C HA M B E R L A I N U N IVE R S I T Y
College of Nursing & Health Professions
COURSE NAME: NR 547 Differential Diagnosis Practicum
TARGET
Advanced Practice Nursing Candidates (NP / PMHNP / FNP)
AUDIENCE:
NR 547: DIFFERENTIAL DIAGNOSIS PRACTICUM
TOTAL
100 Questions (Multiple Choice & Short Answer)
QUESTIONS:
Comprehensive Final Examination
SYSTEMS
Respiratory, Cardiovascular, Neurological, Gastrointestinal, Endocrine
COVERED:
Advanced Clinical Assessment, Pathophysiology, and Differential
EXAMINATION
Diagnosis Academic
Across Major Year Systems
Body 2026
DATE:
FORMAT: Clinical Vignettes, Differential Assessment & Full Answer Rationales
, NR 547 Differential Diagnosis Practicum Examination
Examination Instructions & Guidance
This comprehensive evaluation contains 100 clinical differential diagnosis questions structured into 5 core body system
modules. Each item presents a patient presentation, physical exam findings, or diagnostic test result designed to evaluate
clinical reasoning, differential identification, and therapeutic decision-making in advanced nursing practice.
Structure: Every question includes the clinical vignette/prompt, correct answer key, and an in-depth clinical rationale
grounded in evidence-based guidelines.
Table of Examination Contents
Section I: Respiratory System Differential Diagnosis (Questions 1 – 20)
COPD vs. Asthma, Pulmonary Embolism, Pneumonia, ARDS, Interstitial Lung Disease, Pneumothorax, and Psychiatric
Manifestations (Panic/Hyperventilation).
Section II: Cardiovascular System Differential Diagnosis (Questions 21 – 40)
Acute Coronary Syndromes, Heart Failure, Arrhythmias, Hypertensive Crises, Pericarditis, Aortic Dissection, and Somatic/
Cardiovascular Overlaps.
Section III: Neurological System Differential Diagnosis (Questions 41 – 60)
Ischemic & Hemorrhagic Stroke, Seizures, Encephalopathy, Delirium vs. Dementia, Multiple Sclerosis, Parkinson's, and
Neuromuscular Disorders.
Section IV: Gastrointestinal System Differential Diagnosis (Questions 61 – 80)
Acute Abdomen, Appendicitis, Pancreatitis, Cholecystitis, Peptic Ulcer Disease, Inflammatory Bowel Disease (IBD vs. IBS),
Hepatic Encephalopathy.
Section V: Endocrine System Differential Diagnosis (Questions 81 – 100)
Thyroid Dysfunction (Graves', Hashimoto's), Adrenal Disorders (Cushing's, Addisonian Crisis), DKA/HHS, Pheochromocytoma,
Calcium/Parathyroid Imbalances.
NR 547: Differential Diagnosis Practicum — Final Examination Page 2 of 38
, Section I: Respiratory System
Differential Diagnosis, Pathophysiology, and Clinical Decision Making
Question 1
A 58-year-old male with a 35 pack-year smoking history presents with progressive dyspnea, chronic cough,
and frequent purulent sputum production. Pulmonary function testing (PFT) demonstrates a post-
bronchodilator FEV1/FVC ratio of 0.62. What is the primary diagnosis and hallmark PFT criterion?
• A. Asthma; defined by an FEV1/FVC > 0.70 with 12% bronchodilator reversibility
• B. Chronic Obstructive Pulmonary Disease (COPD); defined by a post-bronchodilator FEV1/FVC < 0.70
• C. Idiopathic Pulmonary Fibrosis; defined by restrictive pattern with elevated FEV1/FVC
• D. Bronchiectasis; defined by reversible airway obstruction
Correct Answer: B. Chronic Obstructive Pulmonary Disease (COPD); defined by a post-bronchodilator FEV1/
FVC < 0.70
Clinical Rationale: According to GOLD guidelines, a post-bronchodilator FEV1/FVC ratio < 0.70 confirms persistent
airflow limitation and diagnoses COPD. Asthma shows significant reversibility (>12% and 200mL increase in FEV1),
whereas COPD typically demonstrates fixed, non-fully reversible airway obstruction.
Question 2
A 24-year-old female presents to the emergency department with acute onset shortness of breath, bilateral
wheezing, and chest tightness following exposure to cold air while jogging. Spirometry reveals an FEV1
increase of 15% and 230 mL following inhalation of albuterol. What diagnosis is best supported?
• A. Exercise-induced pulmonary edema
• B. Acute pulmonary embolism
• C. Asthma
• D. Vocal cord dysfunction
Correct Answer: C. Asthma
Clinical Rationale: Asthma is characterized by hyperresponsive airways and variable, reversible airflow limitation. An
improvement in FEV1 of >12% and >200 mL post-bronchodilator is the classic diagnostic gold standard confirming
asthma over non-reversible conditions like COPD or structural upper airway obstruction.
NR 547: Differential Diagnosis Practicum — Final Examination Page 3 of 38
, Question 3
A 62-year-old female post-hip replacement surgery (Day 4) suddenly develops sharp pleuritic chest pain,
tachypnea, tachycardia (HR 118 bpm), and hypoxemia (SpO2 88% on room air). Chest X-ray is clear. What is
the most critical differential diagnosis to confirm immediately?
• A. Acute Bronchitis
• B. Pulmonary Embolism (PE)
• C. Tension Pneumothorax
• D. Community-Acquired Pneumonia
Correct Answer: B. Pulmonary Embolism (PE)
Clinical Rationale: Post-operative orthopedic state combined with sudden onset pleuritic chest pain, unexplained
tachycardia, and hypoxemia with normal chest radiographs strongly points to PE. Diagnosis should be evaluated using
Wells Criteria followed by CT Pulmonary Angiography (CTPA) or D-dimer depending on risk stratification.
Question 4
Short Answer: Differentiate Community-Acquired Pneumonia (CAP) from Acute Bronchitis based on
physical examination and diagnostic imaging findings.
Correct Answer: CAP features localized lung consolidation signs (focal crackles/rales, egophony, bronchial
breath sounds, dullness to percussion) and infiltrate visible on Chest X-ray. Acute Bronchitis lacks
consolidation signs and chest radiograph is clear.
Clinical Rationale: Acute bronchitis is a self-limiting viral inflammation of the large airways with diffuse rhonchi/
wheezing but no alveolar consolidation or CXR infiltrates. CAP involves alveolar exudate leading to parenchymal
consolidation on imaging and localized auscultatory changes like tactile fremitus and egophony.
Question 5
A 70-year-old male with long-standing rheumatoid arthritis presents with progressive dry cough and
exertional dyspnea. Physical exam reveals fine, dry end-inspiratory 'Velcro-like' crackles at both lung bases
and digital clubbing. High-Resolution CT shows subpleural reticular opacities and honeycombing. What is
the diagnosis?
• A. Idiopathic Pulmonary Fibrosis / Interstitial Lung Disease
• B. Congestive Heart Failure
• C. Chronic Hypersensitivity Pneumonitis
• D. Sarcoidosis
Correct Answer: A. Idiopathic Pulmonary Fibrosis / Interstitial Lung Disease
Clinical Rationale: Velcro crackles, digital clubbing, progressive exertional dyspnea, and HRCT findings of subpleural
reticular opacities with honeycombing (Usual Interstitial Pneumonia pattern) are classic features of Interstitial Lung
Disease / Idiopathic Pulmonary Fibrosis.
NR 547: Differential Diagnosis Practicum — Final Examination Page 4 of 38
College of Nursing & Health Professions
COURSE NAME: NR 547 Differential Diagnosis Practicum
TARGET
Advanced Practice Nursing Candidates (NP / PMHNP / FNP)
AUDIENCE:
NR 547: DIFFERENTIAL DIAGNOSIS PRACTICUM
TOTAL
100 Questions (Multiple Choice & Short Answer)
QUESTIONS:
Comprehensive Final Examination
SYSTEMS
Respiratory, Cardiovascular, Neurological, Gastrointestinal, Endocrine
COVERED:
Advanced Clinical Assessment, Pathophysiology, and Differential
EXAMINATION
Diagnosis Academic
Across Major Year Systems
Body 2026
DATE:
FORMAT: Clinical Vignettes, Differential Assessment & Full Answer Rationales
, NR 547 Differential Diagnosis Practicum Examination
Examination Instructions & Guidance
This comprehensive evaluation contains 100 clinical differential diagnosis questions structured into 5 core body system
modules. Each item presents a patient presentation, physical exam findings, or diagnostic test result designed to evaluate
clinical reasoning, differential identification, and therapeutic decision-making in advanced nursing practice.
Structure: Every question includes the clinical vignette/prompt, correct answer key, and an in-depth clinical rationale
grounded in evidence-based guidelines.
Table of Examination Contents
Section I: Respiratory System Differential Diagnosis (Questions 1 – 20)
COPD vs. Asthma, Pulmonary Embolism, Pneumonia, ARDS, Interstitial Lung Disease, Pneumothorax, and Psychiatric
Manifestations (Panic/Hyperventilation).
Section II: Cardiovascular System Differential Diagnosis (Questions 21 – 40)
Acute Coronary Syndromes, Heart Failure, Arrhythmias, Hypertensive Crises, Pericarditis, Aortic Dissection, and Somatic/
Cardiovascular Overlaps.
Section III: Neurological System Differential Diagnosis (Questions 41 – 60)
Ischemic & Hemorrhagic Stroke, Seizures, Encephalopathy, Delirium vs. Dementia, Multiple Sclerosis, Parkinson's, and
Neuromuscular Disorders.
Section IV: Gastrointestinal System Differential Diagnosis (Questions 61 – 80)
Acute Abdomen, Appendicitis, Pancreatitis, Cholecystitis, Peptic Ulcer Disease, Inflammatory Bowel Disease (IBD vs. IBS),
Hepatic Encephalopathy.
Section V: Endocrine System Differential Diagnosis (Questions 81 – 100)
Thyroid Dysfunction (Graves', Hashimoto's), Adrenal Disorders (Cushing's, Addisonian Crisis), DKA/HHS, Pheochromocytoma,
Calcium/Parathyroid Imbalances.
NR 547: Differential Diagnosis Practicum — Final Examination Page 2 of 38
, Section I: Respiratory System
Differential Diagnosis, Pathophysiology, and Clinical Decision Making
Question 1
A 58-year-old male with a 35 pack-year smoking history presents with progressive dyspnea, chronic cough,
and frequent purulent sputum production. Pulmonary function testing (PFT) demonstrates a post-
bronchodilator FEV1/FVC ratio of 0.62. What is the primary diagnosis and hallmark PFT criterion?
• A. Asthma; defined by an FEV1/FVC > 0.70 with 12% bronchodilator reversibility
• B. Chronic Obstructive Pulmonary Disease (COPD); defined by a post-bronchodilator FEV1/FVC < 0.70
• C. Idiopathic Pulmonary Fibrosis; defined by restrictive pattern with elevated FEV1/FVC
• D. Bronchiectasis; defined by reversible airway obstruction
Correct Answer: B. Chronic Obstructive Pulmonary Disease (COPD); defined by a post-bronchodilator FEV1/
FVC < 0.70
Clinical Rationale: According to GOLD guidelines, a post-bronchodilator FEV1/FVC ratio < 0.70 confirms persistent
airflow limitation and diagnoses COPD. Asthma shows significant reversibility (>12% and 200mL increase in FEV1),
whereas COPD typically demonstrates fixed, non-fully reversible airway obstruction.
Question 2
A 24-year-old female presents to the emergency department with acute onset shortness of breath, bilateral
wheezing, and chest tightness following exposure to cold air while jogging. Spirometry reveals an FEV1
increase of 15% and 230 mL following inhalation of albuterol. What diagnosis is best supported?
• A. Exercise-induced pulmonary edema
• B. Acute pulmonary embolism
• C. Asthma
• D. Vocal cord dysfunction
Correct Answer: C. Asthma
Clinical Rationale: Asthma is characterized by hyperresponsive airways and variable, reversible airflow limitation. An
improvement in FEV1 of >12% and >200 mL post-bronchodilator is the classic diagnostic gold standard confirming
asthma over non-reversible conditions like COPD or structural upper airway obstruction.
NR 547: Differential Diagnosis Practicum — Final Examination Page 3 of 38
, Question 3
A 62-year-old female post-hip replacement surgery (Day 4) suddenly develops sharp pleuritic chest pain,
tachypnea, tachycardia (HR 118 bpm), and hypoxemia (SpO2 88% on room air). Chest X-ray is clear. What is
the most critical differential diagnosis to confirm immediately?
• A. Acute Bronchitis
• B. Pulmonary Embolism (PE)
• C. Tension Pneumothorax
• D. Community-Acquired Pneumonia
Correct Answer: B. Pulmonary Embolism (PE)
Clinical Rationale: Post-operative orthopedic state combined with sudden onset pleuritic chest pain, unexplained
tachycardia, and hypoxemia with normal chest radiographs strongly points to PE. Diagnosis should be evaluated using
Wells Criteria followed by CT Pulmonary Angiography (CTPA) or D-dimer depending on risk stratification.
Question 4
Short Answer: Differentiate Community-Acquired Pneumonia (CAP) from Acute Bronchitis based on
physical examination and diagnostic imaging findings.
Correct Answer: CAP features localized lung consolidation signs (focal crackles/rales, egophony, bronchial
breath sounds, dullness to percussion) and infiltrate visible on Chest X-ray. Acute Bronchitis lacks
consolidation signs and chest radiograph is clear.
Clinical Rationale: Acute bronchitis is a self-limiting viral inflammation of the large airways with diffuse rhonchi/
wheezing but no alveolar consolidation or CXR infiltrates. CAP involves alveolar exudate leading to parenchymal
consolidation on imaging and localized auscultatory changes like tactile fremitus and egophony.
Question 5
A 70-year-old male with long-standing rheumatoid arthritis presents with progressive dry cough and
exertional dyspnea. Physical exam reveals fine, dry end-inspiratory 'Velcro-like' crackles at both lung bases
and digital clubbing. High-Resolution CT shows subpleural reticular opacities and honeycombing. What is
the diagnosis?
• A. Idiopathic Pulmonary Fibrosis / Interstitial Lung Disease
• B. Congestive Heart Failure
• C. Chronic Hypersensitivity Pneumonitis
• D. Sarcoidosis
Correct Answer: A. Idiopathic Pulmonary Fibrosis / Interstitial Lung Disease
Clinical Rationale: Velcro crackles, digital clubbing, progressive exertional dyspnea, and HRCT findings of subpleural
reticular opacities with honeycombing (Usual Interstitial Pneumonia pattern) are classic features of Interstitial Lung
Disease / Idiopathic Pulmonary Fibrosis.
NR 547: Differential Diagnosis Practicum — Final Examination Page 4 of 38
