NUR 634 Midterm Exam Questions and
Correct Answers
Question 1
A patient has possible strep throat what will you see on physical exam that is
indicative of this infection?
Correct Answer
1. White patches (exudate) on tonsils
2. Enlarged tonsils, grade them, sit behind tonsillar pillars
3. Fever > 100.5
4. Enlargement of Submandibular and posterior cervical lymph nodes
Pt complains of sore throat but NO cough
Question 2
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. Vomiting of bile
B. Poorly localized periumbilical pain
C. Associated right shoulder pain
D. Positive McBurney point tenderness
E. Exacerbating factor includes alcohol intake
Correct Answer
ANS: C
Pain with biliary colic can produce referred pain to the right shoulder or scapula due
to irritation of the right hemidiaphragm. Alcohol is not an exacerbating factor for
biliary colic. Positive McBurney point tenderness is associated with acute appendicitis.
The Murphy sign is associated with acute cholecystitis. Vomiting bile is associated with
small bowel obstruction
Page 1 of 100
,Question 3
A high school football player injured his wrist in a game. He is tender between the
two tendons at the base of the thumb. Which of the following should be considered?
A. DeQuervain's tenosynovitis
B. Scaphoid fracture
C. Wrist sprain
D. Rheumatoid arthritis
Correct Answer
ANS: B
Feedback: The “anatomic snuffbox” is found between the extensor and abductor
tendons at the base of the thumb. Tenderness should make one think of a scaphoid
fracture. Not only is this the most common carpal bone injury, but the poor blood
supply puts the bone at risk for avascular necrosis when injured. This fracture is
commonly missed on x-ray, so this is an important physical finding to support further
or repeated studies.
Question 4
On routine screening you notice that the cup-to-disc ratio of the patient's right eye is
1:2. What ocular condition should you suspect?
A. Macular degeneration
B. Diabetic retinopathy
C. Hypertensive retinopathy
D. Glaucoma
Correct Answer
ANS: D
Feedback: This cup-to-disc ratio means that the cup takes up 50% of the disc, which is
abnormally large. This is usually an indication of glaucoma, which is a common cause
of visual loss in the elderly. The cup-to-disc changes are not seen in diabetes,
hypertension, or macular degeneration. Many elderly do not have regular eye
examinations and are not screened for glaucoma.
Page 2 of 100
,Question 5
A young woman comes to you with a cut on her finger caused by the lid of a can she
was opening. She is pacing about the room, crying loudly, and through her sobs she
says, "My career as a pianist is finished!" Which personality type exhibits these
features?
A. Narcissistic
B. Paranoid
C. Histrionic
D. Avoidant
Correct Answer
ANS: C
Feedback: The theatrical nature of her behavior as well as her overreaction leads to a
diagnosis of histrionic character disorder.
Question 6
What are the elements of the FIFE model for interviewing a patient?
A. Feelings, idea, function, and expectation
B. Open ended questioning, re-direction
C. Focus, intensity, function, and evaluation
D. Focus, intensity, function, and emotion
Correct Answer
ANS: A
Page 3 of 100
, Question 7
A 62-year-old manual laborer presents to an annual physical examination with
concerns about skin cancer screening. He does not have any lesions of concern but
was recently told by a friend that he should have his skin checked by a doctor yearly.
What is the best advice for this patient according to the U.S. Preventive Services Task
Force (USPSTF) recommendations on skin cancer screening from 2015?
a. The USPSTF recommends that all individual age >50 years be screened yearly for
skin cancer regardless of risk factors.
b. The USPSTF recommendations mirror those of the American Cancer Society (ACS)
and American Academy of Dermatologists (AAD) in recommending and annual skin
cancer screening for patients age >50 years.
c. The USPSTF recommends skin cancer screening only in sun-exposed areas of fair-
skinned individuals every 6 months.
d. The USPSTF recommends focused screening of individuals with a history of
dysplastic nevus syndrome.
e. The USPSTF recommends against routine screening for skin cancer due to lack of
evidence for this intervention across the general population.
Correct Answer
ANS: E
Question 8
A 8-year-old patient presents 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?
A. Pityriasis rosea
B. Tinea versicolor
C. Psoriasis
D. Atopic eczema
Correct Answer
ANS: A
Page 4 of 100
Correct Answers
Question 1
A patient has possible strep throat what will you see on physical exam that is
indicative of this infection?
Correct Answer
1. White patches (exudate) on tonsils
2. Enlarged tonsils, grade them, sit behind tonsillar pillars
3. Fever > 100.5
4. Enlargement of Submandibular and posterior cervical lymph nodes
Pt complains of sore throat but NO cough
Question 2
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. Vomiting of bile
B. Poorly localized periumbilical pain
C. Associated right shoulder pain
D. Positive McBurney point tenderness
E. Exacerbating factor includes alcohol intake
Correct Answer
ANS: C
Pain with biliary colic can produce referred pain to the right shoulder or scapula due
to irritation of the right hemidiaphragm. Alcohol is not an exacerbating factor for
biliary colic. Positive McBurney point tenderness is associated with acute appendicitis.
The Murphy sign is associated with acute cholecystitis. Vomiting bile is associated with
small bowel obstruction
Page 1 of 100
,Question 3
A high school football player injured his wrist in a game. He is tender between the
two tendons at the base of the thumb. Which of the following should be considered?
A. DeQuervain's tenosynovitis
B. Scaphoid fracture
C. Wrist sprain
D. Rheumatoid arthritis
Correct Answer
ANS: B
Feedback: The “anatomic snuffbox” is found between the extensor and abductor
tendons at the base of the thumb. Tenderness should make one think of a scaphoid
fracture. Not only is this the most common carpal bone injury, but the poor blood
supply puts the bone at risk for avascular necrosis when injured. This fracture is
commonly missed on x-ray, so this is an important physical finding to support further
or repeated studies.
Question 4
On routine screening you notice that the cup-to-disc ratio of the patient's right eye is
1:2. What ocular condition should you suspect?
A. Macular degeneration
B. Diabetic retinopathy
C. Hypertensive retinopathy
D. Glaucoma
Correct Answer
ANS: D
Feedback: This cup-to-disc ratio means that the cup takes up 50% of the disc, which is
abnormally large. This is usually an indication of glaucoma, which is a common cause
of visual loss in the elderly. The cup-to-disc changes are not seen in diabetes,
hypertension, or macular degeneration. Many elderly do not have regular eye
examinations and are not screened for glaucoma.
Page 2 of 100
,Question 5
A young woman comes to you with a cut on her finger caused by the lid of a can she
was opening. She is pacing about the room, crying loudly, and through her sobs she
says, "My career as a pianist is finished!" Which personality type exhibits these
features?
A. Narcissistic
B. Paranoid
C. Histrionic
D. Avoidant
Correct Answer
ANS: C
Feedback: The theatrical nature of her behavior as well as her overreaction leads to a
diagnosis of histrionic character disorder.
Question 6
What are the elements of the FIFE model for interviewing a patient?
A. Feelings, idea, function, and expectation
B. Open ended questioning, re-direction
C. Focus, intensity, function, and evaluation
D. Focus, intensity, function, and emotion
Correct Answer
ANS: A
Page 3 of 100
, Question 7
A 62-year-old manual laborer presents to an annual physical examination with
concerns about skin cancer screening. He does not have any lesions of concern but
was recently told by a friend that he should have his skin checked by a doctor yearly.
What is the best advice for this patient according to the U.S. Preventive Services Task
Force (USPSTF) recommendations on skin cancer screening from 2015?
a. The USPSTF recommends that all individual age >50 years be screened yearly for
skin cancer regardless of risk factors.
b. The USPSTF recommendations mirror those of the American Cancer Society (ACS)
and American Academy of Dermatologists (AAD) in recommending and annual skin
cancer screening for patients age >50 years.
c. The USPSTF recommends skin cancer screening only in sun-exposed areas of fair-
skinned individuals every 6 months.
d. The USPSTF recommends focused screening of individuals with a history of
dysplastic nevus syndrome.
e. The USPSTF recommends against routine screening for skin cancer due to lack of
evidence for this intervention across the general population.
Correct Answer
ANS: E
Question 8
A 8-year-old patient presents 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?
A. Pityriasis rosea
B. Tinea versicolor
C. Psoriasis
D. Atopic eczema
Correct Answer
ANS: A
Page 4 of 100
