NR511 DIFFERENTIAL DIAGNOSIS AND PRIMARY
CARE PRACTICUM EXAM | QUESTIONS AND 100%
CORRECT ANSWERS WITH RATIONALES | LATEST
UPDATE GRADED A+
1. A 45-year-old male presents with fatigue, weight gain, and cold intolerance. Which
lab test would be most appropriate to evaluate for hypothyroidism?
A. Serum calcium
B. Thyroid-stimulating hormone (TSH)
C. Fasting glucose
D. Liver function tests
Answer: B. Thyroid-stimulating hormone (TSH) – TSH is the most sensitive initial test
for diagnosing hypothyroidism.
2. A patient presents with sudden-onset severe headache, neck stiffness, and
photophobia. What is the most likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Tension headache
D. Sinusitis
Answer: B. Subarachnoid hemorrhage – Sudden “worst headache of life” with neck
stiffness suggests bleeding in the subarachnoid space.
3. Which of the following is the first-line treatment for community-acquired pneumonia
in an otherwise healthy adult?
A. Amoxicillin
B. Vancomycin
C. Ciprofloxacin
D. Doxycycline
Answer: A. Amoxicillin – Standard first-line therapy for outpatient CAP in healthy
adults is amoxicillin.
4. A patient has pruritic, scaly plaques on the extensor surfaces of the elbows and knees.
The most likely diagnosis is:
A. Atopic dermatitis
B. Psoriasis
C. Seborrheic dermatitis
D. Tinea corporis
Answer: B. Psoriasis – Classic distribution on extensor surfaces with well-
demarcated plaques.
5. A 25-year-old female presents with polyuria, polydipsia, and polyphagia. Which lab
finding is most indicative of diabetes mellitus?
, A. Serum sodium
B. Fasting plasma glucose ≥126 mg/dL
C. Serum potassium
D. Urinalysis for protein
Answer: B. Fasting plasma glucose ≥126 mg/dL – Diagnostic criteria for diabetes
include fasting glucose ≥126 mg/dL.
6. Which medication is considered first-line therapy for stage 1 hypertension without
comorbidities?
A. Lisinopril
B. Metoprolol
C. Hydrochlorothiazide
D. Nifedipine
Answer: C. Hydrochlorothiazide – Thiazide diuretics are recommended first-line for
uncomplicated hypertension.
7. A patient presents with sudden-onset chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which test is most critical initially?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Echocardiogram
D. D-dimer
Answer: B. Electrocardiogram (ECG) – Immediate ECG is essential to evaluate for
acute myocardial infarction.
8. Which of the following is the classic triad of appendicitis?
A. Fever, rash, headache
B. Right lower quadrant pain, nausea/vomiting, anorexia
C. Cough, fever, dyspnea
D. Fatigue, weight gain, cold intolerance
Answer: B. Right lower quadrant pain, nausea/vomiting, anorexia – These are the
hallmark symptoms of appendicitis.
9. A 30-year-old male presents with dysuria, frequency, and urgency. Urinalysis shows
leukocytes and nitrites. The most likely diagnosis is:
A. Urethritis
B. Acute bacterial prostatitis
C. Urinary tract infection (UTI)
D. Interstitial cystitis
Answer: C. Urinary tract infection (UTI) – Typical symptoms with positive leukocytes
and nitrites indicate bacterial UTI.
10. Which of the following vaccines is recommended for adults ≥65 years old?
A. MMR
B. Varicella
C. Pneumococcal
, D. DTaP
Answer: C. Pneumococcal – Adults ≥65 are recommended to receive pneumococcal
vaccination to prevent pneumonia.
11. Which of the following is a common cause of secondary hypertension?
A. Primary aldosteronism
B. Essential hypertension
C. Hypotension
D. Orthostatic hypotension
Answer: A. Primary aldosteronism – It is a well-known reversible cause of secondary
hypertension.
12. A patient presents with acute onset of right eye pain, blurred vision, and halos around
lights. Intraocular pressure is 45 mmHg. The most likely diagnosis is:
A. Open-angle glaucoma
B. Acute angle-closure glaucoma
C. Cataract
D. Retinal detachment
Answer: B. Acute angle-closure glaucoma – Sudden pain, halos, and elevated IOP
indicate acute angle closure.
13. Which of the following is the first-line treatment for acute otitis media in children?
A. Amoxicillin
B. Azithromycin
C. Ciprofloxacin
D. Cephalexin
Answer: A. Amoxicillin – Standard first-line antibiotic therapy for uncomplicated
pediatric otitis media.
14. A 55-year-old smoker presents with chronic cough, hemoptysis, and weight loss. The
most concerning diagnosis is:
A. Bronchitis
B. Tuberculosis
C. Lung cancer
D. Pneumonia
Answer: C. Lung cancer – Hemoptysis, weight loss, and smoking history raise
concern for malignancy.
15. Which lab finding is most specific for acute myocardial infarction?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
Answer: B. Troponin I – Highly sensitive and specific for cardiac muscle injury.
, 16. A 70-year-old male presents with resting tremor, rigidity, and bradykinesia. The most
likely diagnosis is:
A. Essential tremor
B. Parkinson’s disease
C. Huntington’s disease
D. Multiple sclerosis
Answer: B. Parkinson’s disease – Classic motor features include resting tremor,
rigidity, and bradykinesia.
17. Which of the following medications is indicated for acute gout attacks?
A. Allopurinol
B. Colchicine
C. Febuxostat
D. Probenecid
Answer: B. Colchicine – Colchicine is effective for acute gout flares.
18. Which of the following is the most common cause of peptic ulcer disease?
A. NSAID use
B. Stress
C. Helicobacter pylori infection
D. Alcohol consumption
Answer: C. Helicobacter pylori infection – H. pylori is the leading cause of peptic
ulcers worldwide.
19. A patient presents with fever, headache, myalgia, and a rash that started on the wrists
and ankles spreading to the trunk. The likely diagnosis is:
A. Measles
B. Rocky Mountain spotted fever
C. Chickenpox
D. Scarlet fever
Answer: B. Rocky Mountain spotted fever – Rash distribution on wrists/ankles
progressing centrally is characteristic.
20. Which of the following is a red-flag symptom requiring immediate evaluation in back
pain?
A. Morning stiffness
B. Pain worse with activity
C. Saddle anesthesia
D. Mild sciatica
Answer: C. Saddle anesthesia – Suggests cauda equina syndrome, a surgical
emergency.
21. A 60-year-old female presents with fatigue, pallor, and spoon-shaped nails. Lab
findings show microcytic hypochromic anemia. The most likely cause is:
A. Iron deficiency anemia
B. Vitamin B12 deficiency
CARE PRACTICUM EXAM | QUESTIONS AND 100%
CORRECT ANSWERS WITH RATIONALES | LATEST
UPDATE GRADED A+
1. A 45-year-old male presents with fatigue, weight gain, and cold intolerance. Which
lab test would be most appropriate to evaluate for hypothyroidism?
A. Serum calcium
B. Thyroid-stimulating hormone (TSH)
C. Fasting glucose
D. Liver function tests
Answer: B. Thyroid-stimulating hormone (TSH) – TSH is the most sensitive initial test
for diagnosing hypothyroidism.
2. A patient presents with sudden-onset severe headache, neck stiffness, and
photophobia. What is the most likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Tension headache
D. Sinusitis
Answer: B. Subarachnoid hemorrhage – Sudden “worst headache of life” with neck
stiffness suggests bleeding in the subarachnoid space.
3. Which of the following is the first-line treatment for community-acquired pneumonia
in an otherwise healthy adult?
A. Amoxicillin
B. Vancomycin
C. Ciprofloxacin
D. Doxycycline
Answer: A. Amoxicillin – Standard first-line therapy for outpatient CAP in healthy
adults is amoxicillin.
4. A patient has pruritic, scaly plaques on the extensor surfaces of the elbows and knees.
The most likely diagnosis is:
A. Atopic dermatitis
B. Psoriasis
C. Seborrheic dermatitis
D. Tinea corporis
Answer: B. Psoriasis – Classic distribution on extensor surfaces with well-
demarcated plaques.
5. A 25-year-old female presents with polyuria, polydipsia, and polyphagia. Which lab
finding is most indicative of diabetes mellitus?
, A. Serum sodium
B. Fasting plasma glucose ≥126 mg/dL
C. Serum potassium
D. Urinalysis for protein
Answer: B. Fasting plasma glucose ≥126 mg/dL – Diagnostic criteria for diabetes
include fasting glucose ≥126 mg/dL.
6. Which medication is considered first-line therapy for stage 1 hypertension without
comorbidities?
A. Lisinopril
B. Metoprolol
C. Hydrochlorothiazide
D. Nifedipine
Answer: C. Hydrochlorothiazide – Thiazide diuretics are recommended first-line for
uncomplicated hypertension.
7. A patient presents with sudden-onset chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which test is most critical initially?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Echocardiogram
D. D-dimer
Answer: B. Electrocardiogram (ECG) – Immediate ECG is essential to evaluate for
acute myocardial infarction.
8. Which of the following is the classic triad of appendicitis?
A. Fever, rash, headache
B. Right lower quadrant pain, nausea/vomiting, anorexia
C. Cough, fever, dyspnea
D. Fatigue, weight gain, cold intolerance
Answer: B. Right lower quadrant pain, nausea/vomiting, anorexia – These are the
hallmark symptoms of appendicitis.
9. A 30-year-old male presents with dysuria, frequency, and urgency. Urinalysis shows
leukocytes and nitrites. The most likely diagnosis is:
A. Urethritis
B. Acute bacterial prostatitis
C. Urinary tract infection (UTI)
D. Interstitial cystitis
Answer: C. Urinary tract infection (UTI) – Typical symptoms with positive leukocytes
and nitrites indicate bacterial UTI.
10. Which of the following vaccines is recommended for adults ≥65 years old?
A. MMR
B. Varicella
C. Pneumococcal
, D. DTaP
Answer: C. Pneumococcal – Adults ≥65 are recommended to receive pneumococcal
vaccination to prevent pneumonia.
11. Which of the following is a common cause of secondary hypertension?
A. Primary aldosteronism
B. Essential hypertension
C. Hypotension
D. Orthostatic hypotension
Answer: A. Primary aldosteronism – It is a well-known reversible cause of secondary
hypertension.
12. A patient presents with acute onset of right eye pain, blurred vision, and halos around
lights. Intraocular pressure is 45 mmHg. The most likely diagnosis is:
A. Open-angle glaucoma
B. Acute angle-closure glaucoma
C. Cataract
D. Retinal detachment
Answer: B. Acute angle-closure glaucoma – Sudden pain, halos, and elevated IOP
indicate acute angle closure.
13. Which of the following is the first-line treatment for acute otitis media in children?
A. Amoxicillin
B. Azithromycin
C. Ciprofloxacin
D. Cephalexin
Answer: A. Amoxicillin – Standard first-line antibiotic therapy for uncomplicated
pediatric otitis media.
14. A 55-year-old smoker presents with chronic cough, hemoptysis, and weight loss. The
most concerning diagnosis is:
A. Bronchitis
B. Tuberculosis
C. Lung cancer
D. Pneumonia
Answer: C. Lung cancer – Hemoptysis, weight loss, and smoking history raise
concern for malignancy.
15. Which lab finding is most specific for acute myocardial infarction?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
Answer: B. Troponin I – Highly sensitive and specific for cardiac muscle injury.
, 16. A 70-year-old male presents with resting tremor, rigidity, and bradykinesia. The most
likely diagnosis is:
A. Essential tremor
B. Parkinson’s disease
C. Huntington’s disease
D. Multiple sclerosis
Answer: B. Parkinson’s disease – Classic motor features include resting tremor,
rigidity, and bradykinesia.
17. Which of the following medications is indicated for acute gout attacks?
A. Allopurinol
B. Colchicine
C. Febuxostat
D. Probenecid
Answer: B. Colchicine – Colchicine is effective for acute gout flares.
18. Which of the following is the most common cause of peptic ulcer disease?
A. NSAID use
B. Stress
C. Helicobacter pylori infection
D. Alcohol consumption
Answer: C. Helicobacter pylori infection – H. pylori is the leading cause of peptic
ulcers worldwide.
19. A patient presents with fever, headache, myalgia, and a rash that started on the wrists
and ankles spreading to the trunk. The likely diagnosis is:
A. Measles
B. Rocky Mountain spotted fever
C. Chickenpox
D. Scarlet fever
Answer: B. Rocky Mountain spotted fever – Rash distribution on wrists/ankles
progressing centrally is characteristic.
20. Which of the following is a red-flag symptom requiring immediate evaluation in back
pain?
A. Morning stiffness
B. Pain worse with activity
C. Saddle anesthesia
D. Mild sciatica
Answer: C. Saddle anesthesia – Suggests cauda equina syndrome, a surgical
emergency.
21. A 60-year-old female presents with fatigue, pallor, and spoon-shaped nails. Lab
findings show microcytic hypochromic anemia. The most likely cause is:
A. Iron deficiency anemia
B. Vitamin B12 deficiency
