NU665A Primary Care of Child II EXAM 3 LATEST FALL
SPRING 2024.2025 GRADED A+ WITH SOLUTIONS
You believe your patient is presenting with an acute myocardial infarction, which
one of these signs or symptoms would not be correct for an MI?
A. ST-Elevation seen in all leads
B. Chest-pressure radiating to the right arm
C. Dyspnea
D. Nausea and Diaphoresis
E. Neck and Jaw Pain - ANSWER: A. ST-Elevation seen in all leads
2. Your 62-year-old female patient has just been diagnosed with an MI, she had a
stent placed in the RCA. She states she is feeling fine and would like to discharge
home now. You educate her on the necessity to stay for observation of what
common complication?
A. Cardiac Tamponade
B. Dysrhythmia
C. Endocarditis
D Pulmonary Emboli
E. Dresser's Syndrome - ANSWER: B. Dysrhythmia
3. You order lab tests on a patient presenting with complaints of chest pain for 6
hours. Which of the following abnormal values would you expect to see if the
patient's chest pain is cardiac related?
A. Low Potassium of 3.1
B. Elevated Troponin of 4.5
C. Low Hemoglobin of 7.3
D. Low Glucose of 65
E. BUN of 78 - ANSWER: B. Elevated Troponin of 4.5
4. Based on the following options which modifiable risk factors place your patient at
increased risk for Ml? A. Age of 65
B. A smoking history of 3 packs per day for 30 years
C. Male
D. Vigorous exercise 3 times a week
E. Family history of cardiac disease - ANSWER: B. A smoking history of 3 packs per
day for 30 years
5. Which of the following statements is CORRECT?
A. Myocardial tissue necrosis occurs immediately when blood flow is occluded.
B. Cardiac troponin is highest 30 minutes after infarction.
C. Inflammatory biomarkers are often elevated after an acute MI
D. Chest pain is always present in myocardial infarctions.
E. CK-MB is positive after 15 minutes - ANSWER: C. Inflammatory biomarkers are
often elevated after an acute MI
,6. Your office receives a call from a 60-year-old patient with hypertension, diabetes
mellitus and hypercholesterolemia. His check-up 6 months earlier was
unremarkable. He reports ongoing moderate to severe retrosternal chest pain with
radiation to the shoulders and some sweating as well as nausea. The pain has lasted
for approximately 30 min. What is your advice to him? A. Come to the office
immediately for evaluation
B. Go immediately to the ED
C. Call 911 immediately and notify them of your chest pain
D. Chew on an aspirin then go to the ED
E. Try to relax and see if the pain goes away - ANSWER: C. Call 911 immediately and
notify them of your chest pain
7. Which are the three diagnostic cornerstones of the early diagnosis of non-ST-
elevation acute coronary syndrome (NSTE-ACS):
A. Past clinical history including a detailed description of the chest pain
characteristics, 12-lead ECG, and Cardiac Troponin
B. Cardiac Troponin, Treadmill Test, and Computed Tomography (CT)
C. 12-lead ECG, Cardiac Troponin, and Treadmill Test
D. Past clinical history including a detailed description of the chest pain
characteristics, 12-lead ECG, and Chest X-ray E. 12-lead ECG, Chest X-ray, and Cardiac
Troponin - ANSWER: A. Past clinical history including a detailed description of the
chest pain characteristics, 12-lead ECG, and Cardiac Troponin
8. Which of the following groups is less likely to have the classic chest pain by
associated with heart attack?
A. Women
B. Men
C. People under 75 years old
D. People with high blood pressure
E. Men under 75 years old - ANSWER: A. Women
9. Which of the following is NOT classified as an acute coronary syndrome?
A. Unstable Angina
B. Non ST Segment Elevation MI
C. Stable Angina Pectoris
D. ST-Segment Elevation MI
E. Pulmonary Edema - ANSWER: C. Stable Angina Pectoris
10. Which is not a symptom of a heart attack?
A Dizziness, Weakness, Arm Pain, Chest B. Heart Palpitations, Shortness of Breath,
Weakness
C. No Symptoms
D. Neck Pain, Jaw Pain
E. Hemoptysis, Jaw Pain - ANSWER: E. Hemoptysis, Jaw Pain
11. When a patient presents with typical exertional symptoms of angina pectoris,
ECG is indicated. Because angina resolves with rest. ECG can rarely be done during
,an attack. An abnormal resting ECG alone does not establish or rule out the DX of
angina pectoris. To confirm the diagnosis, which of the following is the most
appropriate next step?
A. Coronary Angiography
B. Spiral CT Scan
C. Intravascular Ultrasound
D. Stress Testing
E. Evening Monitoring - ANSWER: D. Stress Testing
12. A 50-year-old patient with a history of prior MI comes to the clinic because of
dyspnea, cough, and pink frothy sputum. He states that he needs 3 pillows in
order to sleep at night and sometimes wakes up gasping for air. Which of the
following is the most likely diagnosis?
A. Left Sided Heart Failure
B. Right Sided Heart Failure
C. Cirrhosis
D. Dressler Syndrome
E Mitral Valve Prolapse - ANSWER: A. Left Sided Heart Failure
13. A 58-year-old man with type 2 diabetes mellitus for the past 15 years is rushed to
the ED after suddenly feeling short of breath at the gym. Initial labs on admission
indicate the patient is having a STEM. Why did this patient not exhibit symptoms of
chest pain?
A. He is a man and has a high pain tolerance
B. He has diabetic neuropathy
C. He probably took an Advil before going to the gym
D. The majority of MIs do not cause chest pain - ANSWER: B. He has diabetic
neuropathy
14. A 48-year-old woman is referred to a cardiologist because of chest pain that
occurs randomly and is not associated with exertion. A coronary angiogram is
performed and no plaques are seen in the coronary arteries. Which of the following
is the most likely cause of her chest pain?
A. Stable Angina
B. Prinzmetal Angina
C. Unstable Angina
D. STEMI
E. Asthma - ANSWER: B. Prinzmetal Angina
15. A 48-year-old woman is referred to a cardiologist because of chest pain that
occurs randomly and is not associated with exertion. A coronary angiogram is
performed and no plaques are seen in the coronar arteries. Which of the follow is
the recommended treatment for this condition?
A. Beta Blockers
B. ACE Inhibitors
C. ARBS
D. Calcium Channel Blockers
, E. Alpha Blockers - ANSWER: D. Calcium Channel Blockers
16. All can cause cardiomyopathy except
A. Methamphetamine
B. Cocaine
C. Alcohol
D. Antineoplastic Chemotherapeutic Agents
E. Opioids - ANSWER: E. Opioids
17. A 57 year old female complains or pain in her legs. She has smoker 2ppd since
age 18, but is otherwise healthy. She states her leg pain is increased with walking
and relieved with rest. She also admits to getting slightly short of breath after
walking several blocks. Which of the following is the most specific symptom for
peripheral vascular disease?
A. Intermittent Claudication
B. Shortness of Breath
C. Chest Pain with Exertion
D. Knee Pain
E. Hip Pain - ANSWER: A. Intermittent Claudication
18. A 72 year old teacher goes to her provider for an annual examination. She is
concerned about her risk for peripheral vascular disease and states there is a place
near her home that screens for it. Which of the following is a risk factor for
peripheral vascular disease?
A. GE Reflux
B. CAD
C. Migraine Headache
D. Osteoarthritis - ANSWER: B. CAD
19. A 69 year old truck driver comes in with cc of swelling in both legs. He is a
smoker and has had HTN x 20 years for which he is taking lisinopril. Which of the
following tests are most appropriate to evaluate the possibility of PVD?
A. Venogram
B. CT of the Lower Extremities
C. Anklebrachial index (ABI)
D. PET Scan
E. Radiograph of the Legs - ANSWER: C. Ankle brachial index (ABI)
20. A 57 year old female with a recent history of breast cancer s/p chemo and
radiation treatment, hypertension and uterine fibroids comes to the office for a
routine exam. Which of the following parts of the physical exam are important in
assessing the patient for peripheral vascular disease of the upper extremities?
A. Femoral Pulse, Popliteal Pulse
B. Dorsalis Pedis Pulse, Posterior Tibial Pulse
C. Carotid Pulse
D. Radial Pulse, Brachial Pulse
E. Radial Pulse, Femoral Pulse - ANSWER: D. Radial Pulse, Brachial Pulse
SPRING 2024.2025 GRADED A+ WITH SOLUTIONS
You believe your patient is presenting with an acute myocardial infarction, which
one of these signs or symptoms would not be correct for an MI?
A. ST-Elevation seen in all leads
B. Chest-pressure radiating to the right arm
C. Dyspnea
D. Nausea and Diaphoresis
E. Neck and Jaw Pain - ANSWER: A. ST-Elevation seen in all leads
2. Your 62-year-old female patient has just been diagnosed with an MI, she had a
stent placed in the RCA. She states she is feeling fine and would like to discharge
home now. You educate her on the necessity to stay for observation of what
common complication?
A. Cardiac Tamponade
B. Dysrhythmia
C. Endocarditis
D Pulmonary Emboli
E. Dresser's Syndrome - ANSWER: B. Dysrhythmia
3. You order lab tests on a patient presenting with complaints of chest pain for 6
hours. Which of the following abnormal values would you expect to see if the
patient's chest pain is cardiac related?
A. Low Potassium of 3.1
B. Elevated Troponin of 4.5
C. Low Hemoglobin of 7.3
D. Low Glucose of 65
E. BUN of 78 - ANSWER: B. Elevated Troponin of 4.5
4. Based on the following options which modifiable risk factors place your patient at
increased risk for Ml? A. Age of 65
B. A smoking history of 3 packs per day for 30 years
C. Male
D. Vigorous exercise 3 times a week
E. Family history of cardiac disease - ANSWER: B. A smoking history of 3 packs per
day for 30 years
5. Which of the following statements is CORRECT?
A. Myocardial tissue necrosis occurs immediately when blood flow is occluded.
B. Cardiac troponin is highest 30 minutes after infarction.
C. Inflammatory biomarkers are often elevated after an acute MI
D. Chest pain is always present in myocardial infarctions.
E. CK-MB is positive after 15 minutes - ANSWER: C. Inflammatory biomarkers are
often elevated after an acute MI
,6. Your office receives a call from a 60-year-old patient with hypertension, diabetes
mellitus and hypercholesterolemia. His check-up 6 months earlier was
unremarkable. He reports ongoing moderate to severe retrosternal chest pain with
radiation to the shoulders and some sweating as well as nausea. The pain has lasted
for approximately 30 min. What is your advice to him? A. Come to the office
immediately for evaluation
B. Go immediately to the ED
C. Call 911 immediately and notify them of your chest pain
D. Chew on an aspirin then go to the ED
E. Try to relax and see if the pain goes away - ANSWER: C. Call 911 immediately and
notify them of your chest pain
7. Which are the three diagnostic cornerstones of the early diagnosis of non-ST-
elevation acute coronary syndrome (NSTE-ACS):
A. Past clinical history including a detailed description of the chest pain
characteristics, 12-lead ECG, and Cardiac Troponin
B. Cardiac Troponin, Treadmill Test, and Computed Tomography (CT)
C. 12-lead ECG, Cardiac Troponin, and Treadmill Test
D. Past clinical history including a detailed description of the chest pain
characteristics, 12-lead ECG, and Chest X-ray E. 12-lead ECG, Chest X-ray, and Cardiac
Troponin - ANSWER: A. Past clinical history including a detailed description of the
chest pain characteristics, 12-lead ECG, and Cardiac Troponin
8. Which of the following groups is less likely to have the classic chest pain by
associated with heart attack?
A. Women
B. Men
C. People under 75 years old
D. People with high blood pressure
E. Men under 75 years old - ANSWER: A. Women
9. Which of the following is NOT classified as an acute coronary syndrome?
A. Unstable Angina
B. Non ST Segment Elevation MI
C. Stable Angina Pectoris
D. ST-Segment Elevation MI
E. Pulmonary Edema - ANSWER: C. Stable Angina Pectoris
10. Which is not a symptom of a heart attack?
A Dizziness, Weakness, Arm Pain, Chest B. Heart Palpitations, Shortness of Breath,
Weakness
C. No Symptoms
D. Neck Pain, Jaw Pain
E. Hemoptysis, Jaw Pain - ANSWER: E. Hemoptysis, Jaw Pain
11. When a patient presents with typical exertional symptoms of angina pectoris,
ECG is indicated. Because angina resolves with rest. ECG can rarely be done during
,an attack. An abnormal resting ECG alone does not establish or rule out the DX of
angina pectoris. To confirm the diagnosis, which of the following is the most
appropriate next step?
A. Coronary Angiography
B. Spiral CT Scan
C. Intravascular Ultrasound
D. Stress Testing
E. Evening Monitoring - ANSWER: D. Stress Testing
12. A 50-year-old patient with a history of prior MI comes to the clinic because of
dyspnea, cough, and pink frothy sputum. He states that he needs 3 pillows in
order to sleep at night and sometimes wakes up gasping for air. Which of the
following is the most likely diagnosis?
A. Left Sided Heart Failure
B. Right Sided Heart Failure
C. Cirrhosis
D. Dressler Syndrome
E Mitral Valve Prolapse - ANSWER: A. Left Sided Heart Failure
13. A 58-year-old man with type 2 diabetes mellitus for the past 15 years is rushed to
the ED after suddenly feeling short of breath at the gym. Initial labs on admission
indicate the patient is having a STEM. Why did this patient not exhibit symptoms of
chest pain?
A. He is a man and has a high pain tolerance
B. He has diabetic neuropathy
C. He probably took an Advil before going to the gym
D. The majority of MIs do not cause chest pain - ANSWER: B. He has diabetic
neuropathy
14. A 48-year-old woman is referred to a cardiologist because of chest pain that
occurs randomly and is not associated with exertion. A coronary angiogram is
performed and no plaques are seen in the coronary arteries. Which of the following
is the most likely cause of her chest pain?
A. Stable Angina
B. Prinzmetal Angina
C. Unstable Angina
D. STEMI
E. Asthma - ANSWER: B. Prinzmetal Angina
15. A 48-year-old woman is referred to a cardiologist because of chest pain that
occurs randomly and is not associated with exertion. A coronary angiogram is
performed and no plaques are seen in the coronar arteries. Which of the follow is
the recommended treatment for this condition?
A. Beta Blockers
B. ACE Inhibitors
C. ARBS
D. Calcium Channel Blockers
, E. Alpha Blockers - ANSWER: D. Calcium Channel Blockers
16. All can cause cardiomyopathy except
A. Methamphetamine
B. Cocaine
C. Alcohol
D. Antineoplastic Chemotherapeutic Agents
E. Opioids - ANSWER: E. Opioids
17. A 57 year old female complains or pain in her legs. She has smoker 2ppd since
age 18, but is otherwise healthy. She states her leg pain is increased with walking
and relieved with rest. She also admits to getting slightly short of breath after
walking several blocks. Which of the following is the most specific symptom for
peripheral vascular disease?
A. Intermittent Claudication
B. Shortness of Breath
C. Chest Pain with Exertion
D. Knee Pain
E. Hip Pain - ANSWER: A. Intermittent Claudication
18. A 72 year old teacher goes to her provider for an annual examination. She is
concerned about her risk for peripheral vascular disease and states there is a place
near her home that screens for it. Which of the following is a risk factor for
peripheral vascular disease?
A. GE Reflux
B. CAD
C. Migraine Headache
D. Osteoarthritis - ANSWER: B. CAD
19. A 69 year old truck driver comes in with cc of swelling in both legs. He is a
smoker and has had HTN x 20 years for which he is taking lisinopril. Which of the
following tests are most appropriate to evaluate the possibility of PVD?
A. Venogram
B. CT of the Lower Extremities
C. Anklebrachial index (ABI)
D. PET Scan
E. Radiograph of the Legs - ANSWER: C. Ankle brachial index (ABI)
20. A 57 year old female with a recent history of breast cancer s/p chemo and
radiation treatment, hypertension and uterine fibroids comes to the office for a
routine exam. Which of the following parts of the physical exam are important in
assessing the patient for peripheral vascular disease of the upper extremities?
A. Femoral Pulse, Popliteal Pulse
B. Dorsalis Pedis Pulse, Posterior Tibial Pulse
C. Carotid Pulse
D. Radial Pulse, Brachial Pulse
E. Radial Pulse, Femoral Pulse - ANSWER: D. Radial Pulse, Brachial Pulse
