Family Nurse Practitioner (FNP) Diagnostic
Reasoning Mastery Exam – 150 Advanced
Clinical Questions
2025/2026
1. A 35-year-old patient presents with fatigue, pallor, and shortness
of breath. Laboratory studies reveal hemoglobin of 8 g/dL, MCV
70 fL, and ferritin 10 ng/mL. What is the most likely diagnosis?
Iron-deficiency anemia
Rationale: Microcytic anemia with low ferritin indicates iron
deficiency as the most probable cause.
2. A 50-year-old patient reports severe epigastric pain radiating to
the back, associated with nausea and vomiting. Lipase is elevated.
What is the most likely diagnosis?
Acute pancreatitis
Rationale: Sudden epigastric pain radiating to the back with
elevated lipase is classic for acute pancreatitis.
3. A patient presents with sudden-onset unilateral weakness and
slurred speech. What is the first-line imaging to confirm the
diagnosis?
Non-contrast CT scan of the head
Rationale: Non-contrast CT is the initial imaging of choice to rule
out hemorrhagic stroke.
4. A 25-year-old woman presents with dysuria, frequency, and
urgency. Urinalysis shows positive leukocyte esterase and nitrites.
What is the most likely diagnosis?
Urinary tract infection (cystitis)
Rationale: Classic lower urinary tract symptoms with positive
leukocyte esterase and nitrites suggest UTI.
,5. A 60-year-old patient presents with persistent cough, hemoptysis,
and weight loss. Chest X-ray reveals a central lung mass. What is
the most likely diagnosis?
Squamous cell lung carcinoma
Rationale: Central lung masses with hemoptysis are most
commonly squamous cell carcinoma.
6. A patient presents with severe headache, photophobia, and neck
stiffness. Which diagnostic test is most appropriate?
Lumbar puncture
Rationale: Suspected meningitis requires lumbar puncture to
analyze cerebrospinal fluid.
7. A 45-year-old patient has polyuria, polydipsia, and fasting glucose
of 160 mg/dL. What is the most likely diagnosis?
Type 2 diabetes mellitus
Rationale: Fasting glucose ≥126 mg/dL on two occasions with
classic symptoms confirms diabetes.
8. A patient presents with sudden, severe chest pain radiating to the
back and unequal blood pressures in both arms. What is the most
likely diagnosis?
Aortic dissection
Rationale: Chest/back pain with blood pressure discrepancy
suggests aortic dissection.
9. A 30-year-old female presents with heat intolerance, weight loss,
palpitations, and exophthalmos. What is the most likely
diagnosis?
Graves’ disease
Rationale: Hyperthyroid symptoms with eye findings suggest
Graves’ disease.
,10. A patient presents with progressive shortness of breath,
nonproductive cough, and bilateral basal crackles. Chest X-ray
shows diffuse interstitial markings. What is the most likely
diagnosis?
Idiopathic pulmonary fibrosis
Rationale: Chronic progressive dyspnea with interstitial changes
suggests idiopathic pulmonary fibrosis.
11. A patient presents with fatigue, jaundice, and pruritus. Lab
studies show elevated ALP, GGT, and positive anti-mitochondrial
antibodies. What is the most likely diagnosis?
Primary biliary cholangitis
Rationale: Cholestatic liver enzyme pattern with AMA positivity
indicates primary biliary cholangitis.
12. A 55-year-old patient presents with epigastric pain relieved
by food intake. Endoscopy shows a gastric ulcer. What is the most
likely etiology?
Helicobacter pylori infection
Rationale: Gastric ulcers are commonly associated with H. pylori
infection.
13. A patient reports joint pain and morning stiffness lasting
over an hour, primarily affecting the MCP and PIP joints. What is
the most likely diagnosis?
Rheumatoid arthritis
Rationale: Symmetric small joint involvement with prolonged
morning stiffness is typical for RA.
14. A patient presents with severe, sudden-onset right lower
quadrant abdominal pain, fever, and anorexia. What is the most
, likely diagnosis?
Acute appendicitis
Rationale: Classic presentation includes RLQ pain, fever, nausea,
and anorexia.
15. A 70-year-old patient presents with progressive memory
loss, difficulty with language, and disorientation. What is the most
likely diagnosis?
Alzheimer’s disease
Rationale: Gradual cognitive decline with memory and language
deficits is typical of Alzheimer’s disease.
16. A patient presents with unilateral facial droop, inability to
close the eye, and drooping mouth. What is the most likely
diagnosis?
Bell’s palsy
Rationale: Acute, unilateral peripheral facial nerve palsy without
other neurologic deficits suggests Bell’s palsy.
17. A 65-year-old patient presents with sudden-onset severe
headache, nausea, vomiting, and nuchal rigidity. CT scan shows
subarachnoid hemorrhage. What is the most likely cause?
Ruptured cerebral aneurysm
Rationale: Sudden severe headache with subarachnoid
hemorrhage is most commonly due to aneurysmal rupture.
18. A patient presents with persistent diarrhea, weight loss, and
abdominal cramping. Colonoscopy reveals skip lesions and
transmural inflammation. What is the most likely diagnosis?
Crohn’s disease
Rationale: Skip lesions and transmural inflammation are
characteristic of Crohn’s disease.
Reasoning Mastery Exam – 150 Advanced
Clinical Questions
2025/2026
1. A 35-year-old patient presents with fatigue, pallor, and shortness
of breath. Laboratory studies reveal hemoglobin of 8 g/dL, MCV
70 fL, and ferritin 10 ng/mL. What is the most likely diagnosis?
Iron-deficiency anemia
Rationale: Microcytic anemia with low ferritin indicates iron
deficiency as the most probable cause.
2. A 50-year-old patient reports severe epigastric pain radiating to
the back, associated with nausea and vomiting. Lipase is elevated.
What is the most likely diagnosis?
Acute pancreatitis
Rationale: Sudden epigastric pain radiating to the back with
elevated lipase is classic for acute pancreatitis.
3. A patient presents with sudden-onset unilateral weakness and
slurred speech. What is the first-line imaging to confirm the
diagnosis?
Non-contrast CT scan of the head
Rationale: Non-contrast CT is the initial imaging of choice to rule
out hemorrhagic stroke.
4. A 25-year-old woman presents with dysuria, frequency, and
urgency. Urinalysis shows positive leukocyte esterase and nitrites.
What is the most likely diagnosis?
Urinary tract infection (cystitis)
Rationale: Classic lower urinary tract symptoms with positive
leukocyte esterase and nitrites suggest UTI.
,5. A 60-year-old patient presents with persistent cough, hemoptysis,
and weight loss. Chest X-ray reveals a central lung mass. What is
the most likely diagnosis?
Squamous cell lung carcinoma
Rationale: Central lung masses with hemoptysis are most
commonly squamous cell carcinoma.
6. A patient presents with severe headache, photophobia, and neck
stiffness. Which diagnostic test is most appropriate?
Lumbar puncture
Rationale: Suspected meningitis requires lumbar puncture to
analyze cerebrospinal fluid.
7. A 45-year-old patient has polyuria, polydipsia, and fasting glucose
of 160 mg/dL. What is the most likely diagnosis?
Type 2 diabetes mellitus
Rationale: Fasting glucose ≥126 mg/dL on two occasions with
classic symptoms confirms diabetes.
8. A patient presents with sudden, severe chest pain radiating to the
back and unequal blood pressures in both arms. What is the most
likely diagnosis?
Aortic dissection
Rationale: Chest/back pain with blood pressure discrepancy
suggests aortic dissection.
9. A 30-year-old female presents with heat intolerance, weight loss,
palpitations, and exophthalmos. What is the most likely
diagnosis?
Graves’ disease
Rationale: Hyperthyroid symptoms with eye findings suggest
Graves’ disease.
,10. A patient presents with progressive shortness of breath,
nonproductive cough, and bilateral basal crackles. Chest X-ray
shows diffuse interstitial markings. What is the most likely
diagnosis?
Idiopathic pulmonary fibrosis
Rationale: Chronic progressive dyspnea with interstitial changes
suggests idiopathic pulmonary fibrosis.
11. A patient presents with fatigue, jaundice, and pruritus. Lab
studies show elevated ALP, GGT, and positive anti-mitochondrial
antibodies. What is the most likely diagnosis?
Primary biliary cholangitis
Rationale: Cholestatic liver enzyme pattern with AMA positivity
indicates primary biliary cholangitis.
12. A 55-year-old patient presents with epigastric pain relieved
by food intake. Endoscopy shows a gastric ulcer. What is the most
likely etiology?
Helicobacter pylori infection
Rationale: Gastric ulcers are commonly associated with H. pylori
infection.
13. A patient reports joint pain and morning stiffness lasting
over an hour, primarily affecting the MCP and PIP joints. What is
the most likely diagnosis?
Rheumatoid arthritis
Rationale: Symmetric small joint involvement with prolonged
morning stiffness is typical for RA.
14. A patient presents with severe, sudden-onset right lower
quadrant abdominal pain, fever, and anorexia. What is the most
, likely diagnosis?
Acute appendicitis
Rationale: Classic presentation includes RLQ pain, fever, nausea,
and anorexia.
15. A 70-year-old patient presents with progressive memory
loss, difficulty with language, and disorientation. What is the most
likely diagnosis?
Alzheimer’s disease
Rationale: Gradual cognitive decline with memory and language
deficits is typical of Alzheimer’s disease.
16. A patient presents with unilateral facial droop, inability to
close the eye, and drooping mouth. What is the most likely
diagnosis?
Bell’s palsy
Rationale: Acute, unilateral peripheral facial nerve palsy without
other neurologic deficits suggests Bell’s palsy.
17. A 65-year-old patient presents with sudden-onset severe
headache, nausea, vomiting, and nuchal rigidity. CT scan shows
subarachnoid hemorrhage. What is the most likely cause?
Ruptured cerebral aneurysm
Rationale: Sudden severe headache with subarachnoid
hemorrhage is most commonly due to aneurysmal rupture.
18. A patient presents with persistent diarrhea, weight loss, and
abdominal cramping. Colonoscopy reveals skip lesions and
transmural inflammation. What is the most likely diagnosis?
Crohn’s disease
Rationale: Skip lesions and transmural inflammation are
characteristic of Crohn’s disease.
