Download CVRN-BC Exam 2024 Questions and Answers: Cardiovascular Physiology and Pathology and more Exams Cardiology in PDF only on Docsity!
CVRN-BC EXAM 2024 QUESTIONS PERFECTLY ANSWERED!!
"Normal pulse pressure - CORRECT ANSWER 40"
"widened pulse pressure at rest can indicate - CORRECT ANSWER increased cardiovascular
risk"
"What is the most common cause of narrow (low) pulse pressure? - CORRECT ANSWER a drop
in left ventricular stroke volume"
"How does trauma cause narrow pulse pressure? - CORRECT ANSWER Blood loss"
"If pulse pressure is extremely low (25 mmHg or less), what is the cause? - CORRECT ANSWER
low stroke volume such as HF or shock"
"Narrow pulse pressure causes not RT shock or HF - CORRECT ANSWER aortic valve stenosis,
cardiac tamponade"
"Name two meds that lower pulse pressure - CORRECT ANSWER ACE inhibitors, folic acid"
"What meds can raise pulse pressure - CORRECT ANSWER NSAIDS, steroids, birth control,
SSRIs"
"How much folic acid is recommended to decrease pulse pressure? - CORRECT ANSWER 5 mg
daily"
"How does folic acid reduce pulse pressure? - CORRECT ANSWER targets large artery stiffness
and may prevent isolated systolic HTN"
"ABI 0.9-1.0 - CORRECT ANSWER No obstruction"
"ABI 0.4-0.6 - CORRECT ANSWER Severe obstruction"
"ABI <0.4 - CORRECT ANSWER Ischemic"
"ABI > or = 1.3 - CORRECT ANSWER calcified vessels"
"ABI - CORRECT ANSWER Ankle Brachial Index"
"All Physicians Take Money - CORRECT ANSWER Aortic, Pulmonic, Tricuspid, Mitral valves"
"When do you hear the mitral and tricuspid valve closing? - CORRECT ANSWER S1"
"When do you hear S2? - CORRECT ANSWER aortic and pulmonic valves closing"
"S4 - CORRECT ANSWER heard in many adults, only heard in sinus rhythms"
"Split S2 - CORRECT ANSWER delay in pulmonic valve closure"
"When is split S2 heard? - CORRECT ANSWER ASD or AVD, RBBB, Pulm HTN, Pulm stenosis"
"S3 is normal in - CORRECT ANSWER children, young adults and in the third trimester"
"Is S3 abnormal in older people1/ - CORRECT ANSWER Yes"
"Atrial Gallop is AKA - CORRECT ANSWER S4"
"Where do you listen for the aortic valve? - CORRECT ANSWER 2nd right ICS at RSB"
"Where do you listen for pulmonic valve? - CORRECT ANSWER 2nd ICS, LSB"
"Where do you listen for tricuspid valve? - CORRECT ANSWER 5th ICS, LSB"
"Where do you listen for mitral valve? - CORRECT ANSWER 5th ICS MCL"
"Grade 1 murmur - CORRECT ANSWER barely audible"
"Grade 2 murmur - CORRECT ANSWER audible"
"Grade 3 murmur - CORRECT ANSWER moderately loud"
"Grade 4 murmur - CORRECT ANSWER Loud with thrill"
"Accelerated Junctional Rhythm - CORRECT ANSWER 60-100 bpm"
"Junctional Tachycardia - CORRECT ANSWER 100+ bpm"
"Junctional Rhythm - CORRECT ANSWER heart is paced by the AV node"
""Scooped out" ST segment indicative of - CORRECT ANSWER dig toxicity"
"Tall peaked T waves, flattened P waves, ST segment depression, wide QRS interval - CORRECT
ANSWER hyperkalemia"
"U waves on EKG - CORRECT ANSWER hypokalemia"
"Camel Hump and McDonalds on EKG - CORRECT ANSWER hypokalemia"
"What leads are best to see electrolyte disturbances - CORRECT ANSWER V2-V4"
"ST segment leaning towards QRS, prolonged Q-T interval, lengthened ST segment - CORRECT
ANSWER hypercalcemia"
"Athermoa - CORRECT ANSWER consists of foam cells, smooth muscle cells, connective
tissue" "Fibrous cap over fatty lesion = complex (crescent moon) lesion Complicated lesion of fibrous plaques
Plaque rupture - CORRECT ANSWER Advanced stage ACS"
"Responsible for 75% of the thrombi associated with ACS - CORRECT ANSWER Disrupted
plaques" "What med decreases inflammation and creates fibrous caps to make sure plaque doesn't
rupture - CORRECT ANSWER Statins"
"CAD generally develops silently until a crisis occurs. List three. - CORRECT ANSWER Stenosis
Thrombosis Aneurysm or embolism"
"Signs and symptoms of ACS start with - CORRECT ANSWER fatigue, mild angina on exertion,
intermittent claudication"
"Prizmetal's angina - CORRECT ANSWER angina at rest caused by vasospasms"
"Stable angina s/sx - CORRECT ANSWER secondary to overexerting, after eating large meals,
DT exposure to extreme heat/cold"
"Unstable angina (UA) s/sx - CORRECT ANSWER appears at rest or sleep
gradually increases new onset severe, worst the pt ever felt"
"Three most common patterns suggestive of MI on serial EKGs - CORRECT ANSWER
Horizontal ST-T depression Down-sloping ST-T segment T wave inversions"
"Most commonly reported symptoms of MI in women - CORRECT ANSWER unusual fatigue
sleep disturbances SOB"
"PCI Hospital goal - CORRECT ANSWER 90 mins door to balloon"
"Non PCI hospital goal - CORRECT ANSWER if PCI delay >120 mins, fibrinolysis"
"Acute MI diagnostic criteria is rapid rise or fall of troponin plus one additional factor... -
CORRECT ANSWER Symptoms of infarction
ECG changes consistent with MI New pathological Q waves Imaging evidence of new wall motion abnormality/ new loss of viability"
"When is an 18 lead EKG needed? - CORRECT ANSWER If EKG is not diagnostic for an obvious
STEMI but pt is symptomatic because 18 lead shows inferior wall/posterior heart issues"
"40% of inferior wall injuries have what - CORRECT ANSWER RV infarcts, need 18 lead EKG"
"Infero-right ventricular infarction involves what artery - CORRECT ANSWER RCA"
"Infero-right ventricular infarction involves ST elevation in what leads - CORRECT ANSWER II,
III, V1"
"HELLP syndrome - CORRECT ANSWER hemolysis, elevated liver enzymes, low platelets"
"How does baroreceptor reflex control BP - CORRECT ANSWER High BP causes baroreceptors
to stretch, stimulating vagal cholinergic neurons thus lowering HR and causing vasodilation. Low BP creates less stretch causing stimulation of the sympathetic adrenergic neurons, raising BP by increasing HR, improving myocardial contractility, increasing vasoconstriction"
"Aldosterone raises BP by... - CORRECT ANSWER retain sodium and water in the renal
tubules, thus increasing BP"
"Glomerular filtration and lowering BP - CORRECT ANSWER high BP stimulates an increase in
GFR in the kidneys causing diuresis and lowering BP"
"How does angiotensin II increase BP? - CORRECT ANSWER causes peripheral vascular
vasoconstriction"
"How does Aldosterone work to increase BP - CORRECT ANSWER low pressure stimulates the
release of aldosterone which causes the body to retain Na+ and water in the renal tubules to increase BP"
"Classifications of BP - CORRECT ANSWER Normal <120/<
Pre-Hypertensive - 120-139/80- Stage 1 - 140-159/90- Stage 2 - 160 and up/100 and up Stage 3 - >180/>110"
"HTN management for stage 1 and 2 - CORRECT ANSWER diuretics
ACEI or ARB
BB or CCB Alpha Antagonists"
"What diet is recommended to decrease HTN - CORRECT ANSWER DASH diet"
"Med choice for young pts with HTN - CORRECT ANSWER ACEI
a-blocker or BB"
"Med choices for HTN in African American pts - CORRECT ANSWER Diuretic
CCB or a-blockers ACEI (bb are less effective as monotherapy)"
"Med choices to tx HTN in elderly - CORRECT ANSWER Diuretic
CCB
ACEI or a-blocker BB -effective but cause more SE in elderly"
"Med choices to tx HTN in DM pts - CORRECT ANSWER ACEI - shows decrease in progression
of diabetic neuropathy CCB or a-blocker"
"Med choices for HTN management in renal disease - CORRECT ANSWER Need 3 or more
drugs to keep BP <130/80: ACEI and ARBs -decrease DM and non-DM renal disease Loop diuretics"
"K+ sparing diuretics - CORRECT ANSWER Spironolactone, triamterene, amiloride"
"3 common BB used for HTN - CORRECT ANSWER bystolic, coreg, metoprolol"
"ARB - CORRECT ANSWER Losartan (Cozaar)"
"CCB - CORRECT ANSWER diltiazem, nifedipine, amlodipine, nicardipine"
"Loop diuretics - CORRECT ANSWER Bumetanide
Furosemide Torsemide"
"Is diastolic dysfunction normal with aging - CORRECT ANSWER Yes"
"Diastolic dysfunction - CORRECT ANSWER abnormal function of the heart during relaxation
phase, between beats"
"Left side HF s/sx - CORRECT ANSWER Cough - may have pink, frothy sputum
Course rales/crackles DOE pale/cool skin, cyanosis Increased HR Peripheral edema - late sign"
"Right side HF s/sx - CORRECT ANSWER liver congestion
Ascites JVD Abdominal distension Anorexia Edema"
"Left side HF caused by - CORRECT ANSWER ischemia, HTN, Aortic or mitral valve disease"
"Right side HF caused by - CORRECT ANSWER left HF, COPD, Pulm HTN, PE, Tricuspid valve
disease or ARDS"
"HFrEF - CORRECT ANSWER HF with reduced left ventricular EF"
"HFpEF - CORRECT ANSWER HF with preserved left ventricular EF"
"HFrEF deals with what side of the heart - CORRECT ANSWER left side"
"HFpEF deals with what side of the heart - CORRECT ANSWER right side"
"Cornerstone of therapy with HFrEF - CORRECT ANSWER ACEI, BB, Aldosterone Antagonist"
"pharmacological management of HRpEF - CORRECT ANSWER ACEI (1st choice), ARBs,
diuretics, BB (2nd choice)"
"What are the heart hormones - CORRECT ANSWER ANP and BNP"
"What does neurohormonal activation do to compensate with HF - CORRECT ANSWER
Maintains pressure via volume and vasoconstriction Vasodilates Remodels"
"Left Ventricular symptoms in HF - CORRECT ANSWER crackles
orthopnea DOE systolic murmurs S3 and S4 gallop Fatigue mental confusion Decreased SpO2"
"Right ventricular s/sx in HF - CORRECT ANSWER JVD
dependent edema hepatic engorgement hepatojugular reflux anorexia, N/V, abdominal pain nocturia weakness, fatigue weight gain increased CVP"
"Basics of HF in hospital - CORRECT ANSWER Oxygen
Resp treatments I&O Daily weight Discharge planning Progressive activity Low fat, low Na+, low cholesterol diet Fluid retention Patient education"
"Who gets BB in HF? - CORRECT ANSWER All HF with symptoms Class C/D
Selective asymptomatic HF pts
"Revascularization is measured using what scale? - CORRECT ANSWER TIMI Flow"
"What TIMI scale level is the goal for revascularization - CORRECT ANSWER TIMI III"
"What diabetic med should be help prior to cardiac cath? - CORRECT ANSWER metformin"
"Left heart cath is fed through where? - CORRECT ANSWER The artery to the left side of the
heart"
"Left heart cath takes direct pressure measurements of what? - CORRECT ANSWER left atria
and left ventricle"
"Right heart cath is fed through where? - CORRECT ANSWER The vein into the right side of the
heart"
"Right heart cath takes direct pressure measurements of what? - CORRECT ANSWER SVC,
right atria and right ventricle"
"Left heart cath evaluates what - CORRECT ANSWER Cardiac valve disease
cardiac tumors heart defects heart function"
"Risks assoc with left heart cath - CORRECT ANSWER arrhythmias
cardiac tamponade MI Embolism"
"Reasons to perform right heart cath - CORRECT ANSWER HF
Shock Congenital heart disease valvular heart disease Cardiomyopathy Pulm HTN Biopsy"
"Risks assoc with right heart cath - CORRECT ANSWER Bruising of the skin at insertion site
(most common)
Excessive bleeding PTX Air embolism"
"Name the antiplatelet agents for cardiac caths - CORRECT ANSWER ASA
Clopidogrel (plavix) Ticagrelor (Brilinta) - SOB SE Eptifibatide (Integrilin) - given in cath lab"
"Complications RT manual pulling of sheath - CORRECT ANSWER Bleeding - retroperitoneal
(internal) or at access site (external) Psuedoaneurysm Numbness, weakness in affected limb"
"Coincide removal of sheath with patient's.... - CORRECT ANSWER exhalation"
"How long do you hold pressure after removing sheath - CORRECT ANSWER 20 mins"
"How long after removal of sheath should pt stay on bedrest - CORRECT ANSWER about 4
hours"
"How long after sheath is removed can the patient take a bath - CORRECT ANSWER 5-7 days,
when site is fully healed"
"After removal of sheath, what is the lifting restriction for the pt - CORRECT ANSWER <10 lbs
for 3 days"
“Side effect of amlodipine, cardizem, lyrica - CORRECT ANSWER peripheral edema"
"xanthoma - CORRECT ANSWER fatty streaking visible just under the skin under eyes,
indicates HLD"
"corneal arcus - CORRECT ANSWER grayish ring around the eyes, indicates HLD"
"Normal CVP - CORRECT ANSWER 5-10"
"JVD above 5 cm can indicate - CORRECT ANSWER right ventricular failure (RVF)
cardiac tamponade constrictive pericarditis
"2nd degree AV block type I (Wenckebach) - CORRECT ANSWER Progressively prolonged PR
interval until eventually dropped (P wave followed by missing QRS)"
"Second degree AV block type II - CORRECT ANSWER P-R interval fixed and normal, random
dropping of one QRS complex, QRS wide DT BBB."
"Complete AV block (3rd degree) - CORRECT ANSWER no relationship between P and QRS."
"What are the stages of Acute Coronary Syndrome (ACS) - CORRECT ANSWER First stage,
Intermediate stage, Advanced stage"
"First stage of ACS - CORRECT ANSWER Begins with fatty streaks
Infiltration, leukocytes, lipids and macrophages accumulate Foam cells created" "Atheroma Endothelial cell injury via platelet aggregation and PDGF = proliferation of smooth muscle cells that becomes foam cells Edothelial dysfunction that permits various blood components into intimal layer
Inflammation with eventual bulging onto the arterial lumen - CORRECT ANSWER
Intermediate stage of ACS"
"Acute Coronary Syndrome (ACS) - CORRECT ANSWER The clinical manifestation of plaque
rupture with subtotal or total occlusion of the affected artery"
"How to diagnose ACS according to the WHO - CORRECT ANSWER Must have two of the three
criteria: -Clinical hx of ischemic type CP -Changes on serial ECG tracings -A rise and fall in serum cardiac markers"
"Unstable Angina (UA) compared to other anginas - CORRECT ANSWER less predictable and
more serious with prolonged and severe discomfort that lasts more than 20 minutes."
"What population experiences atypical symptoms of angina - CORRECT ANSWER women and
african americans"
"Why are diabetics 50% more likely to die from angina? - CORRECT ANSWER They have nerve
damage and cannot feel the angina pain"
"Atypical angina or MI symptoms include - CORRECT ANSWER dyspnea, unusual fatigue,
absence of classic CP"
"Acute anteroseptal MI shows ST elevation in what leads? - CORRECT ANSWER V1-V4"
"Late presentation (after 12 hours) STEMI s/sx - CORRECT ANSWER EKG may show signs of
active necrosis in Q waves, ST elevation usually present, cardiac enzymes down trending."
"Late presentation STEMI puts pt at higher risk for - CORRECT ANSWER complications"
"NSTEMI EKG findings - CORRECT ANSWER ST depression and T wave inversion"
"TIMI flow - CORRECT ANSWER angiographic reference to the blood flow through the
coronary vessel"
"TIMI score? What does it indicate? - CORRECT ANSWER The TIMI score is a risk of having an
MI or death in pt. with unstable angina or NSTEMI within 14 days. Urgent Catheterization needed: Age > 65 Markers elevated (cardiac enzymes) EKG (ST depression 0.5 mm) Risk factors (3+ risk factors for CAD) Ischemia (2+ anginal events in last 24 hours Known coronary stenosis of 50% or more The TIMI stratifies which patients will benefit with a GIIb/IIIa inhibitor + early PCI"
"How to obtain 18 lead EKG - CORRECT ANSWER Use a standard 12 lead machine, first run the
12 lead EKG, then rearrange the leads as follows: Move V4 to V7 - left side posterior 3rd rib, MAL Move V5 to V8 - left side posterior 5th ICS, posterior axillary line, just to the right of V Move V6 to V9 - Left side posterior rib 6th ICS, just to the right of V8, left paraspinal area Be sure to re-label leads V1-V3 as V4R, V5R, V6R, and relabel V4-V6 as V7, V8, V9."
"Main complications of unmanaged HTN - CORRECT ANSWER Brain - strokes/CVA
Blood - elevated BG levels Retina - retinopathy Heart - MI, HTN cardiomyopathy leading to HF Kidneys - HTN neuropathy leading to chronic renal failure (give ACEI to protect kidneys)"
"Causes of secondary HTN - CORRECT ANSWER Thyroid problems (hyper and hypo)
Hyperparathyroidism (regulates Ca+ and Phos, with too much hormone, Ca+ increases and triggers HTN)"
"Findings in pts with DCM (dilated cardiomyopathy) - CORRECT ANSWER eccentric
hypertrophy - ventricles grow so overall volume and size are enlarged low pulse pressure syncope angina enlarged heart on palpation, poss shift to the left fatigue and weakness sudden weight gain poor apetite"
"findings of hypertrophic cardiomyopathy (HCM) - CORRECT ANSWER frequently
asymptomatic until sudden cardiac death hyperdynamic LV - compensation for decreased filling, EF increases to 70-80% Mitral regurgitation Left atrial enlargement Dynamic LV outflow tract obstruction from thickened septum Impaired relaxation and filling of left ventricle Stiff walls resist filling Myocardial ischemia Sudden cardiac death"
"Do you treat HCM (hypertrophic cardiomyopathy) with diuretics? Why? - CORRECT ANSWER
No. exacerbates symptoms by decreasing ventricular volume and increasing outflow resistance"
"HF compensation mechanisms - CORRECT ANSWER Sympathetic NS activation
Neurohormonal activation Heart Hormones released from cardiac myocytes"
"Precipitating causes of hospitalization for HF - CORRECT ANSWER Increased preload - poor
compliance=diet (Na+ and fluid), not taking meds Increased afterload - uncontrolled HTN, PE (acute right HF) Decreased contractility - ischemia, ACS-MI, ETOH ingestion, negative inotropic meds (new or too much)"
