CEA Prep: Full Practice Exam
In which of the following patients is PRBC transfusion recommended? - CORRECT
ANSWER-73 y.o. M with acute GI bleed and Hgb 6.2
Rationale: PRBC is indicated to provide enough RBCs to maximize clinical outcomes
while avoiding unnecessary transfusions. For most hemodynamically stable medical
and surgical patients, transfusion is recommended/considered at a hemoglobin of 7 to 8
g/dL.
A 78 y.o. M patient reports chronic infections, bruising, fatigue, SOB, and fevers. He has
a history of rectal adenocarcinoma and completed concurrent chemotherapy/radiation
earlier this year. His CBC shows Hgb 7.5, PLT 88, WBC 1.2, ANC 0.8, and peripheral
smear shows dysplasia. What additional work-up would you anticipate for this patient? -
CORRECT ANSWER-Bone marrow biopsy and flow cytometry
Rationale: Diagnosis of MDS involves H&P, CBC, peripheral smear, bone marrow
biopsy (immunocytochemistry and flow cytometry). Diagnosis is dependent on
cytopenias, dysplasia, and cytogenic abnormalities. IPSS is used to identify risk.
Patients with a diagnosis of myasthenia gravis are more likely to have the presence of
which tissue in greater quantities? - CORRECT ANSWER-Thymic tissue
Rationale: Thymic tissue is routinely found in larger quantity on patients with MG and
given this correlation, patients with MG routinely will undergo thymectomy.
Which of the following treatments is not recommended for a patient with a new
diagnosis of rheumatoid arthritis? - CORRECT ANSWER-Oxycontin PRN for mild pain
Rationale: Patients with RA may be controlled with any of the above regimens except
use of opioids for a new diagnosis with a high abuse potential, as this does not safely
balance the risk and benefit of treatment.
Which of the following categories of medication are not likely to be included in the
medication regimen for a patient with HIV? - CORRECT ANSWER-Protease
antagonists
Rationle: NRTIs, NNRTIs, and protease inhibitors represent the three-drug regimen for
HAART therapy.
A 35-year-old woman presents with fatigue, joint pain, and a butterfly-shaped rash on
her face. What is the most appropriate initial management in primary care? - CORRECT
ANSWER-Referral to rheumatology
Rationale: As this represents a likely diagnosis of systemic lupus erythematosus (SLE),
this should be managed by rheumatology to evaluate and initiate therapy when
possible.
,Which of the following symptoms best describes a classic case of systemic lupus
erythematosus? - CORRECT ANSWER-Butterfly rash on the face
Rationale: Rash on the back is more common with pityriasis rosea. A large collection of
urate crystals in the joint is likely gout. Painful ambulation with joint laxity and
ecchymosis suggests ligamentum injury. Butterfly rash on the face is classic SLE.
Patients with Stevens-Johnson syndrome should be managed by which of the following
mechanisms? - CORRECT ANSWER-Similarly to burn patients due to loss of fluid
volume
Rationale: Due to the loss of the protective skin barrier where sloughing occurs,
infection risk is high and substantial insensible fluid loss means these patients need to
be treated as burn victims would be. Hypervolemia is not a typical concern for the same
reason, as they tend to be underfilled. Off floor privileges would not be wise since the
infection risk and pain requires close monitoring, fall risk, and analgesic requirements
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.
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.
,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.
Which of the following people groups represent the least risk of cardiac disease? -
CORRECT ANSWER-Caucasians
, Rationale: Statistically African Americans, Native Hawaiians, and American Indians are
at at increased risk of cardiac disease due to higher rates of hypertension, diabetes,
and obesity than Caucasians.
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.
Preventive cardiac care should focus primarily on addressing all the following except? -
CORRECT ANSWER-Genetic predisposition
Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable risk
factors such as age, gender, genetic/family history should not be the primary focus of
prevention.
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).
In which of the following patients is PRBC transfusion recommended? - CORRECT
ANSWER-73 y.o. M with acute GI bleed and Hgb 6.2
Rationale: PRBC is indicated to provide enough RBCs to maximize clinical outcomes
while avoiding unnecessary transfusions. For most hemodynamically stable medical
and surgical patients, transfusion is recommended/considered at a hemoglobin of 7 to 8
g/dL.
A 78 y.o. M patient reports chronic infections, bruising, fatigue, SOB, and fevers. He has
a history of rectal adenocarcinoma and completed concurrent chemotherapy/radiation
earlier this year. His CBC shows Hgb 7.5, PLT 88, WBC 1.2, ANC 0.8, and peripheral
smear shows dysplasia. What additional work-up would you anticipate for this patient? -
CORRECT ANSWER-Bone marrow biopsy and flow cytometry
Rationale: Diagnosis of MDS involves H&P, CBC, peripheral smear, bone marrow
biopsy (immunocytochemistry and flow cytometry). Diagnosis is dependent on
cytopenias, dysplasia, and cytogenic abnormalities. IPSS is used to identify risk.
Patients with a diagnosis of myasthenia gravis are more likely to have the presence of
which tissue in greater quantities? - CORRECT ANSWER-Thymic tissue
Rationale: Thymic tissue is routinely found in larger quantity on patients with MG and
given this correlation, patients with MG routinely will undergo thymectomy.
Which of the following treatments is not recommended for a patient with a new
diagnosis of rheumatoid arthritis? - CORRECT ANSWER-Oxycontin PRN for mild pain
Rationale: Patients with RA may be controlled with any of the above regimens except
use of opioids for a new diagnosis with a high abuse potential, as this does not safely
balance the risk and benefit of treatment.
Which of the following categories of medication are not likely to be included in the
medication regimen for a patient with HIV? - CORRECT ANSWER-Protease
antagonists
Rationle: NRTIs, NNRTIs, and protease inhibitors represent the three-drug regimen for
HAART therapy.
A 35-year-old woman presents with fatigue, joint pain, and a butterfly-shaped rash on
her face. What is the most appropriate initial management in primary care? - CORRECT
ANSWER-Referral to rheumatology
Rationale: As this represents a likely diagnosis of systemic lupus erythematosus (SLE),
this should be managed by rheumatology to evaluate and initiate therapy when
possible.
,Which of the following symptoms best describes a classic case of systemic lupus
erythematosus? - CORRECT ANSWER-Butterfly rash on the face
Rationale: Rash on the back is more common with pityriasis rosea. A large collection of
urate crystals in the joint is likely gout. Painful ambulation with joint laxity and
ecchymosis suggests ligamentum injury. Butterfly rash on the face is classic SLE.
Patients with Stevens-Johnson syndrome should be managed by which of the following
mechanisms? - CORRECT ANSWER-Similarly to burn patients due to loss of fluid
volume
Rationale: Due to the loss of the protective skin barrier where sloughing occurs,
infection risk is high and substantial insensible fluid loss means these patients need to
be treated as burn victims would be. Hypervolemia is not a typical concern for the same
reason, as they tend to be underfilled. Off floor privileges would not be wise since the
infection risk and pain requires close monitoring, fall risk, and analgesic requirements
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.
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.
,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.
Which of the following people groups represent the least risk of cardiac disease? -
CORRECT ANSWER-Caucasians
, Rationale: Statistically African Americans, Native Hawaiians, and American Indians are
at at increased risk of cardiac disease due to higher rates of hypertension, diabetes,
and obesity than Caucasians.
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.
Preventive cardiac care should focus primarily on addressing all the following except? -
CORRECT ANSWER-Genetic predisposition
Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable risk
factors such as age, gender, genetic/family history should not be the primary focus of
prevention.
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).
