NR511 Differential Diagnosis Primary Care
Practicum Final Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
SECTION 1: Clinical Reasoning & Differential Diagnosis Process
(Questions 1–15)
Q1: A 34-year-old male presents with acute chest pain. You are generating your differential diagnosis.
Which approach best describes how to prioritize your differential list in primary care?
A. List all possible diagnoses alphabetically and work through them systematically
B. Begin with the most common diagnosis and only consider rare conditions if treatment fails
C. Identify "must-not-miss" life-threatening conditions first, then rank by likelihood [CORRECT]
D. Focus solely on the patient's age and gender to narrow the differential immediately
,Correct Answer: C
Rationale: The best answer is to always start with "must-not-miss" diagnoses like MI, PE, or aortic
dissection before considering more common benign causes. In primary care, we use this safety-first
approach because missing a life-threatening condition has far worse consequences than over-testing
for one. Once you've ruled out the dangerous stuff, you can focus on what's most likely based on
prevalence and presentation.
Q2: You are using the Centor criteria to evaluate a 22-year-old college student with sore throat. Which
combination of findings would give the highest probability of group A streptococcal pharyngitis?
A. Fever, absence of cough, and tender anterior cervical nodes only
B. Fever, tonsillar exudates, tender anterior cervical nodes, and absence of cough [CORRECT]
C. Cough, rhinorrhea, and tender posterior cervical nodes
D. Fever alone with hoarseness and conjunctivitis
Correct Answer: B
Rationale: The best answer includes four Centor criteria: fever, tonsillar exudates, tender anterior
cervical adenopathy, and absence of cough. This gives a score of 4, indicating roughly a 40-50%
probability of strep throat. Remember that the absence of cough is one of the most important
discriminators between viral and bacterial pharyngitis.
,Q3: A 45-year-old woman presents with low back pain after lifting boxes at work. She has no red flag
symptoms. What is the most appropriate initial diagnostic approach?
A. Immediate lumbar MRI to evaluate for herniated disc
B. Plain film X-rays of the lumbosacral spine
C. Physical examination with focused neurologic assessment and no immediate imaging [CORRECT]
D. CT scan to rule out occult fracture
Correct Answer: C
Rationale: The best answer is careful physical exam without immediate imaging. In primary care, we
follow the Choosing Wisely guidelines here—most acute low back pain resolves within 4-6 weeks
without any imaging. Since she has no red flags like bowel/bladder dysfunction, saddle anesthesia, or
progressive neurologic deficits, imaging would be inappropriate and potentially harmful by leading to
unnecessary procedures.
Q4: A 28-year-old female presents with acute-onset unilateral headache, severe eye pain, nausea, and
reports seeing halos around lights. Her vision is slightly blurred, and the eye appears injected. What is
your immediate priority?
A. Prescribe sumatriptan for probable migraine and schedule follow-up in 48 hours
B. Perform a thorough fundoscopic exam and check intraocular pressure immediately [CORRECT]
C. Order a CT head to rule out subarachnoid hemorrhage
, D. Start oral antibiotics for suspected orbital cellulitis
Correct Answer: B
Rationale: The best answer is immediate evaluation for acute angle-closure glaucoma. This
presentation—unilateral headache with eye pain, halos around lights, nausea, and injected
conjunctiva—is the classic triad we can't miss. In practice, you'd want to get an IOP reading right
away because this is an ophthalmologic emergency that can cause permanent vision loss within
hours if not treated.
Q5: You are evaluating a 52-year-old man with epigastric pain. Which symptom cluster most strongly
suggests peptic ulcer disease rather than GERD?
A. Burning retrosternal pain worse after meals and when lying flat
B. Epigastric pain that improves with eating and returns 2-3 hours post-meal, with nocturnal pain
[CORRECT]
C. Sharp right upper quadrant pain after fatty meals with radiation to the right scapula
D. Diffuse abdominal cramping with alternating constipation and diarrhea
Correct Answer: B
Rationale: The best answer is pain that improves with eating then recurs—this is the classic "hunger
pain" pattern of duodenal ulcers. In primary care, we remember that GERD typically worsens with
meals and lying down, while PUD (especially duodenal) often feels better with food buffering the acid,
then hurts again when the stomach empties. Nocturnal pain that wakes patients is another red flag
for ulcer disease.
Practicum Final Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
SECTION 1: Clinical Reasoning & Differential Diagnosis Process
(Questions 1–15)
Q1: A 34-year-old male presents with acute chest pain. You are generating your differential diagnosis.
Which approach best describes how to prioritize your differential list in primary care?
A. List all possible diagnoses alphabetically and work through them systematically
B. Begin with the most common diagnosis and only consider rare conditions if treatment fails
C. Identify "must-not-miss" life-threatening conditions first, then rank by likelihood [CORRECT]
D. Focus solely on the patient's age and gender to narrow the differential immediately
,Correct Answer: C
Rationale: The best answer is to always start with "must-not-miss" diagnoses like MI, PE, or aortic
dissection before considering more common benign causes. In primary care, we use this safety-first
approach because missing a life-threatening condition has far worse consequences than over-testing
for one. Once you've ruled out the dangerous stuff, you can focus on what's most likely based on
prevalence and presentation.
Q2: You are using the Centor criteria to evaluate a 22-year-old college student with sore throat. Which
combination of findings would give the highest probability of group A streptococcal pharyngitis?
A. Fever, absence of cough, and tender anterior cervical nodes only
B. Fever, tonsillar exudates, tender anterior cervical nodes, and absence of cough [CORRECT]
C. Cough, rhinorrhea, and tender posterior cervical nodes
D. Fever alone with hoarseness and conjunctivitis
Correct Answer: B
Rationale: The best answer includes four Centor criteria: fever, tonsillar exudates, tender anterior
cervical adenopathy, and absence of cough. This gives a score of 4, indicating roughly a 40-50%
probability of strep throat. Remember that the absence of cough is one of the most important
discriminators between viral and bacterial pharyngitis.
,Q3: A 45-year-old woman presents with low back pain after lifting boxes at work. She has no red flag
symptoms. What is the most appropriate initial diagnostic approach?
A. Immediate lumbar MRI to evaluate for herniated disc
B. Plain film X-rays of the lumbosacral spine
C. Physical examination with focused neurologic assessment and no immediate imaging [CORRECT]
D. CT scan to rule out occult fracture
Correct Answer: C
Rationale: The best answer is careful physical exam without immediate imaging. In primary care, we
follow the Choosing Wisely guidelines here—most acute low back pain resolves within 4-6 weeks
without any imaging. Since she has no red flags like bowel/bladder dysfunction, saddle anesthesia, or
progressive neurologic deficits, imaging would be inappropriate and potentially harmful by leading to
unnecessary procedures.
Q4: A 28-year-old female presents with acute-onset unilateral headache, severe eye pain, nausea, and
reports seeing halos around lights. Her vision is slightly blurred, and the eye appears injected. What is
your immediate priority?
A. Prescribe sumatriptan for probable migraine and schedule follow-up in 48 hours
B. Perform a thorough fundoscopic exam and check intraocular pressure immediately [CORRECT]
C. Order a CT head to rule out subarachnoid hemorrhage
, D. Start oral antibiotics for suspected orbital cellulitis
Correct Answer: B
Rationale: The best answer is immediate evaluation for acute angle-closure glaucoma. This
presentation—unilateral headache with eye pain, halos around lights, nausea, and injected
conjunctiva—is the classic triad we can't miss. In practice, you'd want to get an IOP reading right
away because this is an ophthalmologic emergency that can cause permanent vision loss within
hours if not treated.
Q5: You are evaluating a 52-year-old man with epigastric pain. Which symptom cluster most strongly
suggests peptic ulcer disease rather than GERD?
A. Burning retrosternal pain worse after meals and when lying flat
B. Epigastric pain that improves with eating and returns 2-3 hours post-meal, with nocturnal pain
[CORRECT]
C. Sharp right upper quadrant pain after fatty meals with radiation to the right scapula
D. Diffuse abdominal cramping with alternating constipation and diarrhea
Correct Answer: B
Rationale: The best answer is pain that improves with eating then recurs—this is the classic "hunger
pain" pattern of duodenal ulcers. In primary care, we remember that GERD typically worsens with
meals and lying down, while PUD (especially duodenal) often feels better with food buffering the acid,
then hurts again when the stomach empties. Nocturnal pain that wakes patients is another red flag
for ulcer disease.
