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primary care > AAFP > Flashcards

AAFP Flashcards

1
Q

Caution is necessary when prescribing TZDs in patients with:

A

known heart failure or other heart diseases, those with preexisting edema, and those on concurrent insulin therapy (SOR C).

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2
Q

Metformin is often contraindicated because of:

A

renal insufficiency or heart failure

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3
Q

Danger of sulfonylureas and other insulin secretagogues

A

hypoglycemia

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4
Q

The 2002 joint guidelines of the American College of Cardiology, the American Heart Association (AHA), and the North American Society of Pacing and Electrophysiology endorse the use of cardiac resynchronization therapy (CRT) in patients with:

A

medically refractory, symptomatic, New York Heart Association (NYHA) class III or IV disease with a QRS interval of at least 130 msec, a left ventricular end-diastolic diameter of at least 55 mm, and a left ventricular ejection fraction (LVEF) ≤30%.

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5
Q

What is CRT?

A

Using a pacemaker-like device, CRT aims to get both ventricles contracting simultaneously, for example overcoming the delayed contraction of the left ventricle caused by the left bundle-branch block.

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6
Q

The American Heart Association recommends a goal blood pressure of 130/80 mm Hg or less for the treatment of hypertension in patients with:

A

diabetes mellitus, chronic kidney disease, or coronary artery disease.

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7
Q

Management of dissecting aortic aneurysm

A

Initial management should reduce the systolic blood pressure to 100-120 mm Hg or to the lowest level tolerated. The use of a β-blocker such as propranolol or labetalol to get the heart rate below 60 beats/min should be first-line therapy. If the systolic blood pressure remains over 100 mm Hg, intravenous nitroprusside should be added.

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8
Q

Most common cause of HTN in children under 6 yo

A

renal parenchymal disease

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9
Q

When is surgery indicated?

Dissecting aortic aneurysm

A

only for complications such as occlusion of a major aortic branch, continued extension or expansion of the dissection, or rupture

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10
Q

Who should get screened for AAA?

A

men 65-75 yo who have ever smoked

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11
Q

Management of SVT

A

If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can usually be terminated by the administration of intravenous verapamil or a β-blocker. If that fails, intravenous propafenone or flecainide may be necessary. It is also important to look for and treat possible contributing causes such as hypovolemia, hypoxia, or electrolyte disturbances. Electrical cardioversion may be necessary if these measures fail to terminate the tachyarrhythmia.

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12
Q

Monotherapy for hypertension in African-American patients is more likely to consist of:

A

diuretics or calcium channel blockers than β-blockers or ACE inhibitors. It has been suggested that hypertension in African-Americans is not as angiotensin II-dependent as it appears to be in Caucasians.

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13
Q

Still’s murmur

A

systolic heart murmur. It is heard best in the lower precordium and has a low, short tone similar to a plucked string or kazoo. It does not radiate to the axillae or the back and seems to decrease with inspiration. may be due to vibrations in the chordae tendinae, semilunar valves, or ventricular wall.

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14
Q

Venous hum

A

continuous low-pitched murmur caused by the collapse of the jugular veins and their subsequent fluttering, and it worsens with inspiration or diastole.

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15
Q

Murmur of physiologic peripheral pulmonic stenosis

A

The murmur of physiologic peripheral pulmonic stenosis (PPPS) is caused by physiologic changes in the newborns pulmonary vessels. PPPS is a systolic murmur heard loudest in the axillae bilaterally that usually disappears by 9 months of age.

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16
Q

Metoprolol and carvedilol are metabolized by the __.

A

liver; therefore do not need renal dosage adjustment

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17
Q

Which needs renal dosage adjustment? Enoxaparin vs clopidogrel

A

enoxaparin; clopidogrel can be given at standard dosage

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18
Q

What about tPA?

Renal dosing

A

can be given at standard dosage in renal failure, although hemorrhagic complications are increased

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19
Q

Most useful diagnostic tool for evaluating patients with heart failure

A

2-D echocardiography w/ Doppler

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20
Q

Diagnosis of MI on EKG

A

Myocardial infarction is diagnosed by ST elevation ≥1 mm in two or more limb leads and ≥2 mm in two or more contiguous precordial leads.

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21
Q

New left bundle branch block suggests occlusion of:

A

left anterior descending artery

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22
Q

Isolated systolic HTN in the elderly responds best to:

A

diuretics, and to a lesser extent, beta blockers

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23
Q

Benefits of thiazides

A 
highly effective at preventing CVA >> MI
improved BP control in African-Americans
inexpensive, widely available
kidney stone risk reduction
preservation of calcium stores (could help w/ osteoporosis)
loss of "water weight"
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24
Q

Most common associated etiologic factor of spontaneous axillosubclavian vein thrombosis (ASVT)

A

compressive anomaly in the thoracic outlet, usually bilateral

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25
Q

Budd-Chiari syndrome refers to thrombosis in which vessels?

A

intrahepatic, suprahepatic, or hepatic veins

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26
Q

Ankle-brachial index (ABI) of __ is considered normal.

A

0.9 to 1.2

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27
Q

The INR therapeutic range of 2.5-3.5 is reserved for which patients?

A

those with mechanical heart valves

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28
Q

Therapeutic INR should be maintained for how long in a pt w/ a first DVT related to travel?

A

3-6 months

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29
Q

Which patients with DVTs can get outpatient care?

A

good cardiopulmonary reserve, normal renal function, and no risk for excessive bleeding

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30
Q

Symptoms of congestive heart failure in infants are often related to:

A

feedings

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31
Q

How does hypertrophy in patients with HCM change w/ age?

A

usually stays the same or worsens

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32
Q

Lifespan in pts w/ HCM

A

normal in most cases; mortality rate is 1%

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33
Q

Are beta blockers useful in tx of HCM?

A

no; do not alter disease progression

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34
Q

Inheritance pattern of HCM

A

autosomal dominant

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35
Q

You should recommend surgical intervention when the diameter of a AAA approaches:

A

5.5 cm

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36
Q

Aortic stenosis becomes symptomatic when the mean transvalvular gradient exceeds __ and the aortic valve area is smaller than __.

A

50 mmHg; 1 cm2

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37
Q

Tx for symptomatic aortic stenosis

A

valve replacement

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38
Q

Patients w/ AS who present w/ dyspnea have a __ chance of being alive in 2 yrs unless the valve is promptly replaced.

A

50%

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39
Q

Beta blocker use has been shown to be effective in patients w/ NYHA Class __ or __ heart failure.

A

II or III

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40
Q

Contraindications to beta blocker use

A

hemodynamic instability, heart block, bradycardia, and severe asthma

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41
Q

Leading cause of death in women

A

CV disease

42
Q

A pre-op resting EKG is recommended for which patients?

A

men > 45, females > 55, pts w/ diabetes, symptoms of chest pain, or a previous hx of cardiac disease

43
Q

BNP

A

100; 400

44
Q

Initial therapy for CHF should be __.

A

loop diuretic

45
Q

Patients with BNP values of __ warrant further investigation. What pulmonary problems can cause elevated BNP?

A

lung cancer, cor pulmonale, and PE

46
Q

Statins, haloperidol, and drugs of abuse (cocaine, heroin) can cause __ with the release of __, which causes acute renal injury.

A

Statins, haloperidol, and drugs of abuse (cocaine, heroin) can cause rhabdomyolysis with the release of myoglobin, which causes acute renal injury.

47
Q

Thrombotic microangiopathy is a rare mechanism of injury to the kidney, and may be caused by:

A

clopidogrel, quinine, or certain chemotherapeutic agents.

48
Q

Initial exercise routines for the elderly can be as short as __ in duration. Even __ per week of exercise has been shown to be beneficial.

A

6 minutes; 30 minutes

49
Q

A target HR of __ of the predicted maximum should be set as a ceiling for elderly patients.

A

60-75%

50
Q

Patients w/ peripheral neuropathy should NOT perform which types of exercises?

A

treadmill walking or step aerobics bc of the risk of damage to their feet

51
Q

Most beneficial tx for pts with WPW syndrome who have episodic symptomatic SVT or afib

A

radiofrequency catheter ablation of bypass tracts

52
Q

NSAIDs in pts w/ heart failure

A

should be avoided if possible; they cause sodium and water retension, as well as an increase in SVR which may lead to cardiac decompensation. Pts w/ heart failure who take NSAIDs have a tenfold increased risk of hospitalization for exacerbation of CHF. NSAIDs, including high dose aspirin, may decrease or negate entirely the beneficial unloading effects of ACEI.

53
Q

Which ones are less likely to have negative effects?

NSAID heart failure

A

sulindac and low-dose aspirin

54
Q

Most efficacious drugs for rate control in afib:

A

CCBs and beta blockers

55
Q

In pts 65 yo or older w/ one or more risk factors for stroke, the best choice for anticoagulation to prevent thromboembolic disease is __.

A

warfarin

56
Q

What is cilostazol?

A

drug w/ phosphodiesterase inhibitor activity; used to treat arterial occlusive disease and intermittent claudication

57
Q

Cilostazol should be avoided in which patients?

A

pts w/ CHF

58
Q

Benefits of cilostazol

A

beneficial effects on HDL cholesterol and in tx of third degree heart block

59
Q

First-line therapy for systolic HTN

A

thiazides and long-acting CCBs

60
Q

Tx for severe hypertension in pregnant woman

A

IV hydralazine, IV labetalol, or oral nifedipine

61
Q

Risk of infusions of nitroprusside lasting more than 4 hours

A

fetal cyanide toxicity

62
Q

What are the preferred drugs for CHF due to LV systolic dysfunction (bc they are associated w/ the lowest mortality)?

A

ACE inhibitors

Reasonable alternative : combination of hydralazine/isosorbide dinitrate

63
Q

Clinical predictors of increased perioperative cardiovascular risk for elderly patients

A

major risk factors such as unstable coronary syndrome (acute or recent myocardial infarction, unstable angina), decompensated congestive heart failure, significant arrhythmia (high-grade AV block, symptomatic ventricular arrhythmia, supraventricular arrhythmias with uncontrolled ventricular rate), and severe valvular disease

64
Q

Intermediate predictors

Clinical predictors of increased perioperative cardiovascular risk for elderly patients

A

mild angina, previous MI, compensated CHF, diabetes mellitus, and renal insufficiency

65
Q

Clinical predictors of increased perioperative cardiovascular risk for elderly patients
Minor predictors

A

advanced age, an abnormal EKG, LV hypertrophy, left BBB, ST and T-wave abnormalities, rhythm other than sinus, low functional capacity, hx of stroke, and uncontrolled HTN

66
Q

Patients with significant arterial occlusive disease will have a prominent __ in the ankle-brachial index from baseline following exercise, and usually a __-mm Hg or greater __ in systolic blood pressure.

A

Patients with significant arterial occlusive disease will have a prominent decrease in the ankle-brachial index from baseline following exercise, and usually a 20-mm Hg or greater decrease in systolic blood pressure.

67
Q

Pain during rest and exercise and the presence of swelling and soreness behind the knee and in the calf is found in those with __.

A

Baker’s cysts

68
Q

This type of pain commonly begins immediately upon walking and is unrelieved by rest.

A

peripheral nerve pain

69
Q

Criteria for severe preeclampsia

A

BP of 160/110 mmHg or above on 2 occasions, 6 hours apart
proteinuria > 5g/24hr
platelet count

70
Q

Is DVT ppx indicated with total knee or hip replacements?

A

LMWH and adjusted-dose warfarin

71
Q

What is subclinical thyroid dysfunction?

A

TSH either below or above the normal range, free T3 or T4 levels are normal, and the patient has no sx of thyroid disease.

72
Q

Subclinical hypothyroidism: definition? Associated lab abnormality?

A

TSH > 10; likely to progress to overt hypothyroidism; increased LDL cholesterol

73
Q

Subclinical hyperthyroidism: definition? Associations?

A

TSH

74
Q

Patients taking lithium should have what thyroid values measured and how often?

A

total free T4 and TSH; yearly

75
Q

What diuretic can be used w/ saline infusions to lower significantly elevated calcium levels?

A

furosemide

76
Q

Lithium can __ calcium levels by __.

A

elevate; elevating PTH secretion from parathyroid gland

77
Q

What effect does raloxifene have on elevated calcium levels?

A

mildly reduces elevated Ca levels

78
Q

What diabetic meds can cause or exacerbate delayed gastric emptying and should not be given to a patient w/ diabetic gastroparesis?

A

amylin analogues (eg, pramlintide) and glucagon-like peptide 1 (eg, exenatide)

79
Q

Characteristic lab findings in secondary hypothyroidism

A

low serum free T4 and a low TSH

80
Q

Criteria for diagnosing diabetes mellitus

A

any one of the following: symptoms of diabetes (polyuria, polydipsia, weight loss) plus a casual glucose level ≥200 mg/dL; a fasting plasma glucose level ≥126 mg/dL; or a 2-hour postprandial glucose level ≥200 mg/dL after a 75 gram glucose load

81
Q

Criteria for impaired glucose homeostasis

A

either a fasting glucose level of 100-125 mg/dL (impaired fasting glucose) or a 2-hour glucose level of 140-199 mg/dL on an oral glucose tolerance test

82
Q

Normal values for fasting glucose and for the 2-hour glucose level on an oral glucose tolerance test

A
83
Q

Red flags when evaluating a solitary thyroid nodule that indicate possible thyroid cancer

A

male gender, age 65, rapid growth of nodule, sx of local invasion such as dysphagia, neck pain, and hoarseness, hx of head or neck radiation, FH of thyroid cancer, hard fixed nodule > 4 cm, cervical LAD

84
Q

How do thiazides affect calcium?

A

They decrease the renal clearance of Ca by increasing distal tubular calcium reabsorption.

85
Q

What should you do if pt is on metformin and needs contrast or urgent surgery?

A

metformin should be withheld and hydration maintained until preserved kidney fxn is documented at 24 and 48 hrs after the intervention (general anesthesia can cause hypotension–>renal hypoperfusion–>peripheral tissue hypoxia–>lactate accumulation

86
Q

Tx for myasthenia gravis

A

corticosteroids and anticholinesterase meds such as oral pyridostigmine

87
Q

What about for generalized myasthenia gravis not responding to meds?

A

thymectomy

88
Q

Hypothyroidism is associated with __ bone age relative to height age and chronologic age.

A

markedly delayed

89
Q

What about cystic fibrosis?

A

bone age and height age are equivalent but both lag behind chronologic age

90
Q

Children with chromosomal anomalies such as trisomy 21 (Down syndrome) or XO?
Height/bone age

A

height age that is delayed relative to bone age (also seen in maternal substance abuse)

91
Q

Excess thyroid hormone replacement can lead to what bone problem?

A

increased bone mineral resorption–>increased serum calcium–> osteoporosis; decreased PTH

92
Q

Most reliable indicator of iron deficiency anemia

A

low serum ferritin

As an acute-phase reactant, serum iron may be decreased in response to inflammation even when total body stores of iron are not decreased

93
Q

Indications for parathyroid surgery when elevated PTH levels are found

A

kidney stones, age 1 mg/dL above upper limit of normal, reduced bone density

94
Q

Rotavirus vaccine schedule

A

3 doses given at 2, 4, and 6 mo of age (all 3 should be administered by 32 weeks of age)

95
Q

Why should you avoid foods high in simple sugars in babies w/ diarrhea?

A

the osmotic load can worsen the diarrhea; also avoid fatty foods

96
Q

In acute viral gastroenteritis, which comes first, vomiting or diarrhea?

A

vomiting

97
Q

Volvulus in babies may present in one of three ways:

A
  1. sudden onset of bilious vomiting and abdominal pain in the neonate
  2. hx of feeding problems w/ bilious vomiting that now apepars to be due to bowel obstruction
  3. failure to thrive w/ severe feeding intolerance
98
Q

Sx of necrotizing enterocolitis

A

seen in NICU in premature infants in first few weeks of life; infants are ill, and signs and sx include lethargy, irritability, decreased PO intake, abdominal distention, and bloody stools.

99
Q

A plain abdominal film showing __ is diagnostic of NEC.

A

pneumatosis intestinalis caused by gas in the intestinal wall

100
Q

Recommended age for testing for seroconversion in baby who got HBIG and Hep B vaccine bc mom was positive for HBsAg

A

9-12 months

primary care (4 decks)

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