NR 576 Final Exam V3 | 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 complaint of sudden onset of left-sided chest pain that
radiates to his jaw. According to the differential diagnosis for acute coronary syndrome (ACS),
which diagnostic test should be performed immediately?
A. Chest X-ray
B. Echocardiogram
C. Exercise Stress Test
D. 12-lead Electrocardiogram (ECG)
Answer: D
Explanation: The initial priority for a patient suspected of having ACS is obtaining a 12-
lead ECG within 10 minutes of arrival. This test helps differentiate between ST-elevation
myocardial infarction (STEMI) and non-ST-elevation ACS. Immediate identification of
ischemia or infarction is critical for determining the urgency of reperfusion therapy.
2. A 55-year-old female presents with fatigue, weight gain, and cold intolerance. Laboratory
results show a TSH of 12.5 mIU/L and a low free T4. What is the most likely diagnosis?
A. Subclinical hypothyroidism
B. Secondary hypothyroidism
C. Graves’ disease
D. Primary hypothyroidism (Hashimoto’s)
Answer: D
Explanation: Primary hypothyroidism is characterized by an elevated TSH and a low free
T4 level. In the United States, Hashimoto’s thyroiditis is the most common cause of this
condition. Clinicians should consider treating the patient with levothyroxine and
monitoring TSH levels every 6 to 8 weeks until euthyroid.
3. Which physical examination maneuver is most specific for diagnosing acute cholecystitis in
an older adult?
A. Murphy’s sign
B. Rovsing’s sign
C. McBurney’s sign
,D. Psoas sign
Answer: A
Explanation: Murphy’s sign is performed by palpating the right upper quadrant while the
patient takes a deep breath. A positive result is indicated by the cessation of inspiration due
to pain when the gallbladder contacts the examiner’s hand. This finding has high specificity
for acute cholecystitis in clinical practice.
4. A 72-year-old patient with a history of HTN and smoking presents with sudden onset of
shortness of breath and pleuritic chest pain. What is the gold standard diagnostic test for
suspected Pulmonary Embolism (PE)?
A. D-dimer assay
B. Ventilation-perfusion (V/Q) scan
C. Chest Radiograph
D. Computed Tomographic Angiography (CTA)
Answer: D
Explanation: CTA of the chest is currently considered the gold standard for diagnosing a
pulmonary embolism in most clinical settings. It provides high-resolution visualization of
the pulmonary vasculature to detect thrombi. While V/Q scans are alternatives for patients
with renal failure, CTA is preferred for its speed and accuracy.
5. In the differential diagnosis of microcytic anemia, which lab finding is most suggestive of
Iron Deficiency Anemia?
A. Increased Ferritin
B. Low Serum Ferritin
C. Decreased Total Iron Binding Capacity (TIBC)
D. Increased Mean Corpuscular Volume (MCV)
Answer: B
Explanation: Serum ferritin is the most sensitive and specific test for identifying iron
deficiency anemia. A low ferritin level reflects depleted iron stores, which is the hallmark of
this microcytic condition. In contrast, TIBC would typically be elevated, and MCV would be
decreased in iron deficiency cases.
6. An 80-year-old male presents with urinary urgency, frequency, and a weak stream. Digital
rectal exam reveals a smooth, firm, and non-tender enlarged prostate. What is the most likely
diagnosis?
A. Prostate Cancer
B. Prostatitis
, C. Benign Prostatic Hyperplasia (BPH)
D. Urinary Tract Infection
Answer: C
Explanation: BPH is a common condition in aging males characterized by lower urinary
tract symptoms and a symmetric enlargement of the prostate. Unlike prostate cancer,
which often presents with nodules or asymmetry, BPH typically feels smooth. Management
usually involves alpha-blockers or 5-alpha reductase inhibitors to improve urinary flow.
7. A patient presents with a ‘curtain coming down’ sensation over their right eye. This
symptom is most concerning for which of the following?
A. Glaucoma
B. Retinal Detachment
C. Cataracts
D. Macular Degeneration
Answer: B
Explanation: A ‘curtain coming down’ or sudden loss of vision in one eye is a classic
presentation of retinal detachment. This is an ophthalmological emergency that requires
immediate referral to a specialist to prevent permanent vision loss. Other symptoms may
include new floaters or flashes of light (photopsia).
8. Which of the following criteria is part of the Centor score used to evaluate the likelihood of
Group A Streptococcal (GAS) pharyngitis?
A. Presence of a cough
B. Duration of symptoms > 1 week
C. Tonsillar exudates
D. Nasal congestion
Answer: C
Explanation: The Centor criteria include tonsillar exudates, tender anterior cervical
lymphadenopathy, history of fever, and the absence of a cough. Each criterion is assigned
one point, helping clinicians decide whether to perform a rapid antigen test or prescribe
antibiotics. The absence of a cough is a key negative predictor for GAS pharyngitis.
9. A 40-year-old male presents with acute onset of severe pain, redness, and swelling in the
first metatarsophalangeal (MTP) joint. Which of the following is the definitive diagnostic test
for gout?
A. Serum Uric Acid level
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Final
Exam) | Chamberlain University
1. A 68-year-old male presents with a complaint of sudden onset of left-sided chest pain that
radiates to his jaw. According to the differential diagnosis for acute coronary syndrome (ACS),
which diagnostic test should be performed immediately?
A. Chest X-ray
B. Echocardiogram
C. Exercise Stress Test
D. 12-lead Electrocardiogram (ECG)
Answer: D
Explanation: The initial priority for a patient suspected of having ACS is obtaining a 12-
lead ECG within 10 minutes of arrival. This test helps differentiate between ST-elevation
myocardial infarction (STEMI) and non-ST-elevation ACS. Immediate identification of
ischemia or infarction is critical for determining the urgency of reperfusion therapy.
2. A 55-year-old female presents with fatigue, weight gain, and cold intolerance. Laboratory
results show a TSH of 12.5 mIU/L and a low free T4. What is the most likely diagnosis?
A. Subclinical hypothyroidism
B. Secondary hypothyroidism
C. Graves’ disease
D. Primary hypothyroidism (Hashimoto’s)
Answer: D
Explanation: Primary hypothyroidism is characterized by an elevated TSH and a low free
T4 level. In the United States, Hashimoto’s thyroiditis is the most common cause of this
condition. Clinicians should consider treating the patient with levothyroxine and
monitoring TSH levels every 6 to 8 weeks until euthyroid.
3. Which physical examination maneuver is most specific for diagnosing acute cholecystitis in
an older adult?
A. Murphy’s sign
B. Rovsing’s sign
C. McBurney’s sign
,D. Psoas sign
Answer: A
Explanation: Murphy’s sign is performed by palpating the right upper quadrant while the
patient takes a deep breath. A positive result is indicated by the cessation of inspiration due
to pain when the gallbladder contacts the examiner’s hand. This finding has high specificity
for acute cholecystitis in clinical practice.
4. A 72-year-old patient with a history of HTN and smoking presents with sudden onset of
shortness of breath and pleuritic chest pain. What is the gold standard diagnostic test for
suspected Pulmonary Embolism (PE)?
A. D-dimer assay
B. Ventilation-perfusion (V/Q) scan
C. Chest Radiograph
D. Computed Tomographic Angiography (CTA)
Answer: D
Explanation: CTA of the chest is currently considered the gold standard for diagnosing a
pulmonary embolism in most clinical settings. It provides high-resolution visualization of
the pulmonary vasculature to detect thrombi. While V/Q scans are alternatives for patients
with renal failure, CTA is preferred for its speed and accuracy.
5. In the differential diagnosis of microcytic anemia, which lab finding is most suggestive of
Iron Deficiency Anemia?
A. Increased Ferritin
B. Low Serum Ferritin
C. Decreased Total Iron Binding Capacity (TIBC)
D. Increased Mean Corpuscular Volume (MCV)
Answer: B
Explanation: Serum ferritin is the most sensitive and specific test for identifying iron
deficiency anemia. A low ferritin level reflects depleted iron stores, which is the hallmark of
this microcytic condition. In contrast, TIBC would typically be elevated, and MCV would be
decreased in iron deficiency cases.
6. An 80-year-old male presents with urinary urgency, frequency, and a weak stream. Digital
rectal exam reveals a smooth, firm, and non-tender enlarged prostate. What is the most likely
diagnosis?
A. Prostate Cancer
B. Prostatitis
, C. Benign Prostatic Hyperplasia (BPH)
D. Urinary Tract Infection
Answer: C
Explanation: BPH is a common condition in aging males characterized by lower urinary
tract symptoms and a symmetric enlargement of the prostate. Unlike prostate cancer,
which often presents with nodules or asymmetry, BPH typically feels smooth. Management
usually involves alpha-blockers or 5-alpha reductase inhibitors to improve urinary flow.
7. A patient presents with a ‘curtain coming down’ sensation over their right eye. This
symptom is most concerning for which of the following?
A. Glaucoma
B. Retinal Detachment
C. Cataracts
D. Macular Degeneration
Answer: B
Explanation: A ‘curtain coming down’ or sudden loss of vision in one eye is a classic
presentation of retinal detachment. This is an ophthalmological emergency that requires
immediate referral to a specialist to prevent permanent vision loss. Other symptoms may
include new floaters or flashes of light (photopsia).
8. Which of the following criteria is part of the Centor score used to evaluate the likelihood of
Group A Streptococcal (GAS) pharyngitis?
A. Presence of a cough
B. Duration of symptoms > 1 week
C. Tonsillar exudates
D. Nasal congestion
Answer: C
Explanation: The Centor criteria include tonsillar exudates, tender anterior cervical
lymphadenopathy, history of fever, and the absence of a cough. Each criterion is assigned
one point, helping clinicians decide whether to perform a rapid antigen test or prescribe
antibiotics. The absence of a cough is a key negative predictor for GAS pharyngitis.
9. A 40-year-old male presents with acute onset of severe pain, redness, and swelling in the
first metatarsophalangeal (MTP) joint. Which of the following is the definitive diagnostic test
for gout?
A. Serum Uric Acid level
