Answers (PDF).
NR 511 CEA Final Exam Study Guide
Format: Multiple Choice
Focus: Differential Diagnosis & Primary Care
1. You are evaluating a 41-year-old female patient in your clinic with symptoms of
right upper quadrant pain which worsens with deep breathing. The patient
exhibits a positive Murphy sign. These findings are most consistent with which
one of the following?
A - Appendicitis
B - Cholecystitis
C - Crohn's flare
D - Pancreatitis
Answer: B - Cholecystitis
Rationale: A positive Murphy sign (cessation of inspiration during palpation of the
RUQ) is a classic examination finding for acute cholecystitis. RUQ pain that
radiates to the right shoulder or back is also characteristic .
,2. A 40-year-old African American female presents for a history and physical.
Upon initial assessment, you notice she has severe exophthalmos. Which
diagnosis would be highest on your differential?
A - Bilateral conjunctivitis
B - Hyperthyroidism
C - Hypothyroidism
D - Myxedema
Answer: B - Hyperthyroidism
Rationale: Exophthalmos (protrusion of the eyeballs) is a classic finding associated
with Graves' disease, which is the most common cause of hyperthyroidism. This
occurs due to autoimmune inflammation and edema of the orbital tissues .
3. A patient with a suspected diagnosis of COPD underwent pulmonary function
testing (PFT) with spirometry. The large inspiration of air to the furthest extent
possible followed by a full exhalation is referred to as which measurement?
A - Forced Expiratory Volume over 1 second (FEV1)
B - Functional Reserve Capacity
C - Inspiratory Reserve
D - Forced Vital Capacity (FVC)
,Answer: D - Forced Vital Capacity (FVC)
Rationale: FVC is the total volume of air that can be forcibly exhaled after taking
the deepest possible breath. It is a key measurement in diagnosing and
monitoring obstructive and restrictive lung diseases like COPD .
4. Your 22-year-old male patient states his scrotum is "very enlarged and feels like
a bag of worms." He works as a trash collector and lifts weights. You suspect
which diagnosis?
A - Varicocele
B - Meningocele
C - Rectocele
D - Hydrocele
Answer: A - Varicocele
Rationale: A varicocele is an enlargement of the veins within the scrotum, often
described as a "bag of worms" upon palpation. It is caused by incompetent valves
in the spermatic vein. It is more common in men who do heavy lifting or standing
for long periods .
, 5. The point of maximum impulse (PMI) is MOST often palpable in healthy adults.
Which location is most common?
A - Left 2nd intercostal space, midaxillary line
B - Left 5th intercostal space, midclavicular line
C - Right 4th intercostal space, midaxillary line
D - Right 2nd intercostal space, midclavicular line
Answer: B - Left 5th intercostal space, midclavicular line
Rationale: The PMI (apical impulse) is normally located in the 5th intercostal
space at the left midclavicular line, reflecting the apex of the left ventricle.
Displacement may indicate cardiomegaly .
6. Which dermatologic lesion is precancerous and likely due to prolonged
exposure to UV-B?
A - Actinic Keratosis
B - Basal cell carcinoma
C - Verruca
D - Seborrheic dermatitis
Answer: A - Actinic Keratosis