APA GI And Cardiovascular Flashcards
Which type of vascular disease is relieved by dependent postioning of LE?
Arterial
Aortic Stenosis is common in which age group and how is it tolerated?
Elderly, ususally asymptomatic but once symptomatic outcomes are poor
Which valves are closed during systole?
Mitral/Tricuspid
Which valves are closed during diastole?
Aortic/Pulmonic
Systolic murmurs are head during which sound?
S1
Diastolic murmurs are heard during which sound?
S2
Pulmonic value is heard best at which location
2nd ICS R. Upper sternal border
Aortic valve is best heard at what border?
2nd ICS L. Upper sternal border
Which valve is best heard at 5th ICS L. sternal border?
Tricuspid
Which valve is best heard at 5th ICS L. midclavicular line?
Mitral valve
All functional murmurs are which type?
Systolic, but not all systolic are functional murmurs
How do statins work?
By blocking HMG-CoA reductase in the liver which promotes upregulation of LDL receptors, essentially liver processes more LDL which lowers circulating lipids.
What is the order of Abd exam?
Inspect, auscletate, percuss, palpate in all 4 quads
Diarrhea is the combination of what 2 factors?
Increase in frequency and fluid content
Is elevated bilirubin always evidence of something pathological?
No- adults can have idiopathic bilirubinemia known as Gilbert Syndrome
What 2 positive signs are associated with peritoneal findings in acute appendicitis?
Psoas sign- supine passive extention of R. Thigh against examiners counter pressure
Obturator sign- inward rotation of R. Hip causing RLQ pain. Pain w/ flexion/movement of hip
What is GERD?
The backflow of stomach contents into the esophagus, usually caused by weakened LES (lower esophageal sphincter)
In step up and step down treatment, what is the progression?
Lifestyle modification, antacids, H2 blockers, PPIs
For intense GERD, what drug therapy would be inititated?
PPIs for 8 weeks
If resolved- taper off
If unresolved or return- repeat anothe 8 week course
For mild to moderate GERD, what drug therapy would be initiated?
Antacids if occuring <1/week
H2 blockers for 2 weeks (increasing to PPI if not better)
What is triple therapy for H. Pylori?
10-14 days:
PPI BID
Clarithromycin 500mg bid
Amoxil 1000mg bid
If PCN allergic:
Flagyl 500mg bid
What is included in the Bismuth quadruple therapy for H. Pylori?
10-14 days PPI Bismuth 525 quid Metrondiazole 250 qid Tetracycyline 500 qid
What is classic quadruple therapy for H. Pylori?
PPI + Amoxil 1mg bid + Metrondiazole 500 tid + Clarithromycin 500 bid —X10-14 days
What is the treatment for hemorrhoids?
Topical anesthetics, sitz baths & increased fiber intake.
What are two further tests to perform to determine acute abdomen (peritoneal signs)
Rovsing sign-deep palpation of RLQ elicits pain in LLQ
Markle Test- R. heel jar elicits pain (jump in place test)
What are common risks for colon cancer?
Fm hx, low fiber and plants. High in fat, red meat, refined carbohydrates
Pain in the RUQ that radiates into the R. shoulder would commonly elicit which positive test?
Murphy sign
What labs would most likely be elevated with in a patient with positve murphy sign?
WBC, AST, ALT, alk phos and bilirubin
How does a pt with pancreatitis usually present?
Mid abd pain sharp and intense in nature w/ radiation into the back. Pt appears toxic, hypotensive tachycardic, tachypnic, fever, abd distension and hypoactive BoSo
Which labs in conjunction with physical findings are suggestive of pancreatitis?
Elevated amylase & lipase (2-3 x normal), WBC, HCT, BUN and glucose
Rome III criteria helps to diagnose what condition?
Irritable Bowel Disease (IBS)
When evaluating ROME III, 2 or more of which episdes elicits the diagnosis?
Abd pain episodes 3d/ month or more
Pain relieved by defication
Change in BM frequency
Change in BM form/appearance
S3 is heard just after which sound?
S2
S4 is heard before which found?
S1
What extra sound is always abnormal?
S4
Stiff and hypertrophic ventricles usually produce which extra sound?
S4
Which extra sound is usually related to volume and often indicates heart failure?
S3
The bell of the stethiscope hears which pitched sounds best with the diaphram hearing the other best?
Bell= low pitched Diaphram= high piched
What is Erb’s point and where is it typically located?
Erb’s point= PMI
Generally 3rd ICS L. Sternal border
Stiff or stenotic valves are usually cause this physiological change?
hypertrophy outter and inner muscle thickening of the atria/ventricle
Regurgitant valves are ______ valves
Leaky
Regurgitant valves usually cause this physiological change?
Dilation- thinned and expanded muscle
Mitral Valve stenosis if often associated with which infectious process?
Rheumatic fever and infective endocarditis
Stenotic valves cause difficulty in which important aspect of cardiac output?
Stiff valves resist the flow of blood during systole reducing EF
Regurgitant valves cause what to happen with the flow of blood during cardiac cycle?
Backflow during diastole, stretching the backwards structure
Mitral valve stenosis is a common cause of which dysrythmia?
A Fib
Mitral Valve regurgitation commonly causes which chronic heart condition?
Heart failure r/t low EF and blood backing up from ventricle into atria during systole
Regurgitant valves are commonly caused by what connective tissue disorders
Marfans and Ehlers Danlos Syndrom
According to JNC8 what is hypertension in the general population under the age of 60 years old?
140/90 or higher
According to JNC8, patients over 60 w/o DM or CKD, what is hypertension
150/90
For a black patient with confirmed hypertension, what would be the first line agent?
Thiazide diuretic, CCB (ARB/ACE not contra but less effective)
For a black patient with confirmed hypertension, what would be the first line agent?
Thiazide or CCB
For a diabetic or CKD patient with confirmed hypertension, what would be the first line agent?
ARB/ACE
According to JNC8 hypertensive patients with HF and/or CAD should receive which therapies?
ACE/ARM and BB, diuretics as needed, and CCB if needed
Which beta-blocking agents are cardiac selective?
Metoprolol and bisoprolol
According to guidelines, when is referral for UGI appropriate?
When high-risk symptoms are present such as: failure of PPI post 16weeks, anorexia, blood stools/emesis, IDA, odynophagia (painful swallowing), chronic unremitting refulx, hoarseness and swallowing problems (suggestive of Barrett’s), and new onset >/= 60yo
When is colonscopy typically performed after first dx of diverticulitis if indicated?
6-8 weeks (not always indicated for uncomplicated diverticulitis)
What is the typical out patient antimicrobial therapy for diverticulutis?
Augmentin 875 bid x7-10 days
OR
Metrodiazole 500mg bid x 7-10 days with
-cipro 500mg bid bid
OR
-Levoflaxacin 750 q day
A high pitched diastolic murmur is typically
Aortic regurgitation
A low pitched diastolic murmur is typically?
Mitral Valve stenosis
Why why are thiazide duiretics preferred for women with htn?
Prevents osetoporosis by calcium sparing actions
What are abnormal labs associated with hyperlipdemia?
Total chol >200
LDL >130
HDL <40
Triglycerides >130-150
ACC/AHA 2017 guidelines define stage 1 and stage 2 htn as?
Stage 1: sbp 130/139 dbp 80/89
Stage 2: sbp 140/149 dbp >90
ACC/AHA 2017 guidelines define elevated blood pressure as?
SBP 120/129
DBP <80
ACC/AHA 2017 guidelines define normal blood pressure as?
SBP < 120
BBP < 80
In a 43 year old female with no comorbidites who has a confirmed BP of 138/88 with a 10-year ACC/AHA score of 4.5, what would be the recommendation?
Lifestyle modification
In a 55 yo black male with a bp of 145/90 and an ACC/AHA 10-year risk score of 11, what would be the recommendedation?
Medication & lifestyle: thiazide and CCB
Thiazide diuretics should be avoided with which patients?
Sulfa allergies
Gout
Renal failure
Lithium treatment
Aldosterone receptor antagonists diuretics should be avoided in which patients?
Hyperkalemia
Renal insufficiency cr >2.0/1.8
DM2 w/microalbuminuria
Which class of drugs are appropriate for HTN & BPH
Alpha 1 blockers/antagonists
Terazosin (hytrin)
Doxazosin (cardura)
*potent vasodilators
Hypertensive findings on fundoscopic exam may be?
Copper and silver wire arterioles, arteriovenous nicking.
Which is differnt from diabetic retinopathy which presents with cotton whool spots, neovascularization, and microaneurysms
Why are ACE/ARBs are contraindicated with bilateral renal artery stenosis?
Can precipitate acute kidney failure
What are common R. Sided HF symptoms?
JVD
RUQ abd pain
Anorexia, N/V
Stable HF first line treatment is?
ARB/ACE & duiretic
Or Entresto
And beta blocker
Pain with PAD is worsened with?
Ambulation/Excercise
Janeway lesions (tender red spots on palms), splinter hemorrhages in nail beds, and Osler’s nodes (painful violet colored lesions on fingers) associated with which disease?
Bacterial endocarditis
When considering starting statin therapy on a pt without ASCVD, what acc/aha 10-year risk score would indicate moderate-dose therapy?
> 7.5
Which drugs are indicated for triglycerides >500?
Fibrates and niacin
What is a classic symptom that can differentiate between viral and bacterial gastroenteritis?
Bloody diarrha is generally found with bacterial gastroenteritis and not with viral
In the non-black patient without co-morbidities, according to JNC8 what would be the best first-line drug therapy?
ACE/ARBs or diuretics
