NSG 550-WILKES DIAGNOSTIC REASONING EXAM TESTBANK |
ALL EXAMS QUESTIONS AND ANSWERS 2026/2027 | VERIFIED
ANSWERS PLUS RATIONALES | GRADED Q&A
COMPREHENSIVE STUDY GUIDE | VERIFIED LATEST 2027
1. A 45-year-old male presents with a 2-day history of localized, throbbing pain and
swelling in his left lower leg. Physical examination reveals an area of erythema with poorly
demarcated borders that is warm and tender to the touch. No purulence is observed.
Which of the following is the most likely diagnosis?
A. Cellulitis
B. Abscess
C. Erysipelas
D. Deep vein thrombosis
Cellulitis is a non-necrotizing inflammation of the skin and subcutaneous tissues, typically
characterized by poorly demarcated erythema, warmth, edema, and tenderness without
gross purulence. Non-purulent cellulitis is most commonly caused by Streptococcus species
and requires targeted antibiotic therapy.
2. A 62-year-old female presents to the clinic complaining of worsening shortness of breath
on exertion and a persistent dry cough for the past 3 months. She has a 30 pack-year
smoking history. Auscultation of the lungs reveals fine end-inspiratory crackles throughout
both lower lung zones. Digital clubbing is noted on physical exam. Which diagnostic test is
most definitive for establishing the underlying diagnosis?
A. Chest radiography
B. High-resolution computed tomography (HRCT) of the chest
C. Spirometry alone
D. Pulse oximetry at rest
High-resolution computed tomography (HRCT) is the imaging modality of choice for
diagnosing interstitial lung diseases such as idiopathic pulmonary fibrosis, providing detailed
cross-sectional visualization of reticular opacities and honeycombing that plain radiography
cannot adequately demonstrate.
3. A 28-year-old female presents with fatigue, cold intolerance, weight gain, and
constipation. Laboratory testing reveals an elevated Thyroid-Stimulating Hormone (TSH)
level and a decreased free Thyroxine (T4) level. Which of the following is the primary
underlying pathophysiology?
A. Pituitary adenoma secreting excess TSH
B. Autoimmune destruction of the thyroid gland
,C. Peripheral resistance to thyroid hormones
D. Excessive dietary intake of iodine
Hashimoto thyroiditis, an autoimmune destruction of the thyroid gland, is the most common
cause of primary hypothyroidism in developed countries, characterized by low free T4 and
high TSH due to loss of negative feedback.
4. A 55-year-old male with a history of hypertension presents with acute onset of severe,
tearing chest pain radiating to his upper back between the scapulae. His blood pressure is
185/105 mmHg in the right arm and 140/85 mmHg in the left arm. What is the initial
diagnostic modality of choice in a hemodynamically stable patient?
A. Transthoracic echocardiogram (TTE)
B. Computed Tomography Angiography (CTA) of the chest
C. Exercise stress test
D. Plain chest X-ray
CTA of the chest is the gold standard for rapidly and accurately identifying an aortic
dissection, delineating the intimal flap and true/false lumens in a hemodynamically stable
patient presenting with classic tearing chest pain and asymmetric blood pressures.
5. A 34-year-old male presents with right lower quadrant abdominal pain that started near
the umbilicus before migrating. On physical examination, rebound tenderness is elicited at
McBurney's point. Which sign is demonstrated when passive extension of the right hip
reproduces this pain?
A. Rovsing sign
B. Obturator sign
C. Psoas sign
D. Murphy sign
The Psoas sign is positive when passive extension of the right hip causes abdominal pain,
indicating retrocecal irritation of the psoas muscle associated with acute appendicitis.
6. A 70-year-old male with a history of benign prostatic hyperplasia (BPH) presents with
acute urinary retention. Palpation reveals a suprapubic mass consistent with a distended
bladder. What is the most immediate clinical intervention indicated?
A. Oral tamsulosin administration
B. Emergency transurethral resection of the prostate
C. Urethral catheterization
D. Intravenous administration of loop diuretics
,Acute urinary retention requires immediate decompression of the urinary bladder via urethral
catheterization to relieve pain, prevent upper urinary tract post-renal damage, and restore
urinary drainage.
7. A 22-year-old college student presents with fever, severe headache, photophobia, and
neck stiffness. Physical exam reveals positive Kernig and Brudzinski signs. What is the
most critical initial diagnostic step prior to lumbar puncture if papilledema is absent?
A. MRI of the brain
B. Blood cultures followed immediately by empiric parenteral antibiotics
C. Serum electrolyte panel
D. Polymerase chain reaction (PCR) urine testing
In suspected bacterial meningitis, immediate blood cultures and prompt administration of
empiric parenteral antibiotics are critical priorities to reduce mortality and morbidity before
performing a lumbar puncture.
8. A 50-year-old female presents for a routine checkup. Routine laboratory screening
reveals a fasting serum glucose of 138 mg/dL. A repeat fasting glucose 3 days later is 142
mg/dL. According to clinical practice guidelines, what is the correct diagnosis?
A. Impaired fasting glucose
B. Impaired glucose tolerance
C. Type 2 Diabetes Mellitus
D. Normal metabolic status
Type 2 Diabetes Mellitus is formally diagnosed with two separate fasting plasma glucose
readings of 126 mg/dL or higher on different days.
9. A 19-year-old athlete presents with sudden onset of unilateral testicular pain and
swelling that began 1 hour ago during soccer practice. Physical exam reveals an elevated,
exquisitely tender left testicle with an absent cremasteric reflex. What is the most
appropriate management?
A. Oral antibiotic therapy for epididymitis
B. Immediate surgical consultation for scrotal exploration
C. Scrotal elevation and ice pack application
D. Outpatient ultrasound scheduling within 48 hours
Testicular torsion is a surgical emergency requiring immediate exploration and detorsion to
restore blood flow within a 6-hour window to prevent testicular necrosis and loss.
10. A 68-year-old male complains of gradual, painless vision loss in both eyes over the past
few years. He states that straight lines appear wavy, and he has difficulty recognizing
central facial features. Peripheral vision remains intact. What is the most likely diagnosis?
, A. Acute angle-closure glaucoma
B. Cataracts
C. Age-related macular degeneration
D. Retinal detachment
Age-related macular degeneration affects the central retina (macula), leading to painless
central vision loss, metamorphopsia (distortion of straight lines), and preservation of
peripheral field vision.
11. A 35-year-old male presents with intermittent, severe pain in the left flank that radiates
down to his groin and testicle. Hematuria is detected on dipstick urinalysis. Which non-
invasive imaging modality is preferred for evaluating suspected nephrolithiasis?
A. Non-contrast computed tomography of the abdomen and pelvis
B. Magnetic Resonance Angiography
C. Intravenous Pyelogram
D. Plain abdominal radiograph (KUB)
Non-contrast helical CT of the abdomen and pelvis is the most sensitive and specific imaging
modality for detecting kidney and ureteral stones, visualising stone size, location, and
presence of urinary tract obstruction.
12. A 40-year-old female presents with persistent morning stiffness lasting over an hour,
involving the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints
bilaterally. Radiographs show periarticular osteopenia and joint space narrowing. Which
autoantibody test is most specific for this condition?
A. Antinuclear antibody (ANA)
B. Anti-cyclic citrullinated peptide (anti-CCP)
C. Anti-double stranded DNA (anti-dsDNA)
D. Antineutrophil cytoplasmic antibodies (ANCA)
Anti-cyclic citrullinated peptide (anti-CCP) antibodies demonstrate high specificity (over 90%)
for rheumatoid arthritis, making them critical in confirming early disease presentation
compared to rheumatoid factor or ANA.
13. A 60-year-old male with long-standing hypertension presents with sudden onset of
expressive aphasia and right-sided facial droop. CT scan of the head rules out hemorrhage.
Which artery is most likely occluded?
A. Left Middle Cerebral Artery (MCA)
B. Right Anterior Cerebral Artery (ACA)
C. Left Posterior Cerebral Artery (PCA)
D. Basilar Artery
ALL EXAMS QUESTIONS AND ANSWERS 2026/2027 | VERIFIED
ANSWERS PLUS RATIONALES | GRADED Q&A
COMPREHENSIVE STUDY GUIDE | VERIFIED LATEST 2027
1. A 45-year-old male presents with a 2-day history of localized, throbbing pain and
swelling in his left lower leg. Physical examination reveals an area of erythema with poorly
demarcated borders that is warm and tender to the touch. No purulence is observed.
Which of the following is the most likely diagnosis?
A. Cellulitis
B. Abscess
C. Erysipelas
D. Deep vein thrombosis
Cellulitis is a non-necrotizing inflammation of the skin and subcutaneous tissues, typically
characterized by poorly demarcated erythema, warmth, edema, and tenderness without
gross purulence. Non-purulent cellulitis is most commonly caused by Streptococcus species
and requires targeted antibiotic therapy.
2. A 62-year-old female presents to the clinic complaining of worsening shortness of breath
on exertion and a persistent dry cough for the past 3 months. She has a 30 pack-year
smoking history. Auscultation of the lungs reveals fine end-inspiratory crackles throughout
both lower lung zones. Digital clubbing is noted on physical exam. Which diagnostic test is
most definitive for establishing the underlying diagnosis?
A. Chest radiography
B. High-resolution computed tomography (HRCT) of the chest
C. Spirometry alone
D. Pulse oximetry at rest
High-resolution computed tomography (HRCT) is the imaging modality of choice for
diagnosing interstitial lung diseases such as idiopathic pulmonary fibrosis, providing detailed
cross-sectional visualization of reticular opacities and honeycombing that plain radiography
cannot adequately demonstrate.
3. A 28-year-old female presents with fatigue, cold intolerance, weight gain, and
constipation. Laboratory testing reveals an elevated Thyroid-Stimulating Hormone (TSH)
level and a decreased free Thyroxine (T4) level. Which of the following is the primary
underlying pathophysiology?
A. Pituitary adenoma secreting excess TSH
B. Autoimmune destruction of the thyroid gland
,C. Peripheral resistance to thyroid hormones
D. Excessive dietary intake of iodine
Hashimoto thyroiditis, an autoimmune destruction of the thyroid gland, is the most common
cause of primary hypothyroidism in developed countries, characterized by low free T4 and
high TSH due to loss of negative feedback.
4. A 55-year-old male with a history of hypertension presents with acute onset of severe,
tearing chest pain radiating to his upper back between the scapulae. His blood pressure is
185/105 mmHg in the right arm and 140/85 mmHg in the left arm. What is the initial
diagnostic modality of choice in a hemodynamically stable patient?
A. Transthoracic echocardiogram (TTE)
B. Computed Tomography Angiography (CTA) of the chest
C. Exercise stress test
D. Plain chest X-ray
CTA of the chest is the gold standard for rapidly and accurately identifying an aortic
dissection, delineating the intimal flap and true/false lumens in a hemodynamically stable
patient presenting with classic tearing chest pain and asymmetric blood pressures.
5. A 34-year-old male presents with right lower quadrant abdominal pain that started near
the umbilicus before migrating. On physical examination, rebound tenderness is elicited at
McBurney's point. Which sign is demonstrated when passive extension of the right hip
reproduces this pain?
A. Rovsing sign
B. Obturator sign
C. Psoas sign
D. Murphy sign
The Psoas sign is positive when passive extension of the right hip causes abdominal pain,
indicating retrocecal irritation of the psoas muscle associated with acute appendicitis.
6. A 70-year-old male with a history of benign prostatic hyperplasia (BPH) presents with
acute urinary retention. Palpation reveals a suprapubic mass consistent with a distended
bladder. What is the most immediate clinical intervention indicated?
A. Oral tamsulosin administration
B. Emergency transurethral resection of the prostate
C. Urethral catheterization
D. Intravenous administration of loop diuretics
,Acute urinary retention requires immediate decompression of the urinary bladder via urethral
catheterization to relieve pain, prevent upper urinary tract post-renal damage, and restore
urinary drainage.
7. A 22-year-old college student presents with fever, severe headache, photophobia, and
neck stiffness. Physical exam reveals positive Kernig and Brudzinski signs. What is the
most critical initial diagnostic step prior to lumbar puncture if papilledema is absent?
A. MRI of the brain
B. Blood cultures followed immediately by empiric parenteral antibiotics
C. Serum electrolyte panel
D. Polymerase chain reaction (PCR) urine testing
In suspected bacterial meningitis, immediate blood cultures and prompt administration of
empiric parenteral antibiotics are critical priorities to reduce mortality and morbidity before
performing a lumbar puncture.
8. A 50-year-old female presents for a routine checkup. Routine laboratory screening
reveals a fasting serum glucose of 138 mg/dL. A repeat fasting glucose 3 days later is 142
mg/dL. According to clinical practice guidelines, what is the correct diagnosis?
A. Impaired fasting glucose
B. Impaired glucose tolerance
C. Type 2 Diabetes Mellitus
D. Normal metabolic status
Type 2 Diabetes Mellitus is formally diagnosed with two separate fasting plasma glucose
readings of 126 mg/dL or higher on different days.
9. A 19-year-old athlete presents with sudden onset of unilateral testicular pain and
swelling that began 1 hour ago during soccer practice. Physical exam reveals an elevated,
exquisitely tender left testicle with an absent cremasteric reflex. What is the most
appropriate management?
A. Oral antibiotic therapy for epididymitis
B. Immediate surgical consultation for scrotal exploration
C. Scrotal elevation and ice pack application
D. Outpatient ultrasound scheduling within 48 hours
Testicular torsion is a surgical emergency requiring immediate exploration and detorsion to
restore blood flow within a 6-hour window to prevent testicular necrosis and loss.
10. A 68-year-old male complains of gradual, painless vision loss in both eyes over the past
few years. He states that straight lines appear wavy, and he has difficulty recognizing
central facial features. Peripheral vision remains intact. What is the most likely diagnosis?
, A. Acute angle-closure glaucoma
B. Cataracts
C. Age-related macular degeneration
D. Retinal detachment
Age-related macular degeneration affects the central retina (macula), leading to painless
central vision loss, metamorphopsia (distortion of straight lines), and preservation of
peripheral field vision.
11. A 35-year-old male presents with intermittent, severe pain in the left flank that radiates
down to his groin and testicle. Hematuria is detected on dipstick urinalysis. Which non-
invasive imaging modality is preferred for evaluating suspected nephrolithiasis?
A. Non-contrast computed tomography of the abdomen and pelvis
B. Magnetic Resonance Angiography
C. Intravenous Pyelogram
D. Plain abdominal radiograph (KUB)
Non-contrast helical CT of the abdomen and pelvis is the most sensitive and specific imaging
modality for detecting kidney and ureteral stones, visualising stone size, location, and
presence of urinary tract obstruction.
12. A 40-year-old female presents with persistent morning stiffness lasting over an hour,
involving the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints
bilaterally. Radiographs show periarticular osteopenia and joint space narrowing. Which
autoantibody test is most specific for this condition?
A. Antinuclear antibody (ANA)
B. Anti-cyclic citrullinated peptide (anti-CCP)
C. Anti-double stranded DNA (anti-dsDNA)
D. Antineutrophil cytoplasmic antibodies (ANCA)
Anti-cyclic citrullinated peptide (anti-CCP) antibodies demonstrate high specificity (over 90%)
for rheumatoid arthritis, making them critical in confirming early disease presentation
compared to rheumatoid factor or ANA.
13. A 60-year-old male with long-standing hypertension presents with sudden onset of
expressive aphasia and right-sided facial droop. CT scan of the head rules out hemorrhage.
Which artery is most likely occluded?
A. Left Middle Cerebral Artery (MCA)
B. Right Anterior Cerebral Artery (ACA)
C. Left Posterior Cerebral Artery (PCA)
D. Basilar Artery
