Clinical Methods in Medicine
Midterm Exam
Course Introduction
Clinical Methods in Medicine provides students with foundational knowledge and practical skills necessary for effective patient evaluation and clinical decision-making. The course emphasizes the systematic approach to history taking, physical examination, and the interpretation of clinical findings. Through didactic sessions, case-based discussions, and supervised hands-on practice, students learn to integrate patient information, develop differential diagnoses, and utilize evidence-based clinical reasoning. Special attention is given to communication skills, professional ethics, and cultural competency, preparing students for advanced clinical clerkships and patient-centered medical care.
Recommended Textbook
Seidels Guide to Physical Examination 9th Edition by Jane W. Ball
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26 Chapters
648 Verified Questions
648 Flashcards
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Chapter 1: The History and Interviewing Process
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Sample Questions
Q1) Information that is needed during the initial interview of a pregnant woman includes all the following except:
A) the gender that the woman hopes the baby will be.
B) past medical history.
C) healthcare practices.
D) the woman's remembering (knowledge) about pregnancy.
Answer: A
Q2) Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom's health?
A) Attachment to parents
B) High self-esteem
C) Low peer support needs
D) Propensity for risk taking
Answer: D
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3
Chapter 2: Cultural Competency
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Sample Questions
Q1) Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care healthcare provider. Which of the following describes a physical, not a cultural, differentiator?
A) Race
B) Rite
C) Ritual
D) Norm
Answer: A
Q2) Which variables can intrude on successful communication? (Select all that apply.)
A) Social class
B) Gender
C) Stereotype
D) Phenotype
E) Age
Answer: A, B, E
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Page 4
Chapter 3: Examination Techniques and Equipment
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Sample Questions
Q1) Auscultation should be carried out last, except when examining the:
A) neck area.
B) heart.
C) lungs.
D) abdomen.
Answer: D
Q2) The infant should be placed in which position to have his or her height or length measured?
A) Vertically, with the examiner's hands under the infant's axillae
B) Supine on a measuring board
C) Prone on a measuring board
D) In the lateral position, with the toes against a measuring board
Answer: B
Q3) Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:
A) buzzing or tingling sensations.
B) buzzing from bone conduction.
C) hearing range of normal speech.
D) noise above the threshold level.
Answer: C
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Chapter 4: Clinical Reasoning
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Sample Questions
Q1) The adage that "common problems occur commonly" advises the practitioner to:
A) always diagnose the patient's problem in terms of what their practice usually sees.
B) refer any uncommon complaints to specialists as soon as possible.
C) not consider more than one diagnosis unless necessary.
D) examine uncommon problems critically before assuming that the issue is an unusual presentation of a common problem.
Q2) Which is an accepted method of making a diagnosis?
A) Relying on intuition
B) Making maximal use of laboratory tests
C) Using first assumptions
D) Using algorithms
Q3) The most important guide to sequencing actions should be:
A) probability and utility.
B) assumption and intuition.
C) costs and risks of procedures.
D) reimbursement potential and patient acceptance.
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Chapter 5: Documentation
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Sample Questions
Q1) Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical examination. This visit would be documented by creating a(n):
A) progress note.
B) accident report.
C) problem-oriented medical record.
D) triage note.
Q2) The review of systems is a component of the: A) physical examination.
B) health history.
C) assessment.
D) past medical-surgical history.
Q3) The patient's perceived disabilities and functional limitations are recorded in the: A) problem list.
B) general patient information.
C) social history.
D) history of present illness.
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Chapter 6: Vital Signs and Pain Assessment
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Sample Questions
Q1) The most frequent cause of serious hypertension in children is:
A) heart disease.
B) liver failure.
C) renal disease.
D) rheumatic fever.
Q2) The pyrexia response is triggered by the production and release of:
A) prostaglandins.
B) endogenous pyrogens.
C) hypothalamic enzymes.
D) thyroid hormones.
Q3) Which pulse characteristic in the neonate may indicate infection?
A) Bounding pulse rate
B) Regular pulse rate
C) Sustained high pulse rate
D) Intermittent slow pulse rate
Q4) The fifth vital sign is:
A) pain.
B) orientation.
C) waist-to-hip ratio.
D) body mass index (BMI).
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Chapter 7: Mental Status
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Sample Questions
Q1) A clinical syndrome of failing memory and impairment of other intellectual functions, usually related to obvious structural diseases of the brain, describes:
A) delirium.
B) dementia.
C) depression.
D) anxiety.
Q2) Which observation would be most significant when assessing the condition of a patient who has judgment impairment?
A) Repeated failure to fulfill family obligations
B) Forgetting family members' birth dates
C) Going to church three times a week
D) Planning for retirement in 20 years
Q3) Mrs. Griffiths, a 28-year-old patient, presents to your office to discuss her attention-deficit/hyperactivity disorder (ADHD). Which statement is true in regard to ADHD?
A) It occurs before 7 years of age.
B) It is usually related to mental retardation.
C) It is usually related to dementia.
D) It is manifested by prolonged periods of catatonic behavior.
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Page 9
Chapter 8: Growth, Measurement, and Nutrition
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Sample Questions
Q1) Which statement regarding female pubertal changes is true?
A) Most adolescent girls will develop breasts before they develop pubic hair.
B) Peak height velocity should occur after menarche.
C) Breast asymmetry is an abnormal finding.
D) Menarche should occur by Tanner breast stage 2.
Q2) Between 5 and 24 months of life, the infant's chest circumference is normally:
A) about equal to the head circumference.
B) greater than head circumference by 2 inches.
C) smaller than head circumference by about 4 inches.
D) at least 2 inches smaller than head circumference.
Q3) The term large for gestational age (LGA) indicates that an infant is larger than ____% of infants born at the same number of weeks' gestation.
Q4) Infants normally increase their birth length by ____% during the first year of life.
Q5) An 11-year-old boy is brought in for an annual physical examination by his mother. The boy's height is 60 inches. You suspect Marfan syndrome because the boy's arm span is greater than _______________ inches.
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Chapter 9: Skin, Hair, and Nails
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Sample Questions
Q1) A 17-year-old student complains of a "rash for 3 days." You note pale, erythematous oval plaques over the trunk. They have fine scales and are arranged in a fernlike pattern, with parallel alignment. What is the nurse's next action?
A) Teach infectious control measures.
B) Inquire about another recent skin lesion.
C) Inspect the palms and the soles.
D) Inform the patient that this will resolve within a week.
Q2) A single transverse line seen in the palm of a small child may imply:
A) Down syndrome.
B) Turner syndrome.
C) systemic sclerosis.
D) profound dehydration.
Q3) Which nail change found on examination would be most alarming?
A) Dark bands seen on all fingernails of a dark-skinned person
B) Yellow discoloration of the great toe of an older adult
C) Single dark band in a white adult
D) Pits in both index fingernails of an adult
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Chapter 10: Lymphatic System
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Sample Questions
Q1) Mr. Shea is a 45-year-old patient who presents to the office for multiple complaints. The examination of the upper left quadrant of the abdominal cavity is essential to the evaluation of the immune system because of the location of which organ?
A) Spleen
B) Liver
C) Stomach
D) Pancreas
Q2) An organ that is essential to the development of protective immune function in the infant but has little or no demonstrated function in the adult is the:
A) spleen.
B) liver.
C) thymus.
D) pancreas.
Q3) Which organ does not have lymphatic vessels?
A) Brain
B) Kidneys
C) Liver
D) Lungs
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Chapter 11: Head and Neck
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Sample Questions
Q1) During a physical examination of a 30-year-old Chinese man, you notice a slight asymmetry of his face. The cranial nerve examination is normal. Your best action is to:
A) ask the patient if this characteristic runs in his family.
B) perform monofilament testing on the face.
C) consult with the clinician regarding the laboratory tests needed.
D) record the finding in the patient's chart.
Q2) You are palpating a patient's thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate:
A) a congenital anomaly.
B) a multinodular goiter.
C) a normal thyroid gland.
D) thyroiditis.
Q3) Which type of headache usually occurs at night, is precipitated by alcohol consumption, and occurs more often in men than in women?
A) Classic migraine
B) Temporal arteritis
C) Cluster
D) Hypertensive
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13
Chapter 12: Eyes
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Sample Questions
Q1) Dot hemorrhages, or microaneurysms, in the retina and the presence of hard and soft exudates are most commonly seen in those with:
A) Down syndrome.
B) diabetic retinopathy.
C) systemic lupus.
D) glaucoma.
Q2) Examination to assess for extraocular muscle imbalance is conducted by:
A) comparing pupillary responses to different shapes.
B) having the patient follow your finger through planes.
C) inspecting slightly closed lids for fasciculations.
D) transilluminating the cornea with tangential light.
Q3) When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond with:
A) brisk blinking.
B) copious tearing.
C) pupil dilation.
D) reflex smiling.
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Chapter 13: Ears, Nose, and Throat
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Sample Questions
Q1) Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant's middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:
A) pull the auricle down and back.
B) hold the speculum in the canal.
C) distract the infant.
D) stabilize the chest.
Q2) When you ask the patient to identify smells, you are assessing cranial nerve __.
Q3) A hairy tongue with yellowish brown to black elongated papillae on the dorsum:
A) is indicative of oral cancer.
B) is sometimes seen following antibiotic therapy.
C) usually indicates vitamin deficiency.
D) usually indicates anemia.
Q4) When hearing is evaluated, which cranial nerve is being tested?
A) III
B) IV
C) VIII
D) XII
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15
Chapter 14: Chest and Lungs
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Sample Questions
Q1) Which finding suggests a minor structural variation?
A) Barrel chest
B) Clubbed fingers
C) Pectus carinatum
D) Chest wall retractions
Q2) An Apgar score of __________ is given to the infant who demonstrates irregular respiratory effort.
Q3) To count the ribs and the intercostal spaces, you begin by palpating the reference point of the:
A) distal point of the xiphoid.
B) manubriosternal junction.
C) suprasternal notch.
D) acromion process.
Q4) Which type of apnea requires immediate action?
A) Primary apnea
B) Secondary apnea
C) Sleep apnea
D) Periodic apnea of the newborn
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Chapter 15: Heart
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Sample Questions
Q1) If the apical impulse is more vigorous than expected, it is called a:
A) lift.
B) thrill.
C) bruit.
D) murmur.
Q2) The most helpful finding in determining left-sided heart failure is:
A) dyspnea.
B) orthopnea.
C) jugular vein distention.
D) an S<sub>3</sub> heart sound.
Q3) In the adult, the apical impulse should be most visible when the patient is in what position?
A) Supine
B) Upright
C) Lithotomy
D) Right lateral recumbent
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Chapter 16: Blood Vessels
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Sample Questions
Q1) You are performing a physical examination on a 46-year-old male patient. His examination findings include the following: positive peripheral edema, holosystolic murmur in the tricuspid region, and a pulsatile liver. His diagnosis is:
A) an aortic aneurysm.
B) an arteriovenous fistula.
C) tricuspid stenosis.
D) tricuspid regurgitation.
Q2) In children, coarctation of the aorta should be suspected if you detect:
A) a delay between the radial and femoral pulses.
B) a simultaneous radial and femoral pulse.
C) an absent femoral pulse on the left.
D) bilateral absence of femoral pulses.
Q3) You are examining Mr. S, a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of peripheral arterial disease?
A) Thick, calloused skin
B) Ruddy, thin skin
C) Warmer temperature of extremity in contrast to other body parts
D) Loss of hair over the extremities
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Page 18
Chapter 17: Breasts and Axillae
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Sample Questions
Q1) If your patient has nipple discharge, you will most likely need a:
A) Vacutainer tube.
B) glass slide and fixative.
C) specimen jar with formaldehyde.
D) tape strip to test pH.
Q2) When conducting a clinical breast examination, the examiner should:
A) forgo the examination if the patient has had a recent mammogram.
B) keep the patient's breasts completely covered to respect modesty.
C) dim the lights to minimize anxiety.
D) inspect both breasts simultaneously.
Q3) Ms. Lawson is a 41-year-old patient who presents for a routine annual examination. During her breast examination, you are also completing a lymphatic examination. Which of the following lymph nodes are examined during a breast examination? (Select all that apply.)
A) Supraclavicular
B) Lateral axillary nodes
C) Anterior cervical nodes
D) Anterior axillary nodes
E) Posterior cervical nodes
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Page 19
Chapter 18: Abdomen
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Sample Questions
Q1) When assessing abdominal pain in a college-age woman, one must include:
A) history of interstate travel.
B) food likes and dislikes.
C) age at completion of toilet training.
D) the first day of the last menstrual period.
Q2) A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child's diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a(n):
A) fixed mass palpated in the hypogastric area.
B) tender, midline abdominal mass.
C) olive-sized mass of the right upper quadrant.
D) nontender, slightly movable, flank mass.
Q3) The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it is:
A) a common genetic disorder.
B) one cause of malabsorption syndrome.
C) a curable condition with medical intervention.
D) the most frequent cause of diarrhea in general practice.
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Page 20
Chapter 19: Female Genitalia
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Sample Questions
Q1) The presence of a fishy odor after adding potassium hydroxide to a wet mount slide containing vaginal mucus suggests:
A) bacterial vaginosis.
B) yeast infection.
C) chlamydial infection.
D) pregnancy.
Q2) A bluish color to the cervix during pregnancy is called (the):
A) McDonald sign.
B) Spinnbarkeit.
C) Goodell sign.
D) Chadwick sign.
Q3) The assessment of which structure is not part of the bimanual examination?
A) Cervix
B) Bladder
C) Uterus
D) Ovaries
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Chapter 20: Male Genitalia
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Sample Questions
Q1) In an uncircumcised male, retraction of the foreskin may reveal a cheesy white substance. This is usually:
A) evidence of a fungal infection.
B) a collection of sebaceous material.
C) indicative of penile carcinoma.
D) suggestive of diabetes.
Q2) The most common cancer in young men ages 15 to 30 years is:
A) testicular.
B) penile.
C) prostate.
D) anal.
Q3) Which genital virus infection is known to have a latent phase followed by the production of viral DNA capsids and particles?
A) Condyloma acuminatum
B) Molluscum contagiosum
C) Herpetic lesions
D) Lymphogranuloma venereum
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Chapter 21: Anus, Rectum, and Prostate
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Sample Questions
Q1) Prostate-specific antigen (PSA) screening is controversial because:
A) there are many false-negative results.
B) PSA is produced by many other tissues.
C) it is less sensitive than digital rectal examination.
D) no data have proved that it decreases mortality.
Q2) A lower spinal cord lesion may be indicated by which finding?
A) Lack of an anal wink
B) Rectal prolapse
C) Anal fistula
D) Small flaps of anal skin
Q3) Very light tan or gray stools may indicate:
A) upper gastrointestinal bleeding.
B) obstructive jaundice.
C) lower gastrointestinal bleeding.
D) polyposis.
Q4) The prostatic sulcus:
A) divides the right and left lateral lobes.
B) is the site of the seminal vesicle emergence.
C) refers to the anterior aspect of the prostate.
D) secretes clear viscous mucus.
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Chapter 22: Musculoskeletal System
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Sample Questions
Q1) Expected normal findings during the inspection of spinal alignment include:
A) asymmetric skin folds at the neck.
B) slight right-sided scapular elevation.
C) concave lumbar curve.
D) the head positioned superiorly to the gluteal cleft.
Q2) The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are the result of:
A) decreased mineral deposition.
B) increased hormone secretion.
C) uterine enlargement.
D) gait changes.
Q3) The strength of the trapezius muscle is evaluated by having the patient:
A) clench his or her teeth during muscle palpation.
B) push his or her head against the examiner's hand.
C) straighten his or her leg with examiner opposition.
D) uncross his or her legs with examiner resistance.
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24
Chapter 23: Neurologic System
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Sample Questions
Q1) On a scale of 1+ to 4+, which deep tendon reflex score is appropriate for a finding of clonus in a patient?
A) 1+
B) 2+
C) 3+
D) 4+
Q2) Normal changes of the aging brain include:
A) increased velocity of nerve conduction.
B) diminished perception of touch.
C) increased total number of neurons.
D) diminished intelligence quotient.
Q3) It is especially important to test for ankle clonus if:
A) deep tendon reflexes are hyperactive.
B) deep tendon reflexes are hypoactive.
C) the Romberg sign is positive.
D) the patient has peripheral neuropathy.
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Chapter 24: Sports Participation Evaluation
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Sample Questions
Q1) One of the most important aspects to consider in the orthopedic screening examination is:
A) muscle contraction.
B) flexibility.
C) symmetry.
D) balance.
Q2) Which medical condition would exclude a person from sports participation?
A) Asthma
B) Fever
C) Controlled seizures
D) HIV-positive status
Q3) Part of the screening orthopedic component of the examination includes evaluating the person while he or she is:
A) performing push-ups.
B) duck walking.
C) twisting at the waist.
D) crossing the arms over the chest.
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Chapter 25: Putting it All Together
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Sample Questions
Q1) Which position is most likely the most comfortable for a patient who is 6 months pregnant?
A) Side-lying
B) Lithotomy
C) Prone
D) Flexed-knee
Q2) The examiner should develop a demeanor that is exemplified by which one of the following behaviors?
A) Exhibits visible distaste about the condition.
B) Gives immediate reassurances to the patient.
C) Gives patient unsolicited advice.
D) Validates the patient's justified concerns.
Q3) Which statement accurately reflects the sensitivity and specificity of laboratory tests?
A) The gold standard test has 100% sensitivity and specificity.
B) Sensitivity and specificity are inversely correlated.
C) Sensitivity and specificity are directly correlated.
D) No test has 100% sensitivity and specificity.
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Chapter 26: Emergency or Life-Threatening Situations
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Q1) Adults and children display different physiologic responses to injury and acute illness. An important concept to remember when assessing infants and children is that they:
A) experience lethal dysrhythmias first, progressing to respiratory failure.
B) usually experience cardiac arrest before respiratory failure.
C) usually experience respiratory arrest before circulatory failure.
D) tolerate greater volume changes, with less severe consequences.
Q2) Delayed capillary refill may alert you to:
A) hypovolemic shock.
B) moderate hypoxemia.
C) subnormal intracranial pressure.
D) upper respiratory infection.
Q3) When calculating the force of impact of a penetrating object, use:
A) the size of the missile and size of the patient.
B) the time of the incident and depth of the wound.
C) the amount of blood loss and level of consciousness.
D) the velocity of the missile and distance from the source.
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