GRAND CANYON UNIVERSITY NUR 634
MIDTERM EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
A 55-year-old smoker complains of chest pain and gestures
with a closed fist over her sternum to describe it. Which of the
following diagnoses should you consider because of her
gesture?
• A.Bronchitis
• B.Costochondritis
• C.Pericarditis
• D.Angina pectoris
Feedback: The clenched fist of Levine's sign, while not
completely specific for ischemic pain, should definitely cause
you to consider this etiology. Bronchitis is usually painless, and
pericarditis can produce a sharp pain which worsens with
inspiration. This is called pleuritic pain and can be associated
,with pneumonia and other chest diseases. Costochondritis is a
parasternal pain, usually well localized. It is exquisitely tender
Retinal detachment may be associated with all of the
following EXCEPT:
A. painless, unilateral loss in vision
B. Spontaneous recovery
C. Flashes of light
D. Context of trauma
Optic neuritis may be associated with all the following
conditions EXCEPT:
• A.Sudden, painful loss in unilateral vision
• B.Associated with autoimmune disease
• C.Early sign of multiple sclerosis
• D.Common incidental finding on fundoscopic exam
Mrs. Fletcher comes to your office with unilateral pain during
chewing, which is chronic. She does not have facial tenderness
or tenderness of the scalp. Which of the following is the most
likely cause of her pain?
• A.Trigeminal neuralgia
• B.Temporomandibular joint syndrome
• C.Temporal arteritis
,• D.Tumor of the mandible
Feedback: Temporomandibular joint syndrome is a very
common cause of pain with chewing. Ischemic pain with
chewing, or jaw claudication, can occur with temporal
arteritis, but the lack of tenderness of the scalp overlying the
artery makes this less likely. Trigeminal neuralgia can be
associated with extreme tenderness over the branches of the
trigeminal nerve. While a tumor of the mandible is possible, is
it much less likely than the other choices.
An 8-year-old girl comes with her mother for evaluation of
hair loss. She denies pulling or twisting her hair, and her
mother has not noted this behavior at all. She does not put
her hair in braids. On physical examination, you note a clearly
demarcated, round patch of hair loss without visible scaling or
inflammation. There are no hair shafts visible. Based on this
description, what is your most likely diagnosis?
• A.Alopecia areata
• B.Trichotillomania
• C.Tinea capitis
• D.Traction alopecia
Feedback: This is a typical description for alopecia areata.
There are no risk factors for trichotillomania or for traction
alopecia. The physical examination is not consistent with tinea
capitis because the skin is intact.
, A 46-year-old former salesman presents to the ER,
complaining of black stools for the past few weeks. His past
medical history is significant for cirrhosis. He has gained
weight recently, especially around his abdomen. He has
smoked two packs of cigarettes a day for 30 years and has
drunk approximately 10 alcoholic beverages a day for 25
years. He has used IV heroin and smoked crack in the past. He
denies any recent use. He is currently unemployed and has
never been married. On examination you find a man
appearing older than his stated age. His skin has a yellowish
tint and he is thin, with a prominent abdomen. You note
multiple "spider angiomas" at the base of his neck. Otherwise,
his heart and lung examinations are normal. On inspection he
has dilated veins around his umbilicus. Increased bowel
sounds are heard during auscultation.
Palpation reveals diffuse tenderness that is more severe in
the epigastric area. His liver is small and hard to palpation and
he has a positive fluid wave. He is positive for occult blood on
his rectal examination. What cause of black stools most likely
describes his symptoms and signs?
• A.Infectious diarrhea
• B.Mallory-Weiss tear
• C. Esophageal varices
D.Ulcerative colitis
MIDTERM EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
A 55-year-old smoker complains of chest pain and gestures
with a closed fist over her sternum to describe it. Which of the
following diagnoses should you consider because of her
gesture?
• A.Bronchitis
• B.Costochondritis
• C.Pericarditis
• D.Angina pectoris
Feedback: The clenched fist of Levine's sign, while not
completely specific for ischemic pain, should definitely cause
you to consider this etiology. Bronchitis is usually painless, and
pericarditis can produce a sharp pain which worsens with
inspiration. This is called pleuritic pain and can be associated
,with pneumonia and other chest diseases. Costochondritis is a
parasternal pain, usually well localized. It is exquisitely tender
Retinal detachment may be associated with all of the
following EXCEPT:
A. painless, unilateral loss in vision
B. Spontaneous recovery
C. Flashes of light
D. Context of trauma
Optic neuritis may be associated with all the following
conditions EXCEPT:
• A.Sudden, painful loss in unilateral vision
• B.Associated with autoimmune disease
• C.Early sign of multiple sclerosis
• D.Common incidental finding on fundoscopic exam
Mrs. Fletcher comes to your office with unilateral pain during
chewing, which is chronic. She does not have facial tenderness
or tenderness of the scalp. Which of the following is the most
likely cause of her pain?
• A.Trigeminal neuralgia
• B.Temporomandibular joint syndrome
• C.Temporal arteritis
,• D.Tumor of the mandible
Feedback: Temporomandibular joint syndrome is a very
common cause of pain with chewing. Ischemic pain with
chewing, or jaw claudication, can occur with temporal
arteritis, but the lack of tenderness of the scalp overlying the
artery makes this less likely. Trigeminal neuralgia can be
associated with extreme tenderness over the branches of the
trigeminal nerve. While a tumor of the mandible is possible, is
it much less likely than the other choices.
An 8-year-old girl comes with her mother for evaluation of
hair loss. She denies pulling or twisting her hair, and her
mother has not noted this behavior at all. She does not put
her hair in braids. On physical examination, you note a clearly
demarcated, round patch of hair loss without visible scaling or
inflammation. There are no hair shafts visible. Based on this
description, what is your most likely diagnosis?
• A.Alopecia areata
• B.Trichotillomania
• C.Tinea capitis
• D.Traction alopecia
Feedback: This is a typical description for alopecia areata.
There are no risk factors for trichotillomania or for traction
alopecia. The physical examination is not consistent with tinea
capitis because the skin is intact.
, A 46-year-old former salesman presents to the ER,
complaining of black stools for the past few weeks. His past
medical history is significant for cirrhosis. He has gained
weight recently, especially around his abdomen. He has
smoked two packs of cigarettes a day for 30 years and has
drunk approximately 10 alcoholic beverages a day for 25
years. He has used IV heroin and smoked crack in the past. He
denies any recent use. He is currently unemployed and has
never been married. On examination you find a man
appearing older than his stated age. His skin has a yellowish
tint and he is thin, with a prominent abdomen. You note
multiple "spider angiomas" at the base of his neck. Otherwise,
his heart and lung examinations are normal. On inspection he
has dilated veins around his umbilicus. Increased bowel
sounds are heard during auscultation.
Palpation reveals diffuse tenderness that is more severe in
the epigastric area. His liver is small and hard to palpation and
he has a positive fluid wave. He is positive for occult blood on
his rectal examination. What cause of black stools most likely
describes his symptoms and signs?
• A.Infectious diarrhea
• B.Mallory-Weiss tear
• C. Esophageal varices
D.Ulcerative colitis
