Cardiology

Question 1

Prehypertension

Answer 1

Starts at –
120 systolic

80 diastolic

Question 2

Stage 1 HTN

Answer 2

Starts at –
140 systolic

90 diastolic

Question 2

Stage 2 HTN

Answer 2

> 160 systolic

> 100 diastolic

Question 3

Is the systolic or diastolic number more important in determining risk in someone OVER 50?

Answer 3

Systolic.

And the wider the pulse pressure the greater the cardiovascular risk.

Question 4

Treatment for pre-hypertension?

Answer 4

Lifestyle modification - weight loss, DASH eating plan, sodium restriction, aerobic activity, moderation of alcohol consumption.

Question 5

Treatment for stage 1 hypertension?

Answer 5

Lifestyle modification and medication.

Thiazide diuretic is usually first line.

May add ACE, ARB, BB, CCB.

Question 6

Treatment for stage 2 hypertension?

Answer 6

Lifestyle modification and 2+ medications.

Combination of 2 or more drugs, usually a thiazide plus additional medication.

Question 7

BP goal for general population?

Answer 7

140/90

Question 8

BP goal for those with DM or renal impairment?

Answer 8

130/80

Question 9

What kidney-related cardiovascular risk factors were identified by JNC-7?

Answer 9

Microalbuminuria and and GFR of less than 60 mL/min.

Question 10

Treatment for African Americans with hypertension?

Answer 10

ACE or ARB for renal protection.

CCB or thiazide to increase effectiveness of treatment.

Question 11

A mid-systolic murmur which gets louder when the patient stands may represent…?

Answer 11

Hypertrophic cardiomyopathy

Question 12

A grade III systolic murmur is usually about as loud as what heart sound?

Answer 12

S1

Question 13

S3 and S4 are best heard with what part of the stethoscope?

Answer 13

The bell

Question 14

S3 is heard when in the cardiac cycle?

Answer 14

Early diastole

Question 15

What heart sound is associated with ventricular overload?

Answer 15

S3

Question 16

What heart sound is associated with poorly controlled hypertention?

Answer 16

S4

Question 17

What physical finding is associated with MITRAL VALVE PROLAPSE?

Answer 17

Pectus excavatum

Question 18

When in the cardiac cycle would you expect the murmur of MITRAL VALVE PROLAPSE?

Answer 18

Mid to late systolic

Question 19

What is an additional characteristic sound associated with MITRAL VALVE PROLAPSE?

Answer 19

A mid-systolic click

Question 20

When assessing MITRAL STENOSIS what murmur is anticipated?

Answer 20

Localized diastolic with little radiation

Question 21

Crescendo-descrescendo with radiation to the neck?

Answer 21

Aortic stenosis

Question 22

Is a physiological murmur likely to become louder or softer when the patient stands?

Answer 22

Softer

Question 23

What antibiotic should be used for endocarditis prophylaxis in patients who are allergic to PCN?

Answer 23

Azithromycin

Question 24

S1 and S2 are best heard with what part of the stethoscope?

Answer 24

The diaphragm

Question 25

A PHYSIOLOGIC split of S2 is affected by inspiration in what way?

Answer 25

INcreases with INspiration | Benign, generally seen in the less than age 30 population if at all.

Question 26

A PATHOLOGICAL split of S2 is affected by inspiration in what way?

Answer 26

Fixed split - no change | Paradoxical split - narrows with inspiration

Question 27

A PATHOLOGICAL S2 split may be found in conditions that delay ______ closure, such as ________.

Answer 27

Delay AORTIC closure such as BUNDLE BRANCH BLOCK.

Question 28

When in the cardiac cycle is S3 heard?

Answer 28

Early diastole

Question 29

What is the significance of S3?

Answer 29

Indicative of ventricular overload | Can also be systolic dysfunction or both

Question 30

When in the cardiac cycle is S4 heard?

Answer 30

Late diastole | somtimes called a "presystolic" sound

Question 31

What is the significance of S4?

Answer 31

Often found in poorly controlled hypertension or post MI