NR511 Differential Diagnosis and Primary Care
Week 1 Discussion
Purpose
The purpose of this assignment is to facilitate a dialogue about the student’s practicum rotation with the class. Information gleaned from the dialogue will then be used by the instructor to assign a Clinical Practice Guideline (CPG) for the week 7 assignment.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Discuss the details of his/her practicum site and tentative schedule (WO1.4) (CO 5, 6)
Identify his/her feelings about starting the first clinical rotation (WO1.4) (CO 5, 6)
Identify potential barriers to successful completion of the clinical requirements (WO1.4) (CO 5, 6)
Requirements:
Provide the following information (if more than one list them each separately):
Name of site
Location (city, state) of the practicum location
Type of practice (i.e., IM, Peds, FP)
Are there any age restrictions for patients at this office? (i.e., this office does not see children under the age of 12, etc.)
What is your tentative clinical schedule at the practicum?
Does your preceptor(s) have any other students at the same time?
Discuss your feelings about starting your first practicum rotation (good or bad) and identify at least 3 possible factors which might be barriers to your success in completion of the clinical requirements.
NR511 Differential Diagnosis and Primary Care
Week 3 Discussion
DQ1 Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Synthesize clinical knowledge, didactic learning and research findings to provide appropriate primary care to patients with common acute and stable chronic conditions. (WO3.2) (CO 1, 2, 4 & 5)
Requirements:
Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information.
Provide a differential diagnosis (minimum of 3) which might explain the patient's chief complaint along with a brief statement of pathophysiology for each.
Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
Rank the differential in order of most likely to least likely.
Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence.
Case Study
Date of visit: October 20, 2017
A 19-year-old male freshman college student presents to the student health center today with complaints of bilateral eye discomfort. Upon further questioning you discover the following subjective information regarding the chief complaint.
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History of Present Illness
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Onset
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2-3 days ago
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Location
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Both eyes
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Duration
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Constant
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Characteristics
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Both eyes feel "gritty" with mild to moderate amount of discomfort. Further describes the gritty sensation "like sand caught in your eye"
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Aggravating factors
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None identified
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Relieving factors
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None identified
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Treatments
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Tried OTC visine drops once yesterday which temporarily improved the redness but the gritty sensation, tearing and itching remained.
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Severity
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Level of discomfort is 2/10 on pain scale
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Review of Systems (ROS)
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Constitutional
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Denies fever, chills, or recent illnesses
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Eyes
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Denies contact lenses or glasses, has never experienced these symptoms previously. Last eye exam was "a few years ago". Denies eye injury, trauma, visual changes or dryness. Denies crusting of lids or mucoid or purulent drainage. Bilateral symptoms of +redness, +itching, +tearing + FB sensation.
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Ears
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-otalgia, -otorrhea
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Nose
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+occasional runny nose with intermittent nasal congestion, denies sneezing. History of seasonal nasal allergies which is aggravated in the spring but is well controlled on loratadine and fluticasone nasal spray taken during peak season (he is not taking either right now).
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Throat
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Denies ST and redness
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Neck
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Denies lymph node tenderness or swelling
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Chest
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Denies cough, SOB and wheezing
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Heart
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Denies chest pain
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History
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Medications
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Loratadine 10mg daily and fluticasone nasal spray daily (only takes during the spring months when nasal allergies flare)
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PMH
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Seasonal allergic rhinitis with springtime triggers
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PSH
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None
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Allergies
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None
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Social
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Freshman student at the University of Awesome located in central Illinois. Home is in Phoenix.
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Habits
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Denies cigarettes +recreational marijuana use +drinks 3-6 beers per weekend
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FH
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Adopted, does not know biological parents history
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Physical exam reveals the following.
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Physical Exam
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Constitutional
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Young adult male in NAD, alert and oriented, cooperative
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VS
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Temp-97.9, P-68, R-16, BP 120/75, Height 6'0, Weight 195 pounds
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Head
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Normocephalic
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Eyes
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Visual Acuity 20/20 (uncorrected) OU. PERRL with white sclera bilaterally. Slight light sensitivity noted bilaterally. No crusting, lesions or masses on lids noted. Bilateral conjunctiva with diffuse redness and tearing but no mucoid or purulent drainage noted. No visible FBs under lids or on cornea to gross examination.
Fundiscopic examination: Discs flat with sharp margins. Vessels present in all quadrants without crossing defects. Retinal background has even color, no hemorrhages noted. Macula has even color.
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Ears
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Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender.
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Nose
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Nares patent. Nasal turbinates are pale and boggy with mild to moderate swelling. Nasal drainage is clear.
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Throat
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Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted.
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Neck
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Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
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Cardiopulmonary
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Heart S1 and S2 noted, no murmurs, noted. Lungs clear to auscultation bilaterally. Respirations unlabored.
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DQ2 Now, assume that any procedures and/or testing which were performed are NORMAL.
1. What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
2. Identify the corresponding ICD-10 code.
3. Provide a treatment plan for this patient's primary diagnosis which includes:
Medication*
Any additional testing necessary for this particular diagnosis*
Patient education
Referral
4. Provide an active problem list for this patient based on the information given in the case.
5. Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBM argument for each treatment or testing decision.
6. Provide an appropriate F/U plan.
*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based medicine (EBM) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
NR511 Differential Diagnosis and Primary Care
Week 6 Discussion
DQ1 Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Synthesize clinical knowledge, didactic learning and research findings to provide appropriate primary care to patients with common acute and stable chronic conditions. (WO6.1) (CO 1, 2, 4 & 5)
Requirements:
Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information.
Provide a differential diagnosis (minimum of 3) which might explain the patient's chief complaint along with a brief statement of pathophysiology for each.
Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
Rank the differential in order of most likely to least likely.
Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence.
Case Study
Date of visit: November 7, 2017
A 56-year-old Caucasian female presents to the office today with complaints of fatigue. Upon further questioning you discover the following subjective information regarding the chief complaint.
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History of Present Illness
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Onset
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"about 2-3 months"
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Location
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Generalized
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Duration
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Constant
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Characteristics
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Progressively worsening since onset, feels tired all of the time, sleeps 8hrs per night but does not feel well rested. "No energy to do anything I normally can do"
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Aggravating factors
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Exertion
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Relieving factors
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None identified
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Treatments
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None
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Severity
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Denies pain; missed 1 day of work 2 weeks ago because "couldn't get out of bed"
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Review of Systems (ROS)
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Constitutional
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Denies fever, chills, or recent illnesses. +5lb. weight gain since last visit 6 months ago.
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Eyes
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No visual changes or diploplia
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ENT
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Denies ear pain, coryza, rhinorrhea, or ST. Had tonsillectomy as child Denies snoring or history of sleep apnea.
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Neck
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Denies lymph node tenderness or swelling
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Chest
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Denies cough, SOB, DOE or wheezing
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Heart
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Denies chest pain
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Abdomen
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Denies N/V/D. + Constipation
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Endocrine
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Denies polyuria, polydipsia. + cold intolerance. Menopause status x 5 yrs.
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Skin
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No changes in skin, hair or nails
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Psych
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Reports worsening of depressive symptoms but thinks it is because she is so "unproductive" lately and tired all of the time. -Suicidal or homicidal thoughts. Sleeping 8-9hrs per night (no changes), but not feeling rested.
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Musculoskeletal
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Generalized weakness and intermittent muscles cramping in calves
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History
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Medications
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Multivitamin, B-Complex, Prozac 20mg, Bisoprolol-HCTZ 2.5mg/6.25mg, Calcium 500mg + Vit D3 400IU.
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PMH
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HTN, Depression, Postmenopausal status
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PSH
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Tonsillectomy
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Allergies
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Iodine dyes
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Social
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Married; Works full time as office manager of an internal medicine office; 2 kids (grown)
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Habits
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Denies cigarettes or drug use. +Occasional glass of wine (1-2 per month).
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FH
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Maternal GM & GF deceased with CHF, T2DM and HTN;
Mother alive (age 82) +HTN, +Hyperlipidemia, +T2DM;
Father alive (age 84) +HTN, +Hyperlipidemia, +T2DM, +ASHD (s/p CABG 2 years ago). Also had +CVA at time of CABG (work-up revealed +DVT and +PFO; remains anticoagulated);
Oldest child (26) with seasonal allergies
Youngest child (24) with Bipolar depression and ADHD, and anxiety
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Physical exam reveals the following:
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Physical Exam
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Constitutional
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Middle aged Caucasian female alert, oriented and cooperative
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VS
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Temp-98.2, P-74, R-16, BP 146/95, Height: 5'7", Weight: 180 pounds
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Head
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Normocephalic, atraumatic
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Eyes
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PERRLA
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Ears
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Tympanic membranes gray and intact with light reflex noted.
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Nose
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Nares patent. Nasal turbinates without swelling. Nasal drainage is clear.
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Throat
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Oropharynx moist, no lesions or exudate. Surgically removed tonsils bilaterally. Teeth in good repair, no cavities.
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Neck
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Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
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Cardiopulmonary
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Heart S1 and s2 noted, no murmurs, noted. Lungs clear to auscultation bilaterally. Respirations unlabored. No pedal edema
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Abdomen
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Soft, non-tender. BS active
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Skin
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Skin overall dry, hair coarse and thick, nails without ridging, pitting or discoloration
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Psych
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Mood pleasant and appropriate.
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Musculoskeletal
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Strength full throughout
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Neuro
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DTRs 2+ at biceps, 1+ at knees and ankles
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DQ2 Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Synthesize clinical knowledge, didactic learning and research findings to provide appropriate primary care to patients with common acute and stable chronic conditions. (WO6.1) (CO 1, 2, 4 & 5)
Requirements:
What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
Identify the corresponding ICD-10 code.
Provide a treatment plan for this patient's primary diagnosis which includes:
Medication*
Any additional testing necessary for this particular diagnosis*
Patient education
Referral
Provide an active problem list for this patient based on the information given in the case.
Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBM argument for each treatment or testing decision.
Provide an appropriate F/U plan.
*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based medicine (EBM) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
Case Study
Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.
CBC with differential
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WBC
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8.6 x10E3/uL
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RBC
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4.44 x 10E6/uL
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Hemoglobin
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14.0 g/dL
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Hematocrit
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41.2%
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MCV
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93fL
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MCH
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31.5 pg
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MCHC
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34.0 g/dL
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RDW
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13%
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Platelet
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241 x 10E3/uL
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Neutrophils %
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67%
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Lymphocytes %
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22%
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Monocytes %
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8%
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Eosinophils %
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3%
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Basophils %
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0%
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Absolute Neutrophils
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5.7 x 10E3/uL
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Absolute Lymphocytes
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1.9 x 10E3/uL
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Absolute Monocytes
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0.7 x 10E3/uL
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Eosinophils Absolute
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0.3 x 10E3/uL
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Basophile Absolute
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0.0 x 10E3/uL
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Immature Grans %
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0%
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Absolute Immature Grans
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0.0 x 10E3/uL
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TSH with Reflex to FT4
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TSH
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6.770 uIU/mL
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FT4
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0.62 ng/dL
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PHQ-9 Depression Score=10 (previous was 5 at last visit 6 months ago)
NR511 Differential Diagnosis and Primary Care
Week 2 Assignment
SNAPPS Presentation Assignment
Purpose
SNAPPS is a learner-centered approach to case presentation in the clinical setting. This model allows the student to take an active role in their educational encounter by discussing the patient encounter beyond the facts, verbalizing their clinical reasoning, asking questions, and engaging in follow-up learning pertinent to the educational encounter. This exercise is designed to develop the student’s ability to organize patient information in a meaningful way and guide the student in their oral patient presentations in the clinical setting.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Summarize patient findings into an organized oral presentation. (WO2.3) (CO 5)
Identify their own knowledge gaps and inquire about uncertainties, difficulties, or alternative approaches to diagnosis & treatment of a patient. (WO2.3) (CO 5)
Requirements:
Using a patient seen in their clinical setting, students will give an oral presentation (via Kaltura) using the 6-step learner-centered SNAPPS model to mimic a real-life presentation to the preceptor by:
Briefly summarizing the relative history and findings;
Narrowing the differential to three relevant possibilities using the pertinent positive and negative findings;
Analyzing the differential by comparing and contrasting the possibilities;
Probing the preceptor by asking questions about uncertainties, difficulties, or alternative approaches;
Identifying a treatment plan for the patient; and
Select a case-related issue for self-directed learning
In addition to the oral presentation, the student will submit the written findings of their research for the case-related, self-directed learning topic that was identified in the presentation.
The written portion of this assignment will be submitted on the “SNAPPS Template for Written Assignment” using appropriate evidence-based, scholarly references and using appropriate APA reference and in-text citations.
The oral presentation must be submitted to the Week 2 discussion board before Sunday, 11:59 p.m. MT. The written portion of the assignment must be submitted on the template provided to the assignment box before Sunday, 11:59 p.m. MT. If any of the required items are missing or are submitted after the deadline, late penalties will be applied according to the Late Assignment Policy as discussion in the Syllabus.
Preparing the presentation and paper
The oral presentation part of this assignment should be prepared using the following guidelines:
Students will present a patient seen in their clinical setting for a single, problem-focused (acute) visit.
The oral presentation will be recorded and should mimic a presentation that would be given to the preceptor.
The oral presentation must be recorded in Kaltura (slides are not required).
The presentation should be 5-7min.
The presentation should be shared with the class for viewing by posting a link in the Week 2 discussion board BEFORE Sunday 11:59pm MT.
To help organize your data in preparation for the presentation, it is recommended that students use the “SNAPPS TEMPLATE FOR ORAL PRESENTATION”. This document is only a guide and is not required. It should NOT be submitted to the discussion board or assignment box.
Students should refer to the SNAPPS videos in the Week 2 lesson as an example of the oral presentation.
As part of the patient presentation, the student must provide the following:
Chief complaint with pertinent HPI, ROS and PE findings
Identification of the differential
An analysis of the differential with arguments for or against each diagnosis ranked in order from most likely to least likely
Probing questions that were asked of the preceptor or areas of uncertainties
Novice level plan management (diagnosis, medication, education and follow-up instructions)
The student states the self-directed learning topic that they will investigate further. (NOTE: A self-directed learning topic is something that you want to know more about that relates to the condition, but is not the condition itself).
NR511 Differential Diagnosis and Primary Care
Week 7 Assignment
Clinical Practice Guideline Peer Review
Purpose
A student peer review is a process in which students constructively evaluate the work of another student’s work which promotes mutual learning. Feedback provided from a peer can help the learner master the concepts of an assignment. At the same time, the peer who provides the feedback on a student assignment learns to critically analyze the learner’s work.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Evaluate common primary care clinical practice guidelines for application in clinical practice (WO7.1) (CO3)
Review and provide constructive feedback on a peer’s clinical practice guideline assignment. (WO7.1) (CO 3)
Requirements:
The instructor will provide each student with the name of a peer whose assignment must be reviewed prior to Week 7.
The student will read the peer’s assigned CPG (which should be posted with every peer presentation).
Using the Peer Review Rubric provided, students will critically evaluate their assigned peer’s PowerPoint presentation.
Peer evaluations are due by Sunday 11:59 p.m. MT at the end of Week 7. One (1) copy must be uploaded to the course. The second (2nd) copy should be sent via the course conversation inbox to the peer whose work was reviewed.
Preparing the paper
In this activity you are “grading” your peer’s presentation with the rubric that your instructor uses. Be mindful to follow any additional directions that are required as noted in the peer reviewer form.
The written peer review is to be completed on the corresponding Peer Review TemplatePreview the document.
Add your name and the name of the presenter that you are reviewing in the appropriate section.
Watch your assigned peer’s presentation.
Provide a “grade” for your peer by highlighting the box that you feel most represents the appropriate grade for each criteria.
Provide constructive feedback in the Peer Reviewer Comments section.
Discuss how the CPG that you reviewed can be applied to your clinical practice as stated in the rubric. You can include your response at the bottom of the peer reviewer template form.
Peer evaluations are due by Sunday 11:59pm MT of Week 7.
One (1) copy must be uploaded to the Peer Review assignment box.
One (1) copy should be emailed to the peer whose work was reviewed.
NR511 Differential Diagnosis and Primary Care
Week 7 Assignment
Clinical Practice
Purpose
Clinical practice guidelines (CPGs) are written to provide recommendations that are intended to assist providers in making decisions for specific circumstances or disease conditions. CPGs are based on systematic reviews of the best available evidenced based medicine research. Interpreting and learning to apply guidelines into practice is necessary to develop and enhance diagnostic reasoning skills.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Through this assignment, the student will demonstrate the ability to:
Read and interpret a primary care related CPG for use in practice. (CO 3)
Identify the CPG recommendations and strength of evidence. (CO 3)
Compare and contrast the diagnosis and treatment of a patient seen in the clinical setting to the recommendations given in the CPG. (CO 3)
Due Date:
Students will be RANDOMLY assigned a CPG on a disease topic by their instructor in Week 1. Students will post a brief, narrated, PowerPoint presentation along with a copy of their CPG and a written transcript of their presentation by Wednesday 11:59 p.m. MT of Week 7. This will allow others to view their peer’s presentation in order to provide an evaluation before Sunday.
Total Points Possible: 100
Requirements:
Students will RANDOMLY be assigned a CPG on a disease topic by their instructor in Week 1.
In Week 7, students will provide a brief, narrated PowerPoint presentation using Kaltura while following the directions and rubric listed below.
In addition to the presentation, students will provide a written transcript to the Week 7 assignment box for the instructor’s reference. (NOTE: A written transcript is a word for word script of exactly what is said in the PowerPoint Narration. It is not a paper and does not need to be in APA format. See the transcripts under each lecture in the weekly lessons for examples).
Students will share a copy of their given CPG by attaching it to the discussion board where their presentation (or link) is posted. This will allow the instructor and peer to review along with your presentation.
The narrated PowerPoint presentation, copy of the CPG, and transcript are due before Wednesday 11:59pm MT of Week 7.
If any of the required items are missing or are submitted after the deadline, late penalties will be applied according to the Late Assignment Policy as discussed in the Syllabus.
NR511 Differential Diagnosis and Primary Care
Week 8 Assignment
Reflection
Purpose
Students will complete a self-reflection assignment for the purpose of validating their clinical progress. The goal for this activity is to engage the student in considering how their clinical abilities and professional growth are changing.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Through this assignment, the student will:
Review clinical encounters to identify gaps in experience.
Propose a plan to narrow the gaps in experience.
Identify their own feelings regarding their progress, achievement of personal goals and weaknesses.
Chose two (2) NONPF CORE competencies and discuss how the student has met or plans to meet them in the future.
Requirements:
There are two parts to this assignment.
In part 1, students will review their clinical experience documentation in to write a narrative about their experience thus far. Students should:
Review their patient encounters and identify experience gaps in terms of age, acuity, certain procedures, level of complexity, etc.
State how they plan to narrow this gap in future practicums (i.e., focus on seeing pediatric patients under the age of 5, finding a separate pediatric site for a later practicum, et cetera)
Discuss how they have progressed throughout the practicum by identifying the goals that they have achieved and/or are still working toward
Identify areas of weakness and communicate a plan to address these areas
Choose two of the NONPF CORE competencies and describe either (a) how you have met them or (b) how you plan to work toward meeting them in the future. Provide specific examples from your clinical rotation as support. FNP NONPF CORE competencies can be found at: https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf (Links to an external site.)
NR511 Differential Diagnosis and Primary Care
Week 1 Quiz
Question 1The phrase usual and customary refers to:
The success rate of a specified procedure.
How charges for a service compares with charges made to other persons receiving similar services and supplies.
How an insurer evaluates the need for an ordered diagnostic test.
How much an insurer will charge to provide coverage.
Question 2Which of the following statements does not belong in the past medical history portion of your chart note?
Your patient has an allergy to penicillin.
Your patient had a cholecystectomy 3 years prior.
Your patient’s father passed away from lung cancer.
Your patient had lab work done at their last appointment; CBC was normal.
Question 3Which of the following statements about Medicaid is true?
Medicaid is a federal plan created to provide care for indigent persons.
Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration.
Medicaid is a program for the indigent financed jointly by the federal and state governments.
Medicaid pays for family planning services, dental care, and eyeglasses.
NR511 Differential Diagnosis and Primary Care
Week 2 Quiz
Question 1 The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is:
Amoxicillin (Amoxil).
Azithromycin (Zithromax).
Prednisone (Deltasone).
Amoxicillin and potassium clavulanate (Augmentin).
Question 2 A 72-year-old male patient presents to the clinic for his annual physical. He states that he is worried because he only has a bowel movement every three days. How should the clinician respond?
“You should have at least three stools per week.”
“There is no such thing as a ‘normal’ pattern of defecation.”
“You should have two to three stools per day.”
“You should defecate once a day.”
Question 3 A 30-year-old male presents to the clinic with intermittent diarrhea. He is pretty sure that the antacids taken for heartburn are the cause since the loose stools always occur within 30 minutes after taking them. How should the clinician respond?
“Antacids contain caffeine, which decreases bowel transit time.”
“Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel.”
“Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel.”
“Antacids contain sorbitol or mannitol, which are sugars that aren’t absorbed and can cause fluid to be drawn into the bowel.”
NR511 Differential Diagnosis and Primary Care
Week 3 Quiz
Question 1Henry, 64 years old, is having difficulty getting rid of a corneal infection. He asks why. How do you respond?
“Systemic antibiotics have difficulty getting to that area of the eye.”
“Because the cornea doesn’t have a blood supply, an infection can’t be fought off as usual.”
“Because the infection was painless, it was not treated early enough.”
“We can’t determine the causative agent.”
Question 2A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was recently on spring break and spent every night in the hot tub at her hotel. On physical exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly where her bathing suit covered her buttocks. What is the most likely pathogen causing these lesions?
Staphylococcus aureus.
Streptococcus.
Pseudomonas aeruginosa.
Klebsiella.
Question 3A 3-year-old patient presents to your pediatric office with her mother. She has recently started in day care. Her mother noted slight perioral erythema on the right side of the patient’s mouth last night before bed. The patient awoke today with 3 small, superficial, honey-colored vesicles where the erythema was last night. The patient has no surrounding erythema presently. She had no difficulty eating this morning and is active and energetic and doesn’t appear lethargic or fatigued. She is also afebrile. How would you treat this child?
Oral Keflex for 7 days.
Topical compress with Burow solution and follow-up in 2 to 3 days.
Local debridement and topical compress with Burow solution and close follow-up.
Local debridement and mupirocin for 5 days.
NR511 Differential Diagnosis and Primary Care
WEEEK 4 MIDTERM EXAM
Question 1. Which of the following is a crucial element of developing a
guideline?
Creating a physician expert panel
Reviewing the literature with ratings of available evidence
Conducting an external review of a guideline
Developing evidence-based tables
Question 2. African American patients seem to have a negative reaction
to which of the following asthma medications?
Inhaled corticosteroids
Long-term beta-agonist bronchodilators
Leukotriene receptor agonists
Oral corticosteroids
Question 3. Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean?
The tumor size cannot be evaluated; the cancer has not spread to the lymph nodes; and the distant spread cannot be evaluated.
The cancer is in situ; it is spreading into the lymph nodes,but the spread cannot be evaluated otherwise.
The cancer is less than 2 cm in size and has not spreadto the lymph nodes or other parts of the body.
The cancer is about 5 cm in size; nearby lymph nodes cannot be evaluated; and there is no evidence of distant
spreading.
NR511 Differential Diagnosis and Primary Care
Week 5 Quiz
Question 1A 55-year-old female presents to the clinic with complaints of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, the clinician notes tenderness at the “anatomical snuffbox.” This finding most likely indicates which of the following?
Scaphoid fracture.
Ulnar styloid fracture.
Hamate fracture.
Radial head fracture.
Question 2A 28-year-old male presents to the clinic for follow-up from the emergency department, where he was seen for right forearm pain 3 days ago. He works as a carpenter and is right hand dominant. He states he was diagnosed with right forearm tendinitis and is not sure what this means. As part of teaching, the clinician explains that the condition is caused by inflammation of one or more of the tendons. Which of the following describes tendons?
The collagen fibers that connect muscle to bone.
The pouches of synovial fluid that cushion bone and other joint structures.
The ropelike bundles of collagen fibrils that connect bone to bone.
The fibrocartilaginous disks that separate bony surfaces.
Question 3A conservative approach is recommended in the initial approach to the management of low back pain. Which of the following would be an appropriate treatment plan for a 32-year-old obese male (BMI 33) diagnosed with an acute lumbar strain?
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
Bedrest.
Surgery.
Epidural Steroid Injections (ESI).
NR511 Differential Diagnosis and Primary Care
Week 6 Quiz
Question 1 The most common cause of hyperthyroidism is:
Graves disease.
A pituitary tumor.
Subacute thyroiditis.
A toxic uninodulargoiter.
Question 2 An elderly client presents with atrial fibrillation. Which of the following lab tests is important in forming the diagnosis?
Comprehensive metabolic panel (CMP).
Thyroid-stimulating hormone (TSH).
C-reactive protein (CRP).
Complete blood count (CBC).
Question 3 A client presents with clinical manifestations of hyperthyroidism. The differential diagnosis includes Graves disease and subacute thyroiditis. Which of the following findings is consistent with subacute thyroiditis?
A 24-hour radioactive iodine uptake (RAIU) demonstrating increased uptake.
A 24-hour radioactive iodine uptake (RAIU) demonstrating a “cold” nodule.
A 24-hour radioactive iodine uptake (RAIU) demonstrating decreased uptake.
A fine-needle aspiration is required for diagnosis of subacute thyroiditis.
NR511 Differential Diagnosis and Primary Care
Week 7 Quiz
Question 1 A 32-year-old male appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. The nurse practitioner is trying to differentiate between epididymitis and testicular torsion. Which test should be the provider’s first choice?
Technetium scan.
X-ray.
Ultrasound.
Physical examination.
Question 2 A male patient presents to the clinic for evaluation of infertility. Subjectively, the patient complains of pain and fullness of the testes and states, “My testicles feel like a bag of worms.” On physical examination, the nurse practitioner notes tortuous veins posterior to and above the testes that extend up into the external inguinal ring. Based on the preceding assessment, the nurse practitioner refers the patient to urology with a diagnosis of:
Hydrocele.
Urethritis.
Varicocele.
Orchitis.
Question 3 A patient’s chief complaint is pain and heaviness in the scrotum. The nurse practitioner notes swelling of the testes, along with warm scrotal skin. Which of the following diagnoses is most probable?
Testicular torsion.
Orchitis.
Cryptorchidism.
Epididymitis.
NR511 Differential Diagnosis and Primary Care
WEEK 8 FINAL EXAM
Question 1 The most cost-e?ective screening test for determining HIV status is which of the following?
Western blot
Enzyme-linked immunosorbent assay
Venereal Disease Research Laboratory test
Viral load
Question 2. Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?
Erythrocyte sedimentation rate
White blood cell count
Polymorphonuclear cells
C-reactive protein (CRP)
Question 3. Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?
GABA
Acetylcholine
Dopamine
Serotonin
