NSG6020 final exam questions

A
22-year-old advertising copywriter presents for evaluation of joint pain. The
pain is new, located in the wrists and fingers bilaterally, with some
subjective fever. The patient denies a rash; she also denies recent travel or
camping activities. She has a family history significant for rheumatoid
arthritis. Based on this information, which of the following pathologic
processes would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic

A
35-year-old archaeologist comes to your office (located in Phoenix, Arizona)
for a regular skin check-up. She has just returned from her annual dig site in
Greece. She has fair skin and reddish-blonde hair. She has a family history of
melanoma. She has many freckles scattered across her skin. From this
description, which of the following is not a risk factor for melanoma in this
patient?
A) Age
B) Hair color
C) Actinic lentigines
D) Heavy sun exposure

A
15-year-old high school sophomore and her mother come to your clinic because
the mother is concerned about her daughter’s weight. You measure her daughter’s
height and weight and obtain a BMI of 19.5 kg/m2. Based on this information,
which of the following is appropriate?
A) Refer the patient to a nutritionist and a psychologist because the patient
is anorexic.
B) Reassure the mother that this is a normal body weight.
C) Give the patient information about exercise because the patient is obese.
D) Give the patient information concerning reduction of fat and cholesterol in
her diet because she is obese.

A
middle-aged man comes in because he has noticed multiple small, blood-red,
raised lesions over his anterior chest and abdomen for the past several months.
They are not painful and he has not noted any bleeding or bruising. He is
concerned this may be consistent with a dangerous condition. What should you
do?
A) Reassure him that there is nothing to worry about.
B) Do laboratory work to check for platelet problems.
C) Obtain an extensive history regarding blood problems and bleeding disorders.
D) Do a skin biopsy in the office.

Jacob,
a 33-year-old construction worker, complains of a “lump on his back”
over his scapula. It has been there for about a year and is getting larger. He
says his wife has been able to squeeze out a cheesy-textured substance on
occasion. He worries this may be cancer. When gently pinched from the side, a
prominent dimple forms in the middle of the mass. What is most likely?
A) An enlarged lymph node
B) A sebaceous cyst
C) An actinic keratosis
D) A malignant lesion

A
patient comes to you for the appearance of red patches on his forearms that
have been present for several months. They remain for several weeks. He denies
a history of trauma. Which of the following is likely?
A) Actinic keratoses
B) Pseudoscars
C) Actinic purpura
D) Cherry angiomas

A
19-year old-college student presents to the emergency room with fever,
headache, and neck pain/stiffness. She is concerned about the possibility of
meningococcal meningitis. Several of her dorm mates have been vaccinated, but
she hasn’t been. Which of the following physical examination descriptions is
most consistent with meningitis?
A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple
with full range of motion
B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with
paraspinous muscle spasm and limited range of motion to the right
C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck
tender to palpation, unable to perform range of motion
D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck
supple with full range of motion

A
58-year-old gardener comes to your office for evaluation of a new lesion on her
upper chest. The lesion appears to be “stuck on” and is oval, brown,
and slightly elevated with a flat surface. It has a rough, wartlike texture on
palpation. Based on this description, what is your most likely diagnosis?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Squamous cell carcinoma

A
patient presents for evaluation of a cough. Which of the following anatomic
regions can be responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine

A
72-year-old retired truck driver comes to the clinic with his wife for
evaluation of hearing loss. He has noticed some decreased ability to hear what
his wife and grandchildren are saying to him. He admits to lip-reading more. He
has a history of noise exposure in his young adult years: He worked as a sound
engineer at a local arena and had to attend a lot of concerts. Based on this
information, what is the most likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds

Mrs.
Anderson presents with an itchy rash which is raised and appears and disappears
in various locations. Each lesion lasts for many minutes. What most likely accounts
for this rash?
A) Insect bites
B) Urticaria, or hives
C) Psoriasis
D) Purpura

A new
mother is concerned that her child occasionally “turns blue.” On
further questioning, she mentions that this is at her hands and feet. She does
not remember the child’s lips turning blue. She is otherwise eating and growing
well. What would you do now?
A) Reassure her that this is normal
B) Obtain an echocardiogram to check for structural heart disease and consult
cardiology
C) Admit the child to the hospital for further observation
D) Question the validity of her story

An
89-year-old retired school principal comes for an annual check-up. She would
like to know whether or not she should undergo a screening colonoscopy. She has
never done this before. Which of the following factors should not be considered
when discussing whether she should go for this screening test?
A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
D) Current age of patient

You are
speaking to an 8th grade class about health prevention and are preparing to
discuss the ABCDEs of melanoma. Which of the following descriptions correctly
defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D =
diameter >6 mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D
= diameter >6 mm; E = evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E =
evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D
= diameter >6 mm; E = evolution

A
79-year-old retired banker comes to your office for evaluation of difficulty
with urination; he gets up five to six times per night to urinate and has to go
at least that often in the daytime. He does not feel as if his bladder empties
completely; the strength of the urinary stream is diminished. He denies dysuria
or hematuria. This problem has been present for several years but has worsened
over the last 8 months. You palpate his prostate. What is your expected
physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy

A young
man comes to you with an extremely pruritic rash over his knees and elbows
which has come and gone for several years. It seems to be worse in the winter
and improves with some sun exposure. On examination, you notice scabbing and
crusting with some silvery scale, and you are observant enough to notice small
“pits” in his nails. What would account for these findings?
A) Eczema
B) Pityriasis rosea
C) Psoriasis
D) Tinea infection

A
15-year-old high school sophomore comes to the clinic for evaluation of a
3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear
pain; and nonproductive cough. Which is the most likely pathologic
process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular

A
68-year-old retired farmer comes to your office for evaluation of a skin
lesion. On the right temporal area of the forehead, you see a flattened papule
the same color as his skin, covered by a dry scale that is round and feels
hard. He has several more of these scattered on the forehead, arms, and legs.
Based on this description, what is your most likely diagnosis?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Squamous cell carcinoma

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

A
19-year-old construction worker presents for evaluation of a rash. He notes
that it started 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 has sharp borders and fine scales, scattered 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) Psoriasis
D) Atopic eczema

Which
of the following booster immunizations is recommended in the older adult population?
A) Tetanus
B) Diphtheria
C) Measles
D) Mumps

A
patient presents for evaluation of a sharp, aching chest pain which increases
with breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine

Ms.
Whiting is a 68 year old who comes in for her usual follow-up visit. You notice
a few flat red and purple lesions, about 6 centimeters in diameter, on the
ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They
are tender when you examine them. What should you do?
A) Conclude that these are lesions she has had for a long time.
B) Wait for her to mention them before asking further questions.
C) Ask how she acquired them.
D) Conduct the visit as usual for the patient.

You
have recently returned from a medical missions trip to sub-Saharan Africa,
where you learned a great deal about malaria. You decide to use some of the
same questions and maneuvers in your “routine” when examining
patients in the midwestern United States. You are disappointed to find that
despite getting some positive answers and findings, on further workup, none of
your patients has malaria except one, who recently emigrated from Ghana. How
should you next approach these questions and maneuvers?
A) Continue asking these questions in a more selective way.
B) Stop asking these questions, because they are low yield.
C) Question the validity of the questions.
D) Ask these questions of all your patients.

On
routine screening you notice that the cup-to-disc ratio of the patient’s right
eye is 1:2. What ocular condition should you suspect?
A) Macular degeneration
B) Diabetic retinopathy
C) Hypertensive retinopathy
D) Glaucoma

Mrs.
Hill is a 28-year-old African-American with a history of SLE (systemic lupus
erythematosus). She has noticed a raised, dark red rash on her legs. When you
press on the rash, it doesn’t blanch. What would you tell her regarding her
rash?
A) It is likely to be related to her lupus.
B) It is likely to be related to an exposure to a chemical.
C) It is likely to be related to an allergic reaction.
D) It should not cause any problems.

A
47-year-old contractor presents for evaluation of neck pain, which has been
intermittent for several years. He normally takes over-the-counter medications
to ease the pain, but this time they haven’t worked as well and he still has
discomfort. He recently wallpapered the entire second floor in his house, which
caused him great discomfort. The pain resolved with rest. He denies fever,
chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based
on this description, what is the most likely pathologic process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic

A
28-year-old patient comes to the office for evaluation of a rash. At first
there was only one large patch, but then more lesions erupted 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) Pityriasis rosea
B) Tinea versicolor
C) Psoriasis
D) Atopic eczema

Which
of the following changes are expected in vision as part of the normal aging
process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision

You are
examining an unconscious patient from another region and notice Beau’s lines, a
transverse groove across all of her nails, about 1 cm from the proximal nail
fold. What would you do next?
A) Conclude this is caused by a cultural practice.
B) Conclude this finding is most likely secondary to trauma.
C) Look for information from family and records regarding any problems which
occurred 3 months ago.
D) Ask about dietary intake.

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