NR 603 CEA Midterm Exam - Advanced Clinical Diagnosis 2026/2027
Chamberlain
1. A 45-year-old female presents with sharp right upper quadrant pain that
radiates to her right shoulder. Positive Murphy’s sign is noted. What is the most
likely diagnosis?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Acute Pancreatitis
D. Nephrolithiasis
Answer: A
Rationale: Murphy’s sign is highly specific for acute cholecystitis, involving pain and an
abrupt cessation of inspiration during deep palpation of the RUQ.
2. Which lab result is the most indicative of primary hypothyroidism?
A. Low TSH and High Free T4
B. High TSH and Low Free T4
C. High TSH and High Free T4
D. Low TSH and Low Free T4
Answer: B
Rationale: In primary hypothyroidism, the thyroid gland fails, leading to low Free T4,
which causes the pituitary to produce more TSH in an attempt to stimulate the gland.
,3. A patient with COPD presents with increased sputum production and
dyspnea. According to GOLD guidelines, which medication class is the first-line
maintenance for Category B patients?
A. Short-acting beta-agonist (SABA) only
B. Long-acting muscarinic antagonist (LAMA) or LABA
C. Inhaled corticosteroids (ICS) only
D. Oral Prednisone
Answer: B
Rationale: For GOLD Category B (symptomatic but low risk of exacerbation), LAMA or
LABA is recommended as initial maintenance therapy.
4. Which physical exam maneuver is used to assess for a torn meniscus in the
knee?
A. Lachman Test
B. Valgus Stress Test
C. Anterior Drawer Test
D. McMurray Test
Answer: D
Rationale: The McMurray test involves rotation of the knee with flexion/extension to
identify meniscal tears. Lachman and Anterior Drawer are for ACL.
5. According to the ADA, what is the diagnostic threshold for Hemoglobin A1c
for Diabetes Mellitus?
A. Greater than or equal to 5.7%
B. Greater than or equal to 6.0%
C. Greater than or equal to 7.0%
D. Greater than or equal to 6.5%
Answer: D
, Rationale: An A1c of 6.5% or higher is the diagnostic criterion for Diabetes Mellitus. 5.7%
to 6.4% is considered pre-diabetes.
6. A patient presents with ‘the worst headache of my life’ and neck stiffness.
What is the immediate priority?
A. Administer high-dose Ibuprofen
B. Order an emergent CT scan of the head
C. Perform a Lumbar Puncture
D. Screen for Migraine triggers
Answer: B
Rationale: The description suggests a subarachnoid hemorrhage. An emergent non-
contrast CT is the first step to identify bleeding.
7. Which heart sound is associated with fluid overload and heart failure in an
older adult?
A. S1
B. S2
C. S4
D. S3
Answer: D
Rationale: S3 (ventricular gallop) is an early sign of heart failure and volume overload in
adults, occurring during the rapid filling phase of diastole.
Chamberlain
1. A 45-year-old female presents with sharp right upper quadrant pain that
radiates to her right shoulder. Positive Murphy’s sign is noted. What is the most
likely diagnosis?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Acute Pancreatitis
D. Nephrolithiasis
Answer: A
Rationale: Murphy’s sign is highly specific for acute cholecystitis, involving pain and an
abrupt cessation of inspiration during deep palpation of the RUQ.
2. Which lab result is the most indicative of primary hypothyroidism?
A. Low TSH and High Free T4
B. High TSH and Low Free T4
C. High TSH and High Free T4
D. Low TSH and Low Free T4
Answer: B
Rationale: In primary hypothyroidism, the thyroid gland fails, leading to low Free T4,
which causes the pituitary to produce more TSH in an attempt to stimulate the gland.
,3. A patient with COPD presents with increased sputum production and
dyspnea. According to GOLD guidelines, which medication class is the first-line
maintenance for Category B patients?
A. Short-acting beta-agonist (SABA) only
B. Long-acting muscarinic antagonist (LAMA) or LABA
C. Inhaled corticosteroids (ICS) only
D. Oral Prednisone
Answer: B
Rationale: For GOLD Category B (symptomatic but low risk of exacerbation), LAMA or
LABA is recommended as initial maintenance therapy.
4. Which physical exam maneuver is used to assess for a torn meniscus in the
knee?
A. Lachman Test
B. Valgus Stress Test
C. Anterior Drawer Test
D. McMurray Test
Answer: D
Rationale: The McMurray test involves rotation of the knee with flexion/extension to
identify meniscal tears. Lachman and Anterior Drawer are for ACL.
5. According to the ADA, what is the diagnostic threshold for Hemoglobin A1c
for Diabetes Mellitus?
A. Greater than or equal to 5.7%
B. Greater than or equal to 6.0%
C. Greater than or equal to 7.0%
D. Greater than or equal to 6.5%
Answer: D
, Rationale: An A1c of 6.5% or higher is the diagnostic criterion for Diabetes Mellitus. 5.7%
to 6.4% is considered pre-diabetes.
6. A patient presents with ‘the worst headache of my life’ and neck stiffness.
What is the immediate priority?
A. Administer high-dose Ibuprofen
B. Order an emergent CT scan of the head
C. Perform a Lumbar Puncture
D. Screen for Migraine triggers
Answer: B
Rationale: The description suggests a subarachnoid hemorrhage. An emergent non-
contrast CT is the first step to identify bleeding.
7. Which heart sound is associated with fluid overload and heart failure in an
older adult?
A. S1
B. S2
C. S4
D. S3
Answer: D
Rationale: S3 (ventricular gallop) is an early sign of heart failure and volume overload in
adults, occurring during the rapid filling phase of diastole.
