CEA PREP: FULL PRACTICE EXAM
Questions and Answers
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?: phenyle- phrine
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 frac- tion) 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 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.
, 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 increased risk of
cardiac disease due to higher rates of hypertension, diabetes, and obesity than Caucasians.
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 moth-
er 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 uncon- trolled 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.
Questions and Answers
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?: phenyle- phrine
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 frac- tion) 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 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.
, 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 increased risk of
cardiac disease due to higher rates of hypertension, diabetes, and obesity than Caucasians.
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 moth-
er 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 uncon- trolled 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.
