CEA EXAM 2026 QUESTIONS
AND CORRECT ANSWERS
A frail elderly male with a history of sun exposure and rough, scaly, brownish
lesions on the face, ears, and hands presents with a firm erythematous, ulcerated
nodule on the dorsal surface of the hand. The most likely diagnosis is: -
Squamous cell carcinoma
Rationale: Squamous cell carcinoma (SCC) is a type of skin cancer that can also
occur in other areas of the body, including the lining of the respiratory and
digestive tracts. The symptoms of SCC can vary depending on the location of
the cancer. SCC typically appears as a firm, red nodule or a flat sore with a
scaly crust. It may also present as a rough, scaly patch that may bleed or crust
over.
A pediatric male is present with his mother, who states that he is extremely
restless at night and constantly scratches his anal area. Which diagnostic
procedure would confirm a diagnosis of pinworm infestation? - Examination of
transparent tape sample from perianal skin
Rationale: Scotch Tape Test (Cellophane Tape Test):
This is a common diagnostic method where a piece of transparent adhesive tape
(such as Scotch tape) is pressed against the perianal skin in the morning before
bathing or using the toilet.
,The tape is then carefully placed on a glass slide or slide labeled with the
patient's name and date of collection and submitted to a laboratory for
examination under a microscope.
The presence of pinworm eggs or occasionally adult worms clinging to the tape
can confirm the diagnosis.
A Caucasian male patient with fair skin and green eyes is at a particularly high
risk for which of the following serious skin conditions? - Skin cancer
Rationale: Although wrinkles, sunburn, and keratoacanthoma are skin
conditions, none of them are serious nor predisposed from this patient's profile.
Skin cancer risk is very high for this patient.
During the preadmission history and physical, you examine your patient and
find a new multicolored mole measuring 9mm with irregular borders. What is
the most likely diagnosis? - Melanoma
Rationale: These are all classic findings for melanoma: irregular borders,
diameter over 6mm, multicolor, and new or rapidly evolved.
Your patient presents with darkened, velvety creases of the groin, neck, and
axilla with skin tags present. What does this possibly indicate? - Evidence of
insulin resistance
Rationale: Acanthosis nigricans is described as the presence of darkened,
velvety creases of the groin, neck, and axilla with skin tags present. This is
suggestive of increased insulin resistance and metabolic syndrome.
An adult male presents complaining of a left ankle injury that occurred 2 days
ago while he was playing basketball. The patient cannot bear weight and ROM
is limited by pain. What acute injuries would be included in the differential
diagnosis for this patient? - Ankle sprain, ankle fracture
,Rationale: An ankle fracture results in severe pain, swelling, and bruising
around the ankle, often with visible deformity or misalignment of the joint. It
can lead to an inability to bear weight on the affected leg and severe tenderness
at the fracture site. Immediate medical evaluation is crucial for accurate
diagnosis and appropriate treatment.
An ankle sprain typically causes sudden pain and swelling around the ankle
joint, often accompanied by bruising and tenderness, especially along the outer
ankle. There may be a feeling of instability and difficulty moving the ankle due
to pain and swelling.
An adolescent football player presents to the urgent care with an acute knee
injury. He heard a pop when his knee buckled. The nurse practitioner notes a
positive anterior drawer test. The most likely diagnosis is injury to the: -
anterior cruciate ligament.
Rationale: A positive anterior drawer test is commonly associated with the
diagnosis of an anterior cruciate ligament (ACL) injury in the knee. The ACL is
one of the major ligaments that provides stability to the knee joint, and injury to
this ligament is common, especially in sports-related activities or trauma.
Which of the following distinguishes plantar fasciitis from other common foot
problems? - Pain with initial step after rising in the morning
Rationale: A hallmark of plantar fasciitis is severe pain upon waking or after
periods of rest, which tends to improve with movement as the fascia stretches
out.
Which of the following is a urate lowering drug that may be used in conjunction
with NSAIDs in treating gouty arthritis? - Allopurinol (Zyloprim)
Rationale: Allopurinol is a xanthine oxidase inhibitor that reduces the
production of uric acid in the body. It inhibits the enzyme xanthine oxidase,
, which is involved in the metabolism of purines (substances that contribute to
uric acid formation). Allopurinol is commonly used as a long-term maintenance
therapy to prevent recurrent gout attacks and to reduce the risk of complications
associated with chronic hyperuricemia, such as tophi (deposits of urate crystals
in joints and other tissues).
For primary prevention of osteoporosis in females, the US Preventative Task
Force recommends bone density screening: - At least once after age 65
Rationale: Women at higher risk of osteoporosis, such as those with a family
history, early menopause, or certain medical conditions, should discuss bone
density screening (DEXA scan) with their healthcare provider.
Your patient has presented with an acute GI bleed. In working up potential
causes, which of the following scenarios is most probable as a reason for the
bleed? - Four days of high dose of naproxen sodium for joint pain after a long
hike
Rationale: Acute high dose use of NSAID is a risk of developing a stomach
ulcer and subsequent GI bleeding. Topical use of NSAID is not associated with
systemic absorption over 1-2% and accordingly does not carry the prostaglandin
inhibition risks to the gut lining. Use of prednisone does not predispose to
bleeding, nor does acetaminophen use.
A 25-year-old athlete presents with shoulder pain and difficulty with overhead
activities. Physical examination suggests impingement syndrome. What is the
most appropriate initial treatment? - Physical therapy focusing on rotator cuff
strengthening
Rationale: Exercises to improve shoulder strength and flexibility, focusing on
the rotator cuff and scapular stabilizers is an important initial treatment.
AND CORRECT ANSWERS
A frail elderly male with a history of sun exposure and rough, scaly, brownish
lesions on the face, ears, and hands presents with a firm erythematous, ulcerated
nodule on the dorsal surface of the hand. The most likely diagnosis is: -
Squamous cell carcinoma
Rationale: Squamous cell carcinoma (SCC) is a type of skin cancer that can also
occur in other areas of the body, including the lining of the respiratory and
digestive tracts. The symptoms of SCC can vary depending on the location of
the cancer. SCC typically appears as a firm, red nodule or a flat sore with a
scaly crust. It may also present as a rough, scaly patch that may bleed or crust
over.
A pediatric male is present with his mother, who states that he is extremely
restless at night and constantly scratches his anal area. Which diagnostic
procedure would confirm a diagnosis of pinworm infestation? - Examination of
transparent tape sample from perianal skin
Rationale: Scotch Tape Test (Cellophane Tape Test):
This is a common diagnostic method where a piece of transparent adhesive tape
(such as Scotch tape) is pressed against the perianal skin in the morning before
bathing or using the toilet.
,The tape is then carefully placed on a glass slide or slide labeled with the
patient's name and date of collection and submitted to a laboratory for
examination under a microscope.
The presence of pinworm eggs or occasionally adult worms clinging to the tape
can confirm the diagnosis.
A Caucasian male patient with fair skin and green eyes is at a particularly high
risk for which of the following serious skin conditions? - Skin cancer
Rationale: Although wrinkles, sunburn, and keratoacanthoma are skin
conditions, none of them are serious nor predisposed from this patient's profile.
Skin cancer risk is very high for this patient.
During the preadmission history and physical, you examine your patient and
find a new multicolored mole measuring 9mm with irregular borders. What is
the most likely diagnosis? - Melanoma
Rationale: These are all classic findings for melanoma: irregular borders,
diameter over 6mm, multicolor, and new or rapidly evolved.
Your patient presents with darkened, velvety creases of the groin, neck, and
axilla with skin tags present. What does this possibly indicate? - Evidence of
insulin resistance
Rationale: Acanthosis nigricans is described as the presence of darkened,
velvety creases of the groin, neck, and axilla with skin tags present. This is
suggestive of increased insulin resistance and metabolic syndrome.
An adult male presents complaining of a left ankle injury that occurred 2 days
ago while he was playing basketball. The patient cannot bear weight and ROM
is limited by pain. What acute injuries would be included in the differential
diagnosis for this patient? - Ankle sprain, ankle fracture
,Rationale: An ankle fracture results in severe pain, swelling, and bruising
around the ankle, often with visible deformity or misalignment of the joint. It
can lead to an inability to bear weight on the affected leg and severe tenderness
at the fracture site. Immediate medical evaluation is crucial for accurate
diagnosis and appropriate treatment.
An ankle sprain typically causes sudden pain and swelling around the ankle
joint, often accompanied by bruising and tenderness, especially along the outer
ankle. There may be a feeling of instability and difficulty moving the ankle due
to pain and swelling.
An adolescent football player presents to the urgent care with an acute knee
injury. He heard a pop when his knee buckled. The nurse practitioner notes a
positive anterior drawer test. The most likely diagnosis is injury to the: -
anterior cruciate ligament.
Rationale: A positive anterior drawer test is commonly associated with the
diagnosis of an anterior cruciate ligament (ACL) injury in the knee. The ACL is
one of the major ligaments that provides stability to the knee joint, and injury to
this ligament is common, especially in sports-related activities or trauma.
Which of the following distinguishes plantar fasciitis from other common foot
problems? - Pain with initial step after rising in the morning
Rationale: A hallmark of plantar fasciitis is severe pain upon waking or after
periods of rest, which tends to improve with movement as the fascia stretches
out.
Which of the following is a urate lowering drug that may be used in conjunction
with NSAIDs in treating gouty arthritis? - Allopurinol (Zyloprim)
Rationale: Allopurinol is a xanthine oxidase inhibitor that reduces the
production of uric acid in the body. It inhibits the enzyme xanthine oxidase,
, which is involved in the metabolism of purines (substances that contribute to
uric acid formation). Allopurinol is commonly used as a long-term maintenance
therapy to prevent recurrent gout attacks and to reduce the risk of complications
associated with chronic hyperuricemia, such as tophi (deposits of urate crystals
in joints and other tissues).
For primary prevention of osteoporosis in females, the US Preventative Task
Force recommends bone density screening: - At least once after age 65
Rationale: Women at higher risk of osteoporosis, such as those with a family
history, early menopause, or certain medical conditions, should discuss bone
density screening (DEXA scan) with their healthcare provider.
Your patient has presented with an acute GI bleed. In working up potential
causes, which of the following scenarios is most probable as a reason for the
bleed? - Four days of high dose of naproxen sodium for joint pain after a long
hike
Rationale: Acute high dose use of NSAID is a risk of developing a stomach
ulcer and subsequent GI bleeding. Topical use of NSAID is not associated with
systemic absorption over 1-2% and accordingly does not carry the prostaglandin
inhibition risks to the gut lining. Use of prednisone does not predispose to
bleeding, nor does acetaminophen use.
A 25-year-old athlete presents with shoulder pain and difficulty with overhead
activities. Physical examination suggests impingement syndrome. What is the
most appropriate initial treatment? - Physical therapy focusing on rotator cuff
strengthening
Rationale: Exercises to improve shoulder strength and flexibility, focusing on
the rotator cuff and scapular stabilizers is an important initial treatment.
