NR 603 CEA Final Exam (2026) - Advanced Clinical Diagnosis
Chamberlain
1. A 65-year-old male presents with a harsh, crescendo-decrescendo systolic
murmur heard best at the second right intercostal space. Which diagnosis is
most likely?
A. Mitral Regurgitation
B. Pulmonic Regurgitation
C. Tricuspid Stenosis
D. Aortic Stenosis
Answer: D
Rationale: Aortic stenosis typically presents as a systolic murmur at the right upper
sternal border radiating to the carotids.
2. Which of the following is the gold standard for diagnosing Chronic
Obstructive Pulmonary Disease (COPD)?
A. Spirometry
B. Chest X-ray
C. Peak Flow Meter
D. Arterial Blood Gas
Answer: A
Rationale: Spirometry showing a post-bronchodilator FEV1/FVC ratio of less than 0.70
confirms the diagnosis of COPD.
,3. What is the diagnostic threshold for Hemoglobin A1c in the diagnosis of
Diabetes Mellitus?
A. Greater than or equal to 6.0%
B. Greater than or equal to 5.7%
C. Greater than or equal to 7.0%
D. Greater than or equal to 6.5%
Answer: D
Rationale: An A1c level of 6.5% or higher is one of the criteria used to diagnose Diabetes
Mellitus.
4. A patient presents with right lower quadrant pain and a positive McBurney’s
sign. What is the most likely diagnosis?
A. Cholecystitis
B. Diverticulitis
C. Pancreatitis
D. Appendicitis
Answer: D
Rationale: McBurney’s sign involves tenderness at the point one-third the distance from
the anterior superior iliac spine to the umbilicus, indicative of appendicitis.
5. Which laboratory finding is most characteristic of primary hypothyroidism?
A. Low TSH and High T4
B. Low TSH and Low T4
C. High TSH and High T4
D. High TSH and Low T4
Answer: D
Rationale: In primary hypothyroidism, the thyroid gland fails to produce T4, causing the
pituitary to increase TSH production via negative feedback.
, 6. According to the JNC 8 guidelines, what is the blood pressure goal for a
patient aged 60 or older without diabetes or CKD?
A. Less than 150/90
B. Less than 130/80
C. Less than 140/90
D. Less than 120/80
Answer: A
Rationale: JNC 8 recommended a target of less than 150/90 for adults 60 and older,
though other guidelines like ACC/AHA suggest lower targets.
7. What is the first-line treatment for a patient diagnosed with mild Community-
Acquired Pneumonia (CAP) with no comorbidities?
A. Ceftriaxone
B. Ciprofloxacin
C. Vancomycin
D. Amoxicillin or Doxycycline
Answer: D
Rationale: For healthy outpatients with CAP and no risk factors for MRSA or
Pseudomonas, Amoxicillin or Doxycycline are preferred first-line agents.
8. A 25-year-old female presents with thin, grayish-white vaginal discharge and
a ‘fishy’ odor. Which of the following confirms Bacterial Vaginosis?
A. Presence of Clue Cells on wet mount
B. pH of 4.0
C. Presence of hyphae on KOH prep
D. Whiff test negative
Answer: A
Rationale: Bacterial Vaginosis is diagnosed using Amsel criteria, which includes clue cells,
pH > 4.5, and a positive whiff test.
Chamberlain
1. A 65-year-old male presents with a harsh, crescendo-decrescendo systolic
murmur heard best at the second right intercostal space. Which diagnosis is
most likely?
A. Mitral Regurgitation
B. Pulmonic Regurgitation
C. Tricuspid Stenosis
D. Aortic Stenosis
Answer: D
Rationale: Aortic stenosis typically presents as a systolic murmur at the right upper
sternal border radiating to the carotids.
2. Which of the following is the gold standard for diagnosing Chronic
Obstructive Pulmonary Disease (COPD)?
A. Spirometry
B. Chest X-ray
C. Peak Flow Meter
D. Arterial Blood Gas
Answer: A
Rationale: Spirometry showing a post-bronchodilator FEV1/FVC ratio of less than 0.70
confirms the diagnosis of COPD.
,3. What is the diagnostic threshold for Hemoglobin A1c in the diagnosis of
Diabetes Mellitus?
A. Greater than or equal to 6.0%
B. Greater than or equal to 5.7%
C. Greater than or equal to 7.0%
D. Greater than or equal to 6.5%
Answer: D
Rationale: An A1c level of 6.5% or higher is one of the criteria used to diagnose Diabetes
Mellitus.
4. A patient presents with right lower quadrant pain and a positive McBurney’s
sign. What is the most likely diagnosis?
A. Cholecystitis
B. Diverticulitis
C. Pancreatitis
D. Appendicitis
Answer: D
Rationale: McBurney’s sign involves tenderness at the point one-third the distance from
the anterior superior iliac spine to the umbilicus, indicative of appendicitis.
5. Which laboratory finding is most characteristic of primary hypothyroidism?
A. Low TSH and High T4
B. Low TSH and Low T4
C. High TSH and High T4
D. High TSH and Low T4
Answer: D
Rationale: In primary hypothyroidism, the thyroid gland fails to produce T4, causing the
pituitary to increase TSH production via negative feedback.
, 6. According to the JNC 8 guidelines, what is the blood pressure goal for a
patient aged 60 or older without diabetes or CKD?
A. Less than 150/90
B. Less than 130/80
C. Less than 140/90
D. Less than 120/80
Answer: A
Rationale: JNC 8 recommended a target of less than 150/90 for adults 60 and older,
though other guidelines like ACC/AHA suggest lower targets.
7. What is the first-line treatment for a patient diagnosed with mild Community-
Acquired Pneumonia (CAP) with no comorbidities?
A. Ceftriaxone
B. Ciprofloxacin
C. Vancomycin
D. Amoxicillin or Doxycycline
Answer: D
Rationale: For healthy outpatients with CAP and no risk factors for MRSA or
Pseudomonas, Amoxicillin or Doxycycline are preferred first-line agents.
8. A 25-year-old female presents with thin, grayish-white vaginal discharge and
a ‘fishy’ odor. Which of the following confirms Bacterial Vaginosis?
A. Presence of Clue Cells on wet mount
B. pH of 4.0
C. Presence of hyphae on KOH prep
D. Whiff test negative
Answer: A
Rationale: Bacterial Vaginosis is diagnosed using Amsel criteria, which includes clue cells,
pH > 4.5, and a positive whiff test.
