NURS 8026: Differential Diagnosis with
correct answers and rationale
updated 2026 graded A+ new!!
1. A 35-year-old female presents with a 4-hour history of severe, unilateral, throbbing headache
associated with photophobia and nausea. She reports a history of similar headaches. Which is the
most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Migraine without aura
Answer: D
Rationale: The presentation (unilateral, throbbing, photophobia, nausea) is classic for a migraine.
Because the patient did not report visual or sensory disturbances prior to the onset, it is classified as
"without aura." Tension headaches are typically bilateral/band-like. Cluster headaches are orbital,
severe, and brief.
2. A 55-year-old male smoker complains of substernal chest pressure that occurs with exercise and is
relieved by rest. Which finding would be most suggestive of Stable Angina?
A. Pain lasting longer than 30 minutes
B. Reproducible chest wall tenderness
C. Pain relieved by sublingual nitroglycerin
D. Pain that worsens with inspiration
Answer: C
Rationale: Stable angina is predictable, occurs with exertion, and is relieved by rest or nitrates. Pain
lasting >30 minutes suggests unstable angina or MI. Chest wall tenderness suggests musculoskeletal
pain. Pain with inspiration suggests pleuritic origin.
3. During a physical exam, you elicit a positive Murphy’s sign. This finding is highly suggestive of:
A. Appendicitis
B. Acute Cholecystitis
C. Diverticulitis
D. Nephrolithiasis
,Answer: B
Rationale: Murphy’s sign (arrest of inspiration upon palpation of the RUQ) is a classic physical exam
finding for cholecystitis. Appendicitis is associated with McBurney’s point tenderness. Diverticulitis is
typically LLQ. Nephrolithiasis presents with flank pain/CVA tenderness.
4. A patient presents with dizziness. They describe the room "spinning" when they roll over in bed.
Symptoms last less than 60 seconds. What is the most likely diagnosis?
A. Meniere’s disease
B. Benign Paroxysmal Positional Vertigo (BPPV)
C. Vestibular neuritis
D. Labyrinthitis
Answer: B
Rationale: BPPV is characterized by brief, episodic vertigo triggered by position changes. Meniere’s
involves hearing loss/tinnitus/vertigo. Vestibular neuritis and labyrinthitis usually involve longer-
lasting vertigo and often follow a viral infection.
5. A 60-year-old patient with a history of COPD reports increased sputum production and dyspnea.
You suspect acute exacerbation. Which clinical finding warrants immediate referral?
A. Productive cough
B. Use of accessory muscles for breathing
C. Wheezing upon auscultation
D. O2 saturation of 92%
Answer: B
Rationale: While all may be present, the use of accessory muscles indicates severe respiratory
distress/failure, requiring emergent care. O2 of 92% is often acceptable for chronic COPD patients.
6. Which of the following physical exam findings is a classic sign of iron deficiency anemia?
A. Koilonychia (spoon nails)
B. Hyperreflexia
C. Petechiae
D. Jaundice
Answer: A
,Rationale: Koilonychia (spoon-shaped nails) is a classic, though late-stage, sign of chronic iron
deficiency anemia. Petechiae are associated with platelet issues; Jaundice is associated with
hemolysis or liver issues.
7. A 22-year-old female presents with dysuria, frequency, and suprapubic pain. Urinalysis reveals
nitrates and leukocyte esterase. What is the most likely diagnosis?
A. Pyelonephritis
B. Vaginitis
C. Cystitis
D. Urethritis
Answer: C
Rationale: The combination of dysuria, frequency, and positive nitrites/leuk esterase in the urine is
the classic presentation of a lower urinary tract infection (cystitis). Pyelonephritis would involve CVA
tenderness and fever.
8. Which dermatological condition is characterized by a "herald patch" followed by a Christmas-tree
distribution rash?
A. Tinea corporis
B. Pityriasis rosea
C. Guttate psoriasis
D. Secondary syphilis
Answer: B
Rationale: Pityriasis rosea typically presents with a single herald patch followed by a generalized
eruption in a Christmas-tree pattern.
9. When assessing a patient for suspected hypothyroidism, which laboratory result is expected?
A. Elevated TSH, Low Free T4
B. Low TSH, High Free T4
C. Elevated TSH, Normal Free T4
D. Normal TSH, High Free T4
Answer: A
Rationale: In primary hypothyroidism, the thyroid gland is failing, causing the pituitary to pump out
more TSH (elevated) while T4 levels drop (low).
, 10. A 70-year-old patient reports a sudden onset of "curtain coming down over my eye." What is the
immediate differential consideration?
A. Conjunctivitis
B. Retinal detachment
C. Cataract
D. Glaucoma
Answer: B
Rationale: The sensation of a curtain or shade descending over the visual field is a hallmark symptom
of retinal detachment, which is an ophthalmic emergency.
11. Which of the following is considered a "red flag" symptom for back pain?
A. Pain radiating to the knee
B. Bowel or bladder incontinence
C. History of heavy lifting
D. Pain relieved by sitting
Answer: B
Rationale: Bowel/bladder incontinence combined with back pain is a cardinal sign of Cauda Equina
Syndrome, a surgical emergency.
12. A patient presents with localized RLQ pain and a fever of 101.5°F. Which test is most
sensitive/specific for diagnosis?
A. Abdominal X-ray
B. Urinalysis
C. CT abdomen/pelvis
D. CBC
Answer: C
Rationale: While a CT scan exposes the patient to radiation, it is the gold standard for diagnosing
appendicitis with high sensitivity and specificity.
13. Which of the following is the most appropriate initial screening test for HIV?
A. Western Blot
B. CD4 count
C. ELISA/Fourth generation HIV-1/2 immunoassay
correct answers and rationale
updated 2026 graded A+ new!!
1. A 35-year-old female presents with a 4-hour history of severe, unilateral, throbbing headache
associated with photophobia and nausea. She reports a history of similar headaches. Which is the
most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Migraine without aura
Answer: D
Rationale: The presentation (unilateral, throbbing, photophobia, nausea) is classic for a migraine.
Because the patient did not report visual or sensory disturbances prior to the onset, it is classified as
"without aura." Tension headaches are typically bilateral/band-like. Cluster headaches are orbital,
severe, and brief.
2. A 55-year-old male smoker complains of substernal chest pressure that occurs with exercise and is
relieved by rest. Which finding would be most suggestive of Stable Angina?
A. Pain lasting longer than 30 minutes
B. Reproducible chest wall tenderness
C. Pain relieved by sublingual nitroglycerin
D. Pain that worsens with inspiration
Answer: C
Rationale: Stable angina is predictable, occurs with exertion, and is relieved by rest or nitrates. Pain
lasting >30 minutes suggests unstable angina or MI. Chest wall tenderness suggests musculoskeletal
pain. Pain with inspiration suggests pleuritic origin.
3. During a physical exam, you elicit a positive Murphy’s sign. This finding is highly suggestive of:
A. Appendicitis
B. Acute Cholecystitis
C. Diverticulitis
D. Nephrolithiasis
,Answer: B
Rationale: Murphy’s sign (arrest of inspiration upon palpation of the RUQ) is a classic physical exam
finding for cholecystitis. Appendicitis is associated with McBurney’s point tenderness. Diverticulitis is
typically LLQ. Nephrolithiasis presents with flank pain/CVA tenderness.
4. A patient presents with dizziness. They describe the room "spinning" when they roll over in bed.
Symptoms last less than 60 seconds. What is the most likely diagnosis?
A. Meniere’s disease
B. Benign Paroxysmal Positional Vertigo (BPPV)
C. Vestibular neuritis
D. Labyrinthitis
Answer: B
Rationale: BPPV is characterized by brief, episodic vertigo triggered by position changes. Meniere’s
involves hearing loss/tinnitus/vertigo. Vestibular neuritis and labyrinthitis usually involve longer-
lasting vertigo and often follow a viral infection.
5. A 60-year-old patient with a history of COPD reports increased sputum production and dyspnea.
You suspect acute exacerbation. Which clinical finding warrants immediate referral?
A. Productive cough
B. Use of accessory muscles for breathing
C. Wheezing upon auscultation
D. O2 saturation of 92%
Answer: B
Rationale: While all may be present, the use of accessory muscles indicates severe respiratory
distress/failure, requiring emergent care. O2 of 92% is often acceptable for chronic COPD patients.
6. Which of the following physical exam findings is a classic sign of iron deficiency anemia?
A. Koilonychia (spoon nails)
B. Hyperreflexia
C. Petechiae
D. Jaundice
Answer: A
,Rationale: Koilonychia (spoon-shaped nails) is a classic, though late-stage, sign of chronic iron
deficiency anemia. Petechiae are associated with platelet issues; Jaundice is associated with
hemolysis or liver issues.
7. A 22-year-old female presents with dysuria, frequency, and suprapubic pain. Urinalysis reveals
nitrates and leukocyte esterase. What is the most likely diagnosis?
A. Pyelonephritis
B. Vaginitis
C. Cystitis
D. Urethritis
Answer: C
Rationale: The combination of dysuria, frequency, and positive nitrites/leuk esterase in the urine is
the classic presentation of a lower urinary tract infection (cystitis). Pyelonephritis would involve CVA
tenderness and fever.
8. Which dermatological condition is characterized by a "herald patch" followed by a Christmas-tree
distribution rash?
A. Tinea corporis
B. Pityriasis rosea
C. Guttate psoriasis
D. Secondary syphilis
Answer: B
Rationale: Pityriasis rosea typically presents with a single herald patch followed by a generalized
eruption in a Christmas-tree pattern.
9. When assessing a patient for suspected hypothyroidism, which laboratory result is expected?
A. Elevated TSH, Low Free T4
B. Low TSH, High Free T4
C. Elevated TSH, Normal Free T4
D. Normal TSH, High Free T4
Answer: A
Rationale: In primary hypothyroidism, the thyroid gland is failing, causing the pituitary to pump out
more TSH (elevated) while T4 levels drop (low).
, 10. A 70-year-old patient reports a sudden onset of "curtain coming down over my eye." What is the
immediate differential consideration?
A. Conjunctivitis
B. Retinal detachment
C. Cataract
D. Glaucoma
Answer: B
Rationale: The sensation of a curtain or shade descending over the visual field is a hallmark symptom
of retinal detachment, which is an ophthalmic emergency.
11. Which of the following is considered a "red flag" symptom for back pain?
A. Pain radiating to the knee
B. Bowel or bladder incontinence
C. History of heavy lifting
D. Pain relieved by sitting
Answer: B
Rationale: Bowel/bladder incontinence combined with back pain is a cardinal sign of Cauda Equina
Syndrome, a surgical emergency.
12. A patient presents with localized RLQ pain and a fever of 101.5°F. Which test is most
sensitive/specific for diagnosis?
A. Abdominal X-ray
B. Urinalysis
C. CT abdomen/pelvis
D. CBC
Answer: C
Rationale: While a CT scan exposes the patient to radiation, it is the gold standard for diagnosing
appendicitis with high sensitivity and specificity.
13. Which of the following is the most appropriate initial screening test for HIV?
A. Western Blot
B. CD4 count
C. ELISA/Fourth generation HIV-1/2 immunoassay
