91 minute read
Chapter 07: Mental Status
from TEST BANK for SEIDEL'S GUIDE TO PHYSICAL EXAMINATION. An Interprofessional Approach 9th Edition
by StudyGuide
Multiple Choice
1. When is the mental status portion of the neurologic system examination performed?
a. During the history-taking process b. Immediately after the vital signs are taken c. During the time when questions related to memory are asked d. Constantly, throughout the entire interaction with a patient e. During assessment of cranial nerves and deep tendon reflexes
ANS: D
A mental status evaluation should be continually evaluated throughout the patient encounter. Assessing and validating clues to determine the individual’s ability to interact with the environment is a priority of the mental status evaluation.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous a. There is usually a decline in general intelligence in older adults. b. Vocabulary and inventories of information show a marked decrease in older adults. c. Remote memory decline frequently causes problems in processing information. d. Recent memory is usually more efficient than remote memory. e. There is an increased risk of delirium with acute illness or metabolic derangement.
2. Which statement is true regarding mental status changes in older adults?
ANS: E
Acute illness or metabolic derangement of older adults places such a stress on the declining metabolism and synthesis of neurotransmitters that adaptation is inadequate, and delirium results. None of the other statements are true.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
3. A 69-year-old truck driver presents with a sudden loss of the ability to understand spoken language. This indicates a lesion in the: a. temporal lobe. b. Broca area. c. frontal cortex. d. precentral gyrus. e. occipital lobe.
ANS: A
The temporal lobe, specifically in the Wernicke speech area, is responsible for the comprehension of spoken and written language.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous
4. Slumped posture and a lack of facial expression may indicate depression or: a. anxiety. b. Parkinson disease. c. loss of abstract reasoning. d. attention-deficit/hyperactivity disorder. e. hyperthyroidism.
ANS: B
A slumped posture and lack of facial expression may be clues to more than depression; they also are a defining characteristic of the neurologic disorder known as Parkinson disease.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
5. The ability for abstract thinking normally develops: a. in utero. b. during infancy. c. during early childhood. d. during adolescence. e. during adulthood.
ANS: D
Abstract thinking is an intellectual maturation that develops during adolescence.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
6. The Mini-Mental State Examination (MMSE): a. may be used to estimate cognitive changes quantitatively. b. may be used to estimate personality disorders qualitatively. c. scores do not vary with regard to age or education. d. will determine the cause of memory loss. e. is a good tool to diagnose neurologic disorders.
ANS: A
The MMSE is a standard tool that functions to estimate cognitive function quantitatively or to document cognitive changes serially. None of the other statements are correct.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
7. Assessing orientation to person, place, and time helps determine: a. the ability to understand analogies. b. abstract reasoning. c. attention span. d. state of consciousness. e. emotional status.
ANS: D
Orientation to person, place, and time are measures of states of consciousness and awareness, not degrees of attention span. Analogies and abstract reasoning are higher functions than orientation. Emotional status can be better evaluated by observing behaviors.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous
8. A state of impaired cognition, consciousness, mood, and behavioral dysfunction of acute onset refers to: a. lethargy. b. delirium. c. stupor. d. coma. e. confusion.
ANS: B
Delirium is a state of impaired cognition, consciousness, mood, and behavioral dysfunction of acute onset. Stupor describes arousals for short periods of time after a stimulus for arousal (e.g., visual, verbal, or painful). Lethargy relates to sleepiness with ease of arousal; coma is nonarousal and nonawareness. Confusion relates to inappropriate responses to questions with decreased attention span and memory.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. Level of consciousness b. Abstract reasoning c. Emotional stability d. Memory e. Impaired judgment
9. When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing which of the following?
ANS: B
Asking the patient to tell you the meaning of a proverb, metaphor, or fable assesses the patient’s ability to reason abstractly. This intelligence test does not assess level of consciousness, emotional health, judgment, or memory.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
10. Impairment of arithmetic skills is often caused by: a. impaired execution of motor skills. b. impaired judgment. c. peripheral neuropathies. d. depression. e. perceptual distortions.
ANS: D
The patient with depression or diffuse brain disease can display difficulty with simple arithmetic calculations. This is not commonly seen with motor skill impairments, judgment impairments, or perceptual distortions and hallucinations. Peripheral neuropathies are best assessed by evaluating motor skills.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
11. Peripheral neuropathy is most likely to be manifested by: a. impaired memory. b. impaired abstract reasoning. c. impaired writing ability. d. hallucinations. e. difficulties with analogies.
ANS: C
Uncoordinated writing or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or peripheral neuropathy due to nerve damage and loss of feeling in fingers making it difficult to hold a pencil.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous
12. Loss of immediate and recent memory with retention of remote memory suggests: a. attention-deficit/hyperactivity disorder (ADHD). b. impaired judgment. c. stupor. d. dementia. e. delirium.
ANS: D
Dementia is the loss of immediate and recent memory while retaining remote memories. ADHD is associated with recent and remote memory impairment, impaired judgments are thought process dysfunctions, and stupor is impaired consciousness. Delirium manifests with confusion with disordered perceptions as well as motor and sensory excitement, with inappropriate reactions to stimuli.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
13. Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for the assessment of: a. mood and feelings. b. attention span. c. thought process and content. d. abstract reasoning. e. speech and language skills.
ANS: C
Thought process and content are examined while observing the patient’s patterns of thinking, especially appropriateness of sequence, logic, coherence, and relevance to the topics discussed.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
14. Facial muscle or tongue weakness may result in: a. aphasia. b. word salad. c. neologisms. d. echolalia. e. impaired comprehension.
ANS: A
Aphasia can result from facial muscle or tongue weakness or from neurologic damage to the speech and language region of the brain. Neologisms (word choice based on sound so that words rhyme in a nonsensical way), word salad (meaningless, disconnected word choices), and echolalia (parrot speech) are coherence disturbances.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. 3 days b. 2 weeks c. 1 month d. 3 months e. 6 months
15. The examiner should be concerned about neurologic competence if a social smile cannot be elicited by the time a child is _____ old.
ANS: D
A social smile is expected in the 2- to 3-month-old infant. If it is difficult or impossible to elicit a social smile by 3 months, the infant may not be neurologically intact.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous a. Delirium b. Dementia c. Depression d. Anxiety e. Psychosis
16. Which of the following is usually related to structural diseases of the brain?
ANS: B
One of the distinguishing characteristics that distinguishes dementia from the others is that it is usually related to structural diseases of the brain such as abnormal deposits, or recurrent strokes. The other options are not structural diseases, but instead they are neurochemical imbalances.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. It occurs before 7 years of age. b. It is usually related to mental retardation. c. It is usually related to dementia. d. It is manifested by prolonged periods of catatonic behavior. e. It usually first manifests with decorticate posturing.
17. Which statement is true in regard to attention-deficit/hyperactivity disorder (ADHD)?
ANS: A
ADHD occurs before 7 years of age, is not related to mental retardation or psychiatric disorders, and is not a form of dementia. Decorticate posturing in unresponsive patients indicates a significant lesion above the brainstem.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
18. An aversion to touch or being held, along with delayed or absent language development, is characteristic of: a. attention-deficit/hyperactivity disorder. b. autism. c. dementia. d. mental retardation. e. schizophrenia.
ANS: B
Autistic disorder involves a combination of behavioral traits (e.g., lack of awareness of others, aversion to touch or being held, odd or repetitive behaviors, preoccupation with parts of objects) and communication deficits (usually echolalia [parrot speech]).
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
19. All of the following are usually associated with a neurochemical imbalance except: a. schizophrenia. b. mania. c. anxiety disorder. d. autism. e. depression.
ANS: D
Autism is a pervasive neurodevelopmental disorder of unknown etiology that has a strong genetic influence. All of the other disorders can be related to neurochemical imbalances in the brain.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous
20. While interviewing a patient, you ask him to explain “a stitch in time saves nine” to assess: a. reading comprehension. b. attention span. c. mood and feeling. d. reasoning skills. e. perceptual distortions.
ANS: D
Having the patient explain fables, proverbs, or metaphors determines abstract reasoning skills.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous b. c. d. e.
21. Expected memory skills vary with the age of the child. When testing immediate recall, a 5-year-old can be expected to repeat how many digits or words? a.
ANS: D
When testing immediate recall, a 4-year-old can repeat three digits or words, a 5-year-old can repeat four digits or words, and a 6-year-old can repeat five digits or words.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous
Chapter 08: Growth, Measurement, and Nutrition
Ball: Seidel
Multiple Choice
1. Two hypothalamic hormones control growth hormone synthesis and secretion in the anterior pituitary gland. Growth hormone releasing hormone (GHRH) and: a. IGF-I. b. thyroid hormone. c. leptin. d. somatostatin. e. thyroid-stimulating hormone.
ANS: D
Somatostatin, or growth hormone inhibiting hormone (GHIBH), inhibits the secretion of both GHRH and thyroid-stimulating hormone (TSH).
TOP: Discipline: Physiology MSC: Organ System: Endocrine a. Leptin b. IGF-I c. Ghrelin d. Somatostatin e. TSH
2. Which h e i k a he h ge h e ?
ANS: C
Gh eli , a e ide, k a he h ge h e, hel c l g h h e release and influences food intake and obesity development.
TOP: Discipline: Physiology MSC: Organ System: Endocrine
3. After 50 years of age, stature: a. becomes fixed. b. begins a barely perceptible secondary increase. c. increases at a rate of 0.5 cm/year. d. declines. e. declines and then begins a barely perceptible increase.
ANS: D
As an individual reaches 50 years of age, the intervertebral disk begins to thin and becomes more compressed, which leads to a decline in stature.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal a. 25% of b. 50% of c. the same as d. twice the e. five times the
4. By 10 to 12 years of age, lymphatic tissues are about _____ adult size.
ANS: D
Lymphatic tissues are small compared to the total body size, but they are almost fully developed at birth. They grow fast and are about twice the adult size by 10 to 12 years of age.
TOP: Discipline: Physiology MSC: Organ System: Hematopoietic/Lymphoid a. Brain b. Kidneys c. Heart d. Lungs e. Lymphoid tissue
5. Which organ(s) complete(s) physical development more quickly than any other body part?
ANS: A
Along with the skull, eyes, and ears, the brain completes development more quickly than any other part of the body; its most rapid growth occurs from conception to age 2 years.
TOP: Discipline: Physiology MSC: Organ System: Nervous
6. During adolescence, the head size normally increases as a result of: a. sinus development. b. brain mass increase. c. evolution of lymphatic tissue. d. hypertrophy of glial cells. e. hypertrophy of myelin.
ANS: A
As the facial sinuses grow, the head size enlarges its surface area to accommodate this growth.
TOP: Discipline: Physiology MSC: Organ System: General
7. Fif e ce f a i di id al ideal eigh i gai ed d i g: a. pregnancy. b. preschool years. c. adolescence. d. early adulthood. e. older adulthood.
ANS: C
During adolescence, the trunk and legs grow the most, causing organs and the skeletal mass to double in size. During pregnancy, weight gain is accounted for by the growing fetus and pregnancy organs (placenta and uterus). In the preschool years, weight is gained at a steady rate, with fat tissue increasing slowly until about 7 years of age. In early adulthood, there is a reduction in size and weight. A decrease in weight for height and body mass index has been found with increasing age between 70 and 89 years of age.
TOP: Discipline: Physiology MSC: Organ System: General
8. Sexual maturation begins earlier in girls with a higher: a. upper-to-lower segment ratio. b. arm span. c. head circumference. d. gestational age. e. body mass index (BMI).
ANS: E
Sexual maturation begins earlier in girls with a higher body mass index. On average, black girls enter puberty first, followed by Mexican American girls and then white girls. Sexual maturation, as measured by the onset of pubic hair development, begins ear lier in black boys than white boys.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
9. The legs are the fastest growing body part during: a. early infancy. b. late infancy. c. childhood. d. adolescence. e. early adulthood.
ANS: C
The legs grow the fastest during childhood, the trunk grows fastest in infancy, and the skeletal muscles and organs grow fastest in early adulthood.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
10. Skeletal mass and organ systems double in size during: a. infancy. b. early childhood. c. adolescence. d. early adulthood. e. mid-life.
ANS: C
During puberty, sex steroids stimulate secretion of growth hormone, causing the organs and skeletal mass to double in size.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
11. Achieving an optimal infant birth weight is difficult for pregnant adolescents because: a. they have not completed their own growth spurt. b. there are insufficient uterine supporting structures. c. the amnionic fluid is variable in adolescents. d. blood volume has not reached adult proportions. e. most of the maternal tissue growth occurs in the third trimester.
ANS: A
Pregnant adolescents younger than 16 years of age, or less than 2 years from menarche, may still be in their growth spurt. They may require higher weight gains during pregnancy to achieve an optimal infant birth weight. Maternal tissue growth accounts for most of the weight gain in the first and second trimesters.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Less than 1 pound b. 1 to 2 pounds c. 3 to 4 pounds d. 4 to 6 pounds e. 6 to 8 pounds
12. How much of the weight gained during a normal pregnancy is accounted for by an increase in blood volume?
ANS: C
An increase in blood volume usually accounts for 3 to 4 pounds of the weight gained during pregnancy. The remainder is due to the fetus and increases in maternal tissues (fluid volume, breasts, uterus, amniotic fluid, and increases in maternal fat and protein stores).
TOP: Discipline: Physiology MSC: Organ System: Reproductive
13. Milestone achievements are data most likely to appear in the history of: a. adolescents. b. infants. c. school-age children. d. young adults. e. older adults.
ANS: B
As part of the developmental assessment in infants, milestone achievements at certain ages, such as crawling, laughing, picking up the head, and turning over, are recorded.
TOP: Discipline: Behavioral Science MSC: Organ System: Nervous a. 10 b. 25 c. 50 d. 100 e. 200
14. Infants normally increase their birth length by ____% during the first year of life.
ANS: C
Infant length generally increases by 50% in the first year of life.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. 1 month b. 3 months c. 5 months d. 9 months e. 12 months
15. Healthy term babies generally double their birth weight by what age?
ANS: C
In general, healthy infants double their birth weight by 4 to 5 months of age and triple their birth weight by 12 months of age. Formula-fed infants are heavier after the first 6 months of life than breast-fed infants; they grow faster in the first 6 months of life and experience slower growth in the second 6 months of the first year.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. 3 b. 8 c. 12 d. 18 e. 24
16. Y h ld ea e he child head ci c fe e ce a e e heal h i i il a lea age _____ months.
ANS: E
Head circumference should be measured at every visit until 2 to 3 years of age.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
17. T ea e head ci c fe e ce, he a e i a ed gl a d he child head a he occipital protuberance and the: a. supraorbital prominence. b. brow line. c. nasal bridge. d. chin. e. hairline.
ANS: A
The ea i g a e h ld be gl a ed a d he child head a he cci i al protuberance and the supraorbital prominence, thereby documenting the largest circumference. Care should be taken to ensure that the tape does not cut the skin. Make the reading to the nearest 0.5 cm or inch; remember to remeasure the head circumference at least once to check the accuracy of your measurement.
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
18. Be ee 5 a d 24 h f life, he i fa che ci c fe e ce i all : a. about equal to the head circumference. b. greater than the head circumference by 2 inches. c. smaller than the head circumference by about 4 inches. d. at least 2 inches smaller than head circumference. e. none of the above; there is no relation between head and chest circumference during this period.
ANS: A
Be ee he age f 5 h a d 2 ea , he i fa che ci c fe e ce h ld cl el approximate the head circumference; the ratio should be monitored so that microcephaly can be identified, if present.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
19. I cli ical ac ice, he Balla d A e e T l i ed a e a e b : a. length. b. weight. c. lung maturity. d. gestational age. e. future IQ.
ANS: D
The Ballard Assessment Tool assesses six physical and six neuromuscular characteristics, ad i i e ed i hi 36 h f bi h, c fi he e b ge a i al age.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. 10 b. 25 c. 50 d. 75 e. 90
20. The term large for gestational age (LGA) indicates that an infant is larger than ____% of i fa b a he a e be f eek ge a i .
ANS: E
LGA corresponds to an infant who is in the greater than 90th weight percentile.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
21. The upper-to-lower segment ratio should be calculated: a. bimonthly for the first year of life. b. annually for the first 5 years. c. when a child is suspected of having a growth problem or unusual body proportions. d. in children of first-generation immigrants. e. every 6 months for the first 24 months.
ANS: C
The upper-to-lower ratio is assessed when a child is suspected of having a growth problem or unusual body proportions.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. premature pubarche b. hypothyroidism c. scoliosis d. Marfan syndrome e. dwarfism
22. An 11-year-old boy is brought in for an annual physical examination by his mother. You suspect _____ when you measure his arm span at 65 inches and his height at 60 inches.
ANS: D
A a ha i g ea e ha a child heigh i a cia ed i h Ma fa d e. The e children can have cardiovascular problems and should be thoroughly evaluated with a cardiologist consult.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal a. Most adolescent girls develop breasts before pubic hair. b. Peak height velocity should occur after menarche. c. Breast asymmetry is an abnormal finding. d. Menarche should occur by Tanner breast stage B. e. Sexual maturation begins later in taller and heavier girls.
23. Which of the following statements regarding female pubertal changes is true?
ANS: A
In two-thirds of girls, breasts begin to develop before pubic hair. Peak height velocity actually occurs about 1 year before menarche, breast asymmetry is common, and menarche occurs after Tanner breast stage B. Sexual maturation begins earlier in taller and heavier girls.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. 6 years b. 10 years c. 12 years d. years e. years
24. At what age does peak height growth velocity occur in boys?
ANS: D
Peak height velocity occurs at an average age of years.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal a. 7 years b. 8 years c. 9 years d. 10 years e. 11 years
25. What is the youngest age at which pubic hair growth in a boy may be considered normal?
ANS: C
In boys, sexual development before 9 years of age is precocious puberty and is considered an abnormal finding.
TOP: Discipline: Physiology MSC: Organ System: Endocrine a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5
26. Which Tanner stage is marked by the most significant growth in penis length?
ANS: C
Tanner stage 3 is marked by enlargement of the penis, especially in length.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5
27. Which breast Tanner stage corresponds to a secondary areola mound development above the breast?
ANS: D
Tanner stage 4 depicts the stage in which the areola forms a second mound above the breast.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. 10 b. 15 c. 20 d. 30 e. 40
28. A woman with a normal prepregnancy body mass index (BMI) should gain around _____ pounds during pregnancy.
ANS: D
Women of normal BMI should expect to gain between 25 and 35 pounds during pregnancy.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
29. Frontal skull bossing, cranial ridges, mandibular overgrowth, and maxillary widening are characteristics of: a. infantile hydrocephalus. b. acromegaly. c. Cushing syndrome. d. achondroplasia. e. Turner syndrome.
ANS: B
These presenting features are all prominent characteristics of acromegaly; teeth separation and malocclusion can result from the maxillary widening.
TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine
30. A round face, preauricular fat, hyperpigmentation, and a buffalo hump in the posterior cervical area are associated with: a. infantile hydrocephalus. b. hypopituitary dwarfism. c. Cushing syndrome. d. achondroplasia. e. acromegaly.
ANS: C
These are all commonly associated characteristics of Cushing syndrome, with the buffalo hump as a distinguishing feature.
TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine a. 24-hour diet recall b. Food diary c. Computerized nutrient analysis d. Serum protein assays e. C a i g he i di id al i ake i h he M Pla e.g eb i e.
31. Which f he f ll i g i he acc a e eflec i f a i di id al f d i ake?
ANS: B
A food diary is recorded as it happens, making this method the most accurate reflection of an i di id al f d i ake.
TOP: Discipline: Physiology MSC: Organ System: General a. Ascorbic acid b. Vitamin B12 c. Folate d. Carbohydrates e. Vitamin K
32. Deficiency of which of the following is a concern in the vegetarian diet?
ANS: B
The nutrients that may be deficient in a vegetarian diet if not carefully planned include proteins, calcium, iron, vitamin B12, and vitamin D.
TOP: Discipline: Physiology MSC: Organ System: General
33. M i i g a a ie ai -to-hip ratio provides data concerning: a. daily caloric requirements. b. lung capacity. c. stomach cancer risk. d. cardiovascular disease risk. e. developing an eating disorder.
ANS: D
Waist-to-hip ratios may aid in predicting relative disease risk in terms of cardiovascular disease.
TOP: Discipline: Physiology MSC: Organ System: General a. Iron b. Thiamin c. Calcium d. Fat e. Alcohol
34. Which of the following is a macronutrient?
ANS: D
Carbohydrates, protein, and fat are referred to as macronutrients because they are required in large amounts. Even though alcohol also provides calories, it is not required for any physiologic process by the body.
TOP: Discipline: Physiology MSC: Organ System: General a. Insulin-like growth factor I (IGF-I) b. Leptin c. Growth hormone d. Somatostatin e. Ghrelin
35. Which of the following hormones has a key role in regulating body fat mass and is believed to be a trigger for puberty?
ANS: B
Leptin has a key role in regulating body fat mass, and its concentration is thought to be a trigger for puberty by informing the central nervous system that adequate nutritional status and body fat mass are present to support pubertal changes and growth.
TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine a. Adolescent and young adult women are affected. b. Patients may exercise excessively to lose weight. c. Refusal to maintain body weight at 85% of ideal body weight. d. Patients may abuse laxatives and diuretics. e. Patients have amenorrhea.
36. Which of the following characteristics can distinguish patients with anorexia from those with bulimia?
ANS: C
Bulimic individuals usually do not become malnourished (as occurs with anorexic patients) unless they drop to less than 85% of their weight.
TOP: Discipline: Behavioral Science MSC: Organ System: General
37. A major risk factor for developing an eating disorder is having: a. parents who stress academia and social acceptance. b. a first-degree relative with an eating disorder. c. siblings who are low academic achievers. d. parents who stress the importance of the food pyramid. e. parents in a lower socioeconomic group.
ANS: B
A major risk factor for an eating disorder is having a family history of eating disorders, especially in a first-degree relative.
TOP: Discipline: Behavioral Science MSC: Organ System: General a. 10% b. 25% c. 33% d. 50% e. 66%
38. What percentage of adults over age 20 are estimated to be obese in the United States?
ANS: C
In the United States it is estimated that more than one-third of adults older than 20 years are obese and more than two-thirds are overweight. Poor diet and physical inactivity (regardless of weight status) are associated with serious chronic diseases including type 2 diabetes, hypertension, cardiovascular disease, osteoporosis, and some types of cancer.
TOP: Discipline: Behavioral Science MSC: Organ System: General
Chapter 09: Skin, Hair, and Nails
Ball: Seidel G ide
Multiple Choice
1. The skin repairs epidermal wounds by: a. exaggerating cell replacement. b. excreting lactic acid. c. producing vitamins. d. providing a mechanical barrier. e. increasing the vascularity of the epidermis.
ANS: A
The i i e ce ha e a a id a e f e a d c a e e a , he eb e ab i g he skin to repair damaged surfaces. The epidermis is avascular and depends on the underlying dermis for its nutrition.
TOP: Discipline: Physiology
MSC: Organ System: Skin/Connective
2. The adipose tissue in the hypodermis serves to: a. provide sensory input. b. generate heat and insulate. c. create tensile strength. d. restrict water loss. e. secrete collagen.
ANS: B
The hypodermis layer consists of adipose tissue that serves to generate heat and to provide insulation, shock absorption, and a reserve of calories.
TOP: Discipline: Physiology
MSC: Organ System: Skin/Connective
3. The secretory activity of the sebaceous glands is stimulated by: a. body heat. b. ambient temperature. c. sex hormones. d. dietary protein. e. emotional stimuli.
ANS: C
The sebaceous glands, when stimulated by the sex hormones, become stimulated to produce a lipid-rich substance that keeps the skin moist.
TOP: Discipline: Physiology
MSC: Organ System: Skin/Connective a. Cuticle b. Paronychium c. Eponychium d. Nail bed e. Matrix
4. Which structure is the site of new nail growth?
ANS: E
The white, crescent-shaped area beyond the proximal nail fold (lunula) is the distal end of the nail matrix, which is the site of new nail growth.
TOP: Discipline: Physiology MSC: Organ System: Skin/Connective
5. Newborns are more vulnerable to hypothermia because of: a. the presence of coarse terminal hair. b. desquamation of the stratum corneum. c. their covering of vernix caseosa. d. a poorly developed subcutaneous fat layer. e. excessive secretion of eccrine sweat glands.
ANS: D
Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced ability to generate heat and become insulated from the environment. The eccrine sweat glands do not begin to function until after the first month of life.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
6. Normal hormone-related changes of adolescence include: a. increased oil production. b. the development of fine silky lanugo hair. c. depletion of apocrine glands. d. decreased sebaceous gland activity. e. slowed hair growth.
ANS: A
During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne.
TOP: Discipline: Physiology MSC: Organ System: Skin/Connective
7. Expected hair distribution changes in the older adults include: a. increased terminal hair follicles to the scalp. b. more prominent axillary and pubic hair production. c. i c ea ed e i a hai f ic e he ag f e ea . d. more prominent peripheral extremity hair production. e. women possibly developing less coarse facial hair.
ANS: C
The transition from vellus to terminal hair pattern occurs in older men at the nares and the tragus.
TOP: Discipline: Physiology MSC: Organ System: Skin/Connective
8. Brittle nails are typical findings in: a. adolescents. b. infants. c. pregnant patients. d. older adults. e. children.
ANS: D
Older adults typically have decreased peripheral circulation to the nails, causing the nails characteristically to develop longitudinal ridges that are more brittle and susceptible to splitting into layers.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
9. The nails of older adults grow slowly because of: a. decreased circulation. b. dietary deficiencies. c. fungal infections. d. low hormone levels. e. high estrogen levels.
ANS: A
Decreased circulation to the nails of older adults causes nail growth retardation.
TOP: Discipline: Physiology MSC: Organ System: Skin/Connective
10. Risk factors for skin cancer include: a. an olive complexion. b. repeated trauma or irritation to the skin. c. a history of allergic reactions to sunscreen. d. dark eyes and hair. e. pigmented bands in the nails.
ANS: B
Fair-skinned persons with light-colored eyes and repeated trauma or skin irritation have higher risk factor for skin cancer development. Pigmented bands in the nails are an expected finding in dark-skinned individuals.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
11. Inspection to determine color variations of the skin is best conducted: a. using an episcope. b. under fluorescent lighting. c. with illumination provided by daylight. d. i g a W d a . e. using a pen light.
ANS: C
Daylight provides the best illumination source for determining color variations of the skin.
TOP: Discipline: Physiology MSC: Organ System: Skin/Connective
12. Unusual white areas on the skin may be caused by: a. adrenal disease. b. polycythemia. c. vitiligo. d. Down syndrome. e. lentigo.
ANS: C
The absence of melanin produces unpigmented white areas known as vitiligo
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective a. Native Americans b. African Americans c. Mexican Americans d. Asians e. Eastern Europeans
13. Which cultural group has the lowest incidence of nevi?
ANS: B
Nevi are more common in persons who burn rather than tan; therefore, African Americans have the lowest rates of nevi.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective a. Whether she had unprotected sex b. If she has a history of diabetes mellitus c. Whether she has unusual bleeding problems d. If she eats a lot of yellow and orange vegetables e. If she has a family history of peripheral vascular disease
14. A 29-year-old white woman appears jaundiced. A cause of liver disease has been excluded. What history questions should the nurse ask?
ANS: D
In the absence of liver disease, another cause of jaundice is increased carotene pigmentation. Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin appear to be jaundiced; however, carotene pigmentation will not cause the sclera to turn yellow.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
15. A flat, nonpalpable lesion is described as a macule if the diameter is: a. greater than 1 cm. b. less than 1 cm. c. greater than 2 cm. d. too irregular to measure. e. exactly 5 mm.
ANS: B
A macule by definition is a flat, circumscribed area that is less than 1 cm in diameter. An example of a macular rash is measles.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
16. Skin turgor checks are performed to determine: a. the temperature of the skin. b. hydration status. c. skin texture. d. the extent of an ecchymosis. e. skin moisture.
ANS: B
Skin will remain tented if the patient is dehydrated or will not tent if edema is present.
TOP: Discipline: Physiology MSC: Organ System: Skin/Connective
17. Skin lesions are transilluminated to determine: a. vascular from nonvascular lesions. b. furuncles from folliculitis lesions. c. fluid-filled lesions in solid cysts or masses. d. herpes zoster from varicella. e. macules from papules.
ANS: C
Transillumination is used to determine the presence of fluid in cysts and masses. Fluid-filled lesions transilluminate with a red glow, but solid masses do not transilluminate. This technique does not differentiate the other choices.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
18. Fluorescing lesions are best distinguished using a(n): a. incandescent lamp. b. magnifying glass. c. transilluminator. d. W d a . e. halogen lamp.
ANS: D
Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow -green color under a W d a .
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
19. Women with terminal hair growth in a male distribution pattern should receive further evaluation for a(n): a. circulation condition. b. gastrointestinal disorder. c. inflammatory state. d. nutritional deficit. e. endocrine disorder.
ANS: E
Hirsutism in women (growth of terminal hair in a male distribution) can be a clinical sign of an endocrine disorder. Hair loss can be associated with poor circulation, inflammation, or nutritional deficits.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
20. T a ie i g f he a ie i i a c i a c fi di g i : a. menopausal women. b. newborn infants. c. pregnant patients. d. sedentary adults. e. older adults.
ANS: B
C i a a a, a ed a ea a ce, i a f a e b e e cha ge i temperature.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
21. A single transverse crease seen on the palm of a small child may imply: a. Down syndrome. b. Turner syndrome. c. systemic sclerosis. d. profound dehydration. e. neurofibromatosis.
ANS: A
A single transverse crease is seen on the palm of children with Down syndrome.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
22. Cafe au lait patches are numbered with each assessment of infants and young children because: a. their numbers are expected to increase each year. b. coalescent lesions are a more serious finding. c. the presence of more than six patches suggests neurofibromatosis. d. decreasing numbers are expected with growth. e. a higher number correlates with the development of erythema toxicum.
ANS: C
The presence of more than six patches with diameters of more than 5 mm in children younger than 5 years of age suggests neurofibromatosis. Fewer than five patches are usually considered harmless.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
23. Cherry angiomas are a common finding in: a. adults older than 30 years. b. newborns. c. pregnant patients. d. sunbathers. e. adolescents.
ANS: A
Cherry angiomas occur in virtually everyone older than 30 years and increase numerically with age.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
24. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: a. cutaneous tags from lentigines. b. furuncles from folliculitis. c. sebaceous hyperplasia from eczema. d. seborrheic keratoses from actinic keratoses. e. herpes zoster from varicella.
ANS: D
Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
25. The most common inflammatory skin condition is: a. cutis marmorata. b. eczematous dermatitis. c. intradermal nevus. d. pityriasis rosea. e. psoriasis.
ANS: B
The most common inflammatory skin disorder is eczematous dermatitis. Cutis marmorata and nevi are not inflammatory conditions, pityriasis rosea is not as common as eczema, and psoriasis is a disease of keratin synthesis.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
26. The characteristic that best differentiates psoriasis from other skin abnormalities is the: a. color of the scales. b. formation of tiny papules. c. general distribution over the body. d. recurrence. e. loss of hair.
ANS: A
Unlike other skin conditions, silvery papules and plaques characterize psoriasis.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
27. Painful vesicles are associated with: a. psoriasis. b. pityriasis rosea. c. paronychia. d. herpes zoster. e. rosacea.
ANS: D
Herpes zoster (shingles) produces painful itching or burning of the dermatome area. Psoriasis and pityriasis may itch. Paronychia infection and rosacea may be tender to touch and do not produce vesicles.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective a. Asymmetric borders b. Borders well demarcated c. Color of lesion is uniform d. Diameter less than 6 mm e. Severe blistering or sunburns as a child
28. Which of the following is an ABCD characteristic of malignant melanoma?
ANS: A
The ABCD melanoma mnemonic includes asymmetry, borders that are irregular, color that is not the same all over, and diameter greater than 6 mm and growing. Severe blistering or sunburns as a child is a risk factor and not part of the ABCD characteristics.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
29. The most common cutaneous neoplasm is: a. basal cell carcinoma. b. compound nevus. c. seborrheic keratosis. d. senile actinic keratosis. e. malignant melanoma.
ANS: A
Basal cell carcinoma is the most common form of skin cancer. It occurs more frequently on sun-exposed parts of the body.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective a. Recent bruising over both knees b. A healed laceration under the chin c. A bruise on the right shin with associated abrasion of tissue d. Bruises in various stages of resolution over body soft tissues e. A scab on the elbow
30. You are conducting a preschool examination on a 5-year-old child. Which injury would most likely raise your suspicion that the child was being abused?
ANS: D
Toddlers and older children who bruise themselves accidentally are bruised over bony prominences, such as the knees, elbows, chin, and shin. Bruises over soft tissues are more consistent with abuse.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
31. Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older adults indicates: a. sexual abuse. b. physical neglect. c. psychologic abuse. d. violated rights. e. financial abuse.
ANS: B
The question describes is the most common form of elder abuse physical neglect.
TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
Chapter 10: Lymphatic System
Multiple Choice
1. Which of the following organs does not have lymphatic vessels?
a. Brain b. Kidneys c. Liver d. Lungs e. Appendix
ANS: A
Lymphatic tissues are found abundantly throughout the body except in two places, the placenta and the brain (central nervous system).
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
2. The predominant formed elements of normal lymph fluid are: a. red blood cells. b. white blood cells. c. platelets. d. antigens. e. antibodies.
ANS: B
Lymph fluid is mostly composed of a variety of lymphocytes, minimal red blood cells, no platelets, and some antigens and antibodies according to its immune function.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
3. Cells that line the lymph node sinuses perform the specific function of: a. fat absorption. b. fetal immunization. c. hematopoiesis. d. platelet production. e. phagocytosis.
ANS: E
Lymph nodes defend against the invasion of microorganisms by phagocytosis.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
4. Lymph ducts merge into the venous system at the: a. portal vein. b. pulmonic vein. c. subclavian veins. d. vena cava. e. jugular veins.
ANS: C
The large ducts of the lymphatics merge into the venous system at the left and right subclavian veins.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
5. Lymph flows faster in response to: a. massage. b. decreased blood volume. c. decreased metabolic rate. d. decreased permeability of the capillary walls. e. decreased capillary pressure.
ANS: A
Lymph flow increases with mounting capillary pressure, greater permeability of the capillary walls, increased metabolic rate, and massage.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
6. An organ that is essential to the development of protective immune function in infants but has little or no demonstrated function in adults is the: a. spleen. b. appendix. c. thymus. d. pancreas. e. liver.
ANS: C
In adults, the thymus atrophies, and in older adults, it is replaced by fat and connective tissue.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid a. Occipital b. Anterior cervical c. Posterior cervical d. Femoral e. Supraclavicular
7. When enlarged, which lymph nodes are most likely to be a sign of malignancy?
ANS: E
Supraclavicular nodal enlargement is of special concern because it suggests a malignancy even in children; it may be the sentinel node of Hodgkin lymphoma.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
8. Lymphoid tissue normally regresses to adult size by: a. 2 years of age. b. 5 years of age. c. 10 years of age. d. puberty. e. the early 20s.
ANS: D
The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
9. A congenital defect in the immune system of a 2-week-old infant may be suspected if: a. there are small, palpable inguinal nodes. b. the umbilical cord has not yet dropped off. c. the tonsils are visible. d. the thymus is visible on a chest radiograph. e. the small postauricular nodes are palpable.
ANS: B
In some infants, delayed separation of the umbilical cord has been associated with abnormal granulocyte function.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
10. As adults age, their ability to resist infection decreases because of lymphatic nodes becoming more: a. hematopoietic. b. mucoid. c. porous. d. profuse. e. fibrotic.
ANS: E
Older ad l s l mph nodes diminish in bo h n mber and si e and are replaced i h more fibrotic and fatty tissues.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid a. Prostitution b. Hemophilia c. Intravenous drug use d. Working with AIDS patients e. Sexual contact with intravenous drug users
11. Which risk factor is least likely to result in contracting HIV?
ANS: D
As a work-related risk for HIV infection, providing health care is considered rare. Multiple and indiscriminate sexual contacts, hemophilia, and intravenous drug use carry higher rates of transmission of HIV.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid a. Shotty b. Movable c. Fixed d. Tender e. Matted
12. Which nodes are most often associated with inflammation?
ANS: D
Tenderness is almost always indicative of inflammation.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid a. Clavicle b. Cervical spine c. Sternocleidomastoid muscle d. Sternum e. Hyoid bone
13. Which landmark is the dividing line between the anterior and posterior cervical triangles?
ANS: C
The landmark dividing the anterior and posterior cervical triangles is the sternocleidomastoid muscle.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid a. Internal mammary b. Anterior axillary c. Deep cervical d. Supraclavicular e. Preauricular
14. Which nodes are also called Virchow nodes?
ANS: D
The supraclavicular nodes are also referred to as Virchow nodes.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
15. The harder and more discrete a node, the more likely a(n): a. innocent cause. b. infection. c. malignancy. d. metabolic disease. e. drug reaction.
ANS: C
Tender nodes almost always indicate the presence of an infection, but a hard, discrete, and nontender node is more likely to represent a malignancy.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
16. Normal supraclavicular lymph nodes are: a. clustered in a capsule. b. firm and discrete. c. less than 3 cm in diameter. d. not palpable. e. matted.
ANS: D
Supraclavicular nodes, when palpated, are a concern; normally, they are not palpable.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
17. Transillumination is done during an examination of the lymphatic system to: a. detect lymphatic pulsation. b. distinguish nodes from cysts. c. evaluate nodal contours. d. observe erythematous lesions. e. distinguish blood vessels from nodes.
ANS: B
Larger nodal masses should be transilluminated to determine whether the mass is a cyst, rather than a node. A cyst will transilluminate; a node will not.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid a. Extension of the extremity b. Circumduction of the extremity c. Abduction of the extremity d. Rotation of the extremity e. Flexion of the extremity
18. When examining lymph nodes near a joint in the arm or leg, which of the following maneuvers is likely to facilitate the examination?
ANS: E
Bending joint areas will ease taut tissues and allow for better accessibility to palpation.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
19. To palpate the inguinal nodes, you should have the patient: a. bend over a table and cough. b. lie supine, with the knees slightly flexed. c. lie supine, with the legs extended. d. stand with the back extended. e. lie prone, with the knees slightly flexed.
ANS: B
To palpate the inguinal nodes, you should have the patient lying supine, with the knees slightly flexed.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
20. It is not unusual to find postauricular and occipital nodes in: a. children younger than 2 years of age. b. school-age children. c. adolescents. d. adults. e. older adults.
ANS: A
Children younger than 2 years of age often have enlarged postauricular and occipital nodes.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
21. Obstruction of the nasopharynx, pulmonary hypertension, and risk of sleep apnea may be associated with excessively enlarged: a. branchial cleft cysts. b. cystic hygromas. c. palatine tonsils. d. thyroglossal duct cysts. e. lymphangiomas.
ANS: C
Palatine tonsil enlargement, grade 3+ to 4+, may obstruct the nasopharynx, which increases the risk of sleep apnea and, rarely, pulmonary hypertension. The other choices are congenital embryonic structures in the neck.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
22. The most important clue to the diagnosis of a child with an immunodeficiency disease is: a. family history. b. illness in siblings. c. previous hospitalizations. d. serious recurring infections. e. cervical adenitis.
ANS: D
Although family history, illness in siblings, and previous hospitalizations are helpful clues to discover an immunodeficiency in a child, it is most important to review the occurrence of serious, uncommon infections such as Pneumocystis jirovecii and other fungal infections that do not respond as expected to therapy.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
23. A red streak that follows the course of the lymphatic collecting duct is a finding associated with: a. Hodgkin lymphoma. b. lymphangitis. c. lymphedema. d. non-Hodgkin lymphoma. e. roseola infantum.
ANS: B
Lymphangitis, inflammation of the lymphatic vessels, is evident by a red streak that follows the course of the inflamed lymphatic duct. Hodgkin lymphoma and non-Hodgkin lymphoma refer to malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling that distinguishes itself from interstitial edema because it does not pit. Roseola is a common early childhood viral illness that may present with occipital and postauricular adenopathy.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
24. To find the infection site associated with acute lymphangitis, the examiner should look to the inflammation. a. proximal b. distal c. contralateral d. anterior e. posterior
ANS: B
The red streak of inflammation will follow the direction (proximal) of lymphatic flow, away from the periphery, and with the infection site distal to the streak.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
25. The most common causes of acute suppurative lymphadenitis are: a. HIV and herpes zoster. b. Haemophilus influenzae and adenovirus. c. herpes simplex type 1 and type 2. d. streptococcal and staphylococcal organisms. e. mumps.
ANS: D
Group A beta-hemolytic streptococci and coagulase-positive staphylococci are the most common organisms responsible for suppurative (pus-forming) lymphadenitis. The other choices do not result in suppurative lymphadenitis.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid a. Retropharyngeal abscess b. Streptococcal pharyngitis c. Mononucleosis d. Toxoplasmosis e. Herpes simplex
26. Which disorder is characterized by a single node that is chronically enlarged and nontender in a patient with no other symptoms?
ANS: D
Toxoplasmosis is displayed as a chronically enlarged, nontender, single node usually in the posterior cervical chain.
TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
27. Initial signs and symptoms of Epstein-Barr virus mononucleosis most often include: a. pharyngitis, fever, and malaise. b. bleeding gums and spontaneous nosebleeds. c. headache, visual disturbance, and rash. d. inguinal adenopathy and painful urination. e. discrete labial and gingival ulcers and high-grade fever.
ANS: A
Presenting symptoms of Epstein-Barr virus mononucleosis include pharyngitis, fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly or rash.
TOP: Discipline: Immunology
MSC: Organ System: Hematopoietic/Lymphoid
28. Serum sickness is usually characterized first by the appearance of: a. diffuse lymph node enlargement. b. joint pain. c. urticaria. d. fever. e. a single enlarged posterior cervical node.
ANS: C
Urticaria is the first reaction of serum sickness followed by lymphadenopathy, joint pain, fever, and facial edema.
TOP: Discipline: Immunology
MSC: Organ System: Hematopoietic/Lymphoid
Chapter 11: Head and Neck
Multiple Choice
1. Which cranial nerves innervate the face?
a. II and V b. III and VI c. V and VII d. VIII and IX e. I and VII
ANS: C
Facial nerves are controlled by cranial nerves V and VII, cranial nerve I involves smell, cranial nerves II, III, and VI control the eyes, cranial nerve VIII deals with hearing, and cranial nerve IX deals with swallowing.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. anterior b. posterior c. lateral d. medial e. ventral
2. The trapezius and sternocleidomastoid muscles and the clavicle form a landmark called the _____ triangle.
ANS: B
Anatomically, these landmarks comprise what is referred to as the posterior triangle, which includes the posterior cervical lymph nodes. The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal a. dorsal b. posterior c. lateral d. medial e. anterior
3. The medial border of the sternocleidomastoid muscles and the mandible form the _____ triangle.
ANS: E
The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The trapezius, sternocleidomastoid muscles, and clavicle form the posterior triangle. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal a. anterior b. posterior c. lateral d. medial e. ventral
4. The largest endocrine gland in the body lies in the _____ triangle.
ANS: A
The thyroid gland is the largest endocrine gland and lies in the anterior triangle. The posterior triangle does contain cervical lymph nodes, and the lateral and medial triangles are not anatomic landmarks.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal a. Coronal sutures b. Hyoid and cricoid cartilages c. Mandible and maxilla bones d. Nose and thyroid cartilages e. Mastoid processes and ears
5. Which structures disproportionately enlarge in males during adolescence?
ANS: D
In adolescent males, the nose enlarges, and the thyroid cartilage becomes the largest component of the anterior larynx, known as the Adam apple.
TOP: Discipline: Physiology MSC: Organ System: General
6. When examining the skull of a 4-month-old baby, you should normally find: a. closure of the anterior fontanel. b. closure of the posterior fontanel. c. ossification of the all sutures. d. overlap of the cranial bones. e. closure of the sagittal and coronal sutures.
ANS: B
At 2 months of age, the posterior fontanels should be closed or ossified with the anterior fontanels, a larger fontanel, closing at 12 to 15 months. The only time the cranial bones should overlap is during a vaginal birth as a result of pressure within the birth canal. Ossification of the sutures begins after completion of brain growt h, at about 6 years of age, and is finished by adulthood.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
7. The thyroid gland is partially obscured by the: a. cricoid cartilage. b. carotid artery. c. external jugular. d. sternocleidomastoid. e. hyoid bone.
ANS: D
The thyroid sits just below the cricoid, an anatomic landmark for location of the thyroid; the lobes curve are somewhat hidden by the sternocleidomastoid muscle.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
8. The brown or tan pigmentation on the forehead, nose, and malar prominence of some pregnant women is called: a. hormonal acne. b. erythema. c. alopecia. d. chloasma. e. craniotabes.
ANS: D
Chloasma, brown or tan facial pigmentation during pregnancy, fades after delivery. Hormonal acne and erythema do not result in brown or tan pigmentation, and alopecia is loss of hair. Craniotabes is a softening of the outer table of the skull of an infant, often associated with rickets and hydrocephalus.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
9. A bruit heard over the thyroid is suggestive of: a. hypothyroidism. b. hyperthyroidism. c. thyroid cancer. d. thyroid cyst. e. thyroid nodule.
ANS: B
Because of hypermetabolic states such as hyperthyroidism, a bruit may be heard as a result of the increased blood flow to the area. Auscultating a bruit is not symptomatic of hypothyroidism, cancer, or a cyst. A nodule is more indicative of cancer.
TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine a. A degenerative process may be developing. b. A peripheral trigeminal nerve problem exists. c. Asymmetry of body sides is a normal finding. d. Visual and hearing problems will be present. e. Facial nerve paralysis may be present.
10. What is the significance of a patient with asymmetry of the entire side of the face?
ANS: E
When the entire side of the face is asymmetrical, facial nerve paralysis may be the cause. When asymmetry is concentrated only to the lower portion of the face, weakness of the nerves in this area may be present; if the mouth is asymmetric, there may be an existing trigeminal nerve dysfunction. Degenerative processes are more correlated with facial spasms. Visual and hearing problems may result in a patient turning his or her head to one side to favor the good eye or ear.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. Hypothyroidism b. Diabetes mellitus c. Addison disease d. Cushing syndrome e. Fetal alcohol syndrome
11. Coarse, dry, and brittle hair is associated with which metabolic disorder?
ANS: A
Hypothyroidism affects hair texture, resulting in coarse, dry, and brittle changes.
TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine a. Flexed away from the side being examined b. Flexed directly forward c. Flexed toward the side being examined d. Hyperextended directly backward e. Rotated away from the side being examined
12. Which is the best wa to position a patient s neck for palpation of the th roid?
ANS: C
The patient should be positioned so that the sternocleidomastoid muscle is relaxed and the thyroid is easier to palpate. This is done by having the patient flex the neck slightly forward and laterally toward the side being examined.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
13. A stethoscope is used in a head and neck examination to assess: a. intracranial fluid. b. pulsating fontanels. c. skull bone development. d. thyroid vascular sounds. e. parotid glands.
ANS: D
Although the skull is not routinely auscultated, the neck is auscultated using the bell of the stethoscope at the thyroid gland to screen for states of hypermetabolism that have increased with blood supply and produce bruits.
TOP: Discipline: Gross Anatomy MSC: Organ System: General
14. Tracheal tug suggests the presence of a(n): a. enlarged thyroid. b. swallowing disorder. c. aortic aneurysm. d. thoracic carcinoma. e. hyperparathyroidism.
ANS: C
When palpating the trachea, an ominous sign of an aortic aneurysm is a tugging sensation in sync with the pulse of the patient. An enlarged thyroid, swallowing disorder, hyperparathyroidism, or thoracic carcinoma would not produce a tracheal tug.
TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory
15. The thyroid gland should: a. be slightly left of midline. b. have a clear vascular sound. c. feel nodular. d. tug with each heartbeat. e. move when the patient swallows.
ANS: E
It is a normal finding for the thyroid gland to move with swallowing; however, being off center may indicate a nodular growth or enlargement. Vascular sounds indicate hypermetabolic states such as hyperthyroidism, and a tug with each heartbeat is a sign of an aortic aneurysm. The consistency of the thyroid should be firm but pliable, not nodular.
TOP: Discipline: Gross Anatomy MSC: Organ System: Endocrine
16. You are palpating a patient s th roid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data indicate: a. a congenital anomaly. b. a normal thyroid gland. c. a multinodular goiter. d. thyroiditis. e. a hypothyroid goiter.
ANS: B
The situation described is most likely a normal finding; the right lobe of the thyroid gland is typically 25% larger than the left and measures 4 cm. The other choices produce enlargements beyond these normal findings.
TOP: Discipline: Gross Anatomy MSC: Organ System: Endocrine
17. The most common form of birth trauma of the scalp is: a. caput succedaneum. b. cephalhematoma. c. cranial bossing. d. torticollis. e. dilated scalp veins.
ANS: A
Caput succedaneum as a result of birth trauma causes swelling of the scalp. The swelling can cross the suture lines. Cephalohematoma is a hematoma under the skull, and cranial bossing is compensatory growth of the skull related to craniosynostosis. Torticollis involves the neck. Dilated scalp veins and a head circumference increasing faster than expected may indicate increased intracranial pressure.
TOP: Discipline: Gross Anatomy MSC: Organ System: Skin/Connective a. It is a subperiosteal collection of blood. b. It is firm and its edges are well defined. c. It develops several days after delivery. d. It is seen over the presenting part of the head. e. It is a head circumference increasing faster than expected.
18. Which of the following is true regarding caput succedaneum?
ANS: D
Caput succedaneum is subcutaneous edema seen over the presenting part of the head during delivery as the skull passes through the pelvis; the scalp usually feels edematous to touch, which fades after a few days.
TOP: Discipline: Gross Anatomy MSC: Organ System: Skin/Connective a. It is bound by suture lines. b. The affected part feels soft. c. It is obvious at birth. d. The margins are poorly defined. e. It never feels fluctuant on palpation.
19. Which of the following is true regarding cephalhematoma?
ANS: A
The condition is subperiosteal, under the bone, and is contained by the margins of the suture lines; it does not cross the suture line. It is often unnoticed at birth and typically feels firm with its edges well defined. As it ages, it may liquefy and become fluctuant on palpation.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
20. When noting a bulging fontanel with marked pulsations in a 6-month-old infant, you suspect: a. normal development. b. Down syndrome. c. increased intracranial pressure. d. fever response to a viral infection. e. cephalhematoma.
ANS: C
A bulging fontanel with pulsations suggests increased intracranial pressure. A normal fontanel feels slightly depressed with mild pulsations.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous a. Classic migraine b. Temporal arteritis c. Muscular tension d. Hypertensive e. Cluster
21. Which type of headache occurs at night, is precipitated by alcohol consumption, and occurs more often in men than in women?
ANS: E
Cluster headaches are usually unilateral and occur at night; they are associated with alcohol consumption and have a higher prevalence in men. Classic migraine, temporal arteritis, muscular tension, and hypertensive headaches do not meet these criteria.
TOP: Discipline: Neuroscience MSC: Organ System: Nervous
22. RJ presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a: a. torticollis. b. branchial cleft cyst. c. Stensen duct stone. d. thyroglossal duct cyst. e. parotid gland tumor.
ANS: D
A thyroglossal duct cyst presents as a freely movable mass at the base of the tongue. Torticollis is associated with the sternocleidomastoid muscle. A parotid gland tumor occurs around the ear and cheek bone area, a branchial cleft cyst occurs around the lateral neck area, and a Stensen duct stone occurs in the parotid duct.
TOP: Discipline: Gross Anatomy MSC: Organ System: General
23. Moist skin with fine hair, prominent eyes, eyelid retraction, and a staring expression are characteristics associated with: a. Cushing syndrome. b. Graves disease. c. myxedema. d. systemic lupus erythematosus. e. Hippocratic facies.
ANS: B
Skin problems along with changes in hair, protruding eyes, and a glazed look are symptoms associated with Graves disease or hyperthyroidism. Myxedema is a condition of hypothyroidism. Cushing syndrome is characterized by plump skin around the face, and lup us usually presents with a rash around the face. Hippocratic facies is usually seen in the terminal stages of illness; the skin is dry and rough.
TOP: Discipline: Pathophysiology MSC: Organ System: Endocrine a. Corneal clouding b. Eye slanting c. Mild ptosis d. Symmetric bulging fontanels e. Maxillary hypoplasia
24. Which of the following findings would be consistent with fetal alcohol syndrome?
ANS: C
With fetal alcohol syndrome (FAS), classic findings include a poorly formed or flat philtrum, widespread eyes with inner epicanthal folds and mild ptosis, a hirsute forehead, a short nose, a relatively thin upper lip, and small eye openings. Corneal clouding is seen with Hurler syndrome, eye slanting is seen in Down syndrome, and bulging fontanels are seen in hydrocephalus. Maxillary hypoplasia is seen with several congenital syndromes, but not FAS.
TOP: Discipline: Pathophysiology MSC: Organ System: General
25. The premature union of cranial sutures that involves the shape of the head without mental retardation is: a. craniosynostosis. b. encephalocele. c. microcephaly. d. myxedema. e. fetal alcohol syndrome.
ANS: A
With craniosynostosis, the cranial sutures fuse prematurely, causing a misshapen head, but this does not involve mental retardation. Encephalocele, microcephaly, and fetal alcohol syndrome all involve mental retardation, and myxedema is a condition of hyperthyroidism.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
26. All of the following are recommendations of the American Academy of Pediatrics to reduce the risk of sleep-related infant deaths including SIDS except: a. firm sleep surface. b. breast-feeding. c. routine immunizations. d. prone sleeping position. e. avoidance of tobacco smoke.
ANS: D
The recommendations include supine positioning ( Back to Sleep ), use of a firm sleep surface, breast-feeding, room-sharing without bed-sharing, routine immunizations, consideration of pacifier use, as well as avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
Multiple Choice
1. Contraction or relaxation of the ciliary body: a. allows voluntary blinking. b. changes lens thickness. c. regulates peripheral vision. d. sends light impulses to the brain. e. regulates tear production.
ANS: B
The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a chang e in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body.
TOP: Discipline: Physiology MSC: Organ System: Nervous
2. Term infants have a visual acuity of about: a. 20/20. b. 20/100. c. 20/200. d. 20/300. e. 20/400.
ANS: E
Term infants are hyperopic, with a visual acuity of less than 20/400.
TOP: Discipline: Physiology MSC: Organ System: Nervous a. At birth b. 2 months c. 6 months d. 12 months e. 16 months
3. At what age does an infant usually develop the ability to distinguish color?
ANS: C
By 6 months of age, vision has developed so that colors can be differentiated.
TOP: Discipline: Physiology
MSC: Organ System: Nervous a. Adolescence b. Childhood c. Infancy d. Pregnancy e. Older adults
4. An increased level of lysozyme in the tears will occur normally during which life stage?
ANS: D
Because of rising hormonal levels, lysozyme is present in an increased amount in the tears during pregnancy. Tears are not affected by increased lysozyme at any other stage in life.
TOP: Discipline: Physiology MSC: Organ System: Nervous a. Macular degeneration b. Papilledema c. Subconjunctival hemorrhage d. Cupping of the optic disc e. Presbyopia
5. Which of the following is a relatively benign condition that may occur during pregnancy or labor?
ANS: C
Because of falling intraocular pressure during the late stages of pregnancy, hemorrhages may occur in the conjunctiva and resolve spontaneously. Papilledema is never a benign condition, and presbyopia, macular degeneration, and cupping of the optic disc occur in older adults.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
6. A condition that typically develops by the age of 45 years is: a. presbyopia. b. hyperopia. c. myopia. d. astigmatism. e. cataracts.
ANS: A
By 45 years of age, a condition known as presbyopia develops that involves a weakening of accommodation. Hyperopia occurs in early infancy; myopia and astigmatism can occur at any time. Cataracts generally develop in older adults.
TOP: Discipline: Physiology MSC: Organ System: Nervous a. Difficulty tracking objects with the eyes b. Appearing to have better peripheral than central vision c. Blinking when bright light is directed at face d. White pupils on photographs e. The appearance of convergence
7. Which of the following findings, when seen in an infant, is most ominous?
ANS: D
The absence of a red reflex, either by physical examination or by white pupils with flash photography, is indicative of retinoblastoma, a serious retina tumor. The other choices are expected at this age.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous a. Constrictive iritis b. Retinoblastoma c. Oval pupils d. Retinal hemorrhages e. Maculates
8. Which of the following is a genetic eye disorder that should be included in the history and physical examination, under family history, for all members of the affected family?
ANS: B
Retinal cancer, or retinoblastoma, is a tumor originating from the retina and often occurs during the first 24 months of life. It has been found to be caused by an autosomal trait or a mutation of the chromosomes. Constrictive iritis, maculates, oval pupils, and retinal hemorrhages are not autosomal dominant disorders.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
9. Mr. C s visual acuity is 20/50. This means that he: a. can see 50% of what the average person sees at 20 feet. b. has perfect vision when tested at 50 feet. c. can see 20% of the letters on the chart s 20/50 line. d. can read letters while standing 20 feet from the chart that the average person could read at 50 feet. e. is legally blind.
ANS: D
Visual acuity is measured as a fraction in which the top number is the distance that the patient is standing from the chart and the bottom number is the distance that an average person can stand and still read the line. Vision not correctable to better than 20/200 is considered legal blindness.
TOP: Discipline: Physiology MSC: Organ System: Nervous a. Confrontation b. Pupillary reaction c. Accommodation d. Snellen E chart e. Swinging flashlight
10. Peripheral vision can be estimated by means of which test?
ANS: A
The confrontation test measures peripheral vision. The examiner sits or stands across from the patient and asks the patient to close one eye while the examiner closes the opposite eye. The examiner then proceeds to wave the fingers while moving the extended arms from a lateral to a central position along both the temporal and the nasal fields. The pupillary reaction test is done b observing the pupil s response to light. The accommodation test deals with pupil reaction to light, and the Snellen E chart measures visual acuity. The swinging flashlight test evaluates the health of the optic nerve by looking for an afferent pupillary defect.
TOP: Discipline: Physiology
MSC: Organ System: Nervous
11. The criterion for adequac of a patient s visual field is: a. the ability to discriminate primary colors. b. the ability to discriminate details. c. correspondence with the visual field of the examiner. d. distance vision equal to that of an average person. e. pupillary constriction when an object is moved close to the nose.
ANS: C
The examiner continuously compares his or her own peripheral vision with that of the patient while performing the confrontation test, so unless the examiner is aware of a problem with his or her own vision, the examiner could assume that the fields are full if they match. The confrontation test does not assess colors, details, or distance vision. Having a patient look at a distant object and then one held 10 cm from the nose tests the pupillary response to accommodation.
TOP: Discipline: Physiology MSC: Organ System: Nervous
12. Periorbital edema is: a. an abnormal sign. b. expected with aging. c. more common in males. d. present in children. e. an abnormality of lipid metabolism.
ANS: A
A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise.
TOP: Discipline: Pathophysiology MSC: Organ System: General
13. Xanthelasma may suggest that the patient has an abnormality of: a. lipid metabolism. b. cognitive function. c. renal metabolism. d. bone marrow function. e. thyroid disease.
ANS: A
Small, odd-shaped, yellow-colored plaques around the eyes are actually lipid deposits and are characteristics of a lipid metabolism problem. The other conditions are not associated with eye plaques.
TOP: Discipline: Pathophysiology MSC: Organ System: General
14. Ptosis may be secondary to: a. blepharitis. b. hyperthyroidism. c. psoriasis. d. paresis of a branch of cranial nerve III. e. entropion.
ANS: D
Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthalmos, psoriasis is a skin condition, and blepharitis is a crusting of the eyelashes. Entropion is an inversion of the lower eyelid.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
15. Entropion implies that the eyelid is: a. drooping. b. everted. c. edematous. d. turned inward. e. inflamed.
ANS: D
Entropion of the lower eyelid does not imply drooping, eversion, inflammation, or edema but is a slight inward turn of the lower eyelid.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
16. A condition in which the eyelids do not completely meet to cover the globe is called: a. glaucoma. b. lagophthalmos. c. exophthalmos. d. hordeolum. e. blepharitis.
ANS: B
Lagophthalmos is a term used to describe the condition in which the eyelids do not completely meet when closing. Glaucoma involves the optic nerve, exophthalmos involves bulging eyes, and hordeolum is better known as a sty. Blepharitis is crusting along the eyelashes, which can have several causes.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
17. An allergy can cause the conjunctiva to have a: a. cobblestone pattern. b. dry surface. c. subconjunctival hemorrhage. d. rust-colored pigment. e. pale appearance.
ANS: A
A red or cobblestone pattern, especially to the upper conjunctiva, indicates an allergic conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment.
TOP: Discipline: Pathophysiology MSC: Organ System: General
18. A pterygium is more common in people heavily exposed to: a. high altitudes. b. tuberculosis. c. ultraviolet light. d. cigarette smoke. e. lead.
ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to pterygium developments. High altitudes, tuberculosis, lead, and cigarette smoke do not cause an overgrowth of the conjunctiva.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
19. Mr. B was admitted from the emergency department, and you are completing his physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been: a. in a coma. b. taking sympathomimetic drugs (e.g., cocaine). c. taking opioid drugs (e.g., morphine). d. treated for head trauma. e. atropine overdosed.
ANS: C
Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or drops for glaucoma. Pupils are usually dilated greater than 6 mm in a coma and with sympathomimetic drugs, atropine, and head trauma.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
20. You observe a pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for: a. confrontation reaction. b. accommodation. c. pupillary light reflex. d. nystagmus. e. corneal arcus senilis.
ANS: B
Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then look at another object much closer (pupils constrict). The other choices do not test for accommodation.
TOP: Discipline: Physiology MSC: Organ System: Nervous
21. Mydriasis accompanies: a. coma. b. diabetes. c. hyperopia. d. astigmatism. e. morphine administration.
ANS: A
Coma patients always have mydriasis, which occurs when the pupils are dilated more than 6 mm. Diabetes may cause a coma but not mydriasis. Hyperopia is a condition of infants, describing their visual acuity as at or worse than 20/400. Astigmatism affects t he shape of the lens, not the pupils. Opiates cause miosis.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
22. When inspecting the region of the lacrimal gland, palpate: a. the lower orbital rim near the inner canthus. b. in the area between the arch of the eyebrow and the upper eyelid. c. beneath the lower eyelid adjacent to the inner canthus. d. adjacent to the lateral aspect of the eye, just beneath the upper eyelid. e. medially above the eyebrow.
ANS: A
The lacrimal gland is located in the area between the arch of the eyebrow and the upper lid. The lacrimal sac is located in the corner of the eye closest to the nose near the inner canthus.
TOP: Discipline: Physiology MSC: Organ System: General
23. To see retinal details in a patient with myopia, the examiner will need to: a. adjust the ophthalmoscope into the plus lenses. b. move the ophthalmoscope backward. c. move the hand farther forward. d. examine the patient in a well-lighted room. e. turn the ophthalmoscope to a minus lens.
ANS: E
A patient with myopia (nearsighted) has longer eyeballs, so light rays focus in front of the retina. To see the retina, the examiner should use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a patient with hyperopia, a plus lens should be used.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
24. The unit of measurement in describing lesion size and location on the fundus is the: a. disc diameter. b. macular diameter. c. pupillary diameter. d. centimeter. e. diopter.
ANS: A
When examining the eye and the fundus comes into focus, the branching of blood vessels becomes apparent. These always branch away from the optic disc and can be used as landmarks to locate the optic disc. The disc itself measures about 1.5 mm in diameter and the disc diameter is therefore the unit of measurement used to describe lesion size and location on the fundus.
TOP: Discipline: Physiology MSC: Organ System: Nervous
25. Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the: a. retina. b. lens. c. retinal vessels. d. macula. e. optic disc.
ANS: D
The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light.
TOP: Discipline: Physiology MSC: Organ System: Nervous
26. After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate the optic disc. You should: a. follow the vessel as it branches out. b. have the patient move his or her eye laterally. c. have the patient move his or her eye up. d. have the patient move his or her eye down. e. follow the vessel as it converges into larger vessels.
ANS: E
When you locate a vessel, follow it in the direction of the optic disc. Vessels nearer the disc are directionally toward the nose, are larger, and have less branching.
TOP: Discipline: Physiology MSC: Organ System: Nervous
27. If a patient has early papilledema, the examiner will be able to detect: a. dilated retinal veins. b. retinal vein pulsations. c. sharply defined optic discs. d. visual defects. e. narrowed retinal veins.
ANS: A
Papilledema is caused by increased intracranial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. On examination, papilledema is characterized by loss of definition of the optic disc. Vein pulsations and visual defects are not visible with an ophthalmoscope.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
28. Cupping of the optic disc may be a result of: a. migraine headaches. b. diabetes. c. glaucoma. d. dehydration. e. cataracts.
ANS: C
Cupping is seen with causes of increased intraocular pressure such as glaucoma. Migraine headaches and dehydration do not cause cupping of the optic disc. Diabetes results in cotton wool patches and hemorrhages. Cataracts are clouding of the lens.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
29. Drusen bodies are most commonly a consequence of: a. glaucoma. b. aging. c. presbyopia. d. papilledema. e. hypertension.
ANS: B
Drusen bodies, or lesions or spots on the retina, are part of the aging process. Glaucoma, presbyopia, and papilledema do not present with spots on the retina. Retinal hemorrhages and cotton wool spots are associated with hypertensive retinopathy.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
30. Cotton wool spots are most closely associated with: a. glaucoma. b. normal aging processes. c. hypertension. d. eye trauma. e. hyperthyroidism.
ANS: C
Cotton wool spots actually represent infarcts of the retina and are associated with hypertension or diabetes. Hyperthyroidism, glaucoma, and eye trauma do not present with cotton wool spots.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
31. White specks scattered in a linear pattern around the entire circumference of the iris are called: a. drusen bodies. b. cotton wool spots. c. rust spots. d. Brushfield spots. e. band keratopathy.
ANS: D
Brushfield spots strongly suggest Down syndrome or mental retardation and are characterized by white specks that align perfectly around the circumference of the iris. Drusen bodies, cotton wool spots, band keratopathy, and rust spots are not associated with mental retardation.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
32. Opacities of the red reflex may indicate the presence of: a. hypertension. b. hydrocephalus. c. cataracts. d. myopia. e. diabetes.
ANS: C
Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in newborns. Opacities or dark spots of the red reflex are not associated with hypertension, diabetes, hydrocephalus, or myopia.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous a. Have the woman keep her eyes closed for several minutes. b. Instill half the usual dosage. c. Keep the patient supine. d. Use nasolacrimal occlusion after instillation. e. Have the patient keep her head turned and flexed.
33. What maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic agents when examining a pregnant patient if the examination is mandatory?
ANS: D
To reduce absorption systemically, the examiner may use the nasolacrimal occlusion after application, which involves pinching the upper bridge of the nose. Keeping the eyes closed, instilling half of the usual dosage, and having the patient position her head a certain way will not prevent absorption through the nasal membranes.
TOP: Discipline: Physiology MSC: Organ System: Nervous
34. Episcleritis may indicate: a. lipid abnormalities. b. an autoimmune disorder. c. an anaphylactoid reaction. d. severe anemia. e. thyroid disease.
ANS: B
Episcleritis is an inflammation of the sclera, involves purplish bumps, and is commonly associated with autoimmune disorder. Lipid abnormalities, anaphylactoid reactions, anemia, and thyroid disease are not associated with these symptoms.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
35. Horner syndrome is manifested by: a. proptosis and contralateral mydriasis. b. excessive watering of the eyes. c. blurring of vision when glucose levels fall. d. ipsilateral miosis and mild ptosis. e. band keratopathy and miosis.
ANS: D
Horner syndrome is characterized by mild pupil constriction and drooping of the upper eyelid of the same eye. Horner syndrome is a result of a break in the sympathetic nerve supply to that eye. Mydriasis involves enlarged pupils. Watering of the eyes and blurred vision are not affected by a disruption in the sympathetic nervous system. Band keratopathy is a result of chronic corneal disease and is not associated with Horner syndrome.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
36. Dot hemorrhages, or microaneurysms, and the presence of hard and soft exudates are most commonly seen in: a. Down syndrome. b. diabetic retinopathy. c. systemic lupus. d. glaucoma. e. retinitis pigmentosa.
ANS: B
Dot hemorrhages or tiny aneurysms are characteristics of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages. Aneurysms in the retina are not symptoms of Down syndrome, lupus, glaucoma, or retinitis pigmentosa
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
37. Changes seen in proliferative diabetic retinopathy are the result of: a. anoxic stimulation. b. macular damage. c. papilledema. d. minute hemorrhages. e. chorioretinal scarring.
ANS: A
New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply because of failing capillaries causes new vessel growth. Macular damage, papilledema, chorioretinal inflammation, and resultant scarring do not involve new inadequate vessel growth.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
38. Bone spicule pigmentation is a hallmark of: a. chorioretinal pigmentosa. b. cytomegalovirus infection. c. lipemia retinalis. d. retinitis pigmentosa. e. choroidal nevus.
ANS: D
Retinitis pigmentosa is inherited night blindness, characterized by the hallmark pigmentation of the peripheral fields or bone spicules.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
39. Retinal hemorrhages in an infant require investigation for: a. retinoblastoma. b. retrolental fibroplasia. c. pituitary tumor. d. child abuse. e. strabismus.
ANS: D
Beyond newborn age, any hemorrhages to the retina indicate infection, allergy, or trauma and should be further investigated. Retinoblastoma, retrolental fibroplasia, pituitary tumors, and strabismus are not associated with retinal hemorrhages.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
Chapter 13: Ears, Nose, and Throat
Multiple Choice
1. The middle ear contains the: a. cerumen and sebaceous glands. b. umbo and malleus. c. vestibule and cochlea. d. pars tensa and semicircular canals. e. helix and antihelix.
ANS: B
The middle ear contains the ossicles, which are three small bones: the malleus (the umbo is part of the malleus), the incus, and the stapes. The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa. Cerumen and sebaceous glands lie outside the middle ear; the semicircular canals, vestibule, and cochlea lie in the inner ear. The helix and antihelix are parts of the auricle.
TOP: Discipline: Gross Anatomy MSC: Organ System: General
2. The hair cells of Corti and membrane of Corti: a. maintain equilibrium. b. protect the ear from foreign particles. c. stimulate the eighth cranial nerve. d. transmit vibrations to the ossicles. e. produce a waxy lubricant.
ANS: C
Vibrations from the tympanic membrane cause the delicate hair cells of the organ of Corti to strike against the membrane of Corti, stimulating impulses in the sensory endings of the auditory division of the eighth cranial nerve.
TOP: Discipline: Physiology MSC: Organ System: Nervous a. Eustachian tube b. Inner ear c. Semicircular canals d. Triangular fossa e. Oval window
3. Which ear structure is responsible for equalizing atmospheric pressure when swallowing, sneezing, and yawning?
ANS: A
The eustachian tube is a cartilaginous and bony passageway between the nasopharynx and the middle ear that opens briefly to equalize the middle ear pressure with that of the atmospheric pressure when swallowing, yawning, or sneezing.
TOP: Discipline: Physiology MSC: Organ System: General
4. A 30-year-old woman presents with rapid swelling beneath her jaw that suddenly appears while she is eating. The swelling is mildly painful but is not hot or red. You suspect Wharton salivary duct stones and proceed to palpate: a. bilaterally along the buccal mucosa. b. under the tongue, along each side of the frenulum. c. dorsum of the tongue. d. beside the gingivae near each molar. e. along the roof of the mouth.
ANS: B
The vast majority of these stones occur in the Wharton duct from the submaxillary gland, which can be palpated along each side of the frenulum under the tongue.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
5. An infant s auditor canal, hen compared ith an adult s, is: a. short, narrow, and straight. b. short and curved upward. c. long, narrow, and curved forward. d. short and curved downward. e. long, wide, and straight.
ANS: B
Compared ith an adult s, the infant s auditor canal is shorter and has an up ard cur e, which is why pulling the pinna down straightens the canal.
TOP: Discipline: Gross Anatomy MSC: Organ System: General
6. When e amining an infant s middle ear, the practitioner should use one hand to stabili e the otoscope against the head while using the other hand to: a. pull the auricle down and back. b. hold the speculum in the canal. c. distract the infant. d. stabilize the chest. e. pull the auricle up.
ANS: A
You should use your other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal.
TOP: Discipline: Physiology MSC: Organ System: General
7. The pregnant patient can expect to experience: a. more nasal stuffiness. b. a sensitive sense of smell. c. drooling. d. enhanced hearing. e. decreased vascularity of the gums.
ANS: A
Physiologic changes of pregnancy include nasal stuffiness, a decreased sense of smell, impaired hearing, epistaxis, and a sense of fullness in the ears. Increased vascularity and proliferation of connective tissue of the gums also may occur.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Adolescence b. Infancy c. Menopause d. Pregnancy e. Childhood
8. During what developmental stage are hoarseness, voice cracking, and a persistent cough a common finding?
ANS: D
Laryngeal changes in pregnancy include hoarseness, deepening or cracking of the voice, vocal changes, and persistent cough.
TOP: Discipline: Physiology MSC: Organ System: General a. Degeneration of the hair cells of the organ of Corti b. Excess resorption of bone cells of the ossicle chain c. Increased pliability of the tympanic membrane d. More serous cerumen e. Proliferation of the stria vascularis
9. Which of the following is associated with age-related hearing loss?
ANS: A
About two-thirds of adults ages 70 years and older have a hearing loss that affects their daily living. Age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea.
TOP: Discipline: Physiology MSC: Organ System: Nervous a. Chlorothiazide b. Acetaminophen c. Salicylates d. Cephalosporins e. Penicillins
10. Mr. S presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss?
ANS: C
Ototoxic medications include aminoglycoside, salicylates, furosemide, streptomycin, quinine, ethacrynic acid, and cisplatin. Chlorothiazide diuretics, acetaminophen, penicillins, and cephalosporins are considered non-ototoxic.
TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Nervous a. 100 to 300 Hz b. 200 to 400 Hz c. 500 to 1000 Hz d. 1500 to 2000 Hz e. Greater than 2000 Hz
11. To approximate vocal frequencies, which tuning fork should be used to assess hearing?
ANS: C
Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies.
TOP: Discipline: Physiology MSC: Organ System: Nervous
12. You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to: a. remove all cerumen from the canal. b. make sure the speculum is sealed form outside air. c. squeeze the bulb with more force. d. insert the speculum to depth of 2 cm. e. use a smaller plastic speculum.
ANS: B
When using the pneumatic attachment, to see tympanic movement, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of pressure changes from the insufflator bulb.
TOP: Discipline: Physiology MSC: Organ System: General
13. An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or: a. digestive disorder. b. skeletal anomaly. c. renal disorder. d. Ménière disease. e. heart defect.
ANS: C
A low-set position or unusual angle may indicate a genetic syndrome or be a clue to look for renal anomalies as the ears and kidneys grow at the same time during pregnancy.
TOP: Discipline: Pathophysiology MSC: Organ System: General
14. When conducting an adult otoscopic examination, you should: a. position the patient s head leaning to ard ou. b. grasp the handle of the otoscope as you would a baseball bat. c. select the largest speculum that will fit in the canal. d. ask the patient to keep his or her eyes closed. e. pull the auricle down and forward.
ANS: C
Select the largest speculum that ill comfortabl fit in the patient s ear. The handle should be held bet een the thumb and the inde finger, supported on the middle finger. The patient s head should be positioned toward the opposite shoulder. To straighten the external auditory in an adult, pull the auricle up and back. There is no reason for the patient to keep her or his eyes shut.
TOP: Discipline: Physiology MSC: Organ System: General
15. Speech with a monotonous tone and erratic volume may indicate: a. otitis externa. b. hearing loss. c. serous otitis media. d. sinusitis. e. dry cerumen.
ANS: B
Speech with a monotonous tone and erratic volume may indicate hearing loss. Although hearing may be affected in the other choices, they do not result in hearing loss.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
16. Placing the base of a ibrating tuning fork on the midline erte of the patient s head is a test for: a. air conduction of sound. b. bone versus air conduction. c. otitis externa. d. otitis media. e. lateralization of sound.
ANS: E
Placing the fork on the midline erte of the patient s head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear.
TOP: Discipline: Physiology MSC: Organ System: Nervous
17. To perform the Rinne test, place the tuning fork on the: a. top of the head. b. mastoid bone. c. forehead. d. preauricular area. e. occiput.
ANS: B
The tuning fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. The tuning fork is placed on the midline top of the patient s head for the Weber test, a test that helps assess unilateral hearing loss.
TOP: Discipline: Physiology MSC: Organ System: Nervous
18. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, the air conduction to bone conduction-to-ratio was less than 2:1. You interpret these findings as suggestive of: a. a defect in the inner ear. b. a defect in the middle ear. c. otitis externa. d. impacted cerumen. e. serous otitis.
ANS: A
These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa, impacted cerumen, and serous otitis are conditions that can cause conductive hearing problems.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
19. Nasal symptoms that imply an allergic response include: a. purulent nasal drainage. b. bluish gray turbinates. c. small, atrophied nasal membranes. d. a firm consistency of the turbinates. e. a deviated septum.
ANS: B
An allergic finding includes bluish gray or pale pink nasal turbinates that are swollen and boggy and a transverse crease at the junction between the cartilage and the bone of the nose.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
20. A smooth red tongue with a slick appearance may indicate: a. a niacin or vitamin B12 deficiency. b. oral cancer. c. recent use of antibiotics. d. a fungal infection. e. a geographic tongue.
ANS: A
A smooth red tongue with a slick appearance may indicate a vitamin B12 deficiency. Oral cancer involves lesions; recent use of antibiotics can turn the tongue yellow -brown to black and hairy; and fungal infections result in slightly raised white, cream-colored, or yellow spots in the mouth. A geographic tongue has irregular areas of whitish and red areas.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
21. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are: a. Fordyce spots. b. aphthous ulcers. c. Stensen ducts. d. leukoedema. e. angular cheilitis.
ANS: B
Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
22. A hairy tongue with yellowish brown to black elongated papillae on the dorsum: a. is indicative of oral cancer. b. is sometimes seen after antibiotic therapy. c. usually indicates a vitamin deficiency. d. usually indicates anemia. e. is characteristic of a geographic tongue.
ANS: B
Recent antibiotic use can turn the tongue yellow-brown to black and hairy.
TOP: Discipline: Pharmacology/Therapeutics
MSC: Organ System: Gastrointestinal
23. To inspect the lateral borders of the tongue, you should: a. ask the patient to extend the tongue outward. b. insert the tongue blade obliquely against the tongue. c. lift the tongue upward with gloved fingers. d. pull the gauze-wrapped tongue to each side. e. ask the patient to lift the tongue upward.
ANS: D
To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then pull the tongue to each side for inspection. The other maneuvers do not result in adequate lateral border inspection.
TOP: Discipline: Physiology
MSC: Organ System: Gastrointestinal a. Diffuse light reflex b. Purulent material in the ear canal c. Redness and swelling of the mastoid process d. Small perforations of the tympanic membrane e. Increased mobility and clarity of the tympanic membrane
24. Which variation may be an expected finding in the ear examination of a newborn?
ANS: A
The ne born s t mpanic membrane does not become conical for se eral months; therefore, the light reflex appears diffuse.
TOP: Discipline: Physiology
MSC: Organ System: General
25. For best results, an otoscopic and oral examination in a child should be: a. conducted at the beginning of the assessment. b. done after inspection. c. performed at the end of the examination. d. performed before palpation. e. deferred until they can fully cooperate.
ANS: C
Because young children often resist otoscopic and oral examination, it may be wise to postpone these procedures until the end of the examination after you have gained some trust.
TOP: Discipline: Physiology
MSC: Organ System: General
26. Expected physical changes associated with older adults include: a. shiny buccal mucosa. b. teeth appear shorter. c. wetter nasal mucosa. d. bristly hairs in the vestibule. e. smoothing of the tongue.
ANS: D
With age, the buccal mucosa becomes less shiny, the teeth appear longer because of receding gums, the nasal mucosa are drier, the tongue may appear more fissured, and more bristly hairs appear in the nose, especially in men.
TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal
27. Intense pain with movement of the pinna is most closely associated with: a. sinusitis. b. otitis externa. c. purulent otitis media. d. bacterial otitis media. e. otitis media with effusion.
ANS: B
Suspect otitis e terna (s immer s ear) hen pulling the pinna reproduces ear pain. The other conditions do not commonly cause the same finding.
TOP: Discipline: Pathophysiology MSC: Organ System: General
28. Severe vertigo, tinnitus, and episodes of hearing loss are the characteristics of: a. cholesteatoma. b. Ménière disease. c. otosclerosis. d. cocaine abuse. e. labyrinthitis.
ANS: B
Ménière disease is an inner ear disorder characterized by episodes of hearing loss, vertigo, tinnitus, and ear fullness
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
29. Evidence-based practice suggests that the strongest predictor of sinusitis is: a. a maxillary toothache. b. dull or opaque sinus transilluminations. c. ineffective decongestants and colored nasal drainage. d. purulent nasal secretions. e. any combination of the above.
ANS: E
Evidence-based practice suggests that the strongest predictor of sinusitis is any combination of these symptoms including maxillary toothache, purulent nasal secretions, dull or opaque sinus transillumination, poor response to decongestants, and colored nasal discharge.
TOP: Discipline: Pathophysiology MSC: Organ System: General
Multiple Choice
1. Which bronchial structure(s) is (are) most susceptible to aspiration of foreign bodies?
a. Left mainstem bronchus b. Terminal bronchioles c. Right mainstem bronchus d. Right respiratory bronchioles e. Left respiratory bronchioles
ANS: C
The right mainstem bronchus has a more downward slope and is less angled than the left bronchus. Therefore, it is more likely to be a site of aspiration and is a more likely site for endotracheal tubes that are advanced too far.
TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory
2. When auscultating the apex of the lung, you should listen: a. even with the second rib. b. 4 cm above the first rib. c. higher on the right side. d. on the convex diaphragm surface. e. directly over the clavicles.
ANS: B
The apices of the lungs are 4 cm above the first rib.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
3. You are documenting a rash between the eighth and ninth ribs on the lateral border. This intercostal space will be documented in terms of the: a. rib immediately above it. b. rib immediately below it. c. number of centimeters it is positioned below the clavicle. d. number of inches it is positioned below the clavicle. e. relationship to the sternum.
ANS: A
The number of each intercostal space corresponds to that of the rib immediately above it.
TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory
4. To begin counting the ribs and the intercostal spaces, you begin by palpating the reference point of the: a. distal point of the xiphoid. b. manubriosternal junction. c. suprasternal notch. d. acromion process. e. clavicle.
ANS: B
The angle of Louis, the junction of the manubrium and the sternum, corresponds to the second rib, the reference point for counting ribs and intercostal spaces.
TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory
5. The foramen ovale should close by: a. 24 weeks of gestation. b. the initiation of labor. c. within minutes of birth. d. 4 weeks of age. e. 12 months of age.
ANS: C
The decrease in pulmonary pressures within the first minutes of life leads to closure of the foramen ovale.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
6. Increased oxygen tension in the arterial blood of a newborn infant causes: a. closure of the ductus arteriosus. b. hyperinflation of the lungs. c. passive respiratory movements. d. reopening of the foramen ovale. e. the pulmonary arteries to contract.
ANS: A
Increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
7. To accommodate the enlarging uterus of pregnancy, the chest changes result in: a. intercostal muscle atrophy. b. lowering of the resting diaphragm. c. decreased alveoli expansion. d. decreased diaphragmatic movement. e. increased costal angle.
ANS: E
The costal angle progressively increases from around 68.5 to 103.5 degrees in later pregnancy. The resting diaphragm rises, yet diaphragmatic movement increases, the alveolar ventilation and tidal volume increase, and the muscles do not atrophy.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
8. The characteristic barrel chest of an older adult is caused by a combination of factors, including: a. skeletal changes of aging. b. increased muscular expansion of the chest wall. c. less fibrous alveoli. d. increased vital capacity. e. increased lung resiliency.
ANS: A
Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory a. Platypnea b. Orthopnea c. Tachypnea d. Bradypnea e. Hypopnea
9. A patient describes shortness of breath that gets worse when he sits up. Which term documents this?
ANS: A
Dyspnea that increases in the upright posture is called platypnea. Orthopnea is dyspnea that worsens with lying down, tachypnea is increased respiratory rate, and bradypnea is decreased respiratory rate. Hypopnea refers to abnormally shallow respirations.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
10. Bradypnea may accompany: a. pneumothorax. b. an excellent level of cardiovascular fitness. c. ascites. d. a pulmonary embolus. e. anxiety.
ANS: B
Bradypnea, a rate slower than 12 breaths/min, may result from cardiorespiratory fitness. The other choices accompany tachypnea.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
11. A 34-year-old man is being seen for complaints of dull pain between the shoulder blades that is more intense with deep breathing and coughing. Upon auscultation of the chest, you suspect that you will hear: a. rhonchi. b. expiratory wheeze. c. crackles. d. pleural friction rub. e. crepitus.
ANS: A
This patient is describing the bronchi as the source of the pain; the trachea divides at T4-5, between the shoulder blades. The adventitious bronchial sound expected is rhonchi. Wheezing might be expected if the patient had productive coughing or dyspnea; a pleural friction rub usually causes sudden stabbing pain over the pleuritic site. Crepitus can be both palpated and heard; it indicates air in the subcutaneous tissue and is usually found anteriorly and toward the axilla.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. tympany heard with b. dullness heard on c. resonance heard on d. hyperresonance heard on e. occasional hyperresonance heard on
12. Both pleural effusion and lobar pneumonia are characterized by _____ percussion.
ANS: B
Pleural effusion and lobar pneumonia are more dense than air, with an expected finding of dullness to percussion. Tympany is expected over hollow organs such as the stomach; resonance and hyperresonance are heard over air-filled areas.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. Patient with depression b. Patient who abuses narcotics c. Patient with metabolic acidosis d. Patient with myasthenia gravis e. Patient with metabolic alkalosis
13. In which patient situation would you expect to assess tachypnea?
ANS: C
In metabolic acidosis, the body compensates by increasing the respiratory rate to blow off the excess carbon dioxide. The other choices cause respiratory depression.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
14. Respiratory effort usually exhibited by the patient with cerebral brain damage is called: a. Cheyne-Stokes respiration. b. paroxysmal nocturnal dyspnea. c. Kussmaul breathing. d. Biot respiration. e. ataxic respiration.
ANS: A
Cheyne-Stokes respirations occur in children and older adults during sleep but otherwise occur in seriously ill patients, particularly those with brain damage at the cerebral level. The other choices are not apnea associated with cerebral damage.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. Lower chest b. Along the anterior axillary line c. Above the clavicles d. At the nipple line e. Along the posterior axillary line
15. Which site of chest wall retractions indicates a more severe obstruction in a patient with asthma?
ANS: C
Asthma more commonly produces retractions of the lower chest. The more severe th e obstruction, the greater is the negative pressure produced in the chest during inspiration and retractions are seen in the upper thorax.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. Primary apnea b. Secondary apnea c. Sleep apnea d. Periodic apnea of the newborn e. Apnea of prematurity
16. Which type of apnea requires immediate action?
ANS: B
Primary apnea is self-limiting, sleep apnea should be evaluated but does not require immediate action, and periodic apnea of the newborn is a normal condition. Apnea of prematurity is a more intense version of periodic apnea of the newborn. Secondary apnea is grave, and unless resuscitative measures are immediately instituted, breathing will not resume spontaneously.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. Fremitus b. Stridor c. Rhonchi d. Crepitus e. Wheezing
17. Laryngeal obstructions would elicit which breath sound?
ANS: B
Obstructions high in the respiratory tree are characterized by stridor.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
18. Breath odors may alert the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify: a. uremia. b. tuberculosis. c. hepatic dysfunction. d. diabetic ketoacidosis. e. intestinal obstruction.
ANS: A
The breath smell described as ammonia-like suggests uremia, a renal condition; cinnamon suggests tuberculosis, a musty fish or clover odor suggests hepatic failure, a sweet and fruity odor suggests diabetic ketoacidosis; and a foul or feculent odor suggests intestinal obstruction.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
19. You would expect to document the presence of a pleural friction rub for a patient being treated for: a. bronchitis. b. atelectasis. c. pleurisy. d. emphysema. e. pneumonia.
ANS: C
A pleural friction rub is caused by inflammation of the pleural surfaces and is expected to be auscultated with pleurisy.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
20. Tactile fremitus is best felt: a. along the costal margin and xiphoid process. b. in the suprasternal notch along the clavicle. c. at the level of bifurcation of the bronchi. d. posterolaterally over the scapulas. e. in the midaxillary lines.
ANS: C
Fremitus is best felt posteriorly and laterally at the level of the bifurcation of the bronchi. There is great variability depending on the intensity and pitch of the voice and the structure and thickness of the chest wall. In addition, the scapulae obscure fremitus.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
21. In the most effective percussion technique of the posterior lung fields, the patient cooperates by: a. folding the arms in front. b. bending the head back. c. standing and bending forward. d. lying on the side and extending the top arm. e. lying prone.
ANS: A
Asking the patient to sit with the head forward and arms folded in front moves the scapula laterally, exposing more lung to percussion.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
22. The examiner percusses for diaphragmatic excursion along the: a. vertebral column. b. midvertebral line. c. midaxillary line. d. scapular line. e. sternum.
ANS: D
The technique for diaphragmatic excursion is to percuss along the scapular line, after the patient inhales deeply, and to mark the site when resonance changes to dullness, representing the diaphragm. The sequence is repeated with exhalation.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
23. The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it: a. amplifies all types of sounds. b. filters extraneous sounds. c. pinpoints focal sound areas. d. transmits high-pitched sounds. e. transmits low-pitched sounds.
ANS: D
Unless specially modified, the stethoscope does not amplify sound, nor does it filter sound or pinpoint focal sounds. The stethoscope does transmit sound waves from the source to the ear. The diaphragm is the better source because it transmits the normally high -pitched sounds of the lung and has a broader area from which to listen.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
24. Breath sounds normally auscultated over most of the lung fields are called: a. vesicular. b. hyperresonance. c. bronchial. d. tubular. e. bronchovesicular.
ANS: A
The low-intensity sounds heard over most healthy lung tissue are called vesicular breath sounds.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
25. Breath sounds normally heard over the trachea are called: a. bronchovesicular. b. amphoric. c. crepitus. d. vesicular. e. bronchial.
ANS: E
The highest sounds in intensity and pitch are called the bronchial sounds, which are normally heard over the trachea.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
26. When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because: a. consolidation will echo in the chest. b. consolidation is a poor conductor of sound. c. air-filled lung sounds are from smaller spaces. d. air-filled lung tissue is an insulator of sound. e. consolidation causes hyperinflation of the lungs.
ANS: D
Whereas air is a poor conductor of sound, more dense consolidation promotes louder sounds and is a better conductor of sound.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
27. The middle lobe of the right lung is best auscultated over the: a. anterior chest. b. posterior chest. c. axilla. d. midclavicular line. e. scapula.
ANS: C
The sounds of the middle lobe of the right lung are best heard in the right axilla.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
28. To distinguish crackles from rhonchi, you should auscultate the lungs: a. before and after the patient coughs. b. first at the lung base and then at the apex. c. with the patient inhaling and then exhaling. d. with the patient prone and then supine. e. with the patient recumbent and then sitting.
ANS: A
To distinguish between crackles and rhonchi, ask the patient to cough and auscul tate again over the same area. Rhonchi, because they represent secretions in larger airways, can clear with coughing.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. In a supine position b. Lying on the left side c. Sitting completely upright d. With the head elevated 30 degrees e. In a prone position
29. In what position can the mediastinal crunch (Hamman sign) be heard best?
ANS: B
The Hamman sign is heard with mediastinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are heard best when the patient leans to the left or lies down on the left side these maneuvers bring the heart muscle closer to the chest wall.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
30. Changes in clarity and volume of spoken sounds during auscultation of the lungs can help you distinguish: a. crepitus from stridor. b. a foreign body from a purulent exudate. c. pulmonary edema from pleurisy. d. a right from left tracheal deviation. e. consolidation from airway constriction.
ANS: E
When chest auscultation results in decreased breath sounds or wheezes, the examiner can use techniques that involve the spoken word to distinguish these adventitious breath sounds as a result of consolidation rather than narrowing of a patent lumen.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. There is more sputum production with viral conditions than bacterial infections. b. The sputum is odorous with viral conditions and nonodorous with bacterial infections. c. The sputum is yellow, green, or rust colored with bacterial infections and mucoid with viral. d. The sputum is much thinner with bacterial infections and viscid with viral. e. Viral pneumonia sputum is never blood streaked.
31. How is the sputum of a viral infection different from the sputum of a bacterial infection?
ANS: C
The more likely differentiating characteristic between viral and bacterial sputum is the color. Whereas viral infections typically produce mucoid sputum, bacterial infections produce yellow, green, or rust-colored sputum.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
32. A signal for alarm during newborn chest assessment is: a. crackles. b. rhonchi. c. gurgles from the gastrointestinal tract. d. stridor. e. a mobile xiphoid.
ANS: D
Crackles and rhonchi at birth are caused by the presence of remaining fetal fluid; intermittent gurgles are transmitted bowel sound through the thin-walled chest and are not alarming; id i ala mi g a a age. The e b i h id ce i m e m bile and prominent than in older children.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
33. Bronchovesicular breath sounds in young children that are loud and harsh are an indication of: a. an accumulation of fluid. b. malignant tumors or solid masses. c. normal, thin chest wall structures. d. pus-filled abscesses and tumors. e. tension pneumothorax.
ANS: C
Y g child e che all a e all hi a d he ef e able mall a mi l d, harsh, and more bronchial breath sounds than can adults.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory
34. The pregnant woman is expected to develop: a. tachypnea and decreased tidal volume. b. deep breathing but not more frequent breathing. c. dyspnea and increased functional residual capacity. d. bradypnea and increased tidal volume. e. tachypnea and increased functional residual capacity.
ANS: B
In pregnant women, tidal volume and vital capacity increase, and functional residual capacity decreases. Also, pregnant women breathe more deeply but not more frequently.
TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory a. Patient with pleuritic pain without dyspnea b. Patient with fever and a productive cough c. Patient with tachypnea but no chest retractions d. Patient with pleuritic pain and rib tenderness e. Patient with absent breath sounds and dull percussion tones
35. Which condition requires immediate emergency intervention?
ANS: A
A patient who experiences unexpected pleuritic pain without prior respiratory distress or dyspnea has most likely developed a pulmonary embolism, a condition with a high mortality rate.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory a. Respiratory syncytial virus b. Haemophilus influenzae type B c. Adenovirus d. Parainfluenza virus e. Human metapneumovirus
36. Epiglottitis has frequently associated with infection by which organism?
ANS: B
Epiglottitis is an acute inflammation of the epiglottis caused by bacterial invasion. Immunization against the bacterium Haemophilus influenzae type B has greatly reduced the incidence in the United States. All of the other choices are viruses associated with bronchiolitis.
TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
Multiple Choice
1. Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located: a. more to the right and hanging more vertically. b. more to the left and lying more horizontally. c. riding higher in the chest and pushed anteriorly. d. hanging lower in the chest and riding more vertically. e. more to the right and lying more horizontally.
ANS: B
The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall, slender person s heart tends to hang vertically and is positioned centrally. A stocky, short person s heart tends to lie more to the left and more horizontally.
TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular a. Both atria b. Both ventricles c. The right atrium and ventricle d. The left atrium and ventricle e. Superior and inferior venae cavae
2. Which two heart structures are most anterior in the chest?
ANS: C
The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart. The superior and inferior venae cavae lie posteriorly.
TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular
3. Contraction of the ventricles causes: a. closure of the atrioventricular valves. b. closure of the pulmonic and aortic valves. c. opening of the mitral valve and closure of the tricuspid valve. d. opening of the mitral and tricuspid valves. e. opening of the auricular septa.
ANS: A
When the ventricles contract, the semilunar, pulmonic, and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
4. The major heart sounds are normally created by: a. valves opening. b. valves closing. c. the rapid movement of blood. d. rubbing together of the cardiac walls. e. pulmonic veins.
ANS: B
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S 1 “lubb. When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2 “dubb. Valve opening is usually a silent event.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
5. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the: a. P wave. b. PR interval. c. QRS complex. d. ST segment. e. T wave.
ANS: A
The P wave represents the spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization).
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
6. A third heart sound is created by: a. atrial contraction. b. ventricular contraction. c. diastolic filling. d. regurgitation between the right and left ventricles. e. blood in the pericardium.
ANS: C
Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria, and the filling sometimes produces a third heart sound S3.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
7. The “pacing structure of the heart s electrical activity is the: a. atrioventricular (AV) node. b. bundle of His. c. Purkinje fibers. d. coronary sinus. e. sinoatrial (SA) node.
ANS: E
An electrical impulse stimulates each myocardial contraction, and this impulse originates in and is paced by the SA node.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
8. Purkinje fibers are located in the: a. sinoatrial node. b. atrioventricular node. c. myocardium. d. aortic arch. e. pericardium.
ANS: C
The Purkinje fibers are located in the ventricular myocardium.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
9. The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the: a. P wave. b. QRS complex. c. PR interval. d. T wave. e. U wave.
ANS: B
The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of the stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
10. In a fetus, the right ventricle pumps blood through the: a. left atrium. b. ductus arteriosus. c. lungs. d. foramen ovale. e. septum primum.
ANS: B
The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
11. Closure of the ductus arteriosus usually occurs: a. just before the initiation of labor. b. 24 to 48 hours after birth. c. after 7 days of life. d. between the second and third months of life. e. during the toddler stage.
ANS: B
Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular a. First-degree block b. Bundle branch block c. Left ventricular hypertrophy d. Ventricular fibrillation e. Atrial fibrillation
12. Which ECG change would not be expected as an age-related pattern?
ANS: D
Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular a. Supine b. Leaning backward c. Lithotomy d. Right lateral recumbent e. Upright
13. In an adult, the apical impulse should be most visible when the patient is in which position?
ANS: E
In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
14. If the apical impulse is more vigorous than expected to the chest wall, it is called: a. a lift. b. a thrill. c. a bruit. d. a murmur. e. crepitus.
ANS: A
The apical impulse is more vigorous than expected; it is referred to as a heave or lift. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound that is caused by turbulent blood flow into, through, or out of the heart. Crepitus is air in the subcutaneous tissue from respirations.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
15. A palpable rushing vibration over the base of the heart at the second intercostal space is called a: a. heave. b. lift. c. thrill. d. thrust. e. murmur.
ANS: C
A thrill is a fine, palpable, rushing vibration, or a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is a movement forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
16. An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate: a. decreased cardiac output. b. dextrocardia. c. left ventricular hypertrophy. d. hyperventilation. e. obesity.
ANS: C
An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. In dextrocardia, the PMI would be displaced to the right.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
17. A lift along the left sternal border is most likely the result of: a. aortic stenosis. b. atrial septal defect. c. pulmonary hypertension. d. right ventricular hypertrophy. e. left ventricular hypertrophy.
ANS: D
A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
18. To estimate heart size by percussion, you should begin tapping at the: a. apex. b. left sternal border. c. midclavicular line. d. midsternal line. e. anterior axillary line.
ANS: E
Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
19. Normal heart sounds are best heard: a. directly over the semilunar and bicuspid heart valves. b. over areas where blood flows after it passes through a valve. c. near the carotid vessels. d. over the central sternum. e. over the ribs.
ANS: B
Normal heart sounds are best heard in areas where blood flows after it passes through a valve in the direction of blood flow.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
20. To hear diastolic heart sounds, you should ask patients to: a lie on their backs. b. lie on their left sides. c. lie on their right sides. d. sit up and lean forward. e. lie prone.
ANS: B
The left lateral recumbent position is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating a right rotated heart of dextrocardia.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular a. S1 b. S2 c. S3 d. S4 e. S3-4
21. The carotid pulse should coincide with which heart sound?
ANS: A
S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S 1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular a. S1 b. S2 c. S3 d. S4 e. S3-4
22. You are listening to a patient s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following?
ANS: B
S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S 1. S2 typically splits during inspiration.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular a. aortic b. pulmonic c. tricuspid d. mitral e. apex
23. During auscultation of heart tones, you are uncertain whether the sound you hear is an S 2 split. You should ask the patient to inhale deeply while listening at the _____ area.
ANS: B
Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
24. The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing: a. the splitting of S2. b. high-pitched murmurs. c. presystolic gallops. d. systolic ejection sounds. e. pericardial friction rub.
ANS: C
Using the bell of the stethoscope at the apex is more useful for low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
25. A grade I or II murmur, without radiation and of medium pitch, is a common variation found in: a. school-age children. b. older women. c. middle-aged men. d. sedentary individuals. e. older adults.
ANS: A
Many murmurs, particularly in children, adolescents, and especially young athletes, have no apparent cause. These are generally grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by splitting of S2
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
26. A split second heart sound is: a. abnormal. b. greatest at the peak of inspiration. c. heard best after forceful expiration. d. supposed to disappear with deep inspiration. e. always accompanied by a thrill.
ANS: B
Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill.
TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
27. The earliest sign of heart failure in an infant is frequently: a. an apical impulse in the fourth intercostal space. b. moisture in the lungs. c. enlarged thyroid. d. clubbing of the fingers. e. liver enlargement.
ANS: E
If heart failure is suspected, note that the infant s liver may enlarge before there is any suggestion of moisture in the lungs, and the left lobe of the liver may be more distinctly enlarged than the right. An apical impulse in the fourth intercostal space is a normal finding.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular a. First-degree AV block b. Mobitz type II c. Multifocal PVCs d. Sinus dysrhythmia e. Third-degree AV block
28. Which dysrhythmia is a physiologic event during childhood?
ANS: D
Sinus dysrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
29. Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of: a. rheumatic fever. b. cor pulmonale. c. pericarditis. d. endocarditis. e. cardiac tamponade.
ANS: D
Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and a sudden onset of congestive heart symptoms. The lesions described are Janeway lesions.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
30. The most helpful finding in determining left-sided heart failure is: a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S4 heart sound. e. tachycardia.
ANS: C
Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. The other choices are not as reliable.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
31. Chest pain that is intensified or provoked by movement, particularly twisting, i s long lasting, and is often associated with focal tenderness is most likely: a. cardiac. b. pleural. c. esophageal. d. musculoskeletal. e. psychoneurotic.
ANS: D
The description given is a classic example of musculoskeletal chest pain.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
32. All of the following are characteristics of the Frailty syndrome in older adults except: a. weight gain. b. inability to climb one flight of stairs. c. inability to walk one block. d. most common in adults over age 70. e. linked to comorbid conditions.
ANS: A
Frailty syndrome is characterized by signs and symptoms of being frail: weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. It is linked to comorbid conditions and carries an elevated risk of catastrophic declines in health and function, including disability, hospitalization falls, fracture, and death It is most common in adults older than 70 years old and is increasingly common after age 80 years of age.
TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
