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Section 4: Cardiovascular Disorders

All of the following are modifiable risk factors for cardiovascular disease except:

A. hypertension.

B. physical activity.

C. total cholesterol.

D. family history.

The answer is D. Nonmodifiable risk factors for cardiovascular disease (CVD) include age, sex, race/ethnicity, and family history of premature cardiovascular disease in first degree relatives (men <55 years of age, women <65 years of age). See Table e29-2 for a comparison of modifiable and nonmodifiable risk factors for CVD.

Which of the following characteristics can be used to differentiate nonischemic from ischemic chest pain?

A. Concomitant nausea or epigastric pain

B. Relief when sitting up and leaning forward

C. Radiation to the neck, jaw, or shoulder

D. Improvement with rest

The answer is B. Pain relief with a change in position is more likely to occur with pericarditis or other inflammatory conditions and not with ischemic chest pain. Ischemic chest pain is more likely to be relieved by rest. See the section on chest pain for more information.

All of the following are important steps for obtaining an accurate blood pressure measurement except:

A. using the arm that gives the lower reading at each visit.

B. removing clothing that covers the location of the cuff.

C. being seated for at least 5 minutes prior to the reading.

D. using a cuff that encircles 80% of the arm.

The answer is A. The blood pressure should be measured in both arms at the first visit and the arm that gives the higher reading should be used for subsequent visits. Recommendations for obtaining an accurate blood pressure reading can be found in Table e29-4.

The next two questions (Questions 4 and 5) relate to the following vignette:

A 64-year-old man with a history of nonischemic cardiomyopathy presents to clinic with gradually worsening shortness of breath over the last several weeks.

When interviewing the patient about his symptoms, which of the following can be used to characterize orthopnea?

A. The number of city blocks he can walk before dyspnea occurs

B. Whether he is awakened at night by ...

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