NUR 504 Exam 3: Advanced Health Assessment
and Differential Diagnosis - St. Thomas University
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient presents with a ‘moon face,’ buffalo hump, and abdominal striae. Which
endocrine disorder is most likely?
A. Addison’s Disease
B. Cushing’s Syndrome
C. Hypothyroidism
D. Pheochromocytoma
Correct Answer: B
Rationale: Cushing’s syndrome results from chronic exposure to excessive glucocorticoids
like cortisol. Common physical findings include central obesity and a fatty hump between
the shoulders. The presence of purple striae on the abdomen is a hallmark sign of this
condition. Diagnosis often involves measuring 24-hour urinary free cortisol levels. Proper
management is essential to prevent long-term complications like hypertension and
osteoporosis.
2. During a musculoskeletal exam, a positive Lachman test is indicative of an injury to which
structure?
A. Medial collateral ligament (MCL)
B. Posterior cruciate ligament (PCL)
C. Anterior cruciate ligament (ACL)
D. Lateral meniscus
Correct Answer: C
Rationale: The Lachman test is widely considered the most sensitive clinical test for ACL
stability. To perform it, the knee is flexed to 20-30 degrees while the tibia is pulled forward.
A positive result occurs when there is increased anterior translation of the tibia compared
to the unaffected side. It is more reliable than the anterior drawer test in acute injury
settings. This assessment helps determine if surgical intervention or physical therapy is
necessary for the patient.
3. A 55-year-old male reports sudden, severe pain and swelling in his first
metatarsophalangeal joint. What is the most likely diagnosis?
A. Rheumatoid Arthritis
,B. Septic Arthritis
C. Osteoarthritis
D. Gouty Arthritis
Correct Answer: D
Rationale: Gout typically presents as an acute monoarthritis affecting the great toe, known
as podagra. It is caused by the deposition of monosodium urate crystals in the joint space.
Risks include a diet high in purines, alcohol consumption, and certain medications. Patients
often describe the pain as so severe they cannot bear the weight of a bedsheet. Definitive
diagnosis requires synovial fluid analysis showing negatively birefringent crystals.
4. Which cranial nerve is responsible for the motor function of the muscles of mastication?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve XII (Hypoglossal)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve V (Trigeminal)
Correct Answer: D
Rationale: The trigeminal nerve has both sensory and motor components. Its motor
branch innervates the muscles used for chewing, such as the masseter and temporalis.
Testing involves asking the patient to clench their teeth while palpating the muscles.
Dysfunction can lead to difficulty eating or deviations of the jaw. This assessment is a
standard part of a comprehensive neurological examination.
5. A patient exhibits a resting tremor, bradykinesia, and ‘cogwheel’ rigidity. These are
hallmark signs of:
A. Multiple Sclerosis
B. Amyotrophic Lateral Sclerosis
C. Parkinson’s Disease
D. Huntington’s Disease
Correct Answer: C
Rationale: Parkinson’s disease is a neurodegenerative disorder characterized by a loss of
dopaminergic neurons in the substantia nigra. The classic triad of symptoms includes
tremor, rigidity, and slowness of movement. Postural instability is also a common feature
as the disease progresses. Management focuses on levodopa therapy and symptomatic
relief. Early diagnosis is important for maintaining the patient’s quality of life and
functional independence.
, 6. Which laboratory value is the most sensitive indicator for diagnosing primary
hypothyroidism?
A. Thyroid Stimulating Hormone (TSH)
B. Serum Total T3
C. Serum Free T4
D. Thyroglobulin Antibodies
Correct Answer: A
Rationale: TSH is the gold standard screening test for thyroid dysfunction. In primary
hypothyroidism, the pituitary gland increases TSH production to stimulate a failing thyroid
gland. Therefore, a high TSH level combined with a low T4 confirms the diagnosis. Small
changes in free thyroid hormones lead to large changes in TSH concentration. This makes
TSH an incredibly sensitive marker for even subclinical thyroid disease.
7. The Phalen’s maneuver is used to assess for which of the following conditions?
A. Carpal Tunnel Syndrome
B. De Quervain’s Tenosynovitis
C. Ulnar Nerve Entrapment
D. Lateral Epicondylitis
Correct Answer: A
Rationale: Phalen’s maneuver involves holding the wrists in extreme flexion for 60
seconds. This action compresses the median nerve within the carpal tunnel. If the patient
experiences numbness or tingling in the thumb and first two fingers, the test is positive. It
is a key clinical tool for identifying carpal tunnel syndrome. Along with Tinel’s sign, it helps
guide the need for further electrodiagnostic studies.
8. An 18-year-old female presents with fatigue, cold intolerance, and weight gain. Her thyroid
is enlarged but non-tender. What is the most likely diagnosis?
A. Hashimoto’s Thyroiditis
B. Graves’ Disease
C. Subacute Thyroiditis
D. Thyroid Storm
Correct Answer: A
Rationale: Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the
United States. It is an autoimmune condition where the body attacks the thyroid gland.
Patients often present with symptoms of a slow metabolism, such as weight gain and
and Differential Diagnosis - St. Thomas University
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient presents with a ‘moon face,’ buffalo hump, and abdominal striae. Which
endocrine disorder is most likely?
A. Addison’s Disease
B. Cushing’s Syndrome
C. Hypothyroidism
D. Pheochromocytoma
Correct Answer: B
Rationale: Cushing’s syndrome results from chronic exposure to excessive glucocorticoids
like cortisol. Common physical findings include central obesity and a fatty hump between
the shoulders. The presence of purple striae on the abdomen is a hallmark sign of this
condition. Diagnosis often involves measuring 24-hour urinary free cortisol levels. Proper
management is essential to prevent long-term complications like hypertension and
osteoporosis.
2. During a musculoskeletal exam, a positive Lachman test is indicative of an injury to which
structure?
A. Medial collateral ligament (MCL)
B. Posterior cruciate ligament (PCL)
C. Anterior cruciate ligament (ACL)
D. Lateral meniscus
Correct Answer: C
Rationale: The Lachman test is widely considered the most sensitive clinical test for ACL
stability. To perform it, the knee is flexed to 20-30 degrees while the tibia is pulled forward.
A positive result occurs when there is increased anterior translation of the tibia compared
to the unaffected side. It is more reliable than the anterior drawer test in acute injury
settings. This assessment helps determine if surgical intervention or physical therapy is
necessary for the patient.
3. A 55-year-old male reports sudden, severe pain and swelling in his first
metatarsophalangeal joint. What is the most likely diagnosis?
A. Rheumatoid Arthritis
,B. Septic Arthritis
C. Osteoarthritis
D. Gouty Arthritis
Correct Answer: D
Rationale: Gout typically presents as an acute monoarthritis affecting the great toe, known
as podagra. It is caused by the deposition of monosodium urate crystals in the joint space.
Risks include a diet high in purines, alcohol consumption, and certain medications. Patients
often describe the pain as so severe they cannot bear the weight of a bedsheet. Definitive
diagnosis requires synovial fluid analysis showing negatively birefringent crystals.
4. Which cranial nerve is responsible for the motor function of the muscles of mastication?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve XII (Hypoglossal)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve V (Trigeminal)
Correct Answer: D
Rationale: The trigeminal nerve has both sensory and motor components. Its motor
branch innervates the muscles used for chewing, such as the masseter and temporalis.
Testing involves asking the patient to clench their teeth while palpating the muscles.
Dysfunction can lead to difficulty eating or deviations of the jaw. This assessment is a
standard part of a comprehensive neurological examination.
5. A patient exhibits a resting tremor, bradykinesia, and ‘cogwheel’ rigidity. These are
hallmark signs of:
A. Multiple Sclerosis
B. Amyotrophic Lateral Sclerosis
C. Parkinson’s Disease
D. Huntington’s Disease
Correct Answer: C
Rationale: Parkinson’s disease is a neurodegenerative disorder characterized by a loss of
dopaminergic neurons in the substantia nigra. The classic triad of symptoms includes
tremor, rigidity, and slowness of movement. Postural instability is also a common feature
as the disease progresses. Management focuses on levodopa therapy and symptomatic
relief. Early diagnosis is important for maintaining the patient’s quality of life and
functional independence.
, 6. Which laboratory value is the most sensitive indicator for diagnosing primary
hypothyroidism?
A. Thyroid Stimulating Hormone (TSH)
B. Serum Total T3
C. Serum Free T4
D. Thyroglobulin Antibodies
Correct Answer: A
Rationale: TSH is the gold standard screening test for thyroid dysfunction. In primary
hypothyroidism, the pituitary gland increases TSH production to stimulate a failing thyroid
gland. Therefore, a high TSH level combined with a low T4 confirms the diagnosis. Small
changes in free thyroid hormones lead to large changes in TSH concentration. This makes
TSH an incredibly sensitive marker for even subclinical thyroid disease.
7. The Phalen’s maneuver is used to assess for which of the following conditions?
A. Carpal Tunnel Syndrome
B. De Quervain’s Tenosynovitis
C. Ulnar Nerve Entrapment
D. Lateral Epicondylitis
Correct Answer: A
Rationale: Phalen’s maneuver involves holding the wrists in extreme flexion for 60
seconds. This action compresses the median nerve within the carpal tunnel. If the patient
experiences numbness or tingling in the thumb and first two fingers, the test is positive. It
is a key clinical tool for identifying carpal tunnel syndrome. Along with Tinel’s sign, it helps
guide the need for further electrodiagnostic studies.
8. An 18-year-old female presents with fatigue, cold intolerance, and weight gain. Her thyroid
is enlarged but non-tender. What is the most likely diagnosis?
A. Hashimoto’s Thyroiditis
B. Graves’ Disease
C. Subacute Thyroiditis
D. Thyroid Storm
Correct Answer: A
Rationale: Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the
United States. It is an autoimmune condition where the body attacks the thyroid gland.
Patients often present with symptoms of a slow metabolism, such as weight gain and
