In obtaining a history, you note that a patient uses the word "largely" repeatedly, to
the point of being a distraction to your task. Which word best describes this speech
pattern?
A. Clanging
B. Echolalia
C. Confabulation
D. Perseveration
Give this one a try later!
ANS: D
Feedback: Perseveration is the repetition of words or ideas. Echolalia
differs in that the patient repeats what is said to him. Clanging is the
repetition of the same sounds in different words. Confabulation is making
up a story in response to a question. This is sometimes seen in chronic
alcohol use with Korsakoff's syndrome.
,A 21-year-old college senior presents to your clinic, complaining of shortness of
breath and a nonproductive nocturnal cough. She states she used to feel this way
only with extreme exercise, but lately she has felt this way continuously. She denies
any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or
urinary tract symptoms. Her past medical history is significant only for seasonal
allergies, for which she takes a nasal steroid spray but is otherwise on no other
medications. She has had no surgeries. Her mother has allergies and eczema and her
father has high blood pressure. She is an only child. She denies smoking and illegal
drug use but drinks three to four alcoholic beverages per weekend. She is a junior in
finance at a local university and she has recently started a job as a bartender in town.
On examination she is in no acute distress and her temperature is 98.6. Her blood
pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears,
nose, and throat examinations are essentially normal. Inspection of her anterior and
posterior chest shows no abnormalities. On auscultation of her chest, there is
decreased air movement and a high-pitched whistling on expiration in all lobes.
Percussion reveals resonant lungs. Which disorder of the thorax or lung does this best
describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
Give this one a try later!
, ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is
often associated with a history of allergies and can be made worse by
exercise or irritants such as smoke in a bar. On auscultation there can be
normal to decreased air movement. Wheezing is heard on expiration and
sometimes inspiration. The duration of wheezing in expiration usually
correlates with severity of illness, so it is important to document this length
(e.g., wheezes heard halfway through exhalation). Realize that in severe
asthma, wheezes may not be heard because of the lack of air movement.
Paradoxically, these patients may have more wheezes after treatment,
which actually indicates an improvement in condition. Peak flow
measurements help to discern this.
A patient has possible strep throat what will you see on physical exam that is
indicative of this infection?
Give this one a try later!
1. White patches (exudate) on tonsils
2. Enlarged tonsils, grade them, sit behind tonsillar pillars
3. Fever > 100.5
4. Enlargement of Submandibular and posterior cervical lymph nodes
Pt complains of sore throat but NO cough
A patient states she is feeling just blah, nothing is going her way, nothing good ever
happens, she states that her life sucks, what type of disorder would you say this is?
Give this one a try later!
, Dysthymic Mood
Dysthymia is a milder, but long-lasting form of depression. Patients can
present with the following symptoms poor appetite or overeating; insomnia
or excessive sleep; low energy or fatigue; low self-esteem; poor
concentration or indecisiveness; and hopelessness
Which is the proper sequence of examination for the abdomen?
A. Auscultation, inspection, palpation, percussion
B. Inspection, percussion, palpation, auscultation
C. Inspection, auscultation, percussion, palpation
D. Auscultation, percussion, inspection, palpation
Give this one a try later!
ANS: C
Feedback: The abdominal examination is conducted in a sequence different
from other systems, for which the usual order is inspection, percussion,
palpation, and auscultation. Because palpation may actually cause some
bowel noise when the bowels are not moving, auscultation is performed
before percussion and palpation in an abdominal examination.
Ray works a physical job and notes pain when he attempts to lift his arm over his
head. When you move the shoulder passively, he has full range of motion without pain
and there is no gross swelling or tenderness. What type of joint disease does this most
likely represent?
A. Articular
B. Extra-articular
C. Neither
D. Both
the point of being a distraction to your task. Which word best describes this speech
pattern?
A. Clanging
B. Echolalia
C. Confabulation
D. Perseveration
Give this one a try later!
ANS: D
Feedback: Perseveration is the repetition of words or ideas. Echolalia
differs in that the patient repeats what is said to him. Clanging is the
repetition of the same sounds in different words. Confabulation is making
up a story in response to a question. This is sometimes seen in chronic
alcohol use with Korsakoff's syndrome.
,A 21-year-old college senior presents to your clinic, complaining of shortness of
breath and a nonproductive nocturnal cough. She states she used to feel this way
only with extreme exercise, but lately she has felt this way continuously. She denies
any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or
urinary tract symptoms. Her past medical history is significant only for seasonal
allergies, for which she takes a nasal steroid spray but is otherwise on no other
medications. She has had no surgeries. Her mother has allergies and eczema and her
father has high blood pressure. She is an only child. She denies smoking and illegal
drug use but drinks three to four alcoholic beverages per weekend. She is a junior in
finance at a local university and she has recently started a job as a bartender in town.
On examination she is in no acute distress and her temperature is 98.6. Her blood
pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears,
nose, and throat examinations are essentially normal. Inspection of her anterior and
posterior chest shows no abnormalities. On auscultation of her chest, there is
decreased air movement and a high-pitched whistling on expiration in all lobes.
Percussion reveals resonant lungs. Which disorder of the thorax or lung does this best
describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
Give this one a try later!
, ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is
often associated with a history of allergies and can be made worse by
exercise or irritants such as smoke in a bar. On auscultation there can be
normal to decreased air movement. Wheezing is heard on expiration and
sometimes inspiration. The duration of wheezing in expiration usually
correlates with severity of illness, so it is important to document this length
(e.g., wheezes heard halfway through exhalation). Realize that in severe
asthma, wheezes may not be heard because of the lack of air movement.
Paradoxically, these patients may have more wheezes after treatment,
which actually indicates an improvement in condition. Peak flow
measurements help to discern this.
A patient has possible strep throat what will you see on physical exam that is
indicative of this infection?
Give this one a try later!
1. White patches (exudate) on tonsils
2. Enlarged tonsils, grade them, sit behind tonsillar pillars
3. Fever > 100.5
4. Enlargement of Submandibular and posterior cervical lymph nodes
Pt complains of sore throat but NO cough
A patient states she is feeling just blah, nothing is going her way, nothing good ever
happens, she states that her life sucks, what type of disorder would you say this is?
Give this one a try later!
, Dysthymic Mood
Dysthymia is a milder, but long-lasting form of depression. Patients can
present with the following symptoms poor appetite or overeating; insomnia
or excessive sleep; low energy or fatigue; low self-esteem; poor
concentration or indecisiveness; and hopelessness
Which is the proper sequence of examination for the abdomen?
A. Auscultation, inspection, palpation, percussion
B. Inspection, percussion, palpation, auscultation
C. Inspection, auscultation, percussion, palpation
D. Auscultation, percussion, inspection, palpation
Give this one a try later!
ANS: C
Feedback: The abdominal examination is conducted in a sequence different
from other systems, for which the usual order is inspection, percussion,
palpation, and auscultation. Because palpation may actually cause some
bowel noise when the bowels are not moving, auscultation is performed
before percussion and palpation in an abdominal examination.
Ray works a physical job and notes pain when he attempts to lift his arm over his
head. When you move the shoulder passively, he has full range of motion without pain
and there is no gross swelling or tenderness. What type of joint disease does this most
likely represent?
A. Articular
B. Extra-articular
C. Neither
D. Both
