NR511 CEA EXAM
QUESTIONS & RATIONALES
100 Practice Questions | Complete Study Guide
1. A 45-year-old male presents with 3 days of productive cough, fever of 101.5°F, and pleuritic chest pain.
Chest X-ray shows right lower lobe consolidation. He is otherwise healthy with no comorbidities. Which is
the most appropriate first-line outpatient treatment?
A. Amoxicillin 1g TID
B. Azithromycin 500mg day 1, then 250mg daily x4 days
C. Doxycycline 100mg BID x7 days
D. Levofloxacin 750mg daily x5 days
Correct Answer: A
Rationale: High-dose amoxicillin monotherapy is preferred first-line for healthy outpatients without
comorbidities per ATS/IDSA guidelines. Macrolide monotherapy is no longer preferred due to rising S.
pneumoniae resistance, and fluoroquinolones are reserved for patients with comorbidities.
2. A 68-year-old smoker presents with progressive dyspnea, chronic productive cough, and a barrel chest.
Post-bronchodilator spirometry shows an FEV1/FVC ratio of 0.62. What is the diagnosis?
A. Asthma
B. COPD
C. Chronic bronchitis without airflow limitation
D. Restrictive lung disease
Correct Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio below 0.70 confirms persistent airflow limitation diagnostic of
COPD. Asthma typically shows significant reversibility, and restrictive disease shows a reduced FVC with a
normal or increased ratio.
3. A 4-year-old has recurrent wheezing episodes triggered by URIs and exercise, with occasional nocturnal
cough. Symptoms occur about once weekly with no nighttime awakenings. Per NAEPP guidelines, which
classification fits?
A. Intermittent asthma
B. Mild persistent asthma
C. Moderate persistent asthma
D. Severe persistent asthma
Correct Answer: A
Rationale: Intermittent asthma is defined by daytime symptoms ≤ 2 days/week, nighttime awakenings ≤
2x/month, and no interference with normal activity.
4. A patient has a cough lasting 10 days, no fever, clear lung sounds, and normal vital signs. What is the
best management?
A. Prescribe azithromycin
B. Symptomatic treatment and reassurance
, C. Order a chest X-ray
D. Prescribe oral corticosteroids
Correct Answer: B
Rationale: Acute bronchitis is usually viral, and antibiotics do not improve outcomes absent signs of pneumonia.
Symptomatic care is appropriate; imaging is reserved for concerning vital signs or exam findings.
5. A 55-year-old woman with a history of asbestos exposure presents with progressive dyspnea and dry
cough. Chest CT shows bilateral pleural plaques. What is the most likely diagnosis?
A. Silicosis
B. Asbestosis
C. Hypersensitivity pneumonitis
D. Sarcoidosis
Correct Answer: B
Rationale: Asbestosis is characterized by pleural plaques and interstitial fibrosis following asbestos exposure,
typically with a latency period of decades.
6. A patient with COPD presents with increased dyspnea, increased sputum volume, and increased sputum
purulence. Per Anthonisen criteria, when are antibiotics indicated?
A. Any 1 of the 3 cardinal symptoms
B. At least 2 of the 3 cardinal symptoms, including increased sputum purulence
C. Fever alone
D. Any change in sputum color only
Correct Answer: B
Rationale: Anthonisen criteria recommend antibiotics when at least 2 of 3 cardinal symptoms are present,
particularly when increased sputum purulence is one of them.
7. A patient develops sudden unilateral pleuritic chest pain, dyspnea, and tachycardia after a long flight.
Wells score indicates high pretest probability for PE. What is the next best step?
A. D-dimer testing
B. CT pulmonary angiography
C. Empiric anticoagulation and observation only
D. Chest X-ray alone
Correct Answer: B
Rationale: In patients with high pretest probability for PE, CT pulmonary angiography is the preferred diagnostic
test; D-dimer is more useful when pretest probability is low to moderate.
8. Which vaccine strategy is currently recommended for adults ≥65 years without prior pneumococcal
vaccination?
A. PPSV23 only
B. PCV13 followed by PPSV23 only
C. PCV15 followed by PPSV23, or PCV20 alone
D. No vaccine needed after age 65
, Correct Answer: C
Rationale: Current ACIP guidance recommends PCV15 (followed by PPSV23) or PCV20 alone for adults ≥65
without prior pneumococcal vaccination.
9. A 30-year-old with seasonal allergic rhinitis reports nasal congestion, clear rhinorrhea, and itchy eyes.
What is first-line treatment?
A. Oral decongestant only
B. Intranasal corticosteroid
C. Oral antihistamine only
D. Nasal saline alone
Correct Answer: B
Rationale: Intranasal corticosteroids are first-line for allergic rhinitis due to superior efficacy for nasal
congestion, itching, and rhinorrhea compared to antihistamines alone.
10. A high-risk patient presents within 36 hours of influenza symptom onset. What is the best treatment?
A. Oseltamivir
B. Amantadine
C. Ribavirin
D. Supportive care only, no antivirals indicated
Correct Answer: A
Rationale: Oseltamivir is most effective when started within 48 hours of symptom onset and is recommended for
high-risk patients to reduce complications.
11. A newly diagnosed hypertensive Black patient has a BP of 148/94 mmHg with no comorbidities. What is
the recommended first-line agent?
A. Lisinopril
B. Thiazide diuretic or calcium channel blocker
C. Beta-blocker
D. Alpha-blocker
Correct Answer: B
Rationale: Guidelines recommend thiazide diuretics or calcium channel blockers as first-line therapy in Black
patients due to greater BP-lowering efficacy compared to ACE inhibitors alone.
12. A patient reports exertional chest pain relieved by rest, with a normal resting ECG. What is the best
initial diagnostic test?
A. Cardiac catheterization
B. Exercise stress test
C. Resting echocardiogram
D. Holter monitor
Correct Answer: B
Rationale: Exercise stress testing is the appropriate initial test for suspected stable angina in a patient with a
normal resting ECG who is able to exercise.
QUESTIONS & RATIONALES
100 Practice Questions | Complete Study Guide
1. A 45-year-old male presents with 3 days of productive cough, fever of 101.5°F, and pleuritic chest pain.
Chest X-ray shows right lower lobe consolidation. He is otherwise healthy with no comorbidities. Which is
the most appropriate first-line outpatient treatment?
A. Amoxicillin 1g TID
B. Azithromycin 500mg day 1, then 250mg daily x4 days
C. Doxycycline 100mg BID x7 days
D. Levofloxacin 750mg daily x5 days
Correct Answer: A
Rationale: High-dose amoxicillin monotherapy is preferred first-line for healthy outpatients without
comorbidities per ATS/IDSA guidelines. Macrolide monotherapy is no longer preferred due to rising S.
pneumoniae resistance, and fluoroquinolones are reserved for patients with comorbidities.
2. A 68-year-old smoker presents with progressive dyspnea, chronic productive cough, and a barrel chest.
Post-bronchodilator spirometry shows an FEV1/FVC ratio of 0.62. What is the diagnosis?
A. Asthma
B. COPD
C. Chronic bronchitis without airflow limitation
D. Restrictive lung disease
Correct Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio below 0.70 confirms persistent airflow limitation diagnostic of
COPD. Asthma typically shows significant reversibility, and restrictive disease shows a reduced FVC with a
normal or increased ratio.
3. A 4-year-old has recurrent wheezing episodes triggered by URIs and exercise, with occasional nocturnal
cough. Symptoms occur about once weekly with no nighttime awakenings. Per NAEPP guidelines, which
classification fits?
A. Intermittent asthma
B. Mild persistent asthma
C. Moderate persistent asthma
D. Severe persistent asthma
Correct Answer: A
Rationale: Intermittent asthma is defined by daytime symptoms ≤ 2 days/week, nighttime awakenings ≤
2x/month, and no interference with normal activity.
4. A patient has a cough lasting 10 days, no fever, clear lung sounds, and normal vital signs. What is the
best management?
A. Prescribe azithromycin
B. Symptomatic treatment and reassurance
, C. Order a chest X-ray
D. Prescribe oral corticosteroids
Correct Answer: B
Rationale: Acute bronchitis is usually viral, and antibiotics do not improve outcomes absent signs of pneumonia.
Symptomatic care is appropriate; imaging is reserved for concerning vital signs or exam findings.
5. A 55-year-old woman with a history of asbestos exposure presents with progressive dyspnea and dry
cough. Chest CT shows bilateral pleural plaques. What is the most likely diagnosis?
A. Silicosis
B. Asbestosis
C. Hypersensitivity pneumonitis
D. Sarcoidosis
Correct Answer: B
Rationale: Asbestosis is characterized by pleural plaques and interstitial fibrosis following asbestos exposure,
typically with a latency period of decades.
6. A patient with COPD presents with increased dyspnea, increased sputum volume, and increased sputum
purulence. Per Anthonisen criteria, when are antibiotics indicated?
A. Any 1 of the 3 cardinal symptoms
B. At least 2 of the 3 cardinal symptoms, including increased sputum purulence
C. Fever alone
D. Any change in sputum color only
Correct Answer: B
Rationale: Anthonisen criteria recommend antibiotics when at least 2 of 3 cardinal symptoms are present,
particularly when increased sputum purulence is one of them.
7. A patient develops sudden unilateral pleuritic chest pain, dyspnea, and tachycardia after a long flight.
Wells score indicates high pretest probability for PE. What is the next best step?
A. D-dimer testing
B. CT pulmonary angiography
C. Empiric anticoagulation and observation only
D. Chest X-ray alone
Correct Answer: B
Rationale: In patients with high pretest probability for PE, CT pulmonary angiography is the preferred diagnostic
test; D-dimer is more useful when pretest probability is low to moderate.
8. Which vaccine strategy is currently recommended for adults ≥65 years without prior pneumococcal
vaccination?
A. PPSV23 only
B. PCV13 followed by PPSV23 only
C. PCV15 followed by PPSV23, or PCV20 alone
D. No vaccine needed after age 65
, Correct Answer: C
Rationale: Current ACIP guidance recommends PCV15 (followed by PPSV23) or PCV20 alone for adults ≥65
without prior pneumococcal vaccination.
9. A 30-year-old with seasonal allergic rhinitis reports nasal congestion, clear rhinorrhea, and itchy eyes.
What is first-line treatment?
A. Oral decongestant only
B. Intranasal corticosteroid
C. Oral antihistamine only
D. Nasal saline alone
Correct Answer: B
Rationale: Intranasal corticosteroids are first-line for allergic rhinitis due to superior efficacy for nasal
congestion, itching, and rhinorrhea compared to antihistamines alone.
10. A high-risk patient presents within 36 hours of influenza symptom onset. What is the best treatment?
A. Oseltamivir
B. Amantadine
C. Ribavirin
D. Supportive care only, no antivirals indicated
Correct Answer: A
Rationale: Oseltamivir is most effective when started within 48 hours of symptom onset and is recommended for
high-risk patients to reduce complications.
11. A newly diagnosed hypertensive Black patient has a BP of 148/94 mmHg with no comorbidities. What is
the recommended first-line agent?
A. Lisinopril
B. Thiazide diuretic or calcium channel blocker
C. Beta-blocker
D. Alpha-blocker
Correct Answer: B
Rationale: Guidelines recommend thiazide diuretics or calcium channel blockers as first-line therapy in Black
patients due to greater BP-lowering efficacy compared to ACE inhibitors alone.
12. A patient reports exertional chest pain relieved by rest, with a normal resting ECG. What is the best
initial diagnostic test?
A. Cardiac catheterization
B. Exercise stress test
C. Resting echocardiogram
D. Holter monitor
Correct Answer: B
Rationale: Exercise stress testing is the appropriate initial test for suspected stable angina in a patient with a
normal resting ECG who is able to exercise.
