NR 511 FINAL EXAM: DIFFERENTIAL
DIAGNOSIS QUESTIONS & VERIFIED
ANSWERS 2026/2027 UPDATE
1. A 45-year-old male presents with a sudden onset of excruciating pain, redness, and
swelling in the first metatarsophalangeal joint. What is the most likely differential diagnosis?
A. Rheumatoid Arthritis
B. Gouty Arthritis
C. Osteoarthritis
D. Septic Arthritis
Answer: B
Conceptual Explanation: Gouty arthritis typically presents as a sudden, severe attack of
pain, redness, and tenderness in joints, often the joint at the base of the big toe.
2. When differentiating between viral and bacterial sinusitis, which clinical finding most
strongly suggests a bacterial etiology?
A. Clear nasal discharge for 3 days
,B. Symptoms lasting more than 10 days without improvement
C. Mild facial pain
D. Occasional low-grade fever
Answer: B
Conceptual Explanation: Bacterial sinusitis is characterized by symptoms lasting more
than 10 days, ‘double worsening’ after initial improvement, or high fever with purulent
discharge.
3. Which physical exam maneuver is most specific for diagnosing acute cholecystitis?
A. Rovsing’s sign
B. Psoas sign
C. McBurney’s point tenderness
D. Murphy’s sign
Answer: D
Conceptual Explanation: Murphy’s sign (arrest of inspiration on deep palpation of the
RUQ) is highly suggestive of acute cholecystitis.
4. A patient presents with a ‘curtain dropping’ sensation over their vision in one eye. This is a
hallmark sign of:
A. Glaucoma
B. Retinal detachment
, C. Cataracts
D. Macular degeneration
Answer: B
Conceptual Explanation: Retinal detachment often presents with flashes of light, floaters,
and a sensation of a shadow or curtain moving across the field of vision.
5. In a patient with suspected iron deficiency anemia, which lab value is expected to be
decreased?
A. Serum Ferritin
B. Mean Corpuscular Volume (MCV)
C. Red Cell Distribution Width (RDW)
D. Total Iron Binding Capacity (TIBC)
Answer: A
Conceptual Explanation: Serum ferritin is the most sensitive marker for iron deficiency
and is decreased in early stages.
6. Which of the following is a classic clinical triad for Meniere’s disease?
A. Fever, Neck stiffness, Altered mental status
B. Headache, Nausea, Photophobia
C. Vertigo, Tinnitus, Hearing loss
DIAGNOSIS QUESTIONS & VERIFIED
ANSWERS 2026/2027 UPDATE
1. A 45-year-old male presents with a sudden onset of excruciating pain, redness, and
swelling in the first metatarsophalangeal joint. What is the most likely differential diagnosis?
A. Rheumatoid Arthritis
B. Gouty Arthritis
C. Osteoarthritis
D. Septic Arthritis
Answer: B
Conceptual Explanation: Gouty arthritis typically presents as a sudden, severe attack of
pain, redness, and tenderness in joints, often the joint at the base of the big toe.
2. When differentiating between viral and bacterial sinusitis, which clinical finding most
strongly suggests a bacterial etiology?
A. Clear nasal discharge for 3 days
,B. Symptoms lasting more than 10 days without improvement
C. Mild facial pain
D. Occasional low-grade fever
Answer: B
Conceptual Explanation: Bacterial sinusitis is characterized by symptoms lasting more
than 10 days, ‘double worsening’ after initial improvement, or high fever with purulent
discharge.
3. Which physical exam maneuver is most specific for diagnosing acute cholecystitis?
A. Rovsing’s sign
B. Psoas sign
C. McBurney’s point tenderness
D. Murphy’s sign
Answer: D
Conceptual Explanation: Murphy’s sign (arrest of inspiration on deep palpation of the
RUQ) is highly suggestive of acute cholecystitis.
4. A patient presents with a ‘curtain dropping’ sensation over their vision in one eye. This is a
hallmark sign of:
A. Glaucoma
B. Retinal detachment
, C. Cataracts
D. Macular degeneration
Answer: B
Conceptual Explanation: Retinal detachment often presents with flashes of light, floaters,
and a sensation of a shadow or curtain moving across the field of vision.
5. In a patient with suspected iron deficiency anemia, which lab value is expected to be
decreased?
A. Serum Ferritin
B. Mean Corpuscular Volume (MCV)
C. Red Cell Distribution Width (RDW)
D. Total Iron Binding Capacity (TIBC)
Answer: A
Conceptual Explanation: Serum ferritin is the most sensitive marker for iron deficiency
and is decreased in early stages.
6. Which of the following is a classic clinical triad for Meniere’s disease?
A. Fever, Neck stiffness, Altered mental status
B. Headache, Nausea, Photophobia
C. Vertigo, Tinnitus, Hearing loss
