A patient with chronic heart failure is on an ACE inhibitor. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as chronic heart failure? a. it is dry and nonproductive b. it is wet and worse with recumbence c. it is purulent and tachycardia accompanies it d. shortness of breath always results after coughing b. it is wet and worse with recumbence A patient with hypertension and myocardial infarction six years ago presents today with mild shortness of breath. He takes quinapril, ASA, metoprolol, and a statin daily. What symptom is NOT indicative of a CHF exacerbation? a. fatigue b. headache c. orthopnea d. cough b. headache A patient with shortness of breath has suspected CHF. What test would best help determine this? a. echocardiogram b. BNP c. EKG d. BUN/creat b. BNP Ramipril has been initiated at a low dose in a patient with CHF. What is most important to monitor in about one week? a. heart rate b. blood pressure c. EKG d. potassium level d. potassium level ACE inhibitors and ARBs reduce proteinuria by lowering the intraglomerular pressure, reducing hyperfiltration. These drugs tend to raise the serum potassium level and reduce the glomerular filtration rate (GFR). Monitoring the serum potassium and creatinine levels and the GFR is therefore imperative. Enlargement of the atrium or ventricle is important in assessing a patient with an audible murmur. Which study below would be most helpful in evaluating the degree of hypertrophy of the atrium or ventricle? a. chest x-ray b. EKG c. echocardiogram d. doppler ultrasound c. echocardiogram A patient has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past two years. This murmur is probably: a. mitral valve prolapse b. acute mitral regurgitation c. chronic mitral regurgitation d. mitral stenosis d. mitral stenosis MS. ARD MR. ASS MVP is on Mr. Ass's team A 28yo has a grade 3 murmur. Which characteristic indicates a need for referral? a. a fixed split b. an increase in splitting with inspiration c. None of these d. changes in intensity with position changes a. a fixed split The most common arrhythmia resulting from valvular heart disease is: a. atrial fibrillation b. paroxysmal supraventricular tachycardia c. ventricular fibrillation d. heart block a. atrial fibrillation What are the most common signs and symptoms associated with mononucleosis? a. fatigue and lymphadenopathy b. cough and phayngitis c. splenomegaly and fever d. rash and pharyngitis a. fatigue and lymphadenopathy Most common signs are fatigue, lymphadenopathy, and pharyngitis. A cough is not common. Drugs that target the renin-angiotensin-aldosterone system are particularly beneficial in patients with: a. hypertension b. chronic heart failure c. kidney stones d. diabetic nephropathy d. diabetic nephropathy All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except a. epigastric pain b. positive obturator sign c. marked febrile response d. rebound tenderness c. marked febrile response Appendix = obturator and psoas sign A positive obturator sign is pain that is elicited in a supine patient by internally and externally rotating the flexed right hip. Psoas sign is elicited by having the patient lie on his or her left side while the right thigh is flexed backward. Which patient would be expected to have the highest systolic blood pressure? a. a 21yo male b. a 50yo perimenopausal female c. a 35yo with diabetes d. a 75yo male d. a 75yo male The nurse practitioner performs a fundoscopic exam on a patient who has recently been diagnosed with hypertension. She identifies AV nicking. a. This is an incidental finding b. This is indicative of long standing hypertension c. The patient should be screened for diabetes d. The patient should be referred to ophthalmology b. This is indicative of long standing hypertension AV nicking = Chronic hypertension stiffens and thickens arteries. At AV crossing points arteries indent and displace veins. Benazepril should be discontinued immediately if: a. dry cough develops b. pregnancy occurs c. potassium levels decrease d. gout develops b. pregnancy occurs Which of the following medications does not warrant monitoring of potassium levels? a. fosinopril