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Mrs. Bowers is a 38-year-old patient who presents to your office for a routine examination. The ability of an observation to identify correctly those who have a disease is the definition of: A. specificity. B. sensitivity. C. certainty. D. positive predictive value. ---------CORRECT ANSWER-----------------B: Sensitivity is the ability of an observation to identify correctly those who have a disease. If an individual is suspected of having a specific condition, the condition is in fact present, and a laboratory test confirms its presence, then the outcome of the laboratory test is identified as a(n): A. true positive. B. absolute positive. C. false positive. D. sensitive positive. ---------CORRECT ANSWER-----------------A:A true positive is an expected observation that is found when the disease characterized by that observation is present. Which of the following best describes Bayes theorem? A. The validity of your diagnosis depends on the reliability of the individual as a historian. B. The greater your years of experience, the greater your probability of a valid diagnosis.
C. The likelihood of your diagnosis being related to your findings depends on the probability of the findings being associated with that diagnosis and the prevalence of both that diagnosis and combination of findings in the community. D. The probability that you will come up with the correct diagnosis is indirectly proportional to the specificity of your observations and directly proportional to the sensitivity of your observations. ---------CORRECT ANSWER-----------------C: As a critical thinker, you will discover that the likelihood of your diagnosis being related to your findings depends on the probability of those findings being associated with that diagnosis and the prevalence of both that particular diagnosis and that combination of findings in the community in which you are serving. Which of the following is appropriate to use in the decision-making process but must also be subject to critical thinking? A. Intuition B. Inferences C. Divination D. Premonitions ---------CORRECT ANSWER-----------------A:Much as you strive to be scientific and base what you do on the disciplined principles of science, at times you will make undeniable intuitive judgments. Intuition, however, must be as fully subject to critical thinking as any other aspect of your effort. The indiscriminate use of technology can be minimized by recognizing that: A. the great majority of diagnoses can be achieved with information gleaned from a competent clinical examination. B. limiting the amount of time required to perform the physical examination will increase the patient's satisfaction and reduce litigation. C. reducing consultation and frequency of return visits will maximize patients' involvement with their own treatment and improve compliance.
D. Right to self-determination ---------CORRECT ANSWER----------------- A:Our responsibilities for offering care are established by tradition and in cultural contexts. The examiner is interviewing the mother of a 3-month-old infant as part of the infant's neurologic system examination. Which response of the mother may indicate a need for further evaluation of the infant? A. "My baby sometimes falls asleep when I am feeding her." B. "My baby seems to jump when there is a loud noise in the room." C. "I drank a glass of wine about once a week while I was pregnant." D. "I had problems with hypertension the entire time I was pregnant." --------
- CORRECT ANSWER-----------------D: CorrectA prenatal/maternal history of intrauterine infections such as toxoplasmosis, syphilis, tuberculosis, rubella, cytomegalovirus, herpes, prior history of hypertension, preeclampsia, bleeding, history of trauma or stress, persistent vomiting, hypertension, or drug or alcohol use alerts the examiner to the need for further evaluation of an infant. Mr. Harrien is a 56-year-old patient who presents to your office. On examination, you note impaired pain sensation. Which additional testing is appropriate to further evaluate this finding? A. Temperature and deep pressure sensation B. Ultrasonic perception C. Deep tendon reflex D. Transillumination of the involved area ---------CORRECT ANSWER-------- ---------A: CorrectTemperature and deep pressure sensation tests are performed only if superficial pain sensation is not intact. A patient presents with a bilaterally symmetric intention tremor of the hands that she describes as "worse when I'm stressed and better when I have a cocktail." How would you document this tremor?
A. Physiologic tremor B. Essential tremor C. Resting tremor D. Psychological tremor ---------CORRECT ANSWER-----------------B: CorrectEssential tremor may worsen with stress or fatigue; it may improve temporarily with alcohol. The main function of cerebrospinal fluid is to: A. provide nutrients for the brain and spinal cord cells. B. act as a shock absorber. C. cleanse the brain and spinal cord cells and remove debris. D. function as a neurotransmitter. ---------CORRECT ANSWER----------------- B: CorrectCerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber. Which assessment finding is consistent with upper motor neuron disease affecting the face? A. Movement of the affected side occurs with emotion but not volition B. Movement of the affected side occurs only on direct command C. Asynchronized movements of the two sides of the face D. Total paralysis of the affected side of the face ---------CORRECT ANSWER-----------------A: CorrectWhen the upper motor neurons are affected, as in a stroke or brain attack, voluntary movements are paralyzed but emotional movements are spared. The cerebellum is primarily responsible for: A. controlling temperature sensation and voluntary skeletal muscle activity. B. processing visual data as they are received. C. controlling the perception and interpretation of sight and sound.
that all begin and end within the central nervous system. They comprise the descending pathways from the brain to the spinal cord. Motor maturation in an infant proceeds in which direction? A. Inferosuperior B. Mediolateral C. Cephalocaudal D. Inferoexterior ---------CORRECT ANSWER-----------------C: CorrectMotor maturation proceeds in a cephalocaudal direction. Mrs. Green brings her 6-month-old infant in for examination. Which observation is most indicative of a normal timetable of neurologic development? A. The infant grasps your finger when you place it on the palm of the hand. B. The infant takes and holds a spoon in one hand. C. The infant can throw a soft ball. D. The infant can make and hold a fist. ---------CORRECT ANSWER---------- -------B: CorrectPurposeful movement (e.g., reaching and grasping for objects) begins at about 2 months of age. The infant progresses to taking objects with one hand at 6 months, transferring objects hand to hand at 7 months, and purposefully releasing objects by 10 months of age. A dermatome is that part of the body that: A. is innervated by a particular spinal nerve. B. is governed by a specific cranial nerve. C. is receptive to sensory stimuli. D. responds to motor impulses. ---------CORRECT ANSWER-----------------A: CorrectDermatomes of the body are areas of body surface innervated by particular spinal nerves; C1 usually has no cutaneous distribution.
A functioning cranial nerve (CN) I allows an individual to: A. differentiate light from dark. B. differentiate hot from cold. C. differentiate various odors. D. differentiate touch from light pain. ---------CORRECT ANSWER------------- ----C: CorrectCranial nerve I (olfactory nerve) is a sensory nerve that allows reception of smell and its interpretation. By asking an individual to make various faces at you, you are testing: A. CN II. B. CN III. C. CN IX. D. CN VII. ---------CORRECT ANSWER-----------------D: CorrectCranial nerve VII (facial nerve) has both motor and sensory components. The motor component is responsible for movement of facial expression muscles except the jaw; it is also responsible for closing the eyelids and for labial speech sounds (b, m, w, and rounded vowels). The sensory component of CN VII is responsible for which function? A. Taste B. Smell C. Balance D. Pain ---------CORRECT ANSWER-----------------A; CorrectThe sensory component of cranial nerve VII (facial nerve) mediates taste sensation from the anterior two-thirds of the tongue. During the examination of a 49-year-old patient, you test rapid rhythmic alternating movements. This tests an individual's: A. sense of balance.
D. leg up or down. ---------CORRECT ANSWER-----------------B: CorrectTo test joint position sensation, assess the great toe of each foot and a finger on each hand. Hold the joint to be tested (e.g., great toe or finger) by the lateral aspects to avoid giving a clue about the direction moved. Beginning with the joint in neutral position, raise or lower the digit and ask the patient which way the joint was moved. Expect patients to identify the joint position. A pill-rolling tremor is an expected finding in patients with which disorder? A. Multiple sclerosis B. Parkinson disease C. Hyperthyroidism D. Hypoglycemia ---------CORRECT ANSWER-----------------B: CorrectParkinson disease is characterized by slow supination-pronation (pill-rolling) movements when the limb is at rest. By simultaneously touching the individual in two distinct areas of the body and asking the number and location of stimuli, you are testing: A. two-point discrimination. B. superficial pain. C. extinction phenomenon. D. dermatome function. ---------CORRECT ANSWER-----------------C: CorrectThe extinction phenomenon is tested by simultaneously touching two areas on each side of the body (e.g., cheek, hand, or other area) with the sharp edge of a broken tongue blade and asking the patient to tell you the number of stimuli and where they are felt. Similar sensations should be felt bilaterally. Mr. Tucker is a 56-year-old patient who presents to your office with a complaint of rectal pain. On examination you are palpating the lateral and posterior rectal walls. What should you expect to feel?
A. A smooth, even, and uninterrupted surface B. Small nodules from internal hemorrhoids C. Tissue folds from the valves of Houston D. Bulging from the bladder wall ---------CORRECT ANSWER----------------- A: CorrectThe walls should feel smooth, even, and uninterrupted. Mr. Yates is a 62-year-old patient who presents with a chief complaint of rectal pain. The examiner will focus the history and examination on which known fact? A. Rectal pain is almost always accompanied by an infection. B. Rectal pain is almost always an indication of local disease. C. A complaint of rectal pain is usually associated with a serious systemic process. D. One of the most common causes of rectal pain is prostatic enlargement. ---------CORRECT ANSWER-----------------B: CorrectRectal pain is almost always indicative of a local disease. Mr. Bower is a 78-year-old patient who is unable to assume a standing position for a routine rectal examination. Which is the best alternative position? A. Lithotomy position B. Left lateral position with the knees flexed C. Knee-chest position D. Prone position ---------CORRECT ANSWER-----------------B: CorrectThe rectal examination can be performed with the patient in any of these positions: knee-chest; left lateral with hips and knees flexed; lithotomy, or standing with the hips flexed and the upper body supported by the examining table. A pregnant woman presents to the emergency department with the complaint of dark stools. She tells the examiner, "I read in a magazine that
A. It feels like a soft olive or grape. B. It feels like the topside of a plastic LEGO piece. C. It feels like a small baseball. D. It feels like a pencil eraser ---------CORRECT ANSWER-----------------D:. CorrectThe gland should feel like a pencil eraser—firm, smooth, and slightly movable—and it should be nontender. What is the best method of verifying anal patency in a newborn? A. Inserting a lubricated thermometer through the anus and into the rectum B. Inserting the fifth digit through the anus and into the rectum C. Checking for the passage of meconium in the first 24 to 48 hours after birth D. Inspecting the anus for an anal opening ---------CORRECT ANSWER----- ------------C: CorrectIf there is no passage of stool in 24 hours in a newborn, suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis. Mr. Santos is a 67-year-old patient who presents to your office. On examination, you palpate his prostate, noting that it is hard and irregular. The median sulcus is not palpable. These findings are consistent with: A. prostate cancer. B. benign prostate hypertrophy. C. prostatitis. D. a rectal mass. ---------CORRECT ANSWER-----------------A: CorrectWith cancer of the prostate, a hard, irregular nodule may be palpable on prostate examination. Mr. Mills, a 38-year-old patient, presents with severe rectal pain and fever. Which condition might be the cause of the symptoms?
A. An imperforate anus B. A perianal abscess C. Benign prostatic hypertrophy D. An anorectal fistula ---------CORRECT ANSWER-----------------B: CorrectPerianal abscess is an infection of the soft tissues surrounding the anal canal, with formation of a discrete abscess cavity. Symptoms include tenderness, fever, and pain on defecation or with sitting or walking. "Boggy, enlarged, and tender" on rectal examination is descriptive of which condition? A. Prostatitis B. Anorectal abscess C. Prostatic carcinoma D. Rectal polyp ---------CORRECT ANSWER-----------------A: CorrectSeminal vesicles are often involved in prostatitis and may be dilated and tender on palpation; however, the prostate may feel boggy, enlarged, and tender or have palpable areas of fibrosis that simulate neoplasm. A newborn does not pass meconium in the first 24 hours after birth. Which problem must be suspected? A. Biliary atresia B. Cystic fibrosis C. Meckel diverticulum D. Spinal bifida ---------CORRECT ANSWER-----------------B: CorrectIf there is no passage of stool in 24 hours in a newborn, suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis. Enlargement of the prostate may cause: A. urinary retention. B. a forceful urinary stream.
D. an underlying problem such as portal hypertension. ---------CORRECT ANSWER-----------------D; CorrectHemorrhoids are rare in children, and their presence suggests a serious underlying problem such as portal hypertension. When examining the prostate, you feel fluctuant softness. This finding indicates: A. prostatic abscess. B. posterior rectal wall neoplasm. C. prostatic hypertrophy. D. rectal prolapse. ---------CORRECT ANSWER-----------------A: CorrectA prostatic abscess is felt as a fluctuant mass in the prostate. A patient tells the examiner that she has liquid stools containing small flecks of blood stained mucous. Stools of this type result from: A. amebiasis. B. excessive fiber intake. C. excessive dietary beef. D. insufficient fluid intake. ---------CORRECT ANSWER-----------------A: CorrectSmall flecks of blood-stained mucus in liquid feces are indicative of amebiasis. Which examination finding in the child is a clue to the diagnosis of Hirschsprung disease? A. Passing of frequent, loose stools in the absence of other symptoms B. A consistently empty rectum with a history of constipation C. Itching and irritation around the anus D. Rectal prolapse ---------CORRECT ANSWER-----------------B: CorrectA consistently empty rectum in the presence of constipation is a clue to the diagnosis of Hirschsprung disease.
In which situation would the examiner perform a rectal examination on an infant or child? A. A newborn infant passes a greenish-black viscous stool 12 hours after birth. B. The mother of a 3-month-old baby describes the baby's stools as "loose and golden yellow." C. A stool of a 6-year-old child is guaiac positive. D. A mother tells the examiner that her 3-year-old child was sent home from daycare after two episodes of diarrhea. ---------CORRECT ANSWER-- ---------------C: CorrectRectal examination is not always performed on infants and children unless there is a particular problem. An examination is required whenever there is any symptom that suggests an intraabdominal or pelvic problem, a mass or tenderness, bladder distention, bleeding, or rectal or bowel abnormalities. Prostate enlargement is determined by the: A. diameter of the rectum near the bladder. B. circumference of the prostate. C. estimation of the depth of the sulcus. D. protrusion of the prostate into the rectum. ---------CORRECT ANSWER-- ---------------D: CorrectProstate enlargement is classified by the amount of protrusion into the rectum During a rectal examination, you find shelf lesions when you palpate the anterior rectal wall. What is the significance of this finding? A. A sexually transmitted infection exists. B. Peritoneal metastases are present. C. Houston valves have fibrosed.
Mr. Custer is a 56-year-old patient who presents to your office. On examination, you note a smooth and firm protrusion into the rectum. Which condition can present as as a smooth, firm 4-cm protrusion into the rectum? A. Anorectal fistula B. Imperforate anus C. Benign prostatic hypertrophy D. Prostatitis ---------CORRECT ANSWER-----------------C: CorrectWith benign prostatic hypertrophy, the prostate feels smooth, rubbery, symmetric, and enlarged. Which factor increases a man's risk for developing prostate cancer? A. High-fiber diet B. Hispanic ethnicity C. Congestive heart failure D. Family history ---------CORRECT ANSWER-----------------D: CorrectA person with one first-degree relative with a history of prostate cancer has twice the risk of developing prostate cancer himself; the risk increases with more than one first-degree relative. Which is a possible explanation for an examination finding of "absence of the anal wink"? A. Upper motor neuron disorder B. Chronic constipation C. Pilonidal cyst D. Chronic abuse ---------CORRECT ANSWER-----------------D: CorrectLack of contraction may indicate a lower spinal cord lesion or chronic abuse.
Mrs. Black brings her infant son to your office. She tells you that his stools are thin, slimy, and brown to green. You explain that this is a normal finding for a: A. newborn infant. B. breastfed infant. C. 3- to 6-day-old infant. D. formula-fed infant. ---------CORRECT ANSWER-----------------C: CorrectStools of infants 3 to 6 days old are transitional: thin, slimy, and brown to green. Which statement applies to screening for sexually transmitted infections (STIs) in men who have sex with men? A. Screening for common STIs should be done every 6 months if the man is sexually active. B. Regular screening should be done for human papillomavirus (HPV) infection. C. HIV screening should be done if HIV serologic testing is positive or if the patient has not been tested within past year. D. Screening for gonorrheal pharyngeal infection should be done if the man has had receptive oral intercourse with a condom ---------CORRECT ANSWER-----------------D:. CorrectTest for the following infection in men who have had receptive oral intercourse during the preceding year regardless of history of condom use during exposure: urethral infection and rectal infection with Neiserria gonorrhoeae and Chlamydia trachomatis; pharyngeal infection with N. gonorrhoeae. On rectal examination, you note a lax anal sphincter. This is an indication of which problem? A. Meckel diverticulum B. Volvulus
