NUR 643E Advanced Health Assessment Final Exam:
Comprehensive Evaluation of Clinical Reasoning, Differential
Diagnosis, Advanced Interviewing, and Evidence-Based Physical
Examination Techniques for Family and Adult-Gerontology Nurse
Practitioners
Year: 2026
Week: 16 (Final Exam Week)
Difficulty: Advanced / Hard / Mixed
Target Audience: Graduate-level NP students
Questions 1–150
1. A 45-year-old male presents with a 3-month history of
progressive dysphagia to solids and liquids. On exam, you note a
hoarse voice and a palpable left supraclavicular node. The most
likely diagnosis is:
A) Esophageal cancer
B) Stroke
C) Achalasia
D) Benign stricture
Correct Answer: A
Rationale: Progressive dysphagia to solids then liquids +
hoarseness (recurrent laryngeal nerve) + Virchow’s node =
esophageal malignancy.
,2. During a cardiovascular exam, you hear a mid-systolic click
followed by a late systolic murmur at the apex. Which maneuver
would move the click closer to S1?
A) Squatting
B) Handgrip
C) Standing
D) Lying supine
Correct Answer: C
Rationale: Standing decreases preload, causing earlier prolapse of
mitral valve, moving click toward S1.
3. A 68-year-old female reports a 6-month history of bilateral hand
stiffness, swelling, and pain that improves with activity. On exam,
you note bony enlargement of the DIP joints. These findings
suggest:
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Psoriatic arthritis
Correct Answer: B
Rationale: Bony enlargement of DIP joints (Heberden’s nodes) with
stiffness improving with activity is osteoarthritis.
4. A 34-year-old male has a 2-day history of severe, throbbing
unilateral headache, ipsilateral conjunctival injection, lacrimation,
,and rhinorrhea. The headache wakes him at the same time each
night. This is most consistent with:
A) Migraine
B) Cluster headache
C) Tension headache
D) Subarachnoid hemorrhage
Correct Answer: B
Rationale: Cluster headache — severe, unilateral, autonomic
symptoms, circadian pattern.
5. On abdominal exam, a patient has a firm, irregular, non-tender
liver edge palpable 6 cm below the costal margin. The liver span is
18 cm. This most likely represents:
A) Hepatomegaly from metastasis
B) Fatty liver
C) Cirrhosis
D) Normal variant
Correct Answer: A
Rationale: Irregular, firm, non-tender enlarged liver suggests
metastatic disease.
6. A 58-year-old diabetic reports burning pain in both feet, worse
at night. On exam, you note loss of pinprick sensation up to the
ankles but intact vibration sense at the great toes. This pattern
indicates:
, A) Large fiber neuropathy
B) Small fiber neuropathy
C) L5 radiculopathy
D) Peripheral artery disease
Correct Answer: B
Rationale: Loss of pinprick (small fiber) with intact vibration (large
fiber) = small fiber neuropathy.
7. A 72-year-old male reports a 20-lb unintentional weight loss and
early satiety. On abdominal exam, you palpate a left supraclavicular
node (Virchow’s node). This node most likely drains from:
A) Lung
B) Abdomen (stomach, pancreas)
C) Breast
D) Head and neck
Correct Answer: B
Rationale: Virchow’s node (left supraclavicular) drains abdominal
malignancy, especially gastric.
8. A patient’s pupillary exam reveals a dilated right pupil that does
not constrict to light but constricts to accommodation. This is
called:
A) Horner syndrome
B) Adie tonic pupil
Comprehensive Evaluation of Clinical Reasoning, Differential
Diagnosis, Advanced Interviewing, and Evidence-Based Physical
Examination Techniques for Family and Adult-Gerontology Nurse
Practitioners
Year: 2026
Week: 16 (Final Exam Week)
Difficulty: Advanced / Hard / Mixed
Target Audience: Graduate-level NP students
Questions 1–150
1. A 45-year-old male presents with a 3-month history of
progressive dysphagia to solids and liquids. On exam, you note a
hoarse voice and a palpable left supraclavicular node. The most
likely diagnosis is:
A) Esophageal cancer
B) Stroke
C) Achalasia
D) Benign stricture
Correct Answer: A
Rationale: Progressive dysphagia to solids then liquids +
hoarseness (recurrent laryngeal nerve) + Virchow’s node =
esophageal malignancy.
,2. During a cardiovascular exam, you hear a mid-systolic click
followed by a late systolic murmur at the apex. Which maneuver
would move the click closer to S1?
A) Squatting
B) Handgrip
C) Standing
D) Lying supine
Correct Answer: C
Rationale: Standing decreases preload, causing earlier prolapse of
mitral valve, moving click toward S1.
3. A 68-year-old female reports a 6-month history of bilateral hand
stiffness, swelling, and pain that improves with activity. On exam,
you note bony enlargement of the DIP joints. These findings
suggest:
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Psoriatic arthritis
Correct Answer: B
Rationale: Bony enlargement of DIP joints (Heberden’s nodes) with
stiffness improving with activity is osteoarthritis.
4. A 34-year-old male has a 2-day history of severe, throbbing
unilateral headache, ipsilateral conjunctival injection, lacrimation,
,and rhinorrhea. The headache wakes him at the same time each
night. This is most consistent with:
A) Migraine
B) Cluster headache
C) Tension headache
D) Subarachnoid hemorrhage
Correct Answer: B
Rationale: Cluster headache — severe, unilateral, autonomic
symptoms, circadian pattern.
5. On abdominal exam, a patient has a firm, irregular, non-tender
liver edge palpable 6 cm below the costal margin. The liver span is
18 cm. This most likely represents:
A) Hepatomegaly from metastasis
B) Fatty liver
C) Cirrhosis
D) Normal variant
Correct Answer: A
Rationale: Irregular, firm, non-tender enlarged liver suggests
metastatic disease.
6. A 58-year-old diabetic reports burning pain in both feet, worse
at night. On exam, you note loss of pinprick sensation up to the
ankles but intact vibration sense at the great toes. This pattern
indicates:
, A) Large fiber neuropathy
B) Small fiber neuropathy
C) L5 radiculopathy
D) Peripheral artery disease
Correct Answer: B
Rationale: Loss of pinprick (small fiber) with intact vibration (large
fiber) = small fiber neuropathy.
7. A 72-year-old male reports a 20-lb unintentional weight loss and
early satiety. On abdominal exam, you palpate a left supraclavicular
node (Virchow’s node). This node most likely drains from:
A) Lung
B) Abdomen (stomach, pancreas)
C) Breast
D) Head and neck
Correct Answer: B
Rationale: Virchow’s node (left supraclavicular) drains abdominal
malignancy, especially gastric.
8. A patient’s pupillary exam reveals a dilated right pupil that does
not constrict to light but constricts to accommodation. This is
called:
A) Horner syndrome
B) Adie tonic pupil
