NR509 Midterm
?? - ANSWER✅✅✅9
1. A 65-year-old overweight male presents at the clinic with hoarseness which has lasted for around 2
months. He thinks it began along with a cold. He is not feeling badly other than frequent heartburn, and
he has continued to work as a bartender (for the past 30 years), but he is having difficulty being heard
and understood because of his hoarse voice. A diagnosis that is on the differential list includes which of
the following?
a. Voice strain from bartending and talking amidst loud ambient noise
b. Viral infection
c. Acid reflux
d. Inhalation of fumes
e. Environmental allergies - ANSWER✅✅✅c. Acid reflux
6 EOMs - ANSWER✅✅✅Ask the patient to follow your finger or pencil as you sweep through the six
cardinal directions of gaze. Making a wide H in the air, lead the patient's gaze
A 13-year-old girl is brought by her mother to the clinic one day before the start of eighth grade because
of a 3-day history of episodes of shortness of breath. When she gets the shortness of breath, she also
notices tingling around her lips. She has no fever, cough, sputum production, or chest pain. She has no
history of serious illness and takes no medications. Vital signs are within normal limits. Cardiac, lung, and
extremity examinations show no abnormalities. Which of the following is the most likely diagnosis?
a. Aspiration of a foreign body
b. Anxiety
c. Asthma
d. Left-sided heart failure
e. Pneumonia - ANSWER✅✅✅b. Anxiety
A 14-year-old high school student comes to the clinic for a 3-month history of periodic dyspnea when
playing basketball. It resolves shortly after resting. He has not had fever, chills, cough, sputum
production, or chest pain. He has no history of serious illness. Based on the boy's history, asthma is
,NR509 Midterm
suspected. Which of the following sounds heard on expiration during lung auscultation would be most
suggestive of asthma?
a. Mediastinal crunch
b. Pleural rub
c. Rhonchi
d. Wheezes
e. Stridor - ANSWER✅✅✅d. Wheezes
A 14-year-old male presents to a new primary care provider after his family relocates to a state. The
patient underwent treatment for sarcoma when he was age 11 years, including an above-the-knee
amputation. He has learned to successfully navigate with a prosthetic leg and even engage in
competitive athletics at school. He does not like to speak of his experience with cancer and often makes
up humorous stories to tell new acquaintances about his amputation (such as, "I got bit by a squirrel and
they had to amputate."). Although he is very well engaged in most of the visit with the new clinician,
when the topic of cancer arises, he demurs to his father, who accompanies him to this appointment.
Which of the following statements is most likely to be helpful in cementing the patient's trust in the new
provider
a. "That sounds like a frightening experience that you are recovering well from."
b. "You are becoming an adult - ANSWER✅✅✅a. "That sounds like a frightening experience that you
are recovering well from."
A 16-year-old boy is brought to the Emergency Department (ED) after a motor vehicle accident for
shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a pneumothorax on the right side.
The ED physician decides that a chest tube needs to be placed in the fourth intercostal space. How does
he determine where the fourth intercostal space is?
a. He finds the suprasternal notch and then moves his finger laterally to the third rib. The fourth
intercostal space is just below the third rib.
b. He finds the angle of Louis and then moves laterally to the first rib. He walks down from there to the
fourth intercostal space.
c. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to
the second
,NR509 Midterm
intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space.
d. He finds the clavicle. The second intercostal space is just below - ANSWER✅✅✅c. He finds the
sternal angle and then moves his finger laterally to the second rib. He then walks down to the second
intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space
A 16-year-old male high school student presents with a primary concern of acne. He relates a history of
2 years of moderate mild acne and closed comedones (whiteheads), which have recently worsened such
that a classmate started calling him a pirate due to a large pustule that developed at the tip of his nose.
He has increasing outbreaks of cyst-like acne as well as a generally poor complexion with pitting and
scarring from prior outbreaks. Which of the following best describes this condition in the adolescent
population?
a. Acne vulgaris affects <50% of the adolescent population.
b. Acne vulgaris is associated with an identified virus for which there is no definitive treatment.
c. Acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as
well as other
contributory factors
d. The primary hormonal stimulus for acne vulgaris is estrogen, causing preferentially worse cases in -
ANSWER✅✅✅c. Acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and
heavy sweating as well as other
contributory factors
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother, who
convinced the patient to attend the clinic after he disclosed that he prefers homosexual partners but is
afraid that his last partner may have given him an infection. The patient expresses to the intake nurse
that he is unashamed of his sexual orientation and will not stay through the visit if he feels that he is
dismissed or discriminated against because of it. The nurse practitioner receives this communication
prior to entering the examination room and decides to employ active listening to best connect with the
patient at this critical juncture in his care with the clinic. Which of the following is an example of an
active listening technique?
a. Ignoring visual cues to focus on the patient's exact words
b. Setting aside the patient's emotional state to focus on his medical needs
, NR509 Midterm
c. Paring down the patient's conce - ANSWER✅✅✅d. Using nonverbal communication to encourage
the patient to expand their narrative
A 17-year-old woman presents with her parents to her primary care provider. She desires to utilize a
tanning facility ahead of an upcoming event. Her parents have heard that this is a dangerous practice,
although the tanning facility insists it is safe without risk of skin cancer in the future after tanning. Which
of the following is true regarding ultraviolet (UV) light exposure and subsequent risk of skin cancer?
a. Chronic sun exposure confers greater risk for skin cancer than intermittent intensive exposure.
b. Tanning beds and sunlamps do not increase risks of skin cancer as they utilize UV wavelengths that
are not carcinogenic.
c. Water-resistant sunscreens confer no advantage over water-soluble products.
d. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors.
e. Sunscreen with a sun protective factor (SPF) of 15 blocks ~50% of UV-B light. - ANSWER✅✅✅d.
Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors.
A 19-year-old carwash attendant sustained a laceration to the ulnar aspect of his mid-forearm while at
work last week. He did not have it evaluated at that time and is now noticing purulent discharge and
increasing pain from the wound along with fever and chills. Where would the clinician expect to find the
first signs of lymphadenopathy?
a. Epitrochlear nodes
b. Lateral axillary nodes
c. Central axillary nodes
d. Infraclavicular nodes
e. Cervical chain nodes - ANSWER✅✅✅a. Epitrochlear nodes
A 19-year-old student of art history presents to clinic after a syncopal (fainting) episode at school. He is
notably thin; on a thorough review of his medical history, he admits that he eats only minimally to
maintain a very low body weight that he feels is ideal. He is embarrassed that his issues were discussed
by peers after this episode, especially because he believes that this is a problem that is only faced by
girls and women. Concerning the two most common eating disorders (anorexia nervosa and bulimia
nervosa), which of the following statements is true?
?? - ANSWER✅✅✅9
1. A 65-year-old overweight male presents at the clinic with hoarseness which has lasted for around 2
months. He thinks it began along with a cold. He is not feeling badly other than frequent heartburn, and
he has continued to work as a bartender (for the past 30 years), but he is having difficulty being heard
and understood because of his hoarse voice. A diagnosis that is on the differential list includes which of
the following?
a. Voice strain from bartending and talking amidst loud ambient noise
b. Viral infection
c. Acid reflux
d. Inhalation of fumes
e. Environmental allergies - ANSWER✅✅✅c. Acid reflux
6 EOMs - ANSWER✅✅✅Ask the patient to follow your finger or pencil as you sweep through the six
cardinal directions of gaze. Making a wide H in the air, lead the patient's gaze
A 13-year-old girl is brought by her mother to the clinic one day before the start of eighth grade because
of a 3-day history of episodes of shortness of breath. When she gets the shortness of breath, she also
notices tingling around her lips. She has no fever, cough, sputum production, or chest pain. She has no
history of serious illness and takes no medications. Vital signs are within normal limits. Cardiac, lung, and
extremity examinations show no abnormalities. Which of the following is the most likely diagnosis?
a. Aspiration of a foreign body
b. Anxiety
c. Asthma
d. Left-sided heart failure
e. Pneumonia - ANSWER✅✅✅b. Anxiety
A 14-year-old high school student comes to the clinic for a 3-month history of periodic dyspnea when
playing basketball. It resolves shortly after resting. He has not had fever, chills, cough, sputum
production, or chest pain. He has no history of serious illness. Based on the boy's history, asthma is
,NR509 Midterm
suspected. Which of the following sounds heard on expiration during lung auscultation would be most
suggestive of asthma?
a. Mediastinal crunch
b. Pleural rub
c. Rhonchi
d. Wheezes
e. Stridor - ANSWER✅✅✅d. Wheezes
A 14-year-old male presents to a new primary care provider after his family relocates to a state. The
patient underwent treatment for sarcoma when he was age 11 years, including an above-the-knee
amputation. He has learned to successfully navigate with a prosthetic leg and even engage in
competitive athletics at school. He does not like to speak of his experience with cancer and often makes
up humorous stories to tell new acquaintances about his amputation (such as, "I got bit by a squirrel and
they had to amputate."). Although he is very well engaged in most of the visit with the new clinician,
when the topic of cancer arises, he demurs to his father, who accompanies him to this appointment.
Which of the following statements is most likely to be helpful in cementing the patient's trust in the new
provider
a. "That sounds like a frightening experience that you are recovering well from."
b. "You are becoming an adult - ANSWER✅✅✅a. "That sounds like a frightening experience that you
are recovering well from."
A 16-year-old boy is brought to the Emergency Department (ED) after a motor vehicle accident for
shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a pneumothorax on the right side.
The ED physician decides that a chest tube needs to be placed in the fourth intercostal space. How does
he determine where the fourth intercostal space is?
a. He finds the suprasternal notch and then moves his finger laterally to the third rib. The fourth
intercostal space is just below the third rib.
b. He finds the angle of Louis and then moves laterally to the first rib. He walks down from there to the
fourth intercostal space.
c. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to
the second
,NR509 Midterm
intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space.
d. He finds the clavicle. The second intercostal space is just below - ANSWER✅✅✅c. He finds the
sternal angle and then moves his finger laterally to the second rib. He then walks down to the second
intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space
A 16-year-old male high school student presents with a primary concern of acne. He relates a history of
2 years of moderate mild acne and closed comedones (whiteheads), which have recently worsened such
that a classmate started calling him a pirate due to a large pustule that developed at the tip of his nose.
He has increasing outbreaks of cyst-like acne as well as a generally poor complexion with pitting and
scarring from prior outbreaks. Which of the following best describes this condition in the adolescent
population?
a. Acne vulgaris affects <50% of the adolescent population.
b. Acne vulgaris is associated with an identified virus for which there is no definitive treatment.
c. Acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as
well as other
contributory factors
d. The primary hormonal stimulus for acne vulgaris is estrogen, causing preferentially worse cases in -
ANSWER✅✅✅c. Acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and
heavy sweating as well as other
contributory factors
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother, who
convinced the patient to attend the clinic after he disclosed that he prefers homosexual partners but is
afraid that his last partner may have given him an infection. The patient expresses to the intake nurse
that he is unashamed of his sexual orientation and will not stay through the visit if he feels that he is
dismissed or discriminated against because of it. The nurse practitioner receives this communication
prior to entering the examination room and decides to employ active listening to best connect with the
patient at this critical juncture in his care with the clinic. Which of the following is an example of an
active listening technique?
a. Ignoring visual cues to focus on the patient's exact words
b. Setting aside the patient's emotional state to focus on his medical needs
, NR509 Midterm
c. Paring down the patient's conce - ANSWER✅✅✅d. Using nonverbal communication to encourage
the patient to expand their narrative
A 17-year-old woman presents with her parents to her primary care provider. She desires to utilize a
tanning facility ahead of an upcoming event. Her parents have heard that this is a dangerous practice,
although the tanning facility insists it is safe without risk of skin cancer in the future after tanning. Which
of the following is true regarding ultraviolet (UV) light exposure and subsequent risk of skin cancer?
a. Chronic sun exposure confers greater risk for skin cancer than intermittent intensive exposure.
b. Tanning beds and sunlamps do not increase risks of skin cancer as they utilize UV wavelengths that
are not carcinogenic.
c. Water-resistant sunscreens confer no advantage over water-soluble products.
d. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors.
e. Sunscreen with a sun protective factor (SPF) of 15 blocks ~50% of UV-B light. - ANSWER✅✅✅d.
Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors.
A 19-year-old carwash attendant sustained a laceration to the ulnar aspect of his mid-forearm while at
work last week. He did not have it evaluated at that time and is now noticing purulent discharge and
increasing pain from the wound along with fever and chills. Where would the clinician expect to find the
first signs of lymphadenopathy?
a. Epitrochlear nodes
b. Lateral axillary nodes
c. Central axillary nodes
d. Infraclavicular nodes
e. Cervical chain nodes - ANSWER✅✅✅a. Epitrochlear nodes
A 19-year-old student of art history presents to clinic after a syncopal (fainting) episode at school. He is
notably thin; on a thorough review of his medical history, he admits that he eats only minimally to
maintain a very low body weight that he feels is ideal. He is embarrassed that his issues were discussed
by peers after this episode, especially because he believes that this is a problem that is only faced by
girls and women. Concerning the two most common eating disorders (anorexia nervosa and bulimia
nervosa), which of the following statements is true?
