Mod 6 Buttaro Ch 98-108 Flashcards
An asymptomatic 63-year-old adult has a low-density lipoprotein level of 135 mg/dL. Which test is beneficial to assess this patient’s coronary artery disease risk?
a. Coronary artery calcium score (CACS)
b. hsCRP (high-sensitivity CRP)
c. Exercise echocardiography
d. Myocardial perfusion imaging
b. hsCRP (high-sensitivity CRP)
CAD: occurs when coronary arteries are narrowed by atherosclerotic plaques formation, rupture or spasm that impedes coronary BF characterized by chest pain and ECG changes
The hsCRP is useful in asymptomatic men >50 years and women >60 years who have LDL <160 mg/dL to predict CAD risk.
Exercise echocardiography and myocardial perfusion imaging are not performed initially.
Which risk assessment for coronary artery disease is recommended for all female patients?
a. Coronary artery calcium score
b. Electrocardiogram
c. Exercise stress test
d. Framingham risk score
d. Framingham risk score
The Framingham risk score is a quick method for identifying potential risk for CAD and can guide providers in choosing subsequent tests based on risk level.
asymtomatic women not recommended
The ECG is performed on women with risk factors (DM, HTN)
Asymptomatic women not recommended for stress test unless symptomatic women who have a normal ECG.
in general, Stress test is first line initial testing for CAD anyone with a baseline ECG abnormality a stress test will not work, also anyone on beta blockers-they must be stopped 1-2 days before test c/s with cardio first
positive test is development of horizontal or downward slopping of ST segments or hypotension
A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action?
a. Immediate referral to a thoracic surgeon
b. Ordering computerized tomography (CT) angiography
c. Scheduling a magnetic resonance imaging (MRI) to evaluate for aortic disease
d. Ultrasound of the mass to determine size (US)
d. Ultrasound of the mass to determine size (US)
AAA- slowly progressive, permanent, localized dilation of aorta >3.0 cm.
- typically asymptomatic
- close to 5.0-5.5cm at risk for rupture and then 80-90% chance of death
- normal size ~2.0 **less than 3.0
symptoms: asymptomatic, can see a pulsating mass on abdomen when supine and knees flexed. - OTHER symptoms: dyspnea, anorexia, flank, back and abdomen pain
- TRIAD: hypotension, abd pain or back pain, pulsitile mass
Size determines management
This patient has symptoms consistent with an aortic aneurysm. The initial step is to determine the size of the aneurysm; this can be done by US. crucial part
Immediate referral is not necessary.
MRI and CT diagnostic tests are ordered before surgery to evaluate the characteristics of the aneurysm.
A 70-year-old patient presents with an aortic aneurysm measuring 5.0 cm. The patient has poorly controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient?
a. Endovascular stent grafting of the aneurysm
b. Immediate open surgical repair of the aneurysm
c. No intervention is necessary for this patient
d. Serial ultrasonographic surveillance (US) of the aneurysm
d. Serial ultrasonographic surveillance (US) of the aneurysm
AAA- slowly progressive, permanent, localized dilation of aorta >3.0 cm.
- typically asymptomatic
- close to 5.0-5.5cm at risk for rupture and then 80-90% chance of death
- normal size ~2.0 **less than 3.0
symptoms: asymptomatic, can see a pulsating mass on abdomen when supine and knees flexed. - OTHER symptoms: dyspnea, anorexia, flank, back and abdomen pain
- TRIAD: hypotension, abd pain or back pain, pulsitile mass
SIZE determines management.
This patient’s aneurysm is less than 5.5 cm and repair is not necessary at this time. Serial US surveillance is necessary to continue to evaluate size.
Repair is risky in patients with hypertension and heart failure, so avoiding procedures if possible is recommended.
A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms?
a. Anemia
b. Atrial fibrillation
c. Extrasystole
d. Paroxysmal attacks
b. Atrial fibrillation
common disorders that cause tachyarrtythmias: Afib, anemia, fever, infection, dehydration, hypoglycemia, hyperthyroid, hPT ** must determine if there is underlying cause
AF= most common
-associated with HF and shock consider if new onset
-AF causes palpitations that are irregular and tend to be sustained.
-may not be treated if asymptomatic but will be on anticoagulants (warfarin) d/t high risk for stroke and clots
-hr may be controlled with Beta blockers or CCB, digoxin saved for those with HF and low EF
3. rhythm controlled with cardioversion only done if symptomatic
Anemia will cause rapid palpitations that are regular. (may check CBC
Extrasystole causes palpitations or an awareness of isolated extra beats with a pause.
Paroxysmal attacks start and terminate abruptly and are usually rapid and regular.
An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minutes. What action will the provider take next?
a. Evaluation of the patient’s orthostatic vital signs
b. Monitoring the patient’s heart rate while the patient is bearing down
c. Prescribing an electrocardiogram (ECG) and exercise stress test (ETT)
d. Reassuring the patient that the symptoms are non-cardiac in origin
a. Evaluation of the patient’s orthostatic vital signs
syncompe is when hr increase when standing and blood pressure drops: could also be signs of dehydration
Orthostatic vital signs are helpful to exclude orthostatic hypotension as a cause of syncope and are easily performed in the clinic.
Assessment for vagal bradycardia may be performed next.
ECG and ETT are not recommended as an initial evaluation in a healthy patient, unless other causes are not determined. Without assessment of the cause of the syncope, cardiac causes cannot be excluded.
A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the emergency department. What initial intervention may be attempted in the clinic?
a. Intravenous adenosine
b. Administration of a beta blocker
c. A loading dose of digoxin
d. A carotid massage
d. A carotid massage
his child has paroxysmal supraventricular tachycardia (PSVT). regular hr b/t 140-240
Vagal maneuvers or carotid massage may be attempted to slow the ventricular rate =** 1st line emergent treatment**
followed by IV verpamil or diltazem.
- cardioversion (adenosine) ***do not use adensosine in asthmatics patients cause at risk for AF
Adenosine is contraindicated in patients with asthma. Medications such as beta blockers and digoxin are not used in emergency treatment of PSVT.
During a routine health maintenance examination, the provider auscultates a cervical/carotid bruit. The patient denies syncope, weakness, or headache. What will the provider do, based on this finding?
a. Order a carotid duplex ultrasound (US).
b. Order catheter-based angiography.
c. Refer the patient to a neurosurgeon.
d. Schedule a computed tomography angiography (CTA).
a. Order a carotid duplex ultrasound (US).
Carotid duplex ultrasound is the primary diagnostic tool for carotid stenosis. = **1st line treatment with suspected carotid stenosis
A cervical bruit = symptoms of turbulent blood flow that may be obstructing blood flow to brain. most likely caused by atherosclerotic plaque.
In an asymptomatic patient is an indication for this test.
CTA = 2nd line only used instead of duplex US if the test is not available, if US results are inconclusive, or further evaluation is needed based on US results.
According to current research, which are associated with a decreased incidence of stroke?
(Select all that apply.)
a. Statin therapy for low density lipoproteins (LDL) of <75 mg
b. B-complex vitamin supplements
c. Glycemic control for patients with diabetes
d. Low-sugar soda
e. Maintain a body mass index (BMI) of <30 kg/m2
a. Statin therapy for low density lipoproteins (LDL) of <75 mg
c. Glycemic control for patients with diabetes
e. Maintain a body mass index (BMI) of <30 kg/m2
Statin therapy for low density lipoproteins (LDL) of <75 mg, glycemic control for patients with diabetes, and maintaining a body mass index (BMI) of <30 kg/m2 has shown to lower the risk of stroke. B-complex vitamins and low-sugar soda have not shown to decreased risk.
A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action?
a. Administer a second nitroglycerin tablet.
b. Give the patient a beta blocker medication.
c. Prescribe a calcium channel blocker mediation.
d. Start aspirin therapy and refer the patient to a cardiologist.
b. Give the patient a beta blocker medication.
Patient with these symptoms who do not respond to nitroglycerin is likely to have microvascular angina. Treatment is effective with beta blockers.
These symptoms are not characteristic of acute MI, so aspirin is not given.
A second nitroglycerin tablet is used for classic angina. Calcium channel blockers are not indicated.
A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient?
a. Administer heparin.
b. Give the patient an oral beta blocker.
c. Initiate fibrinolytic treatment.
d. Transfer to the PCI-capable institution.
c. Initiate fibrinolytic treatment.
Fibrinolytic therapy should be administered to any patient with evolving STEMI within 30 minutes of the time of first medical contact.
Patients more than 120 minutes away from a PCI-capable hospital should be given fibrinolytic therapy since PCI should be performed within 90 minutes if possible. Giving heparin or beta blockers is not helpful.
Which patient meets the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease? (Select all that apply.)
a. A 55-year old with a history of congestive health failure (CHF)
b. A 70-year old nondiabetic with a 10-year risk score of 7.5% with an LDL-C of 80
mg/dL
c. An otherwise healthy 25-year old with a low-density lipoprotein (LDL-C) level of
196 mg/dL
d. A 45-year old diabetic with an LDL-C of 150 mg/dL
e. A 60-year old with a history of myocardial infarction
b. A 70-year old nondiabetic with a 10-year risk score of 7.5% with an LDL-C of 80
c. An otherwise healthy 25-year old with a low-density lipoprotein (LDL-C) level of
196 mg/dL
d. A 45-year old diabetic with an LDL-C of 150 mg/dL
e. A 60-year old with a history of myocardial infarction
Adults with a history of known cardiovascular disease, including stroke, caused by atherosclerosis; those with LDL-C level of greater than 190 mg/dL; adults 40 to 75 years, with diabetes; adults 40 to 75 years, with LDL-C level of 70 to 189 mg/dL and a 5% to 19.9% 10-year risk of developing cardiovascular disease from atherosclerosis, with risk enhancing factors; adults 40 to 75 years, with LDL-C level of 70 to 189 mg/dL and a 20% or greater 10-year risk of developing cardiovascular disease from atherosclerosis.
A patient experiencing heart failure with reduced ejection fraction will have which symptoms?
a. Dyspnea and fatigue without volume overload
b. Impairment of ventricular filling and relaxation
c. Mild, exertionally related dyspnea
d. Pump failure from left ventricular systolic dysfunction
d. Pump failure from left ventricular systolic dysfunction
Heart failure with reduced ejection fraction results in pump failure from ventricular systolic dysfunction. Heart failure with preserved ejection fraction may have milder symptoms and is associated with impairment of ventricular filling and relaxation.
A patient who has been diagnosed with heart failure for over a year reports being comfortable while at rest but experiences palpitations and dyspnea when walking to the bathroom. Which classification of heart failure is appropriate based on these symptoms?
a. Class I
b. Class II
c. Class III
d. Class IV
b. Class II
Patients with Class II heart failure (HF) will have slight limitation of activity and will be comfortable at rest with symptoms occurring with ordinary physical activity.
Patients with Class I HF do not have limitations and ordinary physical activity.
Patients with Class I HF do not have limitations and ordinary physical activity does not produce symptoms.
With Class III HF, less than usual activity will produce symptoms.
With Class IV HF, symptoms are present even at rest and all physical activity worsens symptoms
A patient who has Class II heart failure is taking an ACE inhibitor and reports a recurrent cough that does not interfere with sleep or activity. What will the provider do initially to manage this patient?
a. Assess serum potassium and sodium immediately
b. Discontinue the ACE inhibitor and prescribe an ARB
c. Provide reassurance that this is a benign side effect
d. Withhold the drug and evaluate renal and pulmonary function
c. Provide reassurance that this is a benign side effect
Cough occurs in about 20% of patients who take ACE inhibitors and is not dangerous. The patient should be reassured that this is the case. If the cough is annoying, alternate therapy with an ARB may be considered. It is not necessary to evaluate electrolytes, renal function, or pulmonary function.
