Clinical Medicine part 2 Cardiac and Hematologic

Question 1

Signs/Symptoms of cardiac disease

Answer 1

Chest, neck or arm pain/discomfort-may radiate
Palpitations
Dyspnea
Syncope
Fatigue
Cough
Cyanosis

Question 2

Chest pain

Answer 2

angina

Question 3

angina cause

Answer 3

heart muscle does not get enough oxygen: symptom of CAD

Question 4

shortness of breath

Answer 4

dyspnea

Question 5

sudden SOB during night in supine

Answer 5

paroxysmal nocturnal dyspnea

Question 6

SOB during recumebncy

Answer 6

orthopnea

Question 7

pulmonary rehab components

Answer 7

ACTs, smoking cessation, exercise, nutrition and weight control, psychosocial, lifestyle modification

Question 8

fainting, light-headedness

Answer 8

syncope

Question 9

causes of dry cough in cardiac patients

Answer 9

left ventricular dysfunction, cardiac meds

Question 10

hallmark of right ventricular failure

Answer 10

peripheral edema

Question 11

cramping or leg pain with walking in PAD; relieved by rest

Answer 11

claudication (intermittent claudication)

Question 12

greatest risk factor for cardiovascular disease

Answer 12

age

Question 13

when are cardiovascular changes with age more apparent?

Answer 13

during exercise

Question 14

effect of age on max heart rate

Answer 14

decreases max HR

Question 15

Female heart differences

Answer 15

more prone to mitral valve prolapse,
smaller,
greater risk for serious arrhythmia,
estrogen has cardioprotective benefit
less likely to receive prevention/therapeutic strategies

Question 16

lousy cholesterol, carries cholesterol TO cells

Answer 16

LDL

Question 16

healthy cholesterol, carries cholesterol AWAY from cells

Answer 16

HDL

Question 17

Plaques of fatty deposits form in the inner layer (intima) of arteries

Answer 17

atherosclerosis

Question 18

drugs to lower LDL, increase HDL

Answer 18

statins

Question 19

atherosclerosis surgical interventions

Answer 19

PTCA, stents (also CABG and carotid endarterectomy)

Question 20

unstable angina types

Answer 20

nocturnal, variant, post-infarction

Question 21

most likely cause of angina

Answer 21

CAD

Question 22

words to describe angina

Answer 22

squeezing, burning, pressing, heartburn, indigestion, choking

Question 23

MOST hypertensive disease cause

Answer 23

idiopathic (primary, essential)

Question 24

MI symptoms for women

Answer 24

atypical, nocturnal SOB, chronic unexplained fatigue

Question 25

leading preventable cause of CAD

Answer 25

smoking

Question 26

elevated serum cholesterol level

Answer 26

>200mg/dL

Question 27

coronary artery disease

Answer 27

one or more coronary arteries becomes narrowed or blocked-areas of heart muscle supplied by that artery do not receive sufficient oxygen --resulting in injury and ischemia; infarction may result

Question 28

hollow, internal space within the blood vessel where blood flows

Answer 28

lumen

Question 29

Common complication of ischemic and hypertensive disease

Answer 29

congestive heart failure

Question 30

drugs in treatment of CHF

Answer 30

ACE inhibitors, diuretics, Beta blockers

Question 31

Decrease of 20mmHg or more systolic BP or drop of 10mmHg or more in both systolic/diastolic BP with concomitant pulse increase of 15 beats/min or more on position change

Answer 31

orthostatic hypotension

Question 32

sternal precautions (for 6 weeks or physician order)

Answer 32

no pulling/pushing/lifting >10 lbs, no pulling up in bed, no driving, hand-held assist OR wheeled walker with light hands for balance, use chest harness or splinting pillow, no horizontal abduction with external rotation

Question 33

2 factors that regulate blood pressure

Answer 33

blood flow (cardiac output) peripheral vascular resistance

Question 34

Drugs for hypertension that can cause dizziness

Answer 34

Beta blockers (-olol), diuretics such as Lasix (furosemide), alpha blockers (-zosin)

Question 35

clinical manifestations of orthostatic hypotension

Answer 35

dizziness, blurred vision, syncope older adults especially: falls/mobility issues, confusion, cardiac symptoms

Question 36

abdominal heartbeat in supine, dull ache in mid-abdominal left flank or lower back

Answer 36

abdominal aortic aneurysm

Question 37

One method to differentiate cardiac vs pulmonary dyspnea

Answer 37

If relieved by specific breathing patterns=pulmonary see p 250 Special Impl

Question 38

key to PVD management

Answer 38

prevention-risk factor reduction (what are the risk factors?)

Question 39

who is at risk for DVT (leading to possible PE)

Answer 39

history of recent DVT, surgeries (CABG, abdominal, major ortho) recent lower extremity fracture, CVA

Question 40

reliable and valid tool for diagnosis of DVT

Answer 40

Wells Clinical Decision Doppler duplex ultrasonography for rapid screening for mod-high risk

Question 41

prevention of DVT

Answer 41

early mobilization, prophylactic anticoagulants, anti-embolism stockings/pneumatic pressure devices, ankle pumping

Question 42

clinical manifestations of shock

Answer 42

tachycardia, increased respiratory rate, distended neck veins cold and clammy skin, altered consciousness

Question 43

inflammation of lymphatic vessel

Answer 43

lymphangitis

Question 44

increased amount of lymph

Answer 44

lymphedema

Question 45

painless enlargement of lymph nodes

Answer 45

lymphadenopathy

Question 46

anticoagulants for prevention of DVT post surgery

Answer 46

heparin (LMWH), then coumadin (warfarin)

Question 47

Most common site for myocardial infarction

Answer 47

left ventricle

Question 49

Clinical manifestations of MI

Answer 49

sudden sensation of pressure-crushing, may radiate to arms, throat, neck, back pallor SOB profuse sweating (diaphoresis) N&V

Question 50

anemia is a reduction in what

Answer 50

erythrocytes (red blood cells) or hemoglobin (carried on red blood cells, transports oxygen)

Question 51

Most common leukemia affecting children

Answer 51

acute lymphoblastic leukemia

Question 52

malignancy that increases the rate of cell division of plasma cells produced in bone marrow

Answer 52

Multiple myeloma

Question 53

Clinical manifestations of leukemia

Answer 53

anemia, infection, bleeding tendencies

Question 54

reduction in number of leukocytes below 5000/mL

Answer 54

leukopenia

Question 55

rapidly progressive malignant disease that results in the accumulation of immature, functionless, cells called blast cells in the bone marrow and blood that block the development of normal cell development

Answer 55

acute leukemia

Question 56

appropriate initial strengthening after a joint bleed in a patient with hemophilia (knee most common joint for a bleed)

Answer 56

isometrics (muscle setting)

Question 57

causes of CHF

Answer 57

valvular heart disease, cardiomyopathy, CAD, MI, HTN, myocarditis, chronic alcoholism

Question 58

Increased number of leukocytes in blood >10,000WBCs/mm3

Answer 58

leukocytosis