Exam (elaborations)
NU 518-Comprehensive Health Assessment
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NU 518-Comprehensive Health Assessment
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NU 518-Comprehensive Health AssessmentA 38-year-old accountant comes to your clinic for evaluation of a headache. The
throbbing sensation is located in the right temporal region and is an 8 on a scale of 1
to 10. It started a few hours ago, and she has noted nausea with sensitivity to light;
she has had headaches like this in the past, usually less than one per week, but not
as severe. She does not know of any inciting factors. There has been no change in
the frequency of her headaches. She usually takes an over the-counter analgesic,
and this results in resolution of the headache. Based on this description, what is the
most likely diagnosis of the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound - ANSWER B
A 29-year-old computer programmer comes 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?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound - ANSWER A
Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea - ANSWER A
A 49-year-old administrative assistant comes to your office for evaluation of
dizziness. You elicit the information that the dizziness is a spinning sensation of
sudden onset, worse with head position changes. The episodes last a few seconds
and then go away, and they are accompanied by intense nausea. She has vomited
one time. She denies tinnitus. You perform a physical examination of the head and
neck and note that the patient's hearing is intact to Weber and Rinne and that there
is nystagmus. Her gait is normal. Based on this description, what is the most likely
diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma - ANSWER A
A 55-year-old bank teller comes to your office for persistent episodes of dizziness.
The first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of
,nausea with vomiting; the episode resolved spontaneously. He has had five
episodes in the past 1½ weeks. He does note
some tinnitus that comes and goes. Upon physical examination, you note that he has
a normal gait. The Weber localizes to the right side and the air conduction is equal to
the bone conduction in the right ear. Nystagmus is present. Based on this
description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma - ANSWER C
A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She
is not on any medications and does not take herbs or supplements. She has no
chronic medical conditions. She does not smoke or drink alcohol. She walks into the
examination room with slow movements and shuffling steps. She has decreased
facial mobility and a blunt expression,
without any changes in hair distribution on her face. Based on this description, what
is the most likely reason for the patient's symptoms?
A) Cushing's syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson's disease - ANSWER D
A 29-year-old physical therapist presents for evaluation of an eyelid problem. On
observation, the right eyeball appears to be protruding forward. Based on this
description, what is the most likely diagnosis?
A) Ptosis
B) Exophthalmos
C) Ectropion
D) Epicanthus - ANSWER B
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in
the left eye. It started this morning. He denies any trauma or injury. There is no
visual disturbance. Upon physical examination, there is a red raised area at the
margin of the eyelid that is tender to palpation; no tearing occurs with palpation of
the lesion. Based on this description, what is the
most likely diagnosis?
A) Dacryocystitis
B) Chalazion
C) Hordeolum
D) Xanthelasma - ANSWER C
A 15-year-old high school sophomore presents to the emergency room with his
mother for evaluation of an area of blood in the left eye. He denies trauma or injury
but has been coughing forcefully with a recent cold. He denies visual disturbances,
eye pain, or discharge from the eye. On physical examination, the pupils are equal,
round, and reactive to light, with a visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply
demarcated area at the lateral aspect of the base of the left eye. The cornea is clear.
Based on this description, what is the most likely diagnosis?
,A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage - ANSWER D
A 67-year-old lawyer comes to your clinic for an annual examination. He denies any
history of eye trauma. He denies any visual changes. You inspect his eyes and find a
triangular thickening of the bulbar conjunctiva across the outer surface of the cornea.
He has a normal pupillary reaction to light and accommodation. Based on this
description, what is the most likely diagnosis?
A) Corneal arcus
B) Cataracts
C) Corneal scar
D) Pterygium - ANSWER D
Which of the following is a "red flag" regarding patients presenting with headache?
A) Unilateral headache
B) Pain over the sinuses
C) Age over 50
D) Phonophobia and photophobia - ANSWER C
A sudden, painless unilateral vision loss may be caused by which of the following?
A) Retinal detachment
B) Corneal ulcer
C) Acute glaucoma
D) Uveitis - ANSWER A
Sudden, painful unilateral loss of vision may be caused by which of the following
conditions?
A) Vitreous hemorrhage
B) Central retinal artery occlusion
C) Macular degeneration
D) Optic neuritis - ANSWER D
Diplopia, which is present with one eye covered, can be caused by which of the
following problems?
A) Weakness of CN III
B) Weakness of CN IV
C) A lesion of the brainstem
D) An irregularity in the cornea or lens - ANSWER D
A patient complains of epistaxis. Which other cause should be considered?
A) Intracranial hemorrhage
B) Hematemesis
C) Intestinal hemorrhage
D) Hematoma of the nasal septum - ANSWER B
Glaucoma is the leading cause of blindness in African Americans and the second
leading cause of blindness overall. What features would be noted on funduscopic
examination?
, A) Increased cup-to-disc ratio
B) AV nicking
C) Cotton wool spots
D) Microaneurysms - ANSWER A
Very sensitive methods for detecting hearing loss include which of the following?
A) The whisper test
B) The finger rub test
C) The tuning fork test
D) Audiometric testing - ANSWER D
Which area of the fundus is the central focal point for incoming images?
A) The fovea
B) The macula
C) The optic disk
D) The physiologic cup - ANSWER A
A light is pointed at a patient's pupil, which contracts. It is also noted that the other
pupil contracts as well, though it is not exposed to bright light. Which of the following
terms describes this latter phenomenon?
A) Direct reaction
B) Consensual reaction
C) Near reaction
D) Accommodation - ANSWER B
A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following
is true?
A) She obtains a 20% correct score at 100 feet.
B) She can accurately name 20% of the letters at 20 feet.
C) She can see at 20 feet what a normal person could see at 100 feet.
D) She can see at 100 feet what a normal person could see at 20 feet. - ANSWER
C
On visual confrontation testing, a stroke patient is unable to see your fingers on his
entire right side with either eye covered. Which of the following terms would describe
this finding?
A) Bitemporal hemianopsia
B) Right temporal hemianopsia
C) Right homonymous hemianopsia
D) Binasal hemianopsia - ANSWER C
You note that a patient has anisocoria on examination. Pathologic causes of this
include which of the following?
A) Horner's syndrome
B) Benign anisocoria
C) Differing light intensities for each eye
D) Eye prosthesis - ANSWER A
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