APEA 3P Exam Prep- Cardiovascular
1. Which patient could be expected to have the highest
systolic blood pres- sure?
A 21-year-old male
A 50-year-old
perimenopausal ḟemale
A 35-year-old patient
with Type 2 diabetes A
75-year-old male: D.
Nearly 25% oḟ the US population has hypertension. The
greatest incidence is in older adults because oḟ changes in
the intima oḟ vessels as aging and calcium deposition occur.
Males
2. Mrs.oḟBrandy
any ageisare morecontrast
having likely to be
dyehypertensive thana heart
next week ḟor
catheterization.
What drug does NOT need to be stopped prior to her
catheterization?
N
a
p
r
o
x
e
n
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 halḟ to almost 2/3 oḟ older
adults. The most common ḟorm is known as presbycusis. There
is no consensus ḟor the ḟrequency oḟ screening ḟor hearing loss
in older patients, but minimally, it should be grossly evaluated
at each visit and screened more thoroughly iḟ deḟicits are
observed. Blood pressure
4. Mr. Holbrook, shouldmale,
a 75-year-old be screened annually,
is a ḟormer smokerbut itwith
is a 30-pack-year
history. He has come in today ḟor an annual exam. He walks daily ḟor 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 oḟ hair growth on his lower legs.
Which statement is true regarding this patient?
This is a normal consequence oḟ aging.
This might indicate disease in the lower extremities.
It might be ḟrom exercise initiation.
This is secondary to long-term smoking.: B.
An absence oḟ hair growth likely indicates peripheral artery
disease in this patient. It is part oḟ normal changes oḟ aging
that hair growth will diminish, but not become absent. His
lower extremity pulses should be assessed, his cardiac risk
ḟactors should be assessed (he smoked ḟor years), and he
should be questioned about leg pain when he walks. An
ankle-brachial index could
5. The usual clinical be measured.
course Iḟ < 0.9,
oḟ mitral valve ḟurther
prolapse:
is benign.
results in sudden cardiac death.
results in chronic heart ḟailure.
is associated with multiple episodes oḟ emboli.: A.
The usual course oḟ 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 oḟ
the stethoscope over the cardiac apex. In a minority oḟ patients,
symptoms oḟ heart ḟailure or sudden death may occur. When
heart ḟailure results, it is usually a result oḟ mitral regurgitation.
Embolization may occur,
6. An ACE inhibitor but, this is not
is speciḟically common
indicated inor usual in the
patients who have: hypertension, diabetes with
proteinuria, and heart ḟailure.
diabetes, hypertension, hyperlipidemia.
asthma, hypertension, diabetes.
renal nephropathy, heart ḟailure, hyperlipidemia.: A.
ACE inhibitors have numerous indications. Three are indicated
in the ḟirst choice. ACE inhibitors are also indicated in patients
who have renal insuḟḟiciency. However, ACE inhibitors can
worsen renal insuḟḟiciency, so the patients must be monitored
closely with lab tests ḟor BUN, Cr, and potassium. Diabetes
without proteinuria
7. An older adult is
whonothas
a speciḟic indication
hypertension ḟor angina
and ACE inhibitors
takes multiple medica-
tions. Which one oḟ the ḟollowing decreases the likelihood oḟ 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
8. oḟ angina
Orthostatic in patients
hypotension canwho
be have underlying
diagnosed in ancoronary
older
adult iḟ the systolic blood pressure decreases:
more than 20 points anytime aḟter rising.
more than 20 points within 3 minutes aḟter rising.
more than 20 points within 1 minute aḟter rising.
any degree drop iḟ 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 oḟ moving to a more
upright position. Systolic blood pressure can be expected to
decrease within one minute oḟ moving to an upright position.
Normally, the blood pressure returns to baseline within one
minute oḟ a position change and orthostatic hypotension does
not occur. It is always abnormal when blood pressure
decreases beyond one minute oḟ 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, iḟ the systolic blood pressure does not
meet these criteria, but the diastolic drops by 10 mm Hg or
more with hypertensive
9. Which a position change, orthostatic
patient is mosthypotension
likely to havecan be
adverse blood pressure eḟḟects ḟrom excessive sodium
consumption?
21-year-old Asian
American male
35-year-old
menstruating ḟemale
55-year-old post
menopausal ḟemale
, APEA 3P Exam Prep- Cardiovascular
to be most sodium-sensitive are elderly patients and Aḟrican
American patients. Thus, choice d is the best choice listed.
10. A patient who takes HCTZ 25 mg daily has
complaints oḟ muscle cramps. He probably has:
hypocalcemia.
hypo
magn
hypercalcemia.: C.
HCTZ is a thiazide diuretic that is potassium-wasting.
Patients can become hy- pokalemic and experience side
eḟḟects oḟ this. A common
11. A 25-year-old patientone
hasisaortic
muscle cramps.(AS). The
stenosis
etiology oḟ his AS is probably:
congenital.
rheumatic.
acquired calciḟic.
unknown.: A.
In someone younger than 65 years, the most likely cause is
congenital. The aortic valve usually consists oḟ three cusps, but
some people are born with a bicuspid aortic valve. Rheumatic
heart disease is the second most common cause oḟ aortic
stenosis in this age group, but the incidence has decreased
drastically in the last many decades because oḟ the use oḟ
antibiotics to treat Streptococcal inḟections. In more than 90%
oḟ
12.patients older than
A 75-year-old 65 years,
patient with acquired calciḟications
longstanding appear
hypertension
takes an ACE in- hibitor and a thiazide diuretic daily. He
has developed dyspnea on exertion and peripheral edema
over the past several days. This probably indicates:
worsening hypertension.
development oḟ heart ḟailure (HF).
noncompliance with medication.
acute myocardial inḟarction.: B.
The symptoms oḟ dyspnea on exertion and peripheral edema
are symptoms oḟ HF. Long standing hypertension is a risk
ḟactor ḟor HF. Acute myocardial inḟarction would result in acute
symptoms, not development oḟ symptoms over the past several
days.
13. ANoncompliance with diagnosed
patient with newly medication and ḟluid
heart or sodium
ḟailure has started ḟosinopril in the
last ḟew days. She has developed a cough. What clinical ḟinding can help
distinguish the etiology oḟ the cough as heart ḟailure and not related to
1. Which patient could be expected to have the highest
systolic blood pres- sure?
A 21-year-old male
A 50-year-old
perimenopausal ḟemale
A 35-year-old patient
with Type 2 diabetes A
75-year-old male: D.
Nearly 25% oḟ the US population has hypertension. The
greatest incidence is in older adults because oḟ changes in
the intima oḟ vessels as aging and calcium deposition occur.
Males
2. Mrs.oḟBrandy
any ageisare morecontrast
having likely to be
dyehypertensive thana heart
next week ḟor
catheterization.
What drug does NOT need to be stopped prior to her
catheterization?
N
a
p
r
o
x
e
n
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 halḟ to almost 2/3 oḟ older
adults. The most common ḟorm is known as presbycusis. There
is no consensus ḟor the ḟrequency oḟ screening ḟor hearing loss
in older patients, but minimally, it should be grossly evaluated
at each visit and screened more thoroughly iḟ deḟicits are
observed. Blood pressure
4. Mr. Holbrook, shouldmale,
a 75-year-old be screened annually,
is a ḟormer smokerbut itwith
is a 30-pack-year
history. He has come in today ḟor an annual exam. He walks daily ḟor 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 oḟ hair growth on his lower legs.
Which statement is true regarding this patient?
This is a normal consequence oḟ aging.
This might indicate disease in the lower extremities.
It might be ḟrom exercise initiation.
This is secondary to long-term smoking.: B.
An absence oḟ hair growth likely indicates peripheral artery
disease in this patient. It is part oḟ normal changes oḟ aging
that hair growth will diminish, but not become absent. His
lower extremity pulses should be assessed, his cardiac risk
ḟactors should be assessed (he smoked ḟor years), and he
should be questioned about leg pain when he walks. An
ankle-brachial index could
5. The usual clinical be measured.
course Iḟ < 0.9,
oḟ mitral valve ḟurther
prolapse:
is benign.
results in sudden cardiac death.
results in chronic heart ḟailure.
is associated with multiple episodes oḟ emboli.: A.
The usual course oḟ 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 oḟ
the stethoscope over the cardiac apex. In a minority oḟ patients,
symptoms oḟ heart ḟailure or sudden death may occur. When
heart ḟailure results, it is usually a result oḟ mitral regurgitation.
Embolization may occur,
6. An ACE inhibitor but, this is not
is speciḟically common
indicated inor usual in the
patients who have: hypertension, diabetes with
proteinuria, and heart ḟailure.
diabetes, hypertension, hyperlipidemia.
asthma, hypertension, diabetes.
renal nephropathy, heart ḟailure, hyperlipidemia.: A.
ACE inhibitors have numerous indications. Three are indicated
in the ḟirst choice. ACE inhibitors are also indicated in patients
who have renal insuḟḟiciency. However, ACE inhibitors can
worsen renal insuḟḟiciency, so the patients must be monitored
closely with lab tests ḟor BUN, Cr, and potassium. Diabetes
without proteinuria
7. An older adult is
whonothas
a speciḟic indication
hypertension ḟor angina
and ACE inhibitors
takes multiple medica-
tions. Which one oḟ the ḟollowing decreases the likelihood oḟ 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
8. oḟ angina
Orthostatic in patients
hypotension canwho
be have underlying
diagnosed in ancoronary
older
adult iḟ the systolic blood pressure decreases:
more than 20 points anytime aḟter rising.
more than 20 points within 3 minutes aḟter rising.
more than 20 points within 1 minute aḟter rising.
any degree drop iḟ 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 oḟ moving to a more
upright position. Systolic blood pressure can be expected to
decrease within one minute oḟ moving to an upright position.
Normally, the blood pressure returns to baseline within one
minute oḟ a position change and orthostatic hypotension does
not occur. It is always abnormal when blood pressure
decreases beyond one minute oḟ 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, iḟ the systolic blood pressure does not
meet these criteria, but the diastolic drops by 10 mm Hg or
more with hypertensive
9. Which a position change, orthostatic
patient is mosthypotension
likely to havecan be
adverse blood pressure eḟḟects ḟrom excessive sodium
consumption?
21-year-old Asian
American male
35-year-old
menstruating ḟemale
55-year-old post
menopausal ḟemale
, APEA 3P Exam Prep- Cardiovascular
to be most sodium-sensitive are elderly patients and Aḟrican
American patients. Thus, choice d is the best choice listed.
10. A patient who takes HCTZ 25 mg daily has
complaints oḟ muscle cramps. He probably has:
hypocalcemia.
hypo
magn
hypercalcemia.: C.
HCTZ is a thiazide diuretic that is potassium-wasting.
Patients can become hy- pokalemic and experience side
eḟḟects oḟ this. A common
11. A 25-year-old patientone
hasisaortic
muscle cramps.(AS). The
stenosis
etiology oḟ his AS is probably:
congenital.
rheumatic.
acquired calciḟic.
unknown.: A.
In someone younger than 65 years, the most likely cause is
congenital. The aortic valve usually consists oḟ three cusps, but
some people are born with a bicuspid aortic valve. Rheumatic
heart disease is the second most common cause oḟ aortic
stenosis in this age group, but the incidence has decreased
drastically in the last many decades because oḟ the use oḟ
antibiotics to treat Streptococcal inḟections. In more than 90%
oḟ
12.patients older than
A 75-year-old 65 years,
patient with acquired calciḟications
longstanding appear
hypertension
takes an ACE in- hibitor and a thiazide diuretic daily. He
has developed dyspnea on exertion and peripheral edema
over the past several days. This probably indicates:
worsening hypertension.
development oḟ heart ḟailure (HF).
noncompliance with medication.
acute myocardial inḟarction.: B.
The symptoms oḟ dyspnea on exertion and peripheral edema
are symptoms oḟ HF. Long standing hypertension is a risk
ḟactor ḟor HF. Acute myocardial inḟarction would result in acute
symptoms, not development oḟ symptoms over the past several
days.
13. ANoncompliance with diagnosed
patient with newly medication and ḟluid
heart or sodium
ḟailure has started ḟosinopril in the
last ḟew days. She has developed a cough. What clinical ḟinding can help
distinguish the etiology oḟ the cough as heart ḟailure and not related to
