Advanced Health Assessment Quiz
During a routine physical exam of a 44 yo woman you note she has an inverted left
nipple. You decide to investigate because: - ANSWER The inversion may be a
recent change
A 30 yo F is in the office c/o palpitations and some lightheadedness for the past ?,
random episodes, no detectable pattern. NP notes a mid systolic click with a late
systolic murmur heard best in the apical area. You suspect - ANSWER Mitral valve
prolapse (MVP)
All of the following tests require the patient's voice to perform correctly except: -
ANSWER -egophany
-tactile fremitus
-whispered pectoriloquy
auscultation
59 yo M with history of COPD presents with worsening dyspnea. Patient is afebrile,
breath sounds are decreased bilaterally, noted to have JVD and pitting edema of
lower extremities. What is the most likely cause of his dyspnea? - ANSWER CHF
James Jones 55 yo M smoker presents with thick sputum producing cough. Exam:
+tactile fremitus, resonant percussion, and normal voice transmission. You suspect: -
ANSWER bronchitis
During the breast exam of a 30 year old nulliparous female. The NP palpates several
rubbery areas of the breast tissue. They are slightly tender to palpation and present
in both breasts. Expecting menses in 5 days. Which intervention is best? - ANSWER
Tell her to recheck 1 week after her menses
All of the following symptoms associated with chest pain are likely to represent CAD
except? - ANSWER pain with inspiration
60 yo landscaper presents to your office to establish care, history of CHF controlled
with medications. Denies cp, edema. Early diastolic ? with opening snap ___. You
suspect? - ANSWER Mitral stenosis
A patient states that she has had a rash on her breast for about 2 weeks. In order to
determine if it is pagets disease you would expect to have all of the following on
physical exam EXCEPT - ANSWER inverted nipple
You notice a medium-pitched harsh systolic murmur during a routine exam or R
upper border of the sternum. Which of the following is most likely? - ANSWER Aortic
stenosis
Which of the following statements in NOT typical of the murmur it is describing? -
ANSWER Grade II/Grade VI murmur is associated with a thrill?
, A 58 yo dentist presents for routine check up. He has been healthy. Non smoker,
does not drink alcohol. You hear a moderately loud murmur, no palpable thrill. What
is the appropriate grade for this murmur? - ANSWER Grade 3
57 yo college professor is hospitalized for SOB. As you examine her in ER, JVP of
45 degrees 8 cm above the clavicle. finding is most consistent with which of the
following diagnoses? - ANSWER Right sided heart failure
What technique should be used to best auscultate the 2nd heart sounds? -
ANSWER Diaphragm of the stethoscope at 2nd intercostal space at the base of the
heart
You hear a split s2 on auscultation of a 25 yo client. What is your best action? -
ANSWER Tell them to hold their breath and repeat
The client has been told he has a heart murmur. He asks you what this means. You
explain - ANSWER It is the rushing sound blood makes moving through narrow
places. Some are harmless and others indicate problems
Where would you expect to hear best an abnormal sound with mitral valve
insufficiency? - ANSWER 5th ICS at MCL
when auscultating the heart sounds of a 72 yo client with history of HTN. NP notes
an S4. This finding could indicate - ANSWER An increased resistance to ventricular
filling
As you assess Ms Jones you recall that the most prevalent cardiac symptom is -
ANSWER Fatigue
Joe Tiger presents with complaints of pain in his leg when walking that is relieved
with rest. You perform ABI. Which result would be consistent with physical
symptoms? - ANSWER 0.6
As you assess your patient you document Osler's nodes. You realize that this could
be a sign of? - ANSWER Endocarditis
During the physical exam of 72 yo Mary Rose you note a BP of 140/90. According to
JNC 8, what would you do first? - ANSWER Calculate cardiac risk
When auscultating a clients heart you note short, high-frequency click (opening
snap) after S2 during the beginning of diastole. What could this indicate? - ANSWER
Mitral stenosis
To rule out middle lobe pneumonia you would make sure to auscultate - ANSWER
Under the right axillae
In assessing a patient with a positive cardiac history, you utilize CHADS scoring.
What are the elements of this scoring system? - ANSWER HTN, DM, CHF
During a routine physical exam of a 44 yo woman you note she has an inverted left
nipple. You decide to investigate because: - ANSWER The inversion may be a
recent change
A 30 yo F is in the office c/o palpitations and some lightheadedness for the past ?,
random episodes, no detectable pattern. NP notes a mid systolic click with a late
systolic murmur heard best in the apical area. You suspect - ANSWER Mitral valve
prolapse (MVP)
All of the following tests require the patient's voice to perform correctly except: -
ANSWER -egophany
-tactile fremitus
-whispered pectoriloquy
auscultation
59 yo M with history of COPD presents with worsening dyspnea. Patient is afebrile,
breath sounds are decreased bilaterally, noted to have JVD and pitting edema of
lower extremities. What is the most likely cause of his dyspnea? - ANSWER CHF
James Jones 55 yo M smoker presents with thick sputum producing cough. Exam:
+tactile fremitus, resonant percussion, and normal voice transmission. You suspect: -
ANSWER bronchitis
During the breast exam of a 30 year old nulliparous female. The NP palpates several
rubbery areas of the breast tissue. They are slightly tender to palpation and present
in both breasts. Expecting menses in 5 days. Which intervention is best? - ANSWER
Tell her to recheck 1 week after her menses
All of the following symptoms associated with chest pain are likely to represent CAD
except? - ANSWER pain with inspiration
60 yo landscaper presents to your office to establish care, history of CHF controlled
with medications. Denies cp, edema. Early diastolic ? with opening snap ___. You
suspect? - ANSWER Mitral stenosis
A patient states that she has had a rash on her breast for about 2 weeks. In order to
determine if it is pagets disease you would expect to have all of the following on
physical exam EXCEPT - ANSWER inverted nipple
You notice a medium-pitched harsh systolic murmur during a routine exam or R
upper border of the sternum. Which of the following is most likely? - ANSWER Aortic
stenosis
Which of the following statements in NOT typical of the murmur it is describing? -
ANSWER Grade II/Grade VI murmur is associated with a thrill?
, A 58 yo dentist presents for routine check up. He has been healthy. Non smoker,
does not drink alcohol. You hear a moderately loud murmur, no palpable thrill. What
is the appropriate grade for this murmur? - ANSWER Grade 3
57 yo college professor is hospitalized for SOB. As you examine her in ER, JVP of
45 degrees 8 cm above the clavicle. finding is most consistent with which of the
following diagnoses? - ANSWER Right sided heart failure
What technique should be used to best auscultate the 2nd heart sounds? -
ANSWER Diaphragm of the stethoscope at 2nd intercostal space at the base of the
heart
You hear a split s2 on auscultation of a 25 yo client. What is your best action? -
ANSWER Tell them to hold their breath and repeat
The client has been told he has a heart murmur. He asks you what this means. You
explain - ANSWER It is the rushing sound blood makes moving through narrow
places. Some are harmless and others indicate problems
Where would you expect to hear best an abnormal sound with mitral valve
insufficiency? - ANSWER 5th ICS at MCL
when auscultating the heart sounds of a 72 yo client with history of HTN. NP notes
an S4. This finding could indicate - ANSWER An increased resistance to ventricular
filling
As you assess Ms Jones you recall that the most prevalent cardiac symptom is -
ANSWER Fatigue
Joe Tiger presents with complaints of pain in his leg when walking that is relieved
with rest. You perform ABI. Which result would be consistent with physical
symptoms? - ANSWER 0.6
As you assess your patient you document Osler's nodes. You realize that this could
be a sign of? - ANSWER Endocarditis
During the physical exam of 72 yo Mary Rose you note a BP of 140/90. According to
JNC 8, what would you do first? - ANSWER Calculate cardiac risk
When auscultating a clients heart you note short, high-frequency click (opening
snap) after S2 during the beginning of diastole. What could this indicate? - ANSWER
Mitral stenosis
To rule out middle lobe pneumonia you would make sure to auscultate - ANSWER
Under the right axillae
In assessing a patient with a positive cardiac history, you utilize CHADS scoring.
What are the elements of this scoring system? - ANSWER HTN, DM, CHF
