NR511 | NR511 Differential Diagnosis & Primary
Care Exam 2 v2 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 24-year-old patient presents with a single, large, oval, pinkish-red patch on the trunk,
followed a week later by a ‘Christmas tree’ distribution of smaller lesions. What is the most
likely diagnosis?
A. Pityriasis Rosea
B. Tinea Corporis
C. Psoriasis
D. Atopic Dermatitis
Correct Answer: A
Expert Explanation: Pityriasis Rosea typically begins with a solitary herald patch before
spreading in a characteristic distribution. The secondary rash often follows the cleavage
lines of the skin, creating a Christmas tree pattern. This condition is usually self-limiting
and requires only symptomatic treatment.
2. Which of the following findings is most diagnostic for Acute Otitis Media (AOM)?
A. Erythema of the tympanic membrane without bulging
B. Bulging of the tympanic membrane with impaired mobility
C. Fluid behind the tympanic membrane with a neutral position
D. Presence of a small amount of cerumen in the canal
Correct Answer: B
Expert Explanation: Bulging of the tympanic membrane is the most specific sign of acute
inflammation in the middle ear. A neutral or retracted membrane often points toward otitis
media with effusion rather than an acute infection. Effective diagnosis requires assessing
both the position and the mobility of the membrane.
3. A patient presents with a ‘honey-crusted’ lesion around the nose and mouth. What is the
primary treatment for this condition if it is localized?
A. Topical Mupirocin
B. Oral Amoxicillin
C. Oral Acyclovir
,D. Topical Hydrocortisone
Correct Answer: A
Expert Explanation: Honey-crusted lesions are a hallmark sign of impetigo, which is
commonly caused by Staphylococcus aureus or Streptococcus pyogenes. For localized
infections, topical antibiotics like Mupirocin are the first-line treatment. Systemic
antibiotics are generally reserved for widespread cases or complications.
4. According to the Centor Criteria, which of the following patients is MOST likely to have
Group A Beta-Hemolytic Streptococcal (GABHS) pharyngitis?
A. A patient with cough, rhinorrhea, and conjunctivitis
B. A patient with fever, tonsillar exudates, and absent cough
C. A patient with a sore throat and diffuse maculopapular rash
D. A patient with a scratchy throat and hoarseness
Correct Answer: B
Expert Explanation: The Centor Criteria help clinicians estimate the probability of a
bacterial cause for a sore throat. Key criteria include fever, tonsillar exudates, tender
anterior cervical lymphadenopathy, and the absence of a cough. Viral infections are more
likely when symptoms like cough and rhinorrhea are present.
5. A 60-year-old patient presents with a pearly papule on the face that has telangiectasias
and a central ulceration. What should the clinician suspect?
A. Actinic Keratosis
B. Malignant Melanoma
C. Basal Cell Carcinoma
D. Squamous Cell Carcinoma
Correct Answer: C
Expert Explanation: Basal Cell Carcinoma (BCC) is the most common form of skin cancer
and often appears as a pearly or waxy bump. Telangiectasias and a ‘rodent ulcer’ central
depression are classic clinical features. While it rarely metastasizes, it can be locally
invasive and requires surgical excision or referral.
6. When evaluating a patient for Sinusitis, at what point are antibiotics typically
recommended?
A. Immediately upon the onset of nasal congestion
B. As soon as the patient reports green nasal discharge
C. When symptoms have lasted more than 10 days without improvement
, D. Only if the patient has a history of seasonal allergies
Correct Answer: C
Expert Explanation: Most cases of rhinosinusitis are viral in origin and do not require
antibiotics. Guidelines recommend watchful waiting unless symptoms persist for more
than 10 days, involve high fever, or show ‘double worsening.’ This approach helps reduce
unnecessary antibiotic resistance in the community.
7. A patient presents with intense itching that is worse at night and small burrows in the
finger webs. What is the gold standard for diagnosis?
A. Clinical observation alone
B. Skin scraping for microscopic examination
C. Wood’s lamp examination
D. Fungal culture
Correct Answer: B
Expert Explanation: Scabies is caused by a mite that burrows into the skin, causing severe
nocturnal pruritus. Skin scraping of the burrows and visualizing the mites, eggs, or feces
under a microscope confirms the diagnosis. Permethrin cream is the standard treatment
for the patient and their close contacts.
8. Which of the following is a classic sign of Bacterial Conjunctivitis?
A. Watery discharge with significant itching
B. Purulent discharge with eyelids ‘glued shut’ in the morning
C. Cobblestone papillae under the upper eyelid
D. Unilateral redness with severe eye pain and blurred vision
Correct Answer: B
Expert Explanation: Bacterial conjunctivitis typically presents with thick, purulent
discharge that causes the eyelids to stick together. In contrast, viral conjunctivitis usually
presents with watery discharge, and allergic conjunctivitis is characterized by intense
itching. Severe pain or vision loss should prompt an immediate referral for more serious
conditions.
9. A 45-year-old patient reports a sudden onset of ‘the worst headache of my life.’ What is
the most appropriate next step?
A. Prescribe a triptan for migraine relief
B. Recommend a cool compress and dark room
C. Start a trial of NSAIDs and follow up in 24 hours
Care Exam 2 v2 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 24-year-old patient presents with a single, large, oval, pinkish-red patch on the trunk,
followed a week later by a ‘Christmas tree’ distribution of smaller lesions. What is the most
likely diagnosis?
A. Pityriasis Rosea
B. Tinea Corporis
C. Psoriasis
D. Atopic Dermatitis
Correct Answer: A
Expert Explanation: Pityriasis Rosea typically begins with a solitary herald patch before
spreading in a characteristic distribution. The secondary rash often follows the cleavage
lines of the skin, creating a Christmas tree pattern. This condition is usually self-limiting
and requires only symptomatic treatment.
2. Which of the following findings is most diagnostic for Acute Otitis Media (AOM)?
A. Erythema of the tympanic membrane without bulging
B. Bulging of the tympanic membrane with impaired mobility
C. Fluid behind the tympanic membrane with a neutral position
D. Presence of a small amount of cerumen in the canal
Correct Answer: B
Expert Explanation: Bulging of the tympanic membrane is the most specific sign of acute
inflammation in the middle ear. A neutral or retracted membrane often points toward otitis
media with effusion rather than an acute infection. Effective diagnosis requires assessing
both the position and the mobility of the membrane.
3. A patient presents with a ‘honey-crusted’ lesion around the nose and mouth. What is the
primary treatment for this condition if it is localized?
A. Topical Mupirocin
B. Oral Amoxicillin
C. Oral Acyclovir
,D. Topical Hydrocortisone
Correct Answer: A
Expert Explanation: Honey-crusted lesions are a hallmark sign of impetigo, which is
commonly caused by Staphylococcus aureus or Streptococcus pyogenes. For localized
infections, topical antibiotics like Mupirocin are the first-line treatment. Systemic
antibiotics are generally reserved for widespread cases or complications.
4. According to the Centor Criteria, which of the following patients is MOST likely to have
Group A Beta-Hemolytic Streptococcal (GABHS) pharyngitis?
A. A patient with cough, rhinorrhea, and conjunctivitis
B. A patient with fever, tonsillar exudates, and absent cough
C. A patient with a sore throat and diffuse maculopapular rash
D. A patient with a scratchy throat and hoarseness
Correct Answer: B
Expert Explanation: The Centor Criteria help clinicians estimate the probability of a
bacterial cause for a sore throat. Key criteria include fever, tonsillar exudates, tender
anterior cervical lymphadenopathy, and the absence of a cough. Viral infections are more
likely when symptoms like cough and rhinorrhea are present.
5. A 60-year-old patient presents with a pearly papule on the face that has telangiectasias
and a central ulceration. What should the clinician suspect?
A. Actinic Keratosis
B. Malignant Melanoma
C. Basal Cell Carcinoma
D. Squamous Cell Carcinoma
Correct Answer: C
Expert Explanation: Basal Cell Carcinoma (BCC) is the most common form of skin cancer
and often appears as a pearly or waxy bump. Telangiectasias and a ‘rodent ulcer’ central
depression are classic clinical features. While it rarely metastasizes, it can be locally
invasive and requires surgical excision or referral.
6. When evaluating a patient for Sinusitis, at what point are antibiotics typically
recommended?
A. Immediately upon the onset of nasal congestion
B. As soon as the patient reports green nasal discharge
C. When symptoms have lasted more than 10 days without improvement
, D. Only if the patient has a history of seasonal allergies
Correct Answer: C
Expert Explanation: Most cases of rhinosinusitis are viral in origin and do not require
antibiotics. Guidelines recommend watchful waiting unless symptoms persist for more
than 10 days, involve high fever, or show ‘double worsening.’ This approach helps reduce
unnecessary antibiotic resistance in the community.
7. A patient presents with intense itching that is worse at night and small burrows in the
finger webs. What is the gold standard for diagnosis?
A. Clinical observation alone
B. Skin scraping for microscopic examination
C. Wood’s lamp examination
D. Fungal culture
Correct Answer: B
Expert Explanation: Scabies is caused by a mite that burrows into the skin, causing severe
nocturnal pruritus. Skin scraping of the burrows and visualizing the mites, eggs, or feces
under a microscope confirms the diagnosis. Permethrin cream is the standard treatment
for the patient and their close contacts.
8. Which of the following is a classic sign of Bacterial Conjunctivitis?
A. Watery discharge with significant itching
B. Purulent discharge with eyelids ‘glued shut’ in the morning
C. Cobblestone papillae under the upper eyelid
D. Unilateral redness with severe eye pain and blurred vision
Correct Answer: B
Expert Explanation: Bacterial conjunctivitis typically presents with thick, purulent
discharge that causes the eyelids to stick together. In contrast, viral conjunctivitis usually
presents with watery discharge, and allergic conjunctivitis is characterized by intense
itching. Severe pain or vision loss should prompt an immediate referral for more serious
conditions.
9. A 45-year-old patient reports a sudden onset of ‘the worst headache of my life.’ What is
the most appropriate next step?
A. Prescribe a triptan for migraine relief
B. Recommend a cool compress and dark room
C. Start a trial of NSAIDs and follow up in 24 hours
