NR511 | NR511 Differential Diagnosis & Primary
Care Final Exam v2 | Questions with Correct
Answers and Expert Explanation for Each Question
| Chamberlain
1. A 24-year-old female presents with a chief complaint of a ‘red eye’ for two days. She
reports watery discharge and a gritty sensation but denies any change in vision or significant
pain. On examination, there is bilateral conjunctival injection and preauricular
lymphadenopathy. What is the most likely diagnosis?
A. Bacterial conjunctivitis
B. Allergic conjunctivitis
C. Viral conjunctivitis
D. Acute angle-closure glaucoma
Correct Answer: C
Expert Explanation: Viral conjunctivitis is typically characterized by watery discharge and
is often associated with a recent upper respiratory infection. The presence of preauricular
lymphadenopathy is a clinical hallmark that helps distinguish viral from bacterial causes.
Management is generally supportive as the condition is self-limiting.
2. When evaluating a patient for sinusitis, which of the following ‘red flag’ symptoms would
necessitate an immediate referral or advanced imaging?
A. Periorbital edema and abnormal extraocular movements
B. Maxillary toothache
C. Purulent nasal discharge for 5 days
D. Hyposmia (reduced sense of smell)
Correct Answer: A
Expert Explanation: Periorbital edema and abnormal extraocular movements are signs of
orbital cellulitis, which is a serious complication of sinusitis. These symptoms indicate that
the infection may have spread beyond the sinuses into the orbital space or cranial cavity.
Immediate intervention is required to prevent vision loss or intracranial abscess.
3. A 12-year-old boy is brought in for ear pain. Physical exam reveals pain when pulling on the
pinna and a swollen, erythematous external auditory canal. The tympanic membrane is
partially visualized and appears mobile. What is the most appropriate initial treatment?
A. Oral Amoxicillin
B. Watchful waiting for 48 hours
,C. Oral Azithromycin
D. Topical Ciprofloxacin/Dexamethasone drops
Correct Answer: D
Expert Explanation: The clinical presentation is consistent with Otitis Externa, also known
as ‘swimmer’s ear.’ Topical antibiotic drops are the first-line treatment as they provide a
high concentration of medication directly to the infected tissue. Systemic antibiotics are
usually reserved for cases involving cellulitis of the pinna or immunocompromised
patients.
4. An adult patient presents with a sore throat, fever, and cervical lymphadenopathy. The
provider uses the Centor criteria to determine the likelihood of Group A Streptococcus (GAS).
Which of the following is NOT a component of the original Centor criteria?
A. Tonsillar exudate
B. Absence of cough
C. History of fever
D. Abdominal pain
Correct Answer: D
Expert Explanation: The Centor criteria include fever, tonsillar exudates, tender anterior
cervical lymphadenopathy, and the absence of a cough. While abdominal pain is common in
pediatric patients with strep throat, it is not a formal component of the Centor scoring
system. Scoring helps determine whether to perform rapid antigen testing or provide
empiric treatment.
5. Which of the following describes the correct technique for performing the Weber test?
A. Placing a vibrating tuning fork on the mastoid process
B. Placing a vibrating tuning fork 1 inch from the ear canal
C. Placing a vibrating tuning fork in the middle of the forehead
D. Using a whisper to check hearing acuity
Correct Answer: C
Expert Explanation: The Weber test is used to evaluate lateralization of sound by placing
a tuning fork on the midline of the head. In conductive hearing loss, the sound is heard
louder in the affected ear. In sensorineural hearing loss, the sound is heard louder in the
unaffected ear.
6. A 65-year-old patient reports gradual loss of peripheral vision, described as ‘tunnel vision.’
Intraocular pressure is measured at 26 mmHg. What is the most likely diagnosis?
A. Cataracts
, B. Age-related macular degeneration
C. Retinal detachment
D. Primary open-angle glaucoma
Correct Answer: D
Expert Explanation: Primary open-angle glaucoma is characterized by increased
intraocular pressure leading to progressive optic nerve damage and peripheral field loss.
Unlike acute glaucoma, it is usually painless and develops slowly over time. Cataracts
would present with cloudy vision, while macular degeneration affects central vision.
7. According to the GOLD criteria for COPD, which of the following is required for a definitive
diagnosis of airflow limitation?
A. Positive sputum culture
B. A pre-bronchodilator FEV1/FVC ratio < 0.80
C. Total Lung Capacity > 120%
D. A post-bronchodilator FEV1/FVC ratio < 0.70
Correct Answer: D
Expert Explanation: The diagnosis of COPD is confirmed by spirometry when the post-
bronchodilator FEV1/FVC ratio is less than 0.70. This indicates persistent airflow
obstruction that is not fully reversible. Clinical symptoms like dyspnea and chronic cough
further support the diagnosis.
8. A 30-year-old female presents with symptoms of asthma that occur 3-4 days per week. She
wakes up at night due to symptoms about 3 times per month. How would you classify her
asthma severity?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
Correct Answer: D
Expert Explanation: Mild persistent asthma is defined as symptoms occurring more than
2 days per week but not daily, and nighttime awakenings 3-4 times per month. This
classification is crucial for determining the appropriate step-up in pharmacological
therapy. For mild persistent asthma, a low-dose inhaled corticosteroid is typically
recommended.
Care Final Exam v2 | Questions with Correct
Answers and Expert Explanation for Each Question
| Chamberlain
1. A 24-year-old female presents with a chief complaint of a ‘red eye’ for two days. She
reports watery discharge and a gritty sensation but denies any change in vision or significant
pain. On examination, there is bilateral conjunctival injection and preauricular
lymphadenopathy. What is the most likely diagnosis?
A. Bacterial conjunctivitis
B. Allergic conjunctivitis
C. Viral conjunctivitis
D. Acute angle-closure glaucoma
Correct Answer: C
Expert Explanation: Viral conjunctivitis is typically characterized by watery discharge and
is often associated with a recent upper respiratory infection. The presence of preauricular
lymphadenopathy is a clinical hallmark that helps distinguish viral from bacterial causes.
Management is generally supportive as the condition is self-limiting.
2. When evaluating a patient for sinusitis, which of the following ‘red flag’ symptoms would
necessitate an immediate referral or advanced imaging?
A. Periorbital edema and abnormal extraocular movements
B. Maxillary toothache
C. Purulent nasal discharge for 5 days
D. Hyposmia (reduced sense of smell)
Correct Answer: A
Expert Explanation: Periorbital edema and abnormal extraocular movements are signs of
orbital cellulitis, which is a serious complication of sinusitis. These symptoms indicate that
the infection may have spread beyond the sinuses into the orbital space or cranial cavity.
Immediate intervention is required to prevent vision loss or intracranial abscess.
3. A 12-year-old boy is brought in for ear pain. Physical exam reveals pain when pulling on the
pinna and a swollen, erythematous external auditory canal. The tympanic membrane is
partially visualized and appears mobile. What is the most appropriate initial treatment?
A. Oral Amoxicillin
B. Watchful waiting for 48 hours
,C. Oral Azithromycin
D. Topical Ciprofloxacin/Dexamethasone drops
Correct Answer: D
Expert Explanation: The clinical presentation is consistent with Otitis Externa, also known
as ‘swimmer’s ear.’ Topical antibiotic drops are the first-line treatment as they provide a
high concentration of medication directly to the infected tissue. Systemic antibiotics are
usually reserved for cases involving cellulitis of the pinna or immunocompromised
patients.
4. An adult patient presents with a sore throat, fever, and cervical lymphadenopathy. The
provider uses the Centor criteria to determine the likelihood of Group A Streptococcus (GAS).
Which of the following is NOT a component of the original Centor criteria?
A. Tonsillar exudate
B. Absence of cough
C. History of fever
D. Abdominal pain
Correct Answer: D
Expert Explanation: The Centor criteria include fever, tonsillar exudates, tender anterior
cervical lymphadenopathy, and the absence of a cough. While abdominal pain is common in
pediatric patients with strep throat, it is not a formal component of the Centor scoring
system. Scoring helps determine whether to perform rapid antigen testing or provide
empiric treatment.
5. Which of the following describes the correct technique for performing the Weber test?
A. Placing a vibrating tuning fork on the mastoid process
B. Placing a vibrating tuning fork 1 inch from the ear canal
C. Placing a vibrating tuning fork in the middle of the forehead
D. Using a whisper to check hearing acuity
Correct Answer: C
Expert Explanation: The Weber test is used to evaluate lateralization of sound by placing
a tuning fork on the midline of the head. In conductive hearing loss, the sound is heard
louder in the affected ear. In sensorineural hearing loss, the sound is heard louder in the
unaffected ear.
6. A 65-year-old patient reports gradual loss of peripheral vision, described as ‘tunnel vision.’
Intraocular pressure is measured at 26 mmHg. What is the most likely diagnosis?
A. Cataracts
, B. Age-related macular degeneration
C. Retinal detachment
D. Primary open-angle glaucoma
Correct Answer: D
Expert Explanation: Primary open-angle glaucoma is characterized by increased
intraocular pressure leading to progressive optic nerve damage and peripheral field loss.
Unlike acute glaucoma, it is usually painless and develops slowly over time. Cataracts
would present with cloudy vision, while macular degeneration affects central vision.
7. According to the GOLD criteria for COPD, which of the following is required for a definitive
diagnosis of airflow limitation?
A. Positive sputum culture
B. A pre-bronchodilator FEV1/FVC ratio < 0.80
C. Total Lung Capacity > 120%
D. A post-bronchodilator FEV1/FVC ratio < 0.70
Correct Answer: D
Expert Explanation: The diagnosis of COPD is confirmed by spirometry when the post-
bronchodilator FEV1/FVC ratio is less than 0.70. This indicates persistent airflow
obstruction that is not fully reversible. Clinical symptoms like dyspnea and chronic cough
further support the diagnosis.
8. A 30-year-old female presents with symptoms of asthma that occur 3-4 days per week. She
wakes up at night due to symptoms about 3 times per month. How would you classify her
asthma severity?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
Correct Answer: D
Expert Explanation: Mild persistent asthma is defined as symptoms occurring more than
2 days per week but not daily, and nighttime awakenings 3-4 times per month. This
classification is crucial for determining the appropriate step-up in pharmacological
therapy. For mild persistent asthma, a low-dose inhaled corticosteroid is typically
recommended.
