NR 511 Differential Diagnosis and Primary
Care Practicum ACTUAL EXAM 2026/2027 |
Final Examination & Comprehensive Study
Guide | 150 Questions | Correct Answers and
Rationales | Verified Q&A | Pass Guaranteed
- A+ Graded
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS (45 Questions)
Cardiovascular
Q1. A 58-year-old male presents with crushing substernal chest pain radiating to the left arm and
jaw, associated with diaphoresis and nausea. Pain started 30 minutes ago at rest. ECG shows
ST-segment elevation in leads V1-V4. Which diagnosis is most likely?
A. Non-ST elevation myocardial infarction (NSTEMI)
B. Anterior ST-elevation myocardial infarction (STEMI) [CORRECT]
C. Unstable angina
D. Pericarditis
Correct Answer: B
Rationale: ST-elevation in leads V1-V4 indicates an anterior wall STEMI. This presentation
(crushing chest pain, diaphoresis, nausea, radiation to arm/jaw) is classic for acute MI. NSTEMI (A)
and unstable angina (C) would show ST depressions or T-wave inversions without ST elevation.
Pericarditis (D) presents with diffuse ST elevation and PR depression.
Chamberlain Note: Anterior STEMIs involve the left anterior descending artery (LAD)—the "widow
maker." Immediate reperfusion therapy is indicated within 90 minutes of first medical contact.
,Q2. A 42-year-old female presents with sharp, pleuritic chest pain that improves when leaning
forward. She had a viral upper respiratory infection last week. Physical exam reveals a friction rub.
ECG shows diffuse ST-segment elevation and PR-segment depression. Which condition is most
consistent with this presentation?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Acute pericarditis [CORRECT]
D. Aortic dissection
Correct Answer: C
Rationale: Acute pericarditis presents with pleuritic chest pain relieved by sitting forward, a
pericardial friction rub, and diffuse ST elevation with PR depression on ECG. MI (A) shows localized
ST changes. PE (B) presents with tachycardia, dyspnea, and possible S1Q3T3 pattern. Aortic
dissection (D) presents with tearing pain radiating to the back.
Chamberlain Note: Pericarditis pain worsens with inspiration and lying flat (supine position). The
friction rub is pathognomonic and best heard at the left sternal border with the patient leaning
forward.
Q3. A 65-year-old male with hypertension presents with sudden onset of tearing chest pain
radiating to his back. Blood pressure is 185/110 mmHg in the right arm and 140/85 mmHg in the left
arm. Radial pulse is absent on the left. Which diagnosis is most likely?
A. Myocardial infarction
B. Aortic dissection [CORRECT]
C. Thoracic aortic aneurysm
D. Pulmonary embolism
Correct Answer: B
Rationale: Aortic dissection classically presents with tearing chest pain radiating to the back, pulse
deficits, and blood pressure differential >20 mmHg between arms. This is a hypertensive
emergency requiring immediate CT angiography. MI (A) typically presents with pressure-like pain.
Aneurysm (C) is usually asymptomatic until rupture. PE (D) causes pleuritic pain and dyspnea
without pulse deficits.
Chamberlain Note: Type A dissections (ascending aorta) require emergency surgery; Type B
(descending) may be managed medically with IV beta-blockade to reduce shear stress.
Q4. A 28-year-old female on oral contraceptives presents with acute onset dyspnea, pleuritic chest
pain, and tachycardia after a 6-hour car ride. Vital signs: HR 118, RR 24, BP 110/70, SpO2 91% on
room air. Which condition should be suspected first?
A. Acute coronary syndrome
B. Pulmonary embolism [CORRECT]
C. Pneumothorax
D. Anxiety attack
Correct Answer: B
,Rationale: The presentation (dyspnea, pleuritic chest pain, tachycardia, hypoxia) combined with
risk factors (oral contraceptives, prolonged immobility) is classic for PE. Wells' criteria would
indicate high probability. ACS (A) is less likely in a 28-year-old without cardiac risk factors.
Pneumothorax (C) would show decreased breath sounds and hyperresonance. Anxiety (D) is a
diagnosis of exclusion.
Chamberlain Note: Virchow's triad for thrombosis: stasis (long car ride), hypercoagulability (OCPs),
endothelial injury. CT pulmonary angiography (CTPA) is the gold standard diagnostic test.
Q5. A 72-year-old female presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal
dyspnea, and bilateral lower extremity edema. Physical exam reveals jugular venous distension and
bilateral crackles on lung auscultation. Which condition is most likely?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction [CORRECT]
C. Pulmonary fibrosis
D. Acute bronchitis
Correct Answer: B
Rationale: This presentation (dyspnea, orthopnea, JVD, peripheral edema, crackles) represents
classic left-sided and right-sided heart failure symptoms. The combination of pulmonary congestion
(orthopnea, PND, crackles) and systemic congestion (JVD, peripheral edema) indicates
biventricular failure. COPD (A) would show wheezing and prolonged expiration. Pulmonary fibrosis
(C) presents with dry crackles and clubbing. Bronchitis (D) involves cough and sputum production.
Q6. A 35-year-old male presents with palpitations described as "heart racing" that started suddenly
while at rest and terminated abruptly after 15 minutes. ECG during symptoms shows a
narrow-complex regular tachycardia at 180 bpm with no discernible P waves. Between episodes,
ECG is normal. Which arrhythmia is most likely?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Supraventricular tachycardia (SVT) [CORRECT]
D. Atrial flutter
Correct Answer: C
Rationale: SVT presents with sudden onset/offset, narrow QRS complex, regular rhythm, and rate
typically 150-250 bpm. Atrial fibrillation (A) is irregularly irregular. VT (B) presents with wide QRS
complex. Atrial flutter (D) shows sawtooth flutter waves and is often regular but at rates around 150
bpm (2:1 block).
Chamberlain Note: Vagal maneuvers (Valsalva, carotid sinus massage) are first-line for terminating
SVT. Adenosine is the first-line pharmacologic treatment.
, Q7. A 68-year-old male presents with syncope after exertion. He describes chest discomfort with
activity and denies prodromal symptoms. Vital signs are stable. Which type of syncope is most
likely?
A. Vasovagal syncope
B. Cardiogenic syncope [CORRECT]
C. Orthostatic hypotension
D. Seizure
Correct Answer: B
Rationale: Exertional syncope without prodrome suggests cardiogenic syncope, possibly due to
aortic stenosis, hypertrophic cardiomyopathy, or arrhythmia. The associated chest discomfort
suggests cardiac ischemia. Vasovagal (A) typically has prodromal symptoms (nausea, diaphoresis,
lightheadedness) and triggers. Orthostatic (C) occurs with position changes. Seizures (D) involve
postictal confusion and tonic-clonic activity.
Chamberlain Note: Syncope with exertion is cardiac until proven otherwise and carries high risk for
sudden cardiac death. Immediate cardiology referral and echocardiography are indicated.
Q8. A 55-year-old male with a history of heart failure presents with bilateral lower extremity edema
that is pitting and symmetric, extending to the knees. He has gained 5 pounds in one week. Which
condition is most likely responsible?
A. Chronic venous insufficiency
B. Lymphedema
C. Heart failure exacerbation [CORRECT]
D. Deep vein thrombosis
Correct Answer: C
Rationale: Symmetric bilateral pitting edema with rapid weight gain in a patient with known heart
failure suggests volume overload from HF exacerbation. Venous insufficiency (A) is usually
asymmetric with skin changes (stasis dermatitis, brawny discoloration). Lymphedema (B) is
non-pitting and often involves the feet/toes (Stemmer sign positive). DVT (D) is typically unilateral,
painful, and associated with erythema/warmth.
Q9. A 45-year-old female presents with episodic chest pain that occurs with emotional stress, is not
relieved by nitroglycerin, and is associated with paresthesias around the mouth. ECG and cardiac
enzymes are normal. Which diagnosis should be considered?
A. Stable angina
B. Panic disorder [CORRECT]
C. Costochondritis
D. GERD
Correct Answer: B
Rationale: Chest pain associated with emotional stress, paresthesias (often perioral), normal
cardiac workup, and lack of response to nitroglycerin suggests panic disorder. Stable angina (A)
Care Practicum ACTUAL EXAM 2026/2027 |
Final Examination & Comprehensive Study
Guide | 150 Questions | Correct Answers and
Rationales | Verified Q&A | Pass Guaranteed
- A+ Graded
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS (45 Questions)
Cardiovascular
Q1. A 58-year-old male presents with crushing substernal chest pain radiating to the left arm and
jaw, associated with diaphoresis and nausea. Pain started 30 minutes ago at rest. ECG shows
ST-segment elevation in leads V1-V4. Which diagnosis is most likely?
A. Non-ST elevation myocardial infarction (NSTEMI)
B. Anterior ST-elevation myocardial infarction (STEMI) [CORRECT]
C. Unstable angina
D. Pericarditis
Correct Answer: B
Rationale: ST-elevation in leads V1-V4 indicates an anterior wall STEMI. This presentation
(crushing chest pain, diaphoresis, nausea, radiation to arm/jaw) is classic for acute MI. NSTEMI (A)
and unstable angina (C) would show ST depressions or T-wave inversions without ST elevation.
Pericarditis (D) presents with diffuse ST elevation and PR depression.
Chamberlain Note: Anterior STEMIs involve the left anterior descending artery (LAD)—the "widow
maker." Immediate reperfusion therapy is indicated within 90 minutes of first medical contact.
,Q2. A 42-year-old female presents with sharp, pleuritic chest pain that improves when leaning
forward. She had a viral upper respiratory infection last week. Physical exam reveals a friction rub.
ECG shows diffuse ST-segment elevation and PR-segment depression. Which condition is most
consistent with this presentation?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Acute pericarditis [CORRECT]
D. Aortic dissection
Correct Answer: C
Rationale: Acute pericarditis presents with pleuritic chest pain relieved by sitting forward, a
pericardial friction rub, and diffuse ST elevation with PR depression on ECG. MI (A) shows localized
ST changes. PE (B) presents with tachycardia, dyspnea, and possible S1Q3T3 pattern. Aortic
dissection (D) presents with tearing pain radiating to the back.
Chamberlain Note: Pericarditis pain worsens with inspiration and lying flat (supine position). The
friction rub is pathognomonic and best heard at the left sternal border with the patient leaning
forward.
Q3. A 65-year-old male with hypertension presents with sudden onset of tearing chest pain
radiating to his back. Blood pressure is 185/110 mmHg in the right arm and 140/85 mmHg in the left
arm. Radial pulse is absent on the left. Which diagnosis is most likely?
A. Myocardial infarction
B. Aortic dissection [CORRECT]
C. Thoracic aortic aneurysm
D. Pulmonary embolism
Correct Answer: B
Rationale: Aortic dissection classically presents with tearing chest pain radiating to the back, pulse
deficits, and blood pressure differential >20 mmHg between arms. This is a hypertensive
emergency requiring immediate CT angiography. MI (A) typically presents with pressure-like pain.
Aneurysm (C) is usually asymptomatic until rupture. PE (D) causes pleuritic pain and dyspnea
without pulse deficits.
Chamberlain Note: Type A dissections (ascending aorta) require emergency surgery; Type B
(descending) may be managed medically with IV beta-blockade to reduce shear stress.
Q4. A 28-year-old female on oral contraceptives presents with acute onset dyspnea, pleuritic chest
pain, and tachycardia after a 6-hour car ride. Vital signs: HR 118, RR 24, BP 110/70, SpO2 91% on
room air. Which condition should be suspected first?
A. Acute coronary syndrome
B. Pulmonary embolism [CORRECT]
C. Pneumothorax
D. Anxiety attack
Correct Answer: B
,Rationale: The presentation (dyspnea, pleuritic chest pain, tachycardia, hypoxia) combined with
risk factors (oral contraceptives, prolonged immobility) is classic for PE. Wells' criteria would
indicate high probability. ACS (A) is less likely in a 28-year-old without cardiac risk factors.
Pneumothorax (C) would show decreased breath sounds and hyperresonance. Anxiety (D) is a
diagnosis of exclusion.
Chamberlain Note: Virchow's triad for thrombosis: stasis (long car ride), hypercoagulability (OCPs),
endothelial injury. CT pulmonary angiography (CTPA) is the gold standard diagnostic test.
Q5. A 72-year-old female presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal
dyspnea, and bilateral lower extremity edema. Physical exam reveals jugular venous distension and
bilateral crackles on lung auscultation. Which condition is most likely?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction [CORRECT]
C. Pulmonary fibrosis
D. Acute bronchitis
Correct Answer: B
Rationale: This presentation (dyspnea, orthopnea, JVD, peripheral edema, crackles) represents
classic left-sided and right-sided heart failure symptoms. The combination of pulmonary congestion
(orthopnea, PND, crackles) and systemic congestion (JVD, peripheral edema) indicates
biventricular failure. COPD (A) would show wheezing and prolonged expiration. Pulmonary fibrosis
(C) presents with dry crackles and clubbing. Bronchitis (D) involves cough and sputum production.
Q6. A 35-year-old male presents with palpitations described as "heart racing" that started suddenly
while at rest and terminated abruptly after 15 minutes. ECG during symptoms shows a
narrow-complex regular tachycardia at 180 bpm with no discernible P waves. Between episodes,
ECG is normal. Which arrhythmia is most likely?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Supraventricular tachycardia (SVT) [CORRECT]
D. Atrial flutter
Correct Answer: C
Rationale: SVT presents with sudden onset/offset, narrow QRS complex, regular rhythm, and rate
typically 150-250 bpm. Atrial fibrillation (A) is irregularly irregular. VT (B) presents with wide QRS
complex. Atrial flutter (D) shows sawtooth flutter waves and is often regular but at rates around 150
bpm (2:1 block).
Chamberlain Note: Vagal maneuvers (Valsalva, carotid sinus massage) are first-line for terminating
SVT. Adenosine is the first-line pharmacologic treatment.
, Q7. A 68-year-old male presents with syncope after exertion. He describes chest discomfort with
activity and denies prodromal symptoms. Vital signs are stable. Which type of syncope is most
likely?
A. Vasovagal syncope
B. Cardiogenic syncope [CORRECT]
C. Orthostatic hypotension
D. Seizure
Correct Answer: B
Rationale: Exertional syncope without prodrome suggests cardiogenic syncope, possibly due to
aortic stenosis, hypertrophic cardiomyopathy, or arrhythmia. The associated chest discomfort
suggests cardiac ischemia. Vasovagal (A) typically has prodromal symptoms (nausea, diaphoresis,
lightheadedness) and triggers. Orthostatic (C) occurs with position changes. Seizures (D) involve
postictal confusion and tonic-clonic activity.
Chamberlain Note: Syncope with exertion is cardiac until proven otherwise and carries high risk for
sudden cardiac death. Immediate cardiology referral and echocardiography are indicated.
Q8. A 55-year-old male with a history of heart failure presents with bilateral lower extremity edema
that is pitting and symmetric, extending to the knees. He has gained 5 pounds in one week. Which
condition is most likely responsible?
A. Chronic venous insufficiency
B. Lymphedema
C. Heart failure exacerbation [CORRECT]
D. Deep vein thrombosis
Correct Answer: C
Rationale: Symmetric bilateral pitting edema with rapid weight gain in a patient with known heart
failure suggests volume overload from HF exacerbation. Venous insufficiency (A) is usually
asymmetric with skin changes (stasis dermatitis, brawny discoloration). Lymphedema (B) is
non-pitting and often involves the feet/toes (Stemmer sign positive). DVT (D) is typically unilateral,
painful, and associated with erythema/warmth.
Q9. A 45-year-old female presents with episodic chest pain that occurs with emotional stress, is not
relieved by nitroglycerin, and is associated with paresthesias around the mouth. ECG and cardiac
enzymes are normal. Which diagnosis should be considered?
A. Stable angina
B. Panic disorder [CORRECT]
C. Costochondritis
D. GERD
Correct Answer: B
Rationale: Chest pain associated with emotional stress, paresthesias (often perioral), normal
cardiac workup, and lack of response to nitroglycerin suggests panic disorder. Stable angina (A)
