NR 603 CEA Final Exam - Advanced Clinical Diagnosis 2026/2027
Chamberlain
1. A 65-year-old male presents with a TSH of 12.4 mIU/L and a low free T4.
Which is the most appropriate initial management?
A. Monitor TSH in 6 months
B. Initiate Levothyroxine at 25-50 mcg daily
C. Initiate Levothyroxine at 1.6 mcg/kg/day
D. Refer to Surgery for thyroidectomy
Answer: B
Rationale: In elderly patients or those with cardiac risk, ‘start low and go slow’ is the rule
for thyroid replacement. Initial doses of 25-50 mcg are safer than weight-based dosing.
2. Which physical exam finding is most indicative of a S3 heart sound?
A. A friction rub heard over the left sternal border
B. Heard during late diastole, associated with stiff ventricles
C. A high-pitched clicking sound in mid-systole
D. Heard during early diastole, often associated with heart failure
Answer: D
Rationale: The S3 gallop is a sign of volume overload and occurs during the rapid filling
phase of early diastole.
,3. According to the GOLD criteria, which diagnostic test is required to confirm
the diagnosis of COPD?
A. Chest X-ray showing hyperinflation
B. Post-bronchodilator FEV1/FVC ratio < 0.70
C. Peak expiratory flow rate < 80%
D. Arterial blood gas showing hypercapnia
Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the physiological
requirement for a COPD diagnosis.
4. A 45-year-old female presents with RUQ pain that radiates to the right
shoulder after eating a fatty meal. What is the most likely diagnosis?
A. Acute Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Peptic Ulcer Disease
Answer: C
Rationale: Biliary colic or cholecystitis typically presents as RUQ pain radiating to the
shoulder, triggered by fatty foods.
5. Which of the following is a first-line treatment for an uncomplicated UTI in a
non-pregnant female?
A. Amoxicillin 500mg TID for 10 days
B. Ciprofloxacin 500mg BID for 7 days
C. Nitrofurantoin (Macrobid) 100mg BID for 5 days
D. Doxycycline 100mg BID for 7 days
Answer: C
Rationale: Nitrofurantoin, Fosfomycin, and TMP-SMX (if resistance is low) are first-line
agents for uncomplicated cystitis.
, 6. An elderly patient presents with gradual loss of central vision. Peripheral
vision remains intact. What is the suspected condition?
A. Cataracts
B. Glaucoma
C. Macular Degeneration
D. Retinal Detachment
Answer: C
Rationale: Age-related macular degeneration primarily affects the macula, leading to loss
of central vision, while peripheral vision is spared.
7. In a patient with Type 2 Diabetes, at what GFR level should Metformin be
discontinued?
A. < 60 mL/min
B. < 45 mL/min
C. < 15 mL/min
D. < 30 mL/min
Answer: D
Rationale: Metformin is contraindicated when the GFR is less than 30 mL/min due to the
risk of lactic acidosis.
8. Which laboratory value is the most sensitive marker for iron deficiency
anemia?
A. Serum Iron
B. Serum Ferritin
C. Total Iron Binding Capacity (TIBC)
D. Hemoglobin level
Answer: B
Rationale: Serum ferritin reflects iron stores and is the most sensitive and specific test for
diagnosing iron deficiency anemia.
Chamberlain
1. A 65-year-old male presents with a TSH of 12.4 mIU/L and a low free T4.
Which is the most appropriate initial management?
A. Monitor TSH in 6 months
B. Initiate Levothyroxine at 25-50 mcg daily
C. Initiate Levothyroxine at 1.6 mcg/kg/day
D. Refer to Surgery for thyroidectomy
Answer: B
Rationale: In elderly patients or those with cardiac risk, ‘start low and go slow’ is the rule
for thyroid replacement. Initial doses of 25-50 mcg are safer than weight-based dosing.
2. Which physical exam finding is most indicative of a S3 heart sound?
A. A friction rub heard over the left sternal border
B. Heard during late diastole, associated with stiff ventricles
C. A high-pitched clicking sound in mid-systole
D. Heard during early diastole, often associated with heart failure
Answer: D
Rationale: The S3 gallop is a sign of volume overload and occurs during the rapid filling
phase of early diastole.
,3. According to the GOLD criteria, which diagnostic test is required to confirm
the diagnosis of COPD?
A. Chest X-ray showing hyperinflation
B. Post-bronchodilator FEV1/FVC ratio < 0.70
C. Peak expiratory flow rate < 80%
D. Arterial blood gas showing hypercapnia
Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the physiological
requirement for a COPD diagnosis.
4. A 45-year-old female presents with RUQ pain that radiates to the right
shoulder after eating a fatty meal. What is the most likely diagnosis?
A. Acute Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Peptic Ulcer Disease
Answer: C
Rationale: Biliary colic or cholecystitis typically presents as RUQ pain radiating to the
shoulder, triggered by fatty foods.
5. Which of the following is a first-line treatment for an uncomplicated UTI in a
non-pregnant female?
A. Amoxicillin 500mg TID for 10 days
B. Ciprofloxacin 500mg BID for 7 days
C. Nitrofurantoin (Macrobid) 100mg BID for 5 days
D. Doxycycline 100mg BID for 7 days
Answer: C
Rationale: Nitrofurantoin, Fosfomycin, and TMP-SMX (if resistance is low) are first-line
agents for uncomplicated cystitis.
, 6. An elderly patient presents with gradual loss of central vision. Peripheral
vision remains intact. What is the suspected condition?
A. Cataracts
B. Glaucoma
C. Macular Degeneration
D. Retinal Detachment
Answer: C
Rationale: Age-related macular degeneration primarily affects the macula, leading to loss
of central vision, while peripheral vision is spared.
7. In a patient with Type 2 Diabetes, at what GFR level should Metformin be
discontinued?
A. < 60 mL/min
B. < 45 mL/min
C. < 15 mL/min
D. < 30 mL/min
Answer: D
Rationale: Metformin is contraindicated when the GFR is less than 30 mL/min due to the
risk of lactic acidosis.
8. Which laboratory value is the most sensitive marker for iron deficiency
anemia?
A. Serum Iron
B. Serum Ferritin
C. Total Iron Binding Capacity (TIBC)
D. Hemoglobin level
Answer: B
Rationale: Serum ferritin reflects iron stores and is the most sensitive and specific test for
diagnosing iron deficiency anemia.
