NR-571 Complex Diagnosis & Management —
2025-2026
1.
A 45-year-old female presents with fatigue, weight gain, and
cold intolerance. Her TSH is elevated, and free T4 is low. What
is the most likely diagnosis?
A. Hyperthyroidism
B. Subclinical hypothyroidism
C. Primary hypothyroidism
D. Central hypothyroidism
Primary hypothyroidism is characterized by elevated TSH and
low free T4 due to thyroid gland dysfunction.
2.
A patient with COPD presents with acute shortness of breath,
confusion, and SpO₂ 84% on room air. ABG shows pH 7.29,
PaCO₂ 68 mmHg, HCO₃⁻ 26. What is the diagnosis?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis
D. Compensated respiratory acidosis
Elevated PaCO₂ and low pH indicate acute respiratory acidosis
due to hypoventilation.
,3.
In managing a diabetic patient with an HbA1c of 9.5%, which
agent provides cardiovascular protection?
A. Sulfonylurea
B. DPP-4 inhibitor
C. Thiazolidinedione
D. SGLT2 inhibitor
SGLT2 inhibitors lower HbA1c and reduce heart failure and renal
complications.
4.
A 60-year-old male with hypertension and diabetes presents
with new-onset ankle swelling and proteinuria. What is the best
initial test?
A. Renal biopsy
B. Urine albumin-to-creatinine ratio
C. Renal ultrasound
D. Serum uric acid
Screening for diabetic nephropathy begins with a urine albumin-
to-creatinine ratio.
5.
,A 35-year-old woman presents with unilateral throbbing
headaches, photophobia, and nausea. What is the most
appropriate abortive therapy?
A. Acetaminophen
B. Sumatriptan
C. Propranolol
D. Amitriptyline
Triptans are first-line for acute migraine attacks.
6.
Which finding is most consistent with pneumonia on physical
exam?
A. Wheezes and hyperresonance
B. Decreased tactile fremitus
C. Egophony and dullness to percussion
D. Diminished breath sounds with hyperinflation
Egophony and dullness suggest consolidation.
7.
A patient with atrial fibrillation and CHA₂DS₂-VASc score of 3
should be started on:
A. Aspirin
B. Clopidogrel
C. Oral anticoagulant
, D. No therapy
A CHA₂DS₂-VASc ≥2 warrants anticoagulation to prevent stroke.
8.
What is the most sensitive test for diagnosing iron deficiency
anemia?
A. Serum iron
B. Hemoglobin
C. Hematocrit
D. Ferritin
Ferritin is the earliest marker to drop in iron deficiency.
9.
A patient taking lisinopril develops a persistent dry cough. The
best next step is:
A. Continue medication
B. Switch to an ARB
C. Add antitussive
D. Stop antihypertensive therapy
ACE inhibitor–induced cough resolves when switched to an ARB.
10.
A 58-year-old smoker presents with hematuria. What is the
most appropriate next diagnostic step?
2025-2026
1.
A 45-year-old female presents with fatigue, weight gain, and
cold intolerance. Her TSH is elevated, and free T4 is low. What
is the most likely diagnosis?
A. Hyperthyroidism
B. Subclinical hypothyroidism
C. Primary hypothyroidism
D. Central hypothyroidism
Primary hypothyroidism is characterized by elevated TSH and
low free T4 due to thyroid gland dysfunction.
2.
A patient with COPD presents with acute shortness of breath,
confusion, and SpO₂ 84% on room air. ABG shows pH 7.29,
PaCO₂ 68 mmHg, HCO₃⁻ 26. What is the diagnosis?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis
D. Compensated respiratory acidosis
Elevated PaCO₂ and low pH indicate acute respiratory acidosis
due to hypoventilation.
,3.
In managing a diabetic patient with an HbA1c of 9.5%, which
agent provides cardiovascular protection?
A. Sulfonylurea
B. DPP-4 inhibitor
C. Thiazolidinedione
D. SGLT2 inhibitor
SGLT2 inhibitors lower HbA1c and reduce heart failure and renal
complications.
4.
A 60-year-old male with hypertension and diabetes presents
with new-onset ankle swelling and proteinuria. What is the best
initial test?
A. Renal biopsy
B. Urine albumin-to-creatinine ratio
C. Renal ultrasound
D. Serum uric acid
Screening for diabetic nephropathy begins with a urine albumin-
to-creatinine ratio.
5.
,A 35-year-old woman presents with unilateral throbbing
headaches, photophobia, and nausea. What is the most
appropriate abortive therapy?
A. Acetaminophen
B. Sumatriptan
C. Propranolol
D. Amitriptyline
Triptans are first-line for acute migraine attacks.
6.
Which finding is most consistent with pneumonia on physical
exam?
A. Wheezes and hyperresonance
B. Decreased tactile fremitus
C. Egophony and dullness to percussion
D. Diminished breath sounds with hyperinflation
Egophony and dullness suggest consolidation.
7.
A patient with atrial fibrillation and CHA₂DS₂-VASc score of 3
should be started on:
A. Aspirin
B. Clopidogrel
C. Oral anticoagulant
, D. No therapy
A CHA₂DS₂-VASc ≥2 warrants anticoagulation to prevent stroke.
8.
What is the most sensitive test for diagnosing iron deficiency
anemia?
A. Serum iron
B. Hemoglobin
C. Hematocrit
D. Ferritin
Ferritin is the earliest marker to drop in iron deficiency.
9.
A patient taking lisinopril develops a persistent dry cough. The
best next step is:
A. Continue medication
B. Switch to an ARB
C. Add antitussive
D. Stop antihypertensive therapy
ACE inhibitor–induced cough resolves when switched to an ARB.
10.
A 58-year-old smoker presents with hematuria. What is the
most appropriate next diagnostic step?
