15 free questions from the CinnaEMS secondary assessment bank (373 in the app). Tap an answer to check it. The rationale opens right away.
An older man answers yes to every symptom you name, including two that cannot both be true. The most useful way to test his answers is to:
Answer: A. Ask a question with no yes available
Automatic agreement is common with hearing loss, fatigue, confusion or a wish to be a good patient, and a yes-or-no format cannot detect it because every answer fits. 'Show me where it hurts' or 'what time did this start?' has nothing agreeable to fall into. Recording the contradictions fills the chart with noise, and moving the questions to a relative replaces his history with somebody else's.
A woman 34 weeks pregnant has a severe headache, blurred vision and swelling of the hands and face. You should be most concerned about:
Answer: A. Preeclampsia, which can progress to seizures
Headache, visual changes and swelling after 20 weeks suggest preeclampsia, which involves high blood pressure and can progress to eclampsia — seizures. Keep her calm, limit stimulation, be prepared for a seizure and transport. Treating it as normal or a migraine misses a dangerous condition.
Two patients both have crackles. Patient A has them only over the right lower back, with fever and a productive cough. Patient B has them over both lower backs, with swollen ankles and breathlessness when lying flat. The distribution points toward:
Answer: A. A localized problem in A and fluid backing up into both lungs in B
Where a sound is heard matters as much as what it is. Crackles confined to one area with fever and a productive cough suggest a localized process such as pneumonia, while crackles at both bases with ankle swelling and orthopnea suggest fluid backing up into both lungs. Crackles have several causes, so treating them as one process discards the most useful information, and bronchospasm produces wheezes, not crackles.
Palpating the abdomen of an older adult with back pain, you feel a mass near the midline that pushes against your hand with each beat. You should:
Answer: A. Stop palpating and report it
A mass that pulses with the heartbeat may be a weakened aortic wall, and deeper or repeated palpation gains you nothing you could act on while risking the one outcome you most want to avoid. Sizing it by hand is not a measurement anyone will use, and asking a second provider to press on it simply takes the same risk over again.
Your stethoscope earpieces are angled backward in your ears and the tubing is brushing the stretcher rail. The likely effect on your blood pressure is that you:
Answer: A. Hear the sounds poorly and misjudge the numbers
Earpieces are shaped to point forward into the ear canals, and tubing that rubs anything generates noise louder than the sounds you are straining to hear, so both faults make a quiet signal quieter still. The result is a guessed first or last sound rather than a delayed or partial one, and the fix costs nothing but attention before you begin.
During your survey you find a firm, tender swelling on the upper back of a patient who reports no injury there and no illness that explains it. You should:
Answer: A. Describe it, record it and pass it on
A finding does not have to be understood to be reported; it has to be described accurately — site, size, firmness, tenderness — so somebody with more information can place it. Dropping it means the only person who ever felt it takes the knowledge away, and attaching a guessed cause is worse still, because the guess travels onward as though it were an observation.
A patient says her weakness began 'this morning.' Her daughter, who sees her every day, says it started on Thursday. You should record:
Answer: A. Both accounts, and who gave each
Onset time decides which possibilities are still open, so a disagreement about it is clinical information rather than an inconvenience, and attributing each version to its source lets the receiving team weigh them. Picking one and writing it as fact deletes the disagreement, and a patient whose sense of time is altered is herself a finding worth passing on.
You are about to palpate the abdomen of a patient who points to the left lower quadrant as the painful area. You should begin:
Answer: A. In a quadrant away from the pain
Palpating the painful area last preserves the patient's cooperation, because guarding provoked in the first quadrant makes every remaining quadrant feel tense. Starting where it hurts also removes your comparison: you need to know what this patient's relaxed abdomen feels like before you can judge the tender one.
A monitoring device displays a pulse rate of 48 while you count a radial pulse of 96 on the same patient. The most likely explanation is that:
Answer: A. The device is registering every second beat
A weak or poorly detected signal commonly makes a device miss alternate beats and report a tidy half of the true rate, which is why the displayed number is always checked against fingers on an artery. An artery does not generate extra beats, and a rate that halves and doubles between two counts a moment apart is far less likely than a device with a poor signal.
Your patient is deaf, communicates in sign language, and no interpreter is present. The best way to take the history in the meantime is to:
Answer: A. Face her in good light and use written questions and short notes
Writing gives a deaf patient a clear channel for questions and answers, and facing her in good light lets her read your expressions and any lip movement. Shouting does not help a person who cannot hear and may distress her, a bystander may know little and has no right to her history, and postponing questions loses information you need now.
You press your thumb over the shin of a patient with swollen legs and the dent remains after you lift it away. This finding is recorded as:
Answer: A. Pitting edema
A dent that stays is fluid displaced out of the tissue, and whether it is new or long-standing is the question that decides what it means, which is why you ask how the legs looked last week. Air under the skin crackles and holds no impression at all, so the two findings feel nothing alike even though both are discovered by pressing.
An alert 30-year-old cut one hand on a kitchen knife, has no other complaint and has normal vital signs. The appropriate secondary assessment is:
Answer: A. A focused exam of the injured hand and arm
A patient who is alert, has an isolated complaint and a minor mechanism can direct you to the problem, so the exam is focused on the region involved and the function distal to it. Running a full head-to-toe survey here spends time on regions no mechanism ever touched, and it delays the wound care that is the only thing this patient actually needs.
You look at both forearms of a patient who fell and see no swelling, no bruising and no change in shape. Calling the forearms uninjured on that basis alone risks missing:
Answer: A. Tenderness and abnormal motion only touch finds
Inspection finds only what has already changed the surface — blood, swelling, a changed contour — and a fresh fracture that has not yet swollen changes nothing an eye can see. Palpation is what produces point tenderness and abnormal movement, so an examination that stops at looking reports a normal forearm the patient will nonetheless refuse to use.
A patient with a head injury responds to pain by stiffly extending both arms straight at his sides and pointing his toes. Compared with pulling his arms up onto his chest, this response:
Answer: A. Indicates deeper injury and scores lower on the motor scale
Abnormal extension (decerebrate posturing) reflects injury deeper in the brain than abnormal flexion (decorticate posturing) and scores 2 on the Glasgow motor scale, compared with 3 for abnormal flexion. A patient who localizes reaches toward the painful stimulus, which is a higher score, so describing extension as improvement reverses its meaning. A change from flexion to extension signals deterioration.
A patient is lying on the stretcher with the legs out straight and the head raised, and you are about to palpate the abdomen. The adjustment that most improves the examination is to:
Answer: A. Bend the knees so the abdominal wall relaxes
A stretched abdominal wall is a tight abdominal wall, and flexing the hips and knees slackens it so your hands reach what is underneath. Sitting up, breath-holding and lifting the head all contract the same muscles you are trying to relax, which is how a normal abdomen comes to be documented as tense and an early finding is buried under the patient's own posture.
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