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NR576 / NR 576 FINAL EXAM ( NEWLY UPDATED):
DIFFERENTIAL DIAGNOSIS IN ADULT-GERONTOLOGY PRIMARY
CARE | GUIDE WITH VERIFIED ANSWERS – CHAMBERLAIN
Question 1:
A 62-year-old male presents with progressive dyspnea on exertion, chronic cough
producing white sputum, and a barrel-shaped chest. On auscultation, breath sounds
are diminished bilaterally with prolonged expiration. What is the most likely
diagnosis?
A. Asthma
B. Bronchiectasis
C. Chronic obstructive pulmonary disease (COPD)
D. Pulmonary fibrosis
Correct Answer: C. Chronic obstructive pulmonary disease (COPD)
Rationale:
The combination of chronic productive cough, dyspnea, and barrel chest with
diminished breath sounds indicates COPD, particularly emphysematous changes.
Chronic airflow limitation is confirmed by spirometry showing a reduced
FEV1/FVC ratio.
Question 2:
A 75-year-old female presents with fatigue, pallor, and exertional dyspnea. Lab
results show MCV 72 fL, MCHC 28 g/dL, and low ferritin. Which diagnosis is
most consistent with these findings?
A. Vitamin B12 deficiency anemia
B. Iron deficiency anemia
C. Thalassemia
D. Anemia of chronic disease
, 2
Correct Answer: B. Iron deficiency anemia
Rationale:
Microcytosis (low MCV), hypochromia, and low ferritin are hallmark findings
of iron deficiency anemia. In elderly adults, evaluation for occult gastrointestinal
bleeding is essential to identify potential malignancy.
Question 3:
A 55-year-old male presents with left lower quadrant pain, fever, and leukocytosis.
CT abdomen reveals localized colonic wall thickening and pericolic fat stranding.
What is the best initial management?
A. Immediate surgical resection
B. Antibiotic therapy and bowel rest
C. Colonoscopy within 24 hours
D. High-fiber diet
Correct Answer: B. Antibiotic therapy and bowel rest
Rationale:
Typical CT findings and symptoms confirm acute diverticulitis, which is managed
initially with bowel rest, broad-spectrum antibiotics, and close monitoring.
Colonoscopy should be delayed until after resolution to rule out malignancy.
Question 4:
A 67-year-old male presents with resting tremor, rigidity, and bradykinesia. He also
exhibits a shuffling gait. Which diagnosis is most likely?
A. Essential tremor
B. Parkinson’s disease
C. Huntington’s disease
D. Myasthenia gravis
Correct Answer: B. Parkinson’s disease
Rationale:
Resting tremor, rigidity, and bradykinesia form the triad of Parkinson’s
disease, a neurodegenerative disorder due to dopamine depletion in the substantia
nigra. Early identification enables effective dopaminergic therapy initiation.
, 3
Question 5:
A 59-year-old woman complains of chronic fatigue and pruritus. Lab results show
elevated alkaline phosphatase and positive antimitochondrial antibodies. What is
the most likely diagnosis?
A. Autoimmune hepatitis
B. Primary biliary cholangitis (PBC)
C. Gallstones
D. Cirrhosis due to alcohol
Correct Answer: B. Primary biliary cholangitis (PBC)
Rationale:
PBC presents with elevated ALP and positive antimitochondrial antibodies due
to autoimmune destruction of intrahepatic bile ducts. Early treatment with
ursodeoxycholic acid slows disease progression.
Question 6:
A 71-year-old man presents with progressive memory loss and impaired executive
function but intact motor control. MRI shows cortical atrophy. What is the most
likely diagnosis?
A. Parkinson’s dementia
B. Alzheimer’s disease
C. Lewy body dementia
D. Normal pressure hydrocephalus
Correct Answer: B. Alzheimer’s disease
Rationale:
Alzheimer’s disease presents with gradual cognitive decline involving memory,
judgment, and language but without early motor deficits. Cortical atrophy supports
the diagnosis, and cholinesterase inhibitors may improve symptoms.
Question 7:
A 68-year-old male presents with weight loss, abdominal pain, and jaundice. On
exam, there is palpable, non-tender gallbladder enlargement. Which diagnosis is
, 4
most likely?
A. Hepatitis C infection
B. Pancreatic carcinoma
C. Gallstones
D. Alcoholic hepatitis
Correct Answer: B. Pancreatic carcinoma
Rationale:
The Courvoisier sign (non-tender, palpable gallbladder with jaundice) indicates
obstruction from pancreatic cancer rather than gallstones. Early imaging with
contrast-enhanced CT or MRI is essential for staging.
Question 8:
A 74-year-old woman presents with postmenopausal vaginal bleeding. What is the
most appropriate initial diagnostic step?
A. Pelvic MRI
B. Transvaginal ultrasound
C. CT abdomen and pelvis
D. Endometrial biopsy immediately
Correct Answer: B. Transvaginal ultrasound
Rationale:
In postmenopausal bleeding, transvaginal ultrasound evaluates endometrial
thickness; a stripe >4 mm warrants biopsy for endometrial carcinoma. Ultrasound
is noninvasive and the recommended first-line investigation.
Question 9:
A 65-year-old male smoker complains of persistent cough and hemoptysis. Chest
x-ray reveals a central mass in the right hilum. Which diagnosis is most probable?
A. Adenocarcinoma of the lung
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Pulmonary metastasis
NR576 / NR 576 FINAL EXAM ( NEWLY UPDATED):
DIFFERENTIAL DIAGNOSIS IN ADULT-GERONTOLOGY PRIMARY
CARE | GUIDE WITH VERIFIED ANSWERS – CHAMBERLAIN
Question 1:
A 62-year-old male presents with progressive dyspnea on exertion, chronic cough
producing white sputum, and a barrel-shaped chest. On auscultation, breath sounds
are diminished bilaterally with prolonged expiration. What is the most likely
diagnosis?
A. Asthma
B. Bronchiectasis
C. Chronic obstructive pulmonary disease (COPD)
D. Pulmonary fibrosis
Correct Answer: C. Chronic obstructive pulmonary disease (COPD)
Rationale:
The combination of chronic productive cough, dyspnea, and barrel chest with
diminished breath sounds indicates COPD, particularly emphysematous changes.
Chronic airflow limitation is confirmed by spirometry showing a reduced
FEV1/FVC ratio.
Question 2:
A 75-year-old female presents with fatigue, pallor, and exertional dyspnea. Lab
results show MCV 72 fL, MCHC 28 g/dL, and low ferritin. Which diagnosis is
most consistent with these findings?
A. Vitamin B12 deficiency anemia
B. Iron deficiency anemia
C. Thalassemia
D. Anemia of chronic disease
, 2
Correct Answer: B. Iron deficiency anemia
Rationale:
Microcytosis (low MCV), hypochromia, and low ferritin are hallmark findings
of iron deficiency anemia. In elderly adults, evaluation for occult gastrointestinal
bleeding is essential to identify potential malignancy.
Question 3:
A 55-year-old male presents with left lower quadrant pain, fever, and leukocytosis.
CT abdomen reveals localized colonic wall thickening and pericolic fat stranding.
What is the best initial management?
A. Immediate surgical resection
B. Antibiotic therapy and bowel rest
C. Colonoscopy within 24 hours
D. High-fiber diet
Correct Answer: B. Antibiotic therapy and bowel rest
Rationale:
Typical CT findings and symptoms confirm acute diverticulitis, which is managed
initially with bowel rest, broad-spectrum antibiotics, and close monitoring.
Colonoscopy should be delayed until after resolution to rule out malignancy.
Question 4:
A 67-year-old male presents with resting tremor, rigidity, and bradykinesia. He also
exhibits a shuffling gait. Which diagnosis is most likely?
A. Essential tremor
B. Parkinson’s disease
C. Huntington’s disease
D. Myasthenia gravis
Correct Answer: B. Parkinson’s disease
Rationale:
Resting tremor, rigidity, and bradykinesia form the triad of Parkinson’s
disease, a neurodegenerative disorder due to dopamine depletion in the substantia
nigra. Early identification enables effective dopaminergic therapy initiation.
, 3
Question 5:
A 59-year-old woman complains of chronic fatigue and pruritus. Lab results show
elevated alkaline phosphatase and positive antimitochondrial antibodies. What is
the most likely diagnosis?
A. Autoimmune hepatitis
B. Primary biliary cholangitis (PBC)
C. Gallstones
D. Cirrhosis due to alcohol
Correct Answer: B. Primary biliary cholangitis (PBC)
Rationale:
PBC presents with elevated ALP and positive antimitochondrial antibodies due
to autoimmune destruction of intrahepatic bile ducts. Early treatment with
ursodeoxycholic acid slows disease progression.
Question 6:
A 71-year-old man presents with progressive memory loss and impaired executive
function but intact motor control. MRI shows cortical atrophy. What is the most
likely diagnosis?
A. Parkinson’s dementia
B. Alzheimer’s disease
C. Lewy body dementia
D. Normal pressure hydrocephalus
Correct Answer: B. Alzheimer’s disease
Rationale:
Alzheimer’s disease presents with gradual cognitive decline involving memory,
judgment, and language but without early motor deficits. Cortical atrophy supports
the diagnosis, and cholinesterase inhibitors may improve symptoms.
Question 7:
A 68-year-old male presents with weight loss, abdominal pain, and jaundice. On
exam, there is palpable, non-tender gallbladder enlargement. Which diagnosis is
, 4
most likely?
A. Hepatitis C infection
B. Pancreatic carcinoma
C. Gallstones
D. Alcoholic hepatitis
Correct Answer: B. Pancreatic carcinoma
Rationale:
The Courvoisier sign (non-tender, palpable gallbladder with jaundice) indicates
obstruction from pancreatic cancer rather than gallstones. Early imaging with
contrast-enhanced CT or MRI is essential for staging.
Question 8:
A 74-year-old woman presents with postmenopausal vaginal bleeding. What is the
most appropriate initial diagnostic step?
A. Pelvic MRI
B. Transvaginal ultrasound
C. CT abdomen and pelvis
D. Endometrial biopsy immediately
Correct Answer: B. Transvaginal ultrasound
Rationale:
In postmenopausal bleeding, transvaginal ultrasound evaluates endometrial
thickness; a stripe >4 mm warrants biopsy for endometrial carcinoma. Ultrasound
is noninvasive and the recommended first-line investigation.
Question 9:
A 65-year-old male smoker complains of persistent cough and hemoptysis. Chest
x-ray reveals a central mass in the right hilum. Which diagnosis is most probable?
A. Adenocarcinoma of the lung
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Pulmonary metastasis
