NR 511 Exam 2: Differential Diagnosis - Chamberlain
University Updated and Latest Questions and Correct
Answers with Rationale
1. A 55-year-old male reports chest pain that occurs consistently when climbing two flights of stairs and
resolves with rest. Which condition is the most likely diagnosis?
A. Unstable Angina
B. Pericarditis
C. Myocardial Infarction
D. Stable Angina
Correct Answer: D
Rationale: Stable angina is characterized by predictable patterns of chest pain triggered by physical
exertion or stress. The pain is typically relieved by rest or nitroglycerin within a few minutes. Unstable
angina differs because the pain occurs at rest or changes in frequency and intensity. A myocardial
infarction involves prolonged pain often associated with systemic symptoms like nausea. Differentiating
these conditions requires a thorough history of symptom onset and relief factors.
2. Which physical examination finding is most suggestive of community-acquired pneumonia rather than
acute bronchitis?
A. Productive cough
B. Presence of wheezing
C. Low-grade fever
D. Dullness to percussion
Correct Answer: D
,Rationale: Dullness to percussion indicates consolidation in the lung tissue which is common in
pneumonia. Acute bronchitis typically presents with clear lung fields or scattered wheezing but lacks
signs of consolidation. Other signs of pneumonia include increased tactile fremitus and bronchial breath
sounds over the affected area. Bronchitis is primarily an airway inflammation without significant alveolar
involvement. The presence of consolidation helps the clinician choose appropriate antibiotic therapy for
pneumonia.
3. A patient presents with sharp right upper quadrant pain that radiates to the right shoulder and a positive
Murphy’s sign. What is the most likely diagnosis?
A. Appendicitis
B. Acute Cholecystitis
C. Acute Pancreatitis
D. Gastroesophageal Reflux
Correct Answer: B
Rationale: Acute cholecystitis typically causes right upper quadrant pain that may radiate to the scapula
or shoulder. A positive Murphy’s sign occurs when the patient halts inspiration during deep palpation of
the gallbladder area. This finding is highly specific for gallbladder inflammation often caused by
gallstones. Appendicitis pain usually begins peri-umbilically and migrates to the right lower quadrant.
Prompt ultrasound imaging is usually the next step to confirm gallbladder wall thickening.
4. Which laboratory value is most specific for diagnosing heart failure in a patient with acute dyspnea?
A. Troponin I
B. B-type Natriuretic Peptide (BNP)
C. C-Reactive Protein
, D. Creatinine Kinase
Correct Answer: B
Rationale: B-type Natriuretic Peptide (BNP) is released by the ventricles in response to increased wall
tension and volume overload. High levels of BNP are very sensitive for identifying heart failure as the
cause of shortness of breath. Troponin I is a marker of myocardial injury but does not specifically indicate
heart failure. CRP is a non-specific marker of inflammation used in various diagnostic contexts. BNP
testing helps differentiate cardiac-related dyspnea from primary respiratory causes.
5. A patient with asthma reports using their Short-Acting Beta-Agonist (SABA) four times a week for
symptom relief. How should this asthma be classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Correct Answer: A
Rationale: Mild persistent asthma is defined by symptoms occurring more than twice a week but not
daily. The use of a rescue inhaler more than two days per week indicates the need for daily controller
therapy. Intermittent asthma requires rescue use two or fewer days per week. Moderate persistent
asthma would involve daily symptoms and daily rescue inhaler use. Proper classification is essential for
selecting the correct step-up in pharmacological management.
6. A 22-year-old patient presents with right lower quadrant pain and exhibits pain when the right hip is
internally rotated. What is this clinical sign called?
A. Rovsing’s Sign
University Updated and Latest Questions and Correct
Answers with Rationale
1. A 55-year-old male reports chest pain that occurs consistently when climbing two flights of stairs and
resolves with rest. Which condition is the most likely diagnosis?
A. Unstable Angina
B. Pericarditis
C. Myocardial Infarction
D. Stable Angina
Correct Answer: D
Rationale: Stable angina is characterized by predictable patterns of chest pain triggered by physical
exertion or stress. The pain is typically relieved by rest or nitroglycerin within a few minutes. Unstable
angina differs because the pain occurs at rest or changes in frequency and intensity. A myocardial
infarction involves prolonged pain often associated with systemic symptoms like nausea. Differentiating
these conditions requires a thorough history of symptom onset and relief factors.
2. Which physical examination finding is most suggestive of community-acquired pneumonia rather than
acute bronchitis?
A. Productive cough
B. Presence of wheezing
C. Low-grade fever
D. Dullness to percussion
Correct Answer: D
,Rationale: Dullness to percussion indicates consolidation in the lung tissue which is common in
pneumonia. Acute bronchitis typically presents with clear lung fields or scattered wheezing but lacks
signs of consolidation. Other signs of pneumonia include increased tactile fremitus and bronchial breath
sounds over the affected area. Bronchitis is primarily an airway inflammation without significant alveolar
involvement. The presence of consolidation helps the clinician choose appropriate antibiotic therapy for
pneumonia.
3. A patient presents with sharp right upper quadrant pain that radiates to the right shoulder and a positive
Murphy’s sign. What is the most likely diagnosis?
A. Appendicitis
B. Acute Cholecystitis
C. Acute Pancreatitis
D. Gastroesophageal Reflux
Correct Answer: B
Rationale: Acute cholecystitis typically causes right upper quadrant pain that may radiate to the scapula
or shoulder. A positive Murphy’s sign occurs when the patient halts inspiration during deep palpation of
the gallbladder area. This finding is highly specific for gallbladder inflammation often caused by
gallstones. Appendicitis pain usually begins peri-umbilically and migrates to the right lower quadrant.
Prompt ultrasound imaging is usually the next step to confirm gallbladder wall thickening.
4. Which laboratory value is most specific for diagnosing heart failure in a patient with acute dyspnea?
A. Troponin I
B. B-type Natriuretic Peptide (BNP)
C. C-Reactive Protein
, D. Creatinine Kinase
Correct Answer: B
Rationale: B-type Natriuretic Peptide (BNP) is released by the ventricles in response to increased wall
tension and volume overload. High levels of BNP are very sensitive for identifying heart failure as the
cause of shortness of breath. Troponin I is a marker of myocardial injury but does not specifically indicate
heart failure. CRP is a non-specific marker of inflammation used in various diagnostic contexts. BNP
testing helps differentiate cardiac-related dyspnea from primary respiratory causes.
5. A patient with asthma reports using their Short-Acting Beta-Agonist (SABA) four times a week for
symptom relief. How should this asthma be classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Correct Answer: A
Rationale: Mild persistent asthma is defined by symptoms occurring more than twice a week but not
daily. The use of a rescue inhaler more than two days per week indicates the need for daily controller
therapy. Intermittent asthma requires rescue use two or fewer days per week. Moderate persistent
asthma would involve daily symptoms and daily rescue inhaler use. Proper classification is essential for
selecting the correct step-up in pharmacological management.
6. A 22-year-old patient presents with right lower quadrant pain and exhibits pain when the right hip is
internally rotated. What is this clinical sign called?
A. Rovsing’s Sign
