NR 511 DIFFERENTIAL DIAGNOSIS AND
PRIMARY CARE PRACTICUM REVIEW
EXAM
1. A 45-year-old male presents with sudden onset of excruciating pain in his right great toe.
On examination, the joint is erythematous, swollen, and tender. Which diagnostic test is the
‘gold standard’ for confirming the suspected diagnosis?
A. Serum uric acid level
B. Joint aspiration and synovial fluid analysis for urate crystals
C. X-ray of the foot
D. C-reactive protein and ESR
Answer: B
Conceptual Explanation: While serum uric acid is often elevated, the definitive diagnosis
of gout (podagra) requires identifying monosodium urate crystals in synovial fluid under
polarized light microscopy.
,2. A patient presents with a cough, fever, and pleuritic chest pain. On physical exam, you note
increased tactile fremitus and dullness to percussion over the right lower lobe. Which
condition is most likely?
A. Bacterial pneumonia
B. Pleural effusion
C. Pneumothorax
D. Asthma exacerbation
Answer: A
Conceptual Explanation: Consolidation, as seen in bacterial pneumonia, increases tactile
fremitus and produces dullness to percussion. Pleural effusion would show decreased
tactile fremitus.
3. When using the CURB-65 scale for community-acquired pneumonia, which of the following
scores indicates the need for consideration of inpatient hospitalization?
A. 0
B. 2 or higher
C. 1
D. Only scores above 4
Answer: B
, Conceptual Explanation: A CURB-65 score of 0-1 suggests outpatient treatment; a score of
2 suggests inpatient admission, and 3 or more suggests intensive care consideration.
4. Which of the following is a key differentiating factor between Erysipelas and Cellulitis?
A. Erysipelas involves the deep dermis and subcutaneous fat
B. Cellulitis typically has well-demarcated borders
C. Erysipelas involves the upper dermis and has clear, raised borders
D. Only cellulitis presents with fever
Answer: C
Conceptual Explanation: Erysipelas is a more superficial infection with sharp, well-
demarcated borders, whereas cellulitis involves deeper tissues and has indistinct borders.
5. A 65-year-old female smoker presents with a new onset of a ‘hoarse’ voice that has lasted
for 4 weeks. What is the most appropriate next step in management?
A. Prescribe a 7-day course of Amoxicillin
B. Recommend vocal rest and hydration for 2 weeks
C. Order a chest X-ray to look for pneumonia
D. Refer to an Otolaryngologist for laryngoscopy
Answer: D
PRIMARY CARE PRACTICUM REVIEW
EXAM
1. A 45-year-old male presents with sudden onset of excruciating pain in his right great toe.
On examination, the joint is erythematous, swollen, and tender. Which diagnostic test is the
‘gold standard’ for confirming the suspected diagnosis?
A. Serum uric acid level
B. Joint aspiration and synovial fluid analysis for urate crystals
C. X-ray of the foot
D. C-reactive protein and ESR
Answer: B
Conceptual Explanation: While serum uric acid is often elevated, the definitive diagnosis
of gout (podagra) requires identifying monosodium urate crystals in synovial fluid under
polarized light microscopy.
,2. A patient presents with a cough, fever, and pleuritic chest pain. On physical exam, you note
increased tactile fremitus and dullness to percussion over the right lower lobe. Which
condition is most likely?
A. Bacterial pneumonia
B. Pleural effusion
C. Pneumothorax
D. Asthma exacerbation
Answer: A
Conceptual Explanation: Consolidation, as seen in bacterial pneumonia, increases tactile
fremitus and produces dullness to percussion. Pleural effusion would show decreased
tactile fremitus.
3. When using the CURB-65 scale for community-acquired pneumonia, which of the following
scores indicates the need for consideration of inpatient hospitalization?
A. 0
B. 2 or higher
C. 1
D. Only scores above 4
Answer: B
, Conceptual Explanation: A CURB-65 score of 0-1 suggests outpatient treatment; a score of
2 suggests inpatient admission, and 3 or more suggests intensive care consideration.
4. Which of the following is a key differentiating factor between Erysipelas and Cellulitis?
A. Erysipelas involves the deep dermis and subcutaneous fat
B. Cellulitis typically has well-demarcated borders
C. Erysipelas involves the upper dermis and has clear, raised borders
D. Only cellulitis presents with fever
Answer: C
Conceptual Explanation: Erysipelas is a more superficial infection with sharp, well-
demarcated borders, whereas cellulitis involves deeper tissues and has indistinct borders.
5. A 65-year-old female smoker presents with a new onset of a ‘hoarse’ voice that has lasted
for 4 weeks. What is the most appropriate next step in management?
A. Prescribe a 7-day course of Amoxicillin
B. Recommend vocal rest and hydration for 2 weeks
C. Order a chest X-ray to look for pneumonia
D. Refer to an Otolaryngologist for laryngoscopy
Answer: D
