Final Exam NR 509 Practice
Questions and Correct
Answers/ NR 509 Final
Exam Prep 2026-2027
(Correctly Answered
Questions with Rationales)
NR 509 Final Practice Exam
,Osteoarthritis (OA)
Question:
A 66-year-old woman complains of chronic knee and hand pain that worsens after gardening and
improves with rest. She denies morning stiffness lasting more than 15 minutes. Examination reveals bony
enlargement at the distal and proximal interphalangeal joints. No redness or swelling is noted. Her ESR
and CRP are normal.
Which of the following findings best supports the diagnosis?
A) Symmetric synovial swelling of MCP joints
B) Ulnar deviation of the fingers
C) Heberden and Bouchard nodes
D) Morning stiffness lasting >1 hour
Answer: C) Heberden and Bouchard nodes
Explanation:
OA is noninflammatory, affects asymmetric weight-bearing joints, and involves DIP (Heberden) and PIP
(Bouchard) nodes.
RA affects MCP and PIP joints symmetrically and has prolonged morning stiffness.
1. Rheumatoid Arthritis (RA)
Question:
A 42-year-old woman reports 2 hours of morning stiffness in both hands that improves with movement.
She notes swelling of her wrists and MCP joints for the past 3 months. She also complains of fatigue and
weight loss. Exam shows symmetric tenderness and swelling of both wrists and 2nd–3rd MCP joints.
Which of the following extra-articular findings is most consistent with her disease?
A) Heberden’s nodes
B) Uveitis and sacroiliitis
C) Subcutaneous nodules over the extensor surfaces
D) Tophi on the ears and elbows
Answer: C) Subcutaneous nodules over the extensor surfaces
Explanation:
RA = autoimmune symmetric polyarthritis of small joints with systemic features (fatigue, weight loss).
Rheumatoid nodules are classic extra-articular findings.
Tophi → gout; uveitis/sacroiliitis → ankylosing spondylitis.
2. Gout
1
,Question:
A 54-year-old man presents with sudden, excruciating pain and swelling in his right great toe after
attending a weekend barbecue. He drinks several beers daily. On exam, the 1st MTP joint is
erythematous, warm, and exquisitely tender. Joint aspiration shows needle-shaped, negatively
birefringent crystals.
Which of the following medications most likely contributed to his condition?
A) Hydrochlorothiazide
B) Furosemide
C) Lisinopril
D) Amlodipine
Answer: A) Hydrochlorothiazide
Explanation:
Thiazide diuretics ↓ uric acid excretion, precipitating gout attacks.
Furosemide can also raise uric acid, but thiazides are more classically tested.
Lisinopril and amlodipine don’t cause gout.
3. Ankylosing Spondylitis (AS)
Question:
A 28-year-old man presents with chronic low back pain and stiffness that improves with exercise but not
rest. He has also developed pain in both heels. Exam shows limited spinal flexion and tenderness over
the sacroiliac joints. Chest expansion is decreased.
Which of the following additional findings is most characteristic of his condition?
A) Erosions of DIP joints
B) Uveitis
C) Tophi deposition
D) Subcutaneous nodules
Answer: B) Uveitis
Explanation:
AS (a seronegative spondyloarthropathy, HLA-B27+) → sacroiliitis, morning stiffness, and uveitis.
Pain improves with activity — unlike mechanical back pain.
4. Spinal Stenosis
Question:
2
, A 70-year-old man complains of bilateral leg pain and numbness that occur when he walks for several
minutes but improve when he leans forward on a shopping cart. He has no back trauma. His symptoms
are not relieved by rest alone. Peripheral pulses are normal.
Which of the following is the most likely diagnosis?
A) Peripheral vascular disease
B) Lumbar spinal stenosis
C) Cauda equina syndrome
D) Herniated nucleus pulposus
Answer: B) Lumbar spinal stenosis
Explanation:
Neurogenic claudication (pain worsens with standing/walking, relieved by lumbar flexion).
PVD pain improves with rest regardless of position.
Cauda equina has saddle anesthesia, bladder dysfunction — not described here.
5. Cauda Equina Syndrome
Question:
A 58-year-old man presents with severe low back pain, bilateral leg weakness, and numbness around his
inner thighs and perineum. He has urinary retention and decreased anal sphincter tone.
Which of the following is the best next step in management?
A) Start oral corticosteroids and schedule outpatient MRI
B) Obtain emergent MRI and surgical decompression
C) Begin physical therapy and analgesics
D) Start antibiotics for possible spinal infection
Answer: B) Obtain emergent MRI and surgical decompression
Explanation:
Cauda equina syndrome = surgical emergency.
Caused by massive lumbar disc herniation compressing nerve roots.
Delay in decompression → permanent paralysis or incontinence.
Would you like me to create a second, even trickier set (e.g., with overlapping features or lab/imaging
clues) for advanced exam prep?
You said:
yes
3
Questions and Correct
Answers/ NR 509 Final
Exam Prep 2026-2027
(Correctly Answered
Questions with Rationales)
NR 509 Final Practice Exam
,Osteoarthritis (OA)
Question:
A 66-year-old woman complains of chronic knee and hand pain that worsens after gardening and
improves with rest. She denies morning stiffness lasting more than 15 minutes. Examination reveals bony
enlargement at the distal and proximal interphalangeal joints. No redness or swelling is noted. Her ESR
and CRP are normal.
Which of the following findings best supports the diagnosis?
A) Symmetric synovial swelling of MCP joints
B) Ulnar deviation of the fingers
C) Heberden and Bouchard nodes
D) Morning stiffness lasting >1 hour
Answer: C) Heberden and Bouchard nodes
Explanation:
OA is noninflammatory, affects asymmetric weight-bearing joints, and involves DIP (Heberden) and PIP
(Bouchard) nodes.
RA affects MCP and PIP joints symmetrically and has prolonged morning stiffness.
1. Rheumatoid Arthritis (RA)
Question:
A 42-year-old woman reports 2 hours of morning stiffness in both hands that improves with movement.
She notes swelling of her wrists and MCP joints for the past 3 months. She also complains of fatigue and
weight loss. Exam shows symmetric tenderness and swelling of both wrists and 2nd–3rd MCP joints.
Which of the following extra-articular findings is most consistent with her disease?
A) Heberden’s nodes
B) Uveitis and sacroiliitis
C) Subcutaneous nodules over the extensor surfaces
D) Tophi on the ears and elbows
Answer: C) Subcutaneous nodules over the extensor surfaces
Explanation:
RA = autoimmune symmetric polyarthritis of small joints with systemic features (fatigue, weight loss).
Rheumatoid nodules are classic extra-articular findings.
Tophi → gout; uveitis/sacroiliitis → ankylosing spondylitis.
2. Gout
1
,Question:
A 54-year-old man presents with sudden, excruciating pain and swelling in his right great toe after
attending a weekend barbecue. He drinks several beers daily. On exam, the 1st MTP joint is
erythematous, warm, and exquisitely tender. Joint aspiration shows needle-shaped, negatively
birefringent crystals.
Which of the following medications most likely contributed to his condition?
A) Hydrochlorothiazide
B) Furosemide
C) Lisinopril
D) Amlodipine
Answer: A) Hydrochlorothiazide
Explanation:
Thiazide diuretics ↓ uric acid excretion, precipitating gout attacks.
Furosemide can also raise uric acid, but thiazides are more classically tested.
Lisinopril and amlodipine don’t cause gout.
3. Ankylosing Spondylitis (AS)
Question:
A 28-year-old man presents with chronic low back pain and stiffness that improves with exercise but not
rest. He has also developed pain in both heels. Exam shows limited spinal flexion and tenderness over
the sacroiliac joints. Chest expansion is decreased.
Which of the following additional findings is most characteristic of his condition?
A) Erosions of DIP joints
B) Uveitis
C) Tophi deposition
D) Subcutaneous nodules
Answer: B) Uveitis
Explanation:
AS (a seronegative spondyloarthropathy, HLA-B27+) → sacroiliitis, morning stiffness, and uveitis.
Pain improves with activity — unlike mechanical back pain.
4. Spinal Stenosis
Question:
2
, A 70-year-old man complains of bilateral leg pain and numbness that occur when he walks for several
minutes but improve when he leans forward on a shopping cart. He has no back trauma. His symptoms
are not relieved by rest alone. Peripheral pulses are normal.
Which of the following is the most likely diagnosis?
A) Peripheral vascular disease
B) Lumbar spinal stenosis
C) Cauda equina syndrome
D) Herniated nucleus pulposus
Answer: B) Lumbar spinal stenosis
Explanation:
Neurogenic claudication (pain worsens with standing/walking, relieved by lumbar flexion).
PVD pain improves with rest regardless of position.
Cauda equina has saddle anesthesia, bladder dysfunction — not described here.
5. Cauda Equina Syndrome
Question:
A 58-year-old man presents with severe low back pain, bilateral leg weakness, and numbness around his
inner thighs and perineum. He has urinary retention and decreased anal sphincter tone.
Which of the following is the best next step in management?
A) Start oral corticosteroids and schedule outpatient MRI
B) Obtain emergent MRI and surgical decompression
C) Begin physical therapy and analgesics
D) Start antibiotics for possible spinal infection
Answer: B) Obtain emergent MRI and surgical decompression
Explanation:
Cauda equina syndrome = surgical emergency.
Caused by massive lumbar disc herniation compressing nerve roots.
Delay in decompression → permanent paralysis or incontinence.
Would you like me to create a second, even trickier set (e.g., with overlapping features or lab/imaging
clues) for advanced exam prep?
You said:
yes
3
