NURS 550 Midterm Exam Questions And
Verified Detailed Answers
Differential Diagnosis - Answer • In deciding on which diseases to include in the
differential, think about the following: - What's the most life-threatening disease the
patient could have? - Could this be a common disease presenting with unusual features?
- What diseases present with misleading symptoms? - What rare diseases could be
causing these signs and symptoms?
Formulate a broad, framed differential diagnosis (hypothesis)- Best Answer • Not all
diagnoses within a differential diagnosis are: - of equal likelihood - of equal importance
• You must determine: - a chief (working) hypothesis - a can't miss hypothesis - An active
alternative hypothesis
SOAP is an abbreviation for: - Best Answer • Subjective • Objective • Assessment • Plan
Subiective - Answer The subiective is what the patient relates to you about the present
illness/injury and past illnesses/injuries.
Chief Compliant - Answer • Why the patient came to the clinic
• Example: Sore throat for 2 days
History of Present Illness/Injury - Answer - Onset - When the symptoms and/or signs
started, what was the mechanism of injury
- Chronology - episodic, variable, constant, etc
Quality: sharp, dull, ache, sudden, insidious Severity: pain rating, 0-10 pain scale
interferes with daily activities Modifying factors: aggravating and alleviating factors
Additional symptoms unrelated or significant symptoms Treatment: medications, herbs,
"home remedies", rest, activity, splint, etc Use "OLDCART" to help you - Onset,
Location, Duration, Character, Aggravating factors, Relieving factors, Treatments"
,History - Answer Allergies - list of allergies to food, medication and products with type of
reaction
- Medical - past and present medical conditions (ie. asthma, hypertension, malaria, etc.)
- Surgical - past surgeries (ie. appendectomy, CABG, craniotomy, etc.)
- Family - mother, father, siblings, etc. - Social - occupation, alcohol, drug, tobacco use,
risky behaviour
- Immunizations - current and past received with dates
- Screenings/Health Promotion - mammography, testicular exams, dental, vision
- Review of Systems - systemic symptoms related to the current problem(s) including
pertinent positives and negatives
Review of Systems - Answer General - fever (subjective) with chills and sweats, denies
fatigue, weakness, weight loss, or malaise
- Skin - denies rashes, lesions, discolorations
HEENT: positive for generalized headache, sore throat, pain with swallowing and
rhinorrhea. Denies difficulty swallowing saliva, earache, sinus congestion, sinus pain,
visual or auditory aura. Neck: denies lump, pain, stiffness, or decreased range of
motion. Cardiac: denies chest pain, pressure, tightness, palpitations. Pulmonary: denies
cough, wheeze, hemoptysis. GI: denies nausea, vomiting, abdominal pain.
-GU-denies missed menses, urinary frequency, urgency or hematuria
-MS-denies cramping, pain,
-Neuro- denies unilateral weakness, numbness, tingling
Review of Systems - Answer • Should elaborate on the chief complaint and HPI • Don't
ask questions that the patient may not know
Review of Systems
Is your prostate bothering you? Are you anemic, or have you any heart failure,
malignancy? Is it true that you get up often at night to urinate? Have you noticed
anything different about the stream of your urine? Do you not drink fluids during work
time? Do you get tired easily? Do you have shortness of breath? Have you lost weight
lately?
,Objective - Answer In this section you document what you observe during the
examination and visit.
Physical Examination - Answer - Vital signs - Physical examination findings - the use of
"normal", "within normal limits", "unremarkable" and other phrases are NOT
acceptable. - Diagnostic results - Measurements including height, weight, screening
tools, etc. - Mental Status
-Weight 50 Kg previously documented height 5'3" -Vital signs - BP 118/76, HR 104, RR
16, T 38.2C, pulse Ox 99% RA -Diagnostic results •Rapid strep test positive
-Physical examination findings - Answer • General -Well nourished and hydrated 28 yo
female. Awake, alert and orient; appropriately dressed for season. Pleasant and
cooperative.
*Skin - hot, dry and pink. No rashes or lesions including petechiae noted
• HEENT-normocephalic, symmetric face features. No scalp, face,
ethmoid/maxillary/frontal sinus tenderness. Transillumination negative. External ears
show no deviation. Ear canal clear bilaterally. Tympanic membranes are pearly gray
with the cone of light. Bony landmarks can be visualized bilaterally. Nasal mucosa pink
and moist turbinates, no edema or erythema noted. Oral cavity-pink and moist oral
mucosa; dentition without obvious caries. No lesions noted in the oral cavity. Pharynx
with moderate erythema of the tonsillar pillars ¼ bilaterally. No exudate. Uvula midline
gag reflex present. • Neck - supple. Anterior cervical lymphadenopathy with mobile,
tender nodes bilaterally all less than 1 cm diameter. No JVD\
- Cardiac - S1 S2 with no murmurs, gallops, or clicks. PMI 5th ICS mid-clavicular line \
- Pulmonary - lungs clear to auscultation bilaterally in all fields. Negative tactile fremitus,
egophony, bronchophony, and whispered pectoriloquy
GI - no masses or pulsations. Bowel sounds normoactive all 4 quadrants. No
organomegaly no fruits.
GU- denies missed menses, urinary frequency, urgency or hematuria
MS - Strength 4/5 bilateral upper and lower extremities. Gait steady Neuro - awake,
alert, and oriented to name, place, date and surroundings. No nuchal rigidity, Kernigs or
Brudzinski signs
Assessment - Answer This is where the diagnosis and differential diagnosis are listed
for the date the note is written.
, Sample
Diagnosis: - Strep Pharyngitis
• Differential Diagnosis:
- Viral pharyngitis
- Rheumatic fever
- Scarlet fever
Plan - Answer This is where the treatment plan goes.
- Medications
- Diagnostic tests (i.e. laboratory, radiologic, hearing, etc.)
- Education
- Counseling
- Referrals
Procedure(s) performed and result(s)
Return to office date(s)/Follow up
Sample
Amoxicillin 875mg BID for 10 days
Rapid Strep test done in office
Verbal instructions provided regarding warm salt water gargles and spit 3-4 times a
day, rest, increased fluids, rest, no work 2 days note given to patient
Patient instructed to return to office in 2 days if not improved. Instructed to report to ED
with difficulty swallowing or breathing, rash develops, or symptoms worse.
VERBALIZED UNDERSTANDING.
How to Interview a Patient - Answer Stay calm!! • Prepare before you go into the room -
Read the chart, familiarize yourself with the patient • Set an agenda - Time, needs,
issues • Look and be professional - If you look the part you have already conquered the
Verified Detailed Answers
Differential Diagnosis - Answer • In deciding on which diseases to include in the
differential, think about the following: - What's the most life-threatening disease the
patient could have? - Could this be a common disease presenting with unusual features?
- What diseases present with misleading symptoms? - What rare diseases could be
causing these signs and symptoms?
Formulate a broad, framed differential diagnosis (hypothesis)- Best Answer • Not all
diagnoses within a differential diagnosis are: - of equal likelihood - of equal importance
• You must determine: - a chief (working) hypothesis - a can't miss hypothesis - An active
alternative hypothesis
SOAP is an abbreviation for: - Best Answer • Subjective • Objective • Assessment • Plan
Subiective - Answer The subiective is what the patient relates to you about the present
illness/injury and past illnesses/injuries.
Chief Compliant - Answer • Why the patient came to the clinic
• Example: Sore throat for 2 days
History of Present Illness/Injury - Answer - Onset - When the symptoms and/or signs
started, what was the mechanism of injury
- Chronology - episodic, variable, constant, etc
Quality: sharp, dull, ache, sudden, insidious Severity: pain rating, 0-10 pain scale
interferes with daily activities Modifying factors: aggravating and alleviating factors
Additional symptoms unrelated or significant symptoms Treatment: medications, herbs,
"home remedies", rest, activity, splint, etc Use "OLDCART" to help you - Onset,
Location, Duration, Character, Aggravating factors, Relieving factors, Treatments"
,History - Answer Allergies - list of allergies to food, medication and products with type of
reaction
- Medical - past and present medical conditions (ie. asthma, hypertension, malaria, etc.)
- Surgical - past surgeries (ie. appendectomy, CABG, craniotomy, etc.)
- Family - mother, father, siblings, etc. - Social - occupation, alcohol, drug, tobacco use,
risky behaviour
- Immunizations - current and past received with dates
- Screenings/Health Promotion - mammography, testicular exams, dental, vision
- Review of Systems - systemic symptoms related to the current problem(s) including
pertinent positives and negatives
Review of Systems - Answer General - fever (subjective) with chills and sweats, denies
fatigue, weakness, weight loss, or malaise
- Skin - denies rashes, lesions, discolorations
HEENT: positive for generalized headache, sore throat, pain with swallowing and
rhinorrhea. Denies difficulty swallowing saliva, earache, sinus congestion, sinus pain,
visual or auditory aura. Neck: denies lump, pain, stiffness, or decreased range of
motion. Cardiac: denies chest pain, pressure, tightness, palpitations. Pulmonary: denies
cough, wheeze, hemoptysis. GI: denies nausea, vomiting, abdominal pain.
-GU-denies missed menses, urinary frequency, urgency or hematuria
-MS-denies cramping, pain,
-Neuro- denies unilateral weakness, numbness, tingling
Review of Systems - Answer • Should elaborate on the chief complaint and HPI • Don't
ask questions that the patient may not know
Review of Systems
Is your prostate bothering you? Are you anemic, or have you any heart failure,
malignancy? Is it true that you get up often at night to urinate? Have you noticed
anything different about the stream of your urine? Do you not drink fluids during work
time? Do you get tired easily? Do you have shortness of breath? Have you lost weight
lately?
,Objective - Answer In this section you document what you observe during the
examination and visit.
Physical Examination - Answer - Vital signs - Physical examination findings - the use of
"normal", "within normal limits", "unremarkable" and other phrases are NOT
acceptable. - Diagnostic results - Measurements including height, weight, screening
tools, etc. - Mental Status
-Weight 50 Kg previously documented height 5'3" -Vital signs - BP 118/76, HR 104, RR
16, T 38.2C, pulse Ox 99% RA -Diagnostic results •Rapid strep test positive
-Physical examination findings - Answer • General -Well nourished and hydrated 28 yo
female. Awake, alert and orient; appropriately dressed for season. Pleasant and
cooperative.
*Skin - hot, dry and pink. No rashes or lesions including petechiae noted
• HEENT-normocephalic, symmetric face features. No scalp, face,
ethmoid/maxillary/frontal sinus tenderness. Transillumination negative. External ears
show no deviation. Ear canal clear bilaterally. Tympanic membranes are pearly gray
with the cone of light. Bony landmarks can be visualized bilaterally. Nasal mucosa pink
and moist turbinates, no edema or erythema noted. Oral cavity-pink and moist oral
mucosa; dentition without obvious caries. No lesions noted in the oral cavity. Pharynx
with moderate erythema of the tonsillar pillars ¼ bilaterally. No exudate. Uvula midline
gag reflex present. • Neck - supple. Anterior cervical lymphadenopathy with mobile,
tender nodes bilaterally all less than 1 cm diameter. No JVD\
- Cardiac - S1 S2 with no murmurs, gallops, or clicks. PMI 5th ICS mid-clavicular line \
- Pulmonary - lungs clear to auscultation bilaterally in all fields. Negative tactile fremitus,
egophony, bronchophony, and whispered pectoriloquy
GI - no masses or pulsations. Bowel sounds normoactive all 4 quadrants. No
organomegaly no fruits.
GU- denies missed menses, urinary frequency, urgency or hematuria
MS - Strength 4/5 bilateral upper and lower extremities. Gait steady Neuro - awake,
alert, and oriented to name, place, date and surroundings. No nuchal rigidity, Kernigs or
Brudzinski signs
Assessment - Answer This is where the diagnosis and differential diagnosis are listed
for the date the note is written.
, Sample
Diagnosis: - Strep Pharyngitis
• Differential Diagnosis:
- Viral pharyngitis
- Rheumatic fever
- Scarlet fever
Plan - Answer This is where the treatment plan goes.
- Medications
- Diagnostic tests (i.e. laboratory, radiologic, hearing, etc.)
- Education
- Counseling
- Referrals
Procedure(s) performed and result(s)
Return to office date(s)/Follow up
Sample
Amoxicillin 875mg BID for 10 days
Rapid Strep test done in office
Verbal instructions provided regarding warm salt water gargles and spit 3-4 times a
day, rest, increased fluids, rest, no work 2 days note given to patient
Patient instructed to return to office in 2 days if not improved. Instructed to report to ED
with difficulty swallowing or breathing, rash develops, or symptoms worse.
VERBALIZED UNDERSTANDING.
How to Interview a Patient - Answer Stay calm!! • Prepare before you go into the room -
Read the chart, familiarize yourself with the patient • Set an agenda - Time, needs,
issues • Look and be professional - If you look the part you have already conquered the
