CV 2

Question 1

systolic murmurs mnemonic

Answer 1

MR PM AS MVP
mitral regur
physiologic murmur
aortic stenosis
MVP

Question 2

only the ____ murmurs radiate

Answer 2

systolic

Question 3

where does MR radiate to

Answer 3

axilla

Question 4

where does AS radiate to

Answer 4

neck

Question 5

risk factors for bacterial endocarditis include
7

Answer 5

older age > 60
male sex
infection drug use
poor dentition or dental infection
heart disease
chronic HD
HIV infection

Question 6

classic case for bacterial endocarditis

Answer 6

adult male presents with fever, chills, anorexia, weight loss, malaise, and subungual hemorrhages

Question 7

bacterial endocarditis CBC findings

Answer 7

elevated WBC
elevated ESR

Question 8

bacterial endocarditis dx tools include
2

Answer 8

microbiologic data w/ BCs
echo

Question 9

endocarditis prophylaxis - preferred oral regimen before procedure

Answer 9

give 1 hour before procedure - amoxicillin 2 g PO x 1 dose

Question 10

considerations for endocarditis prophylaxis - high risk conditions
5

Answer 10

1. prosthetic heart valves or prosthetic valve repair material
2. previous hx or recurrent bacterial endocarditis
3. implanted durable mechanical circulatory support device
4. cardiac transplant
5. certain types of congenital heart disease

Question 11

endocarditis prophylaxis - w/ penicillin allergy oral regimen before procedure

Answer 11

oral cephalexin or clarithromycin

Question 12

red macules on palms/soles but not painful

Answer 12

janeway lesions

Question 13

painful nodes found mostly on pads of the fingers and toes

Answer 13

osler nodes

Question 14

a fib dx evaluation includes
7

Answer 14

EKG
TSH
serum electrolytes
renal function
B-TNP
Troponin
digoxin level (if on dig)

Question 15

A fib - for rate control use what
3

Answer 15

beta blockers
CCBs
digoxin

Question 16

a fib - for rhythm control use what to maintain normal sinus rhythm

Answer 16

amiodarone

Question 17

a fib - agent of choice for coagulation in patients with severe MS and mechanical heart valves

Answer 17

warfarin

Question 18

warfarin target INR

Answer 18

2-3

Question 19

warfarin initial dose for average adults and for sensitive patients

Answer 19

5 mg or 2.5 mg

Question 20

warfarin - full anticoagulation effect can take how long, check INR when

Answer 20

can take 3 days; check INR every 2-3 days until therapeutic for 2 consecutive checks, then weekly; check every 4 weeks when stable

Question 21

a fib - you can take clopidogrel/Plavix how

Answer 21

alone or in combo with ASA or other anticoags, may be better tolerated but are less effective than others

Question 22

a fib on warfarin - INR 4.01-4.99 do what

Answer 22

hold one dose of warfarin ; do not give vitamin K

Question 23

drug classes/meds that can interact with warfarin and increase INR
10

Answer 23

glucocorticoids
SSRIs
fluoroquinolones
macrolides
PNCs
azole antifungals
statins
tramadol
Bactrim
fenofibrate

Question 24

on warfarin - INR < 4.5

Answer 24

skin next dose and/or reduce slightly the maintenance dose; check INR 1-2 x week when adjusting dose

Question 25

on warfarin, INR 4.5-10 - do what

Answer 25

hold 1-2 doses, w/ or w/o administration of low dose oral vitamin K; decrease maintenance dose

Question 26

a proximal DVT is a thrombus in what veins
3

Answer 26

popliteal
femoral
iliac

Question 27

a distal DVT refers to a thrombus where

Answer 27

in the calf veins

Question 28

virchow triad proposes that VTE occurs as a result of

Answer 28

1. alterations in blood flow
2. alterations in blood components
3. vascular endothelial injury (e.g. cell injury from SARS-CoV-2)

Question 29

DVT dx to order
6

Answer 29

CBC
platelets
clotting time (PT/PTT, INR)
D dimer
chest x ray
EKG

Question 30

dx test for choice for DVT

Answer 30

compression US w/ doppler

Question 31

DVT treatment options
4

Answer 31

1. low molecular weight heparin (enoxaprin/Lovenox)
2. heparin SQ
3. warfarin PO (Coumadin)
4. DOACs

Question 32

HF - pulmonary crackles, cough, dyspnea

Answer 32

left HF

Question 33

HF - paroxysmal nocturnal dyspnea, orthopnea

Answer 33

both right and left HF

Question 34

HF - dyspnea, abd distention

Answer 34

right HF

Question 35

HF - enlarged spleen and enlarged liver

Answer 35

right HF

Question 36

HF dx eval includes
7

Answer 36

1. chest x ray
2. 12 lead EKG
3. cardiac troponin T or I
4. BNP or NT proBNP
5. CMP
6. CBC
7. echo

Question 37

what is the definitive dx test for right HF

Answer 37

cardiac catheterization

Question 38

S3 heart sounds are a sign of ___ although what

Answer 38

sx of HF, although can be heard in pregnant people and children/young adults

Question 39

HFpEF tx plan

Answer 39

diuretic; if elevated BNP then SGLT2 inhibitor and a MRSA is recommended; add sacubitril-valsartan for poorly controlled HTN

Question 40

HFrEF tx plan

Answer 40

combo tx with diuretic, ACE or ARB or ARNI and a BB

Question 41

NYHA class - no limitation

Answer 41

class I

Question 42

NYHA class - ordinary physical activity results in fatigue, exertional dyspnea

Answer 42

class II

Question 43

NYHA class - marked limitation in physical activity

Answer 43

class III

Question 44

NYHA class - symptoms are present at rest with or without physical activity

Answer 44

class IV

Question 45

first line med for stable HF is

Answer 45

ACEI or ARB