Pdci Msii Exam 4

Front 1

What occupies most of the anterior cardiac surface?

Back 1

R ventricle

Front 2

What is the term for the proximal surface of the heart at the R and L 2nd interspaces close to the sternum?

Back 2

Base of the heart

Front 3

Closure of what valve produces S1?

Back 3

mitral valve

Front 4

Closure of what valve produces S2?

Back 4

aortic valve

Front 5

What causes S3?

Back 5

rapid deceleration of the column of blood against the ventricular wall

Front 6

What causes S4?

Back 6

it marks atrial contraction. ii reflects pathologic change in ventricular compliance

Front 7

When is S2 split into 2 sounds?

Back 7

during inspiration. (should disappear during expiration)

Front 8

what is pulse pressure?

Back 8

the difference between systolic and diastolic pressures

Front 9

What does pressure in the jugular veins reflect?

Back 9

the R atrial pressure, giving clinicians an important clinical indicator of cardiac function and R heart hemodynamics. The JVP is best measured on the R side in the internal jugular vein

Front 10

What point do you measure JVP from?

Back 10

sternal angle (where manubrium joins sternum)

Front 11

what is paroxysmal nocturnal dyspnea?

Back 11

sudden dyspnea and orthopnea that awaken the PT from sleep. May suggest L vent heart failure or mitral stenosis. mimicked by nocturnal asthma attacks

Front 12

pulsus arternans

Back 12

beat to beat variation

Front 13

What are the 3 key charac of Junctional rhythm?

Back 13

narrow QRS, no p wave, slower rhythm (~60 bpm)

Front 14

L axis deviation

Back 14

0 to (-90) degrees. upper R quadrant. common causes: L vent hypertrophy and L anterior hemiblock

Front 15

R axis deviation

Back 15

90 to 180 deg. bottom L quadrant. common causes: R vent hypertrophy, MI, L posterior hemiblock, pectus excavatum

Front 16

Intermediate axis

Back 16

180 - 270 deg. top L corner. Only exist if put the leads on wrong

Front 17

Net axis

Back 17

to det net axis, look at AVF and lead I. determine if more R wave tall than S wave deep or vice versa.

Front 18

Lead I is more R wave tall than S wave deep

Back 18

eastern hemisphere

Front 19

Lead I more S wave deep than R wave tall

Back 19

western hemisphere

Front 20

AVF more R wave tall than S wave deep

Back 20

southern hemis

Front 21

AVF more S wave deep than R wave tall

Back 21

northern hemis

Front 22

what leads do you look at to determine isoelectric point?

Back 22

I, II, III, V1, V2, V3 only

Front 23

isoelectric point movement

Back 23

find isoelectric point, note the lead it is in and move 90 degrees from the lead where the isoelectric point is (on the circle graph) into the quadrant determined by R wave tall vs S wave deep.

Front 24

Atrial activity is best seen on what leads?

Back 24

II, V1, V2

Front 25

How do you determine ventricular hypertrophy on an EKG?

Back 25

Count depth of S wave in V1 (in mm) and add to height of R in V5…..If greater than 35 and the PT is 35 or older…then L vent hypertrophy.

Front 26

R ven hypertrophy sign on EKG

Back 26

Tall R waves in V1

Front 27

What does T wave inversion indicate?

Back 27

ischemia....make sure it isn't bundle branch block

Front 28

What does ST segment elevation indicate?

Back 28

injury to muscle

Front 29

Q waves

Back 29

Q waves are normal in lead I and V6. look for Q wave to be abnormal if greater than one block wide or its depth is more than a third the total height of the R wave. …this implies infarction.

Front 30

How do you determine LV hypertrophy on an EKG?

Back 30

measure S wave in V1 + R wave in V5. if PT is 35 y.o. or older... >35mm...LVH.

if PT under 35 y.o. must be greater than 53 mm

each block ~5mm

Front 31

What is the goal of therapy for HTN in general pop? PT with DM?

Back 31

general pop: <140/90

DM: <130/80

Front 32

There is a correlation btwn the risk of CV disease and...

Back 32

There is a correlation btwn the risk of CV disease and...
--level of HTN
--presence of target organ damage
--presence of other risk factors

Front 33

Best med to start with to tx HTN in PT with diabetes?

Back 33

ACEI

Front 34

Best med to start with to tx HTN in PT with CAD?

Back 34

beta blocker

Front 35

what is the typical 1st line drug for benign HTN?

Back 35

thiazides diuretic

Front 36

What drug is a central alpha 2a agonist?

Back 36

clonidine

Front 37

What is the best drug to use to tx HTN in a PT with chronic kidney disease?

Back 37

ACEI or ARB

Front 38

You see a PT with a hx of gout, and they are in renal failure. can you use thiazide diuretics to tx HTN?

Back 38

No! don't use thiazides to tx HTN in PT with gout, renal failure or problems with K+

Front 39

Basis to dx HTN in terms of office visits and readings....

Back 39

based upon avg of 2 or more properly measured readings at each of 2 or more visits after the initial screen

Front 40

Name some end organ damage from HTN...

Back 40

--LVH, CHF, CAD

--stroke

--Renal failure

--hypertensive retinopathy

Front 41

On an fundoscopic exam you see Retinal edema, Cotton-wool spots and hemorrhages. What KWB classification?

Back 41

Group 3, Mild angiospastic retinopathy

Front 42

On a fundoscopic exam you see: Moderate to marked sclerosis of the arterioles. Exaggerated arterial light reflex. A-V crossing changes. What KWB classification?

Back 42

group 2, more marked hypertensive retinopathy

Front 43

On a fundoscopic exam you see: Mild narrowing or sclerosis of the retinal arterioles. KWB classification?

Back 43

Group 1, benign HTN

Front 44

On a fundoscopic exam you see: Retinal edema. Cotton-wool spots and hemorrhages. Sclerosis and spastic lesions of arterioles and papilledema. KWB classification?

Back 44

Group 4, malignant HTN

Front 45

A normal QRS is less than __________________

Back 45

3 little blocks wide

(if greater than 3 little blocks, probably a ventricular rhythm)

Front 46

1st degree AV block

Back 46

PR interval greater than 0.2 sec (1 big block)

usually best in lead II or VI (b/c atrial activ)

(don't give meds that further block AV node...Beta blocker, CCB...)

Front 47

Mobitz Type I 2nd degree AV block

Back 47

gradual lengthening of PR interval and then drop a QRS

Front 48

Mobitz Type II 2nd degree AV block

Back 48

drop QRS without lengthening PR interval

can be 2:1, 3:1, 4:1

Front 49

3rd degree AV block

Back 49

no relation of atrial to ventricular activity

Front 50

Right Bundle branch block

Back 50

widened QRS (greater than 3 blocks) (wide QRS w. double peak)

rsR' pattern in V1

Front 51

Left Bundle branch block

Back 51

widened QRS (greater than 3 blocks)

completely upright QRS in V6 and I (no Q or S wave)

Front 52

Atrial fib

Back 52

most common arrhythmia

multiple areas in atria trying to be pacemaker

no distinct p waves...jagged, irreg baseline

Front 53

Clinical implications of Atrial fib/ atrial flutter

Back 53

dec ventricular filling

inc oxygen demand -> angina

blood pool in atria -> clot

Front 54

atrial flutter

Back 54

saw tooth pattern if upside down

only 2-3 areas in atria try to be pacemaker

Front 55

Wandering pacemaker

Back 55

Clinically can imply vascular disease affecting SA node

p waves vary, normal QRS, irreg rhythm

non-sinus rhythm

Front 56

Junctional rhythm

Back 56

narrow QRS

no p waves ( check lead II)

slow rhythm (usually 60 bpm)

Front 57

The 2 best leads to look at QRS for RBBB are __________.

Back 57

R chest leads: V1 and V2

Front 58

The 2 best leads to look at QRS for LBBB are __________.

Back 58

L chest leads: V5 and V6

Front 59

On an EKG, always observe the PR interval....greater than one large block (5 small blocks), look for ___________.

Back 59

AV block (also p's missing a QRS)

Front 60

On an EKG if QRS is greater than 3 small blocks wide, check for __________.

Back 60

bundle branch block

Front 61

You cannot determine ventricular hypertrophy if ________________ is present.

Back 61

bundle branch block

this is b/c the criteria for hypertrophy are based on a normal QRS

(you can determine atrial hypertrophy if BBB)

Front 62

A hypertrophied ventricle have more (and larger) ventricles, which draw the mean QRS vector in that direction.

Back 62

Keep working hard!

Front 63

In obese ppl, the inc abdominal pressure often pushes the diaphragm up, so position of heart may be altered...i.e. 'horizontal heart'

Back 63

this changes the net axis.

or a tall slender person may have a vertical heart

Front 64

If you calculate the net axis to be 210 deg what is the likely dx?

Back 64

the leads are put on wrong

Front 65

The net axis tends to point ___________ ventricular hypertrophy and ____________ from area of MI.

Back 65

The net axis tends to point TOWARD ventricular hypertrophy and AWAY from area of MI.

Front 66

A diphasic p wave is characteristic of _________________.

Back 66

atrial enlargement

Front 67

If the initial part of the diphasic p wave is the larger of the two phases, then there is _________ atrial enlargement.

Back 67

RIGHT

Front 68

If the height of a p wave in any of the limb leads exceeds ___ mm (even if it's not diphasic), suspect R atrial enlargement.

Back 68

2.5 mm

Front 69

If the terminal part of the diphasic p wave in V1 is large and wide, then there is _______________.

Back 69

Left atrial enlargement

(i.e. from mitral valve stenosis)

Front 70

If there is a large R wave in V1, then suspect ______________.

Back 70

R ventricular hypertrophy

Front 71

Inverted T waves are commonly associated with __________________________

Back 71

L vent hypertrophy

best to check in leads V5 or V6 b/c these are the left chest leads

inverted T waves often are asymm with long gradual downslope and a rapid steep upslope

Front 72

What waves tell you about coronary artery blood flow?

Back 72

T waves

Front 73

Marked T wave inversion in leads V2 and V3 are the hallmark of ______________, and alert us to stenosis of the anterior descending coronary a.

Back 73

WELLENS SYNDROME - stenosis of anterior descending coronary a.

Front 74

ST segment elevation suggests _______________.

Back 74

injury

(possible Prinzmetal angina, MI...)

Front 75

Symmetric T wave inversion suggests _________.

Asymmetric T wave inversion suggests ___________.

Back 75

symmetric -> ischemia

asym -> LVH

Front 76

ST segment depression can be caused by:

Back 76

Digitalis

subendocardial infarction

Front 77

The _____ wave indicates necrosis and makes the dx of infarction.

Back 77

Q wave

Front 78

The Q wave is the first downward stroke of the QRS complex, and it is never preceded by anything in the complex.

In the QRS complex, if there is any positive wave - even a tiny spike - before the downward wave, the downward wave is an S wave and the upward wave preceding it is an R wave.

Back 78

yes!

(insignificant q waves are less than .04 seconds (1 small block))

Front 79

the criteria for a significant Q wave....

Back 79

--one small block or more wide

--Q wave is 1/3 the amplitude of the entire QRS complex

Front 80

Scan all leads for the presence of Q waves, except ____.

Back 80

AVR

Front 81

Q waves in V1, V2, V3, V4 signify ________________.

Back 81

anterior infarction

LAD

Front 82

Q waves in leads I and AVL signify a __________.

Back 82

high lateral infarct

circumflex a.

Front 83

Q waves in leads II, III, and AVF signify _________________.

Back 83

inferior infarct

R coronary or LAD

Front 84

A large R wave in V1 or V2 signifies a __________.

Back 84

posterior infarct

R coronary a.