74 year old female, May Smith, presents to ER (rural hospital) complaining of chest discomfort for about 30 minutes. Mrs. Smith arrives in a private car and is accompanied by her husband who is in the waiting room. She describes the pain like nothing she has ever had before. It is sub-sternal, not radiating and rates it a 6/10. The pain is not exacerbated by movement. She reports nausea but no vomiting. Patient belching during the assessment. She took some Tums before coming in but that didn’t help. Patient becomes increasingly anxious, thinks she is having a heart attack. NP students will demonstrate the approach to formulating 3 priority differential diagnoses with the patient in the practice setting based on history and physical exam findings to accurately reassess the patient’s condition, and order appropriate diagnostic tests to diagnose the patient’s condition.