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Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular

disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD

and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in

Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness

among the general public increased from 30% in 1997 to 54% in 2009. Unfortunately, CVD continues to be the

leading cause of death in the United States for both men and women. Since 1984, the number of deaths related

to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54

years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity

epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of

women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3

leading causes of death combined, including all forms of cancer. Due to the ongoing prevalence of CVD,

increasing awareness and understanding of CVD, especially among the female population, is still a top priority

for many health care professionals. As one of the most accessible health care professionals, pharmacists are in

a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies,

and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans

by 20%, while reducing deaths from CVD and stroke by 20%. According to the American Heart Association, in

the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some

form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis,

treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs

and symptoms of a heart attack because they sometimes appear more subtle when compared with those

typically experienced by men. Results from a study of 515 women who had heart attacks report that 43% did

not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms

include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience

some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the

neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their

cardiovascular health and get treatment earlier to prevent further complications.

Throughout the passage, it is implied that which of the following will lead to fewer deaths resulting from CVD?

Teaching women about the consequences of CVD.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of

America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell

trait. While SCD is known to primarily affect individuals of African American descent, individuals from South

America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the

SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are

estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By

increasing awareness about SCD and promoting patient education, health care professionals can help patients

and their families cope with SCD and better manage the associated pain. Recurring episodes of acute and/or

severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to

patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point,

most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the

duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others

may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted

to manage the pain. An acute pain event is the most common type of pain, and the onset is typically abrupt. It is

often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled

erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme

temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold

climates, menstruation, and fatigue. Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain

often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of

chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and

chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of

potential addiction and adverse effects. Many studies report that some health care professionals are also

concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may

involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.

Out of this group, which of the following demographic is the LEAST likely to have SCD?

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