NR511 CEA Examination
Questions with Verified Rationalized Answers
Academic Cycle
Chamberlain University
Differential Diagnosis and Primary Care Practicum
150 Questions | Comprehensive Evaluation Assessment
100% Verified Solutions | Guaranteed Pass
, Table of Contents
Section 1: Differential Diagnosis & Clinical Reasoning (Q1-Q10)
Section 2: Respiratory Conditions (Q11-Q22)
Section 3: Cardiovascular Conditions (Q23-Q35)
Section 4: Gastrointestinal Conditions (Q36-Q46)
Section 5: Genitourinary Conditions (Q47-Q55)
Section 6: Musculoskeletal Conditions (Q56-Q65)
Section 7: Neurological Conditions (Q66-Q75)
Section 8: Dermatological Conditions (Q76-Q85)
Section 9: Endocrine Conditions (Q86-Q100)
Section 10: Psychiatric/Mental Health (Q101-Q110)
, Section 1: Differential Diagnosis & Clinical Reasoning
Questions 1-10
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. Which of the following is the most appropriate initial diagnostic test?
A) Thyroid-stimulating hormone (TSH)
B) Free T4 only
C) Thyroid ultrasound
D) Radioactive iodine uptake scan
Rationale: TSH is the single most sensitive and specific initial screening test for thyroid dysfunction
according to the American Thyroid Association (ATA) guidelines. If TSH is abnormal, free T4 is
then measured to differentiate between overt and subclinical disease. Thyroid ultrasound and
radioactive iodine uptake are reserved for evaluating thyroid nodules or determining the etiology
of hyperthyroidism, not for initial screening.
2. A 60-year-old male presents with acute onset of severe chest pain radiating to the left
arm, diaphoresis, and shortness of breath. What is the most appropriate initial diagnostic
study?
A) Chest X-ray
B) 12-lead electrocardiogram (ECG)
C) CT angiography of the chest
D) Cardiac biomarkers (troponin only)
Rationale: A 12-lead ECG should be obtained within 10 minutes of first medical contact in any
patient presenting with symptoms suggestive of acute coronary syndrome (ACS), per the American
Heart Association (AHA) and American College of Cardiology (ACC) guidelines. The ECG can
identify ST-elevation myocardial infarction (STEMI), which requires immediate reperfusion
therapy. Troponins confirm the diagnosis but may not be elevated on initial presentation, and
imaging studies should not delay ECG acquisition.
3. A 28-year-old female presents with recurrent episodes of wheezing, chest tightness, and
cough that worsen at night and with exercise. Spirometry shows FEV1/FVC ratio of 65%
with 12% improvement after bronchodilator administration. What is the most likely
diagnosis?
A) Chronic obstructive pulmonary disease (COPD)
B) Asthma
C) Vocal cord dysfunction
D) Pulmonary embolism
Rationale: The clinical presentation of episodic wheezing and nocturnal symptoms combined with
spirometry demonstrating reversible airflow obstruction (FEV1/FVC less than 70% with greater
than 12% and 200 mL improvement post-bronchodilator) is diagnostic of asthma per the NAEPP
and GINA guidelines. COPD is unlikely in a 28-year-old without significant smoking history. Vocal
, cord dysfunction and pulmonary embolism would not show bronchodilator reversibility on
spirometry.
4. When using the Ottawa Ankle Rules to determine the need for radiography in a patient
with an ankle injury, which finding necessitates an X-ray?
A) Swelling over the lateral malleolus only
B) Pain with passive range of motion of the ankle
C) Bone tenderness at the base of the fifth metatarsal
D) Inability to bear weight for four steps immediately after the injury and in the
clinical setting
Rationale: The Ottawa Ankle Rules are a validated clinical decision tool with nearly 100%
sensitivity for detecting ankle fractures. The rules mandate radiography if the patient cannot bear
weight both immediately after the injury and in the clinical evaluation setting (defined as inability
to take four consecutive steps). Bone tenderness at the posterior edge or tip of either malleolus also
mandates X-ray. Swelling alone or pain with passive range of motion are not specific criteria in the
Ottawa rules.
5. A 35-year-old male presents with a sore throat, fever, and anterior cervical
lymphadenopathy. Rapid streptococcal antigen testing is negative. The Centor criteria
score is 3. What is the next most appropriate step in management?
A) Treat empirically with antibiotics
B) Obtain a throat culture and await results
C) Reassure and provide supportive care only
D) Prescribe oral corticosteroids
Rationale: When the rapid streptococcal antigen test is negative but the Centor criteria score is 3 or
higher, the Infectious Diseases Society of America (IDSA) recommends obtaining a throat culture to
confirm the diagnosis. A negative rapid test does not rule out group A streptococcal (GAS)
pharyngitis due to its approximately 70-90% sensitivity. Empiric antibiotic treatment without
confirmation contributes to antibiotic resistance. Supportive care alone is inappropriate when GAS
is still suspected.
6. Which of the following is the most reliable method for differentiating between bacterial
and viral rhinosinusitis?
A) Duration of symptoms exceeding 10 days without clinical improvement
B) Presence of purulent nasal discharge
C) Presence of facial pain and pressure
D) Elevated white blood cell count
Rationale: According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-
HNS) clinical practice guidelines, the diagnosis of acute bacterial rhinosinusitis (ABRS) should be
reserved for patients with symptoms lasting at least 10 days without improvement, or with severe
symptoms (fever greater than 39 degrees C and purulent nasal discharge) for at least 3-4
Questions with Verified Rationalized Answers
Academic Cycle
Chamberlain University
Differential Diagnosis and Primary Care Practicum
150 Questions | Comprehensive Evaluation Assessment
100% Verified Solutions | Guaranteed Pass
, Table of Contents
Section 1: Differential Diagnosis & Clinical Reasoning (Q1-Q10)
Section 2: Respiratory Conditions (Q11-Q22)
Section 3: Cardiovascular Conditions (Q23-Q35)
Section 4: Gastrointestinal Conditions (Q36-Q46)
Section 5: Genitourinary Conditions (Q47-Q55)
Section 6: Musculoskeletal Conditions (Q56-Q65)
Section 7: Neurological Conditions (Q66-Q75)
Section 8: Dermatological Conditions (Q76-Q85)
Section 9: Endocrine Conditions (Q86-Q100)
Section 10: Psychiatric/Mental Health (Q101-Q110)
, Section 1: Differential Diagnosis & Clinical Reasoning
Questions 1-10
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. Which of the following is the most appropriate initial diagnostic test?
A) Thyroid-stimulating hormone (TSH)
B) Free T4 only
C) Thyroid ultrasound
D) Radioactive iodine uptake scan
Rationale: TSH is the single most sensitive and specific initial screening test for thyroid dysfunction
according to the American Thyroid Association (ATA) guidelines. If TSH is abnormal, free T4 is
then measured to differentiate between overt and subclinical disease. Thyroid ultrasound and
radioactive iodine uptake are reserved for evaluating thyroid nodules or determining the etiology
of hyperthyroidism, not for initial screening.
2. A 60-year-old male presents with acute onset of severe chest pain radiating to the left
arm, diaphoresis, and shortness of breath. What is the most appropriate initial diagnostic
study?
A) Chest X-ray
B) 12-lead electrocardiogram (ECG)
C) CT angiography of the chest
D) Cardiac biomarkers (troponin only)
Rationale: A 12-lead ECG should be obtained within 10 minutes of first medical contact in any
patient presenting with symptoms suggestive of acute coronary syndrome (ACS), per the American
Heart Association (AHA) and American College of Cardiology (ACC) guidelines. The ECG can
identify ST-elevation myocardial infarction (STEMI), which requires immediate reperfusion
therapy. Troponins confirm the diagnosis but may not be elevated on initial presentation, and
imaging studies should not delay ECG acquisition.
3. A 28-year-old female presents with recurrent episodes of wheezing, chest tightness, and
cough that worsen at night and with exercise. Spirometry shows FEV1/FVC ratio of 65%
with 12% improvement after bronchodilator administration. What is the most likely
diagnosis?
A) Chronic obstructive pulmonary disease (COPD)
B) Asthma
C) Vocal cord dysfunction
D) Pulmonary embolism
Rationale: The clinical presentation of episodic wheezing and nocturnal symptoms combined with
spirometry demonstrating reversible airflow obstruction (FEV1/FVC less than 70% with greater
than 12% and 200 mL improvement post-bronchodilator) is diagnostic of asthma per the NAEPP
and GINA guidelines. COPD is unlikely in a 28-year-old without significant smoking history. Vocal
, cord dysfunction and pulmonary embolism would not show bronchodilator reversibility on
spirometry.
4. When using the Ottawa Ankle Rules to determine the need for radiography in a patient
with an ankle injury, which finding necessitates an X-ray?
A) Swelling over the lateral malleolus only
B) Pain with passive range of motion of the ankle
C) Bone tenderness at the base of the fifth metatarsal
D) Inability to bear weight for four steps immediately after the injury and in the
clinical setting
Rationale: The Ottawa Ankle Rules are a validated clinical decision tool with nearly 100%
sensitivity for detecting ankle fractures. The rules mandate radiography if the patient cannot bear
weight both immediately after the injury and in the clinical evaluation setting (defined as inability
to take four consecutive steps). Bone tenderness at the posterior edge or tip of either malleolus also
mandates X-ray. Swelling alone or pain with passive range of motion are not specific criteria in the
Ottawa rules.
5. A 35-year-old male presents with a sore throat, fever, and anterior cervical
lymphadenopathy. Rapid streptococcal antigen testing is negative. The Centor criteria
score is 3. What is the next most appropriate step in management?
A) Treat empirically with antibiotics
B) Obtain a throat culture and await results
C) Reassure and provide supportive care only
D) Prescribe oral corticosteroids
Rationale: When the rapid streptococcal antigen test is negative but the Centor criteria score is 3 or
higher, the Infectious Diseases Society of America (IDSA) recommends obtaining a throat culture to
confirm the diagnosis. A negative rapid test does not rule out group A streptococcal (GAS)
pharyngitis due to its approximately 70-90% sensitivity. Empiric antibiotic treatment without
confirmation contributes to antibiotic resistance. Supportive care alone is inappropriate when GAS
is still suspected.
6. Which of the following is the most reliable method for differentiating between bacterial
and viral rhinosinusitis?
A) Duration of symptoms exceeding 10 days without clinical improvement
B) Presence of purulent nasal discharge
C) Presence of facial pain and pressure
D) Elevated white blood cell count
Rationale: According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-
HNS) clinical practice guidelines, the diagnosis of acute bacterial rhinosinusitis (ABRS) should be
reserved for patients with symptoms lasting at least 10 days without improvement, or with severe
symptoms (fever greater than 39 degrees C and purulent nasal discharge) for at least 3-4
