ICM first4 test3

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  1. Patient has BP of 136/82 on office visit. Which is true concerning the patient?
    A. Ambulatory blood pressure monitoring should be done to verify his out-of-office readings.
    B. His risk of ischemic heart disease is twice that of someone with a blood pressure of 115/75.
    C. Because his BP is greater than 120/80, he has HTN and should be treated accordingly.
    D. Because his blood pressure is less than 140/90, dietary changes will have little benefit on his BP.
    (this multiple choice question has been scrambled)
  2. What is the goal BP of someone who has Diabetes and someone who does not?
    • Diabetes patient goal is under 130/80
    • Regular person goal is under 140/90
  3. Which of the following is true concerning blood pressure management?
    A. Eliminating table salt will drop his SBP by about 10 mmHg.
    B. A diet rich in whole grains, fruits and vegetables will reduce his BP, even if it has no effect on his weight.
    C. Complete cessation of alcohol will lower his BP considerably.
    D. Quitting smoking will have a greater effect on his BP than any dietary modification.
    (this multiple choice question has been scrambled)
  4. what are first line drugs to treat stage 1 hypertension?
    a. Clonidine
    b. Hydrochlorothiazide
    c. Hydralazine
    d. Rampiril
    e. Atenolol
    • b.
    • d.
  5. What treatments should be considered for people with hypertension due to bilateral adrenal hyperplasia?
    • Spironolactone/Eplerenone
    • Surgical if discreet nodules
  6. Patient who has uncontrolled hypertension is put on ACE inhibitor and they get sicker, what should be considered as the cause of the hypertension?
    Bilateral renal artery stenosis – Kidneys think BP is low, increased blood pressure to increase flow. The ACE inhibitor decreases blood flow to kidney leading to kidney failure
  7. Concerning auscultation, what does the term “PMI” refer to?
    • Point of maximum impact
    • It is usually the lateral heart border, at or just inside the mid-clavicular line
    • It should be the size of a nickel
  8. What is the Angle of Louis?
    • Junction of manubrium with body of sternum
    • It marks the second rib
  9. What is important about the 4th intercostal space?
    It goes across the atria
  10. What is important about “ERBS’s Point”?
    • It is the 3rd left intercostal space
    • It is the best place to hear aortic regurgitation
  11. What are the four heart sounds?
    • S1 – closing of mitral and tricuspid valves
    • S2 – closing of aortic and pulmonic valves
    • S3 – occurs during end of rapid ventricular filling
    • S4 – Only with atrial contraction
  12. Which heart sound is the closing of the mitral and tricuspid valves?
  13. Which heart sound occurs during the end of rapid ventricular filling?
    • S3
    • This sound is normal in young people, but if heard in older individuals it indicates systolic failure
  14. Which heart sound is the closing event of aortic and pulmonic valves?
  15. Which heart sound occurs with atrial contraction?
    • S4
    • This sound indicates decreased compliance of the corresponding ventricle, “diastolic stiffness”
    • Can’t be heard with atrial fibrillation
  16. Which valve closes first, aortic or pulmonic? (both part of the S2 sound)
    • Aortic valve closes first
    • Pulmonic valve closes second
  17. Which of the two foot pulses are more important?
    Posterior tibial pulse, because the dorsalis pedis is absent in 7% of people
  18. What problem is there when the brachial pulse significantly precedes the femoral pulse?
    • Coarctation of Aorta
    • Normally is precedes it by a little bit, but when the aorta is coarcted it precedes it by a lot.
  19. What does a water hammer pulse (corrigan’s pulse) lead us to believe if the BP is 180/40?
    There is Aortic insufficiency
  20. Where is there a problem if the right arm BP is higher than the left arm BP?
    • There is a coarctation of the aorta before the LSA comes off the aorta
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ICM first4 test3
ICM first4 test3
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