NR509 | NR509 Advanced Physical Assessment
Exam 2 v3 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. A patient presents with sharp pain in the right upper quadrant during inspiration while the
examiner applies pressure under the right costal margin. This finding is known as:
A. Rovsing’s sign
B. Murphy’s sign
C. Psoas sign
D. Obturator sign
Correct Answer: B
Expert Explanation: Murphy’s sign is a clinical indicator of acute cholecystitis. It is
performed by asking the patient to inhale while the clinician palpates the area of the
gallbladder. A positive test occurs when the patient abruptly halts inspiration because of
significant pain.
2. During a musculoskeletal exam, the provider asks the patient to flex both wrists to 90
degrees and press the backs of the hands together for 60 seconds. What is being assessed?
A. Phalen’s test
B. Finkelstein’s test
C. Tinel’s sign
D. Lachman test
Correct Answer: A
Expert Explanation: Phalen’s test is used to screen for carpal tunnel syndrome by
compressing the median nerve. A positive result is indicated if the patient experiences
numbness or tingling in the distribution of the median nerve within 60 seconds. This test
has high sensitivity for detecting nerve entrapment at the wrist.
3. While assessing the abdomen, the clinician notes a loud, blowing sound heard over the
epigastric area. This is documented as a:
A. Friction rub
B. Borborygmi
C. Bruit
,D. Venous hum
Correct Answer: C
Expert Explanation: An abdominal bruit is a vascular sound that suggests turbulent blood
flow through a narrowed artery, such as renal artery stenosis or an aortic aneurysm. It is
best heard with the bell of the stethoscope during auscultation. The presence of a bruit
warrants further imaging to rule out significant vascular pathology.
4. A 55-year-old male reports a protrusion in his groin that appears when he coughs. The
clinician notes the hernia descends into the scrotum. This is likely a(n):
A. Direct inguinal hernia
B. Femoral hernia
C. Indirect inguinal hernia
D. Umbilical hernia
Correct Answer: C
Expert Explanation: Indirect inguinal hernias pass through the internal inguinal ring and
can often travel down the inguinal canal into the scrotum. This type of hernia is more
common in males and can be congenital or acquired. Clinicians differentiate it from direct
hernias by the path of protrusion relative to the epigastric vessels.
5. During the breast exam of a 30-year-old female, the provider notes a firm, mobile, non-
tender, marble-like mass. This most likely represents a:
A. Mammary duct ectasia
B. Breast cyst
C. Invasive ductal carcinoma
D. Fibroadenoma
Correct Answer: D
Expert Explanation: Fibroadenomas are common, benign breast tumors typically found in
younger women. They are characterized by their smooth, rubbery consistency and extreme
mobility within the breast tissue. While benign, any new mass requires clinical follow-up or
imaging to confirm the diagnosis.
6. Which cranial nerve is being tested when the clinician asks the patient to puff out their
cheeks and show their teeth?
A. CN V (Trigeminal)
B. CN IX (Glossopharyngeal)
C. CN VII (Facial)
, D. CN XII (Hypoglossal)
Correct Answer: C
Expert Explanation: Cranial Nerve VII, the facial nerve, controls the muscles of facial
expression. Testing involves observing for symmetry when the patient smiles, frowns, or
puffs their cheeks. Weakness on one side can indicate Bell’s palsy or a central nervous
system lesion like a stroke.
7. The provider performs the Lachman test on a patient who sustained a sports-related knee
injury. A positive result indicates damage to the:
A. Anterior cruciate ligament (ACL)
B. Posterior cruciate ligament (PCL)
C. Medial collateral ligament (MCL)
D. Lateral meniscus
Correct Answer: A
Expert Explanation: The Lachman test is considered the most sensitive clinical test for
detecting an ACL tear. It involves pulling the tibia forward while the knee is flexed at 20-30
degrees. Significant forward excursion of the tibia relative to the femur indicates a positive
test.
8. When assessing the liver, the clinician uses percussion to estimate the liver span. What is
the normal liver span in the right midclavicular line for an adult?
A. 6-12 cm
B. 2-4 cm
C. 15-20 cm
D. 4-8 cm
Correct Answer: A
Expert Explanation: A normal liver span in the midclavicular line ranges from 6 to 12
centimeters in a healthy adult. Percussion helps identify the upper and lower borders by
noting the change from resonance/tympany to dullness. An increased span may suggest
hepatomegaly or systemic disease.
9. A patient displays a ‘positive Romberg’ test. This suggests an issue with:
A. Cerebellar function
B. Basal ganglia coordination
C. Upper motor neuron strength
D. Proprioception and vestibular function
Exam 2 v3 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. A patient presents with sharp pain in the right upper quadrant during inspiration while the
examiner applies pressure under the right costal margin. This finding is known as:
A. Rovsing’s sign
B. Murphy’s sign
C. Psoas sign
D. Obturator sign
Correct Answer: B
Expert Explanation: Murphy’s sign is a clinical indicator of acute cholecystitis. It is
performed by asking the patient to inhale while the clinician palpates the area of the
gallbladder. A positive test occurs when the patient abruptly halts inspiration because of
significant pain.
2. During a musculoskeletal exam, the provider asks the patient to flex both wrists to 90
degrees and press the backs of the hands together for 60 seconds. What is being assessed?
A. Phalen’s test
B. Finkelstein’s test
C. Tinel’s sign
D. Lachman test
Correct Answer: A
Expert Explanation: Phalen’s test is used to screen for carpal tunnel syndrome by
compressing the median nerve. A positive result is indicated if the patient experiences
numbness or tingling in the distribution of the median nerve within 60 seconds. This test
has high sensitivity for detecting nerve entrapment at the wrist.
3. While assessing the abdomen, the clinician notes a loud, blowing sound heard over the
epigastric area. This is documented as a:
A. Friction rub
B. Borborygmi
C. Bruit
,D. Venous hum
Correct Answer: C
Expert Explanation: An abdominal bruit is a vascular sound that suggests turbulent blood
flow through a narrowed artery, such as renal artery stenosis or an aortic aneurysm. It is
best heard with the bell of the stethoscope during auscultation. The presence of a bruit
warrants further imaging to rule out significant vascular pathology.
4. A 55-year-old male reports a protrusion in his groin that appears when he coughs. The
clinician notes the hernia descends into the scrotum. This is likely a(n):
A. Direct inguinal hernia
B. Femoral hernia
C. Indirect inguinal hernia
D. Umbilical hernia
Correct Answer: C
Expert Explanation: Indirect inguinal hernias pass through the internal inguinal ring and
can often travel down the inguinal canal into the scrotum. This type of hernia is more
common in males and can be congenital or acquired. Clinicians differentiate it from direct
hernias by the path of protrusion relative to the epigastric vessels.
5. During the breast exam of a 30-year-old female, the provider notes a firm, mobile, non-
tender, marble-like mass. This most likely represents a:
A. Mammary duct ectasia
B. Breast cyst
C. Invasive ductal carcinoma
D. Fibroadenoma
Correct Answer: D
Expert Explanation: Fibroadenomas are common, benign breast tumors typically found in
younger women. They are characterized by their smooth, rubbery consistency and extreme
mobility within the breast tissue. While benign, any new mass requires clinical follow-up or
imaging to confirm the diagnosis.
6. Which cranial nerve is being tested when the clinician asks the patient to puff out their
cheeks and show their teeth?
A. CN V (Trigeminal)
B. CN IX (Glossopharyngeal)
C. CN VII (Facial)
, D. CN XII (Hypoglossal)
Correct Answer: C
Expert Explanation: Cranial Nerve VII, the facial nerve, controls the muscles of facial
expression. Testing involves observing for symmetry when the patient smiles, frowns, or
puffs their cheeks. Weakness on one side can indicate Bell’s palsy or a central nervous
system lesion like a stroke.
7. The provider performs the Lachman test on a patient who sustained a sports-related knee
injury. A positive result indicates damage to the:
A. Anterior cruciate ligament (ACL)
B. Posterior cruciate ligament (PCL)
C. Medial collateral ligament (MCL)
D. Lateral meniscus
Correct Answer: A
Expert Explanation: The Lachman test is considered the most sensitive clinical test for
detecting an ACL tear. It involves pulling the tibia forward while the knee is flexed at 20-30
degrees. Significant forward excursion of the tibia relative to the femur indicates a positive
test.
8. When assessing the liver, the clinician uses percussion to estimate the liver span. What is
the normal liver span in the right midclavicular line for an adult?
A. 6-12 cm
B. 2-4 cm
C. 15-20 cm
D. 4-8 cm
Correct Answer: A
Expert Explanation: A normal liver span in the midclavicular line ranges from 6 to 12
centimeters in a healthy adult. Percussion helps identify the upper and lower borders by
noting the change from resonance/tympany to dullness. An increased span may suggest
hepatomegaly or systemic disease.
9. A patient displays a ‘positive Romberg’ test. This suggests an issue with:
A. Cerebellar function
B. Basal ganglia coordination
C. Upper motor neuron strength
D. Proprioception and vestibular function
