33 minute read
Chapter 19: Female Genitalia
from TEST BANK for SEIDEL'S GUIDE TO PHYSICAL EXAMINATION. An Interprofessional Approach 9th Edition
by StudyGuide
Multiple Choice
1. Posteriorly, the labia minora meet as two ridges that fuse to form the: a. fourchette. b. vulva. c. clitoris. d. perineum. e. perineal body.
ANS: A
The labia minora join posteriorly at a junction called the fourchette.
TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive a. Skene glands b. Perineal bodies c. Labia majora d. Bartholin glands e. Labia minora
2. Wha c e a e l ca ed a he 5 cl ck a d he 7 clock positions of the vaginal orifice and open onto the sides of the vestibule in the groove between the labia minora and the hymen?
ANS: D
Bartholin glands are found posteriorly on each side of the vaginal orifice and open onto the sides of the vestibule.
TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive a. Bartholin glands secrete mucus. b. Clitoris produces moisture. c. Skene glands secrete fluid. d. Urethral surfaces secrete water. e. Hymen secretes mucus.
3. During sexual excitement, how is the vaginal introitus lubricated?
ANS: A
The Bartholin glands secrete mucus into the introitus for lubrication during sexual stimulation.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
4. The adnexa of the uterus are composed of the: a. corpus and cervix. b. fallopian tubes and ovaries. c. uterosacral and broad ligaments. d. round ligaments and ovaries. e. vagina and fundus.
ANS: B
The fallopian tubes and the ovaries are collectively referred to as the adnexa of the uterus.
TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive
5. The pelvic joint that separates most appreciably during late pregnancy is the: a. sacroiliac. b. symphysis pubis c. sacrococcygeal. d. iliofemoral. e. sacrosciatic notch.
ANS: B
Of the four pelvic joints, the one that appreciably moves later in pregnancy is the symphysis pubis. The sacrosciatic notch is not a joint, and no changes occur.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
6. Pregnancy-related cervical changes include: a. flattening and lengthening. b. thinning and reddening. c. hardening and pallor. d. shortening and reddening. e. softening and bluish coloring.
ANS: E
During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign).
TOP: Discipline: Physiology MSC: Organ System: Reproductive
7. The conventional definition of menopause is: a. 3 months with no menses. b. 1 year with no menses. c. 6 months of progressively shorter menses. d. 3 consecutive anovulatory cycles. e. the cessation of ovulation.
ANS: B
Menopause is defined as 1 year without menses.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Increased intraabdominal fat deposition b. Decreased LDL levels c. Cold intolerant d. Decreased cholesterol levels e. Decreased risk of cardiovascular disease
8. Which systemic feature is related to the effects of menopause?
ANS: A
Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
9. The risk of ovarian cancer is increased by a history of: a. low-fat diet. b. cigarette smoking. c. age between 35 and 50 years. d. thin body habitus. e. nulliparity.
ANS: E
There is a relationship between nulliparity and an increased risk of ovarian cancer. Although the risk increases with age, most ovarian cancers develop after menopause; half are found in women older than 63 years. The other choices have no relationship with ovarian cancer.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
10. The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her da gh e s underwear. Both the mother and daughter appear nervous and concerned. You ld eed a k e i a e he child : a. drug ingestion. b. fluid intake. c. risk for sexual abuse. d. hormone responsiveness. e. fat intake.
ANS: C
Vaginal discharge in a child could be related to a chemical irritation from soaps, lotions, or powders or to urinary tract infections. Concerned parents or children should be assessed for the risk of sexual abuse.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Fowler b. Prone c. Lateral-supine d. Lithotomy e. Trendelenburg
11. The female patient should ideally be in which position for the pelvic examination?
ANS: D
Ideally, position the woman in a lithotomy position for a pelvic examination.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
12. During a pelvic examination, you ask the patient to perform the Valsalva maneuver while you observe for bulging and urinary incontinence, to test for the presence of: a. a cystocele. b. a rectocele. c. vaginal prolapse. d. rectal prolapse. e. hymenal remnants.
ANS: A
Asking the woman to bear down as you watch for anterior wall bulging and urinary incontinence is done to assess for the presence of a cystocele.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
13. When you plan to obtain cytologic studies, speculum introduction may be facilitated by: a. Valsalva maneuver. b. lubrication with warm water. c. use of plastic speculum. d. opening the blades completely. e. lubrication with gel.
ANS: B
Until further studies conclusively determine that gel lubricant does not adversely interfere with specimen analysis, we continue to recommend lubrication with water. However, if gel lubricant is used, a thin layer on the external surface of the blades only will help avoid contamination of the specimen.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
14. When performing a gynecologic examination, the examiner should change gloves after chi g he a ie : a. anal area. b. Bartholin glands. c. Skene glands. d. cervix. e. urethra.
ANS: A
Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. retroverted b. anteverted c. midline d. laterally deviated e. retroflexed
15. During digital examination of the vagina, the cervix is noted to be positioned posteriorly. Upon bimanual examination of this woman, you would expect to palpate a(n) _____ uterus.
ANS: B
The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Allow the labia to spread; insert the speculum slightly open. b. Press the introitus upward; insert the closed speculum horizontally. c. Press the introitus downward; insert the closed speculum obliquely. d. Spread the labia; insert the closed speculum horizontally. e. Insert one finger; insert the opened speculum.
16. Which one of the following is a proper technique for use of a speculum during a vaginal examination?
ANS: C
Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
17. Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should: a. chart this as nabothian cysts. b. chart this as a friable cervix. c. obtain a viral culture. d. test the pH of the cervical os. e. chart this as an eroded cervix.
ANS: A
This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Gonococcal culture b. Cytology smear c. Haemophilus smear d. Trichomonas smear e. Fungal cultures
18. An examiner rotated a brush several times into the cervical os. The brush was wi thdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
ANS: B
This describes the technique for obtaining a cytology Pap smear.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
19. The i ali a i f a la ge i f cl e cell on your wet mount slide examination suggests: a. trichomonal infection. b. bacterial vaginosis. c. candidiasis. d. gonorrhea. e. cervical cancer.
ANS: B
Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount.
TOP: Discipline: Microbiology MSC: Organ System: Reproductive a. Cervix b. Bladder c. Uterus d. Ovaries e. Adnexa
20. The assessment of which structure is not part of the bimanual examination?
ANS: B
The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries.
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
21. The rectovaginal examination is an important component of the total pelvic examination because it: a. is the most direct cervical examination route. b. is a more comfortable examination for the posthysterectomy patient. c. is an alternate source for cytology specimens. d. allows the examiner to reach almost 2.5 cm higher into the pelvis. e. provides better evaluation of the bladder.
ANS: D
The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for the patient and is not the source for cytology specimens or more complete evaluation of the bladder.
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
22. Prominent labia minora are a normal finding in: a. adolescents. b. menopausal women. c. newborns. d. pregnant women. e. postmenopausal women.
ANS: C
Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent.
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
23. The most common cause of a foul vaginal discharge in children is a(n): a. rectocele. b. foreign body. c. infection. d. ruptured hymen. e. accident.
ANS: B
Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
24. A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with: a. chronic masturbation. b. congenital defects. c. acute urinary tract infection. d. sexual abuse. e. malignancy.
ANS: D
A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. 10 b. 16 c. 20 d. 24 e. 30
25. Fundal height to the level of the umbilicus normally occurs around week _____ of pregnancy.
ANS: C
At 20 weeks of gestation, the fundal height reaches the level of the umbilicus.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
26. During a pelvic examination for a postmenopausal woman, you would expect to assess: a. a wider and longer vaginal vault. b. absence of vaginal wall rugation. c. a nonpalpable cervical os. d. a more mobile cervix. e. palpable ovaries.
ANS: B
Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, a less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
27. Asking the woman to close the introitus during a pelvic examination is a test for: a. endometriosis. b. rectocele. c. cervical polyps. d. muscle tone. e. cystocele.
ANS: D
Test for muscle tone is to have the woman squeeze the vaginal opening around your finger. A rectocele can be seen as a bulge on the posterior wall. A cystocele will be seen as bulge on the anterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without squeezing.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
28. The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is: a. homogeneous and gray with a low pH. b. scant and curdy with a low pH. c. profuse and frothy with a high pH. d. profuse and curdy with a low pH. e. bloody and thin with a high pH.
ANS: C
Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5).
TOP: Discipline: Microbiology MSC: Organ System: Reproductive a. Menstrual b. Postmenstrual c. Ovulation d. Secretory e. Luteal
29. Mittelschmerz may occur in which phase of the menstrual cycle?
ANS: C
Mittelschmerz, lower abdominal pain associated with ovulation, may also be accompanied by tenderness on the side where ovulation took place that month.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Cervical b. Vaginal c. Vulvar d. Ovarian e. Penile
30. Which of the following cancers is not associated with human papillomavirus (HPV) infection?
ANS: C
HPV infection can cause cervical, vaginal, and vulvar cancers in women; penile cancer in men; anal and oropharyngeal cancer and genital warts in both men and women. Vaccination against HPV before exposure to the virus through sexual contact is recommended for preadolescent and adolescent girls and boys
TOP: Discipline: Pathophysiology
Organ System: Reproductive
Multiple Choice
1. What structure of the male genitalia travels through the inguinal canal and unites with the seminal vesicle to form the ejaculatory duct?
a. Epididymis b. Corpus cavernosum c. Urethra d. Vas deferens e. Ureter
ANS: D
The vas deferens begins at the end of the epididymis, travels the spermatic cord, goes through the inguinal canal, and then unites with the seminal vesicle to form the ejaculatory duct.
TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive
2. While examining an 18-year-old man, you note that the penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be: a. caused by a lack of testosterone. b. suggestive of a skin fungus. c. suggestive of psoriasis. d. caused by excessive progesterone. e. within normal limits.
ANS: E
Darker pigmentation from other body skin is a normal finding on the penis and testicles.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
3. In an uncircumcised male, retraction of the foreskin may reveal cheesy white material. This is usually: a. evidence of a fungal infection. b. a collection of sebaceous material. c. indicative of penile carcinoma. d. suggestive of diabetes. e. evidence of a gonococcal infection.
ANS: B
The glans secretes a sebaceous material, smegma, in uncircumcised males. It looks like a cheesy white material. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. Smegma is not candidiasis nor is it suggestive of diabetes, cancer, or gonorrhea.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
4. The greatest contribution to the volume of ejaculate comes from the: a. prostate. b. epididymis. c. seminal vesicles. d. corpus cavernosa. e. testes.
ANS: A
The major volume of ejaculatory fluid comes from the prostate gland.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. 8 b. 12 c. 16 d. 20 e. 30
5. Sexual differentiation in the fetus has occurred by _____ weeks’ gestation.
ANS: B
By 12 weeks’ gestation, sexual differentiation has occurred in the fetus.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
6. Expected genitalia changes that occur as men age include: a. that ejaculatory volume decreases with age. b. that erections develop more quickly. c. that the viability of sperm increases. d. that the scrotum becomes more pendulous. e. an increase in time for mature sperm to develop.
ANS: D
Ejaculatory volume may increase with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. There is no change in the length of time necessary for mature sperm production.
TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Circumcision b. Condyloma acuminatum c. Cryptorchidism d. Poor hygiene e. Multiple sexual partners
7. Which of the following is a risk factor for testicular cancer?
ANS: C
Cryptorchidism (testes that fail to descend by 12 months of age) is a risk factor for testicular cancer.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
8. You are inspecting the genitalia of an uncircumcised man. The foreskin is tight and cannot be easily retracted. You should: a. chart the finding as paraphimosis. b. inquire about previous penile infections. c. retract the foreskin firmly. d. transilluminate the glans. e. chart the finding as balanitis.
ANS: B
This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum. Balanitis is inflammation of the glans that may occur with phimosis.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Umbilical b. Direct c. Indirect d. Femoral e. Incisional
9. Which type of hernia lies within the inguinal canal?
ANS: C
Hernias found within the inguinal canal are called indirect hernias.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. A viscus felt medial to the external canal b. Continuous penile erection c. Lumps in scrotal skin d. Venous dilation in spermatic cord e. Adhesions of the foreskin
10. Which one of the following conditions is of minor consequence on the adult male genitalia?
ANS: C
Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits. The other choices require medical or surgical intervention.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
11. A characteristic related to syphilis or diabetic neuropathy is testicular: a. dropping with asymmetry. b. enlargement. c. insensitivity to painful stimulation. d. recession into the abdomen. e. nodularity.
ANS: C
Diabetic neuropathy or syphilis can cause a marked reduction of tactile percepti ons. Asymmetry is a normal finding; enlargement and recession are not related to diabetes or syphilis. Any nodules found on the testes must be evaluated for malignancy and are not characteristic of syphilis or diabetes.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
12. A normal vas deferens should feel: a. tender. b. smooth. c. rugated. d. spongy. e. beaded.
ANS: B
The vas deferens should normally feel smooth, discrete, and nontender.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
13. A premature infant’s scrotum will be: a. bifid. b. loose. c. rugated. d. smooth. e. enlarged.
ANS: D
A scrotum in a premature infant will appear underdeveloped and smooth without rugae or testes; a full-term infant should have a loose, pendulous scrotum with rugae and a midline raphe.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
14. An enlarged, painless testicle in an adolescent or adult may indicate: a. epididymitis. b. testicular torsion. c. a tumor. d. an undescended testicle. e. hypospadias.
ANS: C
A hard, enlarged, painless testicle can indicate a tumor in an adolescent or adult male. Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months. Hypospadias is a congenital defect of the urethral opening causing the meatus to be located ventral to its normal position.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
15. The most emergent cause of testicular pain in a young male is: a. varicocele. b. epididymitis. c. tumor. d. hydrocele. e. testicular torsion.
ANS: E
Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in a much lower salvage rate.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Trendelenburg b. Tailor c. Standing d. Prone e. Supine
16. When examining a small child, in which position should he be placed to help push the testicles into the scrotum?
ANS: B
When the child is old enough to sit cooperatively, ask him to sit in a tailor position with legs crossed for the testicular examination.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
17. The most common type of hernia occurring in young males is: a. direct inguinal b. incisional. c. indirect inguinal. d. umbilical. e. femoral.
ANS: C
The most common type of hernia in children and young males is an indirect inguinal hernia.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
18. Difficulty replacing the retracted foreskin of the penis to its normal position is called: a. paraphimosis. b. Peyronie disease. c. prepuce. d. priapism. e. phimosis.
ANS: A
Paraphimosis refers to the inability to replace the foreskin to its original position after it has been retracted behind the glans.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
19. The finding of a painless indurated lesion on the glans penis is most consistent with: a. herpes simplex. b. herpes zoster. c. warts. d. chancre. e. molluscum contagiosum.
ANS: D
Syphilitic chancre is a painless lesion with an indurated border and a clear base.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
20. A finding associated with male genital herpes is: a. disseminated lymphadenopathy. b. pain subsiding with scrotal elevation. c. soft, red papules on the prepuce. d. painful superficial penile vesicles. e. pearly gray, dome-shaped lesions.
ANS: D
Genital herpes presents as painful superficial vesicles on an erythemic base.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Peyronie disease b. Hydrocele c. Hypospadias d. Normal variation e. Epispadias
21. A male whose urethral meatus opens on the ventral surface of his penis has which condition?
ANS: C
The congenital defect in which the urethral meatus is located on the ventral surface of the glans is called hypospadias.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
22. Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably: a. lymphogranuloma venereum. b. condylomata. c. molluscum contagiosum. d. chancres. e. herpetic lesions.
ANS: C
Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative of molluscum contagiosum.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
23. A 12-year-old boy says that his left scrotum has a soft swollen mass. The scrotum is not painful upon palpation. The left inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with: a. orchitis. b. hydrocele. c. rectocele. d. scrotal hernia. e. epididymitis.
ANS: B
A hydrocele is a soft scrotal mass that occurs from fluid accumulation and therefore does transilluminate. Orchitis results in a swollen, tender testis. A rectocele does not result in scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal. Epididymitis is an extremely painful condition.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Varicocele b. Epididymitis c. Orchitis d. Paraphimosis e. Cystitis
24. Which condition is a complication of mumps in an adolescent or adult?
ANS: C
Orchitis is uncommon unless seen as a complication of mumps in an adolescent or adult.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. 16 b. 26 c. 36 d. 46 e. 56
25. All males may receive the human papillomavirus vaccine through which age?
ANS: B
Vaccination against HPV before exposure to the virus through sexual activity is recommended for preadolescent and adolescent girls and boys. All males may receive the vaccine through age 26 and should speak with their healthcare provider to determine wheth er getting vaccinated is right for them. The vaccine is also recommended for any man who has sex with men and men with compromised immune systems (including human immunodeficiency virus [HIV]) through age 26 if they did not get fully vaccinated when they were younger.
TOP: Discipline: Physiology MSC: Organ System: Reproductive
Chapter 21: Anus, Rectum, and Prostate
Multiple Choice
1. The adult internal rectal sphincter is controlled by the: a. autonomic nervous system. b. central nervous system. c. peripheral nervous system. d. lumbar spinal reflexes. e. sacral spinal reflexes.
ANS: A
The internal ring of smooth muscle of the anal canal is under involuntary autonomic control.
TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal a. Median lobe b. Posterior c. Superior d. Anterior e. Lateral
2. In males, which surface of the prostate gland is accessible by digital examination?
ANS: B
The posterior surface of the prostate gland lies close to the anterior wall of the rectum and is palpable through digital rectal examination.
TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary a. White race b. Diet low in animal fats and proteins c. Physical inactivity d. Infection with high-risk type HPV e. Low body fat
3. Which of the following is a risk factor for anal cancer?
ANS: D
Infection with high-risk type human papillomavirus is considered a risk factor for anal cancer. The other answers are not.
TOP: Discipline: Biostatistics MSC: Organ System: Gastrointestinal
4. Factors associated with increased risk of prostate cancer include: a. African American descent. b. cigarette smoking. c. low-fat diet. d. alcoholism. e. obesity.
ANS: A
The incidence rate of prostate cancer is more common in African Americans and in Caribbean patients of African ancestry; less common in Asian American and Hispanic/Latinos than in non-Hispanic whites.
TOP: Discipline: Biostatistics MSC: Organ System: Renal/Urinary a. Lithotomy b. Prone c. Trendelenburg d. Left lateral e. Supine
5. When performing a rectal examination in a man, in which position is the patient generally placed?
ANS: D
Male patients are usually positioned left lateral or standing with upper body flexed at the waist over the examination table, with the toes pointed together for increased exposure of the area.
TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal a. Pinworms b. Pilonidal cysts c. Perianal fistula d. Pruritus ani e. Anorectal fissure
6. Which of the following conditions is most commonly seen in adults with diabetes?
ANS: D
Pruritus ani refers to chronic itching of the skin around the anus, which can be caused by fungal infections and is more common in diabetic patients. Pinworms are more common in children; the other conditions do not cause pruritus.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
7. To make visualization of polyps in the anorectal area easier, you should: a. apply clear jelly around the anal orifice. b. ask the patient to bear down. c. ask the patient to relax the sphincter. d. rotate your finger inside the anal canal. e. have the patient contract the external sphincter.
ANS: B
Asking the patient to perform a Valsalva maneuver will make fistulas, fissures, polyps, and hemorrhoids more visible.
TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal
8. Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience: a. bulging and wrinkling. b. constipation and pallor. c. urinary symptoms. d. tenderness and inflammation. e. diarrhea and redness.
ANS: D
Pain, tenderness, and inflammation to the perianal area may be related to abscess, fistula or fissure, pilonidal cyst, or pruritus ani.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
9. The initial digital approach to the rectal examination should be: a. at a right angle to the anus. b. with direct horizontal pressure of fingertip. c. with the finger pad pressed against anal verge. d. during sphincter tightening. e. bidigital palpation with thumbs.
ANS: A
The initial approach should be with the finger pad pressed against the perianal area at the anal junction. The sphincter will tighten and relax, and then the examination index finger should be flexed and inserted.
TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal a. less than 1 b. 1 to 2 c. 2 to 3 d. 3 to 4 e. more than 4
10. A healthy prostate protrudes into the rectal wall a distance of _____ cm.
ANS: A
A healthy prostate should not protrude more than 1 cm into the rectum.
TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary
11. The posterior surface of the prostate can be located by palpation of the: a. posterior wall of the rectum. b. anterior wall of the rectum. c. lateral wall of the anus. d. lower abdomen and perineum. e. anal canal and perineum.
ANS: B
Palpation of the rectal anterior wall facilitates posterior prostate location.
TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary
12. Very light tan or gray stool may indicate: a. Hirschsprung disease. b. obstructive jaundice. c. lower gastrointestinal bleeding. d. polyposis. e. upper gastrointestinal bleeding.
ANS: B
Very light tan or gray stools suggest obstructive jaundice.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
13. Tarry black stool should make you suspect: a. internal hemorrhoids. b. rectal fistula. c. upper intestinal bleeding. d. prostatic cancer. e. lower intestinal bleeding.
ANS: C
Upper intestinal tract bleeding results in tarry black stools.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
14. Prostate-specific antigen (PSA) screening is controversial because: a. there are few false-negative results. b. PSA is produced by many other tissues. c. it is less sensitive than digital rectal examination. d. there are associated harms of false-positive test results. e. it detects prostate cancer only in its late stage.
ANS: D
The persistent issue is whether the benefits of prostate cancer screening are large enough to outweigh the associated harms, which include false-positive screening test results, unnecessary biopsies, and overdiagnosis.
TOP: Discipline: Biostatistics MSC: Organ System: Renal/Urinary a. Lack of an anal ink b. Anorectal fissure c. Anal fistula d. Passage of meconium e. Small flaps of anal skin
15. A lower spinal cord lesion may be indicated by which finding?
ANS: A
Lightly touching the anal opening of an infant should produce a contraction referred to as the anal ink. A nega i e ink ma indica e a lo e inal co d le ion.
TOP: Discipline: Pathophysiology MSC: Organ System: Nervous
16. Pinworms and Candida may both cause: a. shrunken buttocks. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion. e. constipation.
ANS: C
Pinworms and Candida both cause perirectal irritation and itch.
TOP: Discipline: Microbiology MSC: Organ System: Gastrointestinal a. After she develops a scaphoid abdomen b. During her first feeding when she vomits c. When she bleeds from the rectum d. When she fails to pass meconium stool e. When the rectum prolapses
17. Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. When is it likely that her closed anal passageway will be suspected by her healthcare providers?
ANS: D
Anal patency of the newborn is confirmed by passage of meconium stool.
TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
18. A common cause of dark green or black stool color during pregnancy is indicative of: a. consumption of iron preparations. b. consumption of vitamins. c. intestinal parasites. d. slow bleeding of hemorrhoids. e. slow intestinal bleeding.
ANS: A
The daily use of iron replacement therapy, as expected during pregnancy, causes dark green or black stools.
TOP: Discipline: Pharmacology/Therapeutics
MSC: Organ System: Gastrointestinal
19. An expected anal or rectal finding late in pregnancy is the presence of: a. cysts. b. rectal prolapse. c. skin tags. d. polyps. e. hemorrhoids.
ANS: E
Hemorrhoids are an expected variation late in pregnancy.
TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive
20. Palpation of a normal prostate in an older adult is likely to feel: a. cool. b. grainy. c. polypoid. d. rubbery. e. hard.
ANS: D
Older men are more likely to experience prostate hypertrophy, which, when palpated, feels smooth, rubbery, and symmetric.
TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary
21. Prostate examination findings of a hard, irregular, painless nodule with obliteration of the median sulcus are signs of: a. benign prostatic hypertrophy. b. cancer of the prostate. c. longstanding prostatitis. d. swelling caused by aging. e. acute prostatitis.
ANS: B
Obliteration of the median sulcus is consistent with organ enlargement; associated findings of a hard, irregular, and painless nodule are more likely a cancerous growth.
TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary
Chapter 22: Musculoskeletal System
Multiple Choice
1. Bones are attached to muscles by: a. synovial membranes. b. ligaments. c. muscles. d. cartilage. e. tendons.
ANS: E
Tendons attach muscle to bone. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Ligaments attach bone to bone. Muscles are not bound together by other muscles, and cartilage helps in the production of new bone and acts a s an insulator for bones in joints.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
2. The cruciate ligaments within the knee provide for: a. anterior and posterior stability. b. medial and lateral stability. c. movement on one plane. d. pivoting and rotation. e. shock absorption.
ANS: A
The cruciate ligaments within the knee are positioned so as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane. Cartilage is the structure that provides shock absorption.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
3. Medial and lateral surfaces of the tibiotalar joint are protected by: a. bursae. b. tendons. c. muscles. d. ligaments. e. synovial fluid.
ANS: D
The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides. Bursae, tendons, muscles, and synovial fluid do not offer stabilization protection to the ankle.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
4. Ligaments are stronger than bone until: a. birth. b. infancy. c. adolescence. d. middle adulthood. e. old age.
ANS: C
Ligaments are stronger than bone during birth and infancy. It is not until adolescence that bone becomes stronger.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
5. The elasticity of pelvic ligaments and softening of cartilage in a pregnant patients are caused by: a. decreased mineral deposition. b. increased hormone secretion. c. uterine enlargement. d. gait changes. e. increased mineral resorption.
ANS: B
Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
6. Skeletal changes in older adults are the result of: a. increased bone deposition. b. increased bone resorption. c. tendons becoming more elastic. d. decreased bone deposition. e. decreased bone resorption.
ANS: B
As a person ages, the skeletal system undergoes several changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition. Tendons become less elastic in older adults.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
7. The usual number of vertebrae is: a. 23. b. 24. c. 25. d. 26. e. 27.
ANS: B
The number of vertebrae that is most common is 24; as few as 11% of persons have 23, and almost 5% have 26.
TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
8. Risk factors for sports-related injuries include: a. competing in colder climates. b. previous fractures. c. history of recent weight loss. d. failure to warm up before activity. e. light body frame.
ANS: D
Failure to warm up before exercise is one risk factor for sports-related injuries. Climate, previous fractures, and weight loss are not as strong risk factors for sports -related injuries. A light body frame is a risk factor for osteoporosis, not sports-related injuries.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
9. The musculoskeletal examination should begin when: a. the patient enters the examination room. b. during the collection of subjective data. c. when height is measured. d. when joint mobility is assessed. e. the remainder of the physical examination is completed.
ANS: A
When the patient first walks in the room, the examiner should observe the gait and posture as part of the musculoskeletal examination.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
10. Pain, disease of the muscle, and damage to the motor neuron may all cause: a. bony hypertrophy. b. muscle crepitus. c. muscle hypertrophy. d. muscle wasting. e. claudication.
ANS: D
Muscle wasting is a consequence of pain from injury, pathology of the muscle, and injury to the motor neuron.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
11. An increase in muscle tone is known as: a. crepitus. b. effusion. c. tenosynovitis. d. atrophy. e. spasticity.
ANS: E
An increase in muscle tone is referred to as spasticity. Crepitus, effusion, and tenosynovitis do not relate to muscle, and atrophy is wasting or a decrease in muscle mass.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
12. A goniometer is used to assess: a. bone maturity. b. joint proportions. c. range of motion. d. muscle strength. e. body fat.
ANS: C
The angle of a joint can be accurately measured using a goniometer. This is used when the joint range of motion is beyond the normal limits. Muscle strength, bone maturity, body fat, and joint proportions are not measured by a goniometer.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
13. When palpating joints, crepitus may be caused when: a. irregular bony surfaces rub together. b. supporting muscles are excessively spastic. c. joints are excessively lax. d. there is excess fluid within the synovial membrane. e. there is muscle wasting.
ANS: A
Crepitus is felt or heard when irregular bony surfaces rub together. Spastic muscles, muscle wasting, lax joints, and excess synovial fluid do not produce this grating sound upon palpation.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
14. Expected normal findings during inspection of spinal alignment include: a. asymmetrical skinfolds at the neck. b. slight right-sided scapular elevation. c. convex lumbar curve. d. head positioned superiorly to the gluteal cleft. e. convex cervical curve.
ANS: D
S i al alig me i c ide ed i hi mal limi he he a ie head i i i ed directly over the gluteal cleft. The skin folds should be symmetrical, the scapulae are at even heights, and both the cervical and lumbar curves are concave.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal a. A prominent lumbar hump b. A prominent cervical concave curve c. Lateral curvature of the spine d. Restricted ability to flex at the hips e. A gibbus
15. When the patient flexes forward at the waist, what spinal observation would lead you to suspect scoliosis?
ANS: C
Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
16. Ulnar deviation and boutonniere deformities are characteristics of: a. winged scapula. b. osteoarthritis. c. osteoporosis. d. congenital defects. e. rheumatoid arthritis.
ANS: E
Deviation of the fingers toward the ulnar side and boutonniere deformities are classic symptoms of rheumatoid arthritis. Winged scapula, osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
17. A finding that is indicative of osteoarthritis is: a. swan neck deformities. b. Bouchard nodes. c. ganglion cysts d. Heberden nodes. e. spindle-shaped fingers.
ANS: D
Heberden nodes are bony overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint, they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities and spindle-shaped fingers; ganglion cysts are not associated with osteoarthritis.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal a. Phalen b. Gower c. Homan d. Tinel e. Allis
18. A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign.
ANS: D
The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
19. Classic carpal tunnel syndrome would result in: a. pain in the fourth and fifth digits. b. a negative Phalen test. c. reduced abduction of the thumb. d. palm tingling. e. a negative Tinel sign.
ANS: C
Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, a positive Phalen sign, reduced abduction of the thumb, and sparing of palm tingling. The median half of the fourth digit and entire fifth digit are asymptomatic.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
20. Excessive hyperextension of the knee with weight bearing may indicate: a. advanced joint degeneration. b. early signs of gout. c. rotation of the Achilles tendon. d. a meniscal tear. e. weakness of the quadriceps muscle.
ANS: E
Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness. Gout, joint degeneration, Achilles tendon rotation, and meniscal tears do not cause hyperextension of the knee.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
21. Arm length is measured from the acromion process through the: a. olecranon joint to carpal thumb hinge. b. olecranon process to distal ulnar prominence. c. proximal radial prominence to distal joint. d. proximal ulnar joint to middle fingertip. e. olecranon process to the second fingertip.
ANS: B
Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow (olecranon process) joint to the wrist (distal ulnar prominence).
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
22. The Thomas test is used to detect: a. hip dislocation. b. unstable sacroiliac joints. c. knee instability. d. flexion contractures of the hip. e. asymmetry in the level of the iliac crests.
ANS: D
The Thomas test requires the patient to lie supine with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture. The Thomas test does not assess hip dislocation, sacroiliac joints, knee instability, or asymmetry of the iliac crests.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal a. Phalen test b. McMurray test c. Thomas test d. Trendelenburg test e. Drawer test
23. Which one of the following techniques is used to detect a torn meniscus?
ANS: B
The McMurray test points to a meniscus tear. The Phalen test detects carpal tunnel syndrome. The drawer test detects an anterior cruciate ligament tear, the Thomas test detects hip contraction, and the Trendelenburg test detects weak hip abductor muscles.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
24. When performing the drawer test, the examiner would place the patient in a supine position and flex the knee 45 to 90 degrees, placing the foot flat on the table, and then: a. grasp and evert the foot and extend the knee. b. grasp and invert the foot and rotate the knee. c. grasp the lower leg with both hands and draw the tibia forward and then backward. d. apply varus stress with the foot planted. e. apply valgus stress after the leg is extended.
ANS: C
The next step is to place both hands on the lower leg with the thumbs on the ridge of the anterior tibia just distal to the tibial tuberosity. Draw the tibia forward, forcing the tibia to slide forward of the femur. Then push the tibia backward. Anterior or posterior movement of the knee greater than 5 mm in either direction is an unexpected finding.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal a. Lachman b. straight leg raise c. valgus stress d. Homan e. Thomas
25. Anterior cruciate ligament integrity is assessed via the _____ test.
ANS: A
The Lachman test evaluates anterior cruciate ligament integrity. The straight leg raise test assesses nerve root damage, the valgus stress test assesses instability of the lateral and medial collateral ligaments, the Homan test assesses for blood clots in the legs, and the Thomas test is used to detect flexion contractures of the hips.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal a. varus stress b. valgus stress c. Apley d. Lachman e. drawer
26. During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the _____ test.
ANS: B
The injury described will most likely result in a medial meniscus or medial coll ateral ligament damage. Your initial assessment would be to apply the valgus stress test to assess the medial meniscus.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
27. Term infants normally resist: a. ankle dorsiflexion. b. McMurray test. c. forefoot adduction. d. knee extension. e. elbow flexion.
ANS: D
Along with elbows and hips, newborns tend to resist extension of the knee; however, movements should be symmetrical.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal a. Ballottement maneuvers b. Barlow-Ortolani maneuvers c. Range of motion d. Thomas McMurray assessment e. Trendelenburg test
28. What technique is performed at every infant examination during the first year of life to detect hip dislocation?
ANS: B
A e e e ami a i d i g a i fa fi ea f life, he Ba l -Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation and is signified by a clicking noise wit h the maneuver.
TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
29. You note that a child has a positive Gower sign. You know that this indicates generalized: a. arthropathy. b. muscle weakness. c. bursitis. d. muscle hypertrophy. e. scoliosis.
ANS: B
Gower sign is generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee, pushing down on the thighs while trying to pull up the trunk. It is often associated with muscular dystrophy.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal a. Carpal tunnel syndrome b. Osteitis deformans c. Radial head subluxation d. Talipes equinovarus e. Legg-Calvé-Perthes disease
30. What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention?
ANS: A
Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms of the syndrome.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
31. An adult with bowed tibias and a shortened thorax may have: a. ankylosing spondylitis. b. Paget disease. c. rheumatoid arthritis. d. Dupuytren contracture. e. Sprengel deformity.
ANS: B
Paget disease is characterized by bowed tibias, asymmetric skull, shortened chest, and susceptibility to fractures.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
32. In differentiating osteoarthritis from rheumatoid arthritis (RA), the patient with osteoarthritis typically exhibits: a. metatarsus adductus. b. depression. c. sudden onset. d. less weakness and fatigue. e. pain most pronounced after periods of rest.
ANS: D
One of the key differences between the symptoms of osteoarthritis and those of RA is that fatigue is uncommon in osteoarthritis patients. The joints of patients with RA are stiff after rest.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
33. Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would perform a: a. startle reflex. b. Barlow-Ortolani maneuver. c. Trendelenburg test. d. tibial torsion test. e. Lachman test.
ANS: B
The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm results for hip dislocation.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
34. A 7-year-old child who begins to limp and complains of persistent hip pain may have: a. myelomeningocele. b. Dupuytren contracture. c. Legg-Calvé-Perthes disease. d. osteoarthritis. e. congenital hip dislocation.
ANS: C
Constant hip pain with a limp in a young child is indicative of Legg -Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by inadequate blood supply. Myelomeningocele, Dupuytren contracture, osteoarthritis, and congenital hip dislocation are not characterized by age group and these symptoms.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
35. Dupuytren contracture affects the: a. hip flexor muscle. b. plantar fascia. c. carpal tunnel. d. palmar fascia. e. rotator cuff.
ANS: D
A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture.
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
36. A dowager hump is: a. the hallmark of osteoporosis. b. pathognomic of scoliosis. c. indicative of tendonitis. d. characteristic of rickets. e. indicative of muscular dystrophy.
ANS: A
Osteoporosis leads to vertebral compression and kyphotic bowing of the spine known as d age h m .
TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
