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3rd Year (Step 2) > Ambulatory > Flashcards

Ambulatory Flashcards

1
Q

Most common type of HTN?

A

Essential HTN (i.e. no identifiable cause)

**applies to >95% of the population

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2
Q

Causes of Secondary HTN?

A

Renal artery stenosis (most common cause)
- Other renal/renovascular disease (CKD, PCK)

Endocrine: Hyperaldosteronism, Hyperthyroid, Parathyroid disease, Cushing’s Syndrome, Pheochromocytoma, Acromegaly

Meds: OCs, Decongestants, Estrogen, appetite suppressants, chronic steroids, TCAs, NSAIDs

Coarctation of Aorta
Cocaine, stimulants
Sleep apnea

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3
Q

Labs to order upon HTN diagnosis?

A
  • Urinalysis
  • Chemistry panel: K, BUN, Cr
  • Fasting Glucose
  • Lipid panel
  • ECG
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4
Q

Antihypertensive meds contraindicated in pregnancy?

A

Thiazides, ACE-inhibitors, CCBs, ARBs

β-blockers & Hydralazine are safe

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5
Q

Lifestyle changes as first-line HTN Tx?

A
  • Reduce salt intake
  • – No-added-salt diet (4g sodium/day)
  • – Low-sodium diet (2g sodium/day)
  • Weight loss
  • Avoid excessive alcohol intake
  • Exercise regularly
  • Low-saturated-fat diet & low-fat dairy products
  • Stop meds that cause HTN
  • Stress mgmt
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6
Q

African-American patient w/ HTN – initial Tx?

A

Thiazides

(unless diabetic, then choose ACE-inhibitor)

    • b/c “salt-sensitive” HTN is more common in A-A patients
    • Check serum K+ regularly (hypokalemia exacerbated by high salt intake)
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7
Q

β-blockers – effect in treating HTN?

When are they 1st line Tx?

A

Decrease HR, CO, & renin release

    • Not 1st line for HTN
    • 1st line: post-MI &/or w/ Hx of heart failure
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8
Q

ACE-inhibitors – effect in treating HTN?

A

Inhibit renin-angiotensin-aldosterone system & inhibit bradykinin

  • Preferred in diabetics b/c of protective effect on kidneys
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9
Q

Goal for LDL in a diabetic patient?

A

< 100 mg/dL

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10
Q

Goal for LDL in a patient w/ CAD & DM?

A

< 70 mg/dL

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11
Q

Total Cholesterol – Ideal, Borderline, & High?

A 
Ideal = < 200 mg/dL
Borderline = 200-240 mg/dL
High = > 240 mg/dL
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12
Q

LDL – Ideal, Borderline, & High?

A 
Ideal = < 130 mg/dL
Borderline = 130-160 mg/dL
High = > 160 mg/dL
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13
Q

Triglycerides – Ideal, Borderline, & High?

A 
Ideal = < 125 mg/dL
Borderline = 125-250 mg/dL
High = > 250
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14
Q

Meds that are risk factors for Hyperlipidemia?

A

Thiazides – increase LDL, total cholesterol, TG (VLDL) levels

β-blockers (propranolol) – increase TGs (VLDL) & lower HDL levels

Estrogens – TG levels may further increase in patients w/ hypertriglyceridemia

Corticosteroids & HIV protease inhibitors can elevate serum lipids

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15
Q

In postmenopausal women w/ CHD, is estrogen replacement therapy indicated?

A

No (recent HERS trial)

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16
Q

What diseases do statins lower the risk of?

A
  • MI
  • Stroke
  • Coronary & all-cause mortality
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17
Q

What levels of HDL count as negative or positive risk factors for CAD?

A

HDL < 40 mg/dL = Positive risk factor

HDL > 60 mg/dL = Negative risk factor

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18
Q

Total cholesterol-to-HDL ratio in risk of CAD?

A 
5.0  = average (standard) risk
10 = double the risk
20 = triple the risk

Ratio < 4.5 = desirable

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19
Q

Potency of statins in order?

A

Simvastatin (Socor) & Atorvastatin (Lipitor) > Lovastatin (Mevacor) & Pravastatin (Pravachol) > Fluvastatin (Lescol)

(cost increases w/ potency)

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20
Q

Screening for Hyperlipidemia?

A

USPSTF recommends:

    • routine screening in men ≥ 35 y/o
    • screen women ≥ 45 y/o if at increased risk for CAD
    • screen men & women >20 y/o if risk of CAD (i.e. smokers, diabetics, FMH of CAD, HTN)

SUTM:
Healthy adults >20 yrs:
– non-fasting Total Cholesterol & HDL every 5 years (more frequently if CAD risks)
(continue if TC35, if not get complete lipid profile)

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21
Q

CRC screening?

A
  • Fecal occult blood test every year, 1 colonoscopy every 10 yrs

OR…
- Fecal occult blood test every year, 1 flexible sigmoidoscopy every 5 yrs

Lifetime CRC risk for American = 6-8%

22
Q

Breast exam screening?

A

No data to show it actually decreases mortality

But, in practice:

  • Self-exam monthly for all women >20 yrs old
  • Physician exam every 3yrs age 20-40, yearly after 40yrs
23
Q

Mammogram screening?

A

Every 1-2 yrs for women >40 & yearly >50

24
Q

Pap smear screening for cervical cancer?

A
    • Screen women 21-65 y/o every 3 years

- - every 5 years if combined w/ HPV testing

25
STD screening in women?
All women at risk should be screened for Chlamydia & Gonorrhea (pelvic exam w/ cultures or enzyme immunoassay or DNA probe) -- Women ages 15-25 should be screened for Chlamydia -- women & men w/ risk factors should be screened for HIV regularly
26
Elderly patients should be assessed for risk factors for what conditions?
PVD, osteoporosis, stroke, & CAD
27
Osteoporosis screening?
DEXA scan starting at age 65 in women
28
Is HIV a contraindication for MMR vaccine?
Not unless they're severely immunocompromised
29
Who should get pneumococcal polysaccharide vaccine?
- Adults > 65 yrs old - Sickle cell disease or asplenia - Adults w/ chronic medical problems or immunodeficiencies (dialysis) - Women w/ high-risk pregnancies - CSF leaks, cochlear implant - Alcoholics - 1st dose > 65 y/o only - 2nd dose 5 yrs later if patient's immunocompromised or if 1st dose was before 65 y/o)
30
Who should get Tetanus vaccine?
* Everyone: Td (tetanus) toxoid every 10 yrs * One Tdap (tetanus with acellular pertussis) as one of the boosters * Tetanus immune globulin in those never vaccinated (- When indicated in wound mgmt - Pts traveling to countries where risk of Diphtheria is high)
31
Who gets Hepatitis A vaccine?
- Travelers to developing countries | - Pts w/ chronic liver disease, HCV
32
Vaccines that are live attenuated?
- MMR, Varicella | - Influenza has both LA & inactivated
33
Vaccines that are "inactivated"?
Polio, Influenza, Pneumococcal (given to children routinely, but not routinely given to unvaccinated adults unless they plan to travel to endemic areas)
34
Who gets Varicella (shingles) vaccine?
Adults > 60 yrs old
35
Who gets Meningococcal vaccine?
- Adults w/ asplenia - Military recruits - Residents of college dorms - Terminal complement deficiency - Travelers to Mecca or Medina in Saudi Arabia for the Hajj
36
Who gets Hep A & B vaccines?
Both: - Adults w/ chronic liver disease - Homosexual men - IV drug users - Household contacts w/ Hep A or B Hep B: ESRD (dialysis), Healthcare workers, Diabetes Hep A: Travelers to endemic areas
37
Who should get the HPV vaccine?
- Females aged 9-26 years to prevent cervical cancer, vaginal cancer, vulvar cancer, anal cancer, precancerous genital lesions, & genital warts - Males aged 9-26 years to prevent anal cancer & genital warts (condyloma acuminata)
38
Who gets the Influenza vaccine?
- Adults > 50 - Adults < 50 w/ chronic medical problems (CHF, DM, lung disease, ESRD) - Health care workers - Pregnant women in 2nd or 3rd trimester during flu season - Anyone wanting to reduce risk of getting the flu
39
Bile acid-binding resins -- effects?
Lowers LDL Increases TG (ex: Cholestyramine & Colestipol)
40
Fibrates -- effects?
Lower VLDL & TG Increase HDL (ex: Gemfibrozil)
41
Tension headaches -- Tx?
1. Stress reduction, find cause 2. NSAIDS or Acetaminophen for mild/moderate 3. If severe, use migraine meds
42
Difference in general effects between NSAIDS & Acetaminophen?
NSAIDS = anti-inflammatory, anti-pyretic, analgesic Acetaminophen = anti-pyretic, analgesic
43
Cluster headaches -- acute Tx?
Sumatriptan (Imitrex) = drug of choice -- O2 inhalation also helpful (combo usually effective, narcotics NOT usually effective)
44
Cluster headaches -- Proph Tx?
Verapamil | -- cause resolution (or decrease) of # of headaches w/in 1 week cluster headaches = most responsive to proph Tx
45
4 "types" of migraine?
1. Common migraine - w/out aura (85%) 2. Classic migraine - w/ aura (15%) - - aura usually visual, but can be neurological (sensory disturbance, hemiparesis, dysphagia) 3. Menstrual migraine -- ass'd w/ estrogen w/drawal (Tx same as other migraines but estrogen sometimes added also) 4. Status migrainosus -- lasts > 72 hrs & does not resolve spontaneously
46
What type of vaccine is the HPV vaccine?
Gardasil is a quadrivalent vaccine against HPV types 6, 11, 16, & 18 -- 0.5 mL IM injections into deltoid or anterolateral thigh given at 0, 2, and 6 months
47
Can capsule endoscopy be used to screen for CRC?
No. | Capsule endoscopy detects small bowel bleeding. It is not a cancer screening method.
48
Proph Tx that can benefit an asymptomatic woman w/ multiple first-degree relatives w/ breast cancer?
SERMS (Tamoxifen or Raloxifene) - result in a 50% to 66% reduction in breast cancer when compared with placebo. The benefit is greatest in those with 2 first-degree relatives with breast cancer (mother or sister). SERMs are amazingly underutilized in preventing breast cancer.
49
________ are very useful in preventing metastases in those with proven breast cancer.
Aromatase inhibitors | but they are not proven to benefit those who are asymptomatic
50
In what patients can you not use a live, attenuated vaccine?
-- Patients > 50 y/o -- Pts w/ chronic medical illness: • Chronic heart, lung, liver, & kidney disease including asthma • HIV/AIDS • Steroid users • Immunocompromised patients in general such as cancer or functional or anatomic asplenia • Diabetes mellitus (use inactivated
51
Pneumococcal vaccine -- indications?
``` • Everyone above age 65 • Cochlear implant • CSF leaks • Alcoholics • One vaccine above 65 only • Single revaccination after 5 years if the patient is immunocompromised or the first injection was prior to age 65 ```

3rd Year (Step 2) (44 decks)

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