NR511 FINAL EXAM DIFFERENTIAL DIAGNOSIS AND
PRIMARY CARE PRACTICE QUESTIONS WITH VERIFIED
ANSWERS
1. A 45-year-old male presents with acute onset of severe, tearing
chest pain radiating to the back. Blood pressure is 100/60 in the right
arm and 140/90 in the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C – Aortic dissection classically presents with tearing chest pain
and asymmetric blood pressures between arms.
2. A 30-year-old woman reports fatigue, weight gain, cold intolerance,
and constipation. On exam, she has bradycardia and delayed
relaxation of deep tendon reflexes. What is the most appropriate
initial test?
A) Free T4 only
B) TSH and free T4
C) T3 uptake
D) Thyroid ultrasound
Answer: B – TSH and free T4 are the initial tests for suspected
hypothyroidism.
,3. A 22-year-old college student presents with sore throat, fever, and
fatigue. Exam reveals posterior cervical lymphadenopathy and
petechiae on the palate. What is the most likely diagnosis?
A) Streptococcal pharyngitis
B) Infectious mononucleosis
C) Influenza
D) Acute HIV
Answer: B – Posterior cervical lymphadenopathy and palatal petechiae
are classic for Epstein-Barr virus (mononucleosis).
4. A 55-year-old female complains of bilateral hand pain, stiffness, and
swelling in the mornings lasting over 1 hour. Which lab finding is most
specific for rheumatoid arthritis?
A) Rheumatoid factor
B) Anti-CCP antibody
C) Elevated ESR
D) ANA positive
Answer: B – Anti-CCP antibody has higher specificity for RA than
rheumatoid factor.
5. A 55-year-old female presents with a rash on her right flank that
started as burning pain followed by vesicles on an erythematous base
3 days later. What is the most likely diagnosis?
A) Contact dermatitis
B) Herpes zoster
C) Impetigo
D) Cellulitis
,Answer: B – Herpes zoster (shingles) presents with prodromal burning
pain followed by vesicles on an erythematous base in a dermatomal
distribution.
6. A 60-year-old smoker presents with hemoptysis, weight loss, and a
new cough for 6 weeks. Chest X-ray shows a right hilar mass. What is
the next best step?
A) CT chest
B) PPD
C) Empiric antibiotics
D) Bronchoscopy with biopsy
Answer: A – CT chest is the next step to characterize the mass and
guide biopsy.
7. Your patient has made an attempt on their own life and has
survived. In assessing them, it is important the nurse practitioner
recognize that patients with a history of self-harm need to be
evaluated for which underlying disease state, which is the most
common co-diagnosis in patients who have made attempts of self-
harm?
A) Depression
B) Anxiety
C) Schizophrenia
D) Bipolar Disorder
Answer: A – Depression is the most common co-diagnosis in patients
who have made suicide attempts.
8. You are assessing a 26-year-old male patient who complains that his
arm hurts. When assessing ROM of the shoulder, you ask him to touch
, the opposite scapula by placing his arm up and over the back of his
neck, but the patient reports tremendous pain when attempting to do
this. Which one of the following would you suspect?
A) Humeral malignancy
B) Rotator cuff injury
C) Ulnar nerve injury
D) Biceps brachii injury
Answer: B – Pain with reaching behind the neck to touch the opposite
scapula suggests rotator cuff injury.
9. The 19-year-old female patient complains of jaw pain anterior and
inferior to the ear bilaterally. All of the following are common
symptoms of a temporomandibular joint (TMJ) disorder EXCEPT which
one?
A) Pain and tenderness with palpation, often increases with chewing
B) Facial asymmetry and unilateral pain with jaw clenching
C) Palpable swelling and tenderness of the joint
D) Relief from pain with joint displacement
Answer: D – Relief from pain with joint displacement is NOT a symptom
of TMJ disorder.
10. Unequal shoulder height with a lateral and rotary curvature of the
spine would be associated with which one of the following spinal
deformity diagnoses?
A) Scoliosis
B) Rheumatoid Arthritis (RA)
C) Kyphosis
D) Lordosis
PRIMARY CARE PRACTICE QUESTIONS WITH VERIFIED
ANSWERS
1. A 45-year-old male presents with acute onset of severe, tearing
chest pain radiating to the back. Blood pressure is 100/60 in the right
arm and 140/90 in the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C – Aortic dissection classically presents with tearing chest pain
and asymmetric blood pressures between arms.
2. A 30-year-old woman reports fatigue, weight gain, cold intolerance,
and constipation. On exam, she has bradycardia and delayed
relaxation of deep tendon reflexes. What is the most appropriate
initial test?
A) Free T4 only
B) TSH and free T4
C) T3 uptake
D) Thyroid ultrasound
Answer: B – TSH and free T4 are the initial tests for suspected
hypothyroidism.
,3. A 22-year-old college student presents with sore throat, fever, and
fatigue. Exam reveals posterior cervical lymphadenopathy and
petechiae on the palate. What is the most likely diagnosis?
A) Streptococcal pharyngitis
B) Infectious mononucleosis
C) Influenza
D) Acute HIV
Answer: B – Posterior cervical lymphadenopathy and palatal petechiae
are classic for Epstein-Barr virus (mononucleosis).
4. A 55-year-old female complains of bilateral hand pain, stiffness, and
swelling in the mornings lasting over 1 hour. Which lab finding is most
specific for rheumatoid arthritis?
A) Rheumatoid factor
B) Anti-CCP antibody
C) Elevated ESR
D) ANA positive
Answer: B – Anti-CCP antibody has higher specificity for RA than
rheumatoid factor.
5. A 55-year-old female presents with a rash on her right flank that
started as burning pain followed by vesicles on an erythematous base
3 days later. What is the most likely diagnosis?
A) Contact dermatitis
B) Herpes zoster
C) Impetigo
D) Cellulitis
,Answer: B – Herpes zoster (shingles) presents with prodromal burning
pain followed by vesicles on an erythematous base in a dermatomal
distribution.
6. A 60-year-old smoker presents with hemoptysis, weight loss, and a
new cough for 6 weeks. Chest X-ray shows a right hilar mass. What is
the next best step?
A) CT chest
B) PPD
C) Empiric antibiotics
D) Bronchoscopy with biopsy
Answer: A – CT chest is the next step to characterize the mass and
guide biopsy.
7. Your patient has made an attempt on their own life and has
survived. In assessing them, it is important the nurse practitioner
recognize that patients with a history of self-harm need to be
evaluated for which underlying disease state, which is the most
common co-diagnosis in patients who have made attempts of self-
harm?
A) Depression
B) Anxiety
C) Schizophrenia
D) Bipolar Disorder
Answer: A – Depression is the most common co-diagnosis in patients
who have made suicide attempts.
8. You are assessing a 26-year-old male patient who complains that his
arm hurts. When assessing ROM of the shoulder, you ask him to touch
, the opposite scapula by placing his arm up and over the back of his
neck, but the patient reports tremendous pain when attempting to do
this. Which one of the following would you suspect?
A) Humeral malignancy
B) Rotator cuff injury
C) Ulnar nerve injury
D) Biceps brachii injury
Answer: B – Pain with reaching behind the neck to touch the opposite
scapula suggests rotator cuff injury.
9. The 19-year-old female patient complains of jaw pain anterior and
inferior to the ear bilaterally. All of the following are common
symptoms of a temporomandibular joint (TMJ) disorder EXCEPT which
one?
A) Pain and tenderness with palpation, often increases with chewing
B) Facial asymmetry and unilateral pain with jaw clenching
C) Palpable swelling and tenderness of the joint
D) Relief from pain with joint displacement
Answer: D – Relief from pain with joint displacement is NOT a symptom
of TMJ disorder.
10. Unequal shoulder height with a lateral and rotary curvature of the
spine would be associated with which one of the following spinal
deformity diagnoses?
A) Scoliosis
B) Rheumatoid Arthritis (RA)
C) Kyphosis
D) Lordosis
