CEA Prep: Full Practice
Exam
1.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: 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.
2.The inability to fully relax the myocardium during relaxation is a trademark of which of
the following diagnoses?: 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.
3.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?: 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.
4.Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial surveillance?: 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.
5.Which of the following medications does not cause beta 1 stimulation?: phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have
beta receptor activity.
6.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?-
: 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.
7.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?: 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.
, CEA Prep: Full Practice
Exam
8. Which of the following people groups represent the least risk of cardiac disease?:
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.
9. 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:: 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.
10. Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?: 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.
11. Preventive cardiac care should focus primarily on addressing all the following
except?: 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.
12. 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?: 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).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
13. A 50-year-old woman with hypertension and diabetes comes in for a routine
check-up. What screening test should be regularly performed to monitor for early signs of
diabetic nephropathy?: Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the evidence of
small proteins in the urine (proteinuria) as found on urinalysis. The other options might
describe macro-organ function (such as BUN/Creat from a BMP, a renal biopsy which is not
indicated for routine diabetic nephropathy testing, and a Abd CT, which is more akin to
evaluation of less subtle findings), but at the functional level of the nephron, namely the
glomerulus, evidence of glucose-related damage is easily identified with proteinuria from
a UA.
14. Which of the following is at highest risk for DMII?: An adult woman with a BMI of 27
who just delivered a baby weighing 9 1/2 lbs
Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a baby
weighing 9 1/2 lbs is the most likely due to their increased BMI and the large size of the
baby. giving birth to a large baby, also known as a large-for-gestational-age (LGA) baby,
can increase the risk of developing type 2 diabetes later in life. Women who give birth to
Exam
1.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: 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.
2.The inability to fully relax the myocardium during relaxation is a trademark of which of
the following diagnoses?: 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.
3.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?: 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.
4.Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial surveillance?: 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.
5.Which of the following medications does not cause beta 1 stimulation?: phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have
beta receptor activity.
6.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?-
: 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.
7.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?: 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.
, CEA Prep: Full Practice
Exam
8. Which of the following people groups represent the least risk of cardiac disease?:
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.
9. 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:: 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.
10. Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?: 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.
11. Preventive cardiac care should focus primarily on addressing all the following
except?: 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.
12. 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?: 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).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
13. A 50-year-old woman with hypertension and diabetes comes in for a routine
check-up. What screening test should be regularly performed to monitor for early signs of
diabetic nephropathy?: Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the evidence of
small proteins in the urine (proteinuria) as found on urinalysis. The other options might
describe macro-organ function (such as BUN/Creat from a BMP, a renal biopsy which is not
indicated for routine diabetic nephropathy testing, and a Abd CT, which is more akin to
evaluation of less subtle findings), but at the functional level of the nephron, namely the
glomerulus, evidence of glucose-related damage is easily identified with proteinuria from
a UA.
14. Which of the following is at highest risk for DMII?: An adult woman with a BMI of 27
who just delivered a baby weighing 9 1/2 lbs
Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a baby
weighing 9 1/2 lbs is the most likely due to their increased BMI and the large size of the
baby. giving birth to a large baby, also known as a large-for-gestational-age (LGA) baby,
can increase the risk of developing type 2 diabetes later in life. Women who give birth to
