8/15/26, 2:23 AM NR511 CEA Exam · Study Guide
NR511 CEA EXAM QUESTIONS & RATIONALES
2025–2026 Updated Version | Complete Study
Guide
1. A 45-year-old female with hypertension and obesity presents with recurrent right upper
quadrant pain after meals. Ultrasound shows gallstones. What is the most appropriate initial
management?
A. Ursodeoxycholic acid therapy
B. Laparoscopic cholecystectomy
C. Observation and dietary modification
D. Extracorporeal shock wave lithotripsy
Correct Answer: B
Rationale: Symptomatic cholelithiasis with recurrent pain is best managed with laparoscopic
cholecystectomy. Ursodeoxycholic acid is for small cholesterol stones in patients who cannot undergo
surgery, and observation is not appropriate for symptomatic disease. Lithotripsy is rarely used.
2. A 68-year-old male with a 40-pack-year smoking history presents with a new cough and
hemoptysis. Chest X-ray shows a 3 cm lung mass. Which diagnostic test has the highest
sensitivity for staging?
A. CT chest with contrast
B. PET/CT scan
C. Transbronchial biopsy
D. MRI of the chest
Correct Answer: B
Rationale: PET/CT is the gold standard for non-small cell lung cancer staging, offering superior sensitivity
for nodal and distant metastasis. CT chest provides anatomical detail but less
metabolic information. Biopsy is for diagnosis, not staging.
3. A 32-year-old woman presents with fatigue, weight gain, and cold intolerance. TSH is
12.5 mIU/L, free T4 is 0.6 ng/dL. Which medication is first-line therapy?
A. Methimazole
B. Levothyroxine
C. Liothyronine
LECTSKYL 1/27
,8/15/26, 2:23 AM NR511 CEA Exam · Study Guide
D. Propylthiouracil
Correct Answer: B
Rationale: Primary hypothyroidism (elevated TSH, low free T4) is treated with levothyroxine (T4)
replacement. Methimazole and PTU are for hyperthyroidism. Liothyronine (T3) is not first-line.
4. A 55-year-old male with diabetes and CKD stage 3 presents with a painful, swollen right knee.
Joint aspiration reveals needle-shaped, negatively birefringent crystals under polarized light.
What is the diagnosis?
A. Pseudogout
B. Gout
C. Septic arthritis
D. Rheumatoid arthritis
Correct Answer: B
Rationale: Negatively birefringent, needle-shaped crystals are classic for monosodium urate (gout).
Pseudogout shows positively birefringent, rhomboid crystals. Septic arthritis would show WBCs and
bacteria, RA is inflammatory without crystals.
5. A 28-year-old healthy woman complains of a 3-day history of dysuria, frequency, and
suprapubic pain. Urinalysis shows positive nitrites and leukocyte esterase. What is the most
appropriate antibiotic?
A. Nitrofurantoin
B. Ciprofloxacin
C. Trimethoprim-sulfamethoxazole
D. Amoxicillin-clavulanate
Correct Answer: A
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis in women, especially given low resistance.
TMP-SMX is an alternative but resistance is increasing. Fluoroquinolones are reserved for complicated
cases.
6. A 72-year-old man presents with a 2-week history of severe lower back pain, new-onset urinary
retention, and bilateral leg weakness. Which condition should be suspected?
A. Lumbar strain
B. Cauda equina syndrome
C. Sciatica
LECTSKYL 2/27
, 8/15/26, 2:23 AM NR511 CEA Exam · Study Guide
D. Degenerative disc disease
Correct Answer: B
Rationale: Cauda equina syndrome is a surgical emergency characterized by severe back pain, urinary
retention, and lower extremity weakness. MRI is urgent. Lumbar strain and sciatica do not cause bladder
dysfunction.
7. A 50-year-old female with HTN and hyperlipidemia reports chest pressure with exertion that
resolves with rest. EKG shows no acute changes. What is the next best step?
A. Exercise stress test
B. Coronary CT angiography
C. Cardiac catheterization
D. Resting echocardiogram
Correct Answer: A
Rationale: In a patient with stable angina and intermediate pretest probability, exercise stress testing is
appropriate. Cardiac cath is for high-risk or positive stress. CT angiography is an
alternative but not first step.
8. A 65-year-old patient with a history of AFib on warfarin presents with sudden, severe
headache and vomiting. Neurologic exam shows right-sided weakness. What is the most likely
diagnosis?
A. Ischemic stroke
B. Subarachnoid hemorrhage
C. Intracerebral hemorrhage
D. Migraine with aura
Correct Answer: C
Rationale: Sudden severe headache with vomiting and focal deficit in a patient on anticoagulation
suggests intracerebral hemorrhage. Ischemic stroke typically presents with less
severe headache; SAH presents with "thunderclap" headache but often without focal deficit early.
9. A 40-year-old man with GERD is started on omeprazole. He returns with diarrhea and
abdominal cramps. Stool culture grows Campylobacter jejuni. What is the most
appropriate management?
A. Continue omeprazole, add azithromycin
B. Discontinue omeprazole, start loperamide
C. Discontinue omeprazole, start azithromycin
LECTSKYL 3/27
NR511 CEA EXAM QUESTIONS & RATIONALES
2025–2026 Updated Version | Complete Study
Guide
1. A 45-year-old female with hypertension and obesity presents with recurrent right upper
quadrant pain after meals. Ultrasound shows gallstones. What is the most appropriate initial
management?
A. Ursodeoxycholic acid therapy
B. Laparoscopic cholecystectomy
C. Observation and dietary modification
D. Extracorporeal shock wave lithotripsy
Correct Answer: B
Rationale: Symptomatic cholelithiasis with recurrent pain is best managed with laparoscopic
cholecystectomy. Ursodeoxycholic acid is for small cholesterol stones in patients who cannot undergo
surgery, and observation is not appropriate for symptomatic disease. Lithotripsy is rarely used.
2. A 68-year-old male with a 40-pack-year smoking history presents with a new cough and
hemoptysis. Chest X-ray shows a 3 cm lung mass. Which diagnostic test has the highest
sensitivity for staging?
A. CT chest with contrast
B. PET/CT scan
C. Transbronchial biopsy
D. MRI of the chest
Correct Answer: B
Rationale: PET/CT is the gold standard for non-small cell lung cancer staging, offering superior sensitivity
for nodal and distant metastasis. CT chest provides anatomical detail but less
metabolic information. Biopsy is for diagnosis, not staging.
3. A 32-year-old woman presents with fatigue, weight gain, and cold intolerance. TSH is
12.5 mIU/L, free T4 is 0.6 ng/dL. Which medication is first-line therapy?
A. Methimazole
B. Levothyroxine
C. Liothyronine
LECTSKYL 1/27
,8/15/26, 2:23 AM NR511 CEA Exam · Study Guide
D. Propylthiouracil
Correct Answer: B
Rationale: Primary hypothyroidism (elevated TSH, low free T4) is treated with levothyroxine (T4)
replacement. Methimazole and PTU are for hyperthyroidism. Liothyronine (T3) is not first-line.
4. A 55-year-old male with diabetes and CKD stage 3 presents with a painful, swollen right knee.
Joint aspiration reveals needle-shaped, negatively birefringent crystals under polarized light.
What is the diagnosis?
A. Pseudogout
B. Gout
C. Septic arthritis
D. Rheumatoid arthritis
Correct Answer: B
Rationale: Negatively birefringent, needle-shaped crystals are classic for monosodium urate (gout).
Pseudogout shows positively birefringent, rhomboid crystals. Septic arthritis would show WBCs and
bacteria, RA is inflammatory without crystals.
5. A 28-year-old healthy woman complains of a 3-day history of dysuria, frequency, and
suprapubic pain. Urinalysis shows positive nitrites and leukocyte esterase. What is the most
appropriate antibiotic?
A. Nitrofurantoin
B. Ciprofloxacin
C. Trimethoprim-sulfamethoxazole
D. Amoxicillin-clavulanate
Correct Answer: A
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis in women, especially given low resistance.
TMP-SMX is an alternative but resistance is increasing. Fluoroquinolones are reserved for complicated
cases.
6. A 72-year-old man presents with a 2-week history of severe lower back pain, new-onset urinary
retention, and bilateral leg weakness. Which condition should be suspected?
A. Lumbar strain
B. Cauda equina syndrome
C. Sciatica
LECTSKYL 2/27
, 8/15/26, 2:23 AM NR511 CEA Exam · Study Guide
D. Degenerative disc disease
Correct Answer: B
Rationale: Cauda equina syndrome is a surgical emergency characterized by severe back pain, urinary
retention, and lower extremity weakness. MRI is urgent. Lumbar strain and sciatica do not cause bladder
dysfunction.
7. A 50-year-old female with HTN and hyperlipidemia reports chest pressure with exertion that
resolves with rest. EKG shows no acute changes. What is the next best step?
A. Exercise stress test
B. Coronary CT angiography
C. Cardiac catheterization
D. Resting echocardiogram
Correct Answer: A
Rationale: In a patient with stable angina and intermediate pretest probability, exercise stress testing is
appropriate. Cardiac cath is for high-risk or positive stress. CT angiography is an
alternative but not first step.
8. A 65-year-old patient with a history of AFib on warfarin presents with sudden, severe
headache and vomiting. Neurologic exam shows right-sided weakness. What is the most likely
diagnosis?
A. Ischemic stroke
B. Subarachnoid hemorrhage
C. Intracerebral hemorrhage
D. Migraine with aura
Correct Answer: C
Rationale: Sudden severe headache with vomiting and focal deficit in a patient on anticoagulation
suggests intracerebral hemorrhage. Ischemic stroke typically presents with less
severe headache; SAH presents with "thunderclap" headache but often without focal deficit early.
9. A 40-year-old man with GERD is started on omeprazole. He returns with diarrhea and
abdominal cramps. Stool culture grows Campylobacter jejuni. What is the most
appropriate management?
A. Continue omeprazole, add azithromycin
B. Discontinue omeprazole, start loperamide
C. Discontinue omeprazole, start azithromycin
LECTSKYL 3/27
