Exam 2

Question 1

Upper right sternal border: which murmurs can be best heard here?

Answer 1

aortic valve clicks (AS), venous hum

Question 2

Upper left sternal border: which murmurs can be best heard here?

Answer 2

pulmonary valve clicks (PS), pulmonary flow murmurs, ASD, PDA, venous hum

Question 3

Lower left sternal border: which murmurs can be best heard here?

Answer 3

VSD, still’s murmur, tricuspid regurgitation, hypertrophic cardiomyopathy

Question 4

Erb point: which murmurs can be best heard here?

Answer 4

aortic ejection click (AS), dilated aortic root)

Question 5

Name the ECG

Answer 5

A Fib

Question 6

Name the ECG

Answer 6

atrial flutter

Question 7

Name the ECG

Answer 7

SVT

Question 8

Name the ECG

Answer 8

Ventricular tachycardia

Question 9

Name the ECG

Answer 9

Ventricular fibrillation

Question 10

What are the ECG changes that occur during an anginal episode (chronic or unstable)?

Answer 10

ST segment depressions w/ symmetric T wave inversions

Question 11

What ECG change distinguishes NSTEMI from angina?

Answer 11

ST depression longer than 48 hours

Question 12

What ECG change occurs in a STEMI?

Answer 12

persistent ST elevation

Question 13

Left or Right sided HF?

• paroxysmal nocturnal dysnpea
• pulmonary congestion
• confusion
• orthopnea
• tachycardia
• exertional dyspnea
• fatigue

Answer 13

Left

Question 14

Left or Right sided HF?

• fatigue
• ascites
• anorexia and GI distress
• weight gain
• dependent edema

Answer 14

Right

Question 15

Name the HF stage/classification:

High risk for HF but no structural heart disease or sx of HF present

Answer 15

ACC stage A

Question 16

Name the HF stage/classification:

no limitation of physical activity

Answer 16

NYHA Class I

Question 17

Name the HF stage/classification:

structural heart disease + prior or current s/s HF

Answer 17

Stage C

Question 18

Name the HF stage/classification:

unable to carry on any physical activity w/o sx of HF or sx at rest

Answer 18

Class IV

Question 19

Name the HF stage/classification:

refractory HF requiring specialized interventions

Answer 19

Stage D

Question 20

Name the HF stage/classification:

slight limitation of physical activity, ordinary physical activity results in sx of HF

Answer 20

Stage II

Question 21

Name the HF stage/classification:

structural heart disease w/o s/s of HF

Answer 21

Stage B

Question 22

Name the HF stage/classification:

marked limitation of physical activity; less than ordinary activity causes sx of HF

Answer 22

Class III

Question 23

Best place to hear an aortic murmur?

Answer 23

R upper sternal border or 2^nd intercostal space

Question 24

Best place to hear a pulmonic mumur?

Answer 24

left upper sternal border or 2^nd intercostal space

Question 25

Best place to hear a tricuspid murmur?

Answer 25

lower left sternal border

Question 26

Best place to hear a mitral murmur?

Answer 26

apex

Question 27

Name the murmur R sternal border, 2nd intercostal space; harsh, crescendo-decrescendo VM decreases the murmur

Answer 27

Aortic stenosis

Question 28

Name the murmur LLSB, loud, blowing high pitched VM increases murmur

Answer 28

Aortic regurgitation

Question 29

Name the murmur Pansystolic blowing at the apex VM does not change murmur

Answer 29

Mitral regurgitation

Question 30

Name the murmur Mid (early) or late (later s/s) systolic click and then high-pitched murmur during systole heard best at the LLSB; may be honking or clicks Accentuated with standing Quieter with squatting

Answer 30

MVP

Question 31

Name the murmur low pitched diastolic rumble at the apex VM does not change or increases murmur

Answer 31

Mitral stenosis

Question 32

Name the murmur LLSB that is occurs some time during systole VM reduces murmur

Answer 32

tricuspid regurgitation

Question 33

Name the murmur 4^th or 5^th left intercostal space, decrescendo low-itched VM decreases murmur

Answer 33

tricuspid stenosis

Question 34

Which valvular diseases carry a risk of a.fib?

Answer 34

Mitral regurgitation and stenosis

Question 35

Which valvular diseases require immediate referral to cardio?

Answer 35

Aortic regurgitation, mitral stenosis

Question 36

What are the criteria for IE prophylaxis?

Answer 36

* Prosthetic cardiac valves or prosthetic material used for valve repair * Previous IE * CHD * Unrepaired cyanotic CHD * Completed repaired CHD * Repaired CHD w/ residual defects * Cardiac transplantation recipients who have valve disease

Question 37

What medication is used for IE prophylaxis?

Answer 37

amoxicillin

Question 38

Name the asthma severity and the step to start at: * symptoms 2 days or less per week * 0-2 nighttime awakenings per month * SABA use less than 2 days per week * Normal FEV1 between exacerbations, FEV1 \>80%, normal FEV1/FVC * 0-1 exacerbations requiring OCs

Answer 38

Intermittent Start at step 1

Question 39

Name the asthma severity: * \> 2 days per week but not daily * 3-4 nighttime awakenings per month * SABA use \>2 days per week but not daily and not more than once on any day * Minor limitation of activity * FEV1 \>80%; normal FEV1/FVC * Exacerbations 2+ times per year

Answer 39

mild persistent Start at step 2

Question 40

Name the asthma severity * Daily symptoms * Nighttime awakenings \>1x per week but not nightly * Daily SABA use * Some activity limitation * FEV1 60-80%; FEV1/FVC reduced 5% * Exacerbations 2+ times per year at least

Answer 40

Moderate persistent Start at step 3, consider short dose of OCs

Question 41

Name the asthma severity: * Symptoms throughout the day * Nighttime awakenings 7x week * SABA use several times per day * Activity extremely limited * FEV1 \<60%; FEV1/FVC reduced \>5% * Exacerbations 2+ times per year at least

Answer 41

Severe persistent start at step 4 or 5, consider short dose of OCs

Question 42

Name the level of asthma control: * Symptoms \<2 days per week * Nighttime awakenings \<2x per month * No interference with normal activity * SABA use \<2 days per week * FEV1 \> 80% * ACT \>20 * 0-1 exacerbations per year

Answer 42

Well controlled maintain current step, consider step down if well controlled for at least 3 months

Question 43

Name the level of control: * Symptoms \> 2 days per week * Nighttime awakenings 1-3x per week * Some activity limitation * SABA use \> 2 days per week * FEV1 60-80%; * ACT 16-19 * 2+ exacerbations per year

Answer 43

Not well controlled step up 1 step and re-evaluate in 2-6 weeks

Question 44

Name the level of control: * Symptoms throughout the day * Nighttime awakenings \>4x per week * Activity extremely limited * SABA use several times throughout the day * FEV1 \<60% * ACT \<15 * 2+ exacerbations per year

Answer 44

Very poorly controlled Consider short course of OCs, step up 1-2 steps and re-evaluate in 2 weeks

Question 45

What medications are indicated in step 1 of asthma treatment?

Answer 45

SABA as needed

Question 46

What medications are indicated in step 2 of asthma treatment?

Answer 46

low dose ICS, SABA PRN

Question 47

What medications are indicated in step 3 of asthma treatment?

Answer 47

low dose ICS + LABA OR medium dose ICS SABA PRN

Question 48

What meds are indicated in step 4 of asthma treatment?

Answer 48

medium dose ICS + LABA SARA PRN

Question 49

What medications are indicated in step 5 & 6 asthma treatment?

Answer 49

high dose ICS + LABA + OC (step 6) SABA PRN

Question 50

Name the COPD group and treatment: * Low risk for exacerbation * Less symptoms * One or fewer moderate exacerbations per year * mMRC 0-1

Answer 50

Group A Monotherapy w/ SABA, LAMA or LABA

Question 51

Name the COPD group and treatment: * Low risk for exacerbation * More sx * One or fewer moderate exacerbations per year * mMRC greater than or equal to 2

Answer 51

Group B Monotherapy w/ LAMA or LABA

Question 52

Name the COPD group and treatment: * High risk for exacerbation * Less sx * Two+ exacerbations per year * mMRC 0-1

Answer 52

Group C Monotherapy w/ LAMA

Question 53

Name the COPD group and treatment: * High risk for exacerbation * More sx * Two + exacerbations per year * mMRC 2+

Answer 53

Group D LAMA LAMA + LABA ICS + LABA