NR511 / NR 511 Midterm Exam (Latest )
Differential Diagnosis & Primary Care Practicum - Chamberlain University
100 Questions | Verified Answers | Grade A
Section 1: Clinical Decision-Making and Differential Diagnosis (Week 1)
Q1: A 55-year-old female presents for her annual wellness visit. She has no symptoms and no family history
of breast cancer. According to the USPSTF 2026 guidelines, which screening recommendation is most
appropriate for this patient?
A. Annual mammography starting now
B. Biennial mammography starting at age 50 with shared decision-making for ages 40-49 [CORRECT]
C. MRI breast screening due to age
D. No breast cancer screening is recommended at this age
Correct Answer: B
Rationale: The USPSTF assigns a Grade B recommendation for biennial mammography screening for women aged 50-74. For
women aged 40-49, the decision should be individualized through shared decision-making, as the net benefit is moderate. Annual
mammography is not the current USPSTF recommendation for this age group, and MRI screening is reserved for high-risk patients,
not average-risk individuals.
Q2: A new diagnostic test for diabetes has a sensitivity of 95% and a specificity of 80%. If the test is positive,
which of the following best describes what the clinician can conclude?
A. There is a 95% probability the patient has diabetes
B. There is an 80% probability the patient does not have diabetes
C. The patient likely has diabetes, but the probability depends on the pre-test prevalence (PPV)
[CORRECT]
D. The test result is definitively diagnostic and no further testing is needed
Correct Answer: C
Rationale: Sensitivity (95%) means the test correctly identifies 95% of individuals who truly have the disease (true positive rate).
However, a positive result does not mean there is a 95% probability the patient has diabetes. The Positive Predictive Value (PPV)
depends on disease prevalence in the population being tested. With a specificity of only 80%, there will be false positives, making
PPV lower than sensitivity, especially in low-prevalence populations.
Q3: A 45-year-old male presents with an LDL cholesterol of 160 mg/dL and no other cardiovascular risk
factors. His 10-year ASCVD risk is calculated at 4%. According to the USPSTF guidelines, what is the
recommended approach for lipid screening?
A. Start high-intensity statin immediately
B. Lipid screening is recommended for adults aged 40-75 with risk factors; lifestyle modification and
reassessment are appropriate at this time [CORRECT]
C. Lipid screening is not recommended for this patient since his risk is low
D. Prescribe a moderate-intensity statin and recheck in 3 months
Correct Answer: B
,Rationale: The USPSTF Grade B recommendation supports lipid screening for adults aged 40-75 with risk factors for
cardiovascular disease. For this patient with a 10-year ASCVD risk below 7.5% and no additional risk factors, pharmacologic
therapy is not indicated. Lifestyle modifications including diet, exercise, and weight management are the first-line approach. Statin
therapy would be considered if the 10-year ASCVD risk exceeded 7.5-10% or if risk factors were present.
Q4: A 52-year-old patient has a positive likelihood ratio (LR+) of 12 for a specific diagnostic test for
pulmonary embolism. What is the clinical significance of this finding?
A. The disease is very unlikely given this positive result
B. This is a strong indicator that the disease is present (LR+ > 10 = strong evidence for disease)
[CORRECT]
C. The test has poor diagnostic accuracy
D. The negative likelihood ratio must also be above 10 for the test to be useful
Correct Answer: B
Rationale: A positive likelihood ratio (LR+) above 10 provides strong evidence that the disease is present. The LR+ indicates how
much the odds of disease increase when the test is positive. An LR+ of 12 means the post-test odds of pulmonary embolism are 12
times the pre-test odds, which is a clinically significant finding. The LR- (negative likelihood ratio) is a separate metric; it does not
need to be above 10. A useful test typically has LR+ > 10 and LR- < 0.1.
Q5: A nurse practitioner is ordering colorectal cancer screening for a 60-year-old average-risk patient.
Which of the following screening strategies is endorsed by the USPSTF with a Grade A recommendation?
A. Colonoscopy every 5 years
B. Flexible sigmoidoscopy every 10 years
C. Colonoscopy every 10 years, annual FIT, or FIT-DNA every 3 years for adults aged 50-75 [CORRECT]
D. CT colonography every 3 years
Correct Answer: C
Rationale: The USPSTF assigns a Grade A recommendation for colorectal cancer screening in adults aged 50-75 using
colonoscopy every 10 years, annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT), flexible sigmoidoscopy
every 5 years (not 10), or FIT-DNA every 3 years. CT colonography is an option but not the primary recommendation. Colonoscopy
every 5 years is not the standard interval for average-risk individuals.
Q6: A 30-year-old female presents for a well-woman visit. She has no history of abnormal Pap smears and is
immunocompetent. According to the USPSTF cervical cancer screening guidelines, what is the
recommended screening approach?
A. Pap smear every year
B. Pap smear every 3 years (ages 21-29) and Pap/HPV co-testing every 5 years (ages 30-65) [CORRECT]
C. HPV testing alone every 5 years
D. Pap smear every 5 years regardless of age
Correct Answer: B
Rationale: The USPSTF Grade A recommendation for cervical cancer screening is Pap smear every 3 years for women aged
21-29, and Pap smear with HPV co-testing every 5 years for women aged 30-65. Annual Pap smears are not recommended by
USPSTF as they increase false-positive results without significantly improving outcomes. HPV testing alone is an option for some
women aged 30-65 but is not the sole recommendation for all ages.
Q7: A 62-year-old patient with a 40 pack-year smoking history is currently smoking and quit smoking 2
years ago at age 60. Does this patient meet the USPSTF criteria for lung cancer screening with low-dose CT
(LDCT)?
, A. Yes, because the patient has a 40 pack-year history and is within the age range [CORRECT]
B. No, because the patient quit smoking more than 15 years ago
C. No, because the patient must be a current smoker to qualify
D. Yes, but only if the patient has a cough or hemoptysis
Correct Answer: A
Rationale: The USPSTF Grade B recommendation for lung cancer screening with LDCT applies to adults aged 55-80 who have a
30 pack-year smoking history and currently smoke or have quit within the past 15 years. This patient is 62 (within range), has a 40
pack-year history (exceeds 30), and quit only 2 years ago (well within the 15-year criterion). Symptoms are not required for
screening eligibility.
Q8: A 35-year-old patient with a body mass index (BMI) of 32 kg/m2 presents for a routine checkup.
According to the USPSTF guidelines, which screening should be offered?
A. Diabetes screening with fasting plasma glucose or A1C [CORRECT]
B. Diabetes screening only if the patient has a family history
C. No diabetes screening until age 40
D. Oral glucose tolerance test only if symptomatic
Correct Answer: A
Rationale: The USPSTF Grade B recommendation supports diabetes screening for overweight or obese adults (BMI 25 or greater)
aged 35-70. This patient has a BMI of 32 and is 35 years old, meeting both criteria. Screening can be done with fasting plasma
glucose, A1C, or oral glucose tolerance test. A family history is not required for screening eligibility in this age group with elevated
BMI.
Q9: Which immunization is recommended as a one-time dose for all adults, followed by a Td booster every
10 years?
A. Tdap (tetanus, diphtheria, pertussis) [CORRECT]
B. Td (tetanus, diphtheria) only
C. DTaP (diphtheria, tetanus, acellular pertussis)
D. Tetanus toxoid alone
Correct Answer: A
Rationale: The CDC recommends that all adults receive a single dose of Tdap (which includes tetanus, diphtheria, and acellular
pertussis) if they have not previously received it, followed by a Td (tetanus and diphtheria) booster every 10 years. DTaP is the
pediatric formulation. Tetanus toxoid alone does not provide adequate protection against diphtheria and pertussis. Tdap replaces
one of the Td boosters.
Q10: A 70-year-old female with no risk factors asks about osteoporosis screening. What is the USPSTF
recommendation?
A. DXA scan for all women starting at age 60
B. DXA scan for women aged 65 and older (Grade B), younger women with risk factors [CORRECT]
C. No osteoporosis screening is recommended
D. Ultrasound heel measurement for all postmenopausal women
Correct Answer: B
Rationale: The USPSTF Grade B recommendation supports osteoporosis screening with dual-energy X-ray absorptiometry (DXA)
for women aged 65 and older. For younger postmenopausal women, screening should be individualized based on risk factors such
as low body weight, prior fracture, and family history. DXA is the gold standard; heel ultrasound is not recommended for screening
by USPSTF.
Differential Diagnosis & Primary Care Practicum - Chamberlain University
100 Questions | Verified Answers | Grade A
Section 1: Clinical Decision-Making and Differential Diagnosis (Week 1)
Q1: A 55-year-old female presents for her annual wellness visit. She has no symptoms and no family history
of breast cancer. According to the USPSTF 2026 guidelines, which screening recommendation is most
appropriate for this patient?
A. Annual mammography starting now
B. Biennial mammography starting at age 50 with shared decision-making for ages 40-49 [CORRECT]
C. MRI breast screening due to age
D. No breast cancer screening is recommended at this age
Correct Answer: B
Rationale: The USPSTF assigns a Grade B recommendation for biennial mammography screening for women aged 50-74. For
women aged 40-49, the decision should be individualized through shared decision-making, as the net benefit is moderate. Annual
mammography is not the current USPSTF recommendation for this age group, and MRI screening is reserved for high-risk patients,
not average-risk individuals.
Q2: A new diagnostic test for diabetes has a sensitivity of 95% and a specificity of 80%. If the test is positive,
which of the following best describes what the clinician can conclude?
A. There is a 95% probability the patient has diabetes
B. There is an 80% probability the patient does not have diabetes
C. The patient likely has diabetes, but the probability depends on the pre-test prevalence (PPV)
[CORRECT]
D. The test result is definitively diagnostic and no further testing is needed
Correct Answer: C
Rationale: Sensitivity (95%) means the test correctly identifies 95% of individuals who truly have the disease (true positive rate).
However, a positive result does not mean there is a 95% probability the patient has diabetes. The Positive Predictive Value (PPV)
depends on disease prevalence in the population being tested. With a specificity of only 80%, there will be false positives, making
PPV lower than sensitivity, especially in low-prevalence populations.
Q3: A 45-year-old male presents with an LDL cholesterol of 160 mg/dL and no other cardiovascular risk
factors. His 10-year ASCVD risk is calculated at 4%. According to the USPSTF guidelines, what is the
recommended approach for lipid screening?
A. Start high-intensity statin immediately
B. Lipid screening is recommended for adults aged 40-75 with risk factors; lifestyle modification and
reassessment are appropriate at this time [CORRECT]
C. Lipid screening is not recommended for this patient since his risk is low
D. Prescribe a moderate-intensity statin and recheck in 3 months
Correct Answer: B
,Rationale: The USPSTF Grade B recommendation supports lipid screening for adults aged 40-75 with risk factors for
cardiovascular disease. For this patient with a 10-year ASCVD risk below 7.5% and no additional risk factors, pharmacologic
therapy is not indicated. Lifestyle modifications including diet, exercise, and weight management are the first-line approach. Statin
therapy would be considered if the 10-year ASCVD risk exceeded 7.5-10% or if risk factors were present.
Q4: A 52-year-old patient has a positive likelihood ratio (LR+) of 12 for a specific diagnostic test for
pulmonary embolism. What is the clinical significance of this finding?
A. The disease is very unlikely given this positive result
B. This is a strong indicator that the disease is present (LR+ > 10 = strong evidence for disease)
[CORRECT]
C. The test has poor diagnostic accuracy
D. The negative likelihood ratio must also be above 10 for the test to be useful
Correct Answer: B
Rationale: A positive likelihood ratio (LR+) above 10 provides strong evidence that the disease is present. The LR+ indicates how
much the odds of disease increase when the test is positive. An LR+ of 12 means the post-test odds of pulmonary embolism are 12
times the pre-test odds, which is a clinically significant finding. The LR- (negative likelihood ratio) is a separate metric; it does not
need to be above 10. A useful test typically has LR+ > 10 and LR- < 0.1.
Q5: A nurse practitioner is ordering colorectal cancer screening for a 60-year-old average-risk patient.
Which of the following screening strategies is endorsed by the USPSTF with a Grade A recommendation?
A. Colonoscopy every 5 years
B. Flexible sigmoidoscopy every 10 years
C. Colonoscopy every 10 years, annual FIT, or FIT-DNA every 3 years for adults aged 50-75 [CORRECT]
D. CT colonography every 3 years
Correct Answer: C
Rationale: The USPSTF assigns a Grade A recommendation for colorectal cancer screening in adults aged 50-75 using
colonoscopy every 10 years, annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT), flexible sigmoidoscopy
every 5 years (not 10), or FIT-DNA every 3 years. CT colonography is an option but not the primary recommendation. Colonoscopy
every 5 years is not the standard interval for average-risk individuals.
Q6: A 30-year-old female presents for a well-woman visit. She has no history of abnormal Pap smears and is
immunocompetent. According to the USPSTF cervical cancer screening guidelines, what is the
recommended screening approach?
A. Pap smear every year
B. Pap smear every 3 years (ages 21-29) and Pap/HPV co-testing every 5 years (ages 30-65) [CORRECT]
C. HPV testing alone every 5 years
D. Pap smear every 5 years regardless of age
Correct Answer: B
Rationale: The USPSTF Grade A recommendation for cervical cancer screening is Pap smear every 3 years for women aged
21-29, and Pap smear with HPV co-testing every 5 years for women aged 30-65. Annual Pap smears are not recommended by
USPSTF as they increase false-positive results without significantly improving outcomes. HPV testing alone is an option for some
women aged 30-65 but is not the sole recommendation for all ages.
Q7: A 62-year-old patient with a 40 pack-year smoking history is currently smoking and quit smoking 2
years ago at age 60. Does this patient meet the USPSTF criteria for lung cancer screening with low-dose CT
(LDCT)?
, A. Yes, because the patient has a 40 pack-year history and is within the age range [CORRECT]
B. No, because the patient quit smoking more than 15 years ago
C. No, because the patient must be a current smoker to qualify
D. Yes, but only if the patient has a cough or hemoptysis
Correct Answer: A
Rationale: The USPSTF Grade B recommendation for lung cancer screening with LDCT applies to adults aged 55-80 who have a
30 pack-year smoking history and currently smoke or have quit within the past 15 years. This patient is 62 (within range), has a 40
pack-year history (exceeds 30), and quit only 2 years ago (well within the 15-year criterion). Symptoms are not required for
screening eligibility.
Q8: A 35-year-old patient with a body mass index (BMI) of 32 kg/m2 presents for a routine checkup.
According to the USPSTF guidelines, which screening should be offered?
A. Diabetes screening with fasting plasma glucose or A1C [CORRECT]
B. Diabetes screening only if the patient has a family history
C. No diabetes screening until age 40
D. Oral glucose tolerance test only if symptomatic
Correct Answer: A
Rationale: The USPSTF Grade B recommendation supports diabetes screening for overweight or obese adults (BMI 25 or greater)
aged 35-70. This patient has a BMI of 32 and is 35 years old, meeting both criteria. Screening can be done with fasting plasma
glucose, A1C, or oral glucose tolerance test. A family history is not required for screening eligibility in this age group with elevated
BMI.
Q9: Which immunization is recommended as a one-time dose for all adults, followed by a Td booster every
10 years?
A. Tdap (tetanus, diphtheria, pertussis) [CORRECT]
B. Td (tetanus, diphtheria) only
C. DTaP (diphtheria, tetanus, acellular pertussis)
D. Tetanus toxoid alone
Correct Answer: A
Rationale: The CDC recommends that all adults receive a single dose of Tdap (which includes tetanus, diphtheria, and acellular
pertussis) if they have not previously received it, followed by a Td (tetanus and diphtheria) booster every 10 years. DTaP is the
pediatric formulation. Tetanus toxoid alone does not provide adequate protection against diphtheria and pertussis. Tdap replaces
one of the Td boosters.
Q10: A 70-year-old female with no risk factors asks about osteoporosis screening. What is the USPSTF
recommendation?
A. DXA scan for all women starting at age 60
B. DXA scan for women aged 65 and older (Grade B), younger women with risk factors [CORRECT]
C. No osteoporosis screening is recommended
D. Ultrasound heel measurement for all postmenopausal women
Correct Answer: B
Rationale: The USPSTF Grade B recommendation supports osteoporosis screening with dual-energy X-ray absorptiometry (DXA)
for women aged 65 and older. For younger postmenopausal women, screening should be individualized based on risk factors such
as low body weight, prior fracture, and family history. DXA is the gold standard; heel ultrasound is not recommended for screening
by USPSTF.
