Cardiovascular Flashcards
What is the BP goal for someone under 60 years old?
Less than 140/90
What is the blood pressure goal for someone over 60?
Less than 150/90
What antihypertensive medication has beneficial effects for an elderly white female with osteoporosis
Calcium channel blocker
Middle age or older adult complains of mid sternal chest pain that feels like heavy pressure on the chat. The pain is associated with numbness and tingling in the left jaw and the left arm. The patient is diaphoretic with cool, clammy skin. Women present with nonspecific symptoms such as dyspnea, fatigue, back pain, and nausea.
Acute MI
Elderly white male complains of pulsating type sensation in abdomen and or low back pain. With pending rapture, sudden onset of severe chest and low back pain that suddenly becomes sharp and excruciating. Patients with hypertension and smokers are at a higher risk.
Dissecting abdominal aortic aneurysm
Elderly patient complains of an acute or gradual onset of dyspnea, fatigue, dry cough, and swollen feet and ankles. The patient has a sudden or gradual increase in weight. Lung exam will reveal crackles on both the long bases along with an F3 heart sound. History of pre-existing coronary artery disease, prior MI, or previous episode is possible usually is taking diuretics, digoxin or antihypertensive medication
Congestive heart failure
Patient presents with fever, chills, and malaise that is associated with the new murmur and the abrupt onset of CHF. Associated skin findings are found mostly on the fingers hands and toes. These are sub ungual hemorrhages, petechiae on the palate, painful violet colored nodes on the fingers or feet i.e. Osler nodes, and tender red spots on the palms and soles i.e. Janeway lesions.
Bacterial endocarditis
The lower border of the left ventricle is where
The apical impulse is generated
Located at the fifth intercostal space by the midclavicular line on the left side of the chest
Apical impulse
What causes displacement of the point of maximal impulse
Severe left ventricular hypertrophy, cardiomyopathy, and pregnancy in the third trimester.
What Heart valves create S1 heart sound
MOTIVATED
M=mitral valve
T=tricuspid
AV=atrioventricular
What heart valves create S2 heart sounds
APPLES
A=Aortic
P=pulmonic
S=semilunar
What heart sound is pathogmomic for CHF
S3
When does S3 heart sound occur
It occurs during early diastole also called a ventricular gallop and sounds like “Kentucky”. Always considered abnormal if it occurs after the age of 35.
This heart sound is caused by increased resistance due to a stiff left ventricle, usually indicates LVH, considered a normal finding in some elderly slight thickening of the left ventricle
S4 heart sound
When does S4 occur
During late diastole also called atrial gallop. Sounds like “Tennessee”.
Where is the best place to hear an S4 heart sound
Best heard at the apex or Apical area i.e. mitral area using the bell of the stethoscope
When do you use the bell of the stethoscope
To listen to low tones such as the extra heart sounds of S3 or S4 and mitral stenosis
When do you use the diaphragm of the stethoscope
To listen to mid to high-pitched tones such as lung sounds, mitral regurgitation, and aortic stenosis
What could be some causes of secondary hypertension
Renal artery stenosis, vascular, endocrine, hypothyroidism, no logic, pharmacologic, pregnancy only after 20 weeks
Elevated systolic with normal diastolic i.e. 160/80. Seeing an elderly patients because of Stephon vessels.
Isolated systolic hypertension
Isolated systolic hypertension is a significant predictor of what in the elderly
Predict strokes and myocardial infarction’s
What are the initial choices according to JNC8 for African-Americans with or without diabetes for blood pressure medication
Thiazide diuretics for a systolic drop of 2 to 8 points, and then calcium channel blocker for systolic drop more than eight points
What is the initial choice according to JNC8 for non blacks with or without diabetes for hypertension medication
Thiazide diuretic for systolic drop of 2 to 8 points, calcium channel blocker, ACE, or ARB for systolic drop of more than eight points
This hypertension medication has a suffix of IDE. No longer first line, excellent synergist. Works well with other drugs
Thiazide diuretics
This blood pressure medication has a suffix of PRIL. This medication is used in high renin states, diabetes.
ACE inhibitors
This hypertension medication has a suffix of SARTAN. Use in high renin states, diabetes. Alternative to ACE.
Angiotensin receptor blocker
What type of people produce a high number of renin
Young Caucasian
This hypertension medication has a suffix of LOL. Not for use in uncomplicated hypertension but good add on medication
Beta blockers
This hypertension medication has a suffix of PINE. Use for isolated systolic hypertension and in African Americans
Calcium channel blocker’s
What lab studies are needed for hypertensive patients
Hematocrit, glucose, urine analysis for proteinuria, estimated GFR, serum potassium, creatinine, calcium, fasting lipid profile, ECG.
What blood pressure medication does not affect the pulse
Calcium channel blocker’s
When a patient is on an Ace Inhibitor what lab needs to be ordered
serum potassium
What is a common side effect of HCTZ
Erectile dysfunction
A normal GFR rate is
Greater than 60
What type of hypertension medication causes the patient to hold potassium
ACE & ARB
What type of blood pressure medication causes the patient to waste potassium
HCTZ
What are two examples of non-DHP calcium channel blocker’s
Diltiazem & Verapamil
What type of pain medication hold on to sodium and causes fluid retention while diminishing prostaglandins for the kidney which produces renal artery hydration
NSAIDS
When should the elderly take their medication
In the evening or at night time
When should statins be taken
In the evening
When should a baby aspirin be taken
in the evening
If a patient has renal insufficiency what is needed
Fluids
Do you ever add ACE or ARB in the same patient
Never
What type of hypertensive medication hold onto potassium
ARBs
What type of hypertensive medication loses potassium
HCTZ
If a patient has low HDL and high triglycerides what does that mean
Insulin insensitivity
If a patient is on in angiotensin receptor in blocker what must be monitored
Potassium and kidney function must be checked after one week
What type of hypertension medication can precipitate gout in a patient with a history of gout
HCTZ
What hypertension medication will always affect the kidneys so the kidney function must be always checked
ACE/ARB
If a patient is on simvastatin what hypertension medication must be avoided
amlodipine
If a patient is on atorvastatin can they take amlodipine
Yes
What to fruits with amlodipine can cause adverse affects
Grapefruits and cranberries
What are the characteristics for dyslipidemia treatment with statins
History of heart disease or stroke, LDL greater than 190, diabetes aged 40 to 75 with LDL 70-189, global 10 year risk score of greater than 7.5%.
What is the first choice to reduce risks of dyslipidemia (medication)
Statins
What can elevate triglyceride levels
Alcohol use and increased glucose/A1c
If a patient has a triglyceride level of less than 500 what must be done first
Lifestyle modifications
What are to high potency statins
Atorvastatin i.e. Lipitor, Rosuvastatin i.e. Crestor
What are moderate potency statins
Simvastatin i.e. Zocor, Pitavastat (Livalo), Pravastain (Pravachol)
Clinical syndrome that impairs the ventricle from filling or ejecting blood. Characterized by specific symptoms.
Heart failure
Dyspnea on exertion, fatigue, fluid retention are all symptoms of
Heart failure
Structural heart disease but without signs or symptoms of heart failure or is what classification
I
Structural heart disease with prior or current symptoms of heart failure is what classification
II
At risk for heart failure but without structural disease or symptoms of heart failure is what classification
None
Structural heart disease with prior or current symptoms of heart failure or is what classification
III
Refractory heart failure requiring specialized interventions is what kind of heart failure
IV
What are clinical signs and symptoms of heart failure
Resting tachycardia, narrow pulse pressure less than 25, tachypnea, crackles, diaphoretic, S3 and or S4, peripheral edema may be present
What is an early sign of heart failure
Holding onto fluids into the lungs
Where do you auscultate S3 and S4 sound
Pulmonic listening point
What is a late sign of heart failure
Peripheral edema via lungs filling with fluid and lower extremity edema is also a late sign of CHF
How to identify CHF early and patient care
Identification/correction of systemic factors such as thyroid dysfunction, diabetes infection, MI, valvular dysfunction, arrhythmia. Reinforced lifestyle modifications such as sodium restriction and medication compliance. Illuminate medications that contribute to CHF
What medications can contribute to heart failure
Amlodipine and calcium channel blocker’s because they block calcium and the heart cannot contract for a long periods of time forcefully into the muscle. Metoprolol and beta blockers causes cardiac output to drop, increased heart rate. Pioglitazine (Actos)
can worsen heart failure
Are NSAIDS i.e. Naproxen safe to give to a patient with heart failure
No because it holds onto sodium thus the patient will retain fluid
Is aspirin safe for a patient in heart failure
Yes
The sound detected when there is a turbulent bloodflow to the great vessels or across a heart valve
Heart murmur
Which two heart valves cause all of the trouble in heart murmur’s
Aortic and mitral
What type of heart valves do not open properly
Stenotic valves
What type of valves do not close properly
Regurgitant valves
With stenotic and regurgitant valves, what are the highest risk
Arrhythmias
Mnuemonic for systolic murmurs
Mr. Payton Manning As MVP
Mnemonic for diastolic murmurs
ARMS
Or diastolic murmur’s normal or abnormal
Always abnormal. Refer
Angina, syncope and heart failure or all associated findings of what type of heart murmur
Aortic stenosis
This heart murmur affects ages 15 to 65, are usually congenital in the bicuspid valve, rheumatic fever is second most common cause, calcified valve.
Aortic stenosis
ASC is the mnemonic for what type of murmur
Aortic stenosis
Angina
Syncope
Congestive Heart Failure
Which heart murmur is heard loudest along upper sternal border and carotids or apex, usually Audible S4, Apex and pulse is forceful but as left ventricle dilates apex becomes defuse and lateral, narrow pulse pressure
Aortic stenosis
This heart murmur occurs from rheumatic heart disease, congenital deformity, aortic root abnormalities, and syphilis
Aortic regurgitation
The PMI is displaced downward and left in which heart murmur
Aortic Regurgitation
Dyspnea and atrial fib are associated findings of what type heart murmur
Mitral Stenosis
Rheumatic fever is the cause of what type of heart murmur
Mitral stenosis
Atrial fib is associated with what type of heart murmur
Mitral stenosis
Shortness of breath, fatigue, and heart failure are all associated findings of
Mitral regurgitation
This heart murmur is usually a result of a congenital condition, rheumatic heart disease, acute endocarditis, mitral valve prolapse’s, calcified annulus
Mitral regurgitation
CHF, fatigue, and bacterial endocarditis are all symptoms of what type of heart murmur
Mitral regurgitation
With this murmur the PMI is displaced laterally and is diffuse, murmur is holosystolic, and apical, transmission to the axilla and sternum, usually grade 2 or more
Mitral regurgitation
Palpitations, chest pain, and audible click is associated with what type of murmur
Mitral valve prolapse
Redundancy of the mitral valve leaflets with degeneration of the mitral valve tissue. Common in women 14 to 30 years old and most are asymptomatic
Mitral valve prolapse
Palpitations, PSVT, chest pain, dyspnea, dizziness, and numbness are all symptoms of what type of murmur
Mitral valve prolapse
First finding is midsystolic click heard best at Apex and left sternal border, second later finding is late systolic click accentuated withstanding, quieter with squatting. What type of murmur is this
Mitral valve prolapse
A 67-year-old female complains of pain in her right lower leg when she walks. She gets complete relief when she stops walking and rest. It has worsened over the past three months. What finding is likely
Weakened pedal pulse
Intermittent claudication is consistent with what type of disease
Peripheral artery disease
The most common side effect of amlodipine is
Lower extremity edema
If a murmur is heard at the second intercostal space at the right sternal border what type of murmur would this be
Aortic
If a murmur is heard at the apex what type of murmur would this be
Mitral
Does obesity contribute to peripheral artery disease
No
Angioedema associated with ace inhibitor use is often most characterized by
Edema of the lips and face
What population is at the highest risk for angioedema associated with ace inhibitor use
African Americans and they must take Benadryl
You hear a bruit with
Carotid artery disease
What grade of murmur is very soft and heard only under optimal conditions
Grade 1
What grade of murmur is mild to moderately loud
Grade 2
What grade of murmur is a loud murmur that is easily heard once the stethoscope is placed on the chest
Grade 3
What grade of murmur is a louder Murmur. First time that a thrill is present. A thrill is like a palpable murmur.
Grade 4
What grade of murmur is a very loud murmur heard with the edge of the stethoscope off of the chest. Thrill is more obvious.
Grade 5
What grade of murmur is so loud that it can be heard even with the stethoscope off of the chest. The thrill is easily palpated.
Grade 6
All benign murmurs occur during
Systole S2
Apex of the heart, apical area, or fifth intercostal space on the left side of the sternum medial to the midclavicular line is what listening point
Mitral
What type of murmurs radiate
Systolic
What type of murmur radiates to the axilla
Mitral regurgitation
What type of murmur radiates to the neck
Aortic stenosis
S3 is a sign of
CHF
S4 is a sign of
LVH
A split S2 is best heard at
The pulmonic area
The first time a thrill is palpated is at what murmur grade
Grade 4
aoRtic is on what side
Right side
puLmonic is on what side
Left side
What must be ruled out in an older male who has a pulsatile abdominal mass that is more than 3 cm in width.
AAA
In a patient that presents with AAA symptoms, what are the diagnostic tests that need to be ordered
Abdominal ultrasound and CT
The most common cardiac arrhythmia in the United States and a major cause of stroke. Also classified as supraventricular tachyarrhythmia. Maybe asymptomatic
Atrial fib
Hypertension, coronary coronary artery disease, nicotine, caffeine, hyperthyroidism, alcohol intake, heart failure, and LVH are all risk factors for
A Fib
Patient complains of the sudden onset of heart palpitations accompanied by feelings of weakness, dizziness, and dyspnea. They may complain of chest pain and feeling like passing out. Rapid and irregular pulse maybe more than 110 bpm with hypotension
A fib
What is a diagnostic test for a fib
12 lead ECG he which will not show discrete P waves
What are lifestyle modifications for patients with a fib
Avoid stimulants such as caffeine, nicotine, and decongestants and alcohol
Simvastatin and amiodarone can cause
Rhabdomyolysis
What does the INR need to be in a patient with a fib
2.0 to 3.0
What is the INR in a patient with synthetic/prosthetic valves
2.5 to 3.5
What are dietary sources for a fib patients
Patients need to be consistent with their day today consumption of vitamin K foods. Greens such as kale, collard, mustard, turnip, spinach, iceberg or Romain lettuce, and Brussels sprouts. Only one serving per day it’s recommended
EKG shows tachycardia with peaked QRS complex and P waves
Paroxysmal atrial tachycardia also known as paroxysmal supraventricular tachycardia
Digitalis toxicity, alcohol, hyper thyroidism, caffeine intake, alcohol, and illegal drug use or all causes of
Paroxysmal Atrial Tachycardia
Patient complains of the abrupt onset of palpitations, rapid pulse, lightheadedness, shortness of breath, and anxiety. Rapid heart rate can change from 150 to 250 bpm
Paroxysmal Atrial Tachycardia
How is Paroxysmal Atrial Tachycardia managed
Tell the patient to hold one’s breath and strain hard, carotid massage, splashing ice cold water on the face can interrupt and stop this arrhythmia i.e. Valsalva maneuver’s
The apical pulse can still be heard even though the radial pulse is no longer palpable. It is measured by using the blood pressure cuff and a stethoscope. What kind of arrhythmia is this
Pulses paradoxus
If an INR is 3.0 to 5.0 with no bleeding what action is needed
Skip one dose. Decrease maintenance dose. If only minimally prolonged, no need to decrease dose. Check INR in 1 to 2 days until normal
If an INR is 5.0 to 9.0 and there was no bleeding what action is needed
Omit a dose and give small dose of oral vitamin K or omit next 1 to 2 doses of warfarin. Daily INR monitoring until normal. Decrease the Coumadin maintenance dose.
What can be a pulmonary cause of pulses paradoxus
Asthma, emphysema
What can be a cardiac causes of pulses paradoxus
Tamponade, pericarditis, cardiac effusion
What can cause A fib and PAT
Alcohol intoxication, hypothyroidism, stimulants such as theophylline, decongestants, cocaine, and heart disease.
If bleeding is suspected what must be ordered
INR with PT and PTT
It may take how many days after changing the warfarin dose to see a change in the INR
2 to three days
What FDA category is Coumadin
Category X
What can cause silver and or copper wire arterioles, AV Junction nicking, and flame shape hemorrhages with papilledema in the eyes
Hypertension
Obstructive sleep apnea and coarctation of the aorta and can cause
Hypertension
When the blood pressure of the arms is higher than the blood pressure of the legs what is this condition
Coarctation of the aorta
If a patient has diabetes or chronic kidney disease with protein urea or CAD what type of hypertension medication should be prescribed
ACE or ARB
How do you check a patient for orthostatic hypotension
Check the blood pressure in both sitting and standing position. When the patient stands wait for one to three minutes to measure understanding blood pressure. If the patient is dizzy or lightheaded then they have it
What are side effects of Aldactone (Spironolactone) and Eplerenone (Inspra)
Gynecomastia, hyperkalemia, G.I. upset, vomiting, diarrhea, stomach cramps, post menopausal bleeding, erectile dysfunction
What type of hypertension medication is contra indicated in asthma, COPD, chronic bronchitis, emphysema, chronic lung disease, second and 3rd° heart block and sinus bradycardia
Beta blockers
Headaches, ankle edema, heart block or bradycardia, reflex tachycardia are all side effects of
Calcium channel blockers
Second and 3rd° heart block, bradycardia, and CHF are all contra indications for what type of hypertension medication
Calcium channel blockers
Dry hacking cough and hyperkalemia and angioedema are all side effects of
ACE and ARB
Moderate to severe kidney disease is a contraindication for what type of Hypertension medication
ACE and ARB
If a patient has renal artery stenosis what type of antihypertensive medication cannot be given
ACE or ARB
What type of antihypertensive medication has a favorable affect on osteopenia and osteoporosis
Thiazide diuretic such as HCTZ
Can a thiazide diuretics be given to a patient that is allergic to sulfa
No
Hyperglycemia, hyperuricemia i.e. can precipitate a gout attack, hypertriglyceridemia and hyper cholesterolemia, hypokalemia, hyponatremia are all side effects of
Thiazide diuretics
Hydrochlorothiazide, Chlorothalidone, and Indapamide are all
Thiazide diuretics
Neovascularization, microaneurysms, hard exudates, cotton wool spots are all what condition in the eye
Diabetic retinopathy
What can happen when you combine an ACR and a potassium sparing diuretic such as triamterene or spironolactone
Hyperkalemia
If a patient has bilateral renal artery stenosis what antihypertensive medication will precipitate in acute renal failure
ACE
Women with hypertension and osteopenia or osteoporosis should receive what medication
Thiazide diuretic
How does Thiazide diuretics help patients with osteopenia or osteoporosis
It helps bone loss by slowing down calcium loss from the bone and stimulating osteoclasts
If a patient has an ejection fraction less than 40% what do they have
Acute CHF
Crackles, bibasilar rales, cough, dyspnea, decreased breath sounds, dullness to percussion, paroxysmal nocturnal dyspnea, orthopnea, nocturnal nonproductive cough, and wheezing are all signs of
Left ventricular failure.
Jugular venous distention, enlarged spleen, enlarged liver, lower extremity edema with cool skin is indicative of
Right ventricular failure
If a chest X-ray Shows increased height size, interstitial and Alveolar edema, Kerley B lines, and other signs of pulmonary edema what is this indicative of
CHF
What test need to be ordered for patients with CHF
ECG, CPK, troponin, BNP, echocardiogram with Doppler flow study
The left-sided heart failure or is caused by what symptoms hint L as in
Lung
Can CHF cause DVT
Yes
A positive Homans sign is indicative of
DVT
When a patient has lower leg pain on dorsiflexion of the foot what is this test
Homans sign
What lab do you order for a patient with DVT
CBC, platelets, clotting time, PT, PTT, INR, chest x-ray, EKG
What is the gold standard test for DVT
Contrast venography
What medication is a patient with DVT put on
Blood thinner such is warfarin PO
Inflammation of a superficial vein due to local trauma . Higher risk if indwelling catheter’s, IV drugs, secondary bacterial infection
Superficial thrombophlebitis
An adult complains of an acute onset of an indurated vein localized redness, swelling, and tenderness. Usually located on the extremities. The patient is afebrile with normal vital signs.
Superficial thrombophlebitis
What is the treatment plan for superficial thrombophlebitis
NSAIDs such as ibuprofen or naproxen b.i.d. Warm compresses. Elevate limb. If septic admitted to hospital
Hypertension, smoking, diabetes, and hyperlipidemia are all higher risk factors for
PVD or Peripheral Artery Disease
What is the treatment plan for peripheral vascular disease or peripheral arterial disease
Ankle and brachial blood pressure before and after exercise. Order a Doppler ultrasound flow study. Smoking cessation and daily ambulation Exercises.
What is the gold standard for diagnosis of peripheral vascular disease or peripheral arterial disease
Angiography
Gangrene of the foot and or lower limb with amputation, increased risk of CAD, and increased risk of carotid plaquing are all complications of
Peripheral Vascular Disease or Peripheral Arterial Disease
Reversible vasospasm Of the peripheral arterioles On the fingers and toes. Unknown etiology. Associated with an increased risk of autoimmune disorders. Most patients are female with the gender of 8 to 1.
Reynauds phenomenon
What is the treatment plan for Reynauds phenomenon
Avoid touching cold objects, cold weather. Avoid stimulants i.e. caffeine. Smoking sensation. Calcium channel blocker‘s can be used such as amlodipine or Nifidepine. Do not use any vasoconstricting drugs such as Imitrex, ergots, Psuedoephedrine, decongestant or amphetamines. Avoid nonselective beta blocker’s.
Middle-aged male presents with fever, chills, malaise that is associated with sub ungual hemorrhages i.e. splinter hemorrhages on the nail bed and tender violet colored nodules on the fingers and or the toes i.e. Osler nodes. Palms and soles may have tender red spots on the skin i.e. Janeway lesions. Some may have heart murmur.
Bacterial endocarditis
What is the treatment plan for bacterial endocarditis
Referred to cardiologist or ED for hospitalization. Blood cultures within the first 24 hours times three. CBC and sedimentation rate
What health conditions need endocarditis prophylaxis
Previous history of bacterial endocarditis, prosthetic valves, certain types of congenital heart disease, cardiac transplant with valvulopathy
What medication should be getting for endocarditis prophylaxis
Amoxicillin and with penicillin allergy clindamycin or Keflex
What are Statin drug interactions that create a high-risk for rhabdomyolysis
Grapefruit juice, other fibrates, antifungal, macrolides, amiodarone, and calcium channel blocker’s such as amlodipine verapamil and diltiazem
What labs must be taken for starting statins
Baseline LFTs and periodically. Recheck lipids in three months then six months during the first year of therapy
Acute breakdown of skeletal muscle will cause acute renal failure. Triad of muscle pain, weakness, and dark urine. Look for muscle pain and aches that persist.
Rhabdomyolysis
What labs should be ordered in suspected rhabdomyolysis
Creatinine kinase which will be elevated, urine which will be reddish brown in color and protein urea will be found. Other labs are urinanalysis, BUN, creatinine, potassium and electrolytes, EKG
Anorexia, nausea, dark colored urine, jaundice, fatigue, and flu like symptoms are all signs of
Acute drug induced hepatitis
What labs would be elevated in a cute drug induced hepatitis
ALT and AST
What patient education is important for acute drug-induced hepatitis
Minimize alcohol intake or other hepatotoxic substances while on statins, avoid prescribing to alcoholics, advise patient to report symptoms of hepatitis or rhabdomyolysis. If Present, tell patient to stop the drug and call or go to the ED
Low HDL less than 40 mg is a risk factor for
Congestive heart disease
What diet can lower triglycerides
Reduce intake of simple carbohydrates, junk foods, and fried foods
Increasing aerobic type exercises can increase
HDL
If a patient on a statin complains of muscular pain with dark colored urine what must be ruled out
Rhabdomyolysis
Abdominal obesity, hypertension, and hyperlipidemia our criteria for diagnosing
Metabolic syndrome
A BMI of 18.5 to 24.9 is considered
Normal weight
A BMI of 25 to 29.9 is considered
Overweight
A BMI of 30 to 39.9 is considered
Obese
Caused by triglyceride fat deposits in the hepatocytes of the liver. And asymptomatic and reversible condition.
Fatty liver or steatosis
Obesity, diabetes, metabolic syndrome, hypertension, and certain drugs are all risk factors for
Fatty liver or steatosis
Usually asymptomatic. Annual PE labs will show slight elevation of ALT and AST. Hepatitis A, B, and C profile is negative or obese female complains of fatigue and malaise with vague Right upper quadrant pain. Associated with obesity, metabolic syndrome, diabetes, and hyperlipidemia
Fatty liver or steatosis
What is the gold standard for fatty liver or steatosis diagnosis
Liver biopsy
What is the treatment plan for fatty liver or steatosis
Lose weight, exercise and watch diet. Discontinue alcohol intake permanently. Avoid hepatotoxic drugs such as acetaminophen, isoniazid and statins. Recommend vaccination for hepatitis a and B and recommend flu vaccine.
For males what is the waist Circumference that is associated with abdominal obesity
Greater than 40 inches
For females what is the waist circumference that is associated with obesity
Greater than 35 inches
How do you calculate BMI
Wait in kilometers divided by height in meters squared
A Person with a BMI of 27 is considered
Overweight initiate lifestyle education
First line treatment for overweight patient is
Lifestyle modification i.e. diet, nutrition, exercise
How long should a patient fast before being screened for hyperlipidemia via blood
12 to 14 hours
Swelling, pain, and discoloration in the lower extremity are symptoms of
DVT
A common early finding in patients who have chronic aortic regurgitation is
An hypertrophied left ventricle
What drug would be a good choice for reducing morbidity and mortality in mild heart failure
Beta blocker
An Ace Inhibitor should be discontinued immediately if
Pregnancy occurs
A patient taking an ace inhibitor should avoid
Potassium supplements
This term is used to describe healthcare providers who fail to intensify therapy despite patients not reaching their goal
Clinical inertia
What medications need to be stopped prior to cardiac catheterization
NSAIDs, Furosemide, Metformin
What diagnostic test has the highest sensitivity for diagnosing heart failure
BNP
What medication can have an unfavorable affect on a hypertensive patients blood pressure
NSAIDs
After a patient has a myocardial event what medications should be prescribed if there was not any contraindications
ACE, ASA, beta blocker and satin
What is a non-modifiable risk factor for PAD
Diabetes
What are the three most common ailments in older adults
Hearing loss, hypertension, arthritis
A young child has a grade 4 murmur. How should this be managed
The child should be referred to cardiology
How would you describe the cough that is associated with heart failure
It is wet and worse with recumbence
A 25-year-old patient has aortic stenosis. The ideology is probably
Congenital
The most common indicator of end organ damage in adolescents with hypertension is
Left ventricular hypertrophy
If a patient is lipids are elevated what serum study should be ordered
TSH
What class of medication is frequently used to improve long-term outcomes in patients with systolic dysfunction
Ace inhibitors
The carotid artery’s are auscultated for bruits because
This is indicative of generalized arthrosclerosis
What medications can decrease INR in a patient who takes warfarin
Sucralfate and cholestyramine
The most common arrhythmia resulting from valvular heart disease is
Atrial fib
The valve was commonly involved in chronic rheumatic heart disease is the
Mitral valve
What antihypertensive medication is contraindicated in patients with heart failure
Calcium channel blocker’s
What is the most common arrhythmia associated with mitral regurgitation
A fib
What characterizes a patient who has aortic regurgitation
Long asymptomatic period, Followed by exercise intolerance then dyspnea at rest
When auscultating the heart for aortic insufficiency ask the patient to
Sit up, lean forward, and exhale
What type of murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left Midclavicular line
Tricuspid regurgitation
When auscultating the heart S one sound is located at the apex of the heart and signifies
Closure of the mitral and tricuspid valve
Chest pain described as persistent, sharp, and knife like is characteristic of
Pericarditis and pleuritic pain
Deep cervical lymph nodes drain lymphatic fluid from the
Head and the neck
Absent or diminished pulses in the rest could be indicative of
Arterial occlusive disease
This murmur produces a soft intensity with a crescendo – decrescendo pitch
Pulmonic stenosis
A patient with Cirrhosis develops portal hypertension by the presence of
Splenomegaly
In order to bring the ventricular apex closer to the chest wall when assessing the point of maximal impulse ask the patient to
Turn to the left side
To assess a murmur of aortic insufficiency he position the patient
Sitting leaning forward
A patient suspected of having chronic venous insufficiency he may present with
A brownish discoloration just above the malleolus
The anterior mediastinal lymph nodes drain lymphatic fluid from the
Thymus, thyroid gland and the anterior part of the pericardium
When performing a cardiovascular assessment on a healthy two-year-old child
Auscultate the heart sounds in all four cardiac areas
Symptoms of acrocyanosis in the newborn include
Bluish color of the feet
A condition that presents with symptomatic limb ischemia upon exertion is termed
Atherosclerotic Peripheral vascular disease
A pediatric patient presents with erythema marginatum, chorea, and heart murmur. This is indicative of
Rheumatic heart disease
A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the neck is usually associated with
Aortic dissection
Characteristic symptoms of chronic venous insufficiency he may include
Petechiae leading to brown pigmentation noted over the feet
Intermittent claudication is associated with
Chronic arterial insufficiency
The classic signs of tetralogy of fallot are
Ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy
What kind of diuretics can produce decreased potassium levels
Loop diuretics such as furosemide (Lasix)
If a patient’s feet up appear pale on elevation and dusky red on dependency what is this indicative of
Chronic arterial insufficiency
The superior and inferior mesenteric lymph nodes drain lymphatic fluid from the
Small and large intestines
Enlarged or tender lymph nodes are most associated with
Infection and it’s nearby draining area
A three week old infant presents with a generalized Lacy, reticulated blue discoloration of the skin. This is indicative of
Cutis marmorata
The posterior chest wall and portions of the arms are drained by which group of lymph nodes
Sub scapular nodes
The lymphatic duct drain into the
Venous system
Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet maybe seen with
Neurogenic claudication
The anterior cervical lymph node chain is located anterior and
Superficial to the sternomastoid muscle
A third heart sound is audible in a 45-year-old. This S3 sound maybe
A sign of valvular heart disease
The internal iliac lymph nodes drain fluid from the
Gluteal region
Hiccoughs are associated with
Pacemaker failure
Which lymph nodes receive lymphatic fluid from the stomach, duodenum, liver, gallbladder, and pancreas
Hepatic lymph nodes
Cervical lymphadenopathy, bilateral nonpurulent conjunctivitis, Periungual desquamation, and polymorphous rash are all symptoms of
Kawasaki disease
A widened pulse pressure greater than or equal to 60 in an older adult is a risk factor for cardiovascular disease, stroke, and
Renal disease
The great saphenous vein enters the deep venous system by way of the
Femoral vein
In older adults the presence of heart sound S4 suggests
Hypertension
The heart sound S2 is caused by
Closure of the semi lunar valve’s
-pril
Ace inhibitor
A healthy 50-year-old patient presents to the clinic for a routine physical examination. He has no significance personal or family history of clinical heart disease. What should be part of his CV assessment
Blood pressure only
The most effective intervention to prevent stroke is
Smoking cessation and treatment of hypertension
A 49-year-old Hispanic female has a blood pressure of 145/95 during a routine annual evaluation. She has no previous history of hypertension. She takes a Statin for dyslipidemia. How should the NP proceed with this patient
The patient’s blood pressure should be checked in about 2 to 4 weeks
An expected finding in a patient with long-standing poorly controlled hypertension is
Laterally displaced apical impulse
What constitutes as stage two hypertension
Systolic greater than 160 over diastolic greater than 100
A patient’s chief complaint is abdominal pain. What can mistakingly be associated with abdominal pain
Chest pain
A patient with no significant medical history has varicose vein’s. She complains of aching legs. The intervention that will provide the greatest relief for her would be
Elevate her legs periodically
There are several different classes of innocent heart murmur’s in children. A vibratory murmur (Stills murmur) is defected in what age group?
Usually detected at 8 to 14 years old
Can a CBC be used to confirm a diagnosis of congestive heart disease
No
Any condition or substance such as hyperthyroidism or caffeine that irritates or overstimulates the heart can cause what condition
Atrial fib
