NR511 WEEK 8 FINAL EXAMINATION:
DIFFERENTIAL DIAGNOSIS & PRIMARY
CARE PRACTICUM MASTER ASSESSMENT
SECTION A: GASTROINTESTINAL DISORDERS
(Questions 1-20)
1. A 34-year-old female presents with recurrent abdominal pain, bloating, and alternating
diarrhea and constipation for the past 6 months. She reports symptom improvement with
defecation. Which of the following is the most appropriate initial diagnostic approach?
A. Colonoscopy with biopsy
B. Complete blood count and erythrocyte sedimentation rate
C. Rome IV criteria-based clinical diagnosis
D. Upper endoscopy
Answer: C
2. A 55-year-old male with a 20-year history of gastroesophageal reflux disease presents
with progressive dysphagia to solids and unintentional weight loss of 15 pounds over 3
months. Which of the following diagnostic tests should be ordered first?
A. Barium swallow study
B. Upper endoscopy with biopsy
,C. Esophageal manometry
D. CT scan of the chest
Answer: B
3. A 28-year-old female with known Crohn's disease presents with right lower quadrant
pain, fever, and a palpable abdominal mass. Which of the following is the most likely
complication requiring immediate surgical consultation?
A. Fistula formation
B. Stricture
C. Abscess formation
D. Perforation
Answer: C
4. A 45-year-old female presents with episodic burning epigastric pain that improves with
food intake but worsens 2-3 hours after meals. She reports taking ibuprofen daily for
chronic knee pain. Which of the following is the most appropriate initial treatment
regimen?
A. Proton pump inhibitor and discontinuation of NSAIDs
B. H2 receptor antagonist alone
C. Antacids as needed
D. Antibiotic therapy for Helicobacter pylori
Answer: A
,5. A 32-year-old male presents with acute onset of periumbilical pain that migrated to the
right lower quadrant over 12 hours. He has nausea, vomiting, and fever of 101.2°F. On
examination, there is rebound tenderness at McBurney's point. Which of the following
findings would most strongly support the diagnosis?
A. Positive psoas sign
B. Positive obturator sign
C. Positive Rovsing's sign
D. Positive Murphy's sign
Answer: C
6. A 68-year-old female presents with severe right upper quadrant pain, fever, and jaundice.
Ultrasound reveals gallbladder wall thickening and a dilated common bile duct. Which of
the following is the most appropriate next step?
A. Oral cholecystogram
B. Magnetic resonance cholangiopancreatography (MRCP)
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Hepatobiliary iminodiacetic acid (HIDA) scan
Answer: C
7. A 24-year-old female with a history of irritable bowel syndrome presents with acute
watery diarrhea, cramping, and low-grade fever after returning from a trip to Mexico. She
reports drinking tap water. Which of the following organisms is most likely responsible for
her symptoms?
, A. Salmonella
B. Shigella
C. Campylobacter
D. Giardia lamblia
Answer: D
8. A 52-year-old male with a 30-pack-year smoking history presents with early satiety,
unintentional weight loss, and melena. Laboratory studies reveal iron deficiency anemia
with hemoglobin of 9.2 g/dL. Which of the following is the most appropriate next step?
A. Iron supplementation and stool guaiac testing
B. Upper endoscopy with gastric biopsy
C. Colonoscopy
D. CT scan of the abdomen and pelvis
Answer: B
9. A 45-year-old female presents with chronic constipation for 6 months. She reports
straining during defecation and a sensation of incomplete evacuation. She has tried over-
the-counter laxatives with minimal improvement. Which of the following is the most
appropriate initial management strategy?
A. High-fiber diet and increased fluid intake
B. Stimulant laxatives daily
C. Biofeedback therapy
DIFFERENTIAL DIAGNOSIS & PRIMARY
CARE PRACTICUM MASTER ASSESSMENT
SECTION A: GASTROINTESTINAL DISORDERS
(Questions 1-20)
1. A 34-year-old female presents with recurrent abdominal pain, bloating, and alternating
diarrhea and constipation for the past 6 months. She reports symptom improvement with
defecation. Which of the following is the most appropriate initial diagnostic approach?
A. Colonoscopy with biopsy
B. Complete blood count and erythrocyte sedimentation rate
C. Rome IV criteria-based clinical diagnosis
D. Upper endoscopy
Answer: C
2. A 55-year-old male with a 20-year history of gastroesophageal reflux disease presents
with progressive dysphagia to solids and unintentional weight loss of 15 pounds over 3
months. Which of the following diagnostic tests should be ordered first?
A. Barium swallow study
B. Upper endoscopy with biopsy
,C. Esophageal manometry
D. CT scan of the chest
Answer: B
3. A 28-year-old female with known Crohn's disease presents with right lower quadrant
pain, fever, and a palpable abdominal mass. Which of the following is the most likely
complication requiring immediate surgical consultation?
A. Fistula formation
B. Stricture
C. Abscess formation
D. Perforation
Answer: C
4. A 45-year-old female presents with episodic burning epigastric pain that improves with
food intake but worsens 2-3 hours after meals. She reports taking ibuprofen daily for
chronic knee pain. Which of the following is the most appropriate initial treatment
regimen?
A. Proton pump inhibitor and discontinuation of NSAIDs
B. H2 receptor antagonist alone
C. Antacids as needed
D. Antibiotic therapy for Helicobacter pylori
Answer: A
,5. A 32-year-old male presents with acute onset of periumbilical pain that migrated to the
right lower quadrant over 12 hours. He has nausea, vomiting, and fever of 101.2°F. On
examination, there is rebound tenderness at McBurney's point. Which of the following
findings would most strongly support the diagnosis?
A. Positive psoas sign
B. Positive obturator sign
C. Positive Rovsing's sign
D. Positive Murphy's sign
Answer: C
6. A 68-year-old female presents with severe right upper quadrant pain, fever, and jaundice.
Ultrasound reveals gallbladder wall thickening and a dilated common bile duct. Which of
the following is the most appropriate next step?
A. Oral cholecystogram
B. Magnetic resonance cholangiopancreatography (MRCP)
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Hepatobiliary iminodiacetic acid (HIDA) scan
Answer: C
7. A 24-year-old female with a history of irritable bowel syndrome presents with acute
watery diarrhea, cramping, and low-grade fever after returning from a trip to Mexico. She
reports drinking tap water. Which of the following organisms is most likely responsible for
her symptoms?
, A. Salmonella
B. Shigella
C. Campylobacter
D. Giardia lamblia
Answer: D
8. A 52-year-old male with a 30-pack-year smoking history presents with early satiety,
unintentional weight loss, and melena. Laboratory studies reveal iron deficiency anemia
with hemoglobin of 9.2 g/dL. Which of the following is the most appropriate next step?
A. Iron supplementation and stool guaiac testing
B. Upper endoscopy with gastric biopsy
C. Colonoscopy
D. CT scan of the abdomen and pelvis
Answer: B
9. A 45-year-old female presents with chronic constipation for 6 months. She reports
straining during defecation and a sensation of incomplete evacuation. She has tried over-
the-counter laxatives with minimal improvement. Which of the following is the most
appropriate initial management strategy?
A. High-fiber diet and increased fluid intake
B. Stimulant laxatives daily
C. Biofeedback therapy
