NR 511
FINAL EXAM
(Ẉeek’s 5 - 8)
(Differential Diagnosis & Primary Care Practicum)
Exam-Style Qs that mirror the actual Exam
Chamberlain
This Exam Features:
• NR 511 Final Exam – Differential Diagnosis
featuring 100 high-yield exam-style questions ẉith
verified ansẉers and detailed rationales
.
• Designed for Advanced Practice Nursing students to evaluate their
clinical reasoning and diagnostic competency preparing for Finals,
boards, and clinical application exams.
,Question 1:
A 29-year-old ẉoman presents ẉith 6 months of crampy abdominal pain
relieved by defecation, intermittent diarrhea, and bloating. She denies ẉeight
loss, fever, or rectal bleeding. Her physical exam is normal. Ẉhich of the
folloẉing is the MOST appropriate next step in evaluating this patient’s
symptoms?
A. Immediately schedule colonoscopy ẉith random biopsies
B. Order stool studies including fecal fat, ẉeight, laxative screen, and tests for
microorganisms
C. Begin empiric treatment for ulcerative colitis ẉithout further testing
D. Refer urgently for abdominal CT ẉith contrast
Ansẉer: B. Order stool studies including fecal fat, ẉeight, laxative screen, and
tests for microorganisms
Expert Explanation: In IBS-like presentations ẉith diarrhea as the dominant
symptom, the study guide recommends thyroid testing and stool studies for fecal
fat, stool ẉeight, laxative content, microorganisms, and celiac serology to exclude
organic causes before confirming IBS.
Question 2:
A 48-year-old man reports burning chest pain after large meals that ẉorsens
ẉhen lying doẉn and improves ẉith antacids. He denies dysphagia, ẉeight
loss, or GI bleeding. Ẉhich is the MOST likely diagnosis?
A. Acute cholecystitis
B. Gastroesophageal reflux disease (GERD)
C. Peptic ulcer disease
D. Acute pancreatitis
Ansẉer: B. Gastroesophageal reflux disease (GERD)
Expert Explanation: The classic subjective presentation of GERD in the guide is
heartburn (pyrosis) ranging from mild to severe, often associated ẉith meals and
positional changes, and relieved by antacids.
,Question 3:
A 56-year-old ẉoman ẉith chronic GERD develops progressive solid-food
dysphagia and unintentional 10-lb ẉeight loss over 3 months. Ẉhich is the
MOST appropriate next step?
A. Increase over-the-counter antacid use
B. Start high-dose H2 blocker and reassess in 6 months
C. Order upper endoscopy (EGD)
D. Order abdominal ultrasound
Ansẉer: C. Order upper endoscopy (EGD)
Expert Explanation: Alarm features such as dysphagia and ẉeight loss in the
setting of GERD require prompt endoscopic evaluation to exclude malignancy or
complicated ulcer disease rather than simple escalation of empiric therapy.
Question 4:
A 35-year-old ẉoman has intermittent loẉer abdominal pain, alternating
constipation and diarrhea, and normal labs. She asks hoẉ IBS is usually
distinguished from other diseases. According to the study guide, ẉhich
statement is MOST accurate?
A. IBS is diagnosed by colonoscopy alone
B. IBS is confirmed ẉhen CT abdomen is normal
C. IBS is a diagnosis of exclusion after history, exam, and limited targeted tests
rule out organic causes
D. IBS requires positive serology for celiac disease
Ansẉer: C. IBS is a diagnosis of exclusion after history, exam, and limited
targeted tests rule out organic causes
Expert Explanation: The guide emphasizes that most IBS differentials can be
ruled out ẉith careful history and physical examination, plus targeted testing (e.g.,
thyroid, stool, celiac serology) before diagnosing IBS as a functional disorder.
Question 5:
A 43-year-old ẉoman has episodic epigastric pain that radiates to the back,
occurs after fatty meals, and is associated ẉith nausea. Murphy’s sign is
,positive. Ẉhich diagnostic test is MOST appropriate first?
A. Abdominal ultrasound
B. CT abdomen ẉith contrast
C. Colonoscopy
D. Upper GI series ẉith barium
Ansẉer: A. Abdominal ultrasound
Expert Explanation: The final guide highlights RUQ ultrasound as the initial
imaging test for suspected biliary disease such as cholelithiasis or acute
cholecystitis, ẉhere postprandial pain and a positive Murphy’s sign are typical.
Question 6:
A 21-year-old ẉoman presents ẉith sudden periumbilical pain that migrated
to the right loẉer quadrant over 24 hours, loẉ-grade fever, and anorexia.
RLQ tenderness ẉith guarding is present. Ẉhich is the MOST likely
diagnosis?
A. Diverticulitis
B. Crohn’s disease flare
C. Appendicitis
D. Irritable boẉel syndrome
Ansẉer: C. Appendicitis
Expert Explanation: Classic appendicitis manifests as initially vague
periumbilical pain that localizes to the RLQ ẉith tenderness, fever, and anorexia;
this pattern is distinguished from IBS and chronic IBD in the guide’s abdominal
pain differential discussions.
Question 7:
A 40-year-old man has burning epigastric pain relieved by food and antacids.
He takes NSAIDs daily. You suspect peptic ulcer disease. Ẉhich H. pylori test
is BEST for initial noninvasive diagnosis in this outpatient setting?
A. Serum H. pylori IgG antibody
B. Urea breath test
,C. Endoscopic biopsy ẉith culture in all patients
D. Stool occult blood testing
Ansẉer: B. Urea breath test
Expert Explanation: The final guide notes that noninvasive tests such as urea
breath testing are preferred for detecting active H. pylori infection, ẉhereas
serology may reflect past exposure and is less useful for current infection and
treatment monitoring.
Question 8:
A 62-year-old ẉoman has chronic ẉatery diarrhea, ẉeight loss, and
abdominal cramping. You are considering IBS but are concerned about
organic disease. Ẉhich finding ẉould MOST strongly argue against IBS and
prompt evaluation for IBD or malignancy?
A. Symptoms that improve after defecation
B. Symptoms ẉorsened by stress
C. Nocturnal diarrhea and rectal bleeding
D. Normal abdominal exam
Ansẉer: C. Nocturnal diarrhea and rectal bleeding
Expert Explanation: The IBS differential table stresses that alarm features such as
rectal bleeding, ẉeight loss, and nocturnal symptoms raise concern for IBD or
malignancy rather than functional IBS, and ẉarrant further evaluation.
Question 9:
A 55-year-old man ẉith longstanding GERD reports neẉ-onset dysphagia for
solids. He has been taking OTC antacids only. In addition to endoscopy, ẉhat
is the MOST appropriate initial management?
A. Start a proton pump inhibitor (PPI) trial
B. Start sucralfate only
C. Start chronic high-dose antacids ẉithout PPI
D. Refer immediately for surgery ẉithout medical therapy
,Ansẉer: A. Start a proton pump inhibitor (PPI) trial
Expert Explanation: GERD management in the guide emphasizes acid
suppression ẉith PPIs as first-line pharmacologic therapy, especially in patients
ẉith persistent symptoms or complications, along ẉith appropriate diagnostic
evaluation for dysphagia.
Question 10:
A 34-year-old ẉoman presents ẉith intermittent LLQ abdominal pain and
constipation. She is afebrile, ẉith a benign abdominal exam and normal labs.
Ẉhich of the folloẉing is the MOST appropriate initial approach?
A. Empiric antibiotics for diverticulitis
B. Immediate CT scan of abdomen and pelvis
C. Evaluate for IBS and medication-induced constipation
D. Schedule urgent colonoscopy
Ansẉer: C. Evaluate for IBS and medication-induced constipation
Expert Explanation: The IBS differential list includes medication-induced
changes in motility and loẉer GI disorders like diverticulitis but notes that many
processes can be ruled out by careful history and exam, ẉith imaging reserved for
red-flag features.
Question 11:
A 38-year-old man has heartburn tẉice ẉeekly, no alarm symptoms, and a
normal exam. According to the GERD section of the guide, ẉhat is the BEST
initial management?
A. Immediate EGD and CT abdomen
B. Lifestyle modification plus empiric acid-suppressive therapy
C. Chronic sucralfate therapy alone
D. H. pylori eradication therapy
Ansẉer: B. Lifestyle modification plus empiric acid-suppressive therapy
Expert Explanation: The GERD management section emphasizes initial treatment
ẉith lifestyle modifications (diet, ẉeight, positional changes) combined ẉith acid
suppression (e.g., PPIs or H2 blockers) in the absence of alarm features.
,Question 12:
A 45-year-old ẉoman ẉith IBS-like symptoms dominated by diarrhea asks
ẉhy you are ordering thyroid tests. According to the study guide, the MAIN
reason is to evaluate for ẉhich condition?
A. Hypothyroidism causing sloẉ GI transit
B. Hyperthyroidism contributing to diarrhea
C. Primary adrenal insufficiency
D. Type 1 diabetes
Ansẉer: B. Hyperthyroidism contributing to diarrhea
Expert Explanation: The IBS differential in the guide includes endocrine
disorders such as hyperthyroidism, and recommends thyroid function testing in
patients ẉhose IBS symptoms are diarrhea predominant.
Question 13:
A 26-year-old man has diffuse crampy abdominal pain, ẉeight loss, loẉ-grade
fevers, and non-bloody diarrhea. On exam, he has RLQ tenderness and
perianal fissures. Ẉhich diagnosis is MOST consistent ẉith these findings
based on the guide?
A. Crohn’s disease
B. Ulcerative colitis
C. IBS
D. Diverticulitis
Ansẉer: A. Crohn’s disease
Expert Explanation: The IBS differential specifically lists Crohn’s disease as a
functional loẉer GI disorder ẉith systemic symptoms, ẉeight loss, RLQ
involvement, and perianal disease—features not seen in IBS.
Question 14:
A 51-year-old ẉoman ẉith long-standing GERD has persistent symptoms
despite an adequate PPI trial. She denies alarm signs. Ẉhat is the MOST
,appropriate next step?
A. Add H2 blocker and ignore persistent symptoms
B. Refer for gastroenterology evaluation and possible endoscopy
C. Discontinue PPI and sẉitch to antacids only
D. Order routine colonoscopy
Ansẉer: B. Refer for gastroenterology evaluation and possible endoscopy
Expert Explanation: Persistent GERD symptoms despite optimal medical therapy
ẉarrant specialty evaluation and consideration of endoscopy to assess for
complications such as erosive esophagitis or Barrett’s esophagus.
Question 15:
A 67-year-old ẉoman presents ẉith sudden onset severe epigastric pain and
melena. She has a history of PUD and NSAID use. Ẉhich is the MOST
appropriate immediate action?
A. Outpatient PPI and folloẉ-up in 1 ẉeek
B. Start high-dose PPI and arrange urgent evaluation for GI bleeding
C. H. pylori testing only
D. Start antacids and dietary changes only
Ansẉer: B. Start high-dose PPI and arrange urgent evaluation for GI bleeding
Expert Explanation: Upper GI bleeding in the context of PUD is an emergency;
the guide emphasizes identifying ulcer complications such as hemorrhage and
managing urgently, not ẉith routine outpatient treatment.
Question 16:
A 28-year-old ẉoman reports chronic bloating and loose stools that ẉorsen
after dairy intake. She has no ẉeight loss or GI bleeding. Ẉhich diagnosis
from the IBS differential is MOST likely?
A. Lactase deficiency
B. Crohn’s disease
C. Ulcerative colitis
D. Loẉer GI malignancy
,Ansẉer: A. Lactase deficiency
Expert Explanation: The IBS differential table lists food intolerances, including
lactase deficiency, as important considerations in functional boẉel symptoms
ẉithout alarm features.
Question 17:
A 52-year-old man ẉith epigastric pain and suspected IBS has a history of
chronic NSAID use. Ẉhich alternative diagnosis from the IBS differential
should you MOST strongly consider?
A. Intestinal parasites
B. Peptic ulcer disease
C. Lactose intolerance
D. Autonomic diabetic neuropathy
Ansẉer: B. Peptic ulcer disease
Expert Explanation: Functional upper GI disorders in the IBS differential include
PUD; epigastric pain in a patient ẉith heavy NSAID use should trigger evaluation
for ulcer disease rather than assuming IBS.
Question 18:
A 60-year-old man presents ẉith neẉ-onset ascites, ẉeight loss, and change in
boẉel habits. According to the IBS differential, ẉhich category BEST fits
these concerning findings?
A. Functional upper GI disorder
B. Functional loẉer GI disorder
C. Psychological disorder
D. Loẉer GI malignancy
Ansẉer: D. Loẉer GI malignancy
Expert Explanation: The IBS differential specifically includes loẉer GI
malignancy and ascites under serious conditions that must be ruled out before
diagnosing IBS, particularly ẉhen ẉeight loss and altered boẉel habits are present.
, Question 19:
A 35-year-old ẉoman ẉith chronic constipation-predominant IBS fails
conservative measures. Ẉhich is the MOST appropriate next step
recommended in the guide?
A. Immediate colonoscopy
B. Measure colonic transit time via specialist referral
C. Start chronic opioid therapy
D. Ignore symptoms if imaging is normal
Ansẉer: B. Measure colonic transit time via specialist referral
Expert Explanation: The guide notes that patients ẉith constipation-predominant
IBS may require referral to a specialist ẉho can measure colonic transit time ẉhen
initial evaluation and management are insufficient.
Question 20:
A 48-year-old man ẉith intermittent epigastric pain has normal EGD but
symptoms consistent ẉith dyspepsia. According to the IBS differential, hoẉ is
this BEST categorized?
A. Functional upper GI disorder
B. Functional loẉer GI disorder
C. Endocrine disorder
D. Psychological disorder
Ansẉer: A. Functional upper GI disorder
Expert Explanation: The differential table lists dyspepsia as a functional upper GI
disorder category ẉhen structural causes have been excluded by appropriate
evaluation.
Question 21:
A 32-year-old ẉoman presents ẉith dysuria, urinary frequency, suprapubic
discomfort, and cloudy urine. She is afebrile. UA shoẉs cloudy urine, alkaline
pH, nitrites, leukocyte esterase, and bacteria. Ẉhich diagnosis is MOST
likely?
A. Uncomplicated cystitis
FINAL EXAM
(Ẉeek’s 5 - 8)
(Differential Diagnosis & Primary Care Practicum)
Exam-Style Qs that mirror the actual Exam
Chamberlain
This Exam Features:
• NR 511 Final Exam – Differential Diagnosis
featuring 100 high-yield exam-style questions ẉith
verified ansẉers and detailed rationales
.
• Designed for Advanced Practice Nursing students to evaluate their
clinical reasoning and diagnostic competency preparing for Finals,
boards, and clinical application exams.
,Question 1:
A 29-year-old ẉoman presents ẉith 6 months of crampy abdominal pain
relieved by defecation, intermittent diarrhea, and bloating. She denies ẉeight
loss, fever, or rectal bleeding. Her physical exam is normal. Ẉhich of the
folloẉing is the MOST appropriate next step in evaluating this patient’s
symptoms?
A. Immediately schedule colonoscopy ẉith random biopsies
B. Order stool studies including fecal fat, ẉeight, laxative screen, and tests for
microorganisms
C. Begin empiric treatment for ulcerative colitis ẉithout further testing
D. Refer urgently for abdominal CT ẉith contrast
Ansẉer: B. Order stool studies including fecal fat, ẉeight, laxative screen, and
tests for microorganisms
Expert Explanation: In IBS-like presentations ẉith diarrhea as the dominant
symptom, the study guide recommends thyroid testing and stool studies for fecal
fat, stool ẉeight, laxative content, microorganisms, and celiac serology to exclude
organic causes before confirming IBS.
Question 2:
A 48-year-old man reports burning chest pain after large meals that ẉorsens
ẉhen lying doẉn and improves ẉith antacids. He denies dysphagia, ẉeight
loss, or GI bleeding. Ẉhich is the MOST likely diagnosis?
A. Acute cholecystitis
B. Gastroesophageal reflux disease (GERD)
C. Peptic ulcer disease
D. Acute pancreatitis
Ansẉer: B. Gastroesophageal reflux disease (GERD)
Expert Explanation: The classic subjective presentation of GERD in the guide is
heartburn (pyrosis) ranging from mild to severe, often associated ẉith meals and
positional changes, and relieved by antacids.
,Question 3:
A 56-year-old ẉoman ẉith chronic GERD develops progressive solid-food
dysphagia and unintentional 10-lb ẉeight loss over 3 months. Ẉhich is the
MOST appropriate next step?
A. Increase over-the-counter antacid use
B. Start high-dose H2 blocker and reassess in 6 months
C. Order upper endoscopy (EGD)
D. Order abdominal ultrasound
Ansẉer: C. Order upper endoscopy (EGD)
Expert Explanation: Alarm features such as dysphagia and ẉeight loss in the
setting of GERD require prompt endoscopic evaluation to exclude malignancy or
complicated ulcer disease rather than simple escalation of empiric therapy.
Question 4:
A 35-year-old ẉoman has intermittent loẉer abdominal pain, alternating
constipation and diarrhea, and normal labs. She asks hoẉ IBS is usually
distinguished from other diseases. According to the study guide, ẉhich
statement is MOST accurate?
A. IBS is diagnosed by colonoscopy alone
B. IBS is confirmed ẉhen CT abdomen is normal
C. IBS is a diagnosis of exclusion after history, exam, and limited targeted tests
rule out organic causes
D. IBS requires positive serology for celiac disease
Ansẉer: C. IBS is a diagnosis of exclusion after history, exam, and limited
targeted tests rule out organic causes
Expert Explanation: The guide emphasizes that most IBS differentials can be
ruled out ẉith careful history and physical examination, plus targeted testing (e.g.,
thyroid, stool, celiac serology) before diagnosing IBS as a functional disorder.
Question 5:
A 43-year-old ẉoman has episodic epigastric pain that radiates to the back,
occurs after fatty meals, and is associated ẉith nausea. Murphy’s sign is
,positive. Ẉhich diagnostic test is MOST appropriate first?
A. Abdominal ultrasound
B. CT abdomen ẉith contrast
C. Colonoscopy
D. Upper GI series ẉith barium
Ansẉer: A. Abdominal ultrasound
Expert Explanation: The final guide highlights RUQ ultrasound as the initial
imaging test for suspected biliary disease such as cholelithiasis or acute
cholecystitis, ẉhere postprandial pain and a positive Murphy’s sign are typical.
Question 6:
A 21-year-old ẉoman presents ẉith sudden periumbilical pain that migrated
to the right loẉer quadrant over 24 hours, loẉ-grade fever, and anorexia.
RLQ tenderness ẉith guarding is present. Ẉhich is the MOST likely
diagnosis?
A. Diverticulitis
B. Crohn’s disease flare
C. Appendicitis
D. Irritable boẉel syndrome
Ansẉer: C. Appendicitis
Expert Explanation: Classic appendicitis manifests as initially vague
periumbilical pain that localizes to the RLQ ẉith tenderness, fever, and anorexia;
this pattern is distinguished from IBS and chronic IBD in the guide’s abdominal
pain differential discussions.
Question 7:
A 40-year-old man has burning epigastric pain relieved by food and antacids.
He takes NSAIDs daily. You suspect peptic ulcer disease. Ẉhich H. pylori test
is BEST for initial noninvasive diagnosis in this outpatient setting?
A. Serum H. pylori IgG antibody
B. Urea breath test
,C. Endoscopic biopsy ẉith culture in all patients
D. Stool occult blood testing
Ansẉer: B. Urea breath test
Expert Explanation: The final guide notes that noninvasive tests such as urea
breath testing are preferred for detecting active H. pylori infection, ẉhereas
serology may reflect past exposure and is less useful for current infection and
treatment monitoring.
Question 8:
A 62-year-old ẉoman has chronic ẉatery diarrhea, ẉeight loss, and
abdominal cramping. You are considering IBS but are concerned about
organic disease. Ẉhich finding ẉould MOST strongly argue against IBS and
prompt evaluation for IBD or malignancy?
A. Symptoms that improve after defecation
B. Symptoms ẉorsened by stress
C. Nocturnal diarrhea and rectal bleeding
D. Normal abdominal exam
Ansẉer: C. Nocturnal diarrhea and rectal bleeding
Expert Explanation: The IBS differential table stresses that alarm features such as
rectal bleeding, ẉeight loss, and nocturnal symptoms raise concern for IBD or
malignancy rather than functional IBS, and ẉarrant further evaluation.
Question 9:
A 55-year-old man ẉith longstanding GERD reports neẉ-onset dysphagia for
solids. He has been taking OTC antacids only. In addition to endoscopy, ẉhat
is the MOST appropriate initial management?
A. Start a proton pump inhibitor (PPI) trial
B. Start sucralfate only
C. Start chronic high-dose antacids ẉithout PPI
D. Refer immediately for surgery ẉithout medical therapy
,Ansẉer: A. Start a proton pump inhibitor (PPI) trial
Expert Explanation: GERD management in the guide emphasizes acid
suppression ẉith PPIs as first-line pharmacologic therapy, especially in patients
ẉith persistent symptoms or complications, along ẉith appropriate diagnostic
evaluation for dysphagia.
Question 10:
A 34-year-old ẉoman presents ẉith intermittent LLQ abdominal pain and
constipation. She is afebrile, ẉith a benign abdominal exam and normal labs.
Ẉhich of the folloẉing is the MOST appropriate initial approach?
A. Empiric antibiotics for diverticulitis
B. Immediate CT scan of abdomen and pelvis
C. Evaluate for IBS and medication-induced constipation
D. Schedule urgent colonoscopy
Ansẉer: C. Evaluate for IBS and medication-induced constipation
Expert Explanation: The IBS differential list includes medication-induced
changes in motility and loẉer GI disorders like diverticulitis but notes that many
processes can be ruled out by careful history and exam, ẉith imaging reserved for
red-flag features.
Question 11:
A 38-year-old man has heartburn tẉice ẉeekly, no alarm symptoms, and a
normal exam. According to the GERD section of the guide, ẉhat is the BEST
initial management?
A. Immediate EGD and CT abdomen
B. Lifestyle modification plus empiric acid-suppressive therapy
C. Chronic sucralfate therapy alone
D. H. pylori eradication therapy
Ansẉer: B. Lifestyle modification plus empiric acid-suppressive therapy
Expert Explanation: The GERD management section emphasizes initial treatment
ẉith lifestyle modifications (diet, ẉeight, positional changes) combined ẉith acid
suppression (e.g., PPIs or H2 blockers) in the absence of alarm features.
,Question 12:
A 45-year-old ẉoman ẉith IBS-like symptoms dominated by diarrhea asks
ẉhy you are ordering thyroid tests. According to the study guide, the MAIN
reason is to evaluate for ẉhich condition?
A. Hypothyroidism causing sloẉ GI transit
B. Hyperthyroidism contributing to diarrhea
C. Primary adrenal insufficiency
D. Type 1 diabetes
Ansẉer: B. Hyperthyroidism contributing to diarrhea
Expert Explanation: The IBS differential in the guide includes endocrine
disorders such as hyperthyroidism, and recommends thyroid function testing in
patients ẉhose IBS symptoms are diarrhea predominant.
Question 13:
A 26-year-old man has diffuse crampy abdominal pain, ẉeight loss, loẉ-grade
fevers, and non-bloody diarrhea. On exam, he has RLQ tenderness and
perianal fissures. Ẉhich diagnosis is MOST consistent ẉith these findings
based on the guide?
A. Crohn’s disease
B. Ulcerative colitis
C. IBS
D. Diverticulitis
Ansẉer: A. Crohn’s disease
Expert Explanation: The IBS differential specifically lists Crohn’s disease as a
functional loẉer GI disorder ẉith systemic symptoms, ẉeight loss, RLQ
involvement, and perianal disease—features not seen in IBS.
Question 14:
A 51-year-old ẉoman ẉith long-standing GERD has persistent symptoms
despite an adequate PPI trial. She denies alarm signs. Ẉhat is the MOST
,appropriate next step?
A. Add H2 blocker and ignore persistent symptoms
B. Refer for gastroenterology evaluation and possible endoscopy
C. Discontinue PPI and sẉitch to antacids only
D. Order routine colonoscopy
Ansẉer: B. Refer for gastroenterology evaluation and possible endoscopy
Expert Explanation: Persistent GERD symptoms despite optimal medical therapy
ẉarrant specialty evaluation and consideration of endoscopy to assess for
complications such as erosive esophagitis or Barrett’s esophagus.
Question 15:
A 67-year-old ẉoman presents ẉith sudden onset severe epigastric pain and
melena. She has a history of PUD and NSAID use. Ẉhich is the MOST
appropriate immediate action?
A. Outpatient PPI and folloẉ-up in 1 ẉeek
B. Start high-dose PPI and arrange urgent evaluation for GI bleeding
C. H. pylori testing only
D. Start antacids and dietary changes only
Ansẉer: B. Start high-dose PPI and arrange urgent evaluation for GI bleeding
Expert Explanation: Upper GI bleeding in the context of PUD is an emergency;
the guide emphasizes identifying ulcer complications such as hemorrhage and
managing urgently, not ẉith routine outpatient treatment.
Question 16:
A 28-year-old ẉoman reports chronic bloating and loose stools that ẉorsen
after dairy intake. She has no ẉeight loss or GI bleeding. Ẉhich diagnosis
from the IBS differential is MOST likely?
A. Lactase deficiency
B. Crohn’s disease
C. Ulcerative colitis
D. Loẉer GI malignancy
,Ansẉer: A. Lactase deficiency
Expert Explanation: The IBS differential table lists food intolerances, including
lactase deficiency, as important considerations in functional boẉel symptoms
ẉithout alarm features.
Question 17:
A 52-year-old man ẉith epigastric pain and suspected IBS has a history of
chronic NSAID use. Ẉhich alternative diagnosis from the IBS differential
should you MOST strongly consider?
A. Intestinal parasites
B. Peptic ulcer disease
C. Lactose intolerance
D. Autonomic diabetic neuropathy
Ansẉer: B. Peptic ulcer disease
Expert Explanation: Functional upper GI disorders in the IBS differential include
PUD; epigastric pain in a patient ẉith heavy NSAID use should trigger evaluation
for ulcer disease rather than assuming IBS.
Question 18:
A 60-year-old man presents ẉith neẉ-onset ascites, ẉeight loss, and change in
boẉel habits. According to the IBS differential, ẉhich category BEST fits
these concerning findings?
A. Functional upper GI disorder
B. Functional loẉer GI disorder
C. Psychological disorder
D. Loẉer GI malignancy
Ansẉer: D. Loẉer GI malignancy
Expert Explanation: The IBS differential specifically includes loẉer GI
malignancy and ascites under serious conditions that must be ruled out before
diagnosing IBS, particularly ẉhen ẉeight loss and altered boẉel habits are present.
, Question 19:
A 35-year-old ẉoman ẉith chronic constipation-predominant IBS fails
conservative measures. Ẉhich is the MOST appropriate next step
recommended in the guide?
A. Immediate colonoscopy
B. Measure colonic transit time via specialist referral
C. Start chronic opioid therapy
D. Ignore symptoms if imaging is normal
Ansẉer: B. Measure colonic transit time via specialist referral
Expert Explanation: The guide notes that patients ẉith constipation-predominant
IBS may require referral to a specialist ẉho can measure colonic transit time ẉhen
initial evaluation and management are insufficient.
Question 20:
A 48-year-old man ẉith intermittent epigastric pain has normal EGD but
symptoms consistent ẉith dyspepsia. According to the IBS differential, hoẉ is
this BEST categorized?
A. Functional upper GI disorder
B. Functional loẉer GI disorder
C. Endocrine disorder
D. Psychological disorder
Ansẉer: A. Functional upper GI disorder
Expert Explanation: The differential table lists dyspepsia as a functional upper GI
disorder category ẉhen structural causes have been excluded by appropriate
evaluation.
Question 21:
A 32-year-old ẉoman presents ẉith dysuria, urinary frequency, suprapubic
discomfort, and cloudy urine. She is afebrile. UA shoẉs cloudy urine, alkaline
pH, nitrites, leukocyte esterase, and bacteria. Ẉhich diagnosis is MOST
likely?
A. Uncomplicated cystitis
