MSN 622 Final Exam () Questions and
Verified Answers, 100% Guarantee Pass
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)? - CORRECT
ANSWER -Troponin I
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? - CORRECT
ANSWER -Coronary artery calcium scoring
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? - CORRECT ANSWER -Coronary artery bypass graft (CABG)
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? - CORRECT ANSWER -
Defer surgery for at least 2 months.
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? - CORRECT ANSWER -Lifestyle modification
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? - CORRECT ANSWER -Smoking cessation
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? - CORRECT ANSWER -Start patient on aspirin or
clopidogrel
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 - CORRECT
ANSWER -The ratio of systolic ankle blood pressure to systolic brachial blood pressure
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? - CORRECT ANSWER -Repeat ankle-brachial index
after exercise
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? - CORRECT ANSWER -Deep, symmetric T-wave
inversions in V2 and V3 accompanied by flat ST-segment
What heart sound would one hear in a patient with systolic congestive heart failure (CHF)? -
CORRECT ANSWER -S3 heart sound
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? - CORRECT
ANSWER -.
A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? - CORRECT
ANSWER -Cerebrovascular accident
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? - CORRECT
ANSWER -.
Pulmonary artery
Verified Answers, 100% Guarantee Pass
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)? - CORRECT
ANSWER -Troponin I
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? - CORRECT
ANSWER -Coronary artery calcium scoring
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? - CORRECT ANSWER -Coronary artery bypass graft (CABG)
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? - CORRECT ANSWER -
Defer surgery for at least 2 months.
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? - CORRECT ANSWER -Lifestyle modification
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? - CORRECT ANSWER -Smoking cessation
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? - CORRECT ANSWER -Start patient on aspirin or
clopidogrel
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 - CORRECT
ANSWER -The ratio of systolic ankle blood pressure to systolic brachial blood pressure
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? - CORRECT ANSWER -Repeat ankle-brachial index
after exercise
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? - CORRECT ANSWER -Deep, symmetric T-wave
inversions in V2 and V3 accompanied by flat ST-segment
What heart sound would one hear in a patient with systolic congestive heart failure (CHF)? -
CORRECT ANSWER -S3 heart sound
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? - CORRECT
ANSWER -.
A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? - CORRECT
ANSWER -Cerebrovascular accident
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? - CORRECT
ANSWER -.
Pulmonary artery
