NR 509 ADVANCED PHYSICAL ASSESSMENT –
COMPREHENSIVE FINAL EXAM 260 MCQ
Revision Questions with Answers & Rationales
1. When performing a comprehensive health history, which component addresses the
patient's perception of their own health?
A. Past medical history B. Review of systems C. Health perception and health management D.
Social history
Correct Answer: C
Rationale: Health perception and health management is the component of the health
history that captures how patients view their own health status and how they manage it.
This is distinct from the review of systems (symptom inventory), past medical history (prior
diagnoses/treatments), and social history (lifestyle factors).
2. A patient presents with chest pain. Which question is MOST important to ask first?
A. "Does the pain radiate to your arm?" B. "What were you doing when the pain started?" C.
"Can you describe the pain?" D. "Have you had this pain before?"
Correct Answer: C
Rationale: Open-ended questions such as "Can you describe the pain?" allow the patient to
provide their own narrative without leading them. This is the foundation of the
OLDCARTS mnemonic and should precede more specific closed-ended questions about
radiation, onset, or prior episodes.
3. Which of the following BEST describes the purpose of the Review of Systems (ROS)?
A. To document the physical examination findings B. To identify symptoms the patient may not
have volunteered C. To review the patient's past medical history D. To document laboratory and
diagnostic findings
Correct Answer: B
,Rationale: The ROS is a systematic inventory of symptoms by body system designed to
uncover problems the patient has not spontaneously mentioned. It is part of the subjective
history and does not include physical exam findings, lab results, or prior diagnoses.
4. A 45-year-old male reports pain described as "crushing" in the substernal area radiating
to the left jaw and arm with diaphoresis. The MOST likely diagnosis is:
A. Gastroesophageal reflux disease B. Musculoskeletal chest pain C. Acute myocardial
infarction D. Pulmonary embolism
Correct Answer: C
Rationale: Classic AMI presentation includes substernal crushing chest pain radiating to
the left arm or jaw, accompanied by diaphoresis, nausea, and shortness of breath. GERD
typically presents with burning, musculoskeletal pain is positional, and PE typically
presents with pleuritic pain and dyspnea.
5. When examining a patient's cranial nerve VII (facial nerve), which assessment is MOST
appropriate?
A. Ask the patient to shrug their shoulders B. Ask the patient to smile, raise eyebrows, and puff
cheeks C. Test the patient's hearing with a tuning fork D. Ask the patient to follow your finger
with their eyes
Correct Answer: B
Rationale: Cranial nerve VII (facial nerve) controls facial expression muscles. Testing
includes asking the patient to smile, raise eyebrows, frown, and puff out cheeks. Shoulder
shrug tests CN XI, hearing tests CN VIII, and extraocular movements test CN III, IV, and
VI.
6. A patient presents with sudden onset unilateral facial droop affecting both the upper and
lower face. This finding is MOST consistent with:
A. Central (cortical) stroke B. Bell's palsy (peripheral CN VII lesion) C. Trigeminal neuralgia D.
Horner's syndrome
Correct Answer: B
,Rationale: Peripheral CN VII lesions (Bell's palsy) affect both upper and lower facial
muscles on the ipsilateral side because the entire facial nerve is involved. Central lesions
(stroke) spare the forehead because the upper face has bilateral cortical representation.
Trigeminal neuralgia involves CN V (pain), and Horner's involves the sympathetic chain.
7. When assessing a patient's level of consciousness, the Glasgow Coma Scale (GCS)
evaluates which THREE components?
A. Pupils, motor response, verbal response B. Eye opening, verbal response, motor response C.
Eye opening, pupil reactivity, motor response D. Orientation, memory, motor response
Correct Answer: B
Rationale: The GCS assesses Eye opening (1–4), Verbal response (1–5), and Motor
response (1–6), with a maximum score of 15. Pupil reactivity and orientation are assessed
separately and are not part of the formal GCS scoring.
8. Which of the following is the CORRECT order of abdominal examination?
A. Inspection, palpation, percussion, auscultation B. Auscultation, percussion, palpation,
inspection C. Inspection, auscultation, percussion, palpation D. Percussion, inspection,
auscultation, palpation
Correct Answer: C
Rationale: The abdomen is the only body region where auscultation precedes palpation and
percussion. This sequence prevents artificially altering bowel sounds through mechanical
stimulation. Inspection always comes first to identify visible abnormalities before touching
the patient.
9. A positive Murphy's sign is MOST consistent with:
A. Appendicitis B. Acute cholecystitis C. Pancreatitis D. Peptic ulcer disease
Correct Answer: B
Rationale: Murphy's sign is elicited by pressing under the right costal margin and asking
the patient to inhale. Sharp pain causing inspiratory arrest is a positive sign and is highly
specific for acute cholecystitis due to the inflamed gallbladder descending onto the
examiner's fingers. Appendicitis involves McBurney's point tenderness.
, 10. Rovsing's sign, used to assess appendicitis, is BEST described as:
A. Pain at McBurney's point with direct palpation B. RLQ pain elicited by palpation of the LLQ
C. Pain with internal rotation of the right hip D. Pain on release of deep palpation
Correct Answer: B
Rationale: Rovsing's sign is positive when palpation of the left lower quadrant produces
pain in the right lower quadrant, suggesting peritoneal irritation consistent with
appendicitis. McBurney's point tenderness is direct, psoas sign involves hip extension, and
rebound tenderness is pain on release.
11. When assessing deep tendon reflexes, a grade of 2+ indicates:
A. Absent reflex B. Diminished reflex C. Normal reflex D. Hyperactive reflex
Correct Answer: C
Rationale: The DTR grading scale is: 0 = absent, 1+ = diminished, 2+ = normal, 3+ =
increased/hyperactive, 4+ = clonus. A 2+ response is a brisk but normal reflex and is the
expected finding in a healthy adult.
12. A patient presents with a resting tremor that improves with intentional movement. This
finding is MOST associated with:
A. Essential tremor B. Cerebellar ataxia C. Parkinson's disease D. Multiple sclerosis
Correct Answer: C
Rationale: A resting "pill-rolling" tremor that diminishes with voluntary movement is a
hallmark of Parkinson's disease. Essential tremor worsens with action/intention.
Cerebellar ataxia produces an intention tremor that worsens as the limb approaches a
target. MS can cause various movement abnormalities but not specifically resting tremor.
13. The MOST appropriate technique for assessing fremitus is:
A. Placing the fingertips on the chest wall and asking the patient to say "ninety-nine" B. Placing
the ulnar edge of the hands on the chest wall while the patient says "ninety-nine" C. Percussing
COMPREHENSIVE FINAL EXAM 260 MCQ
Revision Questions with Answers & Rationales
1. When performing a comprehensive health history, which component addresses the
patient's perception of their own health?
A. Past medical history B. Review of systems C. Health perception and health management D.
Social history
Correct Answer: C
Rationale: Health perception and health management is the component of the health
history that captures how patients view their own health status and how they manage it.
This is distinct from the review of systems (symptom inventory), past medical history (prior
diagnoses/treatments), and social history (lifestyle factors).
2. A patient presents with chest pain. Which question is MOST important to ask first?
A. "Does the pain radiate to your arm?" B. "What were you doing when the pain started?" C.
"Can you describe the pain?" D. "Have you had this pain before?"
Correct Answer: C
Rationale: Open-ended questions such as "Can you describe the pain?" allow the patient to
provide their own narrative without leading them. This is the foundation of the
OLDCARTS mnemonic and should precede more specific closed-ended questions about
radiation, onset, or prior episodes.
3. Which of the following BEST describes the purpose of the Review of Systems (ROS)?
A. To document the physical examination findings B. To identify symptoms the patient may not
have volunteered C. To review the patient's past medical history D. To document laboratory and
diagnostic findings
Correct Answer: B
,Rationale: The ROS is a systematic inventory of symptoms by body system designed to
uncover problems the patient has not spontaneously mentioned. It is part of the subjective
history and does not include physical exam findings, lab results, or prior diagnoses.
4. A 45-year-old male reports pain described as "crushing" in the substernal area radiating
to the left jaw and arm with diaphoresis. The MOST likely diagnosis is:
A. Gastroesophageal reflux disease B. Musculoskeletal chest pain C. Acute myocardial
infarction D. Pulmonary embolism
Correct Answer: C
Rationale: Classic AMI presentation includes substernal crushing chest pain radiating to
the left arm or jaw, accompanied by diaphoresis, nausea, and shortness of breath. GERD
typically presents with burning, musculoskeletal pain is positional, and PE typically
presents with pleuritic pain and dyspnea.
5. When examining a patient's cranial nerve VII (facial nerve), which assessment is MOST
appropriate?
A. Ask the patient to shrug their shoulders B. Ask the patient to smile, raise eyebrows, and puff
cheeks C. Test the patient's hearing with a tuning fork D. Ask the patient to follow your finger
with their eyes
Correct Answer: B
Rationale: Cranial nerve VII (facial nerve) controls facial expression muscles. Testing
includes asking the patient to smile, raise eyebrows, frown, and puff out cheeks. Shoulder
shrug tests CN XI, hearing tests CN VIII, and extraocular movements test CN III, IV, and
VI.
6. A patient presents with sudden onset unilateral facial droop affecting both the upper and
lower face. This finding is MOST consistent with:
A. Central (cortical) stroke B. Bell's palsy (peripheral CN VII lesion) C. Trigeminal neuralgia D.
Horner's syndrome
Correct Answer: B
,Rationale: Peripheral CN VII lesions (Bell's palsy) affect both upper and lower facial
muscles on the ipsilateral side because the entire facial nerve is involved. Central lesions
(stroke) spare the forehead because the upper face has bilateral cortical representation.
Trigeminal neuralgia involves CN V (pain), and Horner's involves the sympathetic chain.
7. When assessing a patient's level of consciousness, the Glasgow Coma Scale (GCS)
evaluates which THREE components?
A. Pupils, motor response, verbal response B. Eye opening, verbal response, motor response C.
Eye opening, pupil reactivity, motor response D. Orientation, memory, motor response
Correct Answer: B
Rationale: The GCS assesses Eye opening (1–4), Verbal response (1–5), and Motor
response (1–6), with a maximum score of 15. Pupil reactivity and orientation are assessed
separately and are not part of the formal GCS scoring.
8. Which of the following is the CORRECT order of abdominal examination?
A. Inspection, palpation, percussion, auscultation B. Auscultation, percussion, palpation,
inspection C. Inspection, auscultation, percussion, palpation D. Percussion, inspection,
auscultation, palpation
Correct Answer: C
Rationale: The abdomen is the only body region where auscultation precedes palpation and
percussion. This sequence prevents artificially altering bowel sounds through mechanical
stimulation. Inspection always comes first to identify visible abnormalities before touching
the patient.
9. A positive Murphy's sign is MOST consistent with:
A. Appendicitis B. Acute cholecystitis C. Pancreatitis D. Peptic ulcer disease
Correct Answer: B
Rationale: Murphy's sign is elicited by pressing under the right costal margin and asking
the patient to inhale. Sharp pain causing inspiratory arrest is a positive sign and is highly
specific for acute cholecystitis due to the inflamed gallbladder descending onto the
examiner's fingers. Appendicitis involves McBurney's point tenderness.
, 10. Rovsing's sign, used to assess appendicitis, is BEST described as:
A. Pain at McBurney's point with direct palpation B. RLQ pain elicited by palpation of the LLQ
C. Pain with internal rotation of the right hip D. Pain on release of deep palpation
Correct Answer: B
Rationale: Rovsing's sign is positive when palpation of the left lower quadrant produces
pain in the right lower quadrant, suggesting peritoneal irritation consistent with
appendicitis. McBurney's point tenderness is direct, psoas sign involves hip extension, and
rebound tenderness is pain on release.
11. When assessing deep tendon reflexes, a grade of 2+ indicates:
A. Absent reflex B. Diminished reflex C. Normal reflex D. Hyperactive reflex
Correct Answer: C
Rationale: The DTR grading scale is: 0 = absent, 1+ = diminished, 2+ = normal, 3+ =
increased/hyperactive, 4+ = clonus. A 2+ response is a brisk but normal reflex and is the
expected finding in a healthy adult.
12. A patient presents with a resting tremor that improves with intentional movement. This
finding is MOST associated with:
A. Essential tremor B. Cerebellar ataxia C. Parkinson's disease D. Multiple sclerosis
Correct Answer: C
Rationale: A resting "pill-rolling" tremor that diminishes with voluntary movement is a
hallmark of Parkinson's disease. Essential tremor worsens with action/intention.
Cerebellar ataxia produces an intention tremor that worsens as the limb approaches a
target. MS can cause various movement abnormalities but not specifically resting tremor.
13. The MOST appropriate technique for assessing fremitus is:
A. Placing the fingertips on the chest wall and asking the patient to say "ninety-nine" B. Placing
the ulnar edge of the hands on the chest wall while the patient says "ninety-nine" C. Percussing
