NRNP 6550 EXAM
QNS & ANS
2023/2024
,1. A patient presents with the lesion shown below. Which of the following drugs should be
given as post-exposure prophylaxis (PEP) for this disease?
Correct Answer: B. Doxycycline
2. A 45-year-old white woman with clinical findings suggestive of Cushing syndrome has 2
elevated late night salivary cortisol levels and 2 elevated urinary free-cortisol tests of 220
and 300 (normal 2-50mg/24 hour); her ACTH level is 55 (normal 5-50pg/mL), and her
pituitary MRI shows a 3mm adenoma. Which of the followings is the best next course of
action?
Correct answer: (D) High-dose dexamethasone suppression test (HDDST) and/or
corticotropin-releasing hormone (CRH) stimulation test.
3. A female patient with primary hypothyroidism has been stable (normal TSH) on
replacement LT4 (dose 1.6μg/kg of body weight) for several years. On annual follow-up,
the following laboratory tests are obtained: T4 = 14.1μg/dL (normal 5.0-10.5) and TSH =
23.4μU/mL (normal 0.4-5.5). Which is the most likely diagnosis?
Correct answer: (D) Poor compliance this past year, with recent attempt to “catch up” with
excessive LT4 intake.
4. Which of the following is the organism most frequently implicated in toxic shock
syndrome in women who are using tampons?
, Correct answer: (B) Staphylococcus aureus.
5. Rocky Mountain spotted fever is caused by which of the following?
Correct answer: (C) Tick bite.
6. A 36-year-old female presents to a primary healthcare provider with a history of irregular
menstrual cycles and secondary amenorrhea. She had no problem conceiving her first
child at age 24, but she has been trying unsuccessfully to become pregnant for the past 2
years. She also reports a weight gain of about 5kg, increasing fatigue, a puffy face, and
marked cold intolerance. CBC reveals an Hb of 11.1 and an MCV of 90. Physical exam
reveals a moderate-sized diffuse enlargement of the thyroid gland. Which of the following
thyroid profiles is most likely present in this woman?
Correct answer: (A) Low T3, low T4, high TSH.
7. A 40-year-old white woman with a history of severe asthma and Hashimoto thyroiditis
reports 2 months of fatigue, anorexia, nausea, weight loss, and myalgia. Examination is
remarkable only for a BP of 98/60 mmHg and a pulse of 98 beats/minute without
orthostasis. She shows no hyperpigmentation. Lab values are as follows: sodium 130
mEq/L, potassium 4.5 mEq/L, chloride 105 mEq/L, and bicarbonate 24 mEq/L. ACTH
stimulation testing shows an AM cortisol level of 5.8 μg/dL at T0 (normal is 10-20 μg/dL)
and 13.2 μg/dL (normal >18 μg/dL) at T60 (60 minutes after administration of ACTH).
Which of the following is correct?
ANSWER: B. The most likely cause of her adrenal insufficiency is prior exogenous
corticosteroid use.
8. Which of the following is the first line treatment for gonorrheal infections?
Correct answer: (C) Azithromycin plus ceftriaxone.
9. A 59-year-old woman presents to the ED feeling generally unwell with 2 months of
worsening lethargy, nausea, generalized abdominal pain, and constipation. She is a heavy
smoker and has hypertension, high cholesterol, and chronic bronchitis. She takes
amlodipine 5mg daily and atorvastatin 40mg daily with no recent changes in doses or
frequency. The patient has lost 15lbs despite a normal appetite over this period. There has
been no recent exacerbation of her chronic cough. She had a few episodes of minimal
hemoptysis a few months ago but none since. Vital signs are within normal limits.
Auscultation of the lungs reveals mild decreased air entry throughout and no adventitious
sounds. Mild generalized abdominal tenderness to palpation is noted. Physical
examination is otherwise unremarkable. Laboratory investigations are notable for a Cr of
0.8 and Ca of 12.1. Albumin is 3.8. Chest radiograph shows a discrete mass in the right
hilum that is approximately 10mm in diameter; otherwise, lung fields are clear without
collapse or consolidation. What is the best initial management of this patient?
Correct answer: (B) IV hydration with normal saline.
10. A 26-year-old man has had a painless penile lesion for several weeks and new swelling in
the groin. On examination, a single nontender penile ulcer and bilateral palpable
QNS & ANS
2023/2024
,1. A patient presents with the lesion shown below. Which of the following drugs should be
given as post-exposure prophylaxis (PEP) for this disease?
Correct Answer: B. Doxycycline
2. A 45-year-old white woman with clinical findings suggestive of Cushing syndrome has 2
elevated late night salivary cortisol levels and 2 elevated urinary free-cortisol tests of 220
and 300 (normal 2-50mg/24 hour); her ACTH level is 55 (normal 5-50pg/mL), and her
pituitary MRI shows a 3mm adenoma. Which of the followings is the best next course of
action?
Correct answer: (D) High-dose dexamethasone suppression test (HDDST) and/or
corticotropin-releasing hormone (CRH) stimulation test.
3. A female patient with primary hypothyroidism has been stable (normal TSH) on
replacement LT4 (dose 1.6μg/kg of body weight) for several years. On annual follow-up,
the following laboratory tests are obtained: T4 = 14.1μg/dL (normal 5.0-10.5) and TSH =
23.4μU/mL (normal 0.4-5.5). Which is the most likely diagnosis?
Correct answer: (D) Poor compliance this past year, with recent attempt to “catch up” with
excessive LT4 intake.
4. Which of the following is the organism most frequently implicated in toxic shock
syndrome in women who are using tampons?
, Correct answer: (B) Staphylococcus aureus.
5. Rocky Mountain spotted fever is caused by which of the following?
Correct answer: (C) Tick bite.
6. A 36-year-old female presents to a primary healthcare provider with a history of irregular
menstrual cycles and secondary amenorrhea. She had no problem conceiving her first
child at age 24, but she has been trying unsuccessfully to become pregnant for the past 2
years. She also reports a weight gain of about 5kg, increasing fatigue, a puffy face, and
marked cold intolerance. CBC reveals an Hb of 11.1 and an MCV of 90. Physical exam
reveals a moderate-sized diffuse enlargement of the thyroid gland. Which of the following
thyroid profiles is most likely present in this woman?
Correct answer: (A) Low T3, low T4, high TSH.
7. A 40-year-old white woman with a history of severe asthma and Hashimoto thyroiditis
reports 2 months of fatigue, anorexia, nausea, weight loss, and myalgia. Examination is
remarkable only for a BP of 98/60 mmHg and a pulse of 98 beats/minute without
orthostasis. She shows no hyperpigmentation. Lab values are as follows: sodium 130
mEq/L, potassium 4.5 mEq/L, chloride 105 mEq/L, and bicarbonate 24 mEq/L. ACTH
stimulation testing shows an AM cortisol level of 5.8 μg/dL at T0 (normal is 10-20 μg/dL)
and 13.2 μg/dL (normal >18 μg/dL) at T60 (60 minutes after administration of ACTH).
Which of the following is correct?
ANSWER: B. The most likely cause of her adrenal insufficiency is prior exogenous
corticosteroid use.
8. Which of the following is the first line treatment for gonorrheal infections?
Correct answer: (C) Azithromycin plus ceftriaxone.
9. A 59-year-old woman presents to the ED feeling generally unwell with 2 months of
worsening lethargy, nausea, generalized abdominal pain, and constipation. She is a heavy
smoker and has hypertension, high cholesterol, and chronic bronchitis. She takes
amlodipine 5mg daily and atorvastatin 40mg daily with no recent changes in doses or
frequency. The patient has lost 15lbs despite a normal appetite over this period. There has
been no recent exacerbation of her chronic cough. She had a few episodes of minimal
hemoptysis a few months ago but none since. Vital signs are within normal limits.
Auscultation of the lungs reveals mild decreased air entry throughout and no adventitious
sounds. Mild generalized abdominal tenderness to palpation is noted. Physical
examination is otherwise unremarkable. Laboratory investigations are notable for a Cr of
0.8 and Ca of 12.1. Albumin is 3.8. Chest radiograph shows a discrete mass in the right
hilum that is approximately 10mm in diameter; otherwise, lung fields are clear without
collapse or consolidation. What is the best initial management of this patient?
Correct answer: (B) IV hydration with normal saline.
10. A 26-year-old man has had a painless penile lesion for several weeks and new swelling in
the groin. On examination, a single nontender penile ulcer and bilateral palpable
