CEA PREP: FULL PRACTICE EXAM QUESTIONS
WITH 100% ACCURATE ANSWERS
The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA view shows a left
lower chest area of consolidation adjacent to the left border of the heart approximately 2 rib spaces
above the costophrenic angle. The lateral x-ray view shows this lesion absent of the window posterior to
the cardiac silhouette. Which is the most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe - Accurate answers Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette is
obliterated by the mass, the lesion is either right middle lobe or left upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark of which of the following
diagnoses? - Accurate answers Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of diastolic dysfunction and
is common in patients with thickened hypertrophic myocardium.
An otherwise healthy African American adult male has been diagnosed with hypertension. He has been
restricting his salt intake, eating a DASH (Dietary Approaches to Stop Hypertension) diet, and exercising
more, but his blood pressure is still elevated. Which is the BEST medication to prescribe him? -
Accurate answers Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be managed with a
dihydropyridine calcium channel blocker such as amlodipine (Norvasc) as first line management therapy
for hypertension not at goal with DASH and lifestyle modifications.
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical imaging is
considered standard of care for serial surveillance? - Accurate answers CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascular luminal dimensions
with contrast. CT PE protocol is not timed properly for the aorta (it's timed for the pulmonary artery).
Although a plain film is able to catch large aneurysms at times, they are not able to provide multi-axis
reconstruction needed to accurately measure the size. Transesophageal echo is not needed to
accurately measure the aorta and requires the patient to undergo sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation? - Accurate answers
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor
activity.
A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea.
On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is
the most likely diagnosis? - Accurate answers Congestive heart failure
,Rationale: Of the available options, the most accurate response is congestive heart failure as it is
signifying both a right ventricular back up with jugular venous extension and crackles on lung assault,
which are suggestive of left ventricular back up. it is possible the patient may have an acute myocardial
infarction that precipitated this, however, a patient has not described that, rather is only describing
dyspnea on exertion and orthopnea, which both speak to a state of fluid overload. The only appropriate
response of these available is congestive heart failure.
Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection
fraction of 40% who is also not on optimal medical therapy has been diagnosed with a myocardial
infarction this admission and received emergent placement of a drug-eluting stent to the left anterior
descending artery. As the medical home who will manage this patient after discharge, which medication
strategy would you expect to be a priority in the patient's care? - Accurate answers Ordering a
transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an implantable automated
cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due to the increased risk of
sudden cardiac death with low EF states. Since most patients are not eligible for 90 days for an AICD in
this state, optimizing their medication regimen and repeating an echo in 2-3 months to re-evaluate for
improvement in their EF is required by most insurance companies. A baseline echo is needed at
discharge to provide a baseline for improvement vs their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as presented.
A 65-year-old woman presents for a follow-up examination. She is a smoker, and her hypertension is
now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting
lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic
lifestyle changes, the nurse practitioner should start the patient on: - Accurate answers a statin
drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be useful in reducing ASVD
risk, but for a patient who is an active smoker with premature coronary disease history (less than age 65
for women), has hypertension and is far from an LDL goal, this patient is most certainly a candidate for
statin therapy, which represents the most aggressive therapy option of these four listed.
Which of the following end-organ sequelae is not directly caused by uncontrolled hypertension? -
Accurate answers Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral neuropathy, it is only directly
attributed to patients who are also diabetic and is commonly found in non-hypertensive diabetic
patients. Proteinuria, AV nicking, and hemorrhagic stroke are all caused by uncontrolled hypertension.
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and obesity. Laboratory tests
reveal elevated serum testosterone and LH ratio > 2:1. What is the most appropriate initial treatment? -
Accurate answers Oral contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and the patient should be treated
with oral contraceptives to help stabilize their estrogen and progesterone. Additionally, they may be
managed on metformin and/or spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for polycystic ovary
syndrome (PCOS) because they help manage in several ways:
,Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods lighter and more
regular. This is important because irregular ovulation can lead to endometrial hyperplasia, which is a
buildup of uterine tissue that can increase the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex hormone-binding globulin
(SHBG), which binds androgens. This can help reduce symptoms like acne, hirsutism (unwanted body
and facial hair), and androgenic alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine check-up. What screening
test should be regularly performed to monitor for early signs of diabetic nephropathy? - Accurate
answers Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the evidence of small proteins
in the urine (proteinuria) as found on urinalysis. The other options might describe macro-organ function
(such as BUN/Creat from a BMP, a renal biopsy which is not indicated for routine diabetic nephropathy
testing, and a Abd CT, which is more akin to evaluation of less subtle findings), but at the functional level
of the nephron, namely the glomerulus, evidence of glucose-related damage is easily identified with
proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine - Accurate answers
25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism in the elderly is to "go
slow and start low". 25 mcg is the most appropriate low dose to start with of these options. It is possible
that over time the dose will be increased until therapeutic levels are obtained, but the risk of over-
dosing the patient outweighs the desire to quickly achieve this state.
An adult female who recently returned for a recheck appointment. The only remarkable laboratory
result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 0.4-6 microunits/mL).
The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following
laboratory tests should the nurse practitioner order now? - Accurate answers Triiodothyronine (T3)
and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism with a corresponding
finding of elevated T3/T4 and clinical symptoms of a goiter, tremulousness, anxiety, palpitations, weight
loss, insomnia, diarrhea, etc. This patient is describing a sore neck as well, which is suggestive of Graves
disease (hyperthyroid state).
All the following are symptoms of hypocalcemia except: - Accurate answers Visual field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are symptoms
related to hypocalcemia.
An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The patient follows a
carbohydrate counting diet and walks 30 minutes 5 times weekly. Current fasting blood glucose = 116
mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the
American Diabetes Association, the nurse practitioner would recommend that the next follow-up
appointment be scheduled for: - Accurate answers 6 months.
Rationale: Based off of the ADA recommendation, this patient should be evaluated in six months. They
are actually showing good control and excellent compliance with diet and exercise management
strategies. If there compliance was worse or they were not controlled with their A1c, this would likely be
a three month follow up.
, Your patient has a diagnosis of Hashimoto's and is on Levothyroxine 75 mcg daily. Her recent TSH was
elevated at 15 uU/mL. Your next best action is to: - Accurate answers Increase Levothyroxine to
100 mcg daily
Rationale: When the TSH is elevated the patient needs more thyroid hormone. Once diagnosed with
Hashimoto's there is no clinical need/benefit to repeating anti bodies.
A patient has a 3 cm pituitary mass noted on CT. What is your next step in evaluating the patient? -
Accurate answers Screen for hormone deficiencies
Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for prolactinoma.
Surgery consult is indicated when there are VF deficits and/or abutment/compression on optic nerves or
chiasm or if adenoma is hyperfunctioning. Adenomas >1 cm with no VF deficit or abutment/compression
of optic nerves or chiasm require a follow up MRI at 6 months.
An adult female presents with a chief complaint of fatigue and weight gain. She states that she doesn't
feel like herself. A diagnosis of hypothyroidism is suspected. Which of the following physical findings
would support this diagnosis? - Accurate answers Dry skin, bradycardia, and hypoactive deep
tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly classic signs of
hypothyroidism. To further substantiate these concerns, the patient should have their TSH and T3 and
Free T4 checked, and it is likely their TSH would be elevated, T3/T4 low.
An older adult patient with new onset GERD, cough, heartburn. Initial tx - Accurate answers
Antacid and lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate diet/exercise and symptom
management when present with an antacid. Loss of weight/dieting is most likely to deal with obesity as
the most common underlying cause of GERD.
A 59-year-old male presents with symptoms of abdominal pain, jaundice, and weight loss which he has
not been trying to lose weight. What would be a malignancy associated with these symptoms? -
Accurate answers Pancreatic cancer
Raionale: Pancreatic cancer, the most typically presentation includes abdominal pain, jaundice, and
weight loss. Although weight loss and abdominal pain may be present with adenocarcinoma it is unlikely
to present with jaundice, and you're unlikely to have abdominal pain or jaundice with any esophageal
malignancy.
A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools a day.
She also reports mild cramping. Which labs would be helpful in further workup of a diagnosis? -
Accurate answers ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the potential
cause of her symptoms.
An adult female presents with a 1-week history of left lower quadrant abdominal pain. T=101.2 degrees
F. (38.4 degrees C) and an elevated WBC count. This is the patient's first episode of severe abdominal
pain. The nurse practitioner suspects diverticulitis. Which of the following diagnostic tests would confirm
the diagnosis? - Accurate answers CT scan of the abdomen
WITH 100% ACCURATE ANSWERS
The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA view shows a left
lower chest area of consolidation adjacent to the left border of the heart approximately 2 rib spaces
above the costophrenic angle. The lateral x-ray view shows this lesion absent of the window posterior to
the cardiac silhouette. Which is the most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe - Accurate answers Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette is
obliterated by the mass, the lesion is either right middle lobe or left upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark of which of the following
diagnoses? - Accurate answers Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of diastolic dysfunction and
is common in patients with thickened hypertrophic myocardium.
An otherwise healthy African American adult male has been diagnosed with hypertension. He has been
restricting his salt intake, eating a DASH (Dietary Approaches to Stop Hypertension) diet, and exercising
more, but his blood pressure is still elevated. Which is the BEST medication to prescribe him? -
Accurate answers Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be managed with a
dihydropyridine calcium channel blocker such as amlodipine (Norvasc) as first line management therapy
for hypertension not at goal with DASH and lifestyle modifications.
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical imaging is
considered standard of care for serial surveillance? - Accurate answers CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascular luminal dimensions
with contrast. CT PE protocol is not timed properly for the aorta (it's timed for the pulmonary artery).
Although a plain film is able to catch large aneurysms at times, they are not able to provide multi-axis
reconstruction needed to accurately measure the size. Transesophageal echo is not needed to
accurately measure the aorta and requires the patient to undergo sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation? - Accurate answers
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor
activity.
A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea.
On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is
the most likely diagnosis? - Accurate answers Congestive heart failure
,Rationale: Of the available options, the most accurate response is congestive heart failure as it is
signifying both a right ventricular back up with jugular venous extension and crackles on lung assault,
which are suggestive of left ventricular back up. it is possible the patient may have an acute myocardial
infarction that precipitated this, however, a patient has not described that, rather is only describing
dyspnea on exertion and orthopnea, which both speak to a state of fluid overload. The only appropriate
response of these available is congestive heart failure.
Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection
fraction of 40% who is also not on optimal medical therapy has been diagnosed with a myocardial
infarction this admission and received emergent placement of a drug-eluting stent to the left anterior
descending artery. As the medical home who will manage this patient after discharge, which medication
strategy would you expect to be a priority in the patient's care? - Accurate answers Ordering a
transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an implantable automated
cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due to the increased risk of
sudden cardiac death with low EF states. Since most patients are not eligible for 90 days for an AICD in
this state, optimizing their medication regimen and repeating an echo in 2-3 months to re-evaluate for
improvement in their EF is required by most insurance companies. A baseline echo is needed at
discharge to provide a baseline for improvement vs their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as presented.
A 65-year-old woman presents for a follow-up examination. She is a smoker, and her hypertension is
now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting
lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic
lifestyle changes, the nurse practitioner should start the patient on: - Accurate answers a statin
drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be useful in reducing ASVD
risk, but for a patient who is an active smoker with premature coronary disease history (less than age 65
for women), has hypertension and is far from an LDL goal, this patient is most certainly a candidate for
statin therapy, which represents the most aggressive therapy option of these four listed.
Which of the following end-organ sequelae is not directly caused by uncontrolled hypertension? -
Accurate answers Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral neuropathy, it is only directly
attributed to patients who are also diabetic and is commonly found in non-hypertensive diabetic
patients. Proteinuria, AV nicking, and hemorrhagic stroke are all caused by uncontrolled hypertension.
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and obesity. Laboratory tests
reveal elevated serum testosterone and LH ratio > 2:1. What is the most appropriate initial treatment? -
Accurate answers Oral contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and the patient should be treated
with oral contraceptives to help stabilize their estrogen and progesterone. Additionally, they may be
managed on metformin and/or spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for polycystic ovary
syndrome (PCOS) because they help manage in several ways:
,Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods lighter and more
regular. This is important because irregular ovulation can lead to endometrial hyperplasia, which is a
buildup of uterine tissue that can increase the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex hormone-binding globulin
(SHBG), which binds androgens. This can help reduce symptoms like acne, hirsutism (unwanted body
and facial hair), and androgenic alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine check-up. What screening
test should be regularly performed to monitor for early signs of diabetic nephropathy? - Accurate
answers Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the evidence of small proteins
in the urine (proteinuria) as found on urinalysis. The other options might describe macro-organ function
(such as BUN/Creat from a BMP, a renal biopsy which is not indicated for routine diabetic nephropathy
testing, and a Abd CT, which is more akin to evaluation of less subtle findings), but at the functional level
of the nephron, namely the glomerulus, evidence of glucose-related damage is easily identified with
proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine - Accurate answers
25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism in the elderly is to "go
slow and start low". 25 mcg is the most appropriate low dose to start with of these options. It is possible
that over time the dose will be increased until therapeutic levels are obtained, but the risk of over-
dosing the patient outweighs the desire to quickly achieve this state.
An adult female who recently returned for a recheck appointment. The only remarkable laboratory
result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 0.4-6 microunits/mL).
The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following
laboratory tests should the nurse practitioner order now? - Accurate answers Triiodothyronine (T3)
and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism with a corresponding
finding of elevated T3/T4 and clinical symptoms of a goiter, tremulousness, anxiety, palpitations, weight
loss, insomnia, diarrhea, etc. This patient is describing a sore neck as well, which is suggestive of Graves
disease (hyperthyroid state).
All the following are symptoms of hypocalcemia except: - Accurate answers Visual field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are symptoms
related to hypocalcemia.
An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The patient follows a
carbohydrate counting diet and walks 30 minutes 5 times weekly. Current fasting blood glucose = 116
mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the
American Diabetes Association, the nurse practitioner would recommend that the next follow-up
appointment be scheduled for: - Accurate answers 6 months.
Rationale: Based off of the ADA recommendation, this patient should be evaluated in six months. They
are actually showing good control and excellent compliance with diet and exercise management
strategies. If there compliance was worse or they were not controlled with their A1c, this would likely be
a three month follow up.
, Your patient has a diagnosis of Hashimoto's and is on Levothyroxine 75 mcg daily. Her recent TSH was
elevated at 15 uU/mL. Your next best action is to: - Accurate answers Increase Levothyroxine to
100 mcg daily
Rationale: When the TSH is elevated the patient needs more thyroid hormone. Once diagnosed with
Hashimoto's there is no clinical need/benefit to repeating anti bodies.
A patient has a 3 cm pituitary mass noted on CT. What is your next step in evaluating the patient? -
Accurate answers Screen for hormone deficiencies
Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for prolactinoma.
Surgery consult is indicated when there are VF deficits and/or abutment/compression on optic nerves or
chiasm or if adenoma is hyperfunctioning. Adenomas >1 cm with no VF deficit or abutment/compression
of optic nerves or chiasm require a follow up MRI at 6 months.
An adult female presents with a chief complaint of fatigue and weight gain. She states that she doesn't
feel like herself. A diagnosis of hypothyroidism is suspected. Which of the following physical findings
would support this diagnosis? - Accurate answers Dry skin, bradycardia, and hypoactive deep
tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly classic signs of
hypothyroidism. To further substantiate these concerns, the patient should have their TSH and T3 and
Free T4 checked, and it is likely their TSH would be elevated, T3/T4 low.
An older adult patient with new onset GERD, cough, heartburn. Initial tx - Accurate answers
Antacid and lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate diet/exercise and symptom
management when present with an antacid. Loss of weight/dieting is most likely to deal with obesity as
the most common underlying cause of GERD.
A 59-year-old male presents with symptoms of abdominal pain, jaundice, and weight loss which he has
not been trying to lose weight. What would be a malignancy associated with these symptoms? -
Accurate answers Pancreatic cancer
Raionale: Pancreatic cancer, the most typically presentation includes abdominal pain, jaundice, and
weight loss. Although weight loss and abdominal pain may be present with adenocarcinoma it is unlikely
to present with jaundice, and you're unlikely to have abdominal pain or jaundice with any esophageal
malignancy.
A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools a day.
She also reports mild cramping. Which labs would be helpful in further workup of a diagnosis? -
Accurate answers ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the potential
cause of her symptoms.
An adult female presents with a 1-week history of left lower quadrant abdominal pain. T=101.2 degrees
F. (38.4 degrees C) and an elevated WBC count. This is the patient's first episode of severe abdominal
pain. The nurse practitioner suspects diverticulitis. Which of the following diagnostic tests would confirm
the diagnosis? - Accurate answers CT scan of the abdomen
