NBCE - Part 2: General Diagnosis| 223
QUESTIONS| WITH COMPLETE SOLUTIONS
Course
NBCE
1. A 32-year-old male presents with a history of severe, sharp chest pain
radiating to his left arm and jaw. The pain is associated with shortness of breath
and sweating. His vital signs are: BP 160/90 mmHg, pulse 110 bpm, and
respiratory rate 22/min. What is the most likely diagnosis?
A. Acute pericarditis
B. Aortic dissection
C. Myocardial infarction
D. Gastroesophageal reflux disease
Correct Answer: C. Myocardial infarction
Explanation: The symptoms described (sharp chest pain radiating to the left arm and jaw,
shortness of breath, sweating, elevated blood pressure and pulse rate) are classic signs of a
myocardial infarction (heart attack). Immediate medical attention is required.
2. A 45-year-old female presents with a sudden onset of severe headache, nausea,
vomiting, and a decreased level of consciousness. Her blood pressure is 200/110
mmHg. What is the most likely diagnosis?
A. Subarachnoid hemorrhage
B. Migraine
C. Stroke
D. Hypertensive emergency
Correct Answer: A. Subarachnoid hemorrhage
Explanation: The presentation of a sudden onset of severe headache, nausea, vomiting, and
altered consciousness, combined with a very high blood pressure, suggests subarachnoid
hemorrhage, a life-threatening condition caused by bleeding into the space surrounding the brain.
3. A 25-year-old male complains of a persistent cough for the past three weeks,
along with weight loss, night sweats, and fever. He reports that he has been
around a family member who was recently diagnosed with tuberculosis. What is
the most likely diagnosis?
,A. Pneumonia
B. Bronchitis
C. Tuberculosis
D. Asthma
Correct Answer: C. Tuberculosis
Explanation: The patient’s symptoms of persistent cough, weight loss, night sweats, and a
history of exposure to a family member with tuberculosis strongly suggest active tuberculosis.
Diagnostic testing, including a chest X-ray and sputum culture, is needed.
4. A 60-year-old male presents with a complaint of sudden, severe, unilateral eye
pain, nausea, vomiting, and blurred vision. He has a history of glaucoma. What
is the most likely diagnosis?
A. Acute angle-closure glaucoma
B. Retinal detachment
C. Acute conjunctivitis
D. Keratitis
Correct Answer: A. Acute angle-closure glaucoma
Explanation: The sudden onset of severe eye pain, nausea, vomiting, and blurred vision,
especially in a patient with a history of glaucoma, suggests acute angle-closure glaucoma, a
medical emergency that requires immediate treatment to reduce intraocular pressure.
5. A 47-year-old female presents with complaints of difficulty swallowing,
regurgitation of food, and a feeling of fullness in her chest. She also reports a
sour taste in her mouth. What is the most likely diagnosis?
A. Achalasia
B. Gastroesophageal reflux disease (GERD)
C. Esophageal cancer
D. Peptic ulcer disease
Correct Answer: B. Gastroesophageal reflux disease (GERD)
Explanation: The symptoms of difficulty swallowing, regurgitation, and sour taste are classic
signs of GERD. GERD occurs when stomach acid backs up into the esophagus, causing irritation
and discomfort.
,6. A 68-year-old male with a history of hypertension and smoking presents with
sudden onset of left-sided weakness, slurred speech, and facial drooping. What is
the most likely diagnosis?
A. Stroke
B. Transient ischemic attack (TIA)
C. Bell's palsy
D. Multiple sclerosis
Correct Answer: A. Stroke
Explanation: The sudden onset of left-sided weakness, slurred speech, and facial drooping are
indicative of a stroke, particularly in a patient with risk factors like hypertension and smoking.
Immediate evaluation and treatment are essential.
7. A 30-year-old female presents with a complaint of bilateral lower extremity
swelling, which is worse at the end of the day. She denies any chest pain,
shortness of breath, or fever. On examination, you note a positive Homan's sign.
What is the most likely diagnosis?
A. Deep vein thrombosis (DVT)
B. Congestive heart failure
C. Venous insufficiency
D. Lymphedema
Correct Answer: C. Venous insufficiency
Explanation: The presentation of bilateral lower extremity swelling, worsening at the end of the
day, along with a positive Homan's sign, is most consistent with venous insufficiency, where the
veins have difficulty returning blood to the heart, leading to fluid buildup.
8. A 72-year-old female presents with pain and swelling in her right hip after a
fall. On examination, her right leg is externally rotated and shortened. What is
the most likely diagnosis?
A. Hip fracture
B. Osteoarthritis
C. Dislocated hip
D. Pulled muscle
Correct Answer: A. Hip fracture
Explanation: The combination of pain, swelling, external rotation, and shortening of the leg
, following trauma is highly suggestive of a hip fracture. This requires imaging (X-ray or CT) for
confirmation and management.
9. A 22-year-old male presents with joint pain, particularly in his knees, ankles,
and elbows. He has a history of a recent gastrointestinal infection. On physical
examination, you notice erythema and swelling in his joints. What is the most
likely diagnosis?
A. Rheumatoid arthritis
B. Gout
C. Reactive arthritis
D. Osteoarthritis
Correct Answer: C. Reactive arthritis
Explanation: The patient’s history of a recent gastrointestinal infection followed by the
development of joint pain, erythema, and swelling suggests reactive arthritis, a condition that
occurs after an infection, often involving the joints.
10. A 55-year-old female presents with a history of excessive thirst, frequent
urination, and unintentional weight loss. On examination, she is tachycardic and
has dry skin. Laboratory results show elevated blood glucose levels. What is the
most likely diagnosis?
A. Diabetes mellitus type 1
B. Diabetes mellitus type 2
C. Diabetic ketoacidosis (DKA)
D. Hyperthyroidism
Correct Answer: A. Diabetes mellitus type 1
Explanation: The symptoms of excessive thirst, frequent urination, weight loss, and elevated
blood glucose levels are classic signs of type 1 diabetes mellitus, an autoimmune condition
where the pancreas cannot produce insulin.
11. A 60-year-old male with a history of smoking and alcohol consumption presents with a
persistent cough, hemoptysis (coughing up blood), and weight loss. On physical
examination, you notice clubbing of the fingers. What is the most likely diagnosis?
A. Chronic bronchitis
B. Lung cancer
C. Tuberculosis
D. Pneumonia
QUESTIONS| WITH COMPLETE SOLUTIONS
Course
NBCE
1. A 32-year-old male presents with a history of severe, sharp chest pain
radiating to his left arm and jaw. The pain is associated with shortness of breath
and sweating. His vital signs are: BP 160/90 mmHg, pulse 110 bpm, and
respiratory rate 22/min. What is the most likely diagnosis?
A. Acute pericarditis
B. Aortic dissection
C. Myocardial infarction
D. Gastroesophageal reflux disease
Correct Answer: C. Myocardial infarction
Explanation: The symptoms described (sharp chest pain radiating to the left arm and jaw,
shortness of breath, sweating, elevated blood pressure and pulse rate) are classic signs of a
myocardial infarction (heart attack). Immediate medical attention is required.
2. A 45-year-old female presents with a sudden onset of severe headache, nausea,
vomiting, and a decreased level of consciousness. Her blood pressure is 200/110
mmHg. What is the most likely diagnosis?
A. Subarachnoid hemorrhage
B. Migraine
C. Stroke
D. Hypertensive emergency
Correct Answer: A. Subarachnoid hemorrhage
Explanation: The presentation of a sudden onset of severe headache, nausea, vomiting, and
altered consciousness, combined with a very high blood pressure, suggests subarachnoid
hemorrhage, a life-threatening condition caused by bleeding into the space surrounding the brain.
3. A 25-year-old male complains of a persistent cough for the past three weeks,
along with weight loss, night sweats, and fever. He reports that he has been
around a family member who was recently diagnosed with tuberculosis. What is
the most likely diagnosis?
,A. Pneumonia
B. Bronchitis
C. Tuberculosis
D. Asthma
Correct Answer: C. Tuberculosis
Explanation: The patient’s symptoms of persistent cough, weight loss, night sweats, and a
history of exposure to a family member with tuberculosis strongly suggest active tuberculosis.
Diagnostic testing, including a chest X-ray and sputum culture, is needed.
4. A 60-year-old male presents with a complaint of sudden, severe, unilateral eye
pain, nausea, vomiting, and blurred vision. He has a history of glaucoma. What
is the most likely diagnosis?
A. Acute angle-closure glaucoma
B. Retinal detachment
C. Acute conjunctivitis
D. Keratitis
Correct Answer: A. Acute angle-closure glaucoma
Explanation: The sudden onset of severe eye pain, nausea, vomiting, and blurred vision,
especially in a patient with a history of glaucoma, suggests acute angle-closure glaucoma, a
medical emergency that requires immediate treatment to reduce intraocular pressure.
5. A 47-year-old female presents with complaints of difficulty swallowing,
regurgitation of food, and a feeling of fullness in her chest. She also reports a
sour taste in her mouth. What is the most likely diagnosis?
A. Achalasia
B. Gastroesophageal reflux disease (GERD)
C. Esophageal cancer
D. Peptic ulcer disease
Correct Answer: B. Gastroesophageal reflux disease (GERD)
Explanation: The symptoms of difficulty swallowing, regurgitation, and sour taste are classic
signs of GERD. GERD occurs when stomach acid backs up into the esophagus, causing irritation
and discomfort.
,6. A 68-year-old male with a history of hypertension and smoking presents with
sudden onset of left-sided weakness, slurred speech, and facial drooping. What is
the most likely diagnosis?
A. Stroke
B. Transient ischemic attack (TIA)
C. Bell's palsy
D. Multiple sclerosis
Correct Answer: A. Stroke
Explanation: The sudden onset of left-sided weakness, slurred speech, and facial drooping are
indicative of a stroke, particularly in a patient with risk factors like hypertension and smoking.
Immediate evaluation and treatment are essential.
7. A 30-year-old female presents with a complaint of bilateral lower extremity
swelling, which is worse at the end of the day. She denies any chest pain,
shortness of breath, or fever. On examination, you note a positive Homan's sign.
What is the most likely diagnosis?
A. Deep vein thrombosis (DVT)
B. Congestive heart failure
C. Venous insufficiency
D. Lymphedema
Correct Answer: C. Venous insufficiency
Explanation: The presentation of bilateral lower extremity swelling, worsening at the end of the
day, along with a positive Homan's sign, is most consistent with venous insufficiency, where the
veins have difficulty returning blood to the heart, leading to fluid buildup.
8. A 72-year-old female presents with pain and swelling in her right hip after a
fall. On examination, her right leg is externally rotated and shortened. What is
the most likely diagnosis?
A. Hip fracture
B. Osteoarthritis
C. Dislocated hip
D. Pulled muscle
Correct Answer: A. Hip fracture
Explanation: The combination of pain, swelling, external rotation, and shortening of the leg
, following trauma is highly suggestive of a hip fracture. This requires imaging (X-ray or CT) for
confirmation and management.
9. A 22-year-old male presents with joint pain, particularly in his knees, ankles,
and elbows. He has a history of a recent gastrointestinal infection. On physical
examination, you notice erythema and swelling in his joints. What is the most
likely diagnosis?
A. Rheumatoid arthritis
B. Gout
C. Reactive arthritis
D. Osteoarthritis
Correct Answer: C. Reactive arthritis
Explanation: The patient’s history of a recent gastrointestinal infection followed by the
development of joint pain, erythema, and swelling suggests reactive arthritis, a condition that
occurs after an infection, often involving the joints.
10. A 55-year-old female presents with a history of excessive thirst, frequent
urination, and unintentional weight loss. On examination, she is tachycardic and
has dry skin. Laboratory results show elevated blood glucose levels. What is the
most likely diagnosis?
A. Diabetes mellitus type 1
B. Diabetes mellitus type 2
C. Diabetic ketoacidosis (DKA)
D. Hyperthyroidism
Correct Answer: A. Diabetes mellitus type 1
Explanation: The symptoms of excessive thirst, frequent urination, weight loss, and elevated
blood glucose levels are classic signs of type 1 diabetes mellitus, an autoimmune condition
where the pancreas cannot produce insulin.
11. A 60-year-old male with a history of smoking and alcohol consumption presents with a
persistent cough, hemoptysis (coughing up blood), and weight loss. On physical
examination, you notice clubbing of the fingers. What is the most likely diagnosis?
A. Chronic bronchitis
B. Lung cancer
C. Tuberculosis
D. Pneumonia
