NR 576 Exam 4 V2 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
4) | Chamberlain University
1. A 58-year-old male patient presents with complaints of polyuria, polydipsia, and
unexplained weight loss. His fasting plasma glucose is 132 mg/dL. What is the most
appropriate next step to confirm a diagnosis of Diabetes Mellitus?
A. Order a repeat fasting plasma glucose or an A1c test on a different day.
B. Initiate Metformin 500 mg twice daily immediately.
C. Perform a 24-hour urine collection for glucose and ketones.
D. Diagnose the patient with Type 2 Diabetes based on these results.
Answer: A
Explanation: The diagnosis of Diabetes Mellitus typically requires two abnormal test
results from the same sample or two separate test samples. A single fasting plasma glucose
of 126 mg/dL or higher is suggestive but requires confirmation in an asymptomatic patient.
The clinician should follow American Diabetes Association guidelines to ensure diagnostic
accuracy before starting long-term pharmacotherapy.
2. An elderly female patient presents with fatigue and cold intolerance. Lab results reveal a
TSH level of 12.4 mIU/L and a low Free T4 level. Which of the following is the most likely
diagnosis?
A. Secondary Hypothyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Graves’ Disease
Answer: B
Explanation: Primary hypothyroidism is characterized by an elevated TSH and a low Free
T4 level, indicating thyroid gland failure. In subclinical hypothyroidism, the TSH is elevated
but the Free T4 remains within the normal reference range. Treatment with levothyroxine
is indicated when TSH levels exceed 10 mIU/L or if the patient is symptomatic.
3. A 65-year-old male reports difficulty starting his urinary stream and a feeling of incomplete
bladder emptying. Digital rectal examination (DRE) reveals a smooth, firm, and symmetrically
enlarged prostate. Which laboratory test should be ordered to evaluate for potential prostate
cancer?
A. Serum Creatinine
,B. Urinalysis and Culture
C. Prostate-Specific Antigen (PSA)
D. Fractionated Alkaline Phosphatase
Answer: C
Explanation: The Prostate-Specific Antigen (PSA) test is the primary biomarker used in
conjunction with DRE to screen for prostate cancer. While Benign Prostatic Hyperplasia
(BPH) also causes PSA elevations, a significant rise or high absolute value warrants further
investigation. The clinician must discuss the risks and benefits of screening with the patient
prior to testing.
4. A 22-year-old female presents with a malodorous, thin, grayish-white vaginal discharge. A
‘whiff test’ is positive, and microscopy reveals clue cells. What is the recommended first-line
treatment?
A. Fluconazole 150 mg PO once
B. Ceftriaxone 500 mg IM once
C. Metronidazole 500 mg PO BID for 7 days
D. Doxycycline 100 mg PO BID for 7 days
Answer: C
Explanation: Bacterial Vaginosis (BV) is diagnosed using Amsel’s criteria, which includes
the presence of clue cells and a positive whiff test. Metronidazole is the gold standard
treatment for symptomatic non-pregnant women. Patient education should include
avoiding alcohol consumption during treatment to prevent a disulfiram-like reaction.
5. A 40-year-old patient presents with a TSH of 0.05 mIU/L and an elevated Free T4. Physical
exam shows exophthalmos and a diffuse, non-tender goiter. What is the most likely
underlying pathology?
A. Hashimoto’s Thyroiditis
B. Graves’ Disease
C. Toxic Multinodular Goiter
D. Subacute Thyroiditis
Answer: B
Explanation: Graves’ Disease is an autoimmune condition and the most common cause of
hyperthyroidism, often presenting with exophthalmos. The presence of thyroid-stimulating
immunoglobulin (TSI) leads to excessive thyroid hormone production. Management may
include beta-blockers for symptom control and antithyroid medications like Methimazole.
, 6. CBC results for a 70-year-old female show Hgb 9.8 g/dL, MCV 72 fL, and increased RDW.
Which follow-up laboratory result is most consistent with Iron Deficiency Anemia?
A. Elevated Serum Ferritin
B. Low Serum Ferritin
C. Low Total Iron Binding Capacity (TIBC)
D. Increased Vitamin B12 levels
Answer: B
Explanation: Iron Deficiency Anemia (IDA) is characterized by a microcytic, hypochromic
blood picture with a high RDW. A low serum ferritin level is the most sensitive and specific
marker for depleted iron stores. In geriatric patients, IDA necessitates an investigation for
potential occult gastrointestinal bleeding.
7. A patient complains of a ‘strawberry cervix’ and a profuse, frothy, yellow-green vaginal
discharge. Which organism is the most likely cause?
A. Trichomonas vaginalis
B. Gardnerella vaginalis
C. Candida albicans
D. Neisseria gonorrhoeae
Answer: A
Explanation: Trichomoniasis is a protozoan infection often characterized by a strawberry
cervix (punctate hemorrhages) and frothy discharge. Diagnosis is typically confirmed via
wet mount microscopy or NAAT testing. Both the patient and their sexual partners must be
treated simultaneously to prevent reinfection.
8. A 30-year-old male presents with sudden onset of unilateral scrotal pain, nausea, and an
absent cremasteric reflex. What is the most critical differential diagnosis to consider?
A. Testicular Torsion
B. Acute Epididymitis
C. Inguinal Hernia
D. Hydrocele
Answer: A
Explanation: Testicular torsion is a surgical emergency characterized by the twisting of
the spermatic cord, compromising blood flow. The absence of the cremasteric reflex is a
highly sensitive physical finding for torsion. Immediate urological consultation is required
to salvage the testicle, as necrosis can occur within hours.
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
4) | Chamberlain University
1. A 58-year-old male patient presents with complaints of polyuria, polydipsia, and
unexplained weight loss. His fasting plasma glucose is 132 mg/dL. What is the most
appropriate next step to confirm a diagnosis of Diabetes Mellitus?
A. Order a repeat fasting plasma glucose or an A1c test on a different day.
B. Initiate Metformin 500 mg twice daily immediately.
C. Perform a 24-hour urine collection for glucose and ketones.
D. Diagnose the patient with Type 2 Diabetes based on these results.
Answer: A
Explanation: The diagnosis of Diabetes Mellitus typically requires two abnormal test
results from the same sample or two separate test samples. A single fasting plasma glucose
of 126 mg/dL or higher is suggestive but requires confirmation in an asymptomatic patient.
The clinician should follow American Diabetes Association guidelines to ensure diagnostic
accuracy before starting long-term pharmacotherapy.
2. An elderly female patient presents with fatigue and cold intolerance. Lab results reveal a
TSH level of 12.4 mIU/L and a low Free T4 level. Which of the following is the most likely
diagnosis?
A. Secondary Hypothyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Graves’ Disease
Answer: B
Explanation: Primary hypothyroidism is characterized by an elevated TSH and a low Free
T4 level, indicating thyroid gland failure. In subclinical hypothyroidism, the TSH is elevated
but the Free T4 remains within the normal reference range. Treatment with levothyroxine
is indicated when TSH levels exceed 10 mIU/L or if the patient is symptomatic.
3. A 65-year-old male reports difficulty starting his urinary stream and a feeling of incomplete
bladder emptying. Digital rectal examination (DRE) reveals a smooth, firm, and symmetrically
enlarged prostate. Which laboratory test should be ordered to evaluate for potential prostate
cancer?
A. Serum Creatinine
,B. Urinalysis and Culture
C. Prostate-Specific Antigen (PSA)
D. Fractionated Alkaline Phosphatase
Answer: C
Explanation: The Prostate-Specific Antigen (PSA) test is the primary biomarker used in
conjunction with DRE to screen for prostate cancer. While Benign Prostatic Hyperplasia
(BPH) also causes PSA elevations, a significant rise or high absolute value warrants further
investigation. The clinician must discuss the risks and benefits of screening with the patient
prior to testing.
4. A 22-year-old female presents with a malodorous, thin, grayish-white vaginal discharge. A
‘whiff test’ is positive, and microscopy reveals clue cells. What is the recommended first-line
treatment?
A. Fluconazole 150 mg PO once
B. Ceftriaxone 500 mg IM once
C. Metronidazole 500 mg PO BID for 7 days
D. Doxycycline 100 mg PO BID for 7 days
Answer: C
Explanation: Bacterial Vaginosis (BV) is diagnosed using Amsel’s criteria, which includes
the presence of clue cells and a positive whiff test. Metronidazole is the gold standard
treatment for symptomatic non-pregnant women. Patient education should include
avoiding alcohol consumption during treatment to prevent a disulfiram-like reaction.
5. A 40-year-old patient presents with a TSH of 0.05 mIU/L and an elevated Free T4. Physical
exam shows exophthalmos and a diffuse, non-tender goiter. What is the most likely
underlying pathology?
A. Hashimoto’s Thyroiditis
B. Graves’ Disease
C. Toxic Multinodular Goiter
D. Subacute Thyroiditis
Answer: B
Explanation: Graves’ Disease is an autoimmune condition and the most common cause of
hyperthyroidism, often presenting with exophthalmos. The presence of thyroid-stimulating
immunoglobulin (TSI) leads to excessive thyroid hormone production. Management may
include beta-blockers for symptom control and antithyroid medications like Methimazole.
, 6. CBC results for a 70-year-old female show Hgb 9.8 g/dL, MCV 72 fL, and increased RDW.
Which follow-up laboratory result is most consistent with Iron Deficiency Anemia?
A. Elevated Serum Ferritin
B. Low Serum Ferritin
C. Low Total Iron Binding Capacity (TIBC)
D. Increased Vitamin B12 levels
Answer: B
Explanation: Iron Deficiency Anemia (IDA) is characterized by a microcytic, hypochromic
blood picture with a high RDW. A low serum ferritin level is the most sensitive and specific
marker for depleted iron stores. In geriatric patients, IDA necessitates an investigation for
potential occult gastrointestinal bleeding.
7. A patient complains of a ‘strawberry cervix’ and a profuse, frothy, yellow-green vaginal
discharge. Which organism is the most likely cause?
A. Trichomonas vaginalis
B. Gardnerella vaginalis
C. Candida albicans
D. Neisseria gonorrhoeae
Answer: A
Explanation: Trichomoniasis is a protozoan infection often characterized by a strawberry
cervix (punctate hemorrhages) and frothy discharge. Diagnosis is typically confirmed via
wet mount microscopy or NAAT testing. Both the patient and their sexual partners must be
treated simultaneously to prevent reinfection.
8. A 30-year-old male presents with sudden onset of unilateral scrotal pain, nausea, and an
absent cremasteric reflex. What is the most critical differential diagnosis to consider?
A. Testicular Torsion
B. Acute Epididymitis
C. Inguinal Hernia
D. Hydrocele
Answer: A
Explanation: Testicular torsion is a surgical emergency characterized by the twisting of
the spermatic cord, compromising blood flow. The absence of the cremasteric reflex is a
highly sensitive physical finding for torsion. Immediate urological consultation is required
to salvage the testicle, as necrosis can occur within hours.
