NR511 Final exam with questions and well
verified answers actual exam!!! 2026
SECTION 1: GASTROINTESTINAL DISORDERS
Question 1: A 72-year-old patient presents with a 2-week history of dysphagia to
solids and liquids, with associated weight loss. He reports a history of long-
standing GERD. The most appropriate initial diagnostic test is:
A) Esophageal manometry
B) Esophagogastroduodenoscopy (EGD) with biopsy
C) Upper GI barium swallow
D) pH monitoring
Correct Answer: B
Rationale: This presentation is concerning for esophageal stricture or malignancy,
especially with weight loss and a history of GERD. EGD with biopsy is the gold
standard for direct visualization and tissue sampling. This allows for diagnosing
Barrett's esophagus, a premalignant condition, and ruling out esophageal cancer .
Question 2: A 45-year-old patient presents with acute onset of right lower
quadrant abdominal pain that began as periumbilical pain, followed by nausea
and vomiting. The pain is worse with walking and movement. Which physical
exam finding is most likely to be positive?
A) Murphy's sign
B) Psoas sign
C) McBurney's point tenderness
D) Rovsing's sign
Correct Answer: C
Rationale: Classic appendicitis presents with pain migration from the periumbilical
,area to the right lower quadrant (McBurney's point). This is the most common and
reliable physical exam finding for acute appendicitis .
Question 3: A 78-year-old man presents with dysuria, urinary frequency, and
dribbling. The patient is also experiencing difficulty starting his stream. Which of
the following conditions should be included in the differential diagnosis?
A) Benign Prostatic Hyperplasia (BPH)
B) Prostate Cancer
C) Urinary Tract Infection (UTI)
D) All of the above
Correct Answer: D
Rationale: In an older male presenting with lower urinary tract symptoms, the
differential should include BPH, prostate cancer, and UTI. All can present with
symptoms of obstruction and irritation. A comprehensive diagnostic workup is
necessary .
Question 4: Which of the following findings suggests anemia of chronic disease
rather than iron deficiency anemia?
A) Low ferritin, high TIBC
B) Low serum iron, low TIBC, normal or high ferritin
C) High MCV, high MCHC
D) Low serum iron, high total iron-binding capacity (TIBC)
Correct Answer: B
Rationale: In anemia of chronic disease, serum iron and TIBC are low, but ferritin is
typically normal to high (because iron is trapped in the reticuloendothelial system).
Iron deficiency anemia presents with low ferritin and high TIBC .
Question 5: The most effective initial management for a suspected herniated disc
with new-onset neurological deficits is:
A) Muscle relaxants and bed rest
B) Urgent MRI and neurosurgical referral
,C) Physical therapy and NSAIDs
D) Epidural steroid injection
Correct Answer: B
Rationale: New-onset neurological deficits require urgent imaging (MRI) to
determine the extent of neural compromise. This will guide the need for surgical
intervention .
SECTION 2: GENITOURINARY & REPRODUCTIVE DISORDERS
Question 6: Which of the following is a common cause of acute bacterial
prostatitis?
A) Chlamydia trachomatis
B) Escherichia coli
C) Herpes simplex virus
D) Candida albicans
Correct Answer: B
Rationale: E. coli is the most common pathogen in acute bacterial prostatitis. It is
often associated with urinary tract infections and is part of the normal bowel
flora .
Question 7: What simple test can help determine if erectile dysfunction (ED) is
organic or caused by stress?
A) Penile duplex ultrasonography
B) Nocturnal penile tumescence and rigidity (NPTR) test
C) Intracavernous injection
D) Serum prostate-specific antigen (PSA)
Correct Answer: B
Rationale: The NPTR test assesses for nocturnal erections. If normal erections
occur during sleep, it suggests that the ED is likely psychogenic (stress) rather than
organic .
, Question 8: A 56-year-old man with chronic prostatitis is started on trimethoprim-
sulfamethoxazole. The appropriate length of treatment is:
A) 3-7 days
B) 14-21 days
C) 3-6 weeks
D) 6-12 weeks
Correct Answer: D
Rationale: Chronic prostatitis requires prolonged antibiotic therapy (6-12 weeks)
to adequately penetrate the prostate tissue and eradicate the infection .
Question 9: An 82-year-old man presents with complaints of dribbling urine and
difficulty starting his stream. The differential should include:
A) Benign Prostatic Hyperplasia (BPH)
B) Prostate Cancer
C) Urinary Tract Infection (UTI)
D) All of the above
Correct Answer: D
Rationale: Similar to Question 3, lower urinary tract symptoms in older males can
be attributed to BPH, prostate cancer, or UTI. All are viable differentials requiring
further investigation .
Question 10: A patient is diagnosed with Giardia after a backpacking trip. Which
of the following would be the appropriate treatment?
A) Ciprofloxacin
B) Metronidazole
C) Amoxicillin
D) Doxycycline
Correct Answer: B
Rationale: Metronidazole is the treatment of choice for giardiasis. It is effective
against the protozoan parasite Giardia lamblia and is typically prescribed for 5-7
days .
verified answers actual exam!!! 2026
SECTION 1: GASTROINTESTINAL DISORDERS
Question 1: A 72-year-old patient presents with a 2-week history of dysphagia to
solids and liquids, with associated weight loss. He reports a history of long-
standing GERD. The most appropriate initial diagnostic test is:
A) Esophageal manometry
B) Esophagogastroduodenoscopy (EGD) with biopsy
C) Upper GI barium swallow
D) pH monitoring
Correct Answer: B
Rationale: This presentation is concerning for esophageal stricture or malignancy,
especially with weight loss and a history of GERD. EGD with biopsy is the gold
standard for direct visualization and tissue sampling. This allows for diagnosing
Barrett's esophagus, a premalignant condition, and ruling out esophageal cancer .
Question 2: A 45-year-old patient presents with acute onset of right lower
quadrant abdominal pain that began as periumbilical pain, followed by nausea
and vomiting. The pain is worse with walking and movement. Which physical
exam finding is most likely to be positive?
A) Murphy's sign
B) Psoas sign
C) McBurney's point tenderness
D) Rovsing's sign
Correct Answer: C
Rationale: Classic appendicitis presents with pain migration from the periumbilical
,area to the right lower quadrant (McBurney's point). This is the most common and
reliable physical exam finding for acute appendicitis .
Question 3: A 78-year-old man presents with dysuria, urinary frequency, and
dribbling. The patient is also experiencing difficulty starting his stream. Which of
the following conditions should be included in the differential diagnosis?
A) Benign Prostatic Hyperplasia (BPH)
B) Prostate Cancer
C) Urinary Tract Infection (UTI)
D) All of the above
Correct Answer: D
Rationale: In an older male presenting with lower urinary tract symptoms, the
differential should include BPH, prostate cancer, and UTI. All can present with
symptoms of obstruction and irritation. A comprehensive diagnostic workup is
necessary .
Question 4: Which of the following findings suggests anemia of chronic disease
rather than iron deficiency anemia?
A) Low ferritin, high TIBC
B) Low serum iron, low TIBC, normal or high ferritin
C) High MCV, high MCHC
D) Low serum iron, high total iron-binding capacity (TIBC)
Correct Answer: B
Rationale: In anemia of chronic disease, serum iron and TIBC are low, but ferritin is
typically normal to high (because iron is trapped in the reticuloendothelial system).
Iron deficiency anemia presents with low ferritin and high TIBC .
Question 5: The most effective initial management for a suspected herniated disc
with new-onset neurological deficits is:
A) Muscle relaxants and bed rest
B) Urgent MRI and neurosurgical referral
,C) Physical therapy and NSAIDs
D) Epidural steroid injection
Correct Answer: B
Rationale: New-onset neurological deficits require urgent imaging (MRI) to
determine the extent of neural compromise. This will guide the need for surgical
intervention .
SECTION 2: GENITOURINARY & REPRODUCTIVE DISORDERS
Question 6: Which of the following is a common cause of acute bacterial
prostatitis?
A) Chlamydia trachomatis
B) Escherichia coli
C) Herpes simplex virus
D) Candida albicans
Correct Answer: B
Rationale: E. coli is the most common pathogen in acute bacterial prostatitis. It is
often associated with urinary tract infections and is part of the normal bowel
flora .
Question 7: What simple test can help determine if erectile dysfunction (ED) is
organic or caused by stress?
A) Penile duplex ultrasonography
B) Nocturnal penile tumescence and rigidity (NPTR) test
C) Intracavernous injection
D) Serum prostate-specific antigen (PSA)
Correct Answer: B
Rationale: The NPTR test assesses for nocturnal erections. If normal erections
occur during sleep, it suggests that the ED is likely psychogenic (stress) rather than
organic .
, Question 8: A 56-year-old man with chronic prostatitis is started on trimethoprim-
sulfamethoxazole. The appropriate length of treatment is:
A) 3-7 days
B) 14-21 days
C) 3-6 weeks
D) 6-12 weeks
Correct Answer: D
Rationale: Chronic prostatitis requires prolonged antibiotic therapy (6-12 weeks)
to adequately penetrate the prostate tissue and eradicate the infection .
Question 9: An 82-year-old man presents with complaints of dribbling urine and
difficulty starting his stream. The differential should include:
A) Benign Prostatic Hyperplasia (BPH)
B) Prostate Cancer
C) Urinary Tract Infection (UTI)
D) All of the above
Correct Answer: D
Rationale: Similar to Question 3, lower urinary tract symptoms in older males can
be attributed to BPH, prostate cancer, or UTI. All are viable differentials requiring
further investigation .
Question 10: A patient is diagnosed with Giardia after a backpacking trip. Which
of the following would be the appropriate treatment?
A) Ciprofloxacin
B) Metronidazole
C) Amoxicillin
D) Doxycycline
Correct Answer: B
Rationale: Metronidazole is the treatment of choice for giardiasis. It is effective
against the protozoan parasite Giardia lamblia and is typically prescribed for 5-7
days .
