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DIT cardiac path 1
murmurs, inflammation,shock,vasculitis, end quiz
| Question | Answer |
|---|---|
| crescendo-decrescendo systolic murmur best heard in the 2nd/3rd right interspace close to the sternum | aortic stenosis |
| Early diastolic decrescendo murmur heard best along the left side of the sternum | pulmonary regurg |
| late diastolic decrescendo murmur heard best along the lest side of the sternum | tricuspid stenosis |
| pansystolic/holosystolic/unifrom murmur best heard at the apex and often radiates to the left axilla | mitral regurg |
| late systolic murmur preceded by a mid systolic click | mitral prolapse |
| crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspace close to the sternum | pulmonary stenosis |
| pansystolic/holosystolic/uniform murmur best heard along the left lower sternal border and generally radiating to the right lower sternal border | VSD or tricuspid regurg |
| rumbling late diastolic murmur with an opening snap | mitral stenosis |
| pansystolic/holosystolic/uniform murmur best heard at the 4th to 6th left intercostal spaces | tricuspid regurg |
| continuous machine-like murmur (in systole and diastole) | PDA |
| high pitched diastolic murmur a/w a widened pulse pressure | aortic regurg |
| What are the most common causes of aortic stenosis? | congenital bicuspid valve, senile/degenerative calcification, chronic rheumatic valve disease, congenital unicuspid aortic valve |
| What heart sounds are benign when there is no evidence of disease? | spilit S1, split S2 on inspiration, S3 in pts <40, early quiet systolic murmum |
| murmurs best heard in left lateral decubitus position | mitral regurg, mitral stenosis, left sided S3/S4 sounds |
| 80 yo with a systolic crescendo decrescendo murmur | aortic stenosis |
| signs of right sided HF | peripheral edema, JVD, hepatosplenomegaly |
| signs of left sided HF | pulmonary edema, orthopnea, DOE |
| meds for chronic heart failure | diuretics, digoxin, ace/arb, beta blockers |
| meds for acute HF | (LMNOP)Loops, Morphine, Nitrates, O2, Positioning/Pressors |
| signs of embolism from endocarditis | brain infarct = focal neuro defects, renal infart = hematuria, splenic infarct = abdominal and shoulder pain |
| most common valve in endocarditis | mitral valve |
| common valve in IVDA with endocarditis | tricuspid valve = septic pulmonary infarcts |
| new regurgitation heart murmur or heart failure | endocarditis |
| SVR, CO and tx of hypovolemic shock | increased SVR, decreased CO, fluids and blood |
| SVR, CO and tx of heart failure | increased SVR, decreased CO, LMNOP |
| SVR, CO and tx of septic/anaphylactic shock | decreased SVR, increased CO (tachycardia), Abx, IV fluids, NE |
| SVR, CO, and tx of neurgenic shock | decreased SVR, decreased CO, IV fluids, steroids |
| What are the diagnostic (jones) criteria for rheumatic fever? | (JONES) 2 or mor + evidence of GAS. Joints, Pancarditis, Nodules, Erythema marginatum, Syndeham's chorea |
| JVD with inspiration due to decreased capacity of RV | Kussmaul's sign |
| constrictive pericarditis>>tamponade | Kussmaul's sign |
| decreased SBP by more than 10mmHG with inspiration because of a decreased capacity of LV | Pulsus paradoxus |
| cardiac tamponade>>pericarditis | Pulsus paradoxus |
| IVDA with chest pain, dyspnea, tachycardia, and tachypnea | tricuspid endocarditis with a bacterial embolism |
| MVA presents with chest pain, dyspnea, tachycardia, and tachypnea | Tension pneumothorax |
| post op with chest pain, dyspnea, tachycardia, and tachypnea | pulmonary embolism |
| young girl with congenital valve disease is given penicillin prophylactically. She's go bacterial endocarditis, what's the next step? | IV Vancomycin until culture comes back |
| In what circumstances might you see pulsus paradoxus? | cardiac tamponade, asthma, OSA, croup, severe COPD |
| diffuse myocardial inflammation with necrosis and mononuclear cells | myocarditis |
| focal myocardial inflammation with multinucleate giant cells | aschoff body (RF) |
| fever + IVDA + new heart murmur | tricuspid endocarditis |
| chest pain and course rubbing heart sounds in pt with Cr of 5.0 | pericarditis (Uremic) |
| tree-barking of the aorta | tertiary syphillis |
| child with fever, joint pain, cutaneous nodules 4 weeks after a throat infection | Rheumatic HD |
| ST elevations in all EKG leads | pericarditis |
| Disordered growth of myocytes | hypertrophic cardiomyopathy |
| EKG shows electrical alternans | cardiac tamponade |
| weak pulses in upper extremities | Takayasu |
| necrotizing granulomas of lung and necrotizing glomerulonephritis | Wegeners |
| Necrotizing immune complex inflammation of visceral/renal vessels | Polyarteritis Nodosa |
| Young male smokers | Bergers |
| Young Asian women | Takayasu |
| Young asthmatics | Churg-strauss |
| INfants and young children; involves coronary aa | Kawasaki's |
| most common vasculitis | henoch schloen |
| a/w hep B | polyarteritis nodosa |
| occlusion of ophthalmic a can lead to blindness | temporal arteritis |
| perforation of nasal septum | wegeners |
| unilateral HA, jaw claudication | temporal arteritis |
| Benign raised red lesion about the size of a mole in older patients | cherry hemangioma |
| raised, red area present at birth, increases in size initially then regresses over months to years | strawberry angioma |
| lesion caused by lymphoangiogenic growth factors in an infected HIV pt | kaposi sarcoma |
| polypoid red lesion found in pregnancy or after trauma | pyogenic granuloma |
| benign painful red blue tumor under fingernails | glomus tumor |
| cavernous lymphangioma a/w Turner's syndrome | cystic hygroma |
| skin papule in AIDS pt caused by bartonella | bacillary angiomatosis |
| classic presentation of pt with temporal arteritis | jaw claudication, unilateral HA, blindness |
| What lab finding helps diagnose temporal arteritis? | elevated ESR |
| staph aureus, large vegetations, rapid growth | acute bacterial endocarditis |
| viridans strep, small, previously diseased valves, slow growth | subacute bacterial endocarditis |
| Why do the kidneys retian fluid in CHF pts | decreased CO --> JGA --> renin --> ang II --> aldosterone |
| common causes of restrictive cardiomyopathy | sarcoidosis, amyloidosis, hemochromatosis, loeffler's eosinophilia, post radiation fibrosis |
| post-MI a/i fibrinous pericarditis with an elevated ESR | dressler's syndrome |
| 2 most common complications after MI | arrhythmia, LV insufficiency (= Pulm Edema) |
| 4-24 hrs post MI | contraction bands and enzyme spillage |
| 2-4 days post MI | NPs, red hepatization |
| 5-10 days post MI | MP, yellow stuff |
| 2 weeks post MI | scarring |
| most common locations for atherosclerosis | abdominal aorta, coronary a, popliteal a, carotid a |
| adult with history of hypertension has sudden sharp tearing pain radiating to the back. What do you see on CXR? | widening of the medistinum |
| pansystolic murmur at the apex with radiation to axilla | mitral regurg |
| 25 yo pregger in 3rd tri has nL BP standing and sitting, but it drops to 90/50 when supine. | Compression of the IVC |
| onion skin periosteal reaction | ewings sarcoma |
| pseudopalisading tumor cell arrangement | glioblastoma multiforme |
| elevated serum uric acid | Gout, Lesch Nyhan, tumor lysis, loop and thiazide diuretics |
Created by:
kayjames
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