NURS 5463 Cardiac Latest Exam
Questions Fully Solved.
Carotids - Answer supply blood to the brain, face and neck
Carotid disease - Answer causes ischemia from both hypoperfusion and atheroembolic events and
presents w/ various symptoms
ABCD scoring for stroke risk - Answer Age>60 = 1 point
BP >140/90 = 1 point
Unilateral weakness = 2 points,
speech impairment w/o weakness = 1 point
DM = 1 point
Stroke risk based on scores:
0-3 = 1.2% stroke in 7 days
4-5 = 5.4% stroke in 7 days
5-6 = 11.7% stroke in 7 days
Vaso vesorum - Answer patients with atherosclerosis have a higher density of vasa vasorum - smaller
vessels that supply blood to the walls of larger vessels
Exercise - Answer counteracts the proatherosclerotic conditions of HTN, DM, HLD, which can disrupt
endothelial response to laminar shear stress
Carotid artery disease exam - Answer carotid bruit when auscultating the neck on the ipsilateral side of
stenosis
Carotid Artery Disease Clinical Presentatio - Answer ipsilateral monocular vision loss
contralateral heisensory loss or contralateral hemiparesis
,contralateral homonymous hemianopia or quandrantanopia
language impairment including expressive and receptive aphasia
Syncope is less likely
Decrased responsiveness can be seen in basilar thrombosis
Carotid artery disease diagnostics - Answer Carotid duplex ultrasound
CTA
MRA
Digital subtraction angiography (DSA) - gold standard diagnostic tool for carotic atherosclerosis, and is a
required part of treatment with carotid stenting, allows for direct visualization and can measure the
velocity of flow -- not commonly done for routine diagnosis
Statins - Answer lipid modulating and anti-inflammatory benefits
Leads to plaque stabilization and regression
SPARCL trial - high dose atorvastatin was assoc w/ reduction in 5 yr risk of ischemic stroke
Adverse reactions: statin myosisitis and drug related rash, monitor hepatic functions
Simvastatin and pravastatin most favorable in pient tolerability
CREST trial goal of LDL<70 in those w/ DM
Antihypertensives - Answer Initiate when SBP>140 or DBP>90
Restarting these medication in the days following stroke is assoc w/ less stroke recurrence as well as less
incidence of other secondary cardiac endpoints -- typically 2 wks of stroke
Life's Simple 7 - Answer AHA aggregated score ranging from 0-14 (risk profile)
,Smoking, HTN, BMI, Physical Activity, Diet, Total Cholesterol and Glycemic Control
Score is graded for each category a 0 (poor), 1 (intermediate) and 2 (Ideal)
Antiplatelets - Answer ASA - before through and after carotid endarterectomy or stenting
DAPT - for symptomatic disease (ASA 81-325mg + clopidogrel 75mg daily) before and for a min of 30
days after stenting
Lowering A1C - Answer Reduction in stroke risk with A1c<7.0
Carotid endarterectomy (CEA) - Answer surgical procedure to remove blockage from the ICA with goal
of reducing risk of stroke
Meant for those w/ >=70% stenosis, no benefit for <50%
if a pt presents w/ symptoms a CEA should be scheduled w/in 1-2 wks or asap
If patient has bilateral stenosis, the symptomatic side should be operated on first, followed by the other
side in 1-2 weeks ( most severe lesion is prioritized )
Carotid artery stenting (CAS) - Answer There is a greater risk for patients treated with stenting and
there hasn't been a consensus stating that CAS is better than CEA
for plaques located at higher surgically inaccessible areas, stenting is appropriate
CEA not for those >70
CREST study suggests that older patients have an increased combined stroke and death rates in
comparison to younger patients
, 84 y/o w/ HX of DM and CHF that is refractory to medical treatment. Duplex study suggests 50% to 75%
right carotid stenosis. Which treatment is most appropriate? - Answer Medical management - her CHF
is refractery, asymptomatic stenosis has a less margin of benefit for CEA, CAS is not indicated for her age
Which of the following does *NOT* need to be instituted for a patient following carotid endarterectomy
- Answer Coumadin to target an INR of 2-3 (you do not have to start a patient on coumadin)
For which of the following patients is a left carotid endarterectomy most indicated? - Answer A 70 y/o
man with transient loss of vision in the left eye that recovered at 20 mins, and he has 75% left carotid
stenosis
Low probability of ischemia (descriptive words) - Answer Sharp
Fleeting
Shifting
Pleuritic
Positional
EKG for ACS - Answer Should be done w/in 10 mins of arrival
EKG findings for STEMI - Answer ST segment elevation
New LBBB
Winter Sign
Transient ST segment elevation
Posterior MI - Answer - ST depression V1,V2, V3
15-20% of STEMIs
Horizontal ST depression
Tall, brouad R waves (>30ms)
Questions Fully Solved.
Carotids - Answer supply blood to the brain, face and neck
Carotid disease - Answer causes ischemia from both hypoperfusion and atheroembolic events and
presents w/ various symptoms
ABCD scoring for stroke risk - Answer Age>60 = 1 point
BP >140/90 = 1 point
Unilateral weakness = 2 points,
speech impairment w/o weakness = 1 point
DM = 1 point
Stroke risk based on scores:
0-3 = 1.2% stroke in 7 days
4-5 = 5.4% stroke in 7 days
5-6 = 11.7% stroke in 7 days
Vaso vesorum - Answer patients with atherosclerosis have a higher density of vasa vasorum - smaller
vessels that supply blood to the walls of larger vessels
Exercise - Answer counteracts the proatherosclerotic conditions of HTN, DM, HLD, which can disrupt
endothelial response to laminar shear stress
Carotid artery disease exam - Answer carotid bruit when auscultating the neck on the ipsilateral side of
stenosis
Carotid Artery Disease Clinical Presentatio - Answer ipsilateral monocular vision loss
contralateral heisensory loss or contralateral hemiparesis
,contralateral homonymous hemianopia or quandrantanopia
language impairment including expressive and receptive aphasia
Syncope is less likely
Decrased responsiveness can be seen in basilar thrombosis
Carotid artery disease diagnostics - Answer Carotid duplex ultrasound
CTA
MRA
Digital subtraction angiography (DSA) - gold standard diagnostic tool for carotic atherosclerosis, and is a
required part of treatment with carotid stenting, allows for direct visualization and can measure the
velocity of flow -- not commonly done for routine diagnosis
Statins - Answer lipid modulating and anti-inflammatory benefits
Leads to plaque stabilization and regression
SPARCL trial - high dose atorvastatin was assoc w/ reduction in 5 yr risk of ischemic stroke
Adverse reactions: statin myosisitis and drug related rash, monitor hepatic functions
Simvastatin and pravastatin most favorable in pient tolerability
CREST trial goal of LDL<70 in those w/ DM
Antihypertensives - Answer Initiate when SBP>140 or DBP>90
Restarting these medication in the days following stroke is assoc w/ less stroke recurrence as well as less
incidence of other secondary cardiac endpoints -- typically 2 wks of stroke
Life's Simple 7 - Answer AHA aggregated score ranging from 0-14 (risk profile)
,Smoking, HTN, BMI, Physical Activity, Diet, Total Cholesterol and Glycemic Control
Score is graded for each category a 0 (poor), 1 (intermediate) and 2 (Ideal)
Antiplatelets - Answer ASA - before through and after carotid endarterectomy or stenting
DAPT - for symptomatic disease (ASA 81-325mg + clopidogrel 75mg daily) before and for a min of 30
days after stenting
Lowering A1C - Answer Reduction in stroke risk with A1c<7.0
Carotid endarterectomy (CEA) - Answer surgical procedure to remove blockage from the ICA with goal
of reducing risk of stroke
Meant for those w/ >=70% stenosis, no benefit for <50%
if a pt presents w/ symptoms a CEA should be scheduled w/in 1-2 wks or asap
If patient has bilateral stenosis, the symptomatic side should be operated on first, followed by the other
side in 1-2 weeks ( most severe lesion is prioritized )
Carotid artery stenting (CAS) - Answer There is a greater risk for patients treated with stenting and
there hasn't been a consensus stating that CAS is better than CEA
for plaques located at higher surgically inaccessible areas, stenting is appropriate
CEA not for those >70
CREST study suggests that older patients have an increased combined stroke and death rates in
comparison to younger patients
, 84 y/o w/ HX of DM and CHF that is refractory to medical treatment. Duplex study suggests 50% to 75%
right carotid stenosis. Which treatment is most appropriate? - Answer Medical management - her CHF
is refractery, asymptomatic stenosis has a less margin of benefit for CEA, CAS is not indicated for her age
Which of the following does *NOT* need to be instituted for a patient following carotid endarterectomy
- Answer Coumadin to target an INR of 2-3 (you do not have to start a patient on coumadin)
For which of the following patients is a left carotid endarterectomy most indicated? - Answer A 70 y/o
man with transient loss of vision in the left eye that recovered at 20 mins, and he has 75% left carotid
stenosis
Low probability of ischemia (descriptive words) - Answer Sharp
Fleeting
Shifting
Pleuritic
Positional
EKG for ACS - Answer Should be done w/in 10 mins of arrival
EKG findings for STEMI - Answer ST segment elevation
New LBBB
Winter Sign
Transient ST segment elevation
Posterior MI - Answer - ST depression V1,V2, V3
15-20% of STEMIs
Horizontal ST depression
Tall, brouad R waves (>30ms)
