NR511 Differential Diagnosis & Primary Care Practicum
Master Study Guide 2026 | Chamberlain FNP Exam Prep
Questions & Rationales
1) A 28-year-old female presents with sudden onset severe sore throat, fever 102°F,
tonsillar exudates, and tender anterior cervical lymphadenopathy. No cough. She
has a history of recurrent strep.
A. Viral pharyngitis
B. Streptococcal pharyngitis
C. Mononucleosis
D. Allergic rhinitis
Correct Answer: B
Rationale: This presentation aligns with Centor criteria (fever, tonsillar exudate,
tender LAD, no cough) scoring high for Group A Streptococcus (GAS). Rapid
antigen test or throat culture is warranted. First-line treatment is penicillin V or
amoxicillin per IDSA guidelines. Differential includes viral causes, but bacterial
features predominate. Red flags for complications like peritonsillar abscess include
trismus or uvular deviation. Always rule out GAS to prevent rheumatic fever;
supportive care for viral etiologies. In pediatrics, consider scarlet fever rash.
2) A patient presents with two office blood pressure readings of 148/92 mmHg and
152/94 mmHg. BMI is 31 kg/m². No diabetes, CKD, or heart failure.
,A. Lifestyle modifications alone for the next 6 months
B. Initiate a thiazide diuretic or calcium channel blocker
C. Start an ACE inhibitor or ARB immediately
D. Begin beta-blocker monotherapy
Correct Answer: B
Rationale: This represents stage 1 hypertension with elevated ASCVD risk.
ACC/AHA guidelines recommend initiating pharmacologic therapy with a
thiazide-type diuretic or calcium channel blocker in Black patients without HF or
CKD, alongside intensive lifestyle changes (DASH diet, sodium <1,500 mg/day,
≥150 min/week aerobic exercise, weight loss). Target BP is <130/80 mmHg.
ACEI/ARB are not first-line here due to reduced efficacy in this population.
Monitor electrolytes and renal function; evaluate for secondary causes if resistant.
3) A 4-year-old boy is brought in by his mother with fever, irritability, and pulling
at his right ear following a recent upper respiratory infection. Otoscopy reveals a
bulging, erythematous tympanic membrane with absent light reflex.
A. Otitis externa
B. Acute otitis media
C. Otitis media with effusion
D. Mastoiditis
Correct Answer: B
Rationale: This is a classic presentation of acute otitis media (AOM) in a pediatric
patient. AAP guidelines support diagnosis based on acute onset, middle ear
, effusion, and signs of inflammation. First-line treatment for severe cases or young
children is high-dose amoxicillin. Pain control with ibuprofen or acetaminophen is
essential. Watchful waiting may be appropriate in select older children with non-
severe illness. Red flags include post-auricular swelling or persistent high fever
suggesting mastoiditis. Prevention includes up-to-date vaccinations (PCV13,
influenza) and avoidance of secondhand smoke.
4) A patient with chronic hepatitis C presents for follow-up. Labs show elevated
ALT and platelet count of 90,000/µL.
A. Reassure and monitor annually
B. Order abdominal ultrasound and refer for HCV treatment
C. Start empiric interferon therapy
D. Order immediate liver biopsy
Correct Answer: B
Rationale: All patients with chronic HCV should receive direct-acting antiviral
therapy. Ultrasound screens for hepatocellular carcinoma and portal hypertension.
Thrombocytopenia suggests possible cirrhosis. FibroScan or serologic fibrosis
scores can further assess disease stage. Sustained virologic response markedly
reduces complications.
5) A 52-year-old male smoker presents with progressive hoarseness for 6 weeks, no
fever or cough. He reports occasional dysphagia.
A. Acute laryngitis
B. Vocal cord nodules
C. Laryngeal carcinoma
Master Study Guide 2026 | Chamberlain FNP Exam Prep
Questions & Rationales
1) A 28-year-old female presents with sudden onset severe sore throat, fever 102°F,
tonsillar exudates, and tender anterior cervical lymphadenopathy. No cough. She
has a history of recurrent strep.
A. Viral pharyngitis
B. Streptococcal pharyngitis
C. Mononucleosis
D. Allergic rhinitis
Correct Answer: B
Rationale: This presentation aligns with Centor criteria (fever, tonsillar exudate,
tender LAD, no cough) scoring high for Group A Streptococcus (GAS). Rapid
antigen test or throat culture is warranted. First-line treatment is penicillin V or
amoxicillin per IDSA guidelines. Differential includes viral causes, but bacterial
features predominate. Red flags for complications like peritonsillar abscess include
trismus or uvular deviation. Always rule out GAS to prevent rheumatic fever;
supportive care for viral etiologies. In pediatrics, consider scarlet fever rash.
2) A patient presents with two office blood pressure readings of 148/92 mmHg and
152/94 mmHg. BMI is 31 kg/m². No diabetes, CKD, or heart failure.
,A. Lifestyle modifications alone for the next 6 months
B. Initiate a thiazide diuretic or calcium channel blocker
C. Start an ACE inhibitor or ARB immediately
D. Begin beta-blocker monotherapy
Correct Answer: B
Rationale: This represents stage 1 hypertension with elevated ASCVD risk.
ACC/AHA guidelines recommend initiating pharmacologic therapy with a
thiazide-type diuretic or calcium channel blocker in Black patients without HF or
CKD, alongside intensive lifestyle changes (DASH diet, sodium <1,500 mg/day,
≥150 min/week aerobic exercise, weight loss). Target BP is <130/80 mmHg.
ACEI/ARB are not first-line here due to reduced efficacy in this population.
Monitor electrolytes and renal function; evaluate for secondary causes if resistant.
3) A 4-year-old boy is brought in by his mother with fever, irritability, and pulling
at his right ear following a recent upper respiratory infection. Otoscopy reveals a
bulging, erythematous tympanic membrane with absent light reflex.
A. Otitis externa
B. Acute otitis media
C. Otitis media with effusion
D. Mastoiditis
Correct Answer: B
Rationale: This is a classic presentation of acute otitis media (AOM) in a pediatric
patient. AAP guidelines support diagnosis based on acute onset, middle ear
, effusion, and signs of inflammation. First-line treatment for severe cases or young
children is high-dose amoxicillin. Pain control with ibuprofen or acetaminophen is
essential. Watchful waiting may be appropriate in select older children with non-
severe illness. Red flags include post-auricular swelling or persistent high fever
suggesting mastoiditis. Prevention includes up-to-date vaccinations (PCV13,
influenza) and avoidance of secondhand smoke.
4) A patient with chronic hepatitis C presents for follow-up. Labs show elevated
ALT and platelet count of 90,000/µL.
A. Reassure and monitor annually
B. Order abdominal ultrasound and refer for HCV treatment
C. Start empiric interferon therapy
D. Order immediate liver biopsy
Correct Answer: B
Rationale: All patients with chronic HCV should receive direct-acting antiviral
therapy. Ultrasound screens for hepatocellular carcinoma and portal hypertension.
Thrombocytopenia suggests possible cirrhosis. FibroScan or serologic fibrosis
scores can further assess disease stage. Sustained virologic response markedly
reduces complications.
5) A 52-year-old male smoker presents with progressive hoarseness for 6 weeks, no
fever or cough. He reports occasional dysphagia.
A. Acute laryngitis
B. Vocal cord nodules
C. Laryngeal carcinoma
