NR 511 MIDTERM EXAM REVIEW AND
SOLUTIONS 2026
◉ Which of the following is not a risk factor for cholecystitis?
1.Female gender.
2.Obesity.
3.Sickle cell anemia.
4.Younger age. Answer: Younger age
rationale: The risk of cholecystitis actually increases with age
◉ A 54-year-old female presents to your primary care office for
routine reevaluation for gastroesophageal reflux disease (GERD).
She has been treated with diet modifications and 6 weeks of
omeprazole without improvement of her symptoms. What is the
next step in management of this patient's GERD?
1.Order an endoscopy.
2.Order a Helicobacter pylori blood test.
3.Try adding ranitidine to the patient's regimen.
4.Try adding bismuth to the patient's regimen. Answer: Order an
endoscopy
,rationale: This is the next step in treatment in order to evaluate the
etiology of the patient's GERD and consider biopsy if necessary
◉ A 25-year-old male presents with "bleeding in my eye" for 1 day.
He awoke this morning with a dark area of redness in his eye. He has
no visual loss or changes. He denies constitutional symptoms,
pruritus, drainage, or recent trauma. The redness presents on
physical exam as a dark red area in the patient's sclera of the right
eye only and takes up less than 50% of the eye. The patient's
remaining sclera is clear and white. He also notes he was drinking
alcohol last night and vomited afterward. What is the best
treatment?
1.Topical steroids and close follow-up with an ophthalmologist.
2.Sending the patient to the emergency department for immediate
ophthalmology consult.
3.Reassurance that this lesion will resolve without any treatment in
2 to 4 weeks.
4.Cold compresses and frequent handwashing Answer: Reassurance
that this lesion will resolve without any treatment in 2 to 4 weeks.
rationale: This is the classic presentation of a subconjunctival
hemorrhage. It will resolve without treatment in 2 to 4 weeks.
Vomiting probably caused his hemorrhage
◉ Which of the following statements about macular degeneration is
not true?
,1.Macular degeneration is characterized by gradual loss of
peripheral vision.
2.Macular degeneration is the leading cause of blindness in people
younger than 60.
3.Tobacco use is a risk factor for macular degeneration.
4.There are 2 different types of macular degeneration: wet and dry
Answer: Macular degeneration is characterized by gradual loss of
peripheral vision
rationale: This is how open-angle glaucoma is characterized.
Macular degeneration is gradual loss of central vision
◉ A 75-year-old female presents to your office complaining of
dizziness and hearing loss. The patient states she awoke yesterday
with dizziness, which she described as feeling the room spinning.
She also notes intermittent ringing in her ears. On physical exam, the
patient has lateralization of her hearing loss to the unaffected ear.
Rinne test shows air conduction lasts longer than bone conduction.
What is the next step in helping this patient's symptoms?
1.Order a computed tomography (CT) scan to rule out acoustic
neuroma.
2.Start her on high-dose Augmentin.
3.Start the patient on a low-salt, low-caffeine diet and give her
meclizine for vertigo attacks.
, 4.Immediate referral to an ear, nose, and throat (ENT) specialist
Answer: Start the patient on a low-salt, low-caffeine diet and give
her meclizine for vertigo attacks
rationale: This is the treatment for symptoms of Meniere disease.
You would also want to consider an ear, nose, and throat consult to
rule out other etiologies of the patient's symptoms. Meniere disease
is diagnosed based on history and the exclusion of other conditions
as well
◉ What is the most common bacterial pathogen associated with
acute otitis media?
1.Streptococcus pneumoniae.
2.Haemophilus influenzae.
3.Streptococcus pyogenes.
4.Moraxella (Branhamella) catarrhalis. Answer: Streptococcus
pneumoniae
rationale: This causes 40% to 50% of cases.
◉ A 20-year-old male presents to your primary care clinic. This
patient is a college student. He complains of fatigue, sore throat, and
low-grade fever for 3 days. On physical exam, he has a temperature
of 100.7°F. His ear exam is normal. His nose and throat exam shows
mild erythema of the nasal mucosa and edematous, enlarged tonsils
SOLUTIONS 2026
◉ Which of the following is not a risk factor for cholecystitis?
1.Female gender.
2.Obesity.
3.Sickle cell anemia.
4.Younger age. Answer: Younger age
rationale: The risk of cholecystitis actually increases with age
◉ A 54-year-old female presents to your primary care office for
routine reevaluation for gastroesophageal reflux disease (GERD).
She has been treated with diet modifications and 6 weeks of
omeprazole without improvement of her symptoms. What is the
next step in management of this patient's GERD?
1.Order an endoscopy.
2.Order a Helicobacter pylori blood test.
3.Try adding ranitidine to the patient's regimen.
4.Try adding bismuth to the patient's regimen. Answer: Order an
endoscopy
,rationale: This is the next step in treatment in order to evaluate the
etiology of the patient's GERD and consider biopsy if necessary
◉ A 25-year-old male presents with "bleeding in my eye" for 1 day.
He awoke this morning with a dark area of redness in his eye. He has
no visual loss or changes. He denies constitutional symptoms,
pruritus, drainage, or recent trauma. The redness presents on
physical exam as a dark red area in the patient's sclera of the right
eye only and takes up less than 50% of the eye. The patient's
remaining sclera is clear and white. He also notes he was drinking
alcohol last night and vomited afterward. What is the best
treatment?
1.Topical steroids and close follow-up with an ophthalmologist.
2.Sending the patient to the emergency department for immediate
ophthalmology consult.
3.Reassurance that this lesion will resolve without any treatment in
2 to 4 weeks.
4.Cold compresses and frequent handwashing Answer: Reassurance
that this lesion will resolve without any treatment in 2 to 4 weeks.
rationale: This is the classic presentation of a subconjunctival
hemorrhage. It will resolve without treatment in 2 to 4 weeks.
Vomiting probably caused his hemorrhage
◉ Which of the following statements about macular degeneration is
not true?
,1.Macular degeneration is characterized by gradual loss of
peripheral vision.
2.Macular degeneration is the leading cause of blindness in people
younger than 60.
3.Tobacco use is a risk factor for macular degeneration.
4.There are 2 different types of macular degeneration: wet and dry
Answer: Macular degeneration is characterized by gradual loss of
peripheral vision
rationale: This is how open-angle glaucoma is characterized.
Macular degeneration is gradual loss of central vision
◉ A 75-year-old female presents to your office complaining of
dizziness and hearing loss. The patient states she awoke yesterday
with dizziness, which she described as feeling the room spinning.
She also notes intermittent ringing in her ears. On physical exam, the
patient has lateralization of her hearing loss to the unaffected ear.
Rinne test shows air conduction lasts longer than bone conduction.
What is the next step in helping this patient's symptoms?
1.Order a computed tomography (CT) scan to rule out acoustic
neuroma.
2.Start her on high-dose Augmentin.
3.Start the patient on a low-salt, low-caffeine diet and give her
meclizine for vertigo attacks.
, 4.Immediate referral to an ear, nose, and throat (ENT) specialist
Answer: Start the patient on a low-salt, low-caffeine diet and give
her meclizine for vertigo attacks
rationale: This is the treatment for symptoms of Meniere disease.
You would also want to consider an ear, nose, and throat consult to
rule out other etiologies of the patient's symptoms. Meniere disease
is diagnosed based on history and the exclusion of other conditions
as well
◉ What is the most common bacterial pathogen associated with
acute otitis media?
1.Streptococcus pneumoniae.
2.Haemophilus influenzae.
3.Streptococcus pyogenes.
4.Moraxella (Branhamella) catarrhalis. Answer: Streptococcus
pneumoniae
rationale: This causes 40% to 50% of cases.
◉ A 20-year-old male presents to your primary care clinic. This
patient is a college student. He complains of fatigue, sore throat, and
low-grade fever for 3 days. On physical exam, he has a temperature
of 100.7°F. His ear exam is normal. His nose and throat exam shows
mild erythema of the nasal mucosa and edematous, enlarged tonsils
