NR 511 Differential Diagnosis Primary Care
I Final Exam V2 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
Q1: A 62-year-old man presents with acute-onset chest pain described as pressure-like, radiating
to his left arm. His ECG shows no ST elevations, and initial troponin is negative. His HEART score
is calculated as follows: history highly suspicious (2 points), ECG nonspecific repolarization
disturbance (1 point), age 62 (1 point), risk factors include hypertension and smoking (1 point),
troponin normal (0 points). What is the most appropriate next step in management?
A. Immediate cardiac catheterization regardless of score
B. Discharge home with outpatient stress testing within 72 hours
C. Admit for observation with serial troponins and ECGs [CORRECT]
D. Discharge with reassurance and primary care follow-up in 1 week
Correct Answer: C
Rationale: Correct because the HEART score is 5 (moderate risk, 4-6 points), which requires
admission for observation with serial troponins and ECGs to rule out acute coronary syndrome.
Scores 0-3 permit early discharge, while 7-10 warrant immediate invasive strategies.
,Q2: A 28-year-old woman presents with sore throat, fever of 101.2°F, tender anterior cervical
lymphadenopathy, and tonsillar exudates. She reports cough absent. Her Centor score is
calculated. Based on standard criteria, what is the recommended management?
A. Prescribe amoxicillin empirically without testing
B. Recommend supportive care only with no testing
C. Perform rapid antigen detection testing or throat culture before antibiotic therapy [CORRECT]
D. Prescribe azithromycin empirically due to penicillin allergy
Correct Answer: C
Rationale: Correct because her Centor score is 4 (fever, tonsillar exudates, tender anterior cervical
nodes, absence of cough), which indicates moderate probability of group A streptococcal
pharyngitis. Current guidelines recommend confirmatory rapid antigen testing or throat culture
before antibiotics to avoid unnecessary treatment.
Q3: A 55-year-old man with hypertension presents for follow-up. His home blood pressure log
shows consistent readings of 142/88 mmHg and 138/86 mmHg, while clinic readings have been
146/92 mmHg and 150/94 mmHg. What is the most appropriate next step?
A. Diagnose stage 2 hypertension and initiate dual antihypertensive therapy
B. Reassure the patient that white coat hypertension is present and no treatment is needed
,C. Confirm the diagnosis of hypertension with out-of-office blood pressure monitoring [CORRECT]
D. Immediately initiate triple therapy for resistant hypertension
Correct Answer: C
Rationale: Correct because hypertension diagnosis requires confirmation with out-of-office
readings (home BP monitoring or ambulatory BP monitoring) to exclude white coat hypertension
before initiating long-term pharmacotherapy, per current guidelines.
Q4: A 68-year-old woman presents with sudden onset of severe vertigo triggered by rolling over in
bed. She denies neurological deficits. The Dix-Hallpike maneuver reproduces her symptoms with
torsional nystagmus. What is the most appropriate treatment?
A. Meclizine 25 mg three times daily for 2 weeks
B. Urgent brain MRI to rule out posterior circulation stroke
C. Perform the Epley maneuver for canalith repositioning [CORRECT]
D. Prescribe vestibular suppressants and schedule ENT referral in 4 weeks
Correct Answer: C
Rationale: Correct because the presentation with positional vertigo triggered by head movement
and positive Dix-Hallpike with torsional nystagmus is diagnostic of benign paroxysmal positional
vertigo (BPPV), and the Epley maneuver is the first-line treatment for posterior canal canalithiasis.
, Q5: A 45-year-old man presents with low back pain after lifting a heavy box. He reports bilateral leg
weakness, saddle anesthesia, and urinary retention for the past 8 hours. What is the priority
action?
A. Prescribe oral prednisone and schedule outpatient MRI in 2 weeks
B. Initiate physical therapy with McKenzie exercises
C. Obtain emergent MRI of the lumbosacral spine and urgent neurosurgical consultation
[CORRECT]
D. Prescribe NSAIDs and muscle relaxants with follow-up in 1 week
Correct Answer: C
Rationale: Correct because saddle anesthesia, urinary retention, and bilateral sciatica constitute
the classic triad of cauda equina syndrome, a surgical emergency requiring emergent imaging and
urgent neurosurgical evaluation to prevent permanent neurological deficits.
Q6: A 34-year-old woman presents with recurrent episodes of unilateral, pulsating headache
lasting 24-48 hours, associated with nausea, photophobia, and phonophobia. The headaches are
aggravated by routine physical activity. What is the most appropriate prophylactic medication?
A. Sumatriptan 100 mg at onset of headache
B. Ibuprofen 800 mg as needed for acute episodes
C. Propranolol 80 mg daily for migraine prevention [CORRECT]
I Final Exam V2 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
Q1: A 62-year-old man presents with acute-onset chest pain described as pressure-like, radiating
to his left arm. His ECG shows no ST elevations, and initial troponin is negative. His HEART score
is calculated as follows: history highly suspicious (2 points), ECG nonspecific repolarization
disturbance (1 point), age 62 (1 point), risk factors include hypertension and smoking (1 point),
troponin normal (0 points). What is the most appropriate next step in management?
A. Immediate cardiac catheterization regardless of score
B. Discharge home with outpatient stress testing within 72 hours
C. Admit for observation with serial troponins and ECGs [CORRECT]
D. Discharge with reassurance and primary care follow-up in 1 week
Correct Answer: C
Rationale: Correct because the HEART score is 5 (moderate risk, 4-6 points), which requires
admission for observation with serial troponins and ECGs to rule out acute coronary syndrome.
Scores 0-3 permit early discharge, while 7-10 warrant immediate invasive strategies.
,Q2: A 28-year-old woman presents with sore throat, fever of 101.2°F, tender anterior cervical
lymphadenopathy, and tonsillar exudates. She reports cough absent. Her Centor score is
calculated. Based on standard criteria, what is the recommended management?
A. Prescribe amoxicillin empirically without testing
B. Recommend supportive care only with no testing
C. Perform rapid antigen detection testing or throat culture before antibiotic therapy [CORRECT]
D. Prescribe azithromycin empirically due to penicillin allergy
Correct Answer: C
Rationale: Correct because her Centor score is 4 (fever, tonsillar exudates, tender anterior cervical
nodes, absence of cough), which indicates moderate probability of group A streptococcal
pharyngitis. Current guidelines recommend confirmatory rapid antigen testing or throat culture
before antibiotics to avoid unnecessary treatment.
Q3: A 55-year-old man with hypertension presents for follow-up. His home blood pressure log
shows consistent readings of 142/88 mmHg and 138/86 mmHg, while clinic readings have been
146/92 mmHg and 150/94 mmHg. What is the most appropriate next step?
A. Diagnose stage 2 hypertension and initiate dual antihypertensive therapy
B. Reassure the patient that white coat hypertension is present and no treatment is needed
,C. Confirm the diagnosis of hypertension with out-of-office blood pressure monitoring [CORRECT]
D. Immediately initiate triple therapy for resistant hypertension
Correct Answer: C
Rationale: Correct because hypertension diagnosis requires confirmation with out-of-office
readings (home BP monitoring or ambulatory BP monitoring) to exclude white coat hypertension
before initiating long-term pharmacotherapy, per current guidelines.
Q4: A 68-year-old woman presents with sudden onset of severe vertigo triggered by rolling over in
bed. She denies neurological deficits. The Dix-Hallpike maneuver reproduces her symptoms with
torsional nystagmus. What is the most appropriate treatment?
A. Meclizine 25 mg three times daily for 2 weeks
B. Urgent brain MRI to rule out posterior circulation stroke
C. Perform the Epley maneuver for canalith repositioning [CORRECT]
D. Prescribe vestibular suppressants and schedule ENT referral in 4 weeks
Correct Answer: C
Rationale: Correct because the presentation with positional vertigo triggered by head movement
and positive Dix-Hallpike with torsional nystagmus is diagnostic of benign paroxysmal positional
vertigo (BPPV), and the Epley maneuver is the first-line treatment for posterior canal canalithiasis.
, Q5: A 45-year-old man presents with low back pain after lifting a heavy box. He reports bilateral leg
weakness, saddle anesthesia, and urinary retention for the past 8 hours. What is the priority
action?
A. Prescribe oral prednisone and schedule outpatient MRI in 2 weeks
B. Initiate physical therapy with McKenzie exercises
C. Obtain emergent MRI of the lumbosacral spine and urgent neurosurgical consultation
[CORRECT]
D. Prescribe NSAIDs and muscle relaxants with follow-up in 1 week
Correct Answer: C
Rationale: Correct because saddle anesthesia, urinary retention, and bilateral sciatica constitute
the classic triad of cauda equina syndrome, a surgical emergency requiring emergent imaging and
urgent neurosurgical evaluation to prevent permanent neurological deficits.
Q6: A 34-year-old woman presents with recurrent episodes of unilateral, pulsating headache
lasting 24-48 hours, associated with nausea, photophobia, and phonophobia. The headaches are
aggravated by routine physical activity. What is the most appropriate prophylactic medication?
A. Sumatriptan 100 mg at onset of headache
B. Ibuprofen 800 mg as needed for acute episodes
C. Propranolol 80 mg daily for migraine prevention [CORRECT]
