CEA Prep Full Practice Exam || || || || ||
Questions with Correct 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 - CORRECT ANSWER(S)✔✔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? - CORRECT ANSWER(S)✔✔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? - CORRECT
|| || || || || || || ||
ANSWER(S)✔✔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? - CORRECT
|| || || || || || || ||
ANSWER(S)✔✔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? - CORRECT ANSWER(S)✔✔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? - CORRECT ANSWER(S)✔✔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? - CORRECT || || || || || || ||
ANSWER(S)✔✔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. || || || || ||
Questions with Correct 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 - CORRECT ANSWER(S)✔✔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? - CORRECT ANSWER(S)✔✔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? - CORRECT
|| || || || || || || ||
ANSWER(S)✔✔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? - CORRECT
|| || || || || || || ||
ANSWER(S)✔✔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? - CORRECT ANSWER(S)✔✔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? - CORRECT ANSWER(S)✔✔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? - CORRECT || || || || || || ||
ANSWER(S)✔✔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. || || || || ||
