NGR 6619 BARKLEY CARDIOVASCULAR-Regis College
BARKLEY CARDIOVASCULAR
1. Your colleague's patient experiences a sudden onset of pain in her lower leg.
... [Show More] The area
where the patient identifies the pain is erythematous and warm to the touch but not swollen.
The patient also has a consistent temperature. Your colleague suggests elevating the leg and
applying warm compresses at night. He also prescribes a nonsteroidal anti-inflammatory drug
and suggests bed rest for at least a week to help the pain subside. Based on these findings,
which of these measures is not a correct form of treatment for the patient's condition?
a. Elevating the leg
b. Applying warm compresses
c. Prescribing non-steroidal anti-inflammatory drugs
d. Ordering bed rest
- Based on the sudden simultaneous presentation of pain, heat, and erythema in the
affected leg, accompanied by lack of swelling, the patient is most likely experiencing
superficial thrombosis, which is generally not treated with bed rest. Rather, mobility is
encouraged in patients with superficial thrombosis, whereas bed rest would be a
standard treatment for deep thrombosis. Elevating the leg, applying warm compresses,
and taking non-steroidal anti-inflammatory drugs are all effective methods of managing
superficial thrombosis.
2. Which of the following is not a common finding of acute left-sided heart failure?
a. Coarse rales in all lung fields
b. Hepatomegaly
c. Wheezing, frothy cough
d. An S3 gallop sound
- Hepatomegaly is common in chronic right-sided heart failure but is much less common
in acute heart failure. Coarse rales over all lung fields; a wheezing, frothy cough; and an
S3 gallop are all common findings of acute, left-sided heart failure.
3. With regard to S3 and S4 heart sounds, which statement is true?
a. An S3 sounds like "Kentucky" and is expected during pregnancy but otherwise, it is not a
normal finding in the adult.
b. An S3 is an atrial gallop and sounds like "Tennessee."
c. An S4 sounds like "Kentucky" and is expected during pregnancy but otherwise, it is not a
normal finding in the adult.
d. An S4 is a ventricular gallop and sounds like "Tennessee."
- An S3 heart sound is a ventricular gallop that matches the cadence of the word
"Kentucky" and typically presents as a result of increased fluid states; although it may be
normal during pregnancy, presentation of the S3 heart sound at other times may
indicate conditions such as chronic heart failure. An S4 heart sound, on the other hand,
is an atrial gallop that matches the cadence of "Tennessee" and is often associated with
conditions that result in a stiff ventricular wall, such as myocardial infarction and chronic
hypertension.
4. Which of the following statements is not typical of the heart murmur with which it is
associated?
a. A grade INI murmur is barely audible.
b. A grade IINI murmur is associated with a thrill.
c. A grade IIINI murmur can easily be heard.
d. A grade VNI murmur can be heard off the chest wall with one corner of the stethoscope.
- A grade IVNI heart murmur, not a grade IINI murmur, is often accompanied by a palpable
thrill. A grade INI murmur is barely audible, whereas a grade IINI murmur is audible but
faint. A grade IIINI murmur can easily be heard, and a VNI murmur is loud enough to be
heard with one corner of the stethoscope off the chest wall.
5. You hear a low-pitched diastolic rumble at the fifth intercostal space with the patient in the
left lateral position. The murmur does not radiate. You refer the patient to cardiology to "rule
out”
a. Aortic stenosis
b. Mitral regurgitation
c. Mitral stenosis
d. Aortic regurgitation
- Mitral stenosis often presents at the fifth intercostal space {ICS) with a low-pitched
diastolic rumble with minimal radiation. Mitral regurgitation likewise often presents at
the fifth ICS, but with a systolic "blowing· murmur that may radiate to the base or left
axilla. Aortic stenosis is systolic and often presents at the second right ICS, whereas
aortic regurgitation is diastolic and typically presents at the second left ICS; both
murmurs may be characterized by a "blowing" sound.
6. Which type of heart sound is caused by aortic and pulmonic valve closures?
a. S1
b. S2
c. S3
d. S4
- The S2 heart sound is caused by aortic and pulmonic valve closures. The S1 sound, on
the other hand, is caused by mitral and tricuspid valve closures, whereas the S3 sound is
typically caused by increased fluid states. Lastly, the S4 sound is usually caused by a stiff
ventricular wall.
7. Frank, age 56, has just been diagnosed with hypertension. After looking at his medical
history, you decide that propranolol would be the most effective form of treatment, as it
would treat his hypertension while also managing other conditions. Given the decided
treatment, Frank most likely has which of the following co-occurring conditions?
a. Migraines
b. Diabetes mellitus
c. Edema
d. Chronic kidney disease
- Beta blockers, such as propranolol, are particularly effective for treating hypertension as
well as remedying migraines. Patients with hypertension and diabetes mellitus may
benefit from calcium channel blockers or angiotensin converting enzyme (ACE)
inhibitors, but the potential side effects of those treatments include edema. Propranolol
may also cause edema. If a patient has hypertension, chronic kidney disease is one of
the conditions that must be considered when deciding course of treatment.
Hypertension associated with chronic kidney disease is not usually treated with beta
blockers, but more commonly with ACE inhibitors or angiotensin II receptor blockers.
8. According to the Eighth Joint National Committee hypertension guidelines, which of the
following is not used to estimate 10-year and lifetime atherosclerotic cardiovascular disease
risks?
a. High-density lipid cholesterol
b. Race
c. Diastolic blood pressure
d. Diabetes status
- By the hypertension recommendations of the Eighth Joint National Committee, systolic,
not diastolic, blood pressure is used to estimate 10-year and lifetime atherosclerotic
cardiovascular disease risks. Other such risks include high-density lipid cholesterol, race,
and diabetes status, as well as sex, total cholesterol, and history of smoking.
Normal 90/60 - 119/79 Normal 90/59-119/59
Pre HTN 120/80-139/89 Elevated 120/60-129/79
Stage 1 140/90-159/99 Stage 1 130/80-139/89
Stage 2 >160/100 Stage 2 >140/90
HTensive Crisis >180/120
9. Dependent rubor is a physical finding associated with which of these diseases or
conditions?
a. Chronic venous insufficiency
b. Superficial thrombophlebitis
c. Deep vein thrombosis
d. Peripheral vascular disease
- Dependent rubor, or a dusky, red tint to the foot when it is placed on the floor, is a
finding associated with peripheral vascular disease. Chronic venous insufficiency is more
likely to present with stasis leg ulcers and edema of the lower extremities. Superficial
thrombophlebitis is often characterized by localized heat and erythema, whereas a limb
affected by deep vein thrombosis may be cool to the touch and manifest with edema
distal to the occlusion.
10. Sarah, age 24, comes to your practice complaining of sudden pain in her legs and a lowgrade temperature. A physical exam reveals her right leg is hot to the touch and
erythematous. Sarah has been bed-ridden for the past few weeks due to a minor surgical
operation. Her medical history indicates that she is a smoker and uses an intrauterine device
for contraception. Given the most likely condition, which of the following is likely to be
considered a risk factor?
a. The patient is female.
b. The patient is bed-ridden.
c. The patient is a smoker.
d. The patient has an intrauterine device. [Show Less]