CLINICAL EDUCATION ASSOCIATES (CEA)Pre-
Clinical Diagnostic Exam Question and Answers
Latest Updates 2026 Graded A+
1. Question: An elderly patient presents with confusion. Vital signs: BP
110/76, HR 86, RR 12, Temp 97°F. What is the next step?
Answer: Assess for infection
Rationale: Elderly patients often have atypical presentations of
infection (e.g., no fever); high suspicion is needed.
2. Question: A frail elderly patient presents with constipation. What
screening tool is appropriate for mobility and fall risk?
Answer: Timed Up and Go (Get Up and Go) test
Rationale: This directly assesses mobility; other tools (e.g., PHQ-2,
clock drawing) do not.
3. Question: A 78-year-old man leans to the right ear during
conversation and asks for repetition. His daughter worries about
dementia. What should the PMHNP do first?
Answer: Examine the patient's ear canals
Rationale: Hearing loss (e.g., cerumen impaction) can mimic cognitive
issues; rule out reversible causes first.
4. Question: What physical exam maneuver is Murphy's sign?
, Answer: Palpate right upper quadrant below costal margin during
deep inspiration; positive if pain on inhalation.
Rationale: Classic for cholecystitis.
5. Question: A patient with allergic rhinitis has tried OTC
antihistamines with limited relief. Next step?
Answer: Intranasal corticosteroids
Rationale: First-line for moderate-persistent symptoms per guidelines.
6. Question: An adult female returns for a recheck. The only
remarkable lab is TSH at 0 microunits/mL (normal 0.4-4.0). She reports
neck pain; exam shows thyroid tenderness. Which labs should the NP
order next?
Answer: Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Low TSH with tenderness suggests hyperthyroidism (e.g.,
subacute thyroiditis); elevated T3/FT4 confirms diagnosis.
7. Question: An adult with type 2 diabetes follows carb-counting diet
and walks 30 min 5x/week. Fasting glucose 116 mg/dL, A1c 6%. Per ADA
guidelines, next follow-up?
Answer: 6 months
, Rationale: Well-controlled (A1c <7%, fasting <130) warrants biannual
visits if stable.
8. Question: An 18-year-old with acne washes face 3-4x daily with mild
cleanser, but acne worsens. NP explains:
Answer: Frequent facial scrubs can worsen acne
Rationale: Over-washing strips natural oils, increasing irritation and
acne.
9. Question: A patient presents with swollen exudative pharynx,
profound fatigue, and tender left upper quadrant abdomen. Most likely
diagnosis?
Answer: Epstein-Barr virus (mononucleosis)
Rationale: Pharyngitis + splenomegaly (tender LUQ) + fatigue classic
for mono; not just strep.
10. Question: A 43-year-old male with GERD, smoking, obesity has
worsening symptoms despite PPI. EGD biopsy shows what for Barrett's
esophagus?
Answer: Intestinal metaplasia (columnar epithelium with goblet cells
replacing squamous)
Rationale: Barrett's is precancerous change from chronic reflux; risk
factors include obesity/smoking.
, 11. Question: Adult with increasing abdominal girth; NP suspects
ascites. Confirmatory physical exam finding?
Answer: Fluid wave or shifting dullness
Rationale: Percussion shows dullness shifting with position; fluid wave
transmitted across abdomen.
12. Question: Adult female with 1-week left lower quadrant pain, fever
101°F, elevated WBC. First episode. Suspected diverticulitis;
confirmatory test?
Answer: CT abdomen/pelvis with contrast
Rationale: Gold standard for diagnosing diverticulitis and
complications (e.g., abscess).
13. Question: Diagnostic test commonly used for fungal skin infections?
Answer: KOH preparation (potassium hydroxide scrape)
Rationale: Dissolves keratin to visualize hyphae/spores under
microscope.
14. Question: Most effective technique for negative margins in basal cell
carcinoma or melanoma?
Answer: Mohs micrographic surgery
Rationale: Layer-by-layer excision with immediate microscopic exam
ensures clear margins while sparing tissue.
Clinical Diagnostic Exam Question and Answers
Latest Updates 2026 Graded A+
1. Question: An elderly patient presents with confusion. Vital signs: BP
110/76, HR 86, RR 12, Temp 97°F. What is the next step?
Answer: Assess for infection
Rationale: Elderly patients often have atypical presentations of
infection (e.g., no fever); high suspicion is needed.
2. Question: A frail elderly patient presents with constipation. What
screening tool is appropriate for mobility and fall risk?
Answer: Timed Up and Go (Get Up and Go) test
Rationale: This directly assesses mobility; other tools (e.g., PHQ-2,
clock drawing) do not.
3. Question: A 78-year-old man leans to the right ear during
conversation and asks for repetition. His daughter worries about
dementia. What should the PMHNP do first?
Answer: Examine the patient's ear canals
Rationale: Hearing loss (e.g., cerumen impaction) can mimic cognitive
issues; rule out reversible causes first.
4. Question: What physical exam maneuver is Murphy's sign?
, Answer: Palpate right upper quadrant below costal margin during
deep inspiration; positive if pain on inhalation.
Rationale: Classic for cholecystitis.
5. Question: A patient with allergic rhinitis has tried OTC
antihistamines with limited relief. Next step?
Answer: Intranasal corticosteroids
Rationale: First-line for moderate-persistent symptoms per guidelines.
6. Question: An adult female returns for a recheck. The only
remarkable lab is TSH at 0 microunits/mL (normal 0.4-4.0). She reports
neck pain; exam shows thyroid tenderness. Which labs should the NP
order next?
Answer: Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Low TSH with tenderness suggests hyperthyroidism (e.g.,
subacute thyroiditis); elevated T3/FT4 confirms diagnosis.
7. Question: An adult with type 2 diabetes follows carb-counting diet
and walks 30 min 5x/week. Fasting glucose 116 mg/dL, A1c 6%. Per ADA
guidelines, next follow-up?
Answer: 6 months
, Rationale: Well-controlled (A1c <7%, fasting <130) warrants biannual
visits if stable.
8. Question: An 18-year-old with acne washes face 3-4x daily with mild
cleanser, but acne worsens. NP explains:
Answer: Frequent facial scrubs can worsen acne
Rationale: Over-washing strips natural oils, increasing irritation and
acne.
9. Question: A patient presents with swollen exudative pharynx,
profound fatigue, and tender left upper quadrant abdomen. Most likely
diagnosis?
Answer: Epstein-Barr virus (mononucleosis)
Rationale: Pharyngitis + splenomegaly (tender LUQ) + fatigue classic
for mono; not just strep.
10. Question: A 43-year-old male with GERD, smoking, obesity has
worsening symptoms despite PPI. EGD biopsy shows what for Barrett's
esophagus?
Answer: Intestinal metaplasia (columnar epithelium with goblet cells
replacing squamous)
Rationale: Barrett's is precancerous change from chronic reflux; risk
factors include obesity/smoking.
, 11. Question: Adult with increasing abdominal girth; NP suspects
ascites. Confirmatory physical exam finding?
Answer: Fluid wave or shifting dullness
Rationale: Percussion shows dullness shifting with position; fluid wave
transmitted across abdomen.
12. Question: Adult female with 1-week left lower quadrant pain, fever
101°F, elevated WBC. First episode. Suspected diverticulitis;
confirmatory test?
Answer: CT abdomen/pelvis with contrast
Rationale: Gold standard for diagnosing diverticulitis and
complications (e.g., abscess).
13. Question: Diagnostic test commonly used for fungal skin infections?
Answer: KOH preparation (potassium hydroxide scrape)
Rationale: Dissolves keratin to visualize hyphae/spores under
microscope.
14. Question: Most effective technique for negative margins in basal cell
carcinoma or melanoma?
Answer: Mohs micrographic surgery
Rationale: Layer-by-layer excision with immediate microscopic exam
ensures clear margins while sparing tissue.
