Final Exam Cards

Question 1

Heart Murmur:

Systolic cresesendo-decresendo murmur

Heard best at right 2nd ICS

May radiate to carotid

Answer 1

Aortic stenosis

*associated with bicuspid aortic valve

Question 2

Heart Murmur:

Diastolic blowing decresendo murmur

Heard best at apex

Answer 2

Aortic regurgitation

Question 3

Heart Murmur:

Diastolic opening snap

Heard best at apex in left lateral decubitus position

Answer 3

Mitral stenosis

Question 4

Heart Murmur:

Holosystolic murmur

Heard best at apex

May radiate to axilla, back or clavicle

Answer 4

Mitral regurgitation

Question 5

Heart Murmur:

Blowing systolic murmur

Heard best at left 4th ICS

Increases with inspiration

***prominent V wave on JVP

Answer 5

Tricuspid regurgitation

Question 6

Heart Murmur:

Systolic murmur

Heard best at upper left sternal border with fixed splitting of S2

Answer 6

ASD

• L to R shunt
• risk of paradoxical emboli

*fixed splitting because increased R heart pressure delays closure of pulmonic valve (P2)

Question 7

Heart Murmur:

Blowing holosystolic murmur

Heard best at L 3rd ICS

Increases with handgrip

Answer 7

VSD

*L to R shunt

Question 8

Heart Murmur:

Continuous machine-like murmur

Heard best at L 2nd ICS

Answer 8

PDA

*L to R shunt

Question 9

Arteriovenous malformation:

HTN in the UEs
Hypotension in the LEs
Notched ribs on CXR

Answer 9

Coarctation of the aorta

Question 10

Systolic Murmurs (6)

Answer 10

AS, PS, MR, TR, VSD, ASD

Question 11

Diastolic Murmurs (4)

Answer 11

AR, PR, MS, TS

Question 12

Heart sound heard in early diastole due to overload or decompensated HF

Answer 12

S3

Question 13

Heart sound heard late in diastole due to blood hitting a stiff ventricle

Answer 13

S4

Question 14

Obesity is a risk factor for

Answer 14

DM, dyslipidemia, HTN

Question 15

Diagnosis?

A1C >6.5% or fasting plasma glucose >126mg/dL or glucose >200 2hours after glucose tolerance test or patient who is symptomatic w/ glucose >200 randomly

Answer 15

Diabetes

Question 16

What is included in a BMP?

Answer 16

sodium, potassium, chloride, CO2, BUN, Creat, Glucose, anion gap

Question 17

What is included in a CMP?

Answer 17

BMP (sodium, potassium, chloride, CO2, BUN, Creat, Glucose, anion gap) +

AST/ALT, Bili, Alk phos, Ca, Albumin, total protein

Question 18

Hemoglobin A1C in diabetes

Answer 18

> 6.5

• moderate risk is 5.7-6.5
• low risk is <5.7

Question 19

Indications for starting statin therapy

Answer 19

LDL > 190 or 10yr CVD risk > 10%

Question 20

STEMI management:

Not at PCI capable hospital

Answer 20

Transfer to PCI capable hospital in <120min

*if unable to do so, administer thrombolytics in <30min and then transfer to PCI capable hospital

Question 21

Diagnosis?

Substernal chest pain/discomfort
Worsened with exertion or stress
Relieved by rest/nitro

Answer 21

Typical angina

• atypical angina has 2/3
• non-angina chest pain has 1 or 0

Question 22

Inhialed rib SD treatment

Answer 22

depress key rib on exhalation

BITE (bottom on inspired)

Question 23

Upper ureter sympathetic viscerosomatics

Answer 23

T10-T11

Question 24

Lower ureter sympathetic viscerosomatics

Answer 24

T12-L2

Question 25

Upper ureter parasympathetic viscerosomatics

Answer 25

OA, AA, Vagus

Question 26

Lower ureter and bladder parasympathetic viscerosomatics

Answer 26

S2-S4 (sacrum)

Question 27

Kidney chapman points

Answer 27

1 in superior and 1 in lateral to umbilicus

Question 28

Bladder chapman point

Answer 28

umbilicus