| Course | NU673 PMHNP Diagnosis and Management Across the Lifespan I |
|---|---|
| Unit | Unit 2 |
| Paper type | Medical differential paper |
| Length | About 1,090 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU673 Unit 2
A Slip on the Ice in January: A Medical Differential Paper Testing Seven Explanations Before Late-Life Depression in a 69-Year-Old Retired Bus Mechanic
[Student Name]
Purdue University Global
NU673: PMHNP Diagnosis and Management Across the Lifespan I
Unit 2 Medical Differential Paper
[Instructor Name]
[Date]
The patient is composite; values and dates are bracketed.
The Presentation
Mr. [B.] is a [69]-year-old retired school bus mechanic referred by his primary care clinician for possible depression. His wife says that since about [March] he has lost interest in his woodshop, sits in his chair for hours, answers questions after long pauses and has twice left the stove on. He says he feels "foggy" and "tired," not sad. He has atrial fibrillation treated with apixaban, hypertension treated with amlodipine, and osteoarthritis. He does not drink. His PHQ-9 score is [11]. His Montreal Cognitive Assessment score is [21], with points lost on recall, trail-making and serial sevens.
Depression in older adults often presents with apathy, slowing and cognitive complaints rather than sadness, and medical illness, medications and neurological disease frequently contribute (Taylor, 2014). That is exactly why the differential must be tested before the label is applied.
Seven Explanations Tested First
1. Hypothyroidism. It causes slowing, fatigue and apathy. Test: TSH. Result: [2.1] mIU/L, normal.
2. Vitamin B12 deficiency. It causes cognitive impairment and mood change, especially in older adults. Test: B12 level. Result: [410] pg/mL, normal.
3. Medication effects. Amlodipine and apixaban are not typical causes of apathy; he takes no anticholinergic drugs, benzodiazepines or opioids. Result: no medication explanation identified.
4. Obstructive sleep apnea. It causes daytime fatigue and poor concentration. Test: history from his wife and a sleep questionnaire. Result: he does not snore loudly and she has not seen pauses in breathing; low probability.
5. Hypercalcemia or other metabolic disturbance. Test: basic metabolic panel and calcium. Result: normal.
6. Early neurodegenerative disease, including Parkinson disease or Lewy body dementia. Test: examination for rigidity, tremor and slowness of movement, and history of hallucinations or fluctuating alertness. Result: no tremor or rigidity; no hallucinations.
7. A structural brain lesion, including chronic subdural hematoma. Test: history of falls, neurological examination, and brain imaging if indicated.
The Finding That Changed the Differential
When asked directly about falls, his wife remembered that in [January] he slipped on ice in the driveway and hit the back of his head. He did not lose consciousness and did not seek care. He has had mild headaches most mornings since [February], which he had put down to "sinus." On examination there was a subtle left pronator drift and he was slightly unsteady on tandem gait.
A head injury on an anticoagulant, followed by weeks of headache and a slow change in behavior, is a chronic subdural hematoma until imaging says otherwise. A non-contrast CT of the head showed a right-sided chronic subdural hematoma, [18] mm at its widest, with [6] mm of midline shift.
Chronic subdural hematoma typically affects older adults, often after minor head trauma, and anticoagulants increase the risk. Symptoms may develop weeks after the injury and include headache, confusion, gait disturbance and personality change, which can be mistaken for dementia or depression (Kolias et al., 2014).
Why the Fall Was Missed
Three things kept the fall out of view for five months. First, it seemed trivial at the time: he got up, finished shoveling and went inside, and neither he nor his wife thought of it again. Second, the change in him came on slowly, over weeks, so that each day looked much like the one before, and the family explained it with the story they already had, that he had been "down" since his brother died the previous autumn. Third, the referral question itself pointed toward depression. The primary care note read "possible depression, please assess," and a psychiatric assessment can easily confirm the question it is given. A structured review of systems that asks every older patient about falls, head injuries and new headaches, and that is completed before the mental status examination, would have brought the fall forward at the first visit. So would a habit of asking the family, separately, what else changed around the time the patient did.
How the Differential Was Ordered
The seven explanations were not tested in random order. Blood tests that are cheap and quick came first, since they can be drawn at the first visit. The medication review and the sleep history came from the interview. The neurological examination came next, and imaging was reserved for the explanation that the history and examination supported. That sequence meant the CT was ordered on day one of the assessment rather than after a failed trial of antidepressants, and it is the sequence I would follow again for new apathy in an older adult.
Management
He was referred urgently to neurosurgery. Apixaban was held after discussion with his cardiologist. Burr hole drainage was performed [two] days later. Surgical drainage is the usual treatment for symptomatic hematomas with mass effect, and recurrence requiring further surgery occurs in about [10 to 20] percent of patients (Kolias et al., 2014). The team did not add dexamethasone: in a large randomized trial in patients with symptomatic chronic subdural hematoma, most of whom had surgery, dexamethasone reduced repeat operations but led to fewer favorable outcomes and more adverse events than placebo at six months (Hutchinson et al., 2020).
Was It Depression After All?
Six weeks after surgery his headaches had resolved, he was back in his woodshop, and his MoCA score was [26]. His PHQ-9 was [4]. The apathy and slowing appear to have been caused largely by the hematoma. It remains possible that he had some depressive symptoms, perhaps in reaction to feeling unwell; follow-up is planned at three months to check.
What the Case Teaches
Three lessons follow for a psychiatric nurse practitioner assessing an older adult with new apathy or slowing. First, ask about falls and head injuries directly, especially in patients taking anticoagulants, since patients and families may not connect a minor fall with later changes. Second, a focused neurological examination, including pronator drift and gait, is part of the psychiatric assessment of late-life change. Third, cognitive screening scores that fall on executive and attention items, as his did, should raise the question of a structural cause rather than being assumed to reflect depression.
Late-life depression is common and treatable, and it deserves active treatment when present (Alexopoulos, 2005). But treating Mr. [B.] with an antidepressant would have delayed a diagnosis that required surgery.
References
Alexopoulos, G. S. (2005). Depression in the elderly. The Lancet, 365(9475), 1961-1970. https://doi.org/10.1016/S0140-6736(05)66665-2
Hutchinson, P. J., Edlmann, E., Bulters, D., Zolnourian, A., Holton, P., Suttner, N., Agyemang, K., Thomson, S., Anderson, I. A., Al-Tamimi, Y. Z., Henderson, D., Whitfield, P. C., Gherle, M., Brennan, P. M., Allison, A., Thelin, E. P., Tarantino, S., Pantaleo, B., Caldwell, K., . . . Kolias, A. G. (2020). Trial of dexamethasone for chronic subdural hematoma. New England Journal of Medicine, 383(27), 2616-2627. https://doi.org/10.1056/NEJMoa2020473
Kolias, A. G., Chari, A., Santarius, T., & Hutchinson, P. J. (2014). Chronic subdural haematoma: Modern management and emerging therapies. Nature Reviews Neurology, 10(10), 570-578. https://doi.org/10.1038/nrneurol.2014.163
Taylor, W. D. (2014). Depression in the elderly. New England Journal of Medicine, 371(13), 1228-1236. https://doi.org/10.1056/NEJMcp1402180
Reading the NU 673 Unit 2 instructions
In Unit 2 you write a medical differential for a patient whose presentation suggests a psychiatric disorder. The usual prompt wants you to name the likely psychiatric diagnosis, then test several medical explanations in a reasoned order, stating for each the test, its result and what it means. Most sections expect four to six pages. Faculty reward a differential built from the case, a logical order of testing, clear interpretation of each result and an honest statement of whether the psychiatric diagnosis still stands at the end. Including what happened after the decisive finding, and what the case teaches about assessment, strengthens the paper considerably and shows how the differential changed care.
How the NU 673 Unit 2 example is put together
The presentation section gives his history, his PHQ-9 of 11 and a MoCA of 21, and cites Taylor on how late-life depression presents. Seven explanations follow in a numbered list, each with its test and result. The decisive finding has its own section: the fall, the morning headaches and a subtle pronator drift, with a highlighted sentence and the CT result. A section explains why the fall was missed and another explains the order of testing. Management covers drainage, the Kolias review and the Dex-CSDH trial. A section asks whether it was depression after all, using his scores after surgery, and three lessons close the paper.
NU673 Unit 2 rubric: what earns full points
Differential papers in this course are usually graded on the breadth and relevance of the differential, the reasoning behind the order of testing, interpretation of results, clinical outcome and application to practice. Breadth earns full points when each explanation is justified by the case. Order is judged on whether quick, low-risk tests come before imaging, and whether imaging is ordered when the history supports it. Interpretation rewards clear statements of what each result rules in or out. The outcome row looks for follow-up that tests the final diagnosis. Application points go to lessons that would change how the student assesses the next older adult with new apathy.
NU673 Unit 2 help from the desk
A common mistake is accepting the referral question, possible depression, as the answer. Another is running a standard panel of blood tests and stopping when they are normal. Students often forget to ask about falls and head injuries in older adults, especially those on anticoagulants. Some papers skip the neurological examination as outside psychiatric practice. Others read low cognitive scores as proof of depression or dementia without considering a structural cause. And a paper that ends at the diagnosis, without follow-up scores, cannot show whether the psychiatric symptoms resolved, which is the test of whether the medical explanation was the right one. Keep the patient's own account of the change in view throughout, since his wife's description was what first pointed away from depression.
Get an NU673 Unit 2 example written to your instructions
Send your NU673 Unit 2 case exactly as written, including any starting list of conditions the prompt supplies, with the rubric. Ranking every candidate under a stated rule, pairing each with a deciding test and saying what a positive result would change, the first paper is free and ready within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU673 Unit 2 questions, answered
Should the differential include rare conditions?
Include a rare condition when something in the presentation points toward it or when missing it would be catastrophic, and say which reason applies. Otherwise leave it out. A differential crowded with unlikely possibilities reads as a textbook inventory rather than reasoning about the person described, and it is usually graded as one.
How detailed should the testing section be?
Name each test, say what it is meant to detect, and state its main limitation. Reference ranges are rarely needed unless the case supplies results to interpret. Where one test leads to another, as a borderline B12 leads to methylmalonic acid, show the sequence. A test named without its purpose earns little.
What if every test in the case comes back normal?
Then the paper says so and explains what that result supports. Normal findings across a well-chosen workup strengthen the case for a primary psychiatric diagnosis, which is the point of doing it. The paper can also note any test still pending or any finding that would reopen the differential if symptoms change.
Where can I find a free NU673 Unit 2 sample paper?
This page shows the full NU673 Unit 2 medical differential paper, with seven explanations tested, the decisive fall history, the imaging result, management, follow-up scores and three lessons, plus four references. Share your own case details and a differential can be built around them.
What caused the symptoms in NU673 Unit 2?
A right-sided chronic subdural hematoma, 18 mm wide with midline shift, after a fall on ice while he was taking apixaban. After burr hole drainage his headaches resolved, his MoCA rose from 21 to 26 and his PHQ-9 fell to 4.