Physician Assistant History and Physical Examination 5 — Questions and Answers
Question 1: A 45-year-old woman has a positive straight leg raise (SLR) test at 40°. This finding is most consistent with:
- Hip flexor strain
- L4-S1 nerve root compression (lumbar disc herniation) (Correct answer)
- Sacroiliac joint dysfunction
- Piriformis syndrome
Correct answer: L4-S1 nerve root compression (lumbar disc herniation)
A positive SLR at less than 60° (reproduction of radicular pain, not just tightness) strongly suggests L4-S1 nerve root irritation from disc herniation.
Question 2: Which history-taking mnemonic is used to characterize the quality of a patient's pain comprehensively?
- SOAP
- OLDCARTS (Correct answer)
- CAGE
- HEADSSS
Correct answer: OLDCARTS
OLDCARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity) is used to fully characterize pain in the HPI.
Question 3: During a cardiovascular exam, you note that a patient's JVP is elevated at 45° with hepatojugular reflux present. These findings suggest:
- Dehydration
- Right heart failure or elevated central venous pressure (Correct answer)
- Tamponade as the only diagnosis
- Normal variant in obese patients
Correct answer: Right heart failure or elevated central venous pressure
Elevated JVP with a positive hepatojugular reflux (sustained rise with abdominal compression) indicates elevated right-sided filling pressures consistent with right heart failure.
Question 4: When examining the eyes, the consensual light reflex tests the integrity of which pathway?
- Ipsilateral CN II and ipsilateral CN III only
- Contralateral CN II and ipsilateral CN III
- Ipsilateral CN II, optic chiasm, and contralateral CN III (Correct answer)
- CN IV and CN VI bilaterally
Correct answer: Ipsilateral CN II, optic chiasm, and contralateral CN III
Light in one eye travels via CN II to the optic chiasm; efferent fibers cross to activate the contralateral CN III, producing the consensual pupillary response.
Question 5: A 30-year-old athlete has pain with resisted forearm supination and tenderness at the lateral epicondyle. This presentation is most consistent with:
- Medial epicondylitis (golfer's elbow)
- Lateral epicondylitis (tennis elbow) (Correct answer)
- Olecranon bursitis
- Cubital tunnel syndrome
Correct answer: Lateral epicondylitis (tennis elbow)
Lateral epicondylitis involves the extensor origin at the lateral epicondyle; pain with resisted wrist extension/supination and lateral tenderness are hallmarks.
Question 6: A patient with a history of chronic alcohol use presents with gait ataxia, ophthalmoplegia, and confusion. These findings form which classic triad?
- Korsakoff psychosis
- Wernicke encephalopathy (Correct answer)
- Alcohol withdrawal delirium
- Hepatic encephalopathy
Correct answer: Wernicke encephalopathy
The triad of ophthalmoplegia, ataxia, and confusion (altered mental status) defines Wernicke encephalopathy, caused by thiamine (B1) deficiency.
Question 7: During a pelvic exam, the PA notes a blue-gray discoloration of the cervix and vaginal walls in a patient with amenorrhea. This is known as:
- Goodell's sign
- Chadwick's sign (Correct answer)
- Hegar's sign
- Cullen's sign
Correct answer: Chadwick's sign
Chadwick's sign is the blue-violet discoloration of the vagina and cervix due to increased vascularity, appearing in early pregnancy.
Physician Assistant History and Physical Examination 5
A 45-year-old woman has a positive straight leg raise (SLR) test at 40°.
This finding is most consistent with: