3Ps Exam well elaborated with questions and
correct answers
Aortic Stenosis (mid systolic ejection): - CORRECT ANSWER Radiates to neck!
Higher risk of sudden death • Location:
oAortic area, 2nd ICS by right upper sternum; at the base of the heart by the right upper
sternum; base of heart on the right side of sternum
Diastolic murmurs occur when - CORRECT ANSWER S2 Heart sound
diastolic murmurs are always - CORRECT ANSWER PATHOLOGICAL-indicative of
heart disease
Mitral stenosis (Mid/late diastolic) - CORRECT ANSWER Afib most common risk-emboli
risk
narrowing of the mitral valve
Only murmur you listen to with your Bell
**Dyspnea most common symptom**
Heart Murmur Grading System: - CORRECT ANSWER Grades I-VI :
• Grade I: Barely audible
• Grade II: Audible
• Grade III: Clearly audible
• Grave IV: First time thrill is present (more than likely will ask for this on exam)
• Grade V:Hear the murmur even with edge of stethoscope off
• Grade VI: Murmur is so loud that it can be heard with entire stethoscope off chest
S3 sound associated with? - CORRECT ANSWER Heart failure
Sounds like "Kentucky"
Abnormal in ages under 35
S3 is a normal heart sound in: - CORRECT ANSWER Pregnancy, young children,
athletes
How to listen to S4 - CORRECT ANSWER Bell of stethoscope
Sounds like "Tennessee"
Late diastole is when __Valves close; occurs in S1 - CORRECT ANSWER Late
diastole, S1, is when the AV valves close
Late diastole is when __valves close; occurs in S2 - CORRECT ANSWER Late diastole,
S2, is when the SL valves close
,Motivated-S1 heart sound-Lub includes what valves - CORRECT ANSWER Motivated
(S1 heart sound-lub)
M (mitral valve)
T (tricuspid valve)
AV (atrioventricular valves)
Apples- s2 heart sound-dub-includes what valves - CORRECT ANSWER A (aortic
valve)
P (pulmonic valve)
S (semilunar valves)
Isolated systolic hypertension (ISH) - CORRECT ANSWER Systolic is 140+ and
diastolic is 90 or less--occurs mainly in older adults
HTN meds that cause heartburn - CORRECT ANSWER CCB, BB, alpha agonists
Atrial Fibrillation (AF) (Most common arrhythmia in the US) - CORRECT ANSWER •
Can be paroxysmal or persistent
• Pt. will complain of the sudden onset of heart palpitations accompanied by weakness,
dizziness, fatigue, and dyspnea
• May have chest pain and feel like passing out
Rapid and irregular pulse which may be greater than 110 per minute with hypotension
--> Consider antithrombic therapy
Afib diagnosis - CORRECT ANSWER A diagnostic test is 12 lead ECG which won't
show discrete P waves and will be irregularly irregular
CHA2DS2-VASc score - CORRECT ANSWER C- congestive heart failure -1
H- hypertension - 1
A2- Age > 75 -2
D- Diabetes mellitus - 1
S2- Stroke - Tia - throboembo-2
V- vascular disease -1
A-Age -65-74-1
Sc- Sex women - 1
Max score 9
Score of 0= low risk
Score of 2 or more= requires anticoagulation
A2 & S2= gives PT 2 points right away
Drugs that increase INR include: - CORRECT ANSWER Sulfa drugs (Bactrim)
macrolides (erythromycin)
NSAIDS/Ibuprofen
, Anticoagulation Therapy Goal - CORRECT ANSWER INR 2-3
Orthostatic Hypotension - CORRECT ANSWER A decrease in the systolic BP of at
least 20 mmHg or the diastolic BP of at least
10 mmHg within 3 minutes upon standing
Coarctation of the Aorta: Background/ SX/ DX - CORRECT ANSWER Background:
• Normally SBP is higher in the legs than the arms.
• If patient has coarctation of aorta the SBP is higher in the arms than legs.
Symptoms:
• Pulses in legs won't be palpable
• The radial pulse will be bounding
• The BP will be high
• A heart murmur may be present
Dx:
• Echo, ECG, cardiac MRI or cardiac CT
hypertension - CORRECT ANSWER Stage 1 (140-159/90-99)
Hypertension: If Goal BP is not reached at __ month, increase the dose on the initial
drug and/or add a second drug - CORRECT ANSWER • If Goal BP is not reached at 1
month, increase the dose on the initial drug and/or add a second drug
Thiazide diuretics; do not give to a patient with a _____ allergy - CORRECT ANSWER
Do not give thiazide diuretics to a patient who has a sulfa allergy
Ace inhibitors - CORRECT ANSWER -pril: HTN, HF. AD: angioedema, cough,
hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis, pancreatitis,
SJS. Contra: pregnancy. Nursing: empty stomach, monitor for infection, dry cough, use
contraception (teratogenic), avoid sports drinks/salt substitutes (extra K)
ARB drugs - CORRECT ANSWER -sartan
Losartan
Valsartan
HTN drug of choice for diabetics - CORRECT ANSWER Ace inhibitors or ARBS
these protect kidneys
Do not use Ace drugs and _____ together - CORRECT ANSWER Do not use Ace drugs
(lisinopril) and Arb drugs (losartan) together
Beta bocker - CORRECT ANSWER -olol
Avoid abrupt discontinuation: wean slowly to avoid rebound HTN
correct answers
Aortic Stenosis (mid systolic ejection): - CORRECT ANSWER Radiates to neck!
Higher risk of sudden death • Location:
oAortic area, 2nd ICS by right upper sternum; at the base of the heart by the right upper
sternum; base of heart on the right side of sternum
Diastolic murmurs occur when - CORRECT ANSWER S2 Heart sound
diastolic murmurs are always - CORRECT ANSWER PATHOLOGICAL-indicative of
heart disease
Mitral stenosis (Mid/late diastolic) - CORRECT ANSWER Afib most common risk-emboli
risk
narrowing of the mitral valve
Only murmur you listen to with your Bell
**Dyspnea most common symptom**
Heart Murmur Grading System: - CORRECT ANSWER Grades I-VI :
• Grade I: Barely audible
• Grade II: Audible
• Grade III: Clearly audible
• Grave IV: First time thrill is present (more than likely will ask for this on exam)
• Grade V:Hear the murmur even with edge of stethoscope off
• Grade VI: Murmur is so loud that it can be heard with entire stethoscope off chest
S3 sound associated with? - CORRECT ANSWER Heart failure
Sounds like "Kentucky"
Abnormal in ages under 35
S3 is a normal heart sound in: - CORRECT ANSWER Pregnancy, young children,
athletes
How to listen to S4 - CORRECT ANSWER Bell of stethoscope
Sounds like "Tennessee"
Late diastole is when __Valves close; occurs in S1 - CORRECT ANSWER Late
diastole, S1, is when the AV valves close
Late diastole is when __valves close; occurs in S2 - CORRECT ANSWER Late diastole,
S2, is when the SL valves close
,Motivated-S1 heart sound-Lub includes what valves - CORRECT ANSWER Motivated
(S1 heart sound-lub)
M (mitral valve)
T (tricuspid valve)
AV (atrioventricular valves)
Apples- s2 heart sound-dub-includes what valves - CORRECT ANSWER A (aortic
valve)
P (pulmonic valve)
S (semilunar valves)
Isolated systolic hypertension (ISH) - CORRECT ANSWER Systolic is 140+ and
diastolic is 90 or less--occurs mainly in older adults
HTN meds that cause heartburn - CORRECT ANSWER CCB, BB, alpha agonists
Atrial Fibrillation (AF) (Most common arrhythmia in the US) - CORRECT ANSWER •
Can be paroxysmal or persistent
• Pt. will complain of the sudden onset of heart palpitations accompanied by weakness,
dizziness, fatigue, and dyspnea
• May have chest pain and feel like passing out
Rapid and irregular pulse which may be greater than 110 per minute with hypotension
--> Consider antithrombic therapy
Afib diagnosis - CORRECT ANSWER A diagnostic test is 12 lead ECG which won't
show discrete P waves and will be irregularly irregular
CHA2DS2-VASc score - CORRECT ANSWER C- congestive heart failure -1
H- hypertension - 1
A2- Age > 75 -2
D- Diabetes mellitus - 1
S2- Stroke - Tia - throboembo-2
V- vascular disease -1
A-Age -65-74-1
Sc- Sex women - 1
Max score 9
Score of 0= low risk
Score of 2 or more= requires anticoagulation
A2 & S2= gives PT 2 points right away
Drugs that increase INR include: - CORRECT ANSWER Sulfa drugs (Bactrim)
macrolides (erythromycin)
NSAIDS/Ibuprofen
, Anticoagulation Therapy Goal - CORRECT ANSWER INR 2-3
Orthostatic Hypotension - CORRECT ANSWER A decrease in the systolic BP of at
least 20 mmHg or the diastolic BP of at least
10 mmHg within 3 minutes upon standing
Coarctation of the Aorta: Background/ SX/ DX - CORRECT ANSWER Background:
• Normally SBP is higher in the legs than the arms.
• If patient has coarctation of aorta the SBP is higher in the arms than legs.
Symptoms:
• Pulses in legs won't be palpable
• The radial pulse will be bounding
• The BP will be high
• A heart murmur may be present
Dx:
• Echo, ECG, cardiac MRI or cardiac CT
hypertension - CORRECT ANSWER Stage 1 (140-159/90-99)
Hypertension: If Goal BP is not reached at __ month, increase the dose on the initial
drug and/or add a second drug - CORRECT ANSWER • If Goal BP is not reached at 1
month, increase the dose on the initial drug and/or add a second drug
Thiazide diuretics; do not give to a patient with a _____ allergy - CORRECT ANSWER
Do not give thiazide diuretics to a patient who has a sulfa allergy
Ace inhibitors - CORRECT ANSWER -pril: HTN, HF. AD: angioedema, cough,
hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis, pancreatitis,
SJS. Contra: pregnancy. Nursing: empty stomach, monitor for infection, dry cough, use
contraception (teratogenic), avoid sports drinks/salt substitutes (extra K)
ARB drugs - CORRECT ANSWER -sartan
Losartan
Valsartan
HTN drug of choice for diabetics - CORRECT ANSWER Ace inhibitors or ARBS
these protect kidneys
Do not use Ace drugs and _____ together - CORRECT ANSWER Do not use Ace drugs
(lisinopril) and Arb drugs (losartan) together
Beta bocker - CORRECT ANSWER -olol
Avoid abrupt discontinuation: wean slowly to avoid rebound HTN
