NR511 CEA COMPREHENSIVE EXAM - DIFFERENTIAL
DIAGNOSIS AND PRIMARY CARE PRACTICUM -
CHAMBERLAIN UNIVERSITY QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES - 120 Questions with Answers
Page 1
,Q1. A 45-year-old patient presents with fatigue, weight gain, and cold intolerance.
Labs show TSH 8.2 mIU/L, free T4 0.8 ng/dL. Which additional finding would most
strongly suggest an autoimmune etiology rather than central hypothyroidism?
A. Elevated serum prolactin
B. Positive anti-thyroid peroxidase antibodies
C. Low free T4 with low TSH
D. Macroprolactinemia
Correct Answer: B. Positive anti-thyroid peroxidase antibodies
Rationale: Positive anti-TPO antibodies indicate autoimmune thyroiditis (Hashimoto's),
the most common cause of primary hypothyroidism. Central hypothyroidism would show
low TSH with low T4, not elevated TSH. Elevated prolactin can occur in both primary and
central hypothyroidism due to TRH stimulation.
Why Wrong:
A - Elevated prolactin can occur in primary hypothyroidism but is not specific for
autoimmune etiology.
C - Low free T4 with low TSH suggests central hypothyroidism, not autoimmune.
D - Macroprolactinemia is a benign cause of elevated prolactin, unrelated to
autoimmune thyroid disease.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 54
Q2. In a patient with recurrent calcium oxalate kidney stones, which 24-hour urine
parameter would most directly inform the decision to initiate thiazide diuretic
therapy?
A. Urinary citrate < 320 mg/day
B. Urinary calcium > 300 mg/day
C. Urinary oxalate > 45 mg/day
D. Urinary uric acid > 800 mg/day
Correct Answer: B. Urinary calcium > 300 mg/day
Rationale: Thiazides reduce urinary calcium excretion and are indicated for
hypercalciuria (urinary calcium > 300 mg/day in men or > 250 mg/day in women). Low
citrate would prompt alkali therapy, high oxalate prompts dietary changes, and high uric
acid may benefit from allopurinol.
Why Wrong:
A - Low citrate is treated with potassium citrate, not thiazides.
C - High oxalate requires dietary oxalate restriction and calcium supplementation.
D - High uric acid is managed with allopurinol and urine alkalinization, not thiazides.
Reference: Kasper, D.L., et al. (2023). Harrison's Principles of Internal Medicine, 21st
Ed., Ch. 315
Page 2
,Q3. Which clinical scenario most strongly suggests a diagnosis of migraine with
brainstem aura (MBA) rather than basilar-type migraine?
A. Aura consisting of visual scotomata and paresthesias followed by throbbing
unilateral headache
B. Aura with dysarthria, vertigo, tinnitus, and ataxia followed by bilateral headache
C. Aura with unilateral weakness and aphasia followed by headache
D. Aura with diplopia and bilateral visual symptoms followed by headache
Correct Answer: B. Aura with dysarthria, vertigo, tinnitus, and ataxia followed by
bilateral headache
Rationale: MBA requires at least two brainstem symptoms (dysarthria, vertigo, tinnitus,
hypacusis, diplopia, ataxia, or decreased level of consciousness) followed by migraine
headache. Option A describes typical aura, option C describes hemiplegic migraine, and
option D is not specific.
Why Wrong:
A - Visual and sensory symptoms are typical aura, not brainstem aura.
C - Motor weakness defines hemiplegic migraine, not MBA.
D - Diplopia alone is insufficient; MBA requires 2 brainstem symptoms.
Reference: Headache Classification Committee of the IHS (2018). Cephalalgia, 38(1)
Q4. A patient with type 2 diabetes and CKD stage 3 is started on canagliflozin. Which
mechanism explains its renoprotective effect independent of glycemic control?
A. Inhibition of the renin-angiotensin-aldosterone system
B. Reduction of intraglomerular pressure via tubuloglomerular feedback
C. Blockade of aldosterone receptors in the distal nephron
D. Increased natriuresis leading to plasma volume contraction
Correct Answer: B. Reduction of intraglomerular pressure via tubuloglomerular
feedback
Rationale: SGLT2 inhibitors reduce sodium and glucose reabsorption in the proximal
tubule, increasing distal sodium delivery and activating tubuloglomerular feedback, which
constricts afferent arterioles and reduces intraglomerular pressure. This is the primary
mechanism for renoprotection, independent of glucose lowering.
Why Wrong:
A - SGLT2 inhibitors do not directly inhibit RAAS.
C - Aldosterone receptor blockade is the mechanism of spironolactone, not SGLT2
inhibitors.
D - Natriuresis contributes to volume contraction but is not the primary renoprotective
mechanism.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 61
Page 3
, Q5. A patient presents with acute onset of severe headache, nausea, and photophobia.
CSF analysis reveals lymphocytic pleocytosis, elevated protein, and normal glucose.
Which finding would most likely distinguish viral meningitis from early bacterial
meningitis?
A. CSF lactate < 2.0 mmol/L
B. CSF white blood cell count > 1000/µL
C. Positive Gram stain
D. Peripheral blood leukocytosis with left shift
Correct Answer: A. CSF lactate < 2.0 mmol/L
Rationale: CSF lactate is low (< 2.0 mmol/L) in viral meningitis and typically > 3.5
mmol/L in bacterial meningitis. A high WBC count, positive Gram stain, and peripheral
leukocytosis are more consistent with bacterial infection.
Why Wrong:
B - WBC > 1000/µL is more typical of bacterial meningitis.
C - Positive Gram stain indicates bacterial meningitis.
D - Peripheral leukocytosis with left shift is a systemic sign of bacterial infection.
Reference: Kasper, D.L., et al. (2023). Harrison's Principles of Internal Medicine, 21st
Ed., Ch. 177
Q6. Which ECG finding is most specific for hyperkalemia and would prompt urgent
treatment before laboratory confirmation?
A. Tall, peaked T waves with a narrow base
B. PR interval prolongation and QRS widening
C. ST-segment depression and T-wave inversion
D. Prominent U waves and prolonged QT interval
Correct Answer: A. Tall, peaked T waves with a narrow base
Rationale: Tall, peaked T waves (narrow base) are the earliest and most specific ECG sign
of hyperkalemia. PR prolongation and QRS widening occur with severe hyperkalemia, but
peaked T waves are the classic hallmark. ST depression and U waves are seen in
hypokalemia.
Why Wrong:
B - PR prolongation and QRS widening are late signs, but not as specific as peaked T
waves.
C - ST depression and T-wave inversion are nonspecific and can occur in ischemia.
D - Prominent U waves and prolonged QT are characteristic of hypokalemia, not
hyperkalemia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 57
Page 4
DIAGNOSIS AND PRIMARY CARE PRACTICUM -
CHAMBERLAIN UNIVERSITY QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES - 120 Questions with Answers
Page 1
,Q1. A 45-year-old patient presents with fatigue, weight gain, and cold intolerance.
Labs show TSH 8.2 mIU/L, free T4 0.8 ng/dL. Which additional finding would most
strongly suggest an autoimmune etiology rather than central hypothyroidism?
A. Elevated serum prolactin
B. Positive anti-thyroid peroxidase antibodies
C. Low free T4 with low TSH
D. Macroprolactinemia
Correct Answer: B. Positive anti-thyroid peroxidase antibodies
Rationale: Positive anti-TPO antibodies indicate autoimmune thyroiditis (Hashimoto's),
the most common cause of primary hypothyroidism. Central hypothyroidism would show
low TSH with low T4, not elevated TSH. Elevated prolactin can occur in both primary and
central hypothyroidism due to TRH stimulation.
Why Wrong:
A - Elevated prolactin can occur in primary hypothyroidism but is not specific for
autoimmune etiology.
C - Low free T4 with low TSH suggests central hypothyroidism, not autoimmune.
D - Macroprolactinemia is a benign cause of elevated prolactin, unrelated to
autoimmune thyroid disease.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 54
Q2. In a patient with recurrent calcium oxalate kidney stones, which 24-hour urine
parameter would most directly inform the decision to initiate thiazide diuretic
therapy?
A. Urinary citrate < 320 mg/day
B. Urinary calcium > 300 mg/day
C. Urinary oxalate > 45 mg/day
D. Urinary uric acid > 800 mg/day
Correct Answer: B. Urinary calcium > 300 mg/day
Rationale: Thiazides reduce urinary calcium excretion and are indicated for
hypercalciuria (urinary calcium > 300 mg/day in men or > 250 mg/day in women). Low
citrate would prompt alkali therapy, high oxalate prompts dietary changes, and high uric
acid may benefit from allopurinol.
Why Wrong:
A - Low citrate is treated with potassium citrate, not thiazides.
C - High oxalate requires dietary oxalate restriction and calcium supplementation.
D - High uric acid is managed with allopurinol and urine alkalinization, not thiazides.
Reference: Kasper, D.L., et al. (2023). Harrison's Principles of Internal Medicine, 21st
Ed., Ch. 315
Page 2
,Q3. Which clinical scenario most strongly suggests a diagnosis of migraine with
brainstem aura (MBA) rather than basilar-type migraine?
A. Aura consisting of visual scotomata and paresthesias followed by throbbing
unilateral headache
B. Aura with dysarthria, vertigo, tinnitus, and ataxia followed by bilateral headache
C. Aura with unilateral weakness and aphasia followed by headache
D. Aura with diplopia and bilateral visual symptoms followed by headache
Correct Answer: B. Aura with dysarthria, vertigo, tinnitus, and ataxia followed by
bilateral headache
Rationale: MBA requires at least two brainstem symptoms (dysarthria, vertigo, tinnitus,
hypacusis, diplopia, ataxia, or decreased level of consciousness) followed by migraine
headache. Option A describes typical aura, option C describes hemiplegic migraine, and
option D is not specific.
Why Wrong:
A - Visual and sensory symptoms are typical aura, not brainstem aura.
C - Motor weakness defines hemiplegic migraine, not MBA.
D - Diplopia alone is insufficient; MBA requires 2 brainstem symptoms.
Reference: Headache Classification Committee of the IHS (2018). Cephalalgia, 38(1)
Q4. A patient with type 2 diabetes and CKD stage 3 is started on canagliflozin. Which
mechanism explains its renoprotective effect independent of glycemic control?
A. Inhibition of the renin-angiotensin-aldosterone system
B. Reduction of intraglomerular pressure via tubuloglomerular feedback
C. Blockade of aldosterone receptors in the distal nephron
D. Increased natriuresis leading to plasma volume contraction
Correct Answer: B. Reduction of intraglomerular pressure via tubuloglomerular
feedback
Rationale: SGLT2 inhibitors reduce sodium and glucose reabsorption in the proximal
tubule, increasing distal sodium delivery and activating tubuloglomerular feedback, which
constricts afferent arterioles and reduces intraglomerular pressure. This is the primary
mechanism for renoprotection, independent of glucose lowering.
Why Wrong:
A - SGLT2 inhibitors do not directly inhibit RAAS.
C - Aldosterone receptor blockade is the mechanism of spironolactone, not SGLT2
inhibitors.
D - Natriuresis contributes to volume contraction but is not the primary renoprotective
mechanism.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 61
Page 3
, Q5. A patient presents with acute onset of severe headache, nausea, and photophobia.
CSF analysis reveals lymphocytic pleocytosis, elevated protein, and normal glucose.
Which finding would most likely distinguish viral meningitis from early bacterial
meningitis?
A. CSF lactate < 2.0 mmol/L
B. CSF white blood cell count > 1000/µL
C. Positive Gram stain
D. Peripheral blood leukocytosis with left shift
Correct Answer: A. CSF lactate < 2.0 mmol/L
Rationale: CSF lactate is low (< 2.0 mmol/L) in viral meningitis and typically > 3.5
mmol/L in bacterial meningitis. A high WBC count, positive Gram stain, and peripheral
leukocytosis are more consistent with bacterial infection.
Why Wrong:
B - WBC > 1000/µL is more typical of bacterial meningitis.
C - Positive Gram stain indicates bacterial meningitis.
D - Peripheral leukocytosis with left shift is a systemic sign of bacterial infection.
Reference: Kasper, D.L., et al. (2023). Harrison's Principles of Internal Medicine, 21st
Ed., Ch. 177
Q6. Which ECG finding is most specific for hyperkalemia and would prompt urgent
treatment before laboratory confirmation?
A. Tall, peaked T waves with a narrow base
B. PR interval prolongation and QRS widening
C. ST-segment depression and T-wave inversion
D. Prominent U waves and prolonged QT interval
Correct Answer: A. Tall, peaked T waves with a narrow base
Rationale: Tall, peaked T waves (narrow base) are the earliest and most specific ECG sign
of hyperkalemia. PR prolongation and QRS widening occur with severe hyperkalemia, but
peaked T waves are the classic hallmark. ST depression and U waves are seen in
hypokalemia.
Why Wrong:
B - PR prolongation and QRS widening are late signs, but not as specific as peaked T
waves.
C - ST depression and T-wave inversion are nonspecific and can occur in ischemia.
D - Prominent U waves and prolonged QT are characteristic of hypokalemia, not
hyperkalemia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 57
Page 4
