MSN 621 UPDATED 2026 TEST PAPER QUESTIONS AND
SOLUTIONS RATED A+
✔✔A 43-year-old woman presents for evaluation. Her left knee has been painful and
swollen for the past week. Her symptoms have worsened, and now she finds it difficult
to bear weight. She denies any trauma or falls. She denies any other joint pain, and a
review of systems is otherwise negative except for an annular rash that she had on the
upper back about 1 month ago that resolved on its own. Medical and family history are
unremarkable. Her vital signs are normal. The left knee is erythematous, has an
effusion, and is tender. The range of motion is limited in flexion and extension. The rest
of the exam is normal. Laboratory evaluation shows a normal complete blood count and
liver and renal function. Her erythrocyte sedimentation rate is 44 mm/hr. Rheumatoid
factor, ANA, and anti-CCP are negative. Synovial fluid analysis reveals 12,000 white
blood cells/microliter and no crystals. Bacterial cultures are negative. An x- -
✔✔Serological studies for infectious etiology
✔✔An otherwise healthy 17-year-old male presents for an initial evaluation after
recently immigrating from Sudan, Africa. He says he has received all the necessary
vaccinations, including the BCG vaccine. Further inquiry reveals his sister was treated
for tuberculosis seven years ago. He is not sexually active, takes no medications, and
does not drink alcohol, use illicit drugs, or smoke cigarettes. What is the most
appropriate next step in evaluation? - ✔✔Interferon-gamma release assay
✔✔A 35-year-old man complains of cough and low-grade fever for the past 3 months.
The patient developed a fever 3 months ago, which was low-grade and associated with
night sweats. He also has had a troublesome cough. He had an episode of hemoptysis,
which prompted the visit. His history is significant for HIV infection 8 years ago, for
which he has never taken treatment. His vitals are temperature 99 °F (37.2 °C), heart
rate 90 bpm, blood pressure 110/70 mm Hg, and respiratory rate 22 breaths/min. His
general physical examination reveals the presence of oropharyngeal thrush and mild
pallor. Chest examination reveals coarse crackles and bronchial breathing in the left
upper lobe. His investigations reveal a WBC count of 3,000 cells/microliter, hemoglobin
of 10 gm/dL, platelet count of 150,000 cells/microliter, erythrocyte sedimentation rate of
50 mm per hour, serum creatinine of 0.8 mg/dL and a CD4+ count of 60/microl -
✔✔Start antitubercular treatment (ATT) now and antiretroviral therapy (ART) after 2
weeks
✔✔A 39-year-old woman is brought to the emergency department with 2 days history of
fever, headache, severe myalgias, dry cough, breathlessness, and coryza. She is a
school teacher, and many students in her class have been reported sick with "the flu."
Physical examination reveals scattered crackles in both lung fields. Blood tests indicate
a white blood cell count of 12,900 cells/microL with 69% lymphocytes. Chest x-ray
shows increased interstitial markings on both sides. She has had rheumatoid arthritis,
and she takes prednisone. Which of the following tests is most likely to confirm the
diagnosis in this patient? - ✔✔Rapid influenza diagnostic test from a throat swab
, ✔✔A 39-year-old woman is brought to the emergency department with complaints of
fever, headache, severe body aches, dry cough, dyspnea, and coryza for the last 2
days. She has had rheumatoid arthritis for the previous 5 years, and she is on oral
prednisone therapy. History reveals that she is a school teacher; many of her students
have been sick with similar symptoms. Physical examination shows scattered crackles
in both lung fields. Laboratory findings indicate a white blood cell (WBC) count of 12,000
cells/microliter with 67% lymphocytes. Chest x-ray (CXR) detects bilateral increased
interstitial markings. Which of the following treatments will most likely be given to this
patient? - ✔✔Oseltamivir 75 mg orally 2 times daily
✔✔A patient is diagnosed with pulmonary tuberculosis. Which of the following is the
most common diagnostic histopathological hallmark of the patient's condition? -
✔✔Caseating granuloma
✔✔A 25-year-old woman presents with 5 days of painful urination and increased
frequency of urination. She has no significant history. Her last menstrual period was two
weeks ago, and she is taking combined oral contraceptive pills. She smoked a pack of
cigarettes daily for the last 5 years. She does not drink alcohol and denies any illicit
drug use. Vital signs are blood pressure 119/78 mm Hg, heart rate 74 bpm, temperature
37.1 C (98.8 F), and respiratory rate 16 breaths/min. Which of the following imaging
studies is required in this patient? - ✔✔No imaging is needed
✔✔A man presents with nausea, vomiting, and left flank pain. He feels pain during
micturition, and his urine appears cloudy and reddish-brown. His history is significant for
hypertension and asthma, which are under control. Which of the following tests is the
most sensitive and specific for making a diagnosis? - ✔✔Non-contrast abdominal CT
✔✔A 17-year-old girl presents with left flank, pain, nausea, vomiting, and dysuria that
started a day ago. She has no significant history. She is afebrile, and her vital signs are
stable. A physical examination demonstrates costovertebral tenderness as well as
tenderness in the left flank on palpation. Urinalysis shows 12 RBC/hpf and 2 WBC/hpf.
What is the best next step in making a definitive diagnosis? - ✔✔Non-contrast CT scan
of the abdomen and pelvis
✔✔A 28-year-old man presents for his annual physical. He has no complaints and feels
perfectly healthy. He has no significant history. Vital signs are blood pressure 120/80
mmHg, heart rate 60 bpm, and respiratory rate 15 breaths/min. Physical examination is
normal. A urine dipstick test reveals 1+ proteinuria. His 24-hour urinary protein excretion
is 1 g/day. The patient's renal function tests are normal. The patient is concerned about
these lab findings. Which of the following is the correct response? - ✔✔Transient
proteinuria is not indicative of underlying renal disease.
SOLUTIONS RATED A+
✔✔A 43-year-old woman presents for evaluation. Her left knee has been painful and
swollen for the past week. Her symptoms have worsened, and now she finds it difficult
to bear weight. She denies any trauma or falls. She denies any other joint pain, and a
review of systems is otherwise negative except for an annular rash that she had on the
upper back about 1 month ago that resolved on its own. Medical and family history are
unremarkable. Her vital signs are normal. The left knee is erythematous, has an
effusion, and is tender. The range of motion is limited in flexion and extension. The rest
of the exam is normal. Laboratory evaluation shows a normal complete blood count and
liver and renal function. Her erythrocyte sedimentation rate is 44 mm/hr. Rheumatoid
factor, ANA, and anti-CCP are negative. Synovial fluid analysis reveals 12,000 white
blood cells/microliter and no crystals. Bacterial cultures are negative. An x- -
✔✔Serological studies for infectious etiology
✔✔An otherwise healthy 17-year-old male presents for an initial evaluation after
recently immigrating from Sudan, Africa. He says he has received all the necessary
vaccinations, including the BCG vaccine. Further inquiry reveals his sister was treated
for tuberculosis seven years ago. He is not sexually active, takes no medications, and
does not drink alcohol, use illicit drugs, or smoke cigarettes. What is the most
appropriate next step in evaluation? - ✔✔Interferon-gamma release assay
✔✔A 35-year-old man complains of cough and low-grade fever for the past 3 months.
The patient developed a fever 3 months ago, which was low-grade and associated with
night sweats. He also has had a troublesome cough. He had an episode of hemoptysis,
which prompted the visit. His history is significant for HIV infection 8 years ago, for
which he has never taken treatment. His vitals are temperature 99 °F (37.2 °C), heart
rate 90 bpm, blood pressure 110/70 mm Hg, and respiratory rate 22 breaths/min. His
general physical examination reveals the presence of oropharyngeal thrush and mild
pallor. Chest examination reveals coarse crackles and bronchial breathing in the left
upper lobe. His investigations reveal a WBC count of 3,000 cells/microliter, hemoglobin
of 10 gm/dL, platelet count of 150,000 cells/microliter, erythrocyte sedimentation rate of
50 mm per hour, serum creatinine of 0.8 mg/dL and a CD4+ count of 60/microl -
✔✔Start antitubercular treatment (ATT) now and antiretroviral therapy (ART) after 2
weeks
✔✔A 39-year-old woman is brought to the emergency department with 2 days history of
fever, headache, severe myalgias, dry cough, breathlessness, and coryza. She is a
school teacher, and many students in her class have been reported sick with "the flu."
Physical examination reveals scattered crackles in both lung fields. Blood tests indicate
a white blood cell count of 12,900 cells/microL with 69% lymphocytes. Chest x-ray
shows increased interstitial markings on both sides. She has had rheumatoid arthritis,
and she takes prednisone. Which of the following tests is most likely to confirm the
diagnosis in this patient? - ✔✔Rapid influenza diagnostic test from a throat swab
, ✔✔A 39-year-old woman is brought to the emergency department with complaints of
fever, headache, severe body aches, dry cough, dyspnea, and coryza for the last 2
days. She has had rheumatoid arthritis for the previous 5 years, and she is on oral
prednisone therapy. History reveals that she is a school teacher; many of her students
have been sick with similar symptoms. Physical examination shows scattered crackles
in both lung fields. Laboratory findings indicate a white blood cell (WBC) count of 12,000
cells/microliter with 67% lymphocytes. Chest x-ray (CXR) detects bilateral increased
interstitial markings. Which of the following treatments will most likely be given to this
patient? - ✔✔Oseltamivir 75 mg orally 2 times daily
✔✔A patient is diagnosed with pulmonary tuberculosis. Which of the following is the
most common diagnostic histopathological hallmark of the patient's condition? -
✔✔Caseating granuloma
✔✔A 25-year-old woman presents with 5 days of painful urination and increased
frequency of urination. She has no significant history. Her last menstrual period was two
weeks ago, and she is taking combined oral contraceptive pills. She smoked a pack of
cigarettes daily for the last 5 years. She does not drink alcohol and denies any illicit
drug use. Vital signs are blood pressure 119/78 mm Hg, heart rate 74 bpm, temperature
37.1 C (98.8 F), and respiratory rate 16 breaths/min. Which of the following imaging
studies is required in this patient? - ✔✔No imaging is needed
✔✔A man presents with nausea, vomiting, and left flank pain. He feels pain during
micturition, and his urine appears cloudy and reddish-brown. His history is significant for
hypertension and asthma, which are under control. Which of the following tests is the
most sensitive and specific for making a diagnosis? - ✔✔Non-contrast abdominal CT
✔✔A 17-year-old girl presents with left flank, pain, nausea, vomiting, and dysuria that
started a day ago. She has no significant history. She is afebrile, and her vital signs are
stable. A physical examination demonstrates costovertebral tenderness as well as
tenderness in the left flank on palpation. Urinalysis shows 12 RBC/hpf and 2 WBC/hpf.
What is the best next step in making a definitive diagnosis? - ✔✔Non-contrast CT scan
of the abdomen and pelvis
✔✔A 28-year-old man presents for his annual physical. He has no complaints and feels
perfectly healthy. He has no significant history. Vital signs are blood pressure 120/80
mmHg, heart rate 60 bpm, and respiratory rate 15 breaths/min. Physical examination is
normal. A urine dipstick test reveals 1+ proteinuria. His 24-hour urinary protein excretion
is 1 g/day. The patient's renal function tests are normal. The patient is concerned about
these lab findings. Which of the following is the correct response? - ✔✔Transient
proteinuria is not indicative of underlying renal disease.
