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PCM Flashcards

1
Q

normal blood pressure

A

120/80

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2
Q

preHTN

A

120-139 / 80-89

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3
Q

stage 1 HTN

A

140-149 / 90-99

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4
Q

stage 2 HTN

A

> 160 / >100

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5
Q

Classification of HTN if diabetes or renal disease

A

bad if higher than 130/80

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6
Q

where is S3 heard?

A

apex of the heart using the bell (heard in early diastole)

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7
Q

where is S4 best heard?

A

diaphragm over ICS2 (ask pt to lean forward, also good for hearing pericardial friction rubs)

  • marks atrial contraction
  • heard late in diastole right before S1
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8
Q

if you have congenital aortic stenosis when will you usually develop symptoms?

A

before you are 30

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9
Q

degenerative valve disease is _____________xs more frequent in men than women

A

3-4 times

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10
Q

what does an aortic stenosis murmur sound like?

A 
loud crescendo-decrescendo
systolic
harsh
heard best @ right ICS2
radiates to carotids (delayed upstroke)
softer w/ valsalva
S4 heart sounds often heard in asymptomatic pts
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11
Q

risks for calcific aortic stenosis

A 
hypercholesterolemia
DM I and II
HTN
cigarette smoking
paget disease of bone
ESRD
rheumatic fever
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12
Q

what is the most common valvular disease in the developed world?

A

aortic stenosis

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13
Q

what is the prognosis once an aortic stenosis becomes symptomatic

A

poor, untreated 3 yr mortality rate

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14
Q

what are 3 causes of aortic stenosis?

A

degenerative calcification of aortic cusps
rheumatic inflammation
progressive valvular calcification on congenital bicuspid valve

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15
Q

when do we refer pts with aortic stenosis?

A

when they start to develop symptoms

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16
Q

severe Aortic stenosis

A

when it becomes severe enough the systolic murmur may become inaudible
-aortic closure of S2 absent
S4 often present
also see delayed carotid upstroke

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17
Q

name the murmur:

holosystolic murmur heard best at apex of heart
loud S3 and quiet first heart sound are seen since mitral valve doesnt snap closed
louder w/ valsalva

A

mitral regurgitation

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18
Q

name the murmur:
diastolic blowing murmur along the L. sternal border
-increases w/ handgrip or squatting

A

aortic regurg.

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19
Q

name the murmur:
apical, rumbling diastolic murmur
accentuated in L. lateral decubitus position or w/ exercise
-first heart sound often loud

A

mitral stenosis

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20
Q

name the murmur:

continuous machinery murmur heard best over L. 2nd ICS

A

PDA

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21
Q

what is the most common structural cardiac palpitations

A

mitral valve prolapse

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22
Q

what is the most common cause of non-cardiac palpitations

A

panic disorder

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23
Q

a normal resting ECG cant rule out what

A

can’t rule out an arrhythmia (just a snapshot)

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24
Q

who most often gets mitral valve prolapse

A

women, young women

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25
which pts have the highest rate of complications of MVP
men over 50
26
what is the hallmark finding in MVP
mid-systolic click and a late -systolic or pansystolic murmur
27
what percentageof pts w/ MVP have no increased morbidity or mortality?
75%
28
what is the most common arrhythmia in clinical practice
atrial fibrillation
29
what is the median age of A. fib
75
30
which arrhythmia is known by an irregularly irregular pulse
atrial fibrillation
31
what are the risk factors for atrial fibrillation
``` HTN hyperthyroidism CAD HF diabetes ```
32
Is A. fib more common in men or women?
1.5-3x more common in women
33
what is the major complication of A. Fib
stroke
34
what is CHADs
tool for determining the stroke risk and guides the need for anticoagulation
35
what is the most common cause of Heart failure
CAD (particularly systolic HF)
36
what is the most common cause of diastolic heart failure?
HTN
37
which pts get diastolic HF?
women over 50
38
is mortality same or different with diastolic HF vs. systolic HF
same
39
what is one of the strongest risk factors for HF in women
DM
40
Which 2 findings most effectively rule in systemic heart failure?
displaced cardiac apex S3 heart sound ``` other signs: peripheral edema PND JVD orthopnea murmur crackles ```
41
what things are helpful in ruling out HF?
absence of dyspnea on exertion | reduced BNP
42
Class I heart failure
no limitations, asymptomatic
43
class II heart fialure
mild limitations, HF w/ significant exertion
44
Class III HF
marked limitation of physical activity, only comfortable at rest
45
Class IV HF
discomfort with any activity; HF symptoms occur at rest
46
________ pain accounts for 20% of chest pain in primary care
chest wall pain
47
Costochondritis accounts for ________% of chest pain in primary care.
13%
48
GERD accounts for __________% of chest pain in primary care
13%
49
what is the most common cause of death in women
CVD
50
what is different about the way women experience heart attacks
have other heart attack symptoms: - upper body pain - SOB - N/V - fatigue - cold sweats - lightheadedness
51
are men or women more likely to have delayed dx and receive fewer interventions to prevent and tx heart disease
women
52
what things are less accurate in women than men
diagnostic test
53
women with acute MI's (3 things)
1. older 2. have more comorbid conditions 3. more likely to die than men with same disease
54
initial care of a suspected acute MI includes administration of MONA
1. morphine 2. oxygen 3. nitroglycerine 4. aspirin
55
which drug does choby say improves survival in women with heart attacks?
beta-blocker
56
what is the clinical triad in pericarditis?
1. pleuritic chest pain (symptoms lessened when leaning forward) 2. pericardial friction rub (ask pt to lean forward) 3. diffuse ST wave changes on ECG
57
sick a couple wks ago (cold/cough), now pleuritic chest pain, reproducible chest pain
costochondritis
58
how do you treat costochondritis?
couple weeks NSAIDs follow up in a few weeks
59
who is at high risk of aortic dissection?
HTN cocaine younger pts tertiary syphilis
60
motivational interviewing
- uses pt insight as means for exploring attitude/behavioral changes that would benefit their health - useful in many settings - can be done in very short segments and incorporated into routine medical visits - pts usually appreciate the rapport - pt controls the interaction

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