Final Exam: NR 509 / NR509 (Latest 2023/ 2024 Update) Advanced Physical Assessment Exam Review | Weeks 5-8 Covered| Questions and Verified Answers

Final Exam: NR 509 / NR509 (Latest 2023/ 2024 Update) Advanced Physical Assessment Exam Review | Weeks 5-8 Covered| Questions and Verified Answers QUESTION A 66-year-old female museum curator presents for a routine annual ex- amination. On examination, a notably enlarged supraclavicular lymph node is appreciated on the right side. The lymph node is nontender and feels firm and rubbery. She denies any localized or systemic symptoms such as breast lumps, fevers, or night sweats. She has been taking conjugated estrogen tablets for 9 years since menopause, though she has not taken progestin compounds since she had a hysterectomy for heavy bleeding at age 45 years. Which of the following is true about this presentation of lymphadenopathy? a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics of the breast uniformly drain into the axilla. b. Supraclavicular nodes are generally considered benign and require no further evaluation or follow-up. c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the neck. d. Firm, rubbery lymph nodes are generally considered to be benign. e. Metastatic breast cancer cells may spread directly into the infraclavicular and then supraclavicular nodes without first causing notable changes in the axillary nodes. Answer: : e. Metastatic breast cancer cells may spread directly into the infraclavicular and then supraclavicular nodes without first causing notable changes in the axillary nodes. QUESTION 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 firbroadenoma. 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? a. "Rubbery, mobile, nontender mass located in right breast, in the 10 Answer: : 30 position from the nipple" b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer quadrant" c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner quadrant" d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant" e. "Rubbery, mobile, nontender mass located in right breast, in the 1 Answer: : 30 position from the nipple" Answer: : a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from the nipple" QUESTION 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? a. Transformation of breasts to primarily fatty tissue with menopause decreas- es the sensitivity and specificity of mammograms. b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density after menopause. c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of lobules. d. Breast density has no genetic component and is entirely due to estrogen dose from endogenous and exogenous sources over the lifetime. e. Mammography performs most poorly in the menopausal and post- menopausal age group and should be limited for that reason. Answer: : c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of lobules. QUESTION A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While counseling him, the clinician mentions that multiple processes must take place to achieve an erection. Which of the following structures would be most affected by vascular deficiencies related to his preexisting medical conditions and is likely contributing to his symptoms? a. Corpora cavernosa b. Ejaculatory duct c. Epididymis d. Seminal vesicle e. Vas deferens Answer: : a. Corpora cavernosa QUESTION A 29-year-old graduate student states that he is able to achieve an erec- tion and ejaculate during sexual intercourse; however, he does not experience any pleasurable sensation of orgasm. He is otherwise healthy and is not on any medications. What is the most likely cause of his problem? a. Androgen insufficiency b. Endocrine dysfunction c. Peyronie disease d. Psychogenic e. Sexually transmitted infection (STI) Answer: : d. Psychogenic QUESTION Multiple processes must take place in order for a male to sustain an erec- tion. Various cues stimulate sympathetic outflow from higher brain centers to the T11-L2 levels of the spinal cord and parasympathetic outflow from S2 to S4 reflex arcs. Local vasodilatation within the penis erectile tissue results from increased levels of which of the following? a. Follicle-stimulating hormone (FSH) b. Gonadotropin-releasing hormone (GRH) c. Luteinizing hormone (LH) d. Nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) e. Testosterone Answer: : d. Nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) QUESTION The human papillomavirus (HPV) can cause genital warts in males and females as well as cervical cancer in females. Vaccination against HPV is available and should be offered to males between what ages? a. 6-9 months b. 1-3 years c. 5-7 years d. 9-21 years e. 30-50 years Answer: : d. 9-21 years QUESTION A 32-year-old male complains of a painless, cystic mass just above his left testicle. During the physical examination, a strong flashlight is placed behind the scrotum through the area in question and transillumination is noted. What is the most likely diagnosis? a. Direct hernia b. Indirect hernia c. Spermatocele d. Testicular tumor e. Varicocele Answer: : c. Spermatocele QUESTION A 25-year-old graduate student presents to the clinic complaining of scrotal pain, which has been increasing over the past 2 days. He is sexually active and has had unprotected intercourse with multiple partners in the past couple of weeks. On examination, some mild to moderate swelling of the scrotum on the right and tenderness with palpation of the right testicle are notes. What is the most likely diagnosis? a. Acute epididymitis b. Hydrocele c. Primary syphilis d. Spermatocele e. Testicular cancer Answer: : a. Acute epididymitis QUESTION A 32-year-old elementary teacher requests a workup for infertility. He and his wife have been trying to conceive for the last 2 years. He reports that his wife has been evaluated and does not appear to have any infertility issues. The overall examination does not reveal any significant abnormalities. He is of average height and weight and has normal secondary sex characteristics of the genitalia. Of the following, which would be most likely be abnormal and causing male infertility? a. 5±D- ihydrotestosterone b. 5±R- eductase c. Follicle-stimulating hormone (FSH) d. Luteinizing hormone (LH) e. Thyroid-stimulating hormone (TSH) Answer: : c. Follicle-stimulating hormone (FSH)