NSG6020 FINAL EXAM QUESTIONS
AND ANSWERS
Heberden's55nodes55are55commonly55found55in55which55one55of55the55following55diseas
es?55-55answer--Degenerative55joint55disease
You55are55beginning55the55examination55of55the55skin55on55a5525-year-
old55teacher.55You55have55previously55elicited55that55she55came55to55the55office55for55ev
aluation55of55fatigue,55weight55gain,55and55hair55loss.55You55strongly55suspect55that55she
55has55hypothyroidism.55What55is55the55expected55moisture55and55texture55of55the55skin5
5of55the55patient55with55hypothyroidism55-55answer--dry55and55rough
You55are55assessing55a55patient55with55joint55pain55and55are55trying55to55decide55whethe
r55it55is55inflammatory55or55noninflammatory55in55nature.55Which55one55of55the55following
55symptoms55is55consistent55with55an55inflammatory55process?55-55answer--tenderness
A5568-year-
old55retired55farmer55comes55to55your55office55for55evaluation55of55a55skin55lesion.55On55t
he55right55temporal55area55of55the55forehead,55you55see55a55flattened55papule55the55sam
e55color55as55his55skin,55covered55by55a55dry55scale55that55is55round55and55feels55hard.55
He55has55several55more55of55these55scattered55on55the55forehead,55arms55and55legs.55B
ased55on55this55description,55what55is55your55most55likely55diagnosis?55-55answer--
actinic55keratosis
A5528-year-
old55graduate55student55comes55to55your55clinic55for55evaluation55of55pain55"all55over."55
With55further55questioning,55she55is55able55to55relate55that55the55pain55is55worse55in55the
55neck,55shoulders,55hands,55low55back55and55knees.55She55denies55swelling55in55her55j
oints.55She55states55that55the55pain55is55worse55in55the55morning.55There55is55no55limitati
on55in55her55range55of55motion.55On55physical55examination,55she55has55several55points
55on55the55muscles55of55the55neck,55shoulders55and55back55that55are55tender55to55palpat
ion.55Muscle55strength55and55range55of55motion55are55normal.55Which55one55of55the55foll
owing55is55likely55the55cause55of55her55pain?55-55answer--fibromyalgia
A55new55patient55is55complaining55of55severe55pruritus55that55is55worse55at55night.55Seve
ral55family55members55also55have55the55same55symptoms.55Upon55examination,55areas5
5of55excoriated55papules55are55noted55on55some55of55the55interdigital55webs55of55both55h
ands55and55on55the55axillae.55This55finding55is55most55consistent55with:55-55answer--
Scabies
, An55obese5555-year-
old55woman55went55through55menarche55at55age551655and55menopause55255years55ago.
55She55is55concerned55because55an55aunt55had55severe55osteoporosis.55Which55one55of
55the55following55is55a55risk55factor55for55osteoporosis?55-55answer--Delayed55menarche
Ms.55Whiting55is55a5568-year-old55female55who55comes55in55for55her55usual55follow-
up55visit.55You55notice55a55few55flat55red55and55purple55lesions,55about55655centimeters55
in55diameter,55on55the55ulnar55aspect55of55her55forearms55but55nowhere55else.55She55do
esn't55mention55them.55They55are55tender55when55you55examine55them.55What55should5
5you55do?55-55answer--Ask55how55she55acquired55them.
A5558-year-
old55man55comes55to55your55office55complaining55of55bilateral55back55pain55that55now55a
wakens55him55at55night.55This55has55been55steadily55increasing55for55the55past55255mont
hs.55Which55one55of55the55following55is55the55most55reassuring55in55this55patient55with55b
ack55pain?55-55answer--Pain55that55is55bilateral
The55Phalen's55test55is55used55to55evaluate:55-55answer--
inflammation55of55the55median55nerve
Which55of55the55following55would55lead55you55to55suspect55a55hydrocele55versus55other5
5causes55of55scrotal55swelling?55-55answer--A55positive55transillumination55test
You55are55examining55a55newborn55and55note55that55the55right55testicle55is55not55in55the5
5scrotum.55What55should55you55do55next?55-55answer--
Attempt55to55bring55down55the55testis55from55the55inguinal55canal
A5550-year-
old55truck55driver55comes55to55your55clinic55for55a55work55physical.55He55has55had55no55
upper55respiratory,55cardiac,55pulmonary,55gastrointestinal,55urinary,55or55musculoskelet
al55system55complaints.55His55past55medical55history55is55significant55for55mild55arthritis5
5and55prior55knee55surgery55in55college.55He55is55married55and55just55changed55jobs,55w
orking55for55a55different55trucking55company.55He55smokes55one55pack55of55cigarettes55
a55day,55drinks55less55than55six55beers55a55week,55and55denies55using55any55illegal55dru
gs.55His55mother55has55high55blood55pressure55and55arthritis55and55his55father55died55of5
5lung55cancer55in55his55sixties.55On55examination,55his55blood55pressure55is55130/8055an
d55his55pulse55is5580.55His55cardiac,55lung,55and55abdominal55examinations55are55norma
l.55He55has55no55inguinal55hernia,55but55on55his55digital55rectal55examination55you55palpa
te55a55soft,55smooth,55and55nontender55pedunculated55mass55on55the55posterior55wall55o
f55the55rectum.55What55anal,55rectal,55or55prostate55disorder55best55fits55his55presentatio
n?55-55answer--Rectal55polyp
A5515-year-
old55high55school55football55player55is55brought55to55your55office55by55his55mother.55He55i
s55complaining55of55severe55testicular55pain55since55exactly558:0055this55morning.55He55
AND ANSWERS
Heberden's55nodes55are55commonly55found55in55which55one55of55the55following55diseas
es?55-55answer--Degenerative55joint55disease
You55are55beginning55the55examination55of55the55skin55on55a5525-year-
old55teacher.55You55have55previously55elicited55that55she55came55to55the55office55for55ev
aluation55of55fatigue,55weight55gain,55and55hair55loss.55You55strongly55suspect55that55she
55has55hypothyroidism.55What55is55the55expected55moisture55and55texture55of55the55skin5
5of55the55patient55with55hypothyroidism55-55answer--dry55and55rough
You55are55assessing55a55patient55with55joint55pain55and55are55trying55to55decide55whethe
r55it55is55inflammatory55or55noninflammatory55in55nature.55Which55one55of55the55following
55symptoms55is55consistent55with55an55inflammatory55process?55-55answer--tenderness
A5568-year-
old55retired55farmer55comes55to55your55office55for55evaluation55of55a55skin55lesion.55On55t
he55right55temporal55area55of55the55forehead,55you55see55a55flattened55papule55the55sam
e55color55as55his55skin,55covered55by55a55dry55scale55that55is55round55and55feels55hard.55
He55has55several55more55of55these55scattered55on55the55forehead,55arms55and55legs.55B
ased55on55this55description,55what55is55your55most55likely55diagnosis?55-55answer--
actinic55keratosis
A5528-year-
old55graduate55student55comes55to55your55clinic55for55evaluation55of55pain55"all55over."55
With55further55questioning,55she55is55able55to55relate55that55the55pain55is55worse55in55the
55neck,55shoulders,55hands,55low55back55and55knees.55She55denies55swelling55in55her55j
oints.55She55states55that55the55pain55is55worse55in55the55morning.55There55is55no55limitati
on55in55her55range55of55motion.55On55physical55examination,55she55has55several55points
55on55the55muscles55of55the55neck,55shoulders55and55back55that55are55tender55to55palpat
ion.55Muscle55strength55and55range55of55motion55are55normal.55Which55one55of55the55foll
owing55is55likely55the55cause55of55her55pain?55-55answer--fibromyalgia
A55new55patient55is55complaining55of55severe55pruritus55that55is55worse55at55night.55Seve
ral55family55members55also55have55the55same55symptoms.55Upon55examination,55areas5
5of55excoriated55papules55are55noted55on55some55of55the55interdigital55webs55of55both55h
ands55and55on55the55axillae.55This55finding55is55most55consistent55with:55-55answer--
Scabies
, An55obese5555-year-
old55woman55went55through55menarche55at55age551655and55menopause55255years55ago.
55She55is55concerned55because55an55aunt55had55severe55osteoporosis.55Which55one55of
55the55following55is55a55risk55factor55for55osteoporosis?55-55answer--Delayed55menarche
Ms.55Whiting55is55a5568-year-old55female55who55comes55in55for55her55usual55follow-
up55visit.55You55notice55a55few55flat55red55and55purple55lesions,55about55655centimeters55
in55diameter,55on55the55ulnar55aspect55of55her55forearms55but55nowhere55else.55She55do
esn't55mention55them.55They55are55tender55when55you55examine55them.55What55should5
5you55do?55-55answer--Ask55how55she55acquired55them.
A5558-year-
old55man55comes55to55your55office55complaining55of55bilateral55back55pain55that55now55a
wakens55him55at55night.55This55has55been55steadily55increasing55for55the55past55255mont
hs.55Which55one55of55the55following55is55the55most55reassuring55in55this55patient55with55b
ack55pain?55-55answer--Pain55that55is55bilateral
The55Phalen's55test55is55used55to55evaluate:55-55answer--
inflammation55of55the55median55nerve
Which55of55the55following55would55lead55you55to55suspect55a55hydrocele55versus55other5
5causes55of55scrotal55swelling?55-55answer--A55positive55transillumination55test
You55are55examining55a55newborn55and55note55that55the55right55testicle55is55not55in55the5
5scrotum.55What55should55you55do55next?55-55answer--
Attempt55to55bring55down55the55testis55from55the55inguinal55canal
A5550-year-
old55truck55driver55comes55to55your55clinic55for55a55work55physical.55He55has55had55no55
upper55respiratory,55cardiac,55pulmonary,55gastrointestinal,55urinary,55or55musculoskelet
al55system55complaints.55His55past55medical55history55is55significant55for55mild55arthritis5
5and55prior55knee55surgery55in55college.55He55is55married55and55just55changed55jobs,55w
orking55for55a55different55trucking55company.55He55smokes55one55pack55of55cigarettes55
a55day,55drinks55less55than55six55beers55a55week,55and55denies55using55any55illegal55dru
gs.55His55mother55has55high55blood55pressure55and55arthritis55and55his55father55died55of5
5lung55cancer55in55his55sixties.55On55examination,55his55blood55pressure55is55130/8055an
d55his55pulse55is5580.55His55cardiac,55lung,55and55abdominal55examinations55are55norma
l.55He55has55no55inguinal55hernia,55but55on55his55digital55rectal55examination55you55palpa
te55a55soft,55smooth,55and55nontender55pedunculated55mass55on55the55posterior55wall55o
f55the55rectum.55What55anal,55rectal,55or55prostate55disorder55best55fits55his55presentatio
n?55-55answer--Rectal55polyp
A5515-year-
old55high55school55football55player55is55brought55to55your55office55by55his55mother.55He55i
s55complaining55of55severe55testicular55pain55since55exactly558:0055this55morning.55He55
