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MVU Adult 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Risk factors for hypertension

A

Age (>65)
Male
African American
Obesity
FHx
ETOH
Sedentary
Smoking
Stress
Diet

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2
Q

Secondary hypertension causes

A

Cushings
Coarctation of aorta
Pheochromocytoma
Hyperaldosteronism
Renovascular HTN
OSA

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3
Q

Description of “resistant” HTN

A

Uncontrolled HTN despite 3-drug max regimen

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4
Q

How to treat a patient with resistant HTN

A

Referral to a cardiologist and look at secondary causes

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5
Q

Differential diagnosis for HTN

A

OSA, Drug-induced, CKD, Thyroid/Parathyroid

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6
Q

What is the recommendation of when to start HTN medications according to JNCB

A

For most ages and co-morbidities: > 140/90
If >60years: >150/90

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7
Q

What is the preferred antihypertensive for Black people?

A

TTD or CCB

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8
Q

Examples of TTDs

A

HCTZ, Chlorthalidone

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9
Q

Examples of CCBs

A

Amlodipine
Felodipine
Diltiazem
Verapamil

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10
Q

Examples of ARBs

A

Losartan
Olmesartan
Valsartan

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11
Q

Examples of ACEIs

A

Lisinopril
Enalapril

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12
Q

When would you treat a black patient with an ACE or ARB?

A

If they have co-morbid CKD; this is true for all races

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13
Q

Diabetics should also be monitored closely for which disease?

A

HLD

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14
Q

Criteria for metabolic syndrome

A

Abdominal obesity
Elevated triglycerides
Low HDL
HTN
Elevated fasting glucose

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15
Q

Total cholesterol desired level

A

<200 mg/dL

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16
Q

Triglyceride level

A

<150 mg/dL

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17
Q

HDL level

A

W: >45
M: >40

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18
Q

LDL Level

A

<100

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19
Q

Non-modifiable RFs for CAD

A

Males
Increased age
FHx
African American

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20
Q

Define stable angina

A

angina that is typically triggered by exertion and relieved with rest

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21
Q

Define unstable angina

A

angina that persists even at rest

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22
Q

Define Variant angina

A

Also known as Prinzmetal’s; coronary artery spasm

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23
Q

Differential Dx for ACS

A

PE
AAA Dissection
Tension Pneumo
Cardiac tamponade
Esophageal rupture
GERD

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24
Q

Sx of acute MI

A

Substernal compression (pressure, tight, heavy)
Indigestion
Epigastric pain
Radiating pain
Dyspnea
N/V
Diaphoresis

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25
Q

S&S of Afib

A

Chest pain
JVD
Crackles
S3
Rapid HR
Dizziness
SOB
Lightheaded

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26
Q

Tx for heart failure

A

ACEI
ARB
Beta Blocker
Entresto (sacubitril & valsartan)
Diuretics

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27
Q

S&S of Stage 4 HF

A

Sx at rest:
Ankle edema
JVD
Crackles
S3
Hepatojugular reflux
Pleural effusion
Paraoxysmal nocturnal dyspnea

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28
Q

S&S of Stage 3 HF

A

Sx w/ moderate exertion:
Fatigue
Dyspnea on exertion
Pulmonary congestion on CXR
Cardiomegaly

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29
Q

DDx for syncope

A

Arrhythmia
PE
Vasovagal
CVA
Seizure

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30
Q

Rx factors for PAD

A

Smoking
Obesity
Sedentary
HTN
HLD
DM

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31
Q

Rx factors for PVD

A

Coagulation abnormalities
Abdomen/pelvic surgery
Estrogen/oral contraceptives
Pregnancy
Obesity
HF
Advanced cancer

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32
Q

S&S of PAD

A

Intermittent leg pain that increases w/ exertion
9 Ps: Pain, Pulselessness, Pallor, Paresthesia, Paralysis, Poikilothermia (cool)

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33
Q

Pharmacological treatment for PAD

A

ASA (antiplatelet)
If can’t tolerate ASA than clopidogrel (Plavix)
+ Statin

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34
Q

Dx for PAD

A

-Doppler ultrasound flow study which will estimate the ABI (Normal is > 0.9, < 0.5 = severe)
-Arteriogram if consult with vascular surgeon

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35
Q

Pt education for PAD

A

-Walk for 30 minutes at least 3-4 times/wk
-Ulcers/lesions need immediate care
-Avoid tight dressings/stockings
-Keep legs dependent to improve blood flow

36
Q

What is the diagnostic test of choice for patients with DVT?

A

compression ultrasonography of the femoral and popliteal pulses (Do this immediately if Well’s score is moderate or high; if Well’s score is low, D-Dimer first)

37
Q

What would a low risk Well’s score and negative D-Dimer indicate?

A

No DVT present

38
Q

What is Virchow’s triad?

A

Describes Rx factors for DVT
Venuous Stasis
Vessel Injury
Hypercoagulability

39
Q

Tx for Chronic venuous insufficiency

A

Light exercise
Compression stockings
Weight loss
Elevation of legs several times/day for 30+ minutes

40
Q

Difference between PAD & PVD

A

PAD- Intermittent claudication, No edema, no pulse or decreased pulse, round smooth sores on toes and feed, black/eschar color or dusky color
PVD- Dull, achy pain, lower leg edema, pulse present, Sores with irregular borders on ankles, yellow slough or ruddy skin

41
Q

S&S of PE

A

SOB, Tachypnea, Tachycardia, low fever, chest pain

42
Q

Wells Probability scoring

A

High if > 6
Moderate if 2-6
Low if <2

43
Q

Most likely pathogens for CAP

A

S. Pneumoniae
Pnuemococcal pneumonia
Staph aureus
Mycoplasma pneumonia
H. influenzae

44
Q

Tx for CAP for patient w/o comorbidities

A

Azithromycin, Clarithromycin, or doxycycline

45
Q

Tx for CAP for patient with comorbidities

A

Respiratory fluroquinolone (-floxacin) OR a beta lactam (PCN) WITH a macrolide (azithromycin)

46
Q

Tx for CAP for patient with recent ABX

A

Respiratory fluoroquinolone OR macrolide + high dose amoxicillin/augmentin

47
Q

CURB-65 scoring

A

0-1: Low risk, home treatment
2: Short inpatient or closely monitored outpatient
3-4: sever pneumonia; hospitalize, maybe ICU

48
Q

What is CURB-65?

A

An easy to remember tool to determine severity of CAP

49
Q

What does CURB-65 test?

A

C- Confusion
U- BUN (>19 is +)
R- Respiratory Rate (>30 is +)
B- BP (SBP <90, DBP 60 is +)
Age- >65 is +

50
Q

F/U for patients with CAP

A

For outpatients: contact within 24-48 hours of treatment start, follow up visit 1 week after, and follow up 4-6 weeks after
CXR if symptoms not improving

51
Q

Diagnostics for CAP

A

CXR
Gram stain of sputum
Leukocyte count

52
Q

S&S of HLD

A

Carotid bruit
Corneal arcus
Yellowish skin deposits (also known as Xanthelasma (on eyelids)

53
Q

Pharmacological Tx of HLD

A

Statins
Statin + CCB
Ezetimibe
Niacin

54
Q

What is the single most important sign of OSA?

A

Hypersomnolence (uncontrollable sleepiness)

55
Q

When should you test for OSA?

A

When hypersomnolence and snoring are both present and/or new diagnosis of hypertension

56
Q

Diagnostic tools for OSA

A

-Subjective assessments of sleepiness including Stanford Sleepiness Score and Epworth Sleepiness Scale
-Sleep study- overnight polysonogram

57
Q

DDx for OSA

A

Narcoloepsy, depression, Hypothyroidism, Seizure, drugs or alcohol use

58
Q

Define mild persistent asthma

A

symptoms more than 2 days per week but not daily; PEF or FEV1 60-80% predicted; PFT variability = 20-30%

59
Q

Define moderate persistent asthma

A

symptoms daily but not continual; nighttime sx more than once a week; PEF or FEV1 60-80% predicted; PFT variability >30%

60
Q

Define severe persistent asthma

A

Continueous daily symptoms and frequent nighttime symptoms with activity limitations and frequent exacerbations; PEF or FEV1 <60% predicted; PFT variability >30%

61
Q

How do you interpret PFTs?

A

Measure pre-bronchodilator and postbronchodilater function tests such as spirometer and diffusing capacity to determine the response; result is % change

62
Q

What is FEV1 and what does it measure?

A

Forced expiratory volume in 1 second; reversibility is defined as 10% or greater increase in the FEV1 after two puffs of a short-acting beta-agonist

63
Q

What often precedes an asthma attack?

A

infections

64
Q

Tx for intermittent asthma

A

SABA PRN less than twice per week

65
Q

Tx for mild persistent asthma

A

Low dose ICS, SABA PRN, not to exceed three to four times per day

66
Q

Treatment for moderate persistent asthma

A

Daily low-dose ICS plus LABA; SABA PRN

67
Q

Tx for severe persistent asthma

A

Medium-dose ICS plus LABA and SABA PRN 3-4 times daily; consider short course of systemic corticosteroids

68
Q

Step-up from severe persistent asthma

A

High dose ICS plus LABA, SABA, short course systemic corticosteroids

69
Q

Management of asthma

A

-Remove triggers
-Step up to the next step if control is not achieved
-Step down if controlled for 3 months

70
Q

Patient education for asthma

A

-Basic facts
-How to use inhalers
-How to recognize early symptoms of attack
-Role of medications
-Avoidance measures for asthma triggers
-Importance of pneumococcal and annual influenza vaccines
-Stress proper use of medications and adherence to regiment

71
Q

Stages of severity for COPD

A

Mild: FEV >80% predicted
Moderate: FEV1 50-80%
Severe: FEV1 30-50%
Very severe: FEV1 <30%

72
Q

Tx for Very severe COPD

A

PDI4 inhibitor, roflumilast (Dalirespt) and azithromycine (Zithromax)

73
Q

Tx for mild COPD

A

short acting or long acting bronchodilator

74
Q

Tx for moderate COPD

A

a long-acting muscarinic antagonist (LAMA) or LAMA+LABA or LABA+ICS

75
Q

What is the first line therapy for COPD?

A

SABA (Albuterol, proventil Ventolin)

76
Q

What is the goal of therapy for COPD?

A

to prevent bronchospam with long-acting bronchodilators and to use a SABA as a rescue medication to alleviate acute episodes of bronchospasm

77
Q

What are LABA medications used for?

A

for maintenance therapy to prevent acute bronchospastic episodes (not first line)

78
Q

Examples of ICS

A

beclomethasone, budesonide (pulmicort), or fluticasone (Flovent)

79
Q

Examples of comination medications used to treat COPD

A

Advair: salmeterol + fluticasone; Symbicort (formoterol plus budesonide)

80
Q

When would a PDE4 inhibitor (roflumilast/daliresp) be indicated for COPD?

A

For patients with COPD and bronchitis who have exacerbations

81
Q

When are xanthines (theophylline) used for the treatment of COPD?

A

as a fourth-line drug if other drugs fail to prove effective; they have a narrow therapeutic index and interact with many drugs

82
Q

What could be caused by long term uncontrolled HTN?

A

Target organ damage: CVA, HF, Pulmonary edema, MI, Acute Renal failure

83
Q

When should pharmacologic treatment be initiated in a patient with HTN and DMII?

A

140/90 or higher

84
Q

Follow-up for HTN after starting therapy

A

One month: if target pressure still is not reached, increase dose or start a second medication

85
Q

A patient with CKD and HTN should receive which medications?

A

ACE inhibitor or ARB initially or as add-on therapy

MVU Adult 1 (4 decks)

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