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NR601 Primary Care of Adults Week 4 Midterm Exam –
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Comprehensive Practice Examination – 138 Questions width), Right: (Single solid line, Dark Red, 3 pt Line
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with Answers and Rationales
1. A 58-year-old male presents with a 3-month history of intermittent chest pain that occurs with
exertion and resolves with rest. Which of the following is the most likely diagnosis?
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
Correct Answer: A) Stable angina
Rationale: Stable angina is characterized by predictable chest pain that occurs with exertion and
resolves with rest or nitroglycerin. Unstable angina occurs at rest or with minimal exertion and
is unpredictable. Myocardial infarction presents with persistent pain and elevated troponin.
Pericarditis presents with pleuritic pain relieved by leaning forward.
2. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Which
of the following laboratory tests is most appropriate to order first?
A) TSH
B) Free T4
C) CBC
D) Comprehensive metabolic panel
Correct Answer: A) TSH
Rationale: TSH is the most sensitive initial test for evaluating thyroid dysfunction. In primary
hypothyroidism, TSH is elevated. Free T4 is used to confirm the diagnosis. CBC and CMP may be
ordered but are not the first-line tests for suspected hypothyroidism.
3. A 62-year-old male with a history of COPD presents with increased dyspnea, productive cough, and
wheezing. Which of the following is the most appropriate initial treatment?
A) Short-acting beta-agonist inhaler
B) Oral corticosteroids
,C) Antibiotics
D) Long-acting beta-agonist inhaler
Correct Answer: A) Short-acting beta-agonist inhaler
Rationale: Short-acting beta-agonists (e.g., albuterol) are the first-line treatment for acute
COPD exacerbations. Oral corticosteroids may be added for moderate-to-severe exacerbations.
Antibiotics are indicated if there is evidence of bacterial infection. Long-acting beta-agonists are
for maintenance therapy.
4. A 55-year-old female presents with a painless, firm breast mass. Which of the following is the most
appropriate next step?
A) Mammography
B) Ultrasound
C) Fine needle aspiration
D) MRI
Correct Answer: A) Mammography
Rationale: Mammography is the initial imaging study for a suspicious breast mass in women
over 40. Ultrasound may be used as an adjunct. Fine needle aspiration or biopsy is performed
after imaging. MRI is reserved for high-risk patients.
5. A 48-year-old male presents with a 2-week history of heartburn and regurgitation. Which of the
following is the most appropriate initial management?
A) Lifestyle modifications and proton pump inhibitor
B) H2 blocker
C) Antacid
D) Endoscopy
Correct Answer: A) Lifestyle modifications and proton pump inhibitor
Rationale: Lifestyle modifications (weight loss, avoiding trigger foods, elevating head of bed)
and a proton pump inhibitor are the initial management for GERD. H2 blockers and antacids are
less effective. Endoscopy is reserved for alarm symptoms or failure of empiric therapy.
6. A 70-year-old female presents with sudden onset of severe headache, neck stiffness, and
photophobia. Which of the following is the most appropriate next step?
A) CT scan of the head without contrast
B) Lumbar puncture
,C) MRI of the brain
D) Empiric antibiotics
Correct Answer: A) CT scan of the head without contrast
Rationale: CT scan without contrast is the initial imaging study to rule out subarachnoid
hemorrhage before lumbar puncture. If CT is negative and clinical suspicion remains high,
lumbar puncture is performed. MRI is more sensitive but less readily available. Empiric
antibiotics are appropriate for bacterial meningitis but diagnosis should be confirmed first.
7. A 35-year-old female presents with dysuria, frequency, and urgency. Which of the following is the
most appropriate initial management?
A) Urinalysis and empiric antibiotics
B) Urine culture and sensitivity
C) Renal ultrasound
D) CT scan of the abdomen
Correct Answer: A) Urinalysis and empiric antibiotics
Rationale: Uncomplicated UTI is diagnosed with urinalysis and treated empirically with
antibiotics. Urine culture is reserved for complicated or recurrent UTIs. Renal ultrasound and CT
are not indicated for uncomplicated UTI.
8. A 50-year-old male presents with a 6-month history of intermittent claudication. Which of the
following is the most appropriate initial test?
A) Ankle-brachial index
B) Doppler ultrasound
C) CT angiography
D) MRI angiography
Correct Answer: A) Ankle-brachial index
Rationale: Ankle-brachial index (ABI) is the initial non-invasive test for peripheral arterial
disease. ABI less than 0.9 is diagnostic. Doppler ultrasound, CT angiography, and MRI
angiography are used for further evaluation or planning intervention.
9. A 65-year-old female presents with a 3-day history of unilateral facial paralysis. Which of the
following is the most likely diagnosis?
A) Bell's palsy
B) Stroke
, C) Trigeminal neuralgia
D) Myasthenia gravis
Correct Answer: A) Bell's palsy
Rationale: Bell's palsy is an idiopathic facial nerve palsy that causes unilateral facial paralysis,
including the forehead. Stroke typically spares the forehead. Trigeminal neuralgia causes facial
pain. Myasthenia gravis causes generalized weakness.
10. A 42-year-old male presents with a 1-week history of low back pain after lifting heavy boxes.
Which of the following is the most appropriate initial management?
A) Conservative management with NSAIDs and activity modification
B) MRI of the lumbar spine
C) Opioid analgesics
D) Physical therapy referral
Correct Answer: A) Conservative management with NSAIDs and activity modification
Rationale: Acute mechanical low back pain without red flags is managed conservatively with
NSAIDs and activity modification. MRI is reserved for red flags (cauda equina, malignancy,
infection). Opioids are not first-line. Physical therapy may be beneficial but is not initial
management.
11. A 55-year-old female presents with a 2-month history of dry cough, fatigue, and weight loss. Chest
X-ray shows a solitary pulmonary nodule. Which of the following is the most appropriate next step?
A) CT scan of the chest
B) PET scan
C) Bronchoscopy
D) Repeat chest X-ray in 3 months
Correct Answer: A) CT scan of the chest
Rationale: CT scan of the chest is the next step to characterize a solitary pulmonary nodule. PET
scan may be used for further evaluation. Bronchoscopy is used for tissue diagnosis. Repeat chest
X-ray is not appropriate for a suspicious nodule.
12. A 60-year-old male presents with a 3-day history of severe epigastric pain radiating to the back.
Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Peptic ulcer disease
NR601 Primary Care of Adults Week 4 Midterm Exam –
Formatted: Centered
Actual Examplify Questions & Verified Solutions Formatted: Top: (Single solid line, Dark Red, 3 pt Line
width), Bottom: (Single solid line, Dark Red, 3 pt Line
width), Left: (Single solid line, Dark Red, 3 pt Line
Comprehensive Practice Examination – 138 Questions width), Right: (Single solid line, Dark Red, 3 pt Line
width)
with Answers and Rationales
1. A 58-year-old male presents with a 3-month history of intermittent chest pain that occurs with
exertion and resolves with rest. Which of the following is the most likely diagnosis?
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
Correct Answer: A) Stable angina
Rationale: Stable angina is characterized by predictable chest pain that occurs with exertion and
resolves with rest or nitroglycerin. Unstable angina occurs at rest or with minimal exertion and
is unpredictable. Myocardial infarction presents with persistent pain and elevated troponin.
Pericarditis presents with pleuritic pain relieved by leaning forward.
2. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Which
of the following laboratory tests is most appropriate to order first?
A) TSH
B) Free T4
C) CBC
D) Comprehensive metabolic panel
Correct Answer: A) TSH
Rationale: TSH is the most sensitive initial test for evaluating thyroid dysfunction. In primary
hypothyroidism, TSH is elevated. Free T4 is used to confirm the diagnosis. CBC and CMP may be
ordered but are not the first-line tests for suspected hypothyroidism.
3. A 62-year-old male with a history of COPD presents with increased dyspnea, productive cough, and
wheezing. Which of the following is the most appropriate initial treatment?
A) Short-acting beta-agonist inhaler
B) Oral corticosteroids
,C) Antibiotics
D) Long-acting beta-agonist inhaler
Correct Answer: A) Short-acting beta-agonist inhaler
Rationale: Short-acting beta-agonists (e.g., albuterol) are the first-line treatment for acute
COPD exacerbations. Oral corticosteroids may be added for moderate-to-severe exacerbations.
Antibiotics are indicated if there is evidence of bacterial infection. Long-acting beta-agonists are
for maintenance therapy.
4. A 55-year-old female presents with a painless, firm breast mass. Which of the following is the most
appropriate next step?
A) Mammography
B) Ultrasound
C) Fine needle aspiration
D) MRI
Correct Answer: A) Mammography
Rationale: Mammography is the initial imaging study for a suspicious breast mass in women
over 40. Ultrasound may be used as an adjunct. Fine needle aspiration or biopsy is performed
after imaging. MRI is reserved for high-risk patients.
5. A 48-year-old male presents with a 2-week history of heartburn and regurgitation. Which of the
following is the most appropriate initial management?
A) Lifestyle modifications and proton pump inhibitor
B) H2 blocker
C) Antacid
D) Endoscopy
Correct Answer: A) Lifestyle modifications and proton pump inhibitor
Rationale: Lifestyle modifications (weight loss, avoiding trigger foods, elevating head of bed)
and a proton pump inhibitor are the initial management for GERD. H2 blockers and antacids are
less effective. Endoscopy is reserved for alarm symptoms or failure of empiric therapy.
6. A 70-year-old female presents with sudden onset of severe headache, neck stiffness, and
photophobia. Which of the following is the most appropriate next step?
A) CT scan of the head without contrast
B) Lumbar puncture
,C) MRI of the brain
D) Empiric antibiotics
Correct Answer: A) CT scan of the head without contrast
Rationale: CT scan without contrast is the initial imaging study to rule out subarachnoid
hemorrhage before lumbar puncture. If CT is negative and clinical suspicion remains high,
lumbar puncture is performed. MRI is more sensitive but less readily available. Empiric
antibiotics are appropriate for bacterial meningitis but diagnosis should be confirmed first.
7. A 35-year-old female presents with dysuria, frequency, and urgency. Which of the following is the
most appropriate initial management?
A) Urinalysis and empiric antibiotics
B) Urine culture and sensitivity
C) Renal ultrasound
D) CT scan of the abdomen
Correct Answer: A) Urinalysis and empiric antibiotics
Rationale: Uncomplicated UTI is diagnosed with urinalysis and treated empirically with
antibiotics. Urine culture is reserved for complicated or recurrent UTIs. Renal ultrasound and CT
are not indicated for uncomplicated UTI.
8. A 50-year-old male presents with a 6-month history of intermittent claudication. Which of the
following is the most appropriate initial test?
A) Ankle-brachial index
B) Doppler ultrasound
C) CT angiography
D) MRI angiography
Correct Answer: A) Ankle-brachial index
Rationale: Ankle-brachial index (ABI) is the initial non-invasive test for peripheral arterial
disease. ABI less than 0.9 is diagnostic. Doppler ultrasound, CT angiography, and MRI
angiography are used for further evaluation or planning intervention.
9. A 65-year-old female presents with a 3-day history of unilateral facial paralysis. Which of the
following is the most likely diagnosis?
A) Bell's palsy
B) Stroke
, C) Trigeminal neuralgia
D) Myasthenia gravis
Correct Answer: A) Bell's palsy
Rationale: Bell's palsy is an idiopathic facial nerve palsy that causes unilateral facial paralysis,
including the forehead. Stroke typically spares the forehead. Trigeminal neuralgia causes facial
pain. Myasthenia gravis causes generalized weakness.
10. A 42-year-old male presents with a 1-week history of low back pain after lifting heavy boxes.
Which of the following is the most appropriate initial management?
A) Conservative management with NSAIDs and activity modification
B) MRI of the lumbar spine
C) Opioid analgesics
D) Physical therapy referral
Correct Answer: A) Conservative management with NSAIDs and activity modification
Rationale: Acute mechanical low back pain without red flags is managed conservatively with
NSAIDs and activity modification. MRI is reserved for red flags (cauda equina, malignancy,
infection). Opioids are not first-line. Physical therapy may be beneficial but is not initial
management.
11. A 55-year-old female presents with a 2-month history of dry cough, fatigue, and weight loss. Chest
X-ray shows a solitary pulmonary nodule. Which of the following is the most appropriate next step?
A) CT scan of the chest
B) PET scan
C) Bronchoscopy
D) Repeat chest X-ray in 3 months
Correct Answer: A) CT scan of the chest
Rationale: CT scan of the chest is the next step to characterize a solitary pulmonary nodule. PET
scan may be used for further evaluation. Bronchoscopy is used for tissue diagnosis. Repeat chest
X-ray is not appropriate for a suspicious nodule.
12. A 60-year-old male presents with a 3-day history of severe epigastric pain radiating to the back.
Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Peptic ulcer disease
