Midterm Exam: FNP654/ FNP 654 (Latest 2025/2026 Update) Family Primary
Care I Exam | Questions and Verified Answers| 100% Correct| Grade A - GCU
Question 1
In primary care, what is the current comprehensive medical term used to describe sexual and
gender minorities?
A) LGBTQ+ individuals
B) Transgender populations
C) Sexual and gender minorities (SGM)
D) Gender non-conforming persons
E) Non-binary individuals
Correct Answer: C) Sexual and gender minorities (SGM)
Rationale: The term "Sexual and Gender Minorities" (SGM) is the broad, medically
accepted umbrella term used by organizations like the NIH and CDC to describe
individuals whose sexual orientation or gender identity differs from the majority. It is more
inclusive for research and clinical purposes than acronyms which may change over time.
Question 2
When providing care for a transgender patient, which of the following definitions most
accurately describes the term "transgender"?
A) Individuals who have undergone gender reassignment surgery only.
B) Individuals who identify as the opposite of their biological birth gender or whose gender is
not evident.
C) Individuals who identify with the gender assigned at birth.
D) Individuals who choose to dress in clothing traditionally associated with the opposite gender.
E) Only those patients currently receiving cross-sex hormone therapy.
Correct Answer: B) individuals who identify as the opposite of their birth / bio gender or for
those whose gender is not evident
Rationale: Gender identity is an internal sense of being male, female, or another gender.
Being transgender refers to the mismatch between internal gender identity and the sex
assigned at birth. It does not strictly require medical or surgical intervention to be a valid
identification.
Question 3
A 34-year-old male presents to the clinic complaining of "milky nipple discharge" and new-onset
breast enlargement. Which of the following symptoms would further increase your suspicion of a
pituitary adenoma?
A) Increased appetite and weight gain
B) Blurred vision or visual field disturbances
C) Acute lower back pain
, 2
D) Dysuria and hematuria
E) Night sweats and chills
Correct Answer: B) visual disturbances, gynomastia, hypogonadism
Rationale: Pituitary adenomas, particularly prolactinomas, can cause galactorrhea and
gynecomastia due to excess prolactin. Because the pituitary gland sits in the sella turcica
beneath the optic chiasm, an enlarging tumor often compresses the chiasm, leading to
visual disturbances, classically bitemporal hemianopsia.
Question 4
Which of the following is considered a core component of the initial laboratory evaluation for a
suspected pituitary adenoma?
A) Comprehensive metabolic panel and CBC only
B) 24-hour urine for cortisol, TSH, ACTH, and FSH/LH
C) Fasting blood glucose and hemoglobin A1c
D) Prostate-specific antigen (PSA)
E) Electrolytes and liver function tests
Correct Answer: B) ACTH, TSH, 24 hr urine for cortisol levels, FSH, LH or MRI
Rationale: Evaluating the pituitary requires assessing the hormones the anterior pituitary
produces or regulates. This includes ACTH (adrenal function), TSH (thyroid function),
FSH/LH (gonadal function), and growth hormone. Cortisol levels help rule out Cushing’s
disease. Imaging via MRI is the gold standard for visualizing the sella turcica.
Question 5
What is a common medical management strategy for a somatotropinoma (a type of pituitary
adenoma) or for controlling hormone-producing symptoms?
A) Broad-spectrum antibiotics
B) High-dose corticosteroids
C) Ketoconazole or somatostatin analogs
D) Immediate neurosurgery for all patients regardless of size
E) Watchful waiting with no medication
Correct Answer: C) medical, somatotrpioma, ketoconazole OR (symptomatic) requires
neuro surgery
Rationale: Somatotropinomas (which cause acromegaly) can be managed with somatostatin
analogs to inhibit growth hormone. Ketoconazole is sometimes used to suppress cortisol
production in ACTH-secreting tumors. If medical management fails or visual symptoms
are severe, neurosurgical intervention (Transsphenoidal resection) is necessary.
Question 6
A female patient presents with a painful, fluctuant mass at the 5 o'clock position of the vaginal
, 3
introitus. What is the recommended initial conservative management for a symptomatic
Bartholin cyst?
A) Immediate surgical excision in the office
B) High-dose oral antifungal therapy
C) Sitz baths and improved perineal hygiene
D) Topical estrogen cream
E) Strict bed rest for 48 hours
Correct Answer: C) Sitz bath, good peri hygiene, I/D, antibiotics, OR resection if recurrent
Rationale: Initial management for a small or mildly symptomatic Bartholin cyst focuses on
sitz baths to promote spontaneous drainage. If the cyst becomes an abscess, Incision and
Drainage (I/D) with a Word catheter placement is required. Antibiotics are used if cellulitis
is present, and surgical resection is reserved for chronic recurrences.
Question 7
A 42-year-old female presents with a rapidly enlarging right breast. On examination, the breast is
tender, itchy, and has an appearance resembling an orange peel (peau d'orange). Which of the
following is the most likely diagnosis?
A) Fibroadenoma
B) Mastitis
C) Inflammatory breast cancer
D) Paget's disease of the breast
E) Fat necrosis
Correct Answer: C) breat pain, rapidly growing, often self diagnosed, tender, itching, lymph
involvement +, Peau de Orange
Rationale: Inflammatory breast cancer is a highly aggressive form of cancer. It often
presents without a distinct lump, but rather with skin changes (peau d'orange) caused by
cancer cells blocking the lymph vessels in the skin. Tenderness, itching, and rapid growth
are hallmark signs.
Question 8
What is the standard diagnostic and treatment sequence for a patient suspected of having
inflammatory breast cancer?
A) Warm compresses followed by a return visit in one month
B) Imaging (mammogram/ultrasound) followed by biopsy and chemotherapy
C) Incision and drainage for presumed abscess
D) Routine screening mammogram in six months
E) Referral to physical therapy for lymphedema management
Correct Answer: B) Imaging, biopsy, chemo, tumor removal
Rationale: Inflammatory breast cancer progresses rapidly; therefore, immediate imaging
, 4
and core needle biopsy are required for diagnosis. Treatment usually involves neoadjuvant
chemotherapy to shrink the tumor before surgical removal and radiation therapy.
Question 9
A patient reports breast pain that consistently occurs 5-7 days before her menstrual cycle and
resolves once her period begins. This is classified as:
A) Non-cyclic breast pain
B) Inflammatory mastalgia
C) Cyclic breast pain (Luteal phase)
D) Pathologic breast pain
E) Idiopathic mastalgia
Correct Answer: C) Luteal phase
Rationale: Cyclic breast pain is most commonly associated with hormonal fluctuations
during the luteal phase of the menstrual cycle (the time between ovulation and the start of
the period). Estrogen and progesterone changes cause fluid retention and ductal changes,
leading to bilateral tenderness.
Question 10
Which of the following is a potential cause of non-cyclic breast pain?
A) Standard ovulation
B) Normal luteal phase hormones
C) Mastitis or tumor fibrosis
D) First day of the follicular phase
E) Moderate exercise
Correct Answer: C) pregnancy, mastitis, thrombophlebitis, tumor fibrosis
Rationale: Non-cyclic breast pain does not follow the menstrual cycle and is often unilateral
or localized. Causes include localized infection (mastitis), trauma, pregnancy-related
changes, or underlying pathology like tumor fibrosis or Mondor’s disease
(thrombophlebitis of the breast veins).
Question 11
For a patient who has tested positive for the BRCA1 or BRCA2 gene mutation, which strategy is
recommended to reduce the risk of developing breast cancer?
A) Twice-yearly PAP smears
B) Chemoprevention with Tamoxifen or Raloxifene and yearly mammograms
C) Avoiding all forms of physical exercise
D) Low-dose aspirin therapy
E) Colonoscopy starting at age 30
Care I Exam | Questions and Verified Answers| 100% Correct| Grade A - GCU
Question 1
In primary care, what is the current comprehensive medical term used to describe sexual and
gender minorities?
A) LGBTQ+ individuals
B) Transgender populations
C) Sexual and gender minorities (SGM)
D) Gender non-conforming persons
E) Non-binary individuals
Correct Answer: C) Sexual and gender minorities (SGM)
Rationale: The term "Sexual and Gender Minorities" (SGM) is the broad, medically
accepted umbrella term used by organizations like the NIH and CDC to describe
individuals whose sexual orientation or gender identity differs from the majority. It is more
inclusive for research and clinical purposes than acronyms which may change over time.
Question 2
When providing care for a transgender patient, which of the following definitions most
accurately describes the term "transgender"?
A) Individuals who have undergone gender reassignment surgery only.
B) Individuals who identify as the opposite of their biological birth gender or whose gender is
not evident.
C) Individuals who identify with the gender assigned at birth.
D) Individuals who choose to dress in clothing traditionally associated with the opposite gender.
E) Only those patients currently receiving cross-sex hormone therapy.
Correct Answer: B) individuals who identify as the opposite of their birth / bio gender or for
those whose gender is not evident
Rationale: Gender identity is an internal sense of being male, female, or another gender.
Being transgender refers to the mismatch between internal gender identity and the sex
assigned at birth. It does not strictly require medical or surgical intervention to be a valid
identification.
Question 3
A 34-year-old male presents to the clinic complaining of "milky nipple discharge" and new-onset
breast enlargement. Which of the following symptoms would further increase your suspicion of a
pituitary adenoma?
A) Increased appetite and weight gain
B) Blurred vision or visual field disturbances
C) Acute lower back pain
, 2
D) Dysuria and hematuria
E) Night sweats and chills
Correct Answer: B) visual disturbances, gynomastia, hypogonadism
Rationale: Pituitary adenomas, particularly prolactinomas, can cause galactorrhea and
gynecomastia due to excess prolactin. Because the pituitary gland sits in the sella turcica
beneath the optic chiasm, an enlarging tumor often compresses the chiasm, leading to
visual disturbances, classically bitemporal hemianopsia.
Question 4
Which of the following is considered a core component of the initial laboratory evaluation for a
suspected pituitary adenoma?
A) Comprehensive metabolic panel and CBC only
B) 24-hour urine for cortisol, TSH, ACTH, and FSH/LH
C) Fasting blood glucose and hemoglobin A1c
D) Prostate-specific antigen (PSA)
E) Electrolytes and liver function tests
Correct Answer: B) ACTH, TSH, 24 hr urine for cortisol levels, FSH, LH or MRI
Rationale: Evaluating the pituitary requires assessing the hormones the anterior pituitary
produces or regulates. This includes ACTH (adrenal function), TSH (thyroid function),
FSH/LH (gonadal function), and growth hormone. Cortisol levels help rule out Cushing’s
disease. Imaging via MRI is the gold standard for visualizing the sella turcica.
Question 5
What is a common medical management strategy for a somatotropinoma (a type of pituitary
adenoma) or for controlling hormone-producing symptoms?
A) Broad-spectrum antibiotics
B) High-dose corticosteroids
C) Ketoconazole or somatostatin analogs
D) Immediate neurosurgery for all patients regardless of size
E) Watchful waiting with no medication
Correct Answer: C) medical, somatotrpioma, ketoconazole OR (symptomatic) requires
neuro surgery
Rationale: Somatotropinomas (which cause acromegaly) can be managed with somatostatin
analogs to inhibit growth hormone. Ketoconazole is sometimes used to suppress cortisol
production in ACTH-secreting tumors. If medical management fails or visual symptoms
are severe, neurosurgical intervention (Transsphenoidal resection) is necessary.
Question 6
A female patient presents with a painful, fluctuant mass at the 5 o'clock position of the vaginal
, 3
introitus. What is the recommended initial conservative management for a symptomatic
Bartholin cyst?
A) Immediate surgical excision in the office
B) High-dose oral antifungal therapy
C) Sitz baths and improved perineal hygiene
D) Topical estrogen cream
E) Strict bed rest for 48 hours
Correct Answer: C) Sitz bath, good peri hygiene, I/D, antibiotics, OR resection if recurrent
Rationale: Initial management for a small or mildly symptomatic Bartholin cyst focuses on
sitz baths to promote spontaneous drainage. If the cyst becomes an abscess, Incision and
Drainage (I/D) with a Word catheter placement is required. Antibiotics are used if cellulitis
is present, and surgical resection is reserved for chronic recurrences.
Question 7
A 42-year-old female presents with a rapidly enlarging right breast. On examination, the breast is
tender, itchy, and has an appearance resembling an orange peel (peau d'orange). Which of the
following is the most likely diagnosis?
A) Fibroadenoma
B) Mastitis
C) Inflammatory breast cancer
D) Paget's disease of the breast
E) Fat necrosis
Correct Answer: C) breat pain, rapidly growing, often self diagnosed, tender, itching, lymph
involvement +, Peau de Orange
Rationale: Inflammatory breast cancer is a highly aggressive form of cancer. It often
presents without a distinct lump, but rather with skin changes (peau d'orange) caused by
cancer cells blocking the lymph vessels in the skin. Tenderness, itching, and rapid growth
are hallmark signs.
Question 8
What is the standard diagnostic and treatment sequence for a patient suspected of having
inflammatory breast cancer?
A) Warm compresses followed by a return visit in one month
B) Imaging (mammogram/ultrasound) followed by biopsy and chemotherapy
C) Incision and drainage for presumed abscess
D) Routine screening mammogram in six months
E) Referral to physical therapy for lymphedema management
Correct Answer: B) Imaging, biopsy, chemo, tumor removal
Rationale: Inflammatory breast cancer progresses rapidly; therefore, immediate imaging
, 4
and core needle biopsy are required for diagnosis. Treatment usually involves neoadjuvant
chemotherapy to shrink the tumor before surgical removal and radiation therapy.
Question 9
A patient reports breast pain that consistently occurs 5-7 days before her menstrual cycle and
resolves once her period begins. This is classified as:
A) Non-cyclic breast pain
B) Inflammatory mastalgia
C) Cyclic breast pain (Luteal phase)
D) Pathologic breast pain
E) Idiopathic mastalgia
Correct Answer: C) Luteal phase
Rationale: Cyclic breast pain is most commonly associated with hormonal fluctuations
during the luteal phase of the menstrual cycle (the time between ovulation and the start of
the period). Estrogen and progesterone changes cause fluid retention and ductal changes,
leading to bilateral tenderness.
Question 10
Which of the following is a potential cause of non-cyclic breast pain?
A) Standard ovulation
B) Normal luteal phase hormones
C) Mastitis or tumor fibrosis
D) First day of the follicular phase
E) Moderate exercise
Correct Answer: C) pregnancy, mastitis, thrombophlebitis, tumor fibrosis
Rationale: Non-cyclic breast pain does not follow the menstrual cycle and is often unilateral
or localized. Causes include localized infection (mastitis), trauma, pregnancy-related
changes, or underlying pathology like tumor fibrosis or Mondor’s disease
(thrombophlebitis of the breast veins).
Question 11
For a patient who has tested positive for the BRCA1 or BRCA2 gene mutation, which strategy is
recommended to reduce the risk of developing breast cancer?
A) Twice-yearly PAP smears
B) Chemoprevention with Tamoxifen or Raloxifene and yearly mammograms
C) Avoiding all forms of physical exercise
D) Low-dose aspirin therapy
E) Colonoscopy starting at age 30
