NR511 DIFFERENTIAL DIAGNOSIS &
PRIMARY CARE PRACTICUM EXAM
QUESTIONS AND VERIFIED ANSWERS
|GRADE A+| JUST RELEASED.
CHAMBERLAIN
1. A 45-year-old male presents with a sore throat, fever of 101.5F, and lack of cough. On
examination, he has tonsillar exudates and tender anterior cervical lymphadenopathy.
According to the modified Centor criteria, what is the most appropriate next step?
A. Prescribe amoxicillin immediately without testing
B. Order a chest X-ray to rule out secondary infection
C. Reassure the patient it is likely viral and provide supportive care
D. Perform a Rapid Antigen Detection Test (RADT)
Answer: D
Conceptual Explanation: The patient has a Centor score of 4 (fever, no cough, exudates,
lymphadenopathy). In adults, clinical scoring helps identify who should be tested. Current
guidelines recommend confirming the diagnosis of Group A Strep with RADT or culture
before starting antibiotics.
,2. Which of the following physical exam findings is most suggestive of acute angle-closure
glaucoma?
A. Increased cup-to-disk ratio without pain
B. Profuse purulent discharge and crusting
C. Yellowish deposits (drusen) on the retina
D. A cloudy cornea with a fixed, mid-dilated pupil
Answer: D
Conceptual Explanation: Acute angle-closure glaucoma is a medical emergency
characterized by sudden eye pain, a cloudy cornea, and a mid-dilated non-reactive pupil.
Drusen are seen in macular degeneration, and cup-to-disk changes occur in chronic
glaucoma.
3. A 68-year-old female smoker presents with a chronic cough and progressive dyspnea. Her
spirometry shows an FEV1/FVC ratio of 0.62. How should this result be interpreted?
A. Restrictive lung disease
B. Obstructive lung disease (COPD)
C. Normal lung function for her age
D. Reversible airway obstruction
Answer: B
, Conceptual Explanation: An FEV1/FVC ratio of less than 0.70 post-bronchodilator
confirms the presence of persistent airflow limitation, which is diagnostic of COPD
according to GOLD guidelines.
4. When evaluating a patient for secondary hypertension, which of the following findings
would most likely suggest renal artery stenosis?
A. An abdominal bruit heard in the epigastric region
B. Low serum creatinine levels
C. Bilateral pitting edema in the lower extremities
D. A significant drop in blood pressure when standing
Answer: A
Conceptual Explanation: The presence of a systolic-diastolic bruit in the epigastric or
flank area is highly specific for renal artery stenosis, a common cause of secondary
hypertension.
5. A 30-year-old patient presents with a ‘herald patch’ on the trunk, followed by a ‘Christmas
tree’ distribution of smaller maculopapular lesions. What is the most likely diagnosis?
A. Tinea corporis
B. Secondary syphilis
C. Pityriasis rosea
D. Guttate psoriasis
PRIMARY CARE PRACTICUM EXAM
QUESTIONS AND VERIFIED ANSWERS
|GRADE A+| JUST RELEASED.
CHAMBERLAIN
1. A 45-year-old male presents with a sore throat, fever of 101.5F, and lack of cough. On
examination, he has tonsillar exudates and tender anterior cervical lymphadenopathy.
According to the modified Centor criteria, what is the most appropriate next step?
A. Prescribe amoxicillin immediately without testing
B. Order a chest X-ray to rule out secondary infection
C. Reassure the patient it is likely viral and provide supportive care
D. Perform a Rapid Antigen Detection Test (RADT)
Answer: D
Conceptual Explanation: The patient has a Centor score of 4 (fever, no cough, exudates,
lymphadenopathy). In adults, clinical scoring helps identify who should be tested. Current
guidelines recommend confirming the diagnosis of Group A Strep with RADT or culture
before starting antibiotics.
,2. Which of the following physical exam findings is most suggestive of acute angle-closure
glaucoma?
A. Increased cup-to-disk ratio without pain
B. Profuse purulent discharge and crusting
C. Yellowish deposits (drusen) on the retina
D. A cloudy cornea with a fixed, mid-dilated pupil
Answer: D
Conceptual Explanation: Acute angle-closure glaucoma is a medical emergency
characterized by sudden eye pain, a cloudy cornea, and a mid-dilated non-reactive pupil.
Drusen are seen in macular degeneration, and cup-to-disk changes occur in chronic
glaucoma.
3. A 68-year-old female smoker presents with a chronic cough and progressive dyspnea. Her
spirometry shows an FEV1/FVC ratio of 0.62. How should this result be interpreted?
A. Restrictive lung disease
B. Obstructive lung disease (COPD)
C. Normal lung function for her age
D. Reversible airway obstruction
Answer: B
, Conceptual Explanation: An FEV1/FVC ratio of less than 0.70 post-bronchodilator
confirms the presence of persistent airflow limitation, which is diagnostic of COPD
according to GOLD guidelines.
4. When evaluating a patient for secondary hypertension, which of the following findings
would most likely suggest renal artery stenosis?
A. An abdominal bruit heard in the epigastric region
B. Low serum creatinine levels
C. Bilateral pitting edema in the lower extremities
D. A significant drop in blood pressure when standing
Answer: A
Conceptual Explanation: The presence of a systolic-diastolic bruit in the epigastric or
flank area is highly specific for renal artery stenosis, a common cause of secondary
hypertension.
5. A 30-year-old patient presents with a ‘herald patch’ on the trunk, followed by a ‘Christmas
tree’ distribution of smaller maculopapular lesions. What is the most likely diagnosis?
A. Tinea corporis
B. Secondary syphilis
C. Pityriasis rosea
D. Guttate psoriasis
