NR511 / NR 511 Midterm Exam Study Guide
Differential Diagnosis & Primary Care Practicum - Complete Solutions
Chamberlain University • Week 1-4 • Latest 2026/2027
Midterm Examination • 150 Multiple-Choice Questions • Cognitive Levels: 30% Recall, 50% Application, 20%
Analysis
Total Questions 150
8 (Reasoning, EBP, History, Exam, HEENT/Resp, CV/GI/MSK, Testing,
Sections
Documentation)
Question Style 80% scenario-based, 20% direct recall
Format Multiple choice, 4 options (A-D), ONE correct answer
Advanced practice nursing reasoning with guideline references and study guide
Rationale
value
Section 1: Clinical Reasoning and Differential Diagnosis Process (Week 1)
Q1: A graduate nursing student is developing a differential diagnosis list for a 45-year-old
patient with chest pain. The student identifies acute coronary syndrome, GERD, musculoskeletal
pain, anxiety, and pulmonary embolism as possibilities. Which principle should the student
apply FIRST when prioritizing these diagnoses?
A. Rank by frequency of occurrence in primary care populations
B. Use 'most dangerous' (life-threatening) conditions principle - prioritize acute coronary syndrome and
pulmonary embolism for exclusion [CORRECT]
C. Select the diagnosis with the most supportive positive findings
D. Order alphabetically for organizational purposes
Correct Answer: B
Rationale: The 'most dangerous' principle prioritizes exclusion of life-threatening conditions first (acute coronary
syndrome, pulmonary embolism, aortic dissection, tension pneumothorax) regardless of frequency. This is foundational
to advanced practice nursing clinical reasoning and the differential diagnosis process taught in NR511. Frequency
(epidemiologic) reasoning is secondary and applies to non-emergent differentials; positive findings alone do not exclude
serious conditions; alphabetical ordering has no clinical value in prioritization.
Q2: A nurse practitioner student is taught about illness scripts during a clinical reasoning
lecture. Which statement BEST describes an 'illness script'?
A. A formal written document used to communicate with consulting physicians
B. A mental framework of knowledge about a disease including epidemiology, time course, clinical features,
and pathophysiology, used for pattern recognition in diagnostic reasoning [CORRECT]
C. A patient education handout describing a disease
D. A billing document used for insurance reimbursement
Correct Answer: B
Rationale: An illness script is a cognitive mental framework developed through experience that integrates epidemiology,
time course, symptom patterns, physical findings, and pathophysiology of a disease. Expert clinicians compare the
patient's presentation to stored illness scripts to generate diagnostic hypotheses rapidly. This pattern recognition
(System 1 thinking) is contrasted with analytic reasoning (System 2), and novice NPs build scripts through deliberate
practice, case reviews, and clinical exposure.
Page 1
,NR511 Midterm | Differential Diagnosis & Primary Care Practicum | Chamberlain Week 1-4 | Latest 2026/2027
Q3: When using System 1 (intuitive) versus System 2 (analytic) thinking in clinical reasoning,
which scenario MOST appropriately warrants switching from System 1 to System 2 thinking?
A. Diagnosing uncomplicated viral URI in a healthy adult with classic presentation
B. Patient presentation does not match a known illness script, symptoms are atypical, or red flags are
present [CORRECT]
C. Routine medication refill for stable chronic hypertension
D. Healthy 25-year-old with simple pharyngitis and negative strep test
Correct Answer: B
Rationale: Dual process theory (Kahneman) describes System 1 (fast, intuitive, pattern recognition) and System 2 (slow,
analytic, deliberate). System 1 works well for typical presentations matching established illness scripts. Switch to System
2 when the presentation is atypical, red flags are present, multiple comorbidities exist, or diagnostic uncertainty
persists. Cognitive forcing strategies (structured differential diagnosis generation, Bayesian reasoning) reduce cognitive
bias and diagnostic error.
Q4: A 55-year-old man presents with 2 days of progressive dyspnea, productive cough, fever
(101.5F), and pleuritic chest pain. The NP initially suspects community-acquired pneumonia but
considers pulmonary embolism, COPD exacerbation, and heart failure. The patient has
tachycardia (110 bpm), hypoxia (SpO2 90% on room air), and right lower lobe crackles. Which
cognitive bias is the NP MOST at risk of if she anchors on her initial diagnosis?
A. Anchoring bias - fixating on the initial diagnosis and failing to adjust with new data
B. Availability heuristic - overestimating based on recent memorable cases
C. Premature closure - accepting a diagnosis before it is fully verified
D. Both A and C are relevant cognitive biases in this scenario [CORRECT]
Correct Answer: D
Rationale: Anchoring bias (fixating on initial diagnostic impression) and premature closure (accepting a diagnosis
before full verification) are both risks when a clinician latches onto an early hypothesis. Other relevant biases include
availability (overestimating what is easily recalled), search-satisficing (stopping search after finding one abnormality),
and diagnostic momentum (carrying forward a prior label). Metacognition and structured differential diagnosis
generation mitigate these errors.
Q5: A 32-year-old woman presents with acute-onset severe headache described as 'worst
headache of my life,' reaching maximum intensity within 1 minute. She has neck stiffness and
photophobia. Which is the PRIORITY action?
A. Prescribe sumatriptan for migraine and schedule follow-up in 1 week
B. Emergent referral for non-contrast head CT and lumbar puncture; consider subarachnoid hemorrhage
and urgent neurosurgical evaluation [CORRECT]
C. Order brain MRI as outpatient in 3 days
D. Begin acetaminophen and reassess in 24 hours
Correct Answer: B
Rationale: A 'thunderclap' headache (maximum intensity within 1 minute) with meningeal signs (neck stiffness,
photophobia) is the classic presentation of subarachnoid hemorrhage (SAH) from ruptured aneurysm. SAH is a
neurological emergency requiring emergent non-contrast head CT (sensitivity 100% within 6 hours), lumbar puncture if
CT negative (looking for xanthochromia), and neurosurgical consultation. Misdiagnosis is associated with 15-20%
mortality. Other red flags for headache include focal neurologic deficits, immunosuppression, fever/meningismus,
sudden onset, and 'worst of life' character.
Page 2
,NR511 Midterm | Differential Diagnosis & Primary Care Practicum | Chamberlain Week 1-4 | Latest 2026/2027
Q6: An NP is evaluating a 60-year-old woman with fatigue, weight loss, and new-onset
constipation. The patient also reports night sweats and unexplained fevers. Which 'red flag'
should prompt consideration of malignancy and urgent workup?
A. Single episode of fatigue
B. Constitutional symptoms (unexplained weight loss >10% body weight, night sweats, fever) concerning for
malignancy, infection, or systemic disease; require urgent workup [CORRECT]
C. Mild constipation for 2 days
D. Slight decrease in appetite for one meal
Correct Answer: B
Rationale: Constitutional 'red flag' symptoms for malignancy and serious systemic disease include unexplained weight
loss (>10% body weight in 6 months), drenching night sweats, persistent fever, fatigue, and anorexia. These warrant
urgent workup including CBC with differential, CMP, ESR/CRP, age/gender-appropriate cancer screening
(colonoscopy, mammography, PSA), and imaging as indicated. Other red flags include hemoptysis,
hematochezia/melena, hematuria, dysphagia, persistent adenopathy, and changing skin lesions.
Q7: A nurse practitioner uses Bayesian reasoning to estimate the probability of streptococcal
pharyngitis. The pretest probability based on Centor criteria is 50%, and a rapid strep test with
sensitivity 90% and specificity 95% is positive. What is the approximate post-test probability
(positive predictive value)?
A. Approximately 50% (no change)
B. Approximately 95% (PPV is high with high specificity and reasonable pretest probability) [CORRECT]
C. Approximately 25% (the test is unreliable)
D. Approximately 90% (PPV equals sensitivity)
Correct Answer: B
Rationale: Bayesian reasoning integrates pretest probability (Centor score) with test characteristics (sensitivity,
specificity) to estimate post-test probability (PPV). With 50% pretest probability and high specificity (95%), the positive
likelihood ratio is approximately 18, yielding post-test probability ~95%. This reasoning supports the NR511 emphasis
on integrating clinical findings with diagnostic tests rather than treating any single finding as definitive. Negative tests
with high sensitivity (NPV) rule out disease.
Q8: A 65-year-old patient presents with acute onset of focal neurologic deficits (right-sided
weakness and slurred speech) lasting 45 minutes that have now resolved. The patient has
hypertension and atrial fibrillation. What is the most appropriate interpretation and action?
A. Symptoms resolved - no further workup needed
B. Transient ischemic attack (TIA); emergent evaluation for stroke risk, carotid imaging, neurology consult,
antithrombotic therapy [CORRECT]
C. Migraine with aura; prescribe triptan
D. Hypoglycemia episode; fingerstick and glucose
Correct Answer: B
Rationale: A transient ischemic attack (TIA) is defined as transient neurologic dysfunction from focal brain ischemia
without acute infarction on imaging, typically resolving within 1 hour (historically <24 hours). TIA is a medical
emergency with 10-20% risk of subsequent stroke within 90 days. Evaluation includes brain MRI (DWI sequences),
carotid imaging (Doppler ultrasound, CTA, or MRA), cardiac evaluation (ECG, echocardiography, telemetry), and
antithrombotic therapy (antiplatelet or anticoagulation based on etiology). ABCD2 score stratifies stroke risk.
Page 3
, NR511 Midterm | Differential Diagnosis & Primary Care Practicum | Chamberlain Week 1-4 | Latest 2026/2027
Q9: An NP is developing a differential diagnosis for a 40-year-old patient with abdominal pain.
The student lists appendicitis, ovarian cyst, ectopic pregnancy, UTI, and gastroenteritis. Which
principle should guide the inclusion of conditions on the differential?
A. Include only the most likely diagnosis
B. Include life-threatening conditions (appendicitis, ectopic pregnancy), common conditions (gastroenteritis,
UTI), and conditions specific to the patient demographics and risk factors [CORRECT]
C. List conditions alphabetically without prioritization
D. Include only conditions the NP has personally seen
Correct Answer: B
Rationale: The differential diagnosis should include: (1) most likely diagnosis based on epidemiology and presentation;
(2) serious or life-threatening conditions that must not be missed (CAN'T MISS); (3) conditions specific to patient
demographics (women of childbearing age - ectopic pregnancy; elderly - aortic aneurysm, mesenteric ischemia); (4)
conditions based on comorbidities and risk factors. VINDICATE mnemonic (Vascular, Infection, Neoplasm,
Degenerative, Intoxication, Congenital, Autoimmune, Trauma, Endocrine) generates comprehensive differentials.
Q10: A 28-year-old woman presents with abdominal pain, vaginal bleeding, and a positive
pregnancy test. Vital signs: BP 90/60, HR 120, RR 22. What is the most appropriate action?
A. Outpatient ultrasound in 24 hours
B. Emergent evaluation for ectopic pregnancy with quantitative beta-hCG, transvaginal ultrasound, and
possible surgery [CORRECT]
C. Send home with NSAIDs and reassurance
D. Schedule routine OB appointment in 1 week
Correct Answer: B
Rationale: The combination of abdominal pain, vaginal bleeding, positive pregnancy test, and hemodynamic instability
(hypotension, tachycardia) is highly suggestive of ruptured ectopic pregnancy, a life-threatening emergency. Immediate
evaluation includes IV access, type and crossmatch, quantitative beta-hCG, transvaginal ultrasound, urgent
gynecology/surgical consultation. Risk factors: prior ectopic, PID, tubal surgery, IUD, infertility treatments.
Methotrexate (unruptured) or surgery (ruptured or unstable). Delayed diagnosis risks maternal mortality.
Q11: An NP student is creating a diagnostic hypothesis for a 50-year-old man with progressive
dyspnea, orthopnea, lower extremity edema, and fatigue. The student lists heart failure, COPD,
pneumonia, anemia, and pulmonary embolism. The process of generating these hypotheses
based on the chief complaint is BEST described as:
A. Diagnostic anchoring
B. Hypothesis generation (early diagnostic reasoning, where chief complaint and key findings activate
stored illness scripts and generate candidate diagnoses) [CORRECT]
C. Premature closure
D. Heuristic shortcut
Correct Answer: B
Rationale: Hypothesis generation is the early step in diagnostic reasoning where the chief complaint and key clinical
findings activate stored illness scripts and generate candidate diagnoses. This is followed by hypothesis refinement
through additional history, physical examination, and diagnostic testing, eventually leading to a working diagnosis.
Cognitive psychology research (Elstein) describes this as hypothetico-deductive reasoning, with experts generating
fewer but more accurate hypotheses than novices.
Page 4
Differential Diagnosis & Primary Care Practicum - Complete Solutions
Chamberlain University • Week 1-4 • Latest 2026/2027
Midterm Examination • 150 Multiple-Choice Questions • Cognitive Levels: 30% Recall, 50% Application, 20%
Analysis
Total Questions 150
8 (Reasoning, EBP, History, Exam, HEENT/Resp, CV/GI/MSK, Testing,
Sections
Documentation)
Question Style 80% scenario-based, 20% direct recall
Format Multiple choice, 4 options (A-D), ONE correct answer
Advanced practice nursing reasoning with guideline references and study guide
Rationale
value
Section 1: Clinical Reasoning and Differential Diagnosis Process (Week 1)
Q1: A graduate nursing student is developing a differential diagnosis list for a 45-year-old
patient with chest pain. The student identifies acute coronary syndrome, GERD, musculoskeletal
pain, anxiety, and pulmonary embolism as possibilities. Which principle should the student
apply FIRST when prioritizing these diagnoses?
A. Rank by frequency of occurrence in primary care populations
B. Use 'most dangerous' (life-threatening) conditions principle - prioritize acute coronary syndrome and
pulmonary embolism for exclusion [CORRECT]
C. Select the diagnosis with the most supportive positive findings
D. Order alphabetically for organizational purposes
Correct Answer: B
Rationale: The 'most dangerous' principle prioritizes exclusion of life-threatening conditions first (acute coronary
syndrome, pulmonary embolism, aortic dissection, tension pneumothorax) regardless of frequency. This is foundational
to advanced practice nursing clinical reasoning and the differential diagnosis process taught in NR511. Frequency
(epidemiologic) reasoning is secondary and applies to non-emergent differentials; positive findings alone do not exclude
serious conditions; alphabetical ordering has no clinical value in prioritization.
Q2: A nurse practitioner student is taught about illness scripts during a clinical reasoning
lecture. Which statement BEST describes an 'illness script'?
A. A formal written document used to communicate with consulting physicians
B. A mental framework of knowledge about a disease including epidemiology, time course, clinical features,
and pathophysiology, used for pattern recognition in diagnostic reasoning [CORRECT]
C. A patient education handout describing a disease
D. A billing document used for insurance reimbursement
Correct Answer: B
Rationale: An illness script is a cognitive mental framework developed through experience that integrates epidemiology,
time course, symptom patterns, physical findings, and pathophysiology of a disease. Expert clinicians compare the
patient's presentation to stored illness scripts to generate diagnostic hypotheses rapidly. This pattern recognition
(System 1 thinking) is contrasted with analytic reasoning (System 2), and novice NPs build scripts through deliberate
practice, case reviews, and clinical exposure.
Page 1
,NR511 Midterm | Differential Diagnosis & Primary Care Practicum | Chamberlain Week 1-4 | Latest 2026/2027
Q3: When using System 1 (intuitive) versus System 2 (analytic) thinking in clinical reasoning,
which scenario MOST appropriately warrants switching from System 1 to System 2 thinking?
A. Diagnosing uncomplicated viral URI in a healthy adult with classic presentation
B. Patient presentation does not match a known illness script, symptoms are atypical, or red flags are
present [CORRECT]
C. Routine medication refill for stable chronic hypertension
D. Healthy 25-year-old with simple pharyngitis and negative strep test
Correct Answer: B
Rationale: Dual process theory (Kahneman) describes System 1 (fast, intuitive, pattern recognition) and System 2 (slow,
analytic, deliberate). System 1 works well for typical presentations matching established illness scripts. Switch to System
2 when the presentation is atypical, red flags are present, multiple comorbidities exist, or diagnostic uncertainty
persists. Cognitive forcing strategies (structured differential diagnosis generation, Bayesian reasoning) reduce cognitive
bias and diagnostic error.
Q4: A 55-year-old man presents with 2 days of progressive dyspnea, productive cough, fever
(101.5F), and pleuritic chest pain. The NP initially suspects community-acquired pneumonia but
considers pulmonary embolism, COPD exacerbation, and heart failure. The patient has
tachycardia (110 bpm), hypoxia (SpO2 90% on room air), and right lower lobe crackles. Which
cognitive bias is the NP MOST at risk of if she anchors on her initial diagnosis?
A. Anchoring bias - fixating on the initial diagnosis and failing to adjust with new data
B. Availability heuristic - overestimating based on recent memorable cases
C. Premature closure - accepting a diagnosis before it is fully verified
D. Both A and C are relevant cognitive biases in this scenario [CORRECT]
Correct Answer: D
Rationale: Anchoring bias (fixating on initial diagnostic impression) and premature closure (accepting a diagnosis
before full verification) are both risks when a clinician latches onto an early hypothesis. Other relevant biases include
availability (overestimating what is easily recalled), search-satisficing (stopping search after finding one abnormality),
and diagnostic momentum (carrying forward a prior label). Metacognition and structured differential diagnosis
generation mitigate these errors.
Q5: A 32-year-old woman presents with acute-onset severe headache described as 'worst
headache of my life,' reaching maximum intensity within 1 minute. She has neck stiffness and
photophobia. Which is the PRIORITY action?
A. Prescribe sumatriptan for migraine and schedule follow-up in 1 week
B. Emergent referral for non-contrast head CT and lumbar puncture; consider subarachnoid hemorrhage
and urgent neurosurgical evaluation [CORRECT]
C. Order brain MRI as outpatient in 3 days
D. Begin acetaminophen and reassess in 24 hours
Correct Answer: B
Rationale: A 'thunderclap' headache (maximum intensity within 1 minute) with meningeal signs (neck stiffness,
photophobia) is the classic presentation of subarachnoid hemorrhage (SAH) from ruptured aneurysm. SAH is a
neurological emergency requiring emergent non-contrast head CT (sensitivity 100% within 6 hours), lumbar puncture if
CT negative (looking for xanthochromia), and neurosurgical consultation. Misdiagnosis is associated with 15-20%
mortality. Other red flags for headache include focal neurologic deficits, immunosuppression, fever/meningismus,
sudden onset, and 'worst of life' character.
Page 2
,NR511 Midterm | Differential Diagnosis & Primary Care Practicum | Chamberlain Week 1-4 | Latest 2026/2027
Q6: An NP is evaluating a 60-year-old woman with fatigue, weight loss, and new-onset
constipation. The patient also reports night sweats and unexplained fevers. Which 'red flag'
should prompt consideration of malignancy and urgent workup?
A. Single episode of fatigue
B. Constitutional symptoms (unexplained weight loss >10% body weight, night sweats, fever) concerning for
malignancy, infection, or systemic disease; require urgent workup [CORRECT]
C. Mild constipation for 2 days
D. Slight decrease in appetite for one meal
Correct Answer: B
Rationale: Constitutional 'red flag' symptoms for malignancy and serious systemic disease include unexplained weight
loss (>10% body weight in 6 months), drenching night sweats, persistent fever, fatigue, and anorexia. These warrant
urgent workup including CBC with differential, CMP, ESR/CRP, age/gender-appropriate cancer screening
(colonoscopy, mammography, PSA), and imaging as indicated. Other red flags include hemoptysis,
hematochezia/melena, hematuria, dysphagia, persistent adenopathy, and changing skin lesions.
Q7: A nurse practitioner uses Bayesian reasoning to estimate the probability of streptococcal
pharyngitis. The pretest probability based on Centor criteria is 50%, and a rapid strep test with
sensitivity 90% and specificity 95% is positive. What is the approximate post-test probability
(positive predictive value)?
A. Approximately 50% (no change)
B. Approximately 95% (PPV is high with high specificity and reasonable pretest probability) [CORRECT]
C. Approximately 25% (the test is unreliable)
D. Approximately 90% (PPV equals sensitivity)
Correct Answer: B
Rationale: Bayesian reasoning integrates pretest probability (Centor score) with test characteristics (sensitivity,
specificity) to estimate post-test probability (PPV). With 50% pretest probability and high specificity (95%), the positive
likelihood ratio is approximately 18, yielding post-test probability ~95%. This reasoning supports the NR511 emphasis
on integrating clinical findings with diagnostic tests rather than treating any single finding as definitive. Negative tests
with high sensitivity (NPV) rule out disease.
Q8: A 65-year-old patient presents with acute onset of focal neurologic deficits (right-sided
weakness and slurred speech) lasting 45 minutes that have now resolved. The patient has
hypertension and atrial fibrillation. What is the most appropriate interpretation and action?
A. Symptoms resolved - no further workup needed
B. Transient ischemic attack (TIA); emergent evaluation for stroke risk, carotid imaging, neurology consult,
antithrombotic therapy [CORRECT]
C. Migraine with aura; prescribe triptan
D. Hypoglycemia episode; fingerstick and glucose
Correct Answer: B
Rationale: A transient ischemic attack (TIA) is defined as transient neurologic dysfunction from focal brain ischemia
without acute infarction on imaging, typically resolving within 1 hour (historically <24 hours). TIA is a medical
emergency with 10-20% risk of subsequent stroke within 90 days. Evaluation includes brain MRI (DWI sequences),
carotid imaging (Doppler ultrasound, CTA, or MRA), cardiac evaluation (ECG, echocardiography, telemetry), and
antithrombotic therapy (antiplatelet or anticoagulation based on etiology). ABCD2 score stratifies stroke risk.
Page 3
, NR511 Midterm | Differential Diagnosis & Primary Care Practicum | Chamberlain Week 1-4 | Latest 2026/2027
Q9: An NP is developing a differential diagnosis for a 40-year-old patient with abdominal pain.
The student lists appendicitis, ovarian cyst, ectopic pregnancy, UTI, and gastroenteritis. Which
principle should guide the inclusion of conditions on the differential?
A. Include only the most likely diagnosis
B. Include life-threatening conditions (appendicitis, ectopic pregnancy), common conditions (gastroenteritis,
UTI), and conditions specific to the patient demographics and risk factors [CORRECT]
C. List conditions alphabetically without prioritization
D. Include only conditions the NP has personally seen
Correct Answer: B
Rationale: The differential diagnosis should include: (1) most likely diagnosis based on epidemiology and presentation;
(2) serious or life-threatening conditions that must not be missed (CAN'T MISS); (3) conditions specific to patient
demographics (women of childbearing age - ectopic pregnancy; elderly - aortic aneurysm, mesenteric ischemia); (4)
conditions based on comorbidities and risk factors. VINDICATE mnemonic (Vascular, Infection, Neoplasm,
Degenerative, Intoxication, Congenital, Autoimmune, Trauma, Endocrine) generates comprehensive differentials.
Q10: A 28-year-old woman presents with abdominal pain, vaginal bleeding, and a positive
pregnancy test. Vital signs: BP 90/60, HR 120, RR 22. What is the most appropriate action?
A. Outpatient ultrasound in 24 hours
B. Emergent evaluation for ectopic pregnancy with quantitative beta-hCG, transvaginal ultrasound, and
possible surgery [CORRECT]
C. Send home with NSAIDs and reassurance
D. Schedule routine OB appointment in 1 week
Correct Answer: B
Rationale: The combination of abdominal pain, vaginal bleeding, positive pregnancy test, and hemodynamic instability
(hypotension, tachycardia) is highly suggestive of ruptured ectopic pregnancy, a life-threatening emergency. Immediate
evaluation includes IV access, type and crossmatch, quantitative beta-hCG, transvaginal ultrasound, urgent
gynecology/surgical consultation. Risk factors: prior ectopic, PID, tubal surgery, IUD, infertility treatments.
Methotrexate (unruptured) or surgery (ruptured or unstable). Delayed diagnosis risks maternal mortality.
Q11: An NP student is creating a diagnostic hypothesis for a 50-year-old man with progressive
dyspnea, orthopnea, lower extremity edema, and fatigue. The student lists heart failure, COPD,
pneumonia, anemia, and pulmonary embolism. The process of generating these hypotheses
based on the chief complaint is BEST described as:
A. Diagnostic anchoring
B. Hypothesis generation (early diagnostic reasoning, where chief complaint and key findings activate
stored illness scripts and generate candidate diagnoses) [CORRECT]
C. Premature closure
D. Heuristic shortcut
Correct Answer: B
Rationale: Hypothesis generation is the early step in diagnostic reasoning where the chief complaint and key clinical
findings activate stored illness scripts and generate candidate diagnoses. This is followed by hypothesis refinement
through additional history, physical examination, and diagnostic testing, eventually leading to a working diagnosis.
Cognitive psychology research (Elstein) describes this as hypothetico-deductive reasoning, with experts generating
fewer but more accurate hypotheses than novices.
Page 4
