NR 576 Exam 3 V3 | 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 resting tremor, bradykinesia, and postural instability.
Which of the following is the most likely diagnosis?
A. Essential Tremor
B. Huntington’s Disease
C. Multiple Sclerosis
D. Parkinson’s Disease
Answer: D
Explanation: Parkinson’s Disease is characterized by the clinical triad of resting tremor,
bradykinesia, and rigidity. The tremor typically presents as a ‘pill-rolling’ motion that
improves with intentional activity. Diagnosis is primarily clinical, often supported by a
positive response to dopaminergic therapy.
2. Which physical examination finding is most specific for a diagnosis of Bell’s Palsy?
A. Sparing of the forehead muscles
B. Inability to furrow the brow on the affected side
C. Lower facial drooping with intact eye closure
D. Contralateral hemiparesis
Answer: B
Explanation: Bell’s Palsy involves the lower motor neuron of the facial nerve (CN VII),
which leads to paralysis of both the upper and lower facial muscles. In contrast, a central
nervous system lesion such as a stroke typically spares the forehead due to bilateral
innervation. Patients with Bell’s Palsy will be unable to wrinkle their forehead or close
their eye on the affected side.
3. A 30-year-old female presents with a unilateral, throbbing headache associated with
photophobia and nausea. What is the first-line abortive treatment?
A. Propranolol
B. Topiramate
C. Amitriptyline
D. Sumatriptan
,Answer: D
Explanation: Triptans, such as Sumatriptan, are considered first-line abortive therapy for
moderate to severe migraines. They work as selective serotonin receptor agonists to cause
vasoconstriction and inhibit pro-inflammatory neuropeptide release. Propranolol and
Topiramate are used for prophylaxis, not acute relief.
4. A patient presents with a ‘curtain falling’ over their vision in one eye, which resolved after
10 minutes. This likely represents:
A. Retinal Detachment
B. Amaurosis Fugax
C. Glaucoma
D. Macular Degeneration
Answer: B
Explanation: Amaurosis fugax is a transient loss of vision in one eye, often described as a
shade or curtain being pulled down. It is frequently caused by an embolic event from the
carotid artery and serves as a warning sign for an impending stroke. Immediate
cardiovascular and neurological evaluation is required to prevent permanent deficit.
5. Which of the following is the most appropriate initial screening tool for Major Depressive
Disorder in the primary care setting?
A. GAD-7
B. MMSE
C. PHQ-9
D. CAGE Questionnaire
Answer: C
Explanation: The PHQ-9 (Patient Health Questionnaire-9) is a validated tool for screening,
diagnosing, and monitoring the severity of depression. It consists of nine criteria based on
the DSM-5 for depressive disorders. The GAD-7 is used for anxiety, while the MMSE
assesses cognitive impairment.
6. A 45-year-old patient reports sudden, severe pain in the first metatarsophalangeal joint.
The joint is red, swollen, and tender. What is the gold standard for diagnosis?
A. Serum Uric Acid level
B. Synovial fluid analysis for crystals
C. X-ray of the foot
D. C-reactive protein
, Answer: B
Explanation: The definitive diagnosis of gout is made by identifying negatively
birefringent needle-shaped urate crystals in synovial fluid. While serum uric acid levels are
often elevated, they can be normal during an acute flare. Visualizing the crystals under
polarized light microscopy confirms the diagnosis and differentiates it from pseudogout.
7. Which of the following findings is most characteristic of Osteoarthritis (OA) compared to
Rheumatoid Arthritis (RA)?
A. Heberden’s nodes
B. Symmetrical joint involvement
C. Morning stiffness lasting more than one hour
D. Systemic symptoms like fever and fatigue
Answer: A
Explanation: Heberden’s nodes are bony enlargements of the distal interphalangeal (DIP)
joints and are a classic sign of Osteoarthritis. OA is generally characterized by asymmetric
involvement and brief morning stiffness (less than 30 minutes). RA typically involves
symmetrical joints and prolonged morning stiffness due to systemic inflammation.
8. An 82-year-old patient presents with new-onset confusion and a decline in daily
functioning over the last 3 days. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Lewy Body Dementia
Answer: C
Explanation: Delirium is characterized by an acute onset, fluctuating course, and
disturbances in consciousness and attention. Unlike dementia, which is a chronic and
progressive decline, delirium is often reversible and triggered by underlying medical issues
such as infections (UTI) or medication side effects. The rapid onset over three days strongly
points toward delirium.
9. A 50-year-old patient has a TSH of 8.5 mIU/L and a normal Free T4. This pattern is
consistent with:
A. Primary Hypothyroidism
B. Secondary Hypothyroidism
C. Subclinical Hypothyroidism
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
3) | Chamberlain University
1. A 65-year-old male presents with a resting tremor, bradykinesia, and postural instability.
Which of the following is the most likely diagnosis?
A. Essential Tremor
B. Huntington’s Disease
C. Multiple Sclerosis
D. Parkinson’s Disease
Answer: D
Explanation: Parkinson’s Disease is characterized by the clinical triad of resting tremor,
bradykinesia, and rigidity. The tremor typically presents as a ‘pill-rolling’ motion that
improves with intentional activity. Diagnosis is primarily clinical, often supported by a
positive response to dopaminergic therapy.
2. Which physical examination finding is most specific for a diagnosis of Bell’s Palsy?
A. Sparing of the forehead muscles
B. Inability to furrow the brow on the affected side
C. Lower facial drooping with intact eye closure
D. Contralateral hemiparesis
Answer: B
Explanation: Bell’s Palsy involves the lower motor neuron of the facial nerve (CN VII),
which leads to paralysis of both the upper and lower facial muscles. In contrast, a central
nervous system lesion such as a stroke typically spares the forehead due to bilateral
innervation. Patients with Bell’s Palsy will be unable to wrinkle their forehead or close
their eye on the affected side.
3. A 30-year-old female presents with a unilateral, throbbing headache associated with
photophobia and nausea. What is the first-line abortive treatment?
A. Propranolol
B. Topiramate
C. Amitriptyline
D. Sumatriptan
,Answer: D
Explanation: Triptans, such as Sumatriptan, are considered first-line abortive therapy for
moderate to severe migraines. They work as selective serotonin receptor agonists to cause
vasoconstriction and inhibit pro-inflammatory neuropeptide release. Propranolol and
Topiramate are used for prophylaxis, not acute relief.
4. A patient presents with a ‘curtain falling’ over their vision in one eye, which resolved after
10 minutes. This likely represents:
A. Retinal Detachment
B. Amaurosis Fugax
C. Glaucoma
D. Macular Degeneration
Answer: B
Explanation: Amaurosis fugax is a transient loss of vision in one eye, often described as a
shade or curtain being pulled down. It is frequently caused by an embolic event from the
carotid artery and serves as a warning sign for an impending stroke. Immediate
cardiovascular and neurological evaluation is required to prevent permanent deficit.
5. Which of the following is the most appropriate initial screening tool for Major Depressive
Disorder in the primary care setting?
A. GAD-7
B. MMSE
C. PHQ-9
D. CAGE Questionnaire
Answer: C
Explanation: The PHQ-9 (Patient Health Questionnaire-9) is a validated tool for screening,
diagnosing, and monitoring the severity of depression. It consists of nine criteria based on
the DSM-5 for depressive disorders. The GAD-7 is used for anxiety, while the MMSE
assesses cognitive impairment.
6. A 45-year-old patient reports sudden, severe pain in the first metatarsophalangeal joint.
The joint is red, swollen, and tender. What is the gold standard for diagnosis?
A. Serum Uric Acid level
B. Synovial fluid analysis for crystals
C. X-ray of the foot
D. C-reactive protein
, Answer: B
Explanation: The definitive diagnosis of gout is made by identifying negatively
birefringent needle-shaped urate crystals in synovial fluid. While serum uric acid levels are
often elevated, they can be normal during an acute flare. Visualizing the crystals under
polarized light microscopy confirms the diagnosis and differentiates it from pseudogout.
7. Which of the following findings is most characteristic of Osteoarthritis (OA) compared to
Rheumatoid Arthritis (RA)?
A. Heberden’s nodes
B. Symmetrical joint involvement
C. Morning stiffness lasting more than one hour
D. Systemic symptoms like fever and fatigue
Answer: A
Explanation: Heberden’s nodes are bony enlargements of the distal interphalangeal (DIP)
joints and are a classic sign of Osteoarthritis. OA is generally characterized by asymmetric
involvement and brief morning stiffness (less than 30 minutes). RA typically involves
symmetrical joints and prolonged morning stiffness due to systemic inflammation.
8. An 82-year-old patient presents with new-onset confusion and a decline in daily
functioning over the last 3 days. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Lewy Body Dementia
Answer: C
Explanation: Delirium is characterized by an acute onset, fluctuating course, and
disturbances in consciousness and attention. Unlike dementia, which is a chronic and
progressive decline, delirium is often reversible and triggered by underlying medical issues
such as infections (UTI) or medication side effects. The rapid onset over three days strongly
points toward delirium.
9. A 50-year-old patient has a TSH of 8.5 mIU/L and a normal Free T4. This pattern is
consistent with:
A. Primary Hypothyroidism
B. Secondary Hypothyroidism
C. Subclinical Hypothyroidism
