Multiple choice Items
Test 40 QS
· Question Points: 0.0 / 1.0
· Which of the following represents age-related changes in the lungs?
· Decrease in chest wall compliance
· Speed of expiration increases
· Increase in respiratory muscle strength
· Increased elastic recoil of lung tissue
· Question Points: 0.0 / 1.0
· A 32-year-old white female presents to your clinic complaining of overwhelming sadness. She says for the past 2 months she has had crying episodes, difficulty sleeping, and problems with overeating. She says she used to go out with her friends from work, but now she just wants to go home and be by herself. She also thinks that her work productivity has been dropping because she just is too tired to care or concentrate. She denies any feelings of guilt or any suicidal ideation. She states that she has never felt this way in the past. She denies any recent illness or injuries. Her past medical history consists of an appendectomy when she was a teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her father has had a history of mental illness. On examination, you see a woman appearing her stated age who seems quite sad. Her facial expression does not change while you talk to her and she makes little eye contact. She speaks so softly you cannot always understand her. Her thought processes and content seem unremarkable.
What type of mood disorder do you think is most likely?
· Dysthymic disorder
· Manic (bipolar) disorder
· Major depressive episode
· Anxiety disorder
· Question Points: 0.0 / 1.0
· A 40-year-old mother of two presents to your office for consultation. She is interested in knowing what her relative risks are for developing breast cancer. She is concerned because her sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that she began having periods at age 11 and has been fairly regular ever since, except during her two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise, she has had no health problems. Her father has high blood pressure. Her mother had unilateral breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law attorney and is married. Her examination is essentially unremarkable.
Which risk factor of her personal and family history most puts her in danger of getting breast cancer?
.
· Age at menarche of less than 12
· First live birth between the ages of 25 and 29
·
· First-degree relative with postmenopausal breast cancer
· First-degree relative with premenopausal breast cancer
· Question Points: 0.0 / 1.0
· Ray works a physical job and notes pain when he attempts to lift his arm over his head. When you move the shoulder passively, he has full range of motion without pain and there is no gross swelling or tenderness. What type of joint disease does this most likely represent?
· Articular
· Extra-articular
· Neither
· Both
· Question Points: 0.0 / 1.0
· A 36-year-old married bank teller presents to your office, complaining of pain with defecation and occasional blood on the toilet paper. She states that last week she had food poisoning with nausea, vomiting, and diarrhea. She had runny stools but no black or bloody stools. Ever since her illness, she has continued to have severe pain with bowel movements. She now tries to put off defecation as long as possible. Although she is having constipation she denies any further diarrhea or leakage of stool. She has a past medical history of hypothyroidism and two spontaneous vaginal deliveries. She has had no other chronic illnesses or surgeries. She does not smoke and rarely drinks. She has two children. There is no family history of breast or colon cancer. She has had no weight gain, weight loss, fever, or night sweats. On examination she is afebrile, with a blood pressure of 115/70 and a pulse of 80. On abdominal examination, she has active bowel sounds, is nontender in all quadrants, and has no hepatosplenomegaly. Inspection of the anus reveals inflammation on the posterior side with erythema. Digital rectal examination is painful for the patient but no abnormalities are palpated. Anoscopic examination reveals no inflammation or bleeding. What is the anal disorder that best describes her symptoms?
· Anorectal fistula
· External hemorrhoids
· Anal fissure
· Anorectal cancer
· Question Points: 0.0 / 1.0
· Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When you speak with him alone in the room, he states it “would be better if I was not here.” What would you do next?
· Tell him that he has a very promising career in anything he chooses and soon he will feel better.
· Tell him that he needs an antidepressant and it will take about 4 weeks to work.
· Speak with his mother about getting him together more with his friends.
· Assess his suicide risk.
· Question Points: 1.0 / 1.0
· Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have?
· Medial epicondylitis (golfer’s elbow)
· Olecranon bursitis
· Lateral epicondylitis (tennis elbow)
· Supracondylar fracture
· Question Points: 0.0 / 1.0
· A 26-year-old violinist presents to your clinic complaining of anxiety. He is a first-chair violinist in the local symphony orchestra and has started having symptoms during performances, such as sweating, shaking, and hyperventilating. It has gotten so bad that he has thought about giving up his first-chair status so he does not have to play the solo during one of the movements. He says that he never has these symptoms during rehearsals or when he is practicing. He denies having any of these symptoms at any other time. His past medical history is unremarkable. He denies any tobacco use, drug use, or alcohol abuse. His parents are both healthy. On examination you see a young man who appears worried. His vital signs and physical examination are unremarkable.
What type of anxiety disorder best describes this situation?
· Panic disorder
· Specific phobia
· Social phobia
· Generalized anxiety disorder
· Question Points: 0.0 / 1.0
· A 52-year-old secretary presents to your office, complaining about accidentally leaking urine when she coughs or sneezes. She says this has been going on for about a year now. She relates that she has not had a period for 2 years. She denies any recent illness or injuries. Her past medical history is significant for four spontaneous vaginal deliveries. She is married and has four children. She denies alcohol, tobacco, or drug use. During her pelvic examination, you note some atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal examinations are unremarkable.
Which type of urinary incontinence does she have?
· Stress incontinence
· Urge incontinence
· Overflow incontinence
· Mixed Incontinence
· Question Points: 0.0 / 1.0
· A 37-year-old nurse presents for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
· Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
· Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.
· Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
· Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.
· Question Points: 0.0 / 1.0
· A 29-year-old computer programmer presents to your office for evaluation of a headache. The tightening sensation is located all over the head and is of moderate intensity. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours each day at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain but not taken it away. Based on this description, what is your most likely diagnosis?
· Tension
· Migraine
· Cluster
· Analgesic rebound
· Question Points: 0.0 / 1.0
· You are having trouble examining the abdomen of a school-aged child due to ticklishness. What should you do?
· Have the child press on your hand.
· Have the parent insist that the child allow you to examine her.
· Ask the parent to leave the room.
· Make the child realize that this is part of the examination and must be done.
· Question Points: 1.0 / 1.0
· A 27-year-old woman is brought to your office by her mother. The mother tells you that her daughter has been schizophrenic for the last 8 years and is starting to decompensate despite medication. The patient states that she has been taking her antipsychotic and she is doing just fine. Her mother retorts that her daughter has become quite paranoid. When asked why, the mother gives an example about the mailman. She says that her daughter goes and gets the mail every day and then microwaves the letters. The patient agrees that she does this but only because she sees the mailman flipping through the envelopes and she knows he’s putting anthrax on the letters. Her mother turns to her and says, “He’s only sorting the mail!”
Which best describes the patient’s abnormality of perception?
· Illusion
· Hallucination
· Fugue state
· Facticious
· Question Points: 0.0 / 1.0
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· A 29-year-old married computer programmer presents to…
