NR 668 CEA Final Exam Study Guide (2026/2027)
1. A 55-year-old male presents with loud snoring, daytime sleepiness,
and witnessed apneas. His BMI is 34. Which of the following is the most
appropriate initial diagnostic test?
A) Polysomnography (PSG)
B) Home sleep apnea test (HSAT)
C) Nocturnal pulse oximetry
D) Multiple sleep latency test (MSLT)
Answer: A) Polysomnography (PSG)
Rationale: In-laboratory polysomnography is the gold standard for
diagnosing obstructive sleep apnea (OSA), especially in patients with
significant cardiopulmonary comorbidities or when other sleep
disorders are suspected. An HSAT may be used for uncomplicated cases
but PSG is definitive.
2. A 45-year-old female presents with profound fatigue, weight gain,
cold intolerance, and constipation. Her TSH is 14 mIU/L (normal 0.4-4.0)
and free T4 is low. What is the most appropriate initial pharmacologic
intervention?
A) Liothyronine (Cytomel)
B) Levothyroxine (Synthroid)
C) Methimazole (Tapazole)
D) Propylthiouracil (PTU)
,Answer: B) Levothyroxine (Synthroid)
Rationale: The patient presents with primary overt hypothyroidism.
Levothyroxine (synthetic T4) is the standard of care for replacement
therapy. Liothyronine (T3) is rarely used as monotherapy.
3. A 62-year-old male with a history of CHF (HFrEF, EF 30%) reports
dyspnea on exertion and bilateral lower extremity edema. He is
currently on a beta-blocker and an ACE inhibitor. Which medication
should be added to reduce morbidity and mortality?
A) Spironolactone
B) Furosemide
C) Digoxin
D) Nifedipine
Answer: A) Spironolactone
Rationale: Spironolactone is an aldosterone antagonist indicated for
patients with HFrEF (NYHA Class II-IV) to reduce morbidity and
mortality. Loop diuretics like furosemide are used for volume overload
but do not improve long-term survival.
4. A 30-year-old female presents with a severe, throbbing unilateral
headache, photophobia, and nausea. She reports having these
headaches 3-4 times a month. Which of the following is first-line
abortive therapy?
A) Naproxen sodium
,B) Sumatriptan
C) Propranolol
D) Amitriptyline
Answer: B) Sumatriptan
Rationale: Triptans (like sumatriptan) are first-line abortive therapies for
moderate to severe migraines. NSAIDs can be used for mild to moderate
migraines. Propranolol and amitriptyline are prophylactic medications.
5. A 65-year-old male presents with acute onset of severe, tearing chest
pain radiating to his back. His blood pressure is 180/100 mmHg in the
right arm and 140/80 mmHg in the left arm. What is the most
appropriate next step?
A) Administer aspirin 325 mg
B) Administer IV morphine and labetalol
C) Order an outpatient stress test
D) Prescribe azithromycin for suspected pneumonia
Answer: B) Administer IV morphine and labetalol
Rationale: This patient presents with classic signs of an aortic
dissection. Immediate IV access, blood pressure and heart rate control
(to reduce shear stress on the aorta) with IV beta-blockers (labetalol)
and analgesia are critical before immediate surgical consult. Aspirin is
contraindicated.
, 6. A 28-year-old female presents with vaginal discharge that has a
"fishy" odor, especially after intercourse. A wet mount shows clue cells.
Which of the following is the treatment of choice?
A) Fluconazole 150 mg PO
B) Metronidazole 500 mg PO BID x 7 days
C) Doxycycline 100 mg PO BID x 7 days
D) Clindamycin cream intravaginally
Answer: B) Metronidazole 500 mg PO BID x 7 days
Rationale: The patient has Bacterial Vaginosis (BV), indicated by clue
cells and a fishy odor. Oral or intravaginal metronidazole is first-line.
Fluconazole treats yeast, and doxycycline treats chlamydia.
7. A 70-year-old male presents with hesitancy, weak stream, and
nocturia. His PSA is 1.2 ng/mL. Digital rectal exam reveals a
symmetrically enlarged, smooth prostate. What is the first-line
pharmacologic treatment?
A) Finasteride
B) Tamsulosin
C) Doxazosin
D) Both A and B
Answer: D) Both A and B
Rationale: For moderate to severe BPH symptoms, an alpha-1 blocker
(tamsulosin) provides rapid relief of dynamic obstruction. A 5-alpha
1. A 55-year-old male presents with loud snoring, daytime sleepiness,
and witnessed apneas. His BMI is 34. Which of the following is the most
appropriate initial diagnostic test?
A) Polysomnography (PSG)
B) Home sleep apnea test (HSAT)
C) Nocturnal pulse oximetry
D) Multiple sleep latency test (MSLT)
Answer: A) Polysomnography (PSG)
Rationale: In-laboratory polysomnography is the gold standard for
diagnosing obstructive sleep apnea (OSA), especially in patients with
significant cardiopulmonary comorbidities or when other sleep
disorders are suspected. An HSAT may be used for uncomplicated cases
but PSG is definitive.
2. A 45-year-old female presents with profound fatigue, weight gain,
cold intolerance, and constipation. Her TSH is 14 mIU/L (normal 0.4-4.0)
and free T4 is low. What is the most appropriate initial pharmacologic
intervention?
A) Liothyronine (Cytomel)
B) Levothyroxine (Synthroid)
C) Methimazole (Tapazole)
D) Propylthiouracil (PTU)
,Answer: B) Levothyroxine (Synthroid)
Rationale: The patient presents with primary overt hypothyroidism.
Levothyroxine (synthetic T4) is the standard of care for replacement
therapy. Liothyronine (T3) is rarely used as monotherapy.
3. A 62-year-old male with a history of CHF (HFrEF, EF 30%) reports
dyspnea on exertion and bilateral lower extremity edema. He is
currently on a beta-blocker and an ACE inhibitor. Which medication
should be added to reduce morbidity and mortality?
A) Spironolactone
B) Furosemide
C) Digoxin
D) Nifedipine
Answer: A) Spironolactone
Rationale: Spironolactone is an aldosterone antagonist indicated for
patients with HFrEF (NYHA Class II-IV) to reduce morbidity and
mortality. Loop diuretics like furosemide are used for volume overload
but do not improve long-term survival.
4. A 30-year-old female presents with a severe, throbbing unilateral
headache, photophobia, and nausea. She reports having these
headaches 3-4 times a month. Which of the following is first-line
abortive therapy?
A) Naproxen sodium
,B) Sumatriptan
C) Propranolol
D) Amitriptyline
Answer: B) Sumatriptan
Rationale: Triptans (like sumatriptan) are first-line abortive therapies for
moderate to severe migraines. NSAIDs can be used for mild to moderate
migraines. Propranolol and amitriptyline are prophylactic medications.
5. A 65-year-old male presents with acute onset of severe, tearing chest
pain radiating to his back. His blood pressure is 180/100 mmHg in the
right arm and 140/80 mmHg in the left arm. What is the most
appropriate next step?
A) Administer aspirin 325 mg
B) Administer IV morphine and labetalol
C) Order an outpatient stress test
D) Prescribe azithromycin for suspected pneumonia
Answer: B) Administer IV morphine and labetalol
Rationale: This patient presents with classic signs of an aortic
dissection. Immediate IV access, blood pressure and heart rate control
(to reduce shear stress on the aorta) with IV beta-blockers (labetalol)
and analgesia are critical before immediate surgical consult. Aspirin is
contraindicated.
, 6. A 28-year-old female presents with vaginal discharge that has a
"fishy" odor, especially after intercourse. A wet mount shows clue cells.
Which of the following is the treatment of choice?
A) Fluconazole 150 mg PO
B) Metronidazole 500 mg PO BID x 7 days
C) Doxycycline 100 mg PO BID x 7 days
D) Clindamycin cream intravaginally
Answer: B) Metronidazole 500 mg PO BID x 7 days
Rationale: The patient has Bacterial Vaginosis (BV), indicated by clue
cells and a fishy odor. Oral or intravaginal metronidazole is first-line.
Fluconazole treats yeast, and doxycycline treats chlamydia.
7. A 70-year-old male presents with hesitancy, weak stream, and
nocturia. His PSA is 1.2 ng/mL. Digital rectal exam reveals a
symmetrically enlarged, smooth prostate. What is the first-line
pharmacologic treatment?
A) Finasteride
B) Tamsulosin
C) Doxazosin
D) Both A and B
Answer: D) Both A and B
Rationale: For moderate to severe BPH symptoms, an alpha-1 blocker
(tamsulosin) provides rapid relief of dynamic obstruction. A 5-alpha
