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IPAP JUNIOR SEM. > FINAL CARDS > Flashcards

FINAL CARDS Flashcards

1
Q

A pt presents with acute intracranial hemmorage, what is the approach to lowering the BP

A

If the BP is above 220, start lowering tx with IV infusion

If below 220 the lower BP to less than 140 (can cause harm)

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2
Q

A pt presents with acute (less than 72 hrs) with ischemic stroke
What is the BP lowering Tx approach

A

Does the pt qualify for thrombolytics?
Yes? Then lower BP to less than 185/100-110 in the first hour and before starting thrombolytics then maintain BP less than 180/105 for the first 24 hours.

No?
Is the SBP above 220?
No? Then restart pts BP medication
yes? Lower BP by 15% during the 1st 24hrs

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3
Q

What are the acyanotic congenital heart dz

A

VSD/ASD (without eisnmenger)
PFO
PDA
Coart

All these are L to R shunts (high pressure to low pressure)

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4
Q

What are the Cyanotic Congenital Heart Dz

A

Transpo of the Great vessels (incompatible with life)
Truncus Arteriosis ( basically an overriding aorta)
Hypoplastic L heart (pt never develops a left ventricle)
Tetralogy of fallout ( VSD +PS+RVH+Overriding Aorta)
Pentalogy of Fallot (tetra +ASD)
Total Anomolous Pulm Venous return

All are naturally R to L shunts

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5
Q

What are the common risk factors for Congeintal Heart Dz

A 
Genetics 
Rubella exposure 
Alcohol while pregnant 
Multi fetal births 
DM 
HTN 
Connective Tissue Disorders 
Mood D/o 
Epilepsy 
Thyroid D/o
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6
Q

You are evaluating an infant and you heard a harsh systolic murmur over the left scapula or left shoulder

Think >?./

A

Coart of the aorta

These pts will have life long HTN problems

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7
Q

You are listening to lung sounds and you hear an ejection/ Systolic murmur at the LUSB that increases with inspiration, with a Wide Split S2

Think?

A

PS

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8
Q

What is the MC obstructive Heart Lesion in Children/ Infants

A

AS, Harsh sys ejection murmur that radiates to the carotids. Increases with expiration, and increases with hand grip

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9
Q

Where is the common site for Coart to occur

A

Adjacent to the Ductus Arteriosis

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10
Q

What is the Tx appraoch to Coart (congenital)

A

Surgical repair, ballon angio

Life long HTN tx

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11
Q

You hear a fixed wide S2 split, tat first is acyanotic and later develops cyanosis, and clubbing

Think what MC congenital HDz later found in adults

A

ASD

ASD is a L to R shunt that eventually develops RVH and eisnmerger syndrome leading to cyanosis

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12
Q

At what age does the PFO close

A

At 6 months

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13
Q

A new born presents with HF s/s , poor growths, and has an increased risk of infections,
You hear a pansystolic murmur at the LSB

Think

A

VSD

These pts present acyanotic and then later can develop eisnmerger syndrome and become cyanotic

Increased R Vent pressure lead to what looks like CHF with Edema in the periphery
O se the shunt reverse these pts has a large apical pulse and pulm congestion
With labored RR, grunting, rib contractions

CXR will show Cardiomegaly and prom pulm arteries
EKG LAE, LVH leading to RVH

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14
Q

What is the Treatment approach to VSD in infants

A

Is its small and AS/s then f/u at 8-10 weeks
Then again at 12 months
Most will spont. Recovery

If its large
Then Diet intervention 2 prevent wt gain
Dietetics, the ACEI, and SRGRY if PAP is greater than 50mmHg

pts with need ABX prophylaxis for dental and RR procedures for any produced with in 6 months of SRGICAL repair

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15
Q

You hear a continous machine like murmur In a new born, with Lower extremity cyanosis yet uppers are not

What natural pathway of circulation has not closed

A

PDA

Which normally closes at 1 wk

Leads to LHF to RHF to eisnmerger syndrome leading to LE cyanosis and UE acyanotic

Pt will also have a wide pulse pressure

Tx with SRGY ligation

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16
Q

What is the MC cyanotic Heart lesion

A

Tetralogy

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17
Q

What are the 4 findings in tetralogy

A
  1. VSD
  2. RVOO (PS)
  3. RVH
  4. Overriding aorta
  5. ASD? =pentalogy

PS leads to RVH leading to Eisnmerger through the VSD, and Cyanosis

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18
Q

Describe the murmur of PS

A

Sys ejection murmur at the LUSB
With a loud s2 sound
+/- systolic thrill
Prominent RV pulse

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19
Q

A mother says her baby gets cyanotic but then does a squat and is able to keep playing

What is this ?>

A

Text spell seen in tetralogy

Then squat increases SVR which increase LV pressure

Causing reversal of eisnmergers and reduces cyanosis

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20
Q

What are the later findings of tetralogy in infants

A 
Poor feeding 
Tets spells 
Increase HR and BP 
Cyanosis 
Syncope 
Poor growth 
And late puberty
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21
Q

You see a “boot shaped” heart on CXR
With a right aortic arch

Think

A

Tetralogy

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22
Q

How do you Dx tetralogy

A

Gestalt and ECHO!

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23
Q

What is the immediate Tx approach to a baby with tetralogy

A

Place the knees againt the chest
Start O2
And give fluid bolus

May need to treat HF with morphine, propranolol/ esmolol and then SRGY
(With out SRGY 50% DIE)

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24
Q

What are the major bad outcomes of Tetrology

A

Pulm regurgition, RV enlargement, RV dysfunction
Aortic root dilation
High risk of developing infectious endocarditis

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25
Q

What is Blue Baby syndrome

A

Transposition of the Great Arteries

Not comparable with life unless there is a Shunt ( PDA or PFO)

Must give PGE1 to maintain patency of PDA or PFO (NSAIDS WILL CLOSE IT)
Then perform Baloon arterial septostomy (BAS)

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26
Q

You see “egg on a string” pattern on CXR of an infant

What is this?

A

Transposition of the Great Vessels

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27
Q

describe eisnmenger syndrome

A

R to L shunt initially

Leads to PULM HTN
Increased RV pressure
Leads to R to L shunt
And Cyanosis

Findings: 
Hypoxia 
Polycythemia 
Increased Thrombus (ESR) 
Stroke/ ACS
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28
Q

What is the Tx approach toe eisnmenger syndrome

A

Excercise restrictions and transplant

Mean age of death 37y/0

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29
Q

What are the H/Ts

A 
Hypoxia 
Hypothermia 
HyperK
HypoK 
Hypogl
Hypovolemic 
High H+ 
Tamp 
Tension Pneumo 
Toxins 
Thrombus Pulm 
Thrombu Cardio
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30
Q

A pt is in cardiac arrest with a ph less than 7.4

What is the most immediate tx to correct acid base

A

Ventilate!

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31
Q

What is the step by step process to treat hyper K

A

Give calcium gluconate to stabilize the membrane then give insulin and D50W( if glucose is below 220)

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32
Q

What is a severe K level

A

Below 3.5 or above 5.5 (7)

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33
Q

What is Becks triad

A

Muffled Heart tones
JVD
HOTN

Signs of Tamp

Need to centesis

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34
Q

What is the reveresal agent for APAP

A

N-acetylcytine

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35
Q

What is the reversal method for asprin

A

Alkaline the blood/ urine

Supportive care

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36
Q

What is the reversal method for TCAs

A

Alky the urine and blood

Supportive care

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37
Q

What is the reveresal agent for Benzos

A

Flumazinil

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38
Q

What is the reversal agent for Opiates

A

Naloxone

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39
Q

What is the reversal agent for Methanol/ Ethenol

A

Fomepizol/ dialysis

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40
Q

What is the reversal method for BB

A

Glucagon, + pacing + inotropes

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41
Q

What is the reversal method to CCB

A

Glucagon, Pacing, and Inotropes

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42
Q

What is the reversal agent for digitalis

A

DIgibind and close monitoring

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43
Q

A pt presents with unilateral rise and fall of the chest
With absent lung sounds unilaterally
JVD and Tracy deviation of CXR

What is this?

A

Tension Pneumo

ND the chest and then move up to a chest tube in necessary

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44
Q

A pt presents with new SOB and chest pain , narrow QRS and is TachyHR

Recently went on a long trip and is a cancer survivor

What is the approach to this reversible H/T

A

This is a PE

Wells criteria greater than 4, goes straight to CTPA

If CKD, pregnant or C/I then V/Q scan or US

(Remember Low risk PE, wells less than 4 get a D-dimer which if less than 400 excludes PE)

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45
Q

If you find a STEMI what do you do

A

SEND TO PCI SEND TO PCI SEND TO PCI with in 90 minutes or 120

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46
Q

What are the 4 types of syncope

A

Vasovagal
Cardiac cause
Ortho HOTN
Cardio pulm structure (Exertional/ Non)

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47
Q

A woman was at a baseball game and she stood up to cheer, she felt a warm sensation and passed out

The EMS said that her HR and BP are both low

What type of syncope is this

A

Vasovagal ( could have been ortho from the quick positional change, but look at the HR and BP they are both low, in Ortho HOTN the BP will go down but the HR will go up)

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48
Q

Describe carotid sinus induced syncope

A

Often in older men, shaving, or tight collars

Baro receptor stimulation lead se to increase pressure on CN IX and X leading to increase in parasympathetic tone and syncope
(Hr and BP will drop)

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49
Q

What are the key findings of BP in ortho HOTN

A

SBP drops by 20 or more

DBP drops by 10 or more over 5 min

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50
Q

What are the common meds that cause ortho HOTN

A

Alpha blockers or A2 agonist

BB blockers, CCB

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51
Q

How does Addison’s disease cause ortho HOTN

A

Primary adrenal insufficiency leads to decrease aldosterone production

Which leads to low NA retention and there for low water retention

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52
Q

What is the most common cause of syncope from cardiac cause

A

bradycardia (Sick Sinus syndrome, AVB or sinus Brady)

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53
Q

An elderly man passed out while watching Tv at home

What kind of syncope should be suspected

A

Cardiac nature

Af RVR? WPW, SVT? VTAc? Prolonged QTC?
Torsaded D Pointes

Or a pacer failure

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54
Q

A young athlete presents with syncope think

A

HOCM

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55
Q

Describe the murmur of AS

A

Systolic crescendo decrescendo murmur @ RUSB that rads to the carotids

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56
Q

Describe the murmur of MS

A

Diastolic murmur that radiates to the apex

Can also have LAE, or Pulm Edma

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57
Q

Describe PS

A

Systolic murmur heard at the LUSB with a split S2 and increases of inspiration

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58
Q

Describe TS

A

Diastolic murmur that radiates to the right best heard at the LLSB

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59
Q

What are the holosystolioc murmurs

A

TR, MR, And VSD

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60
Q

What are the non exertional causes of cardio plum syncope

A

NYHA C IV HF
Carbon monoxide
COPD exacerbation

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61
Q

What is the admission criteria for pts with syncope

A 
MI! 
AAA
Decomp CHF 
Valvular HDz 
Pulm HTN 
AVB (II-III) 
WPW 
Long QTC (eval/observe)

Or ANY SYNCOPE THAT OCCURED WHILE SITTING DOWN/ DRIVING/ Excercising

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62
Q

What is the Lab w/u for syncope

A

W/u to rule out anemia
HF (BNP)
Ischemia
Pregnancy

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63
Q

A pt just Presents with syncope what should you do

A

Get and EKG

R/o WPW, BBB, QTci, AVB

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64
Q

When would you put a syncope pt on a holler monitor, loop recorder, or event monitor

A

Holter if S/s are daily
Event if S/s are weekly
And Loop recorder if S/s are monthly

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65
Q

When should you use ECHO in a syncope pt

A

To r/o RVOO/ LVOO

And should be done prior to any stress testing

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66
Q

Before you stress test a syncope pt what must you do 1st

A

ECHO! To r/o RV/LVOO

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67
Q

If you think the pt had a SZR what should you do

A

Order CT or EEG

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68
Q

If you believe the pts syncope is due to HOTN what test Can be ordered

A

Tilts test

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69
Q

You hear a diastolic blowing murmur at the LUSB

What is this murmur

A

AR

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70
Q

A young woman presents with abd pain, plus syncope

Think

A

Ectopic pregnancy

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71
Q

An old male smoker presents with flank pain plus syncope think

A

AA dissection

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72
Q

A pt presents with severe sudden HA and syncope think

A

SAH

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73
Q

A woman present with syncope preceded by a prodrome of warmth/tingling N/V and sweaty
Think

A

Vasovagal syncope

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74
Q

A cancer pt presents with SOB and syncope think !

A

PE PE PE

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75
Q

What does CHESS mean for high risk w/u syncope pts

A 
CHF 
Hematocrit <30 
ECG ABNML 
SOB 
SBP<90

Pts with any of the above should be admitted and eval/tx

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76
Q

What is the ACLS clinical approach

A
  1. Scene safety
  2. Unresponsive? Active emergency+AED
  3. Breathing or not Breathing?
    Yes? Monitor
    No? 4. Pulses?
    Yes =rescue breathing
    No? 5? Start CPR
    6? Shockable Rhythm?
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77
Q

You respond to a cardiac code and there is a shockable rtrhym
CPR is already started
What are the next steps

A 
Rhythm is shockable (vTac/ PVfib) 
CPR already started 
(Shock) 
CPR x2 min 
(SHOCK+Epi 1mg +Advanced Airway) 
CPR 
(Shock +Amio 300/150 plus H/Ts?)
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78
Q

Youre responded to a Cardiac Code and the pt converts from a shockable rhythm to asystole

What is the next steps

A

Unshockbale Rhythms include asystole and PEA

CPR
EPI 
CRP 
EPI 
CPR 
EPI

Until Rosc or death or conversion to Shockable

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79
Q

You just finished doing CPR and your pt is in ROSC

What are the next steps

A
  1. Ensure proper Aiway ( Intubate as needed)
  2. Maintain SPO2 above 94%
  3. Maintain PaCO2 within 35-45 (proper ventilation)
  4. If SBP is below 90 initiate fluids Or if MAP is below 65
    (Use inotropes and pressers as appropriate)
  5. Obtain 12 lead to eval for STEMI
    (PCI within 90 min )
    6.Maintain gl 70-110

Evaluate need for admission

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80
Q

You pt is in ROSC and can follow commands

What is the next step

A

Admit to ICU

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81
Q

Youre at the END of ROSC and your pt cannot follow commands what is the next step

A

Start TTM at 32-26*C

Obtain CT and EEG eval for stroke

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82
Q

What are the criteria for stable vs unstable Dx

A

HOTN
AMS
S/s Shock
CP or HF

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83
Q

What is the Brady Algorithm

A

Is HR below 50 and pt is S/s

  1. Stable or Unstable?
    Stable= monitor and observe e
    Unstable= Atropine 0.5 mg Q3-5min max dose 3mg
  2. Transcutaneous Pacing
    Or Rx pacing with Dopamine or EPI
84
Q

What is the definitive Tx for symptomatic Brady HR

A

ICD (pacer)

85
Q

What is ICD (pacer) criteria

A 
Ej fx less than 35% 
Greater than 40 days s/p MI 
Greater than 1 year life expectancy 
NYHA class 4 
Sustained VTACH 
Or Sustained VTACH with an EF <40%
86
Q

A pt has unsustained VTACH but has an EJFx less than 40%

What is the Tx

A

ICD

87
Q

What is the criteria for CRT

A 
EF Fx lesss than 35% 
New LBBB with wide QRS 
2* type I AVB is S/s 
All 2*type II 
All 3* AVB
88
Q

What is the Tachy HR ACLS algorithm

A
  1. Asses pt
  2. Maintain O2 above 94 percent
  3. Monitor, EKG, IV
  4. Stable vs Unstable

Stable: Vagal
Look at H/Ts
If regular; Adenosine 6/12/12
Is irregular ask is there any chance of WPW
If no: CCB or BB (verapamil, Carvedilol)
If yes: procanimide

Unstable: (HOTN, CHF, SHOCK, CP, AMS)
-Cardiovert without delay
If narrow and regular: consider adenosine
(Then can consider dyrhtmics Amio, procanimde, sotalol)

  1. Narrow or Wide (Stable)
    Narrow: BB or CCB if no evidence of WPW

Wide: and regular consider Adenosine
If irregular: Amioderne 150 or procanimide

89
Q

What medication must be avoided in WPW

A

BB and CCB

90
Q

How will antidromic RVT present

A

Wide complex tachycardia

91
Q

How will orthodromic SVT present

A

narrow complex SVT

92
Q

What is the DOC in Stable Monomorph vTac

A

Procanimide

93
Q

What are the drugs that can be used as a pill in the pocket approach for Afib

A

Flecanide and propafenone

94
Q

If a pt has SVT and is unstable what do we do

A

Cardiovert

+/- adenosine

95
Q

What is the criteria to use rate vs rhythm controle

A

Rate: older pts
Rhythm: younger pts or if the S/s are intolerable or they are athletes

96
Q

What is the appraoch with rate control

A
  1. In older pts with Afib 180-350 bpm
  2. Start anticoagulant (heparin, warfarin, Apixaban)
  3. BB or CCB
    Metoprolol, Carvedilol
    Verapamil or diltiazem

If s/s of HF : digoxin

  1. Evaluate a CHA2Ds2Vasc
    To determine long term aniotcoag tx
97
Q

A CHADVASC score great than what in men and women means we must start antiocoag tx

A

Greater than 2 in men and 3 in women

98
Q

What are the anti coagulation options in Afib after a CHADVASC score is obtained

A

Score greater than 2 (men) or 3 (women)

Dabigatran unless there is MS, prosethic valve, GFR is less than 30 or they are unstable

Unstable= IV heparin
MS, Prostethic Valve, or GFR <30= Warfarin

99
Q

An Afib Pt with a CHADVASC score of 5 needs anticoagulant tx
They have a GFR <30

What is the Rx option

A

Warfarin

100
Q

Describe rhythm control for Afib

A
  1. Must meet criteria for AFIB
  2. Start immediate anticoagulant
    Onset less than 48hrs
  3. Cardiovert
  4. Rx: Felcaninde, Amio/ Drenedrone, sotalol + Anticoagulant x 1 month
  5. CHADVASC score

Onset more than 48 hrs

  1. Anticoagulant x3 wks
  2. Cardio vert
  3. Rx: Rx: Felcaninde, Amio/ Drenedrone, sotalol + Anticoagulant x 1 month
101
Q

A pt presents with Afib and needs to be Cardiovert immediately (*unstable )

What is the appraoch to cardio version for this pt

A
  1. Anticoagulant (iv heparin)
  2. TEE
  3. Cardiovert
  4. Rx: Felcaninde, Amio/ Drenedrone, sotalol + Anticoagulant x 1 month
    Calc CHADVASC
102
Q

What are the 4 types of shock

A

Cardiogenic
distributive
Hypovolemic
Obstructive

103
Q

describe Cardiogenic shock

A

CHF
MI
Arrhythmia

S/s Cold clammy
S3 gallop
Crackles in lung fields
+JVP

INCREASED PCWP
INCREASED SVR

DECREASED CO

Tx: inotropes and diuretics

104
Q

Describe Distributive shock

A

From sepsis, anaphylactic,

S/s warm, dry, bounding pulses, wide pulse pressure,

DECREASED PCWP
INCRESAED CO

VERY VERY DECREASED SVR

Tx: IVF/ Pressors

105
Q

Define Hypovolemic Shock

A

From any acute fluid loss
3rd spacing/ BUrns
S.s cold clammy

DECREASED PCWP
DECREASED CO

INCREASED SVR

Tx: IVF or Blood if loss is greater than 30%

106
Q

Define obstructive shock

A

Can be from Tamp, Tension Pnuemo
PE,

S/s Becks triad

INCREASED CVP
DECREADED PRELOAD
DECREASED CO

INCREASED SVR

Tx: relieve obstruction

107
Q

Denise DO2

A

DO2 is delivery of O2 to the tissues

COxCaO2

108
Q

Define C. Output

A

Sv x HR

109
Q

Define CaCo2

A

Concentration of O2 on the Hgb

SaO2 x HbG amount

110
Q

What are the major causes of Hypovolemia

A

Hemorrhage, GI bleed, Fistula drainage, DI, Hypergylcemia

Diuretics

111
Q

What is the gen approach to treating shock

A

1,. Intubate early and tx O2

  1. Main Tina cvp> 8 with IVF (NS or LR)
  2. Maintain map >65 with pressors
  3. Maintained Hct greater than 30
  4. Main ting CO with inotropes PRN
  5. IV access with large bore IV

Remember SHOCK IS TISSUE LEVEL HYPOXIA! NOT HOTN

112
Q

Describe neurogenic shock

A

Truama at T5 or above

S/s can last 6 weeks or longer (inflammation vs perm damage)

S/s HOTN, LOW HR, HEAT LOSS, dry skin, and poikilothermia

Tx with pressors as appropriate

113
Q

Describe anaphylactic shock

A

Massive vasodilation from histamine responce (mast cells)

Increased cap permeability

Tx with EPI EPI EPI +/- bronchodilator’s PRN
IVF

114
Q

What is SIRS criteria

A

A combination of any of the 2:

Temp greater than 38 or less than 36* C

HR greater than 90

RR greater than 30 or PaCO2 less than 32

WBC greater than 12,000 or less than 4,000

115
Q

SIRS criteria + suspected infection think

A

Sepsis

116
Q

SIRS criteria + EOD think

A

Severe sepsis

117
Q

Severe Sepsis (Sirs +EOD) + refractory HOTN think

A

Septic SHock

118
Q

Describe septic shock

A

Séquele of conditions that lead to increased coagulation, decreased fibrinolytics,

INCREASED CO with DECRESAED SVR
Hyperdynamic state

DECRESAED UOP

ACIDOSIS form retention and accumulation of lactic acid

Edema (periph perm.)

Profound HOTN and Hypoxia

119
Q

What are bad lactate and BUN # in septic shock

A

Lactate greater than 4 is bad

BUN above 16 is bad (sometimes above 12 is bad)

120
Q

What is the Tx to septic shock

A
  1. IVF (2-3 liters) with NS or LR , maybe even blood

Prevent hypothermia
And Coagulation

Maintain map greater than 65

Start TPN within 24 hrs

RX: Epi w/ 6-10 L NS/LR
Or 2-4 L of blood

If refractory HOTN start steroids

Glucose goal is greater than 250

PPI for PUD prevention

121
Q

What is the infusion criteria for Blood products

A

HBG less than 7
Or less than 8 with active bleed
Or less than 9 with cardiogenic shock

&7,8,9

122
Q

If persistant HOTN persists despite IV fluids for 1-2 hours in shock

What is the next step

A

IV steroids

123
Q

Define elevated BP

A

SBP 120-129

DBP less than 80

124
Q

Define STAGE I HTN

A

SBP 130-139

DBP 80-89

125
Q

Define Stage II HTN

A

Greater than 140/90

126
Q

Define primary HTN

A

Common
Silent killer
Leads to MI, Stroke, Aneurysms

Increased Risk with Age
Inactivity 
DM 
Obesity 
(Insulin increases Na retention) 
Smoking 
FMHX 
And Diet/ ETOH consumption
127
Q

What renin level is primary HTN

A

Low Renin STATE

128
Q

Describe white coat HTN

A

Increased HTN in the office with out HTN at home

129
Q

Describe masked HTN

A

NML blood pressure in the office with HTN at home

130
Q

Define Isolated SBP

A

SBP greater than 120

With DBP less than 80

131
Q

Define Isolated DBP HTN

A

SBP lesss than 120

DBP greater than 80

132
Q

Define secondary HTN

A

Drug resistant HTN on 3 medications or controlled on 4

Acute onset

Onset less than 30 years old

COntrolled HTN that is not uncontrolled acutely

EOD

Malignant Hyperthermia

Diaostiolic HTN with age greater than 65

Any Hypokalemia state that has HTN

133
Q

A pt Presesnt with abdominal mass on PE and skin pallor, has frequent UTIs and has refractive HTN

Think

A

Renal Parynchal Dz

Order Renal US

134
Q

A pt presents with abdominal systolic bruits, and resistant HTN, that is abrupt onset and getting harder to control,
+flash pulm edema

Think ?

A

renovasulr Dz
(Young women, older men)
(Fibromuscular hyperplasia)

Order Renal duplex U/s or abdominal CT, MRA

Confirm with a bilateral era al arterial angiography

135
Q

A pt presents with Afib and refractive HTN, with Hypokalemia, and muscle aches, +/- OSA, and a FMHx of early onset stroke

Think

A

Primary Aldosteronism 2nd HTN

Order Plasma aldosterone level
Or Sodium loading test

136
Q

A pt presents with marked obesity and a poor mallanpati score
With resistant HTN

Think

A

OSA

Calculate epworth scale and order sleep study

137
Q

A pt presente with fine tremor, Tachy hr, and acute abdominal pain

With resistant HTN

Think

A

DRUG OR ETOH abuse

NSAIDS, caffeine, cocaine, cyclosporine, tacrolimus clonidine withdrawal

Order drug test

138
Q

A pt priests with skin stigma tat of neurofibromatiosis with Ortho HOTN
With resitsntat HTN
With palpations, sweating, and HA

Think?

A

PHEO

Order metanephrines

And CCT of the Abd and pelvis

139
Q

A pt presents with moon face, truncal obesity, and hirstuisn

With refractory HTN

Think

A

Cushing’s syndrome

Order dexamethasone test or 24 hr free cortisol

140
Q

A pt presents with delayed ankle reflex, preiorbital puffiness, and source skin, that is dry, and has cold Intolernce
With refrac HTN

Think

A

Hypothyroidism

Order T3/T4 TSH

141
Q

A pt presents with lid lag, fine tremor and warm moist skin, with heat intolerance, insomina and wt loss

Has refrac HTN

Think

A

Hyperthyroidism

Order TSH, FT4 and Radioactive Uptake scans

142
Q

A 229 yr old pt presentes with refrac HTN
Has BP greater in up extremities and lower in the LE

Has a continous murmur heard across the upper back

Think

A

Coart undiagnosed or repaired

Order Echo
And Thoracic/ Abdominla CT angio or MRA

143
Q

A pt prestent with Refrac HTN and an elevated calcium

Think

A

Primary Hyper Parathyroid ism

Order a serum calcium and PTH

144
Q

A pt presents with signs of masculinization with hypertension and Hypokalemia,

Think

A

Congenital Adrenal Hyperplasia

order Aldosterone to see if low

Elevated 11 beta oh or elevated deoxycortisone

145
Q

A pt prestent with early onset HTN, with hypo or hyper kalemia, also has arrhythmia (flat T waves) and low aldosterone and renin state

With refractory HTN
Think

A

Mineral corticoide excess

146
Q

What labs should be ordered in an acromegaly pt iwth refrac HTN

A

HGH and IGF1

147
Q

What antidepressants can lead to refrac HTN 2nd HTN

A

Duloxetine and Venlafaxine

Switch to an SSRI

148
Q

A pt has Stage I HTN and a ASCVD risk less than 10%.

What is the tx approach

A

Goal for their BP is less than 130/80

Unless they are old then only SBP <130

Start non pharm Tx (dash diet or excerise)

And 1 Rx drug

F/u 1 month

If at goal F/u in 3-6 months

If not at goal increase Tx

149
Q

A pt has stage II HTN

What is the Tx approach

A

Start on 2 Rx meds

F/u in 1 month

150
Q

A pt only has elevated HTN, that is not Isolated DBP

What is the tx approach

A

Non pharm intervention (DASH diet and excercise) F/U in 3-6 months

151
Q

What are the 1st line medications for lowering BP in the non acute setting

A

Thiazides (must monitor K and Na)
ACE/ARBS (must monitor for hyper K)
CCB (amlodipe, Verapamil, dilatizem)

152
Q

If a pt has HTN and HF what is the BP lowering DOC

A

Furosemide

153
Q

If a pt has HTN and CKD what is the BP lowering dieruetic of choice

A

Furosemide

154
Q

If a pt has primary hyper aldosteronism
And has HTN
What is the BP lowering DOC

A

Pt will present with muscle cramps/ fatigue, and have low potassium levels

Rx: Spirinolactone

155
Q

What are the DOC for HTN in HFREF

A

BB (Carvedilol, bisprolol, and metoprolol)

156
Q

If a pr has CKD and HTN what is the Tx approach

A

BP goal is 130/80 or less

Is there albuminuria?
>300

ACE is first line
If Ace intolerant then ARB

157
Q

What is the Tx approach to a pt with Stable Ischemic HDz and HTN

A

BP goal is less than 130/80

1st line is a BB + ACE /ARB

If they have CP then add a CCB (amlodipine)

158
Q

What are tehe pregnancy/ HTN drugs

A

Methyldopa
Labetalol
Nifedipine

159
Q

What is the approach to a pt with HTN emergency

A

BP is greater than 180/120 with evidence of EOD

1 admit to the ICU

  1. Is there a PHEO, preclampsia, or AA discretion?
    Eclampsia or PHEO= Lower BP to less than 140 in 1st hour (Nicaridpine)
    If AA discretion= lower to less than 120 in first hour

If none of the above is present then lower BP by 25 % in 1st hour then to 160/100 in 2-6 hours then to NML within 24 hrs

160
Q

A pt prestns with a BP 180/100, bust has no evidence of EOD

What is the approach

A

Restart oral medication

161
Q

What is the appraoch to a pt with HTN and ischemic stroke

A

Is the Pt a candidate for fibrinolytics ?

Yes?

Lower BP to 180/110 before starting fibrinolytics
Then to 180/110 for the first 24 hours

162
Q

How many blood pressure readings do you need to Dx HTN

A

at least 2 separate measurements on at least 2 separate occasions are necessary to diagnose a patient with hypertension.

163
Q

What is the BP goal for pts older than 65

A

SBP less than 130

164
Q

A pt with Stage II HTN and Ischemic HT Dz should ge t what specific BB

A

Carvedilol, metoprolol or Metoprolol

165
Q

A pt has HTN with HEpEF

What are the appropriate medications for Tx the HTN

A

for HFpEF, any combination of two 1st agents would be appropriate (thiazide, CCB, ACE-I or ARB)

166
Q

if a patient has stage 2 HTN with primary hyperaldosteronism. What Rx should be started

A

spironolactone should be started in combination with one other 1st line agent (thiazide, CCB, ACE-I or ARB)

167
Q

Pts on thiazide diuretic are at risk of what electo abNML

A

HypoNa+ and Hypo K+

168
Q

What are the three main renal parenchyma Dz

A

Diabetic nephropathy
Glomelurlos Nephritis
Polyscytic Kidney

Will presten with an abdominal mass, frequent UTI
Hematuria, anagelsia abuse, elevated serum cr.

169
Q

A pt presesnt with HypoK, Hyper Na+
And HTN with Met Alky

Think

A

hyperaldostro

170
Q

What type of HTN does Hyperparathyroidsim lead to

A

It’s a cause of 2nd HTN and leads to Isolated Systolic HTN

171
Q

What kind of HTN does Hypothyroidsm lead to

A

2nd HTN

With increased renal retention of Na+

So elevated DBP

172
Q

What kind of HTN does Hyperparathyroidsm lead to

A

2nd HTN with hypercalcemia that leads to increased Peripehrl resistant

173
Q

How does Birth Control raise BP

A

Positve effect on angiotensinogen

174
Q

What is the perferred HTN emergency Rx in ACS

A

Nitro

175
Q

What is the Major ADE of Sodium Nitroprusside

A

Cyanide Toxic

176
Q

What is the preferred Rx for HTN emergency in preeclampsia

A

Hydralazine

177
Q

How should enalaprit be used in HTN emergency

A

Indicated for high renin HTN Emergency

Contraindications: pregnancy, renal artery stenosis, angioedema, renal insufficiency, hyperkalemia

178
Q

What are the perferred Rx for HTN emergency Rx with PHEO

A

nicardipine

179
Q

What is the preferred Rx in HTN emergency for abdominal Dissection

A

Esmolol

180
Q

What is the perferred Rx in HTN emergency due to cocaine

A

Phentolamine

181
Q

What are the indications for an ICD

A

NYHA 2-3 with EF ≤35%
(> 40 days after MI)

NYHA 4

Survivor of Sustained VT Cardiac Syncope

Non-Sustained VT Cardiac Syncope with EF ≤40%

All require > 1 year life expectancy!

182
Q

A continuous machine like murmur best heard of the pulmonic area

Is what

A

PDA

183
Q

What is always the 1st step in evaluating syncope

A

EKG!

184
Q

Pts with VTACH that fail Cath ablation should get what intervention

A

ICD

185
Q

What is always the best 1st answer in unstable tachycardia with a pulse

A

Synch Cardioversion

186
Q

What is always the best answer in Stable Narrow complex Tachycardia

A

Vagal and adenosine

187
Q

How will posterior wall MIs always present

A

Tall R wav with St depression in V1 V2 or V3

With St elevations in II, III, AVF

188
Q

A pt has a heart score of 1-3

What is the approach to Tx

A

Dc home and encourage PCM follow up

189
Q

A pt has a Heart score greater than 3 and a timi of 1-2

What is the appraoch

A

Non invasive stress testing

190
Q

If the heart score and time score is greater than 3 with a grace over 140
What is the appraoch

A

12 hour procedure time

OMI+MONA+BASHC

If grace is 109 but not over 140 then 72 hours

191
Q

What would make a pt high risk with ah heart score greater than 3 that would require 2 hr invasive angio?

A 
Cardiogenic shock 
LV dysfunction or HF 
Persistnet angina 
Mitral regurgitation 
New VSD 
Sustained VTACH
192
Q

What is an adequate UOP

A

Greater tahn 0.5 ml/kg/hr

193
Q

What is the lactate goal in Shock

A

Less than 4

194
Q

If a pt has Hf and is warm and dry what is the tx

A

Out pt diuretics

195
Q

Hf that is warm and wet

What is the tx

A

Inpt furosemide

196
Q

Hf that is cold and dry

What is the Tx

A

ICU inotropes

197
Q

HF that is Cold and wet

What is the tx

A

Inotropes + diuretics, + vasodilators

198
Q

If a pt is not making urine what is the necessary intervention

A

Hemmofiltariotn

199
Q

If a hf pt does not respond to inoptrops what is the solution

A

Mechanical intervention IABP LVAD ect

200
Q

Pulm embolism can lead to what acid base

A

Resp Alky

201
Q

What does mud piles stand for

A 
Methanol 
Uremia 
DKA 
Propylene 
Isoniazid/ iron 
Lactic Acidosis 
Ethylene 
Salicylic acid
202
Q

If a pt has low Albumin how is the Anion gap corrected

A 
Corrected AG (CAG) =
AG +2.5 (4-Albumin)

Example if AG is 12 and Albumin is 2
Corrected AG = 12 + 2.5(4-2) = 17

If CAG is high for the patient, look for cause: MUDPILES

203
Q

Aortic stenosis effects the S2 sound how

A

Paradoxical split that is eliminated on inspiration

204
Q

What murmur presents with a fixed S2 split

A

ASD

205
Q

Wha are the two criteria to surgical correct a VSD

A

HF or PAP greater than 50

206
Q

You hear an continous machine like murmur

What other finding would accompany this Murmur

A

Widend pulse pressure

this is a PDA

IPAP JUNIOR SEM. (43 decks)

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