APEA Predictor Remediation Study Set
AFIB/ EKG finding Abnormal atrial depolarization w/ normal ventricular depolarization
CHAOS IN THE ATRIUM
NO P waves
Types of AFIB Controlled- <100 bpm
Uncontrolled- >100 bpm
Management & Meds ( rate control, rhythm control, Rate control: Metoprolol (BBS) or Diltiazem (CCBs)
anticoags) rhythm control w/ antiarrhythmics ( Amiodarone)
Anticoags- Warfarin - ASSESS CHADS-VASC score
CHADS-VASC score Stroke risk tool used for AFIB
CHF, HTN, >/= 75 yo, DM, prior stroke/ TIA/Thromboembolism
Amiodarone (MOA, LONG TERM USE CAUSES?) prevents conduction of unwanted cardiac impulses
Test tip: assess chest x-ray & PFTs prior to initiation
Long term use can lead to hypothyroidism, pulmonary toxicity & optic neuropathy
Warfarin normal:1 goal:2-3,
Tx: if <2 increase dose; antidote: Vitamin K
INR 2-9: hold & drop dose
INR >10 (- BLEEDING): Oral Vit K
INR >10 (+ BLEEDING_): IV vit K
Things to avoid with Wafarin Green leafy vegs, mayo, canola oil, beef liver,
Drug to drug interaction (Warfarin) 8 A'S ABX, antifungal, antidepressants, alternative (St. Johns wort, Gingko),
antiplatelet, and anti-inflammatories, amiodarone, acetaminophen
HTN (goal) <140/90 in pts <60 and past hx of HTN/DM
<150/90 in pts >60 (more flexibity b/c arteries get stiff)
JNC <130/80; If ACVSD risk >10 initiate HTN meds
TX HTN (1ST) Lifestyle modifications, herbal ( COQ10)
ACE Inhibitors ( slow down how much AT2 your body "PRIL" Captopril, Enalapril, Afosiopril
makes)
Antihypertensive. Blocks ACE ( angiotension converting enzyme) lungs from
converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases
BP, Decreased Aldosterone secretions, Sodium and fluid loss. Heart and renal
protective for DM
*Orthostatic Hypotension, cough, angioedema, HYPERKALEMIA RISK
ARB (Angiotensin Receptor Blocker) ( blocks the -Sartan (losartan
receptors that use AT2 use to narrow the blood vessels) antagonizes action of aldosterone
Heart and renal protective for DM
Hyperkalemia risk, dizziness
THIAZIDE HCTZ or chlorthalidone
Blocks the sodium chloride channel in the distal convoluted tubule of the kidney(
decrease sodium reabsorption and therefore decreases fluid reabsorption)
preferred in osteoporosis & AA pts.
Avoid in pts w/ hypercholestermia, gout and DM; causes increases in uric acid,
glucose, triglycerides, and calcium
, APEA Predictor Remediation Study Set
Calcium channel blockers agents that inhibit the entry of calcium ions into heart muscle cells, causing a
slowing of the heart rate, a lessening of the demand for oxygen and nutrients,
and a relaxing of the smooth muscle cells of the blood vessels to cause dilation;
used to prevent or treat angina pectoris, some arrhythmias, and hypertension
Preferred in >65 yo & AA pts
SE: ankle edema, headaches
AVOID IN PTS WITH GERD- WEAKENS GASTRIC SPHINCTER
Idiopathic systolic HTN Caused by stiff arteries; overactive thyroid, DM, seen in pts >60; bp goal: <150
systolic
TX: CCB
Kawaski (CREAM) Acute febrile illness of unknown cause resulting in vascular inflammation
leading cause of heart disease in < 5 yo
high fever (up to 104 greater than 5 days), strawberry tongue, peripheral edema,
conjunctival redness, peeling polymorphic rash over trunk, cervical
lymphadenopathy (Often unilateral) dry lips, hand/foot swelling
TX of Kawasaki Aspirin & IVIG
Resolves in 4-8 weeks; f/u w. cardiology
Murmurs s3 & s4 S3- Gallop- heard @ the end of diastole, heard in HF or pregnancy
S4- Atrial kick- heard right before systole caused by uncontrolled HTN or LV
hypertrophy; benign finding in elderly
Systolic murmur ( MR PASS MVP) Mitral regurgitation- mitral valve doesn't close properly and causes blood to flow
backward into left atrium of the heart; radiates to the axillae; can cause
circulation issues
physiological- innocent murmur; turbulent blood flow
aortic stenosis- narrowing of the aortic valve, can cause dyspnea, syncope and
angina on exertion
systolic mitral valve prolapse- mitral valve's flaps bulge into the left atrium of the
heart during contraction phase of the heart.
Dental prophylaxis not necessary for MVP
Diastolic murmurs (ARMS DEALER)- sound when heart Aortic regurgitation- aortic valve doesn't close tightly causing leaks
relaxes during beat mitral stenosis- the mitral valve is narrowed
diastolic= DOOM- must be referred to cardiology
Grading of murmurs • 1/6 murmur is just audible by an expert in optimal setting.
• 2/6 is quiet.
• 3/6 is moderately loud.
• 4/6 is markedly loud and accompanied by a thrill.
• 5/6 is very loud and accompanied by a thrill.
• 6/6 is audible without a stethoscope.
• A grade I and II midsystolic murmur in an asymptomatic patient requires no
further workup. If the patient is symptomatic: echo.
• A grade III or higher holosystolic, or late systolic murmur requires
Basal cell carcinoma Most common and least severe type of skin cancer; often characterized by light
or pearly nodules w/ ulcerated center that do not heal, key finding: telangiectasia
fair-skinned w/ chronic UV exposure,
refer to derm for biopsy and removal
Bites (animals, people) may produce redness, swelling & pain within 12-24 hours
Sxs, TX, f/u TX: Augmentin: all bites and infected wounds need wound culture & sensitivity;
irrigate with normal saline
DO NOT SUTURE HIGH INFECTION RISK WOUNDS (>12 hrs old); Give
tetanus if not given within last 5 years;
F/U 24-48 hrs after tx
CAT scratch disease infection of lymph nodes following a scratch/bite from cat
red bump, fatigue, discomfort
Clear on its own
AFIB/ EKG finding Abnormal atrial depolarization w/ normal ventricular depolarization
CHAOS IN THE ATRIUM
NO P waves
Types of AFIB Controlled- <100 bpm
Uncontrolled- >100 bpm
Management & Meds ( rate control, rhythm control, Rate control: Metoprolol (BBS) or Diltiazem (CCBs)
anticoags) rhythm control w/ antiarrhythmics ( Amiodarone)
Anticoags- Warfarin - ASSESS CHADS-VASC score
CHADS-VASC score Stroke risk tool used for AFIB
CHF, HTN, >/= 75 yo, DM, prior stroke/ TIA/Thromboembolism
Amiodarone (MOA, LONG TERM USE CAUSES?) prevents conduction of unwanted cardiac impulses
Test tip: assess chest x-ray & PFTs prior to initiation
Long term use can lead to hypothyroidism, pulmonary toxicity & optic neuropathy
Warfarin normal:1 goal:2-3,
Tx: if <2 increase dose; antidote: Vitamin K
INR 2-9: hold & drop dose
INR >10 (- BLEEDING): Oral Vit K
INR >10 (+ BLEEDING_): IV vit K
Things to avoid with Wafarin Green leafy vegs, mayo, canola oil, beef liver,
Drug to drug interaction (Warfarin) 8 A'S ABX, antifungal, antidepressants, alternative (St. Johns wort, Gingko),
antiplatelet, and anti-inflammatories, amiodarone, acetaminophen
HTN (goal) <140/90 in pts <60 and past hx of HTN/DM
<150/90 in pts >60 (more flexibity b/c arteries get stiff)
JNC <130/80; If ACVSD risk >10 initiate HTN meds
TX HTN (1ST) Lifestyle modifications, herbal ( COQ10)
ACE Inhibitors ( slow down how much AT2 your body "PRIL" Captopril, Enalapril, Afosiopril
makes)
Antihypertensive. Blocks ACE ( angiotension converting enzyme) lungs from
converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases
BP, Decreased Aldosterone secretions, Sodium and fluid loss. Heart and renal
protective for DM
*Orthostatic Hypotension, cough, angioedema, HYPERKALEMIA RISK
ARB (Angiotensin Receptor Blocker) ( blocks the -Sartan (losartan
receptors that use AT2 use to narrow the blood vessels) antagonizes action of aldosterone
Heart and renal protective for DM
Hyperkalemia risk, dizziness
THIAZIDE HCTZ or chlorthalidone
Blocks the sodium chloride channel in the distal convoluted tubule of the kidney(
decrease sodium reabsorption and therefore decreases fluid reabsorption)
preferred in osteoporosis & AA pts.
Avoid in pts w/ hypercholestermia, gout and DM; causes increases in uric acid,
glucose, triglycerides, and calcium
, APEA Predictor Remediation Study Set
Calcium channel blockers agents that inhibit the entry of calcium ions into heart muscle cells, causing a
slowing of the heart rate, a lessening of the demand for oxygen and nutrients,
and a relaxing of the smooth muscle cells of the blood vessels to cause dilation;
used to prevent or treat angina pectoris, some arrhythmias, and hypertension
Preferred in >65 yo & AA pts
SE: ankle edema, headaches
AVOID IN PTS WITH GERD- WEAKENS GASTRIC SPHINCTER
Idiopathic systolic HTN Caused by stiff arteries; overactive thyroid, DM, seen in pts >60; bp goal: <150
systolic
TX: CCB
Kawaski (CREAM) Acute febrile illness of unknown cause resulting in vascular inflammation
leading cause of heart disease in < 5 yo
high fever (up to 104 greater than 5 days), strawberry tongue, peripheral edema,
conjunctival redness, peeling polymorphic rash over trunk, cervical
lymphadenopathy (Often unilateral) dry lips, hand/foot swelling
TX of Kawasaki Aspirin & IVIG
Resolves in 4-8 weeks; f/u w. cardiology
Murmurs s3 & s4 S3- Gallop- heard @ the end of diastole, heard in HF or pregnancy
S4- Atrial kick- heard right before systole caused by uncontrolled HTN or LV
hypertrophy; benign finding in elderly
Systolic murmur ( MR PASS MVP) Mitral regurgitation- mitral valve doesn't close properly and causes blood to flow
backward into left atrium of the heart; radiates to the axillae; can cause
circulation issues
physiological- innocent murmur; turbulent blood flow
aortic stenosis- narrowing of the aortic valve, can cause dyspnea, syncope and
angina on exertion
systolic mitral valve prolapse- mitral valve's flaps bulge into the left atrium of the
heart during contraction phase of the heart.
Dental prophylaxis not necessary for MVP
Diastolic murmurs (ARMS DEALER)- sound when heart Aortic regurgitation- aortic valve doesn't close tightly causing leaks
relaxes during beat mitral stenosis- the mitral valve is narrowed
diastolic= DOOM- must be referred to cardiology
Grading of murmurs • 1/6 murmur is just audible by an expert in optimal setting.
• 2/6 is quiet.
• 3/6 is moderately loud.
• 4/6 is markedly loud and accompanied by a thrill.
• 5/6 is very loud and accompanied by a thrill.
• 6/6 is audible without a stethoscope.
• A grade I and II midsystolic murmur in an asymptomatic patient requires no
further workup. If the patient is symptomatic: echo.
• A grade III or higher holosystolic, or late systolic murmur requires
Basal cell carcinoma Most common and least severe type of skin cancer; often characterized by light
or pearly nodules w/ ulcerated center that do not heal, key finding: telangiectasia
fair-skinned w/ chronic UV exposure,
refer to derm for biopsy and removal
Bites (animals, people) may produce redness, swelling & pain within 12-24 hours
Sxs, TX, f/u TX: Augmentin: all bites and infected wounds need wound culture & sensitivity;
irrigate with normal saline
DO NOT SUTURE HIGH INFECTION RISK WOUNDS (>12 hrs old); Give
tetanus if not given within last 5 years;
F/U 24-48 hrs after tx
CAT scratch disease infection of lymph nodes following a scratch/bite from cat
red bump, fatigue, discomfort
Clear on its own
