Page 1 of 191
NR576 MIDTERM EXAM BANK
DIFFERENTIAL DIAGNOSIS IN ADULT-
GERONTOLOGY PRIMARY CARE
250+ PRACTICE QUESTIONS & VERIFIED ANSWERS
WITH RATIONALES
2026-2027 ACADEMIC YEAR | 100% VERIFIED |
GRADED A+
# TABLE OF CONTENTS
| Section | Topic Area | Questions |
|---------|------------|-----------|
| **I** | **Cardiovascular Disorders** | 1-45 |
| **II** | **Pulmonary Disorders** | 46-80 |
| **III** | **Gastrointestinal Disorders** | 81-110 |
| **IV** | **Endocrine & Metabolic Disorders** | 111-140 |
| **V** | **Neurological Disorders** | 141-165 |
| **VI** | **Dermatological Disorders** | 166-195 |
| **VII** | **Eyes, Ears, Nose & Throat (EENT)** | 196-220 |
| **VIII** | **Genitourinary & Renal Disorders** | 221-240 |
| **IX** | **Musculoskeletal Disorders** | 241-260 |
| **X** | **Hematologic & Immunologic Disorders** | 261-275 |
,Page 2 of 191
SECTION I: CARDIOVASCULAR DISORDERS
## Questions 1-45
**Question 1**
A 64-year-old male presents with substernal chest pressure radiating to the jaw, accompanied by
diaphoresis and nausea. The pain began 30 minutes ago while walking. What is the most
appropriate initial diagnostic step?
A. Administer sublingual nitroglycerin
B. Draw serial troponin levels
C. Obtain a stat 12-lead ECG and assess for ST-segment changes
D. Perform a chest x-ray
---
**Correct Answer: C. Obtain a stat 12-lead ECG and assess for ST-segment changes**
**Rationale:** In a patient presenting with anginal symptoms, the priority is to rule out an ST-
elevation myocardial infarction (STEMI). An ECG should be obtained within 10 minutes of
arrival per American Heart Association guidelines. Nitroglycerin (A) is a treatment intervention,
not the first diagnostic step. Troponins (B) are important biomarkers but take time to result and
should not delay initial ECG acquisition. A chest x-ray (D) can rule out other causes such as
aortic dissection or pneumonia but does not identify an acute MI.
---
**Question 2**
A patient presents with sharp, pleuritic chest pain that improves when sitting up and leaning
forward but worsens when lying flat. What is the most likely diagnosis?
,Page 3 of 191
A. Pulmonary embolism
B. Pericarditis
C. Costochondritis
D. Stable angina
---
**Correct Answer: B. Pericarditis**
**Rationale:** This is the classic presentation of acute pericarditis. The pain is caused by
inflammation of the pericardium and is relieved by the forward-leaning position, which reduces
friction between the inflamed pericardial layers. Pulmonary embolism (A) typically presents with
pleuritic pain but is not positionally relieved. Costochondritis (C) presents with localized chest
wall tenderness. Stable angina (D) is exertional and relieved by rest, not positional changes.
---
**Question 3**
Which physical exam finding best differentiates heart failure with reduced ejection fraction
(HFrEF) from heart failure with preserved ejection fraction (HFpEF)?
A. S3 heart sound
B. Fatigue and dyspnea
C. Lower extremity edema
D. Elevated BNP
---
**Correct Answer: A. S3 heart sound**
, Page 4 of 191
**Rationale:** An S3 gallop is classically associated with systolic dysfunction (HFrEF) due to
rapid ventricular filling in a dilated ventricle. Both types of heart failure may present with
fatigue, dyspnea, edema, and elevated BNP (though levels may be higher in HFrEF). An S4
gallop is more commonly associated with HFpEF due to reduced ventricular compliance.
---
**Question 4**
A 68-year-old man with a history of hypertension and diabetes presents with exertional chest
pain that is reliably relieved by rest. His ECG is normal. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. GERD
---
**Correct Answer: B. Stable angina**
**Rationale:** Stable angina is characterized by predictable, reproducible chest discomfort that
occurs with exertion or emotional stress and resolves with rest or nitroglycerin. Unstable angina
(A) is new-onset, occurs at rest, or is worsening in pattern. An MI (C) presents with prolonged
pain not relieved by rest. GERD (D) pain is not typically exertional and is more related to meals
and recumbency.
---
**Question 5**
NR576 MIDTERM EXAM BANK
DIFFERENTIAL DIAGNOSIS IN ADULT-
GERONTOLOGY PRIMARY CARE
250+ PRACTICE QUESTIONS & VERIFIED ANSWERS
WITH RATIONALES
2026-2027 ACADEMIC YEAR | 100% VERIFIED |
GRADED A+
# TABLE OF CONTENTS
| Section | Topic Area | Questions |
|---------|------------|-----------|
| **I** | **Cardiovascular Disorders** | 1-45 |
| **II** | **Pulmonary Disorders** | 46-80 |
| **III** | **Gastrointestinal Disorders** | 81-110 |
| **IV** | **Endocrine & Metabolic Disorders** | 111-140 |
| **V** | **Neurological Disorders** | 141-165 |
| **VI** | **Dermatological Disorders** | 166-195 |
| **VII** | **Eyes, Ears, Nose & Throat (EENT)** | 196-220 |
| **VIII** | **Genitourinary & Renal Disorders** | 221-240 |
| **IX** | **Musculoskeletal Disorders** | 241-260 |
| **X** | **Hematologic & Immunologic Disorders** | 261-275 |
,Page 2 of 191
SECTION I: CARDIOVASCULAR DISORDERS
## Questions 1-45
**Question 1**
A 64-year-old male presents with substernal chest pressure radiating to the jaw, accompanied by
diaphoresis and nausea. The pain began 30 minutes ago while walking. What is the most
appropriate initial diagnostic step?
A. Administer sublingual nitroglycerin
B. Draw serial troponin levels
C. Obtain a stat 12-lead ECG and assess for ST-segment changes
D. Perform a chest x-ray
---
**Correct Answer: C. Obtain a stat 12-lead ECG and assess for ST-segment changes**
**Rationale:** In a patient presenting with anginal symptoms, the priority is to rule out an ST-
elevation myocardial infarction (STEMI). An ECG should be obtained within 10 minutes of
arrival per American Heart Association guidelines. Nitroglycerin (A) is a treatment intervention,
not the first diagnostic step. Troponins (B) are important biomarkers but take time to result and
should not delay initial ECG acquisition. A chest x-ray (D) can rule out other causes such as
aortic dissection or pneumonia but does not identify an acute MI.
---
**Question 2**
A patient presents with sharp, pleuritic chest pain that improves when sitting up and leaning
forward but worsens when lying flat. What is the most likely diagnosis?
,Page 3 of 191
A. Pulmonary embolism
B. Pericarditis
C. Costochondritis
D. Stable angina
---
**Correct Answer: B. Pericarditis**
**Rationale:** This is the classic presentation of acute pericarditis. The pain is caused by
inflammation of the pericardium and is relieved by the forward-leaning position, which reduces
friction between the inflamed pericardial layers. Pulmonary embolism (A) typically presents with
pleuritic pain but is not positionally relieved. Costochondritis (C) presents with localized chest
wall tenderness. Stable angina (D) is exertional and relieved by rest, not positional changes.
---
**Question 3**
Which physical exam finding best differentiates heart failure with reduced ejection fraction
(HFrEF) from heart failure with preserved ejection fraction (HFpEF)?
A. S3 heart sound
B. Fatigue and dyspnea
C. Lower extremity edema
D. Elevated BNP
---
**Correct Answer: A. S3 heart sound**
, Page 4 of 191
**Rationale:** An S3 gallop is classically associated with systolic dysfunction (HFrEF) due to
rapid ventricular filling in a dilated ventricle. Both types of heart failure may present with
fatigue, dyspnea, edema, and elevated BNP (though levels may be higher in HFrEF). An S4
gallop is more commonly associated with HFpEF due to reduced ventricular compliance.
---
**Question 4**
A 68-year-old man with a history of hypertension and diabetes presents with exertional chest
pain that is reliably relieved by rest. His ECG is normal. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. GERD
---
**Correct Answer: B. Stable angina**
**Rationale:** Stable angina is characterized by predictable, reproducible chest discomfort that
occurs with exertion or emotional stress and resolves with rest or nitroglycerin. Unstable angina
(A) is new-onset, occurs at rest, or is worsening in pattern. An MI (C) presents with prolonged
pain not relieved by rest. GERD (D) pain is not typically exertional and is more related to meals
and recumbency.
---
**Question 5**
