NR511 WEEK 4 FINAL EXAM/ ACTUAL EXAM
NR 511: DIFFERENTIAL DIAGNOSIS & PRIMARY CARE
QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 58-year-old man presents with fatigue, decreased exercise tolerance, and
intermittent dizziness. He reports that his stools have been darker than usual for
several months but denies bright-red blood. Laboratory results show hemoglobin
9.6 g/dL, MCV 72 fL, and elevated RDW. Which additional finding would most
strongly support the suspected underlying cause?
A. Low serum ferritin
B. Elevated vitamin B12
C. Increased reticulocyte count
D. Elevated serum haptoglobin
Answer: A
Rationale: A low serum ferritin is strongly supportive of iron deficiency. In an
older adult with microcytic anemia and possible occult gastrointestinal blood loss,
the clinician should investigate for a gastrointestinal source rather than attributing
the anemia solely to dietary deficiency.
2. A 34-year-old woman reports episodic palpitations, tremulousness, sweating,
and a sensation of impending death. Episodes occur unexpectedly and peak within
approximately 10 minutes. Between episodes, she worries about experiencing
another attack. Physical examination and ECG are normal. Which diagnosis best
explains this presentation?
A. Generalized anxiety disorder
B. Panic disorder
C. Hyperthyroidism
D. Somatic symptom disorder
Answer: B
,Rationale: Panic disorder is characterized by recurrent unexpected panic attacks
followed by persistent concern about additional attacks or maladaptive behavioral
changes. The abrupt onset and rapid peak of autonomic and cognitive symptoms
are characteristic.
3. A 67-year-old patient presents with unilateral calf swelling and tenderness that
began after a long-distance flight. The affected leg is approximately 3 cm larger in
circumference than the opposite leg. Which diagnostic approach is most
appropriate?
A. Plain radiography of the lower leg
B. Venous duplex ultrasonography
C. Arterial Doppler study
D. MRI of the lumbar spine
Answer: B
Rationale: Venous duplex ultrasonography is the primary imaging study for
suspected lower-extremity deep vein thrombosis. Recent prolonged immobility
combined with unilateral swelling and tenderness increases clinical suspicion.
4. A 29-year-old woman reports recurrent episodes of wheezing and chest
tightness, particularly after exposure to cats and during exercise. Her baseline
spirometry is normal. Which finding would provide objective evidence supporting
asthma?
A. Persistent reduction in FEV1/FVC without reversibility
B. Significant improvement in airflow after bronchodilator administration
C. Reduced total lung capacity
D. Increased residual volume without symptom variability
Answer: B
,Rationale: Asthma is characterized by variable expiratory airflow limitation.
Demonstrable improvement in airflow following bronchodilator administration
supports reversible airway obstruction and helps distinguish asthma from fixed
obstructive disease.
5. A 45-year-old woman presents with progressive difficulty swallowing. Initially,
she had difficulty swallowing solid foods, but she now has difficulty with both
solids and liquids. Which mechanism is most consistent with this progression?
A. Mechanical obstruction
B. Esophageal motility disorder
C. Peptic ulcer disease
D. Gastric outlet obstruction
Answer: B
Rationale: Dysphagia initially limited to solids suggests a mechanical obstruction.
Dysphagia involving both solids and liquids, particularly as the condition
progresses, suggests an esophageal motility disorder such as achalasia.
6. A 62-year-old man reports urinary hesitancy, weak urinary stream,
intermittency, and nocturia. He denies dysuria, fever, and hematuria. Digital rectal
examination reveals a symmetrically enlarged, smooth prostate. Which diagnosis is
most likely?
A. Prostate cancer
B. Acute prostatitis
C. Benign prostatic hyperplasia
D. Urethral stricture
Answer: C
Rationale: Benign prostatic hyperplasia commonly produces lower urinary tract
symptoms through enlargement of the prostate surrounding the urethra. A smooth,
symmetrically enlarged prostate is typical.
, 7. A 71-year-old woman presents with new-onset headache localized to the
temporal region. She reports scalp tenderness when brushing her hair and transient
episodes of blurred vision. ESR and CRP are markedly elevated. What is the most
appropriate immediate management?
A. Schedule routine ophthalmology follow-up
B. Begin high-dose glucocorticoid therapy
C. Treat with a nonsteroidal anti-inflammatory drug
D. Obtain a brain MRI before initiating therapy
Answer: B
Rationale: Giant cell arteritis is an emergency because untreated disease can cause
permanent visual loss. When clinical suspicion is high, glucocorticoid therapy
should be initiated promptly while confirmatory evaluation is pursued.
8. A 52-year-old woman has chronic diarrhea, abdominal bloating, and weight loss.
Laboratory testing demonstrates iron deficiency and low folate levels. Which
condition should be strongly considered?
A. Celiac disease
B. Irritable bowel syndrome
C. Lactose intolerance
D. Diverticulosis
Answer: A
Rationale: Celiac disease can cause malabsorption leading to chronic diarrhea,
weight loss, iron deficiency, folate deficiency, and other nutritional abnormalities.
The combination of gastrointestinal symptoms and multiple deficiencies warrants
evaluation for an underlying malabsorptive disorder.
NR 511: DIFFERENTIAL DIAGNOSIS & PRIMARY CARE
QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 58-year-old man presents with fatigue, decreased exercise tolerance, and
intermittent dizziness. He reports that his stools have been darker than usual for
several months but denies bright-red blood. Laboratory results show hemoglobin
9.6 g/dL, MCV 72 fL, and elevated RDW. Which additional finding would most
strongly support the suspected underlying cause?
A. Low serum ferritin
B. Elevated vitamin B12
C. Increased reticulocyte count
D. Elevated serum haptoglobin
Answer: A
Rationale: A low serum ferritin is strongly supportive of iron deficiency. In an
older adult with microcytic anemia and possible occult gastrointestinal blood loss,
the clinician should investigate for a gastrointestinal source rather than attributing
the anemia solely to dietary deficiency.
2. A 34-year-old woman reports episodic palpitations, tremulousness, sweating,
and a sensation of impending death. Episodes occur unexpectedly and peak within
approximately 10 minutes. Between episodes, she worries about experiencing
another attack. Physical examination and ECG are normal. Which diagnosis best
explains this presentation?
A. Generalized anxiety disorder
B. Panic disorder
C. Hyperthyroidism
D. Somatic symptom disorder
Answer: B
,Rationale: Panic disorder is characterized by recurrent unexpected panic attacks
followed by persistent concern about additional attacks or maladaptive behavioral
changes. The abrupt onset and rapid peak of autonomic and cognitive symptoms
are characteristic.
3. A 67-year-old patient presents with unilateral calf swelling and tenderness that
began after a long-distance flight. The affected leg is approximately 3 cm larger in
circumference than the opposite leg. Which diagnostic approach is most
appropriate?
A. Plain radiography of the lower leg
B. Venous duplex ultrasonography
C. Arterial Doppler study
D. MRI of the lumbar spine
Answer: B
Rationale: Venous duplex ultrasonography is the primary imaging study for
suspected lower-extremity deep vein thrombosis. Recent prolonged immobility
combined with unilateral swelling and tenderness increases clinical suspicion.
4. A 29-year-old woman reports recurrent episodes of wheezing and chest
tightness, particularly after exposure to cats and during exercise. Her baseline
spirometry is normal. Which finding would provide objective evidence supporting
asthma?
A. Persistent reduction in FEV1/FVC without reversibility
B. Significant improvement in airflow after bronchodilator administration
C. Reduced total lung capacity
D. Increased residual volume without symptom variability
Answer: B
,Rationale: Asthma is characterized by variable expiratory airflow limitation.
Demonstrable improvement in airflow following bronchodilator administration
supports reversible airway obstruction and helps distinguish asthma from fixed
obstructive disease.
5. A 45-year-old woman presents with progressive difficulty swallowing. Initially,
she had difficulty swallowing solid foods, but she now has difficulty with both
solids and liquids. Which mechanism is most consistent with this progression?
A. Mechanical obstruction
B. Esophageal motility disorder
C. Peptic ulcer disease
D. Gastric outlet obstruction
Answer: B
Rationale: Dysphagia initially limited to solids suggests a mechanical obstruction.
Dysphagia involving both solids and liquids, particularly as the condition
progresses, suggests an esophageal motility disorder such as achalasia.
6. A 62-year-old man reports urinary hesitancy, weak urinary stream,
intermittency, and nocturia. He denies dysuria, fever, and hematuria. Digital rectal
examination reveals a symmetrically enlarged, smooth prostate. Which diagnosis is
most likely?
A. Prostate cancer
B. Acute prostatitis
C. Benign prostatic hyperplasia
D. Urethral stricture
Answer: C
Rationale: Benign prostatic hyperplasia commonly produces lower urinary tract
symptoms through enlargement of the prostate surrounding the urethra. A smooth,
symmetrically enlarged prostate is typical.
, 7. A 71-year-old woman presents with new-onset headache localized to the
temporal region. She reports scalp tenderness when brushing her hair and transient
episodes of blurred vision. ESR and CRP are markedly elevated. What is the most
appropriate immediate management?
A. Schedule routine ophthalmology follow-up
B. Begin high-dose glucocorticoid therapy
C. Treat with a nonsteroidal anti-inflammatory drug
D. Obtain a brain MRI before initiating therapy
Answer: B
Rationale: Giant cell arteritis is an emergency because untreated disease can cause
permanent visual loss. When clinical suspicion is high, glucocorticoid therapy
should be initiated promptly while confirmatory evaluation is pursued.
8. A 52-year-old woman has chronic diarrhea, abdominal bloating, and weight loss.
Laboratory testing demonstrates iron deficiency and low folate levels. Which
condition should be strongly considered?
A. Celiac disease
B. Irritable bowel syndrome
C. Lactose intolerance
D. Diverticulosis
Answer: A
Rationale: Celiac disease can cause malabsorption leading to chronic diarrhea,
weight loss, iron deficiency, folate deficiency, and other nutritional abnormalities.
The combination of gastrointestinal symptoms and multiple deficiencies warrants
evaluation for an underlying malabsorptive disorder.
