CEA PREP EXAMINATION SET QUESTIONS AND
ANSWERS SET A+
✔✔Which of the following is a true statement about squamous cell carcinoma? -
✔✔Squamous cell carcinoma is more likely to have metastasis than basal cell
carcinoma
Rationale: Squamous cell carcinoma is more common to have metastasis than basal
cell carcinoma. Basal cell carcinoma is more common than squamous cell carcinoma.
✔✔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. Physical therapy may
include stretching and strengthening exercises, as well as techniques to improve
shoulder mechanics.
✔✔A 75-year-old presents with depression. The patient also has osteoarthritis of both
knees that interferes with mobility. Which antidepressant may also benefit
osteoarthritis? - ✔✔Duloxetine (Cymbalta)
Rationale: For individuals with both osteoarthritis and depression, duloxetine offers the
advantage of addressing both conditions simultaneously, potentially improving overall
quality of life. Its dual action can also be beneficial in managing chronic pain and
associated emotional distress often experienced by patients with osteoarthritis.
✔✔Which of the following treatments is most successful for patients with chronic fatigue
syndrome? - ✔✔Graded exercise program
Rationale: A graded exercise program (GEP) for chronic fatigue syndrome (CFS), also
known as myalgic encephalomyelitis (ME), is a structured approach to physical activity
, aimed at gradually increasing exercise tolerance and improving overall function. Here
are key components and considerations for implementing a GEP:
Individualized Assessment: Before starting a GEP, it's crucial to conduct a thorough
assessment of the individual's current physical capabilities, symptom severity, and any
specific limitations or concerns related to CFS.
Goal Setting: Establish clear and realistic goals with the patient, focusing on improving
function, reducing symptom severity, and enhancing quality of life rather than aiming for
rapid fitness gains.
Structured Program: Develop a structured exercise plan tailored to the individual's
baseline fitness level and tolerance. The program typically involves incremental
increases in exercise intensity, duration, or frequency over time.
Pacing: Emphasize the importance of pacing activities to avoid overexertion and
exacerbation of symptoms. Encourage regular breaks during activity and gradual
progression based on symptom response.
✔✔A 25-year-old woman presents with dysuria, frequency, and urgency. Urinalysis
shows pyuria and bacteriuria. What is the most likely diagnosis? - ✔✔Cystitis
Rationale: Symptoms of cystitis include frequent urges to urinate, which may be
accompanied by pain or burning during urination. The urine may appear bloody or
cloudy, and there can be discomfort or pressure in the lower abdomen or pelvic area.
Additionally, individuals may feel generally unwell, fatigued, or experience a mild fever.
✔✔Inability to reach the bathroom before urinating is a feature consistent with which of
the following diagnoses? - ✔✔urge-type incontinence
Rationale: Urge-type incontinence, also known as overactive bladder (OAB) or urgency
incontinence, is a condition characterized by a sudden and strong need to urinate, often
followed by involuntary leakage of urine. This type of incontinence occurs when the
bladder muscle (detrusor) contracts involuntarily, leading to urgency and sometimes an
inability to reach the toilet in time.
✔✔An older adult with diabetes mellitus, COPD, hypertension, and osteoarthritis
develops chronic kidney disease. The most likely cause is: - ✔✔Diabetes
Rationale: Diabetes is a leading cause of kidney failure, medically known as end-stage
renal disease (ESRD), and it is often referred to as diabetic nephropathy when
discussing kidney damage specifically caused by diabetes.
✔✔An older adult female presents with a 2-month history of incontinence. She
specifically complains of an inability to make it to the bathroom without the loss of some
urine most of the time, and denies incontinence due to laughing, coughing, or sneezing;
she denies dysuria. Her medications include an angiotensin-converting enzyme (ACE)
inhibitor. The initial plan of action for this patient would be: - ✔✔Obtaining a urinalysis
for pyuria, hematuria, and glucosuria
Rationale: Obtaining a urinalysis for pyuria (pus in the urine), hematuria (blood in the
urine), and glucosuria (glucose in the urine) is typically done to assess and diagnose
various medical conditions affecting the urinary tract and overall health.
ANSWERS SET A+
✔✔Which of the following is a true statement about squamous cell carcinoma? -
✔✔Squamous cell carcinoma is more likely to have metastasis than basal cell
carcinoma
Rationale: Squamous cell carcinoma is more common to have metastasis than basal
cell carcinoma. Basal cell carcinoma is more common than squamous cell carcinoma.
✔✔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. Physical therapy may
include stretching and strengthening exercises, as well as techniques to improve
shoulder mechanics.
✔✔A 75-year-old presents with depression. The patient also has osteoarthritis of both
knees that interferes with mobility. Which antidepressant may also benefit
osteoarthritis? - ✔✔Duloxetine (Cymbalta)
Rationale: For individuals with both osteoarthritis and depression, duloxetine offers the
advantage of addressing both conditions simultaneously, potentially improving overall
quality of life. Its dual action can also be beneficial in managing chronic pain and
associated emotional distress often experienced by patients with osteoarthritis.
✔✔Which of the following treatments is most successful for patients with chronic fatigue
syndrome? - ✔✔Graded exercise program
Rationale: A graded exercise program (GEP) for chronic fatigue syndrome (CFS), also
known as myalgic encephalomyelitis (ME), is a structured approach to physical activity
, aimed at gradually increasing exercise tolerance and improving overall function. Here
are key components and considerations for implementing a GEP:
Individualized Assessment: Before starting a GEP, it's crucial to conduct a thorough
assessment of the individual's current physical capabilities, symptom severity, and any
specific limitations or concerns related to CFS.
Goal Setting: Establish clear and realistic goals with the patient, focusing on improving
function, reducing symptom severity, and enhancing quality of life rather than aiming for
rapid fitness gains.
Structured Program: Develop a structured exercise plan tailored to the individual's
baseline fitness level and tolerance. The program typically involves incremental
increases in exercise intensity, duration, or frequency over time.
Pacing: Emphasize the importance of pacing activities to avoid overexertion and
exacerbation of symptoms. Encourage regular breaks during activity and gradual
progression based on symptom response.
✔✔A 25-year-old woman presents with dysuria, frequency, and urgency. Urinalysis
shows pyuria and bacteriuria. What is the most likely diagnosis? - ✔✔Cystitis
Rationale: Symptoms of cystitis include frequent urges to urinate, which may be
accompanied by pain or burning during urination. The urine may appear bloody or
cloudy, and there can be discomfort or pressure in the lower abdomen or pelvic area.
Additionally, individuals may feel generally unwell, fatigued, or experience a mild fever.
✔✔Inability to reach the bathroom before urinating is a feature consistent with which of
the following diagnoses? - ✔✔urge-type incontinence
Rationale: Urge-type incontinence, also known as overactive bladder (OAB) or urgency
incontinence, is a condition characterized by a sudden and strong need to urinate, often
followed by involuntary leakage of urine. This type of incontinence occurs when the
bladder muscle (detrusor) contracts involuntarily, leading to urgency and sometimes an
inability to reach the toilet in time.
✔✔An older adult with diabetes mellitus, COPD, hypertension, and osteoarthritis
develops chronic kidney disease. The most likely cause is: - ✔✔Diabetes
Rationale: Diabetes is a leading cause of kidney failure, medically known as end-stage
renal disease (ESRD), and it is often referred to as diabetic nephropathy when
discussing kidney damage specifically caused by diabetes.
✔✔An older adult female presents with a 2-month history of incontinence. She
specifically complains of an inability to make it to the bathroom without the loss of some
urine most of the time, and denies incontinence due to laughing, coughing, or sneezing;
she denies dysuria. Her medications include an angiotensin-converting enzyme (ACE)
inhibitor. The initial plan of action for this patient would be: - ✔✔Obtaining a urinalysis
for pyuria, hematuria, and glucosuria
Rationale: Obtaining a urinalysis for pyuria (pus in the urine), hematuria (blood in the
urine), and glucosuria (glucose in the urine) is typically done to assess and diagnose
various medical conditions affecting the urinary tract and overall health.
