APEA 3P Exam Prep- Cardiovascular 2022 with complete
solution
Which patient could be expected to have the highest systolic blood pressure?
A 21-year-old male
A 50-year-old perimenopausal female
A 35-year-old patient with Type 2 diabetes
A 75-year-old male
D.
Nearly 25% of the US population has hypertension. The greatest incidence is in older
adults because of changes in the intima of vessels as aging and calcium deposition
occur. Males of any age are more likely to be hypertensive than females of the same
age. African American adults have the highest incidence in the general population.
Among adolescents, African Americans and Hispanics have the highest rates.
Hypertension occurs in 5-10% of pregnancies.
Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug
does NOT need to be stopped prior to her catheterization?
Naproxen
Furosemide
Metformin
Losartan
D.
Naproxen and furosemide should be stopped for 24 hours prior to the catheterization.
Metformin should be stopped 48 hours prior to the catheterization. Furosemide is
stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld
because of the impact on renal prostaglandin production. Metformin has been
implicated in lactic acidosis when combined with contrast dye in an impaired kidney.
In older adults, the three most common ailments are:
hearing loss, vision loss, hypertension.
hearing loss, hypertension, arthritis.
depression, vision loss, hypertension.
arthritis, hearing loss, depression.
B.
Hypertension and arthritis are the two most common ailments in older adults. Hearing
loss occurs in half to almost 2/3 of older adults. The most common form is known as
presbycusis. There is no consensus for the frequency of screening for hearing loss in
older patients, but minimally, it should be grossly evaluated at each visit and screened
more thoroughly if deficits are observed. Blood pressure should be screened annually,
but it is usually screened at each visit. Arthritis is not routinely screened.
Mr. Holbrook, a 75-year-old male, is a former smoker with a 30-pack-year history. He
has come in today for an annual exam. He walks daily for 25 minutes, has had
intentional weight loss, and has a near-normal BMI. On examination, the patient is
noted to have an absence of hair growth on his lower legs. Which statement is true
regarding this patient?
This is a normal consequence of aging.
,This might indicate disease in the lower extremities.
It might be from exercise initiation.
This is secondary to long-term smoking.
B.
An absence of hair growth likely indicates peripheral artery disease in this patient. It is
part of normal changes of aging that hair growth will diminish, but not become absent.
His lower extremity pulses should be assessed, his cardiac risk factors should be
assessed (he smoked for years), and he should be questioned about leg pain when he
walks. An ankle-brachial index could be measured. If < 0.9, further assessment should
be done. A normal ankle-brachial index should be greater than 0.9. Less than 0.4 is
considered critical.
The usual clinical course of mitral valve prolapse:
is benign.
results in sudden cardiac death.
results in chronic heart failure.
is associated with multiple episodes of emboli.
A.
The usual course of mitral valve prolapse (MVP) is benign, and most patients who have
MVP are asymptomatic. A murmur may be present and is best auscultated with the
diaphragm of the stethoscope over the cardiac apex. In a minority of patients,
symptoms of heart failure or sudden death may occur. When heart failure results, it is
usually a result of mitral regurgitation. Embolization may occur, but, this is not common
or usual in the majority of patients.
An ACE inhibitor is specifically indicated in patients who have:
hypertension, diabetes with proteinuria, and heart failure.
diabetes, hypertension, hyperlipidemia.
asthma, hypertension, diabetes.
renal nephropathy, heart failure, hyperlipidemia.
A.
ACE inhibitors have numerous indications. Three are indicated in the first choice. ACE
inhibitors are also indicated in patients who have renal insufficiency. However, ACE
inhibitors can worsen renal insufficiency, so the patients must be monitored closely with
lab tests for BUN, Cr, and potassium. Diabetes without proteinuria is not a specific
indication for ACE inhibitors use, though they are used by some healthcare providers in
this way. This is an off-label use.
An older adult who has hypertension and angina takes multiple medications. Which one
of the following decreases the likelihood of his having angina?
ACE inhibitor
Beta blocker
Diuretic
Angiotensin receptor blocker
,B.
The beta blocker slows down heart rate, depresses myocardial contractility, and
decreases sympathetic stimulation. These decrease myocardial oxygen demand and
improve angina symptoms. It is an excellent drug class to use to prevent symptoms of
angina in patients who have underlying coronary artery disease. Calcium channel
blockers are another class of medications that could be used to improve symptoms of
angina.
Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure
decreases:
more than 20 points anytime after rising.
more than 20 points within 3 minutes after rising.
more than 20 points within 1 minute after rising.
any degree drop if the patient becomes weak or dizzy.
B.
Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults
when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving
to a more upright position. Systolic blood pressure can be expected to decrease within
one minute of moving to an upright position. Normally, the blood pressure returns to
baseline within one minute of a position change and orthostatic hypotension does not
occur. It is always abnormal when blood pressure decreases beyond one minute of
moving to an upright position. Orthostatic hypotension can then be diagnosed. Moving
to an upright position may be 1) lying to sitting or 2) sitting to standing. Additionally, if
the systolic blood pressure does not meet these criteria, but the diastolic drops by 10
mm Hg or more with a position change, orthostatic hypotension can be diagnosed.
Patients become symptomatic when this occurs and often report lightheadedness,
weakness, dizziness, blurred vision, or decreased hearing.
Which hypertensive patient is most likely to have adverse blood pressure effects from
excessive sodium consumption?
21-year-old Asian American male
35-year-old menstruating female
55-year-old post menopausal female
70-year-old African American male
D.
Two groups of patients typically experience adverse blood pressure effects from
consumption of sodium greater than 2,000 mg daily. Those patients considered to be
most sodium-sensitive are elderly patients and African American patients. Thus, choice
d is the best choice listed.
A patient who takes HCTZ 25 mg daily has complaints of muscle cramps. He probably
has:
hypocalcemia.
hypomagnesemia.
, hypokalemia.
hypercalcemia.
C.
HCTZ is a thiazide diuretic that is potassium-wasting. Patients can become hypokalemic
and experience side effects of this. A common one is muscle cramps.
A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably:
congenital.
rheumatic.
acquired calcific.
unknown.
A.
In someone younger than 65 years, the most likely cause is congenital. The aortic valve
usually consists of three cusps, but some people are born with a bicuspid aortic valve.
Rheumatic heart disease is the second most common cause of aortic stenosis in this
age group, but the incidence has decreased drastically in the last many decades
because of the use of antibiotics to treat Streptococcal infections. In more than 90% of
patients older than 65 years, acquired calcifications appear on a normal aortic valve and
produce aortic stenosis.
A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a
thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema
over the past several days. This probably indicates:
worsening hypertension.
development of heart failure (HF).
noncompliance with medication.
acute myocardial infarction.
B.
The symptoms of dyspnea on exertion and peripheral edema are symptoms of HF.
Long standing hypertension is a risk factor for HF. Acute myocardial infarction would
result in acute symptoms, not development of symptoms over the past several days.
Noncompliance with medication and fluid or sodium excess might result in peripheral
edema and development of heart failure.
A patient with newly diagnosed heart failure has started fosinopril in the last few days.
She has developed a cough. What clinical finding can help distinguish the etiology of
the cough as heart failure and not related to fosinopril?
It is dry and nonproductive.
It is wet and worse with recumbence.
It is purulent and tachycardia accompanies it.
Shortness of breath always results after coughing.
B.
The cough associated with fosinopril, an ACE inhibitor, is a dry, nonproductive cough
that may be described as annoying. Its severity does not change with position or time of
solution
Which patient could be expected to have the highest systolic blood pressure?
A 21-year-old male
A 50-year-old perimenopausal female
A 35-year-old patient with Type 2 diabetes
A 75-year-old male
D.
Nearly 25% of the US population has hypertension. The greatest incidence is in older
adults because of changes in the intima of vessels as aging and calcium deposition
occur. Males of any age are more likely to be hypertensive than females of the same
age. African American adults have the highest incidence in the general population.
Among adolescents, African Americans and Hispanics have the highest rates.
Hypertension occurs in 5-10% of pregnancies.
Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug
does NOT need to be stopped prior to her catheterization?
Naproxen
Furosemide
Metformin
Losartan
D.
Naproxen and furosemide should be stopped for 24 hours prior to the catheterization.
Metformin should be stopped 48 hours prior to the catheterization. Furosemide is
stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld
because of the impact on renal prostaglandin production. Metformin has been
implicated in lactic acidosis when combined with contrast dye in an impaired kidney.
In older adults, the three most common ailments are:
hearing loss, vision loss, hypertension.
hearing loss, hypertension, arthritis.
depression, vision loss, hypertension.
arthritis, hearing loss, depression.
B.
Hypertension and arthritis are the two most common ailments in older adults. Hearing
loss occurs in half to almost 2/3 of older adults. The most common form is known as
presbycusis. There is no consensus for the frequency of screening for hearing loss in
older patients, but minimally, it should be grossly evaluated at each visit and screened
more thoroughly if deficits are observed. Blood pressure should be screened annually,
but it is usually screened at each visit. Arthritis is not routinely screened.
Mr. Holbrook, a 75-year-old male, is a former smoker with a 30-pack-year history. He
has come in today for an annual exam. He walks daily for 25 minutes, has had
intentional weight loss, and has a near-normal BMI. On examination, the patient is
noted to have an absence of hair growth on his lower legs. Which statement is true
regarding this patient?
This is a normal consequence of aging.
,This might indicate disease in the lower extremities.
It might be from exercise initiation.
This is secondary to long-term smoking.
B.
An absence of hair growth likely indicates peripheral artery disease in this patient. It is
part of normal changes of aging that hair growth will diminish, but not become absent.
His lower extremity pulses should be assessed, his cardiac risk factors should be
assessed (he smoked for years), and he should be questioned about leg pain when he
walks. An ankle-brachial index could be measured. If < 0.9, further assessment should
be done. A normal ankle-brachial index should be greater than 0.9. Less than 0.4 is
considered critical.
The usual clinical course of mitral valve prolapse:
is benign.
results in sudden cardiac death.
results in chronic heart failure.
is associated with multiple episodes of emboli.
A.
The usual course of mitral valve prolapse (MVP) is benign, and most patients who have
MVP are asymptomatic. A murmur may be present and is best auscultated with the
diaphragm of the stethoscope over the cardiac apex. In a minority of patients,
symptoms of heart failure or sudden death may occur. When heart failure results, it is
usually a result of mitral regurgitation. Embolization may occur, but, this is not common
or usual in the majority of patients.
An ACE inhibitor is specifically indicated in patients who have:
hypertension, diabetes with proteinuria, and heart failure.
diabetes, hypertension, hyperlipidemia.
asthma, hypertension, diabetes.
renal nephropathy, heart failure, hyperlipidemia.
A.
ACE inhibitors have numerous indications. Three are indicated in the first choice. ACE
inhibitors are also indicated in patients who have renal insufficiency. However, ACE
inhibitors can worsen renal insufficiency, so the patients must be monitored closely with
lab tests for BUN, Cr, and potassium. Diabetes without proteinuria is not a specific
indication for ACE inhibitors use, though they are used by some healthcare providers in
this way. This is an off-label use.
An older adult who has hypertension and angina takes multiple medications. Which one
of the following decreases the likelihood of his having angina?
ACE inhibitor
Beta blocker
Diuretic
Angiotensin receptor blocker
,B.
The beta blocker slows down heart rate, depresses myocardial contractility, and
decreases sympathetic stimulation. These decrease myocardial oxygen demand and
improve angina symptoms. It is an excellent drug class to use to prevent symptoms of
angina in patients who have underlying coronary artery disease. Calcium channel
blockers are another class of medications that could be used to improve symptoms of
angina.
Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure
decreases:
more than 20 points anytime after rising.
more than 20 points within 3 minutes after rising.
more than 20 points within 1 minute after rising.
any degree drop if the patient becomes weak or dizzy.
B.
Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults
when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving
to a more upright position. Systolic blood pressure can be expected to decrease within
one minute of moving to an upright position. Normally, the blood pressure returns to
baseline within one minute of a position change and orthostatic hypotension does not
occur. It is always abnormal when blood pressure decreases beyond one minute of
moving to an upright position. Orthostatic hypotension can then be diagnosed. Moving
to an upright position may be 1) lying to sitting or 2) sitting to standing. Additionally, if
the systolic blood pressure does not meet these criteria, but the diastolic drops by 10
mm Hg or more with a position change, orthostatic hypotension can be diagnosed.
Patients become symptomatic when this occurs and often report lightheadedness,
weakness, dizziness, blurred vision, or decreased hearing.
Which hypertensive patient is most likely to have adverse blood pressure effects from
excessive sodium consumption?
21-year-old Asian American male
35-year-old menstruating female
55-year-old post menopausal female
70-year-old African American male
D.
Two groups of patients typically experience adverse blood pressure effects from
consumption of sodium greater than 2,000 mg daily. Those patients considered to be
most sodium-sensitive are elderly patients and African American patients. Thus, choice
d is the best choice listed.
A patient who takes HCTZ 25 mg daily has complaints of muscle cramps. He probably
has:
hypocalcemia.
hypomagnesemia.
, hypokalemia.
hypercalcemia.
C.
HCTZ is a thiazide diuretic that is potassium-wasting. Patients can become hypokalemic
and experience side effects of this. A common one is muscle cramps.
A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably:
congenital.
rheumatic.
acquired calcific.
unknown.
A.
In someone younger than 65 years, the most likely cause is congenital. The aortic valve
usually consists of three cusps, but some people are born with a bicuspid aortic valve.
Rheumatic heart disease is the second most common cause of aortic stenosis in this
age group, but the incidence has decreased drastically in the last many decades
because of the use of antibiotics to treat Streptococcal infections. In more than 90% of
patients older than 65 years, acquired calcifications appear on a normal aortic valve and
produce aortic stenosis.
A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a
thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema
over the past several days. This probably indicates:
worsening hypertension.
development of heart failure (HF).
noncompliance with medication.
acute myocardial infarction.
B.
The symptoms of dyspnea on exertion and peripheral edema are symptoms of HF.
Long standing hypertension is a risk factor for HF. Acute myocardial infarction would
result in acute symptoms, not development of symptoms over the past several days.
Noncompliance with medication and fluid or sodium excess might result in peripheral
edema and development of heart failure.
A patient with newly diagnosed heart failure has started fosinopril in the last few days.
She has developed a cough. What clinical finding can help distinguish the etiology of
the cough as heart failure and not related to fosinopril?
It is dry and nonproductive.
It is wet and worse with recumbence.
It is purulent and tachycardia accompanies it.
Shortness of breath always results after coughing.
B.
The cough associated with fosinopril, an ACE inhibitor, is a dry, nonproductive cough
that may be described as annoying. Its severity does not change with position or time of
