DIFFERENTIAL DIAGNOSIS AND PRIMARY CARE | ACTUAL
EXAMS 2026 || MOST RECENT EXAM 2026|2027 ACTUAL
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A 52-year-old patient presents with substernal chest pressure that
began while walking and improves after several minutes of rest. Which
diagnosis is most consistent with this presentation?
A. Gastroesophageal reflux disease
B. Stable angina
C. Acute pericarditis
D. Costochondritis
Answer: B. Stable angina
Rationale: Stable angina typically produces predictable substernal
pressure or discomfort with exertion that improves with rest or
nitroglycerin. Acute coronary syndrome must be considered if
symptoms become new, prolonged, or occur at rest.
A patient reports sudden, severe unilateral headache described as “the
worst headache of my life.” What is the priority diagnosis to exclude?
A. Migraine
B. Tension headache
,C. Subarachnoid hemorrhage
D. Sinus headache
Answer: C. Subarachnoid hemorrhage
Rationale: A sudden, maximal-at-onset “thunderclap” headache is a
classic warning sign for subarachnoid hemorrhage. This presentation
requires urgent evaluation rather than routine outpatient headache
management.
Which finding is most characteristic of bacterial pneumonia?
A. Dry cough with rhinorrhea only
B. Fever, productive cough, and focal lung findings
C. Chronic cough without systemic symptoms
D. Episodic cough relieved by bronchodilator
Answer: B. Fever, productive cough, and focal lung findings
Rationale: Bacterial pneumonia commonly presents with fever,
productive cough, dyspnea, and focal crackles or bronchial breath
sounds. Viral respiratory infections may produce more diffuse
symptoms.
A patient has polyuria, polydipsia, and unexplained weight loss. Which
condition should be strongly suspected?
A. Hypothyroidism
B. Diabetes mellitus
,C. Iron-deficiency anemia
D. Hyperparathyroidism
Answer: B. Diabetes mellitus
Rationale: Polyuria and polydipsia are classic manifestations of
hyperglycemia. Unintentional weight loss may occur when glucose
cannot be effectively utilized and the body begins breaking down fat
and muscle.
Which symptom is most concerning for colorectal malignancy in an
older adult?
A. Occasional bloating after meals
B. Persistent change in bowel habits with rectal bleeding
C. Mild intermittent heartburn
D. Increased appetite
Answer: B. Persistent change in bowel habits with rectal bleeding
Rationale: Persistent changes in bowel habits, gastrointestinal bleeding,
iron-deficiency anemia, unexplained weight loss, and abdominal
symptoms can indicate colorectal cancer and warrant appropriate
diagnostic evaluation.
A patient presents with dysuria, urinary frequency, and urgency
without vaginal symptoms or flank pain. Which diagnosis is most
likely?
, A. Acute uncomplicated cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Vaginitis
Answer: A. Acute uncomplicated cystitis
Rationale: Dysuria, frequency, and urgency are typical symptoms of
lower urinary tract infection. Fever, flank pain, and systemic illness
would raise concern for pyelonephritis.
Which finding most strongly suggests pyelonephritis rather than
uncomplicated cystitis?
A. Urinary frequency
B. Dysuria
C. Costovertebral-angle tenderness with fever
D. Urinary urgency
Answer: C. Costovertebral-angle tenderness with fever
Rationale: Pyelonephritis involves the upper urinary tract and
commonly causes fever, chills, flank pain, nausea, and costovertebral-
angle tenderness. Cystitis generally causes lower urinary tract
symptoms without systemic illness.
A 68-year-old patient reports new-onset temporal headache, jaw
claudication, and visual disturbance. Which diagnosis should be
suspected?