NR 576 Midterm Exam
Differential Diagnosis in
Adult-Gerontology
Primary Care
Q1. A 64-year-old man presents with exertional chest pain relieved by rest. ECG is
normal. Which is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. GERD
Answer: B. Stable angina
Rationale: Stable angina presents with predictable chest discomfort relieved by rest
or nitroglycerin. Unstable angina would not be relieved by rest and is
new/worsening. MI presents with prolonged pain not relieved by rest. GERD pain is
not classically exertional.
Q2. Which finding differentiates heart failure with reduced ejection fraction (HFrEF)
from diastolic heart failure (HFpEF)?
,A. S3 heart sound
B. Fatigue and dyspnea
C. Lower extremity edema
D. Elevated BNP
Answer: A. S3 heart sound
Rationale: S3 is associated with systolic dysfunction (HFrEF). Both types may show
fatigue, edema, and elevated BNP.
Pulmonary Disorders
Q3. A 70-year-old woman presents with chronic cough, sputum production, and
dyspnea. She has a 40 pack-year smoking history. Which is the most likely diagnosis?
A. Asthma
B. COPD—Chronic bronchitis
C. COPD—Emphysema
D. Lung cancer
Answer: B. COPD—Chronic bronchitis
Rationale: Chronic productive cough for ≥3 months in 2 consecutive years is
diagnostic for chronic bronchitis. Emphysema is more associated with dyspnea and
barrel chest without significant sputum.
Q4. Which diagnostic test is most useful for distinguishing asthma from COPD?
,A. Chest X-ray
B. CT scan
C. Spirometry with bronchodilator response
D. Arterial blood gas
Answer: C. Spirometry with bronchodilator response
Rationale: Asthma is reversible with bronchodilators, COPD is not.
Endocrine & Metabolic Disorders
Q5. A 55-year-old man presents with polyuria, polydipsia, and blurred vision. Labs
show fasting glucose of 145 mg/dL on two separate occasions. What is the
diagnosis?
A. Prediabetes
B. Diabetes mellitus type 2
C. Diabetes mellitus type 1
D. Metabolic syndrome
Answer: B. Diabetes mellitus type 2
Rationale: Fasting plasma glucose ≥126 mg/dL on 2 separate occasions confirms
diabetes. Prediabetes = 100–125 mg/dL.
Q6. Which lab finding suggests primary hypothyroidism?
, A. Low TSH, low T4
B. High TSH, low T4
C. Low TSH, high T4
D. High TSH, high T4
Answer: B. High TSH, low T4
Rationale: In primary hypothyroidism, the thyroid gland fails → low T4. The pituitary
compensates with elevated TSH.
Renal & Genitourinary Disorders
Q7. A 68-year-old male presents with dysuria, frequency, nocturia, and weak urine
stream. Which diagnosis is most likely?
A. Acute prostatitis
B. Benign prostatic hyperplasia (BPH)
C. UTI
D. Prostate cancer
Answer: B. Benign prostatic hyperplasia (BPH)
Rationale: LUTS (lower urinary tract symptoms) in older men are classic for BPH.
Prostate cancer usually asymptomatic until late. Prostatitis would include pain/fever.
Q8. A 72-year-old woman presents with fever, chills, flank pain, and dysuria. What is
the best initial test?
Differential Diagnosis in
Adult-Gerontology
Primary Care
Q1. A 64-year-old man presents with exertional chest pain relieved by rest. ECG is
normal. Which is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. GERD
Answer: B. Stable angina
Rationale: Stable angina presents with predictable chest discomfort relieved by rest
or nitroglycerin. Unstable angina would not be relieved by rest and is
new/worsening. MI presents with prolonged pain not relieved by rest. GERD pain is
not classically exertional.
Q2. Which finding differentiates heart failure with reduced ejection fraction (HFrEF)
from diastolic heart failure (HFpEF)?
,A. S3 heart sound
B. Fatigue and dyspnea
C. Lower extremity edema
D. Elevated BNP
Answer: A. S3 heart sound
Rationale: S3 is associated with systolic dysfunction (HFrEF). Both types may show
fatigue, edema, and elevated BNP.
Pulmonary Disorders
Q3. A 70-year-old woman presents with chronic cough, sputum production, and
dyspnea. She has a 40 pack-year smoking history. Which is the most likely diagnosis?
A. Asthma
B. COPD—Chronic bronchitis
C. COPD—Emphysema
D. Lung cancer
Answer: B. COPD—Chronic bronchitis
Rationale: Chronic productive cough for ≥3 months in 2 consecutive years is
diagnostic for chronic bronchitis. Emphysema is more associated with dyspnea and
barrel chest without significant sputum.
Q4. Which diagnostic test is most useful for distinguishing asthma from COPD?
,A. Chest X-ray
B. CT scan
C. Spirometry with bronchodilator response
D. Arterial blood gas
Answer: C. Spirometry with bronchodilator response
Rationale: Asthma is reversible with bronchodilators, COPD is not.
Endocrine & Metabolic Disorders
Q5. A 55-year-old man presents with polyuria, polydipsia, and blurred vision. Labs
show fasting glucose of 145 mg/dL on two separate occasions. What is the
diagnosis?
A. Prediabetes
B. Diabetes mellitus type 2
C. Diabetes mellitus type 1
D. Metabolic syndrome
Answer: B. Diabetes mellitus type 2
Rationale: Fasting plasma glucose ≥126 mg/dL on 2 separate occasions confirms
diabetes. Prediabetes = 100–125 mg/dL.
Q6. Which lab finding suggests primary hypothyroidism?
, A. Low TSH, low T4
B. High TSH, low T4
C. Low TSH, high T4
D. High TSH, high T4
Answer: B. High TSH, low T4
Rationale: In primary hypothyroidism, the thyroid gland fails → low T4. The pituitary
compensates with elevated TSH.
Renal & Genitourinary Disorders
Q7. A 68-year-old male presents with dysuria, frequency, nocturia, and weak urine
stream. Which diagnosis is most likely?
A. Acute prostatitis
B. Benign prostatic hyperplasia (BPH)
C. UTI
D. Prostate cancer
Answer: B. Benign prostatic hyperplasia (BPH)
Rationale: LUTS (lower urinary tract symptoms) in older men are classic for BPH.
Prostate cancer usually asymptomatic until late. Prostatitis would include pain/fever.
Q8. A 72-year-old woman presents with fever, chills, flank pain, and dysuria. What is
the best initial test?
