NR509 WEEK 4 MIDTERM EXAM PRACTICE
Questions and Correct Answers with Rationales
Advanced Physical Assessment | 2026 Edition
CORE DOMAINS
1. HEENT assessment
2. Neck and lymphatic assessment
3. Thorax and lung examination
4. Cardiovascular assessment
5. Peripheral vascular assessment
6. Abdominal assessment
7. Neurologic screening and red flags
8. Skin, general survey, and vital sign interpretation
Question 1
A 65-year-old male presents with sudden, painless monocular vision loss described
as a "curtain coming down" over his left eye. Which of the following is the most
likely diagnosis?
A) Acute angle-closure glaucoma
B) Retinal detachment
C) Cataract
D) Conjunctivitis
Answer: B) Retinal detachment
Rationale: Sudden, painless monocular vision loss with a curtain-like shadow is
classic for retinal detachment. Acute angle-closure glaucoma (Option A) typically
presents with severe eye pain, halos, headache, and nausea. Cataracts (Option C)
,cause gradual, progressive vision decline, not acute changes. Conjunctivitis
(Option D) presents with redness and discharge, not curtain-like vision loss.
Question 2
Which retinal finding is most commonly associated with chronic hypertension?
A) AV nicking
B) Cherry-red spot
C) Papilledema
D) Corneal arcus
Answer: A) AV nicking
Rationale: AV nicking (arteriovenous nicking) is a classic retinal vascular change
seen in chronic hypertension, where the arteriole compresses the venule at crossing
points. Papilledema (Option C) is more concerning for increased intracranial
pressure. Cherry-red spot (Option B) is associated with retinal artery occlusion.
Corneal arcus (Option D) is associated with corneal thinning and hyperlipidemia.
Question 3
A patient presents with severe eye pain, halos around lights, nausea, and vomiting.
On examination, the pupil is mid-dilated and nonreactive, and the cornea appears
cloudy. What is the most likely diagnosis?
A) Chronic open-angle glaucoma
B) Acute angle-closure glaucoma
C) Retinal detachment
D) Allergic conjunctivitis
Answer: B) Acute angle-closure glaucoma
Rationale: Acute angle-closure glaucoma presents with severe eye pain, halos
around lights, nausea, vomiting, a mid-dilated nonreactive pupil, and cloudy
cornea. This is an emergency requiring immediate treatment to prevent permanent
,vision loss. Chronic open-angle glaucoma (Option A) is typically asymptomatic
until late stages. Retinal detachment (Option C) presents with painless vision loss.
Allergic conjunctivitis (Option D) presents with itching and watery discharge.
Question 4
A 72-year-old patient reports a gradual, painless loss of central vision, making
reading difficult. Fundoscopic examination reveals drusen and pigmentary changes
in the macula. Which of the following is the most likely diagnosis?
A) Diabetic retinopathy
B) Age-related macular degeneration (AMD)
C) Retinal detachment
D) Cataract
Answer: B) Age-related macular degeneration (AMD)
Rationale: Age-related macular degeneration (AMD) is characterized by gradual,
painless central vision loss with drusen and pigmentary changes in the macula.
This is the most common cause of vision loss in older adults. Diabetic retinopathy
(Option A) presents with microaneurysms and hemorrhages. Retinal detachment
(Option C) presents with sudden vision loss. Cataract (Option D) presents with
painless, gradual opacification of the lens.
Question 5
A patient presents with a 2-day history of purulent discharge from the right eye,
conjunctival injection, and morning eyelid crusting. Visual acuity is normal. Which
of the following is the most likely diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Keratitis
Answer: B) Bacterial conjunctivitis
, Rationale: Bacterial conjunctivitis presents with purulent discharge, conjunctival
injection, and eyelid crusting (especially in the morning). Visual acuity is typically
normal. Viral conjunctivitis (Option A) typically presents with watery discharge
and may be associated with upper respiratory symptoms. Allergic conjunctivitis
(Option C) presents with itching and watery discharge. Keratitis (Option D)
presents with pain, photophobia, and decreased visual acuity.
Question 6
A 45-year-old diabetic patient with a history of poor glycemic control presents
with gradually worsening vision. Fundoscopic examination reveals dot and blot
hemorrhages, cotton-wool spots, and hard exudates. Which of the following is the
most likely diagnosis?
A) Glaucoma
B) Non-proliferative diabetic retinopathy
C) Proliferative diabetic retinopathy
D) Hypertensive retinopathy
Answer: B) Non-proliferative diabetic retinopathy
Rationale: Non-proliferative diabetic retinopathy (NPDR) is characterized by dot
and blot hemorrhages, cotton-wool spots (nerve fiber layer infarcts), and hard
exudates. Proliferative diabetic retinopathy (Option C) would additionally show
neovascularization. Glaucoma (Option A) presents with optic disc cupping.
Hypertensive retinopathy (Option D) presents with AV nicking and copper/silver
wiring.
Question 7
A patient presents with right-sided facial pain, purulent nasal discharge, and
headache. On transillumination of the sinuses, the right maxillary sinus appears
opaque. Which of the following is the most likely diagnosis?
A) Allergic rhinitis
B) Acute sinusitis
Questions and Correct Answers with Rationales
Advanced Physical Assessment | 2026 Edition
CORE DOMAINS
1. HEENT assessment
2. Neck and lymphatic assessment
3. Thorax and lung examination
4. Cardiovascular assessment
5. Peripheral vascular assessment
6. Abdominal assessment
7. Neurologic screening and red flags
8. Skin, general survey, and vital sign interpretation
Question 1
A 65-year-old male presents with sudden, painless monocular vision loss described
as a "curtain coming down" over his left eye. Which of the following is the most
likely diagnosis?
A) Acute angle-closure glaucoma
B) Retinal detachment
C) Cataract
D) Conjunctivitis
Answer: B) Retinal detachment
Rationale: Sudden, painless monocular vision loss with a curtain-like shadow is
classic for retinal detachment. Acute angle-closure glaucoma (Option A) typically
presents with severe eye pain, halos, headache, and nausea. Cataracts (Option C)
,cause gradual, progressive vision decline, not acute changes. Conjunctivitis
(Option D) presents with redness and discharge, not curtain-like vision loss.
Question 2
Which retinal finding is most commonly associated with chronic hypertension?
A) AV nicking
B) Cherry-red spot
C) Papilledema
D) Corneal arcus
Answer: A) AV nicking
Rationale: AV nicking (arteriovenous nicking) is a classic retinal vascular change
seen in chronic hypertension, where the arteriole compresses the venule at crossing
points. Papilledema (Option C) is more concerning for increased intracranial
pressure. Cherry-red spot (Option B) is associated with retinal artery occlusion.
Corneal arcus (Option D) is associated with corneal thinning and hyperlipidemia.
Question 3
A patient presents with severe eye pain, halos around lights, nausea, and vomiting.
On examination, the pupil is mid-dilated and nonreactive, and the cornea appears
cloudy. What is the most likely diagnosis?
A) Chronic open-angle glaucoma
B) Acute angle-closure glaucoma
C) Retinal detachment
D) Allergic conjunctivitis
Answer: B) Acute angle-closure glaucoma
Rationale: Acute angle-closure glaucoma presents with severe eye pain, halos
around lights, nausea, vomiting, a mid-dilated nonreactive pupil, and cloudy
cornea. This is an emergency requiring immediate treatment to prevent permanent
,vision loss. Chronic open-angle glaucoma (Option A) is typically asymptomatic
until late stages. Retinal detachment (Option C) presents with painless vision loss.
Allergic conjunctivitis (Option D) presents with itching and watery discharge.
Question 4
A 72-year-old patient reports a gradual, painless loss of central vision, making
reading difficult. Fundoscopic examination reveals drusen and pigmentary changes
in the macula. Which of the following is the most likely diagnosis?
A) Diabetic retinopathy
B) Age-related macular degeneration (AMD)
C) Retinal detachment
D) Cataract
Answer: B) Age-related macular degeneration (AMD)
Rationale: Age-related macular degeneration (AMD) is characterized by gradual,
painless central vision loss with drusen and pigmentary changes in the macula.
This is the most common cause of vision loss in older adults. Diabetic retinopathy
(Option A) presents with microaneurysms and hemorrhages. Retinal detachment
(Option C) presents with sudden vision loss. Cataract (Option D) presents with
painless, gradual opacification of the lens.
Question 5
A patient presents with a 2-day history of purulent discharge from the right eye,
conjunctival injection, and morning eyelid crusting. Visual acuity is normal. Which
of the following is the most likely diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Keratitis
Answer: B) Bacterial conjunctivitis
, Rationale: Bacterial conjunctivitis presents with purulent discharge, conjunctival
injection, and eyelid crusting (especially in the morning). Visual acuity is typically
normal. Viral conjunctivitis (Option A) typically presents with watery discharge
and may be associated with upper respiratory symptoms. Allergic conjunctivitis
(Option C) presents with itching and watery discharge. Keratitis (Option D)
presents with pain, photophobia, and decreased visual acuity.
Question 6
A 45-year-old diabetic patient with a history of poor glycemic control presents
with gradually worsening vision. Fundoscopic examination reveals dot and blot
hemorrhages, cotton-wool spots, and hard exudates. Which of the following is the
most likely diagnosis?
A) Glaucoma
B) Non-proliferative diabetic retinopathy
C) Proliferative diabetic retinopathy
D) Hypertensive retinopathy
Answer: B) Non-proliferative diabetic retinopathy
Rationale: Non-proliferative diabetic retinopathy (NPDR) is characterized by dot
and blot hemorrhages, cotton-wool spots (nerve fiber layer infarcts), and hard
exudates. Proliferative diabetic retinopathy (Option C) would additionally show
neovascularization. Glaucoma (Option A) presents with optic disc cupping.
Hypertensive retinopathy (Option D) presents with AV nicking and copper/silver
wiring.
Question 7
A patient presents with right-sided facial pain, purulent nasal discharge, and
headache. On transillumination of the sinuses, the right maxillary sinus appears
opaque. Which of the following is the most likely diagnosis?
A) Allergic rhinitis
B) Acute sinusitis
