CEA MIDTERM PRACTICE EXAM • PASSPOINT PRO
NR511
Differential Diagnosis
and Primary Care
150-Question CEA Midterm Practice Exam
Focused primary-care practice emphasizing symptom analysis, history and physical examination, differential
diagnosis, common diagnostic studies, and initial management decisions.
150 A-D 150
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 42-year-old woman explains that repeated office blood pressure readings are
elevated without symptoms or an obvious secondary cause. What is the best initial management plan?
A. Delay treatment until every possible diagnosis has been excluded
B. Start multiple medications before establishing the working diagnosis
C. Provide reassurance only and arrange no follow-up
D. begin lifestyle modification and initiate guideline-directed antihypertensive therapy when treatment thresholds are met
Answer: D
Explanation: The preferred management approach is to begin lifestyle modification and initiate guideline-directed antihypertensive
therapy when treatment thresholds are met. This plan targets the likely condition while still allowing reassessment if the response is
not as expected. Features such as hypertensive emergency with acute target-organ injury would require urgent escalation or a
different level of care.
2. A 22-year-old man presents to primary care because substernal pressure occurs with exertion and resolves
within minutes of rest. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. Delay treatment until every possible diagnosis has been excluded
C. Start multiple medications before establishing the working diagnosis
D. address cardiovascular risk factors and use antianginal therapy while evaluating for coronary disease
Answer: D
Explanation: The preferred management approach is to address cardiovascular risk factors and use antianginal therapy while
evaluating for coronary disease. This plan targets the likely condition while still allowing reassessment if the response is not as
expected. Features such as chest pain at rest, dynamic ECG changes, or hemodynamic instability suggesting acute coronary
syndrome would require urgent escalation or a different level of care.
3. A 63-year-old man presents to primary care because progressive dyspnea, orthopnea, and bilateral ankle
edema are present. What is the best initial management plan?
A. treat congestion and institute evidence-based heart-failure therapy according to phenotype and comorbidities
B. Start multiple medications before establishing the working diagnosis
C. Delay treatment until every possible diagnosis has been excluded
D. Provide reassurance only and arrange no follow-up
Answer: A
Explanation: The preferred management approach is to treat congestion and institute evidence-based heart-failure therapy
according to phenotype and comorbidities. This plan targets the likely condition while still allowing reassessment if the response is not
as expected. Features such as acute pulmonary edema, hypoxia, shock, or severe respiratory distress would require urgent
escalation or a different level of care.
4. A 72-year-old woman presents to primary care because the pulse is irregularly irregular and the patient
reports intermittent palpitations. What is the best initial management plan?
A. control ventricular rate when needed and assess candidacy for anticoagulation based on thromboembolic and bleeding risk
B. Start multiple medications before establishing the working diagnosis
C. Provide reassurance only and arrange no follow-up
D. Delay treatment until every possible diagnosis has been excluded
Answer: A
Explanation: The preferred management approach is to control ventricular rate when needed and assess candidacy for
anticoagulation based on thromboembolic and bleeding risk. This plan targets the likely condition while still allowing reassessment if
the response is not as expected. Features such as hemodynamic instability, ischemic chest pain, syncope, or severe heart failure
would require urgent escalation or a different level of care.
Page 1
,PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
5. During an outpatient visit, a 76-year-old woman reports that episodic wheezing, chest tightness, and cough
vary over time and are triggered by exercise or allergens. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. use an inhaled corticosteroid-containing controller strategy and provide an individualized action plan
C. Start multiple medications before establishing the working diagnosis
D. Delay treatment until every possible diagnosis has been excluded
Answer: B
Explanation: The preferred management approach is to use an inhaled corticosteroid-containing controller strategy and provide an
individualized action plan. This plan targets the likely condition while still allowing reassessment if the response is not as expected.
Features such as silent chest, severe hypoxemia, inability to speak, altered mental status, or poor response to initial bronchodilator
therapy would require urgent escalation or a different level of care.
6. During an outpatient visit, a 72-year-old woman reports that chronic cough and progressive exertional
dyspnea occur in a long-term smoker. What is the best initial management plan?
A. Delay treatment until every possible diagnosis has been excluded
B. Provide reassurance only and arrange no follow-up
C. support smoking cessation, vaccinations, pulmonary rehabilitation when appropriate, and inhaled bronchodilator therapy
based on symptoms and exacerbations
D. Start multiple medications before establishing the working diagnosis
Answer: C
Explanation: The preferred management approach is to support smoking cessation, vaccinations, pulmonary rehabilitation when
appropriate, and inhaled bronchodilator therapy based on symptoms and exacerbations. This plan targets the likely condition while
still allowing reassessment if the response is not as expected. Features such as acute hypercapnia, severe hypoxemia, confusion, or
marked respiratory distress would require urgent escalation or a different level of care.
7. A 31-year-old man seeks evaluation after noticing that fever, productive cough, pleuritic discomfort, and
focal crackles developed over several days. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. Start multiple medications before establishing the working diagnosis
C. start appropriate empiric antimicrobial therapy based on setting, comorbidities, and local recommendations
D. Delay treatment until every possible diagnosis has been excluded
Answer: C
Explanation: The preferred management approach is to start appropriate empiric antimicrobial therapy based on setting,
comorbidities, and local recommendations. This plan targets the likely condition while still allowing reassessment if the response is
not as expected. Features such as hypoxemia, hypotension, confusion, severe tachypnea, or inability to maintain oral intake would
require urgent escalation or a different level of care.
8. At a same-day clinic visit, a 76-year-old woman explains that cough followed an upper respiratory infection
and the lung examination lacks focal consolidation. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. Start multiple medications before establishing the working diagnosis
C. provide supportive care and avoid routine antibiotics
D. Delay treatment until every possible diagnosis has been excluded
Answer: C
Explanation: The preferred management approach is to provide supportive care and avoid routine antibiotics. This plan targets the
likely condition while still allowing reassessment if the response is not as expected. Features such as abnormal vital signs, hypoxia,
hemoptysis, or focal findings suggesting pneumonia or another serious cause would require urgent escalation or a different level of
care.
Page 2
, PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
9. During an outpatient visit, a 72-year-old woman reports that burning retrosternal discomfort and sour
regurgitation worsen after large meals and when lying down. What is the best initial management plan?
A. use weight and meal-timing measures plus acid suppression when indicated
B. Provide reassurance only and arrange no follow-up
C. Delay treatment until every possible diagnosis has been excluded
D. Start multiple medications before establishing the working diagnosis
Answer: A
Explanation: The preferred management approach is to use weight and meal-timing measures plus acid suppression when
indicated. This plan targets the likely condition while still allowing reassessment if the response is not as expected. Features such as
dysphagia, GI bleeding, weight loss, anemia, or persistent vomiting would require urgent escalation or a different level of care.
10. A 31-year-old man presents to primary care because recurrent epigastric pain is associated with NSAID
use and intermittent nausea. What is the best initial management plan?
A. Start multiple medications before establishing the working diagnosis
B. stop ulcerogenic medications when possible, eradicate H. pylori if present, and provide acid suppression
C. Delay treatment until every possible diagnosis has been excluded
D. Provide reassurance only and arrange no follow-up
Answer: B
Explanation: The preferred management approach is to stop ulcerogenic medications when possible, eradicate H. pylori if present,
and provide acid suppression. This plan targets the likely condition while still allowing reassessment if the response is not as
expected. Features such as hematemesis, melena with instability, perforation signs, or severe persistent pain would require urgent
escalation or a different level of care.
11. A 54-year-old woman presents to primary care because abdominal pain migrated from the periumbilical
region to the right lower quadrant with anorexia and nausea. What is the best initial management plan?
A. arrange urgent surgical evaluation and provide supportive care
B. Delay treatment until every possible diagnosis has been excluded
C. Provide reassurance only and arrange no follow-up
D. Start multiple medications before establishing the working diagnosis
Answer: A
Explanation: The preferred management approach is to arrange urgent surgical evaluation and provide supportive care. This plan
targets the likely condition while still allowing reassessment if the response is not as expected. Features such as peritonitis, sepsis,
hypotension, or suspected perforation would require urgent escalation or a different level of care.
12. At a same-day clinic visit, a 42-year-old woman explains that persistent right upper quadrant pain, fever,
and nausea follow a fatty meal. What is the best initial management plan?
A. Start multiple medications before establishing the working diagnosis
B. Provide reassurance only and arrange no follow-up
C. Delay treatment until every possible diagnosis has been excluded
D. provide analgesia, appropriate antimicrobial therapy when indicated, and prompt surgical evaluation
Answer: D
Explanation: The preferred management approach is to provide analgesia, appropriate antimicrobial therapy when indicated, and
prompt surgical evaluation. This plan targets the likely condition while still allowing reassessment if the response is not as expected.
Features such as jaundice with systemic toxicity, hypotension, or concern for ascending cholangitis would require urgent escalation or
a different level of care.
Page 3
NR511
Differential Diagnosis
and Primary Care
150-Question CEA Midterm Practice Exam
Focused primary-care practice emphasizing symptom analysis, history and physical examination, differential
diagnosis, common diagnostic studies, and initial management decisions.
150 A-D 150
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 42-year-old woman explains that repeated office blood pressure readings are
elevated without symptoms or an obvious secondary cause. What is the best initial management plan?
A. Delay treatment until every possible diagnosis has been excluded
B. Start multiple medications before establishing the working diagnosis
C. Provide reassurance only and arrange no follow-up
D. begin lifestyle modification and initiate guideline-directed antihypertensive therapy when treatment thresholds are met
Answer: D
Explanation: The preferred management approach is to begin lifestyle modification and initiate guideline-directed antihypertensive
therapy when treatment thresholds are met. This plan targets the likely condition while still allowing reassessment if the response is
not as expected. Features such as hypertensive emergency with acute target-organ injury would require urgent escalation or a
different level of care.
2. A 22-year-old man presents to primary care because substernal pressure occurs with exertion and resolves
within minutes of rest. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. Delay treatment until every possible diagnosis has been excluded
C. Start multiple medications before establishing the working diagnosis
D. address cardiovascular risk factors and use antianginal therapy while evaluating for coronary disease
Answer: D
Explanation: The preferred management approach is to address cardiovascular risk factors and use antianginal therapy while
evaluating for coronary disease. This plan targets the likely condition while still allowing reassessment if the response is not as
expected. Features such as chest pain at rest, dynamic ECG changes, or hemodynamic instability suggesting acute coronary
syndrome would require urgent escalation or a different level of care.
3. A 63-year-old man presents to primary care because progressive dyspnea, orthopnea, and bilateral ankle
edema are present. What is the best initial management plan?
A. treat congestion and institute evidence-based heart-failure therapy according to phenotype and comorbidities
B. Start multiple medications before establishing the working diagnosis
C. Delay treatment until every possible diagnosis has been excluded
D. Provide reassurance only and arrange no follow-up
Answer: A
Explanation: The preferred management approach is to treat congestion and institute evidence-based heart-failure therapy
according to phenotype and comorbidities. This plan targets the likely condition while still allowing reassessment if the response is not
as expected. Features such as acute pulmonary edema, hypoxia, shock, or severe respiratory distress would require urgent
escalation or a different level of care.
4. A 72-year-old woman presents to primary care because the pulse is irregularly irregular and the patient
reports intermittent palpitations. What is the best initial management plan?
A. control ventricular rate when needed and assess candidacy for anticoagulation based on thromboembolic and bleeding risk
B. Start multiple medications before establishing the working diagnosis
C. Provide reassurance only and arrange no follow-up
D. Delay treatment until every possible diagnosis has been excluded
Answer: A
Explanation: The preferred management approach is to control ventricular rate when needed and assess candidacy for
anticoagulation based on thromboembolic and bleeding risk. This plan targets the likely condition while still allowing reassessment if
the response is not as expected. Features such as hemodynamic instability, ischemic chest pain, syncope, or severe heart failure
would require urgent escalation or a different level of care.
Page 1
,PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
5. During an outpatient visit, a 76-year-old woman reports that episodic wheezing, chest tightness, and cough
vary over time and are triggered by exercise or allergens. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. use an inhaled corticosteroid-containing controller strategy and provide an individualized action plan
C. Start multiple medications before establishing the working diagnosis
D. Delay treatment until every possible diagnosis has been excluded
Answer: B
Explanation: The preferred management approach is to use an inhaled corticosteroid-containing controller strategy and provide an
individualized action plan. This plan targets the likely condition while still allowing reassessment if the response is not as expected.
Features such as silent chest, severe hypoxemia, inability to speak, altered mental status, or poor response to initial bronchodilator
therapy would require urgent escalation or a different level of care.
6. During an outpatient visit, a 72-year-old woman reports that chronic cough and progressive exertional
dyspnea occur in a long-term smoker. What is the best initial management plan?
A. Delay treatment until every possible diagnosis has been excluded
B. Provide reassurance only and arrange no follow-up
C. support smoking cessation, vaccinations, pulmonary rehabilitation when appropriate, and inhaled bronchodilator therapy
based on symptoms and exacerbations
D. Start multiple medications before establishing the working diagnosis
Answer: C
Explanation: The preferred management approach is to support smoking cessation, vaccinations, pulmonary rehabilitation when
appropriate, and inhaled bronchodilator therapy based on symptoms and exacerbations. This plan targets the likely condition while
still allowing reassessment if the response is not as expected. Features such as acute hypercapnia, severe hypoxemia, confusion, or
marked respiratory distress would require urgent escalation or a different level of care.
7. A 31-year-old man seeks evaluation after noticing that fever, productive cough, pleuritic discomfort, and
focal crackles developed over several days. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. Start multiple medications before establishing the working diagnosis
C. start appropriate empiric antimicrobial therapy based on setting, comorbidities, and local recommendations
D. Delay treatment until every possible diagnosis has been excluded
Answer: C
Explanation: The preferred management approach is to start appropriate empiric antimicrobial therapy based on setting,
comorbidities, and local recommendations. This plan targets the likely condition while still allowing reassessment if the response is
not as expected. Features such as hypoxemia, hypotension, confusion, severe tachypnea, or inability to maintain oral intake would
require urgent escalation or a different level of care.
8. At a same-day clinic visit, a 76-year-old woman explains that cough followed an upper respiratory infection
and the lung examination lacks focal consolidation. What is the best initial management plan?
A. Provide reassurance only and arrange no follow-up
B. Start multiple medications before establishing the working diagnosis
C. provide supportive care and avoid routine antibiotics
D. Delay treatment until every possible diagnosis has been excluded
Answer: C
Explanation: The preferred management approach is to provide supportive care and avoid routine antibiotics. This plan targets the
likely condition while still allowing reassessment if the response is not as expected. Features such as abnormal vital signs, hypoxia,
hemoptysis, or focal findings suggesting pneumonia or another serious cause would require urgent escalation or a different level of
care.
Page 2
, PASSPOINT PRO | CHAMBERLAIN NR511 - CEA PRACTICE
9. During an outpatient visit, a 72-year-old woman reports that burning retrosternal discomfort and sour
regurgitation worsen after large meals and when lying down. What is the best initial management plan?
A. use weight and meal-timing measures plus acid suppression when indicated
B. Provide reassurance only and arrange no follow-up
C. Delay treatment until every possible diagnosis has been excluded
D. Start multiple medications before establishing the working diagnosis
Answer: A
Explanation: The preferred management approach is to use weight and meal-timing measures plus acid suppression when
indicated. This plan targets the likely condition while still allowing reassessment if the response is not as expected. Features such as
dysphagia, GI bleeding, weight loss, anemia, or persistent vomiting would require urgent escalation or a different level of care.
10. A 31-year-old man presents to primary care because recurrent epigastric pain is associated with NSAID
use and intermittent nausea. What is the best initial management plan?
A. Start multiple medications before establishing the working diagnosis
B. stop ulcerogenic medications when possible, eradicate H. pylori if present, and provide acid suppression
C. Delay treatment until every possible diagnosis has been excluded
D. Provide reassurance only and arrange no follow-up
Answer: B
Explanation: The preferred management approach is to stop ulcerogenic medications when possible, eradicate H. pylori if present,
and provide acid suppression. This plan targets the likely condition while still allowing reassessment if the response is not as
expected. Features such as hematemesis, melena with instability, perforation signs, or severe persistent pain would require urgent
escalation or a different level of care.
11. A 54-year-old woman presents to primary care because abdominal pain migrated from the periumbilical
region to the right lower quadrant with anorexia and nausea. What is the best initial management plan?
A. arrange urgent surgical evaluation and provide supportive care
B. Delay treatment until every possible diagnosis has been excluded
C. Provide reassurance only and arrange no follow-up
D. Start multiple medications before establishing the working diagnosis
Answer: A
Explanation: The preferred management approach is to arrange urgent surgical evaluation and provide supportive care. This plan
targets the likely condition while still allowing reassessment if the response is not as expected. Features such as peritonitis, sepsis,
hypotension, or suspected perforation would require urgent escalation or a different level of care.
12. At a same-day clinic visit, a 42-year-old woman explains that persistent right upper quadrant pain, fever,
and nausea follow a fatty meal. What is the best initial management plan?
A. Start multiple medications before establishing the working diagnosis
B. Provide reassurance only and arrange no follow-up
C. Delay treatment until every possible diagnosis has been excluded
D. provide analgesia, appropriate antimicrobial therapy when indicated, and prompt surgical evaluation
Answer: D
Explanation: The preferred management approach is to provide analgesia, appropriate antimicrobial therapy when indicated, and
prompt surgical evaluation. This plan targets the likely condition while still allowing reassessment if the response is not as expected.
Features such as jaundice with systemic toxicity, hypotension, or concern for ascending cholangitis would require urgent escalation or
a different level of care.
Page 3
