NR511 Differential Diagnosis and Primary Care Review
Final Exam Actual Exam 2026/2027 | Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Section 1: Dermatologic Disorders
Q1: A 62-year-old patient presents with a sharply demarcated, raised, erythematous
plaque on the lower extremity with a clearly defined border. The lesion is warm and
tender to palpation. Which diagnosis is most consistent with this presentation?
A. Cellulitis with poorly defined borders
B. Necrotizing fasciitis with crepitus
C. Erysipelas [CORRECT]
D. Contact dermatitis with vesicular weeping
Correct Answer: C
Rationale: Correct because erysipelas is a superficial streptococcal infection
characterized by sharply demarcated, raised, erythematous lesions with distinct
borders, distinguishing it from the deeper, poorly defined borders of cellulitis.
Q2: A 4-year-old child has multiple pruritic, tender vesicles surrounded by erythema on
the lower extremities that have progressed to punched-out ulcers with overlying crust.
Which condition is most likely?
A. Nonbullous impetigo with honey-colored crust
B. Bullous impetigo with flaccid bullae
C. Ecthyma [CORRECT]
D. Herpes simplex with grouped vesicles
Correct Answer: C
Rationale: Correct because ecthyma is the ulcerative form of impetigo caused by
staphylococcal infection, characterized by pruritic tender vesicles surrounded by
erythema that progress to deep, punched-out ulcers.
,Q3: Which of the following is the most appropriate first-line treatment for scabies in an
adult patient?
A. Oral griseofulvin for 4 weeks
B. Topical permethrin 5% cream applied neck down overnight [CORRECT]
C. Topical mupirocin ointment twice daily
D. Oral cephalexin for 10 days
Correct Answer: B
Rationale: Correct because permethrin 5% cream is the first-line treatment for scabies,
applied from the neck down and left overnight, with ivermectin reserved for refractory or
crusted cases.
Q4: A 45-year-old patient presents with a pediculosis capitis infestation. Which
statement about treatment is most accurate?
A. Permethrin 1% shampoo is applied and repeated in 7-10 days [CORRECT]
B. Oral ivermectin is first-line for all cases
C. Lindane is the preferred treatment in children
D. Nits must be manually removed because no pediculicides kill eggs
Correct Answer: A
Rationale: Correct because permethrin 1% shampoo is the first-line treatment for
pediculosis capitis, and a repeat application in 7-10 days addresses any newly hatched
lice.
Q5: A 70-year-old patient has multiple waxy, "stuck-on" appearing papules and plaques
on the trunk and face. Which diagnosis is most consistent?
A. Actinic keratosis with rough, scaly patches
B. Seborrheic keratosis [CORRECT]
C. Malignant melanoma with asymmetrical borders
D. Basal cell carcinoma with pearly borders
Correct Answer: B
Rationale: Correct because seborrheic keratosis presents as waxy, verrucous, "stuck-on"
appearing papules and plaques, commonly on the trunk and face of older adults.
Q6: Which of the following is a major risk factor for the development of malignant
melanoma?
A. Dark skin phototype (Fitzpatrick V-VI)
B. History of blistering sunburns in childhood [CORRECT]
,C. Presence of seborrheic keratosis
D. Chronic fungal infection of the skin
Correct Answer: B
Rationale: Correct because a history of blistering sunburns, particularly in childhood, is a
well-established major risk factor for malignant melanoma due to UV-induced DNA
damage.
Q7: A 58-year-old patient presents with rough, scaly, erythematous patches on the
forehead and dorsal hands. These lesions feel like sandpaper and are tender to touch.
Which condition is most likely?
A. Seborrheic keratosis
B. Actinic keratosis [CORRECT]
C. Squamous cell carcinoma with nodular growth
D. Bullous impetigo
Correct Answer: B
Rationale: Correct because actinic keratosis presents as rough, scaly, erythematous
patches on sun-exposed areas such as the face and dorsal hands, often described as
feeling like sandpaper.
Q8: A 3-year-old child has honey-colored crusted lesions around the nose and mouth.
The lesions are not deep or ulcerative. Which diagnosis is most likely?
A. Ecthyma with ulcerative lesions
B. Bullous impetigo with large flaccid bullae
C. Nonbullous impetigo [CORRECT]
D. Erysipelas with raised borders
Correct Answer: C
Rationale: Correct because nonbullous impetigo is the most common form and
presents with honey-colored crusted lesions, typically around the nose and mouth,
without deep ulceration.
Q9: A patient presents with multiple flaccid, transparent bullae that rupture easily,
leaving a thin brown varnish-like crust. Which type of impetigo is most likely?
A. Nonbullous impetigo with honey-colored crust
B. Bullous impetigo [CORRECT]
C. Ecthyma with punched-out ulcers
D. Herpes zoster with dermatomal distribution
, Correct Answer: B
Rationale: Correct because bullous impetigo is characterized by large, flaccid,
transparent bullae that rupture easily and leave a thin brown varnish-like crust, caused
by exfoliative toxin-producing Staphylococcus aureus.
Q10: A 28-year-old patient presents with intense nocturnal pruritus and linear burrows in
the interdigital web spaces. Close contacts report similar symptoms. Which treatment
is most appropriate?
A. Topical clotrimazole for 2 weeks
B. Permethrin 5% cream applied to entire body from neck down, repeated in 1 week
[CORRECT]
C. Oral doxycycline for 14 days
D. Topical hydrocortisone 1% for symptom control only
Correct Answer: B
Rationale: Correct because the presentation is classic for scabies, and permethrin 5%
cream applied to the entire body from the neck down with repeat application in one
week is the standard treatment, along with treating close contacts.
Section 2: Ear, Nose, and Throat Disorders
Q11: A 22-year-old swimmer presents with severe ear pain, especially when the tragus is
manipulated or the pinna is pulled. The ear canal is edematous with purulent discharge.
Which diagnosis is most likely?
A. Acute otitis media with bulging tympanic membrane
B. Otitis externa [CORRECT]
C. Serous otitis media with air-fluid levels
D. Mastoiditis with postauricular erythema
Correct Answer: B
Rationale: Correct because otitis externa is characterized by pain with tragal
manipulation and pinna traction, along with edema and purulent discharge in the ear
canal, commonly seen in swimmers.
Q12: A 3-year-old child presents with fever, ear pain, and a bulging, erythematous
tympanic membrane that is immobile on pneumotoscopy. Which diagnosis is most
consistent?
A. Otitis externa with ear canal edema
Final Exam Actual Exam 2026/2027 | Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Section 1: Dermatologic Disorders
Q1: A 62-year-old patient presents with a sharply demarcated, raised, erythematous
plaque on the lower extremity with a clearly defined border. The lesion is warm and
tender to palpation. Which diagnosis is most consistent with this presentation?
A. Cellulitis with poorly defined borders
B. Necrotizing fasciitis with crepitus
C. Erysipelas [CORRECT]
D. Contact dermatitis with vesicular weeping
Correct Answer: C
Rationale: Correct because erysipelas is a superficial streptococcal infection
characterized by sharply demarcated, raised, erythematous lesions with distinct
borders, distinguishing it from the deeper, poorly defined borders of cellulitis.
Q2: A 4-year-old child has multiple pruritic, tender vesicles surrounded by erythema on
the lower extremities that have progressed to punched-out ulcers with overlying crust.
Which condition is most likely?
A. Nonbullous impetigo with honey-colored crust
B. Bullous impetigo with flaccid bullae
C. Ecthyma [CORRECT]
D. Herpes simplex with grouped vesicles
Correct Answer: C
Rationale: Correct because ecthyma is the ulcerative form of impetigo caused by
staphylococcal infection, characterized by pruritic tender vesicles surrounded by
erythema that progress to deep, punched-out ulcers.
,Q3: Which of the following is the most appropriate first-line treatment for scabies in an
adult patient?
A. Oral griseofulvin for 4 weeks
B. Topical permethrin 5% cream applied neck down overnight [CORRECT]
C. Topical mupirocin ointment twice daily
D. Oral cephalexin for 10 days
Correct Answer: B
Rationale: Correct because permethrin 5% cream is the first-line treatment for scabies,
applied from the neck down and left overnight, with ivermectin reserved for refractory or
crusted cases.
Q4: A 45-year-old patient presents with a pediculosis capitis infestation. Which
statement about treatment is most accurate?
A. Permethrin 1% shampoo is applied and repeated in 7-10 days [CORRECT]
B. Oral ivermectin is first-line for all cases
C. Lindane is the preferred treatment in children
D. Nits must be manually removed because no pediculicides kill eggs
Correct Answer: A
Rationale: Correct because permethrin 1% shampoo is the first-line treatment for
pediculosis capitis, and a repeat application in 7-10 days addresses any newly hatched
lice.
Q5: A 70-year-old patient has multiple waxy, "stuck-on" appearing papules and plaques
on the trunk and face. Which diagnosis is most consistent?
A. Actinic keratosis with rough, scaly patches
B. Seborrheic keratosis [CORRECT]
C. Malignant melanoma with asymmetrical borders
D. Basal cell carcinoma with pearly borders
Correct Answer: B
Rationale: Correct because seborrheic keratosis presents as waxy, verrucous, "stuck-on"
appearing papules and plaques, commonly on the trunk and face of older adults.
Q6: Which of the following is a major risk factor for the development of malignant
melanoma?
A. Dark skin phototype (Fitzpatrick V-VI)
B. History of blistering sunburns in childhood [CORRECT]
,C. Presence of seborrheic keratosis
D. Chronic fungal infection of the skin
Correct Answer: B
Rationale: Correct because a history of blistering sunburns, particularly in childhood, is a
well-established major risk factor for malignant melanoma due to UV-induced DNA
damage.
Q7: A 58-year-old patient presents with rough, scaly, erythematous patches on the
forehead and dorsal hands. These lesions feel like sandpaper and are tender to touch.
Which condition is most likely?
A. Seborrheic keratosis
B. Actinic keratosis [CORRECT]
C. Squamous cell carcinoma with nodular growth
D. Bullous impetigo
Correct Answer: B
Rationale: Correct because actinic keratosis presents as rough, scaly, erythematous
patches on sun-exposed areas such as the face and dorsal hands, often described as
feeling like sandpaper.
Q8: A 3-year-old child has honey-colored crusted lesions around the nose and mouth.
The lesions are not deep or ulcerative. Which diagnosis is most likely?
A. Ecthyma with ulcerative lesions
B. Bullous impetigo with large flaccid bullae
C. Nonbullous impetigo [CORRECT]
D. Erysipelas with raised borders
Correct Answer: C
Rationale: Correct because nonbullous impetigo is the most common form and
presents with honey-colored crusted lesions, typically around the nose and mouth,
without deep ulceration.
Q9: A patient presents with multiple flaccid, transparent bullae that rupture easily,
leaving a thin brown varnish-like crust. Which type of impetigo is most likely?
A. Nonbullous impetigo with honey-colored crust
B. Bullous impetigo [CORRECT]
C. Ecthyma with punched-out ulcers
D. Herpes zoster with dermatomal distribution
, Correct Answer: B
Rationale: Correct because bullous impetigo is characterized by large, flaccid,
transparent bullae that rupture easily and leave a thin brown varnish-like crust, caused
by exfoliative toxin-producing Staphylococcus aureus.
Q10: A 28-year-old patient presents with intense nocturnal pruritus and linear burrows in
the interdigital web spaces. Close contacts report similar symptoms. Which treatment
is most appropriate?
A. Topical clotrimazole for 2 weeks
B. Permethrin 5% cream applied to entire body from neck down, repeated in 1 week
[CORRECT]
C. Oral doxycycline for 14 days
D. Topical hydrocortisone 1% for symptom control only
Correct Answer: B
Rationale: Correct because the presentation is classic for scabies, and permethrin 5%
cream applied to the entire body from the neck down with repeat application in one
week is the standard treatment, along with treating close contacts.
Section 2: Ear, Nose, and Throat Disorders
Q11: A 22-year-old swimmer presents with severe ear pain, especially when the tragus is
manipulated or the pinna is pulled. The ear canal is edematous with purulent discharge.
Which diagnosis is most likely?
A. Acute otitis media with bulging tympanic membrane
B. Otitis externa [CORRECT]
C. Serous otitis media with air-fluid levels
D. Mastoiditis with postauricular erythema
Correct Answer: B
Rationale: Correct because otitis externa is characterized by pain with tragal
manipulation and pinna traction, along with edema and purulent discharge in the ear
canal, commonly seen in swimmers.
Q12: A 3-year-old child presents with fever, ear pain, and a bulging, erythematous
tympanic membrane that is immobile on pneumotoscopy. Which diagnosis is most
consistent?
A. Otitis externa with ear canal edema
