NR 603 Advanced Clinical Diagnosis Comprehensive Final Exam
2026/2027 Chamberlain College
1. A 55-year-old male presents with a sudden onset of ‘the worst headache of
my life.’ Which diagnostic test should be ordered first?
A. MRI of the brain
B. Cerebral angiography
C. Lumbar puncture
D. Non-contrast CT scan of the head
Answer: D
Rationale: A non-contrast CT is the initial gold standard for detecting acute subarachnoid
hemorrhage due to its high sensitivity for fresh blood.
2. Which physical examination finding is most indicative of acute cholecystitis?
A. McBurney’s sign
B. Rovsing’s sign
C. Psoas sign
D. Murphy’s sign
Answer: D
Rationale: Murphy’s sign is a clinical test for gallbladder inflammation where the patient
catches their breath upon palpation of the right upper quadrant during deep inspiration.
,3. In the management of Type 2 Diabetes, which medication is considered the
first-line therapy unless contraindicated?
A. Glipizide
B. Metformin
C. Sitagliptin
D. Pioglitazone
Answer: B
Rationale: Metformin is recommended as the initial pharmacological treatment for its
efficacy, safety profile, and weight-neutral effects.
4. A patient presents with a ‘curtain coming down’ over their vision. This classic
description is associated with:
A. Macular degeneration
B. Glaucoma
C. Cataracts
D. Retinal detachment
Answer: D
Rationale: A sudden sensation of a shade or curtain across the visual field is a hallmark
symptom of retinal detachment.
5. Which heart sound is typically associated with heart failure and fluid overload
in adults?
A. S3
B. S2
C. S1
D. S4
Answer: A
Rationale: S3 (ventricular gallop) occurs early in diastole and is a sign of ventricular filling
into a non-compliant or overloaded ventricle.
, 6. What is the primary diagnostic test for confirming Chronic Obstructive
Pulmonary Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Pulse Oximetry
D. Arterial Blood Gas (ABG)
Answer: B
Rationale: Spirometry is required to confirm the diagnosis of COPD by showing persistent
airflow limitation (FEV1/FVC < 0.70).
7. A 65-year-old male with a 40 pack-year smoking history presents with
painless hematuria. What is the most likely diagnosis?
A. Urinary tract infection
B. Bladder cancer
C. Nephrolithiasis
D. Prostatitis
Answer: B
Rationale: Gross, painless hematuria in an older smoker is considered bladder cancer until
proven otherwise.
8. Which lab value is most sensitive for diagnosing primary hypothyroidism?
A. Free T4
B. TSH
C. Total T3
D. Thyroid peroxidase antibodies
Answer: B
Rationale: Thyroid Stimulating Hormone (TSH) is the most sensitive initial test for thyroid
dysfunction.
2026/2027 Chamberlain College
1. A 55-year-old male presents with a sudden onset of ‘the worst headache of
my life.’ Which diagnostic test should be ordered first?
A. MRI of the brain
B. Cerebral angiography
C. Lumbar puncture
D. Non-contrast CT scan of the head
Answer: D
Rationale: A non-contrast CT is the initial gold standard for detecting acute subarachnoid
hemorrhage due to its high sensitivity for fresh blood.
2. Which physical examination finding is most indicative of acute cholecystitis?
A. McBurney’s sign
B. Rovsing’s sign
C. Psoas sign
D. Murphy’s sign
Answer: D
Rationale: Murphy’s sign is a clinical test for gallbladder inflammation where the patient
catches their breath upon palpation of the right upper quadrant during deep inspiration.
,3. In the management of Type 2 Diabetes, which medication is considered the
first-line therapy unless contraindicated?
A. Glipizide
B. Metformin
C. Sitagliptin
D. Pioglitazone
Answer: B
Rationale: Metformin is recommended as the initial pharmacological treatment for its
efficacy, safety profile, and weight-neutral effects.
4. A patient presents with a ‘curtain coming down’ over their vision. This classic
description is associated with:
A. Macular degeneration
B. Glaucoma
C. Cataracts
D. Retinal detachment
Answer: D
Rationale: A sudden sensation of a shade or curtain across the visual field is a hallmark
symptom of retinal detachment.
5. Which heart sound is typically associated with heart failure and fluid overload
in adults?
A. S3
B. S2
C. S1
D. S4
Answer: A
Rationale: S3 (ventricular gallop) occurs early in diastole and is a sign of ventricular filling
into a non-compliant or overloaded ventricle.
, 6. What is the primary diagnostic test for confirming Chronic Obstructive
Pulmonary Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Pulse Oximetry
D. Arterial Blood Gas (ABG)
Answer: B
Rationale: Spirometry is required to confirm the diagnosis of COPD by showing persistent
airflow limitation (FEV1/FVC < 0.70).
7. A 65-year-old male with a 40 pack-year smoking history presents with
painless hematuria. What is the most likely diagnosis?
A. Urinary tract infection
B. Bladder cancer
C. Nephrolithiasis
D. Prostatitis
Answer: B
Rationale: Gross, painless hematuria in an older smoker is considered bladder cancer until
proven otherwise.
8. Which lab value is most sensitive for diagnosing primary hypothyroidism?
A. Free T4
B. TSH
C. Total T3
D. Thyroid peroxidase antibodies
Answer: B
Rationale: Thyroid Stimulating Hormone (TSH) is the most sensitive initial test for thyroid
dysfunction.
