Question

UK 3. A 40-year-old man is undergoing a yearly physical. Everything is fine except that the nurse practitioner hears a murmur. All the following are likely etiologies EXCEPT pulmonic valve insufficiency. a heart valve that is ischemic from a coronary artery blockage. incompetent venous valves a stenotic mitral valve a. b. C. d. A patient has a DVT of the right calf. Which of the following is the LEAST LIKELY to develop? 4. Pain at the DVT site. Loss of perfusion in right foot because of the thrombus blocking distal arterial flow. Erythema of the skin in the local DVT area. Shortness of breath secondary to an embolus that breaks off the DVT,X a. b. C. d. An otherwise healthy patient has had hypertension (HTN) for many years. Which of the following is most likely true? 5. He has secondary hypertension. Etiologic factors of the HTN include epinephrine depletion The atrial natriuretic peptide system is in overdrive. Etiologic factors of the HTN include pathologic overaction of the RAAS. a. b. C. d.

Answer 1

3. A 40-year old man is undergoing a yearly physical. Everything is fine except that the nurse practitioner hears a murmur. All the following are likely etiologies except:

a. pulmonic valve insufficiency

b. a heart valve that is ischemic from a coronary artery blockage

c. incompetent venous valves
-the other answers are appropriate to the scenario; this is the exception, since it is talking about about valves in the veins; vein valves don't usually have murmurs that can be heard in this fashion.

d. a stenotic mitral valve

4. A patient has a DVT of the right calf. Which of the following is the least likely to develop?

a. Pain at the DVT site.
Wrong —pain IS a typical symptom.

b. Loss of perfusion in right foot because of the thrombus blocking distal arterial flow.
Correct -- DVT = deep VENOUS thrombosis; there might be thrombophlebitis (pain, erythema) as the vein & surrounding area become more inflamed, but since this is not an arterial situation, loss of pulse isn’t likely.

c. Erythema of the skin in the local DVT area.
Wrong —erythema IS a typical symptom of DVT.

d. Shortness of breath secondary to an embolus that breaks off the DVT.
Wrong — this may happen if an embolus develops form the DVT & travels to the lungs, so this IS a true fact about DVT, at least potentially.

5. An otherwise healthy patient has had hypertension (HTN) for many years. Which of the following is most likely true?

a. He has secondary hypertension
Wrong - unless you are told otherwise in the scenario, assume that the patient has essential hypertension, which is much more common than secondary HTN

b. Etiologic factors of the HTN include epinephrine depletion
Wrong - HTN's etiology includes pathological overaction of the sympathetic nervous system, inclusing subtly increased epinephrine levels

c. The atrial natriuretic peptide system is in overdrive

d. Etiologic factors of the HTN include pathologic overaction of the RAAS
Correct - instead of only kicking in when we have low BP or low volume, the RAAS pathologically kicks in a low-level way that results in subtly higher blood volume and pressure