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NR511 / NR 511 Final Exam Questions & Answers 2026–
2027 | Differential Diagnosis & Primary Care Practicum
Study Guide | Practice Questions with Verified Explanation
Question 1
Janet is a 30 year old woman who has been recently diagnosed with a herniated disc at the
level of L5-S1. She is currently in the emergency room with suspicion of cauda equina
compression. Which of the following is a sign or symptom of cauda equina compression?
a. gastrocnemius weakness
b. reduced or absent ankle reflexes c.
numbness of the lateral foot
d. paresthesia of the perineum and buttocks
Answer: d. paresthesia of the perineum and buttocks
Rationale: Cauda equina compression is a surgical emergency characterized by compression of
the spinal nerve roots below the conus medullaris. Classic signs include saddle anesthesia
(paresthesia of the perineum and buttocks), bilateral leg pain or weakness, and bowel/bladder
dysfunction. The "saddle" distribution corresponds to the S2-S4 dermatomes. While options a, b,
and c may occur with isolated nerve root compression (such as L5-S1 herniation affecting S1
roots), the presence of perineal paresthesia is the hallmark sign of cauda equina syndrome
requiring emergent surgical decompression.
Question 2
The patient has acute pancreatitis with 7 of the diagnostic criteria from Ranson's Criteria.
In order to plan care, the clinician understands that this criteria score has which of the
following meanings?
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a. a high mortality rate
b. an increased chance of recurrence
c. 7% chance of the disease becoming chronic d. all
of the above
Answer: a. a high mortality rate
Rationale: Ranson's Criteria is a prognostic scoring system used to assess the severity and
mortality risk in acute pancreatitis. A score of 7 indicates severe pancreatitis with a
mortality rate of approximately 60%. The Ranson's criteria include 11 parameters (5 at
admission, 6 within 48 hours) that predict morbidity and mortality. Higher scores correlate with
increased mortality rates: 0-2 = <1% mortality, 3-4 = 15-16% mortality, 5- 6 = 40% mortality,
and 7+ = >60% mortality. The scoring system does not predict recurrence or chronicity of the
disease.
Question 3
Reuben, age 24, has HIV and just had a routine viral load test done. The results show a
falling viral load. What does this indicate?
a. a favorable diagnostic trend b.
disease progression
c. the need to be more aggressive with Reuben's medications d. the
eradication of the HIV
Answer: a. a favorable diagnostic trend
Rationale: A falling viral load in an HIV-positive patient indicates that antiretroviral therapy is
effective in suppressing viral replication. This is a favorable trend suggesting that the treatment
regimen is working and the patient's immune function is being preserved. A declining viral load
is associated with a slower rate of CD4+ T-cell decline and reduced risk of opportunistic
infections. It does not indicate eradication of HIV
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(which is currently not possible) or disease progression. It suggests that the current
medication regimen is appropriate, not that it needs to be more aggressive.
Question 4
Which is the differentiating symptom between labyrinthitis and vestibular
neuritis?
a. symptoms with vestibular neuritis are usually acute in onset, whereas with labyrinthitis the
onset is more gradual
b. hearing loss may be associated with vestibular neuritis, but not with labyrinthitis
c. symptoms with labyrinthitis are usually acute in onset, whereas with vestibular neuritis the
onset is more gradual
d. hearing loss may be associated with labyrinthitis, but not with vestibular neuritis
Answer: d. hearing loss may be associated with labyrinthitis, but not with
vestibular neuritis
Rationale: The key differentiating symptom between labyrinthitis and vestibular neuritis is the
presence of hearing loss or tinnitus. Labyrinthitis involves inflammation of both
the vestibular and cochlear portions of the inner ear, resulting in both vestibular symptoms
(vertigo, nystagmus, ataxia) and auditory symptoms (hearing loss, tinnitus). Vestibular neuritis
involves isolated inflammation of the vestibular nerve, affecting balance but not hearing. Both
conditions typically have an acute onset. The presence of hearing loss points to labyrinthitis,
while its absence suggests vestibular neuritis.
Question 5
A 27 year old female presents with a chief complaint of burning and pain on urination.
She has no previous history of urinary tract infection. What are some additional
symptoms consistent with a diagnosis of lower UTI?
NR511 / NR 511 Final Exam Questions & Answers 2026–
2027 | Differential Diagnosis & Primary Care Practicum
Study Guide | Practice Questions with Verified Explanation
Question 1
Janet is a 30 year old woman who has been recently diagnosed with a herniated disc at the
level of L5-S1. She is currently in the emergency room with suspicion of cauda equina
compression. Which of the following is a sign or symptom of cauda equina compression?
a. gastrocnemius weakness
b. reduced or absent ankle reflexes c.
numbness of the lateral foot
d. paresthesia of the perineum and buttocks
Answer: d. paresthesia of the perineum and buttocks
Rationale: Cauda equina compression is a surgical emergency characterized by compression of
the spinal nerve roots below the conus medullaris. Classic signs include saddle anesthesia
(paresthesia of the perineum and buttocks), bilateral leg pain or weakness, and bowel/bladder
dysfunction. The "saddle" distribution corresponds to the S2-S4 dermatomes. While options a, b,
and c may occur with isolated nerve root compression (such as L5-S1 herniation affecting S1
roots), the presence of perineal paresthesia is the hallmark sign of cauda equina syndrome
requiring emergent surgical decompression.
Question 2
The patient has acute pancreatitis with 7 of the diagnostic criteria from Ranson's Criteria.
In order to plan care, the clinician understands that this criteria score has which of the
following meanings?
Downloaded by ANTONY KIMANI ()
, 2
a. a high mortality rate
b. an increased chance of recurrence
c. 7% chance of the disease becoming chronic d. all
of the above
Answer: a. a high mortality rate
Rationale: Ranson's Criteria is a prognostic scoring system used to assess the severity and
mortality risk in acute pancreatitis. A score of 7 indicates severe pancreatitis with a
mortality rate of approximately 60%. The Ranson's criteria include 11 parameters (5 at
admission, 6 within 48 hours) that predict morbidity and mortality. Higher scores correlate with
increased mortality rates: 0-2 = <1% mortality, 3-4 = 15-16% mortality, 5- 6 = 40% mortality,
and 7+ = >60% mortality. The scoring system does not predict recurrence or chronicity of the
disease.
Question 3
Reuben, age 24, has HIV and just had a routine viral load test done. The results show a
falling viral load. What does this indicate?
a. a favorable diagnostic trend b.
disease progression
c. the need to be more aggressive with Reuben's medications d. the
eradication of the HIV
Answer: a. a favorable diagnostic trend
Rationale: A falling viral load in an HIV-positive patient indicates that antiretroviral therapy is
effective in suppressing viral replication. This is a favorable trend suggesting that the treatment
regimen is working and the patient's immune function is being preserved. A declining viral load
is associated with a slower rate of CD4+ T-cell decline and reduced risk of opportunistic
infections. It does not indicate eradication of HIV
Downloaded by ANTONY KIMANI ()
, 3
(which is currently not possible) or disease progression. It suggests that the current
medication regimen is appropriate, not that it needs to be more aggressive.
Question 4
Which is the differentiating symptom between labyrinthitis and vestibular
neuritis?
a. symptoms with vestibular neuritis are usually acute in onset, whereas with labyrinthitis the
onset is more gradual
b. hearing loss may be associated with vestibular neuritis, but not with labyrinthitis
c. symptoms with labyrinthitis are usually acute in onset, whereas with vestibular neuritis the
onset is more gradual
d. hearing loss may be associated with labyrinthitis, but not with vestibular neuritis
Answer: d. hearing loss may be associated with labyrinthitis, but not with
vestibular neuritis
Rationale: The key differentiating symptom between labyrinthitis and vestibular neuritis is the
presence of hearing loss or tinnitus. Labyrinthitis involves inflammation of both
the vestibular and cochlear portions of the inner ear, resulting in both vestibular symptoms
(vertigo, nystagmus, ataxia) and auditory symptoms (hearing loss, tinnitus). Vestibular neuritis
involves isolated inflammation of the vestibular nerve, affecting balance but not hearing. Both
conditions typically have an acute onset. The presence of hearing loss points to labyrinthitis,
while its absence suggests vestibular neuritis.
Question 5
A 27 year old female presents with a chief complaint of burning and pain on urination.
She has no previous history of urinary tract infection. What are some additional
symptoms consistent with a diagnosis of lower UTI?
