Cases 31-35

Question 1

What are 4 risk factors for CAD?

Answer 1

DM

HTN

HLD

tobacco

Question 2

What does USPSTF say about initiation of ASA?

Answer 2

Start low-dose at 50-59 in people with 10%+ 10 year risk

Question 3

What are 7 ways to slow the progression of CAD?

Answer 3

Glucose control
HTN control
Cholesterol control
Weight control
ASA
Immunizations (pneumovax)
Beta-blockers

Question 4

What drugs are/can be used to manage stage C HF?

Answer 4

ACEI

ARBs
Digoxin
Loop diuretics
Metoprolol
eplerenone

Question 5

What are some radiographic findings of CHF? (5)

Answer 5

Cardiomegaly
Central vascular congestion and hilar fullness
Pleural effusions
Cephalization of pulmonary vasculature
Kerley B lines

Question 6

What is the most common cause of vertigo? Seconds causes?

Answer 6

1. Benign paroxysmal positional vertigo (BPPV)
2. vestibular neuritis (infection inflammation of vestibular branch) and acute labrynthitis (both branches of CNVIII causing tinnitus and/or hearing loss as well as virtigo)

Question 7

Describe the Dix-hallpike maneuver for diagnosing BPPV

Answer 7

turn the patient’s head 45 degrees then have them lay down quickly. Note dizziness and nystagmus.

Question 8

What does a positive head thrust test mean?

Answer 8

there is a central lesion in the vestibular system

Question 9

What medication is commonly used to treat meniere’s disease?

Answer 9

diuretics

thought to decrease endolymphatic pressure (not a lot of studies for or against the use)

Question 10

What is the epley maneuver?

Answer 10

hallmark treatment of BPPV

To perform the Epley maneuver for right-sided symptoms, the patient sits on the exam table with his head turned 45 degrees to the right. With the clinician supporting the head, the patient quickly lies back with his head hanging over the exam table supported by the clinician as in the Dix-Hallpike test. Once the nystagmus has stopped, the clinician turns the head 90 degrees to the left and the position is held for 30 seconds. Next, the patient rolls onto his left side, with his face at a 45 degree angle to the floor. This position is held for 30 more seconds. The patient returns to the sitting position now with his legs off the left edge of the table. After another 30 seconds, the patient can resume normal head position. The maneuver can also be repeated on the other side. Repositioning maneuvers are not effective for the treatment of vertigo not caused by canalith debris.

Question 11

can meclizine and promethazine be used for vertigo during pregnancy?

Answer 11

Yeah, for short-term use

Question 12

Name 3 criteria for typical angina

Answer 12

substerna chest discomfort

exertional in nature

relief with nitroglycerin or rest

Question 13

What is the difference between stable and unastable angina?

Answer 13

unstable can occur at rest or with increasingly less exertion

Question 14

Define metabolic syndrome

Answer 14

waist circumference Men: >40in; Women: >35in

>150mg/dL triglycerides

HDL Men: <40 ; Women: <50mg/dL

Blood pressure >130/85 mmHg

Fasting glucose >110mg/dL

Question 15

If a stress test is positive, what 2 options are available?

Answer 15

antianginal medication and follow (B-blockers, calcium blockers, nitrates)

angiogram

Question 16

Which patients should start a statin? (4)

Answer 16

Current ASCVD

LDL >190

DM ages 40-75

10-year ASCVD risk >7.5%