NR509 BATES TEST BANK - MIDTERM
A65patient65presents65for65evaluation65of65a65sharp,65aching65chest65pain65which65increa
ses65with65breathing.65Which65anatomic65area65would65you65localize65the65symptom65to
?
A)65Musculoskeletal
B)65Reproductive
C)65Urinary
D)65Endocrine65-65answer--A)65Musculoskeletal
Chest65pain65may65be65due65to65a65musculoskeletal65condition,65such65as65costochondri
tis65or
intercostal65muscle65cramp.65This65would65be65worsened65by65motion65of65the65chest65
wall.65Pleuritic65chest65pain65is65also65a65sharp65chest65pain65which65increases65with65a6
5deep65breath.65This65type65of65pain65can
occur65with65inflammation65of65the65pleura65from65pneumonia65or65other65conditions65an
d65pulmonary
embolus.
A65patient65comes65to65the65emergency65room65for65evaluation65of65shortness65of65breat
h.65To65which65anatomic65region65would65you65assign65the65symptom?
A)65Reproductive
B)65Urinary
C)65Cardiac
D)65Hematologic65-65answer--C)65Cardiac
Cardiac65disorders65such65as65congestive65heart65failure65are65the65most65likely65on65thi
s65list65to65result65in65shortness65of65breath.65There65are65cases65within65the65other65cat
egories65which65may65also65result
in65shortness65of65breath,65such65as65anemia65in65the65hematologic65category,65pregna
ncy65in65the65reproductive
category,65or65sepsis65with65UTI65in65the65urinary65category.
A65patient65presents65for65evaluation65of65a65cough.65Which65of65the65following65anatomi
c65regions65can65be65responsible65for65a65cough?
A)65Ophthalmologic
B)65Auditory
,C)65Cardiac
D)65Endocrine65-65answer--C)65Cardiac65
The65cardiac65system65can65cause65a65cough65if65the65patient65has65congestive65heart65
failure.65This65results65in65fluid65buildup65in65the65lungs,65which65in65turn65can65cause65a
65cough65that65produces65pink,
frothy65sputum.65A65foreign65body65in65the65ear65may65also65cause65a65cough65by65stim
ulating65Arnold's65branch65of65the65vagus65nerve,65but65this65is65less65likely65to65be65see
n65clinically65than65heart65failure.
A6522-year-
old65advertising65copywriter65presents65for65evaluation65of65joint65pain.65The65pain65is65n
ew,
located65in65the65wrists65and65fingers65bilaterally,65with65some65subjective65fever.65The65
patient65denies65a
rash;65she65also65denies65recent65travel65or65camping65activities.65She65has65a65family65
history65significant65for
rheumatoid65arthritis.65Based65on65this65information,65which65of65the65following65patholo
gic65processes
would65be65the65most65correct?
A)65Infectious
B)65Inflammatory
C)65Hematologic
D)65Traumatic65-65answer--B)65Inflammatory
The65description65is65most65consistent65with65an65inflammatory65process,65although65all6
5the65other65etiologies65should65be65considered.65Lyme65disease65is65an65infection65whi
ch65commonly65causes
arthritis,65hemophilia65is65a65hematologic65condition65which65can65cause65bleeding65in65t
he65joints,65and65trauma65can65obviously65cause65joint65pain.
A6547-year-
old65contractor65presents65for65evaluation65of65neck65pain,65which65has65been65intermitt
ent65for65several65years.65He65normally65takes65over-the-
counter65medications65to65ease65the65pain,65but65this65time65they65haven't65worked65as6
5well65and65he65still65has65discomfort.65He65recently65wallpapered65the65entire65second6
5floor65in65his65house,65which65caused65him65great65discomfort.65The65pain65resolved65w
ith65rest.65He65denies65fever,65chills,65rash,65upper65respiratory65symptoms,65trauma,65o
r65injury65to65the65neck.65Based65on65this65description,65what65is65the65most65likely65path
ologic65process?
A)65Infectious
B)65Neoplastic
C)65Degenerative
D)65Traumatic65-65answer--C)65Degenerative
,The65description65is65most65consistent65with65degenerative65arthritis65in65the65neck.65Th
e
patient65has65had65intermittent65symptoms65and65the65questions65asked65to65elicit65perti
nent65negative65and
positive65findings65are65negative65for65infectious,65traumatic,65or65neoplastic65disease.
A6515-year-
old65high65school65sophomore65comes65to65the65clinic65for65evaluation65of65a653-
week65history
of65sneezing;65itchy,65watery65eyes;65clear65nasal65discharge;65ear65pain;65and65nonpro
ductive65cough.65Which
is65the65most65likely65pathologic65process?
A)65Infection
B)65Inflammation
C)65Allergic
D)65Vascular65-65answer--C)65Allergic
This65description65is65most65consistent65with65allergic65rhinitis.
A6519-year65old-
college65student65presents65to65the65emergency65room65with65fever,65headache,65and
neck65pain/
stiffness.65She65is65concerned65about65the65possibility65of65meningococcal65meningitis.
Several65of65her65dorm65mates65have65been65vaccinated,65but65she65hasn't65been.65Whi
ch65of65the65following
physical65examination65descriptions65is65most65consistent65with65meningitis?
A)65Head65is65normocephalic65and65atraumatic,65fundi65with65sharp65discs,65neck65suppl
e65with65full65range
of65motion
B)65Head65is65normocephalic65and65atraumatic,65fundi65with65sharp65discs,65neck65with6
5paraspinous
muscle65spasm65and65limited65range65of65motion65to65the65right
C)65Head65is65normocephalic65and65atraumatic,65fundi65with65blurred65disc65margins,65n
eck65tender65to
palpation,65unable65to65perform65range65of65motion
D)65Head65is65normocephalic65and65atraumatic,65fundi65with65blurred65disc65margins,65n
eck65supple65with
full65range65of65motion65-65answer--
C)65Head65is65normocephalic65and65atraumatic,65fundi65with65blurred65disc65margins,65n
eck65tender65to
palpation,65unable65to65perform65range65of65motion
, Blurred65disc65margins65are65consistent65with65papilledema,65and65neck65tenderness65a
nd65lack65of65range65of65motion65are65consistent65with65neck65stiffness,65which65in65this6
5scenario65is65likely65to65be65caused
by65meningeal65inflammation.65Kernig's65and65Brudzinski's65signs65are65also65helpful65in
65testing65for65meningeal65irritation65on65exam.
A6537-year-
old65nurse65comes65for65evaluation65of65colicky65right65upper65quadrant65abdominal65pai
n.65The65pain65is65associated65with65nausea65and65vomiting65and65occurs65165to65265ho
urs65after65eating65greasy65foods.65Which65one65of65the65following65physical65examinati
on65descriptions65would65be65most65consistent65with65the65diagnosis65of65cholecystitis?
A)65Abdomen65is65soft,65nontender,65and65nondistended,65without65hepatosplenomegaly
65or65masses.
B)65Abdomen65is65soft65and65tender65to65palpation65in65the65right65lower65quadrant,65wit
hout65rebound65or
guarding.
C)65Abdomen65is65soft65and65tender65to65palpation65in65the65right65upper65quadrant65wit
h65inspiration,65to65the
point65of65stopping65inspiration,65and65there65is65no65rebound65or65guarding.
D)65Abdomen65is65soft65and65tender65to65palpation65in65the65mid-
epigastric65area,65without65rebound65or
guarding.65-65answer--
C)65Abdomen65is65soft65and65tender65to65palpation65in65the65right65upper65quadrant65wit
h65inspiration,65to65the
point65of65stopping65inspiration,65and65there65is65no65rebound65or65guarding.
In65cholecystitis,65the65pain,65which65originates65from65the65gallbladder,65is65located65in6
5the
right65upper65quadrant.65Severity65of65pain65with65inspiration65that65is65sufficient65to65sto
p65further65inhalation
is65also65known65as65Murphy's65sign,65which,65if65present,65is65further65indicative65of65inf
lammation65of65the
gallbladder.
A6555-year-
old65data65entry65operator65comes65to65the65clinic65to65establish65care.65She65has65the65
following
symptoms:65headache,65neck65pain,65sinus65congestion,65sore65throat,65ringing65in65ear
s,65sharp65brief65chest
pains65at65rest,65burning65abdominal65pain65with65spicy65foods,65constipation,65urinary65f
requency65that65is65worse65with65coughing65and65sneezing,65and65swelling65in65legs.65T
his65cluster65of65symptoms65is65explained
by:
A)65One65disease65process
A65patient65presents65for65evaluation65of65a65sharp,65aching65chest65pain65which65increa
ses65with65breathing.65Which65anatomic65area65would65you65localize65the65symptom65to
?
A)65Musculoskeletal
B)65Reproductive
C)65Urinary
D)65Endocrine65-65answer--A)65Musculoskeletal
Chest65pain65may65be65due65to65a65musculoskeletal65condition,65such65as65costochondri
tis65or
intercostal65muscle65cramp.65This65would65be65worsened65by65motion65of65the65chest65
wall.65Pleuritic65chest65pain65is65also65a65sharp65chest65pain65which65increases65with65a6
5deep65breath.65This65type65of65pain65can
occur65with65inflammation65of65the65pleura65from65pneumonia65or65other65conditions65an
d65pulmonary
embolus.
A65patient65comes65to65the65emergency65room65for65evaluation65of65shortness65of65breat
h.65To65which65anatomic65region65would65you65assign65the65symptom?
A)65Reproductive
B)65Urinary
C)65Cardiac
D)65Hematologic65-65answer--C)65Cardiac
Cardiac65disorders65such65as65congestive65heart65failure65are65the65most65likely65on65thi
s65list65to65result65in65shortness65of65breath.65There65are65cases65within65the65other65cat
egories65which65may65also65result
in65shortness65of65breath,65such65as65anemia65in65the65hematologic65category,65pregna
ncy65in65the65reproductive
category,65or65sepsis65with65UTI65in65the65urinary65category.
A65patient65presents65for65evaluation65of65a65cough.65Which65of65the65following65anatomi
c65regions65can65be65responsible65for65a65cough?
A)65Ophthalmologic
B)65Auditory
,C)65Cardiac
D)65Endocrine65-65answer--C)65Cardiac65
The65cardiac65system65can65cause65a65cough65if65the65patient65has65congestive65heart65
failure.65This65results65in65fluid65buildup65in65the65lungs,65which65in65turn65can65cause65a
65cough65that65produces65pink,
frothy65sputum.65A65foreign65body65in65the65ear65may65also65cause65a65cough65by65stim
ulating65Arnold's65branch65of65the65vagus65nerve,65but65this65is65less65likely65to65be65see
n65clinically65than65heart65failure.
A6522-year-
old65advertising65copywriter65presents65for65evaluation65of65joint65pain.65The65pain65is65n
ew,
located65in65the65wrists65and65fingers65bilaterally,65with65some65subjective65fever.65The65
patient65denies65a
rash;65she65also65denies65recent65travel65or65camping65activities.65She65has65a65family65
history65significant65for
rheumatoid65arthritis.65Based65on65this65information,65which65of65the65following65patholo
gic65processes
would65be65the65most65correct?
A)65Infectious
B)65Inflammatory
C)65Hematologic
D)65Traumatic65-65answer--B)65Inflammatory
The65description65is65most65consistent65with65an65inflammatory65process,65although65all6
5the65other65etiologies65should65be65considered.65Lyme65disease65is65an65infection65whi
ch65commonly65causes
arthritis,65hemophilia65is65a65hematologic65condition65which65can65cause65bleeding65in65t
he65joints,65and65trauma65can65obviously65cause65joint65pain.
A6547-year-
old65contractor65presents65for65evaluation65of65neck65pain,65which65has65been65intermitt
ent65for65several65years.65He65normally65takes65over-the-
counter65medications65to65ease65the65pain,65but65this65time65they65haven't65worked65as6
5well65and65he65still65has65discomfort.65He65recently65wallpapered65the65entire65second6
5floor65in65his65house,65which65caused65him65great65discomfort.65The65pain65resolved65w
ith65rest.65He65denies65fever,65chills,65rash,65upper65respiratory65symptoms,65trauma,65o
r65injury65to65the65neck.65Based65on65this65description,65what65is65the65most65likely65path
ologic65process?
A)65Infectious
B)65Neoplastic
C)65Degenerative
D)65Traumatic65-65answer--C)65Degenerative
,The65description65is65most65consistent65with65degenerative65arthritis65in65the65neck.65Th
e
patient65has65had65intermittent65symptoms65and65the65questions65asked65to65elicit65perti
nent65negative65and
positive65findings65are65negative65for65infectious,65traumatic,65or65neoplastic65disease.
A6515-year-
old65high65school65sophomore65comes65to65the65clinic65for65evaluation65of65a653-
week65history
of65sneezing;65itchy,65watery65eyes;65clear65nasal65discharge;65ear65pain;65and65nonpro
ductive65cough.65Which
is65the65most65likely65pathologic65process?
A)65Infection
B)65Inflammation
C)65Allergic
D)65Vascular65-65answer--C)65Allergic
This65description65is65most65consistent65with65allergic65rhinitis.
A6519-year65old-
college65student65presents65to65the65emergency65room65with65fever,65headache,65and
neck65pain/
stiffness.65She65is65concerned65about65the65possibility65of65meningococcal65meningitis.
Several65of65her65dorm65mates65have65been65vaccinated,65but65she65hasn't65been.65Whi
ch65of65the65following
physical65examination65descriptions65is65most65consistent65with65meningitis?
A)65Head65is65normocephalic65and65atraumatic,65fundi65with65sharp65discs,65neck65suppl
e65with65full65range
of65motion
B)65Head65is65normocephalic65and65atraumatic,65fundi65with65sharp65discs,65neck65with6
5paraspinous
muscle65spasm65and65limited65range65of65motion65to65the65right
C)65Head65is65normocephalic65and65atraumatic,65fundi65with65blurred65disc65margins,65n
eck65tender65to
palpation,65unable65to65perform65range65of65motion
D)65Head65is65normocephalic65and65atraumatic,65fundi65with65blurred65disc65margins,65n
eck65supple65with
full65range65of65motion65-65answer--
C)65Head65is65normocephalic65and65atraumatic,65fundi65with65blurred65disc65margins,65n
eck65tender65to
palpation,65unable65to65perform65range65of65motion
, Blurred65disc65margins65are65consistent65with65papilledema,65and65neck65tenderness65a
nd65lack65of65range65of65motion65are65consistent65with65neck65stiffness,65which65in65this6
5scenario65is65likely65to65be65caused
by65meningeal65inflammation.65Kernig's65and65Brudzinski's65signs65are65also65helpful65in
65testing65for65meningeal65irritation65on65exam.
A6537-year-
old65nurse65comes65for65evaluation65of65colicky65right65upper65quadrant65abdominal65pai
n.65The65pain65is65associated65with65nausea65and65vomiting65and65occurs65165to65265ho
urs65after65eating65greasy65foods.65Which65one65of65the65following65physical65examinati
on65descriptions65would65be65most65consistent65with65the65diagnosis65of65cholecystitis?
A)65Abdomen65is65soft,65nontender,65and65nondistended,65without65hepatosplenomegaly
65or65masses.
B)65Abdomen65is65soft65and65tender65to65palpation65in65the65right65lower65quadrant,65wit
hout65rebound65or
guarding.
C)65Abdomen65is65soft65and65tender65to65palpation65in65the65right65upper65quadrant65wit
h65inspiration,65to65the
point65of65stopping65inspiration,65and65there65is65no65rebound65or65guarding.
D)65Abdomen65is65soft65and65tender65to65palpation65in65the65mid-
epigastric65area,65without65rebound65or
guarding.65-65answer--
C)65Abdomen65is65soft65and65tender65to65palpation65in65the65right65upper65quadrant65wit
h65inspiration,65to65the
point65of65stopping65inspiration,65and65there65is65no65rebound65or65guarding.
In65cholecystitis,65the65pain,65which65originates65from65the65gallbladder,65is65located65in6
5the
right65upper65quadrant.65Severity65of65pain65with65inspiration65that65is65sufficient65to65sto
p65further65inhalation
is65also65known65as65Murphy's65sign,65which,65if65present,65is65further65indicative65of65inf
lammation65of65the
gallbladder.
A6555-year-
old65data65entry65operator65comes65to65the65clinic65to65establish65care.65She65has65the65
following
symptoms:65headache,65neck65pain,65sinus65congestion,65sore65throat,65ringing65in65ear
s,65sharp65brief65chest
pains65at65rest,65burning65abdominal65pain65with65spicy65foods,65constipation,65urinary65f
requency65that65is65worse65with65coughing65and65sneezing,65and65swelling65in65legs.65T
his65cluster65of65symptoms65is65explained
by:
A)65One65disease65process
