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NR511 Week 4 Midterm Exam
Study Guide 2026/2027 –
Differential Diagnosis & Primary
Care Practicum | Chamberlain
NR511 Week 4 Midterm Exam study guide for
Chamberlain University. Covers diagnostic reasoning,
OLDCARTS, SNAPPS, evidence-based practice, sensitivity
and specificity, E&M coding, skin disorders, eye
conditions, and ENT disorders. Includes clinical encounter
documentation and differential diagnosis frameworks.
Practice questions with detailed rationales for the
2026/2027 curriculum
Question 1: What does the "C" in the OLDCARTS mnemonic stand for when
assessing the history of present illness?
A) Cause
B) Character
C) Cough
D) Circulation
Answer: B) Character
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Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating
factors, Relieving factors, Timing, and Severity. "Character" refers to the quality or
nature of the symptom, such as whether pain is sharp, dull, burning, or throbbing. This
systematic framework ensures comprehensive characterization of the chief complaint
during the history of present illness .
Question 2: A 52-year-old man with a history of hypertension presents with
sudden onset of severe, tearing chest pain radiating to the back. Blood pressure
is 160/90 mm Hg in the right arm and 110/70 mm Hg in the left arm. What is
the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Esophageal rupture
Answer: C) Aortic dissection
Rationale: Tearing chest pain with a pulse differential between arms is classic for aortic
dissection. The sudden, severe nature of the pain and the significant difference in
systolic blood pressure readings support this diagnosis over acute MI, which typically
presents with crushing substernal pain and no pulse differential .
Question 3: A 35-year-old woman complains of episodic palpitations, sweating,
and headache. Her blood pressure is 180/100 mm Hg during an episode. What
is the most likely diagnosis?
A) Essential hypertension
B) Pheochromocytoma
C) Hyperthyroidism
D) Panic disorder
Answer: B) Pheochromocytoma
Rationale: Paroxysmal hypertension with palpitations, sweating, and headache is the
classic triad for pheochromocytoma. This catecholamine-secreting tumor of the adrenal
medulla causes episodic release of epinephrine and norepinephrine, leading to these
paroxysmal symptoms. Essential hypertension would not present with episodic severe
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elevations, and hyperthyroidism typically causes sustained tachycardia and heat
intolerance rather than paroxysmal hypertension .
Question 4: A 55-year-old man with a 40-pack-year smoking history presents
with new onset of hemoptysis, weight loss, and a persistent cough. Which
diagnosis should be highest on the differential?
A) Asthma
B) Bronchitis
C) Lung cancer
D) GERD
Answer: C) Lung cancer
Rationale: In a patient with a significant smoking history and hemoptysis, lung cancer
must be high on the differential. Hemoptysis is a red flag symptom that requires
prompt evaluation. Unexplained weight loss further increases suspicion for malignancy.
Asthma and bronchitis would not typically present with hemoptysis and significant
weight loss in this context .
Question 5: Which of the following is an example of tertiary prevention in a
patient with chronic renal failure?
A) Fluid restriction
B) Hemodialysis 4 days a week
C) High-protein diet
D) Maintenance of blood pressure at 120/80
Answer: B) Hemodialysis 4 days a week
Rationale: Tertiary prevention aims to manage established disease and prevent further
complications or disability. Hemodialysis is a treatment for end-stage renal disease
that falls under tertiary prevention. Fluid restriction, dietary modification, and blood
pressure control are secondary prevention measures aimed at slowing disease
progression in earlier stages .
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Question 6: Which ethnic group has the highest lung cancer incidence and
mortality rates?
A) African American men
B) Scandinavian men and women
C) Caucasian women
D) Asian men
Answer: A) African American men
Rationale: African American men have the highest lung cancer incidence and mortality
rates in the United States. This disparity is likely multifactorial, involving differences in
smoking patterns, access to healthcare, socioeconomic factors, and possibly genetic
susceptibility. This is a key epidemiological fact for primary care providers to recognize
when assessing risk .
Question 7: A 45-year-old man with hypertension is found to have a serum
potassium of 3.2 mEq/L on a routine check. He takes hydrochlorothiazide. What
is the most appropriate next step?
A) Increase the hydrochlorothiazide dose
B) Add a potassium-sparing diuretic or supplement potassium
C) Switch to a loop diuretic
D) Stop the diuretic immediately
Answer: B) Add a potassium-sparing diuretic or supplement potassium
Rationale: Thiazide diuretics cause hypokalemia by increasing renal potassium
excretion. The management of thiazide-induced hypokalemia includes potassium
supplementation or adding a potassium-sparing agent such as spironolactone.
Increasing the thiazide dose would worsen the hypokalemia. Switching to a loop
diuretic would not address the potassium issue and may actually worsen it .
Question 8: A 28-year-old woman presents with acute onset of severe
headache, fever, and nuchal rigidity. Which diagnosis must be ruled out first?
A) Tension headache
B) Migraine
NR511 Week 4 Midterm Exam
Study Guide 2026/2027 –
Differential Diagnosis & Primary
Care Practicum | Chamberlain
NR511 Week 4 Midterm Exam study guide for
Chamberlain University. Covers diagnostic reasoning,
OLDCARTS, SNAPPS, evidence-based practice, sensitivity
and specificity, E&M coding, skin disorders, eye
conditions, and ENT disorders. Includes clinical encounter
documentation and differential diagnosis frameworks.
Practice questions with detailed rationales for the
2026/2027 curriculum
Question 1: What does the "C" in the OLDCARTS mnemonic stand for when
assessing the history of present illness?
A) Cause
B) Character
C) Cough
D) Circulation
Answer: B) Character
,2|Page
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating
factors, Relieving factors, Timing, and Severity. "Character" refers to the quality or
nature of the symptom, such as whether pain is sharp, dull, burning, or throbbing. This
systematic framework ensures comprehensive characterization of the chief complaint
during the history of present illness .
Question 2: A 52-year-old man with a history of hypertension presents with
sudden onset of severe, tearing chest pain radiating to the back. Blood pressure
is 160/90 mm Hg in the right arm and 110/70 mm Hg in the left arm. What is
the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Esophageal rupture
Answer: C) Aortic dissection
Rationale: Tearing chest pain with a pulse differential between arms is classic for aortic
dissection. The sudden, severe nature of the pain and the significant difference in
systolic blood pressure readings support this diagnosis over acute MI, which typically
presents with crushing substernal pain and no pulse differential .
Question 3: A 35-year-old woman complains of episodic palpitations, sweating,
and headache. Her blood pressure is 180/100 mm Hg during an episode. What
is the most likely diagnosis?
A) Essential hypertension
B) Pheochromocytoma
C) Hyperthyroidism
D) Panic disorder
Answer: B) Pheochromocytoma
Rationale: Paroxysmal hypertension with palpitations, sweating, and headache is the
classic triad for pheochromocytoma. This catecholamine-secreting tumor of the adrenal
medulla causes episodic release of epinephrine and norepinephrine, leading to these
paroxysmal symptoms. Essential hypertension would not present with episodic severe
,3|Page
elevations, and hyperthyroidism typically causes sustained tachycardia and heat
intolerance rather than paroxysmal hypertension .
Question 4: A 55-year-old man with a 40-pack-year smoking history presents
with new onset of hemoptysis, weight loss, and a persistent cough. Which
diagnosis should be highest on the differential?
A) Asthma
B) Bronchitis
C) Lung cancer
D) GERD
Answer: C) Lung cancer
Rationale: In a patient with a significant smoking history and hemoptysis, lung cancer
must be high on the differential. Hemoptysis is a red flag symptom that requires
prompt evaluation. Unexplained weight loss further increases suspicion for malignancy.
Asthma and bronchitis would not typically present with hemoptysis and significant
weight loss in this context .
Question 5: Which of the following is an example of tertiary prevention in a
patient with chronic renal failure?
A) Fluid restriction
B) Hemodialysis 4 days a week
C) High-protein diet
D) Maintenance of blood pressure at 120/80
Answer: B) Hemodialysis 4 days a week
Rationale: Tertiary prevention aims to manage established disease and prevent further
complications or disability. Hemodialysis is a treatment for end-stage renal disease
that falls under tertiary prevention. Fluid restriction, dietary modification, and blood
pressure control are secondary prevention measures aimed at slowing disease
progression in earlier stages .
, 4|Page
Question 6: Which ethnic group has the highest lung cancer incidence and
mortality rates?
A) African American men
B) Scandinavian men and women
C) Caucasian women
D) Asian men
Answer: A) African American men
Rationale: African American men have the highest lung cancer incidence and mortality
rates in the United States. This disparity is likely multifactorial, involving differences in
smoking patterns, access to healthcare, socioeconomic factors, and possibly genetic
susceptibility. This is a key epidemiological fact for primary care providers to recognize
when assessing risk .
Question 7: A 45-year-old man with hypertension is found to have a serum
potassium of 3.2 mEq/L on a routine check. He takes hydrochlorothiazide. What
is the most appropriate next step?
A) Increase the hydrochlorothiazide dose
B) Add a potassium-sparing diuretic or supplement potassium
C) Switch to a loop diuretic
D) Stop the diuretic immediately
Answer: B) Add a potassium-sparing diuretic or supplement potassium
Rationale: Thiazide diuretics cause hypokalemia by increasing renal potassium
excretion. The management of thiazide-induced hypokalemia includes potassium
supplementation or adding a potassium-sparing agent such as spironolactone.
Increasing the thiazide dose would worsen the hypokalemia. Switching to a loop
diuretic would not address the potassium issue and may actually worsen it .
Question 8: A 28-year-old woman presents with acute onset of severe
headache, fever, and nuchal rigidity. Which diagnosis must be ruled out first?
A) Tension headache
B) Migraine
