NR 511 CEA Midterm Exam (2026) | Chamberlain
Diff Diagnosis – Q&A (PDF)
1. A 45-year-old male presents with epigastric burning
pain after meals. You suspect peptic ulcer disease. Which
is the most appropriate next step in diagnostic reasoning?
A. Prescribe a PPI and follow up in 4 weeks
B. Order an upper endoscopy immediately
C. Test for H. pylori
D. Start antacids and reassess in 1 week
Correct Answer: C
Rationale: In suspected PUD without alarm symptoms
(bleeding, weight loss, dysphagia), noninvasive H.
pylori testing (stool antigen or urea breath test) is first-
line. Endoscopy is reserved for alarm features or
treatment failure. PPIs can be started but should not
precede testing (false negatives). Antacids are
symptomatic only and delay diagnosis.
1
,2. A 62-year-old woman with no prior mammogram asks
about breast cancer screening. According to current
USPSTF guidelines, what is the strongest recommendation?
A. Begin screening at age 40 biennially
B. Begin screening at age 50 biennially
C. Screen biennially from age 50–74
D. Shared decision-making for ages 40–49, biennial
screening 50–74
Correct Answer: D
Rationale: USPSTF (2024 update) recommends biennial
screening for women ages 50–74 (Grade B). For ages
40–49, the recommendation is individualized (Grade C).
Option D accurately reflects this two-tiered approach.
3. You calculate the likelihood ratio (LR+) of a test as 8.5.
This means:
A. The test is useless
B. The post-test probability equals pre-test probability
times 8.5
2
,C. A positive test markedly increases the probability of
disease
D. The test has high sensitivity but low specificity
Correct Answer: C
Rationale: LR+ >5–10 is a strong "rule-in" test,
significantly increasing post-test probability. Post-test
odds = pre-test odds × LR (not probability directly). An
LR+ of 8.5 indicates that a positive test is 8.5 times more
likely in a diseased than a non-diseased person.
4. A 28-year-old presents with intermittent dizziness,
palpitations, and anxiety. Your differential includes panic
disorder, vestibular disorder, and cardiac arrhythmia.
Which question best helps differentiate?
A. “Do your symptoms occur with position changes?”
B. “Does anything make the dizziness better?”
C. “Do you ever feel your heart skipping beats during a
dizzy spell?”
D. “Have you had any recent life stressors?”
3
, Correct Answer: C
Rationale: Palpitations concurrent with dizziness strongly
suggest cardiac arrhythmia (e.g., SVT, AF, PVCs).
Positional dizziness (A) points to BPPV. Stressors (D)
suggest panic but do not rule out arrhythmia. Directly
asking about palpitations during symptoms helps
differentiate.
5. A previously healthy 35-year-old man has 2 weeks of
nonproductive cough, low-grade fever, and chest
tightness. He is afebrile now, lungs clear. Which is the
most appropriate next step?
A. Chest X-ray
B. Empiric azithromycin
C. Symptomatic care with follow-up
D. Pertussis PCR
Correct Answer: C
Rationale: Acute bronchitis in healthy adults is viral in >90%
of cases; antibiotics are not indicated. Chest X-ray is not
4
Diff Diagnosis – Q&A (PDF)
1. A 45-year-old male presents with epigastric burning
pain after meals. You suspect peptic ulcer disease. Which
is the most appropriate next step in diagnostic reasoning?
A. Prescribe a PPI and follow up in 4 weeks
B. Order an upper endoscopy immediately
C. Test for H. pylori
D. Start antacids and reassess in 1 week
Correct Answer: C
Rationale: In suspected PUD without alarm symptoms
(bleeding, weight loss, dysphagia), noninvasive H.
pylori testing (stool antigen or urea breath test) is first-
line. Endoscopy is reserved for alarm features or
treatment failure. PPIs can be started but should not
precede testing (false negatives). Antacids are
symptomatic only and delay diagnosis.
1
,2. A 62-year-old woman with no prior mammogram asks
about breast cancer screening. According to current
USPSTF guidelines, what is the strongest recommendation?
A. Begin screening at age 40 biennially
B. Begin screening at age 50 biennially
C. Screen biennially from age 50–74
D. Shared decision-making for ages 40–49, biennial
screening 50–74
Correct Answer: D
Rationale: USPSTF (2024 update) recommends biennial
screening for women ages 50–74 (Grade B). For ages
40–49, the recommendation is individualized (Grade C).
Option D accurately reflects this two-tiered approach.
3. You calculate the likelihood ratio (LR+) of a test as 8.5.
This means:
A. The test is useless
B. The post-test probability equals pre-test probability
times 8.5
2
,C. A positive test markedly increases the probability of
disease
D. The test has high sensitivity but low specificity
Correct Answer: C
Rationale: LR+ >5–10 is a strong "rule-in" test,
significantly increasing post-test probability. Post-test
odds = pre-test odds × LR (not probability directly). An
LR+ of 8.5 indicates that a positive test is 8.5 times more
likely in a diseased than a non-diseased person.
4. A 28-year-old presents with intermittent dizziness,
palpitations, and anxiety. Your differential includes panic
disorder, vestibular disorder, and cardiac arrhythmia.
Which question best helps differentiate?
A. “Do your symptoms occur with position changes?”
B. “Does anything make the dizziness better?”
C. “Do you ever feel your heart skipping beats during a
dizzy spell?”
D. “Have you had any recent life stressors?”
3
, Correct Answer: C
Rationale: Palpitations concurrent with dizziness strongly
suggest cardiac arrhythmia (e.g., SVT, AF, PVCs).
Positional dizziness (A) points to BPPV. Stressors (D)
suggest panic but do not rule out arrhythmia. Directly
asking about palpitations during symptoms helps
differentiate.
5. A previously healthy 35-year-old man has 2 weeks of
nonproductive cough, low-grade fever, and chest
tightness. He is afebrile now, lungs clear. Which is the
most appropriate next step?
A. Chest X-ray
B. Empiric azithromycin
C. Symptomatic care with follow-up
D. Pertussis PCR
Correct Answer: C
Rationale: Acute bronchitis in healthy adults is viral in >90%
of cases; antibiotics are not indicated. Chest X-ray is not
4
