Midterm Exam: NR511 / NR 511
(Latest Update )
Differential Diagnosis & Primary
Care Practicum | Questions &
Answers with Rationales | 100%
Correct | Grade A - Chamberlain
Question:
You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you
slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his
right lower quadrant. Which sign did you elicit?
1.Rovsing sign.
2.Psoas sign.
3.Obturator sign.
4.McBurney sign
Answer:
Obturator sign.
rationale: Obturator sign is elicited when, with the patient's right hip and knee flexed, the
examiner slowly rotates the right leg internally, which stretches the obturator muscle. Pain
over the right lower quadrant (RLQ) is considered a positive sign.
,Question:
Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning.
You tell him that it is a ventral hernia, also known as an:
1.Inguinal hernia.
2.Epigastric hernia.
3.Umbilical hernia.
4.Incisional hernia.
Answer:
Epigastric hernia.
rationale: A ventral hernia, also known as an epigastric hernia, occurs along the midline
between the xiphoid process and the umbilicus. The fibers along the linea alba are brought
together in a patchwork-type closure; the defect exists within this decussation. As these
fibers weaken, the contents can herniate through the abdomen. Epigastric hernias are 3
times more likely to occur in men than women.
Question:
You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you
suspect?
1.Cirrhosis.
2.Inflammation of the kidney.
3.Inflammation of the spleen.
4.Peritonitis.
Answer:
Inflammation of the kidney.
rationale: Costovertebral angle tenderness is tenderness or sharp pain that is elicited when
one hand is "thumped" with the ulnar edge of the other fist over the 12th rib at the
,costovertebral angle on the back. It indicates inflammation of the kidney (and possible
associated renal calculi, renal artery or vein occlusion, and perirenal abscess).
Question:
Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and
occasionally receives blood transfusions. His wife asks you why he has bleeding problems.
How do you respond?
1."Occasionally he accumulates blood in the gut."
2."There is an interruption of the normal clotting mechanism."
3."Long-term alcohol abuse has made his vessels very friable."
4."His bone marrow has been affected."
Answer:
"There is an interruption of the normal clotting mechanism."
rationale: Because of Marvin's alcoholism and his resulting dietary insufficiencies, there is
an inadequate amount of vitamin K in the liver for thrombin to convert fibrinogen to
fibrin; thus, the sequence of coagulation is disrupted.
Question:
In a 2-month-old infant with vomiting and diarrhea, the most effective way of determining
a fluid deficit is to check for:
1.Decreased peripheral perfusion.
2.Hyperventilation.
3.Irritability.
4.Hyperthermia.
Answer:
Decreased peripheral perfusion.
, rationale: In a 2-month-old infant with vomiting and diarrhea, the most effective way of
determining a fluid deficit is to check for decreased peripheral perfusion, dry oral mucous
membranes, and sunken fontanels. The body compensates for loss of fluid by shifting the
interstitial fluid into the intravascular space, thereby maintaining perfusion of vital organs.
If the fluid loss continues, circulating volume is diminished and vasoconstriction occurs in
the peripheral vessels, resulting in decreased perfusion.
Question:
Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) would
you expect to be decreased?
1.Sedimentation rate.
2.Liver enzyme levels.
3.Vitamin A, B complex, and C levels.
4.Bilirubin level.
Answer:
Vitamin A, B complex, and C levels.
rationale: Folic acid and serum levels of most vitamins, including A, B complex, C, and the
fat-soluble vitamins, are decreased in Crohn's disease as a result of malabsorption.
Question:
You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly
associated with:
1.Anxiety and panic attacks.
2.Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs).
3.Infection by Helicobacter pylori.
4.A family history of peptic ulcers
