NR 511/ NR511 (LATEST 2026 UPDATE) DIFFERENTIAL DIAGNOSIS AND
PRIMARY CARE PRACTICUM GUIDE| QUESTIONS & ANSWERS| GRADE
A+| 100% CORRECT (VERIFIED SOLUTIONS)- CHAMBERLAIN,
GUARANTEED PASS
Chapter: Cardiovascular Disorders
1. A 55-year-old patient presents with exertional chest discomfort that radiates to
the left arm and jaw, accompanied by shortness of breath. His EKG shows ST-
segment depression during a stress test. Which of the following is the most likely
diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Answer: A. Stable angina
Rationale: Stable angina is characterized by predictable chest pain with exertion
and relief with rest or nitroglycerin. ST-segment depression on stress testing is
typical. Unstable angina and MI are usually more acute and unpredictable.
2. A 63-year-old patient reports fatigue, dizziness, and palpitations over the last
month. Lab results reveal a hemoglobin of 8 g/dL. Which is the most appropriate
initial step in evaluation?
A. Immediate transfusion
B. Colonoscopy and GI evaluation
C. Iron supplementation without testing
D. Referral to cardiology
Answer: B. Colonoscopy and GI evaluation
Rationale: In older adults, new-onset anemia is often due to occult gastrointestinal
bleeding. While iron supplementation may help, identifying the source is critical.
,Transfusion may be indicated if symptomatic but is not first-line diagnostic
evaluation.
3. A patient presents with a productive cough, low-grade fever, and pleuritic chest
pain for 3 days. On examination, crackles are noted in the right lower lobe. What is
the most likely cause?
A. Viral bronchitis
B. Bacterial pneumonia
C. Asthma exacerbation
D. Pulmonary embolism
Answer: B. Bacterial pneumonia
Rationale: Fever, productive cough, and localized crackles suggest bacterial
pneumonia. Viral bronchitis usually lacks localized findings and high fever.
Pulmonary embolism often presents with sudden dyspnea, pleuritic pain, and
sometimes hemoptysis without productive cough.
4. A 28-year-old patient presents with sudden-onset, severe right lower quadrant
abdominal pain, nausea, and mild fever. Which is the most likely diagnosis?
A. Acute appendicitis
B. Cholecystitis
C. Ovarian torsion
D. Gastroenteritis
Answer: A. Acute appendicitis
Rationale: Right lower quadrant pain with nausea and low-grade fever in a young
adult is classic for appendicitis. Cholecystitis pain is typically in the right upper
quadrant. Ovarian torsion usually has sudden pelvic pain but may lack GI
symptoms.
5. A 45-year-old female presents with polyuria, polydipsia, and unintentional
weight loss over 2 months. Labs show fasting glucose of 210 mg/dL. Which is the
most likely diagnosis?
,A. Type 1 diabetes mellitus
B. Type 2 diabetes mellitus
C. Diabetes insipidus
D. Cushing’s syndrome
Answer: B. Type 2 diabetes mellitus
Rationale: Adult onset with hyperglycemia, polyuria, and weight loss is most
consistent with type 2 diabetes. Type 1 is less common in adults. Diabetes
insipidus typically presents with polyuria without hyperglycemia.
6. A 70-year-old patient presents with progressive shortness of breath, orthopnea,
and lower extremity edema. BNP is elevated, and echocardiogram shows reduced
ejection fraction. What is the primary diagnosis?
A. Chronic obstructive pulmonary disease
B. Congestive heart failure
C. Pulmonary hypertension
D. Acute renal failure
Answer: B. Congestive heart failure
Rationale: Symptoms of fluid overload, orthopnea, and elevated BNP with
reduced ejection fraction are diagnostic for heart failure. COPD may cause
dyspnea but not elevated BNP or edema. Pulmonary hypertension usually lacks
volume overload.
7. A 30-year-old woman reports fatigue, cold intolerance, constipation, and weight
gain over 6 months. Lab results reveal TSH of 8.5 mIU/L and low free T4. What is
the likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid cancer
D. Cushing’s disease
Answer: B. Hypothyroidism
Rationale: Fatigue, weight gain, cold intolerance, constipation, and lab findings of
, elevated TSH with low T4 indicate primary hypothyroidism. Hyperthyroidism
presents with weight loss, heat intolerance, and tachycardia.
8. A 60-year-old male presents with sudden-onset severe headache, nausea, and
photophobia. Blood pressure is 200/110 mmHg. Which is the most concerning
diagnosis?
A. Migraine headache
B. Hypertensive emergency with possible intracranial bleed
C. Tension headache
D. Cluster headache
Answer: B. Hypertensive emergency with possible intracranial bleed
Rationale: Severe sudden headache with extremely high BP raises concern for
intracranial hemorrhage. Migraines are usually recurrent and less severe in onset.
Tension headaches are mild and bilateral.
9. A patient presents with burning epigastric pain relieved by food intake. Which is
the most likely cause?
A. Gastric ulcer
B. Duodenal ulcer
C. GERD
D. Gallstones
Answer: B. Duodenal ulcer
Rationale: Pain that improves with food is classic for duodenal ulcers. Gastric
ulcer pain is often worsened by eating. GERD causes heartburn but not typically
epigastric pain relieved by food.
10. A 35-year-old presents with fatigue, pallor, and spoon-shaped nails. Labs reveal
microcytic anemia. Which is the most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
PRIMARY CARE PRACTICUM GUIDE| QUESTIONS & ANSWERS| GRADE
A+| 100% CORRECT (VERIFIED SOLUTIONS)- CHAMBERLAIN,
GUARANTEED PASS
Chapter: Cardiovascular Disorders
1. A 55-year-old patient presents with exertional chest discomfort that radiates to
the left arm and jaw, accompanied by shortness of breath. His EKG shows ST-
segment depression during a stress test. Which of the following is the most likely
diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Answer: A. Stable angina
Rationale: Stable angina is characterized by predictable chest pain with exertion
and relief with rest or nitroglycerin. ST-segment depression on stress testing is
typical. Unstable angina and MI are usually more acute and unpredictable.
2. A 63-year-old patient reports fatigue, dizziness, and palpitations over the last
month. Lab results reveal a hemoglobin of 8 g/dL. Which is the most appropriate
initial step in evaluation?
A. Immediate transfusion
B. Colonoscopy and GI evaluation
C. Iron supplementation without testing
D. Referral to cardiology
Answer: B. Colonoscopy and GI evaluation
Rationale: In older adults, new-onset anemia is often due to occult gastrointestinal
bleeding. While iron supplementation may help, identifying the source is critical.
,Transfusion may be indicated if symptomatic but is not first-line diagnostic
evaluation.
3. A patient presents with a productive cough, low-grade fever, and pleuritic chest
pain for 3 days. On examination, crackles are noted in the right lower lobe. What is
the most likely cause?
A. Viral bronchitis
B. Bacterial pneumonia
C. Asthma exacerbation
D. Pulmonary embolism
Answer: B. Bacterial pneumonia
Rationale: Fever, productive cough, and localized crackles suggest bacterial
pneumonia. Viral bronchitis usually lacks localized findings and high fever.
Pulmonary embolism often presents with sudden dyspnea, pleuritic pain, and
sometimes hemoptysis without productive cough.
4. A 28-year-old patient presents with sudden-onset, severe right lower quadrant
abdominal pain, nausea, and mild fever. Which is the most likely diagnosis?
A. Acute appendicitis
B. Cholecystitis
C. Ovarian torsion
D. Gastroenteritis
Answer: A. Acute appendicitis
Rationale: Right lower quadrant pain with nausea and low-grade fever in a young
adult is classic for appendicitis. Cholecystitis pain is typically in the right upper
quadrant. Ovarian torsion usually has sudden pelvic pain but may lack GI
symptoms.
5. A 45-year-old female presents with polyuria, polydipsia, and unintentional
weight loss over 2 months. Labs show fasting glucose of 210 mg/dL. Which is the
most likely diagnosis?
,A. Type 1 diabetes mellitus
B. Type 2 diabetes mellitus
C. Diabetes insipidus
D. Cushing’s syndrome
Answer: B. Type 2 diabetes mellitus
Rationale: Adult onset with hyperglycemia, polyuria, and weight loss is most
consistent with type 2 diabetes. Type 1 is less common in adults. Diabetes
insipidus typically presents with polyuria without hyperglycemia.
6. A 70-year-old patient presents with progressive shortness of breath, orthopnea,
and lower extremity edema. BNP is elevated, and echocardiogram shows reduced
ejection fraction. What is the primary diagnosis?
A. Chronic obstructive pulmonary disease
B. Congestive heart failure
C. Pulmonary hypertension
D. Acute renal failure
Answer: B. Congestive heart failure
Rationale: Symptoms of fluid overload, orthopnea, and elevated BNP with
reduced ejection fraction are diagnostic for heart failure. COPD may cause
dyspnea but not elevated BNP or edema. Pulmonary hypertension usually lacks
volume overload.
7. A 30-year-old woman reports fatigue, cold intolerance, constipation, and weight
gain over 6 months. Lab results reveal TSH of 8.5 mIU/L and low free T4. What is
the likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid cancer
D. Cushing’s disease
Answer: B. Hypothyroidism
Rationale: Fatigue, weight gain, cold intolerance, constipation, and lab findings of
, elevated TSH with low T4 indicate primary hypothyroidism. Hyperthyroidism
presents with weight loss, heat intolerance, and tachycardia.
8. A 60-year-old male presents with sudden-onset severe headache, nausea, and
photophobia. Blood pressure is 200/110 mmHg. Which is the most concerning
diagnosis?
A. Migraine headache
B. Hypertensive emergency with possible intracranial bleed
C. Tension headache
D. Cluster headache
Answer: B. Hypertensive emergency with possible intracranial bleed
Rationale: Severe sudden headache with extremely high BP raises concern for
intracranial hemorrhage. Migraines are usually recurrent and less severe in onset.
Tension headaches are mild and bilateral.
9. A patient presents with burning epigastric pain relieved by food intake. Which is
the most likely cause?
A. Gastric ulcer
B. Duodenal ulcer
C. GERD
D. Gallstones
Answer: B. Duodenal ulcer
Rationale: Pain that improves with food is classic for duodenal ulcers. Gastric
ulcer pain is often worsened by eating. GERD causes heartburn but not typically
epigastric pain relieved by food.
10. A 35-year-old presents with fatigue, pallor, and spoon-shaped nails. Labs reveal
microcytic anemia. Which is the most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
