NR 511/ NR511 (LATEST / 2026 UPDATE) DIFFERENTIAL DIAGNOSIS
AND PRIMARY CARE PRACTICUM GUIDE|160 QUESTIONS &
ANSWERS| GRADE A+| 100% CORRECT (VERIFIED SOLUTIONS)-
CHAMBERLAIN, GUARANTEED PASS
Question 1
A 55-year-old patient with a 30-year history of smoking presents with a chronic
productive cough lasting 4 months per year for the past 2 years. What is the most
likely diagnosis?
A. Asthma
B. Chronic bronchitis (COPD)
C. Lung cancer
D. Tuberculosis
Correct Answer: B. Chronic bronchitis (COPD)
Rationale:
Chronic bronchitis is defined as a productive cough that lasts for at least three
months per year over two consecutive years. The patient’s long history of smoking
is a significant risk factor for developing COPD. Asthma typically presents with
episodic symptoms and wheezing rather than a persistent productive cough. Lung
cancer may present with weight loss, hemoptysis, or localized pulmonary findings,
which are not described in this patient. Tuberculosis often presents with systemic
symptoms such as fever, night sweats, and hemoptysis, making chronic bronchitis
the most likely diagnosis.
Question 2
A 30-year-old woman presents with sudden severe right lower quadrant abdominal
pain, nausea, and rebound tenderness. What is the priority differential diagnosis?
,A. Acute appendicitis
B. Ectopic pregnancy
C. Ovarian cyst rupture
D. Gastroenteritis
Correct Answer: A. Acute appendicitis
Rationale:
Acute appendicitis is suggested by the classic presentation of right lower quadrant
pain, nausea, and rebound tenderness. While ectopic pregnancy is a critical
consideration in women of childbearing age and should be ruled out with a
pregnancy test, the acute abdominal presentation aligns most closely with
appendicitis. Ovarian cyst rupture can cause sudden pain but usually lacks the
systemic signs and localized rebound tenderness characteristic of appendicitis.
Gastroenteritis generally produces diffuse abdominal pain accompanied by
diarrhea and does not typically present with isolated rebound tenderness.
Question 3
A patient presents with fatigue, pallor, and spoon-shaped nails. Laboratory tests
reveal low hemoglobin and low ferritin. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Hemolytic anemia
D. Thalassemia
Correct Answer: A. Iron deficiency anemia
Rationale:
The clinical features of fatigue, pallor, and koilonychia (spoon-shaped nails) are
indicative of iron deficiency anemia. Low hemoglobin and low ferritin levels
confirm the diagnosis. Vitamin B12 deficiency typically results in macrocytic
anemia and neurological symptoms, which are not reported here. Hemolytic
anemia usually presents with jaundice, elevated reticulocyte count, and hemolysis
markers. Thalassemia is a genetic disorder presenting with microcytosis and often
a family history of anemia. Therefore, the most consistent diagnosis is iron
deficiency anemia.
,Question 4
A 65-year-old patient is newly diagnosed with hypertension. Which is the most
appropriate initial management?
A. Lifestyle modification plus ACE inhibitor
B. Immediate beta-blocker only
C. Diuretic therapy only
D. No treatment needed
Correct Answer: A. Lifestyle modification plus ACE inhibitor
Rationale:
First-line management for hypertension includes lifestyle modifications such as
dietary changes, increased physical activity, weight management, and moderation
of alcohol intake. Pharmacologic therapy with an ACE inhibitor is appropriate as it
is commonly recommended for initial treatment unless contraindicated. Beta-
blockers are not first-line therapy for uncomplicated hypertension but may be used
if there are specific comorbidities such as coronary artery disease. Diuretics alone
may be used but are usually combined with lifestyle modification. Untreated
hypertension increases the risk of cardiovascular and renal complications, so no
treatment is not appropriate.
Question 5
What is the best initial test for diagnosing type 2 diabetes in an asymptomatic
adult?
A. Random plasma glucose
B. Fasting plasma glucose
C. Oral glucose tolerance test
D. HbA1c only
Correct Answer: B. Fasting plasma glucose
Rationale:
Fasting plasma glucose is the preferred initial screening test for type 2 diabetes in
asymptomatic adults because it is cost-effective, widely available, and meets
, established diagnostic criteria. While HbA1c testing can also be used for diagnosis,
it may require confirmation if results are borderline. The oral glucose tolerance test
is more sensitive but is generally reserved for specific cases such as gestational
diabetes or when initial screening results are inconclusive. Random plasma glucose
alone is insufficient for screening asymptomatic patients and cannot reliably
confirm a diagnosis.
Question 6
A 40-year-old patient presents with acute-onset shortness of breath, pleuritic chest
pain, and tachycardia. What is the most likely cause?
A. Myocardial infarction
B. Pulmonary embolism
C. Pneumonia
D. Asthma exacerbation
Correct Answer: B. Pulmonary embolism
Rationale:
Pulmonary embolism (PE) should be suspected in patients with sudden onset
dyspnea, pleuritic chest pain, and tachycardia, especially if there are risk factors
such as recent surgery, immobility, or use of oral contraceptives. Myocardial
infarction typically presents with pressure-like chest pain radiating to the arm or
jaw and may have ECG changes. Pneumonia usually develops more gradually and
is accompanied by fever, productive cough, and infiltrates on chest imaging.
Asthma exacerbation presents with wheezing and history of chronic asthma rather
than acute pleuritic pain. Prompt diagnosis with CT pulmonary angiography is
essential.
Question 7
A patient presents with chronic diarrhea and unintentional weight loss. Which
condition should be considered first?
A. Irritable bowel syndrome
B. Inflammatory bowel disease
AND PRIMARY CARE PRACTICUM GUIDE|160 QUESTIONS &
ANSWERS| GRADE A+| 100% CORRECT (VERIFIED SOLUTIONS)-
CHAMBERLAIN, GUARANTEED PASS
Question 1
A 55-year-old patient with a 30-year history of smoking presents with a chronic
productive cough lasting 4 months per year for the past 2 years. What is the most
likely diagnosis?
A. Asthma
B. Chronic bronchitis (COPD)
C. Lung cancer
D. Tuberculosis
Correct Answer: B. Chronic bronchitis (COPD)
Rationale:
Chronic bronchitis is defined as a productive cough that lasts for at least three
months per year over two consecutive years. The patient’s long history of smoking
is a significant risk factor for developing COPD. Asthma typically presents with
episodic symptoms and wheezing rather than a persistent productive cough. Lung
cancer may present with weight loss, hemoptysis, or localized pulmonary findings,
which are not described in this patient. Tuberculosis often presents with systemic
symptoms such as fever, night sweats, and hemoptysis, making chronic bronchitis
the most likely diagnosis.
Question 2
A 30-year-old woman presents with sudden severe right lower quadrant abdominal
pain, nausea, and rebound tenderness. What is the priority differential diagnosis?
,A. Acute appendicitis
B. Ectopic pregnancy
C. Ovarian cyst rupture
D. Gastroenteritis
Correct Answer: A. Acute appendicitis
Rationale:
Acute appendicitis is suggested by the classic presentation of right lower quadrant
pain, nausea, and rebound tenderness. While ectopic pregnancy is a critical
consideration in women of childbearing age and should be ruled out with a
pregnancy test, the acute abdominal presentation aligns most closely with
appendicitis. Ovarian cyst rupture can cause sudden pain but usually lacks the
systemic signs and localized rebound tenderness characteristic of appendicitis.
Gastroenteritis generally produces diffuse abdominal pain accompanied by
diarrhea and does not typically present with isolated rebound tenderness.
Question 3
A patient presents with fatigue, pallor, and spoon-shaped nails. Laboratory tests
reveal low hemoglobin and low ferritin. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Hemolytic anemia
D. Thalassemia
Correct Answer: A. Iron deficiency anemia
Rationale:
The clinical features of fatigue, pallor, and koilonychia (spoon-shaped nails) are
indicative of iron deficiency anemia. Low hemoglobin and low ferritin levels
confirm the diagnosis. Vitamin B12 deficiency typically results in macrocytic
anemia and neurological symptoms, which are not reported here. Hemolytic
anemia usually presents with jaundice, elevated reticulocyte count, and hemolysis
markers. Thalassemia is a genetic disorder presenting with microcytosis and often
a family history of anemia. Therefore, the most consistent diagnosis is iron
deficiency anemia.
,Question 4
A 65-year-old patient is newly diagnosed with hypertension. Which is the most
appropriate initial management?
A. Lifestyle modification plus ACE inhibitor
B. Immediate beta-blocker only
C. Diuretic therapy only
D. No treatment needed
Correct Answer: A. Lifestyle modification plus ACE inhibitor
Rationale:
First-line management for hypertension includes lifestyle modifications such as
dietary changes, increased physical activity, weight management, and moderation
of alcohol intake. Pharmacologic therapy with an ACE inhibitor is appropriate as it
is commonly recommended for initial treatment unless contraindicated. Beta-
blockers are not first-line therapy for uncomplicated hypertension but may be used
if there are specific comorbidities such as coronary artery disease. Diuretics alone
may be used but are usually combined with lifestyle modification. Untreated
hypertension increases the risk of cardiovascular and renal complications, so no
treatment is not appropriate.
Question 5
What is the best initial test for diagnosing type 2 diabetes in an asymptomatic
adult?
A. Random plasma glucose
B. Fasting plasma glucose
C. Oral glucose tolerance test
D. HbA1c only
Correct Answer: B. Fasting plasma glucose
Rationale:
Fasting plasma glucose is the preferred initial screening test for type 2 diabetes in
asymptomatic adults because it is cost-effective, widely available, and meets
, established diagnostic criteria. While HbA1c testing can also be used for diagnosis,
it may require confirmation if results are borderline. The oral glucose tolerance test
is more sensitive but is generally reserved for specific cases such as gestational
diabetes or when initial screening results are inconclusive. Random plasma glucose
alone is insufficient for screening asymptomatic patients and cannot reliably
confirm a diagnosis.
Question 6
A 40-year-old patient presents with acute-onset shortness of breath, pleuritic chest
pain, and tachycardia. What is the most likely cause?
A. Myocardial infarction
B. Pulmonary embolism
C. Pneumonia
D. Asthma exacerbation
Correct Answer: B. Pulmonary embolism
Rationale:
Pulmonary embolism (PE) should be suspected in patients with sudden onset
dyspnea, pleuritic chest pain, and tachycardia, especially if there are risk factors
such as recent surgery, immobility, or use of oral contraceptives. Myocardial
infarction typically presents with pressure-like chest pain radiating to the arm or
jaw and may have ECG changes. Pneumonia usually develops more gradually and
is accompanied by fever, productive cough, and infiltrates on chest imaging.
Asthma exacerbation presents with wheezing and history of chronic asthma rather
than acute pleuritic pain. Prompt diagnosis with CT pulmonary angiography is
essential.
Question 7
A patient presents with chronic diarrhea and unintentional weight loss. Which
condition should be considered first?
A. Irritable bowel syndrome
B. Inflammatory bowel disease
