Assignment: Skin Examination
Assignment: Skin Examination
Question 1. You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?
Moist and smooth
Moist and rough
Dry and smooth
Dry and rough
Question 2. Question : You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?
Question 3. Question : A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?
Basal cell carcinoma
Squamous cell carcinoma
Question 4. Question : A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain?
Question 5. Question : Heberden’s nodes are commonly found in which one of the following diseases?
Degenerative joint disease
Question 6. Question : A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with:
Question 7. Question : An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which one of the following is a risk factor for osteoporosis?
Having an aunt with osteoporosis
Question 8. Question : Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?
Conclude that these are lesions she has had for a long time.
Wait for her to mention them before asking further questions.
Ask how she acquired them.
Conduct the visit as usual for the patient.
Question 9. Question : A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain?
: Age over 50
Pain at night
Pain lasting more than 1 month or not responding to therapy
Pain that is bilateral
Question 10. Question : The Phalen’s test is used to evaluate:
Inflammation of the median nerve
Degenerative joint changes
1. Question : Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?
The presence of bowel sounds in the scrotum
Being unable to palpate superior to the mass
A positive transillumination test
Normal thickness of the skin of the scrotum
Refer to urology
Recheck in six months
Tell the parent the testicle is absent but that this should not affect fertility
Attempt to bring down the testis from the inguinal canal
Question 3. Question : A 50-year-old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. His past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than six beers a week, and denies using any illegal drugs. His mother has high blood pressure and arthritis and his father died of lung cancer in his sixties. On examination, his blood pressure is 130/80 and his pulse is 80. His cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but on his digital rectal examination you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?
Question 4. Question : A 15-year-old high school football player is brought to your office by his mother. He is complaining of severe testicular pain since exactly 8:00 this morning. He denies any sexual activity and states that he hurts so bad he can’t even urinate. He is nauseated and is throwing up. He denies any recent illness or fever. His past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. On examination, you see a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. His blood pressure is 150/100, his pulse is 110, and his respirations are 24. On visualization of the penis, he is circumcised and there are no lesions and no discharge from the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left but is normal on the right. By catheter you get a urine sample and the analysis is unremarkable. You send the boy with his mother to the emergency room for further workup.
Torsion of the spermatic cord
Question 5. Question : Which is true of prostate cancer?
It is commonly lethal.
It is one of the less common forms of cancer.
Family history does not appear to be a risk factor.
Ethnicity is a risk factor.
Question 6. Question : Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?
Question 7. Question : A 12-year-old is brought to your clinic by his father. He was taught in his health class at school to do monthly testicular self-examinations. Yesterday, when he felt his left testicle, it was enlarged and tender. He isn’t sure if he has had burning with urination and he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last three days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure and his mother is healthy. On examination, you see a child in no acute distress. His temperature is 100.8 and his blood pressure and pulse are unremarkable. On visualization of his penis, he is uncircumcised and has no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings, and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this child most likely have?
Torsion of the spermatic cord
Question 8. Question : The most common cause of cancer deaths in males is:
Question 9. Question : Important techniques in performing the rectal examination include which of the following?
Waiting for the sphincter to relax
Explaining what the patient should expect with each step before it occurs
All of the above
Question 10. Question : Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?
Decreased testosterone levels
Abnormal hypogastric arterial circulation
Impaired neural innervation
Question 1. Which of the following is true of human papilloma virus (HPV) infection?
Pap smear is a relatively ineffective screening method.
It commonly resolves spontaneously in one to two years.
It is the second most common STI in the United States.
HPV infections cause a small but important number of cervical cancers.
Question 2. Question : Which of the following is the most effective pattern of palpation for breast cancer?
Beginning at the nipple, make an ever-enlarging spiral.
Divide the breast into quadrants and inspect each systematically.
Examine in lines resembling the back and forth pattern of mowing a lawn.
Beginning at the nipple, palpate vertically in a stripe pattern.
Question 3. Question : A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise, his examination is normal. He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia?
Imbalance of hormones of puberty
Question 4. Question : Which of the following represents metrorrhagia?
Fewer than 21 days between menses
Bleeding between periods
Question 5. Question : What does a KOH (potassium hydroxide) prep help the nurse practitioner diagnose?
Herpes zoster infections
Herpes simplex infections
This is most likely due to lack of lubrication.
This is most likely due to atrophic vaginitis.
This is most likely due to pressure on an ovary.
Psychosocial reasons may cause this condition.
Question 7. Question : A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis?
Question 8. Question : Which of the following is true regarding breast self-examination?
It has been shown to reduce mortality from breast cancer.
It is recommended unanimously by organizations making screening recommendations.
A high proportion of breast masses are detected by breast self-examination.
The undue fear caused by finding a mass justifies omitting instruction in breast self-examination.
Question 9. Question : A 23-year-old computer programmer comes to your office for an annual examination. She has recently become sexually active and wants to be placed on birth control. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes, and her father has high blood pressure. The patient denies using tobacco but has four to five drinks on Friday and Saturday nights. She denies any illegal drug use. On examination, you see a mildly obese female who is breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you see dark, velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have?
Question 10. Question : Which of the following is true of women who have had a unilateral mastectomy?
They no longer require breast examination.
They should be examined carefully along the surgical scar for masses.
Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer.
Women with breast reconstruction over their mastectomy site no longer require examination.
Question 1. A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about three days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, three days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over fifty years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative.His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending.
What diagnosis for abdominal pain best describes his symptoms and signs?
Question 2. Question : Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for two days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?
Bleeding from a diverticulum
Bleeding from a peptic ulcer
Bleeding from a colon cancer
Bleeding from cholecystitis
Question 3. Question : A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for twelve hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was the night before and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one-third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular examinations are normal.
What is the most likely cause of his pain?
Acute mechanical intestinal obstruction
Question 4. Question : Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?
His spleen is definitely enlarged and further workup is warranted.
His spleen is possibly enlarged and close attention should be paid to further examination.
His spleen is possibly enlarged and further workup is warranted.
His spleen is definitely normal.
Question 5. Question : Diminished radial pulses may be seen in patients with which of the following?
Early “warm” septic shock
Question 6. Question : A 42-year-old florist comes to your office, complaining of chronic constipation for the last six months. She has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems (ROS), you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination, she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons.
What is the best choice for the cause of her constipation?
Large bowel obstruction
Irritable bowel syndrome
Question 7. Question : A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of sixteen, but is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?
Chest pressure with exertion
Shortness of breath
Question 8. Question : You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient’s pain make you concerned for this disease process?
Question 9. Question : A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?
Femoral pulse, popliteal pulse
Dorsalis pedis pulse, posterior tibial pulse
Radial pulse, brachial pulse
Question 10. Question : Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant (LUQ) pain. On examination of this area, a rough grating noise is heard. What is this sound?
It is a splenic rub.
It is a variant of bowel noise.
It represents borborygmi.
It is a vascular noise.
Question 1.A 30-year-old woman with a history of mitral valve problems states that she has been “very tired.” She has started waking up at night and feels like her “heart is pounding.” During the assessment, the nurse practitioner palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse practitioner also auscultates a blowing, swishing sound right after S1. These findings would be most consistent with:
Question 2. Question : A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse practitioner suspects:
Question 3. Question : A patient complains that while studying for an examination he began to notice a severe headache in the frontotemporal area of his head that is throbbing and is somewhat relieved when he lies down. He tells the nurse practitioner that his mother also had these headaches. The nurse practitioner suspects that he may be suffering from:
Question 5. Question : The most important reason to share information and offer brief teaching while performing the physical examination is to help:
the examiner feel more comfortable and gain control of the situation.
build rapport and increase the patient’s confidence in the examiner.
the patient understand his or her disease process and treatment modalities.
the patient identify questions about his or her disease and potential areas of patient education.
Question 6. Question : A patient says that she has recently noticed a lump in the front of her neck below her “Adam’s apple” that seems to be getting bigger. During the assessment, the finding that reassures the nurse practitioner that this may not be a cancerous thyroid nodule is that the lump (nodule):
is mobile and not hard.
disappears when the patient smiles.
is hard and fixed to the surrounding structures.
Question 7. Question : A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse practitioner suspects that he has:
had a cerebrovascular accident (stroke).
Question 8. Question : The temporomandibular joint is just below the temporal artery and anterior to the:
Question 9. Question : During an examination of a patient’s abdomen, the nurse practitioner notes that the abdomen is rounded and firm to the touch. During percussion, the nurse practitioner notes a drum-like quality of the sound across the quadrants. This type of sound indicates:
the presence of a tumor.
the presence of dense organs.
“Are you allergic to any other drugs?”
“How often have you received penicillin?”
“I’ll write your allergy on your chart so you won’t receive any.”
“Please describe what happens to you when you take penicillin.”
low gurgling sound best heard with the diaphragm of the stethoscope.
loud, whooshing, blowing sound best heard with the bell of the stethoscope.
soft, whooshing, pulsatile sound best heard with the bell of the stethoscope.
high-pitched tinkling sound best heard with the diaphragm of the stethoscope.
“Can you point to where it hurts?”
“We’ll talk more about that later in the interview.”
“What have you had to eat in the last 24 hours?”
“Have you ever had any surgeries on your abdomen?”
Question 14. Question : A teenage patient comes to the emergency department with complaints of an inability to “breathe and a sharp pain in my left chest.” The assessment findings include the following: cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with:
an asthmatic attack.
Question 15. Question : The inspection phase of the physical assessment:
yields little information.
takes time and reveals a surprising amount of information.
may be somewhat uncomfortable for the expert practitioner.
requires a quick glance at the patient’s body systems before proceeding on with palpation.
“It is unusual for a small child to have frequent ear infections unless there is something else wrong.”
“We need to check the immune system of your son to see why he is having so many ear infections.”
“Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear.”
“Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.”
Question 17. Question : The nurse practitioner would use bimanual palpation technique in which situation?
Palpating the thorax of an infant
Palpating the kidneys and uterus
Assessing pulsations and vibrations
Assessing the presence of tenderness and pain
Question 18. Question : The patient’s record, laboratory studies, objective data, and subjective data combine to form the:
Question 19. Question : When preparing to perform a physical examination on an infant, the examiner should:
have the parent remove all clothing except the diaper on a boy.
instruct the parent to feed the infant immediately before the exam.
encourage the infant to suck on a pacifier during the abdominal exam.
ask the parent to briefly leave the room when assessing the infant’s vital signs.
Question 20. Question : The nurse practitioner notices that an infant has a large, soft lump on the side of his head and that his mother is very concerned. She tells the nurse practitioner that she noticed the lump about 8 hours after her baby’s birth, and that it seems to be getting bigger. One possible explanation for this is:
Question 21. Question : When examining an infant, the nurse practitioner should examine which area first?
Question 22. Question : When preparing to examine a 6-year-old child, which action is most appropriate?
Start with the thorax, abdomen, and genitalia before examining the head.
Avoid talking about the equipment being used because it may increase the child’s anxiety.
Keep in mind that a child this age will have a sense of modesty.
Have the child undress from the waist up.
Use the fingertips because they’re more sensitive to small changes in temperature.
Use the dorsal surface of the hand because the skin is thinner than on the palms.
Use the ulnar portion of the hand because there is increased blood supply that enhances temperature sensitivity.
Use the palmar surface of the hand because it is most sensitive to temperature variations because of increased nerve supply in this area.
Question 24. Question : Percussion notes heard during the abdominal assessment may include:
flatness, resonance, and dullness.
resonance, dullness, and tympany.
tympany, hyperresonance, and dullness.
resonance, hyperresonance, and flatness.
Question 25. Question : The nurse practitioner is assessing a patient for possible peptic ulcer disease and knows that which condition often causes this problem?
History of constipation and frequent laxative use
Frequent use of nonsteroidal anti-inflammatory drugs
Question 1: You are participating in a health fair and performing cholesterol screens. One person has a cholesterol level of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?
Upright, but leaning forward
Left lateral decubitus
Stage 1 hypertension
Stage 2 hypertension
Question 4. Question : How should you determine whether a murmur is systolic or diastolic?
Palpate the carotid pulse.
Palpate the radial pulse.
Judge the relative length of systole and diastole by auscultation.
Correlate the murmur with a bedside heart monitor.
Question 5. Question : A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an electrocardiogram (ECG) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this.Which of the following symptoms would be more common in this patient’s age group for an AMI?
Pain radiating into the left arm
Pain radiating into the jaw
Mitral valve prolapse
Question 7. Question : Which of the following correlates with a sustained, high-amplitude point of maximal impulse (PMI)?
Question 8. Question : A 68-year-old woman with hypertension and diabetes is seen by the nurse practitioner for a dry cough that worsens at night when she lies in bed. She has shortness of breath, which worsens when she exerts herself. The patient’s pulse rate is 90/min and regular. The patient has gained 6 lbs over the past two months. She is on a nitroglycerine patch and furosemide daily. The explanation for her symptoms is:
Congestive heart failure
Angiotensin-converting enzyme (ACE) inhibitor induced coughing
Question 9. Question : When listening to a soft murmur or bruit, which of the following may be necessary?
Asking the patient to hold their breath.
Asking the patient in the next bed to turn down the TV.
Checking your stethoscope for air leaks.
All of the above.
Severe left heart failure
Question 1. Question : A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?
Question 2. Question : A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer.She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.
Left-sided heart failure
Question 3. Question : A patient with long-standing COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?
Percuss the lower border of the liver.
Measure the span of the liver.
Order a hepatitis panel.
Obtain an ultrasound of the liver.
Question 4. Question : A fifty-five-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should be considered because of her gesture?
Question 5. Question : When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?
Question 7. Question : All of the following are implicated in causing chronic cough except:
Acute viral upper respiratory infection
Gastroesophageal reflux disease
Different sounds from the nose and the chest
Sounds louder in the lower chest
Question 9. Question : Which of the following is consistent with good percussion technique?
Allow all of the fingers to touch the chest while performing percussion.
Maintain a stiff wrist and hand.
Leave the plexor finger on the pleximeter after each strike.
Strike the pleximeter over the distal interphalangeal joint.