NR511 Final Exam Differential Diagnosis and Primary Care Practicum with Complete solutions 2026 Update

Question 1 A 58-year-old male presents to the primary care clinic with a three-month history of worsening fatigue and dyspnea upon exertion. He has a significant past medical history of gastrointestinal reflux disease (GERD), for which he has been taking omeprazole (20 mg) daily for five years. Physical examination reveals pale conjunctiva and a smooth tongue. Laboratory evaluation shows a Hemoglobin of 9.2 g/dL and a Mean Corpuscular Volume (MCV) of 74 fL. Based on the patient's history and laboratory findings, what is the most likely cause of his microcytic anemia? A) Acute blood loss from an esophageal tear B) Iron deficiency due to impaired absorption or occult blood loss C) G6PD deficiency triggered by medication D) Vitamin B12 deficiency due to chronic PPI use ________________________________________ Question 2 A child is brought to the clinic for evaluation of easy bruising, petechiae, and bone pain. Which type of leukemia is statistically most prevalent in the pediatric population? A) Chronic Myeloid Leukemia (CML) B) Chronic Lymphocytic Leukemia (CLL) C) Acute Myeloid Leukemia (AML) D) Acute Lymphoblastic Leukemia (ALL) ________________________________________ Question 3 When evaluating a patient for suspected Peptic Ulcer Disease (PUD) using the urea breath test for H. pylori, for how long must the patient abstain from Proton Pump Inhibitors (PPIs) to prevent false-negative results? A) 1 week B) 4 weeks C) 48 hours D) 2 weeks ________________________________________ Question 4 A 19-year-old male presents with sudden, severe unilateral scrotal pain. Physical examination shows an absent cremasteric reflex and a high-riding testicle on the affected side. What is the priority management step? A) Perform a Doppler ultrasound in the clinic tomorrow B) Immediate surgical consultation for suspected testicular torsion C) Order a midstream urine culture D) Prescribe a 10-day course of Ciprofloxacin ________________________________________ Question 5 During a physical examination of the knee, the clinician applies forward pressure to the tibia while the knee is flexed at 20 to 30 degrees. Excessive anterior displacement without a firm endpoint suggests an injury to which structure? A) Posterior cruciate ligament (PCL) B) Anterior cruciate ligament (ACL) C) Lateral collateral ligament (LCL) D) Medial meniscus ________________________________________ Question 6 According to the Healthy People 2030 initiatives, which group of vaccines is prioritized for young adults (ages 18–25) to prevent under-immunization during the transition from pediatric to adult care? A) HPV, Tdap, and Meningococcal B) DTaP and Hib C) Shingrix and Pneumovax 23 D) Hepatitis A and Rotavirus ________________________________________ Question 7 What is the underlying pathophysiology of Pernicious Anemia? A) Excessive intake of oxidative food products B) Genetic mutation in the beta-globin chain C) Chronic loss of blood in the stool D) Autoimmune destruction of gastric parietal cells ________________________________________