CEA PREP: FULL PRACTICE EXAM WITH COMPLETE SOLUTION
1.The dpatient dis dexhibiting da dproductive dcough dand da dlow-grade dfever.
dChest dX-ray don dPA dview dshows da dleft dlower dchest darea dof dconsolidation
dadjacent dto dthe dleft dborder dof dthe dheart dapproximately d2 drib dspaces
dabove dthe dcostophrenic dangle. dThe dlateral dx-ray dview dshows dthis dlesion
dabsent dof dthe dwindow dposterior dto dthe dcardiac dsilhouette. dWhich dis dthe
dmost dlikely dlocation dof dthis darea dof dfocal dconsolidation?
*Left dupper dlobe dapex
*Right dmiddle dlobe
Lingular dconsolidation dis ddescribed din dthis dquestion dprecisely. dIf dthe
dcardiac dmargin/silhouette dis dobliterated dby dthe dmass, dthe dlesion dis deither
dright dmiddle dlobe dor dleft dupper dlobe dlingula.
*Left dupper dlobe dlingula
*Left dlower dlobe:
2.The dinability dto dfully drelax dthe dmyocardium dduring drelaxation dis da
dtrademark dof dwhich dof dthe dfollowing ddiagnoses?: dDiastolic ddysfunction
Rationale: dThe dinability dfor dthe dheart dto drelax dis da dtrademark dof dthe
ddiagnosis dof ddias- dtolic ddysfunction dand dis dcommon din dpatients dwith
dthickened dhypertrophic dmyocardium.
1 d/
d113
,3.An dotherwise dhealthy dAfrican dAmerican dadult dmale dhas dbeen
ddiagnosed dwith dhypertension. dHe dhas dbeen drestricting dhis dsalt dintake,
deating da dDASH d(Dietary dApproaches dto dStop dHypertension) ddiet, dand
dexercising dmore, dbut dhis dblood dpressure dis dstill delevated. dWhich dis dthe
dBEST dmedication dto dprescribe dhim?: dCalcium dchannel dblocker
Rationale: dAfrican dAmerican dpatients dper dJNC8 dHypertension
dGuidelines dshould d be dmanaged dwith da ddihydropyridine dcalcium
dchannel dblocker dsuch das damlodipine d(Norvasc) das dfirst dline
dmanagement dtherapy dfor dhypertension dnot dat dgoal dwith dDASH dand
dlifestyle dmodifications.
4.Your dpatient dhas dbeen ddiagnosed dwith da d4.5cm dascending daortic
daneurysm. dWhich dmedical dimaging dis dconsidered dstandard dof dcare dfor
dserial dsurveillance?-
: dCT dangiography dof dthe dchest
Rationale: dCT dangiography dis dconsidered dthe dstandard dof dcare dfor
dmeasuring dvascu- dlar dluminal ddimensions dwith dcontrast. dCT dPE
dprotocol dis dnot dtimed dproperly dfor dthe daorta d(it's dtimed dfor dthe
dpulmonary dartery). dAlthough da dplain dfilm dis dable dto dcatch dlarge
daneurysms dat dtimes, dthey dare dnot dable dto dprovide dmulti-axis
dreconstruction dneeded dto daccurately dmeasure dthe dsize.
dTransesophageal decho dis dnot dneeded dto daccurately dmeasure dthe
daorta dand drequires dthe dpatient dto dundergo dsedation dwhich dis
dunnecessary.
5.Which dof dthe dfollowing dmedications ddoes dnot dcause dbeta d1 dstimulation
d-
phenylephrine
2 d/
d113
,Rationale: dPhenylephrine donly dstimulates dalpha d1 dreceptors. dThe
dremaining dthree dall dhave dbeta dreceptor dactivity.
6.A d50-year-old dwoman dwith da dhistory dof dhypertension dpresents dwith
ddyspnea don dexertion dand dorthopnea. dOn dexamination, dshe dhas djugular
dvenous ddistention dand dbilateral dcrackles don dlung dauscultation. dWhat dis
dthe dmost dlikely ddiagnosis?-
: dCongestive dheart dfailure
Rationale: dOf dthe davailable doptions, dthe dmost daccurate dresponse dis
dcongestive dheart dfailure das dit dis dsignifying dboth da dright dventricular
dback dup dwith djugular dvenous dextension dand dcrackles don dlung dassault,
dwhich dare dsuggestive dof dleft dventricular dback dup. dit
is dpossible dthe dpatient dmay dhave dan dacute dmyocardial dinfarction
dthat dprecipitated dthis, dhowever, da dpatient dhas dnot ddescribed dthat,
drather dis donly ddescribing ddyspnea don dexertion dand dorthopnea, dwhich
dboth dspeak dto da dstate dof dfluid doverload. dThe donly dappropriate
dresponse dof dthese davailable dis dcongestive dheart dfailure.
7.Your dpatient dwith da dhistory dof dHFrEF d(heart dfailure dwith dreduced
dejection dfraction) dwith dan dejection dfraction dof d40% dwho dis dalso dnot don
doptimal dmed- dical dtherapy dhas dbeen ddiagnosed dwith da dmyocardial
dinfarction dthis dadmission dand dreceived demergent dplacement dof da ddrug-
eluting dstent dto dthe dleft danterior ddescending dartery. dAs dthe dmedical
dhome dwho dwill dmanage dthis dpatient dafter ddischarge, dwhich dmedication
dstrategy dwould dyou dexpect dto dbe da dpriority din dthe dpatient's dcare?:
dOrdering da dtransthoracic dechocardiogram dand dorder da dLifevest dif dEF
dis dless dthan d35%
Rationale: dThe dpatient dshould dhave da dprotective dmechanism dsuch das
dan dimplantable dautomated dcardioverter ddefibrillator d(AICD) dor da
dLifevest dif dthe dEF dis dless dthan
35% ddue dto dthe dincreased drisk dof dsudden dcardiac ddeath dwith dlow
dEF dstates. dSince dmost dpatients dare dnot deligible dfor d90 ddays dfor dan
dAICD din dthis dstate, doptimizing dtheir dmedication dregimen dand
drepeating dan decho din d2-3 dmonths dto dre-evaluate dfor
improvement din dtheir dEF dis drequired dby dmost dinsurance dcompanies. dA
dbaseline decho dis dneeded dat ddischarge dto dprovide da dbaseline dfor
dimprovement dvs dtheir drepeat decho din d2-3 dmonths.
Dual danti-platelet dtherapy dis drequired dfor d12 dmonths dminimum dpost-M
A dHolter dmonitor ddoes dnot dprovide dany dconceivable dbenefit dfor dthis
dpatient das dpresent- ded.
8.Which dof dthe dfollowing dpeople dgroups drepresent dthe dleast drisk dof
3 d/
d113
, dcardiac ddisease?: dCaucasians
Rationale: dStatistically dAfrican dAmericans, dNative dHawaiians, dand
dAmerican dIndians dare dat dat dincreased drisk dof dcardiac ddisease ddue dto
dhigher drates dof dhypertension, ddiabetes, dand dobesity dthan dCaucasians
9.A d65-year-old dwoman dpresents dfor da dfollow-up dexamination. dShe dis da
dsmoker, dand dher dhypertension dis dnow dadequately dcontrolled dwith
dmedication. dHer dmoth-
4 d/
d113
1.The dpatient dis dexhibiting da dproductive dcough dand da dlow-grade dfever.
dChest dX-ray don dPA dview dshows da dleft dlower dchest darea dof dconsolidation
dadjacent dto dthe dleft dborder dof dthe dheart dapproximately d2 drib dspaces
dabove dthe dcostophrenic dangle. dThe dlateral dx-ray dview dshows dthis dlesion
dabsent dof dthe dwindow dposterior dto dthe dcardiac dsilhouette. dWhich dis dthe
dmost dlikely dlocation dof dthis darea dof dfocal dconsolidation?
*Left dupper dlobe dapex
*Right dmiddle dlobe
Lingular dconsolidation dis ddescribed din dthis dquestion dprecisely. dIf dthe
dcardiac dmargin/silhouette dis dobliterated dby dthe dmass, dthe dlesion dis deither
dright dmiddle dlobe dor dleft dupper dlobe dlingula.
*Left dupper dlobe dlingula
*Left dlower dlobe:
2.The dinability dto dfully drelax dthe dmyocardium dduring drelaxation dis da
dtrademark dof dwhich dof dthe dfollowing ddiagnoses?: dDiastolic ddysfunction
Rationale: dThe dinability dfor dthe dheart dto drelax dis da dtrademark dof dthe
ddiagnosis dof ddias- dtolic ddysfunction dand dis dcommon din dpatients dwith
dthickened dhypertrophic dmyocardium.
1 d/
d113
,3.An dotherwise dhealthy dAfrican dAmerican dadult dmale dhas dbeen
ddiagnosed dwith dhypertension. dHe dhas dbeen drestricting dhis dsalt dintake,
deating da dDASH d(Dietary dApproaches dto dStop dHypertension) ddiet, dand
dexercising dmore, dbut dhis dblood dpressure dis dstill delevated. dWhich dis dthe
dBEST dmedication dto dprescribe dhim?: dCalcium dchannel dblocker
Rationale: dAfrican dAmerican dpatients dper dJNC8 dHypertension
dGuidelines dshould d be dmanaged dwith da ddihydropyridine dcalcium
dchannel dblocker dsuch das damlodipine d(Norvasc) das dfirst dline
dmanagement dtherapy dfor dhypertension dnot dat dgoal dwith dDASH dand
dlifestyle dmodifications.
4.Your dpatient dhas dbeen ddiagnosed dwith da d4.5cm dascending daortic
daneurysm. dWhich dmedical dimaging dis dconsidered dstandard dof dcare dfor
dserial dsurveillance?-
: dCT dangiography dof dthe dchest
Rationale: dCT dangiography dis dconsidered dthe dstandard dof dcare dfor
dmeasuring dvascu- dlar dluminal ddimensions dwith dcontrast. dCT dPE
dprotocol dis dnot dtimed dproperly dfor dthe daorta d(it's dtimed dfor dthe
dpulmonary dartery). dAlthough da dplain dfilm dis dable dto dcatch dlarge
daneurysms dat dtimes, dthey dare dnot dable dto dprovide dmulti-axis
dreconstruction dneeded dto daccurately dmeasure dthe dsize.
dTransesophageal decho dis dnot dneeded dto daccurately dmeasure dthe
daorta dand drequires dthe dpatient dto dundergo dsedation dwhich dis
dunnecessary.
5.Which dof dthe dfollowing dmedications ddoes dnot dcause dbeta d1 dstimulation
d-
phenylephrine
2 d/
d113
,Rationale: dPhenylephrine donly dstimulates dalpha d1 dreceptors. dThe
dremaining dthree dall dhave dbeta dreceptor dactivity.
6.A d50-year-old dwoman dwith da dhistory dof dhypertension dpresents dwith
ddyspnea don dexertion dand dorthopnea. dOn dexamination, dshe dhas djugular
dvenous ddistention dand dbilateral dcrackles don dlung dauscultation. dWhat dis
dthe dmost dlikely ddiagnosis?-
: dCongestive dheart dfailure
Rationale: dOf dthe davailable doptions, dthe dmost daccurate dresponse dis
dcongestive dheart dfailure das dit dis dsignifying dboth da dright dventricular
dback dup dwith djugular dvenous dextension dand dcrackles don dlung dassault,
dwhich dare dsuggestive dof dleft dventricular dback dup. dit
is dpossible dthe dpatient dmay dhave dan dacute dmyocardial dinfarction
dthat dprecipitated dthis, dhowever, da dpatient dhas dnot ddescribed dthat,
drather dis donly ddescribing ddyspnea don dexertion dand dorthopnea, dwhich
dboth dspeak dto da dstate dof dfluid doverload. dThe donly dappropriate
dresponse dof dthese davailable dis dcongestive dheart dfailure.
7.Your dpatient dwith da dhistory dof dHFrEF d(heart dfailure dwith dreduced
dejection dfraction) dwith dan dejection dfraction dof d40% dwho dis dalso dnot don
doptimal dmed- dical dtherapy dhas dbeen ddiagnosed dwith da dmyocardial
dinfarction dthis dadmission dand dreceived demergent dplacement dof da ddrug-
eluting dstent dto dthe dleft danterior ddescending dartery. dAs dthe dmedical
dhome dwho dwill dmanage dthis dpatient dafter ddischarge, dwhich dmedication
dstrategy dwould dyou dexpect dto dbe da dpriority din dthe dpatient's dcare?:
dOrdering da dtransthoracic dechocardiogram dand dorder da dLifevest dif dEF
dis dless dthan d35%
Rationale: dThe dpatient dshould dhave da dprotective dmechanism dsuch das
dan dimplantable dautomated dcardioverter ddefibrillator d(AICD) dor da
dLifevest dif dthe dEF dis dless dthan
35% ddue dto dthe dincreased drisk dof dsudden dcardiac ddeath dwith dlow
dEF dstates. dSince dmost dpatients dare dnot deligible dfor d90 ddays dfor dan
dAICD din dthis dstate, doptimizing dtheir dmedication dregimen dand
drepeating dan decho din d2-3 dmonths dto dre-evaluate dfor
improvement din dtheir dEF dis drequired dby dmost dinsurance dcompanies. dA
dbaseline decho dis dneeded dat ddischarge dto dprovide da dbaseline dfor
dimprovement dvs dtheir drepeat decho din d2-3 dmonths.
Dual danti-platelet dtherapy dis drequired dfor d12 dmonths dminimum dpost-M
A dHolter dmonitor ddoes dnot dprovide dany dconceivable dbenefit dfor dthis
dpatient das dpresent- ded.
8.Which dof dthe dfollowing dpeople dgroups drepresent dthe dleast drisk dof
3 d/
d113
, dcardiac ddisease?: dCaucasians
Rationale: dStatistically dAfrican dAmericans, dNative dHawaiians, dand
dAmerican dIndians dare dat dat dincreased drisk dof dcardiac ddisease ddue dto
dhigher drates dof dhypertension, ddiabetes, dand dobesity dthan dCaucasians
9.A d65-year-old dwoman dpresents dfor da dfollow-up dexamination. dShe dis da
dsmoker, dand dher dhypertension dis dnow dadequately dcontrolled dwith
dmedication. dHer dmoth-
4 d/
d113
