Cardiovascular

Question 1

standard first line initial testing for CAD

Answer 1

Exercise tolerance test (exercise stress test)

Question 2

how is exercise tolerance test conducted

Answer 2

patient connected to 12 lead EKG and continuously monitored during exercise

Question 3

primary goal of exercise stress test

Answer 3

increase workload incrementally to induce ischemia / until predetermined workload reached; used to detect CAD (seen as ischemic changes on EKG)

Question 4

factors that decrease exercise stress test sensitivity

Answer 4

prior MI
resting BBB
conduction abnormality
pacemaker
inability to exercise / effort dependent
meds: beta blockers, digoxin

Question 5

contraindications for exercise stress test

Answer 5

-previous MI (past two days)
-uncontrolled dysrhythmias
-decompensated HF
-endocarditis
-high grade heart block
-persistent stable angina
-hemodynamically significant aortic stenosis

Question 6

what is a fusiform aneurysm

Answer 6

symmetric weakness of the entire circumference of the aorta that produces a bulge

Question 7

what is a saccular aneurysm

Answer 7

asymmetric weakness or bleb on the side of the aorta - result from trauma or internal war defect caused by ulcer

Question 8

what is a pseudo aneurysm

Answer 8

enlargement of only outer layer of the blood vessel wall; “false” aneurysm

Question 9

classic diagnostic triad of AAA

Answer 9

hypotension
pulsatile abdominal mass and abdominal/back pain

Question 10

ACC/AHA recommended screening for AAA

Answer 10

-Men 60+ with first degree relative w/ AAA
-Men 65-75+ that have ever smoked

*need PE and US to rule out AAA

Question 11

Indications for ordering carotid US

Answer 11

Serial surveillance of known stenosis (>20%)
Vascular assessment in patient with multiple risk factors
Stroke assessment in patient with symptomatic CAD or PAD
Amaurosis fugax or Hollenhorst plaques seen on retinal exam
Hemispheric TIA
Stroke in candidate for carotid revascularization
Surveillance after carotid revascularization procedure (ex: endarterectomy)
Intraoperative monitoring during endarterectomy

Question 12

symptoms indicative of end organ damage HTN

Answer 12

-loss of visual acuity
-severe HA
-confusion
-claudication
-chest pain
-dyspnea
-palpitations
-syncope
-hematuria
-oliguria

Question 13

ACC/AHA stage 1 vs stage 2 htn dx

Answer 13

stage 1: 130-139/80-89
stage 2: >140/>90

*average 2+ readings on 2+ occasions for dx; home readings best if possible

Question 14

ACC/AHA goal BP

Answer 14

130/80

Question 15

labs/studies to obtain for HTN dx

Answer 15

-urine albumin to cr ratio
-CBC w/ diff
-Fasting blood glucose
-BMP
-fasting lipids
-EKG

*TSH if indicated
*24 h urine cortisol if Cushings suspected

Question 16

BP med classes recommended for AA patients

Answer 16

thiazide
dihydropine CCB

Question 17

BP med classes recommended of asian patients

Answer 17

CCB
ARB

Question 18

BP med classes recommended for non-black patients

Answer 18

thiazide
ACE/ARB
CCB
combination (ex: lisinopril/HCTZ)

Question 19

JNC BP goal for patients with CKD or DM

Answer 19

140/90

Question 20

long-term complications of HTN

Answer 20

-LV hypertrophy
-HF
-CAD
-MI
-sudden death
-aortic dissection
-CVA
-proteinuria
-renal insufficiency
-retinopathy
-atherosclerotic conditions