AANP EXAM NOTES 5 Flashcards
Increased risk for insulin resistance, Type 2 diabetes mellitus, renal dz.. hepatic dz., hyperlipidemia, HTN, CV dz are risk factors for PTs who are obese. T/F
TRUE
WHAT IS THE MEANING OF LUB, DUB, KENTUCKY, TENNESSEE
S1, S2, S3, S4
S1 = Systole, LUB. What valves are included in the S1?
(S1 heart sounds: mitral, tricuspid, & atrioventricular valves)
S2 = diastole DUB. Where is this sound best heard?
2nd ICS on left side
If the S2 sound is heard during inspiration, is it normal/abnormal?
normal
S3 = Cardiac apex. Where on the body is the S3 sound best heard?
5th ICS on left MCL.
If the S2 sound is heard during expiration, is it normal/abnormal?
abnormal
What valves are associated with the S2 sound?
(aortic, pulmonic, semilunar valves)
An abnormal S3 sound may be a sign of CHF in PTs older than what age?
40
Hearing the S3 sound is normal in children, athletes, and during pregnancy. T/F?
TRUE. The left lateral recumbent position brings the apex closer to the wall & improves the ability to hear the left ventricular S3.
The S4 sound is best heard where on the body?
5th ICS on left side,
An S3 that sounds like “Kentucky,” is associated with CHF in children, pregnancy, and some athletes. T/F
TRUE
The S4 sound is best heard at apex (bell). It indicates LVH (think oldest). T/F
TRUE
The S4 sound occurs early/late in diastole.
LATE
If the S4 sounds like “Tennessee” it indicates what atrial condition?
atrial gallop/atrial kick
The Bell of stethoscope is used for high/low tones ?
LOW Tones, (mitral stenosis),
The Diaphragm of the stethoscope is best used for Mid to high pitched sounds. T/F
TRUE. ? (MR, AS)
A Physiological S2 Split is normal if heard on expiration. T/F
FALSE. A Physiological S2 Split is normal if heard on INSPIRATION.
WHERE IS A PHYSIOLOGICAL S2 SPLIT BEST HEARD ON THE BODY?
2ND ICS UPPER LEFT SIDE OF STERNUM
What is the most common cause of death for people with DM?
HEART DZ
Heart disease & DM are common in what ethnic groups?
Mexican & African Americans, East Asians
What type of murmur radiates?
Systolic murmurs
Name 2 condx that may be indicated by Diastolic murmors
Aortic regurgitation, Mitral stenosis
If a murmur is found in a child, what is your next step?
Refer to cardiology
What type of holosystolic atrial murmur radiates to the axilla?
MR
A PT with Afib requires what type of TX?
Anticoagulation
Where is Aortic Regurgitation heard the loudest?
2nd ICS to right of sternum
What condx is characterized by a long asymptomatic period followed by exercise intolerance.
Aortic Regurgitation
What is a common early finding in a PT with AR?
Hypertrophied left ventricle
What murmur presents as a high pitched, diastolic that radiates toward the cardiac apex?
AR
Where is Mitral Stenosis murmur best heard?
Loudest Near cardiac apex
What GRADE is a murmur that is easily audible, associated with a thrill?
IV/VI
HTN is defined as BP above what levels?
130/80
A correlation between BP and age > 60 years exists. As age increases DBP decreases
TRUE
Naproxen has a FAVORABLE effect on HTN (Na + & K+). T/F
FALSE. Naproxen may have an UNFAVORABLE effect on HTN (Na + & K+).
Pt on Thiazide should have what levels monitored?
K+ Levels
Pt on Thiazide may experience what symptoms due to hypokalemia?
weakness, fatigue, muscle cramps, ED
A PT treated with candesartan (ARB) should avoid what supplement?
Potassium
What is one side effect of Lisinopril?
dry cough
Lisinopril is what type of enzyme inhibitor?
ACE
A 35 YO Caucasian male using lisinopril may have an increase in what?
K+ (Potassium)
What is The most common indicator of end organ damage in adolescents with hypertension
left ventricular hypertrophy
A low sodium diet is considered to be intake of less than how much sodium/day?
Less than 1.5g/day
What type of diet is considered low sodium?
Mediterranean
What is a diet you can recommend to PTs who need a low-sodium diet?
Dash
Name 2 labs that can be ordered to check kidney function
Creatinine, eGFR, UA
Name 2 labs that can check endocrine levels
TSH, Fasting blood glucose
What lab checks for K+. NA+, CA+ etc/
Electrolyte panel
Name 3 labs that can be ordered to check heart function
Chol, HDL, LDL, Trig (complete lipid panel)
What lab can be ordered to check for anemia?
cbc
What is considered an elevated BP?
120-129 / 80
What is considered Stage 1 HTN
130-139 / 80-89
What is considered Stage 2 HTN
> = 140 / >= 90
TX for PT with Stage 1 HTN?
Start lifestyle changes and reassess
PT with Stage 2 HTN should be making lifestyle changes and prescribed with medication. How often should the patient be reassessed?
Reassess in 1 month. If goal met, reassess in 3
to 6 months.
If a PT with Stage 2 HTN is making lifestyle changes and prescribed medication but not meeting goals, what should be done?
If goal not met, consider different medication/ titration and recheck monthly.
What tx should be given to children with secondary HTN?
Pharmacologic treatement
R/t renal (Kidney failure), endocrine (hepatomegaly), respiratory disorders (bibasilar crackles), and damage to the retina (AV nicking) can be caused by …
Secondary HTN
Isolated Systolic HTN is caused by loss of recoil in the arteries (atherosclerosis), which increases PVR. T/F
TRUE
What is the TX for isolated systolic HTN?
Treatment: Low dose thiazide diuretic or a calcium channel blocker
Name a common CCB used to treat Isolated systolic HTN
AMLODIPINE
Amlodipine may cause urinary incontinence. Why?
CCBs weaken muscle contraction
Amlodipine requires K+ monitoring. T/F
FALSE. Amlodipine DOES NOT require K+ monitoring.
PT with Pain that improves when dangling foot (elevation makes it worse) may have what dz?
Peripheral artery dz
What ABI value is specific to PAD
< 0.9
HOw is ankle brachial index (ABI) measured?
Divide highest SBP by Highest SBP in ankle
Name 2 signs of Peripheral Vascular dz
Dull/ achy pain, Edema, yellow slough/ ruddy skin
Name 2 symptoms of Chronic Venous Insufficiency
swelling/ heaviness, pain, itchiness, varicose veins, reddish/brown looking skin, scattered telangiectasias, & ulcers.
MVP is usually benign. T/F
TRUE
MVP often presents by a late systolic murmur and what type of click?
Mid systolic click
Best test for MVP?
Echocardiography
S/S of Abdominal aortic aneurysm includes:
Acute/ sudden onset of tearing, severe low back pain/ abd. Pain. May have pustule abd. T/F
TRUE
What is the most cost effective screen for Abdominal aortic aneurysm?
Abd ultrasound
Complication of aortic dissection includes left/right pleural effusion:
LEFT (NOT RIGHT)
When treating Hyperlipidemia Statins are most beneficial when taken in conjunction with what?
Diet & Exercise
Alcoholic drinks should be avoided in PTs with Hyperlipidemia. T/F
TRUE
How long do PTs need to fast for Hyperlipidemia lab?
12-14 hours
Triglycerides require PT to fast how long?
x 12 hours
What is normal total cholesterol
< 200
What is the value of optimal LDL?
< 100 MG/DL
Name 2 agents that are best for lowering triglycerides
Niacin, Fibrates
Name 1 fibrate used to lower triglycerides
Fenofibrate (Tricor). ALSO: gemfibrozil (Lopid), &
benzafibrate (Bezalip).
What 2 meds are strong statins that can reduce triglycerides by 33 to 50%
Atorvastatin (Lipitor) & rosuvastatin (Crestor)
Auscultation of ….. is indicated to assess for generalized atherosclerosis.
carotid bruits
A PT with c/o pain in lower legs with ambulation (resolution with rest), reports pain in calf muscle (intermittent claudication). This may be caused by what condx?
atherosclerosis
Lipid measurements should be repeated how often after initiating statin/dose adjustment?
4 to 12 weeks after initiating statin/dose adjustment.
What dz is a connective tissue dz that leads to autoimmune driven vascular dz & diffuse fibrosis affecting the skin of the hands & face, joints, GI tract, & lungs.
Systemic sclerosis
What is the TX for systemic sclerosis
Tx: Sildenafil, endothelin antagonists & prostacyclin agonists.
PT reports acute onset (3 days) of unilateral swelling, pain, & discoloration (Red) in lower extremity from impaired blood flow, pain NOT
relieved by walking. What is your diagnosis?
DVT
Why is DVT an increased risk in pregnancy?
Inferior vena caba & pelvic vein compression by enlarging uterus
Holman’s Sign (lower leg pain with dorsiflexion) indicates the PT has what condx?
DVT
What can a PT use to help relieve DVT?
compression stockings
What is a condition caused by blockage in the lymphatic system, part of the immune & circulatory system ?
Lymphedema
What can a PT use to help relieve lymphedema?
Compression stockings
Name 2 medications that can exacerbate heart failure
Metoprolol, Naproxen
What are Typical heart sounds associated with CHF
S1, S2, S3
The presence of S3 ventricular gallop acompanied by anasarca, dyspnea, dry cough, fatigue, SOB, wt. gain, audible bibasilar rales, is associated with what condx
CHF
Crackles, bibasilar rales lower lobes, cough, mild dyspnea, decreased breath sounds, dullness to percussion are s/s of what type of heart failure?
Left ventricular failure
Anorexia, nausea, RUQ pain, and lower extremity edema with cool skin HTN are s/s of what type of heart failure?
Right ventricular failure
What CHF class is described by a patient whose ordinary physical activity results in fatigue, exertional dyspnea?
CLASS II