NR 511 Differential Diagnosis and Primary Care
Practicum ACTUAL EXAM 2026 | Midterm
Test Bank Latest 3 Updated Versions | 150
Questions | Correct Answers & Rationales |
Graded A+ | Verified Q&A | Pass Guaranteed -
A+ Graded
VERSION 1 (50 QUESTIONS)
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL
DIAGNOSIS (15 Questions)
Q1. A 58-year-old male presents with crushing, substernal chest pain radiating to the left arm and
jaw, associated with diaphoresis and nausea. The pain began 30 minutes ago at rest. Vital signs:
BP 90/60, HR 110, RR 24, O2 sat 92% on room air. Which diagnosis is most likely?
● A. Stable angina pectoris
● B. Acute anterior wall myocardial infarction [CORRECT]
● C. Costochondritis
● D. Gastroesophageal reflux disease
Correct Answer: B
,Rationale: The presentation of crushing, substernal chest pain with radiation to the arm and jaw,
accompanied by autonomic symptoms (diaphoresis, nausea) and hemodynamic instability
(hypotension, tachycardia, hypoxemia) is classic for acute MI. The pain occurring at rest suggests
plaque rupture rather than stable angina (A), which typically occurs with exertion. Costochondritis
(C) causes reproducible chest wall pain without systemic symptoms. GERD (D) causes burning
retrosternal pain without radiation or hemodynamic compromise.
Chamberlain Note: Acute MI requires immediate ECG and troponins. Remember MONA (Morphine,
Oxygen, Nitrates, Aspirin) for initial management while awaiting reperfusion decisions.
Q2. A 42-year-old female presents with sudden onset of unilateral, periorbital headache associated
with ipsilateral lacrimation, nasal congestion, and ptosis. The headaches occur daily for 2 weeks,
then remit. Which diagnosis is most likely?
● A. Migraine without aura
● B. Tension-type headache
● C. Cluster headache [CORRECT]
● D. Trigeminal neuralgia
Correct Answer: C
Rationale: Cluster headaches present with unilateral, severe periorbital pain with autonomic
features (lacrimation, rhinorrhea, ptosis/miosis). The temporal pattern (daily episodes for weeks
followed by remission) is pathognomonic. Migraine (A) typically features photophobia/phonophobia
and lasts 4-72 hours without daily clustering. Tension headaches (B) are bilateral and band-like
without autonomic symptoms. Trigeminal neuralgia (D) causes brief, electric shock-like facial pain
triggered by touch.
,Q3. A 65-year-old male with COPD presents with acute dyspnea, pleuritic chest pain, and
hemoptysis. Vital signs: HR 118, RR 28, BP 140/90, O2 sat 88% on room air. Which condition
should be suspected first?
● A. Acute exacerbation of COPD
● B. Community-acquired pneumonia
● C. Pulmonary embolism [CORRECT]
● D. Spontaneous pneumothorax
Correct Answer: C
Rationale: The triad of dyspnea, pleuritic chest pain, and hemoptysis is classic for pulmonary
embolism. Tachycardia, tachypnea, and hypoxemia support this diagnosis in a patient with risk
factors (COPD, likely immobility or hypercoagulability). While AECOPD (A) and pneumonia (B)
cause dyspnea, they typically present with productive cough and fever rather than hemoptysis and
pleuritic pain. Pneumothorax (D) causes sudden dyspnea and diminished breath sounds without
hemoptysis.
Q4. A 28-year-old female presents with bilateral, symmetrical joint pain and swelling in the small
joints of the hands and feet. She reports morning stiffness lasting 3 hours. Examination reveals
swan-neck deformities and rheumatoid nodules. Which diagnosis is most likely?
● A. Osteoarthritis
● B. Rheumatoid arthritis [CORRECT]
● C. Systemic lupus erythematosus
● D. Psoriatic arthritis
Correct Answer: B
Rationale: Rheumatoid arthritis presents with symmetrical, additive polyarthritis of small joints,
prolonged morning stiffness (>1 hour), and characteristic deformities (swan-neck, boutonnière).
Osteoarthritis (A) affects weight-bearing joints with brief morning stiffness (<30 minutes) and bony
, enlargement without systemic features. SLE (C) causes non-erosive arthritis with extra-articular
manifestations (malar rash, nephritis). Psoriatic arthritis (D) presents with asymmetric oligoarthritis,
dactylitis, and nail changes.
Q5. A 45-year-old male presents with severe, sudden-onset epigastric pain radiating to the back,
associated with vomiting. He admits to heavy alcohol consumption. Examination reveals epigastric
tenderness and bruising around the umbilicus (Cullen's sign). Which diagnosis is most likely?
● A. Acute cholecystitis
● B. Acute pancreatitis [CORRECT]
● C. Peptic ulcer perforation
● D. Mesenteric ischemia
Correct Answer: B
Rationale: Severe epigastric pain radiating to the back with alcohol history suggests acute
pancreatitis. Cullen's sign (periumbilical ecchymosis) indicates retroperitoneal hemorrhage, a
severe complication. Cholecystitis (A) causes RUQ pain radiating to the right scapula. Perforated
ulcer (C) presents with rigid abdomen and free air under the diaphragm. Mesenteric ischemia (D)
causes severe pain out of proportion to examination.
Q6. A 32-year-old female presents with episodic vertigo lasting 20-30 minutes, associated with
fluctuating hearing loss, tinnitus, and aural fullness in the right ear. Which diagnosis is most likely?
● A. Benign paroxysmal positional vertigo (BPPV)
● B. Vestibular neuritis
● C. Ménière's disease [CORRECT]
● D. Acoustic neuroma
Correct Answer: C
Practicum ACTUAL EXAM 2026 | Midterm
Test Bank Latest 3 Updated Versions | 150
Questions | Correct Answers & Rationales |
Graded A+ | Verified Q&A | Pass Guaranteed -
A+ Graded
VERSION 1 (50 QUESTIONS)
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL
DIAGNOSIS (15 Questions)
Q1. A 58-year-old male presents with crushing, substernal chest pain radiating to the left arm and
jaw, associated with diaphoresis and nausea. The pain began 30 minutes ago at rest. Vital signs:
BP 90/60, HR 110, RR 24, O2 sat 92% on room air. Which diagnosis is most likely?
● A. Stable angina pectoris
● B. Acute anterior wall myocardial infarction [CORRECT]
● C. Costochondritis
● D. Gastroesophageal reflux disease
Correct Answer: B
,Rationale: The presentation of crushing, substernal chest pain with radiation to the arm and jaw,
accompanied by autonomic symptoms (diaphoresis, nausea) and hemodynamic instability
(hypotension, tachycardia, hypoxemia) is classic for acute MI. The pain occurring at rest suggests
plaque rupture rather than stable angina (A), which typically occurs with exertion. Costochondritis
(C) causes reproducible chest wall pain without systemic symptoms. GERD (D) causes burning
retrosternal pain without radiation or hemodynamic compromise.
Chamberlain Note: Acute MI requires immediate ECG and troponins. Remember MONA (Morphine,
Oxygen, Nitrates, Aspirin) for initial management while awaiting reperfusion decisions.
Q2. A 42-year-old female presents with sudden onset of unilateral, periorbital headache associated
with ipsilateral lacrimation, nasal congestion, and ptosis. The headaches occur daily for 2 weeks,
then remit. Which diagnosis is most likely?
● A. Migraine without aura
● B. Tension-type headache
● C. Cluster headache [CORRECT]
● D. Trigeminal neuralgia
Correct Answer: C
Rationale: Cluster headaches present with unilateral, severe periorbital pain with autonomic
features (lacrimation, rhinorrhea, ptosis/miosis). The temporal pattern (daily episodes for weeks
followed by remission) is pathognomonic. Migraine (A) typically features photophobia/phonophobia
and lasts 4-72 hours without daily clustering. Tension headaches (B) are bilateral and band-like
without autonomic symptoms. Trigeminal neuralgia (D) causes brief, electric shock-like facial pain
triggered by touch.
,Q3. A 65-year-old male with COPD presents with acute dyspnea, pleuritic chest pain, and
hemoptysis. Vital signs: HR 118, RR 28, BP 140/90, O2 sat 88% on room air. Which condition
should be suspected first?
● A. Acute exacerbation of COPD
● B. Community-acquired pneumonia
● C. Pulmonary embolism [CORRECT]
● D. Spontaneous pneumothorax
Correct Answer: C
Rationale: The triad of dyspnea, pleuritic chest pain, and hemoptysis is classic for pulmonary
embolism. Tachycardia, tachypnea, and hypoxemia support this diagnosis in a patient with risk
factors (COPD, likely immobility or hypercoagulability). While AECOPD (A) and pneumonia (B)
cause dyspnea, they typically present with productive cough and fever rather than hemoptysis and
pleuritic pain. Pneumothorax (D) causes sudden dyspnea and diminished breath sounds without
hemoptysis.
Q4. A 28-year-old female presents with bilateral, symmetrical joint pain and swelling in the small
joints of the hands and feet. She reports morning stiffness lasting 3 hours. Examination reveals
swan-neck deformities and rheumatoid nodules. Which diagnosis is most likely?
● A. Osteoarthritis
● B. Rheumatoid arthritis [CORRECT]
● C. Systemic lupus erythematosus
● D. Psoriatic arthritis
Correct Answer: B
Rationale: Rheumatoid arthritis presents with symmetrical, additive polyarthritis of small joints,
prolonged morning stiffness (>1 hour), and characteristic deformities (swan-neck, boutonnière).
Osteoarthritis (A) affects weight-bearing joints with brief morning stiffness (<30 minutes) and bony
, enlargement without systemic features. SLE (C) causes non-erosive arthritis with extra-articular
manifestations (malar rash, nephritis). Psoriatic arthritis (D) presents with asymmetric oligoarthritis,
dactylitis, and nail changes.
Q5. A 45-year-old male presents with severe, sudden-onset epigastric pain radiating to the back,
associated with vomiting. He admits to heavy alcohol consumption. Examination reveals epigastric
tenderness and bruising around the umbilicus (Cullen's sign). Which diagnosis is most likely?
● A. Acute cholecystitis
● B. Acute pancreatitis [CORRECT]
● C. Peptic ulcer perforation
● D. Mesenteric ischemia
Correct Answer: B
Rationale: Severe epigastric pain radiating to the back with alcohol history suggests acute
pancreatitis. Cullen's sign (periumbilical ecchymosis) indicates retroperitoneal hemorrhage, a
severe complication. Cholecystitis (A) causes RUQ pain radiating to the right scapula. Perforated
ulcer (C) presents with rigid abdomen and free air under the diaphragm. Mesenteric ischemia (D)
causes severe pain out of proportion to examination.
Q6. A 32-year-old female presents with episodic vertigo lasting 20-30 minutes, associated with
fluctuating hearing loss, tinnitus, and aural fullness in the right ear. Which diagnosis is most likely?
● A. Benign paroxysmal positional vertigo (BPPV)
● B. Vestibular neuritis
● C. Ménière's disease [CORRECT]
● D. Acoustic neuroma
Correct Answer: C
