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Cardiovascular Flashcards

1
Q

s/s of MI in women

A

dyspnea, fatigue, back pain, nausea

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2
Q

s/s of AAA

A

pulsating-type sensation in abd or lower back

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3
Q

risk factors for AAA

A

elderly white male, hx of HTN, smoker

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4
Q

s/s of CHF

A

dyspnea, fatigue, swollen feet/ankles, lung crackles, S3 heart sound

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5
Q

painful violet-colored nodes on the fingers or feet in those with bacterial endocarditis

A

Osler nodes

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6
Q

tender red spots on the palms/soles in those with bacterial endocarditis

A

Janeway lesions

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7
Q

where is the apical pulse

A

5th intercostal space at midclavicular line

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8
Q

flow of blood in the heart

A

vena cava–> right ventricle –> tricuspid valve –> right ventricle –> AV valve –> pulmonary artery –> the lungs –> pulmonary veins –> left atrium –> mitral valve –> left ventricle –> aorta

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9
Q

S1 is the

A

closure of the mitral and tricuspid valves

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10
Q

S2 is the

A

closure of the pulmonic and aortic valves

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11
Q

mneumonic to remember type of valves

A

MOTIVATED APPLES:
Mitral
Tricuscpid
AV valves (3 leaflets)

Aortic
Pulmonic
Semilunar valves (2 leaflets)

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12
Q

S3 sounds like

A

KENTUCKY

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13
Q

S3 is only abnormal in those

A

greater than 35

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14
Q

S4 is caused by

A

stiff left ventricle

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15
Q

Sign of left ventricular hypertrophy

A

S4

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16
Q

atrial gallop or atrial kick

A

S4

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17
Q

ventricular gallop

A

S3

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18
Q

S4 sounds like

A

Tennessee

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19
Q

the bell of the stethoscope is to hear for

A

extra heart sounds (S3 or S4), mitral stenosis

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20
Q

heart sound that can be normal in the elderly

A

S4

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21
Q

Mnemonic for systolic murmurs

A

Mr. Peyton Manning AS MVP (Mitral regurgitation, Physiologic murmurs, aortic stenosis, mitral valve prolapse)

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22
Q

Mnemonic for diastolic murmurs

A

ARMS (aortic regurgitation, mitral stenosis)

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23
Q

These murmurs are ALWAYS indicative of heart disease

A

diastolic murmur

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24
Q

Also called the “opening snap” and is best heard with ___

A

mitral stenosis; bell of stethescope

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25
Q

murmur grade where a thrill is first heard

A

grade IV

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26
Q

____ murmurs are always abnormal; whereas ____ murmurs are usually benign

A

diastolic; systolic

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27
Q

mitral regurgitation murmur radiates to the

A

axilla

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28
Q

aortic stenosis murmur radiates to the

A

neck

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29
Q

A split S2 is best heard at the

A

pulmonic area

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30
Q

When afib is intermittent and terminates in 7 days or less; asymptomatic

A

paroxysmal afib

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31
Q

amiodarone has a black box warning for

A

pulmonary and liver damage

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32
Q

simvastatin and amiodarone together can cause

A

rhabdomyolysis

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33
Q

INR for those with prosthetic valves

A

2.5-3.5

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34
Q

diet teaching for those on coumadin

A

only one serving per day of foods high in vitamin K (“greens”: kale, collards, mustard, turnip, spinach, romaine lettuce, brussel sprouts)

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35
Q

treatment for paroxysmal atrial tachycardia (PSVT)

A

Valsalva, carotid massage, splashing cold water on face

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36
Q

what is paradoxical pulse

A

when the apical pulse is still heard but no radial pulse can be palpated

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37
Q

If INR is between 3-5, then

A

skip one dose, may need to decrease maintenance dose, recheck every 1-2 days until normal

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38
Q

If INR is between 5-9, then

A

hold dose and give either small dose of oral vitamin K OR skip the next 1-2 doses. Recheck INR daily until normal.

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39
Q

screening in BP for those with normal BP

A

every 2 years

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40
Q

screening in BP for those with prehypertension

A

every year

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41
Q

Prehypertension

A

SBP 120-139, DBP 80-89

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42
Q

Stage I HTN

A

SBP 140-159, DBP 90-99

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43
Q

Stage II HTN

A

SBP greater than 160, DBP greater than 100

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44
Q

eye changes in those with HTN

A

copper and silver arterioles; AV nicking; papilledema

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45
Q

can cause HTN in young adults

A

renal artery stenosis

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46
Q

how to check for coarctation of the aorta

A

check radial and femoral pulse at same time

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47
Q

Goal BP for those greater than 60 without hx of DM or CKD

A

less than 150/90

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48
Q

Goal BP for those less than 60 without hx of DM or CKD

A

less than 140/90

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49
Q

Goal BP for those with DM or CKD

A

less than 140/90

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50
Q

first line of trx in those with HTN and CAD

A

ACE or ARB

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51
Q

first line of trx in those with HTN post-MI

A

beta blocker

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52
Q

first line of trx in those with HTN with hx of heart failure or CHF

A

thiazide

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53
Q

dietary source of magnesium

A

dried beans, whole grains, nuts

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54
Q

where loop diuretics have effect

A

Loop of Henle

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55
Q

ex of loop diuretics

A

furosemide (Lasix), bumetanide (Bumex)

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56
Q

ex of aldosterone receptor antagonist diuretics

A

spironolactone

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57
Q

MOA of spironolactone

A

antagonizes effect of aldosterone –> increase water elimination and conserves potassium

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58
Q

Side effect of spironolactone

A

gynecomastia, hyperkalemia, vomiting/diarrhea

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59
Q

contraindications to spironolactone

A

high K+, renal insufficiency, DM with microalbuminuria

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60
Q

avoid abrupt discontinuation of this BP med

A

beta blockers: can cause rebound HTN

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61
Q

Beta1 receptors are specific to the ____ ; and beta2 receptors are specific to the ____

A

heart; lungs and peripheral vasculature

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62
Q

contraindications to beta blocker use

A

asthma, COPD, second/third degree block

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63
Q

Do not use this beta blocker to treat HTN as it has a short half-life

A

propranolol (Inderal)

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64
Q

side effects of CCB

A

headaches, ankle edema, bradycardia

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65
Q

one side of effect of nifedipine is

A

reflex tachycardia

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66
Q

The nondihydropyridine CCBs MOA

A

Decrease HR, a little BP

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67
Q

The dihydropyridine CCBs MOA

A

Decrease BP, doesn’t hurt pulse

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68
Q

ex of nondihydropyridine CCB

A

verapamil and diltiazem

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69
Q

ex of dihydropyridine CCB

A

nifedipine and amlodipine

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70
Q

MOA of ACEI and ARBS

A

block conversion of angiotensin I to II (a potent vasoconstrictor)

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71
Q

BP med that is contraindicated in pregnancy

A

ACEI and ARB

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72
Q

side effects of ACEI and ARB

A

dry hacking cough, hyperkalemia, angioedema

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73
Q

This med is contraindicated in renal artery stenosis

A

ACEI or ARB

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74
Q

ex of ARB

A

losartan

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75
Q

MOA of alpha-adrenergic blockers

A

vasodilation

76
Q

common side effects of alpha-adrenergic blockers

A

dizziness and hypotension

77
Q

first dose orthostatic hypotension is common in this medication

A

alpha-adrenergic blocker

78
Q

administration of alpha-adrenergic blockers

A

give a bedtime, start at low doses and titrate slowly

79
Q

first choice medication for a male with HTN and BPH

A

alpha-adrenergic blockers

80
Q

MOA of diuretics

A

decrease volume and preload

81
Q

This BP medication has a sulfa component and should be avoided in patients with sulfa allergy

A

thiazide diuretics

82
Q

Has a favorable effect for those with HTN and osteopenia/osteoporosis

A

thiazide diuretics

83
Q

side effects of thiazide diuretics

A

hyperglycemia, hyperuricemia, high cholesterol, hypokalemia, hyponatremia

84
Q

examples of thiazide diuretics

A

HCTZ, chlorthalidone

85
Q

these two BP med combinations can increase risk of hyperkalemia

A

ACEI and spironolactone

86
Q

CHF is an EF less than

A

40%

87
Q

normal JVD is less than

A

4 cm

88
Q

If a patient with CHF has no limitations of physical activity, they are classified as

A

Class I

89
Q

If a patient with CHF has ordinary physical activity that results in fatigue, and exertional dyspnea, then they are classified as

A

Class II

90
Q

If a patient with CHF has marked limitation in physical activity, then they are classified as

A

Class III

91
Q

If a patient with CHF has symptoms at rest with or without physical activity, then they are classified as

A

Class IV

92
Q

risk factors of DVT

A

oral contraception use, inactivity for more than 3 hours, CHF, pregnancy, bone fx in long bones, trauma, recent surgery

93
Q

s/s of DVT

A

swelling of extremity that is painful, red, and warm.

94
Q

gold standard to diagnose DVT/PE

A

contrast venography

95
Q

Trx for DVT/PE

A

heparin IV, then warfarin PO for at least 3-6 mo

96
Q

risk factors for superficial thrombophlebitis

A

catheter, IV potassium, Staph aureus infection

97
Q

s/s of superficial thrombophlebitis

A

indurated, cordlike vein that is warm, red, and tender to touch

98
Q

trx for superficial thrombophlebitis

A

NSAIDS (ibuprofen, Anaprox DS/naproxen), warm compresses

99
Q

intermittent claudication

A

worsening pain on ambulation that is relieved by rest

100
Q

golden standard for dx of peripheral vascular/arterial disease

A

angiography

101
Q

Pentoxifylline (Trental) is indicated for

A

peripheral vascular/arterial disease

102
Q

reversible vasospasm of the peripheral arterioles on fingers and toes

A

Raynaud’s

103
Q

s/s of Raynaud’s

A

color changes that occur symmetrically in hands and feet, numbness/tingling with cold temperatures.

104
Q

treatment for Raynaud’s

A

nifedipine or amlodipine

105
Q

important not to use these drugs in those with Raynaud’s

A

Imitrex, decongestants, amphetamines

106
Q

subungual hemorrhages

A

splinter hemorrhages on nailbed

107
Q

s/s of endocarditis

A

subungual hemorrhages, Osler nodes, Janeway lesions, fever/chills

108
Q

endocarditis prophylaxis is given to those with

A

prosthetic valves, heart transplant, invasive dental procedures

109
Q

endocarditis prophylaxis is NO longer given to those with

A

mitral valve prolapse, GU/GI invasive procedures

110
Q

endocarditis prophylaxis medication

A

amoxicillin 2 g PO x 1 (adults); amox 50 mg/kg (children) one hour before procedure;

111
Q

treatment for MVP with symptoms

A

beta blockers, avoid caffeine/alcohol/smoking

112
Q

normal cholesterol is less than

A

200

113
Q

normal HDL is

A

greater than 40

114
Q

normal triglycerides

A

less than 150

115
Q

high risk of pancreatitis

A

triglycerides greater than 500

116
Q

simvastatin drug interactions

A

grapefruit juice, antifungals, macrolides, amiodarone

117
Q

serious complication of statins

A

rhabdomyolosis and drug-induced hepatitits

118
Q

MOA of statins

A

decrease LDL and raise HDL

119
Q

MOA of fibrates and nicotinic acid

A

reduces triglycerides and increases HDL

120
Q

SE of fibrates

A

dyspepsia, gallstones

121
Q

patient education for those with high triglycerides

A

reduce simple carbs, “junk food” and fried foods

122
Q

patient education for those with low HDL

A

increase exercise, trial of OTC niacin

123
Q

gemfibrozil (Lopid), Tricor

A

fibrate

124
Q

Cholestyramine (Questran)

A

bile acid sequestrant

125
Q

work on the small intestine and interfere with fat absorption (including fat-soluble vitamins A, D, E, and K).

A

bile acid sequestrant

126
Q

side effects of bile acid sequestrant

A

bloating, gas, abd pain

127
Q

labs for cholesterol meds

A

baseline LFTs

128
Q

triad of rhabdomyolosis

A

muscle pain, weakness, red-brown urine

129
Q

labs in rhabdomyolosis

A

high CK, proteinuria

130
Q

high waist circumference in males

A

greater than 40 in

131
Q

high waist circumference in females

A

greater than 35

132
Q

criteria for metabolic syndrome

A

abdominal obesity, HTN, HLD

133
Q

fatty liver or nonalcoholic fatty liver disease is caused by

A

triglyceride deposits in the liver

134
Q

labs for fatty liver

A

elevated ALT and AST; Hep A, B, and C negative

135
Q

treatment for fatty liver

A

weight loss, avoid hepatotoxic drugs (statins, tylenol), vaccination for Hep A&B

136
Q

BMI calculation

A

weight/height2

137
Q

when to screen for lipid disorders

A

men: 35, women: 45

138
Q

normal BP in children

A

both systolic and diastolic are less than 90th percentile for gender, age, and height

139
Q

when should BP meds be started in children

A

if lifestyle modifications fail in 6 months

140
Q

management for statin therapy

A

baseline LFTs, CK does not need to be routinely measured

141
Q

normal cholesterol in children is

A

below 75th percentile

142
Q

abnormal cholesterol values in children

A

above 95th percentile

143
Q

when to screen for dyslipidemia in children

A

age 9-11 and again at 17-21

144
Q

systemic inflammatory illness that particularly affects medium-sized arteries, especially the coronary arteries

A

Kawasaki disease

145
Q

s/s of Kawasaki disease

A

fever, conjunctivitis, strawberry tongue, rash, swelling of hands and feet

146
Q

diagnostic for kawasaki disease

A

high ESR/CRP, thrombocytosis, leukocytosis.

147
Q

screening for AAA

A

one time screening for all men 65-75 who have smoked

148
Q

outpatient trx for DVT

A

LMWH then add warfarin for at least 5 days, can d/c LMWH once INR is therapeutic for at least 2 consecutive days

149
Q

management of DVT

A

compression stockings after anticoagulant therapy initiated; early ambulation

150
Q

s/s of arterial ulcers

A

painful; mostly on toes; necrotic

151
Q

abnormal ABI

A

less than 0.90

152
Q

s/s of venous ulcers

A

located between knee and ankle; mild pain; scaling, weeping, erythema

153
Q

aortic regurgitation is best heard when

A

leaning forward or during Valsalva

154
Q

location best heard for venous hum

A

under right clavicle

155
Q

quality of venous hum

A

continuous murmur

156
Q

location best heard for stills murmur

A

2-4th left ICS

157
Q

quality of stills murmur

A

musical

158
Q

characteristic of hypertropic cardiomyopathy

A

systolic murmur that gets louder when the patient stands

159
Q

therapeutic range for digoxin

A

0.5-2.0

160
Q

s/s of digoxin overdose

A

anorexia, N/V, abd pain, confusion, visual changes

161
Q

examples of potassium sparing diuretics

A

triamterene, amiloride

162
Q

adverse effects of beta blockers

A

bronchospasm, blunts hypoglycemic response, depression

163
Q

med choices for african american with HTN

A

thiazide or CCB

164
Q

med choices for non-black person with HTN

A

thiazide, CCB, ACEI, ARB

165
Q

thiazide diuretic is good to treat

A

mild HTN

166
Q

these people are known to have high renin states causing HTN

A

young white males

167
Q

First line treatment for isolated systolic HTN

A

CCB

168
Q

Side effect of HCTZ

A

erectile dysfunction

169
Q

-pine drugs are

A

DHP CCB

170
Q

DHP Calcium channel blockers decrease ____ and not the _____.

A

BP; pulse (Don’t Hurt Pulse)

171
Q

These people should be placed on a moderate to high statin

A

Hx of CHD or stroke;
LDL greater than 190;
DM, age 40-75;
10-year risk score greater than 7.5%

172
Q

High potency statins

A

atorvastatin (Lipitor), rosuvastatin (Crestor)

173
Q

Moderate potency statins

A

simvastatin (Zocor), pravastatin (Pravachol)

174
Q

med contraindicated to give in heart failure

A

TZDs, CCB, naproxen

175
Q

Areas of heart valves

A

Aortic;
Pulmonic;
Tricuspid;
Mitral

176
Q

These valves don’t open properly

A

stenotic valves

177
Q

these valves don’t close properly

A

regurgitant valves

178
Q

s/s of aortic stenosis

A

syncope, angina, HF

179
Q

murmur with an audible “click”

A

mitral valve prolapse

180
Q

mitral valve prolapse can be common in

A

pregnant women; women 15-30.

181
Q

causes of peripheral artery disease

A

diabetic, smoker, dyslipidemia, no exercise

182
Q

trx for kawasaki disease

A

aspirin daily x 2 months to prevent MI

183
Q

innocent murmur clues

A

less than grade II, softer when sitting than lying, musical quality

184
Q

pathologic murmur clues

A

grade III or higher, harsh quality, increased intensity when standing

185
Q

foods high in folic acid

A

spinach, liver, whole wheat bread

186
Q

this BP med can increase blood sugars

A

thiazide diuretics

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