Question 1

Your 47-year-old female patient has a waist to hip ratio of 1.In terms of cardiovascular disease risk,this is considered:

Accepted Answer

A waist to hip ratio of 1 indicates that the waist circumference is equal to the hip circumference, which suggests high visceral fat accumulation. This is associated with an increased risk of cardiovascular disease, type 2 diabetes, and other health conditions. Therefore, a waist to hip ratio of 1 is greater than acceptable limits. A normal waist to hip ratio for women should generally be 0.85 or less.

Question 2

A patient with hypertension who has hyperlipidemia should aim for LDL measurement to be:

Accepted Answer

According to the American Heart Association, people with hypertension and hyperlipidemia should aim for an LDL cholesterol measurement of 100 mg/dL or less. This is because high LDL cholesterol levels increase the risk of cardiovascular diseases, and hypertension further elevates this risk. Lowering LDL levels reduces the risk of cardiovascular diseases in these patients. Therefore, option C is the best choice. Options A, B, and D have higher LDL limits, which may not be adequate for reducing the cardiovascular risk in these patients.

Question 3

Your patient complains of worsening ankle edema and weight gain over the last week.On physical examination,you note jugular venous distension,ascites,hepatomegaly,and splenomegaly.These conditions are indicative of:

Accepted Answer

The presence of jugular venous distension, ascites, hepatomegaly, and splenomegaly are classic symptoms of right-sided heart failure, which can occur secondary to various causes including pulmonary hypertension, chronic obstructive pulmonary disease, or left-sided heart failure. Pulmonary embolism typically presents with sudden onset of shortness of breath, chest pain, and cough, and may be associated with tachycardia and hypoxemia. Left ventricular failure and myocardial infarction typically present with symptoms of shortness of breath, chest pain or discomfort, and fatigue, but would not likely present with hepatomegaly, splenomegaly, or ascites.

Question 4

Your patient has had hypertension for 10 years,a myocardial infarction 5 years ago,and now complains of dyspnea on exertion,cough,and 3-pillow orthopnea.Which of the following conditions is likely?

Accepted Answer

The patient's history of hypertension and previous myocardial infarction indicate a high risk for left ventricular failure, which is supported by the symptoms of dyspnea on exertion and orthopnea. The cough may also indicate possible pulmonary congestion. Right ventricular failure and cor pulmonale may cause similar symptoms, but they are less likely given the patient's history. Pulmonary embolism may cause similar symptoms, but dyspnea on exertion and orthopnea are more likely related to left ventricular failure in this case.

Question 5

Your patient complains of a feeling of heaviness in the lower legs daily.You note varicosities,edema,and dusky color of both ankles and feet.Which of the following is the most likely cause for these symptoms?

Accepted Answer

The presence of varicosities, edema, and dusky color of both ankles and feet are classic signs of venous insufficiency, which results from incompetent valves in the lower extremity veins. Femoral vein thrombosis would present with swelling and pain in the affected leg, while femoral artery thrombus would manifest as acute limb ischemia with absent distal pulses, pallor, and pain. Musculoskeletal injury may cause localized pain or swelling, but is unlikely to cause the widespread symptoms described.

Question 6

The target body mass index for women is:

Accepted Answer

The answer of The target body mass index for women...

Question 7

After multiple pregnancies,the following vascular disorder is common:

Accepted Answer

Varicose veins are a common vascular disorder that can develop after multiple pregnancies due to increased pressure on the veins in the legs. Deep venous thrombosis (DVT) is another vascular disorder that can occur during pregnancy or after delivery, but it is not necessarily more common after multiple pregnancies. Peripheral arterial disease (PAD) and aortic aneurysm are not specifically related to pregnancy or multiple pregnancies.

Question 8

In aortic stenosis,the patient's point of maximal impulse is commonly located at the:

Accepted Answer

The answer of In aortic stenosis,the patient's point of maximal...

Question 9

An atrial septal defect (ASD)causes a left to right shunt,which enlarges the right atrium.Because of this effect,which of the following conditions often occur with ASD?

Accepted Answer

Jugular venous distension is a common finding in patients with an ASD due to the increased volume and pressure in the right atrium. Atrial fibrillation may also occur due to the enlargement of the atria and the resulting electrical changes in the heart. Asthma is not typically associated with ASD.

Question 10

A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest.On physical examination you note pallor of the right foot,capillary refill of 4 seconds in the right foot,+1 dorsalis pedis pulse in the right foot,and +2 pulse in left foot.Which of the following is a likely cause of the signs and symptoms?

Accepted Answer

The signs and symptoms suggest arterial insufficiency, which is characterized by pain and paresthesias that worsen with exercise and are relieved by rest, pallor of the affected limb, delayed capillary refill, and decreased peripheral pulses. Venous insufficiency and peripheral neuropathy may also cause pain and paresthesias but do not typically present with pallor or decreased peripheral pulses. Femoral vein thrombus may cause pain and swelling but typically does not present with paresthesias or decreased peripheral pulses.

Question 11

Which of the following conditions is/are part of metabolic syndrome?

Accepted Answer

Metabolic syndrome is a cluster of conditions that frequently occur together and increase the risk of heart disease, stroke, and diabetes. The conditions that are part of metabolic syndrome include hypertension, hyperlipidemia, and insulin resistance. Therefore, option D, "All of the above," is the correct choice.

Question 12

Aortic regurgitation occurs after S₂ during because there is turbulent flow that refluxes into the left ventricle after the aortic valve closes.

Accepted Answer

Aortic regurgitation occurs in early diastole because it is the phase where the aortic valve closes and blood regurgitates back from the aorta to the left ventricle due to incomplete valve closure.

Question 13

Which of the following ankle-brachial index measurements require a referral to a vascular consultant?

Accepted Answer

An ABI of 0.5 indicates severe arterial disease and requires referral to a vascular consultant for further evaluation and management. An ABI of 1.2 suggests non-compressible arteries which may be caused by arterial calcification and requires further assessment. An ABI of 1 is considered normal, while an ABI of 0.9 indicates mild to moderate arterial disease and may require lifestyle modifications or medication management.

Question 14

The murmur of a ventricular septal defect (VSD)occurs when the ventricle contracts and blood flows from the left ventricle into the right ventricle.This creates a heart murmur.

Accepted Answer

The murmur of a ventricular septal defect (VSD) is holosystolic, meaning it occurs throughout systole (when the ventricles contract) and is heard from the first heart sound to the second heart sound. It is not heard during diastole (when the ventricles relax), so choices A and B can be ruled out. Late systolic murmurs occur closer to the end of systole and are often associated with mitral valve prolapse, which is not relevant to VSD.

Question 15

When an examiner presses on the liver and elicits hepato-jugular reflux,which of the following conditions is likely?

Accepted Answer

The answer of When an examiner presses on the liver...

Question 16

Dyspnea,cough,and pulmonary crackles are symptoms that can occur in left ventricular failure and respiratory disorders,such as pneumonia.Which of the blood tests below can be used to differentiate cardiovascular from pulmonary disease?

Accepted Answer

B-type natriuretic peptide (BNP) is a marker for left ventricular dysfunction and can help differentiate between cardiovascular and pulmonary disease. Elevated levels of BNP suggest cardiac involvement, while normal or low levels suggest pulmonary disease. The other tests listed may be helpful in evaluating respiratory status but do not specifically differentiate between cardiac and pulmonary disease.

Question 17

A 23-year-old patient presents the emergency department with high fever,chills,extreme fatigue,and arthralgias.Your physical examination reveals grade II heart murmur heard loudest over the fourth intercostal space left sternal border.The arms of the patient reveal past intravenous drug abuse.The clinician should recognize these are signs and symptoms of:

Accepted Answer

The combination of high fever, chills, extreme fatigue, and arthralgias in a patient with a history of intravenous drug abuse and a grade II heart murmur suggests bacterial endocarditis, which is an infection of the inner lining of the heart and heart valves. The heart murmur is likely due to valvular damage from the infection. Pulmonary embolism and right ventricular failure may cause similar symptoms, but they would not be associated with a heart murmur. Functional heart murmurs are typically innocent and not associated with symptoms such as fever and joint pain.

Quiz 7: Cardiac and Peripheral Vascular Systems

Your 47-year-old female patient has a waist to hip ratio of 1.In terms of cardiovascular disease risk,this is considered:

A patient with hypertension who has hyperlipidemia should aim for LDL measurement to be:

Your patient complains of worsening ankle edema and weight gain over the last week.On physical examination,you note jugular venous distension,ascites,hepatomegaly,and splenomegaly.These conditions are indicative of:

Your patient has had hypertension for 10 years,a myocardial infarction 5 years ago,and now complains of dyspnea on exertion,cough,and 3-pillow orthopnea.Which of the following conditions is likely?

Your patient complains of a feeling of heaviness in the lower legs daily.You note varicosities,edema,and dusky color of both ankles and feet.Which of the following is the most likely cause for these symptoms?

The target body mass index for women is:

After multiple pregnancies,the following vascular disorder is common:

In aortic stenosis,the patient's point of maximal impulse is commonly located at the:

An atrial septal defect (ASD) causes a left to right shunt,which enlarges the right atrium.Because of this effect,which of the following conditions often occur with ASD?

Which of the following conditions is/are part of metabolic syndrome?

Aortic regurgitation occurs after S₂ during because there is turbulent flow that refluxes into the left ventricle after the aortic valve closes.

Which of the following ankle-brachial index measurements require a referral to a vascular consultant?

The murmur of a ventricular septal defect (VSD) occurs when the ventricle contracts and blood flows from the left ventricle into the right ventricle.This creates a heart murmur.

When an examiner presses on the liver and elicits hepato-jugular reflux,which of the following conditions is likely?

Dyspnea,cough,and pulmonary crackles are symptoms that can occur in left ventricular failure and respiratory disorders,such as pneumonia.Which of the blood tests below can be used to differentiate cardiovascular from pulmonary disease?

Quiz 7: Cardiac and Peripheral Vascular Systems

Your 47-year-old female patient has a waist to hip ratio of 1.In terms of cardiovascular disease risk,this is considered:

A patient with hypertension who has hyperlipidemia should aim for LDL measurement to be:

Your patient complains of worsening ankle edema and weight gain over the last week.On physical examination,you note jugular venous distension,ascites,hepatomegaly,and splenomegaly.These conditions are indicative of:

Your patient has had hypertension for 10 years,a myocardial infarction 5 years ago,and now complains of dyspnea on exertion,cough,and 3-pillow orthopnea.Which of the following conditions is likely?

Your patient complains of a feeling of heaviness in the lower legs daily.You note varicosities,edema,and dusky color of both ankles and feet.Which of the following is the most likely cause for these symptoms?

The target body mass index for women is:

After multiple pregnancies,the following vascular disorder is common:

In aortic stenosis,the patient's point of maximal impulse is commonly located at the:

An atrial septal defect (ASD) causes a left to right shunt,which enlarges the right atrium.Because of this effect,which of the following conditions often occur with ASD?

Which of the following conditions is/are part of metabolic syndrome?

Aortic regurgitation occurs after S2 during because there is turbulent flow that refluxes into the left ventricle after the aortic valve closes.

Which of the following ankle-brachial index measurements require a referral to a vascular consultant?

The murmur of a ventricular septal defect (VSD) occurs when the ventricle contracts and blood flows from the left ventricle into the right ventricle.This creates a heart murmur.

When an examiner presses on the liver and elicits hepato-jugular reflux,which of the following conditions is likely?

Dyspnea,cough,and pulmonary crackles are symptoms that can occur in left ventricular failure and respiratory disorders,such as pneumonia.Which of the blood tests below can be used to differentiate cardiovascular from pulmonary disease?

Aortic regurgitation occurs after S₂ during because there is turbulent flow that refluxes into the left ventricle after the aortic valve closes.