NSG 550 Exam 2 Diagnostic Reasoning (2026/2027)
PDF | Nursing | Wilkes University, Exams of Nursing
Section 1: Advanced Diagnostic Imaging Principles (Q1–20)
1. A patient with suspected renal colic. Which imaging study has the highest
sensitivity for ureteral stones?
A) KUB X-ray
B) Noncontrast CT abdomen/pelvis
C) Ultrasound
D) MRI
Answer: B
Rationale: Noncontrast CT has >95% sensitivity for urolithiasis, superior to
ultrasound or X-ray.
2. Which modality is best for detecting osteomyelitis in a diabetic foot?
A) X-ray
B) CT
C) MRI
D) Bone scan
Answer: C
Rationale: MRI has highest sensitivity and specificity for osteomyelitis, with
excellent soft tissue detail.
3. A patient with suspected pulmonary embolism cannot receive IV contrast
due to anaphylaxis. Next best test?
A) V/Q scan
B) Noncontrast CT
C) MRI chest
D) D-dimer only
Answer: A
Rationale: V/Q scan is alternative when CTPA contraindicated.
,4. Which finding on ultrasound suggests cholecystitis rather than
cholelithiasis?
A) Gallstone shadowing
B) Gallbladder wall thickening >4mm
C) Sludge
D) Polyp
Answer: B
Rationale: Wall thickening + pericholecystic fluid + sonographic Murphy sign
= cholecystitis.
5. A 65-year-old with new back pain, history of prostate cancer. Best initial
imaging?
A) X-ray spine
B) CT spine
C) MRI spine
D) Bone scan
Answer: C
Rationale: MRI best evaluates metastatic disease and cord compression.
6. A pregnant patient with suspected appendicitis. Imaging of choice?
A) CT abdomen
B) MRI abdomen
C) Ultrasound
D) X-ray
Answer: C
Rationale: Ultrasound first-line in pregnancy; MRI if inconclusive.
7. Which test has the highest negative predictive value for pulmonary
embolism?
A) D-dimer
B) CTPA
C) V/Q scan
D) Lower extremity ultrasound
,Answer: A
Rationale: High sensitivity D-dimer → negative result rules out PE in low-risk.
8. A patient with acute stroke symptoms, last known well 3 hours ago. First
imaging study?
A) MRI brain
B) Noncontrast CT head
C) CTA head/neck
D) Carotid duplex
Answer: B
Rationale: Noncontrast CT rules out hemorrhage before thrombolysis.
9. Which modality is best for evaluating rotator cuff tear?
A) X-ray shoulder
B) Ultrasound
C) MRI
D) CT arthrogram
Answer: C
Rationale: MRI shoulder has highest sensitivity for full-thickness tears.
10. A patient with suspected acute cholangitis. Best initial imaging?
A) CT abdomen
B) HIDA scan
C) MRCP
D) Right upper quadrant ultrasound
Answer: D
Rationale: Ultrasound first to assess biliary dilation; MRCP if needed.
11. Which finding on noncontrast CT head suggests acute ischemic stroke
within 3 hours?
A) Hyperdense MCA sign
B) Gray-white matter effacement
C) Mass effect
D) Subarachnoid blood
, Answer: A
Rationale: Hyperdense MCA sign = acute thrombus, earliest sign.
12. A patient with suspected testicular torsion. Imaging of choice?
A) Ultrasound with Doppler
B) CT scrotum
C) MRI scrotum
D) Nuclear medicine scan
Answer: A
Rationale: Doppler ultrasound assesses flow; torsion shows absent flow.
13. Which imaging study is contraindicated in a patient with a pacemaker?
A) X-ray
B) CT
C) Ultrasound
D) MRI
Answer: D
Rationale: MRI is generally contraindicated with older pacemakers; newer
MRI-conditional devices exist.
14. A patient with hemoptysis and normal CXR. Next imaging step?
A) CT chest without contrast
B) CT chest with contrast (CT angiography)
C) MRI chest
D) PET scan
Answer: B
Rationale: CTA chest evaluates for PE, AV malformation, or bronchial artery
source.
15. Which modality best characterizes an adrenal incidentaloma?
A) CT without contrast
B) CT with contrast
C) MRI with chemical shift
D) PET scan
PDF | Nursing | Wilkes University, Exams of Nursing
Section 1: Advanced Diagnostic Imaging Principles (Q1–20)
1. A patient with suspected renal colic. Which imaging study has the highest
sensitivity for ureteral stones?
A) KUB X-ray
B) Noncontrast CT abdomen/pelvis
C) Ultrasound
D) MRI
Answer: B
Rationale: Noncontrast CT has >95% sensitivity for urolithiasis, superior to
ultrasound or X-ray.
2. Which modality is best for detecting osteomyelitis in a diabetic foot?
A) X-ray
B) CT
C) MRI
D) Bone scan
Answer: C
Rationale: MRI has highest sensitivity and specificity for osteomyelitis, with
excellent soft tissue detail.
3. A patient with suspected pulmonary embolism cannot receive IV contrast
due to anaphylaxis. Next best test?
A) V/Q scan
B) Noncontrast CT
C) MRI chest
D) D-dimer only
Answer: A
Rationale: V/Q scan is alternative when CTPA contraindicated.
,4. Which finding on ultrasound suggests cholecystitis rather than
cholelithiasis?
A) Gallstone shadowing
B) Gallbladder wall thickening >4mm
C) Sludge
D) Polyp
Answer: B
Rationale: Wall thickening + pericholecystic fluid + sonographic Murphy sign
= cholecystitis.
5. A 65-year-old with new back pain, history of prostate cancer. Best initial
imaging?
A) X-ray spine
B) CT spine
C) MRI spine
D) Bone scan
Answer: C
Rationale: MRI best evaluates metastatic disease and cord compression.
6. A pregnant patient with suspected appendicitis. Imaging of choice?
A) CT abdomen
B) MRI abdomen
C) Ultrasound
D) X-ray
Answer: C
Rationale: Ultrasound first-line in pregnancy; MRI if inconclusive.
7. Which test has the highest negative predictive value for pulmonary
embolism?
A) D-dimer
B) CTPA
C) V/Q scan
D) Lower extremity ultrasound
,Answer: A
Rationale: High sensitivity D-dimer → negative result rules out PE in low-risk.
8. A patient with acute stroke symptoms, last known well 3 hours ago. First
imaging study?
A) MRI brain
B) Noncontrast CT head
C) CTA head/neck
D) Carotid duplex
Answer: B
Rationale: Noncontrast CT rules out hemorrhage before thrombolysis.
9. Which modality is best for evaluating rotator cuff tear?
A) X-ray shoulder
B) Ultrasound
C) MRI
D) CT arthrogram
Answer: C
Rationale: MRI shoulder has highest sensitivity for full-thickness tears.
10. A patient with suspected acute cholangitis. Best initial imaging?
A) CT abdomen
B) HIDA scan
C) MRCP
D) Right upper quadrant ultrasound
Answer: D
Rationale: Ultrasound first to assess biliary dilation; MRCP if needed.
11. Which finding on noncontrast CT head suggests acute ischemic stroke
within 3 hours?
A) Hyperdense MCA sign
B) Gray-white matter effacement
C) Mass effect
D) Subarachnoid blood
, Answer: A
Rationale: Hyperdense MCA sign = acute thrombus, earliest sign.
12. A patient with suspected testicular torsion. Imaging of choice?
A) Ultrasound with Doppler
B) CT scrotum
C) MRI scrotum
D) Nuclear medicine scan
Answer: A
Rationale: Doppler ultrasound assesses flow; torsion shows absent flow.
13. Which imaging study is contraindicated in a patient with a pacemaker?
A) X-ray
B) CT
C) Ultrasound
D) MRI
Answer: D
Rationale: MRI is generally contraindicated with older pacemakers; newer
MRI-conditional devices exist.
14. A patient with hemoptysis and normal CXR. Next imaging step?
A) CT chest without contrast
B) CT chest with contrast (CT angiography)
C) MRI chest
D) PET scan
Answer: B
Rationale: CTA chest evaluates for PE, AV malformation, or bronchial artery
source.
15. Which modality best characterizes an adrenal incidentaloma?
A) CT without contrast
B) CT with contrast
C) MRI with chemical shift
D) PET scan
