NP NP Diagnosis & Clinical Decision-Making 2 — Questions and Answers
Question 1: A 40-year-old woman presents with fatigue, weight gain, cold intolerance, constipation, and dry skin. TSH is elevated at 9.2 mIU/L with low free T4. The diagnosis is:
- Hyperthyroidism
- Primary hypothyroidism (Correct answer)
- Subclinical hyperthyroidism
- Secondary hypothyroidism
Correct answer: Primary hypothyroidism
Elevated TSH with low free T4 confirms primary hypothyroidism, where the thyroid gland is not producing adequate hormone despite pituitary stimulation.
Question 2: A patient presents with a painful, well-demarcated, erythematous rash with vesicles following a dermatomal distribution on the right flank. The NP diagnoses:
- Contact dermatitis
- Herpes zoster (shingles) (Correct answer)
- Cellulitis
- Impetigo
Correct answer: Herpes zoster (shingles)
Dermatomal distribution of vesicular rash with pain is the characteristic presentation of herpes zoster, caused by reactivation of varicella-zoster virus.
Question 3: A 60-year-old male reports rectal bleeding, change in bowel habits, and a 20-pound weight loss over three months. The NP's highest-priority action is:
- Recommend dietary fiber and reassess in 3 months
- Order urgent colonoscopy to rule out colorectal cancer (Correct answer)
- Prescribe topical hemorrhoid treatment
- Order H. pylori testing
Correct answer: Order urgent colonoscopy to rule out colorectal cancer
Rectal bleeding, altered bowel habits, and unexplained weight loss in a 60-year-old are red-flag symptoms requiring urgent endoscopic evaluation to exclude colorectal malignancy.
Question 4: A patient presents with unilateral leg swelling, warmth, and redness after a long flight. Duplex ultrasound is ordered to evaluate for:
- Peripheral artery disease
- Deep vein thrombosis (DVT) (Correct answer)
- Superficial thrombophlebitis
- Lymphedema
Correct answer: Deep vein thrombosis (DVT)
Unilateral leg swelling with warmth and erythema following prolonged immobility is a classic DVT presentation; duplex ultrasound is the gold standard diagnostic test.
Question 5: Which finding on a knee examination is most consistent with an anterior cruciate ligament (ACL) tear?
- Positive McMurray test
- Positive Lachman test with loss of firm endpoint (Correct answer)
- Positive patellar apprehension test
- Positive valgus stress test at 30 degrees
Correct answer: Positive Lachman test with loss of firm endpoint
The Lachman test, which demonstrates anterior tibial translation without a firm endpoint, is the most sensitive physical examination test for ACL injury.
Question 6: A urine pregnancy test is positive and the patient has severe lower abdominal pain, shoulder pain, and vaginal spotting. The NP should immediately suspect:
- Threatened abortion
- Ectopic pregnancy (Correct answer)
- Ovarian cyst rupture
- Appendicitis
Correct answer: Ectopic pregnancy
A positive pregnancy test with pelvic pain, vaginal bleeding, and diaphragmatic irritation (shoulder pain) is an ectopic pregnancy until proven otherwise—a surgical emergency.
NP NP Diagnosis & Clinical Decision-Making 2
A 40-year-old woman presents with fatigue, weight gain, cold intolerance, constipation, and dry skin.
TSH is elevated at 9.2 mIU/L with low free T4.
The diagnosis is: