NR 511 LATEST UPDATES DIFFERENTIAL DIAGNOSIS AND PRIMARY CARE
PRACTICUM REAL EXAM QUESTION AND CORRECT DETAILED ANSWERS
1. A 46-year-old patient presents for evaluation of intermittent right upper-
quadrant abdominal discomfort that is worse after fatty meals and
occasionally radiates toward the right shoulder. The patient reports nausea
but denies fever, jaundice, or persistent vomiting. Examination reveals mild
right-upper-quadrant tenderness without guarding. Which diagnosis should
be highest on the differential based on this presentation?
A. Acute appendicitis
B. Cholelithiasis with biliary colic
C. Acute pancreatitis
D. Peptic ulcer perforation
Answer: B
2. A 34-year-old patient reports six months of recurrent abdominal pain
associated with alternating constipation and diarrhea. The pain improves
after bowel movements, and the patient denies fever, rectal bleeding,
nocturnal symptoms, or unexplained weight loss. Laboratory testing is
normal. Which diagnosis best explains the overall clinical pattern?
A. Crohn disease
B. Colorectal cancer
C. Irritable bowel syndrome
D. Ulcerative colitis
Answer: C
3. A 67-year-old patient develops sudden severe abdominal pain that appears
disproportionate to the relatively mild findings on abdominal examination.
The patient has atrial fibrillation and is not taking anticoagulation. Which
diagnosis should the clinician urgently consider?
A. Acute mesenteric ischemia
B. Irritable bowel syndrome
C. Uncomplicated constipation
1
, D. Gastroesophageal reflux disease
Answer: A
4. A patient with several weeks of progressive dysphagia initially has difficulty
swallowing solid foods and later develops difficulty swallowing liquids. The
patient also reports unintended weight loss. Which finding most strongly
suggests a mechanical obstructive process requiring prompt evaluation?
A. Symptoms occurring only after spicy foods
B. Improvement with antacids
C. Occasional heartburn without dysphagia
D. Progressive dysphagia from solids to liquids
Answer: D
5. A 29-year-old patient develops profuse watery diarrhea, abdominal
cramping, nausea, and vomiting approximately 24 hours after eating food
from a buffet. Several other people who ate the same food developed
similar symptoms. The patient is afebrile and has no blood in the stool.
Which diagnosis is most likely?
A. Acute infectious gastroenteritis
B. Ulcerative colitis
C. Colorectal malignancy
D. Irritable bowel syndrome
Answer: A
6. A patient reports burning epigastric pain that frequently occurs several
hours after meals and sometimes awakens the patient during the night. The
patient regularly uses NSAIDs for chronic musculoskeletal pain. Which
condition should be strongly considered?
A. Acute pancreatitis
B. Peptic ulcer disease
C. Acute cholecystitis
D. Diverticulitis
Answer: B
2
, 7. A 52-year-old patient reports chronic diarrhea, abdominal bloating, fatigue,
and unintended weight loss. Laboratory testing demonstrates iron-
deficiency anemia. The patient reports that symptoms become worse after
eating bread and pasta. Which diagnosis is most consistent with the
presentation?
A. Lactose intolerance
B. Irritable bowel syndrome
C. Celiac disease
D. Viral gastroenteritis
Answer: C
8. A 71-year-old patient develops left-lower-quadrant abdominal pain, fever,
and altered bowel habits. Examination reveals localized left-lower-quadrant
tenderness. Which diagnosis is most likely in this older adult?
A. Acute appendicitis
B. Diverticulitis
C. Cholelithiasis
D. Pancreatitis
Answer: B
9. A 42-year-old patient has chronic diarrhea, abdominal pain, fatigue, and
intermittent blood in the stool. The patient has experienced several
episodes of unexplained fever and has lost weight over the past six months.
Which disorder should be included prominently in the differential?
A. Crohn disease
B. Functional constipation
C. Lactose intolerance
D. Gastroesophageal reflux disease
Answer: A
10. A 58-year-old patient reports persistent heartburn and regurgitation that
are worse after large meals and when lying down. The patient frequently
eats late at night and has gained considerable weight. Which diagnosis best
fits these symptoms?
3
, A. Acute pancreatitis
B. Peptic ulcer perforation
C. Gastroesophageal reflux disease
D. Acute cholecystitis
Answer: C
11. A patient presents with severe epigastric pain radiating directly to the back,
accompanied by persistent vomiting. The patient recently consumed a large
amount of alcohol. Which diagnosis should be suspected?
A. Acute pancreatitis
B. Irritable bowel syndrome
C. Diverticulosis
D. Hemorrhoids
Answer: A
12. A 64-year-old patient reports progressive constipation, narrower stools,
intermittent abdominal discomfort, fatigue, and unexplained iron-deficiency
anemia. Which diagnosis should receive urgent consideration?
A. Functional constipation
B. Colorectal cancer
C. Gastroenteritis
D. Lactose intolerance
Answer: B
13. A patient reports painless bright-red blood on toilet tissue after bowel
movements and has a history of chronic constipation and straining. There is
no weight loss, fever, or abdominal pain. Which condition is most likely?
A. Internal hemorrhoids
B. Diverticulitis
C. Crohn disease
D. Colorectal cancer
Answer: A
14. A patient with chronic diarrhea reports that symptoms began after several
courses of antibiotics. The patient now has frequent watery stools and
4
PRACTICUM REAL EXAM QUESTION AND CORRECT DETAILED ANSWERS
1. A 46-year-old patient presents for evaluation of intermittent right upper-
quadrant abdominal discomfort that is worse after fatty meals and
occasionally radiates toward the right shoulder. The patient reports nausea
but denies fever, jaundice, or persistent vomiting. Examination reveals mild
right-upper-quadrant tenderness without guarding. Which diagnosis should
be highest on the differential based on this presentation?
A. Acute appendicitis
B. Cholelithiasis with biliary colic
C. Acute pancreatitis
D. Peptic ulcer perforation
Answer: B
2. A 34-year-old patient reports six months of recurrent abdominal pain
associated with alternating constipation and diarrhea. The pain improves
after bowel movements, and the patient denies fever, rectal bleeding,
nocturnal symptoms, or unexplained weight loss. Laboratory testing is
normal. Which diagnosis best explains the overall clinical pattern?
A. Crohn disease
B. Colorectal cancer
C. Irritable bowel syndrome
D. Ulcerative colitis
Answer: C
3. A 67-year-old patient develops sudden severe abdominal pain that appears
disproportionate to the relatively mild findings on abdominal examination.
The patient has atrial fibrillation and is not taking anticoagulation. Which
diagnosis should the clinician urgently consider?
A. Acute mesenteric ischemia
B. Irritable bowel syndrome
C. Uncomplicated constipation
1
, D. Gastroesophageal reflux disease
Answer: A
4. A patient with several weeks of progressive dysphagia initially has difficulty
swallowing solid foods and later develops difficulty swallowing liquids. The
patient also reports unintended weight loss. Which finding most strongly
suggests a mechanical obstructive process requiring prompt evaluation?
A. Symptoms occurring only after spicy foods
B. Improvement with antacids
C. Occasional heartburn without dysphagia
D. Progressive dysphagia from solids to liquids
Answer: D
5. A 29-year-old patient develops profuse watery diarrhea, abdominal
cramping, nausea, and vomiting approximately 24 hours after eating food
from a buffet. Several other people who ate the same food developed
similar symptoms. The patient is afebrile and has no blood in the stool.
Which diagnosis is most likely?
A. Acute infectious gastroenteritis
B. Ulcerative colitis
C. Colorectal malignancy
D. Irritable bowel syndrome
Answer: A
6. A patient reports burning epigastric pain that frequently occurs several
hours after meals and sometimes awakens the patient during the night. The
patient regularly uses NSAIDs for chronic musculoskeletal pain. Which
condition should be strongly considered?
A. Acute pancreatitis
B. Peptic ulcer disease
C. Acute cholecystitis
D. Diverticulitis
Answer: B
2
, 7. A 52-year-old patient reports chronic diarrhea, abdominal bloating, fatigue,
and unintended weight loss. Laboratory testing demonstrates iron-
deficiency anemia. The patient reports that symptoms become worse after
eating bread and pasta. Which diagnosis is most consistent with the
presentation?
A. Lactose intolerance
B. Irritable bowel syndrome
C. Celiac disease
D. Viral gastroenteritis
Answer: C
8. A 71-year-old patient develops left-lower-quadrant abdominal pain, fever,
and altered bowel habits. Examination reveals localized left-lower-quadrant
tenderness. Which diagnosis is most likely in this older adult?
A. Acute appendicitis
B. Diverticulitis
C. Cholelithiasis
D. Pancreatitis
Answer: B
9. A 42-year-old patient has chronic diarrhea, abdominal pain, fatigue, and
intermittent blood in the stool. The patient has experienced several
episodes of unexplained fever and has lost weight over the past six months.
Which disorder should be included prominently in the differential?
A. Crohn disease
B. Functional constipation
C. Lactose intolerance
D. Gastroesophageal reflux disease
Answer: A
10. A 58-year-old patient reports persistent heartburn and regurgitation that
are worse after large meals and when lying down. The patient frequently
eats late at night and has gained considerable weight. Which diagnosis best
fits these symptoms?
3
, A. Acute pancreatitis
B. Peptic ulcer perforation
C. Gastroesophageal reflux disease
D. Acute cholecystitis
Answer: C
11. A patient presents with severe epigastric pain radiating directly to the back,
accompanied by persistent vomiting. The patient recently consumed a large
amount of alcohol. Which diagnosis should be suspected?
A. Acute pancreatitis
B. Irritable bowel syndrome
C. Diverticulosis
D. Hemorrhoids
Answer: A
12. A 64-year-old patient reports progressive constipation, narrower stools,
intermittent abdominal discomfort, fatigue, and unexplained iron-deficiency
anemia. Which diagnosis should receive urgent consideration?
A. Functional constipation
B. Colorectal cancer
C. Gastroenteritis
D. Lactose intolerance
Answer: B
13. A patient reports painless bright-red blood on toilet tissue after bowel
movements and has a history of chronic constipation and straining. There is
no weight loss, fever, or abdominal pain. Which condition is most likely?
A. Internal hemorrhoids
B. Diverticulitis
C. Crohn disease
D. Colorectal cancer
Answer: A
14. A patient with chronic diarrhea reports that symptoms began after several
courses of antibiotics. The patient now has frequent watery stools and
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