APEA 3P ADVANCED QUESTIONS AND
ANSWERS
You are auscultating Jon's chest. When he sits up and leans forward, you can hear a
high pitched, blowing murmur at S2. What does this type of murmur most likely
indicate?
a. Mitral stenosis
b. Aortic Stenosis
c. Mitral regurgitation
d. Aortic regurgitation - CORRECT ANSWER-d. Aortic regurgitation
Aortic regurg is soft, high pitched, blowing diastolic decrescendo that best heard at the
3rd left interspace at base. Murmur initiated w/ S2 and heard when Pt sits up and leans
forward. Mitral Stenosis= low pitched diastolic rumble & doesn't radiate. Best heard in
apex when in left lateral position. Aortic stenosis= loud, harsh murmur midsystole,
radiated down the side of neck and down apex. Mitral regurg= loud blowing murmur
heard at apex and is pansystolic.
Which of the following is the most common clinical manifestation of osteoporosis?
a. Bone deformity
b. Bone pain
c. Pathologic fracture
d. Fat embolism - CORRECT ANSWER-a. Bone deformity
most common metabolic bone disease, is chronic, progressive, & systemic; Low bone
mass and deterioration of bone tissue, = leads to increased skeletal fragility & deformity.
Osteoporosis usually not apparent until AFTER a fracture; 2/3 of vertebral fractures are
painless. Fat embolism from fat obstruction d/t injury or trauma & not common in
osteoporosis.
A male patient requests a phosphodiesterase inhibitor to treat erectile dysfunction.
Which of the following is appropriate?
, a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take
place two or more times per week.
b. Vardenafil (Levitra), 5 mg, may be taken with a high-fat meal four hours before sexual
activity
c. Sildenafil (Viagra), 50 mg, may be taken one hour before sexual activity as long as
the patient has a resting blood pressure below 170/110 mm Hg
d. Avanafil (Stendra) is recommended at 50 mg for all patients, and may be taken 30
minutes before sexual activity. - CORRECT ANSWER-a. Tadalafil (Cialis) may be used
at a dose of 2.5 mg daily if sexual activity will take place two or more times per week.
Which of the following is NOT part of Virchow's Triad?
a. Hypercoagulability
b. Damage to endothelial cells
c. Sympathetic tone
d. Turbulent blood flow - CORRECT ANSWER-c. Sympathetic tone
Virchow's triad is a method of describing the three main factors that lead to a
thrombosis -- sympathetic tone is not one of those and doesn't affect blood clotting.
Hypercoagulability does lead to clotting, including malignancy, trauma, sepsis, and
thrombophilia. Endothelial cell damage is part of Virchow's triad bc it causes blood to
clot by promoting platelet adherence to the wall of the vessels; vascular wall injury is the
second aspect of Virchow's triad. Lastly, turbulent blood flow is a constituent of
circulatory stasis the third component of the triad, which can be caused by atrial
fibrillation, venous obstruction, and ventricular dysfunction
A patient with kidney stones also presents with hypercalcemia and mental confusion.
The practitioner should evaluate the patient for which of the following?
a. Cushing Syndrome
b. Conn's Syndrome
c. Hyperparathyroidism
d. Addison's disease - CORRECT ANSWER-c. Hyperparathyroidism
Which of the following statements is true regarding contraceptives?
a. Because oral contraceptives may cause harm to the fetus, they are pregnancy
category X drugs in pregnancy.
b. Oral contraceptives are linked to the promotion of ovarian, endometrial, and breast
cancer.
c. By increasing angiotensin and aldosterone, oral contraceptives may increase blood
pressure.
d. Oral contraceptives may reduce the effects of theophylline, benzodiazepines, and
tricyclic antidepressants - CORRECT ANSWER-c. By increasing angiotensin and
aldosterone, oral contraceptives may increase blood pressure.
estrogen promotes aldosterone production= sodium retention & HTN. Also believed
stimulates hepatic production of angiotensinogen, affecting renal system via elevated
, angiotensin & BP. OCP are category X, but because serve no use, decrease incidence
of ovarian and endometrial ca and don't increase risk of breast ca. OCP containing
progestin may enhance effects of theophylline, benzos, and tricyclic antidepressants by
decreasing clearance.
Upon percussion of the chest, you notice hyperresonance. Of the following choices
which would most likely be the cause?
a. Atelectasis
b. Normal Lung
c. Pneumothorax
d. Pulmonary embolism - CORRECT ANSWER-c. Pneumothorax
What is the proper order of steps to accurately perform the Ortolani maneuver?
a. Extend the legs, adduct the legs, and abduct the knees
b. Flex the knees, abduct the knees, and adduct the legs
c. Flex the knees, adduct the legs, and abduct the legs
d. Extend the knees, abduct the legs, and adduct the knees - CORRECT ANSWER-b.
Flex the knees, abduct the knees, and adduct the legs
done on supine infant, flex knees while holding thighs. Adduct legs until thumbs touch,
follow with abduct knees until lateral part of knee touch table.
You have four patients who all have a family history of developing coronary heart
disease at an early age. According to their blood test results, which patient would most
likely develop coronary heart disease first?
a. Cholesterol: 170; LDL: 120; Triglycerides: 120; HDL: 45
b. Cholesterol: 195; LDL: 110; Triglycerides: 135; HDL: 30
c. Cholesterol: 170; LDL: 100; Triglycerides: 140; HDL: 20
d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 - CORRECT ANSWER-d.
Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50
3 of the 4 measurements are above what should be; HDL <40 in men & 50 in women
increase risk, LDL aim is <130, Chol > 200 & trig >150 attributed to increase risk heart
disease.
This low-molecular-weight heparin is indicated for use with warfarin for the treatment of
acute symptomatic deep vein thrombosis, either with or without pulmonary embolism:
a. Nadroparin
b. Dalteparin
c. Tinzaparin
d. Fondaparinux - CORRECT ANSWER-c. Tinzaparin-
can be combined with warfarin for DVT, aids warfarin in inhibiting clotting of blood.
Nadroparin & Dalteparin don't use w/ warfarin, use independently. Fondaparinux is a Xa
inhibitor NOT LMWH.
ANSWERS
You are auscultating Jon's chest. When he sits up and leans forward, you can hear a
high pitched, blowing murmur at S2. What does this type of murmur most likely
indicate?
a. Mitral stenosis
b. Aortic Stenosis
c. Mitral regurgitation
d. Aortic regurgitation - CORRECT ANSWER-d. Aortic regurgitation
Aortic regurg is soft, high pitched, blowing diastolic decrescendo that best heard at the
3rd left interspace at base. Murmur initiated w/ S2 and heard when Pt sits up and leans
forward. Mitral Stenosis= low pitched diastolic rumble & doesn't radiate. Best heard in
apex when in left lateral position. Aortic stenosis= loud, harsh murmur midsystole,
radiated down the side of neck and down apex. Mitral regurg= loud blowing murmur
heard at apex and is pansystolic.
Which of the following is the most common clinical manifestation of osteoporosis?
a. Bone deformity
b. Bone pain
c. Pathologic fracture
d. Fat embolism - CORRECT ANSWER-a. Bone deformity
most common metabolic bone disease, is chronic, progressive, & systemic; Low bone
mass and deterioration of bone tissue, = leads to increased skeletal fragility & deformity.
Osteoporosis usually not apparent until AFTER a fracture; 2/3 of vertebral fractures are
painless. Fat embolism from fat obstruction d/t injury or trauma & not common in
osteoporosis.
A male patient requests a phosphodiesterase inhibitor to treat erectile dysfunction.
Which of the following is appropriate?
, a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take
place two or more times per week.
b. Vardenafil (Levitra), 5 mg, may be taken with a high-fat meal four hours before sexual
activity
c. Sildenafil (Viagra), 50 mg, may be taken one hour before sexual activity as long as
the patient has a resting blood pressure below 170/110 mm Hg
d. Avanafil (Stendra) is recommended at 50 mg for all patients, and may be taken 30
minutes before sexual activity. - CORRECT ANSWER-a. Tadalafil (Cialis) may be used
at a dose of 2.5 mg daily if sexual activity will take place two or more times per week.
Which of the following is NOT part of Virchow's Triad?
a. Hypercoagulability
b. Damage to endothelial cells
c. Sympathetic tone
d. Turbulent blood flow - CORRECT ANSWER-c. Sympathetic tone
Virchow's triad is a method of describing the three main factors that lead to a
thrombosis -- sympathetic tone is not one of those and doesn't affect blood clotting.
Hypercoagulability does lead to clotting, including malignancy, trauma, sepsis, and
thrombophilia. Endothelial cell damage is part of Virchow's triad bc it causes blood to
clot by promoting platelet adherence to the wall of the vessels; vascular wall injury is the
second aspect of Virchow's triad. Lastly, turbulent blood flow is a constituent of
circulatory stasis the third component of the triad, which can be caused by atrial
fibrillation, venous obstruction, and ventricular dysfunction
A patient with kidney stones also presents with hypercalcemia and mental confusion.
The practitioner should evaluate the patient for which of the following?
a. Cushing Syndrome
b. Conn's Syndrome
c. Hyperparathyroidism
d. Addison's disease - CORRECT ANSWER-c. Hyperparathyroidism
Which of the following statements is true regarding contraceptives?
a. Because oral contraceptives may cause harm to the fetus, they are pregnancy
category X drugs in pregnancy.
b. Oral contraceptives are linked to the promotion of ovarian, endometrial, and breast
cancer.
c. By increasing angiotensin and aldosterone, oral contraceptives may increase blood
pressure.
d. Oral contraceptives may reduce the effects of theophylline, benzodiazepines, and
tricyclic antidepressants - CORRECT ANSWER-c. By increasing angiotensin and
aldosterone, oral contraceptives may increase blood pressure.
estrogen promotes aldosterone production= sodium retention & HTN. Also believed
stimulates hepatic production of angiotensinogen, affecting renal system via elevated
, angiotensin & BP. OCP are category X, but because serve no use, decrease incidence
of ovarian and endometrial ca and don't increase risk of breast ca. OCP containing
progestin may enhance effects of theophylline, benzos, and tricyclic antidepressants by
decreasing clearance.
Upon percussion of the chest, you notice hyperresonance. Of the following choices
which would most likely be the cause?
a. Atelectasis
b. Normal Lung
c. Pneumothorax
d. Pulmonary embolism - CORRECT ANSWER-c. Pneumothorax
What is the proper order of steps to accurately perform the Ortolani maneuver?
a. Extend the legs, adduct the legs, and abduct the knees
b. Flex the knees, abduct the knees, and adduct the legs
c. Flex the knees, adduct the legs, and abduct the legs
d. Extend the knees, abduct the legs, and adduct the knees - CORRECT ANSWER-b.
Flex the knees, abduct the knees, and adduct the legs
done on supine infant, flex knees while holding thighs. Adduct legs until thumbs touch,
follow with abduct knees until lateral part of knee touch table.
You have four patients who all have a family history of developing coronary heart
disease at an early age. According to their blood test results, which patient would most
likely develop coronary heart disease first?
a. Cholesterol: 170; LDL: 120; Triglycerides: 120; HDL: 45
b. Cholesterol: 195; LDL: 110; Triglycerides: 135; HDL: 30
c. Cholesterol: 170; LDL: 100; Triglycerides: 140; HDL: 20
d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 - CORRECT ANSWER-d.
Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50
3 of the 4 measurements are above what should be; HDL <40 in men & 50 in women
increase risk, LDL aim is <130, Chol > 200 & trig >150 attributed to increase risk heart
disease.
This low-molecular-weight heparin is indicated for use with warfarin for the treatment of
acute symptomatic deep vein thrombosis, either with or without pulmonary embolism:
a. Nadroparin
b. Dalteparin
c. Tinzaparin
d. Fondaparinux - CORRECT ANSWER-c. Tinzaparin-
can be combined with warfarin for DVT, aids warfarin in inhibiting clotting of blood.
Nadroparin & Dalteparin don't use w/ warfarin, use independently. Fondaparinux is a Xa
inhibitor NOT LMWH.
