NR 509 Final Exam WITH 100 QUESTIONS & CORRECT
ANSWERS
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? -
ANSWER-Cervix
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 historical
elements would be the most concerning for colon cancer in this patient ? -
ANSWER-Recent onset of small-caliber stools
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? - ANSWER-The patient
should undergo colonoscopy for his bowel condition, which confers risk of colon
cancer
,A 49-year-old male with well-controlled HIV undergoes a proctoscopic
examination as routine screening for anal cancer. The patient is asymptomatic and
specifically denies complaints of frequent urination (frequency), large volume of
urination (polyuria), or repeated urination at night (nocturia). Under direct
visualization, the clinician observes a clear, circumferential demarcation of
proximal versus distal tissue. This demarcation was not palpable on digital rectal
examination (DRE) prior to proctoscopy. What is the most likely origin of this
finding? - ANSWER-Normal anatomy of the mucosal surface
A 34-year-old female reports anal pain with defecation. She notes incidentally to
this complaint that she has developed episodic abdominal discomfort and sores in
her mouth. Anoscopic examination reveals anal fissures that appear to be her
source of pain. Which of the following underlying conditions is the clinician most
likely to find? - ANSWER-Inflammatory bowel disease
A 53-year-old African American advertising agent presents for discussion of his
prostate cancer risk and possible screening for this disease. His father was
diagnosed at age 82 years with prostate cancer but died recently at age 87 years
from a myocardial infarction before the disease progressed. Family history also
reveals that his mother died of ovarian cancer when he was age 10 years, and two
of his maternal aunts had breast cancer. Which of the following is true about risk
and screening for prostate cancer? - ANSWER-This patient is at an elevated risk of
prostate cancer due to his family history, thus screening modalities should be
discussed between the patient and provider
A 64-year-old retired architect presents to his primary care provider with a
magazine article about prostate cancer screening that states, "You should talk to
your doctor about the ups and downs of prostate cancer screening." The patient
hands this to the clinician and states, "Tell me about the ups and down of prostate
screening." Which of the following is true about prostate cancer screening? -
ANSWER-Setting normal cut offs for prostate-specific antigen (PSA) testing relies
on balancing the risk of overdiagnosis with the risk of underdiagnosis
, A thin, 58-year-old patient complains of lower back pain for years. On
examination, the clinician finds that the patient has tenderness over the sacroiliac
area. Which of the following conditions is most consistent with this physical sign?
- ANSWER-Ankylosing spondylitis
During an evaluation of an athletic 30-year-old patient, the clinician conducts an
active range of motion evaluation at the neck. Which muscle is being assessed
when the patient is asked to flex the neck? - ANSWER-Sternocleidomastoid
An obese 50-year-old patient presents with a long history of back trouble. What
structure in the spine supports the body's weight? - ANSWER-Vertebral body
A 31-year-old day care worker presents with a worsening stiff, painful neck. On
inspection, the patient's head is laterally deviated toward the shoulder and rotated.
At this point of the examination, what is the most likely diagnosis? - ANSWER-
Torticollis
A young adult patient presents to the clinic stating that something is wrong as he
looks in the mirror and sees that his shoulders are uneven. He fractured his left arm
8 weeks ago and remains in a cast. He noticed the uneven shoulders over the last
week. Upon inspection, his shoulder heights are unequal and there is winging of
the scapula. As the examination continues, which of the following maneuvers
would confirm a likely diagnosis? - ANSWER-Compare the strength of his
trapezia muscles
During a musculoskeletal examination, the clinician instructs the patient to look
over one shoulder, and then the other shoulder. This action assesses the movement
of which muscle(s)? - ANSWER-Sternocleidomastoid (SCM)
During a musculoskeletal examination of the spine, what is the action(s) of the
erector spinae muscle group? - ANSWER-Extension of the spine
ANSWERS
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? -
ANSWER-Cervix
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 historical
elements would be the most concerning for colon cancer in this patient ? -
ANSWER-Recent onset of small-caliber stools
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? - ANSWER-The patient
should undergo colonoscopy for his bowel condition, which confers risk of colon
cancer
,A 49-year-old male with well-controlled HIV undergoes a proctoscopic
examination as routine screening for anal cancer. The patient is asymptomatic and
specifically denies complaints of frequent urination (frequency), large volume of
urination (polyuria), or repeated urination at night (nocturia). Under direct
visualization, the clinician observes a clear, circumferential demarcation of
proximal versus distal tissue. This demarcation was not palpable on digital rectal
examination (DRE) prior to proctoscopy. What is the most likely origin of this
finding? - ANSWER-Normal anatomy of the mucosal surface
A 34-year-old female reports anal pain with defecation. She notes incidentally to
this complaint that she has developed episodic abdominal discomfort and sores in
her mouth. Anoscopic examination reveals anal fissures that appear to be her
source of pain. Which of the following underlying conditions is the clinician most
likely to find? - ANSWER-Inflammatory bowel disease
A 53-year-old African American advertising agent presents for discussion of his
prostate cancer risk and possible screening for this disease. His father was
diagnosed at age 82 years with prostate cancer but died recently at age 87 years
from a myocardial infarction before the disease progressed. Family history also
reveals that his mother died of ovarian cancer when he was age 10 years, and two
of his maternal aunts had breast cancer. Which of the following is true about risk
and screening for prostate cancer? - ANSWER-This patient is at an elevated risk of
prostate cancer due to his family history, thus screening modalities should be
discussed between the patient and provider
A 64-year-old retired architect presents to his primary care provider with a
magazine article about prostate cancer screening that states, "You should talk to
your doctor about the ups and downs of prostate cancer screening." The patient
hands this to the clinician and states, "Tell me about the ups and down of prostate
screening." Which of the following is true about prostate cancer screening? -
ANSWER-Setting normal cut offs for prostate-specific antigen (PSA) testing relies
on balancing the risk of overdiagnosis with the risk of underdiagnosis
, A thin, 58-year-old patient complains of lower back pain for years. On
examination, the clinician finds that the patient has tenderness over the sacroiliac
area. Which of the following conditions is most consistent with this physical sign?
- ANSWER-Ankylosing spondylitis
During an evaluation of an athletic 30-year-old patient, the clinician conducts an
active range of motion evaluation at the neck. Which muscle is being assessed
when the patient is asked to flex the neck? - ANSWER-Sternocleidomastoid
An obese 50-year-old patient presents with a long history of back trouble. What
structure in the spine supports the body's weight? - ANSWER-Vertebral body
A 31-year-old day care worker presents with a worsening stiff, painful neck. On
inspection, the patient's head is laterally deviated toward the shoulder and rotated.
At this point of the examination, what is the most likely diagnosis? - ANSWER-
Torticollis
A young adult patient presents to the clinic stating that something is wrong as he
looks in the mirror and sees that his shoulders are uneven. He fractured his left arm
8 weeks ago and remains in a cast. He noticed the uneven shoulders over the last
week. Upon inspection, his shoulder heights are unequal and there is winging of
the scapula. As the examination continues, which of the following maneuvers
would confirm a likely diagnosis? - ANSWER-Compare the strength of his
trapezia muscles
During a musculoskeletal examination, the clinician instructs the patient to look
over one shoulder, and then the other shoulder. This action assesses the movement
of which muscle(s)? - ANSWER-Sternocleidomastoid (SCM)
During a musculoskeletal examination of the spine, what is the action(s) of the
erector spinae muscle group? - ANSWER-Extension of the spine
