NR 576 Exam 3 V1 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
3) | Chamberlain University
1. A 68-year-old male presents with a persistent cough and exertional dyspnea. Spirometry
reveals a post-bronchodilator FEV1/FVC ratio of 0.65. What is the most likely diagnosis?
A. Restrictive lung disease
B. Chronic Obstructive Pulmonary Disease (COPD)
C. Asthma
D. Congestive Heart Failure
Answer: B
Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the gold standard
diagnostic criterion for COPD. This finding indicates fixed airflow obstruction that is not
fully reversible. Clinicians should also assess for symptoms such as chronic cough, sputum
production, and a history of exposure to risk factors like smoking.
2. An 82-year-old female presents with acute confusion and a low-grade fever. Her urinalysis
is positive for nitrites and leukocyte esterase. What is the most appropriate next step?
A. Initiate antibiotic therapy for a urinary tract infection (UTI)
B. Order a brain MRI to rule out stroke
C. Begin a trial of antipsychotic medication
D. Perform a lumbar puncture to rule out meningitis
Answer: A
Explanation: In geriatric patients, a urinary tract infection often presents with atypical
symptoms such as delirium or confusion rather than typical dysuria. The positive urinalysis
for nitrites and leukocyte esterase strongly supports a bacterial infection. Prompt initiation
of empiric antibiotic therapy is necessary to resolve the delirium and prevent urosepsis.
3. A 55-year-old patient reports burning epigastric pain that is worse at night and after eating
large meals. He has no weight loss or dysphagia. What is the initial recommended
management?
A. Immediate referral for upper endoscopy
B. H. pylori breath testing
C. A 4- to 8-week trial of a Proton Pump Inhibitor (PPI)
,D. Abdominal ultrasound to check for gallstones
Answer: C
Explanation: The clinical presentation is classic for Gastroesophageal Reflux Disease
(GERD). In the absence of alarm symptoms such as weight loss, anemia, or dysphagia, a
trial of PPI therapy is the standard initial approach. This serves both as a treatment and a
diagnostic tool to confirm the diagnosis based on symptom relief.
4. Which physical examination finding is most characteristic of acute cholecystitis?
A. McBurney’s point tenderness
B. Rovsing’s sign
C. Murphy’s sign
D. Grey Turner’s sign
Answer: C
Explanation: Murphy’s sign is identified when a patient halts inspiration due to pain while
the clinician palpates the right upper quadrant. This finding is highly specific for
gallbladder inflammation or acute cholecystitis. In contrast, McBurney’s and Rovsing’s
signs are associated with appendicitis, while Grey Turner’s sign suggests retroperitoneal
hemorrhage.
5. A 72-year-old male complains of difficulty initiating urination, a weak stream, and frequent
nighttime voiding. Digital rectal exam (DRE) reveals a smooth, enlarged, non-tender prostate.
What is the first-line pharmacologic treatment for his symptoms?
A. Finasteride (Proscar)
B. Tamsulosin (Flomax)
C. Ciprofloxacin
D. Oxybutynin
Answer: B
Explanation: Alpha-1 adrenergic antagonists, such as Tamsulosin, are the first-line
treatment for Benign Prostatic Hyperplasia (BPH) symptoms because they provide rapid
relief by relaxing the smooth muscle of the bladder neck and prostate. 5-alpha reductase
inhibitors like Finasteride are usually added or used if the prostate is significantly enlarged
as they take months to work. The smooth, non-tender prostate on DRE is consistent with
BPH rather than malignancy or prostatitis.
6. A patient presents with a TSH level of 8.5 mIU/L (Normal: 0.4-4.0) and a low Free T4 level.
Which diagnosis is most likely?
A. Subclinical hypothyroidism
, B. Primary hypothyroidism
C. Primary hyperthyroidism
D. Secondary hypothyroidism
Answer: B
Explanation: Primary hypothyroidism is characterized by an elevated TSH and a low Free
T4, indicating the thyroid gland is failing to produce enough hormone despite stimulation.
Subclinical hypothyroidism would show an elevated TSH with a normal Free T4. Secondary
hypothyroidism would typically involve low levels of both TSH and Free T4 due to pituitary
dysfunction.
7. According to the American Diabetes Association, what is the diagnostic threshold for
Hemoglobin A1c to diagnose Type 2 Diabetes?
A. Greater than or equal to 5.7%
B. Greater than or equal to 6.0%
C. Greater than or equal to 6.5%
D. Greater than or equal to 7.0%
Answer: C
Explanation: A Hemoglobin A1c level of 6.5% or higher on two separate tests is diagnostic
for Type 2 Diabetes Mellitus. Levels between 5.7% and 6.4% are classified as pre-diabetes.
This measurement reflects the average blood glucose levels over the preceding two to
three months.
8. A 45-year-old female presents with acute left lower quadrant (LLQ) pain, fever, and
nausea. Which diagnostic test is most appropriate to confirm a suspected diagnosis of acute
diverticulitis?
A. CT scan of the abdomen and pelvis with contrast
B. Plain abdominal X-ray
C. Colonoscopy
D. Barium enema
Answer: A
Explanation: CT scan with oral and intravenous contrast is the preferred imaging modality
for diagnosing acute diverticulitis as it can visualize bowel wall thickening and abscesses.
Colonoscopy is contraindicated during the acute phase due to the high risk of bowel
perforation. The presence of LLQ pain and fever is the classic clinical triad for diverticular
inflammation.
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
3) | Chamberlain University
1. A 68-year-old male presents with a persistent cough and exertional dyspnea. Spirometry
reveals a post-bronchodilator FEV1/FVC ratio of 0.65. What is the most likely diagnosis?
A. Restrictive lung disease
B. Chronic Obstructive Pulmonary Disease (COPD)
C. Asthma
D. Congestive Heart Failure
Answer: B
Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the gold standard
diagnostic criterion for COPD. This finding indicates fixed airflow obstruction that is not
fully reversible. Clinicians should also assess for symptoms such as chronic cough, sputum
production, and a history of exposure to risk factors like smoking.
2. An 82-year-old female presents with acute confusion and a low-grade fever. Her urinalysis
is positive for nitrites and leukocyte esterase. What is the most appropriate next step?
A. Initiate antibiotic therapy for a urinary tract infection (UTI)
B. Order a brain MRI to rule out stroke
C. Begin a trial of antipsychotic medication
D. Perform a lumbar puncture to rule out meningitis
Answer: A
Explanation: In geriatric patients, a urinary tract infection often presents with atypical
symptoms such as delirium or confusion rather than typical dysuria. The positive urinalysis
for nitrites and leukocyte esterase strongly supports a bacterial infection. Prompt initiation
of empiric antibiotic therapy is necessary to resolve the delirium and prevent urosepsis.
3. A 55-year-old patient reports burning epigastric pain that is worse at night and after eating
large meals. He has no weight loss or dysphagia. What is the initial recommended
management?
A. Immediate referral for upper endoscopy
B. H. pylori breath testing
C. A 4- to 8-week trial of a Proton Pump Inhibitor (PPI)
,D. Abdominal ultrasound to check for gallstones
Answer: C
Explanation: The clinical presentation is classic for Gastroesophageal Reflux Disease
(GERD). In the absence of alarm symptoms such as weight loss, anemia, or dysphagia, a
trial of PPI therapy is the standard initial approach. This serves both as a treatment and a
diagnostic tool to confirm the diagnosis based on symptom relief.
4. Which physical examination finding is most characteristic of acute cholecystitis?
A. McBurney’s point tenderness
B. Rovsing’s sign
C. Murphy’s sign
D. Grey Turner’s sign
Answer: C
Explanation: Murphy’s sign is identified when a patient halts inspiration due to pain while
the clinician palpates the right upper quadrant. This finding is highly specific for
gallbladder inflammation or acute cholecystitis. In contrast, McBurney’s and Rovsing’s
signs are associated with appendicitis, while Grey Turner’s sign suggests retroperitoneal
hemorrhage.
5. A 72-year-old male complains of difficulty initiating urination, a weak stream, and frequent
nighttime voiding. Digital rectal exam (DRE) reveals a smooth, enlarged, non-tender prostate.
What is the first-line pharmacologic treatment for his symptoms?
A. Finasteride (Proscar)
B. Tamsulosin (Flomax)
C. Ciprofloxacin
D. Oxybutynin
Answer: B
Explanation: Alpha-1 adrenergic antagonists, such as Tamsulosin, are the first-line
treatment for Benign Prostatic Hyperplasia (BPH) symptoms because they provide rapid
relief by relaxing the smooth muscle of the bladder neck and prostate. 5-alpha reductase
inhibitors like Finasteride are usually added or used if the prostate is significantly enlarged
as they take months to work. The smooth, non-tender prostate on DRE is consistent with
BPH rather than malignancy or prostatitis.
6. A patient presents with a TSH level of 8.5 mIU/L (Normal: 0.4-4.0) and a low Free T4 level.
Which diagnosis is most likely?
A. Subclinical hypothyroidism
, B. Primary hypothyroidism
C. Primary hyperthyroidism
D. Secondary hypothyroidism
Answer: B
Explanation: Primary hypothyroidism is characterized by an elevated TSH and a low Free
T4, indicating the thyroid gland is failing to produce enough hormone despite stimulation.
Subclinical hypothyroidism would show an elevated TSH with a normal Free T4. Secondary
hypothyroidism would typically involve low levels of both TSH and Free T4 due to pituitary
dysfunction.
7. According to the American Diabetes Association, what is the diagnostic threshold for
Hemoglobin A1c to diagnose Type 2 Diabetes?
A. Greater than or equal to 5.7%
B. Greater than or equal to 6.0%
C. Greater than or equal to 6.5%
D. Greater than or equal to 7.0%
Answer: C
Explanation: A Hemoglobin A1c level of 6.5% or higher on two separate tests is diagnostic
for Type 2 Diabetes Mellitus. Levels between 5.7% and 6.4% are classified as pre-diabetes.
This measurement reflects the average blood glucose levels over the preceding two to
three months.
8. A 45-year-old female presents with acute left lower quadrant (LLQ) pain, fever, and
nausea. Which diagnostic test is most appropriate to confirm a suspected diagnosis of acute
diverticulitis?
A. CT scan of the abdomen and pelvis with contrast
B. Plain abdominal X-ray
C. Colonoscopy
D. Barium enema
Answer: A
Explanation: CT scan with oral and intravenous contrast is the preferred imaging modality
for diagnosing acute diverticulitis as it can visualize bowel wall thickening and abscesses.
Colonoscopy is contraindicated during the acute phase due to the high risk of bowel
perforation. The presence of LLQ pain and fever is the classic clinical triad for diverticular
inflammation.
