MSN 622 final UPDATED Exam Questions
and CORRECT Answers
Troponin I - CORRECT ANSWER - A 65-year-old woman presents with intermittent,
sudden-onset chest pain and shortness of breath, which radiates to her left jaw and arm. A history
of present illness reveals that the pain initially occurred with activity, but now it occurs
throughout the day. A review of systems is positive for tiring easily with mild physical activity.
Her medical history is significant for hypertension and type 2 diabetes mellitus. An
electrocardiogram (ECG) and cardiac enzyme markers are ordered. Which of the following tests
will be most helpful in differentiating unstable angina from a non-ST segment elevation
myocardial infarction (NSTEMI)?
Coronary artery calcium scoring - CORRECT ANSWER - A 55-year-old asymptomatic,
female smoker, with an extensive family history of premature coronary artery disease, presents
to the office for further cardiovascular risk stratification. Her 10-year ASCVD risk score by the
pool cohort equation is 5.3%, and she is concerned about testing for further risk stratification as
she is reluctant to take medications. Which of the following is most appropriate to order to assist
in treatment decision making?
Coronary artery bypass graft (CABG) - CORRECT ANSWER - A 51-year-old female
patient presents with a chief complaint to shortness of breath, which is present only on exertion.
She is a cashier in a local bank. Her history includes type 1 diabetes mellitus and hypertension.
She is an active smoker for fifteen years and smokes one pack per day. Her BMI is 32.2. Her
current medications include insulin, empagliflozin, and lisinopril. An EKG is obtained in the
office, which shows normal sinus rhythm with heart rate 77/min. Evidence of left ventricular
hypertrophy is also present on the EKG. An exercise stress test is scheduled, and the patient gets
chest pain on the treadmill soon after it is started. Her echo shows a left ventricular ejection
fraction of 30%. Cardiac catheterization is performed, which shows 3-vessel coronary artery
disease. Which of the following is the best strategy for this patient's mechanical heart disease?
Defer surgery for at least 2 months. - CORRECT ANSWER - A 65-year-old man presents
for preoperative evaluation. He plans to undergo bilateral total knee replacement for
osteoarthritis, which has markedly limited his mobility. All conservative measures for
osteoarthritis treatment have failed. He has medical history significant for hypertension,
hyperlipidemia, and smoking. He received one drug-eluting stent to the left anterior descending
artery four months ago for stable ischemic heart disease. Which of the following is the best step
regarding this patient's clearance for surgery?
,Lifestyle modification - CORRECT ANSWER - What is the most appropriate initial
intervention for an older male who complains of leg pain with walking and at night who has
weak pulses in both lower extremities and a reduced ankle-brachial index?
Smoking cessation - CORRECT ANSWER - A 74-year-old woman smoker with
hypertension was found to have weak right lower extremity pulses with a right ankle-brachial
index (ABI) of 0.75. She denies any pain with walking. What is the most appropriate treatment?
Start patient on aspirin or clopidogrel - CORRECT ANSWER - A 65-year-old man who is
a heavy smoker presents with a complaint of pain in both legs when he walks. He claims he can
only walk half a block over the past few years without pain. He has been a smoker for 35 years
and also drinks alcohol. He does not have a history of hypertension or heart disease. The ankle-
brachial index in both legs is 0.70. What should be done to lower this patient's myocardial
infarction risk?
The ratio of systolic ankle blood pressure to systolic brachial blood pressure - CORRECT
ANSWER - A 65-year-old woman presents to the clinic for a 1-year follow-up and
medication management. Her medical history is significant for congestive heart failure,
hypertension, hyperlipidemia, diabetes mellitus type 2, and chronic obstructive pulmonary
disease (COPD). She has smoked 2 packs of cigarettes for 45 years. She drinks alcohol socially.
Her current medications include lisinopril, hydrochlorothiazide, atorvastatin, metformin,
albuterol, and inhaled fluticasone. Per the patient, she feels fine other than "some mild tingling in
my feet." She denies chest pain, dyspnea, palpitations, dizziness, and weakness. She has not had
laboratory work done in over 1 year. Her vital signs are temperature 37 °C (98.6 °F), heart rate
77 bpm, respiratory rate 16 breaths/min, and blood pressure 155/89 mm Hg. A physical exam is
significant for absent bilateral pedal and posterior tibial artery pulses, significant edema, and
brownish discoloration of her lower extremities and ankles bilaterally. Which of the following
would be the most appropriate initial step in the diagnosis of this patient's disease?
Repeat ankle-brachial index after exercise - CORRECT ANSWER - A 65-year-old woman
with claudication symptoms for the last six months presents to the clinic for evaluation. The
patient has a history of diabetes and hypertension. She denies smoking. Physical exam shows
palpable pulses on the bilateral lower extremities. Ankle-brachial index done at bedside shows a
1.1 on the right and 1.0 on the left lower extremity. What is the next best step in the management
of this patient?
, Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment -
CORRECT ANSWER - A 65-year-old female patient presents with complaints of
progressive dyspnea on exertion for the past two weeks. The patient has a past medical history of
hypertension. She has a 25-year smoking history but quit smoking 4 years ago. The patient
reveals further that she initially had dyspnea only on moderate exertion, but now it occurs with
activities like showering. The patient denies chest pain, cough, or wheezing. Her medications
include metformin, amlodipine, and simvastatin. The patient appears comfortable at rest.
Currently, she is afebrile and hemodynamically stable. Physical examination reveals bibasilar
crackles. The patient's troponin-T level is normal. What changes are more likely to be seen on an
electrocardiogram (ECG) if this patient is a suspected case of unstable angina?
S3 heart sound - CORRECT ANSWER - What heart sound would one hear in a patient
with systolic congestive heart failure (CHF)?
.
A S3 gallop - CORRECT ANSWER - A 72-year-old man with a recent history of a large
anterior wall myocardial infarction complains of dyspnea on exertion, orthopnea, and increasing
pedal edema. There is concern about congestive heart failure. Which of the following would
support the diagnosis?
Cerebrovascular accident - CORRECT ANSWER - Which of the following may be the
initial presentation of long-term hypertension?
.
Pulmonary artery - CORRECT ANSWER - A patient presents with shortness of breath.
Rales are heard in the lower lung fields. There is an S4. Hepatojugular reflux is present. The
chest x-ray shows cardiomegaly and enlargement of the mediastinal veins. Congestive heart
failure is suspected. Reduced bloodflow in the ascending aorta would not cause decreased blood
flow in which of the following arteries?
To dilate the venous system and decrease cardiac preload. - CORRECT ANSWER - A 65-
year-old man presents with a 4-hour history of progressively worsening left chest pain that
radiates to his left neck. A history of present illness reveals minor episodes of transient chest
pain over the last 6 months after climbing 2 flights of stairs or running. His past medical history
includes hypertension, type 2 diabetes mellitus, and hyperlipidemia. His vital signs are oxygen
saturation 98% on room air, respiratory rate 18 breaths/min, heart rate 91 bpm, blood pressure
and CORRECT Answers
Troponin I - CORRECT ANSWER - A 65-year-old woman presents with intermittent,
sudden-onset chest pain and shortness of breath, which radiates to her left jaw and arm. A history
of present illness reveals that the pain initially occurred with activity, but now it occurs
throughout the day. A review of systems is positive for tiring easily with mild physical activity.
Her medical history is significant for hypertension and type 2 diabetes mellitus. An
electrocardiogram (ECG) and cardiac enzyme markers are ordered. Which of the following tests
will be most helpful in differentiating unstable angina from a non-ST segment elevation
myocardial infarction (NSTEMI)?
Coronary artery calcium scoring - CORRECT ANSWER - A 55-year-old asymptomatic,
female smoker, with an extensive family history of premature coronary artery disease, presents
to the office for further cardiovascular risk stratification. Her 10-year ASCVD risk score by the
pool cohort equation is 5.3%, and she is concerned about testing for further risk stratification as
she is reluctant to take medications. Which of the following is most appropriate to order to assist
in treatment decision making?
Coronary artery bypass graft (CABG) - CORRECT ANSWER - A 51-year-old female
patient presents with a chief complaint to shortness of breath, which is present only on exertion.
She is a cashier in a local bank. Her history includes type 1 diabetes mellitus and hypertension.
She is an active smoker for fifteen years and smokes one pack per day. Her BMI is 32.2. Her
current medications include insulin, empagliflozin, and lisinopril. An EKG is obtained in the
office, which shows normal sinus rhythm with heart rate 77/min. Evidence of left ventricular
hypertrophy is also present on the EKG. An exercise stress test is scheduled, and the patient gets
chest pain on the treadmill soon after it is started. Her echo shows a left ventricular ejection
fraction of 30%. Cardiac catheterization is performed, which shows 3-vessel coronary artery
disease. Which of the following is the best strategy for this patient's mechanical heart disease?
Defer surgery for at least 2 months. - CORRECT ANSWER - A 65-year-old man presents
for preoperative evaluation. He plans to undergo bilateral total knee replacement for
osteoarthritis, which has markedly limited his mobility. All conservative measures for
osteoarthritis treatment have failed. He has medical history significant for hypertension,
hyperlipidemia, and smoking. He received one drug-eluting stent to the left anterior descending
artery four months ago for stable ischemic heart disease. Which of the following is the best step
regarding this patient's clearance for surgery?
,Lifestyle modification - CORRECT ANSWER - What is the most appropriate initial
intervention for an older male who complains of leg pain with walking and at night who has
weak pulses in both lower extremities and a reduced ankle-brachial index?
Smoking cessation - CORRECT ANSWER - A 74-year-old woman smoker with
hypertension was found to have weak right lower extremity pulses with a right ankle-brachial
index (ABI) of 0.75. She denies any pain with walking. What is the most appropriate treatment?
Start patient on aspirin or clopidogrel - CORRECT ANSWER - A 65-year-old man who is
a heavy smoker presents with a complaint of pain in both legs when he walks. He claims he can
only walk half a block over the past few years without pain. He has been a smoker for 35 years
and also drinks alcohol. He does not have a history of hypertension or heart disease. The ankle-
brachial index in both legs is 0.70. What should be done to lower this patient's myocardial
infarction risk?
The ratio of systolic ankle blood pressure to systolic brachial blood pressure - CORRECT
ANSWER - A 65-year-old woman presents to the clinic for a 1-year follow-up and
medication management. Her medical history is significant for congestive heart failure,
hypertension, hyperlipidemia, diabetes mellitus type 2, and chronic obstructive pulmonary
disease (COPD). She has smoked 2 packs of cigarettes for 45 years. She drinks alcohol socially.
Her current medications include lisinopril, hydrochlorothiazide, atorvastatin, metformin,
albuterol, and inhaled fluticasone. Per the patient, she feels fine other than "some mild tingling in
my feet." She denies chest pain, dyspnea, palpitations, dizziness, and weakness. She has not had
laboratory work done in over 1 year. Her vital signs are temperature 37 °C (98.6 °F), heart rate
77 bpm, respiratory rate 16 breaths/min, and blood pressure 155/89 mm Hg. A physical exam is
significant for absent bilateral pedal and posterior tibial artery pulses, significant edema, and
brownish discoloration of her lower extremities and ankles bilaterally. Which of the following
would be the most appropriate initial step in the diagnosis of this patient's disease?
Repeat ankle-brachial index after exercise - CORRECT ANSWER - A 65-year-old woman
with claudication symptoms for the last six months presents to the clinic for evaluation. The
patient has a history of diabetes and hypertension. She denies smoking. Physical exam shows
palpable pulses on the bilateral lower extremities. Ankle-brachial index done at bedside shows a
1.1 on the right and 1.0 on the left lower extremity. What is the next best step in the management
of this patient?
, Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment -
CORRECT ANSWER - A 65-year-old female patient presents with complaints of
progressive dyspnea on exertion for the past two weeks. The patient has a past medical history of
hypertension. She has a 25-year smoking history but quit smoking 4 years ago. The patient
reveals further that she initially had dyspnea only on moderate exertion, but now it occurs with
activities like showering. The patient denies chest pain, cough, or wheezing. Her medications
include metformin, amlodipine, and simvastatin. The patient appears comfortable at rest.
Currently, she is afebrile and hemodynamically stable. Physical examination reveals bibasilar
crackles. The patient's troponin-T level is normal. What changes are more likely to be seen on an
electrocardiogram (ECG) if this patient is a suspected case of unstable angina?
S3 heart sound - CORRECT ANSWER - What heart sound would one hear in a patient
with systolic congestive heart failure (CHF)?
.
A S3 gallop - CORRECT ANSWER - A 72-year-old man with a recent history of a large
anterior wall myocardial infarction complains of dyspnea on exertion, orthopnea, and increasing
pedal edema. There is concern about congestive heart failure. Which of the following would
support the diagnosis?
Cerebrovascular accident - CORRECT ANSWER - Which of the following may be the
initial presentation of long-term hypertension?
.
Pulmonary artery - CORRECT ANSWER - A patient presents with shortness of breath.
Rales are heard in the lower lung fields. There is an S4. Hepatojugular reflux is present. The
chest x-ray shows cardiomegaly and enlargement of the mediastinal veins. Congestive heart
failure is suspected. Reduced bloodflow in the ascending aorta would not cause decreased blood
flow in which of the following arteries?
To dilate the venous system and decrease cardiac preload. - CORRECT ANSWER - A 65-
year-old man presents with a 4-hour history of progressively worsening left chest pain that
radiates to his left neck. A history of present illness reveals minor episodes of transient chest
pain over the last 6 months after climbing 2 flights of stairs or running. His past medical history
includes hypertension, type 2 diabetes mellitus, and hyperlipidemia. His vital signs are oxygen
saturation 98% on room air, respiratory rate 18 breaths/min, heart rate 91 bpm, blood pressure
