Physician Assistant Physical Diagnosis Study
Guide Questions
Course Introduction
Physician Assistant Physical Diagnosis is a comprehensive course designed to equip students with the foundational skills needed to perform thorough and systematic physical examinations. The course covers techniques for obtaining accurate patient histories, performing detailed physical assessments of all major body systems, and recognizing normal and abnormal findings. Emphasis is placed on the development of strong clinical reasoning, documentation skills, and the ability to integrate physical exam findings with diagnostic decision-making. Through lectures, demonstrations, and supervised practice, students gain confidence and competence in conducting patient-centered assessments, which are essential for effective diagnosis and patient care in the physician assistant profession.
Recommended Textbook
Seidels Guide to Physical Examination 9th Edition by Jane W. Ball
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Chapter 1: The History and Interviewing Process
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Sample Questions
Q1) Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom's health?
A) Attachment to parents
B) High self-esteem
C) Low peer support needs
D) Propensity for risk taking
Answer: D
Q2) When interviewing older adults, the examiner should:
A) speak extremely loudly, because most older adults have significant hearing impairment.
B) provide a written questionnaire in place of an interview.
C) position himself or herself facing the patient.
D) dim the lights to decrease anxiety.
Answer: C
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3
Chapter 2: Cultural Competency
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Sample Questions
Q1) Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:
A) forego the examination for fear of violating cultural norms.
B) ask a colleague from the same geographic area if this examination is acceptable.
C) inform the patient of the reason for the examination and ask if it is acceptable to him.
D) refer the patient to a provider more knowledgeable about cultural differences.
Answer: C
Q2) Campinha-Bacote's Process of Cultural Competence Model includes which cultural constructs? (Select all that apply.)
A) Desire
B) Awareness
C) Thought processes
D) Skill
E) Language
Answer: A, B, D
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Chapter 3: Examination Techniques and Equipment
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Sample Questions
Q1) To perform a deep tendon reflex measurement, you should:
A) briskly tap the tendon with the rubber end of the hammer.
B) place the hammer firmly on the tendon for 3 to 5 seconds.
C) tap the silver end of the hammer on the tendon.
D) use the needle implement to determine sensory perception.
Answer: A
Q2) Auscultation should be carried out last, except when examining the:
A) neck area.
B) heart.
C) lungs.
D) abdomen.
Answer: D
Q3) During percussion, the downward snap of the striking fingers should originate from the:
A) shoulder.
B) forearm.
C) wrist.
D) interphalangeal joint.
Answer: C
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Page 5
Chapter 4: Clinical Reasoning
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Sample Questions
Q1) Positive outcomes depend on the:
A) number of laboratory tests ordered.
B) quality of decisions made.
C) use of pharmacologic modalities.
D) time saved by the use of ancillary personnel.
Q2) Which is an accepted method of making a diagnosis?
A) Relying on intuition
B) Making maximal use of laboratory tests
C) Using first assumptions
D) Using algorithms
Q3) When utilizing a joint approach with the patient, which factors are likely to be considered? (Select all that apply.)
A) Consultations
B) Laboratory studies
C) Assistive technology
D) Patient education
E) Practitioner background
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Chapter 5: Documentation
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Sample Questions
Q1) Which part of the information contained in the patient's record may be used in court?
A) Subjective information only
B) Objective information only
C) Diagnostic information only
D) All information
Q2) Which is an example of a problem that requires recording on the patient's problem list?
A) Common age variations
B) Expected findings
C) Problems needing further evaluation
D) Minor variations
Q3) Data relevant to the social history of older adults includes information on:
A) family support systems.
B) previous healthcare visits.
C) over-the-counter medication intake.
D) date of last cancer screening.
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7
Chapter 6: Vital Signs and Pain Assessment
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Sample Questions
Q1) Underestimation of blood pressure will occur if the cuff's width covers:
A) less than half of the upper arm.
B) less than 5 inches of the lower arm.
C) more than two-thirds of the upper arm.
D) more than 4 inches of the lower arm.
Q2) The perception of pain:
A) is the same across cultures.
B) can be easily assessed in neonates.
C) is predictable with the same circumstances.
D) is affected by emotions and quality of sleep.
Q3) The pyrexia response is triggered by the production and release of:
A) prostaglandins.
B) endogenous pyrogens.
C) hypothalamic enzymes.
D) thyroid hormones.
Q4) During expiration, the internal intercostals:
A) increase the force of muscular contraction.
B) decrease the lateral diameter during expiration.
C) decrease the intrathoracic space.
D) increase elastic recoil during expiration.
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Chapter 7: Mental Status
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Sample Questions
Q1) Which are signs and symptoms of dementia?
A) Aphasia
B) Apathy
C) Odd behaviors
D) Disintegration of personality
E) Lack of awareness of others
Q2) A clinical syndrome of failing memory and impairment of other intellectual functions, usually related to obvious structural diseases of the brain, describes:
A) delirium.
B) dementia.
C) depression.
D) anxiety.
Q3) Which type of hallucination is most commonly associated with alcohol withdrawal?
A) Olfactory
B) Visual
C) Auditory
D) Tactile
Q4) Under most conditions, adult patients should be able to repeat forward a series of _____________ numbers.
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Chapter 8: Growth, Measurement, and Nutrition
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Sample Questions
Q1) An 11-year-old boy is brought in for an annual physical examination by his mother. The boy's height is 60 inches. You suspect Marfan syndrome because the boy's arm span is greater than _______________ inches.
Q2) During a preventive healthcare visit, Ms. G, an older patient, states that she is getting shorter. She says that her son mentioned that her change in stature became noticeable to him during his last visit with her. Her posture appears straight and aligned. When addressing Ms. G.'s present concerns, it is most important to inquire about:
A) the number of pregnancies.
B) her parents' heights.
C) a history of scoliosis.
D) her usual height and weight.
Q3) During adolescence, the head size normally increases as a result of:
A) sinus development.
B) brain mass increase.
C) evolution of lymphatic tissue.
D) hypertrophy of myelin.
Q4) The term large for gestational age (LGA) indicates that an infant is larger than ____% of infants born at the same number of weeks' gestation.
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Page 10
Chapter 9: Skin, Hair, and Nails
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Sample Questions
Q1) Expected hair distribution changes in older adults include:
A) increased terminal hair follicles on the scalp.
B) more prominent axillary and pubic hair production.
C) increased terminal hair follicles to the tragus of men's ears.
D) more prominent peripheral extremity hair production.
Q2) A 5-year-old child presents with discrete vesicles on an erythematous base that began near her scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is the nurse's next action?
A) Teach infectious control measures.
B) Inquire about other patterns of physical abuse.
C) Inspect the buccal mucosa for Koplik spots.
D) Inform the parent that this will resolve within a couple of days.
Q3) The skin repairs surface wounds by:
A) exaggerating cell replacement.
B) excreting lactic acid.
C) producing vitamins.
D) providing a mechanical barrier.
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Chapter 10: Lymphatic System
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Sample Questions
Q1) Which nodes are also called Virchow nodes?
A) Internal mammary
B) Anterior axillary
C) Deep cervical
D) Supraclavicular
Q2) Which finding indicates that the examiner is assessing a blood vessel rather than a lymph node?
A) A bruit
B) Inflammation
C) Tenderness
D) Redness
Q3) When examining lymph nodes near a joint in the arm or leg, which of the following maneuvers is likely to facilitate the examination?
A) Extension of the extremity
B) Circumduction of the extremity
C) Flexion of the extremity
D) Rotation of the extremity
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Chapter 11: Head and Neck
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Sample Questions
Q1) Nuchal rigidity is most commonly associated with:
A) thyroiditis.
B) meningeal irritation.
C) Down syndrome.
D) cranial nerve V damage.
Q2) Which of the following is true regarding a cephalohematoma?
A) It is bound by suture lines.
B) The affected part feels soft.
C) It is obvious at birth.
D) The margins are poorly defined.
Q3) Which cranial nerves innervate the face?
A) II and V
B) III and VI
C) V and VII
D) VIII and IX
Q4) The thyroid gland should:
A) be slightly left of midline.
B) have a clear vascular sound.
C) move when the patient swallows.
D) tug with each heartbeat.
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Chapter 12: Eyes
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Sample Questions
Q1) Which finding, when seen in the infant, is ominous?
A) Difficulty tracking objects with the eyes
B) Appearing to have better peripheral than central vision
C) Blinking when bright light is directed at the face
D) White pupils on photographs
Q2) When inspecting the region of the lacrimal gland, palpate:
A) the lower orbital rim, near the inner canthus.
B) in the area between the arch of the eyebrow and upper lid.
C) beneath the lower lid, adjacent to the inner canthus.
D) adjacent to the lateral aspect of the eye, just beneath the upper lid.
Q3) When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond with:
A) brisk blinking.
B) copious tearing.
C) pupil dilation.
D) reflex smiling.
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14
Chapter 13: Ears, Nose, and Throat
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Sample Questions
Q1) You are performing hearing screening tests. Who would be expected to find difficulty in hearing the highest frequencies?
A) A 7-year-old
B) An 18-year-old
C) A 30-year-old
D) A 50-year-old
Q2) Nasal symptoms that imply an allergic response include:
A) purulent nasal drainage.
B) bluish gray turbinates.
C) small, atrophied nasal membranes.
D) firm consistency of turbinates.
Q3) You are interviewing a parent whose child has a fever, is pulling at her right ear, and is irritable. You ask the parent about the child's appetite and find that the child has a decreased appetite. This additional finding is more suggestive of:
A) acute otitis media.
B) otitis externa.
C) serous otitis media.
D) middle ear effusion.
Q4) When you ask the patient to identify smells, you are assessing cranial nerve __.
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Chapter 14: Chest and Lungs
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Sample Questions
Q1) In which patient situation would you expect to assess tachypnea?
A) Patient who is depressed
B) Patient who abuses narcotics
C) Patient with metabolic acidosis
D) Patient with myasthenia gravis
Q2) The best time to observe and count respirations is while:
A) the patient is answering questions.
B) weighing the patient.
C) palpating the pulse.
D) the patient is sleeping.
Q3) Ms. Rudman, age 74 years, has no known health problems or diseases. You are doing a preventive healthcare history and examination. Which symptom is associated with intrathoracic infection?
A) Barrel chest
B) Cor pulmonale
C) Funnel chest
D) Malodorous breath
Q4) An Apgar score of __________ is given to the infant who demonstrates irregular respiratory effort.
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Chapter 15: Heart
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Sample Questions
Q1) Chest pain with an organic cause in a child is most likely the result of:
A) cardiac disease.
B) asthma.
C) esophageal reflux.
D) arthritis.
Q2) Which one of the following is a common symptom of cardiovascular disorders in the older adult?
A) Fatigue
B) Joint pain
C) Poor night vision
D) Weight gain
Q3) You are listening to a patient's heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound in this area is most likely:
A) S<sub>1</sub>.
B) S<sub>2</sub>.
C) S<sub>3</sub>.
D) S<sub>4</sub>.
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17
Chapter 16: Blood Vessels
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Sample Questions
Q1) Which of the following statements is true regarding the development of venous ulcers in older adults?
A) The major symptom is severe leg pain, especially when walking.
B) The affected leg is commonly pale and hairless, and pulses are difficult to palpate.
C) Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors.
D) The ulcers are generally located on the tips of toes.
Q2) In children, coarctation of the aorta should be suspected if you detect:
A) a delay between the radial and femoral pulses.
B) a simultaneous radial and femoral pulse.
C) an absent femoral pulse on the left.
D) bilateral absence of femoral pulses.
Q3) Observation of hand veins can facilitate the assessment of:
A) mitral valve competency.
B) a heart murmur.
C) right heart pressure.
D) left heart pressure.
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Chapter 17: Breasts and Axillae
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Sample Questions
Q1) You are conducting a clinical breast examination for your 30-year-old patient. Her breasts are symmetric, with bilateral, multiple tender masses that are freely movable and with well-defined borders. You recognize that these symptoms and assessment findings are consistent with:
A) fibroadenoma.
B) Paget disease.
C) cancer.
D) fibrocystic changes.
Q2) Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed:
A) Montgomery tubercle.
B) case of Paget disease.
C) supernumerary nipple.
D) fat necrosis.
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Chapter 18: Abdomen
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Sample Questions
Q1) Infants born weighing less than 1500 g are at higher risk for:
A) hepatitis A.
B) necrotizing enterocolitis.
C) urinary urgency.
D) pancreatitis.
Q2) When percussing a spleen, Traube's space is a:
A) semilunar region.
B) splenic percussion sign.
C) left-sided pleural effusion.
D) solid mass.
Q3) In older adults, overflow fecal incontinence is commonly caused by:
A) malabsorption.
B) parasitic diarrhea.
C) fecal impaction.
D) fistula formation.
Q4) Percussion of the abdomen begins with establishing:
A) liver dullness.
B) spleen dullness.
C) gastric bubble tympany.
D) overall dullness and tympany in all quadrants.
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Chapter 19: Female Genitalia
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Sample Questions
Q1) When you plan to obtain cytologic studies, speculum introduction may be facilitated by:
A) lubrication with gel.
B) lubrication with warm water.
C) use of a plastic speculum.
D) opening the blades completely.
Q2) Itchy, painful, small red vesicles are typical of:
A) condyloma acuminatum.
B) condyloma latum.
C) herpes simplex lesions.
D) syphilitic chancre.
Q3) A cervical polyp usually appears as a:
A) grainy area at the ectocervical junction.
B) bright red, soft protrusion from the endocervical canal.
C) transverse or stellate scar.
D) hard granular surface at or near the os.
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21
Chapter 20: Male Genitalia
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Sample Questions
Q1) The most emergent cause of testicular pain in a young male is:
A) testicular torsion.
B) epididymitis.
C) tumor.
D) hydrocele.
Q2) Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably:
A) herpetic lesions.
B) condylomata.
C) molluscum contagiosum.
D) chancres.
Q3) In an uncircumcised male, retraction of the foreskin may reveal a cheesy white substance. This is usually:
A) evidence of a fungal infection.
B) a collection of sebaceous material.
C) indicative of penile carcinoma.
D) suggestive of diabetes.
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Chapter 21: Anus, Rectum, and Prostate
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Sample Questions
Q1) Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience:
A) bulging and wrinkling.
B) constipation and pallor.
C) diarrhea and redness.
D) tenderness and inflammation.
Q2) Mr. Sweeney is a 58-year-old man who has presented for a routine annual prostate examination. On examination, you note a normal prostate gland. Which of the following characteristics should describe the normal prostate? (Select all that apply.)
A) Rubbery consistency
B) About 4 cm in diameter
C) Fluctuant softness
D) Gland protruding 1 cm into the rectum
E) Firm, smooth, and slightly movable
Q3) Nodules found in the peritoneum through the anterior rectal wall:
A) are found with bidigital palpation.
B) are called shelf lesions.
C) are chronic fibrosis.
D) are found by having the patient bear down.
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23
Chapter 22: Musculoskeletal System
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Sample Questions
Q1) The joint where the humerus, radius, and ulna articulate is the:
A) wrist.
B) elbow.
C) shoulder.
D) clavicle.
Q2) Cardinal signs for rheumatoid disorders include which of the following? (Select all that apply.)
A) Gradual onset
B) Weakness that is usually localized and not severe
C) Coarse crepitus on motion
D) Joint tenderness
E) Sleep disturbance
Q3) Risk factors for sports-related injuries include:
A) competing in colder climates.
B) previous fracture.
C) history of recent weight loss.
D) failure to warm up before activity.
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24
Chapter 23: Neurologic System
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Sample Questions
Q1) A neurologic past medical history should include data about:
A) allergies.
B) circulatory problems.
C) educational level.
D) immunizations.
Q2) Which is the technique most often used for evaluating the neurologic system?
A) Auscultation
B) Inspection
C) Palpation
D) Percussion
Q3) Vibratory sensory testing should be routinely done for the patient with:
A) Parkinson disease.
B) diabetes.
C) cerebral palsy.
D) Guillain-Barré syndrome.
Q4) The finger to nose test allows assessment of:
A) coordination and fine motor function.
B) point location.
C) sensory function.
D) stereognosis.
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Chapter 24: Sports Participation Evaluation
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Sample Questions
Q1) A parent is advised to restrict contact sports participation for their child. An example of a sport in which this child could participate is:
A) hockey.
B) roller skating.
C) riflery.
D) skateboarding.
Q2) Your 15-year-old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her:
A) sleep patterns.
B) salt intake.
C) aerobic workouts.
D) menstrual cycles.
Q3) Which medical condition would exclude a person from sports participation?
A) Asthma
B) Fever
C) Controlled seizures
D) HIV-positive status
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Chapter 25: Putting it All Together
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Sample Questions
Q1) Functional assessment is most important during the examination of a(n):
A) adolescent.
B) infant.
C) older adult.
D) young adult.
Q2) When performing a history and physical assessment, the examiner should:
A) change the sequence of observation with each interview.
B) develop a sequence of standard observations.
C) develop a preliminary diagnosis at the onset.
D) direct patient responses to fit the history sequence.
Q3) An ophthalmoscopic eye examination involves:
A) lens inspection.
B) near vision evaluation.
C) sclera observation.
D) visual field assessment.
Q4) What is the "brown-bag approach" in regard to examining an older adult?
A) The patient's stool sample is brought to the examination in a brown bag.
B) The patient's medications are brought to the examination in a brown bag.
C) The patient's change of clothes is brought to the examination in a brown bag.
D) The patient's assistive device is brought to the examination in a brown bag.
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Chapter 26: Emergency or Life-Threatening Situations
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Sample Questions
Q1) The term status epilepticus is defined as:
A) convulsive activity uncontrolled by medication.
B) nonconvulsive brain wave disturbance, with psychomotor dysfunction.
C) prolonged seizures that occur without recovery of consciousness.
D) seizures that result in hypotension, pallor, and prolonged diaphoresis.
Q2) While performing the primary survey on a trauma victim, the patient is answering your questions. You may assume that during the time of the questioning:
A) his airway is open.
B) he is alert and oriented.
C) no head injury has occurred.
D) there is no respiratory compromise.
Q3) Clear or amber drainage from the nose or ears of a blunt trauma patient may indicate:
A) epiglottitis.
B) a retropharyngeal abscess.
C) a basilar skull fracture.
D) a perforated tympanic membrane.
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