NR509 Advanced Physical Assessment
Final Exam 100 Questions with Detailed
Rationales
2026/2027 Edition - Pass Guaranteed
SECTION 1: HEENT (HEAD, EYES, EARS, NOSE,
THROAT)
Question 1
A 55-year-old male presents with a gradually enlarging, painless mass
on his neck. He has a 30-pack-year smoking history. On examination,
you note a firm, fixed nodule in the left anterior cervical chain. Which
of the following is the most appropriate next step?
A) Prescribe antibiotics and schedule a follow-up in 2 weeks
B) Order an ultrasound-guided fine-needle aspiration biopsy
C) Reassure the patient that this is likely a benign lymph node
D) Order a CBC and ESR
Correct Answer: B) Order an ultrasound-guided fine-needle aspiration
biopsy
Rationale: This patient has a firm, fixed, painless neck mass in the
anterior cervical chain with a significant smoking history. These
findings are concerning for malignancy, particularly head and neck
,cancer or lymphoma. Fine-needle aspiration biopsy is the diagnostic
procedure of choice. Antibiotics (A) are not appropriate without
evidence of infection. Reassurance (C) is not appropriate given the
concerning findings. CBC and ESR (D) are non-specific and would not
confirm the diagnosis.
Question 2
A 45-year-old female presents with episodes of intense, throbbing
headache, preceded by visual disturbances including flashing lights
and zigzag lines. The headaches are associated with nausea and
photophobia. Which of the following is the most likely diagnosis?
A) Tension headache
B) Cluster headache
C) Migraine with aura
D) Sinus headache
Correct Answer: C) Migraine with aura
Rationale: This patient's presentation is classic for migraine with aura:
recurrent headaches with visual disturbances (flashing lights, zigzag
lines), followed by throbbing headache with nausea and photophobia.
Tension headaches (A) are typically bilateral, non-pulsatile, and not
associated with visual disturbances. Cluster headaches (B) are
unilateral, severe, and associated with autonomic symptoms. Sinus
headaches (D) are associated with nasal congestion and facial
pressure.
,Question 3
A 60-year-old female reports gradual loss of central vision. She has
difficulty reading and recognizing faces. On ophthalmoscopic
examination, you note drusen and pigmentary changes in the macula.
Which of the following is the most likely diagnosis?
A) Cataract
B) Glaucoma
C) Age-related macular degeneration
D) Diabetic retinopathy
Correct Answer: C) Age-related macular degeneration
Rationale: Age-related macular degeneration (AMD) is the leading
cause of vision loss in older adults. Drusen and pigmentary changes
in the macula are characteristic findings. Cataracts (A) cause clouding
of the lens and generalized blurring, not central vision loss. Glaucoma
(B) causes peripheral vision loss initially. Diabetic retinopathy (D) is
associated with diabetes and microvascular changes.
Question 4
A patient reports episodes of vertigo lasting several hours, associated
with nausea, vomiting, and hearing loss. Which of the following is the
most likely diagnosis?
A) Benign paroxysmal positional vertigo (BPPV)
B) Ménière's disease
C) Vestibular neuritis
D) Labyrinthitis
, Correct Answer: B) Ménière's disease
Rationale: Ménière's disease is characterized by episodes of vertigo
lasting hours, associated with hearing loss, tinnitus, and a sensation
of fullness in the ear. BPPV (A) causes brief episodes of vertigo
(seconds to minutes) with positional changes. Vestibular neuritis (C)
causes acute, severe vertigo without hearing loss. Labyrinthitis (D)
involves vertigo with hearing loss but is typically acute and often
follows an infection.
Question 5
A 25-year-old female presents with a sore throat, fever, and exudative
tonsillitis. She has anterior cervical lymphadenopathy and fatigue. The
rapid strep test is negative. Which of the following is the most likely
diagnosis?
A) Viral pharyngitis
B) Streptococcal pharyngitis
C) Infectious mononucleosis
D) Diphtheria
Correct Answer: C) Infectious mononucleosis
Rationale: Infectious mononucleosis (caused by Epstein-Barr virus)
typically presents with fever, exudative pharyngitis, lymphadenopathy
(especially posterior cervical), and fatigue. The negative strep test
makes streptococcal pharyngitis (B) less likely. Viral pharyngitis (A) is
less likely with exudates. Diphtheria (D) is rare due to vaccination.
Monospot test or EBV serologies can confirm the diagnosis.
Final Exam 100 Questions with Detailed
Rationales
2026/2027 Edition - Pass Guaranteed
SECTION 1: HEENT (HEAD, EYES, EARS, NOSE,
THROAT)
Question 1
A 55-year-old male presents with a gradually enlarging, painless mass
on his neck. He has a 30-pack-year smoking history. On examination,
you note a firm, fixed nodule in the left anterior cervical chain. Which
of the following is the most appropriate next step?
A) Prescribe antibiotics and schedule a follow-up in 2 weeks
B) Order an ultrasound-guided fine-needle aspiration biopsy
C) Reassure the patient that this is likely a benign lymph node
D) Order a CBC and ESR
Correct Answer: B) Order an ultrasound-guided fine-needle aspiration
biopsy
Rationale: This patient has a firm, fixed, painless neck mass in the
anterior cervical chain with a significant smoking history. These
findings are concerning for malignancy, particularly head and neck
,cancer or lymphoma. Fine-needle aspiration biopsy is the diagnostic
procedure of choice. Antibiotics (A) are not appropriate without
evidence of infection. Reassurance (C) is not appropriate given the
concerning findings. CBC and ESR (D) are non-specific and would not
confirm the diagnosis.
Question 2
A 45-year-old female presents with episodes of intense, throbbing
headache, preceded by visual disturbances including flashing lights
and zigzag lines. The headaches are associated with nausea and
photophobia. Which of the following is the most likely diagnosis?
A) Tension headache
B) Cluster headache
C) Migraine with aura
D) Sinus headache
Correct Answer: C) Migraine with aura
Rationale: This patient's presentation is classic for migraine with aura:
recurrent headaches with visual disturbances (flashing lights, zigzag
lines), followed by throbbing headache with nausea and photophobia.
Tension headaches (A) are typically bilateral, non-pulsatile, and not
associated with visual disturbances. Cluster headaches (B) are
unilateral, severe, and associated with autonomic symptoms. Sinus
headaches (D) are associated with nasal congestion and facial
pressure.
,Question 3
A 60-year-old female reports gradual loss of central vision. She has
difficulty reading and recognizing faces. On ophthalmoscopic
examination, you note drusen and pigmentary changes in the macula.
Which of the following is the most likely diagnosis?
A) Cataract
B) Glaucoma
C) Age-related macular degeneration
D) Diabetic retinopathy
Correct Answer: C) Age-related macular degeneration
Rationale: Age-related macular degeneration (AMD) is the leading
cause of vision loss in older adults. Drusen and pigmentary changes
in the macula are characteristic findings. Cataracts (A) cause clouding
of the lens and generalized blurring, not central vision loss. Glaucoma
(B) causes peripheral vision loss initially. Diabetic retinopathy (D) is
associated with diabetes and microvascular changes.
Question 4
A patient reports episodes of vertigo lasting several hours, associated
with nausea, vomiting, and hearing loss. Which of the following is the
most likely diagnosis?
A) Benign paroxysmal positional vertigo (BPPV)
B) Ménière's disease
C) Vestibular neuritis
D) Labyrinthitis
, Correct Answer: B) Ménière's disease
Rationale: Ménière's disease is characterized by episodes of vertigo
lasting hours, associated with hearing loss, tinnitus, and a sensation
of fullness in the ear. BPPV (A) causes brief episodes of vertigo
(seconds to minutes) with positional changes. Vestibular neuritis (C)
causes acute, severe vertigo without hearing loss. Labyrinthitis (D)
involves vertigo with hearing loss but is typically acute and often
follows an infection.
Question 5
A 25-year-old female presents with a sore throat, fever, and exudative
tonsillitis. She has anterior cervical lymphadenopathy and fatigue. The
rapid strep test is negative. Which of the following is the most likely
diagnosis?
A) Viral pharyngitis
B) Streptococcal pharyngitis
C) Infectious mononucleosis
D) Diphtheria
Correct Answer: C) Infectious mononucleosis
Rationale: Infectious mononucleosis (caused by Epstein-Barr virus)
typically presents with fever, exudative pharyngitis, lymphadenopathy
(especially posterior cervical), and fatigue. The negative strep test
makes streptococcal pharyngitis (B) less likely. Viral pharyngitis (A) is
less likely with exudates. Diphtheria (D) is rare due to vaccination.
Monospot test or EBV serologies can confirm the diagnosis.
