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AANP exam > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is a holosystolic Murmur?

A

It begins at the first heart sound (S1) and continues to the second heart sound (S2)

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2
Q

What is a pansystolic murmur?

A

Its regurgitation type murmur head throughout systole due to blood flow between two chambers

most common:
mitral regurgitation
Tricuspid regurgition
Ventricular septal defects

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3
Q

What is mitral regurgitation? What type of murmur is this?

Where do you hear it?

Where does it radiate to?

A

It is a SYSTOLIC murmur

The blood is coming back up from the left ventricle, it radiates to the L axilla

you will here it at the 5th intercostal space

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4
Q

How do you treat Mitral Regurgitation?

A

Usually its from fluid overload, pulmonary edema

You would want to reduce the cardiac load, use a beta blocker and reduce the amount of fluid using a diuretic

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5
Q

What type of murmur is aortic stenosis?
Where do you hear this murmor?
Where does it radiate to?

A

narrowing of the aortic valve, it is a systolic murmur
You hear it at second intercostal space, on the right side
It radiates to the head/neck

Its loud and HIGH pitched

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6
Q

What type of murmur is tricuspid regurgitation?
Where do you hear it?
When is it best heard?
What other symptoms are associated with it?

A

Tricuspid regurgitation is a systolic murmur (pan/holo)
Best heard when a patient inspires deeply
Located at left 3rd/4th intercostal space
Often associated with drug abuse/endocarditis

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7
Q

What type of murmur is mitral valve prolapse?

A

This is a systolic murmur
Sounds like a click at S2
The leaflets of the mitral valve are bulging into the left atrium

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8
Q

What type of murmurs are you concerned about?

A

Diastolic murmurs, patients will likley need surgery to fix this

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9
Q

What type of murmur is Mitral Stenosis
Describe this murmur
Where is it best heard?

A

A diastolic murmur
It is narrowing of the mitral valve obstructing blood flow from the left atrium to the left ventricle
It can be caused by rheumatic fever/an illness, very dangerous

Best heard at the apex of the heart, mid clavicular line 5th intercostal space

To hear it you must use your bell of stethoscope, soft low rumbling sound

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10
Q

What type of murmur is aortic regurgitation ?

A

Diastolic murmur
It will sound like “high pitched blowing sound”

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11
Q

What type of murmur is tricuspid stenosis?
How do you hear it? What does it sound like?
Where is it located?

A

Diastolic murmur
You must use your bell, heard at 2nd/3rd intercostal space
Best heard while patient bends forward
This is a low pitched murmur

Not a good murmur you are concerned could be caused by rheumatic fever

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12
Q

What is a benign Split S2? Where do you best hear it?

A

The splitting of S2 (physiological split) occurs because the aortic and pulmonic valve are closing at different times
It is best hear at the pulmonic valve site (second Left intercostal space)
This is heard during inspiration, NOT expiration

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13
Q

What is S3?
How do you best hear S3?
What is it described as?

A

S3 occurs after S2, when the mitral valve opens.

It occurs because there is a large amount of blood hitting a complaint left ventricle, caused often by heart failure, very hard to hear

best heard if you “turn patient on their left side, and have them lean forward, using the BELL of stethescope”

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14
Q

What is S4?
How do you best hear S4?
What is it described as?

A

The result of Left ventricular hypertrophy, sounds like a gallop

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15
Q

What is S1 and what is S2?

A

S1 is the closure of the mitral and tricuspid valve
S1 is best heard at tricuspid valve (Left 3-4 ICS)

S2 is the closure of the pulmonic and

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16
Q

What type of HTN medication is often used for isolated systolic hypertension in a patient greater than 65?

A

typically the first line is a calcium channel blocker

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17
Q

What type of HTN medication is often used for angina?

A

Beta blocker + calcium channel blocker

Beta blocker because you want to reduce the cardiac load
You would use a CCB because it will vasodilator those blood vessels to the heart

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18
Q

What HTN medication would you use for PAD in comparison to Venous insufficiency?

A

PAD–> beta blocker
Venous insufficiency–> calcium channel blocker, to increase blood flow back to the heart

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19
Q

What side effects can occur from Thiazide diuretics?

A

HYPER-> glycemia, triclycerides,uricemia

Hypo–> kalemia,natremia,magnesia

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20
Q

What organisms often cause endocarditis?

A
  1. Strep G
  2. Staph aureus

common in prosthetic valve, IV drug use, congenital heart defect

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21
Q

What is pulsus paradox?

A

When the BP drops 10 points during inspiration, common in asthma, COPD

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22
Q

What HTN meds should you avoid with pregnancy?

A

avoid ACE/ARB as it will cause angioedema

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23
Q

What HTN meds should you avoid in chronic heart failure?

A

avoid Calcium channel blocker, use an ACE

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24
Q

In GERD what H?TN medication would you want to avoid?

A

avoid calcium channel blocker as it will vasodilate blood vessels in stomach, worsening GERD

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25
Q

what HTN medication would you prescribe if you patient has prostate hyperplasia

A

Alpha blocker (Hytrin)

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26
Q

If a pt has Raynauds, what medication would you use to treat>

A

Calcium channel blocker

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27
Q

What HTN medication would you avoid in GOUT?

A

Thiazolidinedione (diuretic) it can cause hyperurecemia

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28
Q

What HTN medication do you avoid in COPD and asthma?

A

Beta blockers

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29
Q

What medication do you avoid with grapefruit juice?

A

Statins
calcium channel blockers
Metronidazole

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30
Q

What symptoms would you see in right sided heart failure?

A

Peripheral edema
JVD
Hepatomegaly
Splenomegaly

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31
Q

What symptoms would you see in Left sided HF?

A

Crackles
Cough
SOB excertion

32
Q

What is a carotid bruit?

A

narrowing of a vessel, creating turbulent blood flow

33
Q

What symptoms would you see with Renal Artery stenosis?

A
  1. Elevated Bloodpressure
  2. Bruit on Left or Right side of abdomen
34
Q

What 4 cardiac manifestations present with Tetraology of Fallot?

A
  1. Pulmonary Stenosis
  2. R ventricular hypertrophy
    #. Overriding aorta
  3. VSD

Tet spells: agitation, syncope, tachypnea

35
Q

What are your first line HTN meds for pregnancy?

A
  1. Beta blockers
  2. Calcium channel blockers (-pine)
  3. Hydralazine
  4. Methyldopa
36
Q

When would you suspect Secondary Hypertension and how would you treat it?

A

this occurs when a pts BP is still elevated despite X3 medications

Often this is caused by primary hyperaldosteronism

Pt will have resistant HTN and Hypokalemia

37
Q

What are the characteristics of ventricular septal defect

A

Left to right shunting
holosystolic murmur @ L lower sternal boarder
S2 becomes more prominent

growth failure in infant, easily fatigue-able,

38
Q

What are the characteristics of a thoracic aortic aneurysm?

A

ACUTLEY ILL
chest/back pain
hoarseness of voice
Dysphagia

39
Q

How would you describe atrial fibrillation on an ECG?

A

saw-toothed flutter waves

40
Q

What lipid lowering medication should be avoided in patients who have gallstones?

A

Fibrates, as they can promote gallstone formation by reducing bile acid formation

however, fibrates are the best to use in patients who have hypertriglyceridemia

41
Q

What medication is used to treat wide complex tachycardia?

A

in stable patients the treament is loading dose of amiodarone

42
Q

What medications do you prescribe after an MI/unstable angina/NSTEMI

A

Betablocker + ACE/ARB
Asprin + clopidogrel
Statin

43
Q

What are the thee major risk factors for aneurysmal expansion and rupture?

A

Large diameter, greater than 5.5
expanding 1cm per year
active smoker

44
Q

If a patients ECG shows Q and T wave inversion what does this mean?

A

it means they had a prior MI and they should be started on:

Beta blocker
Statin
Anti-platlets
and ACE inhibitor

45
Q

Please describe ECG findings of atrial fibrillation

A

The patient may experience:
Palpitations
Tachycardia

ECG
irregular rhythm
Absence of P waves
varying R to R intervals

46
Q

Describe the characteristics of Atrial Septal Defect

A

most are asymptomatic and close by the age of 5

if its large than the patient may present with failure to thrive.

Diagnosis is made with wide, fixed, split S2, does not change with respirations

Midsystolic pulmonary flow murmur is often heard aswell

47
Q

Describe the characteristics of Sick Sinus Syndrome

A

aka bradycardia tachycardia syndrome

symptoms: dizziness, presyncope, atrial fibrillation is commone

48
Q

What would you expect to see on an ECG with a patient who has a stable angina?

A

ST segment depression

the classic scenario is a pt who presents with excertional chest pain that is alleviated with rest,

49
Q

What diabetic medications are caardioprotective?

A
  1. GLP-1 (semagluTIDE)
  2. SGLT-2 (FLOZIN)
50
Q

A patient presents with:

  • splinter hemorrhages in nail bed
  • petichaie on palate
  • painful violet nodes on fingers
  • tender spots on palms and soles
  • FEVER

what disease is this?

A

bacterial endocarditis

51
Q

Violet colored PAINFUL nodes on the fingers are what?

A

Osler nodes; endocarditis

52
Q

TENDER red spots on palms and soles are known as what

A

Janeway lesions; endocarditis

53
Q

What Mnemonic can you use to remember what valves close in systole and diastole?

A

MoTiVAted APpleS

Systole
M- Mitral
T- Tricuspid
AV valves

Diastole
Aortic
Pulmonic
Semilunar valves

54
Q

After what age are we concerned if we hear S3?

A

after the age of 40 we should always be concerned if we hear S3

55
Q

what heart sound is also called a ventricular gallop?

A

S3

56
Q

What heart sound is an indicator of CHF?

A

S3

57
Q

What heart sound indicated ventricular hypertrophy?

A

S4

58
Q

Where do you best hear S4?

A

At the Apex of the heart using the bell of the stethescope

59
Q

What heart sounds will you hear using the bell?

A

S3/S4
Mitral stenosis

60
Q

What heart sounds will you hear using the diaphragm of the stethoscope

A

Mitral regurgitation
Aortic stenosis

61
Q

Where is the benign split best heard?

A

Pulmonic area, 2nd L intercostal space

it is NORMAL, if heard during inspiration and disappears at expirations

62
Q

when is it normal to hear S4 in elderly patients ?

A

Typically S4 is associated with left ventricular hypertrophy

however, in the elderly, if you hear an S4 and the patient appears well and DOES NOT have any cardiac symptoms then its considered normal

63
Q

At what grade is a murmur audible?

A

Grade III

64
Q

At what grade is a murmur considered a thrill?

A

Grade IV (4)

You can palpate this

65
Q

List the systolic mumors

A

Mitral Regurgitation - tavels to axilla
Atrial Regurgitation
Aortic Stenosis- travells to head

66
Q

List the diastolic murmors

A

Mitral Stenosis
Tricuspid Stenosis
Aortic regurgitation

67
Q

List the ECG findings of a patient in afib

A

No p waves
Irregular QRS

68
Q

List the ECG findings of a patient in first degree heart block

A

prolonged QR interval

69
Q

What symptoms do you see in a patient with symptomatic atrial fibrillation?

A

syncope, dizziness
chest pain
palpitations

70
Q

When performing an eye exam on a patient with hypertension what findings would indicate damage from hypertension (not diabetes)

A

copper and silver wire arterioles
AV nicking

71
Q

When performing an eye exam on a diabetic patient what findings would indicate damage?

A

Neovascularization
Microaneruysms

72
Q

What hypertension medication can cause hyperkalemia?

A

ACE/ARB

73
Q

What medications are used to treat venous insufficiency compared to peripheral artery disease?

A

both need statins

Venous insufficiency = CCB
Peripheral Artery Disease= BB + antiplatelet (aspirin etc)

74
Q

What cardiac arrythmia is this:

Tachycardia with peaked QRS complex and p waves are present

Patient complains of palpitations, dypnea, chest pain

A

Paroxysmal Supraventricular Tachycardia

75
Q
A

AANP exam (12 decks)

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