NR511 CEA (150) EXAM
QUESTIONS & RATIONALES
2025–2026 Updated Version | Complete
Study Guide
1. A 34-year-old female presents with acute-onset dysuria, frequency, and suprapubic
pain. Urinalysis shows positive nitrites and leukocyte esterase. Which of the following
is the most appropriate initial management?
A. Oral cephalexin 500 mg BID for 7 days
B. Nitrofurantoin 100 mg BID for 5 days
C. Ciprofloxacin 250 mg BID for 3 days
D. Trimethoprim-sulfamethoxazole DS BID for 3 days
Correct Answer: B
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis due to low resistance and good
renal concentration. Cephalexin is less effective against E. coli; fluoroquinolones reserved for
complicated cases; TMP-SMX resistance exceeds 20% in many regions.
2. A 72-year-old male with a history of hypertension and benign prostatic hyperplasia
presents with nocturia, weak stream, and intermittent hematuria. PSA is 6.2 ng/mL.
What is the next best step?
A. Start tamsulosin and repeat PSA in 3 months
B. Obtain a transrectal ultrasound with biopsy
C. Order a urinalysis and urine culture
D. Recommend saw palmetto and watchful waiting
Correct Answer: B
Rationale: PSA >4.0 with hematuria and obstructive symptoms raises concern for prostate cancer.
Biopsy is indicated. Tamsulosin may be used later, but biopsy is priority. Urine culture is not the
next step.
3. A 28-year-old woman presents with 3 days of fatigue, myalgias, and a non-productive
cough. Chest X-ray reveals bilateral interstitial infiltrates. She returned from a cruise 5
days ago. What is the most likely causative organism?
A. Streptococcus pneumoniae
B. Legionella pneumophila
C. Mycoplasma pneumoniae
D. Chlamydia psittaci
Correct Answer: C
,Rationale: Mycoplasma pneumoniae is common in younger adults, often with interstitial infiltrates
and extrapulmonary symptoms. Cruise ship exposure is a clue for Legionella, but the interstitial
pattern and age suggest Mycoplasma.
Legionella often presents with GI symptoms and high fever.
4. A 55-year-old diabetic male presents with a painful, erythematous, swollen left great
toe. He denies trauma. Serum uric acid is 8.9 mg/dL. What is the most appropriate
initial treatment?
A. Allopurinol 300 mg daily
B. Colchicine 1.2 mg stat then 0.6 mg in 1 hour
C. Prednisone 40 mg daily for 5 days
D. Indomethacin 50 mg TID
Correct Answer: D
Rationale: NSAIDs (indomethacin) are first-line for acute gout. Colchicine is effective but has
GI side effects; prednisone is second-line. Allopurinol is for chronic management and may
worsen acute flare.
,5. A 45-year-old woman with a history of migraines presents with a severe, unilateral
headache, photophobia, and nausea. She has taken sumatriptan twice in the past 24 hours
with no relief. Which of the following is the best next step?
A. Administer IV metoclopramide and diphenhydramine
B. Order a non-contrast CT head
C. Prescribe oral rizatriptan
D. Refer to neurology for botulinum toxin
Correct Answer: A
Rationale: For status migrainosus unresponsive to triptans, IV metoclopramide with
diphenhydramine is effective. CT is not indicated unless red flags. Switching to another triptan
may help but not best next step. Botox is for chronic migraine.
6. A 68-year-old male with a 30-pack-year smoking history presents with hemoptysis, weight
loss, and hoarseness. Chest X-ray shows a left hilar mass. What is the most appropriate
initial diagnostic test?
A. CT-guided biopsy
B. Bronchoscopy with biopsy
C. PET/CT scan
D. Sputum cytology
Correct Answer: B
Rationale: Bronchoscopy is the best initial diagnostic for central hilar masses (visible
endobronchially). CT-guided biopsy is for peripheral lesions. PET/CT is staging, not diagnostic.
Sputum cytology has low sensitivity.
7. A 32-year-old woman presents with palpitations, heat intolerance, and a 10-pound
weight loss over 2 months. Heart rate 108 bpm, blood pressure 138/82. Thyroid exam
reveals a diffuse, non-tender goiter. What is the most likely diagnosis?
A. Graves’ disease
B. Toxic multinodular goiter
C. Subacute thyroiditis
D. Pituitary adenoma
Correct Answer: A
Rationale: Graves’ disease is the most common cause of hyperthyroidism in young women, with
diffuse goiter, ophthalmopathy (though not required), and classic symptoms. Toxic multinodular
goiter is more common in older adults. Subacute thyroiditis is painful.
8. A 55-year-old male with chronic alcohol use presents with jaundice, ascites, and
, asterixis. Laboratory shows elevated AST/ALT ratio >2, elevated INR, and low albumin.
What is the most appropriate initial pharmacologic treatment?
A. N-acetylcysteine
QUESTIONS & RATIONALES
2025–2026 Updated Version | Complete
Study Guide
1. A 34-year-old female presents with acute-onset dysuria, frequency, and suprapubic
pain. Urinalysis shows positive nitrites and leukocyte esterase. Which of the following
is the most appropriate initial management?
A. Oral cephalexin 500 mg BID for 7 days
B. Nitrofurantoin 100 mg BID for 5 days
C. Ciprofloxacin 250 mg BID for 3 days
D. Trimethoprim-sulfamethoxazole DS BID for 3 days
Correct Answer: B
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis due to low resistance and good
renal concentration. Cephalexin is less effective against E. coli; fluoroquinolones reserved for
complicated cases; TMP-SMX resistance exceeds 20% in many regions.
2. A 72-year-old male with a history of hypertension and benign prostatic hyperplasia
presents with nocturia, weak stream, and intermittent hematuria. PSA is 6.2 ng/mL.
What is the next best step?
A. Start tamsulosin and repeat PSA in 3 months
B. Obtain a transrectal ultrasound with biopsy
C. Order a urinalysis and urine culture
D. Recommend saw palmetto and watchful waiting
Correct Answer: B
Rationale: PSA >4.0 with hematuria and obstructive symptoms raises concern for prostate cancer.
Biopsy is indicated. Tamsulosin may be used later, but biopsy is priority. Urine culture is not the
next step.
3. A 28-year-old woman presents with 3 days of fatigue, myalgias, and a non-productive
cough. Chest X-ray reveals bilateral interstitial infiltrates. She returned from a cruise 5
days ago. What is the most likely causative organism?
A. Streptococcus pneumoniae
B. Legionella pneumophila
C. Mycoplasma pneumoniae
D. Chlamydia psittaci
Correct Answer: C
,Rationale: Mycoplasma pneumoniae is common in younger adults, often with interstitial infiltrates
and extrapulmonary symptoms. Cruise ship exposure is a clue for Legionella, but the interstitial
pattern and age suggest Mycoplasma.
Legionella often presents with GI symptoms and high fever.
4. A 55-year-old diabetic male presents with a painful, erythematous, swollen left great
toe. He denies trauma. Serum uric acid is 8.9 mg/dL. What is the most appropriate
initial treatment?
A. Allopurinol 300 mg daily
B. Colchicine 1.2 mg stat then 0.6 mg in 1 hour
C. Prednisone 40 mg daily for 5 days
D. Indomethacin 50 mg TID
Correct Answer: D
Rationale: NSAIDs (indomethacin) are first-line for acute gout. Colchicine is effective but has
GI side effects; prednisone is second-line. Allopurinol is for chronic management and may
worsen acute flare.
,5. A 45-year-old woman with a history of migraines presents with a severe, unilateral
headache, photophobia, and nausea. She has taken sumatriptan twice in the past 24 hours
with no relief. Which of the following is the best next step?
A. Administer IV metoclopramide and diphenhydramine
B. Order a non-contrast CT head
C. Prescribe oral rizatriptan
D. Refer to neurology for botulinum toxin
Correct Answer: A
Rationale: For status migrainosus unresponsive to triptans, IV metoclopramide with
diphenhydramine is effective. CT is not indicated unless red flags. Switching to another triptan
may help but not best next step. Botox is for chronic migraine.
6. A 68-year-old male with a 30-pack-year smoking history presents with hemoptysis, weight
loss, and hoarseness. Chest X-ray shows a left hilar mass. What is the most appropriate
initial diagnostic test?
A. CT-guided biopsy
B. Bronchoscopy with biopsy
C. PET/CT scan
D. Sputum cytology
Correct Answer: B
Rationale: Bronchoscopy is the best initial diagnostic for central hilar masses (visible
endobronchially). CT-guided biopsy is for peripheral lesions. PET/CT is staging, not diagnostic.
Sputum cytology has low sensitivity.
7. A 32-year-old woman presents with palpitations, heat intolerance, and a 10-pound
weight loss over 2 months. Heart rate 108 bpm, blood pressure 138/82. Thyroid exam
reveals a diffuse, non-tender goiter. What is the most likely diagnosis?
A. Graves’ disease
B. Toxic multinodular goiter
C. Subacute thyroiditis
D. Pituitary adenoma
Correct Answer: A
Rationale: Graves’ disease is the most common cause of hyperthyroidism in young women, with
diffuse goiter, ophthalmopathy (though not required), and classic symptoms. Toxic multinodular
goiter is more common in older adults. Subacute thyroiditis is painful.
8. A 55-year-old male with chronic alcohol use presents with jaundice, ascites, and
, asterixis. Laboratory shows elevated AST/ALT ratio >2, elevated INR, and low albumin.
What is the most appropriate initial pharmacologic treatment?
A. N-acetylcysteine
