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NR 511/ NR511 MIDTERM EXAM: (NEW 2025/ 2026
UPDATE) DIFFERENTIAL DIAGNOSIS AND PRIMARY CARE
PRACTICUM REVIEW| QUESTIONS & ANSWERS| GRADE A|
100% CORRECT (VERIFIED SOLUTIONS)- CHAMBERLAIN
You suspect that Harry has a peptic ulcer and tell him that it has been found to be
strongly associated with:
1.Anxiety and panic attacks.
2.Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs).
3.Infection by Helicobacter pylori.
4.A family history of peptic ulcers. - ANS ✓Infection by H. Pylori
rationale: About 90% of cases of peptic ulcers have been found to be caused by infection
with the bacteria H pylori
You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and
plan to treat her empirically. What medications should you order?
1.A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole
(Flagyl).
2.Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec).
3.Amoxicillin (Amoxil) and omeprazole (Prilosec).
4.Clarithromycin (Biaxin) and metronidazole (Flagyl) - ANS ✓Amoxicillin (Amoxil) and
omeprazole (Prilosec)
rationale: Both drugs listed are used in the eradication of H pylori, but do not complete
the regimen.
A 7-year-old male presents with his mother to the urgent care clinic complaining of
abdominal pain. He started to complain of pain prior to going to bed; however, it has
gotten progressively worse and is now preventing him from sleeping. He is nauseous but
hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is
complaining of right-sided abdominal pain. His vitals are as follows: blood pressure
130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical
exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a
white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis?
1.Appendicitis.
2.Cholecystitis.
3.Constipation.
4.Gastroenteritis - ANS ✓appendicitis
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rationale: This is the clinical scenario typical for appendicitis
What is the recommended treatment to eradicate a Helicobacter pylori infection?
1.Ranitidine, amoxicillin, and clarithromycin for 2 weeks.
2.Amoxicillin, clarithromycin, and omeprazole for 2 weeks.
3.Bismuth, amoxicillin, and clarithromycin for 2 weeks.
4.Bismuth, doxycycline, metronidazole, and ranitidine. - ANS ✓Amoxicillin,
clarithromycin, and omeprazole for 2 weeks
rationale: This is the recommended treatment to eradicate H pylori.
A 50-year-old female presents to the urgent care clinic complaining of left lower
quadrant pain. She has associated nausea and vomiting, and her vital signs are as
follows: temperature 102.5°F, pulse 110, blood pressure 150/90, pulse oximetry 99% on
room air. What is the best test to evaluate this patient?
1.Sigmoidoscopy.
2.Abdominal series.
3.Computed tomography (CT) scan with oral contrast.
4.Abdominal ultrasound. - ANS ✓Computed tomography (CT) scan with oral contrast
rationale: This is the best diagnostic choice. While diverticulitis is likely the cause of the
patient's symptoms, a CT of the abdomen would show if the patient has any gynecologic
etiology (such as ovarian cyst or tumor) of this pain
Which gastrointestinal disease below could theoretically be completely eradicated with a
total colectomy?
1.Crohn's disease.
2.Irritable bowel syndrome.
3.Ulcerative colitis.
4.Celiac disease - ANS ✓Ulcerative Colitis
rationale: Ulcerative colitis is a disease only of the colon. While it is not the first
treatment choice, total colectomy is a treatment option that can completely resolve this
problem
The screening guidelines for colon cancer recommend which of the following for the
general population?
1.Colonoscopy starting at age 50.
2.Colonoscopy starting at age 45.
3.Fecal occult blood test (FOBT) and rectal exam starting at age 50.
4.Fecal occult blood test (FOBT) and rectal exam starting at age 45. - ANS
✓Colonoscopy after age 50
rationale: This is the recommended age to start colonoscopic examination in someone
with a low risk for colon cancer
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Which of the following is not a risk factor for cholecystitis?
1.Female gender.
2.Obesity.
3.Sickle cell anemia.
4.Younger age - ANS ✓Younger age
rationale: The risk of cholecystitis actually increases with age
A 54-year-old female presents to your primary care office for routine reevaluation for
gastroesophageal reflux disease (GERD). She has been treated with diet modifications
and 6 weeks of omeprazole without improvement of her symptoms. What is the next
step in management of this patient's GERD?
1.Order an endoscopy.
2.Order a Helicobacter pylori blood test.
3.Try adding ranitidine to the patient's regimen.
4.Try adding bismuth to the patient's regimen. - ANS ✓Order an endoscopy
rationale: This is the next step in treatment in order to evaluate the etiology of the
patient's GERD and consider biopsy if necessary
A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this
morning with a dark area of redness in his eye. He has no visual loss or changes. He
denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness
presents on physical exam as a dark red area in the patient's sclera of the right eye only
and takes up less than 50% of the eye. The patient's remaining sclera is clear and white.
He also notes he was drinking alcohol last night and vomited afterward. What is the
best treatment?
1.Topical steroids and close follow-up with an ophthalmologist.
2.Sending the patient to the emergency department for immediate ophthalmology
consult.
3.Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
4.Cold compresses and frequent handwashing - ANS ✓Reassurance that this lesion will
resolve without any treatment in 2 to 4 weeks.
rationale: This is the classic presentation of a subconjunctival hemorrhage. It will
resolve without treatment in 2 to 4 weeks. Vomiting probably caused his hemorrhage
Which of the following statements about macular degeneration is not true?
1.Macular degeneration is characterized by gradual loss of peripheral vision.
2.Macular degeneration is the leading cause of blindness in people younger than 60.
3.Tobacco use is a risk factor for macular degeneration.
4.There are 2 different types of macular degeneration: wet and dry - ANS ✓Macular
degeneration is characterized by gradual loss of peripheral vision
rationale: This is how open-angle glaucoma is characterized. Macular degeneration is
gradual loss of central vision
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A 75-year-old female presents to your office complaining of dizziness and hearing loss.
The patient states she awoke yesterday with dizziness, which she described as feeling the
room spinning. She also notes intermittent ringing in her ears. On physical exam, the
patient has lateralization of her hearing loss to the unaffected ear. Rinne test shows air
conduction lasts longer than bone conduction. What is the next step in helping this
patient's symptoms?
1.Order a computed tomography (CT) scan to rule out acoustic neuroma.
2.Start her on high-dose Augmentin.
3.Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo
attacks.
4.Immediate referral to an ear, nose, and throat (ENT) specialist - ANS ✓Start the
patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks
rationale: This is the treatment for symptoms of Meniere disease. You would also want
to consider an ear, nose, and throat consult to rule out other etiologies of the patient's
symptoms. Meniere disease is diagnosed based on history and the exclusion of other
conditions as well
What is the most common bacterial pathogen associated with acute otitis media?
1.Streptococcus pneumoniae.
2.Haemophilus influenzae.
3.Streptococcus pyogenes.
4.Moraxella (Branhamella) catarrhalis. - ANS ✓Streptococcus pneumoniae
rationale: This causes 40% to 50% of cases.
A 20-year-old male presents to your primary care clinic. This patient is a college
student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On
physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and
throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils
bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has
inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear
lung exam. What is his most likely diagnosis?
1.Viral pharyngitis.
2.Mononucleosis.
3.Streptococcal pharyngitis.
4.Upper respiratory infection - ANS ✓Mono
rationale: This presentation could be a viral pharyngitis; however, with posterior
cervical lymphadenitis, you would suspect mononucleosis.
The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure
in children is:
1.Amoxicillin (Amoxil).
2.Amoxicillin and potassium clavulanate (Augmentin).
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