NR509 FINAL EXAM / ACTUAL EXAM VERIFIED
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A 32-year-old female presents with fatigue, weight gain, and cold
intolerance. On exam, her skin is dry, and reflexes are delayed. Which
diagnostic test is most appropriate to confirm your clinical suspicion?
A. Serum cortisol
B. TSH and free T4
C. Fasting glucose
D. ACTH stimulation test
Answer: B. TSH and free T4
Rationale: These symptoms suggest hypothyroidism. TSH and free T4 confirm
diagnosis; elevated TSH with low T4 indicates primary hypothyroidism.
2. When performing an otoscopic exam on an adult, the correct technique is
to:
A. Pull the auricle down and back
B. Pull the auricle up and back
C. Insert speculum straight without traction
D. Use the largest speculum that fits loosely
Answer: B. Pull the auricle up and back
Rationale: In adults, the ear canal angles upward and backward; pulling the auricle
up and back straightens it for better visualization.
3. A 45-year-old male smoker presents with hemoptysis. On lung exam, you
hear localized wheezes in the right upper lobe. Which finding is most
concerning?
,A. Postnasal drip
B. Bronchitis
C. Lung cancer
D. Viral infection
Answer: C. Lung cancer
Rationale: Hemoptysis in a smoker, particularly with localized findings, raises
concern for malignancy; warrants chest imaging.
4. When palpating the thyroid gland, which technique is correct?
A. Use deep pressure while patient swallows
B. Palpate from the front using thumbs
C. Palpate from behind with patient swallowing
D. Avoid swallowing motion to prevent movement
Answer: C. Palpate from behind with patient swallowing
Rationale: Palpating from behind while the patient swallows helps feel gland
movement and detect nodules or asymmetry.
5. Which cranial nerve is tested by having the patient smile, frown, and puff
out cheeks?
A. CN V
B. CN VII
C. CN IX
D. CN X
Answer: B. CN VII
Rationale: Facial nerve (CN VII) controls facial expression muscles; asymmetry
suggests peripheral or central lesion.
6. A 6-year-old presents with ear pain after a URI. Exam shows bulging,
erythematous tympanic membrane with decreased mobility. What is the
diagnosis?
,A. Otitis externa
B. Otitis media
C. Eustachian tube dysfunction
D. Serous otitis
Answer: B. Otitis media
Rationale: Bulging and erythematous tympanic membrane with pain indicates
acute otitis media.
7. During cardiac assessment, you detect a murmur that increases with
standing and decreases with squatting. What condition is most consistent with
this finding?
A. Aortic stenosis
B. Hypertrophic cardiomyopathy
C. Mitral regurgitation
D. Pulmonic stenosis
Answer: B. Hypertrophic cardiomyopathy
Rationale: Murmur of HCM increases with standing or Valsalva (decreased
preload) and decreases with squatting (increased preload).
8. A patient presents with severe right upper quadrant pain radiating to the
shoulder, positive Murphy’s sign, and nausea after fatty meals. What
diagnosis is likely?
A. Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Gastritis
Answer: C. Cholecystitis
Rationale: RUQ pain with Murphy’s sign (inspiratory arrest on palpation)
suggests gallbladder inflammation.
, 9. When percussing over the lungs, a hyperresonant sound suggests:
A. Consolidation
B. Pleural effusion
C. Pneumothorax or emphysema
D. Atelectasis
Answer: C. Pneumothorax or emphysema
Rationale: Hyperresonance indicates air trapping or free air in pleural space.
10. The “lub-dub” sound corresponds to:
A. Closure of mitral and tricuspid valves, then aortic and pulmonic
B. Opening of aortic and pulmonic valves
C. Systolic ejection sounds
D. Ventricular filling
Answer: A. Closure of mitral/tricuspid (S1) and aortic/pulmonic (S2) valves
Rationale: S1 marks start of systole (AV valves close); S2 marks end (semilunar
valves close).
11. During an abdominal exam, which sequence is correct?
A. Palpation → Auscultation → Percussion → Inspection
B. Inspection → Auscultation → Percussion → Palpation
C. Percussion → Auscultation → Palpation → Inspection
D. Auscultation → Percussion → Inspection → Palpation
Answer: B. Inspection → Auscultation → Percussion → Palpation
Rationale: Auscultate before palpation to avoid stimulating bowel sounds.
12. A patient reports calf pain when walking that resolves with rest. Pulses are
diminished. Which condition is most likely?
A. Venous insufficiency
B. Peripheral arterial disease
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A 32-year-old female presents with fatigue, weight gain, and cold
intolerance. On exam, her skin is dry, and reflexes are delayed. Which
diagnostic test is most appropriate to confirm your clinical suspicion?
A. Serum cortisol
B. TSH and free T4
C. Fasting glucose
D. ACTH stimulation test
Answer: B. TSH and free T4
Rationale: These symptoms suggest hypothyroidism. TSH and free T4 confirm
diagnosis; elevated TSH with low T4 indicates primary hypothyroidism.
2. When performing an otoscopic exam on an adult, the correct technique is
to:
A. Pull the auricle down and back
B. Pull the auricle up and back
C. Insert speculum straight without traction
D. Use the largest speculum that fits loosely
Answer: B. Pull the auricle up and back
Rationale: In adults, the ear canal angles upward and backward; pulling the auricle
up and back straightens it for better visualization.
3. A 45-year-old male smoker presents with hemoptysis. On lung exam, you
hear localized wheezes in the right upper lobe. Which finding is most
concerning?
,A. Postnasal drip
B. Bronchitis
C. Lung cancer
D. Viral infection
Answer: C. Lung cancer
Rationale: Hemoptysis in a smoker, particularly with localized findings, raises
concern for malignancy; warrants chest imaging.
4. When palpating the thyroid gland, which technique is correct?
A. Use deep pressure while patient swallows
B. Palpate from the front using thumbs
C. Palpate from behind with patient swallowing
D. Avoid swallowing motion to prevent movement
Answer: C. Palpate from behind with patient swallowing
Rationale: Palpating from behind while the patient swallows helps feel gland
movement and detect nodules or asymmetry.
5. Which cranial nerve is tested by having the patient smile, frown, and puff
out cheeks?
A. CN V
B. CN VII
C. CN IX
D. CN X
Answer: B. CN VII
Rationale: Facial nerve (CN VII) controls facial expression muscles; asymmetry
suggests peripheral or central lesion.
6. A 6-year-old presents with ear pain after a URI. Exam shows bulging,
erythematous tympanic membrane with decreased mobility. What is the
diagnosis?
,A. Otitis externa
B. Otitis media
C. Eustachian tube dysfunction
D. Serous otitis
Answer: B. Otitis media
Rationale: Bulging and erythematous tympanic membrane with pain indicates
acute otitis media.
7. During cardiac assessment, you detect a murmur that increases with
standing and decreases with squatting. What condition is most consistent with
this finding?
A. Aortic stenosis
B. Hypertrophic cardiomyopathy
C. Mitral regurgitation
D. Pulmonic stenosis
Answer: B. Hypertrophic cardiomyopathy
Rationale: Murmur of HCM increases with standing or Valsalva (decreased
preload) and decreases with squatting (increased preload).
8. A patient presents with severe right upper quadrant pain radiating to the
shoulder, positive Murphy’s sign, and nausea after fatty meals. What
diagnosis is likely?
A. Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Gastritis
Answer: C. Cholecystitis
Rationale: RUQ pain with Murphy’s sign (inspiratory arrest on palpation)
suggests gallbladder inflammation.
, 9. When percussing over the lungs, a hyperresonant sound suggests:
A. Consolidation
B. Pleural effusion
C. Pneumothorax or emphysema
D. Atelectasis
Answer: C. Pneumothorax or emphysema
Rationale: Hyperresonance indicates air trapping or free air in pleural space.
10. The “lub-dub” sound corresponds to:
A. Closure of mitral and tricuspid valves, then aortic and pulmonic
B. Opening of aortic and pulmonic valves
C. Systolic ejection sounds
D. Ventricular filling
Answer: A. Closure of mitral/tricuspid (S1) and aortic/pulmonic (S2) valves
Rationale: S1 marks start of systole (AV valves close); S2 marks end (semilunar
valves close).
11. During an abdominal exam, which sequence is correct?
A. Palpation → Auscultation → Percussion → Inspection
B. Inspection → Auscultation → Percussion → Palpation
C. Percussion → Auscultation → Palpation → Inspection
D. Auscultation → Percussion → Inspection → Palpation
Answer: B. Inspection → Auscultation → Percussion → Palpation
Rationale: Auscultate before palpation to avoid stimulating bowel sounds.
12. A patient reports calf pain when walking that resolves with rest. Pulses are
diminished. Which condition is most likely?
A. Venous insufficiency
B. Peripheral arterial disease
