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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
What time do you advise people to take their CCB? Statins? HCTZ? ACE/ARBs?
CCB+ Statins = at hs HCTS + ARBs/ACE = am
26
Key ECG features of SVT
Peaked, narrow QRS (<120 ms) & P waves
27
Causes of paroxysmal SVT? 2 disease, 4 ingestants
Wolf Parkinson’s white Digitalis toxicity Alcohol Caffeine Hyperthyroid Drugs ie. cocaine
28
Pulses paradoxes - features & how to measure
-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
29
Goal INR when antigoagulating
2-3
30
What minimum CHA2DS2- VASC score indicates need for anticoagulant?
2
31
Lettuce, Brussels sprouts, kale, spinach, collards, mustard greens - these foods are all high in what?
Vitamin K Be cautious with Warfarin
32
Pt on warfarin has an INR between 4.01-4.99- what do you advise for dosing?
Hold one dose
33
How long does it take for Warfarin to change INR?
May take 3 days
34
Stage 1 hypertension values
Systolic 140-159 Diastolic 90-99
35
Stage 2 hypertension
Syst- >160 Diast - >100
36
Pre- HTN parameters
Syst- 120-139 Diast- 80-89
37
Examples of micro vascular damage 2nd to HTN (eyes and kidneys)
Arteriovenous junction nicking on fundoscopic exam Microalbuminurua & proteinuria
38
Examples of macro vascular damage 2nd to HTN
CAD/ PVD TIA’s
39
What is the cause of these Fundoscopic exam findings- Copper and silver wire arterioles + arteriovenous nicking
Hypertensive retinopathy
40
What causes the following fundoscopic exam findings- Neovascularizarion + cotton wall spots + microaneurism
Diabetic retinopathy
41
Adverse affects of thiazides
3 hyper + 3 hypo Hyper- uric acid, calcium, glucose, triglycerides Hypo- potassium, sodium, magnesium
42
ACE inhib adverse effects
Dry cough Angioedema Postural hypotension- resolves with time Hyperkalemia ** caution when combo with spiro
43
Who not to give an ACE
Blacks + ppl with renal artery stenosis
44
What hypertensive patients can be initially treated with mono therapy?
Less than 20mmhg/10mmhg above target bp
45
Systolic heart failure
Reduced EF/ HFrEF <40%
46
Diastolic heart failure
Preserved EF- >40%
47
Humans sign
Pain in lower leg with Dorsiflexion- low sensitivity for DVT
48
NYHA class 2 symptomolgy
Ordinary physical activity results in fatigue, exertions dyspnea
49
Risk factors for DVT
Stasis >3h Coagulation disorders Increased coagulation ie- birth control, pregnancy, fractures, trauma, surgery, malignancy
50
1st line med for patients with stable HF
ACE/ ARB
51
Preferred medication for isolated systolic hypertension in elderly
Low dose thiazides like or CCB
52
ACE and ARB are used in what 3 conditions
Diabetes, CKD, Heart Failure
53
Raynauds colours and treatment
Red, blue, white CCB- nifedipine/ amlodipine
54
Oslers nodes + Jane way lesions +subungual hemorrhages
Infective endocarditis
55
ARB side effects
Hyperkalemia
56
Calcium channel blockers adverse effects
Peripheral edema, bradycardia, hyperprolactinemia, dizziness/lightheaded- usually resolves
57
Beta Blocker adverse effects
Bronchospasm, bradycardia, fatigue, sexual dysfunction
58
Effects of blocking Beta 2 receptors x 8
1. & 2. Mild vasoconstriction of skeletal muscle and brain vessels 3. Bronchoconstrictions 4. Decreased production of aqueous humour- decreased intraoccular pressure 5. Increased GI motility 6. Decreased glucose release in liver 7. Decreased glucagon release in pancreas 8. Increased serum triglycerides
59
Affects of blocking beta 1 receptors
Decreased HR & contractile strength of heart Decreased renin production in kidneys
60
Lipid screening guidelines
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
Triglycerides >1000 is high risk of what?
Acute pancreatitis
62
If Trigs > 500 what treatment is recommended?
Give a fibrate or niacin or high-dose fish oil (lovaza) Once’s trigs are under control- switch to target LDL
63
Causes of elevated triglycerides
Metabolic syndrome/ diabetes Familial hypertriglyceridemia Alcohol abuse Hyperthyroidism Kidney disease Medications ie. anabolic steroids, acutane
64
Encourage use of ———- fibre in hyperlipidemia to help lower LDL’s
Soluble fibre- ie. fruits and veggies
65
True or false- low HDL alone, with normal LDL is a risk factors for heart disease
TRUE- low = <40mg/dL
66
If taking statins- avoid what 5 things?
1. Grapefruit juice 2. Fibrates 3. Antifungals 4. Macrolides 5. Amiodarone
67
Combination regiments of fibrates, statins, niacin and/or ezetimibe are ——
Not recommended and increase risk of rhabdomyolysis
68
Who to avoid fibrates in?
Renal disease
69
Side effects of niacin?
Flushing, itching, tingling, hepatotoxicity Take small doses until tolerated
70
Cholestyramine is an example of what med? Who is it used for?
Bile acid sequesterant Work in small intestine to interfere with fat absorption Used in ppl who do not tolerate statins, niacin, fibrates
71
Triad of rhabdomyolysis?
1. Muscle pain 2. Weakness 3. Dark urine - myoglobinuria
72
1st line tx for hyperlipidemia? And exception?
Lifestyle mod - unless has ASCVD or equivalent ie. CAD, HTN
73
High intensity statin medications and dosing
Atorvastatin 40-80mg Rosuvastatin 20-40mg
74
Who gets high intensity statin? X 3
21-75 + ASCVD Adult with LDL > 190mg/dL 10 yr ASCVD > 7.5%
75
Metabolic syndrome diagnostic criteria
1. Abdo obesity - W- >35inches M- >40 inches 2. Hypertension 3. Hyperlipdemia- elevated fasting plasma glucose (>100) / elevated trigs/ decreased HDL
76
Overweight BMI?
>27 - lifestyle modifications
77
Abdominal aortic aneurysm screening?
Men 65-75 yrs Any smoking hx 1 x abdominal duplex ultrasound
78
Hx of aortic aneurism- what antibiotics would be avoided?
Fluroqinalones- “floxacin” Also with hx tendon rupture

AANP Exam (11 decks)

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