NSG 550 Exam 2
Diagnostic Reasoning
NSG 550 Exam 2
Wilkes University
Questions & Answers Plus Rationales
Detailed Rationales
Latest 2026/27 | PDF
THIS EXAM CONTAINS:
❖100% Pass
❖A+ Verified (2026)
❖Multiple Choice (A-D)
❖Detailed Rationales For Each Question
❖Correct Answers For Each Question
,Section I: Endocrine Diagnostic Reasoning (Questions 1-15)
1. A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory testing reveals elevated TSH and
low free T4. What is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Subclinical hypothyroidism
D) Pituitary adenoma
Answer: B
Rationale: Hypothyroidism is characterized by elevated TSH (due to lack
of negative feedback) and low free T4. Symptoms include fatigue, weight
gain, cold intolerance, and constipation. Hyperthyroidism would present
with low TSH and high free T4. Subclinical hypothyroidism has elevated
TSH with normal free T4. Pituitary adenoma would cause low TSH with
low free T4 (central hypothyroidism).
2. A 28-year-old woman presents with palpitations, heat intolerance, weight
loss, and fine tremor. TSH is <0.01 mIU/L and free T4 is markedly
elevated. What is the most appropriate next step?
A) Start methimazole immediately
B) Order thyroid ultrasound
C) Order radioactive iodine uptake scan
D) Order thyroid antibody panel
Answer: C
Rationale: This patient has overt hyperthyroidism. The radioactive iodine
uptake (RAIU) scan helps differentiate causes of hyperthyroidism: Graves'
disease (diffuse increased uptake), toxic multinodular goiter (focal
increased uptake), or thyroiditis (decreased uptake). Starting methimazole
without identifying the etiology is premature. Thyroid ultrasound evaluates
structural abnormalities, not function. Antibody panel can confirm Graves'
but uptake scan is more comprehensive initially.
AE
,3. A 60-year-old woman with a 2-cm thyroid nodule is referred for fine-
needle aspiration (FNA). Which of the following is an indication for FNA?
A) Nodule < 1 cm without concerning features
B) Nodule > 1 cm with suspicious ultrasound features
C) Multinodular goiter without dominant nodule
D) Simple cyst without solid component
Answer: B
Rationale: FNA is indicated for nodules > 1 cm with suspicious ultrasound
features (microcalcifications, irregular margins, taller-than-wide shape, or
central vascularity). Nodules < 1 cm without concerning features can be
observed. Multinodular goiter without a dominant nodule does not
typically require FNA. Simple cysts without solid components are usually
benign and do not require FNA.
4. A 55-year-old man with hypertension and hypokalemia is found to have
elevated aldosterone-to-renin ratio. What is the most likely diagnosis?
A) Cushing's syndrome
B) Primary aldosteronism
C) Pheochromocytoma
D) Hyperthyroidism
Answer: B
Rationale: Primary aldosteronism presents with hypertension,
hypokalemia, and elevated aldosterone-to-renin ratio (ARR). It should be
suspected in patients with resistant hypertension, spontaneous
hypokalemia, or incidentally discovered adrenal adenoma. Cushing's
syndrome presents with hypercortisolism features. Pheochromocytoma
presents with episodic hypertension, palpitations, and diaphoresis.
AE
, 5. A 35-year-old woman with polycystic ovarian syndrome (PCOS) is being
evaluated. Which laboratory finding is most consistent with PCOS?
A) Elevated FSH
B) Elevated LH/FSH ratio (>2:1)
C) Elevated prolactin
D) Low testosterone
Answer: B
Rationale: PCOS is characterized by elevated LH/FSH ratio (>2:1),
elevated androgens (testosterone, DHEA-S), and normal or mildly elevated
prolactin. Elevated FSH is seen in ovarian failure. Elevated prolactin
suggests hyperprolactinemia. Low testosterone is not consistent with
PCOS; women with PCOS typically have elevated androgens.
6. A 45-year-old man presents with headache, visual field defects, and
gynecomastia. Prolactin level is markedly elevated. What is the most likely
diagnosis?
A) Pituitary adenoma (prolactinoma)
B) Cushing's syndrome
C) Acromegaly
D) Hypothyroidism
Answer: A
Rationale: Prolactinoma presents with headache (due to mass effect), visual
field defects (bitemporal hemianopsia from optic chiasm compression), and
hyperprolactinemia symptoms (gynecomastia, galactorrhea, sexual
dysfunction). Prolactin levels > 200 ng/mL are highly suggestive of
prolactinoma. Cushing's syndrome presents with hypercortisolism features.
Acromegaly presents with growth hormone excess. Hypothyroidism can
cause mild hyperprolactinemia but not typically the mass effect symptoms.
AE
Diagnostic Reasoning
NSG 550 Exam 2
Wilkes University
Questions & Answers Plus Rationales
Detailed Rationales
Latest 2026/27 | PDF
THIS EXAM CONTAINS:
❖100% Pass
❖A+ Verified (2026)
❖Multiple Choice (A-D)
❖Detailed Rationales For Each Question
❖Correct Answers For Each Question
,Section I: Endocrine Diagnostic Reasoning (Questions 1-15)
1. A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory testing reveals elevated TSH and
low free T4. What is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Subclinical hypothyroidism
D) Pituitary adenoma
Answer: B
Rationale: Hypothyroidism is characterized by elevated TSH (due to lack
of negative feedback) and low free T4. Symptoms include fatigue, weight
gain, cold intolerance, and constipation. Hyperthyroidism would present
with low TSH and high free T4. Subclinical hypothyroidism has elevated
TSH with normal free T4. Pituitary adenoma would cause low TSH with
low free T4 (central hypothyroidism).
2. A 28-year-old woman presents with palpitations, heat intolerance, weight
loss, and fine tremor. TSH is <0.01 mIU/L and free T4 is markedly
elevated. What is the most appropriate next step?
A) Start methimazole immediately
B) Order thyroid ultrasound
C) Order radioactive iodine uptake scan
D) Order thyroid antibody panel
Answer: C
Rationale: This patient has overt hyperthyroidism. The radioactive iodine
uptake (RAIU) scan helps differentiate causes of hyperthyroidism: Graves'
disease (diffuse increased uptake), toxic multinodular goiter (focal
increased uptake), or thyroiditis (decreased uptake). Starting methimazole
without identifying the etiology is premature. Thyroid ultrasound evaluates
structural abnormalities, not function. Antibody panel can confirm Graves'
but uptake scan is more comprehensive initially.
AE
,3. A 60-year-old woman with a 2-cm thyroid nodule is referred for fine-
needle aspiration (FNA). Which of the following is an indication for FNA?
A) Nodule < 1 cm without concerning features
B) Nodule > 1 cm with suspicious ultrasound features
C) Multinodular goiter without dominant nodule
D) Simple cyst without solid component
Answer: B
Rationale: FNA is indicated for nodules > 1 cm with suspicious ultrasound
features (microcalcifications, irregular margins, taller-than-wide shape, or
central vascularity). Nodules < 1 cm without concerning features can be
observed. Multinodular goiter without a dominant nodule does not
typically require FNA. Simple cysts without solid components are usually
benign and do not require FNA.
4. A 55-year-old man with hypertension and hypokalemia is found to have
elevated aldosterone-to-renin ratio. What is the most likely diagnosis?
A) Cushing's syndrome
B) Primary aldosteronism
C) Pheochromocytoma
D) Hyperthyroidism
Answer: B
Rationale: Primary aldosteronism presents with hypertension,
hypokalemia, and elevated aldosterone-to-renin ratio (ARR). It should be
suspected in patients with resistant hypertension, spontaneous
hypokalemia, or incidentally discovered adrenal adenoma. Cushing's
syndrome presents with hypercortisolism features. Pheochromocytoma
presents with episodic hypertension, palpitations, and diaphoresis.
AE
, 5. A 35-year-old woman with polycystic ovarian syndrome (PCOS) is being
evaluated. Which laboratory finding is most consistent with PCOS?
A) Elevated FSH
B) Elevated LH/FSH ratio (>2:1)
C) Elevated prolactin
D) Low testosterone
Answer: B
Rationale: PCOS is characterized by elevated LH/FSH ratio (>2:1),
elevated androgens (testosterone, DHEA-S), and normal or mildly elevated
prolactin. Elevated FSH is seen in ovarian failure. Elevated prolactin
suggests hyperprolactinemia. Low testosterone is not consistent with
PCOS; women with PCOS typically have elevated androgens.
6. A 45-year-old man presents with headache, visual field defects, and
gynecomastia. Prolactin level is markedly elevated. What is the most likely
diagnosis?
A) Pituitary adenoma (prolactinoma)
B) Cushing's syndrome
C) Acromegaly
D) Hypothyroidism
Answer: A
Rationale: Prolactinoma presents with headache (due to mass effect), visual
field defects (bitemporal hemianopsia from optic chiasm compression), and
hyperprolactinemia symptoms (gynecomastia, galactorrhea, sexual
dysfunction). Prolactin levels > 200 ng/mL are highly suggestive of
prolactinoma. Cushing's syndrome presents with hypercortisolism features.
Acromegaly presents with growth hormone excess. Hypothyroidism can
cause mild hyperprolactinemia but not typically the mass effect symptoms.
AE
