Physician Assistant History and Physical Examination 3 — Questions and Answers
Question 1: Which cranial nerve is tested when you ask a patient to shrug their shoulders against resistance?
- CN IX
- CN X
- CN XI (Correct answer)
- CN XII
Correct answer: CN XI
CN XI (spinal accessory nerve) innervates the sternocleidomastoid and trapezius, tested by shoulder shrug and head turning against resistance.
Question 2: A 40-year-old presents with painless lymphadenopathy in the right supraclavicular region. What is this finding classically called and what does it suggest?
- Virchow's node — suggests left-sided abdominal malignancy
- Virchow's node — suggests right-sided thoracic or cervical malignancy (Correct answer)
- Sister Mary Joseph node — suggests abdominal malignancy
- Delphian node — suggests thyroid malignancy
Correct answer: Virchow's node — suggests right-sided thoracic or cervical malignancy
The right supraclavicular node (Virchow's on the right side) drains the thorax, lungs, and esophagus and its enlargement suggests right-sided thoracic or mediastinal malignancy.
Question 3: During a musculoskeletal exam, a patient has pain with passive range of motion of a joint. This finding most suggests:
- Pathology within the joint itself (Correct answer)
- Isolated tendon injury
- Muscle strain only
- Nerve entrapment
Correct answer: Pathology within the joint itself
Pain with passive range of motion implicates the joint capsule or intra-articular structures, as the examiner — not the patient's muscles — is generating the movement.
Question 4: Which of the following best describes the CAGE questionnaire used in clinical history-taking?
- A 4-item tool screening for depression
- A 4-item tool screening for alcohol use disorder (Correct answer)
- A 10-item tool for drug use screening
- A screening tool for domestic violence
Correct answer: A 4-item tool screening for alcohol use disorder
CAGE screens for alcohol use disorder using four yes/no questions: Cut down, Annoyed, Guilty, Eye-opener.
Question 5: A patient's apical pulse is palpated at the 6th intercostal space, anterior axillary line. This displacement suggests:
- Normal variant in a thin patient
- Left ventricular hypertrophy or dilation (Correct answer)
- Right ventricular enlargement
- Pericardial effusion
Correct answer: Left ventricular hypertrophy or dilation
The point of maximal impulse (PMI) displaced laterally and inferiorly from the 5th ICS, MCL suggests left ventricular enlargement.
Question 6: When assessing a skin lesion, which ABCDE criterion refers to a lesion greater than 6mm in diameter?
- Asymmetry
- Border
- Color
- Diameter (Correct answer)
- Evolution
Correct answer: Diameter
D in the ABCDE melanoma screening criteria stands for Diameter greater than 6mm, roughly the size of a pencil eraser.
Question 7: A PA student elicits Murphy's sign during an abdominal exam. The correct technique is to:
- Apply pressure over McBurney's point and release suddenly
- Hook fingers under the right costal margin and ask the patient to inhale deeply (Correct answer)
- Percuss the right flank while the patient is in lateral decubitus
- Press over the epigastrium while the patient exhales
Correct answer: Hook fingers under the right costal margin and ask the patient to inhale deeply
Murphy's sign is elicited by hooking the fingers under the right costal margin during deep inspiration; pain and inspiratory arrest suggests acute cholecystitis.
Physician Assistant History and Physical Examination 3
Which cranial nerve is tested when you ask a patient to shrug their shoulders against resistance?