. Squamous zone d. Columnar zone e. Linea nigra
b. Transformation zone A 35-year-old grade school teacher presents for her annual exam. Her last Pap smear was 4 years ago and normal. She is a G1P1 with a 6-year-old child. She has had four lifetime partners but only one partner in the last 12 years. Otherwise she has no complaints. A speculum exam is done followed by a bimanual examination during which a rectovaginal mass is palpated. Which of the following exam findings would be most reassuring that this is not a colonic mass?
a. No cervical motion tenderness b. No pus from the os c. The mass dents with digital pressure d. Both adnexa are nontender e. The perineum has no lesions
c. The mass dents with digital pressure A 21-year-old college student presents for her first annual exam. She has been sexually active for 1 year and has had two partners. She is not aware of having had any sexually transmitted diseases (STIs). She is using condoms for birth control and STI prevention but admits to not always using them regularly. Her last menses was 2 weeks ago. On speculum exam, an unusual appearance is noted, which is diagnosed as warts. What is the best description for these lesions?
a. Several shallow ulcers with a red base b. Translucent nodules c. Raised friable or lobed lesions d. Bright red, soft lesion arising from the cervical canal e. Strawberry cervix (small red granular spots or petechiae)
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c. Withdraw the speculum slightly and reposition it on a different slope
A 63-year-old office worker comes to the clinic for her women's health exam. Her last Pap smear was 5 years ago and was normal. She is married and has been with the same sexual partner for the last 35 years. After performing the majority of the exam, the clinician decides to do a speculum exam to collect cytology for Pap smear. What is the correct position to have the patient in for her speculum exam?
a. Sitting b. Supine c. Prone d. Trendelenburg e. Lithotomy
e. Lithotomy A 68-year-old retired patient presents to the clinic complaining about feeling like something is falling out of her vagina. She is a G6P6007 and had all her children vaginally, even the twins. She went through menopause at age 55 years, and, for the last few months, she has felt this falling sensation. On exam, an anterior bulge in the vaginal wall is apparent when she bears down. Weakness in which muscle would best account for the anterior bulge in the vaginal wall?
a. Levatori ani b. Anal sphincter c. Pubis symphysis d. Ischiocavernosus muscle e. Bulbocavernosus muscle
a. Levatori ani A 49-year-old male nurse experiences fecal incontinence after a motor vehicle accident that left him paralyzed below the waist. He asks his rehabilitation physician about the control of this function in a person without his injuries. Which of the following is true regarding the muscle control of the anal sphincter?
a. The internal anal sphincter is under voluntary control, whereas the external anal sphincter is under involuntary control. b. The internal anal sphincter is under involuntary control, whereas the external anal sphincter is under voluntary control. c. Both internal and external anal sphincter are under voluntary control. d. Both internal and external anal sphincter are under involuntary control. e. Control of the anal sphincters is variable between individuals. b. The internal anal sphincter is under involuntary control, whereas the external anal sphincter is under voluntary control. A 62-year-old male who is undergoing evaluation for possible prostate cancer strongly declines a rectal examination, stating that, "Some trainee once did that and it hurt badly." Which of the following is true
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about the innervation of the anus and rectum that may explain this patient's experience of discomfort?
a. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral nerves, making the rectum the most likely source of this patient's discomfort. b. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral nerves, making the anus the most likely source of this patient's discomfort. c. Proximal to the dentate line, the lower gastrointestinal tract is innervated primarily by somatosensory nerves, making the proximal reach of the examination the most likely site of this patient's pain d. The anal canal has a rich somatosensory innervation,
d. The anal canal has a rich somatosensory innervation, making poorly directed examinations painful in this area.
A 54-year-old male with a strong family history of breast and prostate cancer presents to his primary care provider to discuss prostate screening. His father died at age 73 years from prostate cancer that was not detected on routine digital rectal examinations (DREs), and he would like to minimize his chance of a similar occurrence. Which of the following is true regarding the anatomy and screening of the prostate by DRE?
a. All three lobes of the prostate are palpable on DRE. b. The seminal vesicles are palpable distal to the prostate on DRE. c. The median lobe of the prostate is located anterior to the urethra and is not palpable on DRE. d. The median sulcus divides the lateral lobes from the median lobe and is palpable on DRE. e. A prostate of 5 cm diameter without palpable nodes or masses represents a normal prostate examination.
c. The median lobe of the prostate is located anterior to the urethra and is not palpable on DRE. A third-year medical student rotating on the internal medicine service performs a digital rectal examination (DRE) on a 56-year-old female patient. The patient has been admitted for suspicion of a myocardial infarction, and confirmation that there is no blood in the stool is required before anticoagulation can be started. The student reports that the fecal occult blood test was negative but notes that he palpated a structure through the anterior rectum that he could not identify. The attending physician confirms normal anatomy and reviews with the student that the most likely identity of the structure palpable is which of the following
a. Sacrum b. Pectinate line c. Uterine fundus d. Prostat e. Cervix
e. Cervix A 45-year-old female executive reports to her primary care provider that she has recently experienced a change in the patterns of her bowel movements. She expresses a great concern as her family history includes a maternal aunt who died of colon cancer at age 49 years; her mother has had colonoscopies
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a. Inflammatory bowel disease (IBD) b. Lymphogranuloma venereu c. Human papillomavirus (HPV) d. Gonorrhea cervicitis e. Primary syphilis
a. Inflammatory bowel disease (IBD) A 53-year-old African American advertising agent presents for discussion of his prostate cancer risk and possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died recently at age 87 years from a myocardial infarction before the disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about risk and screening for prostate cancer?
a. The incidence of prostate cancer does not rise until age >65 years, thus this patient needs no screening at this time. b. Prostate cancer is always an aggressive neoplasm, thus the risks of overdiagnosis with screening is outweighed by the benefits of early case-finding. c. This patient is at an elevated risk of prostate cancer due to his family history, thus screening modalities should be discussed betwee c. This patient is at an elevated risk of prostate cancer due to his family history, thus screening modalities should be discussed between the patient and provider. A 64-year-old retired architect presents to his primary care provider with a magazine article about prostate cancer screening that states, "You should talk to your doctor about the ups and downs of prostate cancer screening." The patient hands this to the clinician and states, "Tell me about the ups and down of prostate screening." Which of the following is true about prostate cancer screening?
a. Regardless of sensitivity and specificity of testing modalities, screening for prostate cancer should always be ordered due to the malignant nature of the disease. b. The prostate-specific antigen (PSA) effectively differentiates aggressively malignant prostate tumors from indolent cases. c. The prostate-specific antigen (PSA) cut-off of 4.0 ng/ml is virtually 100% specific for aggressive prostate cancer. d. Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing the risk of overdiagnosis wi
d. Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing the risk of overdiagnosis with the risk of underdiagnosis.
A thin, 58-year-old patient complains of lower back pain for years. On examination, the clinician finds that the patient has tenderness over the sacroiliac area. Which of the following conditions is most consistent with this physical sign?
a. Osteoporosis b. Ankylosing spondylitis
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c. Malignancy d. Infection e. Torticollis
b. Ankylosing spondylitis During an evaluation of an athletic 30-year-old patient, the clinician conducts an active range of motion evaluation at the neck. Which muscle is being assessed when the patient is asked to flex the neck?
a. Splenius capitis b. Trapezius c. Splenius cervicis d. Sternocleidomastoid (SCM) e. Sacrospinalis d. Sternocleidomastoid (SCM)
An obese 50-year-old patient presents with a long history of back trouble. What structure in the spine supports the body's weight?
a. Vertebral arch b. Intervertebral disk c. Transverse process d. Vertebral body e. Spinous process
d. Vertebral body A 31-year-old day care worker presents with a worsening stiff, painful neck. On inspection, the patient's head is laterally deviated toward the shoulder and rotated. At this point of the examination, what is the most likely diagnosis?
a. Torticollis b. Spondylolisthesis c. Osteoarthritis (OA) d. Thoracic kyphosis e. Ankylosing spondylitis
a. Torticollis A young adult patient presents to the clinic stating that something is wrong as he looks in the mirror and sees that his shoulders are uneven. He fractured his left arm 8 weeks ago and remains in a cast. He noticed the uneven shoulders over the last week. Upon inspection, his shoulder heights are unequal and there is winging of the scapula. As the examination continues, which of the following maneuvers would confirm a likely diagnosis?
a. Assess his ability to touch his toes b. Assess the lateral bending movement of his neck
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d. Gout e. Polymyalgia rheumatica a. Osteoarthritis (OA)
A 62-year-old patient with rheumatoid arthritis (RA) complains of increased joint stiffness. What characteristic(s) are consistent with her diagnosis of RA?
a. Stiffness follows joint activity. b. Joint distribution is asymmetrical. c. Swelling of the synovial tissue is seen in joints and tendon sheaths. d. It most frequently involves the first metatarsophalangeal joint. e. Tophi are found in the subcutaneous tissue.
c. Swelling of the synovial tissue is seen in joints and tendon sheaths. A 55-year-old woman with a headache explains to the clinician that she has had headaches before, but this one is unusual because of some new symptoms. Which of the following symptoms would prompt an immediate investigation?
a. The headache is similar in nature to prior ones she has had for decades but more severe. b. The patient had a car accident and minor head trauma about 3 months ago. c. The patient also has developed fever and night sweats and thinks she lost some weight. d. The headache comes and goes. e. The patient lost her glasses.
c. The patient also has developed fever and night sweats and thinks she lost some weight. In the case of a middle-aged female with a pounding headache, what is an effective question to ask the patient?
a. Does the patient have any aura prior to the headaches? b. How old is the patient? c. Is she feeling stressed? d. Does she think she is losing her memory? e. Has she ever seen anyone with a stroke? a. Does the patient have any aura prior to the headaches?
A 35-year-old female patient has had migraines for much of her adult life. Ather regular checkup, she is healthy, takes no medications except oral contraceptive pills (OCPs), exercises, and has a steady job. Her only complaint is that her migraines seem to have become worse, and, for the past few weeks, she has been waking up at night with headache and also nausea. Which of the following is the best course of action?
a. Reassure her that this is a common pattern with migraines. b. Order studies to evaluate potential transient ischemic attacks (TIAs) because she is on OCPs.
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c. Take a further history and perform a very careful neurological examination. d. Treat her for sinusitis. e. Prescribe a strong medication for her migraines. c. Take a further history and perform a very careful neurological examination. d. Treat her for sinusitis.
An 82-year-old grandmother presents to the Emergency Department in the care of her extended family with new-onset speech impairment. According to family members, the patient awoke with this symptom as well as difficulty in understanding questions or following commands. Her past medical history is remarkable for atrial fibrillation but no other notable conditions. On examination, her speech is verbose but poorly comprehensible and lacks meaning. She is unable to follow simple commands. Which of the following best describes her speech disorder?
a. Dysphonia with expressive deficit b. Dysarthria c. Wernicke aphasia d. Global aphasia e. Broca aphasia
c. Wernicke aphasia A 74-year-old bus driver is delivered to the hospital via emergency transport after an astute passenger noted that the patient exhibited drooping facial features and slurred speech. The patient was diagnosed rapidly with ischemic (nonhemorrhagic) stroke, and urgent intervention lead to a near complete recovery from his symptoms. The astute passenger was thanked and congratulated for recognizing the signs of acute stroke; this individual credited this recognition to a public safety awareness campaign that outlined the critical public health need to recognize strokes early. Which of the following statements is true for risks and rapid recognition of suspected strokes?
a. Atrial fibrillation is not a risk factor for ischemic stroke in individuals age ≥75 years. b. Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke. c. Obesity with normal glucose tolerance is not a risk factor for stroke.
b. Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke. A 70-year-old male presents to the Emergency Department accompanied by his wife, who is concerned that he has experienced a stroke. She states that he awoke with drooping of the right side of his mouth. He has a history of hypertension and diet-controlled diabetes, but no history of prior transient ischemic attacks (TIAs), strokes, or neurologic deficits. Physical examination reveals a wellnourished, right-handed male, who has an obvious flattening of the right nasolabial fold at rest. He is unable to close his right eye, wrinkle his forehead, or raise his eyebrows. The remainder of the neurologic examination is symmetric with intact strength and normal deep tendon reflexes. Based on this history and physical examination, which of the following statements is true?
a. The patient most likely has a central upper motor neuron lesion involving cranial nerve (CN) VII (the facial nerve). b. The patient most likely has a
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a. Right oculomotor nerve (CN III) b. Right trochlear nerve (CN IV) c. Right abducens nerve (CN VI) d. Left oculomotor nerve (CN III) e. Left trochlear nerve (CN IV) f. Left abducens nerve (CN VI)
f. Left abducens nerve (CN VI) A 45-year-old physician is having increasing difficulty with speech for the past 6 months. She is less precise in pronunciation of words (dysarthria), has found it more effortful to speak, and finds that her voice sounds more nasal than usual. On examination, her articulation is less than precise, especially with rapid repetition of single syllables, such as "ta-ta-ta-ta," "go-go-go-go," "la-la-la-la," and "ba-ba-ba." Her neurological examination is otherwise normal. Which nervous system pathway is responsible for control of the muscles producing this symptom?
a. Corticospinal tract b. Corticobulbar tract c. Spinothalamic tract d. Cerebellar system e. Posterior column system b. Corticobulbar tract
A 63-year-old practicing attorney makes an appointment with the office urgently for pain in his right leg for 3 days. Since working in the garden moving heavy bags of mulch for his wife this past weekend, he has had intermittent but excruciating pain shooting down the posterior aspect of his right leg. On examination, sensory loss to light touch in the right leg posteriorly, corresponding to a sacral 1 (S1) dermatome, is noted. Which reflex would be expected to be decreased compared to the other side?
a. Right plantar (Babinski) b. Right ankle c. Right knee d. Left plantar (Babinski) e. Left ankle f. Left knee
b. Right ankle An 82-year-old retired insurance broker complains of difficulty in walking, having to consciously lift up his feet so he does not trip, stumble, or fall. Both feet are affected equally; he has no sensory complaints or pain. This has been worsening over the past 3 years, and he has had to give up his beloved hiking. The symptoms are improved while wearing tall boots and worse when walking around the house with house slippers. What is the likely location of the pathology in this man?
a. Frontal motor area of the cerebral cortex
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b. Brainstem c. Lumbar spinal cord d. Peripheral nerve e. Distal muscle d. Peripheral nerve
A mother brings her 15-month-old toddler to the clinic for his preventive health care visit. The clinician takes the history and observes the child's interactions and behaviors and is then ready to begin the rest of the examination. Which of the following best describes the general approach to the pediatric examination of the young child?
a. Always give immunizations prior to beginning the examination. b. Examine the child in the same order as for an adult patient. c. Children age <2 years do not need to be examined. d. Begin with least invasive parts of the examination first. e. Never examine a young child in the mother's lap.
d. Begin with least invasive parts of the examination first. In caring for children, physicians and other clinicians need to understand child development. Of the following, which is a principle of normal child development?
a. Child development proceeds along a predictable pathway in a healthy child. b. There is minimal variation in when children achieve milestones. c. All delays in development can be explained by one or two risk factors. d. Regression in developmental skills is not a cause for concern. e. A child's developmental level can be ignored in conducting an examination. a. Child development proceeds along a predictable pathway in a healthy child.
The parents of a 21-month-old child explain that their son used to speak nearly 50 words and was using 2-word phrases. In the last month or so, the child has not been using as many words and tends to echo what is being said to him rather than use language spontaneously. They want to know if this is normal. After taking a thorough developmental history, the clinician finds that the child makes poor eye contact and does not play with toys in a purposeful manner. The physical examination is normal except for the child's limited social interactions. There is a family history of autism in two first cousins. Which of the following would be the best response to the parents at this time?
a. Reassure the parents that all toddlers lose skills at some point in development. b. Reassure the parents that the child is fine as long as he has not lost skills in other domains. c. Send the child to the Emergency Department (ED). d. Re
d. Refer the child to a developmental and behavioral pediatrician. A clinician is meeting the mother of a 5-year-old with asthma for the first time. The mother notes that the asthma has been poorly controlled and that the child has had multiple hospitalizations. The clinician
