NR 511 Differential Diagnosis Primary Care
Practicum Final Exam 2026/2027 – Questions
and Answers | 100% Verified | Detailed
Rationales – Pass Guaranteed – A+ Graded
1. A 45-year-old male presents with chest pain. Using the differential diagnosis framework, which
condition should be considered first based on life-threatening potential?
A) Gastroesophageal reflux disease
B) Acute coronary syndrome
C) Costochondritis
D) Musculoskeletal chest pain
Answer B: Acute coronary syndrome
Rationale: ACS represents an immediate life threat that must be ruled out early in the evaluation process
before considering benign causes .
2. A 29-year-old woman presents with 6 months of crampy abdominal pain relieved by defecation,
intermittent diarrhea, and bloating. Physical exam is normal. What is the MOST appropriate next
step?
A) Schedule immediate colonoscopy
B) Order stool studies including fecal fat, weight, laxative screen, and tests for microorganisms
C) Begin empiric treatment for ulcerative colitis
D) Start antidiarrheal medication
Answer B: Order stool studies including fecal fat, weight, laxative screen, and tests for
microorganisms
Rationale: In IBS-like presentations with diarrhea, the guideline recommends thyroid testing and stool
studies to exclude organic causes before confirming IBS .
,3. A 34-year-old woman presents with intermittent LLQ abdominal pain and constipation. She is
afebrile with benign abdominal exam and normal labs. What is the MOST appropriate initial
approach?
A) Empiric antibiotics for diverticulitis
B) Immediate CT scan
C) Evaluate for IBS and medication-induced constipation
D) Schedule urgent colonoscopy
Answer C: Evaluate for IBS and medication-induced constipation
Rationale: IBS is a diagnosis of exclusion after careful history, exam, and targeted testing rule out
organic causes .
4. A 38-year-old man has heartburn twice weekly, no alarm symptoms, and a normal exam. What
is the BEST initial management?
A) Immediate EGD and CT abdomen
B) Lifestyle modification plus empiric acid-suppressive therapy
C) Chronic sucralfate therapy alone
D) H. pylori eradication therapy
Answer B: Lifestyle modification plus empiric acid-suppressive therapy
Rationale: GERD management guidelines emphasize initial treatment with lifestyle modifications
combined with acid suppression in the absence of alarm features .
5. A 43-year-old woman has episodic epigastric pain that radiates to the back, occurs after fatty
meals, and is associated with nausea. Murphy's sign is positive. Which diagnostic test is MOST
appropriate first?
A) Abdominal ultrasound
B) CT abdomen with contrast
C) Colonoscopy
D) Upper GI series
,Answer A: Abdominal ultrasound
Rationale: RUQ ultrasound is the initial imaging test for suspected biliary disease such as cholelithiasis or
acute cholecystitis .
6. A 21-year-old woman presents with sudden periumbilical pain that migrated to the RLQ over 24
hours, low-grade fever, and anorexia. RLQ tenderness with guarding is present. What is the MOST
likely diagnosis?
A) Diverticulitis
B) Crohn's disease flare
C) Appendicitis
D) IBS
Answer C: Appendicitis
Rationale: Classic appendicitis presents with initially vague periumbilical pain that localizes to the RLQ
with tenderness, fever, and anorexia .
7. A 40-year-old man has burning epigastric pain relieved by food and antacids. He takes NSAIDs
daily. Which H. pylori test is BEST for initial noninvasive diagnosis?
A) Serum H. pylori IgG antibody
B) Urea breath test
C) Endoscopic biopsy
D) Stool occult blood testing
Answer B: Urea breath test
Rationale: Noninvasive urea breath testing is preferred for detecting active H. pylori infection; serology
may reflect past exposure .
8. A 62-year-old woman has chronic watery diarrhea, weight loss, and abdominal cramping. Which
finding would MOST strongly argue against IBS and prompt evaluation for IBD or malignancy?
A) Symptoms improve after defecation
, B) Symptoms worsened by stress
C) Nocturnal diarrhea and rectal bleeding
D) Normal abdominal exam
Answer C: Nocturnal diarrhea and rectal bleeding
Rationale: Alarm features such as rectal bleeding, weight loss, and nocturnal symptoms raise concern for
IBD or malignancy rather than functional IBS .
9. A 55-year-old man with longstanding GERD reports new-onset dysphagia for solids. He has
been taking OTC antacids only. In addition to endoscopy, what is the MOST appropriate initial
management?
A) Start a proton pump inhibitor (PPI)
B) Start sucralfate only
C) Start chronic high-dose antacids
D) Refer immediately for surgery
Answer A: Start a proton pump inhibitor (PPI)
Rationale: GERD management guidelines emphasize acid suppression with PPIs as first-line
pharmacologic therapy, especially in patients with persistent symptoms or complications .
10. A 30-year-old woman with a herniated disc at L5-S1 is in the emergency room with suspicion
of cauda equina compression. Which sign or symptom indicates 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 presents with saddle anesthesia (paresthesia of perineum and
buttocks), bowel/bladder dysfunction, and bilateral leg weakness .
Practicum Final Exam 2026/2027 – Questions
and Answers | 100% Verified | Detailed
Rationales – Pass Guaranteed – A+ Graded
1. A 45-year-old male presents with chest pain. Using the differential diagnosis framework, which
condition should be considered first based on life-threatening potential?
A) Gastroesophageal reflux disease
B) Acute coronary syndrome
C) Costochondritis
D) Musculoskeletal chest pain
Answer B: Acute coronary syndrome
Rationale: ACS represents an immediate life threat that must be ruled out early in the evaluation process
before considering benign causes .
2. A 29-year-old woman presents with 6 months of crampy abdominal pain relieved by defecation,
intermittent diarrhea, and bloating. Physical exam is normal. What is the MOST appropriate next
step?
A) Schedule immediate colonoscopy
B) Order stool studies including fecal fat, weight, laxative screen, and tests for microorganisms
C) Begin empiric treatment for ulcerative colitis
D) Start antidiarrheal medication
Answer B: Order stool studies including fecal fat, weight, laxative screen, and tests for
microorganisms
Rationale: In IBS-like presentations with diarrhea, the guideline recommends thyroid testing and stool
studies to exclude organic causes before confirming IBS .
,3. A 34-year-old woman presents with intermittent LLQ abdominal pain and constipation. She is
afebrile with benign abdominal exam and normal labs. What is the MOST appropriate initial
approach?
A) Empiric antibiotics for diverticulitis
B) Immediate CT scan
C) Evaluate for IBS and medication-induced constipation
D) Schedule urgent colonoscopy
Answer C: Evaluate for IBS and medication-induced constipation
Rationale: IBS is a diagnosis of exclusion after careful history, exam, and targeted testing rule out
organic causes .
4. A 38-year-old man has heartburn twice weekly, no alarm symptoms, and a normal exam. What
is the BEST initial management?
A) Immediate EGD and CT abdomen
B) Lifestyle modification plus empiric acid-suppressive therapy
C) Chronic sucralfate therapy alone
D) H. pylori eradication therapy
Answer B: Lifestyle modification plus empiric acid-suppressive therapy
Rationale: GERD management guidelines emphasize initial treatment with lifestyle modifications
combined with acid suppression in the absence of alarm features .
5. A 43-year-old woman has episodic epigastric pain that radiates to the back, occurs after fatty
meals, and is associated with nausea. Murphy's sign is positive. Which diagnostic test is MOST
appropriate first?
A) Abdominal ultrasound
B) CT abdomen with contrast
C) Colonoscopy
D) Upper GI series
,Answer A: Abdominal ultrasound
Rationale: RUQ ultrasound is the initial imaging test for suspected biliary disease such as cholelithiasis or
acute cholecystitis .
6. A 21-year-old woman presents with sudden periumbilical pain that migrated to the RLQ over 24
hours, low-grade fever, and anorexia. RLQ tenderness with guarding is present. What is the MOST
likely diagnosis?
A) Diverticulitis
B) Crohn's disease flare
C) Appendicitis
D) IBS
Answer C: Appendicitis
Rationale: Classic appendicitis presents with initially vague periumbilical pain that localizes to the RLQ
with tenderness, fever, and anorexia .
7. A 40-year-old man has burning epigastric pain relieved by food and antacids. He takes NSAIDs
daily. Which H. pylori test is BEST for initial noninvasive diagnosis?
A) Serum H. pylori IgG antibody
B) Urea breath test
C) Endoscopic biopsy
D) Stool occult blood testing
Answer B: Urea breath test
Rationale: Noninvasive urea breath testing is preferred for detecting active H. pylori infection; serology
may reflect past exposure .
8. A 62-year-old woman has chronic watery diarrhea, weight loss, and abdominal cramping. Which
finding would MOST strongly argue against IBS and prompt evaluation for IBD or malignancy?
A) Symptoms improve after defecation
, B) Symptoms worsened by stress
C) Nocturnal diarrhea and rectal bleeding
D) Normal abdominal exam
Answer C: Nocturnal diarrhea and rectal bleeding
Rationale: Alarm features such as rectal bleeding, weight loss, and nocturnal symptoms raise concern for
IBD or malignancy rather than functional IBS .
9. A 55-year-old man with longstanding GERD reports new-onset dysphagia for solids. He has
been taking OTC antacids only. In addition to endoscopy, what is the MOST appropriate initial
management?
A) Start a proton pump inhibitor (PPI)
B) Start sucralfate only
C) Start chronic high-dose antacids
D) Refer immediately for surgery
Answer A: Start a proton pump inhibitor (PPI)
Rationale: GERD management guidelines emphasize acid suppression with PPIs as first-line
pharmacologic therapy, especially in patients with persistent symptoms or complications .
10. A 30-year-old woman with a herniated disc at L5-S1 is in the emergency room with suspicion
of cauda equina compression. Which sign or symptom indicates 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 presents with saddle anesthesia (paresthesia of perineum and
buttocks), bowel/bladder dysfunction, and bilateral leg weakness .
