MIDTERM NR-511 DIFFERENTIAL
DIAGNOSIS & PRIMARY CARE
PRACTICUM QUESTIONS WITH
VERIFIED ANSWERS.NEW UPDATE.
JUST RELEASED
1. A 45-year-old male presents with a sudden onset of excruciating pain in his right great toe.
On examination, the joint is erythematous, swollen, and tender. What is the definitive
diagnostic test to confirm the suspected diagnosis?
A. Serum uric acid level
B. X-ray of the foot
C. Synovial fluid analysis for monosodium urate crystals
D. C-reactive protein (CRP) level
Answer: C
Conceptual Explanation: Synovial fluid analysis showing negatively birefringent needle-
shaped crystals is the gold standard for diagnosing gout. Serum uric acid can be normal
during an acute flare.
2. In the assessment of a patient with a suspected skin lesion, which characteristic in the
ABCDE mnemonic is most indicative of malignant melanoma?
A. Evolution or change in size, shape, or color
,B. Diameter less than 6 mm
C. Symmetry of the lesion
D. Uniformity of color
Answer: A
Conceptual Explanation: Evolution (E) is often the most sensitive factor in identifying
melanoma in clinical practice, as changing lesions are highly suspicious.
3. A 28-year-old female presents with a ‘herald patch’ followed by a ‘Christmas tree’
distribution of smaller maculopapular lesions on her trunk. What is the most likely diagnosis?
A. Tinea corporis
B. Secondary syphilis
C. Pityriasis rosea
D. Guttate psoriasis
Answer: C
Conceptual Explanation: Pityriasis rosea typically begins with a herald patch and
progresses to a Christmas tree distribution along skin cleavage lines.
4. Which of the following is considered a ‘Red Flag’ in the evaluation of low back pain that
warrants immediate imaging?
A. Pain that worsens with movement
B. History of smoking
, C. Sudden onset of urinary incontinence or saddle anesthesia
D. Age between 30 and 50 years
Answer: C
Conceptual Explanation: Urinary incontinence and saddle anesthesia are signs of Cauda
Equina Syndrome, a neurosurgical emergency.
5. When evaluating a patient for Community-Acquired Pneumonia (CAP), which clinical tool is
used to determine if the patient requires hospitalization?
A. CURB-65 Score
B. Centor Criteria
C. PHQ-9
D. CHADS2 Score
Answer: A
Conceptual Explanation: The CURB-65 score (Confusion, Urea, Respiratory rate, Blood
pressure, Age 65+) helps determine the severity of CAP and the appropriate site of care.
6. A patient presents with a sore throat, fever, and cervical lymphadenopathy. The Rapid
Strep Test is negative. According to the Centor Criteria, what is the next best step for a 10-
year-old patient?
A. Prescribe Amoxicillin regardless of the test
B. Order a Monospot test immediately
DIAGNOSIS & PRIMARY CARE
PRACTICUM QUESTIONS WITH
VERIFIED ANSWERS.NEW UPDATE.
JUST RELEASED
1. A 45-year-old male presents with a sudden onset of excruciating pain in his right great toe.
On examination, the joint is erythematous, swollen, and tender. What is the definitive
diagnostic test to confirm the suspected diagnosis?
A. Serum uric acid level
B. X-ray of the foot
C. Synovial fluid analysis for monosodium urate crystals
D. C-reactive protein (CRP) level
Answer: C
Conceptual Explanation: Synovial fluid analysis showing negatively birefringent needle-
shaped crystals is the gold standard for diagnosing gout. Serum uric acid can be normal
during an acute flare.
2. In the assessment of a patient with a suspected skin lesion, which characteristic in the
ABCDE mnemonic is most indicative of malignant melanoma?
A. Evolution or change in size, shape, or color
,B. Diameter less than 6 mm
C. Symmetry of the lesion
D. Uniformity of color
Answer: A
Conceptual Explanation: Evolution (E) is often the most sensitive factor in identifying
melanoma in clinical practice, as changing lesions are highly suspicious.
3. A 28-year-old female presents with a ‘herald patch’ followed by a ‘Christmas tree’
distribution of smaller maculopapular lesions on her trunk. What is the most likely diagnosis?
A. Tinea corporis
B. Secondary syphilis
C. Pityriasis rosea
D. Guttate psoriasis
Answer: C
Conceptual Explanation: Pityriasis rosea typically begins with a herald patch and
progresses to a Christmas tree distribution along skin cleavage lines.
4. Which of the following is considered a ‘Red Flag’ in the evaluation of low back pain that
warrants immediate imaging?
A. Pain that worsens with movement
B. History of smoking
, C. Sudden onset of urinary incontinence or saddle anesthesia
D. Age between 30 and 50 years
Answer: C
Conceptual Explanation: Urinary incontinence and saddle anesthesia are signs of Cauda
Equina Syndrome, a neurosurgical emergency.
5. When evaluating a patient for Community-Acquired Pneumonia (CAP), which clinical tool is
used to determine if the patient requires hospitalization?
A. CURB-65 Score
B. Centor Criteria
C. PHQ-9
D. CHADS2 Score
Answer: A
Conceptual Explanation: The CURB-65 score (Confusion, Urea, Respiratory rate, Blood
pressure, Age 65+) helps determine the severity of CAP and the appropriate site of care.
6. A patient presents with a sore throat, fever, and cervical lymphadenopathy. The Rapid
Strep Test is negative. According to the Centor Criteria, what is the next best step for a 10-
year-old patient?
A. Prescribe Amoxicillin regardless of the test
B. Order a Monospot test immediately
