Clinical Medicine Part 3 Flashcards
1
Q
S4 heart sound consistent with
A
hypertension
2
Q
HTN Target organ damage
A
- TIA, stroke
- retinopathy
- PVR
- renal failure
- LVH, CHD, HF-TIA, stroke
- retinopathy
- PVR
- renal failure
- LVH, CHD, HF
3
Q
Hypertensive Urgency
A
- a systolic BP >180
- or a diastolic BP >130
- and NO evidence of end organ damage
4
Q
Hypertensive Emergency
A
-may occur at any BP, but involves damage to at least one organ system
5
Q
CV Signs of target organ involvement
A
- MI
- angina
- aortic dissection
- aneurysmal dilation of large vessels,
- LVH
- CHF
6
Q
Renal signs of target organ involvement
A
hematuria, proteinuria, AKI
7
Q
CNS signs of target organ involvement
A
Cerebral edema, altered mental status, bleed, stroke or TIA
8
Q
Ophthalmologic signs of target organ involvement
A
- retinal hemorrhages or exudates, papilledema
- AV nicking
9
Q
Atherosclerosis
A
- over 50 years old
- male predominance
- progressive
- 33% bilateral
- associated risks–tobacco, lipids, diabetes, etc.
10
Q
Fibromuscular dysplasia
A
- age less than 40
- female predominance
- 60% bilateral
- responds to angioplasty
11
Q
Renovascular HTN associated with renal artery stenosis
A
- stenosis is a progressive obstructive disease
- stenosis rate of 1.5%/month
- if untreated, can lead to total occlusion
- causes of stenosis and HTN are atherosclerosis and fibromuscular dysplasia
12
Q
Medial Fibromuscular dysplasia
A
- most common
- 9/1 females to males
- ages 25-45
- can be seen in carotids and iliac arteries
- 70% bilateral
- may appear as solitary mid and distal stenotic lesions or multiple constrictions with intervening aneurysmal dilations
13
Q
Perimuscular dysplasia
A
-usually mid-distal portion of renal artery
14
Q
Intimal fibromuscular dysplasia
A
- males and females equally affected
- infants and young adults more frequently
15
Q
Unilateral Renal artery stenosis, 2 kidneys
A
- decreased intravascular volume
- more renin mediated (increased) than the others
- BP usually falls with ACE-Is
16
Q
Bilateral renal artery stenosis
A
- increased intravascular volume
- renin mediation more varied
- ACE response unpredictable and may worsen HTN
17
Q
Unilateral renal artery stenosis, 1 kidney
A
- increased intravascular volume
- renin mediation is more varied
- ACE response unpredictable and may worsen HTN
18
Q
Diagnosis of renovascular HTN
A
- renal US with arterial dopplers
- Captopril test–reactive rise in renin and large fall in BP after administration
- Digital subtraction angiography
- MRI-angiogrpahy
- arteriography
- renal vein renin ratio greater than 1.5
19
Q
Renovascular HTN treatment
A
- aimed at BP control and preservation of renal function
- antihypertensive meds
- stenting
- grafting
20
Q
Contraindications to ACE inhibitors
A
- bilateral renal artery stenosis
- unilateral renal artery stenosis with solitary kidney
- pregnancy
- known angioneurotic edema with prior ACE administration
- relative contraindication–ACE induced cough
21
Q
Secondary HTN
A
- sleep apnea
- drug induced causes
- primary aldosteronism
- renovascular disease
- steroid therapy or Cushing’s syndrome
- pheochromocytoma
- coarctation fo the aorta
- thyroid disease
- parathyroid disease
22
Q
Cardiovascular causes of HTN
A
- MI
- acute left ventricular failure
- vasculitis
- coarctation of the aorta
- aortic dissection
- volume overloading (including pulmonary edema)
23
Q
Coarctation of the aorta
A
- narrowing of medial layer of aorta
- commonly ligament arteriosum
- interrupted, preductal, postductal
24
Q
Diagnosis of Coarctation
A
- differences in upper and lower extremities
- blood pressure: systolic HTN in an infant; 20 mmHg difference between arms
- heart sounds–if isolated, a systolic ejection murmur in the aortic outlet and between scapulae
- cardiomegaly, rib notching, 3-sign on lateral chest view
25
Primary Hyperaldosteronism
- located in adrenal gland without exogenous stimulus
- elevated aldosterone and low renin levels decrease potassium
- aldosterone producing adenoma, idiopathic, bilateral adrenal hyperplasia, aldosterone producing cancer, aldosterone producing renin-responsive adenoma, ectopic aldosterone producing tumor, dexamethasone suppressible hyperaldosteronism
26
Secondary hyperaldosteronism
- elevated aldosterone and elevated renin levels
| - diuretics, CHF, cirrhosis, ascites, nephrosis, others
27
Treatment after MI
-beta blocker, ACE inhibitor
28
Contraindicated treatment after MI
direct vasodilators
29
Treatment of CHF
ACE inhibitor, diuretics
30
Contraindicated treatment of CHF
beta blockers, CCB
31
Treatment of angina
-beta blockers, CCB, nitroglycerin
32
Treatment of aortic dissection
-nitroprusside, beta blockers
33
Contraindicated drugs in bilateral renal artery stenosis
-ACE inhibitors, angiotensin blockers
34
Treatment of Chronic renal insufficiency
- ACE inhibitors with serum creating less than 2.5
- loop diuretics
- CCB
35
Contraindicated drugs in chronic renal insufficiency
ACE inhibitors, ARBs
36
Contraindicated drugs in Renal transplants
ACE inhibitors
37
Nitroglycerin
- advantage over nitroprusside since it preferentially dilates veins more than arterioles, thus enhancing oxygenation of myocardial cells
- CABG, MI, unstable angina, left ventricular failure
38
Systemic Causes of Nephrotic Syndrome
- DM, SLE, amyloidosis
- drugs: gold, penicillamine, probenecid, captopril, NSAIDs, heroin
- infections: bacterial endocarditis (can also get hematuria), Hep B, shunts, syphilis, malaria
- malignancy: hodgkins, non-hodgkins lymphoma, leukemia, breast and GI cancers
39
Active sediment
-any positive findings on microscopic, particularly those suggesting kidney disease
40
Bland sediment
-normal
