CEA EXAM WITH ALL GRADED A+
SOLUTIONS
During na npost-hospital ndischarge nvisit, nyou nnotice nyour n71 nyear nold nfemale
npatient nhas nbeen ndiagnosed nwith na n"new nmurmur" nfound nby nthe nhospitalist
nduring ntheir nrecent nhospitalization nfor nCHF nexacerbation. nIn nevaluating nthe
npatient, nduring nwhich nphase nof nthe ncardiac ncycle nwould nyou nanticipate
nauscultation nof na nS3 nor nS4 nheart nsound?
*Diastole
*53 nin nsystole nwhile nS4 nin ndiastole
*Systole
*S4 nin ndiastole nwhile nS3 nin nsystole n- ncorrect nanswers n-Diastole
The npoint nof nmaximum nimpulse n(PMI) nis nMOST noften npalpable nin nhealthy nadults
nwhen npositioned nin nthe nsupine nor nleft nlateral ndecubitus nposition. nWhich none nof
nthe nfollowing nlocations nis nmost ncommonly ndescribed nas nthe nPMI nin na nhealthy
nadult?
*Left n2nd nintercostal nspace, nmidaxillary nline.
*Left n5th nintercostal nspace, nmidclavicular nline.
*Right n4th nintercostal nspace, nmidaxillary nline.
,*Right n2nd nintercostal nspace, nmidclavicular nline. n- ncorrect nanswers n-Left n5th
nintercostal nspace, nmidclavicular nline
The nnurse npractitioner nassessing nthe npatient nwith na nrapid ncardiac nrhythm nmay
nassess nfor na npulse ndeficit nby nauscultating nthe npatient's nheart nwhile nwatching
nthe nEKG nrhythm. nWhere nwould nthe nS1 nheart nsounds ncorrelate nwith nthe
nelectrocardiographic nwaves?
*At nthe nend nof nthe nT nwave.
*At nthe nstart nof nthe nT nwave.
*Peak nof nthe nR nwave.
*At nthe nstart nof nthe nP nwave. n- ncorrect nanswers n-Peak nof nthe nR nwave.
Michael, na n72 nyear nold nmale npatient nwho npreviously npresented nwith nstable
ncardiac-type nchest npain nhas nunderwent na nstress ntest. nHe npresents ntoday nto
nreview nthe nstress ntest nresults, nwhich nshow nEKG nfindings nof nST nsegment
ndepression nduring nthe nexam nin nleads nV3 nand nV4 nas nwell nas nsome nconcurrent
nchest ndiscomfort. nBased non nthese nfindings, nwhich nof nthe nfollowing nare nNOT
npriority nmedical ndecisions?
*Prescribe nmetoprolol n(Lopressor) n12.5mg nPO nBID
*Prescribe naspirin n81mg nPO ndaily
*Refer nto ncardiology nfor nangiography
• nCheck nfor nthyroid ndysfunction n- ncorrect nanswers n-Check nfor nthyroid ndysfunction
While nexamining na n53 nyear nold nfemale npatient, nyou nauscultate nabnormal nbreath
nsounds nover nall nfields, nand nnow nassess ntransmission nof nvoice nsounds nby
nhaving nthe npatient nsay n"ee" nwhile nauscultating nthe nchest nwith nthe ndiaphragm nof
nyour nstethoscope. nNormally, nyou nshould nauscultate na nmuffled n"e" nsound,
nhowever, nyou nhear nhear na nnasally n"a" nsound. nWhich none nof nthe nfollowing nwill
nyou ndocument nis npresent?
*Positive nstereognosis.
*Positive nfor negophony.
*Negative nfor nbronchophony.
*Negative nfor negophony n- ncorrect nanswers n-Positive nfor negophony
While nassessing nthe n19 nyear nold npatient nfor na nnew nonset ncough, nthe nnurse
npractitioner nmay ninspect, nauscultate, npalpate, nand/or npercuss.
How ndoes nperforming npercussion nof nthe nthorax nassist nthe nprovider nduring nthe
nphysical nexamination?
*To nassist nwith nthe nconfirmation nof ncardiac norigin nof nangina.
*To nassess nfor ndeep-seated nlesion nand ntumors.
*To nassess nfor nany npain nor ndiscomfort nprior nto npalpitation nof nthe nchest nwall.
*To nidentify nif nunderlying ntissue nare nair-filled, nfluid-filled nor nconsolidated n- ncorrect
nanswers n-To nidentify nif nunderlying ntissue nare nair-filled, nfluid-filled nor nconsolidated
Your n42 nyear nold nmale npatient nhas nbeen nreferred nto nyour nclinic nfor nestablishing
ncare nand non nhis nintake nsurvey, nyou nnote nhe nhas ndocumented ndiagnosis nof
,ninterstitial nlung ndisease. nYou nhave ndecided nto nperform na ndiaphragmatic
nexcursion ntest non nthe npatient. nWhich none nof nthe nfollowing nresults nwould nyou
nexpect nto nsee nin nthis npatient?
*Approximately nequal nlevel nof nchange nin nthe ndescent nof nthe ndiaphragm
nbilaterally nduring nmaximal ninspiration nand nexpiration. nwith na ndecreased noverall
ninspiratory ncapacity.
*Ascension nof n8-12 ninches nof nthe ndiaphragm nnoted nbilaterally non nexpiration,
nthough noften nmuch nless non nthe nright nside ndue nto nthe nlocation nof nthe nheart
nand ngreat nvessels.
*Much ngreater ndescent nof nthe ndiaphragm non nthe nright nside ndue nto nthe nliver
npresent n(two-three ntimes nlarger).
*Absent nor nno nchange nin nmovement nof nthe ndiaphragm nnoted nbetween nfull
ninspiration nand nfull nexpiration nmeasurement. n- ncorrect nanswers n-Approximately
nequal nlevel nof nchange nin nthe ndescent nof nthe ndiaphragm nbilaterally nduring
nmaximal ninspiration nand nexpiration. nwith na ndecreased noverall ninspiratory ncapacity
Your n50 nyear nold nCaucasian nmale npatient nhas nnot nseen na nprimary ncare ngiver
nin n20+ nyears nand nis nhere nfor na nhistory nand nphysical nexamination. nWhile
nexamining nthe nhead nand nface, nyou nsee nyour npatient nhas nnonpitting nperiorbital
nedema, nparticularly nunderneath ntheir neyes nand nvery ndry, nthinned nhair, nincluding
nthe nlateral nthird nof neyebrows n(as npictured nbelow: nSparse nhairline, nthin nlateral
neyebrows, nPeriobital nedema). nWhich none nof nthe nfolowing nwould nyou nexpect nto
ncause nthis nfinding?
*Severe nhypothyroidism
*Addison's ndisease
*Grave's ndisease
*Alzhemiers. n- ncorrect nanswers n-Severe nhypothyroidism
A40 nyear nold, nfemale, nAfrican nAmerican npatient npresents nfor nhistory nand
nphysical. nUpon nyour ninitial nassessment, nyou nnotice nshe nhas nsevere
nexophthalmos nas npictured nbelow. nWhich none nof nthe nfollowing ndiagnoses nbelow
nwould nbe nthe nhighest non nyour ndifferential ndiagnose nof nthis nphysical nexamination
nfinding? n(eyes nbulging nout nof nher nhead)
*Bilateral nconjunctivitis.
*Hyperthyroidism.
*hypothyroidism
*myexedma n- ncorrect nanswers n-Hyperthyroidism.
Your npatient nwith na nsuspected ndiagnosis nof nCOPD nhas nbeen nseen nby
npulmonology nand nhas nunderwent na npulmonary nfunction ntest n(PFT) nwith
nspirometry. nAs nthe npatient's nprimary nhealthcare nprovider, nyou nhave nbeen nasked
nto nexplain nthe nfindings nof nthe nPFT nto nthe npatient nin na
follow-up nvisit nat nwhich ntime nthe npatient nasks nwhat nthe nstudy nwas nevaluating.
nTo ndescribe nthe nPFT nto nthe npatient nin nmore nuseful nterms, nyou nstate nthat nthe
nlarge ninspiration nof nair nto nthe nfurthest nextent nthey ncould nreasonably naccomplish
, nfollowed nby na nfull nexhalation nis nreferred nto nas nwhich nof nthe nfollowing
nmeasurements nduring nthe nPFT? n
*Forced nExpiratory nVolume nover n1 nsecond n(FEV1).
*Functional nReserve nCapacity.
*Inspiratory nReserve
*Forced nVital nCapacity. n- ncorrect nanswers n-Forced nVital nCapacity.
Your nnewly nestablished npatient nstates nin nthe npast nyear, nthey nhave nprogressively
ndeveloped na nnoticeable nbump non ntheir nneck nand nwhen nasked nabout nsymptoms,
nthey nreport nfeeling nvery nanxious, nhave ndeveloped na ntremor, nand nare ncommonly
nfeeling npalpitations nin ntheir nchest.
On nexamination, nyou nidentify nan nenlarged nthyroid ngland nsuspicious nfor na ngoiter.
nOf nthe nfollowing ndiagnoses, nwhich nis nmost nlikely nfor nthe npatient nto ndevelop
nbased non nthese nfindings nabove?
*Thyrotoxicosis.
*lodine nExcess.
*Myxedema nComa.
*Hashimotos nThyroiditis...not nthis none n- ncorrect nanswers n-Thyrotoxicosis
Your n32 nyear nold nfemale npatient npresented nfor na nroutine nhealth nexam nstates
nthey nhave na ndiagnoses nof nhyperthyroidism nby nanother
provider na nyear nago. nIn naddition nto nevaluation nwith nTSH nand nT4 nlabwork, nwhich
nof nthe nfollowing nrepresent ntypical nsigns nof nhyperthyroidism nexpected non nyour
nexam nof nthis npatient?
*Hypersomnia
*Tachycardia.
*Lethargy.
*Recent nunplanned nweight ngain. n- ncorrect nanswers n-Tachycardia
Your npatient nhas na ndiagnosis nof nAddison's ndisease. nWhich nof nthe nfollowing
nmight nyou nexpect nto nfind nduring nexamination?
*Abdominal nstriae.
*Dowager nhump.
*Low nbody ntemperature.
*Moon nface...not nthis none n- ncorrect nanswers n-Low nbody ntemperature
The nnurse npractitioner's nevaluation nof napatient nwith nDiabetes nMellitus ntype n2
nshould ninclude nwhich nof nthe nfolowing nwhile nevaluating
for nend norgan ndysfunction nof nthe ndisease?
*Renal nfunction npanel.
*Urinalysis.
*Non-dilated neye nexam.
*All nof nthese nare nappropriate noptions. n- ncorrect nanswers n-All nof nthese nare
nappropriate noptions.
Your npatient nwith na ndiagnosis nof nautoimmune nhepatitis nis nbeing
SOLUTIONS
During na npost-hospital ndischarge nvisit, nyou nnotice nyour n71 nyear nold nfemale
npatient nhas nbeen ndiagnosed nwith na n"new nmurmur" nfound nby nthe nhospitalist
nduring ntheir nrecent nhospitalization nfor nCHF nexacerbation. nIn nevaluating nthe
npatient, nduring nwhich nphase nof nthe ncardiac ncycle nwould nyou nanticipate
nauscultation nof na nS3 nor nS4 nheart nsound?
*Diastole
*53 nin nsystole nwhile nS4 nin ndiastole
*Systole
*S4 nin ndiastole nwhile nS3 nin nsystole n- ncorrect nanswers n-Diastole
The npoint nof nmaximum nimpulse n(PMI) nis nMOST noften npalpable nin nhealthy nadults
nwhen npositioned nin nthe nsupine nor nleft nlateral ndecubitus nposition. nWhich none nof
nthe nfollowing nlocations nis nmost ncommonly ndescribed nas nthe nPMI nin na nhealthy
nadult?
*Left n2nd nintercostal nspace, nmidaxillary nline.
*Left n5th nintercostal nspace, nmidclavicular nline.
*Right n4th nintercostal nspace, nmidaxillary nline.
,*Right n2nd nintercostal nspace, nmidclavicular nline. n- ncorrect nanswers n-Left n5th
nintercostal nspace, nmidclavicular nline
The nnurse npractitioner nassessing nthe npatient nwith na nrapid ncardiac nrhythm nmay
nassess nfor na npulse ndeficit nby nauscultating nthe npatient's nheart nwhile nwatching
nthe nEKG nrhythm. nWhere nwould nthe nS1 nheart nsounds ncorrelate nwith nthe
nelectrocardiographic nwaves?
*At nthe nend nof nthe nT nwave.
*At nthe nstart nof nthe nT nwave.
*Peak nof nthe nR nwave.
*At nthe nstart nof nthe nP nwave. n- ncorrect nanswers n-Peak nof nthe nR nwave.
Michael, na n72 nyear nold nmale npatient nwho npreviously npresented nwith nstable
ncardiac-type nchest npain nhas nunderwent na nstress ntest. nHe npresents ntoday nto
nreview nthe nstress ntest nresults, nwhich nshow nEKG nfindings nof nST nsegment
ndepression nduring nthe nexam nin nleads nV3 nand nV4 nas nwell nas nsome nconcurrent
nchest ndiscomfort. nBased non nthese nfindings, nwhich nof nthe nfollowing nare nNOT
npriority nmedical ndecisions?
*Prescribe nmetoprolol n(Lopressor) n12.5mg nPO nBID
*Prescribe naspirin n81mg nPO ndaily
*Refer nto ncardiology nfor nangiography
• nCheck nfor nthyroid ndysfunction n- ncorrect nanswers n-Check nfor nthyroid ndysfunction
While nexamining na n53 nyear nold nfemale npatient, nyou nauscultate nabnormal nbreath
nsounds nover nall nfields, nand nnow nassess ntransmission nof nvoice nsounds nby
nhaving nthe npatient nsay n"ee" nwhile nauscultating nthe nchest nwith nthe ndiaphragm nof
nyour nstethoscope. nNormally, nyou nshould nauscultate na nmuffled n"e" nsound,
nhowever, nyou nhear nhear na nnasally n"a" nsound. nWhich none nof nthe nfollowing nwill
nyou ndocument nis npresent?
*Positive nstereognosis.
*Positive nfor negophony.
*Negative nfor nbronchophony.
*Negative nfor negophony n- ncorrect nanswers n-Positive nfor negophony
While nassessing nthe n19 nyear nold npatient nfor na nnew nonset ncough, nthe nnurse
npractitioner nmay ninspect, nauscultate, npalpate, nand/or npercuss.
How ndoes nperforming npercussion nof nthe nthorax nassist nthe nprovider nduring nthe
nphysical nexamination?
*To nassist nwith nthe nconfirmation nof ncardiac norigin nof nangina.
*To nassess nfor ndeep-seated nlesion nand ntumors.
*To nassess nfor nany npain nor ndiscomfort nprior nto npalpitation nof nthe nchest nwall.
*To nidentify nif nunderlying ntissue nare nair-filled, nfluid-filled nor nconsolidated n- ncorrect
nanswers n-To nidentify nif nunderlying ntissue nare nair-filled, nfluid-filled nor nconsolidated
Your n42 nyear nold nmale npatient nhas nbeen nreferred nto nyour nclinic nfor nestablishing
ncare nand non nhis nintake nsurvey, nyou nnote nhe nhas ndocumented ndiagnosis nof
,ninterstitial nlung ndisease. nYou nhave ndecided nto nperform na ndiaphragmatic
nexcursion ntest non nthe npatient. nWhich none nof nthe nfollowing nresults nwould nyou
nexpect nto nsee nin nthis npatient?
*Approximately nequal nlevel nof nchange nin nthe ndescent nof nthe ndiaphragm
nbilaterally nduring nmaximal ninspiration nand nexpiration. nwith na ndecreased noverall
ninspiratory ncapacity.
*Ascension nof n8-12 ninches nof nthe ndiaphragm nnoted nbilaterally non nexpiration,
nthough noften nmuch nless non nthe nright nside ndue nto nthe nlocation nof nthe nheart
nand ngreat nvessels.
*Much ngreater ndescent nof nthe ndiaphragm non nthe nright nside ndue nto nthe nliver
npresent n(two-three ntimes nlarger).
*Absent nor nno nchange nin nmovement nof nthe ndiaphragm nnoted nbetween nfull
ninspiration nand nfull nexpiration nmeasurement. n- ncorrect nanswers n-Approximately
nequal nlevel nof nchange nin nthe ndescent nof nthe ndiaphragm nbilaterally nduring
nmaximal ninspiration nand nexpiration. nwith na ndecreased noverall ninspiratory ncapacity
Your n50 nyear nold nCaucasian nmale npatient nhas nnot nseen na nprimary ncare ngiver
nin n20+ nyears nand nis nhere nfor na nhistory nand nphysical nexamination. nWhile
nexamining nthe nhead nand nface, nyou nsee nyour npatient nhas nnonpitting nperiorbital
nedema, nparticularly nunderneath ntheir neyes nand nvery ndry, nthinned nhair, nincluding
nthe nlateral nthird nof neyebrows n(as npictured nbelow: nSparse nhairline, nthin nlateral
neyebrows, nPeriobital nedema). nWhich none nof nthe nfolowing nwould nyou nexpect nto
ncause nthis nfinding?
*Severe nhypothyroidism
*Addison's ndisease
*Grave's ndisease
*Alzhemiers. n- ncorrect nanswers n-Severe nhypothyroidism
A40 nyear nold, nfemale, nAfrican nAmerican npatient npresents nfor nhistory nand
nphysical. nUpon nyour ninitial nassessment, nyou nnotice nshe nhas nsevere
nexophthalmos nas npictured nbelow. nWhich none nof nthe nfollowing ndiagnoses nbelow
nwould nbe nthe nhighest non nyour ndifferential ndiagnose nof nthis nphysical nexamination
nfinding? n(eyes nbulging nout nof nher nhead)
*Bilateral nconjunctivitis.
*Hyperthyroidism.
*hypothyroidism
*myexedma n- ncorrect nanswers n-Hyperthyroidism.
Your npatient nwith na nsuspected ndiagnosis nof nCOPD nhas nbeen nseen nby
npulmonology nand nhas nunderwent na npulmonary nfunction ntest n(PFT) nwith
nspirometry. nAs nthe npatient's nprimary nhealthcare nprovider, nyou nhave nbeen nasked
nto nexplain nthe nfindings nof nthe nPFT nto nthe npatient nin na
follow-up nvisit nat nwhich ntime nthe npatient nasks nwhat nthe nstudy nwas nevaluating.
nTo ndescribe nthe nPFT nto nthe npatient nin nmore nuseful nterms, nyou nstate nthat nthe
nlarge ninspiration nof nair nto nthe nfurthest nextent nthey ncould nreasonably naccomplish
, nfollowed nby na nfull nexhalation nis nreferred nto nas nwhich nof nthe nfollowing
nmeasurements nduring nthe nPFT? n
*Forced nExpiratory nVolume nover n1 nsecond n(FEV1).
*Functional nReserve nCapacity.
*Inspiratory nReserve
*Forced nVital nCapacity. n- ncorrect nanswers n-Forced nVital nCapacity.
Your nnewly nestablished npatient nstates nin nthe npast nyear, nthey nhave nprogressively
ndeveloped na nnoticeable nbump non ntheir nneck nand nwhen nasked nabout nsymptoms,
nthey nreport nfeeling nvery nanxious, nhave ndeveloped na ntremor, nand nare ncommonly
nfeeling npalpitations nin ntheir nchest.
On nexamination, nyou nidentify nan nenlarged nthyroid ngland nsuspicious nfor na ngoiter.
nOf nthe nfollowing ndiagnoses, nwhich nis nmost nlikely nfor nthe npatient nto ndevelop
nbased non nthese nfindings nabove?
*Thyrotoxicosis.
*lodine nExcess.
*Myxedema nComa.
*Hashimotos nThyroiditis...not nthis none n- ncorrect nanswers n-Thyrotoxicosis
Your n32 nyear nold nfemale npatient npresented nfor na nroutine nhealth nexam nstates
nthey nhave na ndiagnoses nof nhyperthyroidism nby nanother
provider na nyear nago. nIn naddition nto nevaluation nwith nTSH nand nT4 nlabwork, nwhich
nof nthe nfollowing nrepresent ntypical nsigns nof nhyperthyroidism nexpected non nyour
nexam nof nthis npatient?
*Hypersomnia
*Tachycardia.
*Lethargy.
*Recent nunplanned nweight ngain. n- ncorrect nanswers n-Tachycardia
Your npatient nhas na ndiagnosis nof nAddison's ndisease. nWhich nof nthe nfollowing
nmight nyou nexpect nto nfind nduring nexamination?
*Abdominal nstriae.
*Dowager nhump.
*Low nbody ntemperature.
*Moon nface...not nthis none n- ncorrect nanswers n-Low nbody ntemperature
The nnurse npractitioner's nevaluation nof napatient nwith nDiabetes nMellitus ntype n2
nshould ninclude nwhich nof nthe nfolowing nwhile nevaluating
for nend norgan ndysfunction nof nthe ndisease?
*Renal nfunction npanel.
*Urinalysis.
*Non-dilated neye nexam.
*All nof nthese nare nappropriate noptions. n- ncorrect nanswers n-All nof nthese nare
nappropriate noptions.
Your npatient nwith na ndiagnosis nof nautoimmune nhepatitis nis nbeing
