Cardiovascular

Question 1

What is the heart sound S1? (2)

Answer 1

1. Caused by the closure of AV valves
2. Marks the end of diastole, the beginning of systole

Question 2

What is the heart sound S2? (2)

Answer 2

1. Caused by closure of the semilunar valves
2. Marks the end of systole, beginning of diastole.

Question 3

What is S2 splitting on inspiration caused by?

Answer 3

Right bundle branch block

Question 4

What makes S2 louder?

Answer 4

Pulmonary Embolism

Question 5

What is S3? (2)

Answer 5

1. Caused by a rapid of rush of blood into a dilated ventricle
2. Associated with heart failure; may occur before crackles.

Question 6

What is S3 Caused by? (2)

Answer 6

1. Pulmonary hypertension and cor pulmonale.
2. Mitral, aortic, or tricuspid insufficiency

Question 7

What are the 5 auscultatory points?

Answer 7

Aortic, pulmonic, erb’s point, tricuspid, mitral (apical)

Question 8

What is S4?

Answer 8

1. Caused by atrial contraction of blood into a noncompliant ventricle

Question 9

What is S4 associated with? (6)

Answer 9

Myocardial ischemia, infarction, hypertension, ventricular hypertrophy and aortic stenosis

Question 10

What is pulse pressure?

Answer 10

Systolic- Diastolic = Pulse pressure

Question 11

Systolic blood pressure is an indirect measurement of what?

Answer 11

Cardiac output and stroke volume

Question 12

What is narrowing pulse pressure usually seen with?

Answer 12

Severe hypovolemia or severe drop in cardiac output

Question 13

Diastolic blood pressure is an indirect measurement of what?

Answer 13

Systemic vascular resistance

Question 14

A widened pulse pressure may indicate what?

Answer 14

Vasodilation, a drop in systemic vascular resistance - sepsis or septic shock

Question 15

Coronary arteries are perfused during what?

Answer 15

diastole

Question 16

Causes of valvular heart disease

Answer 16

1. CAD/ Ischemia, MI
2. Cardiomyopathy
3. Bicuspid aortic valve
4. Fever/ infection
5. Connective tissue diseases

Question 17

Murmurs of insufficiency occur when the valve is what?

Answer 17

Closed

Question 18

Murmurs of stenosis occur when the valve is what?

Answer 18

Open

Question 19

Murmurs of stenosis are acute or chronic?

Answer 19

Chronic

Question 20

The semilunar (pulmonic, aortic) are what during systole?

Answer 20

OPEN

Question 21

The AV valves (tricuspid, mitral) valves are what during systole?

Answer 21

CLOSED

Question 22

The semilunar valves are what during diastole?

Answer 22

CLOSED

Question 23

The AV valves are what during diastole?

Answer 23

OPEN

Question 24

Anticoagulant for acute chest pain 

Answer 24

Heparin or lovenox

Question 25

And I platelet agents for acute chest pain 

Answer 25

1. Plavix 2. Reopro 3. Integrilin 4. Aggrastat

Question 26

Cardioselective beta blocker

Answer 26

Metropolol

Question 27

Non-cardioselective beta blocker

Answer 27

Propranolol

Question 28

Contraindications to beta blockers in acute chest pain 

Answer 28

Sildenafil (viagra)

Question 29

Changes in II, III aVF

Answer 29

Right coronary artery, inferior LV

Question 30

Changed in V1, V2, V3, V4

Answer 30

Left anterior descending, anterior LV

Question 31

Changed in V5,V6, I, aVL

Answer 31

Circumflex, Lateral LV

Question 32

Changes in V5,V6

Answer 32

Low lateral LV

Question 33

Changes in I, aVL

Answer 33

High lateral LV

Question 34

Changed in VI, V2

Answer 34

Right coronary artery, posterior LV

Question 35

Changes in V3R, V4R

Answer 35

Right coronary artery, right ventricular infarct

Question 36

Inferior MI- ST elevation

Answer 36

II,III, aVF

Question 37

Inferior wall- reciprocal changes

Answer 37

Lateral wall (I, aVL)

Question 38

What is an inferior MI associated with

Answer 38

AV conduction disturbances ( 2° block, 3° block, sick sinus syndrome and sinus Brady)

Question 39

What can an Inferior MI develop into

Answer 39

Systolic murmur, mitral valve regurg

Question 40

Right ventricular infarction

Answer 40

Right coronary artery

Question 41

Signs and symptoms of right ventricular infract

Answer 41

JVD, high cvp, hypotension, clear lungs, bradyarrythmias

Question 42

Right ventricular infarct ST ST elevation

Answer 42

V3R, V4R

Question 43

Avoid in right ventricular infarct 

Answer 43

Preload reducers (nitrates or diuretics) beta blockers

Question 44

ST elevations/ depressions in anterior MI

Answer 44

V1-V4 / inferior wall (I,II,aVF)

Question 45

Anterior my my develop

Answer 45

2° type II block, or RVBB

Question 46

Lateral MI ST elevation

Answer 46

V5, V6 (low lateral) I, aVL (high lateral)

Question 47

Signs of retroperitoneal bleed

Answer 47

Sudden, hypotension, severe low back pain

Question 48

Evidence of reperfusion

Answer 48

Chest pain, relief, resolution of ST segment, deviations, marked elevation of troponin, reperfusion arrhythmias 

Question 49

Signs of coronary artery re-occlusion

Answer 49

Chest pain, ST elevation

Question 50

Hypertensive, emergency or crisis 

Answer 50

Elevated blood pressure where evidence of an organ damage that can be related to acute hypertension 

Question 51

Hypertension urgency 

Answer 51

Elevated blood pressure without evidence of acute and organ damage 

Question 52

Nitroprusside in HTN

Answer 52

Preload and after load reducer, assess for cyanide toxicity

Question 53

Signs and symptoms of peripheral arterial disease

Answer 53

Pain, pallor, pulse absent, parenthesia, paralysis, poikilothermia

Question 54

Normal ankle- brachial index

Answer 54

>0.90

Question 55

WPW syndrome

Answer 55

Genetic conduction abnormality, in which abnormal conduction pathway exist, that allows re-and Trent tachycardia pathway to bypass a normal AV node conduction pathway, resulting in superventricular tachycardia, 

Question 56

EKG changes with WPW

Answer 56

Short PR interval, presence of delta wave

Question 57

Do not give what medications with WPW

Answer 57

Adenine, digoxin, or calcium channel blockers- enhance conduction through abnormal pathway by increasing refractory. And AV node resulting in ventricular fibrillation.