GCU NUR 634 Midterm EXAM 2026
SUMMER-FALL SEMESTER EXAM
GRADED A+
A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to
describe it. Which of the following diagnoses should you consider because of her gesture?
A. Bronchitis
B. Costochondritis
C. Pericarditis
D. Angina pectoris
ANS: D
Feedback: The clenched fist of Levine's sign, while not completely specific for ischemic pain, should
definitely cause you to consider this etiology. Bronchitis is usually painless, and pericarditis can produce a
sharp pain which worsens with inspiration. This is called pleuritic pain and can be associated with
pneumonia and other chest diseases. Costochondritis is a parasternal pain, usually well localized. It is
exquisitely tender
Retinal detachment may be associated with all of the following EXCEPT:
A. painless, unilateral loss in vision
B. Spontaneous recovery
C. Flashes of light
D. Context of trauma
ANS: B
Optic neuritis may be associated with all the following conditions EXCEPT:
A. Sudden, painful loss in unilateral vision
B. Associated with autoimmune disease
C. Early sign of multiple sclerosis
D. Common incidental finding on fundoscopic exam
ANS: D
Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not
have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of
her pain?
,A. Trigeminal neuralgia
B. Temporomandibular joint syndrome
C. Temporal arteritis
D. Tumor of the mandible
ANS: B
Feedback: Temporomandibular joint syndrome is a very common cause of pain with chewing. Ischemic
pain with chewing, or jaw claudication, can occur with temporal arteritis, but the lack of tenderness of
the scalp overlying the artery makes this less likely. Trigeminal neuralgia can be associated with extreme
tenderness over the branches of the trigeminal nerve. While a tumor of the mandible is possible, is it
much less likely than the other choices.
An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her
hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On
physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling
or inflammation. There are no hair shafts visible. Based on this description, what is your most likely
diagnosis?
A. Alopecia areata
B. Trichotillomania
C. Tinea capitis
D. Traction alopecia
ANS: A
Feedback: This is a typical description for alopecia areata. There are no risk factors for trichotillomania or
for traction alopecia. The physical examination is not consistent with tinea capitis because the skin is
intact.
A 46-year-old former salesman presents to the ER, complaining of black stools for the past few weeks.
His past medical history is significant for cirrhosis. He has gained weight recently, especially around
his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk approximately
10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in the past. He
denies any recent use. He is currently unemployed and has never been married. On examination you
find a man appearing older than his stated age. His skin has a yellowish tint and he is thin, with a
prominent abdomen. You note multiple "spider angiomas" at the base of his neck. Otherwise, his
heart and lung examinations are normal. On inspection he has dilated veins around his umbilicus.
Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness that is
more severe in the epigastric area. His
ANS: C
,Varices are often found in alcoholic patients, but only when they have a diagnosis of significant cirrhosis.
This patient has symptoms of cirrhosis, including jaundice, ascites, spider hemangiomas, and dilated
veins on his abdomen (caput medusa).
You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited
that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect
that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with
hypothyroidism?
A. Moist and smooth
B. Moist and rough
C. Dry and smooth
D. Dry and rough
ANS: D
42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months. She
has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any recent
illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new
medications. During the review of systems you note that she has felt fatigued, had some weight gain,
has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal
delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She
denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary
artery disease. There is no family history of cancers. On examination she appears her stated age. Her
vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her
cardiac, lung, and abdominal
ANS: D
COPD is associated with what on physical exam?
increase in A/P diameter
A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and
travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
ANS: A
Feedback: The lack of contact with blood and body fluids makes hepatitis B, C, and D unlikely. She
regularly changes the diapers of her clients and is at risk for hepatitis A. Vaccine against hepatitis A is
recommended for daycare workers
, A young man comes to you with an extremely pruritic rash over his knees and elbows which has come
and gone for several years. It seems to be worse in the winter and improves with some sun exposure.
On examination, you notice scabbing and crusting with some silvery scale, and you are observant
enough to notice small "pits" in his nails. What would account for these findings?
A. Eczema
B. Pityriasis rosea
C. Psoriasis
D. Tinea infection
ANS: C
Feedback: This is a classic presentation of plaque psoriasis. Eczema is usually over the flexor surfaces and
does not scale, whereas psoriasis affects the extensor surfaces. Pityriasis usually is limited to the trunk
and proximal extremities. Tinea has a much finer scale associated with it, almost like powder, and is
found in dark and moist areas
For which of the following patients would a comprehensive health history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respiratory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand"
ANS: C
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health
history is appropriate.
The following information is recorded in the health history: "The patient completed 8th grade. He
currently lives with his wife and two children. He works on old cars on the weekend. He works in a
glass factory during the week." Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems
ANS: C
Feedback: Personal and social history information includes educational level, family of origin, current
household status, personal interests, employment, religious beliefs, military history, and lifestyle
(including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and
history). All of this information is documented in this example
SUMMER-FALL SEMESTER EXAM
GRADED A+
A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to
describe it. Which of the following diagnoses should you consider because of her gesture?
A. Bronchitis
B. Costochondritis
C. Pericarditis
D. Angina pectoris
ANS: D
Feedback: The clenched fist of Levine's sign, while not completely specific for ischemic pain, should
definitely cause you to consider this etiology. Bronchitis is usually painless, and pericarditis can produce a
sharp pain which worsens with inspiration. This is called pleuritic pain and can be associated with
pneumonia and other chest diseases. Costochondritis is a parasternal pain, usually well localized. It is
exquisitely tender
Retinal detachment may be associated with all of the following EXCEPT:
A. painless, unilateral loss in vision
B. Spontaneous recovery
C. Flashes of light
D. Context of trauma
ANS: B
Optic neuritis may be associated with all the following conditions EXCEPT:
A. Sudden, painful loss in unilateral vision
B. Associated with autoimmune disease
C. Early sign of multiple sclerosis
D. Common incidental finding on fundoscopic exam
ANS: D
Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not
have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of
her pain?
,A. Trigeminal neuralgia
B. Temporomandibular joint syndrome
C. Temporal arteritis
D. Tumor of the mandible
ANS: B
Feedback: Temporomandibular joint syndrome is a very common cause of pain with chewing. Ischemic
pain with chewing, or jaw claudication, can occur with temporal arteritis, but the lack of tenderness of
the scalp overlying the artery makes this less likely. Trigeminal neuralgia can be associated with extreme
tenderness over the branches of the trigeminal nerve. While a tumor of the mandible is possible, is it
much less likely than the other choices.
An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her
hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On
physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling
or inflammation. There are no hair shafts visible. Based on this description, what is your most likely
diagnosis?
A. Alopecia areata
B. Trichotillomania
C. Tinea capitis
D. Traction alopecia
ANS: A
Feedback: This is a typical description for alopecia areata. There are no risk factors for trichotillomania or
for traction alopecia. The physical examination is not consistent with tinea capitis because the skin is
intact.
A 46-year-old former salesman presents to the ER, complaining of black stools for the past few weeks.
His past medical history is significant for cirrhosis. He has gained weight recently, especially around
his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk approximately
10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in the past. He
denies any recent use. He is currently unemployed and has never been married. On examination you
find a man appearing older than his stated age. His skin has a yellowish tint and he is thin, with a
prominent abdomen. You note multiple "spider angiomas" at the base of his neck. Otherwise, his
heart and lung examinations are normal. On inspection he has dilated veins around his umbilicus.
Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness that is
more severe in the epigastric area. His
ANS: C
,Varices are often found in alcoholic patients, but only when they have a diagnosis of significant cirrhosis.
This patient has symptoms of cirrhosis, including jaundice, ascites, spider hemangiomas, and dilated
veins on his abdomen (caput medusa).
You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited
that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect
that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with
hypothyroidism?
A. Moist and smooth
B. Moist and rough
C. Dry and smooth
D. Dry and rough
ANS: D
42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months. She
has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any recent
illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new
medications. During the review of systems you note that she has felt fatigued, had some weight gain,
has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal
delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She
denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary
artery disease. There is no family history of cancers. On examination she appears her stated age. Her
vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her
cardiac, lung, and abdominal
ANS: D
COPD is associated with what on physical exam?
increase in A/P diameter
A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and
travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
ANS: A
Feedback: The lack of contact with blood and body fluids makes hepatitis B, C, and D unlikely. She
regularly changes the diapers of her clients and is at risk for hepatitis A. Vaccine against hepatitis A is
recommended for daycare workers
, A young man comes to you with an extremely pruritic rash over his knees and elbows which has come
and gone for several years. It seems to be worse in the winter and improves with some sun exposure.
On examination, you notice scabbing and crusting with some silvery scale, and you are observant
enough to notice small "pits" in his nails. What would account for these findings?
A. Eczema
B. Pityriasis rosea
C. Psoriasis
D. Tinea infection
ANS: C
Feedback: This is a classic presentation of plaque psoriasis. Eczema is usually over the flexor surfaces and
does not scale, whereas psoriasis affects the extensor surfaces. Pityriasis usually is limited to the trunk
and proximal extremities. Tinea has a much finer scale associated with it, almost like powder, and is
found in dark and moist areas
For which of the following patients would a comprehensive health history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respiratory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand"
ANS: C
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health
history is appropriate.
The following information is recorded in the health history: "The patient completed 8th grade. He
currently lives with his wife and two children. He works on old cars on the weekend. He works in a
glass factory during the week." Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems
ANS: C
Feedback: Personal and social history information includes educational level, family of origin, current
household status, personal interests, employment, religious beliefs, military history, and lifestyle
(including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and
history). All of this information is documented in this example
