CEAlExaml(Latestl2025/l2026lUpdate)l QuestionslandlVerifiedlAnswerslwithl Rationalesl|l100%lCorrect|lGradelA
Q:lWhichloflthelfollowinglislatlhighestlrisklforlDMII?
Answer:
AnladultlwomanlwithlalBMIlofl27lwholjustldeliveredlalbabylweighingl9l1/2llbs Rationale:lOfltheseloptions,lanladultlwomanlwithlalBMIlofl27lwholjustldeliveredlalbabylweighi ngl9l1/2llbslislthelmostllikelyldueltoltheirlincreasedlBMIlandlthellargelsizeloflthelbaby.lgivingl birthltolallargelbaby,lalsolknownlaslallarge-for-gestational- agel(LGA)lbaby,lcanlincreaselthelrisklofldevelopingltypel2ldiabetesllaterlinllife.lWomenlwholgi velbirthltolalLGAlbabylarel10%lmorellikelyltoldeveloplDMIIl10- 14lyearslafterlpregnancylcomparedltolwomenlwholgivelbirthltolbabiesloflaveragelgestationallag el(AGA).lThislincreasedlrisklislevenlafterladjustinglforlotherlrisklfactors,lsuchlaslage,lobesity,lh ighlbloodlpressure,landlfamilylhistorylofldiabetes.
Q:lAlstartingldoselforlalelderlyladultlpatientlwithlalBMIlofl20lneedingllevothryoxine
Answer:
25lmcg Rationale:lThelwidelylconsideredlbestlpracticelforltreatmentloflhypothyroidismlinlthelelderlylisl tol"golslowlandlstartllow".l25lmcglislthelmostlappropriatellowldoseltolstartlwithlofltheseloption s.lItlislpossiblelthatloverltimeltheldoselwilllbelincreasedluntilltherapeuticllevelslarelobtained,lbu tlthelriskloflover-dosinglthelpatientloutweighsltheldesireltolquicklylachievelthislstate.
Q:lAnladultlfemalelwholrecentlylreturnedlforlalrechecklappointment.lThelonlylremarkablellab oratorylresultlislforlthyroid-stimulatinglhormonel(TSH),latl0.3lmicrounits/mLl(normall=l0.4- 6lmicrounits/mL).lThelpatientlreportslthatlherlnecklhurts;lexaminationlrevealslthyroidltendernes s.lWhichloflthelfollowingllaboratoryltestslshouldlthelnurselpractitionerlorderlnow? 1 / 4
Answer:
Triiodothyroninel(T3)landlfreelthyroxinel(FT4) Rationale:lRememberlthatlalpatientlwithllowlTSHlislsuspiciousloflhyperthyroidismlwithlalcorre spondinglfindingloflelevatedlT3/T4landlclinicallsymptomsloflalgoiter,ltremulousness,lanxiety,lp alpitations,lweightlloss,linsomnia,ldiarrhea,letc.lThislpatientlisldescribinglalsorelnecklaslwell,lw hichlislsuggestiveloflGravesldiseasel(hyperthyroidlstate).
Q:lAlllthelfollowinglarelsymptomsloflhypocalcemialexcept:
Answer:
Visuallfieldldeficits Rationale:lVisuallfieldldeficitslislalpotentiallsymptomloflpituitaryladenoma.lAlllotherlarelsympt omslrelatedltolhypocalcemia.
Q:lAnladultlpatientldiagnosedlwithltypel2ldiabeteslmellituslpresentslforlalrecheck.lThelpatient lfollowslalcarbohydratelcountingldietlandlwalksl30lminutesl5ltimeslweekly.lCurrentlfastinglblo odlglucosel=l116lmg/dLl[normall=llesslthanl99lmg/dL]landlA1cl=l6.3%l[normall=llesslthanl7.0 %].lInlaccordancelwithlthelAmericanlDiabeteslAssociation,lthelnurselpractitionerlwouldlrecom
mendlthatlthelnextlfollow-uplappointmentlbelscheduledlfor:
Answer:
6lmonths.Rationale:lBasedloffloflthelADAlrecommendation,lthislpatientlshouldlbelevaluatedlinlsixlmonth s.lTheylarelactuallylshowinglgoodlcontrollandlexcellentlcompliancelwithldietlandlexerciselman agementlstrategies.lIfltherelcompliancelwaslworselorltheylwerelnotlcontrolledlwithltheirlA1c,lth islwouldllikelylbelalthreelmonthlfollowlup.
Q:lYourlpatientlhaslaldiagnosisloflHashimoto'slandlislonlLevothyroxinel75lmcgldaily.lHerlrec
entlTSHlwaslelevatedlatl15luU/mL.lYourlnextlbestlactionlislto:
Answer: 2 / 4
IncreaselLevothyroxineltol100lmcgldaily Rationale:lWhenlthelTSHlislelevatedlthelpatientlneedslmorelthyroidlhormone.lOnceldiagnosedl withlHashimoto'sltherelislnolclinicallneed/benefitltolrepeatinglantilbodies.
Q:lAlpatientlhaslal3lcmlpituitarylmasslnotedlonlCT.lWhatlislyourlnextlsteplinlevaluatinglthelp atient?
Answer:
Screenlforlhormoneldeficiencies Rationale:lInitiallworkluplincludeslhormoneltesting.lCabergolinelisltheltreatmentlforlprolactino ma.lSurgerylconsultlislindicatedlwhenltherelarelVFldeficitsland/orlabutment/compressionlonlopt iclnerveslorlchiasmlorlifladenomalislhyperfunctioning.lAdenomasl>1lcmlwithlnolVFldeficitlorl abutment/compressionloflopticlnerveslorlchiasmlrequirelalfollowluplMRIlatl6lmonths.
Q:lAnladultlfemalelpresentslwithlalchieflcomplaintloflfatiguelandlweightlgain.lShelstateslthatl sheldoesn'tlfeelllikelherself.lAldiagnosisloflhypothyroidismlislsuspected.lWhichloflthelfollowin glphysicallfindingslwouldlsupportlthisldiagnosis?
Answer:
Drylskin,lbradycardia,landlhypoactiveldeepltendonlreflexes Rationale:lDrylskin,lbradycardia,landlhypoactiveldeepltendonlreflexeslarelalllfairlylclassiclsigns loflhypothyroidism.lTolfurtherlsubstantiateltheselconcerns,lthelpatientlshouldlhaveltheirlTSHlan dlT3landlFreelT4lchecked,landlitlisllikelyltheirlTSHlwouldlbelelevated,lT3/T4llow.
Q:lAnlolderladultlpatientlwithlnewlonsetlGERD,lcough,lheartburn.lInitialltx
Answer:
Antacidlandllifestylelmodification/weightlloss Rationale:lBeforelinitiatinglalPPIlorlH2RA,litlwouldlalwayslbelwiseltolinitiateldiet/exerciseland lsymptomlmanagementlwhenlpresentlwithlanlantacid.lLossloflweight/dietinglislmostllikelyltold eallwithlobesitylaslthelmostlcommonlunderlyinglcauseloflGERD.
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Q:lAl59-year-
oldlmalelpresentslwithlsymptomsloflabdominallpain,ljaundice,landlweightllosslwhichlhelhaslnot lbeenltryingltolloselweight.lWhatlwouldlbelalmalignancylassociatedlwithltheselsymptoms?
Answer:
Pancreaticlcancer Raionale:lPancreaticlcancer,lthelmostltypicallylpresentationlincludeslabdominallpain,ljaundice,l andlweightlloss.lAlthoughlweightllosslandlabdominallpainlmaylbelpresentlwithladenocarcinoma litlislunlikelyltolpresentlwithljaundice,landlyou'relunlikelyltolhavelabdominallpainlorljaundicel withlanylesophageallmalignancy.
Q:lAl63-year-
oldlmalelpresentslwithlalsuspectedllowerlGIlbleed.lHelreportslpassinglfranklsmalllamountsloflb loodlseveralltimesltoday.lHeldenieslanyluseloflNSAID'slorlbloodlthinners.lWhatlmustlbeltakenli ntolconsiderationlbeforelperforminglalcolonoscopylonlthislpatient?
Answer:
Alllarelreasonableloptions Rationale:lThislpatientlhaslhadlbloodllosslandlshouldlfirstlbelhemodynamicallylstable,landlfluid /bloodlproductlresuscitated.lInlalllcasesloflGIlbleedlrisklfactorslforlanlupperlGIlbleedlmustlbelt akenlintolconsiderationlfirst,lwelmustlalwaysldiscusslwithlthelpatientlalllriskslandlbenefitslasso ciatedlwithlthelprocedureltolprovidelanlinformedlconsent.
Q:lAl39-year-oldlfemalelislbeinglseenlbylyourlservicelforldiarrhea.lPatientlreportsl3- 4llooselstoolslalday.lShelalsolreportslmildlcramping.lWhichllabslwouldlbelhelpfullinlfurtherlwo rkuploflaldiagnosis?
Answer:
ESR,lfecalloccult,lStoollculture Rationale:lESR,lFecalloccult,landlstoollculturelwouldlbelthelbiggestlbenefitltoldeterminelthelpot entiallcauseloflherlsymptoms.
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