NR569 DIFFERENTIAL DIAGNOSIS IN
ACUTE CARE MIDTERM QUESTIONS
WITH VERIFIED ANSEWERSLATEST
2025/2026
EXAM
1. A 58-year-old male with a history of hypertension presents
with sudden onset of tearing chest pain radiating to the back.
Blood pressure is 160/90 in the right arm and 100/60 in the
left arm. What is the most likely diagnosis?
Answer: Aortic dissection
Rationale: Tearing chest pain radiating to the back with unequal
blood pressures between arms is classic for aortic dissection.
Immediate imaging (CT angiogram) is needed.
2. A 34-year-old female presents with episodic wheezing,
chest tightness, and cough that worsens at night and with
exercise. Spirometry shows reversible obstruction. What is the
most likely diagnosis?
Answer: Asthma
Rationale: Asthma is characterized by episodic airway obstruction
that is reversible with bronchodilators. Nocturnal and
exercise-induced symptoms are typical.
,3. In a patient with suspected pulmonary embolism, which
finding on a d-dimer test would help rule out PE?
Answer: Negative d-dimer in a low-pretest probability patient
Rationale: d-Dimer has high sensitivity but low specificity. A
negative d-dimer effectively rules out PE only when the pretest
probability is low (SNOUT principle).
4. A 45-year-old homeless male presents with fever, cough
with rust-colored sputum, and chest pain. Chest x-ray shows
right lower lobe consolidation. What is the most likely
pathogen?
Answer: Streptococcus pneumoniae
Rationale: Rust-colored sputum and lobar consolidation are
classic for pneumococcal pneumonia. S. pneumoniae is the most
common cause of community-acquired pneumonia.
5. Which of the following is a pertinent negative in a patient
with suspected acute appendicitis?
Answer: Absence of Rovsing sign
Rationale: Rovsing sign (pain in right lower quadrant with
,palpation of left lower quadrant) is often present in appendicitis.
Its absence is a pertinent negative that slightly lowers suspicion.
6. A 72-year-old female with atrial fibrillation presents with
sudden left arm weakness and facial droop. What is the most
likely etiology?
Answer: Cardiogenic embolism (stroke)
Rationale: Atrial fibrillation is a major risk factor for cardioembolic
stroke due to thrombus formation in the left atrium. Sudden onset
of focal deficits is characteristic.
7. What does the mnemonic “SNOUT” stand for?
Answer: SeNsitive test – rules OUT disease
Rationale: A highly sensitive test, when negative, effectively
excludes a disease, because false negatives are rare.
8. A 28-year-old female presents with intermittent diarrhea,
abdominal pain, and blood in stool. Colonoscopy shows skip
lesions and cobblestone mucosa. What is the diagnosis?
Answer: Crohn’s disease
Rationale: Crohn’s disease is characterized by transmural
, inflammation with skip lesions, cobblestoning, and often
granulomas. Ulcerative colitis is continuous and limited to the
mucosa.
9. In a patient with suspected meningitis, which finding on
physical exam is most suggestive of meningeal irritation?
Answer: Nuchal rigidity
Rationale: Nuchal rigidity (resistance to passive neck flexion) is a
key sign of meningeal inflammation. Kernig and Brudzinski signs
are less sensitive.
10. Which laboratory finding is most suggestive of acute
pancreatitis?
Answer: Lipase >3 times the upper limit of normal
Rationale: Lipase is more sensitive and specific for acute
pancreatitis than amylase. Elevation >3× ULN is diagnostic.
11. A 60-year-old smoker presents with hemoptysis, weight
loss, and a persistent cough. Chest CT shows a cavitary lesion
in the right upper lobe. What is the most likely diagnosis?
ACUTE CARE MIDTERM QUESTIONS
WITH VERIFIED ANSEWERSLATEST
2025/2026
EXAM
1. A 58-year-old male with a history of hypertension presents
with sudden onset of tearing chest pain radiating to the back.
Blood pressure is 160/90 in the right arm and 100/60 in the
left arm. What is the most likely diagnosis?
Answer: Aortic dissection
Rationale: Tearing chest pain radiating to the back with unequal
blood pressures between arms is classic for aortic dissection.
Immediate imaging (CT angiogram) is needed.
2. A 34-year-old female presents with episodic wheezing,
chest tightness, and cough that worsens at night and with
exercise. Spirometry shows reversible obstruction. What is the
most likely diagnosis?
Answer: Asthma
Rationale: Asthma is characterized by episodic airway obstruction
that is reversible with bronchodilators. Nocturnal and
exercise-induced symptoms are typical.
,3. In a patient with suspected pulmonary embolism, which
finding on a d-dimer test would help rule out PE?
Answer: Negative d-dimer in a low-pretest probability patient
Rationale: d-Dimer has high sensitivity but low specificity. A
negative d-dimer effectively rules out PE only when the pretest
probability is low (SNOUT principle).
4. A 45-year-old homeless male presents with fever, cough
with rust-colored sputum, and chest pain. Chest x-ray shows
right lower lobe consolidation. What is the most likely
pathogen?
Answer: Streptococcus pneumoniae
Rationale: Rust-colored sputum and lobar consolidation are
classic for pneumococcal pneumonia. S. pneumoniae is the most
common cause of community-acquired pneumonia.
5. Which of the following is a pertinent negative in a patient
with suspected acute appendicitis?
Answer: Absence of Rovsing sign
Rationale: Rovsing sign (pain in right lower quadrant with
,palpation of left lower quadrant) is often present in appendicitis.
Its absence is a pertinent negative that slightly lowers suspicion.
6. A 72-year-old female with atrial fibrillation presents with
sudden left arm weakness and facial droop. What is the most
likely etiology?
Answer: Cardiogenic embolism (stroke)
Rationale: Atrial fibrillation is a major risk factor for cardioembolic
stroke due to thrombus formation in the left atrium. Sudden onset
of focal deficits is characteristic.
7. What does the mnemonic “SNOUT” stand for?
Answer: SeNsitive test – rules OUT disease
Rationale: A highly sensitive test, when negative, effectively
excludes a disease, because false negatives are rare.
8. A 28-year-old female presents with intermittent diarrhea,
abdominal pain, and blood in stool. Colonoscopy shows skip
lesions and cobblestone mucosa. What is the diagnosis?
Answer: Crohn’s disease
Rationale: Crohn’s disease is characterized by transmural
, inflammation with skip lesions, cobblestoning, and often
granulomas. Ulcerative colitis is continuous and limited to the
mucosa.
9. In a patient with suspected meningitis, which finding on
physical exam is most suggestive of meningeal irritation?
Answer: Nuchal rigidity
Rationale: Nuchal rigidity (resistance to passive neck flexion) is a
key sign of meningeal inflammation. Kernig and Brudzinski signs
are less sensitive.
10. Which laboratory finding is most suggestive of acute
pancreatitis?
Answer: Lipase >3 times the upper limit of normal
Rationale: Lipase is more sensitive and specific for acute
pancreatitis than amylase. Elevation >3× ULN is diagnostic.
11. A 60-year-old smoker presents with hemoptysis, weight
loss, and a persistent cough. Chest CT shows a cavitary lesion
in the right upper lobe. What is the most likely diagnosis?
