NURS 8026 Differential Diagnosis
Exam 3 with verified answers and
rationale graded A+ new!!
Section 1: Cardiovascular & Pulmonary (Questions 1-20)
1. A 68-year-old male with a history of HTN and DM presents with acute onset of tearing chest pain
radiating to the back. BP is 210/110 in the right arm and 180/90 in the left. What is the most likely
diagnosis?
A. Acute Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pericarditis
Answer: C. Aortic Dissection
Rationale: The classic presentation of aortic dissection is acute, severe, "tearing" chest pain that
radiates to the back, often with a significant blood pressure differential between arms. This
differentiates it from MI (crushing, substernal), PE (pleuritic, dyspnea), and pericarditis (sharp,
positional).
2. A 52-year-old female presents with acute onset of pleuritic chest pain, dyspnea, and hemoptysis.
Her heart rate is 110, RR 26, and O2 sat is 88% on room air. What is the priority differential?
A. Acute Bronchitis
B. Pneumothorax
C. Pulmonary Embolism
D. Costochondritis
Answer: C. Pulmonary Embolism
Rationale: The triad of pleuritic chest pain, dyspnea, and hemoptysis (Wells' criteria) is classic for PE.
Tachycardia and hypoxemia add to the suspicion. Costochondritis has a focal point of tenderness.
Pneumothorax presents with sudden dyspnea but not typically hemoptysis.
,3. A 45-year-old male presents with substernal chest pressure radiating to the left arm, associated
with nausea and diaphoresis. He has a history of hyperlipidemia. ECG shows ST elevation in leads V2-
V4. What is the most specific diagnosis?
A. Unstable Angina
B. ST-Elevation Myocardial Infarction (STEMI)
C. Pericarditis
D. Esophageal Spasm
Answer: B. ST-Elevation Myocardial Infarction (STEMI)
Rationale: ST elevation in contiguous leads with classic ischemic symptoms is diagnostic of STEMI.
Unstable angina does not have ST elevation. Pericarditis has diffuse ST elevation. Esophageal spasm
is often relieved with nitroglycerin but has no ECG changes.
4. A 70-year-old female presents with dyspnea on exertion, fatigue, and bilateral lower extremity
edema. Lung exam reveals crackles at the bases. JVD is present. What is the most likely condition?
A. COPD Exacerbation
B. Pneumonia
C. Congestive Heart Failure (Heart Failure with reduced EF)
D. Pulmonary Fibrosis
Answer: C. Congestive Heart Failure
Rationale: The constellation of dyspnea, peripheral edema, crackles (pulmonary congestion), and
JVD (systemic congestion) is classic for heart failure exacerbation. COPD has prolonged expiration,
not crackles.
5. A 22-year-old male presents with sharp, positional chest pain that improves when leaning
forward. He has a recent history of an upper respiratory infection. A pericardial friction rub is
auscultated. What is the diagnosis?
A. Myocarditis
B. Pericarditis
C. Pleurisy
D. Costochondritis
Answer: B. Pericarditis
,Rationale: Positional chest pain (relieved by leaning forward) and a pericardial friction rub are
pathognomonic for acute pericarditis. Myocarditis presents with arrhythmias or HF. Pleurisy is
pleuritic without the rub.
6. A 60-year-old smoker presents with a chronic cough, dyspnea, and barrel chest. Spirometry shows
an FEV1/FVC ratio of <0.70. What is the most likely condition?
A. Asthma
B. Chronic Bronchitis
C. Emphysema
D. Bronchiectasis
Answer: C. Emphysema
Rationale: Barrel chest and a low FEV1/FVC ratio indicate fixed obstructive lung disease, consistent
with COPD (emphysema type). Asthma is reversible. Bronchiectasis has productive cough and
clubbing.
7. A 35-year-old female presents with pleuritic chest pain, fever, and a cough productive of rusty
sputum. Chest X-ray shows a lobar consolidation. What is the most likely organism?
A. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
C. Legionella pneumophila
D. Influenza virus
Answer: B. Streptococcus pneumoniae
Rationale: Lobar consolidation with rusty sputum is classic for pneumococcal pneumonia.
Mycoplasma presents with dry cough and is atypical. Legionella presents with GI symptoms and
hyponatremia.
8. A 28-year-old female presents with sudden onset of sharp chest pain and dyspnea. She is tall and
thin. Breath sounds are absent on the left. What is the most likely condition?
A. Spontaneous Pneumothorax
B. Pericarditis
C. Pulmonary Embolism
D. Asthma Attack
, Answer: A. Spontaneous Pneumothorax
Rationale: Sudden, unilateral pleuritic pain with absent breath sounds in a tall, thin individual is
classic for spontaneous pneumothorax. This is a medical emergency.
9. A 55-year-old male with a history of DVT presents with sudden dyspnea, tachypnea, and pleuritic
chest pain. D-dimer is elevated. What is the next step to confirm the diagnosis?
A. CT Angiography of the Chest (CTPA)
B. Echocardiogram
C. V/Q Scan
D. Pulmonary Function Tests
Answer: A. CT Angiography of the Chest (CTPA)
Rationale: CTPA is the gold standard for diagnosing PE in hemodynamically stable patients. V/Q scan
is used if contrast is contraindicated.
10. A 75-year-old female presents with dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.
Crackles are heard in the lung bases. Which of the following is the best initial treatment?
A. Albuterol
B. Diuretics (Furosemide)
C. Antibiotics
D. Beta-blockers
Answer: B. Diuretics (Furosemide)
Rationale: Acute pulmonary edema from heart failure requires immediate preload reduction with
loop diuretics. This addresses the fluid overload causing the crackles and dyspnea.
11. A 40-year-old male presents with a cough that lasts >8 weeks, associated with a postnasal drip
sensation. What is the most likely cause?
A. COPD
B. Upper Airway Cough Syndrome (Postnasal Drip)
C. Asthma
D. GERD
Exam 3 with verified answers and
rationale graded A+ new!!
Section 1: Cardiovascular & Pulmonary (Questions 1-20)
1. A 68-year-old male with a history of HTN and DM presents with acute onset of tearing chest pain
radiating to the back. BP is 210/110 in the right arm and 180/90 in the left. What is the most likely
diagnosis?
A. Acute Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pericarditis
Answer: C. Aortic Dissection
Rationale: The classic presentation of aortic dissection is acute, severe, "tearing" chest pain that
radiates to the back, often with a significant blood pressure differential between arms. This
differentiates it from MI (crushing, substernal), PE (pleuritic, dyspnea), and pericarditis (sharp,
positional).
2. A 52-year-old female presents with acute onset of pleuritic chest pain, dyspnea, and hemoptysis.
Her heart rate is 110, RR 26, and O2 sat is 88% on room air. What is the priority differential?
A. Acute Bronchitis
B. Pneumothorax
C. Pulmonary Embolism
D. Costochondritis
Answer: C. Pulmonary Embolism
Rationale: The triad of pleuritic chest pain, dyspnea, and hemoptysis (Wells' criteria) is classic for PE.
Tachycardia and hypoxemia add to the suspicion. Costochondritis has a focal point of tenderness.
Pneumothorax presents with sudden dyspnea but not typically hemoptysis.
,3. A 45-year-old male presents with substernal chest pressure radiating to the left arm, associated
with nausea and diaphoresis. He has a history of hyperlipidemia. ECG shows ST elevation in leads V2-
V4. What is the most specific diagnosis?
A. Unstable Angina
B. ST-Elevation Myocardial Infarction (STEMI)
C. Pericarditis
D. Esophageal Spasm
Answer: B. ST-Elevation Myocardial Infarction (STEMI)
Rationale: ST elevation in contiguous leads with classic ischemic symptoms is diagnostic of STEMI.
Unstable angina does not have ST elevation. Pericarditis has diffuse ST elevation. Esophageal spasm
is often relieved with nitroglycerin but has no ECG changes.
4. A 70-year-old female presents with dyspnea on exertion, fatigue, and bilateral lower extremity
edema. Lung exam reveals crackles at the bases. JVD is present. What is the most likely condition?
A. COPD Exacerbation
B. Pneumonia
C. Congestive Heart Failure (Heart Failure with reduced EF)
D. Pulmonary Fibrosis
Answer: C. Congestive Heart Failure
Rationale: The constellation of dyspnea, peripheral edema, crackles (pulmonary congestion), and
JVD (systemic congestion) is classic for heart failure exacerbation. COPD has prolonged expiration,
not crackles.
5. A 22-year-old male presents with sharp, positional chest pain that improves when leaning
forward. He has a recent history of an upper respiratory infection. A pericardial friction rub is
auscultated. What is the diagnosis?
A. Myocarditis
B. Pericarditis
C. Pleurisy
D. Costochondritis
Answer: B. Pericarditis
,Rationale: Positional chest pain (relieved by leaning forward) and a pericardial friction rub are
pathognomonic for acute pericarditis. Myocarditis presents with arrhythmias or HF. Pleurisy is
pleuritic without the rub.
6. A 60-year-old smoker presents with a chronic cough, dyspnea, and barrel chest. Spirometry shows
an FEV1/FVC ratio of <0.70. What is the most likely condition?
A. Asthma
B. Chronic Bronchitis
C. Emphysema
D. Bronchiectasis
Answer: C. Emphysema
Rationale: Barrel chest and a low FEV1/FVC ratio indicate fixed obstructive lung disease, consistent
with COPD (emphysema type). Asthma is reversible. Bronchiectasis has productive cough and
clubbing.
7. A 35-year-old female presents with pleuritic chest pain, fever, and a cough productive of rusty
sputum. Chest X-ray shows a lobar consolidation. What is the most likely organism?
A. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
C. Legionella pneumophila
D. Influenza virus
Answer: B. Streptococcus pneumoniae
Rationale: Lobar consolidation with rusty sputum is classic for pneumococcal pneumonia.
Mycoplasma presents with dry cough and is atypical. Legionella presents with GI symptoms and
hyponatremia.
8. A 28-year-old female presents with sudden onset of sharp chest pain and dyspnea. She is tall and
thin. Breath sounds are absent on the left. What is the most likely condition?
A. Spontaneous Pneumothorax
B. Pericarditis
C. Pulmonary Embolism
D. Asthma Attack
, Answer: A. Spontaneous Pneumothorax
Rationale: Sudden, unilateral pleuritic pain with absent breath sounds in a tall, thin individual is
classic for spontaneous pneumothorax. This is a medical emergency.
9. A 55-year-old male with a history of DVT presents with sudden dyspnea, tachypnea, and pleuritic
chest pain. D-dimer is elevated. What is the next step to confirm the diagnosis?
A. CT Angiography of the Chest (CTPA)
B. Echocardiogram
C. V/Q Scan
D. Pulmonary Function Tests
Answer: A. CT Angiography of the Chest (CTPA)
Rationale: CTPA is the gold standard for diagnosing PE in hemodynamically stable patients. V/Q scan
is used if contrast is contraindicated.
10. A 75-year-old female presents with dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.
Crackles are heard in the lung bases. Which of the following is the best initial treatment?
A. Albuterol
B. Diuretics (Furosemide)
C. Antibiotics
D. Beta-blockers
Answer: B. Diuretics (Furosemide)
Rationale: Acute pulmonary edema from heart failure requires immediate preload reduction with
loop diuretics. This addresses the fluid overload causing the crackles and dyspnea.
11. A 40-year-old male presents with a cough that lasts >8 weeks, associated with a postnasal drip
sensation. What is the most likely cause?
A. COPD
B. Upper Airway Cough Syndrome (Postnasal Drip)
C. Asthma
D. GERD
