valvular dz class

Question 1

how is the best way to heard pericarditis

Answer 1

inspiration leaning forward

Question 2

how to diagnose acute pericarditis

Answer 2

ECG
Troponin
ESR
CRP
CBC, 
Blood cultures
ECHO

Question 3

How to treat pericarditis

Answer 3

colchicine, NSAIDS, coricosteriods, pain

possible: antiiotice, monitor for tamponade

Question 4

infective endocardits caused by

Answer 4

bacteria or fungi

Question 5

halmark of endocarditis

Answer 5

fever of unknown origin and —– throughout

low grade fever night sweats, weight loss

Question 6

what is a micotic aneruysm

Answer 6

vegatation from heart shows up in brain

Question 7

how ot diagnose endocarditis

Answer 7

CBC, ECHO, BLD CULTURES, ESR

Question 8

Antibiotics to start imperic for endocarditis and treatment

Answer 8

vanc and rocephin, then change after culters for 6 wks, then surgical valve removal

Question 9

fungal endocarditis treatwith

Answer 9

amphotericine B

Question 10

55 yo woman comes to your clinic with progressive shortness of breath. She was doing fine until she
suddenly was very short winded about a month prior to presentation with minimal exertion. She also has
noticed that her pulse is irregular on her FitBit. She has had no angina. She now has to sleep on two
pillows due to shortness of breath when she tries to lie flat.
Her past medical history is relatively insignificant other than having palpitations in her 20s. She was told
by her primary care doctor at that time that she probably had mitral valve prolapse, but there is no
documentation.
• Exam: BP 118/60
HR 123, irregular
Lungs with basilar crackles
Cardiac Irr, irr. III/VI systolic murmur which radiates throughout her precordium
1+ edema
• ECG- A fib with RVR

Answer 10

mitral regurgitatione

Question 11

32-year-old man with risk factors for cardiac disease to include hypertension and cigarette smoking
presents with chest pain. He describes a chest pain that is worse when he lies down. He was told that he
might have a heart murmur. This is been going on for the past two weeks in constant fashion. He recently
reported a upper respiratory tract infection and ear ache.
• Home medication: lisinopril 20 mg daily
• Vitals p 90 BP 135/86 temp 100 F
Cardiac exam reveals a harsh sound in systole and diastole
Neck veins are prominent
• ECG NSR, HR 100, 2 mm ST elevation in I,II, III, V2-V6 with PR segment depression

Answer 11

pericarditis

Question 12

32-year-old man with risk factors for cardiac disease to include hypertension and cigarette smoking
presents with chest pain. He describes a chest pain that is worse when he lies down. He was told that he
might have a heart murmur. This is been going on for the past two weeks in constant fashion. He recently
reported a upper respiratory tract infection and ear ache.
• Home medication: lisinopril 20 mg daily
• Vitals p 90 BP 135/86 temp 100 F
Cardiac exam reveals a harsh sound in systole and diastole
Neck veins are prominent
• ECG NSR, HR 100, 2 mm ST elevation in I,II, III, V2-V6 with PR segment depression

Answer 12

acute pericarditis

Question 13

• 78-year-old comes to the emergency department with sudden onset of aphasia and right-sided
weakness. He has been having fever chills and shortness of breath for the past week and a half.
He has a history of diabetes, high blood pressure, and had a mitral valve repair five years ago.
On his review of systems he has been having trouble with his dental bridge.**
• Physical exam:
Temperature 102.5
Pulse rate 110. Blood pressure 105/70
He appears quite ill and cannot speak; his right side is flaccid
Lungs are clear; Cardiac exam reveals tachycardia with a 2/6 holosystolic murmur.
You notice small red lesions on his fingers.
• Wbc count 22,000. ESR 115

Answer 13

endocarditis

Question 14

patients comes in with complaints of trouble doing things like they use to. they are more fatigued and not able to do as much. they have history of illnesses including pericarditis. looking at patient you see signs of right side heart failure, listening to patient you hear knock sound and s3. you suspect. Tests to include? Treatment?

Answer 14

constrictive pericarditis 
TEST:
BNP ( should be low {RCM if HIGH])
ECHO ( will show constrictive or restrictive)
Cardiac cath
CT/MRI
Tx:
diuretics and low sodium for edema
avoid slowing heart rate

Question 15

Patient come in with saying they feel fatigued, have a feeling of abd fullness, and chest discomfort. They like to sit up right for more comfort. You check bp and find hypotension, you listen to heart and hear distant heart sounds, and you look at jvd and see increased jvd, you suspect? What tests are ordered? Treatment?

Answer 15

cardiac tamponade

• tests: ECG for differential, ECHO for true diagnosis, CT/MRI for other visual of heart.
• Treat: give fluids to prevent shock, refer for pericentesis