Take this quiz as a refresher and find out.


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1. Which sequence should you follow when assessing the abdomen?


a. inspection, percussion, auscultation, palpation


b. auscultation, inspection, percussion, palpation


c. inspection, auscultation, percussion, palpation


d. auscultation, inspection, palpation, percussion



2. In a cardiovascular emergency, which arteries should you palpate to assess the patient's pulse?


a. radial and brachial arteries


b. brachial and femoral arteries


c. carotid and radial arteries


d. carotid and femoral arteries



3. The mnemonic device PQRST stands for


a. practices, quantity, region, source, and tone.


b. provoking or palliative factors, quality or quantity, region or radiation, severity, and timing.


c. provoking factors, quality or quantity, region or radiation, source, and tone.


d. practices, quantity, region, severity, and time.



4. When auscultating your pediatric patient, you notice that his heart rate increases with inspiration and decreases with expiration. This is


a. a normal finding.


b. an abnormal finding.



5. Resonant percussion sounds are typically heard over


a. an area of fluid accumulation, as in pleural effusion.


b. an airless area, as in atelectasis.


c. normal lung tissue.


d. an area of air collection, as in a gastric air bubble or air in the intestines.



6. Wheezes are adventitious lung sounds that


a. are relatively high-pitched and musical sounds with a hissing or shrill quality.


b. can be cleared by coughing.


c. can be heard only with a stethoscope.


d. occur only on inspiration.



7. A barking cough in children is characteristic of


a. asthma.


b. bronchiectasis.


c. cystic fibrosis.


d. croup.



8. Which statement about heart sounds is correct?


a. S1 and S2 sound equally loud over the entire cardiac area.


b. S1 is loudest at the base; S2, at the apex.


c. S1 and S2 sound fainter at the base.


d. S1 usually is louder than S2 at the apex; S2 usually is louder than S1 at the base.



9. To best assess a patient for a pericardial friction rub, have him


a. lie on his right side.


b. lie in a supine position and hold his breath.


c. sit upright, lean forward, and exhale.


d. lie on his left side and inhale.



10. How would you grade a murmur that is readily audible when you put your stethoscope on his chest, but quiet and soft?


a. Grade 1/6


b. Grade 2/6


c. Grade 3/6


d. Grade 4/6



11. Hyperactive bowel sounds can result from all of the followingexcept


a. diarrhea.


b. laxative use.


c. constipation.


d. ileus.



12. Which two percussion sounds are normally heard over the abdomen?


a. tympany and dullness


b. resonance and tympany


c. flatness and dullness


d. flatness and hyperresonance



13. If you detect a bulge sign, suspect fluid in the


a. knee.


b. ankle.


c. hand.


d. elbow.



14. Which skin lesions glow when transilluminated with a penlight?


a. macules


b. papules


c. hives


d. vesicles



15. Asymmetric borders on a skin lesion suggest


a. the lesion is benign.


b. the lesion is malignant.


c. nothing in particular; it's a normal variation.


d. hives have erupted.



16. Breast dimpling usually represents


a. a normal finding.


b. a benign breast lesion.


c. an underlying breast cancer.


d. a breast cyst.



17. Where is the most common site of malignant breast tumors?


a. upper outer quadrant


b. upper inner quadrant


c. lower inner quadrant


d. lower outer quadrant



18. How does physiologic vaginal discharge usually look?


a. mucoid, clear, or white; nonbloody; odorless


b. white, curdlike, and profuse with a yeasty odor


c. yellow or green and foul smelling


d. frothy, greenish yellow, and profuse



19. What is the characteristic sign of testicular torsion?


a. undeveloped scrotum


b. urethral discharge


c. penile lesion


d. scrotal erythema and swelling



20. Which type of hearing loss results from disorders of the inner ear or of the eighth cranial nerve?


a. conductive


b. sensorineural


c. mixed


d. functional



21. Which symptom commonly accompanies throat pain?


a. eye pain


b. ear pain


c. headache


d. nasal congestion



22. What is the most common symptom of an esophageal disorder?


a. epistaxis


b. nasal obstruction


c. dysphagia


d. throat pain



23. Which cause of nasal obstruction is life-threatening?


a. basilar skull fracture


b. common cold


c. nasal polyps


d. sinusitis




1. c. Because percussion and palpation can alter bowel sounds, do them last. Always look, listen, feel. Thus, the proper sequence is inspection, auscultation, percussion, palpation.


2. d. Use the carotid and femoral arteries. Because they're larger and closer to the heart, they more accurately reflect the heart's activity.


3. b. These factors combined will give you a clear understanding of your patient's symptoms. They stand for:


* P: Provoking/palliative


* Q: Quality/quantity


* R: Region/radiation


* S: Severity


* T: Timing.


4. a. In normal infants and children, sinus arrhythmia (heart rate faster in inspiration and slower on expiration) almost always is present.


5. c. Resonant percussion sounds-described as long, loud, and low-pitched-typically are found over normal lung tissue. You'll usually find these percussion sounds over most of the chest.


6. a. Wheezes are adventitious lung sounds with a relatively high-pitched, musical quality that may be heard on inspiration or expiration.


7. d. A child with parainfluenza virus-induced croup begins with an upper respiratory tract infection, followed by hoarseness and a "barking seal" cough. Chronic or recurrent episodes of cough may be caused by asthma, especially if the cough is dry or produces clear mucus. Persistent cough with purulent sputum suggests disorders, such as cystic fibrosis or bronchiectasis.


8. d. Both S1 and S2 are relatively high-pitched sounds. S1 usually is louder than S2 at the apex; S2 usually is louder than S1 at the base.


9. c. Listen for the scratchy, rubbing sound with the patient sitting upright, leaning forward, and exhaling. Although this position brings the heart close to the chest wall, you may need to ask the patient to hold his breath if you have trouble hearing the sound.


10. b. Use the grading system to describe the intensity of the murmur. Grade 2 of 6 describes a murmur that's audible when you place your stethoscope on his chest, but quiet and soft.


11. d. Hypoactive, not hyperactive, bowel sounds are associated with ileus.


12. a. Tympany usually predominates when percussing the abdomen because of gas in the gastrointestinal tract. It's also typical to find scattered areas of dullness due to the presence of fluid and feces.


13. a. You'll usually find the bulge sign in the knee.


14. d. Vesicles are fluid-filled lesions that glow when transilluminated.


15. b. An asymmetric lesion with an irregular border may indicate malignancy.


16. c. Breast dimpling usually suggests an inflammatory or malignant mass beneath the skin surface. Benign lesions and breast cysts usually don't produce this effect.


17. a. The upper outer quadrant, where half the ductal tissue is located, is the most common site of malignant breast tumors.


18. a. Discharge that's mucoid, clear, or white and nonbloody and odorless is produced by the cervical mucosa and vulvar glands. It may be scant or profuse due to estrogenic stimulation and changes during menses.


19. d. Sudden scrotal erythema and swelling, and severe pain signal testicular torsion. Nausea and vomiting also may occur.


20. b. A disorder of the inner ear, the cochlear nerve, or its central connections, sensorineural hearing loss impairs the transmission of nerve impulses to the brain. Conductive hearing loss results from external or middle ear disorders that block sound transmission; mixed hearing loss, from a combination of conductive and sensorineural problems; and functional hearing loss occurs for no organic reason and is thought to be caused by emotional or psychological factors.


21. b. Because cranial nerves IX and X innervate the pharynx as well as the middle and external ear, throat pain and ear pain commonly occur together.


22. c. Dysphagia is the most common, and sometimes the only, symptom of an esophageal disorder, such as esophageal cancer or esophageal diverticulum.


23. a. A basilar skull fracture, which is life-threatening, can cause cerebrospinal rhinorrhea with nasal obstruction.




Source: Skillmasters: 3-Minute Assessment, Lippincott Williams & Wilkins, 2003.