NR 511 DIFFERENTIAL DIAGNOSIS & PRIMARY
CARE PRACTICUM
Week 4 Midterm — Enhanced Original Study
Guide
Clinical reasoning • High-yield review • Exam traps • Original practice questions
Source basis: public preview of the 10-page Version 5 Stuvia document, written for the 2019/2020 academic year. The preview
displays 30 questions covering diabetes foot care, Alzheimer disease, poisoning, breast masses, MS, delirium, ICP, shoulder
dislocation, inflammatory musculoskeletal findings, BMI, gout, HPV, testicular cancer, chlamydia, atrophic vaginitis, vaginal
microscopy, pneumothorax, meniscal injury, prostate cancer, cauda equina, GAD, hypothyroidism, burns, prevention, frostbite,
abnormal uterine bleeding, migraine prophylaxis, and diabetic neuropathy.
Important: This guide is original. It does not reproduce the paid document or claim to contain actual/guaranteed exam
questions. Source wording has been transformed into broader study concepts and newly written practice items.
MASTER EXAM MAP
Domain Must know
Diabetes Foot inspection, neuropathy, injury prevention, treatment principles
Neurology MS testing, delirium vs dementia, ICP, cauda equina, migraine prophylaxis
Musculoskeletal Shoulder dislocation, meniscal tear, inflammatory pain, gout
GU/GYN Prostate findings, chlamydia, atrophic vaginitis, abnormal bleeding
Dermatology/burns Burn depth, frostbite recurrence, wound/foot injury
Prevention Primary vs secondary vs tertiary
Cancer screening Breast mass evaluation, HPV risk, testicular/prostate cancer
Psych/geriatrics Alzheimer pharmacotherapy, GAD duration, delirium
1. DIABETES: FOOT & NEUROPATHY
Diabetes increases risk for peripheral neuropathy, impaired sensation, skin breakdown, infection, and delayed healing. A patient can
sustain a penetrating injury without recognizing it, making routine foot surveillance essential.
• Inspect feet routinely and reinforce daily self-inspection at home, especially when sensation is impaired.
• Use appropriate footwear; avoid walking barefoot and avoid heating pads on insensate feet because burns can occur without
warning.
• Any penetrating injury, ulcer, infection, or concerning wound requires prompt assessment. Specialty foot care may be appropriate
for high-risk patients.
• Peripheral neuropathy can produce burning pain, loss of vibration/protective sensation, and reduced reflexes.
• Neuropathic pain may be treated with agents such as certain antidepressants or anticonvulsants; topical options may help selected
patients. Treatment should match the clinical situation.
Exam logic: loss of protective sensation + foreign body/wound = safety and wound management first. Do not choose a
heat-based intervention for an insensate diabetic foot.
2. NEUROLOGIC DIFFERENTIALS
NR 511 Week 4 — Enhanced Original Study Guide Page 1
, Condition High-yield discriminator Reasoning
Multiple sclerosis No single definitive diagnostic test MRI and CSF studies support diagnosis in the appropriate clinical context.
Delirium Acute/fluctuating disturbance with impaired attention Look for an underlying medical, medication, toxic, or metabolic trigger.
Dementia Usually chronic progressive cognitive decline Attention is often relatively preserved until later stages.
Raised ICP Declining level of consciousness is a late/important warning
Headache,
sign nausea/vomiting, pupillary changes, and other signs may occur.
Cauda equina syndrome Saddle/perineal sensory change, bladder/bowel dysfunction,
A spinal
bilateral
emergency
symptoms
requiring urgent evaluation.
Delirium vs dementia: the most useful exam anchors are acute onset, fluctuating course, and impaired attention for
delirium. Dementia is typically more gradual and persistent.
MS: MRI is highly useful, but there is no single test that by itself establishes MS in every patient. Diagnosis integrates history,
neurologic examination, imaging, and laboratory/CSF evidence while excluding alternatives.
Cauda equina: think “saddle anesthesia + bladder/bowel dysfunction + severe neurologic symptoms.” A patient with suspected
compression needs urgent escalation rather than routine conservative follow-up.
3. MUSCULOSKELETAL EXAM & INJURY
Finding/Test What it points toward
McMurray maneuver Meniscal pathology when the clinical picture supports it.
Lachman test Anterior cruciate ligament injury.
Valgus stress Medial collateral ligament assessment.
Varus stress Lateral collateral ligament assessment.
Inflammatory pain pattern Morning stiffness and other inflammatory features.
Shoulder dislocation Anterior is much more common than posterior; assess distal neurovascular status.
Gout Inflammatory arthritis associated with monosodium urate crystal deposition.
When evaluating a musculoskeletal complaint, compare the affected side with the uninvolved side, inspect before palpating, assess
active and passive range of motion when appropriate, and document neurovascular status after significant trauma.
A twisting knee injury with a pop and inability to fully extend raises concern for internal derangement. A meniscal tear is classically
assessed with a meniscal maneuver such as McMurray, while Lachman targets ACL integrity.
4. GOUT & PURINE REASONING
Gout results from hyperuricemia with deposition of monosodium urate crystals in joints and other tissues. Diet can influence urate
burden, but management is broader than simply listing foods.
• High-purine animal foods and certain seafood can increase urate load.
• Beer and spirits can worsen gout risk in susceptible patients; alcohol counseling may be relevant.
• Thiazide and loop diuretics can raise uric acid; low-dose aspirin can also affect urate handling.
• Acute attacks and long-term urate-lowering therapy are different treatment questions. Do not confuse acute anti-inflammatory
treatment with chronic urate reduction.
Vegetarian diets are not automatically protective: some plant foods contain purines, but dietary advice should be individualized
and should not imply that all plant purines carry the same risk as high-purine animal sources.
NR 511 Week 4 — Enhanced Original Study Guide Page 2
CARE PRACTICUM
Week 4 Midterm — Enhanced Original Study
Guide
Clinical reasoning • High-yield review • Exam traps • Original practice questions
Source basis: public preview of the 10-page Version 5 Stuvia document, written for the 2019/2020 academic year. The preview
displays 30 questions covering diabetes foot care, Alzheimer disease, poisoning, breast masses, MS, delirium, ICP, shoulder
dislocation, inflammatory musculoskeletal findings, BMI, gout, HPV, testicular cancer, chlamydia, atrophic vaginitis, vaginal
microscopy, pneumothorax, meniscal injury, prostate cancer, cauda equina, GAD, hypothyroidism, burns, prevention, frostbite,
abnormal uterine bleeding, migraine prophylaxis, and diabetic neuropathy.
Important: This guide is original. It does not reproduce the paid document or claim to contain actual/guaranteed exam
questions. Source wording has been transformed into broader study concepts and newly written practice items.
MASTER EXAM MAP
Domain Must know
Diabetes Foot inspection, neuropathy, injury prevention, treatment principles
Neurology MS testing, delirium vs dementia, ICP, cauda equina, migraine prophylaxis
Musculoskeletal Shoulder dislocation, meniscal tear, inflammatory pain, gout
GU/GYN Prostate findings, chlamydia, atrophic vaginitis, abnormal bleeding
Dermatology/burns Burn depth, frostbite recurrence, wound/foot injury
Prevention Primary vs secondary vs tertiary
Cancer screening Breast mass evaluation, HPV risk, testicular/prostate cancer
Psych/geriatrics Alzheimer pharmacotherapy, GAD duration, delirium
1. DIABETES: FOOT & NEUROPATHY
Diabetes increases risk for peripheral neuropathy, impaired sensation, skin breakdown, infection, and delayed healing. A patient can
sustain a penetrating injury without recognizing it, making routine foot surveillance essential.
• Inspect feet routinely and reinforce daily self-inspection at home, especially when sensation is impaired.
• Use appropriate footwear; avoid walking barefoot and avoid heating pads on insensate feet because burns can occur without
warning.
• Any penetrating injury, ulcer, infection, or concerning wound requires prompt assessment. Specialty foot care may be appropriate
for high-risk patients.
• Peripheral neuropathy can produce burning pain, loss of vibration/protective sensation, and reduced reflexes.
• Neuropathic pain may be treated with agents such as certain antidepressants or anticonvulsants; topical options may help selected
patients. Treatment should match the clinical situation.
Exam logic: loss of protective sensation + foreign body/wound = safety and wound management first. Do not choose a
heat-based intervention for an insensate diabetic foot.
2. NEUROLOGIC DIFFERENTIALS
NR 511 Week 4 — Enhanced Original Study Guide Page 1
, Condition High-yield discriminator Reasoning
Multiple sclerosis No single definitive diagnostic test MRI and CSF studies support diagnosis in the appropriate clinical context.
Delirium Acute/fluctuating disturbance with impaired attention Look for an underlying medical, medication, toxic, or metabolic trigger.
Dementia Usually chronic progressive cognitive decline Attention is often relatively preserved until later stages.
Raised ICP Declining level of consciousness is a late/important warning
Headache,
sign nausea/vomiting, pupillary changes, and other signs may occur.
Cauda equina syndrome Saddle/perineal sensory change, bladder/bowel dysfunction,
A spinal
bilateral
emergency
symptoms
requiring urgent evaluation.
Delirium vs dementia: the most useful exam anchors are acute onset, fluctuating course, and impaired attention for
delirium. Dementia is typically more gradual and persistent.
MS: MRI is highly useful, but there is no single test that by itself establishes MS in every patient. Diagnosis integrates history,
neurologic examination, imaging, and laboratory/CSF evidence while excluding alternatives.
Cauda equina: think “saddle anesthesia + bladder/bowel dysfunction + severe neurologic symptoms.” A patient with suspected
compression needs urgent escalation rather than routine conservative follow-up.
3. MUSCULOSKELETAL EXAM & INJURY
Finding/Test What it points toward
McMurray maneuver Meniscal pathology when the clinical picture supports it.
Lachman test Anterior cruciate ligament injury.
Valgus stress Medial collateral ligament assessment.
Varus stress Lateral collateral ligament assessment.
Inflammatory pain pattern Morning stiffness and other inflammatory features.
Shoulder dislocation Anterior is much more common than posterior; assess distal neurovascular status.
Gout Inflammatory arthritis associated with monosodium urate crystal deposition.
When evaluating a musculoskeletal complaint, compare the affected side with the uninvolved side, inspect before palpating, assess
active and passive range of motion when appropriate, and document neurovascular status after significant trauma.
A twisting knee injury with a pop and inability to fully extend raises concern for internal derangement. A meniscal tear is classically
assessed with a meniscal maneuver such as McMurray, while Lachman targets ACL integrity.
4. GOUT & PURINE REASONING
Gout results from hyperuricemia with deposition of monosodium urate crystals in joints and other tissues. Diet can influence urate
burden, but management is broader than simply listing foods.
• High-purine animal foods and certain seafood can increase urate load.
• Beer and spirits can worsen gout risk in susceptible patients; alcohol counseling may be relevant.
• Thiazide and loop diuretics can raise uric acid; low-dose aspirin can also affect urate handling.
• Acute attacks and long-term urate-lowering therapy are different treatment questions. Do not confuse acute anti-inflammatory
treatment with chronic urate reduction.
Vegetarian diets are not automatically protective: some plant foods contain purines, but dietary advice should be individualized
and should not imply that all plant purines carry the same risk as high-purine animal sources.
NR 511 Week 4 — Enhanced Original Study Guide Page 2
