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1
Q

A S3 heart sound is associated with?

A

fluid overload

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2
Q

An S4 heart sound is associated with ?

A

hypertrophy- stiff ventricular wall

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3
Q

S4 sounds like?

A

Ten-nes-see

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4
Q

S3 sounds like?

A

Ken-tuck-y

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5
Q

Characteristics of a grade III murmur

A

moderately loud

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6
Q

Characteristics of a grade IV murmur

A

loud, associated with a thrill

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7
Q

Loud S1 murmur, low pitched, mid-diastolic; apical, “crescendo” rumble. Name the murmur.

A

mitral stenosis

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8
Q

S3 with systolic murmur at 5th ICS MCL; may radiate to base or left axilla; musical, blowing or high-pitched. Name the murmur

A

mitral regurg

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9
Q

Systolic, “blowing”, rough, harsh murmur at 2nd R ICS usu radiating to neck. Name the murmur.

A

aortic stenosis

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10
Q

Diastolic, “blowing” murmur at 2nd L ICS. Name the murmur.

A

aortic regurgitation

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11
Q

What murmurs occurs during systole?

A

aortic stenosis, mitral regurg

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12
Q

What murmurs occur during diastole?

A

mitral stenosis, aortic regurg

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13
Q

A patient with HF demonstrating marked limitations of physical activity but comfortable at rest would be classified as what NYHA class?

A

III

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14
Q

A patient with HF demonstrating inability to carry out any physical activity without discomfort (S&S at rest) would be classified as what NYHA class?

A

IV

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15
Q

A suboccipital pulsating HA occurring in the early am, may be indicative of?

A

severe HTN

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16
Q

According to JNC 7, normal BP should be?

A

<120/80

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17
Q

According to JNC 7, prehypertension is defined as?

A

SBP 120-139 OR DBP 80-89

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18
Q

According to JNC 7, stage 1 HTN is defined as?

A

SBP 140-159 OR 90-99

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19
Q

According to JNC 7, stage 2 HTN is defined as?

A

SBP >/= 160 OR DBP >/= 100

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20
Q

According to JNC 8, BP goal for those <60yr?

A

< 140/90

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21
Q

According to JNC 8, BP goal for those >60yr?

A

<150/90

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22
Q

First drug of choice for treatment of HTN in non-African American?

A

**thiazides ACEi CCB ARB

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23
Q

First drug of choice for treatment of HTN in African American?

A

*thiazide diuretics CCB

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24
Q

First drug of choice in treatment of HTN w/CKD/DM?

A

**ACEi (regardless of race or other medical conditions)

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25
Lab abnormalities a/w thiazide diuretics?
- hypokalemia - hypomagnesemia - hyponatremia - hyperglycemia - hypercalcemia
26
What allergy should you ascertain about if you are starting your patient on a thiazide diuretic?
sulfas
27
SE a/w ACEi's/ARBs
\*cough \*angioedema (more so with ACEI's) \*hyperkalemia rash renal impairment taste disturbances
28
SE of CCB's
HA, flushing, bradycardia
29
SE of BBs
dizziness bradycardia fatigue insomnia nausea heart block
30
Prazosin (minipress), terazosin (Hytrin), & Doxazosin (cardura) are of what medication class?
alpha 1 antagonists
31
SE of alpha 1 antagonists
orthostatic hypotension dry mouth dizziness HA
32
Clonidine (catapres) &; Methyldopa (aldomet) are of what medication class?
alpha 2 agonists
33
SE of alpha 1 agonists
dry mouth sedation depression HA bradycardia
34
Minoxidil (Loniten) is of what medication class?
vasodilator
35
HTN urgency definition
BP \>180/110 WO/end organ dysfunction
36
Management of HTN urgency
PO anti-hypertensives
37
HTN emergency definition
BP \>180/120 & impending/progressive end organ damage
38
papilledema
swelling of the optic disc w/blurred margins
39
BP goal when treating HTN emergency
IV agents (Cardene, Nipride) to decrease BP to SBP 160-180 OR DBP \<105 \*\*no more than 25% within minutes to 1-2hr, then gradually lowered over several days
40
Levines sign
"clenched fist sign"
41
normal total cholesterol
\<200
42
normal VLDL (triglycerides)
\<150
43
normal LDL
optimal \<100
44
normal HDL
low \<40mg/dl high \>/= 60mg/dl
45
LDL, HDL, & TG goal for patients w/DM or CAD
LDL: \<70 HDL: \>40 TG: \<150
46
what is the definitive diagnostic procedure for angina?
cardiac angiography
47
high intensity statins should lower LDL by how much?
\>/= 50%
48
Name and dose of high intensity statins
Atorvastatin (Lipitor) 40-80mg Rosuvastatin (Crestor) 20-40mg
49
When do cardiac enzymes rise after MI?
4-6hrs, remain high for several days
50
NL INR:
0.8-1.2sec
51
NL ACT time
70-120sec
52
NL ACT time post PTCA/stent
\>300
53
NL aPTT
28-38sec
54
NL PT
11-16sec
55
NL PTT
60-90sec
56
Indications for tPA revascularization with MI:
unrelieved CP (\>30min & \<6hr) + ST elevation \>0.1mV in 2 or more contiguous leads
57
Contraindications for tPA
- prior ICH - ischemic CVA wi/ 3 mon - intracranial or intraspinal sx wi/3 mon - significant closed head trauma or facial trauma wi/3mon - severe uncontrolled HTN \>185/110 - suspected aortic dissection - active bleeding, or risk thereof, including ABN coags - structural cerebral vascular lesion or malignant intracranial neoplasm
58
Treatment for DVT
lovenox 1mg/kg q12hr OR Heparin x 7-10d \*Coumadin therapy x 12 wk
59
Most common cause of PVD
atherosclerosis
60
Peak incidence of PVD
40-70yr
61
S&S of PVD
1st: c/o calf pain (claudication) - cold/numbness to extremities - progresses to pain at rest
62
Physical findings of PVD
shiny/hairless skin - dependent rubor (redness in dependent position) - \*reduced pulses - pallor - cyanosis - ulcerations
63
Diagnostic tests to diagnose PVD
Dopppler US \*\*ABI -anteriography
64
most definitive test to diagnose PVD
anteriography
65
Management of PVD
\*\*stop smoking -walk 1 hr/d--\> stop when painful, resume when pain subsides--\> develops collateral circulation
66
Pentoxifylline (Trental) and Cilostazol (Pletal) are medications used to treat what disease?
PVD
67
Chronic venous insufficiency (CVI) is more common in which gender?
women
68
S&S of CVI
- aching LE improved w/elevation - edema after prolonged swelling - night cramps of LE
69
Physical findings of CVI
- trophic changes w/discoloration - \*stasis leg ulcers - edema of LE - dermatitis may be common - cool to touch
70
Management of CVI
\*\*elevate legs to diminish edema - \*pneumatic compression stockings for acute weeping dermatitis: - wet compresses -0.5% hydrocortisone cream after compress -systemic abx only if bacterial infection
71
most common cause of pericarditis
viruses
72
Characteristics of pericarditis
localized retrosternal, pleuritic CP pain increased by deep inspiration, coughing, \*recumbent
73
S&S of endocarditis
fever & malaise night sweats weight loss general "sick" feeling
74
Key physical findings with endocarditis (8)
1. \*murmur (may be absent in up to 30%) 2. fever 3. osler nodes 4. petechiae, purpura, pallor 5. splinter hemorrhages 6. janeway lesions 7. roth spots 8. splenomegaly
75
painful, red nodules in the distal phalanges
osler nodes
76
small & NOT painful macules on the palms and soles
janeway lesions \*rarely observed
77
Diagnosis of Pericarditis
ST elevation in all leads \*depression of PR segment highly indicative of pericarditis \*\*inc ESR
78
Management of Pericarditis
\*\*NSAIDS -Ibuprofen 400-600mg q6-8hr - Indomethacin 25-50mg q8hr x 2 wk - corticosteroids -\*only when complete failure of NSAIDs - Codeine 15-60mg PO QID for pain \*\*monitor for tamponade
79
Diagnostic workup of Endocarditis
\*\*bandemia - ECHO to assess valves - BCx x3 (3 separate sites in 1 hr)
80
Management of Endocarditis
PCN G 2million units IV q4hr + Gent OR Naficillin 2g IV q4hr \*Vanco used for PCN-resistant strep or MRSA
81
treatment for venous stasis ulcer/ stasis dermatitis
compression stockings leg elevation

CV (1 decks)

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