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APN1 > APA GI And Cardiovascular > Flashcards

APA GI And Cardiovascular Flashcards

1
Q

Which type of vascular disease is relieved by dependent postioning of LE?

A

Arterial

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2
Q

Aortic Stenosis is common in which age group and how is it tolerated?

A

Elderly, ususally asymptomatic but once symptomatic outcomes are poor

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3
Q

Which valves are closed during systole?

A

Mitral/Tricuspid

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4
Q

Which valves are closed during diastole?

A

Aortic/Pulmonic

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5
Q

Systolic murmurs are head during which sound?

A

S1

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6
Q

Diastolic murmurs are heard during which sound?

A

S2

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7
Q

Pulmonic value is heard best at which location

A

2nd ICS R. Upper sternal border

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8
Q

Aortic valve is best heard at what border?

A

2nd ICS L. Upper sternal border

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9
Q

Which valve is best heard at 5th ICS L. sternal border?

A

Tricuspid

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10
Q

Which valve is best heard at 5th ICS L. midclavicular line?

A

Mitral valve

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11
Q

All functional murmurs are which type?

A

Systolic, but not all systolic are functional murmurs

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12
Q

How do statins work?

A

By blocking HMG-CoA reductase in the liver which promotes upregulation of LDL receptors, essentially liver processes more LDL which lowers circulating lipids.

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13
Q

What is the order of Abd exam?

A

Inspect, auscletate, percuss, palpate in all 4 quads

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14
Q

Diarrhea is the combination of what 2 factors?

A

Increase in frequency and fluid content

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15
Q

Is elevated bilirubin always evidence of something pathological?

A

No- adults can have idiopathic bilirubinemia known as Gilbert Syndrome

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16
Q

What 2 positive signs are associated with peritoneal findings in acute appendicitis?

A

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

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17
Q

What is GERD?

A

The backflow of stomach contents into the esophagus, usually caused by weakened LES (lower esophageal sphincter)

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18
Q

In step up and step down treatment, what is the progression?

A

Lifestyle modification, antacids, H2 blockers, PPIs

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19
Q

For intense GERD, what drug therapy would be inititated?

A

PPIs for 8 weeks
If resolved- taper off
If unresolved or return- repeat anothe 8 week course

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20
Q

For mild to moderate GERD, what drug therapy would be initiated?

A

Antacids if occuring <1/week

H2 blockers for 2 weeks (increasing to PPI if not better)

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21
Q

What is triple therapy for H. Pylori?

A

10-14 days:
PPI BID
Clarithromycin 500mg bid
Amoxil 1000mg bid

If PCN allergic:
Flagyl 500mg bid

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22
Q

What is included in the Bismuth quadruple therapy for H. Pylori?

A 
10-14 days
PPI 
Bismuth 525 quid
Metrondiazole 250 qid
Tetracycyline 500 qid
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23
Q

What is classic quadruple therapy for H. Pylori?

A 
PPI +
Amoxil 1mg bid +
Metrondiazole 500 tid +
Clarithromycin 500 bid 
—X10-14 days
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24
Q

What is the treatment for hemorrhoids?

A

Topical anesthetics, sitz baths & increased fiber intake.

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25
Q

What are two further tests to perform to determine acute abdomen (peritoneal signs)

A

Rovsing sign-deep palpation of RLQ elicits pain in LLQ

Markle Test- R. heel jar elicits pain (jump in place test)

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26
Q

What are common risks for colon cancer?

A

Fm hx, low fiber and plants. High in fat, red meat, refined carbohydrates

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27
Q

Pain in the RUQ that radiates into the R. shoulder would commonly elicit which positive test?

A

Murphy sign

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28
Q

What labs would most likely be elevated with in a patient with positve murphy sign?

A

WBC, AST, ALT, alk phos and bilirubin

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29
Q

How does a pt with pancreatitis usually present?

A

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

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30
Q

Which labs in conjunction with physical findings are suggestive of pancreatitis?

A

Elevated amylase & lipase (2-3 x normal), WBC, HCT, BUN and glucose

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31
Q

Rome III criteria helps to diagnose what condition?

A

Irritable Bowel Disease (IBS)

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32
Q

When evaluating ROME III, 2 or more of which episdes elicits the diagnosis?

A

Abd pain episodes 3d/ month or more
Pain relieved by defication
Change in BM frequency
Change in BM form/appearance

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33
Q

S3 is heard just after which sound?

A

S2

34
Q

S4 is heard before which found?

A

S1

35
Q

What extra sound is always abnormal?

A

S4

36
Q

Stiff and hypertrophic ventricles usually produce which extra sound?

A

S4

37
Q

Which extra sound is usually related to volume and often indicates heart failure?

A

S3

38
Q

The bell of the stethiscope hears which pitched sounds best with the diaphram hearing the other best?

A 
Bell= low pitched
Diaphram= high piched
39
Q

What is Erb’s point and where is it typically located?

A

Erb’s point= PMI

Generally 3rd ICS L. Sternal border

40
Q

Stiff or stenotic valves are usually cause this physiological change?

A

hypertrophy outter and inner muscle thickening of the atria/ventricle

41
Q

Regurgitant valves are ______ valves

A

Leaky

42
Q

Regurgitant valves usually cause this physiological change?

A

Dilation- thinned and expanded muscle

43
Q

Mitral Valve stenosis if often associated with which infectious process?

A

Rheumatic fever and infective endocarditis

44
Q

Stenotic valves cause difficulty in which important aspect of cardiac output?

A

Stiff valves resist the flow of blood during systole reducing EF

45
Q

Regurgitant valves cause what to happen with the flow of blood during cardiac cycle?

A

Backflow during diastole, stretching the backwards structure

46
Q

Mitral valve stenosis is a common cause of which dysrythmia?

A

A Fib

47
Q

Mitral Valve regurgitation commonly causes which chronic heart condition?

A

Heart failure r/t low EF and blood backing up from ventricle into atria during systole

48
Q

Regurgitant valves are commonly caused by what connective tissue disorders

A

Marfans and Ehlers Danlos Syndrom

49
Q

According to JNC8 what is hypertension in the general population under the age of 60 years old?

A

140/90 or higher

50
Q

According to JNC8, patients over 60 w/o DM or CKD, what is hypertension

A

150/90

51
Q

For a black patient with confirmed hypertension, what would be the first line agent?

A

Thiazide diuretic, CCB (ARB/ACE not contra but less effective)

52
Q

For a black patient with confirmed hypertension, what would be the first line agent?

A

Thiazide or CCB

53
Q

For a diabetic or CKD patient with confirmed hypertension, what would be the first line agent?

A

ARB/ACE

54
Q

According to JNC8 hypertensive patients with HF and/or CAD should receive which therapies?

A

ACE/ARM and BB, diuretics as needed, and CCB if needed

55
Q

Which beta-blocking agents are cardiac selective?

A

Metoprolol and bisoprolol

56
Q

According to guidelines, when is referral for UGI appropriate?

A

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

57
Q

When is colonscopy typically performed after first dx of diverticulitis if indicated?

A

6-8 weeks (not always indicated for uncomplicated diverticulitis)

58
Q

What is the typical out patient antimicrobial therapy for diverticulutis?

A

Augmentin 875 bid x7-10 days

OR

Metrodiazole 500mg bid x 7-10 days with
-cipro 500mg bid bid

OR
-Levoflaxacin 750 q day

59
Q

A high pitched diastolic murmur is typically

A

Aortic regurgitation

60
Q

A low pitched diastolic murmur is typically?

A

Mitral Valve stenosis

61
Q

Why why are thiazide duiretics preferred for women with htn?

A

Prevents osetoporosis by calcium sparing actions

62
Q

What are abnormal labs associated with hyperlipdemia?

A

Total chol >200
LDL >130
HDL <40
Triglycerides >130-150

63
Q

ACC/AHA 2017 guidelines define stage 1 and stage 2 htn as?

A

Stage 1: sbp 130/139 dbp 80/89

Stage 2: sbp 140/149 dbp >90

64
Q

ACC/AHA 2017 guidelines define elevated blood pressure as?

A

SBP 120/129

DBP <80

65
Q

ACC/AHA 2017 guidelines define normal blood pressure as?

A

SBP < 120

BBP < 80

66
Q

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?

A

Lifestyle modification

67
Q

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?

A

Medication & lifestyle: thiazide and CCB

68
Q

Thiazide diuretics should be avoided with which patients?

A

Sulfa allergies
Gout
Renal failure
Lithium treatment

69
Q

Aldosterone receptor antagonists diuretics should be avoided in which patients?

A

Hyperkalemia
Renal insufficiency cr >2.0/1.8
DM2 w/microalbuminuria

70
Q

Which class of drugs are appropriate for HTN & BPH

A

Alpha 1 blockers/antagonists
Terazosin (hytrin)
Doxazosin (cardura)

*potent vasodilators

71
Q

Hypertensive findings on fundoscopic exam may be?

A

Copper and silver wire arterioles, arteriovenous nicking.

Which is differnt from diabetic retinopathy which presents with cotton whool spots, neovascularization, and microaneurysms

72
Q

Why are ACE/ARBs are contraindicated with bilateral renal artery stenosis?

A

Can precipitate acute kidney failure

73
Q

What are common R. Sided HF symptoms?

A

JVD
RUQ abd pain
Anorexia, N/V

74
Q

Stable HF first line treatment is?

A

ARB/ACE & duiretic
Or Entresto

And beta blocker

75
Q

Pain with PAD is worsened with?

A

Ambulation/Excercise

76
Q

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?

A

Bacterial endocarditis

77
Q

When considering starting statin therapy on a pt without ASCVD, what acc/aha 10-year risk score would indicate moderate-dose therapy?

A

> 7.5

78
Q

Which drugs are indicated for triglycerides >500?

A

Fibrates and niacin

79
Q

What is a classic symptom that can differentiate between viral and bacterial gastroenteritis?

A

Bloody diarrha is generally found with bacterial gastroenteritis and not with viral

80
Q

In the non-black patient without co-morbidities, according to JNC8 what would be the best first-line drug therapy?

A

ACE/ARBs or diuretics

APN1 (10 decks)

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