NR 603 CEA EXAM / NEWEST NR 603 CEA MIDTERM EXAM 2026/2027
CLINICAL DIAGNOSIS TEST, PRACTICE QUESTIONS & STUDY GUIDE
COMPLETE ACCURATE EXAM APPROVED QUESTIONS WITH WELL
ELABORATED ANSWERS AND RATIONALES (100% CORRECT VERIFIED
SOLUTIONS) LATEST UPDATED VERSION 2026 EDITION |GUARANTEED
PASS A+ (BRAND NEW!) FULL REVISED NR 603 CEA ACTUAL MIDTERM
EXAM |JUST RELEASED
A 58-year-old male with a 40-pack-year smoking history presents with worsening
dyspnea on exertion and a chronic cough productive of mucoid sputum.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. Which of the
following is the most appropriate next step in confirming the diagnosis?
A) High-resolution CT scan of the chest
B) FEV1 improvement of less than 12% after bronchodilator administration
CORRECT ANSWER
C) Diffusion capacity of the lung for carbon monoxide (DLCO) measurement
D) Arterial blood gas analysis
Rationale: The post-bronchodilator FEV1/FVC ratio of 0.65 confirms fixed airflow
obstruction consistent with COPD. The diagnosis of COPD is established by
spirometry showing a post-bronchodilator FEV1/FVC <0.70. While a lack of
significant reversibility (FEV1 improvement <12% and <200 mL) helps
differentiate COPD from asthma, it is not required for diagnosis but is a key
confirmatory feature. HRCT is used for phenotyping or ruling out other diseases.
DLCO assesses gas exchange but is not diagnostic. ABG is for assessing severity
in advanced disease.
,A 72-year-old female with a history of hypertension and type 2 diabetes presents
with acute-onset right-sided facial droop, left arm weakness, and dysarthria that
began 90 minutes ago. Her blood pressure is 185/110 mmHg. Non-contrast head
CT shows no hemorrhage. Which of the following is the most appropriate acute
management?
A) Administer IV labetalol to lower BP to <140/90 mmHg immediately
B) Administer IV alteplase (tPA) after confirming no contraindications CORRECT
ANSWER
C) Start aspirin 325 mg orally and admit for observation
D) Perform emergent carotid endarterectomy
Rationale: The patient presents with acute ischemic stroke within the 3-hour
window and no hemorrhage on CT. IV tPA is indicated for eligible patients within
3-4.5 hours of symptom onset. Blood pressure up to 185/110 mmHg is acceptable
for tPA administration; aggressive lowering is avoided unless >185/110. Aspirin is
given after 24 hours if no tPA is used or after tPA. Carotid endarterectomy is not
acute management for ischemic stroke.
A 34-year-old female presents with palpitations, heat intolerance, weight loss
despite increased appetite, and a fine tremor. On exam, she has a diffusely enlarged
thyroid gland with a bruit. TSH is <0.01 mIU/L (normal 0.4-4.0) and free T4 is
elevated. Which of the following is the most likely diagnosis and initial treatment?
A) Hashimoto thyroiditis; levothyroxine
B) Subacute thyroiditis; propranolol and prednisone
C) Graves disease; methimazole and propranolol CORRECT ANSWER
D) Toxic multinodular goiter; radioactive iodine
Rationale: The combination of hyperthyroidism with diffuse goiter and bruit is
classic for Graves disease, an autoimmune disorder. Methimazole (thionamide) is
first-line for Graves in non-pregnant adults, and propranolol controls adrenergic
,symptoms. Hashimoto causes hypothyroidism. Subacute thyroiditis presents with
painful goiter and transient hyperthyroidism treated with beta-blockers and
steroids. Toxic multinodular goiter typically occurs in older adults with nodular
goiter.
A 45-year-old male with a history of GERD presents with intermittent chest pain
that is burning in nature, occurs after large meals, and is relieved by antacids. He
has no dyspnea or diaphoresis. ECG is normal. Which of the following is the most
appropriate initial diagnostic test?
A) Exercise stress test
B) Empiric trial of a proton pump inhibitor (PPI) CORRECT ANSWER
C) Coronary CT angiography
D) Upper endoscopy
Rationale: The symptoms are typical of GERD (postprandial burning, relief with
antacids) and low risk for cardiac etiology. An empiric trial of a PPI for 4-8 weeks
is the initial diagnostic and therapeutic step. Upper endoscopy is reserved for alarm
symptoms (dysphagia, weight loss, bleeding) or failure of PPI therapy. Cardiac
testing is not indicated without concerning features.
A 28-year-old male presents with sudden-onset severe, sharp left-sided chest pain
that worsens with inspiration and lying flat. He reports a recent upper respiratory
infection. On exam, he has a pericardial friction rub. Vital signs: BP 130/80, HR
110, RR 20, O2 sat 98% on room air. ECG shows diffuse ST-segment elevations.
Which of the following is the most appropriate initial treatment?
A) Aspirin 325 mg and clopidogrel 300 mg
B) Ibuprofen 600 mg every 8 hours and colchicine 0.6 mg twice daily CORRECT
ANSWER
C) IV heparin and enoxaparin
D) Emergent percutaneous coronary intervention
, Rationale: The presentation is consistent with acute pericarditis (pleuritic chest
pain, friction rub, diffuse ST elevations, history of viral illness). First-line
treatment is NSAIDs (ibuprofen) plus colchicine for inflammation and recurrence
prevention. Aspirin and antiplatelets are for MI. Heparin is for thromboembolism.
PCI is for STEMI.
A 62-year-old female with a history of rheumatoid arthritis presents with
progressive dyspnea on exertion, dry cough, and bilateral crackles on lung
auscultation. High-resolution CT shows bilateral ground-glass opacities and
reticulation in a peripheral and basilar distribution. Which of the following is the
most likely diagnosis?
A) Sarcoidosis
B) Hypersensitivity pneumonitis
C) Usual interstitial pneumonia (UIP) pattern consistent with idiopathic pulmonary
fibrosis CORRECT ANSWER
D) Cryptogenic organizing pneumonia
Rationale: The HRCT findings (peripheral, basilar reticulation and ground-glass)
in a patient with rheumatoid arthritis (an autoimmune disease) suggest interstitial
lung disease, specifically usual interstitial pneumonia (UIP) pattern. UIP is the
most common pattern in RA-ILD. Sarcoidosis shows upper lobe and perihilar
involvement. Hypersensitivity pneumonitis has upper or mid-zone ground-glass
with air trapping. COP has patchy, migratory opacities.
A 55-year-old male presents with acute onset of severe right upper quadrant pain,
fever, and jaundice. He has a history of gallstones. On exam, he is febrile (39°C),
with tenderness in the RUQ. Labs: WBC 18,000, total bilirubin 4.5 mg/dL, alkaline
phosphatase 450 U/L. Which of the following is the most appropriate next step?
A) Laparoscopic cholecystectomy
B) Urgent ERCP with sphincterotomy CORRECT ANSWER
CLINICAL DIAGNOSIS TEST, PRACTICE QUESTIONS & STUDY GUIDE
COMPLETE ACCURATE EXAM APPROVED QUESTIONS WITH WELL
ELABORATED ANSWERS AND RATIONALES (100% CORRECT VERIFIED
SOLUTIONS) LATEST UPDATED VERSION 2026 EDITION |GUARANTEED
PASS A+ (BRAND NEW!) FULL REVISED NR 603 CEA ACTUAL MIDTERM
EXAM |JUST RELEASED
A 58-year-old male with a 40-pack-year smoking history presents with worsening
dyspnea on exertion and a chronic cough productive of mucoid sputum.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. Which of the
following is the most appropriate next step in confirming the diagnosis?
A) High-resolution CT scan of the chest
B) FEV1 improvement of less than 12% after bronchodilator administration
CORRECT ANSWER
C) Diffusion capacity of the lung for carbon monoxide (DLCO) measurement
D) Arterial blood gas analysis
Rationale: The post-bronchodilator FEV1/FVC ratio of 0.65 confirms fixed airflow
obstruction consistent with COPD. The diagnosis of COPD is established by
spirometry showing a post-bronchodilator FEV1/FVC <0.70. While a lack of
significant reversibility (FEV1 improvement <12% and <200 mL) helps
differentiate COPD from asthma, it is not required for diagnosis but is a key
confirmatory feature. HRCT is used for phenotyping or ruling out other diseases.
DLCO assesses gas exchange but is not diagnostic. ABG is for assessing severity
in advanced disease.
,A 72-year-old female with a history of hypertension and type 2 diabetes presents
with acute-onset right-sided facial droop, left arm weakness, and dysarthria that
began 90 minutes ago. Her blood pressure is 185/110 mmHg. Non-contrast head
CT shows no hemorrhage. Which of the following is the most appropriate acute
management?
A) Administer IV labetalol to lower BP to <140/90 mmHg immediately
B) Administer IV alteplase (tPA) after confirming no contraindications CORRECT
ANSWER
C) Start aspirin 325 mg orally and admit for observation
D) Perform emergent carotid endarterectomy
Rationale: The patient presents with acute ischemic stroke within the 3-hour
window and no hemorrhage on CT. IV tPA is indicated for eligible patients within
3-4.5 hours of symptom onset. Blood pressure up to 185/110 mmHg is acceptable
for tPA administration; aggressive lowering is avoided unless >185/110. Aspirin is
given after 24 hours if no tPA is used or after tPA. Carotid endarterectomy is not
acute management for ischemic stroke.
A 34-year-old female presents with palpitations, heat intolerance, weight loss
despite increased appetite, and a fine tremor. On exam, she has a diffusely enlarged
thyroid gland with a bruit. TSH is <0.01 mIU/L (normal 0.4-4.0) and free T4 is
elevated. Which of the following is the most likely diagnosis and initial treatment?
A) Hashimoto thyroiditis; levothyroxine
B) Subacute thyroiditis; propranolol and prednisone
C) Graves disease; methimazole and propranolol CORRECT ANSWER
D) Toxic multinodular goiter; radioactive iodine
Rationale: The combination of hyperthyroidism with diffuse goiter and bruit is
classic for Graves disease, an autoimmune disorder. Methimazole (thionamide) is
first-line for Graves in non-pregnant adults, and propranolol controls adrenergic
,symptoms. Hashimoto causes hypothyroidism. Subacute thyroiditis presents with
painful goiter and transient hyperthyroidism treated with beta-blockers and
steroids. Toxic multinodular goiter typically occurs in older adults with nodular
goiter.
A 45-year-old male with a history of GERD presents with intermittent chest pain
that is burning in nature, occurs after large meals, and is relieved by antacids. He
has no dyspnea or diaphoresis. ECG is normal. Which of the following is the most
appropriate initial diagnostic test?
A) Exercise stress test
B) Empiric trial of a proton pump inhibitor (PPI) CORRECT ANSWER
C) Coronary CT angiography
D) Upper endoscopy
Rationale: The symptoms are typical of GERD (postprandial burning, relief with
antacids) and low risk for cardiac etiology. An empiric trial of a PPI for 4-8 weeks
is the initial diagnostic and therapeutic step. Upper endoscopy is reserved for alarm
symptoms (dysphagia, weight loss, bleeding) or failure of PPI therapy. Cardiac
testing is not indicated without concerning features.
A 28-year-old male presents with sudden-onset severe, sharp left-sided chest pain
that worsens with inspiration and lying flat. He reports a recent upper respiratory
infection. On exam, he has a pericardial friction rub. Vital signs: BP 130/80, HR
110, RR 20, O2 sat 98% on room air. ECG shows diffuse ST-segment elevations.
Which of the following is the most appropriate initial treatment?
A) Aspirin 325 mg and clopidogrel 300 mg
B) Ibuprofen 600 mg every 8 hours and colchicine 0.6 mg twice daily CORRECT
ANSWER
C) IV heparin and enoxaparin
D) Emergent percutaneous coronary intervention
, Rationale: The presentation is consistent with acute pericarditis (pleuritic chest
pain, friction rub, diffuse ST elevations, history of viral illness). First-line
treatment is NSAIDs (ibuprofen) plus colchicine for inflammation and recurrence
prevention. Aspirin and antiplatelets are for MI. Heparin is for thromboembolism.
PCI is for STEMI.
A 62-year-old female with a history of rheumatoid arthritis presents with
progressive dyspnea on exertion, dry cough, and bilateral crackles on lung
auscultation. High-resolution CT shows bilateral ground-glass opacities and
reticulation in a peripheral and basilar distribution. Which of the following is the
most likely diagnosis?
A) Sarcoidosis
B) Hypersensitivity pneumonitis
C) Usual interstitial pneumonia (UIP) pattern consistent with idiopathic pulmonary
fibrosis CORRECT ANSWER
D) Cryptogenic organizing pneumonia
Rationale: The HRCT findings (peripheral, basilar reticulation and ground-glass)
in a patient with rheumatoid arthritis (an autoimmune disease) suggest interstitial
lung disease, specifically usual interstitial pneumonia (UIP) pattern. UIP is the
most common pattern in RA-ILD. Sarcoidosis shows upper lobe and perihilar
involvement. Hypersensitivity pneumonitis has upper or mid-zone ground-glass
with air trapping. COP has patchy, migratory opacities.
A 55-year-old male presents with acute onset of severe right upper quadrant pain,
fever, and jaundice. He has a history of gallstones. On exam, he is febrile (39°C),
with tenderness in the RUQ. Labs: WBC 18,000, total bilirubin 4.5 mg/dL, alkaline
phosphatase 450 U/L. Which of the following is the most appropriate next step?
A) Laparoscopic cholecystectomy
B) Urgent ERCP with sphincterotomy CORRECT ANSWER
