NR511/ NR 511 Midterm Exam (latest 2026/2027
update) | Exam Questions With Verified Answers
And Detailed Rationales | Differential Diagnosis
& Primary Care Practicum | A+ Graded
Question 1
A 58-year-old male with hypertension and diabetes presents with a non-healing
ulcer on his right great toe for 3 weeks. The ulcer is painless, has a punched-out
appearance, and is surrounded by callus. Dorsalis pedis pulse is weak. What is the
most likely diagnosis?
Answer: Neuropathic ulcer (diabetic foot ulcer)
Rationale: Painless, punched-out ulcer over pressure point with callus and weak
pulse in a diabetic patient indicates neuropathic ulcer from peripheral neuropathy
and arterial insufficiency. Venous ulcers are usually painful and on gaiter area.
Arterial ulcers are painful with smooth edges.
Question 2
A 22-year-old female reports dysuria and frequency for 2 days. Urinalysis shows
positive nitrites and leukocyte esterase. What is first-line treatment?
Answer: Nitrofurantoin monohydrate 100 mg twice daily for 5 days
Rationale: Uncomplicated cystitis in young healthy female. Nitrofurantoin is first-
line due to low resistance and minimal collateral damage. TMP-SMX is alternative
if local resistance <20%. Fluoroquinolones are avoided as first-line due to side
effects.
Question 3
A 35-year-old obese female has right upper quadrant pain after fatty meals.
Ultrasound shows gallbladder sludge but no stones or wall thickening. What is the
next step?
Answer: Symptomatic management with dietary changes and follow-up
, Rationale: Sludge alone without stones or cholecystitis does not require surgery.
Lifestyle modification (low-fat diet) and observation are appropriate. If pain
persists or stones develop, cholecystectomy is considered.
Question 4
A 7-year-old has a sandpaper-like rash on trunk and flexural areas, strawberry
tongue, and sore throat. Rapid strep test is positive. What is the diagnosis?
Answer: Scarlet fever
Rationale: Group A strep pharyngitis with erythrogenic toxin causes sandpaper
rash, strawberry tongue, and circumoral pallor. Treatment is penicillin or
amoxicillin to prevent rheumatic fever.
Question 5
A 65-year-old with osteoarthritis reports knee pain that is worse with activity and
improves with rest. No swelling or warmth. What is the best initial treatment?
Answer: Acetaminophen up to 3 grams daily
Rationale: Osteoarthritis pain without inflammation. Acetaminophen is first-line
due to safety profile. NSAIDs are added if inadequate response but carry GI and
renal risks in older adults.
Question 6
A 48-year-old female has hot flashes, night sweats, and irregular menses for 6
months. FSH is elevated. What is the diagnosis?
Answer: Perimenopause
Rationale: Perimenopause begins with menstrual irregularity and vasomotor
symptoms. FSH is elevated but not yet menopausal (FSH >40 mIU/mL with 12
months amenorrhea defines menopause). Hormone therapy is option for moderate-
severe symptoms.
Question 7
A 3-year-old has pulling on left ear and fever 101°F. Otoscopy shows
update) | Exam Questions With Verified Answers
And Detailed Rationales | Differential Diagnosis
& Primary Care Practicum | A+ Graded
Question 1
A 58-year-old male with hypertension and diabetes presents with a non-healing
ulcer on his right great toe for 3 weeks. The ulcer is painless, has a punched-out
appearance, and is surrounded by callus. Dorsalis pedis pulse is weak. What is the
most likely diagnosis?
Answer: Neuropathic ulcer (diabetic foot ulcer)
Rationale: Painless, punched-out ulcer over pressure point with callus and weak
pulse in a diabetic patient indicates neuropathic ulcer from peripheral neuropathy
and arterial insufficiency. Venous ulcers are usually painful and on gaiter area.
Arterial ulcers are painful with smooth edges.
Question 2
A 22-year-old female reports dysuria and frequency for 2 days. Urinalysis shows
positive nitrites and leukocyte esterase. What is first-line treatment?
Answer: Nitrofurantoin monohydrate 100 mg twice daily for 5 days
Rationale: Uncomplicated cystitis in young healthy female. Nitrofurantoin is first-
line due to low resistance and minimal collateral damage. TMP-SMX is alternative
if local resistance <20%. Fluoroquinolones are avoided as first-line due to side
effects.
Question 3
A 35-year-old obese female has right upper quadrant pain after fatty meals.
Ultrasound shows gallbladder sludge but no stones or wall thickening. What is the
next step?
Answer: Symptomatic management with dietary changes and follow-up
, Rationale: Sludge alone without stones or cholecystitis does not require surgery.
Lifestyle modification (low-fat diet) and observation are appropriate. If pain
persists or stones develop, cholecystectomy is considered.
Question 4
A 7-year-old has a sandpaper-like rash on trunk and flexural areas, strawberry
tongue, and sore throat. Rapid strep test is positive. What is the diagnosis?
Answer: Scarlet fever
Rationale: Group A strep pharyngitis with erythrogenic toxin causes sandpaper
rash, strawberry tongue, and circumoral pallor. Treatment is penicillin or
amoxicillin to prevent rheumatic fever.
Question 5
A 65-year-old with osteoarthritis reports knee pain that is worse with activity and
improves with rest. No swelling or warmth. What is the best initial treatment?
Answer: Acetaminophen up to 3 grams daily
Rationale: Osteoarthritis pain without inflammation. Acetaminophen is first-line
due to safety profile. NSAIDs are added if inadequate response but carry GI and
renal risks in older adults.
Question 6
A 48-year-old female has hot flashes, night sweats, and irregular menses for 6
months. FSH is elevated. What is the diagnosis?
Answer: Perimenopause
Rationale: Perimenopause begins with menstrual irregularity and vasomotor
symptoms. FSH is elevated but not yet menopausal (FSH >40 mIU/mL with 12
months amenorrhea defines menopause). Hormone therapy is option for moderate-
severe symptoms.
Question 7
A 3-year-old has pulling on left ear and fever 101°F. Otoscopy shows
