Quiz 5: Secondary Assessment

You would like to test a patient's visual acuity, but a visual acuity card or wall chart is not available. You can still test for visual acuity by: A) asking the patient to indicate the farthest object he can see. B) checking the pupils. C) having the patient count your raised fingers. D) covering one eye and testing for light accommodation.

You are able to feel vibrations through the chest wall as your patient speaks. This is called: A) egophony. B) auscultation. C) whispered pectoriloquy. D) tactile fremitus.

The process in which a paramedic places a hand on a body part, then sharply taps a distal knuckle with the tip of another finger, is known as: A) percussion. B) hyperresonance. C) palpation. D) observation.

Asking your patient to recall what he had for a meal earlier in the day would test: A) recent memory. B) remote memory. C) immediate memory. D) long-term memory.

Physical exam techniques include all of the following EXCEPT: A) palpation. B) association. C) auscultation. D) inspection.

Petechiae are skin lesions characterized by: A) reddish lines radiating from a red spot. B) irregular red spots. C) reddish-purple spots less than 0.5 cm in diameter. D) reddish-purple blotches greater than 0.5 cm in diameter.

Which of the following is included in an examination of the cardiovascular system? A) Auscultate for carotid bruits. B) Palpate to check for Murphy's sign. C) Auscultate breath sounds. D) Palpate both carotid arteries simultaneously.

Inspection of the maxillary sinuses is accomplished by: A) palpating under the zygomatic arches. B) obstructing one side of the nares and watching the patient breathe. C) using an otoscope for visualization. D) palpating the nose and septum.

One sign of gonorrhea in males is a(n): A) profuse, yellow discharge. B) white, curdlike discharge. C) scant, clear discharge. D) external pustule.

During a musculoskeletal exam, you find redness of the skin over a nontraumatized joint. Which of the following is LEAST likely to be the cause? A) Rheumatic fever B) Dislocation C) Gout D) Arthritis

During the abdominal exam, areas that are known to be painful or tender should be examined: A) only by a physician. B) at the beginning and end of the exam. C) first. D) last.

Discoloration over the umbilicus, known as ________ sign, is a(n) ________ indicator of intraabdominal bleeding. A) Cullen's; late B) Grey Turner's; early C) Grey Turner's; late D) Cullen's; early

Which of the following best describes the technique of evaluating plantar reflexes? A) Have the patient dorsiflex the foot, then strike the Achilles tendon. B) Stroke the lateral aspect of the sole of the foot from heel to ball, curving medially. C) Tap the patellar tendon just below the edge of the patella. D) Strike the triceps along the posterior aspect of the distal humerus.

To check for symmetrical chest expansion, you should place your hands on the patient's chest, with the thumbs resting on the ________, and ask the patient to inhale. A) costal margins B) nipples C) clavicles D) lateral chest wall

Your patient is complaining of numbness and hand pain that wakes him. Of the following, which is most likely? A) Carpal tunnel syndrome B) Chondromalacia C) Bursitis D) Plantar fasciitis

Which of the following findings is abnormal in a cardiovascular assessment? A) Splitting of the S2 heart sound in children B) Vibrations when palpating the carotid artery C) Jugular venous distension in the supine position D) Visible pulsation of the PMI at the fifth intercostal space, medial to the left midclavicular line

All of the following characteristics indicate a normal appearance to oral mucosa EXCEPT: A) smooth. B) patches of white. C) pink. D) moist.

You have just percussed the patient's chest and heard a loud, booming, low-pitched sound. This indicates: A) atelectasis. B) a normal lung field. C) a hypoinflated lung field. D) a hyperinflated lung field.

A condition marked by exaggerated lumbar concavity is called: A) scoliosis. B) lordosis. C) kyphosis. D) spondylosis.

A light, popping, nonmusical sound heard upon auscultation of the lungs is best described as: A) wheezing. B) crackles. C) stridor. D) rhonchi.

You can test the oculomotor, trochlear, and abducens nerves by: A) shining a light into the pupils and observing constriction of the pupils. B) conducting a visual acuity test. C) evaluating the patient's extraocular movements. D) closing one nostril while presenting a strong smell under the other nostril.

A patient who loses his balance while standing with his eyes closed and feet together for 20 to 30 seconds is exhibiting a positive: A) tilt test. B) Babinski's reflex. C) Romberg test. D) Kehr's sign.

By placing the tip of the index finger in the depression in front of the tragus and asking the patient to open his mouth, the paramedic can evaluate the: A) zygomatic arch. B) sphenoid bone. C) temporomandibular joint. D) external auditory canal.

You are examining a 70-year-old female patient with altered mental status. She is awake and can speak. You detect an odor of acetone and suspect that the patient is suffering from: A) cyanide poisoning. B) alcohol poisoning. C) bowel obstruction. D) diabetic ketoacidosis.

Increased fremitus over part of the patient's chest wall may indicate: A) pneumonia. B) emphysema. C) pleural effusion. D) pneumothorax.

To avoid the carotid sinus, you should palpate for a carotid pulse at the level of: A) Terry's point. B) the cricoid cartilage. C) the sternocleidomastoid muscle. D) carotid bifurcation.

The standard sequence for examining the chest is: A) palpate, percuss, auscultate, inspect. B) inspect, palpate, auscultate, percuss. C) inspect, palpate, percuss, auscultate. D) inspect, auscultate, percuss, palpate.

Which of the following findings is NOT a sign of peritoneal irritation? A) Abdominal pain when the patient coughs B) Rebound tenderness C) Abdominal pain upon light palpation D) DeLorenzo's sign

Select the choice below that best describes the sequence of a joint examination. 1) Palpation 2) Passive range of motion 3) Range of motion against resistance 4) Range of motion against gravity 5) Inspection A) 5, 1, 2, 4, 3 B) 5, 2, 1, 3, 4 C) 2, 3, 4, 5, 1 D) 1, 5, 2, 4, 3

During a neurologic exam, you ask your patient to stick out his tongue. It deviates to the right. This may indicate a lesion to the patient's ________ nerve. A) vagus B) glossopharyngeal C) facial D) hypoglossal

Which of the following guidelines should be observed when examining a one- to three-year-old child? A) Restrain the child if necessary. B) Do not distract the toddler with toys. C) Do the most invasive procedure first in order to get it out of the way. D) Focus on the vital areas as indicated by the chief complaint.

Jugular venous pressure approximates the patient's ________ pressure. A) left atrial B) right ventricular C) left ventricular D) right atrial

Assessing for bronchophony is important if the patient has abnormal or absent lung sounds because its presence can reveal: A) tension pneumothorax. B) breathing obstruction. C) emphysema. D) fluid in the lungs.

Heart sound S2 may be heard at the end of systole by auscultating over the ________ intercostal space. A) second B) sixth C) first D) fifth

The fourth heart sound, S4, is: A) an atrial gallop sound. B) a ventricular gallop sound. C) a high-pitched sound at the base of the heart. D) the "dub" of "dee-lub-dub."

A scalp condition marked by mild flaking of skin is known as: A) psoriasis. B) dandruff. C) seborrheic dermatitis. D) hirsutism.

The loss of muscle tone results in: A) rigidity. B) spasticity. C) paresthesia. D) flaccidity.

Using an otoscope, you can examine the patient for ________ and ________. A) tympanic membrane rupture; color changes B) cranial nerve VIII function; basilar skull fracture C) otitis; mastoiditis D) tinnitus; eustachian tube blockage

Dullness in the chest during percussion of the third to fifth intercostal spaces can be attributed to the location of the: A) spleen. B) heart. C) stomach. D) liver.

When evaluating dorsiflexion, you should instruct the patient to point his: A) foot upward. B) hand downward. C) foot downward. D) hand upward.

Which of the following is an abnormal finding of the pupils? A) Constriction when focusing on a near object B) Both pupils constricting when a penlight is shone in one eye C) Slow but equal reaction to light D) Less than 2 mm difference in size with normal reaction to light

The condition of the nail bed caused by chronic hypoxia associated with cardiopulmonary diseases is called: A) Terry's nails. B) onycholysis. C) clubbing. D) paronychia.

Your patient was in a motor vehicle collision but was not discovered until 3 hours after the event. When you examine her, you discover bilateral discolored skin over the mastoid process. You should suspect: A) temporal bone fracture. B) frontal bone fracture. C) basilar skull fracture. D) a fractured sinus.

While assessing a 23-year-old man with abdominal pain, you note discoloration around the umbilicus. This is known as: A) ascites. B) borborygmi. C) Kernig's sign. D) Cullen's sign.

Pleural effusion is characterized by the presence of: A) fluid in the pleural space. B) atelectasis in the affected area. C) secretions in large airways. D) increased friction between the pleural layers.

A loud, harsh sound over the trachea on auscultation with a stethoscope suggests: A) bronchoconstriction. B) normal air movement. C) pneumothorax. D) foreign body obstruction.

Skin color is best evaluated by observing the: A) limbs and torso. B) dorsum of the hand. C) nail beds and conjunctiva. D) face.

Palpation and inspection of the point of maximal impulse can reveal certain conditions, such as: A) pneumothorax. B) enlarged right ventricle. C) coronary insufficiency. D) cardiac tamponade.

Cyanosis is caused by increased: A) methemoglobin. B) oxyhemoglobin. C) carboxyhemoglobin. D) deoxyhemoglobin.

Moving a finger in an "H" pattern in front of your patient's eyes tests: A) accommodation. B) extraocular muscles. C) visual acuity. D) corneal reflex.

Which of the following sounds is produced when the tricuspid and mitral valves close during systole? A) S4 B) S3 C) S1 D) S2

Which of the following is a normal finding when examining a patient's neck? A) Tracheal tugging B) Visible lymph nodes C) Subcutaneous emphysema D) Movement of the thyroid gland during swallowing

Nasal flaring is an indication of: A) dysfunction of cranial nerve I. B) respiratory distress. C) hypoxia. D) rhinitis.

Which of the following best describes the technique of percussion? A) Using a reflex hammer to produce vibrations B) Pressing the bell of the stethoscope against the skin C) Shining a penlight into the ear to see the eardrum D) Striking the knuckle of one hand with the tip of a finger on the opposite hand

For you to assess for jugular venous distention, your patient should be ________ at a ________-degree angle. A) sitting; 90 B) sitting; 45 C) supine; 45 D) standing; 90

Which of the following is LEAST important to the paramedic when evaluating a patient's skin in an emergency situation? A) Color B) Temperature C) Pigmentation D) Moisture

The sounds auscultated when assessing the blood pressure are the ________ sounds. A) Kobileski B) Korotkoff C) Kunzlemann D) Kernig's

To test an extremity for pain sensation, you should: A) use a sharp object, and have the patient tell you if he feels a sharp or dull sensation. B) firmly pinch a fold of skin over the most sensitive part of the extremity. C) stroke the extremity in a distal-to-proximal direction. D) briskly tap the tendon of the elbow or knee.

Which of the following best describes the correct positioning of a patient for an abdominal exam? A) Lateral recumbent B) Supine with the head flat and legs extended C) Semi-Fowler's position D) Supine with the head and knees supported by pillows

Which of the following best describes the technique for palpating the abdomen for large or deep masses? A) One hand pushing deeply in a quick, smooth motion B) One finger pressing firmly against the abdominal wall C) One hand over another, pushing down slowly D) Both hands side by side over the midline of the abdomen

While you are assessing for Babinski's response, the patient's big toe dorsiflexes and the other toes fan out. This indicates a ________ response, which is ________. A) negative; normal B) positive; abnormal C) negative; abnormal D) positive; normal

Using your sense of touch to gather information about the patient's condition is called: A) auscultation. B) percussion. C) palpation. D) inspection.

A patient experienced a brief loss of consciousness following a blow to the head. During your questioning, she describes a series of events that do not match what observers had noted before the trauma. This might be an example of: A) delusion. B) incoherence. C) mania. D) confabulation.

A patient who is misinterpreting what is happening is experiencing a(n): A) paresthesia. B) hallucination. C) delusion. D) illusion.

Which of the following is included in examination of the mouth? A) Palpating the uvula B) Removing dentures C) Visualizing the larynx D) Looking under the tongue

A condition that makes posterior chest and lung examination difficult is thoracic: A) kyphoscoliosis. B) spondylosis. C) ankylosis. D) lordosis.

Which of the following best describes the pulse pressure? A) The difference between systolic and diastolic blood pressures B) The diastolic pressure plus one-third of systolic pressure C) The sum of systolic and diastolic blood pressures D) The systolic pressure minus one-third of the diastolic pressure

Shining a light onto the iris from the lateral side could cause a crescent-shaped shadow on the medial side if the patient is suffering from: A) hemianopsia. B) glaucoma. C) retinal artery occlusion. D) anisocoria.

Areas of a neurologic exam include all of the following EXCEPT: A) mental status and speech. B) reflexes. C) cranial nerves. D) cranium.

You are assessing a 34-year-old female patient who appears to be in hypovolemic shock. You would expect her pulse to be: A) bradycardic and irregular. B) tachycardic and weak. C) tachycardic and bounding. D) bradycardic and strong.

During the cardiac cycle, the S2 heart sound indicates the ________ of the ________ valves. A) closing; mitral and tricuspid B) opening; aortic and pulmonic C) opening; mitral and tricuspid D) closing; aortic and pulmonic

When checking for skin turgor, you should: A) gently pick up a fold of skin, then release it. B) use the back of your hand to determine temperature. C) press the nail beds, then release. D) palpate the skin for flaking.

A tear in the tracheobronchial tree or a pneumothorax can be characterized by ________ in the neck. A) swollen lymph nodes B) jugular venous distention C) mediastinal deviation D) subcutaneous emphysema

To inspect and examine the anus, a paramedic should place the patient in the ________ position. A) supine B) left lateral recumbent C) kneeling D) prone

The crunching sound that is made when unlubricated skeletal parts rub against each other is called: A) a synovial rub. B) bursal friction. C) crepitus. D) a pleural friction rub.

When auscultating the posterior chest, you should listen: A) only at the apices. B) only at the bases. C) down one side first, then the other. D) from side to side as you proceed down the chest.

A 23-year-old female patient is complaining of lower abdominal and genital pain. Upon examination you find a white, curdlike vaginal discharge. This is most typical of: A) Gardnerella. B) gonorrhea. C) candidiasis. D) herpes simplex.

Components of a general survey include all of the following EXCEPT: A) cardiac monitoring. B) blood pressure. C) medical history. D) the patient's appearance.

When you ask the patient to puff out her cheeks, show her upper and lower teeth, and raise her eyebrows, which cranial nerve are you evaluating? A) VI B) V C) VII D) IX

During ventricular systole, the ventricles contract while the: A) foramen ovale opens. B) tricuspid and mitral valves open. C) pulmonic and aortic semilunar valves close. D) tricuspid and mitral valves close.

You respond to a patient complaining of lower abdominal pain. Upon your arrival, you find a 25-year-old man who also complains of groin pain. After inspecting the penis and scrotum, your next step would be to: A) inspect the glans. B) lift the scrotum and inspect for swelling or lumps. C) palpate the testicles. D) take a urine sample.

When evaluating any patient's genitalia, a paramedic must always: A) maintain privacy. B) use a lubricant. C) be of the same gender as the patient. D) perform a rectal exam, as well.

A 45-year-old patient presents with abdominal pain in the right lower quadrant. Upon auscultation of bowel sounds, you hear high-pitched gurgles and clicks lasting around 10 seconds. This patient may have: A) normal sounds. B) hyperperistalsis. C) borborygmi. D) paralytic ileus.

A complete neurologic exam includes assessment of mental status and speech, the motor and sensory systems, reflexes, and the: A) speed of peripheral nervous conduction. B) tympanic membrane. C) cranial nerves. D) visual acuity.

Normal pediatric respiratory and heart rates ________ as children grow older. A) stay the same B) decrease C) increase D) increase, then decrease

You are examining a 50-year-old male patient complaining of a fever. You inspect the tympanic membrane and note that it is a pearly, translucent gray color. You conclude that the patient has: A) otitis media. B) hemotympanum. C) a buildup of fluid behind the eardrum. D) a normal eardrum.

Rales, or crackles, would be most typically auscultated in patients with which of the following conditions? A) Pulmonary embolus B) Congestive heart failure C) Asthma D) Pneumonia

A patient who is experiencing dysphonia: A) has defective language caused by neurological damage. B) has defective speech caused by motor deficits. C) is speaking clearly and normally. D) has voice changes secondary to vocal cord problems.

An elderly man is complaining of shortness of breath. You discover pitting edema that is 0.5 to 1 inch deep. This is ________ pitting edema. A) +2 B) +4 C) +1 D) +3

You are examining a patient's face. Upon observing the eyes, you notice a droop in the eyelids. This condition is known as: A) nystagmus. B) apoptosis. C) anisocoria. D) ptosis.

Which of the following body systems would you gain the least information about during an abdominal exam? A) Musculoskeletal B) Reproductive C) Cardiovascular D) Digestive

Pain or tenderness on palpation of the tragus could suggest: A) Ménière's disease. B) mastoiditis. C) cerumen impaction. D) perforated tympanic membrane.

While speaking, your patient shifts rapidly from topic to topic without realizing that his thoughts are not connected. This might be a sign of any of the following conditions EXCEPT: A) psychosis. B) schizophrenia. C) manic episodes. D) depression.

A person who has a visual acuity test result of 20/100 can see at ________ feet what a normal person sees at ________ feet. A) 10; 2 B) 20; 100 C) 100; 20 D) 100; 100

Lesions found on the lips may indicate: A) dehydration. B) anemia. C) allergic reaction. D) skin cancer.

What procedure can you perform to determine additional signs of carpal tunnel syndrome? A) Ask the patient to extend his fingers forward for 60 seconds. B) Hold the patient's wrist in acute extension for 60 seconds. C) Ask the patient to gently wave his wrists for 60 seconds. D) Hold the patient's wrist in acute flexion for 60 seconds.

Which of the following statements is FALSE regarding the S3 heart sound? A) It is commonly heard in children. B) It is a high-pitched sound heard at the end of diastole. C) It is the "dee" part of the "lub-dub-dee" cadence. D) It can develop with ventricular failure or ventricular volume overload.

The hard and soft palates are normally colored ________ and ________, respectively. A) white; pink B) pink; white C) white; white D) pink; pink

You are sent to the home of an insulin-dependent diabetic female patient. You ask her to state her name, the month, and her address. This would be an example of assessing the patient's: A) memory and attention. B) general fund of knowledge. C) judgment. D) mood.

The technique of ________ involves careful, noninvasive, informed observation. A) auscultation B) percussion C) inspection D) palpation