NR 511 Final Exam Differential Diagnosis
NR 511 Final Exam Differential Diagnosis
NR 511 Final Exam Differential Diagnosis
Accurate Exam Coverage Area with Main Topic and
Subtopics (Mostly Tested Recent Coverage Areas)
1. Diagnostic Reasoning and Evidence-Based Practice: Hypothesis generation,
illness scripts versus disease prototypes, sensitivity/specificity/predictive
values, Bayesian pretest probability, cognitive biases (anchoring, premature
closure), Murtagh's red flag strategy, OLDCARTS/OPQRST mnemonics.
2. Dermatology: Erythema migrans (Lyme disease), atopic dermatitis, psoriasis,
tinea infections, herpes zoster dermatomal presentation, ABCDE melanoma
screening, basal cell carcinoma, cellulitis versus contact dermatitis.
3. HEENT (Eye, Ear, Nose, Throat): Red eye differential (conjunctivitis, keratitis,
uveitis, glaucoma), otitis externa versus media, cerumen impaction, BPPV/Dix-
Hallpike, sinusitis, pharyngitis versus mononucleosis, peritonsillar abscess red
flags, epistaxis management.
4. Cardiovascular: Acute coronary syndrome classic versus atypical
presentations, heart failure (S3 gallop, JVD, BNP), pericarditis positional pain,
aortic dissection tearing pain with pulse deficit.
, 5. Respiratory: COPD versus heart failure dyspnea differentiation, pneumonia
focal findings, hemoptysis differential (epistaxis versus hematemesis),
pulmonary embolism risk factors.
6. Gastrointestinal: Irritable bowel syndrome (Rome criteria, absence of alarm
features), inflammatory bowel disease red flags (bloody diarrhea, elevated
ESR), GERD empiric therapy, pancreatitis radiation to back relieved by leaning
forward, diverticulitis LLQ pain and imaging, Barrett's esophagus surveillance.
7. Genitourinary and Male Reproductive: Benign prostatic hyperplasia (nocturia,
hesitancy, weak stream), urinary tract infection versus pyelonephritis, prostate
cancer screening distinctions, testicular torsion time-sensitive presentation.
8. Musculoskeletal: Ottawa Ankle Rules, low back pain red flags (history of
cancer, night pain, neurologic deficits, bowel/bladder dysfunction), herniated
disc initial management, ankle sprain versus fracture.
9. Endocrine and Metabolic: Primary hypothyroidism (elevated TSH, low free T4)
versus subclinical (elevated TSH, normal free T4) versus central (low TSH, low
free T4), hyperthyroidism signs (heat intolerance, weight loss, tremor), diabetes
diagnostic criteria.
10. Neurologic and Psychiatric: Delirium versus dementia onset and fluctuation,
meningitis signs (Kernig, Brudzinski, nuchal rigidity), migraine versus tension
headache, depression screening in primary care.
NR 511 Final Exam Differential Diagnosis
,250 Multiple-Choice Questions with Answers and
Rationales
1. A 28-year-old woman reports six months of crampy lower abdominal pain
relieved by defecation, alternating diarrhea and constipation, and denies weight
loss or nocturnal symptoms; which diagnosis is most likely?
A. Crohn's disease
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Celiac disease
Answer: C
Rationale: IBS is a functional bowel disorder characterized by chronic abdominal
pain associated with defecation and changes in stool form, without alarm features
such as weight loss, bleeding, or nocturnal symptoms; inflammatory bowel
diseases typically exhibit those alarm features . 5
2. A 55-year-old man presents with nocturia, urinary hesitancy, and a weak
urinary stream over the past year; which condition should be placed at the top of
the differential diagnosis?
A. Prostate cancer
B. Benign prostatic hyperplasia
C. Acute urinary tract infection
D. Ureteral kidney stone
, Answer: B
Rationale: Nocturia, hesitancy, and a weak stream are classic lower urinary tract
symptoms of benign prostatic hyperplasia, whereas prostate cancer is often
asymptomatic or presents with hard nodules or elevated PSA, and UTI causes
dysuria and urgency . 5
3. A 62-year-old smoker reports coughing up small amounts of blood; which of
the following should also be considered in the differential diagnosis before
labeling it as true hemoptysis?
A. Epistaxis with posterior drainage and upper gastrointestinal bleeding
B. Acute bronchitis and community-acquired pneumonia only
C. Pulmonary embolism and tuberculosis only
D. Bronchogenic carcinoma and bronchiectasis only
Answer: A
Rationale: Hemoptysis can be confused with epistaxis where blood drains
posteriorly into the pharynx and with hematemesis from an upper GI bleed, so
both must be excluded through focused history and examination before attributing
the blood to the respiratory tract . 5
4. A 45-year-old patient presents with epigastric pain that radiates to the back
and is notably relieved by leaning forward; which diagnosis does this pattern
most strongly suggest?
A. Peptic ulcer disease
B. Acute pancreatitis
NR 511 Final Exam Differential Diagnosis
NR 511 Final Exam Differential Diagnosis
Accurate Exam Coverage Area with Main Topic and
Subtopics (Mostly Tested Recent Coverage Areas)
1. Diagnostic Reasoning and Evidence-Based Practice: Hypothesis generation,
illness scripts versus disease prototypes, sensitivity/specificity/predictive
values, Bayesian pretest probability, cognitive biases (anchoring, premature
closure), Murtagh's red flag strategy, OLDCARTS/OPQRST mnemonics.
2. Dermatology: Erythema migrans (Lyme disease), atopic dermatitis, psoriasis,
tinea infections, herpes zoster dermatomal presentation, ABCDE melanoma
screening, basal cell carcinoma, cellulitis versus contact dermatitis.
3. HEENT (Eye, Ear, Nose, Throat): Red eye differential (conjunctivitis, keratitis,
uveitis, glaucoma), otitis externa versus media, cerumen impaction, BPPV/Dix-
Hallpike, sinusitis, pharyngitis versus mononucleosis, peritonsillar abscess red
flags, epistaxis management.
4. Cardiovascular: Acute coronary syndrome classic versus atypical
presentations, heart failure (S3 gallop, JVD, BNP), pericarditis positional pain,
aortic dissection tearing pain with pulse deficit.
, 5. Respiratory: COPD versus heart failure dyspnea differentiation, pneumonia
focal findings, hemoptysis differential (epistaxis versus hematemesis),
pulmonary embolism risk factors.
6. Gastrointestinal: Irritable bowel syndrome (Rome criteria, absence of alarm
features), inflammatory bowel disease red flags (bloody diarrhea, elevated
ESR), GERD empiric therapy, pancreatitis radiation to back relieved by leaning
forward, diverticulitis LLQ pain and imaging, Barrett's esophagus surveillance.
7. Genitourinary and Male Reproductive: Benign prostatic hyperplasia (nocturia,
hesitancy, weak stream), urinary tract infection versus pyelonephritis, prostate
cancer screening distinctions, testicular torsion time-sensitive presentation.
8. Musculoskeletal: Ottawa Ankle Rules, low back pain red flags (history of
cancer, night pain, neurologic deficits, bowel/bladder dysfunction), herniated
disc initial management, ankle sprain versus fracture.
9. Endocrine and Metabolic: Primary hypothyroidism (elevated TSH, low free T4)
versus subclinical (elevated TSH, normal free T4) versus central (low TSH, low
free T4), hyperthyroidism signs (heat intolerance, weight loss, tremor), diabetes
diagnostic criteria.
10. Neurologic and Psychiatric: Delirium versus dementia onset and fluctuation,
meningitis signs (Kernig, Brudzinski, nuchal rigidity), migraine versus tension
headache, depression screening in primary care.
NR 511 Final Exam Differential Diagnosis
,250 Multiple-Choice Questions with Answers and
Rationales
1. A 28-year-old woman reports six months of crampy lower abdominal pain
relieved by defecation, alternating diarrhea and constipation, and denies weight
loss or nocturnal symptoms; which diagnosis is most likely?
A. Crohn's disease
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Celiac disease
Answer: C
Rationale: IBS is a functional bowel disorder characterized by chronic abdominal
pain associated with defecation and changes in stool form, without alarm features
such as weight loss, bleeding, or nocturnal symptoms; inflammatory bowel
diseases typically exhibit those alarm features . 5
2. A 55-year-old man presents with nocturia, urinary hesitancy, and a weak
urinary stream over the past year; which condition should be placed at the top of
the differential diagnosis?
A. Prostate cancer
B. Benign prostatic hyperplasia
C. Acute urinary tract infection
D. Ureteral kidney stone
, Answer: B
Rationale: Nocturia, hesitancy, and a weak stream are classic lower urinary tract
symptoms of benign prostatic hyperplasia, whereas prostate cancer is often
asymptomatic or presents with hard nodules or elevated PSA, and UTI causes
dysuria and urgency . 5
3. A 62-year-old smoker reports coughing up small amounts of blood; which of
the following should also be considered in the differential diagnosis before
labeling it as true hemoptysis?
A. Epistaxis with posterior drainage and upper gastrointestinal bleeding
B. Acute bronchitis and community-acquired pneumonia only
C. Pulmonary embolism and tuberculosis only
D. Bronchogenic carcinoma and bronchiectasis only
Answer: A
Rationale: Hemoptysis can be confused with epistaxis where blood drains
posteriorly into the pharynx and with hematemesis from an upper GI bleed, so
both must be excluded through focused history and examination before attributing
the blood to the respiratory tract . 5
4. A 45-year-old patient presents with epigastric pain that radiates to the back
and is notably relieved by leaning forward; which diagnosis does this pattern
most strongly suggest?
A. Peptic ulcer disease
B. Acute pancreatitis
