APEA 3P EXAM PREP CARDIOVASCULAR LATEST
QUESTIONS WITH CORRECT ANSWERS
1. Which patient could be expected to have the highest 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 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.
2. 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 catheter-
ization. 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.
3. 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.
4. 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
, APEA 3P EXAM PREP- CARDIOVASCULAR
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.
5. 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.
6. 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.
7. An older adult who has hypertension and angina takes multiple medica-
tions. Which one of the following decreases the likelihood of his having
, APEA 3P EXAM PREP- CARDIOVASCULAR
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.
8. 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.
9. 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
QUESTIONS WITH CORRECT ANSWERS
1. Which patient could be expected to have the highest 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 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.
2. 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 catheter-
ization. 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.
3. 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.
4. 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
, APEA 3P EXAM PREP- CARDIOVASCULAR
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.
5. 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.
6. 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.
7. An older adult who has hypertension and angina takes multiple medica-
tions. Which one of the following decreases the likelihood of his having
, APEA 3P EXAM PREP- CARDIOVASCULAR
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.
8. 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.
9. 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
