NR 509 Midterm Exam 2025| Chamberlain
University| Actual Exam Questions and
Correct Answers
Question 1: An 18-year-old patient comes to the office for evaluation of a rash. At first there was
one large patch, but then more lesions appeared suddenly on the back and torso; the lesions itch.
On physical examination, you note that the pattern of eruption is like a Christmas tree and that
there are a variety of erythematous papules and macules on the cleavage lines of the back. Based
on this description, what is the most likely diagnosis?
A) Tinea versicolor
B) Pityriasis rosea
C) Psoriasis
D) Contact dermatitis
Correct Answer: B) Pityriasis rosea
Explanation: The initial herald patch followed by an itchy, Christmas tree-patterned rash with
erythematous papules and macules along cleavage lines is characteristic of pityriasis rosea, a
self-limiting viral exanthem. Tinea versicolor presents with hypo/hyperpigmented patches,
psoriasis with silvery scales, and contact dermatitis with localized, exposure-related lesions.
Question 2: A 19-year-old construction worker presents for evaluation of a rash. He notes that it
appeared on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a
lot. He does sweat more than before because being outdoors is part of his job. On physical
examination, you note dark tan patches with a reddish cast that have sharp borders and fine
scales, more prominently around the upper back, chest, neck, and upper arms as well as under the
arms. Based on this description, what is your most likely diagnosis?
A) Pityriasis rosea
B) Tinea versicolor
C) Seborrheic dermatitis
D) Eczema
Correct Answer: B) Tinea versicolor
,Explanation: Dark tan patches with fine scales, sharp borders, and a reddish cast in sweat-prone
areas (back, chest, neck, arms) suggest tinea versicolor, a fungal infection exacerbated by heat
and humidity. Pityriasis rosea has a herald patch and Christmas tree pattern, seborrheic
dermatitis affects the scalp and face, and eczema is typically more eczematous with oozing.
Question 3: You are examining a child with severe cerebral palsy. When you suddenly move his
foot dorsally, a sustained “beating” of the foot against your hand ensues. What does this
represent?
A) Clonus
B) Spasticity
C) Rigidity
D) Tremor
Correct Answer: A) Clonus
Explanation: Sustained rhythmic beating of the foot upon sudden dorsiflexion indicates clonus,
a sign of upper motor neuron dysfunction common in cerebral palsy. Spasticity involves
increased muscle tone, rigidity is continuous resistance, and tremor is an involuntary oscillatory
movement.
Question 4: A patient presents with a daily headache which has worsened over the past several
months. On funduscopic examination, you notice that the disk edge is indistinct and the veins do
not pulsate. Which is most likely?
A) Migraine
B) Tension headache
C) Increased intracranial pressure
D) Cluster headache
Correct Answer: C) Increased intracranial pressure
Explanation: Indistinct disk edges and absent venous pulsations suggest papilledema, indicative
of increased intracranial pressure (e.g., from a mass or hydrocephalus). Migraine, tension, and
cluster headaches typically have normal funduscopic findings.
Question 5: A patient complains of epistaxis. Which other cause should be considered?
A) Allergic rhinitis
, B) Nasal polyps
C) Hypertension
D) Sinusitis
Correct Answer: C) Hypertension
Explanation: Hypertension is a common cause of epistaxis, especially in adults, due to increased
vascular pressure. Allergic rhinitis and sinusitis may cause nasal irritation but are less directly
linked, and nasal polyps are not typically associated with bleeding.
Question 6: A patient complains of shortness of breath for the past few days. On examination,
you note late inspiratory crackles in the lower third of the chest that were not present a week ago.
What is the most likely explanation for these?
A) Asthma
B) Pneumonia
C) Pulmonary edema
D) Chronic obstructive pulmonary disease
Correct Answer: C) Pulmonary edema
Explanation: Late inspiratory crackles in the lower chest suggest pulmonary edema, often due to
heart failure, causing fluid accumulation in alveoli. Asthma may cause wheezing, pneumonia
typically has coarse crackles and fever, and COPD has chronic symptoms, not acute crackles.
Question 7: You are concerned about a positive test finding you have just observed on physical
examination of your patient. You go on to do more examination, laboratory work, and diagnostic
tests, only to find that there is no sign of the disease you thought would correlate with the
finding. This same experience happens several times. What should you conclude?
A) The test has low specificity
B) The test has low sensitivity
C) The patient is malingering
D) The disease is in remission
Correct Answer: A) The test has low specificity
Explanation: Repeated false-positive findings (positive test without disease) indicate low
specificity, meaning the test often detects positives in healthy individuals. Low sensitivity would
miss disease, malingering requires behavioral evidence, and remission is disease-specific.
University| Actual Exam Questions and
Correct Answers
Question 1: An 18-year-old patient comes to the office for evaluation of a rash. At first there was
one large patch, but then more lesions appeared suddenly on the back and torso; the lesions itch.
On physical examination, you note that the pattern of eruption is like a Christmas tree and that
there are a variety of erythematous papules and macules on the cleavage lines of the back. Based
on this description, what is the most likely diagnosis?
A) Tinea versicolor
B) Pityriasis rosea
C) Psoriasis
D) Contact dermatitis
Correct Answer: B) Pityriasis rosea
Explanation: The initial herald patch followed by an itchy, Christmas tree-patterned rash with
erythematous papules and macules along cleavage lines is characteristic of pityriasis rosea, a
self-limiting viral exanthem. Tinea versicolor presents with hypo/hyperpigmented patches,
psoriasis with silvery scales, and contact dermatitis with localized, exposure-related lesions.
Question 2: A 19-year-old construction worker presents for evaluation of a rash. He notes that it
appeared on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a
lot. He does sweat more than before because being outdoors is part of his job. On physical
examination, you note dark tan patches with a reddish cast that have sharp borders and fine
scales, more prominently around the upper back, chest, neck, and upper arms as well as under the
arms. Based on this description, what is your most likely diagnosis?
A) Pityriasis rosea
B) Tinea versicolor
C) Seborrheic dermatitis
D) Eczema
Correct Answer: B) Tinea versicolor
,Explanation: Dark tan patches with fine scales, sharp borders, and a reddish cast in sweat-prone
areas (back, chest, neck, arms) suggest tinea versicolor, a fungal infection exacerbated by heat
and humidity. Pityriasis rosea has a herald patch and Christmas tree pattern, seborrheic
dermatitis affects the scalp and face, and eczema is typically more eczematous with oozing.
Question 3: You are examining a child with severe cerebral palsy. When you suddenly move his
foot dorsally, a sustained “beating” of the foot against your hand ensues. What does this
represent?
A) Clonus
B) Spasticity
C) Rigidity
D) Tremor
Correct Answer: A) Clonus
Explanation: Sustained rhythmic beating of the foot upon sudden dorsiflexion indicates clonus,
a sign of upper motor neuron dysfunction common in cerebral palsy. Spasticity involves
increased muscle tone, rigidity is continuous resistance, and tremor is an involuntary oscillatory
movement.
Question 4: A patient presents with a daily headache which has worsened over the past several
months. On funduscopic examination, you notice that the disk edge is indistinct and the veins do
not pulsate. Which is most likely?
A) Migraine
B) Tension headache
C) Increased intracranial pressure
D) Cluster headache
Correct Answer: C) Increased intracranial pressure
Explanation: Indistinct disk edges and absent venous pulsations suggest papilledema, indicative
of increased intracranial pressure (e.g., from a mass or hydrocephalus). Migraine, tension, and
cluster headaches typically have normal funduscopic findings.
Question 5: A patient complains of epistaxis. Which other cause should be considered?
A) Allergic rhinitis
, B) Nasal polyps
C) Hypertension
D) Sinusitis
Correct Answer: C) Hypertension
Explanation: Hypertension is a common cause of epistaxis, especially in adults, due to increased
vascular pressure. Allergic rhinitis and sinusitis may cause nasal irritation but are less directly
linked, and nasal polyps are not typically associated with bleeding.
Question 6: A patient complains of shortness of breath for the past few days. On examination,
you note late inspiratory crackles in the lower third of the chest that were not present a week ago.
What is the most likely explanation for these?
A) Asthma
B) Pneumonia
C) Pulmonary edema
D) Chronic obstructive pulmonary disease
Correct Answer: C) Pulmonary edema
Explanation: Late inspiratory crackles in the lower chest suggest pulmonary edema, often due to
heart failure, causing fluid accumulation in alveoli. Asthma may cause wheezing, pneumonia
typically has coarse crackles and fever, and COPD has chronic symptoms, not acute crackles.
Question 7: You are concerned about a positive test finding you have just observed on physical
examination of your patient. You go on to do more examination, laboratory work, and diagnostic
tests, only to find that there is no sign of the disease you thought would correlate with the
finding. This same experience happens several times. What should you conclude?
A) The test has low specificity
B) The test has low sensitivity
C) The patient is malingering
D) The disease is in remission
Correct Answer: A) The test has low specificity
Explanation: Repeated false-positive findings (positive test without disease) indicate low
specificity, meaning the test often detects positives in healthy individuals. Low sensitivity would
miss disease, malingering requires behavioral evidence, and remission is disease-specific.
