Deck 4: Beginning the Physical Examination: General Survey, Vital Signs, and Pain

Question 1

A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter's weight. You measure her daughter's height and weight and obtain a BMI of 19.5 kg/m². Based on this information, which of the following is appropriate?

A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
B) Reassure the mother that this is a normal body weight.
C) Give the patient information about exercise because the patient is obese.
D) Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese.

Answer 1

Reassure the mother that this is a normal body weight.

Question 2

A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 26.0 kg/m². He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit?

A) Refer the patient to a nutritionist because he is anorexic.
B) Reassure the patient that he has a normal body weight.
C) Give the patient information about reduction of fat, cholesterol, and calories because he is overweight.
D) Give the patient information about reduction of fat and cholesterol because he is obese.

Answer 2

Give the patient information about reduction of fat, cholesterol, and calories because he is overweight.

Question 3

A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30.0 kg/m². What is the most appropriate amount for a weekly weight reduction goal?

A) .5 to 1 pound per week
B) 1 to 2.5 pounds per week
C) 2.5 to 3.5 pounds per week
D) 3.5 to 4.5 pounds per week

Answer 3

.5 to 1 pound per week

Question 4

A 67-year-old retired janitor comes to the clinic with his wife. She brought him in because she is concerned about his weight loss. He has a history of smoking 3 packs of cigarettes a day for 30 years, for a total of 90 pack-years. He has noticed a daily cough for the past several years, which he states is productive of sputum. He came into the clinic approximately 1 year ago, and at that time his weight was 140 pounds. Today, his weight is 110 pounds. Which one of the following questions would be the most important to ask if you suspect that he has lung cancer?

A) Have you tried to force yourself to vomit after eating a meal?
B) Do you have heartburn/indigestion and diarrhea?
C) Do you have enough food to eat?
D) Have you tried to lose weight?

Question 5

Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except:

A) Changes in weight
B) Fatigue and weakness
C) Cough
D) Fever and chills

Question 6

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

A) Level of consciousness
B) Signs of distress
C) Dress, grooming, and personal hygiene
D) Blood pressure

Question 7

A 55-year-old bookkeeper comes to your office for a routine visit. You note that on a previous visit for treatment of contact dermatitis, her blood pressure was elevated. She does not have prior elevated readings and her family history is negative for hypertension. You measure her blood pressure in your office today. Which of the following factors can result in a false high reading?

A) Blood pressure cuff is tightly fitted.
B) Patient is seated quietly for 10 minutes prior to measurement.
C) Blood pressure is measured on a bare arm.
D) Patient's arm is resting, supported by your arm at her mid-chest level as you stand to measure the blood pressure.

Question 8

A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient's complete history and physical examination. When you palpate the pulse, what do you expect to feel?

A) Large amplitude, forceful
B) Small amplitude, weak
C) Normal
D) Bigeminal

Question 9

An 18-year-old college freshman presents to the clinic for evaluation of gastroenteritis. You measure the patient's temperature and it is 104 degrees Fahrenheit. What type of pulse would you expect to feel during his initial examination?

A) Large amplitude, forceful
B) Small amplitude, weak
C) Normal
D) Bigeminal

Question 10

A 25-year-old type 1 diabetic clerk presents to the emergency room with shortness of breath and states that his blood sugar was 605 at home. You diagnose the patient with diabetic ketoacidosis. What is the expected pattern of breathing?

A) Normal
B) Rapid and shallow
C) Rapid and deep
D) Slow

Question 11

Mrs. Lenzo weighs herself every day with a very accurate balance-type scale. She has noticed that over the past 2 days she has gained 4 pounds. How would you best explain this?

A) Attribute this to some overeating at the holidays.
B) Attribute this to wearing different clothing.
C) Attribute this to body fluid.
D) Attribute this to instrument inaccuracy.

Question 12

Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell him?

A) "When you get down to your goal weight, you will feel so much better."
B) "Some people seem to be able to lose weight and others just can't, no matter how hard they try."
C) "We are coming up with new medicines and methods to treat your conditions every day."
D) "Even a weight loss of 10% can make a noticeable improvement in the problems you mention."

Question 13

Jenny is one of your favorite patients who usually shares a joke with you and is nattily dressed. Today she is dressed in old jeans, lacks makeup, and avoids eye contact. To what do you attribute these changes?

A) She is lacking sleep.
B) She is fatigued from work.
C) She is running into financial difficulty.
D) She is depressed.

Question 14

You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office staff are: T 37.2, HR 78, BP 118/92, and RR 14, and she denies pain. You notice that she has some hypertensive changes in her retinas and you find mild proteinuria on a urine test in your office. You expected the BP to be higher. She is not on any medications. What do you think is causing this BP reading, which doesn't correlate with the other findings?

A) It is caused by an "auscultatory gap."
B) It is caused by a cuff size error.
C) It is caused by the patient's emotional state.
D) It is caused by resolution of the process which caused her retinopathy and kidney problems.

Question 15

Despite having high BP readings in the office, Mr. Kelly tells you that his readings at home are much lower. He checks them twice a day at the same time of day and has kept a log. How do you respond?

A) You diagnose "white coat hypertension."
B) You assume he is quite nervous when he comes to your office.
C) You question the accuracy of his measurements.
D) You question the accuracy of your measurements.

Question 16

You are observing a patient with heart failure and notice that there are pauses in his breathing. On closer examination, you notice that after the pauses the patient takes progressively deeper breaths and then progressively shallower breaths, which are followed by another apneic spell. The patient is not in any distress. You make the diagnosis of:

A) Ataxic (Biot's) breathing
B) Cheyne-Stokes respiration
C) Kussmaul's respiration
D) COPD with prolonged expiration

Question 17

Mr. Garcia comes to your office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, you note a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side. What type of pain is this?

A) Idiopathic pain
B) Neuropathic pain
C) Nociceptive or somatic pain
D) Psychogenic pain

Question 18

A 50-year-old body builder is upset by a letter of denial from his life insurance company. He is very lean but has gained 2 pounds over the past 6 months. You personally performed his health assessment and found no problems whatsoever. He says he is classified as "high risk" because of obesity. What should you do next?

A) Explain that even small amounts of weight gain can classify you as obese.
B) Place him on a high-protein, low-fat diet.
C) Advise him to increase his aerobic exercise for calorie burning.
D) Measure his waist.

Question 19

Ms. Wright comes to your office, complaining of palpitations. While checking her pulse you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different. It sounds like a triplet rather than the usual "lub dup." How would you document your examination?

A) Regular rate and rhythm
B) Irregularly irregular rhythm
C) Regularly irregular rhythm
D) Bradycardia