lOMoAR cPSD| 47061011
CEA PREP: FULL PRACTICE EXAM
QUESTIONS WITH CORRECT
VERIFIED ANSWERS A+ GRADED
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
, lOMoAR cPSD| 47061011
approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view shows this
lesion absent from 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 - ANS Left upper lobe lingula
Rationale: 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? - ANS 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? - ANS 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? - ANS 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? - ANS 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? - ANS Congestive heart failure
, lOMoAR cPSD| 47061011
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? -
ANS 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: - ANS 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?
- ANS 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.
, lOMoAR cPSD| 47061011
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? - ANS 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?
- ANS 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 - ANS 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? - ANS
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).
CEA PREP: FULL PRACTICE EXAM
QUESTIONS WITH CORRECT
VERIFIED ANSWERS A+ GRADED
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
, lOMoAR cPSD| 47061011
approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view shows this
lesion absent from 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 - ANS Left upper lobe lingula
Rationale: 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? - ANS 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? - ANS 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? - ANS 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? - ANS 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? - ANS Congestive heart failure
, lOMoAR cPSD| 47061011
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? -
ANS 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: - ANS 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?
- ANS 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.
, lOMoAR cPSD| 47061011
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? - ANS 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?
- ANS 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 - ANS 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? - ANS
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).
