AANP EXAM NOTES 5

Question 1

Increased risk for insulin resistance, Type 2 diabetes mellitus, renal dz.. hepatic dz., hyperlipidemia, HTN, CV dz are risk factors for PTs who are obese. T/F

Answer 1

TRUE

Question 2

WHAT IS THE MEANING OF LUB, DUB, KENTUCKY, TENNESSEE

Answer 2

S1, S2, S3, S4

Question 3

S1 = Systole, LUB. What valves are included in the S1?

Answer 3

(S1 heart sounds: mitral, tricuspid, & atrioventricular valves)

Question 4

S2 = diastole DUB. Where is this sound best heard?

Answer 4

2nd ICS on left side

Question 5

If the S2 sound is heard during inspiration, is it normal/abnormal?

Answer 5

normal

Question 6

S3 = Cardiac apex. Where on the body is the S3 sound best heard?

Answer 6

5th ICS on left MCL.

Question 7

If the S2 sound is heard during expiration, is it normal/abnormal?

Answer 7

abnormal

Question 8

What valves are associated with the S2 sound?

Answer 8

(aortic, pulmonic, semilunar valves)

Question 9

An abnormal S3 sound may be a sign of CHF in PTs older than what age?

Answer 9

40

Question 10

Hearing the S3 sound is normal in children, athletes, and during pregnancy. T/F?

Answer 10

TRUE. The left lateral recumbent position brings the apex closer to the wall & improves the ability to hear the left ventricular S3.

Question 11

The S4 sound is best heard where on the body?

Answer 11

5th ICS on left side,

Question 12

An S3 that sounds like “Kentucky,” is associated with CHF in children, pregnancy, and some athletes. T/F

Answer 12

TRUE

Question 13

The S4 sound is best heard at apex (bell). It indicates LVH (think oldest). T/F

Answer 13

TRUE

Question 14

The S4 sound occurs early/late in diastole.

Answer 14

LATE

Question 15

If the S4 sounds like “Tennessee” it indicates what atrial condition?

Answer 15

atrial gallop/atrial kick

Question 16

The Bell of stethoscope is used for high/low tones ?

Answer 16

LOW Tones, (mitral stenosis),

Question 17

The Diaphragm of the stethoscope is best used for Mid to high pitched sounds. T/F

Answer 17

TRUE. ? (MR, AS)

Question 18

A Physiological S2 Split is normal if heard on expiration. T/F

Answer 18

FALSE. A Physiological S2 Split is normal if heard on INSPIRATION.

Question 19

WHERE IS A PHYSIOLOGICAL S2 SPLIT BEST HEARD ON THE BODY?

Answer 19

2ND ICS UPPER LEFT SIDE OF STERNUM

Question 20

What is the most common cause of death for people with DM?

Answer 20

HEART DZ

Question 21

Heart disease & DM are common in what ethnic groups?

Answer 21

Mexican & African Americans, East Asians

Question 22

What type of murmur radiates?

Answer 22

Systolic murmurs

Question 23

Name 2 condx that may be indicated by Diastolic murmors

Answer 23

Aortic regurgitation, Mitral stenosis

Question 24

If a murmur is found in a child, what is your next step?

Answer 24

Refer to cardiology

Question 25

What type of holosystolic atrial murmur radiates to the axilla?

Answer 25

MR

Question 26

A PT with Afib requires what type of TX?

Answer 26

Anticoagulation

Question 27

Where is Aortic Regurgitation heard the loudest?

Answer 27

2nd ICS to right of sternum

Question 28

What condx is characterized by a long asymptomatic period followed by exercise intolerance.

Answer 28

Aortic Regurgitation

Question 29

What is a common early finding in a PT with AR?

Answer 29

Hypertrophied left ventricle

Question 30

What murmur presents as a high pitched, diastolic that radiates toward the cardiac apex?

Answer 30

AR

Question 31

Where is Mitral Stenosis murmur best heard?

Answer 31

Loudest Near cardiac apex

Question 32

What GRADE is a murmur that is easily audible, associated with a thrill?

Answer 32

IV/VI

Question 33

HTN is defined as BP above what levels?

Answer 33

130/80

Question 34

A correlation between BP and age > 60 years exists. As age increases DBP decreases

Answer 34

TRUE

Question 35

Naproxen has a FAVORABLE effect on HTN (Na + & K+). T/F

Answer 35

FALSE. Naproxen may have an UNFAVORABLE effect on HTN (Na + & K+).

Question 36

Pt on Thiazide should have what levels monitored?

Answer 36

K+ Levels

Question 37

Pt on Thiazide may experience what symptoms due to hypokalemia?

Answer 37

weakness, fatigue, muscle cramps, ED

Question 38

A PT treated with candesartan (ARB) should avoid what supplement?

Answer 38

Potassium

Question 39

What is one side effect of Lisinopril?

Answer 39

dry cough

Question 40

Lisinopril is what type of enzyme inhibitor?

Answer 40

ACE

Question 41

A 35 YO Caucasian male using lisinopril may have an increase in what?

Answer 41

K+ (Potassium)

Question 42

What is The most common indicator of end organ damage in adolescents with hypertension

Answer 42

left ventricular hypertrophy

Question 43

A low sodium diet is considered to be intake of less than how much sodium/day?

Answer 43

Less than 1.5g/day

Question 44

What type of diet is considered low sodium?

Answer 44

Mediterranean

Question 45

What is a diet you can recommend to PTs who need a low-sodium diet?

Answer 45

Dash

Question 46

Name 2 labs that can be ordered to check kidney function

Answer 46

Creatinine, eGFR, UA

Question 47

Name 2 labs that can check endocrine levels

Answer 47

TSH, Fasting blood glucose

Question 48

What lab checks for K+. NA+, CA+ etc/

Answer 48

Electrolyte panel

Question 49

Name 3 labs that can be ordered to check heart function

Answer 49

Chol, HDL, LDL, Trig (complete lipid panel)

Question 50

What lab can be ordered to check for anemia?

Answer 50

cbc

Question 51

What is considered an elevated BP?

Answer 51

120-129 / 80

Question 52

What is considered Stage 1 HTN

Answer 52

130-139 / 80-89

Question 53

What is considered Stage 2 HTN

Answer 53

>= 140 / >= 90

Question 54

TX for PT with Stage 1 HTN?

Answer 54

Start lifestyle changes and reassess

Question 55

PT with Stage 2 HTN should be making lifestyle changes and prescribed with medication. How often should the patient be reassessed?

Answer 55

Reassess in 1 month. If goal met, reassess in 3 to 6 months.

Question 56

If a PT with Stage 2 HTN is making lifestyle changes and prescribed medication but not meeting goals, what should be done?

Answer 56

If goal not met, consider different medication/ titration and recheck monthly.

Question 57

What tx should be given to children with secondary HTN?

Answer 57

Pharmacologic treatement

Question 58

R/t renal (Kidney failure), endocrine (hepatomegaly), respiratory disorders (bibasilar crackles), and damage to the retina (AV nicking) can be caused by ...

Answer 58

Secondary HTN

Question 59

Isolated Systolic HTN is caused by loss of recoil in the arteries (atherosclerosis), which increases PVR. T/F

Answer 59

TRUE

Question 60

What is the TX for isolated systolic HTN?

Answer 60

Treatment: Low dose thiazide diuretic or a calcium channel blocker

Question 61

Name a common CCB used to treat Isolated systolic HTN

Answer 61

AMLODIPINE

Question 62

Amlodipine may cause urinary incontinence. Why?

Answer 62

CCBs weaken muscle contraction

Question 63

Amlodipine requires K+ monitoring. T/F

Answer 63

FALSE. Amlodipine DOES NOT require K+ monitoring.

Question 64

PT with Pain that improves when dangling foot (elevation makes it worse) may have what dz?

Answer 64

Peripheral artery dz

Question 65

What ABI value is specific to PAD

Answer 65

< 0.9

Question 66

HOw is ankle brachial index (ABI) measured?

Answer 66

Divide highest SBP by Highest SBP in ankle

Question 67

Name 2 signs of Peripheral Vascular dz

Answer 67

Dull/ achy pain, Edema, yellow slough/ ruddy skin

Question 68

Name 2 symptoms of Chronic Venous Insufficiency

Answer 68

swelling/ heaviness, pain, itchiness, varicose veins, reddish/brown looking skin, scattered telangiectasias, & ulcers.

Question 69

MVP is usually benign. T/F

Answer 69

TRUE

Question 70

MVP often presents by a late systolic murmur and what type of click?

Answer 70

Mid systolic click

Question 71

Best test for MVP?

Answer 71

Echocardiography

Question 72

S/S of Abdominal aortic aneurysm includes: Acute/ sudden onset of tearing, severe low back pain/ abd. Pain. May have pustule abd. T/F

Answer 72

TRUE

Question 73

What is the most cost effective screen for Abdominal aortic aneurysm?

Answer 73

Abd ultrasound

Question 74

Complication of aortic dissection includes left/right pleural effusion:

Answer 74

LEFT (NOT RIGHT)

Question 75

When treating Hyperlipidemia Statins are most beneficial when taken in conjunction with what?

Answer 75

Diet & Exercise

Question 76

Alcoholic drinks should be avoided in PTs with Hyperlipidemia. T/F

Answer 76

TRUE

Question 77

How long do PTs need to fast for Hyperlipidemia lab?

Answer 77

12-14 hours

Question 78

Triglycerides require PT to fast how long?

Answer 78

x 12 hours

Question 79

What is normal total cholesterol

Answer 79

< 200

Question 80

What is the value of optimal LDL?

Answer 80

< 100 MG/DL

Question 81

Name 2 agents that are best for lowering triglycerides

Answer 81

Niacin, Fibrates

Question 82

Name 1 fibrate used to lower triglycerides

Answer 82

Fenofibrate (Tricor). ALSO: gemfibrozil (Lopid), & benzafibrate (Bezalip).

Question 83

What 2 meds are strong statins that can reduce triglycerides by 33 to 50%

Answer 83

Atorvastatin (Lipitor) & rosuvastatin (Crestor)

Question 84

Auscultation of ..... is indicated to assess for generalized atherosclerosis.

Answer 84

carotid bruits

Question 85

A PT with c/o pain in lower legs with ambulation (resolution with rest), reports pain in calf muscle (intermittent claudication). This may be caused by what condx?

Answer 85

atherosclerosis

Question 86

Lipid measurements should be repeated how often after initiating statin/dose adjustment?

Answer 86

4 to 12 weeks after initiating statin/dose adjustment.

Question 87

What dz is a connective tissue dz that leads to autoimmune driven vascular dz & diffuse fibrosis affecting the skin of the hands & face, joints, GI tract, & lungs.

Answer 87

Systemic sclerosis

Question 88

What is the TX for systemic sclerosis

Answer 88

Tx: Sildenafil, endothelin antagonists & prostacyclin agonists.

Question 89

PT reports acute onset (3 days) of unilateral swelling, pain, & discoloration (Red) in lower extremity from impaired blood flow, pain NOT relieved by walking. What is your diagnosis?

Answer 89

DVT

Question 90

Why is DVT an increased risk in pregnancy?

Answer 90

Inferior vena caba & pelvic vein compression by enlarging uterus

Question 91

Holman’s Sign (lower leg pain with dorsiflexion) indicates the PT has what condx?

Answer 91

DVT

Question 92

What can a PT use to help relieve DVT?

Answer 92

compression stockings

Question 93

What is a condition caused by blockage in the lymphatic system, part of the immune & circulatory system ?

Answer 93

Lymphedema

Question 94

What can a PT use to help relieve lymphedema?

Answer 94

Compression stockings

Question 95

Name 2 medications that can exacerbate heart failure

Answer 95

Metoprolol, Naproxen

Question 96

What are Typical heart sounds associated with CHF

Answer 96

S1, S2, S3

Question 97

The presence of S3 ventricular gallop acompanied by anasarca, dyspnea, dry cough, fatigue, SOB, wt. gain, audible bibasilar rales, is associated with what condx

Answer 97

CHF

Question 98

Crackles, bibasilar rales lower lobes, cough, mild dyspnea, decreased breath sounds, dullness to percussion are s/s of what type of heart failure?

Answer 98

Left ventricular failure

Question 99

Anorexia, nausea, RUQ pain, and lower extremity edema with cool skin HTN are s/s of what type of heart failure?

Answer 99

Right ventricular failure

Question 100

What CHF class is described by a patient whose ordinary physical activity results in fatigue, exertional dyspnea?

Answer 100

CLASS II