NR 569 Differential Diagnosis in Acute Care Practicum Final Exam-
Questions and Answers and Explanations | Latest Chamberlain
1. A 65-year-old patient presents with acute onset of shortness of breath and
pleuritic chest pain. The D-dimer is elevated. What is the most appropriate next
step for a stable patient with a high clinical suspicion of Pulmonary Embolism?
A. Ventilation-Perfusion (V/Q) scan
B. CT Angiography (CTPA)
C. Transthoracic Echocardiogram
D. Chest X-ray
Answer: B
Explanation: CT Angiography is the gold standard for diagnosing Pulmonary Embolism in
stable patients. V/Q scans are typically reserved for patients with renal failure or contrast
allergies.
2. Which of the following clinical findings is most specific for differentiating
Acute Heart Failure from other causes of dyspnea in the acute care setting?
A. Bilateral wheezing
B. Third heart sound (S3 gallop)
C. Elevated Brain Natriuretic Peptide (BNP)
D. Peripheral edema
Answer: B
,Explanation: While BNP is a useful marker, the presence of an S3 gallop is highly specific
for heart failure with volume overload.
3. A patient with suspected sepsis has a blood pressure of 88/50 mmHg and a
serum lactate of 4.0 mmol/L after receiving 30 mL/kg of IV fluids. What is the
most likely diagnosis?
A. SIRS
B. Sepsis
C. Septic Shock
D. Hypovolemic Shock
Answer: C
Explanation: Septic shock is defined as sepsis requiring vasopressors to maintain MAP
>65 mmHg and having a lactate >2 mmol/L despite adequate fluid resuscitation.
4. When evaluating Acute Kidney Injury (AKI), a Fractional Excretion of Sodium
(FENa) less than 1% typically suggests which etiology?
A. Acute Tubular Necrosis (ATN)
B. Pre-renal azotemia
C. Post-renal obstruction
D. Contrast-induced nephropathy
Answer: B
,Explanation: A FENa <1% indicates the kidneys are conserving sodium, which is
characteristic of pre-renal states (hypoperfusion).
5. Which electrolyte abnormality is most commonly associated with T-wave
flattening and the presence of U-waves on an EKG?
A. Hyperkalemia
B. Hypocalcemia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Explanation: Hypokalemia causes EKG changes including flat T waves, U waves, and ST
depression.
6. A 45-year-old male presents with severe epigastric pain radiating to the back,
nausea, and vomiting. His serum lipase is three times the upper limit of normal.
What is the most likely diagnosis?
A. Acute Cholecystitis
B. Peptic Ulcer Disease
C. Myocardial Infarction
D. Acute Pancreatitis
Answer: D
, Explanation: The diagnosis of acute pancreatitis requires two of three: characteristic
abdominal pain, lipase/amylase >3x normal, or characteristic imaging.
7. Which physical exam maneuver is performed by asking the patient to inspire
while the clinician palpates the right upper quadrant to detect cholecystitis?
A. McBurney’s sign
B. Rovsing’s sign
C. Murphy’s sign
D. Psoas sign
Answer: C
Explanation: Murphy’s sign is positive when inspiration is arrested due to pain during
palpation of the gallbladder.
8. In a patient presenting with ‘the worst headache of my life’ (thunderclap
headache), what is the gold standard initial imaging study?
A. Non-contrast CT Head
B. MRI Brain
C. Lumbar Puncture
D. Cerebral Angiography
Answer: A
Explanation: Non-contrast CT is the first-line test to detect blood in the subarachnoid
space (Subarachnoid Hemorrhage).
Questions and Answers and Explanations | Latest Chamberlain
1. A 65-year-old patient presents with acute onset of shortness of breath and
pleuritic chest pain. The D-dimer is elevated. What is the most appropriate next
step for a stable patient with a high clinical suspicion of Pulmonary Embolism?
A. Ventilation-Perfusion (V/Q) scan
B. CT Angiography (CTPA)
C. Transthoracic Echocardiogram
D. Chest X-ray
Answer: B
Explanation: CT Angiography is the gold standard for diagnosing Pulmonary Embolism in
stable patients. V/Q scans are typically reserved for patients with renal failure or contrast
allergies.
2. Which of the following clinical findings is most specific for differentiating
Acute Heart Failure from other causes of dyspnea in the acute care setting?
A. Bilateral wheezing
B. Third heart sound (S3 gallop)
C. Elevated Brain Natriuretic Peptide (BNP)
D. Peripheral edema
Answer: B
,Explanation: While BNP is a useful marker, the presence of an S3 gallop is highly specific
for heart failure with volume overload.
3. A patient with suspected sepsis has a blood pressure of 88/50 mmHg and a
serum lactate of 4.0 mmol/L after receiving 30 mL/kg of IV fluids. What is the
most likely diagnosis?
A. SIRS
B. Sepsis
C. Septic Shock
D. Hypovolemic Shock
Answer: C
Explanation: Septic shock is defined as sepsis requiring vasopressors to maintain MAP
>65 mmHg and having a lactate >2 mmol/L despite adequate fluid resuscitation.
4. When evaluating Acute Kidney Injury (AKI), a Fractional Excretion of Sodium
(FENa) less than 1% typically suggests which etiology?
A. Acute Tubular Necrosis (ATN)
B. Pre-renal azotemia
C. Post-renal obstruction
D. Contrast-induced nephropathy
Answer: B
,Explanation: A FENa <1% indicates the kidneys are conserving sodium, which is
characteristic of pre-renal states (hypoperfusion).
5. Which electrolyte abnormality is most commonly associated with T-wave
flattening and the presence of U-waves on an EKG?
A. Hyperkalemia
B. Hypocalcemia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Explanation: Hypokalemia causes EKG changes including flat T waves, U waves, and ST
depression.
6. A 45-year-old male presents with severe epigastric pain radiating to the back,
nausea, and vomiting. His serum lipase is three times the upper limit of normal.
What is the most likely diagnosis?
A. Acute Cholecystitis
B. Peptic Ulcer Disease
C. Myocardial Infarction
D. Acute Pancreatitis
Answer: D
, Explanation: The diagnosis of acute pancreatitis requires two of three: characteristic
abdominal pain, lipase/amylase >3x normal, or characteristic imaging.
7. Which physical exam maneuver is performed by asking the patient to inspire
while the clinician palpates the right upper quadrant to detect cholecystitis?
A. McBurney’s sign
B. Rovsing’s sign
C. Murphy’s sign
D. Psoas sign
Answer: C
Explanation: Murphy’s sign is positive when inspiration is arrested due to pain during
palpation of the gallbladder.
8. In a patient presenting with ‘the worst headache of my life’ (thunderclap
headache), what is the gold standard initial imaging study?
A. Non-contrast CT Head
B. MRI Brain
C. Lumbar Puncture
D. Cerebral Angiography
Answer: A
Explanation: Non-contrast CT is the first-line test to detect blood in the subarachnoid
space (Subarachnoid Hemorrhage).
