Final Exam 2- NR511 / NR 511 (Latest ) :
Differential Diagnosis & Primary Care Practicum –
Chamberlain College Of Nursing
1. A 45-year-old male presents with sudden-onset severe epigastric pain
radiating to the back, nausea, and vomiting. His lipase level is elevated. What is
the most likely diagnosis?
Acute pancreatitis
Rationale: The classic presentation of acute pancreatitis includes severe
epigastric pain radiating to the back, nausea, vomiting, and elevated pancreatic
enzymes such as lipase.
2. A 32-year-old woman presents with fatigue, weight gain, constipation, and
cold intolerance. Her TSH is elevated and free T4 is low. What is the most likely
diagnosis?
Primary hypothyroidism
Rationale: Elevated TSH and low free T4 indicate primary hypothyroidism,
where the thyroid gland is underactive.
3. A 64-year-old man with a 40 pack-year smoking history presents with a new
cough and hemoptysis. What is the next best diagnostic step?
Chest X-ray
,Rationale: A new cough with hemoptysis in a high-risk patient (smoker) should
be evaluated promptly with a chest X-ray to rule out lung cancer or other
pulmonary pathology.
4. Which of the following physical exam findings is most consistent with mitral
regurgitation?
Holosystolic murmur best heard at the apex, radiating to the axilla
Rationale: A holosystolic murmur at the apex radiating to the axilla is the
hallmark finding of mitral regurgitation.
5. A patient with a sore throat, fever, and anterior cervical lymphadenopathy
presents. Which clinical tool helps determine the need for antibiotics?
Centor criteria
Rationale: The Centor criteria help determine the likelihood of streptococcal
pharyngitis and the need for antibiotic therapy.
6. A 27-year-old female presents with dysuria, frequency, and urgency.
Urinalysis reveals positive leukocyte esterase and nitrites. What is the most
appropriate management?
Start empiric antibiotics for uncomplicated UTI
Rationale: This clinical presentation and urinalysis findings are consistent with a
urinary tract infection, and empiric treatment is warranted.
7. What is the most appropriate next step in evaluating a breast lump in a 25-
year-old woman?
Ultrasound of the breast
Rationale: In women under 30, ultrasound is the preferred initial imaging
modality for evaluating a palpable breast mass.
, 8. A 55-year-old male with a history of hypertension presents with a severe
"tearing" chest pain radiating to the back. Blood pressure is unequal in both
arms. What is the most likely diagnosis?
Aortic dissection
Rationale: Sudden severe chest pain with radiation to the back and unequal arm
BPs are classic findings for aortic dissection.
9. Which of the following is the first-line pharmacologic treatment for
generalized anxiety disorder?
Selective serotonin reuptake inhibitors (SSRIs)
Rationale: SSRIs are the first-line pharmacological agents for managing
generalized anxiety disorder due to their efficacy and safety profile.
10. A 48-year-old female presents with recurrent episodes of vertigo, hearing
loss, and tinnitus. What is the most likely diagnosis?
Meniere's disease
Rationale: Meniere's disease is characterized by episodic vertigo, fluctuating
hearing loss, tinnitus, and aural fullness.
11. A 62-year-old male presents with gradual onset fatigue and dark tarry
stools. What is the most likely source of his GI bleeding?
Upper gastrointestinal tract
Rationale: Melena (black, tarry stools) typically indicates bleeding from the
upper GI tract, often above the ligament of Treitz.
12. A 23-year-old woman presents with lower abdominal pain and cervical
motion tenderness. What is the most likely diagnosis?
Differential Diagnosis & Primary Care Practicum –
Chamberlain College Of Nursing
1. A 45-year-old male presents with sudden-onset severe epigastric pain
radiating to the back, nausea, and vomiting. His lipase level is elevated. What is
the most likely diagnosis?
Acute pancreatitis
Rationale: The classic presentation of acute pancreatitis includes severe
epigastric pain radiating to the back, nausea, vomiting, and elevated pancreatic
enzymes such as lipase.
2. A 32-year-old woman presents with fatigue, weight gain, constipation, and
cold intolerance. Her TSH is elevated and free T4 is low. What is the most likely
diagnosis?
Primary hypothyroidism
Rationale: Elevated TSH and low free T4 indicate primary hypothyroidism,
where the thyroid gland is underactive.
3. A 64-year-old man with a 40 pack-year smoking history presents with a new
cough and hemoptysis. What is the next best diagnostic step?
Chest X-ray
,Rationale: A new cough with hemoptysis in a high-risk patient (smoker) should
be evaluated promptly with a chest X-ray to rule out lung cancer or other
pulmonary pathology.
4. Which of the following physical exam findings is most consistent with mitral
regurgitation?
Holosystolic murmur best heard at the apex, radiating to the axilla
Rationale: A holosystolic murmur at the apex radiating to the axilla is the
hallmark finding of mitral regurgitation.
5. A patient with a sore throat, fever, and anterior cervical lymphadenopathy
presents. Which clinical tool helps determine the need for antibiotics?
Centor criteria
Rationale: The Centor criteria help determine the likelihood of streptococcal
pharyngitis and the need for antibiotic therapy.
6. A 27-year-old female presents with dysuria, frequency, and urgency.
Urinalysis reveals positive leukocyte esterase and nitrites. What is the most
appropriate management?
Start empiric antibiotics for uncomplicated UTI
Rationale: This clinical presentation and urinalysis findings are consistent with a
urinary tract infection, and empiric treatment is warranted.
7. What is the most appropriate next step in evaluating a breast lump in a 25-
year-old woman?
Ultrasound of the breast
Rationale: In women under 30, ultrasound is the preferred initial imaging
modality for evaluating a palpable breast mass.
, 8. A 55-year-old male with a history of hypertension presents with a severe
"tearing" chest pain radiating to the back. Blood pressure is unequal in both
arms. What is the most likely diagnosis?
Aortic dissection
Rationale: Sudden severe chest pain with radiation to the back and unequal arm
BPs are classic findings for aortic dissection.
9. Which of the following is the first-line pharmacologic treatment for
generalized anxiety disorder?
Selective serotonin reuptake inhibitors (SSRIs)
Rationale: SSRIs are the first-line pharmacological agents for managing
generalized anxiety disorder due to their efficacy and safety profile.
10. A 48-year-old female presents with recurrent episodes of vertigo, hearing
loss, and tinnitus. What is the most likely diagnosis?
Meniere's disease
Rationale: Meniere's disease is characterized by episodic vertigo, fluctuating
hearing loss, tinnitus, and aural fullness.
11. A 62-year-old male presents with gradual onset fatigue and dark tarry
stools. What is the most likely source of his GI bleeding?
Upper gastrointestinal tract
Rationale: Melena (black, tarry stools) typically indicates bleeding from the
upper GI tract, often above the ligament of Treitz.
12. A 23-year-old woman presents with lower abdominal pain and cervical
motion tenderness. What is the most likely diagnosis?
