Cardiovascular Flashcards
A patient presents with complaints of severe sudden onset retrosternal pain that worsens with inspiration, especially while lying supine. Which assessment finding would be highly suggestive of acute pericarditis?
A. a scratchy or grating sound auscultated at the cardiac apex and left sternal border
B. a drop in systolic blood pressure during inspiration
C. apical pulse auscultated past the midclavicular line
D. apical pulse auscultated at the mid clavicular line
A
A scratchy or grating sound auscultated at the cardiac apex and left sternal border
A pericardial friction rub, as described above, is highly indicative of acute pericarditis (Rogers, p. 1084, 2022).
Which of the following would NOT be considered a positive criterion for the diagnosis of infective endocarditis based on the Modified Duke Criteria?
A. Urgent placement of a non-tunneled hemodialysis catheter earlier that day
B. vegetative lesions adhering to the mitral valve
C. fever
D. History of IV drug abuse
A. - Urgent placement of a non-tunneled hemodialysis catheter earlier that day
rationale
Long-term indwelling IV catheters (rather than a recent history of a temporary/ short term venous catheter) are a risk factor for infective endocarditis and would fall into the Modified Duke Criteria (Rogers, p. 1094, 2022).
Which of the following is NOT a pathophysiologic consequence of aortic stenosis?
A.jugular venous distention
B. decreased cardiac output
C. pulmonary hypertension
D Left ventricular hypertrophy
Jugular Venous Distention
rationale
Not associated w/ aortic stenosis- distractor
A patient is coming into the clinic complaining of more frequent falls and dizziness. When the nurse does the patient vitals they are as follows:
0905: BP 130/85, HR 95, Sp02 98% RA, position sitting
0908: BP 90/60, HR 105, Spo2 98% Ra, position: standing.
After standing the patient reports dizziness and is unsteady on his feet. What is a likely diagnosis for this patient?
A. Hypertension
B. Orthostatic Hypotension
C. Aortic Aneurysm
D. Fat embolism
Orthostatic Hypotension
A patient presents to the clinic with a history of HLD, HTN, and past MI. The patient is complaining of substernal chest pain and shortness of breath when going up and down the stairs or when walking for an extended time. They state that the pain does subside when they rest or take one nitro. This patient is experiencing what type of angina?
A. unstable angina
B. stable angina
C. Prinzmental angina
D. Acute coronary symptom
stable angina. This chest pain is caused by myocardial ischemia and plaques that partially obstruct coronary vessels. With increase in demand on the heart that comes with physical activity the coronary vessels are not able to dilate to provide needed blood flow. It is considered stable angina because when demand is decreased there is no necrosis of the myocardial tissue and cardiac enzymes remain at baseline. The pain is caused by lactic acid buildup and the stretching of of ischemic myocardium.
Which of the following is the congenital cardiac abnormality characterized by the failure of normal speciation and division for the embryonic out flow tract into the pulmonary artery and aorta. This results in a single vessel in the heart. Clinical manifestations include a newborn with mild cyanosis and moderate heart failure.
A. Tetralogy of Fallot
B. Tricuspid atresia
C. truncus arteriosus
D. coarctation of the aorta
Truncus arteriosus with 4 types. This is caused by lack of division between the pulmonary artery and aorta with a single valve. Often the valve experiences dysfunction. A VSD is present to allow mixing of systemic and arterial flow
Which of the following is a risk factor for primary hypertension?
A. 28-year-old male with a BMI < 30
B. 26-year-old white male who works out 3-4 times a week
C. 45-year-old, black male with heavy alcohol consumption
D. 20-year-old female
45-year-old, black male with heavy alcohol consumption(correct) – risk factors are found on in a table on page 1063; advancing age, heavy alcohol consumption, and black race are risk factors for primary hypertension
A 45-year-old female comes into the emergency room with complaints of pain and tenderness of bilateral feet; you examine her feet and notice cyanosis of her toes and thin shiny ulcers between her toes; she states that she smokes 5 packs of cigarettes a day and has for the past 30 years. What diagnosis are you suspecting for this patient?
A. Aneurysm
B. Thromboangiitis obliterans (Buerger disease)
C. Embolism
D. Myocardial infarction
Thromboangiitis obliterans (Buerger disease) (correct) – this is a highly inflammatory autoimmune disease of the peripheral arteries; it is strongly associated with smoking. The chief symptoms are pain and tenderness of the affected extremity, usually affecting more than 1, skin redness, cyanosis, and thin and shiny ulcers on the skin, usually in people < 45 years of age, smoking history
While working in labor and delivery, you are assessing an infant that was just born; you notice the infant has faint pulses, hypotension, tachycardia, and won’t latch for feedings; you assess the heart sounds and notice a loud, harsh, systolic ejection murmur, what diagnosis do you expect for this patient?
A. Ventricular septal defect
B. Aortic stenosis
C. Atrial septal defect
D. Tetralogy of Fallot
Aortic stenosis (correct) – this is a narrowing of the outlets of the LV, causing resistance of blood flow from the LV into the aorta; clinical manifestations include an infant with faint pulses, hypotension, tachycardia, poor feeding, a loud, harsh systolic ejection murmur heard on auscultation
Poor circulation can result in inadequate venous return and chronic venous insufficiency. Complications of chronic venous insufficiency can result in all of the following except:
A. Inflammatory reaction
B. Edema in lower extremities
C. Varicose veins
D. Venous stasis ulcer
Varicose veins
John, a 56 year old male presents with complaints of severe retrosternal chest pain that started last night. He states the pain is worse with a deep breath or when leaning back into recliner to try to sleep. He also reports a fatigue, weakness, and feelings of unease. He briefly mentions had a fever 6 days ago, lasting 48 hours. He is vaccinated for COVID 19, but has not had his annual flu vaccine and had a possible exposure to a coworker who tested positive for influenza. Vital signs are: 100.1 F, HR 105, RR 20, BP 140/83, O2 Sat 97%. Based on the symptoms John is most likely experiencing:
A. Pneumonia
B. Pericarditis
C. Restrictive Pericarditis
D. Myocardial Infarction
Pericarditis is most often idiopathic in nature, iatrogenic or caused by viral infections. The pericardial membrane becomes inflamed resulting in “sudden onset of severe retrosternal chest pain that worsens with respiratory movements and when assuming a recumbent position” (Rogers, 2023, p. 1084). Pain is typically relieved when sitting or leaning forward beyond 90 degrees Other symptoms include dysphagia, restlessness, irritability, anxiety, weakness, and malaise. Low grade fever and tachycardia are also typically present
Which statement regarding patent ductus arteriosus (PDA) is not correct?
A. PDA refers to failure of the fetal ductus arteriosus to close within 10-15 hours after birth
B. IV indomethacin or ibuprofen has proven successful in closing a PDA in premature infants
C. PDA only occurs in premature newborns
D. Manifest as pulmonary distress such poor feeding, fatigue, and failure to thrive
According to Rogers (2023) the hallmark risk factor for PDA is premature birth. But other risk factors are congenital rubella, perinatal asphyxia, and birth in high altitude places. There are also inherited syndromes that increase risk of PDA (p. 1110).
A 3-day-old female infant is brought to a local pediatric urgent care by her parents due to her having fatigue during feeding, generalized cyanosis, and difficulty breathing. During physical examination and taking vitals, the practitioner finds that the infant has low oxygen saturation and a harsh systolic murmur. Which congenital heart defect is the most likely to cause these symptoms?
A. Tetralogy of Fallot.
B. Coarctation of the aorta.
C. Patent ductus arteriosus.
D. Atrial septal defect
Tetralogy of Fallot is a cyanotic heart defect that demonstrates four abnormalities: pulmonary stenosis, an overriding aorta, ventricular septal defect, and right ventricular hypertrophy (Rogers & Brashers, 2023, p. 1117). Due to the defects, a right-to-left shunt is created, bypassing the lungs to enter systemic circulation, leading to cyanosis. Turbulent blood flows through the narrowed pulmonary valve, leading to a harsh systolic murmur. This is the most common cyanotic heart defect, and it occurs in up to 10% of all diagnoses of congestive heart failure
A 68-year-old male presents to his primary care provider with the following symptoms: redness, swelling, and pain located in his left calf. The patient stated that he had had recent surgery for his back, a laminectomy, that left him immobilized for several weeks. The provider is considering deep vein thrombosis (DVT) as the diagnosis, so which of the following mechanisms best explains what is happening with this patient?
A. Impaired arterial blood flow leading to ischemia.
B. Hypercoagulability, venous stasis, and endothelial damage.
C. Decreased platelet production, leading to blood pooling.
D. Increased vascular permeability leads to excessive blood loss.
A DVT primarily develops due to three factors: venous stasis, endothelial damage, and hypercoagulability
During hospital rounds, the medical team visits a 50-year-old male patient admitted due to his symptoms. On admission, the patient was noted to have sharp, central pain that improves when sitting up and leaning forward but worsens with inspiration. The patient also reports being recently diagnosed with viral influenza at his primary care provider’s office. The practitioner observes a scratchy, grating sound upon auscultating the patient’s heart, with the heart sounds otherwise being muffled and distant. The medical team diagnoses him as having acute pericarditis. Based on this diagnosis, which of the following best describes this condition?
A Mitral valve regurgitation leads to volume overload.
B Coronary artery occlusion that results in myocardial ischemia.
C Pericardial inflammation is caused by friction between pericardial layers.
D Increased production of pericardial fluid.
Acute pericarditis is often caused by infection or other triggers and leads to inflammation of the pericardium (Rogers & Brashers, 2023, pp. 1084-1085). The inflammation causes the two layers of the pericardium to rub against each other. This rubbing leads to sharp, pleuritic chest pain that can be heard on auscultation and typically improves when the patient is leaning forward while sitting upright but worsens in a recumbent position.
A 10-year-old boy comes to your office for a physical exam. His BMI is 29, and his blood pressure is elevated. He denies any pain and is asymptomatic. He has a family history of hypertension. Which of the following is the most appropriate action as a primary care provider?
A. Prescribe ACE inhibitors
B. Order ambulatory blood pressure monitoring
C. Encourage him to increase exercise, lose weight, and eat a healthy balanced diet
D. Ensure there is no blood pressure difference between the upper and lower extremities and order an echocardiogram to assess for coarctation of the aorta
C. Encourage him to increase exercise, lose weight, and eat a healthy balanced diet
The first-line management of primary hypertension in children involves nonpharmacologic interventions, including lifestyle changes such as weight loss, increased physical activity, and a healthy diet. These strategies are effective for lowering blood pressure in children with elevated BMI and family history of hypertension. Since the child is asymptomatic, lifestyle modifications should be the initial approach, and no medications or advanced diagnostic tests are needed unless hypertension persists despite these changes. (p. 1127)
Mr. Kent is a 57-year-old man with a recent history of unstable angina and hypertension, currently on hypertensive medication. He has been feeling fatigued for several weeks and has developed extreme shortness of breath, along with coughing up pink, frothy sputum.
His vital signs are as follows: Pulse: 120 bpm, Respiration: 26 breaths per minute, Temperature: 97.8°F, Blood Pressure: 155/83 mmHg, SpO2: 90%
A chest X-ray reveals bilateral pleural effusion. Upon examination, you note that Mr. Kent has not been taking his hypertensive medication for this week. Which of the following is the most likely clinical manifestation and diagnosis?
A. Left Heart Failure; crackles upon auscultation
B. Aortic Aneurysm; severe pain, hypotension
C. Infective Endocarditis; murmur
D. Atherosclerosis; intermittent claudication
Mr. Kent’s symptoms, including shortness of breath, pink frothy sputum, and bilateral pleural effusion, strongly suggest left-sided heart failure. Left heart failure results in fluid accumulation in the lungs (pulmonary edema), causing crackles upon auscultation and frothy sputum—a hallmark sign of pulmonary congestion. The chest X-ray showing bilateral pleural effusion is consistent with left heart failure, where fluid accumulates in the lungs due to the inability of the left ventricle to pump effectively.
A 13-year-old boy presents to your office with symptoms of fever, joint pain, nausea, and vomiting. He has a recent history of a streptococcal pharyngeal infection. Upon physical examination, you note lymphadenopathy, warm and swollen hands and knees, a heart murmur, subcutaneous nodules over his knees, and a skin rash with a slightly raised, red border and a pale center on the trunk and limbs. Which of the following is the most likely diagnosis?
A. Acute rheumatic fever
B. Chronic venous insufficiency
C. Raynaud phenomenon
D. Kawasaki disease
Acute rheumatic fever
Acute rheumatic fever (ARF) is a systemic inflammatory disease that occurs after a group A streptococcal throat infection. It commonly affects children aged 5-15 years and is characterized by fever, arthritis, chorea, carditis, erythema marginatum, and subcutaneous nodules. The clinical presentation of this patient strongly suggests acute rheumatic fever. Acute rheumatic fever is a serious condition that can result in heart damage if untreated which is a common cause of rheumatic heart disease(p. 1094).
A patient newly diagnosed with chronic venous insufficiency will start with conservative treatment. The NP understands that conservative treatment will be:
A Have legs in a dependent position
B Wear loose stockings
C Make sure to have lots of time sitting
D Finding the underlying cause of venous insufficiency
Finding the underlying cause of venous insufficiency
During an annual exam, the patient reports that they do minimal walking and sit in their job for 90% of the day. The NP understands that a sedentary lifestyle can contribute to all EXCEPT:
A Increased coronary artery disease risk
B Insulin resistance
C Increased HDL levels
D Increased blood pressure
Increased HDL levels
A 4-year-old presents to the clinic with his parents. The child has had a fever for the past 6 days with “pink eye” on both eyes with no drainage, swollen hands and feet, swollen lymph nodes in the neck, and irritation of the lips, mouth, and throat. The NP suspects that the child may have:
A Kawasaki Disease
B Heart failure
C Tetralogy of Fallot
D Coarctation of the aorta
A. Kawasaki Disease
Rationale: Is a disease that if not recognized and treated in a timely manner, can lead to myocarditis. It is mostly occurs in children under the age of 5 and is more common in boys than girls. Classic s/s are fever (over 5 days), conjunctivitis, rash, erythema of the palms and soles, lymphadenopathy, and red mucous membranes (strawberry tongue).
According to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, the following drugs are considered first line treatment for HTN, except:
A ARB’s
B Beta blockers
C Thiazide diuretics
D ACE inhibitors
beta blockers–. Angiotensin receptor blockers, thiazide diuretics, ACE inhibitors, and calcium channel blockers are all considered firstline treatment for HTN according to ACC/AHA. Beta blockers should be reserved for patients with ischemic heart disease or heart failure.
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommends completing a cardiovascular risk assessment for all patients aged 40-69 using the Pooled Cohort Equation (PCE), to determine the 10-year risk of fatal and non-fatal cardiovascular disease events. The PCE evaluates each of the following, except:
A HDL/LDL cholesterol
B Current aspirin therapy
C Smoking status
D HgA1C
HgA1C
The PCE assesses the following: age, sex, race, SBP/DBP, total cholesterol, HDL/LDL cholesterol, history of diabetes, smoking status, and whether the patient is on current aspirin therapy, HTN treatment, and statin therapy
A “P” wave on an echocardiogram represents:
A Atrial depolarization
B Atrial repolarization
C Ventricular depolarization
D Ventricular repolarization
Atrial depolarization
The P wave represents atrial depolarization (followed by atrial contraction). The QRS complex represents ventricular depolarization (atrial repolarization is hidden). The T wave represents ventricular repolarization
