NR 576 Exam 2 V2 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
2) | Chamberlain University
1. A 62-year-old male presents with new onset of exertional chest pain and a systolic murmur
at the second right intercostal space that radiates to the neck. Which diagnosis is most likely?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: A
Explanation: Aortic stenosis is classically characterized by a crescendo-decrescendo
systolic murmur heard best at the right upper sternal border. The radiation of the murmur
to the carotid arteries is a hallmark sign of significant stenosis. Symptoms such as chest
pain and dyspnea often correlate with the severity of the valvular narrowing.
2. When evaluating a patient for suspected Heart Failure (HF), the clinician notes a displaced
point of maximal impulse (PMI) and an S3 gallop. Which form of HF is most likely?
A. Diastolic heart failure
B. Systolic heart failure
C. Right-sided heart failure
D. High-output heart failure
Answer: B
Explanation: An S3 gallop is highly suggestive of ventricular volume overload and systolic
dysfunction. A displaced PMI often indicates cardiomegaly or ventricular dilation
associated with reduced ejection fraction. The clinician must differentiate this from an S4,
which is more typical of diastolic dysfunction or non-compliant ventricles.
3. A 70-year-old patient presents with peripheral edema, jugular venous distension (JVD), and
hepatomegaly. These findings are most indicative of:
A. Right-sided Heart Failure
B. Left-sided Heart Failure
C. Chronic Bronchitis
D. Pulmonary Embolism
,Answer: A
Explanation: Right-sided heart failure results in a backup of blood into the systemic
venous circulation. This leads to clinical signs such as JVD, peripheral pitting edema, and
hepatic congestion. While often caused by left-sided failure, primary right-sided failure can
occur in conditions like Cor Pulmonale.
4. In the management of Hypertension based on JNC 8 guidelines, what is the initial
recommended pharmacological class for a non-black patient with no chronic kidney disease?
A. Thiazide-type diuretics
B. Loop diuretics
C. Beta-blockers
D. Alpha-blockers
Answer: A
Explanation: Initial treatment for non-black patients includes thiazide diuretics, calcium
channel blockers, ACE inhibitors, or ARBs. Beta-blockers are no longer recommended as
first-line therapy for uncomplicated hypertension. The clinician must tailor the choice
based on the patient’s individual risk factors and comorbidities.
5. A 55-year-old female presents with sharp, stabbing chest pain that increases with deep
inspiration and improves when leaning forward. What is the primary differential diagnosis?
A. Myocardial Infarction
B. Esophageal Spasm
C. Pericarditis
D. Pneumothorax
Answer: C
Explanation: Pericarditis typically presents with pleuritic chest pain that is positional in
nature. Leaning forward reduces the friction between the pericardial layers, providing
relief to the patient. An ECG may show diffuse ST-segment elevation, which helps
differentiate it from focal ischemia.
6. A patient complains of sudden onset of shortness of breath and pleuritic chest pain. The
clinician observes a heart rate of 115 bpm and unilateral calf swelling. What is the most
appropriate next step?
A. Obtain a chest X-ray
B. Start oral antibiotics for pneumonia
C. Perform a D-dimer and consider CT Angiography
, D. Refer for a treadmill stress test
Answer: C
Explanation: The presentation is highly suspicious for a Pulmonary Embolism (PE),
especially with the presence of tachycardia and signs of DVT. The Wells criteria should be
used to assess the clinical probability of PE before ordering diagnostic tests. CT Pulmonary
Angiography is the gold standard for confirming the presence of a clot in the pulmonary
vasculature.
7. Which physical exam finding is most specific for diagnosing community-acquired
pneumonia (CAP)?
A. Productive cough
B. Wheezing on expiration
C. Fever above 101.5F
D. Egophony (E to A change)
Answer: D
Explanation: Egophony, where the spoken ‘E’ sounds like ‘A’ over consolidated lung tissue,
is a strong indicator of pneumonia. This physical sign represents the transmission of sound
through fluid-filled or solid alveolar spaces. While cough and fever are common, they lack
the specificity provided by signs of consolidation like egophony and tactile fremitus.
8. A 68-year-old smoker presents with chronic cough and sputum production for 4 months
over the last 2 years. The clinician notes a FEV1/FVC ratio of 0.65. What is the diagnosis?
A. Asthma
B. Interstitial Lung Disease
C. Bronchiectasis
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is diagnostic for
airflow obstruction characteristic of COPD. The history of chronic cough and sputum
production for at least 3 months in 2 consecutive years defines chronic bronchitis. The
clinician must differentiate this from asthma, which typically shows significant reversibility
after bronchodilator use.
9. What is the first-line antibiotic treatment for a healthy adult diagnosed with Community-
Acquired Pneumonia (CAP) in a region with low macrolide resistance?
A. Levofloxacin
B. Ciprofloxacin
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
2) | Chamberlain University
1. A 62-year-old male presents with new onset of exertional chest pain and a systolic murmur
at the second right intercostal space that radiates to the neck. Which diagnosis is most likely?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: A
Explanation: Aortic stenosis is classically characterized by a crescendo-decrescendo
systolic murmur heard best at the right upper sternal border. The radiation of the murmur
to the carotid arteries is a hallmark sign of significant stenosis. Symptoms such as chest
pain and dyspnea often correlate with the severity of the valvular narrowing.
2. When evaluating a patient for suspected Heart Failure (HF), the clinician notes a displaced
point of maximal impulse (PMI) and an S3 gallop. Which form of HF is most likely?
A. Diastolic heart failure
B. Systolic heart failure
C. Right-sided heart failure
D. High-output heart failure
Answer: B
Explanation: An S3 gallop is highly suggestive of ventricular volume overload and systolic
dysfunction. A displaced PMI often indicates cardiomegaly or ventricular dilation
associated with reduced ejection fraction. The clinician must differentiate this from an S4,
which is more typical of diastolic dysfunction or non-compliant ventricles.
3. A 70-year-old patient presents with peripheral edema, jugular venous distension (JVD), and
hepatomegaly. These findings are most indicative of:
A. Right-sided Heart Failure
B. Left-sided Heart Failure
C. Chronic Bronchitis
D. Pulmonary Embolism
,Answer: A
Explanation: Right-sided heart failure results in a backup of blood into the systemic
venous circulation. This leads to clinical signs such as JVD, peripheral pitting edema, and
hepatic congestion. While often caused by left-sided failure, primary right-sided failure can
occur in conditions like Cor Pulmonale.
4. In the management of Hypertension based on JNC 8 guidelines, what is the initial
recommended pharmacological class for a non-black patient with no chronic kidney disease?
A. Thiazide-type diuretics
B. Loop diuretics
C. Beta-blockers
D. Alpha-blockers
Answer: A
Explanation: Initial treatment for non-black patients includes thiazide diuretics, calcium
channel blockers, ACE inhibitors, or ARBs. Beta-blockers are no longer recommended as
first-line therapy for uncomplicated hypertension. The clinician must tailor the choice
based on the patient’s individual risk factors and comorbidities.
5. A 55-year-old female presents with sharp, stabbing chest pain that increases with deep
inspiration and improves when leaning forward. What is the primary differential diagnosis?
A. Myocardial Infarction
B. Esophageal Spasm
C. Pericarditis
D. Pneumothorax
Answer: C
Explanation: Pericarditis typically presents with pleuritic chest pain that is positional in
nature. Leaning forward reduces the friction between the pericardial layers, providing
relief to the patient. An ECG may show diffuse ST-segment elevation, which helps
differentiate it from focal ischemia.
6. A patient complains of sudden onset of shortness of breath and pleuritic chest pain. The
clinician observes a heart rate of 115 bpm and unilateral calf swelling. What is the most
appropriate next step?
A. Obtain a chest X-ray
B. Start oral antibiotics for pneumonia
C. Perform a D-dimer and consider CT Angiography
, D. Refer for a treadmill stress test
Answer: C
Explanation: The presentation is highly suspicious for a Pulmonary Embolism (PE),
especially with the presence of tachycardia and signs of DVT. The Wells criteria should be
used to assess the clinical probability of PE before ordering diagnostic tests. CT Pulmonary
Angiography is the gold standard for confirming the presence of a clot in the pulmonary
vasculature.
7. Which physical exam finding is most specific for diagnosing community-acquired
pneumonia (CAP)?
A. Productive cough
B. Wheezing on expiration
C. Fever above 101.5F
D. Egophony (E to A change)
Answer: D
Explanation: Egophony, where the spoken ‘E’ sounds like ‘A’ over consolidated lung tissue,
is a strong indicator of pneumonia. This physical sign represents the transmission of sound
through fluid-filled or solid alveolar spaces. While cough and fever are common, they lack
the specificity provided by signs of consolidation like egophony and tactile fremitus.
8. A 68-year-old smoker presents with chronic cough and sputum production for 4 months
over the last 2 years. The clinician notes a FEV1/FVC ratio of 0.65. What is the diagnosis?
A. Asthma
B. Interstitial Lung Disease
C. Bronchiectasis
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is diagnostic for
airflow obstruction characteristic of COPD. The history of chronic cough and sputum
production for at least 3 months in 2 consecutive years defines chronic bronchitis. The
clinician must differentiate this from asthma, which typically shows significant reversibility
after bronchodilator use.
9. What is the first-line antibiotic treatment for a healthy adult diagnosed with Community-
Acquired Pneumonia (CAP) in a region with low macrolide resistance?
A. Levofloxacin
B. Ciprofloxacin
