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aanp exam > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Where is the right ventricle best heard?

A

Sternum

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2
Q

Where is the left ventricle heard?

A

5th ICS Midclavicuar line- at PMI

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3
Q

Atrioventricular valves?

A

Mitral & tricuspid

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4
Q

The mitral valve separates what chambers?

A

Left atria and ventricles

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5
Q

The tricuspid valve separates what chambers

A

Right atria and ventricles

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6
Q

Semi lunar valves?

A

Aortic and pulmonic- separate ventricles from major vessels

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7
Q

S1 involves closing of what valves? What part of cardiac cycle?

A

Mitral and tricuspid- systole

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8
Q

S2 involves closing of what valves- and what part of cardiac cycle?

A

Closing of pulmonic and aortic/ semilunar valves- diastole

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9
Q

What heart sound makes “Kentucky”?

A

S3. Ventricular gallop

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10
Q

What HS makes “Tennessee”?

A

S4

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11
Q

What extra HS suggests——— Heart Failure? &. LVH?

A

HF= S3
LVH= S4

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12
Q

What grade murmur do you begin to feel a thrill?

A

Grade 4 or higher

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13
Q

Name this murmur-loudest at the 2nd ICS R sterna border, systolic, radiating to the neck

A

Aortic stenosis

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14
Q

Name this murmur- loudest at 5th ICS Mid clavic, systolic, radiating to axilla

A

Mitral regurgitation

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15
Q

Diastolic murmurs?

A

ARMS- Aortic Regurgitate & Mitral Stenosis

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16
Q

Systolic Murmurs (3)

A

MR Peyton Manning AS MVP:
Mitral Regurgitation Physiologic Murmur
Aortic Stenosis
Mitral Valve Prolapse

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17
Q

1 side effect of amlodepine?

A

Lower extremity edema- dose related

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18
Q

Name 2 non DHP Calcium Channel Blockers

A

Verapamil & Diltiazem

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19
Q

Name 2 DHP CCB’s?

A

Amlodipine & Nifedipine

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20
Q

Who do you not want to give CCB’s too?

A

Heart failure

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21
Q

Why do we not give NSAIDs to folks with renal disease

A

Inhibits Rena prostaglandin production which normally promote renal artery dilation = decreased renal perfusion
NSAID’s cause Na retention = fluid overload

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22
Q

Which of the following drug classes Increase Serum K+ vs Decrease Serum K+?
ACE/ARB Vs. HCTZ

A

Increase K+ = ARBs
Decrease K+ = HCTZ

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23
Q

What are 2 causes of elevated triglycerides?

A

Alcohol & elevated BG

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24
Q

Increased Trigs + low HDL = ?

A

Insulin insensitivity

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25
Q

What time do you advise people to take their CCB? Statins? HCTZ? ACE/ARBs?

A

CCB+ Statins = at hs
HCTS + ARBs/ACE = am

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26
Q

Key ECG features of SVT

A

Peaked, narrow QRS (<120 ms) & P waves

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27
Q

Causes of paroxysmal SVT? 2 disease, 4 ingestants

A

Wolf Parkinson’s white
Digitalis toxicity
Alcohol
Caffeine
Hyperthyroid
Drugs ie. cocaine

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28
Q

Pulses paradoxes - features & how to measure

A

-Apical pulse can be heard but radial pulses not palpable
- systolic pressure drop >10 mmHg with inspiration

  • check BP- listen for when heart sounds first heard and then disappear during inspiration- note measurement
  • then note when heart sounds no longer pause during inspiration- note measurement
  • if difference between measurements > 10 mmHg
  • Causes- impaired diastolic filling ie. pericardial effusion/ tamponade
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29
Q

Goal INR when antigoagulating

A

2-3

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30
Q

What minimum CHA2DS2- VASC score indicates need for anticoagulant?

A

2

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31
Q

Lettuce, Brussels sprouts, kale, spinach, collards, mustard greens - these foods are all high in what?

A

Vitamin K
Be cautious with Warfarin

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32
Q

Pt on warfarin has an INR between 4.01-4.99- what do you advise for dosing?

A

Hold one dose

33
Q

How long does it take for Warfarin to change INR?

A

May take 3 days

34
Q

Stage 1 hypertension values

A

Systolic 140-159
Diastolic 90-99

35
Q

Stage 2 hypertension

A

Syst- >160
Diast - >100

36
Q

Pre- HTN parameters

A

Syst- 120-139
Diast- 80-89

37
Q

Examples of micro vascular damage 2nd to HTN (eyes and kidneys)

A

Arteriovenous junction nicking on fundoscopic exam
Microalbuminurua & proteinuria

38
Q

Examples of macro vascular damage 2nd to HTN

A

CAD/ PVD
TIA’s

39
Q

What is the cause of these Fundoscopic exam findings- Copper and silver wire arterioles + arteriovenous nicking

A

Hypertensive retinopathy

40
Q

What causes the following fundoscopic exam findings- Neovascularizarion + cotton wall spots + microaneurism

A

Diabetic retinopathy

41
Q

Adverse affects of thiazides

A

3 hyper + 3 hypo
Hyper- uric acid, calcium, glucose, triglycerides
Hypo- potassium, sodium, magnesium

42
Q

ACE inhib adverse effects

A

Dry cough
Angioedema
Postural hypotension- resolves with time
Hyperkalemia ** caution when combo with spiro

43
Q

Who not to give an ACE

A

Blacks + ppl with renal artery stenosis

44
Q

What hypertensive patients can be initially treated with mono therapy?

A

Less than 20mmhg/10mmhg above target bp

45
Q

Systolic heart failure

A

Reduced EF/ HFrEF <40%

46
Q

Diastolic heart failure

A

Preserved EF- >40%

47
Q

Humans sign

A

Pain in lower leg with Dorsiflexion- low sensitivity for DVT

48
Q

NYHA class 2 symptomolgy

A

Ordinary physical activity results in fatigue, exertions dyspnea

49
Q

Risk factors for DVT

A

Stasis >3h
Coagulation disorders
Increased coagulation ie- birth control, pregnancy, fractures, trauma, surgery, malignancy

50
Q

1st line med for patients with stable HF

A

ACE/ ARB

51
Q

Preferred medication for isolated systolic hypertension in elderly

A

Low dose thiazides like or CCB

52
Q

ACE and ARB are used in what 3 conditions

A

Diabetes, CKD, Heart Failure

53
Q

Raynauds colours and treatment

A

Red, blue, white
CCB- nifedipine/ amlodipine

54
Q

Oslers nodes + Jane way lesions +subungual hemorrhages

A

Infective endocarditis

55
Q

ARB side effects

A

Hyperkalemia

56
Q

Calcium channel blockers adverse effects

A

Peripheral edema, bradycardia, hyperprolactinemia, dizziness/lightheaded- usually resolves

57
Q

Beta Blocker adverse effects

A

Bronchospasm, bradycardia, fatigue, sexual dysfunction

58
Q

Effects of blocking Beta 2 receptors x 8

A
  1. & 2. Mild vasoconstriction of skeletal muscle and brain vessels
  2. Bronchoconstrictions
  3. Decreased production of aqueous humour- decreased intraoccular pressure
  4. Increased GI motility
  5. Decreased glucose release in liver
  6. Decreased glucagon release in pancreas
  7. Increased serum triglycerides
59
Q

Affects of blocking beta 1 receptors

A

Decreased HR & contractile strength of heart
Decreased renin production in kidneys

60
Q

Lipid screening guidelines

A
  1. Fasting lipid profile starting at 20yrs every 5 yrs
  2. > 40yrs, screen q 2-3yrs
  3. Pre-existing hyperlipidemia- screen annually or more
61
Q

Triglycerides >1000 is high risk of what?

A

Acute pancreatitis

62
Q

If Trigs > 500 what treatment is recommended?

A

Give a fibrate or niacin or high-dose fish oil (lovaza)
Once’s trigs are under control- switch to target LDL

63
Q

Causes of elevated triglycerides

A

Metabolic syndrome/ diabetes
Familial hypertriglyceridemia
Alcohol abuse
Hyperthyroidism
Kidney disease
Medications ie. anabolic steroids, acutane

64
Q

Encourage use of ———- fibre in hyperlipidemia to help lower LDL’s

A

Soluble fibre- ie. fruits and veggies

65
Q

True or false- low HDL alone, with normal LDL is a risk factors for heart disease

A

TRUE- low = <40mg/dL

66
Q

If taking statins- avoid what 5 things?

A
  1. Grapefruit juice
  2. Fibrates
  3. Antifungals
  4. Macrolides
  5. Amiodarone
67
Q

Combination regiments of fibrates, statins, niacin and/or ezetimibe are ——

A

Not recommended and increase risk of rhabdomyolysis

68
Q

Who to avoid fibrates in?

A

Renal disease

69
Q

Side effects of niacin?

A

Flushing, itching, tingling, hepatotoxicity
Take small doses until tolerated

70
Q

Cholestyramine is an example of what med?
Who is it used for?

A

Bile acid sequesterant
Work in small intestine to interfere with fat absorption
Used in ppl who do not tolerate statins, niacin, fibrates

71
Q

Triad of rhabdomyolysis?

A
  1. Muscle pain
  2. Weakness
  3. Dark urine - myoglobinuria
72
Q

1st line tx for hyperlipidemia? And exception?

A

Lifestyle mod - unless has ASCVD or equivalent ie. CAD, HTN

73
Q

High intensity statin medications and dosing

A

Atorvastatin 40-80mg
Rosuvastatin 20-40mg

74
Q

Who gets high intensity statin? X 3

A

21-75 + ASCVD
Adult with LDL > 190mg/dL
10 yr ASCVD > 7.5%

75
Q

Metabolic syndrome diagnostic criteria

A
  1. Abdo obesity - W- >35inches M- >40 inches
  2. Hypertension
  3. Hyperlipdemia- elevated fasting plasma glucose (>100) / elevated trigs/ decreased HDL
76
Q

Overweight BMI?

A

> 27 - lifestyle modifications

77
Q

Abdominal aortic aneurysm screening?

A

Men
65-75 yrs
Any smoking hx
1 x abdominal duplex ultrasound

78
Q

Hx of aortic aneurism- what antibiotics would be avoided?

A

Fluroqinalones- “floxacin”
Also with hx tendon rupture

aanp exam (11 decks)

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