NPS CARDIO RESP HEMAT GEN EXAM
WITH COMPLETE SOLUTIONS
16.25 mg/kg - ANS-A 4-year-old, 16 kg girl is brought to the emergency department by
her mother after she was found with an open bottle of ferrous sulfate 325 mg tablets at
home. The mother states that a maximum of eight tablets is missing from the bottle. At
home, the child was noted to have one episode of emesis in which the mother noticed
that four tablets were seen. How much elemental iron has this patient been exposed to?
9 mg by mouth once daily - ANS-A 32-year-old man is admitted to the hospital for an
asthma exacerbation. He is receiving 30 mg prednisone by mouth twice daily while
admitted. The pharmacist calls you and states that due to drug shortages, prednisone is
not available and the patient needs to be converted to dexamethasone. What is an
appropriate equivalent dose of dexamethasone for this patient?
A 50-year-old man with hypertension and stable angina - ANS-Which of the following
patients would most likely benefit from the initiation of amlodipine?
A decreased amount of available iron for red blood cell production due to iron loss
exceeding intake - ANS-A 45-year-old woman presents with shortness of breath and
fatigue. Laboratory results are hemoglobin 8.4 mg/dL, mean corpuscular volume 66 fL,
mean corpuscular hemoglobin concentration 26 g/dL, ferritin 12 ng/mL, and total iron-
binding capacity 520 µg/dL. Which of the following pathophysiology best describes the
patient's suspected condition?
A grade 4 holosystolic murmur that is more intense with upright positioning in a 1 year
old - ANS-- Which of the following children should be referred for cardiac evaluation for
a suspected pathological heart murmur?
A patient with HIV develops Stevens-Johnson syndrome after receiving abacavir - ANS-
Which of the following situations would be an example of a pharmacogenetic
interaction?
Abdominal pain - ANS-Which of the following signs and symptoms is associated with
digoxin toxicity?
Accessory conduction pathway - ANS-A 12-year-old boy presents to your office for a
routine sports physical exam. Family history reveals the patient had an uncle who died
of a sudden unexplained cardiac event. You obtain a screening ECG, which is shown
above. Which of the following best describes the pathophysiology of the suspected
diagnosis?
Accessory electrical pathway - ANS-Which of the following pathologic mechanisms
most commonly causes paroxysmal supraventricular tachycardia
Acute bronchitis - ANS-A 21-year-old woman presents with two weeks of a "wet" cough
following an upper respiratory infection. She is worried because she is coughing up
green phlegm. She has no significant pulmonary disease history and is only mildly short
of breath during "cough fits." On exam, she is afebrile with normal vital signs. She does
, have rhonchi in bilateral lung fields that clears with coughing. Which of the following is
this patient's most likely diagnosis?
Alveolar destruction due to inhibition of normal protease activity - ANS-A 45-year-old
man who is thin and has a medical history of hypertension, dyslipidemia, and a 25 pack-
year smoking history presents to the clinic with reports of dyspnea. He states he
becomes breathless after walking up a slight hill and reports an infrequent cough with
clear sputum. Vital signs include HR of 85 bpm, RR of 18/minute, BP of 133/83 mm Hg,
T of 98.3°F, and SpO2 of 96% on room air. Pulmonary function tests reveal FEV1/FVC
of 0.53 and FEV1 of 2.60 L that increases to 2.65 L after inhaled albuterol
administration. Chest radiograph findings are shown above. Which of the following is
the predominant pathologic mechanism by which the suspected disease causes illness?
Ankle-brachial index - ANS-A 52-year-old man with a history of diabetes mellitus type 2
and cigarette smoking presents to your clinic with a six-month history of worsening leg
pain. The patient reports his pain is worse when walking and improved with rest.
Physical exam reveals decreased hair growth over the distal extremities and bilateral
diminished dorsalis pedis pulses. What is the most appropriate diagnostic test to
establish the suspected diagnosis?
Aortic root dilation - ANS-An 80-year-old woman presents to the clinic reporting chest
pain and dyspnea on exertion. Her symptoms have been present for about a year but
seem to be worsening lately. She takes lisinopril 20 mg daily for hypertension,
acetaminophen 500 mg three times daily for osteoarthritis, and calcium 600 mg daily for
her bone health. Her vital signs include a blood pressure of 160/60 mm Hg, heart rate of
80 bpm, respirations of 16/minute, oxygen saturation of 94% on room air, and a
temperature of 98.5°F. Physical exam reveals a rapid radial pulse with prominent
upstroke and descent, a laterally displaced hyperdynamic apical pulse, a diastolic
decrescendo murmur that is high-pitched and loudest at the right sternal border, 2+
pitting edema of the bilateral lower extremities, and crackles at her bilateral lung bases.
Which of the following is the most likely pathophysiologic cause of this patient's cardiac
condition?
Aortic stenosis - ANS-A 70-year-old woman presents to the clinic following an episode
of syncope. She denies chest pain, palpitations, edema, or shortness of breath. Cardiac
exam reveals a crescendo-decrescendo, systolic murmur which is heard best over the
right upper sternal border and radiates to the carotid artery. Which of the following is the
most likely diagnosis
aortic stenosis - ANS-A 70-year-old woman presents to the clinic following an episode
of syncope. She denies chest pain, palpitations, edema, or shortness of breath. Cardiac
exam reveals a crescendo-decrescendo, systolic murmur which is heard best over the
right upper sternal border and radiates to the carotid artery. Which of the following is the
most likely diagnosis?
Asparagus - ANS-A 48-year-old woman was diagnosed six months ago with atrial
fibrillation and was prescribed warfarin and metoprolol. The patient has been coming to
the clinic for routine international normalized ratio (INR) tests and has been consistently
within the therapeutic range of 2-3. Today she presents to the clinic and her INR is 1.5.
She denies any changes in her medications and reports being compliant with her
warfarin therapy. Increased consumption of which of the following foods or beverages
would most likely be responsible for this subtherapeutic INR?
WITH COMPLETE SOLUTIONS
16.25 mg/kg - ANS-A 4-year-old, 16 kg girl is brought to the emergency department by
her mother after she was found with an open bottle of ferrous sulfate 325 mg tablets at
home. The mother states that a maximum of eight tablets is missing from the bottle. At
home, the child was noted to have one episode of emesis in which the mother noticed
that four tablets were seen. How much elemental iron has this patient been exposed to?
9 mg by mouth once daily - ANS-A 32-year-old man is admitted to the hospital for an
asthma exacerbation. He is receiving 30 mg prednisone by mouth twice daily while
admitted. The pharmacist calls you and states that due to drug shortages, prednisone is
not available and the patient needs to be converted to dexamethasone. What is an
appropriate equivalent dose of dexamethasone for this patient?
A 50-year-old man with hypertension and stable angina - ANS-Which of the following
patients would most likely benefit from the initiation of amlodipine?
A decreased amount of available iron for red blood cell production due to iron loss
exceeding intake - ANS-A 45-year-old woman presents with shortness of breath and
fatigue. Laboratory results are hemoglobin 8.4 mg/dL, mean corpuscular volume 66 fL,
mean corpuscular hemoglobin concentration 26 g/dL, ferritin 12 ng/mL, and total iron-
binding capacity 520 µg/dL. Which of the following pathophysiology best describes the
patient's suspected condition?
A grade 4 holosystolic murmur that is more intense with upright positioning in a 1 year
old - ANS-- Which of the following children should be referred for cardiac evaluation for
a suspected pathological heart murmur?
A patient with HIV develops Stevens-Johnson syndrome after receiving abacavir - ANS-
Which of the following situations would be an example of a pharmacogenetic
interaction?
Abdominal pain - ANS-Which of the following signs and symptoms is associated with
digoxin toxicity?
Accessory conduction pathway - ANS-A 12-year-old boy presents to your office for a
routine sports physical exam. Family history reveals the patient had an uncle who died
of a sudden unexplained cardiac event. You obtain a screening ECG, which is shown
above. Which of the following best describes the pathophysiology of the suspected
diagnosis?
Accessory electrical pathway - ANS-Which of the following pathologic mechanisms
most commonly causes paroxysmal supraventricular tachycardia
Acute bronchitis - ANS-A 21-year-old woman presents with two weeks of a "wet" cough
following an upper respiratory infection. She is worried because she is coughing up
green phlegm. She has no significant pulmonary disease history and is only mildly short
of breath during "cough fits." On exam, she is afebrile with normal vital signs. She does
, have rhonchi in bilateral lung fields that clears with coughing. Which of the following is
this patient's most likely diagnosis?
Alveolar destruction due to inhibition of normal protease activity - ANS-A 45-year-old
man who is thin and has a medical history of hypertension, dyslipidemia, and a 25 pack-
year smoking history presents to the clinic with reports of dyspnea. He states he
becomes breathless after walking up a slight hill and reports an infrequent cough with
clear sputum. Vital signs include HR of 85 bpm, RR of 18/minute, BP of 133/83 mm Hg,
T of 98.3°F, and SpO2 of 96% on room air. Pulmonary function tests reveal FEV1/FVC
of 0.53 and FEV1 of 2.60 L that increases to 2.65 L after inhaled albuterol
administration. Chest radiograph findings are shown above. Which of the following is
the predominant pathologic mechanism by which the suspected disease causes illness?
Ankle-brachial index - ANS-A 52-year-old man with a history of diabetes mellitus type 2
and cigarette smoking presents to your clinic with a six-month history of worsening leg
pain. The patient reports his pain is worse when walking and improved with rest.
Physical exam reveals decreased hair growth over the distal extremities and bilateral
diminished dorsalis pedis pulses. What is the most appropriate diagnostic test to
establish the suspected diagnosis?
Aortic root dilation - ANS-An 80-year-old woman presents to the clinic reporting chest
pain and dyspnea on exertion. Her symptoms have been present for about a year but
seem to be worsening lately. She takes lisinopril 20 mg daily for hypertension,
acetaminophen 500 mg three times daily for osteoarthritis, and calcium 600 mg daily for
her bone health. Her vital signs include a blood pressure of 160/60 mm Hg, heart rate of
80 bpm, respirations of 16/minute, oxygen saturation of 94% on room air, and a
temperature of 98.5°F. Physical exam reveals a rapid radial pulse with prominent
upstroke and descent, a laterally displaced hyperdynamic apical pulse, a diastolic
decrescendo murmur that is high-pitched and loudest at the right sternal border, 2+
pitting edema of the bilateral lower extremities, and crackles at her bilateral lung bases.
Which of the following is the most likely pathophysiologic cause of this patient's cardiac
condition?
Aortic stenosis - ANS-A 70-year-old woman presents to the clinic following an episode
of syncope. She denies chest pain, palpitations, edema, or shortness of breath. Cardiac
exam reveals a crescendo-decrescendo, systolic murmur which is heard best over the
right upper sternal border and radiates to the carotid artery. Which of the following is the
most likely diagnosis
aortic stenosis - ANS-A 70-year-old woman presents to the clinic following an episode
of syncope. She denies chest pain, palpitations, edema, or shortness of breath. Cardiac
exam reveals a crescendo-decrescendo, systolic murmur which is heard best over the
right upper sternal border and radiates to the carotid artery. Which of the following is the
most likely diagnosis?
Asparagus - ANS-A 48-year-old woman was diagnosed six months ago with atrial
fibrillation and was prescribed warfarin and metoprolol. The patient has been coming to
the clinic for routine international normalized ratio (INR) tests and has been consistently
within the therapeutic range of 2-3. Today she presents to the clinic and her INR is 1.5.
She denies any changes in her medications and reports being compliant with her
warfarin therapy. Increased consumption of which of the following foods or beverages
would most likely be responsible for this subtherapeutic INR?
