NR 511 Final Exam Differential
Diagnosis Primary Care
2026/2027 – Practice
Questions, Answers & Detailed
Rationales Guaranteed Pass
(GRADED A+)
Question 1
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. Costochondritis
C. Stable angina
D. Acute pericarditis
Answer: C. Stable angina
Rationale: Stable angina typically causes predictable exertional
chest pressure or discomfort that improves with rest or, when
prescribed, nitroglycerin.
,Question 2
A patient reports burning epigastric discomfort that occurs after
meals and improves with antacids. Which condition should be
included prominently in the differential diagnosis?
A. GERD
B. Appendicitis
C. Renal colic
D. Acute pancreatitis
Answer: A. GERD
Rationale: Gastroesophageal reflux commonly causes burning
retrosternal or upper abdominal discomfort associated with
meals and may improve with antacids.
Question 3
A 28-year-old patient has dysuria, urinary frequency, and
suprapubic discomfort without fever or flank pain. Which
diagnosis is most likely?
A. Acute cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Glomerulonephritis
Answer: A. Acute cystitis
,Rationale: Dysuria, frequency, and suprapubic discomfort are
classic lower urinary tract symptoms of acute uncomplicated
cystitis.
Question 4
Which finding is most suggestive of pyelonephritis rather than
uncomplicated cystitis?
A. Urinary frequency
B. Suprapubic pressure
C. Costovertebral angle tenderness
D. Dysuria
Answer: C. Costovertebral angle tenderness
Rationale: Fever, systemic symptoms, and costovertebral angle
tenderness suggest upper urinary tract involvement and are
characteristic of pyelonephritis.
Question 5
A patient presents with sudden severe flank pain radiating
toward the groin and associated with hematuria. Which
diagnosis is most likely?
A. Nephrolithiasis
B. Acute cystitis
C. Diverticulitis
D. Cholecystitis
, Answer: A. Nephrolithiasis
Rationale: Renal stones commonly produce sudden, severe
colicky flank pain that may radiate toward the groin and can
cause hematuria.
Question 6
A 67-year-old patient develops sudden unilateral weakness and
difficulty speaking. What is the most appropriate initial
diagnostic concern?
A. Migraine
B. Ischemic stroke
C. Tension headache
D. Peripheral neuropathy
Answer: B. Ischemic stroke
Rationale: Sudden focal neurologic deficits such as unilateral
weakness and aphasia require urgent evaluation for acute
stroke.
Question 7
Which headache feature is considered a red flag requiring urgent
evaluation?
A. Mild bilateral pressure
B. Headache relieved by sleep
Diagnosis Primary Care
2026/2027 – Practice
Questions, Answers & Detailed
Rationales Guaranteed Pass
(GRADED A+)
Question 1
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. Costochondritis
C. Stable angina
D. Acute pericarditis
Answer: C. Stable angina
Rationale: Stable angina typically causes predictable exertional
chest pressure or discomfort that improves with rest or, when
prescribed, nitroglycerin.
,Question 2
A patient reports burning epigastric discomfort that occurs after
meals and improves with antacids. Which condition should be
included prominently in the differential diagnosis?
A. GERD
B. Appendicitis
C. Renal colic
D. Acute pancreatitis
Answer: A. GERD
Rationale: Gastroesophageal reflux commonly causes burning
retrosternal or upper abdominal discomfort associated with
meals and may improve with antacids.
Question 3
A 28-year-old patient has dysuria, urinary frequency, and
suprapubic discomfort without fever or flank pain. Which
diagnosis is most likely?
A. Acute cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Glomerulonephritis
Answer: A. Acute cystitis
,Rationale: Dysuria, frequency, and suprapubic discomfort are
classic lower urinary tract symptoms of acute uncomplicated
cystitis.
Question 4
Which finding is most suggestive of pyelonephritis rather than
uncomplicated cystitis?
A. Urinary frequency
B. Suprapubic pressure
C. Costovertebral angle tenderness
D. Dysuria
Answer: C. Costovertebral angle tenderness
Rationale: Fever, systemic symptoms, and costovertebral angle
tenderness suggest upper urinary tract involvement and are
characteristic of pyelonephritis.
Question 5
A patient presents with sudden severe flank pain radiating
toward the groin and associated with hematuria. Which
diagnosis is most likely?
A. Nephrolithiasis
B. Acute cystitis
C. Diverticulitis
D. Cholecystitis
, Answer: A. Nephrolithiasis
Rationale: Renal stones commonly produce sudden, severe
colicky flank pain that may radiate toward the groin and can
cause hematuria.
Question 6
A 67-year-old patient develops sudden unilateral weakness and
difficulty speaking. What is the most appropriate initial
diagnostic concern?
A. Migraine
B. Ischemic stroke
C. Tension headache
D. Peripheral neuropathy
Answer: B. Ischemic stroke
Rationale: Sudden focal neurologic deficits such as unilateral
weakness and aphasia require urgent evaluation for acute
stroke.
Question 7
Which headache feature is considered a red flag requiring urgent
evaluation?
A. Mild bilateral pressure
B. Headache relieved by sleep
