NR 511
Final Exam Prep
(300 Practice Questions)
(Week’s 5 – 8 Covered)
(Differential Diagnosis & Primary Care Practicum)
Exam-Style Qs that mirror the actual Exam
Chamberlain
,Table of Contents
SECTION 1 (1-100 qs) .............................................2
SECTION 2 (1-100 qs) ...........................................37
SECTION 3 (1-100 qs) ...........................................75
SECTION 1 (1-100 qs)
Question 1:
A 29-year-old woman presents with 6 months of crampy abdominal pain relieved
by defecation, intermittent diarrhea, and bloating. She denies weight loss, fever,
or rectal bleeding. Her physical exam is normal. Which of the following is the
MOST appropriate next step in evaluating this patient’s symptoms?
A. Immediately schedule colonoscopy with random biopsies
B. Order stool studies including fecal fat, weight, laxative screen, and tests for
microorganisms
C. Begin empiric treatment for ulcerative colitis without further testing
D. Refer urgently for abdominal CT with contrast
Answer: B. Order stool studies including fecal fat, weight, laxative screen, and tests for
microorganisms
Expert Explanation: In IBS-like presentations with diarrhea as the dominant symptom,
the study guide recommends thyroid testing and stool studies for fecal fat, stool weight,
laxative content, microorganisms, and celiac serology to exclude organic causes before
confirming IBS.
Question 2:
A 48-year-old man reports burning chest pain after large meals that worsens
when lying down and improves with antacids. He denies dysphagia, weight loss,
,or GI bleeding. Which is the MOST likely diagnosis?
A. Acute cholecystitis
B. Gastroesophageal reflux disease (GERD)
C. Peptic ulcer disease
D. Acute pancreatitis
Answer: B. Gastroesophageal reflux disease (GERD)
Expert Explanation: The classic subjective presentation of GERD in the guide is
heartburn (pyrosis) ranging from mild to severe, often associated with meals and
positional changes, and relieved by antacids.
Question 3:
A 56-year-old woman with chronic GERD develops progressive solid-food
dysphagia and unintentional 10-lb weight loss over 3 months. Which is the MOST
appropriate next step?
A. Increase over-the-counter antacid use
B. Start high-dose H2 blocker and reassess in 6 months
C. Order upper endoscopy (EGD)
D. Order abdominal ultrasound
Answer: C. Order upper endoscopy (EGD)
Expert Explanation: Alarm features such as dysphagia and weight loss in the setting of
GERD require prompt endoscopic evaluation to exclude malignancy or complicated
ulcer disease rather than simple escalation of empiric therapy.
Question 4:
A 35-year-old woman has intermittent lower abdominal pain, alternating
constipation and diarrhea, and normal labs. She asks how IBS is usually
distinguished from other diseases. According to the study guide, which
statement is MOST accurate?
A. IBS is diagnosed by colonoscopy alone
B. IBS is confirmed when CT abdomen is normal
C. IBS is a diagnosis of exclusion after history, exam, and limited targeted tests rule out
organic causes
D. IBS requires positive serology for celiac disease
Answer: C. IBS is a diagnosis of exclusion after history, exam, and limited targeted
tests rule out organic causes
Expert Explanation: The guide emphasizes that most IBS differentials can be ruled out
, with careful history and physical examination, plus targeted testing (e.g., thyroid, stool,
celiac serology) before diagnosing IBS as a functional disorder.
Question 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 with barium
Answer: A. Abdominal ultrasound
Expert Explanation: The final guide highlights RUQ ultrasound as the initial imaging
test for suspected biliary disease such as cholelithiasis or acute cholecystitis, where
postprandial pain and a positive Murphy’s sign are typical.
Question 6:
A 21-year-old woman presents with sudden periumbilical pain that migrated to the
right lower quadrant over 24 hours, low-grade fever, and anorexia. RLQ
tenderness with guarding is present. Which is the MOST likely diagnosis?
A. Diverticulitis
B. Crohn’s disease flare
C. Appendicitis
D. Irritable bowel syndrome
Answer: C. Appendicitis
Expert Explanation: Classic appendicitis manifests as initially vague periumbilical pain
that localizes to the RLQ with tenderness, fever, and anorexia; this pattern is
distinguished from IBS and chronic IBD in the guide’s abdominal pain differential
discussions.
Question 7:
A 40-year-old man has burning epigastric pain relieved by food and antacids. He
takes NSAIDs daily. You suspect peptic ulcer disease. Which H. pylori test is
BEST for initial noninvasive diagnosis in this outpatient setting?
A. Serum H. pylori IgG antibody
B. Urea breath test
Final Exam Prep
(300 Practice Questions)
(Week’s 5 – 8 Covered)
(Differential Diagnosis & Primary Care Practicum)
Exam-Style Qs that mirror the actual Exam
Chamberlain
,Table of Contents
SECTION 1 (1-100 qs) .............................................2
SECTION 2 (1-100 qs) ...........................................37
SECTION 3 (1-100 qs) ...........................................75
SECTION 1 (1-100 qs)
Question 1:
A 29-year-old woman presents with 6 months of crampy abdominal pain relieved
by defecation, intermittent diarrhea, and bloating. She denies weight loss, fever,
or rectal bleeding. Her physical exam is normal. Which of the following is the
MOST appropriate next step in evaluating this patient’s symptoms?
A. Immediately schedule colonoscopy with random biopsies
B. Order stool studies including fecal fat, weight, laxative screen, and tests for
microorganisms
C. Begin empiric treatment for ulcerative colitis without further testing
D. Refer urgently for abdominal CT with contrast
Answer: B. Order stool studies including fecal fat, weight, laxative screen, and tests for
microorganisms
Expert Explanation: In IBS-like presentations with diarrhea as the dominant symptom,
the study guide recommends thyroid testing and stool studies for fecal fat, stool weight,
laxative content, microorganisms, and celiac serology to exclude organic causes before
confirming IBS.
Question 2:
A 48-year-old man reports burning chest pain after large meals that worsens
when lying down and improves with antacids. He denies dysphagia, weight loss,
,or GI bleeding. Which is the MOST likely diagnosis?
A. Acute cholecystitis
B. Gastroesophageal reflux disease (GERD)
C. Peptic ulcer disease
D. Acute pancreatitis
Answer: B. Gastroesophageal reflux disease (GERD)
Expert Explanation: The classic subjective presentation of GERD in the guide is
heartburn (pyrosis) ranging from mild to severe, often associated with meals and
positional changes, and relieved by antacids.
Question 3:
A 56-year-old woman with chronic GERD develops progressive solid-food
dysphagia and unintentional 10-lb weight loss over 3 months. Which is the MOST
appropriate next step?
A. Increase over-the-counter antacid use
B. Start high-dose H2 blocker and reassess in 6 months
C. Order upper endoscopy (EGD)
D. Order abdominal ultrasound
Answer: C. Order upper endoscopy (EGD)
Expert Explanation: Alarm features such as dysphagia and weight loss in the setting of
GERD require prompt endoscopic evaluation to exclude malignancy or complicated
ulcer disease rather than simple escalation of empiric therapy.
Question 4:
A 35-year-old woman has intermittent lower abdominal pain, alternating
constipation and diarrhea, and normal labs. She asks how IBS is usually
distinguished from other diseases. According to the study guide, which
statement is MOST accurate?
A. IBS is diagnosed by colonoscopy alone
B. IBS is confirmed when CT abdomen is normal
C. IBS is a diagnosis of exclusion after history, exam, and limited targeted tests rule out
organic causes
D. IBS requires positive serology for celiac disease
Answer: C. IBS is a diagnosis of exclusion after history, exam, and limited targeted
tests rule out organic causes
Expert Explanation: The guide emphasizes that most IBS differentials can be ruled out
, with careful history and physical examination, plus targeted testing (e.g., thyroid, stool,
celiac serology) before diagnosing IBS as a functional disorder.
Question 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 with barium
Answer: A. Abdominal ultrasound
Expert Explanation: The final guide highlights RUQ ultrasound as the initial imaging
test for suspected biliary disease such as cholelithiasis or acute cholecystitis, where
postprandial pain and a positive Murphy’s sign are typical.
Question 6:
A 21-year-old woman presents with sudden periumbilical pain that migrated to the
right lower quadrant over 24 hours, low-grade fever, and anorexia. RLQ
tenderness with guarding is present. Which is the MOST likely diagnosis?
A. Diverticulitis
B. Crohn’s disease flare
C. Appendicitis
D. Irritable bowel syndrome
Answer: C. Appendicitis
Expert Explanation: Classic appendicitis manifests as initially vague periumbilical pain
that localizes to the RLQ with tenderness, fever, and anorexia; this pattern is
distinguished from IBS and chronic IBD in the guide’s abdominal pain differential
discussions.
Question 7:
A 40-year-old man has burning epigastric pain relieved by food and antacids. He
takes NSAIDs daily. You suspect peptic ulcer disease. Which H. pylori test is
BEST for initial noninvasive diagnosis in this outpatient setting?
A. Serum H. pylori IgG antibody
B. Urea breath test
