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EOR Exam - Internal Medicine > Cardiovascular Part 2 > Flashcards

Cardiovascular Part 2 Flashcards

1
Q

What circumstance should raise the most suspicion for a secondary cause for HTN? What are some common secondary causes?

A

Circumstance: Patient refractory to anti-hypertensives
Causes: renovascular is the most common secondary cause. Others: hyperaldosteronism, AUD, sleep apnea, pheochromocytoma, coarctation of the aorta, OCPs, sudafed, COX-2 inhibitors.

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2
Q

What is the most common cause of end-stage renal disease in the US?

A

DM –> HTN 2nd most common cause.

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3
Q

What is required for a diagnosis of HTN?

A

2 elevated readings on 2 separate occasions.

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4
Q

Which BP, systolic or diastolic, is more associated with risk of CAD?

A

Systolic > 140 indicates higher risk of CAD in patients older than 50.

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5
Q

Describe the AHA’s stages of HTN.

A 
Normal: SBP < 120 / DBP < 80
Elevated: 120-129 / < 80
Stage 1: 130-139 / 80-89
Stage 2: > 140 / > 90
Stage 3: > 180 / > 120
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6
Q

What is the management goal in the average patient diagnosed with HTN? In patients with chronic kidney disease? In patients over age 65?

A

General: SBP < 130 / DBP < 80
CKD: < 140 / < 90
Over 65: < 150 / < 90

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7
Q

What four durg classes can be used as first-line therapy in an uncomplicated, non-African Americn patient with a new diagnosis of HTN?

A

Thiazide diuretics, ACEIs, ARBs, CCB

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8
Q

What is the most commonly used first-line medication in the treatment of chronic HTN?

A

HCTZ

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9
Q

What two first line therapy options for treatment of HTN have a synergistic effect when given together?

A

ACEIs and thiazides –> decrease preload and afterload

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10
Q

Which patients with HTN benefit most from ACEIs (or ARBs) and why?

A

DM, nephropathy, CHF, prior MI –> ACEIs and both renal and cardio protective.

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11
Q

What medications are best for use in African American patients with HTN?

A

CCBs and thiazides –> ACEIs and ARBs are n ot indicated in African-Americans.

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12
Q

Which HTN medications are contraindicated in pregnancy?

A

ACEIs and ARBs

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13
Q

What patients would most commonly receive consideration for an ARB to treat HTN?

A

Patients unable to tolerate ACEIs or BBs

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14
Q

Which CCBs are the most potent vasodilators, and thus, best for use in HTN?

A

Dihydropyridines - nifedipine and amlodipine.

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15
Q

What are the contraindications to use of CCBs?

A

2nd/3rd degree heart block, patients taking BBs

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16
Q

What is the MOA of HCTZ?

A

Dec Na and H2O retention by limiting their reabsorption at the distal tubule.

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17
Q

What are the AEs associated with HCTZ?

A

HypoNA, HypoK, hyperuricemia, hyperglycemia.

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18
Q

What is the MOA of loop diuretics?

A

Inc excretion of Na, Cl, and K to inhibit water reabsorption at the loop of Henle.

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19
Q

What are the AEs associated with loop diuretics?

A

HypoK, hyperuricemia, HypoCl, metabolic alkalosis, hyperglycemia

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20
Q

What diuretics are contraindicated in patients that have a sulfa allergy?

A

HCTZ and loop diuretics.

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21
Q

Which diuretics do not decrease serum potassium?

A

Spironolactone, amiloride, eplernone

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22
Q

What is the MOA of potassium sparing diuretics?

A

Inhibit aldosterone mediated Na and H2O reabsorption at the distal tubule.

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23
Q

List the AEs associated with potassium sparing diuretics.

A

Hyperkalemia, gynecomastia specific to spironolactone.

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24
Q

When would BB medications be considered for use in management of HTN?

A

No longer first line –> more common in patients with CAD HX, especially prior MI or tachycardia.

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25
Q

Identify BBs that are nonselective, B1 selective, and both alpha and beta.

A

Non-sel: propranolol most common
B1 sel: atenolol, metoprolol, esmolol
A & B: labetalol, carvedilol

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26
Q

Identify three alpha-1 antagonists and state what they are used for?

A

Prazosin, terazosin, doxazosin –> 1at line in patients with HTN and BPH

27
Q

Differentiate the pathophysiology of STEMI from NSTEMI.

A

STEMI: Necrosis of full thickness of myocardial wall from complete CA occlusion.
NSTEMI: Myocardial necrosis not associated with complete occlusion and likely not full thickness.

28
Q

State the lead location of ST elevation found in anterior, inferior, lateral, and posterior STEMI.

A

Ant: I, aVL, V2 - V6
Inf: II, III, aVF
Lat: I, aVL, V5, V6
Post: No STE –> depression in V1 - V4

29
Q

What is the mainstay of treatment for STEMI?

A

PCI within 90 minutes of first medical contact –> thrombolytics if PCI not immediately available.

30
Q

What medications may be considered as adjunctive therapy in the management of STEMI?

A

BB, NTG, ASA, plavix, heparin, statins, analgesia

31
Q

Describe the serum labs used to assess NSTEMI.

A

Troponin: appears at 2-4 hours, peaks at 12-24 hours and lasts 7-10 days
CK/CK-MB: appears at 4-6 hours, peaks at 12-24 hours and lasts 2-3 days
Myoglobin: appears at 1-4 hours, peaks at 12 hours and lasts 1 day

32
Q

What is the treatment for NSTEMI?

A

Same medications but PCI is less time sensitive.

33
Q

What is the gold standard diagnostic test for myocarditis?

A

endomyocardial biopsy

34
Q

What will be seen on echocardiography in a patient with myocarditis?

A

decreased ventricular EF with hypokinesis

35
Q

What S/S are associated with myocarditis and which is most indicative?

A

Most indicative: tachycardia disproportionate to fever or discomfort.
Other: fatigue, ,fever, chest discomfort, dyspnea, palpitations.

36
Q

What is the treatment for myocarditis?

A

Mostly supportive. Antiarrhythmics PRN and heart failure meds PRN.

37
Q

Describe the pathophysiology of pericarditis.

A

Inflammation of the pericardial sac –> often with pericardial effusion.

38
Q

What clinical presentation is most associated with pericarditis?

A

Pleuritic chest pain worse when supine and during inspiration but better when leaning forward, pericardial friction rub on auscultation.

39
Q

What diagnostic test findings are indicative of pericarditis?

A

ECG: Diffuse ST elevation and PR depression
Echo: may show pericardial effusion

40
Q

What is the treatment for pericarditis?

A

Treat underlying cause (abx, etc.), NSAIDs, keep head at 45 degrees, steroids, pericardiocentesis PRN

41
Q

Define Dressler’s syndrome.

A

Pericarditis 2-5 days after acute MI

42
Q

What is the most common presentation of peripheral artery disease and what are other S/S?

A

MC = intermittent claudication. Other –> erectile dysfunction, pain brought on by exercise and relieved with rest.

43
Q

What is leriche syndrome and what does it indicate?

A

Claudication, erectile dysfunction, and diminished femoral pulses –> indicates peripheral artery disease at aortic bifurcation.

44
Q

What are the six P’s associated with acute arterial embolism?

A 
Pain
Pulselessness
Pallor
Parestehsias
Poiklothermia
Paralysis
45
Q

What is the gold standard diagnostic test for peripheral artery disease and what other tests are used?

A

Gold: arteriography (only if revascularization planned)
Other: doppler ultrasound, ankle-brachial index < 0.9

46
Q

What is the first-line treatment for peripheral artery disease? What is the mainstay pharmacological treatment and what other meds may be used.

A

1st line: risk factor modification (DM, HTN, etc.)
Mainstay pharm: cilostazol
Other pharm: ASA, clopidogrel, BBs, ACEIs, statins

47
Q

What S/S are associated with varicose veins and which vein is most commonly involved?

A

MC: saphenous

S/S: dilated, tortuous veins, reticular veins, telangiectasia (aka spider veins)

48
Q

What is the treatment for varicose veins?

A

Compression stockings, control risk factors

49
Q

What S/S are most commonly associated with phlebitis?

A

dull pain, erythema, swelling, heat, redness, induration

50
Q

What is Homan’s sign and what does it indicate?

A

Calf pain with dorsiflexion –> indicates phlebitis

51
Q

What S/S are most indicative of chronic venouos insufficiency?

A

progressive edema; itching; dull pain; ulcerations; shiny, thin, atrophic skin

52
Q

What diagnostic test is most commonly used to evaluate for disease of peripheral veins?

A

Duplex ultrasound

53
Q

Describe rheumatic fever.

A

Inflammatory response to infection (usually group A strep) with formation of antistreptolysin antibodies which react with proteins on synovium, heart muscle, heart valves.

54
Q

How long after initial infection does rheumatic fever usually manifest?

A

2 - 4 weeks

55
Q

What is the treatment for rheumatic fever?

A

ASA, NSAIDs, steroids, abx

56
Q

What prophylaxis against rheumatic fever is given for recurrent strep infections?

A

penicillin G benzathine 1.2 million units IM q3-4 weeks for 5-10+ years

57
Q

Differentiate clinical S/S of aortic aneurysm from aortic dissection.

A

Aneurysm: flank pain, hypotension, pulsatile abdominal mass
Dissection: tearing C/P, diminished pulses, wide mediastinum, unequal BPs on each arm

58
Q

When is surgical repair indicated for abdominal aortic aneurysm?

A

5.5+ cm or increase by > 0.5cm per year

59
Q

What is the treatment for aortic dissection?

A

Surgical emergency if involving ascending aorta, BBs otherwise.

60
Q

Define Giant Cell Arteritis

A

Inflammation of large and medium vessels (AKA temporal arteritis)

61
Q

What S/S are most commonly associated with giant cell arteritis?

A

Jaw claudication, unilateral HA, scalp pain elicited by light touch, acute vision disturbances

62
Q

In addition to clinical presentation, what is used to diagnose giant cell arteritis?

A

ESR > 100, temporal artery biopsy

63
Q

What is the treatment for giant cell arteritis?

A

Urgent, high dose prednisone

EOR Exam - Internal Medicine (9 decks)

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