NR 576 Exam 4 V3 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
4) | Chamberlain University
1. A 68-year-old male presents with urinary frequency, hesitancy, and a weak stream. His
International Prostate Symptom Score (IPSS) is 15. What is the most appropriate initial
pharmacological management?
A. Finasteride (Proscar)
B. Sildenafil (Viagra)
C. Tamsulosin (Flomax)
D. Oxybutynin (Ditropan)
Answer: C
Explanation: Tamsulosin is an alpha-1 blocker that provides rapid relief of lower urinary
tract symptoms (LUTS) by relaxing the smooth muscles of the bladder neck and prostate.
An IPSS score of 15 indicates moderate symptoms, which typically warrants alpha-blocker
therapy as first-line treatment. 5-alpha reductase inhibitors like Finasteride are generally
reserved for larger prostates and take longer to show clinical benefit.
2. When evaluating an older adult male for Benign Prostatic Hyperplasia (BPH), which finding
on a Digital Rectal Exam (DRE) is most characteristic of the condition?
A. A symmetrical, smooth, and rubbery enlargement
B. A tender, boggy prostate with warmth
C. A hard, fixed nodule on the lateral lobe
D. Obliteration of the median sulcus with stony consistency
Answer: A
Explanation: BPH typically presents as a smooth, rubbery, and symmetrical enlargement
of the prostate gland. A hard or nodular prostate is more suggestive of malignancy and
requires further investigation with PSA testing or biopsy. A boggy, tender prostate is
characteristic of acute prostatitis rather than BPH.
3. A 24-year-old male presents with unilateral scrotal pain that is relieved when the scrotum
is elevated. This clinical finding is known as:
A. Cremasteric reflex
B. Phren’s sign
C. Blue dot sign
,D. Rovsing’s sign
Answer: B
Explanation: A positive Phren’s sign occurs when scrotal elevation relieves pain, which is
classically associated with epididymitis. This helps differentiate it from testicular torsion,
where elevation often worsens the pain or has no effect. The absence of a cremasteric
reflex is more indicative of torsion than epididymitis.
4. Which of the following is a primary risk factor for the development of calcium oxalate
kidney stones?
A. High intake of purine-rich foods
B. Chronic urinary tract infections by Proteus
C. Low fluid intake and hypercalciuria
D. Excessive intake of Vitamin C
Answer: C
Explanation: Low fluid intake leads to concentrated urine, which facilitates the
crystallization of calcium oxalate. Hypercalciuria is the most common metabolic
abnormality found in patients with these types of stones. Management focuses on
increasing hydration and maintaining a diet that balances calcium and oxalate levels.
5. A 75-year-old female presents with sudden, intense urges to urinate followed by
involuntary leakage. She is diagnosed with urge incontinence. Which medication class is
commonly used for this condition?
A. Alpha-agonists
B. Anticholinergics
C. Beta-blockers
D. Calcium channel blockers
Answer: B
Explanation: Anticholinergic medications, such as oxybutynin or tolterodine, work by
inhibiting detrusor muscle contractions. These are the standard pharmacological
treatments for urge incontinence, also known as overactive bladder. However, clinicians
must be cautious in the elderly due to potential side effects like confusion, dry mouth, and
constipation.
6. Which laboratory value is the most accurate indicator of renal function in an elderly patient
with multiple comorbidities?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
, C. Estimated Glomerular Filtration Rate (eGFR)
D. Urine Specific Gravity
Answer: C
Explanation: The eGFR is considered a better measure of kidney function than serum
creatinine alone, especially in older adults who may have reduced muscle mass. Creatinine
production decreases with age and lower muscle mass, which can lead to an
overestimation of renal function if only serum levels are checked. The eGFR accounts for
age, sex, and race to provide a more precise assessment.
7. A patient is diagnosed with Stage 3 Chronic Kidney Disease (CKD). What is the defining
eGFR range for this stage?
A. 60-89 mL/min/1.73m²
B. 15-29 mL/min/1.73m²
C. 30-59 mL/min/1.73m²
D. Less than 15 mL/min/1.73m²
Answer: C
Explanation: Stage 3 CKD is defined by an eGFR between 30 and 59 mL/min/1.73m²,
representing moderate kidney damage. This stage is often sub-divided into 3a (45-59) and
3b (30-44). Management at this stage focuses on slowing progression and treating
complications like hypertension and anemia.
8. A 30-year-old female presents with a ‘strawberry cervix’ and a malodorous, frothy, yellow-
green vaginal discharge. What is the most likely diagnosis?
A. Bacterial Vaginosis
B. Trichomoniasis
C. Vulvovaginal Candidiasis
D. Chlamydia
Answer: B
Explanation: Trichomoniasis is a protozoan infection that causes a characteristic frothy
discharge and punctate hemorrhages on the cervix, known as a strawberry cervix.
Diagnosis is often confirmed via wet mount or nucleic acid amplification test (NAAT).
Treatment requires Metronidazole for both the patient and their sexual partners.
9. Which of the following is an absolute contraindication for the use of Phosphodiesterase-5
(PDE5) inhibitors like Sildenafil?
A. Concurrent use of Nitrates
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
4) | Chamberlain University
1. A 68-year-old male presents with urinary frequency, hesitancy, and a weak stream. His
International Prostate Symptom Score (IPSS) is 15. What is the most appropriate initial
pharmacological management?
A. Finasteride (Proscar)
B. Sildenafil (Viagra)
C. Tamsulosin (Flomax)
D. Oxybutynin (Ditropan)
Answer: C
Explanation: Tamsulosin is an alpha-1 blocker that provides rapid relief of lower urinary
tract symptoms (LUTS) by relaxing the smooth muscles of the bladder neck and prostate.
An IPSS score of 15 indicates moderate symptoms, which typically warrants alpha-blocker
therapy as first-line treatment. 5-alpha reductase inhibitors like Finasteride are generally
reserved for larger prostates and take longer to show clinical benefit.
2. When evaluating an older adult male for Benign Prostatic Hyperplasia (BPH), which finding
on a Digital Rectal Exam (DRE) is most characteristic of the condition?
A. A symmetrical, smooth, and rubbery enlargement
B. A tender, boggy prostate with warmth
C. A hard, fixed nodule on the lateral lobe
D. Obliteration of the median sulcus with stony consistency
Answer: A
Explanation: BPH typically presents as a smooth, rubbery, and symmetrical enlargement
of the prostate gland. A hard or nodular prostate is more suggestive of malignancy and
requires further investigation with PSA testing or biopsy. A boggy, tender prostate is
characteristic of acute prostatitis rather than BPH.
3. A 24-year-old male presents with unilateral scrotal pain that is relieved when the scrotum
is elevated. This clinical finding is known as:
A. Cremasteric reflex
B. Phren’s sign
C. Blue dot sign
,D. Rovsing’s sign
Answer: B
Explanation: A positive Phren’s sign occurs when scrotal elevation relieves pain, which is
classically associated with epididymitis. This helps differentiate it from testicular torsion,
where elevation often worsens the pain or has no effect. The absence of a cremasteric
reflex is more indicative of torsion than epididymitis.
4. Which of the following is a primary risk factor for the development of calcium oxalate
kidney stones?
A. High intake of purine-rich foods
B. Chronic urinary tract infections by Proteus
C. Low fluid intake and hypercalciuria
D. Excessive intake of Vitamin C
Answer: C
Explanation: Low fluid intake leads to concentrated urine, which facilitates the
crystallization of calcium oxalate. Hypercalciuria is the most common metabolic
abnormality found in patients with these types of stones. Management focuses on
increasing hydration and maintaining a diet that balances calcium and oxalate levels.
5. A 75-year-old female presents with sudden, intense urges to urinate followed by
involuntary leakage. She is diagnosed with urge incontinence. Which medication class is
commonly used for this condition?
A. Alpha-agonists
B. Anticholinergics
C. Beta-blockers
D. Calcium channel blockers
Answer: B
Explanation: Anticholinergic medications, such as oxybutynin or tolterodine, work by
inhibiting detrusor muscle contractions. These are the standard pharmacological
treatments for urge incontinence, also known as overactive bladder. However, clinicians
must be cautious in the elderly due to potential side effects like confusion, dry mouth, and
constipation.
6. Which laboratory value is the most accurate indicator of renal function in an elderly patient
with multiple comorbidities?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
, C. Estimated Glomerular Filtration Rate (eGFR)
D. Urine Specific Gravity
Answer: C
Explanation: The eGFR is considered a better measure of kidney function than serum
creatinine alone, especially in older adults who may have reduced muscle mass. Creatinine
production decreases with age and lower muscle mass, which can lead to an
overestimation of renal function if only serum levels are checked. The eGFR accounts for
age, sex, and race to provide a more precise assessment.
7. A patient is diagnosed with Stage 3 Chronic Kidney Disease (CKD). What is the defining
eGFR range for this stage?
A. 60-89 mL/min/1.73m²
B. 15-29 mL/min/1.73m²
C. 30-59 mL/min/1.73m²
D. Less than 15 mL/min/1.73m²
Answer: C
Explanation: Stage 3 CKD is defined by an eGFR between 30 and 59 mL/min/1.73m²,
representing moderate kidney damage. This stage is often sub-divided into 3a (45-59) and
3b (30-44). Management at this stage focuses on slowing progression and treating
complications like hypertension and anemia.
8. A 30-year-old female presents with a ‘strawberry cervix’ and a malodorous, frothy, yellow-
green vaginal discharge. What is the most likely diagnosis?
A. Bacterial Vaginosis
B. Trichomoniasis
C. Vulvovaginal Candidiasis
D. Chlamydia
Answer: B
Explanation: Trichomoniasis is a protozoan infection that causes a characteristic frothy
discharge and punctate hemorrhages on the cervix, known as a strawberry cervix.
Diagnosis is often confirmed via wet mount or nucleic acid amplification test (NAAT).
Treatment requires Metronidazole for both the patient and their sexual partners.
9. Which of the following is an absolute contraindication for the use of Phosphodiesterase-5
(PDE5) inhibitors like Sildenafil?
A. Concurrent use of Nitrates
