NR 509 Final Exam WITH 100 QUESTIONS & CORRECT
ANSWERS
A third-year medical student rotating on the internal medicine service performs a digital rectal examination (DRE) on a 56-year-old female patient. The patient has been admitted for suspicion of a myocardial infarction, and confirmation that there is no blood in the stool is required before anticoagulation can be started. The student reports that the fecal occult blood test was negative but notes that he palpated a structure through the anterior rectum that he could not identify. The attending physician confirms normal anatomy and reviews with the student that the most likely identity of the structure palpable is which of the following? - ANSWER-Cervix
A 45 - year - old female executive reports to her primary care provider that she has recently experienced a change in the patterns of her bowel movements . She expresses a great concern as her family history includes a maternal aunt who died of colon cancer at age 49 years ; her mother has had colonoscopies every 3 years with numerous adenomatous polyps removed . Which of the following historical elements would be the most concerning for colon cancer in this patient ? - ANSWER-Recent onset of small-caliber stools
A 49-year-old customer service representative presents to his gastroenterologist for follow-up of his long-standing inflammatory bowel disease (IBD). He was diagnosed with ulcerative colitis (UC) at age 37 years and has had irregular care for this condition since then. His sole colonoscopy was done at the time of diagnosis 12 years ago. His only relevant family history is of prostate cancer in his father; his mother and sisters are healthy. Which of the following is true about recommended screening for colon cancer in this patient? - ANSWER-The patient should undergo colonoscopy for his bowel condition, which confers risk of colon cancer
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A 49-year-old male with well-controlled HIV undergoes a proctoscopic examination as routine screening for anal cancer. The patient is asymptomatic and specifically denies complaints of frequent urination (frequency), large volume of urination (polyuria), or repeated urination at night (nocturia). Under direct visualization, the clinician observes a clear, circumferential demarcation of proximal versus distal tissue. This demarcation was not palpable on digital rectal examination (DRE) prior to proctoscopy. What is the most likely origin of this finding? - ANSWER-Normal anatomy of the mucosal surface
A 34-year-old female reports anal pain with defecation. She notes incidentally to this complaint that she has developed episodic abdominal discomfort and sores in her mouth. Anoscopic examination reveals anal fissures that appear to be her source of pain. Which of the following underlying conditions is the clinician most likely to find? - ANSWER-Inflammatory bowel disease
A 53-year-old African American advertising agent presents for discussion of his prostate cancer risk and possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died recently at age 87 years from a myocardial infarction before the disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about risk and screening for prostate cancer? - ANSWER-This patient is at an elevated risk of prostate cancer due to his family history, thus screening modalities should be discussed between the patient and provider
A 64-year-old retired architect presents to his primary care provider with a magazine article about prostate cancer screening that states, "You should talk to your doctor about the ups and downs of prostate cancer screening." The patient hands this to the clinician and states, "Tell me about the ups and down of prostate screening." Which of the following is true about prostate cancer screening? - ANSWER-Setting normal cut offs for prostate-specific antigen (PSA) testing relies on balancing the risk of overdiagnosis with the risk of underdiagnosis
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A thin, 58-year-old patient complains of lower back pain for years. On examination, the clinician finds that the patient has tenderness over the sacroiliac area. Which of the following conditions is most consistent with this physical sign?
- ANSWER-Ankylosing spondylitis
During an evaluation of an athletic 30-year-old patient, the clinician conducts an active range of motion evaluation at the neck. Which muscle is being assessed when the patient is asked to flex the neck? - ANSWER-Sternocleidomastoid
An obese 50-year-old patient presents with a long history of back trouble. What structure in the spine supports the body's weight? - ANSWER-Vertebral body
A 31-year-old day care worker presents with a worsening stiff, painful neck. On inspection, the patient's head is laterally deviated toward the shoulder and rotated.At this point of the examination, what is the most likely diagnosis? - ANSWER- Torticollis
A young adult patient presents to the clinic stating that something is wrong as he looks in the mirror and sees that his shoulders are uneven. He fractured his left arm
- weeks ago and remains in a cast. He noticed the uneven shoulders over the last
week. Upon inspection, his shoulder heights are unequal and there is winging of the scapula. As the examination continues, which of the following maneuvers would confirm a likely diagnosis? - ANSWER-Compare the strength of his trapezia muscles
During a musculoskeletal examination, the clinician instructs the patient to look over one shoulder, and then the other shoulder. This action assesses the movement of which muscle(s)? - ANSWER-Sternocleidomastoid (SCM)
During a musculoskeletal examination of the spine, what is the action(s) of the erector spinae muscle group? - ANSWER-Extension of the spine
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