NSG 554 NURSE PRACTITIONERS IN
PRIMARY CARE I - EXAM 4
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A 45-year-old female presents with sharp right upper quadrant pain that radiates to her
right shoulder. The pain began after eating a fatty meal. Physical exam reveals a positive
Murphy’s sign. Which is the most likely diagnosis?
A. Acute Pancreatitis
B. Gastroesophageal Reflux Disease
C. Peptic Ulcer Disease
D. Acute Cholecystitis
Answer: D
Conceptual Explanation: Murphy’s sign is highly specific for acute cholecystitis, often
triggered by fatty meals that stimulate gallbladder contraction against a stone.
2. A patient presents with a 24-hour history of periumbilical pain that has now shifted to the
right lower quadrant. On exam, the NP elicits pain when pressure is released from the left
lower quadrant. This finding is known as:
A. Rovsing’s sign
,B. Obturator sign
C. Psoas sign
D. McBurney’s sign
Answer: A
Conceptual Explanation: Rovsing’s sign is indirect tenderness in the right lower quadrant
when the left lower quadrant is palpated, indicating peritoneal irritation associated with
appendicitis.
3. Which of the following is the gold standard for diagnosing Barrett’s esophagus?
A. Barium swallow
B. 24-hour pH monitoring
C. Urea breath test
D. Upper endoscopy with biopsy
Answer: D
Conceptual Explanation: Barrett’s esophagus is a histological diagnosis requiring biopsy
evidence of intestinal metaplasia (columnar epithelium replacing squamous epithelium).
4. A 60-year-old male reports a change in bowel habits and pencil-thin stools for the past two
months. What is the most appropriate next step?
A. Stool culture for ova and parasites
B. Increase dietary fiber
, C. Colonoscopy
D. Fecal occult blood test (FOBT)
Answer: C
Conceptual Explanation: Thin stools and changes in bowel habits in an older adult are red
flags for colorectal cancer, requiring direct visualization via colonoscopy.
5. A patient tests positive for H. pylori. Which of the following is considered first-line ‘triple
therapy’?
A. PPI, Bismuth, Metronidazole, and Tetracycline
B. PPI, Amoxicillin, and Clarithromycin
C. H2 blocker, Clarithromycin, and Amoxicillin
D. PPI, Ciprofloxacin, and Metronidazole
Answer: B
Conceptual Explanation: Standard triple therapy for H. pylori consists of a Proton Pump
Inhibitor (PPI), Amoxicillin (or Metronidazole if allergic), and Clarithromycin for 10-14
days.
6. Which physical exam finding is most suggestive of an inguinal hernia?
A. Scrotal transillumination
B. Palpable mass in the inguinal canal during cough
C. Positive Prehn’s sign
PRIMARY CARE I - EXAM 4
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A 45-year-old female presents with sharp right upper quadrant pain that radiates to her
right shoulder. The pain began after eating a fatty meal. Physical exam reveals a positive
Murphy’s sign. Which is the most likely diagnosis?
A. Acute Pancreatitis
B. Gastroesophageal Reflux Disease
C. Peptic Ulcer Disease
D. Acute Cholecystitis
Answer: D
Conceptual Explanation: Murphy’s sign is highly specific for acute cholecystitis, often
triggered by fatty meals that stimulate gallbladder contraction against a stone.
2. A patient presents with a 24-hour history of periumbilical pain that has now shifted to the
right lower quadrant. On exam, the NP elicits pain when pressure is released from the left
lower quadrant. This finding is known as:
A. Rovsing’s sign
,B. Obturator sign
C. Psoas sign
D. McBurney’s sign
Answer: A
Conceptual Explanation: Rovsing’s sign is indirect tenderness in the right lower quadrant
when the left lower quadrant is palpated, indicating peritoneal irritation associated with
appendicitis.
3. Which of the following is the gold standard for diagnosing Barrett’s esophagus?
A. Barium swallow
B. 24-hour pH monitoring
C. Urea breath test
D. Upper endoscopy with biopsy
Answer: D
Conceptual Explanation: Barrett’s esophagus is a histological diagnosis requiring biopsy
evidence of intestinal metaplasia (columnar epithelium replacing squamous epithelium).
4. A 60-year-old male reports a change in bowel habits and pencil-thin stools for the past two
months. What is the most appropriate next step?
A. Stool culture for ova and parasites
B. Increase dietary fiber
, C. Colonoscopy
D. Fecal occult blood test (FOBT)
Answer: C
Conceptual Explanation: Thin stools and changes in bowel habits in an older adult are red
flags for colorectal cancer, requiring direct visualization via colonoscopy.
5. A patient tests positive for H. pylori. Which of the following is considered first-line ‘triple
therapy’?
A. PPI, Bismuth, Metronidazole, and Tetracycline
B. PPI, Amoxicillin, and Clarithromycin
C. H2 blocker, Clarithromycin, and Amoxicillin
D. PPI, Ciprofloxacin, and Metronidazole
Answer: B
Conceptual Explanation: Standard triple therapy for H. pylori consists of a Proton Pump
Inhibitor (PPI), Amoxicillin (or Metronidazole if allergic), and Clarithromycin for 10-14
days.
6. Which physical exam finding is most suggestive of an inguinal hernia?
A. Scrotal transillumination
B. Palpable mass in the inguinal canal during cough
C. Positive Prehn’s sign
