,NR 603 Midterm Exam | Advanced Clinical Diagnosis (2026)
Actual Q&A PDF | Chamberlain
1. A 62-year-old male presents with substernal chest pressure that began 90 minutes
ago while shoveling snow. He is diaphoretic and nauseated. Which of the following is
the priority initial diagnostic step?
A) Obtain a 12-lead ECG within 10 minutes of arrival
B) Order a chest X-ray
C) Administer sublingual nitroglycerin
D) Draw serum electrolytes
Correct Answer: Obtain a 12-lead ECG within 10 minutes of arrival
Rationale: For any patient presenting with suspected acute coronary syndrome, a 12-
lead ECG must be obtained and interpreted within 10 minutes of arrival. This is the
priority because it identifies ST-elevation myocardial infarction, which requires emergent
reperfusion. Chest X-ray, nitroglycerin, and electrolytes are important but do not
supersede the immediate need for ECG diagnosis.
2. Which of the following physical examination maneuvers is specifically used to assess
for acute cholecystitis?
A) McBurney's sign
B) Psoas sign
C) Rovsing's sign
,D) Murphy's sign
Correct Answer: Murphy's sign
Rationale: Murphy's sign is performed by palpating the right upper quadrant while
the patient inspires. A positive test is characterized by the patient catching their breath
due to pain when the gallbladder descends against the examiner's hand. McBurney's
sign, Psoas sign, and Rovsing's sign are used to assess for appendicitis.
3. Which class of medications is indicated as first-line management for both post-
traumatic stress disorder and major depressive disorder?
A) Benzodiazepines
B) Selective serotonin reuptake inhibitors
C) Atypical antipsychotics
D) Tricyclic antidepressants
Correct Answer: Selective serotonin reuptake inhibitors
Rationale: SSRIs, such as sertraline and paroxetine, are FDA-approved and considered
first-line for both PTSD and MDD. They have a favorable safety profile and treat the core
symptoms of both conditions. Benzodiazepines are not first-line for PTSD, atypical
antipsychotics are adjunctive, and TCAs are second-line due to side effects.
4. A 55-year-old female presents with fatigue, cold intolerance, weight gain, and
constipation. TSH is elevated and free T4 is low. Which condition is most likely?
, A) Hyperthyroidism
B) Primary hypothyroidism
C) Central hypothyroidism
D) Subclinical hypothyroidism
Correct Answer: Primary hypothyroidism
Rationale: Primary hypothyroidism is characterized by an elevated TSH (as the
pituitary attempts to stimulate the gland) and a low free T4 (as the thyroid fails to
produce sufficient hormone). Hyperthyroidism would show low TSH and high free T4.
Central hypothyroidism would show low TSH and low free T4.
5. A patient presents with a suspected ACL tear. Which test is considered the most
sensitive for this diagnosis?
A) McMurray test
B) Anterior drawer test
C) Lachman test
D) Valgus stress test
Correct Answer: Lachman test
Rationale: The Lachman test is widely considered the most sensitive clinical test for
diagnosing an ACL injury compared to the anterior drawer test. It is performed with the
Actual Q&A PDF | Chamberlain
1. A 62-year-old male presents with substernal chest pressure that began 90 minutes
ago while shoveling snow. He is diaphoretic and nauseated. Which of the following is
the priority initial diagnostic step?
A) Obtain a 12-lead ECG within 10 minutes of arrival
B) Order a chest X-ray
C) Administer sublingual nitroglycerin
D) Draw serum electrolytes
Correct Answer: Obtain a 12-lead ECG within 10 minutes of arrival
Rationale: For any patient presenting with suspected acute coronary syndrome, a 12-
lead ECG must be obtained and interpreted within 10 minutes of arrival. This is the
priority because it identifies ST-elevation myocardial infarction, which requires emergent
reperfusion. Chest X-ray, nitroglycerin, and electrolytes are important but do not
supersede the immediate need for ECG diagnosis.
2. Which of the following physical examination maneuvers is specifically used to assess
for acute cholecystitis?
A) McBurney's sign
B) Psoas sign
C) Rovsing's sign
,D) Murphy's sign
Correct Answer: Murphy's sign
Rationale: Murphy's sign is performed by palpating the right upper quadrant while
the patient inspires. A positive test is characterized by the patient catching their breath
due to pain when the gallbladder descends against the examiner's hand. McBurney's
sign, Psoas sign, and Rovsing's sign are used to assess for appendicitis.
3. Which class of medications is indicated as first-line management for both post-
traumatic stress disorder and major depressive disorder?
A) Benzodiazepines
B) Selective serotonin reuptake inhibitors
C) Atypical antipsychotics
D) Tricyclic antidepressants
Correct Answer: Selective serotonin reuptake inhibitors
Rationale: SSRIs, such as sertraline and paroxetine, are FDA-approved and considered
first-line for both PTSD and MDD. They have a favorable safety profile and treat the core
symptoms of both conditions. Benzodiazepines are not first-line for PTSD, atypical
antipsychotics are adjunctive, and TCAs are second-line due to side effects.
4. A 55-year-old female presents with fatigue, cold intolerance, weight gain, and
constipation. TSH is elevated and free T4 is low. Which condition is most likely?
, A) Hyperthyroidism
B) Primary hypothyroidism
C) Central hypothyroidism
D) Subclinical hypothyroidism
Correct Answer: Primary hypothyroidism
Rationale: Primary hypothyroidism is characterized by an elevated TSH (as the
pituitary attempts to stimulate the gland) and a low free T4 (as the thyroid fails to
produce sufficient hormone). Hyperthyroidism would show low TSH and high free T4.
Central hypothyroidism would show low TSH and low free T4.
5. A patient presents with a suspected ACL tear. Which test is considered the most
sensitive for this diagnosis?
A) McMurray test
B) Anterior drawer test
C) Lachman test
D) Valgus stress test
Correct Answer: Lachman test
Rationale: The Lachman test is widely considered the most sensitive clinical test for
diagnosing an ACL injury compared to the anterior drawer test. It is performed with the
