APEA Review

APEA Review Black Patient With or Without DM Ans- Thiazide diuretic Calcium channel blocker Nonblack Patient With or Without DM Ans- Thiazide diuretic Calcium channel blocker ACE ARB heart murmurs are caused by Ans- turbulent blood flow through the great vessels or across a heart valve occurs • Stenotic valves don't Ans- Stenotic valves don't OPEN properly Regurgitant valves don't Ans- Regurgitant valves don't CLOSE properly If pravastatin is chosen for Mr. Thibodeaux, how would you manage this? Select all that apply. AnsCheck liver enzymes prior to initiation of statin. Start him on 40 mg today and recheck lipids/LFTs in 8 weeks. htn stop Ans- nsaids naproxen calf pain with walking. What's going on? Ans- blockage in lower vessels intermittent claudication peripheral artery disease ABI 0.9 or 1.3 is highly suggestive of Ans- pad What interventions should be initiated to help decrease his triglyceride level (323 mg/dL)? Select all that apply. Ans- . Decreased carbohydrate consumption. Suppose his triglycerides were 550 mg/dL? How would you treat? Ans- fibrates lifestyle If Mrs. Boudreaux were to develop heart failure, which medications would be most beneficial to discontinue? Select all that apply Ans- amlodopine naproxine Heart Failure Clinical Signs and Symptoms Ans- Crackles S3 and/or S4 • Peripheral edema may be present AAA screening Ans- -all men 65-75 who have ever smoked -abdominal US 1 time only statins Ans- liver involvement muscle cramps What is the cutoff value when treatment for hyperlipidemia is recommended? Ans- 7.5 or higher What type of murmur can radiate to the left axilla? Ans- Mitral regurgitation The murmur of mitral regurgitation occurs during systole (holosystolic) and is located in the mitral area of the chest. The location of the mitral area (fifth intercostal space on the left side of the midclavicular line) is near the left axilla, so that a loud murmur can radiate to the left axilla. The causes can be congenital or it may a be sequela of rheumatic fever, mitral valve prolapse, or papillary muscle dysfunction secondary to acute or prior myocardial infarction. pulse deficit Ans- difference between the apical and radial pulse rates radial - apical The goal for patients aged 60 years or older is blood pressure less than Ans- 150/90 shows a triglyceride level of 950 mg/dL, Ans- Initiate a prescription of fenofibrate (Tricor) Prophylaxis treatment for endocarditis is no longer recommended for patients with mitral valve prolapse (MVP). AnsDuring a routine physical exam of a 90-year-old woman, a low-pitched diastolic murmur grade 2/6 is auscultated. It is located on the fifth intercostal space (ICS) on the left side of the midclavicular line. Which of the following identifications is correct? Ans- Mitral stenosis Pulsus paradoxus is best described as: Ans- A decrease in systolic blood pressure on inspiration digoxin (Lanoxin) for 10 years. Her EKG is showing a new onset of atrial fibrillation. Her pulse is 64 beats/min Ans- Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an electrolyte panel Potential complications of mitral valve prolapse (MVP) include all of the following AnsMVP (mitral valve prolapse) Ans- Severe mitral regurgitation Endocarditis Increased risk of stroke and transient ischemic attack During cardiac murmur assessment, which is the first grade intensity that a thrill can be palpated? Ansg4 Which of the following is correct regarding the best site to listen for mitral regurgitation? Ans- It is best heard at the apex during S1 You note a high-pitched and blowing pansystolic murmur while assessing a 70-year-old male patient. It is grade 2/6 and is best heard at the apical area. Which of the following is most likely? Ans- mr You notice a medium-pitched harsh systolic murmur during an episodic examination of a 37-year-old woman. It is best heard at the right upper border of the sternum. What is most likely? Ans- Aortic stenosis The S1 heart sound is caused by: Ans- Closure of the atrioventricular valves A split S2 heart sound is best heard at which of the following areas? Ans- The pulmonic area mvp Ans- palpitations dizziness A systolic murmur that is accompanied by a mid systolic click located at the apical area is a classic finding of mitral valve prolapse (MVP) Which of the following clusters indicates the target organ damage commonly seen in hypertensive patients? Ans- Arteriovenous (AV) nicking, left ventricular hypertrophy, and stroke HEAVY chest pressure Ans- call 911 2nd htn Ans- renal stenosis adrenal tumors A bruit is a murmur heard over the carotid artery in the neck, suggesting arterial narrowing and atherosclerosis. It may increase risk of Ans- cerebrovascular disease abi Ans- pad An ABI score of 1.0 to 1.4 is normal. Any value less than 1.0 is abnormal. A score of 0.5 or less is indicative of severe PAD. s2 Ans- Second intercostal space, left sternal border white Ans- ace intermittent claudication, he or she would first: Ans- Check the ankle and brachial blood pressures before and after exercise hf med Ans- ace arb older dm Ans- 140/90 non old dm Ans- 150/90 The urine culture and sensitivity (C&S) is the best evaluation for diagnosing a UTI. Ans- positive for a large amount of leukocytes and ketones. He has a trace amount of protein cushing Ans- cortisol best hypothyroidism screen Ans- tsh For prediabetes, look for an A1C between. Ans- 5.7% to 6.4%, fasting plasma glucose (FPG) of 100 to 125 mg/dL, and/or 75-g oral glucose tolerance test (OGTT) 2-hour postprandial glucose of 140 to 199 mg/dL Symogi effect Ans- In diabetic BS will tank at 3am and spike in morning. Dawn phenomenon Ans- Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release. Symogi effect v dawn phenomenon: Ans- Symogi: hypoglycemia causes hyperglycemia Dawn phenomen: increase in insulin due to growth hormones, cortisol etc The Somogyi effect is characterized by Ans- high fasting blood glucose in the morning that is caused by the secretion of glucago