NR 603 Midterm Exam Practice - Advanced Clinical Diagnosis
2026/2027 Chamberlain College
1. A 55-year-old male with chronic kidney disease (CKD) and hypertension
presents for follow-up. Which medication is considered first-line to help protect
renal function?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol
Answer: B
Rationale: ACE inhibitors like Lisinopril or ARBs are preferred in CKD patients because
they reduce intraglomerular pressure and proteinuria.
2. Which physical exam finding is most characteristic of Mitral Valve Prolapse?
A. Diastolic rumble
B. Opening snap
C. Midsystolic click
D. Holosystolic murmur at the apex
Answer: C
Rationale: Mitral Valve Prolapse is typically identified by a midsystolic click, often
followed by a late systolic murmur.
,3. According to the GINA guidelines, what is the preferred Step 1 treatment for
adults with intermittent asthma?
A. Low-dose ICS-formoterol as needed
B. SABA as needed
C. Daily low-dose ICS
D. Oral corticosteroids as needed
Answer: A
Rationale: The latest GINA guidelines recommend low-dose ICS-formoterol as the
preferred reliever to reduce the risk of severe exacerbations.
4. A patient presents with a TSH of 12.5 mIU/L and a low Free T4. What is the
most likely diagnosis?
A. Primary hypothyroidism
B. Primary hyperthyroidism
C. Subclinical hypothyroidism
D. Secondary hypothyroidism
Answer: A
Rationale: An elevated TSH combined with a low Free T4 confirms primary
hypothyroidism, usually caused by Hashimoto’s disease.
5. Which of the following is a ‘red flag’ symptom in a patient presenting with
acute low back pain?
A. Pain worsening with movement
B. Unilateral leg numbness
C. New onset urinary incontinence
D. Muscle spasms in the lumbar region
Answer: C
Rationale: Urinary incontinence or saddle anesthesia suggests Cauda Equina Syndrome, a
surgical emergency.
, 6. A 65-year-old patient with a 40 pack-year history of smoking has a FEV1/FVC
ratio of 0.65. This finding is diagnostic for:
A. Asthma
B. COPD
C. Restrictive lung disease
D. Normal aging
Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the gold standard for
diagnosing COPD.
7. Which medication is the first-line pharmacological treatment for Type 2
Diabetes Mellitus, assuming no contraindications?
A. Metformin
B. Pioglitazone
C. Glipizide
D. Sitagliptin
Answer: A
Rationale: Metformin is the first-line agent due to its efficacy, safety, and low cost.
8. A patient presents with a ‘stuck-on,’ waxy, pigmented lesion on the back. This
is most likely:
A. Actinic keratosis
B. Malignant melanoma
C. Basal cell carcinoma
D. Seborrheic keratosis
Answer: D
Rationale: Seborrheic keratosis is a benign skin tumor often described as having a ‘stuck-
on’ appearance.
2026/2027 Chamberlain College
1. A 55-year-old male with chronic kidney disease (CKD) and hypertension
presents for follow-up. Which medication is considered first-line to help protect
renal function?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol
Answer: B
Rationale: ACE inhibitors like Lisinopril or ARBs are preferred in CKD patients because
they reduce intraglomerular pressure and proteinuria.
2. Which physical exam finding is most characteristic of Mitral Valve Prolapse?
A. Diastolic rumble
B. Opening snap
C. Midsystolic click
D. Holosystolic murmur at the apex
Answer: C
Rationale: Mitral Valve Prolapse is typically identified by a midsystolic click, often
followed by a late systolic murmur.
,3. According to the GINA guidelines, what is the preferred Step 1 treatment for
adults with intermittent asthma?
A. Low-dose ICS-formoterol as needed
B. SABA as needed
C. Daily low-dose ICS
D. Oral corticosteroids as needed
Answer: A
Rationale: The latest GINA guidelines recommend low-dose ICS-formoterol as the
preferred reliever to reduce the risk of severe exacerbations.
4. A patient presents with a TSH of 12.5 mIU/L and a low Free T4. What is the
most likely diagnosis?
A. Primary hypothyroidism
B. Primary hyperthyroidism
C. Subclinical hypothyroidism
D. Secondary hypothyroidism
Answer: A
Rationale: An elevated TSH combined with a low Free T4 confirms primary
hypothyroidism, usually caused by Hashimoto’s disease.
5. Which of the following is a ‘red flag’ symptom in a patient presenting with
acute low back pain?
A. Pain worsening with movement
B. Unilateral leg numbness
C. New onset urinary incontinence
D. Muscle spasms in the lumbar region
Answer: C
Rationale: Urinary incontinence or saddle anesthesia suggests Cauda Equina Syndrome, a
surgical emergency.
, 6. A 65-year-old patient with a 40 pack-year history of smoking has a FEV1/FVC
ratio of 0.65. This finding is diagnostic for:
A. Asthma
B. COPD
C. Restrictive lung disease
D. Normal aging
Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the gold standard for
diagnosing COPD.
7. Which medication is the first-line pharmacological treatment for Type 2
Diabetes Mellitus, assuming no contraindications?
A. Metformin
B. Pioglitazone
C. Glipizide
D. Sitagliptin
Answer: A
Rationale: Metformin is the first-line agent due to its efficacy, safety, and low cost.
8. A patient presents with a ‘stuck-on,’ waxy, pigmented lesion on the back. This
is most likely:
A. Actinic keratosis
B. Malignant melanoma
C. Basal cell carcinoma
D. Seborrheic keratosis
Answer: D
Rationale: Seborrheic keratosis is a benign skin tumor often described as having a ‘stuck-
on’ appearance.
