NR 509 FINAL EXAM WITH DETAILED
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS GRADED A+
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 fibroadenoma. 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? Correct Answer 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? Correct Answer Glandular tissue of the breast
atrophies with menopause, primarily due to decrease in the
number of lobules.
,Rational: - The consequent decrease in breast density makes
mammograms ever more useful during the age when breast
cancer incidence starts to rise markedly
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 β-human 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? Correct Answer 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? Correct
Answer 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? Correct Answer 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
follow-up 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 diverticula 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? Correct Answer 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? Correct Answer 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? Correct Answer Tympany to
percussion in the right upper quadrant, dullness to percussion of
the left upper quadrant
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS GRADED A+
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 fibroadenoma. 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? Correct Answer 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? Correct Answer Glandular tissue of the breast
atrophies with menopause, primarily due to decrease in the
number of lobules.
,Rational: - The consequent decrease in breast density makes
mammograms ever more useful during the age when breast
cancer incidence starts to rise markedly
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 β-human 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? Correct Answer 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? Correct
Answer 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? Correct Answer 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
follow-up 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 diverticula 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? Correct Answer 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? Correct Answer 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? Correct Answer Tympany to
percussion in the right upper quadrant, dullness to percussion of
the left upper quadrant
