Final Exam Week 8

  1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase the sound of a cardiac murmur associated with which of these conditions?
  2. Which of the following conditions may result in lower extremity edema?

Nephrotic syndrome

Decompensated congestive heart failure

Cirrhosis

Renal failure

Deep venous thrombosis

Late-stage pregnancy

All of the above

  1. Art Bakke is a 46-year-old male who is being treated for an acute myocardial infarction. He has now developed significant dyspnea at rest and, per physical exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-valve regurgitation.

Question: Which of the following physical findings would support this diagnostic hypothesis?

A palpable diastolic murmur maximal in the second intercostal space (ICS) at the left sternal border

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A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the left sternal border

A holosystolic systolic murmur heard maximally in the fifth ICS at the midclavicular line

  1. The most common ECG finding in a patient with a cardiomyopathy is an ST-elevation MI.

True

False

  1. Nina Martinez is a 70-year-old female who experienced an episode of acute pulmonary edema following an endovascular aneurysm repair. She was discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is now seen in the office at 2 weeks post discharge. Her metabolic panel includes the following lab values:

· Na 126 mEq/L

· K 4.0 mEq/L

· Cl 93 mEq/L

· CO2 28 mEq/L

· BUN 40 mg/dL

· Cr 1.3 mg/dL

Question: This patient has which of the following abnormalities as a likely consequence of diuretic overuse? NUR6550 Final Exam Week 8

Hyponatremia

Hypokalemia

Metabolic acidosis

  1. Which of the following are primary cardiomyopathy categories, as described by the World Health Organization (WHO) in 1995?

Dilated cardiomyopathy

Symbol Hypertrophic cardiomyopathy (HCM)

Symbol Restrictive cardiomyopathy

Symbol Arrhythmogenic right ventricular dysplasia

Symbol Unclassified

All of the above

  1. What is the most common cause of sudden cardiac death in young people?

What is the most common cause of sudden cardiac death in young people?

Myocardial infarction

Hypertrophic cardiomyopathy

Supraventricular tachycardia

Arrhythmogenic right ventricular dysplasia; aka arrhythmogenic right ventricular cardiomyopathy (ARVC)

  1. Which of the following are treatment options for a patient who presents with peripartum cardiomyopathy while still carrying the fetus? (Select all that apply.)

ACE inhibitors

Induction if stable

Emergent cesarean section if unstable

Digoxin

Nitroglycerin

  1. What are the 3 major clinical complications related to cardiomyopathies?

Arrhythmias; including ventricular tachycardia and ventricular fibrillation

Thromboembolic complications; including DVT, PE, and ventricular thrombi

Acute pulmonary edema

  1. Some patients with primary cardiomyopathies remain asymptomatic throughout their lifetime.

True

False

  1. A 38-year -old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take?

Acetaminophen and caffeine (Excedrin ® Migraine)

Naproxen sodium (Aleve ® )

Almotriptan (Axert ® )

Butalbital, acetaminophen and caffeine (Fioricet ® )

  1. You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a:

Drug-related reaction.

Consequence of occupational chemical exposure. NUR6550 Final Exam Week 8

Early sign of dementia.

Normal age-related change in hearing

  1. While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism?

Nitrites

30 mg/dL protein

Epithelial cells

pH>8

  1. All of the following are examples of primary prevention strategies except:

Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination.

Performing a hemoglobin A1C for all patients admitted to the hospital.

Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk.

Immunizing all adults ?60 years with zoster vaccine.

  1. A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics?

Usually obliterates S2.

Becomes softer when going from a supine to standing position.

Occurs late in systole.

Has localized area of auscultation

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