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ACNP Board Review – Questions With Complete Answers
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ACNP Board Review – Questions With Complete Answers
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ACNP Board Review – Questions With CompleteAnswers
PVD Pathology Right Ans - Arteriosclerotic narrowing of the lumen of
arteries resulting in decreased blood supply to the extremities
PVD Causes/Incidence (6) Right Ans - 1. Usually caused by atherosclerosis
2. Similar to risk factors fro CAD
3. Peak incidence: 40-70 years of age
4. Hyperlipidemia
5. Smoking
6. Diabetes mellitus
PVD Signs/Symptoms (3) Right Ans - 1. Usually first symptom: C/O calf
pain (claudication)
2. Cold/numbness in extremities
3. Progresses to pain at rest
PVD Physical Findings (6) Right Ans - 1. Shiny/hairless skin
2. Dependent rubor
3. Pallor
4. Cyanosis
5. Ulcerations
6. Reduced pulses
PVD Labs/Diagnostics (4) Right Ans - 1. Doppler U/S to evaluate flow
2. Ankle-brachial index (ABI)
3. X-rays may show calcifications
4. Arteriography: Most definitive test
PVD Management (9) Right Ans - 1. Stop smoking and all tobacco use
2. *Exercise: Walk 1 hour/day; stoppinf during pain and resuming when pain
subsides to *develop collateral circulation
3. Pentoxifylline (Trental)
4. Cilstazol (Pletal)
5. Weight reduction; as needed
6. Manage diabetes and hyperlipidemia
7. Angioplasty
,8. Bypass surgery
9. Amputation
CVI Pathology Right Ans - Impaired venous return due to either
destruction of valves, changes due to deep thrombophlebitis, leg trauma, or
sustained elevation of venous pressure (CHF)
CVI Causes/Incidence (3) Right Ans - 1. More common in women than men
2. May be genetic predisposition
3. History of leg trauma; may be associated with varicose veins
CVI Signs/Symptoms (3) Right Ans - 1. Aching of the lower extremities
relieved by elevation
2. Edema after prolonged standing
3. Night cramps of the lower extremities
CVI Labs/Diagnostics (2) Right Ans - 1. Nonspecifically diagnostic of CVI
2. R/O edema due to heart failure and other causes
CVI Management (5) Right Ans - 1. Bed rest with legs elevated to diminish
chronic edema
2. Use of heavy duty elastic support stockings
3. Weight reduction in the obese
4. Treat dermatitis or ulcers as indicated
5. Acute weeping dermatitis
a. Wet compresses
b. 0.5% hydrocortisone cream after compresses
c. Systemic antibiotics only indicated if active bacterial infection
Pericarditis Pathology Right Ans - Inflammation of the pericardium. A
thorough history is essential to making an accurate diagnosis
Pericarditis Causes/Incidence (9) Right Ans - 1. *Viruses- most common
cause
2. Post MI
3. Renal failure
4. Neoplastic, TB, Septicemia
5. Endocarditis
6. Collagen diseases
, 7. Drug/trauma induced
8. Viral infection
9. Idiopathic (probably viral)
Pericarditis Signs/Symptoms (4) Right Ans - 1. Very localized
retrosternal/precordial chest pain, pleuritic in nature
2. Pain increased by deep inspiration, coughing, swallowing or recumbent
3. Pain relieved by sitting forward
4. SOB secondary to pain with inspiration
Pericarditis Physical Findings (3) Right Ans - 1. Pericardial friction rub
characteristically present
2. Pleural friction rub may also be present
3. Fever may be present depending on underlying cause
Pericarditis Labs/Diagnostics (8) Right Ans - 1. *ST segment elevation in all
leads
2. Return of ST segment to normal in a few days followed by temporary T
waves inversion
3. *Depression of PR segment highly indicative of pericarditis
4. ESR elevation
5. Blood cultures if bacterial cause suspected
6. CB to r/o infection or leukemia
7. Echo to confirm presence of pericardial fluid or other abnormalities
8. Basline BMP
Pericarditis Management (7) Right Ans - 1. *NSAIDs are mainstay of
treatment
2. Ibuprofen (Advil) 400-600mg every 6-8 hours
3. Indomethacin (indocin) 25-50mg every 8 hours for 2 weeks
4. *Corticosteroids are indicated only when there is total failure of high-dose
NSAIDs over several weeks and with relapsing pericarditis. Can increase viral
replication. When indicated, Dex 4mg IV may relieve pain in a few hours.
Prednisone 60mg daily then tapered.
5. Antibiotics in cases of bacterial infection
6. Codeine 15-60 mg PO QID for pain
7. Monitor for tamponade
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