APEA 3P EXAM WITH EXLANATIONS

APEA 3P EXAM WITH EXLANATIONS

Mr. Holbrook, a 75-year-old male, is a former smoker with a 30-pack-year history. He has come in today for an annual exam. He walks daily for 25 minutes, has had intentional weight loss, and has a near-normal BMI. On examination, the patient is noted to have an absence of hair growth on his lower legs. Which statement is true regarding this patient?

This is a normal consequence of aging.

This might indicate disease in the lower extremities.

It might be from exercise initiation.

This is secondary to long-term smoking.

B.

An absence of hair growth likely indicates peripheral artery disease in this patient. It is part of normal changes of aging that hair growth will diminish, but not become absent. His lower extremity pulses should be assessed, his cardiac risk factors should be assessed (he smoked for years), and he should be questioned about leg pain when he walks. An ankle-brachial index could be measured. If < 0.9, further assessment should be done. A normal ankle-brachial index should be greater than 0.9. Less than 0.4 is considered critical.

The usual clinical course of mitral valve prolapse:

is benign.

results in sudden cardiac death. results in chronic heart failure.

is associated with multiple episodes of emboli.

A.

The usual course of mitral valve prolapse (MVP) is benign, and most patients who have MVP are asymptomatic. A murmur may be present and is best auscultated with the diaphragm of the stethoscope over the cardiac apex. In a minority of patients, symptoms of heart failure or sudden death may occur. When heart failure results, it is usually a result of mitral regurgitation.

Embolization may occur, but, this is not common or usual in the majority of patients.

An ACE inhibitor is specifically indicated in patients who have:

hypertension, diabetes with proteinuria, and heart failure. diabetes, hypertension, hyperlipidemia.

asthma, hypertension, diabetes.

renal nephropathy, heart failure, hyperlipidemia.

A.

ACE inhibitors have numerous indications. Three are indicated in the first choice. ACE inhibitors are also indicated in patients who have renal insufficiency. However, ACE inhibitors can worsen renal insufficiency, so the patients must be monitored closely with lab tests for BUN, Cr, and potassium. Diabetes without proteinuria is not a specific indication for ACE inhibitors use, though they are used by some healthcare providers in this way. This is an off-label use.

Which patient could be expected to have the highest systolic blood pressure? A 21-year-old male

A 50-year-old perimenopausal female

A 35-year-old patient with Type 2 diabetes A 75-year-old male

D.

Nearly 25% of the US population has hypertension. The greatest incidence is in older adults because of changes in the intima of vessels as aging and calcium deposition occur. Males of any age are more likely to be hypertensive than females of the same age. African American adults have the highest incidence in the general population. Among adolescents, African Americans and Hispanics have the highest rates. Hypertension occurs in 5-10% of pregnancies.

Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization?

Naproxen Furosemide Metformin Losartan

D.

Naproxen and furosemide should be stopped for 24 hours prior to the catheterization. Metformin should be stopped 48 hours prior to the catheterization. Furosemide is stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld because of the impact on renal prostaglandin production. Metformin has been implicated in lactic acidosis when combined with contrast dye in an impaired kidney.

In older adults, the three most common ailments are:

hearing loss, vision loss, hypertension. hearing loss, hypertension, arthritis. depression, vision loss, hypertension. arthritis, hearing loss, depression.

B.

Hypertension and arthritis are the two most common ailments in older adults. Hearing loss occurs in half to almost 2/3 of older adults. The most common form is known as presbycusis. There is no consensus for the frequency of screening for hearing loss in older patients, but

minimally, it should be grossly evaluated at each visit and screened more thoroughly if deficits are observed. Blood pressure should be screened annually, but it is usually screened at each visit. Arthritis is not routinely screened.