NR511 Midterm Exam – Differential Diagnosis
& Primary Care Review | Questions and
Verified Answers | 100% Correct | Grade A
(Latest 2024/2025 Update) – Chamberlain
Category 1: Foundations of Differential Diagnosis & Clinical Decision-Making
1. What is the primary purpose of developing a differential diagnosis?
A) To immediately identify the rarest possible condition
B) To list all possible causes for a patient's symptoms in order of probability
C) To confirm the patient's self-diagnosis
D) To eliminate the need for a physical exam
Answer: B) To list all possible causes for a patient's symptoms in order of probability
2. The "SNOUT" mnemonic in diagnostic test characteristics indicates that a test with high
_______ is good for ruling a condition OUT.
A) Specificity
B) Sensitivity
C) Predictive Value
D) Reliability
Answer: B) Sensitivity
3. A 45-year-old patient presents with epigastric pain. According to the ROME IV criteria,
which finding is most suggestive of Functional Dyspepsia over Peptic Ulcer Disease?
A) Pain that improves with eating
B) Pain that worsens at night
C) Presence of early satiety and postprandial fullness
D) Melena
Answer: C) Presence of early satiety and postprandial fullness
4. Which of the following is a "red flag" symptom in a patient presenting with a headache that
warrants immediate neuroimaging?
A) Bilateral, pressure-like pain
B) Headache that is worse in the morning
C) Headache associated with stress
,D) Family history of migraines
Answer: B) Headache that is worse in the morning
5. The USPSTF assigns a Grade "A" recommendation to a service when there is:
A) High certainty that the net benefit is substantial.
B) Moderate certainty that the net benefit is moderate to substantial.
C) At least moderate certainty that the net benefit is small.
D) No recommendation for or against routine service.
Answer: A) High certainty that the net benefit is substantial.
Category 2: Respiratory Disorders
6. A 25-year-old otherwise healthy patient presents with 3 days of clear rhinorrhea, sneezing,
and a non-productive cough. They are afebrile. The most likely diagnosis is:
A) Acute bacterial sinusitis
B) Influenza
C) The common cold (viral rhinitis)
D) Allergic rhinitis
Answer: C) The common cold (viral rhinitis)
7. Which symptom complex is most consistent with a diagnosis of Acute Bacterial Sinusitis
using the "double worsening" criteria?
A) URI symptoms for 5 days that are improving.
B) Purulent nasal drainage and facial pain for 9 days without improvement.
C) Clear rhinorrhea and sneezing for 48 hours.
D) Fever and cough for 3 days.
Answer: B) Purulent nasal drainage and facial pain for 9 days without improvement.
8. A patient with COPD presents with increased dyspnea, yellow-green sputum, and increased
wheezing. What is the most appropriate initial management?
A) Begin a 5-day course of Azithromycin.
B) Initiate systemic corticosteroids and a bronchodilator.
C) Order a chest X-ray and wait for results.
D) Start supplemental oxygen to achieve SpO2 > 92%.
Answer: B) Initiate systemic corticosteroids and a bronchodilator.
9. The first-line antibiotic for treatment of community-acquired pneumonia in a healthy adult
with no recent antibiotics is:
A) Levofloxacin
B) Doxycycline
,C) Amoxicillin
D) Azithromycin
Answer: B) Doxycycline
10. A key physical exam finding that distinguishes Pneumonia from Acute Bronchitis is:
A) Presence of a cough
B) Fever and chills
C) Focal lung findings (e.g., egophony, crackles)
D) Generalized wheezing
Answer: C) Focal lung findings (e.g., egophony, crackles)
Category 3: Cardiovascular Disorders
11. The first-line drug class for uncomplicated hypertension in the African American
population, according to JNC-8 guidelines, is:
A) ACE Inhibitors
B) Thiazide Diuretics or Calcium Channel Blockers
C) Beta-Blockers
D) ARBs
Answer: B) Thiazide Diuretics or Calcium Channel Blockers
12. A patient describes chest pain as "sharp, stabbing, and worse when I take a deep breath."
This description is most consistent with:
A) Unstable Angina
B) Musculoskeletal Chest Pain
C) Pericarditis
D) GERD
Answer: C) Pericarditis
13. Which finding on a lipid panel is considered most atherogenic and a primary target of
therapy?
A) High Total Cholesterol
B) High LDL-C
C) Low HDL-C
D) High Triglycerides
Answer: B) High LDL-C
14. A 55-year-old male with a history of HTN and DM presents with sudden, "tearing" chest
pain radiating to his back. His BP is 180/100 in the right arm and 140/80 in the left arm. The
most likely diagnosis is:
, A) Myocardial Infarction
B) Aortic Dissection
C) Pulmonary Embolism
D) Esophageal Rupture
Answer: B) Aortic Dissection
15. The recommended first-line treatment for symptomatic Supraventricular Tachycardia (SVT)
in a stable patient is:
A) Synchronized Cardioversion
B) Amiodarone IV
C) Vagal maneuvers
D) Adenosine IV
Answer: C) Vagal maneuvers
Category 4: Gastrointestinal Disorders
16. A 30-year-old patient presents with recurrent heartburn triggered by coffee and spicy
foods. What is the first-line pharmacologic treatment?
A) Omeprazole (PPI) daily
B) Famotidine (H2 Blocker) PRN
C) Sucralfate
D) Metoclopramide
Answer: B) Famotidine (H2 Blocker) PRN
17. Which finding is most suggestive of Irritable Bowel Syndrome with Diarrhea (IBS-D)
according to ROME IV criteria?
A) Unintentional weight loss of 10 lbs
B) Blood in the stool
C) Onset of symptoms in a 60-year-old
D) Abdominal pain related to defecation and associated with a change in stool frequency/form
Answer: D) Abdominal pain related to defecation and associated with a change in stool
frequency/form
18. A patient presents with right lower quadrant pain, nausea, and anorexia. McBurney's
point tenderness is present. This is classic for:
A) Diverticulitis
B) Cholecystitis
C) Appendicitis
D) Pancreatitis
Answer: C) Appendicitis
& Primary Care Review | Questions and
Verified Answers | 100% Correct | Grade A
(Latest 2024/2025 Update) – Chamberlain
Category 1: Foundations of Differential Diagnosis & Clinical Decision-Making
1. What is the primary purpose of developing a differential diagnosis?
A) To immediately identify the rarest possible condition
B) To list all possible causes for a patient's symptoms in order of probability
C) To confirm the patient's self-diagnosis
D) To eliminate the need for a physical exam
Answer: B) To list all possible causes for a patient's symptoms in order of probability
2. The "SNOUT" mnemonic in diagnostic test characteristics indicates that a test with high
_______ is good for ruling a condition OUT.
A) Specificity
B) Sensitivity
C) Predictive Value
D) Reliability
Answer: B) Sensitivity
3. A 45-year-old patient presents with epigastric pain. According to the ROME IV criteria,
which finding is most suggestive of Functional Dyspepsia over Peptic Ulcer Disease?
A) Pain that improves with eating
B) Pain that worsens at night
C) Presence of early satiety and postprandial fullness
D) Melena
Answer: C) Presence of early satiety and postprandial fullness
4. Which of the following is a "red flag" symptom in a patient presenting with a headache that
warrants immediate neuroimaging?
A) Bilateral, pressure-like pain
B) Headache that is worse in the morning
C) Headache associated with stress
,D) Family history of migraines
Answer: B) Headache that is worse in the morning
5. The USPSTF assigns a Grade "A" recommendation to a service when there is:
A) High certainty that the net benefit is substantial.
B) Moderate certainty that the net benefit is moderate to substantial.
C) At least moderate certainty that the net benefit is small.
D) No recommendation for or against routine service.
Answer: A) High certainty that the net benefit is substantial.
Category 2: Respiratory Disorders
6. A 25-year-old otherwise healthy patient presents with 3 days of clear rhinorrhea, sneezing,
and a non-productive cough. They are afebrile. The most likely diagnosis is:
A) Acute bacterial sinusitis
B) Influenza
C) The common cold (viral rhinitis)
D) Allergic rhinitis
Answer: C) The common cold (viral rhinitis)
7. Which symptom complex is most consistent with a diagnosis of Acute Bacterial Sinusitis
using the "double worsening" criteria?
A) URI symptoms for 5 days that are improving.
B) Purulent nasal drainage and facial pain for 9 days without improvement.
C) Clear rhinorrhea and sneezing for 48 hours.
D) Fever and cough for 3 days.
Answer: B) Purulent nasal drainage and facial pain for 9 days without improvement.
8. A patient with COPD presents with increased dyspnea, yellow-green sputum, and increased
wheezing. What is the most appropriate initial management?
A) Begin a 5-day course of Azithromycin.
B) Initiate systemic corticosteroids and a bronchodilator.
C) Order a chest X-ray and wait for results.
D) Start supplemental oxygen to achieve SpO2 > 92%.
Answer: B) Initiate systemic corticosteroids and a bronchodilator.
9. The first-line antibiotic for treatment of community-acquired pneumonia in a healthy adult
with no recent antibiotics is:
A) Levofloxacin
B) Doxycycline
,C) Amoxicillin
D) Azithromycin
Answer: B) Doxycycline
10. A key physical exam finding that distinguishes Pneumonia from Acute Bronchitis is:
A) Presence of a cough
B) Fever and chills
C) Focal lung findings (e.g., egophony, crackles)
D) Generalized wheezing
Answer: C) Focal lung findings (e.g., egophony, crackles)
Category 3: Cardiovascular Disorders
11. The first-line drug class for uncomplicated hypertension in the African American
population, according to JNC-8 guidelines, is:
A) ACE Inhibitors
B) Thiazide Diuretics or Calcium Channel Blockers
C) Beta-Blockers
D) ARBs
Answer: B) Thiazide Diuretics or Calcium Channel Blockers
12. A patient describes chest pain as "sharp, stabbing, and worse when I take a deep breath."
This description is most consistent with:
A) Unstable Angina
B) Musculoskeletal Chest Pain
C) Pericarditis
D) GERD
Answer: C) Pericarditis
13. Which finding on a lipid panel is considered most atherogenic and a primary target of
therapy?
A) High Total Cholesterol
B) High LDL-C
C) Low HDL-C
D) High Triglycerides
Answer: B) High LDL-C
14. A 55-year-old male with a history of HTN and DM presents with sudden, "tearing" chest
pain radiating to his back. His BP is 180/100 in the right arm and 140/80 in the left arm. The
most likely diagnosis is:
, A) Myocardial Infarction
B) Aortic Dissection
C) Pulmonary Embolism
D) Esophageal Rupture
Answer: B) Aortic Dissection
15. The recommended first-line treatment for symptomatic Supraventricular Tachycardia (SVT)
in a stable patient is:
A) Synchronized Cardioversion
B) Amiodarone IV
C) Vagal maneuvers
D) Adenosine IV
Answer: C) Vagal maneuvers
Category 4: Gastrointestinal Disorders
16. A 30-year-old patient presents with recurrent heartburn triggered by coffee and spicy
foods. What is the first-line pharmacologic treatment?
A) Omeprazole (PPI) daily
B) Famotidine (H2 Blocker) PRN
C) Sucralfate
D) Metoclopramide
Answer: B) Famotidine (H2 Blocker) PRN
17. Which finding is most suggestive of Irritable Bowel Syndrome with Diarrhea (IBS-D)
according to ROME IV criteria?
A) Unintentional weight loss of 10 lbs
B) Blood in the stool
C) Onset of symptoms in a 60-year-old
D) Abdominal pain related to defecation and associated with a change in stool frequency/form
Answer: D) Abdominal pain related to defecation and associated with a change in stool
frequency/form
18. A patient presents with right lower quadrant pain, nausea, and anorexia. McBurney's
point tenderness is present. This is classic for:
A) Diverticulitis
B) Cholecystitis
C) Appendicitis
D) Pancreatitis
Answer: C) Appendicitis
