NR 509 MIDTERM EXAM 2025 ACTUAL
QUESTIONS AND ANSWERS GRADED A+
A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on
her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile
lymph nodes just behind her sternocleidomastoid muscles
bilaterally. What group of nodes is this?
A) Submandibular
B) Tonsillar
C) Occipital
D) Posterior cervical
D) Posterior cervical
The group of nodes posterior to the sternocleidomastoid muscle is the posterior cervical chain. These
are common in mononucleosis.
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-
side directions. Which of the following is most likely?
A) Cancer
B) Lymph node
C) Deep scar
D) Muscle
,B) Lymph node
A useful maneuver for discerning lymph nodes from other masses in the neck is to check for their
mobility in all directions. Many other masses are mobile in only two directions. Cancerous masses may
also be "fixed," or immobile.
You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate
slightly. Both are noted to constrict briskly when the light is placed on the right
eye. What is the most likely problem?
A) Optic nerve damage on the right
B) Optic nerve damage on the left
C) Efferent nerve damage on the right
D) Efferent nerve damage on the left
B) Optic nerve damage on the left
Because both pupils can constrict, efferent nerve damage is unlikely. When the light is placed on the left
eye, neither a direct nor a consensual response is seen. This indicates that the left eye is not perceiving
incoming light.
A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a
nonproductive nocturnal cough. She states she used to feel this way only with extreme
exercise, but lately she has felt this way continuously. She denies any other upper respiratory
symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is
significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no
other medications. She has had no surgeries. Her mother has allergies and eczema and her father has
high blood pressure. She is an only child. She denies smoking and
,illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in
finance at a local university and she has recently started a job as a bartender in town. On
examination she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80,
her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat examinations are
essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On
auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in
all lobes. Percussion reveals resonant lungs.
Which disorder of the thorax or lung does this best describe?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
C) Asthma
Asthma causes shortness of breath and a nocturnal cough. It is often associated with
a history of allergies and can be made worse by exercise or irritants such as smoke in a bar. On
auscultation there can be normal to decreased air movement. Wheezing is heard on expiration
and sometimes inspiration. The duration of wheezing in expiration usually correlates with
severity of illness, so it is important to document this length (e.g., wheezes heard halfway through
exhalation). Realize that in severe asthma, wheezes may not be heard because of the
lack of air movement.
A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath,
and a productive cough with golden sputum. She says she had a cold last week and her
symptoms have only gotten worse, despite using over-the-counter cold remedies. She denies any
, weight gain, weight loss, or cardiac or gastrointestinal symptoms. Her past medical history includes type
2 diabetes for 5 years and high cholesterol. She takes an oral medication for both diseases. She has had
no surgeries. She denies tobacco, alcohol, or drug use. Her mother has diabetes and high blood
pressure. Her father passed away from colon cancer. On examination you see a middle-aged woman
appearing her stated age. She looks ill and her temperature is elevated, at 101. Her blood pressure and
pulse are unremarkable. Her head, eyes, ears, nose, and throat examinations are unremarkable except
for edema of the nasal turbinates. On auscultation she has decreased air movement, and coarse crackles
are heard over the left lower lobe. There is dullness on percussion, increased fremitus during palpation,
and egophony and whispered pectoriloquy on auscultation.
What disorder of the thorax or lung best describes her symptoms?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
D) Pneumonia
Pneumonia is usually associated with dyspnea, cough, and fever. On auscultation
there can be coarse or fine crackles heard over the affected lobe. Percussion over the affected area is
dull and there is often an increase in fremitus. Egophony and pectoriloquy are heard because of
increased transmission of high-pitched components of sounds. These higher frequencies are usually
filtered out by the multiple air-filled chambers of the alveoli.
A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow
breaths he states he was at home finishing his homework when he suddenly began having right-sided
chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical
history is unremarkable. He doesn't smoke but drinks several beers on the weekend. He has tried
marijuana several times but denies any other illegal drugs. He is an honors student and is on the
basketball team. His parents are both in good health. He denies any recent weight gain, weight loss,
fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is
diaphoretic and is breathing at a rate of 35 breaths per minute. On
auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion
QUESTIONS AND ANSWERS GRADED A+
A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on
her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile
lymph nodes just behind her sternocleidomastoid muscles
bilaterally. What group of nodes is this?
A) Submandibular
B) Tonsillar
C) Occipital
D) Posterior cervical
D) Posterior cervical
The group of nodes posterior to the sternocleidomastoid muscle is the posterior cervical chain. These
are common in mononucleosis.
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-
side directions. Which of the following is most likely?
A) Cancer
B) Lymph node
C) Deep scar
D) Muscle
,B) Lymph node
A useful maneuver for discerning lymph nodes from other masses in the neck is to check for their
mobility in all directions. Many other masses are mobile in only two directions. Cancerous masses may
also be "fixed," or immobile.
You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate
slightly. Both are noted to constrict briskly when the light is placed on the right
eye. What is the most likely problem?
A) Optic nerve damage on the right
B) Optic nerve damage on the left
C) Efferent nerve damage on the right
D) Efferent nerve damage on the left
B) Optic nerve damage on the left
Because both pupils can constrict, efferent nerve damage is unlikely. When the light is placed on the left
eye, neither a direct nor a consensual response is seen. This indicates that the left eye is not perceiving
incoming light.
A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a
nonproductive nocturnal cough. She states she used to feel this way only with extreme
exercise, but lately she has felt this way continuously. She denies any other upper respiratory
symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is
significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no
other medications. She has had no surgeries. Her mother has allergies and eczema and her father has
high blood pressure. She is an only child. She denies smoking and
,illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in
finance at a local university and she has recently started a job as a bartender in town. On
examination she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80,
her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat examinations are
essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On
auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in
all lobes. Percussion reveals resonant lungs.
Which disorder of the thorax or lung does this best describe?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
C) Asthma
Asthma causes shortness of breath and a nocturnal cough. It is often associated with
a history of allergies and can be made worse by exercise or irritants such as smoke in a bar. On
auscultation there can be normal to decreased air movement. Wheezing is heard on expiration
and sometimes inspiration. The duration of wheezing in expiration usually correlates with
severity of illness, so it is important to document this length (e.g., wheezes heard halfway through
exhalation). Realize that in severe asthma, wheezes may not be heard because of the
lack of air movement.
A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath,
and a productive cough with golden sputum. She says she had a cold last week and her
symptoms have only gotten worse, despite using over-the-counter cold remedies. She denies any
, weight gain, weight loss, or cardiac or gastrointestinal symptoms. Her past medical history includes type
2 diabetes for 5 years and high cholesterol. She takes an oral medication for both diseases. She has had
no surgeries. She denies tobacco, alcohol, or drug use. Her mother has diabetes and high blood
pressure. Her father passed away from colon cancer. On examination you see a middle-aged woman
appearing her stated age. She looks ill and her temperature is elevated, at 101. Her blood pressure and
pulse are unremarkable. Her head, eyes, ears, nose, and throat examinations are unremarkable except
for edema of the nasal turbinates. On auscultation she has decreased air movement, and coarse crackles
are heard over the left lower lobe. There is dullness on percussion, increased fremitus during palpation,
and egophony and whispered pectoriloquy on auscultation.
What disorder of the thorax or lung best describes her symptoms?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
D) Pneumonia
Pneumonia is usually associated with dyspnea, cough, and fever. On auscultation
there can be coarse or fine crackles heard over the affected lobe. Percussion over the affected area is
dull and there is often an increase in fremitus. Egophony and pectoriloquy are heard because of
increased transmission of high-pitched components of sounds. These higher frequencies are usually
filtered out by the multiple air-filled chambers of the alveoli.
A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow
breaths he states he was at home finishing his homework when he suddenly began having right-sided
chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical
history is unremarkable. He doesn't smoke but drinks several beers on the weekend. He has tried
marijuana several times but denies any other illegal drugs. He is an honors student and is on the
basketball team. His parents are both in good health. He denies any recent weight gain, weight loss,
fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is
diaphoretic and is breathing at a rate of 35 breaths per minute. On
auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion
