NR511 – Differential Diagnosis and Primary Care Practicum
Exam Study Guide – Midterm Study Guide
Exam Format: Noncumulative
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes
Testing Timeframe: The midterm exam will only be available starting on Wednesday Week 4 at
12:01 am MT until Saturday Week 4 at 11:59 pm MT.
1. Exam Coverage
Content Areas:
● Week 1: Diagnostic Reasoning and Differential Diagnosis (Ch. 4, 5, 86)
● Week 2: Diagnosis and Management of Common Skin and Nail Disorders (Ch. 10, 11,
12, 13, 14, 15, 16, 17)
● Week 3: Diagnosis and Management of Common Eye Disorders (Ch. 18, 19, 20)
● Week 4: Diagnosis and Management of Ear, Nose, and Throat Disorders (Ch. 21, 22, 23,
24, 64)
2. Key Concepts to Study
Diagnostic Reasoning and Differential Diagnosis:
1. Components of the diagnostic reasoning process
- History of present illness (HPI) → 1st step, use OLDCARTS mnemonic commonly used,
after hearing chief complain, ask open ended questions to sort out diagnostic
possibilities,
- Past medical history (PMH) → helps refine hypothesis list by offering new explanations
for symptoms or by ruling out others; also gives suggestions of risk factors for other
problems being considered; PMH includes childhood/other illnesses, surgical hx,
hospitalizations, hx of trauma, pregnancies, and psychiatric diagnoses, meds,
prescriptions, allergies, health maintenance
- Family history/Social history
,- Review of systems → subjective data reported from the patients POV
- Functional health patterns → determines the extent to which the illness is affecting the
person’s ability to live a normal life;
- Physical exam → tailor physical exam to patient’s complaint and history
- Diagnostic tests → confirm or rule-out diagnostic hypothesis or used as screening
devices for conditions
2. Clinical Reasoning and Asking Clinical Questions
3. Formulating a Differential Diagnosis
- List of possible diagnoses in priority order; consider the problem from the “skin in”
4. Evidence-based practice
- There must be evidence, either from clinical trials or case studies, that the approach is
likely to benefit the patient
- Ask the clinical question, search for/collect most relevant, best evidence from a review of
the literature, critically appraise the evidence, integrate into practice, evaluate outcomes
of EBP change, disseminate outcomes of EBP change
5. Choosing the best evidence
- US preventive services task force (USPSTF) uses a 3-tiered system to rate evidence
and a 5-point rating scale to grade recommendations
- GRADE scale
- I to VII rating based on type of research
- Level 1 = systematic review or meta-analysis, Level 2 = single well-designed, Level 3 =
well-designed controlled trials without randomization, Level 4 = well-designed
case-control or cohort studies, Level 5 = systematic reviews of descriptive and
qualitative studies, Level 6 = single descriptive or qualitative studies, Level 7 = opinion of
authorities and/or reports of expert committees
6. Sensitivity/Specificity
- Sensitivity → the # of true positives for a test divided by the # of tested individuals who
truly have the disease
- Specificity → the # of true negatives divided by the # of all tested individuals who do not
have the disease; the specificity of a test is greater when it has few false positives
7. Parts of Medicare coverage
- Medicare A —> covers hospital inpatient services, skilled nursing facility care, hospice
care, some home health services; usually premium-free if patient paid for Medicare taxes
while working; NPI assigned for billing; covers WHERE patient receives care (inpatient)
- Medicare B —> covers outpatient provider visits (MDs, NPs, PAs), preventative services
(wellness visits, screenings, vaccines), diagnostic tests, durable medical equipment; paid
for with monthly premium, typically 80% covered by Medicare after deductible - what
allows you to bill for office visits and outpatient care
- Medicare C —> alternative to Medicare A and B, offered by private insurance companies
approved by Medicare, must include everything in Medicare A and B, often includes D
(prescriptions), may include extras like dental, vision, and hearing - patient must follow
the plan’s network rules, referrals, and prior authorizations, similar to commercial
insurance
, - Medicare D —> covers outpatient prescription medications, monthly premium,
formularies vary by plan - medication coverage depends on the plan’s formulary tier,
which affects prescribing choices and patient costs
- A = admission (hospital/inpatient)
- B = basics (provider visits, outpatient care)
- C = combination (private plan replacing A & B)
- D = drugs (prescriptions)
8. Third-party payers
- Determines reimbursement policies; fall under Medicare (A, B, C, D), Medicaid,
indemnity insurance companies, managed care organizations (MCOs), worker’s
compensation (WC), veterans administration, or auto liability
- Patients are considered “private pay” if they do not have insurance (whether they can
afford it or not)
- All third-party payers use Centers for Medicare and Medicaid Services (CMS) guidelines
as a foundation
- CMS works to make sure that the beneficiaries in its government-funded programs can
obtain high-quality health care
9. Billing and Coding
- Current procedural terminology (CPT) offers official procedural coding rule and
guidelines required in reporting medical services and procedures performed by
physicians and non-physician practitioners
- Practitioners should select the code that provides the most specific and accurate match
to the services performed
- International classification of diseases (ICD) —> standardized alphanumeric codes used
worldwide to identify diagnoses, symptoms, and health conditions; ICD code reflects the
diagnosis (pt symptoms, services provided, level of care billed)
10.Basic Diagnostic Tests
- CBC (complete blood count) —> measures RBCs, WBCs, hemoglobin, hematocrit and
platelets; can evaluate variety of disorders and often included in routine screenings or to
monitor treatment regimens
- CMP (comprehensive metabolic panel) —> gives info on fluid/electrolyte balance,
metabolism, liver function, and kidney function; screens and monitors conditions such as
diabetes, kidney disease, liver disease; monitors diuretic therapy or antihypertensive
therapy
11.Managing infectious diseases- HIV, genital herpes
- No cure exists; recurrences are milder and shorter in duration than primary infection
- Therapy is primarily symptomatic and supportive, oral antiviral meds used especially for
immunocompromised pts
- Goal to eliminate pain, decrease viral shedding, and heal ulcerate tissue
- If recurrent hermetic lesions, suppressive therapy may be needed
- Social and psychological impact should be addressed, informing partners, preventing
transmission
Exam Study Guide – Midterm Study Guide
Exam Format: Noncumulative
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes
Testing Timeframe: The midterm exam will only be available starting on Wednesday Week 4 at
12:01 am MT until Saturday Week 4 at 11:59 pm MT.
1. Exam Coverage
Content Areas:
● Week 1: Diagnostic Reasoning and Differential Diagnosis (Ch. 4, 5, 86)
● Week 2: Diagnosis and Management of Common Skin and Nail Disorders (Ch. 10, 11,
12, 13, 14, 15, 16, 17)
● Week 3: Diagnosis and Management of Common Eye Disorders (Ch. 18, 19, 20)
● Week 4: Diagnosis and Management of Ear, Nose, and Throat Disorders (Ch. 21, 22, 23,
24, 64)
2. Key Concepts to Study
Diagnostic Reasoning and Differential Diagnosis:
1. Components of the diagnostic reasoning process
- History of present illness (HPI) → 1st step, use OLDCARTS mnemonic commonly used,
after hearing chief complain, ask open ended questions to sort out diagnostic
possibilities,
- Past medical history (PMH) → helps refine hypothesis list by offering new explanations
for symptoms or by ruling out others; also gives suggestions of risk factors for other
problems being considered; PMH includes childhood/other illnesses, surgical hx,
hospitalizations, hx of trauma, pregnancies, and psychiatric diagnoses, meds,
prescriptions, allergies, health maintenance
- Family history/Social history
,- Review of systems → subjective data reported from the patients POV
- Functional health patterns → determines the extent to which the illness is affecting the
person’s ability to live a normal life;
- Physical exam → tailor physical exam to patient’s complaint and history
- Diagnostic tests → confirm or rule-out diagnostic hypothesis or used as screening
devices for conditions
2. Clinical Reasoning and Asking Clinical Questions
3. Formulating a Differential Diagnosis
- List of possible diagnoses in priority order; consider the problem from the “skin in”
4. Evidence-based practice
- There must be evidence, either from clinical trials or case studies, that the approach is
likely to benefit the patient
- Ask the clinical question, search for/collect most relevant, best evidence from a review of
the literature, critically appraise the evidence, integrate into practice, evaluate outcomes
of EBP change, disseminate outcomes of EBP change
5. Choosing the best evidence
- US preventive services task force (USPSTF) uses a 3-tiered system to rate evidence
and a 5-point rating scale to grade recommendations
- GRADE scale
- I to VII rating based on type of research
- Level 1 = systematic review or meta-analysis, Level 2 = single well-designed, Level 3 =
well-designed controlled trials without randomization, Level 4 = well-designed
case-control or cohort studies, Level 5 = systematic reviews of descriptive and
qualitative studies, Level 6 = single descriptive or qualitative studies, Level 7 = opinion of
authorities and/or reports of expert committees
6. Sensitivity/Specificity
- Sensitivity → the # of true positives for a test divided by the # of tested individuals who
truly have the disease
- Specificity → the # of true negatives divided by the # of all tested individuals who do not
have the disease; the specificity of a test is greater when it has few false positives
7. Parts of Medicare coverage
- Medicare A —> covers hospital inpatient services, skilled nursing facility care, hospice
care, some home health services; usually premium-free if patient paid for Medicare taxes
while working; NPI assigned for billing; covers WHERE patient receives care (inpatient)
- Medicare B —> covers outpatient provider visits (MDs, NPs, PAs), preventative services
(wellness visits, screenings, vaccines), diagnostic tests, durable medical equipment; paid
for with monthly premium, typically 80% covered by Medicare after deductible - what
allows you to bill for office visits and outpatient care
- Medicare C —> alternative to Medicare A and B, offered by private insurance companies
approved by Medicare, must include everything in Medicare A and B, often includes D
(prescriptions), may include extras like dental, vision, and hearing - patient must follow
the plan’s network rules, referrals, and prior authorizations, similar to commercial
insurance
, - Medicare D —> covers outpatient prescription medications, monthly premium,
formularies vary by plan - medication coverage depends on the plan’s formulary tier,
which affects prescribing choices and patient costs
- A = admission (hospital/inpatient)
- B = basics (provider visits, outpatient care)
- C = combination (private plan replacing A & B)
- D = drugs (prescriptions)
8. Third-party payers
- Determines reimbursement policies; fall under Medicare (A, B, C, D), Medicaid,
indemnity insurance companies, managed care organizations (MCOs), worker’s
compensation (WC), veterans administration, or auto liability
- Patients are considered “private pay” if they do not have insurance (whether they can
afford it or not)
- All third-party payers use Centers for Medicare and Medicaid Services (CMS) guidelines
as a foundation
- CMS works to make sure that the beneficiaries in its government-funded programs can
obtain high-quality health care
9. Billing and Coding
- Current procedural terminology (CPT) offers official procedural coding rule and
guidelines required in reporting medical services and procedures performed by
physicians and non-physician practitioners
- Practitioners should select the code that provides the most specific and accurate match
to the services performed
- International classification of diseases (ICD) —> standardized alphanumeric codes used
worldwide to identify diagnoses, symptoms, and health conditions; ICD code reflects the
diagnosis (pt symptoms, services provided, level of care billed)
10.Basic Diagnostic Tests
- CBC (complete blood count) —> measures RBCs, WBCs, hemoglobin, hematocrit and
platelets; can evaluate variety of disorders and often included in routine screenings or to
monitor treatment regimens
- CMP (comprehensive metabolic panel) —> gives info on fluid/electrolyte balance,
metabolism, liver function, and kidney function; screens and monitors conditions such as
diabetes, kidney disease, liver disease; monitors diuretic therapy or antihypertensive
therapy
11.Managing infectious diseases- HIV, genital herpes
- No cure exists; recurrences are milder and shorter in duration than primary infection
- Therapy is primarily symptomatic and supportive, oral antiviral meds used especially for
immunocompromised pts
- Goal to eliminate pain, decrease viral shedding, and heal ulcerate tissue
- If recurrent hermetic lesions, suppressive therapy may be needed
- Social and psychological impact should be addressed, informing partners, preventing
transmission
