NSG 6001 Final Exam

I I I

Maintenance Iof Ian IIsometric IST-segment Iduring Iexercise Iis Ithe Iresponse Iof?
I
Student IAnswer:
An Iabnormal Iheart I
I

A Inormal Iheart I(Maintenance Iof Ian IIsometric IST-segment

I during Iexercise Iis Ithe Iresponse Iof Ia Inormal Iheart. I I) I
I

CAD I
I

Hypo Iprofusion I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: What Iis Ione Iof Ithe Icommon Icauses Iof Ia ISaccular IAbdominal
I2. IAneurysm?

I
Student IAnswer:
Drugs: Iillicit Iand Iprescribed I
I

Age I
I

Trauma I(One Iof Ithe Icommon Icauses Iof Ia Isaccular Iabdominal

I aneurysm Iis Itrauma.) I
I

Poor Ikidney Ifunctioning I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your Ipatient Iof I58 Iyears Iof Iage Ihas Ichronic Ihypertension. IYou
I3. Ifollow Ithe Iguidelines Ifor Imanagement Ias Idescribed Iby Ithe

IAmerican IHeart IAssociation Iand Inow Ihave Iyour Ipatient Ifully

Imedicated Iand Idosed Iwith Ithree Iseparate Iantihypertensive

 I medications Iwithout Icontrol Iof Ithe Iblood Ipressure. IWhat Ishould
I be Iyour Inext Istep Iin Ithe Imanagement Iof Ithis Ipatient?
I
Student IAnswer:
Increase Iexercise Irecommendations Ito Iinclude Imarathons I
I

Add Ia Ifourth Iagent I

I

Physician Iconsult I(As Ia Inurse Ipractitioner Iit Iis Iimportant Ito

Iknow Iwhen Ito Iseek Iconsultation Iwith Ia Iphysician. IThe Inext Istep
Iwould Ibe Ia Iphysician Iconsult Iafter Iprescribing Ithree

Iantihypertensive Iagents.) I

Continue Ito Iobserve Ifor Ian Iadditional Ithree Imonths Iwithout

I any Ichanges I

I Points IReceived: 0 Iof I5 I

I Comments:

Question Question I: The Idiagnostic Iaccuracy Iof Istress Itesting Iis Idecreased Iamong
I4. Iwomen Icompared Ito Imen Ifor Iwhat Ireasons?

I
Student IAnswer:
Women Icannot Iexercise Ias Ivigorously Ias Imen I
I

Women Itypically Ihave Imultiple Ivessel Idisease I

I

Women Ihaving Ithinner Iventricular Iand Iseptal Imuscles I

I

Women Iusually Ihave Isingle Ivessel Ior Inon-obstructive Idisease

I(The Idiagnostic Iaccuracy Iof Istress Itesting Iis Idecreased Iamong

Iwomen Icompared Ito Imen Ibecause Iwomen Iusually Ihave Isingle

Ivessel Ior Inon-obstructive Idisease.) I

I
Points IReceived: 5 Iof I5 I
I Comments:

Question Question I: Any Ipatient Ipresenting Iwith Isymptomatic Ibradycardia Ishould Ibe
I5. Ireferred Ito Ia Icardiologist Ifor Imanagement. IIs Ithis Istatement Itrue

Ior Ifalse?

I
Student IAnswer:
False I
I

True I(This Istatement Iis Itrue: Iany Ipatient Ipresenting Iwith

Isymptomatic Ibradycardia Ishould Ibe Ireferred Ito Ia Icardiologist Ifor
Imanagement.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Chronic, Inon-communicable Idiseases Iaccount Ifor

I6. Idisproportionate Icosts Ito Ithe Ihealthcare Isystem. IAccording Ito Ithe

IWorld IHealth IOrganization, Iwhat Ipercent Iof Ipreventable Ideaths

Iand Idisabilities Ioccur Iin Ithe IAmericas Irelated Ito Ichronic Inon-

communicable Idiseases?
I
Student IAnswer:
80%-90% I
I

60%-70% I(According Ito Ithe IWorld IHealth IOrganization,

I60%--7 I0% Iof Ipreventable Ideaths Iand Idisabilities Ioccur Iin Ithe

IAmericas Irelated Ito Ichronic Inon-communicable Idiseases. I I

I) I

10%-15% I
I

35%-45% I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: On Ithe Iechocardiography Iduring Ithe IETT Iyou Inotice Ithe
I7. Ifollowing Ichange: Iabnormal Ileft Iventricular Iejection Ifraction.

IWhat Ido Ithese Ichanges Isuggest Irelated Ito Ithis Ipatient?

I
Student IAnswer:
Ischemia Iof Ithe Imyocardium I(Abnormal Ileft Iventricular
I ejection Ifraction Isuggests Iischemia Iof Ithe Imyocardium.) I
I

Weak Iventricular Imuscles I

I

Rise Iin Iheart Irate Iwithout Ievidence Iof Iischemia I

I

Non-ischemic Ichanges Iof Ithe Ibaseline IECG I

 I Points IReceived: 5 Iof I5 I
I Comments:

Question Question I: What Iare Ithe Itwo Itypes Iof Ibradycardia Irecognized Iby Ithe
I8. IAmerican IHeart IAssociation?

I
Student IAnswer:
Relative Iand Idynamic I
I

Absolute Iand Ipending I

I

Refractory Iand Inon-refractory I

I

Relative Iand Iabsolute I(The Itwo Itypes Iof Ibradycardia

Irecognized Iby Ithe IAmerican IHeart IAssociation Iare Irelative Iand
Iabsolute.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Aortic Ianeurysms Iare Idescribed Ibased Ion Itheir Ishape. IAneurysms
I9. Imay Ibe Ifusiform Ior Isaccular. IWhen Ian Ianeurysm Iforms Ias Ia

Iweakness Ior Ibleb Ion Ione Iside Iof Ithe Iaorta, Iit Iis Idescribed Ias Iwhat

Iform Iof Ianeurysm?

I
Student IAnswer:
Fusiform I
I

Saccular I(When Ian Ianeurysm Iforms Ias Ia Iweakness Ior Ibleb Ion
Ione Iside Iof Ithe Iaorta, Iit Iis Idescribed Ias Isaccular Iform Iof

Ianeurysm.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: There Iis Ia Iwide Irange Iof Iantibiotic Iagents Ithat Ican Ibe Iselected Ito
I10. Itreat Ia Iurinary Itract Iinfection. IUnfortunately, Ithere Iis Ioften Ifailure

Iof Itreatment Inoticed. IFrom Ithe Ilist Ibelow, Iwhich Iwould Ibe

Iconsidered Ia Icommon Ireason Ifor Itreatment Ifailure Iin IUTI?

I
Student IAnswer:
Race Ior Iethnicity Iof Ipatient I
I

Inadequate Itreatment Iduration I(A Icommon Ireason Ifor

Itreatment Ifailure Iin IUTI Iinadequate Itreatment Iduration.) I

Therapeutic Idosing Iof Ithe Iantibiotic I

I

Selecting Ithe Iappropriate Iantibiotic Ithe Ifirst Itime I

I Points IReceived: 0 Iof I5 I

I Comments:

Question Question I: You Isee Ia I60-year Iold IAfrican IAmerican Imale Iin Iyour Iclinic Iwith
I11. Ia Irecent Idiagnosis Iof Ihypertension. IHe Iasks Iyou Iwhat Ihe Ishould

Irestrict Iin Ihis Idiet, Iand Iis Iparticularly Iinterested Iin Ilimiting Ihis

Isodium Iintake. IWhat Iamount Iof Isodium Iintake Iwould Iyou

Irecommend Ion Ia Idaily Ibasis Ifor Ithis Ipatient?

I
Student IAnswer:
3.0 Ig/day I
I

No Iadded Itable Isalt I

I

2.3 Ig/day I
I

1.5 Ig/day I(The Irecommended Idaily Iintake Iis I1.5g Iper Iday.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: A I35 Iyear Iold Ifemale Iarrives Iat Iyour Iclinic. IShe Ihas Ihad Idiabetes
I12. Iand Iperipheral Iartery Idisease Ifor Ithe Ipast I5 Iyears. IYou Idecide Ito

Iobtain Ian IETT. IThe Iinsurance Icompany Iargues Ithat Ithis Iis

Iinappropriate. IYou Ijustify Ithe IETT Ibecause Iyou Iare Iplanning

Isecondary Istrategies Ito Iprevent Ifuture Iheart Idisease. IWhere Icould

Ione Ifind Ithe Isupporting Idata Ifor Ithese Iguidelines?

I
Student IAnswer:
Medicaid Iguidelines I
I

Medicare Iguidelines I
I

Do Inot Iexist I
I

Framingham Irisk Iscore I(These Iguidelines Icome Ifrom Ithe

IFramingham Irisk Iscore.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: A I65-year Iold Iwhite Imale Iarrives Iin Iyour Iclinic Iwith Igeneral
I13. Icomplaints Iof Islight Iabdominal Idiscomfort. IHe Ihas Ia Iknown

Ihistory Iof Ismoking Itwo Ipacks Iper Iday Ifor I40 Iyears Iand

Ihypertension. IHe Ialso Ihas ICOPD Iand Ihas Ibeen Itreated Inumerous

Itimes Iwith Ioral Isteroids. IYou Iconsider Iseveral Ioptional Idiagnoses.

IOf Ithe Iones Ilisted Ibelow, Iwhich Ishould Ibe Iincluded Ias Ia Ipotential

Itop Isuspect Iin Iyour Ichoice Iof Idiagnosis?

I
Student IAnswer:
Appendicitis I
I

Abdominal Iaortic Ianeurysm I(Abdominal Iaortic Ianeurysm

Ishould Ibe Iincluded Ias Ia Ipotential Itop Isuspect Iin Iyour Ichoice Iof
Idiagnosis.) I

Chronic Ibowel Iobstruction I

I

Meglacolon I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Of Ithe Ianswers Ibelow, Iwhich Iwould Ibe Iincluded Iin Idefining Ia
I14. Ipositive IExercise IEchocardiogram?

I
Student IAnswer:
Induced Idecrease Iin Iregional Iwall Imotion I(Induced Idecrease
Iin Iregional Iwall Imotion Iwould Ibe Iincluded Iin Idefining Ia Ipositive
Iexercise Iechocardiogram. IWall Ithickening Iwould Inot Itraditionally

Ioccur Iin Ia Ipositive Itest Iand Ihyperkinesis, Inot Ihypokinesis,

Igenerally Ioccurs Iin Ia Ipositive Itest.) I

Regional Ihypokensis Iof Iventricular Imuscles Iwalls I

I

Increase Iin Iwall Ithickening I

I

Death Itwo Idays Iafter Itest I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: You Ireceive Ia Ireport Iback Ion Ithe Isuspected Iabdominal Iaortic
I15. Ianeurysm Ifor Iyour Ipatient. IIt Iconfirms Iyour Isuspicion Iof IAAA.

IThe Ireport Idescribes Ithe Ianeurysm Ias Ia Isymmetric Iweakness Iof

Ithe Ientire Icircumference Iof Ithe Iaorta. IYou Iknow Ithat Ithis Iform Iof

Ianeurysm Iis Ireferred Ito Ias Iwhat Ikind Iof Ianeurysm?

I
Student IAnswer:
Fusiform Ianeurysm I(This Iform Iof Ianeurysm Iis Ireferred Ito Ias Ia
I fusiform Ianeurysm.) I
I

Saccular Ianeurysm I
I

Thoracic Ianeurysm I
I

Budging Isac Ianeurysm I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Ischemic Ichanges Ion IECG Iduring IETT Iis Ihighly Ipredictive Iof
I16. ICAD. IWhat Iis Ianother Iimportant Istrong Ipredictor Iof ICAD Ithat

Iyou Imight Isee Iduring Ian IETT?

I
Student IAnswer:
Rapid Iheart Irate I
I

Slow Iheart Irate I

I

Exercise-induced Ihypertension I
I

Exercise-induced Ihypotension I(Another Iimportant Istrong

Ipredictor Iof ICAD Ithat Iyou Imight Isee Iduring Ian IETT Iis Iexercise-

induced Ihypotension. I I I) I
 I Points IReceived: 5 Iof I5 I
I Comments:

Question Question I: You Itell Ia Ipatient Ithat Ihe Ihas Ia Imurmur. IHe Isays Ihe Ihas Ibeen Itold
I17. Ithis Ibefore, Ibut Iwonders Iwhat Icauses Ithe Iunique Isounds Iof Ia

Imurmur. IWhich Iof Ithe Ifollowing I Iwould Ibe Iyour Ibest Ioption?

I
Student IAnswer:
High Ipressures Icaused Ifrom IHTN I
I

There Iis Ino Ireason, Iit Ijust Ihappens I

I

Turbulent Iflow Iof Iblood I(The Ibest Ianswer Iis Iturbulent Iflow Iof
I blood.) I
I

Almost Ialways Ifrom Ia Isclerotic Ivalve I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your Ipractice Ipartner Ijust Iordered Ian Iexercise Iechocardiography
I18. I2DE Ifor Ia Ipatient Iwith Isuspected Icardiovascular Irisk. IThis Ipatient

Ihas Iknown Iresting Iwall Imotion Iabnormalities. IWhy Iwould Ithis

Inot Ibe Ithe Ibest Itest Ito Iassess Ithis Ipatient’s Icardiac Irisk?

I
Student IAnswer:
Sensitivity Iis Idecreased I(This Iwould Inot Ibe Ithe Ibest Itest Ito
Iassess Ithis Ipatient’s Icardiac Irisk Ibecause Isensitivity Iis Idecreased. I
I) I

Specificity Iis Iincreased I

I

Specificity Iis Idecreased I

I

Sensitivity Iis Iincreased I

I Points IReceived: 5 Iof I5 I

I Comments:
Question Question I: Overall, Ithe Irisk Ifor Iabdominal Iaortic Ianeurysm Iis Igreater Iamong:
I19.

I
Student IAnswer:
Whites I(Overall, Ithe Irisk Ifor Iabdominal Iaortic Ianeurysm Iis
Igreater Iamong Iwhites.) I

Women I
I

Asian IAmericans I
I

African IAmericans I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: What Iare Itwo Iof Ithe Imost Icommon Iforms Iof IExercise IStress ITests
I20. Iused Itoday?

I
Student IAnswer:
Bicycle Iand Itreadmill I(Bicycle Iand Itreadmill Iare Ithe Itwo Imost
I common Iforms Iof Iexercise Istress Itests Iused Itoday. I I) I
I

Unicycle Iand IRunning Iin Ipace I

I

Bicycle Iand Irowing Imachine I

I

Thallium Iand IDobutamine I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: You Ihave Iconfirmed Ithat Iyour Ipatient Idoes Iindeed Ihave Ian
I21. Iabdominal Iaortic Ianeurysm. IIn Iteaching Iyour Ipatient Iabout

Isymptoms Ito Ireport Iimmediately Ito Ithe Ivascular Isurgeon, Iyou

Iinstruct Ithe Ipatient Ito Ireport Iwhich Iof Ithe Ifollowing?

I
Student IAnswer:
Visual Idisturbances I
I

Newly Idiagnosed Idiabetes I

I

Back Ipain Ior Iflank Ipain I(In Iteaching Iyour Ipatient Iabout
Isymptoms Ito Ireport Iimmediately Ito Ithe Ivascular Isurgeon, Iyou
Iinstruct Ithe Ipatient Ito Ireport Iback Ipain Ior Iflank Ipain.) I

Headaches I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your Ipatient Iis Imorbidly Iobese Iand Icannot Isit Ion Ia Ibicycle Ior
I22. Iwalk Ia Itreadmill. IShe Ialso Ihas Imarked Iand Isevere Iemphysema.

IYou Ineed Ito Imake Ian Iassessment Iof Ithe Irisk Iof Isignificant ICAD

Iand Iyour Ipatient’s Ifamily Isays Ithat Itheir Irelative Ihad Itheir

Idiagnosis Ibased Ion Ian Iultrasound Iechocardiography. IWhat Ifacts

Iwould Iinfluence Iyour Idecision Iregarding Ithe Ifamily Irequest Ifor

Iecho Iassessment?

I
Student IAnswer:
Sensitivity Iwould Ibe Iincreased Ibecause Iof Ilung Idisease I
I

Sensitivity Iwould Ibe Ireduced Ibecause Iof Iobesity Iand Ilung

Idisease I(Sensitivity Iwould Ibe Ireduced Ibecause Iof Iobesity Iand
Ilung Idisease.) I

Specificity Iwould Ibe Iincreased Ibecause Iof Iobesity I

I

Specificity Iwould Ibe Ireduced Ibecause Iof Iobesity Iand Ilung

Idisease I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Automaticity Iis Ia Iproperty Icommon Ito Iall Icardiac Icells. IIs Ithis
I23. Istatement Itrue Ior Ifalse?

I
Student IAnswer:
True I(This Iis Ia Itrue Istatement: Iautomaticity Iis Ia Iproperty
I common Ito Iall Icardiac Icells.) I
I

False I
 I Points IReceived: 5 Iof I5 I
I Comments:

Question Question I: You Iare Iconsidering Iadding Ian Iadjunctive Iform Iof Itesting Ito
I24. Idetect Iwall Imotion Iabnormalities Iduring Ithe IETT. IYou Iselect

IEchocardiography Ias Ithe Iadded Itesting. IYou Ichoose Ithis Itest

Ibecause Iyou Iknow Ithat Iechocardiography Idoes Iwhat Iwhen Iadded

Ito Ia Istandard IETT?

I
Student IAnswer:
Enhances Isensitivity Iwhile Ireducing Ispecificity Iof ICAD
Idetection I

You Ilike Ipretty Ipictures Iof Iwall Imotion I

I

Enhances Isensitivity Iand Ispecificity Iof ICAD Idetection I(You

Ichoose Ithis Itest Ibecause Iyou Iknow Ithat Iechocardiography
Ienhances Isensitivity Iand Ispecificity Iof ICAD Idetection.) I

Enhances Ispecificity Iwhile Inot Ichanging Isensitivity Iof

I detection Ifor ICAD I

I Points IReceived: 0 Iof I5 I

I Comments:

Question Question I: More Ithan Ihalf Iof Iall Icardiac Iarrhythmias Iinvolve Ithe Iatria.
I25.

I
Student IAnswer:
False I
I

True I(This Iis Ia Itrue Istatement: Imore Ithan Ihalf Iof Iall Icardiac
I arrhythmias Iinvolve Ithe Iatria.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Medicaid Iis Imandated Ito Ibe Iprovided Iby Ieach Istate Ithrough
I26. Ifederal Icodes. IEach Istate Imust Ioffer IMedicaid Iexactly Ias Ithe

Ifederal Igovernment Iprescribes. ITrue Ior Ifalse?

I
Student IAnswer:
False I(Medicaid Iis Imandated Ito Ibe Iprovided Iby Ieach Istate,
Ihowever, IMediciad Iis Inot Irequired Ito Ibe Idelivered Iby Iany Icertain
Iformula. IEach Istate Ihas Iautonomy Ito Ideliver IMediciad Iservices

Iunder Iits Iown Iguidelines, Iprovided Ithat Ieach Istate Imeets Ithe

Ifederal Iguidelines Ifor IMedicaid Icoverage. I I I) I

True I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: What Ithree Iconditions Idefinitely Ialter Ithe Iresults Iof
I27. Iechocardiography Iin Idetermining ICAD?

I
Student IAnswer:
Diabetes, Ikidney Idisease Iand Itooth Idecay I
I

Obesity, Islow Iheart Irates Iand Ihypertension I

I

Previous IMI, Ihypotension Iand Idiabetes I

I

Obesity, Irapid Iheart Irate Iand Ilung Idisease I(Obesity, Irapid

Iheart Irate Iand Ilung Idisease Idefinitely Ialter Ithe Iresults Iof
Iechocardiography Iin Idetermining ICAD.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your Ipatient Icannot Isit Ion Ia Ibicycle Iand Ihas Idifficulties Iwalking Ia
I28. Itreadmill Iwith Ilimited Icapacity Ifor Iexercising. IStill, Iyou Iknow

Ithat Ithe IETT Iis Ithe Ipreferred Itest Ifor ICAD. IYou Iconsider Iadding Ia

Ipharmacological Iagent Ito Iget Ito Imaximum Iheart Irate. IWhat Iagent

Iwould Ibe Ithe Imost Icommonly Iused Iagent Ito Iassist Iin Ian IETT?

I
Student IAnswer:
Epinephrine I
I

Dobutamine I(The Ipharmacological Iagent Imost Icommonly

I used Ito Iassist Iin Ian IETT Iis Idobutamine.) I
I

Dopamine I
I

Aspirin I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: By Istandard Icriteria, Ihow Iis Ia Ipositive Istress Itest Idefined?
I29.

I
Student IAnswer:
Development Iof Ia Ihorizontal Ior Idown Isloping IST-segment
Idepression Iof I1mm I(A Ipositive Istress Itest Iis Idefined Ias Ithe
Idevelopment Iof Ia Ihorizontal Ior Idown Isloping IST-segment

Idepression Iof I1mm. I I I) I

Down Isloping Iof Ithe IST-segment Iat Ithe IJ Ipoint Iof Ithe IQRS I
I

Development Iof Ia Ihorizontal Ior Idown Isloping IST-segment

Idepression Iof I10mm I

Upward Isloping IST-segment Imeasured Iat Ithe IJ Ipoint Iof Ithe

IQRS I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: For Ian Iuncomplicated IUTI Iyou Ichoose Ito Iorder ITMP-SMZ Ifor
I30. Iyour Ipatient. IWhat Iis Ithe Irecommended Iduration Iof Itherapy Ithat

Iyou Ishould Iconsidered?

I
Student IAnswer:
3 Idays I(The Irecommended Iduration Iof Itherapy Iis I3 Idays.) I
I

7-10 Idays I
I

2 Iweeks I
I

1 Iday I

I Points IReceived: 0 Iof I5 I

I Comments:
Question Question I: Your Ipatient Ihas Ia Imaximum Iage-predicted Iheart Irate Iof I180.
I31. IDuring Ithe Iexercise, Ihe Ireaches Ia Iheart Irate Iof I140 Iand Ithen Istates

Ihe Ican Ino Ilonger Iexercise. IYou Isee Ino Ievidence Iof Iischemia Ion

Ithe IECG. IThis Iwould Ibe Idiagnostic Ifor Iwhat Icondition?

I
Student IAnswer:
Diagnostic Iof Ilaziness I
I

Has Ino Idiagnostic Ivalue Ito Irule Iout ICAD I(This Iscenario Ihas
I no Idiagnostic Ivalue Ito Irule Iout ICAD.) I
I

Predictive Iof Ino ICAD I

I

Diagnostic Ifor Iimpending IMyocardial IInfarction I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your Ipatient Iasks Iyou Iwhat Icauses Ia Irupture Iof Ian Iabdominal
I32. Iaortic Ianeurysm. IYou Iknow Ithe Ianswer Iis Imost Ioften:

I
Student IAnswer:
Work Ior Imarital Istress I
I

Trauma Ito Ithe Iabdomen Iis Imost Ioften Ithe Icause I

I

Ulcerations Ithat I“chew” Ithrough Ithe Iabdominal Iwall I

I

Wall Itension Iexceeds Itensile Istrength Iof Iwall Icollagen I(The

Icause Iof Ia Irupture Iin Ian Iabdominal Iaortic Ianeurysm Iis Iwhen Ithe
Iwall Itension Iexceeds Ithe Itensile Istrength Iof Iwall Icollagen.) I

I
Points IReceived: 5 Iof I5 I
I Comments:

Question Question I: What Icriterion Idoes Ithe IAmerican IHeart IAssociation Iuse Ito
I33. Iclassify Irelative Ibradycardia?

I
Student IAnswer:
Heart Irate Ibelow I60 Ibeats Iper Iminute I
I

Heart Irate Iabove I60 Ibeats Iper Iminute I

I

Heart Irate Ibelow I60 Ithat Idoes Inot Isupport Iadequate Icardiac
I output I
I

Heart Irate Iabove I60 Ithat Idoes Inot Isupport Iadequate Icardiac
Ioutput I(The Icriterion Ithe IAmerican IHeart IAssociation Iuses Ito
Iclassify Irelative Ibradycardia Iis Ia Iheart Irate Iabove I60 Ithat Idoes Inot

Isupport Iadequate Icardiac Ioutput.) I

I Points IReceived: 0 Iof I5 I

I Comments:

Question Question I: Changes Iin IMedicare Iare Ia Imethod Ithe Igovernment Iuses Ito Imake
I34. Ichanges Ito Ireimbursement Ischedules Ifor Ihealthcare. ICurrently,

IMedicare Ireimburses Inurse Ipractitioners Ifor Iall Iservices, Ieven

Ithose Ideemed Ito Ibe Iexclusive Ito Inursing?

I
Student IAnswer:
False I(Currently, IMedicare Idoes Inot Ireimburse Inurse
Ipractitioners Ifor Iall Iservices, Ieven Ithose Ideemed Ito Ibe Iexclusive
Ito Inursing. I I) I

True I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: What Iis Ithe Ileading Icause Iof Ideath Ifor Iwomen Iin Ithe IUnited
I35. IStates?

I
Student IAnswer:
Complications Iof Ichildbirth I
I

Lung Icancer I
I

Breast Icancer I
I

Heart Idisease I(Heart Idisease Iis Ithe Ileading Icause Iof Ideath Ifor
Iwomen Iin Ithe IUnited IStates.) I

I Points IReceived: 5 Iof I5 I

 I Comments:

Question Question I: When Ithere Iis Ia Iconsequential Iloss Iof Istructural Iintegrity Iof Ithe
I36. Iabdominal Iaorta, Ithe Iresulting Iissue Iis Iwhat Icondition?

I
Student IAnswer:
Bloated Istomach I
I

Bleeding Iulcers I
I

Kidney Ifailure I
I

Abdominal Iaortic Ianeurysm I(When Ithere Iis Ia Iconsequential

Iloss Iof Istructural Iintegrity Iof Ithe Iabdominal Iaorta, Ithe Iresulting
Iissue Iis Iabdominal Iaortic Ianeurysm.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Abdominal Iaortic Ianeurysms Iare Ioften Iasymptomatic. IWhat

I37. Ipercent Iof IAAA’s Iare Idiscovered Iin Iasymptomatic Ipatients?

I
Student IAnswer:
75% I(75% Iof Iabdominal Iaortic Ianeurysms Iare Idiscovered Iin
I asymptomatic Ipatients.) I
I

40% I
I

20% I
I

10% I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Narrowed Icoronary Iarteries Ior Iplague Irupture Iwithin Ithe Iarteries
I38. Iof Ithe Icoronary Isystem Imay Idirectly Icause Iwhich Icondition?

I
Student IAnswer:
Venous IStatis I
I

Diabetes I
I

Coronary Iartery Idisease I(Narrowed Icoronary Iarteries, Iplague

Irupture, Iand Isometimes Ieven Ispasms Iof Ithe Icoronary Iarteries Iare
Ithe Ithree Imost Icommon Idirect Icauses Ifor Ithe Idiagnosis Iof

Icoronary Iartery Idisease. I I) I

Hypertension I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: When Ia Imurmur Iis Ifirst Iheard, Iit Iis Iimportant Ito Idetermine Iif Iit Iis
I39. Idue Ito Ia Ipathological Icondition Ior Ibenign. IFor Ian Iexperienced

Ipractitioner, Iit Iis Ialways Ieasy Ito Idetermine Ithe Icause Iof Ia Imurmur

Imerely Iby Ilistening Ito Ithe Isound. IIs Ithis Istatement Itrue Ior Ifalse?

I
Student IAnswer:
True I
I

False I(This Istatement Iis Ifalse: Ifor Ian Iexperienced Ipractitioner,

Iit Iis Ialways Ieasy Ito Idetermine Ithe Icause Iof Ia Imurmur Imerely Iby

Ilistening Ito Ithe Isound) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: What Ipurpose Idoes Ithe Iprinciple Iof Ifidelity Iserve Iin Ithe
I40. Iprovider/patient Irelationship?

I
Student IAnswer:
Ensures Ithat Ipatients Ireceive Iwhatever Ithey Iwant I
I

Ensures Ithat Iproviders Ihonor Itheir Icommitments Ito Ithe Ipatient

I(The Iprinciple Iof Ifidelity Imandate Iassures Ithat Iproviders Ihonor
Itheir Icommitments Ito Ithe Ipatient. I I) I

Maintains Icosts Iin Ithe Ihealthcare Iarena I

I

Obligates Ithe Iprovider Ito Ia Ione-on-one Irelationship Iwith Ithe

I individual I

I Points IReceived: 5 Iof I5 I

 I Comments:

Question Question I: You Isee Ia I75-year Iold Ifemale Iin Iyour Iclinic Itoday Icomplaining Iof
I41. Iurinary Iincontinence. IShe Iis Iotherwise Ihealthy Ibased Iupon Iher

Ilast Ivisit. IShe Istates Ithat Iher Imother Itold Iher Ithis Iwould Ihappen

Isomeday Ibecause Iit Ihappens Ito Ievery Iwoman Iat Isome Iage. IWhat

Iwould Iyou Itell Ithis Ipatient?

I
Student IAnswer:
No Ineed Ito Iworry. IThis Iis Inormal. IYour Imother Iwas Icorrect. I
I

This Iis Inot Ian Iexpected Icondition Irelated Ito Iaging. I(Urinary
I incontinence Iis Inot Ian Iexpected Icondition Irelated Ito Iaging.) I
I

This Ihappens Ito Iall Iwomen Ias Ithey Iage I

I

This Ihappens Ito Imen Ias Iwell Iand Imost Iwomen Ibefore Iyour
Iage. I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Population Idisease Imanagement Iis Ia Iterm Iused Ito Idescribe:
I42.

I
Student IAnswer:
Low Ispecificity Idiseases Istates I
I

Low Iprevalence Ispecific Idiseases I

I

High Iprevalence Ispecific Idiseases I(Population Idisease

Imanagement Iis Ia Iterm Iused Ito Idescribe Ithe Ihigh Iprevalence Iof

Ispecific Idiseases. I I) I

High Ispecificity Idisease Istates I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: What Iis Iconsidered Ithe Ifirst-line Iinitial Iapproach Ito Itest Ifor ICAD?
I43.
I
Student IAnswer:
Echocardiogram I
I

EKG I
I

Cardiac ICatheterization I
I

Exercise IStress ITest I(Exercise Istress Itest Iis Iconsidered Ithe

Ifirst-line Iinitial Iapproach Ito Itest Ifor ICAD. I) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your I56-year Iold Ipatient Ipresents Iwith Ibradycardia Iwith Ia Irate Iof
I44. I55 Iand Ifirst Idegree IAV Iblock. IThe Ipatient Iis Ihemodynamically

Istable Iand Iis Inot Iexperiencing Iany Isyncope Ior Ichest Ipain. IHistory

Iincludes Iprevious Imyocardial Iinfarction. IHome Imedications

Iinclude Ibeta Iblockers, Idaily Iaspirin. ILab Iwork Iis Inon-significant

Ifor Ielectrolyte Iimbalance. IYou Idecided Ito Itreat Ithis Ipatient Ifor Ithe

Iarrhythmia Ito Iprevent Ifuture Idestabilization. IFrom Ithe Ichoices

Ibelow, Iwhich Imight Ibe Ithe Iappropriate Ifirst Imeasure Ito Iconsider?

I
Student IAnswer:
Discontinue IBeta IBlocker Iand Ireplace Iwith Ianother Itherapy Iif
Inecessary I(The Iappropriate Ifirst Imeasure Ito Iconsider Iis Ito
Idiscontinue Ithe Ibeta Iblocker Iand Ireplace Iwith Ianother Itherapy Iif

Inecessary.) I

Add Idigitalis Ito Icontrol Ithe Iheart Irate I

I

Consult Icardiologist Iimmediately Ifor Iguidance I

I

Atropine Iinjections I

I Points IReceived: 0 Iof I5 I

I Comments:

Question Question I: We Iall Iknow Ithat Icollaboration Iis Iintegral Ito Ibecoming Ia
I45. Isuccessful Inurse Ipractitioner. IAmong Icollaborations, Ihowever,

Ionly Ione Ican Ibe Iconsidered Ias Ithe Imost Iimportant. IWhile Ieach

Iexample Ibelow Iis Iimportant, Iwhich Iis Ithe Imost Iimportant

Icollaboration? IThe Ione Ithat Ioccurs:

I
Student IAnswer:
Between Ithe Ipatient Iand Ithe Inurse Ipractitioner I(The
Icollaboration Ithat Iis Imost Iimportant Iis Ithe Ione Ithat Ioccurs
Ibetween Ithe Ipatient Iand Ithe Inurse Ipractitioner. I I) I

Between Ithe Inurse Ipractitioner Iand Itheir Iphysician Imentor I

I

Between Itwo Ihealthcare Iproviders Iabout Ia Isingle Ipatient I

I

Between Ithe Ipatient Iand Itheir Ifamily I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Medicare Ihospital Iinsurance I(Part IA) Iis Ifunded Ithrough Iwhat
I46. Isystem?

I
Student IAnswer:
Federal Iincome Itaxes I
I

Interest Ifrom Iinvestments

II

Federal Ipayroll Itaxes I(Medicare IPart IA Iis Ifunded Ithrough

Ifederal Ipayroll Itaxes. I I) I

State Iincome Itaxes I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: BPH Iis Inot Ia Irisk Ifactor Ifor IProstate Icancer. IIs Ithis Istatement Itrue
I47. Ior Ifalse?

I
Student IAnswer:
True I(This Iis Ia Itrue Istatement: IBPH Iis Inot Ia Irisk Ifactor Ifor
IProstate Icancer.) I

False I

I Points IReceived: 5 Iof I5 I

I Comments:
Question Question I: The Ileads Ion Ithe IECG Ishowing Iischemic Ichanges Iduring Ior
I48. Iimmediately Iafter Ian IETT Ican Icorrelate Iroughly Ito Ithe Iculprit

Iartery Ior Iarteries Iwith Isignificant ICAD. IIs Ithis Itrue Ior Ifalse?

I
Student IAnswer:
False I
I

True I(This Istatement Iis Itrue: Ithe Ileads Ion Ithe IECG Ishowing
Iischemic Ichanges Iduring Ior Iimmediately Iafter Ian IETT Ican
Icorrelate Iroughly Ito Ithe Iculprit Iartery Ior Iarteries Iwith Isignificant

ICAD. I I I) I

I Points IReceived: 0 Iof I5 I

I Comments:

Question Question I: What Ido Iyou Iknow Iregarding Iischemia Ithat Iis Iconfined Ito Ionly Ithe
I49. Iposterior Iand Ior Ilateral Isegments Iof Ithe Ileft Iventricle?

I
Student IAnswer:
Difficult Ito Idetect I Iby IETT I(Ischemia Ithat Iis Iconfined Ito Ionly
Ithe Iposterior Iand Ior Ilateral Isegments Iof Ithe Ileft Iventricle Iis

Idifficult Ito Idetect Iby IETT, Ibut Ithat Idoes Inot Imean Ithat IETT

Icannot Idetect Iischemia Ilimited Ito Ithese Ifunctional Iareas Iof Ithe

Iheart. I I I) I

Requires Iboth Ifor Idetection Iof Ichanges Iby IETT I

I

ETT Icannot Ibe Iused Ifor Idetection I

I

Easier Ito Idetect Iby IETT I

I Points IReceived: 5 Iof I5 I

I
Comments:

Question Question I: Your Ipatient Iunderwent Ian Iexercise Istress Itest Ifor ICAD. IThere Iis
I50. Isignificant Ielevation Iof Ithe IST-segment. IWhat Ido Iyou Ineed Ito

Iknow Iabout Ithese Ichanges Ito Imanage Iyour Ipatient’s Icare?

I
Student IAnswer:
These Ichanges Iare Ipredictive Iof Imyocardial Iinfarction I
I

These Ichanges Ipredict Idire Ioutcomes I

I

These Ichanges Ihave Iminimal Ipredictive Ivalue Ifor ICAD

I(Significant Ielevation Iof Ithe IST-segment Ihas Iminimal Ipredictive
Ivalue Ifor ICAD. I I) I

This Ipatient Ineeds Ito Isee Isomeone Imore Iexperienced Iin

I treatment Iof ICAD I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: A I55-year Iold Iman Iis Ireferred Ito Iyour Iclinic. IHe Ihas Ibeen
I51. Isedentary Iall Iof Ihis Ilife, Iis Igaining Iweight Iand Iwishes Ito Iget Iinto

Ibetter Iphysical Ishape. IHe Ihas Inever Ihad Iany Ichest Ipain Ior

Ishortness Iof Ibreath Iwhen Iwalking Ior Iclimbing Ia Iflight Iof Istairs.

IBefore Irecommending Ia Ivigorous Iexercise Iroutine Ifor Ithis Ipatient,

Iyou Iorder Iwhat Itest?

I
Student IAnswer:
Stool Isamples I
I

Thyroid Ilevels I
I

CBC I
I

ETT I(Many Ipatients Ihave Iunderlying ICAD Ibut Iremain

Iasymptomatic. IBefore Ibeginning Iany Inew Ivigorous Iactivities

Iafter Iyears Iof Isedentary Ilifestyle, Iit Iis Irecommended Ithat Ithe

Ipatient Iobtains Ian IETT Ito Irule Iout Iunderlying ICAD.) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: As Ipatients Ithat Ientrust Iour Icare Ito Ianother Iindividual, Iwe Ialways
I52. Iexpect Ihonesty Ito Iavoid Ileading Ius Idown Ia Ideceptive Ipathway Iin

Iour Ihealthcare Idecisions. IAdherence Ito Iwhich Iprinciple Icompels

Iproviders Ito Ibe Itruthful?

I
Student IAnswer:
Fidelity I
I

Self-reflection I
I

Finance I
I

Veracity I(Adherence Ito Iveracity Icompels Iproviders Ito Ibe

Itruthful Iwith Ipatients. I I) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Of Ithe Ifollowing, Iwhich Iis Ithe Ibest Ianswer Iwhen Iasked Ifor Ian
I53. Iadvantage Iof Iechocardiogram Iexercise Itesting Iover Ithallium Istress

Itesting?

I
Student IAnswer:
Doesn’t Imatter Ibecause Ithere Iare Ino Iadvantages I
I

Results Iare Iavailable Imore Iquickly I(Echocardiogram Iexercise

I test Iresults Iare Iavailable Imore Iquickly.) I
I

Does Inot Idepend Ion Ioperator Iexperience I

I

Costs Iare Ithe Isame I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Spread Iof Igenital Iherpes Ionly Ioccurs Iduring Ithe Itime Iperiod Iwith
I54. Iactive Ilesions. IIs Ithis Istatement Itrue Ior Ifalse?

I
Student IAnswer:
False I(This Iis Ia Ifalse Istatement: Ispread Iof Igenital Iherpes Ionly
Ioccurs Iduring Ithe Itime Iperiod Iwith Iactive Ilesions.) I

True I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Tachyarrhythmias Icause Ia Idrop Iin Icommonly Iblood Ipressure,

I55. Icardiac Ioutput, Isyncope, Ishortness Iof Ibreath, Iand Ichest Ipain.
 I What Iphenomenon Imost Ioften Ioccurs Iduring Ithese Iarrhythmias Ito
I cause Ithese Isymptoms?
I
Student IAnswer:
Shortened Idiastole I(The Iphenomenon Ithat Imost Ioften Ioccurs
Iduring Ithese Iarrhythmias Ito Icause Ithese Isymptoms Iis Ishortened

Idiastole Irelated Ito Ithe Irapid Iheart Irate. ITypically, Ia Ishortened

Isystolye Iwould Inot Icause Ias Isevere Isymptoms.) I

Shortened Isystole I
I

Lengthened Idiastole I
I

Lengthened Isystole I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your Ipatient Ihas Ia Imaximum Iage-predicted Iheart Irate Iof I180.
I56. IDuring Ithe Iexercise Ihe Ireaches Ia Iheart Irate Iof I140 Iand Ithen Istates

Ihe Ican Ino Ilonger Iexercise. IYou Isee Ievidence Iof Iischemic Ichanges

Ion Ithe IECG. IThis Iwould Ibe Ipredictive Iof Iwhat Icondition?

I
Student IAnswer:
Impending Ideath I
I

Stroke I
I

Significant ICAD I(This Iscenario Iis Ipredictive Iof Isignificant

I CAD.) I
I

Low Irisk Iof ICAD I

I Points IReceived: 5 Iof I5 I

I
Comments:

Question Question I: Your Imentor Isays Ithat Iyou Ishould Ibe Iprepared Ito Iknow Ihow Ito
I57. Idetermine Ithe Imaximum Iheart Irate Ifor Iyour Ipatient Iduring Ithe

IETT. IHow Iis Ithe Iage-predicted Imaximum Iheart Irate Iduring Ian

IETT Idetermined?

I
Student IAnswer:
220+age I
I

65+age I
I

120-age I
I

220-age I(The Iage-predicted Imaximum Iheart Irate Iduring Ian

IETT Idetermined Iby Isubtracting Ithe Ipatient’s Iage Ifrom I220 I(220 I–
Iage). I I I) I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Specifically, Iwhen Iis Ian IETT Iconsidered Ito Ibe Inegative?
I58.

I
Student IAnswer:
Patient Iexercises Ito I20% Imaximum Iage-predicted Iheart Irate
I without Iinduced Iischemia I
I

Patient Iexercises Iuntil Itired Iwithout Ievidence Iof Iinduced

I ischemia I
I

Patient Iexercises Ito I85% Iof Iage Ipredicted Imaximum Iheart Irate
Iwithout Ievidence Iof Iinduced Iischemia I(An IETT Iis Iconsidered Ito
Ibe Inegative Iwhen Ithe Ipatient Iexercises Ito I85% Iof Iage Ipredicted

Imaximum Iheart Irate Iwithout Ievidence Iof Iinduced Iischemia. I I I) I

Patient Ihas IST-segmental Ichanges Iwith Idown Isloping Iof

I greater Ithan I1 Imm Iat I50% Iof Iage-predicted Imaximum Iheart Irate I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: Your Ipatient Ipresents Icomplaining Iof Iincontinence Iof Iurine. IHe
I59. Istates Ithat Ithis Ihappens Ievery Itime Isoon Iafter Ihe Iurinates. IWhat

Itype Iof Iincontinence Iis Iyour Ipatient Iexperiencing?

I
Student IAnswer:
Urge Iincontinence I
I

Overflow Iincontinence I(The Icorrect Ianswer Iis Ioverflow

Iincontinence.) I
I

Mixed Iincontinence I
I

Stress Iincontinence I

I Points IReceived: 5 Iof I5 I

I Comments:

Question Question I: In ICAD, Iafter Iboth Isystolic Iand Idiastolic Idysfunction Ihave
I60. Ioccurred, Ithe Itypical Ipattern Iof Ichest Ipain Iand Irelated IEKG

Ichanges Ioccur. IDuring Ian IEKG, Iyou Ishould Iexpect Ito Isee IST-

segment Iand IT-wave Ichanges Ithat Iare Icentral Ito Idemonstration Iof
Iischemia Ioccurring Irelatively Ilate Iin Ithe Iischemic Icascade. IIs Ithis

Itrue Ior Ifalse?

I
Student IAnswer:
True I(This Iis Ia Itrue Istatement. I IDuring Ian IEKG, Iyou Ishould
Iexpect Ito Isee IST-segment Iand IT-wave Ichanges Ithat Iare Icentral Ito
Idemonstration Iof Iischemia Ioccurring Irelatively Ilate Iin Ithe

Iischemic Icascade. I I) I

False I

What Iare Ithe Itwo Imain Itypes Iof Iheart Ifailure?

Question I:
I
Student IAnswer:
I Left Isided Iand Imain
I

I End Idiastolic Iand Ipressure Irelated

I

ISystolic Iand Idiastolic I(The Itwo Imain Itypes Iof Iheart Ifailure Iare

I systolic Iand Idiastolic.)

I

I Hopeless Iand Isevere

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Maintenance Iof Ian IIsometric IST-segment Iduring Iexercise Iis Ithe
I2. Iresponse Iof?

I
Student IAnswer:
I CAD
I

IA Inormal Iheart I(Maintenance Iof Ian IIsometric IST-segment Iduring

I exercise Iis Ithe Iresponse Iof Ia Inormal Iheart. I I)

I

I An Iabnormal Iheart
I

I Hypo Iprofusion

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your Imentor Isays Ithat Iyou Ishould Ibe Iprepared Ito Iknow Ihow Ito
I3. Idetermine Ithe Imaximum Iheart Irate Ifor Iyour Ipatient Iduring Ithe IETT.

IHow Iis Ithe Iage-predicted I maximum Iheart Irate Iduring Ian IETT

Idetermined?

I
Student IAnswer:
I 120-age
I

I 220+age
I

I 65+age
I

I220-age I(The Iage-predicted Imaximum Iheart Irate Iduring Ian IETT

I determined Iby Isubtracting Ithe Ipatient’s Iage Ifrom I220 I(220 I– Iage). I I I)

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your Ipatient Iasks Iyou Iwhat Icauses Ia Irupture Iof Ian Iabdominal Iaortic
I4. Ianeurysm. IYou Iknow Ithe Ianswer Iis Imost Ioften:

I
Student IAnswer:
I Trauma Ito Ithe Iabdomen Iis Imost Ioften Ithe Icause
I

I Work Ior Imarital Istress

I

IWall Itension Iexceeds Itensile Istrength Iof Iwall Icollagen I(The Icause

Iof Ia Irupture Iin Ian Iabdominal Iaortic Ianeurysm Iis Iwhen Ithe Iwall Itension
Iexceeds Ithe Itensile Istrength Iof Iwall Icollagen.)

I Ulcerations Ithat I“chew” Ithrough Ithe Iabdominal Iwall

I Points IReceived: 5 Iof I5

I Comments:
Question Question I: After Icompletion Iof Ithe Iexercise Istress Itest, Iyou Iwould Imeasure Ithe IST-
I5. segment Idepression Iafter Ithe IJ Ipoint Iof Ithe IQRS. IThe IJ Ipoint Iis Ilocated
Iwhere Iin Irelation Ito Ithe IQRS?

I
Student IAnswer:
IJunction Ibetween IQRS Iand IST Isegment I(The IJ Ipoint Iis Ilocated Iat

I the Ijunction Ibetween IQRS Iand IST-segment.)

I

I After Ithe IH Ipoint

I

I Immediately Iafter Ithe IP Iwave

I

I Junction Ibetween IP Iand IR

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your Ipreceptor Idecides Ito Iadd IDoppler IFlow Istudies Ito Ithe
I6. Iechocardiogram Iexercise Itest Ifor Ia Ipatient Iwith Ia Irecent Ihistory Iof Ia

Iholistic Imurmur Ibest Iauscultated Iat Ithe Ileft Isteral Iboarder. IThe Ipatient

Ihas Ino Ihistory Iof Icardiac Isurgeries. IHe Iasks Iyou Iwhat Imight Ibe Ithe

Imain Iadvantages Iof Iadding IDoppler IFlow Ifor Ithis Iparticular Ipatient. IYou

Iknow Ifrom Iyour Ireadings Ithat Ithere Iare Iseveral Ireasons Ito Iadd IDoppler

IFlow Iand Ibelow Iare Ilisted Imore Ithan Ione Icorrect Ireason. IYour Ibest

Iresponse Ifor Ithis Ispecific Icase, Ihowever, Iwould Ibe Ithat IDoppler IFlow

Istudies Iwould Ibe Iof Iwhat Iadditive Ivalue Iduring Ithe Iechocardiogram

Istudy?

I
Student IAnswer:
I Provides Iassessment Iof Iprosthetic Ivalve Ifunction
I

I Gives Ibetter Iscreen Ishots Iof Iwall Iabnormalities

I

IDetect Iand Ievaluate Iblood Ishunting Ifrom Ia Iseptal Idefect I(Your

Ibest Iresponse Ifor Ithis Ispecific Icase, Ihowever, Iwould Ibe Ithat IDoppler
IFlow Istudies Iwould Idetect Iand Ievaluate Iblood Ishunting Ifrom Ia Iseptal

Idefect.)

I No Iadvantage Iis Iseen Ifor Ithis Ipatient

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: You Ireceive Ia Ireport Iback Ion Ithe Isuspected Iabdominal Iaortic Ianeurysm
I7. Ifor Iyour Ipatient. IIt Iconfirms Iyour Isuspicion Iof IAAA. IThe Ireport

Idescribes Ithe Ianeurysm Ias Ia Isymmetric Iweakness Iof Ithe Ientire

 I circumference Iof Ithe Iaorta. IYou Iknow Ithat Ithis Iform Iof Ianeurysm Iis
I referred Ito Ias Iwhat Ikind Iof Ianeurysm?
I
Student IAnswer:
I Saccular Ianeurysm
I

IFusiform Ianeurysm I(This Iform Iof Ianeurysm Iis Ireferred Ito Ias Ia

I fusiform Ianeurysm.)
I

I Budging Isac Ianeurysm

I

I Thoracic Ianeurysm

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: You Isee Ia I35-year Iold Imale Iin Ithe Ioffice Ifor Ithe Ifirst Itime. IHe Istates Ithat
I8. Ihe Ihas Ibeen Idiagnosed Iwith Irecurrent Iurinary Itract Iinfections. IYou

Iknow Ithat Iurinary Itract Iinfections Iare Iuncommon Iamong Imen Iless Ithan

I50 Iyears Iof Iage Iand Iare Iconsidered Ia Icomplicated Iinfection Iin Ithis Iage

Igroup. IOn Iphysical Iexamination, Ithe Ipatient Iis Icircumcised, Iand Ihe

Idenies Ihomosexual Iactivities. IWhat Iother Iassessment Ior Ihistory

Iquestion Imight Ibe Imost Ipertinent Iin Imanaging Ithis Ipatient?

I
Student IAnswer:
I Cleanliness Iof Ianus Iafter Ibowel Imovements
I

IParticipation Iin Iheterosexual Ianal Iintercourse I(Participation Iin

I heterosexual Ianal Iintercourse Iis Ithe Icorrect Ianswer.)

I

I Alcohol Iconsumption
I

I Dietary Ihabits

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: Your Ipatient Ihas Ian IAAA Ithat Iyou Ihave Ibeen Iwatching. IIt Iis Inow
I9. Iprogressed Ito Igreater Ithan I4.0cm Iin Isize. IWhat Iaction Ishould Iyou

Iconsider Iat Ithis Ijuncture Iin Ipatient Imanagement Iof Ithis Icondition?

I
Student IAnswer:
I Diet Ichanges
I

ISurgical Iconsult Iwith Ivascular Isurgeon I(The Iaction Iyou Ishould

Iconsider Iat Ithis Ijuncture Iin Ipatient Imanagement Iis Ia Isurgical Iconsult
Iwith Ia Ivascular Isurgeon.)
I

I Prescription Ifor Iulcers

I

I Diuretic Ito Ilower Ifluid Ipressure

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: The Igoal Iof Iself-management Iis Ito Ispecifically Ido Iwhat?
I10.

I
Student IAnswer:
I Engage Igovernment Iin Igreater Iinvolvement Iin Ipatient Icare
I

IEngage Ipatients Iin Itheir Iown Icare I(The Igoal Iof Iself-management

I is Ito Iengage Ipatients Iin Itheir Iown Icare.)

I

I Engage Iproviders Iin Ipatient Icare

I

I Engage Iinsurance Iproviders Iin Ipatient Icare

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: What Iare Ithe Itwo Itypes Iof Ibradycardia Irecognized Iby Ithe IAmerican
I11. IHeart IAssociation?

I
Student IAnswer:
IRelative Iand Iabsolute I(The Itwo Itypes Iof Ibradycardia Irecognized

I by Ithe IAmerican IHeart IAssociation Iare Irelative Iand Iabsolute.)

I

I Absolute Iand Ipending

I

I Refractory Iand Inon-refractory

I

I Relative Iand Idynamic

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: What Icriterion Idoes Ithe IAmerican IHeart IAssociation Iuse Ito Iclassify
I12. Irelative Ibradycardia?
I
Student IAnswer:
IHeart Irate Iabove I60 Ithat Idoes Inot Isupport Iadequate Icardiac

Ioutput I(The Icriterion Ithe IAmerican IHeart IAssociation Iuses Ito Iclassify
Irelative Ibradycardia Iis Ia Iheart Irate Iabove I60 Ithat Idoes Inot Isupport

Iadequate Icardiac Ioutput.)

I Heart Irate Iabove I60 Ibeats Iper Iminute

I

I Heart Irate Ibelow I60 Ithat Idoes Inot Isupport Iadequate Icardiac Ioutput
I

I Heart Irate Ibelow I60 Ibeats Iper Iminute

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: A I47-year Iold Ifemale Iwith Igeneral Icomplaints Iof Ifatigue Iand Ishortness
I13. Iof Ibreath Ishows Iup Iin Iyour Iclinic Ias Ia Ireferral Ifrom Ianother Inurse

Ipractitioner. ISeveral Iblood Itests Iand Ichest Ix-rays Ihave Ibeen Icompleted

Iwithout Iany Idiagnosis Ior Ioutstanding Iabnormalities. IYou Idecide Ito

Iorder Ian IETT Idespite Ithe Ifact Ithat Ithe Irecent IECG Idoes Inot Ishow Iany

Iabnormalities. IFrom Ithe Ianswers Ibelow, Iwhich Iwould Ibe Ithe Ibest

Ianswer Ito Isupport Iyour Idecision?

I
Student IAnswer:
I Women Ipresent Iwith Ithe I Isame Ipattern Iof ICAD Ias Ido Imales
I

ICAD Iin Iwomen Iis Iunder Idiagnosed I(You Imake Ithis Ichoice

I because Iyou Iare Iaware Ithat ICAD Iin Iwomen Iis Iunder Idiagnosed.)
I

I To Iplease Ithe Ipatient

I

I You Iare Iout Iof Iother Ioptions

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: By Istandard Icriteria, Ihow Iis Ia Ipositive Istress Itest Idefined?
I14.

I
Student IAnswer:
I Upward Isloping IST-segment Imeasured Iat Ithe IJ Ipoint Iof Ithe IQRS
I

IDevelopment Iof Ia Ihorizontal Ior Idown Isloping IST-segment

Idepression Iof I1mm I(A Ipositive Istress Itest Iis Idefined Ias Ithe
Idevelopment Iof Ia Ihorizontal Ior Idown Isloping IST-segment Idepression Iof

I1mm. I I I)
I

IDevelopment Iof Ia Ihorizontal Ior Idown Isloping IST-segment

I depression Iof I10mm

I

I Down Isloping Iof Ithe IST-segment Iat Ithe IJ Ipoint Iof Ithe IQRS

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your Ipatient Iunderwent Ian Iexercise Istress Itest Ifor ICAD. IThere Iis
I15. Isignificant Ielevation Iof Ithe IST-segment. IWhat Ido Iyou Ineed Ito Iknow

Iabout Ithese Ichanges Ito Imanage Iyour Ipatient’s Icare?

I
Student IAnswer:
I These Ichanges Ipredict Idire Ioutcomes
I

IThis Ipatient Ineeds Ito Isee Isomeone Imore Iexperienced I in Itreatment

I of ICAD
I

I These Ichanges Iare Ipredictive Iof Imyocardial Iinfarction

I

IThese Ichanges Ihave Iminimal Ipredictive Ivalue Ifor ICAD I(Significant

I elevation Iof Ithe IST-segment Ihas Iminimal Ipredictive Ivalue Ifor ICAD. I I)

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Why Iwould Iinability Ito Iexercise Ireduce Ithe Ispecificity Iof Ithe Iroutine
I16. IETT?

I
Student IAnswer:
I Produces IQRS Ichanges Ithat Icannot Ibe Iinterpreted
I

I Will Inot Iproduce Iany Ichanges Iin IECG

I

IProduces Ipersistent IST-segmental Ichanges Iand IT-wave

Iabnormalities I(The Iinability Ito Iexercise Ireduces Ithe Ispecificity Iof Ithe
Iroutine IETT Ibecause Iit Iproduces Ipersistent IST-segmental Ichanges Iand

IT-wave Iabnormalities. I I I)

I Causes IST-segment Ichanges Iand IP-wave Iabnormalities

I Points IReceived: 5 Iof I5

I Comments:
Question Question I: Of Ithe Ifollowing, Iwhich Iis Ithe Ibest Ianswer Iwhen Iasked Ifor Ian
I17. Iadvantage Iof Iechocardiogram Iexercise Itesting Iover Ithallium Istress

Itesting?

I
Student IAnswer:
I Does Inot Idepend Ion Ioperator Iexperience
I

IResults Iare Iavailable Imore Iquickly I(Echocardiogram Iexercise Itest

I results Iare Iavailable Imore Iquickly.)

I

I Costs Iare Ithe Isame

I

I Doesn’t Imatter Ibecause Ithere Iare Ino Iadvantages

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: The Idiagnostic Iaccuracy Iof Istress Itesting Iis Idecreased Iamong Iwomen
I18. Icompared Ito Imen Ifor Iwhat Ireasons?

I
Student IAnswer:
IWomen Iusually Ihave Isingle Ivessel Ior Inon-obstructive Idisease

I(The Idiagnostic Iaccuracy Iof Istress Itesting Iis Idecreased Iamong Iwomen
Icompared Ito Imen Ibecause I women Iusually Ihave Isingle Ivessel Ior Inon-

obstructive Idisease.)
I

I Women Itypically Ihave Imultiple Ivessel Idisease

I

I Women Icannot Iexercise Ias Ivigorously Ias Imen

I

I Women Ihaving Ithinner Iventricular Iand Iseptal Imuscles

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: When Ithere Iis Ia Iconsequential Iloss Iof Istructural Iintegrity Iof Ithe
I19. Iabdominal Iaorta, Ithe Iresulting Iissue Iis Iwhat Icondition?

I
Student IAnswer:
IAbdominal Iaortic Ianeurysm I(When Ithere Iis Ia Iconsequential Iloss Iof

Istructural Iintegrity Iof Ithe Iabdominal Iaorta, Ithe Iresulting Iissue Iis
Iabdominal Iaortic Ianeurysm.)

I Bloated Istomach
I

I Bleeding Iulcers
I

I Kidney Ifailure

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: What Iare Ithe Imost Icommon Isymptoms Icaused Iby Itachyarrhythmias?
I20.

I
Student IAnswer:
I Thirst
I

IPalpitations I(The Imost Icommon Isymptoms Icaused Iby

I tachyarrhythmias Iare Ipalpitations.)

I

I Headaches
I

I Sweating

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Medicare Ihospital Iinsurance I(Part IA) Iis Ifunded Ithrough Iwhat Isystem?
I21.

I
Student IAnswer:
I State Iincome Itaxes
I

I Interest Ifrom Iinvestments

I

IFederal Ipayroll Itaxes I(Medicare IPart IA Iis Ifunded Ithrough Ifederal

I payroll Itaxes. I I)
I

I Federal Iincome Itaxes

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your I60-year Iold Imale Ipatient Iarrives Ifor Ihis Iappointment. IHe
I22. Icomplains Iof Igeneral Imalaise Iand Ifever Iover Ithe Ipast Iseveral Idays Iwith

Ilow Iback Ipain. IHe Ialso Istates Ithat Ihe Iis Igetting Iup Iat Inight Imore Ioften

Ito Iurinate Iand Inever Ifeels Ihis Ibladder Iis Icompletely Iempty. IWhat

Idifferential Idiagnosis Ishould Iyou Iconsider Iin Ithis Ipatient?

I
Student IAnswer:
I Acute Iviral Iprostatitis
I

IAcute Ibacterial Iprostatitis I(Acute Ibacterial Iprostatitis Iis Ithe Icorrect

I answer.)
I

I BPH Ionly
I

I Stomach Ivirus

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: What Ido Iyou Iknow Iregarding Iischemia Ithat Iis Iconfined Ito Ionly Ithe
I23. Iposterior Iand Ior Ilateral Isegments Iof Ithe Ileft Iventricle?

I
Student IAnswer:
I ETT Icannot Ibe Iused Ifor Idetection
I

IDifficult Ito Idetect I Iby IETT I(Ischemia Ithat Iis Iconfined Ito Ionly Ithe

Iposterior Iand Ior Ilateral Isegments Iof Ithe Ileft Iventricle Iis Idifficult Ito Idetect
Iby IETT, Ibut Ithat Idoes Inot Imean Ithat IETT Icannot Idetect Iischemia

Ilimited Ito Ithese Ifunctional Iareas Iof Ithe Iheart. I I I)

I Easier Ito Idetect Iby IETT

I

I Requires Iboth Ifor Idetection Iof Ichanges Iby IETT

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your Ipatient Iwas Irecently Itreated Ifor Itachycardia Iand Inow Ihas Ia
I24. Inormalized Iheart Irate Iand Irhythm. IOn Iexamination, Iyou Inotice Ia Inew

IS3 Iheart Isound. IWhat Icondition Iare Iyou Iconcerned Iwith Iat Ithis Itime

Ibased Ion Ithis Inew Ifinding?

I
Student IAnswer:
I Heart Irupture
I

I Myocardial Iinfarction Ioccurring

I

IImpending Iheart Ifailure I(The Icondition Iyou Iare Iconcerned Iwith

I based Ion Ithis Inew Ifinding Iis Iimpending Iheart Ifailure.)

I

I Hypertension
 I Points IReceived: 0 Iof I5
I Comments:

Question Question I: Your Ipatient Iis Imorbidly Iobese Iand Icannot Isit Ion Ia Ibicycle Ior Iwalk Ia
I25. Itreadmill. IShe Ialso Ihas Imarked Iand Isevere Iemphysema. IYou Ineed Ito

Imake Ian Iassessment Iof Ithe Irisk Iof Isignificant ICAD Iand Iyour Ipatient’s

Ifamily Isays Ithat Itheir Irelative Ihad Itheir Idiagnosis Ibased Ion Ian

Iultrasound Iechocardiography. IWhat Ifacts Iwould Iinfluence Iyour Idecision

Iregarding Ithe Ifamily Irequest Ifor Iecho Iassessment?

I
Student IAnswer:
ISensitivity Iwould Ibe Ireduced Ibecause Iof Iobesity Iand Ilung Idisease

I (Sensitivity Iwould Ibe Ireduced Ibecause Iof Iobesity Iand Ilung Idisease.)
I

I Specificity Iwould Ibe Iincreased Ibecause Iof Iobesity

I

I Sensitivity Iwould Ibe Iincreased Ibecause Iof Ilung Idisease

I

I Specificity Iwould Ibe Ireduced Ibecause Iof Iobesity Iand Ilung Idisease

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: What Ihappens Ito Icoronary Iflow Irelated Ito ICAD?
I26.

I
Student IAnswer:
I Cerebral Ivascular Iinfarction
I

I Hyper Iprofusion Iof Ithe Imyocardium

I

I Functional Isystolic Ipressures

I

IHypo Iprofusion Iof Ithe Imyocardium I(Because Iof Ithe Irestrictive Iflow

Iof Iblook Ithrough Ithe Icoronary Iateries, Ihypo Iprofusion Iof Ithe
Imyocardium Iresults Ifrom Icoronary Iflow Irelated Ito ICAD Iwhich Icauses

Ithe Ipresenting Isymptoms. I I I)

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: The Ireason Ifor Ithe Iincrease Iin Ichlamydia Idiagnosis Iis Ithought Ito Ibe
I27. Irelated Ito Iwhat Ievent?
I
Student IAnswer:
I Increased Isexual Iactivities Iamong Iall Ipopulations
I

I Actual Iincreases Iin Iremission Iof Ithe Iinfection Ibetween Ipartners

I

IIncreased Iscreening Iefforts I(The Iincrease Iin Ichlamydia Idiagnosis

I is Ithought Ito Ibe Irelated Ito Iincreased Iscreening Iefforts.)

I

I Increased Isexual Iactivity Iamong Imales

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: In Ia Iperson Iwith Idiagnosed Iabdominal Iaortic Ianeurysm, Iwhich

I28. Isymptoms Imight Iindicate Iimpending Irupture?

I
Student IAnswer:
I Headaches Iwith Ipain Iradiating Ito Ithe Ieyes
I

IA Ideep Iboring Ipain Ithat Iradiates Ito Ithe Ilegs I(In Ia Iperson Iwith

Idiagnosed Iabdominal Iaortic Ianeurysm, Ia Ideep Iboring Ipain Ithat Iradiates

Ito Ithe Ilegs Imight Iindicate Iimpending Irupture.)

I Visual Idisturbances Iwith Ihalos Iaround Iall Ilights

I

I New Ichronic Iillness Idiagnosis Isuch Ias Idiabetes

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: You Isee Ia I75-year Iold Ifemale Iin Iyour Iclinic Itoday Icomplaining Iof Iurinary
I29. Iincontinence. IShe Iis Iotherwise Ihealthy Ibased Iupon Iher Ilast Ivisit. IShe

Istates Ithat Iher Imother Itold Iher Ithis Iwould Ihappen Isomeday Ibecause Iit

Ihappens Ito Ievery Iwoman Iat Isome Iage. IWhat Iwould Iyou Itell Ithis

Ipatient?

I
Student IAnswer:
IThis Iis Inot Ian Iexpected Icondition Irelated Ito Iaging. I(Urinary

I incontinence Iis Inot Ian Iexpected Icondition Irelated Ito Iaging.)

I

I No Ineed Ito Iworry. IThis Iis Inormal. IYour Imother Iwas Icorrect.
I

I This Ihappens Ito Iall Iwomen Ias Ithey Iage

I

I This Ihappens Ito Imen Ias Iwell Iand Imost Iwomen Ibefore Iyour Iage.
 I Points IReceived: 5 Iof I5
I Comments:

Question Question I: Changes Iin IMedicare Iare Ia Imethod Ithe Igovernment Iuses Ito Imake
I30. Ichanges Ito Ireimbursement Ischedules Ifor Ihealthcare. ICurrently,

IMedicare Ireimburses Inurse Ipractitioners Ifor Iall Iservices, Ieven Ithose

Ideemed Ito Ibe Iexclusive Ito Inursing?

I
Student IAnswer:
IFalse I(Currently, IMedicare Idoes Inot Ireimburse Inurse Ipractitioners

I for Iall Iservices, Ieven Ithose Ideemed Ito Ibe Iexclusive Ito Inursing. I I)
I

I True

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: A I35 Iyear Iold Ifemale Iarrives Iat Iyour Iclinic. IShe Ihas Ihad Idiabetes Iand
I31. Iperipheral Iartery Idisease Ifor Ithe Ipast I5 Iyears. IYou Idecide Ito Iobtain Ian

IETT. IThe Iinsurance Icompany Iargues Ithat Ithis Iis Iinappropriate. IYou

Ijustify Ithe IETT Ibecause Iyou Iare Iplanning Isecondary Istrategies Ito

Iprevent Ifuture Iheart Idisease. IWhere Icould Ione Ifind Ithe Isupporting Idata

Ifor Ithese Iguidelines?

I
Student IAnswer:
IFramingham Irisk Iscore I(These Iguidelines Icome Ifrom Ithe

I Framingham Irisk Iscore.)

I

I Medicare Iguidelines
I

I Do Inot Iexist
I

I Medicaid Iguidelines

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: What Iis Iconsidered Ithe Ifirst-line Iinitial Iapproach Ito Itest Ifor ICAD?
I32.

I
Student IAnswer:
IExercise IStress ITest I(Exercise Istress Itest Iis Iconsidered Ithe Ifirst-

line Iinitial Iapproach Ito Itest Ifor ICAD. I)

I

I EKG
I

I Cardiac ICatheterization
I

I Echocardiogram

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: The Imajority Iof Iall Istrokes Iare Inon-ischemic. IIs Ithis Istatement Itrue Ior
I33. Ifalse?

I
Student IAnswer:
I True
I

IFalse I(This Istatement Iis Ifalse: Ithe Imajority Iof Iall Istrokes Iare Inon-

ischemic.)

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: BPH Iis Inot Ia Irisk Ifactor Ifor IProstate Icancer. IIs Ithis Istatement Itrue Ior
I34. Ifalse?

I
Student IAnswer:
I False
I

ITrue I(This Iis Ia Itrue Istatement: IBPH Iis Inot Ia Irisk Ifactor Ifor IProstate

I cancer.)

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: In Iwomen, Iyou Ineed Ito Iknow Ithe Ilimitations Iof Icertain Itests Ifor ICAD.
I35. IFor Iexample, Isingle-photon Iemissions ICT Iimaging, Iwhile Ian Iacceptable

Itest Ifor Imost Imen Iand Isome Iwomen, Iis Itechnically Ilimited Iin Iwomen Ifor

Itwo Ireasons. IFrom Ithe Ifollowing, Ichoose Ithe Ibest Ipossible Ianswer.

I
Student IAnswer:
I Multiple Ivessel Idisease Iand Ifat Ideposits
I

I Smoking Irates Iand Ilack Iof Iuptake Iof Iphotons

I

IBreasts Iand Ismaller Icoronary Iarteries I(Single-photon Iemissions

ICT Iimaging Iis Itechnically Ilimited Iin Iwomen Idue Ito Ibreasts Iand Ismaller
Icoronary Iarteries.)
I

I Breasts Iand Ifat Ideposits Iin Iabdomen

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: When Ia Imurmur Iis Ifirst Iheard, Iit Iis Iimportant Ito Idetermine Iif Iit Iis Idue Ito Ia
I36. Ipathological Icondition Ior Ibenign. IFor Ian Iexperienced Ipractitioner, Iit Iis

Ialways Ieasy Ito Idetermine Ithe Icause Iof Ia Imurmur Imerely Iby Ilistening Ito

Ithe Isound. IIs Ithis Istatement Itrue Ior Ifalse?

I
Student IAnswer:
IFalse I(This Istatement Iis Ifalse: Ifor Ian Iexperienced Ipractitioner, Iit Iis

Ialways Ieasy Ito Idetermine Ithe Icause Iof Ia Imurmur Imerely Iby Ilistening Ito
Ithe Isound)

I True

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: What Isexually Itransmitted Idisease Iis Imost Iwidespread Iin Ithe IUSA
I37. Itoday?

I
Student IAnswer:
I Syphilis
I

I Gonorrhea
I

IChlamydia I(The Imost Iwidespread Isexually Itransmitted Idisease Iin

I the IUSA Itoday Iis Ichlamydia.)

I

I HIV/AIDS

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: You Iare Iconsidering Iadding Ian Iadjunctive Iform Iof Itesting Ito Idetect Iwall
I38. Imotion Iabnormalities Iduring Ithe IETT. IYou Iselect IEchocardiography Ias

Ithe Iadded Itesting. IYou Ichoose Ithis Itest Ibecause Iyou Iknow Ithat

Iechocardiography Idoes Iwhat Iwhen Iadded Ito Ia Istandard IETT?

I
Student IAnswer:
I Enhances Ispecificity Iwhile Inot Ichanging Isensitivity Iof Idetection Ifor
I CAD
I

I You Ilike Ipretty Ipictures Iof Iwall Imotion

I

IEnhances Isensitivity Iand Ispecificity Iof ICAD Idetection I(You Ichoose

Ithis Itest Ibecause Iyou Iknow Ithat Iechocardiography Ienhances Isensitivity

Iand Ispecificity Iof ICAD Idetection.)

I Enhances Isensitivity Iwhile Ireducing Ispecificity Iof ICAD Idetection

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: You Itell Ia Ipatient Ithat Ihe Ihas Ia Imurmur. IHe Isays Ihe Ihas Ibeen Itold Ithis
I39. Ibefore, Ibut Iwonders Iwhat Icauses Ithe Iunique Isounds Iof Ia Imurmur.

IWhich Iof Ithe Ifollowing I Iwould Ibe Iyour Ibest Ioption?

I
Student IAnswer:
I There Iis Ino Ireason, Iit Ijust Ihappens
I

I High Ipressures Icaused Ifrom IHTN

I

I Almost Ialways Ifrom Ia Isclerotic Ivalve

I

ITurbulent Iflow Iof Iblood I(The Ibest Ianswer Iis Iturbulent Iflow Iof

I blood.)

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your Ipatient Ihas Iuncomplicated Ipyelonephritis. IIn Ideciding Iyour
I40. Irecommended Itreatment, Iyou Iconsider Ithe Imost Icommon Ipathogenic

Ireason Ifor Ithis Idiagnosis. IWhat Ipathogen Iaccounts Ifor Ithe Imajority Iof

Ipyelonephritis?

I
Student IAnswer:
IE. IColi I(E. IColi Iis Ithe Ipathogen Ithat Iaccounts Ifor Ithe Imajority Iof

I pyelonephritis.)
I

I Chlamydia
I

I Mycoplasma IHominis
I

I Gardnerella IVaginalis

I Points IReceived: 5 Iof I5

 I Comments:

Question Question I: What Ipurpose Idoes Ithe Iprinciple Iof Ifidelity Iserve Iin Ithe Iprovider/patient
I41. Irelationship?

I
Student IAnswer:
I Maintains Icosts Iin Ithe Ihealthcare Iarena
I

IEnsures Ithat Iproviders Ihonor Itheir Icommitments Ito Ithe Ipatient

I(The Iprinciple Iof Ifidelity Imandate Iassures Ithat Iproviders Ihonor Itheir
Icommitments Ito Ithe Ipatient. I I)

I Ensures Ithat Ipatients Ireceive Iwhatever Ithey Iwant

I

IObligates Ithe Iprovider Ito Ia Ione-on-one Irelationship Iwith Ithe

I individual

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your I56-year Iold Ipatient Ipresents Iwith Ibradycardia Iwith Ia Irate Iof I55 Iand
I42. Ifirst Idegree IAV Iblock. IThe Ipatient Iis Ihemodynamically Istable Iand Iis Inot

Iexperiencing Iany Isyncope Ior Ichest Ipain. IHistory Iincludes Iprevious

Imyocardial Iinfarction. IHome Imedications Iinclude Ibeta Iblockers, Idaily

Iaspirin. ILab Iwork Iis Inon-significant Ifor Ielectrolyte Iimbalance. IYou

Idecided Ito Itreat Ithis Ipatient Ifor Ithe Iarrhythmia Ito Iprevent Ifuture

Idestabilization. IFrom Ithe Ichoices Ibelow, Iwhich Imight Ibe Ithe

Iappropriate Ifirst Imeasure Ito Iconsider?

I
Student IAnswer:
I Atropine Iinjections
I

I Add Idigitalis Ito Icontrol Ithe Iheart Irate

I

IDiscontinue IBeta IBlocker Iand Ireplace Iwith Ianother Itherapy Iif

Inecessary I(The Iappropriate Ifirst Imeasure Ito Iconsider Iis Ito Idiscontinue
Ithe Ibeta Iblocker Iand Ireplace Iwith Ianother Itherapy Iif Inecessary.)

I Consult Icardiologist Iimmediately Ifor Iguidance

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: What Iis Ithe Itreatment Iof Ichoice Ifor Iuncomplicated Icommunity-acquired
I43. Icystitis?
I
Student IAnswer:
I Amoxicillin
I

I Penicillin
I

ITMP-SMZ I(TMP-SMZ Iis Ithe Itreatment Iof Ichoice Ifor Iuncomplicated

I community-acquired Icystitis.)
I

I Any Iantibiotic Iwill Itreat Ithis Idiagnosis

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: What Iis Ithe Imost Icommon Icause Iof Isystolic Iheart Ifailure?
I44.

I
Student IAnswer:
I PAD
I

I Atria Iarrhythmias
I

I CAD I(The Imost Icommon Icause Iof Isystolic Iheart Ifailure Iis ICAD.)
I

I Diabetes

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Chronic, Inon-communicable Idiseases Iaccount Ifor Idisproportionate

I45. Icosts Ito Ithe Ihealthcare Isystem. IAccording Ito Ithe IWorld IHealth

IOrganization, Iwhat Ipercent Iof Ipreventable Ideaths Iand I disabilities Ioccur

Iin Ithe IAmericas Irelated Ito Ichronic Inon-communicable Idiseases?

I
Student IAnswer:
I 35%-45%
I

I60%-70% I(According Ito Ithe IWorld IHealth IOrganization, I60%--7

I0% Iof Ipreventable Ideaths Iand Idisabilities Ioccur Iin Ithe IAmericas Irelated
Ito Ichronic Inon-communicable Idiseases. I I

I)

I 80%-90%
I

I 10%-15%
 I Points IReceived: 5 Iof I5
I Comments:

Question Question I: Skin Icancer Iis Ithe Imost Icommon Imalignant Ineoplasm Iin Imales Iin Ithe
I46. IUS. IWhat Iis Ithe Isecond Ileading Icause Iof Icancer Ideaths Iin Imen Igreater

Ithan I50 Iyears Iof Iage?

I
Student IAnswer:
I Lupus
I

I Lymphoma
I

IProstate Icancer I(The Isecond Ileading Icause Iof Icancer Ideaths Iin

I men Igreater Ithan I50 Iyears Iof Iage Iis Iprostate Icancer.)
I

I Lung Icancer

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: All Ipatients, Ieven Iis Iasymptomatic, Irequire Irisk Istratification Iaccording
I47. Ito Ithe IFarmingham Irisk Iscore. IAt Ipresent, IACC/AHA Iguidelines,

Ihowever, Ido Inot Inormally Isupport Istress Itests Ifor Iasymptomatic

Ipatients Iwithout Iaddiitonal Ijustification. IFrom Ithe Ilist Ibelow, Iwhat Icould

Ibe Iused Ito Ijustify Ia IETT Iin Ian Iasymptomatic Ipatient?

I
Student IAnswer:
I A Ismoker Iof I3 Iweeks
I

I A Imember Iof Icongress

I

ISedentary Iand Iwishes Ito Ibegin Iaggressive Iexercise I(Many

Ipatients Ihave Iunderlying ICAD Ibut Iremain Iasymptomatic. IBefore

Ibeginning Iany Inew Ivigorous Iactivities Iafter Iyears Iof Isedentary Ilifestyle,

Iit Iis Irecommended Ito Iobtain Ia IETT I Ito Irule Iout Iunderlying ICAD.)

I Developmentally Ichallenged

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: Eligibility Ifor IMedicaid Iincludes Ithe Ifollowing:

I48.
I
Student IAnswer:
I Everyone Iunemployed
I

IElderly, Ichildren Iand Iwomen Iliving Iin Ipoverty I(Eligibility Ifor

IMedicaid Iincludes Ithe Ielderly Ias Iwell Ias Ichildren Iand Iwomen Iliving Iin
Ipoverty. I I)

I Very Iyoung Iand Ielderly Ionly

I

I Children Iand Iwomen Iregardless Iof Iincome

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: What Ithree Iconditions Idefinitely Ialter Ithe Iresults Iof Iechocardiography Iin
I49. Idetermining ICAD?

I
Student IAnswer:
IObesity, Irapid Iheart Irate Iand Ilung Idisease I(Obesity, Irapid Iheart

Irate Iand Ilung Idisease Idefinitely Ialter Ithe Iresults Iof Iechocardiography Iin
Idetermining ICAD.)

I Obesity, Islow Iheart Irates Iand Ihypertension

I

I Previous IMI, Ihypotension Iand Idiabetes

I

I Diabetes, Ikidney Idisease Iand Itooth Idecay

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: We Iall Iknow Ithat Icollaboration Iis Iintegral Ito Ibecoming Ia Isuccessful
I50. Inurse Ipractitioner. IAmong Icollaborations, Ihowever, Ionly Ione Ican Ibe

Iconsidered Ias Ithe Imost Iimportant. IWhile Ieach Iexample Ibelow Iis

Iimportant, Iwhich Iis Ithe Imost Iimportant Icollaboration? IThe Ione Ithat

Ioccurs:

I
Student IAnswer:
I Between Ithe Ipatient Iand Itheir Ifamily
I

I Between Ithe Inurse Ipractitioner Iand Itheir Iphysician Imentor

I

IBetween Ithe Ipatient Iand Ithe Inurse Ipractitioner I(The Icollaboration

Ithat Iis Imost Iimportant Iis Ithe Ione Ithat Ioccurs Ibetween Ithe Ipatient Iand
Ithe Inurse Ipractitioner. I I)

I Between Itwo Ihealthcare Iproviders Iabout Ia Isingle Ipatient

 I Points IReceived: 0 Iof I5
I Comments:

Question Question I: Tachyarrhythmias Icause Ia Idrop Iin Icommonly Iblood Ipressure, Icardiac
I51. Ioutput, Isyncope, Ishortness Iof Ibreath, Iand Ichest Ipain. IWhat

Iphenomenon Imost Ioften Ioccurs Iduring Ithese Iarrhythmias Ito Icause

Ithese Isymptoms?

I
Student IAnswer:
I Shortened Isystole
I

I Lengthened Idiastole
I

I Lengthened Isystole
I

IShortened Idiastole I(The Iphenomenon Ithat Imost Ioften Ioccurs

Iduring Ithese Iarrhythmias Ito Icause Ithese Isymptoms Iis Ishortened

Idiastole Irelated Ito Ithe Irapid Iheart Irate. ITypically, Ia Ishortened Isystolye

Iwould Inot Icause Ias Isevere Isymptoms.)

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: Of Ithe Ianswers Ibelow, Iwhich Iwould Ibe Iincluded Iin Idefining Ia Ipositive
I52. IExercise IEchocardiogram?

I
Student IAnswer:
I Regional Ihypokensis Iof Iventricular Imuscles Iwalls
I

IInduced Idecrease Iin Iregional Iwall Imotion I(Induced Idecrease Iin

Iregional Iwall Imotion Iwould Ibe Iincluded Iin Idefining Ia Ipositive Iexercise
Iechocardiogram. IWall Ithickening Iwould Inot Itraditionally Ioccur Iin Ia

Ipositive Itest Iand Ihyperkinesis, Inot Ihypokinesis, Igenerally Ioccurs Iin Ia

Ipositive Itest.)

I Death Itwo Idays Iafter Itest

I

I Increase Iin Iwall Ithickening

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: The Isensitivity Iof Ia Iroutine IETT Iis Ieffort Idependent. IWhat Iphysiological
I53. Ichanges Ioccur Iduring Ieffort Iin Ithe Iroutine IETT?
I
Student IAnswer:
I Decreased Iheart Irate Iand Iincreased Isystolic Iblood Ipressure
I

IIncreased Icoronary Iflow Iand Iincreased Isystolic Iblood Ipressure

I(The Iphysiological Ichanges Ithat Ioccur Iduring Ieffort Iin Ithe Iroutine IETT
Iare Iincreased Icoronary Iflow Iand Iincreased Isystolic Iblood Ipressure.)

I Rapid Iheart Irates Iand Icoronary Iartery Inarrowing

I

I Decrease Iin Icoronary Iblood Iflow

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: For Iwomen Iwith Iknown ICAD Iand Idiabetes, Iwhich Iis Imost Iappropriate Ito
I54. Iassess ICAD Irisk?

I
Student IAnswer:
I Coronary Ibypass Isurgery
I

IETT Iwith Iimaging I(ETT Iwith Iimaging Iis Imost Iappropriate Ito Iassess

I CAD Irisk.)
I

I Coronary Icatheterization
I

I ETT

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: On Ithe Iechocardiography Iduring Ithe IETT Iyou Inotice Ithe Ifollowing
I55. Ichange: Iabnormal Ileft Iventricular Iejection Ifraction. IWhat Ido Ithese

Ichanges Isuggest Irelated Ito Ithis Ipatient?

I
Student IAnswer:
I Weak Iventricular Imuscles
I

I Non-ischemic Ichanges Iof Ithe Ibaseline IECG

I

IIschemia Iof Ithe Imyocardium I(Abnormal Ileft Iventricular Iejection

I fraction Isuggests Iischemia Iof Ithe Imyocardium.)

I

I Rise Iin Iheart Irate Iwithout Ievidence Iof Iischemia

I Points IReceived: 0 Iof I5

 I Comments:

Question Question I: Your Ipatient Iis Inewly Idiagnosed Iwith Ipersistent IAtria IFibrillation. IYou
I56. Iconsider Ielectrocardioversion. IBefore Iundergoing Ithis Iprocedure Iyou

Ishould Iorder Ithe Ifollowing Iexamination Ito Iassess Ithrombus Irisk.

I
Student IAnswer:
ITranesophageal Iechocardiography I(Before Iundergoing Ithis

Iprocedure Iyou Ishould Iorder Itranesophageal Iechocardiography Ito

Iassess Ithrombus Irisk.)

I X-Ray Iof Ichest

I

I Ultrasound Iof Ichest

I

I CT IScan

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: Population Idisease Imanagement Iis Ia Iterm Iused Ito Idescribe:
I57.

I
Student IAnswer:
I High Ispecificity Idisease Istates
I

I Low Ispecificity Idiseases Istates

I

IHigh Iprevalence Ispecific Idiseases I(Population Idisease

Imanagement Iis Ia Iterm Iused Ito Idescribe Ithe Ihigh Iprevalence Iof Ispecific
Idiseases. I I)

I Low Iprevalence Ispecific Idiseases

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: At Iwhat Ipoint Iis Ielective Irepair Iof Ian Iabdominal Iaortic Ianeurysm I(AAA)
I58. Ifor Ia Ihealthy Ipatient Iconsidered Iappropriate?

I
Student IAnswer:
I 1-2 Icm Idiameter
I

I Baseball Isize
I

I5-6 Icm Idiameter I(The Ipoint Iwhen Ielective Irepair Iof Ian Iabdominal

Iaortic Ianeurysm I(AAA) Ifor Ia Ihealthy Ipatient Iis Iconsidered Iappropriate

Iis Iwhen Ithe IAAA Ireaches Ithe Isize Iof I5—6 Icm Idiameter.)

I 10-15 Icm Idiameter

I Points IReceived: 5 Iof I5

I Comments:

Question Question I: Your Ipractice Ipartner Ijust Iordered Ian Iexercise Iechocardiography I2DE
I59. Ifor Ia Ipatient Iwith Isuspected Icardiovascular Irisk. IThis Ipatient Ihas Iknown

Iresting Iwall Imotion Iabnormalities. IWhy Iwould Ithis Inot Ibe Ithe Ibest Itest

Ito Iassess Ithis Ipatient’s Icardiac Irisk?

I
Student IAnswer:
I Specificity Iis Idecreased
I

I Specificity Iis Iincreased

I

ISensitivity Iis Idecreased I(This Iwould Inot Ibe Ithe Ibest Itest Ito Iassess

I this Ipatient’s Icardiac Irisk Ibecause Isensitivity Iis Idecreased. I I)

I

I Sensitivity Iis Iincreased

I Points IReceived: 0 Iof I5

I Comments:

Question Question I: Medicare Icovers Iinpatient Ihospital Iservices Iunder Iwhich Ipart Iof Ithe
I60. IMedicare Iinsurance?

I
Student IAnswer:
I Part IA I(Medicare Icovers Iinpatient Ihospital Iservices Iunder IPart IA. I)
I

I Part ID
I

I Part IB
I

I Part IC