NR 576 Exam 4 V1 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
4) | Chamberlain University
1. A 68-year-old male presents with urinary frequency, nocturia, and a weak urinary stream.
Digital rectal examination (DRE) reveals a smooth, firm, and non-tender enlarged prostate.
Which medication class is the first-line treatment for his symptoms?
A. 5-alpha-reductase inhibitors
B. Alpha-1 adrenergic antagonists
C. Phosphodiesterase-5 inhibitors
D. Anticholinergics
Answer: B
Explanation: Alpha-1 adrenergic antagonists, such as tamsulosin, provide rapid relief of
symptoms by relaxing smooth muscles in the prostate and bladder neck. These medications
are generally preferred as first-line therapy because they work faster than 5-alpha-
reductase inhibitors. Patients should be monitored for orthostatic hypotension as a
common side effect.
2. A 55-year-old patient reports persistent heartburn and regurgitation for the past 6 months
despite using over-the-counter antacids. What is the most appropriate next step in the
diagnostic workup?
A. Prescribe an H2 blocker for 4 weeks
B. Refer for an upper endoscopy (EGD)
C. Order a trial of a daily proton pump inhibitor (PPI)
D. Perform a barium swallow study
Answer: C
Explanation: An empiric trial of a daily proton pump inhibitor (PPI) for 8 weeks is the
standard initial step for diagnosing GERD in patients without alarm symptoms. If the
patient responds to the PPI, the diagnosis of GERD is supported clinicaly. Endoscopy is
typically reserved for those who fail therapy or present with alarm symptoms like
dysphagia.
3. A 72-year-old smoker presents with painless gross hematuria. A urinalysis confirms the
presence of blood but no nitrites or leukocytes. What is the most likely differential diagnosis?
A. Acute Glomerulonephritis
B. Urolithiasis
,C. Bladder Malignancy
D. Benign Prostatic Hyperplasia
Answer: C
Explanation: Painless gross hematuria in an older adult with a smoking history is highly
suspicious for bladder cancer until proven otherwise. Smoking is the primary risk factor for
urothelial carcinoma in the geriatric population. A CT urogram and cystoscopy are
necessary for a definitive diagnosis.
4. An 80-year-old female presents with acute onset of left lower quadrant pain, fever, and
constipation. Physical exam reveals localized tenderness. What is the preferred imaging
modality to confirm the diagnosis?
A. Abdominal X-ray
B. Ultrasound of the abdomen
C. CT scan of the abdomen and pelvis with contrast
D. Colonoscopy
Answer: C
Explanation: A CT scan with intravenous contrast is the gold standard for diagnosing acute
diverticulitis due to its high sensitivity and specificity. It allows for the identification of
bowel wall thickening, fat stranding, and potential complications like abscesses.
Colonoscopy is contraindicated during the acute phase due to the risk of bowel perforation.
5. A patient’s laboratory results show a Glomerular Filtration Rate (GFR) of 42
mL/min/1.73m² maintained for over 3 months. According to the Kidney Disease Improving
Global Outcomes (KDIGO) guidelines, which stage of Chronic Kidney Disease (CKD) does this
represent?
A. Stage 3b
B. Stage 3a
C. Stage 2
D. Stage 4
Answer: A
Explanation: Stage 3b Chronic Kidney Disease is defined by a GFR between 30 and 44
mL/min/1.73m². Stage 3a covers GFR 45-59, while Stage 4 covers GFR 15-29. Management
at this stage involves aggressive blood pressure control and monitoring for complications
like anemia and bone disease.
, 6. A 45-year-old female presents with sharp right upper quadrant pain that radiates to her
right shoulder, accompanied by nausea after eating a fatty meal. Her Murphy’s sign is
positive. What is the most likely diagnosis?
A. Acute Pancreatitis
B. Peptic Ulcer Disease
C. Acute Cholecystitis
D. Gastroenteritis
Answer: C
Explanation: The clinical triad of RUQ pain, radiation to the shoulder, and a positive
Murphy’s sign strongly suggests acute cholecystitis. A positive Murphy’s sign occurs when
the patient arrests inspiration during deep palpation of the RUQ. Ultrasound is the initial
imaging study of choice to look for gallbladder wall thickening or stones.
7. A 60-year-old male with a history of NSAID use for arthritis presents with gnawing
epigastric pain that is relieved by food. Which diagnostic test is most specific for H. pylori
infection?
A. Serum H. pylori antibody test
B. Urea breath test
C. Endoscopy with biopsy
D. Stool antigen test
Answer: C
Explanation: While non-invasive tests like the urea breath test and stool antigen test are
common, endoscopy with biopsy remains the gold standard for confirming H. pylori and
assessing for ulcers. Biopsy allows for histological examination and rapid urease testing.
Serum antibody tests are not recommended for confirming active infection because they
cannot distinguish between past and current exposure.
8. A 75-year-old woman complains of leaking urine when she coughs or sneezes. She denies
urgency or frequency. What type of urinary incontinence is she experiencing?
A. Stress incontinence
B. Urge incontinence
C. Overflow incontinence
D. Functional incontinence
Answer: A
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
4) | Chamberlain University
1. A 68-year-old male presents with urinary frequency, nocturia, and a weak urinary stream.
Digital rectal examination (DRE) reveals a smooth, firm, and non-tender enlarged prostate.
Which medication class is the first-line treatment for his symptoms?
A. 5-alpha-reductase inhibitors
B. Alpha-1 adrenergic antagonists
C. Phosphodiesterase-5 inhibitors
D. Anticholinergics
Answer: B
Explanation: Alpha-1 adrenergic antagonists, such as tamsulosin, provide rapid relief of
symptoms by relaxing smooth muscles in the prostate and bladder neck. These medications
are generally preferred as first-line therapy because they work faster than 5-alpha-
reductase inhibitors. Patients should be monitored for orthostatic hypotension as a
common side effect.
2. A 55-year-old patient reports persistent heartburn and regurgitation for the past 6 months
despite using over-the-counter antacids. What is the most appropriate next step in the
diagnostic workup?
A. Prescribe an H2 blocker for 4 weeks
B. Refer for an upper endoscopy (EGD)
C. Order a trial of a daily proton pump inhibitor (PPI)
D. Perform a barium swallow study
Answer: C
Explanation: An empiric trial of a daily proton pump inhibitor (PPI) for 8 weeks is the
standard initial step for diagnosing GERD in patients without alarm symptoms. If the
patient responds to the PPI, the diagnosis of GERD is supported clinicaly. Endoscopy is
typically reserved for those who fail therapy or present with alarm symptoms like
dysphagia.
3. A 72-year-old smoker presents with painless gross hematuria. A urinalysis confirms the
presence of blood but no nitrites or leukocytes. What is the most likely differential diagnosis?
A. Acute Glomerulonephritis
B. Urolithiasis
,C. Bladder Malignancy
D. Benign Prostatic Hyperplasia
Answer: C
Explanation: Painless gross hematuria in an older adult with a smoking history is highly
suspicious for bladder cancer until proven otherwise. Smoking is the primary risk factor for
urothelial carcinoma in the geriatric population. A CT urogram and cystoscopy are
necessary for a definitive diagnosis.
4. An 80-year-old female presents with acute onset of left lower quadrant pain, fever, and
constipation. Physical exam reveals localized tenderness. What is the preferred imaging
modality to confirm the diagnosis?
A. Abdominal X-ray
B. Ultrasound of the abdomen
C. CT scan of the abdomen and pelvis with contrast
D. Colonoscopy
Answer: C
Explanation: A CT scan with intravenous contrast is the gold standard for diagnosing acute
diverticulitis due to its high sensitivity and specificity. It allows for the identification of
bowel wall thickening, fat stranding, and potential complications like abscesses.
Colonoscopy is contraindicated during the acute phase due to the risk of bowel perforation.
5. A patient’s laboratory results show a Glomerular Filtration Rate (GFR) of 42
mL/min/1.73m² maintained for over 3 months. According to the Kidney Disease Improving
Global Outcomes (KDIGO) guidelines, which stage of Chronic Kidney Disease (CKD) does this
represent?
A. Stage 3b
B. Stage 3a
C. Stage 2
D. Stage 4
Answer: A
Explanation: Stage 3b Chronic Kidney Disease is defined by a GFR between 30 and 44
mL/min/1.73m². Stage 3a covers GFR 45-59, while Stage 4 covers GFR 15-29. Management
at this stage involves aggressive blood pressure control and monitoring for complications
like anemia and bone disease.
, 6. A 45-year-old female presents with sharp right upper quadrant pain that radiates to her
right shoulder, accompanied by nausea after eating a fatty meal. Her Murphy’s sign is
positive. What is the most likely diagnosis?
A. Acute Pancreatitis
B. Peptic Ulcer Disease
C. Acute Cholecystitis
D. Gastroenteritis
Answer: C
Explanation: The clinical triad of RUQ pain, radiation to the shoulder, and a positive
Murphy’s sign strongly suggests acute cholecystitis. A positive Murphy’s sign occurs when
the patient arrests inspiration during deep palpation of the RUQ. Ultrasound is the initial
imaging study of choice to look for gallbladder wall thickening or stones.
7. A 60-year-old male with a history of NSAID use for arthritis presents with gnawing
epigastric pain that is relieved by food. Which diagnostic test is most specific for H. pylori
infection?
A. Serum H. pylori antibody test
B. Urea breath test
C. Endoscopy with biopsy
D. Stool antigen test
Answer: C
Explanation: While non-invasive tests like the urea breath test and stool antigen test are
common, endoscopy with biopsy remains the gold standard for confirming H. pylori and
assessing for ulcers. Biopsy allows for histological examination and rapid urease testing.
Serum antibody tests are not recommended for confirming active infection because they
cannot distinguish between past and current exposure.
8. A 75-year-old woman complains of leaking urine when she coughs or sneezes. She denies
urgency or frequency. What type of urinary incontinence is she experiencing?
A. Stress incontinence
B. Urge incontinence
C. Overflow incontinence
D. Functional incontinence
Answer: A
