NR511 | NR511 Differential Diagnosis & Primary
Care Final Exam v3 | Questions with Correct
Answers and Expert Explanation for Each Question
| Chamberlain
1. A 45-year-old female presents with a ‘butterfly’ rash across her nose and cheeks, along
with telangiectasia. She notes that the redness worsens after drinking wine or eating spicy
food. What is the most likely diagnosis?
A. Systemic Lupus Erythematosus
B. Acne Vulgaris
C. Rosacea
D. Seborrheic Dermatitis
Correct Answer: C
Expert Explanation: The clinical presentation of a malar rash with telangiectasia triggered
by alcohol and spicy foods is classic for rosacea. Unlike acne, rosacea typically lacks
comedones and focuses on vascular reactivity. Systemic Lupus would generally present
with systemic symptoms and a positive ANA, while seborrheic dermatitis usually involves
the nasolabial folds and scales.
2. Which of the following criteria is part of the Centor score used to evaluate for Group A
Beta-Hemolytic Streptococcal (GABHS) pharyngitis?
A. Cough
B. Rhinitis
C. Presence of tonsillar exudates
D. Age over 50 years
Correct Answer: C
Expert Explanation: Tonsillar exudates are a primary component of the Centor score,
which helps determine the probability of a bacterial infection. Other components include
tender anterior cervical lymphadenopathy, history of fever, and the absence of a cough. A
score of 4 or higher indicates a high likelihood of Strep and warrants rapid testing or
empiric treatment.
3. An 18-year-old male presents with sudden onset of unilateral scrotal pain and swelling. On
exam, the Cremasteric reflex is absent on the affected side. What is the most appropriate
next step?
A. Prescribe Ceftriaxone and Doxycycline
,B. Instruct the patient to use an ice pack and scrotal support
C. Perform a Prehn sign maneuver and reassess in 24 hours
D. Order a scrotal ultrasound and consult urology immediately
Correct Answer: D
Expert Explanation: The absence of the Cremasteric reflex in a young male with sudden
scrotal pain is highly suggestive of testicular torsion. This is a surgical emergency that
requires immediate urological consultation to salvage the testicle. Delaying for imaging is
risky, but Doppler ultrasound is the diagnostic gold standard if the diagnosis is unclear.
4. When diagnosing asthma, which of the following results on spirometry indicates a positive
response to a bronchodilator?
A. An increase in FEV1 of >12% and 200 mL
B. A decrease in FEV1/FVC ratio by 10%
C. An increase in Peak Flow by 5%
D. A decrease in FVC of 200 mL
Correct Answer: A
Expert Explanation: A positive bronchodilator response is defined as an improvement in
FEV1 of at least 12% and an absolute increase of 200 mL. This reversibility is a hallmark of
asthma and helps distinguish it from COPD, which is generally irreversible. Clinicians use
this measurement to confirm the diagnosis and assess the effectiveness of treatment.
5. A patient presents with a painful, swollen great toe after a night of heavy drinking and red
meat consumption. What is the first-line treatment for this acute presentation?
A. Allopurinol
B. Probenecid
C. Oral Prednisone for 14 days
D. NSAIDs or Colchicine
Correct Answer: D
Expert Explanation: NSAIDs, Colchicine, and corticosteroids are the mainstays of
treatment for an acute gout flare. Allopurinol is used for chronic management and should
not be started during an acute attack as it can worsen the inflammation. Patient education
should focus on hydration and dietary modifications to prevent future occurrences.
6. Which physical exam finding is most indicative of Osteoarthritis rather than Rheumatoid
Arthritis?
A. Symmetrical joint swelling
, B. Ulnar deviation of the fingers
C. Bouchard’s nodes
D. Morning stiffness lasting more than 1 hour
Correct Answer: C
Expert Explanation: Bouchard’s nodes are bony enlargements of the proximal
interphalangeal joints commonly seen in osteoarthritis. Rheumatoid arthritis typically
presents with symmetrical swelling and morning stiffness that lasts significantly longer
than the few minutes seen in OA. Ulnar deviation is a late-stage deformity specifically
associated with the inflammatory processes of RA.
7. A 60-year-old smoker presents with a cough and dyspnea. Spirometry reveals an FEV1/FVC
ratio of 0.65. According to the GOLD guidelines, what is the classification?
A. Normal lung function
B. Asthma
C. Restrictive lung disease
D. COPD
Correct Answer: D
Expert Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the
diagnostic threshold for COPD according to GOLD guidelines. This indicates persistent
airflow limitation that is not fully reversible. Risk factors like smoking history and chronic
symptoms further support this diagnosis in a primary care setting.
8. What is the first-line pharmacotherapy for a patient diagnosed with mild-to-moderate
Depression?
A. Lithium
B. Selective Serotonin Reuptake Inhibitors (SSRIs)
C. Benzodiazepines
D. Tricyclic Antidepressants (TCAs)
Correct Answer: B
Expert Explanation: SSRIs are considered first-line treatment for depression due to their
favorable safety profile and efficacy. They generally have fewer side effects than older
classes like TCAs or MAOIs. Treatment should be combined with psychotherapy for the
best clinical outcomes in most patients.
Care Final Exam v3 | Questions with Correct
Answers and Expert Explanation for Each Question
| Chamberlain
1. A 45-year-old female presents with a ‘butterfly’ rash across her nose and cheeks, along
with telangiectasia. She notes that the redness worsens after drinking wine or eating spicy
food. What is the most likely diagnosis?
A. Systemic Lupus Erythematosus
B. Acne Vulgaris
C. Rosacea
D. Seborrheic Dermatitis
Correct Answer: C
Expert Explanation: The clinical presentation of a malar rash with telangiectasia triggered
by alcohol and spicy foods is classic for rosacea. Unlike acne, rosacea typically lacks
comedones and focuses on vascular reactivity. Systemic Lupus would generally present
with systemic symptoms and a positive ANA, while seborrheic dermatitis usually involves
the nasolabial folds and scales.
2. Which of the following criteria is part of the Centor score used to evaluate for Group A
Beta-Hemolytic Streptococcal (GABHS) pharyngitis?
A. Cough
B. Rhinitis
C. Presence of tonsillar exudates
D. Age over 50 years
Correct Answer: C
Expert Explanation: Tonsillar exudates are a primary component of the Centor score,
which helps determine the probability of a bacterial infection. Other components include
tender anterior cervical lymphadenopathy, history of fever, and the absence of a cough. A
score of 4 or higher indicates a high likelihood of Strep and warrants rapid testing or
empiric treatment.
3. An 18-year-old male presents with sudden onset of unilateral scrotal pain and swelling. On
exam, the Cremasteric reflex is absent on the affected side. What is the most appropriate
next step?
A. Prescribe Ceftriaxone and Doxycycline
,B. Instruct the patient to use an ice pack and scrotal support
C. Perform a Prehn sign maneuver and reassess in 24 hours
D. Order a scrotal ultrasound and consult urology immediately
Correct Answer: D
Expert Explanation: The absence of the Cremasteric reflex in a young male with sudden
scrotal pain is highly suggestive of testicular torsion. This is a surgical emergency that
requires immediate urological consultation to salvage the testicle. Delaying for imaging is
risky, but Doppler ultrasound is the diagnostic gold standard if the diagnosis is unclear.
4. When diagnosing asthma, which of the following results on spirometry indicates a positive
response to a bronchodilator?
A. An increase in FEV1 of >12% and 200 mL
B. A decrease in FEV1/FVC ratio by 10%
C. An increase in Peak Flow by 5%
D. A decrease in FVC of 200 mL
Correct Answer: A
Expert Explanation: A positive bronchodilator response is defined as an improvement in
FEV1 of at least 12% and an absolute increase of 200 mL. This reversibility is a hallmark of
asthma and helps distinguish it from COPD, which is generally irreversible. Clinicians use
this measurement to confirm the diagnosis and assess the effectiveness of treatment.
5. A patient presents with a painful, swollen great toe after a night of heavy drinking and red
meat consumption. What is the first-line treatment for this acute presentation?
A. Allopurinol
B. Probenecid
C. Oral Prednisone for 14 days
D. NSAIDs or Colchicine
Correct Answer: D
Expert Explanation: NSAIDs, Colchicine, and corticosteroids are the mainstays of
treatment for an acute gout flare. Allopurinol is used for chronic management and should
not be started during an acute attack as it can worsen the inflammation. Patient education
should focus on hydration and dietary modifications to prevent future occurrences.
6. Which physical exam finding is most indicative of Osteoarthritis rather than Rheumatoid
Arthritis?
A. Symmetrical joint swelling
, B. Ulnar deviation of the fingers
C. Bouchard’s nodes
D. Morning stiffness lasting more than 1 hour
Correct Answer: C
Expert Explanation: Bouchard’s nodes are bony enlargements of the proximal
interphalangeal joints commonly seen in osteoarthritis. Rheumatoid arthritis typically
presents with symmetrical swelling and morning stiffness that lasts significantly longer
than the few minutes seen in OA. Ulnar deviation is a late-stage deformity specifically
associated with the inflammatory processes of RA.
7. A 60-year-old smoker presents with a cough and dyspnea. Spirometry reveals an FEV1/FVC
ratio of 0.65. According to the GOLD guidelines, what is the classification?
A. Normal lung function
B. Asthma
C. Restrictive lung disease
D. COPD
Correct Answer: D
Expert Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the
diagnostic threshold for COPD according to GOLD guidelines. This indicates persistent
airflow limitation that is not fully reversible. Risk factors like smoking history and chronic
symptoms further support this diagnosis in a primary care setting.
8. What is the first-line pharmacotherapy for a patient diagnosed with mild-to-moderate
Depression?
A. Lithium
B. Selective Serotonin Reuptake Inhibitors (SSRIs)
C. Benzodiazepines
D. Tricyclic Antidepressants (TCAs)
Correct Answer: B
Expert Explanation: SSRIs are considered first-line treatment for depression due to their
favorable safety profile and efficacy. They generally have fewer side effects than older
classes like TCAs or MAOIs. Treatment should be combined with psychotherapy for the
best clinical outcomes in most patients.
