Bates Chapter 4

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1. 1. A 15-year-old high school sophomore and B) Reassure 4. 4. A 67-year-old retired janitor comes to the D) Have
her mother come to your clinic because the the mother clinic with his wife. She brought him in because you
mother is concerned about her daughter's that this is a she is concerned about his weight loss. He has a tried to
weight. You measure her daughter's height normal body history of smoking 3 packs of cigarettes a day for lose
and weight and obtain a BMI of 19.5 kg/m2. weight. 30 years, for a total of 90 pack-years. He has weight?
Based on this information, which of the noticed a daily cough for the past several years,
following is appropriate? which he states is productive of sputum. He came
A) Refer the patient to a nutritionist and a into the clinic approximately 1 year ago, and at
psychologist because the patient is that time his weight was 140 pounds. Today, his
anorexic. weight is 110 pounds.
B) Reassure the mother that this is a normal Which one of the following questions would be
body weight. the most important to ask if you suspect that he
C) Give the patient information about has lung cancer?
exercise because the patient is obese. A) Have you tried to force yourself to vomit after
D) Give the patient information concerning eating a meal?
reduction of fat and cholesterol in her diet B) Do you have heartburn/indigestion and
because she is obese. diarrhea?
C) Do you have enough food to eat?
2. 2. A 25-year-old radio announcer comes to C) Give the
D) Have you tried to lose weight?
the clinic for an annual examination. His patient
BMI is 26.0 kg/m2. He is concerned about information 5. 5. Common or concerning symptoms to inquire C)
his weight. Based on this information, what about about in the General Survey and vital signs Cough
is appropriate counsel for the patient reduction of include all of the following except:
during the visit? fat, A) Changes in weight
A) Refer the patient to a nutritionist cholesterol, B) Fatigue and weakness
because he is anorexic. and calories C) Cough
B) Reassure the patient that he has a because he is D) Fever and chills
normal body weight. overweight.
6. 6. You are beginning the examination of a patient. D)
C) Give the patient information about
All of the following areas are important to Blood
reduction of fat, cholesterol, and calories
observe as part of the General Survey except: pressure
because he is overweight.
A) Level of consciousness
D) Give the patient information about
B) Signs of distress
reduction of fat and cholesterol because he
C) Dress, grooming, and personal hygiene
is obese.
D) Blood pressure
3. 3. A 30-year-old sales clerk comes to your A) .5 to 1
7. 7. A 55-year-old bookkeeper comes to your A)
office wanting to lose weight; her BMI is pound per
office for a routine visit. You note that on a Blood
30.0 kg/m2. What is the most appropriate week
previous visit for treatment of contact dermatitis, pressure
amount for a weekly weight reduction
her blood pressure was elevated. She does not cuff is
goal?
have prior elevated readings and her family tightly
A) .5 to 1 pound per week
history is negative for hypertension. You measure fitted.
B) 1 to 2.5 pounds per week
her blood pressure in your office today. Which of
C) 2.5 to 3.5 pounds per week
the following factors can result in a false high
D) 3.5 to 4.5 pounds per week
reading?
A) Blood pressure cuff is tightly fitted.
B) Patient is seated quietly for 10 minutes prior to
measurement.
C) Blood pressure is measured on a bare arm.
D) Patient's arm is resting, supported by your arm
at her mid-chest level as you stand to measure
the blood pressure.
8. 8. A 49-year-old truck driver comes to the B) Small 12. 12. Mr. Curtiss has a history of obesity, D) "Even a
emergency room for shortness of breath and amplitude, diabetes, osteoarthritis of the knees, HTN, weight loss
swelling in his ankles. He is diagnosed with weak and obstructive sleep apnea. His BMI is 43 of 10% can
congestive heart failure and admitted to the and he has been discouraged by his make a
hospital. You are the student assigned to do difficulty in losing weight. He is also noticeable
the patient's complete history and physical discouraged that his goal weight is 158 improvement
examination. When you palpate the pulse, what pounds away. What would you tell him? in the
do you expect to feel? A) "When you get down to your goal weight, problems
A) Large amplitude, forceful you will feel so much better." you
B) Small amplitude, weak B) "Some people seem to be able to lose mention."
C) Normal weight and others just can't, no matter how
D) Bigeminal hard they try."
C) "We are coming up with new medicines
9. 9. An 18-year-old college freshman presents A) Large
and methods to treat your conditions every
to the clinic for evaluation of gastroenteritis. amplitude,
day."
You measure the patient's temperature and it is forceful
D) "Even a weight loss of 10% can make a
104 degrees Fahrenheit. What type of pulse
noticeable improvement in the problems
would you expect to feel during his initial
you mention."
examination?
A) Large amplitude, forceful 13. 13. Jenny is one of your favorite patients D) She is
B) Small amplitude, weak who usually shares a joke with you and is depressed.
C) Normal nattily dressed. Today she is dressed in old
D) Bigeminal jeans, lacks makeup, and avoids eye contact.
To what do you attribute these changes?
10. 10. A 25-year-old type 1 diabetic clerk C) Rapid
A) She is lacking sleep.
presents to the emergency room with and deep
B) She is fatigued from work.
shortness of breath and states that his blood
C) She is running into financial difficulty.
sugar was 605 at home. You diagnose the
D) She is depressed.
patient with diabetic ketoacidosis. What is the
expected pattern of breathing? 14. 14. You are seeing an older patient who has A) It is
A) Normal not had medical care for many years. Her caused by
B) Rapid and shallow vital signs taken by your office staff are: T an
C) Rapid and deep 37.2, HR 78, BP 118/92, and RR 14, and she "auscultatory
D) Slow denies pain. You notice that she has some gap."
hypertensive changes in her retinas and you
11. 11. Mrs. Lenzo weighs herself every day with a C)
find mild proteinuria on a urine test in your
very accurate balance-type scale. She has Attribute
office. You expected the BP to be higher.
noticed that over the past 2 days she has this to
She is not on any medications. What do you
gained 4 pounds. How would you best explain body
think is causing this BP reading, which
this? fluid.
doesn't correlate with the other findings?
A) Attribute this to some overeating at the
A) It is caused by an "auscultatory gap."
holidays.
B) It is caused by a cuff size error.
B) Attribute this to wearing different clothing.
C) It is caused by the patient's emotional
C) Attribute this to body fluid.
state.
D) Attribute this to instrument inaccuracy.
D) It is caused by resolution of the process
which caused her retinopathy and kidney
problems.
15. 15. Despite having high BP readings in the C) You 19. 19. Ms. Wright comes to your office, complaining C)
office, Mr. Kelly tells you that his readings question the of palpitations. While checking her pulse you Regularly
at home are much lower. He checks them accuracy of notice an irregular rhythm. When you listen to irregular
twice a day at the same time of day and his her heart, every fourth beat sounds different. It rhythm
has kept a log. How do you respond? measurements. sounds like a triplet rather than the usual "lub
A) You diagnose "white coat hypertension." dup." How would you document your
B) You assume he is quite nervous when he examination?
comes to your office. A) Regular rate and rhythm
C) You question the accuracy of his B) Irregularly irregular rhythm
measurements. C) Regularly irregular rhythm
D) You question the accuracy of your D) Bradycardia
measurements.
16. 16. You are observing a patient with heart B) Cheyne-
failure and notice that there are pauses in Stokes
his breathing. On closer examination, you respiration
notice that after the pauses the patient
takes progressively deeper breaths and
then progressively shallower breaths,
which are followed by another apneic
spell. The patient is not in any distress. You
make the diagnosis of:
A) Ataxic (Biot's) breathing
B) Cheyne-Stokes respiration
C) Kussmaul's respiration
D) COPD with prolonged expiration
17. 17. Mr. Garcia comes to your office for a B)
rash on his chest associated with a burning Neuropathic
pain. Even a light touch causes this burning pain
sensation to worsen. On examination, you
note a rash with small blisters (vesicles) on
a background of reddened skin. The rash
overlies an entire rib on his right side.
What type of pain is this?
A) Idiopathic pain
B) Neuropathic pain
C) Nociceptive or somatic pain
D) Psychogenic pain
18. 18. A 50-year-old body builder is upset by D) Measure his
a letter of denial from his life insurance waist.
company. He is very lean but has gained 2
pounds over the past 6 months. You
personally performed his health
assessment and found no problems
whatsoever. He says he is classified as
"high risk" because of obesity. What should
you do next?
A) Explain that even small amounts of
weight gain can classify you as obese.
B) Place him on a high-protein, low-fat
diet.
C) Advise him to increase his aerobic
exercise for calorie burning.
D) Measure his waist.