Question 1: You are participating in a health fair and performing cholesterol screens. One person has a cholesterol level of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?
Upright, but leaning forward
Left lateral decubitus
Stage 1 hypertension
Stage 2 hypertension
Question 4. Question : How should you determine whether a murmur is systolic or diastolic?
Palpate the carotid pulse.
Palpate the radial pulse.
Judge the relative length of systole and diastole by auscultation.
Correlate the murmur with a bedside heart monitor.
Question 5. Question : A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an electrocardiogram (ECG) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this.Which of the following symptoms would be more common in this patient’s age group for an AMI?
Pain radiating into the left arm
Pain radiating into the jaw
Mitral valve prolapse
Question 7. Question : Which of the following correlates with a sustained, high-amplitude point of maximal impulse (PMI)?
Question 8. Question : A 68-year-old woman with hypertension and diabetes is seen by the nurse practitioner for a dry cough that worsens at night when she lies in bed. She has shortness of breath, which worsens when she exerts herself. The patient’s pulse rate is 90/min and regular. The patient has gained 6 lbs over the past two months. She is on a nitroglycerine patch and furosemide daily. The explanation for her symptoms is:
Congestive heart failure
Angiotensin-converting enzyme (ACE) inhibitor induced coughing
Question 9. Question : When listening to a soft murmur or bruit, which of the following may be necessary?
Asking the patient to hold their breath.
Asking the patient in the next bed to turn down the TV.
Checking your stethoscope for air leaks.
All of the above.
Severe left heart failure
Question 1. Question : A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?
Question 2. Question : A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer.She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.
Left-sided heart failure
Question 3. Question : A patient with long-standing COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?
Percuss the lower border of the liver.
Measure the span of the liver.
Order a hepatitis panel.
Obtain an ultrasound of the liver.
Question 4. Question : A fifty-five-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should be considered because of her gesture?
Question 5. Question : When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?
Question 7. Question : All of the following are implicated in causing chronic cough except:
Acute viral upper respiratory infection
Gastroesophageal reflux disease
Different sounds from the nose and the chest
Sounds louder in the lower chest
Question 9. Question : Which of the following is consistent with good percussion technique?
Allow all of the fingers to touch the chest while performing percussion.
Maintain a stiff wrist and hand.
Leave the plexor finger on the pleximeter after each strike.
Strike the pleximeter over the distal interphalangeal joint.