NR 603 CEA Midterm Exam - Advanced Clinical Diagnosis 2026
Chamberlain College
1. A 65-year-old male presents with a mid-systolic crescendo-decrescendo
murmur heard best at the right upper sternal border, radiating to the carotid
arteries. What is the most likely diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: A
Rationale: Aortic stenosis typically presents as a crescendo-decrescendo systolic murmur
at the right second intercostal space with radiation to the carotids.
2. Which of the following is the primary diagnostic criterion for Diabetes
Mellitus based on a Fasting Plasma Glucose (FPG) test?
A. FPG ≥ 100 mg/dL
B. FPG ≥ 126 mg/dL
C. FPG ≥ 140 mg/dL
D. FPG ≥ 110 mg/dL
Answer: B
Rationale: According to ADA guidelines, a fasting plasma glucose of 126 mg/dL or higher
on two separate occasions is diagnostic for diabetes.
,3. A patient with COPD presents with increased sputum purulence and dyspnea.
According to the GOLD guidelines, what is the first-line treatment for an acute
exacerbation?
A. Inhaled Corticosteroids
B. Short-acting Beta-Agonists (SABA)
C. Long-acting Muscarinic Antagonists (LAMA)
D. Theophylline
Answer: B
Rationale: Short-acting inhaled beta2-agonists, with or without short-acting
anticholinergics, are the preferred initial bronchodilators for an acute exacerbation.
4. A 45-year-old female presents with fatigue and cold intolerance. Her TSH is
12.5 mIU/L (High) and Free T4 is 0.5 ng/dL (Low). What is the most appropriate
next step?
A. Recheck labs in 6 months
B. Start Levothyroxine
C. Start Methimazole
D. Refer for thyroid ultrasound
Answer: B
Rationale: The patient has overt primary hypothyroidism (high TSH, low T4) and requires
hormone replacement therapy with Levothyroxine.
5. Which physical exam finding is most indicative of acute cholecystitis?
A. Rovsing’s sign
B. Psoas sign
C. Murphy’s sign
D. Cullen’s sign
Answer: C
, Rationale: Murphy’s sign (arrest of inspiration on palpation of the gallbladder) is highly
suggestive of acute cholecystitis.
6. A patient’s EKG shows a ‘sawtooth’ pattern in leads II, III, and aVF. What is
the most likely rhythm?
A. Atrial Fibrillation
B. First-degree AV Block
C. Ventricular Tachycardia
D. Atrial Flutter
Answer: D
Rationale: Atrial flutter is characterized by a regular sawtooth-like atrial rate (F waves)
usually around 250-350 bpm.
7. Which of the following is considered the ‘gold standard’ for diagnosing iron
deficiency anemia?
A. Serum Iron level
B. Hemoglobin level
C. Serum Ferritin level
D. Total Iron Binding Capacity (TIBC)
Answer: C
Rationale: Serum ferritin is the most specific biochemical indicator of iron stores.
8. A 28-year-old male presents with a sudden onset of ‘the worst headache of
my life.’ What is the most critical differential diagnosis?
A. Subarachnoid hemorrhage
B. Cluster headache
C. Migraine with aura
D. Tension headache
Answer: A
Chamberlain College
1. A 65-year-old male presents with a mid-systolic crescendo-decrescendo
murmur heard best at the right upper sternal border, radiating to the carotid
arteries. What is the most likely diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: A
Rationale: Aortic stenosis typically presents as a crescendo-decrescendo systolic murmur
at the right second intercostal space with radiation to the carotids.
2. Which of the following is the primary diagnostic criterion for Diabetes
Mellitus based on a Fasting Plasma Glucose (FPG) test?
A. FPG ≥ 100 mg/dL
B. FPG ≥ 126 mg/dL
C. FPG ≥ 140 mg/dL
D. FPG ≥ 110 mg/dL
Answer: B
Rationale: According to ADA guidelines, a fasting plasma glucose of 126 mg/dL or higher
on two separate occasions is diagnostic for diabetes.
,3. A patient with COPD presents with increased sputum purulence and dyspnea.
According to the GOLD guidelines, what is the first-line treatment for an acute
exacerbation?
A. Inhaled Corticosteroids
B. Short-acting Beta-Agonists (SABA)
C. Long-acting Muscarinic Antagonists (LAMA)
D. Theophylline
Answer: B
Rationale: Short-acting inhaled beta2-agonists, with or without short-acting
anticholinergics, are the preferred initial bronchodilators for an acute exacerbation.
4. A 45-year-old female presents with fatigue and cold intolerance. Her TSH is
12.5 mIU/L (High) and Free T4 is 0.5 ng/dL (Low). What is the most appropriate
next step?
A. Recheck labs in 6 months
B. Start Levothyroxine
C. Start Methimazole
D. Refer for thyroid ultrasound
Answer: B
Rationale: The patient has overt primary hypothyroidism (high TSH, low T4) and requires
hormone replacement therapy with Levothyroxine.
5. Which physical exam finding is most indicative of acute cholecystitis?
A. Rovsing’s sign
B. Psoas sign
C. Murphy’s sign
D. Cullen’s sign
Answer: C
, Rationale: Murphy’s sign (arrest of inspiration on palpation of the gallbladder) is highly
suggestive of acute cholecystitis.
6. A patient’s EKG shows a ‘sawtooth’ pattern in leads II, III, and aVF. What is
the most likely rhythm?
A. Atrial Fibrillation
B. First-degree AV Block
C. Ventricular Tachycardia
D. Atrial Flutter
Answer: D
Rationale: Atrial flutter is characterized by a regular sawtooth-like atrial rate (F waves)
usually around 250-350 bpm.
7. Which of the following is considered the ‘gold standard’ for diagnosing iron
deficiency anemia?
A. Serum Iron level
B. Hemoglobin level
C. Serum Ferritin level
D. Total Iron Binding Capacity (TIBC)
Answer: C
Rationale: Serum ferritin is the most specific biochemical indicator of iron stores.
8. A 28-year-old male presents with a sudden onset of ‘the worst headache of
my life.’ What is the most critical differential diagnosis?
A. Subarachnoid hemorrhage
B. Cluster headache
C. Migraine with aura
D. Tension headache
Answer: A
