NR 576 Exam 2 V1 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
2) | Chamberlain University
1. A 42-year-old female presents with sharp, intermittent pain in the right upper quadrant
that worsens after eating a fatty meal. Upon physical examination, you note inspiratory
arrest during deep palpation of the right upper quadrant. Which physical exam sign is this
describing?
A. McBurney’s Sign
B. Rovsing’s Sign
C. Murphy’s Sign
D. Psoas Sign
Answer: C
Explanation: Murphy’s sign is specific for cholecystitis and is elicited by palpating the right
upper quadrant while the patient inhales. A positive sign occurs when the patient abruptly
stops inhaling due to pain as the gallbladder touches the examiner’s hand. This physical
finding is highly suggestive of acute inflammation of the gallbladder.
2. A 25-year-old male presents with periumbilical pain that has shifted to the right lower
quadrant over the past 12 hours. He reports nausea and a low-grade fever. Which diagnosis
must be prioritized in this patient?
A. Diverticulitis
B. Nephrolithiasis
C. Gastroenteritis
D. Acute Appendicitis
Answer: D
Explanation: The migration of pain from the periumbilical region to the right lower
quadrant is a classic presentation of acute appendicitis. Appendicitis is a surgical
emergency that requires prompt evaluation to prevent perforation. Other symptoms often
include anorexia, nausea, and localized tenderness at McBurney’s point.
3. A 68-year-old patient complains of a burning sensation in the chest that occurs primarily
after large meals and when lying down at night. They have tried antacids with only temporary
relief. What is the gold standard for diagnosing Barrett’s esophagus in this patient?
A. Barium Swallow
,B. Urea Breath Test
C. Upper Endoscopy with Biopsy
D. 24-hour pH Monitoring
Answer: C
Explanation: Upper endoscopy (EGD) with biopsy is required to definitively diagnose
Barrett’s esophagus by identifying metaplastic changes in the esophageal lining. Barrett’s
esophagus is a significant complication of chronic GERD and increases the risk of
esophageal adenocarcinoma. While pH monitoring confirms acid reflux, it cannot detect
histological tissue changes.
4. A patient presents with dysuria, urgency, and frequency. The urinalysis shows positive
nitrites and leukocyte esterase. What is the most common causative organism for this
condition?
A. Staphylococcus saprophyticus
B. Klebsiella pneumoniae
C. Proteus mirabilis
D. Escherichia coli
Answer: D
Explanation: Escherichia coli is the most common pathogen responsible for uncomplicated
urinary tract infections in the primary care setting. Nitrites are produced by Gram-negative
bacteria like E. coli that convert nitrates to nitrites. Treatment is typically initiated
empirically based on local resistance patterns and patient history.
5. A 55-year-old male presents with a chief complaint of difficulty starting his urinary stream
and feeling like his bladder is never completely empty. Digital rectal exam reveals a smooth,
firm, non-tender, symmetrically enlarged prostate. What is the first-line pharmacological
treatment for his symptoms?
A. Finasteride
B. Oxybutynin
C. Ciprofloxacin
D. Tamsulosin
Answer: D
Explanation: Tamsulosin is an alpha-1 blocker that provides rapid relief of BPH symptoms
by relaxing the smooth muscle of the bladder neck and prostate. 5-alpha reductase
inhibitors like Finasteride take months to be effective and are used to shrink the prostate
, volume. Tamsulosin is preferred for immediate symptomatic management of lower urinary
tract symptoms (LUTS).
6. A patient presents with a ‘boring’ epigastric pain that radiates to the back, relieved slightly
by leaning forward. Lab results show a serum lipase level three times the upper limit of
normal. What is the most likely diagnosis?
A. Acute Pancreatitis
B. Peptic Ulcer Perforation
C. Acute Cholecystitis
D. Myocardial Infarction
Answer: A
Explanation: Acute pancreatitis typically presents with steady, severe epigastric pain
radiating to the back and elevated pancreatic enzymes. Serum lipase is more specific than
amylase for diagnosing this condition and stays elevated longer. The diagnosis is confirmed
by meeting at least two of the three Atlanta criteria: pain, enzyme elevation, or imaging.
7. A 30-year-old male presents with sudden onset of unilateral scrotal pain and swelling.
Physical exam reveals an absent cremasteric reflex on the affected side. What is the most
appropriate next step?
A. Order a scrotal ultrasound and consult urology immediately
B. Prescribe a 10-day course of Doxycycline
C. Perform a urinalysis to rule out UTI
D. Advise ice packs and scrotal support
Answer: A
Explanation: The absence of the cremasteric reflex in the setting of acute scrotal pain is
highly suggestive of testicular torsion. This is a surgical emergency that requires immediate
intervention to salvage the testicle. Delaying for imaging is risky, but a Doppler ultrasound
is the preferred diagnostic modality if the diagnosis is unclear.
8. A 70-year-old male presents with left lower quadrant pain, fever, and a change in bowel
habits. He has a history of chronic constipation. Which diagnostic imaging is most appropriate
for suspected acute diverticulitis?
A. Abdominal Ultrasound
B. CT Scan with oral and IV contrast
C. Barium Enema
D. Colonoscopy
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
2) | Chamberlain University
1. A 42-year-old female presents with sharp, intermittent pain in the right upper quadrant
that worsens after eating a fatty meal. Upon physical examination, you note inspiratory
arrest during deep palpation of the right upper quadrant. Which physical exam sign is this
describing?
A. McBurney’s Sign
B. Rovsing’s Sign
C. Murphy’s Sign
D. Psoas Sign
Answer: C
Explanation: Murphy’s sign is specific for cholecystitis and is elicited by palpating the right
upper quadrant while the patient inhales. A positive sign occurs when the patient abruptly
stops inhaling due to pain as the gallbladder touches the examiner’s hand. This physical
finding is highly suggestive of acute inflammation of the gallbladder.
2. A 25-year-old male presents with periumbilical pain that has shifted to the right lower
quadrant over the past 12 hours. He reports nausea and a low-grade fever. Which diagnosis
must be prioritized in this patient?
A. Diverticulitis
B. Nephrolithiasis
C. Gastroenteritis
D. Acute Appendicitis
Answer: D
Explanation: The migration of pain from the periumbilical region to the right lower
quadrant is a classic presentation of acute appendicitis. Appendicitis is a surgical
emergency that requires prompt evaluation to prevent perforation. Other symptoms often
include anorexia, nausea, and localized tenderness at McBurney’s point.
3. A 68-year-old patient complains of a burning sensation in the chest that occurs primarily
after large meals and when lying down at night. They have tried antacids with only temporary
relief. What is the gold standard for diagnosing Barrett’s esophagus in this patient?
A. Barium Swallow
,B. Urea Breath Test
C. Upper Endoscopy with Biopsy
D. 24-hour pH Monitoring
Answer: C
Explanation: Upper endoscopy (EGD) with biopsy is required to definitively diagnose
Barrett’s esophagus by identifying metaplastic changes in the esophageal lining. Barrett’s
esophagus is a significant complication of chronic GERD and increases the risk of
esophageal adenocarcinoma. While pH monitoring confirms acid reflux, it cannot detect
histological tissue changes.
4. A patient presents with dysuria, urgency, and frequency. The urinalysis shows positive
nitrites and leukocyte esterase. What is the most common causative organism for this
condition?
A. Staphylococcus saprophyticus
B. Klebsiella pneumoniae
C. Proteus mirabilis
D. Escherichia coli
Answer: D
Explanation: Escherichia coli is the most common pathogen responsible for uncomplicated
urinary tract infections in the primary care setting. Nitrites are produced by Gram-negative
bacteria like E. coli that convert nitrates to nitrites. Treatment is typically initiated
empirically based on local resistance patterns and patient history.
5. A 55-year-old male presents with a chief complaint of difficulty starting his urinary stream
and feeling like his bladder is never completely empty. Digital rectal exam reveals a smooth,
firm, non-tender, symmetrically enlarged prostate. What is the first-line pharmacological
treatment for his symptoms?
A. Finasteride
B. Oxybutynin
C. Ciprofloxacin
D. Tamsulosin
Answer: D
Explanation: Tamsulosin is an alpha-1 blocker that provides rapid relief of BPH symptoms
by relaxing the smooth muscle of the bladder neck and prostate. 5-alpha reductase
inhibitors like Finasteride take months to be effective and are used to shrink the prostate
, volume. Tamsulosin is preferred for immediate symptomatic management of lower urinary
tract symptoms (LUTS).
6. A patient presents with a ‘boring’ epigastric pain that radiates to the back, relieved slightly
by leaning forward. Lab results show a serum lipase level three times the upper limit of
normal. What is the most likely diagnosis?
A. Acute Pancreatitis
B. Peptic Ulcer Perforation
C. Acute Cholecystitis
D. Myocardial Infarction
Answer: A
Explanation: Acute pancreatitis typically presents with steady, severe epigastric pain
radiating to the back and elevated pancreatic enzymes. Serum lipase is more specific than
amylase for diagnosing this condition and stays elevated longer. The diagnosis is confirmed
by meeting at least two of the three Atlanta criteria: pain, enzyme elevation, or imaging.
7. A 30-year-old male presents with sudden onset of unilateral scrotal pain and swelling.
Physical exam reveals an absent cremasteric reflex on the affected side. What is the most
appropriate next step?
A. Order a scrotal ultrasound and consult urology immediately
B. Prescribe a 10-day course of Doxycycline
C. Perform a urinalysis to rule out UTI
D. Advise ice packs and scrotal support
Answer: A
Explanation: The absence of the cremasteric reflex in the setting of acute scrotal pain is
highly suggestive of testicular torsion. This is a surgical emergency that requires immediate
intervention to salvage the testicle. Delaying for imaging is risky, but a Doppler ultrasound
is the preferred diagnostic modality if the diagnosis is unclear.
8. A 70-year-old male presents with left lower quadrant pain, fever, and a change in bowel
habits. He has a history of chronic constipation. Which diagnostic imaging is most appropriate
for suspected acute diverticulitis?
A. Abdominal Ultrasound
B. CT Scan with oral and IV contrast
C. Barium Enema
D. Colonoscopy
