NR 569 Differential Diagnosis in Acute Care Practicum Exam 2-
Questions and Answers and Explanations | Latest Chamberlain
1. A 65-year-old male presents with sudden onset chest pain radiating to his
back between the scapulae. His blood pressure is 180/100 mmHg in the right
arm and 150/90 mmHg in the left arm. Which diagnosis is most likely?
A. Acute Myocardial Infarction
B. Aortic Dissection
C. Pulmonary Embolism
D. Tension Pneumothorax
Answer: B
Explanation: The classic presentation of tearing chest pain radiating to the back combined
with a significant blood pressure differential between arms is highly suggestive of an aortic
dissection.
2. Which physical exam finding is most specific for a diagnosis of acute
cholecystitis?
A. Rovsing sign
B. Murphy sign
C. McBurney point tenderness
D. Psoas sign
Answer: B
,Explanation: Murphy sign is a specific finding for acute cholecystitis, characterized by an
arrest in inspiration during palpation of the right upper quadrant.
3. A patient presents with a ‘thunderclap’ headache, described as the worst
headache of their life. What is the priority differential diagnosis?
A. Migraine with aura
B. Subarachnoid hemorrhage
C. Cluster headache
D. Temporal arteritis
Answer: B
Explanation: A sudden, severe ‘thunderclap’ headache is the hallmark presentation of a
subarachnoid hemorrhage (SAH) and requires immediate imaging.
4. In a patient presenting with dyspnea, pleuritic chest pain, and tachycardia,
which scoring system is used to determine the pre-test probability of a
Pulmonary Embolism?
A. Wells criteria
B. CHADS2 score
C. CURB-65
D. Glasgow Coma Scale
Answer: A
,Explanation: The Wells criteria are used to risk-stratify patients with suspected
pulmonary embolism based on clinical symptoms and risk factors.
5. An 80-year-old patient with atrial fibrillation presents with sudden, severe
abdominal pain that is ‘out of proportion’ to the physical exam findings. What is
the most likely diagnosis?
A. Diverticulitis
B. Perforated peptic ulcer
C. Acute mesenteric ischemia
D. Small bowel obstruction
Answer: C
Explanation: Acute mesenteric ischemia typically presents with severe pain but a
relatively benign physical exam (pain out of proportion to exam), often in patients with risk
factors like AFib.
6. Which of the following is a classic finding on an EKG for a patient with a large
pericardial effusion or cardiac tamponade?
A. Electrical alternans
B. Delta waves
C. Osborn waves
D. U waves
Answer: A
, Explanation: Electrical alternans, characterized by alternating QRS complexes, is seen in
cardiac tamponade due to the heart swinging within the fluid-filled sac.
7. A patient with a history of COPD presents with increased sputum production
and change in sputum color. What is the most appropriate next step in
management?
A. Start high-flow oxygen immediately
B. Perform an urgent bronchoscopy
C. Order a barium swallow
D. Assess for acute COPD exacerbation and consider antibiotics
Answer: D
Explanation: Increased sputum volume and purulence are key indicators of a COPD
exacerbation, often requiring bronchodilators and antibiotics.
8. A 24-year-old female presents with right lower quadrant pain, nausea, and a
positive pregnancy test. What must be ruled out first?
A. Appendicitis
B. Ovarian cyst rupture
C. Ectopic pregnancy
D. Pelvic inflammatory disease
Answer: C
Questions and Answers and Explanations | Latest Chamberlain
1. A 65-year-old male presents with sudden onset chest pain radiating to his
back between the scapulae. His blood pressure is 180/100 mmHg in the right
arm and 150/90 mmHg in the left arm. Which diagnosis is most likely?
A. Acute Myocardial Infarction
B. Aortic Dissection
C. Pulmonary Embolism
D. Tension Pneumothorax
Answer: B
Explanation: The classic presentation of tearing chest pain radiating to the back combined
with a significant blood pressure differential between arms is highly suggestive of an aortic
dissection.
2. Which physical exam finding is most specific for a diagnosis of acute
cholecystitis?
A. Rovsing sign
B. Murphy sign
C. McBurney point tenderness
D. Psoas sign
Answer: B
,Explanation: Murphy sign is a specific finding for acute cholecystitis, characterized by an
arrest in inspiration during palpation of the right upper quadrant.
3. A patient presents with a ‘thunderclap’ headache, described as the worst
headache of their life. What is the priority differential diagnosis?
A. Migraine with aura
B. Subarachnoid hemorrhage
C. Cluster headache
D. Temporal arteritis
Answer: B
Explanation: A sudden, severe ‘thunderclap’ headache is the hallmark presentation of a
subarachnoid hemorrhage (SAH) and requires immediate imaging.
4. In a patient presenting with dyspnea, pleuritic chest pain, and tachycardia,
which scoring system is used to determine the pre-test probability of a
Pulmonary Embolism?
A. Wells criteria
B. CHADS2 score
C. CURB-65
D. Glasgow Coma Scale
Answer: A
,Explanation: The Wells criteria are used to risk-stratify patients with suspected
pulmonary embolism based on clinical symptoms and risk factors.
5. An 80-year-old patient with atrial fibrillation presents with sudden, severe
abdominal pain that is ‘out of proportion’ to the physical exam findings. What is
the most likely diagnosis?
A. Diverticulitis
B. Perforated peptic ulcer
C. Acute mesenteric ischemia
D. Small bowel obstruction
Answer: C
Explanation: Acute mesenteric ischemia typically presents with severe pain but a
relatively benign physical exam (pain out of proportion to exam), often in patients with risk
factors like AFib.
6. Which of the following is a classic finding on an EKG for a patient with a large
pericardial effusion or cardiac tamponade?
A. Electrical alternans
B. Delta waves
C. Osborn waves
D. U waves
Answer: A
, Explanation: Electrical alternans, characterized by alternating QRS complexes, is seen in
cardiac tamponade due to the heart swinging within the fluid-filled sac.
7. A patient with a history of COPD presents with increased sputum production
and change in sputum color. What is the most appropriate next step in
management?
A. Start high-flow oxygen immediately
B. Perform an urgent bronchoscopy
C. Order a barium swallow
D. Assess for acute COPD exacerbation and consider antibiotics
Answer: D
Explanation: Increased sputum volume and purulence are key indicators of a COPD
exacerbation, often requiring bronchodilators and antibiotics.
8. A 24-year-old female presents with right lower quadrant pain, nausea, and a
positive pregnancy test. What must be ruled out first?
A. Appendicitis
B. Ovarian cyst rupture
C. Ectopic pregnancy
D. Pelvic inflammatory disease
Answer: C
