Exam 2 Flashcards
Upper right sternal border: which murmurs can be best heard here?
aortic valve clicks (AS), venous hum
Upper left sternal border: which murmurs can be best heard here?
pulmonary valve clicks (PS), pulmonary flow murmurs, ASD, PDA, venous hum
Lower left sternal border: which murmurs can be best heard here?
VSD, still’s murmur, tricuspid regurgitation, hypertrophic cardiomyopathy
Erb point: which murmurs can be best heard here?
aortic ejection click (AS), dilated aortic root)
Name the ECG
A Fib
Name the ECG
atrial flutter
Name the ECG
SVT
Name the ECG
Ventricular tachycardia
Name the ECG
Ventricular fibrillation
What are the ECG changes that occur during an anginal episode (chronic or unstable)?
ST segment depressions w/ symmetric T wave inversions
What ECG change distinguishes NSTEMI from angina?
ST depression longer than 48 hours
What ECG change occurs in a STEMI?
persistent ST elevation
Left or Right sided HF?
- paroxysmal nocturnal dysnpea
- pulmonary congestion
- confusion
- orthopnea
- tachycardia
- exertional dyspnea
- fatigue
Left
Left or Right sided HF?
- fatigue
- ascites
- anorexia and GI distress
- weight gain
- dependent edema
Right
Name the HF stage/classification:
High risk for HF but no structural heart disease or sx of HF present
ACC stage A
Name the HF stage/classification:
no limitation of physical activity
NYHA Class I
Name the HF stage/classification:
structural heart disease + prior or current s/s HF
Stage C
Name the HF stage/classification:
unable to carry on any physical activity w/o sx of HF or sx at rest
Class IV
Name the HF stage/classification:
refractory HF requiring specialized interventions
Stage D
Name the HF stage/classification:
slight limitation of physical activity, ordinary physical activity results in sx of HF
Stage II
Name the HF stage/classification:
structural heart disease w/o s/s of HF
Stage B
Name the HF stage/classification:
marked limitation of physical activity; less than ordinary activity causes sx of HF
Class III
Best place to hear an aortic murmur?
R upper sternal border or 2nd intercostal space
Best place to hear a pulmonic mumur?
left upper sternal border or 2nd intercostal space
Best place to hear a tricuspid murmur?
lower left sternal border
Best place to hear a mitral murmur?
apex
Name the murmur
R sternal border, 2nd intercostal space; harsh, crescendo-decrescendo
VM decreases the murmur
Aortic stenosis
Name the murmur
LLSB, loud, blowing high pitched
VM increases murmur
Aortic regurgitation
Name the murmur
Pansystolic blowing at the apex
VM does not change murmur
Mitral regurgitation
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
MVP
Name the murmur
low pitched diastolic rumble at the apex
VM does not change or increases murmur
Mitral stenosis
Name the murmur
LLSB that is occurs some time during systole
VM reduces murmur
tricuspid regurgitation
Name the murmur
4th or 5th left intercostal space, decrescendo low-itched
VM decreases murmur
tricuspid stenosis
Which valvular diseases carry a risk of a.fib?
Mitral regurgitation and stenosis
Which valvular diseases require immediate referral to cardio?
Aortic regurgitation, mitral stenosis
What are the criteria for IE prophylaxis?
- 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
What medication is used for IE prophylaxis?
amoxicillin
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
Intermittent
Start at step 1
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
mild persistent
Start at step 2
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
Moderate persistent
Start at step 3, consider short dose of OCs
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
Severe persistent
start at step 4 or 5, consider short dose of OCs
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
Well controlled
maintain current step, consider step down if well controlled for at least 3 months
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
Not well controlled
step up 1 step and re-evaluate in 2-6 weeks
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
Very poorly controlled
Consider short course of OCs, step up 1-2 steps and re-evaluate in 2 weeks
What medications are indicated in step 1 of asthma treatment?
SABA as needed
What medications are indicated in step 2 of asthma treatment?
low dose ICS, SABA PRN
What medications are indicated in step 3 of asthma treatment?
low dose ICS + LABA OR medium dose ICS
SABA PRN
What meds are indicated in step 4 of asthma treatment?
medium dose ICS + LABA
SARA PRN
What medications are indicated in step 5 & 6 asthma treatment?
high dose ICS + LABA + OC (step 6)
SABA PRN
Name the COPD group and treatment:
- Low risk for exacerbation
- Less symptoms
- One or fewer moderate exacerbations per year
- mMRC 0-1
Group A
Monotherapy w/ SABA, LAMA or LABA
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
Group B
Monotherapy w/ LAMA or LABA
Name the COPD group and treatment:
- High risk for exacerbation
- Less sx
- Two+ exacerbations per year
- mMRC 0-1
Group C
Monotherapy w/ LAMA
Name the COPD group and treatment:
- High risk for exacerbation
- More sx
- Two + exacerbations per year
- mMRC 2+
Group D
LAMA
LAMA + LABA
ICS + LABA
