NR 511 – DIFFERENTIAL DIAGNOSIS & PRACTICIUM
CARE FINAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+ LATEST
1. A 32-year-old female presents with fatigue, weight gain, cold intolerance,
constipation, and dry skin. Which is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome
D. Addison disease
Answer: B. Hypothyroidism
Rationale: Classic symptoms of hypothyroidism include fatigue, weight gain, cold
intolerance, constipation, and dry skin.
2. A 27-year-old male presents with sudden onset of severe right lower
quadrant pain, anorexia, and nausea. What is the most appropriate next step?
A. Start oral antibiotics
B. Order abdominal ultrasound
C. Order CT abdomen/pelvis with contrast
D. Begin IV fluids and discharge
Answer: C. Order CT abdomen/pelvis with contrast
Rationale: CT is the most accurate diagnostic test for suspected appendicitis in
adults.
,3. A 60-year-old male smoker presents with hematuria but no pain. What is
the most likely diagnosis?
A. UTI
B. Kidney stones
C. Bladder cancer
D. Prostatitis
Answer: C. Bladder cancer
Rationale: Painless hematuria in a smoker is highly suggestive of bladder cancer
until proven otherwise.
4. A patient presents with severe headache, neck stiffness, fever, and
photophobia. What is the most likely diagnosis?
A. Migraine
B. Tension headache
C. Meningitis
D. Cluster headache
Answer: C. Meningitis
Rationale: Fever, neck stiffness, and photophobia strongly suggest meningitis.
5. A 55-year-old male presents with crushing substernal chest pain radiating
to the left arm, diaphoresis, and nausea. ECG shows ST-elevation in leads V2–
V4. What is the most likely diagnosis?
A. Stable angina
B. NSTEMI
C. STEMI (anterior wall)
D. Pericarditis
Answer: C. STEMI (anterior wall)
Rationale: ST elevation in V2–V4 indicates an anterior wall STEMI, likely LAD
occlusion.
,6. A 24-year-old female presents with polyuria, polydipsia, and weight loss.
Labs show fasting glucose 280 mg/dL. What is the most likely diagnosis?
A. Type 1 diabetes mellitus
B. Type 2 diabetes mellitus
C. Diabetes insipidus
D. Cushing syndrome
Answer: A. Type 1 diabetes mellitus
Rationale: Young age with acute onset polyuria, polydipsia, weight loss, and high
glucose is consistent with type 1 diabetes.
7. A patient presents with sudden onset of unilateral facial droop, inability to
close the eye, and hyperacusis. What is the most likely diagnosis?
A. Stroke
B. Bell’s palsy
C. Myasthenia gravis
D. Trigeminal neuralgia
Answer: B. Bell’s palsy
Rationale: Facial nerve (CN VII) palsy with hyperacusis suggests Bell’s palsy.
Stroke usually spares the forehead.
8. A 30-year-old female presents with fever, right upper quadrant pain, and
positive Murphy sign. Which diagnosis is most likely?
A. Acute pancreatitis
B. Acute cholecystitis
C. Appendicitis
D. Hepatitis
Answer: B. Acute cholecystitis
Rationale: RUQ pain with fever and positive Murphy sign indicates acute
cholecystitis.
, 9. A 45-year-old male presents with fatigue, pruritus, jaundice, and elevated
alkaline phosphatase. Anti-mitochondrial antibodies are positive. What is the
most likely diagnosis?
A. Acute hepatitis
B. Primary biliary cholangitis
C. Gallstones
D. Alcoholic liver disease
Answer: B. Primary biliary cholangitis
Rationale: Elevated ALP with positive AMA indicates primary biliary cholangitis.
10. A 38-year-old female presents with weight loss, tremor, heat intolerance,
and palpitations. TSH is low and free T4 is elevated. What is the most likely
diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Addison disease
D. Cushing syndrome
Answer: B. Hyperthyroidism
Rationale: Symptoms and labs indicate hyperthyroidism.
11. A patient presents with sudden onset of chest pain and shortness of breath
after a long flight. What is the most likely diagnosis?
A. Pneumonia
B. Pulmonary embolism
C. Asthma exacerbation
D. GERD
Answer: B. Pulmonary embolism
Rationale: Sudden chest pain and dyspnea after prolonged immobility suggests
PE.
CARE FINAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+ LATEST
1. A 32-year-old female presents with fatigue, weight gain, cold intolerance,
constipation, and dry skin. Which is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome
D. Addison disease
Answer: B. Hypothyroidism
Rationale: Classic symptoms of hypothyroidism include fatigue, weight gain, cold
intolerance, constipation, and dry skin.
2. A 27-year-old male presents with sudden onset of severe right lower
quadrant pain, anorexia, and nausea. What is the most appropriate next step?
A. Start oral antibiotics
B. Order abdominal ultrasound
C. Order CT abdomen/pelvis with contrast
D. Begin IV fluids and discharge
Answer: C. Order CT abdomen/pelvis with contrast
Rationale: CT is the most accurate diagnostic test for suspected appendicitis in
adults.
,3. A 60-year-old male smoker presents with hematuria but no pain. What is
the most likely diagnosis?
A. UTI
B. Kidney stones
C. Bladder cancer
D. Prostatitis
Answer: C. Bladder cancer
Rationale: Painless hematuria in a smoker is highly suggestive of bladder cancer
until proven otherwise.
4. A patient presents with severe headache, neck stiffness, fever, and
photophobia. What is the most likely diagnosis?
A. Migraine
B. Tension headache
C. Meningitis
D. Cluster headache
Answer: C. Meningitis
Rationale: Fever, neck stiffness, and photophobia strongly suggest meningitis.
5. A 55-year-old male presents with crushing substernal chest pain radiating
to the left arm, diaphoresis, and nausea. ECG shows ST-elevation in leads V2–
V4. What is the most likely diagnosis?
A. Stable angina
B. NSTEMI
C. STEMI (anterior wall)
D. Pericarditis
Answer: C. STEMI (anterior wall)
Rationale: ST elevation in V2–V4 indicates an anterior wall STEMI, likely LAD
occlusion.
,6. A 24-year-old female presents with polyuria, polydipsia, and weight loss.
Labs show fasting glucose 280 mg/dL. What is the most likely diagnosis?
A. Type 1 diabetes mellitus
B. Type 2 diabetes mellitus
C. Diabetes insipidus
D. Cushing syndrome
Answer: A. Type 1 diabetes mellitus
Rationale: Young age with acute onset polyuria, polydipsia, weight loss, and high
glucose is consistent with type 1 diabetes.
7. A patient presents with sudden onset of unilateral facial droop, inability to
close the eye, and hyperacusis. What is the most likely diagnosis?
A. Stroke
B. Bell’s palsy
C. Myasthenia gravis
D. Trigeminal neuralgia
Answer: B. Bell’s palsy
Rationale: Facial nerve (CN VII) palsy with hyperacusis suggests Bell’s palsy.
Stroke usually spares the forehead.
8. A 30-year-old female presents with fever, right upper quadrant pain, and
positive Murphy sign. Which diagnosis is most likely?
A. Acute pancreatitis
B. Acute cholecystitis
C. Appendicitis
D. Hepatitis
Answer: B. Acute cholecystitis
Rationale: RUQ pain with fever and positive Murphy sign indicates acute
cholecystitis.
, 9. A 45-year-old male presents with fatigue, pruritus, jaundice, and elevated
alkaline phosphatase. Anti-mitochondrial antibodies are positive. What is the
most likely diagnosis?
A. Acute hepatitis
B. Primary biliary cholangitis
C. Gallstones
D. Alcoholic liver disease
Answer: B. Primary biliary cholangitis
Rationale: Elevated ALP with positive AMA indicates primary biliary cholangitis.
10. A 38-year-old female presents with weight loss, tremor, heat intolerance,
and palpitations. TSH is low and free T4 is elevated. What is the most likely
diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Addison disease
D. Cushing syndrome
Answer: B. Hyperthyroidism
Rationale: Symptoms and labs indicate hyperthyroidism.
11. A patient presents with sudden onset of chest pain and shortness of breath
after a long flight. What is the most likely diagnosis?
A. Pneumonia
B. Pulmonary embolism
C. Asthma exacerbation
D. GERD
Answer: B. Pulmonary embolism
Rationale: Sudden chest pain and dyspnea after prolonged immobility suggests
PE.
