NR576 / NR 576 Final Exam (2026/2027 Newly Updated): Di...
OBJECTIVE ASSESSMENT - EXAM
NR576 / NR 576 Final Exam (2026/2027 Newly
Updated): Differential Diagnosis in Adult-Gerontology
Primary Care | Guide with Verified Answers -
Chamberlain 2026/2027
75 VERIFIED 2026/2027 80%
QUESTIONS ANSWERS EDITION PASSING
TOPICS COVERED
• Cardiovascular & Respiratory DDx • Musculoskeletal Conditions
• Endocrine & Metabolic Disorders • GI & GU Differential Diagnosis
• Neurological Conditions • Dermatology & Hematology
COVER PAGE - 1
,Section 1: Cardiovascular & Respiratory Differential Diagnosis
QUESTION 1
A 68-year-old male presents with crushing substernal chest pain radiating to his left arm, accompanied by
diaphoresis and nausea. Vital signs reveal BP 88/52 mmHg, HR 48 bpm, and RR 22. ECG shows ST elevation
in leads II, III, and aVF with third-degree AV block.
A. Acute inferior wall STEMI with right ventricular involvement
B. Acute anterior wall STEMI
C. Acute pericarditis
D. Unstable angina pectoris
Correct Answer: A
Rationale: Inferior wall STEMI (ST elevation in II, III, aVF) complicated by bradycardia and hypotension strongly suggests right
ventricular infarction, which requires careful fluid management rather than nitrates. Anterior STEMI would show ST elevation in
V1-V4, while pericarditis presents with diffuse ST elevation and PR depression without hemodynamic collapse.
QUESTION 2
A 72-year-old woman with a history of hypertension and diabetes presents with sudden onset dyspnea,
orthopnea, and pink frothy sputum. Physical exam reveals bilateral crackles, an S3 gallop, and jugular venous
distension. Chest X-ray shows bat-wing opacities and Kerley B lines.
A. Chronic obstructive pulmonary disease exacerbation
B. Acute decompensated heart failure with pulmonary edema
C. Community-acquired pneumonia
D. Pulmonary embolism
Correct Answer: B
Rationale: The combination of pink frothy sputum, S3 gallop, JVD, and bat-wing infiltrates on CXR is pathognomonic for acute
cardiogenic pulmonary edema. COPD exacerbation lacks S3 and Kerley B lines; pneumonia typically presents with fever and lobar
consolidation; PE causes pleuritic pain and normal CXR early on.
QUESTION 3
A 58-year-old male smoker presents with progressive exertional dyspnea, chronic productive cough with
purulent sputum, and barrel-shaped chest. Pulmonary function tests show FEV1/FVC ratio of 62% with
minimal bronchodilator response.
A. Asthma with fixed airway obstruction
B. Bronchiectasis
C. Chronic obstructive pulmonary disease (COPD)
D. Interstitial lung disease
Correct Answer: C
Rationale: COPD is characterized by persistent airflow limitation (FEV1/FVC < 0.70) with minimal reversibility, chronic cough, and
risk factors like smoking. Asthma typically shows significant bronchodilator response; bronchiectasis features daily purulent sputum
and hemoptysis; ILD presents with restrictive pattern and fine crackles.
, QUESTION 4
A 45-year-old woman presents with pleuritic chest pain, dyspnea, and tachycardia after a 12-hour car ride.
D-dimer is elevated, and CT pulmonary angiography reveals a filling defect in the right pulmonary artery.
A. Oral contraceptive use
B. Prolonged immobilization
C. Hypertension
D. Hyperthyroidism
Correct Answer: D
Rationale: Prolonged immobilization (Virchow's triad: stasis) is the strongest modifiable risk factor for deep vein thrombosis leading
to pulmonary embolism in this clinical context. While OCPs increase risk, the 12-hour car ride represents the immediate
precipitating factor. Hypertension and hyperthyroidism are not primary risk factors for venous thromboembolism.
QUESTION 5
A 65-year-old man with atrial fibrillation on warfarin presents with acute right-sided weakness and aphasia. CT
head shows no hemorrhage but a hyperdense middle cerebral artery sign.
A. Cardioembolic stroke from left atrial thrombus
B. Lacunar infarction from small vessel disease
C. Hypoperfusion watershed infarct
D. Subarachnoid hemorrhage
Correct Answer: A
Rationale: Atrial fibrillation causes blood stasis in the left atrial appendage, leading to thrombus formation and subsequent
cardioembolic stroke. The hyperdense MCA sign indicates acute thrombus within the vessel. Lacunar strokes affect small
penetrating arteries and present with pure motor/sensory deficits; watershed infarcts occur in border zones during hypotension.
QUESTION 6
A 70-year-old woman presents with fatigue, dyspnea on exertion, and palpitations. ECG reveals irregularly
irregular rhythm with absent P waves and fibrillatory waves. Echocardiogram shows left atrial enlargement.
A. Ventricular tachycardia
B. Ischemic stroke
C. Acute myocardial infarction
D. Complete heart block
Correct Answer: B
Rationale: Non-valvular atrial fibrillation carries a 4-5% annual stroke risk due to left atrial thrombus formation, particularly with
CHA2DS2-VASc risk factors. Anticoagulation reduces this risk by approximately 60%. VT and complete heart block are not direct
complications of AF; MI risk is elevated but not as dramatically as stroke risk.
OBJECTIVE ASSESSMENT - EXAM
NR576 / NR 576 Final Exam (2026/2027 Newly
Updated): Differential Diagnosis in Adult-Gerontology
Primary Care | Guide with Verified Answers -
Chamberlain 2026/2027
75 VERIFIED 2026/2027 80%
QUESTIONS ANSWERS EDITION PASSING
TOPICS COVERED
• Cardiovascular & Respiratory DDx • Musculoskeletal Conditions
• Endocrine & Metabolic Disorders • GI & GU Differential Diagnosis
• Neurological Conditions • Dermatology & Hematology
COVER PAGE - 1
,Section 1: Cardiovascular & Respiratory Differential Diagnosis
QUESTION 1
A 68-year-old male presents with crushing substernal chest pain radiating to his left arm, accompanied by
diaphoresis and nausea. Vital signs reveal BP 88/52 mmHg, HR 48 bpm, and RR 22. ECG shows ST elevation
in leads II, III, and aVF with third-degree AV block.
A. Acute inferior wall STEMI with right ventricular involvement
B. Acute anterior wall STEMI
C. Acute pericarditis
D. Unstable angina pectoris
Correct Answer: A
Rationale: Inferior wall STEMI (ST elevation in II, III, aVF) complicated by bradycardia and hypotension strongly suggests right
ventricular infarction, which requires careful fluid management rather than nitrates. Anterior STEMI would show ST elevation in
V1-V4, while pericarditis presents with diffuse ST elevation and PR depression without hemodynamic collapse.
QUESTION 2
A 72-year-old woman with a history of hypertension and diabetes presents with sudden onset dyspnea,
orthopnea, and pink frothy sputum. Physical exam reveals bilateral crackles, an S3 gallop, and jugular venous
distension. Chest X-ray shows bat-wing opacities and Kerley B lines.
A. Chronic obstructive pulmonary disease exacerbation
B. Acute decompensated heart failure with pulmonary edema
C. Community-acquired pneumonia
D. Pulmonary embolism
Correct Answer: B
Rationale: The combination of pink frothy sputum, S3 gallop, JVD, and bat-wing infiltrates on CXR is pathognomonic for acute
cardiogenic pulmonary edema. COPD exacerbation lacks S3 and Kerley B lines; pneumonia typically presents with fever and lobar
consolidation; PE causes pleuritic pain and normal CXR early on.
QUESTION 3
A 58-year-old male smoker presents with progressive exertional dyspnea, chronic productive cough with
purulent sputum, and barrel-shaped chest. Pulmonary function tests show FEV1/FVC ratio of 62% with
minimal bronchodilator response.
A. Asthma with fixed airway obstruction
B. Bronchiectasis
C. Chronic obstructive pulmonary disease (COPD)
D. Interstitial lung disease
Correct Answer: C
Rationale: COPD is characterized by persistent airflow limitation (FEV1/FVC < 0.70) with minimal reversibility, chronic cough, and
risk factors like smoking. Asthma typically shows significant bronchodilator response; bronchiectasis features daily purulent sputum
and hemoptysis; ILD presents with restrictive pattern and fine crackles.
, QUESTION 4
A 45-year-old woman presents with pleuritic chest pain, dyspnea, and tachycardia after a 12-hour car ride.
D-dimer is elevated, and CT pulmonary angiography reveals a filling defect in the right pulmonary artery.
A. Oral contraceptive use
B. Prolonged immobilization
C. Hypertension
D. Hyperthyroidism
Correct Answer: D
Rationale: Prolonged immobilization (Virchow's triad: stasis) is the strongest modifiable risk factor for deep vein thrombosis leading
to pulmonary embolism in this clinical context. While OCPs increase risk, the 12-hour car ride represents the immediate
precipitating factor. Hypertension and hyperthyroidism are not primary risk factors for venous thromboembolism.
QUESTION 5
A 65-year-old man with atrial fibrillation on warfarin presents with acute right-sided weakness and aphasia. CT
head shows no hemorrhage but a hyperdense middle cerebral artery sign.
A. Cardioembolic stroke from left atrial thrombus
B. Lacunar infarction from small vessel disease
C. Hypoperfusion watershed infarct
D. Subarachnoid hemorrhage
Correct Answer: A
Rationale: Atrial fibrillation causes blood stasis in the left atrial appendage, leading to thrombus formation and subsequent
cardioembolic stroke. The hyperdense MCA sign indicates acute thrombus within the vessel. Lacunar strokes affect small
penetrating arteries and present with pure motor/sensory deficits; watershed infarcts occur in border zones during hypotension.
QUESTION 6
A 70-year-old woman presents with fatigue, dyspnea on exertion, and palpitations. ECG reveals irregularly
irregular rhythm with absent P waves and fibrillatory waves. Echocardiogram shows left atrial enlargement.
A. Ventricular tachycardia
B. Ischemic stroke
C. Acute myocardial infarction
D. Complete heart block
Correct Answer: B
Rationale: Non-valvular atrial fibrillation carries a 4-5% annual stroke risk due to left atrial thrombus formation, particularly with
CHA2DS2-VASc risk factors. Anticoagulation reduces this risk by approximately 60%. VT and complete heart block are not direct
complications of AF; MI risk is elevated but not as dramatically as stroke risk.
