3P Exam Study APEA Questions &
Answers with Rationale 100% Correct
Grade A+
CARDIOVASCULAR
1. What would cause decreased Digoxin levels?
Correct Answer: Antacids
Rationale:
Antacids reduce the gastrointestinal absorption of digoxin, lowering serum drug concentrations
and decreasing therapeutic effectiveness. Patients should separate digoxin and antacids by at
least 2 hours.
Exam Tip: Low digoxin levels = think antacids, cholestyramine, and high-fiber supplements.
2. What are Janeway lesions and what do they indicate?
Correct Answer:
Irregular, non-tender hemorrhagic macules found on the palms and soles that indicate Infective
Endocarditis.
Rationale:
Janeway lesions occur from septic emboli lodging in the skin and are highly suggestive of
infective endocarditis.
Remember
• Non-tender
• Flat
• Palms & soles
• Septic emboli
3. What are Osler's Nodes and what do they indicate?
, Correct Answer:
Tender, erythematous nodules on the pads of the fingers or toes associated with Infective
Endocarditis.
Rationale:
Osler nodes result from immune complex deposition and inflammation.
Janeway Lesions Osler Nodes
Non-tender Tender
Septic emboli Immune complexes
Flat Raised
Palms/Soles Fingers/Toes
Memory Trick: O = Ouch = Osler (Painful)
4. What is the recommendation for Warfarin management when a patient misses a dose?
Correct Answer:
• Take the missed dose if remembered within 12 hours.
• If more than 12 hours have passed, skip the dose and obtain an INR as directed.
Rationale:
Doubling doses increases bleeding risk. INR monitoring ensures therapeutic anticoagulation.
5. What do we need to know about ACE inhibitors and ARBs?
Correct Answer:
• ACE inhibitors commonly cause a dry hacking cough.
• ACE inhibitors and ARBs are preferred in Diabetes, CKD, and Hypertension.
• May cause hyperkalemia, angioedema, and are contraindicated in pregnancy.
• ACE inhibitors are less effective as monotherapy in many Black patients.
, Rationale:
These medications reduce intraglomerular pressure and provide cardiovascular and renal
protection but require monitoring of renal function and potassium.
Exam Pearl: ACE inhibitor cough occurs because of bradykinin accumulation.
6. Contraindications for Hydrochlorothiazide
Correct Answer:
• Sulfonamide allergy
• History of gout
• Use caution in asthma and severe renal disease
Rationale:
Hydrochlorothiazide may increase uric acid levels, precipitating gout, and can cause electrolyte
abnormalities.
7. Benign Systolic Murmurs
Correct Answer:
• Mitral Regurgitation
• Physiologic (Flow) Murmur
• Aortic Stenosis
• Mitral Valve Prolapse
Rationale:
Mitral Regurgitation
• Holosystolic murmur
• Radiates to axilla
Aortic Stenosis
• Crescendo-decrescendo murmur
• Radiates to carotids
, • Symptoms:
o Angina
o Syncope
o Heart failure
Mitral Valve Prolapse
• Mid-systolic click
• Common in younger women
8. Diastolic Murmurs
Correct Answer:
• Aortic Regurgitation
• Mitral Stenosis
Rationale:
Diastolic murmurs are almost always pathologic and warrant further evaluation.
Exam Tip: Diastolic = Disease
9. What does S1 indicate?
Correct Answer:
Closure of the Mitral and Tricuspid valves.
Rationale:
Marks the beginning of ventricular systole.
10. What does S2 indicate?
Correct Answer:
Closure of the Aortic and Pulmonic valves.
Rationale:
Marks the end of systole and beginning of diastole.
Answers with Rationale 100% Correct
Grade A+
CARDIOVASCULAR
1. What would cause decreased Digoxin levels?
Correct Answer: Antacids
Rationale:
Antacids reduce the gastrointestinal absorption of digoxin, lowering serum drug concentrations
and decreasing therapeutic effectiveness. Patients should separate digoxin and antacids by at
least 2 hours.
Exam Tip: Low digoxin levels = think antacids, cholestyramine, and high-fiber supplements.
2. What are Janeway lesions and what do they indicate?
Correct Answer:
Irregular, non-tender hemorrhagic macules found on the palms and soles that indicate Infective
Endocarditis.
Rationale:
Janeway lesions occur from septic emboli lodging in the skin and are highly suggestive of
infective endocarditis.
Remember
• Non-tender
• Flat
• Palms & soles
• Septic emboli
3. What are Osler's Nodes and what do they indicate?
, Correct Answer:
Tender, erythematous nodules on the pads of the fingers or toes associated with Infective
Endocarditis.
Rationale:
Osler nodes result from immune complex deposition and inflammation.
Janeway Lesions Osler Nodes
Non-tender Tender
Septic emboli Immune complexes
Flat Raised
Palms/Soles Fingers/Toes
Memory Trick: O = Ouch = Osler (Painful)
4. What is the recommendation for Warfarin management when a patient misses a dose?
Correct Answer:
• Take the missed dose if remembered within 12 hours.
• If more than 12 hours have passed, skip the dose and obtain an INR as directed.
Rationale:
Doubling doses increases bleeding risk. INR monitoring ensures therapeutic anticoagulation.
5. What do we need to know about ACE inhibitors and ARBs?
Correct Answer:
• ACE inhibitors commonly cause a dry hacking cough.
• ACE inhibitors and ARBs are preferred in Diabetes, CKD, and Hypertension.
• May cause hyperkalemia, angioedema, and are contraindicated in pregnancy.
• ACE inhibitors are less effective as monotherapy in many Black patients.
, Rationale:
These medications reduce intraglomerular pressure and provide cardiovascular and renal
protection but require monitoring of renal function and potassium.
Exam Pearl: ACE inhibitor cough occurs because of bradykinin accumulation.
6. Contraindications for Hydrochlorothiazide
Correct Answer:
• Sulfonamide allergy
• History of gout
• Use caution in asthma and severe renal disease
Rationale:
Hydrochlorothiazide may increase uric acid levels, precipitating gout, and can cause electrolyte
abnormalities.
7. Benign Systolic Murmurs
Correct Answer:
• Mitral Regurgitation
• Physiologic (Flow) Murmur
• Aortic Stenosis
• Mitral Valve Prolapse
Rationale:
Mitral Regurgitation
• Holosystolic murmur
• Radiates to axilla
Aortic Stenosis
• Crescendo-decrescendo murmur
• Radiates to carotids
, • Symptoms:
o Angina
o Syncope
o Heart failure
Mitral Valve Prolapse
• Mid-systolic click
• Common in younger women
8. Diastolic Murmurs
Correct Answer:
• Aortic Regurgitation
• Mitral Stenosis
Rationale:
Diastolic murmurs are almost always pathologic and warrant further evaluation.
Exam Tip: Diastolic = Disease
9. What does S1 indicate?
Correct Answer:
Closure of the Mitral and Tricuspid valves.
Rationale:
Marks the beginning of ventricular systole.
10. What does S2 indicate?
Correct Answer:
Closure of the Aortic and Pulmonic valves.
Rationale:
Marks the end of systole and beginning of diastole.
