Final Exam: NR511 / NR 511 (Latest Update
) Differential Diagnosis &
Primary Care Practicum – Chamberlain 100
Verified Questions & 100% Correct Answers
with Rationales Grade A
1. A 45-year-old male presents with substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Pain is 8/10 and occurred while shoveling snow. The most likely
diagnosis is: Answer: Acute myocardial infarctionRationale: Classic presentation of
acute coronary syndrome (STEMI or NSTEMI) includes substernal pressure-like pain
radiating to arm/jaw, diaphoresis, nausea, and association with exertion. Immediate ECG
and troponin are required.
2. A 28-year-old female presents with dysuria, frequency, and suprapubic pain. No fever or
flank pain. Urinalysis shows pyuria and bacteriuria. The most appropriate initial
treatment is: Answer: Nitrofurantoin 100 mg BID × 5 daysRationale: Uncomplicated
acute cystitis in non-pregnant women is best treated with nitrofurantoin (first-line per
IDSA 2010/2026 update) or TMP-SMX for 3 days if local resistance <20%.
3. A 62-year-old male with COPD presents with increased dyspnea, cough, and purulent
sputum. He is afebrile. The most appropriate initial management is: Answer:
Azithromycin 500 mg day 1, then 250 mg days 2–5Rationale: GOLD 2026 guidelines
recommend short-course macrolides as first-line for mild-moderate COPD exacerbation
without risk factors for Pseudomonas or resistant organisms.
4. A 35-year-old female presents with fatigue, weight gain, cold intolerance, and dry skin.
TSH is 12.5 mIU/L (elevated) and free T4 is low. The most likely diagnosis is: Answer:
Primary hypothyroidismRationale: Elevated TSH with low free T4 confirms primary
hypothyroidism (most commonly Hashimoto’s thyroiditis). Next step is to order thyroid
peroxidase antibodies.
, 5. A 55-year-old male with type 2 diabetes has an A1C of 9.2% on metformin 1,000 mg
BID. He has established atherosclerotic cardiovascular disease. The next best add-on
therapy is: Answer: Empagliflozin 10 mg dailyRationale: ADA 2026/2027 guidelines
prioritize SGLT2 inhibitors (empagliflozin) or GLP-1 receptor agonists in patients with
established ASCVD for both glycemic control and cardiovascular risk reduction.
6. A 32-year-old female presents with heavy menstrual bleeding and fatigue. Hemoglobin is
8.9 g/dL. Ferritin is low. The most appropriate initial treatment is: Answer: Oral iron
supplementationRationale: Iron deficiency anemia is the most common cause of fatigue
in reproductive-age women with heavy menses. Oral iron (ferrous sulfate 325 mg daily
with vitamin C) is first-line therapy.
7. A 19-year-old male presents with acute onset of severe testicular pain and swelling
during basketball practice. The most likely diagnosis is: Answer: Testicular
torsionRationale: Sudden, severe testicular pain in an adolescent/young adult is
testicular torsion until proven otherwise. Urgent urologic consultation for surgical
exploration is required within 6 hours to preserve testicular viability.
8. A 65-year-old female presents with right upper quadrant pain after eating fatty foods.
Murphy’s sign is positive. The most likely diagnosis is: Answer: Acute
cholecystitisRationale: Postprandial RUQ pain with positive Murphy’s sign (pain and
inspiratory arrest on palpation under right costal margin) is pathognomonic for acute
cholecystitis. Ultrasound is the confirmatory test.
9. A 50-year-old male with hypertension presents with sudden severe headache, nausea, and
photophobia. BP is 210/120 mmHg. The most likely diagnosis is: Answer: Hypertensive
emergencyRationale: Severe headache with markedly elevated BP and end-organ
symptoms (encephalopathy) defines hypertensive emergency. Requires controlled BP
reduction with IV agents (nicardipine, labetalol, or clevidipine).
10. A 40-year-old female presents with fatigue, palpitations, and unintentional weight loss.
TSH is 0.01 mIU/L and free T4 is elevated. The most likely diagnosis is: Answer:
Graves’ diseaseRationale: Suppressed TSH with elevated free T4 and classic
hyperthyroid symptoms (fatigue, palpitations, weight loss) are most consistent with
Graves’ disease. Next step is thyroid-stimulating immunoglobulin (TSI) or uptake scan.
) Differential Diagnosis &
Primary Care Practicum – Chamberlain 100
Verified Questions & 100% Correct Answers
with Rationales Grade A
1. A 45-year-old male presents with substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Pain is 8/10 and occurred while shoveling snow. The most likely
diagnosis is: Answer: Acute myocardial infarctionRationale: Classic presentation of
acute coronary syndrome (STEMI or NSTEMI) includes substernal pressure-like pain
radiating to arm/jaw, diaphoresis, nausea, and association with exertion. Immediate ECG
and troponin are required.
2. A 28-year-old female presents with dysuria, frequency, and suprapubic pain. No fever or
flank pain. Urinalysis shows pyuria and bacteriuria. The most appropriate initial
treatment is: Answer: Nitrofurantoin 100 mg BID × 5 daysRationale: Uncomplicated
acute cystitis in non-pregnant women is best treated with nitrofurantoin (first-line per
IDSA 2010/2026 update) or TMP-SMX for 3 days if local resistance <20%.
3. A 62-year-old male with COPD presents with increased dyspnea, cough, and purulent
sputum. He is afebrile. The most appropriate initial management is: Answer:
Azithromycin 500 mg day 1, then 250 mg days 2–5Rationale: GOLD 2026 guidelines
recommend short-course macrolides as first-line for mild-moderate COPD exacerbation
without risk factors for Pseudomonas or resistant organisms.
4. A 35-year-old female presents with fatigue, weight gain, cold intolerance, and dry skin.
TSH is 12.5 mIU/L (elevated) and free T4 is low. The most likely diagnosis is: Answer:
Primary hypothyroidismRationale: Elevated TSH with low free T4 confirms primary
hypothyroidism (most commonly Hashimoto’s thyroiditis). Next step is to order thyroid
peroxidase antibodies.
, 5. A 55-year-old male with type 2 diabetes has an A1C of 9.2% on metformin 1,000 mg
BID. He has established atherosclerotic cardiovascular disease. The next best add-on
therapy is: Answer: Empagliflozin 10 mg dailyRationale: ADA 2026/2027 guidelines
prioritize SGLT2 inhibitors (empagliflozin) or GLP-1 receptor agonists in patients with
established ASCVD for both glycemic control and cardiovascular risk reduction.
6. A 32-year-old female presents with heavy menstrual bleeding and fatigue. Hemoglobin is
8.9 g/dL. Ferritin is low. The most appropriate initial treatment is: Answer: Oral iron
supplementationRationale: Iron deficiency anemia is the most common cause of fatigue
in reproductive-age women with heavy menses. Oral iron (ferrous sulfate 325 mg daily
with vitamin C) is first-line therapy.
7. A 19-year-old male presents with acute onset of severe testicular pain and swelling
during basketball practice. The most likely diagnosis is: Answer: Testicular
torsionRationale: Sudden, severe testicular pain in an adolescent/young adult is
testicular torsion until proven otherwise. Urgent urologic consultation for surgical
exploration is required within 6 hours to preserve testicular viability.
8. A 65-year-old female presents with right upper quadrant pain after eating fatty foods.
Murphy’s sign is positive. The most likely diagnosis is: Answer: Acute
cholecystitisRationale: Postprandial RUQ pain with positive Murphy’s sign (pain and
inspiratory arrest on palpation under right costal margin) is pathognomonic for acute
cholecystitis. Ultrasound is the confirmatory test.
9. A 50-year-old male with hypertension presents with sudden severe headache, nausea, and
photophobia. BP is 210/120 mmHg. The most likely diagnosis is: Answer: Hypertensive
emergencyRationale: Severe headache with markedly elevated BP and end-organ
symptoms (encephalopathy) defines hypertensive emergency. Requires controlled BP
reduction with IV agents (nicardipine, labetalol, or clevidipine).
10. A 40-year-old female presents with fatigue, palpitations, and unintentional weight loss.
TSH is 0.01 mIU/L and free T4 is elevated. The most likely diagnosis is: Answer:
Graves’ diseaseRationale: Suppressed TSH with elevated free T4 and classic
hyperthyroid symptoms (fatigue, palpitations, weight loss) are most consistent with
Graves’ disease. Next step is thyroid-stimulating immunoglobulin (TSI) or uptake scan.
