NR 603 Advanced Clinical Diagnosis and
Practice Across the Lifespan ACTUAL
EXAM 2025/2026 | CEA Pre-Diagnostic
Exam Practice Set | Chamberlain
University | Newest Update | Verified
Q&A | Pass Guaranteed - A+ Graded
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS (40 Questions)
Cardiovascular & Pulmonary
Q1. A 55-year-old male presents with sudden onset of sharp, tearing chest pain radiating to the
back. He has a history of hypertension and Marfan syndrome. Blood pressure is 160/95 mmHg in
the right arm and 110/70 mmHg in the left arm. Which condition is most likely?
A. Acute coronary syndrome
B. Pulmonary embolism
C. Aortic dissection [CORRECT]
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, "tearing" or "ripping" chest pain that
often radiates to the back. Risk factors include uncontrolled hypertension and connective tissue
disorders (Marfan syndrome, Ehlers-Danlos). Asymmetric blood pressures between arms (>20
mmHg difference) are characteristic findings. Pulse deficits may also be present. Acute coronary
syndrome (A) typically presents with pressure-like, substernal pain without radiation to the back or
blood pressure differentials. Pulmonary embolism (B) presents with pleuritic chest pain, dyspnea,
and tachypnea. Pericarditis (D) presents with sharp, pleuritic pain that worsens lying flat and
improves leaning forward.
,Chamberlain Note: Always check bilateral blood pressures in any patient with sudden severe chest
pain—an inter-arm difference >20 mmHg suggests aortic dissection until proven otherwise.
Q2. A 62-year-old female presents with progressive dyspnea on exertion, orthopnea, and
paroxysmal nocturnal dyspnea. Physical exam reveals bilateral crackles, jugular venous distension,
and peripheral edema. Which condition best explains this presentation?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction [CORRECT]
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: The triad of dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea (PND)
is classic for left-sided heart failure. Physical findings of pulmonary congestion (crackles), fluid
overload (JVD, peripheral edema), and symptoms of both left (pulmonary) and right (systemic)
heart failure suggest biventricular failure or decompensated heart failure. COPD (A) would present
with wheezing, prolonged expiration, and barrel chest. PE (C) presents with acute dyspnea,
pleuritic pain, and tachycardia without chronic symptoms. Pneumonia (D) presents with fever,
productive cough, and localized findings.
Reference: 2022 AHA/ACC/HFSA Heart Failure Management Guidelines.
Q3. A 45-year-old male presents with acute pleuritic chest pain, dyspnea, and hemoptysis. He
recently returned from a long international flight. Vital signs: HR 118, RR 24, BP 130/85, SpO2 89%
on room air. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism [CORRECT]
C. Spontaneous pneumothorax
D. Costochondritis
Correct Answer: B
Rationale: The classic triad of pleuritic chest pain, dyspnea, and hemoptysis, combined with risk
factors (stasis from long flight), tachycardia, hypoxemia, and tachypnea strongly suggests
pulmonary embolism. Virchow's triad (stasis, hypercoagulability, endothelial injury) predisposes to
PE. Wells' Criteria or Geneva Score should be calculated to determine pre-test probability. MI (A)
presents with pressure-like pain, not pleuritic. Pneumothorax (C) presents with sudden unilateral
,pain and decreased breath sounds. Costochondritis (D) is reproducible on palpation and lacks
systemic symptoms.
Q4. A 28-year-old female presents with palpitations, anxiety, and heat intolerance. She has lost 10
pounds unintentionally over 2 months. Physical exam reveals tremor, moist skin, and a thyroid
nodule. Heart rate is 112 bpm. Which condition is most likely?
A. Generalized anxiety disorder
B. Hyperthyroidism [CORRECT]
C. Pheochromocytoma
D. Panic disorder
Correct Answer: B
Rationale: The combination of palpitations, heat intolerance, weight loss with increased appetite,
tremor, and tachycardia suggests hyperthyroidism. Graves' disease is the most common cause in
women of childbearing age. Anxiety disorders (A, D) would not explain the weight loss, heat
intolerance, or physical findings of hypermetabolism. Pheochromocytoma (C) presents with
episodic hypertension, headaches, sweating, and pallor rather than heat intolerance and weight
loss.
Gastrointestinal
Q5. A 42-year-old male presents with severe epigastric pain radiating to the back, nausea, and
vomiting. He reports the pain started after eating a large, fatty meal. Vital signs: T 101.2°F, HR 120,
BP 95/60. Serum lipase is 1,200 U/L (normal 10-140). What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis [CORRECT]
C. Perforated peptic ulcer
D. Myocardial infarction
Correct Answer: B
Rationale: Acute pancreatitis presents with severe epigastric pain radiating to the back,
nausea/vomiting, fever, tachycardia, and elevated lipase (>3 times upper limit of normal). Risk
factors include gallstones and alcohol use. The hemodynamic instability (hypotension) suggests
severe pancreatitis. Cholecystitis (A) presents with right upper quadrant pain and Murphy's sign.
Perforated ulcer (C) presents with rigid abdomen and free air on X-ray. MI (D) can present with
epigastric pain but lipase would not be elevated.
, Reference: 2024 ACG Clinical Guideline for Acute Pancreatitis.
Q6. A 25-year-old female presents with intermittent abdominal pain, bloating, and alternating
diarrhea and constipation. Symptoms worsen with stress and improve after defecation. She has no
weight loss, fever, or blood in stool. Physical exam is benign. What is the most likely diagnosis?
A. Crohn's disease
B. Ulcerative colitis
C. Irritable bowel syndrome [CORRECT]
D. Celiac disease
Correct Answer: C
Rationale: IBS presents with chronic abdominal pain associated with altered bowel habits (diarrhea,
constipation, or mixed) that improves with defecation. The absence of alarm features (weight loss,
fever, bleeding, anemia) supports functional etiology rather than inflammatory bowel disease.
Rome IV criteria require symptom onset >6 months with recurrent abdominal pain >1 day/week for 3
months associated with defecation and change in stool frequency/form. IBD (A, B) presents with
systemic symptoms and inflammation. Celiac disease (D) presents with malabsorption and weight
loss.
Q7. A 68-year-old male presents with left lower quadrant pain, fever, and constipation. He reports
similar milder episodes in the past. CT scan shows colonic wall thickening and pericolic fat
stranding. What is the most likely diagnosis?
A. Appendicitis
B. Diverticulitis [CORRECT]
C. Colon cancer
D. Ischemic colitis
Correct Answer: B
Rationale: Left lower quadrant pain in older adults with prior episodes suggests diverticulitis. CT
findings of wall thickening and pericolic stranding confirm inflammation of diverticula. Appendicitis
(A) presents with right lower quadrant pain. Colon cancer (C) may present with obstruction,
bleeding, or weight loss but not acute inflammatory symptoms. Ischemic colitis (D) presents with
sudden pain and bloody diarrhea in vascular compromise.
Chamberlain Note: "Left is right" for diverticulitis—LLQ pain in older adults think diverticulitis; RLQ
pain think appendicitis.
Practice Across the Lifespan ACTUAL
EXAM 2025/2026 | CEA Pre-Diagnostic
Exam Practice Set | Chamberlain
University | Newest Update | Verified
Q&A | Pass Guaranteed - A+ Graded
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL DIAGNOSIS (40 Questions)
Cardiovascular & Pulmonary
Q1. A 55-year-old male presents with sudden onset of sharp, tearing chest pain radiating to the
back. He has a history of hypertension and Marfan syndrome. Blood pressure is 160/95 mmHg in
the right arm and 110/70 mmHg in the left arm. Which condition is most likely?
A. Acute coronary syndrome
B. Pulmonary embolism
C. Aortic dissection [CORRECT]
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, "tearing" or "ripping" chest pain that
often radiates to the back. Risk factors include uncontrolled hypertension and connective tissue
disorders (Marfan syndrome, Ehlers-Danlos). Asymmetric blood pressures between arms (>20
mmHg difference) are characteristic findings. Pulse deficits may also be present. Acute coronary
syndrome (A) typically presents with pressure-like, substernal pain without radiation to the back or
blood pressure differentials. Pulmonary embolism (B) presents with pleuritic chest pain, dyspnea,
and tachypnea. Pericarditis (D) presents with sharp, pleuritic pain that worsens lying flat and
improves leaning forward.
,Chamberlain Note: Always check bilateral blood pressures in any patient with sudden severe chest
pain—an inter-arm difference >20 mmHg suggests aortic dissection until proven otherwise.
Q2. A 62-year-old female presents with progressive dyspnea on exertion, orthopnea, and
paroxysmal nocturnal dyspnea. Physical exam reveals bilateral crackles, jugular venous distension,
and peripheral edema. Which condition best explains this presentation?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction [CORRECT]
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: The triad of dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea (PND)
is classic for left-sided heart failure. Physical findings of pulmonary congestion (crackles), fluid
overload (JVD, peripheral edema), and symptoms of both left (pulmonary) and right (systemic)
heart failure suggest biventricular failure or decompensated heart failure. COPD (A) would present
with wheezing, prolonged expiration, and barrel chest. PE (C) presents with acute dyspnea,
pleuritic pain, and tachycardia without chronic symptoms. Pneumonia (D) presents with fever,
productive cough, and localized findings.
Reference: 2022 AHA/ACC/HFSA Heart Failure Management Guidelines.
Q3. A 45-year-old male presents with acute pleuritic chest pain, dyspnea, and hemoptysis. He
recently returned from a long international flight. Vital signs: HR 118, RR 24, BP 130/85, SpO2 89%
on room air. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism [CORRECT]
C. Spontaneous pneumothorax
D. Costochondritis
Correct Answer: B
Rationale: The classic triad of pleuritic chest pain, dyspnea, and hemoptysis, combined with risk
factors (stasis from long flight), tachycardia, hypoxemia, and tachypnea strongly suggests
pulmonary embolism. Virchow's triad (stasis, hypercoagulability, endothelial injury) predisposes to
PE. Wells' Criteria or Geneva Score should be calculated to determine pre-test probability. MI (A)
presents with pressure-like pain, not pleuritic. Pneumothorax (C) presents with sudden unilateral
,pain and decreased breath sounds. Costochondritis (D) is reproducible on palpation and lacks
systemic symptoms.
Q4. A 28-year-old female presents with palpitations, anxiety, and heat intolerance. She has lost 10
pounds unintentionally over 2 months. Physical exam reveals tremor, moist skin, and a thyroid
nodule. Heart rate is 112 bpm. Which condition is most likely?
A. Generalized anxiety disorder
B. Hyperthyroidism [CORRECT]
C. Pheochromocytoma
D. Panic disorder
Correct Answer: B
Rationale: The combination of palpitations, heat intolerance, weight loss with increased appetite,
tremor, and tachycardia suggests hyperthyroidism. Graves' disease is the most common cause in
women of childbearing age. Anxiety disorders (A, D) would not explain the weight loss, heat
intolerance, or physical findings of hypermetabolism. Pheochromocytoma (C) presents with
episodic hypertension, headaches, sweating, and pallor rather than heat intolerance and weight
loss.
Gastrointestinal
Q5. A 42-year-old male presents with severe epigastric pain radiating to the back, nausea, and
vomiting. He reports the pain started after eating a large, fatty meal. Vital signs: T 101.2°F, HR 120,
BP 95/60. Serum lipase is 1,200 U/L (normal 10-140). What is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis [CORRECT]
C. Perforated peptic ulcer
D. Myocardial infarction
Correct Answer: B
Rationale: Acute pancreatitis presents with severe epigastric pain radiating to the back,
nausea/vomiting, fever, tachycardia, and elevated lipase (>3 times upper limit of normal). Risk
factors include gallstones and alcohol use. The hemodynamic instability (hypotension) suggests
severe pancreatitis. Cholecystitis (A) presents with right upper quadrant pain and Murphy's sign.
Perforated ulcer (C) presents with rigid abdomen and free air on X-ray. MI (D) can present with
epigastric pain but lipase would not be elevated.
, Reference: 2024 ACG Clinical Guideline for Acute Pancreatitis.
Q6. A 25-year-old female presents with intermittent abdominal pain, bloating, and alternating
diarrhea and constipation. Symptoms worsen with stress and improve after defecation. She has no
weight loss, fever, or blood in stool. Physical exam is benign. What is the most likely diagnosis?
A. Crohn's disease
B. Ulcerative colitis
C. Irritable bowel syndrome [CORRECT]
D. Celiac disease
Correct Answer: C
Rationale: IBS presents with chronic abdominal pain associated with altered bowel habits (diarrhea,
constipation, or mixed) that improves with defecation. The absence of alarm features (weight loss,
fever, bleeding, anemia) supports functional etiology rather than inflammatory bowel disease.
Rome IV criteria require symptom onset >6 months with recurrent abdominal pain >1 day/week for 3
months associated with defecation and change in stool frequency/form. IBD (A, B) presents with
systemic symptoms and inflammation. Celiac disease (D) presents with malabsorption and weight
loss.
Q7. A 68-year-old male presents with left lower quadrant pain, fever, and constipation. He reports
similar milder episodes in the past. CT scan shows colonic wall thickening and pericolic fat
stranding. What is the most likely diagnosis?
A. Appendicitis
B. Diverticulitis [CORRECT]
C. Colon cancer
D. Ischemic colitis
Correct Answer: B
Rationale: Left lower quadrant pain in older adults with prior episodes suggests diverticulitis. CT
findings of wall thickening and pericolic stranding confirm inflammation of diverticula. Appendicitis
(A) presents with right lower quadrant pain. Colon cancer (C) may present with obstruction,
bleeding, or weight loss but not acute inflammatory symptoms. Ischemic colitis (D) presents with
sudden pain and bloody diarrhea in vascular compromise.
Chamberlain Note: "Left is right" for diverticulitis—LLQ pain in older adults think diverticulitis; RLQ
pain think appendicitis.
