NR 603 CEA Midterm Exam (2026) - Advanced Clinical Diagnosis
Chamberlain
1. A positive Murphy’s sign is most indicative of which condition?
A. Acute Appendicitis
B. Acute Pancreatitis
C. Acute Cholecystitis
D. Nephrolithiasis
Answer: C
Rationale: Murphy’s sign is assessed by palpitating the right upper quadrant while the
patient inspires; a sharp halt in inspiration due to pain suggests gallbladder inflammation.
2. Which laboratory value is the most sensitive indicator for iron deficiency
anemia?
A. Serum Ferritin
B. Hemoglobin
C. Serum Iron
D. Total Iron Binding Capacity
Answer: A
Rationale: Serum ferritin reflects total body iron stores and is the first value to drop in
iron deficiency anemia.
,3. A low-pitched, rumbling diastolic murmur heard best at the apex with the
patient in the left lateral decubitus position is:
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Stenosis
D. Tricuspid Stenosis
Answer: C
Rationale: Mitral stenosis typically produces a mid-diastolic rumble best heard at the apex
in the left lateral position.
4. To confirm a diagnosis of Asthma, which spirometry finding is required?
A. Reversibility with a >12% increase in FEV1 after bronchodilator
B. FEV1/FVC ratio greater than 0.80
C. Fixed airway obstruction
D. Increased Total Lung Capacity
Answer: A
Rationale: Asthma is characterized by reversible airway obstruction, defined as a
significant improvement in FEV1 after using a short-acting beta-agonist.
5. Which cranial nerve is being tested when asking a patient to shrug their
shoulders against resistance?
A. CN XI (Spinal Accessory)
B. CN IX (Glossopharyngeal)
C. CN XII (Hypoglossal)
D. CN X (Vagus)
Answer: A
Rationale: The spinal accessory nerve (CN XI) innervates the trapezius and
sternocleidomastoid muscles.
, 6. According to the ADA, what Hemoglobin A1c level is diagnostic for Diabetes
Mellitus?
A. Greater than or equal to 6.5%
B. Greater than or equal to 6.0%
C. Greater than or equal to 5.7%
D. Greater than or equal to 7.0%
Answer: A
Rationale: An A1c of 6.5% or higher on two separate tests (or with symptoms) is
diagnostic for diabetes.
7. In primary hypothyroidism, what is the expected pattern of thyroid labs?
A. High TSH, High Free T4
B. High TSH, Low Free T4
C. Low TSH, Low Free T4
D. Low TSH, High Free T4
Answer: B
Rationale: Primary hypothyroidism involves thyroid gland failure, leading to low T4 and a
compensatory rise in TSH from the pituitary.
8. The McMurray test is used to evaluate for an injury to which structure?
A. Meniscus
B. Anterior Cruciate Ligament
C. Medial Collateral Ligament
D. Patellar Tendon
Answer: A
Rationale: The McMurray test involves rotating the knee with internal/external stress to
detect clicks or pain indicative of a meniscal tear.
Chamberlain
1. A positive Murphy’s sign is most indicative of which condition?
A. Acute Appendicitis
B. Acute Pancreatitis
C. Acute Cholecystitis
D. Nephrolithiasis
Answer: C
Rationale: Murphy’s sign is assessed by palpitating the right upper quadrant while the
patient inspires; a sharp halt in inspiration due to pain suggests gallbladder inflammation.
2. Which laboratory value is the most sensitive indicator for iron deficiency
anemia?
A. Serum Ferritin
B. Hemoglobin
C. Serum Iron
D. Total Iron Binding Capacity
Answer: A
Rationale: Serum ferritin reflects total body iron stores and is the first value to drop in
iron deficiency anemia.
,3. A low-pitched, rumbling diastolic murmur heard best at the apex with the
patient in the left lateral decubitus position is:
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Stenosis
D. Tricuspid Stenosis
Answer: C
Rationale: Mitral stenosis typically produces a mid-diastolic rumble best heard at the apex
in the left lateral position.
4. To confirm a diagnosis of Asthma, which spirometry finding is required?
A. Reversibility with a >12% increase in FEV1 after bronchodilator
B. FEV1/FVC ratio greater than 0.80
C. Fixed airway obstruction
D. Increased Total Lung Capacity
Answer: A
Rationale: Asthma is characterized by reversible airway obstruction, defined as a
significant improvement in FEV1 after using a short-acting beta-agonist.
5. Which cranial nerve is being tested when asking a patient to shrug their
shoulders against resistance?
A. CN XI (Spinal Accessory)
B. CN IX (Glossopharyngeal)
C. CN XII (Hypoglossal)
D. CN X (Vagus)
Answer: A
Rationale: The spinal accessory nerve (CN XI) innervates the trapezius and
sternocleidomastoid muscles.
, 6. According to the ADA, what Hemoglobin A1c level is diagnostic for Diabetes
Mellitus?
A. Greater than or equal to 6.5%
B. Greater than or equal to 6.0%
C. Greater than or equal to 5.7%
D. Greater than or equal to 7.0%
Answer: A
Rationale: An A1c of 6.5% or higher on two separate tests (or with symptoms) is
diagnostic for diabetes.
7. In primary hypothyroidism, what is the expected pattern of thyroid labs?
A. High TSH, High Free T4
B. High TSH, Low Free T4
C. Low TSH, Low Free T4
D. Low TSH, High Free T4
Answer: B
Rationale: Primary hypothyroidism involves thyroid gland failure, leading to low T4 and a
compensatory rise in TSH from the pituitary.
8. The McMurray test is used to evaluate for an injury to which structure?
A. Meniscus
B. Anterior Cruciate Ligament
C. Medial Collateral Ligament
D. Patellar Tendon
Answer: A
Rationale: The McMurray test involves rotating the knee with internal/external stress to
detect clicks or pain indicative of a meniscal tear.
