NR576 / NR 576 Final
Exam Differential
Diagnosis in Adult-
Gerontology Primary Care
| Guide
1.
A 67-year-old woman presents with fatigue, pallor, and dyspnea on exertion. Lab
results show MCV 72, ferritin low, and TIBC elevated. Which is the most likely
diagnosis?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Thalassemia minor
Answer: B. Iron deficiency anemia
Rationale: Low ferritin + microcytosis indicates iron deficiency. Anemia of chronic
disease has normal/high ferritin.
2.
,A 55-year-old man with a 40-pack-year history presents with chronic cough and
sputum production for the past 3 months. Exam: prolonged expiration, diffuse
wheezes. Which diagnosis is most likely?
A. Chronic bronchitis
B. Asthma
C. Heart failure
D. Pulmonary fibrosis
Answer: A. Chronic bronchitis
Rationale: Chronic productive cough for >3 months in 2 consecutive years strongly
suggests chronic bronchitis (COPD spectrum).
3.
A 72-year-old woman complains of unilateral temporal headache, jaw claudication,
and vision changes. ESR is 90. What is the best next step?
A. Start NSAIDs
B. Obtain temporal artery biopsy before treatment
C. Begin high-dose corticosteroids immediately
D. Order MRI brain
Answer: C. Begin high-dose corticosteroids immediately
,Rationale: Temporal arteritis (giant cell arteritis) requires immediate steroids to
prevent vision loss. Biopsy can follow, but treatment should not be delayed.
4.
An 80-year-old man presents with new-onset confusion, urinary frequency, and
suprapubic tenderness. UA: positive nitrites and leukocyte esterase. What is the
most likely diagnosis?
A. Delirium due to UTI
B. Dementia
C. Prostatitis
D. Renal calculi
Answer: A. Delirium due to UTI
Rationale: Elderly often present with atypical UTI symptoms (confusion).
5.
A 64-year-old diabetic patient presents with chest pain relieved by rest and
worsened by exertion. EKG: no acute changes. Which diagnosis is most likely?
A. Stable angina
B. Unstable angina
C. GERD
D. STEMI
, Answer: A. Stable angina
Rationale: Predictable, exertional chest pain relieved with rest is consistent with
stable angina.
6.
A 58-year-old man presents with progressive tremor, bradykinesia, and shuffling gait.
Which is the most likely diagnosis?
A. Parkinson’s disease
B. Essential tremor
C. Alzheimer’s disease
D. Stroke
Answer: A. Parkinson’s disease
Rationale: Classic triad = resting tremor, bradykinesia, rigidity/postural instability.
7.
A 70-year-old woman presents with new-onset abdominal pain, hematochezia, and
fever. Exam: LLQ tenderness. What is the most likely diagnosis?
A. Colon cancer
B. Ischemic colitis
C. Diverticulitis
Exam Differential
Diagnosis in Adult-
Gerontology Primary Care
| Guide
1.
A 67-year-old woman presents with fatigue, pallor, and dyspnea on exertion. Lab
results show MCV 72, ferritin low, and TIBC elevated. Which is the most likely
diagnosis?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Thalassemia minor
Answer: B. Iron deficiency anemia
Rationale: Low ferritin + microcytosis indicates iron deficiency. Anemia of chronic
disease has normal/high ferritin.
2.
,A 55-year-old man with a 40-pack-year history presents with chronic cough and
sputum production for the past 3 months. Exam: prolonged expiration, diffuse
wheezes. Which diagnosis is most likely?
A. Chronic bronchitis
B. Asthma
C. Heart failure
D. Pulmonary fibrosis
Answer: A. Chronic bronchitis
Rationale: Chronic productive cough for >3 months in 2 consecutive years strongly
suggests chronic bronchitis (COPD spectrum).
3.
A 72-year-old woman complains of unilateral temporal headache, jaw claudication,
and vision changes. ESR is 90. What is the best next step?
A. Start NSAIDs
B. Obtain temporal artery biopsy before treatment
C. Begin high-dose corticosteroids immediately
D. Order MRI brain
Answer: C. Begin high-dose corticosteroids immediately
,Rationale: Temporal arteritis (giant cell arteritis) requires immediate steroids to
prevent vision loss. Biopsy can follow, but treatment should not be delayed.
4.
An 80-year-old man presents with new-onset confusion, urinary frequency, and
suprapubic tenderness. UA: positive nitrites and leukocyte esterase. What is the
most likely diagnosis?
A. Delirium due to UTI
B. Dementia
C. Prostatitis
D. Renal calculi
Answer: A. Delirium due to UTI
Rationale: Elderly often present with atypical UTI symptoms (confusion).
5.
A 64-year-old diabetic patient presents with chest pain relieved by rest and
worsened by exertion. EKG: no acute changes. Which diagnosis is most likely?
A. Stable angina
B. Unstable angina
C. GERD
D. STEMI
, Answer: A. Stable angina
Rationale: Predictable, exertional chest pain relieved with rest is consistent with
stable angina.
6.
A 58-year-old man presents with progressive tremor, bradykinesia, and shuffling gait.
Which is the most likely diagnosis?
A. Parkinson’s disease
B. Essential tremor
C. Alzheimer’s disease
D. Stroke
Answer: A. Parkinson’s disease
Rationale: Classic triad = resting tremor, bradykinesia, rigidity/postural instability.
7.
A 70-year-old woman presents with new-onset abdominal pain, hematochezia, and
fever. Exam: LLQ tenderness. What is the most likely diagnosis?
A. Colon cancer
B. Ischemic colitis
C. Diverticulitis
