19 Jan Heart disease

1. Question : Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?

Specificity would be increased because of obesity

Sensitivity would be reduced because of obesity and lung disease

Sensitivity would be increased because of lung disease

Specificity would be reduced because of obesity and lung disease

2. Question : Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes. True or false?

False

True

3. Question : By standard criteria, how is a positive stress test defined?

Development of a horizontal or down sloping ST-segment depression of 10mm

Development of a horizontal or down sloping ST-segment depression of 1mm

Upward sloping ST-segment measured at the J point of the QRS

Down sloping of the ST-segment at the J point of the QRS

4. Question : Population disease management is a term used to describe:

Low prevalence specific diseases

High prevalence specific diseases

Low specificity diseases states

High specificity disease states

5. Question : What are two of the most common forms of Exercise Stress Tests used today?

Bicycle and treadmill

Unicycle and Running in pace

Thallium and Dobutamine

Bicycle and rowing machine

6. Question : You are counseling a patient diagnosed with stress-induced ischemia. You base your discussion on your knowledge that stress-induced ischemia is thought to be caused by what phenomena?

Too many carbonated drinks

Diet and exercise

Endothelial dysfunction of the microvascular

Heart muscle dysfunction

7. Question : Narrowed coronary arteries or plague rupture within the arteries of the coronary system may directly cause which condition?

Venous Statis

Diabetes

Hypertension

Coronary artery disease

8. Question : Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing?

Results are available more quickly

Does not depend on operator experience

Doesn’t matter because there are no advantages

Costs are the same

9. Question : A 55-year old man is referred to your clinic. He has been sedentary all of his life, is gaining weight and wishes to get into better physical shape. He has never had any chest pain or shortness of breath when walking or climbing a flight of stairs. Before recommending a vigorous exercise routine for this patient, you order what test?

Stool samples

CBC

ETT

Thyroid levels

10. Question : What ECG changes can reduce the specificity of the ETT?

Paced rhythm and resting bundle branch block

Low voltage up sloping of the ST-segment

Exercise induced bundle branch blocks

Paced rhythm and exercise induced bundle branch blocks

11. Question : In women, you need to know the limitations of certain tests for CAD. For example, single-photon emissions CT imaging, while an acceptable test for most men and some women, is technically limited in women for two reasons. From the following, choose the best possible answer.

Breasts and fat deposits in abdomen

Smoking rates and lack of uptake of photons

Breasts and smaller coronary arteries

Multiple vessel disease and fat deposits

12. Question : Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?

Monetary savings and limited disruption in healthcare delivery

Population management and healthcare practice

Socialized medicine and governmental controls

President and Congress

13. Question : The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?

Decrease in coronary blood flow

Increased coronary flow and increased systolic blood pressure

Rapid heart rates and coronary artery narrowing

Decreased heart rate and increased systolic blood pressure

14. Question : Your mentor says that you should be prepared to know how to determine the maximum heart rate for your patient during the ETT. How is the age-predicted maximum heart rate during an ETT determined?

220+age

120-age

220-age

65+age

15. Question : Medicare hospital insurance (Part A) is funded through what system?

Interest from investments

State income taxes

Federal income taxes

Federal payroll taxes

16. Question : We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:

Between the patient and their family

Between the patient and the nurse practitioner

Between the nurse practitioner and their physician mentor

Between two healthcare providers about a single patient

17. Question : The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. Is this true or false?

False

True

18. Question : Ischemic changes on ECG during ETT is highly predictive of CAD. What is another important strong predictor of CAD that you might see during an ETT?

Slow heart rate

Exercise-induced hypotension

Exercise-induced hypertension

Rapid heart rate

19. Question : In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. Is this true or false?

False

True

20. Question : Chronic, non-communicable diseases account for disproportionate costs to the healthcare system. According to the World Health Organization, what percent of preventable deaths and disabilities occur in the Americas related to chronic non-communicable diseases?

10%-15%

80%-90%

35%-45%

60%-70%

21. Question : Your patient has a maximum age-predicted heart rate of 180. During the exercise, he reaches a heart rate of 140 and then states he can no longer exercise. You see no evidence of ischemia on the ECG. This would be diagnostic for what condition?

Has no diagnostic value to rule out CAD

Predictive of no CAD

Diagnostic of laziness

Diagnostic for impending Myocardial Infarction

22. Question : What happens to coronary flow related to CAD?

Functional systolic pressures

Hyper profusion of the myocardium

Cerebral vascular infarction

Hypo profusion of the myocardium

23. Question : Your patient cannot sit on a bicycle and has difficulties walking a treadmill with limited capacity for exercising. Still, you know that the ETT is the preferred test for CAD. You consider adding a pharmacological agent to get to maximum heart rate. What agent would be the most commonly used agent to assist in an ETT?

Epinephrine

Dobutamine

Dopamine

Aspirin

24. Question : A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities. You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?

To please the patient

CAD in women is under diagnosed

Women present with the same pattern of CAD as do males

You are out of other options

25. Question : Why would inability to exercise reduce the specificity of the routine ETT?

Produces persistent ST-segmental changes and T-wave abnormalities

Will not produce any changes in ECG

Produces QRS changes that cannot be interpreted

Causes ST-segment changes and P-wave abnormalities

26. Question : On the echocardiography during the ETT you notice the following change: abnormal left ventricular ejection fraction. What do these changes suggest related to this patient?

Ischemia of the myocardium

Weak ventricular muscles

Rise in heart rate without evidence of ischemia

Non-ischemic changes of the baseline ECG

27. Question : Specifically, when is an ETT considered to be negative?

Patient exercises to 20% maximum age-predicted heart rate without induced ischemia

Patient exercises to 85% of age predicted maximum heart rate without evidence of induced ischemia (An ETT is considered to be negative when the patient exercises to 85% of age predicted maximum heart rate without evidence of induced ischemia. )

Patient exercises until tired without evidence of induced ischemia

Patient has ST-segmental changes with down sloping of greater than 1 mm at 50% of age-predicted maximum heart rate

28. Question : Eligibility for Medicaid includes the following:

Elderly, children and women living in poverty

Very young and elderly only

Everyone unemployed

Children and women regardless of income

29. Question : What is the leading cause of death for women in the United States?

Complications of childbirth

Lung cancer

Breast cancer

Heart disease

30. Question : What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle?

Requires both for detection of changes by ETT

Easier to detect by ETT

Difficult to detect by ETT

ETT cannot be used for detection