Diagnosis and Management of Cardiovascular Disorder

Question 1

What are the semilunar valves?

Answer 1

Pulmonic Valve and Aortic Valve

Question 2

What are the AV valves?

Answer 2

Tricuspid Valve and Mitral Valve

Question 3

Heart sound that exemplifies increased fluid states (i.e. HF, pregnancy)

Answer 3

S3

Question 4

Heart sounds that exemplifies stiff ventricular wall (MI, LVH, Chronic HTN)

Answer 4

S4

Question 5

Rate the murmur: moderately loud, easily heard

Answer 5

III/VI

Question 6

Rate the murmur: Audible but faint

Answer 6

II/VI

Question 7

Rate the murmur:
Loud; associated with a thrill

Answer 7

IV/VI

Question 8

Rate the murmur: very loud; heard with one corner of stethoscope off the chest wall

Answer 8

V/VI

Question 9

Systolic mumur at 5th ICS MCL (apex)

Answer 9

Mitral Regurgitation

Question 10

Systolic, “blowing,” rough, harsh murmur at 2nd right ICS usually radiating to the neck

Answer 10

Aortic stenois

Question 11

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

Answer 11

Mitral stenosis

Question 12

Diastolic, “blowing” murmur at 2nd left ICS

Answer 12

Aortic regurgitation

Question 13

Inability to contract results in decreased cardiac output (HFrEF, HFpEF, and or diastolic systolic failure)

Answer 13

HFrEF, systolic failure

Question 14

Inability to relax and fill results in decreased cardiac output (HFrEF, HFpEF, and or diastolic systolic failure)

Answer 14

HFpEF, diastolic failure

Question 15

left or right HF: S3 gallop, murmur of mitral regurgitation

Answer 15

Left Failure

Question 16

left or right HF: frothy cough, appears generally healthy, except for the acute event

Answer 16

Left Failure

Question 17

left or right HF: JVD, S3 and/or S4, paroxysmal nocturnal dyspnea

Answer 17

Right failure

Question 18

what class of NYHA functional classification of the heart failure is this?
Marked limitation of physical activity but comfortable at rest

Answer 18

NYHA Class III

Question 19

what class of NYHA functional classification of the heart failure is this?
Inability to carry out any physical activity without discomfort (s/s while at rest).

Answer 19

NYHA IV

Question 20

what class of NYHA functional classification of the heart failure is this?
Slight limitations of physical activity but comfortable at rest

Answer 20

NYHA II

Question 21

what class of NYHA functional classification of the heart failure is this?
No limitations of physical activity

Answer 21

NYHA I

Question 22

Lab/Diagnostics for HF?

Answer 22

Hypoxemia and hypocapnia, BMP, BNP, UA, chest xray, Echo, ECG, pulmonary function tests for wheezing

Question 23

Management for Hypertension Non-African American

Answer 23

• Thiazide diuretic
• ACEI
• ARB
• CCB

Question 24

Management for Hypertension African American

Answer 24

• Thiazide diuretics
• CCB

Question 25

Management for Hypertension Diabetic

Answer 25

ACEI or ARB

Question 26

Management for > or equal with CKD

Answer 26

ACEI

Question 27

What HTN drug is recommended as first line?

Answer 27

Thiazide-type diuretics

Question 28

What is angina?

Answer 28

Decreased blood flow through the vessel leads to tissue ischemia

Question 29

What type of angina occurs at various times, including rest

Answer 29

Prinzmetal's (variant/vasospastic)

Question 30

What are the criteria of unstable angina?

Answer 30

(1) occur at rest; (2) become more frequent, severe, or prolonged than the usual pattern of angina; (3) change from the usual pattern of angina; or (4) not respond to rest or nitroglycerin

Question 31

Physical exam finding for angina

Answer 31

Levine's sign

Question 32

"clenched fist sign"

Answer 32

physical finding for angina

Question 33

EKG representation of myocardial ischemia

Answer 33

ST-depression

Question 34

Goal for LDL for patients with DM or CAD

Answer 34

<70

Question 35

Goal of HDL

Answer 35

>60

Question 36

Management for angina

Answer 36

1. reduction of risk factors when possible 2. manage diet (low saturated fats and low unsaturated fats) 3. Low dose enteric coated ASA 4. pharmacotherapy 5. optimize lipid panel 6. Statin therapy

Question 37

Pharmacotherapy for angina

Answer 37

nitrates, BB, CCB

Question 38

Who may benefit from statin therapy?

Answer 38

- clinical evidence of ASCVD - LDL >190 - DM 40 - 75 years of age with LDL between 70-189 without clinical evidence of ASCVD - Without DM or hyperlipidemia, but with an estimated 10-year ASCVD risk of 7.5% or highter

Question 39

What agents could be used other than HMG-CoA reductase inhibitors?

Answer 39

- bile acid sequestrants (low LDL, may increase triglycerides) - fibrates (low triglycerides, slightly low LDL and possibly increase HDL) - Cholesterol absorption inhibitor (used in combo with statin to lower LDL) - Niacin (lower LDL and triglycerides and increase HDL)

Question 40

Example of cholesterol absorption inhibitor

Answer 40

Ezetimibe (Zetia)

Question 41

what is the disease of "clot on plaque"

Answer 41

MI/ACS

Question 42

Which leads are the lateral leads

Answer 42

I and aVL

Question 43

which leads are anterior

Answer 43

V3 and V4

Question 44

which leads are inferior

Answer 44

III, II, AVF

Question 45

What are ECG changes that may be noted

Answer 45

Peaked T waves, ST elevations, Q wave development

Question 46

What enzymes are elevated during an MI or ACS?

Answer 46

troponin T, toponin I (cardiac selective), and CK-MB (cardio selective)

Question 47

Indications for pharmacologic revascularization

Answer 47

1. unrelieved chest pain (>30 minutes and <6 hours) WITH 2. ST segment elevation in two or more contiguous leads

Question 48

ABSOLUTE CONTRAINDICATIONS TO REVASCULARIZATION

Answer 48

active bleeding or risk thereof, including abnormal coagulation values

Question 49

What is the most common cause of pericarditis

Answer 49

virus

Question 50

s/s" Very localized retrosternal/precordial chest pain

Answer 50

pericarditis

Question 51

s/s: pleuritic pain

Answer 51

pericarditis

Question 52

s/s: SOB secondary to pain with inspiration, pain increased by deep inspiration, coughing, swallowing, or recumbent

Answer 52

pericarditis

Question 53

s/s: pain relieved by sitting forward

Answer 53

pericarditis

Question 54

Pericardial friction rub

Answer 54

pericarditis

Question 55

ST segment elevation in all leads, return of ST segment to normal in few days/ depression of PR segment

Answer 55

pericarditis

Question 56

Management of pericarditis

Answer 56

NSAIDS, corticosteroids (only when there is a total failure of high dose NSAIDs over several weeks and with relapsing pericarditis bx it can increase viral replication), abx (if bacterial infection)

Question 57

hypotension, JVD, muffled/distant heart sounds, pulsus paradoxus

Answer 57

tamponade

Question 58

dependent rubor, ulcerations, pallor

Answer 58

PVD

Question 59

statis leg ulcers, trophic changes with brownish discoloration

Answer 59

Chronic venous insufficiciency

Question 60

when would we use ankle-branchial index (ABI)?

Answer 60

diagnostic test for PVD

Question 61

what is the most definitive test for PVD

Answer 61

anteriography

Question 62

aching of the lower extremities relieved by elevation

Answer 62

chronic venous insufficiency

Question 63

night cramps of the lower extremities. edema after prolonged standing

Answer 63

chronic venous insufficiency

Question 64

c/o calf pain (claudication)

Answer 64

PVD

Question 65

cold/numbness to extremities, progresses to pain at night

Answer 65

PVD

Question 66

risk factors for PVD

Answer 66

1. HLD 2. Smoking 3. DM

Question 67

Management for PVD

Answer 67

1. stop all tobacco use 2. exercise (stop during pain and resume when pain subsides) 3. cilostazol in combo with aspirin/clopidogrel 4. weight reduction 5. manage DM and HLD 6. angioplasty 7. bypass surgery 8. amputation

Question 68

Manageemet for CVI

Answer 68

1. bed rest with legs elevated 2. support stockings 3. weight reduction in the obese 4. treat dermatitis or ulcers 5. acute weeping dermatitis - tap water compresses, hydrocolloid dressings, hydrocortisone cream

Question 69

in the elderly, what physiologic changes could cause syncope?

Answer 69

baroreceptors that monitor blood pressure become less sensitive

Question 70

geriatric: what are possible findings?

Answer 70

hypertension (increased risk for CVA, MI, and renal failure and/or dysrhythmias