LATEST UPDATED NR 511 Midterm - Differential
Diagnosis and Primary Care | COMPLETE EXAM
WITH CORRECT ANSWERS AND RATIONALES.
A+ GUARANTEED SUCCESS
1. A 45-year-old male presents with acute
onset of severe, tearing chest pain that
radiates to the back. Blood pressure is 160/90
in the right arm and 110/70 in the left arm.
Which diagnosis is most likely?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct answer: B
Rationale: Tearing chest pain radiating to the
back with unequal blood pressures between
arms is classic for aortic dissection.
Myocardial infarction causes crushing
pressure. Pulmonary embolism causes
pleuritic pain and dyspnea. Pericarditis causes
positional pain relieved by leaning forward.
,2. A 28-year-old female presents with episodic
palpitations, headache, sweating, and
hypertension. These episodes last 15-20
minutes and resolve spontaneously. Which
diagnosis is most likely?
A) Panic attack
B) Pheochromocytoma
C) Hyperthyroidism
D) Mitral valve prolapse
Correct answer: B
Rationale: Paroxysmal episodes of
hypertension, palpitations, headache, and
diaphoresis are classic for pheochromocytoma
(catecholamine-secreting tumor). Panic
attacks may mimic but do not typically cause
hypertension. Hyperthyroidism causes
persistent symptoms. Mitral valve prolapse
may cause palpitations but not paroxysmal
hypertension.
3. A 60-year-old male with a history of alcohol
use disorder presents with sudden onset of
severe epigastric pain radiating to the back,
nausea, and vomiting. Which diagnosis is most
likely?
,A) Cholecystitis
B) Acute pancreatitis
C) Perforated peptic ulcer
D) Myocardial infarction
Correct answer: B
Rationale: Sudden severe epigastric pain
radiating to the back in a patient with alcohol
use disorder is classic for acute pancreatitis.
Cholecystitis presents with right upper
quadrant pain radiating to the right shoulder.
Perforated ulcer causes sudden diffuse pain
with rigidity. Myocardial infarction may have
epigastric pain but less likely radiating to back.
4. A 25-year-old female presents with fatigue,
joint pain, and a butterfly rash on her face that
worsens with sun exposure. Which laboratory
finding is most specific for the suspected
diagnosis?
A) Rheumatoid factor positive
B) Anti-double-stranded DNA (anti-dsDNA)
antibodies
C) Antinuclear antibody (ANA) positive
D) Anti-CCP antibodies
, Correct answer: B
Rationale: The presentation suggests systemic
lupus erythematosus (SLE). Anti-dsDNA
antibodies are highly specific for SLE. ANA is
sensitive but not specific. Rheumatoid factor
and anti-CCP are seen in rheumatoid arthritis.
5. A 68-year-old male presents with unilateral
vision loss that occurred suddenly and
resolved after 10 minutes. He reports no pain.
Which diagnosis is most likely?
A) Retinal detachment
B) Amaurosis fugax (transient ischemic attack
of the retina)
C) Optic neuritis
D) Migraine with aura
Correct answer: B
Rationale: Painless, transient monocular vision
loss (amaurosis fugax) suggests transient
ischemic attack (TIA) of the retinal artery
(often due to ipsilateral carotid artery
stenosis). Retinal detachment causes
persistent vision loss. Optic neuritis causes
painful vision loss. Migraine with aura often has
other neurologic symptoms.
Diagnosis and Primary Care | COMPLETE EXAM
WITH CORRECT ANSWERS AND RATIONALES.
A+ GUARANTEED SUCCESS
1. A 45-year-old male presents with acute
onset of severe, tearing chest pain that
radiates to the back. Blood pressure is 160/90
in the right arm and 110/70 in the left arm.
Which diagnosis is most likely?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct answer: B
Rationale: Tearing chest pain radiating to the
back with unequal blood pressures between
arms is classic for aortic dissection.
Myocardial infarction causes crushing
pressure. Pulmonary embolism causes
pleuritic pain and dyspnea. Pericarditis causes
positional pain relieved by leaning forward.
,2. A 28-year-old female presents with episodic
palpitations, headache, sweating, and
hypertension. These episodes last 15-20
minutes and resolve spontaneously. Which
diagnosis is most likely?
A) Panic attack
B) Pheochromocytoma
C) Hyperthyroidism
D) Mitral valve prolapse
Correct answer: B
Rationale: Paroxysmal episodes of
hypertension, palpitations, headache, and
diaphoresis are classic for pheochromocytoma
(catecholamine-secreting tumor). Panic
attacks may mimic but do not typically cause
hypertension. Hyperthyroidism causes
persistent symptoms. Mitral valve prolapse
may cause palpitations but not paroxysmal
hypertension.
3. A 60-year-old male with a history of alcohol
use disorder presents with sudden onset of
severe epigastric pain radiating to the back,
nausea, and vomiting. Which diagnosis is most
likely?
,A) Cholecystitis
B) Acute pancreatitis
C) Perforated peptic ulcer
D) Myocardial infarction
Correct answer: B
Rationale: Sudden severe epigastric pain
radiating to the back in a patient with alcohol
use disorder is classic for acute pancreatitis.
Cholecystitis presents with right upper
quadrant pain radiating to the right shoulder.
Perforated ulcer causes sudden diffuse pain
with rigidity. Myocardial infarction may have
epigastric pain but less likely radiating to back.
4. A 25-year-old female presents with fatigue,
joint pain, and a butterfly rash on her face that
worsens with sun exposure. Which laboratory
finding is most specific for the suspected
diagnosis?
A) Rheumatoid factor positive
B) Anti-double-stranded DNA (anti-dsDNA)
antibodies
C) Antinuclear antibody (ANA) positive
D) Anti-CCP antibodies
, Correct answer: B
Rationale: The presentation suggests systemic
lupus erythematosus (SLE). Anti-dsDNA
antibodies are highly specific for SLE. ANA is
sensitive but not specific. Rheumatoid factor
and anti-CCP are seen in rheumatoid arthritis.
5. A 68-year-old male presents with unilateral
vision loss that occurred suddenly and
resolved after 10 minutes. He reports no pain.
Which diagnosis is most likely?
A) Retinal detachment
B) Amaurosis fugax (transient ischemic attack
of the retina)
C) Optic neuritis
D) Migraine with aura
Correct answer: B
Rationale: Painless, transient monocular vision
loss (amaurosis fugax) suggests transient
ischemic attack (TIA) of the retinal artery
(often due to ipsilateral carotid artery
stenosis). Retinal detachment causes
persistent vision loss. Optic neuritis causes
painful vision loss. Migraine with aura often has
other neurologic symptoms.
