NR 509 Midterm Exam: (Latest 2026/2027 Update) Advanced Health
Assessment | Q&A | Grade A | 100% Correct (Verified Answers) – Chamberlain
University
Subject: Advanced Health Assessment – Dermatology, Neurology, Cardiology, Pulmonary, HEENT,
Musculoskeletal, Mental Status
Source: NR 509 Midterm Exam / Chamberlain University / Bates' Guide to Physical Examination
(2026/2027 Update)
Format: Q&A Guide with Clinical Rationales | Grade A Guaranteed
1. An 18-year-old patient comes to the office for evaluation of a rash. At first there was only one
large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On
physical examination, you note that the pattern of eruption is like a Christmas tree and that there
are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this
description, what is the most likely diagnosis?
Correct Answer: Pityriasis rosea
1. Pityriasis rosea classically begins with a herald patch followed by a Christmas tree pattern
distribution along skin cleavage lines (Langer's lines).
2. It is self-limiting, often pruritic, and typically resolves in 6-8 weeks. No treatment is usually
required.
2. A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his
back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. On physical
examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales,
scattered more prominently around the upper back, chest, neck, and upper arms as well as under
the arms. Based on this description, what is your most likely diagnosis?
Correct Answer: Tinea versicolor
1. Tinea versicolor (pityriasis versicolor) is caused by Malassezia species and presents with
hypopigmented or hyperpigmented macules with fine scale on the upper trunk and arms.
2. It is more common in hot, humid environments and in individuals who sweat heavily.
Treatment includes topical antifungals (ketoconazole, selenium sulfide).
3. You are examining a child with severe cerebral palsy. When you suddenly move his foot dorsally,
a sustained "beating" of the foot against your hand ensues. What does this represent?
Correct Answer: Clonus
1. Clonus is a sign of upper motor neuron lesion, indicating hyperreflexia and loss of inhibitory
control from the cortex.
2. Sustained clonus (>3-5 beats) is abnormal and suggests conditions such as cerebral palsy,
stroke, or spinal cord injury.
, 4. A patient presents with a daily headache which has worsened over the past several months. On
funduscopic examination, you notice that the disk edge is indistinct and the veins do not pulsate.
Which is most likely?
Correct Answer: Increased intracranial pressure
1. Papilledema (blurred disc margins and loss of venous pulsations) is a sign of increased
intracranial pressure.
2. This requires urgent neuroimaging (CT or MRI) to evaluate for mass, hydrocephalus, or
pseudotumor cerebri.
5. A patient complains of epistaxis. Which other cause should be considered?
Correct Answer: Hematemesis
1. Blood from epistaxis can be swallowed and later vomited, presenting as hematemesis.
2. Conversely, hematemesis from upper GI bleeding may present with epistaxis due to retrograde
flow through the nasopharynx.
6. A patient complains of shortness of breath for the past few days. On examination, you note late
inspiratory crackles in the lower third of the chest that were not present a week ago. What is the
most likely explanation for these?
Correct Answer: Heart failure
1. Late inspiratory crackles (pulmonary edema) are characteristic of heart failure due to fluid
transudation into the alveoli.
2. Crackles are first heard in the dependent lung fields (lower third) and progress upward as heart
failure worsens.
7. You are excited about a positive test finding you have just noticed on physical examination of your
patient. You go on to do more examination, laboratory work, and diagnostic tests, only to find that
there is no sign of the disease you thought would correlate with the finding. This same experience
happens several times. What should you conclude?
Correct Answer: Continue using the test, perhaps doing less laboratory work and diagnostics.
1. A positive physical exam finding with negative confirmatory testing may indicate that the
physical exam finding is sensitive but not specific, or that the gold standard test is imperfect.
2. Repeated false positives may suggest the need to refine technique or understand the test's
predictive value in different populations.
8. A 50-year-old woman presents with a new complaint of headache. The patient states, "this is
worst headache of my life". Her concurrent conditions includes hypertension. Her history includes
habitual ER visits for various complaints and panic attacks. Her most recent ER visit was last week.
Today her BP is 200/110 with a HR of 95. Of the following diagnoses, which etiology has the highest
priority?
Correct Answer: Subarachnoid hemorrhage
1. "Worst headache of my life" is a classic description for subarachnoid hemorrhage (SAH) until
proven otherwise.
2. Hypertensive emergency and thunderclap headache with this history require immediate non-
contrast head CT and possible lumbar puncture.
Assessment | Q&A | Grade A | 100% Correct (Verified Answers) – Chamberlain
University
Subject: Advanced Health Assessment – Dermatology, Neurology, Cardiology, Pulmonary, HEENT,
Musculoskeletal, Mental Status
Source: NR 509 Midterm Exam / Chamberlain University / Bates' Guide to Physical Examination
(2026/2027 Update)
Format: Q&A Guide with Clinical Rationales | Grade A Guaranteed
1. An 18-year-old patient comes to the office for evaluation of a rash. At first there was only one
large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On
physical examination, you note that the pattern of eruption is like a Christmas tree and that there
are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this
description, what is the most likely diagnosis?
Correct Answer: Pityriasis rosea
1. Pityriasis rosea classically begins with a herald patch followed by a Christmas tree pattern
distribution along skin cleavage lines (Langer's lines).
2. It is self-limiting, often pruritic, and typically resolves in 6-8 weeks. No treatment is usually
required.
2. A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his
back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. On physical
examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales,
scattered more prominently around the upper back, chest, neck, and upper arms as well as under
the arms. Based on this description, what is your most likely diagnosis?
Correct Answer: Tinea versicolor
1. Tinea versicolor (pityriasis versicolor) is caused by Malassezia species and presents with
hypopigmented or hyperpigmented macules with fine scale on the upper trunk and arms.
2. It is more common in hot, humid environments and in individuals who sweat heavily.
Treatment includes topical antifungals (ketoconazole, selenium sulfide).
3. You are examining a child with severe cerebral palsy. When you suddenly move his foot dorsally,
a sustained "beating" of the foot against your hand ensues. What does this represent?
Correct Answer: Clonus
1. Clonus is a sign of upper motor neuron lesion, indicating hyperreflexia and loss of inhibitory
control from the cortex.
2. Sustained clonus (>3-5 beats) is abnormal and suggests conditions such as cerebral palsy,
stroke, or spinal cord injury.
, 4. A patient presents with a daily headache which has worsened over the past several months. On
funduscopic examination, you notice that the disk edge is indistinct and the veins do not pulsate.
Which is most likely?
Correct Answer: Increased intracranial pressure
1. Papilledema (blurred disc margins and loss of venous pulsations) is a sign of increased
intracranial pressure.
2. This requires urgent neuroimaging (CT or MRI) to evaluate for mass, hydrocephalus, or
pseudotumor cerebri.
5. A patient complains of epistaxis. Which other cause should be considered?
Correct Answer: Hematemesis
1. Blood from epistaxis can be swallowed and later vomited, presenting as hematemesis.
2. Conversely, hematemesis from upper GI bleeding may present with epistaxis due to retrograde
flow through the nasopharynx.
6. A patient complains of shortness of breath for the past few days. On examination, you note late
inspiratory crackles in the lower third of the chest that were not present a week ago. What is the
most likely explanation for these?
Correct Answer: Heart failure
1. Late inspiratory crackles (pulmonary edema) are characteristic of heart failure due to fluid
transudation into the alveoli.
2. Crackles are first heard in the dependent lung fields (lower third) and progress upward as heart
failure worsens.
7. You are excited about a positive test finding you have just noticed on physical examination of your
patient. You go on to do more examination, laboratory work, and diagnostic tests, only to find that
there is no sign of the disease you thought would correlate with the finding. This same experience
happens several times. What should you conclude?
Correct Answer: Continue using the test, perhaps doing less laboratory work and diagnostics.
1. A positive physical exam finding with negative confirmatory testing may indicate that the
physical exam finding is sensitive but not specific, or that the gold standard test is imperfect.
2. Repeated false positives may suggest the need to refine technique or understand the test's
predictive value in different populations.
8. A 50-year-old woman presents with a new complaint of headache. The patient states, "this is
worst headache of my life". Her concurrent conditions includes hypertension. Her history includes
habitual ER visits for various complaints and panic attacks. Her most recent ER visit was last week.
Today her BP is 200/110 with a HR of 95. Of the following diagnoses, which etiology has the highest
priority?
Correct Answer: Subarachnoid hemorrhage
1. "Worst headache of my life" is a classic description for subarachnoid hemorrhage (SAH) until
proven otherwise.
2. Hypertensive emergency and thunderclap headache with this history require immediate non-
contrast head CT and possible lumbar puncture.
