NR 511 Differential Diagnosis and Primary
Care Practicum Final Exam 2025| Actual
Exam Questions and Correct Answers
1. Which test is used to confirm a diagnosis of epididymitis?
A) Scrotal ultrasound
B) Urine culture
C) CT scan of the pelvis
D) Serum PSA level
Correct Answer: A) Scrotal ultrasound
Explanation: Scrotal ultrasound is the primary imaging test to confirm epididymitis, showing
epididymal swelling and increased blood flow. It helps differentiate epididymitis from testicular
torsion, a critical differential diagnosis. Urine culture may identify causative organisms but is not
confirmatory alone.
2. Which of the following is part of the treatment plan for the patient with irritable bowel
syndrome (IBS)?
A) High-dose corticosteroids
B) Dietary modification and symptom management
C) Long-term antibiotic therapy
D) Immediate surgical intervention
Correct Answer: B) Dietary modification and symptom management
Explanation: IBS treatment focuses on dietary modifications (e.g., low FODMAP diet), stress
management, and symptom-specific therapies (e.g., antispasmodics, fiber). Corticosteroids, long-
term antibiotics, and surgery are not standard treatments for IBS.
3. Reuben, age 24 years old, has HIV and just had a routine viral load test done. The results show
a falling viral load. What does this indicate?
A) Worsening disease progression
,B) Effective antiretroviral therapy (ART)
C) Need for immediate hospitalization
D) Development of drug-resistant HIV
Correct Answer: B) Effective antiretroviral therapy (ART)
Explanation: A falling viral load in an HIV patient indicates that ART is effectively
suppressing viral replication, improving immune function. It does not suggest worsening disease,
hospitalization, or resistance unless other clinical signs are present.
4. The patient with gastroesophageal reflux disease (GERD) should be instructed to eliminate
which of these activities?
A) Eating large meals
B) Drinking water with meals
C) Engaging in light exercise
D) Sleeping with the head elevated
Correct Answer: A) Eating large meals
Explanation: Large meals can exacerbate GERD by increasing gastric pressure and acid
reflux. Patients should avoid large meals, eat smaller portions, and avoid lying down after eating.
Elevating the head of the bed and light exercise are beneficial.
5. You have noted the presence of crepitus on examination of a patient with a musculoskeletal
complaint. Additionally, there is limited range of motion with both active and passive movement.
These findings suggest that the origin of the musculoskeletal complaint is:
A) Muscular
B) Articular
C) Tendon-related
D) Neurological
Correct Answer: B) Articular
Explanation: Crepitus (joint sounds) and limited range of motion with both active and passive
movement suggest an articular (joint) pathology, such as osteoarthritis or rheumatoid arthritis,
affecting the joint surfaces or capsule.
, 6. A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and
constipation for the past 3 months. On physical exam, the clinician notices a sinus bradycardia,
muscular stiffness, coarse, dry hair, and a delay in relaxation in deep tendon reflexes (DTRs).
Which of the following tests should be ordered next?
A) Thyroid-stimulating hormone (TSH)
B) Complete blood count (CBC)
C) Fasting glucose
D) Serum electrolytes
Correct Answer: A) Thyroid-stimulating hormone (TSH)
Explanation: The symptoms and signs (fatigue, cold intolerance, weight gain, constipation,
bradycardia, delayed DTRs) strongly suggest hypothyroidism. TSH is the first test to order, with
elevated TSH confirming primary hypothyroidism.
7. Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of
acute low back pain and muscle spasm along with a normal neurological examination. As the
clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the
following symptoms would alert the clinician to the more serious finding of a herniated nucleus
pulposus or disc?
A) Morning stiffness lasting 30 minutes
B) Pain radiating to the leg with a positive straight leg raise
C) Localized tenderness over the lumbar spine
D) Relief with rest and NSAIDs
Correct Answer: B) Pain radiating to the leg with a positive straight leg raise
Explanation: A herniated disc often causes radicular pain (sciatica) radiating to the leg and a
positive straight leg raise test due to nerve root compression, indicating a more serious condition
than simple low back strain.
8. Which of the following data is indicative of testicular torsion?
A) Gradual onset of scrotal pain
B) Fever and dysuria
C) Sudden, severe testicular pain and absent cremasteric reflex
D) Painless scrotal swelling
Care Practicum Final Exam 2025| Actual
Exam Questions and Correct Answers
1. Which test is used to confirm a diagnosis of epididymitis?
A) Scrotal ultrasound
B) Urine culture
C) CT scan of the pelvis
D) Serum PSA level
Correct Answer: A) Scrotal ultrasound
Explanation: Scrotal ultrasound is the primary imaging test to confirm epididymitis, showing
epididymal swelling and increased blood flow. It helps differentiate epididymitis from testicular
torsion, a critical differential diagnosis. Urine culture may identify causative organisms but is not
confirmatory alone.
2. Which of the following is part of the treatment plan for the patient with irritable bowel
syndrome (IBS)?
A) High-dose corticosteroids
B) Dietary modification and symptom management
C) Long-term antibiotic therapy
D) Immediate surgical intervention
Correct Answer: B) Dietary modification and symptom management
Explanation: IBS treatment focuses on dietary modifications (e.g., low FODMAP diet), stress
management, and symptom-specific therapies (e.g., antispasmodics, fiber). Corticosteroids, long-
term antibiotics, and surgery are not standard treatments for IBS.
3. Reuben, age 24 years old, has HIV and just had a routine viral load test done. The results show
a falling viral load. What does this indicate?
A) Worsening disease progression
,B) Effective antiretroviral therapy (ART)
C) Need for immediate hospitalization
D) Development of drug-resistant HIV
Correct Answer: B) Effective antiretroviral therapy (ART)
Explanation: A falling viral load in an HIV patient indicates that ART is effectively
suppressing viral replication, improving immune function. It does not suggest worsening disease,
hospitalization, or resistance unless other clinical signs are present.
4. The patient with gastroesophageal reflux disease (GERD) should be instructed to eliminate
which of these activities?
A) Eating large meals
B) Drinking water with meals
C) Engaging in light exercise
D) Sleeping with the head elevated
Correct Answer: A) Eating large meals
Explanation: Large meals can exacerbate GERD by increasing gastric pressure and acid
reflux. Patients should avoid large meals, eat smaller portions, and avoid lying down after eating.
Elevating the head of the bed and light exercise are beneficial.
5. You have noted the presence of crepitus on examination of a patient with a musculoskeletal
complaint. Additionally, there is limited range of motion with both active and passive movement.
These findings suggest that the origin of the musculoskeletal complaint is:
A) Muscular
B) Articular
C) Tendon-related
D) Neurological
Correct Answer: B) Articular
Explanation: Crepitus (joint sounds) and limited range of motion with both active and passive
movement suggest an articular (joint) pathology, such as osteoarthritis or rheumatoid arthritis,
affecting the joint surfaces or capsule.
, 6. A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and
constipation for the past 3 months. On physical exam, the clinician notices a sinus bradycardia,
muscular stiffness, coarse, dry hair, and a delay in relaxation in deep tendon reflexes (DTRs).
Which of the following tests should be ordered next?
A) Thyroid-stimulating hormone (TSH)
B) Complete blood count (CBC)
C) Fasting glucose
D) Serum electrolytes
Correct Answer: A) Thyroid-stimulating hormone (TSH)
Explanation: The symptoms and signs (fatigue, cold intolerance, weight gain, constipation,
bradycardia, delayed DTRs) strongly suggest hypothyroidism. TSH is the first test to order, with
elevated TSH confirming primary hypothyroidism.
7. Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of
acute low back pain and muscle spasm along with a normal neurological examination. As the
clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the
following symptoms would alert the clinician to the more serious finding of a herniated nucleus
pulposus or disc?
A) Morning stiffness lasting 30 minutes
B) Pain radiating to the leg with a positive straight leg raise
C) Localized tenderness over the lumbar spine
D) Relief with rest and NSAIDs
Correct Answer: B) Pain radiating to the leg with a positive straight leg raise
Explanation: A herniated disc often causes radicular pain (sciatica) radiating to the leg and a
positive straight leg raise test due to nerve root compression, indicating a more serious condition
than simple low back strain.
8. Which of the following data is indicative of testicular torsion?
A) Gradual onset of scrotal pain
B) Fever and dysuria
C) Sudden, severe testicular pain and absent cremasteric reflex
D) Painless scrotal swelling
