NURS 8026 Differential Diagnosis
Group Case Study Exam with correct
answers in option and rationale
updated 2026 graded A+
Section 1: Foundations of Differential Diagnosis (10 Questions)
1. Which of the following best defines differential diagnosis?
A) The process of confirming a single diagnosis through laboratory tests
B) The systematic method of identifying the most likely diagnosis from a list of possible conditions
C) The treatment plan developed after a diagnosis is confirmed
D) The documentation of patient symptoms without further investigation
Correct Answer: B
Rationale: Differential diagnosis is the process of distinguishing between multiple possible conditions
that could explain a patient’s symptoms. It involves comparing and contrasting clinical findings to
arrive at the most probable diagnosis.
2. Which component is NOT part of the SOAP note format?
A) Subjective
B) Objective
C) Assessment
D) Prognosis
Correct Answer: D
Rationale: SOAP stands for Subjective, Objective, Assessment, and Plan. "Prognosis" is not part of
the SOAP format but may be included in the assessment or plan.
3. A 45-year-old male presents with chest pain. Which of the following is the most critical initial step
in differential diagnosis?
,A) Ordering a chest X-ray
B) Assessing for life-threatening conditions (e.g., myocardial infarction, pulmonary embolism)
C) Prescribing antacids for possible GERD
D) Referring to a cardiologist
Correct Answer: B
Rationale: The first step in differential diagnosis is to rule out life-threatening conditions (e.g., acute
coronary syndrome, aortic dissection, pulmonary embolism) before considering less urgent
diagnoses.
4. Which mnemonic is commonly used to structure a differential diagnosis?
A) ABCDE (Airway, Breathing, Circulation, Disability, Exposure)
B) VINDICATE (Vascular, Infectious, Neoplastic, Degenerative, Idiopathic, Congenital, Autoimmune,
Traumatic, Endocrine)
C) OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time)
D) SMART (Specific, Measurable, Achievable, Relevant, Time-bound)
Correct Answer: B
Rationale: VINDICATE is a mnemonic used to systematically consider possible etiologies in
differential diagnosis. The other options are used for different purposes (e.g., trauma assessment,
pain evaluation, goal setting).
5. A patient presents with fatigue, weight loss, and polyuria. Which of the following is the most likely
endocrine disorder to consider?
A) Hypothyroidism
B) Hyperthyroidism
C) Diabetes mellitus
D) Addison’s disease
Correct Answer: C
Rationale: Diabetes mellitus (especially Type 1 or uncontrolled Type 2) presents with fatigue, weight
loss, and polyuria due to hyperglycemia and osmotic diuresis. Hyperthyroidism can cause weight loss
but typically presents with heat intolerance and tremors. Hypothyroidism causes weight gain and
fatigue, while Addison’s disease presents with hypotension and hyperpigmentation.
,6. Which of the following is NOT a red flag symptom requiring urgent evaluation?
A) Sudden onset of severe headache ("worst headache of my life")
B) New-onset chest pain radiating to the left arm
C) Intermittent abdominal bloating after meals
D) Sudden loss of vision in one eye
Correct Answer: C
Rationale: Intermittent abdominal bloating after meals is a common, non-urgent symptom (e.g.,
indigestion, IBS). The other options are red flags for subarachnoid hemorrhage (A), myocardial
infarction (B), and retinal artery occlusion or stroke (D).
7. A 30-year-old female presents with joint pain, fatigue, and a malar rash. Which autoimmune
condition is most likely?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus (SLE)
C) Sjögren’s syndrome
D) Ankylosing spondylitis
Correct Answer: B
Rationale: SLE is characterized by joint pain, fatigue, and a malar ("butterfly") rash. Rheumatoid
arthritis typically presents with symmetric joint swelling without a rash. Sjögren’s syndrome involves
dry eyes/mouth, and ankylosing spondylitis affects the spine.
**8. Which of the following is NOT a component of the H&P (History & Physical) examination?
A) Chief complaint
B) Review of systems
C) Family medical history
D) Insurance authorization
Correct Answer: D
, Rationale: The H&P includes chief complaint, history of present illness (HPI), past medical history
(PMH), family history, social history, review of systems (ROS), and physical exam. Insurance
authorization is an administrative task, not part of clinical assessment.
9. A patient with a history of smoking presents with chronic cough and hemoptysis. Which of the
following is the most concerning differential diagnosis?
A) Chronic bronchitis
B) Lung cancer
C) Gastroesophageal reflux disease (GERD)
D) Allergic rhinitis
Correct Answer: B
Rationale: Hemoptysis in a smoker is a red flag for lung cancer (or tuberculosis). While chronic
bronchitis can cause cough, hemoptysis is less common and warrants further investigation (e.g.,
chest CT, bronchoscopy).
10. Which of the following is NOT a principle of evidence-based practice (EBP) in differential
diagnosis?
A) Using the best available research evidence
B) Relying solely on personal clinical experience
C) Considering patient preferences and values
D) Integrating clinical expertise
Correct Answer: B
Rationale: Evidence-based practice (EBP) integrates research evidence, clinical expertise, and patient
values. Relying solely on personal experience without evidence is not EBP.
Section 2: Cardiovascular Differential Diagnosis (10 Questions)
11. A 65-year-old male presents with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Which is the most likely diagnosis?
A) Gastroesophageal reflux disease (GERD)
B) Acute myocardial infarction (MI)
C) Costochondritis
D) Pulmonary embolism
Group Case Study Exam with correct
answers in option and rationale
updated 2026 graded A+
Section 1: Foundations of Differential Diagnosis (10 Questions)
1. Which of the following best defines differential diagnosis?
A) The process of confirming a single diagnosis through laboratory tests
B) The systematic method of identifying the most likely diagnosis from a list of possible conditions
C) The treatment plan developed after a diagnosis is confirmed
D) The documentation of patient symptoms without further investigation
Correct Answer: B
Rationale: Differential diagnosis is the process of distinguishing between multiple possible conditions
that could explain a patient’s symptoms. It involves comparing and contrasting clinical findings to
arrive at the most probable diagnosis.
2. Which component is NOT part of the SOAP note format?
A) Subjective
B) Objective
C) Assessment
D) Prognosis
Correct Answer: D
Rationale: SOAP stands for Subjective, Objective, Assessment, and Plan. "Prognosis" is not part of
the SOAP format but may be included in the assessment or plan.
3. A 45-year-old male presents with chest pain. Which of the following is the most critical initial step
in differential diagnosis?
,A) Ordering a chest X-ray
B) Assessing for life-threatening conditions (e.g., myocardial infarction, pulmonary embolism)
C) Prescribing antacids for possible GERD
D) Referring to a cardiologist
Correct Answer: B
Rationale: The first step in differential diagnosis is to rule out life-threatening conditions (e.g., acute
coronary syndrome, aortic dissection, pulmonary embolism) before considering less urgent
diagnoses.
4. Which mnemonic is commonly used to structure a differential diagnosis?
A) ABCDE (Airway, Breathing, Circulation, Disability, Exposure)
B) VINDICATE (Vascular, Infectious, Neoplastic, Degenerative, Idiopathic, Congenital, Autoimmune,
Traumatic, Endocrine)
C) OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time)
D) SMART (Specific, Measurable, Achievable, Relevant, Time-bound)
Correct Answer: B
Rationale: VINDICATE is a mnemonic used to systematically consider possible etiologies in
differential diagnosis. The other options are used for different purposes (e.g., trauma assessment,
pain evaluation, goal setting).
5. A patient presents with fatigue, weight loss, and polyuria. Which of the following is the most likely
endocrine disorder to consider?
A) Hypothyroidism
B) Hyperthyroidism
C) Diabetes mellitus
D) Addison’s disease
Correct Answer: C
Rationale: Diabetes mellitus (especially Type 1 or uncontrolled Type 2) presents with fatigue, weight
loss, and polyuria due to hyperglycemia and osmotic diuresis. Hyperthyroidism can cause weight loss
but typically presents with heat intolerance and tremors. Hypothyroidism causes weight gain and
fatigue, while Addison’s disease presents with hypotension and hyperpigmentation.
,6. Which of the following is NOT a red flag symptom requiring urgent evaluation?
A) Sudden onset of severe headache ("worst headache of my life")
B) New-onset chest pain radiating to the left arm
C) Intermittent abdominal bloating after meals
D) Sudden loss of vision in one eye
Correct Answer: C
Rationale: Intermittent abdominal bloating after meals is a common, non-urgent symptom (e.g.,
indigestion, IBS). The other options are red flags for subarachnoid hemorrhage (A), myocardial
infarction (B), and retinal artery occlusion or stroke (D).
7. A 30-year-old female presents with joint pain, fatigue, and a malar rash. Which autoimmune
condition is most likely?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus (SLE)
C) Sjögren’s syndrome
D) Ankylosing spondylitis
Correct Answer: B
Rationale: SLE is characterized by joint pain, fatigue, and a malar ("butterfly") rash. Rheumatoid
arthritis typically presents with symmetric joint swelling without a rash. Sjögren’s syndrome involves
dry eyes/mouth, and ankylosing spondylitis affects the spine.
**8. Which of the following is NOT a component of the H&P (History & Physical) examination?
A) Chief complaint
B) Review of systems
C) Family medical history
D) Insurance authorization
Correct Answer: D
, Rationale: The H&P includes chief complaint, history of present illness (HPI), past medical history
(PMH), family history, social history, review of systems (ROS), and physical exam. Insurance
authorization is an administrative task, not part of clinical assessment.
9. A patient with a history of smoking presents with chronic cough and hemoptysis. Which of the
following is the most concerning differential diagnosis?
A) Chronic bronchitis
B) Lung cancer
C) Gastroesophageal reflux disease (GERD)
D) Allergic rhinitis
Correct Answer: B
Rationale: Hemoptysis in a smoker is a red flag for lung cancer (or tuberculosis). While chronic
bronchitis can cause cough, hemoptysis is less common and warrants further investigation (e.g.,
chest CT, bronchoscopy).
10. Which of the following is NOT a principle of evidence-based practice (EBP) in differential
diagnosis?
A) Using the best available research evidence
B) Relying solely on personal clinical experience
C) Considering patient preferences and values
D) Integrating clinical expertise
Correct Answer: B
Rationale: Evidence-based practice (EBP) integrates research evidence, clinical expertise, and patient
values. Relying solely on personal experience without evidence is not EBP.
Section 2: Cardiovascular Differential Diagnosis (10 Questions)
11. A 65-year-old male presents with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Which is the most likely diagnosis?
A) Gastroesophageal reflux disease (GERD)
B) Acute myocardial infarction (MI)
C) Costochondritis
D) Pulmonary embolism
