Cardiovascular

Question 1

BP Goals: ABMP 24h monitor

Answer 1

<130/80

Question 2

BP Goals: ambulatory mean wake

Answer 2

<135/85

Question 3

BP Goals: HBPM

Answer 3

<135/85

Question 4

BP Goals: AOBP

Answer 4

<135/85

Question 5

BP Goals: Non-AOBP / OBPM

Answer 5

<140/90

Question 6

HTN emergency

Answer 6

HTN encephalopathy
Acute aortic dissection
Acute LVF
ACS
AKI
ICH
CVS
Pre-eclampsia

Question 7

Secondary cause BP risks: Fibromuscular dysplasia

Answer 7

Resistant >/ 3 meds
>1.5cm renal asymmetry
Abdo bruits w/o artherosclerosis
FMD other vascular area
Fam hx

Question 8

Secondary cause BP risks: Renovascular

Answer 8

Sudden onset / worsening <30 or >55 y/o
Abdo bruit
Resistant >/ 3 meds
Increased Cr >/ 30% on ACEi/ARB
Arterosclerosis
Pul edema with increased BP

Question 9

Secondary cause BP risks: Hyperaldosteronism

Answer 9

K+ </3.5 or <3 if not diuretic
Resistant to >/ 3 meds
Incidental adrenal adenoma

Question 10

Secondary cause BP risks: Pheochromocytoma

Answer 10

Paroxysmal/ severe BP >/ 180/110
Refractory to meds
Catecholamine excess - H/A, sweating, palpitations, panic attacks, pallor, HTN triggered by b-blocker and MAOI
Incidental adrenal mass

Question 11

Fibromuscular dysplasia- ix

Answer 11

MRA and CTA - if + screen cervicocephalic intracranial aneurysm

Question 12

Renovascular - ix/tx

Answer 12

Ix:
Captopril-enhanced radioisotope renal scan -egfr >60
Doppler
CT-angio
MRA - egfr >30
Tx:
Stent/angioplasty if uncontrolled hen, acute pul edema, decreased cr

Question 13

Hyperaldosteronism - ix

Answer 13

Plasma aldosterone and plasma renin

Question 14

Pheochromocytoma - ix

Answer 14

MRI
24h urine total metanephrine
+urinary metanephrine:Cr ratio