Cardiac

Question 1

what produces loud, low pitched, S1 murmur, mid-diastolic, apical crescendo rumble

Answer 1

Mitral stenosis

Question 2

What produces systolic murmur at 5th ICS MCL, blowing or high pitched, may include S3

Answer 2

Mitral regurgitation

Question 3

What produces systolic murmur, harsh blowing 2nd R ICS, radiating to neck

Answer 3

aortic stenosis

Question 4

what produces diastolic blowing murmur at 2nd L ICS

Answer 4

aortic regurgitation

Question 5

what are the systolic murmurs?

Answer 5

mitral regurgitation and aortic stenosis

Question 6

what are the diastolic murmurs?

Answer 6

mitral stenosis, aortic regurgitation

Question 7

when does S3 occur?

Answer 7

after S2, increased fluid states- heart failure, pregnancy

Question 8

when does S4 occur ?

Answer 8

before S1, stiff ventricular wall- MI, L ventricular hypertrophy, chronic hypertension

Question 9

what are symptoms of Right sided heart failure?

Answer 9

JVD, PND, dependent edema, hepatomegaly, splenomegaly, displaced PMI, S3/4, fatigue, abdominal fullness

Question 10

describe NYHA Functional Classification of Heart Failure

Answer 10

I- no limitations
II- slight limitation, but comfortable at rest
III- marked limitations of physical activity, but comfortable at rest
IV- severe; inability to carry out any physical activity without discomfort

Question 11

when does AV nicking occur?

Answer 11

uncontrolled chronic hypertension

seen on retinal exam

Question 12

pharmacological hypertension management for Non-African American vs African American population

Answer 12

Non-AA- thiazide diuretic (HCTZ), ACEI (lisinopril), ARB (losartan), CCB (amlodipine)
AA- Thiazide diuretic (HCTZ), CCB (amlodipine)

Question 13

what HTN meds are indicated for diabetic and renal patients?

Answer 13

ACEI or ARB

Question 14

What conditions is hypertensive emergency cutoff reduced lower than 180/120

Answer 14

ICH, unstable angina, acute MI, acute HF, AAA dissection, eclampsia, malignant hypertension, hypertensive encephalopathy

Question 15

what is timeframe for BP reduction in hypertensive emergency

Answer 15

reduce by 25% within 1st hour, then if stable, to 160/100 within next 2-6 hours, then cautiously to normal during following 24-48 hours

Question 16

what is Levine’s sign

Answer 16

clenched fist sign- hand held over chest- indicates patient experiencing chest pain

Question 17

what are lipid goals

vs. lipid goals for DM or CAD patients

Answer 17

cholesterol < 200
VLDL < 150
LDL < 100
HDL 40-60

DM/ CAD/ HLD triad
LDL < 70
HDL> 40
triglyceride < 150

Question 18

what risk scores indicate statin therapy?

Answer 18

w/o ASCVD or DM with LDL 70-189, with estimated 10 year risk ASCVD >7.5%

Question 19

what level of statin therapy gives what level of LDL reduction?

Answer 19

high intensity - 50% or greater LDL reduction
moderate intesity- 30-50% LDL reduction
low intensity- 30% LDL reduction, or less

Question 20

what drug doses are for high, moderate and low intensity statin therapy?

Answer 20

High- atorvastatin 40-80, rosuvastatin 20-40
Med- atorvastatin 10-20, rosuvastatin 5-10, simvastatin 20-40
Low- simvastatin 10mg

Question 21

what are other lipid lowering agents? (4)

Answer 21

1. bile acid sequestrants- cholestyramine, colesevelam, colestipol
2. fibrates - gemfibrozil, fenofibrate
3. Cholesterol absorption inhibitor- Ezetimibe (Zetia)
4. Niacin- high doses may cause flushing sensation- be careful of immediate vs extended release preparations

Question 22

anterior MI leads

Answer 22

V 1-V4

Question 23

lateral MI leads

Answer 23

I, aVL, V5, V6

Question 24

inferior MI leads

Answer 24

II, III, aVF

Question 25

what are therapeutic levels for coagulation labs for MI anticoagulation treatment?

Answer 25

INR 2.5-3.5

APTT, PT, PTT- 1.5-2.5x normal time

Question 26

what are contraindications for pharmacological revascularization?

Answer 26

prior ICH or SAH, structural cerebral vascular lesion or malignant intracranial neoplasm
ischemic stroke within 3 months
suspected aortic dissection
active bleeding
significant closed head trauma or facial trauma within 3 months
intracranial or intraspinal surgery within 3 months
severe uncontrolled hypertension > 185/110
active bleeding or risk of active bleeding- abnormal coagulation values (INR > 1.7) normal INR 0.8-1.2

Question 27

what’s the difference between pathophysiology of peripheral vascular disease and chronic venous insufficiency? what’s the difference in presentation??

Answer 27

PVD- patho- narrowing of arteries resulting in decreased blood supply to extremities- calf pain, cold or numb extremities
CVI- impaired venous return due to destruction of valves, changes due to deep thrombophlebitis, leg trauma, sustained elevation of venous pressure. aching lower extremities relieved by elevation, edema with standing, night cramps

Question 28

endocarditis vs pericarditis

Answer 28

pericarditis- inflammation of heart wall- thorough history essential to make the diagnosis
endocarditis- infection of endothelial surface of heart- affects valves- consider in all patients with heart murmur and fever of unknown origin

Question 29

pericarditis causes

Answer 29

viral.
post- MI
renal failure, endocarditis, septicemia, drug induced

Question 30

endocarditis

Answer 30

commonly bacterial
recent dental surgery
IVDU

Question 31

pericarditis physical finding

Answer 31

friction rub- pain relieved by sitting forward

SOB, pain on deep inspiration and coughing

Question 32

pericarditis EKG changes

Answer 32

ST elevation in all leads

Question 33

what is empiric treatment for endocarditis ?

Answer 33

S. aureus most common, therefore vancomycin is the empiric treatment before cultures come back