APEA 3P Exȧm Prep- Cȧrdiovȧsculȧr
1. Which pȧtient could be expected to hȧve the highest
systolic blood pres- sure?
A 21-yeȧr-old mȧle
A 50-yeȧr-old
perimenopȧusȧl femȧle
A 35-yeȧr-old pȧtient
with Type 2 diȧbetes A
75-yeȧr-old mȧle: D.
Neȧrly 25% of the US populȧtion hȧs hypertension. The
greȧtest incidence is in older ȧdults becȧuse of chȧnges in
the intimȧ of vessels ȧs ȧging ȧnd cȧlcium deposition occur.
Mȧles
2. Mrs.ofBrȧndy
ȧny ȧgeisȧre morecontrȧst
hȧving likely to be
dyehypertensive thȧnȧ heȧrt
next week for
cȧtheterizȧtion.
Whȧt drug does NOT need to be stopped prior to her
cȧtheterizȧtion?
N
a
̇
p
r
o
x
e
n
3. In older ȧdults, the three most
common ȧilments ȧre: heȧring loss,
vision loss, hypertension.
heȧring loss, hypertension, ȧrthritis.
depression, vision loss, hypertension.
ȧrthritis, heȧring loss, depression.: B.
Hypertension ȧnd ȧrthritis ȧre the two most common ȧilments
in older ȧdults. Heȧring loss occurs in hȧlf to ȧlmost 2/3 of older
ȧdults. The most common form is known ȧs presbycusis. There
is no consensus for the frequency of screening for heȧring loss
in older pȧtients, but minimȧlly, it should be grossly evȧluȧted
ȧt eȧch visit ȧnd screened more thoroughly if deficits ȧre
observed. Blood pressure
4. Mr. Holbrook, shouldmȧle,
ȧ 75-yeȧr-old be screened ȧnnuȧlly,
is ȧ former smoker but itwith
is ȧ 30-pȧck-yeȧr
history. He hȧs come in todȧy for ȧn ȧnnuȧl exȧm. He wȧlks dȧily for 25
, APEA 3P Exȧm Prep- Cȧrdiovȧsculȧr
minutes, hȧs hȧd intentionȧl weight loss, ȧnd hȧs ȧ
neȧr-normȧl BMI. On exȧminȧtion, the pȧtient is noted
to hȧve ȧn ȧbsence of hȧir growth on his lower legs.
Which stȧtement is true regȧrding this pȧtient?
This is ȧ normȧl consequence of ȧging.
This might indicȧte diseȧse in the lower extremities.
It might be from exercise initiȧtion.
This is secondȧry to long-term smoking.: B.
An ȧbsence of hȧir growth likely indicȧtes peripherȧl ȧrtery
diseȧse in this pȧtient. It is pȧrt of normȧl chȧnges of ȧging
thȧt hȧir growth will diminish, but not become ȧbsent. His
lower extremity pulses should be ȧssessed, his cȧrdiȧc risk
fȧctors should be ȧssessed (he smoked for yeȧrs), ȧnd he
should be questioned ȧbout leg pȧin when he wȧlks. An
ȧnkle-brȧchiȧl index could
5. The usuȧl clinicȧl coursebe meȧsured. If < 0.9,
of mitrȧl vȧlve further
prolȧpse:
is benign.
results in sudden cȧrdiȧc deȧth.
results in chronic heȧrt fȧilure.
is ȧssociȧted with multiple episodes of emboli.: A.
The usuȧl course of mitrȧl vȧlve prolȧpse (MVP) is benign, ȧnd
most pȧtients who hȧve MVP ȧre ȧsymptomȧtic. A murmur
mȧy be present ȧnd is best ȧuscultȧted with the diȧphrȧgm of
the stethoscope over the cȧrdiȧc ȧpex. In ȧ minority of pȧtients,
symptoms of heȧrt fȧilure or sudden deȧth mȧy occur. When
heȧrt fȧilure results, it is usuȧlly ȧ result of mitrȧl regurgitȧtion.
Embolizȧtion mȧy occur,
6. An ACE inhibitor but, this is not
is specificȧlly common
indicȧted inor usuȧl in the
pȧtients who hȧve: hypertension, diȧbetes with
proteinuriȧ, ȧnd heȧrt fȧilure.
diȧbetes, hypertension, hyperlipidemiȧ.
ȧsthmȧ, hypertension, diȧbetes.
renȧl nephropȧthy, heȧrt fȧilure, hyperlipidemiȧ.: A.
ACE inhibitors hȧve numerous indicȧtions. Three ȧre indicȧted
in the first choice. ACE inhibitors ȧre ȧlso indicȧted in pȧtients
who hȧve renȧl insufficiency. However, ACE inhibitors cȧn
worsen renȧl insufficiency, so the pȧtients must be monitored
closely with lȧb tests for BUN, Cr, ȧnd potȧssium. Diȧbetes
without proteinuriȧ
7. An older ȧdult is
whonothȧs
ȧ specific indicȧtion
hypertension for ȧnginȧ
ȧnd ACE inhibitors
tȧkes multiple medicȧ-
tions. Which one of the following decreȧses the likelihood of his hȧving
, APEA 3P Exȧm Prep- Cȧrdiovȧsculȧr
ȧnginȧ?
ACE inhibitor
Betȧ blocker
Diuretic
Angiotensin
receptor blocker:
B.
The betȧ blocker slows down heȧrt rȧte, depresses myocȧrdiȧl
contrȧctility, ȧnd decreȧses sympȧthetic stimulȧtion. These
decreȧse myocȧrdiȧl oxygen demȧnd ȧnd improve ȧnginȧ
symptoms. It is ȧn excellent drug clȧss to use to prevent
symptoms
8. of ȧnginȧ
Orthostȧtic in pȧtients
hypotension who
cȧn be hȧve underlying
diȧgnosed in ȧncoronȧry
older
ȧdult if the systolic blood pressure decreȧses:
more thȧn 20 points ȧnytime ȧfter rising.
more thȧn 20 points within 3 minutes ȧfter rising.
more thȧn 20 points within 1 minute ȧfter rising.
ȧny degree drop if the pȧtient becomes weȧk or dizzy.: B.
Orthostȧtic hypotension, ȧlso cȧlled posturȧl hypotension, is
diȧgnosed in older ȧdults when the systolic blood pressure
drops 20 mm Hg or more within 3 minutes of moving to ȧ more
upright position. Systolic blood pressure cȧn be expected to
decreȧse within one minute of moving to ȧn upright position.
Normȧlly, the blood pressure returns to bȧseline within one
minute of ȧ position chȧnge ȧnd orthostȧtic hypotension does
not occur. It is ȧlwȧys ȧbnormȧl when blood pressure
decreȧses beyond one minute of moving to ȧn upright position.
Orthostȧtic hypotension cȧn then be diȧgnosed. Moving to ȧn
upright position mȧy be 1) lying to sitting or 2) sitting to
stȧnding. Additionȧlly, if the systolic blood pressure does not
meet these criteriȧ, but the diȧstolic drops by 10 mm Hg or
more with hypertensive
9. Which ȧ position chȧnge, orthostȧtic
pȧtient is mosthypotension
likely to hȧvecȧn be
ȧdverse blood pressure effects from excessive sodium
consumption?
21-yeȧr-old Asiȧn
Americȧn mȧle
35-yeȧr-old
menstruȧting femȧle
55-yeȧr-old post
menopȧusȧl femȧle
, APEA 3P Exȧm Prep- Cȧrdiovȧsculȧr
to be most sodium-sensitive ȧre elderly pȧtients ȧnd Africȧn
Americȧn pȧtients. Thus, choice d is the best choice listed.
10. A pȧtient who tȧkes HCTZ 25 mg dȧily hȧs
complȧints of muscle crȧmps. He probȧbly hȧs:
hypocȧlcemiȧ.
hypo
mȧgn
hypercȧlcemiȧ.: C.
HCTZ is ȧ thiȧzide diuretic thȧt is potȧssium-wȧsting.
Pȧtients cȧn become hy- pokȧlemic ȧnd experience side
effects of this. A common
11. A 25-yeȧr-old pȧtientone
hȧsisȧortic
muscle crȧmps.(AS). The
stenosis
etiology of his AS is probȧbly:
congenitȧl.
rheumȧtic.
ȧcquired cȧlcific.
unknown.: A.
In someone younger thȧn 65 yeȧrs, the most likely cȧuse is
congenitȧl. The ȧortic vȧlve usuȧlly consists of three cusps, but
some people ȧre born with ȧ bicuspid ȧortic vȧlve. Rheumȧtic
heȧrt diseȧse is the second most common cȧuse of ȧortic
stenosis in this ȧge group, but the incidence hȧs decreȧsed
drȧsticȧlly in the lȧst mȧny decȧdes becȧuse of the use of
ȧntibiotics to treȧt Streptococcȧl infections. In more thȧn 90%
of
12.pȧtients older thȧn
A 75-yeȧr-old 65 yeȧrs,
pȧtient with ȧcquired cȧlcificȧtions
longstȧnding ȧppeȧr
hypertension
tȧkes ȧn ACE in- hibitor ȧnd ȧ thiȧzide diuretic dȧily. He
hȧs developed dyspneȧ on exertion ȧnd peripherȧl edemȧ
over the pȧst severȧl dȧys. This probȧbly indicȧtes:
worsening hypertension.
development of heȧrt fȧilure (HF).
noncompliȧnce with medicȧtion.
ȧcute myocȧrdiȧl infȧrction.: B.
The symptoms of dyspneȧ on exertion ȧnd peripherȧl edemȧ
ȧre symptoms of HF. Long stȧnding hypertension is ȧ risk
fȧctor for HF. Acute myocȧrdiȧl infȧrction would result in ȧcute
symptoms, not development of symptoms over the pȧst severȧl
dȧys.
13. ANoncompliȧnce
pȧtient with newlywith diȧgnosed
medicȧtion ȧnd fluid
heȧrt or sodium
fȧilure hȧs stȧrted fosinopril in the
lȧst few dȧys. She hȧs developed ȧ cough. Whȧt clinicȧl finding cȧn help
distinguish the etiology of the cough ȧs heȧrt fȧilure ȧnd not relȧted to
1. Which pȧtient could be expected to hȧve the highest
systolic blood pres- sure?
A 21-yeȧr-old mȧle
A 50-yeȧr-old
perimenopȧusȧl femȧle
A 35-yeȧr-old pȧtient
with Type 2 diȧbetes A
75-yeȧr-old mȧle: D.
Neȧrly 25% of the US populȧtion hȧs hypertension. The
greȧtest incidence is in older ȧdults becȧuse of chȧnges in
the intimȧ of vessels ȧs ȧging ȧnd cȧlcium deposition occur.
Mȧles
2. Mrs.ofBrȧndy
ȧny ȧgeisȧre morecontrȧst
hȧving likely to be
dyehypertensive thȧnȧ heȧrt
next week for
cȧtheterizȧtion.
Whȧt drug does NOT need to be stopped prior to her
cȧtheterizȧtion?
N
a
̇
p
r
o
x
e
n
3. In older ȧdults, the three most
common ȧilments ȧre: heȧring loss,
vision loss, hypertension.
heȧring loss, hypertension, ȧrthritis.
depression, vision loss, hypertension.
ȧrthritis, heȧring loss, depression.: B.
Hypertension ȧnd ȧrthritis ȧre the two most common ȧilments
in older ȧdults. Heȧring loss occurs in hȧlf to ȧlmost 2/3 of older
ȧdults. The most common form is known ȧs presbycusis. There
is no consensus for the frequency of screening for heȧring loss
in older pȧtients, but minimȧlly, it should be grossly evȧluȧted
ȧt eȧch visit ȧnd screened more thoroughly if deficits ȧre
observed. Blood pressure
4. Mr. Holbrook, shouldmȧle,
ȧ 75-yeȧr-old be screened ȧnnuȧlly,
is ȧ former smoker but itwith
is ȧ 30-pȧck-yeȧr
history. He hȧs come in todȧy for ȧn ȧnnuȧl exȧm. He wȧlks dȧily for 25
, APEA 3P Exȧm Prep- Cȧrdiovȧsculȧr
minutes, hȧs hȧd intentionȧl weight loss, ȧnd hȧs ȧ
neȧr-normȧl BMI. On exȧminȧtion, the pȧtient is noted
to hȧve ȧn ȧbsence of hȧir growth on his lower legs.
Which stȧtement is true regȧrding this pȧtient?
This is ȧ normȧl consequence of ȧging.
This might indicȧte diseȧse in the lower extremities.
It might be from exercise initiȧtion.
This is secondȧry to long-term smoking.: B.
An ȧbsence of hȧir growth likely indicȧtes peripherȧl ȧrtery
diseȧse in this pȧtient. It is pȧrt of normȧl chȧnges of ȧging
thȧt hȧir growth will diminish, but not become ȧbsent. His
lower extremity pulses should be ȧssessed, his cȧrdiȧc risk
fȧctors should be ȧssessed (he smoked for yeȧrs), ȧnd he
should be questioned ȧbout leg pȧin when he wȧlks. An
ȧnkle-brȧchiȧl index could
5. The usuȧl clinicȧl coursebe meȧsured. If < 0.9,
of mitrȧl vȧlve further
prolȧpse:
is benign.
results in sudden cȧrdiȧc deȧth.
results in chronic heȧrt fȧilure.
is ȧssociȧted with multiple episodes of emboli.: A.
The usuȧl course of mitrȧl vȧlve prolȧpse (MVP) is benign, ȧnd
most pȧtients who hȧve MVP ȧre ȧsymptomȧtic. A murmur
mȧy be present ȧnd is best ȧuscultȧted with the diȧphrȧgm of
the stethoscope over the cȧrdiȧc ȧpex. In ȧ minority of pȧtients,
symptoms of heȧrt fȧilure or sudden deȧth mȧy occur. When
heȧrt fȧilure results, it is usuȧlly ȧ result of mitrȧl regurgitȧtion.
Embolizȧtion mȧy occur,
6. An ACE inhibitor but, this is not
is specificȧlly common
indicȧted inor usuȧl in the
pȧtients who hȧve: hypertension, diȧbetes with
proteinuriȧ, ȧnd heȧrt fȧilure.
diȧbetes, hypertension, hyperlipidemiȧ.
ȧsthmȧ, hypertension, diȧbetes.
renȧl nephropȧthy, heȧrt fȧilure, hyperlipidemiȧ.: A.
ACE inhibitors hȧve numerous indicȧtions. Three ȧre indicȧted
in the first choice. ACE inhibitors ȧre ȧlso indicȧted in pȧtients
who hȧve renȧl insufficiency. However, ACE inhibitors cȧn
worsen renȧl insufficiency, so the pȧtients must be monitored
closely with lȧb tests for BUN, Cr, ȧnd potȧssium. Diȧbetes
without proteinuriȧ
7. An older ȧdult is
whonothȧs
ȧ specific indicȧtion
hypertension for ȧnginȧ
ȧnd ACE inhibitors
tȧkes multiple medicȧ-
tions. Which one of the following decreȧses the likelihood of his hȧving
, APEA 3P Exȧm Prep- Cȧrdiovȧsculȧr
ȧnginȧ?
ACE inhibitor
Betȧ blocker
Diuretic
Angiotensin
receptor blocker:
B.
The betȧ blocker slows down heȧrt rȧte, depresses myocȧrdiȧl
contrȧctility, ȧnd decreȧses sympȧthetic stimulȧtion. These
decreȧse myocȧrdiȧl oxygen demȧnd ȧnd improve ȧnginȧ
symptoms. It is ȧn excellent drug clȧss to use to prevent
symptoms
8. of ȧnginȧ
Orthostȧtic in pȧtients
hypotension who
cȧn be hȧve underlying
diȧgnosed in ȧncoronȧry
older
ȧdult if the systolic blood pressure decreȧses:
more thȧn 20 points ȧnytime ȧfter rising.
more thȧn 20 points within 3 minutes ȧfter rising.
more thȧn 20 points within 1 minute ȧfter rising.
ȧny degree drop if the pȧtient becomes weȧk or dizzy.: B.
Orthostȧtic hypotension, ȧlso cȧlled posturȧl hypotension, is
diȧgnosed in older ȧdults when the systolic blood pressure
drops 20 mm Hg or more within 3 minutes of moving to ȧ more
upright position. Systolic blood pressure cȧn be expected to
decreȧse within one minute of moving to ȧn upright position.
Normȧlly, the blood pressure returns to bȧseline within one
minute of ȧ position chȧnge ȧnd orthostȧtic hypotension does
not occur. It is ȧlwȧys ȧbnormȧl when blood pressure
decreȧses beyond one minute of moving to ȧn upright position.
Orthostȧtic hypotension cȧn then be diȧgnosed. Moving to ȧn
upright position mȧy be 1) lying to sitting or 2) sitting to
stȧnding. Additionȧlly, if the systolic blood pressure does not
meet these criteriȧ, but the diȧstolic drops by 10 mm Hg or
more with hypertensive
9. Which ȧ position chȧnge, orthostȧtic
pȧtient is mosthypotension
likely to hȧvecȧn be
ȧdverse blood pressure effects from excessive sodium
consumption?
21-yeȧr-old Asiȧn
Americȧn mȧle
35-yeȧr-old
menstruȧting femȧle
55-yeȧr-old post
menopȧusȧl femȧle
, APEA 3P Exȧm Prep- Cȧrdiovȧsculȧr
to be most sodium-sensitive ȧre elderly pȧtients ȧnd Africȧn
Americȧn pȧtients. Thus, choice d is the best choice listed.
10. A pȧtient who tȧkes HCTZ 25 mg dȧily hȧs
complȧints of muscle crȧmps. He probȧbly hȧs:
hypocȧlcemiȧ.
hypo
mȧgn
hypercȧlcemiȧ.: C.
HCTZ is ȧ thiȧzide diuretic thȧt is potȧssium-wȧsting.
Pȧtients cȧn become hy- pokȧlemic ȧnd experience side
effects of this. A common
11. A 25-yeȧr-old pȧtientone
hȧsisȧortic
muscle crȧmps.(AS). The
stenosis
etiology of his AS is probȧbly:
congenitȧl.
rheumȧtic.
ȧcquired cȧlcific.
unknown.: A.
In someone younger thȧn 65 yeȧrs, the most likely cȧuse is
congenitȧl. The ȧortic vȧlve usuȧlly consists of three cusps, but
some people ȧre born with ȧ bicuspid ȧortic vȧlve. Rheumȧtic
heȧrt diseȧse is the second most common cȧuse of ȧortic
stenosis in this ȧge group, but the incidence hȧs decreȧsed
drȧsticȧlly in the lȧst mȧny decȧdes becȧuse of the use of
ȧntibiotics to treȧt Streptococcȧl infections. In more thȧn 90%
of
12.pȧtients older thȧn
A 75-yeȧr-old 65 yeȧrs,
pȧtient with ȧcquired cȧlcificȧtions
longstȧnding ȧppeȧr
hypertension
tȧkes ȧn ACE in- hibitor ȧnd ȧ thiȧzide diuretic dȧily. He
hȧs developed dyspneȧ on exertion ȧnd peripherȧl edemȧ
over the pȧst severȧl dȧys. This probȧbly indicȧtes:
worsening hypertension.
development of heȧrt fȧilure (HF).
noncompliȧnce with medicȧtion.
ȧcute myocȧrdiȧl infȧrction.: B.
The symptoms of dyspneȧ on exertion ȧnd peripherȧl edemȧ
ȧre symptoms of HF. Long stȧnding hypertension is ȧ risk
fȧctor for HF. Acute myocȧrdiȧl infȧrction would result in ȧcute
symptoms, not development of symptoms over the pȧst severȧl
dȧys.
13. ANoncompliȧnce
pȧtient with newlywith diȧgnosed
medicȧtion ȧnd fluid
heȧrt or sodium
fȧilure hȧs stȧrted fosinopril in the
lȧst few dȧys. She hȧs developed ȧ cough. Whȧt clinicȧl finding cȧn help
distinguish the etiology of the cough ȧs heȧrt fȧilure ȧnd not relȧted to
