NR 576 Exam 2 V3 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
2) | Chamberlain University
1. A 55-year-old female presents with a unilateral, throbbing headache associated with
photophobia and nausea. She reports seeing ‘flickering lights’ before the pain started. What
is the most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Temporal arteritis
D. Migraine with aura
Answer: D
Explanation: Migraine with aura is characterized by focal neurological symptoms
preceding the headache phase. The description of flickering lights is a classic visual aura
associated with this condition. Treatment typically involves triptans or NSAIDs depending
on severity.
2. A 70-year-old male reports morning stiffness in his hands that lasts approximately 15
minutes. Physical exam reveals Heberden’s nodes on the distal interphalangeal (DIP) joints.
Which diagnosis is most consistent?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Psoriatic arthritis
D. Systemic lupus erythematosus
Answer: B
Explanation: Osteoarthritis typically causes short-duration morning stiffness lasting less
than 30 minutes. Heberden’s nodes are a classic physical finding representing bony
overgrowth at the DIP joints. In contrast, rheumatoid arthritis usually involves the MCP
joints and prolonged morning stiffness.
3. A patient with Type 2 Diabetes has a current GFR of 28 mL/min/1.73m². Which of the
following adjustments is most appropriate for their Metformin therapy?
A. Increase dose to compensate for renal loss
B. Reduce dose to 500mg daily
C. Continue current dose but monitor weekly
,D. Discontinue Metformin
Answer: D
Explanation: Metformin is contraindicated in patients with a GFR below 30
mL/min/1.73m² due to the increased risk of lactic acidosis. Renal function must be
monitored regularly for all patients on biguanides. Once the GFR falls below this threshold,
alternative glucose-lowering agents must be initiated.
4. A 62-year-old female complains of sudden onset of vertigo triggered by rolling over in bed.
The Dix-Hallpike maneuver elicits rotary nystagmus. What is the first-line management?
A. Meclizine 25mg TID
B. Epley maneuver
C. Betahistine therapy
D. MRI of the brain
Answer: B
Explanation: The Epley maneuver is the gold standard treatment for Benign Paroxysmal
Positional Vertigo (BPPV). It works by repositioning canaliths from the semicircular canals
back into the vestibule. Pharmacological treatments like meclizine only mask symptoms
and do not treat the underlying cause.
5. A patient presents with a painful, vesicular rash in a dermatomal distribution on the left
thoracic region. What is the most likely diagnosis?
A. Contact dermatitis
B. Impetigo
C. Herpes zoster
D. Tinea corporis
Answer: C
Explanation: Herpes zoster, or shingles, typically presents as a unilateral vesicular
eruption following a specific nerve root. Pain often precedes the rash by several days in a
prodromal phase. Prompt treatment with antiviral medications can reduce the duration
and risk of post-herpetic neuralgia.
6. An 80-year-old patient presents with new-onset confusion, urinary incontinence, and a
history of falls. What is the most important initial diagnostic step?
A. Urinalysis and culture
B. Mini-Mental State Exam
C. Head CT
, D. Serum B12 level
Answer: A
Explanation: In geriatric patients, an atypical presentation of a urinary tract infection
(UTI) often includes acute confusion or delirium. While dementia is a chronic condition,
sudden changes in mental status require an evaluation for infection. Urinalysis is a non-
invasive and essential first step in this differential diagnosis.
7. A patient’s lab results show a high TSH and a low Free T4. Which condition does this
pattern indicate?
A. Secondary hypothyroidism
B. Hyperthyroidism
C. Subclinical hypothyroidism
D. Primary hypothyroidism
Answer: D
Explanation: Primary hypothyroidism occurs when the thyroid gland fails to produce
enough hormone, leading to low Free T4. The pituitary gland responds by increasing TSH
production to stimulate the thyroid. This is the most common form of thyroid dysfunction
in the adult population.
8. Which of the following physical exam findings is most suggestive of Acute Cholecystitis?
A. Rovsing’s sign
B. Murphy’s sign
C. McBurney’s point tenderness
D. Grey Turner’s sign
Answer: B
Explanation: Murphy’s sign involves inspiratory arrest during deep palpation of the right
upper quadrant. It is highly specific for gallbladder inflammation or acute cholecystitis.
Other signs like Rovsing’s or McBurney’s are associated with appendicitis.
9. A 65-year-old male reports difficulty starting his urinary stream and frequent nighttime
urination. His DRE reveals a firm, non-tender, symmetrically enlarged prostate. What is the
likely diagnosis?
A. Urethral stricture
B. Prostate cancer
C. Acute prostatitis
D. Benign Prostatic Hyperplasia (BPH)
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
2) | Chamberlain University
1. A 55-year-old female presents with a unilateral, throbbing headache associated with
photophobia and nausea. She reports seeing ‘flickering lights’ before the pain started. What
is the most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Temporal arteritis
D. Migraine with aura
Answer: D
Explanation: Migraine with aura is characterized by focal neurological symptoms
preceding the headache phase. The description of flickering lights is a classic visual aura
associated with this condition. Treatment typically involves triptans or NSAIDs depending
on severity.
2. A 70-year-old male reports morning stiffness in his hands that lasts approximately 15
minutes. Physical exam reveals Heberden’s nodes on the distal interphalangeal (DIP) joints.
Which diagnosis is most consistent?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Psoriatic arthritis
D. Systemic lupus erythematosus
Answer: B
Explanation: Osteoarthritis typically causes short-duration morning stiffness lasting less
than 30 minutes. Heberden’s nodes are a classic physical finding representing bony
overgrowth at the DIP joints. In contrast, rheumatoid arthritis usually involves the MCP
joints and prolonged morning stiffness.
3. A patient with Type 2 Diabetes has a current GFR of 28 mL/min/1.73m². Which of the
following adjustments is most appropriate for their Metformin therapy?
A. Increase dose to compensate for renal loss
B. Reduce dose to 500mg daily
C. Continue current dose but monitor weekly
,D. Discontinue Metformin
Answer: D
Explanation: Metformin is contraindicated in patients with a GFR below 30
mL/min/1.73m² due to the increased risk of lactic acidosis. Renal function must be
monitored regularly for all patients on biguanides. Once the GFR falls below this threshold,
alternative glucose-lowering agents must be initiated.
4. A 62-year-old female complains of sudden onset of vertigo triggered by rolling over in bed.
The Dix-Hallpike maneuver elicits rotary nystagmus. What is the first-line management?
A. Meclizine 25mg TID
B. Epley maneuver
C. Betahistine therapy
D. MRI of the brain
Answer: B
Explanation: The Epley maneuver is the gold standard treatment for Benign Paroxysmal
Positional Vertigo (BPPV). It works by repositioning canaliths from the semicircular canals
back into the vestibule. Pharmacological treatments like meclizine only mask symptoms
and do not treat the underlying cause.
5. A patient presents with a painful, vesicular rash in a dermatomal distribution on the left
thoracic region. What is the most likely diagnosis?
A. Contact dermatitis
B. Impetigo
C. Herpes zoster
D. Tinea corporis
Answer: C
Explanation: Herpes zoster, or shingles, typically presents as a unilateral vesicular
eruption following a specific nerve root. Pain often precedes the rash by several days in a
prodromal phase. Prompt treatment with antiviral medications can reduce the duration
and risk of post-herpetic neuralgia.
6. An 80-year-old patient presents with new-onset confusion, urinary incontinence, and a
history of falls. What is the most important initial diagnostic step?
A. Urinalysis and culture
B. Mini-Mental State Exam
C. Head CT
, D. Serum B12 level
Answer: A
Explanation: In geriatric patients, an atypical presentation of a urinary tract infection
(UTI) often includes acute confusion or delirium. While dementia is a chronic condition,
sudden changes in mental status require an evaluation for infection. Urinalysis is a non-
invasive and essential first step in this differential diagnosis.
7. A patient’s lab results show a high TSH and a low Free T4. Which condition does this
pattern indicate?
A. Secondary hypothyroidism
B. Hyperthyroidism
C. Subclinical hypothyroidism
D. Primary hypothyroidism
Answer: D
Explanation: Primary hypothyroidism occurs when the thyroid gland fails to produce
enough hormone, leading to low Free T4. The pituitary gland responds by increasing TSH
production to stimulate the thyroid. This is the most common form of thyroid dysfunction
in the adult population.
8. Which of the following physical exam findings is most suggestive of Acute Cholecystitis?
A. Rovsing’s sign
B. Murphy’s sign
C. McBurney’s point tenderness
D. Grey Turner’s sign
Answer: B
Explanation: Murphy’s sign involves inspiratory arrest during deep palpation of the right
upper quadrant. It is highly specific for gallbladder inflammation or acute cholecystitis.
Other signs like Rovsing’s or McBurney’s are associated with appendicitis.
9. A 65-year-old male reports difficulty starting his urinary stream and frequent nighttime
urination. His DRE reveals a firm, non-tender, symmetrically enlarged prostate. What is the
likely diagnosis?
A. Urethral stricture
B. Prostate cancer
C. Acute prostatitis
D. Benign Prostatic Hyperplasia (BPH)
