NR 603 CEA Midterm Exam - Advanced Clinical Diagnosis 2026/2027
Chamberlain
1. A 45-year-old male presents with a cough and wheezing that worsens at
night. Spirometry reveals an FEV1/FVC ratio of 0.65. After administration of a
bronchodilator, the FEV1 increases by 15%. What is the most likely diagnosis?
A. Chronic Obstructive Pulmonary Disease (COPD)
B. Congestive Heart Failure
C. Asthma
D. Acute Bronchitis
Answer: C
Rationale: Asthma is characterized by reversible airway obstruction, defined as an FEV1
increase of >12% following bronchodilator use.
2. According to the JNC-8 guidelines, what is the blood pressure goal for a 65-
year-old patient without diabetes or chronic kidney disease?
A. < 130/80 mmHg
B. < 140/90 mmHg
C. < 150/90 mmHg
D. < 120/70 mmHg
Answer: C
Rationale: For patients 65 years or older without DM or CKD, the JNC-8 goal is < 150/90
mmHg.
,3. Which of the following physical exam findings is most indicative of Heart
Failure?
A. Systolic Murmur
B. S3 Gallop
C. Wheezing
D. Clubbing of the fingers
Answer: B
Rationale: An S3 heart sound is a classic sign of fluid overload and ventricular filling,
highly suggestive of heart failure.
4. A patient presents with a TSH of 12.5 mIU/L and a low Free T4. What is the
appropriate initial management?
A. Methimazole
B. Levothyroxine
C. Radioactive Iodine
D. Observation and retest in 6 months
Answer: B
Rationale: High TSH and low Free T4 indicate primary hypothyroidism, which requires
thyroid hormone replacement with levothyroxine.
5. Which antibiotic class is the first-line treatment for an uncomplicated urinary
tract infection (UTI) in a non-pregnant woman?
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin
D. Azithromycin
Answer: C
Rationale: Nitrofurantoin (Macrobid) is considered first-line for uncomplicated cystitis
due to its efficacy and low resistance profile.
, 6. A 55-year-old male with a history of HTN and DM reports sudden onset of
‘the worst headache of my life’. What is the most critical next step?
A. Order a non-contrast Head CT
B. Perform an EKG
C. Administer Ibuprofen
D. Prescribe Sumatriptan
Answer: A
Rationale: A ‘thunderclap’ headache is the classic presentation for a subarachnoid
hemorrhage, necessitating urgent imaging.
7. Which laboratory value is used to differentiate between iron deficiency
anemia and anemia of chronic disease?
A. Hemoglobin
B. Ferritin
C. Mean Corpuscular Volume (MCV)
D. Hematocrit
Answer: B
Rationale: Ferritin is low in iron deficiency anemia but typically normal or high in anemia
of chronic disease (as it is an acute phase reactant).
8. What is the primary diagnostic criterion for Diabetes Mellitus based on
Glycated Hemoglobin (A1c)?
A. >= 5.7%
B. >= 6.0%
C. >= 7.0%
D. >= 6.5%
Answer: D
Rationale: An A1c of 6.5% or higher on two separate occasions (or with symptoms) is
diagnostic for Diabetes Mellitus.
Chamberlain
1. A 45-year-old male presents with a cough and wheezing that worsens at
night. Spirometry reveals an FEV1/FVC ratio of 0.65. After administration of a
bronchodilator, the FEV1 increases by 15%. What is the most likely diagnosis?
A. Chronic Obstructive Pulmonary Disease (COPD)
B. Congestive Heart Failure
C. Asthma
D. Acute Bronchitis
Answer: C
Rationale: Asthma is characterized by reversible airway obstruction, defined as an FEV1
increase of >12% following bronchodilator use.
2. According to the JNC-8 guidelines, what is the blood pressure goal for a 65-
year-old patient without diabetes or chronic kidney disease?
A. < 130/80 mmHg
B. < 140/90 mmHg
C. < 150/90 mmHg
D. < 120/70 mmHg
Answer: C
Rationale: For patients 65 years or older without DM or CKD, the JNC-8 goal is < 150/90
mmHg.
,3. Which of the following physical exam findings is most indicative of Heart
Failure?
A. Systolic Murmur
B. S3 Gallop
C. Wheezing
D. Clubbing of the fingers
Answer: B
Rationale: An S3 heart sound is a classic sign of fluid overload and ventricular filling,
highly suggestive of heart failure.
4. A patient presents with a TSH of 12.5 mIU/L and a low Free T4. What is the
appropriate initial management?
A. Methimazole
B. Levothyroxine
C. Radioactive Iodine
D. Observation and retest in 6 months
Answer: B
Rationale: High TSH and low Free T4 indicate primary hypothyroidism, which requires
thyroid hormone replacement with levothyroxine.
5. Which antibiotic class is the first-line treatment for an uncomplicated urinary
tract infection (UTI) in a non-pregnant woman?
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin
D. Azithromycin
Answer: C
Rationale: Nitrofurantoin (Macrobid) is considered first-line for uncomplicated cystitis
due to its efficacy and low resistance profile.
, 6. A 55-year-old male with a history of HTN and DM reports sudden onset of
‘the worst headache of my life’. What is the most critical next step?
A. Order a non-contrast Head CT
B. Perform an EKG
C. Administer Ibuprofen
D. Prescribe Sumatriptan
Answer: A
Rationale: A ‘thunderclap’ headache is the classic presentation for a subarachnoid
hemorrhage, necessitating urgent imaging.
7. Which laboratory value is used to differentiate between iron deficiency
anemia and anemia of chronic disease?
A. Hemoglobin
B. Ferritin
C. Mean Corpuscular Volume (MCV)
D. Hematocrit
Answer: B
Rationale: Ferritin is low in iron deficiency anemia but typically normal or high in anemia
of chronic disease (as it is an acute phase reactant).
8. What is the primary diagnostic criterion for Diabetes Mellitus based on
Glycated Hemoglobin (A1c)?
A. >= 5.7%
B. >= 6.0%
C. >= 7.0%
D. >= 6.5%
Answer: D
Rationale: An A1c of 6.5% or higher on two separate occasions (or with symptoms) is
diagnostic for Diabetes Mellitus.
