NR511 Differential Diagnosis Practicum Review Midterm 2026/2027 | Page 1 | Passing Score: 80%
CHAMBERLAIN UNIVERSITY
Midterm Exam: NR511 Review
Differential Diagnosis & Primary Care Practicum
Official Review 2026/2027
100 80% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Diagnostic Reasoning & Clinical Decision-Making Q1-Q20
Section 2 Common Acute Conditions in Primary Care Q21-Q40
Section 3 Chronic Condition Management & Prevention Q41-Q60
Section 4 Pharmacotherapeutics in Primary Care Q61-Q80
Section 5 Patient Education & Follow-Up Planning Q81-Q100
Instructions: Select the single best answer for each question. This exam is designed for Chamberlain NR511 Differential Diagnosis
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 1 of 52
, SECTION 1 | Diagnostic Reasoning & Clinical Decision-Making | Q1-Q20 | NR511 Practicum Review 2026/2027
Q1 Question 1 of 100
A 45-year-old woman presents with a 3-week history of fatigue, weight gain, constipation, and
cold intolerance. Her TSH is 18.5 mIU/L and free T4 is 0.4 ng/dL. What is the most likely
diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Euthyroid sick syndrome
D. Subacute thyroiditis
Correct Answer: A
Rationale:
The elevated TSH with low free T4 confirms primary hypothyroidism. Hyperthyroidism would show
suppressed TSH with elevated T4. Euthyroid sick syndrome typically shows low TSH and low T4 in the
setting of non-thyroid illness. Subacute thyroiditis presents with thyroid pain and transient hyperthyroidism.
Q2 Question 2 of 100
A 52-year-old man presents with acute onset of severe tearing chest pain radiating to his
back. His blood pressure is 180/110 mmHg in the right arm and 140/90 mmHg in the left arm.
What is the most likely diagnosis requiring immediate intervention?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pneumothorax
Correct Answer: B
Rationale:
Tearing chest pain radiating to the back with unequal blood pressure readings in both arms is the classic
presentation of aortic dissection. Acute MI typically presents with crushing chest pain with equal arm
pressures. Pulmonary embolism presents with dyspnea and pleuritic pain. Pneumothorax causes sudden
sharp chest pain with decreased breath sounds.
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 2 of 52
, SECTION 1 | Diagnostic Reasoning & Clinical Decision-Making | Q1-Q20 | NR511 Practicum Review 2026/2027
Q3 Question 3 of 100
A 34-year-old woman presents with a symmetric butterfly rash across her cheeks and nose,
fatigue, and joint pain in her hands. Her ANA is positive at 1:640 and anti-dsDNA is positive.
What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Dermatomyositis
D. Rosacea
Correct Answer: C
Rationale:
The malar butterfly rash, positive ANA at high titer, and positive anti-dsDNA are highly specific for systemic
lupus erythematosus. Rheumatoid arthritis primarily causes symmetric joint destruction without malar rash.
Dermatomyositis presents with heliotrope rash and muscle weakness. Rosacea lacks systemic and
serologic findings.
Q4 Question 4 of 100
A 60-year-old man with a 40-pack-year smoking history presents with chronic cough,
hemoptysis, and unintentional 15-pound weight loss over 2 months. Chest X-ray reveals a
3-cm spiculated mass in the right upper lobe. What is the most appropriate next diagnostic
step?
A. Repeat chest X-ray in 3 months
B. CT-guided biopsy of the mass
C. Start empiric antibiotics for pneumonia
D. Obtain a ventilation-perfusion scan
Correct Answer: D
Rationale:
A spiculated lung mass with risk factors for malignancy requires tissue diagnosis via CT-guided biopsy.
Repeating imaging in 3 months would delay diagnosis of a likely malignancy. Antibiotics are not indicated
without signs of infection. A V/Q scan is used for pulmonary embolism, not mass evaluation.
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 3 of 52
, SECTION 1 | Diagnostic Reasoning & Clinical Decision-Making | Q1-Q20 | NR511 Practicum Review 2026/2027
Q5 Question 5 of 100
A 28-year-old woman presents with a 2-day history of right lower quadrant abdominal pain,
nausea, and anorexia. On examination, she has localized tenderness at McBurney point with
rebound tenderness. Her WBC is 14,000. What is the most likely diagnosis?
A. Acute appendicitis
B. Ovarian torsion
C. Ectopic pregnancy
D. Nephrolithiasis
Correct Answer: A
Rationale:
Right lower quadrant pain at McBurney point with rebound tenderness, anorexia, nausea, and leukocytosis
is the classic presentation of acute appendicitis. Ovarian torsion presents with sudden severe pain. Ectopic
pregnancy requires a positive pregnancy test. Nephrolithiasis typically presents with flank pain radiating to
the groin.
Q6 Question 6 of 100
A 55-year-old man presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. Echocardiography shows an ejection fraction of 30% with left
ventricular dilation. What is the most likely diagnosis?
A. Heart failure with reduced ejection fraction
B. Heart failure with preserved ejection fraction
C. Cor pulmonale
D. Constrictive pericarditis
Correct Answer: B
Rationale:
An ejection fraction of 30% with left ventricular dilation and symptoms of volume overload confirms heart
failure with reduced ejection fraction (HFrEF). HFpEF would show EF of 50% or greater. Cor pulmonale
primarily affects the right ventricle. Constrictive pericarditis shows normal EF with impaired filling.
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 4 of 52
CHAMBERLAIN UNIVERSITY
Midterm Exam: NR511 Review
Differential Diagnosis & Primary Care Practicum
Official Review 2026/2027
100 80% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Diagnostic Reasoning & Clinical Decision-Making Q1-Q20
Section 2 Common Acute Conditions in Primary Care Q21-Q40
Section 3 Chronic Condition Management & Prevention Q41-Q60
Section 4 Pharmacotherapeutics in Primary Care Q61-Q80
Section 5 Patient Education & Follow-Up Planning Q81-Q100
Instructions: Select the single best answer for each question. This exam is designed for Chamberlain NR511 Differential Diagnosis
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 1 of 52
, SECTION 1 | Diagnostic Reasoning & Clinical Decision-Making | Q1-Q20 | NR511 Practicum Review 2026/2027
Q1 Question 1 of 100
A 45-year-old woman presents with a 3-week history of fatigue, weight gain, constipation, and
cold intolerance. Her TSH is 18.5 mIU/L and free T4 is 0.4 ng/dL. What is the most likely
diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Euthyroid sick syndrome
D. Subacute thyroiditis
Correct Answer: A
Rationale:
The elevated TSH with low free T4 confirms primary hypothyroidism. Hyperthyroidism would show
suppressed TSH with elevated T4. Euthyroid sick syndrome typically shows low TSH and low T4 in the
setting of non-thyroid illness. Subacute thyroiditis presents with thyroid pain and transient hyperthyroidism.
Q2 Question 2 of 100
A 52-year-old man presents with acute onset of severe tearing chest pain radiating to his
back. His blood pressure is 180/110 mmHg in the right arm and 140/90 mmHg in the left arm.
What is the most likely diagnosis requiring immediate intervention?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pneumothorax
Correct Answer: B
Rationale:
Tearing chest pain radiating to the back with unequal blood pressure readings in both arms is the classic
presentation of aortic dissection. Acute MI typically presents with crushing chest pain with equal arm
pressures. Pulmonary embolism presents with dyspnea and pleuritic pain. Pneumothorax causes sudden
sharp chest pain with decreased breath sounds.
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 2 of 52
, SECTION 1 | Diagnostic Reasoning & Clinical Decision-Making | Q1-Q20 | NR511 Practicum Review 2026/2027
Q3 Question 3 of 100
A 34-year-old woman presents with a symmetric butterfly rash across her cheeks and nose,
fatigue, and joint pain in her hands. Her ANA is positive at 1:640 and anti-dsDNA is positive.
What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Dermatomyositis
D. Rosacea
Correct Answer: C
Rationale:
The malar butterfly rash, positive ANA at high titer, and positive anti-dsDNA are highly specific for systemic
lupus erythematosus. Rheumatoid arthritis primarily causes symmetric joint destruction without malar rash.
Dermatomyositis presents with heliotrope rash and muscle weakness. Rosacea lacks systemic and
serologic findings.
Q4 Question 4 of 100
A 60-year-old man with a 40-pack-year smoking history presents with chronic cough,
hemoptysis, and unintentional 15-pound weight loss over 2 months. Chest X-ray reveals a
3-cm spiculated mass in the right upper lobe. What is the most appropriate next diagnostic
step?
A. Repeat chest X-ray in 3 months
B. CT-guided biopsy of the mass
C. Start empiric antibiotics for pneumonia
D. Obtain a ventilation-perfusion scan
Correct Answer: D
Rationale:
A spiculated lung mass with risk factors for malignancy requires tissue diagnosis via CT-guided biopsy.
Repeating imaging in 3 months would delay diagnosis of a likely malignancy. Antibiotics are not indicated
without signs of infection. A V/Q scan is used for pulmonary embolism, not mass evaluation.
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 3 of 52
, SECTION 1 | Diagnostic Reasoning & Clinical Decision-Making | Q1-Q20 | NR511 Practicum Review 2026/2027
Q5 Question 5 of 100
A 28-year-old woman presents with a 2-day history of right lower quadrant abdominal pain,
nausea, and anorexia. On examination, she has localized tenderness at McBurney point with
rebound tenderness. Her WBC is 14,000. What is the most likely diagnosis?
A. Acute appendicitis
B. Ovarian torsion
C. Ectopic pregnancy
D. Nephrolithiasis
Correct Answer: A
Rationale:
Right lower quadrant pain at McBurney point with rebound tenderness, anorexia, nausea, and leukocytosis
is the classic presentation of acute appendicitis. Ovarian torsion presents with sudden severe pain. Ectopic
pregnancy requires a positive pregnancy test. Nephrolithiasis typically presents with flank pain radiating to
the groin.
Q6 Question 6 of 100
A 55-year-old man presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. Echocardiography shows an ejection fraction of 30% with left
ventricular dilation. What is the most likely diagnosis?
A. Heart failure with reduced ejection fraction
B. Heart failure with preserved ejection fraction
C. Cor pulmonale
D. Constrictive pericarditis
Correct Answer: B
Rationale:
An ejection fraction of 30% with left ventricular dilation and symptoms of volume overload confirms heart
failure with reduced ejection fraction (HFrEF). HFpEF would show EF of 50% or greater. Cor pulmonale
primarily affects the right ventricle. Constrictive pericarditis shows normal EF with impaired filling.
NR511 Differential Diagnosis Practicum Review - 2026/2027 | Passing Score: 80% | Page 4 of 52
