NR603 – Advanced Clinical Diagnosis Clinical Education Associates (CEA)
Comprehensive Practice 2026/2027 Exam
1. A 58-year-old male presents with crushing substernal chest pain radiating to
the left arm for 30 minutes. Which is the priority action?
A. Obtain a 12-lead ECG immediately
B. Order a chest X-ray
C. Prescribe omeprazole
D. Schedule an exercise stress test
Correct Answer: A
Rationale: Suspected acute coronary syndrome requires immediate ECG evaluation, ideally
within 10 minutes of presentation.
2. Which finding is most concerning in a patient with chest pain?
A. Diaphoresis and hypotension
B. Mild anxiety
C. Heartburn after eating
D. Chest tenderness with palpation
Correct Answer: A
Rationale: Diaphoresis and hypotension suggest myocardial ischemia or cardiogenic shock.
3. A 65-year-old smoker presents with a chronic productive cough for 3 months
each year for the past 2 years. The most likely diagnosis is:
A. Chronic bronchitis
B. Asthma
C. Pulmonary embolism
D. Pneumothorax
Correct Answer: A
Rationale: Chronic bronchitis is defined by a productive cough for at least 3 months in each of 2
consecutive years.
,4. Which lung sound is most consistent with pneumonia?
A. Crackles (rales)
B. Pleural friction rub only
C. Stridor
D. Wheezing only
Correct Answer: A
Rationale: Crackles result from fluid within the alveoli and are commonly heard in pneumonia.
5. A patient presents with sudden unilateral leg swelling and calf tenderness.
Which diagnosis should be suspected first?
A. Deep vein thrombosis (DVT)
B. Cellulitis
C. Osteoarthritis
D. Gout
Correct Answer: A
Rationale: Unilateral swelling and calf pain are classic findings of DVT.
6. Which patient requires immediate emergency referral?
A. A patient with sudden facial droop and slurred speech
B. A patient with seasonal allergic rhinitis
C. A patient requesting a refill of antihypertensive medication
D. A patient with chronic low back pain
Correct Answer: A
Rationale: Sudden neurological deficits suggest an acute stroke and require emergency
evaluation.
7. Which laboratory test best reflects long-term glucose control?
,A. Hemoglobin A1c
B. Random glucose
C. Fasting insulin level
D. Urinalysis
Correct Answer: A
Rationale: Hemoglobin A1c reflects average blood glucose over the previous 2–3 months.
8. A patient reports polyuria, polydipsia, and unexplained weight loss. Which
diagnosis is most likely?
A. Diabetes mellitus
B. Hypothyroidism
C. GERD
D. Iron-deficiency anemia
Correct Answer: A
Rationale: These are classic symptoms of hyperglycemia and diabetes mellitus.
9. Which thyroid disorder commonly presents with weight loss, heat intolerance,
and tachycardia?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid cancer
D. Thyroid cyst
Correct Answer: A
Rationale: Hyperthyroidism increases metabolic activity, causing these symptoms.
10. Which physical examination finding is consistent with hypothyroidism?
A. Bradycardia and dry skin
B. Tremor and tachycardia
C. Exophthalmos
D. Warm, moist skin
, Correct Answer: A
Rationale: Hypothyroidism slows metabolism, leading to bradycardia, fatigue, and dry skin.
11. A patient presents with dysuria, urinary frequency, and urgency without
flank pain. The most likely diagnosis is:
A. Acute uncomplicated cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Prostatitis
Correct Answer: A
Rationale: Lower urinary tract symptoms without systemic illness are typical of cystitis.
12. Which finding suggests pyelonephritis rather than cystitis?
A. Costovertebral angle tenderness with fever
B. Urinary urgency only
C. Mild dysuria without fever
D. Increased urinary frequency only
Correct Answer: A
Rationale: Fever and CVA tenderness indicate upper urinary tract infection.
13. A patient with COPD has an oxygen saturation of 86% on room air. What is
the priority action?
A. Administer supplemental oxygen and assess respiratory status
B. Send the patient home
C. Repeat vital signs in 24 hours
D. Encourage vigorous exercise
Correct Answer: A
Rationale: Hypoxemia requires prompt oxygen therapy and further assessment.
Comprehensive Practice 2026/2027 Exam
1. A 58-year-old male presents with crushing substernal chest pain radiating to
the left arm for 30 minutes. Which is the priority action?
A. Obtain a 12-lead ECG immediately
B. Order a chest X-ray
C. Prescribe omeprazole
D. Schedule an exercise stress test
Correct Answer: A
Rationale: Suspected acute coronary syndrome requires immediate ECG evaluation, ideally
within 10 minutes of presentation.
2. Which finding is most concerning in a patient with chest pain?
A. Diaphoresis and hypotension
B. Mild anxiety
C. Heartburn after eating
D. Chest tenderness with palpation
Correct Answer: A
Rationale: Diaphoresis and hypotension suggest myocardial ischemia or cardiogenic shock.
3. A 65-year-old smoker presents with a chronic productive cough for 3 months
each year for the past 2 years. The most likely diagnosis is:
A. Chronic bronchitis
B. Asthma
C. Pulmonary embolism
D. Pneumothorax
Correct Answer: A
Rationale: Chronic bronchitis is defined by a productive cough for at least 3 months in each of 2
consecutive years.
,4. Which lung sound is most consistent with pneumonia?
A. Crackles (rales)
B. Pleural friction rub only
C. Stridor
D. Wheezing only
Correct Answer: A
Rationale: Crackles result from fluid within the alveoli and are commonly heard in pneumonia.
5. A patient presents with sudden unilateral leg swelling and calf tenderness.
Which diagnosis should be suspected first?
A. Deep vein thrombosis (DVT)
B. Cellulitis
C. Osteoarthritis
D. Gout
Correct Answer: A
Rationale: Unilateral swelling and calf pain are classic findings of DVT.
6. Which patient requires immediate emergency referral?
A. A patient with sudden facial droop and slurred speech
B. A patient with seasonal allergic rhinitis
C. A patient requesting a refill of antihypertensive medication
D. A patient with chronic low back pain
Correct Answer: A
Rationale: Sudden neurological deficits suggest an acute stroke and require emergency
evaluation.
7. Which laboratory test best reflects long-term glucose control?
,A. Hemoglobin A1c
B. Random glucose
C. Fasting insulin level
D. Urinalysis
Correct Answer: A
Rationale: Hemoglobin A1c reflects average blood glucose over the previous 2–3 months.
8. A patient reports polyuria, polydipsia, and unexplained weight loss. Which
diagnosis is most likely?
A. Diabetes mellitus
B. Hypothyroidism
C. GERD
D. Iron-deficiency anemia
Correct Answer: A
Rationale: These are classic symptoms of hyperglycemia and diabetes mellitus.
9. Which thyroid disorder commonly presents with weight loss, heat intolerance,
and tachycardia?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid cancer
D. Thyroid cyst
Correct Answer: A
Rationale: Hyperthyroidism increases metabolic activity, causing these symptoms.
10. Which physical examination finding is consistent with hypothyroidism?
A. Bradycardia and dry skin
B. Tremor and tachycardia
C. Exophthalmos
D. Warm, moist skin
, Correct Answer: A
Rationale: Hypothyroidism slows metabolism, leading to bradycardia, fatigue, and dry skin.
11. A patient presents with dysuria, urinary frequency, and urgency without
flank pain. The most likely diagnosis is:
A. Acute uncomplicated cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Prostatitis
Correct Answer: A
Rationale: Lower urinary tract symptoms without systemic illness are typical of cystitis.
12. Which finding suggests pyelonephritis rather than cystitis?
A. Costovertebral angle tenderness with fever
B. Urinary urgency only
C. Mild dysuria without fever
D. Increased urinary frequency only
Correct Answer: A
Rationale: Fever and CVA tenderness indicate upper urinary tract infection.
13. A patient with COPD has an oxygen saturation of 86% on room air. What is
the priority action?
A. Administer supplemental oxygen and assess respiratory status
B. Send the patient home
C. Repeat vital signs in 24 hours
D. Encourage vigorous exercise
Correct Answer: A
Rationale: Hypoxemia requires prompt oxygen therapy and further assessment.
