APEA APEA Differential Diagnosis Questions and Answers 2 — Questions and Answers
Question 1: A 68-year-old presents with sudden painless monocular vision loss described as a 'curtain coming down.' The priority diagnosis is:
- Retinal detachment (Correct answer)
- Acute angle-closure glaucoma
- Central retinal artery occlusion
- Vitreous hemorrhage
Correct answer: Retinal detachment
A curtain or shadow descending over vision is the pathognomonic description of retinal detachment requiring emergency ophthalmology referral.
Question 2: A patient presents with burning epigastric pain relieved by eating, nocturnal awakening with pain, and melena. The most likely diagnosis is:
- Duodenal ulcer (Correct answer)
- Gastric ulcer
- GERD
- Gastritis
Correct answer: Duodenal ulcer
Duodenal ulcers classically cause pain relieved by eating (food buffers acid), with nocturnal pain and possible GI bleeding manifesting as melena.
Question 3: A 25-year-old woman presents with dysmenorrhea, dyspareunia, and infertility. Which diagnosis should be investigated?
- Endometriosis (Correct answer)
- Polycystic ovary syndrome
- Uterine fibroids
- Pelvic inflammatory disease
Correct answer: Endometriosis
The triad of dysmenorrhea, dyspareunia, and infertility in a reproductive-age woman is highly characteristic of endometriosis.
Question 4: A patient with known atrial fibrillation suddenly develops right arm weakness and expressive aphasia. The NP recognizes this as:
- Cardioembolic stroke (Correct answer)
- Lacunar infarct
- Hemorrhagic stroke
- TIA
Correct answer: Cardioembolic stroke
Atrial fibrillation is the most common cardiac source of emboli; sudden focal neurologic deficits in an AF patient indicate cardioembolic stroke until proven otherwise.
Question 5: An 18-year-old presents with pharyngitis, cervical lymphadenopathy, and splenomegaly. The most likely diagnosis is:
- Infectious mononucleosis (Correct answer)
- Streptococcal pharyngitis
- Lymphoma
- Tonsil abscess
Correct answer: Infectious mononucleosis
The triad of pharyngitis, posterior cervical lymphadenopathy, and splenomegaly in a young adult is classic for EBV-mediated infectious mononucleosis.
Question 6: A 72-year-old man with known BPH presents with inability to void, severe lower abdominal pain, and a palpable suprapubic mass. The diagnosis is:
- Acute urinary retention (Correct answer)
- Bladder cancer
- Renal calculus
- Cystitis
Correct answer: Acute urinary retention
Acute urinary retention presents with sudden inability to void, suprapubic pain, and a distended palpable bladder, commonly precipitated by BPH in older men.
APEA APEA Differential Diagnosis Questions and Answers 2
A 68-year-old presents with sudden painless monocular vision loss described as a 'curtain coming down.' The priority diagnosis is: