CEA PREP: FULL PRACTICE EXAM QUESTIONS
AND 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 - 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 - 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 -
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 - 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 - 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
- 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 - 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.
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 mother 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: - CORRECT ANSWER - 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.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension? - CORRECT ANSWER - 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.
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and obesity.
Laboratory tests reveal elevated serum testosterone and LH ratio > 2:1. What is the
most appropriate initial treatment? - CORRECT ANSWER - Oral contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and the patient
should be treated with oral contraceptives to help stabilize their estrogen and
progesterone. Additionally, they may be managed on metformin and/or spironolactone
for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase the risk of
uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex hormone-
binding globulin (SHBG), which binds androgens. This can help reduce symptoms like
acne, hirsutism (unwanted body and facial hair), and androgenic alopecia (male pattern
baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine check-up.
What screening test should be regularly performed to monitor for early signs of diabetic
nephropathy? - CORRECT ANSWER - Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the evidence
of small proteins in the urine (proteinuria) as found on urinalysis. The other options
might describe macro-organ function (such as BUN/Creat from a BMP, a renal biopsy
which is not indicated for routine diabetic nephropathy testing, and a Abd CT, which is
more akin to evaluation of less subtle findings), but at the functional level of the
nephron, namely the glomerulus, evidence of glucose-related damage is easily
identified with proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine -
CORRECT ANSWER - 25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism in the
elderly is to "go slow and start low". 25 mcg is the most appropriate low dose to start
with of these options. It is possible that over time the dose will be increased until
therapeutic levels are obtained, but the risk of over-dosing the patient outweighs the
desire to quickly achieve this state.
An adult female who recently returned for a recheck appointment. The only remarkable
laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal
= 0.4-6 microunits/mL). The patient reports that her neck hurts; examination reveals
, thyroid tenderness. Which of the following laboratory tests should the nurse practitioner
order now? - CORRECT ANSWER - Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism with
a corresponding finding of elevated T3/T4 and clinical symptoms of a goiter,
tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This patient is
describing a sore neck as well, which is suggestive of Graves disease (hyperthyroid
state).
All the following are symptoms of hypocalcemia except: - CORRECT ANSWER - Visual
field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are
symptoms related to hypocalcemia.
An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The
patient follows a carbohydrate counting diet and walks 30 minutes 5 times weekly.
Current fasting blood glucose = 116 mg/dL [normal = less than 99 mg/dL] and A1c =
6.3% [normal = less than 7.0%]. In accordance with the American Diabetes Association,
the nurse practitioner would recommend that the next follow-up appointment be
scheduled for: - CORRECT ANSWER - 6 months.
Rationale: Based off of the ADA recommendation, this patient should be evaluated in
six months. They are actually showing good control and excellent compliance with diet
and exercise management strategies. If there compliance was worse or they were not
controlled with their A1c, this would likely be a three month follow up.
Your patient has a diagnosis of Hashimoto's and is on Levothyroxine 75 mcg daily. Her
recent TSH was elevated at 15 uU/mL. Your next best action is to: - CORRECT
ANSWER - Increase Levothyroxine to 100 mcg daily
Rationale: When the TSH is elevated the patient needs more thyroid hormone. Once
diagnosed with Hashimoto's there is no clinical need/benefit to repeating anti bodies.
A patient has a 3 cm pituitary mass noted on CT. What is your next step in evaluating
the patient? - CORRECT ANSWER - Screen for hormone deficiencies
Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for
prolactinoma. Surgery consult is indicated when there are VF deficits and/or
abutment/compression on optic nerves or chiasm or if adenoma is hyperfunctioning.
Adenomas >1 cm with no VF deficit or abutment/compression of optic nerves or chiasm
require a follow up MRI at 6 months.
An adult female presents with a chief complaint of fatigue and weight gain. She states
that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected. Which of
the following physical findings would support this diagnosis? - CORRECT ANSWER -
Dry skin, bradycardia, and hypoactive deep tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly
classic signs of hypothyroidism. To further substantiate these concerns, the patient
should have their TSH and T3 and Free T4 checked, and it is likely their TSH would be
elevated, T3/T4 low.
AND 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 - 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 - 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 -
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 - 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 - 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
- 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 - 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.
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 mother 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: - CORRECT ANSWER - 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.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension? - CORRECT ANSWER - 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.
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and obesity.
Laboratory tests reveal elevated serum testosterone and LH ratio > 2:1. What is the
most appropriate initial treatment? - CORRECT ANSWER - Oral contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and the patient
should be treated with oral contraceptives to help stabilize their estrogen and
progesterone. Additionally, they may be managed on metformin and/or spironolactone
for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase the risk of
uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex hormone-
binding globulin (SHBG), which binds androgens. This can help reduce symptoms like
acne, hirsutism (unwanted body and facial hair), and androgenic alopecia (male pattern
baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine check-up.
What screening test should be regularly performed to monitor for early signs of diabetic
nephropathy? - CORRECT ANSWER - Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the evidence
of small proteins in the urine (proteinuria) as found on urinalysis. The other options
might describe macro-organ function (such as BUN/Creat from a BMP, a renal biopsy
which is not indicated for routine diabetic nephropathy testing, and a Abd CT, which is
more akin to evaluation of less subtle findings), but at the functional level of the
nephron, namely the glomerulus, evidence of glucose-related damage is easily
identified with proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine -
CORRECT ANSWER - 25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism in the
elderly is to "go slow and start low". 25 mcg is the most appropriate low dose to start
with of these options. It is possible that over time the dose will be increased until
therapeutic levels are obtained, but the risk of over-dosing the patient outweighs the
desire to quickly achieve this state.
An adult female who recently returned for a recheck appointment. The only remarkable
laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal
= 0.4-6 microunits/mL). The patient reports that her neck hurts; examination reveals
, thyroid tenderness. Which of the following laboratory tests should the nurse practitioner
order now? - CORRECT ANSWER - Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism with
a corresponding finding of elevated T3/T4 and clinical symptoms of a goiter,
tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This patient is
describing a sore neck as well, which is suggestive of Graves disease (hyperthyroid
state).
All the following are symptoms of hypocalcemia except: - CORRECT ANSWER - Visual
field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are
symptoms related to hypocalcemia.
An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The
patient follows a carbohydrate counting diet and walks 30 minutes 5 times weekly.
Current fasting blood glucose = 116 mg/dL [normal = less than 99 mg/dL] and A1c =
6.3% [normal = less than 7.0%]. In accordance with the American Diabetes Association,
the nurse practitioner would recommend that the next follow-up appointment be
scheduled for: - CORRECT ANSWER - 6 months.
Rationale: Based off of the ADA recommendation, this patient should be evaluated in
six months. They are actually showing good control and excellent compliance with diet
and exercise management strategies. If there compliance was worse or they were not
controlled with their A1c, this would likely be a three month follow up.
Your patient has a diagnosis of Hashimoto's and is on Levothyroxine 75 mcg daily. Her
recent TSH was elevated at 15 uU/mL. Your next best action is to: - CORRECT
ANSWER - Increase Levothyroxine to 100 mcg daily
Rationale: When the TSH is elevated the patient needs more thyroid hormone. Once
diagnosed with Hashimoto's there is no clinical need/benefit to repeating anti bodies.
A patient has a 3 cm pituitary mass noted on CT. What is your next step in evaluating
the patient? - CORRECT ANSWER - Screen for hormone deficiencies
Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for
prolactinoma. Surgery consult is indicated when there are VF deficits and/or
abutment/compression on optic nerves or chiasm or if adenoma is hyperfunctioning.
Adenomas >1 cm with no VF deficit or abutment/compression of optic nerves or chiasm
require a follow up MRI at 6 months.
An adult female presents with a chief complaint of fatigue and weight gain. She states
that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected. Which of
the following physical findings would support this diagnosis? - CORRECT ANSWER -
Dry skin, bradycardia, and hypoactive deep tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly
classic signs of hypothyroidism. To further substantiate these concerns, the patient
should have their TSH and T3 and Free T4 checked, and it is likely their TSH would be
elevated, T3/T4 low.
