NR667 CEA MODULE NOTES EXAM QUESTIONS &
DETAILED CORRECT SOLUTIONS
1. Cardiovascul
Ø Location
ar anatomy
-Central anterior chest
and flow
-RV is anteriorly located
complication
-LV is posteriorly located
s
Ø Flow of blood in the body
-Lungs > pulmonary veins > left atrium > left ventricle > aorta >
body tissues > vena cava > right atrium > right ventricle >
pulmonary arteries > lungs.
Ø Blood flow complications
-Contractility: EF, CAD, LVH, Cardiomyopathy
-Preload: Central fluid volume status
-Afterload: Arterial backpressure on outflow (Chronic hypertension).
(**RAAS system typically manages this).
2. Hypertension Ø JNC8
-Defined as 140/90
-Secondary HTN: Up flow issue going up to kidney, ex: renal stenosis.
- Age > 60 or < 60 years. (>60 = 150/90).
-DM and CKD: ACE/ARBs (nephro protective).
-Non-black vs. Black: Calcium channel blocker for African Ascent.
-General starting place: Thiazides/ACE/ARBs.
-ACE/ARBS: "Prils" and "Sartans"
-Beta Blockers: "olol" not on JNC8 guidelines, history of cardiac
disease, reduce HR. Carvedilol is a dual alpha/beta, great for Heart
failure.
-CCB: Dihydropyrines and Non-Dihydropyrines. Dihydropyrines work
more pe- ripherally (amlodipine, etc). Non-Dihydropyrines work more on
heart (Verapamil and diltiazem). Common ASE: Constipation and
peripheral edema.
-Diuretics: Thiazides, Loops. Thiazides are less potent. Thiazide= Low
,NR667 CEA MODULE NOTES EXAM QUESTIONS &
DETAILED CORRECT SOLUTIONS
electrolytes, Higher calcium. Loops- lowers everything. Potassium-sparing
diuretics (Increase potassium, lowers sodium).
3. Heart failure Ø HFrEF (Less than 40%)
Ø HFpEF (Higher than 40%)
,NR667 CEA MODULE NOTES EXAM QUESTIONS &
DETAILED CORRECT SOLUTIONS
Ø Systolic heart failure: inability for myocardium to ettectively
contract. Ø Diastolic heart failure: inability to myocardium to
ettectively relax.
Ø Typical patient: elderly with comorbidities of HTN, DM, Smoking.
-Class I: Mild symptoms
-Class II-III: Symptoms with exertion (II), ADL's cause symptoms (III)
-Class IV: Symptoms severe, likely needs hospitalization.
Ø Classic symptoms: SOB, Fatigue, exertional dyspnea, dependent and
pul- monary edema, low activity tolerance, abdominal bloating,
orthopnea.
Ø Causes: ischemic heart disease, valve disease, MI, cardiomyopathy.
Ø Treatment: ACE/ARB, ARB/ARNI, BB, Diuretics, nitrates plus hydralazine,
4. Lipid Fluid and salt restriction, daily weights.
manage-
ment Ø AVSCD
-Statins
-Hight-intensity statins: Atorvastatin 40-80mg and Rovusatan 20-
40mg (Don't require being taken at bedtime). LDL < 190
-Common ASE: Myalgia. Rhabdomyolysis worse case scenario.
-Statins, Ezetimibe in conjunction. PC9-Inhibitors (injectable Q2 weeks).
(Cardi- ology at consult prior to PC9-Inhibitors).
-Familial homozygous hyperlipidemia= PC9-Inhibitors.
-HDL: "Cleaning agent."
-LDL- "Scrum between glass window in shower"
5. Valve
disease and Ø Aortic stenosis: Narrowing of outflow to aortic root through aortic
aneurysms valve due to calcification. Symptoms tend to mirror CAD with addition
of syncope/near syncope.
Ø Aortic Regurgitation/Insuflciency: instability for aortic valve to
appropriately close. Commonly due to aortic root dilation or
endocarditis/infection. A direct contraindication for IABP use (common
,NR667 CEA MODULE NOTES EXAM QUESTIONS &
DETAILED CORRECT SOLUTIONS
board exam
question).
Ø Mitral stenosis:
Narrowing of inflow
into LV through the
mitral valve due to
calcification.
Ø Mitral
regurgitation/Insuflciency:
instability for mitral valve
leaflets to close.
DETAILED CORRECT SOLUTIONS
1. Cardiovascul
Ø Location
ar anatomy
-Central anterior chest
and flow
-RV is anteriorly located
complication
-LV is posteriorly located
s
Ø Flow of blood in the body
-Lungs > pulmonary veins > left atrium > left ventricle > aorta >
body tissues > vena cava > right atrium > right ventricle >
pulmonary arteries > lungs.
Ø Blood flow complications
-Contractility: EF, CAD, LVH, Cardiomyopathy
-Preload: Central fluid volume status
-Afterload: Arterial backpressure on outflow (Chronic hypertension).
(**RAAS system typically manages this).
2. Hypertension Ø JNC8
-Defined as 140/90
-Secondary HTN: Up flow issue going up to kidney, ex: renal stenosis.
- Age > 60 or < 60 years. (>60 = 150/90).
-DM and CKD: ACE/ARBs (nephro protective).
-Non-black vs. Black: Calcium channel blocker for African Ascent.
-General starting place: Thiazides/ACE/ARBs.
-ACE/ARBS: "Prils" and "Sartans"
-Beta Blockers: "olol" not on JNC8 guidelines, history of cardiac
disease, reduce HR. Carvedilol is a dual alpha/beta, great for Heart
failure.
-CCB: Dihydropyrines and Non-Dihydropyrines. Dihydropyrines work
more pe- ripherally (amlodipine, etc). Non-Dihydropyrines work more on
heart (Verapamil and diltiazem). Common ASE: Constipation and
peripheral edema.
-Diuretics: Thiazides, Loops. Thiazides are less potent. Thiazide= Low
,NR667 CEA MODULE NOTES EXAM QUESTIONS &
DETAILED CORRECT SOLUTIONS
electrolytes, Higher calcium. Loops- lowers everything. Potassium-sparing
diuretics (Increase potassium, lowers sodium).
3. Heart failure Ø HFrEF (Less than 40%)
Ø HFpEF (Higher than 40%)
,NR667 CEA MODULE NOTES EXAM QUESTIONS &
DETAILED CORRECT SOLUTIONS
Ø Systolic heart failure: inability for myocardium to ettectively
contract. Ø Diastolic heart failure: inability to myocardium to
ettectively relax.
Ø Typical patient: elderly with comorbidities of HTN, DM, Smoking.
-Class I: Mild symptoms
-Class II-III: Symptoms with exertion (II), ADL's cause symptoms (III)
-Class IV: Symptoms severe, likely needs hospitalization.
Ø Classic symptoms: SOB, Fatigue, exertional dyspnea, dependent and
pul- monary edema, low activity tolerance, abdominal bloating,
orthopnea.
Ø Causes: ischemic heart disease, valve disease, MI, cardiomyopathy.
Ø Treatment: ACE/ARB, ARB/ARNI, BB, Diuretics, nitrates plus hydralazine,
4. Lipid Fluid and salt restriction, daily weights.
manage-
ment Ø AVSCD
-Statins
-Hight-intensity statins: Atorvastatin 40-80mg and Rovusatan 20-
40mg (Don't require being taken at bedtime). LDL < 190
-Common ASE: Myalgia. Rhabdomyolysis worse case scenario.
-Statins, Ezetimibe in conjunction. PC9-Inhibitors (injectable Q2 weeks).
(Cardi- ology at consult prior to PC9-Inhibitors).
-Familial homozygous hyperlipidemia= PC9-Inhibitors.
-HDL: "Cleaning agent."
-LDL- "Scrum between glass window in shower"
5. Valve
disease and Ø Aortic stenosis: Narrowing of outflow to aortic root through aortic
aneurysms valve due to calcification. Symptoms tend to mirror CAD with addition
of syncope/near syncope.
Ø Aortic Regurgitation/Insuflciency: instability for aortic valve to
appropriately close. Commonly due to aortic root dilation or
endocarditis/infection. A direct contraindication for IABP use (common
,NR667 CEA MODULE NOTES EXAM QUESTIONS &
DETAILED CORRECT SOLUTIONS
board exam
question).
Ø Mitral stenosis:
Narrowing of inflow
into LV through the
mitral valve due to
calcification.
Ø Mitral
regurgitation/Insuflciency:
instability for mitral valve
leaflets to close.
