Nr511/ Nr 511 Final Exam Differential Diagnosis And Primary Care Practicum Comprehensive Final Exam Questions And Verified Answers With Rationales Graded A+ Latest

NR511/ NR 511 FINAL EXAM DIFFERENTIAL
DIAGNOSIS AND PRIMARY CARE PRACTICUM
COMPREHENSIVE FINAL EXAM QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST

1. A 42-year-old male presents with sudden onset of chest pain radiating to his left
arm and jaw, associated with diaphoresis and shortness of breath. His EKG shows
ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis?
A. Pulmonary embolism
B. Acute inferior myocardial infarction
C. Acute pericarditis
D. Aortic dissection
Answer: B. Acute inferior myocardial infarction
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
MI. Classic symptoms include chest pain radiating to the jaw/arm with diaphoresis.
Pulmonary embolism may present with chest pain and shortness of breath but
usually shows sinus tachycardia and hypoxia. Acute pericarditis presents with
diffuse ST elevations and a friction rub. Aortic dissection presents with tearing
chest/back pain.


2. A 28-year-old woman presents with fatigue, pallor, and pica (craving ice). Labs
show microcytic anemia with low ferritin. Which is the most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Thalassemia
D. Anemia of chronic disease
Answer: B. Iron deficiency anemia

,Rationale: Microcytic anemia with low ferritin and pica suggests iron deficiency.
B12 deficiency typically causes macrocytic anemia. Thalassemia presents with
microcytosis but normal iron stores. Anemia of chronic disease is usually
normocytic or mildly microcytic with normal/high ferritin.


3. A 55-year-old male presents with a 2-month history of progressive shortness of
breath, chronic cough, and a history of 30 pack-years of smoking. Chest X-ray
shows a central hilar mass. Which is the most likely diagnosis?
A. Small cell lung carcinoma
B. Adenocarcinoma of the lung
C. Squamous cell carcinoma of the lung
D. Mesothelioma
Answer: C. Squamous cell carcinoma of the lung
Rationale: Squamous cell carcinoma often presents centrally with hilar masses
and is strongly associated with smoking. Small cell lung carcinoma also presents
centrally but progresses rapidly with systemic symptoms. Adenocarcinoma is
usually peripheral. Mesothelioma is linked to asbestos exposure.


4. A patient with a history of hypertension presents with sudden, severe headache
described as “worst headache of my life,” nausea, and neck stiffness. What is the
initial imaging of choice?
A. MRI brain without contrast
B. CT scan of the brain without contrast
C. CT angiography
D. Lumbar puncture
Answer: B. CT scan of the brain without contrast
Rationale: A sudden severe headache suggests subarachnoid hemorrhage (SAH).
Non-contrast CT is first-line for detecting acute bleeding. If negative and suspicion
remains, lumbar puncture is next. MRI is less sensitive acutely, and CTA is for
vascular mapping after diagnosis.

,5. A 36-year-old female presents with fatigue, cold intolerance, and constipation.
Labs reveal elevated TSH and low free T4. What is the most likely diagnosis?
A. Hyperthyroidism
B. Hashimoto’s thyroiditis
C. Graves’ disease
D. Subclinical hypothyroidism
Answer: B. Hashimoto’s thyroiditis
Rationale: Elevated TSH with low free T4 indicates primary hypothyroidism.
Hashimoto’s is the most common cause in adults. Graves’ disease causes
hyperthyroidism. Subclinical hypothyroidism shows elevated TSH but normal free
T4.


6. A 60-year-old male with history of type 2 diabetes presents with sudden vision
loss in the right eye. Fundoscopy shows a pale retina with a cherry-red spot. What
is the most likely diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Central retinal vein occlusion
D. Diabetic retinopathy
Answer: B. Central retinal artery occlusion
Rationale: A cherry-red spot on the macula is classic for central retinal artery
occlusion. Retinal detachment presents with floaters and visual curtain. Central
retinal vein occlusion presents with “blood and thunder” appearance. Diabetic
retinopathy causes microaneurysms and hemorrhages.


7. A 48-year-old female presents with progressive shortness of breath and bilateral
leg swelling. Echocardiogram shows reduced ejection fraction. Which medication
class improves mortality in this condition?
A. Calcium channel blockers
B. ACE inhibitors
C. Loop diuretics
D. Beta-2 agonists

, Answer: B. ACE inhibitors
Rationale: ACE inhibitors reduce morbidity and mortality in heart failure with
reduced ejection fraction (HFrEF). Diuretics manage symptoms but do not improve
survival. Calcium channel blockers are not first-line for HFrEF. Beta-2 agonists are
for asthma/COPD.


8. A 35-year-old male presents with dysuria, urethral discharge, and testicular pain.
Nucleic acid amplification test (NAAT) is positive for Neisseria gonorrhoeae.
What is the recommended treatment?
A. Azithromycin 1 g orally once
B. Ceftriaxone 500 mg IM once
C. Doxycycline 100 mg orally twice daily for 7 days
D. Ciprofloxacin 500 mg orally once
Answer: B. Ceftriaxone 500 mg IM once
Rationale: Current CDC guidelines recommend a single dose of ceftriaxone for
uncomplicated gonococcal infections. Azithromycin monotherapy is not
recommended due to resistance. Doxycycline is used for chlamydia co-infection.
Ciprofloxacin is no longer first-line due to resistance.


9. A 72-year-old male presents with resting tremor, bradykinesia, and shuffling
gait. Which neurotransmitter deficiency is primarily implicated in this disorder?
A. Acetylcholine
B. Dopamine
C. Serotonin
D. GABA
Answer: B. Dopamine
Rationale: Parkinson’s disease is caused by dopaminergic neuron loss in the
substantia nigra, resulting in motor symptoms. Acetylcholine excess contributes to
tremor. Serotonin affects mood. GABA is inhibitory but not the primary factor in
Parkinsonism.