DIFFERENTIAL DIAGNOSIS AND PRIMARY CARE
PRACTICUM QUESTIONS AND CORRECT ANSWERS 2026
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1. A 58-year-old man presents with crushing substernal chest pain radiating to the left
arm and jaw for 30 minutes. Which diagnosis should be prioritized first?
A. Gastroesophageal reflux disease
B. Costochondritis
C. Acute myocardial infarction
D. Panic attack
Correct Answer: C
Explanation: Acute myocardial infarction is the priority diagnosis because the presentation
is classic for cardiac ischemia. GERD, costochondritis, and panic attacks may mimic chest
pain but are less immediately life-threatening.
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2. A patient presents with fever, productive cough, and localized crackles in the right
lower lobe. Which condition is most likely?
A. Asthma
B. Community-acquired pneumonia
C. Pulmonary embolism
D. Chronic bronchitis
Correct Answer: B
Explanation: Fever, productive cough, and localized crackles strongly suggest pneumonia.
Asthma usually presents with wheezing, pulmonary embolism often causes sudden dyspnea,
and chronic bronchitis is associated with chronic productive cough without focal findings.
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3. Which physical examination finding is most consistent with heart failure?
A. Hyperactive bowel sounds
B. Bilateral pitting edema
C. Enlarged tonsils
D. Rebound tenderness
Correct Answer: B
Explanation: Bilateral pitting edema commonly occurs in heart failure due to fluid retention.
The other findings are unrelated to cardiac dysfunction.
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4. A patient complains of polyuria, polydipsia, and unexplained weight loss. Which
diagnosis is most likely?
A. Hypothyroidism
B. Type 2 diabetes mellitus
C. Iron deficiency anemia
D. Peptic ulcer disease
Correct Answer: B
Explanation: Polyuria, polydipsia, and weight loss are classic symptoms of diabetes mellitus.
Hypothyroidism usually causes weight gain, while anemia and peptic ulcer disease do not
typically cause excessive urination or thirst.
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5. Which laboratory finding is most suggestive of bacterial infection?
A. Elevated eosinophils
B. Increased neutrophil count
C. Reduced platelet count
D. Elevated basophils
Correct Answer: B
Explanation: Neutrophilia is commonly associated with bacterial infections. Eosinophils are
elevated in allergies and parasitic infections, while basophils and platelets are less specific.
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6. A 23-year-old woman presents with lower abdominal pain, cervical motion
tenderness, and fever. Which diagnosis is most likely?
A. Appendicitis
B. Pelvic inflammatory disease
C. Ovarian cyst
D. Urinary tract infection
Correct Answer: B
Explanation: Cervical motion tenderness with lower abdominal pain and fever strongly
suggests pelvic inflammatory disease. Appendicitis and ovarian cysts may cause pain but not
cervical tenderness.
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7. Which symptom is considered a “red flag” for low back pain?
,A. Pain relieved by rest
B. Pain after exercise
C. Urinary incontinence
D. Mild muscle stiffness
Correct Answer: C
Explanation: Urinary incontinence may indicate cauda equina syndrome, a medical
emergency. The other symptoms are more commonly associated with benign musculoskeletal
causes.
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8. A patient with hyperthyroidism is most likely to present with which sign?
A. Bradycardia
B. Cold intolerance
C. Weight gain
D. Tachycardia
Correct Answer: D
Explanation: Hyperthyroidism increases metabolic activity, causing tachycardia, heat
intolerance, and weight loss. Bradycardia and cold intolerance are more common in
hypothyroidism.
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9. Which condition commonly presents with “coffee-ground” emesis?
A. Lower gastrointestinal bleeding
B. Gastritis with upper GI bleeding
C. Appendicitis
D. Hemorrhoids
Correct Answer: B
Explanation: Coffee-ground emesis indicates partially digested blood from upper GI
bleeding, commonly caused by gastritis or peptic ulcers.
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10. A patient with sudden unilateral weakness and slurred speech should first be
evaluated for:
A. Migraine headache
B. Hypoglycemia
C. Stroke
D. Bell’s palsy
, Correct Answer: C
Explanation: Sudden unilateral weakness and slurred speech are hallmark signs of stroke
and require urgent evaluation. Bell’s palsy affects facial muscles only.
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11. Which diagnostic test is most appropriate for confirming deep vein thrombosis?
A. Chest X-ray
B. Venous Doppler ultrasound
C. Echocardiogram
D. MRI of the brain
Correct Answer: B
Explanation: Venous Doppler ultrasound is the preferred noninvasive test for diagnosing
deep vein thrombosis.
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12. A patient presents with fatigue, pallor, and spoon-shaped nails. Which condition is
most likely?
A. Iron deficiency anemia
B. Hypercalcemia
C. Asthma
D. Hyperthyroidism
Correct Answer: A
Explanation: Pallor, fatigue, and koilonychia (spoon-shaped nails) are classic signs of iron
deficiency anemia.
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13. Which symptom is most characteristic of meningitis?
A. Flank pain
B. Neck stiffness
C. Polyphagia
D. Hematuria
Correct Answer: B
Explanation: Neck stiffness is a hallmark sign of meningeal irritation seen in meningitis.
Flank pain and hematuria suggest renal pathology.
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PRACTICUM QUESTIONS AND CORRECT ANSWERS 2026
━━━━━━━━━━━━━━━━━━
1. A 58-year-old man presents with crushing substernal chest pain radiating to the left
arm and jaw for 30 minutes. Which diagnosis should be prioritized first?
A. Gastroesophageal reflux disease
B. Costochondritis
C. Acute myocardial infarction
D. Panic attack
Correct Answer: C
Explanation: Acute myocardial infarction is the priority diagnosis because the presentation
is classic for cardiac ischemia. GERD, costochondritis, and panic attacks may mimic chest
pain but are less immediately life-threatening.
━━━━━━━━━━━━━━━━━━
2. A patient presents with fever, productive cough, and localized crackles in the right
lower lobe. Which condition is most likely?
A. Asthma
B. Community-acquired pneumonia
C. Pulmonary embolism
D. Chronic bronchitis
Correct Answer: B
Explanation: Fever, productive cough, and localized crackles strongly suggest pneumonia.
Asthma usually presents with wheezing, pulmonary embolism often causes sudden dyspnea,
and chronic bronchitis is associated with chronic productive cough without focal findings.
━━━━━━━━━━━━━━━━━━
3. Which physical examination finding is most consistent with heart failure?
A. Hyperactive bowel sounds
B. Bilateral pitting edema
C. Enlarged tonsils
D. Rebound tenderness
Correct Answer: B
Explanation: Bilateral pitting edema commonly occurs in heart failure due to fluid retention.
The other findings are unrelated to cardiac dysfunction.
,━━━━━━━━━━━━━━━━━━
4. A patient complains of polyuria, polydipsia, and unexplained weight loss. Which
diagnosis is most likely?
A. Hypothyroidism
B. Type 2 diabetes mellitus
C. Iron deficiency anemia
D. Peptic ulcer disease
Correct Answer: B
Explanation: Polyuria, polydipsia, and weight loss are classic symptoms of diabetes mellitus.
Hypothyroidism usually causes weight gain, while anemia and peptic ulcer disease do not
typically cause excessive urination or thirst.
━━━━━━━━━━━━━━━━━━
5. Which laboratory finding is most suggestive of bacterial infection?
A. Elevated eosinophils
B. Increased neutrophil count
C. Reduced platelet count
D. Elevated basophils
Correct Answer: B
Explanation: Neutrophilia is commonly associated with bacterial infections. Eosinophils are
elevated in allergies and parasitic infections, while basophils and platelets are less specific.
━━━━━━━━━━━━━━━━━━
6. A 23-year-old woman presents with lower abdominal pain, cervical motion
tenderness, and fever. Which diagnosis is most likely?
A. Appendicitis
B. Pelvic inflammatory disease
C. Ovarian cyst
D. Urinary tract infection
Correct Answer: B
Explanation: Cervical motion tenderness with lower abdominal pain and fever strongly
suggests pelvic inflammatory disease. Appendicitis and ovarian cysts may cause pain but not
cervical tenderness.
━━━━━━━━━━━━━━━━━━
7. Which symptom is considered a “red flag” for low back pain?
,A. Pain relieved by rest
B. Pain after exercise
C. Urinary incontinence
D. Mild muscle stiffness
Correct Answer: C
Explanation: Urinary incontinence may indicate cauda equina syndrome, a medical
emergency. The other symptoms are more commonly associated with benign musculoskeletal
causes.
━━━━━━━━━━━━━━━━━━
8. A patient with hyperthyroidism is most likely to present with which sign?
A. Bradycardia
B. Cold intolerance
C. Weight gain
D. Tachycardia
Correct Answer: D
Explanation: Hyperthyroidism increases metabolic activity, causing tachycardia, heat
intolerance, and weight loss. Bradycardia and cold intolerance are more common in
hypothyroidism.
━━━━━━━━━━━━━━━━━━
9. Which condition commonly presents with “coffee-ground” emesis?
A. Lower gastrointestinal bleeding
B. Gastritis with upper GI bleeding
C. Appendicitis
D. Hemorrhoids
Correct Answer: B
Explanation: Coffee-ground emesis indicates partially digested blood from upper GI
bleeding, commonly caused by gastritis or peptic ulcers.
━━━━━━━━━━━━━━━━━━
10. A patient with sudden unilateral weakness and slurred speech should first be
evaluated for:
A. Migraine headache
B. Hypoglycemia
C. Stroke
D. Bell’s palsy
, Correct Answer: C
Explanation: Sudden unilateral weakness and slurred speech are hallmark signs of stroke
and require urgent evaluation. Bell’s palsy affects facial muscles only.
━━━━━━━━━━━━━━━━━━
11. Which diagnostic test is most appropriate for confirming deep vein thrombosis?
A. Chest X-ray
B. Venous Doppler ultrasound
C. Echocardiogram
D. MRI of the brain
Correct Answer: B
Explanation: Venous Doppler ultrasound is the preferred noninvasive test for diagnosing
deep vein thrombosis.
━━━━━━━━━━━━━━━━━━
12. A patient presents with fatigue, pallor, and spoon-shaped nails. Which condition is
most likely?
A. Iron deficiency anemia
B. Hypercalcemia
C. Asthma
D. Hyperthyroidism
Correct Answer: A
Explanation: Pallor, fatigue, and koilonychia (spoon-shaped nails) are classic signs of iron
deficiency anemia.
━━━━━━━━━━━━━━━━━━
13. Which symptom is most characteristic of meningitis?
A. Flank pain
B. Neck stiffness
C. Polyphagia
D. Hematuria
Correct Answer: B
Explanation: Neck stiffness is a hallmark sign of meningeal irritation seen in meningitis.
Flank pain and hematuria suggest renal pathology.
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