1
Midterm Exam: NR 576/ NR576 (Latest 2026/ 2027
Update) Differential Diagnosis in Adult-Gerontology
Primary Care Guide |Questions with Verified Answers|
Grade A| 100% Correct -Chamberlain.
Cardiovascular & Respiratory
Q1. A 64-year-old man presents with exertional chest pain relieved by rest. ECG is normal. Which is
the most likely diagnosis?
• A. Unstable angina
• B. Stable angina
• C. Acute myocardial infarction
• D. GERD
Correct Answer: ✅ B. Stable angina is characterized by predictable, exertional chest discomfort that
resolves with rest. Unstable angina would not be relieved by rest, and an MI would present with
prolonged pain. GERD is not typically exertional.
Q2. Which finding differentiates heart failure with reduced ejection fraction (HFrEF) from diastolic
heart failure (HFpEF)?
• A. S3 heart sound
• B. Fatigue and dyspnea
• C. Lower extremity edema
• D. Elevated BNP
Correct Answer: ✅ A. An S3 heart sound is associated with systolic dysfunction (HFrEF). Both types of
HF may present with fatigue, edema, and elevated BNP. An S4 gallop is more common in HFpEF.
Q3. A 70-year-old woman presents with chronic cough, sputum production, and dyspnea. She has a 40
pack-year smoking history. Which is the most likely diagnosis?
• A. Asthma
• B. COPD—Chronic bronchitis
• C. COPD—Emphysema
• D. Lung cancer
,2
Correct Answer: ✅ B. A chronic productive cough for at least 3 months in 2 consecutive years is the
diagnostic criteria for chronic bronchitis. Emphysema is more associated with dyspnea and a barrel chest
without significant sputum production.
Q4. A 68-year-old male presents with substernal chest pressure radiating to the jaw, diaphoresis, and
nausea. The pain began 30 minutes ago while walking. What is the most appropriate initial diagnostic
step?
• A. Order a chest x-ray
• B. Draw cardiac enzymes
• C. Obtain a stat 12-lead ECG
• D. Administer sublingual nitroglycerin
Correct Answer: ✅ C. The priority is to rule out acute coronary syndrome (ACS). An ECG should be
obtained within 10 minutes of arrival to identify ST-segment elevation, which requires immediate
reperfusion, or other ischemic changes.
Q5. A 75-year-old male presents with sharp, pleuritic chest pain that worsens with inspiration and
lying flat. He reports dyspnea and a recent history of prolonged immobility. What is the most likely
diagnosis?
• A. Pulmonary embolism
• B. Acute myocardial infarction
• C. Pericarditis
• D. Pneumonia
Correct Answer: ✅ A. The combination of pleuritic chest pain, dyspnea, and risk factors like prolonged
immobility is highly suspicious for a pulmonary embolism. This warrants immediate diagnostic testing,
such as a CT pulmonary angiogram or a D-dimer.
Hematology & Oncology
Q6. A 67-year-old woman presents with fatigue, pallor, and dyspnea on exertion. Labs show
microcytic, hypochromic anemia. Which is the most likely cause?
• A. Vitamin B12 deficiency
• B. Folate deficiency
• C. Iron deficiency anemia
• D. Anemia of chronic disease
,3
Correct Answer: ✅ C. The presentation of fatigue, pallor, and dyspnea on exertion is classic for anemia.
Microcytic, hypochromic RBCs are hallmark features of iron deficiency anemia. Vitamin B12 and folate
deficiencies typically cause macrocytic anemia.
Q7. A 72-year-old male presents with hematuria and flank pain. Which is the most important initial
diagnostic step?
• A. Urinalysis
• B. CT urogram
• C. Renal ultrasound
• D. Cystoscopy
Correct Answer: ✅ B. Hematuria and flank pain in an older adult raise concern for a renal or urothelial
malignancy. A CT urogram is the preferred initial imaging study to evaluate the upper urinary tract and
renal parenchyma for masses or stones.
Q8. A 65-year-old man with a 50 pack-year smoking history presents with a persistent cough and
weight loss. A chest x-ray shows a cavitary lesion in the right upper lobe. What are the priority
differential diagnoses?
• A. Tuberculosis and fungal infection
• B. Lung cancer and tuberculosis (TB)
• C. Sarcoidosis and histoplasmosis
• D. Bacterial abscess and bronchiectasis
Correct Answer: ✅ B. A cavitary lesion in an older adult with a significant smoking history raises
concern for primary lung cancer, particularly squamous cell carcinoma. TB must also be ruled out,
especially if there are risk factors like immunosuppression or recent travel.
EENT & Dermatology
Q9. What is Pityriasis Rosea?
• A. A viral infection characterized by a vesicular rash in a dermatomal pattern
• B. A fungal infection causing well-circumscribed, scaly plaques
• C. A self-limiting rash often starting with a single "herald patch" and spreading in a "Christmas
tree" pattern
• D. An allergic reaction presenting as weeping, vesicular lesions
Correct Answer: ✅ C. Pityriasis rosea is a common, self-limiting skin condition that often begins with a
single, large "herald patch" followed by a generalized rash of smaller, scaly plaques distributed in a
characteristic "Christmas tree" pattern along skin lines.
, 4
Q10. Which of the following are appropriate treatments for Pityriasis Rosea?
• A. Topical corticosteroids and oral antifungals
• B. Second-generation antihistamines, acetaminophen, and natural sunlight/phototherapy
• C. Systemic antivirals and strict isolation
• D. Oral antibiotics and surgical excision
Correct Answer: ✅ B. Pityriasis rosea is self-limiting and resolves spontaneously in 6 to 12 weeks.
Treatment is symptomatic and includes antihistamines for pruritus, acetaminophen for discomfort, and
natural sunlight or phototherapy to reduce the rash.
Q11. Which of the following are risk factors for Contact/Allergic Dermatitis?
• A. Male sex and dark skin
• B. Increased age, women, Caucasian, fair-skinned, redheads
• C. Children and adolescents
• D. No specific risk factors
Correct Answer: ✅ B. While almost any substance can cause a reaction, contact/allergic dermatitis is
more common in women, fair-skinned individuals, redheads, and with increased age. This may be due to
differences in skin barrier function and immune response.
Q12. Which of the following statements accurately describes Contact/Allergic Dermatitis?
• A. A chronic inflammatory skin condition caused by an autoimmune reaction
• B. An acute or chronic skin inflammation caused by direct contact with an irritant or allergen
• C. A bacterial infection of the hair follicles
• D. A contagious skin infection caused by a parasite
Correct Answer: ✅ B. Contact dermatitis is an inflammatory reaction of the skin caused by direct
contact with an external substance. It can be either irritant (e.g., soaps, acids) or allergic (e.g., poison
ivy, nickel).
Q13. What is the classic presentation of Impetigo?
• A. Well-demarcated, silvery plaques
• B. Honey-crusted, erythematous lesions, often on the face or extremities
• C. Wavy, threadlike, burrowing lines with severe pruritus
• D. A single "herald patch" followed by a generalized rash
Midterm Exam: NR 576/ NR576 (Latest 2026/ 2027
Update) Differential Diagnosis in Adult-Gerontology
Primary Care Guide |Questions with Verified Answers|
Grade A| 100% Correct -Chamberlain.
Cardiovascular & Respiratory
Q1. A 64-year-old man presents with exertional chest pain relieved by rest. ECG is normal. Which is
the most likely diagnosis?
• A. Unstable angina
• B. Stable angina
• C. Acute myocardial infarction
• D. GERD
Correct Answer: ✅ B. Stable angina is characterized by predictable, exertional chest discomfort that
resolves with rest. Unstable angina would not be relieved by rest, and an MI would present with
prolonged pain. GERD is not typically exertional.
Q2. Which finding differentiates heart failure with reduced ejection fraction (HFrEF) from diastolic
heart failure (HFpEF)?
• A. S3 heart sound
• B. Fatigue and dyspnea
• C. Lower extremity edema
• D. Elevated BNP
Correct Answer: ✅ A. An S3 heart sound is associated with systolic dysfunction (HFrEF). Both types of
HF may present with fatigue, edema, and elevated BNP. An S4 gallop is more common in HFpEF.
Q3. A 70-year-old woman presents with chronic cough, sputum production, and dyspnea. She has a 40
pack-year smoking history. Which is the most likely diagnosis?
• A. Asthma
• B. COPD—Chronic bronchitis
• C. COPD—Emphysema
• D. Lung cancer
,2
Correct Answer: ✅ B. A chronic productive cough for at least 3 months in 2 consecutive years is the
diagnostic criteria for chronic bronchitis. Emphysema is more associated with dyspnea and a barrel chest
without significant sputum production.
Q4. A 68-year-old male presents with substernal chest pressure radiating to the jaw, diaphoresis, and
nausea. The pain began 30 minutes ago while walking. What is the most appropriate initial diagnostic
step?
• A. Order a chest x-ray
• B. Draw cardiac enzymes
• C. Obtain a stat 12-lead ECG
• D. Administer sublingual nitroglycerin
Correct Answer: ✅ C. The priority is to rule out acute coronary syndrome (ACS). An ECG should be
obtained within 10 minutes of arrival to identify ST-segment elevation, which requires immediate
reperfusion, or other ischemic changes.
Q5. A 75-year-old male presents with sharp, pleuritic chest pain that worsens with inspiration and
lying flat. He reports dyspnea and a recent history of prolonged immobility. What is the most likely
diagnosis?
• A. Pulmonary embolism
• B. Acute myocardial infarction
• C. Pericarditis
• D. Pneumonia
Correct Answer: ✅ A. The combination of pleuritic chest pain, dyspnea, and risk factors like prolonged
immobility is highly suspicious for a pulmonary embolism. This warrants immediate diagnostic testing,
such as a CT pulmonary angiogram or a D-dimer.
Hematology & Oncology
Q6. A 67-year-old woman presents with fatigue, pallor, and dyspnea on exertion. Labs show
microcytic, hypochromic anemia. Which is the most likely cause?
• A. Vitamin B12 deficiency
• B. Folate deficiency
• C. Iron deficiency anemia
• D. Anemia of chronic disease
,3
Correct Answer: ✅ C. The presentation of fatigue, pallor, and dyspnea on exertion is classic for anemia.
Microcytic, hypochromic RBCs are hallmark features of iron deficiency anemia. Vitamin B12 and folate
deficiencies typically cause macrocytic anemia.
Q7. A 72-year-old male presents with hematuria and flank pain. Which is the most important initial
diagnostic step?
• A. Urinalysis
• B. CT urogram
• C. Renal ultrasound
• D. Cystoscopy
Correct Answer: ✅ B. Hematuria and flank pain in an older adult raise concern for a renal or urothelial
malignancy. A CT urogram is the preferred initial imaging study to evaluate the upper urinary tract and
renal parenchyma for masses or stones.
Q8. A 65-year-old man with a 50 pack-year smoking history presents with a persistent cough and
weight loss. A chest x-ray shows a cavitary lesion in the right upper lobe. What are the priority
differential diagnoses?
• A. Tuberculosis and fungal infection
• B. Lung cancer and tuberculosis (TB)
• C. Sarcoidosis and histoplasmosis
• D. Bacterial abscess and bronchiectasis
Correct Answer: ✅ B. A cavitary lesion in an older adult with a significant smoking history raises
concern for primary lung cancer, particularly squamous cell carcinoma. TB must also be ruled out,
especially if there are risk factors like immunosuppression or recent travel.
EENT & Dermatology
Q9. What is Pityriasis Rosea?
• A. A viral infection characterized by a vesicular rash in a dermatomal pattern
• B. A fungal infection causing well-circumscribed, scaly plaques
• C. A self-limiting rash often starting with a single "herald patch" and spreading in a "Christmas
tree" pattern
• D. An allergic reaction presenting as weeping, vesicular lesions
Correct Answer: ✅ C. Pityriasis rosea is a common, self-limiting skin condition that often begins with a
single, large "herald patch" followed by a generalized rash of smaller, scaly plaques distributed in a
characteristic "Christmas tree" pattern along skin lines.
, 4
Q10. Which of the following are appropriate treatments for Pityriasis Rosea?
• A. Topical corticosteroids and oral antifungals
• B. Second-generation antihistamines, acetaminophen, and natural sunlight/phototherapy
• C. Systemic antivirals and strict isolation
• D. Oral antibiotics and surgical excision
Correct Answer: ✅ B. Pityriasis rosea is self-limiting and resolves spontaneously in 6 to 12 weeks.
Treatment is symptomatic and includes antihistamines for pruritus, acetaminophen for discomfort, and
natural sunlight or phototherapy to reduce the rash.
Q11. Which of the following are risk factors for Contact/Allergic Dermatitis?
• A. Male sex and dark skin
• B. Increased age, women, Caucasian, fair-skinned, redheads
• C. Children and adolescents
• D. No specific risk factors
Correct Answer: ✅ B. While almost any substance can cause a reaction, contact/allergic dermatitis is
more common in women, fair-skinned individuals, redheads, and with increased age. This may be due to
differences in skin barrier function and immune response.
Q12. Which of the following statements accurately describes Contact/Allergic Dermatitis?
• A. A chronic inflammatory skin condition caused by an autoimmune reaction
• B. An acute or chronic skin inflammation caused by direct contact with an irritant or allergen
• C. A bacterial infection of the hair follicles
• D. A contagious skin infection caused by a parasite
Correct Answer: ✅ B. Contact dermatitis is an inflammatory reaction of the skin caused by direct
contact with an external substance. It can be either irritant (e.g., soaps, acids) or allergic (e.g., poison
ivy, nickel).
Q13. What is the classic presentation of Impetigo?
• A. Well-demarcated, silvery plaques
• B. Honey-crusted, erythematous lesions, often on the face or extremities
• C. Wavy, threadlike, burrowing lines with severe pruritus
• D. A single "herald patch" followed by a generalized rash
