NR 576 Exam 1 V3 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
1) | Chamberlain University
1. An 82-year-old female presents with a new onset of confusion and frequent falls. What is
the most common non-neurological cause that should be ruled out first in the primary care
setting?
A. Urinary Tract Infection
B. Alzheimer’s Disease
C. Vitamin D Deficiency
D. Osteoarthritis
Answer: A
Explanation: In geriatric patients, atypical presentations of common illnesses are frequent.
A urinary tract infection (UTI) often presents with delirium or behavioral changes rather
than classic dysuria or frequency. The clinician must perform a urinalysis as part of the
initial workup for any acute change in mental status in the elderly.
2. A 65-year-old patient presents with a ‘boring’ epigastric pain that radiates to the back,
partially relieved by sitting forward. Which diagnostic test is most specific for confirming the
suspected diagnosis?
A. Serum Amylase
B. Serum Lipase
C. Abdominal Ultrasound
D. Plain Film X-ray
Answer: B
Explanation: Serum lipase is more specific than amylase for diagnosing acute pancreatitis.
The clinical presentation described is characteristic of pancreatic inflammation where pain
radiates to the back. Lipase levels stay elevated longer than amylase, making it a more
reliable diagnostic marker in the primary care setting.
3. When differentiating between Osteoarthritis (OA) and Rheumatoid Arthritis (RA), which
clinical finding is most indicative of RA?
A. Morning stiffness lasting less than 30 minutes
B. Asymmetrical joint involvement
C. Presence of Heberden’s nodes
,D. Symmetrical joint swelling and morning stiffness for over 1 hour
Answer: D
Explanation: Rheumatoid Arthritis is a systemic inflammatory disease characterized by
symmetrical joint involvement. Patients typically experience prolonged morning stiffness
lasting more than 60 minutes. In contrast, Osteoarthritis is often asymmetrical and
presents with shorter durations of stiffness after periods of inactivity.
4. A 55-year-old male with a history of HTN presents with acute onset of severe chest pain
that he describes as ‘tearing’ and radiating to the shoulder blades. What is the priority
differential diagnosis?
A. Myocardial Infarction
B. Pneumothorax
C. Aortic Dissection
D. Pulmonary Embolism
Answer: C
Explanation: The description of ‘tearing’ or ‘ripping’ pain radiating to the back is a classic
indicator of aortic dissection. While myocardial infarction is common, the specific quality of
this pain points toward a vascular catastrophe. Immediate imaging, such as a CT
angiogram, is required to confirm this life-threatening condition.
5. Which of the following laboratory findings is most characteristic of Iron Deficiency Anemia?
A. Increased Mean Corpuscular Volume (MCV)
B. Decreased Total Iron Binding Capacity (TIBC)
C. Increased Ferritin level
D. Increased Total Iron Binding Capacity (TIBC)
Answer: D
Explanation: In iron deficiency anemia, the TIBC increases as the body attempts to
compensate for low iron stores by creating more binding sites. The MCV would be
decreased, indicating a microcytic process. Ferritin levels are typically low, reflecting the
depletion of total body iron stores.
6. A 70-year-old patient reports sudden, painless loss of vision in one eye, described as a
‘curtain coming down.’ This finding is most suggestive of:
A. Retinal Detachment
B. Acute Angle-Closure Glaucoma
C. Macular Degeneration
, D. Cataracts
Answer: A
Explanation: Retinal detachment often presents as a sudden, painless loss of vision or the
appearance of a dark curtain in the visual field. This is a medical emergency that requires
immediate referral to an ophthalmologist. Unlike glaucoma, there is typically no pain or
redness associated with the detachment.
7. In the evaluation of a patient with suspected Chronic Obstructive Pulmonary Disease
(COPD), which FEV1/FVC ratio confirms the diagnosis?
A. Greater than 0.80
B. Less than 0.70
C. Between 0.75 and 0.85
D. Greater than 1.0
Answer: B
Explanation: According to the GOLD criteria, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. This ratio is the gold
standard for diagnosing COPD in clinical practice. It distinguishes obstructive disease from
restrictive lung patterns where the ratio may remain normal.
8. A 45-year-old female presents with fatigue, cold intolerance, and a recent weight gain of 10
lbs. The most appropriate initial screening test is:
A. Free T4
B. Thyroid Stimulating Hormone (TSH)
C. Total T3
D. Thyroid Ultrasound
Answer: B
Explanation: TSH is the most sensitive screening test for primary hypothyroidism. If the
TSH is elevated, a Free T4 is then ordered to confirm the diagnosis and determine the
severity. Total T3 is rarely useful in the initial screening of hypothyroidism as it often stays
within normal limits until the disease is advanced.
9. Which physical exam maneuver is used to assess for the presence of a meniscus tear in the
knee?
A. McMurray test
B. Lachman test
C. Anterior Drawer test
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
1) | Chamberlain University
1. An 82-year-old female presents with a new onset of confusion and frequent falls. What is
the most common non-neurological cause that should be ruled out first in the primary care
setting?
A. Urinary Tract Infection
B. Alzheimer’s Disease
C. Vitamin D Deficiency
D. Osteoarthritis
Answer: A
Explanation: In geriatric patients, atypical presentations of common illnesses are frequent.
A urinary tract infection (UTI) often presents with delirium or behavioral changes rather
than classic dysuria or frequency. The clinician must perform a urinalysis as part of the
initial workup for any acute change in mental status in the elderly.
2. A 65-year-old patient presents with a ‘boring’ epigastric pain that radiates to the back,
partially relieved by sitting forward. Which diagnostic test is most specific for confirming the
suspected diagnosis?
A. Serum Amylase
B. Serum Lipase
C. Abdominal Ultrasound
D. Plain Film X-ray
Answer: B
Explanation: Serum lipase is more specific than amylase for diagnosing acute pancreatitis.
The clinical presentation described is characteristic of pancreatic inflammation where pain
radiates to the back. Lipase levels stay elevated longer than amylase, making it a more
reliable diagnostic marker in the primary care setting.
3. When differentiating between Osteoarthritis (OA) and Rheumatoid Arthritis (RA), which
clinical finding is most indicative of RA?
A. Morning stiffness lasting less than 30 minutes
B. Asymmetrical joint involvement
C. Presence of Heberden’s nodes
,D. Symmetrical joint swelling and morning stiffness for over 1 hour
Answer: D
Explanation: Rheumatoid Arthritis is a systemic inflammatory disease characterized by
symmetrical joint involvement. Patients typically experience prolonged morning stiffness
lasting more than 60 minutes. In contrast, Osteoarthritis is often asymmetrical and
presents with shorter durations of stiffness after periods of inactivity.
4. A 55-year-old male with a history of HTN presents with acute onset of severe chest pain
that he describes as ‘tearing’ and radiating to the shoulder blades. What is the priority
differential diagnosis?
A. Myocardial Infarction
B. Pneumothorax
C. Aortic Dissection
D. Pulmonary Embolism
Answer: C
Explanation: The description of ‘tearing’ or ‘ripping’ pain radiating to the back is a classic
indicator of aortic dissection. While myocardial infarction is common, the specific quality of
this pain points toward a vascular catastrophe. Immediate imaging, such as a CT
angiogram, is required to confirm this life-threatening condition.
5. Which of the following laboratory findings is most characteristic of Iron Deficiency Anemia?
A. Increased Mean Corpuscular Volume (MCV)
B. Decreased Total Iron Binding Capacity (TIBC)
C. Increased Ferritin level
D. Increased Total Iron Binding Capacity (TIBC)
Answer: D
Explanation: In iron deficiency anemia, the TIBC increases as the body attempts to
compensate for low iron stores by creating more binding sites. The MCV would be
decreased, indicating a microcytic process. Ferritin levels are typically low, reflecting the
depletion of total body iron stores.
6. A 70-year-old patient reports sudden, painless loss of vision in one eye, described as a
‘curtain coming down.’ This finding is most suggestive of:
A. Retinal Detachment
B. Acute Angle-Closure Glaucoma
C. Macular Degeneration
, D. Cataracts
Answer: A
Explanation: Retinal detachment often presents as a sudden, painless loss of vision or the
appearance of a dark curtain in the visual field. This is a medical emergency that requires
immediate referral to an ophthalmologist. Unlike glaucoma, there is typically no pain or
redness associated with the detachment.
7. In the evaluation of a patient with suspected Chronic Obstructive Pulmonary Disease
(COPD), which FEV1/FVC ratio confirms the diagnosis?
A. Greater than 0.80
B. Less than 0.70
C. Between 0.75 and 0.85
D. Greater than 1.0
Answer: B
Explanation: According to the GOLD criteria, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. This ratio is the gold
standard for diagnosing COPD in clinical practice. It distinguishes obstructive disease from
restrictive lung patterns where the ratio may remain normal.
8. A 45-year-old female presents with fatigue, cold intolerance, and a recent weight gain of 10
lbs. The most appropriate initial screening test is:
A. Free T4
B. Thyroid Stimulating Hormone (TSH)
C. Total T3
D. Thyroid Ultrasound
Answer: B
Explanation: TSH is the most sensitive screening test for primary hypothyroidism. If the
TSH is elevated, a Free T4 is then ordered to confirm the diagnosis and determine the
severity. Total T3 is rarely useful in the initial screening of hypothyroidism as it often stays
within normal limits until the disease is advanced.
9. Which physical exam maneuver is used to assess for the presence of a meniscus tear in the
knee?
A. McMurray test
B. Lachman test
C. Anterior Drawer test
