NR511 / NR 511 Midterm Exam: Differential Diagnosis &
Primary Care Review | 150 Questions & Verified Answers with
Rationales | Chamberlain (Latest 2024–2025 Update)
1. A 58-year-old male with HTN and DM reports exertional chest pressure, relieved by
rest. ECG is normal. Best next step?
A. Statin only
B. Exercise stress test
C. Thrombolysis
D. Stop beta blocker
Answer: B. Exercise stress test
Rationale: Stable angina pattern → noninvasive testing first.
2. First-line treatment for community-acquired pneumonia in healthy outpatient?
A. IV vancomycin
B. Oral macrolide or doxycycline
C. Oral antifungal
D. No antibiotics
Answer: B. Oral macrolide or doxycycline
Rationale: Covers most outpatient CAP pathogens.
3. A 45-year-old with cold intolerance, constipation, weight gain, elevated TSH and low
T4. Diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Central hypothyroidism
D. Hyperthyroidism
,Answer: B. Primary hypothyroidism
Rationale: High TSH + low T4 = primary failure.
4. Red-flag feature in low back pain requiring urgent evaluation?
A. Localized stiffness only
B. Pain after lifting
C. Saddle anesthesia
D. Morning tightness
Answer: C. Saddle anesthesia
Rationale: Suggests cauda equina → emergency.
5. Best initial test for suspected iron deficiency anemia?
A. Serum ferritin
B. B12
C. Electrophoresis
D. Bone marrow
Answer: A. Serum ferritin
Rationale: Low ferritin confirms iron deficiency.
6. Classic cause of microcytic anemia besides iron deficiency?
A. B12 deficiency
B. Thalassemia trait
C. Folate deficiency
D. Aplastic anemia
,Answer: B. Thalassemia trait
Rationale: Hemoglobinopathy with low MCV.
7. A 67-year-old develops sudden unilateral weakness, speech difficulty, onset <3 hrs.
Next action?
A. CT head without contrast
B. Steroids
C. Discharge on aspirin
D. MRI in 2 days
Answer: A. CT head without contrast
Rationale: Rule out bleed, assess reperfusion window.
8. Best initial test for suspected pheochromocytoma?
A. TSH
B. Plasma free metanephrines
C. Echocardiogram
D. Holter monitor
Answer: B. Plasma free metanephrines
Rationale: First-line biochemical test.
9. A 22-year-old female with exudative tonsils, fever, tender cervical nodes. Best initial
test?
A. Throat culture
B. RADT for GAS
C. Monospot
, D. Empiric amoxicillin
Answer: B. RADT for GAS
Rationale: Rapid and accurate for group A strep.
10. Which adult immunization is recommended at age ≥65?
A. Varicella
B. Pneumococcal vaccine
C. HPV
D. Hepatitis A
Answer: B. Pneumococcal vaccine
Rationale: Prevents invasive pneumococcal disease.
11. A 6-year-old with fever, sore throat, gray membrane on tonsils in unvaccinated
community. Diagnosis?
A. Strep throat
B. Diphtheria
C. Herpes pharyngitis
D. Influenza
Answer: B. Diphtheria
Rationale: Gray membrane + low immunization.
12. First-line pharmacologic treatment for large prostate with BPH?
A. PDE-5 inhibitor
B. 5-ARI ± alpha blocker
Primary Care Review | 150 Questions & Verified Answers with
Rationales | Chamberlain (Latest 2024–2025 Update)
1. A 58-year-old male with HTN and DM reports exertional chest pressure, relieved by
rest. ECG is normal. Best next step?
A. Statin only
B. Exercise stress test
C. Thrombolysis
D. Stop beta blocker
Answer: B. Exercise stress test
Rationale: Stable angina pattern → noninvasive testing first.
2. First-line treatment for community-acquired pneumonia in healthy outpatient?
A. IV vancomycin
B. Oral macrolide or doxycycline
C. Oral antifungal
D. No antibiotics
Answer: B. Oral macrolide or doxycycline
Rationale: Covers most outpatient CAP pathogens.
3. A 45-year-old with cold intolerance, constipation, weight gain, elevated TSH and low
T4. Diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Central hypothyroidism
D. Hyperthyroidism
,Answer: B. Primary hypothyroidism
Rationale: High TSH + low T4 = primary failure.
4. Red-flag feature in low back pain requiring urgent evaluation?
A. Localized stiffness only
B. Pain after lifting
C. Saddle anesthesia
D. Morning tightness
Answer: C. Saddle anesthesia
Rationale: Suggests cauda equina → emergency.
5. Best initial test for suspected iron deficiency anemia?
A. Serum ferritin
B. B12
C. Electrophoresis
D. Bone marrow
Answer: A. Serum ferritin
Rationale: Low ferritin confirms iron deficiency.
6. Classic cause of microcytic anemia besides iron deficiency?
A. B12 deficiency
B. Thalassemia trait
C. Folate deficiency
D. Aplastic anemia
,Answer: B. Thalassemia trait
Rationale: Hemoglobinopathy with low MCV.
7. A 67-year-old develops sudden unilateral weakness, speech difficulty, onset <3 hrs.
Next action?
A. CT head without contrast
B. Steroids
C. Discharge on aspirin
D. MRI in 2 days
Answer: A. CT head without contrast
Rationale: Rule out bleed, assess reperfusion window.
8. Best initial test for suspected pheochromocytoma?
A. TSH
B. Plasma free metanephrines
C. Echocardiogram
D. Holter monitor
Answer: B. Plasma free metanephrines
Rationale: First-line biochemical test.
9. A 22-year-old female with exudative tonsils, fever, tender cervical nodes. Best initial
test?
A. Throat culture
B. RADT for GAS
C. Monospot
, D. Empiric amoxicillin
Answer: B. RADT for GAS
Rationale: Rapid and accurate for group A strep.
10. Which adult immunization is recommended at age ≥65?
A. Varicella
B. Pneumococcal vaccine
C. HPV
D. Hepatitis A
Answer: B. Pneumococcal vaccine
Rationale: Prevents invasive pneumococcal disease.
11. A 6-year-old with fever, sore throat, gray membrane on tonsils in unvaccinated
community. Diagnosis?
A. Strep throat
B. Diphtheria
C. Herpes pharyngitis
D. Influenza
Answer: B. Diphtheria
Rationale: Gray membrane + low immunization.
12. First-line pharmacologic treatment for large prostate with BPH?
A. PDE-5 inhibitor
B. 5-ARI ± alpha blocker
