LATEST UPDATED NR 569 FINAL EXAM V2 -
DIFFERENTIAL DIAGNOSIS | COMPLETE EXAM
WITH CORRECT ANSWERS AND RATIONALES.
A+ GUARANTEED SUCCESS
1. A 35-year-old female presents with acute
onset of severe, throbbing right-sided
headache. She reports nausea, photophobia,
and phonophobia. The headache lasts 8 hours
and is preceded by a visual aura of flashing
lights. Which diagnosis is most likely?
A) Cluster headache
B) Migraine with aura
C) Tension-type headache
D) Subarachnoid hemorrhage
Correct answer: B
Rationale: Unilateral throbbing headache with
aura (visual), nausea, photophobia, and
phonophobia lasting 4-72 hours is classic for
migraine with aura. Cluster headaches are
shorter (15-180 minutes) with autonomic
symptoms. Tension headaches are bilateral
and non-throbbing. Subarachnoid hemorrhage
causes thunderclap headache.
,2. A 28-year-old male presents with acute
onset of shortness of breath and sharp chest
pain after a long flight. He has no prior medical
history. Oxygen saturation is 89% on room air.
Which diagnosis is most likely?
A) Spontaneous pneumothorax
B) Pulmonary embolism
C) Pneumonia
D) Pericarditis
Correct answer: B
Rationale: Acute dyspnea and hypoxemia after
prolonged immobilization (flight) suggest
pulmonary embolism (venous
thromboembolism). Spontaneous
pneumothorax occurs in tall thin males but
oxygen saturation is usually normal initially.
Pneumonia would have fever. Pericarditis has
positional chest pain.
3. A 45-year-old female presents with
progressive shortness of breath on exertion
over 6 months. She has a non-productive
cough and crackles on auscultation. Chest x-
,ray shows bilateral reticular opacities. Which
diagnosis is most likely?
A) Idiopathic pulmonary fibrosis
B) Chronic obstructive pulmonary disease
C) Asthma
D) Heart failure
Correct answer: A
Rationale: Progressive dyspnea, dry cough,
Velcro crackles, and reticular opacities on
chest x-ray suggest idiopathic pulmonary
fibrosis (interstitial lung disease). COPD
causes wheezing, hyperinflation. Asthma is
episodic. Heart failure has cardiomegaly and
effusions.
4. A 62-year-old male with a history of
hypertension and diabetes presents with
sudden onset of right-sided weakness and
difficulty speaking. Symptoms began 30
minutes ago. Which imaging study should be
performed first?
A) CT angiography of head and neck
B) Non-contrast head CT
C) Magnetic resonance imaging (MRI) of brain
, D) Carotid ultrasound
Correct answer: B
Rationale: Acute stroke symptoms require
emergent non-contrast head CT to rule out
hemorrhagic stroke before administering
thrombolytics. CT angiography and MRI are
subsequent studies. Carotid ultrasound is not
emergent.
5. A 55-year-old male presents with acute
onset of severe epigastric pain that radiates to
the back. He reports that the pain is relieved by
leaning forward. He has a history of heavy
alcohol use. Which diagnosis is most likely?
A) Acute pancreatitis
B) Peptic ulcer disease
C) Cholecystitis
D) Myocardial infarction
Correct answer: A
Rationale: Severe epigastric pain radiating to
the back, relieved by leaning forward, with
history of alcohol use suggests acute
pancreatitis. Peptic ulcer pain is relieved by
food or antacids. Cholecystitis pain is right
DIFFERENTIAL DIAGNOSIS | COMPLETE EXAM
WITH CORRECT ANSWERS AND RATIONALES.
A+ GUARANTEED SUCCESS
1. A 35-year-old female presents with acute
onset of severe, throbbing right-sided
headache. She reports nausea, photophobia,
and phonophobia. The headache lasts 8 hours
and is preceded by a visual aura of flashing
lights. Which diagnosis is most likely?
A) Cluster headache
B) Migraine with aura
C) Tension-type headache
D) Subarachnoid hemorrhage
Correct answer: B
Rationale: Unilateral throbbing headache with
aura (visual), nausea, photophobia, and
phonophobia lasting 4-72 hours is classic for
migraine with aura. Cluster headaches are
shorter (15-180 minutes) with autonomic
symptoms. Tension headaches are bilateral
and non-throbbing. Subarachnoid hemorrhage
causes thunderclap headache.
,2. A 28-year-old male presents with acute
onset of shortness of breath and sharp chest
pain after a long flight. He has no prior medical
history. Oxygen saturation is 89% on room air.
Which diagnosis is most likely?
A) Spontaneous pneumothorax
B) Pulmonary embolism
C) Pneumonia
D) Pericarditis
Correct answer: B
Rationale: Acute dyspnea and hypoxemia after
prolonged immobilization (flight) suggest
pulmonary embolism (venous
thromboembolism). Spontaneous
pneumothorax occurs in tall thin males but
oxygen saturation is usually normal initially.
Pneumonia would have fever. Pericarditis has
positional chest pain.
3. A 45-year-old female presents with
progressive shortness of breath on exertion
over 6 months. She has a non-productive
cough and crackles on auscultation. Chest x-
,ray shows bilateral reticular opacities. Which
diagnosis is most likely?
A) Idiopathic pulmonary fibrosis
B) Chronic obstructive pulmonary disease
C) Asthma
D) Heart failure
Correct answer: A
Rationale: Progressive dyspnea, dry cough,
Velcro crackles, and reticular opacities on
chest x-ray suggest idiopathic pulmonary
fibrosis (interstitial lung disease). COPD
causes wheezing, hyperinflation. Asthma is
episodic. Heart failure has cardiomegaly and
effusions.
4. A 62-year-old male with a history of
hypertension and diabetes presents with
sudden onset of right-sided weakness and
difficulty speaking. Symptoms began 30
minutes ago. Which imaging study should be
performed first?
A) CT angiography of head and neck
B) Non-contrast head CT
C) Magnetic resonance imaging (MRI) of brain
, D) Carotid ultrasound
Correct answer: B
Rationale: Acute stroke symptoms require
emergent non-contrast head CT to rule out
hemorrhagic stroke before administering
thrombolytics. CT angiography and MRI are
subsequent studies. Carotid ultrasound is not
emergent.
5. A 55-year-old male presents with acute
onset of severe epigastric pain that radiates to
the back. He reports that the pain is relieved by
leaning forward. He has a history of heavy
alcohol use. Which diagnosis is most likely?
A) Acute pancreatitis
B) Peptic ulcer disease
C) Cholecystitis
D) Myocardial infarction
Correct answer: A
Rationale: Severe epigastric pain radiating to
the back, relieved by leaning forward, with
history of alcohol use suggests acute
pancreatitis. Peptic ulcer pain is relieved by
food or antacids. Cholecystitis pain is right
