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NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR, Exams of Nursing

Thomas Jefferson UniversityNursing
Prof. Jualing Huang

NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR NU 570 Final Exam Vignette Answer Key VERIFIED AND APPROVED BY EXPERT TUTOR

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NU 570 Final Exam Vignette Answer
Key
**Answer Key**
Clinical Vignettes for Final Exam Review
1. A 12
-
year
-
old boy presents for a pre
-
summer camp physical examination. Routine
urinalysis discloses 3+ glucosuria. On questioning, the child admits to thirst and
frequent urination, accompanied by weight loss over the past few months. A finger
stick glucose test in the office shows elevated blood sugar level of 280 mg/dL.
Diabetes mellitus type 1, loss of beta cells in pancreas
2. A 21
-
year
-
old man is brought to the emergency room with symptoms of acute
intestinal obstruction. Physical examination reveals a mass in the right lower
abdominal quadrant. The patient subsequently undergoes surgery for an
“inflammatory bowel disease”.
Crohn disease, with transmural granulomatous inflammation
3. A 23
-
year
-
old woman fails to resume her menstrual cycle after pregnancy.
Laboratory findings reveal decreased levels of circulating hormones, including MSH,
TSH, ACTH, and FSH.
Shehan syndrome, pituitary infarction
4. A 30
-
year
-
old woman complains of headache, visual disturbances, deepening of her
voice, and generalized weakness. She reports amenorrhea for the past year, and
states that she recently required a larger shoe size.
Acromegaly, pituitary adenoma
5. A 40
-
year
-
old man reported having sudden attacks of dizziness, blurred vision, and
excruciating headaches. During these attacks his blood pressure was 180/120 mm
Hg.
Pheochromocytoma, neural crest tumor of the adrenal medulla produces adrenaline
6. A 44
-
year
-
old woman presents with a 2
-
month history of burning epigastric pain
that usually occurs between meals. The pain can be relieved with antacids or food.
The patient also reports a recent history of tarry stools (melena). Laboratory studies
show anemia. Gastroscopy reveals a bleeding mucosal defect in the antrum
measuring 1.5 cm in diameter.
Peptic ulcer, H. pylori infection, chronic infectious gastritis
7. A 45
-
year
-
old woman presented with complaints of sweating a lot, feeling hot, and
being constantly tired. She had a fast pulse rate and reported feeling constantly
hungry. On examination, she was found to have bulging eyes and an enlarged
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Key

****Answer Key** Clinical Vignettes for Final Exam Review**

  1. A 12- year- old boy presents for a pre - summer camp physical examination. Routine urinalysis discloses 3+ glucosuria. On questioning, the child admits to thirst and frequent urination, accompanied by weight loss over the past few months. A finger stick glucose test in the office shows elevated blood sugar level of 280 mg/dL. Diabetes mellitus type 1, loss of beta cells in pancreas
  2. A 21- year- old man is brought to the emergency room with symptoms of acute intestinal obstruction. Physical examination reveals a mass in the right lower abdominal quadrant. The patient subsequently undergoes surgery for an “inflammatory bowel disease”. Crohn disease, with transmural granulomatous inflammation
  3. A 23 - year- old woman fails to resume her menstrual cycle after pregnancy. Laboratory findings reveal decreased levels of circulating hormones, including MSH, TSH, ACTH, and FSH. Shehan syndrome, pituitary infarction
  4. A 30- year- old woman complains of headache, visual disturbances, deepening of her voice, and generalized weakness. She reports amenorrhea for the past year, and states that she recently required a larger shoe size. Acromegaly, pituitary adenoma
  5. A 40- year- old man reported having sudden attacks of dizziness, blurred vision, and excruciating headaches. During these attacks his blood pressure was 180/120 mm Hg. Pheochromocytoma, neural crest tumor of the adrenal medulla produces adrenaline
  6. A 44- year- old woman presents with a 2- month history of burning epigastric pain that usually occurs between meals. The pain can be relieved with antacids or food. The patient also reports a recent history of tarry stools (melena). Laboratory studies show anemia. Gastroscopy reveals a bleeding mucosal defect in the antrum measuring 1.5 cm in diameter. Peptic ulcer, H. pylori infection, chronic infectious gastritis
  7. A 45- year- old woman presented with complaints of sweating a lot, feeling hot, and being constantly tired. She had a fast pulse rate and reported feeling constantly hungry. On examination, she was found to have bulging eyes and an enlarged

Key

thyroid. Graves disease, autoantibody to TSH receptor

Key

  1. A 70- year- old man with sclerosis of the lumbar vertebrae had a rock - hard prostate on digital rectal examination. Prostate adenocarcinoma, markers include PSA and Alkaline Phosphatase for bone invasion
  2. A liver biopsy in a 53- year- old man with jaundice reveals evidence of acute alcoholic hepatitis. This biopsy shows neutrophils. Repeated bouts of hepatitis may lead to cirrhosis
  3. Discuss symptoms of hypo - and hyperthyroidism. Symptoms related to general metabolism and include heat (hyper) vs cold (hypo) intolerance
  4. A testicular tumor from a 24- year- old man is removed and tissue sections are examined by light microscopy. The Pathologist observes multinucleated giant cells, reflecting differentiation of trophoblastic stem cells. Choriocarcinoma, germ cell malignant tumor, hCG is tumor marker 20. During clinical rounds you are asked to discuss acromegaly and gigantism. Caused by pituitary adenoma secreting growth hormone, before (gigantism) and after (acromegaly) puberty
  5. A 65 - year- old woman has a past medical history of esophageal varices, splenomegaly, and ascites. Portal hypertension secondary to hepatic cirrhosis 22. A 48- year- old woman presents with renal stones, bone pain, moans, groans. Hyperparathyroidism and hypercalcemia, most likely due to solitary parathyroid adenoma
  6. The parents of a 2- week- old neonate ask you questions about congenital birth defects that affect the esophagus. Congenital anomalies of the esophagus include tracheoesophageal fistulas and webs
  7. A 22- year- old woman has diffuse inflammation of the mucosal lining of the large intestine. Ulcerative colitis affects distal GI, with superficial ulceration of mucosa
  8. While examining the gums of a 30- year- old woman, a yellowish discoloration of the oral mucosa and sclera is noted. Laboratory tests show a significant increase in unconjugated serum bilirubin. Unconjugated hyperbilirubinemia implies overload of liver capacity to conjugate, possible due to ongoing hemolysis
  9. A 1- month- old neonate is brought to the emergency room with severe, unremitting watery diarrhea (systemic dehydration). Her blood pressure is 80 mm Hg systolic, and the pulse is 120/min. Possible lethal complication is mid - sagittal venous sinus thrombosis

Key

  1. A 10- year- old boy sustains cerebral contusions after falling from the upper rafters of a garage. The parents of the child are very concerned about the long - term prognosis for their son, and ask you for general information regarding functional anatomy of the brain. Which of the following lobes of the cerebral cortex provides the main sensory receptive area for touch (i.e., somatosensory cortex)? Parietal lobe houses the somatosensory cortex
  2. A 12- year- old boy is rushed to the emergency room in a coma after falling from an upper story window of his home. MRI shows a subdural hematoma over the left hemisphere. What is the most likely source of intracranial bleeding in this patient? Bridging veins
  3. A 17- year- old woman presents to her gynecologist with a 5 day history of vaginal bleeding. A home pregnancy test had been positive 1 week previously. This morning, the patient passed tissue with the appearance of small grapes. An ultrasound shows a dilated endometrial cavity, but no evidence of a fetus. Endometrial evacuation of the uterus by suction curettage reveals grapelike clusters, with individual units measuring up to 5 mm in diameter. Hydatidiform mole, complication is malignant choriocarcinoma, hCB tumor marker
  4. A 22- year- old woman presents with a painless nodule in the lower outer aspect of her right breast that she has had for 2 months. The nodule appears to be freely movable, sharply demarcated from the surrounding parenchyma, and firm. A mammogram demonstrates a circumscribed and homogeneous density. The encapulated tumor is removed and the surgical specimen is shown in the image. What is the appropriate pathologic diagnosis? Fibroadenoma
  5. A 23- year- old woman requests information from you regarding risk factors for development of breast cancer. Family history
  6. A 24- year- old woman delivers a healthy baby and begins breastfeeding her neonate. The patient presents 2 weeks later with a fever of 38°C (101°F). Physical examination shows no abnormal vaginal discharge or evidence of pelvic pain but does reveal redness on the lower side of the left breast. The patient stops nursing the infant temporarily, but the symptoms persist, and the entire breast becomes swollen and painful. Acute mastitis, fluid would show neutrophils
  7. A 25- year- old woman is referred to the gynecologist for treatment of infertility. The patient is obese (BMI = 32 kg/m2) and has pronounced facial hair (hirsutism). She states that she has always had irregular menstrual periods. On gynecologic examination, both ovaries are found to be symmetrically enlarged. Polycystic ovary syndrome, also known as Stein- Leventhal syndrome

Key

  1. A 36- year- old woman presents with infertility. She complains of having had dull pelvic pain for 9 months, which is accentuated during menstruation. Physical examination and endocrinologic studies are normal. Laparoscopy reveals multiple, small hemorrhagic lesions over the surface of both ovaries and fallopian tubes and abundant pelvic scarring. Endometriosis, reflux of endometrial tissue
  2. A 40- year- old woman presents with a 5- year history of dysmenorrhea. Physical examination and endocrine studies are normal. A hysterectomy is performed. Histologic examination of the uterine wall reveals areas of extensive adenomyosis. Deep penetration of endometrial tissue into the uterine muscle wall
  3. A 45- year- old obese woman (BMI = 32 kg/m2) with a history of diabetes mellitus and poorly controlled hypertension complains of increased menstrual blood flow of 3 months in duration. An endometrial biopsy reveals adenocarcinoma. Atypical hyperplasia caused by hyperestrogenism is likely pre- cancerous lesion
  4. A 45 - year- old woman discovers a solitary mass in her right breast on self- examination, which is confirmed on physical examination. Mammography demonstrates focal calcification, with a linear configuration in the region of the breast mass. A breast biopsy reveals large, pleomorphic epithelial cells confined to dilated ducts, with central zones of necrosis. The word “confined” implies ductal carcinoma in situ (DCIS)
  5. A 45- year- old woman suffered massive head trauma in a snowboarding accident. The patient persists in a vegetative coma for several months and then expires. A section of the temporal lobe shows proliferation of cells with a star- shaped appearance. Astrocytes proliferate in response to CNS injury (astrogliosis)
  6. A 5- year- old boy is brought to the emergency room with fever, vomiting, and convulsions. The patient is febrile to 39.5°C (104°F). Physical examination reveals cervical rigidity and pain in the neck and knees. Examination of cerebrospinal fluid (CSF) reveals neutrophils. Bacterial meningitis
  7. A 50- year- old nulliparous woman complains that her menstrual blood flow is more abundant than usual. During the last two menstrual cycles, she noticed spotting throughout the entire cycle. The patient is obese (BMI = 32 kg/m2), and her blood pressure is 160/100 mm Hg. An ultrasound examination reveals a thickened endometrial stripe with a polypoid mass in the uterine fundus. The patient undergoes a hysterectomy. The uterus is opened to reveal a partially necrotic mass. Microscopic examination of the tumor reveals moderately differentiated adenocarcinoma. Uterine adenocarcinoma develops from atypical hyperplasia, owing to hyperestrogenism

Key

  1. A 50- year- old woman presents with a 1- month history of intermittent vaginal bleeding. A Pap smear is normal. Pelvic examination reveals a left adnexal mass. A uterine curettage shows complex endometrial hyperplasia without atypia. A CT scan of the abdomen reveals a 5 cm mass replacing the left ovary. The patient undergoes hysterectomy and bilateral salpingo- oophorectomy. Could be granulosa cell tumor of ovary that secretes estrogen
  2. A 54- year- old woman dies 48 hours after suffering severe head injuries in an automobile accident. Just before her death, her left pupil became fixed and dilated (oculomotor nerve palsy). Cerebral edema leads to “transtentorial herniation” with compression of brainstem
  3. A 55- year- old man is brought to the emergency room after a near drowning accident while boating. The patient has no pulse when the paramedics arrive, but he is resuscitated. The patient never regains consciousness and expires 3 days later. Examination of the brain at autopsy reveals a watershed zone of infarction in the left cerebral hemisphere. Global (systemic) hypotension leads to watershed infarcts in the brain
  4. A 55- year-- old woman complained of dysfunctional vaginal bleeding. An ulcerated lesion of the uterine cervix was subsequently identified, and the patient obtained a complete hysterectomy. Squamous cell carcinoma of cervix, HPV risk factor
  5. A 6- year- old girl with a history of otitis media developed a cystic lesion in the temporal lobe of the brain. What is the most likely diagnosis? Cerebral abscess filled with neutrophils
  6. A 60- year- old man with a history of smoking and chronic bronchitis complains of difficulty walking. On examination, the patient appears stiff and stooped, shows an expressionless face, and speaks in a monotonous voice. A tremor of his fingers is apparent but ceases when he tries to reach for something. The patient dies 10 years later of metastatic lung cancer. At autopsy, the substantia nigra of the patient demonstrates reduced pigmentation. Parkinson disease
  7. A 65- year- old woman presents with a 3 week history of intractable headaches. Her vital signs and CBC are normal. Two weeks later, the patient develops left sided hemiparesis. MRI reveals a large, necrotic tumor in the right hemisphere of the cerebrum, extending across the corpus callosum into the left hemisphere. Glioblastoma multiform
  8. A 67- year- old woman discovers a lump in her breast on self- examination. Physical examination confirms a mass in the lower, outer quadrant of the left breast. Mammography demonstrates an ill- defined, stellate density measuring

Key

  1. Control of fine movement, as well as equilibrium, posture, and motor learning would be adversely affected by injury to which part of the brain? Cerebellum
  2. Physical examination of a 55- year- old chronic alcoholic reveals signs of dementia, ataxia (lack of voluntary control of movement), and paralysis of some extra - ocular muscles. Wernicke syndrome
  3. What is the term for the delicate innermost layer of the meninges that covers the brain and spinal cord? Pia mater
  4. The parents of an 18- year- old man who sustained head trauma in automobile accident ask for general information on the major functional centers in the brain. Which of the following is the visual processing center of the brain? Occipital lobe
  5. Upon self- examination, a 53- year- old woman discovers a lump in her left breast. Physical examination reveals a palpable lump about 1 cm in diameter in the outer quadrant of the left breast. No palpable lymph nodes are found in the axilla. Mammography reveals an ill defined, stellate density measuring 1 cm in the left breast. Fine needle aspiration of the mass discloses malignant epithelial cells. Invasive ductal carcinoma
  6. What region of the central nervous system regulates vital autonomic processes, such as heart rate and respiration? Brain stem
  7. A 4- year- old child develops puffiness around her eyes and becomes chronically sleepily 2 weeks after an episode of "strep- throat". The mother notes that the child's urine is dark brown and is being excreted in small amounts. Post - strep glomerulonephritis (nephritic syndrome)
  8. A 40- year- old man noticed generalized swelling, most prominently in his face and lower extremities. His physician discovered proteinuria and hypoalbuminemia. Nephrotic syndrome
  9. Bacteriuria is observed in a 30- year- old woman. Acute cystitis, ascending UTI
  10. Complement proteins are demonstrated by immunohistochemical tests in the glomeruli of a 50- year- old man with nephritic syndrome (signs). Signs of nephritic syndrome are oliguria, hematuria and hypertension