(NU 665D Exam III) LAST FINAL EVER 232
Final Questions and answers Newest 100%
PASS
P Wave - Correct Answers Atrial depolarization
II! II! II! II! II! II! II!
II! P-R Interval - Correct Answers 0.12-0.20 seconds
II! II! II! II! II! II! II!
II! QRS Complex - Correct Answers Ventricular Depolarization
II! II! II! II! II! II! II!
0.06-0.10 (up to 0.12) seconds II! II! II! II!
II! ST Segment - Correct Answers Beginning of repolarization; should be isoelectric
II! II! II! II! II! II! II! II! II! II! II!
II! T Wave - Correct Answers End of ventricular depolarization
II! II! II! II! II! II! II! II! II!
II! QT Interval - Correct Answers Ventricular repolarization
II! II! II! II! II! II! II!
Men <0.44 seconds II! II!
Women < (or = to) 0.46 seconds II! II! II! II! II! II!
II! Depolarization - Correct Answers Wave of positively charged sodium ions passing through the II! II! II! II! II! II! II! II! II! II! II! II! II!
II! myocardium
II! Repolarization - Correct Answers Returning to a polarized state II! II! II! II! II! II! II! II! II!
Occurs by potassium ions leaving the cells II! II! II! II! II! II!
II! Electricity of heart - Correct Answers In RA starting at SA node, moving through heart, slowing (d/t Ca++
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! ions), pass thru AV node II! II! II! II!
Conducts rapidly (Na+ ions), through the bundle of His, down through right and left bundle branches
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
,II! Atrial Fibrillation - Correct Answers Irregularly irregular rhythm
II! II! II! II! II! II! II! II!
-Absence of discernible P wave II! II! II! II!
-Atrial disorganization II!
II! Paroxysmal A. Fib - Correct Answers -Recurrent II! II! II! II! II! II! II!
>1 episode lasting 30 or more seconds in duration
II! II! II! II! II! II! II! II!
AF that terminates spontaneously within 7 days
II! II! II! II! II! II!
II! Persistent A. Fib - Correct Answers Sustained A. Fib >7 days OR
II! II! II! II! II! II! II! II! II! II! II! II! II!
Lasts <7 days but requires cardioversion
II! II! II! II! II!
II! Permanent A. Fib - Correct Answers Refractory to cardioversion or accepted as a final rhythm
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Acute A. Fib - Correct Answers New onset OR first episode of A. Fib
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Lone A. Fib - Correct Answers patients <60yo without evidence of cardiac, pulmonary or circulatory
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! disease
II! A. Fib Associated Cardiac Conditions - Correct Answers -HTN
II! II! II! II! II! II! II! II! II!
-CHF
-CAD
-Rheumatic valvular disease II! II!
-Atrial and ventricular dilation or hypertrophy
II! II! II! II! II!
-Congential heart disease II! II!
II! A. Fib Associated Non-Cardiac Conditions - Correct Answers -Thyroid disease
II! II! II! II! II! II! II! II! II! II!
-ETOH and caffeine abuse II! II! II!
-Pulmonary HTN II!
,-COPD, OSA II!
-Infections
-Family/genetics (rare cases) II! II!
II! Clinical Presentation of A.Fib - Correct Answers -Palpitations, tachycardia
II! II! II! II! II! II! II! II! II!
-Fatgiue
-Chest pain II!
-Dizziness
-Syncope/Pre-syncope
-Sxs associated w/stroke (occult A. Fib)
II! II! II! II! II!
-12-20% pf pts may be asymptomatic (often discovered by PCP during routine visit)
II! II! II! II! II! II! II! II! II! II! II! II!
-Note: Irregular pulse does not always indicate A. Fib; PACs, PVCs, A. Tach; confirm rhythm w/EKG
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! A.Fib Patient Evaluation - Correct Answers -PE: Heart sounds
II! II! II! II! II! II! II! II! II!
-EKG- LA dilation? II! II!
-TFTs: should be done during initial discovery/change in condition (e.g. difficult to control rate)
II! II! II! II! II! II! II! II! II! II! II! II! II!
-Electrolytes with Magnesium II! II!
-BUN/Creatinine (helpful when trying to decide if AAD or OAC) II! II! II! II! II! II! II! II! II!
-Echocardiogram: valvular disease or reduced LVEF II! II! II! II! II!
-Ambulatory monitoring: Holter II! II!
II! Stoke Risk in A. Fib - Correct Answers Thromboembolism: primary morbidity assoc. w/ A.Fib. Thrombus
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! formation and dislodgement from left atrial appendage (LAA) II! II! II! II! II! II! II!
-Based on clinical risk factors and NOT on freq/duration of A.Fib
II! II! II! II! II! II! II! II! II! II!
-Non-valvular meaning A. Fib presumably not r/t mitral valve heart disease, specifically mitral stenosisII! II! II! II! II! II! II! II! II! II! II! II! II!
-In general ~48hrs for clot formation; if duration known to be <48hrs, can cardiovert w/o AC
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
-Second option: transesophageal echo to confirm absence of LAA thrombus
II! II! II! II! II! II! II! II! II!
-Risk of thrombus is increased in first 3-4 weeks after DCCV, when gradual return of atrial mechanical
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
function can result in high risk for thrombus
II! II! II! II! II! II! II! II!
, II! CHADS 2 - Correct Answers CHF (1) II! II! II! II! II! II! II!
HTN (1) II!
Age >75 (1) II! II!
DM (1) II!
Prior Stroke (2) II! II!
II! CHADS 2 VASc 2 - Correct Answers CHF (1) II! II! II! II! II! II! II! II! II!
HTN (1) II!
Age >75 (2) II! II!
DM (1) II!
Prior Stroke (2) II! II!
Vascular disease (1) II! II!
Age 65-74 (1)II! II!
Female (1) II!
If score >2, oral anticoagulants (or if non valvular A. Fib for prior stoke, TIA)
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
If pt has nonvalvular A. Fib and CHADS2VASc2 score of 0, reasonable to omit anticoag therapy
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! New Anticoagulants - Correct Answers -3 currently approved
II! II! II! II! II! II! II! II!
-Tested against coumadin II! II!
-No sign. diff b/w the three of them except for S/Es
II! II! II! II! II! II! II! II! II! II!
-Avoid potent Pgp inducers (rifampin, carbemazepine, phehytoin, phenobarb, St. John's wort) as will
II! II! II! II! II! II! II! II! II! II! II! II!
decrease effect
II! II!
-Riva and Apixa: Avoid potent inhibitors of CYP3A4 and Pgp (Azoles, Protease inhibitors, mycins), as will
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
INCREASE AC effect
II! II! II!
II! Eliquis (apixaban) - Correct Answers Dose: 5mg BID
II! II! II! II! II! II! II! II!
Renal adjustment: 2.5mg twice daily, must have 2 or more of the following: Age >80yo, Body wt </= 60kg,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
Serum creatinine >/= 1.5mg/dL
II! II! II! II!
Half life: 12 hours
II! II! II!
Final Questions and answers Newest 100%
PASS
P Wave - Correct Answers Atrial depolarization
II! II! II! II! II! II! II!
II! P-R Interval - Correct Answers 0.12-0.20 seconds
II! II! II! II! II! II! II!
II! QRS Complex - Correct Answers Ventricular Depolarization
II! II! II! II! II! II! II!
0.06-0.10 (up to 0.12) seconds II! II! II! II!
II! ST Segment - Correct Answers Beginning of repolarization; should be isoelectric
II! II! II! II! II! II! II! II! II! II! II!
II! T Wave - Correct Answers End of ventricular depolarization
II! II! II! II! II! II! II! II! II!
II! QT Interval - Correct Answers Ventricular repolarization
II! II! II! II! II! II! II!
Men <0.44 seconds II! II!
Women < (or = to) 0.46 seconds II! II! II! II! II! II!
II! Depolarization - Correct Answers Wave of positively charged sodium ions passing through the II! II! II! II! II! II! II! II! II! II! II! II! II!
II! myocardium
II! Repolarization - Correct Answers Returning to a polarized state II! II! II! II! II! II! II! II! II!
Occurs by potassium ions leaving the cells II! II! II! II! II! II!
II! Electricity of heart - Correct Answers In RA starting at SA node, moving through heart, slowing (d/t Ca++
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! ions), pass thru AV node II! II! II! II!
Conducts rapidly (Na+ ions), through the bundle of His, down through right and left bundle branches
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
,II! Atrial Fibrillation - Correct Answers Irregularly irregular rhythm
II! II! II! II! II! II! II! II!
-Absence of discernible P wave II! II! II! II!
-Atrial disorganization II!
II! Paroxysmal A. Fib - Correct Answers -Recurrent II! II! II! II! II! II! II!
>1 episode lasting 30 or more seconds in duration
II! II! II! II! II! II! II! II!
AF that terminates spontaneously within 7 days
II! II! II! II! II! II!
II! Persistent A. Fib - Correct Answers Sustained A. Fib >7 days OR
II! II! II! II! II! II! II! II! II! II! II! II! II!
Lasts <7 days but requires cardioversion
II! II! II! II! II!
II! Permanent A. Fib - Correct Answers Refractory to cardioversion or accepted as a final rhythm
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Acute A. Fib - Correct Answers New onset OR first episode of A. Fib
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Lone A. Fib - Correct Answers patients <60yo without evidence of cardiac, pulmonary or circulatory
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! disease
II! A. Fib Associated Cardiac Conditions - Correct Answers -HTN
II! II! II! II! II! II! II! II! II!
-CHF
-CAD
-Rheumatic valvular disease II! II!
-Atrial and ventricular dilation or hypertrophy
II! II! II! II! II!
-Congential heart disease II! II!
II! A. Fib Associated Non-Cardiac Conditions - Correct Answers -Thyroid disease
II! II! II! II! II! II! II! II! II! II!
-ETOH and caffeine abuse II! II! II!
-Pulmonary HTN II!
,-COPD, OSA II!
-Infections
-Family/genetics (rare cases) II! II!
II! Clinical Presentation of A.Fib - Correct Answers -Palpitations, tachycardia
II! II! II! II! II! II! II! II! II!
-Fatgiue
-Chest pain II!
-Dizziness
-Syncope/Pre-syncope
-Sxs associated w/stroke (occult A. Fib)
II! II! II! II! II!
-12-20% pf pts may be asymptomatic (often discovered by PCP during routine visit)
II! II! II! II! II! II! II! II! II! II! II! II!
-Note: Irregular pulse does not always indicate A. Fib; PACs, PVCs, A. Tach; confirm rhythm w/EKG
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! A.Fib Patient Evaluation - Correct Answers -PE: Heart sounds
II! II! II! II! II! II! II! II! II!
-EKG- LA dilation? II! II!
-TFTs: should be done during initial discovery/change in condition (e.g. difficult to control rate)
II! II! II! II! II! II! II! II! II! II! II! II! II!
-Electrolytes with Magnesium II! II!
-BUN/Creatinine (helpful when trying to decide if AAD or OAC) II! II! II! II! II! II! II! II! II!
-Echocardiogram: valvular disease or reduced LVEF II! II! II! II! II!
-Ambulatory monitoring: Holter II! II!
II! Stoke Risk in A. Fib - Correct Answers Thromboembolism: primary morbidity assoc. w/ A.Fib. Thrombus
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! formation and dislodgement from left atrial appendage (LAA) II! II! II! II! II! II! II!
-Based on clinical risk factors and NOT on freq/duration of A.Fib
II! II! II! II! II! II! II! II! II! II!
-Non-valvular meaning A. Fib presumably not r/t mitral valve heart disease, specifically mitral stenosisII! II! II! II! II! II! II! II! II! II! II! II! II!
-In general ~48hrs for clot formation; if duration known to be <48hrs, can cardiovert w/o AC
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
-Second option: transesophageal echo to confirm absence of LAA thrombus
II! II! II! II! II! II! II! II! II!
-Risk of thrombus is increased in first 3-4 weeks after DCCV, when gradual return of atrial mechanical
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
function can result in high risk for thrombus
II! II! II! II! II! II! II! II!
, II! CHADS 2 - Correct Answers CHF (1) II! II! II! II! II! II! II!
HTN (1) II!
Age >75 (1) II! II!
DM (1) II!
Prior Stroke (2) II! II!
II! CHADS 2 VASc 2 - Correct Answers CHF (1) II! II! II! II! II! II! II! II! II!
HTN (1) II!
Age >75 (2) II! II!
DM (1) II!
Prior Stroke (2) II! II!
Vascular disease (1) II! II!
Age 65-74 (1)II! II!
Female (1) II!
If score >2, oral anticoagulants (or if non valvular A. Fib for prior stoke, TIA)
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
If pt has nonvalvular A. Fib and CHADS2VASc2 score of 0, reasonable to omit anticoag therapy
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! New Anticoagulants - Correct Answers -3 currently approved
II! II! II! II! II! II! II! II!
-Tested against coumadin II! II!
-No sign. diff b/w the three of them except for S/Es
II! II! II! II! II! II! II! II! II! II!
-Avoid potent Pgp inducers (rifampin, carbemazepine, phehytoin, phenobarb, St. John's wort) as will
II! II! II! II! II! II! II! II! II! II! II! II!
decrease effect
II! II!
-Riva and Apixa: Avoid potent inhibitors of CYP3A4 and Pgp (Azoles, Protease inhibitors, mycins), as will
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
INCREASE AC effect
II! II! II!
II! Eliquis (apixaban) - Correct Answers Dose: 5mg BID
II! II! II! II! II! II! II! II!
Renal adjustment: 2.5mg twice daily, must have 2 or more of the following: Age >80yo, Body wt </= 60kg,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
Serum creatinine >/= 1.5mg/dL
II! II! II! II!
Half life: 12 hours
II! II! II!
