NR509 FINAL EXAM TEST BANK WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED DETAILED
RATIONALES ANSWERS BY EXPERTS
Page | 1
|FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS | 2024 NEWEST |ALREADY GRADED
A+|LATEST UPDATE
A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A rubbery, mobile,
nontender mass is palpated in the right breast as described by the patient, which is consistent with a
firbroadenoma. In describing the location of the mass, the examiner notes that it is 3 cm proximal to and
3 cm to the left of the nipple. Which of the following would be the most appropriate way to report this
finding?
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from the nipple"
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple"
A 54-year-old female dietician presents for a routine annual examination. On review of systems, she
reports that she has had many breast findings over several years, including one biopsy with normal
pathology. She feels that her breasts have become far less lumpy since she underwent menopause 3
years ago. Which of the following is true regarding changes in the breasts with menopause?
a. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity and
specificity of mammograms.
b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after menopause.
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of
lobules.
d. Breast density has no genetic component and is entirely due to estrogen dose from endogenous and
exogenous sources over the lifetime.
e. Mammography performs most poorly in the menopausal and postmenopa
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of
lobules.
An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of
intense abdominal pain, light-headedness, and a fainting episode that finally prompted her to seek
medical attention. She has a strong family history of gallstones and is concerned about this possibility.
She has not had any vomiting or diarrhea. She had a normal bowel movement this morning. Her
, βhuman chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10
weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min;
oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior
to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness.
What is the most likely diagnosis?
Page | 2
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. P
a. Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs
are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also
measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase, alanine
aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appointment and the clinician performs an abdominal exam to
assess his liver. Which of the following findings would be most consistent with hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expir
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history presents with a
several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise and
denies any nausea, vomiting, diarrhea, or constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92; respiratory
rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her
abdominal aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of
the following is her most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
b. History of smoking
A 76-year-old retired man with a history of prostate cancer and hypertension has been screened
annually for colon cancer using high sensitivity fecal occult blood testing (FOBT). He presents for
followup of his hypertension, during which the clinician scans his chart to ensure he is up to date with
, his preventive health care. He has a positive FOBT on one occasion at age 66 years and subsequently
went for a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on colonoscopy. He
has no first-degree relatives with a history of colorectal cancer or adenomatous polyps. What are the
U.S. Preventive Services Task Force (USPSTF) screening recommendations for this patient?
Page | 3 a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
a. Do not screen routinely
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-year history of
recurrent crampy abdominal pain that lasts for about 1-2 weeks each episode and is associated with
onset of constipation. She describes infrequent, small hard stool that she finds very difficult to pass. She
has tried to increase dietary fiber and water intake, but usually this is not sufficient and she resorts to
over-the-counter laxatives, which she finds upset her stomach but do resolve the constipation.
Symptoms typically gradually resolve with bowel movements. Which of the following is the most likely
physiological mechanism for her constipation?
a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
c. Functional change in bowel movement
A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis and
bronchiectasis that is associated with a rare congenital condition called Kartagener syndrome. The
preceptor notes that she has situs inversus and asks for a physical exam. Which of the following
descriptions best fits with findings on the abdominal exam?
a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low diaphragm due to
chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest wall on inspiration
a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-day history of
severe abdominal pain. The emergency physician suspects appendicitis and general surgery is consulted.
The resident believes the patient has signs of peritonitis on exam. Which of the following physical exam
findings supports peritonitis?
, a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous
Page | 4 process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the last 10
months. He presents with a 4-month history of increasing weakness, recurrent epigastric pain radiating
to his back, chronic diarrhea with stools 6-8 times daily, and weight loss of 18 lb over 4 months. What is
the mechanism of his most likely diagnosis?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
e. Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a family medicine clinic with a
3-month course of recurrent severe abdominal pain that usually resolves on its own after a few hours.
Her last episode was prolonged lasting 6 hours, and she is frustrated that she has had to leave or miss
work on three separate occasions. She would like a diagnosis and the problem fixed. Which symptoms
or signs would be most suggestive of a diagnosis of biliary colic?
a. Exacerbating factor includes alcohol intake
b. Positive McBurney point tenderness
c. Poorly localized periumbilical pain
d. Vomiting of bile
e. Associated right shoulder pain
e. Associated right shoulder pain
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his
yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While
counseling him, the clinician mentions that multiple processes must take place to achieve an erection.
Which of the following structures would be most affected by vascular deficiencies related to his
preexisting medical conditions and is likely contributing to his symptoms?
a. Corpora cavernosa
b. Ejaculatory duct
c. Epididymis
CORRECT QUESTIONS AND VERIFIED DETAILED
RATIONALES ANSWERS BY EXPERTS
Page | 1
|FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS | 2024 NEWEST |ALREADY GRADED
A+|LATEST UPDATE
A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A rubbery, mobile,
nontender mass is palpated in the right breast as described by the patient, which is consistent with a
firbroadenoma. In describing the location of the mass, the examiner notes that it is 3 cm proximal to and
3 cm to the left of the nipple. Which of the following would be the most appropriate way to report this
finding?
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from the nipple"
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple"
A 54-year-old female dietician presents for a routine annual examination. On review of systems, she
reports that she has had many breast findings over several years, including one biopsy with normal
pathology. She feels that her breasts have become far less lumpy since she underwent menopause 3
years ago. Which of the following is true regarding changes in the breasts with menopause?
a. Transformation of breasts to primarily fatty tissue with menopause decreases the sensitivity and
specificity of mammograms.
b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after menopause.
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of
lobules.
d. Breast density has no genetic component and is entirely due to estrogen dose from endogenous and
exogenous sources over the lifetime.
e. Mammography performs most poorly in the menopausal and postmenopa
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of
lobules.
An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of
intense abdominal pain, light-headedness, and a fainting episode that finally prompted her to seek
medical attention. She has a strong family history of gallstones and is concerned about this possibility.
She has not had any vomiting or diarrhea. She had a normal bowel movement this morning. Her
, βhuman chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10
weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min;
oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior
to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness.
What is the most likely diagnosis?
Page | 2
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. P
a. Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs
are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also
measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase, alanine
aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appointment and the clinician performs an abdominal exam to
assess his liver. Which of the following findings would be most consistent with hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expir
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history presents with a
several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise and
denies any nausea, vomiting, diarrhea, or constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92; respiratory
rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her
abdominal aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of
the following is her most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
b. History of smoking
A 76-year-old retired man with a history of prostate cancer and hypertension has been screened
annually for colon cancer using high sensitivity fecal occult blood testing (FOBT). He presents for
followup of his hypertension, during which the clinician scans his chart to ensure he is up to date with
, his preventive health care. He has a positive FOBT on one occasion at age 66 years and subsequently
went for a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on colonoscopy. He
has no first-degree relatives with a history of colorectal cancer or adenomatous polyps. What are the
U.S. Preventive Services Task Force (USPSTF) screening recommendations for this patient?
Page | 3 a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
a. Do not screen routinely
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-year history of
recurrent crampy abdominal pain that lasts for about 1-2 weeks each episode and is associated with
onset of constipation. She describes infrequent, small hard stool that she finds very difficult to pass. She
has tried to increase dietary fiber and water intake, but usually this is not sufficient and she resorts to
over-the-counter laxatives, which she finds upset her stomach but do resolve the constipation.
Symptoms typically gradually resolve with bowel movements. Which of the following is the most likely
physiological mechanism for her constipation?
a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
c. Functional change in bowel movement
A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis and
bronchiectasis that is associated with a rare congenital condition called Kartagener syndrome. The
preceptor notes that she has situs inversus and asks for a physical exam. Which of the following
descriptions best fits with findings on the abdominal exam?
a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low diaphragm due to
chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest wall on inspiration
a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-day history of
severe abdominal pain. The emergency physician suspects appendicitis and general surgery is consulted.
The resident believes the patient has signs of peritonitis on exam. Which of the following physical exam
findings supports peritonitis?
, a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous
Page | 4 process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the last 10
months. He presents with a 4-month history of increasing weakness, recurrent epigastric pain radiating
to his back, chronic diarrhea with stools 6-8 times daily, and weight loss of 18 lb over 4 months. What is
the mechanism of his most likely diagnosis?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
e. Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a family medicine clinic with a
3-month course of recurrent severe abdominal pain that usually resolves on its own after a few hours.
Her last episode was prolonged lasting 6 hours, and she is frustrated that she has had to leave or miss
work on three separate occasions. She would like a diagnosis and the problem fixed. Which symptoms
or signs would be most suggestive of a diagnosis of biliary colic?
a. Exacerbating factor includes alcohol intake
b. Positive McBurney point tenderness
c. Poorly localized periumbilical pain
d. Vomiting of bile
e. Associated right shoulder pain
e. Associated right shoulder pain
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his
yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While
counseling him, the clinician mentions that multiple processes must take place to achieve an erection.
Which of the following structures would be most affected by vascular deficiencies related to his
preexisting medical conditions and is likely contributing to his symptoms?
a. Corpora cavernosa
b. Ejaculatory duct
c. Epididymis
