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CVS H+P PA StFru
CVS H+P PA prog St Fran Un 2005
| Question | Answer |
|---|---|
| endocarditis /predental no problem with penicillian | Adults: Amoxicillin 2.0 grams (usually 4 - 500mg capsules), 1 hour before dental appointment. |
| endocarditis /predental allergic to penicillian | Adults: Clindamycin 600 mg (usually 2 - 300mg capsules), 1 hour before dental appointment |
| Cyanosis hemoglobin level | 5g/dl hemoglobin in capillaries what sign? |
| Cyanotic lips sign of? | Central cyanosis |
| Threshold of Hemoglobin for central cyanosis is | 5 g/dl hemoglobin threshold for |
| Pt. presents with Falling O2 sat, JVD,to auscultaion: S3,gallop, tachycardia whats in your Diff DX? | Heart Failure: what sounds to auscutation? |
| name 4 CVS conditions that have both systolic and diastolic sound | 1)Pericardial Friction rub..2) Patent Ductus Arteriosus.3) Venus Hum..4) Mammary souffle |
| what two Cardiac sounds go away when you push hard on the stethoscope? | Venus Hum and mammary souffle...... what auscultation trick can you do? |
| Persistance of a normal fetal structure between the L pulmonary artery and the decending aorta beyond the 10th day of life is what? | PDA Patent Ductus Arteriosus what is it? |
| Hypertrophic myocardium with out a reason such as HTN is called? | HOCM,HCM or IHSS |
| IHSS stands for | Idiopathic Hypertrophic Subaortic Stenosis |
| IHSS,HCM and HOCM often involve what structure? | Ventrical Septum |
| Is there an S4 sound with HOCM,HCM or IHSS? | Yes S4 because of noncomplience |
| What doe HOCM stand for? | Hypertrophic Obstructive Cardiomyopathy |
| What does HCM stand for? | Hypertrophic Cardiomyopathy |
| Is there an S3 sound with HOCM, HCM or IHSS? | No S3! S3 requires excess blood and the Ventrical cavities are tiny. But there is an S4 sound |
| Whats the best way to auscultate a Venus Hum? | With the bell, above the medial aspect of the clavical |
| what symptoms dos an infant with a moderate sized PDA have? | an Infant with : 1) horse cry, cough,lower rep. Infect.,atelectesis or pneumo . what should be in for Diff. Dx? |
| a constant machine like sound with a papable thrill to auscultation is what? | PDA Patent Ductus Arteriosus |
| HCM,HOCM or ICSS Eitiology? | 50% genetic what heart condition can cause Sudden Cardiac Death? |
| Pts that experience Sudden Cardial Death from IHSS ( HCM HoCM) might have what EKG patterns? | tachycardia or fibrillation are likley causes of sudden death ( HCM,IHSS,HOCM) in kids and teens? |
| An infant has poor weight gain. On physical exam you find: tachycardia, tachypnea, peripheral cyanosis, diapherisis , the mother tells you the baby was premature what's at the top of your differential? | Patent Ductus Arteriosus |
| PDA where auscultate? | 2nd ICS |
| Pathological murmur is it diastolic only? | No pathologic murmurs are systolic, diastolic, or continuous |
| Innocent murmur is it a diastolic mumur? | Innocent murmurs are systolic except for venous hum which is continuous |
| Is there a thrill to an innocent murmur? | No thrill with an innocent murmur. |
| In innocent murmur is grade what? | A grade 1 or 2 murmur that can't be heard in the back..... is an innocent murmur |
| Pericardial impulses at an innocent murmur | Normal |
| Pericardial impulses of pathological murmur | May be abnormal |
| A murmur that varies or disappears when the patient changes position is.( Innocent? or pathological? | An innocent murmur varies or disappears with position change |
| An innocent murmur has what extra hard sounds? | None.. there are no extra heart sounds within innocent murmur |
| Are all systolic murmurs innocent? | No what about aortic stenosis!!! |
| A murmur that is accompanied by a click or a gallop , innocent a pathological? | Pathological murmurs may be accompanied by a click were gallop |
| inverted T waves indicate what 2 things? | Ischemia and if anterior inverted T wave consider PE |
| S1 Q3 T3 a sign of.. | Cor pulmonale ( PE, PTX, bronnchospam) |
| Right ventricle pressure or volume overload cause what on EKGs? | In lead III: Q wave..slight ST elevation and inverted T wave |
| a 3+ Pitting edema is how deep? | 6mm pitting edema ..would be rated what? |
| Skin Temperature is cheked how in PE? | Use the back of your hands and go proximal to distal |
| On PE what do you check with your thumbs distal to proximal? | How do you check pitting edema? |
| Calf size do you check the unaffected side first? | No.. in PE of calf size check affected side first |
| You want to get ABG s on a Pt what do you do first? | Allen's Test is done befor... |
| Pt with orthostatic BP rises from a horizontal position to standing. What happens to systolic pressure? | An increase in systolic pressure by 20mmHg with in 3 min.s from when standing indicates what? |
| Pt with orthostatic BP rises from a horizontal position to standing what happens to the diastolic pressure? | A decrease in diastolic pressure by 20mmHg with in 3 min.s when a pt stands ...indicates what? |
| A pt has syncope on rising, that is relieved by lying down.. whats the problem? | Orthoatatic BP ... a pt stands quickly how do the feel? |
| the patient rises from a siting or horizontal position to stand you are checks there pulse . If they have orthostatic BP what do you expect | On rising a Pt develop an increased heart rate...what can this indicate? |
| There is a strong correlation between PVD of LE and what? | CAD has a strong correlation with what? |
| Chronic Arterial Insufficiency.... pulses do what? | Pulses decrease in what Insufficiency ... |
| Chronic Arterial Insufficiency.... color is? | Pale color in what chronic insuffiiency? |
| Chronic Arterial Insufficiency.... are there ulcers ? | Ulcer are at pressure points in what Insufficiency?..... |
| Chronic Arterial Insufficiency.... decribe skin? | Shiny ,hairless and thick nails with ridges in.... what isuffiency? |
| Are there Ulcers in Chronic Venous Insufficiency? | The Ulcers at the medial maleolus ( not at a presure point ) indicates what insuffucuency? |
| A pt presents with legs that have thick brown skin with scaring and ulcers but fortuantly no gangren what your DX? | Chronic Venous Insufficiency what are the skin signs? |
| Chronic Venous Insufficiency ....Pulses are? | Normal pulses in what insuffucuency?? |
| 2 couses of Chronic Venous Insufficiency? | Venous Valve leakage and partial vein blockage can cause what ? Hint Tortuous |
| How do you cure Chronic Venous Insufficiency ? | You cant .. No cure but you can treat .. |
| Is Chronic Arterial Insuffucuency painful? | Yes ! with exertion |
| what is " angina of the legs?" | Chronic Arterial Insufficiency |
| What chronic insufficiency has edema? | Chronic Venous Insufficiency has edema ... no way out for the blood |
| Is there edema in Chronic Arterial insufficiency? | No edema .. the veins are fine |
| Erectile dysfunction an be caused by what chronic insufficiency ? ..and were?? | Chronic Arterial Insufficiency in the Iliac can lead to what condition??? |
| How do you measure claudication? | Measure by distance.. "how many blocks did you walk last year?".. |
| Acute Arterial Emboli 80-90% originate were? .. do to what? | A fib in the heart can cause Acute Arterial Emboli |
| Acute Arterial Emboli lodge 40% of the time in bifurcations of what three arteries? | Aortic, Femoral and popliteal artery bifurcations are were most Emboli lodge |
| How many CABG procedures were done in 2004? | 160,185 coronary artery bypass graft (CABG) procedures were performed in the United States in 2004 |
| Dosage of nitroglycerin | 0.3-0.4 mg sl q 5 min prn chest pain Max three pills |
| two criteria for defining angina | length of time of attack, and does nitroglycerin shorten attack? |
| Unstable angina: | chest discomfort that's not brought on by exertion. |
| Prinzmetal's angina is what? | caused by focal spasm of angiographically normal coronary arteries |
| Prinzmetal's angina s/s | 1)chest painchest pain 2 dyspnoea 3) palpitations |
| Prinzmetal's angina EKG: | ST segment elevated |
| Prinzmetal's angina TX | RX Nifedipine and nitrates,2)Coronary stenting 3)CABG |
| Q wave > then 2 small blocks means | Infarction...(but take a few hours to show up) see non EKG as? |
| What's the cut off for thrombolytics to treat stroke? | three hours |
| What’s the cut off for thrombolytics into heart is? | six hours |
| MI TX | start IV,Morphine,Oxygen,Nito, Aspirin |
| MI Lab you think of first... what how often? | Cardiac enzymes: now q eight hours x 24 |
| MI Other labs | electrolyte panel(potassium sodium glucose, calcium), 2)CBC 3)chest x-ray AP for cardio megaly Liver, Pt/Ptt/INR, echocardiogram |
| T wave inversion | Ischemia |
| ST elevation or the “tomb stone like in a cemetery” | Injury |
| Q wave ( more the 2 small block | Infarction: |
| what are the inferior leads in EKG | II,III AF is for inferior by apex |
| Costro chondritis what do you seeon PE? | No physical manifestation to inspection |
| Tietze Syndrome what do you see | erythematous and edematous around area of rib cartilage |
| To auscultate Aortic sounds better...? | Pt Sit up and lean forward |
| To here Mitral sounds and S3 S4 | Have Pt roll to LLD while auscultaing to sse if they increase |
| To increase venous blood to heart what 2 techn.? | Pt sqauts or lift legs 60degrees for 60 sec |
| Reducing blood to the heart what 2 ways? | Bear down (Valsalva) and stand. |
| Straight back murmur | Vibration of normal blood flow in young F with thin AP |
| Straight back murmur | Echo normal |
| Becks triad | Cardiac Tampoaid: decress HTN , muffeled heartsounds disteneded JVP |
| Cardiac Tamponaide | the heart is restrained by fluid accumulation in pericardial sack |
| cardaic tamponaide what treatment? | pericardial centisis is to treat what? |
| Diastolic murmurs almost always indicate: | Heart disease |
| Mitral regurgitation Diastolic. or Systolic? | Pansystolic murmur, Mitral valve cant close, the ventricles contract and blood squirts back to the left atrium. |
| Tricuspid Regurgitation Diastolic or Systolic? | Pansystolic: The Tricuspid valve fails to close. when thr right ventricle contracts the murmur is caused by the blood squirtng back in to the right atrium. |
| To tell the differrence between Tricuspid Regurgitaion and Mitral Regurgitation On inspriration which on becomes louder??? n | On Inspiration Tricuspid regurgitation becomes loader ( Bates tbl 7-7) |
| Aortic Regurgitation Diastolic or sysytolic? | Diastolic: the aortic valve does not close well and blood goes backward from the Aorta to the left ventrical |
| what 4 conditions mimic Aortic stenosis? | 1)Aortic sclerosis 2) bicuspid aortic valve 3) dilated aorta 4) Pathalogic increased flow |
| Aortic Stenosis is it Diastolic or Systolic? | Aortic Stenosis is a Midsystolic Murmurs due to impaired blood flow |
| Mitral Stenosis Diastolic or Systolic? | Diastolic ..Mitral valve thickens and does not open well during diastole |
| a condition where a clot forms in one of the veins that run close to the surface of the body. visable through the skin? | Thrombophlebitis what is it? |
| Venous stasis, vessel wall injury, hypercoagulable state is called: | Virchow triad |
| 2-6 y/o most commen ( can go to early adolecents) with thin AP diameter, loudest supine LSB what is it called____ Murmur | Stills Murmur is systolic.. who gets it? and were best heard? |
| 10-14 y/o F with thin A-P you hear a systolic murmurecho shows: normal blood through normal structures what is it? | Straightback systolic murmur is innocent discribe |
| Pericardiocentesis Tx for what? | Cardiac Tamponade |
| Most common cause of Cardiac Tamponade? | Malignancy is the most common cause of what Hint "the big squeeze |
| Pt presensts with chest pain and cant breath well they apear anxious on inspect.: distended neck Veins, PE Hypotensive,muffled heart sounds,tachycardic whats the problem? | Cardiac Tomponade |
| whats Becks Triad? | 1)Hypotensive 2) Distended neckVeins 3) Muffled heart sounds |
| Becks Triad indicates what? | Cardiac Tamponade |
| Can TB cause Cardiac Tamponade? | Yes Cardiac Tamponade canbe caused by infection |
| name 4general etiologie of Cardiac tamponade | 1) malingnancy 2) Infection, 3)Trauma 4) surgery ( nicking veins) can be the cause of what condition with Becks triad? |
| What infectious agents can cause Cardiac Tamponade? | Virus, bacteria, Fungal, and TB can in fect the pericardium and ......may cause what? |
| What sound Atrial systole? | S 4 ..caused by contraction of |
| S3 normal in .. | Peds,, pregnant |
| S3 at what age do you worry? | Over age 40 .. you worry becuase this sound indicates voulume overload of the heart... |
| what condition pops in your mind FIRST whith an S3 cardiac sound? | Heart Failure . or CHF old school |
| Opening snap.. what valve? | Mital valve sound when it opens |
| Opening snap..OS... diastolic or systolic? | Diastolic blood flows from the atrium to the ventricle so what sound you hear? |
| Ejection sound diastolic or systolic? | Systolic is when blood is injected into the aorta ... what is the sound? |
| Ejection sound what valve? | Aortic valve with sound occurs by opening? |
| • Syncope:Normal EKG and echocardiogram what 2 condutions | aortic valve stenosis or carotid artery stenosis could they get Syncope? |
| pt gets periodic runs of arrhythmias what do you do? | holter monitor to find possible arrhythmias ...control with pace maker...ablate renegaid pacercell |
| Do pts who get Percutaneous transluminal coronary angioplasty have symptoms return? | 1/3 of pts with PTCA have a return of sx in 6 mos |
| PTCA whats it stand for? | Percutaneous transluminal coronary angioplasty |
| Your Pt. has angina form athersclerosis and refuses bypass sugery. what other procedure might help | Percutaneous transluminal coronary angioplastyo PTCA |
| What is the best artery to use for a CABG? long term | • Left internal mammary artery (lima) |
| Can LIMAs be harvested endoscopically? | Yes EVH ( endoscopic Vein Harvesting ) of the LITA ( or LIMA) is the standard in most CABG |
| BT or Bridging technique was started to avoid wound healing morbidities assocated with open saphenectomies describe the incisions: | four to six 4cm insicion starting at the ankle with 7-8cm subcutaneous tunnels.... what am I describing? |
| What are 3 advantages of EVH over open saphenectomy? | 1) reduced morbidity 2) better cosmetic outcome 3) lower treatment cost |
| What three`vessels can be harvested endoscopically for a CABG? | Radial artery, Saphenous vein and ITA (LIMA) (LITA) |
| CABG .. postoperatively What do you monitor | Atelectasis can be a complication after what cardiac procedure |
| Pericarditis puts the etiology ?(3).. | Idiopathic, 2) infections ( viral or bac.) 3 status/ post MI |
| A patient presents sharp sometimes still achy chest discomfort, worse with inspiration swallowing top of your differential list? | Pericarditis what does the patient complained of? |
| Pt presents substernal pain after eating worse with reclining what two things could it be ( though MIs in the Back your mind) | GERD and pericarditis both positional symptoms ... listen for PFR to differentiate but dont forget Acute Arterial emboli of the mesentary maybe more abdominal |
| 50 year old patient, with uncontrolled HTN , a congenital bicuspid aortic valve, and PMHX connective tissue disease, complains of a tearing inter-scapula pain what... diagnostic test ? in what do you expect to find? | chest Xray signs of Aortic aneurysm |
| Named two conditions that respond to nitroglycerin: | Esophageal spasm in angina what do they have in common? Besides chest pain |
| Herpes zoster true or false the pain occurs after the rash | False ! .. the pain of herpes zoster(shingles) occurs before the rash !!! |
| How many patients present with Virchows's triad before a pulmonary embolism? | 20% of pulmonary emboli patients present with hypercoaguability, venous stasis or inflammation/injury to vessel |
| What three interventions for pulmonary embolism? | 1) thrombolytics 2) anticoagulant 3) surgery to retrieve emboli |
| Pulmonary angiography is the gold standard for diagnosing what? | Pulmonary embolism.... what's the gold standard to diagnose?? |
| what is the Greenfield filter? | A filter sewn into the inferior vena cava to prevent emboli from reaching the pulmonary arteries but called? |
| PE prevention what three things: | 1) ambulate the patient 2) TED hose 3) Prophylactic anticoagulation |
| an abnormal sound on auscultation caused by alterd blood flow into a chamber or through a valve. | Murmur...give a general definition |
| Murmurs classifiy | 1) Dia or Sys?or both? 2) shape 3) quality (harsh musical) 4)Intensity( grade1-6) 5) body position heard best: 6) Radiate to |
| a heart murmur Loud with palpable thrill what grade? | Grade 4 murmur discribe.... |
| Murror Sound radiates: | In the direction of blood flow |
| Murmur caused by High blood flow throuh normal valves | usually innocent uusually diastolic |
| High blood flow Hyper thyroid, pregnant, anemia Murmurs due to | Lots of blood , sound of murmer even ifvalves normal |
| Most Diastolic murmurs are pathalogic? | Yes remeber this |
| a pt has a moderately loaud murmur what do you grade it? | Grade 3 murmur what didiyou hear or feel? |
| MVP when? Dia or sys? | sytole |
| Mitral Valve stenosis how , and were to listen were to radiate? | Apex ,,Bell .. Little radiation |
| aortic sclerosis what is it? | calcium accumulates on the aortic valve |
| DVT s/s | red hot swollen andtender |
| DVT s/s test | Homan's sign |
| DVT dx in clinic most common | duplex ultrasonography |
| DVT Dx diffinative test is | Veinography the diffinative test for___?? |
| Superficial veinous thrombus does it"throw clots?" | superfiecial clots raerly break off |
| What veins alllow blood to pass from the superficial veins into the deep vein system? | Perforating veins... whats their purpose?? |
| Valvular incompentence in one or more perforating veins results in what? | Varicise veins ... what happens to one or more perforating veins?? |
| Varicise veins and telangiectasia are normal veins that have dilated becuse ..? | Increased venous presssure causes normal veins to become.. ?? |
| telagiectasias are also called? | spider veins are also called? |
| What may induce AAA formation? | Atrerosclerosis |
| Retroperitoneal expansion and pressure on a femoral nerve can cause | Isolated groin pain |
| Isolated groin pain is a insidious presentation of ...? | AAA ...is putting pressure on a femoral nerve ...s/s? |
| AAA D/DX name 10!! ( not 9 asked befor Dec 12) | 1) acute appendicitis, 2) cholelithiasis 3) Diverticular Dis. 4) Gastrirtis and PUD 5) MI 6) obstruction LB 7) obstrutionSB 8) pansreatitis 9) UTI 10) Renal Calculi |
| AAA to detect 100% use what?? | CT .. 100% detecting AAA |
| Tests for AAA ..name 5? | 1) plain radiography, 2) US 3) CT 4) MRI 5) angiography |
| Can Ultrasonography detect free peritoneal blood? | Yes free peritoneal blood can be dected by...what bedside test? |
| You think a pt who is obease and recently ate 5 bean burritos is having an AAA. What test wont work well? | Ulrasonography's imaging ability is reduced with bowel gas or obesity. |
| You want to follow up a AAA pt with a surgery at what size? | 4-6 cm |
| What is the leading cause of Heary Failure the first month of life?? | Coarctation of the Aorta .... Leading cause of heart failure in who? |
| Increased incidence of Coarctation of the Aorta in what 2 groups? | Males and Females with Turner's .. are at increased risck of what disease of the Aorta? |
| On PE on infant is hypertensive in UE and hypotensive in LE whats this a classic finding for? | Coarctation of the Aorta a classic PE finding in..? |
| AA mom brings her little girl in to the office saying shes lazy , Test results come back showing she is missing an X chromosome and has colateral circulation just distal to the Lsubclavian vein. You DX?? | Coarctation of Aorta .... name a genetic assoc. and compinsating mechanisim. |
| This test is limited in detecting leakage involving an AAA? | Ultrasonography .. can it detect leakagein an AAA? |
| This test is limited in detecting branch artery or suprarenal involvement in a AAA? | Ultrasosgraphy can not detect branch artery or suprarenal involvment in ab AAA? |
| Acute arterial insufficiency what s/s are the 5 P's? | Pain..Pallor.. Pulselessness.. paraestetias..paralysis |
| Lymphatic system.. the Thoracic duct drains in to.... | The left subclavian vein .... recieves lympatic fluid from what duct? |
| What is WNL in width for an aortic aneurysm? ( cm) | 2 cm for an aorit aneurysm is considered.....? |
| Most AAA occur associated with ___? | Atherosclerosis is associated with what ? |
| An other wise healthy child can have palpable lymph nodes in what 3 area ? | submandibular...axilliary.... ingunal lymph nodes are palpable .. are they always pathalogic??? |
| list in alphabetical order the names of the 600 lymph nodes.. | Just kiding! just know there are 600 lymph node in the body? |
| A breast cancer pt has swollen lymph nodes which 4 make you worie the most? | Infra and supra clavicular, posterior and central axillary lymph nodes are a bad sign with what cancer? |
| whats the clasic triad with AAA? | 1) pulsatile mas in the abdomen, 2) hyPOtension 3) Abdominal pain is the traid of what? |
| I say Reed Sternberg cell you say..? | Hodgkin's lymphoma ( or disease) ... what cell comes to mind? |
| Infectious Mononucleosis ... what adenopathy on PE?? | PCC and maybe inguinal adenopathy ( palpable nodes) are associated with what? Hint (kissing) |
| a number of STD'd are associated with what adenopathy? | Inguinal adenopathy is associated with what type of diseases? ...Hint ( more then kissing) |
| discribing lymphadenopahty : what 4 charateristics? | 1) size 2) matting 3) painfull 4) Generalized or localized ..what are these used to discribe? |
| True of False most of the lymph nodes in a body are generalized.?... | NO ..No.. NO!!! Most lymph nodes are localized inthe headand neck followed by generalized,inguinal axillary and finally Supraclavicular |
| Inflammatory condition of 1 or more lymphatic VESSELs usually resulting from an acute streptococcal infection of an extermity... whats it called? | LymphANGitis... what is it?? |
| If I have LymphANGITIS what constitutional symptoms might I have? | Tachycardia, HA, malais,Fever Chills are the constitution s/s of what disorder of the lymph system? ( Hint red streak) |
| Can lymphedema or impaitment of the lymph system be congenital? | Yes!!! Lymphedema can be acquired AND congenital |
| Lympedema after an event like breast CA whwn are you nolonger at risk? | Most people get lymphedema within 3 yrs of an event but ... will always be suspeptible . |
| What percent of breast CA pts get Lymphedema? | 10-15% get lyphedema ...Who? |
| One funtion of the lymphatic system is to conserve..... | Plasma protiens and fluids that leak out of cappillaries are conserved where...? |
| What does the lymphatic system absorb from the intestinal tract? | Lipids end up in the lyphatic system by being absorbed FROM the intestines |
| Lymph drainage is high in what substances?(3) | protein, Lipids and water are in the L----System |
| Hodgkin's Lymphoma what 2 age groups?? give me the ages.. | 15-34 y/o AND > 55 y/o get Hodgkins ( Reed Sternbeg cells remeber? |
| Etiology of MVP: | Kyphosis..Scoliosis Genetic,,Marfan's.. are the etiology of what Mitral Valve problem? |
| Clasic triad of Aortic Stenosis: | 1) Chest pain 2) HF 3) sycope ..classic triad of what heart valve? |
| Most commonly replaced heart valve? | Aortic Valve supplies blood to the coranary arteries.. if it goes bad you die pretty fast |
| Atherosclerosis :Modifiable Risk Factor (6) | 1.Obesity 2.Physical inactivity 3 Cigarrette smoking >10 cigs/day. 4) HDL <40M <50F 5) HTN 6) DM Modifiable.... risk of what? |
| Abdominal obesity ,Atherogenic dyslipidemia ,HTN, Insulin resistance ,Prothrombotic state,Proinflammatory state what syndrome? | Metabolic syndrom name 6 characteristics |
| Metabolic syndrome be identified as the presence of three or more of these component: | 1.)Elevated waist circumference,2.)Elevated triglycerides,3) Reduced HDL (“good”) cholesterol,4)Elevated Blood pressure:5)Elevated fasting glucose |
| A Female PT with fasting glucose of 102mg/dl, BP 132/85, HDL 48 mg/dl, triglycerides, 152 mg/dl, and a 37 inch waist . what do you say ? | You have Metabolic syndrome wich puts you at risk for developing CAD,other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes ....what symptoms ?? |
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