NR 603 CEA Final Exam - Advanced Clinical Diagnosis 2026/2027
Chamberlain
1. A 55-year-old male with a history of hypertension and diabetes presents with
a blood pressure of 152/94. Which of the following is the most appropriate
initial class of medication according to ACC/AHA guidelines?
A. Beta-blockers
B. ACE Inhibitors
C. Loop diuretics
D. Alpha-blockers
Answer: B
Rationale: ACE inhibitors or ARBs are preferred first-line treatments for hypertensive
patients with diabetes to provide renal protection.
2. To confirm a diagnosis of Chronic Obstructive Pulmonary Disease (COPD),
which spirometry finding is required post-bronchodilator?
A. FEV1/FVC ratio < 0.70
B. FVC < 80% predicted
C. FEV1/FVC ratio > 0.70
D. FEV1 > 80% predicted
Answer: A
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the presence
of persistent airflow limitation, diagnostic of COPD.
,3. Which of the following laboratory findings is most indicative of primary
hypothyroidism?
A. High TSH and low Free T4
B. Low TSH and high Free T4
C. Low TSH and low Free T4
D. High TSH and high Free T4
Answer: A
Rationale: Primary hypothyroidism is characterized by an elevated TSH as the pituitary
attempts to stimulate the failing thyroid gland, resulting in low Free T4 levels.
4. A 68-year-old female reports a sudden onset of ‘the worst headache of her
life.’ What is the most likely diagnosis?
A. Migraine with aura
B. Tension headache
C. Subarachnoid hemorrhage
D. Cluster headache
Answer: C
Rationale: A ‘thunderclap’ headache or the ‘worst headache of one’s life’ is a classic
presentation of a subarachnoid hemorrhage and requires immediate emergency
evaluation.
5. In the management of Type 2 Diabetes, which medication is contraindicated
in patients with a history of medullary thyroid carcinoma?
A. Liraglutide (GLP-1 agonist)
B. Glipizide
C. Metformin
D. Pioglitazone
Answer: A
, Rationale: GLP-1 receptor agonists like liraglutide carry a black box warning for patients
with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine
Neoplasia syndrome type 2.
6. Which physical examination maneuver is used to assess for a torn meniscus in
the knee?
A. Lachman test
B. Phalen’s maneuver
C. McMurray test
D. Drawer test
Answer: C
Rationale: The McMurray test involves rotation of the knee in flexion and extension to
identify meniscal tears. Lachman and Drawer tests assess the ACL.
7. A patient presents with ‘honey-colored’ crusted lesions on the face. This is
classic for which condition?
A. Eczema
B. Psoriasis
C. Impetigo
D. Herpes Simplex
Answer: C
Rationale: Impetigo is a highly contagious bacterial skin infection often caused by S.
aureus or S. pyogenes, characterized by honey-colored crusts.
Chamberlain
1. A 55-year-old male with a history of hypertension and diabetes presents with
a blood pressure of 152/94. Which of the following is the most appropriate
initial class of medication according to ACC/AHA guidelines?
A. Beta-blockers
B. ACE Inhibitors
C. Loop diuretics
D. Alpha-blockers
Answer: B
Rationale: ACE inhibitors or ARBs are preferred first-line treatments for hypertensive
patients with diabetes to provide renal protection.
2. To confirm a diagnosis of Chronic Obstructive Pulmonary Disease (COPD),
which spirometry finding is required post-bronchodilator?
A. FEV1/FVC ratio < 0.70
B. FVC < 80% predicted
C. FEV1/FVC ratio > 0.70
D. FEV1 > 80% predicted
Answer: A
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the presence
of persistent airflow limitation, diagnostic of COPD.
,3. Which of the following laboratory findings is most indicative of primary
hypothyroidism?
A. High TSH and low Free T4
B. Low TSH and high Free T4
C. Low TSH and low Free T4
D. High TSH and high Free T4
Answer: A
Rationale: Primary hypothyroidism is characterized by an elevated TSH as the pituitary
attempts to stimulate the failing thyroid gland, resulting in low Free T4 levels.
4. A 68-year-old female reports a sudden onset of ‘the worst headache of her
life.’ What is the most likely diagnosis?
A. Migraine with aura
B. Tension headache
C. Subarachnoid hemorrhage
D. Cluster headache
Answer: C
Rationale: A ‘thunderclap’ headache or the ‘worst headache of one’s life’ is a classic
presentation of a subarachnoid hemorrhage and requires immediate emergency
evaluation.
5. In the management of Type 2 Diabetes, which medication is contraindicated
in patients with a history of medullary thyroid carcinoma?
A. Liraglutide (GLP-1 agonist)
B. Glipizide
C. Metformin
D. Pioglitazone
Answer: A
, Rationale: GLP-1 receptor agonists like liraglutide carry a black box warning for patients
with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine
Neoplasia syndrome type 2.
6. Which physical examination maneuver is used to assess for a torn meniscus in
the knee?
A. Lachman test
B. Phalen’s maneuver
C. McMurray test
D. Drawer test
Answer: C
Rationale: The McMurray test involves rotation of the knee in flexion and extension to
identify meniscal tears. Lachman and Drawer tests assess the ACL.
7. A patient presents with ‘honey-colored’ crusted lesions on the face. This is
classic for which condition?
A. Eczema
B. Psoriasis
C. Impetigo
D. Herpes Simplex
Answer: C
Rationale: Impetigo is a highly contagious bacterial skin infection often caused by S.
aureus or S. pyogenes, characterized by honey-colored crusts.
