NURS 8026 Differential Diagnosis Exam
2 with questions and verified answers
with rationale updated 2026 graded
A+ new!!
Section 1: Cardiovascular & Respiratory
1. A 58-year-old male presents with substernal chest pain radiating to the left arm, diaphoresis, and
nausea. Which diagnostic test is MOST appropriate initially?
A. Chest X-ray
B. 12-lead ECG
C. Echocardiogram
D. Stress test
Answer: B
Rationale: A 12-lead ECG is the priority initial test in suspected acute coronary syndrome to detect
ST-segment changes and guide immediate management within 10 minutes of presentation.
2. A patient presents with pleuritic chest pain, tachycardia, and sudden dyspnea after a long flight.
Which diagnosis is MOST likely?
A. Pneumonia
B. Pulmonary embolism
C. Costochondritis
D. GERD
Answer: B
Rationale: Prolonged immobility (long flight), pleuritic pain, tachycardia, and sudden dyspnea are
classic for PE due to venous stasis and clot formation.
,3. Which finding differentiates cardiac chest pain from musculoskeletal chest pain?
A. Pain reproducible with palpation
B. Pain relieved by rest
C. Pain worse with movement
D. Pain localized to one spot
Answer: B
Rationale: Cardiac (anginal) pain typically improves with rest and worsens with exertion, whereas
musculoskeletal pain is reproducible with palpation/movement.
4. A 65-year-old with dyspnea, bilateral crackles, and S3 gallop most likely has:
A. COPD exacerbation
B. Left-sided heart failure
C. Pneumothorax
D. Pulmonary fibrosis
Answer: B
Rationale: An S3 gallop with bilateral crackles indicates fluid overload and left ventricular
dysfunction characteristic of left-sided heart failure.
5. Which lab test is MOST specific for myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I
D. LDH
Answer: C
Rationale: Troponin I is the most cardiac-specific and sensitive biomarker for myocardial injury,
remaining elevated for 7–10 days.
,6. A patient with a "tearing" chest pain radiating to the back and unequal blood pressures in both
arms most likely has:
A. Myocardial infarction
B. Aortic dissection
C. Pericarditis
D. Pulmonary embolism
Answer: B
Rationale: Tearing pain radiating to the back with a pulse/BP differential between arms is a hallmark
of aortic dissection.
7. Which condition produces a pericardial friction rub best heard when the patient leans forward?
A. Pericarditis
B. Aortic stenosis
C. Mitral regurgitation
D. Heart failure
Answer: A
Rationale: A pericardial friction rub is the classic finding in pericarditis, best auscultated with the
patient sitting and leaning forward.
8. A young, tall, thin male presents with sudden unilateral chest pain and absent breath sounds on
one side. Diagnosis?
A. Pneumonia
B. Spontaneous pneumothorax
C. Pleural effusion
D. Asthma
, Answer: B
Rationale: Tall, thin young males are at high risk for spontaneous pneumothorax; absent breath
sounds and hyperresonance confirm it.
9. Which physical finding is associated with a tension pneumothorax?
A. Tracheal deviation toward affected side
B. Tracheal deviation away from affected side
C. Bilateral wheezing
D. Bradycardia
Answer: B
Rationale: Tension pneumothorax causes mediastinal shift with tracheal deviation AWAY from the
affected side, a medical emergency.
10. A productive cough with rust-colored sputum and fever suggests:
A. Viral bronchitis
B. Pneumococcal pneumonia
C. Tuberculosis
D. Asthma
Answer: B
Rationale: Rust-colored sputum is classically associated with Streptococcus pneumoniae infection.
11. Which finding differentiates COPD from asthma?
A. Reversible airflow obstruction
B. Chronic, largely irreversible airflow limitation
C. Presence of wheezing
D. Response to bronchodilators
2 with questions and verified answers
with rationale updated 2026 graded
A+ new!!
Section 1: Cardiovascular & Respiratory
1. A 58-year-old male presents with substernal chest pain radiating to the left arm, diaphoresis, and
nausea. Which diagnostic test is MOST appropriate initially?
A. Chest X-ray
B. 12-lead ECG
C. Echocardiogram
D. Stress test
Answer: B
Rationale: A 12-lead ECG is the priority initial test in suspected acute coronary syndrome to detect
ST-segment changes and guide immediate management within 10 minutes of presentation.
2. A patient presents with pleuritic chest pain, tachycardia, and sudden dyspnea after a long flight.
Which diagnosis is MOST likely?
A. Pneumonia
B. Pulmonary embolism
C. Costochondritis
D. GERD
Answer: B
Rationale: Prolonged immobility (long flight), pleuritic pain, tachycardia, and sudden dyspnea are
classic for PE due to venous stasis and clot formation.
,3. Which finding differentiates cardiac chest pain from musculoskeletal chest pain?
A. Pain reproducible with palpation
B. Pain relieved by rest
C. Pain worse with movement
D. Pain localized to one spot
Answer: B
Rationale: Cardiac (anginal) pain typically improves with rest and worsens with exertion, whereas
musculoskeletal pain is reproducible with palpation/movement.
4. A 65-year-old with dyspnea, bilateral crackles, and S3 gallop most likely has:
A. COPD exacerbation
B. Left-sided heart failure
C. Pneumothorax
D. Pulmonary fibrosis
Answer: B
Rationale: An S3 gallop with bilateral crackles indicates fluid overload and left ventricular
dysfunction characteristic of left-sided heart failure.
5. Which lab test is MOST specific for myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I
D. LDH
Answer: C
Rationale: Troponin I is the most cardiac-specific and sensitive biomarker for myocardial injury,
remaining elevated for 7–10 days.
,6. A patient with a "tearing" chest pain radiating to the back and unequal blood pressures in both
arms most likely has:
A. Myocardial infarction
B. Aortic dissection
C. Pericarditis
D. Pulmonary embolism
Answer: B
Rationale: Tearing pain radiating to the back with a pulse/BP differential between arms is a hallmark
of aortic dissection.
7. Which condition produces a pericardial friction rub best heard when the patient leans forward?
A. Pericarditis
B. Aortic stenosis
C. Mitral regurgitation
D. Heart failure
Answer: A
Rationale: A pericardial friction rub is the classic finding in pericarditis, best auscultated with the
patient sitting and leaning forward.
8. A young, tall, thin male presents with sudden unilateral chest pain and absent breath sounds on
one side. Diagnosis?
A. Pneumonia
B. Spontaneous pneumothorax
C. Pleural effusion
D. Asthma
, Answer: B
Rationale: Tall, thin young males are at high risk for spontaneous pneumothorax; absent breath
sounds and hyperresonance confirm it.
9. Which physical finding is associated with a tension pneumothorax?
A. Tracheal deviation toward affected side
B. Tracheal deviation away from affected side
C. Bilateral wheezing
D. Bradycardia
Answer: B
Rationale: Tension pneumothorax causes mediastinal shift with tracheal deviation AWAY from the
affected side, a medical emergency.
10. A productive cough with rust-colored sputum and fever suggests:
A. Viral bronchitis
B. Pneumococcal pneumonia
C. Tuberculosis
D. Asthma
Answer: B
Rationale: Rust-colored sputum is classically associated with Streptococcus pneumoniae infection.
11. Which finding differentiates COPD from asthma?
A. Reversible airflow obstruction
B. Chronic, largely irreversible airflow limitation
C. Presence of wheezing
D. Response to bronchodilators
