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IPAP > FamMed PPP w/ Rosh > Flashcards

FamMed PPP w/ Rosh Flashcards

1
Q

What are the two etiologies for hyperlipidemia

What two PE findings are suggestive of this Dx

When are screening initiated for wo/men

A

HyperCholesterol/Triglyceridemia

Xanthomas: accumulation on Achilles
Xanthelasmas: eyelid plaques

High risk (smoking, HTN, FamHx)- M: 20-25, F: 30-35
Low risk- M: 35, F: 45
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2
Q

National Cholesterol Education Program recommends screening all adults at ? age regardless of RFs

What are the 5 populations that need to have hyperlipidemia Tx

? lab order is needed if Pt develops body aches after starting statin therapy

A

20y/o

Diabetics between 40-75y/o
Atherosclerotic dz/ASCVD risk ≥7.5%
≥21y/o w/ LDL ≥190
<19y/o w/ familial hypercholesterolemia

Creatinine kinase

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3
Q

Best med for lowering elevated LDL

Best meds for lowering triglycerides

Best meds to increase HDL

DM2 get ? two meds

A

Statins, Bile acid sequestrants

Fibrates, Niacin

Niacin, Fibrates

Statins, Fibrates

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4
Q

MOA of statins

Two possible adverse outcomes

Pt education for taking these meds

A

Inhibit HMG-CoA reductase, inc LDL clearance

Rhabdo, Myositis

Take at night (Atorva/Rosuva- anytime of day)

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5
Q

MOA of Niacin

Adverse effect of use

C/i to use

A

Inc HDL levels by decreasing clearance

Inc prostaglandins= flushing/warm skin; Pre-Tx w/ NSAID/ASA 30min prior

PUD, Liver Dz

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6
Q

MOA of Fibrates

Adverse effects of use

C/i to use

A

Dec triglyceride synthesis w/ inc lipoprotein catabolism

Increased gallstones

Hepatobiliary Dz, Breastfeeding

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7
Q

What is the only Fibrate approved for co-use w/ a Statin

Genfibrozil can’t be used w/ ? meglitinide

How is the pruritus associated w/ biliary obstruction Tx

A

Fenofibric acid

Repaglinide

Cholestyramine

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8
Q

MOA of Bile Acid Sequestrants

Adverse effects of use

C/i to use

A

Binds to bile acids preventing absorption and dec LDL

Inc triglycerides
Impairs medication/fat soluble vitamin absorption

Sev hypertriglycerides, Complete biliary obstruction

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9
Q

MOA of Ezetimibe

What are the indications for use

What are the adverse effects of use

A

Inhibits intestinal cholesterol absorption

Combo use w/ statin to dec LDLs

Inc LFTs, HA/D

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10
Q

High intensity statins

Mod intensity statins

Low intensity statins

A

Atrova 40-80mg
Rosuva 20-40mg

Atorva 10
Rosuva 10
Simva 20-40
Prava 40
Lova 40
Fluva 40
Fluva 80
Pita 2-4mg
Simva 10
Prava 10-20
Lova 20
Fluva 20-40
Pita 1mg
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11
Q

Ranges for Normal, Elevated, Stage 1 and Stage 2 HTN

MCC of Essential HTN

MCC of Secondary HTN

A

N: <120/80 and <80
E: 120-129 and <80
1: 130-39 or 80-89
2: ≥140/≥90

Idiopathic

Renovascular

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12
Q

? are the two MCC of end stage renal dz in USA

What are the ACC/AHA HTN targets

What are the JNC-8 HTN targets

A

DM then HTN

<130/80

<60y/o/CKDz/DM: <140/90
≥60y/o: <150/90

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13
Q

? is the only ARB that doesn’t cause hyperuricemia

MOA of Thiazide diuretics (including Metolazone)

S/e of use

A

Losartan

Dec reabsorption and Ca excretion at distal tubule

HypoNa/K, HyperUr/Ca/Glucose

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14
Q

MOA of Loop Diuretics

Adverse effects of use

C/i in ? population

A

Inhibit water transport across LoH

HypoK/Na/Ca

Sulfa allergy

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15
Q

MOA of K-sparing diuretics

S/e of use

C/i to use

A

Inhibit Na/water absorption, most useful combo use w/ Loops

HyperK, metabolic acidosis

Renal failure, HypoNa

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16
Q

MOA of ACEI

Adverse effects of use

C/i to use

A

Dec pre/after load, inc vasodilation and insulin action

1st dose HOTN, HyperK Cough Angioedema

Pregnancy

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17
Q

MOA of ARBS

Adverse effect of use

C/i to use

A

Binds/blocks angiotensin two receptors w/out increasing bradykinin levels

HyperK

Pregnancy

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18
Q

MOA of Non-Dihydro CCBs

MOA of Dihydro CCBs

S/e of use

C/i to use

A

Vasodilators w/out cardiac effect

Affect contractility/conduction along w/ vasodilation

HA Edema Consitpaion- Verapamil

CHF, 2/3 blocks

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19
Q

MOA of BB

Adverse effects of use

Ci to use

A

Catecholamine inhibitor, blocks adrenergic renin release

Impotence, HypoGlycemia

HOTN, HR <50, Asthma/COPD

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20
Q

MOA of A-blockers

Beneficial use for ? population

Adverse effects to use

A

Blockade leads to arterial dilation

HTN w/ BPH

1st dose syncope, HA, weakness

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21
Q

When do USPSTF screening begin and when are f/u needed

Criteria for HTN Urgency

MC c/c Sx

A

18y/o: q12mon,
q6mon if SBP 120-129

SBP >180 or DBP >120 w/out end organ damage

HA

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22
Q

How are HTN Urgency Tx

What is the BP goal for Tx

A 
PO Meds:
Clonidine: A2 agonist
Captopirl
Furosemide
Labetalol
Nicardipine

≤160/100

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23
Q

Define HTN Emergency

How quickly is BP lowered

What are the three exceptions to lowering BP

A

SBP >180 or DBP >120 w/ end organ damage

MAP dec 10-20% first hour
5-15% over 23hrs

Acute phase ischemic stroke
Aortic dissection
intracerebral HTN

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24
Q

What meds are used during HTn Emergencies

What causes angina

Sxs begin to occur when ?% occlusion is present

A

Nicard/Clevidi-pine
Labetalol
Fenoldopam
Na Nitroprusside

Dec perfusion: inc demand along w/ dec supply

≥70%

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25
Q

Time frame for angina pectoris

What are anginal equivalents

Who is more likely to develop an equivalent

A

<30min, resolves <5min w/ rest or Nitro

Dyspnea, Epigastric/Shoulder pain

Elderly Diabetic Obese Women

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26
Q

What is the initial step for Dx Angina Pectoris

What is the most important non-invasive test

What is the definitive Dx method

A

EKG w/ ST depression

Stress test w Bruce protocol

Angiography

27
Q

How is Angina Pectoris managed outpatient

What are the two revascularization techniques and what determines the method

A

ASA BB Nitro Statin

PCI: 1 or 2 vessel Dz in non-DM w/out LAD involvement and normal EF

CABG: L-main or 3 vessel Dz, or two vessel Dz in diabetics, or Pts w/ EF <40%

28
Q

What are the four NYHA classifications of angina

? is the most useful non-invasive test in the Dx of CADz

What are the indications to order this test

A

1: ASx, no limitations
2: Sx w/ mod activity
3: Sx w/ mild activity
4: Sx at rest

Stress test

Baseline EKG is normal

29
Q

What two meds are used for a chemical stress test for Pts unable to exercise

Pts need to d/c ? two meds prior to test

What two meds are used for stress Echos

A

Adenosine: dec AV conduction
Dipyridamole: dec platelet aggregation, coronary artery dilation

Theophylline: adenosine receptor antagonist
Caffeine

Dopamine or Dobutamine (c/i w/ AS, MI <3 days or HTN)

30
Q

What can trigger Rest Angina

What medication may be used during angiography to aid w/ Dx

How are these Pts managed and what is avoided

A

Prinzmetal: cocaine, pseudophedrine

Ergonovine

CCBs, then Nitro;
No BBs

31
Q

Check ? leads for P-wave morphology

How is a sinus rhythm determined

Normal PR interval

A

2, V1

Upright 1, 2, aVF;
Neg in aVR

.12-.2 (3-5 boxes)

32
Q

How is L atria enlargement assessed

How is R atria enlargement assessed

Normal QRS length is ? but if shortened ? step is skipped

A

M-shaped in lead 2
Biphasic in V1 w/ larger terminal component

Tall in lead two ≥3mm
Biphasic in V1 w/ larger initial component

33
Q

RVH criteria

LVH Criterias

A

V1 R>S or R >7mm

Sokolow-Lyon:
V1 S + V5 R >35 (>30 women)
Cornell:
aVL R + V3 S >28mm (>20mm women)

34
Q

Heart moves ? infarct and ? hypertrophy

Define Sinus Arrhythmia

If Sx, how are these Pts Tx

A

Away from infarct, Towards hypertrophy

Beat to beat variation: inc w/ inspiration, dec w/ expiration

Brady w/ Atropine first, then:
Trans-pace, Epi, Dopamine

35
Q

Criteria for Sinus Tach

What med is used for persistent sinus tach during ACS

Criteria for Sinus Brady and how are Pts w/ Sxs Tx

A

> 100bpm w/ P-waves

Metoprolol

<60bpm w/ P-waves;
Atropine then Epi/Trans-pacing

36
Q

MCC of SSS

How does this condition present and how is it Dx

If unstable, how are Pts Tx

How are Pts Tx long term

A

Sinus node fibrosis

Episodic brady/tachy;
EKG or Holter

Atropine then,
Trans-pace, Epi, Dopamine

Pacemaker

37
Q

How does A-flutter appear on EKG

How are stable Pts managed

How are unstable Pts managed

A

Identical saw-tooth waves at 250-350 bpms

Vagal, Rate: BB/CCBs

Sync’d conversion

38
Q

Definitive Tx for A-flutter

? class anti-arrhythmics can be used

What are the four types of Afib

A

Ablation

1A, 1C or 3

Paroxysmal: <7days
Persistent: >7days
Permanent: >12mon, refractory to conversion or no attempts
Lone: no heart Dz

39
Q

? syndrome can occur during Afib

How are stable Pts Tx

How are unstable Pts Tx

A

Ashman: aberrant conduction beats w/ wide QRS after short R-R cycles

Rate: BB or Non-Di CCBs, Digoxin if BB/CCB c/i

Synch’d conversion

40
Q

How are Afib Pts definitively Tx

Anticoagulate ? long prior and after conversion

What are the two types of PSVT

A

Ablation, MAZE surgery

3wks prior, 4wks after

ANRT: one normal, one accessory path within AV node; MC type
AVRT: one normal, one accessory outside AV node (WPW, LGL syndrome)

41
Q

What are the two different EKG presentations of PSVTs

How are the two Tx

A

Orthodromic: narrow complex tachycardia
Antidromic: regular, wide complex tachycardia

Stable, narrow: vagal, Adenosine, BB CCB Digoxin

Stable, Wide:
Amiodarone, Procainamide

Unstable: Synch’d conversion

42
Q

What is the difference between WAP and MAT

MAT frequently co-exists w/ ? other d/o

How is MAT Tx in this population

A

WAP: <100bpm
MAP: >100bpm

COPD

Verapamil;
BB if LV function preserved

43
Q

WPW is a AVRT variant w/ accessory pathway located ?

What are the 3 EKG findings

How is this wide complex Tx

A

Bundle of Kent

Short PR
Wide QRS
D-wave

Procainamide/Amiodarone
Synch’d conversion
Ablation

44
Q

What EKG finding suggest AV junctional rhythms

What EKG finding suggest PVCs

MCC of Vtach

A

Inverted P-wave 1, 2, aVF
Post P-wave aVR

T-wave opposite direction of QRS w/ compensatory pause

Ischemic heart dz

45
Q

Along w/ low E+, what medication toxicity can cause V-tach

How is stable, sustained Vtach Tx

MCC of Vfib

A

Digoxin

Amiodarone Lidocaine Procainamide

ischemic heart Dz

46
Q

Class 1 Anti-arrythmic drugs

A

Na channel blockers: dec Na conduction and AV node automaticity leading to membrane stabilization

1A: Procainamide Quinidine Disopyramide;
Prolong repolarization and action potential

1b: Lidocaine, Tocainide;
Dec conduction velocity and shortens repolarization;
C/i: narrow SVT

1c: Flecainide Propafenone Ecainide;
Inc QRS prolongation and dec conduction velocity w/ affecting action potential

47
Q

Class 2 Anti-arrhythmic drugs

A

Cardio sel: AME-olol
Non-Sel B1, B2: PS-olol
Non-sel A, B1,2: LC-olol

Dec SA/AV node conduction

Non-sels can cause bronchospasms in asthma/COPD

Toxicity Tx w/ glucagon

48
Q

Class 3 anti-arrhythmics

A

Sotalol Amiodarone Ibutilide Dofetilide

Prolongs action potential

Amiodarone: characteristics of Class 1-4 meds w/ s/e of pulm fibrosis and thyroid d/o

49
Q

Class 4 anti-arrhythmics

Class 5 anti-arrhythmics

Class 1 and 3 antiarrhythmics are used for while Class 2 and 4 are used for

A

Verapamil, Diltiazem
Slows SA/AV conduction to inc PR interval and refractory period

Digoxin- cardiac glycoside, dec ATP-ase

1/3: rhythm, 2/4: rate

50
Q

MCC of syncope

Harsh/Rumbling murmur indicates ?

Blowing murmur indicates ?

A

Vasovagal: prodrome of dizzy, light headed, tunnel vision

Stenosis

Regurg

51
Q

Increasing venous return to the heart increases the intensity of ALL murmurs except ? two

What two murmurs radiate

What positions accentuate aortic and mitral murmurs

A

HOCM, MVP

MR: axilla AS: carotid

Aortic: sit, lean forward
Mitral: lay on side

52
Q

What does hand grip do for heart murmurs

This murmur increases ? murmurs

What effect does Amyl nitrate have on murmurs

A

Inc after load, dec LV emptying

Outflow: AS, HOCM, MVP

Dec afterload, inc LV emptying; inc AR/MR murmurs; this is why after load reducers (ACEI) are used

53
Q

? is the MC valvular Dz

What are the two MCC by age

What would be seen on PE indicating this murmur

A

AS- preload depended

> 70: age degeneration <70: bicuspid valve

Pulsus parvus et tardus: weak, delayed carotid pulse w/ narrow pulse pressure

54
Q

How are Pts w/ AS managed until surgical correction

What additional murmur can be heard w/ AR

What two additional PE findings aid w/ Dx AR

A

Avoid exertion and neg inotropes: BBs, CCBs

Austin Flint: Mid-late diastolic rumble at apex d/t regurg from LA into LV

Bounding pulses, Wide pulse pressure

55
Q

What are the 8 types of wide pulse pressures seen w/ AR

A

Water Hammer: rapid up/down of radial pulse

Corrigan: water hammer in carotid artery

Hill’s: SBP popliteal > brachial, most sensitive

Duroziez: femoral artery pressure= bruit

Traubes: double sound at femoral w/ compression

De Musset: head bob w/ pulse

Muller’s: pulsations seen in uvula

Quincke’s: finger nail pulsations

56
Q

How is AR Dx

How are Pts managed until surgery

MCC of MS

A

Echo w/ cath

Dec afterload: ACEI/ARB

Rheumatic heart dz

57
Q

What facial changes are seen on PE in Pts w/ MS

What ENT syndrome can this cause

What will be heard on exam

A

Mitral facies: flushed cheeks w/ facial pallor d/t hypoxia

Ortners- recurrent nerve plasy d/t LA dilation

Loud S1 (MV closure) w/ opening snap

58
Q

MCC of MVP

What does this sound like on PE

What makes this click occur sooner/later

A

USA: MVP
Developing: rheumatic heart dz

Widely split S2 w/ displaced PMI

Soon: dec preload, Late: inc preload

59
Q

What med is used during MVP w/ Sxs

Do Pts need endocarditis prophylaxis

What causes PS

A

BBs

No

Congenital Rubella Syndrome

60
Q

What additional murmur is heard w/ PR

Define Carvallos Sign

? lab result makes a Dx of CHF more likely

A

Graham Steel: early diastolic decrescendo at LUSB, accentuated w/ inc venous return/dec w/ dec return

Inc murmur w/ inspiration w/ pulsatile liver= TR

BNP >100; LMOP:
Fuorsemide Morphine Nitrates O2 Position- sit and dangle legs over bed to dec preload/venous return

61
Q

What are the two MCC of pericarditis

How is pericarditis Dx

How is this Tx based on etiology

A

Infection: Coxsackie, Echovirus
Dresslers

EKG: diffuse, precordial ST elevation/PR depression, opposite in aVR

NSAID/ASA; Dressler: ASA/Colchicine (avoid NSAID)

62
Q

? size of abdominal aorta is considered an aneurysm

What is the MC location

How do un/ruptured aneurysms present

A

> 3cm

Infrarenal

Un: Flank pain, abdominal bruit, pulsatile mass
Rup: Flank pain w/ echymosis, HOTN, mass

63
Q

How are AAA Dx

When are screenings performed

What sizes are indicative of repair/referral

A

Stable: CT w/ contrast Unstable: bedside US

All men 65-75y/o w/ smoking Hx

> 5.4 or expands >0.5cm/6mon
4.5cm: refer
4-4.5cm: US q6mon
3-4cm: US q12mon

IPAP (212 decks)

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