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Flashcards in CV Deck (81)
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1

A S3 heart sound is associated with?

fluid overload

2

An S4 heart sound is associated with ?

hypertrophy- stiff ventricular wall

3

S4 sounds like?

Ten-nes-see

4

S3 sounds like?

Ken-tuck-y

5

Characteristics of a grade III murmur

moderately loud

6

Characteristics of a grade IV murmur

loud, associated with a thrill

7

Loud S1 murmur, low pitched, mid-diastolic; apical, "crescendo" rumble. Name the murmur.

mitral stenosis

8

S3 with systolic murmur at 5th ICS MCL; may radiate to base or left axilla; musical, blowing or high-pitched. Name the murmur

mitral regurg

9

Systolic, "blowing", rough, harsh murmur at 2nd R ICS usu radiating to neck. Name the murmur.

aortic stenosis

10

Diastolic, "blowing" murmur at 2nd L ICS. Name the murmur.

aortic regurgitation

11

What murmurs occurs during systole?

aortic stenosis, mitral regurg

12

What murmurs occur during diastole?

mitral stenosis, aortic regurg

13

A patient with HF demonstrating marked limitations of physical activity but comfortable at rest would be classified as what NYHA class?

III

14

A patient with HF demonstrating inability to carry out any physical activity without discomfort (S&S at rest) would be classified as what NYHA class?

IV

15

A suboccipital pulsating HA occurring in the early am, may be indicative of?

severe HTN

16

According to JNC 7, normal BP should be?

<120/80

17

According to JNC 7, prehypertension is defined as?

SBP 120-139 OR DBP 80-89

18

According to JNC 7, stage 1 HTN is defined as?

SBP 140-159 OR 90-99

19

According to JNC 7, stage 2 HTN is defined as?

SBP >/= 160 OR DBP >/= 100

20

According to JNC 8, BP goal for those <60yr?

< 140/90

21

According to JNC 8, BP goal for those >60yr?

<150/90

22

First drug of choice for treatment of HTN in non-African American?

**thiazides ACEi CCB ARB

23

First drug of choice for treatment of HTN in African American?

*thiazide diuretics CCB

24

First drug of choice in treatment of HTN w/CKD/DM?

**ACEi (regardless of race or other medical conditions)

25

Lab abnormalities a/w thiazide diuretics?

-hypokalemia

-hypomagnesemia

-hyponatremia

-hyperglycemia

-hypercalcemia

26

What allergy should you ascertain about if you are starting your patient on a thiazide diuretic?

sulfas

27

SE a/w ACEi's/ARBs

*cough

*angioedema (more so with ACEI's)

*hyperkalemia

rash renal impairment

taste disturbances

28

SE of CCB's

HA,

flushing,

bradycardia

29

SE of BBs

dizziness

bradycardia

fatigue

insomnia

nausea

heart block

30

Prazosin (minipress), terazosin (Hytrin), & Doxazosin (cardura) are of what medication class?

alpha 1 antagonists

31

SE of alpha 1 antagonists

orthostatic hypotension

dry mouth

dizziness

HA

32

Clonidine (catapres) &; Methyldopa (aldomet) are of what medication class?

alpha 2 agonists

33

SE of alpha 1 agonists

dry mouth

sedation

depression

HA

bradycardia

34

Minoxidil (Loniten) is of what medication class?

vasodilator

35

HTN urgency definition

BP >180/110 WO/end organ dysfunction

36

Management of HTN urgency

PO anti-hypertensives

37

HTN emergency definition

BP >180/120 &amp; impending/progressive end organ damage

38

papilledema

swelling of the optic disc w/blurred margins

39

BP goal when treating HTN emergency

IV agents (Cardene, Nipride) to decrease BP to SBP 160-180 OR DBP <105 **no more than 25% within minutes to 1-2hr, then gradually lowered over several days

40

Levines sign

"clenched fist sign"

41

normal total cholesterol

<200

42

normal VLDL (triglycerides)

<150

43

normal LDL

optimal <100

44

normal HDL

low <40mg/dl high >/= 60mg/dl

45

LDL, HDL, & TG goal for patients w/DM or CAD

LDL: <70 HDL: >40 TG: <150

46

what is the definitive diagnostic procedure for angina?

cardiac angiography

47

high intensity statins should lower LDL by how much?

>/= 50%

48

Name and dose of high intensity statins

Atorvastatin (Lipitor) 40-80mg Rosuvastatin (Crestor) 20-40mg

49

When do cardiac enzymes rise after MI?

4-6hrs, remain high for several days

50

NL INR:

0.8-1.2sec

51

NL ACT time

70-120sec

52

NL ACT time post PTCA/stent

>300

53

NL aPTT

28-38sec

54

NL PT

11-16sec

55

NL PTT

60-90sec

56

Indications for tPA revascularization with MI:

unrelieved CP (>30min & <6hr) + ST elevation >0.1mV in 2 or more contiguous leads

57

Contraindications for tPA

-prior ICH

-ischemic CVA wi/ 3 mon

-intracranial or intraspinal sx wi/3 mon

-significant closed head trauma or facial trauma wi/3mon

-severe uncontrolled HTN >185/110

-suspected aortic dissection

-active bleeding, or risk thereof, including ABN coags

-structural cerebral vascular lesion or malignant intracranial neoplasm

58

Treatment for DVT

lovenox 1mg/kg q12hr OR Heparin x 7-10d *Coumadin therapy x 12 wk

59

Most common cause of PVD

atherosclerosis

60

Peak incidence of PVD

40-70yr

61

S&S of PVD

1st: c/o calf pain (claudication)

-cold/numbness to extremities

-progresses to pain at rest

62

Physical findings of PVD

shiny/hairless skin

-dependent rubor (redness in dependent position)

-*reduced pulses

-pallor

-cyanosis

-ulcerations

63

Diagnostic tests to diagnose PVD

Dopppler US

**ABI

-anteriography 

64

most definitive test to diagnose PVD

anteriography

65

Management of PVD

**stop smoking

-walk 1 hr/d--> stop when painful, resume when pain subsides--> develops collateral circulation

66

Pentoxifylline (Trental) and Cilostazol (Pletal) are medications used to treat what disease?

PVD

67

Chronic venous insufficiency (CVI) is more common in which gender?

women

68

S&S of CVI

-aching LE improved w/elevation

-edema after prolonged swelling

-night cramps of LE

69

Physical findings of CVI

-trophic changes w/discoloration

-*stasis leg ulcers

-edema of LE

-dermatitis may be common

-cool to touch

70

Management of CVI

**elevate legs to diminish edema

-*pneumatic compression stockings for acute weeping dermatitis:

-wet compresses -0.5% hydrocortisone cream after compress -systemic abx only if bacterial infection

71

most common cause of pericarditis

viruses

72

Characteristics of pericarditis

localized retrosternal, pleuritic CP pain increased by deep inspiration, coughing, *recumbent

73

S&S of endocarditis

fever & malaise

night sweats

weight loss

general "sick" feeling

74

Key physical findings with endocarditis (8)

1.*murmur (may be absent in up to 30%)

2. fever

3. osler nodes

4. petechiae, purpura, pallor

5. splinter hemorrhages

6. janeway lesions

7. roth spots

8. splenomegaly

75

painful, red nodules in the distal phalanges

osler nodes

76

small & NOT painful macules on the palms and soles

janeway lesions *rarely observed

77

Diagnosis of Pericarditis

ST elevation in all leads *depression of PR segment highly indicative of pericarditis

**inc ESR

78

Management of Pericarditis

**NSAIDS -Ibuprofen 400-600mg q6-8hr

-Indomethacin 25-50mg q8hr x 2 wk

-corticosteroids -*only when complete failure of NSAIDs

-Codeine 15-60mg PO QID for pain

**monitor for tamponade

79

Diagnostic workup of Endocarditis

**bandemia

-ECHO to assess valves

-BCx x3 (3 separate sites in 1 hr)

80

Management of Endocarditis

PCN G 2million units IV q4hr + Gent OR Naficillin 2g IV q4hr

*Vanco used for PCN-resistant strep or MRSA

81

treatment for venous stasis ulcer/ stasis dermatitis

compression stockings

leg elevation