Physician Assistant History and Physical Examination 4 — Questions and Answers
Question 1: A 28-year-old presents with a painless ulcer on the glans penis with indurated edges. Which historical detail is MOST important to obtain first?
- Travel history to tropical regions
- Recent antibiotic use
- Sexual history and partner information (Correct answer)
- History of genital trauma
Correct answer: Sexual history and partner information
A painless indurated penile ulcer is characteristic of primary syphilis (chancre); sexual history is essential to assess exposure and guide STI workup.
Question 2: On thyroid examination, which technique best differentiates a thyroid mass from another neck mass?
- Auscultate for a bruit over the mass
- Ask the patient to swallow and observe if the mass moves superiorly (Correct answer)
- Transilluminate the mass
- Palpate for lymph nodes in the posterior triangle
Correct answer: Ask the patient to swallow and observe if the mass moves superiorly
Thyroid masses move upward with swallowing because the thyroid is attached to the trachea by the pretracheal fascia.
Question 3: A 65-year-old with COPD has a barrel chest. Which physical exam finding would you also expect?
- Decreased AP diameter
- Hyperresonance to percussion (Correct answer)
- Increased tactile fremitus
- Elevated diaphragm on percussion
Correct answer: Hyperresonance to percussion
Air trapping in COPD leads to hyperinflation, causing hyperresonance to percussion and an increased AP:lateral diameter ratio (barrel chest).
Question 4: During review of systems (ROS), a patient reports 'constitutional symptoms.' Which cluster of symptoms does this term encompass?
- Palpitations, syncope, and dyspnea
- Fever, chills, fatigue, weight loss, and night sweats (Correct answer)
- Headache, dizziness, and vision changes
- Nausea, vomiting, and abdominal pain
Correct answer: Fever, chills, fatigue, weight loss, and night sweats
Constitutional symptoms refer to systemic, non-organ-specific complaints including fever, chills, fatigue, unintentional weight loss, and night sweats.
Question 5: A patient has 3+ pitting edema to the knee bilaterally. Which of the following would be LEAST likely to cause this finding?
- Heart failure
- Nephrotic syndrome
- Cirrhosis
- Peripheral arterial disease (Correct answer)
Correct answer: Peripheral arterial disease
Peripheral arterial disease (PAD) causes ischemia, not dependent edema; bilateral pitting edema results from volume overload or reduced oncotic pressure.
Question 6: The Lachman test is used to assess integrity of which structure?
- Posterior cruciate ligament
- Medial collateral ligament
- Anterior cruciate ligament (Correct answer)
- Lateral meniscus
Correct answer: Anterior cruciate ligament
The Lachman test, performed with the knee at 20-30° flexion with anterior tibial translation, evaluates ACL integrity and has high sensitivity for ACL tears.
Question 7: When documenting a patient's past medical history (PMH), which information is MOST appropriately recorded under PMH rather than history of present illness (HPI)?
- Worsening of shortness of breath over the past 3 days
- Prior hospitalization for pneumonia 5 years ago (Correct answer)
- Current complaint of productive cough for 2 weeks
- Associated fever and chills with the current illness
Correct answer: Prior hospitalization for pneumonia 5 years ago
Past hospitalizations and resolved diagnoses belong in PMH, while details related to the current complaint are part of the HPI.
Physician Assistant History and Physical Examination 4
A 28-year-old presents with a painless ulcer on the glans penis with indurated edges.
Which historical detail is MOST important to obtain first?