NR 576 Final Exam V1 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Final
Exam) | Chamberlain University
1. An 82-year-old male presents with sudden onset of confusion, visual hallucinations, and
fluctuating levels of consciousness over the last 48 hours. Which diagnosis is most likely?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Depression
D. Delirium
Answer: D
Explanation: Delirium is characterized by an acute onset and fluctuating course of
cognitive impairment. Unlike dementia, which is progressive and chronic, delirium often
has an underlying medical cause such as infection or metabolic derangement. The presence
of hallucinations and altered consciousness strongly supports a delirium diagnosis in the
geriatric population.
2. A patient complains of a ‘curtain’ closing over their vision in the right eye, preceded by
flashes of light. What is the most urgent differential diagnosis?
A. Cataracts
B. Macular Degeneration
C. Glaucoma
D. Retinal Detachment
Answer: D
Explanation: The description of a curtain closing over the visual field is a classic sign of
retinal detachment. This condition is a medical emergency that requires immediate referral
to ophthalmology to prevent permanent vision loss. Flashes (photopsia) and floaters often
precede the actual detachment phase.
3. When performing a physical exam on a patient with suspected appendicitis, which sign
involves pain upon internal rotation of the flexed right hip?
A. Rovsing’s Sign
B. Psoas Sign
C. Murphy’s Sign
,D. Obturator Sign
Answer: D
Explanation: The Obturator sign is positive when the patient experiences hypogastric pain
during internal rotation of the flexed right hip. This indicates irritation of the obturator
internus muscle by an inflamed appendix. It is one of several clinical maneuvers used to
build a differential diagnosis for acute abdominal pain.
4. A 65-year-old female presents with a unilateral, throbbing headache localized to the
temple, accompanied by scalp tenderness and jaw claudication. What is the priority
diagnostic test?
A. CT scan of the head
B. Lumbar puncture
C. MRI of the brain
D. Erythrocyte Sedimentation Rate (ESR)
Answer: D
Explanation: The clinical presentation is highly suggestive of Giant Cell Arteritis (GCA),
also known as Temporal Arteritis. An elevated ESR or C-reactive protein (CRP) is a key
laboratory finding that supports this diagnosis. Failure to diagnose and treat GCA promptly
with steroids can lead to irreversible blindness.
5. Which of the following physical exam findings is most characteristic of Osteoarthritis rather
than Rheumatoid Arthritis?
A. Heberden’s nodes
B. Symmetrical joint involvement
C. Morning stiffness lasting over 1 hour
D. Ulnar deviation
Answer: A
Explanation: Heberden’s nodes are bony overgrowths at the distal interphalangeal (DIP)
joints and are classic markers of Osteoarthritis. In contrast, Rheumatoid Arthritis typically
affects the proximal joints and presents with systemic symptoms like prolonged morning
stiffness. OA is generally characterized by asymmetrical wear and tear rather than systemic
inflammation.
6. A 50-year-old male presents with acute onset of severe pain, redness, and swelling in the
first metatarsophalangeal joint. What is the gold standard for confirming this diagnosis?
A. Serum uric acid levels
B. Joint fluid aspiration for crystals
, C. X-ray of the foot
D. Trial of colchicine
Answer: B
Explanation: Joint fluid aspiration (arthrocentesis) with polarized light microscopy is the
definitive gold standard for diagnosing gout. It identifies negatively birefringent needle-
shaped urate crystals within the synovial fluid. While serum uric acid may be elevated, it
can also be normal during an acute attack, making aspiration necessary for confirmation.
7. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’ distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Tinea Corporis
B. Psoriasis
C. Secondary Syphilis
D. Pityriasis Rosea
Answer: D
Explanation: Pityriasis Rosea typically begins with a single herald patch followed by a
generalized eruption along skin cleavage lines, creating a Christmas tree pattern. This
condition is self-limiting and usually viral in origin. The absence of involvement on palms
and soles helps differentiate it from secondary syphilis.
8. A 24-year-old female reports a sudden, ‘thunderclap’ headache that she describes as ‘the
worst headache of my life.’ What is the immediate concern?
A. Subarachnoid Hemorrhage
B. Migraine with aura
C. Cluster headache
D. Tension-type headache
Answer: A
Explanation: A thunderclap headache reaching maximum intensity within seconds is a
hallmark symptom of a Subarachnoid Hemorrhage. This represents a neurosurgical
emergency that requires an immediate non-contrast CT scan. If the CT is negative but
suspicion remains high, a lumbar puncture is the next diagnostic step.
9. Which cranial nerve is primarily affected in a patient presenting with Bell’s Palsy?
A. Cranial Nerve V (Trigeminal)
B. Cranial Nerve III (Oculomotor)
C. Cranial Nerve VII (Facial)
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Final
Exam) | Chamberlain University
1. An 82-year-old male presents with sudden onset of confusion, visual hallucinations, and
fluctuating levels of consciousness over the last 48 hours. Which diagnosis is most likely?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Depression
D. Delirium
Answer: D
Explanation: Delirium is characterized by an acute onset and fluctuating course of
cognitive impairment. Unlike dementia, which is progressive and chronic, delirium often
has an underlying medical cause such as infection or metabolic derangement. The presence
of hallucinations and altered consciousness strongly supports a delirium diagnosis in the
geriatric population.
2. A patient complains of a ‘curtain’ closing over their vision in the right eye, preceded by
flashes of light. What is the most urgent differential diagnosis?
A. Cataracts
B. Macular Degeneration
C. Glaucoma
D. Retinal Detachment
Answer: D
Explanation: The description of a curtain closing over the visual field is a classic sign of
retinal detachment. This condition is a medical emergency that requires immediate referral
to ophthalmology to prevent permanent vision loss. Flashes (photopsia) and floaters often
precede the actual detachment phase.
3. When performing a physical exam on a patient with suspected appendicitis, which sign
involves pain upon internal rotation of the flexed right hip?
A. Rovsing’s Sign
B. Psoas Sign
C. Murphy’s Sign
,D. Obturator Sign
Answer: D
Explanation: The Obturator sign is positive when the patient experiences hypogastric pain
during internal rotation of the flexed right hip. This indicates irritation of the obturator
internus muscle by an inflamed appendix. It is one of several clinical maneuvers used to
build a differential diagnosis for acute abdominal pain.
4. A 65-year-old female presents with a unilateral, throbbing headache localized to the
temple, accompanied by scalp tenderness and jaw claudication. What is the priority
diagnostic test?
A. CT scan of the head
B. Lumbar puncture
C. MRI of the brain
D. Erythrocyte Sedimentation Rate (ESR)
Answer: D
Explanation: The clinical presentation is highly suggestive of Giant Cell Arteritis (GCA),
also known as Temporal Arteritis. An elevated ESR or C-reactive protein (CRP) is a key
laboratory finding that supports this diagnosis. Failure to diagnose and treat GCA promptly
with steroids can lead to irreversible blindness.
5. Which of the following physical exam findings is most characteristic of Osteoarthritis rather
than Rheumatoid Arthritis?
A. Heberden’s nodes
B. Symmetrical joint involvement
C. Morning stiffness lasting over 1 hour
D. Ulnar deviation
Answer: A
Explanation: Heberden’s nodes are bony overgrowths at the distal interphalangeal (DIP)
joints and are classic markers of Osteoarthritis. In contrast, Rheumatoid Arthritis typically
affects the proximal joints and presents with systemic symptoms like prolonged morning
stiffness. OA is generally characterized by asymmetrical wear and tear rather than systemic
inflammation.
6. A 50-year-old male presents with acute onset of severe pain, redness, and swelling in the
first metatarsophalangeal joint. What is the gold standard for confirming this diagnosis?
A. Serum uric acid levels
B. Joint fluid aspiration for crystals
, C. X-ray of the foot
D. Trial of colchicine
Answer: B
Explanation: Joint fluid aspiration (arthrocentesis) with polarized light microscopy is the
definitive gold standard for diagnosing gout. It identifies negatively birefringent needle-
shaped urate crystals within the synovial fluid. While serum uric acid may be elevated, it
can also be normal during an acute attack, making aspiration necessary for confirmation.
7. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’ distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Tinea Corporis
B. Psoriasis
C. Secondary Syphilis
D. Pityriasis Rosea
Answer: D
Explanation: Pityriasis Rosea typically begins with a single herald patch followed by a
generalized eruption along skin cleavage lines, creating a Christmas tree pattern. This
condition is self-limiting and usually viral in origin. The absence of involvement on palms
and soles helps differentiate it from secondary syphilis.
8. A 24-year-old female reports a sudden, ‘thunderclap’ headache that she describes as ‘the
worst headache of my life.’ What is the immediate concern?
A. Subarachnoid Hemorrhage
B. Migraine with aura
C. Cluster headache
D. Tension-type headache
Answer: A
Explanation: A thunderclap headache reaching maximum intensity within seconds is a
hallmark symptom of a Subarachnoid Hemorrhage. This represents a neurosurgical
emergency that requires an immediate non-contrast CT scan. If the CT is negative but
suspicion remains high, a lumbar puncture is the next diagnostic step.
9. Which cranial nerve is primarily affected in a patient presenting with Bell’s Palsy?
A. Cranial Nerve V (Trigeminal)
B. Cranial Nerve III (Oculomotor)
C. Cranial Nerve VII (Facial)
