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NR 603 AANP Diagnostic Exam
Advanced Clinical Diagnosis
Verified Questions and Answers
Question 1
A 58-year-old man presents with substernal chest pressure that occurs while walking uphill and
resolves after 5 minutes of rest. Vital signs are stable, and the ECG obtained in the office is
normal. What is the most likely diagnosis?
A. Stable angina
B. Acute pericarditis
C. Pulmonary embolism
D. Costochondritis
Correct Answer: A. Stable angina
Rationale:
Stable angina is characterized by predictable chest discomfort triggered by exertion or
emotional stress and relieved by rest or nitroglycerin. A normal resting ECG does not exclude
stable coronary artery disease.
Question 2
,A 42-year-old woman presents with fatigue, cold intolerance, constipation, and weight gain.
Which laboratory test should be ordered first?
A. Serum cortisol
B. Thyroid-stimulating hormone (TSH)
C. Vitamin B12
D. Creatine kinase
Correct Answer: B. Thyroid-stimulating hormone (TSH)
Rationale:
These symptoms are classic for hypothyroidism. TSH is the preferred initial screening test in
most adults.
Question 3
A patient presents with sudden onset pleuritic chest pain, dyspnea, tachycardia, and unilateral
calf swelling. Which diagnosis should be considered first?
A. Asthma exacerbation
B. Pulmonary embolism
C. Acute bronchitis
D. Gastroesophageal reflux disease
Correct Answer: B. Pulmonary embolism
Rationale:
The combination of acute dyspnea, pleuritic chest pain, tachycardia, and signs of deep vein
thrombosis strongly suggests pulmonary embolism and warrants urgent evaluation.
Question 4
Which physical examination finding is most suggestive of heart failure?
A. Bibasilar crackles
B. Hyperactive bowel sounds
,C. Splenomegaly
D. Enlarged tonsils
Correct Answer: A. Bibasilar crackles
Rationale:
Pulmonary congestion due to left-sided heart failure commonly produces bibasilar crackles on
auscultation.
Question 5
A 30-year-old woman has dysuria, urinary frequency, and urgency for 2 days. She has no fever
or flank pain. What is the most likely diagnosis?
A. Acute uncomplicated cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Pelvic inflammatory disease
Correct Answer: A. Acute uncomplicated cystitis
Rationale:
Lower urinary tract symptoms without systemic illness are most consistent with uncomplicated
cystitis.
Question 6
A patient with diabetes reports numbness and burning in both feet. Which complication is most
likely?
A. Diabetic peripheral neuropathy
B. Deep vein thrombosis
C. Plantar fasciitis
D. Cellulitis
Correct Answer: A. Diabetic peripheral neuropathy
, Rationale:
Symmetric numbness, tingling, and burning in the feet are characteristic of diabetic peripheral
neuropathy.
Question 7
Which laboratory test is the most sensitive biomarker for acute myocardial injury?
A. Troponin
B. Creatine kinase
C. Lactate dehydrogenase
D. Myoglobin
Correct Answer: A. Troponin
Rationale:
Cardiac troponins are the preferred biomarkers for detecting myocardial injury because of their
high sensitivity and specificity.
Question 8
A patient reports chronic cough for 10 weeks. Which diagnosis should be included among the
common causes of chronic cough in adults?
A. Asthma
B. Acute epiglottitis
C. Meningitis
D. Acute otitis media
Correct Answer: A. Asthma
Rationale:
Asthma, upper airway cough syndrome, gastroesophageal reflux disease, and nonasthmatic
eosinophilic bronchitis are among the common causes of chronic cough.
NR 603 AANP Diagnostic Exam
Advanced Clinical Diagnosis
Verified Questions and Answers
Question 1
A 58-year-old man presents with substernal chest pressure that occurs while walking uphill and
resolves after 5 minutes of rest. Vital signs are stable, and the ECG obtained in the office is
normal. What is the most likely diagnosis?
A. Stable angina
B. Acute pericarditis
C. Pulmonary embolism
D. Costochondritis
Correct Answer: A. Stable angina
Rationale:
Stable angina is characterized by predictable chest discomfort triggered by exertion or
emotional stress and relieved by rest or nitroglycerin. A normal resting ECG does not exclude
stable coronary artery disease.
Question 2
,A 42-year-old woman presents with fatigue, cold intolerance, constipation, and weight gain.
Which laboratory test should be ordered first?
A. Serum cortisol
B. Thyroid-stimulating hormone (TSH)
C. Vitamin B12
D. Creatine kinase
Correct Answer: B. Thyroid-stimulating hormone (TSH)
Rationale:
These symptoms are classic for hypothyroidism. TSH is the preferred initial screening test in
most adults.
Question 3
A patient presents with sudden onset pleuritic chest pain, dyspnea, tachycardia, and unilateral
calf swelling. Which diagnosis should be considered first?
A. Asthma exacerbation
B. Pulmonary embolism
C. Acute bronchitis
D. Gastroesophageal reflux disease
Correct Answer: B. Pulmonary embolism
Rationale:
The combination of acute dyspnea, pleuritic chest pain, tachycardia, and signs of deep vein
thrombosis strongly suggests pulmonary embolism and warrants urgent evaluation.
Question 4
Which physical examination finding is most suggestive of heart failure?
A. Bibasilar crackles
B. Hyperactive bowel sounds
,C. Splenomegaly
D. Enlarged tonsils
Correct Answer: A. Bibasilar crackles
Rationale:
Pulmonary congestion due to left-sided heart failure commonly produces bibasilar crackles on
auscultation.
Question 5
A 30-year-old woman has dysuria, urinary frequency, and urgency for 2 days. She has no fever
or flank pain. What is the most likely diagnosis?
A. Acute uncomplicated cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Pelvic inflammatory disease
Correct Answer: A. Acute uncomplicated cystitis
Rationale:
Lower urinary tract symptoms without systemic illness are most consistent with uncomplicated
cystitis.
Question 6
A patient with diabetes reports numbness and burning in both feet. Which complication is most
likely?
A. Diabetic peripheral neuropathy
B. Deep vein thrombosis
C. Plantar fasciitis
D. Cellulitis
Correct Answer: A. Diabetic peripheral neuropathy
, Rationale:
Symmetric numbness, tingling, and burning in the feet are characteristic of diabetic peripheral
neuropathy.
Question 7
Which laboratory test is the most sensitive biomarker for acute myocardial injury?
A. Troponin
B. Creatine kinase
C. Lactate dehydrogenase
D. Myoglobin
Correct Answer: A. Troponin
Rationale:
Cardiac troponins are the preferred biomarkers for detecting myocardial injury because of their
high sensitivity and specificity.
Question 8
A patient reports chronic cough for 10 weeks. Which diagnosis should be included among the
common causes of chronic cough in adults?
A. Asthma
B. Acute epiglottitis
C. Meningitis
D. Acute otitis media
Correct Answer: A. Asthma
Rationale:
Asthma, upper airway cough syndrome, gastroesophageal reflux disease, and nonasthmatic
eosinophilic bronchitis are among the common causes of chronic cough.
