NR 511 Clinical Differential Diagnosis Comprehensive Exam 2026
Chamberlain
1. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’
distribution of smaller lesions. What is the most likely diagnosis?
A. Pityriasis Rosea
B. Psoriasis
C. Tinea Corporis
D. Atopic Dermatitis
Answer: A
Rationale: Pityriasis Rosea characteristically begins with a single herald patch followed by
a generalized eruption in a Christmas tree pattern.
2. Which physical exam finding is most indicative of Otitis Media with Effusion
(OME)?
A. Erythematous ear canal
B. Fluid bubbles or an air-fluid level behind the tympanic membrane
C. Tenderness when pulling the pinna
D. Bulging, opaque tympanic membrane with severe pain
Answer: B
Rationale: OME is defined by fluid in the middle ear without signs of acute infection, often
showing bubbles or an air-fluid level.
,3. According to the Centor criteria, which of the following is NOT a classic sign of
Group A Beta-Hemolytic Streptococcal pharyngitis?
A. Fever
B. Tonsillar exudates
C. Cough
D. Anterior cervical adenopathy
Answer: C
Rationale: The Centor criteria include fever, tonsillar exudates, tender anterior cervical
lymphadenopathy, and the absence of a cough.
4. A 45-year-old male presents with sudden onset of severe pain in the first
metatarsophalangeal joint. What is the first-line treatment for an acute flare?
A. Allopurinol
B. Aspirin
C. NSAIDs or Colchicine
D. Antibiotics
Answer: C
Rationale: Acute gout is managed with NSAIDs, Colchicine, or Corticosteroids. Allopurinol
is for chronic management, not acute flares.
5. Which diagnostic test is considered the gold standard for diagnosing
obstructive sleep apnea?
A. Polysomnography
B. Chest X-ray
C. Pulse oximetry
D. Pulmonary function test
Answer: A
Rationale: In-lab polysomnography is the gold standard for confirming a diagnosis of
obstructive sleep apnea.
, 6. In the management of COPD, which class of medication is typically the first-
line choice for a patient with infrequent symptoms (Group A)?
A. Inhaled corticosteroid
B. Oral theophylline
C. Long-acting beta-agonist (LABA)
D. Short-acting bronchodilator (SABA or SAMA)
Answer: D
Rationale: For GOLD Group A COPD, a short-acting bronchodilator used as needed is the
recommended starting therapy.
7. A patient has a blood pressure of 145/95 mmHg on two separate office visits.
According to JNC 8/ACC/AHA guidelines, this is classified as:
A. Normal
B. Elevated
C. Stage 2 Hypertension
D. Stage 1 Hypertension
Answer: C
Rationale: Under current ACC/AHA guidelines, Stage 2 Hypertension is defined as systolic
BP >= 140 or diastolic BP >= 90 mmHg.
8. Which of the following is a classic symptom of Gastroesophageal Reflux
Disease (GERD)?
A. Left-sided flank pain
B. Pyrosis (heartburn)
C. Jaundice
D. Positive McBurney’s sign
Answer: B
Rationale: Pyrosis (heartburn) and regurgitation are the hallmark symptoms of GERD.
Chamberlain
1. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’
distribution of smaller lesions. What is the most likely diagnosis?
A. Pityriasis Rosea
B. Psoriasis
C. Tinea Corporis
D. Atopic Dermatitis
Answer: A
Rationale: Pityriasis Rosea characteristically begins with a single herald patch followed by
a generalized eruption in a Christmas tree pattern.
2. Which physical exam finding is most indicative of Otitis Media with Effusion
(OME)?
A. Erythematous ear canal
B. Fluid bubbles or an air-fluid level behind the tympanic membrane
C. Tenderness when pulling the pinna
D. Bulging, opaque tympanic membrane with severe pain
Answer: B
Rationale: OME is defined by fluid in the middle ear without signs of acute infection, often
showing bubbles or an air-fluid level.
,3. According to the Centor criteria, which of the following is NOT a classic sign of
Group A Beta-Hemolytic Streptococcal pharyngitis?
A. Fever
B. Tonsillar exudates
C. Cough
D. Anterior cervical adenopathy
Answer: C
Rationale: The Centor criteria include fever, tonsillar exudates, tender anterior cervical
lymphadenopathy, and the absence of a cough.
4. A 45-year-old male presents with sudden onset of severe pain in the first
metatarsophalangeal joint. What is the first-line treatment for an acute flare?
A. Allopurinol
B. Aspirin
C. NSAIDs or Colchicine
D. Antibiotics
Answer: C
Rationale: Acute gout is managed with NSAIDs, Colchicine, or Corticosteroids. Allopurinol
is for chronic management, not acute flares.
5. Which diagnostic test is considered the gold standard for diagnosing
obstructive sleep apnea?
A. Polysomnography
B. Chest X-ray
C. Pulse oximetry
D. Pulmonary function test
Answer: A
Rationale: In-lab polysomnography is the gold standard for confirming a diagnosis of
obstructive sleep apnea.
, 6. In the management of COPD, which class of medication is typically the first-
line choice for a patient with infrequent symptoms (Group A)?
A. Inhaled corticosteroid
B. Oral theophylline
C. Long-acting beta-agonist (LABA)
D. Short-acting bronchodilator (SABA or SAMA)
Answer: D
Rationale: For GOLD Group A COPD, a short-acting bronchodilator used as needed is the
recommended starting therapy.
7. A patient has a blood pressure of 145/95 mmHg on two separate office visits.
According to JNC 8/ACC/AHA guidelines, this is classified as:
A. Normal
B. Elevated
C. Stage 2 Hypertension
D. Stage 1 Hypertension
Answer: C
Rationale: Under current ACC/AHA guidelines, Stage 2 Hypertension is defined as systolic
BP >= 140 or diastolic BP >= 90 mmHg.
8. Which of the following is a classic symptom of Gastroesophageal Reflux
Disease (GERD)?
A. Left-sided flank pain
B. Pyrosis (heartburn)
C. Jaundice
D. Positive McBurney’s sign
Answer: B
Rationale: Pyrosis (heartburn) and regurgitation are the hallmark symptoms of GERD.
