Chamberlain NR 575 Clinical Evaluation Assessment
(CEA) — Comprehensive Exam Preparation 2026/2027
1. A 68-year-old man presents with sudden onset left-sided weakness and slurred
speech for 45 minutes. Which action is the highest priority?
A. Order a noncontrast head CT and notify stroke team immediately
B. Assess airway, breathing, circulation and prepare for rapid stroke evaluation
C. Provide oral aspirin immediately without imaging
D. Schedule MRI for next day
Answer: B
Rationale: The highest priority in any emergency, including a potential stroke, is to
assess and stabilize the patient's Airway, Breathing, and Circulation (ABCs). This must be
done before any diagnostic imaging or specific interventions can be initiated. Rapid
stroke pathway activation follows to evaluate for thrombolytic therapy within the
treatment window .
2. A 32-year-old woman reports sharp pleuritic chest pain and shortness of breath
after a long flight. Which test most rapidly helps confirm pulmonary embolism at
bedside?
A. Chest x-ray
B. D-dimer
C. Arterial blood gas only
D. Echocardiogram
Answer: B
Rationale: A D-dimer test is a rapid, highly sensitive screening tool used in patients with
low-to-moderate pretest probability of a pulmonary embolism. While a negative D-
dimer can help rule out the diagnosis, a positive result requires further confirmation with
imaging, such as a CT pulmonary angiogram .
3. A patient has focal neurological deficits and CT shows an intracerebral
hemorrhage. Which blood pressure goal is appropriate initially?
A. Allow systolic BP up to 220 mm Hg
B. Lower systolic BP to <140–160 mm Hg per acute hemorrhage guidelines
C. Aggressively reduce systolic BP to <90 mm Hg immediately
D. No blood pressure management needed
Answer: B
Rationale: In the setting of an acute intracerebral hemorrhage, controlled reduction of
,systolic blood pressure to a target range of <140–160 mm Hg is recommended to limit
hematoma expansion. Overly aggressive lowering of blood pressure can risk cerebral
ischemia .
4. A patient with suspected sepsis demonstrates hypotension and lactate >4
mmol/L. What is initial fluid resuscitation goal?
A. Bolus 10 mL total then reassess in 24 hours
B. Administer 30 mL/kg isotonic crystalloid within first 3 hours
C. Use colloids only
D. Restrict fluids to avoid edema
Answer: B
Rationale: For patients presenting with septic shock and elevated lactate, current
guidelines recommend early, aggressive fluid resuscitation with 30 mL/kg of isotonic
crystalloid to be administered within the first 3 hours of recognition .
5. A 50-year-old with hyperthyroidism has tachycardia, fever, and altered mental
status—likely thyroid storm. What is first-line immediate therapy?
A. Beta-blocker, antithyroid medication, iodide, and supportive care
B. Begin propranolol, high-dose PTU or methimazole, glucocorticoids, and iodine after
antithyroid drug
C. Only radioactive iodine therapy
D. Immediate thyroidectomy without stabilization
Answer: B
Rationale: Thyroid storm is a life-threatening emergency requiring a multi-pronged
approach. Therapy includes a beta-blocker (like propranolol) to control tachycardia, a
high-dose thioamide (like propylthiouracil (PTU) or methimazole) to block new hormone
synthesis, iodine (administered after the thioamide to prevent the Jod-Basedow effect),
and glucocorticoids to prevent relative adrenal insufficiency and inhibit T4 to T3
conversion .
6. A 35-year-old with suspected bacterial meningitis arrives. Which immediate
therapy should not be delayed pending imaging?
A. Lumbar puncture only
B. Empiric IV antibiotics (and dexamethasone if indicated) immediately after obtaining
blood cultures
C. Wait for MRI results before treating
D. Oral antibiotics at home
Answer: B
Rationale: Empiric IV antibiotics should be administered as soon as possible in a patient
,with suspected bacterial meningitis. It is crucial to obtain blood cultures before starting
antibiotics, but treatment should not be delayed for a lumbar puncture or imaging,
which can follow promptly .
7. A 45-year-old with asthma uses albuterol frequently (multiple times/day) and
reports nighttime symptoms. Which step is most appropriate?
A. Continue albuterol only as needed
B. Initiate or step up daily inhaled corticosteroid therapy and assess control
C. Add ipratropium as monotherapy
D. Recommend oral corticosteroids for indefinite use
Answer: B
Rationale: Frequent use of a short-acting beta-agonist (SABA) like albuterol, especially
when accompanied by nighttime symptoms, indicates poor asthma control. The
appropriate management step is to initiate or increase the dose of a daily controller
medication, typically an inhaled corticosteroid (ICS), to reduce airway inflammation and
improve control .
8. A 72-year-old diabetic with decreased foot sensation has a foot ulcer with
purulent drainage. What is the best initial management step?
A. Prescribe topical antifungal only
B. Obtain wound culture and start empiric broad-spectrum antibiotics covering MRSA
and gram-negatives
C. Observe without treatment for 2 weeks
D. Refer to podiatry without starting antibiotics
Answer: B
Rationale: A diabetic foot ulcer with purulent drainage is a sign of infection. The initial
management should include obtaining a wound culture to guide antibiotic therapy and
starting empiric broad-spectrum antibiotics that cover common pathogens including
methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative organisms,
pending culture results .
9. A 60-year-old smoker has hemoptysis and weight loss. Which diagnostic step is
highest priority?
A. Empiric antibiotics for cough only
B. Order chest CT scan and refer for bronchoscopy as indicated to evaluate for
malignancy
C. Reassure patient and delay workup for 6 months
D. Only sputum culture for viruses
, Answer: B
Rationale: Hemoptysis in a patient with a significant smoking history and constitutional
symptoms like weight loss is a red flag for lung cancer or other serious pulmonary
pathology. Prompt imaging with a chest CT and referral for bronchoscopy if indicated
are the highest priorities for diagnosis .
10. A patient with possible acute pancreatitis presents with severe epigastric pain
radiating to the back and elevated amylase/lipase. Which is the most important
initial management?
A. Start enteral feeding immediately
B. Aggressive IV fluid resuscitation, pain control, and NPO status initially
C. Immediate surgery on arrival for all cases
D. Outpatient oral antibiotics only
Answer: B
Rationale: The cornerstone of initial management for acute pancreatitis is aggressive IV
fluid resuscitation to maintain intravascular volume, effective pain control, and keeping
the patient NPO (nothing by mouth) to reduce pancreatic stimulation. Surgery is rarely
indicated in the acute phase .
11. A woman of childbearing age with hypertension is being started on therapy.
Which antihypertensive should be avoided if pregnancy is possible?
A. Methyldopa
B. ACE inhibitors (e.g., lisinopril)
C. Labetalol
D. Nifedipine
Answer: B
Rationale: ACE inhibitors and ARBs are known teratogens and are strictly
contraindicated in pregnancy due to the risk of fetal renal agenesis and other congenital
anomalies. Safer alternatives for hypertension in pregnancy include methyldopa,
labetalol, and nifedipine .
12. A patient with atrial fibrillation (AF) is being evaluated for anticoagulation.
Which score helps estimate stroke risk?
A. APGAR score
B. CHA₂DS₂-VASc score
C. MELD score
D. Braden score
Answer: B
Rationale: The CHA₂DS₂-VASc score is a clinical prediction rule used to estimate the risk
(CEA) — Comprehensive Exam Preparation 2026/2027
1. A 68-year-old man presents with sudden onset left-sided weakness and slurred
speech for 45 minutes. Which action is the highest priority?
A. Order a noncontrast head CT and notify stroke team immediately
B. Assess airway, breathing, circulation and prepare for rapid stroke evaluation
C. Provide oral aspirin immediately without imaging
D. Schedule MRI for next day
Answer: B
Rationale: The highest priority in any emergency, including a potential stroke, is to
assess and stabilize the patient's Airway, Breathing, and Circulation (ABCs). This must be
done before any diagnostic imaging or specific interventions can be initiated. Rapid
stroke pathway activation follows to evaluate for thrombolytic therapy within the
treatment window .
2. A 32-year-old woman reports sharp pleuritic chest pain and shortness of breath
after a long flight. Which test most rapidly helps confirm pulmonary embolism at
bedside?
A. Chest x-ray
B. D-dimer
C. Arterial blood gas only
D. Echocardiogram
Answer: B
Rationale: A D-dimer test is a rapid, highly sensitive screening tool used in patients with
low-to-moderate pretest probability of a pulmonary embolism. While a negative D-
dimer can help rule out the diagnosis, a positive result requires further confirmation with
imaging, such as a CT pulmonary angiogram .
3. A patient has focal neurological deficits and CT shows an intracerebral
hemorrhage. Which blood pressure goal is appropriate initially?
A. Allow systolic BP up to 220 mm Hg
B. Lower systolic BP to <140–160 mm Hg per acute hemorrhage guidelines
C. Aggressively reduce systolic BP to <90 mm Hg immediately
D. No blood pressure management needed
Answer: B
Rationale: In the setting of an acute intracerebral hemorrhage, controlled reduction of
,systolic blood pressure to a target range of <140–160 mm Hg is recommended to limit
hematoma expansion. Overly aggressive lowering of blood pressure can risk cerebral
ischemia .
4. A patient with suspected sepsis demonstrates hypotension and lactate >4
mmol/L. What is initial fluid resuscitation goal?
A. Bolus 10 mL total then reassess in 24 hours
B. Administer 30 mL/kg isotonic crystalloid within first 3 hours
C. Use colloids only
D. Restrict fluids to avoid edema
Answer: B
Rationale: For patients presenting with septic shock and elevated lactate, current
guidelines recommend early, aggressive fluid resuscitation with 30 mL/kg of isotonic
crystalloid to be administered within the first 3 hours of recognition .
5. A 50-year-old with hyperthyroidism has tachycardia, fever, and altered mental
status—likely thyroid storm. What is first-line immediate therapy?
A. Beta-blocker, antithyroid medication, iodide, and supportive care
B. Begin propranolol, high-dose PTU or methimazole, glucocorticoids, and iodine after
antithyroid drug
C. Only radioactive iodine therapy
D. Immediate thyroidectomy without stabilization
Answer: B
Rationale: Thyroid storm is a life-threatening emergency requiring a multi-pronged
approach. Therapy includes a beta-blocker (like propranolol) to control tachycardia, a
high-dose thioamide (like propylthiouracil (PTU) or methimazole) to block new hormone
synthesis, iodine (administered after the thioamide to prevent the Jod-Basedow effect),
and glucocorticoids to prevent relative adrenal insufficiency and inhibit T4 to T3
conversion .
6. A 35-year-old with suspected bacterial meningitis arrives. Which immediate
therapy should not be delayed pending imaging?
A. Lumbar puncture only
B. Empiric IV antibiotics (and dexamethasone if indicated) immediately after obtaining
blood cultures
C. Wait for MRI results before treating
D. Oral antibiotics at home
Answer: B
Rationale: Empiric IV antibiotics should be administered as soon as possible in a patient
,with suspected bacterial meningitis. It is crucial to obtain blood cultures before starting
antibiotics, but treatment should not be delayed for a lumbar puncture or imaging,
which can follow promptly .
7. A 45-year-old with asthma uses albuterol frequently (multiple times/day) and
reports nighttime symptoms. Which step is most appropriate?
A. Continue albuterol only as needed
B. Initiate or step up daily inhaled corticosteroid therapy and assess control
C. Add ipratropium as monotherapy
D. Recommend oral corticosteroids for indefinite use
Answer: B
Rationale: Frequent use of a short-acting beta-agonist (SABA) like albuterol, especially
when accompanied by nighttime symptoms, indicates poor asthma control. The
appropriate management step is to initiate or increase the dose of a daily controller
medication, typically an inhaled corticosteroid (ICS), to reduce airway inflammation and
improve control .
8. A 72-year-old diabetic with decreased foot sensation has a foot ulcer with
purulent drainage. What is the best initial management step?
A. Prescribe topical antifungal only
B. Obtain wound culture and start empiric broad-spectrum antibiotics covering MRSA
and gram-negatives
C. Observe without treatment for 2 weeks
D. Refer to podiatry without starting antibiotics
Answer: B
Rationale: A diabetic foot ulcer with purulent drainage is a sign of infection. The initial
management should include obtaining a wound culture to guide antibiotic therapy and
starting empiric broad-spectrum antibiotics that cover common pathogens including
methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative organisms,
pending culture results .
9. A 60-year-old smoker has hemoptysis and weight loss. Which diagnostic step is
highest priority?
A. Empiric antibiotics for cough only
B. Order chest CT scan and refer for bronchoscopy as indicated to evaluate for
malignancy
C. Reassure patient and delay workup for 6 months
D. Only sputum culture for viruses
, Answer: B
Rationale: Hemoptysis in a patient with a significant smoking history and constitutional
symptoms like weight loss is a red flag for lung cancer or other serious pulmonary
pathology. Prompt imaging with a chest CT and referral for bronchoscopy if indicated
are the highest priorities for diagnosis .
10. A patient with possible acute pancreatitis presents with severe epigastric pain
radiating to the back and elevated amylase/lipase. Which is the most important
initial management?
A. Start enteral feeding immediately
B. Aggressive IV fluid resuscitation, pain control, and NPO status initially
C. Immediate surgery on arrival for all cases
D. Outpatient oral antibiotics only
Answer: B
Rationale: The cornerstone of initial management for acute pancreatitis is aggressive IV
fluid resuscitation to maintain intravascular volume, effective pain control, and keeping
the patient NPO (nothing by mouth) to reduce pancreatic stimulation. Surgery is rarely
indicated in the acute phase .
11. A woman of childbearing age with hypertension is being started on therapy.
Which antihypertensive should be avoided if pregnancy is possible?
A. Methyldopa
B. ACE inhibitors (e.g., lisinopril)
C. Labetalol
D. Nifedipine
Answer: B
Rationale: ACE inhibitors and ARBs are known teratogens and are strictly
contraindicated in pregnancy due to the risk of fetal renal agenesis and other congenital
anomalies. Safer alternatives for hypertension in pregnancy include methyldopa,
labetalol, and nifedipine .
12. A patient with atrial fibrillation (AF) is being evaluated for anticoagulation.
Which score helps estimate stroke risk?
A. APGAR score
B. CHA₂DS₂-VASc score
C. MELD score
D. Braden score
Answer: B
Rationale: The CHA₂DS₂-VASc score is a clinical prediction rule used to estimate the risk
