1
NR 511 / NR511 Midterm Exam Differential
Diagnosis and Primary Care Practicum Actual
Exam 2026/2027 | Complete Exam-Style
Questions | 100% Verified – Detailed Rationales –
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Clinical Reasoning and Diagnostic Process | Q1 – Q15
Section 2 | Dermatologic and HEENT Differential Diagnosis | Q16 – Q30
Section 3 | Cardiovascular and Respiratory Differential Diagnosis | Q31 – Q45
Section 4 | Gastrointestinal and Genitourinary Differential Diagnosis | Q46 – Q60
Section 5 | Musculoskeletal, Neurological, and Multisystem Differential Diagnosis | Q61 –
Q75
SECTION 1: CLINICAL REASONING AND DIAGNOSTIC PROCESS
Question 1 of 75
A 34-year-old female presents with acute onset of dyspnea and pleuritic chest pain. She has no
significant past medical history but recently returned from a 12-hour flight. Vital signs are stable,
and Wells score is low. A D-dimer assay is ordered and returns negative.
A. Order CT pulmonary angiography to definitively rule out pulmonary embolism
B. Initiate therapeutic anticoagulation with apixaban
C. Discharge the patient without further imaging for pulmonary embolism ✓ CORRECT
D. Perform a V/Q scan to clarify the diagnosis
Correct Answer: C
Rationale: A negative D-dimer in a patient with a low pre-test probability effectively rules out
pulmonary embolism without the need for radiation-based imaging. Ordering a CT pulmonary
,2
angiography in this scenario would expose the patient to unnecessary radiation and contrast risks
without improving diagnostic yield. Clinical pearl: Always estimate pre-test probability prior to
ordering diagnostic tests to minimize false positives and unnecessary procedures.
Question 2 of 75
A 22-year-old college student presents with a 2-day history of sore throat, fever, and anterior
cervical lymphadenopathy. Physical exam reveals tonsillar exudates and no cough. The patient
has no drug allergies. You decide to utilize the Centor criteria to guide management.
A. Prescribe broad-spectrum antibiotics immediately
B. Perform a rapid streptococcal antigen detection test ✓ CORRECT
C. Recommend symptomatic care only as this is likely viral
D. Obtain monospot test for infectious mononucleosis
Correct Answer: B
Rationale: The patient meets sufficient Centor criteria to warrant testing for Group A
Streptococcus pharyngitis via rapid antigen detection test. Prescribing antibiotics without
confirmation contributes to resistance and misses viral etiologies which are common in this age
group. Clinical pearl: Clinical decision rules like the Centor criteria help stratify risk but should
be combined with diagnostic testing for accurate treatment.
Question 3 of 75
A 55-year-old male presents for a routine commercial driver's license physical. His blood
pressure readings are 162/94 mmHg and 158/92 mmHg. He has no history of hypertension and
reports no headaches or visual changes. A repeat screening in two weeks confirms sustained
hypertension.
A. Initiate monotherapy with an ACE inhibitor or thiazide diuretic ✓ CORRECT
,3
B. Refer to cardiology for secondary hypertension workup
C. Reassure the patient and monitor lifestyle changes for 6 months
D. Start a beta-blocker as first-line therapy
Correct Answer: A
Rationale: Pharmacologic management with an ACE inhibitor or thiazide diuretic is indicated for
stage 2 hypertension to reduce cardiovascular risk. Referral is unnecessary at this stage as the
patient has uncomplicated essential hypertension manageable in primary care. Clinical pearl:
Lifestyle modification is foundational, but stage 2 hypertension typically requires simultaneous
initiation of pharmacotherapy.
Question 4 of 75
A 45-year-old female presents with chronic fatigue and diffuse body aches. She reports sleeping
poorly and feels "stressed" constantly. Her physical exam is unremarkable, and laboratory studies
including CBC, TSH, and metabolic panel are normal. The NP strongly suspects fibromyalgia
but fails to consider the patient's history of hypothyroidism which was treated three years ago.
A. Premature closure
B. Anchoring bias
C. Confirmation bias
D. Representativeness error ✓ CORRECT
Correct Answer: D
Rationale: Representativeness error occurs when a clinician judges the probability of a diagnosis
solely by how similar the patient is to a prototypical case, ignoring base rates. The NP focused on
the classic presentation of fibromyalgia while neglecting the prior history that could suggest
recurrence or inadequacy of thyroid treatment. Clinical pearl: Cognitive biases are best mitigated
by actively considering alternative diagnoses and reviewing past medical history thoroughly.
Question 5 of 75
, 4
A 28-year-old female presents with a 3-month history of intermittent abdominal pain and
bloating. She notes the pain is relieved with defecation and is associated with changes in stool
frequency. She denies weight loss, rectal bleeding, or nocturnal symptoms. Physical exam and
routine labs are normal.
A. Refer for colonoscopy immediately
B. Order abdominal CT scan
C. Diagnose Irritable Bowel Syndrome (IBS) ✓ CORRECT
D. Screen for Celiac disease
Correct Answer: C
Rationale: The patient meets Rome IV criteria for IBS with recurrent abdominal pain related to
defecation and change in stool form in the absence of alarm features. Invasive testing like
colonoscopy is not indicated without red flags such as weight loss, bleeding, or family history of
malignancy. Clinical pearl: IBS is a diagnosis of exclusion that relies heavily on symptom-based
criteria and the absence of alarm features.
Question 6 of 75
You are evaluating a 60-year-old male with knee pain. You decide to order an X-ray. In the
context of diagnostic reasoning, the X-ray findings will determine your post-test probability of
the diagnosis.
A. The result of the test will change the probability of the disease
B. A negative X-ray effectively rules out osteoarthritis
C. Sensitivity is more important than specificity in this scenario
D. Likelihood ratios are irrelevant for this imaging modality ✓ CORRECT
Correct Answer: D
NR 511 / NR511 Midterm Exam Differential
Diagnosis and Primary Care Practicum Actual
Exam 2026/2027 | Complete Exam-Style
Questions | 100% Verified – Detailed Rationales –
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Clinical Reasoning and Diagnostic Process | Q1 – Q15
Section 2 | Dermatologic and HEENT Differential Diagnosis | Q16 – Q30
Section 3 | Cardiovascular and Respiratory Differential Diagnosis | Q31 – Q45
Section 4 | Gastrointestinal and Genitourinary Differential Diagnosis | Q46 – Q60
Section 5 | Musculoskeletal, Neurological, and Multisystem Differential Diagnosis | Q61 –
Q75
SECTION 1: CLINICAL REASONING AND DIAGNOSTIC PROCESS
Question 1 of 75
A 34-year-old female presents with acute onset of dyspnea and pleuritic chest pain. She has no
significant past medical history but recently returned from a 12-hour flight. Vital signs are stable,
and Wells score is low. A D-dimer assay is ordered and returns negative.
A. Order CT pulmonary angiography to definitively rule out pulmonary embolism
B. Initiate therapeutic anticoagulation with apixaban
C. Discharge the patient without further imaging for pulmonary embolism ✓ CORRECT
D. Perform a V/Q scan to clarify the diagnosis
Correct Answer: C
Rationale: A negative D-dimer in a patient with a low pre-test probability effectively rules out
pulmonary embolism without the need for radiation-based imaging. Ordering a CT pulmonary
,2
angiography in this scenario would expose the patient to unnecessary radiation and contrast risks
without improving diagnostic yield. Clinical pearl: Always estimate pre-test probability prior to
ordering diagnostic tests to minimize false positives and unnecessary procedures.
Question 2 of 75
A 22-year-old college student presents with a 2-day history of sore throat, fever, and anterior
cervical lymphadenopathy. Physical exam reveals tonsillar exudates and no cough. The patient
has no drug allergies. You decide to utilize the Centor criteria to guide management.
A. Prescribe broad-spectrum antibiotics immediately
B. Perform a rapid streptococcal antigen detection test ✓ CORRECT
C. Recommend symptomatic care only as this is likely viral
D. Obtain monospot test for infectious mononucleosis
Correct Answer: B
Rationale: The patient meets sufficient Centor criteria to warrant testing for Group A
Streptococcus pharyngitis via rapid antigen detection test. Prescribing antibiotics without
confirmation contributes to resistance and misses viral etiologies which are common in this age
group. Clinical pearl: Clinical decision rules like the Centor criteria help stratify risk but should
be combined with diagnostic testing for accurate treatment.
Question 3 of 75
A 55-year-old male presents for a routine commercial driver's license physical. His blood
pressure readings are 162/94 mmHg and 158/92 mmHg. He has no history of hypertension and
reports no headaches or visual changes. A repeat screening in two weeks confirms sustained
hypertension.
A. Initiate monotherapy with an ACE inhibitor or thiazide diuretic ✓ CORRECT
,3
B. Refer to cardiology for secondary hypertension workup
C. Reassure the patient and monitor lifestyle changes for 6 months
D. Start a beta-blocker as first-line therapy
Correct Answer: A
Rationale: Pharmacologic management with an ACE inhibitor or thiazide diuretic is indicated for
stage 2 hypertension to reduce cardiovascular risk. Referral is unnecessary at this stage as the
patient has uncomplicated essential hypertension manageable in primary care. Clinical pearl:
Lifestyle modification is foundational, but stage 2 hypertension typically requires simultaneous
initiation of pharmacotherapy.
Question 4 of 75
A 45-year-old female presents with chronic fatigue and diffuse body aches. She reports sleeping
poorly and feels "stressed" constantly. Her physical exam is unremarkable, and laboratory studies
including CBC, TSH, and metabolic panel are normal. The NP strongly suspects fibromyalgia
but fails to consider the patient's history of hypothyroidism which was treated three years ago.
A. Premature closure
B. Anchoring bias
C. Confirmation bias
D. Representativeness error ✓ CORRECT
Correct Answer: D
Rationale: Representativeness error occurs when a clinician judges the probability of a diagnosis
solely by how similar the patient is to a prototypical case, ignoring base rates. The NP focused on
the classic presentation of fibromyalgia while neglecting the prior history that could suggest
recurrence or inadequacy of thyroid treatment. Clinical pearl: Cognitive biases are best mitigated
by actively considering alternative diagnoses and reviewing past medical history thoroughly.
Question 5 of 75
, 4
A 28-year-old female presents with a 3-month history of intermittent abdominal pain and
bloating. She notes the pain is relieved with defecation and is associated with changes in stool
frequency. She denies weight loss, rectal bleeding, or nocturnal symptoms. Physical exam and
routine labs are normal.
A. Refer for colonoscopy immediately
B. Order abdominal CT scan
C. Diagnose Irritable Bowel Syndrome (IBS) ✓ CORRECT
D. Screen for Celiac disease
Correct Answer: C
Rationale: The patient meets Rome IV criteria for IBS with recurrent abdominal pain related to
defecation and change in stool form in the absence of alarm features. Invasive testing like
colonoscopy is not indicated without red flags such as weight loss, bleeding, or family history of
malignancy. Clinical pearl: IBS is a diagnosis of exclusion that relies heavily on symptom-based
criteria and the absence of alarm features.
Question 6 of 75
You are evaluating a 60-year-old male with knee pain. You decide to order an X-ray. In the
context of diagnostic reasoning, the X-ray findings will determine your post-test probability of
the diagnosis.
A. The result of the test will change the probability of the disease
B. A negative X-ray effectively rules out osteoarthritis
C. Sensitivity is more important than specificity in this scenario
D. Likelihood ratios are irrelevant for this imaging modality ✓ CORRECT
Correct Answer: D
