Apea 3p final exam 2023/2024(summer-fall qtr)
Section 1: Cardiovascular — Questions 1–20
1.
A 58-year-old male presents with progressive dyspnea on exertion, orthopnea, and
bilateral lower extremity edema. Exam reveals JVD, an S3 gallop, and bibasilar crackles.
BNP is 850 pg/mL. Which diagnosis is most likely?
A. COPD exacerbation
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: The classic triad of heart failure plus objective findings (JVD, S3 gallop,
crackles, elevated BNP) strongly supports HF.
High-Yield Takeaway: JVD + S3 + crackles + elevated BNP = heart failure.
2.
A patient with heart failure has a BNP of 850 pg/mL. What does this indicate?
A. Normal cardiac function
B. Volume overload and heart failure
C. Pulmonary embolism
D. COPD exacerbation
Correct Answer: B
Rationale: BNP >400 pg/mL strongly supports heart failure with volume overload.
High-Yield Takeaway: BNP >400 = heart failure.
,3.
The compensatory mechanism in early congestive heart failure involves:
A. Decreased preload
B. Increased sympathetic tone
C. Decreased afterload
D. Reduced renin release
Correct Answer: B
Rationale: Early heart failure triggers increased sympathetic tone to maintain cardiac
output, though this eventually becomes maladaptive.
High-Yield Takeaway: Early HF = increased sympathetic tone.
4.
A patient with a history of heart failure and hypertension presents with new-onset
dyspnea and bilateral lower extremity edema. Which medication class should be used
with caution?
A. ACE inhibitors
B. Beta-blockers
C. NSAIDs
D. Diuretics
Correct Answer: C
Rationale: NSAIDs can cause fluid retention, reduce renal function, and decrease the
effectiveness of diuretics and antihypertensives, potentially worsening heart failure.
High-Yield Takeaway: NSAIDs worsen heart failure.
5.
A patient is prescribed warfarin for atrial fibrillation. The INR is 4.5. The patient has no
signs of bleeding. What is the most appropriate management?
,A. Administer vitamin K 10 mg IV
B. Hold warfarin and recheck INR in 1–2 days
C. Administer fresh frozen plasma
D. Increase warfarin dose
Correct Answer: B
Rationale: For INR 4.5 without bleeding, warfarin should be held and INR rechecked.
Vitamin K is reserved for serious bleeding or very high INR.
High-Yield Takeaway: INR 4.5 no bleeding = hold warfarin.
6.
The ankle-brachial index is a screening test used to assess a person's risk for:
A. Venous insufficiency
B. Peripheral artery disease
C. Deep vein thrombosis
D. Lymphedema
Correct Answer: B
Rationale: The ABI compares BP in the ankle to the arm and is used to screen for
peripheral artery disease.
High-Yield Takeaway: ABI = peripheral artery disease screening.
7.
When auscultating breath sounds in a patient who has left-sided heart failure, the
breath sounds are:
A. Vesicular with late inspiratory crackles in the dependent portions
B. Wheezing throughout all lung fields
C. Absent in the bases
D. Bronchial with expiratory wheezing
, Correct Answer: A
Rationale: Left-sided heart failure causes pulmonary congestion, producing late
inspiratory crackles in dependent areas.
High-Yield Takeaway: Left HF = late inspiratory crackles in dependent areas.
8.
Which of the following is a common side effect of atorvastatin?
A. Hyperglycemia
B. Muscle pain
C. Weight gain
D. Insomnia
Correct Answer: B
Rationale: Statins can cause myopathy, presenting as muscle pain or weakness.
High-Yield Takeaway: Statins = muscle pain (myopathy).
9.
Which medication is considered first-line treatment for hypertension in a patient with
diabetes?
A. Beta-blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Diuretic
Correct Answer: B
Rationale: ACE inhibitors are preferred in diabetic patients due to their renal protective
effects.
High-Yield Takeaway: Diabetes + HTN = ACE inhibitor first.
Section 1: Cardiovascular — Questions 1–20
1.
A 58-year-old male presents with progressive dyspnea on exertion, orthopnea, and
bilateral lower extremity edema. Exam reveals JVD, an S3 gallop, and bibasilar crackles.
BNP is 850 pg/mL. Which diagnosis is most likely?
A. COPD exacerbation
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: The classic triad of heart failure plus objective findings (JVD, S3 gallop,
crackles, elevated BNP) strongly supports HF.
High-Yield Takeaway: JVD + S3 + crackles + elevated BNP = heart failure.
2.
A patient with heart failure has a BNP of 850 pg/mL. What does this indicate?
A. Normal cardiac function
B. Volume overload and heart failure
C. Pulmonary embolism
D. COPD exacerbation
Correct Answer: B
Rationale: BNP >400 pg/mL strongly supports heart failure with volume overload.
High-Yield Takeaway: BNP >400 = heart failure.
,3.
The compensatory mechanism in early congestive heart failure involves:
A. Decreased preload
B. Increased sympathetic tone
C. Decreased afterload
D. Reduced renin release
Correct Answer: B
Rationale: Early heart failure triggers increased sympathetic tone to maintain cardiac
output, though this eventually becomes maladaptive.
High-Yield Takeaway: Early HF = increased sympathetic tone.
4.
A patient with a history of heart failure and hypertension presents with new-onset
dyspnea and bilateral lower extremity edema. Which medication class should be used
with caution?
A. ACE inhibitors
B. Beta-blockers
C. NSAIDs
D. Diuretics
Correct Answer: C
Rationale: NSAIDs can cause fluid retention, reduce renal function, and decrease the
effectiveness of diuretics and antihypertensives, potentially worsening heart failure.
High-Yield Takeaway: NSAIDs worsen heart failure.
5.
A patient is prescribed warfarin for atrial fibrillation. The INR is 4.5. The patient has no
signs of bleeding. What is the most appropriate management?
,A. Administer vitamin K 10 mg IV
B. Hold warfarin and recheck INR in 1–2 days
C. Administer fresh frozen plasma
D. Increase warfarin dose
Correct Answer: B
Rationale: For INR 4.5 without bleeding, warfarin should be held and INR rechecked.
Vitamin K is reserved for serious bleeding or very high INR.
High-Yield Takeaway: INR 4.5 no bleeding = hold warfarin.
6.
The ankle-brachial index is a screening test used to assess a person's risk for:
A. Venous insufficiency
B. Peripheral artery disease
C. Deep vein thrombosis
D. Lymphedema
Correct Answer: B
Rationale: The ABI compares BP in the ankle to the arm and is used to screen for
peripheral artery disease.
High-Yield Takeaway: ABI = peripheral artery disease screening.
7.
When auscultating breath sounds in a patient who has left-sided heart failure, the
breath sounds are:
A. Vesicular with late inspiratory crackles in the dependent portions
B. Wheezing throughout all lung fields
C. Absent in the bases
D. Bronchial with expiratory wheezing
, Correct Answer: A
Rationale: Left-sided heart failure causes pulmonary congestion, producing late
inspiratory crackles in dependent areas.
High-Yield Takeaway: Left HF = late inspiratory crackles in dependent areas.
8.
Which of the following is a common side effect of atorvastatin?
A. Hyperglycemia
B. Muscle pain
C. Weight gain
D. Insomnia
Correct Answer: B
Rationale: Statins can cause myopathy, presenting as muscle pain or weakness.
High-Yield Takeaway: Statins = muscle pain (myopathy).
9.
Which medication is considered first-line treatment for hypertension in a patient with
diabetes?
A. Beta-blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Diuretic
Correct Answer: B
Rationale: ACE inhibitors are preferred in diabetic patients due to their renal protective
effects.
High-Yield Takeaway: Diabetes + HTN = ACE inhibitor first.
