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NR 511/ NR511 Midterm Exam:
Differential Diagnosis and Primary Care
Practicum (6 Versions Bundled
Together) Exam
what is the sensitivity of the Prostate Specific Antigen (PSA) for detecting prostate cancer?
# men with prostate cancer
# men with positive PSA
160
# men with negative PSA
40
total
200
The correct answer is 160/200. Sensitivity is the proportion of patients with the disease that
have a positive result; it is the number of true positives divided by the total number of patients
who have the disease.
A diagnostic test is used in a sample of 1000 patients. 500 of these patients have the disease,
while 500 do not. Of those 500 patients without the disease, 30 test positive, and 470 test
negative. What is the specificity of the test?
The correct answer is 470/500.
Specificity is the proportion of patients who test negative out of the total number of patients
who do not have the disease; it is the number of true negatives overall negatives. In this
pg. 1
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example, 500/1000 patients have the disease. Of those 500 patients without the disease, 30
test positive, and 470 test negative.
The Positive Predictive Value (PPV) of a test refers to which of the following?
the proportion of patients with a positive test who have the disease.
Which of the following depends on the prevalence of the disease?
positive predictive value.
Predictive values depend on the prevalence of disease in the population whereas sensitivity and
specificity are intrinsic properties of the test. Reliability refers to the consistency or stability of a
measure.
A low pretest probability of disease may lead to which of the following?
low positive predictive value and more false-positive results.
Positive predictive value increases with prevalence; therefore, a low prevalence value yields a
low positive predictive value and implies a high false-positive rate. Negative predictive value
decreases with prevalence, and sensitivity and specificity do not vary with prevalence.
If you strongly suspect that a patient is positive for a specific condition but tests negative, the
negative result may be:
false-negative test results due to a low negative predictive value.
At the individual level, your clinical suspicion is equivalent to pre-test probability and high
prevalence at the population level. Negative predictive value is inversely correlated with
prevalence; therefore, your clinical suspicion translates to a low negative predictive value,
suggesting a false-negative test result.
Which test(s) provide data relevant to the chief complaint: Fever
CBC
Check CBC with differential for neutrophil shift in suspected infection
Which test(s) provide data relevant to the chief complaint: Unexplained bruising
CBC
Check platelet count
Which test(s) provide data relevant to the chief complaint: Fatigue
pg. 2
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Both CBC and CMP
Check RBC, Hgb and Hct for anemia, CMP for potential liver or kidney abnormalities
Which test(s) provide data relevant to the chief complaint: Cardiac dysrhythmias
CMP
Monitor electrolytes for abnormalities
Which test(s) provide data relevant to the chief complaint: Unexplained weight loss
Both CBC and CMP
Check WBC for inflammation or possible cancer, CMP for glucose, liver or kidney abnormalities
Which test(s) provide data relevant to the chief complaint: Edema
CMP
Check for kidney function
What is SNAPPS?
Summarize the history and findings
Narrow the differential diagnosis to two or three possibilities
Analyze the differential by comparing and contrasting the possibilities
Probe the preceptor by asking questions about alternative approaches or uncertainties
Plan the management of the client's health issues
Select an issue from the case for self-directed learning
a 13 year old presents to the clinic complaining of severe left side sore throat and pain with
swallowing for 1
day. upon exam, the patient appears uncomfortable and febrile. Cervical adenopathy is present
on left side,
difficulty opening and closing mouth. What should you do?
Refer to the ER
pg. 3
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a 37 year old female presents for her annual visit. She mentions that her 13 year old daughter
has had to
recent infestions of lice. She asks what she can do to prevent this?
After 2 days of no head lice, her bedding is lice free
Which of the following is the appropriate treatment for giardia
quin.hydr.
Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During
your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the
tongue that you suspect to be cancerous. You document your finding as:
A white, painless, firm, ulcerated lesion with indurated borders
Maryann, age 28, presents to the clinic because of a rapid onset of patchy hair loss. The skin
within these oval patches of hair loss is very smooth. Tapered hairs that resemble exclamation
points are seen at the margin of a patch of hair loss. Based on these findings, you suspect
Maryann has:
Alopecia areata The findings are consistent with alopecia areata, ie, nonscarring hair loss of
rapid onset,
the pattern of which is most commonly sharply defined round or oval patches.
Which of the following is not a complication of group a strep
hemolytic anemia
glomerular nephritis
Which of the following is an example of conductive hearing loss?
Serous OM
Medical coding is the process of submitting and following up on claims made to the payer in
order
Coding is done in order to process demographic, insurance, ... number as shown on insured's ID
card for the payer to whom the claim is being submitted.
Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on his
leather jacket. He recalls having a slightly similar rash last year when he wore his jacket. The
annular lesions are on his neck and both arms. They are erythematous, sharply circumscribed,
and both flat and elevated. His voice seems a little raspy, although he states that his breathing
is normal. What is your first action?
Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.
pg. 4
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NR 511/ NR511 Midterm Exam:
Differential Diagnosis and Primary Care
Practicum (6 Versions Bundled
Together) Exam
what is the sensitivity of the Prostate Specific Antigen (PSA) for detecting prostate cancer?
# men with prostate cancer
# men with positive PSA
160
# men with negative PSA
40
total
200
The correct answer is 160/200. Sensitivity is the proportion of patients with the disease that
have a positive result; it is the number of true positives divided by the total number of patients
who have the disease.
A diagnostic test is used in a sample of 1000 patients. 500 of these patients have the disease,
while 500 do not. Of those 500 patients without the disease, 30 test positive, and 470 test
negative. What is the specificity of the test?
The correct answer is 470/500.
Specificity is the proportion of patients who test negative out of the total number of patients
who do not have the disease; it is the number of true negatives overall negatives. In this
pg. 1
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,https://www.stuvia.com/user/passnursingnow https://www.stuvia.com/user/passnursingnow
example, 500/1000 patients have the disease. Of those 500 patients without the disease, 30
test positive, and 470 test negative.
The Positive Predictive Value (PPV) of a test refers to which of the following?
the proportion of patients with a positive test who have the disease.
Which of the following depends on the prevalence of the disease?
positive predictive value.
Predictive values depend on the prevalence of disease in the population whereas sensitivity and
specificity are intrinsic properties of the test. Reliability refers to the consistency or stability of a
measure.
A low pretest probability of disease may lead to which of the following?
low positive predictive value and more false-positive results.
Positive predictive value increases with prevalence; therefore, a low prevalence value yields a
low positive predictive value and implies a high false-positive rate. Negative predictive value
decreases with prevalence, and sensitivity and specificity do not vary with prevalence.
If you strongly suspect that a patient is positive for a specific condition but tests negative, the
negative result may be:
false-negative test results due to a low negative predictive value.
At the individual level, your clinical suspicion is equivalent to pre-test probability and high
prevalence at the population level. Negative predictive value is inversely correlated with
prevalence; therefore, your clinical suspicion translates to a low negative predictive value,
suggesting a false-negative test result.
Which test(s) provide data relevant to the chief complaint: Fever
CBC
Check CBC with differential for neutrophil shift in suspected infection
Which test(s) provide data relevant to the chief complaint: Unexplained bruising
CBC
Check platelet count
Which test(s) provide data relevant to the chief complaint: Fatigue
pg. 2
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,https://www.stuvia.com/user/passnursingnow https://www.stuvia.com/user/passnursingnow
Both CBC and CMP
Check RBC, Hgb and Hct for anemia, CMP for potential liver or kidney abnormalities
Which test(s) provide data relevant to the chief complaint: Cardiac dysrhythmias
CMP
Monitor electrolytes for abnormalities
Which test(s) provide data relevant to the chief complaint: Unexplained weight loss
Both CBC and CMP
Check WBC for inflammation or possible cancer, CMP for glucose, liver or kidney abnormalities
Which test(s) provide data relevant to the chief complaint: Edema
CMP
Check for kidney function
What is SNAPPS?
Summarize the history and findings
Narrow the differential diagnosis to two or three possibilities
Analyze the differential by comparing and contrasting the possibilities
Probe the preceptor by asking questions about alternative approaches or uncertainties
Plan the management of the client's health issues
Select an issue from the case for self-directed learning
a 13 year old presents to the clinic complaining of severe left side sore throat and pain with
swallowing for 1
day. upon exam, the patient appears uncomfortable and febrile. Cervical adenopathy is present
on left side,
difficulty opening and closing mouth. What should you do?
Refer to the ER
pg. 3
https://www.stuvia.com/user/passnursingnow https://www.stuvia.com/user/passnursingnow
, https://www.stuvia.com/user/passnursingnow https://www.stuvia.com/user/passnursingnow
a 37 year old female presents for her annual visit. She mentions that her 13 year old daughter
has had to
recent infestions of lice. She asks what she can do to prevent this?
After 2 days of no head lice, her bedding is lice free
Which of the following is the appropriate treatment for giardia
quin.hydr.
Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During
your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the
tongue that you suspect to be cancerous. You document your finding as:
A white, painless, firm, ulcerated lesion with indurated borders
Maryann, age 28, presents to the clinic because of a rapid onset of patchy hair loss. The skin
within these oval patches of hair loss is very smooth. Tapered hairs that resemble exclamation
points are seen at the margin of a patch of hair loss. Based on these findings, you suspect
Maryann has:
Alopecia areata The findings are consistent with alopecia areata, ie, nonscarring hair loss of
rapid onset,
the pattern of which is most commonly sharply defined round or oval patches.
Which of the following is not a complication of group a strep
hemolytic anemia
glomerular nephritis
Which of the following is an example of conductive hearing loss?
Serous OM
Medical coding is the process of submitting and following up on claims made to the payer in
order
Coding is done in order to process demographic, insurance, ... number as shown on insured's ID
card for the payer to whom the claim is being submitted.
Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on his
leather jacket. He recalls having a slightly similar rash last year when he wore his jacket. The
annular lesions are on his neck and both arms. They are erythematous, sharply circumscribed,
and both flat and elevated. His voice seems a little raspy, although he states that his breathing
is normal. What is your first action?
Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.
pg. 4
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