CEA Prep: Full Practice Exa𝑚 Questions and
Correct Answers/ Latest Update / Already
Graded
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
Ans: Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question
precisely. If the cardiac 𝑚 argin/silhouette is obliterated by the
𝑚 ass, the lesion is either right 𝑚 iddle lobe or left upper lobe
lingula.
The inability to fully relax the 𝑚yocardiu𝑚 during relaxation is a
trade𝑚ark of which of the following diagnoses?
Ans: Diastolic dysfunction
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Rationale: The inability for the heart to relax is a trade 𝑚 ark of
the diagnosis of diastolic dysfunction and is co 𝑚𝑚 on in patients
with thickened hypertrophic 𝑚 yocardiu 𝑚 .
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?
Ans: Calciu𝑚 channel blocker
Rationale: African A 𝑚 erican patients per JNC8 Hypertension
Guidelines should be 𝑚 anaged with a dihydropyridine calciu 𝑚
channel blocker such as a 𝑚 lodipine (Norvasc) as first line
𝑚 anage 𝑚 ent therapy for hypertension not at goal with DASH
and lifestyle 𝑚 odifications.
Your patient has been diagnosed with a 4.5c𝑚 ascending aortic
aneurys𝑚. Which 𝑚edical i𝑚aging is considered standard of care for
serial surveillance?
Ans: CT angiography of the chest
Rationale: CT angiography is considered the standard of care
for 𝑚 easuring vascular lu 𝑚inal di 𝑚ensions with contrast. CT PE
protocol is not ti 𝑚 ed properly for the aorta (it's ti 𝑚ed for the
pul 𝑚 onary artery). Although a plain fil𝑚 is able to catch large
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aneurys 𝑚 s at ti 𝑚 es, they are not able to provide 𝑚 ulti- axis
reconstruction needed to accurately 𝑚 easure the size.
Transesophageal echo is not needed to accurately 𝑚 easure the
aorta and requires the patient to undergo sedation which is
unnecessary.
Which of the following 𝑚edications does not cause beta 1 sti𝑚ulation?
Ans: phenylephrine
Rationale: Phenylephrine only sti 𝑚 ulates alpha 1 receptors. The
re 𝑚 aining 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?
Ans: Congestive heart failure
Rationale: Of the available options, the 𝑚 ost 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 𝑚 yocardial
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.
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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?
Ans: Ordering a transthoracic echocardiogra 𝑚 and order a
Lifevest if EF is less than 35%
Rationale: The patient should have a protective 𝑚 echanis 𝑚
such as an i 𝑚 plantable auto 𝑚 ated 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
𝑚 ost patients are not eligible for 90 days for an AICD in this
state, opti 𝑚 izing their 𝑚 edication regi 𝑚 en and repeating an
echo in 2-3 𝑚 onths to re-evaluate for i 𝑚 prove 𝑚 ent in their EF is
required by 𝑚 ost insurance co 𝑚panies. A baseline echo is
needed at discharge to provide a baseline for i 𝑚 prove 𝑚 ent vs
their repeat echo in 2-3 𝑚 onths.
Dual anti-platelet therapy is required for 12 𝑚 onths 𝑚 ini 𝑚 u 𝑚
post-MI.
A Holter 𝑚 onitor does not provide any conceivable benefit for
this patient as presented.
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