NURS 8026 Differential Diagnosis
Practice Exam with 100 questions
with correct answers and
rationale UPDATED graded A+
Test 1: HEENT, Pulmonary, Cardiovascular — Questions 1–25
1. A 58-year-old male presents with crushing substernal chest pain, diaphoresis, nausea, and ST
elevation in leads II, III, and aVF. What is the most likely diagnosis?
A. Gastroesophageal reflux disease
B. Acute pericarditis
C. Inferior STEMI
D. Panic attack
Answer: C. Inferior STEMI
Rationale: ST elevation in II, III, and aVF indicates inferior wall myocardial infarction, commonly
involving the right coronary artery.
2. A post-operative patient develops sudden pleuritic chest pain, dyspnea, tachycardia, and oxygen
desaturation. Chest X-ray is normal. What diagnosis is most likely?
A. Pulmonary embolism
B. Pneumonia
C. Acute bronchitis
D. Costochondritis
Answer: A. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic pain, tachycardia, and recent surgery strongly suggest PE, often
with a normal chest X-ray.
,3. A patient with long-standing hypertension reports sudden “tearing” chest pain radiating to the
back. Blood pressures differ significantly between arms. What is the priority differential?
A. Acute pancreatitis
B. Aortic dissection
C. Stable angina
D. Pulmonary hypertension
Answer: B. Aortic dissection
Rationale: Tearing chest/back pain with unequal arm blood pressures is classic for aortic dissection.
4. A 32-year-old reports sharp chest pain that worsens when lying down and improves when leaning
forward. ECG shows diffuse ST elevation and PR depression. What is the likely diagnosis?
A. Acute pericarditis
B. Inferior myocardial infarction
C. Pulmonary embolism
D. Esophageal spasm
Answer: A. Acute pericarditis
Rationale: Positional chest pain, diffuse ST elevation, and PR depression are characteristic of
pericarditis.
5. A patient presents with dyspnea, orthopnea, crackles, jugular venous distention, and an S3 heart
sound. BNP is elevated. What is the most likely diagnosis?
A. Asthma exacerbation
B. Acute decompensated heart failure
C. Pulmonary fibrosis
D. Pneumothorax
Answer: B. Acute decompensated heart failure
Rationale: Orthopnea, JVD, crackles, S3, and elevated BNP support heart failure.
6. A patient has unilateral calf swelling, tenderness, warmth, and recent prolonged immobility.
Which diagnostic test is most appropriate initially?
,A. Chest CT angiography
B. Venous duplex ultrasound
C. Arterial Doppler study
D. Echocardiogram
Answer: B. Venous duplex ultrasound
Rationale: Compression venous ultrasound is the preferred initial test for suspected lower-extremity
DVT.
7. A smoker with known COPD presents with increased dyspnea, wheezing, and increased sputum
production. What is the most likely diagnosis?
A. COPD exacerbation
B. Pulmonary embolism
C. Lung cancer
D. Pneumothorax
Answer: A. COPD exacerbation
Rationale: Increased dyspnea, sputum volume, and sputum purulence are typical of COPD
exacerbation.
8. A trauma patient develops severe respiratory distress, hypotension, tracheal deviation, and
absent breath sounds on the right. What is the diagnosis?
A. Pleural effusion
B. Tension pneumothorax
C. Pulmonary edema
D. Pneumonia
Answer: B. Tension pneumothorax
Rationale: Respiratory distress, hypotension, tracheal deviation, and unilateral absent breath sounds
indicate tension pneumothorax.
9. A patient has episodic wheezing, cough, and chest tightness. Spirometry shows obstruction that
improves after bronchodilator use. What is the diagnosis?
, A. COPD
B. Asthma
C. Interstitial lung disease
D. Pulmonary embolism
Answer: B. Asthma
Rationale: Reversible airway obstruction on spirometry is consistent with asthma.
10. A patient develops a dry persistent cough 3 weeks after starting lisinopril. Lungs are clear and
chest X-ray is normal. What is the likely cause?
A. Pneumonia
B. ACE inhibitor adverse effect
C. Tuberculosis
D. Heart failure
Answer: B. ACE inhibitor adverse effect
Rationale: ACE inhibitors commonly cause a dry cough due to bradykinin accumulation.
11. A 64-year-old smoker has chronic cough, hemoptysis, weight loss, and recurrent pneumonia in
the same lobe. What diagnosis should be suspected?
A. Asthma
B. Lung cancer
C. Acute bronchitis
D. Viral pneumonia
Answer: B. Lung cancer
Rationale: Hemoptysis, weight loss, smoking history, and recurrent localized pneumonia are
concerning for malignancy.
12. A patient has purulent nasal discharge, facial pressure, and symptoms lasting 12 days without
improvement. What diagnosis is most likely?
A. Allergic rhinitis
Practice Exam with 100 questions
with correct answers and
rationale UPDATED graded A+
Test 1: HEENT, Pulmonary, Cardiovascular — Questions 1–25
1. A 58-year-old male presents with crushing substernal chest pain, diaphoresis, nausea, and ST
elevation in leads II, III, and aVF. What is the most likely diagnosis?
A. Gastroesophageal reflux disease
B. Acute pericarditis
C. Inferior STEMI
D. Panic attack
Answer: C. Inferior STEMI
Rationale: ST elevation in II, III, and aVF indicates inferior wall myocardial infarction, commonly
involving the right coronary artery.
2. A post-operative patient develops sudden pleuritic chest pain, dyspnea, tachycardia, and oxygen
desaturation. Chest X-ray is normal. What diagnosis is most likely?
A. Pulmonary embolism
B. Pneumonia
C. Acute bronchitis
D. Costochondritis
Answer: A. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic pain, tachycardia, and recent surgery strongly suggest PE, often
with a normal chest X-ray.
,3. A patient with long-standing hypertension reports sudden “tearing” chest pain radiating to the
back. Blood pressures differ significantly between arms. What is the priority differential?
A. Acute pancreatitis
B. Aortic dissection
C. Stable angina
D. Pulmonary hypertension
Answer: B. Aortic dissection
Rationale: Tearing chest/back pain with unequal arm blood pressures is classic for aortic dissection.
4. A 32-year-old reports sharp chest pain that worsens when lying down and improves when leaning
forward. ECG shows diffuse ST elevation and PR depression. What is the likely diagnosis?
A. Acute pericarditis
B. Inferior myocardial infarction
C. Pulmonary embolism
D. Esophageal spasm
Answer: A. Acute pericarditis
Rationale: Positional chest pain, diffuse ST elevation, and PR depression are characteristic of
pericarditis.
5. A patient presents with dyspnea, orthopnea, crackles, jugular venous distention, and an S3 heart
sound. BNP is elevated. What is the most likely diagnosis?
A. Asthma exacerbation
B. Acute decompensated heart failure
C. Pulmonary fibrosis
D. Pneumothorax
Answer: B. Acute decompensated heart failure
Rationale: Orthopnea, JVD, crackles, S3, and elevated BNP support heart failure.
6. A patient has unilateral calf swelling, tenderness, warmth, and recent prolonged immobility.
Which diagnostic test is most appropriate initially?
,A. Chest CT angiography
B. Venous duplex ultrasound
C. Arterial Doppler study
D. Echocardiogram
Answer: B. Venous duplex ultrasound
Rationale: Compression venous ultrasound is the preferred initial test for suspected lower-extremity
DVT.
7. A smoker with known COPD presents with increased dyspnea, wheezing, and increased sputum
production. What is the most likely diagnosis?
A. COPD exacerbation
B. Pulmonary embolism
C. Lung cancer
D. Pneumothorax
Answer: A. COPD exacerbation
Rationale: Increased dyspnea, sputum volume, and sputum purulence are typical of COPD
exacerbation.
8. A trauma patient develops severe respiratory distress, hypotension, tracheal deviation, and
absent breath sounds on the right. What is the diagnosis?
A. Pleural effusion
B. Tension pneumothorax
C. Pulmonary edema
D. Pneumonia
Answer: B. Tension pneumothorax
Rationale: Respiratory distress, hypotension, tracheal deviation, and unilateral absent breath sounds
indicate tension pneumothorax.
9. A patient has episodic wheezing, cough, and chest tightness. Spirometry shows obstruction that
improves after bronchodilator use. What is the diagnosis?
, A. COPD
B. Asthma
C. Interstitial lung disease
D. Pulmonary embolism
Answer: B. Asthma
Rationale: Reversible airway obstruction on spirometry is consistent with asthma.
10. A patient develops a dry persistent cough 3 weeks after starting lisinopril. Lungs are clear and
chest X-ray is normal. What is the likely cause?
A. Pneumonia
B. ACE inhibitor adverse effect
C. Tuberculosis
D. Heart failure
Answer: B. ACE inhibitor adverse effect
Rationale: ACE inhibitors commonly cause a dry cough due to bradykinin accumulation.
11. A 64-year-old smoker has chronic cough, hemoptysis, weight loss, and recurrent pneumonia in
the same lobe. What diagnosis should be suspected?
A. Asthma
B. Lung cancer
C. Acute bronchitis
D. Viral pneumonia
Answer: B. Lung cancer
Rationale: Hemoptysis, weight loss, smoking history, and recurrent localized pneumonia are
concerning for malignancy.
12. A patient has purulent nasal discharge, facial pressure, and symptoms lasting 12 days without
improvement. What diagnosis is most likely?
A. Allergic rhinitis
