MSN 621 UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔A female presents with progressive confusion over weeks with memory loss. She
has a slight fever at 100.4 F. Prior to cognitive changes, she had been complaining of
arthralgias. History is otherwise unremarkable except for the fact she is an avid camper.
Which of the following is the initial diagnostic test that should be ordered? - ✔✔Serology
✔✔A 50-year-old woman with metastatic ovarian cancer requires at least 12 hours of
active nursing care because of a worsening condition. What is the best description for
this patient's level of hospice service under the Medical Hospice Benefit? -
✔✔Continuous home hospice care
✔✔A 37-year-old woman presents to her clinic with complaints of aching pain in the
breast for six months which is worse before her periods. She is apprehensive as her
mother-in-law has been recently diagnosed with breast cancer. On examination, the
breasts feel lumpy with greenish discharge from the right nipple. Ultrasound reveals
focal areas of thickening of the parenchyma and multiple small cysts. Core biopsy
reveals cystically dilated ducts, with a few ducts showing atypical epithelial hyperplasia
surrounded by dense fibrosis. Which of the following best estimates the patient's risk of
breast cancer? - ✔✔1 to 2 times the normal population
✔✔A 24-year-old woman presents to the office for evaluation of a tender breast
swelling. The patient states she noticed the swelling last week while taking a shower.
She is sexually active and uses oral contraceptive pills regularly. The patient is
concerned as her mother died from metastatic breast cancer 2 years ago. On
examination, a 2x1 cm size lump is present in the upper lateral quadrant of the right
breast. The lump is rubbery in texture and is mobile. A biopsy is performed, and the
histopathology findings are shown in the figure. What is the most likely diagnosis? (see
photo) - ✔✔Fibroadenosis with dystrophic calcifications
✔✔A 65-year-old woman with a past medical history of hypertension, well-controlled
diabetes mellitus, and transient ischemic attacks presents to the clinic for abdominal
bloating for the last four months. Abdominal distension is noted on examination. Further
evaluation by a CT scan abdomen shows liver lesions, ascites, and pleural effusion with
lung lesions. The biopsy of the lesions is consistent with primary ovarian cancer. CA-
125 is elevated. She is negative for BRCA 1 and BRCA 2. Which of the following is the
most appropriate first-line therapy for this patient? - ✔✔Carboplatin with paclitaxel
✔✔A 36-year-old woman presents to the clinic for her annual visit. She is sexually
active, has no children, and her medications include oral contraceptive pills and a daily
multivitamin. Her menses are regular, with mild cramps. She does not smoke tobacco or
drink alcohol. Her family history is significant for a mother diagnosed at 45 years of age
with ovarian cancer. Physical exam, including bimanual exam, is normal. She asks the
,clinician about ovarian cancer screening. Which of the following best describes this
screening? - ✔✔Ovarian cancer screening may be offered to women at high risk
✔✔A 31-year-old female attends the clinics with a complaint of being unable to
conceive. She has been having regular unprotected intercourse for the last 18 months
but still unable to conceive. Her periods are regular every 28 days which last for 4-5
days. She has a history of lower abdominal pain starting a day before her menstruation.
She has been taking paracetamol and mefenamic acid with minimal relief. She has no
other relevant history, and she is a teetotaler and denies smoking. On examination, her
blood pressure is 123/76 mmHg, and her pulse is 81 bpm, her body mass index is 29
kg/m2. On bimanual pelvic examination, there is tenderness on the left side for her
abdomen. What the most appropriate next step in management? - ✔✔Pelvic ultrasound
✔✔A 22-year-old woman presents to the clinic with a history of lower abdominal pain for
the past six months. There is no history of dysuria and dyspareunia. There is no
relevant family history of cancer. The patient noticed that the pain increases during the
first two days of her period. The periods are regular and slightly heavier than usual. She
has to change 6 to 7 pads per day. The patient's blood pressure is 120/80 mmHg, pulse
63/minute, and the temperature is 36.1 C. She denies any loss of weight. The pelvic
examination shows a globularly enlarged and retroverted uterus. The pregnancy test is
negative. She has a recent pelvic ultrasound, which showed some evidence of
endometriosis. What is the most likely diagnosis for this patient? - ✔✔Secondary
dysmenorrhea
✔✔A 65-year-old female presents with complaints of decreased libido. She has been
happily married for 30 years and has no relationship issues. She is physically active and
exercises 30 minutes daily. She complains of vaginal dryness and painful intercourse.
She also complains of frequent vaginal itching. She has tried vaginal lubricants with mild
symptomatic relief. On examination, the vaginal mucosa is pale and dry. She has a past
medical history of diabetes mellitus that is well controlled with metformin. Family history
is significant for colon cancer in her maternal aunt. Which of the following would be the
most effective treatment for this patient's symptoms? - ✔✔Topical estrogen preparation
✔✔A 42-year-old patient comes to the clinic for her annual appointment. She currently
feels well. Her vital signs are within normal limits. She is up to date on her screenings
and vaccinations. She does not smoke or take illicit drugs. She drinks a glass of wine
every day before dinner. She is sexually active and takes oral contraceptive pills. She
has 3 children through normal vaginal deliveries, who are all healthy. Family history is
insignificant. Past medical problems include anxiety and obesity. Which of the following
is a protective factor in this patient for the development of ovarian cancer? -
✔✔Multiparity
✔✔A 35-year-old nulliparous woman presents for a check-up. She currently has no
symptoms. She does not smoke or ingest illicit drugs. She drinks one glass of wine after
dinner every night. Her vitals are within the normal range. She is sexually active with her
, husband and uses contraceptive pills. Menarche was at 14. Menses are regular, with
normal flow and mild cramps. Her past medical problems include obesity. Her BMI is 30
kg/m2. Family history is significant for breast cancer in the paternal grandmother and
ovarian cancer in the mother. She is up to date with her screenings and vaccinations.
After her family history, which of the following is the most important risk factor for the
development of ovarian cancer in this patient? - ✔✔nulliparity
✔✔A 25-year-old G0P0 female presents with intermittent abdominal pain. She states
that the pain starts before her period, is "crampy" in nature, and lasts for a few days
after, and has been occurring intermittently since menarche. Her periods have been
regular, with no spotting or pain in between periods. Her last period was a week ago.
She has no other health issues and takes no medications. She has had no previous
surgeries in the past. She is currently sexually active with her husband and is interested
in starting a family shortly. What is the first line of treatment for this patient? -
✔✔NSAIDS
✔✔A 65-year-old woman with a BMI of 32 kg/m2 comes to the clinician with a complaint
of two episodes of vaginal bleeding in the past 40 days. She has a past medical history
of hypertension and diabetes mellitus type 2. On both occasions, light spotting lasted for
three days. She experienced menopause at the age of 56 years. Currently, she is
afebrile and hemodynamically stable with an unremarkable physical examination. She
takes metformin and lisinopril. What is the first-line imaging study to evaluate a patient
with this complaint? - ✔✔Transvaginal ultrasound
✔✔An 18-year-old white female presents for a wellness examination. After some
questioning, she admits to heavy menstrual cycles that are 28 days apart and last 7-8
days. She reports the passage of clots and on her heaviest days, having to change her
pads every 1-2 hours. She is not sexually active and denies any significant past medical
history. She does admit to an episode of heavy bleeding after tooth extraction for braces
when she was 13 years old. The physical examination is unremarkable except for
scattered ecchymoses on her bilateral shins. Which of the following is the most
appropriate step in the diagnosis of this patient? - ✔✔Coagulopathy studies
✔✔A 51-year-old female presents with a chief complaint of irregular, heavy menstrual
bleeding for the past six months. She reports previously regular cycles every 30 days,
lasting 4 to 6 days, with medium flow. She reports her cycles are now occurring every
30 to 45 days, lasting anywhere from 5 to 12 days, with heavy flow and the occasional
passing of clots. On exam, her BMI is 30.2, and her vitals are within normal limits. Along
with a pelvic examination, what is the next most appropriate step in evaluating this
patient? - ✔✔Endometrial sampling
✔✔A 65-year-old nulligravid woman presents to the clinic with complaints of vaginal
bleeding and vague abdominal pain. She says she has not been feeling well for the past
three months. She denies any weight loss and has not seen a healthcare provider for
the past five years. She smokes one pack of cigarettes per day, and her BMI is 29
SOLUTIONS RATED A+
✔✔A female presents with progressive confusion over weeks with memory loss. She
has a slight fever at 100.4 F. Prior to cognitive changes, she had been complaining of
arthralgias. History is otherwise unremarkable except for the fact she is an avid camper.
Which of the following is the initial diagnostic test that should be ordered? - ✔✔Serology
✔✔A 50-year-old woman with metastatic ovarian cancer requires at least 12 hours of
active nursing care because of a worsening condition. What is the best description for
this patient's level of hospice service under the Medical Hospice Benefit? -
✔✔Continuous home hospice care
✔✔A 37-year-old woman presents to her clinic with complaints of aching pain in the
breast for six months which is worse before her periods. She is apprehensive as her
mother-in-law has been recently diagnosed with breast cancer. On examination, the
breasts feel lumpy with greenish discharge from the right nipple. Ultrasound reveals
focal areas of thickening of the parenchyma and multiple small cysts. Core biopsy
reveals cystically dilated ducts, with a few ducts showing atypical epithelial hyperplasia
surrounded by dense fibrosis. Which of the following best estimates the patient's risk of
breast cancer? - ✔✔1 to 2 times the normal population
✔✔A 24-year-old woman presents to the office for evaluation of a tender breast
swelling. The patient states she noticed the swelling last week while taking a shower.
She is sexually active and uses oral contraceptive pills regularly. The patient is
concerned as her mother died from metastatic breast cancer 2 years ago. On
examination, a 2x1 cm size lump is present in the upper lateral quadrant of the right
breast. The lump is rubbery in texture and is mobile. A biopsy is performed, and the
histopathology findings are shown in the figure. What is the most likely diagnosis? (see
photo) - ✔✔Fibroadenosis with dystrophic calcifications
✔✔A 65-year-old woman with a past medical history of hypertension, well-controlled
diabetes mellitus, and transient ischemic attacks presents to the clinic for abdominal
bloating for the last four months. Abdominal distension is noted on examination. Further
evaluation by a CT scan abdomen shows liver lesions, ascites, and pleural effusion with
lung lesions. The biopsy of the lesions is consistent with primary ovarian cancer. CA-
125 is elevated. She is negative for BRCA 1 and BRCA 2. Which of the following is the
most appropriate first-line therapy for this patient? - ✔✔Carboplatin with paclitaxel
✔✔A 36-year-old woman presents to the clinic for her annual visit. She is sexually
active, has no children, and her medications include oral contraceptive pills and a daily
multivitamin. Her menses are regular, with mild cramps. She does not smoke tobacco or
drink alcohol. Her family history is significant for a mother diagnosed at 45 years of age
with ovarian cancer. Physical exam, including bimanual exam, is normal. She asks the
,clinician about ovarian cancer screening. Which of the following best describes this
screening? - ✔✔Ovarian cancer screening may be offered to women at high risk
✔✔A 31-year-old female attends the clinics with a complaint of being unable to
conceive. She has been having regular unprotected intercourse for the last 18 months
but still unable to conceive. Her periods are regular every 28 days which last for 4-5
days. She has a history of lower abdominal pain starting a day before her menstruation.
She has been taking paracetamol and mefenamic acid with minimal relief. She has no
other relevant history, and she is a teetotaler and denies smoking. On examination, her
blood pressure is 123/76 mmHg, and her pulse is 81 bpm, her body mass index is 29
kg/m2. On bimanual pelvic examination, there is tenderness on the left side for her
abdomen. What the most appropriate next step in management? - ✔✔Pelvic ultrasound
✔✔A 22-year-old woman presents to the clinic with a history of lower abdominal pain for
the past six months. There is no history of dysuria and dyspareunia. There is no
relevant family history of cancer. The patient noticed that the pain increases during the
first two days of her period. The periods are regular and slightly heavier than usual. She
has to change 6 to 7 pads per day. The patient's blood pressure is 120/80 mmHg, pulse
63/minute, and the temperature is 36.1 C. She denies any loss of weight. The pelvic
examination shows a globularly enlarged and retroverted uterus. The pregnancy test is
negative. She has a recent pelvic ultrasound, which showed some evidence of
endometriosis. What is the most likely diagnosis for this patient? - ✔✔Secondary
dysmenorrhea
✔✔A 65-year-old female presents with complaints of decreased libido. She has been
happily married for 30 years and has no relationship issues. She is physically active and
exercises 30 minutes daily. She complains of vaginal dryness and painful intercourse.
She also complains of frequent vaginal itching. She has tried vaginal lubricants with mild
symptomatic relief. On examination, the vaginal mucosa is pale and dry. She has a past
medical history of diabetes mellitus that is well controlled with metformin. Family history
is significant for colon cancer in her maternal aunt. Which of the following would be the
most effective treatment for this patient's symptoms? - ✔✔Topical estrogen preparation
✔✔A 42-year-old patient comes to the clinic for her annual appointment. She currently
feels well. Her vital signs are within normal limits. She is up to date on her screenings
and vaccinations. She does not smoke or take illicit drugs. She drinks a glass of wine
every day before dinner. She is sexually active and takes oral contraceptive pills. She
has 3 children through normal vaginal deliveries, who are all healthy. Family history is
insignificant. Past medical problems include anxiety and obesity. Which of the following
is a protective factor in this patient for the development of ovarian cancer? -
✔✔Multiparity
✔✔A 35-year-old nulliparous woman presents for a check-up. She currently has no
symptoms. She does not smoke or ingest illicit drugs. She drinks one glass of wine after
dinner every night. Her vitals are within the normal range. She is sexually active with her
, husband and uses contraceptive pills. Menarche was at 14. Menses are regular, with
normal flow and mild cramps. Her past medical problems include obesity. Her BMI is 30
kg/m2. Family history is significant for breast cancer in the paternal grandmother and
ovarian cancer in the mother. She is up to date with her screenings and vaccinations.
After her family history, which of the following is the most important risk factor for the
development of ovarian cancer in this patient? - ✔✔nulliparity
✔✔A 25-year-old G0P0 female presents with intermittent abdominal pain. She states
that the pain starts before her period, is "crampy" in nature, and lasts for a few days
after, and has been occurring intermittently since menarche. Her periods have been
regular, with no spotting or pain in between periods. Her last period was a week ago.
She has no other health issues and takes no medications. She has had no previous
surgeries in the past. She is currently sexually active with her husband and is interested
in starting a family shortly. What is the first line of treatment for this patient? -
✔✔NSAIDS
✔✔A 65-year-old woman with a BMI of 32 kg/m2 comes to the clinician with a complaint
of two episodes of vaginal bleeding in the past 40 days. She has a past medical history
of hypertension and diabetes mellitus type 2. On both occasions, light spotting lasted for
three days. She experienced menopause at the age of 56 years. Currently, she is
afebrile and hemodynamically stable with an unremarkable physical examination. She
takes metformin and lisinopril. What is the first-line imaging study to evaluate a patient
with this complaint? - ✔✔Transvaginal ultrasound
✔✔An 18-year-old white female presents for a wellness examination. After some
questioning, she admits to heavy menstrual cycles that are 28 days apart and last 7-8
days. She reports the passage of clots and on her heaviest days, having to change her
pads every 1-2 hours. She is not sexually active and denies any significant past medical
history. She does admit to an episode of heavy bleeding after tooth extraction for braces
when she was 13 years old. The physical examination is unremarkable except for
scattered ecchymoses on her bilateral shins. Which of the following is the most
appropriate step in the diagnosis of this patient? - ✔✔Coagulopathy studies
✔✔A 51-year-old female presents with a chief complaint of irregular, heavy menstrual
bleeding for the past six months. She reports previously regular cycles every 30 days,
lasting 4 to 6 days, with medium flow. She reports her cycles are now occurring every
30 to 45 days, lasting anywhere from 5 to 12 days, with heavy flow and the occasional
passing of clots. On exam, her BMI is 30.2, and her vitals are within normal limits. Along
with a pelvic examination, what is the next most appropriate step in evaluating this
patient? - ✔✔Endometrial sampling
✔✔A 65-year-old nulligravid woman presents to the clinic with complaints of vaginal
bleeding and vague abdominal pain. She says she has not been feeling well for the past
three months. She denies any weight loss and has not seen a healthcare provider for
the past five years. She smokes one pack of cigarettes per day, and her BMI is 29
