MSN 622 Final Questions And Answers With Latest
Quiz
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)? ANS 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? ANS 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? ANS 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? ANS 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? ANS 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? ANS 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? ANS 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 ANS 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? ANS 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? ANS 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)? ANS
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? ANS .
A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? ANS
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? ANS .
Pulmonary artery
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 131/91 mm Hg, and
temperature 98.6 °F (37 °C). A 12-lead electrocardiogram (ECG) demonstrates ST depressions in
leads V5, V6, and aVL. The patient is administered oxygen, morphine, nitroglycerin, and aspirin.
What is the principle behind giving this patient nitroglycerin? ANS To dilate the venous system
and decrease cardiac preload.
A 70-year-old patient comes to the clinic with complaints of increased blood pressure. He was
diagnosed with hypertension 10 years ago. His other problems include osteoporosis and
hyperlipidemia. His readings range from systolic 160 mmHg to 170 mmHg while diastolic falling in
between 70 mmHg to 90 mmHg. His current blood pressure is 160/80 mmHg. His medications
include lisinopril, amlodipine, atorvastatin, calcium and vitamin D supplements, and
bisphosphonates. He does not exercise and smokes a pack of cigarettes daily. He drinks two glasses
of beer every day. Family history is significant for stroke in father and MI in his sister. Which of the
following is the most likely effect of increased blood pressure on his heart? ANS Left ventricular
(concentric) hypertrophy
Quiz
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)? ANS 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? ANS 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? ANS 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? ANS 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? ANS 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? ANS 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? ANS 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 ANS 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? ANS 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? ANS 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)? ANS
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? ANS .
A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? ANS
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? ANS .
Pulmonary artery
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 131/91 mm Hg, and
temperature 98.6 °F (37 °C). A 12-lead electrocardiogram (ECG) demonstrates ST depressions in
leads V5, V6, and aVL. The patient is administered oxygen, morphine, nitroglycerin, and aspirin.
What is the principle behind giving this patient nitroglycerin? ANS To dilate the venous system
and decrease cardiac preload.
A 70-year-old patient comes to the clinic with complaints of increased blood pressure. He was
diagnosed with hypertension 10 years ago. His other problems include osteoporosis and
hyperlipidemia. His readings range from systolic 160 mmHg to 170 mmHg while diastolic falling in
between 70 mmHg to 90 mmHg. His current blood pressure is 160/80 mmHg. His medications
include lisinopril, amlodipine, atorvastatin, calcium and vitamin D supplements, and
bisphosphonates. He does not exercise and smokes a pack of cigarettes daily. He drinks two glasses
of beer every day. Family history is significant for stroke in father and MI in his sister. Which of the
following is the most likely effect of increased blood pressure on his heart? ANS Left ventricular
(concentric) hypertrophy
