MSN 621 Final Exam Questions and Answers| Latest
Update 100% Verified
A 35-year-old female presents to the out-patient department with complaints of cough with
whitish sputum production for the past three months. She mentions that the cough worsens at
night. She has no other complaints. The patient mentions that she has tried chlorpheniramine
for a week, and no improvement was noted. She has a history of gastroesophageal reflux
disease, for which she takes famotidine. She has been smoking a pack of cigarettes a day for the
past seven years and drinks alcohol socially. Vitals show a blood pressure of 133/85 mm Hg,
pulse of 79/min, respiratory rate of 14/min, and temperature of 98.6 F (37 C). Pulmonary
examination reveals normal breath sounds bilaterally. A chest x-ray is normal. Which of the
following is the best next step in the management of the patient's condition? Pulmonary
function tests
A 65-year-old male patient presents to the clinic with complaints of a dry cough and wheezing,
particularly at night. He has had asthma. Six months ago, his symptoms were well-controlled on
inhaled fomoterol and low dose budesonide twice a day and occasional use of an albuterol
inhaler as required. However, now he is more short of breath with morning dipping of his peak
flow readings. On examination, he is mildly dyspneic but able to complete sentences. On
auscultation, there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in the management of this patient?
Increase inhaled budesonide dose
A 65-year-old male patient presents with the complaint of increasing shortness of breath and
nocturnal cough. His condition has been progressively worsening over the past three months.
He is a smoker and works in a cotton factory. He has one son and one daughter with asthma. On
examination, there is a wheeze and coarse end-inspiratory crackles in the chest. A chest
radiograph reveals diffuse non-specific changes consistent with lung disease. Spirometry is
performed on him. Which of the following would indicate asthma? FEV1 to FVC ratio of 68%
Chest X-ray of a long-term smoker shows a 2-cm spiculated mass in the right parahilar lung. A
barium esophagram shows an extrinsic impression in the region of the carina. Which of the
,following choices would be most helpful at this point? Chest x-ray with possible CT-guided
biopsy
A 62-year-old man presents with general malaise, occasional cough, and weight loss of 10 lbs
(4.5 kg) over the last two months. History is significant for prediabetes managed with diet and
cigarette smoking. Physical examination findings include mild edema in the extremities and
clubbing bilaterally. Blood work shows mild anemia and sodium of 122 mg/dL. What test should
be done next? Chest radiograph
A 55-year-old male with a past medical history of benign prostatic hyperplasia presents due to
the clinic with complaints of inability to void on his own associated with intermittent leakage of
urine. The patient denies any known triggers that cause urinary leakage. The patient is on a
maximum dose of tamsulosin. He denies any medication allergies, other medical conditions,
history of surgeries, or traumas. Vitals are within normal limits. Physical examination reveals a
distended bladder and suprapubic tenderness. Which of the following is the next best step in
management? Urethral catheterization
A 37-year-old female patient presents with symptoms of fatigue and ankle swelling. She is found
to have mild hypertension but otherwise appears healthy. She has a negative medical, surgical,
and family history. Her urine is found to have a smoky, tea-colored appearance. A urine dipstick
is positive for blood and protein. This urine finding and her clinical presentation suggest she is
likely bleeding from which of the following structures? Kidney
A 79-year-old man with a past medical history of hypertension, hyperlipidemia, COPD, and
peripheral arterial disease presents to the emergency department with complaints of
intermittent blood in the urine, dysuria, and unintentional weight loss of 15 pounds (7 kg) over
the last 2 months. He denies having any urgency or frequency. His PSA levels were recently
checked and were borderline elevated. He denies having any frequency, urgency, or
incontinence. He used to smoke 2 packs per day for 30 years but quit 15 years ago. Urinalysis
reveals a large amount of blood but is otherwise unremarkable. CBC reveals a hemoglobin of 9
g/dL but is otherwise unremarkable. CMP shows elevated AST and ALT. What is the next best
step in the management of this patient? CT scan of the abdomen and pelvis
, A male patient presents to the emergency department with complaints of nausea, vomiting,
and left flank pain. The patient says that he feels pain during micturition, and his urine appears
cloudy and reddish-brown. He has hypertension and asthma, which are under control. Which of
the following tests is the most sensitive and specific for making a diagnosis in this patient?
Non-contrast abdominal CT
A 17-year-old female presents with abdominal pain, nausea, vomiting, and dysuria that started
a day ago. On further questioning, she admits that the pain is more in the area of her left flank.
A detailed medical history reveals no known medical conditions. She is afebrile, and her vital
signs are stable. A physical examination demonstrates costovertebral tenderness as well as
tenderness in the left flank on palpation. Urinalysis shows 12 red blood cells and two white
blood cells per high power field. What is the best next step in making a definitive diagnosis?
Non-contrast computed tomography (CT) scan abdomen and pelvis with a kidney, ureter,
and bladder (KUB)
A 33-year-old obese female presents in late in the evening for left lower quadrant pain that has
progressively worsened over the last several hours. She describes the pain as sharp and
shooting, which waxes and wanes over time. She has also had dysuria and urgency. Her surgical
history is notable for gastric bypass surgery five years ago. She is not sexually active. Her
temperature is 99.6 deg F, blood pressure is 148/72 mmHg, and the pulse is 86/min. On physical
exam, she has left lower quadrant tenderness to palpation with pain radiating to the left groin
and left flank tenderness on palpation. Her urinalysis shows 102 red blood cells/high power
field. A urine pregnancy test is negative. What is the next best step in management? Non-
contrast CT abdomen/pelvis
A 54-year-old female presents to the clinic with acute onset of right flank pain. She describes
the pain as crampy and severe, radiating to her right groin. Urinalysis shows 1 white blood cell
and 3 red blood cells per high power field. Ultrasound kidney-ureter-bladder does not show any
stones. Which of the following is the next best step in the evaluation of this patient?
Computed tomography (CT) scan without contrast
A young female presents to a clinic complaining of low-grade fever, irritation, and a burning
sensation while passing urine. A urinalysis is performed, and a urinary tract infection is
diagnosed. The provider starts trimethoprim/sulfamethoxazole for three days and asks the
Update 100% Verified
A 35-year-old female presents to the out-patient department with complaints of cough with
whitish sputum production for the past three months. She mentions that the cough worsens at
night. She has no other complaints. The patient mentions that she has tried chlorpheniramine
for a week, and no improvement was noted. She has a history of gastroesophageal reflux
disease, for which she takes famotidine. She has been smoking a pack of cigarettes a day for the
past seven years and drinks alcohol socially. Vitals show a blood pressure of 133/85 mm Hg,
pulse of 79/min, respiratory rate of 14/min, and temperature of 98.6 F (37 C). Pulmonary
examination reveals normal breath sounds bilaterally. A chest x-ray is normal. Which of the
following is the best next step in the management of the patient's condition? Pulmonary
function tests
A 65-year-old male patient presents to the clinic with complaints of a dry cough and wheezing,
particularly at night. He has had asthma. Six months ago, his symptoms were well-controlled on
inhaled fomoterol and low dose budesonide twice a day and occasional use of an albuterol
inhaler as required. However, now he is more short of breath with morning dipping of his peak
flow readings. On examination, he is mildly dyspneic but able to complete sentences. On
auscultation, there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in the management of this patient?
Increase inhaled budesonide dose
A 65-year-old male patient presents with the complaint of increasing shortness of breath and
nocturnal cough. His condition has been progressively worsening over the past three months.
He is a smoker and works in a cotton factory. He has one son and one daughter with asthma. On
examination, there is a wheeze and coarse end-inspiratory crackles in the chest. A chest
radiograph reveals diffuse non-specific changes consistent with lung disease. Spirometry is
performed on him. Which of the following would indicate asthma? FEV1 to FVC ratio of 68%
Chest X-ray of a long-term smoker shows a 2-cm spiculated mass in the right parahilar lung. A
barium esophagram shows an extrinsic impression in the region of the carina. Which of the
,following choices would be most helpful at this point? Chest x-ray with possible CT-guided
biopsy
A 62-year-old man presents with general malaise, occasional cough, and weight loss of 10 lbs
(4.5 kg) over the last two months. History is significant for prediabetes managed with diet and
cigarette smoking. Physical examination findings include mild edema in the extremities and
clubbing bilaterally. Blood work shows mild anemia and sodium of 122 mg/dL. What test should
be done next? Chest radiograph
A 55-year-old male with a past medical history of benign prostatic hyperplasia presents due to
the clinic with complaints of inability to void on his own associated with intermittent leakage of
urine. The patient denies any known triggers that cause urinary leakage. The patient is on a
maximum dose of tamsulosin. He denies any medication allergies, other medical conditions,
history of surgeries, or traumas. Vitals are within normal limits. Physical examination reveals a
distended bladder and suprapubic tenderness. Which of the following is the next best step in
management? Urethral catheterization
A 37-year-old female patient presents with symptoms of fatigue and ankle swelling. She is found
to have mild hypertension but otherwise appears healthy. She has a negative medical, surgical,
and family history. Her urine is found to have a smoky, tea-colored appearance. A urine dipstick
is positive for blood and protein. This urine finding and her clinical presentation suggest she is
likely bleeding from which of the following structures? Kidney
A 79-year-old man with a past medical history of hypertension, hyperlipidemia, COPD, and
peripheral arterial disease presents to the emergency department with complaints of
intermittent blood in the urine, dysuria, and unintentional weight loss of 15 pounds (7 kg) over
the last 2 months. He denies having any urgency or frequency. His PSA levels were recently
checked and were borderline elevated. He denies having any frequency, urgency, or
incontinence. He used to smoke 2 packs per day for 30 years but quit 15 years ago. Urinalysis
reveals a large amount of blood but is otherwise unremarkable. CBC reveals a hemoglobin of 9
g/dL but is otherwise unremarkable. CMP shows elevated AST and ALT. What is the next best
step in the management of this patient? CT scan of the abdomen and pelvis
, A male patient presents to the emergency department with complaints of nausea, vomiting,
and left flank pain. The patient says that he feels pain during micturition, and his urine appears
cloudy and reddish-brown. He has hypertension and asthma, which are under control. Which of
the following tests is the most sensitive and specific for making a diagnosis in this patient?
Non-contrast abdominal CT
A 17-year-old female presents with abdominal pain, nausea, vomiting, and dysuria that started
a day ago. On further questioning, she admits that the pain is more in the area of her left flank.
A detailed medical history reveals no known medical conditions. She is afebrile, and her vital
signs are stable. A physical examination demonstrates costovertebral tenderness as well as
tenderness in the left flank on palpation. Urinalysis shows 12 red blood cells and two white
blood cells per high power field. What is the best next step in making a definitive diagnosis?
Non-contrast computed tomography (CT) scan abdomen and pelvis with a kidney, ureter,
and bladder (KUB)
A 33-year-old obese female presents in late in the evening for left lower quadrant pain that has
progressively worsened over the last several hours. She describes the pain as sharp and
shooting, which waxes and wanes over time. She has also had dysuria and urgency. Her surgical
history is notable for gastric bypass surgery five years ago. She is not sexually active. Her
temperature is 99.6 deg F, blood pressure is 148/72 mmHg, and the pulse is 86/min. On physical
exam, she has left lower quadrant tenderness to palpation with pain radiating to the left groin
and left flank tenderness on palpation. Her urinalysis shows 102 red blood cells/high power
field. A urine pregnancy test is negative. What is the next best step in management? Non-
contrast CT abdomen/pelvis
A 54-year-old female presents to the clinic with acute onset of right flank pain. She describes
the pain as crampy and severe, radiating to her right groin. Urinalysis shows 1 white blood cell
and 3 red blood cells per high power field. Ultrasound kidney-ureter-bladder does not show any
stones. Which of the following is the next best step in the evaluation of this patient?
Computed tomography (CT) scan without contrast
A young female presents to a clinic complaining of low-grade fever, irritation, and a burning
sensation while passing urine. A urinalysis is performed, and a urinary tract infection is
diagnosed. The provider starts trimethoprim/sulfamethoxazole for three days and asks the
