NR 571 COMPLEX DIAGNOSIS &
MANAGEMENT: FINAL
COMPREHENSIVE EXAM REVIEW –
100 QUESTIONS WITH RATIONALES
(AY 2026/2027)
Section 1: Differential Diagnosis and Clinical Reasoning
(Questions 1-7)
Question 1
What is the first step in creating a differential diagnosis for a patient with acute
symptoms?
A. Order diagnostic tests
B. Rule out malingering or factitious disorder
C. Perform a physical exam
D. Prescribe empiric treatment
Answer: B. Rule out malingering or factitious disorder
Rationale: Ruling out malingering or factitious disorder ensures symptoms are not
intentionally produced, guiding accurate diagnosis. This step is essential before
proceeding with costly or invasive diagnostic testing .
Question 2
A patient with vague flank pain and acute colicky pain with increasing intensity likely
has a kidney stone located where?
A. Lower third of the ureter
B. Renal pelvis
C. Ureterovesical junction
D. Urethra
,Answer: B. Renal pelvis
Rationale: Vague flank pain with increasing colicky intensity indicates a kidney stone
in the renal pelvis, where obstruction begins. Stones lower in the urinary tract
typically produce more sharp, radiating pain .
Question 3
Which conditions should be included in the differential diagnosis for abdominal or
flank pain? (Select all that apply)
A. Nephrolithiasis
B. Pyelonephritis
C. Ectopic pregnancy
D. Common cold
E. Ruptured aortic aneurysm
Answer: A, B, C, E
Rationale: Nephrolithiasis, pyelonephritis, ectopic pregnancy, and ruptured aortic
aneurysm can all present with abdominal or flank pain. The common cold is
unrelated to this symptom presentation and should not be included .
Question 4
A patient with right lower quadrant tenderness and a positive Blumberg sign should
be suspected of having what condition?
A. Cholecystitis
B. Appendicitis
C. Diverticulitis
D. Pancreatitis
Answer: B. Appendicitis
Rationale: A positive Blumberg sign (rebound tenderness in the right lower
quadrant) indicates peritonitis, commonly associated with appendicitis. This sign is
elicited by pressing deeply and releasing quickly; pain upon release suggests
peritoneal irritation .
,Question 5
A patient with a sore throat worse with swallowing and a normal oropharynx should
be suspected of having what condition?
A. Strep pharyngitis
B. Thyroiditis
C. Allergic pharyngitis
D. GERD
Answer: B. Thyroiditis
Rationale: A sore throat worsened by swallowing with a normal oropharynx suggests
thyroiditis, requiring thyroid palpation for swelling or pain. Strep pharyngitis would
typically show erythema or exudates in the oropharynx .
Question 6
What is the most likely diagnosis for a patient with a painful red rash, fluid-filled
blisters, and facial weakness on one side?
A. Impetigo
B. Ramsay Hunt syndrome
C. Cellulitis
D. Eczema
Answer: B. Ramsay Hunt syndrome
Rationale: Ramsay Hunt syndrome (herpes zoster oticus) presents with a painful
rash, vesicles, and ipsilateral facial paralysis due to varicella-zoster virus reactivation
in the geniculate ganglion .
Question 7
What is the classic triad of Ramsay Hunt syndrome?
A. Fever, rash, joint pain
B. Otalgia, vesicles, facial paralysis
C. Cough, dyspnea, chest pain
D. Nausea, vomiting, diarrhea
Answer: B. Otalgia, vesicles, facial paralysis
, Rationale: The classic triad of Ramsay Hunt syndrome includes otalgia (ear pain),
vesicles in the ear/mouth, and ipsilateral facial paralysis .
Section 2: Cardiovascular Emergencies (Questions 8-17)
Question 8
A 68-year-old male presents with substernal chest pain radiating to the left jaw,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1-V4. What is
the most likely diagnosis?
A. Unstable angina
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. ST-elevation myocardial infarction (STEMI)
D. Aortic dissection
Answer: C. ST-elevation myocardial infarction (STEMI)
Rationale: ST-segment elevation in contiguous precordial leads (V1–V4) with typical
ischemic symptoms indicates an anterior STEMI, caused by acute occlusion of the left
anterior descending artery. This requires emergent reperfusion therapy
(percutaneous coronary intervention within 90 minutes or fibrinolysis if PCI
unavailable). Unstable angina and NSTEMI typically present with ST-segment
depression or T-wave inversion .
Question 9
A 72-year-old female with hypertension presents with acute onset of severe, tearing
chest pain radiating to the back. BP is 180/100 in the right arm and 140/80 in the left
arm. Which diagnostic test is most appropriate?
A. 12-lead ECG
B. Cardiac troponin
C. CT angiography of the chest
D. Transthoracic echocardiogram
Answer: C. CT angiography of the chest
Rationale: Tearing chest pain radiating to the back with a blood pressure differential
between arms is classic for aortic dissection. CT angiography of the chest is the
MANAGEMENT: FINAL
COMPREHENSIVE EXAM REVIEW –
100 QUESTIONS WITH RATIONALES
(AY 2026/2027)
Section 1: Differential Diagnosis and Clinical Reasoning
(Questions 1-7)
Question 1
What is the first step in creating a differential diagnosis for a patient with acute
symptoms?
A. Order diagnostic tests
B. Rule out malingering or factitious disorder
C. Perform a physical exam
D. Prescribe empiric treatment
Answer: B. Rule out malingering or factitious disorder
Rationale: Ruling out malingering or factitious disorder ensures symptoms are not
intentionally produced, guiding accurate diagnosis. This step is essential before
proceeding with costly or invasive diagnostic testing .
Question 2
A patient with vague flank pain and acute colicky pain with increasing intensity likely
has a kidney stone located where?
A. Lower third of the ureter
B. Renal pelvis
C. Ureterovesical junction
D. Urethra
,Answer: B. Renal pelvis
Rationale: Vague flank pain with increasing colicky intensity indicates a kidney stone
in the renal pelvis, where obstruction begins. Stones lower in the urinary tract
typically produce more sharp, radiating pain .
Question 3
Which conditions should be included in the differential diagnosis for abdominal or
flank pain? (Select all that apply)
A. Nephrolithiasis
B. Pyelonephritis
C. Ectopic pregnancy
D. Common cold
E. Ruptured aortic aneurysm
Answer: A, B, C, E
Rationale: Nephrolithiasis, pyelonephritis, ectopic pregnancy, and ruptured aortic
aneurysm can all present with abdominal or flank pain. The common cold is
unrelated to this symptom presentation and should not be included .
Question 4
A patient with right lower quadrant tenderness and a positive Blumberg sign should
be suspected of having what condition?
A. Cholecystitis
B. Appendicitis
C. Diverticulitis
D. Pancreatitis
Answer: B. Appendicitis
Rationale: A positive Blumberg sign (rebound tenderness in the right lower
quadrant) indicates peritonitis, commonly associated with appendicitis. This sign is
elicited by pressing deeply and releasing quickly; pain upon release suggests
peritoneal irritation .
,Question 5
A patient with a sore throat worse with swallowing and a normal oropharynx should
be suspected of having what condition?
A. Strep pharyngitis
B. Thyroiditis
C. Allergic pharyngitis
D. GERD
Answer: B. Thyroiditis
Rationale: A sore throat worsened by swallowing with a normal oropharynx suggests
thyroiditis, requiring thyroid palpation for swelling or pain. Strep pharyngitis would
typically show erythema or exudates in the oropharynx .
Question 6
What is the most likely diagnosis for a patient with a painful red rash, fluid-filled
blisters, and facial weakness on one side?
A. Impetigo
B. Ramsay Hunt syndrome
C. Cellulitis
D. Eczema
Answer: B. Ramsay Hunt syndrome
Rationale: Ramsay Hunt syndrome (herpes zoster oticus) presents with a painful
rash, vesicles, and ipsilateral facial paralysis due to varicella-zoster virus reactivation
in the geniculate ganglion .
Question 7
What is the classic triad of Ramsay Hunt syndrome?
A. Fever, rash, joint pain
B. Otalgia, vesicles, facial paralysis
C. Cough, dyspnea, chest pain
D. Nausea, vomiting, diarrhea
Answer: B. Otalgia, vesicles, facial paralysis
, Rationale: The classic triad of Ramsay Hunt syndrome includes otalgia (ear pain),
vesicles in the ear/mouth, and ipsilateral facial paralysis .
Section 2: Cardiovascular Emergencies (Questions 8-17)
Question 8
A 68-year-old male presents with substernal chest pain radiating to the left jaw,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1-V4. What is
the most likely diagnosis?
A. Unstable angina
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. ST-elevation myocardial infarction (STEMI)
D. Aortic dissection
Answer: C. ST-elevation myocardial infarction (STEMI)
Rationale: ST-segment elevation in contiguous precordial leads (V1–V4) with typical
ischemic symptoms indicates an anterior STEMI, caused by acute occlusion of the left
anterior descending artery. This requires emergent reperfusion therapy
(percutaneous coronary intervention within 90 minutes or fibrinolysis if PCI
unavailable). Unstable angina and NSTEMI typically present with ST-segment
depression or T-wave inversion .
Question 9
A 72-year-old female with hypertension presents with acute onset of severe, tearing
chest pain radiating to the back. BP is 180/100 in the right arm and 140/80 in the left
arm. Which diagnostic test is most appropriate?
A. 12-lead ECG
B. Cardiac troponin
C. CT angiography of the chest
D. Transthoracic echocardiogram
Answer: C. CT angiography of the chest
Rationale: Tearing chest pain radiating to the back with a blood pressure differential
between arms is classic for aortic dissection. CT angiography of the chest is the
