Deck 5: Secondary Assessment

Question 1

You are able to feel vibrations through the chest wall as your patient speaks. This is called:

A) egophony.
B) auscultation.
C) whispered pectoriloquy.
D) tactile fremitus.

Answer 1

tactile fremitus.

Question 2

To check for symmetrical chest expansion, you should place your hands on the patient's chest, with the thumbs resting on the ________, and ask the patient to inhale.

A) costal margins
B) nipples
C) clavicles
D) lateral chest wall

Answer 2

costal margins

Question 3

Physical exam techniques include all of the following EXCEPT:

A) palpation.
B) association.
C) auscultation.
D) inspection.

Answer 3

association.

Question 4

A light, popping, nonmusical sound heard upon auscultation of the lungs is best described as:

A) wheezing.
B) crackles.
C) stridor.
D) rhonchi.

Question 5

You would like to test a patient's visual acuity, but a visual acuity card or wall chart is not available. You can still test for visual acuity by:

A) asking the patient to indicate the farthest object he can see.
B) checking the pupils.
C) having the patient count your raised fingers.
D) covering one eye and testing for light accommodation.

Question 6

Which of the following best describes the technique of evaluating plantar reflexes?

A) Have the patient dorsiflex the foot, then strike the Achilles tendon.
B) Stroke the lateral aspect of the sole of the foot from heel to ball, curving medially.
C) Tap the patellar tendon just below the edge of the patella.
D) Strike the triceps along the posterior aspect of the distal humerus.

Question 7

Petechiae are skin lesions characterized by:

A) reddish lines radiating from a red spot.
B) irregular red spots.
C) reddish-purple spots less than 0.5 cm in diameter.
D) reddish-purple blotches greater than 0.5 cm in diameter.

Question 8

The process in which a paramedic places a hand on a body part, then sharply taps a distal knuckle with the tip of another finger, is known as:

A) percussion.
B) hyperresonance.
C) palpation.
D) observation.

Question 9

Inspection of the maxillary sinuses is accomplished by:

A) palpating under the zygomatic arches.
B) obstructing one side of the nares and watching the patient breathe.
C) using an otoscope for visualization.
D) palpating the nose and septum.

Question 10

Asking your patient to recall what he had for a meal earlier in the day would test:

A) recent memory.
B) remote memory.
C) immediate memory.
D) long-term memory.

Question 11

A condition marked by exaggerated lumbar concavity is called:

A) scoliosis.
B) lordosis.
C) kyphosis.
D) spondylosis.

Question 12

Your patient is complaining of numbness and hand pain that wakes him. Of the following, which is most likely?

A) Carpal tunnel syndrome
B) Chondromalacia
C) Bursitis
D) Plantar fasciitis

Question 13

You have just percussed the patient's chest and heard a loud, booming, low-pitched sound. This indicates:

A) atelectasis.
B) a normal lung field.
C) a hypoinflated lung field.
D) a hyperinflated lung field.

Question 14

Which of the following is included in an examination of the cardiovascular system?

A) Auscultate for carotid bruits.
B) Palpate to check for Murphy's sign.
C) Auscultate breath sounds.
D) Palpate both carotid arteries simultaneously.

Question 15

All of the following characteristics indicate a normal appearance to oral mucosa EXCEPT:

A) smooth.
B) patches of white.
C) pink.
D) moist.

Question 16

One sign of gonorrhea in males is a(n):

A) profuse, yellow discharge.
B) white, curdlike discharge.
C) scant, clear discharge.
D) external pustule.

Question 17

Discoloration over the umbilicus, known as ________ sign, is a(n) ________ indicator of intraabdominal bleeding.

A) Cullen's; late
B) Grey Turner's; early
C) Grey Turner's; late
D) Cullen's; early

Question 18

Which of the following findings is abnormal in a cardiovascular assessment?

A) Splitting of the S2 heart sound in children
B) Vibrations when palpating the carotid artery
C) Jugular venous distension in the supine position
D) Visible pulsation of the PMI at the fifth intercostal space, medial to the left midclavicular line

Question 19

During a musculoskeletal exam, you find redness of the skin over a nontraumatized joint. Which of the following is LEAST likely to be the cause?

A) Rheumatic fever
B) Dislocation
C) Gout
D) Arthritis

Question 20

During the abdominal exam, areas that are known to be painful or tender should be examined:

A) only by a physician.
B) at the beginning and end of the exam.
C) first.
D) last.

Question 21

You are examining a 70-year-old female patient with altered mental status. She is awake and can speak. You detect an odor of acetone and suspect that the patient is suffering from:

A) cyanide poisoning.
B) alcohol poisoning.
C) bowel obstruction.
D) diabetic ketoacidosis.

Question 22

Which of the following guidelines should be observed when examining a one- to three-year-old child?

A) Restrain the child if necessary.
B) Do not distract the toddler with toys.
C) Do the most invasive procedure first in order to get it out of the way.
D) Focus on the vital areas as indicated by the chief complaint.

Question 23

A scalp condition marked by mild flaking of skin is known as:

A) psoriasis.
B) dandruff.
C) seborrheic dermatitis.
D) hirsutism.

Question 24

Which of the following findings is NOT a sign of peritoneal irritation?

A) Abdominal pain when the patient coughs
B) Rebound tenderness
C) Abdominal pain upon light palpation
D) DeLorenzo's sign

Question 25

During a neurologic exam, you ask your patient to stick out his tongue. It deviates to the right. This may indicate a lesion to the patient's ________ nerve.

A) vagus
B) glossopharyngeal
C) facial
D) hypoglossal

Question 26

Dullness in the chest during percussion of the third to fifth intercostal spaces can be attributed to the location of the:

A) spleen.
B) heart.
C) stomach.
D) liver.

Question 27

A patient who loses his balance while standing with his eyes closed and feet together for 20 to 30 seconds is exhibiting a positive:

A) tilt test.
B) Babinski's reflex.
C) Romberg test.
D) Kehr's sign.

Question 28

The standard sequence for examining the chest is:

A) palpate, percuss, auscultate, inspect.
B) inspect, palpate, auscultate, percuss.
C) inspect, palpate, percuss, auscultate.
D) inspect, auscultate, percuss, palpate.

Question 29

To avoid the carotid sinus, you should palpate for a carotid pulse at the level of:

A) Terry's point.
B) the cricoid cartilage.
C) the sternocleidomastoid muscle.
D) carotid bifurcation.

Question 30

Assessing for bronchophony is important if the patient has abnormal or absent lung sounds because its presence can reveal:

A) tension pneumothorax.
B) breathing obstruction.
C) emphysema.
D) fluid in the lungs.

Question 31

Using an otoscope, you can examine the patient for ________ and ________.

A) tympanic membrane rupture; color changes
B) cranial nerve VIII function; basilar skull fracture
C) otitis; mastoiditis
D) tinnitus; eustachian tube blockage

Question 32

You can test the oculomotor, trochlear, and abducens nerves by:

A) shining a light into the pupils and observing constriction of the pupils.
B) conducting a visual acuity test.
C) evaluating the patient's extraocular movements.
D) closing one nostril while presenting a strong smell under the other nostril.

Question 33

Jugular venous pressure approximates the patient's ________ pressure.

A) left atrial
B) right ventricular
C) left ventricular
D) right atrial

Question 34

By placing the tip of the index finger in the depression in front of the tragus and asking the patient to open his mouth, the paramedic can evaluate the:

A) zygomatic arch.
B) sphenoid bone.
C) temporomandibular joint.
D) external auditory canal.

Question 35

Increased fremitus over part of the patient's chest wall may indicate:

A) pneumonia.
B) emphysema.
C) pleural effusion.
D) pneumothorax.

Question 36

Select the choice below that best describes the sequence of a joint examination.
1) Palpation
2) Passive range of motion
3) Range of motion against resistance
4) Range of motion against gravity
5) Inspection

A) 5, 1, 2, 4, 3
B) 5, 2, 1, 3, 4
C) 2, 3, 4, 5, 1
D) 1, 5, 2, 4, 3

Question 37

When evaluating dorsiflexion, you should instruct the patient to point his:

A) foot upward.
B) hand downward.
C) foot downward.
D) hand upward.

Question 38

The loss of muscle tone results in:

A) rigidity.
B) spasticity.
C) paresthesia.
D) flaccidity.

Question 39

Heart sound S2 may be heard at the end of systole by auscultating over the ________ intercostal space.

A) second
B) sixth
C) first
D) fifth

Question 40

The fourth heart sound, S4, is:

A) an atrial gallop sound.
B) a ventricular gallop sound.
C) a high-pitched sound at the base of the heart.
D) the "dub" of "dee-lub-dub."

Question 41

To test an extremity for pain sensation, you should:

A) use a sharp object, and have the patient tell you if he feels a sharp or dull sensation.
B) firmly pinch a fold of skin over the most sensitive part of the extremity.
C) stroke the extremity in a distal-to-proximal direction.
D) briskly tap the tendon of the elbow or knee.

Question 42

A loud, harsh sound over the trachea on auscultation with a stethoscope suggests:

A) bronchoconstriction.
B) normal air movement.
C) pneumothorax.
D) foreign body obstruction.

Question 43

Pleural effusion is characterized by the presence of:

A) fluid in the pleural space.
B) atelectasis in the affected area.
C) secretions in large airways.
D) increased friction between the pleural layers.

Question 44

Which of the following is LEAST important to the paramedic when evaluating a patient's skin in an emergency situation?

A) Color
B) Temperature
C) Pigmentation
D) Moisture

Question 45

The condition of the nail bed caused by chronic hypoxia associated with cardiopulmonary diseases is called:

A) Terry's nails.
B) onycholysis.
C) clubbing.
D) paronychia.

Question 46

Your patient was in a motor vehicle collision but was not discovered until 3 hours after the event. When you examine her, you discover bilateral discolored skin over the mastoid process. You should suspect:

A) temporal bone fracture.
B) frontal bone fracture.
C) basilar skull fracture.
D) a fractured sinus.

Question 47

Cyanosis is caused by increased:

A) methemoglobin.
B) oxyhemoglobin.
C) carboxyhemoglobin.
D) deoxyhemoglobin.

Question 48

Palpation and inspection of the point of maximal impulse can reveal certain conditions, such as:

A) pneumothorax.
B) enlarged right ventricle.
C) coronary insufficiency.
D) cardiac tamponade.

Question 49

While assessing a 23-year-old man with abdominal pain, you note discoloration around the umbilicus. This is known as:

A) ascites.
B) borborygmi.
C) Kernig's sign.
D) Cullen's sign.

Question 50

Which of the following best describes the technique for palpating the abdomen for large or deep masses?

A) One hand pushing deeply in a quick, smooth motion
B) One finger pressing firmly against the abdominal wall
C) One hand over another, pushing down slowly
D) Both hands side by side over the midline of the abdomen

Question 51

Moving a finger in an "H" pattern in front of your patient's eyes tests:

A) accommodation.
B) extraocular muscles.
C) visual acuity.
D) corneal reflex.

Question 52

Which of the following sounds is produced when the tricuspid and mitral valves close during systole?

A) S4
B) S3
C) S1
D) S2

Question 53

Which of the following is a normal finding when examining a patient's neck?

A) Tracheal tugging
B) Visible lymph nodes
C) Subcutaneous emphysema
D) Movement of the thyroid gland during swallowing

Question 54

Which of the following is an abnormal finding of the pupils?

A) Constriction when focusing on a near object
B) Both pupils constricting when a penlight is shone in one eye
C) Slow but equal reaction to light
D) Less than 2 mm difference in size with normal reaction to light

Question 55

Which of the following best describes the correct positioning of a patient for an abdominal exam?

A) Lateral recumbent
B) Supine with the head flat and legs extended
C) Semi-Fowler's position
D) Supine with the head and knees supported by pillows

Question 56

Which of the following best describes the technique of percussion?

A) Using a reflex hammer to produce vibrations
B) Pressing the bell of the stethoscope against the skin
C) Shining a penlight into the ear to see the eardrum
D) Striking the knuckle of one hand with the tip of a finger on the opposite hand

Question 57

The sounds auscultated when assessing the blood pressure are the ________ sounds.

A) Kobileski
B) Korotkoff
C) Kunzlemann
D) Kernig's

Question 58

For you to assess for jugular venous distention, your patient should be ________ at a ________-degree angle.

A) sitting; 90
B) sitting; 45
C) supine; 45
D) standing; 90

Question 59

Nasal flaring is an indication of:

A) dysfunction of cranial nerve I.
B) respiratory distress.
C) hypoxia.
D) rhinitis.

Question 60

Skin color is best evaluated by observing the:

A) limbs and torso.
B) dorsum of the hand.
C) nail beds and conjunctiva.
D) face.

Question 61

During the cardiac cycle, the S2 heart sound indicates the ________ of the ________ valves.

A) closing; mitral and tricuspid
B) opening; aortic and pulmonic
C) opening; mitral and tricuspid
D) closing; aortic and pulmonic

Question 62

Using your sense of touch to gather information about the patient's condition is called:

A) auscultation.
B) percussion.
C) palpation.
D) inspection.

Question 63

When you ask the patient to puff out her cheeks, show her upper and lower teeth, and raise her eyebrows, which cranial nerve are you evaluating?

A) VI
B) V
C) VII
D) IX

Question 64

The crunching sound that is made when unlubricated skeletal parts rub against each other is called:

A) a synovial rub.
B) bursal friction.
C) crepitus.
D) a pleural friction rub.

Question 65

Shining a light onto the iris from the lateral side could cause a crescent-shaped shadow on the medial side if the patient is suffering from:

A) hemianopsia.
B) glaucoma.
C) retinal artery occlusion.
D) anisocoria.

Question 66

During ventricular systole, the ventricles contract while the:

A) foramen ovale opens.
B) tricuspid and mitral valves open.
C) pulmonic and aortic semilunar valves close.
D) tricuspid and mitral valves close.

Question 67

Components of a general survey include all of the following EXCEPT:

A) cardiac monitoring.
B) blood pressure.
C) medical history.
D) the patient's appearance.

Question 68

A 23-year-old female patient is complaining of lower abdominal and genital pain. Upon examination you find a white, curdlike vaginal discharge. This is most typical of:

A) Gardnerella.
B) gonorrhea.
C) candidiasis.
D) herpes simplex.

Question 69

You are assessing a 34-year-old female patient who appears to be in hypovolemic shock. You would expect her pulse to be:

A) bradycardic and irregular.
B) tachycardic and weak.
C) tachycardic and bounding.
D) bradycardic and strong.

Question 70

To inspect and examine the anus, a paramedic should place the patient in the ________ position.

A) supine
B) left lateral recumbent
C) kneeling
D) prone

Question 71

A tear in the tracheobronchial tree or a pneumothorax can be characterized by ________ in the neck.

A) swollen lymph nodes
B) jugular venous distention
C) mediastinal deviation
D) subcutaneous emphysema

Question 72

When auscultating the posterior chest, you should listen:

A) only at the apices.
B) only at the bases.
C) down one side first, then the other.
D) from side to side as you proceed down the chest.

Question 73

A patient experienced a brief loss of consciousness following a blow to the head. During your questioning, she describes a series of events that do not match what observers had noted before the trauma. This might be an example of:

A) delusion.
B) incoherence.
C) mania.
D) confabulation.

Question 74

A condition that makes posterior chest and lung examination difficult is thoracic:

A) kyphoscoliosis.
B) spondylosis.
C) ankylosis.
D) lordosis.

Question 75

A patient who is misinterpreting what is happening is experiencing a(n):

A) paresthesia.
B) hallucination.
C) delusion.
D) illusion.

Question 76

Which of the following best describes the pulse pressure?

A) The difference between systolic and diastolic blood pressures
B) The diastolic pressure plus one-third of systolic pressure
C) The sum of systolic and diastolic blood pressures
D) The systolic pressure minus one-third of the diastolic pressure

Question 77

While you are assessing for Babinski's response, the patient's big toe dorsiflexes and the other toes fan out. This indicates a ________ response, which is ________.

A) negative; normal
B) positive; abnormal
C) negative; abnormal
D) positive; normal

Question 78

Which of the following is included in examination of the mouth?

A) Palpating the uvula
B) Removing dentures
C) Visualizing the larynx
D) Looking under the tongue

Question 79

When checking for skin turgor, you should:

A) gently pick up a fold of skin, then release it.
B) use the back of your hand to determine temperature.
C) press the nail beds, then release.
D) palpate the skin for flaking.

Question 80

Areas of a neurologic exam include all of the following EXCEPT:

A) mental status and speech.
B) reflexes.
C) cranial nerves.
D) cranium.