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Flashcards in Cardiovascular Deck (295)
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1
Q

What is the BP goal for someone under 60 years old?

A

Less than 140/90

2
Q

What is the blood pressure goal for someone over 60?

A

Less than 150/90

3
Q

What antihypertensive medication has beneficial effects for an elderly white female with osteoporosis

A

Calcium channel blocker

4
Q

Middle age or older adult complains of mid sternal chest pain that feels like heavy pressure on the chat. The pain is associated with numbness and tingling in the left jaw and the left arm. The patient is diaphoretic with cool, clammy skin. Women present with nonspecific symptoms such as dyspnea, fatigue, back pain, and nausea.

A

Acute MI

5
Q

Elderly white male complains of pulsating type sensation in abdomen and or low back pain. With pending rapture, sudden onset of severe chest and low back pain that suddenly becomes sharp and excruciating. Patients with hypertension and smokers are at a higher risk.

A

Dissecting abdominal aortic aneurysm

6
Q

Elderly patient complains of an acute or gradual onset of dyspnea, fatigue, dry cough, and swollen feet and ankles. The patient has a sudden or gradual increase in weight. Lung exam will reveal crackles on both the long bases along with an F3 heart sound. History of pre-existing coronary artery disease, prior MI, or previous episode is possible usually is taking diuretics, digoxin or antihypertensive medication

A

Congestive heart failure

7
Q

Patient presents with fever, chills, and malaise that is associated with the new murmur and the abrupt onset of CHF. Associated skin findings are found mostly on the fingers hands and toes. These are sub ungual hemorrhages, petechiae on the palate, painful violet colored nodes on the fingers or feet i.e. Osler nodes, and tender red spots on the palms and soles i.e. Janeway lesions.

A

Bacterial endocarditis

8
Q

The lower border of the left ventricle is where

A

The apical impulse is generated

9
Q

Located at the fifth intercostal space by the midclavicular line on the left side of the chest

A

Apical impulse

10
Q

What causes displacement of the point of maximal impulse

A

Severe left ventricular hypertrophy, cardiomyopathy, and pregnancy in the third trimester.

11
Q

What Heart valves create S1 heart sound

A

MOTIVATED
M=mitral valve
T=tricuspid
AV=atrioventricular

12
Q

What heart valves create S2 heart sounds

A

APPLES
A=Aortic
P=pulmonic
S=semilunar

13
Q

What heart sound is pathogmomic for CHF

A

S3

14
Q

When does S3 heart sound occur

A

It occurs during early diastole also called a ventricular gallop and sounds like “Kentucky”. Always considered abnormal if it occurs after the age of 35.

15
Q

This heart sound is caused by increased resistance due to a stiff left ventricle, usually indicates LVH, considered a normal finding in some elderly slight thickening of the left ventricle

A

S4 heart sound

16
Q

When does S4 occur

A

During late diastole also called atrial gallop. Sounds like “Tennessee”.

17
Q

Where is the best place to hear an S4 heart sound

A

Best heard at the apex or Apical area i.e. mitral area using the bell of the stethoscope

18
Q

When do you use the bell of the stethoscope

A

To listen to low tones such as the extra heart sounds of S3 or S4 and mitral stenosis

19
Q

When do you use the diaphragm of the stethoscope

A

To listen to mid to high-pitched tones such as lung sounds, mitral regurgitation, and aortic stenosis

20
Q

What could be some causes of secondary hypertension

A

Renal artery stenosis, vascular, endocrine, hypothyroidism, no logic, pharmacologic, pregnancy only after 20 weeks

21
Q

Elevated systolic with normal diastolic i.e. 160/80. Seeing an elderly patients because of Stephon vessels.

A

Isolated systolic hypertension

22
Q

Isolated systolic hypertension is a significant predictor of what in the elderly

A

Predict strokes and myocardial infarction’s

23
Q

What are the initial choices according to JNC8 for African-Americans with or without diabetes for blood pressure medication

A

Thiazide diuretics for a systolic drop of 2 to 8 points, and then calcium channel blocker for systolic drop more than eight points

24
Q

What is the initial choice according to JNC8 for non blacks with or without diabetes for hypertension medication

A

Thiazide diuretic for systolic drop of 2 to 8 points, calcium channel blocker, ACE, or ARB for systolic drop of more than eight points

25
Q

This hypertension medication has a suffix of IDE. No longer first line, excellent synergist. Works well with other drugs

A

Thiazide diuretics

26
Q

This blood pressure medication has a suffix of PRIL. This medication is used in high renin states, diabetes.

A

ACE inhibitors

27
Q

This hypertension medication has a suffix of SARTAN. Use in high renin states, diabetes. Alternative to ACE.

A

Angiotensin receptor blocker

28
Q

What type of people produce a high number of renin

A

Young Caucasian

29
Q

This hypertension medication has a suffix of LOL. Not for use in uncomplicated hypertension but good add on medication

A

Beta blockers

30
Q

This hypertension medication has a suffix of PINE. Use for isolated systolic hypertension and in African Americans

A

Calcium channel blocker’s

31
Q

What lab studies are needed for hypertensive patients

A

Hematocrit, glucose, urine analysis for proteinuria, estimated GFR, serum potassium, creatinine, calcium, fasting lipid profile, ECG.

32
Q

What blood pressure medication does not affect the pulse

A

Calcium channel blocker’s

33
Q

When a patient is on an Ace Inhibitor what lab needs to be ordered

A

serum potassium

34
Q

What is a common side effect of HCTZ

A

Erectile dysfunction

35
Q

A normal GFR rate is

A

Greater than 60

36
Q

What type of hypertension medication causes the patient to hold potassium

A

ACE & ARB

37
Q

What type of blood pressure medication causes the patient to waste potassium

A

HCTZ

38
Q

What are two examples of non-DHP calcium channel blocker’s

A

Diltiazem & Verapamil

39
Q

What type of pain medication hold on to sodium and causes fluid retention while diminishing prostaglandins for the kidney which produces renal artery hydration

A

NSAIDS

40
Q

When should the elderly take their medication

A

In the evening or at night time

41
Q

When should statins be taken

A

In the evening

42
Q

When should a baby aspirin be taken

A

in the evening

43
Q

If a patient has renal insufficiency what is needed

A

Fluids

44
Q

Do you ever add ACE or ARB in the same patient

A

Never

45
Q

What type of hypertensive medication hold onto potassium

A

ARBs

46
Q

What type of hypertensive medication loses potassium

A

HCTZ

47
Q

If a patient has low HDL and high triglycerides what does that mean

A

Insulin insensitivity

48
Q

If a patient is on in angiotensin receptor in blocker what must be monitored

A

Potassium and kidney function must be checked after one week

49
Q

What type of hypertension medication can precipitate gout in a patient with a history of gout

A

HCTZ

50
Q

What hypertension medication will always affect the kidneys so the kidney function must be always checked

A

ACE/ARB

51
Q

If a patient is on simvastatin what hypertension medication must be avoided

A

amlodipine

52
Q

If a patient is on atorvastatin can they take amlodipine

A

Yes

53
Q

What to fruits with amlodipine can cause adverse affects

A

Grapefruits and cranberries

54
Q

What are the characteristics for dyslipidemia treatment with statins

A

History of heart disease or stroke, LDL greater than 190, diabetes aged 40 to 75 with LDL 70-189, global 10 year risk score of greater than 7.5%.

55
Q

What is the first choice to reduce risks of dyslipidemia (medication)

A

Statins

56
Q

What can elevate triglyceride levels

A

Alcohol use and increased glucose/A1c

57
Q

If a patient has a triglyceride level of less than 500 what must be done first

A

Lifestyle modifications

58
Q

What are to high potency statins

A

Atorvastatin i.e. Lipitor, Rosuvastatin i.e. Crestor

59
Q

What are moderate potency statins

A

Simvastatin i.e. Zocor, Pitavastat (Livalo), Pravastain (Pravachol)

60
Q

Clinical syndrome that impairs the ventricle from filling or ejecting blood. Characterized by specific symptoms.

A

Heart failure

61
Q

Dyspnea on exertion, fatigue, fluid retention are all symptoms of

A

Heart failure

62
Q

Structural heart disease but without signs or symptoms of heart failure or is what classification

A

I

63
Q

Structural heart disease with prior or current symptoms of heart failure is what classification

A

II

64
Q

At risk for heart failure but without structural disease or symptoms of heart failure is what classification

A

None

65
Q

Structural heart disease with prior or current symptoms of heart failure or is what classification

A

III

66
Q

Refractory heart failure requiring specialized interventions is what kind of heart failure

A

IV

67
Q

What are clinical signs and symptoms of heart failure

A

Resting tachycardia, narrow pulse pressure less than 25, tachypnea, crackles, diaphoretic, S3 and or S4, peripheral edema may be present

68
Q

What is an early sign of heart failure

A

Holding onto fluids into the lungs

69
Q

Where do you auscultate S3 and S4 sound

A

Pulmonic listening point

70
Q

What is a late sign of heart failure

A

Peripheral edema via lungs filling with fluid and lower extremity edema is also a late sign of CHF

71
Q

How to identify CHF early and patient care

A

Identification/correction of systemic factors such as thyroid dysfunction, diabetes infection, MI, valvular dysfunction, arrhythmia. Reinforced lifestyle modifications such as sodium restriction and medication compliance. Illuminate medications that contribute to CHF

72
Q

What medications can contribute to heart failure

A

Amlodipine and calcium channel blocker’s because they block calcium and the heart cannot contract for a long periods of time forcefully into the muscle. Metoprolol and beta blockers causes cardiac output to drop, increased heart rate. Pioglitazine (Actos)
can worsen heart failure

73
Q

Are NSAIDS i.e. Naproxen safe to give to a patient with heart failure

A

No because it holds onto sodium thus the patient will retain fluid

74
Q

Is aspirin safe for a patient in heart failure

A

Yes

75
Q

The sound detected when there is a turbulent bloodflow to the great vessels or across a heart valve

A

Heart murmur

76
Q

Which two heart valves cause all of the trouble in heart murmur’s

A

Aortic and mitral

77
Q

What type of heart valves do not open properly

A

Stenotic valves

78
Q

What type of valves do not close properly

A

Regurgitant valves

79
Q

With stenotic and regurgitant valves, what are the highest risk

A

Arrhythmias

80
Q

Mnuemonic for systolic murmurs

A

Mr. Payton Manning As MVP

81
Q

Mnemonic for diastolic murmurs

A

ARMS

82
Q

Or diastolic murmur’s normal or abnormal

A

Always abnormal. Refer

83
Q

Angina, syncope and heart failure or all associated findings of what type of heart murmur

A

Aortic stenosis

84
Q

This heart murmur affects ages 15 to 65, are usually congenital in the bicuspid valve, rheumatic fever is second most common cause, calcified valve.

A

Aortic stenosis

85
Q

ASC is the mnemonic for what type of murmur

A

Aortic stenosis
Angina
Syncope
Congestive Heart Failure

86
Q

Which heart murmur is heard loudest along upper sternal border and carotids or apex, usually Audible S4, Apex and pulse is forceful but as left ventricle dilates apex becomes defuse and lateral, narrow pulse pressure

A

Aortic stenosis

87
Q

This heart murmur occurs from rheumatic heart disease, congenital deformity, aortic root abnormalities, and syphilis

A

Aortic regurgitation

88
Q

The PMI is displaced downward and left in which heart murmur

A

Aortic Regurgitation

89
Q

Dyspnea and atrial fib are associated findings of what type heart murmur

A

Mitral Stenosis

90
Q

Rheumatic fever is the cause of what type of heart murmur

A

Mitral stenosis

91
Q

Atrial fib is associated with what type of heart murmur

A

Mitral stenosis

92
Q

Shortness of breath, fatigue, and heart failure are all associated findings of

A

Mitral regurgitation

93
Q

This heart murmur is usually a result of a congenital condition, rheumatic heart disease, acute endocarditis, mitral valve prolapse’s, calcified annulus

A

Mitral regurgitation

94
Q

CHF, fatigue, and bacterial endocarditis are all symptoms of what type of heart murmur

A

Mitral regurgitation

95
Q

With this murmur the PMI is displaced laterally and is diffuse, murmur is holosystolic, and apical, transmission to the axilla and sternum, usually grade 2 or more

A

Mitral regurgitation

96
Q

Palpitations, chest pain, and audible click is associated with what type of murmur

A

Mitral valve prolapse

97
Q

Redundancy of the mitral valve leaflets with degeneration of the mitral valve tissue. Common in women 14 to 30 years old and most are asymptomatic

A

Mitral valve prolapse

98
Q

Palpitations, PSVT, chest pain, dyspnea, dizziness, and numbness are all symptoms of what type of murmur

A

Mitral valve prolapse

99
Q

First finding is midsystolic click heard best at Apex and left sternal border, second later finding is late systolic click accentuated withstanding, quieter with squatting. What type of murmur is this

A

Mitral valve prolapse

100
Q

A 67-year-old female complains of pain in her right lower leg when she walks. She gets complete relief when she stops walking and rest. It has worsened over the past three months. What finding is likely

A

Weakened pedal pulse

101
Q

Intermittent claudication is consistent with what type of disease

A

Peripheral artery disease

102
Q

The most common side effect of amlodipine is

A

Lower extremity edema

103
Q

If a murmur is heard at the second intercostal space at the right sternal border what type of murmur would this be

A

Aortic

104
Q

If a murmur is heard at the apex what type of murmur would this be

A

Mitral

105
Q

Does obesity contribute to peripheral artery disease

A

No

106
Q

Angioedema associated with ace inhibitor use is often most characterized by

A

Edema of the lips and face

107
Q

What population is at the highest risk for angioedema associated with ace inhibitor use

A

African Americans and they must take Benadryl

108
Q

You hear a bruit with

A

Carotid artery disease

109
Q

What grade of murmur is very soft and heard only under optimal conditions

A

Grade 1

110
Q

What grade of murmur is mild to moderately loud

A

Grade 2

111
Q

What grade of murmur is a loud murmur that is easily heard once the stethoscope is placed on the chest

A

Grade 3

112
Q

What grade of murmur is a louder Murmur. First time that a thrill is present. A thrill is like a palpable murmur.

A

Grade 4

113
Q

What grade of murmur is a very loud murmur heard with the edge of the stethoscope off of the chest. Thrill is more obvious.

A

Grade 5

114
Q

What grade of murmur is so loud that it can be heard even with the stethoscope off of the chest. The thrill is easily palpated.

A

Grade 6

115
Q

All benign murmurs occur during

A

Systole S2

116
Q

Apex of the heart, apical area, or fifth intercostal space on the left side of the sternum medial to the midclavicular line is what listening point

A

Mitral

117
Q

What type of murmurs radiate

A

Systolic

118
Q

What type of murmur radiates to the axilla

A

Mitral regurgitation

119
Q

What type of murmur radiates to the neck

A

Aortic stenosis

120
Q

S3 is a sign of

A

CHF

121
Q

S4 is a sign of

A

LVH

122
Q

A split S2 is best heard at

A

The pulmonic area

123
Q

The first time a thrill is palpated is at what murmur grade

A

Grade 4

124
Q

aoRtic is on what side

A

Right side

125
Q

puLmonic is on what side

A

Left side

126
Q

What must be ruled out in an older male who has a pulsatile abdominal mass that is more than 3 cm in width.

A

AAA

127
Q

In a patient that presents with AAA symptoms, what are the diagnostic tests that need to be ordered

A

Abdominal ultrasound and CT

128
Q

The most common cardiac arrhythmia in the United States and a major cause of stroke. Also classified as supraventricular tachyarrhythmia. Maybe asymptomatic

A

Atrial fib

129
Q

Hypertension, coronary coronary artery disease, nicotine, caffeine, hyperthyroidism, alcohol intake, heart failure, and LVH are all risk factors for

A

A Fib

130
Q

Patient complains of the sudden onset of heart palpitations accompanied by feelings of weakness, dizziness, and dyspnea. They may complain of chest pain and feeling like passing out. Rapid and irregular pulse maybe more than 110 bpm with hypotension

A

A fib

131
Q

What is a diagnostic test for a fib

A

12 lead ECG he which will not show discrete P waves

132
Q

What are lifestyle modifications for patients with a fib

A

Avoid stimulants such as caffeine, nicotine, and decongestants and alcohol

133
Q

Simvastatin and amiodarone can cause

A

Rhabdomyolysis

134
Q

What does the INR need to be in a patient with a fib

A

2.0 to 3.0

135
Q

What is the INR in a patient with synthetic/prosthetic valves

A

2.5 to 3.5

136
Q

What are dietary sources for a fib patients

A

Patients need to be consistent with their day today consumption of vitamin K foods. Greens such as kale, collard, mustard, turnip, spinach, iceberg or Romain lettuce, and Brussels sprouts. Only one serving per day it’s recommended

137
Q

EKG shows tachycardia with peaked QRS complex and P waves

A

Paroxysmal atrial tachycardia also known as paroxysmal supraventricular tachycardia

138
Q

Digitalis toxicity, alcohol, hyper thyroidism, caffeine intake, alcohol, and illegal drug use or all causes of

A

Paroxysmal Atrial Tachycardia

139
Q

Patient complains of the abrupt onset of palpitations, rapid pulse, lightheadedness, shortness of breath, and anxiety. Rapid heart rate can change from 150 to 250 bpm

A

Paroxysmal Atrial Tachycardia

140
Q

How is Paroxysmal Atrial Tachycardia managed

A

Tell the patient to hold one’s breath and strain hard, carotid massage, splashing ice cold water on the face can interrupt and stop this arrhythmia i.e. Valsalva maneuver’s

141
Q

The apical pulse can still be heard even though the radial pulse is no longer palpable. It is measured by using the blood pressure cuff and a stethoscope. What kind of arrhythmia is this

A

Pulses paradoxus

142
Q

If an INR is 3.0 to 5.0 with no bleeding what action is needed

A

Skip one dose. Decrease maintenance dose. If only minimally prolonged, no need to decrease dose. Check INR in 1 to 2 days until normal

143
Q

If an INR is 5.0 to 9.0 and there was no bleeding what action is needed

A

Omit a dose and give small dose of oral vitamin K or omit next 1 to 2 doses of warfarin. Daily INR monitoring until normal. Decrease the Coumadin maintenance dose.

144
Q

What can be a pulmonary cause of pulses paradoxus

A

Asthma, emphysema

145
Q

What can be a cardiac causes of pulses paradoxus

A

Tamponade, pericarditis, cardiac effusion

146
Q

What can cause A fib and PAT

A

Alcohol intoxication, hypothyroidism, stimulants such as theophylline, decongestants, cocaine, and heart disease.

147
Q

If bleeding is suspected what must be ordered

A

INR with PT and PTT

148
Q

It may take how many days after changing the warfarin dose to see a change in the INR

A

2 to three days

149
Q

What FDA category is Coumadin

A

Category X

150
Q

What can cause silver and or copper wire arterioles, AV Junction nicking, and flame shape hemorrhages with papilledema in the eyes

A

Hypertension

151
Q

Obstructive sleep apnea and coarctation of the aorta and can cause

A

Hypertension

152
Q

When the blood pressure of the arms is higher than the blood pressure of the legs what is this condition

A

Coarctation of the aorta

153
Q

If a patient has diabetes or chronic kidney disease with protein urea or CAD what type of hypertension medication should be prescribed

A

ACE or ARB

154
Q

How do you check a patient for orthostatic hypotension

A

Check the blood pressure in both sitting and standing position. When the patient stands wait for one to three minutes to measure understanding blood pressure. If the patient is dizzy or lightheaded then they have it

155
Q

What are side effects of Aldactone (Spironolactone) and Eplerenone (Inspra)

A

Gynecomastia, hyperkalemia, G.I. upset, vomiting, diarrhea, stomach cramps, post menopausal bleeding, erectile dysfunction

156
Q

What type of hypertension medication is contra indicated in asthma, COPD, chronic bronchitis, emphysema, chronic lung disease, second and 3rd° heart block and sinus bradycardia

A

Beta blockers

157
Q

Headaches, ankle edema, heart block or bradycardia, reflex tachycardia are all side effects of

A

Calcium channel blockers

158
Q

Second and 3rd° heart block, bradycardia, and CHF are all contra indications for what type of hypertension medication

A

Calcium channel blockers

159
Q

Dry hacking cough and hyperkalemia and angioedema are all side effects of

A

ACE and ARB

160
Q

Moderate to severe kidney disease is a contraindication for what type of Hypertension medication

A

ACE and ARB

161
Q

If a patient has renal artery stenosis what type of antihypertensive medication cannot be given

A

ACE or ARB

162
Q

What type of antihypertensive medication has a favorable affect on osteopenia and osteoporosis

A

Thiazide diuretic such as HCTZ

163
Q

Can a thiazide diuretics be given to a patient that is allergic to sulfa

A

No

164
Q

Hyperglycemia, hyperuricemia i.e. can precipitate a gout attack, hypertriglyceridemia and hyper cholesterolemia, hypokalemia, hyponatremia are all side effects of

A

Thiazide diuretics

165
Q

Hydrochlorothiazide, Chlorothalidone, and Indapamide are all

A

Thiazide diuretics

166
Q

Neovascularization, microaneurysms, hard exudates, cotton wool spots are all what condition in the eye

A

Diabetic retinopathy

167
Q

What can happen when you combine an ACR and a potassium sparing diuretic such as triamterene or spironolactone

A

Hyperkalemia

168
Q

If a patient has bilateral renal artery stenosis what antihypertensive medication will precipitate in acute renal failure

A

ACE

169
Q

Women with hypertension and osteopenia or osteoporosis should receive what medication

A

Thiazide diuretic

170
Q

How does Thiazide diuretics help patients with osteopenia or osteoporosis

A

It helps bone loss by slowing down calcium loss from the bone and stimulating osteoclasts

171
Q

If a patient has an ejection fraction less than 40% what do they have

A

Acute CHF

172
Q

Crackles, bibasilar rales, cough, dyspnea, decreased breath sounds, dullness to percussion, paroxysmal nocturnal dyspnea, orthopnea, nocturnal nonproductive cough, and wheezing are all signs of

A

Left ventricular failure.

173
Q

Jugular venous distention, enlarged spleen, enlarged liver, lower extremity edema with cool skin is indicative of

A

Right ventricular failure

174
Q

If a chest X-ray Shows increased height size, interstitial and Alveolar edema, Kerley B lines, and other signs of pulmonary edema what is this indicative of

A

CHF

175
Q

What test need to be ordered for patients with CHF

A

ECG, CPK, troponin, BNP, echocardiogram with Doppler flow study

176
Q

The left-sided heart failure or is caused by what symptoms hint L as in

A

Lung

177
Q

Can CHF cause DVT

A

Yes

178
Q

A positive Homans sign is indicative of

A

DVT

179
Q

When a patient has lower leg pain on dorsiflexion of the foot what is this test

A

Homans sign

180
Q

What lab do you order for a patient with DVT

A

CBC, platelets, clotting time, PT, PTT, INR, chest x-ray, EKG

181
Q

What is the gold standard test for DVT

A

Contrast venography

182
Q

What medication is a patient with DVT put on

A

Blood thinner such is warfarin PO

183
Q

Inflammation of a superficial vein due to local trauma . Higher risk if indwelling catheter’s, IV drugs, secondary bacterial infection

A

Superficial thrombophlebitis

184
Q

An adult complains of an acute onset of an indurated vein localized redness, swelling, and tenderness. Usually located on the extremities. The patient is afebrile with normal vital signs.

A

Superficial thrombophlebitis

185
Q

What is the treatment plan for superficial thrombophlebitis

A

NSAIDs such as ibuprofen or naproxen b.i.d. Warm compresses. Elevate limb. If septic admitted to hospital

186
Q

Hypertension, smoking, diabetes, and hyperlipidemia are all higher risk factors for

A

PVD or Peripheral Artery Disease

187
Q

What is the treatment plan for peripheral vascular disease or peripheral arterial disease

A

Ankle and brachial blood pressure before and after exercise. Order a Doppler ultrasound flow study. Smoking cessation and daily ambulation Exercises.

188
Q

What is the gold standard for diagnosis of peripheral vascular disease or peripheral arterial disease

A

Angiography

189
Q

Gangrene of the foot and or lower limb with amputation, increased risk of CAD, and increased risk of carotid plaquing are all complications of

A

Peripheral Vascular Disease or Peripheral Arterial Disease

190
Q

Reversible vasospasm Of the peripheral arterioles On the fingers and toes. Unknown etiology. Associated with an increased risk of autoimmune disorders. Most patients are female with the gender of 8 to 1.

A

Reynauds phenomenon

191
Q

What is the treatment plan for Reynauds phenomenon

A

Avoid touching cold objects, cold weather. Avoid stimulants i.e. caffeine. Smoking sensation. Calcium channel blocker‘s can be used such as amlodipine or Nifidepine. Do not use any vasoconstricting drugs such as Imitrex, ergots, Psuedoephedrine, decongestant or amphetamines. Avoid nonselective beta blocker’s.

192
Q

Middle-aged male presents with fever, chills, malaise that is associated with sub ungual hemorrhages i.e. splinter hemorrhages on the nail bed and tender violet colored nodules on the fingers and or the toes i.e. Osler nodes. Palms and soles may have tender red spots on the skin i.e. Janeway lesions. Some may have heart murmur.

A

Bacterial endocarditis

193
Q

What is the treatment plan for bacterial endocarditis

A

Referred to cardiologist or ED for hospitalization. Blood cultures within the first 24 hours times three. CBC and sedimentation rate

194
Q

What health conditions need endocarditis prophylaxis

A

Previous history of bacterial endocarditis, prosthetic valves, certain types of congenital heart disease, cardiac transplant with valvulopathy

195
Q

What medication should be getting for endocarditis prophylaxis

A

Amoxicillin and with penicillin allergy clindamycin or Keflex

196
Q

What are Statin drug interactions that create a high-risk for rhabdomyolysis

A

Grapefruit juice, other fibrates, antifungal, macrolides, amiodarone, and calcium channel blocker’s such as amlodipine verapamil and diltiazem

197
Q

What labs must be taken for starting statins

A

Baseline LFTs and periodically. Recheck lipids in three months then six months during the first year of therapy

198
Q

Acute breakdown of skeletal muscle will cause acute renal failure. Triad of muscle pain, weakness, and dark urine. Look for muscle pain and aches that persist.

A

Rhabdomyolysis

199
Q

What labs should be ordered in suspected rhabdomyolysis

A

Creatinine kinase which will be elevated, urine which will be reddish brown in color and protein urea will be found. Other labs are urinanalysis, BUN, creatinine, potassium and electrolytes, EKG

200
Q

Anorexia, nausea, dark colored urine, jaundice, fatigue, and flu like symptoms are all signs of

A

Acute drug induced hepatitis

201
Q

What labs would be elevated in a cute drug induced hepatitis

A

ALT and AST

202
Q

What patient education is important for acute drug-induced hepatitis

A

Minimize alcohol intake or other hepatotoxic substances while on statins, avoid prescribing to alcoholics, advise patient to report symptoms of hepatitis or rhabdomyolysis. If Present, tell patient to stop the drug and call or go to the ED

203
Q

Low HDL less than 40 mg is a risk factor for

A

Congestive heart disease

204
Q

What diet can lower triglycerides

A

Reduce intake of simple carbohydrates, junk foods, and fried foods

205
Q

Increasing aerobic type exercises can increase

A

HDL

206
Q

If a patient on a statin complains of muscular pain with dark colored urine what must be ruled out

A

Rhabdomyolysis

207
Q

Abdominal obesity, hypertension, and hyperlipidemia our criteria for diagnosing

A

Metabolic syndrome

208
Q

A BMI of 18.5 to 24.9 is considered

A

Normal weight

209
Q

A BMI of 25 to 29.9 is considered

A

Overweight

210
Q

A BMI of 30 to 39.9 is considered

A

Obese

211
Q

Caused by triglyceride fat deposits in the hepatocytes of the liver. And asymptomatic and reversible condition.

A

Fatty liver or steatosis

212
Q

Obesity, diabetes, metabolic syndrome, hypertension, and certain drugs are all risk factors for

A

Fatty liver or steatosis

213
Q

Usually asymptomatic. Annual PE labs will show slight elevation of ALT and AST. Hepatitis A, B, and C profile is negative or obese female complains of fatigue and malaise with vague Right upper quadrant pain. Associated with obesity, metabolic syndrome, diabetes, and hyperlipidemia

A

Fatty liver or steatosis

214
Q

What is the gold standard for fatty liver or steatosis diagnosis

A

Liver biopsy

215
Q

What is the treatment plan for fatty liver or steatosis

A

Lose weight, exercise and watch diet. Discontinue alcohol intake permanently. Avoid hepatotoxic drugs such as acetaminophen, isoniazid and statins. Recommend vaccination for hepatitis a and B and recommend flu vaccine.

216
Q

For males what is the waist Circumference that is associated with abdominal obesity

A

Greater than 40 inches

217
Q

For females what is the waist circumference that is associated with obesity

A

Greater than 35 inches

218
Q

How do you calculate BMI

A

Wait in kilometers divided by height in meters squared

219
Q

A Person with a BMI of 27 is considered

A

Overweight initiate lifestyle education

220
Q

First line treatment for overweight patient is

A

Lifestyle modification i.e. diet, nutrition, exercise

221
Q

How long should a patient fast before being screened for hyperlipidemia via blood

A

12 to 14 hours

222
Q

Swelling, pain, and discoloration in the lower extremity are symptoms of

A

DVT

223
Q

A common early finding in patients who have chronic aortic regurgitation is

A

An hypertrophied left ventricle

224
Q

What drug would be a good choice for reducing morbidity and mortality in mild heart failure

A

Beta blocker

225
Q

An Ace Inhibitor should be discontinued immediately if

A

Pregnancy occurs

226
Q

A patient taking an ace inhibitor should avoid

A

Potassium supplements

227
Q

This term is used to describe healthcare providers who fail to intensify therapy despite patients not reaching their goal

A

Clinical inertia

228
Q

What medications need to be stopped prior to cardiac catheterization

A

NSAIDs, Furosemide, Metformin

229
Q

What diagnostic test has the highest sensitivity for diagnosing heart failure

A

BNP

230
Q

What medication can have an unfavorable affect on a hypertensive patients blood pressure

A

NSAIDs

231
Q

After a patient has a myocardial event what medications should be prescribed if there was not any contraindications

A

ACE, ASA, beta blocker and satin

232
Q

What is a non-modifiable risk factor for PAD

A

Diabetes

233
Q

What are the three most common ailments in older adults

A

Hearing loss, hypertension, arthritis

234
Q

A young child has a grade 4 murmur. How should this be managed

A

The child should be referred to cardiology

235
Q

How would you describe the cough that is associated with heart failure

A

It is wet and worse with recumbence

236
Q

A 25-year-old patient has aortic stenosis. The ideology is probably

A

Congenital

237
Q

The most common indicator of end organ damage in adolescents with hypertension is

A

Left ventricular hypertrophy

238
Q

If a patient is lipids are elevated what serum study should be ordered

A

TSH

239
Q

What class of medication is frequently used to improve long-term outcomes in patients with systolic dysfunction

A

Ace inhibitors

240
Q

The carotid artery’s are auscultated for bruits because

A

This is indicative of generalized arthrosclerosis

241
Q

What medications can decrease INR in a patient who takes warfarin

A

Sucralfate and cholestyramine

242
Q

The most common arrhythmia resulting from valvular heart disease is

A

Atrial fib

243
Q

The valve was commonly involved in chronic rheumatic heart disease is the

A

Mitral valve

244
Q

What antihypertensive medication is contraindicated in patients with heart failure

A

Calcium channel blocker’s

245
Q

What is the most common arrhythmia associated with mitral regurgitation

A

A fib

246
Q

What characterizes a patient who has aortic regurgitation

A

Long asymptomatic period, Followed by exercise intolerance then dyspnea at rest

247
Q

When auscultating the heart for aortic insufficiency ask the patient to

A

Sit up, lean forward, and exhale

248
Q

What type of murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left Midclavicular line

A

Tricuspid regurgitation

249
Q

When auscultating the heart S one sound is located at the apex of the heart and signifies

A

Closure of the mitral and tricuspid valve

250
Q

Chest pain described as persistent, sharp, and knife like is characteristic of

A

Pericarditis and pleuritic pain

251
Q

Deep cervical lymph nodes drain lymphatic fluid from the

A

Head and the neck

252
Q

Absent or diminished pulses in the rest could be indicative of

A

Arterial occlusive disease

253
Q

This murmur produces a soft intensity with a crescendo – decrescendo pitch

A

Pulmonic stenosis

254
Q

A patient with Cirrhosis develops portal hypertension by the presence of

A

Splenomegaly

255
Q

In order to bring the ventricular apex closer to the chest wall when assessing the point of maximal impulse ask the patient to

A

Turn to the left side

256
Q

To assess a murmur of aortic insufficiency he position the patient

A

Sitting leaning forward

257
Q

A patient suspected of having chronic venous insufficiency he may present with

A

A brownish discoloration just above the malleolus

258
Q

The anterior mediastinal lymph nodes drain lymphatic fluid from the

A

Thymus, thyroid gland and the anterior part of the pericardium

259
Q

When performing a cardiovascular assessment on a healthy two-year-old child

A

Auscultate the heart sounds in all four cardiac areas

260
Q

Symptoms of acrocyanosis in the newborn include

A

Bluish color of the feet

261
Q

A condition that presents with symptomatic limb ischemia upon exertion is termed

A

Atherosclerotic Peripheral vascular disease

262
Q

A pediatric patient presents with erythema marginatum, chorea, and heart murmur. This is indicative of

A

Rheumatic heart disease

263
Q

A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the neck is usually associated with

A

Aortic dissection

264
Q

Characteristic symptoms of chronic venous insufficiency he may include

A

Petechiae leading to brown pigmentation noted over the feet

265
Q

Intermittent claudication is associated with

A

Chronic arterial insufficiency

266
Q

The classic signs of tetralogy of fallot are

A

Ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy

267
Q

What kind of diuretics can produce decreased potassium levels

A

Loop diuretics such as furosemide (Lasix)

268
Q

If a patient’s feet up appear pale on elevation and dusky red on dependency what is this indicative of

A

Chronic arterial insufficiency

269
Q

The superior and inferior mesenteric lymph nodes drain lymphatic fluid from the

A

Small and large intestines

270
Q

Enlarged or tender lymph nodes are most associated with

A

Infection and it’s nearby draining area

271
Q

A three week old infant presents with a generalized Lacy, reticulated blue discoloration of the skin. This is indicative of

A

Cutis marmorata

272
Q

The posterior chest wall and portions of the arms are drained by which group of lymph nodes

A

Sub scapular nodes

273
Q

The lymphatic duct drain into the

A

Venous system

274
Q

Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet maybe seen with

A

Neurogenic claudication

275
Q

The anterior cervical lymph node chain is located anterior and

A

Superficial to the sternomastoid muscle

276
Q

A third heart sound is audible in a 45-year-old. This S3 sound maybe

A

A sign of valvular heart disease

277
Q

The internal iliac lymph nodes drain fluid from the

A

Gluteal region

278
Q

Hiccoughs are associated with

A

Pacemaker failure

279
Q

Which lymph nodes receive lymphatic fluid from the stomach, duodenum, liver, gallbladder, and pancreas

A

Hepatic lymph nodes

280
Q

Cervical lymphadenopathy, bilateral nonpurulent conjunctivitis, Periungual desquamation, and polymorphous rash are all symptoms of

A

Kawasaki disease

281
Q

A widened pulse pressure greater than or equal to 60 in an older adult is a risk factor for cardiovascular disease, stroke, and

A

Renal disease

282
Q

The great saphenous vein enters the deep venous system by way of the

A

Femoral vein

283
Q

In older adults the presence of heart sound S4 suggests

A

Hypertension

284
Q

The heart sound S2 is caused by

A

Closure of the semi lunar valve’s

285
Q

-pril

A

Ace inhibitor

286
Q

A healthy 50-year-old patient presents to the clinic for a routine physical examination. He has no significance personal or family history of clinical heart disease. What should be part of his CV assessment

A

Blood pressure only

287
Q

The most effective intervention to prevent stroke is

A

Smoking cessation and treatment of hypertension

288
Q

A 49-year-old Hispanic female has a blood pressure of 145/95 during a routine annual evaluation. She has no previous history of hypertension. She takes a Statin for dyslipidemia. How should the NP proceed with this patient

A

The patient’s blood pressure should be checked in about 2 to 4 weeks

289
Q

An expected finding in a patient with long-standing poorly controlled hypertension is

A

Laterally displaced apical impulse

290
Q

What constitutes as stage two hypertension

A

Systolic greater than 160 over diastolic greater than 100

291
Q

A patient’s chief complaint is abdominal pain. What can mistakingly be associated with abdominal pain

A

Chest pain

292
Q

A patient with no significant medical history has varicose vein’s. She complains of aching legs. The intervention that will provide the greatest relief for her would be

A

Elevate her legs periodically

293
Q

There are several different classes of innocent heart murmur’s in children. A vibratory murmur (Stills murmur) is defected in what age group?

A

Usually detected at 8 to 14 years old

294
Q

Can a CBC be used to confirm a diagnosis of congestive heart disease

A

No

295
Q

Any condition or substance such as hyperthyroidism or caffeine that irritates or overstimulates the heart can cause what condition

A

Atrial fib