Free Physician Assistant History and Physical Examination Questions and Answers — Questions and Answers
Question 1: A 22-year-old collegiate soccer player presents with acute right knee pain after an opponent tackled her during a game, causing a valgus force and external rotation of her tibia. She reports hearing a 'pop' and feeling immediate instability. On physical examination, the Lachman test reveals significant anterior translation of the tibia with a soft endpoint compared to the contralateral knee. Which ligament is most likely injured?
- Posterior cruciate ligament (PCL)
- Anterior cruciate ligament (ACL) (Correct answer)
- Medial collateral ligament (MCL)
- Lateral collateral ligament (LCL)
Correct answer: Anterior cruciate ligament (ACL)
The Lachman test is the most sensitive and specific physical examination maneuver for an anterior cruciate ligament (ACL) tear. The history of a 'pop' with a rotational or valgus force injury mechanism, coupled with a feeling of instability and a positive Lachman test (anterior tibial translation with a soft endpoint), is classic for an ACL rupture.
Question 2: A physical examination finding of weakness when shrugging the shoulders against resistance would indicate a deficit in which cranial nerve?
- CN IX (Glossopharyngeal)
- CN X (Vagus)
- CN XII (Hypoglossal)
- CN XI (Accessory) (Correct answer)
Correct answer: CN XI (Accessory)
Cranial nerve XI, the spinal accessory nerve, provides motor innervation to the trapezius and sternocleidomastoid muscles. The trapezius muscle is primarily responsible for elevating, or shrugging, the shoulders. Therefore, weakness in this action points to a deficit in CN XI.
Question 3: A 19-year-old male presents with a 24-hour history of periumbilical pain that has now localized to the right lower quadrant. He reports anorexia and nausea. On examination, he has a low-grade fever and tenderness to palpation at McBurney's point. When the examiner palpates deeply in the left lower quadrant, the patient experiences sharp pain in the right lower quadrant. What is the name of this physical exam sign?
- Rovsing's sign (Correct answer)
- Murphy's sign
- Psoas sign
- Obturator sign
Correct answer: Rovsing's sign
Rovsing's sign is pain felt in the right lower quadrant upon palpation of the left lower quadrant. This sign is suggestive of peritoneal irritation in the right lower quadrant, as seen in acute appendicitis. Murphy's sign is associated with cholecystitis, while the Psoas and Obturator signs are other maneuvers used to detect appendicitis.
Question 4: Which of the following fundoscopic examination findings is the hallmark of proliferative diabetic retinopathy, distinguishing it from the non-proliferative stage?
- Cotton-wool spots
- Hard exudates
- Neovascularization (Correct answer)
- Microaneurysms
Correct answer: Neovascularization
The defining characteristic of proliferative diabetic retinopathy (PDR) is the development of new, abnormal blood vessels, a process known as neovascularization. These new vessels are fragile and can bleed, leading to severe vision loss. Microaneurysms, hard exudates, and cotton-wool spots are all findings associated with non-proliferative diabetic retinopathy (NPDR).
Question 5: A 35-year-old female presents with a 3-month history of weight loss despite an increased appetite, heat intolerance, anxiety, and palpitations. On examination, she is tachycardic, her skin is warm and moist, and a fine tremor is noted in her outstretched hands. Based on this history and physical examination, which of the following is the most likely diagnosis?
- Cushing's syndrome
- Hypothyroidism
- Addison's disease
- Hyperthyroidism (Correct answer)
Correct answer: Hyperthyroidism
This patient's constellation of symptoms—including weight loss with increased appetite, heat intolerance, tachycardia, anxiety, and tremors—is classic for a hypermetabolic state caused by an overactive thyroid gland, or hyperthyroidism. Hypothyroidism would present with opposite symptoms (weight gain, cold intolerance), while Cushing's and Addison's disease involve the adrenal glands and have different clinical presentations.
Question 6: On a skin examination, a 0.5 cm, circumscribed, elevated lesion containing serous fluid is identified. How should this primary skin lesion be documented?
- Papule
- Vesicle (Correct answer)
- Pustule
- Macule
Correct answer: Vesicle
A vesicle is defined as a small (<1 cm), circumscribed, elevated lesion that contains serous fluid. A papule is a solid, elevated lesion. A pustule is similar to a vesicle but contains purulent material (pus). A macule is a flat, non-palpable change in skin color.
Free Physician Assistant History and Physical Examination Questions and Answers
A 22-year-old collegiate soccer player presents with acute right knee pain after an opponent tackled her during a game, causing a valgus force and external rotation of her tibia.
She reports hearing a 'pop' and feeling immediate instability.
On physical examination, the Lachman test reveals significant anterior translation of the tibia with a soft endpoint compared to the contralateral knee.
Which ligament is most likely injured?