Miscellaneous

Question 1

most common stenotic heart valve

Answer 1

aortic (aortic stenosis)

Question 2

most common heart chamber hypertrophy

Answer 2

LVH (left ventricular hypertrophy)

Question 3

most common incompetent heart valve leading to regurgitation

Answer 3

mitral (mitral regurgitation)

Question 4

priority sequelae of mitral regurgitation

Answer 4

decreased cardiac output s/t blood regurgitating backwards into the atria

Question 5

dx: grade 2-3/6 holosystolic heart murmur with a “blowing” quality with radiation to the axilla

Answer 5

mitral regurgitation

Question 6

(2) most common locations for a heart murmur to radiate to

Answer 6

1. neck/carotids

2. axilla

Question 7

characteristics of mitral regurgitation heart murmur

Answer 7

low grade 2-3/6
holosystolic
“blowing” in quality
radiates to the axilla

Question 8

s/s of decreased CO

Answer 8

dyspnea on exertion
chest pain
orthopnea
syncope

Question 9

where is the PMI usually located and why is it commonly displaced

Answer 9

5th intercostal space, mid-clavicular line

commonly displaced by LVH

Question 10

asthma exacerbation starts by being a problem of:

1. getting air in
2. getting air out

Answer 10

2. getting air out
problem of air trapping
leads to prolonged exhale
decreased FEV1 (exhale) is an early sign
trouble getting air in (decreased SaO2) is a late sign

Question 11

first clinical test to decrease in an asthma exacerbation: o2 sats or FEV1?

Answer 11

FEV1

Question 12

which is a better test in asthma exacerbation: FEV1 or peak flow?

Answer 12

FEV1 (as part of spirometry)

you may see peak flow more commonly in practice because it is cheap, but for boards the FEV1 and spirometry is the more EBP answer

Question 13

chest radiographs are rarely ordered for an asthma exacerbation. what would be the clinical situation in which this might be useful for the PCP?

Answer 13

r/o underlying pneumonia (e.g., presents with fever and copious productive sputum)

Question 14

S3 heart sound typically indicates

Answer 14

systolic dysfunction, such as in heart failure

Question 15

S4 heart sound typically indicates

Answer 15

diastolic dysfunction, typically as the result from longstanding HTN or repeated episodes of cardiac ischemia

Question 16

the BP in secondary vs. primary HTN is typically higher

Answer 16

secondary HTN is markedly higher than primary

Question 17

second most common heart chamber hypertrophy

Answer 17

left atrial hypertrophy

Question 18

describe mitral regurgitation

Answer 18

in mitral regurgitation, incompetent mitral valves fail to close properly, allowing blood to regurgitate back up into the left atrium during systole. the end result is decreased CO potential. classic symptoms of low CO include dyspnea on exertion, orthopnea, chest pain, syncope, or pre-syncope. on physical exam, expect to hear a holosystolic murmur with a blowing quality grade 2-3/6 with radiation to the axilla.

Question 19

common cardiac comorbidity causing mitral regurgitation

Answer 19

LVH

Question 20

VALGUS stress indicates….

Answer 20

force being applied AWAY from midline

The valgus stress test is used to evaluate ligament damage. For the valgus stress test at 30 degrees, the examiner places one hand over the medial joint line while the other hand holds the foot/ankle. Valgus stress force is then applied laterally (away from the patient’s body) to the joint through the foot, while the fingers palpate for an increase in joint line opening.

Question 21

VARUS stress indicates….

Answer 21

force being applied towards MIDLINE