cards

Question 1

S4 gallop

Answer 1

diastolic HF (ejection fraction is usually normal). sounds made when LA trying to push blood into an hypertrophic LV

Question 2

S3

Answer 2

Systolic HF (reduced EF) with volume overload - tachycardia, tachypnea. the sound of blood splashing into the a dilated ventrile

Question 3

what are the classifications for the NYH failure?

Answer 3

Class I: No limitations, no sxs with activity
Class II: comfortable at rest but slight limitation with normal activity.
Class III: marked limitation. only comfortable at rest. sxs with less than normal activities.
Class IV: sxs at rest unable to perform normal activities.

Question 4

findings of pulmonary congestion on Chest-X ray?

Answer 4

Cephalization of pulmonary vessels & Kerley B lines

Question 5

Most common causes of left-side heart failure?

Answer 5

CAD and HTN

Question 6

What is the EF of systolic heart failure?

Answer 6

HFrEF: EF <40%

Question 7

What is the EF of diastolic heart failure?

Answer 7

HFpEF: EF >50%

Question 8

What is the long-term treatment for Heart failure

Answer 8

1) Diuretic
2) ARNI (sacubitril-valsartan). ARB or ACE-I
3) Beta Blocker

Question 9

Lifestyle modifications for heart failure

Answer 9

Decrease sodium to 2 grams per day
Fluid <2 L per day

Question 10

What is the treatment for acute HF exacerbation? (LMNOP)

Answer 10

Laxis
Morphine (reduce preload)
NTG (reduce preload + pulmonary congestion)
Oxygen
Position (upright position reduce venous return)

Question 11

What is the primary cause of coronary artery disease?

Answer 11

Atherosclerotic occlusion of the coronary arteries

Question 12

What disease is considered a CAD equivalent?

Answer 12

Diabetes mellitus

Question 13

What is stable angina?

Answer 13

predictable; presents with a consistent amount of exertion
the patient can achieve relief with rest or nitroglycerin

Question 14

Who should routinely get Aspirin for primary prevention of CVD?

Answer 14

10yr risk >20% in nondiabetics
10yr CVD risk >10% in DM pts

Question 15

What is endocarditis?

Answer 15

Inflammation of the lining or valves of the heart caused by the presence of bacteria in the bloodstream

Question 16

What is acute endocarditis?

Answer 16

Infection of normal valves with a highly virulent organism, Staph Aureus

Question 17

Risk factor reduction of CAD

Answer 17

Smoking cessation
HTN goal <140/90
LDL goal <70
A1c goal <7.0%
ASA

Question 18

Most common valves affected in Endocarditis?

Answer 18

Mitral valve

Question 19

Subacute Bacterial Endocarditis

Answer 19

Infection of abnormal valves w a less virulent organism, strep viridans

Question 20

Presentation of endocarditis

Answer 20

FROM JANE
FEVER
Roth spot(round retinal hemorrhages w pale centers)
Osler nodes (ouch)
MURMUR (new or change murmur)
Janeway lesions (non tender)
Anemia
Nailbed hemorrhage
Embolic (strokes, glomerulonephritis)

Question 21

Duke’s Criteria

Answer 21

Definite: 2 major or 1 major & 3 minor or 5 minor
Possible: 1 major + 1 minor or 3 minor

Question 22

Duke’s Major Criteria

Answer 22

1) pos x2 blood cultures
2) Echocardiogram: vegetations seen (tricuspid IV drug users, mitral valve non-drug users), abscess, new murmur

Question 23

Duke’s minor criteria

Answer 23

1)predisposition (IVDU, prosthetic valve, regurgitation)
2) Fever 100.5
3) Vascular phenomena (septic emboli, Janeway lesion, conjunctival hemorrhage)
4) immunologic phenomena Glomerulonephritis, Osler nose, Roth spots
5) + blood cultures not meeting major criteria

Question 24

treatment of endocarditis

Answer 24

IV vancomycin or ampicillin/sulbactam PLUS aminoglycoside
add rifampin if prosthetic valve.

Question 25

Four groups most likely to benefit from statin therapy

Answer 25

Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)
Patients with primary LDL-C levels of 190 mg per dL or greater
Patients WITH diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL
Patients WITHOUT diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%

Question 26

High intensity Statin

Answer 26

Atorvastation 40-80 mg
Rosuvastatin 20-40 mg

Question 27

Moderate intensity statin

Answer 27

Atorvastatin 10-20mg
Rosuvastatin 5-10 mg

Question 28

Hypertensive retinopathy (formerly called malignant HTN)

Answer 28

Characterized by retinal hemorrhages, exudates, and papilledema

Question 29

Treatment: Hypertensive urgency

Answer 29

clonidine (drug of choice)

Question 30

Treatment: Hypertensive emergency

Answer 30

sodium nitroprusside (drug of choice)

Question 31

Diagnosis of Peripheral Arterial disease.

Answer 31

Ankle-brachial index
*ABI </=0.9 pos for PAD

> 1.4 = incompressible calcified
normal 1-1.4

Question 32

PAD treatment

Answer 32

1st line: structured exercise therapy, smoking cessation & aspirin

Cilostazol is 1st line medication tx.

Question 33

PAD physcial exam findings

Answer 33

hair loss, shiny skin, muscle atrophy, brittle nails

Question 34

PAD ulcers

Answer 34

punched-out appearance located on the lateral malleolus

Question 35

symptoms of chronic venous disease

Answer 35

LE heavines, aching, cramping ot edema associated with prolonged standing, sitting w feet dependent & relieved with ambulation & leg elevation

Question 36

Chronic venosu disease physical exam

Answer 36

varicose veins, brown/blue gray hyperpigmentation, statsis dermatitis (itching, eczematic rash)

Question 37

Chronic venous ulcer

Answer 37

shallow w irregular borders w exudation located above the medial malleolus