NR 603 CEA Midterm Exam (2026) - Advanced Clinical Diagnosis
Chamberlain
1. A 52-year-old male presents for a routine check-up. His blood pressure is
144/92 mmHg today and was 142/90 mmHg at his last visit. According to
ACC/AHA guidelines, how is this classified?
A. Stage 2 Hypertension
B. Stage 1 Hypertension
C. Elevated blood pressure
D. Hypertensive crisis
Answer: A
Rationale: Stage 2 Hypertension is defined as a systolic pressure of at least 140 mmHg or a
diastolic pressure of at least 90 mmHg.
2. Which of the following is the preferred initial diagnostic test for a patient
suspected of having Chronic Obstructive Pulmonary Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Arterial Blood Gas
D. Peak Flow Meter
Answer: B
Rationale: Spirometry is the gold standard for diagnosing COPD, requiring a post-
bronchodilator FEV1/FVC ratio of less than 0.70.
,3. A 65-year-old female presents with sudden onset of ‘curtain-like’ vision loss
in her right eye. This symptom is most characteristic of:
A. Acute angle-closure glaucoma
B. Cataracts
C. Macular degeneration
D. Retinal detachment
Answer: D
Rationale: A ‘curtain-like’ or ‘shadow’ descending over the field of vision is a classic sign of
retinal detachment and requires emergency referral.
4. Which physical exam finding is most specifically associated with
Osteoarthritis of the hands?
A. Swan-neck deformity
B. Ulnar deviation
C. Bouchard’s nodes
D. Boutonniere deformity
Answer: C
Rationale: Bouchard’s nodes (PIP joints) and Heberden’s nodes (DIP joints) are
characteristic of Osteoarthritis, whereas the others are typical of Rheumatoid Arthritis.
5. A patient with a history of heart failure presents with increased dyspnea and
orthopnea. On exam, you hear an extra heart sound early in diastole. This is
likely:
A. Friction rub
B. S4 gallop
C. Systolic click
D. S3 gallop
Answer: D
, Rationale: An S3 heart sound is often associated with fluid overload and ventricular filling
in heart failure; it occurs in early diastole.
6. What is the first-line treatment for an adult diagnosed with uncomplicated
acute bacterial rhinosinusitis?
A. Azithromycin
B. Doxycycline
C. Levofloxacin
D. Amoxicillin-clavulanate
Answer: D
Rationale: Amoxicillin-clavulanate is the current first-line recommendation for bacterial
sinusitis to cover common pathogens like S. pneumoniae and H. influenzae.
7. A 30-year-old female presents with a TSH level of 7.2 mIU/L and a normal
Free T4. She is asymptomatic. What is the most likely diagnosis?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Subclinical hypothyroidism
D. Hyperthyroidism
Answer: C
Rationale: Subclinical hypothyroidism is characterized by an elevated TSH with a normal
Free T4 level, often in asymptomatic patients.
Chamberlain
1. A 52-year-old male presents for a routine check-up. His blood pressure is
144/92 mmHg today and was 142/90 mmHg at his last visit. According to
ACC/AHA guidelines, how is this classified?
A. Stage 2 Hypertension
B. Stage 1 Hypertension
C. Elevated blood pressure
D. Hypertensive crisis
Answer: A
Rationale: Stage 2 Hypertension is defined as a systolic pressure of at least 140 mmHg or a
diastolic pressure of at least 90 mmHg.
2. Which of the following is the preferred initial diagnostic test for a patient
suspected of having Chronic Obstructive Pulmonary Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Arterial Blood Gas
D. Peak Flow Meter
Answer: B
Rationale: Spirometry is the gold standard for diagnosing COPD, requiring a post-
bronchodilator FEV1/FVC ratio of less than 0.70.
,3. A 65-year-old female presents with sudden onset of ‘curtain-like’ vision loss
in her right eye. This symptom is most characteristic of:
A. Acute angle-closure glaucoma
B. Cataracts
C. Macular degeneration
D. Retinal detachment
Answer: D
Rationale: A ‘curtain-like’ or ‘shadow’ descending over the field of vision is a classic sign of
retinal detachment and requires emergency referral.
4. Which physical exam finding is most specifically associated with
Osteoarthritis of the hands?
A. Swan-neck deformity
B. Ulnar deviation
C. Bouchard’s nodes
D. Boutonniere deformity
Answer: C
Rationale: Bouchard’s nodes (PIP joints) and Heberden’s nodes (DIP joints) are
characteristic of Osteoarthritis, whereas the others are typical of Rheumatoid Arthritis.
5. A patient with a history of heart failure presents with increased dyspnea and
orthopnea. On exam, you hear an extra heart sound early in diastole. This is
likely:
A. Friction rub
B. S4 gallop
C. Systolic click
D. S3 gallop
Answer: D
, Rationale: An S3 heart sound is often associated with fluid overload and ventricular filling
in heart failure; it occurs in early diastole.
6. What is the first-line treatment for an adult diagnosed with uncomplicated
acute bacterial rhinosinusitis?
A. Azithromycin
B. Doxycycline
C. Levofloxacin
D. Amoxicillin-clavulanate
Answer: D
Rationale: Amoxicillin-clavulanate is the current first-line recommendation for bacterial
sinusitis to cover common pathogens like S. pneumoniae and H. influenzae.
7. A 30-year-old female presents with a TSH level of 7.2 mIU/L and a normal
Free T4. She is asymptomatic. What is the most likely diagnosis?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Subclinical hypothyroidism
D. Hyperthyroidism
Answer: C
Rationale: Subclinical hypothyroidism is characterized by an elevated TSH with a normal
Free T4 level, often in asymptomatic patients.
