NU 673 Assessment Midterm
A 20 year old male has a history of leukemia and an enlarged spleen. Today he presents with a fairly significant left
upper quadrant pain. On exam of the area a rough grating noise is heard. What is this sound known as?
A. It is a variant of bowel noise
B. It is a splenic rub
C. Vascular noise
D. It represents borborygmi - Correct Answer B. It is a splenic rub
A 21 year old construction worker presents for evaluation of a rash. The pt notes that it started on their back with a
multitude of spots and is also on their upper chest and arms. It itches a little. The patient also reports sweating more
than before because being outdoors is part of their new job. On exam, you note hyperpigmented, oval macules
scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. What is
the most likely diagnosis?
A. Psoriasis
B. Pityriasis rosea
C. Tinea versicolor
D. Atopic eczema - Correct Answer C. Tinea versicolor
A 26 year old female pt presents to the office with unilateral pain during chewing, which is chronic. She does not have
facial tenderness or tenderness of the scalp. The APRN suspects:
A. Tumor of the mandible
B. Trigeminal neuralgia
C. Temporal arthritis
D. TMJ syndrome - Correct Answer D. TMJ syndrome
A 27 year old professional tennis player presents to the office with left shoulder pain after playing in. tournament this
weekend. The pt has supraspinatus weakness on abduction, infraspinatus weakness during external rotation, a
positive impingement sign and a positive drop arm test. the APRN suspects:
A. acromioclavicular arthritis
B. rotator cuff tear
C. Bicipital tendritis
D. adhesive tendritis - Correct Answer B. rotator cuff tear
A 28 year old pt comes to the office for evaluation of a rash. At first there was only one large patch, but more lesions
erupted suddenly on the back and torso; the lesions itch. On exam, the APRN notes that the pattern of eruption is a
herald patch and that there are a variety of erythematous papules and macules on the cleavage lines of the back.
Based on this, what is the most likely diagnosis?
A. Tinea versicolor
B. Atopic eczema
C. Psoriasis
D. Pityriasis rosea - Correct Answer D. Pityriasis rosea
A 31 year old day care worker presents with a worsening stiff, painful neck. On inspection, the pt's head is laterally
deviated toward the shoulder and rotated. At this point of the exam, what is the most likely diagnosis?
A. Torticolis
B. Osteoarthritis
C. Spondylolisthesis
D. Anklylosing spondylitis - Correct Answer A. Torticolis
, A 33 year old female presents with history of weight gain, decreased energy, and menorrhagia over the past several
months. Review of her family history reveals Hashimoto thyroiditis and hypothyroidism in four female first degree
relatives (mother and 3 sisters). Which of the following skin findings best supports a diagnosis of clinical
hypothyroidism?
A. Dry skin, myxedema, alopecia of the eyebrows, and brittle nails
B. Thickened, taut skin with sclerodactyly and telangiectasia
C. Warm moist skin, hyperpigmentation, and pretibial myxedema
D. Discoid rash, alopecia, oral ulcers, and raynaud phenomenon - Correct Answer A. Dry skin, myxedema, alopecia
of the eyebrows, and brittle nails
A 68 year old retired truck driver comes to the office for evaluation of swelling in his legs. He is a smoker and has
been taking medications to control his hypertension for the past 25 years. The APRN is concerned about his risk for
peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this
condition?
A. CT scan of the lower legs
B. Ankle brachial index (ABI)
C. Venogram
D. PET scan - Correct Answer B. Ankle brachial index (ABI)
A middle aged man comes in bc he noticed a small, fiery red lesion on his anterior chest. It is not panful and he has
not noticed any bleeding or bruising. On exam, there is a 1 cm slightly raised lesion with a central body and radiating
legs. Which diagnosis is most likely?
A. Petechia
B. Spider angioma
C. Spider vein
D. Cherry angioma - Correct Answer B. Spider angioma
A patient is suspected to have COPD. The APRN instructs the patient to take a deep breath in, and then with his
mouth open, breathe out as fast and completely as he can. For what is the APRN checking?
A. Whispered pectoriloquy
B. Forced expiratory time
C. Egophony
D. Tactile fremitus - Correct Answer B. Forced expiratory time
A pt presents to the clinic with severe right sided abdominal pain for 12 hours. He began having a "stomach ache"
yesterday, with decreased appetite, but today the pain seems to be just on the lower right side. He has had some
nausea & vomiting, but no constipation or diarrhea. His last BM was last night and was normal. He has had no fever
or chills. He denies any recent illness or injuries. His PMH is unremarkable. He denies any tobacco or drug use and
drinks 4-6 beers/week. on exam, he appears ill and is lying on his right side. His temp is 100.4 F and HR is 110. His
bowel sounds are decreased and he has rebound pain and guarding one third of the way between anterior superior
iliac spine and the umbilicus in the right lower quadrant. What is the most likely cause of his pain?
A. Acute appendicitis
B. Mesenteric ischemia
C. Acute mechanical intestinal obstruction
D. Acute cholecystitis - Correct Answer A. Acute appendicitis
A pt reports "chest pain" during a visit to the APRN. The pt describes it as "severe" and "sharp" and worse when
taking a deep breath. PMH is unremarkable and there is no history of tobacco use. VS are normal. Pt appears
comfortable. Cardiac and respiratory exam are unremarkable. What is the most likely diagnosis?
A. GERD
B. Aortic dissection
C. Myocardial infarction
D. Pleuritic pain - Correct Answer D. Pleuritic pain
A pt with longstanding COPD reports that he was told his liver was enlarged. The APRN needs to assess the pt.
Which of the following should the APRN do first?
A 20 year old male has a history of leukemia and an enlarged spleen. Today he presents with a fairly significant left
upper quadrant pain. On exam of the area a rough grating noise is heard. What is this sound known as?
A. It is a variant of bowel noise
B. It is a splenic rub
C. Vascular noise
D. It represents borborygmi - Correct Answer B. It is a splenic rub
A 21 year old construction worker presents for evaluation of a rash. The pt notes that it started on their back with a
multitude of spots and is also on their upper chest and arms. It itches a little. The patient also reports sweating more
than before because being outdoors is part of their new job. On exam, you note hyperpigmented, oval macules
scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. What is
the most likely diagnosis?
A. Psoriasis
B. Pityriasis rosea
C. Tinea versicolor
D. Atopic eczema - Correct Answer C. Tinea versicolor
A 26 year old female pt presents to the office with unilateral pain during chewing, which is chronic. She does not have
facial tenderness or tenderness of the scalp. The APRN suspects:
A. Tumor of the mandible
B. Trigeminal neuralgia
C. Temporal arthritis
D. TMJ syndrome - Correct Answer D. TMJ syndrome
A 27 year old professional tennis player presents to the office with left shoulder pain after playing in. tournament this
weekend. The pt has supraspinatus weakness on abduction, infraspinatus weakness during external rotation, a
positive impingement sign and a positive drop arm test. the APRN suspects:
A. acromioclavicular arthritis
B. rotator cuff tear
C. Bicipital tendritis
D. adhesive tendritis - Correct Answer B. rotator cuff tear
A 28 year old pt comes to the office for evaluation of a rash. At first there was only one large patch, but more lesions
erupted suddenly on the back and torso; the lesions itch. On exam, the APRN notes that the pattern of eruption is a
herald patch and that there are a variety of erythematous papules and macules on the cleavage lines of the back.
Based on this, what is the most likely diagnosis?
A. Tinea versicolor
B. Atopic eczema
C. Psoriasis
D. Pityriasis rosea - Correct Answer D. Pityriasis rosea
A 31 year old day care worker presents with a worsening stiff, painful neck. On inspection, the pt's head is laterally
deviated toward the shoulder and rotated. At this point of the exam, what is the most likely diagnosis?
A. Torticolis
B. Osteoarthritis
C. Spondylolisthesis
D. Anklylosing spondylitis - Correct Answer A. Torticolis
, A 33 year old female presents with history of weight gain, decreased energy, and menorrhagia over the past several
months. Review of her family history reveals Hashimoto thyroiditis and hypothyroidism in four female first degree
relatives (mother and 3 sisters). Which of the following skin findings best supports a diagnosis of clinical
hypothyroidism?
A. Dry skin, myxedema, alopecia of the eyebrows, and brittle nails
B. Thickened, taut skin with sclerodactyly and telangiectasia
C. Warm moist skin, hyperpigmentation, and pretibial myxedema
D. Discoid rash, alopecia, oral ulcers, and raynaud phenomenon - Correct Answer A. Dry skin, myxedema, alopecia
of the eyebrows, and brittle nails
A 68 year old retired truck driver comes to the office for evaluation of swelling in his legs. He is a smoker and has
been taking medications to control his hypertension for the past 25 years. The APRN is concerned about his risk for
peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this
condition?
A. CT scan of the lower legs
B. Ankle brachial index (ABI)
C. Venogram
D. PET scan - Correct Answer B. Ankle brachial index (ABI)
A middle aged man comes in bc he noticed a small, fiery red lesion on his anterior chest. It is not panful and he has
not noticed any bleeding or bruising. On exam, there is a 1 cm slightly raised lesion with a central body and radiating
legs. Which diagnosis is most likely?
A. Petechia
B. Spider angioma
C. Spider vein
D. Cherry angioma - Correct Answer B. Spider angioma
A patient is suspected to have COPD. The APRN instructs the patient to take a deep breath in, and then with his
mouth open, breathe out as fast and completely as he can. For what is the APRN checking?
A. Whispered pectoriloquy
B. Forced expiratory time
C. Egophony
D. Tactile fremitus - Correct Answer B. Forced expiratory time
A pt presents to the clinic with severe right sided abdominal pain for 12 hours. He began having a "stomach ache"
yesterday, with decreased appetite, but today the pain seems to be just on the lower right side. He has had some
nausea & vomiting, but no constipation or diarrhea. His last BM was last night and was normal. He has had no fever
or chills. He denies any recent illness or injuries. His PMH is unremarkable. He denies any tobacco or drug use and
drinks 4-6 beers/week. on exam, he appears ill and is lying on his right side. His temp is 100.4 F and HR is 110. His
bowel sounds are decreased and he has rebound pain and guarding one third of the way between anterior superior
iliac spine and the umbilicus in the right lower quadrant. What is the most likely cause of his pain?
A. Acute appendicitis
B. Mesenteric ischemia
C. Acute mechanical intestinal obstruction
D. Acute cholecystitis - Correct Answer A. Acute appendicitis
A pt reports "chest pain" during a visit to the APRN. The pt describes it as "severe" and "sharp" and worse when
taking a deep breath. PMH is unremarkable and there is no history of tobacco use. VS are normal. Pt appears
comfortable. Cardiac and respiratory exam are unremarkable. What is the most likely diagnosis?
A. GERD
B. Aortic dissection
C. Myocardial infarction
D. Pleuritic pain - Correct Answer D. Pleuritic pain
A pt with longstanding COPD reports that he was told his liver was enlarged. The APRN needs to assess the pt.
Which of the following should the APRN do first?
