NR 603 CEA Final Exam - Advanced Clinical Diagnosis 2026
Chamberlain
1. A 65-year-old male presents with sudden onset of substernal chest pain and
diaphoresis. The EKG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Left Circumflex (LCx)
C. Right Coronary Artery (RCA)
D. Left Main Coronary Artery
Answer: C
Rationale: Elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, which is most commonly supplied by the Right Coronary Artery.
2. According to the JNC 8 guidelines, what is the blood pressure goal for a 62-
year-old patient with Chronic Kidney Disease?
A. <130/80 mmHg
B. <140/90 mmHg
C. <150/90 mmHg
D. <120/80 mmHg
Answer: B
Rationale: For patients of all ages with CKD or Diabetes, JNC 8 recommends a blood
pressure goal of less than 140/90 mmHg.
,3. Which of the following physical exam findings is most characteristic of
Chronic Obstructive Pulmonary Disease (COPD)?
A. Increased tactile fremitus
B. Pectoriloquy
C. Dullness to percussion
D. Hyperresonance on percussion
Answer: D
Rationale: Hyperresonance is caused by air trapping and hyperinflation of the lungs,
common in COPD. Increased fremitus and dullness suggest consolidation like pneumonia.
4. A 45-year-old female complains of fatigue and cold intolerance. Her TSH is
12.5 mIU/L (High) and Free T4 is 0.6 ng/dL (Low). What is the most likely
diagnosis?
A. Subclinical hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Primary hypothyroidism
Answer: D
Rationale: A high TSH combined with a low Free T4 confirms primary hypothyroidism,
most commonly caused by Hashimoto’s thyroiditis.
5. Which heart sound is frequently associated with heart failure and fluid
volume overload in adults?
A. Opening snap
B. S4
C. Ejection click
D. S3
Answer: D
, Rationale: The S3 gallop is a sign of ventricular filling into a dilated, non-compliant
chamber, often seen in congestive heart failure.
6. A patient presents with a ‘curtain coming down’ over their vision in the right
eye. This is most suspicious for:
A. Retinal detachment
B. Cataracts
C. Glaucoma
D. Macular degeneration
Answer: A
Rationale: A sudden, painless loss of vision described as a curtain or shadow is a classic
symptom of retinal detachment and is an emergency.
7. What is the first-line antibiotic treatment for an uncomplicated urinary tract
infection (UTI) in a non-pregnant woman?
A. Nitrofurantoin (Macrobid)
B. Ciprofloxacin
C. Amoxicillin
D. Azithromycin
Answer: A
Rationale: Nitrofurantoin is considered first-line for uncomplicated UTIs due to its
effectiveness and low resistance rates compared to fluoroquinolones.
8. Which of the following is the gold standard for diagnosing obstructive sleep
apnea?
A. Polysomnography
B. Overnight pulse oximetry
C. Epworth Sleepiness Scale
D. Chest X-ray
Answer: A
Chamberlain
1. A 65-year-old male presents with sudden onset of substernal chest pain and
diaphoresis. The EKG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Left Circumflex (LCx)
C. Right Coronary Artery (RCA)
D. Left Main Coronary Artery
Answer: C
Rationale: Elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, which is most commonly supplied by the Right Coronary Artery.
2. According to the JNC 8 guidelines, what is the blood pressure goal for a 62-
year-old patient with Chronic Kidney Disease?
A. <130/80 mmHg
B. <140/90 mmHg
C. <150/90 mmHg
D. <120/80 mmHg
Answer: B
Rationale: For patients of all ages with CKD or Diabetes, JNC 8 recommends a blood
pressure goal of less than 140/90 mmHg.
,3. Which of the following physical exam findings is most characteristic of
Chronic Obstructive Pulmonary Disease (COPD)?
A. Increased tactile fremitus
B. Pectoriloquy
C. Dullness to percussion
D. Hyperresonance on percussion
Answer: D
Rationale: Hyperresonance is caused by air trapping and hyperinflation of the lungs,
common in COPD. Increased fremitus and dullness suggest consolidation like pneumonia.
4. A 45-year-old female complains of fatigue and cold intolerance. Her TSH is
12.5 mIU/L (High) and Free T4 is 0.6 ng/dL (Low). What is the most likely
diagnosis?
A. Subclinical hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Primary hypothyroidism
Answer: D
Rationale: A high TSH combined with a low Free T4 confirms primary hypothyroidism,
most commonly caused by Hashimoto’s thyroiditis.
5. Which heart sound is frequently associated with heart failure and fluid
volume overload in adults?
A. Opening snap
B. S4
C. Ejection click
D. S3
Answer: D
, Rationale: The S3 gallop is a sign of ventricular filling into a dilated, non-compliant
chamber, often seen in congestive heart failure.
6. A patient presents with a ‘curtain coming down’ over their vision in the right
eye. This is most suspicious for:
A. Retinal detachment
B. Cataracts
C. Glaucoma
D. Macular degeneration
Answer: A
Rationale: A sudden, painless loss of vision described as a curtain or shadow is a classic
symptom of retinal detachment and is an emergency.
7. What is the first-line antibiotic treatment for an uncomplicated urinary tract
infection (UTI) in a non-pregnant woman?
A. Nitrofurantoin (Macrobid)
B. Ciprofloxacin
C. Amoxicillin
D. Azithromycin
Answer: A
Rationale: Nitrofurantoin is considered first-line for uncomplicated UTIs due to its
effectiveness and low resistance rates compared to fluoroquinolones.
8. Which of the following is the gold standard for diagnosing obstructive sleep
apnea?
A. Polysomnography
B. Overnight pulse oximetry
C. Epworth Sleepiness Scale
D. Chest X-ray
Answer: A
