M1 Ch 2-5

Question 1

A 20yr Old patient presents to the office for a wellness exam. The clinician assesses the patient’s use of seat belts. Which component of the wellness exam is assessed?

a. HPI
b. PMH
c. assessment and plan
d. Anticipatory guidance

Answer 1

d. Anticipatory guidance

Question 2

Which of the following is NOT an element of history taking?

a. CC
b. Fam hx
c. Physical examination
d. HPI

Answer 2

C. physical examination

Question 3

Patient presents to the office with shoulder pain. Pain is constant, burning, and reported worse at night. During the patient interview, the Clinician asks the pt "Can you tell me what you have been doing for your shoulder pain" The clinician is asking info about?
a. Modifying factors
b. quality
c associated signs and sx
d. health promotion

Answer 3

a. modifying factors

Question 4

What id the difference b/w an open-ended question and a closed-ended question?

a. OE question are answered with yes or no. CE are answered with more detail
b. OE questions have more details than simple yes or no answers
c. OE questions refer only to the physical exam section of CE questions refer only to the history collection
d. The only difference b/w the two is the timing of when the questions are asking

Answer 4

B. Open-ended questions have more details than simple yes or no

Question 5

A set of EB recommendations for preventative services were developed by which agency?

a. U.S Agency of Health and Human services?
b. U.S Institute of Medicine Task Force
c. U.S Preventative Services Task Force
d. U.S Center for Health and Wellness

Answer 5

c. U.S Preventative Services Task Force

Question 6

An established pt presents for a f/u visit for her stable HTN. During this visit, the clinician can update the ROS, PMI, Fam hx and social hx by simply stating the info was reviewed and updated from the previous encounter.

a. true
b. false

Answer 6

a. true

Question 7

What vaccines would you recommend for a 70 year old pt to receive at a wellness exam?

a. varicella, TD, zoster, pneumococcal
b. TD. zoster pneumococcal
c. flu, zoster. Tdap, pneumococcal, zoster
d. Nasal flu mist, TD, varicella

Answer 7

c. flu, zoster, tdap, pneumococcal, Zoster

Question 8

When considering hx collection during a wellness exam, which statement below is NOT correct?

a. Wellness exams do not require a cc
b. Wellness exams are age and gender appropriate
c. Wellness exams include counseling and anticipatory guidance
d. Wellness exams are based on a presenting problem.

Answer 8

d. Wellness exams are based on a presenting problem

Question 9

Which is TRUE about the use of screening tools to assess depression?

a. screening tools like PHQ-2 and PHQ-9 are recommended and evidence based.
b. screening tools should be used only when the clinician is short on time for the visit
c. screening tools like PHQ-2 and PHQ-9 are not to be used during wellness exams
d. screening tools like PHQ-2 are too short to be effective assessment

Answer 9

a. screening tools like PHQ-2 and PHQ-9 are recommended and evidence based.

Question 10

Wt obtained during a patient’s chronic management f/u visit for HTN finds the pt has increased 10;b over the past year and the her BMI is considered morbidly obese. During the visit, the clinician should place greater emphasis on?

a. physical exam findings
b. lifestyle modifications
c. updating social hx
d. management of HTN

Answer 10

b. lifestyle modifications

Question 11

Which is true about the impact of family on an individual’s health?

a. Family has little impact on an individuals health
b. Family has a negative impact on an individual’s health.
c. Family systems can impact on individuals health and wellness needs
d. Family systems are unlikely to impact healthy individuals

Answer 11

c. Family systems can impact on individuals health and wellness needs

Question 12

How does a clinician BEST assess the impact of an individual’s community on his or her health?

a. Assess the environment and location where the patient was born and raised.
b. assess whether the patient has any medical conditions affecting his or her health.
c. ask the patient if he or she has any community or cultural concerns.
d. ask about where the person resides, works, learns. plays. worships, and connects width others.

Answer 12

d. ask about where the person resides, works, learns. plays. worships, and connects width others.

Question 13

What are health disparities?

a. differences attributed to an individual’s health behaviors
b. differences in illness, injury, disability, or mortality experienced.
c. greater burden of implicit bias experienced
d. greater burden of overt bias experienced

Answer 13

b. differences in illness, injury, disability, or mortality experienced.

Question 14

Which is true about the assessment of population health?

a. Assessments of the health of a population can lead to positive impact within communities.
b. Assessments of the health of a population often lead to clinician burnout.
c. Initiatives to improve health are unlikely to be effective at a community or population level.
d. Initiative to assess population health are better if completed by organizations like the CDC, rather than clinicians

Answer 14

a. Assessments of the health of a population can lead to positive impact within communities.

Question 15

Culture can be defined by

a. beliefs and behaviors only
b. physical characteristics
c. race or ethnicity only
d. race ethnicity, geography, language, values beliefs and behaviors.

Answer 15

d. race ethnicity, geography, language, values beliefs and behaviors.

Question 16

The role of the clinician in assessing health an health disparities includes

a. completing physical assessment w/o regard to rce or ethnicity
b. documenting advanced assessment w/o regard to race or ethnicity
c. recognizing barriers to care and being sensitive to cultural influences
d. telling each individual patient what is best for them and their health

Answer 16

c. recognizing barriers to care and being sensitive to cultural influences

Question 17

Which would be the best way to document an abnormal skin exam?
a Hard, fixed nodule found on left arm
b. 2x3 in firm, nontender, fixed nodule on left arm
c. 2x3 in firm, nontender, fixed nodule on left anterior arm 1 in below wrist
d. 2x3 in firm, nontender, fixed nodule on left anterior arm 1 in below wrist on ulnar side

Answer 17

d. 2x3 in firm, nontender, fixed nodule on left anterior arm 1 in below wrist on ulnar side

Question 18

Documentation provides:

a. a legal document of the visit
b. a way to document clinical progress
c. on ongoing record of the patient’s clinical picture
d. All the above

Answer 18

d. All the above

Question 19

Which of the following would be an appropriate documentation?

a. Patient takes 68 units of insulin
b. patient takes one tablet QD
c. Patient takes 10.0mg of lisinopril
d. Patient on 0mg MS

Answer 19

a. Patient takes 68 units of insulin

Question 20

Which of the following is NOT considered a pertinent negative finding for abdominal pain?

a. No fever
b. No shoulder pain
c. No diarrhea
d. No vomiting

Answer 20

b. No shoulder pain

Question 21

Which best describes how pediatric health history and physical exam are different from adults?

a. The clinician can use the same approach to hx and physical with a child if the clinician is highly skilled and efficient.
b. Compared with adults, children experience rapid periods of growth and development, so the clinician should tailor the approach to the child’s developmental level
c. children are unable to provide reliable info for the health history and exam; therefore, the clinician should solely on the info from the caregiver.

Answer 21

b. Compared with adults, children experience rapid periods of growth and development, so the clinician should tailor the approach to the child’s developmental level
* children must always be included especially greater than age 4-5

Question 22

Which approach by the clinician can increase a younger child’s cooperation with the physical exam?

a. Findings ways to transform the physical exam into a play activity
b. Move quickly through the exam, performing the most distressing assessment first to get it over with.
c. ask the child if it is okay to begin the physical exam to promote autonomy and trust
d. only examine the physical systems that the child permits so the child does not become distressed.

Answer 22

a. Findings ways to transform the physical exam into a play activity

never ask a child permission will always get a “no”

give them choices, but with in reason “do you want me to look in ears first or eyes?”

Question 23

What is the intended outcome of the ALARA principle?

a. Promote the use of CT in all kids
b. promote the use of high dose radiation to improve image quality
c. Limit radiation doses in children when possible to prevent harm
d. clinicians should always use US before CT.

Answer 23

c. Limit radiation doses in children when possible to prevent harm

Question 24

Which statements best applies to the care of the adolescent?

a. Adolescents are more likely to share personal info with the clinician if confidentiality is guaranteed.
b. More adolescents ar willing to seen healthcare if the clinician can provide a private, confidential encounter
c. the clinician should be aware of the state and federal law regarding adolescent consent and confidentiality
d. adolescents are minors and are not entitled to a confidential conversation with the clinician unless the caregiver consents.

Answer 24

a. Adolescents are more likely to share personal info with the clinician if confidentiality is guaranteed.
b. More adolescents are willing to seen healthcare if the clinician can provide a private, confidential encounter
c. the clinician should be aware of the state and federal law regarding adolescent consent and confidentiality

Question 25

Which statements describes the approach to the physical exam of infants and young children? Choose all that apply.

a. It is best to perform the otoscope exam while the caregiver is cradling the newborn.
b. Safe positioning of the infant or young child may require caregiver assistance.
c. The clinician can generate cooperation from young children by allowing them to become familiar with exam equipment like the otoscope or stethoscope
d. If the young child requires restraint to perform the exam sagely, the clinician should forego that part of the exam

Answer 25

b. Safe positioning of the infant or young child may require caregiver assistance.
c. The clinician can generate cooperation from young children by allowing them to become familiar with exam equipment like the otoscope or stethoscope

Question 26

Which statement is TRUE about musculoskeletal considerations in young children?

a. Closure of the growth plate occurs during Tanner stage 3.
b. All infants should be routinely assessed for DDH until they are walking normally.
c. The bones of young children are more brittle than those of adults.
d. clinicians rarely need to worry about growth plate fractures.

Answer 26

b. All infants should be routinely assessed for DDH until they are walking normally.

*Skeletal maturity occurs at the end of puberty
* children’s bones are more pliable not brittle more likely to have deformities (bowing)than breaks
DDH should be assessed/checked at birth and at every wellness exam until the child can walk normally

assessed by Ortolani’s and Barlow’s

Question 27

Normal range of onset for puberty development in girls is?
a. 8-10
b. 10-12
c. 8-13
d 13-14

Answer 27

c. 8-13

males 13-14

** much watch for early puberty

Question 28

Which of the following statements about preventative considerations for the care of children is FALSE?

a. BP in children needs to be checked only if children are showing signs or symptoms of cardiovascular or renal disease
b. According to AAP, BMI should be measured for all children annually beginning at age 2.
c. Children should be screened for dyslipidemia once b/w ages 9-11 and 17-21 yrs
d. Adolescents b/w 12-18yrs should be screened for major depressive disorder

Answer 28

a. BP in children needs to be checked only if children are showing signs or symptoms of cardiovascular or renal disease
* BP in children should be checked annually starting at 3

Question 29

Which of the following describes the BEST approaches to detecting DD in young children?

a. The clinician should conduct developmental surveillance only when a caregiver is concerned about slow development
b. The clinician should perform developmental surveillance at every routine health encounter
c. The clinician should be complete a standardize developmental screening at ages 9, 18, and 24 to 30
d. if a caregiver is offended by the suggestions that his or her child may have a DD delay, the clinician should drop the issue until the next visit.

Answer 29

b. The clinician should perform developmental surveillance at every routine health encounter
c. The clinician should be complete a standardize developmental screening at ages 9, 18, and 24 to 30

• reasoning is for early detection in order to improve the child’s trajectory.

Question 30

Which statement about evaluating growth in children is FALSE?

a. Deviation in growth patterns may indicate a serious underlying conditions.
b. The CDC growth charts should be used for children aged 0-18yrs.
c. BMI is evaluated by comparing the BMI calculations with a reference population of children of the same age and natal sex.
d. Accurate growth measures are essential for a reliable evaluation.

Answer 30

b. The CDC growth charts should be used for children aged 0-18yrs.
* Growth charts are used for children aged 0-23 months
* Wt, HT, head circumference and BMI are all compared with a reference population of children of the same age

Question 31

Proper way to exam ear canal of children less than 3 years old?

Answer 31

Upward and back

• greater than 3 years down and forward

Question 32

Developmental surveillance is performed at every routine admission in order to recognize children’s who may be at risk for DD. What are the months of routine visits?

Answer 32

9, 18, 24,30 months

Question 33

A. Patient is considered obese and at risk for certain medical conditions if his or her BMI is

a. Below 15
b. 18.5-24.9
c. 25.0 to 29.9
d. 30.0 and above

Answer 33

d. 30.0 and above

Question 34

The expected RR for a individual greater than 12 is

a. 12-20
b. 16-22
c. 20-24
d. 22-30

Answer 34

a. 12-20

• 16-22= 6rs-12
• 20-24 =3yrs -6 yrs
• 22-30= 1-3 yrs

Question 35

Which BP is considered expected for an individual 36 yrs of age?

a. 140/88
b. 136/92
c. 118/78
d. 160/100

Answer 35

c. 118/78

<120 SBP and < 90 = normal adult
120-129/80 = elevated in adult
130-139/80-90 = Pre HTN

Question 36

Which factor may contribute to an inaccurate BP reading? Select all that apply
a. being cold
b Having caffeine
c. using a bp that is too small
d. taking an antihypertensive medication on the day of the exam
e. using a BP cuff that is too large

Answer 36

a. being cold
b Having caffeine
c. using a bp that is too smal
e. using a BP cuff that is too largel

Question 37

In assessing Tympanic membrane in an adult, which technique would result in the most accurate reading?

a. A plastic probe placed under the tongue
b. The pinna is pulled back and up
c. Scan across the forehead. and behind ear.
d. Removing hearing aides and wait one minute

Answer 37

b. The pinna is pulled back and up

* children pinna is pulled Back and down