NR 577 Exam 3 V2 | NR 577 Primary Care
Management of Adolescents and Adults | Actual
Q&A with Rationale (NR577 Exam 3) |
Chamberlain University
1. A 45-year-old male presents with a burning sensation in his chest that worsens after heavy
meals and when lying down. He has tried over-the-counter antacids with minimal relief. What
is the initial recommended pharmacological management for suspected Gastroesophageal
Reflux Disease (GERD) in this patient?
A. Daily Proton Pump Inhibitor (PPI) for 8 weeks
B. As-needed H2 receptor antagonists
C. Immediate referral for endoscopy
D. Sucralfate 1g four times daily
Correct Answer: A
Explanation: According to the American College of Gastroenterology guidelines, a trial of
an 8-week course of PPIs is the first-line treatment for classic GERD symptoms without
alarm features. This duration allows for adequate healing of the esophageal mucosa and
symptomatic relief. If symptoms recur after discontinuation, further diagnostic workup or
maintenance therapy may be required.
,2. A 28-year-old female patient presents with fatigue, weight gain, and cold intolerance. Her
laboratory results show an elevated TSH of 12.4 mIU/L and a low Free T4. Which of the
following is the most appropriate starting dose of Levothyroxine for a healthy young adult?
A. 12.5 mcg daily
B. 200 mcg daily
C. 1.6 mcg/kg/day
D. 50 mcg daily regardless of weight
Correct Answer: C
Explanation: In young, healthy patients with overt hypothyroidism, the standard full
replacement dose is approximately 1.6 mcg per kilogram of body weight per day. This
approach ensures that the patient reaches a euthyroid state more efficiently than starting
at a sub-therapeutic dose. Conversely, older patients or those with cardiovascular disease
should start at lower doses like 25 mcg to avoid cardiac stress.
3. Which physical examination finding is most indicative of acute cholecystitis?
A. Rovsing sign
B. McBurney point tenderness
C. Murphy sign
D. Psoas sign
Correct Answer: C
,Explanation: The Murphy sign is characterized by an abrupt cessation of inspiration when
the examiner palpates the right upper quadrant over the gallbladder. This finding has a
high sensitivity for acute cholecystitis as the inflamed gallbladder moves against the
examiner’s hand during deep inhalation. Other signs like Rovsing or McBurney’s are
specific to appendicitis rather than biliary pathology.
4. A 62-year-old male complains of increased urinary frequency, nocturia, and a weak urinary
stream. Digital Rectal Exam (DRE) reveals a smooth, enlarged, non-tender prostate. What is
the most appropriate first-line medication to manage his symptoms of Benign Prostatic
Hyperplasia (BPH)?
A. Finasteride
B. Oxybutynin
C. Ciprofloxacin
D. Tamsulosin
Correct Answer: D
Explanation: Alpha-1 adrenergic antagonists like Tamsulosin are considered first-line
therapy because they provide rapid relief of lower urinary tract symptoms by relaxing
smooth muscles in the prostate and bladder neck. While 5-alpha reductase inhibitors like
Finasteride reduce prostate size over months, they do not offer the immediate symptom
relief that alpha-blockers do. This patient’s presentation is classic for BPH, and the smooth
enlargement on DRE helps rule out malignancy.
, 5. A 35-year-old female presents with irregular menses, acne, and hirsutism. Her BMI is 32
kg/m2. According to the Rotterdam criteria, what is required for a diagnosis of Polycystic
Ovary Syndrome (PCOS)?
A. At least two of: oligo-ovulation, clinical/biochemical hyperandrogenism, and polycystic
ovaries on ultrasound
B. Presence of all three: oligo-ovulation, hyperandrogenism, and polycystic ovaries
C. Elevated LH/FSH ratio only
D. Hyperinsulinemia and obesity
Correct Answer: A
Explanation: The Rotterdam criteria require the presence of at least two out of three
specific clinical features for a PCOS diagnosis. These features include ovulatory
dysfunction, hyperandrogenism (clinical or biochemical), and polycystic morphology on
ultrasound examination. This standardized approach allows clinicians to diagnose the
syndrome even in the absence of polycystic ovaries if other criteria are met.
6. A 55-year-old female presents with sudden onset of severe left lower quadrant pain and
fever. She has a history of constipation. On physical exam, she has localized rebound
tenderness. What is the preferred imaging modality to confirm the diagnosis of acute
diverticulitis?
A. CT Scan of the abdomen and pelvis with IV contrast
B. Abdominal Ultrasound
Management of Adolescents and Adults | Actual
Q&A with Rationale (NR577 Exam 3) |
Chamberlain University
1. A 45-year-old male presents with a burning sensation in his chest that worsens after heavy
meals and when lying down. He has tried over-the-counter antacids with minimal relief. What
is the initial recommended pharmacological management for suspected Gastroesophageal
Reflux Disease (GERD) in this patient?
A. Daily Proton Pump Inhibitor (PPI) for 8 weeks
B. As-needed H2 receptor antagonists
C. Immediate referral for endoscopy
D. Sucralfate 1g four times daily
Correct Answer: A
Explanation: According to the American College of Gastroenterology guidelines, a trial of
an 8-week course of PPIs is the first-line treatment for classic GERD symptoms without
alarm features. This duration allows for adequate healing of the esophageal mucosa and
symptomatic relief. If symptoms recur after discontinuation, further diagnostic workup or
maintenance therapy may be required.
,2. A 28-year-old female patient presents with fatigue, weight gain, and cold intolerance. Her
laboratory results show an elevated TSH of 12.4 mIU/L and a low Free T4. Which of the
following is the most appropriate starting dose of Levothyroxine for a healthy young adult?
A. 12.5 mcg daily
B. 200 mcg daily
C. 1.6 mcg/kg/day
D. 50 mcg daily regardless of weight
Correct Answer: C
Explanation: In young, healthy patients with overt hypothyroidism, the standard full
replacement dose is approximately 1.6 mcg per kilogram of body weight per day. This
approach ensures that the patient reaches a euthyroid state more efficiently than starting
at a sub-therapeutic dose. Conversely, older patients or those with cardiovascular disease
should start at lower doses like 25 mcg to avoid cardiac stress.
3. Which physical examination finding is most indicative of acute cholecystitis?
A. Rovsing sign
B. McBurney point tenderness
C. Murphy sign
D. Psoas sign
Correct Answer: C
,Explanation: The Murphy sign is characterized by an abrupt cessation of inspiration when
the examiner palpates the right upper quadrant over the gallbladder. This finding has a
high sensitivity for acute cholecystitis as the inflamed gallbladder moves against the
examiner’s hand during deep inhalation. Other signs like Rovsing or McBurney’s are
specific to appendicitis rather than biliary pathology.
4. A 62-year-old male complains of increased urinary frequency, nocturia, and a weak urinary
stream. Digital Rectal Exam (DRE) reveals a smooth, enlarged, non-tender prostate. What is
the most appropriate first-line medication to manage his symptoms of Benign Prostatic
Hyperplasia (BPH)?
A. Finasteride
B. Oxybutynin
C. Ciprofloxacin
D. Tamsulosin
Correct Answer: D
Explanation: Alpha-1 adrenergic antagonists like Tamsulosin are considered first-line
therapy because they provide rapid relief of lower urinary tract symptoms by relaxing
smooth muscles in the prostate and bladder neck. While 5-alpha reductase inhibitors like
Finasteride reduce prostate size over months, they do not offer the immediate symptom
relief that alpha-blockers do. This patient’s presentation is classic for BPH, and the smooth
enlargement on DRE helps rule out malignancy.
, 5. A 35-year-old female presents with irregular menses, acne, and hirsutism. Her BMI is 32
kg/m2. According to the Rotterdam criteria, what is required for a diagnosis of Polycystic
Ovary Syndrome (PCOS)?
A. At least two of: oligo-ovulation, clinical/biochemical hyperandrogenism, and polycystic
ovaries on ultrasound
B. Presence of all three: oligo-ovulation, hyperandrogenism, and polycystic ovaries
C. Elevated LH/FSH ratio only
D. Hyperinsulinemia and obesity
Correct Answer: A
Explanation: The Rotterdam criteria require the presence of at least two out of three
specific clinical features for a PCOS diagnosis. These features include ovulatory
dysfunction, hyperandrogenism (clinical or biochemical), and polycystic morphology on
ultrasound examination. This standardized approach allows clinicians to diagnose the
syndrome even in the absence of polycystic ovaries if other criteria are met.
6. A 55-year-old female presents with sudden onset of severe left lower quadrant pain and
fever. She has a history of constipation. On physical exam, she has localized rebound
tenderness. What is the preferred imaging modality to confirm the diagnosis of acute
diverticulitis?
A. CT Scan of the abdomen and pelvis with IV contrast
B. Abdominal Ultrasound
