NR 511 Exam 3: Differential Diagnosis - Chamberlain
University Updated and Latest Questions and Correct
Answers with Rationale
1. A 45-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 level. Which of the following is the most likely diagnosis?
A. Grave’s disease
B. Secondary hypothyroidism
C. Subacute thyroiditis
D. Hashimoto’s thyroiditis
Correct Answer: D
Rationale: The patient’s elevated TSH and low free T4 are diagnostic of primary hypothyroidism.
Hashimoto’s thyroiditis is the most common cause of primary hypothyroidism in iodine-sufficient
regions. Clinical features typically include fatigue, weight gain, and cold intolerance due to decreased
metabolic rate. Diagnosis is often confirmed by checking for thyroid peroxidase antibodies. Treatment
involves levothyroxine replacement therapy to normalize TSH levels.
2. A 62-year-old male describes a resting tremor in his right hand that disappears with intentional
movement. He also reports stiffness and a feeling of ‘slowing down’ over the past year. What is the most
likely neurological diagnosis?
A. Essential tremor
B. Parkinson’s disease
C. Multiple sclerosis
D. Huntington’s chorea
,Correct Answer: B
Rationale: Parkinson’s disease is characterized by the classic triad of resting tremor, bradykinesia, and
rigidity. The tremor is often described as a ‘pill-rolling’ motion that improves with activity. Bradykinesia
refers to the slowness of movement common in these patients. Postural instability is another hallmark
that often develops as the disease progresses. Diagnosis is primarily clinical based on the presence of
these motor symptoms.
3. A 32-year-old woman complains of sudden, severe headaches that occur several times a day, primarily
around her right eye. These episodes last about 45 minutes and are accompanied by tearing and a runny
nose on the right side. What type of headache is most likely?
A. Migraine with aura
B. Tension-type headache
C. Hemicrania continua
D. Cluster headache
Correct Answer: D
Rationale: Cluster headaches are characterized by severe, unilateral periorbital pain that occurs in
‘clusters’ over weeks or months. Associated autonomic symptoms include lacrimation, rhinorrhea, and
miosis on the affected side. These headaches are more common in men but can occur in women. The
duration is typically short, lasting between 15 to 180 minutes. High-flow oxygen is often an effective
acute treatment for these episodes.
4. Which of the following physical examination findings is most specific for a diagnosis of Rheumatoid
Arthritis rather than Osteoarthritis?
A. Heberden’s nodes
, B. Morning stiffness lasting more than one hour
C. Crepitus with joint movement
D. Pain that worsens with activity
Correct Answer: B
Rationale: Rheumatoid arthritis (RA) is an autoimmune inflammatory disorder characterized by
prolonged morning stiffness. In RA, this stiffness typically lasts more than 60 minutes, whereas in
osteoarthritis, it usually resolves within 30 minutes. RA often involves the small joints of the hands
symmetrically, excluding the distal interphalangeal joints. Osteoarthritis is more associated with
mechanical wear and tear rather than systemic inflammation. Elevated inflammatory markers like ESR
and CRP are also common in RA.
5. A patient presents with sudden onset of vertigo when turning their head in bed. The symptoms last for
less than a minute and are associated with nausea. Which diagnostic maneuver should be performed first?
A. Epley maneuver
B. Dix-Hallpike maneuver
C. Romberg test
D. HINTS exam
Correct Answer: B
Rationale: The Dix-Hallpike maneuver is the gold standard for diagnosing Benign Paroxysmal Positional
Vertigo (BPPV). It involves moving the patient from a sitting to a supine position with the head turned to
elicit nystagmus. BPPV is caused by displaced otoconia in the semicircular canals of the inner ear. The
resulting vertigo is brief and triggered by specific head movements. Once diagnosed, the Epley maneuver
can be used as a treatment to reposition the crystals.
University Updated and Latest Questions and Correct
Answers with Rationale
1. A 45-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 level. Which of the following is the most likely diagnosis?
A. Grave’s disease
B. Secondary hypothyroidism
C. Subacute thyroiditis
D. Hashimoto’s thyroiditis
Correct Answer: D
Rationale: The patient’s elevated TSH and low free T4 are diagnostic of primary hypothyroidism.
Hashimoto’s thyroiditis is the most common cause of primary hypothyroidism in iodine-sufficient
regions. Clinical features typically include fatigue, weight gain, and cold intolerance due to decreased
metabolic rate. Diagnosis is often confirmed by checking for thyroid peroxidase antibodies. Treatment
involves levothyroxine replacement therapy to normalize TSH levels.
2. A 62-year-old male describes a resting tremor in his right hand that disappears with intentional
movement. He also reports stiffness and a feeling of ‘slowing down’ over the past year. What is the most
likely neurological diagnosis?
A. Essential tremor
B. Parkinson’s disease
C. Multiple sclerosis
D. Huntington’s chorea
,Correct Answer: B
Rationale: Parkinson’s disease is characterized by the classic triad of resting tremor, bradykinesia, and
rigidity. The tremor is often described as a ‘pill-rolling’ motion that improves with activity. Bradykinesia
refers to the slowness of movement common in these patients. Postural instability is another hallmark
that often develops as the disease progresses. Diagnosis is primarily clinical based on the presence of
these motor symptoms.
3. A 32-year-old woman complains of sudden, severe headaches that occur several times a day, primarily
around her right eye. These episodes last about 45 minutes and are accompanied by tearing and a runny
nose on the right side. What type of headache is most likely?
A. Migraine with aura
B. Tension-type headache
C. Hemicrania continua
D. Cluster headache
Correct Answer: D
Rationale: Cluster headaches are characterized by severe, unilateral periorbital pain that occurs in
‘clusters’ over weeks or months. Associated autonomic symptoms include lacrimation, rhinorrhea, and
miosis on the affected side. These headaches are more common in men but can occur in women. The
duration is typically short, lasting between 15 to 180 minutes. High-flow oxygen is often an effective
acute treatment for these episodes.
4. Which of the following physical examination findings is most specific for a diagnosis of Rheumatoid
Arthritis rather than Osteoarthritis?
A. Heberden’s nodes
, B. Morning stiffness lasting more than one hour
C. Crepitus with joint movement
D. Pain that worsens with activity
Correct Answer: B
Rationale: Rheumatoid arthritis (RA) is an autoimmune inflammatory disorder characterized by
prolonged morning stiffness. In RA, this stiffness typically lasts more than 60 minutes, whereas in
osteoarthritis, it usually resolves within 30 minutes. RA often involves the small joints of the hands
symmetrically, excluding the distal interphalangeal joints. Osteoarthritis is more associated with
mechanical wear and tear rather than systemic inflammation. Elevated inflammatory markers like ESR
and CRP are also common in RA.
5. A patient presents with sudden onset of vertigo when turning their head in bed. The symptoms last for
less than a minute and are associated with nausea. Which diagnostic maneuver should be performed first?
A. Epley maneuver
B. Dix-Hallpike maneuver
C. Romberg test
D. HINTS exam
Correct Answer: B
Rationale: The Dix-Hallpike maneuver is the gold standard for diagnosing Benign Paroxysmal Positional
Vertigo (BPPV). It involves moving the patient from a sitting to a supine position with the head turned to
elicit nystagmus. BPPV is caused by displaced otoconia in the semicircular canals of the inner ear. The
resulting vertigo is brief and triggered by specific head movements. Once diagnosed, the Epley maneuver
can be used as a treatment to reposition the crystals.
