NR511 Differential Diagnosis & Primary Care Practicum Midterm 2026/2027 | Page 1 | Passing Score: 80%
CHAMBERLAIN UNIVERSITY
Midterm Exam: NR511
Differential Diagnosis & Primary Care Practicum
Official Guide 2026/2027
100 80% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Clinical Reasoning & Diagnostic Process Q1-Q20
Section 2 Common Chief Complaints in Primary Care Q21-Q40
Section 3 Chronic Disease Management Q41-Q60
Section 4 Special Populations (Pediatrics, Geriatrics, Pregnancy) Q61-Q80
Section 5 Health Maintenance & Evidence-Based Screening Q81-Q100
Instructions: Select the single best answer for each question. This exam is designed for Chamberlain NR511 Differential Diagnosis
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 1 of 52
, SECTION 1 | Clinical Reasoning & Diagnostic Process | Q1-Q20 | NR511 Differential Diagnosis 2026/2027
Q1 Question 1 of 100
A 52-year-old male presents to the primary care clinic with a 3-day history of substernal chest
pain that worsens with deep inspiration and improves when leaning forward. He recently
recovered from a viral upper respiratory infection. Vital signs are stable and auscultation
reveals a friction rub. What is the most likely diagnosis?
A. Acute pericarditis secondary to viral infection
B. Acute myocardial infarction due to coronary artery occlusion
C. Pulmonary embolism with right ventricular strain
D. Community-acquired pneumonia with pleural involvement
Correct Answer: A
Rationale:
Acute pericarditis classically presents with pleuritic chest pain that worsens with inspiration and improves
when leaning forward, often following a viral illness. A pericardial friction rub is the hallmark finding.
Myocardial infarction typically presents with crushing pain not affected by position or breathing.
Q2 Question 2 of 100
A 34-year-old female presents with diffuse abdominal pain, bloating, and alternating
constipation and diarrhea that has been present for 6 months. She denies weight loss, blood
in stool, or nighttime symptoms. Physical examination is unremarkable and basic laboratory
work is normal. What is the most appropriate next step in diagnosis?
A. Referring for colonoscopy to exclude inflammatory bowel disease
B. Ordering an abdominal CT scan to rule out structural disease
C. Making a clinical diagnosis of irritable bowel syndrome using Rome IV criteria
D. Ordering comprehensive stool studies to evaluate for malabsorption
Correct Answer: A
Rationale:
With chronic symptoms of abdominal pain and altered bowel habits without red flag symptoms (weight loss,
hematochezia, nocturnal symptoms), the Rome IV criteria support a clinical diagnosis of IBS without
extensive invasive testing. Normal labs and absence of alarm features make structural disease unlikely.
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 2 of 52
, SECTION 1 | Clinical Reasoning & Diagnostic Process | Q1-Q20 | NR511 Differential Diagnosis 2026/2027
Q3 Question 3 of 100
A 45-year-old male presents with acute onset of severe right lower quadrant abdominal pain,
nausea, and anorexia that began as periumbilical discomfort 12 hours ago. On examination,
there is localized tenderness at McBurney point with guarding and rebound tenderness. What
is the most likely diagnosis?
A. Acute gastroenteritis with diffuse abdominal involvement
B. Acute appendicitis with localized peritoneal signs
C. Diverticulitis affecting the right colon segment
D. Ruptured ovarian cyst with hemoperitoneum
Correct Answer: C
Rationale:
The classic presentation of acute appendicitis includes migratory pain from the periumbilical area to the right
lower quadrant at McBurney point, accompanied by nausea, anorexia, and localized peritoneal signs such
as guarding and rebound tenderness. This pattern is highly characteristic of appendicitis.
Q4 Question 4 of 100
A 67-year-old female presents with sudden onset of severe left lower quadrant abdominal
pain, low-grade fever, and constipation for 3 days. She has a history of prior episodes of
similar but milder pain. Her white blood cell count is 14,000 with a left shift. What is the most
likely diagnosis?
A. Acute appendicitis with early perforation
B. Ischemic colitis with transmural involvement
C. Acute diverticulitis with localized inflammation
D. Colorectal cancer with partial obstruction
Correct Answer: D
Rationale:
Left lower quadrant pain, fever, constipation, leukocytosis, and a history of prior similar episodes in an older
adult are classic for acute diverticulitis. The left side is most commonly affected in Western populations.
Appendicitis typically affects the right lower quadrant, and ischemic colitis often presents with bloody
diarrhea.
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 3 of 52
, SECTION 1 | Clinical Reasoning & Diagnostic Process | Q1-Q20 | NR511 Differential Diagnosis 2026/2027
Q5 Question 5 of 100
A 28-year-old female presents with a 2-week history of fatigue, weight gain, constipation, and
menorrhagia. On physical examination, her skin is dry and she has delayed deep tendon
reflexes. Her thyroid is enlarged and nontender. Which laboratory finding would most likely
confirm the diagnosis?
A. Elevated TSH with low free T4 indicating primary hypothyroidism
B. Low TSH with elevated free T4 indicating Graves disease
C. Normal TSH with elevated total T4 indicating thyroid binding protein excess
D. Elevated TSH with elevated free T4 indicating a TSH-secreting pituitary adenoma
Correct Answer: A
Rationale:
The clinical presentation of fatigue, weight gain, constipation, menorrhagia, dry skin, delayed reflexes, and
goiter is classic for primary hypothyroidism, which is confirmed by an elevated TSH and low free T4. The
elevated TSH reflects the pituitary response to insufficient thyroid hormone production.
Q6 Question 6 of 100
A 55-year-old male with a 30-pack-year smoking history presents with hemoptysis,
unintentional weight loss of 15 pounds over 2 months, and persistent cough. A chest
radiograph reveals a 3-cm spiculated mass in the right upper lobe. What is the most
appropriate next step in the diagnostic workup?
A. Obtaining a CT scan of the chest with contrast for further characterization and staging
B. Repeating the chest radiograph in 3 months to assess for interval growth
C. Starting empiric antibiotic therapy for possible community-acquired pneumonia
D. Ordering a ventilation-perfusion scan to evaluate for pulmonary embolism
Correct Answer: A
Rationale:
A spiculated lung mass with hemoptysis and weight loss in a smoker is highly suspicious for malignancy. CT
chest with contrast is the appropriate next step for characterization, staging, and planning biopsy. Waiting 3
months could delay critical diagnosis, and antibiotics are not appropriate for a mass.
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 4 of 52
CHAMBERLAIN UNIVERSITY
Midterm Exam: NR511
Differential Diagnosis & Primary Care Practicum
Official Guide 2026/2027
100 80% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Clinical Reasoning & Diagnostic Process Q1-Q20
Section 2 Common Chief Complaints in Primary Care Q21-Q40
Section 3 Chronic Disease Management Q41-Q60
Section 4 Special Populations (Pediatrics, Geriatrics, Pregnancy) Q61-Q80
Section 5 Health Maintenance & Evidence-Based Screening Q81-Q100
Instructions: Select the single best answer for each question. This exam is designed for Chamberlain NR511 Differential Diagnosis
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 1 of 52
, SECTION 1 | Clinical Reasoning & Diagnostic Process | Q1-Q20 | NR511 Differential Diagnosis 2026/2027
Q1 Question 1 of 100
A 52-year-old male presents to the primary care clinic with a 3-day history of substernal chest
pain that worsens with deep inspiration and improves when leaning forward. He recently
recovered from a viral upper respiratory infection. Vital signs are stable and auscultation
reveals a friction rub. What is the most likely diagnosis?
A. Acute pericarditis secondary to viral infection
B. Acute myocardial infarction due to coronary artery occlusion
C. Pulmonary embolism with right ventricular strain
D. Community-acquired pneumonia with pleural involvement
Correct Answer: A
Rationale:
Acute pericarditis classically presents with pleuritic chest pain that worsens with inspiration and improves
when leaning forward, often following a viral illness. A pericardial friction rub is the hallmark finding.
Myocardial infarction typically presents with crushing pain not affected by position or breathing.
Q2 Question 2 of 100
A 34-year-old female presents with diffuse abdominal pain, bloating, and alternating
constipation and diarrhea that has been present for 6 months. She denies weight loss, blood
in stool, or nighttime symptoms. Physical examination is unremarkable and basic laboratory
work is normal. What is the most appropriate next step in diagnosis?
A. Referring for colonoscopy to exclude inflammatory bowel disease
B. Ordering an abdominal CT scan to rule out structural disease
C. Making a clinical diagnosis of irritable bowel syndrome using Rome IV criteria
D. Ordering comprehensive stool studies to evaluate for malabsorption
Correct Answer: A
Rationale:
With chronic symptoms of abdominal pain and altered bowel habits without red flag symptoms (weight loss,
hematochezia, nocturnal symptoms), the Rome IV criteria support a clinical diagnosis of IBS without
extensive invasive testing. Normal labs and absence of alarm features make structural disease unlikely.
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 2 of 52
, SECTION 1 | Clinical Reasoning & Diagnostic Process | Q1-Q20 | NR511 Differential Diagnosis 2026/2027
Q3 Question 3 of 100
A 45-year-old male presents with acute onset of severe right lower quadrant abdominal pain,
nausea, and anorexia that began as periumbilical discomfort 12 hours ago. On examination,
there is localized tenderness at McBurney point with guarding and rebound tenderness. What
is the most likely diagnosis?
A. Acute gastroenteritis with diffuse abdominal involvement
B. Acute appendicitis with localized peritoneal signs
C. Diverticulitis affecting the right colon segment
D. Ruptured ovarian cyst with hemoperitoneum
Correct Answer: C
Rationale:
The classic presentation of acute appendicitis includes migratory pain from the periumbilical area to the right
lower quadrant at McBurney point, accompanied by nausea, anorexia, and localized peritoneal signs such
as guarding and rebound tenderness. This pattern is highly characteristic of appendicitis.
Q4 Question 4 of 100
A 67-year-old female presents with sudden onset of severe left lower quadrant abdominal
pain, low-grade fever, and constipation for 3 days. She has a history of prior episodes of
similar but milder pain. Her white blood cell count is 14,000 with a left shift. What is the most
likely diagnosis?
A. Acute appendicitis with early perforation
B. Ischemic colitis with transmural involvement
C. Acute diverticulitis with localized inflammation
D. Colorectal cancer with partial obstruction
Correct Answer: D
Rationale:
Left lower quadrant pain, fever, constipation, leukocytosis, and a history of prior similar episodes in an older
adult are classic for acute diverticulitis. The left side is most commonly affected in Western populations.
Appendicitis typically affects the right lower quadrant, and ischemic colitis often presents with bloody
diarrhea.
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 3 of 52
, SECTION 1 | Clinical Reasoning & Diagnostic Process | Q1-Q20 | NR511 Differential Diagnosis 2026/2027
Q5 Question 5 of 100
A 28-year-old female presents with a 2-week history of fatigue, weight gain, constipation, and
menorrhagia. On physical examination, her skin is dry and she has delayed deep tendon
reflexes. Her thyroid is enlarged and nontender. Which laboratory finding would most likely
confirm the diagnosis?
A. Elevated TSH with low free T4 indicating primary hypothyroidism
B. Low TSH with elevated free T4 indicating Graves disease
C. Normal TSH with elevated total T4 indicating thyroid binding protein excess
D. Elevated TSH with elevated free T4 indicating a TSH-secreting pituitary adenoma
Correct Answer: A
Rationale:
The clinical presentation of fatigue, weight gain, constipation, menorrhagia, dry skin, delayed reflexes, and
goiter is classic for primary hypothyroidism, which is confirmed by an elevated TSH and low free T4. The
elevated TSH reflects the pituitary response to insufficient thyroid hormone production.
Q6 Question 6 of 100
A 55-year-old male with a 30-pack-year smoking history presents with hemoptysis,
unintentional weight loss of 15 pounds over 2 months, and persistent cough. A chest
radiograph reveals a 3-cm spiculated mass in the right upper lobe. What is the most
appropriate next step in the diagnostic workup?
A. Obtaining a CT scan of the chest with contrast for further characterization and staging
B. Repeating the chest radiograph in 3 months to assess for interval growth
C. Starting empiric antibiotic therapy for possible community-acquired pneumonia
D. Ordering a ventilation-perfusion scan to evaluate for pulmonary embolism
Correct Answer: A
Rationale:
A spiculated lung mass with hemoptysis and weight loss in a smoker is highly suspicious for malignancy. CT
chest with contrast is the appropriate next step for characterization, staging, and planning biopsy. Waiting 3
months could delay critical diagnosis, and antibiotics are not appropriate for a mass.
NR511 Differential Diagnosis & Primary Care Practicum Midterm - 2026/2027 | Passing Score: 80% | Page 4 of 52
