Cardio APEA Assignment
Cardio APEA Assignment
Question 1:
The lymphatic ducts drain into the:
arterial system.
venous system. Correct
arteriovenous system.
capillary bed. Incorrect
Explanation:
The lymphatic ducts drain into the venous system. Cardio APEA Assignment
Question 2:
While auscultating the patient’s heart, a medium, soft murmur is audible. It is pansystolic and heard loudest at the apex with radiation to the left axilla. These findings are consistent with:
tricuspid regurgitation.mitral regurgitation. Correcta ventricular septal defect.an innocent murmur. Incorrect
Explanation:
Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill, it can be loud. With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is pansystolic. The murmur of an uncomplicated ventricular septal defect has a high pitch and is usually heard throughout systole. An innocent murmur is heard loudest at mid systole near the second to fourth intercostal spaces between the left sternal border and the apex. It usually decreases or disappears when sitting. Cardio APEA.
Question 3:
Which of the following group of symptoms would be suggestive of an infant experiencing a congenital heart defect associated with a decreased pulmonary blood flow pattern?
Tissue perfusion greater than 3 seconds, bluish colored skin, and poor feeding Correct
Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen saturation less than 95%
Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds, and oxygen saturation greater than 95%
Poor feeding, audible heart murmur, and oxygen saturation greater than 95%
Explanation:
Infants with defects resulting from decreased pulmonary blood flow have cyanosis because of desaturated blood entering systemic circulation and/or because of the inability to get blood to the lungs. Tetralogy of Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this category and are considered cyanotic defects. Due to the ventricular septal defect in TOF, the absence of the tricuspid valve or pulmonary valve in tricuspid and pulmonary atresia, one should hear abnormal heart sounds either due to the murmur in TOF or single heart sounds of S1 or S2 in pulmonary atresia or tricuspid atresia. Cardio APEA. Usually these infants have activity intolerance and therefore, experience failure to thrive because of their inability to consume enough formula to gain weight appropriately. Capillary refill is usually prolonged due to poor oxygenation and poor perfusion secondary to the defect as well as the O2 sats being lower than normal, sometimes even in the 80% range.
Question 4:
Right atrial pressure can be determined by:
palpating the carotid pulse. Incorrect
identifying the pulsations of the right jugular vein. Correct
analyzing the arterial blood gases.
assessing for dependent edema.
Explanation:
Jugular venous pressure reflects pressure in the right atrium and is best assessed from pulsations in the right internal jugular vein. This is an indicator of cardiac function and right heart hemodynamics. Palpating the carotid artery denotes arterial pressure; analyzing blood gases reflects the status of the arterial blood. Assessing for dependent edema is a reflection of heart failure and poor venous return and not atrial pressure. Cardio APEA Assignment
Question 5:
When assessing the heart rate of a healthy 13-month-old child, which one of the following sites is the most appropriate for this child?
Apical pulse at the 5th intercostal space right midclavicular line
Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line Correct
Apical pulse to the right of the midclavicular line in the 3rd intercostal space
Apical pulse in the 5th intercostal space left midclavicular line Incorrect
Explanation:
The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th intercostal space to the left of the midclavicular line. The only time one would auscultate the right midclavicular line would be if the child had situs inversus or dextrocardia.
Question 6:
The infraorbital or maxillary, buccinator, and supramandibular lymph nodes drain lymphatic fluid from the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region.
eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. Correct
mouth, throat, and face. Incorrect
posterior part of the temporoparietal region.
Explanation:
The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and the skin and mucous membranes of the nose and cheek. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth, throat, and face. The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region. Cardio APEA Assignment
Question 7:
The external iliac lymph nodes drain lymphatic fluid from the following areas except the:
urinary bladder.
prostate.
uterus.
gluteal region. Correct
Explanation:
The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or uterus, and the upper vagina. The internal iliac lymph nodes receive lymphatic fluid from all pelvic viscera, deep part of the perineum, and the gluteal region.
Question 8:
The amplitude of the pulse in a patient in cardiogenic shock would most likely appear:
bounding.
thready. Correct
normal.
as a bruit.
Explanation:
The amplitude of the pulse correlates with pulse pressure. Small, thready, or weak pulses occur in patients in cardiogenic shock. Bounding pulses are seen in patients in aortic insufficiency. A bruit is not typically associated with pulse amplitude. It is associated with stenosis or turbulent arterial blood flow. Usually the presence of a bruit requires further investigation and is not in itself diagnostic. Cardio APEA.
Question 9:
When auscultating the heart for aortic insufficiency, ask the patient to:
lie supine and inhale.
exhale while standing.
turn to the left side and breath deeply.
sit up, lean forward, and exhale. Correct
Explanation:
To bring the left ventricular outflow tract closer to the chest wall to listen for aortic insufficiency, ask the patient to sit up, lean forward, and exhale. Cardio APEA.
Question 10:
The horizontal superficial inguinal lymph nodes are located in the anterior thigh below the inguinal ligament and drain lymphatic fluid from all of these areas except:
lower abdomen.
buttock. Incorrect
testes. Correct
lower vagina.
Explanation:
The horizontal superficial inguinal nodes lie in a chain high in the anterior thigh below the inguinal ligament. They drain the superficial portions of the lower abdomen and buttock, the external genitalia (but not the testes), the anal canal and perianal area, and the lower vagina.
Question 11:
When auscultating the point of maximal impulse (PMI), apex of the heart, in an adult, the stethoscope is placed at the:
third intercostal space to the left of the midclavicular line.
fifth intercostal space to the left of the midclavicular line. Correct
fourth intercostal space to the right of the midclavicular line.
fifth intercostal space to the right of the midclavicular line. Incorrect
Explanation:
To auscultate the apex of the heart in an adult, the proper placement of the stethoscope should be at the fifth intercostal space to the left of the midclavicular line.
Question 12:
Deep cervical lymph nodes drain lymphatic fluid from the:
head and neck. Correct
breasts.
mouth, throat, and face.
posterior part of the temporoparietal region. Incorrect
Explanation:
The deep cervical lymph nodes drain all of the lymphatic fluid from the head and neck. Axillary lymph nodes drain most of the lymphatic fluid of the breast. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region. Cardio APEA Assignment
Question:
Which of the following symptoms would necessitate the need for further evaluation in the newborn?
Blue hands and feet within an hour after birthBlood glucose level 45 mg/dl.Dusky cyanotic when crying CorrectDeep sleep one hour after birth
Explanation:
An infant who is dusky and becomes cyanotic when crying is showing poor cardiovascular adaptation to extrauterine life and requires further evaluation. Acrocyanosis, blue feet and hands, is not central cyanosis and is an expected finding during the early neonatal life. Normal glucose levels for a newborn are 40-60 mg/dL. Infants enter the period of deep sleep or decreased activity when they are about one hour old.
Question:
Symptoms of acrocyanosis in the newborn include:
bluish color of the tongue.bluish color of the mucous membranes.bluish color of the feet. Correctbluish color of the abdomen.
Explanation:
Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and typically resolve in 24 – 48 hours. A blue color around the lips and philtrum is a relatively common finding shortly after birth. The skin in the infant is usually well perfused, and the tongue and mucous membranes in the mouth are pink, a finding that assures that central cyanosis is not present. Cardio APEA.
Question:
A heart rate of 100-180 beats per minute in an adult is considered:
normal sinus rhythm.sinus tachycardia. Correctsupraventricular tachycardia.ventricular tachycardia.
Explanation:
A normal heart rate in an adult is between 60 / 100 beats per minute. Tachycardia is over 100 beats / minute. Rates that exceed 180 beats / minute are usually supraventricular. Normal sinus rhythm is a measurement of the hearts electrical activity, not mechanical activity. Ventricular tachycardia is rapid and chaotic ventricular activity.
Question:
Tissue ischemia is usually observed when assessing a patient with peripheral artery disease (PAD). What other symptom could be observed?
Peripheral edemaIntermittent claudication. CorrectA brownish discoloration to the skin of the affected leg IncorrectBounding pulses in the affected leg
Explanation:
With peripheral vascular disease, arterial peripheral blood flow is impeded resulting in inadequate tissue perfusion and oxygenation. This leads to intermittent claudication, ischemia muscle pain precipitated by a predictable amount of exercise and relieved by rest. Other symptoms include pale cool skin, cyanosis, audible bruits, diminished or absent pulses, and thickened and opaque nails. Usually by the time the symptoms appear, the artery is 75% narrowed. Peripheral edema and brownish discoloration of the skin would be consistent with venous disease. Bounding pulses may reflect hypertension. Cardio APEA.
Question:
When performing a cardiovascular assessment on a healthy 2-year-old child:
expect to hear a swooshing sound during diastole.place the stethoscope over the fifth intercostal space to the left of the mid-clavicular line.auscultate the heart sounds in all four cardiac areas. Correctexpect to hear an S4 sound.
Explanation:
When performing cardiac assessment on the child, the heart sounds should be auscultated in all 4 cardiac areas: aortic, pulmonic, tricuspid, and mitral areas. In children younger than 7 years of age, the point of maximum impact (PMI) is auscultated at the third or fourth intercostal spaces, and one should not hear swooshing sounds as this would be indicative of a pathological heart murmur, especially if heard during diastole. S4 sound is produced by the atrium forcefully contracting against a stiffened ventricle. It is also a dull, low pitched sound. The presence of S4 usually indicates cardiac disease secondary to a decrease in ventricular compliance caused by either ventricular hypertrophy or myocardial ischemia. Cardio APEA.
Question:
A disparity between the brachial and femoral pulses in a 4-month-old could indicate:
an atrial septal defect (ASD).Tetralogy of Fallot. Incorrectcoarctation of the aorta (COA). Correcttricuspid atresia (TA).
Explanation:
In coarctation of the aorta (COA), there is a disparity of pulses between the upper and lower extremities due to the narrowing of the descending aorta resulting in decreased blood flow to the lower extremities. The other choices do not present with these findings. Cardio APEA Assignment
Question:
The right lymph duct drains lymphatic fluid from all the following areas except the:
right side of the head.right upper thorax.right arm.right leg. Correct
Explanation:
The right lymph duct drains lymphatic fluid from the body’s right upper quadrant and includes the right side of the head and neck, right side of the thorax, and right upper limb. The thoracic duct drains lymph from the remainder of the body including the legs. Cardio APEA.
Question:
When auscultating the apex of the heart in an 8-year-old, the bell of the stethoscope should be placed at the:
third intercostal space lateral to the midclavicular line.fifth intercostal space to the left of the midclavicular line. Correctfourth intercostal space lateral of the midclavicular line.fifth intercostal space to the right of the midclavicular line.
Explanation:
In children older than 7 years, the apical pulse, or point of maximum impulse, is heard loudest at the fifth intercostal space and left of the midclavicular line. In children and infants less than seven years, it is heard at the third or fourth intercostal space and lateral to the midclavicular line. The apex would be located on the right side of the chest if dextrocardia was present. Cardio APEA.
Question:
In order to assess for varicosities in the lower extremities, position the patient:
lying supine.standing. Correctsitting facing forward.squatting facing the examiner. Incorrect
Explanation:
The standing posture allows any varicosities to fill with blood and makes them more easily visible.
Question:
A patient complains of a tight, bursting pain in the calf that increases with walking. Elevation of the leg sometimes relieves the pain. These symptoms may be consistent with:
intermittent claudication. IncorrectRaynaud’s disease.deep venous thrombosis. Correctsuperficial thrombophlebitis.
Explanation:
Deep venous thrombosis (DVT) is a venous disorder. The patient often describes the pain as tight, and bursting around the affected area. The pain may be accompanied by swelling and tenderness. Reynaud’s disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Cardio APEA.
Question:
Symptoms of orthostatic hypotension include all of the following except:
syncope.unsteadiness.visual blurring.respiratory rate greater than 30. Correct
Explanation:
Orthostatic hypotension occurs in 20% of older adults and in up to 50% of frail nursing home residents, especially when they first arise in the morning. Symptoms include lightheadedness, weakness, unsteadiness, visual blurring, and in 20% to 30% of patients, syncope.
Question:
A three-week-old infant presents with a generalized lacy, reticulated blue discoloration of the skin. This is suggestive of:
mongolian spots. Incorrectharlequin color changes.acrocyanosis.cutis marmorata. Correct
Explanation:
Cutis marmorata is a marbled or mottled look about the skin of a newborn caused by the uneven distribution of blood flow about the skin. The cause is due to both the immature vascular and neurologic systems in the newborn. Mongolian spots are blue-gray spots that are flat, “bruise-like” areas of skin. Usually confined to the back and buttocks. Acrocyanosis is a bluish discoloration of the hands, feet and lips. The phenomenon is considered normal to newborns because of immature circulation and underdeveloped capillaries.
Question:
The supraclavicular lymph nodes are located:
along the anterior edge of the trapezius.deep in the angle formed by the clavicle and the sternomastoid muscle. Correctsuperficially to the sternomastoid muscle. Incorrectmidway between the angle and the tip of the mandible.
Explanation:
The supraclavicular lymph nodes are located deep in the angle formed by the clavicle and the sternomastoid muscle. The posterior cervical lymph nodes are located along the anterior edge of the trapezius. Cardio APEA. The superficial cervical lymph nodes are located superficial to the sternomastoid muscle. Midway between the angle and the tip of the mandible are the submandibular lymph nodes.
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Question:
In an adult patient, auscultate the sounds arising from the mitral valve by placing the stethoscope:
near the apex of the heard between the 5th and 6th intercostal spaces in the mid-clavicular line. Correctbetween the 3rd, 4th, 5th, and 6th intercostal spaces at the left sternal border.between the 2nd and 3rd intercostal spaces at the left sternal border. Incorrectbetween the 2nd and 3rd intercostal spaces at the right sternal border.
Explanation:
Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. Mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. Aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). Pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). Tricuspid listening point is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB). Cardio APEA.
Question:
The tonsillar lymph node is located:
at the angle of the mandible. Correctin front of the ear.at the base of the skull posteriorly.superficial to the mastoid process. Incorrect
Explanation:
The tonsillar lymph nodes are at the angle of the mandible. The preauricular lymph nodes are located in front of the ear. The occipital lymph nodes are located at the base of the skull posteriorly. The posterior auricular nodes are superficial to the mastoid process.
Question:
A bruit heard in the epigastric area with both systolic and diastolic components is suggestive of:
renal artery stenosis. Correctaortic regurgitation. Incorrectfemoral artery occlusion.an aortic aneurysm.
Explanation:
A bruit heard in the epigastric area, upper quadrants, or in the costovertebral region that has both systolic and diastolic components is suggestive of renal artery stenosis. Aortic regurgitation could be evidenced by the presence of S1, S2, and a diastolic murmur. Femoral artery occlusion would produce a cold, painful, discolored lower extremity. A pulsation visible or palpable in the epigastrium could be consistent with an aortic aneurysm.
Question:
Presence of a heart murmur in a child would be considered organic if the child:
is 18-months-old and was recently diagnosed with anemia.was a 3-year-old, afebrile and diagnosed with an upper respiratory infection.was a 10-month-old who presented with a temperature of 103 °F.was a 2-year-old with a congenital heart defect.
Cardio APEA Assignment
Explanation:
A heart murmur is classified an organic murmur if there is an anatomic cardiac defect with or without a physiologic abnormality. If a murmur was heard and the child presents with fever or anemia, the murmur is considered non organic or physiologic. The 3-year-old with the upper respiratory infection without fever would be an example of an innocent murmur since there is an absence of an anatomic or physiological condition.
Question:
A patient complaints of a sharp, knifelike pain that begins in the chest and radiates to the tip of the shoulder and to the neck. This type of chest pain is suggestive of:
pericarditis. Correctan aortic dissection.angina pectoris.a myocardial infarction. Incorrect
Explanation:
Assessing chest pain can be very difficult but thorough patient history and a physical exam can help the clinician determine the cause. Pain associated with pericarditis may radiate to the tip of the shoulder and to the neck and presents with a sharp, knifelike pain. A sharp pain that radiates to the back or into the neck can be associated with aortic dissection. Exertional pain is often angina pectoris.
Question:
In order to bring the ventricular apex closer to the chest wall when assessing the point of maximal impulse (PMI), ask the patient to:
lie supine.sit up.turn to the left side. Correctlean forward. Incorrect
Explanation:
To bring the ventricular apex closer to the chest wall to assess the PMI, ask the patient to turn to the left side, termed the left lateral decubitus position. The patient should lie supine during this part of the cardiac exam. To auscultate for aortic insufficiency, ask the patient to sit up, lean forward, and exhale.
Question:
The preauricular lymph node is located:
at the angle of the mandible.in front of the ear. Correctat the base of the skull posteriorly.superficial to the mastoid process.
Explanation:
The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly. The posterior auricular nodes are superficial to the mastoid process.
Question:
To auscultate the heart sounds arising from the pulmonic valve in an adult patient, place the stethoscope:
near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. between the 2nd and 3rd intercostal spaces at the right upper sternal border.between the 2nd and 3rd intercostal spaces at the left sternal border. Correctbetween the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border.
Explanation:
Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. The aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid listening point is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB).
Question:
To assess aortic pulsations in patients with carotid obstruction, assess the pulse using the:
temporal artery. Incorrectbrachial artery. Correctfemoral artery.popliteal artery.
Explanation:
Aortic pulsation is most accurately assessed by palpating the carotid arteries. However, if the carotid arteries are obstructed, the brachial artery should be palpated to reflect aortic pulsation. The temporal, femoral, and popliteal are not the most accurate arteries for assessing aortic pulsations.
Question:
When screening a patient for peripheral arterial disease (PAD), one risk factor would include a history of:
smoking. Correctan implantation of a temporary internal pacemaker.dysrhythmias.peripheral edema.
Explanation:
Nicotine in cigarettes promotes vasoconstriction which results in peripheral arterial disease. Cigarette smoking, hypertension, and hyperlipidemia are the three most common causes of peripheral arterial disease (PAD). Peripheral edema is consistent with venous disease. Dysrhythmias and a history of having a temporary internal pacemaker in place are not risk factors for PAD.
Question:
The preauricular nodes drain lymphatic fluid from the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region. Correcteyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek.mouth, throat, and face.posterior part of the temporoparietal region. Cardio APEA.
Explanation:
The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and the skin and mucous membranes of the nose and cheek. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region.
Question:
The ankle-brachial index is a screening test used to assess a person’s risk for:
deep venous thrombosis.peripheral artery disease. Correctvenous insufficiency.thromboangiitis obliterans.
Explanation:
The ankle-brachial index test is a quick, noninvasive way to check a person’s risk for peripheral artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the venous system.
Question:
The internal iliac lymph nodes drain lymphatic fluid from the:
urinary bladder.prostate.uterus.gluteal region. Correct
Explanation:
The internal iliac lymph nodes receive lymphatic fluid from all pelvic viscera, deep part of the perineum, and the gluteal region. The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or uterus, and the upper vagina.
Question:
Causes of orthostatic hypotension in older adults may include all of the following except:
diabetes. Incorrectcardiovascular disorders.medications.impaired visual acuity. Correct
Explanation:
Orthostatic hypotension occurs in 20% of older adults and in up to 50% of frail nursing home residents, especially when they first arise in the morning. Causes include medications, autonomic disorders, diabetes, prolonged bed rest, volume depletion, amyloidosis, and cardiovascular disorders. Impaired visual acuity is not a cause of orthostatic hypotension but can be a resulting symptom.
Question:
A 5-year-old child presents with complaints of fever and headache. Examination reveals a heart rate of 157 beats/minute, respiratory rate of 40 breaths/minute, B/P 108/54, and a temperature of 102.6 °F. The increased heart rate is most likely related to:
an innocent heart murmur.the child’s age.a sinus arrhythmia.the child’s febrile state. Correct
Explanation:
In the presence of fever, the heart rate increases by 10 beats/minute with each degree of fever and the respiratory rate increases by 4 breaths/minute with each degree of fever. Normal heart rate for this age group ranges from 70-120/minute. A murmur does not increase the heart rate. In sinus arrhythmia, the heart rate increases with inspiration and decreases with expiration. Cardio APEA Assignment
Question:
The posterior chest wall and portions of the arms are drained by which group of lymph nodes?
Posterior mediastinal nodesSubscapular nodes CorrectParasternal nodesIntercostal nodes
Explanation:
The subscapular lymph nodes drain lymphatic fluid from the posterior chest wall and a portion of the upper arms. The posterior mediastinal lymph nodes drain lymphatic fluid from the esophagus and posterior part of the pericardium. The lymph nodes of the chest wall include the parasternal, intercostal and the diaphragmatic areas. The parasternal lymph nodes drain the medial half of the breasts. The posterior-lateral aspect of the chest is drained by the intercostal lymph nodes. The diaphragmatic nodes drain the upper surface of the diaphragm.
Question:
A patient states that the only way he can sleep at night is to use several pillows or to sleep upright in a recliner. This sleep pattern is most consistent with:
paroxysmal nocturnal dyspnea. Incorrectobstructive lung disease. Correctangina pectoris.decreased jugular venous pressure. Cardio APEA.
Explanation:
With obstructive lung disease, the patient experiences orthopnea, dyspnea that occurs when the patient lies down but improves with sitting. Therefore, the patient would use several pillows or sleep upright in a recliner. Orthopnea is seen in obstructive lung disease, mitral stenosis, and heart failure. Paroxysmal nocturnal dyspnea describe episodes of sudden dyspnea that cause the patient to awaken from sleep where the patient must sit up, walk, or stand for it to resolve. Coughing and wheezing may also occur. Angina pectoris commonly creates chest pain or shortness of breath. Jugular venous pressure reflects right atrial pressure and volume status. In cases of cardiac or pulmonary dysfunction, jugular venous pressures usually raise.
Question:
A disease that may present as indigestion, but is precipitated by exertion and relieved by rest is most likely:
gastroesophageal reflux.inflammatory bowel disease.angina. Correctaortic stenosis.
Explanation:
A disease that may present as indigestion, but is precipitated by exertion and relieved by rest is most likely angina.
Question:
A patient suspected of having chronic venous insufficiency, may present with:
calf asymmetry.a brownish discoloration just above the malleolus. Correctabsent right pedal pulse.decreased femoral pulse.
Explanation:
Brownish discoloration or ulcers just above the malleolus suggest chronic venous insufficiency. Calf asymmetry increases the likelihood of deep venous thrombosis (DVT). Decreased or absent pulses are reflective of arterial vascular disease.
Question:
The great saphenous vein enters the deep venous system by way of the:
inferior vena cava. Incorrectiliac vein.popliteal vein.femoral vein. Correct
Explanation:
The great saphenous vein, which originates on the dorsum of the foot, joins the femoral vein of the deep venous system below the inguinal ligament.
Question:
Warning signs of peripheral artery disease may include all of the following except:
aching or numbness that limits walking.non-healing lesions of the legs.abdominal pain after meals with weight loss. Incorrectpersistent cough. Correct
Explanation:
Patients with peripheral artery disease (PAD) may not experience any symptoms or may experience a variety of symptoms that indicate ischemia. Some warning signs of peripheral artery disease include: fatigue, aching, numbness, pain that limits walking, or poorly healing lesions on the legs. The nurse practitioner should conduct a thorough assessment and review of symptoms to detect early warning signs and differentiate nonatherosclerotic and nonvascular conditions. PAD is a treatable condition. When recognized early and appropriately managed, complications that can lead to limb loss can be minimized.
Question:
On assessment, which one of the following symptoms would be noted as a compensatory response to chronic hypoxia?
Pulmonary hypertensionDehydrationHematocrit (HCT) of 55% CorrectHemoglobin (Hgb) of 8.5g/dl
Explanation:
With chronic hypoxia, the body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increasing the oxygen carrying capacity of the blood; this condition is termed polycythemia. Clubbing is a classic symptom of chronic hypoxia. Lab values denoting increased RBC such as HCT of 55-60% would be indicative of polycythemia. Pulmonary hypertension is a clinical consequence of increased pressure in the pulmonary arteries and is seen in children with congenital heart defects but it is not a direct result of hypoxia. Dehydration can occur rapidly in children with cyanotic heart defects; however, it is not a compensatory mechanism of chronic hypoxia. Anemia may develop as a result of poor tissue oxygenation secondary to decreased blood viscosity not increased as in polycythemia.
Question:
A patient complains of some pain in the distal portions of her fingers on both hands. She states that it tends to occur more frequently with exposure to cold. These symptoms may be consistent with:
intermittent claudication.Raynaud’s disease. Correctdeep venous thrombosis.superficial thrombophlebitis.
Explanation:
Reynaud’s disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. With Reynaud’s phenomenon, numbness and tingling are more prominent. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Deep venous thrombosis (DVT) is a venous disorder and may present as tight, squeezing, or bursting in the affected area.
Question:
The patient has had an internal pacemaker in place for five years. Pacemaker failure is being considered because over the past few days, the patient has been experiencing episodes of:
hiccoughs. Correctchest pain.wheezing. Incorrecthypertension.
Explanation:
Pacemaker failure is uncommon. Most malfunctions are caused by electrode dislocation, electrode dislocation, poor contact or interference by other tissues. Symptoms include dizziness, lightheadedness, hiccoughs, sudden changes in heart rate, electric shock feeling in the chest. Chest pain is usually absent. Wheezing and hypertension are not specifically characteristic of pacemaker malfunction.
Question:
The thoracic lymph duct drains lymphatic fluid from all the following areas except the:
right leg. Incorrectright upper thorax. Correctleft arm.abdominal cavity. Cardio APEA.
Explanation:
The thoracic duct drains lymphatic fluid from the majority of the body except the right upper thorax. Which includes the right side of the head and neck, right side of the thorax, and right upper limb. The right lymph duct drains these areas.
Question:
When auscultating the heart, the displacement of the point of maximal impulse (PMI) is greater than 10 cm lateral to the midsternal line. This finding is consistent with:
right ventricular hypertrophy. Incorrectleft ventricular hypertrophy. Correctpulmonary stenosis.a normal PMI location.
Explanation:
Displacement of the PMI lateral to the midclavicular line or greater than 10 cm lateral to the midsternal line suggests left ventricular hypertrophy (LVH).
Question:
A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the neck is usually associated with:
angina pectoris.a myocardial infarction. Incorrectan aortic dissection. Correctpericarditis.
Explanation:
Assessing chest pain can be very difficult but a thorough patient history and physical exam can help the clinician determine a likely cause. A sudden sharp pain that radiates to the back or into the neck is usually associated with aortic dissection. Exertional pain can be angina pectoris. Symptoms most often seen with myocardial infarction include a retrosternal type pain that often radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm. Pain associated with pericarditis may radiate to the tip of the shoulder and to the neck and presents with a sharp knifelike pain. Any pain in the chest is cardiac until proven otherwise.
Question:
By placing the ball of the examiner’s hand firmly on the chest, the examiner would be checking for:
bruits.S1 and S2. Incorrectheaves.thrills. Correct
Explanation:
To palpate for thrills, the ball (the thenar and hypothenar areas) of the examiner’s hand is placed firmly on the chest to check for a buzzing or vibratory sensation from underlying vascular turbulence from heart murmurs or aortic insufficiency. A bruit is usually auscultated over an area where a thrill is palpated. For S1 and S2, the index and middle fingers are used to palpate the carotid artery. S1 is identified immediately before the carotid upstroke and S2 immediately after the carotid upstroke.
Question:
Which lymph nodes receive lymphatic fluid from the stomach, duodenum, liver, gallbladder, and pancreas?
Superior mesenteric lymph nodesInferior mesenteric lymph nodesHepatic lymph nodes CorrectGastric lymph nodes
Explanation:
The glands of the hepatic chain drain lymphatic fluid from the stomach, duodenum, liver, gallbladder, and pancreas. The superior and inferior mesenteric lymph nodes drain lymphatic fluid from the small and large intestines. The gastric lymph nodes drain lymphatic fluid from the stomach only.
Question:
When auscultating the heart of a 55-year-old patient, a loud murmur with a thrill is audible in the right second intercostal space that radiates to the carotid arteries. Also noted is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. This finding is consistent with:
pulmonic stenosis.tricuspid regurgitation.mitral regurgitation. Incorrectaortic stenosis. Correct
Explanation:
With aortic stenosis, the murmur is audible loudest in the right second intercostal space and radiates to the carotid arteries, down the left sternal border, or the apex. There is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. The murmur audible with pulmonic stenosis produces a soft intensity with a crescendo-decrescendo pitch. It is loudest at the second or third intercostal spaces and radiates to the left shoulder and neck. With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is pansystolic. The intensity may increase with inspiration. Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft, or if there is an atrial thrill, it can be loud.
Question:
When auscultating heart sounds arising from the aortic valve in an adult patient, place the stethoscope:
near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line.between the 2nd and 3rd intercostal spaces at the right upper sternal border. Correctbetween the 2nd and 3rd intercostal spaces at the left sternal border.between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border. Cardio APEA Assignment
Explanation:
Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine positing and using the diaphragm of the stethoscope. The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. The aortic listening point is between the 2nd and 3rd intercostal spaces in the right upper sternal border (RUSB). The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid listening point is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB). Cardio APEA.
Question:
A patient describes chest pain as persistent, sharp, and knife-like. These symptoms are more characteristic of:
myocardial infarction. Incorrectcostochondritis.pericarditis. Correctdissecting aortic aneurysm.
Explanation:
Chest pain described as persistent, sharp, and knife-like is characteristic of pericarditis and pleuritic pain. Myocardial infarction is described as pressing, squeezing, tight, heavy and occasionally burning. With costochondritis, the pain may be stabbing, sticking, or dull and aching. A dissecting aortic aneurysm is described as ripping and tearing.
Question:
A third heart sound (S3) is audible in a forty-five-year old. This S3 sound may be:
normal for this age group.a sign of valvular heart disease. Correcta sign of heart disease. Incorrectassociated with a jugular venous hum.
Explanation:
After approximately age 40, a third heart sound (S3) strongly suggests either ventricular failure or volume overload of the ventricle from valvular heart disease such as mitral regurgitation. A fourth heart sound (S4) is frequently associated with decreased ventricular compliance from heart disease. A jugular venous hum could be associated with murmurs that originate in large blood vessels usually audible in children and young adults. Cardio APEA.
Question:
Enlarged or tender lymph nodes are most often associated with:
a malignant mass. infection in its nearby drainage area. Correcta normal finding in children.a benign tumor.
Explanation:
Tender and enlarged (greater than 2 cm) lymph nodes suggest inflammation or infection in its nearby drainage area. Hard or fixed nodes suggest malignancy. The lymph nodes associated with benign tumors appear mobile, enlarged and nontender.
Question:
A widened pulse pressure greater than or equal to 60 in an older patient is a risk factor for cardiovascular disease, stroke, and:
emboli. Incorrectsystolic hypertension.renal disease. Correctorthostatic hypertension.
Explanation:
A widened pulse pressure greater than or equal to 60 in the older patients is a risk factor for cardiovascular disease, stroke, and renal disease.
Question:
Characteristic symptoms of chronic venous insufficiency may include which one of the following?
Intermittent claudicationPetechiae leading to brown pigmentation noted over the feet CorrectFeet cool to touchFeet appear pale on elevation and dusky red on dependency
Explanation:
With chronic venous insufficiency, persistent leg pain is noted even at rest. Color appears normal or cyanotic on dependency. Petechia occurs initially then progresses to a brown pigmentation. Feet are usually warm to touch. Persons with chronic arterial insufficiency tend to exhibit intermittent claudication, progressing to pain at rest; pale color to the skin on elevation with a dusky red color on dependency; and skin is usually cool to touch.
Question:
Widened pulse pressure (PP) is defined as systolic blood pressure (SBP):
dropping 20 mm Hg within 3 minutes of standing.minus diastolic blood pressure. Correctdropping 10 mm Hg within 5 minutes of sitting.minus apical heart rate.
Explanation:
Widened pulse pressure (PP) is defined as SBP minus diastolic blood pressure (DBP). With aging, SBP and peripheral vascular resistance increase, whereas DBP decreases.
Question:
Characteristic symptoms of chronic arterial insufficiency may include which one of the following?
Persistent leg painPetechiae leading to brown pigmentation noted over the feetFeet warm to touchFeet appear pale on elevation and dusky red on dependency Correct
Explanation:
Persons with arterial insufficiency tend to exhibit intermittent claudication. Pain occurs with activity and progresses to pain at rest. The skin becomes pale on elevation and a dusky red color on dependency. The skin is usually cool to touch. With chronic venous insufficiency, persistent leg pain is noted. Skin color appears normal or may be cyanotic on dependency. Petechia occur initially, then progress to brown pigmentation. Feet are usually warm to touch.
Question:
Pain or cramping of the legs that occurs during exertion and is relieved by rest is termed:
neurogenic claudication.intermittent claudication. Correctatherosclerotic peripheral vascular disease.Raynaud’s disease.
Explanation:
Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication. Raynaud’s disease usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress.
Question:
In older adults, the presence of heart sound S3 suggests:
hypertension.heart failure. Correctan aortic aneurysm.aortic stenosis. Incorrect
Explanation:
In older adults, an S3 suggest dilatation of the left ventricle from heart failure or cardiomyopathy. S3 is produced when blood strikes a compliant left ventricle. It commonly accompanies fluid overload. It may be normal in children or pregnant women. Cardio APEA.
Question:
To auscultate the tricuspid valve heart sounds in an adult patient, place the stethoscope:
between the 2nd and 3rd intercostal spaces at the right upper sternal border.near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line.located between the 2nd and 3rd intercostal spaces at the left sternal border. Incorrectbetween the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border. Correct
Explanation:
Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. The aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid clavicular line. The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid region is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB).
Question:
When auscultating the heart of a 50-year-old patient, a soft murmur is audible in the left second and third intercostal spaces and radiates to the left shoulder and neck. Also noted is a crescendo-decrescendo pitch to the murmur. This finding could be consistent with:
pulmonic stenosis. Correcttricuspid regurgitation.mitral regurgitation.aortic stenosis.
Explanation:
The murmur audible with pulmonic stenosis produces a soft intensity with a crescendo-decrescendo pitch. It is loudest at the second or third intercostal spaces and radiates to the left shoulder and neck. With aortic stenosis, the murmur is audible loudest in the right second intercostal space and radiates to the carotids, down the left sternal border, or the apex. There is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is pansystolic. The intensity may increase with inspiration. Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill, it can be loud.
Question:
The hemodynamic changes resulting from structural defects in children can lead to heart failure. The most common reason for these changes is related to:
volume and pressure overload resulting in increased cardiac output.volume and pressure overload resulting in decreased cardiac output. Correctincreased heart rate increasing cardiac output.decreased blood volume. Cardio APEA Assignment
Explanation:
Volume and pressure overload are the 2 most common causes of heart failure in children who have structural changes related to congenital heart defects. Volume and pressure overload result in decreased cardiac output and not increased cardiac output. Increased cardiac output and stroke volume usually decrease systemic vascular resistance and are seen more often in sepsis, not in heart failure. Increased blood volume can cause heart failure.
Question:
The posterior auricular lymph nodes drain lymphatic fluid from the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region. Incorrecteyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek.mouth, throat, and face.posterior part of the temporoparietal region. Correct
Explanation:
The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth, throat, and face. The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. Cardio APEA.
Question:
While examining the heart, a pansystolic, blowing murmur is audible over the left sternal border with radiation to the right of the sternum. The intensity increased with inspiration. This finding is characteristic of:
tricuspid regurgitation. Correctmitral regurgitation.a ventricular septal defect.an innocent murmur. Incorrect
Explanation:
With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is pansystolic. The intensity may increase with inspiration. Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft, or if there is an atrial thrill, it can be loud. The murmur of an uncomplicated ventricular septal defect has a high pitch and is usually heard throughout systole. An innocent murmur is heard loudest at mid systole near the second to fourth intercostal spaces between the left sternal border and the apex. It usually decreases or disappears when sitting.
Question:
The axillary lymph nodes drain lymphatic fluid from all of the following areas except the:
breasts.upper part of the abdominal wall. Incorrectupper part of the back.anterior chest wall. Correct
Explanation:
The axillary lymph node drainage area includes the breast, upper part of the abdominal wall, the upper part of the back, pectoral region, and upper limbs. The anterior chest wall is drained by the anterior pectoral nodes. These nodes also aid in draining much of the lymphatic fluid from the breast.
Question:
A patient complains of pain in the arch of the foot sometimes relieved by rest. Occasionally, he experiences intermittent pain in the toes, especially at rest. Exercise aggravates the pain in the arch. History reveals he smokes approximately a half pack of cigarettes per day. These symptoms may be consistent with:
intermittent claudication.Raynaud’s disease.deep venous thrombosis.thromboangiitis obliterans. Correct
Explanation:
Thromboangiitis obliterans or Buerger’s disease, is defined as inflammatory and thrombotic occlusions of small arteries and also of veins, usually occurring in smokers. Symptoms include intermittent claudication especially in the arch of the foot and pain at rest in the toes or fingers. Other symptoms may include distal coldness or cyanosis. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Reynaud’s disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Deep venous thrombosis (DVT) is a venous disorder and the pain is tight, and bursting often in the calf. The pain may be accompanied by swelling and tenderness. Cardio APEA.
Question:
The occipital lymph node is located:
at the angle of the mandible.in front of the ear.at the base of the skull posteriorly. Correctsuperficial to the mastoid process.
Explanation:
The occipital lymph nodes are located at the base of the skull posteriorly. The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly. The posterior auricular nodes are superficial to the mastoid process.
Question:
A patient presents with chest pain that radiates to the left side of the neck and down the left arm when he chops wood. This type of pain could be suggestive of:
an early onset myocardial infarction. Incorrectangina pectoris. Correctcostochondritis.a dissecting aneurysm.
Explanation:
Assessing chest pain can be very difficult but a thorough patient history and physical exam can help the clinician determine a likely cause. Exertional pain can be angina pectoris. Symptoms most often seen with myocardial infarction include a retrosternal type pain that often radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm. Pain and tenderness associated with costochondritis worsens with coughing or taking deep breaths. A sudden sharp pain that radiates to the back or into the neck is usually associated with aortic dissection. Any pain in the chest is cardiac until proven otherwise. Cardio APEA.
Question:
A twelve-month-old has a history of heart failure related to his congenital heart defect. He is receiving aldactone (Spironolactone), enalapril (Vasotec), furosemide (Lasix), and acetaminophen (Tylenol). The infant’s potassium level is 3.1 meq/l. Which medication is most likely decreasing his potassium level?
Aldactone (Spironolactone)Furosemide (Lasix) CorrectEnalapril (Vasotec)Acetaminophen (Tylenol)
Explanation:
Loop diuretics can produce decreased potassium levels. Lasix is a loop diuretic. Potassium levels considered WNL by most labs range between 3.5 and 5.3 meq/l; so 3.1 meq/l is considered low and may need to be adjusted. The other medications are not known for excessive potassium losses.
Question:
The anterior cervical lymph node chain is located anterior and:
midway between the angle and the tip of the mandible. Incorrectsuperficial to the mastoid process.superficial to the sternomastoid muscle. Correctat the angle of the mandible.
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Explanation:
The anterior cervical lymph node chain is located anterior and superficial to the sternomastoid muscle. The posterior auricle is superficial to the mastoid process. The tonsillar nodes are at the angle of the mandible. The submandibular nodes are located midway between the angle and the tip of the mandible.
Question:
The tonsillar, submandibular, and submental nodes drain the lymphatic fluid from portions of the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region.eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek.mouth, throat, and face. Correctposterior part of the temporoparietal region.
Explanation:
Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The preauricular nodes drain the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain the eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. The posterior auricular lymph nodes drain the posterior part of the temporoparietal region.
Question:
A condition that usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress may be associated with:
neurogenic claudication.intermittent claudication.atherosclerotic peripheral vascular disease.Raynaud’s disease. Correct
Explanation:
Raynaud’s disease may present with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress. Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen in neurogenic claudication.
Question:
The sacral lymph nodes receive lymphatic fluid from all the following except the:
prostate.urinary bladder. Incorrectgluteal region. Correctrectum.
Explanation:
The sacral lymph nodes receive lymphatic fluid from the prostate or cervix, rectum, urinary bladder, and posterior pelvic wall. The internal iliac lymph nodes receive lymphatic fluid from all pelvic viscera, deep part of the perineum, and the gluteal region.
Question:
Children presenting with congenital heart defects that result in right to left shunting would most likely exhibit which of the following symptoms?
Cyanosis, decreased cardiac output, and desaturated systemic blood flow CorrectIncreased cardiac output, cyanosis, and poor tissue perfusion IncorrectVentricular volume overload, cyanosis, and increased cardiac outputIncreased pulmonary blood flow, cyanosis, and good tissue perfusion
Explanation:
Hypoplastic left heart syndrome, truncus arteriosus, and transposition of the great arteries as well as total anomalus pulmonary venous return all fall in the mixed defects category and result in a right to left shunting. The symptoms that are usually seen are cyanosis, decreased cardiac output, and desaturated systemic blood flow along with poor tissue perfusion and symptoms of heart failure: increased pressure and increased fluid volume in the heart. The other symptoms are not consistent with right to left shunting.
Question:
An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true? Cardio APEA Assignment
The child has ingested too much caffeine.A cardiology referral is prudent.This is a normal exam. CorrectThere is a need for an echocardiogram. Incorrect
Explanation:
Sinus arrhythmia occurs when an irregular heart rate increases with inspiration and decreases with respiration and is considered normal in children. There is no need for an echo or referral to a cardiologist nor should the child be evaluated for caffeine intake.
Question:
Heart sounds produced by turbulence due to a temporary increase in blood flow in predisposing conditions, such as hyperthyroidism, is considered: Cardio APEA.
an innocent murmur.a pathologic murmur.a physiologic murmur. Correcta normal finding.
Explanation:
A physiologic murmur is a murmur arising from physiologic changes in body metabolism. Common examples are: a patient with fever, anemia, pregnancy, or hyperthyroidism. These conditions are considered temporary and the murmur resolves when the condition resolves. An innocent murmur is present without any detectable physiologic or structural abnormality. A pathologic murmur arises from a structural abnormality in the heart or the great vessels. These findings are not considered normal.
Question:
The four classic structural defects of Tetralogy of Fallot include:
tricuspid atresia, atrial septal defect, pulmonary stenosis, and left ventricular hypertrophy.a ventricular septal defect, an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Correctdextroposition of the aorta, ventricular septal defect, aortic stenosis, and patent ductus stenosis.an atrial septal defect, ventricular septal defect, pulmonary atresia, and the aorta arising from the right ventricle.
Explanation:
The classic signs of Tetralogy of Fallot are a ventricular septal defect, an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy.
Question:
A child presents with fever of 102.5 °F for the past five days. Kawasaki disease is suspected if which of the following groups of symptoms is present?
Strawberry tongue, pounding pulse, elevated blood pressure, and chronic hemolytic anemiaCervical lymphadenopathy, bilateral non-purulent conjunctivitis, periungual desquamation, and polymorphous rash CorrectRetinopathy, petechiae, strawberry tongue, and jaundice IncorrectRecent Group A beta hemolytic streptococcus pharyngitis, erythema marginatum, non-purulent conjunctivitis, and joint pain
Explanation:
In Kawasaki disease there is persistent fever for 5 days. In order to be diagnosed with Kawasaki disease, a child must present with 4 of the following 5 symptoms. These include: cervical lymphadenopathy, bilateral conjunctivitis, macular rash, edema of the hand and/or feet, and strawberry tongue. Pounding pulse, elevated B/P, and chronic hemolytic anemia are not consistent with Kawasaki disease. Retinopathy and jaundice are more consistent with sickle cell disease. Group A beta hemolytic strep and erythema marginatum are common with rheumatic heart disease.
Question:
A finding suggestive of an inflamed lymph node would be one that is:
hard and fixed. Incorrecttender and movable. Correctshotty and movable.non-tender and fixed.
Explanation:
Small, mobile, discrete, non-tender (shotty) nodes are frequently identified as normal findings. Nodes that are tender suggest inflammation. Hard and fixed nodes suggest malignancy.
Question:
The posterior auricular lymph node is located:
at the angle of the mandible. Incorrectin front of the ear.at the base of the skull posteriorly.superficial to the mastoid process. Correct
Explanation:
The posterior auricular nodes are superficial to the mastoid process. The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly.
Question:
Enlargement of which lymph nodes would be suggestive of metastasis from a thoracic or abdominal malignancy?
TonsillarAnterior cervical chain IncorrectSubmandibularSupraclavicular Correct
Explanation:
Enlargement of a supraclavicular node, especially on the left, suggests possible metastasis from a thoracic or an abdominal malignancy. The supraclavicular nodes are deep in the angle formed by the clavicle and the sternomastoid muscle.
Question:
The superior and inferior mesenteric lymph nodes drain lymphatic fluid from the:
stomach.pancreas.liver.small and large intestines. Correct
Explanation:
The superior and inferior mesenteric lymph nodes drain lymphatic fluid from the small and large intestines. The gastric lymph nodes drain lymphatic fluid from the stomach. The glands of the hepatic chain drain lymphatic fluid from the stomach, duodenum, liver, gall-bladder, and pancreas.
Question:
A male patient states that he has difficulty breathing when he is lying down but when he sits up, it improves. This is a classic description of:
eupnea.dyspnea.orthopnea. Correctparoxysmal nocturnal dyspnea. Incorrect
Explanation:
Orthopnea is dyspnea that occurs when the patient is lying down and improves with sitting. It is suggestive of left ventricular heart failure, mitral stenosis, or obstructive lung disease. Eupnea is normal breathing. Dyspnea is difficulty breathing. Paroxysmal nocturnal dyspnea describes episodes of sudden dyspnea that cause the patient to awaken from sleep where the patient must sit up, walk, or stand for it to resolve. Coughing and wheezing may also occur.
Question:
Assessment findings in a newborn at birth include: irregular respirations without crying, heart rate of 105 beats/minute, grimaces with reflex stimulation, kicking of both feet, and moving of both arms. The body and face are pink and hands and feet are cyanotic. What is the APGAR score?
57 Correct910
Explanation:
APGAR stands for: Activity, Pulse, Grimace, Appearance, and Respiration. It is an objective score of the condition of a baby immediately after birth and is determined by scoring the heart rate, respiratory effort, muscle tone, skin color, and response to a catheter in the nostril. Each of these objective signs receives 0, 1, or 2 points. An Apgar score of 10 means an infant is in the best possible condition. The Apgar score is done routinely 60 seconds after the birth of the infant. A child with a score of 0 to 3 needs immediate resuscitation. The Apgar score is often repeated 5 minutes after birth, and in the event of a difficult resuscitation. The Apgar score may be done again at 10, 15, and 20 minutes. This infant’s score is 7: He receives a 1 for respiration, 2 for heart rate, 1 for grimace, 1 for color, and 2 for activity. Scores 7 and greater are generally considered to be normal.
Question:
A patient complains of increased pain in the calf muscles and buttocks especially after walking or riding his bicycle. He states that the pain stops after he sits still for about 2-3 minutes. This condition may be associated with:
intermittent claudication. CorrectRaynaud’s disease.deep venous thrombosis.superficial thrombophlebitis. Cardio APEA.
Explanation:
Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Reynaud’s disease usually affects the distal portions of the fingers. Deep venous thrombosis (DVT) and superficial thrombophlebitis are venous disorders. With DVT’s, the pain feels tight or squeezing and often presents in the calf. Superficial thrombophlebitis is local and presents along the course of a superficial vein .
Question:
A condition that presents with symptomatic limb ischemia upon exertion is termed:
neurogenic claudication.intermittent claudication.atherosclerotic peripheral vascular disease. CorrectRaynaud’s disease. Cardio APEA Assignment
Explanation:
Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication. Raynaud’s disease usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress.
Question:
Absent or diminished pulses in the wrist could be indicative of:
varicosities.right-sided heart failure.venous insufficiency.arterial occlusive disease. Correct
Explanation:
Absent or diminished pulses at the wrist are found in arterial occlusive disease such as acute embolic occlusion, in Buerger’s disease, or thromboangiitis obliterans. Varicosities, venous insufficiency, and right-sided heart failure are consistent with venous conditions.
Question:
In older adults, the presence of heart sound S4 suggests:
hypertension. Correctheart failure. Incorrectan aortic aneurysm.aortic stenosis.
Explanation:
An S4 heart sound occurs when the atria contract and force blood into a left ventricle that is non-compliant. This can be the result of diastolic heart failure, hypertension, infraction, or others. It is known as the “atrial gallop”. This is always abnormal.
Question:
A patient describes chest pain as pressing, squeezing, and tight lasting between 1 and 3 minutes. These symptoms are more characteristic of:
myocardial infarction. Correctcostochondritis.pericarditis.dissecting aortic aneurysm.
Explanation:
Myocardial infarction is described as pressing, squeezing, tight, heavy and occasionally burning. Chest pain described as persistent, sharp, and knife-like is characteristic of pericarditis and pleuritic pain. With costochondritis, the pain may be stabbing, sticking, or dull and aching. A dissecting aortic aneurysm is described as ripping and tearing.
Question:
When auscultating the heart, a scratchy, continuous murmur is audible during atrial systole and ventricular systole and diastole. This finding may be indicative of a:
pericardial friction rub. Correctvenous hum.patent ductus arteriosus.ventricular septal defect.
Explanation:
Cardiovascular sounds that extend beyond one phase of the cardiac cycle are considered continuous murmurs. Pericardial friction rubs usually produces a scratchy, scraping sound with a high pitch. They are heard best with the diaphragm and are associated with friction from cardiac movement in the pericardial sac. If they are heard in atrial systole and ventricular systole and diastole, then the diagnosis is made. Venous hums are benign sounds resulting from turbulence in the jugular veins. They can produce a humming or roaring sound and are heard best with the bell of the stethoscope during diastole. Venous hums are common in children and may be present in patients who have anemia or hyperthyroidism. The murmur of a patent ductus arteriosus produces a harsh, machine-like sound and is loudest during late systole. The murmur of an uncomplicated ventricular septal defect has a high pitch and is usually heard throughout systole.
Question:
The anterior mediastinal lymph nodes drain lymphatic fluid from the:
anterior chest wall.upper part of the abdominal wall.thymus, thyroid gland and the anterior part of the pericardium. Correctbreasts. Cardio APEA.
Explanation:
The anterior mediastinal lymph nodes drain lymphatic fluid from the thymus, thyroid, and the anterior part of the pericardium. The anterior chest wall is drained by the anterior pectoral nodes. These nodes also aid in draining much of the lymphatic fluid from the breast. The axillary lymph node drainage area includes the breasts, upper part of the abdominal wall, the upper part of the back, pectoral region, and upper limbs.
Question:
To assess the murmur of aortic insufficiency, position the patient:
supine.sitting leaning forward. Correctsupine with head elevated 30 degrees and turned partly to the left side.standing.
Explanation:
The preferred position for the patient when assessing an aortic insufficiency murmur is sitting leaning forward. This position moves the heart closer to the chest wall. The other positions are not effective in assessing this murmur.
Question:
A pediatric patient presents with erythema marginatum, chorea, and a heart murmur. These symptoms are consistent with:
Kawasaki Disease.rheumatic heart disease. Correctinfectious endocarditis. Incorrectsickle cell disease.
Explanation:
Classic symptoms of rheumatic heart disease include, erythema marginatum, chorea (aimless uncontrollable movement of the extremities), murmur, joint pain, and shortness of breath. These are usually preceded by history of a recent streptococcal infection. Kawasaki disease presents with unexplained fever for five days along with four of these five symptoms: bilateral non-purulent conjunctivitis, cervical lymphadenopathy, edema of the hands and/or feet, strawberry tongue, and a macular rash. Endocarditis presents with fever, lethargy, petechiae, neurological involvement, Janeway lesions and Osler’s nodes. Sickle cell disease may present with several symptoms: chronic hemolytic anemia, delayed growth and development, renal and neurological dysfunction, and retinopathy.
Question:
When auscultating the heart; S1 sound, is located at the apex of the heart and signifies:
closure of the pulmonic and aortic valves.closure of the mitral and tricuspid valves. Correctboth ventricles filling rapidly.an increased resistance to ventricular filling.
Explanation:
S1 sound is heard at the apex of the heart (5ICS MCL) and produces a dull, low-pitched sound (“lub”). It signifies the closing of the mitral and tricuspid valves. The “dub” is the S2 sound and is heard at the base of the heart. It signifies closure of the aortic and pulmonic valves. The S3 sound is heard at the apex and signifies rapid filling of the ventricles. The S4 sound is heard at the tricuspid and mitral areas and signifies an increased resistance to ventricular filling.
Question:
A patient with cirrhosis develops portal hypertension as indicated by the presence of:
splenomegaly. Correctbleeding gums.jaundice.muscle wasting.
Explanation:
Development of portal hypertension is related to the obstruction to portal blood flow which causes an increase in portal venous pressure resulting in splenomegaly, ascites, and collateral venous channels; para-umbilical and hemorrhoidal veins, cardia of the stomach and into the esophagus. Muscle wasting is seen in cirrhosis but it is related to poor nutritional intake and not to portal hypertension. Jaundice is already present in cirrhosis due to the inability of the liver to conjugate the excessive bilirubin and is not directly related to portal hypertension. Bleeding gums would be related to the insufficient amount of Vitamin K production in the liver.
Question:
Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with:
neurogenic claudication. Correctintermittent claudication.atherosclerotic peripheral vascular disease.Raynaud’s disease.
Explanation:
Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication. Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Raynaud’s disease usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress.
Question:
Why would a newborn with patent ductus arteriosus receive a prostaglandin inhibitor (indomethacin)?
To maintain Ductus Arteriosus patencyTo reduce fluid overload on the pulmonary circulation CorrectTo improve oxygenation of systemic circulation IncorrectTo improve contractility of the left ventricle
Explanation:
Indomethacin is a prostaglandin inhibitor (nonsteroid antiinflammatory drug [NSAID]) and causes constriction of the ductus arteriosus and by closing the ductus. Oxygenated blood is shunted to the systemic circulation and this reduces fluid overload on the pulmonary circulation. The other choices are not actions of indomethacin. The blood is already oxygenated so it does not need to go to the lungs and there is no problem with ventricular contractility.
Question:
When assessing a 3-year-old African American child, the most likely cause of black, dusky mucous membranes is related to:
jaundice.
pallor.
erythema.
cyanosis. Correct
Explanation:
In dark skinned children, black, dusky mucous membranes are significant for cyanosis. The mucous membranes are the best areas to identify cyanosis in African American children. Erythema is denoted as a dusky red or violet color over the body. The other choices are not characteristic of cyanosis. Cardio APEA Assignment
