Exam Questions and Answers – Advanced Health Assessment & Clinical
Diagnosis in Primary Care 7th Edition Dains (180 Q&A with Rationales)
Question 1
Case Scenario: A 45-year-old woman presents with a lump in her right breast
noticed two weeks ago. It is firm, non-tender, and immobile. No nipple discharge.
Question: What is the most appropriate next step?
A. Reassure the patient and advise routine screening
B. Order a mammogram and refer to a breast specialist
C. Prescribe antibiotics
D. Perform fine-needle aspiration immediately
Correct Answer: B
Rationale: Any new, firm, immobile breast lump in a woman over 40 should be
evaluated with imaging and referral to a breast specialist to rule out malignancy.
Question 2
Case Scenario: A 65-year-old man reports sudden onset shortness of breath and
chest tightness while walking. History of hypertension and smoking.
Question: Which is the most concerning differential requiring immediate attention?
,A. Pulmonary embolism
B. Chronic bronchitis
C. Anxiety attack
D. Gastroesophageal reflux disease
Correct Answer: A
Rationale: Sudden dyspnea and chest tightness in an older adult with risk factors
raises concern for pulmonary embolism or acute coronary syndrome.
Question 3
Case Scenario: A 28-year-old woman presents with primary amenorrhea. Normal
secondary sexual characteristics.
Question: What is the next best step?
A. Pelvic ultrasound to check for anatomical abnormalities
B. Start hormone therapy immediately
C. Prescribe oral contraceptives
D. Reassure and follow up in a year
Correct Answer: A
,Rationale: Primary amenorrhea with normal secondary sexual characteristics
suggests possible anatomical or genetic causes. A pelvic ultrasound evaluates the
uterus and ovaries.
Question 4
Case Scenario: A 55-year-old man presents with persistent cough for three months,
producing scant sputum. Smoker.
Question: Which diagnostic test should be prioritized?
A. Chest X-ray
B. Sputum culture
C. Pulmonary function test
D. Allergy testing
Correct Answer: A
Rationale: Chronic cough in a smoker requires imaging to rule out malignancy or
chronic lung disease.
Question 5
, Case Scenario: A 70-year-old woman presents with confusion and new-onset
urinary incontinence. Temperature 37.8°C, mildly dehydrated.
Question: Most likely cause of acute confusion?
A. Urinary tract infection
B. Alzheimer’s disease progression
C. Stroke
D. Depression
Correct Answer: A
Rationale: Acute confusion (delirium) in older adults is commonly precipitated by
infections such as UTI, especially with dehydration.
Question 6
Case Scenario: A 30-year-old patient presents with diarrhea for 5 days, associated
with abdominal cramping. No blood in stool.
Question: Most appropriate initial management?
A. Oral rehydration therapy and symptomatic treatment
B. Start empiric antibiotics
C. Schedule colonoscopy
D. Start corticosteroids
Diagnosis in Primary Care 7th Edition Dains (180 Q&A with Rationales)
Question 1
Case Scenario: A 45-year-old woman presents with a lump in her right breast
noticed two weeks ago. It is firm, non-tender, and immobile. No nipple discharge.
Question: What is the most appropriate next step?
A. Reassure the patient and advise routine screening
B. Order a mammogram and refer to a breast specialist
C. Prescribe antibiotics
D. Perform fine-needle aspiration immediately
Correct Answer: B
Rationale: Any new, firm, immobile breast lump in a woman over 40 should be
evaluated with imaging and referral to a breast specialist to rule out malignancy.
Question 2
Case Scenario: A 65-year-old man reports sudden onset shortness of breath and
chest tightness while walking. History of hypertension and smoking.
Question: Which is the most concerning differential requiring immediate attention?
,A. Pulmonary embolism
B. Chronic bronchitis
C. Anxiety attack
D. Gastroesophageal reflux disease
Correct Answer: A
Rationale: Sudden dyspnea and chest tightness in an older adult with risk factors
raises concern for pulmonary embolism or acute coronary syndrome.
Question 3
Case Scenario: A 28-year-old woman presents with primary amenorrhea. Normal
secondary sexual characteristics.
Question: What is the next best step?
A. Pelvic ultrasound to check for anatomical abnormalities
B. Start hormone therapy immediately
C. Prescribe oral contraceptives
D. Reassure and follow up in a year
Correct Answer: A
,Rationale: Primary amenorrhea with normal secondary sexual characteristics
suggests possible anatomical or genetic causes. A pelvic ultrasound evaluates the
uterus and ovaries.
Question 4
Case Scenario: A 55-year-old man presents with persistent cough for three months,
producing scant sputum. Smoker.
Question: Which diagnostic test should be prioritized?
A. Chest X-ray
B. Sputum culture
C. Pulmonary function test
D. Allergy testing
Correct Answer: A
Rationale: Chronic cough in a smoker requires imaging to rule out malignancy or
chronic lung disease.
Question 5
, Case Scenario: A 70-year-old woman presents with confusion and new-onset
urinary incontinence. Temperature 37.8°C, mildly dehydrated.
Question: Most likely cause of acute confusion?
A. Urinary tract infection
B. Alzheimer’s disease progression
C. Stroke
D. Depression
Correct Answer: A
Rationale: Acute confusion (delirium) in older adults is commonly precipitated by
infections such as UTI, especially with dehydration.
Question 6
Case Scenario: A 30-year-old patient presents with diarrhea for 5 days, associated
with abdominal cramping. No blood in stool.
Question: Most appropriate initial management?
A. Oral rehydration therapy and symptomatic treatment
B. Start empiric antibiotics
C. Schedule colonoscopy
D. Start corticosteroids
