HTN and Pulmonary Disease

Question 1

CREST can cause a pulmonary condition…

Answer 1

Pulmonary hypertension

Question 2

… either alone or combined are the initial Rx for HTN.

Answer 2

Thiazide diuretics

Question 3

The dermatological manifestations of … are clinically and pathologically similar to those seen in infants with purpura fulminans due to severe protein C deficiency.

Answer 3

warfarin-induced skin necrosis

Question 4

… 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

Answer 4

Indefinite anticoagulation

Question 5

The risk of venous thrombosis during pregnancy or the postpartum period was increased …fold.

Answer 5

eight

Question 6

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.

Answer 6

Primary pulmonary hypertension (PPH)

Question 7

When appetite-suppressant medications such as fenfluramine and dexfenfluramine (for the treatment of obesity), there is an increased risk of developing this lung dz:…

Answer 7

pulmonary arterial hypertension

Question 8

Finding a thrombosis in the superficial … vein is equivalent to a diagnosis of DVT.

Answer 8

Femoral

Question 9

A patient younger than 55 years with ischemic stroke has to be w/u in day one with…

Answer 9

hypercoagulable evaluation.

Question 10

… is not appropriate if the source of emboli is an infective endocarditis or cardiac tumor in an ischemic stroke.

Answer 10

Anticoagulation

Question 11

A neck size >… inches in a man is suggestive for OSA.

Answer 11

17.5

Question 12

Aerobic exercise of 30 minutes vigorous enough to cause a sweat significantly reduces… .

Answer 12

BP

Question 13

…are the preferred initial agents for patients with primary HTN but not target organ damage or other complications.

Answer 13

Diuretics

Question 14

ALLHAT study showed … are equivalent to amlodipine and lisinopril in reducing AMI and death in CAD.

Answer 14

thiazide diuretics (chlorthalidone)

Question 15

Only these 2 calcium channel-blockers, …, are shown to be safe in Rx angina in HTN patients with advanced LV dysfunction.

Answer 15

amlodipine and felodipine

Question 16

Gestational hypertension, also called transient hypertension of pregnancy, is not associated with signs of … and resolves after delivery.

Answer 16

preeclampsia

Question 17

The use of … (antihypertensive drug) in pregnancy has been associated with fetal growth restriction.

Answer 17

atenolol

Question 18

Target BP in patients with renal disease and proteinuria more than 1 g/day should be….

Answer 18

125/75

Question 19

… is a combination of HTN and renal disease with proteinuria and failure in a pregnant woman.

Answer 19

Preeclampsia

Question 20

When preeclampsia occurs in the first trimester, a … (dz) is very likely.

Answer 20

hydatiform mole

Question 21

… (4 drugs) and calcium blockers have all been used in pregnancy for HTN.

Answer 21

Hydralazine, labetalol, metil-dopa, clonidine

Question 22

HTN increases the risk for CAD … fold compared to optimal BP population.

Answer 22

two-three

Question 23

… (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.

Answer 23

Chronic HTN

Question 24

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.

Answer 24

4.

Question 25

Patients with HIT have a... days to weeks after exposure.

Answer 25

hypercoagulable state

Question 26

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.

Answer 26

ASA

Question 27

... are new direct thrombin inhibitors effective in HIT Rx.

Answer 27

Lepirudin and argatroban

Question 28

More than one spontaneous event of venous thromboembolism requires... (Rx).

Answer 28

indefinite anticoagulation

Question 29

One spontaneous life-threatening event of venous thromboembolism requires... (Rx).

Answer 29

indefinite anticoagulation

Question 30

One spontaneous event of venous thromboembolism associated with antiphospholipid antibody syndrome, antithrombin deficiency, or more than one genetic or allelic abnormality requires... (Rx).

Answer 30

indefinite anticoagulation

Question 31

... is FDA approved for DVT prophylaxis after major orthopedic surgery, with better results than Lovenox.

Answer 31

Fondaparinux

Question 32

The... consists of cold-insoluble proteins like FVIII, fibrinogen, FvW, FXIII and fibronectin, that remain solid when FFP is thawed at 4C.

Answer 32

cryoprecipitate

Question 33

Pheochromocytomas are best screened for with...

Answer 33

24h urine for fractionated metanephrines and cathecholamines.

Question 34

The classic triad of HA, diaphoresis and palpitations is highly specific for...

Answer 34

pheochromocytomas.

Question 35

Ninety percent of pheochromocytomas are... (location)

Answer 35

intra-adrenal.

Question 36

To distinguish between centrally mediated cathecholamines and from those produced by tumor,... should be done.

Answer 36

a clonidine suppression test

Question 37

HIT patients for PCI should receive ... instead of heparin.

Answer 37

bivalirudin

Question 38

According to GUSTO I the optimal aPTT at 12 hours after heparin initiation with the lowest ischemic and bleeding events was ...

Answer 38

50-70 sec.

Question 39

In patients with liver disease, argatroban dose needs to be adjusted (true/false... ).

Answer 39

true

Question 40

According to REPLACE 2, the advantage of using bivalirudin vs. 2b3a and heparin is ...

Answer 40

less major bleeding.

Question 41

Apart from its thrombotic properties, thrombin is a ...

Answer 41

most potent platelet aggregation stimulator.

Question 42

The antihypertensive treatment of choice in patients with pheochromocytoma consists of...

Answer 42

alpha blockers (phenoxybenzamine, prazosin, terazosin and doxazosin) used also in BPH.

Question 43

The presence of anterolateral hemiblock in HTN patients is a finding suggestive of...

Answer 43

LVH

Question 44

Parenteral antihypertensive therapy is almost always contraindicated in...

Answer 44

acute stroke.

Question 45

... diuretics are effective as long as the creatinine clearance is above 30ml/min or the creatinine is less than 2-2.5 mg/dl.

Answer 45

Thiazide

Question 46

To prevent reflex tachycardia in patients given IV hydralazine, a... should be combined.

Answer 46

beta-blocker

Question 47

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)

Answer 47

PO drugs like nifedipine or atenolol.

Question 48

The maximum initial decrease in BP in malignant HTN is... % to avoid underperfusion of the brain, kidneys and the heart.

Answer 48

25

Question 49

BP should be <130/85 or even 125/75 in patients with proteinuria over...

Answer 49

1g/day.

Question 50

Malignant phase HTN is defined as an increase in BP associated with...

Answer 50

bilateral retinal changes: hemorrhages or exudates.

Question 51

The appropriate initial therapy for severe HTN associated with AMI should include...

Answer 51

IV nitrates.

Question 52

The non-IV drugs that can be used in malignant HTN are... (2)

Answer 52

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

Question 53

DVT prophylaxis should be used in AMI patients during their first... days of hospitalization.

Answer 53

three

Question 54

... is indicated in post-AMI patient with LV thrombus, large akinetic LV segments, or persistent AF.

Answer 54

Long term warfarin therapy

Question 55

The... trial showed that ACEI decreased the mortality by 19% in patients with EF<40% after AMI.

Answer 55

SAVE

Question 56

... 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.

Answer 56

r-tPa

Question 57

The common coagulation pathway starts with...

Answer 57

prothrombin (factor II).

Question 58

The extrinsic coagulation pathway starts with...

Answer 58

factor VII and tissue factor (TF).

Question 59

The intrinsic coagulation pathway starts with...

Answer 59

factor VIII.

Question 60

Spontaneous or primary thrombosis of the subclavian or axillary veins is known as ...

Answer 60

Paget-Schroetter syndrome.

Question 61

... is a venous thrombus causing a significant influence on arterial perfusion.

Answer 61

Phlegmasia alba dolens

Question 62

The addition of... to a beta-blocker is less effective in controlling BP.

Answer 62

an ACEI (beta-blocker already blocks the renin release)

Question 63

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).

Answer 63

diuretic

Question 64

Preoperatively, successful anti-HTN therapy should be... if the patient is normotensive.

Answer 64

continued, even

Question 65

There is little synergy between... and the dihydropyridines (nifedipine, etc.) in HTN therapy.

Answer 65

thiazide diuretics

Question 66

In a pregnant HTN patient that has symptoms of eclampsia (clonus, nausea, vomiting, right hypocondrial pain), this drug is used for BP control...

Answer 66

IV hydralazine.

Question 67

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.

Answer 67

25mmHg

Question 68

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.

Answer 68

3

Question 69

The therapy in advanced pulmonary HTN (classes IIIb and IV) consists of PO...

Answer 69

bosentan

Question 70

The therapy in advanced pulmonary HTN (classes IIIb and IV) consists of IV...

Answer 70

epoprostenol

Question 71

The therapy in advanced pulmonary HTN (classes IIIb and IV) consists of SC...

Answer 71

treprostinil

Question 72

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.

Answer 72

15mmHg

Question 73

The therapy in stable pulmonary HTN (class I-IIIa) in patients NOT vasoreactive to right heart catheterization consists of IV...

Answer 73

epoprostenol

Question 74

The therapy in stable pulmonary HTN (class I-IIIa) in patients NOT vasoreactive to right heart catheterization consists of PO...

Answer 74

bosentan

Question 75

The therapy in stable pulmonary HTN (class I-IIIa) in patients NOT vasoreactive to right heart catheterization consists of SC...

Answer 75

treprostinil (Remodulin®)

Question 76

Systematic reviews have found that initial HTN treatment with any of the... (3 classes) reduce morbidity and mortality, with minimal adverse effects.

Answer 76

diuretics, angiotensin converting enzyme inhibitors, or ß blockers

Question 77

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).

Answer 77

calcium channel antagonists

Question 78

... as the initial HTN treatment reduced the risk of stroke more than the other agents.

Answer 78

Calcium channel antagonists

Question 79

Qp/Qs calculation formula is ... when SaO2 is more than 95%.

Answer 79

(SaO2 - MvO2)/(SaO2 - PAO2)

Question 80

The most common inherited bleeding disorder is...

Answer 80

von Willebrand disease (a qualitative or quantitative deficiency of von Willebrand factor (vWF)).

Question 81

... is the most common inherited thrombophilic defect among whites.

Answer 81

Factor V Leiden

Question 82

Anticoagulation prophylaxis during gestation is highly recommended in women with severe mitral stenosis and... (morphological change), even in the absence of atrial fibrillation.

Answer 82

enlarged left atrium

Question 83

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.

Answer 83

low-dose aspirin

Question 84

Recent guidelines for the management of PHV thrombosis recommend ... as a first-line treatment if there are no contraindications.

Answer 84

thrombolysis

Question 85

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.

Answer 85

metastatic disease

Question 86

Cardiac lipomas are benign primary cardiac tumors located most commonly in ... and occasionally presenting as pedunculated masses.

Answer 86

the body of LV

Question 87

The majority of ... malignancies represent metastatic disease, most commonly from esophagus, lung, or breast.

Answer 87

cardiac

Question 88

The only beta-blocker useful in the therapy of HTN emergencies is...

Answer 88

labetalol (20mg initially, then 20-80 q10min, total max 300mg).

Question 89

Type I HIT is the common, milder form that likely results from ... (mechanism).

Answer 89

heparin-induced aggregation of platelets.

Question 90

In the majority of cases, heparin can be continued and the platelet count will improve in ...

Answer 90

type I HIT.

Question 91

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.

Answer 91

oral anticoagulation

Question 92

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

Answer 92

3.0 (2.5 to 3.5)

Question 93

In general, a pulmonary artery acceleration time less than 70 msec implies presence of a pulmonary artery systolic pressure exceeding... mmHg.

Answer 93

70

Question 94

... is characterized by low factor VIII.

Answer 94

Hemophilia A

Question 95

... is characterized by low factor IX.

Answer 95

Hemophilia B

Question 96

The work-up for... in pregnancy need not be deferred because of concern about fetal radiation exposure.

Answer 96

venous thromboembolic disease

Question 97

Regional wall motion abnormalities of the RV on echo that spare the right ventricular apex ("McConnell's sign") are particularly suggestive of...

Answer 97

pulmonary embolism.

Question 98

Less stable NYHA III and IV patients with pulmonary hypertension should be treated with...

Answer 98

a prostaglandin analogue like epoprostenol.

Question 99

... is essential in patients with pulmonary hypertension associated with venous thromboembolic disease.

Answer 99

Lifelong anticoagulation

Question 100

When in a patient with abnormalities on the CXR a suspicion of PE exists, this test is recommended...

Answer 100

CT.

Question 101

A documented central PE associated with hypotension is an indication for...

Answer 101

thrombolytic therapy - t-PA.

Question 102

The long-term anticoagulation INR target in thrombembolic disease is...

Answer 102

1.5-2.

Question 103

Patients with obesity-hypoventilation syndrome need an overnight polysomnography study due to universal presence of...

Answer 103

OSA.

Question 104

Patients with acute venous thromboembolism in whom conventional anticoagulation is contraindicated (recent surgery, hemorrhagic stroke, active bleeding) need...

Answer 104

an inferior vena caval filter.

Question 105

Patients with acute venous thromboembolism in whom conventional anticoagulation has proven ineffective need...

Answer 105

an inferior vena caval filter.

Question 106

In a large literature review,... was the most common thrombotic presentation of antiphospholipid antibody syndrome.

Answer 106

venous thromboembolism

Question 107

A cardiac murmur changing intensity markedly with different body positions is indicative of...

Answer 107

myxoma.