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NU623 Adult Healthcare questions with
complete solutions. Newly updated!!
What is unstable angina, preinfarct angina, and "crescendo angina - CORRECT
ANSWER -Synonyms used to describe the new onset of cardiac ischemic chest pain
at rest but without evidence of acute myocardial infarction (MI).
Reports of symptoms at rest are more likely to be associated with? - CORRECT
ANSWER -Coronary artery vasospasm, a condition usually seen in patients with
coronary atherosclerosis The pain of costochondritis (a type of chest wall syndrome [CWS]) is often described
as? - CORRECT ANSWER -Localized, and it may be replicated with arm
movement or pressing on the area of tenderness (point tenderness)
How is pain associated with angina pectoris described? - CORRECT ANSWER -
Generally, it is described as a diffuse, retrosternal sensation of pain, often with radiation, and a heavy, burning sensation, usually lasting more than 1 minute but less than 10 minutes. Exertional symptoms are usually more common in individuals with fixed atherosclerotic lesions. In assessing the person with known angina pectoris, it is critical to ascertain if there has been a change in the symptom pattern because this may indicate an alteration in vessel patency such as that found in accelerated atherosclerosis or vessel spasm. Defined as the awareness of the beating of one's heart and may be benign or
pathological in nature. - CORRECT ANSWER -Palpitations-
If the patient reports a sensation of a strong but regular rhythmic beating of the heart after stress or exertion, this likely indicates a normal physiological response to increased catecholamine production. If there is a report of skipped or missed beats, particularly with the sensation that the heart "stopped" momentarily, this may indicate the presence of an atrial or ventricular ectopic beat. What diagnostic testing should be performed for a patient with cardiac-related syncope?
- CORRECT ANSWER -Thyroid function (thyroid-stimulating hormone), blood
chemistries, hemoglobin, and hematocrit should be evaluated to help rule out thyroid disorder, electrolyte imbalance, and anemia as possible, though less common, causes of palpitations. Ambulatory cardiac monitoring (Holter monitoring) until at least one event is recorded is most helpful in ascertaining the presence of a potentially lethal cardiac rhythm disturbance. Echocardiography may be necessary to assess cardiac outflow tract patency and to help rule out valvular stenosis or hypertrophic cardiomyopathy.
Syncope is a loss of consciousness that occurs abruptly as a discrete episode and usually lasts for a short period of only a few minutes. What is the pathology of syncope?
- CORRECT ANSWER -The implied pathology is decreased cerebral blood flow caused by a marked decrease in cardiac output. some of these episodes are explainable and of noncardiac origin (e.g., fluid loss, dehydration, emotional stress), the majority of these episodes are cardiovascular in origin, including the most common etiology of vasovagal or cardioneurogenic syncope. A syncopal episode may be the only warning sign of impending sudden cardiac death. One of the most common cardiac causes of syncope is cardiac arrhythmias What causes dyspnea associated with left-sided cardiac outflow tract blockage, such as
in severe aortic stenosis or obstructive cardiomyopathy? - CORRECT
ANSWER -Dyspnea likely arises from the decrease in cardiac output
What causes dyspnea associated with recurrent myocardial ischemia, as in angina
pectoris? - CORRECT ANSWER -The shortness of breath is likely caused by an
increase in pulmonary vascular pressure, coupled with a transient decrease in cardiac output. What causes dyspnea in right-sided cardiac problems, such as tricuspid and pulmonic
valvular dysfunction? - CORRECT ANSWER -The complaint of dyspnea usually
arises from increased pulmonary pressures and resistance to cardiac emptying of the right ventricle.
What is the most common cause of orthopnea? - CORRECT ANSWER -It is
usually caused by CHF as a result of increased right-sided heart pressure, which increases after the patient has been supine for a few hours, mobilizing fluid that pooled in the extremities during the more active awake hours
What is Paroxysmal nocturnal dyspnea (PND)? - CORRECT ANSWER -
Shortness of breath that occurs 1 to 2 hours into sleep, concurrent with the redistribution of bodily fluids and a subsequent rise in left atrial pressure. The person awakens suddenly with significant difficulty breathing. He or she usually stands or sits up until symptoms are relieved in about 10 to 30 minutes. As with orthopnea, the diagnosis of CHF should be considered in patients with PND.
What is Peripheral Vascular Disease? - CORRECT ANSWER -It affects the
arteries and veins. When the vascular disease is arterial, it is usually the result of atherosclerosis (accumulation of fatty streaks and fibrous plaques and high levels of low-density lipoproteins). Venous problems are related to venous incompetence secondary to valve obstruction, resulting in chronic venous insufficiency and varicose veins.
What is Malignant HTN? - CORRECT ANSWER -Malignant HTN is diagnosed
when a patient presents with severely elevated BP in the range of 180/110 mm Hg or higher and evidence of acute TOD. Although these terms are often used interchangeably, hypertensive emergency or hypertensive crisis denotes this process acutely. If not treated with immediate parenteral antihypertensive therapy in an acute- care setting, a hypertensive emergency may prove fatal. In contrast, a significantly elevated BP alone with no evidence of TOD does not constitute an emergency and is classified as a hypertensive urgency. What clinical assessments should be performed for a patient presenting with acute,
severely elevated BP? - CORRECT ANSWER -Evaluation should include
funduscopic examination, palpation of the chest for point of maximal impulse (PMI), auscultation of the heart, abdominal assessment for bruits or widened aortic diameter and enlarged kidneys, examination of the carotid arteries for bruits, palpation of peripheral pulses, and a neurologic examination, such as funduscopy, electrocardiogram (ECG), urinalysis, serum creatinine measurements, and a chest x- ray. A computed tomography (CT) scan of the head to rule out stroke may be necessary, if the patient presents with mental status changes. The assessment should include two measurements of BP in both arms, with the patient seated with both feet on a flat surface (crossing the legs may increase the systolic BP [SBP] by 2-8 mm Hg) and the back supported with the arm at heart level (diastolic BP [DBP] may be decreased by up to 6 mm Hg if the arm is below the level of the heart). The patient should remain quiet and not speak during the reading.
How is metabolic syndrome characterized? - CORRECT ANSWER -Abdominal
obesity, glucose intolerance, insulin resistance, hyperinsulinemia, dyslipidemia, and HTN.
What physical examination findings correlate with hyperlipidemia? - CORRECT
ANSWER -Physical examination may reveal a carotid bruit or corneal arcus. In some
forms of dyslipidemia, yellowish skin deposits of cholesterol called xanthomas may develop. These deposits commonly occur around the eyelids (xanthelasma) and extensor tendons. Interestingly, even with effective lipid-lowering therapy, these deposits tend not to regress. What indicates an infarction caused by a nonocclusive thrombus that partially interrupts perfusion of the myocardium and results in an infarction affecting only part of the
myocardial wall, rather than its full thickness? - CORRECT ANSWER -Non-
STEMI
What is caused by an occlusive thrombus that leads to a complete transmural MI—an
infarction of the full thickness of the myocardial wall? - CORRECT ANSWER -
STEMI
What is a common complication of a LV MI? - CORRECT ANSWER -Mitral
regurgitation
