A patient who has diabetes presents with pain in his lower legs when he walks
and pain resolution with rest. When specifically asked about the pain in his lower
leg, he likely will report pain:
in and around the ankle joint.
in the calf muscle.
radiating down his leg from the thigh.
pain in his lower leg which waxes and wanes. - ANS ✓in the calf muscle
This patient's symptoms are typical of arteriosclerosis. The term for this
symptom is intermittent claudication. When there is compromised arterial blood
flow in the lower legs, a common complaint is reproducible pain in a specific
group of muscles. The pain occurs because there is an incongruence between
blood supply and demand. This produces pain that causes a patient to stop
exercising in order to obtain relief of pain.
A patient with mitral valve prolapse (MVP) reports chest pain and frequent
arrhythmias. In the absence of other underlying cardiac anomalies, the drug of
choice to treat her symptoms is a(n):
Beta blockers are recommended to alleviate atrial or ventricular arrhythmias
associated with mitral valve prolapse
The valve most commonly involved in chronic rheumatic heart disease is the:
aortic.
mitral.
pulmonic.
tricuspid. - ANS ✓MITRAL
The mitral valve has a propensity for disorders secondary to rheumatic heart
disease. Rarely is the pulmonic valve involved, but the aortic and tricuspid valves
follow in descending order of involvement. Following an episode of rheumatic
fever, which occurs infrequently in the US today but is common in developing
countries, the valves can become stenotic or regurgitant. This is a major cause of
valvular disease in the US seen primarily in immigrants
A decrease in blood pressure can occur in men who take sildenafil and:
amlodipine.
tamsulosin.
metoprolol.
any antihypertensive medication. - ANS ✓ANY B/P MED
Any antihypertensive medication could have an additive effect with sildenafil (or
another medication in this class). Caution is advised and should only be used if
the male has stable blood pressure. A specific drug-drug interaction to be aware
FNP CARDIO
, 3
FNP
of is the one that can occur with sildenafil and alpha blockers like tamsulosin,
alfuzosin, prazosin, doxazosin, or terazosin. This combination of medications may
increase the risk of symptomatic hypotension because the effect of these two
drugs is additive.
IE ALPHA BLOCKERS ARE COREG AND LABETALOL ARE BOTH ALPHA AND
BETA BLOCKERS
Which choice below characterizes a patient with aortic regurgitation?
Long asymptomatic period followed by exercise intolerance, then dyspnea at rest
An acute onset of shortness of breath in the fifth or sixth decade
Dyspnea on exertion for a long period of time before sudden cardiac death
A long asymptomatic period with sudden death usually during exercise - ANS
✓LONG ASYMPTOMATIC PERIOD FOLLOWED BY EXERCISE INTOLERANCE
THEN DYSPNEA AT REST.
The natural course of aortic regurgitation (AR) is that the patient has a long
asymptomatic period with slowing of activities but remains essentially
asymptomatic. Then, shortness of breath develops with activity and finally,
shortness of breath at rest. The left ventricle eventually fails unless the aorta is
replaced.
Most hypertension in pre-adolescents and children is:
related to elevated BMI.
primary hypertension.
secondary hypertension.
endocrine related - ANS ✓SECONDARY HTN
Most hypertension in children and pre-
FNP CARDIO
, 4
FNP
adolescents is secondary hypertension.
60-70% is due to renal parenchymal disease. Rarely does primary hypertension
exist in this age group. However, 85-90% of adolescents have primary
hypertension.
A 77 year-old patient has had an increase in blood pressure since the last exam.
The blood pressure has risen to 168/88 with 2 readings. The last exam's reading
was 144/90. If medication is to be started on this patient, what would be a good
first choice?
This patient is 77 years old and should have a goal blood pressure of < 150/90. A
thiazide diuretic is not a good first choice in this patient because it will not be
potent enough to decrease blood pressure by 25 points to get him to goal. A long
acting calcium channel blocker is appropriate for patients with isolated systolic
hypertension, ISH and will be more likely to get this patient to goal pressure than
HCTZ. Beta-blockers are no longer recommended first line for uncomplicated
hypertension. ACE inhibitors are very effective in patients who are high renin
producers. Elderly patients tend to produce lower amounts of renin.
Mrs. Brandy is having contrast dye next week for a heart catheterization. What
drug does NOT need to be stopped prior to her catheterization?
Naproxen
Furosemide
Metformin
Losartan - ANS ✓LOSARTAN
FNP CARDIO
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