HOSMERIT
MSN 621 FINAL EXAM WITH 100% VERIFIED
QUESTIONS AND CORRECT SOLUTIONS
A 15-year-old female presents to the hospital with a complaint of intermenstrual
bleeding that started four months ago. She also complains of dyspareunia and vaginal
discharge. On further questioning, she gives a history of lower abdominal pain and
fever. Her vital signs show blood pressure 120/70 mmHg, respiratory rate 14/min, heart
rate 84/min, and temperature 101 F (38.8 C). A pelvic examination performed shows
cervical motion tenderness and uterine tenderness. A blood test was ordered, which
showed a white cell count of 18,000 per microliter of blood. What other conditions are in
the primary differential diagnosis? - ANSEctopic pregnancy, appendicitis, and
pyelonephritis
A 16-year-old boy with a low-grade fever and a cough is seen in the ER. The clinician
sends blood work for the measurement of heterophile antibodies because they suspect
which of the following? - ANSInfectious mononucleosis
A 16-year-old female patient presents to the hospital with a complaint of vaginal pain
and dyspareunia that started two weeks ago. She also complains of mild lower
abdominal pain. A detailed medical history reveals that she has had multiple sexual
partners in the last six months. Her vital signs show a blood pressure of 100/70 mmHg,
respiratory rate of 20 breaths/min, temperature of 101 F (38.3 C), and heart rate of 96
beats/min. A pelvic examination is performed, which reveals cervical motion tenderness
and uterine tenderness. A nucleic acid amplification test performed is negative. What is
the most appropriate first-line treatment for the patient? - ANSDoxycycline and
ceftriaxone
A 16-year-old female presents with complaints of fever, lethargy, and night sweats. The
patient also reports a 6-kilogram (13.2 pound) weight loss in the past 3 months. On
examination, painless, enlarged cervical and supraclavicular lymph nodes are palpated.
A fine-needle aspiration biopsy of one of the lymph nodes is shown in the image. The
patient's findings are most suggestive of which of the following? (see photo) -
ANSHodgkin lymphoma
A 16-year-old male presents with fatigue, easy bruisability, and weight loss. On
examination, hepatosplenomegaly is noted. After a detailed evaluation, the patient is
diagnosed with acute lymphocytic leukemia. Which of the following is used in the
management of this patient's condition - ANSL-asparaginase
A 16-year-old male presents with lethargy, fatigue, and occasional mucosal bleeding.
The patient also reports weight loss in the past 5 months. Laboratory analysis reveals a
white blood cell count of 32,000 cells/microL. On examination, hepatosplenomegaly is
noted. Further evaluation shows findings suggestive of acute lymphocytic leukemia.
,What is the most likely cause of the patient's mucosal bleeding? - ANSDecreased
platelet count
A 16-year-old patient presents because she believes she was bitten by a tick while
hiking in the woods a few days ago. She mentions swelling in her right ear and general
malaise. On exam, she has a 1 x 2 cm bluish-red nodule on the right ear lobe. What is
the next best step in management for this patient? - ANSlyme serology
A 16-year-old patient presents to the hospital with fever, fatigue, lymphadenopathy, and
sore throat. Exudative pharyngitis is noted on the throat examination. However, rapid
strep testing is negative. His blood pressure is 135/85 mmHg, the pulse rate is 92/min
regular, and his respiratory rate is 16/min. Past medical history is positive for asthma,
and his father had leukemia. Social history is notable for being involved in multiple
school sporting activities. What is the most appropriate piece of advice for this patient? -
ANSAvoid contact sports for a minimum of 6 weeks
A 17-year-old female patient presents to the hospital with a complaint of lower
abdominal pain for the past week. She complains of vaginal discharge and dyspareunia.
On further questioning, she reveals that the pain is mild and continuous. A detailed
medical history reveals that she started living with her boyfriend recently. Her vital signs
show a blood pressure of 100/70 mmHg, respiratory rate of 20 breaths/min, temperature
of 101 F (38.3 C), and heart rate of 101 beats/min. A pelvic examination performed
reveals cervical motion tenderness. Laboratory investigations show a white cell count of
17,000 per microliter of blood. What are the most likely causative organisms? -
ANSPolymicrobial infection
A 17-year-old female presents to the clinic with a 1-week history of low-grade fever and
abdominal pain. She has presented multiple times in the last year with urinary tract
infections. The patient says she has had multiple sexual partners over the last year and
uses barrier protection inconsistently. On examination, the patient has diffuse lower
abdominal tenderness with no guarding or rigidity. She also has cervical motion
tenderness and mucopurulent vaginal discharge on pelvic examination. Culture and
gram staining are negative for any organism. What is the organism most likely
responsible for the patient's presentation? - ANSchlamydia
A 17-year-old female presents with a complaint of leakage of urine for the last two
weeks. She states that she will randomly have urges to urinate, which can not be
deferred. She also admits to occasional loss of urine when laughing or coughing. She
was diagnosed with myasthenia gravis two years ago. Vital signs show a blood
pressure of 119/72 mmHg, a pulse of 75 beats per minute, a respiratory rate of 12/min,
and a temperature of 37.2 C (99 F). A physical exam is unremarkable. Urinalysis is
negative for leukocyte esterase, nitrites, and red blood cells. Available treatment options
are discussed with the patient and she eventually decides on medical management.
Which of the following medications is contraindicated in this patient? - ANSOxybutinin
, A 17-year-old female presents with a severe sore throat. She has been sick with a fever
for four days. The patient's voice is muffled, and she prefers not to speak secondary to
pain. She has not been able to eat solids for 2 days and has refused to drink for 1 day.
Vital signs show a temperature of 39.8 C, heart rate 140 beats/min, respiratory rate 20,
and blood pressure 110/70 mmHg. The exam shows the tonsils to be four-plus enlarged
with partial airway obstruction and grey-white exudates. It is associated with cervical
lymphadenopathy and splenomegaly. A rapid strep screen is negative. A CBC shows
atypical lymphocytes. What is the most appropriate management? - ANSAdmission for
hydration and corticosteroids
A 17-year-old female presents with abdominal pain, nausea, vomiting, and dysuria that
started a day ago. On further questioning, she admits that the pain is more in the area
of her left flank. A detailed medical history reveals no known medical conditions. She is
afebrile, and her vital signs are stable. A physical examination demonstrates
costovertebral tenderness as well as tenderness in the left flank on palpation. Urinalysis
shows 12 red blood cells and two white blood cells per high power field. What is the
best next step in making a definitive diagnosis? - ANSNon-contrast computed
tomography (CT) scan abdomen and pelvis with a kidney, ureter, and bladder (KUB)
A 17-year-old female presents with fever and low abdominal pain. The patient admits to
unprotected sexual intercourse. There are cervical motion tenderness and an adnexal
mass. Select the most likely diagnosis. - ANSTubo-ovarian abscess
A 17-year-old female presents with lower abdominal pain and vaginal bleeding. She
states that she just missed her period and has been sexually active. She has a past
medical history of gonorrhea and trichomonas, which have been treated successfully.
She is allergic to penicillin. The physical exam reveals mild tenderness to palpation in
the right lower quadrant. The pelvic exam reveals the presence of blood, but no masses
are felt. Her urinary human chorionic gonadotropin (hCG) is positive. Blood hCG level is
1,000 IU. The patient remains stable while waiting for an ultrasound. If this is an ectopic
pregnancy, what blood hCG level will be seen in 48 hours? - ANSLess than 2,000 IU
A 17-year-old female sex worker presents to the hospital with a complaint of vaginal
discharge that started two months ago. She also complains of intermenstrual bleeding
and lower abdominal pain. On further questioning, she reveals that she has been active
with multiple partners lately. Her vital signs show blood pressure 100/80 mmHg,
respiratory rate 18 breaths/min, heart rate 88 beats/min, and temperature 101 F (38.3
C). A pelvic examination shows cervical discharge, cervical motion tenderness, and
uterine tenderness. A blood test is ordered, which shows a white cell count of 17,500
per microliter of blood. What is the most likely mechanism leading to the spread of the
causative organism? - ANSThinning of cervical mucus
A 17-year-old male patient with no significant past medical history presents with several
days of loose, watery stools since returning from a trip to Mexico. He was in Mexico for
one week and frequently drank water from the hotel faucet. He describes having up to
six brown, non-bloody, loose, watery stools per day. His heart rate is 66 beats per
MSN 621 FINAL EXAM WITH 100% VERIFIED
QUESTIONS AND CORRECT SOLUTIONS
A 15-year-old female presents to the hospital with a complaint of intermenstrual
bleeding that started four months ago. She also complains of dyspareunia and vaginal
discharge. On further questioning, she gives a history of lower abdominal pain and
fever. Her vital signs show blood pressure 120/70 mmHg, respiratory rate 14/min, heart
rate 84/min, and temperature 101 F (38.8 C). A pelvic examination performed shows
cervical motion tenderness and uterine tenderness. A blood test was ordered, which
showed a white cell count of 18,000 per microliter of blood. What other conditions are in
the primary differential diagnosis? - ANSEctopic pregnancy, appendicitis, and
pyelonephritis
A 16-year-old boy with a low-grade fever and a cough is seen in the ER. The clinician
sends blood work for the measurement of heterophile antibodies because they suspect
which of the following? - ANSInfectious mononucleosis
A 16-year-old female patient presents to the hospital with a complaint of vaginal pain
and dyspareunia that started two weeks ago. She also complains of mild lower
abdominal pain. A detailed medical history reveals that she has had multiple sexual
partners in the last six months. Her vital signs show a blood pressure of 100/70 mmHg,
respiratory rate of 20 breaths/min, temperature of 101 F (38.3 C), and heart rate of 96
beats/min. A pelvic examination is performed, which reveals cervical motion tenderness
and uterine tenderness. A nucleic acid amplification test performed is negative. What is
the most appropriate first-line treatment for the patient? - ANSDoxycycline and
ceftriaxone
A 16-year-old female presents with complaints of fever, lethargy, and night sweats. The
patient also reports a 6-kilogram (13.2 pound) weight loss in the past 3 months. On
examination, painless, enlarged cervical and supraclavicular lymph nodes are palpated.
A fine-needle aspiration biopsy of one of the lymph nodes is shown in the image. The
patient's findings are most suggestive of which of the following? (see photo) -
ANSHodgkin lymphoma
A 16-year-old male presents with fatigue, easy bruisability, and weight loss. On
examination, hepatosplenomegaly is noted. After a detailed evaluation, the patient is
diagnosed with acute lymphocytic leukemia. Which of the following is used in the
management of this patient's condition - ANSL-asparaginase
A 16-year-old male presents with lethargy, fatigue, and occasional mucosal bleeding.
The patient also reports weight loss in the past 5 months. Laboratory analysis reveals a
white blood cell count of 32,000 cells/microL. On examination, hepatosplenomegaly is
noted. Further evaluation shows findings suggestive of acute lymphocytic leukemia.
,What is the most likely cause of the patient's mucosal bleeding? - ANSDecreased
platelet count
A 16-year-old patient presents because she believes she was bitten by a tick while
hiking in the woods a few days ago. She mentions swelling in her right ear and general
malaise. On exam, she has a 1 x 2 cm bluish-red nodule on the right ear lobe. What is
the next best step in management for this patient? - ANSlyme serology
A 16-year-old patient presents to the hospital with fever, fatigue, lymphadenopathy, and
sore throat. Exudative pharyngitis is noted on the throat examination. However, rapid
strep testing is negative. His blood pressure is 135/85 mmHg, the pulse rate is 92/min
regular, and his respiratory rate is 16/min. Past medical history is positive for asthma,
and his father had leukemia. Social history is notable for being involved in multiple
school sporting activities. What is the most appropriate piece of advice for this patient? -
ANSAvoid contact sports for a minimum of 6 weeks
A 17-year-old female patient presents to the hospital with a complaint of lower
abdominal pain for the past week. She complains of vaginal discharge and dyspareunia.
On further questioning, she reveals that the pain is mild and continuous. A detailed
medical history reveals that she started living with her boyfriend recently. Her vital signs
show a blood pressure of 100/70 mmHg, respiratory rate of 20 breaths/min, temperature
of 101 F (38.3 C), and heart rate of 101 beats/min. A pelvic examination performed
reveals cervical motion tenderness. Laboratory investigations show a white cell count of
17,000 per microliter of blood. What are the most likely causative organisms? -
ANSPolymicrobial infection
A 17-year-old female presents to the clinic with a 1-week history of low-grade fever and
abdominal pain. She has presented multiple times in the last year with urinary tract
infections. The patient says she has had multiple sexual partners over the last year and
uses barrier protection inconsistently. On examination, the patient has diffuse lower
abdominal tenderness with no guarding or rigidity. She also has cervical motion
tenderness and mucopurulent vaginal discharge on pelvic examination. Culture and
gram staining are negative for any organism. What is the organism most likely
responsible for the patient's presentation? - ANSchlamydia
A 17-year-old female presents with a complaint of leakage of urine for the last two
weeks. She states that she will randomly have urges to urinate, which can not be
deferred. She also admits to occasional loss of urine when laughing or coughing. She
was diagnosed with myasthenia gravis two years ago. Vital signs show a blood
pressure of 119/72 mmHg, a pulse of 75 beats per minute, a respiratory rate of 12/min,
and a temperature of 37.2 C (99 F). A physical exam is unremarkable. Urinalysis is
negative for leukocyte esterase, nitrites, and red blood cells. Available treatment options
are discussed with the patient and she eventually decides on medical management.
Which of the following medications is contraindicated in this patient? - ANSOxybutinin
, A 17-year-old female presents with a severe sore throat. She has been sick with a fever
for four days. The patient's voice is muffled, and she prefers not to speak secondary to
pain. She has not been able to eat solids for 2 days and has refused to drink for 1 day.
Vital signs show a temperature of 39.8 C, heart rate 140 beats/min, respiratory rate 20,
and blood pressure 110/70 mmHg. The exam shows the tonsils to be four-plus enlarged
with partial airway obstruction and grey-white exudates. It is associated with cervical
lymphadenopathy and splenomegaly. A rapid strep screen is negative. A CBC shows
atypical lymphocytes. What is the most appropriate management? - ANSAdmission for
hydration and corticosteroids
A 17-year-old female presents with abdominal pain, nausea, vomiting, and dysuria that
started a day ago. On further questioning, she admits that the pain is more in the area
of her left flank. A detailed medical history reveals no known medical conditions. She is
afebrile, and her vital signs are stable. A physical examination demonstrates
costovertebral tenderness as well as tenderness in the left flank on palpation. Urinalysis
shows 12 red blood cells and two white blood cells per high power field. What is the
best next step in making a definitive diagnosis? - ANSNon-contrast computed
tomography (CT) scan abdomen and pelvis with a kidney, ureter, and bladder (KUB)
A 17-year-old female presents with fever and low abdominal pain. The patient admits to
unprotected sexual intercourse. There are cervical motion tenderness and an adnexal
mass. Select the most likely diagnosis. - ANSTubo-ovarian abscess
A 17-year-old female presents with lower abdominal pain and vaginal bleeding. She
states that she just missed her period and has been sexually active. She has a past
medical history of gonorrhea and trichomonas, which have been treated successfully.
She is allergic to penicillin. The physical exam reveals mild tenderness to palpation in
the right lower quadrant. The pelvic exam reveals the presence of blood, but no masses
are felt. Her urinary human chorionic gonadotropin (hCG) is positive. Blood hCG level is
1,000 IU. The patient remains stable while waiting for an ultrasound. If this is an ectopic
pregnancy, what blood hCG level will be seen in 48 hours? - ANSLess than 2,000 IU
A 17-year-old female sex worker presents to the hospital with a complaint of vaginal
discharge that started two months ago. She also complains of intermenstrual bleeding
and lower abdominal pain. On further questioning, she reveals that she has been active
with multiple partners lately. Her vital signs show blood pressure 100/80 mmHg,
respiratory rate 18 breaths/min, heart rate 88 beats/min, and temperature 101 F (38.3
C). A pelvic examination shows cervical discharge, cervical motion tenderness, and
uterine tenderness. A blood test is ordered, which shows a white cell count of 17,500
per microliter of blood. What is the most likely mechanism leading to the spread of the
causative organism? - ANSThinning of cervical mucus
A 17-year-old male patient with no significant past medical history presents with several
days of loose, watery stools since returning from a trip to Mexico. He was in Mexico for
one week and frequently drank water from the hotel faucet. He describes having up to
six brown, non-bloody, loose, watery stools per day. His heart rate is 66 beats per
