NR 576 Exam 3 V2 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
3) | Chamberlain University
1. A 65-year-old male presents with a sudden onset of excruciating pain in his right first
metatarsophalangeal joint. The joint is erythematous, swollen, and warm to the touch. Which
of the following is the gold standard for diagnosing this condition?
A. Joint aspiration and synovial fluid analysis
B. Serum uric acid level
C. Plain film radiography of the foot
D. Dual-energy CT scan
Answer: A
Explanation: Joint aspiration and synovial fluid analysis is the gold standard for
diagnosing gout because it allows for the identification of monosodium urate crystals under
polarized light microscopy. While serum uric acid levels are often elevated, they can be
normal during an acute attack, making them an unreliable diagnostic tool. Radiographic
changes typically only appear in chronic gout, and therefore aspiration remains the
definitive method to differentiate gout from pseudogout or septic arthritis.
2. An 72-year-old patient presents with a ‘pearl-like’ skin lesion on the nose that has a central
indentation and telangiectasia. The nurse practitioner suspects which of the following?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Malignant melanoma
D. Actinic keratosis
Answer: B
Explanation: Basal cell carcinoma is the most common form of skin cancer and
characteristically presents as a pearly or waxy papule with prominent telangiectatic
vessels. These lesions often develop a central ulceration or ‘rodent ulcer’ as they grow.
Unlike squamous cell carcinoma, which tends to be more scaly and crusty, basal cell
carcinoma grows slowly and rarely metastasizes but can cause significant local destruction.
3. Which physical examination maneuver is specifically designed to assess for a tear in the
meniscus of the knee?
A. Lachman test
B. Anterior drawer test
,C. McMurray test
D. Valgus stress test
Answer: C
Explanation: The McMurray test is performed by rotating the patient’s lower leg while the
knee is flexed and then extended to detect clicks or pain indicative of a meniscal tear. In
contrast, the Lachman and Anterior drawer tests are used to evaluate the integrity of the
anterior cruciate ligament. The Valgus stress test specifically assesses the medial collateral
ligament, making the McMurray test the correct choice for meniscal assessment.
4. A 58-year-old female reports unilateral headache localized behind the eye, accompanied by
lacrimation and nasal congestion. She states the pain is severe and lasts about 45 minutes.
This presentation is most consistent with:
A. Migraine headache
B. Tension headache
C. Giant cell arteritis
D. Cluster headache
Answer: D
Explanation: Cluster headaches are characterized by severe, unilateral periorbital pain
that occurs in ‘clusters’ or cyclical patterns, often accompanied by autonomic symptoms
like lacrimation and rhinorrhea. Migraines typically last longer, ranging from 4 to 72 hours,
and are often associated with nausea or photophobia. Tension headaches are usually
bilateral and described as a ‘band-like’ pressure, which differs significantly from the sharp,
stabbing quality of a cluster headache.
5. During a physical exam, a 70-year-old patient is asked to perform the ‘get up and go’ test.
This test is primarily used to evaluate:
A. Cognitive function
B. Functional mobility and fall risk
C. Fine motor skills
D. Cardiovascular endurance
Answer: B
Explanation: The Timed Get Up and Go (TUG) test is a validated clinical tool used to assess
a patient’s mobility, balance, and overall risk for falls in the geriatric population. A time of
greater than 12 to 15 seconds generally indicates a higher risk for falls and the need for
further intervention. This test focuses on the mechanics of standing up, walking, and
turning, rather than cognitive status or cardiovascular capacity.
, 6. A patient presents with a bright red, sharply demarcated rash on the face that is warm and
painful. The nurse practitioner notes the patient has a high fever. What is the most likely
diagnosis?
A. Cellulitis
B. Contact dermatitis
C. Impetigo
D. Erysipelas
Answer: D
Explanation: Erysipelas is a specific form of cellulitis that involves the upper dermis and
superficial lymphatics, characterized by a bright red, raised, and sharply demarcated
border. It is most commonly caused by Group A Streptococcus and frequently presents
with systemic symptoms like fever and chills. While cellulitis involves deeper tissues and
has less defined borders, erysipelas is distinct in its superficial presentation and rapid
onset.
7. Which of the following is considered the first-line pharmacological treatment for an older
adult with newly diagnosed Osteoarthritis?
A. Oral Ibuprofen
B. Topical NSAIDs
C. Oral Acetaminophen
D. Intra-articular corticosteroids
Answer: B
Explanation: According to current guidelines, topical NSAIDs (such as Diclofenac gel) are
recommended as first-line therapy for osteoarthritis, particularly of the knee, because they
provide localized relief with fewer systemic side effects. Oral acetaminophen was
previously first-line but is now considered to have limited efficacy compared to NSAIDs. In
the elderly, topical options are preferred over oral NSAIDs to avoid risks of gastrointestinal
bleeding, renal impairment, and cardiovascular events.
8. A 60-year-old male reports difficulty initiating urination, a weak stream, and the sensation
of incomplete bladder emptying. Digital rectal exam (DRE) reveals a smooth, firm, nontender
enlarged prostate. What is the most appropriate next step?
A. Order a transrectal ultrasound
B. Initiate therapy with Finasteride
C. Perform a Prostate-Specific Antigen (PSA) test
D. Refer for immediate biopsy
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
3) | Chamberlain University
1. A 65-year-old male presents with a sudden onset of excruciating pain in his right first
metatarsophalangeal joint. The joint is erythematous, swollen, and warm to the touch. Which
of the following is the gold standard for diagnosing this condition?
A. Joint aspiration and synovial fluid analysis
B. Serum uric acid level
C. Plain film radiography of the foot
D. Dual-energy CT scan
Answer: A
Explanation: Joint aspiration and synovial fluid analysis is the gold standard for
diagnosing gout because it allows for the identification of monosodium urate crystals under
polarized light microscopy. While serum uric acid levels are often elevated, they can be
normal during an acute attack, making them an unreliable diagnostic tool. Radiographic
changes typically only appear in chronic gout, and therefore aspiration remains the
definitive method to differentiate gout from pseudogout or septic arthritis.
2. An 72-year-old patient presents with a ‘pearl-like’ skin lesion on the nose that has a central
indentation and telangiectasia. The nurse practitioner suspects which of the following?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Malignant melanoma
D. Actinic keratosis
Answer: B
Explanation: Basal cell carcinoma is the most common form of skin cancer and
characteristically presents as a pearly or waxy papule with prominent telangiectatic
vessels. These lesions often develop a central ulceration or ‘rodent ulcer’ as they grow.
Unlike squamous cell carcinoma, which tends to be more scaly and crusty, basal cell
carcinoma grows slowly and rarely metastasizes but can cause significant local destruction.
3. Which physical examination maneuver is specifically designed to assess for a tear in the
meniscus of the knee?
A. Lachman test
B. Anterior drawer test
,C. McMurray test
D. Valgus stress test
Answer: C
Explanation: The McMurray test is performed by rotating the patient’s lower leg while the
knee is flexed and then extended to detect clicks or pain indicative of a meniscal tear. In
contrast, the Lachman and Anterior drawer tests are used to evaluate the integrity of the
anterior cruciate ligament. The Valgus stress test specifically assesses the medial collateral
ligament, making the McMurray test the correct choice for meniscal assessment.
4. A 58-year-old female reports unilateral headache localized behind the eye, accompanied by
lacrimation and nasal congestion. She states the pain is severe and lasts about 45 minutes.
This presentation is most consistent with:
A. Migraine headache
B. Tension headache
C. Giant cell arteritis
D. Cluster headache
Answer: D
Explanation: Cluster headaches are characterized by severe, unilateral periorbital pain
that occurs in ‘clusters’ or cyclical patterns, often accompanied by autonomic symptoms
like lacrimation and rhinorrhea. Migraines typically last longer, ranging from 4 to 72 hours,
and are often associated with nausea or photophobia. Tension headaches are usually
bilateral and described as a ‘band-like’ pressure, which differs significantly from the sharp,
stabbing quality of a cluster headache.
5. During a physical exam, a 70-year-old patient is asked to perform the ‘get up and go’ test.
This test is primarily used to evaluate:
A. Cognitive function
B. Functional mobility and fall risk
C. Fine motor skills
D. Cardiovascular endurance
Answer: B
Explanation: The Timed Get Up and Go (TUG) test is a validated clinical tool used to assess
a patient’s mobility, balance, and overall risk for falls in the geriatric population. A time of
greater than 12 to 15 seconds generally indicates a higher risk for falls and the need for
further intervention. This test focuses on the mechanics of standing up, walking, and
turning, rather than cognitive status or cardiovascular capacity.
, 6. A patient presents with a bright red, sharply demarcated rash on the face that is warm and
painful. The nurse practitioner notes the patient has a high fever. What is the most likely
diagnosis?
A. Cellulitis
B. Contact dermatitis
C. Impetigo
D. Erysipelas
Answer: D
Explanation: Erysipelas is a specific form of cellulitis that involves the upper dermis and
superficial lymphatics, characterized by a bright red, raised, and sharply demarcated
border. It is most commonly caused by Group A Streptococcus and frequently presents
with systemic symptoms like fever and chills. While cellulitis involves deeper tissues and
has less defined borders, erysipelas is distinct in its superficial presentation and rapid
onset.
7. Which of the following is considered the first-line pharmacological treatment for an older
adult with newly diagnosed Osteoarthritis?
A. Oral Ibuprofen
B. Topical NSAIDs
C. Oral Acetaminophen
D. Intra-articular corticosteroids
Answer: B
Explanation: According to current guidelines, topical NSAIDs (such as Diclofenac gel) are
recommended as first-line therapy for osteoarthritis, particularly of the knee, because they
provide localized relief with fewer systemic side effects. Oral acetaminophen was
previously first-line but is now considered to have limited efficacy compared to NSAIDs. In
the elderly, topical options are preferred over oral NSAIDs to avoid risks of gastrointestinal
bleeding, renal impairment, and cardiovascular events.
8. A 60-year-old male reports difficulty initiating urination, a weak stream, and the sensation
of incomplete bladder emptying. Digital rectal exam (DRE) reveals a smooth, firm, nontender
enlarged prostate. What is the most appropriate next step?
A. Order a transrectal ultrasound
B. Initiate therapy with Finasteride
C. Perform a Prostate-Specific Antigen (PSA) test
D. Refer for immediate biopsy
