CEA PREP: FULL PRACTICE EXAM
QUESTIONS COMPLETE WITH 100%
CORRECT ANSWERS AND DETAILED
RATIONALES
\.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 - ANSWERS✔-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? - ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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?
- ANSWERS✔-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: - ANSWERS✔-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? - ANSWERS✔-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.
QUESTIONS COMPLETE WITH 100%
CORRECT ANSWERS AND DETAILED
RATIONALES
\.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 - ANSWERS✔-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? - ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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? -
ANSWERS✔-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?
- ANSWERS✔-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: - ANSWERS✔-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? - ANSWERS✔-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.
