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D. MRI - CORRECT ANSWER: A.

Exam (elaborations) Dec 14, 2025 ★★★★★ (5.0/5)
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Primary Care Management Of Adolescents & Adults (NR-577) Final Exam Latest Update - 350 Questions and 100% Verified Correct Answers Guaranteed A+ Verified by Professor

  • A 56-year-old patient comes in for a routine well visit. He has a history of a previous
  • stroke and Type 2 Diabetes. Which of the following orders would be appropriate for a patient with a previous stroke?

  • Initiate statin therapy

B. EEG

  • Warfarin therapy with an INR goal of 2-3

D. MRI - CORRECT ANSWER: A.

Patients with a history of an ASCVD should be started on statin therapy regardless of current LDL. The question did not mention any other symptoms that would warrant additional diagnostics. Warfarin therapy is only indicated if AFIB would be the primary indication for anticoagulation after a stroke.

  • A 67-year-old female comes into your clinic stating that her daughter just gave birth
  • to her first grandchild and she if planning to fly to visit them next month. She reports her daughter told her to make sure her immunizations were up to date as her grandchild was 2 months premature. She wants to know what immunizations she needs as she has not had any "since high school". You advise her to get which of the following immunizations?

  • Influenza, MMR, PCV 13, Herpes Zoster, Tdap
  • Influenza, PCV13, Herpes Zoster
  • MMR, PCV13, Herpes Zoster

D. Influenza, Herpes Zoster - CORRECT ANSWER: A.

The CDC and The Advisory Committee on Immunization Practices (ACIP) recommend routine influenza vaccination for all persons aged 6 months and older. The ACIP recommend one dose of MMR for non-high-risk adults aged 18 years and older. PCV 13 is recommended for those 65 and older. Increasing reports of pertussis among US 1 / 4

adolescents, adults, and their infant contacts have stimulated vaccine development for older age groups. The ACIP recommends Tdap for those age 65 years and older who are around at-risk infants such as those with prematurity. The ACIP also recommends Herpes Zoster vaccination at age 50.

  • A 4-year-old presents to your clinic today in need of vaccines before starting pre-
  • school. She is currently up to date on all of her other vaccines prior to this visit. What vaccines will she receive today?

a) Hep A, Hib, IPV, DTaP

b) DTaP, IPV, MMR, VAR

c) Tdap, MMR, VAR, IPV

d) DTaP, MMR, VAR, Hib - CORRECT ANSWER: B.

  • In differentiating between acute epididymitis and testicular torsion, which key
  • finding on physical exam should you expect to see with acute epididymitis versus testicular torsion?

  • Positive Prehn's sign
  • Swelling of the effected testicle
  • Irritative voiding symptoms

D. Unilateral groin pain - CORRECT ANSWER: A.

Elevating the scrotum in acute epididymitis alleviates pain, whereas in testicular torsion there is no difference in pain quality. Swelling and unilateral groin pain will be present in both conditions. Irritative voiding symptoms will occur with acute epididymitis than testicular torsion

  • You are seeing a patient in the clinic who states he has tried for over a year with
  • his fiancé to conceive. His fiancé has a child from a previous relationship. When reviewing medical history, a history of _____ in adolescence would help to pinpoint a possible cause of infertility?

  • Chickenpox
  • Wilson's disease
  • Mumps

D. Mononucleosis - CORRECT ANSWER: C. 2 / 4

In reviewing the history, an infection of mumps orchitis impairs fertility in 13% of patients (Defendi, 2019). The other illnesses do not impair fertility.

  • A 30-year old female is being seen in your office utilizing sliding scale self-pay for
  • monitoring of her INR on chronic Coumadin therapy for an artificial valve. She states she had a positive pregnancy test and her last menstrual period was 8 weeks prior. She

denies cramping or bleeding. The next course of action is to:

  • Discontinue Coumadin and begin on a DOAC
  • Refer the patient to cardiology for management
  • Obtain a PT/INR and ensure dosage of Coumadin is at or below 5mg/daily
  • Discontinue Coumadin and avoid blood thinners during the pregnancy - CORRECT

ANSWER: C.

Coumadin in the first trimester is safe at dosages of 5mg/day or less (McPhee & Papadakis, 2018). The risks of stopping Coumadin is greater for the mother than the developing fetus, so discontinuing the medicine would not be appropriate. The patient does not have insurance, so referring to cardiology would be an expense the patient would not be able to afford. DOACs are not recommended for mechanical valve replacements since there is no data to support its use in pregnancy.

104 A 16-year-old female presents to the clinic stating she has noticed a mass in her right breast. On examination, the mass is 2cm, mobile, rubbery, and nontender, located in the upper, outer quadrant in the 10 o'clock position. Fibroadenoma is suspected.What is the next step?

  • Observation
  • Surgical excision
  • Ultrasound

d. Biopsy - CORRECT ANSWER: A.

Fibroadenoma is common in adolescent girls. Diagnosed on examination with findings of nontender, smooth, rubbery, well-circumscribed, and mobile. Management is observation. Fibroadenomas less than 5cm should be monitored over 3-4 months for growth or regression, then semiannually for a few years, and then for regressing fibroadenomas yearly. Referral to breast specialist should be made if larger than 5cm, enlarging, skin changes in overlying skin, or previous malignancy. 3 / 4

  • A 15-year-old female is brought into the clinic by her mother. The mother is
  • concerned she has not started her period. Secondary sex characteristics are present, but no history of menses. Patient denies being sexually active. Patient has not had any recent illness and has no PMH. All of the following laboratory test would be warranted except?

  • Urine pregnancy test
  • CBC
  • CMP

d. TSH, Prolactin, and FSH. - CORRECT ANSWER: C.

Primary amenorrhea- no menses or secondary sex characteristics by 13y, or no menses or secondary sex characteristics by 15y. Page 125 Figure 4-6 provides a guide to laboratory and radiologic evaluation. Initial studies should include pregnancy test, CBC, TSH, Prolactin, and FSH.

  • A 28 year old female presents to the office with a tender lump in her left breast,
  • approximately 1cm. She noticed the lump right before she began her menstrual cycle 2 months ago. She thought it was going away, but symptoms returned few days ago before she started her menstrual cycle, again.Which of the following diagnostic test would you order to for the initial evaluation of the breast lump?

  • Core needle Biopsy
  • Ultrasonography
  • Excisional Biopsy

D. Mammography - CORRECT ANSWER: B.

Core needle biopsy is preferred over Fine needle biopsy, but not for initial evaluation of a suspected fibrocystic condition. Ultrasonography and mammography are the preferred initial diagnostic test for suspected fibrocystic condition. An ultrasound should be ordered if less than 30 years of age and a mammogram if greater than 30 years of age.An excisional biopsy is often not required for this condition.

  • / 4

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