CEA EXAM 2025 SPRING – m m m m
SUMMER EXAM PRACTICE 300+ QUESTION m m m m
S AND ANSWERS WITH RATIONALE GRAD
m m m m m
ED A+ m
The patient is exhibiting a productive cough and a low-grade fever. Chest X-
m m m m m m m m m m m m
ray on PA view shows a left lower chest area of consolidation adjacent to the left
m m m m m m m m m m m m m m m m
border of the heart approximately 2 rib spaces above the costophrenic angle. The l
m m m m m m m m m m m m m
ateral x- m
mray view shows this lesion absent of the window posterior to the cardiac silhouett
m m m m m m m m m m m m m
e. Which is the most likely location of this area of focal consolidation?
m m m m m m m m m m m m
*Left upper lobe apex
m m m
*Right middle lobe m m
*Left upper lobe lingula
m m m
*Left lower lobem m
Left upper lobe lingula
m m m
Ratonale: Lingular consolidation is described in this question precisely. If the card
m m m m m m m m m m m
iac margin/silhouette is obliterated by the mass, the lesion is either right middle lo
m m m m m m m m m m m m m
be or left upper lobe lingula.
m m m m m
The inability to fully relax the myocardium during relaxation is a trademark of wh
m m m m m m m m m m m m m
ich of the following diagnoses?
m m m m
Diastolic dysfunction m
,Rationale: The inability for the heart to relax is a trademark of the diagnosis of dia
m m m m m m m m m m m m m m m
stolic dysfunction and is common in patients with thickened hypertrophic myocard
m m m m m m m m m m
ium.
An otherwise healthy African American adult male has been diagnosed with hype
m m m m m m m m m m m
rtension. He has been restricting his salt intake, eating a DASH (Dietary Approac
m m m m m m m m m m m m
hes to Stop Hypertension) diet, and exercising more, but his blood pressure is still
m m m m m m m m m m m m m
melevated. Which is the BEST medication to prescribe him?
m m m m m m m m
Calcium channel blocker m m
Rationale: African American patients per JNC8 Hypertension Guidelines should b
m m m m m m m m m
e managed with a dihydropyridine calcium channel blocker such as amlodipine (N
m m m m m m m m m m m
orvasc) as first line management therapy for hypertension not at goal with DASH
m m m m m m m m m m m m m
and lifestyle modifications.
m m
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
m m m m m m m m m m m m
medical imaging is considered standard of care for serial surveillance?
m m m m m m m m m
CT angiography of the chest
m m m m
Rationale: CT angiography is considered the standard of care for measuring vascu
m m m m m m m m m m m
lar luminal dimensions with contrast. CT PE protocol is not timed properly for the
m m m m m m m m m m m m m
maorta (it's timed for the pulmonary artery). Although a plain film is able to catch l
m m m m m m m m m m m m m m m
arge aneurysms at times, they are not able to provide multi-
m m m m m m m m m m
axis reconstruction needed to accurately measure the size. Transesophageal echo i
m m m m m m m m m m
s not needed to accurately measure the aorta and requires the patient to undergo se
m m m m m m m m m m m m m m
dation which is unnecessary.
m m m
,Which of the following medications does not cause beta 1 stimulation? phenylephr
m m m m m m m m m m m
ine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three al
m m m m m m m m m m
l have beta receptor activity.
m m m m
A 50-year-
m
old woman with a history of hypertension presents with dyspnea on exertion a
m m m m m m m m m m m m
nd orthopnea. On examination, she has jugular venous distention and bilateral
m m m m m m m m m m m
crackles on lung auscultation. What is the most likely diagnosis?
m m m m m m m m m
Congestive heart failure m m
Rationale: Of the available options, the most accurate response is congestive heart
m m m m m m m m m m m
mfailure as it is signifying both a right ventricular back up with jugular venous exte
m m m m m m m m m m m m m m
nsion and crackles on lung assault, which are suggestive of left ventricular back u
m m m m m m m m m m m m m
p. it is possible the patient may have an acute myocardial infarction that precipitat
m m m m m m m m m m m m m
ed this, however, a patient has not described that, rather is only describing dyspnea
m m m m m m m m m m m m m
mon exertion and orthopnea, which both speak to a state of fluid overload.
m m m m m m m m m m m m
The only appropriate response of these available is congestive heart failure.
m m m m m m m m m m
Your patient with a history of HFrEF (heart failure with reduced ejection fraction)
m m m m m m m m m m m m
mwith an ejection fraction of 40% who is also not on optimal medical therapy has
m m m m m m m m m m m m m m m
been diagnosed with a myocardial infarction this admission and received emergent
m m m m m m m m m m
mplacement of a drug- m m m
eluting stent to the left anterior descending artery. As the medical home who will
m m m m m m m m m m m m m m
manage this patient after discharge, which medication strategy would you expect t
m m m m m m m m m m m
o be a priority in the patient's care?
m m m m m m m
Ordering a transthoracic echocardiogram and order a Lifevest if EF is less tha
m m m m m m m m m m m m
n 35%
m
, Rationale: The patient should have a protective mechanism such as an implantabl
m m m m m m m m m m m
e automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 3
m m m m m m m m m m m m m m
5% due to the increased risk of sudden cardiac death with low EF states. Since m
m m m m m m m m m m m m m m m
ost patients are not eligible for 90 days for an AICD in this state, optimizing their
m m m m m m m m m m m m m m m m
medication regimen and repeating an echo in 2-3 months to re-
m m m m m m m m m m
evaluate for improvement in their EF is required by most insurance companies. A
m m m m m m m m m m m m m
baseline echo is needed at discharge to provide a baseline for improvement vs thei
m m m m m m m m m m m m m
r repeat echo in 2-3 months.
m m m m m
Dual anti-platelet therapy is required for 12 months minimum post-MI.
m m m m m m m m m
A Holter monitor does not provide any conceivable benefit for this patient as prese
m m m m m m m m m m m m m
nted.
Which of the following people groups represent the least risk of cardiac disease? C
m m m m m m m m m m m m m
aucasians
Rationale: Statistically African Americans, Native Hawaiians, and American India
m m m m m m m m
ns are at at increased risk of cardiac disease due to higher rates of hypertension, di
m m m m m m m m m m m m m m m
abetes, and obesity than Caucasians.
m m m m
A 65-year-old woman presents for a follow-
m m m m m m
up examination. She is a smoker, and her hypertension is now adequately controll
m m m m m m m m m m m m
ed with medication. Her mother died at age 40 from a heart attack. The fasting lip
m m m m m m m m m m m m m m m
id profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition
m m m m m m m m m m m m m m m
mto starting therapeutic lifestyle changes, the nurse practitioner should start the pat
m m m m m m m m m m m
ient on: m
a statin drug.
m m
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be usef
m m m m m m m m m m
ul in reducing ASVD risk, but for a patient who is an active smoker with
m m m m m m m m m m m m m m
SUMMER EXAM PRACTICE 300+ QUESTION m m m m
S AND ANSWERS WITH RATIONALE GRAD
m m m m m
ED A+ m
The patient is exhibiting a productive cough and a low-grade fever. Chest X-
m m m m m m m m m m m m
ray on PA view shows a left lower chest area of consolidation adjacent to the left
m m m m m m m m m m m m m m m m
border of the heart approximately 2 rib spaces above the costophrenic angle. The l
m m m m m m m m m m m m m
ateral x- m
mray view shows this lesion absent of the window posterior to the cardiac silhouett
m m m m m m m m m m m m m
e. Which is the most likely location of this area of focal consolidation?
m m m m m m m m m m m m
*Left upper lobe apex
m m m
*Right middle lobe m m
*Left upper lobe lingula
m m m
*Left lower lobem m
Left upper lobe lingula
m m m
Ratonale: Lingular consolidation is described in this question precisely. If the card
m m m m m m m m m m m
iac margin/silhouette is obliterated by the mass, the lesion is either right middle lo
m m m m m m m m m m m m m
be or left upper lobe lingula.
m m m m m
The inability to fully relax the myocardium during relaxation is a trademark of wh
m m m m m m m m m m m m m
ich of the following diagnoses?
m m m m
Diastolic dysfunction m
,Rationale: The inability for the heart to relax is a trademark of the diagnosis of dia
m m m m m m m m m m m m m m m
stolic dysfunction and is common in patients with thickened hypertrophic myocard
m m m m m m m m m m
ium.
An otherwise healthy African American adult male has been diagnosed with hype
m m m m m m m m m m m
rtension. He has been restricting his salt intake, eating a DASH (Dietary Approac
m m m m m m m m m m m m
hes to Stop Hypertension) diet, and exercising more, but his blood pressure is still
m m m m m m m m m m m m m
melevated. Which is the BEST medication to prescribe him?
m m m m m m m m
Calcium channel blocker m m
Rationale: African American patients per JNC8 Hypertension Guidelines should b
m m m m m m m m m
e managed with a dihydropyridine calcium channel blocker such as amlodipine (N
m m m m m m m m m m m
orvasc) as first line management therapy for hypertension not at goal with DASH
m m m m m m m m m m m m m
and lifestyle modifications.
m m
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
m m m m m m m m m m m m
medical imaging is considered standard of care for serial surveillance?
m m m m m m m m m
CT angiography of the chest
m m m m
Rationale: CT angiography is considered the standard of care for measuring vascu
m m m m m m m m m m m
lar luminal dimensions with contrast. CT PE protocol is not timed properly for the
m m m m m m m m m m m m m
maorta (it's timed for the pulmonary artery). Although a plain film is able to catch l
m m m m m m m m m m m m m m m
arge aneurysms at times, they are not able to provide multi-
m m m m m m m m m m
axis reconstruction needed to accurately measure the size. Transesophageal echo i
m m m m m m m m m m
s not needed to accurately measure the aorta and requires the patient to undergo se
m m m m m m m m m m m m m m
dation which is unnecessary.
m m m
,Which of the following medications does not cause beta 1 stimulation? phenylephr
m m m m m m m m m m m
ine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three al
m m m m m m m m m m
l have beta receptor activity.
m m m m
A 50-year-
m
old woman with a history of hypertension presents with dyspnea on exertion a
m m m m m m m m m m m m
nd orthopnea. On examination, she has jugular venous distention and bilateral
m m m m m m m m m m m
crackles on lung auscultation. What is the most likely diagnosis?
m m m m m m m m m
Congestive heart failure m m
Rationale: Of the available options, the most accurate response is congestive heart
m m m m m m m m m m m
mfailure as it is signifying both a right ventricular back up with jugular venous exte
m m m m m m m m m m m m m m
nsion and crackles on lung assault, which are suggestive of left ventricular back u
m m m m m m m m m m m m m
p. it is possible the patient may have an acute myocardial infarction that precipitat
m m m m m m m m m m m m m
ed this, however, a patient has not described that, rather is only describing dyspnea
m m m m m m m m m m m m m
mon exertion and orthopnea, which both speak to a state of fluid overload.
m m m m m m m m m m m m
The only appropriate response of these available is congestive heart failure.
m m m m m m m m m m
Your patient with a history of HFrEF (heart failure with reduced ejection fraction)
m m m m m m m m m m m m
mwith an ejection fraction of 40% who is also not on optimal medical therapy has
m m m m m m m m m m m m m m m
been diagnosed with a myocardial infarction this admission and received emergent
m m m m m m m m m m
mplacement of a drug- m m m
eluting stent to the left anterior descending artery. As the medical home who will
m m m m m m m m m m m m m m
manage this patient after discharge, which medication strategy would you expect t
m m m m m m m m m m m
o be a priority in the patient's care?
m m m m m m m
Ordering a transthoracic echocardiogram and order a Lifevest if EF is less tha
m m m m m m m m m m m m
n 35%
m
, Rationale: The patient should have a protective mechanism such as an implantabl
m m m m m m m m m m m
e automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 3
m m m m m m m m m m m m m m
5% due to the increased risk of sudden cardiac death with low EF states. Since m
m m m m m m m m m m m m m m m
ost patients are not eligible for 90 days for an AICD in this state, optimizing their
m m m m m m m m m m m m m m m m
medication regimen and repeating an echo in 2-3 months to re-
m m m m m m m m m m
evaluate for improvement in their EF is required by most insurance companies. A
m m m m m m m m m m m m m
baseline echo is needed at discharge to provide a baseline for improvement vs thei
m m m m m m m m m m m m m
r repeat echo in 2-3 months.
m m m m m
Dual anti-platelet therapy is required for 12 months minimum post-MI.
m m m m m m m m m
A Holter monitor does not provide any conceivable benefit for this patient as prese
m m m m m m m m m m m m m
nted.
Which of the following people groups represent the least risk of cardiac disease? C
m m m m m m m m m m m m m
aucasians
Rationale: Statistically African Americans, Native Hawaiians, and American India
m m m m m m m m
ns are at at increased risk of cardiac disease due to higher rates of hypertension, di
m m m m m m m m m m m m m m m
abetes, and obesity than Caucasians.
m m m m
A 65-year-old woman presents for a follow-
m m m m m m
up examination. She is a smoker, and her hypertension is now adequately controll
m m m m m m m m m m m m
ed with medication. Her mother died at age 40 from a heart attack. The fasting lip
m m m m m m m m m m m m m m m
id profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition
m m m m m m m m m m m m m m m
mto starting therapeutic lifestyle changes, the nurse practitioner should start the pat
m m m m m m m m m m m
ient on: m
a statin drug.
m m
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be usef
m m m m m m m m m m
ul in reducing ASVD risk, but for a patient who is an active smoker with
m m m m m m m m m m m m m m
