NR511 MIDTERM EXAM STUDY GUIDE:
DIFFERENTIAL DIAGNOSIS & PRIMARY CARE |
CORRECT QUESTIONS ,VERIFIED ANSWERS ~
CHAMBERLAIN UNIVERSITY
NR511 – Differential Diagnosis and Primary Care Practicum
Exam Study Guide – Midterm Study Guide
1. Exam Coverage
Content Areas:
• Week 1: Diagnostic Reasoning and Differential Diagnosis
• Week 2: Diagnosis and Management of Common Skin and Nail Disorders
• Week 3: Diagnosis and Management of Common Eye Disorders
• Week 4: Diagnosis and Management of Ear, Nose, and Throat Disorders
2. Key Concepts to Study
Diagnostic Reasoning and Differential Diagnosis: page 42
Taking a history is the first step in the diagnostic reasoning process. Problems cannot be
found, strengths identified, or appropriate direction known without a real grounding in
the lived experience of the individual patient. If the patient’s visit is for “episodic” care
or if it is for addressing a new complaint, the history begins with a history of
present illness (HPI). Mnemonics can help the clinician remember the
essential data elements; the “OLD CART”
History-taking should always start with the chief complaint (CC), or the reason for the
visit. When there are multiple complaints, identify the one which is the most important
to the client or the highest priority complaint. History of Present Illness (HPI) should
always be included in the chief complaint
o Examples of subjective information include ROS:
▪ This symptom analysis allows the NP to narrow the potential differentials based on
information from the HPI. It also aids in conducting a focused physical examination (PE).
, Objective information is what is seen, heard, or felt as part of the physical exam (PE),
and includes laboratory data and test results.
1. Clinical Reasoning and Asking Clinical Questions
Diagnostic reasoning can be seen as a kind of critical thinking. This kind of thinking
supports clinical judgment in several ways. First, it becomes a habit of mind to have
, humility about one’s thought processes and to know that even the most experienced
thinker can be mistaken. Second, it becomes a systematic way of generating creative
ways of thinking about problems. Third, critical thinking returns one to an examination
of the strength of evidence for a given conclusion. “Evidence” in this context means
more than “hard” data such as laboratory values.
2. Critical thinking includes creative thinking, like developing problem lists. For example, a
patient with unclear abdominal pain might have irritable bowel syndrome. The creative
clinician explores stress management and considers options like a diet and symptom
log, increased fiber, walking, or a follow-up visit. Creativity helps in setting goals for
short- or long-term issues. Besides creativity, critical thinking systematically assesses
new data, supporting or dismissing diagnostic hypotheses.
3. Formulating a Differential Diagnosis
Differential Diagnosis
A differential diagnosis list is the list of possible diagnoses, usually in priority order.
When clinicians discuss a case, the list of differential diagnoses is usually considered.
Supports for developing a rich differential diagnosis list include several guides. One
approach suggests considering the problem from the “skin in.” This means that if the
patient complains of chest pain, the clinician can consider all possible causes of chest
pain, beginning at the skin, and visualize all structures in the area that could possibly be
affected.
The differential diagnosis list should always include any conditions that are life-, organ-,
or function-threatening. An NP describing a different patient situation stated:
I always think in terms of the most dangerous or the most serious thing first—not
necessarily the most catastrophic, but the most serious problem.
4. Evidence-based practice
There is an emphasis in health care today to promote evidence-based practice (EBP)
(see Chapter 5). Guidelines for practice are available from government agencies or from
specialty or disease-related groups, such as the American Heart Association, the
American Academy of Pediatrics, or any of the specialty organizations.
5. Choosing the best evidence
EBP: The Patient
, Applying analytical procedures for determining the credibility or reliability of data to be
employed as evidence is only one aspect of the decision-making process.
Level 1- Systemic review of randomized clinical trial studies- strongest- minimized bias
Level 2- Single, well designed, randomized clinical trial
Level 3- Well designed controlled trials without randomization
Level 4- Well designed case- control or cohort studies
Level 5- Systemic reviews of descriptive and qualitative studies
Level 6- Single descriptive or qualitative studies
Level 7- Opinion of authorities and or reports of expert committees
6. Sensitivity/Specificity
Sensitivity- Ability of a test to correctly identify people who HAVE the disease- focuses
on sick people- tells you how good the test is giving true positives.
Specificity- Ability of a test to correctly identify people who do NOT have the disease-
focuses on healthy people- tells you how good the test is at giving a true negative.
Positive predictive value is true positives over all positives; negative predictive value is
true negatives over all negatives. Predictive value depends partly on condition
prevalence. When a condition is likely, a positive test is more accurate; if unlikely, it
should be questioned, possibly with different tests.
Parts of Medicare coverage
• Medicare A—Hospital Inpatient Services
• Medicare B—Medical outpatient- Physician Services
• Medicare C -Medicare advantage- A+B+extra (vision/dental)
• Medicare D—Pharmaceutical Coverage
7. Third-party payers- Whether NPs are employed by a hospital, a medical practice, a
community health center (such as federally qualified health centers [FQHCs]), or are
self-employed, a third-party payer most often determines reimbursement policies. Third-
party payers fall into seven general categories:
1. Medicare – A, B, C (Medicare Advantage Plans), D
2. Medicaid
3. Indemnity insurance companies
4. Managed care organizations (MCOs)
5. Workers’ compensation (WC)
6. Veterans Administration
8. THIRD-PARTY PAYER RULES
DIFFERENTIAL DIAGNOSIS & PRIMARY CARE |
CORRECT QUESTIONS ,VERIFIED ANSWERS ~
CHAMBERLAIN UNIVERSITY
NR511 – Differential Diagnosis and Primary Care Practicum
Exam Study Guide – Midterm Study Guide
1. Exam Coverage
Content Areas:
• Week 1: Diagnostic Reasoning and Differential Diagnosis
• Week 2: Diagnosis and Management of Common Skin and Nail Disorders
• Week 3: Diagnosis and Management of Common Eye Disorders
• Week 4: Diagnosis and Management of Ear, Nose, and Throat Disorders
2. Key Concepts to Study
Diagnostic Reasoning and Differential Diagnosis: page 42
Taking a history is the first step in the diagnostic reasoning process. Problems cannot be
found, strengths identified, or appropriate direction known without a real grounding in
the lived experience of the individual patient. If the patient’s visit is for “episodic” care
or if it is for addressing a new complaint, the history begins with a history of
present illness (HPI). Mnemonics can help the clinician remember the
essential data elements; the “OLD CART”
History-taking should always start with the chief complaint (CC), or the reason for the
visit. When there are multiple complaints, identify the one which is the most important
to the client or the highest priority complaint. History of Present Illness (HPI) should
always be included in the chief complaint
o Examples of subjective information include ROS:
▪ This symptom analysis allows the NP to narrow the potential differentials based on
information from the HPI. It also aids in conducting a focused physical examination (PE).
, Objective information is what is seen, heard, or felt as part of the physical exam (PE),
and includes laboratory data and test results.
1. Clinical Reasoning and Asking Clinical Questions
Diagnostic reasoning can be seen as a kind of critical thinking. This kind of thinking
supports clinical judgment in several ways. First, it becomes a habit of mind to have
, humility about one’s thought processes and to know that even the most experienced
thinker can be mistaken. Second, it becomes a systematic way of generating creative
ways of thinking about problems. Third, critical thinking returns one to an examination
of the strength of evidence for a given conclusion. “Evidence” in this context means
more than “hard” data such as laboratory values.
2. Critical thinking includes creative thinking, like developing problem lists. For example, a
patient with unclear abdominal pain might have irritable bowel syndrome. The creative
clinician explores stress management and considers options like a diet and symptom
log, increased fiber, walking, or a follow-up visit. Creativity helps in setting goals for
short- or long-term issues. Besides creativity, critical thinking systematically assesses
new data, supporting or dismissing diagnostic hypotheses.
3. Formulating a Differential Diagnosis
Differential Diagnosis
A differential diagnosis list is the list of possible diagnoses, usually in priority order.
When clinicians discuss a case, the list of differential diagnoses is usually considered.
Supports for developing a rich differential diagnosis list include several guides. One
approach suggests considering the problem from the “skin in.” This means that if the
patient complains of chest pain, the clinician can consider all possible causes of chest
pain, beginning at the skin, and visualize all structures in the area that could possibly be
affected.
The differential diagnosis list should always include any conditions that are life-, organ-,
or function-threatening. An NP describing a different patient situation stated:
I always think in terms of the most dangerous or the most serious thing first—not
necessarily the most catastrophic, but the most serious problem.
4. Evidence-based practice
There is an emphasis in health care today to promote evidence-based practice (EBP)
(see Chapter 5). Guidelines for practice are available from government agencies or from
specialty or disease-related groups, such as the American Heart Association, the
American Academy of Pediatrics, or any of the specialty organizations.
5. Choosing the best evidence
EBP: The Patient
, Applying analytical procedures for determining the credibility or reliability of data to be
employed as evidence is only one aspect of the decision-making process.
Level 1- Systemic review of randomized clinical trial studies- strongest- minimized bias
Level 2- Single, well designed, randomized clinical trial
Level 3- Well designed controlled trials without randomization
Level 4- Well designed case- control or cohort studies
Level 5- Systemic reviews of descriptive and qualitative studies
Level 6- Single descriptive or qualitative studies
Level 7- Opinion of authorities and or reports of expert committees
6. Sensitivity/Specificity
Sensitivity- Ability of a test to correctly identify people who HAVE the disease- focuses
on sick people- tells you how good the test is giving true positives.
Specificity- Ability of a test to correctly identify people who do NOT have the disease-
focuses on healthy people- tells you how good the test is at giving a true negative.
Positive predictive value is true positives over all positives; negative predictive value is
true negatives over all negatives. Predictive value depends partly on condition
prevalence. When a condition is likely, a positive test is more accurate; if unlikely, it
should be questioned, possibly with different tests.
Parts of Medicare coverage
• Medicare A—Hospital Inpatient Services
• Medicare B—Medical outpatient- Physician Services
• Medicare C -Medicare advantage- A+B+extra (vision/dental)
• Medicare D—Pharmaceutical Coverage
7. Third-party payers- Whether NPs are employed by a hospital, a medical practice, a
community health center (such as federally qualified health centers [FQHCs]), or are
self-employed, a third-party payer most often determines reimbursement policies. Third-
party payers fall into seven general categories:
1. Medicare – A, B, C (Medicare Advantage Plans), D
2. Medicaid
3. Indemnity insurance companies
4. Managed care organizations (MCOs)
5. Workers’ compensation (WC)
6. Veterans Administration
8. THIRD-PARTY PAYER RULES
