Cardiovascular

Question 1

MI s/s

Answer 1

male: heavy chest, left shoulder/jaw pain, clammy
women: unusual fatigue, back pain, n/v

Question 2

AAA (dissecting abd aortic aneurysm)

Answer 2

elderly white male
pulsating sensation in abdomen or low back
impending rupture- “sudden” sharp pain to chest/low back.

high risk: HTN/smoker

Question 3

CHF

Answer 3

elderly pt c/o sob, “dry cough”, swollen ankles, increase weight
crackles
s3 heart sound
hx: cad, prior MI

Question 4

bacterial endocarditis s/s

Answer 4

check their fingers/toes
janeway lesions- tender red spots on the palms/soles
splinter hemorrhage- splinter hemorrhage on nailbed

Question 5

pregnant PMI

Answer 5

located upward on the left side

Question 6

Deoxygenated blood

Answer 6

SVC, right atrium, tricuspid, right ventricle, PULMONIC VALVE, lungs, alveoli (RBC pick p02 and release co2)

Question 7

oxygenated blood

Answer 7

left atria, mitral valve, left ventricle, , AORTIC VALVE, aorta, general circulation

Question 8

s1 sound

s2 sound

Answer 8

closure of mitral/tricuspid valve
3 leaflets

s2- aortic/pulmonic valves
semilunar valves- 2 leaflets

Question 9

s3

Answer 9

CHF! or heart failure
occurs during "early diastole" 
aka" ventricular gallop"
alway abnormal if >35yo
normal in young children and athletes if no other s/s

In older individuals it indicates the presence of congestive heart failure. The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium.

Question 10

s4

Answer 10

LVH
stiff left ventricle
The fourth heart sound (S4), when audible, is caused by vibration of the ventricular wall during atrial contraction. This sound is usually associated with a stiffened ventricle (low ventricular compliance), and therefore is heard in patients with ventricular hypertrophy, myocardial ischemia, or in older adults.

aka “atrial gallop” or “atrial kick”

Question 11

summation gallop

Answer 11

s1-s4 heart

Question 12

benign split s2

Answer 12

best heard over pulmonaic area (left sternum). normal finding if it occurs during inspiration, disappears expiration

Question 13

bengin s4 in elderly

Answer 13

if no s/s of heart/valvular disease it is normal

Question 14

MR ASS

Answer 14

mitral regur- best heart apex. axilla, high pitched (use diaphragm to listen)

aortic stenosis- radiates to neck
noisy murmur- use bell

systolic murmurs- loud, radiate to neck or axilla

Question 15

MS. ARD

Answer 15

mitral stenosis- use diaphragm
aortic regurg- use bell
diastolic

Question 16

heart murmur grading

Answer 16

I-VI

IV- louder murmur, first time a thrill is present “palpable mur mur”

Question 17

ALL diastolic (MS AR)= abnormal

all benign mumurs occurring during systole (s1)
benign murmur do NOT have a thrill

Answer 17

true

Question 18

Mitral valve location

Answer 18

apex of the heart
apical area
5th ICS on the left side of the sternum medial to the midlclavicular line

Question 19

only systolic murmur radiate

Answer 19

mitral regurg- axilla

aortic stenosis- neck

Question 20

s3 is a sign of what

Answer 20

CHF

Question 21

s4 is a sign of what

Answer 21

LVH

Question 22

s2 split heard best heard where

Answer 22

pulmonic area

Question 23

afib tx

Answer 23

use CHADs2 score (2 or more requires anticoag)
C (CHF)
H (HTN)
A (>75yo)
D (DM)
S (hx Stroke/TIA)
2 (2 or more)

classic case: pt c/o heart palpitations, sob, chest pain, syncope.
tx: ecg, tsh, electrolytes, 24 hr holder, digoxin level, echo (r/o vavular pathology)

lifestyle: avoid stimulants and alcohol

Question 24

afib medications

Answer 24

rate: CCB, BB or dig
rhythm: amiodaron (cordarone) . black box: pulmonary and liver damage

**SIMVASTATIN with AMIODARONE”= rhabdo

anticoag with warfarin, baseline INR and CBC

patient education -eat Vit K in food

Question 25

paroxysmal atrial tachy

Answer 25

peaked qrs. ie: abrupt onset palpitations, sob, anxiety, HR 150-250 management: hold one's breath, carotid massage, splash ice cold water (valsalva maneuvers)

Question 26

pulsus parodoxus (paradoxical pulse)

Answer 26

pericarditis cardio effusion apical pulse heard, radial pulse no longer palpable

Question 27

jnc 8 blood pressure

Answer 27

> 60 yo, 18 yo with CKD or DM

Question 28

HTN medications for blacks

Answer 28

CCB or thiazaide (BB cause angioedema)

Question 29

HTN medications with CKD

Answer 29

ace/arb

Question 30

rule out organ damage in HTN

Answer 30

eyes: silver/copper wire arterioles, AV junction nicking, flame shaped hemorrhages, papilledema kidneys: microalbumin, proteinuria elevated creatine, gfr, edema heart: s3 (CHF), s4 (LVH) carotid vruits

Question 31

CCB medications

Answer 31

``` "pine" nifedipine ( procardia) amlodipine (norvac) verapamil (calan) dilt (cardizem) ```

Question 32

thiazide diuretics

Answer 32

``` good for osteoporosis hyperglycemia hyperuricemia hypokalemia hyper triglyceriemia ( check lipids) ``` don't use if allergic to sulfa

Question 33

side effects of spironolactone

Answer 33

gynecomastia

Question 34

left ventricular failure

Answer 34

Left = L (lungs) | crackles, cough, sob

Question 35

right ventricular failure

Answer 35

GI JVD (normal mvd is 4cm or less) enlarged spleen, enlarged liver, lower extremity edema

Question 36

tx for CHF

Answer 36

lasix 20mg, nitro, ace/arb

Question 37

DVT assessment

Answer 37

positve humans sign (pain with dorsiflexion of the foot) gold standard- contract venography

Question 38

PVD or PAD gold standard dsg

Answer 38

angiography low tech- ankle/brachial BP before and after exercise

Question 39

raynauds tx

Answer 39

CCB (vasodilate)- nifedepine, amlodipine avoid BB, vasoconstriction drugs (decongestants, amphetamines), smoking cesession * think american flag, red/white/blue

Question 40

if triglicerides >500

Answer 40

priority before lowering LDL dt risk of acute pancreatitis tx with niacin or vibrate low fat dient (

Question 41

statin interactions

Answer 41

increase risk for rhabdo: ``` grapefruit juice fibrates ( except fenofibrate) antifungals! (intraconazole, ketonazole) macrolide amiodarone CCB (dilt, amloidipine, verapamil) ```

Question 42

tx plan for high cholesterol

Answer 42

lifestyle (weight loss, exercise most days, smoking cession ), dash (low salt, low sat fat) soluble fiber (inulin, guar gum, fruit, veges) beneficial stanols and sterols (benecol, smart balance margarine) ** If not changes 6 months of lifestyle, consider anti lipid drugs if more than 2 risk factors

Question 43

risk factors for heart disease (CHD)

Answer 43

``` htn family hx of premature heart disease (women with MI 45, women>55) smoking BMI>30 microalbuminuria CAD, PVD ```

Question 44

albuminuria values

Answer 44

ln a single urine specimen, a level of more than 30 mg of albumin per gram of creatinine is considered positive. For a 24-hour urine collection, 30 to 300 mg of albumin means albuminuria. CA: >1:30

Question 45

agents to HDL (no impact on LDL)

Answer 45

nicotinic acid (niacin) OTC, niaspan fibrates: fenofibrate (tricor) alternate: bile acide séquestrants high trig- avoid junk food low HDL- exercise

Question 46

rhabo labs

Answer 46

>CK: 10,000-25,000 proteinuria in up to 45% LFT pain, weakness, dark urine

Question 47

advice if low HDL

Answer 47

aerobics niacin OTC or tx niacin (niaspan) or fibrates

Question 48

waist circumference in obese

Answer 48

females: >35 inches or 88cm males: >40 or 102cm

Question 49

metabolic syndrome critieria

Answer 49

3 must be present; abdominal obesity (>40 male, >35 females) HTN hyerlipidemia hypertension: fasting glucose >100, triglerides >150,

Question 50

trigleride level normal

Answer 50

less than 150

Question 51

increase triglerceride level can cause

Answer 51

fatty liver (steatosis) aka nonalcoholid fatty liver disease look for >ast/alt, negative hep a, b, c. educate: decrease simple carbs

Question 52

bmi calculations

Answer 52

weight divided by height

Question 53

PEF calculations

Answer 53

hag, height, age, gender