NR511 Midterm Exam: Differential Diagnosis &
Primary Care Practicum Guide (2026/2027) –
Chamberlain University | AANPCB-Style Clinical
Reasoning | Grade A Verified
PHASE 1 – TRIAGE & INITIAL DATA SYNTHESIS (15 Qs)
Q1
A 24-year-old female presents with 3-day history of sore throat, 101.2 °F fever, and
“white patches” on tonsils. She has no cough, no rhinorrhea, and tender anterior
cervical nodes. She is otherwise healthy.
Which single HPI question best refines your differential before exam?
A. “Do you have night sweats?”
B. “Have you had similar symptoms before?”
C. “Do you have any joint pain or rash?”
,D. “Have you been exposed to anyone with strep throat?”
Practicum Preceptor Rationale
Correct Answer: D
Clinical Stage: Initial HPI refinement (Centor criteria).
Differential: Viral pharyngitis vs. group A strep (GAS).
Rationale: Exposure history immediately raises pre-test probability for GAS and guides
rapid testing.
Distractors: A/B/C are lower yield at this point.
Teaching Point: Always ask about strep exposure; it’s one of the five Centor criteria.
Q2
A 38-year-old man describes 2-week “pressure” headache, worse in morning, no
nausea, no visual changes. He takes OTC ibuprofen 600 mg BID with partial relief.
PMH: obesity, HTN.
Which red-flag symptom requires immediate action?
A. Morning predominance
,B. Partial relief with NSAID
C. Absence of nausea
D. 2-week duration
Practicum Preceptor Rationale
Correct Answer: A
Clinical Stage: Red-flag screening.
Differential: Idiopathic intracranial HTN, sleep-apnea headache, mass lesion.
Rationale: Morning headache + obesity + HTN suggests raised ICP until proven
otherwise.
Teaching Point: Morning headaches are a classic sign of elevated ICP—image early.
Q3
A 31-year-old woman, 8 weeks postpartum, complains of 4-day “racing heart” and
feeling “shaky.” She is breastfeeding and sleeping 3–4 h/night. No chest pain.
Which HPI element best clarifies etiology?
A. Family history of thyroid disease
, B. Timing of symptoms relative to sleep
C. Caffeine intake (mg/day)
D. Obstetric blood-loss amount
Practicum Preceptor Rationale
Correct Answer: B
Clinical Stage: HPI refinement.
Differential: Sleep-deprivation tachycardia vs. postpartum thyroiditis vs. caffeine excess.
Rationale: Shaky & racing after only 3 h sleep strongly suggests sleep deprivation;
clarifies benign vs. pathologic.
Teaching Point: Always correlate palpitations with sleep quantity in new moms.
Q4
A 42-year-old male accountant says “I can’t stop peeing”—polyuria 3 weeks, no dysuria,
no urgency. Finger-stick in lobby 248 mg/dL.
Which single question best narrows DDx?
A. Any nocturia?
Primary Care Practicum Guide (2026/2027) –
Chamberlain University | AANPCB-Style Clinical
Reasoning | Grade A Verified
PHASE 1 – TRIAGE & INITIAL DATA SYNTHESIS (15 Qs)
Q1
A 24-year-old female presents with 3-day history of sore throat, 101.2 °F fever, and
“white patches” on tonsils. She has no cough, no rhinorrhea, and tender anterior
cervical nodes. She is otherwise healthy.
Which single HPI question best refines your differential before exam?
A. “Do you have night sweats?”
B. “Have you had similar symptoms before?”
C. “Do you have any joint pain or rash?”
,D. “Have you been exposed to anyone with strep throat?”
Practicum Preceptor Rationale
Correct Answer: D
Clinical Stage: Initial HPI refinement (Centor criteria).
Differential: Viral pharyngitis vs. group A strep (GAS).
Rationale: Exposure history immediately raises pre-test probability for GAS and guides
rapid testing.
Distractors: A/B/C are lower yield at this point.
Teaching Point: Always ask about strep exposure; it’s one of the five Centor criteria.
Q2
A 38-year-old man describes 2-week “pressure” headache, worse in morning, no
nausea, no visual changes. He takes OTC ibuprofen 600 mg BID with partial relief.
PMH: obesity, HTN.
Which red-flag symptom requires immediate action?
A. Morning predominance
,B. Partial relief with NSAID
C. Absence of nausea
D. 2-week duration
Practicum Preceptor Rationale
Correct Answer: A
Clinical Stage: Red-flag screening.
Differential: Idiopathic intracranial HTN, sleep-apnea headache, mass lesion.
Rationale: Morning headache + obesity + HTN suggests raised ICP until proven
otherwise.
Teaching Point: Morning headaches are a classic sign of elevated ICP—image early.
Q3
A 31-year-old woman, 8 weeks postpartum, complains of 4-day “racing heart” and
feeling “shaky.” She is breastfeeding and sleeping 3–4 h/night. No chest pain.
Which HPI element best clarifies etiology?
A. Family history of thyroid disease
, B. Timing of symptoms relative to sleep
C. Caffeine intake (mg/day)
D. Obstetric blood-loss amount
Practicum Preceptor Rationale
Correct Answer: B
Clinical Stage: HPI refinement.
Differential: Sleep-deprivation tachycardia vs. postpartum thyroiditis vs. caffeine excess.
Rationale: Shaky & racing after only 3 h sleep strongly suggests sleep deprivation;
clarifies benign vs. pathologic.
Teaching Point: Always correlate palpitations with sleep quantity in new moms.
Q4
A 42-year-old male accountant says “I can’t stop peeing”—polyuria 3 weeks, no dysuria,
no urgency. Finger-stick in lobby 248 mg/dL.
Which single question best narrows DDx?
A. Any nocturia?
