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Clin Med > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Dyslipidemia

A

Increase total LDL

Increased triglycerides

Decreased HDL

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2
Q

What are triglycerides packaged into?

A

Chylomicrons

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3
Q

What organ plays the biggest role in triglyceride metabolism?

A

The liver

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4
Q

What is released from chylomicrons?

A

Fatty acids

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5
Q

Atherosclerosis pathophysiology

A

Damage to vascular endothelium, recruits platelets/monocytes, LDL accumulates

Macrophages ingest oxidized lipids making foam cells

Fatty streak develops

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6
Q

Metabolic syndrome

A 
High triglycerides
Insulin resistance
Abdominal obesity
Hypertension
Low HDL
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7
Q

Coronary artery disease equivalents

A

AAA
Diabetes
Peripheral vascular disease
Carotid artery disease

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8
Q

Clinical findings of coronary artery dz

A

Angina

MI

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9
Q

Cerebrovascular dz clinical findings

A

Stroke

Transient ischemic attack

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10
Q

Peripheral artery dz clinical findings

A

Ischemic extremities

Claudication

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11
Q

Mesenteric ischemia clinical findings

A

Pain out of proportion to exam
Death of intestine due to ischemia
Patient is sick

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12
Q

Eruptive xanthomas

A

Elevated chylomicrons or VLDL

Red-yellow plaques, lipid deposits, especially on butt

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13
Q

Tendinous xanthomas

A

Elevated LDL

Nodular yellow/skin-toned lesions

Lipid deposits

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14
Q

Arcus senilis

A

Opacity of peripheral iris

Can be normal (aging)

Lipid deposits in younger pts

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15
Q

Xanthelasma

A

Lipid deposits around eyelid

Can be hereditary (asian, Mediterranean)

Or hyperlipidemia

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16
Q

Lipemia retinalis

A

Orange-yellow retinal vessels

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17
Q

Pancreatitis

A

Caused by markedly elevated TGs, often >500

Alcohol abuse compounds risk

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18
Q

Who is screened for dyslipidemia?

A

Men >35

Women >45

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19
Q

Non fasting lipids

A

HDL and total cholesterol

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20
Q

Fasting lipids

A

HDL, total cholesterol, LDL, TGs

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21
Q

Fractionated lipids

A

More detailed estimate of risk

Smaller particles are more atherogenic

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22
Q

CRP

A

High sensitivity is suggestive of CVD risk, and very high CRP is plaque rupture

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23
Q

Statin groups

A

Clinical ASCVD

LDL >190

Diabetics

ASCVD risk of >7.5%

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24
Q

What is the reduction is risk with lifestyle modifications?

A

12-14%

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25
Q

DASH

A

Dietary approaches to stop hypertension

High produce, low fat, low sodium

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26
Q

What do statin toxicities cause?

A

Hepatotoxicity

Myopathy

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27
Q

Fibrates

A

TG >200

Also good for excess VLDL

Slight increase in HDL
Slight decrease in LDL

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28
Q

What is the most modifiable risk factor for heart attack and stroke?

A

Hypertension

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29
Q

Normal BP

A

<120 <80

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30
Q

Prehypertension

A

120-139 80-89

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31
Q

Stage 1 HTN

A

140-159 90-99

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32
Q

Stage 2 HTN

A

> 160 >100

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33
Q

Refractory HTN

A

Uncontrolled BP despite 3 antihypertensive medications

OR

BP that requires at least 4 antihypertensive medications to achieve control

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34
Q

Emergency HTN

A

Severe HTN plus acute end organ damage

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35
Q

urgent HTN

A

Severe HTN in asymptomatic patient

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36
Q

Moderate-severe hypertensive retinopathy

A

Severe HTN with retinal exudates, hemorrhages, or papilledema

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37
Q

Gestational HTN

A

HTN that develops after the 20th week of pregnancy and returns to normal postpartum

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38
Q

Preeclampsia

A

Development of HTN with proteinuria and edema after 20 weeks of pregnancy

Headache, visual disturbances, epigastric pain

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39
Q

Eclampsia

A

Additional presence of convulsions with preeclampsia that is not explained by neurological reasons

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40
Q

Primary factors to determine BP

A

Sympathetic nervous system
RAA system
Plasma volume (kidneys)

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41
Q

Peds secondary HTN

A

Primary renal disease

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42
Q

Young adults secondary HTN

A

Thyroid disease

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43
Q

Middle aged adults secondary HTN

A

Aldosteronism

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44
Q

Elderly secondary hypertension

A

atherosclerotic renal artery stenosis

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45
Q

Primary hyperaldosteronism triad

A

HTN

Unexplained or easily provoked hypokalemia or potassium wasting

Metabolic alkalosis

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46
Q

Cushing syndrome

A

Hypercortisolism

Usually iatrogenic, could be a tumor

Moon face, buffalo hump, ecchymosis

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47
Q

Pheochromocytoma

A

Catecholamine secreting tumor

Paroxysmal BP elevations
Triad: HA, palpitations, sweating

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48
Q

Necessary diagnostics in hypertensive patients

A 
CMP
Hgb and Hct
Lipids
Urinalysis
EKG
49
Q

What is the definitive test to diagnose renal artery stenosis?

A

Renal arteriography

50
Q

If you are greater than 60, according to JNC 8 guidelines, the what is the threshold for SBP?

A

150 mm Hg

51
Q

What is the recommended BP goal for patients with DM or CKD?

A

<140/90

52
Q

What is the recommended BP goal in all HTN patients greater than 60 yo?

A

<150/90

53
Q

Urgent BP management

A

Need to lower BP over hours to days to <160/100

54
Q

Emergency HTN management

A

Lower pressure by 10-20% in the first hour, 5-15% over the next 23 hours

55
Q

Follow up for HTN treatment

A

4-6 week intervals until goal achieved

56
Q

Absolute hypotension

A

SBP <90

57
Q

Relative Hypotension

A

Drop in SBP >40

58
Q

Postural/orthostatic hypotension

A

Drop in BP when going from supine to standing position with associated symptomatolgy

59
Q

Orthostatic response values

A

> 20 fall in SBP

>10 fall in DBP

60
Q

Symptoms of orthostatic hypotension

A

Generalized weakness, dizziness, lightheadedness, visual changes, syncope

Maybe even angina or stroke

61
Q

Blood pressure

A

Cardiac output x systemic vascular resistance

62
Q

PCWP

A

Pulmonary capillary wedge pressure

63
Q

Shock

A

Reduction in systemic tissue perfusion, decreased oxygen delivery

64
Q

Hypovolemic shock

A

Decreased preload induced by volume loss

Decreased CO
Increased SVR
Decreased PCWP

65
Q

Cardiogenic shock

A

Consequence of cardiac pump failure

Decreased CO
Increased SCR
increased PCWP

66
Q

Distributive shock

A

Most common, severely decreased SVR

Increase CO

67
Q

Obstructive shock

A

Extracardiac causes of cardiac pump failure

Pulmonary vascular or mechanical

68
Q

Cardinal findings of shock

A 
Hypotension
Oliguria
Cool, clammy skin
Abnormal mental status
Metabolic acidosis
69
Q

Management of shock

A

First, resuscitative efforts (ABCs)

Then IV fluids

70
Q

Primary varicosities

A

Inherent wall defect

71
Q

Secondary varicosities

A

Results from valve damage

Thrombophlebitis, trauma, DVT, etc.

72
Q

Is symptom severity related to number or size of varicosities?

A

No!!

73
Q

Varicose veins symptoms

A

Dull, aching heaviness, leg fatigue, pruritus, dark blue/twisted veins, maybe edema

Most common posterior/medial

74
Q

What is the gold standard diagnosis for varicose veins?

A

Duplex ultrasonography

75
Q

Superficial thrombophelbitis

A

Venous inflammation, thrombus develops in a superficial vein

76
Q

Superficial thrombophlebitis clinical findings

A

Usually self limiting

May have dull pain, maybe mild swelling, tenderness, redness

Fever if septic version from IV catheter

77
Q

Virchow’s triad

A

Venous stasis

Endothelial injury

Hypercoaguable state

78
Q

Deep venous thrombosis

A

Venous thromboembolism- DVT- PE

80% in deep veins of the calf

79
Q

DVT clinical findings

A

Edema
Calf pain on dorsiflexion (homan’s sign)
Low grade fever, tachycardia
Unilateral

80
Q

DVT diagnosis

A

Well’s criteria

Low protest probability- D dimer

Intermediate to high probability- ultrasound

81
Q

Chronic venous insufficiency

A

Result of sustained venous hypertension in the leg

Primary: valve failure
Secondary: post thrombotic syndrome from DVT

82
Q

Chronic venous insufficiency clinical

A

Varicose veins or telangiectasias
Ankle and calf dependent edema
Hyperpigmentation
Stasis dermatitis

83
Q

Superior vena cava obstruction clinical findings

A 
Dyspnea
Swelling of arms and face
Cough/hoarseness/dysphagia
Chest pain
Distended neck and chest veins
Head fullness/headaches
Syncope
84
Q

Classic SCV obstruction picture

A

Elderly male with increased risk for lung cancer

85
Q

Acute arterial occlusion

A

Surgical emergency

Golden period of 4-6 hours

Caused by embolis, thrombosis, trauma, or cardiac

86
Q

6 P’s of acute ischemic limb

A 
Pain
Pallor
Pulselessness
Perishing cold
Parasthesias
Paralysis
87
Q

Acute arterial occlusion clinical findings

A 
Absence of distal pulses
Pallor
Weakness/paralysis
Pain- sudden and severe
Cold
88
Q

Gold standard diagnosis for acute arterial occlusion

A

Angiography

89
Q

Peripheral vascular disease

A

Claudication, arterial insufficiency, etc.

Systemic atherosclerosis

Objectively defined as an ankle-brachial index < .9

90
Q

Leriche’s syndrome

A

Aortoiliac occlusive disease

91
Q

PVD clinical findings

A 
Intermitten claudication
Impotence
Rest pain
Smoker
dependent rubor
Poor nail growth
Absent pulses
92
Q

Aneurysm

A

Stretched and bulging section of the vessel wall (focal dilation >50% enlargement)

93
Q

AAA

A

> 90% are below renal arteries

> 3 cm diameter

94
Q

Classic triad of AAA rupture

A

Pain
Hypotension
Abdominal pulsatile mass

May have tachycardia and severe back or flank pain

95
Q

Flank ecchymosis

A

Grey turner’s sign

96
Q

Periumbilical ecchymosis

A

Cullen’s sign

97
Q

Thoracic aortic aneurysm

A

<10% of aortic aneurysms

Seen more with chest pain, cough or stridor, hoarseness, or dysphagia

98
Q

Type A thoracic aortic aneurysm

A

Ascending aorta, more concerning

99
Q

Tearing chest or mid back pain is characteristic of …

A

Thoracic aortic dissection

100
Q

What is a good test for thoracic aortic aneurysm ?

A

Transesophageal echo

101
Q

Arteritis of Takayuki

A

Pulselessness disease
Asian women under age of 40
Large vessel vasculitis!
Usually aorta and main branches

102
Q

Arteritis of takayasu symptoms

A

Fever, myalgia, arthralgia

Pain over involved artery

103
Q

Physical exam findings arteritis of takayasu

A

Hypertension
Vascular bruins
Diminished peripheral pulses

104
Q

Raynaud’s

A

Vasospastic disorder

Episodic ischemia of the digits of the hands and sometimes feet

Primary phenomenon- disease

Secondary (underlying connective tissue disorder)- syndrome

105
Q

Raynauds symptoms

A

Pallor, cyanosis, then rubor

Discomfort, throbbing pain with rubor

106
Q

Thromboangiitis obliterans aka buerger disease

A

Nonatherosclerotic vascular disease

Inflammatory occlusive disease of arteries of limbs

Usually male smokers < age of 50

Inflammatory process

107
Q

Thromboangiitis obliterans symptoms

A

Resting pain, ischemic ulcerations, gangrene of digits, decreased distal pulses, buerger color

108
Q

Thromboangiitis obliterans test

A

Angiogram showing collateralization and blockage

109
Q

Thromboangiitis obliterans traetment

A

Smoking cessation

110
Q

Giant cell arteritis/temporal arteritis

A

Chronic vasculitis of large and medium vessels

111
Q

Giant cell arteritis presentation

A 
Temporal headache
Scalp tenderness
Thickened temporal arteries
Jaw claudication
Acute visual loss
112
Q

Diagnosis for giant cell arteritis

A

Temporal artery biopsy

113
Q

Kawasaki disease

A

Acute inflammatory process involving multiple organs

Vasculitis in medium sized arteries

114
Q

Kawasaki disease. Clinically

A

Febrile child with rash and multiple visits

Coronary artery aneurysms

Abrupt fever onset, rash, LAD

115
Q

Thoracic outlet syndrome

A

Condition of compression on nerves or vessels in the region around the neck and clavicle (thoracic outlet)

116
Q

TOS risk factors

A

Trauma
Presence of extra rib
Poor posture
Increased muscle bulk

117
Q

TOS clinical findings

A

Neurogenic- most common, pain and paresthesias in upper back, inner arm

Venous- arm claudication, cyanosis, swelling

Arterial- not common. Thrombosis, embolism, aneurysm

118
Q

Roos test

A

Tests for TOS

Patient slowly opens and closes hands for three minutes, positive if arm becomes heavy of paresthesias

Clin Med (7 decks)

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