NR 509 FINAL EXAM
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: A 54-year-old male with a strong family history of
breast and prostate cancer presents to his primary care provider to
discuss prostate screening. His father died at age 73 years from
prostate cancer that was not detected on routine digital rectal
examinations (DREs), and he would like to minimize his chance of a
similar occurrence. Which of the following is true regarding the
anatomy and screening of the prostate by DRE?
A. All three lobes of the prostate are palpable on DRE.
B. The seminal vesicles are palpable distal to the prostate on DRE.
C. The median lobe of the prostate is located anterior to the urethra
and is not palpable on DRE.
D. The median sulcus divides the lateral lobes from the median lobe
and is palpable on DRE.
E. A prostate of 5 cm diameter without palpable nodes or masses
represents a normal prostate examination.
Answer:
c. The median lobe of the prostate is located anterior to the urethra and is not
palpable on DRE. Rationale: Due to its location at the anterior aspect of the
urethra, the median lobe of the prostate is not palpable on DRE, nor are small
tumors in this area
Question 2: A third-year medical student rotating on the internal
medicine service performs a digital rectal examination (DRE) on a
56-year-old female patient. The patient has been admitted for
suspicion of a myocardial infarction, and confirmation that there is
no blood in the stool is required before anticoagulation can be
,started. The student reports that the fecal occult blood test was
negative but notes that he palpated a structure through the anterior
rectum that he could not identify. The attending physician confirms
normal anatomy and reviews with the student that the most likely
identity of the structure palpable is which of the following?
A. Sacrum
B. Pectinate line
C. Uterine fundus
D. Prostate
E. Cervix
Answer:
e. Cervix Rationale: The cervix is often palpable through the anterior rectal wall on
DRE of female patients.
Question 3: A 45-year-old female executive reports to her primary
care provider that she has recently experienced a change in the
patterns of her bowel movements. She expresses a great concern
as her family history includes a maternal aunt who died of colon
cancer at age 49 years; her mother has had colonoscopies every 3
years with numerous adenomatous polyps removed. Which of the
following historical elements would be the most concerning for
colon cancer in this patient?
A. Long-term history of hemorrhoids
B. Recent history of black, tarry stools
C. Remote history of anal pruritus
D. New-onset anal fissures
E. Recent onset of small-caliber stools
Answer:
,e. Recent onset of small-caliber stools Rationale: Small-caliber stools may be
caused by narrowing of the colon due to a mass. Colonoscopy should be
performed to rule out such pathology, especially in a patient with such a notable
family history.
Question 4: A 49-year-old customer service representative presents
to his gastroenterologist for follow-up of his long-standing
inflammatory bowel disease (IBD). He was diagnosed with
ulcerative colitis (UC) at age 37 years and has had irregular care for
this condition since then. His sole colonoscopy was done at the
time of diagnosis 12 years ago. His only relevant family history is of
prostate cancer in his father; his mother and sisters are healthy.
Which of the following is true about recommended screening for
colon cancer in this patient?
A. The patient should begin screening for colon cancer 10 years prior
to the age of onset of his father's prostate cancer.
B. The patient should undergo colonoscopy for his bowel condition,
which confers risk of colon cancer.
C. The patient is due for routine age-based colon cancer screening by
colonoscopy regardless of his risk factors.
D. The patient has a reassuring family history and t
Answer:
, b. The patient should undergo colonoscopy for his bowel condition, which confers
risk of colon cancer. Rationale: The two forms of IBD (UC and Crohn disease)
increase the risk of colon cancer and do warrant increased screening at
shortened intervals. The patient should begin screening for colon cancer 10 years
prior to the age of onset of his father's prostate cancer is incorrect because family
history of breast, ovarian, or colon cancer increases an individual's risk of colon
cancer, whereas family history of prostate cancer alone does not increase an
individual's risk of colon cancer and thus does not indicate increased screening.
(Of note, prostate cancer may rarely be a manifestation of the BRCA genetic
mutation that would put this patient at higher risk for many types cancer, but this
would usually be accompanied by a family history of many cancers, especially
breast and ovarian cancer in the female line.)
Question 5: A 49-year-old male with well-controlled HIV undergoes
a proctoscopic examination as routine screening for anal cancer.
The patient is asymptomatic and specifically denies complaints of
frequent urination (frequency), large volume of urination (polyuria),
or repeated urination at night (nocturia). Under direct visualization,
the clinician observes a clear, circumferential demarcation of
proximal versus distal tissue. This demarcation was not palpable
on digital rectal examination (DRE) prior to proctoscopy. What is
the most likely origin of this finding?
A. Pathological constriction of the anal canal
B. Normal anatomy of the mucosal surface
C. Carcinoma
D. Valve of Houston
E. External anal sphincter
Answer:
b. Normal anatomy of the mucosal surface Rationale: The circumferential border
between the anal canal and rectum is visible on proctoscopic examination but is
not palpable on DRE. This demarcation is known as the dentate or pectinate line.
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: A 54-year-old male with a strong family history of
breast and prostate cancer presents to his primary care provider to
discuss prostate screening. His father died at age 73 years from
prostate cancer that was not detected on routine digital rectal
examinations (DREs), and he would like to minimize his chance of a
similar occurrence. Which of the following is true regarding the
anatomy and screening of the prostate by DRE?
A. All three lobes of the prostate are palpable on DRE.
B. The seminal vesicles are palpable distal to the prostate on DRE.
C. The median lobe of the prostate is located anterior to the urethra
and is not palpable on DRE.
D. The median sulcus divides the lateral lobes from the median lobe
and is palpable on DRE.
E. A prostate of 5 cm diameter without palpable nodes or masses
represents a normal prostate examination.
Answer:
c. The median lobe of the prostate is located anterior to the urethra and is not
palpable on DRE. Rationale: Due to its location at the anterior aspect of the
urethra, the median lobe of the prostate is not palpable on DRE, nor are small
tumors in this area
Question 2: A third-year medical student rotating on the internal
medicine service performs a digital rectal examination (DRE) on a
56-year-old female patient. The patient has been admitted for
suspicion of a myocardial infarction, and confirmation that there is
no blood in the stool is required before anticoagulation can be
,started. The student reports that the fecal occult blood test was
negative but notes that he palpated a structure through the anterior
rectum that he could not identify. The attending physician confirms
normal anatomy and reviews with the student that the most likely
identity of the structure palpable is which of the following?
A. Sacrum
B. Pectinate line
C. Uterine fundus
D. Prostate
E. Cervix
Answer:
e. Cervix Rationale: The cervix is often palpable through the anterior rectal wall on
DRE of female patients.
Question 3: A 45-year-old female executive reports to her primary
care provider that she has recently experienced a change in the
patterns of her bowel movements. She expresses a great concern
as her family history includes a maternal aunt who died of colon
cancer at age 49 years; her mother has had colonoscopies every 3
years with numerous adenomatous polyps removed. Which of the
following historical elements would be the most concerning for
colon cancer in this patient?
A. Long-term history of hemorrhoids
B. Recent history of black, tarry stools
C. Remote history of anal pruritus
D. New-onset anal fissures
E. Recent onset of small-caliber stools
Answer:
,e. Recent onset of small-caliber stools Rationale: Small-caliber stools may be
caused by narrowing of the colon due to a mass. Colonoscopy should be
performed to rule out such pathology, especially in a patient with such a notable
family history.
Question 4: A 49-year-old customer service representative presents
to his gastroenterologist for follow-up of his long-standing
inflammatory bowel disease (IBD). He was diagnosed with
ulcerative colitis (UC) at age 37 years and has had irregular care for
this condition since then. His sole colonoscopy was done at the
time of diagnosis 12 years ago. His only relevant family history is of
prostate cancer in his father; his mother and sisters are healthy.
Which of the following is true about recommended screening for
colon cancer in this patient?
A. The patient should begin screening for colon cancer 10 years prior
to the age of onset of his father's prostate cancer.
B. The patient should undergo colonoscopy for his bowel condition,
which confers risk of colon cancer.
C. The patient is due for routine age-based colon cancer screening by
colonoscopy regardless of his risk factors.
D. The patient has a reassuring family history and t
Answer:
, b. The patient should undergo colonoscopy for his bowel condition, which confers
risk of colon cancer. Rationale: The two forms of IBD (UC and Crohn disease)
increase the risk of colon cancer and do warrant increased screening at
shortened intervals. The patient should begin screening for colon cancer 10 years
prior to the age of onset of his father's prostate cancer is incorrect because family
history of breast, ovarian, or colon cancer increases an individual's risk of colon
cancer, whereas family history of prostate cancer alone does not increase an
individual's risk of colon cancer and thus does not indicate increased screening.
(Of note, prostate cancer may rarely be a manifestation of the BRCA genetic
mutation that would put this patient at higher risk for many types cancer, but this
would usually be accompanied by a family history of many cancers, especially
breast and ovarian cancer in the female line.)
Question 5: A 49-year-old male with well-controlled HIV undergoes
a proctoscopic examination as routine screening for anal cancer.
The patient is asymptomatic and specifically denies complaints of
frequent urination (frequency), large volume of urination (polyuria),
or repeated urination at night (nocturia). Under direct visualization,
the clinician observes a clear, circumferential demarcation of
proximal versus distal tissue. This demarcation was not palpable
on digital rectal examination (DRE) prior to proctoscopy. What is
the most likely origin of this finding?
A. Pathological constriction of the anal canal
B. Normal anatomy of the mucosal surface
C. Carcinoma
D. Valve of Houston
E. External anal sphincter
Answer:
b. Normal anatomy of the mucosal surface Rationale: The circumferential border
between the anal canal and rectum is visible on proctoscopic examination but is
not palpable on DRE. This demarcation is known as the dentate or pectinate line.
