NUR 643E ADVANCED HEALTH ASSESSMENT FINAL
EXAM
"Absent bowel sounds" is after how many minutes? Correct
Answers 5 minutes
"Severe abdominal pain out of proportion to the physical exam"
indicates what? Correct Answers Acute mesenteric ischemia -
blood flow compromised to the bowel from thrombus or
embolus (like a heart attack for your gut)
13 y/o female presents with repeated broken bones with minimal
trauma. On physical exam you see the patient's sclera have a
blue/purple tint. What do you want to work her up for? Correct
Answers Osteogenesis imperfecta
13 y/o patient presents to your ER with abdominal pain. He tells
you he's been nauseous and vomiting all day and about an hour
ago he developed right lower quadrant pain. What physical
exam techniques do you want to do? Correct Answers 1.
Mcburney's rebound tenderness (RLQ)
2. Rovsing referred rebound tenderness (LLQ)
3. Obturator sign (hip rotation)
4. Psoas sign (hip flexion/extension)
Checking for appendicitis
14 y/o female presents to your office complaining of bloating
and severe abdominal pain that has gotten worse over the past
month or so. She tells you it's the worst at school after lunch
when she eats her PB&J sandwiches. Your abdominal exam
,reveals mild distention and tenderness to palpation. On skin
exam you also notice a papulovesicular rash on her posterior
forearms. What is high on your differential? What is this rash
called? Correct Answers Celiac
Rash is dermatitis herpetiformis
16 y/o male presents to the ED after falling out of a tree. His
girlfriend witnessed that fall and tells you he briefly lost
consciousness, then woke up, and then lost consciousness again
and has been unresponsive since. What kind of brain bleed does
this history indicate? Correct Answers Epidural hematoma
17 y/o male presents with fever, fatigue, and neck pain. What do
you want to assess your patient for? How? Correct Answers
Meningeal signs
1. Nuchal rigidity = raise and flex neck with pt supine, look for
tenderness
2. Brudzinski = raise and flex neck with pt supine, see
involuntary flexion of hips and knees
3. Kernig = flex leg at knee and hip with pt supine, see pain in
the lower back and resistance to leg straightening
22 y/o female presents to your office complaining of weakness,
fatigue, and numbness in her hands since starting a new diet a
few months ago. What is the diet and what is causing this?
Correct Answers Vegan
,B12 deficiency
22 y/o female presents to your office with abdominal pain for
the past 3 months accompanied with nonbloody diarrhea. You
decide to send her for a colonoscopy. What are you testing for?
Correct Answers Inflammatory bowel disease - Crohns
40 y/o female presents to your office complaining of headaches.
On physical examine you note that the patient is morbidly obese
and on your eye exam you see pappilodema. What is high on
your differential? Correct Answers Pseudotumor cerebri
45 y/o female presents to your office complaining of achey,
burning epigastric pain, especially after she eats. Your cardiac
workup is negative. What is high on your differential? What
lifestyle modifications do you suggest? Correct Answers
GERD
Stay sitting up after eating
Wait a few hours after eating to go to sleep
Avoid spicy foods, chocolate, caffeine, acidic foods, etc
45 y/o female presents with jaw pain. What does your physical
exam look like? Correct Answers Inspect - symmetry,
deformity, edema, erythema
Palpation - pain, crepitus
Open and close
Lateral movement
Protrusion/contraction
Temopralis masseter muscle
, strength
63 y/o male presents to your office for a well check. You are
reviewing his labs are see that his hemoglobin and hematocrit
are low. What do you want to make sure to test? Correct
Answers Colonoscopy for colon cancer
66 y/o diabetic male presents to your office with burning
tingling in his toes. What kind of test could you use to further
evaluate his peripheral neuropathy? Correct Answers
Monofilament test
A "masklike" facies is a term used to describe a patient with
what disease? Correct Answers Parkinson's
A 38 y/o pregnant woman presents to you office complaining of
right upper quadrant pain and indigestion, especially after eating
fatty foods. On physical exam - you as her to inspire as you
palpate the right upper quadrant. If there is pain, what is this
called? What does it indicate? Correct Answers Positive
Murphy's Sign
Cholecystitis
A 45 year old man relates a several week history of severe
intermittent abdominal burning sensations. He relates that the
pain is relieved with small amounts of food. Before starting the
PE, you review his lab work, anticipating
Elevated WBC
Hypokalemia
EXAM
"Absent bowel sounds" is after how many minutes? Correct
Answers 5 minutes
"Severe abdominal pain out of proportion to the physical exam"
indicates what? Correct Answers Acute mesenteric ischemia -
blood flow compromised to the bowel from thrombus or
embolus (like a heart attack for your gut)
13 y/o female presents with repeated broken bones with minimal
trauma. On physical exam you see the patient's sclera have a
blue/purple tint. What do you want to work her up for? Correct
Answers Osteogenesis imperfecta
13 y/o patient presents to your ER with abdominal pain. He tells
you he's been nauseous and vomiting all day and about an hour
ago he developed right lower quadrant pain. What physical
exam techniques do you want to do? Correct Answers 1.
Mcburney's rebound tenderness (RLQ)
2. Rovsing referred rebound tenderness (LLQ)
3. Obturator sign (hip rotation)
4. Psoas sign (hip flexion/extension)
Checking for appendicitis
14 y/o female presents to your office complaining of bloating
and severe abdominal pain that has gotten worse over the past
month or so. She tells you it's the worst at school after lunch
when she eats her PB&J sandwiches. Your abdominal exam
,reveals mild distention and tenderness to palpation. On skin
exam you also notice a papulovesicular rash on her posterior
forearms. What is high on your differential? What is this rash
called? Correct Answers Celiac
Rash is dermatitis herpetiformis
16 y/o male presents to the ED after falling out of a tree. His
girlfriend witnessed that fall and tells you he briefly lost
consciousness, then woke up, and then lost consciousness again
and has been unresponsive since. What kind of brain bleed does
this history indicate? Correct Answers Epidural hematoma
17 y/o male presents with fever, fatigue, and neck pain. What do
you want to assess your patient for? How? Correct Answers
Meningeal signs
1. Nuchal rigidity = raise and flex neck with pt supine, look for
tenderness
2. Brudzinski = raise and flex neck with pt supine, see
involuntary flexion of hips and knees
3. Kernig = flex leg at knee and hip with pt supine, see pain in
the lower back and resistance to leg straightening
22 y/o female presents to your office complaining of weakness,
fatigue, and numbness in her hands since starting a new diet a
few months ago. What is the diet and what is causing this?
Correct Answers Vegan
,B12 deficiency
22 y/o female presents to your office with abdominal pain for
the past 3 months accompanied with nonbloody diarrhea. You
decide to send her for a colonoscopy. What are you testing for?
Correct Answers Inflammatory bowel disease - Crohns
40 y/o female presents to your office complaining of headaches.
On physical examine you note that the patient is morbidly obese
and on your eye exam you see pappilodema. What is high on
your differential? Correct Answers Pseudotumor cerebri
45 y/o female presents to your office complaining of achey,
burning epigastric pain, especially after she eats. Your cardiac
workup is negative. What is high on your differential? What
lifestyle modifications do you suggest? Correct Answers
GERD
Stay sitting up after eating
Wait a few hours after eating to go to sleep
Avoid spicy foods, chocolate, caffeine, acidic foods, etc
45 y/o female presents with jaw pain. What does your physical
exam look like? Correct Answers Inspect - symmetry,
deformity, edema, erythema
Palpation - pain, crepitus
Open and close
Lateral movement
Protrusion/contraction
Temopralis masseter muscle
, strength
63 y/o male presents to your office for a well check. You are
reviewing his labs are see that his hemoglobin and hematocrit
are low. What do you want to make sure to test? Correct
Answers Colonoscopy for colon cancer
66 y/o diabetic male presents to your office with burning
tingling in his toes. What kind of test could you use to further
evaluate his peripheral neuropathy? Correct Answers
Monofilament test
A "masklike" facies is a term used to describe a patient with
what disease? Correct Answers Parkinson's
A 38 y/o pregnant woman presents to you office complaining of
right upper quadrant pain and indigestion, especially after eating
fatty foods. On physical exam - you as her to inspire as you
palpate the right upper quadrant. If there is pain, what is this
called? What does it indicate? Correct Answers Positive
Murphy's Sign
Cholecystitis
A 45 year old man relates a several week history of severe
intermittent abdominal burning sensations. He relates that the
pain is relieved with small amounts of food. Before starting the
PE, you review his lab work, anticipating
Elevated WBC
Hypokalemia
