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AANP FNP practice questions

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Question 1Assessment (health history, physical examination, and diagnostic reasoning)

Closure of the mitral and tricuspid valves at the start of ventricular systole produces which heart sound?

  1. S4
  2. S2
  3. S1 Correct answer.
  4. S3

Explanation

S1 is generated by closure of the atrioventricular (mitral and tricuspid) valves as ventricular systole begins and is heard best at the apex. S2 reflects semilunar valve closure at the end of systole, while S3 and S4 are diastolic filling sounds.

Question 2Assessment (health history, physical examination, and diagnostic reasoning)

Which blood pressure change meets the standard definition of orthostatic hypotension?

  1. A heart rate rise of 10 beats per minute on standing
  2. A systolic fall of 15 mm Hg within 5 minutes of standing
  3. A systolic fall of 20 mm Hg within 3 minutes of standing Correct answer.
  4. A diastolic fall of 15 mm Hg within 5 minutes of standing

Explanation

Orthostatic hypotension is a fall in systolic pressure of at least 20 mm Hg or diastolic pressure of at least 10 mm Hg measured within 3 minutes of standing or head-up tilt. The change is compared with the seated or supine baseline.

Question 3Assessment (health history, physical examination, and diagnostic reasoning)

Which sequence of maneuvers is correct for a complete abdominal examination?

  1. Auscultation, percussion, palpation, inspection
  2. Inspection, auscultation, percussion, palpation Correct answer.
  3. Percussion, inspection, auscultation, palpation
  4. Inspection, palpation, percussion, auscultation

Explanation

Auscultation is performed before percussion and palpation because manipulating the abdomen alters bowel sounds and can create bruits. Inspection always comes first, and palpation is last.

Question 4Assessment (health history, physical examination, and diagnostic reasoning)

A positive Babinski sign in an adult is characterized by which finding?

  1. Absent sensation to light touch on the sole of the foot
  2. Dorsiflexion of the great toe with fanning of the other toes Correct answer.
  3. Brief dorsiflexion of the ankle when the Achilles tendon is tapped
  4. Flexion of all toes with plantar stimulation

Explanation

A positive Babinski response is dorsiflexion of the great toe with fanning of the remaining toes, indicating corticospinal (upper motor neuron) dysfunction in adults. Plantar flexion of the toes is the normal adult response and is expected in infants under about 1 year.

Question 5Assessment (health history, physical examination, and diagnostic reasoning)

At what age do most healthy infants sit steadily without support?

  1. 13 to 15 months
  2. 6 to 8 months Correct answer.
  3. 10 to 12 months
  4. 2 to 3 months

Explanation

Independent sitting is typically achieved between 6 and 8 months, after head control and sitting with support are established. Independent walking generally follows between 12 and 15 months.

Question 6Assessment (health history, physical examination, and diagnostic reasoning)

A flat, circumscribed area of altered skin color measuring less than 1 cm is best described as which type of lesion?

  1. A papule
  2. A vesicle
  3. A macule Correct answer.
  4. A nodule

Explanation

A macule is a flat lesion with a change in color and a diameter under 1 cm; a similar flat lesion larger than 1 cm is a patch. Elevation, fluid content, and depth define papules, vesicles, and nodules.

Question 7Assessment (health history, physical examination, and diagnostic reasoning)

Which instrument is designed as a brief screening tool for cognitive impairment in older adults?

  1. The PHQ-9
  2. The AUDIT-C
  3. The CAGE questionnaire
  4. The Mini-Cog Correct answer.

Explanation

The Mini-Cog combines a three-item recall with a clock-drawing task and takes about 3 minutes to administer, making it well suited to primary care cognitive screening. The other instruments screen for depression or unhealthy alcohol use.

Question 8Assessment (health history, physical examination, and diagnostic reasoning)

Which otoscopic finding is most consistent with acute otitis media?

  1. A tympanic membrane with an amber fluid level but no erythema
  2. A bulging, opacified tympanic membrane with reduced mobility Correct answer.
  3. A dry central perforation with surrounding squamous debris
  4. A retracted, translucent tympanic membrane with visible landmarks

Explanation

Acute otitis media requires acute middle-ear inflammation, shown by a bulging, erythematous or opacified membrane with decreased mobility, often after a viral upper respiratory infection. Retraction or an amber fluid level without inflammation suggests middle-ear effusion or eustachian tube dysfunction instead.

Question 9Assessment (health history, physical examination, and diagnostic reasoning)

A screening test has a sensitivity of 98% for a disease. What does this value indicate?

  1. The test correctly classifies 98% of all people tested
  2. A positive result is almost always a true positive
  3. Nearly all people with the disease will have a positive result Correct answer.
  4. Nearly all people without the disease will test negative

Explanation

Sensitivity is the proportion of people with disease who test positive, so a highly sensitive test yields few false negatives and is useful for ruling a condition out when negative. Specificity, not sensitivity, determines how many people without disease test negative, and overall accuracy is a separate measure.

Question 10Assessment (health history, physical examination, and diagnostic reasoning)

In which condition is tactile fremitus typically increased over the affected lung field?

  1. Pleural effusion
  2. Pneumothorax
  3. Emphysema
  4. Lobar pneumonia with consolidation Correct answer.

Explanation

Consolidated lung tissue transmits vibration more efficiently, so tactile fremitus is increased over an area of lobar pneumonia. Air or fluid in the pleural space and hyperinflation all dampen transmission and decrease fremitus.

Question 11Assessment (health history, physical examination, and diagnostic reasoning)

Which murmur is characteristic of aortic stenosis?

  1. Mid-diastolic rumble with an opening snap at the apex
  2. Systolic crescendo-decrescendo murmur at the right upper sternal border Correct answer.
  3. Early diastolic decrescendo murmur at the left sternal border
  4. Holosystolic murmur at the apex radiating to the axilla

Explanation

Aortic stenosis produces a harsh crescendo-decrescendo (ejection) systolic murmur at the right second intercostal space that radiates to the carotids, often with a delayed carotid upstroke and a soft S2. The other descriptions fit mitral regurgitation, aortic regurgitation, and mitral stenosis respectively.

Question 12Assessment (health history, physical examination, and diagnostic reasoning)

Which finding during the abdominal examination suggests acute cholecystitis?

  1. Absent bowel sounds with tympany over a distended abdomen
  2. Pain elicited with passive extension of the right hip
  3. Inspiratory arrest on deep palpation of the right upper quadrant Correct answer.
  4. Rebound tenderness localized to McBurney point

Explanation

Inspiratory arrest during deep right upper quadrant palpation is a positive Murphy sign, reflecting an inflamed gallbladder meeting the examiner's hand. Localized McBurney point tenderness and hip extension pain point instead to appendicitis and psoas irritation.

Question 13Assessment (health history, physical examination, and diagnostic reasoning)

Which examination finding is most consistent with hypothyroidism?

  1. Delayed relaxation phase of the deep tendon reflexes Correct answer.
  2. Lid lag with a fine tremor of the outstretched hands
  3. Warm, moist skin with an increased heart rate
  4. Hyperactive reflexes with proximal muscle weakness

Explanation

Hypothyroidism slows muscle relaxation, producing the delayed deep tendon reflex relaxation phase known as Woltman sign, along with bradycardia, cool dry skin, and weight gain. Lid lag, tremor, warm moist skin, and hyperreflexia point toward thyrotoxicosis.

Question 14Assessment (health history, physical examination, and diagnostic reasoning)

A firm, nontender left supraclavicular lymph node in an adult should prompt evaluation for which condition?

  1. An intra-abdominal malignancy Correct answer.
  2. Pulmonary sarcoidosis
  3. Acute Epstein-Barr virus infection
  4. A localized hand infection

Explanation

The left supraclavicular node (Virchow node) drains the thoracic duct and is associated with intra-abdominal and thoracic malignancies, so persistent enlargement warrants investigation. Regional infections produce tender nodes in the draining area, while viral illness and sarcoidosis more often cause generalized adenopathy.

Question 15Assessment (health history, physical examination, and diagnostic reasoning)

Which clinical presentation of acute myocardial infarction is most common in adults older than 80 years?

  1. Crushing substernal chest pain radiating to the arm
  2. Dyspnea or confusion without chest pain Correct answer.
  3. Sharp pleuritic pain relieved by leaning forward
  4. Sudden cardiac arrest as the first manifestation

Explanation

Older adults, women, and people with diabetes often present atypically with dyspnea, fatigue, confusion, syncope, or epigastric discomfort rather than classic chest pain. Relying on chest pain alone in this population leads to missed infarction.

Question 16Assessment (health history, physical examination, and diagnostic reasoning)

Which maneuver is used to assess the integrity of the anterior cruciate ligament?

  1. The Lachman test Correct answer.
  2. The Finkelstein test
  3. The Thomas test
  4. The McMurray test

Explanation

The Lachman test applies an anterior tibial translation force with the knee slightly flexed to assess the anterior cruciate ligament and is more sensitive than the anterior drawer sign. The other maneuvers assess the meniscus, the first dorsal compartment tendons, and hip flexor contracture.

Question 17Assessment (health history, physical examination, and diagnostic reasoning)

Which findings on chest examination are expected over a large pleural effusion?

  1. Hyperresonance to percussion with absent breath sounds
  2. Dullness to percussion with decreased breath sounds at the base Correct answer.
  3. Inspiratory stridor heard over the trachea
  4. Crackles with egophony over the upper lobes

Explanation

Pleural fluid produces an area of percussion dullness with decreased tactile fremitus and diminished breath sounds over the dependent chest. Hyperresonance with absent sounds suggests pneumothorax, while egophony indicates consolidation.

Question 18Assessment (health history, physical examination, and diagnostic reasoning)

Which description corresponds to a stage 2 pressure injury?

  1. Full-thickness loss with visible subcutaneous fat
  2. Intact skin with nonblanchable erythema
  3. Partial-thickness loss with a shallow open ulcer or blister Correct answer.
  4. Full-thickness loss with exposed muscle or bone

Explanation

Stage 2 injury involves partial-thickness loss of the dermis presenting as a shallow open ulcer with a pink or red wound bed, or an intact or ruptured blister. Nonblanchable intact skin is stage 1, and full-thickness injuries represent stages 3 and 4.

Question 19Assessment (health history, physical examination, and diagnostic reasoning)

A patient reports drinking "a few drinks" on weekends. Which action best quantifies alcohol use?

  1. Asking whether drinking has ever caused problems at work
  2. Accepting the patient's report as adequate because it was volunteered
  3. Ordering liver function tests in place of further questioning
  4. Administering a validated instrument such as the AUDIT-C Correct answer.

Explanation

Validated quantity-frequency instruments such as AUDIT-C improve detection of unhealthy alcohol use because vague self-report substantially underestimates intake. A single problem-oriented question or a normal laboratory result does not establish the quantity consumed.

Question 20Assessment (health history, physical examination, and diagnostic reasoning)

Which cranial nerve provides the efferent limb of the pupillary light reflex?

  1. Trigeminal nerve (CN V)
  2. Optic nerve (CN II)
  3. Facial nerve (CN VII)
  4. Oculomotor nerve (CN III) Correct answer.

Explanation

Light is sensed by the retina and carried by the optic nerve (afferent), while the oculomotor nerve delivers parasympathetic fibers to the pupillary constrictor (efferent). CN V and CN VII serve the afferent and efferent limbs of the corneal reflex instead.

Question 21Assessment (health history, physical examination, and diagnostic reasoning)

A test with 90% sensitivity and 95% specificity is used in a population with a 1% prevalence of the disease. Which statement best describes the expected results?

  1. The sensitivity will fall as prevalence falls
  2. Most positive results will be true positives
  3. The negative predictive value will be low
  4. Most positive results will be false positives Correct answer.

Explanation

With a prevalence of 1%, the positive predictive value is roughly (0.90 x 0.01) / [(0.90 x 0.01) + (0.05 x 0.99)], or about 15%, meaning most positives are false positives. Sensitivity and specificity are properties of the test and do not change with prevalence, while the negative predictive value rises as prevalence falls.

Question 22Assessment (health history, physical examination, and diagnostic reasoning)

How does the murmur of hypertrophic obstructive cardiomyopathy typically respond to bedside maneuvers?

  1. It intensifies with the Valsalva strain and softens with squatting Correct answer.
  2. It does not change with alterations in preload
  3. It intensifies with handgrip and softens with standing
  4. It softens with the Valsalva strain and intensifies with squatting

Explanation

The dynamic outflow gradient of hypertrophic cardiomyopathy widens when preload or afterload falls, so the murmur becomes louder with Valsalva strain or standing and softer with squatting or handgrip. This behavior distinguishes it from most other systolic murmurs.

Question 23Assessment (health history, physical examination, and diagnostic reasoning)

Which maneuver is most useful for detecting a moderate amount of ascites on physical examination?

  1. Eliciting shifting dullness Correct answer.
  2. Observing for bulging flanks
  3. Inspecting for an everted umbilicus
  4. Testing for a fluid wave

Explanation

Shifting dullness is the preferred bedside test for moderate ascites and can detect roughly 500 to 1000 mL of fluid. The fluid wave requires a substantially larger volume, and bulging flanks or an everted umbilicus are supportive but insensitive signs.

Question 24Assessment (health history, physical examination, and diagnostic reasoning)

An 82-year-old hospitalized after hip surgery develops fluctuating confusion, inattention, and visual hallucinations over two days. Which diagnosis is most likely?

  1. Dementia with Lewy bodies
  2. Major depressive disorder
  3. Delirium Correct answer.
  4. Normal pressure hydrocephalus

Explanation

Acute onset with fluctuating attention, perceptual disturbances, and a medical or surgical precipitant is the hallmark of delirium. Dementia with Lewy bodies evolves gradually, depression causes sustained mood and cognitive changes, and normal pressure hydrocephalus presents with the subacute triad of gait disturbance, incontinence, and cognitive decline.

Question 25Assessment (health history, physical examination, and diagnostic reasoning)

A patient reports hearing loss in the right ear. The Weber test lateralizes to the right, and the right ear has bone conduction greater than air conduction. What is the most likely diagnosis?

  1. Left conductive hearing loss
  2. Right sensorineural hearing loss
  3. Right conductive hearing loss Correct answer.
  4. Left sensorineural hearing loss

Explanation

The Weber test lateralizes to the affected ear in conductive loss and to the better ear in sensorineural loss, while Rinne shows bone conduction exceeding air conduction in conductive loss. Lateralization to the right with a negative right Rinne therefore localizes a conductive deficit to the right ear.

Question 26Assessment (health history, physical examination, and diagnostic reasoning)

A 45-year-old patient presents for a new-patient visit with several concerns. Which approach best begins the health history?

  1. Ask a series of closed-ended questions about each body system
  2. Review the medication list before addressing the chief concern
  3. Obtain the family history before the history of present illness
  4. Ask an open-ended question about the reason for the visit Correct answer.

Explanation

Beginning with an open-ended question about the reason for the visit allows the patient to describe concerns in their own words and improves diagnostic accuracy. Closed-ended questions and record review are useful later but should not replace the initial open-ended inquiry.

Question 27Assessment (health history, physical examination, and diagnostic reasoning)

Which percussion note is expected over normal lung tissue during thoracic examination?

  1. Resonance Correct answer.
  2. Dullness
  3. Flatness
  4. Tympany

Explanation

Normal air-filled lung tissue produces a resonant percussion note. Dullness suggests fluid or solid tissue, flatness suggests dense tissue, and tympany is heard over the stomach.

Question 28Assessment (health history, physical examination, and diagnostic reasoning)

Which change in vital signs meets the definition of orthostatic hypotension?

  1. A rise in pulse of 10 beats/min on standing
  2. A fall in systolic pressure of 10 mm Hg on standing
  3. A rise in diastolic pressure of 5 mm Hg on standing
  4. A fall in systolic pressure of 20 mm Hg on standing Correct answer.

Explanation

Orthostatic hypotension is defined as a fall in systolic pressure of at least 20 mm Hg or diastolic pressure of at least 10 mm Hg within 3 minutes of standing. A 10 mm Hg systolic fall is below the diagnostic threshold.

Question 29Assessment (health history, physical examination, and diagnostic reasoning)

A positive predictive value of 80% means which of the following?

  1. 80% of people with a negative test will develop disease
  2. 80% of people with a positive test have the disease Correct answer.
  3. 80% of people with the disease have a positive test
  4. 80% of people without disease have a negative test

Explanation

Positive predictive value is the proportion of patients with a positive test who truly have disease. It depends on prevalence as well as sensitivity and specificity.

Question 30Assessment (health history, physical examination, and diagnostic reasoning)

Which part of the health history systematically reviews symptoms by body system?

  1. Chief complaint
  2. Past medical history
  3. Social history
  4. Review of systems Correct answer.

Explanation

The review of systems is a systematic survey of symptoms organized by body system. The chief complaint is the patient's main reason for seeking care.

Question 31Assessment (health history, physical examination, and diagnostic reasoning)

Which resting heart rate is within the normal adult range?

  1. 38 beats/min
  2. 76 beats/min Correct answer.
  3. 112 beats/min
  4. 52 beats/min

Explanation

The normal adult resting heart rate is approximately 60 to 100 beats/min. A rate of 76 beats/min falls within this range.

Question 32Assessment (health history, physical examination, and diagnostic reasoning)

The Babinski response is elicited by stroking which part of the foot?

  1. Medial sole from heel to base of first toe
  2. Plantar surface of the heel only
  3. Lateral sole from heel toward the toes Correct answer.
  4. Dorsum of the foot along the first metatarsal

Explanation

The plantar reflex is elicited by stroking the lateral sole from the heel toward the toes. An abnormal Babinski response consists of dorsiflexion of the great toe with fanning of the other toes.

Question 33Assessment (health history, physical examination, and diagnostic reasoning)

Which assessment begins immediately when the clinician first meets the patient?

  1. Deep tendon reflexes
  2. Lung auscultation
  3. General survey Correct answer.
  4. Cranial nerve testing

Explanation

The general survey begins at first contact and includes appearance, level of consciousness, signs of distress, and body habitus. The other assessments require specific techniques performed later in the examination.

Question 34Assessment (health history, physical examination, and diagnostic reasoning)

Which feature of chest pain most suggests an ischemic cause?

  1. Pain that resolves with rest Correct answer.
  2. Pain lasting seconds with movement
  3. Pain reproduced by palpation
  4. Sharp pain with deep inspiration

Explanation

Ischemic chest pain is typically substernal pressure provoked by exertion and relieved by rest or nitroglycerin. Pain reproduced by palpation suggests a musculoskeletal cause, and pleuritic pain suggests a pulmonary or pleural cause.

Question 35Assessment (health history, physical examination, and diagnostic reasoning)

Which sequence is correct for the abdominal examination?

  1. Percussion, inspection, auscultation, palpation
  2. Inspection, palpation, percussion, auscultation
  3. Inspection, auscultation, percussion, palpation Correct answer.
  4. Auscultation, inspection, palpation, percussion

Explanation

Auscultation is performed before percussion and palpation because these maneuvers can alter bowel sounds. The correct order is inspection, auscultation, percussion, and palpation.

Question 36Assessment (health history, physical examination, and diagnostic reasoning)

A murmur is first associated with a palpable thrill at which grade?

  1. Grade 6
  2. Grade 4 Correct answer.
  3. Grade 2
  4. Grade 1

Explanation

Murmurs are graded 1 through 6, and a palpable thrill first appears at grade 4. Grade 1 is faint, grade 2 is soft, and grade 3 is moderately loud without a thrill.

Question 37Assessment (health history, physical examination, and diagnostic reasoning)

A test with very high specificity is most useful for which purpose?

  1. Ruling out a diagnosis when the result is negative
  2. Ruling in a diagnosis when the result is positive Correct answer.
  3. Estimating the prevalence of disease
  4. Determining the number needed to treat

Explanation

A highly specific test has few false-positive results, so a positive result helps rule in disease. This is summarized by the mnemonic SpPin.

Question 38Assessment (health history, physical examination, and diagnostic reasoning)

A 58-year-old reports exertional dyspnea and ankle swelling. Which historical detail best helps distinguish cardiac from pulmonary causes?

  1. Pleuritic chest pain with fever
  2. Wheezing after exposure to pollen
  3. Productive cough with yellow sputum
  4. Orthopnea and paroxysmal nocturnal dyspnea Correct answer.

Explanation

Orthopnea and paroxysmal nocturnal dyspnea are classic features of cardiac decompensation. Productive cough, fever, and allergen-triggered wheezing point more toward pulmonary disease.

Question 39Assessment (health history, physical examination, and diagnostic reasoning)

A patient has 4 mm of pitting edema that rebounds in about 15 seconds. Which grade is documented?

  1. 3+
  2. 1+
  3. 2+ Correct answer.
  4. 4+

Explanation

Pitting edema is graded by depth: 1+ is 2 mm, 2+ is 4 mm, 3+ is 6 mm, and 4+ is 8 mm. A depth of 4 mm corresponds to 2+ edema.

Question 40Assessment (health history, physical examination, and diagnostic reasoning)

Which cranial nerve is assessed by asking the patient to raise the eyebrows and close the eyes tightly?

  1. CN VII Correct answer.
  2. CN XII
  3. CN V
  4. CN IX

Explanation

CN VII, the facial nerve, provides motor innervation to the muscles of facial expression. Raising the eyebrows and closing the eyes tightly test its motor function.

Question 41Assessment (health history, physical examination, and diagnostic reasoning)

During auscultation, a patient says 'ee' and the clinician hears 'ay' over the right lower lobe. What is this finding called?

  1. Bronchophony
  2. Whispered pectoriloquy
  3. Egophony Correct answer.
  4. Crepitations

Explanation

Egophony is the change of a spoken 'ee' sound to 'ay' over areas of lung consolidation. Bronchophony and whispered pectoriloquy are related voice-transmission findings but do not involve this sound change.

Question 42Assessment (health history, physical examination, and diagnostic reasoning)

A 40-year-old reports the sudden onset of the 'worst headache of my life' that peaked within one minute. Which diagnosis must be excluded first?

  1. Subarachnoid hemorrhage Correct answer.
  2. Migraine without aura
  3. Tension-type headache
  4. Cluster headache

Explanation

A thunderclap headache that reaches maximum intensity within about one minute is a red flag for subarachnoid hemorrhage. Immediate evaluation is required to exclude this life-threatening cause.

Question 43Assessment (health history, physical examination, and diagnostic reasoning)

Which question best screens an older adult for fall risk during a routine visit?

  1. Do you take any medications for high blood pressure?
  2. How many blocks can you walk without stopping?
  3. Have you ever broken a bone in your lifetime?
  4. Have you fallen or felt unsteady in the past year? Correct answer.

Explanation

Asking about falls or unsteadiness in the past year is a validated and efficient fall-risk screen. A positive response should prompt further gait, balance, and medication review.

Question 44Assessment (health history, physical examination, and diagnostic reasoning)

Which description of a tremor is most characteristic of Parkinson disease?

  1. A resting tremor that improves with voluntary movement Correct answer.
  2. A tremor that worsens with movement and is absent at rest
  3. A tremor that occurs only with sustained posture and resolves at rest
  4. A tremor triggered by caffeine and relieved by sleep

Explanation

Parkinson disease classically causes a resting tremor that diminishes with voluntary movement. Postural or action tremor is more typical of essential tremor.

Question 45Assessment (health history, physical examination, and diagnostic reasoning)

A patient has a positive screening test for a rare disease. Which action is most appropriate next?

  1. Repeat the same screening test the following week
  2. Order a confirmatory test before making a diagnosis Correct answer.
  3. Reassure the patient because the disease is rare
  4. Begin treatment immediately based on the screening result

Explanation

When prevalence is low, a positive screening result has a substantial chance of being a false positive. A confirmatory test is needed before diagnosis or treatment.

Question 46Assessment (health history, physical examination, and diagnostic reasoning)

A positive likelihood ratio of 10 for a physical examination finding indicates which of the following?

  1. The finding is present in 10% of people with disease
  2. The finding raises absolute risk by 10 percentage points
  3. The finding is 10 times more common in disease Correct answer.
  4. A negative finding rules the disease out

Explanation

The positive likelihood ratio compares the probability of a positive finding in people with disease to that in people without disease. A value of 10 means the finding is 10 times more likely in those with the disease.

Question 47Assessment (health history, physical examination, and diagnostic reasoning)

Which reasoning bias describes estimating disease probability based on how easily similar cases come to mind?

  1. Availability bias Correct answer.
  2. Anchoring bias
  3. Confirmation bias
  4. Framing bias

Explanation

Availability bias occurs when a clinician judges probability by how readily similar cases are recalled. Recent or vivid cases can therefore distort diagnostic reasoning.

Question 48Assessment (health history, physical examination, and diagnostic reasoning)

Which finding is most consistent with cardiac tamponade?

  1. A systolic pressure rise greater than 10 mm Hg during inspiration
  2. A widened pulse pressure with a bounding pulse
  3. An alternating strong and weak pulse
  4. A systolic pressure fall greater than 10 mm Hg during inspiration Correct answer.

Explanation

Cardiac tamponade classically produces pulsus paradoxus, an exaggerated inspiratory fall in systolic pressure greater than 10 mm Hg. This occurs because right ventricular filling is impaired by pericardial pressure.

Question 49Assessment (health history, physical examination, and diagnostic reasoning)

Which feature most suggests that a transient loss of consciousness was a seizure rather than syncope?

  1. Rapid return to baseline within seconds
  2. Pallor and sweating before the event
  3. A brief period of lightheadedness before the event
  4. Prolonged confusion after the event Correct answer.

Explanation

A postictal period of confusion and drowsiness is characteristic of a seizure. Syncope usually causes rapid recovery once cerebral perfusion is restored.

Question 50Assessment (health history, physical examination, and diagnostic reasoning)

Which physical examination finding is most specific for portal hypertension in cirrhosis?

  1. Jaundice
  2. Spider angiomata
  3. Palmar erythema
  4. Caput medusae Correct answer.

Explanation

Caput medusae consists of dilated periumbilical veins caused by portal hypertension and is relatively specific for this complication. Jaundice, palmar erythema, and spider angiomata reflect liver disease but are less specific.