NP CASE STUDIES HIGH-YIELD Test Bank
Exam-150 Questions, Answers And
Rationales
(2025/2026)
1. A 67-year-old man presents with sudden unilateral vision loss
described as a “curtain coming down.” Fundoscopic exam reveals pale
retina with a cherry-red spot. What is the most likely diagnosis?
Central retinal artery occlusion
Rationale: CRAO presents with sudden, painless monocular blindness
and the classic cherry-red macula.
2. A 34-year-old woman with history of asthma develops wheezing
and shortness of breath after starting naproxen for ankle pain. What
is the most likely cause?
Aspirin-exacerbated respiratory disease
Rationale: NSAIDs can cause bronchospasm in susceptible asthmatic
patients.
3. A 49-year-old patient reports fatigue, cold intolerance, and
constipation. Labs show TSH 9.8 mIU/L and low free T4. What is the
next step?
Start levothyroxine
Rationale: Overt hypothyroidism (high TSH + low free T4) requires
hormone replacement.
4. An 83-year-old nursing home resident presents with confusion and
foul-smelling urine. UA shows nitrites, leukocyte esterase, and
bacteria. What is the best treatment?
,Nitrofurantoin
Rationale: Nitrofurantoin is appropriate for uncomplicated cystitis
when renal function is adequate.
5. A 22-year-old sexually active male presents with dysuria and
mucopurulent urethral discharge. What is the initial treatment?
Ceftriaxone + doxycycline
Rationale: Treats both gonorrhea and chlamydia per CDC guidelines.
6. A 45-year-old woman complains of palpitations. EKG shows
irregularly irregular rhythm with no P waves. What is the diagnosis?
Atrial fibrillation
Rationale: Classic A-fib findings include irregularly irregular rhythm
and absent P waves.
7. A 59-year-old man reports postprandial RUQ pain radiating to the
back. Ultrasound shows gallstones without CBD dilation. What is the
most likely diagnosis?
Cholelithiasis
Rationale: Symptomatic gallstones without obstruction indicate
cholelithiasis.
8. A child presents with barky cough, stridor, and steeple sign on X-
ray. Management?
Dexamethasone
Rationale: Steroids reduce airway inflammation in croup.
9. A 30-year-old woman has symmetric joint pain in the hands with
morning stiffness lasting >1 hour. Labs: positive RF and anti-CCP. Most
likely diagnosis?
,Rheumatoid arthritis
Rationale: Symmetric inflammatory arthritis with positive antibodies
indicates RA.
10. While examining a patient with acute otitis media, you note a
bulging tympanic membrane. What is the best treatment?
Amoxicillin
Rationale: First-line therapy for AOM in most patients.
11. A 72-year-old with COPD presents with worsening cough and
increased sputum. What is the next step?
Start azithromycin
Rationale: Increased sputum and dyspnea suggest COPD
exacerbation; antibiotics indicated.
12. A 28-year-old woman with new-onset severe headache,
photophobia, and nuchal rigidity needs urgent testing. Which is first?
CT head without contrast
Rationale: Rule out mass effect before lumbar puncture.
13. A 50-year-old obese male presents with elevated fasting glucose
of 134 mg/dL. Next step?
Order A1c
Rationale: Confirm diagnosis using another test such as A1c or repeat
fasting glucose.
14. A 6-year-old boy presents with a sandpaper rash, strawberry
tongue, and fever. Most likely diagnosis?
Scarlet fever
Rationale: Caused by GAS toxin; presents with sandpaper rash and
strawberry tongue.
, 15. A patient presents with unilateral facial drooping and cannot close
the eye. What is the diagnosis?
Bell’s palsy
Rationale: Peripheral facial nerve palsy causes inability to close the
eyelid and drooping.
16. In an elderly patient with isolated systolic hypertension, what is
the best first-line medication?
Thiazide diuretic
Rationale: Thiazides reduce systolic BP and have strong evidence in
older adults.
17. A patient reports RUQ pain, fever, and jaundice. Most likely
diagnosis?
Acute cholangitis
Rationale: Charcot’s triad—fever, RUQ pain, jaundice—indicates
cholangitis.
18. A 42-year-old with chronic GERD now has dysphagia to solids.
Concern for:
Esophageal stricture
Rationale: Chronic acid exposure leads to fibrotic narrowing causing
dysphagia.
19. A toddler with wheezing after choking on peanuts likely has:
Foreign body aspiration
Rationale: Sudden wheezing after choking suggests airway
obstruction.
20. A patient on simvastatin develops muscle pain and dark urine.
Next step?
Exam-150 Questions, Answers And
Rationales
(2025/2026)
1. A 67-year-old man presents with sudden unilateral vision loss
described as a “curtain coming down.” Fundoscopic exam reveals pale
retina with a cherry-red spot. What is the most likely diagnosis?
Central retinal artery occlusion
Rationale: CRAO presents with sudden, painless monocular blindness
and the classic cherry-red macula.
2. A 34-year-old woman with history of asthma develops wheezing
and shortness of breath after starting naproxen for ankle pain. What
is the most likely cause?
Aspirin-exacerbated respiratory disease
Rationale: NSAIDs can cause bronchospasm in susceptible asthmatic
patients.
3. A 49-year-old patient reports fatigue, cold intolerance, and
constipation. Labs show TSH 9.8 mIU/L and low free T4. What is the
next step?
Start levothyroxine
Rationale: Overt hypothyroidism (high TSH + low free T4) requires
hormone replacement.
4. An 83-year-old nursing home resident presents with confusion and
foul-smelling urine. UA shows nitrites, leukocyte esterase, and
bacteria. What is the best treatment?
,Nitrofurantoin
Rationale: Nitrofurantoin is appropriate for uncomplicated cystitis
when renal function is adequate.
5. A 22-year-old sexually active male presents with dysuria and
mucopurulent urethral discharge. What is the initial treatment?
Ceftriaxone + doxycycline
Rationale: Treats both gonorrhea and chlamydia per CDC guidelines.
6. A 45-year-old woman complains of palpitations. EKG shows
irregularly irregular rhythm with no P waves. What is the diagnosis?
Atrial fibrillation
Rationale: Classic A-fib findings include irregularly irregular rhythm
and absent P waves.
7. A 59-year-old man reports postprandial RUQ pain radiating to the
back. Ultrasound shows gallstones without CBD dilation. What is the
most likely diagnosis?
Cholelithiasis
Rationale: Symptomatic gallstones without obstruction indicate
cholelithiasis.
8. A child presents with barky cough, stridor, and steeple sign on X-
ray. Management?
Dexamethasone
Rationale: Steroids reduce airway inflammation in croup.
9. A 30-year-old woman has symmetric joint pain in the hands with
morning stiffness lasting >1 hour. Labs: positive RF and anti-CCP. Most
likely diagnosis?
,Rheumatoid arthritis
Rationale: Symmetric inflammatory arthritis with positive antibodies
indicates RA.
10. While examining a patient with acute otitis media, you note a
bulging tympanic membrane. What is the best treatment?
Amoxicillin
Rationale: First-line therapy for AOM in most patients.
11. A 72-year-old with COPD presents with worsening cough and
increased sputum. What is the next step?
Start azithromycin
Rationale: Increased sputum and dyspnea suggest COPD
exacerbation; antibiotics indicated.
12. A 28-year-old woman with new-onset severe headache,
photophobia, and nuchal rigidity needs urgent testing. Which is first?
CT head without contrast
Rationale: Rule out mass effect before lumbar puncture.
13. A 50-year-old obese male presents with elevated fasting glucose
of 134 mg/dL. Next step?
Order A1c
Rationale: Confirm diagnosis using another test such as A1c or repeat
fasting glucose.
14. A 6-year-old boy presents with a sandpaper rash, strawberry
tongue, and fever. Most likely diagnosis?
Scarlet fever
Rationale: Caused by GAS toxin; presents with sandpaper rash and
strawberry tongue.
, 15. A patient presents with unilateral facial drooping and cannot close
the eye. What is the diagnosis?
Bell’s palsy
Rationale: Peripheral facial nerve palsy causes inability to close the
eyelid and drooping.
16. In an elderly patient with isolated systolic hypertension, what is
the best first-line medication?
Thiazide diuretic
Rationale: Thiazides reduce systolic BP and have strong evidence in
older adults.
17. A patient reports RUQ pain, fever, and jaundice. Most likely
diagnosis?
Acute cholangitis
Rationale: Charcot’s triad—fever, RUQ pain, jaundice—indicates
cholangitis.
18. A 42-year-old with chronic GERD now has dysphagia to solids.
Concern for:
Esophageal stricture
Rationale: Chronic acid exposure leads to fibrotic narrowing causing
dysphagia.
19. A toddler with wheezing after choking on peanuts likely has:
Foreign body aspiration
Rationale: Sudden wheezing after choking suggests airway
obstruction.
20. A patient on simvastatin develops muscle pain and dark urine.
Next step?
