NR 511/ NR511 DIFFERENTIAL DIAGNOSIS AND PRIMARY
CARE PRACTICUM MIDTERM EXAM & FINAL EXAM
QUESTIONS & ANSWERS | COMPLETE PACKAGE BUNDLE
SECTION 1: CLINICAL ASSESSMENT, DIAGNOSTIC REASONING & PREVENTIVE
PRIMARY CARE
Questions 1–25
Q1. Which component of the patient history is most important for establishing the chronology of
a presenting complaint?
A. Family history
B. History of present illness
C. Social history
D. Review of systems
Correct Answer: B. History of present illness
Rationale: The history of present illness establishes the onset, progression, duration, severity,
and modifying factors associated with the current complaint. The review of systems may identify
associated symptoms, but it does not provide the same chronological detail.
Q2. A 52-year-old patient reports intermittent substernal chest discomfort for the past 3 weeks.
Which characteristic is most suggestive of myocardial ischemia?
A. Pain reproducible with palpation
B. Burning discomfort occurring after spicy meals
C. Pressure precipitated by exertion and relieved by rest
D. Sharp pain that worsens with inspiration
Correct Answer: C. Pressure precipitated by exertion and relieved by rest
Rationale: Exertional pressure or heaviness relieved by rest is characteristic of stable myocardial
ischemia. Reproducible pain, pleuritic pain, and symptoms associated with meals suggest
alternative musculoskeletal, pulmonary, or gastrointestinal causes.
Q3. During a primary care visit, a patient reports fatigue. Which approach is most appropriate
during the initial evaluation?
,A. Order a comprehensive panel of laboratory tests before obtaining a history
B. Determine the onset, duration, associated symptoms, medications, sleep pattern, and
psychosocial factors
C. Diagnose depression if no physical abnormality is immediately apparent
D. Refer the patient to a specialist without further assessment
Correct Answer: B. Determine the onset, duration, associated symptoms, medications, sleep
pattern, and psychosocial factors
Rationale: Fatigue has a broad differential diagnosis, including sleep disorders, medication
effects, endocrine disease, anemia, infection, mood disorders, and systemic illness. A focused
history and examination help determine which diagnostic testing is appropriate rather than
ordering indiscriminate tests.
Q4. A 68-year-old patient presents for an annual primary care examination. Which finding
should prompt further evaluation rather than being attributed automatically to normal aging?
A. Mildly decreased near vision
B. New unilateral weakness
C. Reduced skin elasticity
D. Gradual decrease in height
Correct Answer: B. New unilateral weakness
Rationale: New unilateral weakness is a potentially significant neurologic finding that may
indicate an acute or progressive neurologic disorder. Although sensory and musculoskeletal
changes can occur with aging, focal neurologic deficits require timely evaluation.
Q5. A patient has a positive screening test for a disease but no symptoms. What does a positive
predictive value primarily describe?
A. The probability that a person with a negative test does not have the disease
B. The probability that a person with a positive test actually has the disease
C. The proportion of diseased patients correctly identified by the test
D. The proportion of healthy patients correctly identified by the test
Correct Answer: B. The probability that a person with a positive test actually has the
disease
Rationale: Positive predictive value is the probability that a patient with a positive test truly has
the condition. Negative predictive value describes the probability that a patient with a negative
test does not have the condition.
, Q6. A 45-year-old patient has a blood pressure of 154/94 mm Hg during a routine visit. The
patient is asymptomatic. What is the most appropriate initial approach?
A. Diagnose hypertensive emergency
B. Confirm the elevated blood pressure with appropriate repeat measurements and assess
cardiovascular risk
C. Immediately administer intravenous antihypertensive medication
D. Assume the elevation is caused by anxiety and document no further action
Correct Answer: B. Confirm the elevated blood pressure with appropriate repeat
measurements and assess cardiovascular risk
Rationale: An isolated elevated office blood pressure should be confirmed using appropriate
measurement techniques and, when indicated, out-of-office monitoring. Hypertensive emergency
requires markedly elevated blood pressure accompanied by acute target-organ injury, which is
not described here.
Q7. Which finding is considered a red flag in a patient presenting with acute headache?
A. Headache occurring after prolonged computer use
B. Headache relieved by sleep
C. Sudden onset of maximal-intensity headache
D. Mild headache associated with dehydration
Correct Answer: C. Sudden onset of maximal-intensity headache
Rationale: A sudden, severe headache reaching maximal intensity rapidly is a red flag for
secondary causes such as subarachnoid hemorrhage. This presentation warrants urgent evaluation
rather than routine treatment for a primary headache disorder.
Q8. A patient reports dizziness when standing from a seated position. Which additional
measurement is most useful in evaluating suspected orthostatic hypotension?
A. Pulse oximetry after exercise
B. Blood pressure and heart rate in supine and standing positions
C. Temperature after meals
D. Peak expiratory flow rate
Correct Answer: B. Blood pressure and heart rate in supine and standing positions
CARE PRACTICUM MIDTERM EXAM & FINAL EXAM
QUESTIONS & ANSWERS | COMPLETE PACKAGE BUNDLE
SECTION 1: CLINICAL ASSESSMENT, DIAGNOSTIC REASONING & PREVENTIVE
PRIMARY CARE
Questions 1–25
Q1. Which component of the patient history is most important for establishing the chronology of
a presenting complaint?
A. Family history
B. History of present illness
C. Social history
D. Review of systems
Correct Answer: B. History of present illness
Rationale: The history of present illness establishes the onset, progression, duration, severity,
and modifying factors associated with the current complaint. The review of systems may identify
associated symptoms, but it does not provide the same chronological detail.
Q2. A 52-year-old patient reports intermittent substernal chest discomfort for the past 3 weeks.
Which characteristic is most suggestive of myocardial ischemia?
A. Pain reproducible with palpation
B. Burning discomfort occurring after spicy meals
C. Pressure precipitated by exertion and relieved by rest
D. Sharp pain that worsens with inspiration
Correct Answer: C. Pressure precipitated by exertion and relieved by rest
Rationale: Exertional pressure or heaviness relieved by rest is characteristic of stable myocardial
ischemia. Reproducible pain, pleuritic pain, and symptoms associated with meals suggest
alternative musculoskeletal, pulmonary, or gastrointestinal causes.
Q3. During a primary care visit, a patient reports fatigue. Which approach is most appropriate
during the initial evaluation?
,A. Order a comprehensive panel of laboratory tests before obtaining a history
B. Determine the onset, duration, associated symptoms, medications, sleep pattern, and
psychosocial factors
C. Diagnose depression if no physical abnormality is immediately apparent
D. Refer the patient to a specialist without further assessment
Correct Answer: B. Determine the onset, duration, associated symptoms, medications, sleep
pattern, and psychosocial factors
Rationale: Fatigue has a broad differential diagnosis, including sleep disorders, medication
effects, endocrine disease, anemia, infection, mood disorders, and systemic illness. A focused
history and examination help determine which diagnostic testing is appropriate rather than
ordering indiscriminate tests.
Q4. A 68-year-old patient presents for an annual primary care examination. Which finding
should prompt further evaluation rather than being attributed automatically to normal aging?
A. Mildly decreased near vision
B. New unilateral weakness
C. Reduced skin elasticity
D. Gradual decrease in height
Correct Answer: B. New unilateral weakness
Rationale: New unilateral weakness is a potentially significant neurologic finding that may
indicate an acute or progressive neurologic disorder. Although sensory and musculoskeletal
changes can occur with aging, focal neurologic deficits require timely evaluation.
Q5. A patient has a positive screening test for a disease but no symptoms. What does a positive
predictive value primarily describe?
A. The probability that a person with a negative test does not have the disease
B. The probability that a person with a positive test actually has the disease
C. The proportion of diseased patients correctly identified by the test
D. The proportion of healthy patients correctly identified by the test
Correct Answer: B. The probability that a person with a positive test actually has the
disease
Rationale: Positive predictive value is the probability that a patient with a positive test truly has
the condition. Negative predictive value describes the probability that a patient with a negative
test does not have the condition.
, Q6. A 45-year-old patient has a blood pressure of 154/94 mm Hg during a routine visit. The
patient is asymptomatic. What is the most appropriate initial approach?
A. Diagnose hypertensive emergency
B. Confirm the elevated blood pressure with appropriate repeat measurements and assess
cardiovascular risk
C. Immediately administer intravenous antihypertensive medication
D. Assume the elevation is caused by anxiety and document no further action
Correct Answer: B. Confirm the elevated blood pressure with appropriate repeat
measurements and assess cardiovascular risk
Rationale: An isolated elevated office blood pressure should be confirmed using appropriate
measurement techniques and, when indicated, out-of-office monitoring. Hypertensive emergency
requires markedly elevated blood pressure accompanied by acute target-organ injury, which is
not described here.
Q7. Which finding is considered a red flag in a patient presenting with acute headache?
A. Headache occurring after prolonged computer use
B. Headache relieved by sleep
C. Sudden onset of maximal-intensity headache
D. Mild headache associated with dehydration
Correct Answer: C. Sudden onset of maximal-intensity headache
Rationale: A sudden, severe headache reaching maximal intensity rapidly is a red flag for
secondary causes such as subarachnoid hemorrhage. This presentation warrants urgent evaluation
rather than routine treatment for a primary headache disorder.
Q8. A patient reports dizziness when standing from a seated position. Which additional
measurement is most useful in evaluating suspected orthostatic hypotension?
A. Pulse oximetry after exercise
B. Blood pressure and heart rate in supine and standing positions
C. Temperature after meals
D. Peak expiratory flow rate
Correct Answer: B. Blood pressure and heart rate in supine and standing positions
