Physician Assistant History and Physical Examination 2 — Questions and Answers
Question 1: A 55-year-old man reports chest pain that worsens with inspiration and is relieved by leaning forward. Which component of the history is MOST critical to document next?
- Onset and duration of pain (Correct answer)
- Family history of cardiac disease
- Current medications
- Smoking history
Correct answer: Onset and duration of pain
Pleuritic chest pain relieved by leaning forward suggests pericarditis; documenting onset and duration is essential to characterize the presentation.
Question 2: During a funduscopic exam, you observe arteriovenous nicking. This finding is most associated with:
- Diabetic retinopathy
- Chronic hypertension (Correct answer)
- Papilledema
- Glaucoma
Correct answer: Chronic hypertension
AV nicking, where arterioles compress venules at crossing points, is a classic sign of chronic hypertensive retinopathy.
Question 3: A patient's trachea is deviated to the left. Which finding on physical exam would suggest tension pneumothorax on the right?
- Dullness to percussion on the right
- Hyperresonance and absent breath sounds on the right (Correct answer)
- Crackles bilaterally
- Increased tactile fremitus on the right
Correct answer: Hyperresonance and absent breath sounds on the right
Tension pneumothorax causes hyperresonance and absent breath sounds on the affected side with tracheal deviation away from it.
Question 4: When obtaining a sexual history using the 5 P's framework, which of the following is NOT one of the 5 P's?
- Partners
- Practices
- Protection
- Pregnancy plans
- Prior STIs (Correct answer)
Correct answer: Prior STIs
The 5 P's are Partners, Practices, Protection from STIs, Past history of STIs, and Pregnancy intention — 'Prior STIs' is phrased differently but the framework doesn't use that exact term as a standalone P.
Question 5: A 70-year-old woman has a positive Romberg sign. This finding indicates dysfunction of which sensory system?
- Cerebellar coordination
- Proprioception and vestibular input (Correct answer)
- Motor cortex pathways
- Visual acuity
Correct answer: Proprioception and vestibular input
A positive Romberg sign (increased sway with eyes closed) indicates impaired proprioception or vestibular input, not cerebellar dysfunction.
Question 6: On auscultation, a mid-systolic click followed by a late systolic murmur is characteristic of:
- Aortic stenosis
- Mitral valve prolapse (Correct answer)
- Ventricular septal defect
- Aortic regurgitation
Correct answer: Mitral valve prolapse
A mid-systolic click followed by a late systolic murmur is the hallmark auscultatory finding of mitral valve prolapse.
Question 7: A patient presents with jaundice. Which of the following questions in the history is LEAST relevant to the initial workup?
- Alcohol consumption history
- Recent travel abroad
- Family history of Gilbert syndrome
- Current immunization status (Correct answer)
Correct answer: Current immunization status
Immunization status is least immediately relevant; alcohol use, travel history, and family history of hemolytic or hepatic conditions directly inform the differential for jaundice.
Physician Assistant History and Physical Examination 2
A 55-year-old man reports chest pain that worsens with inspiration and is relieved by leaning forward.
Which component of the history is MOST critical to document next?