Cards Test 2 Flashcards
1
Q
HTN for which the cause is unknown
A
Essential hypertension
2
Q
Normal blood pressure values
A
- SBP: < 120 and
- DBP: < 80
3
Q
Prehypertension blood pressure values
A
SBP: 120-139
or
DBP: 80-89
4
Q
Stage I HTN blood pressure values
A
SBP: 140-159
or
DBP: 90-99
5
Q
Stage II HTN blood pressure values
A
SBP: > 160
or
DBP: > 100
6
Q
When evaluating a patient for hypertension, what should you think if you hear flank abdominal or flank bruits?
A
HTN may be caused by renovascular HTN or renal artery stenosis?
7
Q
When evaluating a patient for hypertension, what should you think if you detect absent or diminished femoral pulses?
A
Coarctation of the aorta
8
Q
When evaluating a patient for hypertension, what should you think if you palpate flank or abdominal masses?
A
HTN may be due to polycystic kidney disease or AAA
9
Q
What physical signs might you expect to see in a patient with end organ damage from hypertension?
A
- Fundoscopic exam: AV nicking, arteriolar narrowing, exudates, papilledema, hemorrhages
- Signs of heart failure: S3, S4, laterally displaced PMI
- Neurologic deficits
10
Q
Most causes of death fro mHTN have to do with complications of what?
A
Atherosclerosis
11
Q
Primary organs/tissues that suffer from HTN
A
Heart Brain Kidneys Blood vessels Eyes
12
Q
Lacunar stroke
A
occlusion of small penetrating brain arteries resulting in multiple tiny infarcts
13
Q
Water-Shed stroke
A
generalized arterial narrowing that causes structural requirements for higher perfusion pressure in order to maintain adequate tissue flow; a sudden drop in BP can cause a CVA
14
Q
Good marker for renal dysfunction in HTN
A
Microalbuninuria
15
Q
Essential or Secondary HTN more common?
A
Essential (95%)
16
Q
Medications that can cause hypertension
A
- OCP
- Glucocorticoids
- Cyclosporine
- Erythropoietin
- Sympathomimetic drugs (for colds)
17
Q
Most common cause of secondary hypertension
A
Renal parenchymal disease
18
Q
2 common causes of renal artery stenosis
A
- Atherosclerotic lesions
- Fibromuscular lesions
19
Q
When evaluating a patient for hypertension, what should you think if you observe unexplained hypokalemia?
A
- Renovascular hypertension
- Or hyperaldosteronism
20
Q
Gold standard for diagnosing renovascular hypertension
A
Renal angiography
21
Q
If an aorta has coarcation, where is the coarctation likely located?
A
Just distal to the origin of the left subclavian artery
22
Q
When evaluating a patient for hypertension, what should you think if you auscultate a midsystolic murmur that’s particularly loud over the back?
A
Coarctation of the aorta
23
Q
When evaluating a patient for hypertension, what should you think if the patient has “attacks” of severe, throbbing headaches, profuse sweating, and tachycardic palpitations?
A
Pheochromocytoma
24
Q
When evaluating a patient for hypertension, what should you think if you observe Trousseau’s Sign?
A
Hyperaldosteronism
25
Tetanic muscle cramps of the hand distal to an inflated BP cuff
Trousseau's sign
26
How do you differentiate between primary and secondary aldosteronism?
- Measure renin activity
- Low renin activity with primary
- High renin activity with secondary
27
Why might Cushing syndrome cause secondary HTN?
-Excessie cortisol increases blood volume and stimulates the synthesis of RAAS components
28
Dominant long-term controller of blood pressure
The kidneys via pressure natriuresis (PN)
29
What do chemoreceptors detect?
Changes in oxygen and carbon dioxide in the blood
30
What does the CNS respond to (in terms of blood pressure control)?
Ischemia of the vasomotor centers int he brain (the medulla oblongata)
31
Most powerful hormone system for regulating body volumes and BP
RAAS
32
BP Treatment goals
< 140/90
| of < 130/80 w/ DM or chronic kidney disease
33
When evaluating a patient for hypertension, what should you think if you hear flank abdominal or flank bruits?
HTN may be caused by renovascular HTN or renal artery stenosis?
34
When evaluating a patient for hypertension, what should you think if you detect absent or diminished femoral pulses?
Coarctation of the aorta
35
When evaluating a patient for hypertension, what should you think if you palpate flank or abdominal masses?
HTN may be due to polycystic kidney disease or AAA
36
What physical signs might you expect to see in a patient with end organ damage from hypertension?
- Fundoscopic exam: AV nicking, arteriolar narrowing, exudates, papilledema, hemorrhages
- Signs of heart failure: S3, S4, laterally displaced PMI
- Neurologic deficits
37
Most causes of death fro mHTN have to do with complications of what?
Atherosclerosis
38
Primary organs/tissues that suffer from HTN
```
Heart
Brain
Kidneys
Blood vessels
Eyes
```
39
Lacunar stroke
occlusion of small penetrating brain arteries resulting in multiple tiny infarcts
40
Water-Shed stroke
generalized arterial narrowing that causes structural requirements for higher perfusion pressure in order to maintain adequate tissue flow; a sudden drop in BP can cause a CVA
41
Good marker for renal dysfunction in HTN
Microalbuninuria
42
Essential or Secondary HTN more common?
Essential (95%)
43
Medications that can cause hypertension
- OCP
- Glucocorticoids
- Cyclosporine
- Erythropoietin
- Sympathomimetic drugs (for colds)
44
Most common cause of secondary hypertension
Renal parenchymal disease
45
2 common causes of renal artery stenosis
- Atherosclerotic lesions
| - Fibromuscular lesions
46
When evaluating a patient for hypertension, what should you think if you observe unexplained hypokalemia?
- Renovascular hypertension
| - Or hyperaldosteronism
47
Gold standard for diagnosing renovascular hypertension
Renal angiography
48
If an aorta has coarcation, where is the coarctation likely located?
Just distal to the origin of the left subclavian artery
49
When evaluating a patient for hypertension, what should you think if you auscultate a midsystolic murmur that's particularly loud over the back?
Coarctation of the aorta
50
When evaluating a patient for hypertension, what should you think if the patient has "attacks" of severe, throbbing headaches, profuse sweating, and tachycardic palpitations?
Pheochromocytoma
51
When evaluating a patient for hypertension, what should you think if you observe Trousseau's Sign?
Hyperaldosteronism
52
Tetanic muscle cramps of the hand distal to an inflated BP cuff
Trousseau's sign
53
How do you differentiate between primary and secondary aldosteronism?
- Measure renin activity
- Low renin activity with primary
- High renin activity with secondary
54
Why might Cushing syndrome cause secondary HTN?
-Excessie cortisol increases blood volume and stimulates the synthesis of RAAS components
55
Dominant long-term controller of blood pressure
The kidneys via pressure natriuresis (PN)
56
What do chemoreceptors detect?
Changes in oxygen and carbon dioxide in the blood
57
What does the CNS respond to (in terms of blood pressure control)?
Ischemia of the vasomotor centers int he brain (the medulla oblongata)
58
Most powerful hormone system for regulating body volumes and BP
RAAS
59
HTN for which the cause is unknown
Essential hypertension
60
Normal blood pressure values
- SBP: < 120 and
| - DBP: < 80
61
Prehypertension blood pressure values
SBP: 120-139
or
DBP: 80-89
62
Stage I HTN blood pressure values
SBP: 140-159
or
DBP: 90-99
63
Stage II HTN blood pressure values
SBP: > 160
or
DBP: > 100
64
When evaluating a patient for hypertension, what should you think if you hear flank abdominal or flank bruits?
HTN may be caused by renovascular HTN or renal artery stenosis?
65
When evaluating a patient for hypertension, what should you think if you detect absent or diminished femoral pulses?
Coarctation of the aorta
66
When evaluating a patient for hypertension, what should you think if you palpate flank or abdominal masses?
HTN may be due to polycystic kidney disease or AAA
67
What physical signs might you expect to see in a patient with end organ damage from hypertension?
- Fundoscopic exam: AV nicking, arteriolar narrowing, exudates, papilledema, hemorrhages
- Signs of heart failure: S3, S4, laterally displaced PMI
- Neurologic deficits
68
Most causes of death fro mHTN have to do with complications of what?
Atherosclerosis
69
Primary organs/tissues that suffer from HTN
```
Heart
Brain
Kidneys
Blood vessels
Eyes
```
70
Lacunar stroke
occlusion of small penetrating brain arteries resulting in multiple tiny infarcts
71
Water-Shed stroke
generalized arterial narrowing that causes structural requirements for higher perfusion pressure in order to maintain adequate tissue flow; a sudden drop in BP can cause a CVA
72
Good marker for renal dysfunction in HTN
Microalbuninuria
73
Essential or Secondary HTN more common?
Essential (95%)
74
Medications that can cause hypertension
- OCP
- Glucocorticoids
- Cyclosporine
- Erythropoietin
- Sympathomimetic drugs (for colds)
75
Most common cause of secondary hypertension
Renal parenchymal disease
76
2 common causes of renal artery stenosis
- Atherosclerotic lesions
| - Fibromuscular lesions
77
When evaluating a patient for hypertension, what should you think if you observe unexplained hypokalemia?
- Renovascular hypertension
| - Or hyperaldosteronism
78
Gold standard for diagnosing renovascular hypertension
Renal angiography
79
If an aorta has coarcation, where is the coarctation likely located?
Just distal to the origin of the left subclavian artery
80
When evaluating a patient for hypertension, what should you think if you auscultate a midsystolic murmur that's particularly loud over the back?
Coarctation of the aorta
81
When evaluating a patient for hypertension, what should you think if the patient has "attacks" of severe, throbbing headaches, profuse sweating, and tachycardic palpitations?
Pheochromocytoma
82
When evaluating a patient for hypertension, what should you think if you observe Trousseau's Sign?
Hyperaldosteronism
83
Tetanic muscle cramps of the hand distal to an inflated BP cuff
Trousseau's sign
84
How do you differentiate between primary and secondary aldosteronism?
- Measure renin activity
- Low renin activity with primary
- High renin activity with secondary
85
Why might Cushing syndrome cause secondary HTN?
-Excessie cortisol increases blood volume and stimulates the synthesis of RAAS components
86
Dominant long-term controller of blood pressure
The kidneys via pressure natriuresis (PN)
87
What do chemoreceptors detect?
Changes in oxygen and carbon dioxide in the blood
88
What does the CNS respond to (in terms of blood pressure control)?
Ischemia of the vasomotor centers int he brain (the medulla oblongata)
89
Most powerful hormone system for regulating body volumes and BP
RAAS
90
Cornerstone for antihypertensive therapy
Thiazide diuretics
91
Number one cause of resistant hypertension
compliance
92
Definition of hypertensive emergency
BP > 220/120 with signs and symptoms of:
- encephalopathy
- acute MI
- stroke
- pulmonary edema
- aortic dissection
93
BP reduction time frame for patient in HTN emergency
1-2 hours
94
Most common cause of hypertensive emergency
Something to do with kidneys
95
Hypertensive urgency definition
BP >220/120 with minimal or no symptoms
96
Blood pressure reduction time frame in patient in hypertensive urgency
24 hours
97
Good drug for hypertensive urgency
IV Labetalol
98
Most common cause of orthostatic hypertension
hypovolemia secondary to diuretic use
99
What does the endothelial intima release when it's injured?
Cytokines
100
Chemical irritants that can injure vessel endothelium
Nicotine, elevated lipids, elevated sugars in diabetcs
101
Formula for LDL if it's not directly measured
LDL = total cholesterol - HDL - TG/5
102
Desirable total cholesterol
< 200
103
Borderline high total cholesterol
200 - 239
104
high total cholesterol
> 240
105
low (bad) HDL
< 40
106
high (good) HDL
> 60
107
desirable LDL levels
< 100
108
near or above optimal LDL levels
100-129
109
borderline high LDL levels
130-159
110
high LDL leels
160-189
111
Very high LDL levels
> 190
112
normal TG levels
< 150
113
Borderline high TG levels
150-199
114
High TG levels
200-499
115
Very high TG levels
> 500
116
LDL goal < 2 risk factors
160mg/dL
117
LDL goal with 2 or more risk factors
130mg/dL
118
LDL goal with CAD, Diabetes, or Established atherosclerosis
< 100mg/dL
119
LDL goal with acute coronary syndrome, multiple risk factors, metabolic syndrome, and tobacco usage
< 70 mg/dL
120
Although LDLs are the primary treatment goal, at what point should TG be the primary goal of treatment and why?
When TG > 500 because of pancreatitis risk
121
Characteristics of metabolic syndrome
- abdominal obesity
- atherogenic dyslipidemia
- elevated BP
- insulin resistance or glucose intolerance
- prothrombotic state
- proinflammatory state
- low HDL
122
Wast circumference defining level for metabolic syndrome
> 102cm (40in) for men
| > 88 cm (35in) for women
123
Most common manifestation of ischemic heart disease
Angina pectoris
124
Most patients with chronic ischemic heart disease have what?
coronary atherosclerosis
125
How do we estimate perfusion pressure?
By measuring aortic diastolic pressure
126
Relationship of wall stress to afterload
directly proportional
127
Relationship of wall stress to LV radius
directly proportional
128
relationship of wall stress to LV thickness
inversely proportional
129
Evidence of ischemia on EKG
Horizontal or down-sloping ST depression
130
Equation for maximal predicted HR
220-age
131
Target HR for stress testing
85% of maximal predicted HR (220 - age)
132
How much ST depression is considered a positive stress test?
> 1mm
133
How much ST depression is considered a markedly positive stress test
> 2mm
134
Gold standard for evaluating the anatomy of the coronary artery tree
Contrast coronary angiography
135
Where does cardiac catheterization measure pressures?
LV and aorta
136
Screening test that you'd perform on someone with risk factors for CAD, but no symptoms
Electron beam computed tomography (EBCT)
137
What test is indicated when a patient has a positive stress test?
coronary angiography
138
What test should you perform if the patient presents as unstable or has profound symptoms?
Proceed directly with coronary angiography
139
Typical angina symptoms with no evidence of significant atherosclerotic coronary stenosis on angiogram
Syndrome X
140
Single most important coronary artery risk factor
Tobacco exposure
141
If you were a little RBC wanting to get to the diaphragmatic surface of the left ventricle, which coronary would you flow through?
The RCA
142
If you were a little RBC wanting to get to the posterior aspect of the LV, through which coronary would you travel?
The posterior descending branch of the RCA or possibly the circumflex, if it was posterolateral
143
If you were a little RBC wanting to get to the AV node, through which coronary would you travel?
RCA
144
What causes > 90% of UA and STEMIs?
Disruption of atherosclerotic plaque with subsequent platelet aggregation and intracoronary thrombus formation
145
Role of Antithrombin III
Irreversibly binds to thrombin, inactivating it
146
Role of prostacyclin
Inhibits platelet activation and aggregation; potent vasodilator
147
Role of NO
Inhibits platelet activation; potent vasodilator
148
Role of tissue plasminogen activator (tPA)
- cleaves plasminogen to form plasmin
| - plasmin degrades fibrin clots
149
Role of thrombin
Helps to form a fibrin clot
150
Two hemostatic "players" that are involved in clot degradation or prevention of formation?
Antithrombin III
| tPA
151
Primary difference between UA and NSTEMI
UA has no evidence of necrosis, while NSTEMI does
152
Pattern of pain associated with UA
Crescendo pattern of chest pain
153
What should you think if you have elevated cardiac markers without evolution of Q waves?
NSTEMI
154
How long can Troponin levels stay elevated?
10-14 days
155
How long can CK and CK-MB levels stay elevated?
3-5 days
156
Biochemical marker of choice in the evaluation of myonecrosis and diagnosis
Troponin
157
Cornerstone of therapy for UA and NSTEMI
Nitrates
158
How is unfractionated heparin administered?
IV
159
How is LMWH administered?
SQ injection
160
Sign of hand over the chest indicating an MI
Levine Sign
161
What should you think if you have elevated JVPs and the lungs sound clear?
IWMI with right-sided failure
162
How would you treat an IWMI with right heart failure?
Fluids
163
What should you think if you ahve elevated JVPs and the lungs have rales?
Left heart failure
164
How would you treat left heart failure (as opposed to right heart failure)?
Diuretics
165
How long after patient arrival with chest pain do you have to perform an EKG?
10 minutes
166
Where would you have ST elevation with an anteroseptal wall MI?
V1, V2, V3, and V4
167
Where would you have ST elevation with an anterior wall MI?
V3 and V4
168
EKG changes associated with a lateral wall MI
ST elevation in I, aVL, V5 and V6
| Reciprocal ST depression in II, III, and aVF
169
EKG changes associated with an inferior wall MI
- ST elevation in II, III, and aVF
| - Reciprocal ST depression in I and aVL (high lateral leads
170
EKG changes with a RV infarct
> 1mm ST elevation in lead V4R
171
EKG changes with a posterior wall MI
Large R waves in V1 and V2
| ST depression in V1 and V2
172
Door-to-balloon time
90 minutes
173
door-to-needle time (fibrinolytic therapy)
30 minutes
174
Revascularization time limit after STEMI symptom onset
12 hours
175
Best drug for ischemia in HF patients
IV NTG
176
What type of murmur would you hear if someone developed a VSD after an MI?
pansystolic on the LSB
177
Uncommon form of pericarditis that occurs several weeks after an MI
Dressler Syndrome
178
Normal aorta diameter at the base of the heart
3cm
179
descending aorta diameter
2-2.5cm
180
AAA that's distal to the renal arteries
Infrarenal abdominal aortic syndrome
181
Most useful mode of diagnosis for aortic aneurysm
Ultrasound
182
When would you repair an ascending aortic aneurysm?
> 5.5 cm
183
When would you repair a descending aortic aneurysm?
> 6.5 cm
184
When would you repair an AAA?
> 5.5 cm
185
Where are aortic dissections most common?
Ascending thoracic aorta
186
Type A aortic dissection
proximal to the left subclavian artery
187
Type B aortic dissection
distal to the left subclavian artery
188
In which type of aortic dissection is early surgical correction indicated?
Type A
189
Ankle-brachial index is useful in assessing which pathology?
PAD
190
What is often the origin of the embolus that causes acute aortic arterial occlusion?
cardiac
191
primary treatment for superficial thrombophlebitis
local heat
192
Virchow's triad
- stasis
- hypercoagulability
- vascular damage
193
Homans Sign
calf pain produced by dorsiflexion of the foot
