CLINICAL READINESS EXAM (CRE) Actual Exam
Complete Questions and Answers Detailed Rationales
Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Patient Assessment & Clinical Reasoning | Q1 – Q10
Section 2 | Common Medical Conditions & Differential Diagnosis | Q11 – Q20
Section 3 | Pharmacology & Medication Management | Q21 – Q30
Section 4 | Emergency Response & Critical Thinking | Q31 – Q40
Section 5 | Professional Standards, Ethics & Patient Safety | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: PATIENT ASSESSMENT & CLINICAL REASONING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 78-year-old woman from a nursing home is brought to the emergency department
with acute confusion over the past 24 hours. Her vital signs are temperature 38.2°C,
heart rate 102, blood pressure 110/68, respiratory rate 18, and SpO2 94% on room air.
She has a history of dementia and hypertension. On examination she is disoriented,
lungs are clear, and she has mild suprapubic tenderness. Urinalysis is pending.
A. Order a head CT to rule out intracranial hemorrhage before any other workup
B. Start empiric antibiotics for urinary tract infection and reassess in 48 hours
C. Obtain urine culture, start empiric antibiotics, and search for additional infection
sources ✓ CORRECT
D. Attribute the confusion to progression of underlying dementia and return her to the
nursing home
,Correct Answer: C
Rationale: Acute delirium in an older adult with fever and suprapubic tenderness
strongly suggests a urinary source, but clinicians must also look for pneumonia,
bacteremia, or other occult infections before settling on one cause. Starting antibiotics
alone without cultures prevents targeted therapy, while assuming this is simply
dementia progression misses a potentially life-threatening infection. A thorough but
efficient search for infection sources is the standard of care in new-onset delirium.
Question 2 of 50
A 54-year-old man presents to the emergency department with 45 minutes of crushing
substernal chest pain radiating to his left arm. Vital signs show heart rate 98, blood
pressure 148/92, respiratory rate 20, and SpO2 97% on room air. He is diaphoretic. The
ECG shows 2 mm ST elevation in leads V2 through V4.
A. Activate the cardiac catheterization lab immediately for primary PCI ✓ CORRECT
B. Administer thrombolytics in the ED and admit to a monitored bed
C. Obtain a chest CT angiogram to exclude pulmonary embolism first
D. Give sublingual nitroglycerin and observe for 30 minutes to see if pain resolves
Correct Answer: A
Rationale: Anterior ST-elevation myocardial infarction with active symptoms demands
emergent reperfusion via primary percutaneous coronary intervention. Thrombolytics
are second-line when PCI is not available within 120 minutes, and observing or pursuing
alternative diagnoses wastes myocardium. Door-to-balloon time targets make
immediate activation the only acceptable response.
Question 3 of 50
A mother brings her 3-week-old infant to the clinic with a rectal temperature of 38.5°C,
poor feeding for 12 hours, and irritability. The birth was full-term and uncomplicated.
,Vital signs are heart rate 165, respiratory rate 45, and SpO2 96% on room air. The
physical examination is otherwise unremarkable.
A. Reassure the mother that fevers are common in newborns and recommend
acetaminophen with follow-up in 24 hours
B. Admit the infant for full sepsis workup including blood, urine, and cerebrospinal fluid
cultures ✓ CORRECT
C. Start oral amoxicillin and schedule a recheck appointment for the next morning
D. Order a chest x-ray and if negative, discharge home with close observation
Correct Answer: B
Rationale: Any infant under 28 days with a fever of 38.0°C or higher is at high risk for
serious bacterial infection and requires a full sepsis evaluation and empiric intravenous
antibiotics. Outpatient management or delayed workup risks rapid deterioration from
early-onset sepsis, meningitis, or bacteremia. The threshold for admission in this age
group remains low even when the examination appears benign.
Question 4 of 50
A 42-year-old woman presents with 18 hours of worsening right lower quadrant pain,
anorexia, and two episodes of vomiting. Vital signs are temperature 37.8°C, heart rate
105, and blood pressure 118/76. Examination reveals localized tenderness at
McBurney's point, guarding, and a positive psoas sign. Her white blood cell count is 13.2
with a left shift.
A. Order a CT abdomen with oral and IV contrast to confirm the diagnosis before
consulting surgery
B. Start broad-spectrum antibiotics for presumed pelvic inflammatory disease and
reassess in 48 hours
C. Obtain a pelvic ultrasound to exclude ovarian torsion prior to any surgical intervention
D. Call the surgical team for emergent appendectomy evaluation ✓ CORRECT
Correct Answer: D
, Rationale: Classic history and physical examination findings with leukocytosis make
acute appendicitis a clinical diagnosis that should not be delayed for unnecessary
imaging. While CT can be useful in atypical presentations, pursuing pelvic inflammatory
disease or ovarian torsion as primary diagnoses contradicts the localized peritoneal
signs pointing directly to appendiceal inflammation. Surgical consultation should
proceed without waiting for advanced imaging in clear-cut cases.
Question 5 of 50
A 68-year-old man with COPD presents with increased dyspnea over 3 days and thick
yellow-green sputum production. Vital signs are temperature 37.6°C, heart rate 110,
blood pressure 132/84, respiratory rate 26, and SpO2 88% on room air. Examination
reveals diffuse wheezing, prolonged expiration, and use of accessory muscles. Arterial
blood gas on room air shows pH 7.32, PaCO2 58, and PaO2 62.
A. Start empiric antibiotics for community-acquired pneumonia and obtain a chest x-ray
B. Administer high-flow oxygen via non-rebreather to achieve SpO2 greater than 94%
C. Initiate bronchodilator therapy, oral corticosteroids, and controlled oxygen to maintain
SpO2 88-92% ✓ CORRECT
D. Intubate immediately given the respiratory acidosis and low oxygen saturation
Correct Answer: C
Rationale: This represents a COPD exacerbation with type II respiratory failure, where
the priority is reversing bronchospasm and inflammation while avoiding excessive
oxygen that suppresses the hypoxic respiratory drive. Immediate intubation is not
indicated in a patient who is alert and compensating, and treating this as routine
pneumonia misses the need for steroids and controlled oxygen titration. Targeting an
SpO2 of 88-92% prevents CO2 retention and worsening acidosis.
Question 6 of 50
Complete Questions and Answers Detailed Rationales
Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Patient Assessment & Clinical Reasoning | Q1 – Q10
Section 2 | Common Medical Conditions & Differential Diagnosis | Q11 – Q20
Section 3 | Pharmacology & Medication Management | Q21 – Q30
Section 4 | Emergency Response & Critical Thinking | Q31 – Q40
Section 5 | Professional Standards, Ethics & Patient Safety | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PATIENT ASSESSMENT & CLINICAL REASONING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 78-year-old woman from a nursing home is brought to the emergency department
with acute confusion over the past 24 hours. Her vital signs are temperature 38.2°C,
heart rate 102, blood pressure 110/68, respiratory rate 18, and SpO2 94% on room air.
She has a history of dementia and hypertension. On examination she is disoriented,
lungs are clear, and she has mild suprapubic tenderness. Urinalysis is pending.
A. Order a head CT to rule out intracranial hemorrhage before any other workup
B. Start empiric antibiotics for urinary tract infection and reassess in 48 hours
C. Obtain urine culture, start empiric antibiotics, and search for additional infection
sources ✓ CORRECT
D. Attribute the confusion to progression of underlying dementia and return her to the
nursing home
,Correct Answer: C
Rationale: Acute delirium in an older adult with fever and suprapubic tenderness
strongly suggests a urinary source, but clinicians must also look for pneumonia,
bacteremia, or other occult infections before settling on one cause. Starting antibiotics
alone without cultures prevents targeted therapy, while assuming this is simply
dementia progression misses a potentially life-threatening infection. A thorough but
efficient search for infection sources is the standard of care in new-onset delirium.
Question 2 of 50
A 54-year-old man presents to the emergency department with 45 minutes of crushing
substernal chest pain radiating to his left arm. Vital signs show heart rate 98, blood
pressure 148/92, respiratory rate 20, and SpO2 97% on room air. He is diaphoretic. The
ECG shows 2 mm ST elevation in leads V2 through V4.
A. Activate the cardiac catheterization lab immediately for primary PCI ✓ CORRECT
B. Administer thrombolytics in the ED and admit to a monitored bed
C. Obtain a chest CT angiogram to exclude pulmonary embolism first
D. Give sublingual nitroglycerin and observe for 30 minutes to see if pain resolves
Correct Answer: A
Rationale: Anterior ST-elevation myocardial infarction with active symptoms demands
emergent reperfusion via primary percutaneous coronary intervention. Thrombolytics
are second-line when PCI is not available within 120 minutes, and observing or pursuing
alternative diagnoses wastes myocardium. Door-to-balloon time targets make
immediate activation the only acceptable response.
Question 3 of 50
A mother brings her 3-week-old infant to the clinic with a rectal temperature of 38.5°C,
poor feeding for 12 hours, and irritability. The birth was full-term and uncomplicated.
,Vital signs are heart rate 165, respiratory rate 45, and SpO2 96% on room air. The
physical examination is otherwise unremarkable.
A. Reassure the mother that fevers are common in newborns and recommend
acetaminophen with follow-up in 24 hours
B. Admit the infant for full sepsis workup including blood, urine, and cerebrospinal fluid
cultures ✓ CORRECT
C. Start oral amoxicillin and schedule a recheck appointment for the next morning
D. Order a chest x-ray and if negative, discharge home with close observation
Correct Answer: B
Rationale: Any infant under 28 days with a fever of 38.0°C or higher is at high risk for
serious bacterial infection and requires a full sepsis evaluation and empiric intravenous
antibiotics. Outpatient management or delayed workup risks rapid deterioration from
early-onset sepsis, meningitis, or bacteremia. The threshold for admission in this age
group remains low even when the examination appears benign.
Question 4 of 50
A 42-year-old woman presents with 18 hours of worsening right lower quadrant pain,
anorexia, and two episodes of vomiting. Vital signs are temperature 37.8°C, heart rate
105, and blood pressure 118/76. Examination reveals localized tenderness at
McBurney's point, guarding, and a positive psoas sign. Her white blood cell count is 13.2
with a left shift.
A. Order a CT abdomen with oral and IV contrast to confirm the diagnosis before
consulting surgery
B. Start broad-spectrum antibiotics for presumed pelvic inflammatory disease and
reassess in 48 hours
C. Obtain a pelvic ultrasound to exclude ovarian torsion prior to any surgical intervention
D. Call the surgical team for emergent appendectomy evaluation ✓ CORRECT
Correct Answer: D
, Rationale: Classic history and physical examination findings with leukocytosis make
acute appendicitis a clinical diagnosis that should not be delayed for unnecessary
imaging. While CT can be useful in atypical presentations, pursuing pelvic inflammatory
disease or ovarian torsion as primary diagnoses contradicts the localized peritoneal
signs pointing directly to appendiceal inflammation. Surgical consultation should
proceed without waiting for advanced imaging in clear-cut cases.
Question 5 of 50
A 68-year-old man with COPD presents with increased dyspnea over 3 days and thick
yellow-green sputum production. Vital signs are temperature 37.6°C, heart rate 110,
blood pressure 132/84, respiratory rate 26, and SpO2 88% on room air. Examination
reveals diffuse wheezing, prolonged expiration, and use of accessory muscles. Arterial
blood gas on room air shows pH 7.32, PaCO2 58, and PaO2 62.
A. Start empiric antibiotics for community-acquired pneumonia and obtain a chest x-ray
B. Administer high-flow oxygen via non-rebreather to achieve SpO2 greater than 94%
C. Initiate bronchodilator therapy, oral corticosteroids, and controlled oxygen to maintain
SpO2 88-92% ✓ CORRECT
D. Intubate immediately given the respiratory acidosis and low oxygen saturation
Correct Answer: C
Rationale: This represents a COPD exacerbation with type II respiratory failure, where
the priority is reversing bronchospasm and inflammation while avoiding excessive
oxygen that suppresses the hypoxic respiratory drive. Immediate intubation is not
indicated in a patient who is alert and compensating, and treating this as routine
pneumonia misses the need for steroids and controlled oxygen titration. Targeting an
SpO2 of 88-92% prevents CO2 retention and worsening acidosis.
Question 6 of 50
