Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUNP 547 - Older Adult > Cardiovascular & Hematology > Flashcards

Cardiovascular & Hematology Flashcards

1
Q

Possible causes of microcytic anaemia + mnemonic

A

TAILS; Thalassemia, anaemia of chronic disease, iron deficiency anemia, sideroblastic anemia, sickle cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of macrocytic anaemia + mnemonic

A

PreFAB; Preleukemia, folate deficiency, alcohol, B12/pernicious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

True/ False; Decreased reticulocytes is associated with bone marrow suppression

A

True- indicatvive of aplastic anemia, hematologic cancers, drugs or toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

True/False

Ferritin is the test of choice for the diagnosis of iron deficiency.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

First-line therapy for iron deficiency anemia

A

Oral iron. One preparation is not preferred over another; patient tolerance should be the guide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anemia with IDA should correct in ______ with oral supplementation

A

2-4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Oral iron should be continued for _____ after anemia corrects

A

4-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of IDA

A

increased requirements
decreased intake
increased loss
decreased absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name that condition –>

microcytic anemia, hypochromia, and decreased ferritin

A

IDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

True/False

All adults age >65 are at increased risk of IDA

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Target ferritin for restless legs with iron deficiency

A

> 75 ug/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In adults, iron deficiency is unlikely if ferritin >___ ug/L (or >___ to ____ in a patient with chronic inflammatory disease, or >___ in the elderly)

A

In adults, iron deficiency is unlikely if ferritin >30 ug/L (or >70-100 in a patient with chronic inflammatory disease, or >50 in the elderly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

True/False

Ferritin is an acute phase reactant. Testing ferritin is recommended during acute infection or hospitalization.

A

False.
Ferritin may be unreliable in patients with chronic disease, active inflammation, or malignancy. Testing ferritin is not recommended during acute infection or hospitalization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

True/False
If patient has microcytic anemia with suspected IDA, you may start supplementation before additional diagnostic tests are performed.

A

False
Patients with microcytic anemia should not be given iron supplements until iron deficiency is confirmed by testing ferritin. Low MCV in the setting of normal ferritin may indicate hemoglobinopathies such as thalassemia especially in high risk ethnic groups. Long term iron therapy is harmful for these patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What additional tests should be ordered for diagnosis of iron deficiency in patients with chronic disease, inflammation or malignancy? (AOCD + IDA)

A

ordering a fasting serum iron and transferrin saturation may be helpful to diagnose iron deficiency that may be missed by solely relying on ferritin
Results: +
low serum iron
low or normal transferrin (i.e. total iron binding capacity), and
fasting transferrin saturation below 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the current recommended test and threshold to confirm iron deficiency in CKD?

A

TSAT <24%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When to consideration of IV iron therapy for heart failure patients?

A

ejection fraction ≤40%, serum ferritin < 100 mg/L or between 100-299 mg/L, and TSAT <20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the only indication for ordering asymptomatic CRP?

A

to review a therapeutic approach in primary prevention of cardiovascular disease in patients assessed at intermediate risk. This is the only indication for CRP assessment in asymptomatic individuals. MUST order hsCRP (high sensitivity CRP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What patient populations with IDA would you suspect underlying malignancy?
AKA what populations are IDA uncommon?

A

Iron deficiency/IDA in adult men and post-menopausal women and in pre-menopausal women without menorrhagia is more likely to have a serious underlying cause of blood loss including malignancy. Consider upper/lower endoscopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a target normal ferritin for IDA?

A

Target normal ferritin >100 µg/L.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SE of oral iron supplements

A

Oral iron preparations may cause nausea, vomiting, dyspepsia, constipation, diarrhea or dark stools.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Instructions to prevent SE with oral iron supplements

A

start at a lower dose and increase gradually after 4 to 5 days (to reach target dose in a few weeks)
give divided doses
give the lowest effective dose
take supplements with meals (note: iron absorption is enhanced when supplements are taken on an empty stomach; however, tolerance and adherence may be improved when iron is taken with meals)
try a different iron preparation
try alternative dosing schedules such as every other day dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How to improve iron absorption with PO iron?

A

taking them on an empty stomach (at least 1 hour before or 2 hours after eating)
taking with 600-1200 mg vitamin C.
Iron absorption can be decreased by various medications and supplements such as multivitamins, calcium, or antacid tablets. Space administration by at least 2 hours apart. Avoid taking iron supplements with tea, coffee or milk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When to reassess patients with moderate to severe anemia? What test to perform?

A

CBC as early as 2-4 weeks. Hemoglobin should increase by 10-20 g/L by 4 weeks. It may take up to 6 months to replenish iron stores.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dosing for IV iron sucrose

A 
100 to 300 mg IV
intermittent per
session, given as a total
cumulative dose of
1000 mg over 14 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In the elderly, serum ferritin below ____ ug/L should be investigated for iron deficiency

Investigation of anemia in the elderly is recommended if the life expectancy is more than ____.

A

50 ug/L

one year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Recommended daily allowance of B12

A

The recommended daily allowance of cobalamin is 2.4 mcg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are two main RF for B12 deficiency?

A 
Risk Factors
Elderly people (>75-years) and long-term vegans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Testing for B12 deficiency should be considered with age >75 years, ,medical history: inflammatory bowel disease (of small intestine), Surgical history: gastric or small intestine resection, Dietary history: prolonged vegan diet, i.e., no meat, poultry or dairy products and Medication history: long-term use of H2 receptor antagonists or proton pump inhibitors (for at least _____), or metformin (at least _____)

A

Medication history: long-term use of H2 receptor antagonists8 or proton pump inhibitors (at least 12 months), or metformin (at least 4 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

True/False

Elderly patients may have normal cobalamin levels with clinically significant cobalamin deficiency

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

First line therapy for low B12

A

Oral crystalline cyanocobalamin (commonly available form) is the treatment of choice. Dosing for pernicious anemia or food-bound cobalamin malabsorption is 1000 mcg/day. In most other cases a dose of 250 mcg/day may be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When is parenteral B12 warranted?

A

reserved for those with significant neurological symptoms. It includes 1-5 intramuscular or subcutaneous injections of 1000 mcg crystalline cyanocobalamin daily, followed by oral doses of 1000-2000 mcg/day. Retest serum cobalamin levels after 4-6 months to ensure they are in the normal range.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Frequency of testing for non-nutritional B12 deficiency

A

Annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What does HATCH score stand for and what is its relevance?

A

A higher HATCH score correlates with higher occurrence of AF and a higher risk for stroke.
Hypertension

Age > 75 years

TIA previously or Stroke

COPD

Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Ejection click, crescendo-decrescendo murmur that can be heard in neck/carotids

A

AS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

pansystolic murmur that is flat shape and heard at auxilla

A

MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Early diastolic murmur, descrescendo in pattern heard at sternal border

A

AR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Opening snap with mid-diastolic rumble

A

MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Midsystolic click, late systolic murmur

A

Mitral valve prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Ventricular gallop and meaning

A

S3, volume overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Atrial gallop and meaning

A

S4, pressure overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Prolonged QTC in males and females

A

Males >450 ms

Female >470 ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

List 5 risk factors for prolonged QT

A 
Hypokalemia (/=65 years, increased risk with increasing age
Arrhythmia
Female sex
HTN
Hypocalcemia
Smoking
Liver failure
Renal dx (eGFR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Scoring system for risk for increased QTC

A

RISQ-PATH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

BW for atrial fibrillation

A
  • Complete blood count
  • Coagulation profile
  • Renal function
  • Thyroid and liver function
  • Fasting lipid profile
  • Fasting glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Persistent A fib definition

A

AF episode

duration ≥ 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Paroxysmal a fib definition

A

Paroxysmal
AF episode
duration < 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

True/False

OSA is a risk factor for atrial fibrillation

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Rate control drug choices for the following with a. fib:

1) Heart failure
2) CAD
3) No HF or CAD

A

1) BB +/- digoxin
2) BB, ∆ Non-dihydropyridine calcium channel blockers (diltiazem, verapamil), combination Rx
3) BB, ND-CCB, Digoxin can be considered for rate control in patients who are sedentary, Combination Rx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Common SE of BB

A

Bronchospasm, depression, hypotension, fatigue, bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Common SE Verapamil

A

Bradycardia, hypotension, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Common SE Diltiazem

A

Bradycardia, hypotension, ankle swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

SE digoxin

A

Bradycardia, nausea, vomiting, visual disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

All of the following are criteria for what?

1) patients with symptomatic AF
2) sustained AF episodes (e.g. ≥ 2 hours)
3) AF episodes that occur less frequently than monthly
4) absence of severe or disabling symptoms during an AF episode
(e. g. fainting, severe chest pain, or breathlessness)
5) ability to comply with instructions, and proper medication use

A

Appropriate candidates for PIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

PIP administration for a. fib

A

Immediate release oral AV nodal blocker (one of diltiazem 60 mg, verapamil
80 mg, or metoprolol tartrate 25 mg) 30 minutes prior to the administration of
a class Ic AAD (300 mg of flecainide or 600 mg of propafenone if ≥ 70 kg; 200
mg of flecainide or 450 mg of propafenone if < 70 kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

All of the following are criteria for what?
1) significant structural heart disease (e.g. left ventricular systolic dysfunction
[LVEF < 50%], active ischemic heart disease, severe left ventricular hypertrophy)
2) abnormal conduction parameters at baseline (e.g. QRS duration > 120 msec, PR
interval > 200 msec; or evidence of pre-excitation)
3) clinical or electrocardiographic evidence of sinus node dysfunction/bradycardia or
advanced AV block
4) hypotension (systolic BP < 100mmHg)

A

Contraindication to PIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Instructions for subsequent out-of-hospital use of PIP

A

1) Patients should take the AV nodal agent 30 minutes after the perceived arrhythmia
onset, followed by the Class Ic AAD 30 minutes following the AV nodal agent.
2) Following AAD administration patients should rest in a supine or seated
position for the next 4 hours, or until the episode resolves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Patients should present to the emergency department after taking PIP for a fib in the event that:

A

a) the AF episode did not terminate within 6-8 hours
b) they felt unwell after taking the medication at home (e.g. a subjective worsening
of the arrhythmia following AAD ingestion, or if they developed new or severe
symptoms such as dyspnea, presyncope, or syncope)
c) more than one episode occurred in a 24-hour period (patients should not take a
second PIP-AAD dose within 24 hours)
d) if the AF episode was associated with severe symptoms at baseline (e.g.
significant dyspnea, chest pain, pre-syncope, or symptoms of stroke), even in
the absence of PIP-AAD use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q 
With which of the following SYMPTOMATIC conditions is ablation first-line (benefits outweigh risks)
A) Paroxysmal a fib
B) Persistent
C) Longstanding
D) None. It is not first line.
A

A)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the CHA₂DS₂-VASc Score used for and what does the acronym stand for?

A 
determine the 1 year risk of a TE event in a non-anticoagulated patient with non-valvular AF.
CHF
HTN
Age >/= 65
Age >/= 75 (even higher risk)
Diabetes
Stroke/TIA/thromboembolism hx
Sex - higher risk with females
Vascular disease history (prior MI, peripheral artery disease, or aortic plaque)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q 
According to the CCS algorithm, all the following conditions are indications for what treatment for atrial fibrillation?
Age > 65 years
Prior Stroke or
TIA or
Hypertension or
Heart failure or
Diabetes Mellitus
A

OAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

According to the CCS algorithm, all the following conditions are indications for what treatment for atrial fibrillation?
Coronary artery disease or
Peripheral arterial disease

A

Anti-platelet therapy

Therapeutic options include single antiplatelet therapy
(ASA 81-100 mg daily) alone; or in combination with
either a second antiplatelet agent (e.g. clopidogrel 75
mg daily or ticagrelor 60 mg bid), or an antithrombotic
agent (rivaroxaban 2.5 mg bid).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

CCB Guideline - True/False
For patients with AF aged ≥ 65 years or with a CHADS2 score ≥ 1 and coronary or arterial vascular disease (peripheral vascular disease or aortic plaque), we recommend long-term therapy with OAC ONLY

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What do you suspect if HTN that was previously controlled has an acute rise or a person has severe refractory HTN?

A

Secondary causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is your next step if you identify abnormal nocturnal BP differences (BP dip <10% or >20%) or increase in nocturnal BP OR more than 15mm Hg difference between arms

A

Refer to specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

If you start medication for HTN when is appropriate follow up?

A

1-2 months (BC guideline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Consider pharmacological treatment in all of the following for HTN except:
A) Average BP >135/85 with target organ damage or CVD risk >15%
B) Average BP >135/85 with 1+ comorbidities
C) Average BP SBP> 160
D) Desirable BP not achieved by lifestyle
E) Average BP >135/85 with 2+ comorbidities

A

E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

ACEI contraindication

A

Pregnancy, hx angioedema, bilateral renal artery stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

CI to BB

A

2nd or 3rd degree AV block, SSS or SA block, bradycardia, decompensated HF, severe peripheral arterial circulatory disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

CI to thiazides

A

Anuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

BW following initiation of BP medication and when to complete

A

2 weeks eGFR
Monthly until BP desired range for 2 consecutive visits
then Q3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

CI to NOAC

A 
Valvular a fib
Mechanical heart valve
Severe renal impairment
Severe liver dysfunction
Pregnant
Interaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

After procedure or surgery NOACs should not be started within _______

A

24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

True/False

Missing 1-2 doses of NOACS does not increase risk for stroke

A

False due to relatively short half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

True/False

Patients on warfarin are advised to avoid vitamin K containing foods

A

False, consistent diet is reccomended

76
Q

True/False

Because warfarin is almost fully bound to albumin in blood, hypoalbuminemic patients need higher doses

A

False, they require lower doses

77
Q

Full anticoagulant effect of warfarin may be ____

A

5-7 days

78
Q

Relative CI to warfarin

A

Uncontrolled HTN (>160/110)
Severe liver dx
Recent surgery of spine, eye, NS

79
Q 
Which of the following are risk factors for bleeding on warfarin: (may have multiple options)
A) > 60 years
B) > 70 years
C) within 3 months of starting warfarin treatment
D) Uncontrolled HTN/HF
E) Underlying malignancy
F) smoking
G) EtOH use
H) use of NSAIDS
A

B, C, D, E, G, H

80
Q

Starting dose of warfarin

A

5mg/day, may be < 5mg if >70 years

81
Q

Instructions of how to take warfarin

A

Once daily in evening, BW in AM

82
Q

Therapeutic range for warfarin

A

2-3 with increased range for valvular disorders

83
Q

Monitoring schedule for warfarin

A

Every 2-4 days until therapeutic level for 2 consecutive then weekly. If 4 consecutive normal values can extend by 2 additional weeks and gradually increased to Q4 weeks, if >/= 3 months stable can extend to Q12 weeks

84
Q

True/False

If INR normal range or 1.5< INR < 2 then no change in dose

A

True, if two consecutive INRs low then increase weekly dose by 10-20%

85
Q

What to do if INR >9

A

D/C warfarin, consider admin vit k 2-5mg orally then recheck INR

86
Q

What to do if INR <1.5

A

Give one time top up of 20% weekly dose and increase weekly dose by 10-20%

87
Q

INR> therapeutic but <5.0

A

lower weekly dose 10-20% or consider omitting one dose

88
Q

INR 5.0-9.0

A

Omit 1-2 dose and resume therapy at 10-20% lower weekly dose when INR therapeutic

89
Q

Beers criteria

Dabigatran/rivaroxaban - use with caution for treatment of VTE or a fib in adults ____ years old

A

> /= 75 years old, due to increased risk for GI bleeding compared with warfarin

90
Q

Drug-Drug interactions for warfarin (Beers)

A 
(increased risk of bleeding)
Cipro
Macrolides (clarithromycin, excluding azithromycin)
Septra (trimethoprim-sulfamethoxazole)
NSAIDs
Amiodarone
91
Q

What NOAC can be given in non-valvular a.fib with reduced dose if CrCl 15-50 mls?

A

Rivaroxaban

92
Q

What NOAC should be avoided with CrCL < 30

A

Dabigatran, apixaban should be avoided with CrCL <25

93
Q

What rhythm control medication should be avoided as first line therapy for atrial fibrillation unless patient has HF or substantial LVH?

A

Amiodarone

94
Q

Avoid this rate control agent as first-line therapy for atrial fibrillation or HF. If used for either, avoid dosages >0.125 mg/d

A

Digoxin

95
Q

What test is used to determine pre-test probability for DVT?

A

Wells score

96
Q

Diagnostic criteria for PE (Wells)

A

Score < 4 is low risk
The components of the modified Wells criteria for PE can be remembered with the mnemonic: “ EAT CHIPS”.

“E” is for edema in the leg or any other symptoms of DVT, and this is given 3 points.

“A” is for alternative diagnosis being less likely, and this also gets 3 points.

“T” is for tachycardia, which is given 1.5 points.

“C” and “H” are for cancer and hemoptysis, and each is given 1 point.

“I” is for immobilization, “P” is for previous history of DVT or PE, and “S” is for major surgery in the past month, and these are all are given 1.5 points.

97
Q

Diagnostic criteria for PE (PERC)

A

HAD CLOTS
Hormones - Is the patient taking exogenous estrogen?
Age - Is the patient >/= 50 years old?
DVT/PE - Does the patient have prior history of DVT/PE?
Coughing blood - Does the patient have hemoptysis?
Lower extremity - Does the patient have unilateral lower extremity edema?
O2 sat - Does the patient have SpO2 < 95% on room air?
Tachycardia - Does the patient have heart rate >/= 100 bpm?
Surgery/trauma - Does the patient have history of surgery or trauma requiring hospitalization in the past 4 weeks?

98
Q

Scoring system for bleeding risk with A. fib when considering anticoagulants and description of measurement.

A

HAS-BLED - The HAS-BLED score estimates the 1-year risk of major bleeding for patients on anticoagulation for atrial fibrillation.

HTN (SBP>160)
Age >65
Stroke
Bleeding history or predisposition.
Liver and Kidney dysfunction. 1pt each, a total of 2pts.
Elevated or unstable INRs, time in the therapeutic range <60%
Drugs and Alcohol. Drugs – Antiplatelets (Aspirin, Clopidogrel, NSAIDs). Alcohol – more than 8 drinks per week –1pt each, a total of 2pts.

99
Q

Risk factors for VTE/Virchow’s triad

A

Risk factors for VTE revolve around Virchow’s triad, and can be remembered with the mnemonic “ THROMBOSIS”: “T” is for trauma or history of travel.

“H” is for hospitalization and hormones, meaning any form of exogenous estrogen such as hormone replacement therapy, tamoxifen or combined oral contraceptives, which promote the formation of clots in the venous circulation.

“R” is for relatives, that is family history of inherited hypercoagulable disorders, like Factor V Leiden.

“O” is for old age.

“M” is for having any malignancy.

“B” is for long bone fractures.

“O” is for obesity and obstetrics; that is pregnancy and the early post-partum period.

“S” is for any form of major surgery, especially orthopedic surgery as well as smoking.

“I” is for immobilization, such as a paralyzed limb.

And the final “S” is for other sickness, like antiphospholipid syndrome, nephrotic syndrome, and paroxysmal nocturnal hemoglobinuria.

100
Q

If pretest probability of PE is moderate or high, what is the next step?

A

Treat with anticoagulants immediately and confirm diagnosis later (differs from DVT treatment)

101
Q

Iron deficiency anemia causes

A 
T- thalassemia
A- anema lf CHronic disease
I- iron def
L- lead poison
S- sideroblastic
102
Q

Macrocytic anemoa causes- most common

A

B12, folate, atrophic gastroperesis, thyroid

103
Q

True or false _ men between the age of 65-80 should have l time screening for aaa?

A

True

104
Q 
Select all that are RF for AAA
Female sex 
male sex
CVD 
dm
Hyperlipidemia
Smoking
A

Male sex, CVD, hyperlipidemia, smoking

Female sex and dm decrease risk

105
Q

What diagnostic tests should be used with a wells score of 2+ ?

A

Compression US

106
Q

What diagnostic tests for wells score of less than 2

A

D-dimer

107
Q

True or false. In pts with a mod to high likelihood of DVTs treatment can start before results of tests are available

A

True

108
Q

Warfarin indicated conditions when treating dvts

A

Antiphospholipid syndromes
wt extremes
Severe renal impairment
(Must bridge with LMWH)

109
Q

Duration of anticoagulant treatment with duts

A

3 months minimum

110
Q

CRAB neumonic for Multiple Myeloma

A

C- calcium high
R- renal failure
A- anemia
B- bone disease/ pain

111
Q

Who qualifies for AAA screening as per Canadian task force

A

Men 65 to 80 – screen once with abdominal ultrasound

112
Q

What are the two AV valves

A

Tricuspid & Bicuspid/ Mitral vale

Mighty mitral delivers blood to the rest of the body! Thank you mighty mitral!

113
Q

What are the two semi lunar valves

A

Pulmonic and aortic valves

114
Q

What are the three most common symptoms associated with atrial stenosis

A

SAD

Syncope- Angina- Dyspnea

115
Q

Describe what is happening during the S1 heart sound x3

A

Takes place at the start of systole
When ventricular pressure > atrial pressure
Closing of AV valves

116
Q

Describe what is happening during the S2 heart sound

Split S2

A

Start of diastole
closing of semilunar valves- aortic and pulmonic
Split S2= aortic closing before pulmonic

117
Q

Crescendo decrescendo murmur that radiates to the carotid arteries, is best heard at the 2nd R ICS and includes a weak pulse

A

Aortic stenosis

118
Q

When is a systolic murmur and diastolic murmur heard in the cardiac cycle?

A

Syst- between S1 & S2

Diast- between S2 & S1

119
Q

A harsh murmur made worse with valsalva maneuvers (ie. leg raise)

A

Aortic stenosis

120
Q

In aortic stenosis the murmur radiates to the carotid arteries. Which artery would you expect to hear the murmur more loudly

A

Left > right

121
Q

Explain the pathology of aortic stenosis

A

Stiffening of the three leaflets of the aortic valve = obstruct blood OUT FLOW
increased stress on LV

122
Q

Explain the pathophysiology of mitral valve regurgitation

A

The mitral valve allows blood to flow from the LA to the LV and closes during systole to prevent backflow.
Mitral regurg refers to the valves in ability to close, causing blood to flow from the LV to the LA during systole.

123
Q

What does the presence of S3 indicate?

A

Dilated left ventricle

124
Q

Holosystolic/ pansystolic murmur, soft S1, worse with increased peripheral resistance ie. hand squeeze/squad

A

Mitral valve regurgitation

125
Q

Where is mitral regurgitation best heard and where does it radiate

A

Best heard- apex- L 5/6 ICS mid clavicular line

Radiates to left axilla

126
Q

Common symptoms of mitral valve regurgitation

A

Palpitations and dyspnoea

127
Q

Valvular disease in Atrial fibrillation is an indicator for what medication?

A

Warfarin

No DOACs

128
Q

What is the potential complication of mitral regurgitation? (Think structurally/ other structures)

A

Increased in left atrial pressure can cause pulmonary hypertension.
Eventually leads to atrial dilation- increases pace maker cells irritability——> cause A-fib

129
Q 
Between Mitral Regurg and Atrial Stenosis- which one is;
Systolic?
Diastolic?
Increases LA pressure?
Increases LV pressure?
A

Syst- AS
Systolic- MR
LA- MR
LV- AS

130
Q

Systolic vs diastolic
Stenotic valve dx=
Regurgitation valve dx=

A

Stenosis- systolic

Regurgitation- diastolic

131
Q

Target INR in patients on Warfarin-

+ mitral valve replacement-

A

Target 2.5 (2-3)

MV- 3 (2.5-3.5)

132
Q

T/F- Increased alcohol intake increase INR

A

True

133
Q

Acute illness such as diarrhoea or fever does what to INR

A

Increases

134
Q

Both increased edema and increaed physicalmactivity do what to INR?

A

Decrease

135
Q

What is the antidote to warfarin?

Which of the NOACs has an antidote?

A

Vit K

Dabigatran- idarucizimab

136
Q

ASA, Clopidogre; and Ticagrelor are examples of what type of medication

A

Anti-platelet

137
Q

For patients with non-valvular atrial fibrillation or Atrial flutter+ aged <65, + NO CHADS-65 R/F

  • is anticoagulation indicated?
  • is anti-platelet therapy indicated?
A

No anti-coag

Yes anti platelet- ie. 81 mg ASA daily +/- clopidogreal or tecagralor if presence of CAD or PVD

138
Q

Management approach to A-Fib focuses on what 2 aspects-

A
  1. Identify risk of thrombosis/stroke

2. Management of arrhythmia

139
Q

A-fib rate control drug choice in patients with heart failure?

A

Beta blockers +/- Digoxin

140
Q

A-fib rate control drug choise in pts with CAD

A

Beta blockers
calcium channel blockers
or combination

141
Q

A-fib rate control drugs for pts with NO HF or CAD?

A

Beta blockers
Calcium channel blockers
Digoxin
Combo therapy

142
Q

Bilateral aorta-iliac disease causes what symptom in male sex?

A

Erectile Dysfunction

143
Q

Intermittent claudication + absent/diminished femoral pulses + erectile disfunction = what syndrome?

A

Leriche Syndrome

144
Q 
Pain in PAD Is indicative of what artery is involved.
Aorta-
Iliac-
Commin femoral-
Superficial femoral-
Popliteal art-
Tibial-
A 
Aorta / Iliac- hip & buttock
Common femoral- thigh
Superficial femoral- upper 2/3 of calf
Popliteal art- lower 2/3 of calf
Tibial- foot
145
Q

Peripheral pain worse with exercise, relieved with rest and dangling of legs, Deep ulcer wounds, on toes, Shiny hairless skin

A

Peripheral arterial disease

146
Q

Peripheral pain that’s worse withstanding, shallow ulcers, haemosiderin staining, edema, relieved with elevation =

A

Peripheral Vascular Disease

147
Q

Describe a cardiac stress test and it’s utility

A

Cardiac stress test compares CA Perfusion at rest and exertional via either treadmill or chemical i.e. with dobutamine.
Used to identify chest pain secondary to coronary artery ischaemia or narrowing.
Also used to evaluate progression of coronary artery disease and identify need for coronary angiography reperfusion therapy.

148
Q

Early risk stratification to determine whether patients with coronary artery disease require early invasive interventions can be determined using what 2 scoring tools?

A

Timmi risk score (
Grace score
(>109/363 - Coronary angio in 24 or 72h)
< 109 = stress test to determine need for reperfusion

149
Q

Stable versus unstable angina

A 
Stable = no pain at rest
Unstable = pain at rest
150
Q

5 M’s of geriatric care

A 
Matters Most
Mind
Mobility
Medications
Multi-complexity
151
Q

What measurement is used for heparin monitoring?

Heparin antidote?

A

PTT

Protamine sulfate

152
Q

Mnemonic for early Digoxin toxicity

Lab value = toxic

A

Brady/toely
Anorexia
Diarrhea

Visual disturbance
Abdo cramps
Nausea/vomit

> 2ng/ml

153
Q

All of the following are risk factors for what condition:

  • OSA
  • diastolic dysfunction
  • parenchymal lung disease
  • long-term endurance exercise
  • hyperthyroidism
  • PE
  • obesity
A

A. fib

154
Q

RF for rupture of AA

A

Female, low FEV1, smoking, HTN

155
Q

What laboratory test for CAD should be ordered with calculated ASCVD risk >7.5%?

A

Coronary artery calcium level

156
Q

True/False

Stress imaging studies should NOT be ordered on asymptomatic pts

A

True

157
Q

CT angiography is useful in patients with CAD if…

A

an uninterpretable ECG and in those who cannot exercise

158
Q

Initial management of pts with angina should be completed by _____

A

Cardiology

159
Q

Diagnostics for CAD

A

ASCVD (not validated for > 80 years old)

Framingham

160
Q

S3 gallop can be commonly be heart with HFpEF. T/F?

A

False

161
Q

PE for suspected HF

A 
VS
Wt
Volume status
CVS
RES
ABD
PVS
162
Q

Initial investigations for ? HF

A 
CBC
Electrolytes
eGFR
UA
Glucose
Thyroid
163
Q

When ordering a BNP/proBNP for suspected HF. What results would lead you to order an ECHO?

A

proBNP >125

BNP >50

164
Q

NYHA Classes

A

I - asymptomatic with normal activity
II - symptoms with ordinary activity, slight limitations with physical activity
III - symptoms with less than ordinary activity, noticeable limitations on physical activity
IV - symptoms at rest

165
Q

Triple therapy example and target doses for HFrEF

A

Ramipril 5mg PO BID + Bisoprolol 10mg OD + Spironolactone 50mg OD

166
Q

Walking 30 min 3 x per week can ____ or _____ walking distance with PAD

A

Double or triple

167
Q

All patients with PAD should be on what medications?

A

Statin

ASA (antiplatelet)

168
Q

How long do patients need to rest to relieve symptoms with intermittent claudication?

A

10 min

169
Q

AAA definition

A

Increase in vessel diameter by 50% or > 3 cm

170
Q

Red flag development with AAA

A

0.05-0.07 cm in 6 months or 1 cm in 12 months –> surgical repair

171
Q

Monitoring for AAA

A
  1. 5-3.5 = 3-5 years
  2. 5-4.5 = yearly
  3. 5-5.5 = 6 months
172
Q

CTF recommends screening for AAA in what population?

A

Male, 65-80 years, once

173
Q

amaurosis fugax definition and what does it indicate?

A

transient unilateral vision loss, carotid stenosis

174
Q

Which symptoms are NOT associated with carotid disease?

A

vertigo, ataxia (uncoordinated mvmts), diplopia, N/V, decreased LOC, generalized weakness

175
Q

Subjective symptoms of carotid stenosis

A

unilateral weakness, numbness, paresthesia, aphasia, dysarthria

176
Q

What treatment is indicated for carotid stenosis with > 60% and asymptomatic OR symptomatic with >50% stenosis

A

Carotid stenting

177
Q

What treatment is indicated for carotid stenosis with longer segment occlusion or >70% stenosed?

A

Endarterectomy (CEA)

178
Q

What diagnostic test is initially indicated for carotid stenosis?

A

Duplex US

179
Q

What is the gold standard diagnostic test for carotid stenosis?

A

Digital angio

180
Q

What class of CCB is amlodipine?

A

DHP CCB

181
Q

What class of CCB is verapamil?

A

N-DHP CCB

182
Q

What class of CCB is diltiazem?

A

N-DHP CCB

183
Q

T/F?
Dihydropyridine (DHP) CCBs tend to be more potent vasodilators than non-dihydropyridine (non-DHP) agents, whereas the latter have more marked negative inotropic effects.

A

True

184
Q

The usual 1st line medication prescribed for endocarditis prophylaxis in an adult patient, without any allergies, is which of the following?

Clindamycin 300mg PO

Cephalexin 2 mg PO

Amoxicillin 2 g PO

Doxycycline 200mg PO

A

Amoxicillin 2 g PO

185
Q

What are 5 exam components to complete for PAD?

A

Checking for femoral bruits - indicates turbulent blood flow through major arteries of the lower extremity most often as a result of atherosclerotic changes

Grading pedal pulses - DP & PT. A number of studies have concluded that in healthy individuals the dorsalis pedis (DP), posterior tibial (PT) & femoral pulses are not palpable 8.1%, 2.9%, & 0% of the time, respectively (CCS, 2005). However, DP & PT arteries are both absent at the same time in only 0.7% of normal feet since hypoplasia of one of these vessels is usually compensated by prominence of the other. The absence of apparent palpable pulses may be often contradicted by the presence of audible arterial flow on further Doppler examination, such that true congenital absence of the DP and PT arteries is seen in only 2% and 0.1% of cases respectively.

Looking for trophic changes in hair, nails, or skin

Inspecting skin temperature and looking for pallor/rubor/venous dependent filling time or capillary refill

Palpation to exclude aneurysms (e.g. AAA)

186
Q

Which of the following leukemias are more common in adults over age 60?

Acute Myelogenous Leukemia

Chronic Myeloid Leukemia

Acute Lymphocytic Leukemia

Chronic Lymphocytic Leukemia

A

Chronic Lymphocytic Leukemia

NUNP 547 - Older Adult (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions