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MSN 622 FINAL ACTUAL EXAM 100+ QUESTION AND ANSWERS LATEST 2024 A 65-year-old man who is a heavy smoker presents with a complaint of pain in both legs when he walks. He claims he can only walk half a block over the past few years without pain. He has been a smoker for 35 years and also drinks alcohol. He does not have a history of hypertension or heart disease. The ankle-brachial index in both legs is 0.70. What should be done to lower this patient's myocardial infarction risk? - Start patient on aspirin or clopidogrel A 65-year-old woman presents to the clinic for a 1-year follow-up and medication management. Her medical history is significant for congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus type 2, and chronic obstructive pulmonary disease (COPD). She has smoked 2 packs of cigarettes for 45 years. She drinks alcohol socially. Her current medications include lisinopril, hydrochlorothiazide, atorvastatin, metformin, albuterol, and inhaled fluticasone. Per the patient, she feels fine other than "some mild tingling in my feet." She denies chest pain, dyspnea, palpitations, dizziness, and weakness. She has not had laboratory work done in over 1 year. Her vital signs are temperature 37 °C (98.6 °F), heart rate 77 bpm, respiratory rate 16 breaths/min, and blood pressure 155/89 mm Hg. A physical exam is significant for absent bilateral pedal and posterior tibial artery pulses, significant edema, and brownish - The ratio of systolic ankle blood pressure to systolic brachial blood pressure A 65-year-old woman with claudication symptoms for the last six months presents to the clinic for evaluation. The patient has a history of diabetes and hypertension. She denies smoking. Physical exam shows palpable pulses on the bilateral lower extremities. Ankle-brachial index done at bedside shows a 1.1 on the right and 1.0 on the left lower extremity. What is the next best step in the management of this patient? - Repeat ankle-brachial index after exercise A 65-year-old female patient presents with complaints of progressive dyspnea on exertion for the past two weeks. The patient has a past medical history of hypertension. She has a 25-year smoking history but quit smoking 4 years ago. The patient reveals further that she initially had dyspnea only on moderate exertion, but now it occurs with activities like showering. The patient denies chest pain, cough, or wheezing. Her medications include metformin, amlodipine, and simvastatin. The patient appears comfortable at rest. Currently, she is afebrile and hemodynamically stable. Physical examination reveals bibasilar crackles. The patient's troponin-T level is normal. What changes are more likely to be seen on an electrocardiogram (ECG) if this patient is a suspected case of unstable angina? - Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment What heart sound would one hear in a patient with systolic congestive heart failure (CHF)? - S3 heart sound A 72-year-old man with a recent history of a large anterior wall myocardial infarction complains of dyspnea on exertion, orthopnea, and increasing pedal edema. There is concern about congestive heart failure. Which of the following would support the diagnosis? - . A S3 gallop Which of the following may be the initial presentation of long-term hypertension? - Cerebrovascular accident A patient presents with shortness of breath. Rales are heard in the lower lung fields. There is an S4. Hepatojugular reflux is present. The chest x-ray shows cardiomegaly and enlargement of the mediastinal veins. Congestive heart failure is suspected. Reduced bloodflow in the ascending aorta would not cause decreased blood flow in which of the following arteries? - . Pulmonary artery A 65-year-old man presents with a 4-hour history of progressively worsening left chest pain that radiates to his left neck. A history of present illness reveals minor episodes of transient chest pain over the last 6 months after climbing 2 flights of stairs or running. His past medical history includes hypertension, type 2 diabetes mellitus, and hyperlipidemia. His vital signs are oxygen saturation 98% on room air, respiratory rate 18 breaths/min, heart rate 91 bpm, blood pressure 131/91 mm Hg, and temperature 98.6 °F (37 °C). A 12-lead electrocardiogram (ECG) demonstrates ST depressions in leads V5, V6, and aVL. The patient is administered oxygen, morphine, nitroglycerin, and aspirin. What is the principle behind giving this patient nitroglycerin? - To dilate the venous system and decrease cardiac preload. A 65-year-old woman presents with intermittent, sudden-onset chest pain and shortness of breath, which radiates to her left jaw and arm. A history of present illness reveals that the pain initially occurred with activity, but now it occurs throughout the day. A review of systems is positive for tiring easily with mild physical activity. Her medical history is significant for hypertension and type 2 diabetes mellitus. An electrocardiogram (ECG) and cardiac enzyme markers are ordered. Which of the following tests will be most helpful in differentiating unstable angina from a non-ST segment elevation myocardial infarction (NSTEMI)? - Troponin I A 55-year-old asymptomatic, female smoker, with an extensive family history of premature coronary artery disease, presents to the office for further cardiovascular risk stratification. Her 10-year ASCVD risk score by the pool cohort equation is 5.3%, and she is concerned about testing for further risk stratification as she is reluctant to take medications. Which of the following is most appropriate to order to assist in treatment decision making? - Coronary artery calcium scoring