NR-511 Differential Diagnosis
& Primary Care Practicum
Final Exam Study Guide
Practice Exam 2025-2026
1. A 55-year-old man presents with crushing substernal chest pain
radiating to his left arm. What is the priority diagnosis?
A. GERD
B. Costochondritis
C. Acute Myocardial Infarction
D. Anxiety attack
Answer: C. Acute Myocardial Infarction
Rationale: Crushing chest pain with radiation to the left arm is classic
for myocardial infarction and requires immediate emergency
evaluation. GERD and anxiety may mimic symptoms but should only
be considered after ruling out life-threatening causes.
2. Which physical examination maneuver is most useful for
diagnosing appendicitis?
A. Tinel sign
B. McBurney point tenderness
C. Phalen test
D. Murphy sign
,Answer: B. McBurney point tenderness
Rationale: McBurney point tenderness in the right lower quadrant is
a classic finding in acute appendicitis. Murphy sign suggests
cholecystitis, while Tinel and Phalen tests evaluate carpal tunnel
syndrome.
3. A patient with diabetes has an HbA1c of 8.9%. According to ADA
recommendations, this result indicates:
A. Excellent glycemic control
B. Prediabetes
C. Poor glycemic control
D. Normal glucose regulation
Answer: C. Poor glycemic control
Rationale: Most adults with diabetes have a target HbA1c of less
than 7%. A value of 8.9% indicates inadequate glucose control and
increased risk of complications.
4. Which organism is the most common cause of uncomplicated
urinary tract infections?
A. Klebsiella pneumoniae
B. Enterococcus faecalis
C. Proteus mirabilis
D. Escherichia coli
Answer: D. Escherichia coli
Rationale: E. coli accounts for approximately 75–95% of
uncomplicated urinary tract infections in healthy women.
, 5. Which finding is most consistent with bacterial pneumonia?
A. Clear lung sounds
B. Bilateral wheezing only
C. Localized crackles with fever and productive cough
D. Hyperresonance
Answer: C. Localized crackles with fever and productive cough
Rationale: Bacterial pneumonia typically presents with fever,
productive cough, localized crackles, and infiltrates on chest
radiograph.
6. A positive Murphy sign suggests:
A. Pancreatitis
B. Appendicitis
C. Diverticulitis
D. Acute cholecystitis
Answer: D. Acute cholecystitis
Rationale: Murphy sign is pain with inspiratory arrest during
palpation of the right upper quadrant and is highly suggestive of
gallbladder inflammation.
7. Which antihypertensive medication should generally be avoided
during pregnancy?
A. Methyldopa
B. Nifedipine
& Primary Care Practicum
Final Exam Study Guide
Practice Exam 2025-2026
1. A 55-year-old man presents with crushing substernal chest pain
radiating to his left arm. What is the priority diagnosis?
A. GERD
B. Costochondritis
C. Acute Myocardial Infarction
D. Anxiety attack
Answer: C. Acute Myocardial Infarction
Rationale: Crushing chest pain with radiation to the left arm is classic
for myocardial infarction and requires immediate emergency
evaluation. GERD and anxiety may mimic symptoms but should only
be considered after ruling out life-threatening causes.
2. Which physical examination maneuver is most useful for
diagnosing appendicitis?
A. Tinel sign
B. McBurney point tenderness
C. Phalen test
D. Murphy sign
,Answer: B. McBurney point tenderness
Rationale: McBurney point tenderness in the right lower quadrant is
a classic finding in acute appendicitis. Murphy sign suggests
cholecystitis, while Tinel and Phalen tests evaluate carpal tunnel
syndrome.
3. A patient with diabetes has an HbA1c of 8.9%. According to ADA
recommendations, this result indicates:
A. Excellent glycemic control
B. Prediabetes
C. Poor glycemic control
D. Normal glucose regulation
Answer: C. Poor glycemic control
Rationale: Most adults with diabetes have a target HbA1c of less
than 7%. A value of 8.9% indicates inadequate glucose control and
increased risk of complications.
4. Which organism is the most common cause of uncomplicated
urinary tract infections?
A. Klebsiella pneumoniae
B. Enterococcus faecalis
C. Proteus mirabilis
D. Escherichia coli
Answer: D. Escherichia coli
Rationale: E. coli accounts for approximately 75–95% of
uncomplicated urinary tract infections in healthy women.
, 5. Which finding is most consistent with bacterial pneumonia?
A. Clear lung sounds
B. Bilateral wheezing only
C. Localized crackles with fever and productive cough
D. Hyperresonance
Answer: C. Localized crackles with fever and productive cough
Rationale: Bacterial pneumonia typically presents with fever,
productive cough, localized crackles, and infiltrates on chest
radiograph.
6. A positive Murphy sign suggests:
A. Pancreatitis
B. Appendicitis
C. Diverticulitis
D. Acute cholecystitis
Answer: D. Acute cholecystitis
Rationale: Murphy sign is pain with inspiratory arrest during
palpation of the right upper quadrant and is highly suggestive of
gallbladder inflammation.
7. Which antihypertensive medication should generally be avoided
during pregnancy?
A. Methyldopa
B. Nifedipine
