NR509 ADVANCED HEALTH ASSESSMENT FINAL EXAM
PREP: 200 BOARD-STYLE QUESTIONS WITH RATIONALES
COVERING EVERY TESTED SYSTEM (HEENT, CARDIAC,
RESPIRATORY, GI, GU, NEURO, MSK, DERM, AND
ENDOCRINE)
1. A 45-year-old man presents with a painless, slowly enlarging mass
in his right groin that increases in size when he coughs. On
examination, the mass is located above and medial to the pubic
tubercle. Which of the following is the most likely diagnosis?
A) Femoral hernia
B) Direct inguinal hernia
C) Indirect inguinal hernia
D) Hydrocele
Correct Answer: C
Rationale: An indirect inguinal hernia passes through the deep inguinal
ring and is the most common type of hernia. It presents as a bulge
above and medial to the pubic tubercle. A direct hernia bulges through
the posterior wall of the inguinal canal, often medial to the inferior
epigastric vessels, but it is less common and typically occurs in older
men. A femoral hernia is below the inguinal ligament.
2. A 68-year-old female with a history of hypertension presents with
shortness of breath and lower extremity edema. On examination, you
note an elevated jugular venous pressure (JVP) with a prominent x
descent but a blunted y descent. Which of the following is the most
,likely underlying diagnosis?
A) Tricuspid stenosis
B) Constrictive pericarditis
C) Right-sided heart failure
D) Cardiac tamponade
Correct Answer: C
Rationale: Right-sided heart failure causes elevated JVP due to
increased right atrial pressure. The x descent is prominent, but the y
descent is often blunted or absent because the right ventricle cannot
accommodate inflow during diastole. Constrictive pericarditis shows a
prominent y descent (Friedreich's sign). Tricuspid stenosis also causes a
prominent a wave, not typically a blunted y descent.
3. A 55-year-old mechanic presents with a chronic cough and dyspnea
on exertion. He has a 30-pack-year smoking history. On auscultation,
you hear prolonged expiration and wheezes. Which of the following
physical examination findings is most consistent with his likely
diagnosis?
A) Increased tactile fremitus
B) Hyperresonance on percussion
C) Egophony
D) Decreased AP diameter
Correct Answer: B
Rationale: This patient likely has chronic obstructive pulmonary disease
(COPD) due to smoking history and obstructive pattern.
Hyperresonance on percussion is characteristic of hyperinflation in
COPD. Increased tactile fremitus is seen in consolidation (e.g.,
pneumonia). Egophony is also a sign of consolidation.
,4. You are examining the skin of a 25-year-old teacher with fatigue,
weight gain, and hair loss, suspecting hypothyroidism. What is the
expected moisture and texture of her skin?
A) Moist and smooth
B) Moist and rough
C) Dry and smooth
D) Dry and rough
Correct Answer: D
Rationale: Hypothyroidism leads to decreased sweating and sebaceous
gland activity, resulting in dry, coarse, rough skin. The skin may also be
cool and pale. Moist and smooth skin is typical of hyperthyroidism.
5. A 28-year-old African-American woman with systemic lupus
erythematosus (SLE) notices a raised, dark red rash on her legs that
does not blanch with pressure. What is the most appropriate
explanation for this finding?
A) It is likely to be related to her lupus.
B) It is likely to be related to an exposure to a chemical.
C) It is likely to be related to an allergic reaction.
D) It should not cause any problems.
Correct Answer: A
Rationale: Non-blanching, raised dark red rashes in SLE patients may
represent cutaneous vasculitis, which is a known manifestation of active
lupus. Allergic reactions and chemical exposures typically cause
blanching erythema or urticaria. This finding requires further evaluation
as it indicates possible systemic activity.
6. You are palpating the abdomen of a 60-year-old patient and feel a
small, firm mass in the right lower quadrant. The mass is immobile
and nontender. Which of the following should you do next during the
, physical examination?
A) Ultrasound
B) Examination with the abdominal muscles tensed
C) Surgery referral
D) Determine size by percussion
Correct Answer: B
Rationale: When a mass is palpated, the next step is to determine if it is
intra-abdominal or in the abdominal wall. Having the patient tense the
abdominal muscles (e.g., by lifting the head) will make an abdominal
wall mass more prominent and easier to feel, while an intra-abdominal
mass will become less palpable or disappear.
7. A 40-year-old banker with well-controlled hypertension, no
smoking, and regular exercise is being evaluated for coronary heart
disease risk. Which of the following conditions is considered a
coronary heart disease risk equivalent?
A) Atrial fibrillation
B) Peripheral artery disease
C) Chronic kidney disease stage 2
D) Obstructive sleep apnea
Correct Answer: B
Rationale: Peripheral artery disease (PAD) is considered a coronary
heart disease (CHD) risk equivalent, meaning patients with PAD have a
similar 10-year risk of myocardial infarction or cardiac death as patients
with established CHD. Diabetes mellitus is also a classic risk equivalent.
CKD stage 3 or higher is a risk equivalent, but stage 2 is not.
8. A 78-year-old man complains of progressive blurring of near vision
over the past few years. He can see distant objects clearly. Which of
the following age-related changes is the most likely cause?
PREP: 200 BOARD-STYLE QUESTIONS WITH RATIONALES
COVERING EVERY TESTED SYSTEM (HEENT, CARDIAC,
RESPIRATORY, GI, GU, NEURO, MSK, DERM, AND
ENDOCRINE)
1. A 45-year-old man presents with a painless, slowly enlarging mass
in his right groin that increases in size when he coughs. On
examination, the mass is located above and medial to the pubic
tubercle. Which of the following is the most likely diagnosis?
A) Femoral hernia
B) Direct inguinal hernia
C) Indirect inguinal hernia
D) Hydrocele
Correct Answer: C
Rationale: An indirect inguinal hernia passes through the deep inguinal
ring and is the most common type of hernia. It presents as a bulge
above and medial to the pubic tubercle. A direct hernia bulges through
the posterior wall of the inguinal canal, often medial to the inferior
epigastric vessels, but it is less common and typically occurs in older
men. A femoral hernia is below the inguinal ligament.
2. A 68-year-old female with a history of hypertension presents with
shortness of breath and lower extremity edema. On examination, you
note an elevated jugular venous pressure (JVP) with a prominent x
descent but a blunted y descent. Which of the following is the most
,likely underlying diagnosis?
A) Tricuspid stenosis
B) Constrictive pericarditis
C) Right-sided heart failure
D) Cardiac tamponade
Correct Answer: C
Rationale: Right-sided heart failure causes elevated JVP due to
increased right atrial pressure. The x descent is prominent, but the y
descent is often blunted or absent because the right ventricle cannot
accommodate inflow during diastole. Constrictive pericarditis shows a
prominent y descent (Friedreich's sign). Tricuspid stenosis also causes a
prominent a wave, not typically a blunted y descent.
3. A 55-year-old mechanic presents with a chronic cough and dyspnea
on exertion. He has a 30-pack-year smoking history. On auscultation,
you hear prolonged expiration and wheezes. Which of the following
physical examination findings is most consistent with his likely
diagnosis?
A) Increased tactile fremitus
B) Hyperresonance on percussion
C) Egophony
D) Decreased AP diameter
Correct Answer: B
Rationale: This patient likely has chronic obstructive pulmonary disease
(COPD) due to smoking history and obstructive pattern.
Hyperresonance on percussion is characteristic of hyperinflation in
COPD. Increased tactile fremitus is seen in consolidation (e.g.,
pneumonia). Egophony is also a sign of consolidation.
,4. You are examining the skin of a 25-year-old teacher with fatigue,
weight gain, and hair loss, suspecting hypothyroidism. What is the
expected moisture and texture of her skin?
A) Moist and smooth
B) Moist and rough
C) Dry and smooth
D) Dry and rough
Correct Answer: D
Rationale: Hypothyroidism leads to decreased sweating and sebaceous
gland activity, resulting in dry, coarse, rough skin. The skin may also be
cool and pale. Moist and smooth skin is typical of hyperthyroidism.
5. A 28-year-old African-American woman with systemic lupus
erythematosus (SLE) notices a raised, dark red rash on her legs that
does not blanch with pressure. What is the most appropriate
explanation for this finding?
A) It is likely to be related to her lupus.
B) It is likely to be related to an exposure to a chemical.
C) It is likely to be related to an allergic reaction.
D) It should not cause any problems.
Correct Answer: A
Rationale: Non-blanching, raised dark red rashes in SLE patients may
represent cutaneous vasculitis, which is a known manifestation of active
lupus. Allergic reactions and chemical exposures typically cause
blanching erythema or urticaria. This finding requires further evaluation
as it indicates possible systemic activity.
6. You are palpating the abdomen of a 60-year-old patient and feel a
small, firm mass in the right lower quadrant. The mass is immobile
and nontender. Which of the following should you do next during the
, physical examination?
A) Ultrasound
B) Examination with the abdominal muscles tensed
C) Surgery referral
D) Determine size by percussion
Correct Answer: B
Rationale: When a mass is palpated, the next step is to determine if it is
intra-abdominal or in the abdominal wall. Having the patient tense the
abdominal muscles (e.g., by lifting the head) will make an abdominal
wall mass more prominent and easier to feel, while an intra-abdominal
mass will become less palpable or disappear.
7. A 40-year-old banker with well-controlled hypertension, no
smoking, and regular exercise is being evaluated for coronary heart
disease risk. Which of the following conditions is considered a
coronary heart disease risk equivalent?
A) Atrial fibrillation
B) Peripheral artery disease
C) Chronic kidney disease stage 2
D) Obstructive sleep apnea
Correct Answer: B
Rationale: Peripheral artery disease (PAD) is considered a coronary
heart disease (CHD) risk equivalent, meaning patients with PAD have a
similar 10-year risk of myocardial infarction or cardiac death as patients
with established CHD. Diabetes mellitus is also a classic risk equivalent.
CKD stage 3 or higher is a risk equivalent, but stage 2 is not.
8. A 78-year-old man complains of progressive blurring of near vision
over the past few years. He can see distant objects clearly. Which of
the following age-related changes is the most likely cause?
