NR511 | NR511 Differential Diagnosis & Primary
Care Midterm v3 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. Which of the following describes the ‘sensitivity’ of a diagnostic test?
A. The ability of a test to correctly identify those without the disease.
B. The proportion of people with a negative test who are disease-free.
C. The probability that a person with a positive test actually has the disease.
D. The ability of a test to correctly identify those with the disease.
Correct Answer: D
Expert Explanation: Sensitivity refers to the true positive rate, meaning the test’s ability
to identify individuals who actually have the condition. A highly sensitive test is useful for
screening because a negative result helps rule out the disease (SnNout). This is distinct
from specificity, which focuses on true negatives and ruling in a disease.
2. In the SOAP note format, where would the clinician record the patient’s current
medications and allergies?
A. Objective
B. Subjective
C. Assessment
D. Plan
Correct Answer: B
Expert Explanation: The Subjective section includes information provided by the patient,
such as history, symptoms, and current medications. Medications and allergies are part of
the past medical history or current status as reported by the patient. Objective data,
conversely, involves physical exam findings and lab results observed by the clinician.
3. What is the gold standard for diagnosing a corneal abrasion?
A. Fluorescein staining with a Wood’s lamp
B. Visual acuity testing
C. Slit lamp examination without dye
D. Intraocular pressure measurement
Correct Answer: A
,Expert Explanation: Fluorescein staining is the definitive diagnostic tool for identifying
corneal abrasions as the dye collects in the epithelial defect and glows under cobalt blue
light. Visual acuity should always be checked first, but it does not confirm the abrasion
itself. Other tests like tonometry are used for glaucoma rather than surface injuries.
4. A 45-year-old patient presents with sudden onset of severe ‘eye pain’, halos around lights,
and a cloudy cornea. What is the most likely diagnosis?
A. Chronic Open-Angle Glaucoma
B. Cataracts
C. Bacterial Conjunctivitis
D. Acute Angle-Closure Glaucoma
Correct Answer: D
Expert Explanation: Acute Angle-Closure Glaucoma is a medical emergency characterized
by rapid intraocular pressure increase, pain, and visual halos. Chronic glaucoma is typically
painless and progresses slowly over years. Bacterial conjunctivitis involves discharge and
redness but usually lacks severe pain and corneal clouding.
5. Which physical exam finding is most consistent with Otitis Media with Effusion (OME)?
A. A bulging, erythematous tympanic membrane
B. Fluid bubbles or a fluid level behind a retracted TM
C. Fever and severe ear pain
D. Purulent drainage in the external auditory canal
Correct Answer: B
Expert Explanation: OME is characterized by the presence of fluid in the middle ear
without signs of acute infection like fever or bulging. Retraction of the tympanic membrane
is common due to negative pressure in the middle ear space. Acute Otitis Media (AOM)
would show more inflammatory signs like bulging and redness.
6. According to the Centor criteria, which of the following patients is most likely to require a
rapid strep test?
A. A patient with cough, rhinorrhea, and no fever.
B. A patient with a low-grade fever and a sandpaper-like rash but no sore throat.
C. A patient with fever, tonsillar exudates, and tender anterior cervical lymphadenopathy.
D. A patient with hoarseness and posterior cervical lymphadenopathy.
Correct Answer: C
, Expert Explanation: The Centor criteria help determine the likelihood of Group A Strep
pharyngitis based on fever, tonsillar exudate, absence of cough, and tender nodes. A higher
score increases the probability of bacterial infection and the need for testing. Viral
infections are more likely when symptoms like cough and rhinorrhea are present.
7. What is the first-line antibiotic treatment for an adult with uncomplicated Acute Bacterial
Rhinosinusitis (ABRS) and no allergies?
A. Azithromycin
B. Amoxicillin-clavulanate (Augmentin)
C. Doxycycline
D. Ciprofloxacin
Correct Answer: B
Expert Explanation: Current guidelines recommend Amoxicillin-clavulanate as the first-
line agent due to increasing resistance of S. pneumoniae and H. influenzae. Azithromycin is
no longer recommended due to high rates of resistance among respiratory pathogens.
Doxycycline is an alternative for those with penicillin allergies but is not the primary
choice.
8. Which of the following is a ‘red flag’ symptom in a patient presenting with a headache?
A. Bilateral pressure-like sensation
B. Photophobia and nausea
C. Sudden ‘thunderclap’ onset of pain
D. Relief of pain after taking ibuprofen
Correct Answer: C
Expert Explanation: A ‘thunderclap’ headache is a sudden, severe pain that reaches
maximum intensity within a minute and can indicate a subarachnoid hemorrhage.
Migraines often include photophobia and nausea, which are common but not typically life-
threatening. Tension headaches usually present as bilateral pressure and lack red-flag
characteristics.
9. When performing the Weber test, lateralization of sound to the affected ear (the one with
the hearing loss) suggests which type of hearing loss?
A. Conductive hearing loss
B. Sensineural hearing loss
C. Central hearing loss
D. Normal hearing
Care Midterm v3 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. Which of the following describes the ‘sensitivity’ of a diagnostic test?
A. The ability of a test to correctly identify those without the disease.
B. The proportion of people with a negative test who are disease-free.
C. The probability that a person with a positive test actually has the disease.
D. The ability of a test to correctly identify those with the disease.
Correct Answer: D
Expert Explanation: Sensitivity refers to the true positive rate, meaning the test’s ability
to identify individuals who actually have the condition. A highly sensitive test is useful for
screening because a negative result helps rule out the disease (SnNout). This is distinct
from specificity, which focuses on true negatives and ruling in a disease.
2. In the SOAP note format, where would the clinician record the patient’s current
medications and allergies?
A. Objective
B. Subjective
C. Assessment
D. Plan
Correct Answer: B
Expert Explanation: The Subjective section includes information provided by the patient,
such as history, symptoms, and current medications. Medications and allergies are part of
the past medical history or current status as reported by the patient. Objective data,
conversely, involves physical exam findings and lab results observed by the clinician.
3. What is the gold standard for diagnosing a corneal abrasion?
A. Fluorescein staining with a Wood’s lamp
B. Visual acuity testing
C. Slit lamp examination without dye
D. Intraocular pressure measurement
Correct Answer: A
,Expert Explanation: Fluorescein staining is the definitive diagnostic tool for identifying
corneal abrasions as the dye collects in the epithelial defect and glows under cobalt blue
light. Visual acuity should always be checked first, but it does not confirm the abrasion
itself. Other tests like tonometry are used for glaucoma rather than surface injuries.
4. A 45-year-old patient presents with sudden onset of severe ‘eye pain’, halos around lights,
and a cloudy cornea. What is the most likely diagnosis?
A. Chronic Open-Angle Glaucoma
B. Cataracts
C. Bacterial Conjunctivitis
D. Acute Angle-Closure Glaucoma
Correct Answer: D
Expert Explanation: Acute Angle-Closure Glaucoma is a medical emergency characterized
by rapid intraocular pressure increase, pain, and visual halos. Chronic glaucoma is typically
painless and progresses slowly over years. Bacterial conjunctivitis involves discharge and
redness but usually lacks severe pain and corneal clouding.
5. Which physical exam finding is most consistent with Otitis Media with Effusion (OME)?
A. A bulging, erythematous tympanic membrane
B. Fluid bubbles or a fluid level behind a retracted TM
C. Fever and severe ear pain
D. Purulent drainage in the external auditory canal
Correct Answer: B
Expert Explanation: OME is characterized by the presence of fluid in the middle ear
without signs of acute infection like fever or bulging. Retraction of the tympanic membrane
is common due to negative pressure in the middle ear space. Acute Otitis Media (AOM)
would show more inflammatory signs like bulging and redness.
6. According to the Centor criteria, which of the following patients is most likely to require a
rapid strep test?
A. A patient with cough, rhinorrhea, and no fever.
B. A patient with a low-grade fever and a sandpaper-like rash but no sore throat.
C. A patient with fever, tonsillar exudates, and tender anterior cervical lymphadenopathy.
D. A patient with hoarseness and posterior cervical lymphadenopathy.
Correct Answer: C
, Expert Explanation: The Centor criteria help determine the likelihood of Group A Strep
pharyngitis based on fever, tonsillar exudate, absence of cough, and tender nodes. A higher
score increases the probability of bacterial infection and the need for testing. Viral
infections are more likely when symptoms like cough and rhinorrhea are present.
7. What is the first-line antibiotic treatment for an adult with uncomplicated Acute Bacterial
Rhinosinusitis (ABRS) and no allergies?
A. Azithromycin
B. Amoxicillin-clavulanate (Augmentin)
C. Doxycycline
D. Ciprofloxacin
Correct Answer: B
Expert Explanation: Current guidelines recommend Amoxicillin-clavulanate as the first-
line agent due to increasing resistance of S. pneumoniae and H. influenzae. Azithromycin is
no longer recommended due to high rates of resistance among respiratory pathogens.
Doxycycline is an alternative for those with penicillin allergies but is not the primary
choice.
8. Which of the following is a ‘red flag’ symptom in a patient presenting with a headache?
A. Bilateral pressure-like sensation
B. Photophobia and nausea
C. Sudden ‘thunderclap’ onset of pain
D. Relief of pain after taking ibuprofen
Correct Answer: C
Expert Explanation: A ‘thunderclap’ headache is a sudden, severe pain that reaches
maximum intensity within a minute and can indicate a subarachnoid hemorrhage.
Migraines often include photophobia and nausea, which are common but not typically life-
threatening. Tension headaches usually present as bilateral pressure and lack red-flag
characteristics.
9. When performing the Weber test, lateralization of sound to the affected ear (the one with
the hearing loss) suggests which type of hearing loss?
A. Conductive hearing loss
B. Sensineural hearing loss
C. Central hearing loss
D. Normal hearing
