Exam (elaborations)
NU 673 FINAL EXAM
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Exam of 16 pages for the course NU 673 at NU 673 (NU 673 FINAL EXAM)
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NU 673 FINAL EXAMA 68-year-old complains of a 3-month history of recurring pain after ambulating that
radiates from her back in the upper lumbar region into both buttocks, bilateral thighs
and mid-calf regions. Her pain is improved by sitting or leaning forward. The origin of
her pain is secondary to what condition? - ANSWER Neurogenic claudication
Mimics PAD (pain r/t walking) but differs with relief from sitting or leaning forward
P. 517
A patient with a known history of CV disease including MI and positive ABI with PVD
in his left leg now has issues with erectile dysfunction. If the symptoms are related to
vascular disease, where would the lesion be located? - ANSWER Iliac pudenal
(major blood supply for penis)
P. 518
A 73-year-old presents to the ED complaining of chest pain that started about 2
hours ago. EKG, cardiac enzymes and CXR are normal but his BP is lower in his
right arm compared to his left arm. What can explain his symptoms? - ANSWER
Dissecting aortic aneurysm
"Tearing" type pain
P. 522
A 19-year-old sustained a laceration to the ulnar aspect o his mid-forearm while at
work last week and is now noticing purulent discharge, pain, fever and chills. Where
would the clinician expect to find the first signs of lymphadenopathy? - ANSWER
Epitrochlear nodes
First nodes in drainage region from ulnar surface of forearm and hand, little and ring
fingers and adjacent surfaces of middle finger
P. 523
When assessing for femoral pulse, where should the clinician begin deeply
palpating? - ANSWER Below the inguinal ligament, midway between the anterior
superior iliac spine and symphysis pubis
Palpating above inguinal ligament will assess external iliac artery
P. 526
Which pulse is located on the dorsum of the foot, just lateral to the extensor tendon
of the big toe? - ANSWER Dorsalis pedis
,P. 528
A 61-year-old was recently diagnosed with ovarian cancer. She presents to the clinic
with a cough and mild shortness of breath. She has pain and swelling in her right
groin and leg with 2+ edema of the right leg up to the thigh. What is the chief
concern? - ANSWER Pulmonary embolism (PE)
Cancer patients have a high risk of DVT/PE
P. 534-535
A 32-year-old notes a small wound on the lateral aspect of his mid-shin. Upon exam,
some mild erythema surround the wound and flat, non-palpable red streaks
progressing up his leg are noted. What do these streaks represent? - ANSWER
Draining lymphatic channels (acute lymphangitis)
P. 534-535
A clinician, evaluating a patient for valvular competency in the communicating veins
of the saphenous system, starts with the patient supine then elevates one leg to
about 90 degrees to empty it of venous blood. Next, the great saphenous vein is
occluded with manual compression and the patient stands. The clinician keeps the
vein occluded while watching for venous filling in the leg. Which test is being
performed? - ANSWER Trendelenburg (retrograde filling test)
P. 532
A 44-year-old noticed an increasing dilation of the veins in her legs. It is noted that
she has significant varicosities on the posterior aspects of both legs which begin in
the lateral side of the foot and pass upward along the posterior calf. Which veins are
currently affected? - ANSWER Small saphenous veins
P. 514, 516
A 42-year old fair-skinned woman presents with an abnormal skin growth first noted
7 years ago. Which of the following historical elements most increases the suspicion
that the lesion is malignant?
A. Mild intermittent pruritis over the last 2 years
B. Proximal location over the bicep vs distal arm
C. Similar pinkish tan lesion on sun-exposed areas of face and hands
D. Uniformly darkly pigmented color
E. Minimal but discernible increase in size over last 6 months - ANSWER E.
Minimal but discernible increase in size over past 6 months
P. 178-180
A 17-year-old presents to the clinic because she desires to use a tanning facility
ahead of an upcoming event. Which of the following is true regarding UV exposure
and subsequent risk of skin cancer?
, A. Tanning beds do not increase risk of skin cancer
B. Water resistant sunscreen has no advantage over water-soluble products
C. Target messaging and practitioner reinforcement in primary care amplify sun-
protective behaviors
D. Chronic sun exposure confers greater risk than intermittent intense exposure
E. Sunscreen SPF 15 blocks about 50% of UV-B light. - ANSWER C. Target
messaging and practitioner reinforcement in primary care amplify sun-protective
behaviors
SPF 15 blocks about 90% of UV-B rays
P. 177
Which of the following skin lesions is LEAST likely to metastasize?
A. Actinic keratosis
B. SCC
C. Melanoma
D. Seborrheic keratosis
E. BCC - ANSWER D. Seborrheic keratosis - entirely benign lesions that do not
carry any risk of metastasis
P. 176, 197t, 198t
What is the best advice according to the USPSTF recommendations on skin cancer
screening from 2009? - ANSWER Recommends against routine screening for skin
cancer due to lack of evidence for this intervention across the general population
P. 178
Concerning the initial recognition of melanoma, what is considered to be true? -
ANSWER About 50% of melanomas are noticed first by patients then brought to the
attention of a practitioner (as opposed to the majority being discovered at annual
exams)
P. 176-180
A mother brings her 9-year-old daughter to the clinic with several days of a diffuse
rash on the trunk. She has a decreased appetite, easy fatigue and low grade fevers.
Additional findings include strawberry tongue and erythema (desquamation) on the
palms and soles. What is the most likely diagnosis and course of action? - ANSWER
Kawasaki disease, for which close monitoring and possibly hospitalization might be
required
Aka "mucocutaneous lymph node syndrome" treated with immune globulin
P. 208t
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