CM

Question 1

Rheumatic fever, HD- Eti

Answer 1

• Uncommon in US, rate before 4, after 40.

- Age 5-15

Question 2

Rheumatic fever, HD- Sx

Answer 2

• Fever: 2-3 weeks post infection
• Carditis
• Carey-coombs mid-diastolic murmur
• Erythema marginatum- ringed macule
• subcutaneous nodules
• polyarthritis
• Sydenham chorea- involuntary mvmnt of face, tongue, arms

Question 3

Rheumatic fever, HD- Dx

Answer 3

• Jones criteria + strep infection
• ESR indicates inflammation
• Increasing titers of antistrep Abs

Question 4

Rheumatic fever, HD- Tx

Answer 4

• Rest until pulse, ESG, ECG normalize

- Salcylates (aspirin), penicillin, prednisone

Question 5

Jones Criteria:

Answer 5

1 required + 2 major + 0 minor OR 1 required +1 major + 2 minor

Question 6

Jones criteria- Required

Answer 6

Evidence of antecedent Strep. infection- Abs, culture, scarlet fever

Question 7

Jones criteria- Major

Answer 7

• Carditis
• Polyarthritis
• Chorea
• Erythema marginatum
• Subq nodules

Question 8

Jones criteria- Minor

Answer 8

• Fever
• Arthralgia
• Prev rheumatic
• Acute phase reactants- ESR, CRP, leukocytosis
• Prolonged PR interval

Question 9

Rheumatic Heart Disease

Answer 9

• Rigidity and deformity of valve cusps
• Valvular stenosis and/or regurg
• Mitral, aortic, tricuspid- rarely pulm.

Question 10

NY HF classification-

Answer 10

Classify extent of heart failure based on physical activity, angina & SOB

Question 11

NY HF- Stage 1

Answer 11

Cardiac disease, no symptoms, limitations

Question 12

NY HF- Stage 2

Answer 12

Mild SOB, angina, slight limit with activity

Question 13

NY HF- Stage 3

Answer 13

Marked angina due to symptoms, comfortable only at rest

Question 14

NY HF- Stage 4

Answer 14

Severe limitations. Symptoms at rest, bed bound

Question 15

Left heart failure

Answer 15

• Due to systolic or diastolic dysfunction
• Low cardiac output, congestion,
• Dyspnea: Elevated pulm venous pressure

Question 16

Right heart failure

Answer 16

• Secondary to left
• Sx of fluid overload- edema, hepatic congestion
• LV dysfunction

Question 17

CHF- Eti

Answer 17

• Very common- >65 yo

- Primarily due to post-MI, excessive preload

Question 18

CHF- Sx

Answer 18

• Dyspnea- varies with severity
• Nocturia
• Chronic cough
• Edema
• Pleural effusion
• Parasternal lift

Question 19

CHF- Dx

Answer 19

• BNP
• ECG
• Echo

Question 20

CHF- Tx

Answer 20

Systolic: Diuretic + ACE/ARB + beta blocker
Moderate salt
-Diastolic: diuretics + HTN mgmt

Question 21

Systolic HF

Answer 21

CAD + MI

Question 22

Diastolic HF

Answer 22

LV hypertrophy due to HTN, cardiomyopathy, DM

Question 23

Sick sinus syndrome- ETI

Answer 23

• Elderly
• Concomitant a-fib
• Caused by drug therapy
• Recurrent SVA, bradyarrthymia

Question 24

Sick sinus syndrome-Sx

Answer 24

• Asymptomatic

- Syncope, dizziness, confusion, palpitations, HF, angina that coincides with arrthymia

Question 25

Sick sinus syndrome-Tx

Answer 25

• Permanent pacing