1|Page
NR 509 Final Exam|| QUESTIONS AND CORRECT
DETAILED ANSWERS|| VERIFIED EXAM!!! (VERIFIED
ANSWERS) |ALREADY GRADED A+||NEWEST EXAM!!!
A 54-year-old male with a strong family history of breast
and prostate cancer presents to his primary care provider
to discuss prostate screening. His father died at age 73
years from prostate cancer that was not detected on
routine digital rectal examinations (DREs), and he would
like to minimize his chance of a similar occurrence. Which
of the following is true regarding the anatomy and
screening of the prostate by DRE?
a. All three lobes of the prostate are palpable on DRE.
b. The seminal vesicles are palpable distal to the prostate
on DRE.
c. The median lobe of the prostate is located anterior to
the urethra and is not palpable on DRE.
d. The median sulcus divides the lateral lobes from the
median lobe and is palpable on DRE.
e. A prostate of 5 cm diameter without palpable nodes or
masses represents a normal prostate examination. -
ANSWER-c. The median lobe of the prostate is located
anterior to the urethra and is not palpable on DRE.
Rationale: Due to its location at the anterior aspect of the
urethra, the median lobe of the prostate is not palpable on
DRE, nor are small tumors in this area
,2|Page
A third-year medical student rotating on the internal
medicine service performs a digital rectal examination
(DRE) on a 56-year-old female patient. The patient has
been admitted for suspicion of a myocardial infarction, and
confirmation that there is no blood in the stool is required
before anticoagulation can be started. The student reports
that the fecal occult blood test was negative but notes that
he palpated a structure through the anterior rectum that he
could not identify. The attending physician confirms normal
anatomy and reviews with the student that the most likely
identity of the structure palpable is which of the following?
a. Sacrum
b. Pectinate line
c. Uterine fundus
d. Prostate
e. Cervix - ANSWER-e. Cervix
Rationale: The cervix is often palpable through the anterior
rectal wall on DRE of female patients.
A 45-year-old female executive reports to her primary care
provider that she has recently experienced a change in the
patterns of her bowel movements. She expresses a great
concern as her family history includes a maternal aunt
who died of colon cancer at age 49 years; her mother has
had colonoscopies every 3 years with numerous
adenomatous polyps removed. Which of the following
,3|Page
historical elements would be the most concerning for colon
cancer in this patient?
a. Long-term history of hemorrhoids
b. Recent history of black, tarry stools
c. Remote history of anal pruritus
d. New-onset anal fissures
e. Recent onset of small-caliber stools - ANSWER-e.
Recent onset of small-caliber stools
Rationale: Small-caliber stools may be caused by
narrowing of the colon due to a mass. Colonoscopy should
be performed to rule out such pathology, especially in a
patient with such a notable family history.
A 49-year-old customer service representative presents to
his gastroenterologist for follow-up of his long-standing
inflammatory bowel disease (IBD). He was diagnosed with
ulcerative colitis (UC) at age 37 years and has had
irregular care for this condition since then. His sole
colonoscopy was done at the time of diagnosis 12 years
ago. His only relevant family history is of prostate cancer
in his father; his mother and sisters are healthy. Which of
the following is true about recommended screening for
colon cancer in this patient?
, 4|Page
a. The patient should begin screening for colon cancer 10
years prior to the age of onset of his father's prostate
cancer.
b. The patient should undergo colonoscopy for his bowel
condition, which confers risk of colon cancer.
c. The patient is due for routine age-based colon cancer
screening by colonoscopy regardless of his risk factors.
d. The patient has a reassuring family history and t -
ANSWER-b. The patient should undergo colonoscopy for
his bowel condition, which confers risk of colon cancer.
Rationale: The two forms of IBD (UC and Crohn disease)
increase the risk of colon cancer and do warrant increased
screening at shortened intervals. The patient should begin
screening for colon cancer 10 years prior to the age of
onset of his father's prostate cancer is incorrect because
family history of breast, ovarian, or colon cancer increases
an individual's risk of colon cancer, whereas family history
of prostate cancer alone does not increase an individual's
risk of colon cancer and thus does not indicate increased
screening. (Of note, prostate cancer may rarely be a
manifestation of the BRCA genetic mutation that would put
this patient at higher risk for many types cancer, but this
would usually be accompanied by a family history of many
cancers, especially breast and ovarian cancer in the
female line.)
NR 509 Final Exam|| QUESTIONS AND CORRECT
DETAILED ANSWERS|| VERIFIED EXAM!!! (VERIFIED
ANSWERS) |ALREADY GRADED A+||NEWEST EXAM!!!
A 54-year-old male with a strong family history of breast
and prostate cancer presents to his primary care provider
to discuss prostate screening. His father died at age 73
years from prostate cancer that was not detected on
routine digital rectal examinations (DREs), and he would
like to minimize his chance of a similar occurrence. Which
of the following is true regarding the anatomy and
screening of the prostate by DRE?
a. All three lobes of the prostate are palpable on DRE.
b. The seminal vesicles are palpable distal to the prostate
on DRE.
c. The median lobe of the prostate is located anterior to
the urethra and is not palpable on DRE.
d. The median sulcus divides the lateral lobes from the
median lobe and is palpable on DRE.
e. A prostate of 5 cm diameter without palpable nodes or
masses represents a normal prostate examination. -
ANSWER-c. The median lobe of the prostate is located
anterior to the urethra and is not palpable on DRE.
Rationale: Due to its location at the anterior aspect of the
urethra, the median lobe of the prostate is not palpable on
DRE, nor are small tumors in this area
,2|Page
A third-year medical student rotating on the internal
medicine service performs a digital rectal examination
(DRE) on a 56-year-old female patient. The patient has
been admitted for suspicion of a myocardial infarction, and
confirmation that there is no blood in the stool is required
before anticoagulation can be started. The student reports
that the fecal occult blood test was negative but notes that
he palpated a structure through the anterior rectum that he
could not identify. The attending physician confirms normal
anatomy and reviews with the student that the most likely
identity of the structure palpable is which of the following?
a. Sacrum
b. Pectinate line
c. Uterine fundus
d. Prostate
e. Cervix - ANSWER-e. Cervix
Rationale: The cervix is often palpable through the anterior
rectal wall on DRE of female patients.
A 45-year-old female executive reports to her primary care
provider that she has recently experienced a change in the
patterns of her bowel movements. She expresses a great
concern as her family history includes a maternal aunt
who died of colon cancer at age 49 years; her mother has
had colonoscopies every 3 years with numerous
adenomatous polyps removed. Which of the following
,3|Page
historical elements would be the most concerning for colon
cancer in this patient?
a. Long-term history of hemorrhoids
b. Recent history of black, tarry stools
c. Remote history of anal pruritus
d. New-onset anal fissures
e. Recent onset of small-caliber stools - ANSWER-e.
Recent onset of small-caliber stools
Rationale: Small-caliber stools may be caused by
narrowing of the colon due to a mass. Colonoscopy should
be performed to rule out such pathology, especially in a
patient with such a notable family history.
A 49-year-old customer service representative presents to
his gastroenterologist for follow-up of his long-standing
inflammatory bowel disease (IBD). He was diagnosed with
ulcerative colitis (UC) at age 37 years and has had
irregular care for this condition since then. His sole
colonoscopy was done at the time of diagnosis 12 years
ago. His only relevant family history is of prostate cancer
in his father; his mother and sisters are healthy. Which of
the following is true about recommended screening for
colon cancer in this patient?
, 4|Page
a. The patient should begin screening for colon cancer 10
years prior to the age of onset of his father's prostate
cancer.
b. The patient should undergo colonoscopy for his bowel
condition, which confers risk of colon cancer.
c. The patient is due for routine age-based colon cancer
screening by colonoscopy regardless of his risk factors.
d. The patient has a reassuring family history and t -
ANSWER-b. The patient should undergo colonoscopy for
his bowel condition, which confers risk of colon cancer.
Rationale: The two forms of IBD (UC and Crohn disease)
increase the risk of colon cancer and do warrant increased
screening at shortened intervals. The patient should begin
screening for colon cancer 10 years prior to the age of
onset of his father's prostate cancer is incorrect because
family history of breast, ovarian, or colon cancer increases
an individual's risk of colon cancer, whereas family history
of prostate cancer alone does not increase an individual's
risk of colon cancer and thus does not indicate increased
screening. (Of note, prostate cancer may rarely be a
manifestation of the BRCA genetic mutation that would put
this patient at higher risk for many types cancer, but this
would usually be accompanied by a family history of many
cancers, especially breast and ovarian cancer in the
female line.)
