NP NP Diagnosis & Clinical Decision-Making 1 — Questions and Answers
Question 1: A 55-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea for 45 minutes. His ECG shows ST elevations in leads II, III, and aVF. The NP should suspect:
- Stable angina pectoris
- Inferior ST-elevation myocardial infarction (STEMI) (Correct answer)
- Acute pericarditis
- Pulmonary embolism
Correct answer: Inferior ST-elevation myocardial infarction (STEMI)
ST elevations in leads II, III, and aVF indicate inferior STEMI, most commonly caused by right coronary artery occlusion, requiring immediate reperfusion therapy.
Question 2: A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' After ruling out trauma, what is the most critical diagnosis to exclude?
- Migraine with aura
- Subarachnoid hemorrhage (Correct answer)
- Tension headache
- Cluster headache
Correct answer: Subarachnoid hemorrhage
A thunderclap headache reaching maximal intensity within seconds is the classic presentation of subarachnoid hemorrhage, a life-threatening emergency.
Question 3: A 28-year-old female presents with dysuria, frequency, and urinary urgency. Urinalysis shows positive nitrites and leukocyte esterase. The most likely diagnosis is:
- Pyelonephritis
- Uncomplicated urinary tract infection (Correct answer)
- Interstitial cystitis
- Urethritis due to STI
Correct answer: Uncomplicated urinary tract infection
Dysuria, frequency, urgency, and a positive urinalysis in a non-pregnant young woman without systemic symptoms is consistent with uncomplicated lower UTI.
Question 4: A 65-year-old with a history of smoking presents with progressive dyspnea, chronic productive cough for 3 years, and barrel chest. Spirometry shows FEV1/FVC ratio of 0.62 post-bronchodilator. The most likely diagnosis is:
- Asthma
- COPD (Correct answer)
- Pulmonary fibrosis
- Congestive heart failure
Correct answer: COPD
A post-bronchodilator FEV1/FVC ratio below 0.70 confirms airflow obstruction consistent with COPD in this high-risk smoking patient.
Question 5: A patient presents with polyuria, polydipsia, polyphagia, and a random blood glucose of 320 mg/dL. What is the appropriate diagnosis?
- Pre-diabetes
- Diabetes mellitus (Correct answer)
- Diabetes insipidus
- Metabolic syndrome
Correct answer: Diabetes mellitus
A random plasma glucose ≥ 200 mg/dL with classic symptoms of hyperglycemia (3 Ps) meets the diagnostic criteria for diabetes mellitus.
Question 6: An NP evaluates a patient with symmetric joint pain, morning stiffness lasting more than one hour, and positive anti-CCP antibodies. The most likely diagnosis is:
- Osteoarthritis
- Rheumatoid arthritis (Correct answer)
- Gout
- Systemic lupus erythematosus
Correct answer: Rheumatoid arthritis
Symmetric polyarthritis, prolonged morning stiffness, and positive anti-CCP antibodies are hallmarks of rheumatoid arthritis.
NP NP Diagnosis & Clinical Decision-Making 1
A 55-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea for 45 minutes.
His ECG shows ST elevations in leads II, III, and aVF.
The NP should suspect: