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NSG6020 / NSG 6020 Final Exam 2025 Questions
and Answers Updated (2025 / 2026) (Verified
Answers plus Rationales
- A 55-year-old male presents with chest pain that radiates to his left arm. What is the most appropriate initial diagnostic test? ECG An ECG is the first-line diagnostic test to assess for myocardial ischemia or infarction.
- Which antihypertensive is contraindicated in pregnancy? Lisinopril ACE inhibitors like lisinopril are teratogenic and should be avoided during pregnancy.
- What is the most likely cause of microcytic anemia? Iron deficiency anemia Iron deficiency is the most common cause of microcytic anemia, especially in menstruating women or those with GI blood loss.
- Which medication is first-line for type 2 diabetes? Metformin
Metformin is the recommended initial pharmacologic agent due to its efficacy, safety, and low cost.
- A patient on warfarin has an INR of 5.0 but is not bleeding. What is the recommended action? Hold warfarin and monitor INR With an INR of 5.0 and no bleeding, warfarin should be held, and INR should be closely monitored.
- Which cranial nerve is responsible for facial symmetry? CN VII The facial nerve (CN VII) controls facial expression and symmetry.
- A patient presents with sudden onset severe headache and neck stiffness. What condition must be ruled out first? Subarachnoid hemorrhage These symptoms are classic for subarachnoid hemorrhage and require immediate imaging.
- What is the best test to confirm hypothyroidism? TSH and Free T TSH is the most sensitive test, and Free T4 confirms the diagnosis.
- Which heart sound is associated with heart failure? S An S3 gallop indicates volume overload and is often heard in systolic heart failure.
A fasting glucose of 126 or more confirms diabetes per ADA criteria. 17.What is the hallmark sign of appendicitis? RLQ tenderness (McBurney's point) Pain at McBurney’s point is classic for appendicitis. 18.What is the most appropriate imaging for suspected pulmonary embolism? CT pulmonary angiography This is the gold standard for PE diagnosis. 19.A positive Phalen’s and Tinel’s test indicates: Carpal tunnel syndrome These maneuvers reproduce symptoms of median nerve compression. 20.What is the first-line treatment for generalized anxiety disorder? SSRIs SSRIs are first-line pharmacologic treatment for GAD due to their efficacy and tolerability. 21.A patient has been diagnosed with GERD. Which class of medication is most effective? Proton pump inhibitors PPIs provide superior acid suppression and symptom relief. 22.What is the first-line antibiotic for uncomplicated cystitis? Nitrofurantoin Nitrofurantoin is effective and has low resistance for uncomplicated UTIs.
23.What is the most common cause of peptic ulcer disease? Helicobacter pylori H. pylori infection is the primary cause of PUD worldwide. 24.A 72-year-old with atrial fibrillation is at risk of: Stroke A-fib increases the risk of thromboembolic stroke due to clot formation in the atria. 25.What is the gold standard test for diagnosing diabetes insipidus? Water deprivation test This test differentiates between central and nephrogenic diabetes insipidus. 26.Which of the following vaccines is contraindicated in pregnancy? MMR MMR is a live vaccine and should not be given during pregnancy. 27.Which heart murmur is heard best at the apex and radiates to the axilla? Mitral regurgitation This murmur is classically heard best at the apex and radiates laterally. 28.A patient complains of fatigue, weight gain, and cold intolerance. Which condition is likely? Hypothyroidism These symptoms are hallmark signs of hypothyroidism. 29.The drug of choice for status epilepticus is:
36.What is the hallmark of Alzheimer’s disease? Progressive memory loss Memory impairment, especially short-term, is the hallmark early symptom. 37.Which electrolyte imbalance can cause peaked T waves? Hyperkalemia Elevated potassium levels can cause characteristic ECG changes like peaked T waves. 38.What is the primary treatment for anaphylaxis? Epinephrine Epinephrine is life-saving and must be administered immediately. 39.A child with a barking cough and stridor likely has: Croup Croup causes upper airway swelling, leading to a barking cough. 40.Which vitamin deficiency causes bleeding gums and petechiae? Vitamin C Vitamin C deficiency leads to scurvy, presenting with bleeding and poor wound healing. 41.A patient with RUQ pain, fever, and jaundice most likely has: Cholangitis Charcot’s triad (pain, fever, jaundice) is diagnostic of cholangitis. 42.What is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae S. pneumoniae remains the most common cause of CAP. 43.A patient with tremor at rest, bradykinesia, and rigidity likely has: Parkinson’s disease These cardinal features define Parkinson’s disease. 44.A positive Murphy's sign suggests: Cholecystitis Murphy’s sign is pain on inspiration with palpation of the RUQ. 45.What is the treatment for Lyme disease in adults? Doxycycline Doxycycline is effective against Borrelia burgdorferi in early Lyme disease. 46.A child with fever, sore throat, and sandpaper-like rash likely has: Scarlet fever Scarlet fever results from group A strep and causes a characteristic rash. 47.What condition is associated with a positive Homan’s sign? Deep vein thrombosis Homan’s sign suggests DVT, though it’s neither sensitive nor specific. 48.A 70-year-old with confusion, hyponatremia, and lung mass may have: SIADH SIADH is often associated with small-cell lung cancer and presents with hyponatremia.
55.A patient with COPD should receive which annual vaccines? Influenza and pneumococcal These reduce risk of respiratory complications in COPD patients. 56.Which condition is characterized by demyelination in the CNS? Multiple sclerosis MS is an autoimmune disorder that causes CNS demyelination. 57.What is the treatment of choice for streptococcal pharyngitis? Penicillin V Penicillin remains first-line for group A strep pharyngitis. 58.What is the hallmark of nephrotic syndrome? Proteinuria >3.5 g/day Massive proteinuria is the defining feature of nephrotic syndrome. 59.Which electrolyte imbalance can cause seizures? Hyponatremia Low sodium levels can lead to cerebral edema and seizures. 60.A diabetic patient has a HbA1c of 9%. What does this indicate? Poor glycemic control An A1c above 7% suggests inadequate diabetes management. 61.Which skin lesion is pearly, with rolled edges and central ulceration? Basal cell carcinoma
This is the classic description of basal cell carcinoma. 62.What is the best diagnostic for deep vein thrombosis? Venous Doppler ultrasound Non-invasive Doppler is the test of choice for DVT. 63.What is the antidote for benzodiazepine overdose? Flumazenil Flumazenil is a benzodiazepine receptor antagonist. 64.A patient with “worst headache of my life” likely has: Subarachnoid hemorrhage This description is typical of SAH, often from a ruptured aneurysm. 65.Which murmur is systolic and heard at the second right intercostal space? Aortic stenosis Aortic stenosis murmur is systolic and best heard at the right upper sternal border. 66.What is the most common cause of liver cirrhosis in the U.S.? Alcohol abuse Chronic alcohol consumption is the leading cause of cirrhosis. 67.What is the most common cause of end-stage renal disease? Diabetes mellitus Diabetes is the #1 cause of ESRD due to diabetic nephropathy. 68.What condition causes pain relief with eating?
75.Which vitamin deficiency leads to night blindness? Vitamin A Vitamin A is essential for retinal function. 76.What is the first-line treatment for depression? Selective serotonin reuptake inhibitors (SSRIs) SSRIs are most commonly used due to favorable side effect profiles. 77.A patient with chronic cough and barrel chest likely has: Emphysema Barrel chest is classic in advanced emphysema due to air trapping. 78.What test diagnoses rheumatoid arthritis? Rheumatoid factor and anti-CCP These markers help confirm the diagnosis of RA. 79.Which type of hepatitis is transmitted through fecal-oral route? Hepatitis A Hepatitis A is commonly spread via contaminated food or water. 80.What lab finding is characteristic of anemia of chronic disease? Low serum iron and low TIBC Inflammation suppresses iron availability and TIBC. 81.Which antibiotic should not be used in children due to tooth discoloration? Tetracycline
Tetracyclines bind calcium and stain developing teeth. 82.A painless testicular mass is most suspicious for: Testicular cancer Any painless, firm testicular mass should be evaluated urgently. 83.Which cardiac marker rises first in myocardial infarction? Troponin I Troponin is highly specific and rises early in MI. 84.What is the hallmark of diabetic ketoacidosis (DKA)? Metabolic acidosis with anion gap DKA leads to ketoacidosis with high anion gap. 85.What is the recommended treatment for bacterial vaginosis? Metronidazole Metronidazole is first-line for anaerobic organisms in BV. 86.A patient with butterfly rash across the cheeks may have: Systemic lupus erythematosus (SLE) Malar rash is a key diagnostic clue for SLE. 87.What drug class causes dry cough as a side effect? ACE inhibitors ACE inhibitors increase bradykinin, leading to cough. 88.A bruit over the carotid artery suggests:
95.What is the best imaging test for gallstones? Abdominal ultrasound Ultrasound is the first-line diagnostic for cholelithiasis. 96.A GCS score of 3 indicates: Deep coma or death GCS of 3 is the lowest score and indicates no neurological responsiveness. 97.A patient with resting tremor, rigidity, and shuffling gait likely has: Parkinson’s disease These are the cardinal signs of Parkinsonism. 98.What is the first-line treatment for bipolar disorder? Lithium Lithium is effective in controlling manic and depressive episodes. 99.What is the cause of elevated BNP? Heart failure BNP is released in response to ventricular stretching due to fluid overload.
- A blood pressure of 180/120 with papilledema is: Hypertensive emergency Evidence of end-organ damage (like papilledema) makes this an emergency.
- What is the first-line treatment for otitis externa? Topical antibiotics
Ear drops are used unless systemic infection is suspected.
- What is the treatment for acute gout flare? NSAIDs NSAIDs reduce inflammation quickly and are first-line for acute gout.
- Which of the following is a sign of upper motor neuron lesion? Spasticity Spasticity and hyperreflexia are typical UMN signs.
- What is the recommended age for colon cancer screening? 45 years Recent guidelines recommend starting screening at age 45.
- What should be monitored in patients on amiodarone? Thyroid function Amiodarone can cause hypo- or hyperthyroidism.
- What is the most sensitive test for HIV? HIV RNA PCR HIV RNA PCR detects viral load before antibodies appear.
- What is the classic EKG finding in pericarditis? Diffuse ST elevation ST elevation in all leads suggests pericardial inflammation.
- What type of anemia is associated with B12 deficiency?
- What symptom suggests a transient ischemic attack (TIA)? Temporary unilateral weakness TIA causes brief neurologic deficits that resolve within 24 hours.
- What is the most common cause of epididymitis in men under 35? Chlamydia trachomatis STIs are the most common cause in younger men.
- Which test confirms syphilis? FTA-ABS This test confirms Treponema pallidum infection.
- What is the first-line treatment for hypertension in Black patients? Thiazide diuretics or calcium channel blockers These are more effective in African American populations per guidelines.
- What is the most appropriate imaging for appendicitis? Abdominal CT CT is highly sensitive and specific for diagnosing appendicitis.
- What is the hallmark symptom of hypercalcemia? Constipation Hypercalcemia slows GI motility, causing constipation.
- What is a classic sign of retinal detachment? Curtain over the visual field
This symptom suggests acute detachment and requires urgent care.
- What test should be performed before initiating isotretinoin? Pregnancy test Isotretinoin is teratogenic; a negative test is required before use.
- What is the diagnostic test for peptic ulcer perforation? Abdominal X-ray (upright) Free air under the diaphragm indicates perforation.
- What is the most common cause of blindness in diabetics? Diabetic retinopathy Progressive retinal damage from hyperglycemia leads to blindness.
- Which disorder is associated with obesity, hirsutism, and infertility? Polycystic ovary syndrome (PCOS) PCOS presents with these classic symptoms and elevated androgens.
- What is a sign of dehydration in infants? Sunken fontanelle This reflects volume depletion in infants.
- What is the classic presentation of Kawasaki disease? Fever, rash, conjunctivitis, strawberry tongue These features help diagnose this pediatric vasculitis.
- What medication is used in Alzheimer’s disease?
