Midterm Exam: NR 509 / NR509 Advanced
Physical Assessment Exam Review | Weeks 5-
8 Covered| Questions and Verified Answers
(2023/ 2024 Update)
Q: A first-semester physician assistant student reports to his supervisor that he has trouble
determining the diastolic blood pressure. On manual blood pressure, which of the following
provides the best estimate of the true diastolic blood pressure?
Answer:
a. The point at which Korotkoff sounds first muffle after systolic blood pressure is discerned.
b. The average between the highest and lowest points of the auscultatory gap.
c. The recommencement of Korotkoff sounds following the lower point of the auscul- tatory gap.
d. The disappearance of Korotkoff sounds following initial muffling.
e. The average reading between the onset of the auscultatory gap and the resump- tion of
Korotkoff sounds.
Q: A 72-year-old retiree presents to the cardiology clinic with palpitations after several months
of symptoms. An electrocardiogram (ECG) shows a tachyarrhythmia, which the cardiologist
diagnoses as atrial fibrillation. In measuring the blood pressure of a patient with chronic atrial
fibrillation, which of the following statements is true?
Answer:
a. The precise blood pressure is measured by taking the average of three pressures in both arms
over a span of 20 minutes.
b. Single automated measurement in the office setting provides a reliable value for the true blood
pressure.
c. Ambulatory monitoring over 2-24 hours is recommended because this rhythm produces
variable and inconsistent blood pressures.
d. Measuring blood pressure in patients with atrial fibrillation is no different than measuring
blood pressure in patients with normal cardiac rhythms.
e. Because atrial fibrillation is an uncommon arrhythmia, blood pressure management of these patients does not have widespread significance in office or ambulatory practice.
Q: A 42-year-old architect presents with widespread pain complaints, includ- ing headaches
almost daily, pain at the site of an old motor vehicle accident injury, and generalized achiness
and hypersensitivity throughout the body. He recounts that his first episodes of ongoing pain
occurred in his early 20s, and he has been to many practitioners over several years seeking a firm
diagnosis and adequate treatment of his complaints. Which of the following statements is true
regarding chronic pain?
Answer:
a. Following assessment and evaluation, ~80% of patients with non-cancer-related pain report
control of their symptoms.
b. Chronic pain is defined as pain not due to cancer or a recognized medical condition that
persists for >3-6 months.
c. Chronic pain is defined as focused pain lasting >8 months following acute injury or illness.
d. In primary care practices, non-cancer-related chronic pain is seen in <10% of patients.
e. Pain that recurs at intervals of months or years is never considered to be “chronic pain.”
Q: Disparities in pain treatment have been well described in numerous stud- ies comparing
Caucasian patients to those of African American and Hispanic origin. Which of the following
statements is true concerning this issue?
Answer:
a. Racial and ethnic biases are only relevant in geographic areas that have a history of racial and
ethnic discrimination.
b. Racial and ethnic biases never involve two persons of the same race or ethnic group.
c. Language barriers do not contribute to the problem of racial and ethnic biases. d. Biases of the
treating clinician are associated with overtreatment of pain in minority patients and non-English
speakers.
e. Biases of the treating clinician are associated with under-treatment of pain in minority patients
and non-English speakers.
Q: Which of the following statements is true concerning mental health disor- ders in primary
care?
Answer:
a. The prevalence for mental disorders is estimated to be
~10%, of which only 25% are not diagnosed.
b. Anxiety disorders are the most prevalent of all diagnoses in this setting.
c. Somatic symptom disorder (DSM-5) is distinctly uncommon in this setting and constitutes less
than 5% of these disorders.
d. Mood disorders make up ~25% of all diagnoses.
e. Alcohol and substance abuse are not considered mental health disorders.
Q: Which of the following complaints/findings is considered to be a patient identifier for
mental health screening?
Answer:
a. High use of health services due to chronic unstable medical diagnoses
b. Symptoms lasting for >2 weeks
c. Acute pain syndromes of 10 days’ duration that require opiates for relief d. Substance abuse
e. A patient with type I diabetes and neuropathic pain
Q: A 38-year-old accountant presents to the office with a series of generalized complaints. He
relates that he feels a loss of pleasure in daily activities, has difficulty sleeping, and is
experiencing problems making decisions. Which of the following best explains the patient’s
presentation?
Answer:
a. Substance abuse with anhedonia
b. Bipolar disorder in the early pre-excitatory phase c. Histrionic personality
d. Depression
e. Antisocial personality
Q: Concerning hallucinations, an abnormal perception experienced by a pa- tient, which of the
following statements is true about this abnormality?
Answer:
a. They include false perceptions associated with dreaming and occurring with falling asleep and
awakening.
b. Objective testing can be performed by a trained neuropsychologist to ascertain the correct
diagnosis associated with this complaint.
c. Although alcoholism may be associated with abnormalities of perception, it is not considered a
cause of hallucinations as this finding is due to its direct toxic effects. d. It may occur in
association with a number of conditions including delirium and dementia, posttraumatic stress
disorder (PTSD), and schizophrenia.
e. By definition, hallucinations are confined to those abnormal perceptions that are either
auditory or visual in nature.
Q: A 24-year-old veteran returns from his second tour of duty in the Middle East. He was
witness to a number of violent military encounters and experi- enced the death of several of his
closest friends. He describes a number of problems including nightmares, poor sleep pattern, and
mild panic attacks. In persons with trauma- and stress-related disorders as well as other disor-
ders that may be associated with hallucinations and illusions, which of the following statements
is true that distinguishes these two entities from each
other?
Answer:
a. Illusions occur only when awake, whereas hallucinations can occur both while awake and
while sleeping.
b. Illusions are a misinterpretation of real stimuli, whereas hallucinations are subjec- tive
perceptions in the absence of real stimuli.
c. Illusions involve an irrational fear or perceptions, whereas hallucinations are a
misinterpretation of real external stimuli.
d. Hallucinations may be visual or auditory, causing an alteration of the real external world,
whereas illusions are entirely imaginary.
e. Hallucinations by definition never include somatic perceptions, whereas illusions always
involve at least some component of a somatic complaint.
Q: Abstract thinking is an important component of the human thought process. A person’s
ability to understand questions that test his or her ability to answer appropriately is dependent
upon a number of factors. Which one
of the following answers is true in identifying a patient with concrete thinking and a reduced
ability to think abstractly?
Answer:
a. An inability to correctly perform serial
7s
b. An inability to spell “world” backward
c. An inability to name the occupations of common well-known public figures such as the
President and Vice President
d. An inability to draw a clock correctly including all numbers and make it tell time as requested
(i.e., 10:15)
e. An inability to discern the similarity between two words (e.g., a cat and a mouse by answering
“The cat chases the mouse.”)
Q: Concerning a patient that may demonstrate a diagnosis of aphasia, which of the following
statements is true?
Answer:
a. It involves a loss of the voice or a slurring or hoarseness of speech secondary to pathology of
the larynx or its nerve supply. b. It is best characterized by slurred speech with an associated
defect in language control.