NP Clinical Assessment & Differential Diagnosis
Test Bank – 150 Questions, Answers And
Rationales.
(2025/2026)
1. A 65-year-old man presents with gradual onset exertional chest
pain relieved by rest. Most likely diagnosis?
A. Pulmonary embolism
B. Pericarditis
C. Stable angina
D. Aortic dissection
Rationale: Typical exertional chest pain relieved by rest is classic
for stable angina due to fixed coronary atherosclerosis.
2. A 25-year-old woman with pleuritic chest pain, fever, and a
pleural friction rub — most likely cause?
A. Myocardial ischemia
B. Pericarditis
C. Pulmonary embolism
D. Pneumothorax
Rationale: Pleuritic chest pain and a friction rub are
characteristic of pericarditis (inflammation of pericardial layers).
3. Sudden severe chest pain radiating to the back with a widened
mediastinum on chest x-ray — most likely?
A. Pulmonary embolism
B. Tension pneumothorax
C. Aortic dissection
D. Esophageal reflux
, Rationale: Tearing chest pain radiating to the back plus widened
mediastinum suggests aortic dissection.
4. Young adult with sudden onset dyspnea, unilateral pleuritic chest
pain, and decreased breath sounds on one side — most likely?
A. Pneumonia
B. Pulmonary embolism
C. Spontaneous pneumothorax
D. Heart failure
Rationale: Sudden unilateral pleuritic pain and decreased breath
sounds indicate pneumothorax, especially in young tall adults.
5. Subacute cough, fever, rusty sputum, lobar consolidation on chest
x-ray — most likely?
A. Atypical pneumonia
B. Streptococcal (typical) lobar pneumonia
C. Pulmonary embolism
D. Bronchial asthma
Rationale: Lobar consolidation and rusty sputum fit typical
bacterial pneumonia, often Streptococcus pneumoniae.
6. Chronic productive cough for >3 months/year for 2 consecutive
years — best diagnosis?
A. Bronchiectasis
B. Chronic bronchitis (COPD phenotype)
C. Bronchial asthma
D. Interstitial lung disease
Rationale: Chronic productive cough with that duration defines
chronic bronchitis, a COPD form.
7. Episodic wheeze, dyspnea, cough worse at night, reversible
airflow obstruction — most likely?
A. COPD
, B. Asthma
C. Pulmonary fibrosis
D. Heart failure
Rationale: Reversible airflow limitation and nocturnal symptoms
are hallmark features of asthma.
8. Progressive dyspnea on exertion, inspiratory crackles, clubbing,
restrictive PFTs — most likely?
A. Emphysema
B. Bronchiectasis
C. Interstitial pulmonary fibrosis
D. Asthma
Rationale: Progressive dyspnea, crackles, clubbing, and
restrictive pattern point to interstitial pulmonary fibrosis.
9. Sudden onset shortness of breath after long flight, tachycardia,
pleuritic chest pain, normal chest x-ray often — most likely?
A. Pneumonia
B. Pulmonary embolism
C. Myocardial infarction
D. Pneumothorax
Rationale: Recent immobilization and sudden pleuritic dyspnea
suggest PE; CXR often non-diagnostic.
10. Young patient with recurrent sinus infections, chronic
productive cough, clubbing, and bronchiectasis on CT — consider:
A. COPD
B. TB
C. Cystic fibrosis (or primary ciliary dyskinesia)
D. Lung cancer
Rationale: Recurrent infections, bronchiectasis, and early onset
, suggest CF or PCD; age and additional findings help
differentiate.
11. Child with barking cough, inspiratory stridor, worse at night
— most likely?
A. Bronchiolitis
B. Croup (laryngotracheobronchitis)
C. Epiglottitis
D. Foreign body aspiration
Rationale: Barking cough and stridor, commonly viral, indicate
croup in young children.
12. Sudden onset stridor, drooling, muffled voice, high fever —
emergency diagnosis?
A. Croup
B. Epiglottitis
C. Laryngomalacia
D. Bronchiolitis
Rationale: Rapid progression with drooling and muffled voice
suggests epiglottitis; airway emergency.
13. Older smoker with hemoptysis, weight loss, focal
consolidation or mass on imaging — most concerning for:
A. Bronchiectasis
B. Tuberculosis
C. Lung cancer
D. Pulmonary embolism
Rationale: Hemoptysis, weight loss, and focal mass in a smoker
raise high suspicion for lung cancer.
14. Fever, night sweats, weight loss, cavitary lesions on chest x-
ray — most likely?
A. Fungal infection
Test Bank – 150 Questions, Answers And
Rationales.
(2025/2026)
1. A 65-year-old man presents with gradual onset exertional chest
pain relieved by rest. Most likely diagnosis?
A. Pulmonary embolism
B. Pericarditis
C. Stable angina
D. Aortic dissection
Rationale: Typical exertional chest pain relieved by rest is classic
for stable angina due to fixed coronary atherosclerosis.
2. A 25-year-old woman with pleuritic chest pain, fever, and a
pleural friction rub — most likely cause?
A. Myocardial ischemia
B. Pericarditis
C. Pulmonary embolism
D. Pneumothorax
Rationale: Pleuritic chest pain and a friction rub are
characteristic of pericarditis (inflammation of pericardial layers).
3. Sudden severe chest pain radiating to the back with a widened
mediastinum on chest x-ray — most likely?
A. Pulmonary embolism
B. Tension pneumothorax
C. Aortic dissection
D. Esophageal reflux
, Rationale: Tearing chest pain radiating to the back plus widened
mediastinum suggests aortic dissection.
4. Young adult with sudden onset dyspnea, unilateral pleuritic chest
pain, and decreased breath sounds on one side — most likely?
A. Pneumonia
B. Pulmonary embolism
C. Spontaneous pneumothorax
D. Heart failure
Rationale: Sudden unilateral pleuritic pain and decreased breath
sounds indicate pneumothorax, especially in young tall adults.
5. Subacute cough, fever, rusty sputum, lobar consolidation on chest
x-ray — most likely?
A. Atypical pneumonia
B. Streptococcal (typical) lobar pneumonia
C. Pulmonary embolism
D. Bronchial asthma
Rationale: Lobar consolidation and rusty sputum fit typical
bacterial pneumonia, often Streptococcus pneumoniae.
6. Chronic productive cough for >3 months/year for 2 consecutive
years — best diagnosis?
A. Bronchiectasis
B. Chronic bronchitis (COPD phenotype)
C. Bronchial asthma
D. Interstitial lung disease
Rationale: Chronic productive cough with that duration defines
chronic bronchitis, a COPD form.
7. Episodic wheeze, dyspnea, cough worse at night, reversible
airflow obstruction — most likely?
A. COPD
, B. Asthma
C. Pulmonary fibrosis
D. Heart failure
Rationale: Reversible airflow limitation and nocturnal symptoms
are hallmark features of asthma.
8. Progressive dyspnea on exertion, inspiratory crackles, clubbing,
restrictive PFTs — most likely?
A. Emphysema
B. Bronchiectasis
C. Interstitial pulmonary fibrosis
D. Asthma
Rationale: Progressive dyspnea, crackles, clubbing, and
restrictive pattern point to interstitial pulmonary fibrosis.
9. Sudden onset shortness of breath after long flight, tachycardia,
pleuritic chest pain, normal chest x-ray often — most likely?
A. Pneumonia
B. Pulmonary embolism
C. Myocardial infarction
D. Pneumothorax
Rationale: Recent immobilization and sudden pleuritic dyspnea
suggest PE; CXR often non-diagnostic.
10. Young patient with recurrent sinus infections, chronic
productive cough, clubbing, and bronchiectasis on CT — consider:
A. COPD
B. TB
C. Cystic fibrosis (or primary ciliary dyskinesia)
D. Lung cancer
Rationale: Recurrent infections, bronchiectasis, and early onset
, suggest CF or PCD; age and additional findings help
differentiate.
11. Child with barking cough, inspiratory stridor, worse at night
— most likely?
A. Bronchiolitis
B. Croup (laryngotracheobronchitis)
C. Epiglottitis
D. Foreign body aspiration
Rationale: Barking cough and stridor, commonly viral, indicate
croup in young children.
12. Sudden onset stridor, drooling, muffled voice, high fever —
emergency diagnosis?
A. Croup
B. Epiglottitis
C. Laryngomalacia
D. Bronchiolitis
Rationale: Rapid progression with drooling and muffled voice
suggests epiglottitis; airway emergency.
13. Older smoker with hemoptysis, weight loss, focal
consolidation or mass on imaging — most concerning for:
A. Bronchiectasis
B. Tuberculosis
C. Lung cancer
D. Pulmonary embolism
Rationale: Hemoptysis, weight loss, and focal mass in a smoker
raise high suspicion for lung cancer.
14. Fever, night sweats, weight loss, cavitary lesions on chest x-
ray — most likely?
A. Fungal infection
