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CPD 2 > Cardio PE and Lab findings > Flashcards

Cardio PE and Lab findings Flashcards

1
Q

You hear high pitched decrescendo diastolic murmur that is loudest at 3rd/4th left IS. Even better with pt leaning forward with held expiration.

A

Aortic Regurgitation

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2
Q

You hear loud rough systolic crescendo-decrescendo murmur at the upper right sternal border. When pt leans forward and it radiates to the right clavicle and neck with a thrill.

A

Aortic Stenosis

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3
Q

You hear Late systolic murmur and midsystolic click

A

MVP

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4
Q

You hear blowing holosystolic murmur best heard at the apex, with th pt in the left lateral decubitus position

A

Mitral Valve Regurgitation

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5
Q

You hear an opening snap, diastolic murmur, loud S1

A

Mitral Stenosis

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6
Q

You hear a high pitched diastolic murmur, upper left sternal border

A

Pulmonic regurgitation

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7
Q

You hear widened splitting of S2, may hear early systolic click. Harsh crescendo-decrescendo murmur at left 2nd parasteral IS with no radiation, louder with inspiration

A

Pulmonic Stenosis

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8
Q

You hear pansystolic blowing murmur loudest on inspiration, best heard at right of left lower sternal border

A

tricuspid regurgitation

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9
Q

You hear a short, scratchy diastolic murmur that increases with inspiration. Heard best in lower right and left parasternal borders

A

Tricuspid stenosis

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10
Q

EKG: normal P wave and QRS with a long PR interval. Which heart block?

A

first degree av block

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11
Q

EKG: progressive delay in PR interval until a normal impulse is dropped. Which heart block?

A

second degree av block/ mobitz I or wenkebach phenomena

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12
Q

EKG: constant PR interval with intermittent dropped QRS complexes. Which heart block?

A

second degree av block/ mobitz II

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13
Q

EKG: appearance depends on the area initiating conducted beats

A

third degree av block (complete) with av dissociation

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14
Q

EKG: 2 R wave peaks and modest QRS widening. maybe wide s2 splitting.

A

bundle branch/fascicular blocks

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15
Q

What test do you order for all valvular disorders?

A

echocardiogram

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16
Q

In which two valvular disorders would you also want a doppler with the echo?

A

Aortic Regurgitation, Aortic stenosis

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17
Q

How do you dx MVP?

A

echo, holter monitoring or EKG

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18
Q

Someone presents with anxiety, what valvular disorder should come to mind?

A

MVP. Sometimes caused by anxiety, sometimes causes anxiety

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19
Q

How do you dx mitral valve regurgitation?

A

echo, EKG, CXR, catheterization on if surgery is required to repair/replace valve

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20
Q

How do you dx mitral stenosis?

A

echo and EKG. Notched or wide P wave due to atrial hypertrophy

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21
Q

how do you dx pulmonic regurgitation?

A

echo. EKG may show RV enlargement and CXR may show pulmonary hypertension

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22
Q

How do you dx pulmonic stenosis?

A

echo, duh. But an EKG may also show RV hypertrophy

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23
Q

What population has a particularly high occurrence of IE?

A

IV Drug Users

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24
Q

Name 5 predisposing factors for IE.

A 
congenital heart defects
rheumatic valve disease
bicuspid/calcified aortic valves
MVP
hypertrophic cardiomyopathy
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25
Q

What causes 50% of community-aquired native valve IE?

A

Strep viridans

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26
Q

Does IE occur more commonly on the right or left side of the heart?

A

Left (80%-90%)

Right (30%-70%) - more common with IV drug use

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27
Q

Name 4 potential consequences of IE.

A

myocardial abscess
conduction abnormalities
heart failure
death!!!

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28
Q

When would you give antibx to prevent IE?

A

prosthetic valve replacements/repairs
previous IE
Certain congenital heart disease
cardiac transplant recipients with valvulopathy

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29
Q

s/sx IE.

A

unexplainable fever with murmur

positive blood cultures in pts with valve disease and IV drug users

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30
Q

How do you Dx IE? 4 main things.

A 
hx
PE
3 serial blood cultures in 24 hr period
echo
mb also see anemia, high WBC, elevated ESR/CRP
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31
Q

SBE. Where would you look and what would you find?

A

General: fever, tachycardia
Skin: pallor
Eyes: roth spots
Digits: petechiae, mb osler’s spots, janeway lesions and splinter hemorrhages (on nails)

32
Q

Cause of ABE?

A

Staph/strep

mb fungi after valve replacement

33
Q

What are 3 causes of noninfectious endocarditis?

A

catheter injury to valves
SLE immune complexes
anti-phospholipid syndrome

34
Q

What are 5 causes of pericarditis?

A 
Idiopathic
Infections, mostly viral (EBV)
Post-MI
Connective tissue dz (SLE)
Tumors
35
Q

What are commonly the first sxs of acute pericarditis?

A

chest pain
dyspnea
pericardial friction rub

36
Q

How do you Dx pericarditis?

A 
Must have 2 of 4:
chest pain
pericardial friction rub
suggestive EKG changes
new/worsening pericardial effusion
37
Q

How do you Dx pericardial effusion?

A

CXR

EKG

38
Q

how do you dx tamponade?

A

EKG
Echo if there is time
otherwise, Pericardiocentesis for dx and tx

39
Q

how do you dx constrictive pericarditis?

A

CXR shows pericardial calcification
Catheterization confirms
High WBC and ESR
EKG, Echo are non-specific

40
Q

Name 5 risk factors for abdominal aortic aneurysms (AAA)?

A 
atherosclerosis
smoking
HTN
old age
white male
41
Q

Prevalence of AAA?

A

3/4 of aortic aneurysms

3x greater in men

42
Q

PE findings of AAA?

A

pulsatile mass in abd. or abd. pain

43
Q

Dx AAA?

A

US or CT

44
Q

prevalence of thoracic aneurysms?

A

1/4 of all aortic aneurysms

affect men and women equally

45
Q

Name 5 sxs that would make you think thoracic aneurysm?

A 
chest/back pain
cough
dyspnea
hoarsness
hemoptysis
abd pain
mb horner's syn.
46
Q

name 5 predisposing factors for aortic dissection

A 
cocaine use
smoking 
htn
CT disorders
Iatrogenic trauma
47
Q

PE findings for aortic dissection?

A 
sudden severe pain, looks like MI
pulses may wax and wane
differing limp bps
aortic regurg. murmur in 50%
ummm...i don't think we're going to see these much.
48
Q

what testing would you do if you suspect aortic dissection?

A 
CXR
EKG
D-dimer
TEE, CTA, MRA once pt is stable
CK-MB and troponin to ddx with MI
Consult with a cardiothoracic surgeon
49
Q

Where does erythromelalgia occur?

A

hands and feet

50
Q

Name 5 conditions that could lead to secondary erythromelalgia?

A 
DM
SLE
RA
gout
MS
51
Q

What group is most at risk for peripheral arterial aneurysms?

A

men (20:1) age 65

52
Q

What are risk factors for Peripheral arterial aneurysms?

A

atherosclerosis, popliteal artery entrapment, septic emboli

53
Q

What testing would you order if you suspected peripheral arterial aneurysm?

A

US
MRI
CT

54
Q

What causes peripheral arterial dz?

A

atherosclerosis resulting in lower limb ischemia. same risk factors as atherosclerosis.

55
Q

What is the patient picture for peripheral arterial dz?

A

pain on exertion, relieved by rest (intermittent claudication)
numbness and tingling
if severe, ulceration

56
Q

What would you expect to find on PE with PVD?

A

reduced pulses in feet
severely ischemic feet are cold, blue, painful or numb
No edema usually

57
Q

how would you dx PVD?

A

ankle brachial index.
doppler US
angiography
labs: lipid levels, CRP-hs, homocysteine, fibrinogen, bleeding time

58
Q

What might Raynaud’s be secondary to?

A 
CT disease
endocrine disorders
drug use
infections
trauma
59
Q

what is the typical pt population for primary raynauds?

A

<40 yo, often women

no abnormal PE or Hx findings that suggest another cause

60
Q

what is the typical pt population for secondary raynauds?

A

> 30 yo
severe painful attacks, ischemia lesions
hx and pe suggest underlying disorder

61
Q

What is commonly seen with Raynaud’s?

A

migraine HA, variant angina and pulmonary HTN

62
Q

What most aggravates Buerger’s dz?

A

tobacco

63
Q

What are 5 risk factors for chronic venous insufficiency?

A 
DVT
venous HTN
sedentary lifestyle
trauma
obesity
64
Q

What is the progression of Chronic venous insufficiency?

A

no change>varicose veins>stasis derm>mb ulceration

65
Q

4 s/sx of chronic venous insufficiency?

A

sense of fullness
heaviness
aching
paresthesias

66
Q

What do you want to rule out when dx chronic venous insufficiency?

A

DVT, done with US

67
Q

What most commonly causes superficial venous thrombosis?

A

IV catheterization in upper extremities

varicose veins in lower extremities

68
Q

What would PE reveal with superficial venous thrombosis?

A

palpated as a linear indurated cord with local inflammation

mb tenderness, erythema mottling and warmth

69
Q

What makes varicose veins feel better?

A

elevation of the legs

70
Q

What is the best position to assess varicose veins? What else do you want to check?

A

standing
Diabetic neuropathy
look for ulcerations
look for other sources of pain such as arthritis, arterial insufficiency and intermittent claudication

71
Q

what are 3 complications of varicosities?

A

edema
eczema
painful ulcerations

72
Q

What 5 potential causes of lymphedema?

A 
surgery
trauma
radiation therapy
tumors
infection
73
Q

What are the complications of lymphedema?

A

lymphangitis

74
Q

What is the main cause of sudden cardiac death in athletes?

A

hypertrophic cardiomyopathy

75
Q

Athletic heart syndrome is usually asx. What might you see on PE?

A

bradycardia
laterally displaced PMI
ejection murmur
additional heart sounds

76
Q

What testing might you suggest to an athlete with s/sx of athletic heart syndrome?

A

EKG
Echo
Stress testing

CPD 2 (5 decks)

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