NR 603 CEA Midterm Exam - Advanced Clinical Diagnosis 2026/2027
Chamberlain College
1. Which physical examination finding is most indicative of heart failure in an
older adult presenting with dyspnea?
A. S4 heart sound
B. Bilateral wheezing
C. S3 heart sound
D. Systolic murmur at the apex
Answer: C
Rationale: An S3 heart sound, or ventricular gallop, is a highly specific sign of volume
overload and ventricular dysfunction in adults, suggesting heart failure.
2. A 45-year-old patient presents with a ‘curtain-like’ shadow over their vision.
This is most characteristic of which condition?
A. Cataracts
B. Glaucoma
C. Retinal detachment
D. Macular degeneration
Answer: C
Rationale: Retinal detachment often presents as a sudden sensation of a curtain or shadow
being pulled across the field of vision, often preceded by floaters or flashes.
,3. Which of the following is the gold standard for diagnosing community-
acquired pneumonia?
A. Sputum culture
B. Chest X-ray
C. Pulse oximetry
D. Complete blood count
Answer: B
Rationale: A chest radiograph (X-ray) showing an infiltrate is the gold standard for
confirming a diagnosis of pneumonia in clinical practice.
4. In a patient with suspected cholecystitis, which physical exam sign involves
halting inspiration during deep palpation of the right upper quadrant?
A. Murphy’s sign
B. McBurney’s sign
C. Rovsing’s sign
D. Psoas sign
Answer: A
Rationale: Murphy’s sign is positive when the patient experiences sharp pain and stops
breathing in during palpation of the gallbladder area.
5. Which of the following murmurs is best heard at the second intercostal space,
right sternal border, and radiates to the carotids?
A. Mitral regurgitation
B. Aortic regurgitation
C. Aortic stenosis
D. Mitral stenosis
Answer: C
Rationale: Aortic stenosis is a systolic murmur heard at the right upper sternal border that
characteristically radiates to the carotid arteries.
, 6. A patient presents with a ‘bulls-eye’ rash (Erythema Migrans). What is the
most likely diagnosis?
A. Rocky Mountain Spotted Fever
B. Lyme Disease
C. Tinea Corporis
D. Cellulitis
Answer: B
Rationale: Erythema migrans is the pathognomonic skin lesion associated with the early
stage of Lyme disease.
7. Which diagnostic test is considered the definitive standard for diagnosing
COPD?
A. Chest CT scan
B. Peak flow monitoring
C. Spirometry
D. Arterial blood gas
Answer: C
Rationale: Spirometry showing a post-bronchodilator FEV1/FVC ratio of less than 0.70 is
required to confirm the diagnosis of COPD.
8. What is the primary diagnostic indicator of iron deficiency anemia in initial
lab results?
A. High MCV
B. High Reticulocyte count
C. Low Ferritin
D. Low Vitamin B12
Answer: C
Rationale: Ferritin is the most sensitive test to determine iron deficiency, as it reflects the
body’s total iron stores.
Chamberlain College
1. Which physical examination finding is most indicative of heart failure in an
older adult presenting with dyspnea?
A. S4 heart sound
B. Bilateral wheezing
C. S3 heart sound
D. Systolic murmur at the apex
Answer: C
Rationale: An S3 heart sound, or ventricular gallop, is a highly specific sign of volume
overload and ventricular dysfunction in adults, suggesting heart failure.
2. A 45-year-old patient presents with a ‘curtain-like’ shadow over their vision.
This is most characteristic of which condition?
A. Cataracts
B. Glaucoma
C. Retinal detachment
D. Macular degeneration
Answer: C
Rationale: Retinal detachment often presents as a sudden sensation of a curtain or shadow
being pulled across the field of vision, often preceded by floaters or flashes.
,3. Which of the following is the gold standard for diagnosing community-
acquired pneumonia?
A. Sputum culture
B. Chest X-ray
C. Pulse oximetry
D. Complete blood count
Answer: B
Rationale: A chest radiograph (X-ray) showing an infiltrate is the gold standard for
confirming a diagnosis of pneumonia in clinical practice.
4. In a patient with suspected cholecystitis, which physical exam sign involves
halting inspiration during deep palpation of the right upper quadrant?
A. Murphy’s sign
B. McBurney’s sign
C. Rovsing’s sign
D. Psoas sign
Answer: A
Rationale: Murphy’s sign is positive when the patient experiences sharp pain and stops
breathing in during palpation of the gallbladder area.
5. Which of the following murmurs is best heard at the second intercostal space,
right sternal border, and radiates to the carotids?
A. Mitral regurgitation
B. Aortic regurgitation
C. Aortic stenosis
D. Mitral stenosis
Answer: C
Rationale: Aortic stenosis is a systolic murmur heard at the right upper sternal border that
characteristically radiates to the carotid arteries.
, 6. A patient presents with a ‘bulls-eye’ rash (Erythema Migrans). What is the
most likely diagnosis?
A. Rocky Mountain Spotted Fever
B. Lyme Disease
C. Tinea Corporis
D. Cellulitis
Answer: B
Rationale: Erythema migrans is the pathognomonic skin lesion associated with the early
stage of Lyme disease.
7. Which diagnostic test is considered the definitive standard for diagnosing
COPD?
A. Chest CT scan
B. Peak flow monitoring
C. Spirometry
D. Arterial blood gas
Answer: C
Rationale: Spirometry showing a post-bronchodilator FEV1/FVC ratio of less than 0.70 is
required to confirm the diagnosis of COPD.
8. What is the primary diagnostic indicator of iron deficiency anemia in initial
lab results?
A. High MCV
B. High Reticulocyte count
C. Low Ferritin
D. Low Vitamin B12
Answer: C
Rationale: Ferritin is the most sensitive test to determine iron deficiency, as it reflects the
body’s total iron stores.
