HTN and Pulmonary Disease Flashcards
CREST can cause a pulmonary condition…
Pulmonary hypertension
… either alone or combined are the initial Rx for HTN.
Thiazide diuretics
The dermatological manifestations of … are clinically and pathologically similar to those seen in infants with purpura fulminans due to severe protein C deficiency.
warfarin-induced skin necrosis
… is indicated only in the following high-risk patients with hereditary thrombophilia: two or more spontaneous thromboses, one spontaneous life-threatening thrombosis, one spontaneous thrombosis at an unusual site, one spontaneous thrombosis in the pres
Indefinite anticoagulation
The risk of venous thrombosis during pregnancy or the postpartum period was increased …fold.
eight
This lung disease, … is caused by plexogenic arteriopathy in patients who test positive for antibodies to the human immunodeficiency virus (HIV), even in the absence of AIDS.
Primary pulmonary hypertension (PPH)
When appetite-suppressant medications such as fenfluramine and dexfenfluramine (for the treatment of obesity), there is an increased risk of developing this lung dz:…
pulmonary arterial hypertension
Finding a thrombosis in the superficial … vein is equivalent to a diagnosis of DVT.
Femoral
A patient younger than 55 years with ischemic stroke has to be w/u in day one with…
hypercoagulable evaluation.
… is not appropriate if the source of emboli is an infective endocarditis or cardiac tumor in an ischemic stroke.
Anticoagulation
A neck size >… inches in a man is suggestive for OSA.
17.5
Aerobic exercise of 30 minutes vigorous enough to cause a sweat significantly reduces… .
BP
…are the preferred initial agents for patients with primary HTN but not target organ damage or other complications.
Diuretics
ALLHAT study showed … are equivalent to amlodipine and lisinopril in reducing AMI and death in CAD.
thiazide diuretics (chlorthalidone)
Only these 2 calcium channel-blockers, …, are shown to be safe in Rx angina in HTN patients with advanced LV dysfunction.
amlodipine and felodipine
Gestational hypertension, also called transient hypertension of pregnancy, is not associated with signs of … and resolves after delivery.
preeclampsia
The use of … (antihypertensive drug) in pregnancy has been associated with fetal growth restriction.
atenolol
Target BP in patients with renal disease and proteinuria more than 1 g/day should be….
125/75
… is a combination of HTN and renal disease with proteinuria and failure in a pregnant woman.
Preeclampsia
When preeclampsia occurs in the first trimester, a … (dz) is very likely.
hydatiform mole
… (4 drugs) and calcium blockers have all been used in pregnancy for HTN.
Hydralazine, labetalol, metil-dopa, clonidine
HTN increases the risk for CAD … fold compared to optimal BP population.
two-three
… (dz) is the most common systemic condition causing nephrosclerosis, but older age, black ethnicity, and DM increase the risk when in a patient with this dz.
Chronic HTN
The switch from argatroban to warfarin should be done when Rx with both and INR is approximately… due to argatroban’s own effect on the INR.
4.
Patients with HIT have a… days to weeks after exposure.
hypercoagulable state
Low-dose… may be safe and possibly effective in preventing thrombosis in essential thrombocythemia (ET), especially effective in treating the vasomotor symptoms of ET and PV, such as vision symptoms, acral paresthesias and erythromelalgia.
ASA
… are new direct thrombin inhibitors effective in HIT Rx.
Lepirudin and argatroban
More than one spontaneous event of venous thromboembolism requires… (Rx).
indefinite anticoagulation
One spontaneous life-threatening event of venous thromboembolism requires… (Rx).
indefinite anticoagulation
One spontaneous event of venous thromboembolism associated with antiphospholipid antibody syndrome, antithrombin deficiency, or more than one genetic or allelic abnormality requires… (Rx).
indefinite anticoagulation
… is FDA approved for DVT prophylaxis after major orthopedic surgery, with better results than Lovenox.
Fondaparinux
The… consists of cold-insoluble proteins like FVIII, fibrinogen, FvW, FXIII and fibronectin, that remain solid when FFP is thawed at 4C.
cryoprecipitate
Pheochromocytomas are best screened for with…
24h urine for fractionated metanephrines and cathecholamines.
The classic triad of HA, diaphoresis and palpitations is highly specific for…
pheochromocytomas.
Ninety percent of pheochromocytomas are… (location)
intra-adrenal.
To distinguish between centrally mediated cathecholamines and from those produced by tumor,… should be done.
a clonidine suppression test
HIT patients for PCI should receive … instead of heparin.
bivalirudin
According to GUSTO I the optimal aPTT at 12 hours after heparin initiation with the lowest ischemic and bleeding events was …
50-70 sec.
In patients with liver disease, argatroban dose needs to be adjusted (true/false… ).
true
According to REPLACE 2, the advantage of using bivalirudin vs. 2b3a and heparin is …
less major bleeding.
Apart from its thrombotic properties, thrombin is a …
most potent platelet aggregation stimulator.
The antihypertensive treatment of choice in patients with pheochromocytoma consists of…
alpha blockers (phenoxybenzamine, prazosin, terazosin and doxazosin) used also in BPH.
The presence of anterolateral hemiblock in HTN patients is a finding suggestive of…
LVH
Parenteral antihypertensive therapy is almost always contraindicated in…
acute stroke.
… diuretics are effective as long as the creatinine clearance is above 30ml/min or the creatinine is less than 2-2.5 mg/dl.
Thiazide
To prevent reflex tachycardia in patients given IV hydralazine, a… should be combined.
beta-blocker
Antihypertensive therapy in acute stroke should be administered only in the case of severe increases in BP (DBP>130) and only with… (way of administration and drugs)
PO drugs like nifedipine or atenolol.
The maximum initial decrease in BP in malignant HTN is… % to avoid underperfusion of the brain, kidneys and the heart.
25
BP should be <130/85 or even 125/75 in patients with proteinuria over…
1g/day.
Malignant phase HTN is defined as an increase in BP associated with…
bilateral retinal changes: hemorrhages or exudates.
The appropriate initial therapy for severe HTN associated with AMI should include…
IV nitrates.
The non-IV drugs that can be used in malignant HTN are… (2)
sublingual nifedipine (10 mg) and sublingual captopril (25 mg); they can substantially lower the BP within 10 to 30 minutes in many patients. They are not recomended because of a slower onset of action and an inability to control the degree of BP reductio
DVT prophylaxis should be used in AMI patients during their first… days of hospitalization.
three
… is indicated in post-AMI patient with LV thrombus, large akinetic LV segments, or persistent AF.
Long term warfarin therapy
The… trial showed that ACEI decreased the mortality by 19% in patients with EF<40% after AMI.
SAVE
… is the thrombolytic with the most rapid resolution of right sided pressure in PE with hemodynamic compromise or RV dysfunction without shock and pulmonary hypertension.
r-tPa
The common coagulation pathway starts with…
prothrombin (factor II).
The extrinsic coagulation pathway starts with…
factor VII and tissue factor (TF).
The intrinsic coagulation pathway starts with…
factor VIII.
Spontaneous or primary thrombosis of the subclavian or axillary veins is known as …
Paget-Schroetter syndrome.
… is a venous thrombus causing a significant influence on arterial perfusion.
Phlegmasia alba dolens
The addition of… to a beta-blocker is less effective in controlling BP.
an ACEI (beta-blocker already blocks the renin release)
Black patients need an increase 2-4 times over the doses of beta-blockers and ACEI used to control same increase in BP as in white, difference generally eliminated by the addition of a… (class).
diuretic
Preoperatively, successful anti-HTN therapy should be… if the patient is normotensive.
continued, even
There is little synergy between… and the dihydropyridines (nifedipine, etc.) in HTN therapy.
thiazide diuretics
In a pregnant HTN patient that has symptoms of eclampsia (clonus, nausea, vomiting, right hypocondrial pain), this drug is used for BP control…
IV hydralazine.
Pulmonary arterial HTN is defined as a mean pulmonary arterial pressure greater than… , a pulmonary capillary wedge pressure less than 15mmHg and a pulmonary vascular resistance greater than 3 Wood units.
25mmHg
Pulmonary arterial HTN is defined as a mean pulmonary arterial pressure greater than 25mmHg, a pulmonary capillary wedge pressure less than 15mmHg and a pulmonary vascular resistance greater than… Wood units.
3
The therapy in advanced pulmonary HTN (classes IIIb and IV) consists of PO…
bosentan
The therapy in advanced pulmonary HTN (classes IIIb and IV) consists of IV…
epoprostenol
The therapy in advanced pulmonary HTN (classes IIIb and IV) consists of SC…
treprostinil
Pulmonary arterial HTN is defined as a mean pulmonary arterial pressure greater than 25mmHg, a pulmonary capillary wedge pressure less than… and a pulmonary vascular resistance greater than 3 Wood units.
15mmHg
The therapy in stable pulmonary HTN (class I-IIIa) in patients NOT vasoreactive to right heart catheterization consists of IV…
epoprostenol
The therapy in stable pulmonary HTN (class I-IIIa) in patients NOT vasoreactive to right heart catheterization consists of PO…
bosentan
The therapy in stable pulmonary HTN (class I-IIIa) in patients NOT vasoreactive to right heart catheterization consists of SC…
treprostinil (Remodulin®)
Systematic reviews have found that initial HTN treatment with any of the… (3 classes) reduce morbidity and mortality, with minimal adverse effects.
diuretics, angiotensin converting enzyme inhibitors, or ß blockers
We found limited evidence from two systematic reviews that diuretics, ß blockers, and angiotensin converting enzyme inhibitors reduced coronary heart disease and heart failure more than… (drug class).
calcium channel antagonists
… as the initial HTN treatment reduced the risk of stroke more than the other agents.
Calcium channel antagonists
Qp/Qs calculation formula is … when SaO2 is more than 95%.
(SaO2 - MvO2)/(SaO2 - PAO2)
The most common inherited bleeding disorder is…
von Willebrand disease (a qualitative or quantitative deficiency of von Willebrand factor (vWF)).
… is the most common inherited thrombophilic defect among whites.
Factor V Leiden
Anticoagulation prophylaxis during gestation is highly recommended in women with severe mitral stenosis and… (morphological change), even in the absence of atrial fibrillation.
enlarged left atrium
In patients with PHV receiving warfarin, the international normalized ratio should be maintained between 2.0 and 3.0 with the lowest possible dose of warfarin, and … should be added.
low-dose aspirin
Recent guidelines for the management of PHV thrombosis recommend … as a first-line treatment if there are no contraindications.
thrombolysis
The appearance of … in the heart is typically of mobile echo-dense masses attached to the endothelium, although isolated intramural masses and diffuse myocardial invasion have also been noted.
metastatic disease
Cardiac lipomas are benign primary cardiac tumors located most commonly in … and occasionally presenting as pedunculated masses.
the body of LV
The majority of … malignancies represent metastatic disease, most commonly from esophagus, lung, or breast.
cardiac
The only beta-blocker useful in the therapy of HTN emergencies is…
labetalol (20mg initially, then 20-80 q10min, total max 300mg).
Type I HIT is the common, milder form that likely results from … (mechanism).
heparin-induced aggregation of platelets.
In the majority of cases, heparin can be continued and the platelet count will improve in …
type I HIT.
Thromboembolic prophylaxis in high-risk patients (older-generation PHV in the mitral position, atrial fibrillation, history of thromboembolism while receiving anticoagulation) seems to be best achieved with … for the first 35 weeks.
oral anticoagulation
Because pregnancy is associated with increased risk, a target international normalized ratio of … should be achieved in high-risk patients (older-generation PHV in the mitral position, atrial fibrillation, history of thromboembolism while receiving anti
3.0 (2.5 to 3.5)
In general, a pulmonary artery acceleration time less than 70 msec implies presence of a pulmonary artery systolic pressure exceeding… mmHg.
70
… is characterized by low factor VIII.
Hemophilia A
… is characterized by low factor IX.
Hemophilia B
The work-up for… in pregnancy need not be deferred because of concern about fetal radiation exposure.
venous thromboembolic disease
Regional wall motion abnormalities of the RV on echo that spare the right ventricular apex (“McConnell’s sign”) are particularly suggestive of…
pulmonary embolism.
Less stable NYHA III and IV patients with pulmonary hypertension should be treated with…
a prostaglandin analogue like epoprostenol.
… is essential in patients with pulmonary hypertension associated with venous thromboembolic disease.
Lifelong anticoagulation
When in a patient with abnormalities on the CXR a suspicion of PE exists, this test is recommended…
CT.
A documented central PE associated with hypotension is an indication for…
thrombolytic therapy - t-PA.
The long-term anticoagulation INR target in thrombembolic disease is…
1.5-2.
Patients with obesity-hypoventilation syndrome need an overnight polysomnography study due to universal presence of…
OSA.
Patients with acute venous thromboembolism in whom conventional anticoagulation is contraindicated (recent surgery, hemorrhagic stroke, active bleeding) need…
an inferior vena caval filter.
Patients with acute venous thromboembolism in whom conventional anticoagulation has proven ineffective need…
an inferior vena caval filter.
In a large literature review,… was the most common thrombotic presentation of antiphospholipid antibody syndrome.
venous thromboembolism
A cardiac murmur changing intensity markedly with different body positions is indicative of…
myxoma.
