Midterm Exam: NR 511/ NR511 (Latest 2026/ 2027
Update) Differential Diagnosis and Primary Care
Practicum Review| Questions & Answers| Grade A|
100% Correct (Verified Solutions)- Chamberlain
1. A 55-year-old male presents with substernal chest pressure radiating to the left arm,
diaphoresis, and nausea. Which is the priority differential?
A) GERD
B) Acute coronary syndrome
C) Costochondritis
D) Anxiety
Answer: B
Rationale: Diaphoresis, nausea, and radiation to the arm are classic for ACS; immediate ECG and
troponin.
2. A 24-year-old female presents with sharp chest pain worse with inspiration, relieved by sitting
forward. Which is most likely?
A) Myocardial infarction
B) Pericarditis
C) Pneumothorax
D) PE
Answer: B
Rationale: Pleuritic chest pain relieved by sitting forward is characteristic of pericarditis.
,3. A 68-year-old smoker presents with sudden dyspnea, pleuritic chest pain, and tachycardia.
Which is the priority?
A) Pneumonia
B) Pulmonary embolism
C) COPD exacerbation
D) Heart failure
Answer: B
Rationale: Sudden dyspnea with pleuritic pain and tachycardia in a smoker suggests PE.
4. A 45-year-old female presents with dyspnea on exertion, orthopnea, and bilateral crackles.
Which is most likely?
A) Asthma
B) Heart failure
C) COPD
D) Pneumonia
Answer: B
Rationale: Orthopnea and crackles suggest pulmonary congestion from heart failure.
5. A 30-year-old male presents with episodic wheezing, cough at night, and dyspnea after exercise.
Which is most likely?
A) COPD
B) Asthma
C) Bronchitis
D) GERD
Answer: B
Rationale: Nocturnal cough, wheezing, and exercise-induced symptoms suggest asthma.
2
,6. A 60-year-old smoker presents with chronic productive cough for 3 months for 2 years. Which is
most likely?
A) Asthma
B) Chronic bronchitis
C) Emphysema
D) Bronchiectasis
Answer: B
Rationale: Chronic bronchitis is defined by productive cough for ≥3 months for 2 consecutive years.
7. A 72-year-old presents with fever, productive cough, and right-sided crackles. Which is most
likely?
A) Bronchitis
B) Pneumonia
C) Asthma
D) PE
Answer: B
Rationale: Fever, productive cough, and focal crackles suggest pneumonia.
8. A 50-year-old presents with epigastric burning that worsens after meals and at night. Which is
most likely?
A) GERD
B) Peptic ulcer disease
C) Gastritis
D) Pancreatitis
Answer: B
Rationale: Epigastric burning that worsens after meals and at night suggests PUD.
9. A 35-year-old presents with heartburn and regurgitation after large meals. Which is most likely?
3
, A) PUD
B) GERD
C) Gastritis
D) Cholecystitis
Answer: B
Rationale: Heartburn and regurgitation after meals are classic for GERD.
10. A 40-year-old presents with right upper quadrant pain radiating to the right scapula after fatty
meals. Which is most likely?
A) PUD
B) GERD
C) Cholecystitis
D) Pancreatitis
Answer: C
Rationale: RUQ pain radiating to the scapula after fatty meals suggests gallbladder disease.
11. A 55-year-old alcoholic presents with severe epigastric pain radiating to the back, nausea, and
vomiting. Which is most likely?
A) Cholecystitis
B) Pancreatitis
C) PUD
D) MI
Answer: B
Rationale: Severe epigastric pain radiating to back in an alcoholic suggests pancreatitis.
12. A 30-year-old presents with alternating diarrhea and constipation, relieved by defecation.
Which is most likely?
A) IBD
4
Update) Differential Diagnosis and Primary Care
Practicum Review| Questions & Answers| Grade A|
100% Correct (Verified Solutions)- Chamberlain
1. A 55-year-old male presents with substernal chest pressure radiating to the left arm,
diaphoresis, and nausea. Which is the priority differential?
A) GERD
B) Acute coronary syndrome
C) Costochondritis
D) Anxiety
Answer: B
Rationale: Diaphoresis, nausea, and radiation to the arm are classic for ACS; immediate ECG and
troponin.
2. A 24-year-old female presents with sharp chest pain worse with inspiration, relieved by sitting
forward. Which is most likely?
A) Myocardial infarction
B) Pericarditis
C) Pneumothorax
D) PE
Answer: B
Rationale: Pleuritic chest pain relieved by sitting forward is characteristic of pericarditis.
,3. A 68-year-old smoker presents with sudden dyspnea, pleuritic chest pain, and tachycardia.
Which is the priority?
A) Pneumonia
B) Pulmonary embolism
C) COPD exacerbation
D) Heart failure
Answer: B
Rationale: Sudden dyspnea with pleuritic pain and tachycardia in a smoker suggests PE.
4. A 45-year-old female presents with dyspnea on exertion, orthopnea, and bilateral crackles.
Which is most likely?
A) Asthma
B) Heart failure
C) COPD
D) Pneumonia
Answer: B
Rationale: Orthopnea and crackles suggest pulmonary congestion from heart failure.
5. A 30-year-old male presents with episodic wheezing, cough at night, and dyspnea after exercise.
Which is most likely?
A) COPD
B) Asthma
C) Bronchitis
D) GERD
Answer: B
Rationale: Nocturnal cough, wheezing, and exercise-induced symptoms suggest asthma.
2
,6. A 60-year-old smoker presents with chronic productive cough for 3 months for 2 years. Which is
most likely?
A) Asthma
B) Chronic bronchitis
C) Emphysema
D) Bronchiectasis
Answer: B
Rationale: Chronic bronchitis is defined by productive cough for ≥3 months for 2 consecutive years.
7. A 72-year-old presents with fever, productive cough, and right-sided crackles. Which is most
likely?
A) Bronchitis
B) Pneumonia
C) Asthma
D) PE
Answer: B
Rationale: Fever, productive cough, and focal crackles suggest pneumonia.
8. A 50-year-old presents with epigastric burning that worsens after meals and at night. Which is
most likely?
A) GERD
B) Peptic ulcer disease
C) Gastritis
D) Pancreatitis
Answer: B
Rationale: Epigastric burning that worsens after meals and at night suggests PUD.
9. A 35-year-old presents with heartburn and regurgitation after large meals. Which is most likely?
3
, A) PUD
B) GERD
C) Gastritis
D) Cholecystitis
Answer: B
Rationale: Heartburn and regurgitation after meals are classic for GERD.
10. A 40-year-old presents with right upper quadrant pain radiating to the right scapula after fatty
meals. Which is most likely?
A) PUD
B) GERD
C) Cholecystitis
D) Pancreatitis
Answer: C
Rationale: RUQ pain radiating to the scapula after fatty meals suggests gallbladder disease.
11. A 55-year-old alcoholic presents with severe epigastric pain radiating to the back, nausea, and
vomiting. Which is most likely?
A) Cholecystitis
B) Pancreatitis
C) PUD
D) MI
Answer: B
Rationale: Severe epigastric pain radiating to back in an alcoholic suggests pancreatitis.
12. A 30-year-old presents with alternating diarrhea and constipation, relieved by defecation.
Which is most likely?
A) IBD
4
