NR 576 Final Exam V2 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Final
Exam) | Chamberlain University
1. A 68-year-old male presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotids. What is the most likely
diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: A
Explanation: Aortic stenosis typically presents with a harsh systolic murmur at the right
upper sternal border that radiates to the neck. The crescendo-decrescendo pattern is
characteristic of the pressure gradient changes during ventricular ejection. As the disease
progresses, patients may experience syncope, angina, or heart failure, requiring surgical
intervention.
2. During a physical examination, the clinician elicits pain in the right lower quadrant when
palpating the left lower quadrant. What is this sign called?
A. Rovsing’s sign
B. McBurney’s sign
C. Murphy’s sign
D. Psoas sign
Answer: A
Explanation: Rovsing’s sign is a classic indicator of peritoneal irritation, specifically
associated with acute appendicitis. By applying pressure to the left lower quadrant, gas or
fluid is shifted toward the inflamed appendix in the right lower quadrant, causing pain. This
physical assessment technique is a fundamental component of the abdominal differential
diagnosis process.
3. A 55-year-old female smoker presents with a chronic cough and progressive shortness of
breath. Pulmonary function testing reveals an FEV1/FVC ratio of 0.65. What does this finding
indicate?
A. Restrictive lung disease
B. Normal lung function
,C. Acute bronchitis
D. Obstructive lung disease
Answer: D
Explanation: An FEV1/FVC ratio of less than 0.70 is the diagnostic threshold for
obstructive lung disease, such as COPD or asthma. This ratio indicates that the patient is
unable to exhale air effectively due to airway resistance or narrowing. Given the patient’s
smoking history and age, chronic obstructive pulmonary disease (COPD) is the most
probable diagnosis.
4. A patient presents with a ‘herald patch’ followed by a Christmas tree distribution of
smaller maculopapular lesions on the trunk. What is the diagnosis?
A. Pityriasis rosea
B. Tinea corporis
C. Psoriasis
D. Secondary syphilis
Answer: A
Explanation: Pityriasis rosea is a common, self-limiting skin condition that begins with a
single, larger ‘herald patch.’ The subsequent eruption follows the cleavage lines of the skin,
creating a characteristic ‘Christmas tree’ pattern on the back. While the etiology is
uncertain, it is often suspected to be viral, and management is typically focused on
symptom relief for itching.
5. Which of the following laboratory findings is most characteristic of iron deficiency anemia?
A. Increased Ferritin, Decreased TIBC
B. Decreased Ferritin, Increased TIBC
C. Normal MCV, Increased Ferritin
D. Increased MCV, Decreased TIBC
Answer: B
Explanation: Iron deficiency anemia is a microcytic anemia characterized by low serum
ferritin, which reflects depleted iron stores. The Total Iron Binding Capacity (TIBC)
increases as the body attempts to compensate by producing more transferrin to bind
whatever iron is available. This pattern distinguishes iron deficiency from anemia of
chronic disease, where ferritin is typically normal or high.
6. An 82-year-old patient presents with sudden onset of unilateral vision loss described as a
‘curtain coming down’ over the eye. This is highly suggestive of:
A. Acute angle-closure glaucoma
, B. Macular degeneration
C. Retinal detachment
D. Cataracts
Answer: C
Explanation: The ‘curtain coming down’ sensation is a classic symptom of retinal
detachment, which is a medical emergency. Patients may also report new floaters or flashes
of light (photopsia) preceding the vision loss. Immediate referral to an ophthalmologist is
necessary to prevent permanent blindness in the affected eye.
7. What is the primary diagnostic marker used to confirm the diagnosis of Giant Cell Arteritis?
A. Temporal artery biopsy
B. Positive ANA
C. Elevated C-reactive protein (CRP)
D. MRI of the brain
Answer: A
Explanation: Temporal artery biopsy remains the gold standard for diagnosing Giant Cell
Arteritis (GCA). While elevated inflammatory markers like ESR and CRP support the clinical
suspicion, the biopsy provides definitive histopathological evidence of vasculitis. Prompt
diagnosis and treatment with high-dose corticosteroids are essential to prevent vision loss.
8. A 45-year-old male with a history of hypertension presents with sudden onset of severe
toe pain, swelling, and redness. The Joint fluid analysis shows negatively birefringent needle-
shaped crystals. What is the diagnosis?
A. Pseudogout
B. Rheumatoid arthritis
C. Gouty arthritis
D. Septic arthritis
Answer: C
Explanation: Gout is caused by the deposition of monosodium urate crystals in the joints,
which appear as needle-shaped and negatively birefringent under polarized light. This
condition often affects the first metatarsophalangeal joint, a presentation known as
podagra. Differential diagnosis includes pseudogout, which involves calcium
pyrophosphate crystals that are rhomboid-shaped and positively birefringent.
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Final
Exam) | Chamberlain University
1. A 68-year-old male presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotids. What is the most likely
diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: A
Explanation: Aortic stenosis typically presents with a harsh systolic murmur at the right
upper sternal border that radiates to the neck. The crescendo-decrescendo pattern is
characteristic of the pressure gradient changes during ventricular ejection. As the disease
progresses, patients may experience syncope, angina, or heart failure, requiring surgical
intervention.
2. During a physical examination, the clinician elicits pain in the right lower quadrant when
palpating the left lower quadrant. What is this sign called?
A. Rovsing’s sign
B. McBurney’s sign
C. Murphy’s sign
D. Psoas sign
Answer: A
Explanation: Rovsing’s sign is a classic indicator of peritoneal irritation, specifically
associated with acute appendicitis. By applying pressure to the left lower quadrant, gas or
fluid is shifted toward the inflamed appendix in the right lower quadrant, causing pain. This
physical assessment technique is a fundamental component of the abdominal differential
diagnosis process.
3. A 55-year-old female smoker presents with a chronic cough and progressive shortness of
breath. Pulmonary function testing reveals an FEV1/FVC ratio of 0.65. What does this finding
indicate?
A. Restrictive lung disease
B. Normal lung function
,C. Acute bronchitis
D. Obstructive lung disease
Answer: D
Explanation: An FEV1/FVC ratio of less than 0.70 is the diagnostic threshold for
obstructive lung disease, such as COPD or asthma. This ratio indicates that the patient is
unable to exhale air effectively due to airway resistance or narrowing. Given the patient’s
smoking history and age, chronic obstructive pulmonary disease (COPD) is the most
probable diagnosis.
4. A patient presents with a ‘herald patch’ followed by a Christmas tree distribution of
smaller maculopapular lesions on the trunk. What is the diagnosis?
A. Pityriasis rosea
B. Tinea corporis
C. Psoriasis
D. Secondary syphilis
Answer: A
Explanation: Pityriasis rosea is a common, self-limiting skin condition that begins with a
single, larger ‘herald patch.’ The subsequent eruption follows the cleavage lines of the skin,
creating a characteristic ‘Christmas tree’ pattern on the back. While the etiology is
uncertain, it is often suspected to be viral, and management is typically focused on
symptom relief for itching.
5. Which of the following laboratory findings is most characteristic of iron deficiency anemia?
A. Increased Ferritin, Decreased TIBC
B. Decreased Ferritin, Increased TIBC
C. Normal MCV, Increased Ferritin
D. Increased MCV, Decreased TIBC
Answer: B
Explanation: Iron deficiency anemia is a microcytic anemia characterized by low serum
ferritin, which reflects depleted iron stores. The Total Iron Binding Capacity (TIBC)
increases as the body attempts to compensate by producing more transferrin to bind
whatever iron is available. This pattern distinguishes iron deficiency from anemia of
chronic disease, where ferritin is typically normal or high.
6. An 82-year-old patient presents with sudden onset of unilateral vision loss described as a
‘curtain coming down’ over the eye. This is highly suggestive of:
A. Acute angle-closure glaucoma
, B. Macular degeneration
C. Retinal detachment
D. Cataracts
Answer: C
Explanation: The ‘curtain coming down’ sensation is a classic symptom of retinal
detachment, which is a medical emergency. Patients may also report new floaters or flashes
of light (photopsia) preceding the vision loss. Immediate referral to an ophthalmologist is
necessary to prevent permanent blindness in the affected eye.
7. What is the primary diagnostic marker used to confirm the diagnosis of Giant Cell Arteritis?
A. Temporal artery biopsy
B. Positive ANA
C. Elevated C-reactive protein (CRP)
D. MRI of the brain
Answer: A
Explanation: Temporal artery biopsy remains the gold standard for diagnosing Giant Cell
Arteritis (GCA). While elevated inflammatory markers like ESR and CRP support the clinical
suspicion, the biopsy provides definitive histopathological evidence of vasculitis. Prompt
diagnosis and treatment with high-dose corticosteroids are essential to prevent vision loss.
8. A 45-year-old male with a history of hypertension presents with sudden onset of severe
toe pain, swelling, and redness. The Joint fluid analysis shows negatively birefringent needle-
shaped crystals. What is the diagnosis?
A. Pseudogout
B. Rheumatoid arthritis
C. Gouty arthritis
D. Septic arthritis
Answer: C
Explanation: Gout is caused by the deposition of monosodium urate crystals in the joints,
which appear as needle-shaped and negatively birefringent under polarized light. This
condition often affects the first metatarsophalangeal joint, a presentation known as
podagra. Differential diagnosis includes pseudogout, which involves calcium
pyrophosphate crystals that are rhomboid-shaped and positively birefringent.
