CEA COMPREHENSIVE PRACTICE EXAM • PASSPOINT PRO
NR511
Differential Diagnosis
and Primary Care
200-Question CEA Comprehensive Practice Exam
Mixed-system clinical reasoning practice covering focused assessment, differential diagnosis, diagnostic testing,
evidence-based management, prevention, red flags, and follow-up.
200 A-D 200
Practice Questions Multiple Choice Explained Answers
Original study and revision material • Clean print-ready format PASSPOINT PRO
,PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
1. At a same-day clinic visit, a 22-year-old man explains that repeated office blood pressure readings are
elevated without symptoms or an obvious secondary cause. Which diagnostic approach is most appropriate
next?
A. confirm with repeat standardized measurements or out-of-office blood pressure monitoring
B. Repeat the same physical examination in several months without additional evaluation
C. Order a broad panel of tests without first estimating pretest probability
D. Use advanced imaging as the first test in every patient regardless of risk
Answer: A
Explanation: The most appropriate next diagnostic step is to confirm with repeat standardized measurements or out-of-office blood
pressure monitoring. This approach matches the expected pretest probability and avoids unnecessary testing that would not change
immediate management. If the patient develops hypertensive emergency with acute target-organ injury, the evaluation should be
escalated rather than continuing a routine outpatient workup.
2. A 76-year-old woman presents to primary care because substernal pressure occurs with exertion and
resolves within minutes of rest. Which diagnostic approach is most appropriate next?
A. Order a broad panel of tests without first estimating pretest probability
B. Repeat the same physical examination in several months without additional evaluation
C. obtain resting ECG and assess ischemic risk; use noninvasive ischemia testing when indicated
D. Use advanced imaging as the first test in every patient regardless of risk
Answer: C
Explanation: The most appropriate next diagnostic step is to obtain resting ECG and assess ischemic risk; use noninvasive ischemia
testing when indicated. This approach matches the expected pretest probability and avoids unnecessary testing that would not
change immediate management. If the patient develops chest pain at rest, dynamic ECG changes, or hemodynamic instability
suggesting acute coronary syndrome, the evaluation should be escalated rather than continuing a routine outpatient workup.
3. At a same-day clinic visit, a 31-year-old woman explains that progressive dyspnea, orthopnea, and bilateral
ankle edema are present. Which diagnostic approach is most appropriate next?
A. Order a broad panel of tests without first estimating pretest probability
B. Use advanced imaging as the first test in every patient regardless of risk
C. Repeat the same physical examination in several months without additional evaluation
D. obtain ECG, chest imaging, natriuretic peptide when appropriate, and echocardiography to assess structure and ejection
fraction
Answer: D
Explanation: The most appropriate next diagnostic step is to obtain ECG, chest imaging, natriuretic peptide when appropriate, and
echocardiography to assess structure and ejection fraction. This approach matches the expected pretest probability and avoids
unnecessary testing that would not change immediate management. If the patient develops acute pulmonary edema, hypoxia, shock,
or severe respiratory distress, the evaluation should be escalated rather than continuing a routine outpatient workup.
4. A 42-year-old woman presents to primary care because the pulse is irregularly irregular and the patient
reports intermittent palpitations. Which diagnostic approach is most appropriate next?
A. Use advanced imaging as the first test in every patient regardless of risk
B. obtain a 12-lead ECG and evaluate for precipitating causes and stroke risk
C. Order a broad panel of tests without first estimating pretest probability
D. Repeat the same physical examination in several months without additional evaluation
Answer: B
Explanation: The most appropriate next diagnostic step is to obtain a 12-lead ECG and evaluate for precipitating causes and stroke
risk. This approach matches the expected pretest probability and avoids unnecessary testing that would not change immediate
management. If the patient develops hemodynamic instability, ischemic chest pain, syncope, or severe heart failure, the evaluation
should be escalated rather than continuing a routine outpatient workup.
Page 1
,PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
5. At a same-day clinic visit, a 27-year-old man explains that episodic wheezing, chest tightness, and cough
vary over time and are triggered by exercise or allergens. Which diagnostic approach is most appropriate
next?
A. Use advanced imaging as the first test in every patient regardless of risk
B. perform spirometry with bronchodilator response when feasible
C. Order a broad panel of tests without first estimating pretest probability
D. Repeat the same physical examination in several months without additional evaluation
Answer: B
Explanation: The most appropriate next diagnostic step is to perform spirometry with bronchodilator response when feasible. This
approach matches the expected pretest probability and avoids unnecessary testing that would not change immediate management. If
the patient develops silent chest, severe hypoxemia, inability to speak, altered mental status, or poor response to initial bronchodilator
therapy, the evaluation should be escalated rather than continuing a routine outpatient workup.
6. During an outpatient visit, a 59-year-old man reports that chronic cough and progressive exertional dyspnea
occur in a long-term smoker. Which diagnostic approach is most appropriate next?
A. Repeat the same physical examination in several months without additional evaluation
B. Order a broad panel of tests without first estimating pretest probability
C. confirm with post-bronchodilator spirometry
D. Use advanced imaging as the first test in every patient regardless of risk
Answer: C
Explanation: The most appropriate next diagnostic step is to confirm with post-bronchodilator spirometry. This approach matches the
expected pretest probability and avoids unnecessary testing that would not change immediate management. If the patient develops
acute hypercapnia, severe hypoxemia, confusion, or marked respiratory distress, the evaluation should be escalated rather than
continuing a routine outpatient workup.
7. A 42-year-old woman seeks evaluation after noticing that fever, productive cough, pleuritic discomfort, and
focal crackles developed over several days. Which diagnostic approach is most appropriate next?
A. Order a broad panel of tests without first estimating pretest probability
B. obtain chest imaging when pneumonia is suspected and results will affect management
C. Use advanced imaging as the first test in every patient regardless of risk
D. Repeat the same physical examination in several months without additional evaluation
Answer: B
Explanation: The most appropriate next diagnostic step is to obtain chest imaging when pneumonia is suspected and results will
affect management. This approach matches the expected pretest probability and avoids unnecessary testing that would not change
immediate management. If the patient develops hypoxemia, hypotension, confusion, severe tachypnea, or inability to maintain oral
intake, the evaluation should be escalated rather than continuing a routine outpatient workup.
8. During an outpatient visit, a 36-year-old woman reports that cough followed an upper respiratory infection
and the lung examination lacks focal consolidation. Which diagnostic approach is most appropriate next?
A. Repeat the same physical examination in several months without additional evaluation
B. Order a broad panel of tests without first estimating pretest probability
C. Use advanced imaging as the first test in every patient regardless of risk
D. usually no routine imaging or laboratory testing is needed when pneumonia is not suspected
Answer: D
Explanation: The most appropriate next diagnostic step is to usually no routine imaging or laboratory testing is needed when
pneumonia is not suspected. This approach matches the expected pretest probability and avoids unnecessary testing that would not
change immediate management. If the patient develops abnormal vital signs, hypoxia, hemoptysis, or focal findings suggesting
pneumonia or another serious cause, the evaluation should be escalated rather than continuing a routine outpatient workup.
Page 2
, PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
9. A 27-year-old woman seeks evaluation after noticing that burning retrosternal discomfort and sour
regurgitation worsen after large meals and when lying down. Which diagnostic approach is most appropriate
next?
A. Use advanced imaging as the first test in every patient regardless of risk
B. Order a broad panel of tests without first estimating pretest probability
C. an empiric therapeutic trial is reasonable for classic symptoms; endoscopy is indicated for alarm features or selected
refractory cases
D. Repeat the same physical examination in several months without additional evaluation
Answer: C
Explanation: The most appropriate next diagnostic step is to an empiric therapeutic trial is reasonable for classic symptoms;
endoscopy is indicated for alarm features or selected refractory cases. This approach matches the expected pretest probability and
avoids unnecessary testing that would not change immediate management. If the patient develops dysphagia, GI bleeding, weight
loss, anemia, or persistent vomiting, the evaluation should be escalated rather than continuing a routine outpatient workup.
10. At a same-day clinic visit, a 22-year-old man explains that recurrent epigastric pain is associated with
NSAID use and intermittent nausea. Which diagnostic approach is most appropriate next?
A. test for H. pylori using an appropriate noninvasive test when indicated and evaluate alarm features for endoscopy
B. Order a broad panel of tests without first estimating pretest probability
C. Use advanced imaging as the first test in every patient regardless of risk
D. Repeat the same physical examination in several months without additional evaluation
Answer: A
Explanation: The most appropriate next diagnostic step is to test for H. pylori using an appropriate noninvasive test when indicated
and evaluate alarm features for endoscopy. This approach matches the expected pretest probability and avoids unnecessary testing
that would not change immediate management. If the patient develops hematemesis, melena with instability, perforation signs, or
severe persistent pain, the evaluation should be escalated rather than continuing a routine outpatient workup.
11. A 27-year-old man seeks evaluation after noticing that abdominal pain migrated from the periumbilical
region to the right lower quadrant with anorexia and nausea. Which diagnostic approach is most appropriate
next?
A. use clinical assessment plus imaging when needed to confirm diagnosis and exclude alternatives
B. Use advanced imaging as the first test in every patient regardless of risk
C. Repeat the same physical examination in several months without additional evaluation
D. Order a broad panel of tests without first estimating pretest probability
Answer: A
Explanation: The most appropriate next diagnostic step is to use clinical assessment plus imaging when needed to confirm diagnosis
and exclude alternatives. This approach matches the expected pretest probability and avoids unnecessary testing that would not
change immediate management. If the patient develops peritonitis, sepsis, hypotension, or suspected perforation, the evaluation
should be escalated rather than continuing a routine outpatient workup.
12. During an outpatient visit, a 54-year-old woman reports that persistent right upper quadrant pain, fever,
and nausea follow a fatty meal. Which diagnostic approach is most appropriate next?
A. right upper quadrant ultrasonography is the preferred initial imaging study
B. Use advanced imaging as the first test in every patient regardless of risk
C. Order a broad panel of tests without first estimating pretest probability
D. Repeat the same physical examination in several months without additional evaluation
Answer: A
Explanation: The most appropriate next diagnostic step is to right upper quadrant ultrasonography is the preferred initial imaging
study. This approach matches the expected pretest probability and avoids unnecessary testing that would not change immediate
management. If the patient develops jaundice with systemic toxicity, hypotension, or concern for ascending cholangitis, the evaluation
should be escalated rather than continuing a routine outpatient workup.
Page 3
NR511
Differential Diagnosis
and Primary Care
200-Question CEA Comprehensive Practice Exam
Mixed-system clinical reasoning practice covering focused assessment, differential diagnosis, diagnostic testing,
evidence-based management, prevention, red flags, and follow-up.
200 A-D 200
Practice Questions Multiple Choice Explained Answers
Original study and revision material • Clean print-ready format PASSPOINT PRO
,PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
1. At a same-day clinic visit, a 22-year-old man explains that repeated office blood pressure readings are
elevated without symptoms or an obvious secondary cause. Which diagnostic approach is most appropriate
next?
A. confirm with repeat standardized measurements or out-of-office blood pressure monitoring
B. Repeat the same physical examination in several months without additional evaluation
C. Order a broad panel of tests without first estimating pretest probability
D. Use advanced imaging as the first test in every patient regardless of risk
Answer: A
Explanation: The most appropriate next diagnostic step is to confirm with repeat standardized measurements or out-of-office blood
pressure monitoring. This approach matches the expected pretest probability and avoids unnecessary testing that would not change
immediate management. If the patient develops hypertensive emergency with acute target-organ injury, the evaluation should be
escalated rather than continuing a routine outpatient workup.
2. A 76-year-old woman presents to primary care because substernal pressure occurs with exertion and
resolves within minutes of rest. Which diagnostic approach is most appropriate next?
A. Order a broad panel of tests without first estimating pretest probability
B. Repeat the same physical examination in several months without additional evaluation
C. obtain resting ECG and assess ischemic risk; use noninvasive ischemia testing when indicated
D. Use advanced imaging as the first test in every patient regardless of risk
Answer: C
Explanation: The most appropriate next diagnostic step is to obtain resting ECG and assess ischemic risk; use noninvasive ischemia
testing when indicated. This approach matches the expected pretest probability and avoids unnecessary testing that would not
change immediate management. If the patient develops chest pain at rest, dynamic ECG changes, or hemodynamic instability
suggesting acute coronary syndrome, the evaluation should be escalated rather than continuing a routine outpatient workup.
3. At a same-day clinic visit, a 31-year-old woman explains that progressive dyspnea, orthopnea, and bilateral
ankle edema are present. Which diagnostic approach is most appropriate next?
A. Order a broad panel of tests without first estimating pretest probability
B. Use advanced imaging as the first test in every patient regardless of risk
C. Repeat the same physical examination in several months without additional evaluation
D. obtain ECG, chest imaging, natriuretic peptide when appropriate, and echocardiography to assess structure and ejection
fraction
Answer: D
Explanation: The most appropriate next diagnostic step is to obtain ECG, chest imaging, natriuretic peptide when appropriate, and
echocardiography to assess structure and ejection fraction. This approach matches the expected pretest probability and avoids
unnecessary testing that would not change immediate management. If the patient develops acute pulmonary edema, hypoxia, shock,
or severe respiratory distress, the evaluation should be escalated rather than continuing a routine outpatient workup.
4. A 42-year-old woman presents to primary care because the pulse is irregularly irregular and the patient
reports intermittent palpitations. Which diagnostic approach is most appropriate next?
A. Use advanced imaging as the first test in every patient regardless of risk
B. obtain a 12-lead ECG and evaluate for precipitating causes and stroke risk
C. Order a broad panel of tests without first estimating pretest probability
D. Repeat the same physical examination in several months without additional evaluation
Answer: B
Explanation: The most appropriate next diagnostic step is to obtain a 12-lead ECG and evaluate for precipitating causes and stroke
risk. This approach matches the expected pretest probability and avoids unnecessary testing that would not change immediate
management. If the patient develops hemodynamic instability, ischemic chest pain, syncope, or severe heart failure, the evaluation
should be escalated rather than continuing a routine outpatient workup.
Page 1
,PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
5. At a same-day clinic visit, a 27-year-old man explains that episodic wheezing, chest tightness, and cough
vary over time and are triggered by exercise or allergens. Which diagnostic approach is most appropriate
next?
A. Use advanced imaging as the first test in every patient regardless of risk
B. perform spirometry with bronchodilator response when feasible
C. Order a broad panel of tests without first estimating pretest probability
D. Repeat the same physical examination in several months without additional evaluation
Answer: B
Explanation: The most appropriate next diagnostic step is to perform spirometry with bronchodilator response when feasible. This
approach matches the expected pretest probability and avoids unnecessary testing that would not change immediate management. If
the patient develops silent chest, severe hypoxemia, inability to speak, altered mental status, or poor response to initial bronchodilator
therapy, the evaluation should be escalated rather than continuing a routine outpatient workup.
6. During an outpatient visit, a 59-year-old man reports that chronic cough and progressive exertional dyspnea
occur in a long-term smoker. Which diagnostic approach is most appropriate next?
A. Repeat the same physical examination in several months without additional evaluation
B. Order a broad panel of tests without first estimating pretest probability
C. confirm with post-bronchodilator spirometry
D. Use advanced imaging as the first test in every patient regardless of risk
Answer: C
Explanation: The most appropriate next diagnostic step is to confirm with post-bronchodilator spirometry. This approach matches the
expected pretest probability and avoids unnecessary testing that would not change immediate management. If the patient develops
acute hypercapnia, severe hypoxemia, confusion, or marked respiratory distress, the evaluation should be escalated rather than
continuing a routine outpatient workup.
7. A 42-year-old woman seeks evaluation after noticing that fever, productive cough, pleuritic discomfort, and
focal crackles developed over several days. Which diagnostic approach is most appropriate next?
A. Order a broad panel of tests without first estimating pretest probability
B. obtain chest imaging when pneumonia is suspected and results will affect management
C. Use advanced imaging as the first test in every patient regardless of risk
D. Repeat the same physical examination in several months without additional evaluation
Answer: B
Explanation: The most appropriate next diagnostic step is to obtain chest imaging when pneumonia is suspected and results will
affect management. This approach matches the expected pretest probability and avoids unnecessary testing that would not change
immediate management. If the patient develops hypoxemia, hypotension, confusion, severe tachypnea, or inability to maintain oral
intake, the evaluation should be escalated rather than continuing a routine outpatient workup.
8. During an outpatient visit, a 36-year-old woman reports that cough followed an upper respiratory infection
and the lung examination lacks focal consolidation. Which diagnostic approach is most appropriate next?
A. Repeat the same physical examination in several months without additional evaluation
B. Order a broad panel of tests without first estimating pretest probability
C. Use advanced imaging as the first test in every patient regardless of risk
D. usually no routine imaging or laboratory testing is needed when pneumonia is not suspected
Answer: D
Explanation: The most appropriate next diagnostic step is to usually no routine imaging or laboratory testing is needed when
pneumonia is not suspected. This approach matches the expected pretest probability and avoids unnecessary testing that would not
change immediate management. If the patient develops abnormal vital signs, hypoxia, hemoptysis, or focal findings suggesting
pneumonia or another serious cause, the evaluation should be escalated rather than continuing a routine outpatient workup.
Page 2
, PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
9. A 27-year-old woman seeks evaluation after noticing that burning retrosternal discomfort and sour
regurgitation worsen after large meals and when lying down. Which diagnostic approach is most appropriate
next?
A. Use advanced imaging as the first test in every patient regardless of risk
B. Order a broad panel of tests without first estimating pretest probability
C. an empiric therapeutic trial is reasonable for classic symptoms; endoscopy is indicated for alarm features or selected
refractory cases
D. Repeat the same physical examination in several months without additional evaluation
Answer: C
Explanation: The most appropriate next diagnostic step is to an empiric therapeutic trial is reasonable for classic symptoms;
endoscopy is indicated for alarm features or selected refractory cases. This approach matches the expected pretest probability and
avoids unnecessary testing that would not change immediate management. If the patient develops dysphagia, GI bleeding, weight
loss, anemia, or persistent vomiting, the evaluation should be escalated rather than continuing a routine outpatient workup.
10. At a same-day clinic visit, a 22-year-old man explains that recurrent epigastric pain is associated with
NSAID use and intermittent nausea. Which diagnostic approach is most appropriate next?
A. test for H. pylori using an appropriate noninvasive test when indicated and evaluate alarm features for endoscopy
B. Order a broad panel of tests without first estimating pretest probability
C. Use advanced imaging as the first test in every patient regardless of risk
D. Repeat the same physical examination in several months without additional evaluation
Answer: A
Explanation: The most appropriate next diagnostic step is to test for H. pylori using an appropriate noninvasive test when indicated
and evaluate alarm features for endoscopy. This approach matches the expected pretest probability and avoids unnecessary testing
that would not change immediate management. If the patient develops hematemesis, melena with instability, perforation signs, or
severe persistent pain, the evaluation should be escalated rather than continuing a routine outpatient workup.
11. A 27-year-old man seeks evaluation after noticing that abdominal pain migrated from the periumbilical
region to the right lower quadrant with anorexia and nausea. Which diagnostic approach is most appropriate
next?
A. use clinical assessment plus imaging when needed to confirm diagnosis and exclude alternatives
B. Use advanced imaging as the first test in every patient regardless of risk
C. Repeat the same physical examination in several months without additional evaluation
D. Order a broad panel of tests without first estimating pretest probability
Answer: A
Explanation: The most appropriate next diagnostic step is to use clinical assessment plus imaging when needed to confirm diagnosis
and exclude alternatives. This approach matches the expected pretest probability and avoids unnecessary testing that would not
change immediate management. If the patient develops peritonitis, sepsis, hypotension, or suspected perforation, the evaluation
should be escalated rather than continuing a routine outpatient workup.
12. During an outpatient visit, a 54-year-old woman reports that persistent right upper quadrant pain, fever,
and nausea follow a fatty meal. Which diagnostic approach is most appropriate next?
A. right upper quadrant ultrasonography is the preferred initial imaging study
B. Use advanced imaging as the first test in every patient regardless of risk
C. Order a broad panel of tests without first estimating pretest probability
D. Repeat the same physical examination in several months without additional evaluation
Answer: A
Explanation: The most appropriate next diagnostic step is to right upper quadrant ultrasonography is the preferred initial imaging
study. This approach matches the expected pretest probability and avoids unnecessary testing that would not change immediate
management. If the patient develops jaundice with systemic toxicity, hypotension, or concern for ascending cholangitis, the evaluation
should be escalated rather than continuing a routine outpatient workup.
Page 3
