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NR511 FINAL EXAM STUDY GUIDE 2026/2027| Differential Diagnosis & Primary Care Practicum | 200+ Ques

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 5 pages. Originally published on StudyMerit.

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5
Academic year
2025/2026
Language
English

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NRSI1 FINAL EXAM STUDY GUIDE 2026/2027 | Differential Diagnosis & Primary Care Practicum | 200+ Questions & Verified Answers | Chamberlain | Pass Guaranteed - A+ Graded Q1: A 58-year-old male presents with substemal chest pressure radiating to his left arm, occurring with exertion and relieved by rest. He has a history of hypertension and hyperlipidemia. Vital signs are stable. EKG shows 1 mm ST depression in leads V4-V6 during pain that resolves with rest. Troponin is negative. What is the most likely diagnosis? A. Acute myocardial infarction B. Stable angina pectoris C. Unstable angina D. Costochondritis Correct Answer: 8 Rationale: Correct: This patient presents with classic exertional chest pain that is relieved by rest, consistent with stable angina pectoris. The pain is substernal with radiation to the left arm, occurs with exertion, and is associated with transient EKG changes (ST depression in leads V4-V6 representing lateral wall ischemia) that resolve when the pain subsides. The negative troponin indicates no myocardial necrosis has occurred. Stable angina is predictable, occurs with similar levels of exertion, and is relieved by rest or nitroglycerin within minutes. Incorrect Options: A: Acute MI would show elevated troponins and persistent EKG changes; this patient's pain is relieved by rest and troponin is negative. C. Unstable angina presents with pain at rest, new-onset severe pain, or increasing frequency/severity of previously stable angina (crescendo pattern); this patient's symptoms are predictable and exertional. D: Costochondritis

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causes reproducible chest wall pain with palpation, not exertional pressure with EKG changes. Clinical Pearl The "4 Es” of angina pectoris: Exertion, Emotional stress, Eating, Exposure to cold. ST depression indicates subendocardial ischemia; ST elevation indicates transmural injury. Guideline Reference: 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Q2: A 45-year-old female with a history of migraines presents with sudden onset ‘worst headache of my life’ that peaked within seconds. She has nuchal rigidity and photophobia. CT scan shows subarachnoid hemorrhage. What is the most appropriate next step in management? A. Lumbar puncture to confirm diagnosis B. Immediate neurosurgical consultation C. Start sumatriptan for migraine abortive therapy D. Administer oral acetaminophen and observe Correct Answer: 8 Rationale: Correct: This patient presents with a classic "thunderclap headache’ (sudden onset, severe, peaks within seconds) with meningeal signs (nuchal rigidity, photophobia) and CT-confirmed subarachnoid hemorrhage (SAH). Immediate neurosurgical consultation is critical because the most common cause is a ruptured cerebral aneurysm, which requires urgent intervention (clipping or coiling) to prevent rebleeding, the leading cause of death in SAH. Blood in the subarachnoid space irritates meninges causing meningeal signs. Incorrect Options: A: Lumbar puncture is contraindicated with confirmed SAH on CT and may precipitate herniation; it is only used when CT is negative but suspicion remains high. C: Triptans are contraindicated in SAH and thunderclap headaches; they are vasoconstrictors that could worsen cerebral ischemia. D: Observation is inappropriate; SAH has 40-50% mortality, with highest risk in

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