NR 603 CEA Final Exam: Advanced Clinical Diagnosis 2026/2027
Chamberlain
1. A 65-year-old African American male presents with a blood pressure of
155/95 mmHg. According to JNC 8 guidelines, which class of medication is
preferred as first-line therapy?
A. ACE Inhibitor
B. Angiotensin Receptor Blocker
C. Beta-Blocker
D. Calcium Channel Blocker
Answer: D
Rationale: For the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or a calcium
channel blocker (CCB).
2. Which of the following laboratory findings is most characteristic of iron
deficiency anemia?
A. Elevated Ferritin
B. Low Serum Ferritin
C. High Mean Corpuscular Volume (MCV)
D. Low Total Iron Binding Capacity (TIBC)
Answer: B
Rationale: Low serum ferritin is the most sensitive and specific marker for iron deficiency
anemia, reflecting depleted iron stores.
,3. A patient presents with a ‘curtain’ closing over their vision in one eye. This is
most suggestive of:
A. Glaucoma
B. Cataracts
C. Retinal Detachment
D. Macular Degeneration
Answer: C
Rationale: Retinal detachment often presents as a sudden shadow or ‘curtain’ across the
field of vision, which is a medical emergency.
4. In the diagnosis of COPD, which spirometry result is required to confirm
airflow limitation?
A. TLC < 70% predicted
B. Pre-bronchodilator FEV1/FVC ratio > 0.80
C. Post-bronchodilator FEV1 > 80% predicted
D. Post-bronchodilator FEV1/FVC ratio < 0.70
Answer: D
Rationale: The GOLD criteria state that a post-bronchodilator FEV1/FVC ratio of less than
0.70 confirms the presence of persistent airflow limitation.
5. Which physical exam maneuver is specifically used to assess for acute
cholecystitis?
A. McBurney’s Sign
B. Rovsing’s Sign
C. Murphy’s Sign
D. Psoas Sign
Answer: C
Rationale: Murphy’s sign, performed by palpating the right upper quadrant while the
patient inspires, indicates gallbladder inflammation if pain causes inspiratory arrest.
, 6. A 45-year-old female presents with fatigue and cold intolerance. Her TSH is
12.5 mIU/L (High) and Free T4 is low. What is the most likely diagnosis?
A. Graves’ Disease
B. Secondary Hypothyroidism
C. Hashimoto’s Thyroiditis
D. Subacute Thyroiditis
Answer: C
Rationale: Elevated TSH with low Free T4 indicates primary hypothyroidism, most
commonly caused by Hashimoto’s thyroiditis in developed countries.
7. Which medication is considered the first-line pharmacological treatment for
Type 2 Diabetes Mellitus?
A. Glipizide
B. Pioglitazone
C. Sitagliptin
D. Metformin
Answer: D
Rationale: Metformin is the preferred initial pharmacological agent for the treatment of
type 2 diabetes unless contraindicated.
8. A 30-year-old patient presents with a ‘strawberry cervix’ and yellow-green
vaginal discharge. The clinician should suspect:
A. Bacterial Vaginosis
B. Trichomoniasis
C. Candidiasis
D. Chlamydia
Answer: B
Rationale: Trichomoniasis typically presents with a malodorous green discharge and
punctate hemorrhages on the cervix (strawberry cervix).
Chamberlain
1. A 65-year-old African American male presents with a blood pressure of
155/95 mmHg. According to JNC 8 guidelines, which class of medication is
preferred as first-line therapy?
A. ACE Inhibitor
B. Angiotensin Receptor Blocker
C. Beta-Blocker
D. Calcium Channel Blocker
Answer: D
Rationale: For the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or a calcium
channel blocker (CCB).
2. Which of the following laboratory findings is most characteristic of iron
deficiency anemia?
A. Elevated Ferritin
B. Low Serum Ferritin
C. High Mean Corpuscular Volume (MCV)
D. Low Total Iron Binding Capacity (TIBC)
Answer: B
Rationale: Low serum ferritin is the most sensitive and specific marker for iron deficiency
anemia, reflecting depleted iron stores.
,3. A patient presents with a ‘curtain’ closing over their vision in one eye. This is
most suggestive of:
A. Glaucoma
B. Cataracts
C. Retinal Detachment
D. Macular Degeneration
Answer: C
Rationale: Retinal detachment often presents as a sudden shadow or ‘curtain’ across the
field of vision, which is a medical emergency.
4. In the diagnosis of COPD, which spirometry result is required to confirm
airflow limitation?
A. TLC < 70% predicted
B. Pre-bronchodilator FEV1/FVC ratio > 0.80
C. Post-bronchodilator FEV1 > 80% predicted
D. Post-bronchodilator FEV1/FVC ratio < 0.70
Answer: D
Rationale: The GOLD criteria state that a post-bronchodilator FEV1/FVC ratio of less than
0.70 confirms the presence of persistent airflow limitation.
5. Which physical exam maneuver is specifically used to assess for acute
cholecystitis?
A. McBurney’s Sign
B. Rovsing’s Sign
C. Murphy’s Sign
D. Psoas Sign
Answer: C
Rationale: Murphy’s sign, performed by palpating the right upper quadrant while the
patient inspires, indicates gallbladder inflammation if pain causes inspiratory arrest.
, 6. A 45-year-old female presents with fatigue and cold intolerance. Her TSH is
12.5 mIU/L (High) and Free T4 is low. What is the most likely diagnosis?
A. Graves’ Disease
B. Secondary Hypothyroidism
C. Hashimoto’s Thyroiditis
D. Subacute Thyroiditis
Answer: C
Rationale: Elevated TSH with low Free T4 indicates primary hypothyroidism, most
commonly caused by Hashimoto’s thyroiditis in developed countries.
7. Which medication is considered the first-line pharmacological treatment for
Type 2 Diabetes Mellitus?
A. Glipizide
B. Pioglitazone
C. Sitagliptin
D. Metformin
Answer: D
Rationale: Metformin is the preferred initial pharmacological agent for the treatment of
type 2 diabetes unless contraindicated.
8. A 30-year-old patient presents with a ‘strawberry cervix’ and yellow-green
vaginal discharge. The clinician should suspect:
A. Bacterial Vaginosis
B. Trichomoniasis
C. Candidiasis
D. Chlamydia
Answer: B
Rationale: Trichomoniasis typically presents with a malodorous green discharge and
punctate hemorrhages on the cervix (strawberry cervix).
