CEA Prep: Full Practice
CEA PREP: FULL PRACTICE
EXAM
Learning master
, CEA Prep: Full Practice
1. 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: 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.
2. The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses?: 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. 3. 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?: 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.
4. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial
surveillance?-
: 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.
,5. Which of the following medications does not cause beta 1 stimulation?:
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all
have beta receptor activity.
6. 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?: 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.
7. 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?: 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
reevaluate 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.
8. Which of the following people groups represent the least risk of cardiac
disease?: Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and American Indians
are at at increased risk of cardiac disease due to higher rates of hypertension,
diabetes, and obesity than Caucasians.
, CEA Prep: Full Practice
9. 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:: 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.
10. Which of the following end-organ sequelae is not directly caused by
uncontrolled hypertension?: 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.
11. Preventive cardiac care should focus primarily on addressing all the
following except?: Genetic predisposition
Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable
risk factors such as age, gender, genetic/family history should not be the primary
focus of prevention.
12. 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?: 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.
CEA PREP: FULL PRACTICE
EXAM
Learning master
, CEA Prep: Full Practice
1. 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: 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.
2. The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses?: 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. 3. 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?: 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.
4. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial
surveillance?-
: 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.
,5. Which of the following medications does not cause beta 1 stimulation?:
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all
have beta receptor activity.
6. 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?: 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.
7. 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?: 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
reevaluate 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.
8. Which of the following people groups represent the least risk of cardiac
disease?: Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and American Indians
are at at increased risk of cardiac disease due to higher rates of hypertension,
diabetes, and obesity than Caucasians.
, CEA Prep: Full Practice
9. 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:: 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.
10. Which of the following end-organ sequelae is not directly caused by
uncontrolled hypertension?: 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.
11. Preventive cardiac care should focus primarily on addressing all the
following except?: Genetic predisposition
Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable
risk factors such as age, gender, genetic/family history should not be the primary
focus of prevention.
12. 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?: 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.
