Description

1. Question: A patient with alcoholism is brought in with confusion. You ask him to stop traffic with his palms and notice that every few seconds his palms suddenly move toward the floor. What does this indicate?
2. Question: Which of the following is a “red flag” regarding patients presenting with headaches?
3. Question: You are conducting a mental status examination and note impairment of speech and judgment, but the rest of your examination is Where is the most likely location of the problem?
4. Question: The NP is testing the function of cranial nerve XI. Which of these best describes the response the NP should expect if the nerve is intact?
5. Question: A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of pain after lifting a set of boxes that were heavier than He also states that he has numbness and tingling in the left leg. He wants to know if he needs to be from work. What test should you perform to assess for a herniated disc?
6. Question: A patient presents with a daily headache which has worsened over the past several months. On funduscopic examination, you notice that the disk edge is intact and veins do not Which is most likely?
7. Question: A 29-year-old computer programmer comes to your office for evaluation of a headache. The tightening sensation is located all over the head and is of moderate intensity. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours each day at a computer monitor/keyboard. He has tried over-the- counter medication; it has dulled the pain, but not taken it Based on this description, what is your most likely diagnosis?
8. Question: A 50-year-old woman presents with a new complaint of headache. The patient states, “This is the worst headache of my life.” Her concurrent history includes hypertension. Her BP is 200/110 with an HR of 95. Of the following differential diagnosis, which is the most likely etiology?”
9. Question: A 47-year-old male presents to the Emergency Department with back pain associated with saddle numbness and urinary retention. Which of the following is an accurate interpretation of these assessment findings?
10. Question: Dawn is a 55-year-old woman who comes in today for her yearly wellness You carefully perform the rectal examination in the lithotomy position and feel an irregular mass against the bowel wall which is firm and immobile. Which of the following is most likely?
11. Question: Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past It is not related to her menses. She notes relief with defecation and a change in the form and frequency of her bowel movements with these episodes. Which of the following is most likely?
12. Question: You are palpating the abdomen and feel a small Which of the following would you do next?
13. Question: A 24-year-old female presents to your office with jaundice. She denies IV drug use, blood transfusion, and travel and has not been sexually active for the past year. What type of hepatitis is most likely?
14. Question: A 19-year-old Black female presents to the clinic with moderate to severe right lower quadrant abdominal pain for the last 2 days. She has been experiencing nausea and vomiting but unsure if she has had a Which of the following is a possible differential diagnosis.
15. Question: An elderly woman with dementia is brought in by her daughter for a rectal mass. On examination, you notice a moist pink mass protruding from the anus, which is non-tender and soft and does not have any associated Which of the following is most likely?
16. Question: A healthy 30-year-old female presents to the ED with a 1-day history of severe abdominal The NP suspects appendicitis and consults general surgery. Based on exam findings the NP believes this patient has signs of peritonitis on exam. Which of the following physical examination findings supports peritonitis?
17. Question: A 44-year-old female presents with nausea and pain in the right upper quadrant. The NP notices the patient winces in pain and there is cessation of inspiration with palpation of the right upper quadrant. The nurse practitioner would document which of the following is a positive finding for this patient.
18. Question: Jim is a 60-year-old man who presents with He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?
19. Question: A 42-year-old female website developer presents for an annual preventive examination with questions about breast cancer screening. She is concerned about the radiation exposure associated with mammography and is interested in magnetic resonance imaging (MRI) as a possible alternative for routine She is otherwise healthy with no family history of breast, ovarian, or colon cancer. Which of the following is true about MRI as a screening modality for breast cancer in the general population?
20. Question: A 44-year-old female mathematician presents to clinic with a complaint of a mass in the right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty because she has only had one mammogram and does not engage in breast self-examination (BSE) on any regular basis. She has no family history of breast cancer, and her prior mammogram was ordered as a routine screening test at age 43 years after a brief discussion with her primary care provider. After a thorough investigation reveals a benign cyst, what advice should be given to this patient about screening for breast cancer in her age group?
21. Question: A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple This discharge started several weeks ago and has occurred at irregular intervals since that time. She does not complain of local tenderness, redness, fever, or any other systemic symptoms aside from slightly irregular periods over the last few months. On examination, she is able to express a small amount of discharge, which is sent to the laboratory and found to be consistent with breast milk but without any signs of blood or pus. Screening laboratories are also sent, which reveal a normal blood count, metabolic panel, thyroid-stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories are still pending. Which of the following is the most likely diagnosis?
22. Question: A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-examination (BSE) at home. The mass is non-tender without skin changes, erythema, or overlying swelling. She has heard that most breast cancers are found by patients themselves, and she is very concerned that she may have breast cancer. Which of the following is true about BSE and self-detection of breast cancer?
23. Question: A 48-year-old female psychologist presents to clinic with concerns about her breast cancer risk after an age-matched cousin was recently diagnosed with this disease. This cousin is the third family member on her father’s side in as many years to be diagnosed with breast cancer, including the patient’s own father, who had surgery and subsequent treatment 3 years ago for breast The patient has little other knowledge of her family history, only that her grandparents independently arrived from Eastern Europe near the end of World War II and were among very few members of their family that survived the war. The patient has read about testing for the breast cancer genes (BRCA1 and BRCA2) and desires further information about whether this would be appropriate for her. Which of the following is true about this patient’s indications for BRCA testing?
24. Question: A 68-year-old former paleontologist presents to clinic with concerns about her breast cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A younger cousin developed the disease a few years ago before the age of 50 years, but this individual was not tested for the BRCA1 and BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s and had radiation to the chest. She did take hormone replacement therapy for a few years before data emerged that this may contribute to breast cancer risk. She has had several abnormal mammograms in her 50s for persistently dense breasts with subtle findings, but follow-up biopsies never showed any malignant pathology. Which of the following is true regarding magnetic resonance imaging (MRI) screening of this patient?
25. Question: A 66-year-old female museum curator presents for a routine annual examination. On examination, a notably enlarged supraclavicular lymph node is appreciated on the right The lymph node is nontender and feels firm and rubbery. She denies any localized or systemic symptoms such as breast lumps, fevers, or night sweats. She has been taking conjugated estrogen tablets for 9 years since menopause, though she has not taken progestin compounds since she had a hysterectomy for heavy bleeding at age 45 years. Which of the following is true about this presentation of lymphadenopathy?
26. Question: A 24-year-old graphic designer presents to the clinic with a concern for a breast mass. A rubbery, mobile, non-tender mass is palpated in the right breast as described by the patient, which is consistent with a In describing the location of the mass, the examiner notes that it is 3 cm proximal to and 3 cm to the left of the nipple. Which of the following would be the most appropriate way to report this finding?
27. Question: A 54-year-old female dietician presents for a routine annual examination. On review of systems, she reports that she has had many breast findings over several years, including one biopsy with normal pathology. She feels that her breasts have become far less lumpy since she underwent menopause 3 years ago. Which of the following is true regarding changes in the breasts with menopause?
28. Question: A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While counseling him, the clinician mentions that multiple processes must take place to achieve an erection. Which of the following structures would be most affected by vascular deficiencies related to his preexisting medical conditions and is likely contributing to his symptoms?
29. Question: A 29-year-old graduate student states that he is able to achieve an erection and ejaculate during sexual intercourse; however, he does not experience any pleasurable sensation of He is otherwise healthy and is not on any medications. What is the most likely cause of his problem?
30. Question: Multiple processes must take place in order for a male to sustain an erection. Various cues stimulate sympathetic outflow from higher brain centers to the T11–L2 levels of the spinal cord and parasympathetic outflow from S2 to S4 reflex arcs. Local vasodilatation within the penis erectile tissue results from increased levels of which of the following?
31. Question: The human papillomavirus (HPV) can cause genital warts in males and females as well as cervical cancer in Vaccination against HPV is available and should be offered to males between what ages?
32. Question: A 32-year-old male complains of a painless, cystic mass just above his left testicle. During the physical examination, a strong flashlight is placed behind the scrotum through the area in question and transillumination is What is the most likely diagnosis?
33. Question: A 25-year-old graduate student presents to the clinic complaining of scrotal pain, which has been increasing over the past 2 days. He is sexually active and has had unprotected intercourse with multiple partners in the past couple of weeks. On examination, some mild to moderate swelling of the scrotum on the right and tenderness with palpation of the right testicle are What is the most likely diagnosis?
34. Question: A 32-year-old elementary teacher requests a workup for infertility. He and his wife have been trying to conceive for the last 2 years. He reports that his wife has been evaluated and does not appear to have any infertility issues. The overall examination does not reveal any significant He is of average height and weight and has normal secondary sex characteristics of the genitalia. Of the following, which would be most likely be abnormal and causing male infertility?
35. Question: While performing a physical examination on male patients, it is possible to palpate multiple structures in relation to the inguinal canal and related hernias. Which of the following is not palpable during an external examination of the abdominal wall or inguinal region?
36. Question: A 20-year-old college student presents for his annual physical examination. He recently became sexually active and is inquiring about the best means of preventing sexually transmitted infections (STIs). Of the following, which would be the most effective means of prevention?
37. Question: A 21-year-old college student presents to the student health clinic for a full physical He is generally healthy; however, he reports that he has had sexual intercourse with multiple partners in the past couple of months. He noticed a small lesion on the shaft of his penis a few days ago. While performing the examination, he unwillingly achieves an erection. How should the clinician proceed at this point?
38. Question: A 45-year-old driver’s education instructor presents to the clinic for heavy periods and pelvic pain during her menses. She reached menarche at age of 13 years and has had regular periods except during her pregnancies. She is a G4P3013 and does not use birth control as her husband has had a vasectomy. She states this has been going on for about a year but seems to be getting Her last period was 1 week ago. On the bimanual exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. What is the best explanation for her physical finding?
39. Question: A 32-year-old G0 woman comes for evaluation on why she and her husband have been unable to get pregnant. Her husband has been married before and has two other children, ages 7 and 4 years. The patient relates she began her periods at age 12 and has been fairly regular ever since. She began oral contraceptive pills when she got married until last year when she began to try for a pregnancy. Before this, she had regular cycles for 10 years. She has had a history of five prior She relates she was once treated for a severe genital infection when she was in college. Based on this patient’s history, what is the best explanation for her infertility?
40. Question: A 24-year-old retail clerk presents to the clinic for an annual exam. Her last Pap was 3 years ago and was She is a G0 and is currently not sexually active although she has had two lifetime partners. She is on oral contraceptive pills for cycle control and has no medical problems. Based on guidelines, the clinician proceeds to perform a Pap smear and places the speculum. There are two layers of cells, squamous and columnar. Where is the most important area to obtain cells for a Pap smear?
41. Question: A 35-year-old grade school teacher presents for her annual Her last Pap smear was 4 years ago and normal. She is a G1P1 with a 6-year-old child. She has had four-lifetime partners but only one partner in the last 12 years. Otherwise, she has no complaints. A speculum exam is done followed by a bimanual examination during which a rectovaginal mass is palpated. Which of the following exam findings would be most reassuring that this is not a colonic mass?
42. Question: A 21-year-old college student presents for her first annual exam. She has been sexually active for 1 year and has had two partners. She is not aware of having had any sexually transmitted diseases (STIs). She is using condoms for birth control and STI prevention but admits to not always using them regularly. Her last menses was 2 weeks ago. On speculum exam, an unusual appearance is noted, which is diagnosed as warts. What is the best description for these lesions?
43. Question: A 23-year-old female comes to the clinic to discuss her birth control options. Although she has been sexually active since age 16 years, she has been with one partner for the last She has decided to discontinue condoms and would like a different birth control option. She has not had a pelvic exam for 2 years. She had a normal Pap smear that year and negative sexually transmitted infection (STI) testing. Her last menstrual period was 2 days ago. She states that she is still spotting. She also states that she last had sex with her boyfriend 1 week ago, so the clinician elects to postpone her speculum exam. What is the best explanation for the decision to postpone her exam?
44. Question: An 18-year-old high school senior presents to the clinic complaining of a vaginal She states that it is thick and yellow and that she has had some recent pelvic pain. She is sexually active and is not using any type of birth control or sexually transmitted infection (STI) prevention. She denies any burning with urination, nausea, vomiting, or diarrhea. She has had some fever and chills with a temperature up to 101.5ºF. Her last menstrual period was last week. After a physical exam, she is diagnosed with pelvic inflammatory disease (PID). Visualization of purulent discharge in which of the following areas would best support a diagnosis of PID?
45. Question: A 27-year-old G0 bus driver presents to the clinic complaining of an itchy vaginal discharge for the last She reached menarche at age 12 years, became sexually active at age 18 years, and has had a total of five sexual partners. She has been with her current partner for 1 month. She is on oral contraceptive pills and does not use condoms as she is allergic to latex. Her last menstrual period was 3 weeks ago. She is not having any pelvic pain, fever, nausea, or vomiting. Her vitals are normal with a body mass index of 22. The clinician places the metal medium Graves speculum in the vagina but cannot find the cervix. What is the best next maneuver to visualize the cervix?
46. Question: A 63-year-old office worker comes to the clinic for her women’s health exam. Her last Pap smear was 5 years ago and was normal. She is married and has been with the same sexual partner for the last 35 years. After performing most of the exam, the clinician decides to do a speculum exam to collect cytology for Pap smear. What is the correct position to have the patient in for her speculum exam?
47. Question: A 68-year-old retired patient presents to the clinic complaining about feeling like something is falling out of her She is a G6P6007 and had all her children vaginally, even the twins. She went through menopause at age 55 years, and, for the last few months, she has felt this falling sensation. On exam, an anterior bulge in the vaginal wall is apparent when she bears down. Weakness in which muscle would best account for the anterior bulge in the vaginal wall?
48. Question: The nurse practitioner is performing a pelvic exam on a woman who is 13 weeks pregnant An expected normal finding is that her uterus is located at which of the following areas?
49. Question: A 26-year-old comes in for a third-trimester prenatal visit. She has had prenatal care since her sixth week of She has complaints today and her prenatal course has been unremarkable. Today her blood pressure and weight gain are appropriate and her urine is unremarkable. You measure the patient’s uterus in centimeters by placing one end of the tape over the uterus fundus. From what inferior anatomic position should the beginning of the tape be placed?
50. Question: A woman has a positive pregnancy test and comes to you with abdominal pain. On physical examination you palpate a large, fixed, and ill-defined adnexal following should you suspect?