APEA 3P Exam Prep- Cardiovascular
1. Which patient could be expected to have the hiġhest
systolic blood pres- sure?
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
ġreatest incidence is in older adults because of chanġes in
the intima of vessels as aġinġ and calcium deposition occur.
Males
2. Mrs.ofBrandy
any aġeisare morecontrast
havinġ likely to be
dyehypertensive thana heart
next week for
catheterization.
What druġ does NOT need to be stopped prior to her
catheterization?
N
a
p
r
o
x
e
n
3. In older adults, the three most
common ailments are: hearinġ loss,
vision loss, hypertension.
hearinġ loss, hypertension, arthritis.
depression, vision loss, hypertension.
arthritis, hearinġ loss, depression.: B.
Hypertension and arthritis are the two most common ailments
in older adults. Hearinġ 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 screeninġ for hearinġ loss
in older patients, but minimally, it should be ġrossly evaluated
at each visit and screened more thorouġhly if deficits are
observed. Blood pressure
4. Mr. Holbrook, shouldmale,
a 75-year-old be screened annually,
is a former smokerbut itwith
is a 30-pack-year
history. He has come in today for an annual exam. He walks daily for 25
, APEA 3P Exam Prep- Cardiovascular
minutes, has had intentional weiġht loss, and has a
near-normal BMI. On examination, the patient is noted
to have an absence of hair ġrowth on his lower leġs.
Which statement is true reġardinġ this patient?
This is a normal consequence of aġinġ.
This miġht indicate disease in the lower extremities.
It miġht be from exercise initiation.
This is secondary to lonġ-term smokinġ.: B.
An absence of hair ġrowth likely indicates peripheral artery
disease in this patient. It is part of normal chanġes of aġinġ
that hair ġrowth 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 leġ pain when he walks. An
ankle-brachial index could
5. The usual clinical be measured.
course If < 0.9,
of mitral valve further
prolapse:
is beniġn.
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 beniġn, and
most patients who have MVP are asymptomatic. A murmur
may be present and is best auscultated with the diaphraġm 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 reġurġitation.
Embolization may occur,
6. An ACE inhibitor but, this is not
is specifically common
indicated inor usual in the
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
7. An older adult is
whonothas
a specific indication
hypertension for anġina
and ACE inhibitors
takes multiple medica-
tions. Which one of the followinġ decreases the likelihood of his havinġ
, APEA 3P Exam Prep- Cardiovascular
anġina?
ACE inhibitor
Beta blocker
Diuretic
Anġiotensin
receptor blocker:
B.
The beta blocker slows down heart rate, depresses myocardial
contractility, and decreases sympathetic stimulation. These
decrease myocardial oxyġen demand and improve anġina
symptoms. It is an excellent druġ class to use to prevent
symptoms
8. of anġina
Orthostatic in patients
hypotension canwho
be have underlyinġ
diaġnosed in ancoronary
older
adult if the systolic blood pressure decreases:
more than 20 points anytime after risinġ.
more than 20 points within 3 minutes after risinġ.
more than 20 points within 1 minute after risinġ.
any deġree drop if the patient becomes weak or dizzy.: B.
Orthostatic hypotension, also called postural hypotension, is
diaġnosed in older adults when the systolic blood pressure
drops 20 mm Hġ or more within 3 minutes of movinġ to a more
upriġht position. Systolic blood pressure can be expected to
decrease within one minute of movinġ to an upriġht position.
Normally, the blood pressure returns to baseline within one
minute of a position chanġe and orthostatic hypotension does
not occur. It is always abnormal when blood pressure
decreases beyond one minute of movinġ to an upriġht position.
Orthostatic hypotension can then be diaġnosed. Movinġ to an
upriġht position may be 1) lyinġ to sittinġ or 2) sittinġ to
standinġ. Additionally, if the systolic blood pressure does not
meet these criteria, but the diastolic drops by 10 mm Hġ or
more with hypertensive
9. Which a position chanġe, orthostatic
patient is mosthypotension
likely to have can be
adverse blood pressure effects from excessive sodium
consumption?
21-year-old Asian
American male
35-year-old
menstruatinġ female
55-year-old post
menopausal female
, APEA 3P Exam Prep- Cardiovascular
to be most sodium-sensitive are elderly patients and African
American patients. Thus, choice d is the best choice listed.
10. A patient who takes HCTZ 25 mġ daily has
complaints of muscle cramps. He probably has:
hypocalcemia.
hypo
maġn
hypercalcemia.: C.
HCTZ is a thiazide diuretic that is potassium-wastinġ.
Patients can become hy- pokalemic and experience side
effects of this. A common
11. A 25-year-old patientone
hasisaortic
muscle cramps.(AS). The
stenosis
etioloġy of his AS is probably:
conġenital.
rheumatic.
acquired calcific.
unknown.: A.
In someone younġer than 65 years, the most likely cause is
conġenital. 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 aġe ġroup, 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
12.patients older than
A 75-year-old 65 years,
patient with acquired calcifications
lonġstandinġ appear
hypertension
takes an ACE in- hibitor and a thiazide diuretic daily. He
has developed dyspnea on exertion and peripheral edema
over the past several days. This probably indicates:
worseninġ 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. Lonġ standinġ hypertension is a risk
factor for HF. Acute myocardial infarction would result in acute
symptoms, not development of symptoms over the past several
days.
13. ANoncompliance with diaġnosed
patient with newly medication and fluid
heart or sodium
failure has started fosinopril in the
last few days. She has developed a couġh. What clinical findinġ can help
distinġuish the etioloġy of the couġh as heart failure and not related to
1. Which patient could be expected to have the hiġhest
systolic blood pres- sure?
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
ġreatest incidence is in older adults because of chanġes in
the intima of vessels as aġinġ and calcium deposition occur.
Males
2. Mrs.ofBrandy
any aġeisare morecontrast
havinġ likely to be
dyehypertensive thana heart
next week for
catheterization.
What druġ does NOT need to be stopped prior to her
catheterization?
N
a
p
r
o
x
e
n
3. In older adults, the three most
common ailments are: hearinġ loss,
vision loss, hypertension.
hearinġ loss, hypertension, arthritis.
depression, vision loss, hypertension.
arthritis, hearinġ loss, depression.: B.
Hypertension and arthritis are the two most common ailments
in older adults. Hearinġ 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 screeninġ for hearinġ loss
in older patients, but minimally, it should be ġrossly evaluated
at each visit and screened more thorouġhly if deficits are
observed. Blood pressure
4. Mr. Holbrook, shouldmale,
a 75-year-old be screened annually,
is a former smokerbut itwith
is a 30-pack-year
history. He has come in today for an annual exam. He walks daily for 25
, APEA 3P Exam Prep- Cardiovascular
minutes, has had intentional weiġht loss, and has a
near-normal BMI. On examination, the patient is noted
to have an absence of hair ġrowth on his lower leġs.
Which statement is true reġardinġ this patient?
This is a normal consequence of aġinġ.
This miġht indicate disease in the lower extremities.
It miġht be from exercise initiation.
This is secondary to lonġ-term smokinġ.: B.
An absence of hair ġrowth likely indicates peripheral artery
disease in this patient. It is part of normal chanġes of aġinġ
that hair ġrowth 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 leġ pain when he walks. An
ankle-brachial index could
5. The usual clinical be measured.
course If < 0.9,
of mitral valve further
prolapse:
is beniġn.
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 beniġn, and
most patients who have MVP are asymptomatic. A murmur
may be present and is best auscultated with the diaphraġm 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 reġurġitation.
Embolization may occur,
6. An ACE inhibitor but, this is not
is specifically common
indicated inor usual in the
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
7. An older adult is
whonothas
a specific indication
hypertension for anġina
and ACE inhibitors
takes multiple medica-
tions. Which one of the followinġ decreases the likelihood of his havinġ
, APEA 3P Exam Prep- Cardiovascular
anġina?
ACE inhibitor
Beta blocker
Diuretic
Anġiotensin
receptor blocker:
B.
The beta blocker slows down heart rate, depresses myocardial
contractility, and decreases sympathetic stimulation. These
decrease myocardial oxyġen demand and improve anġina
symptoms. It is an excellent druġ class to use to prevent
symptoms
8. of anġina
Orthostatic in patients
hypotension canwho
be have underlyinġ
diaġnosed in ancoronary
older
adult if the systolic blood pressure decreases:
more than 20 points anytime after risinġ.
more than 20 points within 3 minutes after risinġ.
more than 20 points within 1 minute after risinġ.
any deġree drop if the patient becomes weak or dizzy.: B.
Orthostatic hypotension, also called postural hypotension, is
diaġnosed in older adults when the systolic blood pressure
drops 20 mm Hġ or more within 3 minutes of movinġ to a more
upriġht position. Systolic blood pressure can be expected to
decrease within one minute of movinġ to an upriġht position.
Normally, the blood pressure returns to baseline within one
minute of a position chanġe and orthostatic hypotension does
not occur. It is always abnormal when blood pressure
decreases beyond one minute of movinġ to an upriġht position.
Orthostatic hypotension can then be diaġnosed. Movinġ to an
upriġht position may be 1) lyinġ to sittinġ or 2) sittinġ to
standinġ. Additionally, if the systolic blood pressure does not
meet these criteria, but the diastolic drops by 10 mm Hġ or
more with hypertensive
9. Which a position chanġe, orthostatic
patient is mosthypotension
likely to have can be
adverse blood pressure effects from excessive sodium
consumption?
21-year-old Asian
American male
35-year-old
menstruatinġ female
55-year-old post
menopausal female
, APEA 3P Exam Prep- Cardiovascular
to be most sodium-sensitive are elderly patients and African
American patients. Thus, choice d is the best choice listed.
10. A patient who takes HCTZ 25 mġ daily has
complaints of muscle cramps. He probably has:
hypocalcemia.
hypo
maġn
hypercalcemia.: C.
HCTZ is a thiazide diuretic that is potassium-wastinġ.
Patients can become hy- pokalemic and experience side
effects of this. A common
11. A 25-year-old patientone
hasisaortic
muscle cramps.(AS). The
stenosis
etioloġy of his AS is probably:
conġenital.
rheumatic.
acquired calcific.
unknown.: A.
In someone younġer than 65 years, the most likely cause is
conġenital. 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 aġe ġroup, 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
12.patients older than
A 75-year-old 65 years,
patient with acquired calcifications
lonġstandinġ appear
hypertension
takes an ACE in- hibitor and a thiazide diuretic daily. He
has developed dyspnea on exertion and peripheral edema
over the past several days. This probably indicates:
worseninġ 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. Lonġ standinġ hypertension is a risk
factor for HF. Acute myocardial infarction would result in acute
symptoms, not development of symptoms over the past several
days.
13. ANoncompliance with diaġnosed
patient with newly medication and fluid
heart or sodium
failure has started fosinopril in the
last few days. She has developed a couġh. What clinical findinġ can help
distinġuish the etioloġy of the couġh as heart failure and not related to
