Pt Assessment - History and Physical Exam Techniques
On-Line Practice Exam 5 - This exam is from another publisher other than the one used in class. Therefore some questions may require some research to answer. Furthermore this exam includes questions that should have been obtained in an EMT-Basic program. It is recommended that you take the exam by placing your answers on a sheet of paper then Click here for "Answer Key Exam 5".
1. One of the best techniques for establishing patient rapport when taking a history is to:
a. speak loudly and establish your authority with the patient.
b. use specific medical terms when asking questions of the patient.
c. immediately make and maintain eye contact with the patient.
d. advance toward the patient and begin your physical exam.
2. Questions that allow the patient to explain a complaint in detail are known as ______ questions.
3. The active listening technique of reflection involves:
a. repeating the patient's words exactly.
b. making eye-to-eye contact with the patient.
c. asking for clarification of the patient's complaint.
d. confronting the patient if you detect inconsistencies.
4. Saying "I understand" when patients convey very personal information about themselves is an example of:
5. Part of active listening includes maintaining eye contact and using appropriate gestures in a process known as:
6. The ability to ______ lays the foundation for good patient care.
a. ask open-ended questions
b. elicit a good history
c. use active listening
d. use common sense
7. A sign or symptom that causes a patient or bystander to request medical help is known as the:
a. primary problem.
b. associated symptom.
c. chief complaint.
d. present illness.
8. A mnemonic for remembering the steps for determining the present illness is:
9. When asking about a patient's current health status, the paramedic gathering information on current health status should include:
a. asking about medication use.
b. asking about associated symptoms.
c. asking about childhood diseases.
d. doing a review of systems.
10. A comprehensive health history includes all of the following EXCEPT:
a. gathering preliminary data.
b. determining the chief complaint.
c. asking about past history.
d. performing a physical exam.
11. The technique of ______ involves careful, informed observation.
12. Physical exam techniques include all of the following EXCEPT:
13. Which technique does a paramedic use to effectively evaluate for tenderness, rigidity, pain, or crepitus?
14. The process in which a paramedic places a hand on a body part and then sharply taps a distal knuckle with the tip of another finger is known as:
15. Scenario: You are sent to the home of an insulin-dependent diabetic female. You ask her to state her name, the month, and her address. This would be an example of:
a. assessing memory and attention.
c. assessing mood.
d. assessing judgment.
16. As part of the mental status exam, assessing a patient's mood can be accomplished by:
a. observing verbal and nonverbal behavior.
b. determining coherence of thoughts.
c. listening to the articulation of words.
d. observing personal hygiene.
17. The physical examination begins when the paramedic first:
a. sees the patient.
b. talks to the patient.
c. touches the patient.
d. asks the patient about past history.
18. The part of the comprehensive exam that provides information such as signs of distress, vital statistics, blood pressure, and cardiac monitoring is:
a. primary survey.
b. anatomical exam.
c. general survey.
d. patient assessment.
19. Skin color is best evaluated at the:
a. nail beds and conjunctiva.
b. wrists and neck.
c. cheeks and nose.
d. limbs and torso.
20. Scenario: A paramedic suspects that a patient is dehydrated. Checking for skin turgor, the paramedic should:
a. press the nail beds, then release and observe for blanching.
b. use the backs of the fingers to determine temperature.
c. palpate the skin for dryness.
d. pick up a fold of skin and then release it, looking for tenting.
21. The condition of a patient's fingernails can give insight into the patient's:
a. level of distress.
b. motor activity.
c. self-care and hygiene.
d. psychiatric history.
22. Cyanosis, a condition causing a bluish skin color, is caused by increased:
23. Petechiae are skin lesions characterized by:
a. reddish legs radiating from a red spot.
b. reddish-purple spots less than 0.5 cm in diameter.
c. irregular red spots.
d. reddish-purple blotches greater than 0.5 cm in diameter.
24. Pale skin color can be a result of all of the following EXCEPT:
a. decreased blood flow to the skin.
c. compensatory shock.
25. By placing the tip of the index finger into the depression in front of the tragus and asking the patient to open his mouth, the paramedic can evaluate the:
a. zygomatic arch.
b. temporomandibular joint.
c. sphenoid bone.
d. external auditory canal.
26. A scalp condition marked by mild flaking of skin is known as:
c. seborrheic dermatitis.
27. Scenario: You encounter a patient who was in a motor vehicle collision but was not discovered until three hours later. When you examine the patient, you discover bilateral discolored skin over the mastoid processes. You should suspect:
a. ethmoid bone fracture.
c. basilar skull fracture.
d. macular degeneration.
28. A person who has a visual acuity test result of 20/100 can see at ____ feet what a normal person can see at ____ feet.
a. 100, 20
b. 10, 2
c. 20, 100
d. 100, 100
29. Arterial occlusions, retinal hemorrhages, and cataracts can be visualized with a(n):
b. naked eye.
c. corneal lens.
30. Moving a finger in an H pattern in front of your patient's eyes tests:
b. corneal reflex.
c. extraocular muscles.
d. visual acuity.
31. Scenario: You are examining a patient's face and you observe the external eyes and notice a droop in the eyelids. This condition is known as:
32. Shining a light onto the iris from the lateral side could cause a shadow on the medial side if the patient were suffering from:
b. opiate overdose.
33. Using an otoscope placed in the ear canal, a paramedic can examine the patient for ________ and ________.
a. tinnitus, Eustachian tube blockage.
b. cranial nerve VIII function, basilar skull fracture.
c. otitis, mastoiditis.
d. tympanic membrane rupture, color changes.
34. Pain or tenderness on palpation of the tragus could suggest:
35. Scenario: You are examining a 50-year-old male 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(n):
a. buildup of fluid behind the eardrum.
b. normal eardrum.
c. ear infection.
d. basilar skull fracture.
36. Inspection of the maxillary sinuses is accomplished by:
a. using an otoscope for visualization.
b. palpating the nose and septum.
c. palpating under the zygomatic arches.
d. obstructing one side and watching the patient breathe.
37. Nasal flaring is an indication of:
b. cocaine abuse.
c. respiratory distress.
38. Scenario: You are testing a patient for nasal obstruction. You occlude one side of the nose and have the patient breathe. You note one side is slightly more patent than the other is. You suspect:
a. a normal functioning nose.
b. a mucus plug.
c. swollen frontal sinuses.
d. a deviated septum.
39. Examination of the mouth includes palpating the lips, inspecting the mucosa, and:
a. visualizing the larynx.
b. looking under the tongue.
c. removing any dentures.
d. palpating the uvula.
40. The hard and soft palates are normally colored ________ and ________, respectively.
a. pink, white
b. pink, pink
c. white, white
d. white, pink
41. Scenario: You are examining a 70-year-old female patient with an altered mental status. She is awake and can speak. You detect an odor of acetone and suspect that the patient is suffering from:
a. diabetic ketoacidosis.
b. cyanide poisoning.
c. bowel obstruction.
d. alcohol poisoning.
42. In an emergency, why is examining the neck a critical part of your assessment?
a. to ensure that the lymph system is functioning.
b. because it connects the torso and head.
c. because it contains many vital structures.
d. to observe jugular venous distention.
43. A patient should be positioned in a ________ position and at a ____ degree angle to be assessed for JVD.
a. standing, 90
b. sitting, 45
c. sitting, 90
d. supine, 45
44. A tear in the tracheo-bronchial tree or a pneumothorax can be characterized by ________ in the neck.
a. subcutaneous emphysema
b. swollen lymph nodes
c. mediastinal deviation
d. jugular venous distention
45. ___________ respiration is characterized by tachypnea and hyperpnea.
46. The standard sequence for examining the chest is:
a. inspect, palpate, auscultate, percuss.
b. palpate, percuss, auscultate, inspect.
c. inspect, auscultate, percuss, palpate.
d. inspect, palpate, percuss, auscultate.
47. A condition that makes posterior chest and lung examination difficult is thoracic:
48. When percussing the chest, the finger should lie ________ to and ________ the ribs.
a. perpendicular, between
b. parallel, between
c. perpendicular, across
d. parallel, over
49. Scenario: You have just percussed the chest and heard a loud, booming, low-pitched sound. This is indicative of:
a. a normal lung.
b. a hyperinflated lung.
c. a hypoinflated lung.
50. Scenario: You are examining a patient who complains of difficulty breathing. Upon auscultation of the lung fields you notice a light, popping, nonmusical sound. This is known as:
51. To check for symmetrical chest expansion, a paramedic should place her thumbs along the ________ and ask the patient to inhale.
b. lateral chest wall
c. costal margins
52. A loud, harsh sound over the trachea suggests:
a. normal air movement.
b. foreign body obstruction.
53. Effusion is characterized by diminished or absent lung sounds in the affected area and is defined as:
b. infectious pus in alveoli.
c. fluid in the pleural space.
d. secretions in large airways.
54. Dullness in the chest during percussion of the 3rd to 5th intercostal spaces can be attributed to the:
c. thyroid gland.
55. Assessing for bronchophony is important if the patient has abnormal or absent lung sounds because it can reveal:
a. tension pneumothorax.
b. fluid in the lung.
d. breathing obstruction.
56. Pulse quality refers to:
57. Scenario: You are assessing a 34-year-old female who appears to be in hypovolemic shock. You would expect her pulse to be:
a. tachycardic and bounding.
b. bradycardic and strong.
c. bradycardic and irregular.
d. tachycardic and weak.
58. Jugular venous pressure approximates your patient's _______________ pressure.
a. left atrial
b. right atrial
c. left ventricular
d. right ventricular
59. Jugular venous pressure should be assessed in the area of the:
a. suprasternal notch.
b. cricoid cartilage.
c. carotid sinus.
d. temporomandibular joint.
60. Scenario: You are assessing a patient for jugular venous pressure. The normal measurement should be:
a. 5-6 cm.
b. 3-4 cm.
c. 1-2 mm.
d. 1-2 cm.
61. Examination of the heart and blood vessels includes: (1) palpating the apical impulse, (2) auscultating heart sounds, (3) palpating the carotid sinuses simultaneously, (4) auscultating for bruits.
a. 1, 2, and 3.
b. 2, 3, and 4.
c. 1, 2, and 4.
d. all of the above.
62. During systole, the (1) ________ contract, and the (2) ________ and (3) ________ valves close.
a. ventricles, pulmonic, aortic semilunar
b. atria, tricuspid, mitral
c. ventricles, tricuspid, mitral
d. atria, pulmonic, aortic semilunar
63. ________ are the sounds of turbulent blood flow around a partial obstruction in the carotid sinuses.
64. At the end of systole, a paramedic can listen for the ____ heart sounds at the ____ intercostal space.
a. S1, 5th
b. S2, 2nd
c. S3, 6th
d. S4, 1st
65. The S3 ventricular heart sound is characterized by the sound:
66. Pulse pressure is the:
a. difference between systolic blood pressure and pulse rate.
b. difference between systolic and diastolic blood pressures.
c. sum of diastolic blood pressure and pulse rate.
d. sum of systolic and diastolic blood pressures.
67. Palpation and inspection of the PMI (apical impulse) can reveal certain conditions such as:
a. enlarged right ventricle.
b. tension pneumothorax.
c. cardiac tamponade.
d. coronary insufficiency.
68. To detect rebound tenderness in the abdomen, a paramedic should:
a. press in firmly and quickly, release slowly.
b. press in lightly.
c. press in slowly, release quickly.
d. press in quickly, release quickly.
69. Using a test for fluid wave in the abdomen is one way to examine the patient for the presence of:
a. intra-abdominal bleeding.
c. intestinal gas build-up.
70. Discoloration over the umbilicus, known as ________ sign, is a(n) ________ indicator of intra-abdominal bleeding.
a. Grey-Turner's, late
b. Grey-Turner's, early
c. Cullen's, early
d. Cullen's, late
71. Scenario: You are palpating the abdomen of a 60-year-old male and you feel a solid structure in the right upper quadrant (RUQ). Upon percussion of the area, you hear a dull sound. The underlying structure is probably:
a. a tumor.
b. an aneurysm.
c. the liver.
d. the spleen.
72. Auscultation for bowel sounds should be done:
a. systematically in all four abdominal quadrants.
b. randomly in all four abdominal quadrants.
c. laterally in all four abdominal quadrants.
d. medially in the two lower quadrants.
73. Scenario: A 45-year-old patient presents with abdominal pains to the right lower quadrant (RLQ). Upon auscultation of bowel sounds you hear high-pitched gurgles and clicks lasting approximately 10 seconds. This patient has:
b. normal sounds.
d. intestinal obstruction.
74. When evaluating a female's genitalia, a paramedic must always:
a. maintain privacy.
b. give a sedative to reduce anxiety.
c. palpate the uterus.
d. utilize a speculum.
75. Scenario: A 23-year-old female is complaining of lower abdominal and genital pain. Upon examination, you find a white, curd-like vaginal discharge with a sweet odor. This is indicative of:
d. herpes simplex
76. Scenario: You respond to a patient complaining of lower abdominal pain. Upon your arrival, you find a 25-year-old male who also complains of pain to his groin. After inspecting the penis and scrotum, your next step would be to:
a. palpate the testicles.
b. inspect the glans.
c. take a urine sample.
d. lift the scrotum and inspect for swelling or lumps.
77. One sign of gonorrhea in males is a(n):
a. scant, clear discharge.
b. exterior pustule.
c. profuse, yellow discharge.
d. white, curd-like discharge.
78. To inspect and examine the anus, a paramedic should place the patient:
a. supine with legs spread.
b. prone with legs spread.
d. on one side.
79. External bleeding from hemorrhoids can be distinguished from internal gastrointestinal bleeding by:
a. the color of the blood.
b. the presence of occult blood in the stool.
c. "coffee ground" material.
d. there is no way to tell.
80. Auscultation of blood pressure is dependent on hearing the sounds of blood hitting the arterial walls, known as ___________ sounds.
81. Scenario: An elderly male is complaining of shortness of breath. During your evaluation you discover pitting peripheral edema that is one-half inch deep. When you describe this to the receiving facility you call this edema:
82. Scenario: You are examining a patient's peripheral vasculature when you note that he has no radial pulse. Your next step would be to:
a. palpate a more proximal pulse site.
b. palpate the ulnar pulse.
c. start cardiopulmonary resuscitation.
d. defibrillate with 200 Joules.
83. Scenario: A 48-year-old female patient is complaining of arm pain. You initially inspect and palpate her arms and find no abnormalities. Your next step in the exam would be to:
a. immobilize the extremity.
b. test for bilateral strength.
c. test deep reflexes.
d. evaluate range of motion.
84. ________ is the crunching sound of unlubricated skeletal parts rubbing against each other.
85. A condition marked by exaggerated lumbar concavity (swayback) is called:
d. vertebral concavity.
86. To evaluate plantar reflexes:
a. tap the tendon below the patella.
b. strike the triceps tendon along the posterior aspect of the distal humerus.
c. have the patient dorsiflex the foot and then strike the Achilles tendon.
d. stroke the lateral aspect of the sole of the foot from heel to ball, curving medially.
87. To test the nervous system for pain sensation, the paramedic should:
a. ask the patient to watch the procedure.
b. use a sharp object and have the patient tell you if he feels a sharp or dull sensation.
c. tap the tendon below the patella.
d. ask the patient to squeeze his fists simultaneously.
88. A complete neurological exam includes assessment of mental status, the motor and sensory systems, reflexes, and the:
a. cranial nerves.
b. patient's mood.
c. patient's memory.
89. Loss of muscle tone causing a limb or part of the body to be loose is defined as:
90. Scenario: You are assigned to respond to a motor vehicle collision where a car has struck a telephone pole. You assess the patient and find no life-threatening problems during the primary survey. However, your patient cannot move any muscles below her knees. This patient probably has a spinal cord lesion at the level of:
91. A patient who opens her eyes and looks at you but gives slow, confused responses is:
c. unconscious and unresponsive.
d. unconscious, responsive to painful stimuli.
92. The cranial nerves that can be assessed using the eyes are:
a. II and III only.
b. II, III, and IV only.
c. II, IV, and VI only.
d. II, III, IV, and VI.
93. How should you test function of the first cranial nerve (CN-I)?
a. Have the patient clench her teeth while you palpate the temporal muscles.
b. Have the patient occlude one ear while you whisper in the other ear.
c. Have the patient close her eyes and present her with a variety of common odors.
d. First observe the patient's face at rest, then have her frown and smile.
94. Scenario: While evaluating neurologic status in an elderly patient, you ask him to stick out his tongue, and you notice that it deviates to the right. This is probably due to a lesion to the patient's ________ cranial nerve.
95. When documenting exam findings, a paramedic should record:
a. only positive findings.
c. only negative findings.
d. his interpretation of patient statements.
96. One generally accepted method for organizing patient charts is the ________ format.
97. School-age children should:
a. undergo the same physical exam as an adult.
b. be allowed to participate in the exam.
c. have their parents answer all questions.
d. have invasive procedures performed first.
98. Fontanelles usually remain open until:
b. six months after delivery.
c. 18 months old.
d. preschool age.
99. Normal pediatric vital signs ________ as the child grows older.
c. stay the same
d. increase then decrease
100. Scenario: You are dispatched to a residence where a three-year-old male presents with a fever. His parents state that he has had diarrhea and vomiting for two days. The patient has not eaten in 24 hours. To best assess his peripheral perfusion status you should evaluate:
a. blood pressure.
b. fingertip sensation.
c. respiratory rate.
d. capillary refill.