Fhea FNP review (15-21) UPDATED
ACTUAL Questions and CORRECT
Answers
Presentation of acute coronary syndrome in women - CORRECT ANSWER -Shortness of
breath, weakness, unusual fatigue
Presentation of acute coronary syndrome in elderly - CORRECT ANSWER -Dyspnea,
neurological symptoms, such as syncope, weakness, and confusion, chest pain, or pressure in less
than 50%
Best position for PMI - CORRECT ANSWER -Left lateral decubitus position
* may be harder to feel in people with thick chest wall, obesity, COPD
Physiologic split of S2 - CORRECT ANSWER -Inspiration separates S2 into A2 followed
by P2, heard best in pulmonic region, split increases with patient inspiration. Benign.
Pathologic Fixed split S2 - CORRECT ANSWER -No change with inspiration or narrows
or closes with inspiration. Also heard best in pulmonic region. Often found an uncorrected septal
defect.
Pathologic S3 heart sound - CORRECT ANSWER -Sign of ventricular overload and or
systolic dysfunction. Heard early in diastole, low pitch and heard best with Bell. May be seen in
heart failure
S4 heart sound - CORRECT ANSWER -Means poor diastolic function, and most often
heard in poorly controlled hypertension or recurrent MI. Heard in late diastole also called
presystolic sound. Soft Low pitch best heard with Bell. If you can find the cause and treat it, it
will resolve.
MR.PASS - CORRECT ANSWER -Mitral Regurgitation
,Physiologic(innocent)
Aortic Stenosis
Systolic
Mitral regurgitation description - CORRECT ANSWER ---Heard at apex
—holosystolic
--Radiates Axilla
--Grade 2-3/6, harsh, blowing holosystolic murmur heard best at the apex and radiating to the left
axilla/back with the diaphragm when the patient is in the left lateral decubitus position.
o No rubs, clicks, or gallops appreciated.
Aortic stenosis description - CORRECT ANSWER -Crescendo/decrescendo systolic
murmur
MVP (mitral valve prolapse) description - CORRECT ANSWER -Mid systolic click, late
systolic murmur
MSARD - CORRECT ANSWER -Mitral stenosis
Aortic regurgitation
Diastolic ( always pathological)
Mitral stenosis description - CORRECT ANSWER -Late diastolic murmur
Aortic regurgitation description - CORRECT ANSWER -Early diastolic murmur
Benign murmur criteria - CORRECT ANSWER -Negative history.
Lower grade.
No radiation beyond precordium.
, S1 and S2 intact.
No heave or thrill.
PMI WNL.
Softens or disappears with supine to stand position.
Hypertrophic cardiomyopathy murmur description - CORRECT ANSWER -Agreed two
out of six mid systolic murmur that increases an intensity with position change from supine to
standing, accompanied by a loud S4
Common presentation sites of gout - CORRECT ANSWER -First Metatarsophalangeal
and wrist
Acute Gout medications - CORRECT ANSWER -Colchicine, steroids, or high dose
NSAIDs
When to start preventative therapy for gout - CORRECT ANSWER -Six months following
treatment of acute gouty attack. Xanthine oxidase inhibitor- Allopurinol is the most common
preventative medication. Febuxostat(uloric)
is another preventative that is a urate-lowering therapy.
-Target urate level is under six at minimum and often under 5 for improvement of symptoms
Diet modifications for gout - CORRECT ANSWER -low purine diet (No organ meat, no
shellfish); limit alcohol; avoid starvation diets, no spinach, no oatmeal
McMurray Test - CORRECT ANSWER -Meniscal tear- twisting injury
Talar Tilt Test - CORRECT ANSWER -identifies ligamentous instability (particularly
calcaneofibular ligament) in the ankle
Tinnel sign - CORRECT ANSWER -Carpal tunnel syndrome
ACTUAL Questions and CORRECT
Answers
Presentation of acute coronary syndrome in women - CORRECT ANSWER -Shortness of
breath, weakness, unusual fatigue
Presentation of acute coronary syndrome in elderly - CORRECT ANSWER -Dyspnea,
neurological symptoms, such as syncope, weakness, and confusion, chest pain, or pressure in less
than 50%
Best position for PMI - CORRECT ANSWER -Left lateral decubitus position
* may be harder to feel in people with thick chest wall, obesity, COPD
Physiologic split of S2 - CORRECT ANSWER -Inspiration separates S2 into A2 followed
by P2, heard best in pulmonic region, split increases with patient inspiration. Benign.
Pathologic Fixed split S2 - CORRECT ANSWER -No change with inspiration or narrows
or closes with inspiration. Also heard best in pulmonic region. Often found an uncorrected septal
defect.
Pathologic S3 heart sound - CORRECT ANSWER -Sign of ventricular overload and or
systolic dysfunction. Heard early in diastole, low pitch and heard best with Bell. May be seen in
heart failure
S4 heart sound - CORRECT ANSWER -Means poor diastolic function, and most often
heard in poorly controlled hypertension or recurrent MI. Heard in late diastole also called
presystolic sound. Soft Low pitch best heard with Bell. If you can find the cause and treat it, it
will resolve.
MR.PASS - CORRECT ANSWER -Mitral Regurgitation
,Physiologic(innocent)
Aortic Stenosis
Systolic
Mitral regurgitation description - CORRECT ANSWER ---Heard at apex
—holosystolic
--Radiates Axilla
--Grade 2-3/6, harsh, blowing holosystolic murmur heard best at the apex and radiating to the left
axilla/back with the diaphragm when the patient is in the left lateral decubitus position.
o No rubs, clicks, or gallops appreciated.
Aortic stenosis description - CORRECT ANSWER -Crescendo/decrescendo systolic
murmur
MVP (mitral valve prolapse) description - CORRECT ANSWER -Mid systolic click, late
systolic murmur
MSARD - CORRECT ANSWER -Mitral stenosis
Aortic regurgitation
Diastolic ( always pathological)
Mitral stenosis description - CORRECT ANSWER -Late diastolic murmur
Aortic regurgitation description - CORRECT ANSWER -Early diastolic murmur
Benign murmur criteria - CORRECT ANSWER -Negative history.
Lower grade.
No radiation beyond precordium.
, S1 and S2 intact.
No heave or thrill.
PMI WNL.
Softens or disappears with supine to stand position.
Hypertrophic cardiomyopathy murmur description - CORRECT ANSWER -Agreed two
out of six mid systolic murmur that increases an intensity with position change from supine to
standing, accompanied by a loud S4
Common presentation sites of gout - CORRECT ANSWER -First Metatarsophalangeal
and wrist
Acute Gout medications - CORRECT ANSWER -Colchicine, steroids, or high dose
NSAIDs
When to start preventative therapy for gout - CORRECT ANSWER -Six months following
treatment of acute gouty attack. Xanthine oxidase inhibitor- Allopurinol is the most common
preventative medication. Febuxostat(uloric)
is another preventative that is a urate-lowering therapy.
-Target urate level is under six at minimum and often under 5 for improvement of symptoms
Diet modifications for gout - CORRECT ANSWER -low purine diet (No organ meat, no
shellfish); limit alcohol; avoid starvation diets, no spinach, no oatmeal
McMurray Test - CORRECT ANSWER -Meniscal tear- twisting injury
Talar Tilt Test - CORRECT ANSWER -identifies ligamentous instability (particularly
calcaneofibular ligament) in the ankle
Tinnel sign - CORRECT ANSWER -Carpal tunnel syndrome
