APEA 3P EXAM WITH EXLANATIONS

APEA 3P EXAM WITH EXLANATIONS
Mr. Holbrook, a 75-year-old male, is a former smoker with a 30-pack-year
history. He has comein today for an annual exam. He walks daily for 25 minutes,
has had intentional weight loss, andhas a near-normal BMI. On examination, the
patient is noted to have an absence of hair growth on his lower legs. Which
statement is true regarding this patient?
This is anormal consequenceof aging.
This might indicate disease in the lower
extremities.
It might be from exercise initiation.
This is secondary to long-term smoking.
B.
An absence of hair growth likely indicates peripheral artery disease in this
patient. It is part of normal changes of aging that hair growth will diminish, but
not become absent. His lower extremity pulses should be assessed, his cardiac
risk factors should be assessed (he smoked foryears), and he should be
questioned about leg pain when he walks. An ankle-brachial index could be
measured. If < 0.9, further assessment should be done. A normal ankle-brachial
indexshould begreater than 0.9. Less than 0.4 is considered critical.
Theusual clinical course of mitral valve prolapse:
is benign.
results in sudden cardiac
death.results inchronic
heart failure.
is associated with multipleepisodes of emboli.
A.
The usual course of mitral valve prolapse (MVP) is benign, and most patients who
have MVP are asymptomatic. A murmur may be present and is best auscultated
with the diaphragm of the stethoscope over the cardiac apex. In a minority of
patients, symptoms of heart failure or suddendeath mayoccur. When heart
failureresults, it is usually a result of mitral regurgitation.
Embolization mayoccur, but, this is not commonor usual in the majority of patients.
An ACE inhibitor is specifically indicated in patients who have:
hypertension, diabetes with proteinuria, and
heart failure.diabetes, hypertension,
hyperlipidemia.
asthma,hypertension, diabetes.
renal nephropathy, heart failure, hyperlipidemia.
A.
ACE inhibitors havenumerous indications. Three are indicated in the first choice.
ACE inhibitors are also indicated in patients who have renal insufficiency.
However, ACE inhibitors can worsen renal insufficiency, so the patients must be
monitored closely with lab tests for BUN,Cr, and potassium. Diabetes without
proteinuria is not a specific indication for ACE inhibitors use, though they are
used by somehealthcareproviders in this way. This is an off-label use.
Which patient could be expected to have the highest systolic
blood pressure?A 21-year-old male
A 50-year-old perimenopausal female
A 35-year-old patient with Type 2
diabetesA 75-year-old male
D.
Nearly 25% of the US population has hypertension. The greatest incidence is in
older adults because of changes in the intima of vessels as aging and calcium
deposition occur. Males of any age are more likely to be hypertensive than
females of the same age. African American adults have the highest incidence in
the general population. Among adolescents, African Americans andHispanics have
the highest rates. Hypertension occurs in 5-10% of pregnancies.
Mrs. Brandy is having contrast dye next week for a heart catheterization. What
drug does NOTneed to be stopped prior to her catheterization?
Naproxen
Furosemi
de
Metformi
n
Losartan
D.
Naproxen and furosemide should be stopped for 24 hours prior to the
catheterization. Metforminshould be stopped 48 hours prior to the
catheterization. Furosemide is stopped because it contributes to volume
depletion. NSAIDs like naproxen are withheld because of the impact on renal
prostaglandin production. Metformin has been implicated in lactic acidosis when
combinedwith contrast dye in an impaired kidney.
Inolder adults, the three most common ailments are:
hearing loss, vision loss,
hypertension.hearing loss,
hypertension, arthritis.
depression, vision loss,
hypertension. arthritis, hearing
loss, depression.
B.
Hypertension and arthritis are the two most common ailments in older adults.
Hearing loss occurs in half to almost 2/3 of older adults. The most common
form is known as presbycusis.There is noconsensus for the frequencyof
screening for hearing loss in older patients, but
minimally, it should be grossly evaluated at each visit and screened more
thoroughly if deficits areobserved. Blood pressureshould bescreened annually,
but it isusually screened at each visit.Arthritis is not routinely screened.
An older adult who has hypertension and angina takes multiple medications.
Which one of thefollowingdecreases the likelihood of his having angina?
ACE
inhibitor
Beta
blocker
Diuretic
Angiotensin receptor blocker
B.
The beta blocker slows down heart rate, depresses myocardial contractility,
and decreases sympathetic stimulation. These decrease myocardial oxygen
demand and improve angina symptoms. It is an excellent drug class to use to
prevent symptoms of angina in patients whohave underlying coronary artery
disease. Calcium channel blockers are another class of medications that could
beused to improvesymptoms of angina.