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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
Q

STD screening in women?

A

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
Q

Elderly patients should be assessed for risk factors for what conditions?

A

PVD, osteoporosis, stroke, & CAD

27
Q

Osteoporosis screening?

A

DEXA scan starting at age 65 in women

28
Q

Is HIV a contraindication for MMR vaccine?

A

Not unless they’re severely immunocompromised

29
Q

Who should get pneumococcal polysaccharide vaccine?

A
  • 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
Q

Who should get Tetanus vaccine?

A
  • 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
Q

Who gets Hepatitis A vaccine?

A
  • Travelers to developing countries

- Pts w/ chronic liver disease, HCV

32
Q

Vaccines that are live attenuated?

A
  • MMR, Varicella

- Influenza has both LA & inactivated

33
Q

Vaccines that are “inactivated”?

A

Polio, Influenza, Pneumococcal
(given to children routinely, but not routinely given to unvaccinated adults unless they plan to travel to endemic areas)

34
Q

Who gets Varicella (shingles) vaccine?

A

Adults > 60 yrs old

35
Q

Who gets Meningococcal vaccine?

A
  • Adults w/ asplenia
  • Military recruits
  • Residents of college dorms
  • Terminal complement deficiency
  • Travelers to Mecca or Medina in Saudi Arabia for the Hajj
36
Q

Who gets Hep A & B vaccines?

A

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
Q

Who should get the HPV vaccine?

A
  • 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
Q

Who gets the Influenza vaccine?

A
  • 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
Q

Bile acid-binding resins – effects?

A

Lowers LDL
Increases TG

(ex: Cholestyramine & Colestipol)

40
Q

Fibrates – effects?

A

Lower VLDL & TG
Increase HDL

(ex: Gemfibrozil)

41
Q

Tension headaches – Tx?

A
  1. Stress reduction, find cause
  2. NSAIDS or Acetaminophen for mild/moderate
  3. If severe, use migraine meds
42
Q

Difference in general effects between NSAIDS & Acetaminophen?

A

NSAIDS = anti-inflammatory, anti-pyretic, analgesic

Acetaminophen = anti-pyretic, analgesic

43
Q

Cluster headaches – acute Tx?

A

Sumatriptan (Imitrex) = drug of choice

– O2 inhalation also helpful (combo usually effective, narcotics NOT usually effective)

44
Q

Cluster headaches – Proph Tx?

A

Verapamil

– cause resolution (or decrease) of # of headaches w/in 1 week
cluster headaches = most responsive to proph Tx

45
Q

4 “types” of migraine?

A
  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
Q

What type of vaccine is the HPV vaccine?

A

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
Q

Can capsule endoscopy be used to screen for CRC?

A

No.

Capsule endoscopy detects small bowel bleeding. It is not a cancer screening method.

48
Q

Proph Tx that can benefit an asymptomatic woman w/ multiple first-degree relatives w/ breast cancer?

A

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
Q

________ are very useful in preventing metastases in those with proven breast cancer.

A

Aromatase inhibitors

but they are not proven to benefit those who are asymptomatic

50
Q

In what patients can you not use a live, attenuated vaccine?

A

– 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
Q

Pneumococcal vaccine – indications?

A 
• 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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