MIDTERM EXAM: NR 511/ NR511 (2026 UPDATE)
DIFFERENTIAL DIAGNOSIS AND PRIMARY
CARE PRACTICUM REVIEW QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1
A 45-year-old male presents with sudden onset of severe chest pain radiating to the
left arm, associated with diaphoresis and shortness of breath. His blood pressure is
160/95 mmHg, and ECG shows ST-segment elevation in leads II, III, and aVF.
Which is the most likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Acute inferior myocardial infarction
D. Aortic dissection
Answer: C. Acute inferior myocardial infarction
Rationale: ST-segment elevation in leads II, III, and aVF corresponds to the
inferior wall of the heart. Associated symptoms like chest pain radiating to the left
arm and diaphoresis are classic for acute myocardial infarction.
Question 2
A 30-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. On examination, she has dry skin, brittle hair, and a delayed
relaxation phase of deep tendon reflexes. What is the most appropriate initial
laboratory test?
A. Serum cortisol
B. TSH (Thyroid Stimulating Hormone)
C. Fasting glucose
D. Serum ferritin
,Answer: B. TSH (Thyroid Stimulating Hormone)
Rationale: Symptoms suggest hypothyroidism. TSH is the most sensitive initial
test for diagnosing primary hypothyroidism.
Question 3
A 62-year-old male with a history of smoking presents with persistent cough,
hemoptysis, and unintentional weight loss. Chest X-ray shows a 3 cm spiculated
mass in the right upper lobe. What is the next best step?
A. Empiric antibiotic therapy
B. Sputum culture
C. CT-guided biopsy
D. Bronchodilator trial
Answer: C. CT-guided biopsy
Rationale: A spiculated mass in a smoker with systemic symptoms is highly
suspicious for lung cancer. Tissue diagnosis is necessary to guide management.
Question 4
A 25-year-old female presents with dysuria, frequency, and urgency for 2 days.
Urinalysis shows positive leukocyte esterase and nitrites. Which is the first-line
treatment?
A. Ciprofloxacin 500 mg PO BID x 7 days
B. Nitrofurantoin 100 mg PO BID x 5 days
C. Amoxicillin 500 mg PO TID x 10 days
D. Phenazopyridine 200 mg PO TID x 5 days
Answer: B. Nitrofurantoin 100 mg PO BID x 5 days
Rationale: Nitrofurantoin is first-line for uncomplicated urinary tract infections in
non-pregnant adults. Phenazopyridine is only for symptomatic relief.
,Question 5
A 50-year-old male presents with a history of episodic headaches, palpitations, and
sweating. Blood pressure is 180/110 mmHg. Labs show elevated plasma
metanephrines. What is the most likely diagnosis?
A. Hyperthyroidism
B. Pheochromocytoma
C. Cushing’s syndrome
D. Essential hypertension
Answer: B. Pheochromocytoma
Rationale: The triad of episodic headache, sweating, and palpitations with
elevated metanephrines is classic for pheochromocytoma, a catecholamine-
secreting tumor.
Question 6
A 28-year-old female presents with sudden onset of right lower quadrant
abdominal pain, nausea, and vomiting. She has a low-grade fever, leukocytosis,
and rebound tenderness at McBurney’s point. Which is the most likely diagnosis?
A. Ovarian cyst rupture
B. Ectopic pregnancy
C. Acute appendicitis
D. Diverticulitis
Answer: C. Acute appendicitis
Rationale: Classic presentation includes periumbilical pain migrating to RLQ,
tenderness at McBurney’s point, fever, and leukocytosis.
, Question 7
A 35-year-old male presents with persistent diarrhea, weight loss, and abdominal
cramping. Colonoscopy reveals continuous inflammation of the colon starting from
the rectum. Biopsy shows mucosal ulceration without granulomas. Which is the
most likely diagnosis?
A. Crohn’s disease
B. Ulcerative colitis
C. Celiac disease
D. Irritable bowel syndrome
Answer: B. Ulcerative colitis
Rationale: Continuous colonic involvement from the rectum, mucosal ulceration,
and absence of granulomas are characteristic of ulcerative colitis. Crohn’s disease
usually shows skip lesions and granulomas.
Question 8
A 55-year-old female with type 2 diabetes presents with blurred vision.
Fundoscopy shows microaneurysms, dot-blot hemorrhages, and hard exudates.
What is the most likely diagnosis?
A. Age-related macular degeneration
B. Diabetic retinopathy
C. Hypertensive retinopathy
D. Retinal detachment
Answer: B. Diabetic retinopathy
Rationale: Microaneurysms, dot-blot hemorrhages, and hard exudates are classic
signs of non-proliferative diabetic retinopathy.
DIFFERENTIAL DIAGNOSIS AND PRIMARY
CARE PRACTICUM REVIEW QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1
A 45-year-old male presents with sudden onset of severe chest pain radiating to the
left arm, associated with diaphoresis and shortness of breath. His blood pressure is
160/95 mmHg, and ECG shows ST-segment elevation in leads II, III, and aVF.
Which is the most likely diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Acute inferior myocardial infarction
D. Aortic dissection
Answer: C. Acute inferior myocardial infarction
Rationale: ST-segment elevation in leads II, III, and aVF corresponds to the
inferior wall of the heart. Associated symptoms like chest pain radiating to the left
arm and diaphoresis are classic for acute myocardial infarction.
Question 2
A 30-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. On examination, she has dry skin, brittle hair, and a delayed
relaxation phase of deep tendon reflexes. What is the most appropriate initial
laboratory test?
A. Serum cortisol
B. TSH (Thyroid Stimulating Hormone)
C. Fasting glucose
D. Serum ferritin
,Answer: B. TSH (Thyroid Stimulating Hormone)
Rationale: Symptoms suggest hypothyroidism. TSH is the most sensitive initial
test for diagnosing primary hypothyroidism.
Question 3
A 62-year-old male with a history of smoking presents with persistent cough,
hemoptysis, and unintentional weight loss. Chest X-ray shows a 3 cm spiculated
mass in the right upper lobe. What is the next best step?
A. Empiric antibiotic therapy
B. Sputum culture
C. CT-guided biopsy
D. Bronchodilator trial
Answer: C. CT-guided biopsy
Rationale: A spiculated mass in a smoker with systemic symptoms is highly
suspicious for lung cancer. Tissue diagnosis is necessary to guide management.
Question 4
A 25-year-old female presents with dysuria, frequency, and urgency for 2 days.
Urinalysis shows positive leukocyte esterase and nitrites. Which is the first-line
treatment?
A. Ciprofloxacin 500 mg PO BID x 7 days
B. Nitrofurantoin 100 mg PO BID x 5 days
C. Amoxicillin 500 mg PO TID x 10 days
D. Phenazopyridine 200 mg PO TID x 5 days
Answer: B. Nitrofurantoin 100 mg PO BID x 5 days
Rationale: Nitrofurantoin is first-line for uncomplicated urinary tract infections in
non-pregnant adults. Phenazopyridine is only for symptomatic relief.
,Question 5
A 50-year-old male presents with a history of episodic headaches, palpitations, and
sweating. Blood pressure is 180/110 mmHg. Labs show elevated plasma
metanephrines. What is the most likely diagnosis?
A. Hyperthyroidism
B. Pheochromocytoma
C. Cushing’s syndrome
D. Essential hypertension
Answer: B. Pheochromocytoma
Rationale: The triad of episodic headache, sweating, and palpitations with
elevated metanephrines is classic for pheochromocytoma, a catecholamine-
secreting tumor.
Question 6
A 28-year-old female presents with sudden onset of right lower quadrant
abdominal pain, nausea, and vomiting. She has a low-grade fever, leukocytosis,
and rebound tenderness at McBurney’s point. Which is the most likely diagnosis?
A. Ovarian cyst rupture
B. Ectopic pregnancy
C. Acute appendicitis
D. Diverticulitis
Answer: C. Acute appendicitis
Rationale: Classic presentation includes periumbilical pain migrating to RLQ,
tenderness at McBurney’s point, fever, and leukocytosis.
, Question 7
A 35-year-old male presents with persistent diarrhea, weight loss, and abdominal
cramping. Colonoscopy reveals continuous inflammation of the colon starting from
the rectum. Biopsy shows mucosal ulceration without granulomas. Which is the
most likely diagnosis?
A. Crohn’s disease
B. Ulcerative colitis
C. Celiac disease
D. Irritable bowel syndrome
Answer: B. Ulcerative colitis
Rationale: Continuous colonic involvement from the rectum, mucosal ulceration,
and absence of granulomas are characteristic of ulcerative colitis. Crohn’s disease
usually shows skip lesions and granulomas.
Question 8
A 55-year-old female with type 2 diabetes presents with blurred vision.
Fundoscopy shows microaneurysms, dot-blot hemorrhages, and hard exudates.
What is the most likely diagnosis?
A. Age-related macular degeneration
B. Diabetic retinopathy
C. Hypertensive retinopathy
D. Retinal detachment
Answer: B. Diabetic retinopathy
Rationale: Microaneurysms, dot-blot hemorrhages, and hard exudates are classic
signs of non-proliferative diabetic retinopathy.
