, SET 1 & 2
NR 511 FINAL EXAM DIFFERENTIAL DIAGNOSIS & PRIMARY
CARE PRACTICUM STUDY QUESTION
1. Janet is a 30-year-old woman who has recently been diagnosed with a herniated
disc at the L5-S1 level. She presents to the emergency department because of
increasing symptoms and concern for possible cauda equina compression. The
clinician performs a focused neurologic assessment to identify findings that would
require urgent intervention. Which of the following is a sign or symptom of cauda
equina compression?
A. Gastrocnemius weakness
B. Reduced or absent ankle reflex
C. Numbness of the lateral foot
D. Paresthesia of the perineum and buttocks
Correct answer: D. Paresthesia of the perineum and buttocks
Rationale: Paresthesia involving the perineum and buttocks, often described as
saddle anesthesia, is a classic warning sign of cauda equina compression.
Compression of the lower spinal nerve roots can produce sensory changes in the
saddle region and may occur with bladder, bowel, or sexual dysfunction. This finding
requires urgent evaluation because prolonged nerve compression can result in
permanent neurologic impairment.
2. A patient is being treated for acute pancreatitis, and the clinician calculates a
Ranson's Criteria score of 7. The clinician uses this score to help determine the
severity of the patient's illness and guide the overall plan of care. A higher Ranson's
score is associated with a more severe episode of acute pancreatitis and a poorer
prognosis. In order to plan care, the clinician understands that this criteria score
has which of the following meanings?
,A. A high mortality rate
B. An increased chance of recurrence
C. A 7% chance of the disease becoming chronic
D. All of the above
Correct answer: A. A high mortality rate
Rationale: A Ranson's Criteria score of 7 indicates severe acute pancreatitis and is
associated with a high mortality risk. The score is used primarily to assess the
severity and prognosis of acute pancreatitis rather than to predict recurrence or a
specific percentage chance of chronic disease. Therefore, the most appropriate
interpretation is a high mortality rate.
3. Reuben is a 24-year-old man living with HIV who recently had a routine viral load
test performed. When the clinician reviews his results, the viral load is found to be
falling compared with his previous measurement. The clinician explains that viral
load trends are important for evaluating the response to HIV treatment and the
level of viral replication. What does a falling viral load indicate?
A. A favorable diagnostic trend
B. Disease progression
C. The need to be more aggressive with Reuben's medications
D. The eradication of HIV
Correct answer: A. A favorable diagnostic trend
Rationale: A falling HIV viral load generally indicates that viral replication is
decreasing and that treatment is producing a favorable response. The trend is an
important indicator of treatment effectiveness and helps clinicians evaluate ongoing
disease control. A decreasing viral load does not mean that HIV has been eradicated
from the body.
4. A patient presents with acute dizziness and vertigo, and the clinician is
considering several possible disorders affecting the vestibular system. The clinician
, explains that labyrinthitis and vestibular neuritis can have similar presentations but
differ in important clinical features. Hearing function is assessed along with the
patient's vestibular symptoms to help distinguish between the two conditions.
Which is the differentiating symptom between labyrinthitis and vestibular neuritis?
A. Symptoms with vestibular neuritis are usually acute in onset, whereas with
labyrinthitis the onset is more gradual.
B. Hearing loss may be associated with vestibular neuritis, but not with labyrinthitis.
C. Symptoms with labyrinthitis are usually acute in onset, whereas with vestibular
neuritis the onset is more gradual.
D. Hearing loss may be associated with labyrinthitis, but not with vestibular
neuritis.
Correct answer: D. Hearing loss may be associated with labyrinthitis, but not
with vestibular neuritis.
Rationale: Labyrinthitis involves inflammation of the inner ear structures and can
affect both the vestibular and auditory systems, resulting in vertigo accompanied by
hearing loss. Vestibular neuritis primarily affects the vestibular portion of the
vestibulocochlear nerve and generally does not cause hearing loss. Therefore, the
presence of hearing loss favors labyrinthitis over vestibular neuritis.
5. A 27-year-old woman presents with a chief complaint of burning and pain during
urination. She reports that she has never previously been diagnosed with a urinary
tract infection. The clinician obtains additional information about urinary
frequency, hematuria, systemic symptoms, and other possible signs of urinary tract
involvement. Which of the following additional symptoms is most consistent with a
diagnosis of a lower UTI?
A. Back and abdominal pain
B. Fever, chills, and costovertebral angle (CVA) tenderness
C. Blood in the urine and frequency
D. Foul-smelling discharge and perineal itching
NR 511 FINAL EXAM DIFFERENTIAL DIAGNOSIS & PRIMARY
CARE PRACTICUM STUDY QUESTION
1. Janet is a 30-year-old woman who has recently been diagnosed with a herniated
disc at the L5-S1 level. She presents to the emergency department because of
increasing symptoms and concern for possible cauda equina compression. The
clinician performs a focused neurologic assessment to identify findings that would
require urgent intervention. Which of the following is a sign or symptom of cauda
equina compression?
A. Gastrocnemius weakness
B. Reduced or absent ankle reflex
C. Numbness of the lateral foot
D. Paresthesia of the perineum and buttocks
Correct answer: D. Paresthesia of the perineum and buttocks
Rationale: Paresthesia involving the perineum and buttocks, often described as
saddle anesthesia, is a classic warning sign of cauda equina compression.
Compression of the lower spinal nerve roots can produce sensory changes in the
saddle region and may occur with bladder, bowel, or sexual dysfunction. This finding
requires urgent evaluation because prolonged nerve compression can result in
permanent neurologic impairment.
2. A patient is being treated for acute pancreatitis, and the clinician calculates a
Ranson's Criteria score of 7. The clinician uses this score to help determine the
severity of the patient's illness and guide the overall plan of care. A higher Ranson's
score is associated with a more severe episode of acute pancreatitis and a poorer
prognosis. In order to plan care, the clinician understands that this criteria score
has which of the following meanings?
,A. A high mortality rate
B. An increased chance of recurrence
C. A 7% chance of the disease becoming chronic
D. All of the above
Correct answer: A. A high mortality rate
Rationale: A Ranson's Criteria score of 7 indicates severe acute pancreatitis and is
associated with a high mortality risk. The score is used primarily to assess the
severity and prognosis of acute pancreatitis rather than to predict recurrence or a
specific percentage chance of chronic disease. Therefore, the most appropriate
interpretation is a high mortality rate.
3. Reuben is a 24-year-old man living with HIV who recently had a routine viral load
test performed. When the clinician reviews his results, the viral load is found to be
falling compared with his previous measurement. The clinician explains that viral
load trends are important for evaluating the response to HIV treatment and the
level of viral replication. What does a falling viral load indicate?
A. A favorable diagnostic trend
B. Disease progression
C. The need to be more aggressive with Reuben's medications
D. The eradication of HIV
Correct answer: A. A favorable diagnostic trend
Rationale: A falling HIV viral load generally indicates that viral replication is
decreasing and that treatment is producing a favorable response. The trend is an
important indicator of treatment effectiveness and helps clinicians evaluate ongoing
disease control. A decreasing viral load does not mean that HIV has been eradicated
from the body.
4. A patient presents with acute dizziness and vertigo, and the clinician is
considering several possible disorders affecting the vestibular system. The clinician
, explains that labyrinthitis and vestibular neuritis can have similar presentations but
differ in important clinical features. Hearing function is assessed along with the
patient's vestibular symptoms to help distinguish between the two conditions.
Which is the differentiating symptom between labyrinthitis and vestibular neuritis?
A. Symptoms with vestibular neuritis are usually acute in onset, whereas with
labyrinthitis the onset is more gradual.
B. Hearing loss may be associated with vestibular neuritis, but not with labyrinthitis.
C. Symptoms with labyrinthitis are usually acute in onset, whereas with vestibular
neuritis the onset is more gradual.
D. Hearing loss may be associated with labyrinthitis, but not with vestibular
neuritis.
Correct answer: D. Hearing loss may be associated with labyrinthitis, but not
with vestibular neuritis.
Rationale: Labyrinthitis involves inflammation of the inner ear structures and can
affect both the vestibular and auditory systems, resulting in vertigo accompanied by
hearing loss. Vestibular neuritis primarily affects the vestibular portion of the
vestibulocochlear nerve and generally does not cause hearing loss. Therefore, the
presence of hearing loss favors labyrinthitis over vestibular neuritis.
5. A 27-year-old woman presents with a chief complaint of burning and pain during
urination. She reports that she has never previously been diagnosed with a urinary
tract infection. The clinician obtains additional information about urinary
frequency, hematuria, systemic symptoms, and other possible signs of urinary tract
involvement. Which of the following additional symptoms is most consistent with a
diagnosis of a lower UTI?
A. Back and abdominal pain
B. Fever, chills, and costovertebral angle (CVA) tenderness
C. Blood in the urine and frequency
D. Foul-smelling discharge and perineal itching
