NR601 Adult Primary Care Week 6 Final Exam Case Studies
& Rationales
Practice Exam –
1. A 58-year-old male presents with a 3-month history of nocturia, urinary hesitancy, and a weak
urinary stream. Digital rectal exam reveals a smooth, enlarged, non-tender prostate. Which
condition is most likely?
A. Prostate cancer
B. Benign prostatic hyperplasia (BPH)
C. Prostatitis
D. Urinary tract infection
Correct Answer: B
Rationale: BPH classically presents with lower urinary tract symptoms (nocturia,
hesitancy, weak stream) and a smooth, enlarged, non-tender prostate on DRE.
Prostate cancer typically presents with a hard, nodular prostate. Prostatitis
presents with a tender, boggy prostate and systemic symptoms.
2. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. TSH
is elevated, and free T4 is low. Which is the most appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine
D. Propranolol
Correct Answer: B
Rationale: The presentation is consistent with hypothyroidism (elevated TSH,
low free T4). Levothyroxine is the standard replacement therapy. Methimazole,
radioactive iodine, and propranolol are used for hyperthyroidism.
3. A 62-year-old male with a history of hypertension and diabetes presents with a blood pressure of
158/94 mmHg on two separate visits. Which is the most appropriate initial antihypertensive class?
,A. ACE inhibitor
B. Beta-blocker
C. Calcium channel blocker
D. Thiazide diuretic
Correct Answer: A
Rationale: In a diabetic patient with hypertension, ACE inhibitors (or ARBs) are
first-line due to their renoprotective effects. They reduce proteinuria and slow the
progression of diabetic nephropathy.
4. A 35-year-old female presents with a 2-day history of dysuria, urinary frequency, and suprapubic
discomfort. Urinalysis shows positive leukocyte esterase and nitrites. Which is the most
appropriate treatment?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin
D. Doxycycline
Correct Answer: A
Rationale: Uncomplicated urinary tract infection (UTI) in a healthy non-pregnant
female is treated with nitrofurantoin or trimethoprim-sulfamethoxazole.
Fluoroquinolones are reserved for complicated UTIs. Amoxicillin has high
resistance rates. Doxycycline is not first-line.
5. A 70-year-old male presents with sudden onset of severe, tearing chest pain radiating to the
back. Blood pressure is 180/100 mmHg, and pulses are unequal in the arms. Which is the most
likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Sudden, severe, tearing chest pain radiating to the back with unequal
pulses and hypertension is classic for aortic dissection. MI typically presents
, with substernal pressure. PE presents with dyspnea and pleuritic pain.
Pericarditis presents with positional pain and a friction rub.
6. A 28-year-old female presents with a 3-day history of severe unilateral headache, nausea, and
photophobia. She reports similar episodes in the past. Which is the most likely diagnosis?
A. Tension headache
B. Migraine headache
C. Cluster headache
D. Sinus headache
Correct Answer: B
Rationale: Migraine headaches are typically unilateral, pulsating, associated with
nausea, photophobia, and phonophobia. Tension headaches are bilateral and
pressing. Cluster headaches are severe, unilateral, periorbital, and associated
with autonomic symptoms. Sinus headaches are associated with sinus
congestion.
7. A 55-year-old male with a 40-pack-year smoking history presents with a chronic cough and
weight loss. Chest X-ray shows a hilar mass. Which is the most likely diagnosis?
A. Tuberculosis
B. Lung cancer
C. COPD
D. Pneumonia
Correct Answer: B
Rationale: A hilar mass in a long-term smoker with chronic cough and weight
loss is highly suspicious for lung cancer. TB presents with fever, night sweats,
and upper lobe infiltrates. COPD presents with chronic dyspnea and
hyperinflation. Pneumonia presents with acute fever and consolidation.
8. A 42-year-old female presents with fatigue, palpitations, and heat intolerance. TSH is low, and
free T4 is elevated. Which is the most appropriate initial diagnostic test?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
& Rationales
Practice Exam –
1. A 58-year-old male presents with a 3-month history of nocturia, urinary hesitancy, and a weak
urinary stream. Digital rectal exam reveals a smooth, enlarged, non-tender prostate. Which
condition is most likely?
A. Prostate cancer
B. Benign prostatic hyperplasia (BPH)
C. Prostatitis
D. Urinary tract infection
Correct Answer: B
Rationale: BPH classically presents with lower urinary tract symptoms (nocturia,
hesitancy, weak stream) and a smooth, enlarged, non-tender prostate on DRE.
Prostate cancer typically presents with a hard, nodular prostate. Prostatitis
presents with a tender, boggy prostate and systemic symptoms.
2. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. TSH
is elevated, and free T4 is low. Which is the most appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine
D. Propranolol
Correct Answer: B
Rationale: The presentation is consistent with hypothyroidism (elevated TSH,
low free T4). Levothyroxine is the standard replacement therapy. Methimazole,
radioactive iodine, and propranolol are used for hyperthyroidism.
3. A 62-year-old male with a history of hypertension and diabetes presents with a blood pressure of
158/94 mmHg on two separate visits. Which is the most appropriate initial antihypertensive class?
,A. ACE inhibitor
B. Beta-blocker
C. Calcium channel blocker
D. Thiazide diuretic
Correct Answer: A
Rationale: In a diabetic patient with hypertension, ACE inhibitors (or ARBs) are
first-line due to their renoprotective effects. They reduce proteinuria and slow the
progression of diabetic nephropathy.
4. A 35-year-old female presents with a 2-day history of dysuria, urinary frequency, and suprapubic
discomfort. Urinalysis shows positive leukocyte esterase and nitrites. Which is the most
appropriate treatment?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin
D. Doxycycline
Correct Answer: A
Rationale: Uncomplicated urinary tract infection (UTI) in a healthy non-pregnant
female is treated with nitrofurantoin or trimethoprim-sulfamethoxazole.
Fluoroquinolones are reserved for complicated UTIs. Amoxicillin has high
resistance rates. Doxycycline is not first-line.
5. A 70-year-old male presents with sudden onset of severe, tearing chest pain radiating to the
back. Blood pressure is 180/100 mmHg, and pulses are unequal in the arms. Which is the most
likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Sudden, severe, tearing chest pain radiating to the back with unequal
pulses and hypertension is classic for aortic dissection. MI typically presents
, with substernal pressure. PE presents with dyspnea and pleuritic pain.
Pericarditis presents with positional pain and a friction rub.
6. A 28-year-old female presents with a 3-day history of severe unilateral headache, nausea, and
photophobia. She reports similar episodes in the past. Which is the most likely diagnosis?
A. Tension headache
B. Migraine headache
C. Cluster headache
D. Sinus headache
Correct Answer: B
Rationale: Migraine headaches are typically unilateral, pulsating, associated with
nausea, photophobia, and phonophobia. Tension headaches are bilateral and
pressing. Cluster headaches are severe, unilateral, periorbital, and associated
with autonomic symptoms. Sinus headaches are associated with sinus
congestion.
7. A 55-year-old male with a 40-pack-year smoking history presents with a chronic cough and
weight loss. Chest X-ray shows a hilar mass. Which is the most likely diagnosis?
A. Tuberculosis
B. Lung cancer
C. COPD
D. Pneumonia
Correct Answer: B
Rationale: A hilar mass in a long-term smoker with chronic cough and weight
loss is highly suspicious for lung cancer. TB presents with fever, night sweats,
and upper lobe infiltrates. COPD presents with chronic dyspnea and
hyperinflation. Pneumonia presents with acute fever and consolidation.
8. A 42-year-old female presents with fatigue, palpitations, and heat intolerance. TSH is low, and
free T4 is elevated. Which is the most appropriate initial diagnostic test?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
