MSN 622 FINAL EXAM QUESTIONS AND
ANSWERS 2025
A 67-year-old man with a history of hypertension and tobacco use presents
with a two-day history of hypogastric pain. An examination reveals a 5 cm,
non-tender, pulsatile abdominal mass above the umbilicus. Which of the
following type of sounds might be heard upon auscultation at the midline,
two inches cephalad to the umbilicus? - correct answer- blowing
What is the recommended management for a patient with a 3.5 cm
abdominal aortic aneurysm? - correct answer- ultrasound every 3 years
A 75-year-old man presents to the emergency department with complaints
of severe abdominal pain and sweating. The pain started about an hour ago
and is becoming worse with time. He has been diagnosed with hypertension
and diabetes and is on amlodipine and metformin, respectively. On
presentation, the vital signs show blood pressure 70/40 mmHg, pulse
140/min, respiratory rate 32/min, temperature 38.5 C (101.3 F), and oxygen
saturation 87% at room air. On physical examination of the abdomen,
generalized tenderness and guarding are seen.
There is a midline pulsatile mass. What is the next best step in the
management of this patient? - correct answer- immediate surgery
A 67-year-old male with a history of hypertension and nicotine dependence
presents to the emergency department with sudden onset of abdominal pain
radiating to the back. There is no history of alcohol use. On examination, he
is thin, pale, and diaphoretic. His vital signs show a blood pressure of
110/70 mmHg and a heart rate of 95 bpm. Which of the following is most
likely to confirm the diagnosis? - correct answer- abdominal CT
,A 78-year-old is found to have an asymptomatic pulsatile abdominal mass.
The ultrasound shows an abdominal aortic aneurysm measuring 5.5 cm.
Which of the following statements concerning this patient's condition is
correct? - correct answer- Surgery will improve 5-year survival
A 65-year-old man presents to the office with complaints of occasional
chest pain. The patient has a past medical history significant for
hypertension, diabetes mellitus, and hyperlipidemia. The patient states he
experiences chest pain on exertion, which is only relieved on rest. An
electrocardiogram is normal. Which of the following is the next step in
management? - correct answer- stress electrocardiogram
A 65-year-old man presents with complaints of chest pain that started 30
mins ago but stopped on his way to the hospital. The patient has a past
medical history significant for hypertension and diabetes mellitus. An
electrocardiogram (ECG) is normal. A stress ECG shows mild ST
elevations after 12 minutes of exercise. A diagnosis of stable angina is
made. Which of the following should be the first step in counseling the
patient about his condition? - correct answer- Determining the precipitating
factors for his condition
A 47-year-old male presents to the office for routine health maintenance.
His blood pressure is 182/138, with all other vital signs within normal
limits. The patient is currently complaining of a headache and blurred
vision but denies chest pain, shortness of breath, and abdominal pain. Under
which of the following forms of hypertension would this patient be
classified - correct answer- hypertensive emergency
A 65-year-old male with a history of type 2 diabetes comes into the
provider's office complaining of blurry vision, nosebleeds, and exertional
chest pain for the past six months. The blood pressure is measured to be
,160/94 mmHg. A CT angiogram is performed, which reveals partially
occlusive coronary artery plaques. Which of the following medication
regimens would be most appropriate for this patient? - correct answer-
Losartan/hydrochlorothiazide and atorvastatin
A 68-year-old male with a past medical history of type 2 diabetes mellitus
and diabetic nephropathy presented to the clinic for a follow-up
appointment. His blood pressure on the last visit was 150/90 mmHg. He
was called in for a follow-up appointment in 4 weeks to monitor his blood
pressure. The blood pressure on this visit is 168/105 mmHg, and HbA1c is
8.9%. His antihypertensive regimen was adjusted, and an ACE inhibitor
was added. He is on metformin and sitagliptin for diabetes mellitus. One
week later, his blood pressure was 130/80 mmHg, the patient's potassium
was 5.1 mEq/L, sodium was 133 mEq/L, and the rest of the renal panel was
within normal limits. He reports no symptoms. What is the next best step
in his care? - correct answer- Reassure him that this is expected from his
ACE inhibitor and continue therapy with periodic monitoring.
A 50-year-old man presents to the clinic for routine evaluation. His systolic
blood pressure has persistently been in the 150- 160 mmHg range.
Treatment with ramipril is initiated. On the next visit, he complained of an
itchy throat and a dry cough, which is not distressing for him, but he is
concerned that there might be something serious as he used to smoke but
quit 5 years ago. A chest x-ray is within normal limits. What is the next best
step in the management of this patient? - correct answer- Reassurance
A 65-year-old man presents for a review of his medications. The patient
states his blood pressure (BP) is always elevated whenever he checks it with
his digital BP monitoring machine, despite taking all of his medications. He
has a past medical history significant for hypertension, diabetes mellitus,
and hyperlipidemia. Laboratory evaluation reveals a normal random blood
glucose level and a normal lipid profile. Which of the following is the most
appropriate initial step before changing the patient's antihypertensive
medication? - correct answer- Assess the accuracy of his digital BP readings
, A 65-year-old man presents with episodic substernal pain. Initially, he
experienced chest pain with physical activity, which remits with rest. But
now it occurs at rest too. He has a history of hypertension and smokes 30
cigarettes/day. In addition, he has aspirin hypersensitivity. His blood
pressure is 145/90 mmHg, pulse is 78/min, and oxygen saturation is 97%.
Physical examination is unremarkable. ECG reveals mild ST-segment
depressions in V1-V2. Cardiac troponins are not elevated.
Which of the following is the best option for the management in this
patient? - correct answer- clopidogrel
A 65-year-old female patient presents with worsening chest pain and
blurring of vision. She has a history of hypertension, diabetes mellitus,
hyperlipidemia, renal insufficiency, and atrial fibrillation. Vital signs show
temperature 37.8°C (100 F), heart rate 98 bpm, blood pressure 190/110
mmHg, respiratory rate 20 breaths/min, and oxygen saturation 91%. Her
complete blood count shows a WBC of 12.0 and hematocrit 30%. Her
eGFR is 39 ml/min/1.73 m2. What is the contraindication for cardiac
catheterization in this patient? - correct answer- uncontrolled malignant
hypertension
A 65-year-old male presents to the emergency department with chest pain
for the past two hours. The pain is located at the precordial region,
described as sharp, 7/10 intensity, lasting for 20 minutes, radiating to the
upper left upper limb and accompanied by dyspnea. His past medical history
is significant for hypertension and diabetes mellitus type 2. His blood
pressure is 120/80 mmHg, the pulse rate 72/min; the temperature 98 F.
EKG reveals ST-segment depression. What is the best enzyme assay to
diagnose this condition? - correct answer- troponin
A 65-Year-Old Male Presents With Severe Substernal Pain For 20 Minutes,
Radiating To The Upper Left Limb And Accompanied By Dyspnea. He
ANSWERS 2025
A 67-year-old man with a history of hypertension and tobacco use presents
with a two-day history of hypogastric pain. An examination reveals a 5 cm,
non-tender, pulsatile abdominal mass above the umbilicus. Which of the
following type of sounds might be heard upon auscultation at the midline,
two inches cephalad to the umbilicus? - correct answer- blowing
What is the recommended management for a patient with a 3.5 cm
abdominal aortic aneurysm? - correct answer- ultrasound every 3 years
A 75-year-old man presents to the emergency department with complaints
of severe abdominal pain and sweating. The pain started about an hour ago
and is becoming worse with time. He has been diagnosed with hypertension
and diabetes and is on amlodipine and metformin, respectively. On
presentation, the vital signs show blood pressure 70/40 mmHg, pulse
140/min, respiratory rate 32/min, temperature 38.5 C (101.3 F), and oxygen
saturation 87% at room air. On physical examination of the abdomen,
generalized tenderness and guarding are seen.
There is a midline pulsatile mass. What is the next best step in the
management of this patient? - correct answer- immediate surgery
A 67-year-old male with a history of hypertension and nicotine dependence
presents to the emergency department with sudden onset of abdominal pain
radiating to the back. There is no history of alcohol use. On examination, he
is thin, pale, and diaphoretic. His vital signs show a blood pressure of
110/70 mmHg and a heart rate of 95 bpm. Which of the following is most
likely to confirm the diagnosis? - correct answer- abdominal CT
,A 78-year-old is found to have an asymptomatic pulsatile abdominal mass.
The ultrasound shows an abdominal aortic aneurysm measuring 5.5 cm.
Which of the following statements concerning this patient's condition is
correct? - correct answer- Surgery will improve 5-year survival
A 65-year-old man presents to the office with complaints of occasional
chest pain. The patient has a past medical history significant for
hypertension, diabetes mellitus, and hyperlipidemia. The patient states he
experiences chest pain on exertion, which is only relieved on rest. An
electrocardiogram is normal. Which of the following is the next step in
management? - correct answer- stress electrocardiogram
A 65-year-old man presents with complaints of chest pain that started 30
mins ago but stopped on his way to the hospital. The patient has a past
medical history significant for hypertension and diabetes mellitus. An
electrocardiogram (ECG) is normal. A stress ECG shows mild ST
elevations after 12 minutes of exercise. A diagnosis of stable angina is
made. Which of the following should be the first step in counseling the
patient about his condition? - correct answer- Determining the precipitating
factors for his condition
A 47-year-old male presents to the office for routine health maintenance.
His blood pressure is 182/138, with all other vital signs within normal
limits. The patient is currently complaining of a headache and blurred
vision but denies chest pain, shortness of breath, and abdominal pain. Under
which of the following forms of hypertension would this patient be
classified - correct answer- hypertensive emergency
A 65-year-old male with a history of type 2 diabetes comes into the
provider's office complaining of blurry vision, nosebleeds, and exertional
chest pain for the past six months. The blood pressure is measured to be
,160/94 mmHg. A CT angiogram is performed, which reveals partially
occlusive coronary artery plaques. Which of the following medication
regimens would be most appropriate for this patient? - correct answer-
Losartan/hydrochlorothiazide and atorvastatin
A 68-year-old male with a past medical history of type 2 diabetes mellitus
and diabetic nephropathy presented to the clinic for a follow-up
appointment. His blood pressure on the last visit was 150/90 mmHg. He
was called in for a follow-up appointment in 4 weeks to monitor his blood
pressure. The blood pressure on this visit is 168/105 mmHg, and HbA1c is
8.9%. His antihypertensive regimen was adjusted, and an ACE inhibitor
was added. He is on metformin and sitagliptin for diabetes mellitus. One
week later, his blood pressure was 130/80 mmHg, the patient's potassium
was 5.1 mEq/L, sodium was 133 mEq/L, and the rest of the renal panel was
within normal limits. He reports no symptoms. What is the next best step
in his care? - correct answer- Reassure him that this is expected from his
ACE inhibitor and continue therapy with periodic monitoring.
A 50-year-old man presents to the clinic for routine evaluation. His systolic
blood pressure has persistently been in the 150- 160 mmHg range.
Treatment with ramipril is initiated. On the next visit, he complained of an
itchy throat and a dry cough, which is not distressing for him, but he is
concerned that there might be something serious as he used to smoke but
quit 5 years ago. A chest x-ray is within normal limits. What is the next best
step in the management of this patient? - correct answer- Reassurance
A 65-year-old man presents for a review of his medications. The patient
states his blood pressure (BP) is always elevated whenever he checks it with
his digital BP monitoring machine, despite taking all of his medications. He
has a past medical history significant for hypertension, diabetes mellitus,
and hyperlipidemia. Laboratory evaluation reveals a normal random blood
glucose level and a normal lipid profile. Which of the following is the most
appropriate initial step before changing the patient's antihypertensive
medication? - correct answer- Assess the accuracy of his digital BP readings
, A 65-year-old man presents with episodic substernal pain. Initially, he
experienced chest pain with physical activity, which remits with rest. But
now it occurs at rest too. He has a history of hypertension and smokes 30
cigarettes/day. In addition, he has aspirin hypersensitivity. His blood
pressure is 145/90 mmHg, pulse is 78/min, and oxygen saturation is 97%.
Physical examination is unremarkable. ECG reveals mild ST-segment
depressions in V1-V2. Cardiac troponins are not elevated.
Which of the following is the best option for the management in this
patient? - correct answer- clopidogrel
A 65-year-old female patient presents with worsening chest pain and
blurring of vision. She has a history of hypertension, diabetes mellitus,
hyperlipidemia, renal insufficiency, and atrial fibrillation. Vital signs show
temperature 37.8°C (100 F), heart rate 98 bpm, blood pressure 190/110
mmHg, respiratory rate 20 breaths/min, and oxygen saturation 91%. Her
complete blood count shows a WBC of 12.0 and hematocrit 30%. Her
eGFR is 39 ml/min/1.73 m2. What is the contraindication for cardiac
catheterization in this patient? - correct answer- uncontrolled malignant
hypertension
A 65-year-old male presents to the emergency department with chest pain
for the past two hours. The pain is located at the precordial region,
described as sharp, 7/10 intensity, lasting for 20 minutes, radiating to the
upper left upper limb and accompanied by dyspnea. His past medical history
is significant for hypertension and diabetes mellitus type 2. His blood
pressure is 120/80 mmHg, the pulse rate 72/min; the temperature 98 F.
EKG reveals ST-segment depression. What is the best enzyme assay to
diagnose this condition? - correct answer- troponin
A 65-Year-Old Male Presents With Severe Substernal Pain For 20 Minutes,
Radiating To The Upper Left Limb And Accompanied By Dyspnea. He
